Pulmonary artery banding in a kitten with a partial atrioventricular septal defect.

A 9-month-old kitten with increased resting respiratory rate and exercise intolerance was diagnosed with a congenital partial atrioventricular septal defect causing pulmonary over circulation and presumed pulmonary hypertension based on echocardiogram. Invasive pressure measurements and contrast angiography confirmed this diagnosis. The cat underwent pulmonary artery banding under general anesthesia. Findings of echocardiogram 10 days postoperatively suggested reduced left-to-right shunt volume. Echocardiographic findings were static 4 months postoperatively.

Feline visceral hemangiosarcoma.

BACKGROUND: Feline visceral hemangiosarcoma (HSA) is an uncommon tumor, and the clinical progression and outcome are rarely reported. HYPOTHESIS: The prognosis of feline visceral HSA is poor because of severe clinical signs, anemia, and a high rate of metastasis. ANIMALS: The medical records of 26 client-owned cats with visceral HSA were reviewed. METHODS: Multi-institutional retrospective study. RESULTS: The most common historical findings and clinical signs included lethargy, anorexia, respiratory difficulty, collapse, and vocalizing. Eighty-two percent of cats were anemic, and aspartate transaminase was increased in 53% of the study population. Metastatic lung disease was noted in 33% of affected cats. In 75% of the cats, abdominal ultrasonography identified a specific location of HSA. However, ultrasound identification of all multifocal lesions was successful only in 3/9 cats (33%). Tumor location was identified in the following organs: liver (35%), small intestine (31%), large intestine (31%), abdominal lymph node (31%), mesentery (27%), spleen (23%), lung (19%), omentum (12%), brain (8%), pancreas (8%), and diaphragm (8%). Multifocal HSA was noted in 77% of cats. Three cats received adjuvant chemotherapy (doxorubicin). Seventy-one percent of euthanized cats were euthanized within 1 day of diagnosis. The median survival time of the remaining cats (n = 6) was 77 days (range, 23-296 days). CONCLUSION AND CLINICAL IMPORTANCE: Feline visceral HSA is most often multifocal at the time of diagnosis. The prognosis appears poor, and the number of cats receiving chemotherapy is low.

p160 Bcr mediates platelet-derived growth factor activation of extracellular signal-regulated kinase in vascular smooth muscle cells.

BACKGROUND: The human Bcr gene was originally identified by its presence in the chimeric Bcr/Abl oncogene, which is causative for chronic myeloblastic leukemia. Because Bcr encodes a serine/threonine protein kinase, we studied its kinase activity and determined the role of Bcr in the PDGF signaling pathway to ERK1/2 activation and DNA synthesis in rat aortic smooth muscle cells (RASMCs). METHODS AND RESULTS: In RASMCs, platelet-derived growth factor-BB (PDGF) stimulated Bcr kinase activity, with a maximum at 1 minute. Because phosphatidylinositol 3'-kinase (PI3-K) is essential for Bcr/Abl leukemogenesis, we evaluated the role of mouse PDGF-beta-receptor binding sites for PI3-K (Y708, Y719) and for phospholipase C-gamma (Y977, Y989) in PDGF-mediated Bcr kinase activation. The mutant PDGF receptor Y708F/Y719F but not Y977F/Y989F showed significantly reduced Bcr kinase activity. To determine the role of Bcr in PDGF-mediated signal transduction events leading to ERK1/2 and its downstream Elk1 transcription activation, wild-type (WT) and kinase-negative (KN) Bcr were transiently expressed in RASMCs. Bcr WT enhanced, whereas Bcr KN inhibited, PDGF-stimulated ERK1/2 and Elk1 transcriptional activity. Overexpression of Bcr also enhanced PDGF-induced Ras/Raf-1 activity and DNA synthesis, but this regulation is independent of the kinase activity of Bcr. Finally, we found that Bcr expression was increased in the neointimal layer after balloon injury of rat carotid artery. CONCLUSIONS: These results demonstrated the importance of Bcr in PDGF-mediated events, such as activation of Ras, Raf-1, ERK1/2, and Elk1, and stimulation of DNA synthesis.

Prolonged hyperprolactinemia in preterm infants.

Serum PRL levels were followed serially in full term (FT; 39-41 weeks) and preterm (PT; 30-32 weeks) infants, from birth to 12 and 20 postnatal weeks, respectively. Values were higher in FT infants than in PT infants on day 1 after birth (267 +/- 20 vs. 156 +/- 8 ng/ml) but were similar in both by the age of 2-4 weeks (69 +/- 8 vs. 69 +/- 6 ng/ml). Between the ages of 4-12 weeks, the serum PRL in FT infants fell to near adult levels (24 +/- 2 ng/ml), but this fall was seen much later in PT infants, between 12-20 weeks postnatally (23 +/- 2 ng/ml). When values in FT and PT infants were compared at parallel postmenstrual ages in contradistinction to postnatal ages, a similar course of PRL was discernable in both groups. These data may provide indirect evidence for the establishment and maturation of inhibition of PRL secretion (i.e. PRL-inhibitory factor production) postnatally, between 44-52 weeks postmenstrually.

