Inhibition of tumor necrosis factor-alpha and inducible nitric oxide synthase correlates with the induction of IL-10 in septic rats undergoing laparotomy and laparoscopy.

Proinflammatory mediators are implicated in the mediation of host response to surgical stress. Greater inflammatory response has been reported after open surgery than after laparoscopic surgery in animal models. This study investigated the inflammatory response of tumor necrosis factor alpha (TNF) and inducible nitric oxide synthase (iNOS) and the anti-inflammatory response of interleukin (IL)-10 after laparotomy and laparoscopy in a rat endotoxic shock model.

1st- and 2nd-year medical student exposure to emergency medicine.

Background: Medical societies in emergency medicine (EM) have recommended teaching EM topics in the preclinical years of medical school. However, the magnitude of integrating an EM curriculum into the 1st and 2nd year of medical school is unknown.

Purpose: The purpose of this survey was to determine the extent and type of exposure to EM in the 1st and 2nd years of medical schools in the United States.

Primary care access decreases nonurgent hospital visits for indigent diabetics.

The objective was to determine the relationship between the source of primary care and utilization of health services among public hospital walk-in clinic patients. A group of 218 adults with diabetes mellitus presenting to a walk-in hospital clinic was followed prospectively with baseline and 3-, 6-, and 12-month surveys; baseline and 6-month hemoglobin A1Cs; and chart reviews. Sites of care, acquisition of primary care, and report of four diabetes services were recorded.

A longitudinal evaluation of oxidative stress in trauma patients.

Background: The purpose of this study was to determine the course of oxidative stress in trauma patients as measured by antioxidant disappearance and modulation of DNA damage. The study also explored the role of injury severity and the effect of changes in plasma lipoprotein concentration as the result of hemodilution on lipid-soluble plasma antioxidant concentrations.

Methods: The study population included 17 adult male trauma patients in an urban level-1 trauma hospital and 12 healthy adult male controls.

Gender differences in narcotic-induced emesis in the ED.

Narcotic analgesia is commonly given in the emergency department. Narcotic-induced nausea and vomiting is thought to be a common occurrence, but the gender incidence and associations are not well defined. The aim of this study was to document the sex-related complication of nausea and vomiting after opiate administration for pain relief in the ED.

Coagulation changes in individuals with sickle cell trait.

Sickle cell disorders, such as Hb SS and Hb SC, are associated with a hypercoagulable state that may contribute to the vaso-occlusive episodes observed in the disorders. To what extent increased coagulation activity occurs in individuals with sickle cell trait has had limited study. Because such information may help clarify clinical and pathologic findings that may occur in these individuals and may be useful in clarifying the hypercoagulable state in sickle cell disease, we have examined individuals with Hb AS to determine the extent that increased coagulation activity does occur.

Intestinal volvulus following laparoscopic cholecystectomy.

The introduction of laparoscopic cholecystectomy has revolutionized the surgical management of biliary diseases. As the application of this procedure becomes more popular, a variety of associated complications have emerged. We present a rare case of a patient who developed an intestinal volvulus 3 days following laparoscopic cholecystectomy.

Cervical dysplasia in pregnancy: progression versus regression post-partum.

Objective: To assess the natural history of cervical dysplasia during pregnancy and determine the rates for progression or regression post-partum by the severity of the lesion.

Method: This was a retrospective study of 100 patients screened by PAP smear. Lesions were graded by colposcopy and biopsy, and followed post-partum.

Follicular neoplasms of the thyroid: predictors of malignancy?

Follicular neoplasms of the thyroid present a therapeutic challenge. Initial limited thyroidectomy may result in some patients requiring completion thyroidectomy for malignancy. In the current study we examined age, gender, race, time from nodule discovery to operation in months, history of radiation exposure, tumor size (cm), and cell type in patients with follicular neoplasms identified at the time of thyroidectomy in two socioeconomically diverse settings from 1993 through 2000 to identify possible factors associated with a greater chance of malignancy.

The learning organization: adapted from The fifth discipline by Peter Senge.

In his book The Fifth Discipline, Peter Senge presents a system of thinking and acting that can be the basis for reducing the "learning disabilities" in an organization. In an article, written from the perspective of a multidepartmental health care manager, the author reviews Senge's disciplines and how they relate to running a department today.

Therapeutic effect of dimethyl sulfoxide on ICAM-1 gene expression and activation of NF-kappaB and AP-1 in septic rats.

Background: Dimethyl sulfoxide (DMSO) is a potent antioxidant which protects against endotoxemia and septic shock in animal models. We investigated the therapeutic effect of DMSO on intercellular adhesion molecule 1 (ICAM-1) gene expression and activation of nuclear factor-kappaB (NF-kappaB) and activating protein-1 (AP-1) in a rat model of peritonitis sepsis. This postchallenge model simulates the clinical treatment of ruptured viscus peritonitis.

Ascorbate levels in red blood cells and urine in patients with sickle cell anemia.

