Leukaemia clusters in Great Britain. 2. Geographical concentrations.

The aim was to test a large set of childhood leukaemia and lymphoma registrations for the presence of short radius spacial clusters. The study was a geographical cluster analysis. England, Wales and Scotland. All registrations for leukaemia and lymphoma between 1966 and 1983 in children aged 0 to 14 years were examined. The records included date and age of registration, sex, diagnosis, and the map reference of the postcode of residence. Of the 9411 registrations, 8888 were suitable for inclusion. There was a significant excess of case pair addresses separated by < 0.5 km. There was also a significant excess of pairs sharing the same postcode. Both findings were based upon comparison with random pairs of postcodes drawn from the Central Postcode Directory. Examination for clustering at this very short range was based upon a clear prior hypothesis derived from the results of a study of space-time interaction, reported in a companion paper. It is postulated that the space-time interaction and the geographical concentrations shown here result from a common epidemic process. The epidemiology of this disease is characterised by short range geographical concentrations, with temporal non-homogeneity superimposed. The findings exclude certain artefacts which remained unresolved in the space-time interaction study. The distributions almost certainly reflect biological processes, and the most probable explanation is in terms of an infective process.


Effect of subject age on costs of screening for colorectal cancer.

The aim was to estimate costs and yields of faecal occult blood screening and rescreening for colorectal cancer, for differing age cohorts. Cost and clinical data were used as the basis for modelling the expected costs, and cost savings, resulting from the treatment of screen detected cancers, as compared with cancers detected by symptomatic presentation. Data were derived from the MRC screening trial currently in progress in Nottingham. Approximately 140,000 subjects, age 50-79 years, were randomly allocated to a test (screened) and a control (unscreened) group. The net costs of detecting and treating a cancer following colorectal screening fall as the age of the target population increases, owing principally to the increasing incidence of the disease with age. Generally, the marginal detection and treatment costs falls for all age groups with the first screening round, but rises considerably with the second. If allowance is made for cancers prevented as a result of early detection and excision of adenomas, the costs of screening are substantially reduced for all age groups. Assuming a cost per QALY (quality adjusted life year gained) equivalent to that derived for the breast cancer screening programme, and a QALY gain from colorectal screening of one year, three screens, each separated by two years, appear economically justified for populations aged 60 years and above. Expected gains from cancer prevention make two screens justifiable for those between 45 and 59 years of age.


A new approach to estimating AIDS incubation times: results in homosexual infected men.

The aim was to develop a new approach for estimating the incubation period of acquired immunodeficiency syndrome (AIDS), based on age distributions. Incubation period was expressed as the difference between age at time of diagnosis and age at time of contamination. Assuming independence between age at time of infection and incubation period, the age distribution of newly diagnosed AIDS cases is thus the convolution product between the distributions of the age of freshly infected patients and of the incubation times. AIDS incubation time can therefore be estimated from the age distribution of newly HIV infected subjects and newly diagnosed AIDS cases. Subjects were 2220 AIDS cases diagnosed until 1987, reported to the Ministry of Health, France, and 172 subjects discovered to be HIV-1 seropositive during a blood donation in Paris between August 1985 and July 1988. In both groups, the only known risk factor was homosexuality. The estimated median incubation time was 9.9 years (90% CI 9.0-10.9 years). Confidence intervals were narrow, even when taking into account the uncertainty in serodetection delay (90% CI 6.7-13.5 years). The incubation estimate is as accurate as previous estimates based on other models. This technique could therefore be applied to other risk groups.


Cost-benefit analysis of a nationwide neonatal inoculation programme against hepatitis B in an area of intermediate endemicity.

The aim was to estimate the costs and benefits of a nationwide neonatal vaccination campaign against hepatitis B in Israel for the 1990-2034 period. Using morbidity, mortality, utilisation, and cost data from Israeli and international sources, a spreadsheet model was constructed to carry out the cost-benefit analysis. The entire State of Israel, an area of intermediate endemicity. The population of Israel from 1990-2034. A policy of immunising all Israeli neonates would, for a cost of $13.8 million, reduce the number of cases of hepatitis B during the 1990-2035 period in the cohort from 359,000 to 166,000 and save the nation around $21.5 million in health resources alone, $16.6 million in averted work absences, and a further $0.6 million in averted premature mortality costs. Even when the savings to the health services ($0.6 million) arising from the reduction in hepatocellular carcinoma are excluded, the direct benefit to cost ratio is 1.51/1, still in excess of unity. The decision to adopt a nationwide neonatal inoculation policy, starting in January 1992, appears to be not only medically but also economically justifiable.


Parity as a correlate of adult female urinary incontinence prevalence.

The aim was to investigate the possible association between parity, as indicated by the number of childbirths, and prevalence of urinary incontinence in an adult female population sample. A sample of 3114 women aged 30-59 years was selected at random from the population of Aarhus, Denmark, and mailed a self administered questionnaire on urinary incontinence and, among other things, parity. A total of 2631 questionnaires was returned (85%) with a slight but significant decrease in respondency by age. The 1987 urinary incontinence period prevalence was 17%. Seventy eight percent were parous, and 24% had had three or more childbirths. In women aged 30-44 years, the prevalence of urinary incontinence was found to be associated with parity and, in women aged 45 years and more, with three or more childbirths. In parous women 30-44 years of age, the prevalence of urinary incontinence increased with age at least childbirth and, in women aged 45 years and over, it increased with increasing parity but decreased with increasing age at first childbirth. In parous women, no association was found with time since last childbirth. Among clinical types of urinary incontinence, stress incontinence consistently showed the strongest associations with indicators of parity. In women aged 30-44 years, nearly two thirds of the 1987 prevalence of stress incontinence could be attributed to parity. These findings support the hypothesis that pregnancy and childbirth are potent causes of female urinary incontinence, so that they exert considerable impact on the level of population urinary incontinence prevalence. In the individual woman, the effect seems to be cumulative and long lasting but fades with age.


Mortality among female manual workers.

The aim was to determine whether female manual workers have higher mortality than other women. This was a retrospective cohort study in which mortality was compared with that of the general female population. Main outcome measures were standardised mortality ratio (SMR) and 95% confidence intervals (CI). Reykjavík region. Participants were 18,878 women, the cumulated members of a pension fund for manual workers between 1970 and 1986. A healthy worker effect was observed in the total cohort. The study was then restricted to those who had contributed to the pension fund any time after reaching 20 years of age, and a 10 year latency period was instituted. When analysing subcohorts by duration of employment the standardised mortality ratios for all causes of death and all cancers increased with longer employment time up to 10 years. However, the ratios were low in the group with over 10 years of employment. Those who began contributing to the fund in 1977 or later had higher mortality than those who began earlier. There was an excess of lung and bladder cancer in the total cohort and in all the subcohorts except in the group with over 10 years' employment. Mortality from accidents and suicides was in excess in all the groups. Mortality is high among some groups of female manual workers. A deficit was found among those with the longest employment. Differences in mortality have widened in recent years. An excess of suicides shows that women in this group have, for some reason, less will to live than other women.


Effects of economic change on male morbidity in neighbouring industrial and rural municipalities in northern Sweden.

The aim was to investigate the health effects of economic changes in a rural and industrial community. This was a historical cohort study with retrospective information on exposure and information on health outcome from a mailed questionnaire (response rate 82.5%). An industrial and a rural community in northern Sweden. Participants included all men born in a rural community and a random sample of men born in a neighbouring industrial community 1915-1924 and alive in 1984 (N = 1989). Morbidity was higher in the cohort born in the rural municipality in which more profound changes in the socioeconomic structure had occurred. Even when taking such factors as childhood deprivation, migration, socioeconomic status, early retirement, unemployment, and single living into consideration, most of the differences in morbidity in the two municipalities still remained. However, the changes in employment conditions alone do not appear to explain the differences in morbidity that were found. The higher morbidity in the rural community indicates a health effect of the profound economic changes in that community but this difference cannot be explained by crude indicators of exposure to migration, unemployment, and other indicators of economic change.


Regional differences in mental health in Great Britain.

The aim was to study the pattern and magnitude of regional differences in psychiatric morbidity and compare these with regional differences in all cause mortality. The study was a secondary analysis of data from a cross sectional survey. The main outcome was the prevalence of psychiatric morbidity. This was assessed using the general health questionnaire, a self administered measure of neurotic symptoms. England, Wales and Scotland. 9003 adults were selected from the electoral register. The prevalence of psychiatric morbidity was 31% with a statistically significant difference between the regions (p = 0.006). All four northern regions of England had a higher prevalence of psychiatric morbidity than the four southern regions. These differences were comparable in size to the regional differences in all cause mortality. Scotland had low psychiatric morbidity but high all cause mortality while Greater London had high psychiatric morbidity but low mortality. Regional variation in psychiatric morbidity was less marked within social classes I and II and among those living in urban areas. Psychiatric morbidity is common and is an important public health problem. Regions with relatively high psychiatric morbidity did not always have relatively high mortality. Knowledge of the causes of these regional differences could ultimately lead to preventive action and be important when distributing health service resources.


Quality of life in the first 100 days after suspected acute myocardial infarction--a suitable trial endpoint?

The aim was to determine the loss of quality of life following admission to hospital with suspected myocardial infarction. The study involved a cohort of admissions, with interview and follow up for 100 days. Main outcome measures were the quality of life prior to admission and at each stage of convalescence, estimated using the Rosser-Kind matrix: the calculated number of quality adjusted days during a 100 d follow up period. The study took place in a teaching hospital in Scotland. 206 patients were admitted with suspected acute myocardial infarction. Infarction was confirmed in 160 (Q wave infarcts 100, non-Q-wave infarcts 60), and unconfirmed in 46. The quality of life scores before the suspected heart attack were similar for patients whose final diagnosis was Q wave infarction, non-Q-wave infarction, or non-infarction. Of the 160 patients with confirmed infarction, only 54 (34%) had regained their previous quality of life scores at the end of 100 days, compared with 26 of 46 (57%) patients with unconfirmed infarction (p < 0.01). The mean numbers of quality adjusted days lost to patients with Q wave infarction, non-Q-wave infarction, and non-infarction were 17.0, 12.4, and 5.9 respectively (infarction v non-infarction, p < 0.0001). Measurements of both quantity and quality of life contributed to these results. The number of quality adjusted days lost after acute myocardial infarction is a practicable measurement that is relevant to patients' lives. It might be suitable as an outcome measure for clinical trials of thrombolytic therapy.


