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We report a patient presenting with hydrocephalus secondary to a posterior third ventricular plasma-cell lesion which exhibited delayed transudation of contrast medium into the adjacent aqueduct and fourth ventricle.

The question of whether to enforce agreements to implant frozen embryos after divorce has become a major concern for the 300 clinics and thousands of couples who use infertility services every year. Although courts in New York and Tennessee support enforcement, recent decisions by appellate courts in Massachusetts and New Jersey have refused to enforce such agreements on the ground that courts should not force people to reproduce. This article analyzes conflicts over enforcement of agreements for disposition of frozen embryos in terms of the precommitment strategies that persons use to plan their lives. It shows that refusal to enforce contracts for frozen embryos is unfair to the parties who relied on them in undertaking invasive infertility treatments, and possibly unconstitutional. It also addresses the extent to which precommitments for rearing rights and duties in resulting children should be enforced, if agreements to implant embryos are recognized.

The clinical use of pharmacogenetic drugs will require that a sample of a patient's DNA be tested before a drug is prescribed. Although pharmacogenetic tests pose fewer risks than genetic tests for disease mutations, they might still reveal personal information that could be used adversely to a patient's interests. Informed consent and privacy of pharmacogenetic test results may be essential in most clinical uses of pharmacogenetic drugs.

We assessed the ability of ICI 182,780 (ICI) to block the estradiol (E2) responses of genes within the sheep uterus. Ovariectomized ewes in the 'ICI+E2' treatment group received a uterine infusion with 10(-7) M ICI for 14 h, an injection of 50 microg E2 6 h after the infusion started, and were hysterectomized 18 h postinjection. Other groups received only ICI or E2, or neither treatment ('Con'). Both E2 and ICI increased the wet weight of dissected endometrium: averaging 10.0+/-1.2 g for ICI+E2, ICI, and E2 groups compared to 6.8+/-0.6 g for Con. Slot blot analyses of endometrial RNA showed that estrogen receptor-alpha (ER), progesterone receptor (PR), glyceraldehyde 3-phosphate dehydrogenase (GAPDH), cyclophilin, actin and c-fos mRNAs responded to E2 treatment: the first five increased an average of 60% while the last decreased 38%. In situ hybridization identified more subtle ICI effects: agonistic up-regulation of GAPDH mRNA in superficial endometrial cells, and antagonistic down-regulation of ER and PR mRNAs in the inner layer of the myometrium. Thus, we conclude that the agonist versus antagonist effects of ICI relative to those of E2 are a function of the gene examined as well as the specific cell within the uterus.

Ureaplasma urealyticum has been associated with urethritis in men, obstetric problems in women, and respiratory distress syndrome in preterm infants. U. urealyticum can be divided into two biovars comprising 14 serovars. Partial sequences of genes encoding the multiple-banded antigens of the cell surface are known. Using a commercially available precast DNA mutation detection gel system, we have developed a simple and reproducible PCR-single-strand conformation polymorphism analysis method for differentiating the biovars of this species that reveals five patterns among the 14 serovars and enables clinical isolates to be typed directly from broth cultures.

Most reports on the effectiveness and side effects of oral versus parenteral calcitriol or alfacalcidol in hemodialysis patients with secondary hyperparathyroidism show no advantage of parenteral treatment. The efficacy and safety of intravenous doxercalciferol (1alphaD(2)) were studied in hemodialysis patients with secondary hyperparathyroidism (plasma intact parathyroid hormone [iPTH]: range, 266 to 3,644 pg/mL; median, 707 pg/mL). These results were compared with those of a previous trial using intermittent oral 1alphaD(2); the same 70 patients were entered onto both trials, and 64 patients completed both trials per protocol. Twelve weeks of open-label treatment in both trials were preceded by identical 8-week washout periods. Degrees of iPTH suppression from baseline were similar in the two trials, with iPTH level reductions less than 50% in 89% and 78% of patients during oral and intravenous treatment, respectively. Grouping patients according to entry iPTH levels (<750 and >/=750 pg/mL) showed similar but more rapid iPTH suppression in the low-iPTH groups, whereas longer treatment and larger doses were required by the high-iPTH groups. Highest serum calcium levels averaged 9.82 +/- 0.14 and 9.67 +/- 0.11 mg/dL during oral and intravenous 1alphaD(2) treatment, respectively (P: = not significant [NS]). Prevalences of serum calcium levels greater than 11.2 mg/dL during oral and intravenous treatment were 3.62% and 0.86% of calcium measurements, respectively (P: < 0.001). Highest serum phosphorus levels during oral and intravenous treatment averaged 5.82 +/- 0.21 and 5.60 +/- 0.21 mg/dL, respectively (P: = NS). The percentage of increments in serum phosphorus levels during oral treatment exceeded that during intravenous treatment during 5 of 12 treatment weeks. Thus, intermittent oral and intravenous therapy with 1alphaD(2) reduced iPTH levels effectively and similarly, hypercalcemia was less frequent, and serum phosphorus levels increased less during intravenous than oral 1alphaD(2) therapy, suggesting that intravenous 1alphaD(2) therapy may be advantageous in patients prone to hypercalcemia or hyperphosphatemia.

