De novo cataract development following a standard course of hyperbaric oxygen therapy.

A 49 y/o female under went 48 hyperbaric oxygen (HBO2) treatments at 2.5 ATA (atmospheres absolute) (253 kPa) for 90 minutes for chronic refractory osteomyelitis of the sacrum and recurrent failure of a sacral myocutaneous flap. Prior to HBO2 therapy, formal ophthalmic exams revealed myopia but no evidence of cataract formation. Eight weeks following the completion of HBO2 therapy, on repeat ophthalmic exam, the patient was discovered to have worsening myopia. Changes of the crystalline lens, consistent with nuclear cataract development, were identified in each eye. Other common causes of cataract formation including diabetes, corticosteroid use, and excessive exposure to ultraviolet light, were excluded. While transient visual changes are known to occur during HBO2 therapy, cataract formation has only rarely been reported and only after prolonged courses of treatment (150 or more treatments). This case identifies the need to further investigate the ocular effects of HBO2 therapy, especially with regard to cataract development and progression.

Genetic diversity and relatedness within and between species of the genus Oligoryzomys (Rodentia; Sigmodontinae).

A RAPD analysis on six species of the rodent genus Oligoryzomys trapped in a wide area (ranging from 01 degrees N to 32 degrees S) of Brazilian territory was performed in order to determine the levels of genetic variability within and between its populations and species. One-hundred and ninety-three animals were collected in 13 different sites (corresponding to 17 samples) located at Pampas, Atlantic Rain Forest, Cerrado, and Amazon domains. Oligoryzomys sp., O. nigripes (8 populations), O. flavescens (4 populations), O. moojeni, O. stramineus, and O. fornesi were the taxa analyzed. Of the 20 primers tested, 4 generated a total of 75 polymorphic products simultaneously amplified in 151 specimens. Various diversity estimators analyzed showed considerable differences between species and populations, indicating a great genetic variation occurring in the Oligoryzomys taxa investigated. A cluster analysis was made using Nei's standard genetic distances, however, it did not correlate the genetic heterogeneity of the species and populations with the geographical areas.

Impact of the Ile105Val Polymorphism of the Glutathione S-transferase P1 (GSTP1) Gene on Obesity and Markers of Cardiometabolic Risk in Young Adult Population.

The aim of the study was to investigate the association between Glutathione S-transferase P1 (GSTP1) gene polymorphism with obesity and markers of cardiometabolic risk. A cross-sectional study was carried out in individuals aged≥18 and ≤30 years. The study included 54 normal weight, 27 overweight and 68 obese volunteers. Anthropometric measurements and biochemical parameters were evaluated, the DNA was extracted from blood samples and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to measure GSTP1 Ile105Val gene polymorphism of the study participants. Also, biochemical analysis and hormone assays were carried out. A positive association between GSTP1 polymorphism and obesity was observed on subjects carrying at least one G allele (AG and GG). GG genotype was found only in the obese group. The G allele carriers presented 2.4 times higher chance of obesity when compared to those with the AA genotype. These results were independent of sex and age. We suggest that despite a study in population regional (south of Brazil), the GSTP1 gene polymorphism may play a significant role in the increase of susceptibility of obesity and contribute to identify the cardiovascular risk in young adults.

Development of a specific assay for cardiac glycoside-like compounds based on cross-resistance of human cell mutants.

The cross-resistance patterns of single- and two-step mutants of HeLa cells resistant to SC4453 (a digoxin analog) and digoxin, which involve specific alteration in Na+, K+-ATPase towards numerous other compounds, have been examined. The mutants exhibited increased resistance to all of the steroidal compounds known to elicit a digitalis-like positive inotropic response (viz. various cardiac glycosides and their genins, erythrophleum alkaloid cassaine), but they showed no cross-resistance to any of a large number of other compounds which do not show cardiac glycoside (CG)-like biological activity. Based on the above characteristics of the mutants, a new cross-resistance assay for identifying compounds that show CG-like activity has been developed. In this assay, a sample is considered to possess CG-like activity if, in comparison to the parental HeLa cells, the CGR mutants exhibit increased resistance to it. From the known D10 value (drug concentration which reduces cloning efficiency of cells to 10%) of the drug for HeLa cells and the sample dilution necessary to produce equivalent cytotoxicity, the concentration of CGs in a given sample can be estimated. In blind studies the assay correctly identified all of the samples containing CGs; none of the other samples which lacked such activity tested positive. In the blind studies the assay also provided a good estimate of the concentration of CGs (+/- 50% of the actual concentration) that was not affected by the presence of either serum components or a 20-fold excess of various steroidal compounds known to interfere in other assays. In view of the high specificity of the present assay for CG-like compounds, it should prove very useful in establishing/characterizing the presence of such activity in various biological (namely endogenous digitalis-like substances) and other samples.

