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Background & Aims: Abdominal bloating is a frequent symptom in various categories of patients; however, its origin is unclear. Our aim was to establish the mechanisms of abdominal bloating., Methods: The study evaluated 56 patients whose predominant symptom was abdominal bloating. Of these, 47 (44 female and 3 male; aged 19-74 years) were diagnosed with functional intestinal disorder by Rome II criteria and 9 (7 female and 2 male; aged 18-64 years) were diagnosed with intestinal dysmotility by gastrointestinal manometry. Computed tomographic scans were obtained before (basal level) and during a severe bloating episode. Control scans were also obtained from 12 healthy subjects (11 female and 1 male; aged 19-62 years). Morpho-volumetric differences between basal and severe bloating scans were measured using an original computer analysis program., Results: During severe bloating, patients with dysmotility exhibited anterior wall protrusion (23 +/- 4 mm; P < .001 vs basal) associated with a marked increase in total abdominal volume (1.4 +/- 0.3 L; P = .002 vs basal) and with cephalic displacement of the diaphragm. By contrast, in patients with functional intestinal disorder, total abdominal volume barely increased (0.3 +/- 0.1 L; P < .001 vs dysmotility); in these patients, abdominal distention (14 +/- 2 mm anterior wall protrusion; P < .001 vs basal) was related to diaphragmatic descent (-12 +/- 3 mm; R = -0.62; P < .001)., Conclusions: Abdominal distention might be caused by an increase in intra-abdominal volume or abdomino-phrenic displacement and ventro-caudal redistribution of contents.

In non-neuronal cells, inactivation of protein kinase D (PKD) blocks fission of trans-Golgi network (TGN) transport carriers, inducing the appearance of long tubules filled with cargo. We now report on the function of PKD1 in neuronal protein trafficking. In cultured hippocampal pyramidal cells, the transferrin receptor (TfR) and the low-density receptor-related protein (LRP) are predominantly transported to dendrites and excluded from axons. Expression of kinase-inactive PKD1 or its depletion by RNA interference treatment dramatically and selectively alter the intracellular trafficking and membrane delivery of TfR- and LRP-containing vesicles, without inhibiting exit from the TGN or inducing Golgi tubulation. After PKD1 suppression, dendritic membrane proteins are mispackaged into carriers that transport VAMP2; these vesicles are distributed to both axons and dendrites, but are rapidly endocytosed from dendrites and preferentially delivered to the axonal membrane. A kinase-defective mutant of PKD1 lacking the ability to bind diacylglycerol and hence its Golgi localization does not cause missorting of TfR or LRP. These results suggest that in neurons PKD1 regulates TGN-derived sorting of dendritic proteins and hence has a role in neuronal polarity.

Background: It is unknown if abdominal bloating is attributable to excess abdominal gas or improved by a prokinetic agent., Aims: To assess abdominal gas content in functional abdominal bloating and to ascertain the effect of a prokinetic agent on intestinal gas symptoms in these patients., Methods: In 20 patients, intra-abdominal gas content and symptoms were quantified before and during treatment with pyridostigmine (30 mg/8 hp. o) in this randomized, placebo-controlled, double-blind study. Daily symptoms were quantified for 5 days before and 10 days during treatment, and abdominal gas volume was quantified by CT imaging before and at the fourth day of treatment. A CT scan was also obtained in 10 healthy subjects., Results: Before treatment, the total volume of intestinal gas was similar in patients (112 +/- 18 mL) and in healthy controls (116 +/- 20 mL). The treatment-induced change in total and regional intestinal gas volume was not significantly different between pyridostigmine (-4 +/- 18 mL; mean +/- SEM) and placebo (0 +/- 15 mL). However, pyridostigmine reduced the severity of bloating from 3.3 +/- 0.3 to 2.6 +/- 0.4 (P < 0.05), whereas placebo did not (3.2 +/- 0.3 vs 3.0 +/- 0.4), although the change did not reach statistical difference across groups., Conclusion: In patients complaining of functional bloating, the volume and distribution of intestinal gas, measured on nonselected days, is comparable to asymptomatic subjects. Prokinetic stimulation improves bloating sensation without detectable changes in gas content.

Krukenberg's tumor refers to unilateral or bilateral ovarian metastatic tumors whose origin may be known or unknown. The incidence of this type of tumor is difficult to evaluate but may represent between 3% and 8% of ovarian tumors. In most cases, the primary tumor is identified and is usually digestive (basically gastric or colorectal). There are some references to primary hepatic tumors (gall bladder tumor and hepatocarcinoma) but none to fibrolamellar hepatocarcinoma as the primary tumor. We present the case of a 45-year-old woman who presented with lower hemiabdominal pain and who was diagnosed with Krukenberg's tumor of hepatic origin. Although ovarian involvement in primary digestive tumors is possible, hepatic origin is rare.

Introduction: Arterial hypertension and aging are the main cardiovascular risk factors (CVRF) in the elderly population. Aging is associated with an increase in systolic blood pressure (SBP) levels and a decrease of diastolic blood pressure (DBP), due to increased large artery stiffness. Several epidemiological studies have demonstrated that pulse pressure (PP) is an independent risk factor, better than SBP, for overall, cardiovascular mortality, coronary heart disease and cerebrovascular, particularly in the elderly., Objectives: To determine the association of PP with clinical cardiovascular damage, in a population-based sample of Spanish elders subjects. To quantify the association between PP and the background of clinical cardiovascular damage. To determine which PP, SBP, DBP or mean arterial pressure (MAP) are better associated to the history of clinical cardiovascular damage., Patients and Methods: The sample analyzed included individuals from the EPICARDIAN study in the areas of Lista district (Madrid) and Arévalo (Avila). The following CVRF of age, gender, hypertension, diabetes, dyslipidemia, obesity, abdominal obesity and smoking were considered. Clinical cardiovascular damage is defined as the personal background of stroke, myocardial infarction, angina pectoris and/or intermittent claudication., Results: The sample included 2665 individuals, 56% women, mean age: 74 year-old; 74.3% were hypertensive, 55.6% had central obesity and 31.9% hypercholesterolemia. In the multivariate analysis, the PP was the BP parameter associated most to stroke, angina pectoris and intermittent claudication: OR, 1.015, (95% CI: 1.001-1.030), 1.029 (95% CI: 1.006-1.052) and 1.012 (95% CI: 1.002-1.023), respectively., Conclusions: In the elderly population studied, an elevated PP is the component of arterial pressure with the greatest association to the background of cardiovascular damage.