Baseline characteristics are not sufficient indicators of non-response bias follow up studies.

The aim was to examine whether baseline characteristics from a cross sectional survey provided sufficient information regarding non-response bias in a follow up study when compared with information on hospital admissions in the intervening years. This was an 11 year follow up study of a cohort selected in 1974 with register information on hospital admissions during follow up. The study was based on a sample of cement workers from a particular Portland cement factory with suitable controls from other occupations. A total of 1404 men participated in the first survey in 1974, including a questionnaire and lung function tests. In 1985 1070 men were alive and of these, 928 men (87%) responded to a postal questionnaire. Non-responders in 1985 did not differ markedly from responders when smoking habits, respiratory symptoms, and lung function were examined in 1974. During follow up, non-responders had twice as high rates of hospital admission due to respiratory diseases as responders. These differences remained present after adjusting for minor differences in age and smoking habits. Equal distributions of baseline characteristics among responders and non-responders in a follow up study do not preclude non-response bias.


External validation, repeat determination, and precision of risk estimation in misclassified exposure data in epidemiology.

The aim was to quantify the difference in precision of risk estimates in epidemiology between the situations where misclassification of exposure is corrected for by external validation and where it is corrected for by internal repeat measurement. Precision was measured in terms of the expected width of the 95% confidence interval on the odds ratio. In a hypothetical case-control study, first with 100 cases and 100 controls, then with 100 cases and 1000 controls (the latter to approximate the cohort study situation), expected estimated odds ratios and confidence intervals were calculated based on postulated underlying true odds ratios and misclassification error rates. The sizes of the confidence intervals using the two design strategies were compared, based on the same number of subjects receiving internal repeat measurements as were used in the external validation study. Confidence intervals obtained using internal repeat measurement were considerably narrower than those using external validation. Both methods yielded approximately correct point estimates. In terms of precision, it is preferable to correct for misclassification using internal repeat measurement rather than external validation.


Pregnancy after perinatal loss: parental reactions and nursing interventions.

This article summarizes the recent literature on pregnancy after perinatal loss and suggests nursing practice strategies that can be used to assist parents experiencing such a pregnancy. It discusses problems with current theories, models of grief and mourning, and some common myths and applies Peretz's model of types of loss to a pregnancy loss. It describes, too, factors that influence parental response to grief and attachment and nursing interventions that may be appropriate when providing care during a pregnancy that follows perinatal loss.


The use of antibiotic-impregnated polymethylmethacrylate beads to prevent the evolution of localized infection.

The effect of antibiotic bead chains on the evolution of infection cannot be studied entirely in man due to the ethical problems of obtaining valid controls. Therefore, a model of musculoskeletal injury was devised in rabbits by making a paraspinal wound, fracturing a spinous process, and contaminating the wound with 1 x 10(4) colony-forming units/ml of Staphylococcus aureus. These contaminated wounds were treated with tobramycin-containing polymethylmethacrylate (PMMA) beads. Control rabbits were either treated with PMMA beads that did not contain antibiotic, treated with IM tobramycin, or left untreated. At 5 days, six of eight animals treated with antibiotic-impregnated beads had no recoverable organisms. Six of eight rabbits receiving IM tobramycin had wound infections, and five of five in whom non-antibiotic-containing beads had been implanted had significant wound infections, with one of the five dying of sepsis on the 3rd day of the experiment. The clinical course of infected controls was the same as the course of those animals receiving IM antibiotics and the same as those in whom beads without antibiotics were implanted. That is, the rabbits had grossly infected wounds and the organisms recovered were of the same type as those implanted. This research shows a highly statistically significant effect of tobramycin-containing antibiotic beads in retarding the evolution of an experimental Staphylococcus infection in rabbits.


Comparison of closed reduction and percutaneous pinning versus open reduction and percutaneous pinning in displaced supracondylar fractures of the humerus in children.

A retrospective review of 29 children with displaced supracondylar humerus fractures was performed. Fifteen patients treated with closed reduction and percutaneous pinning and 14 patients treated with open reduction and percutaneous pinning were evaluated at a minimum of 18 months (range 18-80 months). Results were graded according to the criteria of Flynn et al. (Flynn JC, Matthews JG, Benoit RL: Blind pinning of displaced supracondylar fractures of the humerus in children. J Bone Joint Surg [Am] 56:263-272, 1974) using both cosmetic and functional evaluations. Excellent or good results were obtained in 14 of the 15 fractures treated with closed reduction and percutaneous pinning and in 12 of the 14 fractures treated with open reduction and percutaneous pinning. The three fair cosmetic results were associated with inadequate reduction and residual medial angulation. Ten to 15 degrees of motion loss occurred in three older patients. One patient in each group had a minor pintract infection. There were no cases of iatrogenic nerve injury or myositis ossificans. The treatment goal in displaced supracondylar humerus fractures in children is anatomic reduction. If an anatomic reduction cannot be achieved with closed reduction, open reduction is indicated. This can be done without an increased risk of complications.


Closed reduction of mallet fractures using extension-block Kirschner wire.

Fourteen cases of mallet fingers with a displaced large fracture fragment and/or a subluxated distal phalanx were treated by closed reduction using extension-block Kirschner wire. The follow-up evaluations took place after a mean of 9 months. The results according to Crawford's criteria were eight excellent, four good, one fair, and one poor. This technique is simple, is easier than other techniques for reduction of mallet fractures, and is associated with a low morbidity.


Prenatal prediction of small- and large-for-gestational age neonates.

To test the predictive accuracy of five fundal height growth curves in the identification of twin gestations and small-, appropriate-, and large-for-gestational age neonates. Retrospective review of prenatal records. Perinatal clinic at a tertiary-care center. Five hundred seven medically indigent women. Fundal height measurements were tested against the limits of normal for each week of gestation on five fundal height curves. Neonates were classified as small-, appropriate-, or large-for-gestational age (based on weight for gestational age), except for twin gestations, which were classified as twins. The accuracy of the predictions depended on which curve was used and what criteria were used to classify fundal height measurements as abnormal. Small-for-gestational age neonates (n = 40) were correctly predicted in 27.5-70% of the cases, large-for-gestational age neonates (n = 74) in 36.5-98.6% of the cases, and all four twin gestations. Clinicians should test the accuracy of any fundal height curve before using it in practice.


Helping infertile couples explore the option of adoption.

Adoption often is considered an ideal option for infertile couples. This article presents topics health-care professionals should address when discussing adoption with infertile couples and delineates interventions for anticipatory guidance once they decide to adopt.


The vertical axis fracture: a report on three cases.

We report on three cases of a rare fracture of the posterior body of C2. This is a variant of the classic traumatic spondylolisthesis and appears to respond to conservative management.


Nursing diagnosis and obstetric, gynecologic, and neonatal nursing: breastfeeding as an example.

Nursing diagnosis is steadily gaining acceptance as the tool to use to communicate nursing's contribution to health care. Historically, however, obstetric, gynecologic, and neonatal (OGN) nurses have had difficulty applying the primarily problem-based diagnoses to a primarily well population. Two nursing diagnoses addressing breastfeeding have been accepted by the North American Nursing Diagnosis Association. The development and use of these diagnoses are discussed in this article. In addition, OGN nurses are challenged to develop other diagnoses that work within the OGN specialties.


Social networks and help-seeking experiences of pregnant teens.

To describe low-income pregnant teens' perceptions of their social network characteristics and their prenatal help-seeking experiences. Descriptive, cross sectional. Prenatal clinic of an urban hospital (n = 29) and two other sites (n = 2). Thirty-one unmarried, low-income, pregnant teenage girls. Social network characteristics, including social support; relationships between social network characteristics and demographic variables; and help-seeking characteristics. Length of pregnancy was negatively correlated with network size (-.45, p = .011), emotional support (-.40, p = .026), tangible support (-.38, p = .033), and prenatal support (-.41, p = .022). Compared with older teens (18-19 years old), younger teens (16-17 years old) perceived their families, relatives, or both as providing a larger proportion of their total support (t(28) = 2.64, p = .014) and prenatal support (t(25.55) = 2.93, p = .007), and friends as providing a smaller proportion of their total support. Types of help most often needed were emotional and financial. The resource most used was the teen's mother, followed by the father of the unborn child. Barriers to help were most often the unavailability of someone on whom the teen relied and financial inadequacies. The perception of less support as pregnancy progresses may indicate a gap between needs and resources. Differences in younger and older teens' support sources and the focus of help seeking on emotional and financial support have implications for nursing care.


Computed tomography-guided fixation of unstable posterior pelvic ring disruptions.

Open reduction and internal fixation (ORIF), the current treatment of choice of posterior pelvic ring disruptions with instability, has significant disadvantages. These include relatively "blind" placement of the fixation screws, infection, exsanguinating hemorrhage, and high wound complication rates. We feel fluoroscopy does not offer significant clarity in defining the posterior structure. Advantages of computed tomography (CT)-guided sacral fixation are direct visualization of the course of the screws and absence of significant wound complications. This technique provides superior visualization of the nerve roots and sacral canal compared to fluoroscopic methods. Thirteen patients (10 unilateral and 3 bilateral) with unstable but reducible sacral fractures or sacroiliac joint (SIJ) disruptions underwent CT-guided posterior pelvic ring fixation using a cannulated screw system. Skeletal traction was required intraoperatively in one case by a traction-counteraction pulley system in the CT scanner. All other reductions were performed by preoperative skeletal traction or manually by the surgeons after anesthesia in the scanner or after push-pull films demonstrated instability. The guide pin, using depth and angulation measurements derived from the scout CT scans, was positioned across the fracture or SIJ. Following CT confirmation of the position of the pin, the screw tract was drilled and the cannulated screw was placed into position. Radiographic and clinical follow-up observation (7-24 months) showed healing with no significant complications in all 13 patients. Computed tomography-guided sacral fixation is a safe alternative to ORIF in selected patients with reducible unstable pelvic fractures.


