The presence of fat droplets in synovial fluid signifies major or minor joint trauma with damage to the bones or adjacent supporting structures. Synovial fluids aspirated after traumatic hemorrhage usually have a low white blood cell count. In this report 2 patients with hemorrhagic effusions had synovial fluid leukocytosis, presumably secondary to lipid droplet phagocytosis. Lipid globules intra- and extracellulalary in the synovial fluid and a top fatty layer in the hematocrit spin of the hemorrhagic synovial fluid are indications of the traumatic etiology of this inflammatory arthritis.

Adult↗

PubMedDate not supplied

Semi-volatile and particulate emissions from the combustion of alternative diesel fuels.

Motor vehicle emissions are a major anthropogenic source of air pollution and contribute to the deterioration of urban air quality. In this paper, we report results of a laboratory investigation of particle formation from four different alternative diesel fuels, namely, compressed natural gas (CNG), dimethyl ether (DME), biodiesel, and diesel, under fuel-rich conditions in the temperature range of 800-1200 degrees C at pressures of approximately 24 atm. A single pulse shock tube was used to simulate compression ignition (CI) combustion conditions. Gaseous fuels (CNG and DME) were exposed premixed in air while liquid fuels (diesel and biodiesel) were injected using a high-pressure liquid injector. The results of surface analysis using a scanning electron microscope showed that the particles formed from combustion of all four of the above-mentioned fuels had a mean diameter less than 0.1 microm. From results of gravimetric analysis and fuel injection size it was found that under the test conditions described above the relative particulate yields from CNG, DME, biodiesel, and diesel were 0.30%. 0.026%, 0.52%, and 0.51%, respectively. Chemical analysis of particles showed that DME combustion particles had the highest soluble organic fraction (SOF) at 71%, followed by biodiesel (66%), CNG (38%) and diesel (20%). This illustrates that in case of both gaseous and liquid fuels, oxygenated fuels have a higher SOF than non-oxygenated fuels.

Journal Article↗

PubMedDate not supplied

Comparison of two endotracheal tube securement techniques on unplanned extubation, oral mucosa, and facial skin integrity.

OBJECTIVE: To determine the effect of 2 standard methods (i.e., twill tape versus adhesive tape) of securement on unplanned extubation, oral mucosa, and facial skin integrity of the orally intubated patient. DESIGN: A prospective, quasi-experimental design was used for the pilot study. SETTING: The setting for the pilot study included critical care units of 3 community hospitals and 1 veterans' hospital in a midwestern city. SUBJECTS: A total of 52 orally intubated adult subjects were enrolled in the study from the 4 clinical sites over a 6-month period of time. The participants in the study consisted of 30 men and 22 women. The subjects ranged in age from 22 to 85 years, with a mean age of 62.3 years. The mean length of intubation was 89.6 hours. OUTCOME MEASURES: The outcome measures of the study were (1) unplanned extubation, (2) oral mucosa status, and (3) facial skin integrity. INTERVENTIONS: Endotracheal tube securement with either the twill tape or the adhesive tape securement method. RESULTS: With use of multiple analysis of variances (MANOVA) and repeated analyses of variances (ANOVAs), there were no significant differences by time or type of endotracheal tube securement method on oral mucosa or facial skin integrity. A chi-square analysis demonstrated no significant association between the 2 types of endotracheal tube securement when comparing their efficacy in preventing unplanned extubation. CONCLUSION: The findings of this pilot study demonstrated both methods of endotracheal tube securement to be comparable in preventing unplanned extubation and in maintaining oral mucosa status and facial skin integrity.

Adhesives↗

PubMedDate not supplied

A critical evaluation of current protocols for the follow-up of women treated for gynecological malignancies: a pilot study.

