The culture of morning report: ethnography of a clinical teaching conference.

We studied the structure, process, and subjective meaning of "morning report," a time-honored, medical teaching conference attended by faculty, house officers, and students at a pediatric teaching hospital. Methods included participant observation, focused interviews, and content analyses. Results showed substantial variation by rank in behavior, perception, and participation based on a highly structured division of labor. The most frequent suggestion for improving morning report was to shorten it. Data indicate that morning report, at least at our study site, is out of step with current learner-centered models, seems perfunctory, and may be costly in the current climate of decreased revenues and downsizing. The persistence of morning report, despite these liabilities, attests to its significance as a cultural event.

History of the cytomegalovirus.

Because it is capable of producing both congenital and acquired infections, the cytomegalovirus (CMV) has become an extremely important pathogen, and review of its history is pertinent. Inclusion-bearing cells were first shown by Ribbert in 1881. Goodpasture and Talbert in 1921 were the first to suggest that the "cytomegalia" could be due to a viral agent. In 1950, Smith and Vellios showed that infection may occur in utero. The introduction of exfoliative cytology methods allowed identification of characteristic cells in the urine of infected infants. Smith in 1956, Rowe and coworkers in 1956, and Weller et al in 1957 independently isolated human CMV strains. In 1960, Weller and coworkers proposed the term "cytomegalovirus" and subsequently isolated CMV from the urine of infants with generalized disease. CMV has now become one of the most common opportunistic pathogens encountered in patients immunocompromised from congenital or acquired causes such as AIDS or transplantation procedures.

The expression of acylphosphatase is associated with the metastatic phenotype in human colorectal tumors.

We have performed differential display comparing gene expression from cell lines derived from human colorectal tumors. The cell lines were selected for study based on their ability to form metastases following injection into athymic mice. One gene which was expressed exclusively by the metastatic lines was identified as human acylphosphatase (e.c. 3.6.1.7, acylphosphate phosphohydrolase). The expression of this gene was confirmed by RT-PCR using gene-specific primers. This gene product catalyzes the hydrolysis of phosphorylated intermediates of Na+/K(+)-ATPase and of Ca(2+)-ATPases of mammalian cells. Changes in the activity of the Na+/K(+)-ATPase pump, regulated by acylphosphatase, have been previously reported in chemically-induced colonic tumors. The differential expression of this gene in the human metastatic colorectal lines suggests it may be involved in the metastatic phenotype.

Acute necrotizing fasciitis in childhood.

Acute necrotizing fasciitis is a rare but frequently catastrophic infection of the subcutaneous tissues and fascial sheaths. It is rare in infants and children. The case of a 3 1/2-year-old boy with acute necrotizing fasciitis caused by group A beta hemolytic streptococcus is described.

Effect of prescribed prism on monocular interpupillary distances and fitting heights for progressive add lenses.

Success in fitting progressive addition lenses is dependent upon the accurate placement of the progressive zone. Both eyes must track simultaneously within the boundary of the progressive corridor. Vertical prism will displace the wearer's lines of sight and consequently eye position. Because fitting heights are measured using an empty frame, subjects with vertical phorias usually will fuse, and not show the vertical differences in pupil heights during the measuring process. Therefore, when prescriptions contain vertical prism one must consider the changes in measured fitting heights that will occur once the lenses are placed in the frame. Fitting heights must be altered approximately 0.3 mm for each vertical prism diopter prescribed. The fitting height adjustment is opposite from the base direction of the prescribed prism. An explanation of the effect of prescribed horizontal prism on monocular interpupillary distance (PD) measurements is also included.

Pneumococcal septicemia and pneumonia in the neonatal period.

Infections due to Streptococcus pneumoniae are extremely rare in the neonatal period. A newly born infant with pneumococcal septicemia and pneumonia is described.

Arachidonic acid metabolism in cells transfected with sense and anti-sense cDNA to annexin I.

Thymic epithelial cell line TEA3A1 produce prostaglandin E2 (PGE2) and express high levels of annexin I. In order to study the relationship between the levels of annexin I expression and the arachidonic acid metabolism, TEA3A1 cells transfected with expression vector containing full length annexin I cDNA in either sense or anti-sense orientation was studied. In the anti-sense cells where the level of annexin I was reduced, the PGE2 production was significantly lower. On the other hand, PGE2 production was significantly higher in sense cells where the production of annexin I was also higher than in control cells. Our results show that increased PGE2 production in sense cells was accompanied by higher levels of PLA2 enzymatic activities. These results suggest that the production of annexin I is positively associated with the phospholipase A2 enzymatic activity and the prostaglandin production in thymic epithelial cells.

Comparison of restriction fragment length polymorphisms of proto-oncogenes in native Hawaiians and other ethnic groups in Hawaii.

The relative genetic diversity of selected proto-oncogenes in the native Hawaiian gene pool was examined by comparing the restriction fragment length polymorphisms of these genes in a group of 23 individuals with at least part Hawaiian ancestry, and in 20 individuals from other ethnic groups. Twenty-one combinations of the proto-oncogenes, c-fms, c-myc, L-myc, c-Ha-ras, and c-Ki-ras, tested with 1 or more of the restriction enzymes Bam HI, Eco RI, Hind III, Pst I, Pvu I and Kpn I were examined. Sixteen of these did not exhibit RFLPs in Hawaiians or in other ethnic groups. Four of the combinations exhibiting RFLPs in native Hawaiians exhibited similar-sized restriction fragments in the other ethnic groups. Only in the case of c-myc digested with Pst I were 5 individuals of Hawaiian ancestry found to have an RFLP which has not been detected in other ethnic groups. These 5 cases exhibited a 13-kb c-myc fragment in addition to the 5.5-kb fragment found in most Hawaiians and always present in other ethnic groups. The presence in Hawaiians of most RFLPs found in other ethnic groups indicates that the genetic diversity of proto-oncogenes in the gene pool of native Hawaiians is not substantially less than that of other ethnic groups.

Malignant melanoma--a new epidemic.

The incidence of cutaneous malignant melanoma is rising steadily. Guidelines for early recognition and treatment as well as prevention of this potentially fatal disorder are outlined.