Migration from can coatings: Part 1. A size-exclusion chromatographic method for the simultaneous determination of overall migration and migrating substances below 1000 Da.

The Council of Europe Resolution on coatings suggests a limit of 10 mg dm-2 for the sum of substances migrating into food simulants from an internal can coating. The Scientific Committee on Food differentiates the migrants into the substances with a molecular weight below 1000 Da, potentially being of toxicological concern, and the less toxicologically relevant species above 1000 Da. Hitherto, the determination of overall migration was based on a gravimetric method. A new method is described for the simultaneous determination of both overall migration and the migration of substances below 1000 Da based on separation by size exclusion chromatography (SEC) followed by ultraviolet detection (UVD) and evaporative light scattering detection (ELSD). The method is suitable for all volatile extraction media and simulants recommended by the European Union. For statistical comparison of both methods, the slightly modified reference method was validated in-house and extended to an additional gravimetric measurement of the migrants below 1000 Da. For the determination of the overall migration, both methods provided similar reproducibility (validated gravimetry: standard deviation (SD) = 0.16 mg dm-2; SEC-ELSD/UVD: SD = 0.12 mg dm-2) but significantly better results were obtained by the SEC-ELSD/UVD method. For migrating substances below 1000 Da, the gravimetric determination provides a poor sensitivity (limit of detection = 0.35 mg dm-2) compared with the SEC-ELSD/UVD method (limit of detection = 0.04 mg dm-2). The new method offers a lower limit of detection and higher precision as well as being less time consuming and easier to use.

Effect of feedback on obstetrics and gynecology residents' teaching performance and attitudes.

OBJECTIVE: To evaluate obstetrics and gynecology residents' teaching performance, perception of the importance of teaching and satisfaction with their evaluations after the institution of an oral or written medical student feedback and award system. STUDY DESIGN: Residents at a single, university-based obstetrics and gynecology program were assigned to receive either oral, written or no medical student feedback on their teaching skills in a prospective, randomized, controlled trial. Students rated resident performance in seven teaching categories. Residents' scores per six-week block were evaluated for one year. Questionnaires addressing resident attitudes toward feedback were collected at baseline and at 6 and 12 months. All residents then received written feedback and public awards for high scores for an additional year. RESULTS: After 12 months of feedback there were trends toward improvement in several of the teaching categories and overall evaluations. None of the controls, 29% of residents receiving oral feedback and 50% of residents receiving written feedback rated teaching as more important than before. None of the controls, 57% of those receiving oral feedback (P = NS) and 88% of those receiving written feedback (P = .009), for a total of 73% of residents receiving any feedback (P = .001), thought that the amount of feedback was adequate at 12 months. Follow-up of 15 residents after one year of written feedback with an award for high evaluations showed that 60% improved their overall scores. The mean overall group score improved. CONCLUSION: A feedback and award system can lead to improved resident teaching performance as well as enhanced perception of residents' role as teachers and greater resident satisfaction.

An ACOG-affiliated medical student obstetrics and gynecology club.

An ACOG-affiliated obstetrics and gynecology club for medical students was developed at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School to introduce medical students to the specialty early in their careers, to educate them about obstetrician-gynecologists effect on women's health, and to guide them through exploration of the field. With ACOG District III Fellow and Junior Fellow support and collaboration, the club was formed and operational within 6 months. Because of this club students feel included in the district and national organizations by participating in Junior Fellow and Fellow activities. Through Junior Fellow activities, medical students get first-hand exposure to numerous obstetrics and gynecology residency programs. Through workshops and noncredit electives, medical students receive personal mentoring by Fellows and Junior Fellows. Students participate in community projects and from those programs can better understand the needs of women, especially women with inadequate or no health insurance. The collaboration between Junior Fellows, Fellows, and medical students is the most important component in establishing a student-run club affiliated with ACOG. This project has effectively introduced students to the field of women's health early in their careers and could provide a model for implementation at other medical schools.

Bilateral vertebral artery dissection causing a cerebrovascular accident in pregnancy. A case report.

