A database of biological and geomorphological sea-level markers from the Last Glacial Maximum to present.

The last deglacial was an interval of rapid climate and sea-level change, including the collapse of large continental ice sheets. This database collates carefully assessed sea-level data from peer-reviewed sources for the interval 0 to 25 thousand years ago (ka), from the Last Glacial Maximum to the present interglacial. In addition to facilitating site-specific reconstructions of past sea levels, the database provides a suite of data beyond the range of modern/instrumental variability that may help hone future sea-level projections. The database is global in scope, internally consistent, and contains U-series and radiocarbon dated indicators from both biological and geomorpohological archives. We focus on far-field data (i.e., away from the sites of the former continental ice sheets), but some key intermediate (i.e., from the Caribbean) data are also included. All primary fields (i.e., sample location, elevation, age and context) possess quantified uncertainties, which-in conjunction with available metadata-allows the reconstructed sea levels to be interpreted within both their uncertainties and geological context.

American Association of Electrodiagnostic Medicine guidelines for outcome studies in electrodiagnostic medicine.

Based on a review of the literature and the clinical research experience of the authors and reviewers, the AAEM proposes 17 criteria which should be used to construct and evaluate diagnostic and/or therapeutic outcome studies for patients with symptoms and signs of neuromuscular diseases. Neuromuscular diseases are defined as diseases that cause pathology and/or dysfunction of the sensory, motor, and/or autonomic nerve offers and/or muscles.

Pain rehabilitation. 4. Therapeutic options in pain management.

This self-directed learning module highlights advances in therapeutic options in pain management. It is part of the chapter on pain rehabilitation for the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This section discusses pharmacologic agents, modalities, behavioral strategies, and invasive techniques in pain management, with case studies illustrating pain management approaches in clinical practice. Advances that are covered include use of opioid receptors, receptor-specific categories of drugs used in painful conditions, components of behavioral programming for chronic pain, and the limitations of invasive techniques in chronic pain patients.

Pain rehabilitation. 3. Cancer pain, pelvic pain, and age-related considerations.

This self-directed learning module highlights assessment and therapeutic options in the management of cancer pain, pelvic pain, and the pain problems of the elderly and children. It is part of the chapter on pain rehabilitation in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This article delineates causes of cancer pain, discusses strategies for approaching each specialized population, and provides specific clinical examples to illustrate management issues, with emphasis on prevention. New advances include understanding the pain experience in children and elderly adults; investigation of psychosocial aspects of pelvic pain; and use of patient-controlled analgesia, opioids, and multimodality techniques for acute, perioperative, and chronic pain in these age groups.

The role of major histocompatibility complex and non-major histocompatibility complex encoded antigens in generation of bile duct lesions during hepatic graft-vs.-host responses mediated by helper or cytotoxic T cells.

In these studies, we examined the role of discrete classes of alloantigen differences in generating nonsuppurative cholangitis during graft-vs.-host disease. Transfer of C57BL/6J (B6) splenocytes to class I major histocompatibility complex-disparate bm1 x B6 F1, class II major histocompatibility complex-disparate B6 x bm12 F1, or multiple non-major histocompatibility complex antigen-disparate Balb,B x B6 F1 mice led to the development of periportal inflammatory infiltrates and lymphocyte invasion of bile duct walls. However, frank destruction of bile duct walls was observed only in strain combinations with class I major histocompatibility complex or multiple non-major histocompatibility complex-encoded disparities. The concomitant presence of class II major histocompatibility complex differences and class I major histocompatibility complex or multiple non-major histocompatibility complex differences did not increase and in some cases was associated with less severe bile duct disease than was observed in strain combinations with discrete histocompatibility antigen differences. Depletion of L-leucyl-L-leucine methyl ester-sensitive cytotoxic T lymphocytes from donor inocula reduced the incidence of destructive bile duct lesions observed early in the course of graft-vs.-host disease in B6-->Balb.B x B6 F1 or B6-->bm1 x B6 F1 mice. However, transfer of CD8-negative, L-leucyl-L-leucine methyl ester-resistant T helper cells alone was sufficient to generate destructive cholangitis in class I+II major histocompatibility complex-disparate or multiple non-major histocompatibility complex antigen-disparate strain combinations.(ABSTRACT TRUNCATED AT 250 WORDS)

Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome. AAEM Quality Assurance Committee.