Moral decision making in neonatal intensive care.

To gain information about the perspective that neonatal intensive-care unit nurses use to make moral decisions. Descriptive. Neonatal intensive-care unit of a large teaching hospital in the midwestern United States. Convenience sample of 26 female nurses working in a neonatal intensive-care unit. Audiotaped, semistructured interviews and demographic questionnaires. The results indicated that most (65%) of the nurses used the care perspective to make moral decisions. A small number (12%) used the justice perspective, and the remaining nurses (23%) used a combined care and justice perspective. Both the care and justice perspectives were found to be important for understanding how nurses make moral decisions.


Heterotopic ossification and other perioperative complications of acetabular fractures.

Thirty-eight operatively treated fractures of the acetabulum were evaluated retrospectively for perioperative complications. Functionally significant heterotopic ossification (Brooker class III or IV) developed in 23% of those patients who did not receive adequate prophylactic irradiation or indomethacin. Irradiation and indomethacin were effective in the prevention of severe heterotopic ossification. The development of severe heterotopic ossification (class III or IV) was associated with increased time from injury to operation. We conclude that prophylaxis against heterotopic ossification is warranted to decrease the incidence of this potentially preventable complication in patients who incur significant time delays prior to surgery. Other significant complications included avascular necrosis (26%), infection (13%), and neural injury (16%). Avascular necrosis developed in one patient who did not have a documented dislocation.


Chronically unreduced traumatic anterior dislocation of the hip: a report of four cases.

Four cases of unreduced (2-11 months postinjury) anterior hip dislocation are reported. One public dislocation 2 months postinjury was treated by open reduction with a fair result. A unique case of iliac dislocation 11 months postinjury, overlooked due to an associated femoral shaft fracture, was treated by valgus/derotation osteotomy. Two obturator dislocations 7.5 and 9.5 months postinjury were treated by a subcapital osteotomy and displacement of the femoral neck into the acetabulum (modified excision arthroplasty). Both of these patients had fairly stable, painless, and mobile hips at 2.1 and 2.8 years follow-up. By our method, subsequent total hip arthroplasty remains a viable option, in contrast to the previously described method of trochanteric osteotomy, whereby the proximal femoral anatomy is distorted.


Operative management of displaced femoral head fractures: case-matched comparison of anterior versus posterior approaches for Pipkin I and Pipkin II fractures.

Because of the controversy surrounding the selection of the surgical approach for the operative management of femoral head fractures, we retrospectively reviewed the combined experience with femoral head fractures at two major trauma centers. Forty-three femoral head fractures in 41 patients were identified. Twenty-six of the 43 fractures were Pipkin types I and II, and were managed operatively. Of the 26 patients, 12 with > 2 years of follow-up were managed with posterior surgical approaches and 12 with anterior surgical approaches. These patients were assessed with respect to operative time, estimated blood loss and function, and the radiographs for reduction, avascular necrosis, and heterotopic ossification. There was a significant decrease in operative time, estimated blood loss, and improved visualization and fixation with the anterior approach; however, there was a significant increase in functionally significant heterotopic ossification. The functional results in the two groups were identical; 67% good and excellent in each. There were no cases of avascular necrosis of the femoral head associated with an anterior approach. Because of the greater ease of access to the fracture, the anterior approach is recommended when operative reduction of a displaced Pipkin type I or II is indicated, but newer methods of minimizing heterotopic ossification must be developed.


Femur fractures in alpine skiers.

From the years 1982 to 1989, 377 patients with alpine skiing-related injuries were admitted to St. Anthony's Hospital (a level one regional trauma center). Fifty femur fractures were recorded in 48 patients: 29 femoral shaft fractures (2 open), 15 hip fractures, and 6 supracondylar fractures (2 open). In the femoral shaft fracture group, the predominant fracture pattern was a short, transverse, comminuted fracture, illustrating the high kinetic energy of the accident. In this group, 11 patients returned to skiing, 7 of whom had hardware in place. Of the 10 Garden femoral neck fractures, 4 progressed to avascular necrosis. Three patients required press-fit total hip arthroplasties. Only 4 of these 10 patients returned to skiing. Median injury severity scores were 9.1 in 345 patients (94%), suggesting isolated trauma. Collisions with trees or poles accounted for 32% (15 patients) of all injuries. Follow-up data on return to skiing was available on 43 patients and of these 19 (44%) returned to skiing.


Intramedullary nailing of the femoral shaft: a prospective, randomized study.

We conducted a prospective, randomized study on 84 consecutive patients with 88 acute, traumatic femoral shaft fractures using 32 Grosse-Kempf nails, 29 Russell-Taylor nails, and 27 Synthes nails. Although total operative times and proximal and distal locking times were similar for the three groups, the procedure was faster with the Grosse-Kempf nail. Three proximal fractures could not be locked with the Synthes nail. At first follow-up, we found no significant difference in terms of pain, limp, range of motion, or time to union; however, we removed fewer Synthes nails to resolve patient complaints of pain. Three delayed unions were attributed to fracture distraction. We conclude that all three nails are suitable for the treatment of almost all femoral shaft fractures. A careful analysis of intraoperative technique and instrumentation indicates that all three nails can be used safely and easily once experience is gained. Clinical outcome is similar regardless of the nail chosen.


Stabilization of pediatric diaphyseal femur fractures with flexible intramedullary nails (a technique paper).

The indications for surgical stabilization of a pediatric diaphyseal femur fracture are expanding. Children with multiple system injuries, a head injury, and/or multiple fractures have fewer local and distant complications if the femur fracture is treated operatively. Other indications include a pathological fracture in osteoporotic bone, a fracture in a child with a preexisting condition that prevents the application of a spica cast, a child older than 10 years of age, or a child less than 10 years of age who cannot be kept adequately aligned using conventional (traction/casting) methods of fracture management. Here we describe a technique of stabilizing pediatric diaphyseal femur fractures using flexible intramedullary nails (Ender). This technique can be used in children of all ages and with all patterns of diaphyseal fractures.


Removal of intramedullary rods after femoral shaft fracture.

We are reporting a retrospective review of the removal of 60 intramedullary rods in 58 patients. All fractures had healed at the time of rod extraction. The implant was removed from 34 asymptomatic patients (36 femurs). Twenty-four patients (24 femurs) had preoperative symptoms attributed to the femoral rod. Fourteen patients had symptoms about the greater trochanter preoperatively, five patients had symptoms referable to the knee, and five had infections about the femoral implant. Problems encountered included broken rods in five femurs, one of which was not apparent on preoperative radiographs. There were six patients (six femurs) who required further hospital care for postoperative hematomas. The development of a significant hematoma was not related to the location of the fracture, the presence of interlocking devices requiring removal, the length of time since injury, the performance of this procedure as an inpatient or outpatient, or the presence or absence of a functional drain. Of the 10 patients (10 femurs) who had proximal heterotopic ossification Brooker stage 2 or greater, wound hematomas developed in four patients (40%). There were no refractures. Although there may be an indication for rod removal, we do not recommend the procedure in asymptomatic patients.


Tension band fixation of medial malleolus fractures.

A prospective study on tension band fixation of medial malleolus fractures was performed on 30 consecutive patients with 31 fractures from October 1987 until December 1990. All patients had at least a displaced medial malleolus fracture unreduced by closed methods. The fractures were classified into small, medium and large using a modified Lauge-Hansen classification. There were no nonunions or movements of wires postoperatively and only two patients had subjective complaints with reference to the wires that required hardware removal. There was one 2-mm malreduction and one patient with a wound slough and subsequent osteomyelitis. One fragment had 2 mm of displacement after fixation but went on to union. A biomechanical study was undertaken to compare fixation of the medial malleolus with K wires alone, K wires plus a tension band, and two cancellous screws. The tension band fixation provided the greatest resistance to pronation forces: for times stiffer than the two screws and 62% of the intact specimen. Tension band fixation of the medial malleolus is a biomechanically strong and clinically acceptable method of treatment for displaced medial malleolus fractures. This method of fixation may be especially useful for small fragments and in osteoporotic bone.


Compartment syndrome of the lower limb caused by a tourniquet: a report of two cases.

Two patients sustained a severe compartment syndrome of the lower limb after surgery under bloodless field for 1 h 25 min and 43 min and with a tourniquet pressure of 350 and 450 mm Hg, respectively. In both cases fasciotomies were performed as an emergency procedure shortly after the initial operation. Renal failure was avoided but functional deficiencies, peroneal weakness, and restricted movements of the ankle resulted in both cases. We conclude that when using a tourniquet, any pre- and postoperative swelling or stiffness of the muscles in the operation area should be noted, even if the recommended time or pressure limits are not exceeded. Immediate fasciotomies of the affected compartments should be considered if the diagnosis is suspected.


In vitro and ex vivo Ca-antagonistic effect of 2-methoxyethyl(E)-3-phenyl-2-propen-1-yl(+/-)-1,4-dihydro-2,6-dimethyl- 4-(3- nitrophenyl)pyridine-3,5-dicarboxylate (FRC-8653), a new dihydropyridine derivative.

