Anatomy of the Internal Iliac Vein: Implications for Uterine Transplant

Study Objective

Uterine transplantation has proven feasible since the first live birth reported in 2014. To enable attachment of the uterus in the recipient, long vascular pedicles of the uterine and internal iliac vessels were obtained during donor hysterectomy, which required a prolonged laparotomy to the living donors. To assist further attempts at uterine transplantation, our video serves to review literature reports of internal iliac vein anatomy and demonstrate a laparoscopic dissection of cadaver pelvic vascular anatomy.

Deterministic center of pressure patterns characterize postural instability in Parkinson’s disease

Static posturographic recordings were obtained from six Parkinson’s patients and six age-matched, healthy control participants. The availability of vision and visuo-spatial cognitive load were manipulated. Postural sway patterns were analyzed using recurrence quantification analysis (RQA), which revealed differences in center of pressure (COP) dynamics between Parkinson’s and control participants. AP COP trajectories for the Parkinson’s group were not only significantly more variable than for the control group, but also exhibited distinct patterns of temporal dynamics. The visual manipulation did not differentially affect the two groups. No cognitive load effects were found. The results are generally consistent with the hypothesis that pathological physiological systems exhibit a tendency for less flexible, more deterministic dynamic patterns.     

Different cellular p16(INK4a) localisation may signal different survival outcomes in head and neck cancer

Background:

Recently, the management of head and neck squamous cell carcinoma (HNSCC) has focused considerable attention on biomarkers, which may influence outcomes. Tests for human papilloma infection, including direct assessment of the virus as well as an associated tumour suppressor gene p16, are considered reproducible. Tumours from familial melanoma syndromes have suggested that nuclear localisation of p16 might have a further role in risk stratification. We hypothesised p16 staining that considered nuclear localisation might be informative for predicting outcomes in a broader set of HNSCC tumours not limited to the oropharynx, human papilloma virus (HPV) status or by smoking status.

Methods:

Patients treated for HNSCC from 2002 to 2006 at UNC (University of North Carolina at Chapel Hill) hospitals that had banked tissue available were eligible for this study. Tissue microarrays (TMA) were generated in triplicate. Immunohistochemical (IHC) staining for p16 was performed and scored separately for nuclear and cytoplasmic staining. Human papilloma virus staining was also carried out using monoclonal antibody E6H4. p16 expression, HPV status and other clinical features were correlated with progression-free (PFS) and overall survival (OS).

Results:

A total of 135 patients had sufficient sample for this analysis. Median age at diagnosis was 57 years (range 20–82), with 68.9% males, 8.9% never smokers and 32.6% never drinkers. Three-year OS rate and PFS rate was 63.0% and 54.1%, respectively. Based on the p16 staining score, patients were divided into three groups: high nuclear, high cytoplasmic staining group (HN), low nuclear, low cytoplasmic staining group (LS) and high cytoplasmic, low nuclear staining group (HC). The HN and the LS groups had significantly better OS than the HC group with hazard ratios of 0.10 and 0.37, respectively, after controlling for other factors, including HPV status. These two groups also had significantly better PFS than the HC staining group. This finding was consistent for sites outside the oropharynx and did not require adjustment for smoking status.

Conclusion:

Different p16 protein localisation suggested different survival outcomes in a manner that does not require limiting the biomarker to the oropharynx and does not require assessment of smoking status.     

Learning from the body about the mind

In some areas of cognitive science we are confronted with ultrafast cognition, exquisite context sensitivity, and scale-free variation in measured cognitive activities. To move forward, we suggest a need to embrace this complexity, equipping cognitive science with tools and concepts used in the study of complex dynamical systems. The science of movement coordination has benefited already from this change, successfully circumventing analogous paradoxes by treating human activities as phenomena of self-organization. Therein, action and cognition are seen to be emergent in ultrafast symmetry breaking across the brain and body; exquisitely constituted of the otherwise trivial details of history, context, and environment; and exhibiting the characteristic scale-free signature of self-organization.     

Chemoradiation for locally advanced squamous cell carcinoma of the head and neck for organ preservation and palliation.

