Transvenous embolization of a direct carotid cavernous fistula through the pterygoid plexus

Closure of a direct carotid cavernous fistula with detachable coils by transpterygoid venous approach to the cavernous sinus is an alternative technique that may be applied in cases in which other techniques offer increased risk or in which other techniques have failed. In this case report, we present the details of the management of a direct carotid cavernous fistula by this method.     

Drug interactions of Hypericum perforatum (St. John's wort) are potentially hazardous

Hypericum can lower the plasma levels of simultaneously administered drugs by induction of metabolism. Combinations of hypericum products with warfarin, cyclosporin, oral contraceptives, theophylline, fenprocoumon, digoxin and indinavir have led to reported interactions and reduced therapeutic activity. It is therefore not advisable to combine hypericum products with other drugs, especially CYP3A4 and p-glycoprotein substrates. Discontinuing hypericum after protracted use may lead to higher plasma levels of the drugs used simultaneously, with the risk of adverse effects. Registered homeopathic preparations with a dilution of 1 in 10,000 or weaker may be regarded as safe.     

Ein dreijähriges Hilfsprogramm für Plastische Chirurgie in Peshawar (Pakistan) Kontinuierliche Versorgung Schwerverletzter Patienten des afghanischen Krieges: 1528 große Operationen, 5171 kleinere Eingriffe, 15932 untersuchte Patienten

Since 1980 Interplast Germany has sent many plastic surgeons to developing countries. In 1989 a new Interplast Germany program for helping Afghan refugees in Pakistan's Peshawar was started. The Federal Republic of Germany financed the first two years; thereafter, the European Community and Help supported the project. Twenty-four teams with 123 nurses, surgeons and anesthesiologists operated on 1,528 patients in two hospitals. In the same period 5,171 smaller operations have been performed and 15,932 patients have been examined. Low expense for the teams, good support by officials, and professional administration have made this project highly effective for 3 years.     

The effect of surgical removal of a rat sarcoma on lymphocyte cytotoxicity

The effect of surgical removal of tumors on cytotoxicity reactions was studied in Lewis-Wister inbred rats bearing a transplantable methylcholanthrene-induced sarcoma (MCI). Lymphocyte cytotoxicity and the effect of the serum in blocking (decreasing) or potentiating (increasing) lymphocyte cytotoxicity were studied using MCI tissue culture cells, prelabeled with ³H-proline, as target cells. After surgical removal of the tumors, tumor nodules were again palpable in all rats by the seventh day after surgery and regrew at an accelerated rate. In control rats bearing the MCI sarcoma, serum blocking activity appeared between the 8th and 13th days and completely inhibited lymphocyte cytotoxicity until death of the animals. Surgical removal of the tumors resulted in a decrease in lymphocyte cytotoxicity and complete absence of serum blocking activity for at least 7 days. By the 13th day, when tumors were again growing rapidly, lymphocyte cytotoxicity had increased markedly, and blocking activity again appeared in the serum.     

Dehydrohalogenation of atmospheric contaminants in the space cabin

A total of nine chlorinated ethanes and ethenes were circulated over lithium hydroxide in a laboratory scale closed system simulator. System volume and lithium hydroxide temperature were varied from that intended to maximize possible reactions to conditions approximating those of a space cabin environment. Of the nine compounds tested, seven were found to be dehydrohalogenated (viz., loss of hydrogen chloride) in the course of one or more experimental treatments. Of particular significance was the conversion of 1,2-dichloroethane to chloroethene, a known carcinogen, and of trichloroethene to dichloroethyne, a highly toxic substance. It is therefore concluded that a potentially hazardous situation exists for the inhabitants of closed ecological systems such as spacecraft, one for which precautions must continue to be taken.     

The normal range: a concept in transition

One of the most frequent and perhaps frustrating questions the pathologist is called on to answer regarding laboratory tests is, "What is normal?" In recent years the term "normal range" has been replaced by "reference range." "Upper limit of normal" has been replaced by "referent value," "critical value," or "cut-off point." Our literature now reflects increasing contributions from biostatistics, decision theory, and systems analysis. Yet, for most of us, although the names have changed, the problem has not. Understanding Bayes' Theorum will not help the busy internist when he complains about false-positive elevations in alkaline phosphatase activity on hospital admission profiles. The laboratory director must be able to integrate reference range data and predictive value theory in his own environment if he wishes to provide meaningful information to clinicians. It is the objective of this review to focus on the definition and integration of these areas of emerging concern for the laboratorian.     

