Modern interventional management of stroke.

Acute ischemic stroke continues to be one of the leading causes of disability and death and is a financial burden to an already taxed health care system. Much research and investigation has been carried out over the past decade on various recanalization devices aimed at restoring cerebral blood flow. Despite the rapidly improving technical abilities of these devices, it has been difficult to demonstrate corresponding improved clinical outcomes.

Spindle cell rhabdomyosarcoma: a brief diagnostic review and differential diagnosis.

Spindle cell rhabdomyosarcoma is a rare variant of embryonal rhabdomyosarcoma that has a predilection for young males and most commonly involves the paratesticular region followed by head and neck. Histopathology demonstrates elongated spindle cells with fusiform to cigar-shaped nuclei and indistinct eosinophilic cytoplasm arranged in fascicles or whorls. Although the tumor demonstrates increased cellularity and moderate atypia, the microscopic and architectural patterns can allow this tumor to be confused with multiple entities, such as leiomyosarcoma, spindle cell carcinoma, desmoplastic melanoma, or fibrosarcoma, with important therapeutic implications.

Developments on the horizon in the treatment of neurovascular problems.

The field of Interventional Neuroradiology and Endovascular Neurosurgery has seen much technical advancement in the past two decades, which has brought the specialty from its infancy as an alternative therapy to the current standing as near standard of care for many complex neurovascular pathologies. This past year is no exception with flow diverting stents and stent retriever devices aiming to make their mark on advanced treatments for intracranial aneurysms and ischemic stroke, respectively. This review article will focus on the development of these technologies, current data supporting their advantages and limitations, and a brief expert opinion on where these technologies may take the field in the next few years.

Evolution of a Level I Trauma System: changes in injury mechanism and its impact in the delivery of care.

Background: Mechanisms of injury in trauma populations evolve over time as a result of system changes, prevention and safety activities, and shifts in population composition. Such changes have implications for reimbursement and resource utilization within all trauma centers. This study examines the evolution of trauma mechanisms at a regional Level I trauma center over 10 years to document the impact of these changes.

Impact of an educational intervention on steroid prescribing and dosing effect on patient outcomes in COPD exacerbations.

Unlabelled: The increasing number of patients affected by chronic obstructive pulmonary disease (COPD) and associated exacerbations has led to both rising hospital admissions and significant economic impact. Evidence-based guidelines have been formulated for COPD management recommending the use of low dose, oral corticosteroid therapy in the treatment of exacerbations. However, fewer than 50% of physicians' prescribing practices appropriately reflect the published clinical guidelines on the use of systemic corticosteroids in these patients.

Minimally invasive parathyroidectomy: how effective is preoperative sestamibi scanning?

Minimally invasive parathyroidectomy (MIP) guided by preoperative sestamibi scanning has been shown to reduce operative time, hospital stay, and cost in treating primary hyperparathyroidism. However, controversy exists over routine preoperative sestamibi scanning. The purpose of this study was to determine the utility of sestamibi scanning at our institution as part of the MIP protocol and to analyze calcium and parathyroid hormone levels as possible predictors of successful sestamibi scanning.

A randomized, placebo controlled, trial of preoperative sustained release Betamethasone plus non-controlled intraoperative Ketorolac or Fentanyl on pain after diagnostic laparoscopy or laparoscopic tubal ligation [ISRCTN52633712].

BACKGROUND: Gynecological laparoscopic surgery procedures are often complicated by postoperative pain resulting in an unpleasant experience for the patient, delayed discharge, and increased cost. Glucocorticosteroids have been suggested to reduce the severity and incidence of postoperative pain. METHODS: This study examines the efficacy of a sustained release betamethasone preparation to reduce postoperative pain and the requirement for pain relief drugs after either diagnostic laparoscopy or tubal ligation.

Isolated torsion of the fallopian tube in an adolescent: a case report.

Isolated torsion of the fallopian tube is an uncommon event. It is a difficult condition to evaluate clinically and surgery is often necessary to establish the diagnosis. This report focuses on a 15-year-old female who presented with acute pelvic pain, nausea, and vomiting.

Necrotizing pneumococcal pneumonia in childhood.

