Bilateral hypoglossal nerve injury following the use of the laryngeal mask airway

A healthy 54-year-old man undergoing elective knee arthroscopy developed bilateral hypoglossal nerve palsy, lasting 6 weeks following the use of a laryngeal mask airway. He suffered impairment of speech and difficulty in swallowing, the latter resulting in almost 7 kg loss of weight within 2 weeks of surgery. We discuss the possible aetiology of the injury and review the literature describing injuries to the hypoglossal nerve.     

Overexpression of parathyroid hormone-related protein inhibits pancreatic beta-cell death in vivo and in vitro

Pancreatic beta-cell survival is critical in the setting of diabetes as well as in islet transplantation. Transgenic mice overexpressing parathyroid hormone-related protein (PTHrP) targeted to beta-cells using the rat insulin II promoter (RIP) display hyperinsulinemia, hypoglycemia, and islet hyperplasia, without a concomitant increase in beta-cell proliferation rate or enlargement of individual beta-cell size. Thus, the mechanism for increased beta-cell mass is unknown. In this study, we demonstrated that beta-cells of transgenic mice are resistant to the cytotoxic effects of streptozotocin (STZ) in vivo, as documented by a sixfold reduction in the rate of STZ-induced beta-cell death in RIP-PTHrP mice relative to their normal siblings. The reduced cell death in transgenic mice is due neither to their increased islet mass nor to a decrease in their sensing of STZ, but rather results from PTHrP-induced resistance to beta-cell death. This is also demonstrated in vitro by markedly reduced cell death rates observed in beta-cells of transgenic mice compared with normal mice when cultured in the absence of serum and glucose or in the presence of STZ. Finally, we demonstrated that NH(2)-terminal PTHrP inhibits beta-cell death. These findings support the concept that PTHrP overexpression increases islet mass in transgenic mice through inhibition of beta-cell death.     

Improved microvessel repair: laser welding with an anti-thrombotic solder

BACKGROUND AND OBJECTIVES: Concentrated protein solutions can be used as thermally polymerized solders in laser welding. Solders supplemented with biologically active chemicals may provide in situ drug delivery for localized therapeutics. These studies characterize a serum albumin (SA) solder containing heparin, designed to reduce microvascular thrombosis rates. STUDY DESIGN/MATERIALS AND METHODS: Samples of heparin added to 30% SA to obtain heparin-to-albumin molar ratios (HAMR) of 4:1 and 2:1 were thermally polymerized, and heparin release into saline was measured. Using a rat thrombosis model, patency was determined for suture, and 0 U/ml (control), 2.5 U/ml, 50 U/ml heparin solder repairs. RESULTS: Heparin release was five times higher for 4:1 than 2:1 HAMR solder acutely, but was equivalent after 2 days. Animal patency rates were: 50% suture, 0% control, 50% low heparin, 66% high heparin (P < 0.05 vs. control). CONCLUSIONS: Solders incorporating heparin should provide in situ anti-thrombotic therapy reducing the risk of microvascular thromboses.     

Medical students' experiences of diseases in internal medicine in university and community hospitals

Because medical students in The Netherlands should achieve common national objectives, it is important to know whether clinical experiences in different hospitals are comparable. The research questions were: (1) Do students achieve learning experiences of the required diseases during the internship in Internal Medicine and to what extent do they achieve these experiences? (2) Are there differences between the diseases experienced at a university hospital and at community hospitals? Completed logbooks of students were analysed; the percentage of students that achieved the required diseases and the mean number of experiences of diseases were calculated. A t-test was done to test for differences. Medical students in the university and in community hospitals get broad experience (76-131%) of the required diseases. In both hospitals there are many students who are not achieving the requirements, but the mean number of experiences of students at the community hospitals is higher than those at the university hospital. To eliminate the differences between students from the university hospital and the community hospitals, the educational programmes within both hospitals should be adjusted.     

