Double Facial Nerve Trunk Emerged from the Stylomastoid Foramen and Petrotympanic Fissure: A Case Report

There are several studies concerning branches of the facial nerve, but we encountered less information about the trunk of the facial nerve in the literature. During the routine dissection of a 65-yr-old Caucasian male cadaver, double facial nerve trunk emerged from the stylomastoid foramen and petrotympanic fissure were encountered. Because of an extremely rare variation, we presented this case report. In addition this cadaver had two buccal plexuses. These plexuses and other branches were formed to structures like to polygon. These anatomic peculiarities were described, photographed and illustrated. Finally, magnetic resonance imaging was performed by using 1.5T scanner to this cadaver. The facial nerve trunk can be damaged during surgical procedures of the parotid gland tumours and submandibular region. Surgeons who are willing to operate on this area should be aware of the possible anatomical variations of the facial nerve trunk.     

Patients were more consistent in randomized trial at prioritizing childbirth preferences using graphic-numeric than verbal formats

ObjectiveWe developed an evidence-based decision aid to help women with a prior cesarean to prioritize their childbirth preferences related to a future birth. Because there was uncertainty about which scale format would assist the patients in being most consistent in prioritizing preferences in a multiattribute decision model, we compared a graphic-numeric scale with a text-anchored scale.Study Design and SettingNinety-six postnatal women with a prior cesarean were randomized to use 1 of 2 preference scale formats in a computerized childbirth decision aid. We measured the level of inconsistency (intransitivity) when patients prioritized their childbirth preferences and clarity of values before and after using the decision aid.ResultsWhen the trade-offs involved risk, women were more consistent when using graphic-numeric than text-anchored formats (P = 0.015). They prioritized safety to their baby as 4 times more important than any other decision factor including safety to self. Both groups reduced unclear childbirth values over time (P < 0.001). Women who over-used the extreme ends of the scale when evaluating risk were more likely to be inconsistent (P < 0.001).ConclusionPatients were more consistent in making trade-offs involving risk using graphic-numeric formats than text-anchored formats to measure patient preferences.     

Quality Assurance in DNR (Do Not Resusciate) Decisions-The Role of Chaplaincy

The current study examines patterns of referrals to chaplains documented in the 1994–1996 New York Chaplaincy Study. The data were collected at thirteen healthcare institutions in the Greater New York City area. Of the 38,600 usable records in the sample, 18.4% were referrals, which form the sample for the current study (N = 7,094). The most common sources of referrals were nurses (27.8%) and patients themselves (22.3%), with relatively few referrals coming from physicians and social workers. The study shows the range of patient issues that are referred to chaplains, including emotional, spiritual, medical, relationship/support, and a change in diagnosis or prognosis. Although the reasons for referral varied by hospital setting and referral source, overall, patients were referred more frequently for emotional (30.0%) than for spiritual issues (19.9%). Results are discussed in relation to the need to clarify the role of the chaplain to the rest of the healthcare team, to recognize when there is a spiritual cause of emotional distress, and to establish effective referral protocols.     

Survival after curative resection for stage IE and IIE primary gastric lymphoma

BACKGROUND/AIMS: There is considerable controversy regarding the optimal treatment of patients with primary gastric lymphomas. However, surgery still plays an important role in the management of stage IE and IIE gastric lymphomas. We aimed at assessing survival of primary gastric lymphoma cases with stage IE or IIE that were surgically treated at the Surgical Oncology Department. METHODOLOGY: Thirty-seven patients with stage IE and IIE primary gastric lymphoma who were surgically treated and had complete follow-up from January 1990 to September 1998 were reviewed retrospectively. Patients' age, gender, tumor location, tumor grade, histologic type, depth of tumor invasion, regional lymph node status, tumor stage, type of gastrectomy (total/subtotal), combined resection, extensive lymphadenectomy, adjuvant chemotherapy were used as the clinicopathologic variables. RESULTS: Five-year survival rates for stage IE and stage IIE disease were 75% and 37%, respectively. The overall 5-year survival rate of the patients was 57%. Univariate analysis demonstrated that age, tumor stage, and type of gastrectomy were associated with prognosis, but only type of gastrectomy (subtotal gastrectomy) and tumor stage were found to be independent prognostic factors (P < 0.05). CONCLUSIONS: To obtain prolonged survival we recommend radical resection with extensive lymphadenectomy for malignant lymphoma stages IE and IIE. Patients with small distal lymphomas of the stomach can be treated with subtotal gastric resection.     

Stem cell factor and interleukin-7 synergize to enhance early myelopoiesis in vitro

Interleukin-7 (IL-7) has been shown to be a critical factor in murine lymphoid development. It stimulates pre-B cells to divide in the absence of stroma cells and it is an important growth regulator of immature and mature T cells. IL-7 has been shown to synergize with stem cell factor (SCF) to provide a potent growth stimulus for pre-B cells. However, the combined effects of IL-7 and SCF on murine primitive hematopoietic cells in vitro have not been established. In the present study, the effects of recombinant rat (rr) SCF and recombinant human (rh) IL-7 on primitive murine bone marrow progenitors (Lin-Sca1+) were investigated in single-cell cloning experiments. rhIL-7 alone had no proliferative effect on Lin-Sca1+ cells, but in a dose-dependent manner directly enhanced rrSCF-induced colony formation, with an average increase in colony numbers of 2.7-fold. Interestingly, the cells formed in response to SCF and IL-7 were predominantly mature granulocytes. Thus, SCF and IL-7 synergize to stimulate early myelopoiesis in vitro.     

Functional differences between CD38- and DR- subfractions of CD34+ bone marrow cells

Several studies have previously demonstrated enrichment in primitive progenitor cells in subfractions of CD34+ bone marrow (BM) cells not expressing CD38 or HLA-DR (DR) antigens. However, no studies have directly compared these two cell populations with regard to their content of primitive and more committed progenitor cells. Flow cytometric analysis of immunomagnetic isolated CD34+ cells demonstrated little overlap between CD34+CD38- and CD34+DR- progenitor subpopulations in that only 12% to 14% of total CD34+DR- and CD34+CD38- cells were double negative (CD34+CD38-DR-). Although the number of committed myeloid progenitor cells (colony-forming units granulocyte- macrophage) was reduced in both subpopulations, only CD34+CD38- cells were significantly depleted in committed erythroid progenitor cells (burst-forming units-erythroid). In single-cell assay, CD34+CD38- cells showed consistently poorer response to single as opposed to multiple hematopoietic growth factors as compared with unfractionated CD34+ cells, indicating that the CD34+CD38- subset is relatively enriched in primitive hematopoietic progenitor cells. Furthermore, CD34+CD38- and CD34+DR- cells, respectively, formed 3.2-fold and 1.6-fold more high proliferative potential colony-forming cell (HPP-CFC) colonies than did unfractionated CD34+ cells. Finally, CD34+CD38-DR- cells were depleted in HPP-CFCs as compared with CD34+CD38+DR+ cells. The results of the present study suggest that both the CD38- and DR- subfractions of CD34+ bone marrow cells are enriched in primitive hematopoietic progenitor cells, with the CD34+CD38- subpopulation being more highly enriched than CD34+DR- cells.