The sensitivity and specificity of nerve conduction studies (NCS's) and electromyography (EMG) for the diagnosis of carpal tunnel syndrome (CTS) were evaluated by a critical review of the literature. With a search of the medical literature in English through May 1991, 165 articles were identified and reviewed on the basis of six criteria of scientific methodology. The findings of 11 articles that met all six criteria and the results of 48 additional studies that met four or five criteria are presented. We concluded that median sensory and motor NCS's are valid and reproducible clinical laboratory studies that confirm a clinical diagnosis of CTS with a high degree of sensitivity and specificity. Clinical practice recommendations are made based on a comparison of the sensitivities of the several different median nerve conduction study (NCS) techniques.

Are nerve conduction studies useful for monitoring the adequacy of renal dialysis?

When hemodialysis was first used clinically, a peripheral neuropathy frequently emerged. The discovery that sufficient dialysis time would prevent the emergence of symptomatic neuropathy led to the routine use of nerve conduction studies (NCS) to monitor the "adequacy" of dialysis. Modern dialysis practice has evolved since then, and the patient population is markedly different. This report addresses the question of whether there is evidence to indicate that routine use of NCS is helpful to monitor the adequacy of present-day dialysis. A critical review of the available literature reveals that there is insufficient evidence to allow one to answer the question.

The role of leucyl-leucine methyl ester-sensitive cytotoxic cells in skin allograft rejection.

Treatment of murine spleen cells (SpC) with L-leucyl-L-leucine methyl ester (Leu-Leu-OMe) depletes L3T4(+) and Lyt2(+) cytotoxic T lymphocyte precursors and the capacity to generate lethal graft-versus-host disease in semiallogeneic class I + II MHC and multiple non-MHC-disparate recipient mice, whereas T helper cell function is preserved. In the present studies the role of Leu-Leu-OMe-sensitive CTL in skin graft rejection was examined. C57BL/6J (B6) mice were serially thymectomized, lethally irradiated, reconstituted with T cell-depleted bone marrow, and treated with intraperitoneal injections of anti-L3T4 and anti-Lyt2 monoclonal antibodies. These adult thymectomized, bone marrow-reconstituted, T cell-depleted (ATXBM, TCD) mice were unable to reject B6xDBA/2F1 (B6D2F1) skin grafts. When such ATXBM, TCD mice were reconstituted with 7 x 10(7) control B6 SpC, acute rejection of B6D2F1 skin was observed. When B6 donor SpC were Leu-Leu-OMe-treated prior to transfer to ATXBM, TCD mice, uniform rejection of B6D2F1 skin grafts was still observed, although a significant delay in the time to rejection was observed. More rigorous T cell depletion of ATXBM, TCD host mice by infusion of antithymocyte globulin did not prevent delayed rejection of B6D2F1 skin initiated by transfer of Leu-Leu-OMe-treated B6 SpC. Despite the lack of complete prevention of skin allograft rejection, Leu-Leu-OMe treatment of B6 donor cells prevented lethal GVHD even in thymectomized B6D2F1 recipients. Precursors of anti-B6D2F1-specific CTL were greatly reduced or undetectable in unreconstituted ATXBM, TCD mice or in irradiated B6D2F1 recipients of Leu-Leu-OMe-treated B6 SpC. By contrast, ATXBM, TCD recipients of Leu-Leu-OMe-treated B6 SpC were found to contain a population of anti-class I MHC-specific CTL precursors of host origin within 28 days of reconstitution. These findings have indicated a number of features of the cells involved in skin graft rejection. First, Leu-Leu-OMe-sensitive CTL play a major role in acute rejection of class I + II MHC and multiple non-MHC antigen-disparate skin grafts. Moreover, the thymus-independent expansion of host-derived CTL precursors in ATXBM, TCD mice reconstituted with syngeneic Leu-Leu-OMe-resistant T helper cells also appears to play a role in mediating rejection of allogeneic skin grafts.

Brain abscess: a rare complication of halo usage.

The halo traction device for cervical spine immobilization has few complications and is routinely used for spinal cord injured patients. The following case report describes a patient with lower cervical and upper thoracic fractures stabilized with a halo. She completed a two-month rehabilitation program without complications, but developed frontal headaches and vomiting within one or two days of discharge. A head CT revealed a right frontal isodense mass consistent with a brain abscess. The abscess was resected surgically, and she was placed on antibiotics. Mortality rates from brain abscesses are as high as 24%, making a prompt diagnosis critical. This case report describes an unusual etiology for a brain abscess, and it discusses the appropriate work-up in a neurologically impaired patient.