The use of human embryonic stem cells to replace damaged cells and tissues promises future hope for the treatment of many diseases. However, many countries now face complex ethical and legal questions as a result of the research needed to develop these cell-replacement therapies. The challenge that must be met is how to permit research on human embryonic tissue to occur while maintaining respect for human life generally.

Hypercalcemia and hyperphosphatemia frequently necessitate vitamin D withdrawal in hemodialysis patients with secondary hyperparathyroidism. In short-term trials, doxercalciferol (1alpha-hydroxyvitamin D(2) [1alphaD(2)]) suppressed intact parathyroid hormone (iPTH) effectively with minimal increases in serum calcium and phosphorus (P) levels. This modified, double-blinded, controlled trial examined the efficacy and safety of 1alphaD(2) use in 138 hemodialysis patients with moderate to severe secondary hyperparathyroidism by using novel dose titration; 99 patients completed the study. Hemodialysis patients with secondary hyperparathyroidism were enrolled onto this study, consisting of washout (8 weeks), open-label 1alphaD(2) treatment (16 weeks), and randomized, double-blinded treatment with 1alphaD(2) or placebo (8 weeks). Oral 1alphaD(2) was administered at each hemodialysis session, with doses titrated to achieve target iPTH levels of 150 to 300 pg/mL. Baseline iPTH levels (897 +/- 52 [SE] pg/mL) decreased by 20% +/- 3.4% by week 1 (P: < 0.001) and by 55% +/- 2.9% at week 16; iPTH levels returned to baseline during placebo treatment but remained suppressed with 1alphaD(2) treatment. In 80% of the patients, iPTH level decreased by 70%, reaching the target level in 83% of the patients. Grouping patients by entry iPTH level (<600, 600 to 1,200, and >1,200 pg/mL) showed rapid iPTH suppression in the group with the lowest level; greater doses and longer treatment were required in the group with the highest level. During open-label treatment, serum calcium and P levels were 9.2 +/- 0.84 (SD) to 9.7 +/- 1.05 mg/dL and 5.4 +/- 1.10 to 5.9 +/- 1.55 mg/dL, respectively. During double-blinded treatment, serum calcium levels were slightly greater with 1alphaD(2) than placebo, but P levels did not differ. During double-blinded treatment, 3.26% and 0.46% of serum calcium measurements exceeded 11.2 mg/dL with 1alphaD(2) and placebo, respectively (P: < 0.01); median level was 11.6 mg/dL during hypercalcemia. Intermittent oral 1alphaD(2) therapy effectively suppresses iPTH in hemodialysis patients with secondary hyperparathyroidism, with acceptable mild hypercalcemia and hyperphosphatemia.

Research that identifies genes useful in the prevention and treatment of disease will require access to biologic samples and medical records protected by traditional notions of privacy and confidentiality. Resolving conflicts between privacy and genomic research will require articulating the ethical rules that should govern such practices and then implementing those rules in the national, regional, or local health systems in which the data of interest exists. As consensus develops about the ethical rules that should govern such research, attention will shift to the practical and political problems of installing and implementing those rules in the agencies and institutions where such research will occur.

