Early ontogeny of the Atlantic halibut Hippoglossus hippoglossus head.

An ontogenetic sequence of Atlantic halibut Hippoglossus hippoglossus larvae, reared in intensive culture conditions, was cleared and stained and histologically processed to determine normal cranial chondrification for specimens ranging from 0 to 41 days post-hatch (dph). Twenty-six cranial cartilaginous structures were described, at daily intervals post-hatch. The ontogenetic trajectory, composed of alternating steps and thresholds, was interpreted as saltatory. In comparison with other flatfishes, H. hippoglossus exhibits delayed onset of chondrification. From 9 dph onwards, the ontogenetic trajectory resembles more than that of the turbot Psetta maxima than that of the common sole Solea solea or the summer flounder Paralichthys dentatus and winter flounder Pseudopleuronectes americanus. Hippoglossus hippoglossus with the gaping-jaw malformation, common in intensively cultured individuals of this species, were examined histologically. The reason larvae cannot close their mouth, as their yolk-sac resorbs, seems to be related to the fusion of the interhyal to the hyosymplectic and ceratohyal with which it is normally articulated.

The fossil record of fish ontogenies: insights into developmental patterns and processes.

One of the properties of fossils is to provide unique ontogenies that have the potential to inform us of developmental patterns and processes in the past. Although fossilized ontogenies are fairly rare, size series of relatively complete specimens for more than 90 fish species have been documented in the literature. These fossilized ontogenies are known for most major phylogenetic groups of fishes and have a broad stratigraphic range extending from the Silurian to the Quaternary with a good representation during the Devonian. Classically, size series have been studied in terms of size and shape differences, where subsequently allometric changes were used as indicators of heterochronic changes in Paleozoic placoderms and sarcopterygians. Quantitative analyses of fossilized ontogenies of dipnoans have been interpreted in terms of morphological integration and fluctuating asymmetry. Recently, reconstructed sequences of ossification have been used to identify recurrent patterns of similar development in actinopterygians and sarcopterygians in order to infer phenotypic developmental modularity and saltatory pattern of development. Phylogenetic and temporal landmarks are put forward for some of the major developmental patterns in the evolution of fishes.

Can geotextiles modify the transfer of heavy metals transported by stormwater in infiltration basins?

Geotextiles are fibrous materials increasingly employed for the design of infiltration basins. However, their influence on the transfer of contaminants carried by stormwater has not been fully investigated. This study, based on column leaching experiments, aims at showing the effect of geotextiles on the transfer of three heavy metals (Zn, Pb and Cd) in a reactive soil (simulating an infiltration basin at laboratory scale). This effect depends on several factors, such as type of geotextile, hydric conditions (geotextile water content), hydraulic conditions (flow-rates) and the number of geotextiles installed. In all cases, geotextiles influence heavy metal retention by modifying flow and thus regulating contact between these metals and the reactive soil.

Retention of three heavy metals (Zn, Pb, and Cd) in a calcareous soil controlled by the modification of flow with geotextiles.

Although geotextiles are increasingly employed in stormwater infiltration basins, their influence on the flow and transfer of contaminants, such as heavy metals, has not been fully investigated. Leaching column experiments were conducted to characterize the flow and transfer of three heavy metals (zinc, lead, and cadmium) in a calcareous soil with and without geotextiles under steady-state flow and close to saturation forthe soil. The influence of geotextiles was characterized for two types of geotextiles (needlepunched and thermosealed) and for two different initial saturation degrees for the needlepunched geotextile. The main results showed that, when placed wet, the needlepunched geotextile had no influence. When placed dry, it homogenized the flow in its surroundings and thus allowed better contact between heavy metals and the reactive soil, resulting in an increase of their retention. The thermosealed geotextile, placed dry, homogenized the flow and increased retention over a larger area, resulting in optimal global retention. In conclusion, geotextiles could be used in infiltration basins, provided that their effect on both flow and heavy metal retention is optimized by appropriate design--choice of geotextiles--and appropriate monitoring--control of hydric conditions.

Effect of ABT-627 (A-147627), a potent selective ET(A) receptor antagonist, on the cardiopulmonary profile of newborn lambs with surgically-induced diaphragmatic hernia.