Enteral nutrition in infants with congenital heart disease and growth failure.

To determine an effective nutritional regimen for management of growth failure in infants with congenital heart disease and congestive heart failure, the authors studied 19 infants with cardiac anomalies who were not candidates for early corrective surgery. Patients were randomly assigned to one of three feeding groups: group 1 (n = 7) received continuous, 24-hour nasogastric alimentation; group 2 (n = 5) received overnight, 12-hour nasogastric infusions plus daytime oral feedings as tolerated; and group 3 (n = 7) received oral feedings alone. For all patients, commercial infant formula (cow's milk or soy protein) was supplemented to a calorie density of approximately 1 kcal/mL. During a 5.25 +/- 0.45 month study period, only group 1 infants achieved intakes greater than 140 kcal/kg per day (mean = 147 kcal). Serial anthropometric measurements demonstrated that only 24-hour infusions (group 1) were associated with significantly improved nutritional status, when assessed by z scores for weight (P less than .01) and length (P less than .05). Group 1 infants also showed marked increases in midarm muscle circumference and triceps and subscapular skinfold thicknesses (P less than .01, compared with groups 2 and 3). These data suggest that infants with congenital cardiac defects complicated by malnutrition manifest increased nutrient requirements for growth and weight gain. Continuous, 24-hour, nasogastric alimentation is a safe and effective method for achieving both increased nutrient intake and improved overall nutritional status in these infants.

Breast-feeding and maternal smoking in the etiology of Crohn's disease and ulcerative colitis in childhood.

Medical records concerning pediatric or adolescent patients first diagnosed with Crohn's disease or ulcerative colitis in two New York hospitals during a 5-year period (1986 to 1990) were abstracted, and information concerning sex, age, race, birthplace, sibship size, birth order, maternal age at birth, month of birth, duration of breast-feeding, and maternal smoking was recorded. Medical records of patients presenting at the respective pediatric gastroenterology departments immediately before or after the patients with inflammatory bowel disease were seen were also abstracted in order to generate a control series. Data concerning 68 patients with Crohn's disease, 39 patients with ulcerative colitis, and 202 control patients were analyzed through multiple logistic regression. Breast-feeding was negatively associated with Crohn's disease (P approximately 0.04) and ulcerative colitis (P approximately 0.07), with relative risk point estimates around 0.5 and with evidence of duration-dependent trends in both instances. There was no evidence of association of either disease with maternal age at birth, birth order, maternal smoking, or season of birth.

Bcr in vascular smooth muscle cells involvement of Ras and Raf-1 activation by Bcr.

Bcr gene was originally identified by its presence in the chimeric Bcr/Abl oncogene. In vascular smooth muscle cells, platelet-derived growth factor-BB (PDGF) stimulated Bcr kinase activity. The mutant PDGF receptor for PI3-K, but not for PLC-gamma binding sites, showed significantly reduced Bcr kinase activity. Bcr wild-type enhanced, whereas Bcr kinase negative form inhibited PDGF-stimulated ERK1/2 activity. A dominant negative Ras did not inhibit Bcr kinase activation, and overexpression of Bcr increased Ras/Raf-1 activity and DNA synthesis. These results demonstrated the importance of Bcr in PDGF-mediated events such as activation of Ras, Raf-1, and ERK1/2 and stimulation of DNA synthesis.

Relaxation of imprinting in carcinogenesis.

The study of genes at the heat of tumorigenesis has helped unveil an elaborate biochemical circuitry that governs the proliferation and differentiation of cells. Genomic imprinting is rapidly being recognized as a fundamental process in tumor biology. Aberrant relaxation of imprinted genes have been detected in a wide variety of cancers, of both embryonal and nonembryonal origin. However, despite a vast array of experimental observation, both the purpose and pathogenic mechanism of relaxation of imprinting remain an enigma. Hypotheses are examined in this regard along with speculation for future research.

Perianal pseudoverrucous papules and nodules in children.

BACKGROUND: Pseudoverrucous papules and nodules were originally described as a reaction to irritation in association with urostomies. These changes have not been described as occurring on the perianal skin or around colostomies. OBSERVATIONS: Five children had remarkably similar-appearing papules and nodules of the perianal and suprapubic skin. The rash consisted of more than a dozen 2- to 8-mm shiny, smooth, red, moist, flat-topped, round lesions. This peculiar and striking reaction appears to be the result of encopresis or urinary incontinence. Biopsy specimens reveal reactive acanthosis or psoriasiform spongiotic dermatitis. The lesions regress when the irritating factor is removed. CONCLUSIONS: Recognition of this entity is important because pseudoverrucous papules and nodules may mimic more serious dermatoses and unnecessary workup may be initiated. Although this reaction involving perianal skin has not been reported previously, we believe it is not uncommon.