Embryonic stem cells, which have the potential to save many lives, must be recovered from aborted fetuses or live embyros. Although tissue from aborted fetuses can be used without moral complicity in the underlying abortion, obtaining stem cells from embryos necessarily kills them, thus raising difficult questions about the use of embryonic human material to save others. This article draws on previous controversies over embryo research and distinctions between intrinsic and symbolic moral status to analyze these issues. It argues that stem cell research with spare embryos produced during infertility treatment, or even embryos created specifically for research or therapeutic purposes, is ethically acceptable and should receive federal funding.

The effects of heat treatment and dehydration on fiber structure and hydration properties, using cauliflower floret/curd and stem tissues, have been investigated. No major changes in fiber composition resulted from sample treatments, but the degree of esterification of pectic polysaccharides, approximately 60% in fresh cauliflower, decreased by approximately 12% in samples heated at temperatures >40 degrees C. Enzymic activity was considered to be responsible, through pectin methyl esterase activity. De-esterification was temperature and moisture sensitive. Hydration properties were also affected by processing conditions. The solubility of nonstarch polysaccharides in fresh, freeze-dried, and 40 degrees C dried samples was approximately 6% but increased to 12% in boiled samples and decreased in samples dried at 75 degrees C. Similar behavior occurred for swelling and water retention capacity (WRC), with swelling and WRC highest for boiled samples and lowest for samples dried at 75 degrees C. Hence, a decrease in de-esterification was not directly responsible for changes in hydration properties. The results demonstrate the importance of processing history on functional properties and on the preparation of fiber-rich ingredients for successful incorporation into foods.

Fermentation of fiber can lead to an enhanced production of short chain fatty acids (SCFA) and, hence, contribute to the proposed anticarcinogenic properties of butyrate in the colon. The fermentation of fiber isolates and the corresponding ileal effluents has been compared under in vitro conditions. Yield of SCFA per gram of substrate fermented was similar for isolates and fiber-enriched effluents (approximately 4.9 mmol/g) and it could be inferred that nonfiber components of effluent also generated SCFA. Butyrate production was highest for glucan-based polymers (approximately 30% total SCFA) and, from the measured acidogenic profile, production of SCFA will occur mainly in the proximal colon. The buffering capacity of ileal effluents during fermentation restrict the potential for a reduction in pH during acidogenesis compared to fiber isolates. This buffering capacity could limit the bioavailability of butyrate in the colon and, hence, the ability to satisfy the proposed antineoplastic properties of butyrate in the colon.

Tamoxifen, the antiestrogen most widely used in medicine, was tested in ewes to determine whether it antagonizes oestradiol up-regulation of ER, PR, and other genes reported to be oestrogen-modulated (c-fos, oxytocin receptor (OTR), glyceraldehyde phosphate dehydrogenase (GAPDH), and apolipoprotein AI (apo AI)) in endometrium and liver. Ovariectomized ewes (n = 6 ewes per group) were injected with 20 mg tamoxifen (Tam) 24 h prior to tissue collection, 50 microg oestradiol (E2) 18 h prior to tissue collection, both drugs (T + E2) or drug vehicle (Con). E2 treatment resulted in 857 +/- 93 pg oestradiol/g endometrium. Gross uterine characteristics of Tam- and T + E2-treated ewes were intermediate to those in Con and E2 groups. In endometrium, Tam treatment mimicked E2 treatment in up-regulating ER, c-fos, and GAPDH mRNAs two- or three-fold. However, neither E2 nor Tam treatments affected concentrations of OTR mRNA in endometrium, or ER, c-fos, GAPDH, OTR and apo AI mRNAs in liver. Like oestradiol, tamoxifen stabilized endometrial ER mRNA more than 3-fold in endometrial explants cultured with the transcription inhibitor 5,6-dichloro-1-beta-D-ribofuranosylbenzimidazole (DRB). Thus, tamoxifen acts as an oestradiol agonist in ovine endometrium and shares a posttranscriptional mechanism with oestradiol in the up-regulation of ER gene expression.

