Otolaryngological manifestations of velocardiofacial syndrome: a retrospective review of 35 patients.

OBJECTIVE: Because many patients with velocardiofacial syndrome (VCFS) are first examined by otolaryngologists for ear or speech problems before being diagnosed with VCFS, we describe a series of patients with this genetic disorder, which is associated with multiple anomalies, including velopharyngeal insufficiency, cardiac defects, characteristic facial features, and learning disabilities. STUDY DESIGN: We retrospectively analyzed the medical charts and available nasoendoscopic observations for 35 patients who were diagnosed with VCFS and who had a microscopic deletion in chromosome 22q11 as shown by DNA probe and fluorescence in situ hybridization. RESULTS: For most patients, the medical chart documented cardiac anomalies, velopharyngeal insufficiency with hypernasal speech, and characteristic facial features including nasal, auricular, craniofacial, and ocular abnormalities. Incidence of middle ear infection with associated conductive hearing loss was also high and necessitated early placement of pressure equalization tubes. Some patients were treated with adenoidectomy for chronic otitis media; consequently, velopharyngeal insufficiency and hypernasal speech worsened. Nasoendoscopic examination as documented in the medical chart showed occult cleft palate, a small adenoid pad, and pulsation in the muscular wall. CONCLUSION: Otolaryngologists have an important role in diagnosis and treatment of persons with VCFS and therefore should familiarize themselves with the typical history and most frequent head and neck manifestations of this syndrome.

A deviant comes of age.

Reflecting on 30 years of sociopolitical and professional changes in health care, the cofounder of the nurse practitioner movement compares and contrasts enabling environments, past and present, with the introduction and growth of the nurse practitioner. Differing responses of individual groups and institutions and research thrusts are reported as health care reforms offer new opportunities for the introduction of the nurse practitioner in acute care services.

Decreased superovulation in adult mice following neonatal exposures to technical methoxychlor.

To examine the effects of technical methoxychlor (MXC) on superovulation, neonatal mice received intraperitoneal (i.p.) injections of either sesame oil, 10 micrograms of estradiol 17 beta, or 0.1, 0.5, or 1 mg of technical MXC. At 2 and 4 months, half of the mice received a superovulatory regimen of 10 IU pregnant mare's serum gonadotropin followed by 10 IU human chorionic gonadotropin. The mice were sacrificed 15 to 20 h later, the number of ovulated oocytes were counted, and the ovaries were removed for histology. In the lowest MXC dose, the ovaries appeared normal and at 2 months, ovulated the same number of oocytes as controls. Estradiol or the highest two MXC doses induced ovarian atrophy. Following gonadotropin injections, these ovaries also ovulated oocytes. However, the number of oocytes recovered from experimental mice exhibited a time- and dose-dependent decline, and by 4 months, their number was significantly reduced. Neonatal exposures to MXC reduces ovulatory rates and ovarian functions in adults.

Advanced nursing practice.

Advanced OR nursing practice is emerging and the roles, responsibilities, relationships, and rewards are spread over preoperative, operative, and postoperative work units. The roles of the nurse in advanced practice are multidimensional: clinical, collegial, educative, investigatory, and administrative. Though the primary allegiance of the ANP is to nursing, she has a commitment and the skills to work collaboratively with other nurses and disciplines on the surgery team.

Effects of cefotetan disodium, cefoxitin, cefazolin, and cefotaxime in vitro on polymorphonuclear leukocytes from patients with leukopenia and severe pelvic inflammatory disease.

The effects of cefotetan, cefoxitin, cefazolin, and cefotaxime on polymorphonuclear leukocyte chemotaxis and chemiluminescence were determined in 10 patients with pelvic inflammatory disease and 10 oncologically treated patients. It was found that cefotetan enhanced both chemotaxis and chemiluminescence, with the favorable effects more pronounced in the oncologically treated patients with leukopenia. Cefotaxime depressed polymorphonuclear leukocyte functions. Cefoxitin and cefazolin had no significant effects. It would be logical, when treating empirically, to choose a regimen that enhances and not depresses host defenses in all patients but more expressly in leukopenic and other immunologically compromised patients.

Cost-effective use of antibiotic prophylaxis for cesarean section.

Clinical experience has indicated that the prophylactic use of antibiotics reduces infectious morbidity in patients undergoing cesarean section. Several factors must be considered (for instance, in vivo and in vitro efficacy, patient allergies, side effect profiles, status of host defenses, the total cost of therapy, and the risk of selecting resistant organisms that cause superinfections) before prescribing prophylactic antibiotic drugs for this indication. Moreover, medical-legal consequences associated with potential postpartum infections must be considered in assessing the costs and impact of a prophylactic regimen. Results of comparative antibiotic trials in indigent patients undergoing cesarean section demonstrated differing rates of successful antibiotic prophylaxis: piperacillin, 98%; cefoxitin, 91%; cephalothin and ceftazidime, 82%; cefotaxime, 80%; and ampicillin, 77%. Although the acquisition costs of antibiotics vary greatly, these costs are dwarfed by the substantial cost savings that can be realized by use of broad-spectrum antibiotics, which, in our hands, have resulted in reduced laboratory and pharmacy expenses and decreased hospital stays for both mother and neonate. Controlled studies designed to investigate microbiologic as well as clinical efficacy of antibiotics are indicated. Further refinements in individualizing antibiotic regimens according to patient population should be sought.

Determination of estrogen and androgen receptors in Trichomonas vaginalis and the effects of antihormones.

