Electrocardiographic manifestations of dual atrioventricular node conduction during sinus rhythm

In search of critical genes associated with the mechanism of transforming growth factor-alpha (TGF alpha) action in human ovarian cancer, it was found that TGF alpha stimulates c-myc gene expression in human ovarian NIH:OVCAR-3. The role of c-myc in TGF alpha-stimulated growth of NIH:OVCAR-3 cells was examined by the use of the synthetic antisense-myc phosphorothioate oligonucleotide (OPT). Prior exposure of NIH:OVCAR-3 cells to an antisense-myc OPT inhibited TGF alpha-stimulated cell growth and DNA synthesis in a dose-dependent and sequence-specific manner over 4 days. c-Myc protein expression was down-regulated in the antisense-myc treated cells. These results demonstrate both the specific and durable effects of the antisense-myc OPT. Furthermore, the results suggest a role for c-myc in TGF alpha-stimulated cell proliferation.     

Myocardial infarction following electric shock

A 17 year old man presented with a five-month history of swelling of the distal phalanx and a small ulcer on the pulp of the right fifth finger. Despite biopsy the diagnosis was missed until more than six months after onset, when the lesion was excised and histological examination showed a dermal leiomyosarcoma.     

Skin manifestations of graft-versus-host reaction following bone marrow transplantation

We review the cutaneous manifestations of acute and chronic graft versus host disease (GvHD). Acute GvHD is characterized by initial itching, pain on pressure and erythema which begins on posterior auricular skin, palms and soles. The disease evolves into a typical but nonspecific maculopapular rash. Confluent rashes and follicular erythema may occur. Erosive oral lesions usually develop. The most severe variant of GvHD is toxic epidermal necrolysis, which often has a fatal outcome. The onset of chronic GvHD usually occurs more than 100 days after bone marrow transplantation and may be preceded by the acute form. The spectrum of skin changes includes lichenoid pruritic lesions with violaceous color and scleroderma-like skin involvement. Investigation of unknown rashes in these patients includes skin biopsy, which clearly differentiates leukocytoclastic vasculitis and erythema exsudativum multiforme with lymphocytic vasculitis from cutaneous manifestations of GvHD. Special stains may reveal bacteria and fungus in septicemic patients. The therapeutic options are discussed.     

Employment outcomes following spinal cord injury

PURPOSE: We determined the clinical utility of proton MR spectroscopy in defining the extent of disability in benign versus secondary-progressive multiple sclerosis (MS). METHODS: Thirty patients with clinically definite MS, including 16 patients with benign MS and 14 with secondary-progressive MS, and a group of 13 healthy volunteers were studied with combined stimulated-echo acquisition mode proton MR spectroscopy and MR imaging (all patients received contrast material). RESULTS: Acute enhancing lesions of benign and secondary-progressive MS were characterized by a reduction in N-acetylaspartate (NAA)/choline and NAA/creatine and an increase in inositol compounds/creatine as compared with normal white matter. Such variations were also detected in chronic unenhancing lesions in patients with secondary-progressive MS, although they were not found in chronic unenhancing lesions in patients with benign MS. Chronic lesions of the two forms of the disease have significative differences in NAA and inositol signals. CONCLUSION: Proton MR spectroscopy is able to show metabolic changes occurring in the white matter of patients with MS. Such changes differ according to the phase (acute versus chronic) and the clinical form (benign versus secondary-progressive) of the disease.     

Obsessive compulsive disorder following head injury

An epithelial ovarian tumor with steroid production was examined in a 70-year-old postmenopausal female. The stromal cells of this tumor were rather dense and occasionally characterized by luteinization or hyperthecosis, which has been associated with steroidogenesis. Subcellular visualization using confocal laser scanning microscopy (CLSM) successfully led to the identification of 3 beta-hydroxysteroid dehydrogenase (HSD) in both mitochondria-like small particles and endoplasmic reticulum-like linear profiles, and P450-aromatase also in endoplasmic reticulum-like linear profiles, on the three-dimensional images.     

The peripheral pulse following arterial injury

There has been little attention paid to the persistence of the pulse following complete forearm arterial transection, and we found no report that has established the etiology or frequency of this phenomenon. Eighteen patients with documented complete radial or ulnar artery transections were evaluated. Nine of the 18 patients had persistently palpable pulse distal to the transections. Seven of the pulses were due to retrograde flow and two were due to transmission from the proximal arterial stump or large collaterals. The Allen test was accurate in demonstrating arterial occlusion in each case. Digital compression of the intact artery eliminated the pulse in those cases due to retrograde flow. Documentation of flow direction and collateral vessels was performed with the Doppler directional velocity meter. The fallibility of the peripheral pulse following complete arterial injury is stressed. The Allen test, digital compression of the intact artery, and Doppler studies should be performed on patients with suspected arterial injuries. The exploration of all wounds in the region of major arteries from which profuse bleeding has occurred is recommended.     

Adjustment following spinal cord injury.

