Two methods of assessing pain intensity in English-speaking and Spanish-speaking emergency department patients

A 13-year-old girl underwent a right salpingo-o-ophorectomy and partial omentectomy for an ovarian tumor that on microscopic examination was a grade 1 immature teratoma. Mature glial implants were found in the omentum (Stage III). No additional treatment was given. Ten months later, grade 0 and grade 1 peritoneal glial implants were found on laparotomy. Chemotherapy with four cycles of vincristine/cisplatin/etoposide/bleomycin was administered. A second laparotomy 4 months later showed persistence of grade 0 and grade 1 peritoneal glial implants. The patient was well for the next 7 years, after which time she presented with a pelvic mass that on microscopic examination was a malignant neuroectodermal tumor resembling a glioblastoma multiforme. The tumor did not respond to debulking and chemotherapy, and the patient died 6 months later, 8 years after her initial presentation. This case represents the second report of malignant transformation of peritoneal glial implants.     

Outcomes for antidepressant trials in late-life depression

Most randomized controlled trials of antidepressant efficacy in older depressive patients use outcome measures similar to those applied in younger patients. Defining subjects as geriatric based on chronological age alone misses the opportunity to study relationships among efficacy, safety, and the range of impairments associated with aging. Assessment of outcomes related to the medical comorbidities and disabilities associated with late-life depression is needed to understand the broad range of treatment effects. Assessment of changes in subjective and objective measures of functioning can address relationships between clinical state and health-related quality of life. Sensitive measurement of the number and severity of comorbid medical illnesses can precisely characterize the study sample and assess the impact of efficacious treatment on medical illnesses. In long-term studies of heterogeneous geriatric samples, use of appropriate outcome measures can determine the effect of efficacious treatment on changes in health status and functional independence.     

An investigation of the feasibility of utilizing GPS/TEC“signatures” for near-real time forecasting of auroral-Epropagation at high-HF and low-VHF frequencies

VHF propagation on ⩽5300 km polar paths has been documented during the maximum phase of sunspot cycle 19. Mode analysis on these polar paths has shown that auroral-E ionization (AEI) supported some modes. Electron densities and plasma frequencies which could support AEI modes at frequencies up to 46 MHz have also been measured. Long distance VHF propagation from AEI has also been reported by radio amateurs using frequencies in the 2 m band in a “sidescatter mode”. An AEI experiment has been in operation between Wales (Alaska) and Fairbanks (Alaska) where a 75-watt CW transmitter located in Wales transmits the Morse letter “R” every 5 s, and a receiver in Fairbanks detects the 25.5 MHz signal whenever AEI is present near the midpoint of the 960 km path. Another experiment is underway using a GPS total electron content (TEC) receiving station at Fairbanks also using AEI data from the Wales-Fairbanks experiment. From this, the authors examine 58 passes of GPS satellites whose E-layer penetration points lie close to the midpoint of the Wales-Fairbanks path and find that there is a threshold value of TEC above which auroral-E (AE) propagation occurs. They also find that AEI propagation is strongly correlated with large- and medium-scale E-region structures in TEC determined by the GPS measurements. When TEC ionospheric structures are not present near the Wales-Fairbanks path midpoint, no AEI signal is received. The authors tentatively conclude that the occurrence of these specific TEC signatures may be utilized as predictors of AEI forward propagation on paths within and parallel to the auroral oval     

Chromosomes of Damaliscus (Artiodactyla, Bovidae): simple and complex centric fusion rearrangements

G- and C-banded karyotypes of Damaliscus hunteri, D. lunatus and D. pygargus were compared using the standard karyotype of Bos taurus. Chromosomal complements were 2n = 36 in D. lunatus jimela, 2n = 38 in D. pygargus phillipsi and D. p. pygargus, and 2n = 44 in D. hunteri. The fundamental number in all karyotypes was 60. Among the three species of Damaliscus, seven autosomal pairs and the X chromosomes were conserved. Y-chromosome differences were attributed to heterochromatic additions or deletions. Banded karyotypes of the two subspecies of D. pygargus exhibited complete homology. Chromosomal complements of D. pygargus and D. lunatus differed by a simple centric fusion. However, karyotypes of D. pygargus and D. lunatus differed from D. hunteri by numerous centric fusions, several of which were related by monobrachial chain complexes. Between the karyotypes of D. hunteri and D. pygargus or D. lunatus, there were two chain complexes, one involving five chromosomes (chain V) and the other involving 12 in pygargus (chain XII) or 13 in lunatus (chain XIII). There were also two simple centric fusions between D. hunteri and D. lunatus/D. pygargus; acrocentric chromosomes 13, 15, 20 and 22 in D hunteri were fused as 13;15 and 20;22 in D. lunatus and D. pygargus.     

