Incidence of gastrectomy in United States army hospitals worldwide from 1975 to 1985

In the past 30 yr, hospitalization for peptic ulcer disease (PUD) has decreased. The use of total or partial gastrectomy to treat PUD has also declined. The discharge cover sheets of over 3000 patients who had a gastrectomy between 1975 and 1985 in U.S. Army hospitals were reviewed.     

Skilled birth attendant competence: an initial assessment in four countries, and implications for the Safe Motherhood movement.

OBJECTIVES: Percentage of deliveries assisted by a skilled birth attendant (SBA) has become a proxy indicator for reducing maternal mortality in developing countries, but there is little data on SBA competence. Our objective was to evaluate the competence of health professionals who typically attend hospital and clinic-based births in Benin, Ecuador, Jamaica, and Rwanda. Methods: We measured competence against World Health Organization's (WHO) Integrated Management of Pregnancy and Childbirth guidelines. To evaluate knowledge, we used a 49-question multiple-choice test covering seven clinical areas. To evaluate skill, we had participants perform five different procedures on anatomical models. The 166 participants came from facilities at all levels of care in their respective countries. Results: On average, providers answered 55.8% of the knowledge questions correctly and performed 48.2% of the skills steps correctly. Scores differed somewhat by country, provider type, and subtopic. Conclusion: A wide gap exists between current evidence-based standards and current levels of provider competence.     

Evaluation of three substitutes for Percoll in sperm isolation by density gradient centrifugation

Silane-coated silica particle solutions (ISolate(TM) and PureSperm)TM)) and iodixanol (OptiPrep(TM)) were compared to polyvinylpyrrolidone (PVP)-coated silica particles (Percoll(TM)) in their efficacy to recover spermatozoa by gradient centrifugation for use in assisted reproductive procedures. Efficacy was assessed in terms of percentages of sperm recovery, sperm vitality and motility, normal sperm morphology and normal sperm chromatin condensation. No significant difference was found in the recovery of spermatozoa for men with both normal sperm counts and oligozoospermia, between PVP-coated and silane-coated particle solutions. Iodixanol had significantly lower sperm recovery compared to the other products. Sperm vitality, progressive motility, normal morphology and normal chromatin condensation did not differ significantly between any of the sperm isolation products.      

Mutation spectrum and genotype-phenotype analyses in Cowden disease and Bannayan-Zonana syndrome, two hamartoma syndromes with germline PTEN mutation

The tumour suppressor gene PTEN , which maps to 10q23.3 and encodes a 403 amino acid dual specificity phosphatase (protein tyrosine phosphatase; PTPase), was shown recently to play a broad role in human malignancy. Somatic PTEN deletions and mutations were observed in sporadic breast, brain, prostate and kidney cancer cell lines and in several primary tumours such as endometrial carcinomas, malignant melanoma and thyroid tumours. In addition, PTEN was identified as the susceptibility gene for two hamartoma syndromes: Cowden disease (CD; MIM 158350) and Bannayan-Zonana (BZS) or Ruvalcaba-Riley-Smith syndrome (MIM 153480). Constitutive DNA from 37 CD families and seven BZS families was screened for germline PTEN mutations. PTEN mutations were identified in 30 of 37 (81%) CD families, including missense and nonsense point mutations, deletions, insertions, a deletion/insertion and splice site mutations. These mutations were scattered over the entire length of PTEN , with the exception of the first, fourth and last exons. A 'hot spot' for PTEN mutation in CD was identified in exon 5 that contains the PTPase core motif, with 13 of 30 (43%) CD mutations identified in this exon. Seven of 30 (23%) were within the core motif, the majority (five of seven) of which were missense mutations, possibly pointing to the functional significance of this region. Germline PTEN mutations were identified in four of seven (57%) BZS families studied. Interestingly, none of these mutations was observed in the PTPase core motif. It is also worthy of note that a single nonsense point mutation, R233X, was observed in the germline DNA from two unrelated CD families and one BZS family. Genotype-phenotype studies were not performed on this small group of BZS families. However, genotype-phenotype analysis inthe group of CD families revealed two possible associations worthy of follow-up in independent analyses. The first was an association noted in the group of CD families with breast disease. A correlation was observed between the presence/absence of a PTEN mutation and the type of breast involvement (unaffected versus benign versus malignant). Specifically and more directly, an association was also observed between the presence of a PTEN mutation and malignant breast disease. Secondly, there appeared to be an interdependent association between mutations upstream and within the PTPase core motif, the core motif containing the majority of missense mutations, and the involvement of all major organ systems (central nervous system, thyroid, breast, skin and gastrointestinal tract). However, these observations would need to be confirmed by studying a larger number of CD families.      