The characteristics of calcium antagonism and vascular effect of 2-methoxyethyl(E)-3-phenyl-2-propen-1-yl(+/-)-1,4-dihydro-2,6-dime thyl-4-(3- nitrophenyl)pyridine-3,5-dicarboxylate (FRC-8653) were investigated. FRC-8653 inhibited an increase in intracellular free calcium concentration during membrane depolarization in PC12 cells. FRC-8653 also inhibited the specific binding of 3H-nitrendipine to cardiac membranes, in a similar manner to nifedipine and nicardipine. FRC-8653 inhibited KCl- and CaCl-induced contractions in isolated rabbit aorta, but failed to affect norepinephrine-induced contraction. The vasorelaxing effect of FRC-8653 in rabbit aorta developed more slowly than those of nifedipine and nicardipine. In ex vivo experiment, the inhibitory effect of orally administered FRC-8653 against KCl-contraction in rat aorta lasted longer than that of nifedipine. These findings suggest that FRC-8653 dilates blood vessels by blocking calcium influx via dihydropyridine-sensitive, voltage-dependent calcium channels and that the vascular effects are slow in development and long in duration.


Influence of para substituent of phenol on phospholipid dependence of uridine diphosphate-glucuronyltransferase.

The influence of para substituent of phenol on the property of phospholipid dependence of uridine diphosphate-glucuronyltransferase (UDPGT) was studied using hepatic microsomes of the rats. para Substituents used were p-ethyl, p-tert-butyl and p-phenyl. Glucuronidations of phenol and its derivatives were inhibited with each other. When phospholipids of the microsomes were removed with phospholipase A2, Vmax and Km decreased in the order phenol, p-ethylphenol, p-tert-butylphenol, p-phenylphenol, indicating that this change by delipidation increased with van der Waals volume (Vw) of para substituent. Arrhenius plots of glucuronidation for phenol and p-ethylphenol exhibited a change in slope, responding to thermotropic property of the membrane labelled with 1,6-diphenyl-1,3,5-hexatriene (DPH). In contrast, p-tert-butyl and p-phenyl substituents showed linear Arrhenius plots. The activation energy (Ea) for glucuronidation of p-phenylphenol was increased by delipidation, whereas Ea of other substrates did not show any remarkable change.


An enzyme immunoassay for cell proliferation using monoclonal antibodies directed against a cell proliferation-associated antigen.

An enzyme immunoassay (EIA) for assessment of cell activation and proliferation was developed by the use of monoclonal antibodies (MoAb) directed against a ubiquitous growth-associated antigen, gp125. Test cells distributed in a microtest plate were labeled with anti-rat gp125 MoAb, B3, for rat cells or anti-human gp125 MoAb, HBJ127, for human cells and subsequently with rabbit anti-mouse immunoglobulins. The cell-bound antibody was assessed by a colorimetric enzyme assay using horse-radish peroxidase-modified protein A and 2,2'-azinobis(3-ethylbenzthiazoline sulfonic acid). To terminate the reaction and to make the reaction mixture transparent, sodium dodecyl sulfate (SDS) was added to the mixture. The intensity of the developed color was measured by use of a multiwell scanning spectrometer. The titration curves obtained by the EIA for cells were practically similar to those obtained by the conventional 3H-thymidine (Tdr) uptake method, and the appropriate cell number to be used for the assay was indicated to be 3 to 50 x 10(3) cells per well. This method was applicable not only for quantitation of cell number of growing cells but also for measuring mitogenic responses of lymphocytes as revealed by the data obtained from Con A stimulation of lymphocytes. These results indicate that this new EIA method using anti-gp125 antibodies is useful for quantitative assays of cell growth and cell activation in the research fields of oncology and immunology.


Hypocholesterolemic effect of ursodeoxycholylcysteic acid in hamsters fed a high cholesterol diet.

We studied the effect of feeding ursodeoxycholylcysteic acid, the cysteic acid conjugated analog of ursodeoxycholyltaurine, on serum and liver cholesterol levels and on intestinal absorption of cholesterol and bile salts in hamsters. Addition of ursodeoxycholylcysteic acid to the cholesterol-enriched diet reduced the elevation of serum and liver cholesterol levels caused by feeding cholesterol. However, supplementation with ursodeoxycholylcysteic acid to the standard diet did not show any significant change in serum and liver cholesterol levels. Administration of ursodeoxycholylcysteic acid caused a decrease in dietary cholesterol absorption but did not interfere with the ileal transport of endogenous bile salts. Hence the hypocholesterolemic activity of dietary ursodeoxycholylcysteic acid is thought to be the effect on intestinal absorption of cholesterol but not to be the interruption of the enterohepatic circulation of bile salts.


Study of interaction of pranoprofen with human serum albumin: binding properties of enantiomers and metabolite.

The interaction of pranoprofen, pranoprofen glucuronide and pranoprofen methylester with human serum albumin (HSA), was investigated by equilibrium dialysis and spectroscopic techniques. The binding affinities of pranoprofen glucuronide and pranoprofen methylester to HSA were found to be almost the same, although they were remarkably small as compared to that of the parent compound, pranoprofen. Pranoprofen and pranoprofen methylester showed stereoselective affinities to HSA. It was found from the competitive displacement experiments using the fluorescent probes that the specific binding site for pranoprofen was site II, the diazepam site, and that the binding sites of pranoprofen glucuronide and pranoprofen methylester were site I, the warfarin site. In addition, from the binding data with modified HSA, it seemed that tyrosine-411 was specifically involved in the pranoprofen binding. The absorption spectral changes which accompanied the binding of pranoprofen and pranoprofen methylester to HSA or detergents implied that the HSA binding site of pranoprofen consisted of a cationic site on the surface of the albumin molecule with a hydrophobic region to accommodate the aromatic ring and that the binding site for pranoprofen methylester seemed to occupy a wide hydrophobic area. These limited data indicated differences in the location and microenvironments of binding sites for pranoprofen and its glucuronide on the HSA molecule.


[Dielectric analysis of the rat thyroid gland by modeling the follicle as a key structure].

To correlate the dielectric behavior of the thyroid gland with its follicle structure, I examined the admittance properties of isolated rat thyroid hemilobes over the frequency range from 100 Hz up to 500 MHz. Rats were divided into three groups: control, thyroxine (T4) administered, and goitrogen (propylthiouracil, PTU) administered. In control glands, observed dielectric dispersions with a permittivity increment (delta epsilon) of 60,000 were of the beta-type having two separate characteristic frequencies (fc1 and fc2) around 12 kHz and 3 MHz. In T4- or PTU-treated thyroid, both delta epsilon and fc1 departed from those of control, resulting in the following sequences: For delta epsilon, T4 < control < PTU, and for fc1, PTU < control < T4. These contrasting results were then correlated with morphological features involved. Histomorphometry revealed apparent differences in follicular size distribution between the three groups of tissue. Based on a model analysis using curve fitting technique, I estimated the electrical conductivity of colloid to be about 2 mS/cm, a value 6-fold smaller than that of blood plasma. Another conclusion worthy of note is that the gross dielectric behavior of the thyroid gland can be interpreted only by taking the follicular structure into account.


Compression resistance of four interocclusal recording materials.

Elastomeric impression materials are popular for making interocclusal records to mount casts on dental articulators. The resistance of these materials to compressive forces is critical, because any deformation during the recording or mounting process could result in inaccurate articulation of casts and faulty fabrication of restorations. This investigation compared the deformation of designated thicknesses (2 mm, 5 mm, 10 mm, and 20 mm) for four elastomeric interocclusal recording materials (Blu-Mousse, Stat BR, Ramitec, and Regisil) when subjected to a 25 N compressive load. Compressive distortions of clinical significance were recorded for all of the materials with various thicknesses. The Blu-Mousse vinyl polysiloxane registration material exhibited the greatest resistance to compression for the designated thicknesses, and these resistance values were significantly lower than those of the other recording materials with thicknesses of 5, 10, and 20 mm (alpha < 0.05).


Stresses induced by different loadings around weak abutments.

Stresses and deflections of abutments induced by various loadings were analyzed with a two-dimensional finite element model. The biomechanic system consisted of the mandibular posterior three-unit fixed partial denture (FPD). Four different loading types were analyzed: (1) a distributed force of 600 N; (2) concentrated nonaxial and (3) axial 300 N forces at the marginal ridge of the molar; and (4) a concentrated vertical 300 N force at the center of the pontic. All computations were conducted for three different alveolar bone levels. The premolar exerted a greater pressure during occlusal loadings (except axially) on the alveolar bone than the molar. According to the stresses induced in the alveolar bone, the most critical loading was the distributed force. With diminishing periodontal support, stresses elevated in the biomechanic system and critical increases were noted for the concentrated nonaxial load on the molar.


Use of luting agents with an implant system: Part II.

The purposes of this study were to determine the amount of die space necessary to reduce seating discrepancies of castings cemented onto implant abutments and to determine the effect that this space created for the luting-agent has on crown retention. Noble metal castings were made with 0.000 inch, 0.001 inch, 0.002 inch, and 0.003 inch spacing for premanufactured titanium implant abutments. The castings were cemented onto the abutments with three permanent luting agents. Seating discrepancies of each casting/abutment combination were measured, and the castings were pulled from the abutments by use of tensile force. The results of this study indicate that the use of die spacing decreased seating discrepancies and increased retentive values under the test conditions.


Sealing effectiveness of light-cured glass ionomer cement liners.

Glass ionomer materials have been used as liners or bases beneath restorations, but light-cured varieties have recently been introduced. Microleakage at the restoration/tooth interface in cervical cavities was used to test the adhesion to dentin of two new light-cured glass ionomer cement lining materials, XR-Ionomer and Fuji Lining LC. Wedge-shaped cervical cavities were prepared on extracted teeth with a gingival cavosurface margin involving dentin, and the specimens were assigned randomly to three groups. The experimental groups were restored with two light-cured glass ionomer cements, the controls were restored with a chemically cured glass ionomer cement; and marginal leakage was assessed by dye penetration. The two light-cured glass ionomer cements displayed some adhesion to dentin in class V test cavities, but there was no significant difference between the two materials.


