Acute mastoiditis in children

Cystic lymphatic malformations are haemodynamically inactive vascular malformations that never regress. During a nine-year period, 52 patients with cervico-facial superficial cystic lymphatic malformations underwent percutaneous sclerotherapy with Ethibloc (a corn-based alcohol derivative). In 57 percent (30/52) of cases, the outcome of sclerotherapy alone was excellent or good: in 19 percent (10/52), the procedure had to be combined with surgery for aesthetic reasons; and in the remaining 24 percent (12/52), the treatment failed. The results suggest percutaneous sclerotherapy with Ethibloc to be safe and effective, and that it is to be recommended as the treatment of choice in cases of superficial cystic lymphatic malformations.     

Correlation between health outcome and length of hospital stay in lumbar microdiscectomy

STUDY DESIGN: Prospective observational trial in a community hospital setting. OBJECTIVES: To examine the effect on patient-reported outcome of a clinical practice, namely, decrease in hospital length of stay for single-level lumbar microdiscectomy. SUMMARY OF BACKGROUND DATA: Health care reform and the economic demands of managed care have created increasing pressure to manage health care resources more effectively. Spine surgery is one of the most common surgeries. METHODS: Starting in October 1993, length of stay for patients undergoing lumbar microdiscectomy was decreased at the study institution. Patients completed questionnaires (SF-36) before surgery and 3 months after surgery that assessed health status, back-related functional status, and treatment satisfaction. Comparisons were made between the intervention group and a historical control group and between 1-day and 2-day patients. RESULTS: SF-36 scores 3 months after surgery approximated age and sex norms of five of the eight SF-36 scales and improved significantly on the remaining three scales. The physical functioning and general health scores were significantly better for the 1-day than the 2-day patients. Patient satisfaction was similar in all groups. Hospital charges for the 1-day patients were $781 less per patient than for the 2-day patients. CONCLUSIONS: Hospital length of stay for lumbar microdiscectomy can be decreased without adverse effect on short-term patient self-reported health status or satisfaction and with lower hospital charges. This model assesses the effect of efficient management of health care resources on patient-perceived quality and satisfaction.     

Protein sorting by transport vesicles

Eukaryotic life depends on the spatial and temporal organization of cellular membrane systems. Recent advances in understanding the machinery of vesicle transport have established general principles that underlie a broad variety of physiological processes, including cell surface growth, the biogenesis of distinct intracellular organelles, endocytosis, and the controlled release of hormones and neurotransmitters.     

Chronic atrophic fundic gastritis diagnosed by a modified Congo red test

BACKGROUND AND STUDY AIMS: Chronic atrophic fundic gastritis (CAFG) is associated with several diseases, such as gastric cancer, gastric ulcer, pernicious anemia, and bacterial overgrowth. In spite of recent technical improvements, the gastroscopic diagnosis of CAFG remains uncertain. Congo red chromogastroscopy is capable of visualizing acid-producing normal fundic mucosa, but has hitherto not been suitable for routine use. The aim of our study was to establish a reliable endoscopic technique with which to diagnose CAFG. PATIENTS AND METHODS: This prospective study comprises 124 consecutive patients (71 women, 53 min) with a mean age of 65 years (range 36-92). Macroscopic evaluation of the gastric fundic mucosa in routine endoscopy using video techniques was compared with evaluation by means of a modified endoscopic Congo red test (MCRT). In routine gastroscopy, CAFG was recognized by the thin, friable mucosa, with a marked visible vascular pattern and fold atrophy. With MCRT, the diagnosis of CAFG was made within five minutes' observation when no red-to-blue color shift in the fundic mucosa could be induced by 0.2 mu g/kg intravenous pentagastrin. The results were then compared with the histological examination of biopsies from the fundic mucosa. RESULTS: CAFG was confirmed by histology in 40 of 124 cases. The diagnostic sensitivity of MCRT was 1.0 (40/40), with a positive predictive value of 0.90, whereas the values for macroscopic gastroscopic evaluation were 0.25 (10/40) and 0.50, respectively. CONCLUSIONS: We conclude that MCRT is a sensitive, fast, and cost-effective method of identifying patients with CAFG, and well suited for use in routine gastroscopy.     

Organization and evolution of C4 and CYP21 genes in primates: importance of genomic segments

The evolutionary relationship between two central major histocompatibility complex (MHC) genes, C4 and CYP21, was investigated by employing pulsed field gel electrophoresis (PFGE) and conventional restriction fragment length polymorphism (RFLP) analyses in human and nonhuman primates. Using Taq I in conjunction with C4 and CYP21 probes, it has been found that there are four major types of C4 genes [defined by 7.0, 6.4, 6.0, and 5.4 kilobases (kb) Taq I fragments] and two major types of CYP21 genes (3.7 and 3.2 kb fragments) in human and nonhuman primates including chimpanzee, gorilla, and orangutan. All of the eight possible combinations of C4 and CYP21 genes can be identified on one or more human ancestral haplotypes (AH). It is concluded that each of the major types of C4 and CYP21 (and each of the combinations between these) predated human speciation. PFGE analysis with Mlu I and Pvu I suggested that each C4+CYP21 segment has a specific length of 30-50 kb and that each AH carries one, two, three, or even more segments. In the case of C4, it is important to note that there is no simple relationship between the RFLP and the protein classifications. Thus, at least some of the expressed polymorphisms could be relatively recent in that they are carried by the same or different gene types. These findings are consistent with the hypothesis that MHC AHs have been formed from a large pool of specific genomic segments and that further haplospecific polymorphism has developed subsequently.     