Unlabelled: Ascorbic acid can be important in sickle cell anemia (SCA) because significant oxidative stress occurs in the disease. Ascorbate could contribute to reduction of the increased oxygen free radicals generated in sickle red blood cells (SRBC) and to the recycling of vitamin E in the cells, while renal loss could contribute to the low plasma levels. Evaluation of red blood cell (RBC) and urine ascorbate in SCA has not been reported.

Right lower quadrant abdominal pain due to appendicitis and an incarcerated spigelian hernia.

Spigelian hernias are uncommon and difficult to diagnose because of their location in the aponeurosis in the anterior abdominal wall. When they occur on the right side, the symptoms can include nonspecific abdominal pain mimicking appendicitis. We present an adult with right lower quadrant abdominal pain due to an incarcerated spigelian hernia and acute appendicitis.

Gastric adenocarcinoma of Meckel's diverticulum as a cause of colonic obstruction.

A 45-year-old-female patient with no prior surgical history presented with bowel obstruction. At laparotomy, a bulky tumor arising from the ileum, which completely obstructed the sigmoid colon, was found. A left hemicolectomy followed by a transverse colostomy and a Hartman's pouch were performed.

Antiphospholipid antibodies, proteins C and S, and coagulation changes in sickle cell disease.

The significance, interactions, and sources of coagulation abnormalities and their relationship to clinical severity and painful episodes in sickle cell disease are not clear. To evaluate this, we have examined various measures of coagulation in 37 patients with sickle cell disease (20 patients with HbSS disease and 17 patients with HbSC disease). Measurements have included isotypes of antiphospholipid antibodies (IgG, IgM, IgA) to specific phospholipids; proteins C (activity, total antigen) and S (activity, total and free antigen); measures of coagulation activation (prothrombin fragment 1.

Inhibitory effect of dimethyl sulfoxide on nuclear factor-kappa B activation and intercellular adhesion molecule 1 gene expression in septic rats.

Antioxidants are potent radical scavengers that protect against endotoxemia and septic shock in animal models. Using a rat model of peritonitis sepsis induced by cecal incision we studied the effect of the free radical scavenger dimethyl sulfoxide (DMSO) on hepatic nuclear factor kappa B (NF-kappa B) activation, hepatic intercellular adhesion molecule 1 (ICAM-1) gene expression, serum tumor necrosis factor alpha (TNF) formation, and serum glucose concentration. Five groups of rats (N = 5) were treated as follows: (1) untreated control (Untreated), (2) sham operated with laparotomies (Sham), (3) pretreated with 6 ml/kg DMSO followed by sham operation (DMSO/Sham), (4) cecal incision (Sepsis), and (5) pretreated with DMSO followed by cecal incision (DMSO/Sepsis).

When is facial pain trigeminal neuralgia?

The pain of trigeminal neuralgia can be excruciating and debilitating. Fortunately, effective medical and surgical therapies for the disorder exist. Successful treatment hinges on thorough history taking and accurate diagnosis.

Microscopic examination of routine tonsillectomy specimens: is it necessary?

Controversy continues to exist regarding the routine histologic examining of tonsillectomy specimens. Proponents suggest that among other reasons, missing an important diagnosis such as occult malignancy or granulomatous disease and possible medicolegal consequences argue in favor of routine histologic examination. Others state that we should consider the very low yield of significant histologic findings in routine tonsillectomy specimens and its added cost.

Human immune cells mediate catecholamine secretion from adrenal chromaffin cells.

Objectives: To determine the ability of human mononuclear cells to produce factors that cause catecholamine secretion from adrenomedullary chromaffin cells; to determine conditions that stimulate mononuclear cells to produce such factors; and to compare these results with catecholamine secretion in response to the cytokines interleukin (IL)-1 and IL-2.

Design: Randomized, controlled, prospective study using in vitro conditions.

Setting: University research laboratory.

Head and neck manifestations of AIDS in adults.

Head and neck manifestations of acquired immunodeficiency syndrome (AIDS) are among the most common complications of this disease. Some of these manifestations are the initial signs of human immunodeficiency virus (HIV) infection, and others are associated with full-blown AIDS. Otologic manifestations include otitis externa, otitis media, Kaposi's sarcoma and sensorineural hearing loss.

Effect of dexamethasone on NF-kB activation, tumor necrosis factor formation, and glucose dyshomeostasis in septic rats.

Glucocorticoids are potent anti-inflammatory and immunosuppressive therapeutic agents. The protective effect of dexamethasone (DEX) on hepatic phosphoenolpyruvate carboxykinase (PEPCK) transcript level, hepatic NF-kB (nuclear factor-kB) activation, and serum tumor necrosis factor alpha (TNF) formation was investigated in peritoneal sepsis induced by cecal incision in rats. For the control the rats were sham-operated with laparotomies only.

Development of distant metastasis after treatment of advanced-stage head and neck cancer.

Background: The recognition of risk factors for the development of distant metastasis is necessary for identifying high-risk patients who may benefit from systemic therapy. Previous investigations studying possible risk factors have been heterogeneous, with patients having varied forms of therapy. This study is designed to evaluate the clinical and histologic risk factors for the development of distant metastasis (DM) in patients with only advanced-stage head and neck squamous cell carcinoma after surgery and radiotherapy.