Synchronous metastatic renal cell carcinoma to the genitourinary tract: two rare case reports and a review of the literature.

Synchronous metastasis of renal cell carcinoma (RCC) to the ureter or the bladder represents an extremely rare event. We report one case of synchronous metastasis of RCC to the ipsilateral ureter and one case of solitary synchronous metastasis of RCC to the urinary bladder. We review the literature and discuss possible mechanisms of dissemination. We discuss the surgical management of metastases from RCC as well as the surgical options in the treatment of these rare occurrences.

Does race affect postoperative outcomes in patients with low-risk prostate cancer who undergo radical prostatectomy?

OBJECTIVES: To assess the magnitude of racial disparities in prostate cancer outcomes following radical prostatectomy for low-risk prostate cancer. METHODS: We retrospectively reviewed our database of 2407 patients who under went radical prostatectomy and isolated 2 cohorts of patients with low-risk prostate cancer. Cohort 1 was defined using liberal criteria, and cohort 2 was isolated using more stringent criteria. We then studied pre- and postoperative parameters to discern any racial differences in these 2 groups. Statistical analyses, including log-rank, chi(2), and Fisher's exact analyses, were used to ascertain the significance of such differences. RESULTS: Preoperatively, no significant differences were found between the white and African-American patients with regard to age at diagnosis, mean prostate-specific antigen, median follow-up, or percentage of involved cores on prostate biopsy. African-American patients in cohort 1 had a greater mean body mass index than did white patients (26.9 vs 27.8, P = .026). The analysis of postoperative data demonstrated no significant difference between white and African-American patients in the risk of biochemical failure, extraprostatic extension, seminal vesicle involvement, positive surgical margins, tumor volume, or risk of disease upgrading. African-American patients in cohort 2 demonstrated greater all-cause mortality compared with their white counterparts (9.4% vs 3.1%, P = .027). CONCLUSIONS: In patients with low-risk prostate cancer treated with radical prostatectomy, there exist no significant differences in surrogate measures of disease control, risk of disease upgrading, estimated tumor volume, or recurrence-free survival between whites and African-Americans.

Comparison of electronic microarray to enzyme hybridization assay for multiplex reverse-transcriptase PCR detection of common respiratory viruses in children.

A new assay, composed of the NGEN RVA (Nanogen, Inc., San Diego, CA; Prodesse, Inc., Waukesha, WI), which is a pair of analyte-specific reagents that allow the multiplex reverse transcriptase polymerase chain reaction (RT-PCR) and electronic microarray detection of influenza virus A and B, respiratory syncytial virus A and B, and human parainfluenza virus types 1, 2, and 3, was evaluated in comparison with the Hexaplex (Prodesse), a multiplex RT-PCR-enzyme hybridization assay. Comparisons included the detection of respiratory viruses from whole-virus stocks (ATCC) and from frozen pediatric respiratory specimens collected at Children's Hospital of Wisconsin between 1991 and October 1998. After the retesting of six indeterminants and 20 discrepants, overall agreement improved to 96% on the positives and 100% on negatives, with only eight specimens still discrepant. The RVA reagents allow a rapid, sensitive, and specific assay for detecting seven of the most common respiratory viruses in children.

Comparative studies of Avipox-GM-CSF versus recombinant GM-CSF protein as immune adjuvants with different vaccine platforms.

Granulocyte-macrophage colony-stimulating factor (GM-CSF) is a potent immune stimulant when administered with different vaccines. Optimal use of GM-CSF resides in its ability to act locally to stimulate the proliferation and maturation of professional antigen-presenting cells (APCs) (i.e., Langerhans' cells) at the injection site. GM-CSF was engineered into a replication-incompetent recombinant avian (fowlpox) virus (rF-GM-CSF) and a single subcutaneous injection resulted in a sustained enrichment of activated dendritic cells within the regional draining lymph nodes. Those changes were attributed to local GM-CSF production at the injection site by rF-GM-CSF-infected cells. Studies were carried out in which mice were administered different types of beta-galactosidase (beta-gal)-based vaccines--whole protein, peptide, recombinant poxviruses--and GM-CSF was administered either as a single injection of rF-GM-CSF or four daily bolus injections of the recombinant protein. The use of rF-GM-CSF either improved the immune adjuvant effect, as observed for poxvirus-based vaccines, or was equivalent to rGM-CSF, as observed with the beta-gal protein vaccine. It is important to note that with either the replication-competent (vaccinia) or replication-incompetent (fowlpox) vaccines expressing LacZ, strong CTL responses directed against beta-gal were induced only when rF-GM-CSF was used as the immune adjuvant. Engineering GM-CSF into a recombinant fowlpox virus offers an excellent vehicle for the delivery of this cytokine as an immune adjuvant with specific vaccine platforms. In particular, delivery of GM-CSF via the rF-GM-CSF construct would be preferred over bolus injections of rGM-CSF when used as an immune adjuvant with whole protein or recombinant poxvirus-based vaccines. The study underscores the importance of defining the appropriate delivery form of an immune adjuvant, such as GM-CSF, relative to the immunization strategy to maximize the host immune responses against a specific antigen.

