In search of a method: permanent disability assessment revisited.

How workers are compensated for the permanent consequences of their workplace injuries remains a hotly contested subject. The spreading misuse of the AMA Guides as the sole determinate of permanent disability has intensified the debate. This commentary highlights critical issues surrounding the AMA Guides. Finally, a restatement of the principles recommended for the assessment of permanent disability is set forth.

Does an SVC electrode further reduce DFT in a hot-can ICD system?

Pectorally implanted ICDs that defibrillate with the RV electrode and the ICD housing have gained clinical acceptance. However, it is still debatable whether adding an SVC electrode connected to the housing will further reduce the threshold of defibrillation (DFT). This study utilized eight pigs. DFTs were measured with a 50 V step-down protocol starting at 650 V (20 J). Shock strength for 50% success (E50) was estimated with the average of three reversals. In addition to alpha dummy device, Lead I (Pacesetter Models 1558 and 1538) or Lead II (Endotak 72) were used. Leads I are active fixation, true bipolar sensing with 5-cm shocking coils. Lead II has an integrated bipolar sensing with a 4.7-cm RV and 6.9-cm SVC shocking coils. A 95 microF defibrillation system was used to deliver a 44% tilt tuned biphasic 1.6/2.5 ms waveform, and to measure lead impedance. The RV electrode was the anode during phase I. With Lead IRV-->CAN the DFT was 531 +/- 75 V (13.6 +/- 3.8J) and the E50 was 496 +/- 89 (12 +/- 4.3 J). These were not significantly (NS) different than the DFT for RV-->CAN and SVC which was 518 +/- 84 V (13 +/- 4.2 J) or the E50 which was 476 +/- 84 V (11 +/- 3.9 J). Similar results were obtained with Lead II. Despite a decrease in lead impedance there was no apparent benefit from the addition of the SVC electrode. Lead I provided equivalent DFT performance to Lead II.

Cultured porcine myogenic cells produce insulin-like growth factor binding protein-3 (IGFBP-3) and transforming growth factor beta-1 stimulates IGFBP-3 production.

Insulin-like growth factor binding proteins (IGFBP) may act locally as autocrine or paracrine regulators of insulin-like growth factor activity in specific tissues such as muscle. Although secretion of IGFBP by cultured myogenic cell lines has been examined, little is known about secretion of IGFBP by primary myogenic cell cultures. This may be because primary myogenic cultures contain non-muscle cells (fibroblasts) that complicate interpretation of IGFBP determinations. We have circumvented this problem by subculturing nonfusing cells from extensively fused porcine myogenic cultures and comparing the IGFBP production of these nonfusing, porcine muscle-derived cells with that of primary porcine myogenic cell cultures. Immunoprecipitation with specific antibodies and 125I-IGF-I ligand blot analysis showed that myogenic cultures secreted IGFBP-3 (doublet band, 43 kDa and 39 kDa), IGFBP-2 (34 kDa), IGFBP-4 (30 and 24 kDa), and IGFBP-5 (30 and 28 kDa). Muscle-derived fibroblasts secreted no detectable IGFBP-3 but approximately 10 times more IGFBP-2 than did myogenic cell cultures. Treatment of myogenic cultures for 24 h with transforming growth factor (TGF) beta-1 caused a concentration-dependent increase in IGFBP-3 secretion with a maximum 1.5-fold increase occurring at .5 ng of TGF beta-1/mL. In contrast, TGF beta-1 treatment did not stimulate detectable IGFBP-3 secretion by muscle-derived fibroblast cultures. Northern analysis of total RNA using a porcine IGFBP-3 probe revealed that TGF beta-1 treatment resulted in a fourfold increase in the steady-state level of IGFBP-3 mRNA in myogenic cultures. Insulin-like growth factor binding protein-3 mRNA was not detectable in fibroblast cultures either before or after TGF beta-1 treatment. This is the first report of IGFBP-3 secretion by cultured myogenic cells.