BACKGROUND: Vertebral artery dissection, occurring spontaneously or following a traumatic event, is a cause of posterior circulation stroke in young individuals, including pregnant women. CASE: A 20-year-old, primagravid woman acutely developed headache, right-sided hemiparesis and parasthesias, and blurred vision. Within days she complained of cervical neck pain. Magnetic resonance imaging findings were consistent with a posterior circulation cerebrovascular accident (CVA). An arteriogram, performed to exclude vasculitis, revealed bilateral vertebral artery dissection. No inciting event could be recalled. CONCLUSION: Vascular dissections occur rarely during pregnancy. Spontaneous extracranial vertebral artery dissection itself is very rare in general. Cerebral ischemia can follow vertebral artery dissection. In young patients with CVA, consideration of the diagnosis of vertebral artery dissection followed-by angiography and anticoagulation is an important component of the workup and care.

Association between a shift in vaginal flora on Papanicolaou smear and acute chorioamnionitis and preterm delivery.

Bacterial vaginosis has been implicated as a cause of acute chorioamnionitis and preterm delivery. This study was designed to determine any association between the detection of bacterial vaginosis on a prenatal Papanicolaou (Pap) smear, defined as a shift in vaginal flora, and the subsequent occurrence of acute chorioamnionitis or preterm labor. A 47-mo retrospective case-control analysis comparing 186 patients with histologically-proven acute chorioamnionitis (cases) and 186 controls was performed. Initial prenatal Pap smears were evaluated for the presence of altered vaginal flora. Pap smears from women with acute chorioamnionitis were more likely to have altered vaginal flora than those without chorioamnionitis (P < 0.01). Preterm delivery was also more common among women with a shift in vaginal flora (P < 0.01). In conclusion, women at risk for chorioamnionitis and/or preterm delivery may be able to be identified by the results of their prenatal Pap smear.

Complications of the translabyrinthine approach for the removal of acoustic neuromas.

OBJECTIVE: To report the complications that occurred during a large series of surgical procedures for the removal of acoustic neuromas using the translabyrinthine approach. DESIGN: Retrospective analysis. SETTING: Neuro-otology practice with academic affiliation. Procedures were performed at either a university medical center or a community hospital in conjunction with a neurosurgery team. PATIENTS: A total of 258 patients (142 men, 116 women; mean age, 51 years) underwent the translabyrinthine approach during a 14-year period. All patients had a histologically proven diagnosis of acoustic neuroma. RESULTS: There were no deaths. There were 3 cases (1.1%) of neurovascular compromise. There were 20 cases (7.8%) of cerebrospinal fluid leak, 16 (80%) of which presented as rhinorrhea and 4 (20%) as incisional leaks. The leaks at the incision responded to conservative management, while rhinorrhea usually required more aggressive means of closure. Four patients (1.6%) were diagnosed as having bacterial meningitis. Complete gross tumor removal was not achieved in 4 patients (1.6%). Facial nerve function, as measured by the House-Brackmann system, was recorded in all patients at 1 year: 76% had a score of I or II; 18%, a score of III or IV; and 6%, a score of V or VI. Other complications included 3 cases of pneumonia, 1 case of severe gastric hemorrhage, and 1 case of wound infection. CONCLUSIONS: The results of this series generally agree with those of other large series and demonstrate the safety and effectiveness of the translabyrinthine approach in excising acoustic neuromas.

Coronal computed tomography: indications and accuracy.

The application of wide aperture scanners to neuroradiology permits improved anatomic definition and localization of intracranial and intraorbital lesions. Coronal scans are most useful in demonstrating lesions of the skull base and apex, distinguishing between infra- and supratentorial lesions, and in determining if a lesion is intra- or extraaxial. Limitations of coronal scans include discomfort in positioning, high spatial frequency artifacts, and additional radiation exposure.

Radiographic diagnosis of meningioma of the lateral ventricle. Review of 22 cases.

Review of 22 cases of meningioma indicates that this lesion occurs slightly more frequently on the left but without predilection for sex or age of the patient. The presenting symptoms were nonspecific. Plain radiographs of the skull sometimes demonstrated calcification in the tumor, but more often did not. Cerebral angiography frequently showed enlargement and displacement of the anterior choroidal artery on the side of the tumor; the lateral posterior choroidal artery on the side of the tumor was also enlarged and displaced in seven of nine patients who underwent vertebral arteriography. Pneumoencephalography accurately demonstrated the site and size of the lesion, as did radionuclide scanning if the lesion was vascular. Computerized tomographic (TC) scanning also determined the location and size of the tumors, as well as their mass effect and vascularity; CT scanning also demonstrated calcification that was not visible on the plain skull radiographs in two of six patients who underwent CT scanning and had calcification.