Trichomonas vaginalis, a common genital pathogen, was found to possess both specific estrogen and specific androgen receptors. These 4.3 S macromolecules were proteinaceous in nature. Both metronidazole-resistant and metronidazole-sensitive strains possessed both types of sex hormone-binding proteins. The estrogen receptor binding was competitively inhibited by the antiestrogen tamoxifen citrate, and the androgen binding was competitively inhibited by the antiandrogen cyoctol. The presence of these specific receptors may allow the use of hormonal and antihormonal manipulation in the treatment of infections caused by these organisms.

A comparison of piperacillin, cephalothin and cefoxitin in the prevention of postoperative infections in patients undergoing vaginal hysterectomy.

A randomized, double-blind, multicenter trial was initiated to compare the safety and efficacy of piperacillin, cephalothin and cefoxitin in the prophylactic treatment of patients undergoing vaginal hysterectomy. The total dose of each antibiotic was 6 grams given in three equally divided doses. A satisfactory prophylactic response was obtained in 143 of 151 (95 per cent) patients treated with piperacillin, in 82 of 87 (94 per cent) patients treated with cephalothin and in 57 of 60 (95 per cent) patients treated with cefoxitin. The pooled data indicated that the piperacillin treatment group did not differ from the combined cephalosporin treatment groups with respect to prophylactic response, presence of febrile morbidity, fever index, duration of postoperative hospitalization and incidence of reported adverse experiences.

Polysiloxane vaginal rings and cylinders for physiologic endometrial priming in functionally agonadal women.

17 beta-estradiol (E2)-and/or crystalline progesterone (P)-impregnated polysiloxane vaginal rings and cylinders were tested as a system for endometrial priming in functionally agonadal women awaiting donor embryo transfer. Endometrial tissue was obtained by a transcervical biopsy procedure on simulated cycle day 26. The adequacy of the replacement regimen was judged by endometrial histologic dating, scanning electron micrographs, receptor content, and circulating E2 and P serum concentrations. Endometrial dating was consistent with cycle day 26. Electron micrographs showed normal surface characteristics. E2 and P receptor concentrations were within the normal range. Serum E2 levels were midfollicular, 105 +/- 12.8 pg/ml (mean +/- SEM), and midcycle, 254 +/- 28.6 pg/ml. P levels during the simulated follicular phase were undetectable (less than 0.2 ng/ml) but rose to a mean peak level of 17.3 +/- 1.8 ng/ml. The steroid-impregnated polysiloxane vaginal ring and cylinder system provided continuous and sustained hormone release, morphologically and endocrinologically normal endometrium, serum levels of E2 and P within the normal range for the entire menstrual cycle, and a convenient and physiologic therapeutic alternative to oral, vaginal, or intramuscular steroid replacement.

Cost of antibiotic prophylaxis in cesarean section.

Two hundred sixty-three patients were randomly assigned to receive either piperacillin or cefoxitin for prophylaxis in cesarean section. Although both drugs were considered effective, piperacillin achieved a level of 98 percent satisfactory prophylaxis compared with only 91 percent for cefoxitin. Costs of prophylactic failure in cesarean section were calculated and then assessed for four different antibiotic regimens (based on 100 patients). Because of its high failure rate, ampicillin was the most expensive antibiotic; piperacillin was the least expensive. It was suggested that highly effective prophylaxis with an antibiotic agent such as piperacillin can result in significant cost savings when used for high-risk patients undergoing cesarean section.

In vitro testing of Today vaginal contraceptive sponge with bacteria.

PIP: In vitro methods were used to test Today vaginal contraceptive sponges for sterility, contamination by handling, and inhibition of bacterial growth. Also tested was an in vitro vaginal model surrounded by growth medium that continually seeded the dialysis tubing with nutrient in an attempt to replicate vaginal secretions. A goal of this research was to investigate manufacturer claims of hostility of the sponge in the presence of Staph aureus. Sponges added in a sterile manner to brain-heart infusion broth produced no growth under aerobic or anaerobic conditions when no organisms were added. However, the experiments that involved contamination of the sponges by hadling in a nonsterile fashion resulted in 10.8 colony forming units of Staph epidermidis and Staph aureus, coagulese negative. In the in vitro vaginal model, 16 hours after an inoculum of Staph aureus colony forming units was placed on a sponge, 3.5 x 10.10 colony forming units were cultured and there was a similar profusion of E coli sludge. These results fail to confirm claims of hostility of the vaginal sponge to the bacteria tested. There is concern that the technique recommended by the manufacturer involves adding water and then inserting the sponge with 1 hand and leaving it in place for 24 hours. This procedure may facilitate the enhancement of vaginitis and perhaps pelvic inflammatory disease.^ieng

A double-blind, controlled comparison of piperacillin and cefoxitin in the prevention of postoperative infection in patients undergoing cesarean section.

Data are presented from a randomized, double-blind multicenter trial (six study sites, involving 346 patients) in which piperacillin was compared with cefoxitin as a prophylactic agent for patients undergoing cesarean section. One hundred and sixty-nine patients received piperacillin and 177 received cefoxitin; in each instance, the total dosage was 6 grams. Strict criteria were used to evaluate safety and efficacy. The courses of all of the patients were evaluable for safety and 183 courses were evaluable for efficacy (136 efficacy-evaluable courses were from patients treated with piperacillin and 147, from those treated with cefoxitin). Postoperative infection was prevented in 89 per cent of the patients treated with piperacillin and in 93 per cent of the those treated with cefoxitin. The difference was not statistically significant. The data from each of the individual study sites, as well as the pooled data, indicated that the short term perioperative administration of piperacillin in patients undergoing a cesarean section was as safe and effective as cefoxitin with regard to prophylactic response, duration of hospitalization and the usage of other systemic antibiotics.