Suprascapular nerve entrapment at the spinoglenoid notch in a professional baseball pitcher

Suprascapular nerve injuries at the spinoglenoid notch are uncommon. The true incidence of this lesion is unknown; however, it appears to be more common in athletes who participate in sports involving overhead activities. When a patient is being evaluated for posterior shoulder pain and infraspinatus muscle weakness, electrodiagnostic studies are an essential part of the evaluation. Electromyography will identify an injury to the suprascapular nerve as well as assist in localizing the site of injury. In addition, imaging studies are also indicated to help exclude other diagnoses that can mimic a suprascapular nerve injury. The initial management should consist of cessation of the aggravating activity along with an organized shoulder rehabilitation program. If the patient fails to improve with 6 months to 1 year of nonoperative management, surgical exploration of the suprascapular nerve should be considered. Release of the spinoglenoid ligament with resultant suprascapular nerve decompression may result in relief of pain and a return of normal shoulder function.     

Legg-Calve-Perthes Disease: Imaging Evaluation and Management

Legg-Calve-Perthes disease reflects avascular necrosis of the proximal femoral epiphysis and growth plate in children age 4 to 8 years typically. The most likely etiology is vascular deficiency to the epiphysis and growth plate. The pathologic stages consist of necrosis, resorption, reossification, and remodeling. Radiologic findings reflect the pathologic stages. Containment of the femoral head with the acetabulum is the most important component of treatment, with preservation of range of motion also indicated in most patients. Surgical options for treatment include varus or valgus femoral osteotomy, innominate osteotomy, and shelf arthroplasty.     

The interaction between fluoropyrimidines and methotrexate,and [14C]-formate incorporation into nucleic acids and protein

Summary Changes are reported in [¹⁴C]-formate incorporation into nucleic acids and protein of Ehrlich ascites tumor cells during exposure to methotrexate (MTX) and fluoropyrimidines. The rate of [¹⁴C]-formate incorporation into RNA, DNA, and protein in the presence of only MTX was inhibited by 82%, 91%, and 75% respectively, when compared with control rates. However, in the presence of 5-fluorodeoxyuridine (FdUrd) plus MTX, formate incorporation into RNA, DNA, and protein was inhibited by 67%, 85%, and 66%. Incubation of cells in vitro with [³H]-dihydrofolate (DHF) results in its rapid conversion to [³H]-tetrahydrofolate (THF). The THF/DHF ratio from the soluble fraction of cells that were incubated with [³H]-DHF was 43% greater in the presence of FdUrd and MTX than in the presence of MTX alone. As the rate of [³H]-dUrd incorporation into DNA was reduced by 88% and 99% by pretreating cells with 0.1 M and 1 M FdUrd, respectively, the inhibitory effect of MTX on [¹⁴C]-formate incorporation into (a) RNA was decreased by 63% and 46%; (b) DNA was decreased by 74% and 61%; and (c) protein was decreased by 63% and 32%. These data suggest that fluoropyrimidines can antagonize the effects of MTX on purines or nucleic acid synthesis and protein synthesis by preventing the consumption of THF for dTMP synthesis.The abbreviations used are MTX methotrexate - FdUrd 5-fluorodeoxyuridine - Fura 5-fluorouracil - FdUMP 5-fluorodeoxyuridine monophosphate - dUrd deoxyuridine - dUMP deoxyuridine monophosphate - dTMP thymidylate - DHF dihydrofolate - THF tetrahydrofolate - 5,10-CH₂THF 5,10-methylene tetrahydrofolate - DHFR dihydrofolate reductase     

Modulation of tissue immunogenicity by organ culture. Comparison of adult islets and fetal pancreas

Uncultured mouse islet allografts (BALB/c to CBA) are rejected 2 to 4 weeks after transplantation. Allografts, cultured in 95% O2 and 5% CO2 for 7 days before transplantation, show no sign of rejection up to 3 months post-transplantation. However, the cultured allografts are rejected if the CBA recipient is given an i.v. injection of 10(5) peritoneal cells at the time of transplantation. Organ culture of BALB/c fetal pancreas (16 to 17 days gestation) under the same conditions failed to prevent allograft rejection. The immunogenicity of fetal pancreas is reduced if this tissue is cultured in 95% O2 and 5% CO2 for 17 days before transplantation.     

