Geographic origin and risk for congenital infection in a Canadian inner city: findings and implications for policy.

This study examines associations between geographic origin and risk for congenital infections, through a chart review of women from the St. James Town area of Toronto delivering at Wellesley Hospital in 1996. Foreign-born women (n = 203) were significantly less likely than Canadian-born women (n = 53) to be HBsAg negative (187/193 vs.

Long-term follow-up of survivors of acute lung injury: lack of effect of a ventilation strategy to prevent barotrauma.

Objectives: To determine the effect of a ventilation strategy to prevent barotrauma on long-term outcome in survivors of acute lung injury.

Design: Prospective blinded cohort analysis.

Setting: Three university-affiliated medical-surgical intensive care units.

Silicon assays in women with and without silicone gel breast implants--a review.

During the past 5 years, as the failure properties of silicone gel breast implants have emerged, there has been considerable interest in measuring the levels of silicone and silicon in blood, serum, breast milk, and body tissues. Assays have been done in control patients without implant exposure, and in patients with silicone gel implants in an attempt to predict implant failure. Nuclear magnetic resonance measurements of silicone compounds have not been helpful because of their low sensitivity of detection.

Venous stenosis and thrombosis associated with the use of internal jugular vein catheters for hemodialysis.

Previous studies have demonstrated venous stenosis and thrombosis in hemodialysis patients who had repeated or prolonged cannulation of the subclavian vein. Early reports, however suggested that patients with catheters placed in the internal jugular vein were not at risk of such complications. We conducted a retrospective case series to determine if this was correct.

Expandable metal stents for benign esophageal obstruction.

Extensive experience with expandable metal stents for benign esophageal obstruction is limited. A review of the literature demonstrates a high incidence of complications varying from stent migration to stent-induced trauma leading to fistulization. The most common complication (41%) is that of stent-induced stenosis caused by granulation tissue and fibrosis.

Relative hypoparathyroidism and adynamic bone disease.

Renal bone disease results in significant morbidity in patients with end-stage renal failure. Renal osteodystrophy is a mixture of different conditions with different pathogenetic factors involved. Most recently a new form of renal bone disease, adynamic bone disease, has emerged as the most frequent finding on bone biopsy of patients on dialysis therapy.

Cartilaginous metaplasia in the capsule of a Dacron-backed silicone gel breast prosthesis.

Capsular metaplastic changes described as "synovial metaplasia" have been reported in association with silicone gel breast prostheses. Initially this finding was thought to be more common with textured implants. Recent studies have shown no relation between implant shell type (textured vs.

Intra-articular calcaneal fractures: effect of open reduction and internal fixation on the contact characteristics of the subtalar joint.

Intra-articular calcaneal fractures are associated with significant long-term morbidity, and considerable controversy exists regarding the optimum method of treating them. The contact characteristics in the intact subtalar joint were determined at known loads and for different positions of the ankle and subtalar joint, using pressure-sensitive film (Super Low; Fuji, Itochu Canada Ltd, Montreal, Quebec). We measured the contact area to joint area ratio (pressure > 5 kg force/cm2 [kgf/cm2]) which normalizes for differences in joint size and the ratio of high pressure zone (>20 kgf/cm2) as a reflection of overall increase in joint pressure.

Lipoproteins are substrates for human secretory group IIA phospholipase A2: preferential hydrolysis of acute phase HDL.

Group IIA secretory phospholipase A2 is an acute phase enzyme, co-expressed with serum amyloid A protein. Both are present in atherosclerotic lesions. We report that human normal and acute phase high density lipoproteins and low density lipoprotein are effective substrates for human group IIA phospholipase A2.

Capsular calcification associated with silicone breast implants: incidence, determinants, and characterization.

Capsular calcification was present clinically in 64 of 404 silicone gel breast implant capsules (15.8%) analyzed from 1981 to 1996. It presented as white-gray plaques on the inner surface of capsules in 62 of 64 capsules, and as massive heterotopic ossification in 2 capsules.

Clinical practice guidelines: prevention of cytomegalovirus disease after renal transplantation.

Objective: To develop a set of comprehensive, standardized, evidence-based guidelines for the use of antiviral therapy to prevent cytomegalovirus disease in adult patients having undergone renal transplantation.

Options: The use of medication, at the time of induction therapy or at the earliest sign of viremia. Treatments were evaluated by patient and donor serologic groups and the induction regimen used.