Background and Aims: Patients frequently complain of gas symptoms precipitated by meals, but the effect of early digestion on intestinal gas content remains unknown. Our aim was to determine the influence of meals on intestinal gas volume and distribution., Methods: First, we developed a CT image analysis program, based on independent software modules, to measure gas content within the gut. The system was validated in nine healthy subjects by taking helical abdominal CT scans before and after rectal infusion of known volumes of air (100-400 mL). In 15 healthy subjects, intestinal gas distribution was measured in fast and early postcibal CT scans. The postcibal scan was taken 99 +/- 22 minutes after a 597 +/- 57 kcal meal., Results: The volume of gas infused per rectum was detected with an accuracy of 100.4 +/- 3.0%. During fasting, intestinal gas volume was 94 +/- 7 mL (excluding two extreme outliers). After the meal, gas content within the gut increased by 64.7% (up to 149 +/- 21 mL, P < 0.01 vs fast) and the increment occurred in the colon (59 +/- 9 mL precibal vs 121 +/- 20 mL postcibal, P < 0.001), while other gut compartments remained unchanged., Conclusion: Ingestion of a meal activated gas metabolism and increased gas content within the gut. The increment occurred early, presumably prior to colonic fermentation of food substrates and was localized in the distal gut, suggesting that gas had a proximal origin and was propelled caudally.

Aim: The aim of this study is to present our experience with two cases of hepatic angiomyolioma in hepatitis C virus (HCV) positive patients, and to up-date the clinical manage, diagnostic and treatment of this entity., Clinical Observations: Both cases were presented in women in their 4-5th decade of life. Clinical presentation was with symptoms in one but incidental in the other. Both were HCV positive. Values of alpha-fetoprotein were normal. Radiological imaging was not diagnostic. Histopathological examination and immunohistochemical findings gave the diagnosis of angiomyolipoma. At time of diagnosis the size of tumours was 4.8 and 8 cm of diameter. Both cases were treated with surgery in order to definetly rule out malignancy. After 6 and 3 years of follow-up, there is no evidence of recurrence., Discussion and Conclusion: The hepatic angiomyolipoma is a rare benign tumour, mimicking other liver tumours. Although no patognomonic features, there are some radiological findings that point out to the diagnosis of angiomy olipoma. Nevertheless, definitive diagnosis is done by his tological and immunohistochemical findings (HMB-45). The hepatic angiomyolipoma consists of varing proportion of three elements, mature fat cells, smooth muscle cells and blood vessels. Although it is a benign tumour, the difficulty in ruling out malignancy, prompted surgical management. It is not described its relation with HCV virus, thus we consider our cases as an coincident finding.

How a neuron becomes polarized remains largely unknown. Results obtained with a function-blocking antibody and an siRNA targeting the insulin-like growth factor-1 (IGF-1) receptor suggest that an essential step in the establishment of hippocampal neuronal polarity and the initiation of axonal outgrowth is the activation of the phosphatidylinositol 3-kinase (PI3k)-Cdc42 pathway by the IGF-1 receptor, but not by the TrkA or TrkB receptors.

Exocytotic incorporation of plasmalemmal precursor vesicles (PPVs) into the cell surface is necessary for axonal outgrowth and is known to occur mainly at the nerve growth cone. We have demonstrated recently that plasmalemmal expansion is regulated at the growth cone by IGF-1, but not by BDNF, in a manner that is quasi independent of the neuron's perikaryon. To begin elucidating the signaling pathway by which exocytosis of the plasmalemmal precursor is regulated, we studied activation of the IRS/PI3K/Akt pathway in isolated growth cones and hippocampal neurons in culture stimulated with IGF-1 or BDNF. Our results show that IGF-1, but not BDNF, significantly and rapidly stimulates IRS/PI3K/Akt and membrane expansion. Inhibition of PI3K with Wortmannin or LY294002 blocked IGF-1-stimulated plasmalemmal expansion at the growth cones of cultured neurons. Finally, our results show that, upon stimulation with IGF-1, most active PI3K becomes associated with distal microtubules in the proximal or central domain of the growth cone. Taken together, our results suggest a critical role for IGF-1 and the IRS/PI3K/Akt pathway in the process of membrane assembly at the axonal growth cone.

In this study, we examined the subcellular distribution and functions of LIMK1 in developing neurons. Confocal microscopy, subcellular fractionation, and expression of several epitope-tagged LIMK1 constructs revealed that LIMK1 is enriched in the Golgi apparatus and growth cones, with the LIM domain required for Golgi localization and the PDZ domain for its presence at neuritic tips. Overexpression of wild-type LIMK1 suppresses the formation of trans-Golgi derived tubules, and prevents cytochalasin D-induced Golgi fragmentation, whereas that of a kinase-defective mutant has the opposite effect. Transfection of wild-type LIMK1 accelerates axon formation and enhances the accumulation of Par3/Par6, insulin-like growth factor (IGF)1 receptors, and neural cell adhesion molecule (NCAM) at growth cones, while inhibiting the Golgi export of synaptophysin-containing vesicles. These effects were dependent on the Golgi localization of LIMK1, paralleled by an increase in cofilin phosphorylation and phalloidin staining in the region of the Golgi apparatus, and prevented by coexpression of constitutive active cofilin. The long-term overexpression of LIMK1 produces growth cone collapse and axon retraction, an effect that is dependent on its growth cone localization. Together, our results suggest an important role for LIMK1 in axon formation that is related with its ability to regulate Golgi dynamics, membrane traffic, and actin cytoskeletal organization.

Aims: The purpose of this work was to study the characteristics of the behavioural disorders (non-cognitive or neuropsychiatric symptoms) presented by subjects with Alzheimer's disease from a sample of the population together with their relation to the cognitive and functional impairment suffered by these patients., Patients and Methods: NEDICES is a longitudinal populational study based on the census of neurological diseases in subjects above the age of 64. In 2001, a study was conducted of the situation of 83 subjects who had started suffering from Alzheimer's disease between 1994 and 1997. Due to death and a number of other reasons, only 32 of them could be examined. Patients were administered a structured interview with scales referring to the cognitive state, functional capacity, severity of the dementia and the presence and severity of neuropsychiatric disorders., Results: All the patients studied presented some non-cognitive symptom. Apathy was the most frequent (93.8%), followed by irritability (81.1%), anxiety (75.0%), dysphoria (71.8%) and agitation-aggressiveness (56.2%). The least frequent were deliria (50.2%), altered nocturnal behaviour and aberrant motor activity (37.6%), altered appetite and eating, and hallucinations (24.9%), disinhibition (21.8%) and euphoria (21.6%). The degree of cognitive impairment and the presence of non-cognitive symptoms exerted a similar and independent effect on functional capacity. Only 56.3% of the patients were treated with some kind of anticholinesterase or psychotropic medication., Conclusions: Our census-based populational study confirmed the high prevalence rate of non-cognitive symptoms in patients with Alzheimer's disease. These data confirm the notion that these symptoms are intrinsic manifestations of the disease.