Retention properties of a split-shaft threaded post: cut at different apical lengths.

The retention of the post to the root of an endodontically treated tooth is critical for a successful restoration. Modification of the post length to accommodate a specific clinical situation is common. This study compared the retention of No. 1 and No. 2 Flexi-Post restorations shortened apically from 1 to 5 mm with that reported for full-length control No. 1 and No. 2 Flexi-Post dowels. The experimental material was divided into 10 groups with 10 samples in each group. Retentive values were recorded in pounds with a universal testing machine. Analysis of variance with a Tukey-Student range, multiple-comparison test showed no statistical differences from apical reductions of 1, 2, 3, and 5 mm including the full-length control Flexi-Post No. 1 system. With 4 mm of apical shortening statistically greater retention was recorded. No statistical differences resulted with apical reductions of 1 to 4 mm or with the full-length control Flexi-Post No. 2 system, but 5 mm of apical shortening caused significantly less retention.


The resistance to tensile, compression, and torsional forces provided by four post systems.

This study measured the force required to displace four different endodontic posts (an experimental, Para-Post, Flexi-Post, and V Lock) when tensile, torsion, or compressive forces were applied. Extracted mandibular premolars were decoronated at the cementoenamel junction, the roots were divided into groups of similar size, and the pulpal tissue was removed. The canals were enlarged, cleaned, and filled with gutta percha. Post preparations were made, and the posts were cut and cemented into the post spaces with resin cement. The roots were notched with a separating disc and lowered into a metal tube filled with acrylic resin. Two Minim pins were placed into the coronal dentin paralleling the post. Composite resin cores were made around the coronal 4 mm of the posts and the two pins for 10 specimens from each group. The specimens were placed into a standardized fixture and a load applied until failure. The tensile load required to pull the experimental post and resin was significantly less than the load required to remove the threaded posts. Flexi-Posts provided the greatest resistance to torsion and tensile loading. The compressive load required to fracture the core over the V-Lock post was significantly greater than the other post systems.


Comparison of the shear bond strength of a titanium composite resin material with dentinal bonding agents versus glass ionomer cements.

This study compared the in vitro shear bond strength of an autopolymerizing composite resin system (CR) (Ti-Core) with two third-generation dentinal bonding agents (DBA) (Tenure and Scotchbond 2) to glass ionomer cements (GIC) (Ketac-Silver, GC Miracle Mix, and Ketac-Cem). The experiment was divided in five groups. The shear bond strengths were evaluated on a universal testing apparatus at three different intervals; 15 minutes, 24 hours, and 7 days. Statistically, (two-way analysis of variance), the shear bond strengths from the greatest to least were: Ti-Core CR with Tenure DBA > Ti-Core CR with Scotchbond 2 DBA > Ketac-Silver GIC, GC Miracle Mix GIC > Ketac-Cem GIC. There were no differences in shear bond strengths according to time, and no interactions between groups and time. The shear bond strengths for Tenure DBA with Ti-Core CR were two and a half to three times greater than the silver-filled glass ionomers, Ketac-Silver GIC and GC Miracle Mix GIC. Tenure DBA with Ti-Core CR also had consistently greater shear bond strengths than Scotchbond 2 DBA with Ti-Core CR, and this trend is in agreement with similar research.


Retentive properties of threaded split-shaft posts with titanium-reinforced composite cement.

The retention of posts in tooth roots is vital to the success of the restoration. This study compared the retention of posts of various sizes and diameters cemented with a titanium-reinforced composite cement with that of posts previously reported cemented with zinc phosphate cement. Four groups made up of 10 samples each were used and retention values were compared using a universal testing machine. Two-way analysis of variance and the Newman-Keuls multiple range comparison test were performed. Larger diameter posts cemented with titanium cement had better retention than similar posts cemented with zinc phosphate cement. The statistical increase in retention for the larger size posts is probably the result of the deeper channels (threads) in the dentin and the higher cohesive strength for the titanium-reinforced composite resin.


Endodontic dowel retention with resinous cements.

This study compared the capability of three composite resin cements to sustain a standard endodontic dowel. All of the systems incorporated some form of smear layer removal on the dentin of the endodontic channel. One system that used a methyl ethyl ketone drying agent provided inadequate clinical resistance to dislodgment of 5.4 DaN. A second cementing system that used only smear layer removal resisted loads at 54.7 DaN. The third cementing regimen that included a surface-initiated dentinal adhesive and smear layer removal recorded retention of 77.4 DaN. This study supported the concept that passively cemented dowels with composite resin can be as effective as actively seated dowels.


Masticatory function in patients with extensive fixed cantilever prostheses.

Eleven patients with complete maxillary dentures and 12-unit fixed partial dentures that included the mandibular canines were studied before and during specific intervals after prosthodontic treatment. Established methods for evaluation of oral function were used and the last examination was performed 30 months after treatment. All patients reported that their masticatory function had been substantially improved and there were no symptoms of dysfunction in the masticatory system. Masticatory efficiency improved after the prosthodontic treatment because both the number of cycles before the initial swallow and the total number of strokes including the time for completed mastication diminished after treatment. The occlusal force elevated after the prosthodontic treatment. Although great individual variations were recorded for all occasions and force levels, forces recorded on the extensions of the cantilever were similar to those on the canine regions.


The tooth-removable partial denture interface.

During the metal finishing phase of removable partial denture construction, metal is removed from all aspects of the casting. The amount removed from areas designed to contact prepared surfaces of abutments is critical to the resulting fit of the partial. Castings were evaluated before and during finishing procedures to measure metal loss at the tooth-removable partial denture interface. Finishing and fitting techniques for controlling the loss of metal are presented.


The effect of reducing the number of clasps on removable partial denture retention.

Retention to a master model of 10 nominally identical chrome-cobalt removable partial denture castings with standardized bilateral molar and premolar clasps engaging 0.25 mm (0.01 inch) undercuts and 10 castings with clasps engaging 0.5 mm (0.02 inch) undercuts was measured on an Instron testing machine. The retention of each framework was remeasured as the clasps were removed in one of two sequences. Differences between frameworks, number of clasps, and depth of undercuts were all significant. The order of removal of the clasps was not statistically significant. In a separate experiment the position of the dislodging force was found to be significant. It was concluded that the dislodging force was dependent on (1) the fit of the framework, (2) the depth of the undercut, (3) the number of clasps, and (4) its point of application.


Reinforcement of complete denture bases with continuous high performance polyethylene fibers.

Clinical literature details the causes for deformation and failure of acrylic resin complete denture bases. These findings are used to select patterns of high performance polyethylene fiber reinforcement that would best use the properties of the material and improve the mechanical behavior of the prostheses. A technique is described for making reinforced maxillary and mandibular bases with the fibers placed as suggested by the analysis. Microscopic observations of cross sections of reinforced bases revealed good fiber/resin integration and polish.


A technique for fabrication of interim midfacial prostheses.

The interim midfacial prosthesis uses a rigid backing support with flexible margins and can be made with most types of commercially available medical grade silicone elastomers. The technique may be modified for fabrication of definitive midfacial prostheses. The disadvantage of the technique is that an extra step is required to make a duplicate master cast, and a vacuum adaptor is needed.


Mechanical behavior of three maxillofacial prosthetic adhesive systems: a pilot project.

The use of maxillofacial prosthetic adhesives remains controversial. A new machine for mechanical testing of adhesives was developed. This machine was used for in vivo testing of three adhesive systems to determine the adhesive joint strength of bonding silicone facial prosthetic elastomer to facial skin. Tensile, torsion, and combined tensile-torsion tests were carried out on two human subjects. The three adhesives tested were PSA1, Pros-Aide, and Dow Corning 355. All adhesives were applied according to the manufacturers' instructions. A 900 gm bonding load was applied for 20 seconds. The experimental design made use of two subjects, and the entire experiment was repeated on each subject. One test site on the cheek was used. Adhesive types were compared by means of the Student-Newman-Keuls method. Within the limitations of the design of this pilot study, the results showed that Dow Corning 355 adhesive was statistically significantly stronger than the other two adhesives evaluated by means of tensile and combined tensile-torsional tests. Although the results of the present pilot project are of interest, extrapolation to definitive conclusions of a clinical nature should be avoided.


A study of 589 consecutive implants supporting complete fixed prostheses. Part II: Prosthetic aspects.

In 91 consecutive edentulous patients, 103 jaws were treated with complete fixed prostheses supported by Brånemark Implants (n = 589). As a result of fixture loss in each of two patients (two jaws), an overdenture instead of a fixed prosthesis was installed. For one patient (two jaws), data were not available after abutment connection. At the end of the seventh year, the cumulative failure rates for the remaining 99 prostheses reached 4.9% for mandibles and 10.1% for maxillae. After loading, 12 fixtures showed signs of nonintegration, but only one patient had to revert to complete dentures. Neither the fixture location nor the cantilever length revealed a significant difference in marginal bone loss around the supporting fixtures. Patients with fixture-supported fixed prostheses in both jaws showed significantly more marginal bone loss than did those with only one fixed prosthesis opposed by either natural dentition (50%) or a complete denture (50%). Component complications were limited to fixture fracture (3/564), abutment screw fracture (5/564), and gold screw fracture (7/564). The predictability of Brånemark implants in the treatment of completely edentulous jaws is confirmed.


Occlusal adjustment therapy for craniomandibular disorders: a clinical assessment by a double-blind method.

Fifty-one patients with craniomandibular disorders were divided in two groups. One group underwent mock occlusal adjustment, the other was treated with adjustments to remove significant slides and non-working side interferences. Both groups received identical counseling. The results show that there was no significant difference in the improvements on the signs and symptoms obtained by real or mock adjustments after the first treatment session.