Efficacy of topiramate.

In controlled clinical trials, topiramate (Topamax) has demonstrated efficacy in refractory patients with complex partial seizures and secondarily generalized tonic-clonic seizures. Approximately 45 percent of 534 patients had a > or = 50 percent reduction in seizure frequency. Limited open label trials have shown that topiramate has broad spectrum activity and may be effective in patients with primary generalized epilepsies.

Regulation of the cellular expression of secretory and cytosolic phospholipases A2, and cyclooxygenase-2 by peptide growth factors.

Secretory group II (sPLA2) and cytosolic (cPLA2) phospholipases A2 and cyclooxygenase-2 (Cox-2) play a pivotal role in release of proinflammatory eicosanoids. Excessive activity of sPLA2 per se can also propagate inflammation. Endogenous control of the above enzymes has not been completely elucidated.

Splenic artery embolization before laparoscopic splenectomy. An update.

Background: This study assessed preoperative splenic artery embolization before laparoscopic splenectomy.

Methods: Preoperative splenic artery embolization was used in 26 of 54 patients (48%) undergoing laparoscopic splenectomy. Between 1992 and 1994, this procedure was used in all patients with spleens shorter than 20 cm (group I), except the first two (18/20).

Hepatitis G and hepatitis C RNA viruses coexisting in cryoglobulinemia.

Objective: Hepatitis G virus (HGV) has been identified as a new member of the Flaviridae family, which includes the hepatitis C virus (HCV). There is a well established association between HCV and cryoglobulinemia; however, to date HGV has not been linked with various types of cryoglobulinemia. We investigated the association of HGV with cryoglobulinemia.

Nocturnal hemodialysis: three-year experience.

There is evidence that high frequency, as well as long duration, hemodialysis provides better clinical outcomes. We developed nocturnal hemodialysis, a new innovative form of renal replacement therapy, which is performed six to seven nights per week for 8 to 10 h during sleep at home. Blood flow was set at 300 ml/min and dialysate flow at 100 ml/min.

Nocturnal hemodialysis (NHD) adapted to the in-centre setting--a pilot study.

Nocturnal hemodialysis has proven to be an effective and safe modality with many benefits. Using NHD parameters, two in-centre conventional hemodialysis (CHD) patients participated in a three-week in-hospital trial to test the viability of an in-hospital nocturnal hemodialysis (NHD) program. One RN was responsible for the initiation and monitoring of all treatments.

Management of common musculoskeletal problems: a survey of Ontario primary care physicians.

Background: In Canada, primary care physicians manage most musculoskeletal problems. However, their training in this area is limited, and some aspects of management may be suboptimal. This study was conducted to examine primary care physicians' management of 3 common musculoskeletal problems, ascertain the determinants of management and compare management with that recommended by a current practice panel.

Control of serum phosphate without any phosphate binders in patients treated with nocturnal hemodialysis.

We compared the efficacy and the long-term effects of nocturnal hemodialysis (NHD) versus conventional hemodialysis (CHD) in controlling serum phosphate levels in patients with end-stage renal disease (ESRD). Patients underwent thrice weekly CHD and were subsequently switched to NHD six nights weekly. In the "acute" study serum and dialysate phosphate were measured during and after dialysis, and the total dialysate was collected to calculate mass solute removal.

Transmissibility and infection control implications of Burkholderia cepacia in cystic fibrosis.

Objective: To describe the microbiology and potential virulence factors of Burkholderia cepacia; to discuss the studies that have investigated its mode of transmission among cystic fibrosis patients; and to identify the major risk factors associated with acquisition of this pathogen inside and outside of the hospital environment.

Data Sources: MEDLINE search of the literature published between 1986 and 1997 using the key words/subject words Pseudomonas cepacia, Burkholderia cepacia, cystic fibrosis, infection control and transmissibility, and the bibliography of selected papers.

Data Extraction: Selected studies examining epidemiology, microbiology, virulence factors and mode of transmission of B cepacia in cystic fibrosis.

Induction of secretory phospholipase A2 confirms the systemic inflammatory nature of adjuvant arthritis.

Adjuvant arthritis (AA) is an accepted model of inflammatory arthritis. Until now, however, there is little information about inflammatory mediators, specifically in relation to the arachidonic acid cascade in AA. Our objective was to study the expression of secretory (sPLA2) and cytosolic (cPLA2) phospholipases A2 in various organs during the course of AA.