We describe the rare complication of necrotizing pneumonia and invasive pneumococcal infection in 3 previously healthy pediatric patients. Lobar consolidation and pleural effusions appeared initially, followed within several days by the appearance of multiple small lucencies in the area of consolidation. In one case, necrosis progressed to a large abscess cavity.

The financial impact of teaching surgical residents in the operating room.

Background: There have been no published data regarding the cost of training surgical residents in the operating room.

Methods: At the University of Tennessee Medical Center-Knoxville, in addition to resident-performed teaching cases, some cases are performed without the assistance of residents by the same faculty.

Results: Sixty-two case categories involving 14,452 cases were compared for operative times alone.

Marsupialization of the pancreas for infected pancreatic necrosis.

Infected pancreatic necrosis is a devastating and lethal complication of acute pancreatitis. Late death is usually a result of sepsis. W.

Intraventricular haemorrhage in preterm infants: evidence of suppressed fibrinolysis.

Intraventricular hemorrhage (IVH) in premature infants may be related to the immaturity of the vascular bed in the germinal matrix. We measured six hemostatic parameters whose alterations may represent an additional risk factor for IVH in preterm infants. On postnatal day 1 there were differences between plasminogen activator inhibitor-1 (PAI-1) activity and antigen, of both full-term and preterm infants with and without IVH (P < 0.

HPLC analysis of amino acids in inborn errors of metabolism.

Analysis of amino acids in blood or urine is a valuable diagnostic tool in cases of suspected metabolic disorders. The presence of a characteristic pattern of elevated amino acids is very useful in the diagnosis of these rare disorders. The detection of an apparently normal pattern of amino acids is also helpful to the clinician since it will eliminate many inborn errors of metabolism from the list of potential disorders.

Detection of delta F508 mutation of the cystic fibrosis gene by matrix-assisted laser desorption/ionization mass spectrometry.

The most common mutation of the cystic fibrosis gene is characterized by the deletion of three nucleotides that code phenylalanine in the 508 position of the cystic fibrosis transmembrane conductance regulator. We report the first measurements by matrix-assisted laser desorption/ionization (MALDI) time-of-flight mass spectrometry for the delta F508 mutation in cystic fibrosis carriers and patients. Furthermore, in a blind test, results from the normal and delta F508 mutant alleles in 30 clinical samples based on MALDI mass spectrometry and on conventional gel analysis of the DNA were in total agreement.

Ethanol modulates the hormone secretory responses induced by epidermal growth factor in choriocarcinoma cells.

Analysis of clinical data has implicated ethanol (EtOH) as an embryotoxic agent and as an agent that disrupts normal placental structure and function. Because epidermal growth factor (EGF) is an important regulator of placental function, we have studied the effects of EtOH on EGF-induced hormone secretion using JEG-3 choriocarcinoma cells that serve as a model for trophoblast cells. EtOH at physiological (5-100 mM) concentrations modulated effects of EGF in a time and dose-dependent manner.

Epoxide metabolite of quinine and inhibition of the multidrug resistance pump in human leukemic lymphoblasts.

Multidrug resistance (MDR) in neoplastic cells is usually due to decreased cellular retention of drugs such as vincristine or doxorubicin. An ATP-dependent drug efflux pump has been detected in MDR-1-phenotypic cells; inhibition of the MDR pump is probably the primary mechanism for reversal of MDR. Although quinine (SQ1) and quinidine are reversal agents and inhibitors of the MDR pump, the results from in vivo experiments and in vitro experiments with these diastereomers are contradictory.

Selective inhibition of luteinizing hormone action by ethanol in cultured human granulosa cells.

To extend further our previous observations on the inhibition of luteinizing hormone (LH)-induced increases in steroid secretion by ethanol (EtOH) (Alcohol. Clin. Exp.

Haemostatic derangements associated with arenavirus infection in the guinea-pig: radioimmunoassay of fibrinopeptide A to assess thrombin action in infected animals.

Pichinde virus infection of inbred guinea-pigs is a model for arenaviral infections in humans. Infected animals experience reduced levels of multiple coagulation factors caused by either consumption coagulopathy or impaired factor synthesis. A radioimmunoassay (RIA) of guinea-pig fibrinopeptide A (gFPA) has been developed to measure the degree of thrombin action in vivo.