Ophthalmologic procedures in the emergency department--Part II: Routine evaluation procedures.

The emergency physician (EP) must be familiar with performance of ophthalmologic procedures for evaluation and treatment of a multitude of eye complaints. This article is the second of three articles addressing ophthalmologic procedures potentially of use by the EP. This article reviews the indications and the techniques for the following routine procedures: visual acuity testing, pupil dilatation, topical anesthesia use, and tonometry. Criteria for consultation also are addressed.

Ophthalmologic procedures in the emergency department--Part III: Slit lamp use and foreign bodies.

The emergency physician (EP) must be familiar with carrying out ophthalmologic procedures for evaluation and treatment of a multitude of eye complaints. This article is the last of three articles addressing ophthalmologic procedures of use by the EP. This article reviews the indications and the techniques for slit lamp examination of the eye and techniques of foreign body removal. Criteria for consultation also are addressed.

A comparative study of the percutaneous versus intraoral technique for mental nerve block.

OBJECTIVE: Mental nerve block is frequently used to aid repair of facial lacerations; both percutaneous and intraoral approaches to blocking this nerve are used, but have never been compared. The authors compared the two techniques for pain of administration and effectiveness of anesthesia. METHODS: A prospective, randomized, single-blind, crossover study was conducted using ten healthy volunteers aged 22 to 33 years. Patients having prior experience with mental nerve blocks, lidocaine allergy, active oral/facial infection, or previous facial fractures were excluded. Bilateral mental nerve blocks were done using intraoral technique on one side and percutaneous technique on the other. Both techniques were used by the same investigator and were carried out with 27-gauge needles and 2.5 mL of 2% buffered lidocaine at room temperature injected over 20 seconds. The oral mucosa was topically anesthetized with viscous lidocaine for 1 minute prior to intraoral injection. The orders of the blocks and sides of the face anesthetized were randomized. Subjective and objective pain (visual-analog scale), efficacy (anesthesia of lower lip), time to onset, and duration of anesthesia were evaluated. RESULTS: The intraoral technique was subjectively less painful than the percutaneous approach in nine of ten subjects (p = 0.02). Scores on the visual-analog pain scale were significantly lower for the intraoral technique (p = 0.03). Intraoral injection produced lower-lip anesthesia in 10/10 subjects versus 7/10 for percutaneous (p = 0.25). Times to onset (approximately 1-2 minutes) and durations of anesthesia (approximately one hour) were similar for the two techniques. CONCLUSION: The intraoral approach to the mental nerve block with adjunctive topical anesthesia was subjectively and objectively less painful than the percutaneous approach without adjunctive anesthesia. While the intraoral approach had a greater efficacy of lower-lip anesthesia and a longer duration of action, these differences were not statistically significant.

Current status of academic emergency medicine within academic medicine in the United States.

OBJECTIVE: To characterize the status of emergency medicine within U.S. academic medical centers. METHODS: All accredited emergency medicine residency programs and all four-year allopathic medical schools in the United States were identified. Institutions were defined as academic medical centers based upon NIH research grant funding. These institutions were ranked using five measures of academic stature: a survey of medical school deans, a survey of internal medicine residency directors, level of research funding, characteristics of the student body, and an unweighted composite variable reflecting overall academic stature. The relationship between institutional academic stature and an empiric scale of institutional affiliation with emergency medicine was assessed. RESULTS: Sixty-two institutions were designated academic medical centers. These medical schools captured 90% of all NIH grant monies awarded in fiscal year 1990. Twenty-six of 87 emergency medicine residency programs (30%) were closely affiliated with one of these medical schools. Within academic medical centers, the presence of a residency or an academic department of emergency medicine was inversely associated with the medical school deans' ranking (p < 0.005), research rank (p < 0.001), and composite academic rank (p < 0.001). CONCLUSION: The majority of emergency medicine residency programs (70%) are not closely affiliated with institutions receiving the bulk (90%) of NIH resources for research. Within the institutions receiving the majority of NIH funding, there is a quantitatively and statistically significant inverse association of institutional emergency medicine affiliation and institutional academic rank.

