Case report: A ball valve blood clot in the airways – life-saving whole tube suction

Respiratory tract obstruction due to a blood clot may result in life threatening ventilatory impairment. Ball valve blood clot obstructions of the airways are rare. A ball valve blood clot acts as a one-way valve, allowing (near) normal air entry into the airways, but (completely) blocking expiration. In a near fatal case of obstruction of the airways by a ball valve blood clot, we performed 'whole tube suction' to resolve the airway problem.     

Development of a nucleoprotein-based enzyme-linked immunosorbent assay using a synthetic peptide antigen for detection of avian metapneumovirus antibodies in Turkey sera

Avian metapneumoviruses (aMPV) cause an upper respiratory tract disease with low mortality but high morbidity, primarily in commercial turkeys, that can be exacerbated by secondary infections. There are three types of aMPV, of which type C is found only in the United States. The aMPV nucleoprotein (N) amino acid sequences of serotypes A, B, and C were aligned for comparative analysis. On the basis of the predicted antigenicity of consensus sequences, five aMPV-specific N peptides were synthesized for development of a peptide antigen enzyme-linked immunosorbent assay (aMPV N peptide-based ELISA) to detect aMPV-specific antibodies among turkeys. Sera from naturally and experimentally infected turkeys were used to demonstrate the presence of antibodies reactive to the chemically synthesized aMPV N peptides. Subsequently, aMPV N peptide 1, which had the sequence 10-DLSYKHAILKESQYTIKRDV-29, with variations at only three amino acids among aMPV serotypes, was evaluated as a universal aMPV ELISA antigen. Data obtained with the peptide-based ELISA correlated positively with total aMPV viral antigen-based ELISAs, and the peptide ELISA provided higher optical density readings. The results indicated that aMPV N peptide 1 can be used as a universal ELISA antigen to detect antibodies for all aMPV serotypes.     

The questioning skills of tutors and students in a context based baccalaureate nursing program

This paper explores, describes and compares the types and levels of questions asked by 30 randomly selected tutors (nurse educators) and their 314 students in context-based learning tutorial seminars in a Canadian baccalaureate nursing program. Thirty 90-min seminars were audio taped, transcribed and coded using a Questioning Framework designed for this study. The framework includes types and levels of questions, related wording and examples. The results of this study indicate that the majority of questions asked by tutors and students in the first three years of the program were framed at the low level (knowledge, comprehension, and application) and were aimed at seeking yes/no responses and factual information more so than probing. Although these questions are important to facilitate the teaching/learning process, educators and students need to increase the number of questions requiring analysis, synthesis, and evaluation as well as questions that involve probing, exploration, and explanation - questions believed to activate and facilitate critical thinking skills. Recommendations include the need for students and tutors to be taught how to question, the creation of a supportive environment for questioning and the use of appropriate strategies to teach the use of higher order questions. Future research using a cross sectional longitudinal design and qualitative approaches are also recommended. This study has direct implications for enhancing student learning and the development of nurse educators.     

Semiologic value of ictal autoscopy

PURPOSE: Autoscopy is a pathologic perception of one's body or one's face image within space, either from an internal ("as in a mirror") or from an external ("out-of-body experience") point of view. Among various psychiatric and neurologic disorders, partial epilepsy is the main etiology. However, the significance of this rare ictal symptom remains controversial. We report this phenomenon in three epilepsy patients and discuss its semiologic value and neuropsychological significance. METHODS: Interictal EEG and/or video-EEG monitoring was performed, as well as neuropsychological examination and cerebral magnetic resonance imaging (MRI). RESULTS: The three patients had a lesion involving, or limited to, the right parietal region on cerebral MRI. All three patients experienced autoscopy associated with other ictal signs supporting a right parietal lobe origin of seizures. In one patient, seizure origin was documented with video and surface EEG ictal recordings. CONCLUSIONS: Autoscopy was shown to have an ictal mechanism and was associated with seizures arising from the nondominant parietal region. We hypothesize that ictal autoscopy may result from disruption of the normal integration of body representation.     

Synovial sarcoma—unusual presentation with cerebral hemorrhage

Introduction Soft-tissue sarcomas account for 1% of all malignancies in adults. Typical symptoms comprise a growing and painless mass. Occasionally, the diagnosis is facilitated by secondaries.Materials and methods Here we report the first case presented with intracranial hemorrhage caused by a metastasis of a previously unknown synovial sarcoma. The 74-year-old female patient was under anticoagulation for recurrent thrombosis of the right popliteal vein due to compression by the sarcoma, misdiagnosed as Baker`s cyst. The brain metastasis was resected, and after an incisional biopsy of the suspected tumor, which confirmed the diagnosis of a synovial sarcoma, an above knee amputation was performed because of the invasion of the neurovascular structures in the popliteal fossa.Results The patient died 11 months after the initial event from pulmonary and further brain metastases.Conclusion Brain metastases are seldom the primary factor in the management of advanced synovial sarcoma. Initially, the primary tumor was thought to be a benign cyst; we therefore recommend a biopsy/excision of lesions greater than 5 cm in size and with growth tendency to allow appropriate treatment.     

