Anatomy, physiology, and updates on the clinical management of constipation.

Clinical management of constipation has evolved from the prescription of dietary supplements, to potent stimulant laxatives, to corrective surgeries for organic blockage. Yet constipation does not respond to a one-size-fits-all treatment. In recent decades, the Bristol Stool Form Scale and Rome III diagnostic criteria have allowed for algorithmic diagnosis, yet these criteria could benefit from further extension and meaningful discussion. This review incorporates pertinent clinical updates and uses the anatomy and physiology of constipation as helpful signposts for the practicing clinician.

Developing and testing an algorithm for automatic segmentation of the fetal face from three-dimensional ultrasound images.

Fetal craniofacial abnormalities are challenging to detect and diagnose on prenatal ultrasound (US). Image segmentation and computer analysis of three-dimensional US volumes of the fetal face may provide an objective measure to quantify fetal facial features and identify abnormalities. We have developed and tested an atlas-based partially automated facial segmentation algorithm; however, the volumes require additional manual segmentation (MS), which is time and labour intensive and may preclude this method from clinical adoption. These manually refined segmentations can then be used as a reference (atlas) by the partially automated segmentation algorithm to improve algorithmic performance with the aim of eliminating the need for manual refinement and developing a fully automated system. This study assesses the inter- and intra-operator variability of MS and tests an optimized version of our automatic segmentation (AS) algorithm. The manual refinements of 15 fetal faces performed by three operators and repeated by one operator were assessed by Dice score, average symmetrical surface distance and volume difference. The performance of the partially automatic algorithm with difference size atlases was evaluated by Dice score and computational time. Assessment of the manual refinements showed low inter- and intra-operator variability demonstrating its suitability for optimizing the AS algorithm. The algorithm showed improved performance following an increase in the atlas size in turn reducing the need for manual refinement.

Stafne bone cavity: a rare cadaveric case report.

The Stafne bone cavity (SBC), also called the static bone cavity, salivary inclusion cyst, latent cyst, and lingual bone defect is an asymptomatic bony defect that is commonly located inferior to the mandibular canal and slightly above the inferior border of the mandible. It is rare to see the actual bony defect in the cadaver because of its relatively low incidence of 0.1% to 6.06%. We report a unilateral SBC found in a 76-year-old at death male Caucasian cadaver and involving the right mandible. The SBC was oval in shape with a smooth surface and measured 10.8×6.0 mm. The SBC was continuous with the right mylohyoid groove. Since actual photographs of the SBC are lacking in the literature, this report might provide additional insight for better understanding the SBC.

A comprehensive review of the sinuvertebral nerve with clinical applications.

The anatomy and clinical significance of the sinuvertebral nerve is a topic of considerable interest among anatomists and clinicians, particularly its role in discogenic pain. It has required decades of research to appreciate its role, but not until recently could these studies be compiled to establish a more complete description of its clinical significance. The sinuvertebral nerve is a recurrent nerve that originates from the ventral ramus, re-entering the spinal canal via the intervertebral foramina to innervate multiple meningeal and non-meningeal structures. Its complex anatomy and relationship to discogenic pain have warranted great interest among clinical anatomists owing to its sympathetic contribution to the lumbar spine. Knowledge of the nerve has been used to design a variety of diagnostic and treatment procedures for chronic discogenic pain. This paper reviews the anatomy and clinical aspects of the sinuvertebral nerve.

A multiply split femoral nerve and psoas quartus muscle.

The femoral nerve is the largest branch of the lumbar plexus. It is normally composed of the ventral rami of spinal nerves L2 to L4. The psoas major has proximal attachments onto the T12 to L5 vertebrae and related intervertebral discs, fuses with the iliacus deep to the inguinal ligament and then attaches onto the lesser trochanter of the femur. Normally, the anatomical relationship is that the femoral nerve is located between the iliacus and psoas major. Herein, we report a case of the psoas quartus muscle related to several splits of the femoral nerve within the pelvis. Although the embryology for this is unclear, surgeons and physicians should be aware of such anatomical variants in order to better understand pain and entrapment syndromes and during surgical maneuvers in this region such as lateral transpsoas approaches to the lumbar spine.