Apolipoprotein E polymorphism and cardiovascular disease: a HuGE review

This review examines the association between the apolipoprotein (apo) var epsilon gene polymorphism (or its protein product (apo E)), metabolic regulation of cholesterol, and cardiovascular disease. The apo var epsilon gene is located at chromosome 19q13.2. Among the variants of this gene, alleles (*) epsilon2, (*) epsilon3, and (*) epsilon4 constitute the common polymorphism found in most populations. Of these variants, apo (*) epsilon3 is the most frequent (>60%) in all populations studied. The polymorphism has functional effects on lipoprotein metabolism mediated through the hepatic binding, uptake, and catabolism of chylomicrons, chylomicron remnants, very low density lipoprotein (VLDL), and high density lipoprotein subspecies. Apo E is the primary ligand for two receptors, the low density lipoprotein (LDL) receptor (also known as the B/E receptor) found on the liver and other tissues and an apo E-specific receptor found on the liver. The coordinate interaction of these lipoprotein complexes with their receptors forms the basis for the metabolic regulation of cholesterol. Allelic variation in apo var epsilon is consistently associated with plasma concentrations of total cholesterol, LDL cholesterol, and apo B (the major protein of LDL, VLDL, and chylomicrons). Apo var epsilon has been studied in disorders associated with elevated cholesterol levels or lipid derangements (i.e., hyperlipoproteinemia type III, coronary heart disease, strokes, peripheral artery disease, and diabetes mellitus). The apo var epsilon genotype yields poor predictive values when screening for clinically defined atherosclerosis despite positive, but modest associations with plaque and coronary heart disease outcomes. In addition to genotype-phenotype associations with vascular disease, the alleles and isoforms of apo var epsilon have been related to dementias, most commonly Alzheimer's disease.     

Factors in recruitment and employment of allied health students: preliminary findings

The efforts of a group of participants in the Coalition for Allied Health Leadership program to assess how and why allied health students became interested in their professions and students' plans for future employment are described. Results of a survey administered to 29 physical therapist assistant (PTA) and 54 communication disorders (CD) students revealed that most of the students first learned about their professions through personal experience. Almost half of the PTA students decided to pursue their career after working in another career, and most of the CD students made the decision during high school or in college. The most important factors in students' decisions to enter the professions were a desire to help others and the nature of the work. CD students preferred private practice, whereas the most desired employment setting for PTA students was an outpatient clinical facility. For both groups, the three most important factors influencing where they wish to live and work were job availability, access to medical care, and proximity to family and loved ones. Although half of the CD students hailed from small towns and rural areas, less than one third intended to work in these areas. Implications of survey findings are discussed.     

Cancer in Korean war navy technicians: mortality survey after 40 years

This study reports on over 40 years of mortality follow-up of 40,581 Navy veterans of the Korean War with potential exposure to high-intensity radar. The cohort death rates were compared with mortality rates for White US men using standardized mortality ratios, and the death rates for men in occupations considered a priori to have high radar exposure were compared with the rates for men in low-exposure occupations using Poisson regression. Deaths from all diseases and all cancers were significantly below expectation overall and for the 20,021 sailors with high radar exposure potential. There was no evidence of increased brain cancer in the entire cohort (standardized mortality ratio (SMR) = 0.9, 95% confidence interval (CI): 0.7, 1.1) or in high-exposure occupations (SMR = 0.7, 95% CI: 0.5, 1.0). Testicular cancer deaths also occurred less frequently than expected in the entire cohort and high-exposure occupations. Death rates for several smoking-related diseases were significantly lower in the high-exposure occupations. Nonlymphocytic leukemia was significantly elevated among men in high-exposure occupations but in only one of the three high-exposure occupations, namely, electronics technicians in aviation squadrons (SMR = 2.2, 95% CI: 1.3, 3.7). Radar exposure had little effect on mortality in this cohort of US Navy veterans.     

Timing of pubertal maturation and heterosexual behavior among Hong Kong Chinese adolescents

This study presents a cross-sectional examination of the independent contribution of pubertal maturation timing to heterosexual activity among Chinese adolescents. A standardized self-administered questionnaire was designed to obtain information on a spectrum of physical heterosexual behaviors from dating to sexual intercourse, age at first nocturnal ejaculation in boys, age at menarche in girls, and several psychosocial variables that might be associated with sexual behavior in adolescents. A total of 4,116 students aged from 14 to 18 years (2,175 boys and 1,941 girls) were recruited in the Youth Sexuality Survey of the Hong Kong Family Planning Association in 1996–97. When groups were defined as early, average, and late maturers, among boys, early maturers were youngest to report dating and to have sexual intercourse, followed by average and late maturers. Among girls, late maturers were slower to date and have sexual intercourse, but early maturers showed no difference from average maturers. Age of maturation was significantly lower for those reporting all heterosexual behaviors for both sexes. Our findings illustrate culture's moderation of the expression of biological differences.