Maximizing worksite survey response rates through community organization strategies and multiple contacts

BACKGROUND. Worksites are natural settings for health promotion. In many cases, the effectiveness of such interventions is appraised by surveying employees to assess worksite-wide changes in the targeted behavior. Little attention has been paid to increasing worksite survey response rates. One way is to utilize community organization strategies, which involve enlisting the individuals within a group to work together with researchers to affect the social environment. METHODS. Community organization strategies and multiple contacts were used to obtain responses from employees in five worksites involved in a smoking cessation project. Employee Advisory Board members in each worksite reviewed, adapted, and revised the survey distribution method, the messages that accompanied the survey, and the survey content. Three major survey waves were undertaken: a worksite effort, a home mailing (in the pilot worksite only), and a telephone call to nonrespondents. RESULTS. Response rates to a worksite-wide survey in one worksite the first year and four additional worksites the next year yielded 99.3% and 98.4% response rates, respectively. In the pilot worksite, 273 employees were eligible for the survey with 366 eligible employees in the four other worksites. Chi-square or analysis of variance computations were used, as appropriate, to test for differences in characteristics of respondents in the various data collection waves. DISCUSSION. These results suggest that there may be merit in adapting such community organization intervention methods for research applications.     

Minority recruitment in hereditary breast cancer research.

Although recruitment of ethnic and racial minorities in medical research has been evaluated in several studies, much less is known about the methods used to recruit these populations to participate in cancer genetics research. This report reviews the resources that have been used to identify and recruit ethnic and racial minorities to participate in hereditary breast cancer research. Overall, hospital-based resources were used most often to identify potential subjects, and active recruitment methods were used most frequently to enroll eligible subjects. This review suggests that there appears to be a finite number of resources and strategies to identify and recruit potential subjects to participate in cancer genetics research; however, options for improving awareness about cancer genetics research among ethnic and racial minorities have not been extensively evaluated. To study ethnic and racial minority participation in cancer genetics research, stronger evaluation components will need to be integrated into research methods. Both observational and experimental studies are needed to determine resources that are most effective for identifying potential subjects who are ethnic and racial minorities and to evaluate the effects of different recruitment strategies on enrollment decisions among these populations.     

Initial response to portoenterostomy determines long-term outcome in patients with biliary atresia

PURPOSE: The aim of this study was to assess the efficacy of portoenterostomy in biliary atresia and determine factors that predict outcomes. METHODS: The outcomes after portoenterostomy for biliary atresia from 1976 to 1996 were graded into 3 defined groups: G (good, jaundice free); I (intermediate, progressive liver disease with liver transplant if needed after 3 years of age); P (poor, liver transplant or death at less than 3 years of age). RESULTS: Twenty-seven of 49 children (55%) who underwent portoenterostomy responded. Of these, 13 (26%) were jaundice free (G). Of 14 children (28%) in I, 6 underwent liver transplant after 3 years of age. Of 22 children (44.8%) in P, 14 (28%) died before 3 years and 8 underwent liver transplant before 3 years. Thus, 42% of the children in this series are surviving with native liver. Age at operation in P was significantly different compared with G. Preoperative values of bilirubin and alanine transaminase were comparable in the 3 groups. Postoperative values of bilirubin and alanine transaminase were lower in G and I compared with P Complications were significantly lower in group G. CONCLUSIONS: Portoenterostomy alone in biliary atresia is beneficial in 40% of cases. Factors associated with the outcome include age at operation, postoperative cholangitis, and change in values of bilirubin and alanine transaminase. A classification based on decline of bilirubin and enzyme levels 3 months after portoenterostomy is proposed to predict the long-term outcome of an individual case of biliary atresia. It is particularly relevant in the intermediate group in which timing of referral may preclude or compromise liver transplant.