Investigated specific coping strategies associated with psychological adjustment following spinal cord injury with a battery of assessments administered to 57 patients (median age 26.5 yrs) participating in a spinal cord injury rehabilitation program. Ss were divided into 3 groups based on degree of psychological distress. High-distress Ss reported using more Wish-Fulfilling Fantasy, Emotional Expression, Self-Blame, and Threat Minimization Coping strategies relative to the low and moderate distress groups. The Self-Blame Coping strategy was significantly correlated with psychological distress over and above age, time since injury, or level of injury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lactate clearance and survival following injury

Previous reports cite optimization of O2 delivery (DO2) to 660 mL/min/m2, O2 consumption (VO2) to 170 mL/min/m2, and cardiac index (CI) of 4.5 L/min as predicting survival. We prospectively evaluated 76 consecutive patients with multiple trauma admitted directly to the ICU from the operating room or emergency department. Patients had serum lactate levels and oxygen transport measured on ICU admission and at 8, 16, 24, 36, and 48 hours. Patients were analyzed with respect to survival (S) versus nonsurvival (NS), lactate clearance to normal (< or = 2 mmol/L) by 24 and 48 hours, hemodynamic optimization as defined above, as well as Injury Severity Score (ISS), ICU stay (LOS), and admission blood pressure. All patients achieved non-flow-dependent VO2. There was no difference in CI, DO2, VO2, or ISS when S was compared with NS. All 27 patients whose lactate level normalized in 24 hours survived. If lactate levels cleared to normal between 24 and 48 hours, the survival rate was 75%. Only 3 of the 22 patients who did not clear their lactate level to normal by 48 hours survived. Ten of the 25 nonsurvivors (40%) achieved the above arbitrary optimization criteria. Fifteen of the survivors never achieved any of these criteria. Optimization alone does not predict survival. However, the time needed to normalize serum lactate levels is an important prognostic factor for survival in severely injured patients.     

Clinodactyly following electric burns. Observations on two cases

The authors report two cases of distal clinodactyly secondary to electrical burns. It is hypothesized that the etiology is a unilateral ischemic necrosis of the epiphysis. Depending on the stage in which the deformity is discovered, treatment is preventive or palliative.     

Electroclinical manifestations elicited by intracerebral electric stimulation "shocks" in temporal lobe epilepsy

In patients with severe drug-resistant partial epilepsy, undergoing Stereo-EEG investigations, spatial definition of the "epileptogenic area" is mainly based on spontaneous seizures recordings, but also on seizures induced by intracerebral electrical stimulation (ES). Only "trains" ES (TES, 50 pps) are currently used with this aim; "shocks" ES (SES, 1 pps) are principally applied to localize motor pathways. We have shown, during a prospective study concerning 10 temporal lobe epileptic patients, that SES could frequently induce seizures, especially when stimulation is applied in the anterior part of the Ammon's horn. Even if its efficacy seems lower than by TES, this kind of stimulation, in the majority of the cases, does reproduce isolated ictal subjective symptomatology, allowing the visualization of the progressive organisation of ictal electrical discharges, and avoids "unexpected" ("false positive"?) clinical responses.     

Dissociative stupor--differential diagnosis of coma following injury

Two cases are described in which a dissociative stupor originating from conversion neurosis simulated a coma following a sustained trauma. At first both patients showed no response to being addressed or to pain stimuli. They presented an upward eye gaze deviation, cardiorespiratory functions were stable. Following extensive diagnostic procedures revealing no organic cause for the clinical symptoms, the diagnosis of a hysterical consciousness disorder was stated. Symptoms of conversion neuroses include lacking call response, gait disorder, seizure-like conditions and strength diminution in one or more extremities. In these cases suspicious facts are the absence of injuries (for example by falling down or tongue bite during a dissociative attack), eye gaze deviation and the phenomenon that, when the patient's arm is raised above the head and let fall, it never hits the face but glides down beside the body.     

Anterior interosseus nerve injury following elbow arthroscopy

Elbow arthroscopy is becoming an increasingly invaluable tool for both evaluation of and treatment of a variety of interarticular disease processes. Case reports have documented radial and posterior interosseus injuries following anterior capsular release. To date, this is the first report of an anterior interosseus nerve injury following arthroscopic surgery of the elbow. Arthroscopic surgery offers unparalleled visualization of the multiple articulations and facets of the elbow. It has been reported as useful for removal of loose bodies, synovectomy, release of arthrofibrosis, and the treatment of osteochondritis dessicans. However, the technique does require thorough knowledge of neurovascular structures about the elbow as well as appreciation of the protective layers including the capsule, brachialis, and brachioradialis muscles. This report documents direct injury to the anterior interosseus branch of the median nerve during an elbow debridement and synovectomy in a 65-year-old patient with rheumatoid arthritis.     

Indications for thoracotomy following penetrating thoracic injury

The treatment of penetrating thoracic injuries has been reviewed in both civilian and military series. Although most surgeons agree that closed that closed thoracostomy drainage is the initial treatment of choice, the timing of early thoracotomy and perhaps cardiorrhaphy upon patients with penetrating thoracic injuries remains controversial. The purpose of this study was to determine which patients will require immediate thoractomy or cardiorrhaphy following penetrating chest injury. Over a two-year period 190 patients with penetrating thoracic injuries were treated. Of 53 patients who required immediate thoracotomy, 31 suffered cardiac wounds. Seventy-nine patients required laparotomy for associated intra-abdominal injuries. The mortality rate was related to exsanguinating hemorrhage or postoperative intra-abdominal sepsis. Cardiopulmonary complications were rare in the absence of intra-abdominal sepsis and could not be attributed to the thoracic injury or thoracotomy. Indications for immediate cardiorrhaphy or thoracotomy are: 1) location of the entrance wound (70% in upper mediastinum); 2) blood pressure on admission less than 90; 3) initial thoracostomy blood loss greater than 800 cc; 4) radiographic evidence of retained hemothorax; and/or 5) clinical evidence of pericardial tamponade.