Gamete intrafallopian transfer. A cost-effective alternative to donor oocyte in vitro fertilization in women aged 40-42 years

Two cases of eumycotic mycetomas in the head and neck region are reported. The first case is the localized mycetoma which involved only the soft tissue of the neck. It was completely excised and the patient needed no further treatment. In the second case, the lesion extensively involved the structures in the parapharyngeal space, submandibular space and carotid sheath. The upper limit is the skull base. The patient was treated by combination of wide excision with radial forearm flap and antifungal agents, however, the prognosis is fair.     

Medical decisions made by teams: carefulness and responsibility

To a growing extent, medical decision making takes place in the context of a team. Where multidisciplinary cooperation is necessary and the decisions to be taken are complex and consequential (in particular at the beginning and the end of life) joint decision making is considered an essential requirement of careful medical practice. From a legal point of view, this raises the question who is accountable for such decisions. Basically, accountability (and the liability that may result from it) will stay with the individual participants, and in particular with the first responsible, attending physician. In this respect, decision making in such situations is not basically different from other, more informal consultation structures (such as regular case reviews at department level) which are current practice in many health care institutions. Finally, if joint decision making is required, it should be clear in advance how decisions are to be arrived at in the team.     

Effects of group discussion and guided patient care experience on nurses'' attitudes towards care of patients with AIDS

An in vivo study was carried out to determine if capacitive coupled electrical stimulation increased the rate of recovery of strength of regenerate bone produced as a result of lengthening by the Ilizarov technique. Thirty-four adult male beagles underwent a right tibial mid-diaphyseal corticotomy, followed by a 5-day delay, and then 21 days of lengthening (1 mm/day). At the start of the post-distraction period (day 27), stimulation (3-6.3 V peak to peak, 5-10 mA root-mean-square at 60 kHz) was applied for 28 days to one group. The nonstimulated group (n = 17) underwent a 28-day period with no stimulation. From each group, four tibiae were prepared for histology; both ends of the remaining bones were embedded in polymethylmethacrylate and tested in torsion (internal rotation at 4.7 degrees/sec) until failure. Statistically significant changes included a 37% lower maximum torque capacity and a 40% decrease in strain energy to failure in the stimulated group compared with the nonstimulated group. The findings are supported by measured trends to a lower modulus of rigidity (37% decrease) and a smaller percentage of active osteoid perimeter (20% decrease) for the stimulated group. The experimental data suggest that when this dose of capacitive coupled electrical stimulation is applied to the regenerating bone created during distraction osteogenesis, it delays the recovery of bone strength compared with an untreated control.     

Incidence of symptomatic urinary tract infections in HIV seropositive patients and the use of cotrimoxazole as prophylaxis against Pneumocystis carinii pneumonia

A case of complete synostosis of the cervical spine in a 12-year-old girl is described. Differential diagnosis included dysontogenetic forms of synostosis, Klippel-Feil syndrome, rheumatic synostosis and synostosis of other inflammatory origin. This severe case, the first of its type to be described, appeared to be due to tuberculosis of the cervical spine.     

Relationship between muscle fiber composition and functional capacity of back muscles in healthy subjects and patients with back pain

Back muscles are important to the stability of the lumbar spine. Muscle fiber composition may give some indication of the functional capacity of these muscles. This review explores the relationship between muscle fiber composition and functional capacity of back muscles. The reference values for the type and size of the muscle fibers found in the back musculature of healthy subjects and patients with back pain are also presented. A high percentage of type I fibers, which are larger in size than type II fibers, has been found in back muscles at the thoracic and lumbar levels. This is in accordance with the postural function of these muscles. The diameter of type II fibers is smaller in females than males, which may partly explain the lesser strength and greater endurance capacity of back muscles in females. Due to the limited amount of pertinent data, no conclusive evidence is available regarding age-related changes in muscle fiber composition in the musculature of the back. In patients with lumbar disorders, pathological changes and selective atrophy of type II fibers are seen, and these can be changed with adequate exercises. Further research is suggested to address issues related to gender, age, back pain, and exercise and their effects on the apparent back muscle fiber composition.     

Cardiorespiratory kinetics and femoral artery blood velocity during dynamic knee extension exercise

The kinetics of femoral artery mean blood velocity (MBV; measured by pulsed Doppler) and whole body oxygen uptake (VO2; measured breath by breath) were assessed from the time constant during the on (tau on) and off (tau off) transients to step changes in work rate between complete rest and dynamic knee extension (KE) exercise. Six healthy men performed 5 min of seated KE exercise, with each leg alternately raising and lowering a weight (10% maximum voluntary contraction) over a 2-s duty cycle. Because kinetic analysis of VO2 kinetics during KE exercise is a new approach, the VO2 responses were also evaluated during the on and off transitions to the more familiar upright cycling exercise in which the magnitude of increase in VO2 and cardiac output was similar to that during KE exercise. During KE exercise, VO2 tau on [mean 72.2 +/- 11.2 (SE) s] was slower than VO2 tau off (33.3 +/- 1.8 s; P < 0.01). Cardiac output, measured with impedance cardiography, was not different for tau on (67.1 +/- 20.0 s) compared with that for tau off (52.9 +/- 7.6 s). Likewise, MBV tau on (34.5 +/- 3.9 s) was not different from tau off (35.3 +/- 3.2 s). During cycling, the VO2 tau on (18.0 +/- 2.4 s) and tau off (30.7 +/- 1.2 s) were both faster than KE VO2 tau on (P < 0.01). Even though the MBV kinetics indicated a rapid adaptation of blood flow during KE exercise, there was a slow adaptation of VO2. A transient hyperemia immediately on cessation of KE exercise, indicated by both MBV and calculated systemic vascular conductance responses, suggested that blood flow might have been inadequate and could have contributed to the delayed adaptation of VO2 at the onset of exercise, although other explanations are possible.     

Levels of organochlorine pesticides residues in milk of urban mothers in Kenya

Organochlorine compounds (OCPs) are toxic products capable of producing serious adverse health consequences. When used to control pests, certain OCPs persist in the environment and accumulate in the fatty tissues of living organisms, reaching higher levels in animals higher in the food chain. Many countries have therefore either restricted or banned the use of OCPs. DDT used to be widely used in Kenya to control pests, but is now used only to control mosquito populations. The contamination of human milk by organochlorine and other related compounds is a major concern in many parts of the world. Findings are reported from a study conducted to assess the levels of OCPs in an urban area of Kenya and to compare OCP levels in human milk from a previous study in rural areas of the country. 216 milk samples were collected from mothers aged 18-30 years in hospital maternity wards or attending postnatal clinics in selected areas in Nairobi in 1991. All mothers involved in the study were nursing either their first or second child, and had lived in Nairobi for at least 5 years before the date of sampling. Samples were collected from mothers who were up to 4 weeks postpartum and analyzed for the presence of OCP residues. 9 OCPs were detected, with p,p'DDT and p,p'DDE being the most frequently encountered contaminants in all samples analyzed. p,p'DDE was detected in 99.5% and p,p'DDT in 78.2% of all samples. Other residues detected were dieldrin (27%), beta-HCH (18.5%), lindane (12%), and alpha-HCH (8.8%). Levels of sum DDT ranged from 0.004 to 6.321 mg/kg fat. Mothers living in Nairobi have low levels of OCPs in their breast milk compared to mothers in rural areas. The relatively lower urban levels could be attributed to the restricted use of OCPs. People need to be taught how to safely use pesticides.