Familial trends of inheritance in gastro esophageal reflux disease, Barrett's esophagus and Barrett's adenocarcinoma: 20 families.

We reported four families with familial Barrett's esophagus (FBE) in 1993. This follow-up study includes an additional 16 families with FBE, gastroesophageal reflux disease (GERD) and BE-related adenocarcinoma (BEAC) highlighting the familial trends of inheritance. A retrospective survey of endoscopic and histopathological reports on 95 confirmed cases of BE from 1975 to 2005 was performed and a detailed family history was obtained. Five representative pedigrees from a total of 20 are discussed here. These 20 families represent one of the largest cohorts studied over three decades from a single institution. Familial BE is more common than previously thought and the prevalence of GERD, BE and BEAC in these families is distinctly higher than with sporadic cases. The conditions appear to be inherited in an autosomal dominant fashion with incomplete penetrance. Hence diligence in taking family history with BE patients is critical since the endoscopic screening of relatives is warranted in FBE. Earlier diagnosis and surveillance of FBE should hopefully improve outcomes.

Cell interactions influence the pattern of biomineralization in the Ilyanassa obsoleta (Mollusca) embryo.

Ilyanassa obsoleta larvae have two calcium carbonate-containing organs, shell and statocyst, which are derived from five micromere cells (2a, 2c, 2d, 3c, 3d). "Internal shell," an abnormal, internal calcium carbonate mass, was previously observed when cells which normally induce shell and statocyst were removed. This study utilizes multiple-cell deletions to examine how these calcium carbonate-producing precursors control the pattern of biomineralization, whether it is in external shell, statocyst, or internal shell. It was demonstrated that internal shell was solely derived from any of these five cells. However, there was a quantitative difference in the frequency of internal shell production depending upon which cells, as well as how many, are deleted. In general, when external shell or statocyst production was diminished, as the result of removing several of the calcium carbonate-producing cells, internal shell was deposited instead. The presence of internal shell can best be explained as the result of altered interactions between these five cells after one or more have been deleted. Electron diffraction and transmission electron microscopy show that internal shell differs from normal shell in both structure and crystal morphology and it can also be produced by statocyst precursors. Thus, both the deletion and electron microscopy data support the interpretation that the development of internal shell is controlled by shell- and statocyst-producing cells when the cell communication between these cells is disrupted.

Clinical experience with cefamandole for treatment of serious bone and joint infections.

The safety and efficacy of treatment with cefamandole were evaluated in 30 patients (from 18 institutions) with serious bone and joint infections. Five of the subjects were children. The antibiotic was given intramuscularly or intravenously in doses ranging from 2 to 12 g daily for five to 44 days. Twenty-six of the 30 patients responded satisfactorily. Fourteen of the fifteen infections due to Staphylococcus aureus were among the successful cases. Other pathogens were streptococci, Escherichia coli, Proteus mirabilis, and Bacteroides fragilis. The drug was well tolerated in patients in this series. Studies indicated that cefamandole penetrated the bones and joints. Further investigation of cefmandole in the treatment of bone and joint infections is warranted.

Cefamandole in the treatment of infections due to Enterobacter and indole-positive Proteus.

Clinical and bacteriologic results are reported for 80 patients treated with 1.5--12 g of cefamandole daily for a variety of infections caused by Enterobacter and indole-positive Proteus, organisms that have been resistant to most available cephalosporins. Of 45 patients with infections due to Enterobacter, 41 (91%) had satisfactory clinical responses; 36 were bacteriologic successes, and six cases of complicated urinary tract infections relapsed. Of 37 patients with infections due to indole-positive Proteus, 28 (88%) were clinical successes and 30 (81%) were bacteriologic successes. Fourteen cases of complicated urinary tract infection relapsed. Of 104 patients in whom the drug was evaluated for safety, use of cefamandole was discontinued in five; nine adverse reactions were considered drug-related. A summary of published in vitro data shows that the majority of strains of these organisms were susceptible to cefamandole at concentrations achievable in the serum. Minimal inhibitory concentrations are variable, and there is a significant inoculum effect, the clinical significance of which has not been determined.