The case of the pregnant adolescent.

In this case an adolescent, minor female presents herself for routine dental care, but is pregnant without parental knowledge. She asks the dentist not to reveal the pregnancy to her parents. Three experts including one attorney, one dental educator with 25 years of private practice experience, and one member of a state psychological association's ethics committee comment on the difficult ethical and legal issues found in this actual case.

Mechanisms of electrode induced injury. Part 3: practical concepts and avoidance.

This three part series of articles has discussed mechanisms of electrode related injuries from a theoretical viewpoint in Part 1 (Stecker et al. 2006) and from a clinical experience viewpoint in Part 2 (Patterson et al. 2007).

Mechanisms of electrode induced injury. Part 2: Clinical experience.

In the previous paper in this series, basic mechanisms of electrode related injuries were discussed. In this paper, the discussion begins with some of the clinical aspects of burns. This is followed by a summary of the clinical literature on injuries produced by surface and subdermal electrodes.

Mechanisms of electrode induced injury. Part 1: theory.

Electrodes are the essential elements of clinical neurophysiology both in recording of neural activity and in functional electrical stimulation of the nervous system. Therefore it is important to understand the potential complications of using electrodes. In this paper, the factors that influence the chance of electrode related injury are discussed from a theoretical standpoint.

Relational diagnosis--a brief historical overview: comment on the special section.

Various mental health disciplines have attempted to bring the significance of relational interaction and dysfunction to the attention of the entire field. Over the past 20 years, these efforts have been initiated and developed both independently and collaboratively, and although progress has been made, results have been incremental and insufficient. The inclusion of the Global Assessment of Relational Functioning (GARF) as an option on Axis IV of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) was a milestone but fell short of recognition as a major disorder on Axis I.

Sensitivity of scalp EEG, cortical EGG, and somatosensory evoked responses during surgery for intracranial aneurysms.

Background: We estimated the relative sensitivity and reliability of scalp EEG, cortical EEG and somatosensory evoked potentials (SSEPs) to detect significant changes during aneurysm surgery.

Methods: Two observers independently reviewed data from 18 patients who were monitored with scalp EEG, cortical EEG, and SSEPs to determine which if any modality demonstrated significant changes during 25 different episodes of temporary intracranial vascular occlusion.

Results: Kappa scores indicating the degree of agreement between the two observers were highest for the cortical strip EEG (kappa = 0.

Comparison of endotracheal tube and hookwire electrodes for monitoring the vagus nerve.

Monitoring the vagus nerve and the recurrent laryngeal nerve during surgical procedures may reduce the probability of significant nerve injury. As such, a number of methods to monitor these nerves have been devised including placing electrodes directly into the vocal cords or recording from surface electrodes. In direct comparison, monitoring the identical muscles, bipolar hookwire electrodes displayed approximately one order of magnitude greater amplitude, of both spontaneously occurring and evoked electrical activity than double wire endotracheal tube electrodes.

Anesthesia and temperature effects on somatosensory evoked potentials produced by train stimuli.

Objective: To determine the effect of anesthesia, temperature, and stimulus characteristics on the response of upper extremity somatosensory evoked responses (SSEP) to repetitive stimulation.

Methods: Pairs and trains of electrical stimuli were used to elicit the upper extremity SSEP, and the amplitudes of the N20-P22, N13, and Erb's point potentials produced by each stimulus were measured. The ratio of the amplitude of the response to each stimulus to that produced by the first stimulus in a given train was computed.

Global cardiac-specific transgene expression using cardiopulmonary bypass with cardiac isolation.

Background: The available techniques for intravascular gene delivery to the heart are inefficient and not organ-specific. Yet, effective treatment of heart failure will likely require transgene expression by the majority of cardiac myocytes. To address this problem, we developed a novel cannulation technique that achieves efficient isolation of the heart in situ using separate cardiopulmonary bypass (CPB) circuits for the heart and body in dogs.

Effects of acute hypoxemia/ischemia on EEG and evoked responses at normothermia and hypothermia in humans.

Background: Hypothermia is used clinically to prevent neurologic injury but the degree of protection which it affords at various levels of the nervous system in humans is difficult to establish.

Material/methods: The temporal changes in EEG amplitude and somatosensory evoked potential (SEP) amplitudes in a patient experiencing acute normothermic hypoxemia, a patient experiencing acute circulatory arrest at moderate hypothermia and a collection of patients undergoing deep hypothermic circulatory arrest were analyzed to determine the rate at which changes occur during acute lack of oxygen delivery at various temperatures.

Results: In each case, it was found that more rostrally generated potentials disappeared more quickly than more peripheral potentials.