Graduating internal medicine residents' self-assessment and performance of advanced cardiac life support skills

Internal medicine residents in the US must be competent to perform procedures including Advanced Cardiac Life Support (ACLS) to become board-eligible. Our aim was to determine if residents near graduation could assess their skills in ACLS procedures accurately. Participants were 40 residents in a university-based training program. Self-assessments of confidence in managing six ACLS scenarios were measured on a 0 (very low) to 100 (very high) scale. These were compared to reliable observational ratings of residents' performance on a high-fidelity simulator using published treatment protocols. Residents expressed strong self-confidence about managing the scenarios. Residents' simulator performance varied widely (range from 45% to 94%). Self-confidence assessments correlated poorly with performance (median r = 0.075). Self-assessment of performance by graduating internal medicine residents was not accurate in this study. The use of self-assessment to document resident competence in procedures such as ACLS is not a proxy for objective evaluation.     

Multidetector CT of the female pelvis

In the emergency room setting, multidetector detector CT (MDCT) offers rapid, noninvasive, multiplanar evaluation of female patients who have acute pelvic pain. MDCT has been integrated into several of the major trauma centers, and its use may surpass the use of ultrasound in the trauma evaluation of the pregnant patient. In the nonemergent setting, MDCT can be used to stage gynecologic malignancy and to evaluate tumor recurrence. Multiplanar MDCT has received some acceptance for evaluation of small primary tumor volume and small metastatic implants. MDCT also has a role in the evaluation of pelvic varices and suspected pelvic congestion syndrome.     

软腭等离子射频打孔消融治疗阻塞性睡眠呼吸暂停综合征

目的：探讨等离子低温射频软腭打孔消融对阻塞性睡眠呼吸暂停低通气综合征的临床疗效。方法：对65例经多导睡眠图监测确诊为阻塞性睡眠呼吸暂停低通气综合征的患者行软腭等离子低温射频打孔消融术，缩短软腭及悬雍垂。结果：术后随访3～6个月，患者均取得了满意效果。患者射频治疗前和治疗12周后多导睡眠参数比较显示：治疗后Ⅰ Ⅱ期睡眠时间明显缩短，Ⅲ Ⅳ期睡眠时间明显延长，睡眠效率及最低脉氧饱和度(LSpO2)均显著提高(P＜0．05)；呼吸暂停低通气指数减低及打鼾时间缩短与治疗前相比差异非常显著(P＜0．01)。患者射频治疗12周后软腭长度及悬雍垂长度的缩短及鼾声评级的降低均较治疗前有显著差异(P＜0．01)。Epworth嗜睡程度评分亦较治疗前明显降低(P＜0．01)。结论：等离子低温射频软腭打孔消融对于轻度OSAHS患者具有较好的近期疗效，且方便、安全、微创、康复快，无不良反应，有较好的发展前景，值得推广应用。     

Expression of the duffy antigen/receptor for chemokines (DARC) by the inflamed synovial endothelium

The expression of chemokine binding sites on the endothelial cells of venules in inflamed synovia was examined and whether the Duffy antigen/receptor for chemokines (DARC) was involved. In situ binding assays were performed to determine the expression of chemokine binding sites from rheumatoid (n = 10) and non-rheumatoid (n = 10) synovia. The expression of DARC protein and mRNA was examined by immunohistochemistry and northern blotting. The involvement of DARC in chemokine binding was studied by incubating sections with blocking antibodies to DARC (Fy3 and 6), to find out if these reduced 125I-IL-8 binding. Binding of radiolabelled chemokines IL-8, RANTES, MCP-1, but not MIP-1alpha, was found on venular endothelial cells in inflamed synovia from both rheumatoid and non-rheumatoid patients. Excess homologous unlabelled chemokine displaced binding and excess unlabelled RANTES could displace radiolabelled IL-8 binding. DARC protein expression was demonstrated on venular endothelial cells in all samples and DARC mRNA could be detected in extracts from synovia. There was downregulation of DARC protein and mRNA in rheumatoid samples. Binding of IL-8 to both rheumatoid and non-rheumatoid synovia was significantly reduced in the presence of anti-DARC Fy3 and Fy6 monoclonal antibodies. These findings show the expression of a multispecific chemokine binding site on the inflamed synovial endothelium, with evidence for involvement of DARC. This suggests a potential role for DARC in the inflammatory processes involved in synovitis.     

Do men undergoing sterilizing cancer treatments have a fertile future?

This study was designed to assess the effect of cancer treatments on the natural and assisted reproductive potential of men. A cohort of men with cancer, in whom radiotherapy and/or chemotherapy was planned, were invited to participate. Twenty-two pre- and post-treatment semen samples were analysed. The reproductive potential of participants was assessed with respect to the current range of fertility treatment options available. Abnormal sperm concentrations were found in 27% of patients pre-treatment compared to 68% post-treatment following a mean latency of 20 months from treatment. Fifty-nine percent of patients experienced a clinically significant decrease in sperm, concentration following radiotherapy and/or chemotherapy; 23% developed azoospermia following treatment. Eighty-two percent of patients with testicular malignancy had oligo- or azoospermia post-treatment. Only one patient had a clinically significant reduction in the percentage of motile spermatozoa post-treatment. Cryopreservation of semen prior to treatment improved the fertility prospects of 55% of patients. Intracytoplasmic sperm injection (ICSI) enhanced the fertility prospects of a further 14%. In the absence of, or after depletion of, cryopreserved semen, ICSI could enhance the fertility prospects of 45% of patients. Fertilization has been achieved by ICSI using spermatozoa retrieved by testicular biopsy from an azoospermic testicular cancer survivor 8 years after chemotherapy. It was concluded that chemotherapy and/or radiotherapy may depress semen concentration to the extent of rendering a man infertile. The severity of the reduction in sperm concentration following treatment is unpredictable but likely to be most severe in those with testicular malignancy and those treated with radiotherapy or alkylating chemotherapy agents. Not all men are keen to undergo an appraisal of their post-treatment fertility potential, for reasons which are unclear. Improving awareness and education of patients concerning the effects of both cancer and cancer treatments on reproductive potential is essential. With the advent of ICSI, it is possible to offer a very reasonable chance of conception in all men with cancer who present for cryopreservation of semen prior to treatment in whom spermatozoa (even in very low concentrations) are present in the ejaculate.      

Multicentric giant cell tumour and phaeochromocytoma

A rare case of multicentric giant cell tumours (MGCT) in an adult male patient is presented. Incidental concurrence of metastatic phaeochromocytoma is also noted in the same patient.