A new technique for performing Syed-Neblett template interstitial implants for gynecologic malignancies using transrectal-ultrasound guidance

The authors review the literature on intra-adenomatous pituitary apoplexy with special emphasis on pathophysiology, diagnosis and therapeutic approach. They present five cases, from a series of 86 patients with pituitary tumors, that developed this syndrome. The patients were diagnosed and followed by the Neurosurgery and Endocrinology Services of Hospital Universitario Clementino Fraga Filho, Universidade Federal do Rio de Janeiro. Diagnosis was confirmed by CT-Scan and MRI in all cases, and the treatment of choice was surgical. Conclusions point to the diagnostic difficulties and the urgency of treatment in this clinical setting.     

Pharmacokinetics of nicotine carbomer enemas: a new treatment modality for ulcerative colitis

BACKGROUND: Ulcerative colitis is largely a disease of nonsmokers, and transdermal nicotine is of therapeutic value in the active disease. Because side effects are common, we developed a topical enema formulation of nicotine. OBJECTIVE: To study the pharmacokinetics of nicotine complexed with a polyacrylic carbomer and administered by enema to eight healthy volunteers and to eight patients with active ulcerative colitis, verified sigmoidoscopically. PATIENTS AND METHODS: All 16 subjects were nonsmokers. The mean age for normal subjects was 33 years; the mean for patients with ulcerative colitis was 60 years. Median stool frequency for patients with ulcerative colitis was four daily. Patients were taking 5-amino salicylic acid compounds and five were taking oral prednisolone (median dose, 12 mg daily). Nicotine, 6 mg, complexed with carbomer 974P, 400 mg, was administered in a 100 ml enema after an overnight fast, with serial blood measurements taken over 8 hours. Serum nicotine and cotinine were measured by gas liquid chromatography. Area under the concentration-time curves were calculated by the trapezoidal method, and the terminal elimination half-life was derived by extrapolation of the log-linear terminal phase. RESULTS: With the exception of nicotine time to reach peak concentration, which was longer in patients (median of 60 minutes compared with 45 minutes; p < 0.005), other comparisons between normal subjects and patients showed no statistically significant difference, although there was considerable inter-subject variation. Maximum concentration of nicotine, 8.1 +/- 3.5 ng/ml, in the 16 subjects occurred after a median of 60 minutes (range, 30 to 180 minutes); maximum cotinine concentrations of 60.4 +/- 11.5 ng/ml occurred after 4 hours. Side effects in five subjects were mild (four subjects) or moderate (one subject) and included lightheadedness, nausea, and headache; these five subjects were female lifelong nonsmokers of low body weight. CONCLUSION: Because most of the active ingredient of nicotine is converted to continine on the first pass through the liver, substantial concentrations can be achieved at the site of disease with only modest rises in serum nicotine, which are responsible for side effects; cotinine has low pharmacologic activity. Topical administration of nicotine may be useful treatment for distal ulcerative colitis.     

Alternative Australian climate change plans: The public’s views

Climate change has come to the forefront of Australian politics and there is now an active on-going policy debate about how to best reach a commonly agreed long term goal. This paper looks at five major dimensions of this debate and constructs policy options based on them. A discrete choice experiment approach was used with a representative sample from a major internet panel provider. Survey respondents made choices between pairs of policy options with different characteristics. They favored policies starting in 2010 rather than 2012, and spending 20% of revenue raised on energy-related R&D. They were almost evenly split on whether the plan should initially exempt the transport sector and two competing approaches that redistribute revenue from the plan, and, they opposed plans giving special treatment to energy-intensive sectors of the economy. A number of other policy relevant questions related to understanding Australian views and knowledge related to climate change also were asked.     

Some remarks on Gati's theory of career decision-making models.

I. Gati's (see record 1987-05798-001) theory of models of career decision making is discussed in reference to C. Taylor's (1985) theory of evaluation modes. It is suggested that there exist at least 3 basic orientations for making career decisions: optimalizing, questing and instant choice. It is argued that these orientations do not simply represent alternative algorithms for acquiring and processing information related to career decisions, a la Gati, but instead speak to the phenomenologically moral nature of the career decision-making situation in a way that Gati's models do not. Implications for career counseling are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cerumen impaction

Cerumen impaction represents the most common otologic problem encountered by physicians. It can affect up to 6% of the general population and a much higher percentage in the mentally retarded population. Cerumen is a mixture of secretory products of two glands in the external auditory canal where it serves a protective function. The external auditory canal possesses a unique anatomy and physiology that permits an efficient self-cleaning system. In most cases, a breakdown in the epithelial migration of the external auditory canal is thought to cause cerumen impaction. The management of cerumen impaction include direct removal, irrigation, and the use of cerumenolytics.