Design, synthesis, and biological activity of prazosin-related antagonists. Role of the piperazine and furan units of prazosin on the selectivity for alpha1-adrenoreceptor subtypes

Prazosin-related quinazolines 4-20 were synthesized, and their biological profiles at alpha1-adrenoreceptor subtypes were assessed by functional experiments in isolated rat vas deferens (alpha1A), spleen (alpha1B), and aorta (alpha1D) and by binding assays in CHO cells expressing human cloned alpha1-adrenoreceptor subtypes. The replacement of piperazine and furan units of prazosin (1) by 1, 6-hexanediamine and phenyl moieties, respectively, affording 3-20, markedly affected both affinity and selectivity for alpha1-adrenoreceptor subtypes in functional experiments. Cystazosin (3), bearing a cystamine moiety, was a selective alpha1D-adrenoreceptor antagonist being 1 order of magnitude more potent at alpha1D-adrenoreceptors (pA2, 8.54 +/- 0.02) than at the alpha1A- (pA2, 7.53 +/- 0.01) and alpha1B-subtypes (pA2, 7.49 +/- 0. 01). The insertion of substituents on the furan ring of 3, as in compounds 4 and 5, did not improve the selectivity profile. The simultaneous replacement of both piperazine and furan rings of 1 gave 8 which resulted in a potent, selective alpha1B-adrenoreceptor antagonist (85- and 15-fold more potent than at alpha1A- and alpha1D-subtypes, respectively). The insertion of substituents on the benzene ring of 8 affected, according to the type and the position of the substituent, affinity and selectivity for alpha1-adrenoreceptors. Consequently, the insertion of appropriate substituents in the phenyl ring of 8 may represent the basis of designing new selective ligands for alpha1-adrenoreceptor subtypes. Interestingly, the finding that polyamines 11, 16, and 20, bearing a 1,6-hexanediamine moiety, retained high affinity for alpha1-adrenoreceptor subtypes suggests that the substituent did not give rise to negative interactions with the receptor. Finally, binding assays performed with selected quinazolines (2, 3, and 14) produced affinity results, which were not in agreement with the selectivity profiles obtained from functional experiments. This rather surprising and unexpected finding may be explained by considering neutral and negative antagonism.     

Temporal alterations in mRNA levels for proteinases and inhibitors and their potential regulators in the healing medial collateral ligament

Thrombin elicits responses in platelets such as shape change, aggregation, arachidonate liberation and secretion of the contents of three storage granules, processes that coincide with serine/threonine and tyrosine phosphorylation of numerous proteins, hydrolysis of polyphosphoinositides and mobilisation of Ca2+ within the cell. However, the significance of these parallel signal transduction processes has not been clearly elucidated in the light of the prevalent autocrine stimulation in platelets: a great amplification of the thrombin signal through secreted ADP, by production of thromboxane A2 from the liberated arachidonic acid, by the close cell contact produced by aggregation caused by exposure of integrin receptors that become ligated by fibrinogen and other platelet-produced factors. In the present communication five pathways of autocrine stimulation have been prevented by appropriate inhibitors. Under these conditions thrombin stimulated platelet secretion with little tyrosine phosphorylation, except for a 125-130 kDa protein that was tyrosine-phosphorylated in response to one of the inhibitors, the peptide Arg-Gly-Asp-Ser (RGDS) used to block aggregation. In sharp contrast, collagen elicits massive tyrosine phosphorylation and platelet secretion in the absence of autocrine stimulation. When the thrombin-induced tyrosine phosphorylations was corrected for RGDS-induced phosphorylation, the presence of inhibitors of autocrine stimulation reduced the thrombin-induced phosphorylation by 97%. Our results strongly suggests that tyrosine phosphorylation is not part of the signal transduction pathway initiated by thrombin per se, but it represents an integral part of signal transduction initiated by collagen.     