Background/aims: Congenital portosystemic shunts are rare abnormalities of liver vasculature that can cause neurological symptoms, probably secondarily to the effects of the metabolism of ammonia in the brain. Our aim was to investigate the relationship between capillary blood ammonia after oral glutamine challenge and magnetic resonance spectroscopy in three patients with congenital portosystemic shunts., Methods: Neuropsychological tests, oral glutamine challenge and magnetic resonance spectroscopy were performed at baseline and after 6 months of follow-up in three patients with congenital portosystemic shunts. The results were compared to those obtained in a group of six cirrhotic patients with prior episodes of hepatic encephalopathy and healthy controls., Results: Patients with congenital portosystemic shunts exhibited abnormalities of neuropsychological tests, magnetic resonance spectroscopy and a response to the oral glutamine challenge similar to those observed in patients with cirrhosis. The intensity of the rise of brain glutamine was correlated to the area under the curve of ammonia after the oral glutamine challenge (R=0.72)., Conclusions: Neurological manifestations of patients with congenital portosystemic shunts are mediated through similar mechanisms that are involved in the pathogenesis of hepatic encephalopathy. The area under the curve appears to be the better parameter that defines the response to the oral glutamine challenge.

Background: Despite a greater incidence of ischemic heart disease among individuals over age 65, most cardiovascular research has been focused on the middle-aged adult population. To date no cohort study on this population have been made in Spain. This study is aimed as reviewing the role and methodology of cohort studies as an epidemiological tool absolutely essential for researching the prevalence and incidence of angina, AMI, stroke and the major cardiovascular risk factors., Methods: Cohort study in three areas of Spain (Lista district in Madrid), Arevalo (Avila) and Begonte (Lugo). Age and sex stratified random sample by based on the municipal censuses of each area and municipality (n = 5.079). Two-stage initial cohort assessment: home survey structured for the screening ischemic heart disease and classic risk factors (hypertension, dyslipemia, diabetes and smoking habit) and clinical assessment for case confirmation. In the follow-up phase the MONICA project "cold pursuit" method modified for pinpointing and investigating indicent cases was used, employing all of the hospital and primary care clinical records for confirming the cardiovascular event. Data was also requested from the Spanish National Institute of Statistics as to the cause and date of death of the deceased individuals in the cohort., Results: The overall AMI prevalence was 4% (95% CI: 3.4%, 4.5%); definite plus probable AMI being 6.2% (95% CI: 5.5-6.9). The definite AMI prevalence was higher among the mean 6.7% (95% CI: 5.63-7.79) than among the women, 2% (95% CI: 1.51-2.55) (p < 0.001). Hypertension prevalence according to JNCV1 criteria was 68%, hypercholesterolemia 26.4% according to NCEP criteria, diabetes prevalence 13.4% according to WHO criteria, and 11.3% were smokers. The cumulative incidence for a 3.2-year period for nonfatal definite AMI was 1.4% (95% CI: 1.1-1.8); 1.1% (95% CI: 0.74-1.37) probable AMI: 1.17 (IC95%: 0.824-1.48) for fatal definite AMI or death due to AMI and 1.13% (IC 95%: 0.824-1.48) for sudden death., Conclusions: The elderly population included in this study shows a high prevalence of cardiovascular risk factors, as well as ischemic heart disease incidence rates three times higher than those of the middle-aged adult population in Spain. The risk profile for women is significantly worse than for men, which may be due to the higher death rate at earlier ages among men.

Aortic stenosis, or narrowing of the aortic lumen, has many causes. It may originate in coarctation or pseudocoarctation of the aorta, midaortic dysplastic syndrome, atherosclerosis, Takayasu arteritis, aortic dissection, or various intraaortic and periaortic diseases or as a result of aortic surgical repair. The impedance of blood flow through the stenotic segment may lead to the development of various collateral arterial pathways, according to the location of stenosis. Aortography is the standard technique for evaluating aortic stenosis; however, helical computed tomography (CT), particularly multisection CT, may provide additional information or in some cases may be used instead of arteriography. Multisection CT can depict the aorta and thoracoabdominal collateral pathways in less than 1 minute and provide high-quality arterial-phase imaging data suitable for multiple two-dimensional and three-dimensional reformations. To produce a useful differential diagnosis, the imaging specialist must be able to recognize the type of stenosis and the configuration of collateral circulatory pathways., (Copyright RSNA, 2003)

A 41-year-old woman with end-stage renal insufficiency in peritoneal dialysis for 3 years received a kidney transplant under anesthesia with remifentanil, propofol, and cisatracurium. She had a history of hypertension and was being treated with enalapril, metoprolol and erythropoietin. After anesthetic induction, blood pressure fell significantly and surgery was performed in a context of hemodynamic stability. The postoperative course was good, with a functional graft and adequate diuresis from the start. Anesthetics with minimal residual effects and as little renal toxicity as possible are ideal for use in kidney transplantation. The drugs used in this case had pharmacokinetic and pharmacodynamic properties that make them particularly appropriate for such patients.

Exocytotic incorporation of plasmalemmal precursor vesicles (PPVs) into the cell surface is necessary for neurite extension and is known to occur mainly at the growth cone. This report examines whether this is a regulated event controlled by growth factors. The Golgi complex and nascent PPVs of hippocampal neurons in culture were pulse-labeled with fluorescent ceramide. We studied the dynamics of labeled PPVs upon arrival at the axonal growth cone. In controls and cultures stimulated with brain-derived neurotrophic factor (BDNF), PPV clusters persisted in growth cones with a half-life (t(1/2)) of >14 minutes. Upon challenge with IGF-1, however, fluorescent elements cleared from the growth cones with a t(1/2) of only 6 minutes. Plasmalemmal expansion was measured directly as externalization of membrane glycoconjugates in resealed growth cone particles (GCPs) isolated from fetal forebrain. These assays demonstrated that membrane expansion could be stimulated by IGF-1 in a dose-dependent manner but not by BDNF, even though intact, functional BDNF receptor was present on GCPs. Because both BDNF and IGF-1 are known to enhance neurite growth, but BDNF did not stimulate membrane expansion at the growth cone, we studied the effect of BDNF on the IGF-1 receptor. BDNF was found to cause the translocation of the growth-cone-specific IGF-1 receptor subunit beta(gc) to the distal axon, in a KIF2-dependent manner. We conclude that IGF-1 stimulates axonal assembly at the growth cone, and that this occurs via regulated exocytosis of PPVs. This mechanism is affected by BDNF only indirectly, by regulation of the beta(gc) level at the growth cone.