Linking commercial burglaries by modus operandi: tests using regression and ROC analysis.

This paper uses statistical models to test directly the police practice of utilising modus operandi to link crimes to a common offender. Data from 86 solved commercial burglaries committed by 43 offenders are analysed using logistic regression analysis to identify behavioural features that reliably distinguish between linked and unlinked crime pairs. Receiver operating characteristic analysis is then used to assign each behavioural feature an overall level of predictive accuracy. The results indicate that certain features, in particular the distances between burglary locations, lead to high levels of predictive accuracy. This study therefore reveals some of the important consistencies in commercial burglary behaviour. These have theoretical value in helping to explain criminal activity. They also have practical value by providing the basis for a diagnostic tool that could be used in comparative case analysis.

Spatial patterns of serial murder: an analysis of disposal site location choice.

Although the murders committed by serial killers may not be considered rational, there is growing evidence that the locations in which they commit their crimes may be guided by an implicit, if limited rationality. The hypothesized logic of disposal site choice of serial killers led to predictions that (a) their criminal domains would be around their home base and relate to familiar travel distances, (b) they would have a size that was characteristic of each offender, (c) the distribution would be biased towards other non-criminal activities, and (d) the size of the domains would increase over time. Examination of the geographical distribution of the sites at which 126 US and 29 UK serial killers disposed of their victims' bodies supported all four hypotheses. It was found that rational choice and routine activity models of criminal behavior could explain the spatial choices of serial murderers. It was concluded that the locations at which serial killers dispose of their victims' bodies reflect the inherent logic of the choices that underlie their predatory activities.

Antimicrobial resistance and bacterial identification utilizing a microelectronic chip array.

Species-specific bacterial identification of clinical specimens is often limited to a few species due to the difficulty of performing multiplex reactions. In addition, discrimination of amplicons is time-consuming and laborious, consisting of gel electrophoresis, probe hybridization, or sequencing technology. In order to simplify the process of bacterial identification, we combined anchored in situ amplification on a microelectronic chip array with discrimination and detection on the same platform. Here, we describe the simultaneous amplification and discrimination of six gene sequences which are representative of different bacterial identification assays: Escherichia coli gyrA, Salmonella gyrA, Campylobacter gyrA, E. coli parC, Staphylococcus mecA, and Chlamydia cryptic plasmid. The assay can detect both plasmid and transposon genes and can also discriminate strains carrying antibiotic resistance single-nucleotide polymorphism mutations. Finally, the assay is similarly capable of discriminating between bacterial species through reporter-specific discrimination and allele-specific amplification. Anchored strand displacement amplification allows multiplex amplification and complex genotype discrimination on the same platform. This assay simplifies the bacterial identification process greatly, allowing molecular biology techniques to be performed with minimal processing of samples and practical experience.

The application of an action system model to destructive behaviour: the examples of arson and terrorism.

This article argues that criminal and deviant behaviour can be productively viewed through an action system framework. The idea is developed by considering two forms of destructive behaviour: arson and barricade-hostage terrorist incidents. Two studies are presented. The first study tests the hypothesis that different forms of arson will reflect the four dominant states that an action system can take; integrative, expressive, conservative, and adaptive. A smallest space analysis was performed on 46 variables describing 230 cases of arson and the results identified the four themes of action system functioning. An examination of the personal characteristics of the arsonists also produced four variable groupings and a combined analysis of the four action scales and four characteristics scales also supported the structural hypothesis of the action system model. The second study applied the action system model to the study acts of terrorist barricade-hostage incidents. A smallest space analysis of 44 variables coded from 41 incidents again revealed four distinct forms of activity, which were psychologically similar to the four modes of arson identified in study one. Overall, these two studies provide support for the appropriateness of the action system framework as a way of classifying different forms of deviant behaviour.