This retrospective review was undertaken to determine the efficacy of routine follow-up in the detection and management of recurrent cancer. The case notes of all women attending a regional cancer center who were diagnosed with cancer in 1997 were reviewed. Of 81 new cancers followed up for a median of 42 months (range 36-48), 14 have recurred after curative treatment and there were six cases of persistent disease. The median number of clinic visits per patient was 3.5 (range 1-16). Eight recurrences (57.1%) were diagnosed at scheduled outpatient appointments, three (2 l.4%) presented to the general practitioner (GP), and three were seen as emergencies in hospital. Seventeen patients with persistent/recurrent disease have died and three are alive with disease. The median time from initial presentation to disease recurrence was 12 months (range 5-25) and the median time from recurrence to death was 5 months (range 1-20). The longest interval between onset of symptoms and diagnosis of recurrence (4 months) occurred in those presenting at scheduled outpatient clinics. This study demonstrates that the current follow-up protocol is associated with delays in diagnosing recurrence, because symptomatic patients postpone seeking help until their scheduled visit. We have therefore commenced a prospective study evaluating other models of follow-up.

Adult↗

PubMedDate not supplied

What syndrome is this? Restrictive dermopathy.

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Biopsy↗

PubMedDate not supplied

Role of exposure databases in risk assessment.

Risk assessments have assumed an increasingly important role in the management of risks in this country. The determination of which pollutants or public health issues are to be regulated, the degree and extent of regulation, and the priority assigned to particular problems are all areas of risk assessment that influence the country's $100 billion annual investment in environmental protection. Recent trends in public policy have brought the practice of risk assessment under greater scrutiny. As policy makers increasingly insist that specific numerical risk levels (so-called bright lines) be incorporated into regulatory decisions, the stakes for good risk assessment practice, already high, are raised even further. Enhancing the scientific basis of risk assessments was a major goal of the Workshop on Exposure Databases. In this article, we present the Risk Assessment Work Group's evaluation of the use of exposurerelated databases in risk assessment and the group's recommendations for improvement. The work group's discussion focused on the availability, suitability, and quality of data that underly exposure assessments, a critical component of risk assessment. The work group established a framework for evaluation, based on exposure scenarios typically used in regulatory decisions. The scenarios included examples from Superfund, the Clean Air Act, the Toxic Substances Control Act, and other regulatory programs. These scenarios were used to illustrate current use of exposure data, to highlight gaps in existing data sources, and to discuss how improved exposure information can improve risk assessments. The work group concluded that many of the databases available are designed for purposes that do not meet exposure and risk assessment needs. Substantial gaps exist in measurements of actual human exposure and in the data necessary to model exposures, to characterize distributions of exposure, to identify high-risk groups, and to identify possible environmental inequities in exposure. The work group, on the basis of its findings, made both short-term and longer-term recommendations for improving the collection of exposure data in the future.

Animals↗

PubMedDate not supplied

Disseminated pelvic actinomycosis presenting as metastatic carcinoma: association with the progestasert intrauterine device.

Actinomycosis is caused by the anaerobic bacterium Actinomyces israelii. Asymptomatic colonization of the cervix with this organism has been noted in users of an intrauterine device (IUD), and its prevalence ranges between 1.6% and 36%. Rarely, symptomatic infection may occur, with the potential for extensive morbidity and even death. Herein we report a patient who survived severe disseminated actinomycosis yet presented with the clinical picture of a metastasized malignancy. This is the first report of disseminated pelvic actinomycosis presenting as an external lesion of the abdominal wall and in which a Progestasert IUD (Alza, Palo Alto, CA) was present. The common difficulty, and thus delay, in diagnosing this disease led to considerable morbidity due to an infection considered curable with penicillin. We recommend that all patients with an IUD or a history of IUD use have such information made known to those responsible for interpreting the Papanicolaou smear. Such knowledge may heighten suspicion and focus attention on the identification of these organisms before onset of clinical disease. It is important to consider this disease when caring for patients with an IUD or when counseling those contemplating its use as a contraceptive.

Abdominal Muscles↗

PubMedDate not supplied

Canine intracranial epidermoid cyst.

A 7-year-old intact male pitbull presented with a 2-month history of progressive dysequilibrium. Cerebrospinal fluid analysis was indicative of a central inflammatory or neoplastic disorder. A cerebellar cystic structure was identified on magnetic resonance imaging which was found to be an epidermoid cyst on histopathology.