Pectic substances are a major component of cell walls in vegetable plants and have an important influence on plant food texture. Cauliflower (Brassica oleracea L. var. botrytis) stem sections at different regions of the mature plant stem have been monitored for tissue-related changes in the native pectic polysaccharides. Chemical analysis detected appreciable differences in the degree of methyl-esterification (ME) of pectic polysaccharides. About 65% of galacturonic acid (GalpA) residues were methyl-esterified in floret tissues. Relative ME showed a basipetal decrease, from 94% in the upper stem to 51% in the lower-stem vascular tissues. The decrease was not related to a basipetal increase in glucuronic acid (GlcpA) residues. The monoclonal antibodies, JIM 5 and JIM 7, produced distinct labelling patterns for the relatively low-methylesterified and high-methyl-esterified pectin epitopes, respectively. Labelling was related to cell type and tissue location in the stem. Floret cell walls contained epitopes for both JIM 5 and JIM 7 throughout the wall. Stem vascular tissues labelled more strongly with JIM 5. Whereas pith parenchyma in the upper stem labelled more strongly with JIM 7, in the lower-stem pith parenchyma, JIM 5 labelling predominated. Localization of pectic polysaccharide epitopes in cell walls provides an insight into how structural modifications might relate to the textural and nutritional properties of cell walls.

We produced a monoclonal antibody (MAb) to Ureaplasma urealyticum Vancouver, the serotype 9 standard strain. By immunoblotting, this MAb showed a single, 85-kDa band with the homologous serotype and a minor, 100-kDa band with serotype 2 but did not react with any other serotype standard strain. Clinical isolates of U. urealyticum were tested with this MAb and with two sets of polyclonal antisera against the 14 serotype standard strains. The use of MAb 9-2H9 correctly identified certain serotype 9 strains but did not react with wild-type strains lacking the serotype 9 determinant.

Authors argue that risk-of-failure insurance for IVF, a form of contingent fee, may be ethically offered to patients if there is a full explanation of program details and advantages and disadvantages for patients.

The behaviour of barley beta-glucans in the upper gut has been assessed using ileal effluents recovered from a barley-based test meal. Results have been compared to in vitro treatments used to extract beta-glucans. In vitro, exposure to endogenous proteases led to a solubilisation of beta-glucan, ranging from 28% in the untreated to 83% following NSP isolation. In ileal effluent 60% of the beta-glucan was solubilised, similar to the in vitro treatment. However, the viscosity of the ileal effluent was low, comparable to a mucin standard. Although beta-glucan can be solubilised in the upper gut its viscosity would appear to have only a limited potential to affect nutrient bioavailability.

Binding capacities and affinities of dietary fibres and fermented fibre residues for MeIQx are much higher for brans than for fruit and vegetable fibres. Bran residues concentrated distally in the colon would provide a substantial binding matrix. Small intestinal conditions are not so conducive to hydrophobic adsorption.

We describe the first documented case of Mycoplasma felis infection in a woman who had common variable immunodeficiency and who presented with septic arthritis of the left hip and right knee. M. felis was isolated from both joints. She had been exposed to cats before the diagnosis of M. felis septic arthritis was made. Both of the patient's joints were surgically debrided, and she was treated with doxycycline for several months. In spite of initial improvement, destruction of her hip was noted. Subsequently, she underwent hip arthroplasty; histopathological examination of the bone at the time of surgery showed chronic osteomyelitis, and doxycycline therapy was continued.

Ureaplasma gallorale is a urease-containing mycoplasma (a member of the Mollicutes) which is pathogenic for chickens, from which it was originally isolated. We amplified the 16S rRNA gene of this bacterium and then cloned and sequenced the amplicon. A phylogenetic analysis based on an alignment of the 16S rRNA sequences of U. gallorale and several other Ureaplasma species revealed that U. gallorale is more closely related to Ureaplasma urealyticum than to other Ureaplasma species.

The effects of pH and of the bile salts, sodium cholate, chenodeoxycholate, taurocholate, deoxycholate and glycodeoxycholate on the adsorption of the heterocyclic aromatic amine mutagen and carcinogen 2-amino-3,8-dimethylimidazo[4,5-f]-quinoxaline (MeIQx) onto wheat bran cell wall material have been examined. The highest binding affinity of MeIQx for bran was at pH 5.5. Binding affinity declined more rapidly with pH > 5.5 than with pH < 5.5. Bile salts in solution did not appreciably affect the binding of MeIQx to bran, but where the bile salts formed a suspension then the adsorption was reduced. Where precipitation of bile salts occurred then the free concentration of MeIQx was also reduced, indicating that MeIQx binding/immobilization could be enhanced through interaction with bile salts.