Perceived control, coping efficacy, and avoidance coping as mediators between spouses' unsupportive behaviors and cancer patients' psychological distress.

This study examined whether avoidance, coping efficacy, and perceived control mediate the effects of spouses' unsupportive behaviors on patient psychological distress among 191 married individuals enrolled in cancer treatment. Results of the structural equation analyses suggested that avoidance and coping efficacy mediated the relationship between spouses' unsupportive behaviors and patient psychological distress. Perceived control of emotional aspects of the illness, including emotional responses and relationships with family and friends, and perceived control of the medical course of the cancer did not mediate the relationship between spouses' unsupportive behaviors and patient psychological distress. These findings suggest 2 mechanisms to explain why unsupportive responses from spouses may be associated with psychological distress among cancer patients.

The relationship between ethnicity, gender and alcohol consumption: a strategy for testing competing models.

AIM: This study tested mediator, moderator and main effects models to determine the pattern of relationships between ethnicity, gender, temperament, and alcohol use. DESIGN: A large-scale survey was employed. Respondents were interviewed in their homes. Participants were 523 Puerto Rican and 490 Irish American adults residing in the New York metropolitan area. MEASURES: Quantity and frequency of alcohol consumption were assessed with standard measures, and recent drinking problems with the substance abuse module of the Composite International Diagnostic Instrument. FINDINGS: Rather than supporting a complex, nested model, the findings supported a main effects model and indicated that each of the three predictors was related to one or more drinking measure. While gender strongly influenced each drinking behavior, ethnicity only influenced frequency, and temperament only influenced recent drinking problems. CONCLUSIONS: The results support previous studies indicating consistent male-female drinking differences while highlighting a statistical strategy for comparing competing models of ethnic drinking behavior.

Peptic ulcer disease in children.

Although much of the understanding of the pathogenesis of ulcer disease is derived from data studying adults, there are certain manifestations and presentations that differentiate ulcers in children from those seen in adults. Therapy is aimed at reducing acid or improving mucosal defense. The recent recognition of the association of Helicobacter pylori with acid peptic disease has added to our understanding of the disease process and opened new avenues of therapy.

Noncardiac chest pain in adolescents and children with mitral valve prolapse.

Chest pain in adolescents and children is usually not of cardiac origin. Of cardiac conditions commonly linked to chest pain in childhood, mitral valve prolapse (MVP) is the most prevalent, but this association has recently been questioned. In light of recent reports of gastroesophageal sources of chest pain in adults with MVP, we performed a comprehensive gastroesophageal evaluation of 17 preadolescents and adolescents with mitral valve prolapse who had chest pain as their presenting symptom. Evaluation consisted of esophageal manometry, Bernstein test, esophageal pH probe, and/or esophagogastroscopy. Fourteen of the 17 patients had at least one abnormal finding. Five patients had esophagitis, five had gastritis, one had high-amplitude esophageal contractions, one had abnormal esophageal manometry with positive Bernstein test, one had esophageal reflux and positive Bernstein test, and one had abnormal manometry with esophageal reflux. The 13 patients with esophagitis, gastritis, reflux, or positive Bernstein test were treated with antacid, with resolution of chest pain in 12 patients. Two of these patients underwent follow-up endoscopy with documentation of improvement. The patient with high-amplitude esophageal contractions was treated with dicyclomine, which resulted in resolution of chest pain. The observation that the chest pain was not related to mitral valve prolapse is important in clinical practice and raises further questions as to whether mitral valve prolapse causes chest pain.

Sudden infant death syndrome prevention and an understanding of selected clinical issues.

The etiology and prevention of sudden infant death syndrome (SIDS) are among the more frustrating topics in pediatrics. This article addresses several clinically relevant issues, including the relationships between apnea and SIDS, the nature of the "terminal event," effectiveness of home monitoring, the role of gastroesophageal reflux in apparent life-threatening events, and the association between the prone sleeping position and SIDS. This article is intended to provide the clinician with an awareness of the issues and the scientific basis needed to understand their contribution to SIDS.

The moderating effects of gender and ethnicity on the relationship between effect expectancies and alcohol problems.