OBJECTIVES: To measure the efficacy and toxic effects of our chemoradiotherapy regimen by means of response and survival in patients with advanced squamous cell carcinoma of the head and neck (HNSCC) for organ preservation in resectable disease or palliation in unresectable disease. DESIGN: All patients underwent evaluation by the multidisciplinary head and neck cancer team, with pathological diagnosis and staging. All patients underwent assessment for response to therapy using results of physical examination and radiologic imaging. Patients were followed up at 3-month intervals for a planned period of 5 years. SETTING: Academic center. PATIENTS: Thirty-eight previously untreated patients with newly diagnosed HNSCC were treated from June 1, 1996, through December 31, 1998, of whom 20 had resectable and 18 had unresectable tumors. INTERVENTION: Patients received intravenous cisplatin, 100 mg/m(2) for 1 hour on days 1 and 29; a 24-hour continuous infusion of fluorouracil, 1000 mg/m(2) on days 1 through 4 and 29 through 32; and radiation therapy, 150 rad twice daily for 12 days. The patients were given a 7- to 10-day break, and radiation therapy was restarted on day 29 for 12 additional days (total dose, 7200 rad). MAIN OUTCOME MEASURES: Complete, partial, and total response rates; disease-free survival; overall survival; and toxic effects. RESULTS: Toxic effects of treatment were moderately severe, including grades III to IV mucositis (89%), neutropenia (71%), and renal toxic effects (8%). In the 18 patients in the unresectable group, complete response in the 17 primary tumors and 15 cervical nodal metastases was achieved in 12 (71%) and 9 (60%), respectively; in the 20 patients undergoing organ preservation, complete response rates were 100% in the 23 primary tumors and 15 cervical nodal metastases. Complete response for all 38 patients was achieved in 31 (82%). In the unresectable group, the Kaplan-Meier relapse-free survival estimate is 56%, with follow-up from 29 to 45 months. In the organ preservation group, 75% of patients are alive without disease, and 8 have been followed up for 36 to 48 months. Of the 5 patients who have died, only 2 died of disease, with recurrences at 13.0 and 16.5 months. CONCLUSIONS: Chemoradiotherapy consisting of cisplatin, fluorouracil, and twice-daily external beam radiation is highly effective in achieving durable complete responses in patients with resectable HNSCC undergoing organ preservation and patients with unresectable HNSCC undergoing palliation. Toxic effects of this regimen were moderate to severe.     

Does participation in the electronic residency application service (ERAS) affect the quality of applications to a residency program?

PURPOSE: To determine whether the quality of applicants to an emergency medicine (EM) residency would improve during a year that the program did not participate in the Electronic Residency Application Service (ERAS). METHODS: Applications to the Denver Health Medical Center Residency in Emergency Medicine (DHMCREM) were retrospectively compared for three consecutive years: 1996-97, during which ERAS was not available to EM programs; 1997-98, during which DHMCREM did not participate in ERAS; and 1998-99, during which DHMCREM participated in ERAS. The quality of applicants was based on their application scores, which were determined using a 20-point equation that rated individual attributes: U.S. Medical Licensing Examination Step 1 score, medical school, research, extracurricular activities, personal statement, letters of recommendation, and dean's letter. T-tests were used to compare application scores and individual attributes among applicants, those invited for an interview, and those who matched to the program. In addition, numbers of applications to the DHMCREM were compared with national trends. RESULTS: A total of 1,318 complete applications were reviewed for the three-year study period. There was a 50% reduction in applications during 1997-98 when DHMCREM did not participate in ERAS, which did not correlate with the national trend in applications to residency programs. However, there was no statistically significant difference in the quality of applicants, interviewees, or matched candidates as defined by the overall application score. In addition, applicants who matched to the program were higher on the rank-order list during the 1997-98 application year than were applicants who matched for the year prior to ERAS and for the year DHMCREM participated in ERAS. CONCLUSIONS: Participation in ERAS increased the number of applicants, but did not correlate with an increase in the quality of applicants.     

Pancreatic acinar cell carcinoma with subcutaneous and intraosseous fat necrosis

On rare occasions, excessive lipase production by functioning pancreatic acinar cell carcinoma results in subcutaneous and intraosseous fat necrosis. A patient with subcutaneous nodules and osteolytic lesions from metastatic fat necrosis associated with this malignancy is reported. Prompt recognition of the syndrome led to complete resection of the otherwise asymptomatic neoplasm of the exocrine pancreas.     

Genetic analysis of spontaneous resistance to ampicillin in Neisseria gonorrhoeae.

Several antibiotics which inhibit protein synthesis on 70S ribosomes, including clindamycin, pirlimycin, 4'-pentyl-N-demethyl clindamycin, four tetracyclines, chloramphenicol, thiamphenicol, and erythromycin, had antimalarial effects against Plasmodium falciparum in culture which were greatly influenced by the duration of drug exposure and by oxygen tension. In 96-h incubations, potency was increased by a factor of up to 10(6) over the first 48-h period and by a factor of up to 10(4) in 15% O2 versus 1% O2. Two aminoglycosides, kanamycin and tobramycin, had no antimalarial activity. Rifampin and nalidixic acid, which inhibit nucleic acid synthesis, were not similar to the 70S inhibitors. The mitochondrial inhibitors Janus Green, rhodamine 123, antimycin A1, and 8-methylamino-8-desmethyl riboflavin had activities which were influenced by the duration of exposure and oxygen tension. Quinoline-containing antimalarial agents, ionophores, and other antimalarial drugs were influenced to a minor extent by the duration of exposure but were not affected by oxygen tension. These data can best be explained by the hypothesis that antimalarial 70S ribosome-specific protein synthesis inhibitors are toxic to the parasites by acting on the mitochondrion.