Meta-analysis by combining p-values: simulated linkage studies

Meta-analysis has been little explored to make an overall assessment of linkage from different studies. In practice, it is likely that published linkage studies will only report p-values. We compared the performance of the widely used Fisher method for combining p-values with that of pooling raw data. More loci were consistently found by pooling raw data. In the absence of further information, combining p-values can provide an overall, but limited, assessment of different linkage studies. However, meta-analysis would be better viewed as a preliminary step toward the goal of analyzing the pooled raw data.     

Cardiovascular Response and Anesthetic Recovery in Electroconvulsive Therapy with Propofol or Thiopental

Propofol provokes a slight hypotensive effect that could mitigate the cardiovascular response to electroconvulsive therapy (ECT). In this study we compared the effects of propofol and thiopental for ECT anesthesia in seven women (22-67 years of age). Anesthesia was induced with either thiopental or propofol, and with atropine and suxamethonium for each treatment. The first anesthesia was assigned to thiopental or propofol at random; the next anesthesia was induced with the other drug, and alternated thereafter. Systolic blood pressure, diastolic blood pressure (DBP), and heart rate (HR) were recorded before anesthesia, after anesthetic induction, and 1 and 5 min after ECT. ECT-induced increases in DBP and HR were less marked with propofol than with thiopental. Seizure durations were decreased with propofol compared with thiopental.     

The adult hip: an anatomic study. Part I: the bony landmarks

A comprehensive anatomic, pathologic and radiographic study of the adult hip was undertaken to define bony landmarks which, when altered, are reliable indicators of disease. Methodology included radiography of cadaveric specimens and analysis of over 300 anteroposterior (AP) radiographs of "normal" adult hips. This information was applied to clinical situations with the following conclusions: (a) The diagnosis of protrusio acetabuli is warranted if the acetabular line projects medial to the ilioischial line by 3 mm or more in men and by 6 mm or more in women. (b) In acetabular trauma, an AP and two oblique radiographs (30 degrees anterior oblique and 30--45 degrees posterior oblique) are required for complete evaluation. (c) Characteristic alterations in the joint space allow accurate diagnosis of disease.     

The secretion of aspartyl proteinase,a virulence enzyme,by isolates of Candida albicans from the oral cavity of HIV-infected subjects

Prevalence, serotype and in vitro secretion of aspartyl proteinase, a virulence enzyme, were studied in Candida isolates from the oral cavity of 337 HIV-infected subjects. Controls were 95 age-sex-matched HIV- (seronegative) subjects, belonging to either HIV-risk categories (47) or to the normal, general population (48). Fungi were isolated from 155 HIV+ subjects. C. albicans was the most prevalent species (85.8% of all isolates). 94.6% of C. albicans isolates were serotype A and all were agglutinated by a monoclonal antibody (AF1) directed against a major mannoprotein immunogen of the candidal cell wall, confirming previous results with C. albicans isolates from non-immunodeficient subjects. With regard to the stage of HIV infection, there were no statistically significant differences in the incidence of oral Candida carriage between asymptomatic (stage II) HIV+ and HIV- subjects, and between stage II and lymphadenopathic (stage III) individuals. Also, the low (3.8%) incidence of oral candidiasis in the subjects of the latter stage was insignificant with respect to stage II subjects. However, the incidence of C. albicans in stage IV (AIDS) subjects (46.8%) was significantly higher than in all other subjects, and in almost all cases, fungal isolation was accompanied by oral thrush and lower CD4+ lymphocyte counts (< 400 × 10°/L).All isolates of C. albicans were proteolytic in vitro, as assessed by scoring the proteinase activity on BSA agar and monitoring the secreted proteinase antigen by a highly sensitive (1 ng) and specific immunoenzymatic assay. However, by both methods, the isolates from subjects at stages III and IV of infection produced more secretory proteinase than the isolates from either HIV+ asymptomatic subjects or HIV- controls. The differences could not be attributed to particular culture media or source of Candida isolation (carriage versus active infection). Thus, the isolates of C. albicans from advanced HIV infection are serologically similar but more proteolytic than the isolates from earlier stages of HIV infection or those from HIV-uninfected subjects. The apparently higher virulence of C. albicans from AIDS subjects may represent a co-factor in determining and/or aggravating oral candidiasis in these patients.     

Fentanyl-induced electrocorticographic seizures in patients with complex partial epilepsy.