Evaluation of NxTAG Respiratory Pathogen Panel and Comparison with xTAG Respiratory Viral Panel Fast v2 and Film Array Respiratory Panel for Detecting Respiratory Pathogens in Nasopharyngeal Aspirates and Swine/Avian-Origin Influenza A Subtypes in Culture Isolates.

This study evaluated a new multiplex kit, Luminex NxTAG Respiratory Pathogen Panel, for respiratory pathogens and compared it with xTAG RVP Fast v2 and FilmArray Respiratory Panel using nasopharyngeal aspirate specimens and culture isolates of different swine/avian-origin influenza A subtypes (H2N2, H5N1, H7N9, H5N6, and H9N2). NxTAG RPP gave sensitivity of 95.2%, specificity of 99.6%, PPV of 93.5%, and NPV of 99.7%. NxTAG RPP, xTAG RVP, and FilmArray RP had highly concordant performance among each other for the detection of respiratory pathogens. The mean analytic sensitivity (TCID50/ml) of NxTAG RPP, xTAG RVP, and FilmArray RP for detection of swine/avian-origin influenza A subtype isolates was 0.7, 41.8, and 0.8, respectively. All three multiplex assays correctly typed and genotyped the influenza viruses, except for NxTAG RRP that could not distinguish H3N2 from H3N2v. Further investigation should be performed if H3N2v is suspected to be the cause of disease. Sensitive and specific laboratory diagnosis of all influenza A viruses subtypes is especially essential in certain epidemic regions, such as Southeast Asia. The results of this study should help clinical laboratory professionals to be aware of the different performances of commercially available molecular multiplex RT-PCR assays that are commonly adopted in many clinical diagnostic laboratories.

Rehabilitation of a mandibulotomy/onlay/graft-reconstructed mandible using a milled bar and a tooth- and implant-supported removable dental prosthesis: A clinical report.

Prosthodontic rehabilitation of a surgically resected/reconstructed jaw with a conventional tissue-borne dental prosthesis is often challenging, if not impossible, because of the suboptimal conditions of the soft and hard tissue topography/architecture of the reconstructed site. Placing dental implants in grafted bone to provide appropriate support, stability, and retention for prosthodontic rehabilitation offers the potential for improved oral function. There are, however, some clinical conditions for which an implant-supported removable prosthesis may be preferred to a fixed implant prosthesis. This clinical report describes the design and fabrication of a milled bar and a tooth- and implant-supported removable dental prosthesis for oral rehabilitation of a reconstructed mandible, which considers patient factors associated with oral and financial conditions, ease of oral hygiene procedures, and long-term maintenance.

Salmonella serotypes isolated from pet chews in New Zealand.

AIMS: To survey the prevalence of Salmonella in imported and domestic pet chews for assessing their potential in introducing novel pathogenic and antimicrobial resistant Salmonella serotype clones into New Zealand, and as vehicles of salmonellosis in the domestic home environment. METHODS AND RESULTS: Three hundred samples, each of imported and domestic pet chews, were examined bacteriologically for the presence of Salmonella. Salmonella cells in the pre-enrichment culture were concentrated by using Dynabeads, and then selective enrichment and plating were performed by a method described in the Bacteriological and Analytical Manual, USFDA. Salmonella was isolated from 16 (5.3%) of the imported and 20 (6.7%) of the domestic pet chews, but the prevalences of Salmonella in imported and domestic products were not significantly different. All Salmonella isolates were serotyped and genotyped by pulsed-field gel electrophoresis and antimicrobial susceptibility determined by the Clinical and Laboratory Standards Institute disc diffusion methods. Salmonella Borreze has never been recorded earlier in New Zealand and was detected from Australian raw hide. Three isolates of Salmonella London were resistant to ampicillin and gentamicin, and two isolates of Salmonella Infantis were resistant to nalidixic acid, one of which was also resistant to streptomycin. CONCLUSIONS: Novel pathogenic and antimicrobial-resistant Salmonella are being introduced into New Zealand through the import of pet chews. This indicates that pet chews are a potential source of exposure to Salmonella in the domestic home environment. SIGNIFICANCE AND IMPACT OF THE STUDY: Contaminated pet chews are potential sources of Salmonella infection for domestic pets, and humans are at risk of exposure either directly by contact through handling or inadvertently by cross-contamination of food or food-contact surfaces in home environments.