Children's foot problems.

The most common conditions seen in a children's foot clinic are those of flatfeet and pigeon toe. Both respond to conservative treatment and few require surgical correction. However, one sees other types of flatfeet such as congenital vertical talus and tarsal coalition that frequently require surgical intervention. In general, many of the foot problems seen in children lend themselves to conservative measures, and surgical treatment can be delayed until a later age.

Fractures of the foot in children.

Fractures of the foot in children are less common than in adults and are due to severe trauma in which associated injuries may take precedence. Disturbances of growth can occur, usually when there is associated soft tissue damage. Because remodeling of the long bones of the foot does not always correct marked displacement, adequate reduction should be sought to prevent subsequent foot discomfort. Open fractures of the foot deserve considerable care. Primary closure of the wounds should be avoided.

Diagnostic modalities in gynecologic and obstetric emergencies.

Gynecologic emergencies are an integral part of the practice of an emergency physician. In fact, the occurrence of one of these, ectopic pregnancy, has increased dramatically in recent years. Fortunately, the diagnostic modalities available to emergency physicians, particularly serologic pregnancy testing and ultrasonography, have kept pace by undergoing tremendous technologic improvements that allow more rapid and accurate diagnosis of these potential life threats. Armed with the still valuable procedure of culdocentesis as well, the emergency physician has never been in a better position to cope with the distressed gynecological patient.

Chronic skin ulcers.

Chronic skin ulceration is a common complication of diabetes, peripheral vascular disease, and disorders that decrease mobility. Local ulcer care will be successful only if the underlying cause is correctly identified and steps are taken to reverse it. This article reviews the emergency department assessment and management of the patient with chronic skin ulceration.

Recurrent meningitis: a case report.

Recurrent meningitis is an uncommon clinical problem. It is most likely to result from head trauma. Streptococcus pneumoniae is the most common infecting pathogen. Computed tomographic techniques are required to identify persistent bony defects in the skull that might predispose to this disorder. Because emergency physicians regularly care for victims of head trauma and meningitis, knowledge of this entity can be useful.

Transcutaneous cardiac pacing.

Transvenous cardiac pacing is currently the pacing procedure of choice in patients with severe, life-threatening bradyarrhythmias that do not respond to pharmacotherapy. However, pacing catheters can be difficult to insert and frequently fail to capture in severely hypotensive patients. Therefore, there has been a recent resurgence of interest in external pacing methods. Newer transcutaneous cardiac pacing units are easy to apply and especially suited for unconscious patients with severe, life-threatening bradyarrhythmias. There is no operator danger and, if need be, cardiopulmonary resuscitation can continue while the electrodes are in place and the unit is operating. Human and animal studies to date have shown that there are no significant short-term clinical hazards or pathologic abnormalities when using this technique.

Microbiology of adult cellulitis.

Needle aspiration of cellulitis sites is commonly advocated to assist in the identification of causative organisms. Twenty-five nondiabetic, adult patients with a clinical diagnosis of cellulitis had site aspirations and blood cultures obtained before antibiotic therapy was initiated. Site cultures were positive in 6 of 25 patients. Blood cultures were positive in 4 of 25 patients. All organisms except one (Enterobacter agglomerans) were staphylococci or streptococci. The gram-negative bacilli were not believed to be a pathogen based on the patient's prompt response to nafcillin. In adult patients who do not have complications, the use of needle aspiration was not supported. Empiric treatment of cellulitis aimed at gram-positive cocci appears to be sufficient.

Premenstrual syndrome: diagnosis and treatment.

Premenstrual syndrome (PMS), many physicians do not believe that the disorder exists. Numerous special interest groups also dispute its existence. There is still no clear consensus about the diagnosis of PMS. It is now a diagnosable disorder which can be effectively treated. This article describes the diagnosis, clinical features, and approach to management of PMS.

Dalteparin sodium injection treatment in patients with immunologic recurrent pregnancy loss.

Dalteparin sodium injection in patients with an immunologic component to RPL resulted in an increase in compliance without any adverse early pregnancy outcomes.

The Cherney incision for removal of a large pelvic mass: a case report.

A 40-year-old woman presented with complaints due to an enlarging uterine leiomyoma. We report the first case of a Cherney incision used to facilitate removal of a huge uterine leiomyoma.