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.     

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).     

Effect of coenzyme Q10 supplementation on statin-induced myalgias

Coenzyme Q10 (CoQ10) deficiency has been proposed to be causal in 3-hydroxy-3-methyl-glutaryl coenzyme A reductase inhibitor (statin)-induced myopathies. However, the clinical benefit of supplementation is unproved. The purpose of the present study was to assess the effect of CoQ10 supplementation on myalgias presumed to be caused by statins. Patients currently receiving a statin who developed new-onset myalgias in ≥ 2 extremities within 60 days of initiation or a dosage increase were eligible. Patients continued statin therapy and were randomized using a matched design to either CoQ10 60 mg twice daily or matching placebo. Double-blind treatment continued for 3 months, and patients completed a 10-cm visual analog scale (VAS) and the Short-Form McGill Pain Questionnaire at baseline and at each monthly visit. The primary end point was the comparison of the VAS score at 1 month. A total of 76 patients were enrolled (40 in the CoQ10 arm and 36 in the placebo arm). The mean VAS score was 6 cm at baseline in both groups. At 1 month, no difference was seen in the mean VAS score between the 2 groups (3.9 cm in the CoQ10 group and 4 cm in the placebo group; p = 0.97). However, 5 patients in the CoQ10 group and 3 in the placebo group discontinued therapy during the first month because of myalgias. The baseline median score on the Sensory Pain Rating Index subscale was 10 in the CoQ10 group and 11.5 in the placebo group. At 1 month, these scores had decreased to 6.5 and 7.5, respectively, with no statistically significant difference (p = 0.34). In conclusion, CoQ10 did not produce a greater response than placebo in the treatment of presumed statin-induced myalgias.     

La Crosse encephalitis in Eastern Tennessee: clinical,environmental, and entomological characteristics from a blinded cohort study

A blinded cohort study was conducted in 2000 to better understand the emergence of La Crosse virus infection in eastern Tennessee, with special emphasis on the potential mosquito vector(s). Children with suspected central nervous system infection were enrolled at the time of clinical presentation at a large pediatric referral hospital. Clinical, environmental, and entomological data were collected prior to case confirmation. Sixteen of the 40 children included in the final analysis were confirmed to have La Crosse infection by a fourfold increase in antibody titers between collection of acute- and convalescent-phase sera. Factors significantly associated with La Crosse infection included average number of hours per day spent outdoors (5.9 for La Crosse virus cases vs. 4.0 for noncases, p = 0.049); living in a residence with one or more tree holes within 100 m (relative risk = 3.96 vs. no tree holes within 100 m, p = 0.028); and total burden of Aedes albopictus (number of female and male larvae and adults collected at a site), which was more than three times greater around the residences of La Crosse virus cases versus noncases (p = 0.013). Evidence is accumulating that the newly introduced mosquito species Ae. albopictus may be involved in the emergence of La Crosse virus infection in eastern Tennessee.     

Tolerance to methadone lethality and microsomal enzyme induction in mice tolerant to and dependent on morphine

In an attempt to explain a loss of cross-tolerance between morphine and methadone and an increased tolerance to methadone lethality in morphine-dependent mice administered methadone orally for six days, the possibility that methadone was stimulating its own metabolism was investigated. It was found that methadone did enhance its own metabolism two-fold. This increase in activity correlated with the development of tolerance to the lethal effects of methadone as measured by an elevation of the oral methadone LD₅₀. Furthermore, SKF-525A, a potent microsomal inhibitor, abolished this tolerance. The intracerebroventricular methadone LD₅₀ was not altered by six days administration of oral methadone, suggesting that the tolerance observed was dispositional in nature.