The xylose isomerase gene from Thermoanaerobacterium thermosulfurogenes allows effective selection of transgenic plant cells using D-xylose as the selection agent

Transthyretin, an extracellular thyroid-hormone-binding protein (THBP) in higher vertebrates, is synthesized and secreted by the choroid plexus of all classes of vertebrates, except fish and amphibians, and synthesized in the liver of endothermic animals. Here, we report the nucleotide sequence of the cDNA for a THBP found in plasma of bullfrog (Rana catesbeiana) tadpoles before the climax of metamorphosis. The amino acid sequence clearly shows this protein to be an amphibian transthyretin. The three-dimensional structure of bullfrog transthyretin was derived using homology modeling. Compared with transthyretins from other vertebrate species, bullfrog transthyretin is highly conserved at the thyroid hormone-binding sites and other important structural regions of the subunits. Bullfrog transthyretin mRNA was found in tadpole liver, but not in tadpole choroid plexus. Thus, during evolution, synthesis of transthyretin in the liver of metamorphosing amphibians preceded that in the choroid plexus of reptiles, birds and mammals. It was previously observed that the protein most abundantly synthesized and secreted by the choroid plexus in adult amphibians is a lipocalin [Achen, M. G., Harms, P. J., Thomas, T., Richardson, S. J., Wettenhall, R. E. H. & Schreiber, G. (1992) J. Biol. Chem. 267, 23170-23174], in contrast to transthyretin being the most abundantly synthesized and secreted protein in the choroid plexus of mammals, birds and reptiles. Lipocalin mRNA was found in large amounts in tadpole choroid plexus, but not livers.     

Effects of a split keyboard design and wrist rest on performance, posture, and comfort

The purpose of this study was to examine differences in experienced typists' performance, posture, and musculoskeletal pain when using a split, adjustable (SA) computer keyboard and when using a standard flat keyboard. In addition, the use of a wrist rest was examined for performance, posture, and musculoskeletal pain effects. Eighteen participants were exposed to the SA keyboard and a flat keyboard in a laboratory study of text typing for four consecutive hours on five days. The results indicated that after just 2 h of orientation and practice, the participants could perform as well on the SA keyboard as on the flat keyboard. The SA keyboard provided advantages for reduced wrist/hand pronation. There was no difference between the keyboards in the level of musculoskeletal pain reported by participants after typing. However, they reported increased pain in the back, neck, shoulders, and wrists from the beginning to the end of each of the experimental periods for both keyboards.     

Expanding the phenotype of the 8344 transfer RNAlysine mitochondrial DNA mutation

The A-to-G mutation at position 8344 in the transfer RNAlysine mitochondrial DNA gene is associated mostly with the myoclonic epilepsy and ragged red fibers syndrome. We describe a five-generation family with this mutation and 19 affected members with a variant neurologic syndrome of ataxia, myopathy, hearing loss, and neuropathy. Along with axial lipomas and diabetes mellitus, hypertension is a frequent somatic feature, suggesting that mitochondrial mutations may contribute to hypertension in these patients.     

Laryngeal mask airway vs face mask and Guedel airway during pediatric myringotomy

OBJECTIVE: To compare perioperative conditions when a face mask and Guedel oral airway (FM-OA) or a laryngeal mask airway (LMA) are used to maintain airway patency during bilateral myringotomy with insertion of tympanostomy tubes (BMT). DESIGN: Randomized controlled trial in children's hospital tertiary-care operating rooms. PARTICIPANTS: Fifty healthy children undergoing BMT procedures during halothane--nitrous oxide (N2O) anesthesia. INTERVENTIONS: During BMT we managed the airway by inserting a Guedel oral airway or an LMA. MAIN OUTCOME MEASURES: We recorded the time taken to insert the airway device along with oxygen saturation during the operation and time from the end of surgery to eye opening, response to commands, and home readiness. In addition the surgeon assessed perioperative conditions on a 10-point scale (1, poor, through 10, excellent). RESULTS: Although insertion of the LMA took longer than the Guedel oral airway (mean +/- SD, 9 +/- 2 seconds vs 6 +/- 2 seconds; P < .05), no differences were noted in the actual operating, anesthesia, or recovery times. However, the frequency of hypoxemic episodes was decreased (8% vs 36%, P < .05) and the lowest recorded oxygen saturations were higher (mean +/- SD, 95% +/- 7% vs 88% +/- 12%; P < .05) in the LMA group than in the FM-OA group. Surgeons rated perioperative conditions better when the LMA was used (median score, 9 vs 8; P < .05). CONCLUSION: The LMA is an excellent alternative to the FM-OA technique for airway maintenance in children undergoing BMT procedures during halothane--N2O anesthesia.