Although electrical seizure activity in response to opioids such as fentanyl has been well described in animals, scalp electroencephalographic (EEG) recordings have failed to demonstrate epileptiform activity following narcotic administration in humans. The purpose of this study was to determine whether fentanyl is capable of evoking electrical seizure activity in patients with complex partial (temporal lobe) seizures. Nine patients were studied in whom recording electrode arrays had been placed in the bitemporal epidural space several days earlier to determine which temporal lobe gave rise to their seizures. The symptomatic temporal lobe was localized by correlating clinical and electrical seizure activity obtained during continuous simultaneous videotape and epidural EEG monitoring. In each patient, clinical seizures and electrical seizure activity were consistently demonstrated to arise unilaterally from one temporal lobe (four on the right, five on the left). During fentanyl induction of anesthesia in preparation for secondary craniotomy for anterior temporal lobectomy, eight of the nine patients exhibited electrical seizure activity at fentanyl doses ranging from 17.7 to 35.71 micrograms.kg-1 (mean 25.75 micrograms.kg-1). More importantly, four of these eight seizures occurred initially in the "healthy" temporal lobe contralateral to the surgically resected lobe from which the clinical seizures had been shown to arise. These findings indicate that, in patients with complex partial seizures, moderate doses of fentanyl can evoke electrical seizure activity. The results of this study could have important implications for neurosurgical centers where electrocorticography is used during surgery for the purpose of determining the extent of the resection.     

Perceived exertion during isometric quadriceps contraction. A comparison between men and women

BACKGROUND: 1) To examine the validity and accuracy of the CR-10 scale for evaluating perceived exertion, and 2) to assess gender differences in perceived exertion across different levels of contraction intensity. METHODS: Experimental design: cross-sectional, comparative design. Setting: Human Performance and Fatigue Laboratory, Eastern Washington University. Subjects: 30 healthy, college age volunteers (15 males, 15 females). Measures: All subjects were assessed for isometric torque and perceived exertion of the quadriceps femoris muscles, via the CR-10 scale. One low anchor was applied under resting conditions with the knee flexed to 60 degrees, and a high anchor was applied during a maximal voluntary muscle contraction (MVC). Subjects performed five-second isometric contractions equivalent to 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, and 90% of their MVC, in a random order, and were assessed for perceived exertion by visually observing the CR-10 scale. One sample "t"-tests and 95% confidence intervals were calculated for perceived exertion at each relative torque level. A single factor ANOVA with repeated measures was performed across al levels of exercise intensity. Linearity for perceived exertion was assessed via regression analysis. RESULTS: Perceived exertion at each exercise intensity were as follows: 10%: 1.87+/-1.14, 20%: 2.43+/-1.19, 30%: 3.5+/-1.36, 40%: 3.97+/-1.52, 50%: 4.73+/-1.28, 60%: 5.53+/-1.28, 70%: 6.73+/-1.62, 80%: 7.57+/-1.72, and 90%: 8.6+/-1.52. The increase in perceived exertion across the intensity spectrum was found to fit both linear and quadratic trends. There were no gender differences in perceived exertion across all levels of exercise intensity. CONCLUSIONS: The findings demonstrate that the CR-10 scale closely approximates perceived exertion of the quadriceps femoris muscles during sub-maximal, static contractions, and is not gender specific.     

The midvastus surgical approach in total knee arthroplasty

We report a study of 2 surgical approaches to the knee in 42 consecutive patients undergoing a total arthroplasty. They were divided into 2 groups. In Group 1 (n=17) the knee was exposed through classic medial parapatellar arthrotomy and in Group 2 (n=25) the knee was approached through the fibers of the medial vastus. Preoperative assessment did not reveal any statistical differences between the groups, and blood loss, operation time, biochemistry values and radiographic evaluation were also similar. However, a higher number of lateral releases, a loss of knee extension and a reduced range of motion were significantly associated with classical parapatellar arthrotomy. As the number of operative or postoperative complications was not increased, we recommend the mid-vastus approach for total knee arthroplasty.

---

Résumé  Nous présentons une étude de 42 arthroplasties totales consécutives de genoux qui ont été divisées en deux groupes. Le groupe 1 (n=17) a eu une voie d’abord classique par arthrotomie antéro-interne parapatellaire et le groupe 2 (n=25) a eu un abord à travers les fibres du vastus medialis. Entre les deux groupes, il n’y a pas de différence significative entre les données pré-opératoires, la perte sanguine, le temps opératoire et l’état radiographique. Dans le groupe 1, un plus grand nombre de libérations externes a été nécessaire, une perte de la force d’extension a été notée ainsi qu’une diminution de l’amplitude articulaire. Comme le taux de complications opératoires et postopératoires n’a pas été majoré, nous recommandons ce type d’approche à travers les fibres du vastus medialis pour l’arthroplastie totale de genou.

---

---

Accepted: 3 January 2000     

Giant intracranial aneurysm of the anterior communicating artery treated by direct surgical approach. Case report

We report the singular case of an exceptionally large giant communicating artery aneurysm successfully treated with a direct surgical approach. The clinical presentation was a relatively short history of frontal headache. In the pre- and postcontrast CT scans the lesion mimicked an intracranial tumor. At surgery the intraluminal thrombus was partially removed with an ultrasonic surgical aspirator; the decompression allowed the isolation and subsequent temporary dipping of the tracts A1 and A2 of both the anterior cerebral arteries. It was then possible to complete the thrombectomy and to dip the neck of the aneurysm. The report emphasizes the indispensable role of MRI for the accurate diagnosis of giant intracranial aneurysms and the recent improvement of the surgical results concerning this category of aneurysms (mainly related to the present wider availability of technical surgical instrumentation).