Effect of altered occlusal guidance on lateral border movement of the mandible.

The purpose of this study was to evaluate the effects of a change in the lateral anterior guidance pathway on the lateral border movement pathway of mandible. The results showed that altered occlusal guidance reproducibly and reversibly changed (increased) the lateral border movement area in two subjects who had unilaterally restricted lateral border movements.


The informed consent treatment report.

A brief history of informed consent and introduction of the "Informed Consent Treatment Report" (ICTR) is presented. The ICTR is a document developed in 1984 that combines the requirements of informed consent and the elements of good treatment planning and presentation to achieved improved patient and practice management. An outline of the parts and sections of the ICTR is included as a guide for preparing an informed consent and treatment planning document.


Developing a workable infection control policy for the dental laboratory.

An enforced infection control policy in a laboratory will reduce occupational exposure to blood-borne pathogens and other infectious diseases and protect the dental laboratory personnel from exposure to infective disease. An outline of a workable laboratory infection control policy based on "Occupational Exposure to Bloodborne Pathogens" requirements is presented.


Index to reposition the metal framework accurately on the altered cast.

The relieved portion of a master cast below the major connector of a cast removable partial denture framework can be filled with dental stone to act as a third point of reference when the framework is reseated in an altered cast procedure. With this simple procedure, an index is formed that will allow accurate repositioning of the metal framework on the altered cast.


Common principle of guidance by echolocation and vision.

1. Using echolocation, bats move as gracefully as birds through the cluttered environment, suggesting common principles of optic and acoustic guidance. We tested the idea by analysing braking control of bats (Macroderma gigas) flying through a narrow aperture with eyes covered and uncovered. 2. Though braking control would seem to require rapid detection of distance and velocity and computation of deceleration, simpler control is possible using the tau function of any sensory variable S that is a power function of distance to aperture. Tau function of S is tau (S) = S/S (the dot means time derivative). Controlled braking is achievable by keeping tau (S) constant. 3. Previous experiments indicated the tau (S) constant procedure is followed by humans and birds in visually controlling braking. Analysis of the bats' flight trajectories indicated they too followed the braking procedure using echolocation. 4. The tau function of echo-delay or of echo-intensity or of angle subtended by directions of echoes from two points on the approach surface could be used to control braking. Aperture size was modulated during flight on some trials in an attempt to test between these possibilities, but the results were inconclusive.


Processing of frequency-modulated stimuli in the chick auditory cortex analogue: evidence for topographic representations and possible mechanisms of rate and directional sensitivity.

Responses of units in the auditory forebrain (field L/hyperstriatum ventrale-complex) of awake domestic chicks were studied to frequency-modulated (FM) signals and isointensity tone bursts, presented to the ear contralateral to the recording sites. FM signals, linear frequency sweeps in the range of 50 Hz to 10.25 kHz, differed in the rate of change of frequency (RCF) and in the direction of modulation. The majority of RCF response functions obtained could be classified as predominantly ascending and bell shaped. Best rates of change of frequency (BRCFs), assigned to these functions, covered a range of nearly 3 orders of magnitude. BRCFs of the same units for upward (positive BRCFs) and for downward modulations (negative BRCFs) were correlated. The lowest BRCF encountered among all units for a given isointensity ON-response bandwidth (delta FON) increased as a function of delta FON. delta FON was derived from the responses to tone bursts of various frequencies at 70 dB SPL. As delta FON tended to increase with the best frequency (BF) of units the lowest BRCF encountered among all units for a given BF also increased as a function of BF. Positive and negative BRCFs of a unit were also correlated with the slopes of onset latency-frequency relationships below and above BF, respectively. FM responses were optimal, when the frequency-specific latency differences at a given unit were compensated by the direction and rate of frequency change in the signal. FM-directional sensitivity varied with BF. Most units with BFs below about 2 kHz preferred upward modulations, while those with BFs above 2 kHz preferred downward modulations. Directional preference and sensitivity correlated with asymmetric distributions of inhibitory sidebands around BF, as derived from the analysis of OFF-responses.(ABSTRACT TRUNCATED AT 400 WORDS)


Eye movements and brainstem neuronal responses evoked by cerebellar and vestibular stimulation in chicks.

The vestibulo-ocular reflex undergoes adaptive changes that require inputs from the cerebellar flocculus onto brainstem vestibular neurons. As a step toward developing an in vitro preparation in chicks for studying the synaptic basis of those changes, we have elucidated the organization of the pathways through which the flocculus influences vestibulo-ocular movements. Electrical stimulation of the vestibular ampulla evoked brief, contralaterally directed movements in both eyes. Although single current pulses to the flocculus elicited no response, conjunctive stimulation of the flocculus and the vestibular apparatus significantly reduced the vestibularly-evoked movement. Trains of current pulses applied to the flocculus and ampulla evoked eye movements directed toward and away from the side of stimulation, respectively. Recordings from the brainstem revealed neurons that were activated by ipsilateral vestibular stimulation and inhibited by ipsilateral floccular stimulation. Our sample included neurons in the lateral vestibular nucleus, the ventrolateral portion of the medial vestibular nucleus, and the superior vestibular nucleus. Similarities between these findings and those of similar studies in mammals indicate that the chick will provide a good model system for cellular studies of adaptive changes in the vestibulo-ocular reflex.


Effects of lesion of the inferior olivary complex by 3-acetylpyridine on learning and memory in the rat.

DA/HAN-strained male rats (pigmented rats) were submitted to two experimental tasks consisting of spatial learning (water-escape) and a passive avoidance conditioning. Both these tasks were performed by different animals. In order to destroy the inferior olivary complex, the animals were injected with 3-acetylpyridine either 9 days prior to the initial learning session or 24 h after completion of the learning task. They were retested (retrieval test) 10 days after the initial learning was achieved. Learning and retention were compared to those noted in control rats. Administration of 3-acetylpyridine before the initial learning did not prevent the spatial learning but the scores were greatly altered and the number of trials needed to reach the fixed learning criterion was much greater than in controls. However, 10 days later the animals had memorized their initial experience. Injection of 3-acetylpyridine after the initial learning session impaired memory: the animals had completely forgotten their initial learning. It can therefore be concluded that lesion of the afferent climbing fibres to the cerebellar cortex alters learning and retention of a spatial task. Such a lesion does not interfere with learning and retention of a passive avoidance conditioning, since in this condition the experimental animals injected with 3-acetylpyridine either before or after the initial learning behave similarly to controls. The effects of the inferior olivary complex lesion are obviously different according to the task to be learnt, suggesting that these two tasks do not require the integrity of the same nervous structures.


Development of brainstem auditory pathway in mallard duck embryos and hatchlings.

The development of the brainstem auditory evoked potential (BAEP) was studied in mallard duck (Anas platyrhynchos) embryos and hatchlings from 5-6 days before hatching through two days after hatching in response to tone pips of different frequencies. BAEPs showed a different time of onset and a different rate of development for low, middle, and high frequencies. Although auditory sensitivity in the mid-frequency range (1.0, 1.5, 2.0, and 3.0 kHz) appeared 1-2 days later than in the low-frequency range, development of the BAEPs in the mid-frequency range was almost complete by hatching. In contrast, the development of auditory sensitivity in the low- and high-frequency ranges continued to develop after hatching. Accelerated development of BAEPs to middle frequencies during the embryonic period and to high frequencies after hatching was correlated with the ducklings' exposure to their own mid-frequency and high-frequency vocalizations before and after hatching, respectively.


Pilot study results: the psychiatric RN case manager.

1. It is important to examine client and staff satisfaction with the RN case management (RNCM) model to enhance the quality of care in psychiatric settings. 2. Ninety-two percent of clients surveyed ranked the RNCM care as "excellent" or "above average." Clients valued most the humanistic role of the RNCM and repeatedly commented on the importance of the nurse being caring, genuine, and supportive. 3. RNCMs expressed high satisfaction with their role, which they described as collaborative with the psychiatrist, yet also professional and independent. Psychiatrists expressed a high degree of confidence that clients were receiving excellent care by competent nurse professionals.


Daily light exposure among psychiatric inpatients.

1. The light environment is a key element in the restoration and maintenance of health. 2. People need exposure to bright light (greater than 2,000 lux) to synchronize their circadian rhythms. 3. The affective state of people is related to their light exposure. 4. Bright light among psychiatric inpatients is low. Interventions to increase light exposure in therapeutic environments and individual care plans are recommended.


The use of antidepressants with elderly patients.

If we are to prevent treatment failures, we should eliminate the schism between psychosocial and biological treatments. Most depressed patients require both psychosocial and biological treatments. The patient who responds to biological treatment but does not make appropriate corrections regarding current environmental factors is at an increased risk for relapse. A strong support system can have an important preventive effect without the risks involved in long-term medication maintenance therapy. After a correct diagnosis of a major depressive disorder is made in elderly patients, the dosage of antidepressants should only be about half of the standard adult dose. Preference should be given to those antidepressants with a therapeutic profile appropriate to each particular patient. The antidepressant should have few side effects. Although antidepressant drugs are effective in treating depression, their demonstrable efficacy is surprisingly limited. Because of suicide risk and physical illnesses, older patients are more likely to require electroconvulsive therapy than younger patients. The presence of somatic delusion is a good predictor of positive response. Newer antidepressants have not been proven more effective than the older agents, such as imipramine or amitriptyline, in treating mild or severe depressions. However, they have fewer or varied side effects and therefore they are better tolerated by elderly patients (Figure 6). The consideration of side effects is a major determinant in choosing an antidepressant for a specific elderly patient. Research into the effectiveness of antidepressants has been limited by the existence of heterogeneous groups of depression and by the different therapeutic responses.(ABSTRACT TRUNCATED AT 250 WORDS)


The mental health of African-American and Caucasian-American women who are homeless.