We show here that an active Cdk5-p35 kinase is present in Golgi membranes, where it associates with a detergent-insoluble fraction containing actin. In addition, Cdk5-p35-dependent phosphorylation of alpha-PAK immunoreactive protein species was detected in Golgi membranes, as well as an interaction with the small GTPase, Cdc42. Moreover, antisense oligonucleotide suppression of Cdk5 or p35 in young cultured neurons, as well as inhibition of Cdk5 activity with olomoucine, blocks the formation of membrane vesicles from the Golgi apparatus. Taken together, these results show a novel subcellular localization of this kinase and suggest a role for Cdk5-p35 in membrane traffic during neuronal process outgrowth.

Magnetic resonance spectroscopy allows the assessment of several metabolites in brain tissue. In patients with hepatic encephalopathy, this technique shows a rise in glutamine and a decrease in myoinositol in brain tissue. However, the role of magnetic resonance spectroscopy in the diagnosis of hepatic encephalopathy is not known. We report the case of a patient with a relapsing confusional syndrome who underwent magnetic resonance spectroscopy. Previously, hepatic encephalopathy was ruled out because of the negative results of a transjugular liver biopsy and normal hepatic venous pressure gradient. The results of magnetic resonance were characteristic of hepatic encephalopathy. Abdominal computed tomography demonstrated large portosystemic shunts associated with cirrhosis of the liver. This case shows that magnetic resonance spectroscopy is an useful technique for the diagnosis of hepatic encephalopathy in selected cases, such as those without clinical signs of cirrhosis and/or large portosystemic shunts.

Over a 5-year period, 346 helical computed tomographic (CT) studies were performed in renal transplant recipients. Helical CT proved useful in this context by depicting parenchymal, perirenal, renal sinus, pyeloureteral, and vascular complications in great detail. CT often delineates fluid collections and their anatomic relationship to adjacent structures better than ultrasonography (US), particularly in obese patients. CT-guided puncture and drainage can be performed in cases in which US is deemed inadequate. CT angiography can depict arterial diseases such as stenosis, thrombosis, arteriovenous fistulas, aneurysms, and pseudoaneurysms in the graft artery and in the recipient iliac arterial system, thereby obviating conventional angiography in some cases. Helical CT with three-dimensional image reformatting allows accurate imaging of the entire course of ureteral and periureteral diseases (eg, hydronephrosis, ureteral leak and stricture, pyeloureteral obstruction). CT can be used in the confirmation and staging of malignancies of the renal parenchyma and urothelium. It is also helpful in evaluating associated disease in the native kidneys, acute and chronic rejection, graft embolization, and end-stage disease. Although US and nuclear medicine examination are the imaging modalities of choice in renal transplantation, helical CT is a valuable alternative when these techniques are inconclusive.

Orthotopic liver transplantation has become the treatment of choice for patients with end-stage nonmalignant liver disease. The surgical techniques and immunosuppressive therapy for this procedure have improved considerably. Nevertheless, there are still significant complications, particularly those of vascular origin, which can lead to graft failure and require retransplantation unless prompt treatment is instituted. These complications include arterial and venous thrombosis and stenosis; arterial pseudoaneurysm; biliary leakage, stricture, and obstruction; liver ischemia, infarction, and abscess; fluid collections and hematomas; lymphoproliferative disorders; recurrent tumors; hepatitis C virus infection; and splenic infarction. Since the clinical presentation of posttransplantation complications is frequently nonspecific and varies widely, imaging studies are critical for early diagnosis. Helical computed tomography (CT) is a valuable complement to ultrasonography (US) in the postoperative period and is a safe, accurate, and noninvasive method of demonstrating hepatic vessels (hepatic artery, portal vein, hepatic veins, and inferior vena cava) and evaluating nonvascular complications (in the hepatic parenchyma and bile duct abnormalities) and extrahepatic tissues. Knowledge and early recognition of these complications is essential for graft salvage, and CT can provide valuable information, particularly for patients with indeterminate US results or in whom US examination is difficult.

In cultured neurons, axon formation is preceded by the appearance in one of the multiple neurites of a large growth cone containing a labile actin network and abundant dynamic microtubules. The invasion-inducing T-lymphoma and metastasis 1 (Tiam1) protein that functions as a guanosine nucleotide exchange factor for Rac1 localizes to this neurite and its growth cone, where it associates with microtubules. Neurons overexpressing Tiam1 extend several axon-like neurites, whereas suppression of Tiam1 prevents axon formation, with most of the cells failing to undergo changes in growth cone size and in cytoskeletal organization typical of prospective axons. Cytochalasin D reverts this effect leading to multiple axon formation and penetration of microtubules within neuritic tips devoid of actin filaments. Taken together, these results suggest that by regulating growth cone actin organization and allowing microtubule invasion within selected growth cones, Tiam1 promotes axon formation and hence participates in neuronal polarization.

Hemoperitoneum is a well-known form of hepatocellular carcinoma presentation and represents a frequent complication in countries with a high incidence of hepatocellular carcinoma, but it is rarely seen in Western countries. Our aim was to report the results and describe the arteriographic and CT-scan characteristics in a series of seven consecutive patients. They were admitted to our hospital because of hemoperitoneum due to ruptured tumor as a first manifestation of hepatocellular carcinoma, and the rupture was effectively controlled by transcatheter arterial embolization. From April 1989 to April 1998, 440 consecutive patients were admitted to our liver unit with the diagnosis of hepatocellular carcinoma and liver cirrhosis. Fourteen patients (3%) presented with acute hemoperitoneum due to tumor rupture as a first manifestation of hepatocellular carcinoma. We here report our experience in the group of patients treated by transcatheter arterial embolization. Mean age was 67.1+/-5 years (range, 61-73). All patients presented with sudden abdominal pain, abdominal distension, and four patients had symptoms of acute anemia. In all cases the ruptured tumor was subcapsular. The procedure was effective in the control of bleeding in all cases, without significant impairment in liver function or treatment-related deaths. In six of the seven patients, a self-limited postembolization syndrome was observed. Mean survival time was 273+/-488.7 days (range: 15-1290). Three patients survived more than six months but at the time of evaluation, only one patient was alive. In conclusion, the present results confirm that transcatheter arterial embolization is an effective and well-tolerated treatment in the management of hemoperitoneum due to ruptured hepatocellular carcinoma in patients with liver cirrhosis.