Microbiological survey of prepackaged pâté and ham in New Zealand.

AIMS: To gauge the effectiveness of pâté and ham manufacturers' management of the microbial safety and quality of their products. METHODS AND RESULTS: A survey of 60 batches of prepackaged pâté showed that 41.7% of the batches had aerobic plate counts (APC) exceeding 10(5) CFU g(-1), one of pâté sample contained a Bacillus cereus count of >5000 CFU g(-1) and another contained 1700 CFU g(-1) of Listeria monocytogenes. No other pathogens were isolated from any of the samples. The survey of prepackaged ham showed that only 1% (1/104) of the ham samples were positive for L. monocytogenes (50 CFU g(-1)). CONCLUSIONS: The presence of microbial hazards in these foods has generally declined since the early 1990s in New Zealand. Noncomplying APC levels may be due to an over-estimation of product shelf life or poor food handling practices during manufacture. SIGNIFICANCE AND IMPACT OF THE STUDY: Few of the samples tested contained pathogens at significant levels. The prevalences of L. monocytogenes in pâté and ham were low. The presence of 1700 CFU g(-1) of L. monocytogenes in a pâté sample indicates that occasionally, the population can be exposed to levels of L. monocytogenes above the zero tolerance level set in New Zealand.

Growth of enterotoxigenic Staphylococcus aureus in povi masima, a traditional Pacific island food.

AIMS: To obtain preliminary data on the microbiology and hurdles to pathogen growth in the traditional Pacific Island food, povi masima, which is essentially beef brisket cured in brine. METHODS AND RESULTS: Six containers of povi masima were prepared and two were inoculated with five enterotoxigenic strains of Staphyloccocus aureus. The povi masima were divided into two lots each containing two uninoculated control and an inoculated container. Lot 1 was incubated at room temperature (20 degrees C) and lot 2 under refrigeration (4-5 degrees C) for up to 98 days. During storage, samples were removed and tested for aerobic plate count, coagulase-producing Staphylococci, Clostridium perfringens, staphylococcal enterotoxin and various chemical parameters of the food. Coagulase-producing Staphylococci and aerobic plate counts grew to high levels in both the inoculated and uninoculated lots stored at room temperature, but enterotoxin was only detected at one time point in these lots and this may represent a false positive result. The concentration of NaCl in the meat increased with time as concentrations equilibrated, and nitrite was rapidly lost in those lots stored at room temperature. Storage at 4-5 degrees C prevented proliferation of coagulase-producing Staphylococci. CONCLUSIONS: For safe curing and storage, this food should be kept under refrigeration as this prevented growth of staphylococci. Optimum storage would also be achieved with improved attempts to ensure equal distribution of NaCl prior to storage. SIGNIFICANCE AND IMPACT OF THE STUDY: Under conditions traditionally used to cure and store this food, enterotoxigenic staphylococci can grow to numbers where toxigenesis might occur, especially during the early stages of curing where the salt has not diffused from the brine into the meat.

Accuracy and implications of a reported family history of glaucoma: experience from the Glaucoma Inheritance Study in Tasmania.

