The fundamental manipulations of surgery: a structured vocabulary for designing surgical curricula and simulators

A structured vocabulary is proposed for supporting the design and development of advanced surgical simulators. Nine fundamental surgical instrument-tissue actions or manipulations are defined and common synonyms provided. The vocabulary focuses on "target skills" that are familiar to surgeons, in comparison with "enabling skills" from the lexicon of instructional designers and psychometricians. The adoption of this vocabulary can facilitate communication among surgeons and bioengineers developing "high-fidelity" surgical simulators.     

A study on serum advanced glycation end products and its association with oxidative stress and paraoxonase activity in type 2 diabetic patients with vascular complications

ObjectivesEnhanced formation of advanced glycation end products (AGEs) formed secondary to hyperglycemic conditions has been linked to diabetes mellitus (DM) associated complications. We investigated the clinical relevance of estimating AGEs and their relationship with oxidative stress (OS) and paraoxonase (PON1) activity in type 2 DM (T2DM) in relation to development of vascular complications.Design and MethodsSerum AGEs along with PON1 activity, protein carbonyl (PCO), advanced oxidation protein products (AOPP), lipid peroxidation (MDA), and total thiol (T-SH) were determined in 157 T2DM patients (DM without complications n = 57, DM micro-vascular complications n = 53, DM macro-vascular complications n = 47) and 40 healthy controls.ResultsSerum AGE level increased significantly in various study groups in following manner: healthy control < DM without complications < DM-macro < DM-micro. Logistic regression analysis using diabetic complications as dependent variable showed significant association with AGE level and PON1 activity even after adjustment for confounding factors. Receiver-operating-characteristics curve analysis showed that 2-fold increased in glycation and 50% decrease in PON1 activity may lead to development of vascular complications in diabetic subjects. PCO, AOPP and MDA were higher and PON1 activity was lower in T2DM with complications than those without complications. Among diabetic patients AGEs showed significant positive correlation with HbA_1C, MDA, AOPP, and negative correlation with PON1 activity and T-SH.ConclusionHigh serum AGE concentration and low PON1 activity may be considered as additional risk factor for development of vascular complications in T2DM. AGE formation plays significant role in induction of OS in diabetes.     

Incidental finding of esophageal pneumatosis

Pneumatosis of the gastrointestinal tract is a rare condition characterized by the presence of air filled cavities in the gastrointestinal tract wall.Its occurrence has been described throughout the gastrointestinal tract from the esophagus to the rectum,however it is most commonly reported in the small intestine.Despite multiple case reports in literature,its pathogenesis still remains unclear.Pneumatosis may be idiopathic or associated with a variety of disorders namely peptic ulcer disease,jejunoileal bypass,intestinal obstruction and non-gastrointestinal disorders like asthma,chronic obstructive pulmonary disease,systemic lupus erythematosus,infectious enteritis,etc.We here present a rare case of pneumatosis of the esophagus diagnosed incidentally at an esophagogastroduodenoscopy(EGD).A 78-year-old asymptomatic woman underwent EGD and colonoscopy at our hospital for evaluation of anemia.Few months prior to EGD,she had undergone excision of laryngocele at our hospital.EGD revealed extensive submucosal blebs distributed throughout the esophagus,otherwise unremarkable stomach and duodenum.Colonoscopy showed a tubular adenomatous polyp.Since our patient was asymptomatic she did not require any surgical intervention.Management of pneumatosis depends on the underlying cause.     

Manganese Accumulates within Golgi Apparatus in Dopaminergic Cells as Revealed by Synchrotron X-ray Fluorescence Nanoimaging

Chronic exposure to manganese results in neurological symptoms referred to as manganism and is identified as a risk factor for Parkinson's disease. In vitro, manganese induces cell death in the dopaminergic cells, but the mechanisms of manganese cytotoxicity are still unexplained. In particular, the subcellular distribution of manganese and its interaction with other trace elements needed to be assessed. Applying synchrotron X-ray fluorescence nanoimaging, we found that manganese was located within the Golgi apparatus of PC12 dopaminergic cells at physiologic concentrations. At increasing concentrations, manganese accumulates within the Golgi apparatus until cytotoxic concentrations are reached resulting in a higher cytoplasmic content probably after the Golgi apparatus storage capacity is exceeded. Cell exposure to manganese and brefeldin A, a molecule known to specifically cause the collapse of the Golgi apparatus, results in the striking intracellular redistribution of manganese, which accumulates in the cytoplasm and the nucleus. These results indicate that the Golgi apparatus plays an important role in the cellular detoxification of manganese. In addition manganese exposure induces a decrease in total iron content, which could contribute to the overall neurotoxicity.     