The liver has a unique dual blood supply, which makes helical computed tomography (CT) a highly suitable technique for hepatic imaging. Helical CT allows single breath-hold scanning without motion artifacts. Because of rapid image acquisition, two-phase (hepatic arterial phase and portal venous phase) evaluation of the hepatic parenchyma is possible, improving tumor detection and tumor characterization in a single CT study. The arterial and portal venous supplies to the liver are not independent systems. There are several communications between the vessels, including transsinusoidal, transvasal, and transplexal routes. When vascular compromise occurs, there are often changes in the volume of blood flow in individual vessels and even in the direction of blood flow. These perfusion disorders can be detected with helical CT and are generally seen as an area of high attenuation on hepatic arterial phase images that returns to normal on portal venous phase images; this finding reflects increased arterial blood flow and arterioportal shunting in most cases. Familiarity with the helical CT appearances of these perfusion disorders will result in more accurate diagnosis. By recognizing these perfusion disorders, false-positive diagnosis (hypervascular tumors) or overestimation of the size of liver tumors (eg, hepatocellular carcinoma) can be avoided.

The number and proportion of older U.S. adults who live alone have increased dramatically in the past three decades, and there is concern that these individuals may have particularly poor dietary quality. We examined the association of four living arrangements (living with a spouse only, with a spouse plus someone else, with someone other than a spouse or living alone) with dietary quality (the number of low nutrients out of a possible 15, with low defined as <67% of the recommended dietary allowance) among 6525 U.S. adults aged 50-64 y and those >/=65 y in the third National Health and Nutrition Examination Survey (NHANES III 1988-1994). Among non-Hispanic Caucasian adults, those who lived with a spouse only had better dietary quality, with significant differences ranging from 0.8 to 1.5 fewer low nutrients compared with those with other living arrangements. Effects of living arrangements on dietary quality were also seen among non-Hispanic African-Americans, Mexican-Americans, and those of "other" races, but differences were significant only for African-American men aged >65 y living with a spouse plus others (1.6 additional low nutrients compared with those living with a spouse only). Energy intake was strongly associated with dietary quality, but did not account for the associations between living arrangements and dietary quality. Although middle-aged and older adults with living arrangements other than living with a spouse only (including those living alone) tended to have poorer dietary quality, the effects varied substantially across age, gender and ethnic categories.

Portomesenteric vein gas is a rare condition whose pathogenesis is not fully understood. Portomesenteric vein gas is most commonly caused by mesenteric ischemia but may have a variety of other causes. The primary factors that favor the development of this pathologic entity are intestinal wall alterations, bowel distention, and sepsis. Portomesenteric vein gas is idiopathic in approximately 15% of cases. Advanced imaging techniques such as computed tomography (CT) have increased the sensitivity for detection of portomesenteric vein gas. At CT, portal vein gas appears as tubular areas of decreased attenuation in the liver, predominantly in the left lobe. Gas in the great mesenteric veins can easily be demonstrated with contrast material-enhanced CT, whereas gas in the small mesenteric veins appears as tubular or branched areas of decreased attenuation in the mesenteric border of the bowel. Findings of portomesenteric vein gas at CT should be carefully evaluated in the context of clinical findings. In the majority of cases, the prognosis is favorable and surgery is not required. However, when CT demonstrates portomesenteric vein gas and clinical findings suggest the presence of mesenteric ischemia, surgery is mandatory.

Background & Aims: The diagnosis of colonic angiodysplasia is often challenging and relies on endoscopy or catheter angiography. We investigated whether computed tomographic angiography (CTA) contributes to the diagnosis of colonic angiodysplasia., Methods: Twenty-eight patients with suspected bleeding from colonic angiodysplasia were prospectively evaluated. Gastrointestinal bleeding was investigated by colonoscopy plus visceral angiography and by CTA. The level of agreement between CTA and the former procedures was determined., Results: CTA images of diagnostic quality were obtained in 26 patients. Eighteen patients were diagnosed with colonic angiodysplasia by colonoscopy plus visceral angiography, and 14 by CTA (kappa = 0.68; P < 0.001). Sensitivity, specificity, and positive predictive values of CTA for detection of colonic angiodysplasia were 70%, 100%, and 100%, respectively. CTA signs including accumulation of vessels in the colonic wall, early filling vein, and supplying enlarged artery were present in 55%, 50%, and 22% of cases, respectively. None of these signs were present in the 8 patients with obscure gastrointestinal bleeding and negative diagnostic investigation of the digestive tract., Conclusions: CTA is a sensitive, specific, well-tolerated, and minimally invasive tool for the diagnosis of colonic angiodysplasia.

2,4-Dichlorophenoxyacetic acid (2,4-D) is a potent neurotoxic herbicide widely used in agriculture. The basic mechanisms by which 2,4-D produces cell damage have not yet been determined. In this study we have examined the effects of 2,4-D in primary cultures of cerebellar granule cells in order to obtain insights into the possible mechanisms underlying the toxic effects of this herbicide. The results obtained indicate that a 24-hour exposure to 2,4-D produces a striking and dose-dependent inhibition of neurite extension. This phenomenon is paralleled by a significant reduction in the cellular content of both dynamic and stable microtubules, a disorganization of the Golgi apparatus, and an inhibition in the synthesis of complex gangliosides. Interestingly, 2,4-D inhibits the in vitro polymerization of purified tubulin. Taken together, the present observations raise the possibility that at least one basic mechanism underlying 2,4-D neurotoxicity involves an inhibition of microtubule assembly. That event may cause a decreased neurite outgrowth response, and could also explain the observed differences in the pattern of ganglioside biosynthesis and/or the disorganization of the Golgi apparatus.

In this study we present evidence about the cellular functions of KIF4. Using subcellular fractionation techniques and immunoisolation, we have now identified a type of vesicle that associates with KIF4, an NH(2)-terminal globular motor domain kinesin-like protein. This vesicle is highly concentrated in growth cones and contains L1, a cell adhesion molecule implicated in axonal elongation. It lacks synaptic vesicle markers, receptors for neurotrophins, and membrane proteins involved in growth cone guidance. In cultured neurons, KIF4 and L1 predominantly localize to the axonal shaft and its growth cone. Suppression of KIF4 with antisense oligonucleotides results in the accumulation of L1 within the cell body and in its complete disappearance from axonal tips. In addition, KIF4 suppression prevents L1-enhanced axonal elongation. Taken collectively, our results suggest an important role for KIF4 during neuronal development, a phenomenon which may be related to the anterograde transport of L1-containing vesicles.