Fluorescence hysteroscopy using 5-aminolevulinic: a descriptive study

BACKGROUND AND OBJECTIVES: To assess the feasibility of fluorescence hysteroscopy following topical ALA application and to describe the optical appearance of normal and neoplastic endometrium. STUDY DESIGN/MATERIALS AND METHODS: Fifty-four patients scheduled for routine hysteroscopy and D&C were assigned to the study group using topically applied ALA. Two milliliters of a 2% 5-ALA-solution at pH = 4.0 (ASAT AG/Zug, Switzerland) was administrated into the uterine cavity 4 hours before fluorescence hysteroscopy, using a STORZ-D-Light (Tuttlingen, Germany) system. Hysteroscopic findings were compared to the histological diagnosis of hematoxylin & eosin (H&E) stained sections. In the study group, 60 histological specimens were taken (47 materials of curettage and 13 targeted biopsies). The percentage of fluorescence positive patients was calculated. RESULTS: The rate of fluorescent endometrial samples was low in atrophic endometrium 1/16 (6.2%). Endometrial carcinoma were diagnosed in two patients. Both cases exhibited selective and intense PpIX-mediated red fluorescence. Fluorescence hysteroscopy could not differentiate between hyperplastic areas with or without atypia. Minimal uterine cramps or discomfort following ALA instillation were complained by 30 (56%) patients, no pain was indicated by 24 patients (44%). CONCLUSIONS: Fluorescence hysteroscopy following intrauterine application of ALA is feasible. Cancerous, hyperplastic, and secretory endometrial tissue showed high red fluorescence.     

Who comes to voluntary,community-based alcohol screening? Results of the first annual National Alcohol Screening Day, 1999

OBJECTIVE: The feasibility of the 1999 voluntary, community-based National Alcohol Screening Day (NASD) was assessed by determining 1) the extent to which community and college sites were registered to hold screenings and the extent to which the subjects came to participate, 2) the demographic and clinical characteristics of the participants at these screening sites, and 3) the extent to which individuals who were referred for evaluation and treatment adhered to follow-up recommendations. METHOD: Registered community and college sites were documented. Screening forms returned by the participants were analyzed. A subgroup of randomly selected participants from community and college sites was contacted by telephone. RESULTS: A total of 1,218 community sites and 367 [corrected] college sites participated in NASD. At the 1,089 sites that reported results, 32,876 people participated, 18,043 were screened, and 5,959 were referred for treatment. Forty-three percent of those screened at these sites had a score of 8 or more on the Alcohol Use Disorders Identification Test (AUDIT), indicating harmful or hazardous drinking. Only 13% of those screened had previous alcohol treatment. In the subgroup that participated in the follow-up survey (N=704), community participants (N=337) had higher mean scores on the AUDIT than the college participants (N=337). Approximately 50% of the community participants and 20% of the college participants adhered to the recommendation to pursue follow-up. CONCLUSIONS: Voluntary, community-based screening for alcohol problems is feasible and offers education, screening, and referral for many individuals with harmful or hazardous drinking behavior.     

Comparative efficacy and safety of atypical and conventional antipsychotic drugs in first-episode psychosis: a randomized,double-blind trial of olanzapine versus haloperidol

OBJECTIVE: Few long-term studies have compared the efficacy and safety of typical and atypical antipsychotic medications directly in patients with a first episode of psychosis who met the criteria for schizophrenia or a related psychotic disorder. This study compared the acute and long-term effectiveness of haloperidol with that of olanzapine in patients with first-episode psychosis in a large, controlled clinical trial. METHOD: Patients with first-episode psychosis (N=263) were randomly assigned under double-blind conditions to receive haloperidol or olanzapine and were followed for up to 104 weeks. Domains measured included psychopathology, psychosocial variables, neurocognitive functioning, and brain morphology and metabolism. This report presents data from clinical measures of treatment response and safety data from the 12-week acute treatment phase. RESULTS: Haloperidol and olanzapine were associated with substantial and comparable baseline-to-endpoint reductions in symptom severity, which did not differ significantly in last-observation-carried-forward analyses. However, in a mixed-model analysis, olanzapine-treated subjects had significantly greater decreases in symptom severity as measured by the Positive and Negative Syndrome Scale total score and negative and general scales and by the Montgomery-Asberg Depression Rating Scale but not as measured by the Positive and Negative Syndrome Scale positive scale and by the Clinical Global Impression severity rating. Olanzapine-treated patients experienced a lower rate of treatment-emergent parkinsonism and akathisia but had significantly more weight gain, compared with the haloperidol-treated patients. Overall, significantly more olanzapine-treated subjects than haloperidol-treated subjects completed the 12-week acute phase of the study (67% versus 54%). CONCLUSIONS: As expected on the basis of previous studies, both olanzapine and haloperidol were effective in the acute reduction of psychopathological symptoms in this group of patients with first-episode psychosis. However, olanzapine had several relative advantages in therapeutic response. Although the nature of adverse events differed between the two agents, retention in the study was greater with olanzapine. Retention in treatment is important in this patient population, given their risk of relapse. Longer-term results are needed to determine whether treatment with atypical antipsychotics results in superior outcomes for a first episode of schizophrenia.