Sacral fatigue fracture in a female runner: a case report.

OBJECTIVE: This case report describes and discusses the clinical presentation, diagnosis, and management of a patient with a sacral fatigue fracture. CLINICAL FEATURES: A 26-year-old female long-distance runner presented with nonspecific low-back and buttock pain that prevented her from training. INTERVENTION AND OUTCOME: Radiographic findings on the patient's lumbar spine and pelvis were interpreted as normal. Single-photon emission computed tomography and magnetic resonance imaging were performed, revealing a fatigue fracture of the left sacral ala. The patient discontinued training for 6 months and gradually returned to running. CONCLUSIONS: A high index of suspicion should prompt investigation with skeletal scintigraphy, computed tomography, or magnetic resonance imaging. Sacral stress fractures may respond well to conservative measures if diagnosed in a timely fashion.

Parelaphostrongylus odocoilei in Columbian black-tailed deer from Oregon.

Documenting the occurrence of Parelaphostrongylus odocoilei has historically relied on the morphological examination of adult worms collected from the skeletal muscle of definitive hosts, including deer. Recent advances in the knowledge of protostrongylid genetic sequences now permit larvae to be identified. Dorsal-spined larvae (DSLs) collected in 2003-2004 from the lung and feces of six Columbian black-tailed deer (Odocoileus hemionus columbianus) from Oregon were characterized genetically. The sequences from unknown DSLs were compared to those from morphologically validated adults and larvae of P. odocoilei at both the second internal transcribed spacer (ITS-2) of ribosomal DNA and the mitochondrial cytochrome oxidase II gene. We provide the first unequivocal identification of P. odocoilei in Columbian black-tailed deer from Oregon. The broader geographic distribution, prevalence, and pathology of P. odocoilei are not known in populations of Oregon deer.

Structure and function of neurons in the complex of the nucleus electrosensorius of Sternopygus and Eigenmannia: diencephalic substrates for the evolution of the jamming avoidance response.

The ability to discriminate the sign of the difference in frequency (DF) between two wavelike signals is integral to the jamming avoidance response (JAR) of weakly electric gymnotiform fish such as Eigenmannia. 'Whole-cell' intracellular recordings from neurons in the nucleus electrosensorius (nE) of Sternopygus, a gymnotiform that lacks the JAR, revealed that this nucleus receives information from both the ampullary and the tuberous electrosensory systems. Most tuberous units responded to DF stimuli, and many of these cells were DF sign-sensitive, i.e., they responded differently for one sign of DF. Although the distribution of ampullary units was somewhat restricted, sign-sensitive units were found in all areas of the nE in Sternopygus. Whole-cell recordings made in the nE of Eigenmannia revealed that, as in Sternopygus, sign-sensitive cells were not restricted to areas associated with control of the JAR. The diverse neurophysiology and connectivity of the nucleus electrosensorius suggests that, besides its role in the JAR of some members of the order, this nucleus likely serves as an interface between sensory input and neural circuits controlling other behaviors and endocrinological states in other gymnotiforms as well. The discovery of sign sensitivity in the nE of Sternopygus indicates that this property is not uniquely associated with the presence of a JAR; rather, the ability to discriminate the sign of DF may be relevant to many other behavioral contexts in gymnotiforms. Existing evidence indicates that the JAR evolved more than once in this group; the presence of sign sensitivity in ancestral gymnotiforms may have made this parallelism more likely.

Explanations and unresolved issues pertaining to the development of the Nuclear Pharmacy Compounding Guidelines.

OBJECTIVES: To provide background information related to the development of the Nuclear Pharmacy Compounding Guidelines, to discuss regulatory complexities related to radiopharmaceutical compounding practice, and to summarize the gaps in the current compounding regulations for radiopharmaceuticals. DATA SOURCES: The Guidelines closely follow the provisions of section 503A of the Federal Food, Drug, and Cosmetic Act (FD&C Act), the monographs and chapters related to pharmacy compounding in the United States Pharmacopeia (USP), and the recommended guidelines published by the American Society of Health-System Pharmacists. SUMMARY: The Food and Drug Administration Modernization Act (FDAMA) of 1997 established parameters under which the compounding of drug products is appropriate and lawful, but these criteria expressly do not apply to radiopharmaceuticals. The Nuclear Pharmacy Compounding Practice Committee, a group of nuclear pharmacists convened by the American Pharmaceutical Association, developed the Nuclear Pharmacy Compounding Guidelines to establish a set of principles and guidelines for good radiopharmaceutical compounding practice. The intent of the new document is to provide guidance on radiopharmaceutical compounding practices that have evolved over the last 2 decades and to place them in an appropriate regulatory framework in accordance with previous enforcement policies and guidelines issued by the U.S. Food and Drug Administration (FDA) regarding the exemption of certain pharmacy practices from enforcement of adulteration, misbranding, and new drug requirements. CONCLUSION: The Nuclear Pharmacy Compounding Guidelines, recently released by APhA, is the first official document that provides realistic and practical compounding guidance for nuclear pharmacists. Even though the United States Court of Appeals for the Ninth Circuit recently ruled section 503A of the FD&C Act to be invalid in its entirety, and the Supreme Court upheld that ruling, the compliance policy guides issued by FDA in March 1992 and revised in May 2002 maintain guiding principles on pharmacy compounding similar to those stated in section 503A of the FD&C Act. The Nuclear Pharmacy Compounding Practice Committee is optimistic that the practical information contained in the Guidelines will assist state boards of pharmacy, FDA, and the United States Pharmacopeial Convention in setting appropriate standards for nuclear pharmacy compounding practice that will ensure the continued availability of high-quality compounded radiopharmaceuticals at reasonable cost.