Objective: To identify main ethical and legal issues that arise with donation of embryos left over from IVF treatments of infertility or created from separate gamete donations., Design: Analysis of ethical commentary, advisory committee reports, statutes, court cases, and legal commentary relating to gamete and embryo donation and assisted reproduction to assess their effect on donation of created or leftover embryos., Results: Donation of surplus embryos or embryos created from separate gamete donations would help a subset of infertile couples to form families. A program undertaking embryo donation will have to coordinate the donation of embryos from its own patients or other programs or arrange for separate gamete donations to form embryos. The main ethical issues concern the effect on offspring, consent and counseling of donors and recipients, avoidance of mixing embryos or gametes from different sources, and payment of donor expenses. The main legal issues concern whether embryo donation is viewed as gamete donation or adoption; the rearing rights and duties of donors and recipients in resulting offspring; liability; and compensation issues; and the legality of monetary compensation for donors. Donation of embryos for research raises separate issues., Conclusion: Human embryo donation is an ethically and legally acceptable way for infertile couples to form families.

Fruits and vegetables provide dietary fibre some of which is partly soluble in the upper gut; in the colon it is highly fermentable. Using alcohol-insoluble residues prepared from a range of fruits and vegetables the effects of fermentation on the changes in composition and binding capacity have been assessed for the hydrophobic mutagen 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx). Fermentation was extensive and resulted in destruction of most of the pectic polysaccharides. Of the unfermented vegetable fibre only cabbage had a measurable hydrophobic binding capacity. The binding capacities of unfermented apple, carrot and sugar beet were negligible. After fermentation, binding capacities, (per mg of fermented residue), increased. Although fermented cabbage was found to have the highest capacity of the fruit and vegetable fibres this remained less than the least effective of unfermented wheat bran samples which had a relatively high affinity for MeIQx. Mucin inhibited the binding of MeIQx to wheat bran fibre but apple fibre did not. The results show that the contribution of fruit and vegetable fibre to a hydrophobic binding matrix in the colon is insignificant and the suggested harmful effect of fruit and vegetable fibre, maintaining hydrophobic mutagens in solution, can be prevented by the presence of wheat bran fibre.

The macro-restriction map of Mycoplasma fermentans (incognitus strain) was constructed and its rRNA genes were located on the map. It was found that this organism contains two sets of rRNA genes. The 16S and 23S rRNA genes were closely linked as two clusters. However, both 5S rRNA genes were separated from the 16S and 23S genes. The two 16S-23S rRNA gene clusters were arranged in an unusual tail to tail orientation.

Preparations of dietary fibre have an ability to bind potentially toxic compounds in vitro, but it is unclear how the measured binding properties are a reflection of either the relative affinity of such compounds for fibre or the saturation binding capacity of the fibre. Cooking and processing of foods and fermentation activity in the colon can result in significant modification of the structure of the fibre matrix. Hence, binding properties measured in vitro may be significantly altered from those at the proposed site of fibre activity. Using cell wall material (CWM) prepared from three distinct wheat fibre sources, the effects of fermentation have been monitored and the consequences on the binding properties assessed. The CWM preparations were feremented for either 0, 6, 18 or 24 h in vitro, using a human faecal inoculum. The coarse bran CWM was also subjected to a simulated gastric treatment. Fermentation resulted in a loss of material from each CWM preparation, the loss being consistent with the bran source, and the maximum extent of fermentation was reached within 18 h. The in vitro binding of the mutagen 2-amino-3,8- dimethylimidazo[4,5-f]quinoxaline (MeIQx) to the unfermented and fermented fibre fractions showed fine bran CWM had a much higher affinity for MeIQx than coarse bran. A 6 h fermentation had little effect on the binding affinity to fine bran, but the affinity for coarse bran became similar to that of the fine bran. Further fermentation for 18 h or 24 h resulted in a further slight increase in the binding affinity for coarse and fine bran, but, more significantly, the binding capacity of each was increased. The binding properties of the beeswing bran were not significantly affected by fermentation. Wheat bran has the potential to bind hydrophobic mutagens in the diet and this potential can be enhanced after fermentation under colonic conditions.