A study of the dynamic anatomy of extensor tendons and implications for treatment

This study correlates the excursion of the extrinsic finger extensors in zones V, VI, and VII and the extensor pollicis longus tendon in zones T IV and T V ("T" is used to designate thumb zones) with joint motion. Excursion was estimated by review of the literature, biomechanic calculations, and intraoperative observations. A simple equation determines extrinsic extensor tendon excursion in zone V, VI, and VII. This equation is substantiated by Brand's work on radians and by intraoperative studies. Guidelines are suggested for controlled motion for extrinsic finger extensors and the extensor pollicis longus tendon on the basis of our 6 years experience of treating extensor tendon injury with early passive motion.     

Differential subcellular localization of forward and feedback interareal inputs to parvalbumin expressing GABAergic neurons in rat visual cortex

In rat visual cortex, forward and feedback interareal pathways innervate both pyramidal and gamma-aminobutyric acid (GABA)ergic (Johnson and Burkhalter [1996] J. Comp. Neurol. 368:383-398). GABAergic neurons consist of different cell types of which the largest group expresses parvalbumin (PV; Gonchar and Burkhalter [1997] Cereb. Cortex 4:347-358). Here, we report that PV neurons in layers 2/3 are synaptic targets of forward and feedback projections between area 17 and the lateromedial area (LM) of rat visual cortex. In both forward and feedback pathways, approximately 90% of axon terminals in layer 2/3 labeled by tracing with biotinylated dextran amine formed synapses with PV-negative profiles. In both pathways, most of these profiles resembled dendritic spines. Although there were no differences in the innervation of PV-negative targets, the two pathways differed in the innervation of PV-positive neurons. In each pathway, approximately 10% of terminals formed synapses with PV-positive profiles. However, in the forward pathway, the size of the contacted PV-positive profiles was larger than in the feedback pathway. Moreover, in the forward pathway, axon terminals on PV-positive profiles were larger, contained more mitochondria and docked synaptic vesicles than feedback synapses on PV neurons. Our results show that PV neurons provide a major target for area 17 <-> LM forward and feedback pathways terminating in upper layers. In each pathway, the proportion of axons contacting PV neurons is similar. However, both pathways differ in the subcellular localization and morphology of synapses on PV neurons. These asymmetries may contribute to the inequality in the strength of disynaptic inhibition evoked by forward and feedback inputs (Shao and Burkhalter [1996] J. Neurosci. 16:7353-7365).     

Efficacy of "high-intensity" blue-light and "standard" daylight phototherapy for non-haemolytic hyperbilirubinaemia

We report our clinical experience with phototherapy in 3802 infants; 3629 were exposed to "standard" daylight phototherapy and 173 to "high-intensity" blue-light phototherapy. High-intensity blue-light phototherapy was twice as effective as standard daylight phototherapy in decreasing bilirubin concentrations. No failures occurred with high-intensity phototherapy compared with an overall failure rate of 1.84/1000 with daylight lamps; these cases were transferred to high-intensity phototherapy with prompt response. Rebound after cessation of phototherapy was greater in those exposed to high-intensity blue light with a significantly greater number requiring a second exposure. However, the incidence was still low. No third exposure was required in any infant. Nursing of infants under high-intensity blue light was more difficult and inconvenient as was clinical monitoring. The light also caused more stress on the nursing and medical personnel. However, the infants tolerated both types of phototherapy equally well. High-intensity blue-light phototherapy would seem to be the treatment of choice for infants with rapidly increasing or very high bilirubin levels, as well as in those not responding adequately to daylight phototherapy.     

Fatal meningoencephalitis due to Bacillus anthracis

Abstract: We report the first case of fatal anthrax meningoencephalitis in Hong Kong over the past 60 years. A 13 year-old boy presented with right lower quadrant pain, diarrhoea and progressive headache. Lumbar puncture yielded gram positive bacilli initially thought to be Bacillus cereus, a contaminant. He was treated with ampicillin and cefotaxime, but died 3 days after hospitalization. The organism isolated from blood and cerebrospinal fluid was later identified as Bacillus anthracis.