Continuing education for general practice and the role of the pharmaceutical industry.

A survey of the involvement in and attitudes towards continuing medical education of 101 general practitioners achieved a 95% response rate. Ninety per cent of the 96 doctors worked in practices which held meetings the content of which was organized by representatives of pharmaceutical companies but only 46% worked in practices which organized their own educational meetings. Seventy six per cent attended meetings away from their practice which were organized by drug companies and 75% had attended at some time continuing medical education activities organized by a local postgraduate centre. The promotional aspects of the drug company organized meetings were disliked by a majority of respondents (58%); more of the trainers (62%) and more of those who had entered general practice within the last seven years (71%) disliked this aspect. Nonetheless the educational content of both meetings held in the practice and those held elsewhere was the aspect most liked by over half of the respondents (59% and 53% respectively). Only 16% of all respondents thought that visits by representatives from pharmaceutical companies were educationally valuable and 37% thought that educational events organized by these companies were of value. Surprisingly 60% of those who worked in practices which held meetings organized by drug company representatives thought them to be of little or no educational value. There is clearly a need for practice based continuing medical education but the current level of dependence on drug companies for organizing these meetings must be questioned. Alternative strategies for the provision of independent non-sponsored educational activities should be sought.     

Gain of 1q and loss of 22 are the most common changes detected by comparative genomic hybridisation in paediatric ependymoma

Ependymomas are the third most common brain tumour in the paediatric population. Although cytogenetic and molecular analyses have pinpointed deletions of chromosomes 6q, 17, and 22 in a subset of tumours, definitive patterns of genetic aberrations have not been determined. In the present study, we analysed 40 ependymomas from paediatric patients for genomic loss or gain using comparative genomic hybridisation (CGH). Eighteen of the tumours (45%) had no detectable regions of imbalance. In the remaining cases, the most common copy number aberrations were loss of 22 (25% of tumours) and gain of 1q (20%). Three regions of high copy number amplification were noted at 1q24-31 (three cases), 8q21-23 (two cases), and 9p (one case). Although there was no association with the loss or gain of any chromosome arm or with benign versus anaplastic histologic characteristics, the incidence of gain of 7q and 9p and loss of 17 and 22 was significantly higher in recurrent versus primary tumours. This study has identified a number of chromosomal regions that may contain candidate genes involved in the development of different subgroups of ependymoma.     

Molecular analysis of <Emphasis Type="Italic">Fiji disease virus</Emphasis> genome segments 5, 6, 8 and 10

Summary. The complete sequences of Fiji disease virus (FDV) genome segments 5 (S5), S6, S8 and S10 were obtained and comprised 3150nt, 2831nt, 1959nt and 1819nt, respectively. Each segment contained a single ORF which encoded putative proteins of 115kDa, 97kDa, 69kDa and 63.0kDa, respectively. The putative amino acid sequences encoded by S5 and S6 contained putative leucine zipper motifs while FDV S5 and S8 each contained an ATP-GTP-binding motif. At the amino acid level, FDV S5, S6, S8 and S10 showed most similarity to the corresponding segments of Rice black-streaked dwarf virus. Based on sequence similarities, it is predicted that FDV S8 encodes a minor core protein, while FDV S10 encodes an outer capsid protein. The evolutionary relationships of FDV to other reoviruses are discussed.The nucleotide sequence data for FDV S5, S6, S8 and S10 are available in the DDBJ/EMBL/GenBank databases under the accession numbers AY029521, AF356083, AY297693 and AY297694, respectively.     

Androgen receptor blockade in the MPOA or VMN: effects on male sociosexual behaviors

Previously, our laboratory has shown that androgen receptors in the medial preoptic area (MPOA) and ventromedial nucleus (VMN) are necessary for copulation in male rats. The present study examined whether these receptors are required for other sociosexual behaviors. In Experiment 1, different regions of the VMN were implanted with the antiandrogen hydroxyflutamide (OHF). We found that implants located in anterodorsal portions of the VMN were more effective at inhibiting the restoration of copulation than implants in the posteroventral VMN. In Experiment 2, a second set of male rats was pretested for copulation and other sociosexual behaviors and was castrated. Experimental animals then received Silastic capsules filled with testosterone (T) plus intracranial (IC) implants filled with OHF to selectively block androgen receptors in either the MPOA or VMN. We found that androgen receptor blockade in the MPOA inhibited the restoration of copulation but had no effect on other sociosexual behaviors. OHF directed at the VMN inhibited the restoration of copulation and 50-kHz vocalizations but had no effect on scent marking. Two tests were used to assay sexual motivation: partner preference and conditioned place preference (CPP). Both methods revealed impairments in sexual motivation in the VMN group but not in animals receiving OHF in the MPOA. Taken together, these data suggest that androgen receptors in the MPOA are essential for copulatory performance, while androgen receptors in the VMN are important for copulation, sexual motivation, and androgen-dependent vocalizations.     

Anaerobic and aerobic urethral flora in healthy females.

We characterized the aerobic and anaerobic urethral flora of five healthy females by performing urethral and midstream urine cultures once weekly for 8 weeks. Aerobic cultures were performed monthly for an additional 3 months. Lactobacillus spp. were isolated from 52 of 57 samples, Staphylococcus epidermidis from 42 of 57, Corynebacterium spp. from 26 of 57, and alpha-hemolytic streptococci from 14 of 57. Two subjects had E. coli serogroup O6 and group B streptococci isolated on five occasions, respectively. Anaerobes were isolated from 32 of 35 urethral urines (91%). Bacteroides melaninogenicus accounted for 46% of these isolates. The anaerobic urethral flora varied slightly from week to week, and a similar anaerobic flora was isolated from the introitus, fourchette, and cutaneous perineum. In addition, anaerobes were isolated from 16 of 18 healthy females who had a urethral urine sample cultured once only, and B. melaninogenicus was the most frequent isolate. Of the 21 B. melaninogenicus isolates identified to subspecies, 14 were subsp. intermedius.     