OBJECTIVE: Research has demonstrated that alcohol outcome expectancies moderate the relationship between psychological states such as stress and negative affect and alcohol use. This study examined whether the relationship between expectancies and alcohol problems would be moderated by gender and ethnicity. METHOD: Using a household survey format, personal interviews were conducted with Puerto Rican and Irish American men and women. The final sample consisted of 412 (231 male) Puerto Ricans and 476 (252 male) Irish Americans. Alcohol expectancies were measured with the Effects of Drinking Alcohol Scale. All subjects resided in the New York metropolitan area. The original study was designed to compare the drinking behaviors and alcohol-related beliefs of groups with varied drinking practices and distinct drinking beliefs. RESULTS: Both gender and ethnicity moderated the links between aggressive and self-control expectancies and drinking problems. For example, anticipated loss of control from drinking was more negatively related to Puerto Rican and female alcohol problems than it was to Irish and male problems. CONCLUSIONS: The present findings suggest that whether an outcome expectancy is associated with more alcohol problems depends upon the particular meaning of the outcome. This meaning, in turn, depends upon an individual's particular sociocultural perspective which is associated with such personal characteristics as gender and ethnicity.

The origin of life: self-replicating asymmetrical frozen probability.

Within each of us, as within each living or extinct creature, is a broad piece from the story of life and creation. Both the evolution of the universe and the emergence of life on Earth can be considered as being the result of critical events, such as phase transitions, that occur with a certain probability and are characterized by a sudden breakage of prior symmetry. These in turn result in self-perpetuating conditions that are responsible for what we know and perceive today.

Time reversal in biological systems.

Fundamental physical laws provide us appropriate descriptions of the basic behavior of nature. Science possesses a hierarchical structure with various levels of complexity and organization. This extends from the physics of elementary particles and atomic constituents, to the chemistry of molecules, to the biology of the cell and multicellular levels, up to an individual and beyond. Molecular biology thus has its roots based upon fundamental physical descriptors of macromolecules and chemical reactions. The purpose of this paper is to relate an operation in physics, time reversal symmetry, to the realm of biology. This is done with regard to the process of carcinogenesis. Tumor development and progression can be considered a microcosm of evolution, on the level of an individual organism, as well as from the aspect of evolutionary lineage. The driving forces of selection inherent in malignancy can be considered to result in the emergence of a new biological species, which is characterized by reproductive immortality and a remarkable equivalence with our unicellular ancestors. Thus, by its very nature, carcinogenesis as a closed system conceptually represents a reversal of motion with respect to order, stability and evolutionary standards of time.

Antenatal diagnosis and early surgery for choledochal cyst.

The pathogenesis and optimal treatment of choledochal cyst have long remained questions of considerable speculation and dispute. Because the pregnancy of a 37-year-old woman was felt to be at risk, five antenatal ultrasound examinations were made. The fourth examination at 31.5 weeks of gestation demonstrated a choledochal cyst. Following birth, the child was studied with repeat ultrasound examinations and scintigraphy. The results of these studies plus the findings at surgery contributed new evidence regarding the possible pathogenesis and optimal treatment of choledochal cysts. Although the time at which the cyst originated is compatible with the concept of reflux of pancreatic juice into the common duct, no abnormal junction of the pancreatic and common duct was identified. No evidence of obstruction as part of the pathogenesis could be demonstrated. Progressive changes in the choledochal cyst in the first ten days of life suggested that delay in diagnosis and treatment of a choledochal cyst may contribute to early complications such as cholangitis. Early excision of the cyst in the newborn is considered to be the optimal treatment and may pose less risk to the patient than delayed surgical exploration.

The physical, functional, and developmental outcome of pediatric burn survivors from 1 to 12 months postinjury.

Fifty-one children with an average age of 27 months and who had sustained a burn injury were tested at 1, 6, and 12 months postinjury to determine their physical, functional, and developmental outcomes. Most parents were either African-American or Hispanic, lived on public assistance, and had a high school education or less. Most children had normal range of motion and were appropriate for their age in self-care skills. On the basis of the Home Screening Questionnaire, 48% of the children came from suspect home environments. Developmental delays were noted in language acquisition that persisted over the first year postburn. Although the outcomes of these burn injuries were good in physical and functional areas, the developmental findings raised concerns. The results alert clinicians to screen for potential developmental problems during the burned child's recovery phase and to include appropriate developmental activities and parental guidance in the treatment plan.

Evaluation of cavernous transformation of the portal vein by magnetic resonance imaging.

We describe two children who underwent magnetic resonance imaging (MRI) as part of the evaluation of isolated splenomegaly after Doppler ultrasound was unable to identify the portal vein. The diagnosis of cavernous transformation of the portal vein and the normalcy of the biliary tract and hepatic architecture were confirmed by MRI. Because of the risks associated with computed tomography (CT) and angiographic evaluation of such patients, the use of MRI, a noninvasive modality, in the evaluation of pediatric patients requires further consideration.