Rapid, high fidelity analysis of simple sequence repeats on an electronically active DNA microchip.

We describe a method for the discrimination of short tandem repeat (STR) alleles based on active microarray hybridization. An essential factor in this method is electronic hybridization of the target DNA, at high stringency, in <5 min. High stringency is critical to avoid slippage of hybrids along repeat tracts at allele-specific test sites in the array. These conditions are attainable only with hybridization kinetics realized by electronic concentration of DNA. A sandwich hybrid is assembled, in which proper base stacking of juxtaposed terminal nucleotides results in a thermodynamically favored complex. The increased stability of this complex relative to non-stacked termini and/or base pair mismatches is used to determine the identification of STR alleles. This method is capable of simultaneous and precise identification of alleles containing different numbers of repeats, as well as mutations within these repeats. Given the throughput capabilities of microarrays our system has the potential to enhance the use of microsatellites in forensic criminology, diagnostics and genetic mapping.

Differentiating stranger murders: profiling offender characteristics from behavioral styles.

The literature on "offender profiling" suggests that different "styles" of homicide will reflect differences in the background characteristics of the offender. To test this suggestion, hypotheses were drawn from studies of aggression to propose that murder crime scenes would reveal stylistic distinctions in the role of the aggression in the offense. It was further hypothesized that these distinctions would be clearest for those crime scene indicators that reflect the instrument (cognitive) actions that shape the offense rather than the more expressive (impulsive and emotional) components. Hypotheses about associated offender characteristics were also deduced on the assumption that the murder scene theme revealed the killers' typical styles of interpersonal transaction. To test these hypotheses MDS analyses were carried out on the crime scene and offender characteristics derived from 82 single offender, single victim stranger homicides. A multivariate structure resulted, including all three hypothesized styles, allowing 65% of the cases to be assigned to unique styles and a further 36% to be assigned to appropriate hybrids. Offender characteristics related in the anticipated way to the different crime scene styles, providing a basis for law enforcement inferences about offenders in stranger murders.

Analysis of the decision to select a conventional or cook-chill system for hospital foodservice.

OBJECTIVE: The objectives of this study were to determine what variables hospital foodservice directors consider when selecting a conventional or cook-chill system, to determine the importance of each variable considered, and to compare decision variables by type of foodservice system. DESIGN: Survey questionnaire. SUBJECTS/SETTING: Hospital foodservice directors in general, medical-surgical hospitals who had been involved in the decision to select a conventional or cook-chill system (N = 127). STATISTICAL ANALYSIS: Analysis of variance and chi 2. RESULTS: The decision process used by foodservice directors who selected a conventional system appears to differ significantly from the process used by directors who selected cook-chill systems. However, directors in this study who selected a cook-chill system were more likely than those who selected conventional systems to consider more issues in the decision process, visit other operations, place more importance on return on investment and projected labor costs, calculate more values, consider both conventional and cook-chill options, and use nonfoodservice personnel such as manufactures' representatives and consultants. APPLICATIONS: Results of this research suggest that the decision process to select a foodservice system in hospitals is complex and is one that foodservice directors will likely be involved in several times throughout their careers. Directors who have made such decisions appear to consider many issues, both quantitative and qualitative, when selecting either a conventional or cook-chill system. Regardless of the system chosen, directors indicated that numerous issues were important in the decision.

Flexor digitorum accessorius longus muscle: an etiology of tarsal tunnel syndrome?

During routine lower extremity laboratory dissection at the Ohio College of Podiatric Medicine, an anomalous muscle, the flexor digitorum accessorius longus was uncovered on one male and one female cadaver. The muscles were located in the deep posterior compartment of the leg and were of differing sizes and origins. This anomalous muscle has been implicated as an etiology for tarsal tunnel syndrome. In cases of tarsal tunnel syndrome that undergo surgical decompression, the flexor digitorum accessorius longus muscle may be present and may be the cause of the tibial nerve compression.

Profitability and acceptability of fat- and sodium-modified hot entrees in a worksite cafeteria.

