Dissipative Reactions with Intermediate-Energy Beams: A Novel Approach to Populate Complex-Structure States in Rare Isotopes.

A novel pathway for the formation of multiparticle-multihole excited states in rare isotopes is reported from highly energy- and momentum-dissipative inelastic-scattering events measured in reactions of an intermediate-energy beam of ^{38}Ca on a Be target. The negative-parity, complex-structure final states in ^{38}Ca are observed following the in-beam γ-ray spectroscopy of events in the ^{9}Be(^{38}Ca,^{38}Ca+γ)X reaction in which the scattered projectile loses longitudinal momentum of order Δp_{||}=700 MeV/c. The characteristics of the observed final states are discussed and found to be consistent with the formation of excited states involving the rearrangement of multiple nucleons in a single, highly energetic projectile-target collision. Unlike the far-less-dissipative, surface-grazing reactions usually exploited for the in-beam γ-ray spectroscopy of rare isotopes, these more energetic collisions appear to offer a practical pathway to nuclear-structure studies of more complex multiparticle configurations in rare isotopes-final states conventionally thought to be out of reach with high-luminosity fast-beam-induced reactions.

New

The discrepancy between observations from γ-ray astronomy of the ^{60}Fe/^{26}Al γ-ray flux ratio and recent calculations is an unresolved puzzle in nuclear astrophysics. The stellar ß-decay rate of ^{59}Fe is one of the major nuclear uncertainties impeding us from a precise prediction. The important Gamow-Teller strengths from the low-lying states in ^{59}Fe to the ^{59}Co ground state are measured for the first time using the exclusive measurement of the ^{59}Co(t,^{3}He+γ)^{59}Fe charge-exchange reaction. The new stellar decay rate of ^{59}Fe is a factor of 3.5±1.1 larger than the currently adopted rate at T=1.2 GK. Stellar evolution calculations show that the ^{60}Fe production yield of an 18 solar mass star is decreased significantly by 40% when using the new rate. Our result eliminates one of the major nuclear uncertainties in the predicted yield of ^{60}Fe and alleviates the existing discrepancy of the ^{60}Fe/^{26}Al ratio.

Extracorporeal shock wave lithotripsy for clearance of refractory bile duct stones.

BACKGROUND AND STUDY AIMS: Following endoscopic sphincterotomy, 90% of bile duct stones can be removed with a Dormia basket or balloon catheter. The removal can fail in patients with large stones, intrahepatic stones, bile duct strictures or a difficult anatomy. The aim of this retrospective study is to investigate the efficacy and safety of extracorporeal shock wave lithotripsy in fragmenting and allowing the extraction of bile duct stones that could not be cleared by routine endoscopic means including mechanical lithotripsy. PATIENTS AND METHODS: From 1989 to January 2005, we treated with extracorporeal shock wave lithotripsy 376 patients (133 males and 243 females, median age 71.4 years) with bile duct stones that were not removable following endoscopic sphincterotomy, using the extracorporeal shock wave lithotripsy Lithostar Plus machine built by Siemens Co. of Erlangen, Germany. Stone targeting was performed fluoroscopically following injection of contrast via nasobiliary drain or T-tube in 362 patients and by ultrasonography in eight patients. Residual fragments were cleared at endoscopic retrograde cholangiopancreatograhy. Two hundred and ten of the 370 patients treated (56.7%) showed only 1 stone, 57 (15.4%) showed 2, 45 (12.1%) showed 3, 58 (15.6%) showed more than 3 stones. The median diameter of the stones was 21mm (range 7-80mm). RESULTS: Complete stone clearance was achieved in 334 of the 376 patients who underwent the extracorporeal shock wave lithotripsy procedure (90.2%). Six patients (1.5%) dropped out of treatment during their first sessions, mainly because of intolerance. Each patient averaged 3.7 treatments (1-12), at an average rate of 3470 shocks per session (1500-5400), at an average energy level of 3.4mJ (1-7). Complications were recorded in 34 patients (9.1%); 22 patients experienced symptomatic cardiac arrhythmia, 4 haemobilia, 2 cholangitis, 3 haematuria, 3 dyspnoea; no deaths were associated with the procedure. CONCLUSIONS: Extracorporeal shock wave lithotripsy is a safe and effective therapy in those patients in whom endoscopic techniques have failed with a clearing rate of 90.2% of refractory bile duct stones with a low rate of complications.

Mortality and community mental health. The Alachua County, Florida, mortality study.