Detection of human herpesviruses 6 and 7 in heart transplant recipients by a multiplex polymerase chain reaction method

Cystic lesions of the pancreas are relatively uncommon. We describe the case of a young man with a complex cystic mass located within the head of the pancreas. The patient underwent exploration with resection of the mass. Pathology revealed a ciliated epithelial cyst, a rare cystic lesion of the pancreas.     

Serum hepatitis G virus (HGV) RNA in multitransfused thalassemics from eastern Sicily

To evaluate the efficacy of continuous administration of 50% nitrous oxide in oxygen for reducing pain during flexible fiberoptic bronchoscopy 32 children aged 3-60 months were randomly assigned to an experimental or a control group. Indications for endoscopy included persistent atelectasis (6), wheezing (10) cystic fibrosis (2) pneumonia (11) persistent cough (3). All patients received Midazolam (0.3 mg/kg) atropine (20 mcg/kg) intra rectaly 20 minutes before the procedure. The flexible fiberoptic bronchoscope (Olympus BF3C4) was inserted transnasally through a face mask. Topical anesthesia with 1% lidocaine hydrochloride (3 mg/kg) was applied to the nose, larynx, trachea and bronchial tree over 15 minutes through the suction chanel of the bronchoscope. All patients were monitored with a pulse oximeter and a cardiac monitor. The experimental group (n = 16) received 50% nitrous oxide in oxygen prior (3 minutes) and during flexible fiberoptic bronchoscopy, the control group (n = 16) received only oxygen. We measured pain of the children by a behavioral observation scale (Children's Hospital of Eastern Ontario Pain Scale: CHEOPS) at each phase of topical anesthesia during bronchoscopy in the two groups. At the end of bronchoscopy physician's satisfaction was scored by a visual analogue scale (VAS 0-100) in which 0 corresponded to absence of satisfaction. Nitrous oxide was associated with lesser pain scores than those with oxygen. Physician significantly preferred these procedure compared with oxygen. No complication occurred during procedure. Combined with local anesthesia midazolam and atropin the administration of 50% nitrous oxide in oxygen seems a better choice for flexible fiberoptic bronchoscopy in children and should be used routinely.     

Effects of the PIPC model on outcome measures of productivity and costs

The purpose of this experimental research was to determine the effects of the Partners in Care Practice Model (PIPC) on the outcomes of productivity and costs. Over an 18-month study period, no significant differences were found in costs per patient day between the pilot and control units; however, significant differences were found in actual salaries, amount of time spent in documentation, and supply costs. Differences in costs and productivity reflected increased training costs and costs for additional supplies on the pilot unit.     

Hysterosalpingo contrast sonography (HyCoSy) with SH U 454 (Echovist) for the assessment of tubal patency

A total of 88 Fallopian tubes from 44 patients was examined with hysterosalpingo contrast sonography (HyCoSy), hysterosalpingogram (HSG), and laparoscopic chromopertubation (LC) in order to assess their relative accuracy for measuring tubal patency. HyCoSy was done by transvaginal ultrasound and the contrast was SH U 454 (Echovist). The flow of multiple fractions of the contrast medium through each Fallopian tube was observed in real time in appropriate imaging planes by means of a transvaginal probe. Compared with laparoscopic results, we found a sensitivity of 85.2%, a specificity of 85.2%, a positive predictive value (PPV) of 71.9%, a negative predictive value (NPV) of 92.9% and concordance (HyCoSy/LC) of 85.2%, while the corresponding values for HSG were sensitivity = 85.2%, specificity = 83.6%, PPV = 69.7%, NPV = 92.7% and concordance (HSG/LC) of 84.1%. Compared with HSG results, HyCoSy obtained a co-positivity of 66.7%, a co-negativity of 81.8% and a concordance of 76.1%. In conclusion, HyCoSy with SH U 454 proved to be a reliable and safe modality for evaluating tubal patency; it is suitable as an outpatient diagnostic procedure to be used before more invasive procedures.