Development of hip dysplasia in a child with perinatal contralateral high above-knee amputation

The development of acetabular dysplasia in the growing child has been postulated to be due to abnormal forces on the acetabular rim, such as when the hip is in an adducted position. In this case report we document the development of acetabular dysplasia, as measured radiographically, in a child with a perinatal contralateral high above-knee amputation.     

Evaluation of the Sports Ankle Rating System in young,athletic individuals with acute lateral ankle sprains

The purpose of this paper is to introduce the Sports Ankle Rating System and provide the initial validation for its use. As its name implies, this outcomes measurement system is intended for use in assessing the functional outcomes of athletes with ankle injuries. This unique system consists of three distinct instruments: the Quality of Life Measure, the Clinical Rating Score, and the Single Assessment Numeric Evaluation. We began the validation process of the Sports Ankle Rating System with subjects who had sustained lateral ankle sprains because this is the most common injury in sports. The results of this study indicate that the Sports Ankle Rating System is: 1. effective at assessing the impact that an ankle sprain has on an athlete's functional and psychosocial status, 2. responsive to changes in an athlete's ankle-related health status, and 3. valid and reliable as tested.     

Efficacy of venous reconstruction in patients with adenocarcinoma of the pancreatic head

Pancreaticoduodenectomy is often avoided in patients with portal or superior mesenteric venous involvement due to the perception that venous resection is complex, morbid, and carries a poor longterm survival. Our recent experience using state-of-the-art imaging and strict resection criteria show that venous reconstruction increases operative time, transfusion requirements, intensive care unit stay, and total hospital length of stay, but has no significant impact on operative morbidity rates, mortality rates, or the incidence of positive histologic margins. Kalpan-Meier life table analysis shows similar survival curves when compared to a contemporary cohort of patients who do not undergo venous reconstruction. Presented as an abstract at the Americas Hepato-Pancreatico-Biliary Association Meeting, Miami Beach, Florida, February 28–March 1, 2003.     

Preparedness for hospital practice among graduates of a problem-based,graduate-entry medical program

OBJECTIVE: To compare preparedness for hospital practice between graduates from a problem-based, graduate-entry medical program and those from other programs (undergraduate problem-based and traditional). DESIGN: Survey of graduates (by mailed questionnaire) and organisers of clinical training (by semistructured interview); results were compared with published results of surveys of graduates from other programs. SETTING AND PARTICIPANTS: All graduates of the first intake of the University of Sydney graduate-entry medical program were surveyed at the end of their first intern year (2001), along with the director of clinical training or intern manager at each of the New South Wales hospitals that employed the graduates. MAIN OUTCOME MEASURES: Graduates' self-reported level of preparedness in the eight domains of the Preparation for Hospital Practice Questionnaire; and organisers' opinions of their strengths and weaknesses. RESULTS: 76 of 108 graduates from the graduate-entry program (70%) and organisers of clinical training at all 17 hospitals participated. Graduates from the program felt more prepared than did those from other programs in five of the eight domains assessed (interpersonal skills, confidence, collaboration, holistic care, and self-directed learning) and no less prepared in any domain. Organisers rated the graduates highly, especially in clinical competence, confidence, communication and professional skills. Opinions of interns' knowledge of basic sciences conflicted, with strengths and weaknesses mentioned with equal frequency. CONCLUSION: Graduates from the graduate-entry, problem-based program are at least as well prepared for their intern year as graduates from traditional and undergraduate problem-based programs.     

Discontinuation of antidepressants in newly admitted psychotic patients

Antidepressants may exacerbate manic or psychotic symptoms in vulnerable individuals. The authors discontinued antidepressants in 16 consecutive cases in which patients with manic or psychotic symptoms were otherwise judged to be on a satisfactory regimen prior to admission. Thirteen of the patients improved rapidly, which suggests a possible association between antidepressant discontinuation and clinical improvement in this patient group.     

Protofibrils of amyloid beta-protein inhibit specific K+ currents in neocortical cultures

Protofibrils (PFs) are recently described intermediate assemblies formed during the fibrillogenesis of amyloidogenic proteins and may play an important pathogenic role in Parkinson's and Alzheimer's disease (AD). Here we show for the first time that amyloid beta-protein (Abeta) attenuation of specific K(+) currents is dependent on the aggregation state; PFs inhibit K(+) currents, whereas low-molecular-weight assemblies have no effect. Using patch clamp analysis in whole cell current-clamp mode, we showed that at low nanomolar concentrations Abeta(1-42) PFs induce reversible, Ca(2+)-dependent increases in spontaneous action potentials and membrane depolarizations. The low nanomolar PF concentrations used, the instantaneous responses observed, and the reversibility of the effect all suggest that PFs may bind to specific channels or membrane proteins. Switching to voltage-clamp mode, we found that PFs at 1-2 microM can inhibit specifically the 4AP-sensitive K(+) currents, A-type and D-type, but not other outward or inward rectifying K(+) channels. Finally, we show that a consequence of PF-induced membrane activity is an increase in intracellular Ca(2+) spikes that are dependent on synaptic connections in the neural network formed in culture. Our data strongly support the concept that PFs can induce subtle synaptic alterations that may underlie early symptoms of AD.