This study reports the results of a household survey and search of death certificates that show a relationship between depression, anxiety, and subsequent mortality. It is part of an effort to develop practical epidemiologic techniques for continuous assessment of community mental health. Use is made of the population attributable mortality rate, estimated from a comparison of the prevalence of a given factor in life and at death. The study estimated attributable mortality prospectively by following up participants in a mental health survey of Alachua County, Florida, for up to four years. Of eight mental scales examined, five (mood, depression, somatic symptoms of anxiety, the Health Opinion Survey, and selected psychopathologic symptoms) showed significant association of scores with community mortality. The data suggest linkages of mental factors to mortality of an order of magnitude sufficient to warrant consideration of these factors as leading causes of death.

In vivo interaction of cis-platinum and fosfomycin on squamous cell carcinoma.

OBJECTIVES/HYPOTHESIS: Cis-platinum is the most frequently used chemotherapeutic agent for the treatment of head and neck squamous cell carcinoma (SCCA). Ototoxicity and nephrotoxicity continue to be the primary dose-limiting toxicities encountered. Fosfomycin, a broad-spectrum antibiotic, has been previously shown to be both otoprotective and nephroprotective against cis-platinum toxicity. Previous in vitro work demonstrated that fosfomycin does not inhibit the tumoricidal actions of cis-platinum. This study tests whether fosfomycin inhibits cisplatinum in vivo. METHODS: An SCCA cell line was grown in vivo in four groups of nude mice, which then received no treatment, standard-dose cis-platinum, high-dose cis-platinum, or high-dose cis-platinum with fosfomycin. RESULTS: Fosfomycin did not inhibit the tumoricidal activity of cis-platinum. Mice treated with fosfomycin also had longer survival, which is probably due to lessening of immediate cis-platinum systemic toxicity. CONCLUSION: This study shows that fosfomycin in combination with cis-platinum may be useful in treating advanced, and possibly relatively chemoresistant, SCCA of the head and neck.

Office dispensing: a responsible approach.

Office dispensing is a value added service in the dermatologist's office. As dermatologists we can recommend products with known scientific validity that will enhance patient care and provide reliable therapeutic results. Patients enjoy the convenience of being able to purchase products in the office and appreciate the dermatologist who spends time outlining a daily skin care regimen. Office dispensing benefits the physician by forcing him or her to keep current on new innovations in skin care and serves as an effective way to develop your cosmetic practice. Antiaging products, moisturizers and sunscreens, cleansers, and acne products are the basics for any in-office dispensing operation. The addition of hair and nail care products constitutes more advanced dispensing. Despite the mutual benefits for both the patient and physician, office dispensing continues to be controversial. The American Medical Association is concerned that selling health-related goods in the office may compromise the patient-physician relationship. The American Academy of Dermatology continues to support the right of dermatologists to dispense products in their office as long as it is in the best interest of the patient, as it is with all other dermatologic care. Dermatologists must preserve the right to dispense by conducting themselves in a highly professional and ethical manner.

Case managed mental health care in the San Antonio catchment area: the crisis-intervention unit.

Through the use of government nursing case management, this crisis-focused inpatient psychiatric program provided cost-effective and therapeutically directed services to Civilian Health and Medical Program for the Uniformed Services (CHAMPUS)-eligible beneficiaries in the San Antonio catchment area. Using managed care principles and a continuum-based case management model, these services were provided in local contracted civilian facilities. This acute care mental health program directly saved Brooke Army Medical Center 1.1 million mental health dollars and saved 7.7 million CHAMPUS dollars in total cost avoidance. Program costs were minimal, resulting in a 557% return on investment. A joint Army/Air Force endeavor, the program was originally administered by the Coordinated Care Division, Brooke Army Medical Center as a CHAMPUS recapture initiative. Currently under TRICARE management, the program continues intact as a managed care mental health service alternative.

Marketing budgeting in nonprofit hospitals.

The authors summarize the results of an investigation of the marketing budgeting practices of nonprofit hospitals. They examine various dimensions of budgeting behavior, including (1) the prevalence of budgeting methods that are widely used in the marketing of consumer and industrial goods, (2) the relationship between budgeting practices and the budgeting process, and (3) the relationship between budgeting practices and hospital strategy and performance. The authors also discuss implications for marketing executives and directions for future research.

Some observations on the preference deficits produced by lateral preoptic lesions in the rat.

Following water drprivation, rats with lateral preoptic (LPO) damage lose the normal preference for glucose solutions. Food deprivation reinstates the preference. This dependency is specific to sweet-tasting fluids, and the deficit persists even if thirst is alleviated prior to the preference test. Such rats will drink sweet solutions in response to intravascular fluid depletion, but they are deficient in response to sweet solutions under nondeprived conditions. This last finding in particular suggests that hunger and palatability, as determinants of the response to sweet solutions, may be dissociated by LPO damage.

Congenital dermoid cyst of the middle ear.