This study identifies social, political, and cultural barriers to help seeking from health care organizations faced by abused Latina and Asian immigrant women. Qualitative data were collected through four semistructured ethnic-specific focus group interviews with 28 abused Latina and Asian immigrant women. Participants who had suffered intimate partner abuse were recruited through urban community-based organizations in San Francisco, California. Sociopolitical barriers to help seeking and patient-provider communication included social isolation, language barriers, and, for some, discrimination and fears of deportation. Sociocultural barriers included dedication to the children and family unity, shame related to the abuse, and the cultural stigma of divorce. Abused Latina and Asian immigrant women face significant social, cultural, and political barriers to patient-provider communication and help seeking. Medical and social service providers and policy makers may improve the quality of care for these women by understanding and addressing these barriers.

Tau protein is a predominantly neuronal microtubule-associated protein that is enriched in axons and is capable of promoting microtubule assembly and stabilization. In the present article we review some of the key experiments directed to obtain insights about tau protein function in developing neurons. Aspects related to whether or not tau has essential, unique, or complementary functions during axonal formation are discussed.

We describe the case of a 59-year-old man who presented a mycotic aneurysm of the common right iliac artery due to Streptococcus agalactiae and developed an arteriovenous fistula within the inferior vena cava secondary to spontaneous rupture of the aneurysm. The clinical syndrome, helical computed tomographic, and angiographic findings are described and discussed.

The purpose of this study was to characterize the appearance of intrahepatic arterioportal shunts (APS) on two-phase helical CT, with emphasis on the importance of the hepatic arterial-dominant phase (HAP) to demonstrate perfusion disorders. We review eight cases of APS diagnosed by helical CT in our institution from January 1996 to March 1997 and describe the CT findings that established diagnosis. Five of them were confirmed by angiography. In seven (87. 5 %) cases of APS we found early enhancement of the peripheral portal branches during the HAP of helical CT, whereas the superior mesenteric and splenic veins remained unenhanced. In five (62.5 %) cases of APS, transient, peripheral, triangular parenchymal enhancement was depicted during the HAP of helical CT; in four of these cases there was associated early enhancement of the portal branches. Helical CT can show perfusion alterations that might remain undiagnosed with conventional CT. An understanding of the hemodynamic changes that occur in APS can help in the interpretation of focal transient hepatic parenchymal enhancement and to differentiate APS from hypervascular tumors. We believe that the helical CT findings described herein are characteristic enough to suggest the diagnosis of APS.

Acute aortic dissection is a cardiovascular emergency that requires prompt diagnosis and treatment. Helical computed tomography (CT) allows diagnosis of acute aortic dissection with a sensitivity and specificity of nearly 100%. With helical CT, a dissection involving the ascending aorta (type A in the Stanford classification) can be differentiated from one distal to the left subclavian artery (type B). Helical CT can also be used to identify atypical forms of aortic dissection such as intramural hematoma, penetrating atherosclerotic ulcer, ruptured type B dissection, and atypical configurations of the intimal flap. Helical CT is useful in follow-up of aortic dissection by allowing assessment of early and late changes after surgery or medical treatment. Such changes include postoperative complications of type A dissection, healing of intramural hematoma, progression of intramural hematoma, and aneurysms of the true or false lumen. Helical CT can also be used to monitor potentially life-threatening ischemic complications of abdominal branch vessels.

The aim of this study was to present CT findings of occult ureteropelvic junction obstruction in patients with renal trauma and to describe the clinical signs and singular CT features that are characteristically observed with trauma and are relevant to management of these patients. We retrospectively reviewed 82 helical CT studies in patients with renal trauma referred to our institution. We found 13 cases of occult preexisting renal pathology, six of which were occult ureteropelvic junction obstructions. The clinical presentation, radiologic findings of trauma according to the Federle classification, and CT findings of obstructed ureteropelvic junction are presented. We found three category-I lesions (one in horseshoe kidney), two of them treated with nephrostomy because of increased ureteropelvic junction obstruction due to pelvic clots; two category-II lesions (parenchymal and renal pelvis lacerations) that had presented only with microhematuria; and one category-IV lesion (pelvic laceration alone). Pelvic extension was demonstrated in all the cases with perirenal collections. The CT studies in all the cases with suspected ureteropelvic junction obstruction showed decreased parenchymal thickness and enhancement, and dilatation of the renal pelvis and calyx, with a normal ureter. Computed tomography can provide information to confidently diagnose underlying ureteropelvic junction obstruction in renal trauma, categorize the traumatic injury (at times clinically silent) and facilitate proper management according to the singularities observed, such us rupture of the renal pelvis alone (Federle category IV) and increasing ureteropelvic obstruction due to clots which can be decompressed by nephrostomy.

Cultures of cerebellar macroneurons were used to study the pattern of expression, subcellular localization, and function of the neuronal cdk5 activator p35 during laminin-enhanced axonal growth. The results obtained indicate that laminin, an extracellular matrix molecule capable of selectively stimulating axonal extension and promoting MAP1B phosphorylation at a proline-directed protein kinase epitope, selectively stimulates p35 expression, increases its association with the subcortical cytoskeleton, and accelerates its redistribution to the axonal growth cones. Besides, suppression of p35, but not of a highly related isoform designated as p39, by antisense oligonucleotide treatment selectively reduces cdk5 activity, laminin-enhanced axonal elongation, and MAP1b phosphorylation. Taken collectively, the present results suggest that cdk5/p35 may serve as an important regulatory linker between environmental signals (e.g., laminin) and constituents of the intracellular machinery (e.g., MAP1B) involved in axonal elongation.

In this study we have examined the cellular functions of ERM proteins in developing neurons. The results obtained indicate that there is a high degree of spatial and temporal correlation between the expression and subcellular localization of radixin and moesin with the morphological development of neuritic growth cones. More importantly, we show that double suppression of radixin and moesin, but not of ezrin-radixin or ezrin-moesin, results in reduction of growth cone size, disappearance of radial striations, retraction of the growth cone lamellipodial veil, and disorganization of actin filaments that invade the central region of growth cones where they colocalize with microtubules. Neuritic tips from radixin-moesin suppressed neurons displayed high filopodial protrusive activity; however, its rate of advance is 8-10 times slower than the one of growth cones from control neurons. Radixin-moesin suppressed neurons have short neurites and failed to develop an axon-like neurite, a phenomenon that appears to be directly linked with the alterations in growth cone structure and motility. Taken collectively, our data suggest that by regulating key aspects of growth cone development and maintenance, radixin and moesin modulate neurite formation and the development of neuronal polarity.