OBJECTIVES: To compare the acceptability of fat- and sodium-modified entrees before and after implementation of a marketing program and to determine the effect offering and marketing these healthful entrees had on total cafeteria and entree sales in a worksite cafeteria. DESIGN: The research was conducted in five phases, including sales data collection, acceptance testing of unmodified hot entrees, acceptance testing of modified entrees, and implementation of a marketing campaign for promoting low-fat, sodium-controlled food selections. SETTING: The Kansas Farm Bureau and Affiliated Services (KFB) employee cafeteria. SUBJECTS: KFB employees who ate lunch in the employee cafeteria and were willing to participate in the study. MAIN OUTCOME MEASURES: Sales data (percent of customers purchasing a modified entree and sales of modified entree as a percent of total sales); nutrient analysis data (energy, grams of total fat, percent of energy from fat, milligrams of cholesterol, and milligrams of sodium); and acceptability data (11 characteristics were measured using a seven-point hedonic scale). STATISTICAL ANALYSIS PERFORMED: General linear model analysis of variance was used to compare sales data from phases 1 to 5 and to compare acceptability data from phases 2 to 4. RESULTS: No significant differences in sales data were observed during the 7-month study. No significant changes in overall acceptability were found for any entree. However, customers tended to rate overall acceptability higher when entrees were marketed as lower in fat and sodium. APPLICATIONS/CONCLUSIONS: Customers in worksite cafeterias may be more willing to tolerate changes in flavor attributes when modified entrees are marketed as "healthful" and nutrition information is available.

Assessing the clinical need for short-term conversion from oral to parenteral angiotensin converting enzyme inhibitor therapy in hypertensive patients. A quinapril to quinaprilat placebo-controlled model.

UNLABELLED: RATIONALE AND STUDY DESIGN: This study assesses safety and efficacy when hypertensive patients convert from an oral angiotensin converting enzyme inhibitor, quinapril, to its intravenous counterpart, quinaprilat, and evaluates the need for short-term conversion from oral to parenteral therapy. Blood pressure was measured by clinical measurements using a sphygmomanometer and by 24-h ambulatory blood pressure monitoring. During a placebo-baseline phase, patients blood pressure had to increase within 3 days in the absence of an angiotensin converting enzyme inhibitor. Responding patients were stabilized on oral quinapril and then randomized to 3 days of double-blind treatment with one 5 ml or 10 ml injection twice daily of quinaprilat or placebo. RESULTS: Overall response to quinaprilat in ambulatory blood pressure monitoring and clinic blood pressure measurements was not statistically or clinically different from the response to oral quinapril therapy during baseline. Withdrawal from quinapril resulted in clinically significant increases in all blood pressure measurements compared with baseline therapy; the differences between placebo and quinaprilat therapy were statistically and clinically significant. Two patients treated with quinaprilat withdrew due to hypotension; one patient required a dosage reduction. Parenteral quinaprilat safely maintained blood pressure control whereas placebo control did not during the 72-h interruption of quinapril.

Constitutive phosphorylation of the vesicular stomatitis virus P protein modulates polymerase complex formation but is not essential for transcription or replication.

As a subunit of both the P-L polymerase complex and the P-N assembly complex, the vesicular stomatitis virus (VSV) P protein plays a pivotal role in transcription and replication of the viral genome. Constitutive phosphorylation of this protein is currently thought to be essential for formation of the P-L complex. We recently identified the three relevant phosphate acceptor sites in the VSV Indiana serotype P protein (R. L. Jackson, D. Spadafora, and J. Perrault, Virology 214:189-197, 1995). We now report the effects of substituting Ala at these acceptor sites on transcription reconstitution in vitro and replication of defective interfering virus (DI) templates in vivo. The singly substituted S60A, T62A, and S64A mutants and the doubly substituted S60A/T62A and T62A/S64A mutants, all of which retain some constitutive phosphorylation, were nearly as active as the wild type in both assays. Surprisingly, the nonphosphorylated S60A/S64A protein was also active in transcription (> or = 28%)) and replication (> or = 50%) under optimal conditions. However, this mutant was much less active in in vitro transcription (< or = 5% of wild type) at low P concentrations (<27 nM). In addition, S60A/S64A required higher concentrations of L protein than did the wild type for optimal DI replication in vivo. DI replication efficiency and intracellular accumulation of L, P, and N proteins in the transfected system were very similar to those in VSV-infected cells. We conclude that P protein constitutive phosphorylation is not essential for VSV RNA synthesis per se but likely plays an important role in vivo in facilitating P multimerization and possibly P-L complex formation.

Stabilization of vesicular stomatitis virus L polymerase protein by P protein binding: a small deletion in the C-terminal domain of L abrogates binding.

