A randomized trial of misoprostol versus extra-amniotic sodium chloride infusion with oxytocin for induction of labor.

Objective: Our purpose was to compare the efficacy and safety of misoprostol and extra-amniotic sodium chloride infusion with oxytocin for induction of labor.

Study Design: This randomized trial compared two methods of labor induction in women requiring cervical ripening. One hundred twenty-three women undergoing labor induction with a Bishop score < or =5 were randomly selected to receive either misoprostol, 50 microg intravaginally every 4 hours, or extra-amniotic sodium chloride infusion.

The occipital transtentorial approach for cerebellar arteriovenous malformation in a child.

This report presents a case of arteriovenous malformation (AVM) in the region of the superior vermis and quadrigeminal plate, which was partially embolized using a endovascular technique and subsequently surgically excised. An occipital transtentorial approach was employed to excise the AVM, and the patient did well without neurological complications postoperatively. Comparing various surgical approaches, we believe the occipital transtentorial approach is the best for the AVM of this region.

Adenosine-mediated killing of cultured epithelial cancer cells.

Because micromolar concentrations of adenosine (Ado) have been documented recently in the interstitial fluid of carcinomas growing in animals, we examined the effects of low concentrations of Ado on the growth of cultured human carcinoma cells. Ado alone had little effect upon cell growth. In the presence of one of a number of Ado deaminase (ADA) inhibitors, Ado led to significant growth inhibition of all cell lines tested.

Medical education and postgraduate training in the USA: special reference to children's hospital.

The American medical education from undergraduate to postgraduate education is introduced. All physicians and surgeons require residency training before becoming eligible to be certified by the American Board of Medical Specialty. The residency program is tightly overseen and regulated by the Accreditation Council for Graduate Medical Education (ACGME) and the Residency Review Committee in order to maintain its quality.

Hypersensitivity pneumonitis resulting from community exposure to Canada goose droppings: when an external environmental antigen becomes an indoor environmental antigen.

Background: In the past, hypersensitivity pneumonitis has been attributed to occupational, agricultural, or home environmental exposure.

Objective: This report describes the first case of hypersensitivity pneumonitis due to community exposure to droppings from Canada geese migrating through a suburban environment.

Method: Clinical and serologic information was used in making the diagnosis of hypersensitivity pneumonitis.

Invasive micropapillary carcinoma of the breast: a prognostic study.

Invasive micropapillary carcinoma (IMC) of the breast is a rare variant of infiltrating ductal carcinoma that has been associated with an extremely high incidence of lymph node metastases. Follow-up studies on patients with pure IMC breast cancer histology have been limited by low patient numbers, short duration of follow-up, and a lack of multivariate analyses. Using invasive breast cancers from 1,287 patients (median follow-up, 13.

Fatal hypermagnesemia in a child treated with megavitamin/megamineral therapy.

We report a case of fatal hypermagnesemia resulting from the unsupervised use of high doses of magnesium oxide administered as part of a regimen of megavitamin and megamineral therapy to a child with mental retardation, spastic quadriplegia, and seizures. The treatment regimen was given at the recommendation of a dietician working as a private nutritional consultant without the involvement or notification of the child's pediatrician. Hypermagnesemia is an uncommon but serious side effect of the use of magnesium containing compounds.

Insulin-like growth factor I activates c-Jun N-terminal kinase in MCF-7 breast cancer cells.

Insulin-like growth factor I (IGF-I) is an important mediator of breast cancer cell growth, although the signaling pathways important for IGF-I-mediated effects in breast cancer cells are still being elucidated. We had demonstrated previously that increased intracellular cAMP in MCF-7 breast cancer cells inhibited cell growth and IGF-I-induced gene expression, as determined using a reporter gene assay. This effect of cAMP on IGF-I signaling was independent of IGF-I-induced activation of the mitogen-activated protein kinases extracellular signal-regulated kinases 1 and 2 (ERK1 and -2).

A clinical and immunologic study to assess risk of TMA-induced lung disease as related to exposure.

The objective of this study was to determine whether there are trimellitic anhydride (TMA) exposure levels that are very unlikely to cause immunologically mediated respiratory disease. A 3-year clinical and immunologic survey study of 286 employees was conducted at a facility that manufactures TMA. Each employee was assigned an exposure classification from 1 (highest) to 5 (lowest).

Clinical implications of atypical chromosome abnormalities diagnosed prenatally.

Objective: To determine the frequency of atypical aneuploidy resulting from prenatal testing and assess the implications of these diagnoses on prenatal decision making.

Methods: We reviewed all amniotic fluid and chorionic villus samples obtained between January 1994 and September 1997 and grouped the abnormal cases into typical or atypical subcategories. This distinction was based upon whether the diagnosis provided a straightforward range of prognoses or an ambiguous clinical implication.

Epidemics of diarrhea caused by a clindamycin-resistant strain of Clostridium difficile in four hospitals.