A rodent model for artificial gravity: VOR adaptation and Fos expression

Vestibulo-ocular reflex (VOR) adaptation and brainstem Fos expression as a result of short radius cross-coupling stimuli were investigated to find neural correlates of the inherent Coriolis force asymmetry from an artificial gravity (AG) environment. Head-fixed gerbils (Meriones unguiculatus, N=79) were exposed, in the dark, to 60--90 minutes of cross-coupled rotations, combinations of pitch (or roll) and yaw rotation, while binocular horizontal, vertical, and torsional eye position were determined using infrared video-oculography. Centripetal acceleration in combination with angular cross-coupling was also studied. Simultaneous sinusoidal rotations in two planes (yaw with roll or pitch) provided a net symmetrical stimulus for the right and left labyrinths. In contrast, a constant velocity yaw rotation during sinusoidal roll or pitch provided the asymmetric stimulus model for AG. We found orthogonally oriented half-cycle VOR gain changes. The results depended on the direction of horizontal rotation during asymmetrical cross-coupling, and other aspects of the stimulus, including the phase relationship between the two rotational inputs, the symmetry of the stimulus, and training. Fos expression also revealed laterality differences in the prepositus and inferior olivary C subnucleus. In contrast the inferior olivary beta and ventrolateral outgrowth were labeled bilaterally. Additional cross-coupling dependent labeling was found in the flocculus, hippocampus, and several cortical regions, including the perirhinal and temporal association cortices. Analyses showed significant differences across the brain regions for several factors (symmetry, rotation velocity and direction, the presence of centripetal acceleration or a visual surround, and training). Finally, animals compensating from a unilateral surgical labyrinthectomy who received multiple cross-coupling training sessions had improved half-cycle VOR gain in the ipsilateral eye with head rotation toward the intact side. We hypothesize that cross-coupling vestibular training can benefit aspects of motor recovery or performance.     

The use of Visual Analog Scale in urogynecologic research: a psychometric evaluation

OBJECTIVE: The purpose of this study was to assess the validity of Visual Analog Scales in urogynecologic research. STUDY DESIGN: In phase I, 35 women completed short forms of the urogenital distress inventory, incontinence impact questionnaire, and Beck depression inventory fast screen using the Likert-type scale and Visual Analog Scale formats. Reliability was estimated with Spearman's correlations and Cronbach's alpha; construct validity was assessed with the use of factor analyses. In phase II, 101 women were recruited for the test-retest reliability assessment of the Visual Analog Scale formats of the urogenital distress inventory and incontinence impact questionnaire short forms. Reproducibility was analyzed with intraclass correlations. RESULTS: In phase I, correlations between the Likert-type scale and the Visual Analog Scale were good: urogenital distress inventory (0.748), incontinence impact questionnaire (0.787), and Beck depression inventory fast screen (0.852; P <.05). In phase II, intraclass correlations were 0.898 and 0.938 for the urogenital distress inventory and incontinence impact questionnaire scores, respectively ( P <.001). CONCLUSION: The Visual Analog Scale is a simple, reliable, and reproducible method for the assessment of quality of life in urogynecologic research.     

Development of a symptom assessment instrument for chronic hemodialysis patients: the Dialysis Symptom Index

Little is known about the prevalence, severity, or impact of symptoms in hemodialysis patients because of the lack of a validated symptom assessment instrument. We systematically developed an index to assess physical and emotional symptom burden in this patient population. We employed four steps in the generation of this index: a review of dialysis quality-of-life instruments, three focus groups, experts' content validity assessment, and test-retest reliability measurement. Seventy-five symptoms were identified. Of these, 46 appeared in > or = 4 of the instruments/focus groups and were considered for inclusion. Twelve were grouped into other symptom constructs and experts judged four of the remaining items not to be pertinent, leaving 30 items in the new index. Overall kappa statistic was 0.48+/-0.22. These steps allowed the systematic development of a 30-item symptom assessment index for hemodialysis patients. Additional reliability and validity testing is needed prior to its widespread use.