1. Postnatal mortality in isolated congenital diaphragmatic hernia (CDH) is mainly related to the associated pulmonary hypertension (PH) and to right-to-left shunting. 2. Endothelins (ETs) are potent vasoconstrictors and pro-mitogenic peptides. Strong evidences support their participation in CDH and in the etiology of PH via the activation of ET(A) receptors (ET(A)-Rs). 3. Evaluation of the effect of ABT-627, a selective non-peptidic ET(A)-R antagonist, given from -15 to 210 min post-delivery (1 mg kg(-1) bolus +0.01 mg kg(-1) h(-1) infusion, i.v.), was conducted in the lamb model of CDH. 4. Severity of CDH was assessed in comparison to untreated controls (n=5). Untreated CDH lambs (n=7) had a higher mean pulmonary arterial pressure (MPAP; P<0.0001), lower mean blood pressure (MBP; P=0.0004), higher MPAP / MBP ratio (P<0.0001), lower arterial pH (P<0.0001), higher paCO(2) (P<0.0001), lower paO(2) (P<0.0001) and lower post-ductal pulsatile SaO(2) (P<0.0001) than untreated controls. 5. Treated controls (n=7) showed a higher MPAP, lower MBP, higher MPAP/MBP ratio, lower arterial pH, higher paCO(2), lower paO(2), lower post-ductal pulsatile SaO(2) and lower plasmatic ir-ET ratios compared to untreated controls (P<0.0001). 6. Treated CDH lambs (n=8) showed a higher MBP (P<0.0001), lower MPAP / MBP ratio (P<0.0001), higher arterial pH (P<0.0001), lower paCO(2) (P<0.0001), higher paO(2) (P=0.0228), higher post-ductal pulsatile SaO(2) (P=0.0016) and lower plasmatic ir-ET ratios (P=0.0247) when compared to untreated CDH lambs. 7. These observations revealed that, although acute perinatal treatment with a selective non-peptidic ET(A)-R antagonist had some adverse effects in controls, it attenuated the progressive cardiopulmonary deterioration that occurred after birth in CDH lambs.

Effect of CGS 26303, an endothelin-converting enzyme-neutral endopeptidase inhibitor, on nitrofen-induced congenital diaphragmatic hernia in the rat.

BACKGROUND/PURPOSE: The pathophysiology of congenital diaphragmatic hernia (CDH) associated with lung hypoplasia and pulmonary hypertension is not understood fully. Endothelins (ETs) are the most potent vasoconstrictors that also act as promitogenic agents. They may play a role during pregnancy in leading to the condition found at birth and ongoing mortality in CDH. Therefore, the authors studied the effect of CGS 26303, a nonselective endothelin-converting enzyme and neutral endopeptidase inhibitor, in the rat model of CDH. METHODS: Pregnant Sprague-Dawley rats were divided into 3 groups: group 1 (n = 4) received CGS 26303 (50 mg/kg, subcutaneously, twice a day), from gestational day 12 until term (21 to 23 days); group 2 (n = 8) received nitrofen (100 mg/kg, orally) at gestational day 11.5; group 3 (n = 8) received both nitrofen and CGS 26303. The survival of the newborn rats was monitored up to 240 minutes. After natural death or euthanasia, they were weighed and microdissected. The degree of hernia was quantified as small, moderate, or severe, and lungs and liver were harvested and weighed. RESULTS: Newborn rats from mothers of group 3 (n = 81) survived 196 +/- 8 minutes compared with 173 +/- 9 minutes of those of group 2 (n = 97). Severe CDH from group 3 (n = 20) had a mean survival time of 66 +/- 13 minutes compared with 26 +/- 4 minutes for those of group 2 (n = 27). Lung index in severe CDH pups of group 3 was increased by 13% compared with those from group 2 (P < .0001), whereas their liver index went down by 8% (P < .05). CONCLUSIONS: These results suggest that CGS 26303 might have a beneficial effect when given during pregnancy in increasing survival at birth and reducing the severity of the pulmonary hypoplasia in newborn rats with nitrofen-induced CDH.

Redefining Rowell's syndrome.

Rowell's syndrome is believed to be a distinct and rare clinical entity originally described as lupus erythematosus associated with erythema multiforme-like lesions with immunological findings of speckled antinuclear antibodies, anti-La antibodies and a positive test for rheumatoid factor. We report two additional patients with Rowell's syndrome and review all the diagnostic criteria found in the literature. In view of the inconsistent findings of some of the diagnostic features, we propose that major and minor criteria be used to diagnose Rowell's syndrome.

Calciphylaxis: seven new cases.

