Measurement of leptin in dried blood spot samples.

Leptin is important in a wide range of physiological processes, but logistical constraints associated with venipuncture blood collection have limited research on leptin in diverse, community-based settings. The aim of this short report is to present and validate an enzyme immunoassay method for quantifying leptin in samples of capillary whole blood collected from a simple finger prick and dried on filter paper. The method was evaluated through analysis of precision, reliability, stability, and comparisons with matched plasma and blood spot samples. We report acceptable levels of assay precision and reliability, and good agreement between results obtained from matched plasma and blood spot samples (r = 0.976, P < 0.001). Leptin concentrations begin to deteriorate after only 3 days at room temperature. Thus, care should be taken to refrigerate or freeze samples promptly. The relative ease of blood spot sample collection may facilitate research on leptin in a wider range of cultural and ecological settings.     

Combined tool approach is 100% successful for emergency football face mask removal.

OBJECTIVE: To compare effectiveness of two techniques for removing football face masks: cutting loop straps [cutting tool: FMXtractor (FMX)] or removing screws with a cordless screwdriver and using the FMXtractor as needed for failed removals [combined tool (CT)]. Null hypotheses: no differences in face mask removal success, removal time or difficulty between techniques or helmet characteristics. DESIGN: Retrospective, cross-sectional. SETTING: NOCSAE-certified helmet reconditioning plants. PARTICIPANTS: 600 used high school helmets. INTERVENTIONS: Face mask removal attempted with two techniques. MAIN OUTCOME MEASUREMENTS: Success, removal time, rating of perceived exertion (RPE). RESULTS: Both techniques were effective [CT 100% (300/300); FMX 99.4% (298/300)]. Use of the backup FMXtractor in CT trials was required in 19% of trials. There was significantly (P<0.001) less call for the backup tool in helmets with silver screws (6%) than in helmets with other screws (31%). Mean removal time was 44.51+/-18.79s (CT: 37.84+/-15.37s, FMX: 51.21+/-19.54s; P<0.001). RPE was different between techniques (CT: 1.83+/-1.20, FMX: 3.11+/-1.27; P<0.001). Removal from helmets with silver screws was faster (Silver=33.38+/-11.03, Others=42.18+/-17.64; P<0.001) and easier (Silver=1.42+/-0.89, Other=2.23+/-1.33; P<0.001). CONCLUSIONS: CT was faster and easier than FMX. Most CT trials were completed with the screwdriver alone; helmets with silver screws had 94% screwdriver success. Clinically, these findings are important because this and other research shows that compared to removal with cutting tools, screwdriver removal decreases time, difficulty and helmet movement (reducing potential for iatrogenic injury). The combined-tool approach captures benefits of the screwdriver while offering a contingency for screw removal failure. Teams should use degradation-resistant screws. CLINICAL RELEVANCE: Sports medicine professionals must be prepared with appropriate tools and techniques to efficiently remove the face mask from an injured football player's helmet.     

Ankle fusion: a retrospective review

The results of ankle fusion were reviewed in 26 patients who underwent 32 arthrodesis procedures. Posttraumatic degenerative arthritis was the most common indication for fusion (54%). Crossed cancellous screws were the primary method employed (43%), with an external fixator being used in 22% of cases. The overall union rate was 81%, with both crossed cancellous screws and external fixation attaining the best results (86%). Nonunion and infection were the most frequent complications. Progression of subtalar arthritis was demonstrated in 29% of patients postoperatively. Seventy-eight percent of patients graded extremity appearance as excellent or good, with the majority being able to return to work.     

The utility of fine needle aspiration in parotid malignancy.

OBJECTIVE: To determine clinical utility of fine needle aspiration (FNA) in parotid neoplasia. STUDY DESIGN AND SETTING: Retrospective cohort study. METHODS: FNA and final pathology data were reviewed for patients who underwent parotidectomy for malignancy. Surgical outcomes were compared between patients with malignant cytology versus nonmalignant/nondiagnostic cytology. RESULTS: Twenty-seven of 33 primary malignant parotid lesions underwent FNA. Seventeen (63.0%) patients were diagnosed with cancer on FNA. The remaining 16 patients did not undergo FNA (n = 6), had a nondiagnostic FNA specimen (n = 5), or were incorrectly diagnosed with a benign lesion (n = 5). Patients who went on to parotidectomy with intent to treat malignancy based on FNA had significantly higher rates of upfront neck dissections (47.1% vs 12.5%, P = 0.036) as well as clear pathological margins (70.6% vs 31.3%, P = 0.027) vs those with nonmalignant FNA diagnoses. CONCLUSIONS: Preoperative FNA diagnosis of malignancy improves surgical treatment of parotid cancer. SIGNIFICANCE: FNA in the evaluation of parotid masses should strongly be considered.     

