OBJECTIVE: To study the efficacy of acellular human dermal (AHD) allograft as a material for static slings used to treat ptosis of the oral commissure after facial paralysis. DESIGN: In the university facial plastic surgery practices (Baltimore, Md, and Albuquerque, NM) of the senior author (J.L.F.), 11 consecutive patients with facial paralysis were treated with AHD allograft slings. Follow-up was 4 to 14 months with 1 patient excluded for inadequate follow-up. Six of the remaining 10 patients received radiation therapy. Results were considered excellent and designated grade 1 when the affected oral commissure was at the same level as the normal commissure. Complete ptosis was designated grade 4. Grades 2 and 3 were designated between these extremes. RESULTS: All 10 patients showed improvement in the position of the oral commissure, in oral competence, and in cheek ptosis. Four patients were grade 1; 5, grade 2; and 1, grade 3. There were no implant extrusions or infections. CONCLUSIONS: The increased biointegration of AHD allografts in comparison with alloplastic materials may account for the absence of infection reported in this study and the relatively high success rate, especially in patients receiving radiation therapy.

Facial Paralysis↗

PubMedDate not supplied

Quantitative determination of valproic acid and 14 metabolites in serum and urine by gas chromatography/mass spectrometry.

A method for the determination of the antiepileptic drug valproic acid and 14 of its metabolites in serum and urine by gas chromatography/mass spectrometry with selected ion monitoring of the trimethylsilylated derivatives has been developed. Sample preparation, including hydrolysis of VPA-conjugates and removal of urea in urine is carried out at pH 5.0 and is rapid and simple. The samples are extracted with ethyl acetate and the concentrated extracts are trimethylsilylated. Analysis with adequate separation of metabolites is achieved with a DB 1701 fused silica (Megabore) capillary column. The method exhibits high recovery and reproducibility and is sufficiently sensitive and selective for analysis of small sample volumes. Application of the method for screening patient serum and urine samples for unusual metabolite patterns, with possible predictive value for early detection of liver injury, is presented.

Chromatography, Liquid↗

PubMedDate not supplied

Midazolam pretreatment does not ameliorate myoglobinemia or the clinical side effects of succinylcholine.

STUDY OBJECTIVE: To determine whether the levels of serum myoglobin and the occurrence of fasciculations and postoperative symptoms following a single dose of succinylcholine are modified by the prior administration of midazolam. DESIGN: Randomized, double-blind, placebo-controlled study. SETTING: Outpatient surgical service of a university hospital. PATIENTS: 69 ASA physical status I and II healthy, adult female outpatients undergoing laparoscopy (for diagnosis or tubal ligation) with general anesthesia that included succinylcholine. INTERVENTIONS: Patients received pretreatment of either a saline placebo (Group 1, n = 31) or intravenous midazolam 0.03 mg/kg (Group 2, n = 38) 5 minutes before succinylcholine. MEASUREMENTS AND MAIN RESULTS: Serum myoglobin prior to pretreatment and at 5 (t5) and 30 (t30) minutes after succinylcholine was determined by radioimmunoassay. Pain was assessed by telephone interview 24 to 36 hours postoperatively. Baseline myoglobin levels ranged from 14 to 69 ng/ml; the 5- and 30-minute samples varied widely (range, 16 to 900 ng/ml). The rise was 3 or more SDs above the baseline mean in 23% and 42% of Group 1 at t5 and t30, respectively, and in 21% and 35% of Group 2 at t5 and t30, respectively. The differences between groups were not significant. The frequency of fasciculations (77% in Group 1, 87% in Group 2), postoperative sore throat (64% in Group 1, 57% in Group 2), and myalgias (44% in Group 1, 51% in Group 2) also was not significantly different between groups. CONCLUSIONS: Midazolam had no effect on myoglobin level or postoperative symptoms following succinylcholine.

Adult↗

PubMedDate not supplied

Profound conditioned taste aversion induced by oral consumption of 2-deoxy-D-glucose.

In a previous experiment rats avidly avoided a solution of 2-deoxy-d-glucose in 0.2% saccharin (2-DG+S), drinking less than 1 mL over 3 days. The present study investigated taste avoidance and conditioned taste aversion (CTA) to orally presented 2-DG+S as well as CTA in response to i.p. injections of 2-DG. In Experiment 1, rats were given either a glucose/saccharin(G +S) solution or 2-DG+S for eight 30-s test periods. Four seconds into the first 30-s test, rats in the 2-DG+S group licked significantly less than rats in the G+S group, and licking almost totally ceased in the remaining seven tests. Overnight water intake was not different between the groups, but when offered a G+S solution, rats in the 2-DG+S group almost totally avoided the solution and still showed a significant aversion to G+S when retested 6 days later. In Experiment 2, rats were allowed to drink G +S, and were then injected i.p. with 500 mg 2-DG/kg, 500 mg D-glucose/kg body weight in 0.3 mL water, or with 0.3 mL saline. When tested with a G +S solution the next day, rats in the 2-DG group showed a highly significant avoidance, while rats in the glucose group were not different from those in the saline group. The results of the second experiment are consistent with earlier studies of CTA induced by i.p. injections of 2-DG. The present study indicates that small amounts of orally ingested 2-DG produce a CTA as strong or even stronger than that following injected 2-DG, most likely by inducing malaise. Whether the onset of malaise is fast enough to account for the rapid initial avoidance of this solution or a taste factor is also involved is not yet clear.

