Intermittent Transient Motor Aphasia Associated with Acute Lithium Toxicity: A Case Report and Brief Review.

Background: Lithium is known to cause certain neurological deficits. However, reports of aphasia secondary to lithium toxicity are scant. We report the case of a 70 year old African American woman with a history of schizoaffective disorder and mild dementia who developed transient intermittent aphasia secondary to lithium toxicity.

Hypertension in patients with Cushing's disease: pathophysiology, diagnosis, and management.

Hypertension is a very common comorbidity in patients with Cushing's disease/syndrome, resulting from the interplay of several pathophysiologic mechanisms, including stimulation of mineralocorticoid and glucocorticoid receptors as well as the associated insulin resistance, sleep apnea, and overexpression of renin-angiotensin system. Although treatment of Cushing's disease results in resolution or amelioration of hypertension in these patients, a significant proportion of patients do not achieve complete cure or require a prolonged period of time for complete response to therapy. Therefore, therapeutic strategies for Cushing's-specific hypertension are necessary to decrease morbidity and mortality associated with this disease.

DNA replication and nuclear organization: prospects for a soluble in vitro system.

The role of nuclear structure in the replication of eukaryotic DNA has been the subject of debate for many decades. The recent demonstration that once-per-cell-cycle replication can take place in vitro without a nucleus, providing sufficiently high concentrations of replication factors are supplied, suggests that one role of the nucleus is to concentrate essential factors. This important finding has paved the way for the establishment of a purified biochemical system for replication of eukaryotic DNA.

Inter-laboratory comparisons: approaching a new standard for prosthetic heart valve testing in vitro.

Current standards governing the evaluation of prosthetic heart valve designs have come under scrutiny. Generally, standards require measurements of pressure drops and regurgitant flow. While this information is important in the characterization of valve performance, these standards are both insufficient and ambiguous.

Mcm2, but not RPA, is a component of the mammalian early G1-phase prereplication complex.

Previous experiments in Xenopus egg extracts identified what appeared to be two independently assembled prereplication complexes (pre-RCs) for DNA replication: the stepwise assembly of ORC, Cdc6, and Mcm onto chromatin, and the FFA-1-mediated recruitment of RPA into foci on chromatin. We have investigated whether both of these pre-RCs can be detected in Chinese hamster ovary (CHO) cells. Early- and late-replicating chromosomal domains were pulse-labeled with halogenated nucleotides and prelabeled cells were synchronized at various times during the following G1-phase.

Reduction in the incidence of methicillin-resistant Staphylococcus aureus and ceftazidime-resistant Klebsiella pneumoniae following changes in a hospital antibiotic formulary.

In 1995, changes in our hospital formulary were made to limit an outbreak of vancomycin-resistant enterococci and resulted in decreased usage of cephalosporins, imipenem, clindamycin, and vancomycin and increased usage of beta-lactam/beta-lactamase-inhibitor antibiotics. In this report, the effect of this formulary change on other resistant pathogens is described. Following the formulary change, there was a reduction in the monthly number (mean +/- SD) of patients with methicillin-resistant Staphylococcus aureus (from 21.

Craniocervical junction venous anatomy on enhanced MR images: the suboccipital cavernous sinus.

Background And Purpose: The suboccipital cavernous sinus, a vertebral venous plexus surrounding the horizontal portion of the vertebral artery at the skull base, provides an alternative pathway of cranial venous drainage by virtue of its connections to the cranial dural sinuses, the vertebral venous plexus, and the jugular venous system. Knowledge of the anatomy of this system facilitates interpretation of images and might reduce the number of false-positive diagnoses of lesions, such as adenopathy or schwannoma. We hypothesized that this circulation could be visualized on contrast-enhanced, fat-suppressed T1-weighted MR images.

Head and face injuries in scholastic women's lacrosse with and without eyewear.

Purpose: The use of protective equipment has been absent or inconsistent in scholastic women's lacrosse leading to increasing concern for eye and head injury. There is a paucity of field data, however, on which to base strategic decisions on how best to prevent head injuries in young athletes.

Methods: This study examined the effects of protective eyewear on injury rates in scholastic women's lacrosse in a cohort of approximately 700 varsity and junior varsity players in central New York studied prospectively for 2 yr during a transition from sparse to almost complete eyewear use.

Pituitary gland. Variable signal intensities on MRI. A pictorial essay.

The anterior pituitary gland may exhibit high signal on T1-weighted (T1w) images and/or low signal on T2-weighted (T2w) images in several normal and pathological states. High T1w signal may be seen in normal fetuses, neonates, and in pregnant and postpartum women. It may also occur in Rathke's cleft cyst, craniopharyngioma, subacute hemorrhage, manganese deposition, melanoma, dermoid, and lipoma.

Identification and restoration of lapsed skills for primary care providers.

Objective: Individualized educational programs based upon structured comprehensive evaluations have the highest opportunity for success in addressing the needs of physicians with lapsed skills. The purpose of this article is to describe the Physician Prescribed Educational Program (PPEP), an integrated series of programs that incorporate a formalized, structured evaluation strategy.

Methods: The PPEP is structured to determine: 1) The presence of deficits which are amenable to educational remediation, 2) The likelihood that an appropriate educational program can be developed, and 3) The structure of such a program.

Giant cervical epidural veins after craniectomy for head trauma.

Markedly dilated cervical epidural veins and right upper extremity weakness developed in a 43-year-old man 4 months after contralateral craniectomy for head trauma. After cranioplasty, his symptoms improved markedly and the size of the veins returned to normal. These findings suggest that enlarged cervical epidural veins may occur without an underlying vascular lesion and that upper extremity weakness may occasionally be attributable to spinal cord venous stasis.