BACKGROUND: Calciphylaxis is a rare condition occurring most frequently in patients with end-stage renal disease (ESRD). It is characterized by vascular calcifications with a large variety of skin lesions. Even though this entity was first reported almost 50 years ago, the pathogenesis is still not well understood. OBJECTIVE: Having retrieved seven new cases from a single tertiary care hospital, the disease occurs probably more frequently than reported until now. The potential mechanism of action in this disease is discussed, particularly the hypercoagulability state. We also review potential treatments described in the literature. METHODS: Seven patients with calciphylaxis that occurred at the Hôtel-Dieu hospital between 1992 and 1998 were identified and their case histories reviewed and analyzed. CONCLUSION: Although hyperparathyroidism and imbalance of calcium-phosphorus homeostasis are paramount for calciphylaxis to occur, other mechanisms must be involved because the disease manifests itself in only a minority of ESRD patients. As the majority were under anticoagulation therapy and as we found abnormalities of the coagulation pathway in one patient, we suggest emphasizing these phenomena in the future. Along with evaluation of putative risk factors (abnormalities of the calcium:phosphate axis, diabetes), a detailed evaluation of the coagulation system should be done in every patient with calciphylaxis until more data are available.

Juvenile xanthogranuloma presenting as obstructive jaundice.

The authors report the case of a 9-month-old infant presenting with obstructive jaundice. Preoperative investigation findings showed distension of the extrahepatic biliary tract. Urine analysis result was positive for cytomegalovirus. At laparotomy, a 1-cm round mass was found within the head of the pancreas, near its upper border and in the course of the common bile duct. Findings on frozen sections could not rule out a malignant process and an hepaticoduodenostomy was constructed. Final diagnosis was juvenile xanthogranuloma. An association between cytomegalovirus and juvenile xanthogranuloma has been reported previously in the literature.

[Recurrence of erosive pustular scalp dermatosis after a skin graft]. / Récidive après greffe cutanée d'une dermatose érosive et pustuleuse du cuir chevelu.

INTRODUCTION: Erosive pustular dermatosis of the scalp is a rare and chronic dermatosis of unknown etiology with non specific histology and without effective treatment. It affects mostly old women. We have observed a 80 year-old male suffering from an erosive pustular dermatosis of the scalp following application of 5 p. 100 fluorouracile cream (Efudex) and his resistance to various treatments including skin graft. OBSERVATION: An 80 year-old man had been suffering, for many years from recurrent episodes of pustules, erosions and crusts of the scalp, following treatment with 5 p. 100 fluorouracile cream for skin lesions diagnosed as actinic keratosis. Different topical and systemic treatments were tried without much improvement. A skin graft of the scalp lesional area was finally done, showing a severe recurrence as a Koebner's reaction. Despite this recurrence, we have observed an easier control with a topical mixture of steroid and antibiotic. CONCLUSION: This recurrence of erosive pustular dermatosis of the scalp following skin graft had never been previously observed before, showing that removing affected skin did not control the disease, suggesting that anti-inflammatory agents probably originating from trauma persist.

Improved pulmonary function after surgical reduction of congenital diaphragmatic hernia in lambs.

BACKGROUND/PURPOSE: Modern trends are toward delayed surgical reduction of congenital diaphragmatic hernia. This study was conducted to verify the hypothesis that the "ease" of ventilation found in the authors' postoperative experience in infants with congenital diaphragmatic hernia (CDH) is associated with postsurgical improvement in pulmonary mechanics. METHODS: Very severe CDH was surgically induced in utero at 90 days' gestation in 31 lambs. At birth pulmonary mechanics (PeDS-Lab) was measured in these preterm lambs with (n = 24) and without (n = 7) early surgical reduction, and in eight non-CDH controls over the same period; functional residual capacity (FRC) also was obtained from 14 of the 31 CDH lambs (seven reduced animals and seven unreduced ones). Management excluded aspiration from the thorax and insertion of chest drains. RESULTS: After 30 minutes of life CDH animals with early surgical reduction demonstrated significantly greater improvement in lung volume, pulmonary mechanics, and oxygenation than those without reduction: FRC, 235% versus 19%; compliance, 57% versus 14%; minute ventilation, 71% versus 30%; and PO2, 143% versus -15%. Over the same period, in preterm controls without CDH, only the compliance varied significantly, demonstrating a 32% increase. CONCLUSION: Based on the mechanics of breathing in these lambs, the authors speculate that neonates with CDH could benefit from early surgical repair because of improvement in pulmonary function, provided extra care is taken to prevent pulmonary overdistension.

