New advances transform the management of women with abnormal pap tests

New advances in Papanicolaou test technology, human papillomavirus DNA testing, and revisions in the Bethesda terminology for cervical cytology have transformed the management of abnormal Pap tests. This approach has been validated by a recent randomized clinical trial, and in some instances can reduce the number of colposcopies by 50%.     

The Influence of Various Irradiances of Artificial Light, Twilight, and Moonlight on the Suppression of Pineal Melatonin Content in the Syrian Hamster

The purpose of the present studies using artificial light was to determine how the timing and duration of exposure influence the light-induced suppression of pineal melatonin levels in hamsters. An 8-min exposure to 0.186 microW/cm2 of cool white fluorescent light caused a continued depression of pineal melatonin even when animals were returned to darkness. In addition, the pineal gland does not appear to change its sensitivity to light throughout the night. A 20-min exposure to 0.019 microW/cm2 of cool white fluorescent light did not significantly suppress pineal melatonin during any time of the melatonin peak, whereas a 20-min exposure to 0.186 microW/cm2 was capable of always suppressing melatonin. Furthermore, increasing the duration of 0.019-microW/cm2 exposure to 30, 60, 120, or 180 min does not increase the capacity of this irradiance to depress melatonin. Similar to artifical light, natural light has a variable capacity for suppressing nocturnal levels of pineal melatonin. Twilight irradiances of 0.138 microW/cm2 or less did not suppress nocturnal melatonin whereas twilight irradiances of 3.0 microW/cm2 or greater did suppress pineal melatonin. A few animals did have lower melatonin after a 40-min exposure to full moonlight during July (0.045 microW/cm2) or January (0.240 microW/cm2). However, pineal melatonin levels remained high in the majority of animals exposed to full moonlight.     

Acute thrombotic obstruction with Bj?rk-Shiley valves: diagnostic and surgical considerations

Eight patients have had thrombotic obstruction of a prosthetic valve since 1971, six mitral valves and two aortic. All eight patients had a Bj?rk-Shiley valve. During the same period 159 Bj?rk-Shiley valves were placed, 85 in the mitral and 74 in the aortic area. This represents a valve thrombotic occlusive incidence of 4.4 percent in our series, 5.9 percent of mitral and 2.7 percent of aortic prostheses. Among the six patients with mitral prostheses only one survived. The two patients with occluded aortic valves survived. The onset of symptoms was very abrupt in most patients and progressed very rapidly. Acute pulmonary edema was observed in five patients. Anticoagulation was considered inadequate in all patients. Aspirin or dipyridamole was being used in seven patients at the time of thrombosis. The data indicate a high frequency of thrombotic occlusion of Bj?rk-Shiley valves in the absence of full anticoagulation with warfarin derivatives and emphasizes the urgent need for surgery once valve thrombosis is suspected.     

Ventricular septal defect and aortic insufficiency. Surgical treatment.

Twenty-five patients with ventricular septal defect (VSD) associated with aortic insufficiency (AI) have been since 1964. Of these patients, one died suddenly without operation; in 2 patients, AI developed in the late postoperative period following VSD closure; and in 3 others, AI developed shortly after VSD closure. The remaining 19 patients are discussed in detail. The VSD was subpulmonic in 13 (68 per cent) and subcristal in 6 (32 per cent). Primary suture of the VSD was undertaken in 13 patients and patch closure in 6. Seven patients had aortic valvuloplasty and 2 had aortic valve replacement. There were no surgical deaths, and the long-term follow-up shows that VSD closure alone has been sufficient to arrest progression of AI in patients with mild insufficiency, particularly in those with subpulmonic VSD. Valvuloplasty, when necessary, was more effective when done at an early age.     

Fracture patterns and mechanisms in pedestrian motor-vehicle trauma: the ipsilateral dyad.