OBJECTIVES: To ascertain the prevalence of previously undiagnosed primary open-angle glaucoma (POAG) within 5 large POAG pedigrees and to evaluate the reliability of a reported family history of glaucoma within these pedigrees. METHODS: The Glaucoma Inheritance Study in Tasmania (GIST) identified several large adult POAG pedigrees. Intraocular pressure (IOP), optic disc stereophotography, and automated perimetry were performed on all adult pedigree members. Participants were classified as normal (IOP <22 mm Hg and normal optic disc and field); glaucoma suspect (normal field, but an IOP >/=22 mm Hg and/or suspicious optic disc); or POAG (field defect and glaucomatous optic disc). Some individuals with POAG had been previously diagnosed by their local ophthalmologist; others were diagnosed as a result of the GIST project. Family members with a prior diagnosis of POAG were asked to report if they were aware of any relatives with POAG. This reported family history was then directly compared with the actual pedigree (before the diagnosis of new cases) to calculate agreement. MAIN OUTCOME MEASURE: The rate of glaucoma in pedigrees and percentage of previously diagnosed glaucoma cases who were aware of the positive family history of POAG. RESULTS: Four hundred forty-two subjects (mean age, 54 years [range, 13-97 years]) from 5 pedigrees were examined: 316 subjects (71%) were normal, 47 (11%) were previously diagnosed with POAG, and 8 (2%) were previously diagnosed glaucoma suspects; 30 cases (7%) of POAG and 41 suspects (9%) were newly diagnosed as a direct result of the GIST examination. Of the 47 previously diagnosed POAG cases, 41 were questioned about their prior knowledge of any family history and 11 (27%) were unaware of their family history of POAG. CONCLUSIONS: Examination of all adult subjects from POAG families yields new cases. Even in large POAG pedigrees, 27% of previously diagnosed POAG patients were unaware of their positive family history. These findings suggest that a higher percentage of adult POAG may be inherited than hitherto reported. Arch Ophthalmol. 2000;118:900-904

Early syphilis in an active duty military population and the surrounding civilian community, 1985-1993.

Syphilis among active duty soldiers at Fort Bragg, North Carolina, and the nonmilitary population of Cumberland County was examined during a 9-year period encompassing the most recent nationwide syphilis epidemic. A total of 762 cases of primary and secondary syphilis were recorded between 1985 and 1993, 27% of which occurred in soldiers. The epidemic struck both military and civilian populations simultaneously; epidemic curves in the two populations were parallel, peaking in 1990-1991, with highest annual incidences of 122.6/ 100,000 (military) and 48.0/100,000 (civilian). Individual risk factor data were not available for analysis, but a relationship was observed between primary and secondary syphilis diagnoses in both populations and cocaine arrests in Cumberland County. Our findings provide epidemiological support for a high degree of interplay between the military and the surrounding civilian communities that has significant implications for control of sexually transmitted diseases. Enhanced collaboration between military and civilian public health authorities is essential to the control of syphilis and other sexually transmitted diseases.

Infantile cystinosis : the first reported case in Seychelles

The authors report here a case of infantile cystinosis which highlights some of the difficulties encountered in securing a diagnosis over a period of five years

PHOEBE, a prototype scanning laser-feedback microscope for imaging biological cells in aqueous media.

Based on the principle of laser-feedback interferometry (LFI), a laser-feedback microscope (LFM) has been constructed capable of providing an axial (z) resolution of a target surface topography of approximately 1 nm and a lateral (x,y) resolution of approximately 200 nm when used with a high-numerical-aperture oil-immersion microscope objective. LFI is a form of interferometry in which a laser's intensity is modulated by light re-entering the illuminating laser. Interfering with the light circulating in the laser resonant cavity, this back-reflected light gives information about an object's position and reflectivity. Using a 1-mW He-Ne (lambda = 632.8 nm) laser, this microscope (PHOEBE) is capable of obtaining 256 x 256-pixel images over fields from (10 microns x 10 microns) to (120 microns x 120 microns) in approximately 30 s. An electromechanical feedback circuit holds the optical pathlength between the laser output mirror and a point on the scanned object constant; this allows two types of images (surface topography and surface reflectivity) to be obtained simultaneously. For biological cells, imaging can be accomplished using back-reflected light originating from small refractive-index changes (> 0.02) at cell membrane/water interfaces; alternatively, the optical pathlength through the cell interior can be measured point-by-point by growing or placing a cell suspension on a higher-reflecting substrate (glass or a silicon wafer).(ABSTRACT TRUNCATED AT 250 WORDS)