Retinol status of newborn infants with congenital diaphragmatic hernia.

The etiology of congenital diaphragmatic hernia (CDH) is not yet known. Studies in the literature from 1941 have reported that nutritional deficiency of vitamin A during pregnancy could lead to CDH, associated or not with other malformations in young rats. More recently, possible correlations between expression patterns of cellular retinoid-binding protein and retinoic-acid receptors and morphologic effects of vitamin A deficiency have been suggested. The purpose of this study was to verify in human newborns the possible link between vitamin A deficiency and CDH previously observed in experimental animals. Blood samples were obtained during the first hours after birth from 11 term CDH newborns and 11 healthy controls matched for gestational age, and also from 7 mothers in each group, for a total of 7 newborn-mother pairs of matched CDH-controls. Plasma retinol was measured by high-performance liquid chromatography and retinol-binding protein (RBP) by nephelometry. In the 11 matched CDH-control newborns, plasma retinol and RBP levels in CDH newborns were 50% less than control values (P< 0.0002 and <0.006, respectively); in contrast, retinol levels in CDH mothers were significantly higher than those of control mothers (P < 0.005). The observation that the plasma concentrations of retinol and RBP are low in infants with CDH relative to controls may be clinically very relevant and may help to elucidate the mechanism of development of this congenital anomaly.

Incidence of venographically proved deep vein thrombosis after knee arthroscopy.

BACKGROUND: Deep vein thrombosis is a common, important complication of major orthopedic surgery, particularly knee arthroplasty. Knee arthroscopy is performed more frequently and in younger patients than knee arthroplasty. However, the true risk of deep vein thrombosis in patients who undergo this procedure is unknown. OBJECTIVE: To determine the incidence of deep vein thrombosis after knee arthroscopy in a large cohort of patients. METHODS: Consecutive patients scheduled for knee arthroscopy were eligible for the study. Enrolled study patients received no thromboprophylaxis. They were discharged home the day of surgery and underwent unilateral contrast venography approximately 1 week after their operation. The primary outcome measure was the incidence of venous thromboembolism. Risk factors for deep vein thrombosis were evaluated. RESULTS: Among the 184 patients who had adequate venography, deep vein thrombosis was detected in 33 (17.9%; 95% confidence interval, 12.7%-24.3%). Of these, 9 were proximal (4.9%; 95% confidence interval, 2.3%-9.1%). No patient died and no patient presented with clinically suspected pulmonary embolism. Of 33 patients, only 20 (60.6%) with deep vein thrombosis had symptoms while 13 (39.4%) were asymptomatic. The risk of deep vein thrombosis was significantly higher among patients who had a tourniquet applied for more than 60 minutes. CONCLUSIONS: The results of our study demonstrate that 17.9% of patients develop deep vein thrombosis after knee arthroscopy (most being either proximal or extensive). It is reasonable to perform a randomized trial to determine whether the incidence of deep vein thrombosis can be safely reduced in patients undergoing knee arthroscopy.

Social consequences of long term impairments and disabilities: conceptual approach and assessment of handicap.

OBJECTIVES: To present a conceptual model of disablement adapted from the WHO model and to conduct a pilot study with a measurement tool (LIFE-H) of the concepts of life habits and handicap situations. DESIGN: Content validity and test-retest reliability study. SETTING: General community. PARTICIPANTS: A panel of 12 experts of rehabilitation for the process of content validity and 49 individuals with spinal cord disorders (adults and children) for the reliability study. OUTCOMES MEASURES: a person's life habits (activities of daily living and social roles). RESULTS: The LIFE-H questionnaire was designed to assess the handicap situations observed in daily life of individuals with disability. The experts concluded that the LIFE-H items covered most of a person's life habits (ADL and social roles) and that it could be used to determine the appearance of handicap situations. The LIFE-H total score showed a good level of reliability for the children and the adult samples (ICC = 0.73 and 0.74, respectively). Taken individually, a majority of life habit categories have shown a moderate to high reliability level (ICC > or = 0.50) while a few life habit categories such as the interpersonal relationship or nutrition showed a lower reliability level. CONCLUSION: The development of LIFE-H allows fulfillment of the need to determine the disruptions in life habits of persons with disabilities.

Oral terbinafine in the treatment of toenail onychomycosis: North American multicenter trial.