We showed previously that cells expressing the vesicular stomatitis virus (VSV) L polymerase gene via the vaccinia-T7 RNA polymerase system accumulated 2- to 5-fold more L protein when the P protein was coexpressed (Canter et al., 1993, Virology 194, 518-529). The results presented here provide an explanation for this phenomenon. Pulse-chase analysis revealed that L was unstable with a half-life of 3 to 6 hr if expressed in the absence of P protein, but was stable for at least 16 hr when coexpressed with a 10- to 15-fold molar excess of P. The P protein, in contrast, was stable under both conditions. Stabilization correlated with formation of a P:L polymerase complex evidenced both by coimmunoprecipitation and by glycerol gradient sedimentation analyses. A mutant L protein, lacking amino acids 1638 to 1673, was not stabilized by coexpression and showed no binding to P protein. Its anomalous sedimentation, however, suggested misfolding and/or aggregation as the cause for the failure to bind P. Transcription reconstitution in vitro, using extracts from cells expressing excess of P over L protein, strongly depended on coexpression of the proteins for optimal activity. We propose that the coexpression dependence for polymerase reconstitution documented here for VSV, as well as that reported previously for the Sendai paramyxovirus, reflects the protective effect of P protein on L protein stability.

Prior convictions of child molesters.

Both the stereotypes held by investigating officers and the clinical literature assume that child molesters have distinct characteristics. these are generally expected to be reflected in a prior offence history of assaults on children and sexually deviant behaviour. A further assumption is that there is an escalation of offending, less serious crimes being precursors to more serious ones. To test these assumptions the criminal convictions, if any, prior to the offence were examined for all 416 detected offenders who had committed sexual offences upon children aged between 5 and 12 years, in the Lancashire Police area, during 1987, 1988 and 1989. Of the 183 (44%) of offenders who had previous convictions, 72 involved indecency, 17% of the total sample. Only 9 (2%) of offenders had an exclusive conviction history in respect of indecency. Previous convictions for theft, burglary and violence were all much more frequent. The results also do not generally support the hypothesis that serious offenders have progressed from less serious offences against children. A criminal opportunist model is proposed as of more value for guiding investigations than the existing stereotypes.

Identifying the residential location of rapists.

The spatial offence behaviour of 45 British serial rapists was examined in order to generate a predictive model, of use to criminal investigators. Two alternative hypotheses were explored. One predicted that rapists would commute into an area to carry out their offence. The second predicted that they would "maraud" out from a fixed location. Of the 45 offenders, 39 fitted the "maurader" hypothesis. However, the area covered by this model was an average of nearly 180 square miles. A second complementary theory, developed from facets of offenders' backgrounds, was therefore used to refine the predictions of distance travelled to and between offences. This enabled the size of the residential zone predicted from the marauder model to be reduced to a mean area of just over ten square miles. Tests of these models, combined into a small scale expert system, predicted the correct area for 82% of the cases. Suggestions for the further development of this expert system are discussed.

Quinapril hydrochloride effects on renal function in patients with renal dysfunction and hypertension: a drug-withdrawal study.

Patients with mild to moderate hypertension (diastolic blood pressure > or = 95 and < or = 115 mmHg) and renal dysfunction entered one of two studies to assess the safety of efficacious daily doses of quinapril on renal function and blood pressure. Twenty-four patients with moderate renal impairment (MRI) (creatinine clearance > 30 and < or = 60 ml/min) entered 24 weeks of open-label quinapril treatment; 31 patients with chronic renal failure (CRF) (creatinine clearance < 30 ml/min) entered 16 weeks of open-label quinapril treatment. Patients with MRI initially received quinapril 5 mg once daily (qd) followed by titration to a maximum dosage of 40 mg/day (furosemide optional at 40 mg only). Patients with CRF initially received quinapril 2.5 mg qd and were titrated up to 20 mg/day (furosemide optional). Open-label quinapril treatment resulted in significant decreases in mean systolic (SBP) and diastolic (DBP) blood pressure. The 20 patients with MRI and the 28 with CRF who completed the open-label phase were then randomly assigned to continue active drug or to receive placebo in a 4-week, double-blind, drug-withdrawal phase. During the double-blind withdrawal phase, placebo-treated patients had significant increases in mean SBP and DBP from the end of open label. Creatinine clearance was essentially unchanged following open-label quinapril treatment or quinapril withdrawal. In conclusion, in patients with mild to moderate hypertension and renal dysfunction, quinapril in dosages of 5-40 mg qd for patients with MRI and 2.5 to 20 mg qd for patients with CRF significantly reduces blood pressure without adversely affecting renal function.