Transformation abrogates an early G1-phase arrest point required for specification of the Chinese hamster DHFR replication origin.

The origin decision point (ODP) was originally identified as a distinct point during G1-phase when Chinese hamster ovary (CHO) cell nuclei experience a transition that is required for specific recognition of the dihydrofolate reductase (DHFR) origin locus by Xenopus egg extracts. Passage of cells through the ODP requires a mitogen-independent protein kinase that is activated prior to restriction point control. Here we show that inhibition of an early G1-phase protein kinase pathway by the addition of 2-aminopurine (2-AP) prior to the ODP arrests CHO cells in G1-phase.

Neuroelectric correlates of response production and inhibition in individuals at risk to develop alcoholism.

P300 recordings were made from males at high risk (HR) for alcoholism and low-risk (LR) controls, participating in a visual go/no go reaction time paradigm. The go (button press) and no go (inhibit response) stimuli were large and small forms of the same letters. The LR group had significantly larger go than no go P300 amplitudes in the central, parietal, and temporal regions; the HR group manifested no response differences in any region.

Modeling the tensile behavior of the cement-bone interface using nonlinear fracture mechanics.

The tensile mechanical behavior of the cement-bone interface where there was a large process (plastic) zone at the interface was modeled using a nonlinear fracture mechanics approach. A finite element method was employed, which included a piecewise nonlinear interface, to investigate the behavior of experimental cement-bone test specimens and an idealized stem-cement-bone (SCB) structure. The interface model consisted of a linear elastic region with high stiffness until the yield strength was reached, followed by an exponential softening region, until zero stress.

Colonic tattooing with India ink: benefits, risks, and alternatives.

Objective: To provide comprehensive information on key issues concerning colonic tattooing with India ink in reported literature.

Methods: A total of 735 citations on India ink alone were present in the English literature (1966-1995), including 16 on India ink and colonic tattooing. Nine major studies were identified and reviewed for 1) preparation before tattooing (type of ink used, sterilization process, colonic preparation, and antibiotic prophylaxis), 2) the tattooing process (technique and volume injected), 3) success in localization, and 4) complications.

Endodermal sinus tumor of the ovary: imaging evaluation.

Objective: Endodermal sinus tumor of the ovary is a rare complex malignant tumor that occurs in young women. We performed this study to determine the imaging characteristics of this tumor.

Conclusion: Endodermal sinus tumor of the ovary presents as a large complex abdominal mass that can be predominantly cystic and should be considered in the differential diagnosis of complex abdominal masses in girls and young women.

Linear disruption of umbilical cord: a rare anomaly of the cord associated with acute fetal distress and perinatal death/profound psychomotor retardation.

We report on a non-malformed child with severe microcephaly and profound psychomotor delay. Review of the delivery/birth records documented descriptions consistent with linear disruption of the umbilical cord. This rare anomaly typically leads to acute fetal distress and perinatal death.

Anticholinergic effects in a depressed parkinsonian patient.

Depression is commonly associated with idiopathic Parkinson's disease. Various antidepressants can be helpful in the treatment of this type of depression. Anticholinergic medications are at times used for treating the motor symptoms of parkinsonism.

Chronic pain and depression: is social support relevant?

This study examined the relationship between social support and depression for 70 patients with chronic back pain. We also explored whether the family environments of these patients related to depression and whether the patients' depression predicted outcome subsequent to involvement in a functional restoration program. The patients completed a battery of psychological questionnaires to assess depression, social support, and family environment.

Nitric oxide inhibition in the treatment of the sepsis syndrome is detrimental to tissue oxygenation.

The manifestations of the septic syndrome are thought to be mediated by cytokines through their role in the production of nitric oxide (NO). It is hypothesized that the inhibition of NO production with an inhibitor such as NG-monomethyl-L-arginine (L-NMMA) may be beneficial in the treatment of septic shock. Sepsis was induced by the intravenous administration of Escherichia coli endotoxin (60 micrograms/kg) in six conditioned mongrel dogs (20-24 kg).

Ability of PCR assay to identify Mycobacterium tuberculosis in BACTEC 12B vials.

Introduction of PCR to directly detect Mycobacterium tuberculosis in clinical specimens has shown promise; however, interfering substances in clinical material have contributed to lowered assay sensitivities. We evaluated the ability of a PCR assay to detect M. tuberculosis in BACTEC 12B broth cultures.

In vitro elution of ciprofloxacin from polymethylmethacrylate cement beads.

The use of antibiotic-impregnated polymethylmethacrylate (PMMA) cement beads for the local delivery of antibiotics in the treatment of chronic osteomyelitis has become a standard orthopaedic practice. The increasing resistance to antibiotics of organisms associated with orthopaedic infections has led to interest in the incorporation of more effective antibiotics into PMMA cement. Ciprofloxacin, a synthetic fluoroquinolone, is potent against a broad spectrum of bacteria associated with osteomyelitis.

Rethinking the merger of the clinical nurse specialist and the nurse practitioner roles.

The clinical nurse specialist (CNS) and nurse practitioner (NP) have been distinct and separate advanced nursing practice roles since the 1960s. The forces of economics and health care reform have fostered an interest in merging these two advanced practice roles. Economic and regulatory advantages have been noted in the literature for both roles.

The effects of ethanol on EEG activity in males at risk for alcoholism.

The present investigation examined the effects of placebo (P), low dose (LD) and high dose (HD) ethanol on EEG activity in two groups of males. One group consisted of individuals at high risk for the development of alcoholism (HR, N = 21) while the other consisted of matched, low risk (LR, N = 21) controls. Only one condition (P, LD or HD) was presented each day and condition order was randomized.