Genetic aspects of hereditary motor and sensory neuropathy (types I and II)

The genetic features of a series of 227 patients with hereditary motor and sensory neuropathy (HMSN) have been analysed. The series comprised 119 index cases from 110 families in which 108 affected relatives were identified. The cases were classified as having type I or type II HMSN on the basis of nerve conduction studies. Inheritance in the type I cases was autosomal dominant in 139 (45 families) and autosomal recessive in eight (four families) with 26 single cases. For the type II cases, 35 (17 families) were autosomal dominant and three (two families) autosomal recessive with 16 single cases. A significant excess of males was present in the combined single and recessive type I cases and in the type I index cases. No X linked pedigrees were identified.     

Morphological and functional characteristics of myocytes isolated from human left ventricular aneurysms

Isolated single myocytes were prepared from myocardium of developing ventricular aneurysms and from myocardium within the scar of chronic ventricular aneurysms. The morphology and function of the individual cells were compared. The cells from developing aneurysms were rod-shaped, with a distinct sarcomeric structure, but did not contract even in the presence of high calcium concentrations. The sarcomere length was significantly higher than that of cells from chronic aneurysms and approached the theoretical point at which no contraction can occur. Cells from chronic aneurysms were either rod-shaped and contractile, or rounded due to hypercontracture of the myofilaments. Electron microscopy of cells from developing aneurysms confirmed the presence of elongated sarcomeres, a loss of the actin-myosin interdigitation, and damage to the contractile proteins which was particularly evident in the thin filaments. Cells with similar characteristics have also been isolated from a ruptured, ischaemic papillary muscle. These changes, which are due either to ischaemia or to overstretching of cells, may account for the weakness of the wall of developing aneurysms and be a cause of rupture or enlargement.     

Regeneration following tibial nerve crush in the rabbit: the effect of proximal constriction.

In order to test the regenerative capacity of atrophic axons, a constricting ligature was placed around the proximal tibial nerve of the rabbit, and the nerve crushed at the ankle one week later. Axonal atrophy with altered g ratios was subsequently confirmed in fibres distal to the site of ligature and proximal to the site of crush. In nerves with tight proximal ligatures the reinnervation of plantar muscles and the subsequent recovery of distal motor latency were delayed, indicating impaired regeneration. This result may be relevant to the "double-crush" theory of nerve damage.     

Crohn's disease with pelvic abscess appearing as lumbar disc herniation

Crohn's disease (regional enteritis) is a chronic inflammatory disease of the bowel with well-documented clinical manifestations and complications. This report of a 35-year-old woman with Crohn's disease outlines the clinical presentation and studies illustrating "quiescent" regional enteritis. The patient was treated for one of the complications of this disease entity. She was referred to the orthopedic clinic with symptoms of lumbar disc syndrome, as well as a painful hip. Crohn's disease was diagnosed and assumed to be well controlled. Physical examination revealed a subgluteal abscess, ostensibly caused by Crohn's disease. The abscess fistulized through the greater sciatic notch. The capricious nature of this disease entity is self-evident.     

Management of giant omphalocele with a simple and efficient nonsurgical silo

Introduction: Giant omphaloceles can be a challenge for pediatric surgeons and neonatologists worldwide. It is a rare and low-frequency congenital anomaly with no standardized management schemes or treatment protocols. Over the past few decades, we have developed a simple and efficient staged management for giant omphaloceles that allows definitive closure in the neonatal period, the results of which we outline in this report.Material and methods: With IRB approval, a retrospective and multicentric cohort study was carried out between 1994 and 2019 with patients with giant omphalocele defined as an abdominal wall defect greater than 5 cm in diameter and/or that contains more than 50% of the liver within the sac. We included all patients managed with the nonsurgical silo technique. Data on demographics, gestational age, associated malformations, amnion reduction and inversion time, anatomic closure, requirement of a mesh, intra- and post-silo complications, mortality and follow-up were collected. The technique consists of the construction of a silo with an adhesive hydrocolloid dressing (Duoderm^?) to achieve an omphalocele staged-reduction until complete abdominal reintegration of the liver and bowel preservation of the amnion sac. This also enables the simulation of abdominal closure before definitive surgical closure, being managed in the neonatal intensive care unit (NICU).Results: Forty patients, 21 of whom were female, were managed with this technique. The average weight was 2900 gs (890–3900), and the median gestational age was 38 weeks (28–40). In total, 37.5% of cases had an associated comorbidity. The average silo reduction time was 7.3 days (0–35), the average time of amnion inversion was 5 days (2–9), and the average time to closure was 14.6 days (6–38). Anatomical closure was achieved in 95% of cases. In 4 patients, an absorbable mesh was used to reinforce the anatomical closure, and in 2 patients (5%), a mesh (Dualmesh^?) was required to achieve an abdominal closure. There was no mortality associated with this nonsurgical silo technique. The average follow-up time was 60 (6 - 288) months.Conclusion: The staged silo management of giant omphalocele in this series is safe and effective and reduces the time to closure and potential morbidity and mortality compared with traditional surgical or medical management.