Small bowel obstruction in chronic granulomatous disease.

Intestinal obstruction, enteritis, and colitis have been reported in patients with previously documented chronic granulomatous disease (CGD). We describe here an 11-year-old boy whose initial presentation was compatible with inflammatory bowel disease. A mild but persistent dermatitis was his only other manifestation of CGD.

Length of gestation and nutritional composition of human milk.

A comparative analysis of the composition of milk produced during the first 14 days of lactation by mothers who deliver prematurely and those who deliver at term is described and these values are contrasted with the composition of donor milk specimens. Twenty-four-hour milk collections (days 3, 7, and 14 postpartum) were obtained from nine mothers delivered between 37 to 42 wk gestation (term) and from 14 mothers who delivered between 28 to 36 wk gestation (preterm). A single spot milk collection was obtained from nine mothers who were 6 to 10 months postpartum (donor). Term and preterm milk was compared on specific postpartum days using an analysis of covariance controlling for 24-h milk volume. The protein, carbohydrate, fat, and energy content varied in a similar fashion in term and preterm milk over the 14 postpartum days studied. Furthermore, there was no significant difference between the two milk groups on any single postpartum day evaluated in terms of protein, carbohydrate, fat, or energy concentration. The milk volumes were significantly greater from the mothers delivered at term on days 7 and 14 (p less than 0.01) and the protein content of both term and preterm milk was negatively correlated with milk volume (r = -0.6 or more on each day studied). The nutrient and energy composition of spot donor milk was highly variable and frequently quite different from either term or preterm 24-h milk collections. These data indicate that milk from mothers who deliver prematurely does not contain significantly different concentrations of nutrients or energy than milk from mothers delivered at term and suggest that the differences previously noted between the two groups may be related to 24-h milk volume.

PIP: A comparative analysis of the composition of milk produced during the first 14 days of lactation by mothers who deliver prematurely and those who deliver at term is described and these values are contrasted with the compostiion of donor milk specimens. 24 hour milk collections (days 3, 7, and 14 postpartum) were obtained from 9 mothers delivered between 37 to 42 weeks gestation (term) and from 14 mothers who delivered between 28 to 36 weeks gestation (preterm). A single spot milk collection was obtained from 9 mothers who were 6 to 10 months postpartum (donor). The milk was compared using an analysis of covarience controlling for 24 hour milk volume. The protein, carbohydrate, fat, and energy content varied in a similar fashion in term and preterm milk over the 14 postpartum days studied. There was insignificant difference between the 2 groups, though the milk volumes were significantly greater from the mothers delivered at term on days 7 and 14. The nutrient and energy composition of spot donor milk was highly variable and frequently quite different from either term or preterm milk collections. These data indicate that milk from mothers who deliver prematurely contains insignificantly different concentrations of nutrients or energy than milk from mothers delivered at term and suggest that the differences previously noted may be related to 24 hour milk volume.

Effects of cardioselective beta adrenoceptor blockade on specific airways resistance in normal subjects and in patients with bronchial asthma.

The effects of single oral doses of the cardioselective beta adrenoceptor blocking drugs, metoprolol and tolamolol, on specific airways resistance (SRaw) were compared with those of propranolol and practolol in 6 healthy volunteers and in 12 patients with bronchial asthma. Whole-body plethysmography was used to measure SRaw and the blocking potency of different antagonists assessed by the degree of inhibition of tachycardia due to exercise on a treadmill. The changes correlated with plasma drug levels. Propranolol and practolol were measured fluorometrically and metoprolol by electron-capture gas-liquid chromatography. In normal subjects, about 30% reduction in exercise-induced tachycardia resulted from single doses of 80 mg propranolol (plasma levels, 50.3, SD, 29.5 to 60.8, SD, 26 ng/ml), 250 mg practolol (plasma levels, 1.05, SD, 0.32 to 1.10, SD, 0.55 mug/ml), 100 mg metoprolol (plasma levels, 137, SD, 111 to 152, SD, 100 ng/ml), and 100 mg tolamolol. In patients, these doses of the drugs produced significant increases in SRaw. These increases were greater than those after placebo but significantly so only during the peak effect 1 hr after propranolol. Compared with changes after placebo, significant effects on SRaw were also found in 3 patients given 200 mg of tolamolol. None of the drugs had a significant effect on SRaw in normal subjects. It is concluded that metoprolol, practolol, and tolamolol may impair ventilatory function in asthmatics less than propranolol and that at high doses this difference may not be demonstrable.