Long-term effects of polytetrafluoroethylene injected into the rat bladder submucosa.

OBJECTIVE: The use of polytetrafluoroethylene (PTFE) paste in the lower urinary tract for the treatment of vesicoureteral reflux or urinary incontinence is increasing. Its use remains controversial and the long-term consequence of this substance injected into the lower urinary system of humans is largely unknown. When injected into the bladder submucosa, PTFE paste has been shown to elicit a foreign body reaction with chronic inflammation and possibly granuloma formation. Whether these inflammatory changes result in neoplastic changes over the long term has yet to be determined. The purpose of this study was to evaluate histologically the potential for submucosal PTFE paste to induce bladder neoplasia in a rodent model, realizing that others have shown an increased tendency for such alloplastic materials to produce sarcomas in these animals. METHODS: Sixteen experimental animals and 4 control animals were sacrificed at various time intervals and evaluated for systemic and local tumor formation following submucosal injection of PTFE paste in the bladder. A time well beyond the equivalent of the latency period believed to be necessary for the induction of tumors in humans (15 months) was evaluated. RESULTS: On sacrifice, histologic changes consistent with encapsulation and chronic inflammation were evident, but there was no evidence of either epithelial or sarcomatous tumor formation. CONCLUSIONS: A quiescent foreign body reaction occurs when injecting PTFE into the bladder submucosa of rodents. Urologic use of PTFE has never been proven to induce tumors in humans or animals.

Transrectal ultrasound for staging prior to radical prostatectomy.

Transrectal ultrasound (TRUS) was used to predict tumor stage in 43 patients prior to radical prostatectomy. For assessing extracapsular extension, the sensitivity was 54 percent, specificity 58 percent, and accuracy 56 percent. For detecting seminal vesicle involvement, the sensitivity was 60 percent, specificity 89 percent, and accuracy 82 percent. The predominant tumor echo pattern was isoechoic in 37 percent of cases, mixed (hyper-, iso-, and hypoechoic) in 47 percent, and hypoechoic in 16 percent. An anterior-posterior to transverse dimension ratio of greater than 0.8 suggested diffuse involvement of the prostate with an increased chance of extracapsular spread.

Granulomatous colitis and ileitis complicating jejunoileal bypass.

There are many complications of a jejunoileal bypass for obesity. I report what is, to my knowledge, a previously unrecognized complication--granulomatous colitis and ileitis. Caution is urged in recommending this procedure for the treatment of obesity.

Spontaneous cytomegalovirus mononucleosis-like syndrome and aseptic meningitis.

The spontaneous development of a cytomegalovirus infection in a healthy adult is described. This illness manifested with fever, headache, malaise, an absolute lymphocytosis with atypical lymphocytes, and liver function abnormalities, but without tonsillitis, pharyngitis, lymphadenopathy, or splenomegaly. Aseptic meningitis also was present. The pathogenesis of cytomegalovirus mononucelosis and its relationship to other related syndromes are discussed.

Clindamycin-associated pseudomembranous colitis treated with prednisone.

A patient with clindamycin-associated pseudomembranous colitis is presented. His dramatic response to prednisone suggested an immunologic basis of the disease process. This aspect of etiology and therapy has not been emphasized previously. Similar patients with clindamycin-associated pseudomembranous colitis should be sought out and consideration should be given to this type of treatment.

The benign lymphoepithelial lesion--a harbinger of neoplasia.

The patient presented had well-documented benign lymphoepithelial lesion, many years before the appearance of neoplastic disease. The relationship between this type of lesion and the later development of neoplasia is unclear, but evidence points to its existence, and further study is needed to clarify its frequency and significance. It appears that in some patients the benign lymphoepithelial lesion is a forerunner of the neoplastic process, and thus may serve as another clinical clue to the early diagnosis of neoplasia, especially that on the lymphoreticuloendothelial cell type.