Dermoid cysts of the head and neck are rare lesions comprised of epidermal and mesodermal elements. We report a dermoid cyst presenting in the middle ear of the youngest patient reported to date. Structures of endodermal descent were also identified, but, given that the entire middle ear mucosa is of endodermal origin, specific classification as a teratoma would be imprecise. This lesion is interesting in that it did not directly involve the mastoid. Possible embryologic sites of origin are discussed.

Middle ear mucocele: an unusual complication of the tranlabyrinthine approach to acoustic neuroma.

The complications of posterior fossa surgery continue to decrease in incidence as our collective experience broadens. Most complications are seen in the immediate postoperative period and the minimized by careful attentiveness to subtle changes in mental status, vital signs, and cranial nerve examination. Long-term follow-up is necessary to identify tumor recurrence, but strict imaging protocols as yet do not exist to facilitate the early identification of recurrent disease, as recurrence is very rare. We report the first case of secondary mucocele formation in the middle ear cleft following translabyrinthine excision of an intracanalicular acoustic neuroma. This complication was found in the fourth postoperative year on routine magnetic resonance imaging, which itself followed previously normal contrasted magnetic resonance imaging in the second postoperative year. The genesis of this complication and possible treatment options are discussed.

Rhabdomyomatous mesenchymal hamartoma.

We present the fifth case of rhabdomyomatous mesenchymal hamartoma, the first reported in a female infant. The patient is an otherwise healthy 3-day-old Latin American infant, the product of an uneventful pregnancy and term delivery by a primigravida 23-year-old. Otolaryngic consultation was obtained when a 4-mm polypoid mass was noted within the left naris. Histopathology revealed the characteristic central core of mature skeletal muscle with extension peripherally into the glandular and follicular dermal structures. Although primarily of cosmetic significance, a possible association with other anomalies has been reported.

A pronounced thymic B cell deficiency in the spontaneously diabetic BB rat.

In an attempt to elucidate the origin of the T cell lymphopenia and/or the beta-cell-specific autoimmunity observed in diabetes-prone Bio-Breeding (DP-BB) rats, a thymic cDNA library was subjected to differential screening with thymic cDNA probes of DP-BB rats and nonlymphopenic nondiabetic controls. This approach resulted in the identification of a prominent lack of thymic B cells in DP-BB rats. This deficiency is distinct from a less pronounced peripheral B cell deficiency of different timing. The thymic B cell defect is linked to the lymphopenia trait on chromosome 4 and thereby with susceptibility to diabetes in crosses involving the DP-BB rat. In conclusion, our data suggest that the contribution of thymic B cells to the (negative) selection of thymocytes is inadequate in DP-BB rats, thus providing a plausible explanation for at least some of the spontaneous autoimmune phenomena in this animal model.

Passive cutaneous anaphylaxis inhibition: evidence for heterogeneity in IgE mast cell interaction.

Recent evidence suggests that IgE molecules are heterogeneous with respect to ability to compete with IgE myeloma for sensitization of histamine release from chopped human lung and ability to passively sensitize human basophils for antigen-induced histamine release. These observations prompted further investigation of the possibility that there exists a functional heterogeneity in the IgE molecules with respect to mast-cell binding properties. Using eight different purified rat IgE myeloma proteins, we found that they differ in their ability to inhibit the passive cutaneous anaphylaxis (PCA) reaction of mouse reaginic antisera. This suggests that IgE molecules differ in their ability to bind to mast cell receptors. Since maximal inhibition of different mouse reaginic antisera and mouse IgE hybridomas is achieved with different IgE myelomas, there may exist a functional heterogeneity in mast-cell binding receptors as well.

Extradural pneumatocele: an unusual cause of pulsatile tinnitus.

Our objective is to heighten the awareness of the clinician to the unusual features of latrogenic, pulsatile, yet nonvascular tinnitus. We present the case of an elderly white male with pulsatile tinnitus immediately following microvascular trigeminal decompression. Computed tomography revealed an extradural air collection and mastoidal fistula. The patient noticed resolution of tinnius with digital pressure over the mastoidal operative site. Treatment included exposure of the aerocele with resection of the lateral wall, fistula obliteration with wax, and abdominal fat graft. The patient noted complete resolution of his tinnitus in the recovery room. The etiology of pulsatile tinnitus can be suspected based on history and can be confirmed with corroborative imaging techniques.

Primary basal cell carcinoma of the middle ear presenting as recurrent cholesteatoma.

OBJECTIVE: This study aimed to sensitize the practitioner to the unusual presentation of basal cell carcinoma in a recurrent cholesteatoma mass. STUDY DESIGN: The study design was a case report format. SETTING: The study was conducted at a tertiary referral hospital. PATIENT: The patient studied was a contralaterally anacusic veteran. INTERVENTION: Interventions were excision of cholesteatoma and withholding of adjunctive radiation. CONCLUSION: Primary basal cell carcinoma may present in a revision cholesteatoma field.