Inflammatory myocarditis presenting as acute myocardial infarction

We present data of two patients with endomyocardial biopsy proven acute myocarditis presenting with clinical and electrocardiographic features of acute transmural myocardial infarction. Coronary angiograms were normal in both of them. The presentation of inflammatory myocarditis as myocardial infarction is emphasized.     

Subconjunctival antibiotics for acute postcataract extraction endophthalmitis--is it necessary?

PURPOSE: To evaluate the efficacy of adjunctive subconjunctival antibiotic injection in the treatment of acute postcataract extraction endophthalmitis. DESIGN: Retrospective cohort study. METHODS: Patients who presented with hand motions or better vision and received subconjunctival antibiotics (SC+ group) were compared with those who did not (SC- group) in the treatment of acute postoperative endophthalmitis. RESULTS: The rate of obtaining a final vision of 20/40 or better was 60% in the SC+ group (n = 25) compared with 72% in the SC- group (n = 18) (P =.69), and the mean change in logMAR was -1.36 (improvement) versus -1.34 (P =.93). Based on a linear regression model controlling for presenting vision, there was no statistical difference in the mean logMAR change between the two groups (P =.73). CONCLUSION: Subconjunctival antibiotic injection as an adjunct to intravitreal antibiotics was unassociated with treatment benefit in patients with acute postoperative endophthalmitis presenting with vision of hand motions or better.     

Combining universal and targeted prevention for school-based eating disorder programs

OBJECTIVE: This study examined a step toward providing a universal prevention program to all students while targeting those at risk. METHOD: Seventy-eight 10th-grade female students were provided an on-line eating disorder prevention program and randomized to participate in (1) a higher risk and higher motivated group, (2) a lower risk or lower motivated group, or (3) a combined group. RESULTS: The students in the first group made significantly fewer negative and more positive comments in the on-line group discussion than the higher risk and higher motivated participants in the combined group. However, there were no differences among groups on outcome measures. DISCUSSION: The results suggest that, because it is relatively easy to provide interventions with separate groups, it seems appropriate to do so, if for no other reason than to minimize the few very negative comments that were posted by students that might have created an adverse environment for the higher risk-participants that the intervention specifically targets.     

Are health states ‘timeless’? A case study of an acute condition: post‐chemotherapy nausea and vomiting1

Rationale, aims and objectives The objective was to test whether individuals’ responses to standard gamble (SG) and visual analogue scale (VAS) questions do not depend on the time horizon of the health scenario presented. Methods Face‐to‐face interviews were conducted in a convenience sample of 18 women aged 22–50 years with no history of breast cancer or cancer requiring chemotherapy. Data were collected from March 2000 to June 2000 at a university in the Midwest of the United States of America. Preference weights were estimated using SG top‐down titration method and VAS scaled from zero (death) to one (perfect health). Subjects were asked to rate their preferences if faced with two scenarios: post‐chemotherapy nausea and vomiting (PCNV) occurring for 3 days (scenario 1), and PCNV lasting for the rest of their lives (scenario 2). Three PCNV health states of varying severity were tested: complete alleviation, partial alleviation, and no alleviation. Results Paired‐t‐test analysis showed statistically significantly lower preference weights (P < 0.05) when the health state was for the rest of the respondent's life vs. 3 days. Mean SG weights for scenario 1 vs. scenario 2 were: 0.968 vs. 0.927 (complete alleviation), 0.942 vs. 0.810 (partial alleviation) and 0.866 vs. 0.644 (no alleviation). Mean VAS weights for scenario 1 vs. scenario 2 were: 0.741 vs. 0.676 (complete alleviation), 0.490 vs. 0.307 (partial alleviation) and 0.276 vs. 0.136 (no alleviation). Discussion and conclusions For the majority of respondents the utility independence assumption for SG and VAS did not hold. Similar to Bala et al., the results of this study indicated that preference weights as measured by SG and VAS techniques were not ‘timeless’. Regardless of the preference measure used, both SG and VAS yielded higher scores when PCNV lasted for a shorter period of time.