Animals↗

PubMedDate not supplied

Magnetic resonance imaging and ultrasonography in the diagnosis of a malignant peripheral nerve sheath tumor in a dog.

A 9-year-old male neutered mixed breed dog had a two-month history of progressive left thoracic limb lameness. There was electromyographic evidence of denervation potentials in all muscles of this limb. In magnetic resonance images a multilobulated, hyperintense mass was visible caudal to the middiaphysis of the left humerus on T-2 weighted images. The mass, which was isointense with surrounding tissue on T1 weighted images, extended proximally towards the brachial plexus. The mass was also visible as a fusiform structure of mixed echogenicity sonographically, although fine-needle aspiration performed at this time was nondiagnostic. A malignant peripheral nerve sheath tumor was diagnosed histopathologically.

Action Potentials↗

PubMedDate not supplied

Pheochromocytoma in the vertebral canal of two dogs.

Pheochromocytomas are uncommon tumors arising from the adrenal gland, which have potential for aggressive local spread. The diagnosis is extremely challenging, particularly when classical endocrine signs are absent. This paper presents two canine cases of pheochromocytoma in the vertebral canal and illustrates the potential for detection of the tumor by abdominal ultrasonography.

Adrenal Gland Neoplasms↗

PubMedDate not supplied

Secondary hypoadrenocorticism associated with craniocerebral trauma in a dog.

An 11-month-old, neutered female miniature schnauzer presented with a severe head injury. The dog was treated for the acute effects of craniocerebral trauma and was hospitalized for just over a week. Several weeks later, she became weak and lethargic. A diagnosis of hypoadrenocorticism was confirmed with an adrenocorticotropin hormone (ACTH) stimulation test. An endogenous ACTH assay confirmed secondary hypoadrenocorticism. The dog was tested for hypopituitarism with canine thyroid-stimulating hormone and thyroxine serum assays and an insulin-like growth factor assay. These tests could not confirm panhypopituitarism in this dog. The hypoadrenocorticism was treated with prednisone, and the dog remains controlled adequately three years later.

Adrenal Insufficiency↗

PubMedDate not supplied

Negative association between type 1 diabetes and HLA DQB10602-DQA10102 is attenuated with age at onset. Swedish Childhood Diabetes Study Group.

HLA-associated relative risks of type 1 (insulin-dependent) diabetes mellitus were analysed in population-based Swedish patients and controls aged 0-34 years. The age dependence of HLA-associated relative risks was assessed by likelihood ratio tests of regression parameters in separate logistic regression models for each HLA category. The analyses demonstrated an attenuation with increasing age at onset in the relative risk for the positively associated DQB1*0201-A1*0502/B1*0302-A1*0301 (DQ2/8) genotype (P = 0.02) and the negatively associated DQB1*0602-A1*0102 (DQ6.2) haplotype (P = 0.004). At birth, DQ6.2-positive individuals had an estimated relative risk of 0.03, but this increased to 1.1 at age 35 years. Relative risks for individuals with DQ genotype 8/8 or 8/X or DQ genotype 2/2 or 2/X, where X is any DQ haplotype other than 2, 8 or 6.2, were not significantly age-dependent. An exploratory analysis of DQ haplotypes other than 2, 8 and 6.2 suggested that the risk of type 1 diabetes increases with age for DQB1*0604-A1*0102 (DQ6.4) and that the peak risk for the negatively associated DQB1*0301-A1*0501 haplotype is at age 18 years. There was also weak evidence that the risk for DQB1*0303-A1*0301 (DQ9), which has a positive association in the Japanese population, may decrease with age. We speculate that HLA-DQ alleles have a significant effect on the rate of beta cell destruction, which is accelerated in DQ2/8-positive individuals and inhibited, but not completely blocked, in DQ6.2-positive individuals.

Adolescent↗

PubMedDate not supplied

Home births. A place to breathe.

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Delivery, Obstetric↗