1. Nurses can use research findings to educate other health professionals about homeless subcultures with attention to specific cultural and socioeconomic needs, as well as to develop interventions for homeless women. 2. Minority women are more susceptible to homelessness as they experience increased poverty levels and are often single mothers. Of all minority women, African-American women are the most vulnerable to physical and psychological illness. 3. In this study, 75% of the subjects had scores on a psychological assessment test that indicated they needed additional psychological testing.


Early detection of water intoxication.

1. It has been estimated that between 3% and 6% of patients in psychiatric treatment settings are affected by water intoxication. Water intoxication with consequent hyponatremia can result in disturbing clinical conditions. 2. Early detection is an important factor because of the insidious nature and rapid development of this syndrome. 3. A risk analysis for the early detection of this serious condition has been developed. It is easily administered and effective in categorizing a patient's level of risk.


'Til death do us part: intimacy and sexuality in the marriages of Alzheimer's patients.

1. Alzheimer's disease (AD) is likely to have a significant effect on sexual behavior, but both patient and partner will still have sexual feelings and needs. 2. Research has shown that a high proportion of men with AD develop erection problems, but causes of their erection difficulties are not understood. 3. Research has shown that inappropriate sexual behavior in AD patients is uncommon, although it can be very troubling to the family and health-care provider if it occurs. 4. More professionals need to be trained to discuss sexual issues openly and sensitively with AD patients and partners and to offer useful clinical suggestions.


Establishing therapeutic alliance across cultural barriers.

1. The therapeutic alliance is a mutually defined helping relationship that encompasses mutual respect and acceptance of ethnocultural variance, predicated upon empathic rapport. 2. Sensitivity to two psycholinguistic phenomena may help establish a transcultural relationship: the detachment effect (limited expression of affect and reduced access to developmental events between languages) and code switching (a complete or partial change of language or dialect within a single utterance or conversation). 3. Issues related to differing sociocultural expectations of nurses and clients will be increasingly encountered as ease of travel combines with economic and political unrest to produce increasing numbers of displaced persons.


Nursing care challenges: homosexual psychiatric patients.

1. Stereotypes of homosexual behavior may negatively affect the nursing care for homosexual patients. Nurses must closely examine their attitudes toward homosexuals. To be able to provide quality care to homosexual patients, nurses must feel comfortable and fully aware of their own attitudes toward sexuality and homosexuality. 2. Nurses stand in a unique position to foster acceptance of homosexuality by assuming the advocacy role and addressing the stereotypes regarding homosexuality for both individual clients and the community. 3. Nurses need to provide an atmosphere of acceptance for homosexual patients by creating an environment where sexuality can be discussed in nonthreatening ways.


A target weight procedure for disordered water balance in long-term care facilities.

1. Water intoxication is a severe complication of disordered water balance. Hyponatremia precedes water intoxication and can be identified through abnormal diurnal weight variation. 2. The St. Louis Target Weight Procedure (STWP) is a nonintrusive method that includes a client's baseline weight, frequent weights throughout the day, a target weight of 5% above the baseline weight, and restricted fluids if the target weight is exceeded. 3. The STWP was positively related to an increase in urine concentration; thus it is successful in restoring normal fluid balance.


The psychiatric technician: trespasser or welcomed ally?

1. The increasing shortage of nurses, higher patient acuity levels, and greater demands placed on nursing to meet standards of care have contributed to the use of psychiatric technicians to alleviate the burden on nursing and ensure the delivery of quality patient care. 2. Psychiatric technicians provide care for a select group of patients under the supervision of the primary nurse. The patients assigned to psychiatric technicians require minimal direct nursing intervention. 3. Psychiatric technicians reported increased self-confidence and self-esteem; the nurses were able to perform more professional nursing activities, increasing their job satisfaction and promoting staff retention; and the patients received high-quality care.


Adherence and accuracy. Self-medication during inpatient psychiatric treatment.

1. The goals of the Medication Education and Self-Administration Program were to develop a way to assess inpatient self-medication accuracy; create a comprehensive intervention that would address individual characteristics that may produce nonadherence; and evaluate the effectiveness of the intervention. 2. The majority of program participants demonstrated significant errors within days when given the opportunity to administer their own medications, suggesting that participants' in-hospital self-administration may be an accurate predictor of postdischarge performance. 3. Even in cases where training failed to influence self-administered performance, program participation provided valuable information that guided subsequent treatment decisions and programmatic refinements.


Dysfunctional grieving.

Dysfunctional grieving represents a failure to follow the predictable course of normal grieving to resolution (Lindemann, 1944). When the process deviates from the norm, the individual becomes overwhelmed and resorts to maladaptive coping. The process implies movement toward assimilation to or accommodation of the loss, resulting in progression toward social, psychological, and medical morbidity. Nurses will better assess the needs of the client with adequate information about the client's recent losses and perception of those losses. Such an assessment, in conjunction with an understanding of the signs, symptoms, and predisposing factors of complicated bereavement, will enable the nurse to develop a plan of effective intervention. Both case examples illustrate unresolved grief. In Case Example 1, the patient denied the importance of the relationship, which became masked with displaced anger and therefore delayed the grieving process. In Case Example 2, the patient's attempts at grieving over the loss of her son were complicated by her long-standing struggle with her husband's infidelity at the time of her pregnancy. The revelation of secondary loss is common in dysfunctional grieving. Resolution of grief encompasses not only accommodation to object loss, but also change in the pathological behaviors incorporated into the patient's self-image as a result of the loss (Lazare, 1979). The maladaptive operations employed by these patients to preserve self-image were discarded as the grief resolved. The focus of therapy included the loss of those behaviors as they were relinquished to prevent the patient from experiencing further anxiety and sense of loss (Zisook, 1987).(ABSTRACT TRUNCATED AT 250 WORDS)


An evaluation of the Royal Air Force helicopter search and rescue services in Britain with reference to Royal Air Force Valley 1980-1989.

The Royal Air Force (RAF) operates a helicopter Search and Rescue (SAR) service in the United Kingdom and territorial waters; it also provides a similar service in several locations abroad. A 10-year retrospective study of the SAR helicopter service operating from the RAF base at Valley on the island of Anglesey in North Wales is presented, with national SAR statistics over a similar period provided for comparison. Analysis of records kept by SAR aircrew at RAF Valley shows that their assistance had been requested on 1490 occasions during the 10-year period studied; most of these requests were the result of incidents involving holidaymakers, particularly in the mountains or along the coast. The results illustrate the versatility and life-saving potential of a highly skilled and motivated service able to work in adverse weather and dangerous locations. In the light of current debate, the value of aeromedical evacuation of seriously ill patients using helicopters is discussed.


Treatment of leg ulcers.

A system of treatment of venous leg ulcers by leg elevation, dry gauze dressings and inelastic bandage boots is compared with regimens in which a series of elastic bandage boots are applied to squeeze oedema from swollen ulcerated legs.


The role of the fifth digit in music: discussion paper.

The increasing digital skill made manifest in the development of instrumental music is reviewed and supports the hypothesis that the fifth digit was belatedly used even when a suitable instrument had already become established. With notable exceptions, such as the harp, it appears that progressive improvements in instrument design was influenced by the need to utilize the fifth digits. Its greater use was accomplished in overlapping stages of increasing dexterity, of which the highest is exemplified by the left hand of the violinist. The apparent evolutional background of these observations is discussed. It is proposed that man has an inherent atavistic tendency to ignore the fifth digit and this view agrees with its neglect in gesture and sign language.


Real-life performance considerations of four pediatric multi-channel cochlear implant recipients.

Most pediatric cochlear implant programs support a team approach for post-implant services. However, individuals directly involved in the care of these children often have differing opinions on the child's performance. We describe our experience with four children, aged 3 to 10 at the time of implantation, who have used the Nucleus 22-channel cochlear implant device for at least nine months. A questionnaire, focusing on the individual's observations of the child's speech and hearing performance in their particular setting (i.e., clinic, home, school), was completed by the child's parent(s), therapist and classroom teacher. Overall, performance in structured settings (i.e., testing and therapy sessions) was not in agreement with performance in unstructured settings (i.e., classroom and home environments). The results suggest that different individuals interacting with the same child in different environments often have differing perceptions of the child's performance. Based on the information obtained on the four cases, we discuss factors to consider in assessing the real-life performance of pediatric cochlear implant recipients.


Down syndrome: an otolaryngologic perspective.

The otolaryngologic manifestations of Down syndrome often masquerade as common and seemingly trivial conditions. Behind this facade lies a broad spectrum of disease which can detract from an inherently diminished level of function and jeopardize survival. This paper examines the pertinent associations between Down syndrome and various pathological entities related to the head and neck. Evaluation of current therapeutic modalities reinforces the need for early diagnosis and treatment so that the potential of this patient group is fulfilled.


Practical aspects of managing non-malignant lumps of the neck.

The etiologies of pediatric neck masses are legion. Optimal management depends upon making the correct diagnosis. A detailed history to ascertain the duration of the illness, presence of systemic symptoms, animal exposures, tuberculous contacts, medications ingested, recent trauma, dental work or upper respiratory infection (URI), as well as a travel history, may yield important clues to establishing the diagnosis. The work-up for neck masses must be individualized based upon history and physical examination. Common diagnostic studies often obtained are listed in Table 1, and will be further clarified as individual diagnoses are discussed.


Failed tracheotomy decannulation in children.

Airway lesions preventing tracheotomy decannulation may not always be readily apparent or may be underestimated by the inexperienced observer. Examples of tracheal keloid, tracheomalacia due to vascular compression, vocal cord dislocation and fixation and subglottic webbing with emphasis on the need for meticulous endoscopy are demonstrated.


Practical aspects of pediatric tracheotomy care.

