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The cholate-resistant Lactococcus lactis strain C41-2, derived from wild-type L. lactis MG1363 through selection for growth on cholate-containing medium, displayed a reduced accumulation of cholate due to an enhanced active efflux. However, L. lactis C41-2 was not cross resistant to deoxycholate or cationic drugs, such as ethidium and rhodamine 6G, which are typical substrates of the multidrug transporters LmrP and LmrA in L. lactis MG1363. The cholate efflux activity in L. lactis C41-2 was not affected by the presence of valinomycin plus nigericin, which dissipated the proton motive force. In contrast, cholate efflux in L. lactis C41-2 was inhibited by ortho-vanadate, an inhibitor of P-type ATPases and ATP-binding cassette transporters. Besides ATP-dependent drug extrusion by LmrA, two other ATP-dependent efflux activities have previously been detected in L. lactis, one for the artificial pH probe 2',7'-bis-(2-carboxyethyl)-5(and 6)-carboxyfluorescein (BCECF) and the other for the artificial pH probe N-(fluorescein thio-ureanyl)-glutamate (FTUG). Surprisingly, the efflux rate of BCECF, but not that of FTUG, was significantly enhanced in L. lactis C41-2. Further experiments with L. lactis C41-2 cells and inside out membrane vesicles revealed that cholate and BCECF inhibit the transport of each other. These data demonstrate the role of an ATP-dependent multispecific organic anion transporter in cholate resistance in L. lactis.

We report on a large Dutch family with a syndrome characterized by severe hand and/or foot anomalies, and hypoplasia/aplasia of the mammary gland and nipple. Less frequent findings include lacrimal-duct atresia, nail dysplasia, hypohydrosis, hypodontia, and cleft palate with or without bifid uvula. This combination of symptoms has not been reported previously, although there is overlap with the ulnar mammary syndrome (UMS) and with ectrodactyly, ectodermal dysplasia, and clefting syndrome. Allelism with UMS and other related syndromes was excluded by linkage studies with markers from the relevant chromosomal regions. A genomewide screening with polymorphic markers allowed the localization of the genetic defect to the subtelomeric region of chromosome 3q. Haplotype analysis reduced the critical region to a 3-cM interval of chromosome 3q27. This chromosomal segment has not been implicated previously in disorders with defective development of limbs and/or mammary tissue. Therefore, we propose to call this apparently new disorder "limb mammary syndrome" (LMS). The SOX2 gene at 3q27 might be considered an excellent candidate gene for LMS because the corresponding protein stimulates expression of FGF4, an important signaling molecule during limb outgrowth and development. However, no mutations were found in the SOX2 open reading frame, thus excluding its involvement in LMS.

Placenta percreta is a serious complication of pregnancy. A 38-year-old nullipara presented at 25 weeks gestation with preterm labour. Spontaneous delivery was followed by retained placenta. During an attempt to remove the placenta manually placental tissue could not be distinguished. Initially, placenta increta was considered as the most likely diagnosis and conservative management was planned, but progressive shock emerged due to intra-abdominal hemorrhage and laparotomy was performed. Placenta percreta was diagnosed, followed by a supracervical hysterectomy. A review of risk factors, diagnostic tools and treatment possibilities is given.

The purpose of this study was to prospectively evaluate the prevalence of abnormal magnetic resonance imaging scans of the knees of asymptomatic subjects. A prospective analysis of magnetic resonance imaging to arthroscopic findings in symptomatic knees was also performed. The prevalence of meniscal tears found in asymptomatic knees was 5.6% (medial meniscus, 1.9%; lateral meniscus, 3.7%). Other abnormal findings included a prevalence of 1.9% for degenerative changes of the medial femoral condyle and 3.7% both for ganglion cysts and patellofemoral joint articular cartilage degenerative changes. There was also a prevalence of 24.1% of Grade II signal changes of the posterior horn of the medial meniscus. Statistical comparison of our results to previous studies revealed that the magnetic resonance imaging scan readings on the asymptomatic knees in this study were accurate and lesions were correctly identified. We recommend that clinicians match clinical signs and symptoms with magnetic resonance imaging findings before instituting surgical treatment because of a 5.6% prevalence of meniscal tears in the asymptomatic population. The significance of the high percentage of posterior horn medial meniscal Grade II signal changes is unknown.

Os acromiale is the result of failure of one of the outer ossification centers of the acromion to unite with the more medial portion. This creates an additional motion segment which may itself contribute to impingement syndrome of the shoulder or which may create hypertrophy or spurs which directly impinge on the cuff. Three cases of impingement syndrome of the shoulder with associated os acromiale are presented. All three were initially relieved with arthroscopic subacromial decompression of either the entire os acromiale or simply of the impinging spur. After 1 year, however, all three had recurrent or continued complaints of pain and/or impingement. Therefore, it would appear that arthroscopic subacromial decompression is not a solution to impingement syndrome secondary to os acromiale. Careful preoperative radiographic evaluation to rule out all causes of impingement syndrome including os acromiale is essential so that the surgeon may better choose an approach to decompression.

We examined 50 serum samples, submitted to our laboratory for gentamicin levels, by the enzyme multiplied immuno technique (EMIT), by a radioimmunoassay procedure and by a latex agglutination method. Significant differences in concentrations, rates of throughput, and costs between the latex agglutination and the other two procedures were observed. The precision of the assay ranged from 5.21 to 15.70%, whereas recovery values ranged from 83.8 to 110.0%. The latex agglutination procedure provided simplicity and speed at a relatively low cost. However, the significant analytical difference between this and the other two procedures indicates that the latex agglutination procedure is not adequate for measuring accurate gentamicin levels.