Pedestrians struck by motor vehicles have the highest mortality and morbidity rates of all motor-vehicle traumas. Fracture patterns and mechanisms were reviewed in a retrospective study of 115 consecutive patients. The most common fracture was tibia-fibula (39 patients), followed by pelvic (35 patients) and femur fractures (31 patients). A majority (90%) of long-bone fractures were the result of a direct-blow mechanism, and pelvic fractures were caused usually by lateral-compressive forces. Unstable pelvic and femur fractures both correlated with mortality (p less than 0.05), whereas tibia-fibula fractures (open or closed) did not. The triad of head, pelvis, and knee injuries traditionally associated with pedestrian motor-vehicle accident (MVA) victims was not found to occur with any statistical significance in this study group. Several characteristic fracture patterns were discovered: femur fractures associated with an accompanying pelvic fracture, and the ipsilateral dyad, an upper- and lower-extremity fracture on the same side, were found to occur with statistical significance (p less than 0.05). A lower extremity fracture warrants particularly close attention to the examination of the corresponding upper extremity, and a femur fracture should alert the clinician to the possibility of pelvic injury. The ipsilateral dyad has not been described previously in the literature and should be appreciated by physicians evaluating and treating pedestrian MVA victims.     

Magnetic resonance imaging study of the rat cerebral ventricular system utilizing intracerebrally administered contrast agents

Magnetic resonance imaging (MRI) was employed to study the rat brain in conjunction with intracerebral (ic) injection of three contrast agents: GdHAM, GdDPTA, and MnCl2. The results demonstrate several advantages of ic administration of MRI contrast agents over the other routes of injection in examining CSF dynamics and brain ventricular structure. Apparent affinity of the luminal ventricular wall of the brain for positively charged GdHAM and Mn2+ ions is observed, presumably reflecting the presence of negatively charged wall components. Respiratory distress caused by (intravenous) injection of GdHAM was found to be minimized in the case of ic injections. Time-dependent changes in observed contrast indicate that diffusive processes rather than flow of CSF play a dominant role in distributing the contrast agents. Possible applications of this approach in brain research are discussed.     

Changes in brain catecholamines and dopamine uptake sites at different stages of MPTP parkinsonism in monkeys.

1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) has been shown to produce parkinsonism in primates. We have studied the changes in brain catecholamines and the distribution of desipramine insensitive mazindol binding sites in MPTP parkinsonian primates at different levels of parkinsonism. Thirty-seven monkeys (Macaca fascicularis) were utilized in this study. Twelve naive animals received no treatment and served as controls. Twenty-five animals were rendered parkinsonian with serial injections of MPTP. All animals were given scored neurologic examinations throughout the study. Their movement was quantitated in an activity box. The animals were sacrificed 30-360 days after their last MPTP injection. The clinical exam of the MPTP parkinsonian monkeys demonstrated mildly to severely affected animals. There was an exponential decrease in brain catecholamine levels with increased clinical parkinsonism. The MPTP parkinsonian animals showed the greatest decrease (67-99.8%) in tissue dopamine levels in the caudate nucleus. The putamen followed closely in severity (48-99.8%) and the nucleus accumbens was much less affected (0-40%). The percent reduction of norepinephrine in the anterior pole of the frontal cortex (0-48%) was similar in degree to the decreased dopamine levels in the nucleus accumbens. Mazindol binding was decreased 30-98% in the caudate nucleus, 20-97% in the putamen, 0-26% in the nucleus accumbens, 80-96% in the substantia nigra pars compacta and 49-94% in the ventral tegmental area. In the striatum, the decreased mazindol binding was more pronounced laterally and posteriorly. In each animal, there was good correlation between tissue dopamine levels and the number of mazindol binding sites.     

Evaluation of methods for calculating census healthindicators for GP practices

The patients registered with a general practice are usually spread over many censusareas and overlap with the distribution of neighbouring practices, so a validated method of aggregating census data to describe the characteristics of practice patients is required. Four methods were used to provide estimates of the percentage of patients aged 75 years and over from census data for 81 practices in Suffolk, England, and these were compared with values derived from the FHSA patient register. Census values for practice areas produced better estimates than those based on the location of the surgery, but the best methods were based on patient-weighted averages of ward and enumeration district data. The finer geographical detail of enumeration districts did not produce substantially more accurate estimates than the ward-level data: both gave estimates with limits of agreement within 2% of the patient register values. Errors in the census, errors in patient registers and selective geographical distributions of practice patients prevent close matching of census and register measures, but two of the methods tested produced estimates that allow broad comparisons between practices.