Electromagnetic fields of surface coil in vivo NMR at high frequencies.

A high frequency solution of the electromagnetic field produced by a circular surface coil adjacent to a homogeneous conducting, dielectric sphere is used to predict the attainable signal to noise ratio (S/N) and specific absorption rate (SAR) for in vivo 1H NMR spectroscopy experiments from 200 to 430 MHz (4.7-10 T). Above 200 MHz the S/N increases more rapidly with frequency and the SAR increases less rapidly compared with the respective S/N and SAR frequency dependence below 200 MHz. The difference in frequency dependence is due to dielectric resonances of the magnetic field inside the sphere at frequencies above 200 MHz. It is predicted that surface coil 1H NMR experiments may be performed on a head-sized sphere, having conductivity and relative dielectric constant of brain, at frequencies up to 430 MHz without exceeding 8 W/kg local SAR and 3.2 W/kg SAR. The calculations of the S/N and SAR are used to determine optimum surface coil geometries for NMR experiments. The power radiated by the surface coil in the absence of shielding and asymmetries in the received signal with respect to the plane defined by the surface coil axis and the direction of the static magnetic field are significant at high frequency. Experimental measurements of the magnetic field inside a head-sized sphere verify the presence of dielectric resonances at frequencies above 200 MHz.

The impact of jitter on separation discrimination: combination of monocular inputs.

The eyes are in continuous motion. A robust system required to make spatial separation judgments should be resistant to the positional noise produced by such movements. Two parallel lines have been jittered horizontally in order to assess the impact of stimulus movement on the retina. Jitter that maintains the separation between the two lines has minimal effect on separation discrimination thresholds, regardless of whether the targets in the two eyes jitter in a positively correlated, negatively correlated or uncorrelated manner. Presenting both eyes with line pairs but only altering the separation in one eye in the second interval yields poorer performance. However, if one eye receives a change in separation while the other views a dark screen then that monocular threshold is very similar to the binocular threshold. These results are most simply explained by procedures which average the monocular separation estimates.

Resistance to positional noise in human vision.

Human eyes are in constant and rapid motion even when observers try to maintain steady fixation. Also, the visual system has a sluggish temporal response. In combination, these two factors would be expected to blur stimuli and reduce spatial sensitivity. But observers are able to detect a difference in separation of a few seconds of arc between two closely spaced parallel lines. Here we report that even very large amounts of positional jitter of the line pair has minimal impact on this ability. This result is in marked contrast to the deterioration observed when targets are swept linearly across the retina, but is consistent with a system that must ignore oculomotor jitter. To explain these results will require a re-evaluation of current models of position coding in human vision.

The sensitivity of separation discrimination to spatiotemporal jitter.

Differences of less than 20 sec of visual angle in the separation of a pair of closely spaced parallel lines can be reliably detected. This ability is known as a hyperacuity because the thresholds are smaller than the diameter of one foveal cone. It is shown that this ability does not require a stationary pattern. Indeed, correlated horizontal jitter of the line pair has little detrimental effect on performance for jitter that ranges up to 8 min arc for two lines with a separation of only 6 min arc. Uncorrelated jitter of the two lines, which allows the actual separation to vary from moment to moment, causes performance to deteriorate at a rate similar to the rise of signal uncertainty. The results reflect the operation of a system which is not only extremely robust to oculomotor instability but is also robust to positional variation that could not be produced by eye movements.