BACKGROUND: Onychomycosis is an increasing problem with limited therapeutic options. OBJECTIVE: We evaluated the safety and efficacy, of oral terbinafine, a new fungicidal antimycotic, in patients with toenail onychomycosis. METHODS: A North American multicenter, double-blind, placebo-controlled study evaluated the mycologic and clinical efficacy of oral terbinafine 250 mg/day for 12 or 24 weeks in 358 patients with toenail onychomycosis. RESULTS: A total of 74% of patients treated with 12 or 24 weeks of terbinafine achieved a successful clinical outcome. Approximately 11% of terbinafine responders showed evidence of relapse 18 of 21 months after cessation of treatment. Terbinafine was well tolerated; most adverse events were transient and mild to moderate in severity. CONCLUSION: The results of this study confirm that oral terbinafine is a safe and effective therapy for the treatment of onychomycosis.

Anal reeducation for postoperative fecal incontinence in congenital diseases of the rectum and anus.

From October 1993 to March 1996, 14 patients with anorectal disease were referred to an anal reeducation clinic. Initial evaluation allowed the authors to identify three classes of defects: lack of proprioception in the sphincters, use of synergistic muscles (gluteal) to compensate for anal dysfunction, and inversion of command by contraction, rather than relaxation, of abdominal muscles. Patients were treated by electrostimulation through an anal probe as well as biofeedback therapy coupled with home exercises. This therapy resulted in rapid correction of the abnormal motor commands and erroneous use of accessory muscles. All patients became able to isolate their continence muscles with success, with documented increase in strength, rapidity of response, and duration of contraction. The mean Kelly score went from 1.46 (range, 0 to 4.5) to 3.07 (range, 0.5 to 5.5). This physiological improvement also increased patient motivation and discipline toward continence and subsequently their quality of life.

Aggressive giant condyloma acuminatum associated with oncogenic human papilloma virus: a case report.

Malignant transformation has been described in 30% of cases of giant anorectal condyloma acuminatum. The authors report on a 33-year-old man who was heterosexual and HIV negative and who had a giant anal condyloma. Despite aggressive therapy with multiple fulgurations, interferon alpha and isotretinoin, an invasive squamous cell carcinoma of the rectum developed. An abdominoperineal resection was done followed by radiotherapy and chemotherapy, but this treatment regimen was unsuccessful in controlling the progression of his carcinoma. Human papillomavirus (HPV) serotyping in tumoral tissue was positive for HPV types 11 and 16. In patients with giant anorectal condylomas associated with oncogenic HPV, the course of the disease may be aggressive, so they may benefit from early surgical and medical intervention.

Morphometrics of normal and hypoplastic lungs in preterm lambs with gas and partial liquid ventilation

To test the hypothesis that perfluorochemical (PFC) instillation may reduce the pulmonary trauma commonly associated with conventional gas ventilation, we studied 12 lambs with normal lungs and 10 with pulmonary hypoplasia secondary to congenital diaphragmatic hernia (CDH). We used mechanical ventilation for up to 3.5 h, with and without tracheal instillation of LiquiVent PFC liquid. At the end of experimentation lungs were fixed for morphometrical analysis of their components and pulmonary trauma was evaluated by measurement of the perivascular compression index (PCI = % perivascular emphysema/% vessels). In normal lungs good gas exchange and respiratory mechanics were obtained with all modes of ventilation, with no statistical difference in the index of pulmonary trauma with or without instillation of LiquiVent (P >0.05). In the hypoplastic lungs, tracheal instillation of PFC liquid after 30 min of conventional gas ventilation significantly improved PaCO2 (from 107+/-8 to 55+/-6 mmHg, P <0.05), pH (from 7.00+/-0.03 to 7.29+/-0.04, P <0.05), compliance (from 0.08+/-0.01 to 0.25+/-0.03 ml/cmH2O . kg, P <0.05), and ventilatory index (from 1,445+/-148 to 794+/-139, P <0.05). Survival was 6/6 animals with PFC ventilation compared to 1/4 with conventional gas ventilation with no more pulmonary trauma (mean PCI 12.6+/-1.8 vs. 11.4+/-4.0%, P >0.05) for a longer mean ventilatory period in the PFC group. We conclude that the PFC liquid technique of ventilation can improve respiratory physiology when conventional gas ventilation alone is proving inefficient. There was no significant difference in pulmonary trauma at morphometrics between gas and partial liquid ventilation.