Dega-Osteotomie bei Hüftgelenkdysplasie

Zusammenfassung Operationsziel überdachung des Femurkopfes bei Hüftgelenkdysplasie. Indikationen Dysplastisches Acetabulum bei Patienten mit neuromuskul?ren und nichtneuromuskul?ren Erkrankungen. übergro?es, flaches Acetabulum. Fehlen einer lateralen und kranialen überdachung. Kontraindikationen Y-Fuge geschlossen, Wachstum abgeschlossen. Stark verformter Femurkopf. Operationstechnik Modifizierter Zugang nach Salter/Smith-Petersen. Freilegung und Teilung der Apophyse des Beckenkammes mit einem Messer. Freilegung der Darmbeinschaufel. Osteotomie der ?u?eren Wand des Iliums; sie wird vorsichtig mit Hilfe eines gebogenen mei?els nach unten gebogen und in dieser Stellung durch Einsetzen von trikortikalen Beckenkammsp?nen gehalten. Eine Osteosynthese ist nicht notwendig. Becken-Bein-Gipsverband mit Einschlu? des gegenseitigen Oberschenkels für sechs Wochen. Ergebnisse Zwischen 1987 und 1997 wurden 26 Hüften von 23 Patienten operiert. überwiegend handelte es sich um Kinder mit spastischen Paresen. Folgende zus?tzliche Eingriffe wurden vorgenommen: Offene Reposition zehnmal, Femurosteotomie 18mal und Tenotomien sowie Muskelabl?sungen 15mal. Der Durchschnittswert des azetabul?ren Index verbesserte sich von 32° auf 22°, der durchschnittliche Wert des Kopfzentrum-Pfannenrand-Winkels von −25° auf 22° und der durchschnittliche Migrationsindex von 62% auf 69%. Als Komplikationen wurden beobachtet: eine erneute Subluxation, ein frühzeitiger Verschlu? des Y-Knorpels, eine Fraktur des anderen Femur, einmal heterotope Ossifikationen und einmal eine Infektion der Harnwege.     

Low-artifact intravascular devices: MR imaging evaluation

Flow-phantom magnetic resonance (MR) imaging, with use of both spin-echo (SE) and gradient-echo (GRE) techniques at 1.5 T, was performed on the percutaneous Greenfield (beta-III titanium alloy [TMA wire]), Amplatz (MP32-N alloy), and Simon nitinol filters and TMA wire facsimiles of the bird's nest, Gunther, new retrievable, and Amplatz vena caval filters. SE imaging allowed detection of thrombi as small as 5 X 5 mm trapped within the percutaneous Greenfield, Simon nitinol, and TMA-wire facsimile filters; with the MP32-N Amplatz filter, a larger volume of thrombus (10 X 20-mm clots) was necessary for clot detection. GRE imaging allowed detection of intraluminal tilting of the percutaneous Greenfield and facsimile Amplatz (TMA-wire) filters. GRE imaging was useful for demonstrating postfilter turbulence due to clots, which was greatest for the Amplatz filter. Imaging of facsimile vascular devices made of tantalum or TMA wire did not cause the severe "black-hole" MR artifacts typical of the stainless-steel devices. SE and GRE imaging were very useful for determining caval patency in two patients with previously placed Mobin-Uddin filters. Noninvasive MR evaluation of blood vessels in the presence of a variety of low-artifact intravascular devices appears feasible.     

Good outcome in prune-belly syndrome despite associated severe anomalies

A boy aged 4.5 years with prune-belly syndrome (PBS) and associated urethral stenosis, oligohydramnios, imperforate anus and vesicosigmoid fustula is described. In contrast to the anticipated poor prognosis, vesicostomy and divided transverse colostomy performed after birth followed by prophylaxis of infection and bicarbonate supplementation have resulted in a good outcome. The vesicosigmoid fistula might have served in utero as a natural diversion protecting from pressure-induced renal damage. It is suggested that the main determinant of prognosis in PBS is the presence and degree of kidney dysplasia at birth as reflected by the neonatal renal function after performance of an indicated urinary diversion procedure rather than the presence of severe associated anomalies.Supported in part by grants from the National Institute of Health AM 37223-01 and the Medical School and Graduate School Research Committees of the University of Wisconsin and a Research Career Development Award KO4 AM 00421 (RWC), by the Pearl M. Stetler Foundation (SD) and by a National Kidney Foundation fellowship (IZ)     

The role of imperatives in psychopathology: A reply to Ellis

In his recent formulations of rational emotive therapy (RET), Ellis (1985) has increasingly emphasized what he believes to be the central role of necessitous thinking or musturbation in the development of depression. In his most recent article (Ellis, 1987), he suggests that necessitous thinking is the primary cognitive component of depression and that RET stands alone in its recognition of the role of this cognitive element. The present study addressed three issues raised by Ellis's paper: (1) Clarify whether necessitous thinking has been neglected by other cognitive theorists, (2) test empirically the role of necessitou thinking in depression relative to other established cognitive constructs, e.g., the cognitive triad (Beck, 1967), and (3) determine whether necessitous thinking is particularly salient in depression as compared with other forms of psychopathology. It was predicted that necessitous thinking would be found in other forms of psychology in addition to depression, and this was confirmed. The results are discussed as highlighting the importance of empirically testing theoretical predictions.From the Foundation for Cognitive Therapy.     

Costello syndrome: Clinical phenotype,genotype, and management guidelines

Costello syndrome (CS) is a RASopathy caused by activating germline mutations in HRAS. Due to ubiquitous HRAS gene expression, CS affects multiple organ systems and individuals are predisposed to cancer. Individuals with CS may have distinctive craniofacial features, cardiac anomalies, growth and developmental delays, as well as dermatological, orthopedic, ocular, and neurological issues; however, considerable overlap with other RASopathies exists. Medical evaluation requires an understanding of the multifaceted phenotype. Subspecialists may have limited experience in caring for these individuals because of the rarity of CS. Furthermore, the phenotypic presentation may vary with the underlying genotype. These guidelines were developed by an interdisciplinary team of experts in order to encourage timely health care practices and provide medical management guidelines for the primary and specialty care provider, as well as for the families and affected individuals across their lifespan. These guidelines are based on expert opinion and do not represent evidence‐based guidelines due to the lack of data for this rare condition.