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Background: Although aortography has been the long-held "gold standard" for diagnosis of traumatic blunt aortic injury, advances in imaging technology offer less-invasive, more-rapid, and potentially more cost-effective evaluation. The purpose of this study was to review this hospital's experience with the screening and diagnosis of blunt aortic injury with emphasis on the critical evaluation of computed tomography (CT) scans for defining descending thoracic aortic injury., Methods: A retrospective single-center analysis of all patients undergoing aortography to evaluate for blunt aortic injury between January 1, 1997, and August 31, 2004, was performed. A policy of relying on CT scans to definitively diagnose blunt aortic injury was not in force, and all patients with positive, equivocal, and negative screening CT scans with significant injury mechanism underwent subsequent aortography; this contributed to an unbiased analysis. A subgroup of patients imaged with the latest generation multislice CT scanners (July 1, 2003, to August 31, 2004) was separately analyzed with rapid three-dimensional reconstruction., Results: Of 856 aortograms, 206 (24.1%) were preceded by chest CT scan. Of 31 patients with confirmed aortic injury, 20 had undergone CT scan with 16 positive for definite injury, 3 positive for possible injury, and 1 false-negative study. Of the 206 patients scanned, 114 (55.3%) showed possible injury, 76 (36.9%) were negative, and 16 (7.8%) were positive. Only 3 of the 114 with possible injury (2.6%) were true positives whereas 1 of the 76 negative scans (1.3%) was a false negative and all 16 positive scans were true positives. These data for CT scan imaging result in a sensitivity of 95%, a specificity of 40%, a positive predictive value of 15%, and a negative predictive value of 99%., Conclusions: Chest CT is an acceptable screening tool based on prerequisite high sensitivity and ease of performance in the trauma patient suspected of having a descending thoracic aortic injury. Although the excellent negative predictive value resulted in an algorithm change at this institution, there were a significant number of equivocal scans that required subsequent aortography. Three-dimensional software reconstruction of the aorta can aid in diagnosing blunt aortic injury when findings are equivocal, but there will continue to be artifacts and limitations that require aortography for clarification.

The authors report a patient who presented 4 times a systemic urticaria with arthralgias and fever treated by corticosteroids with efficacy. Wild hop (Humulus lupulus) was finally proved to be the causal factor. H.L. belongs to the cannabinaceas family. Hop dermatitis in hop workers population is the main widely described clinical manifestation. Rhinitis, conjunctivitis, asthma are rare as soon as contact urticaria. IgE-anti Hop induced allergies are described in the literature. However, in some cases of reactions to hop the mechanisms are uncertain: toxicity--possible role of lupuline--or immunoallergic processus with immunocomplexes (IC) (with increased IC in serum) and systemic urticaria such as in our observation.

The authors present a case of a Latin American patient with systemic lupus erythematosus who was referred for a mesenteric arteriogram because of acute lower gastrointestinal bleeding. Multiple segments of dilation alternating with stenosis or spasm were noted in the superior mesenteric artery/inferior mesenteric artery distributions. At the time, these irregularities were thought to be representative of lupus vasculitis. Despite appropriate treatment for vasculitis, the patient continued to have bleeding episodes and ultimately died of multiple organ failure. Autopsy demonstrated no evidence of vasculitis, but did demonstrate the unexpected finding of Strongyloides stercoralis hyperinfection with vessel invasion.

Objectives: Profound and growing disparities exist in oral health among certain US populations. We sought here to determine the prevalence of oral health complaints among Harlem adults by measures of social class, as well as their access to oral health care., Methods: A population-based survey of adults in Central Harlem was conducted from 1992 to 1994. Two questions on oral health were included: whether participants had experienced problems with their teeth or gums during the past 12 months and, if so, whether they had seen a dentist., Results: Of 50 health conditions queried about, problems with teeth or gums were the chief complaint among participants (30%). Those more likely to report oral health problems than other participants had annual household incomes of less than $9000 (36%), were unemployed (34%), and lacked health insurance (34%). The privately insured were almost twice as likely to have seen a dentist for oral health problems (87%) than were the uninsured (48%)., Conclusions: There is an urgent need to provide oral health services for adults in Harlem. Integrating oral health into comprehensive primary care is one promising mechanism.

In spite of the direct referral system and family-centered model of primary oral health care linking medical and dental care providers, most HIV-positive patients at the Columbia Presbyterian Medical Center received only emergency and episodic dental care between 1993 and 1998. To improve access to dental care for HIV/AIDS patients, a mobile program, called WE CARE, was developed and colocated in community-based organizations serving HIV-infected people. WE CARE provided preventive, early intervention, and comprehensive oral health services to minorities, low-income women and children, homeless youths, gays and lesbians, transgender individuals, and victims of past abuse. More efforts to colocate dental services with HIV/AIDS care at community-based organizations are urgently needed.

We report a new homozygous CTG-->CCG (Leu-->Pro) mutation at codon 354 in the factor XIIIA gene of a patient suffering from FXIII deficiency. Leu354 lies in a pocket within the core domain of the FXIIIA molecule, with its side chain pointing into the structure of the barrel 1 domain. Replacement of leucine with a proline residue gives rise to steric hindrance between the proline ring and the surrounding residues, and rearrangement of these residues would be necessary for proline to be accommodated at this position. Using PCR-RFLP, we have demonstrated the absence of this mutation from 220 normal alleles. Together, these data suggest that Leu354Pro is likely to be the disease-causing mutation in this factor XIII deficient family.

Background: The concentration of steroid glucuronides in serial samples of early morning urine (EMU) can be used to predict the fertile period in the female menstrual cycle. The monoclonal antibody 4155 has been used as a convenient means of measuring the concentration of steroid glucuronides in EMU, as it specifically recognises the steroid hormone estrone beta-D-glucuronide (E3G), with very high affinity, and the closely related hormone estriol 3-(beta-d-glucuronide) (EI3G), with reduced affinity. Although 4115 binds these hormones with different affinities, EI3G differs from E3G only in the addition of a hydroxyl group and reduction of an adjacent carbonyl. To investigate the structural basis of this fine binding specificity, we have determined the crystal structures of the variable fragment (Fv) of 4155 in complex with each of these hormones., Results: Two crystal forms of the Fv4155-EI3G complex, at resolutions of 2.1 A and 2.5 A, and one form of the Fv4155-E3G complex, at 2.1 A resolution were solved and refined. The crystal structures show the E3G or EI3G antigen lying in an extended cleft, running form the centre of the antibody combining site down one side of the variable domain interface, and formed almost entirely from residues in the heavy chain. The binding cleft lies primarily between the heavy chain complementarity determining regions (CDRs), rather than in the interface between the heavy and light chains. In both complexes the binding of the glucuronic sugar, and rings A and B of the steroid, is specified by the shape of the narrow cleft. Analysis of the Fv structure reveals that five of the six CDR regions can be assigned to one of the predefined canonical structural classes., Conclusions: The difference in the binding affinity of Fv4155 for the two steroid hormones is accounted for by a subtle combination of a less favoured hydrogen-bond geometry, and a minor rearrangement of the water molecule network around the binding site. The rearrangement of water molecules results from the burial of the additional hydroxyl group of the EI3G in a hydrophobic environment.