Administration, Oral↗

PubMedDate not supplied

Valproate metabolites in serum and urine during antiepileptic therapy in children with infantile spasms: abnormal metabolite pattern associated with reversible hepatotoxicity.

The purpose of this study was to identify abnormal metabolite patterns of valproate (VPA) as possible early indicators of VPA-induced liver toxicity. In a prospective study, we determined serum and urine levels of VPA metabolites by gas chromatography-mass spectrometry (GC-MS) during the course of therapy in 25 children treated for infantile spasms with high VPA doses (less than or equal to 100 mg/kg body weight/day). Most patients had similar metabolite profiles: The main metabolites in serum were the beta-oxidation products (2-en-VPA and 3-keto-VPA) and the major diunsaturated metabolite 2,3'-dien-VPA. Glucuronide conjugates and the oxidation products represent the most abundant metabolites in urine. Other metabolites, including the potential hepatotoxin 4-en-VPA, were detected only in low concentrations. Two children had transiently aberrant metabolite profiles, indicating altered beta-oxidation, (levels of 2-en-VPA, 2,3'-dien-VPA, and 3-en-VPA were markedly increased) in connection with hepatomegaly and increased liver enzyme activities at a time when both had febrile infections and were receiving dexamethasone comedication. At no time were increased levels of 4-en-VPA or its derivatives detected. Establishing the VPA metabolite profile may aid in evaluation of patients who show signs and symptoms of liver dysfunction during VPA therapy. The present study shows that initial stages of hepatotoxicity reactions to VPA may be accompanied by characteristic changes in VPA metabolism; early detection of such abnormal metabolite patterns might decrease the risk of severe hepatic injury.

Chemical and Drug Induced Liver Injury↗

PubMedDate not supplied

The Neurobehavioural Rating Scale: replication in an acute, inpatient rehabilitation setting.

The Neurobehavioural Rating Scale (NRS) was developed to allow quantification of clinical observations of the behaviour of individuals following traumatic head injury. Initial validation of this instrument reported satisfactory interobserver reliability, as well as preliminary support for its validity in differentiating both severity and chronicity of head injury. In the present study, reliability and content validity of the NRS were replicated using a population of severe head injury patients undergoing inpatient rehabilitation. Concurrent, independent assessment using the NRS was conducted weekly by two members of an inpatient, traumatic head injury team. Acceptable levels of interobserver reliability were found, despite less control over observed behaviour in the naturalistic setting used. Content validity was also supported in this replication, although recommendations for 'tightening' the NRS included better definition of the seven-point severity rating for each item, as well as potential deletion of two items that contributed little to differential variance in the total NRS score. The NRS appears to be a promising clinical and research tool for assessing the neurobehavioural sequelae of traumatic head injury. Its strengths include efficiency of administration and the flexibility to administer through brief, structured interviews or observations in a naturalistic setting. Continued research on the NRS in different settings and with different populations is required to establish its validity.

Adolescent↗

PubMedDate not supplied

Low literacy levels in adults: implications for patient education.

BACKGROUND: Patients are being discharged with the need for more complex care in the home. Written information frequently is used in health education. Patients and caregivers must be able to read and understand this information. METHOD: A comprehensive literature review of articles on literacy and health education materials was performed. RESULTS: The literature review revealed that low literacy is more prevalent in the United States than is generally recognized. Health education materials often require a reading level higher than the reading level of most patients. There are a number of tools available for assessing reading levels. CONCLUSION: Findings indicate there are implications for nursing practice, education, and research. There is a need for nurses to be aware of the prevalence of low literacy. They need to know how to accurately assess reading ability and develop material that is at the appropriate level for patients and caregivers. There is a need for research to investigate possible relationships between health status and low literacy and to examine the effects of remedial reading programs on health practices.

Adult↗

PubMedDate not supplied

Nurse executives: decision points in their careers.

Nurse executives identified key decision points in their careers. Typical of executive women, they had a general sense of career direction but reported no overall career plan.

Career Choice↗

PubMedDate not supplied

Intraocular HIV-1-specific IgG synthesis in a patient with CMV retinitis.

A sight-threatening cytomegalovirus (CMV) retinitis is often associated with acquired immune deficiency syndrome (AIDS). We report the detection and quantitation of antibodies specific for CMV and human immunodeficiency virus type 1 (HIV-1) in the vitreous fluid and serum of an AIDS patient suffering from bilateral CMV retinitis. The ratio of the concentrations of HIV-1-specific immunoglobulin G (IgG) to total IgG in the vitreous fluid was found to be higher than that of the peripheral blood, indicating a local production of HIV-1-specific IgG synthesis within the ocular compartment. In contrast, CMV-specific IgG levels in serum were found to be higher than that of vitreous fluid, indicating an intact blood-ocular barrier. CMV and HIV were also isolated from the ocular tissues of this patient. These findings are consistent with the hypothesis that CMV retinitis may be associated with HIV-1 infection of the ocular tissues, which evokes an HIV-1-specific humoral immune response locally within the ocular compartment.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Multicultural midwifery.

Explore the source record for details and available documents.

Black People↗

PubMedDate not supplied

Experiences, events, people. Do they influence the leadership style of nurse executives?

Nurse executives play a key role in healthcare organizations. This study asked nurse executives whether there were particular experiences, events, or persons that influenced their leadership style. The answers to this question provide guidance for nurses who aspire to this role. Nurse administrators, leaders, and educators are in pivotal positions to influence the development of leadership in others.

Adult↗