Background: Large outbreaks of diarrhea caused by a newly recognized strain of Clostridium difficile occurred in four hospitals located in different parts of the United States between 1989 and 1992. Since frequent use of clindamycin was associated with the outbreak in one of the hospitals, we examined the resistance genes of the epidemic-strain isolates and studied the role of clindamycin use in these outbreaks.

Methods: Case-control studies were performed at three of the four hospitals to assess the relation of the use of clindamycin to C.

Deep vein thrombosis outcome and the level of oral anticoagulation therapy.

Objective: The purpose of this study was to assess the rate of deep vein thrombosis (DVT) resolution and DVT outcomes as functions of the level of oral anticoagulation therapy achieved with warfarin.

Methods: In 33 consecutive patients, a series of 35 limbs with acute symptomatic DVT was followed throughout 1 year of anticoagulation therapy. All the patients underwent 5 days of intravenous unfractionated sodium heparin therapy that was adjusted in dose to prolong the activated thromboplastin time to 2.

Gangrenous cholecystitis: analysis of risk factors and experience with laparoscopic cholecystectomy.

Background: Gangrenous cholecystitis occurs in up to 30% of patients admitted with acute cholecystitis. Factors predicting gangrenous disease in patients with acute cholecystitis remain poorly defined, making preoperative diagnosis difficult. Identification of these factors and early diagnosis of gangrenous cholecystitis will indicate more aggressive treatment, earlier operation, and a lower threshold for conversion of laparoscopic to open cholecystectomy.

Quantitative 19F NMR study of trifluorothymidine metabolism in rat brain.

Metabolism of trifluorothymidine (TFT) and its transport across the blood-brain barrier (BBB) has been measured quantitatively in rats by fluorine-19 nuclear magnetic resonance spectroscopy ((19)F NMR). It is demonstrated that TFT crosses the BBB in micromolar quantities and is metabolized in brain tissue primarily to its free base trifluoromethyluracil (TFMU) by the enzyme thymidine phosphorylase (TP). It is further proposed that the rate of TFMU production can be used as a measure of cerebral TP.

The presence of transcription factors in chicken albumin, yolk and blastoderm.

Embryonic development is determined by preset intrinsic programs and extrinsic signals. To explore the possibility that transcription factors are present at the onset of development, preparations of yolk, albumin, and blastoderm from unfertilized and fertilized white Leghorn chicken eggs were screened by a panel of 16 transcription factor antibodies with Western blot techniques. Yolk was positive for 13 transcription factors, whereas blastoderm was positive for 10, and albumin was positive for 5.

Stimulation of the dopamine 1 receptor increases lung edema clearance.

We previously reported that lung edema clearance was stimulated by dopamine (DA). The purpose of this study was to determine whether the DA-mediated stimulation of edema clearance occurs via an adrenergic or dopaminergic regulation of alveolar epithelial Na, K-ATPase. When isolated perfused rat lungs were coinstilled with DA and SCH 23390 (a specific D(1) receptor antagonist), there was a dose-dependent attenuation of the stimulatory effects of DA.

Factors that increase the risk of leakage during surgical removal of benign cystic teratomas.

The contents of mature cystic teratomas can be a potent irritant resulting in chemical peritonitis. Using a retrospective cohort, we examined the various risk factors for leakage of benign cystic teratomas during laparoscopy and laparotomy. Cyst leakage of the benign cystic teratoma contents was the primary endpoint.

Assessment of coagulation system activation using spot urine measurements.

Coagulation system activation is most commonly assessed by measuring levels of one or more proteins in peripheral blood. Because faulty blood-drawing can cause activation of the coagulation system, artifactual elevations of such markers have been reported. We have therefore investigated the possibility of using randomly collected ('spot') urine samples as a non-invasive means of assessing the state of coagulation system activation.

Clinically significant differences in the International Normalized Ratio measured with reagents of different sensitivities. SPAF Investigators. Stroke Prevention in Atrial Fibrillation.

The International Normalized Ratio (INR) system was introduced a decade ago as a way of standardizing the results of prothrombin time testing for patients taking oral anticoagulants. A strong emphasis has been placed upon using thromboplastin reagents that are very sensitive to the effects of oral anticoagulants upon the prothrombin time [i.e.

Diagnostic discrepancies in breast specimens subjected to gross reexamination.

To determine the accuracy of gross examination of breast specimens from a large university pathology service, 1120 breast specimens submitted from 1995 to 1997 that had residual tissue after submission of tissue sections were reexamined for diagnostic discrepancies. A total of 520 mastectomies, 143 wire localization excisions, 156 lumpectomies, and 301 mammoplasties were reexamined. Fifty-three (5%) major and 65 (6%) minor diagnostic discrepancies were detected.

Sleep and behavior problems among preschoolers.

This study described the relationship between amount of sleep and behavior problems among preschoolers. Participants were 510 children aged 2 to 5 years who were enrolled through 68 private pediatric practices. Parents reported on the amount of sleep their child obtained at night and in 24-hour periods.