Infants and children who manifest respiratory distress secondary to congenital or acquired abnormalities of the airway pose a unique problem that frequently requires a tracheotomy to control the patient's airway. These tracheotomies often are required for extended periods of time. Skilled care and astute observation are essential for the care of these patients while in hospital and at home. Although many of the care concerns relate to nursing and social issues, the otolaryngologist must maintain an active role in the medical management and co-ordination of discharge. This paper provides the otolaryngologist with an outline of the hospital care required for the pediatric tracheotomy patient. Additionally, it offers the otolaryngologist a model program for discharge planning and follow-up for the pediatric tracheotomy patient in the community.


Evaluation and management of the drooling patient.

Drooling, or sialorrhea, may appear to be a most mundane problem but in fact can be a condition with a wide spectrum of etiologies. Unhappily, drooling also may lead to several unfortunate medical and psychosocial outcomes for the affected patient. The senior author (WSC) has had a 13 year interest in the treatment of drooling patients. This paper is essentially a distillation of the experience gained in managing these patients. Since 1979 he has participated in a team (which includes an otolaryngologist, a dentist and a speech pathologist) that attends these patients and makes recommendations in a consensus fashion. This team concept, as well as historical and physiologic background material, will be discussed below.


Subglottic hemangioma: a practical approach.

A specific entity known as a subglottic hemangioma may present in a six to 12-week-old baby with gradual onset of a two-way stridor. A cough may be present. The voice and feeding may be normal, until severe airway obstruction occurs. A barium swallow with fluoroscopy should be performed by a radiologist or technician experienced with babies to rule out other lesions such as a vascular ring. Direct examination is then performed using a 3.0 mm Storz-Hopkins bronchoscope under general anesthetic as a method of choice. Other methods are discussed. Ideal treatment is probably best undertaken in a large center, using a carbon dioxide laser through a subglottiscope again under general anesthesia with the child breathing spontaneously. Airway support may be necessary at any stage. Alternative treatments are discussed.


Salivary gland disease in infancy and childhood: non-malignant lesions.

The differential diagnosis for benign lesions of the salivary glands in infancy and childhood can be somewhat overwhelming, especially in light of their infrequent occurrence in a general otolaryngologic practice. The purpose of this review is to discuss these conditions under the headings of inflammatory conditions, immunologic disorders, granulomatous disease, trauma, cysts, systemic disorders and benign neoplasms. Basic techniques of diagnosis and treatment as they apply to children will be outlined.


Practical aspects of managing the child with apnea.

Sleep apnea is a common problem in children and probably more common than currently realized. Apnea in children may be central, obstructive or mixed. Otolaryngologists are called upon to diagnose and treat obstructive apnea. The most common cause of obstructive apnea in children is adenotonsillar hyperplasia, and several conditions predispose children to sleep apnea. The most severe, and occasionally only, signs occur during sleep. The majority of children can be diagnosed by a careful history from parents or caretakers. However, sleep sonography, pulse oximetry and polysomnography may be needed to assist in diagnosis. The treatment of apnea in children may include medications, but the most common procedure employed to resolve obstructive apnea in children is adenotonsillectomy.


Differential bacteriology in adenoid disease.

In order to define the differential bacteriology in adenoid disease, adenoids were obtained from 10 children with adenoid hypertrophy and 29 children with chronic adenoiditis. The patients' ages ranged from 18 months to 13 years. After removal of the adenoids, the surface organisms were destroyed by alcohol and flame disinfection. One gram of tissue was sampled for aerobic and anaerobic culture. There was an average of 4.8 isolates per specimen, with 4.2 aerobes and 0.6 anaerobes. The most common isolates were: Haemophilus influenzae (84%), diphtheroids (66%), non-pathogenic Neisseria species (66%), alpha-hemolytic streptococci (64%) and non-hemolytic streptococci (59%). Anaerobes were present in 56% of all cases. The distribution of organisms was similar, regardless of clinical diagnosis. Only eight (21%) of the 39 cases had 'significant' (> or = 10(5) organisms/gm) colony counts. Our study detected no difference in either organism distribution or in total colony counts in chronic adenoiditis vs. adenoid hypertrophy.


Paroxysmal sneezing in children: two new cases.

Paroxysmal sneezing is an uncommon condition primarily affecting adolescents. Most of the reported cases were thought to be psychogenic, and only two were felt to be due to nasal sensitivity. This paper reports two adolescents with paroxysmal sneezing, neither of whom had apparent psychologic or emotional problems. In one child the sneezing continued during sleep. The other child was successfully treated with topical nasal anesthesia. Both children were felt to have nasal sensitivity as the etiology of their paroxysmal sneezing. The evaluation of the patient with paroxysmal sneezing requires a thorough history and physical examination. One must not assume that every case of paroxysmal sneezing is of psychogenic origin. Topical nasal anesthesia should be tried for control of intractable paroxysmal sneezing.


The effect of peritonsillar infiltration on intra-operative blood loss in children.

Infiltration of the peritonsillar space in one group of patients with lidocaine 0.5% containing epinephrine (Group I) and with normal saline in another (Group II) did reduce the intra-operative blood loss significantly compared to the control group (Group III) who did not get any injections. The benefits of reducing intra-operative blood loss in children is discussed.


Fibrosarcoma of the infratemporal fossa in childhood: a challenging problem.

Fibrosarcoma in childhood is a rare disease. An interesting new case involving the infratemporal fossa in a three-year-old girl is reported. The literature, the symptomatology and the diagnostic features are reviewed. The difficult management decisions and the thorny problem of reconstruction of head and neck malignancies in growing children are discussed. Suggestions are made for management of similar cases.


Fourth branchial cleft cyst.

Remnants of the fourth branchial arch are uncommon clinical entities. They may present in either the neck or chest in association with aortic arch development. They are encountered more frequently in younger individuals as an asymptomatic left-sided neck mass, recurrent neck abscess or suppurative thyroiditis. In view of the rarity of this lesion, we thought it worthwhile to present the case of a 25-year-old female with a diagnosed fourth branchial cleft cyst in her left lower neck. The embryology and management of these cases is discussed.


Pediatric laryngeal granular cell tumor.

Granular cell tumor of the larynx is an uncommon, benign tumor which has rarely been described in the pediatric population. Fewer than 10 cases in children under the age of 10 years have been reported. This paper describes two pediatric patients: An eight-year-old boy with a seven-year history of hoarseness due to an anterior subglottic tumor, and an 11-year-old boy with a one-year history of hoarseness due to a left true vocal cord tumor. Subglottic involvement by laryngeal granular cell tumor is rare in adults, but has been seen in half of the reported cases in the pediatric population. The clinical course of granular cell tumor and its pathology are reviewed.


The hazards of button batteries in the nose.

Foreign bodies in the nose are commonly encountered in ORL practice. Miniature button battery impaction in the nose has rarely been reported. Seven such cases have been encountered, each suffering complications directly attributable to the button battery. The complications included septal burns in five patients leading to septal perforation in one child, one case of severe nasal bleeding and one case of necrosis of the lateral nasal wall. The site of maximal damage corresponded with the negative pole of the battery in every case. The possible explanation for this and mechanisms of cellular injury are proposed. This paper underlines the potential hazards of button batteries as foreign bodies in the nose and emphasizes the need for rapid removal and long-term follow-up of these patients.


New scoring system for prediction of ovarian malignancy based on transvaginal color Doppler sonography.

The goal of this prospective study was to develop a new scoring system using transvaginal color and pulsed Doppler characterization of ovarian lesions. Transvaginal color Doppler sonography was performed on 812 women, among whom 174 adnexal masses were found and analyzed. Ovarian lesions were assessed by means of morphological and color Doppler scoring systems. Tumors were characterized ultrasonically as benign or suspected of being malignant. Scoring system results were correlated with histopathological findings. Among our study group, 38 malignant and 136 benign ovarian tumors were found and verified. The color Doppler scoring system was very useful in distinguishing benign from malignant masses, with a sensitivity of 97.3% and a specificity of 100%, compared with the morphological scoring system's sensitivity of 92.1% and specificity of 94.8%. We also evaluated a combination of both scoring systems. We believe that new color Doppler scoring system maximizes the ability to discriminate between benign and malignant entities.


Intrarenal Doppler: characteristics of aging kidneys.

The normal range of Doppler findings in native kidneys has not been studied extensively. This study correlates changes in Doppler resistive index (RI) with age in patients without renal risk factors or renal disease. Young and old patients demonstrated the highest RI values (age < 1, mean RI = 0.73; age > 59, RI = 0.68), and patients in the 20-39 year age group showed the lowest values (RI = 0.59). The mean RI for all ages was 0.63. The cause of this variability is unknown. We suggest that age-related changes in Doppler values should be considered in the interpretation of renal Doppler measurements.


Spontaneous improvement of intrathoracic masses diagnosed in utero.

The diagnosis and pregnancy outcome for 14 fetuses with sonographically detected chest masses were reviewed retrospectively. Six lesions became smaller or less apparent during gestation or resolved between antenatal and perinatal imaging studies; these included all three types of cystic adenomatoid malformation (CAM), as well as one case of pulmonary sequestration (PS). This information is extremely important in counseling patients in the second trimester who are considering termination of pregnancy. The poor prognosis traditionally assigned to type II and type III CAM needs changing to reflect the phenomenon of improvement with excellent long-term outcomes. Sonographic indicators of poor outcome were polyhydramnios, hydrops or marked cardiac deviation.


Fetal stomach measurements: not reproducible by the same observer.

We hypothesized that because fetal stomach filling and emptying is a dynamic process, measurements of the stomach dimensions might not be reproducible. Serial measurements 20 minutes apart were made of the stomach in 146 fetuses at 14 to 41 weeks of gestation. In 88 of these fetuses, the biparietal diameter also was measured to provide a standard for comparison. The mean percentage change between each of the paired measurements was 16.6% to 43.1% for the different stomach dimensions, compared with only 2% for the biparietal diameter (P < 0.001). We suggest that caution be excised in the diagnostic use of stomach measurements owing to their dynamically changing nature.