Background: Domestic violence is one of today's most serious health issues. Abused Latina and Asian immigrant women face unique barriers to the discussion of abuse with health care providers. This research was undertaken to identify any provider-related factors that may affect patient-provider communication for these women., Methods: Qualitative data were collected using semistructured focus group interviews with abused Latina and Asian immigrant women. Participants were recruited through urban community-based organizations. Twenty-eight immigrant women with histories of domestic violence participated in four focus groups: two groups of Latina women and two groups of Asian women. Iterative readings by independent researchers identified provider-related factors affecting patient-provider communication., Results: The study participants identified the provider behaviors that demonstrate trust, compassion, and understanding as elements that improve patient-provider communication. In addition, participants wanted providers to initiate discussions about partner abuse., Conclusions: Improved understanding of factors that may affect abused immigrant patients' communication may assist health care providers in offering meaningful support and assistance to these patients. Providers, administrators, policy makers, and educators should consider these factors when developing policy, protocols, and educational curricula for a variety of health care settings.

We have previously reported that high-density lipoprotein (HDL) exhibits antineuritogenic effects on chicken cerebral cells in culture. In the present study, we show the effects of HDLs, oxidized by UV irradiation or heating, on chicken cerebral neurons in culture. Both treatments produced several physical and chemical changes in the HDLs, i.e., formation of lipid peroxides, enlargement of HDL diameters, an increased exposure of the tryptophan groups of the apolipoprotein A-I to a more hydrophilic environment, formation of bityrosines, and cross-linking of apolipoprotein A-I. When these treatments were performed in the absence of EDTA, most of the modifications described above were more intense and HDLs formed a macroaggregate that displays a rosette-like structure. The aggregated HDLs produced neurodegeneration and death when added to both undifferentiated and differentiated cerebral neurons in culture. This process was accompanied by the disorganization of the cellular microtubular cytoskeleton and hyperphosphorylation of the microtubule-associated protein tau. Native HDL or HDLs treated in the presence of EDTA inhibited the neuritogenesis of undifferentiated neurons but did not show any significant effect on the differentiated neurons in culture. The effects on the cellular cytoskeleton and morphology of aggregated HDLs recall those of the fibrillar beta-amyloid peptide. The present results suggest that aggregated HDLs could participate in neurodegeneration associated with oxidative stress in the CNS.

In the present study, we present evidence about the cellular functions of KIF2, a kinesin-like superfamily member having a unique structure in that its motor domain is localized at the center of the molecule (Noda Y., Y. Sato-Yoshitake, S. Kondo, M. Nangaku, and N. Hirokawa. 1995. J. Cell Biol. 129:157-167.). Using subcellular fractionation techniques, isopicnic sucrose density centrifugation of microsomal fractions from developing rat cerebral cortex, and immunoisolation with KIF2 antibodies, we have now identified a type of nonsynaptic vesicle that associates with KIF2. This type of organelle lacks synaptic vesicle markers (synapsin, synaptophysin), amyloid precursor protein, GAP-43, or N-cadherin. On the other hand, it contains betagc, which is a novel variant of the beta subunit of the IGF-1 receptor, which is highly enriched in growth cone membranes. Both betagc and KIF2 are upregulated by NGF in PC12 cells and highly concentrated in growth cones of developing neurons. We have also analyzed the consequences of KIF2 suppression by antisense oligonucleotide treatment on nerve cell morphogenesis and the distribution of synaptic and nonsynaptic vesicle markers. KIF2 suppression results in a dramatic accumulation of betagc within the cell body and in its complete disappearance from growth cones; no alterations in the distribution of synapsin, synaptophysin, GAP-43, or amyloid percursor protein are detected in KIF2-suppressed neurons. Instead, all of them remained highly enriched at nerve terminals. KIF2 suppression also produces a dramatic inhibition of neurite outgrowth; this phenomenon occurs after betagc has disappeared from growth cones. Taken collectively, our results suggest an important role for KIF2 in neurite extension, a phenomenon that may be related with the anterograde transport of a type of nonsynaptic vesicle that contains as one of its components a growth cone membrane receptor for IGF-1, a growth factor implicated in nerve cell development.

Objective: To examine the influence of gender, male infertility factor, and other demographic variables on stigma and whether parents tell their children that they were conceived by donor insemination (DI) and to ascertain if stigma and the disclosure decision affect parental bonding with the child or the quality of the interparental relationship., Design: One hundred eighty-four San Francisco Bay Area couples who had become parents by DI were asked to complete a self-administered questionnaire., Setting: A private infertility practice., Patient(s): Eighty-two men and 94 women who completed the questionnaire., Main Outcome Measure: A questionnaire assessing disclosure, stigma, parental bonding, and the quality of the interparental relationship., Result(s): Factors that increased the couple's likelihood of disclosure included younger age, azoospermia, lower stigma scores, and having more than one DI child. Fathers who scored higher on stigma reported less parental warmth and parental fostering of independence., Conclusion(s): Because the decision regarding disclosure of DI treatment was not linked to parental bonding with the child or to the quality of the interparental relationship, we cannot conclude that nondisclosure is harmful to family relationships or is a symptom of family problems. The husband's perceptions of stigma however, may affect the father--child relationship adversely.

Two cases of small bowel obstruction secondary to phytobezoar diagnosed by computed tomography (CT) and confirmed at surgery are presented. CT findings were dilated intestinal loops and an intraluminal mass with air bubbles retained in its interstices, resulting in a mottled appearance. We propose that definite diagnosis of small bowel bezoar can be made on the basis of these CT findings.

Neurogenic tumors of the small intestine are extremely rare and represent an unusual cause of gastrointestinal hemorrhage. We present a case of schwannoma of the fourth portion of the duodenum demonstrated by helical computed tomography. Multiplanar reconstructions showed a hypervascular tumor arising from the inferior wall of the duodenum. The use of water as oral contrast agent instead of iodinated contrast permitted a better visualization of the intact mucosa and differentiated a hypervascular tumor from hypodense gastrointestinal content.

Betagc is a beta-subunit variant of the insulin-like growth factor-1 (IGF-1) receptor highly enriched in growth cone membranes prepared by subcellular fractionation of fetal rat brain (). The present study is focused on the expression and on the cellular and subcellular distribution of betagc in developing neurons and differentiating PC12 cells. In the developing cerebral cortex and, at least at early stages, in cultured primary neurons, betagc expression was found to be correlated with neurite outgrowth. In PC12 cells betagc expression was nerve growth factor (NGF)-dependent and also paralleled neurite outgrowth. In contrast, beta-subunits of the insulin receptor and/or of other IGF-1 receptors ("betaP5"; detected with antibody AbP5) were downregulated as betagc expression increased. Immunofluorescence studies confirmed the enrichment of betagc at growth cones and demonstrated morphologically its spatial separation from betaP5, which is confined to the perikaryon. At the growth cone, betagc colocalizes and associates in a proximal region with microtubules, but it seems independent of the more peripheral microfilaments. Some betagc immunoreactivity is detected in the perinuclear region of PC12 cells, most likely the Golgi complex and its vicinity. betagc seems to emerge from the periphery of this structure in an apparently vesicular compartment distinct from that carrying synaptophysin to the growth cones. The facts that (1) betagc expression is correlated closely with neurite outgrowth, that (2) it is regulated in PC12 cells by a neurotrophin, NGF, and that (3) betagc is concentrated in the proximal growth cone region raise new questions regarding a possible role of IGF-1 receptors containing betagc in the regulation of neurite growth.

