The gynecologist must master microsurgical techniques in the laboratory prior to engaging in clinical microsurgical work. This article describes an introductory microsurgical workshop program that is sponsored by the American Association of Gynecologic Laparoscopists in cooperation with the University of California at Irvine. The program encompasses films and lectures as well as laboratory experience that progresses from inanimate objects to small animals to fresh-frozen human fallopian tubes. The goals, preliminary arrangements, and curriculum of the workshop are explained, and guidelines are offered for optimal workshop experience. The workshop can serve as a model for hospitals or educational institutions planning to create a microsurgical laboratory and for the physician who wishes to establish a small personal laboratory area.

Gynecology↗

PubMedDate not supplied

A new peptide in the FMRFamide family isolated from the CNS of the hawkmoth, Manduca sexta.

We have purified a FMRFamide-like peptide from extracts of brain-subesophageal ganglion of the moth, Manduca sexta. The purification was monitored with a new, competitive ELISA, and accomplished with ion exchange and reverse-phase HPLC. The peptide structure was determined by a combination of tandem mass spectrometry and automated Edman degradation. The amino acid sequence of the peptide is less than Glu-Asp-Val-Val-His-Ser-Phe-Leu-Arg-Phe-amide (pEDVVHSFLRF-NH2). In a separate purification, an identical peptide was isolated from extracts of brain-associated neurohemal structures. We have named this peptide ManducaFLRFamide, to indicate its homology with other members of the "FMRFamide" family. In bioassays, chemically synthesized peptide increased the force of neurally evoked contractions in the major power-producing flight muscles, the dorsal longitudinal muscles. This observation suggests that hormonally released ManducaFLRFamide may play a role in sustaining or promoting the flight behavior necessary for mate-seeking (in males) or oviposition (in females) in sphingid moths.

Amino Acid Sequence↗

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Clinical assessment of asymptomatic knees: comparison of men and women.

Two hundred ten adults, 100 women and 110 men, were recruited on the condition of always having asymptomatic knee joints. These recruits were initially solicited by newspaper advertisement. The women were recruited in 3 weeks, but additional efforts and 3 months were necessary to assemble the group of men. The volunteers underwent a uniform comprehensive medical history questionnaire, physical examination, and plain film radiographs. The data collected were subjected to computerization and statistical analysis. Although these subjects were always asymptomatic, only 4.5% of 200 women's knees and 21% of 220 men's knees had no "positive" physical findings. The findings of hypermobile patella, patellar crepitus, and lateral patellar position on Merchant x-ray view were common. Findings not present or infrequent in these asymptomatic subjects and potentially pathological were patellar J-sign, decreased range of motion, asymmetrical ligamentous laxity, McMurray's sign, compartmental crepitus, and severe degenerative arthritis or loose bodies on radiograph. The findings in women were different from those observed in men. This gender-specific information should be helpful in patient management but also useful and timely for establishing practice guidelines, treatment algorithms, and outcome study instruments.

Adolescent↗

PubMedDate not supplied

Influence of arm positioning on rest/stress technetium-99m labeled sestamibi tomographic myocardial perfusion imaging.

BACKGROUND: Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is routinely performed with patients' arms positioned above their heads to avoid potential attenuation artifact and reduced image quality. Currently no data are available to support the use of this practice using 99mTc SPECT MPI: METHODS AND RESULTS: Forty-one patients referred for routine rest/stress MPI were imaged using the standard protocol with arms positioned above their heads and again with their arms at their sides. The patients were injected with 10 to 45 mCi (370 to 1665 MBq) of 99mTc-labeled sestamibi (99mTc-sestamibi), and SPECT images were acquired 30 to 90 minutes later. Thirty patients were imaged on an ADAC Vertex dual-head camera and 11 patients on an ADAC Cirrus single-head camera. Images were interpreted by 3 nuclear cardiologists without knowledge of patient identity, arm position, or camera type using a 17-segment scoring model. No significant differences were noted in the percentage of abnormal study results, reversibility extent, or location of MPI defects between the 2 arm positions in the same patients. Image quality was also similar. CONCLUSION: Arm positioning does not influence the interpretation of 99mTc-sestamibi SPECT myocardial perfusion imaging with regard to image quality or defect location and extent.

Adult↗

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Advance directive decision making among medical inpatients.

Per the Patient Self-Determination Act of 1991, hospitals are required to ascertain whether patients have an advance directive (AD). At this point, factors prompting patients to issue ADs have not been studied. The purpose of this study was to describe patients' understanding of ADs as well as the process patients used to arrive at their decisions to implement an AD. A stratified random sample of 26 patients from two intensive care units, one general medical unit, one general cardiac unit, and one acquired immunodeficiency unit were selected for participation. Patients were asked a series of open-ended questions to determine their knowledge and understanding of ADs. The constant comparative method was used to review the transcripts. It was found that only 31 per cent of patients had issued an AD, and 20% had learned of ADs for the first time during their hospitalization. Response analysis showed four phases of AD decision making: evaluation of illness, establishment of priorities, consideration of implications of the directives, and selection or rejection of directives. In conclusion, patients continue to have limited understanding of ADs and their implications. Continued investigation will elucidate the best strategies to educate patients about this topic.

Advance Directives↗

PubMedDate not supplied

Vancomycin: a rapid HPLC assay for a potent antibiotic.

Vancomycin 'Vancocin HCl' is a potent antimicrobial used most frequently in the treatment of gram positive septicemias. Ototoxicity has occurred at serum levels of 80 micrograms/mL. A rapid, sensitive assay for vancomycin that utilizes high-pressure liquid chromatography with ultraviolet detection, and requires only 100 microL of serum, is presented. The method shows excellent linearity and precision throughout the therapeutic and toxic range.

Chromatography, High Pressure Liquid↗

PubMedDate not supplied

Characteristics of patients successfully treated for cervicogenic headache by surgical decompression of the second cervical root.

We have recently reported 90% success in a series of patients undergoing microsurgical decompression of the second cervical (C2) nerve root and ganglion for cervicogenic headache. Review and analysis of our database was carried out in order to cull factors characterizing patients amenable to this surgical treatment. Thirty-five sequential C2 decompressions performed on 31 patients who were pain-free or significantly improved in follow-up were evaluated retrospectively. Preoperative factors and intraoperative findings were analyzed for prognostic significance. The diagnosis of cervicogenic headache was made using established criteria and success of CT-guided C2 anesthetic blockade in alleviating the headache. Numerous historical factors noted preoperatively including age, sex, history of trauma, autonomic symptoms, visual changes, and many others were not able to be well correlated with outcome in univariate analysis. Likewise, no strong correlation could be made for findings on physical examination. Thus, no specific prognostic factors could be established, other than the accepted diagnostic criteria and successful anesthetic blockade of the C2 root and ganglion. These factors should identify the subset of patients with cervicogenic headache predominantly due to C2 root or ganglion effect and thus may favor a surgical treatment.

Adult↗

PubMedDate not supplied

Increased mobility with an articulated lens in gynecologic endoscopic photography.

A new device in endoscopic photography, called an articulated lens, allows a video or movie camera to be separated from the laparoscopic endoscope, thereby removing the camera from the operating field and allowing the laparoscopist improved maneuverability during photographed procedures. By forming a segmented optical link between the telescope and the television or movie camera, the lens allows the two units to be separated by as much as 3 ft and permits the endoscope to move easily in all planes, horizontally, vertically and diagonally. This improved video and cinematographic technique enchances the teaching of surgical procedures and provides the means for keeping permanent records of such procedures.

Endoscopy↗