We evaluated the CT scans of 13 patients with spontaneous subcapsular or perinephric hemorrhage (SPH) associated with these underlying causes: 4 angiomyolipomas, 2 renal cell carcinomas, 1 renal metastatic malignant melanoma, 1 ruptured renal artery aneurysm, 1 adrenal myelolipoma, 1 ruptured renal abscess, 2 ruptured hemorrhagic cysts, and 1 patient with undiagnosed coagulation disorder. Our objective was to ascertain whether an underlying cause of SPH was identifiable by CT, and to determine the extension of the hematomas. Computed tomography identified the hematoma in all 13 cases (sensitivity 100 %). In all 12 cases in which there was a renal or adrenal anatomic lesion, the underlying cause was identified with CT (100 %), with correct diagnosis in 11 cases (91.6 %). The case in which no lesion was identified was the undiagnosed coagulation disorder. We conclude that CT is a useful technique for the initial evaluation of SPH, permitting diagnosis of hemorrhage and identification of the underlying cause.

The investigation of the molecular properties of nerve growth cones depends to a significant degree on their isolation from fetal brain in the form of 'growth cone particles' (GCPs). The availability of markers for developing axons and dendrites, as well as glial cells, has made it possible to characterize the GCP fraction in much greater detail than before and to optimize its yield. Marker analyses show that a member of the N-CAM family (5B4-CAM), synaptophysin, and especially GAP-43 and non-phosphorylated tau, are enriched in the GCP fraction. In contrast, MAP2 and, particularly, glial fibrillary acidic protein and vimentin are fractionated away from GCPs. Furthermore, GCP yield can be doubled relative to the original procedure, without compromising purity, by raising the sucrose concentration of the fractionation gradient's uppermost layer. The results indicate that GCPs are highly purified growth cone fragments with very little glial contamination, and that they are primarily of axonal origin.

Objectives: To describe the frequency and distribution of the consumption of medicines in a census-based sample of people of 60 or over. To determine the association between the consumption of medicines and other socio-demographic and clinical (presence of disease) variables., Design: An epidemiological crossover study based in the community., Setting: Rural population: the Health District of Arévalo in Castilla y León., Participants: 825 subjects (446 women and 379 men) over 60, with an average age of 71,84., Measurements: A standard questionnaire was used, containing medicine consumption, prescription, and clinical and demographic features., Results: The consumption of medicines per person per day was 1,92. Therapeutic groups most consumed were, in this order, hypotension drugs, cardiotonics, antirheumatics, peripheral vasodilators, digestive system drugs, neurotropics and analgesics. The number of illnesses suffered by this age-group was 2,19. There is a strong connection between consumption of medicines and age, especially in the over 80's., Conclusions: 75% of the target population took some medicine each day. Consumption is higher among women than men. Cardiovascular drugs are the most frequently used therapeutic group. Consumption of medicines is directly related to age and the number of illnesses.

Objective: To determine the barriers to identification and management of domestic violence from the battered women's perspective., Design: Qualitative research methods using semistructured focus groups., Setting: Urban and suburban community-based organizations serving women and their families in the San Francisco Bay (Calif) area., Participants: Fifty-one women with histories of domestic violence comprised eight focus groups divided as follows: two groups of Latino (n=14), two groups of white (n=14), Asian (n=14), and two groups of African-American (n=9) women., Results: Participants from all ethnic groups identified major factors that affect identification and management of battered women in the health care setting. Factors that interfere with patient disclosure included threats of violence from the partner, embarrassment, adherence to gender roles, concerns about police involvement and lack of trust in the health care provider. One factor that predisposed a woman to seek help from providers was a need for the providers to exhibit compassion, awareness, and respect for the patient's need to make the final decisions about her situation. Most participants said that providers should take the initiative to ask directly about domestic violence, establish a supportive patient-provider relationship, and refer battered women to available community resources. The major institutional barriers to using the health care system included the high cost of medical care and long waiting periods., Conclusions: Many battered women experience social, institutional, and provider barriers to obtaining help from the health care system for problems related to domestic violence. Providers as well as institutions can overcome these barriers through an understanding of the social context of domestic violence and the victim's needs. Identification may be improved through a trusting patient-provider relationship and by direct questioning about domestic violence.

We present a case of aortocaval fistula (ACF) secondary to spontaneous rupture of an atherosclerotic infrarenal aortic aneurysm into the inferior vena cava that was initially diagnosed with computed tomography (CT). This is believed to be the first report of this condition with CT demonstration of the exact site of fistula and CT-pathologic correlation. We retrospectively reviewed the CT findings of another two cases of ACF and the previous literature.

We have previously described a thermostable inhibitor of the UDP-N-acetylgalactosamine:GM3,N-acetylgalactosaminyltransferase (GM2 synthase) purified from chicken blood serum. Some properties of the GM2 synthase inhibitory preparation (IP) resemble those of high-density lipoprotein (HDL), i.e., both have a MW of 200,000 in native conditions and are resistant to denaturation by heat. These and other facts prompted us to test the possibility that lipoproteins regulate ganglioside biosynthesis in the CNS. For this purpose, serum lipoprotein fractions were isolated from chicken serum by flotation and were assayed as inhibitors of GM2 synthase activity and of neuron differentiation in culture. HDL (in contrast to fractions containing very low-density or low-density lipoprotein) inhibited GM2 synthase with the same specific activity as IP and inhibited neuron cell differentiation in culture in a similar way. Furthermore, these two preparations also share several other characteristics; i.e., both have the same cholesterol content, the same floating behavior on KBr gradients, and the same polypeptide pattern as detected by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and staining with Coomassie Blue, or after western blot and revealing with an antibody prepared against IP, which is able to diminish the inhibitory effect of this preparation. The results described indicate identity between HDL and IP and suggest that HDL (particularly apolipoprotein A) could play an important role on ganglioside biosynthesis modulation during CNS development. The antineuritogenic effect of HDL described in this study could be of physiological relevance during CNS development and response to injury.