Uncertainty calculation methodologies in microflow measurements: Comparison of GUM, GUM-S1 and Bayesian approach.

The importance of measurement quality cannot be over emphasized in medical applications, as one is dealing with life issues and the wellbeing of society, from oncology to new-borns, and more recently to patients of the COVID-19 pandemic. In all these dire situations, the accuracy of fluid delivered according to a prescribed dose can be critical. Microflow applications are growing in importance for a wide variety of scientific fields, namely drug development and administration, Organ-on-a-Chip, or bioanalysis, but accurate and reliable measurements are a tough challenge in micro-to-femto flow operating ranges, from 2.78 × 10-4 mL/s down to 2.78 × 10-7 mL/s (1000 µL/h down to 1 µL/h). Several sources of error have been established such as the mass measurement, the fluid evaporation dependent on the gravimetric methodology implemented, the tube adsorption and the repeatability, believed to be closely related to the operating mode of the stepper motor and drive screw pitch of a syringe pump. In addition, the difficulty in dealing with microflow applications extends to the evaluation of measurement uncertainty which will qualify the quality of measurement. This is due to the conditions entailed when measuring very small values, close to zero, of a quantity such as the flow rate which is inherently positive. Alternative methods able to handle these features were developed and implemented, and their suitability will be discussed.

Intra-operative methadone effect on quality of recovery compared with morphine following laparoscopic gastroplasty: a randomised controlled trial.

The effect of intra-operative intravenous methadone on quality of postoperative recovery was compared with morphine after laparoscopic gastroplasty. We included 137 adult patients with a body mass index > 35 kg.m-2 who underwent bariatric surgery. Patients were allocated at random to receive either intra-operative methadone (n = 69) or morphine (n = 68). All patients received the same postoperative care and analgesia. The primary outcome of postoperative quality of recovery was assessed using the Quality of Recovery-40 questionnaire total score 24 h after surgery. Secondary outcomes were assessed in the post-anaesthesia care unit the night of the day of surgery (T1), in the morning after surgery (T2); and at night on the day following surgery (T3). The median (IQR [range]) total Quality of Recovery-40 questionnaire score of 194 (190-197 [165-200]) was higher (p < 0.0001) in the methadone group compared with the score of 181 (174-185.5 [121-200]) in the morphine group. In the post-anaesthesia care unit, the pain burden; incidence of nausea and vomiting; rescue morphine dose; and time to discharge, were significantly lower in the methadone group. On the ward, the methadone group had a lower: incidence of rescue morphine requests at T1 (5.8 vs. 54.4%, p < 0.0001) and T2 (0 vs. 20.1%, p < 0.0001); and incidence of nausea (21.7 vs. 41.2%, p = 0.014), compared with the morphine group. We conclude that intra-operative intravenous methadone improved quality of recovery in patients who underwent laparoscopic gastroplasty, compared with intra-operative morphine. Methadone also reduced postoperative pain, postoperative opioid consumption and the incidence of opioid-related adverse events.

Molecular marker-based genetic diversity analysis of scantly studied Brazilian accessions of a medicinal plant, Morinda citrifolia L. (noni).

Morinda citrifolia L., commonly known as noni, has been used for the treatment of various diseases for over two centuries. It was introduced and widely disseminated in Brazil because of its high market value and ease of adaptation to the soil and climatic conditions of the country. The aim of this study was to estimate the genetic variability of noni accessions from the collection of Embrapa Agroindústria Tropical in Brazil. We evaluated 36 plants of the 13 accessions of noni from the germplasm collection of M. citrifolia. Several methods of DNA extraction were tested. After definition of the method, the DNA of each sample was subjected to polymerase chain reactions using 20 random amplified polymorphic DNA primers. The band patterns on agarose gel were converted into a binary data matrix, which was used to estimate the genetic distances between the plants and to perform the cluster analyses. Of the total number of markers used in this study, 125 (81.1%) were polymorphic. The genetic distances between the genotypes ranged from 0.04 to 0.49. Regardless of the high number of polymorphic bands, the genetic variability of the noni plants evaluated was low since most of the genotypes belonged to the same cluster as shown by the dendrogram and Tocher's cluster analysis. The low genetic diversity among the studied noni individuals indicates that additional variability should be introduced in the germplasm collection of noni by gathering new individuals and/or by hybridizing contrasting individuals.

Radial scar of the breast: Is it possible to avoid surgery?

INTRODUCTION: Breast radial scar (RS) management remains controversial. The need for surgical excision is supported by the concern of an associated high-grade lesion missed in the biopsy. The aim of this study was to assess histologic upgrade rate after a percutaneous biopsy, to determine if vacuum assisted biopsy prevents the need for subsequent RS surgical resection and to evaluate the upgrade risk factors. PATIENTS AND METHODS: This was a uni-institutional retrospective study of consecutive patients with RS histologically diagnosed from January 2010 to December 2015. RESULTS: A total of 113 cases of RS were diagnosed. We verify that there was a histologic upgrade in 22 (19.5%) cases. The upgrade risk factors were the type of biopsy performed, the presence of atypia, the presence of calcifications and the number of fragments obtained in the biopsy (p < 0.05). The biopsy type was vacuum assisted in 25 (22.1%). The upgrade rate in the vacuum assisted biopsy group was 4.0%, whereas in the standard core needle biopsy group was 23,9% (p = 0.041). DISCUSSION AND CONCLUSION: We demonstrated that the risk of upgrade after a RS diagnosis depends on the type of biopsy performed, the presence of atypia, the presence of calcifications and the number of fragments obtained. When a standard core biopsy is performed the risk of upgrade and malignancy is not negligible, and surgery is indicated. When the biopsy is vacuum assisted, the risk of upgrade and malignancy is significantly decreased and so the indication for excisional biopsy seems not to be so imperative.

Desenvolvimento vegetativo do noni (Morindacitrifolia L. ) sob diferentes sistemas e lâminas de irrigação / Vegetative development of noni (Morinda citrifolia L. ) under different irrigation systems and water depths

O noni é uma cultura de origem asiática que vem despertando interesse de agricultores brasileiros em virtude de suas propriedades fitoterápicas na medicina popular e de seu elevado valor comercial; contudo, são escassas as informações quanto ao manejo da cultura em geral e inexistentes estudos a respeito da irrigação da cultura no Brasil. Objetivou-se com este estudo definir, entre dois sistemas de irrigação e cinco laminas d´água, qual a melhor condição para o desenvolvimento vegetativo da cultura. O experimento foi realizado no período de maio de 2009 a março de 2010, em Trairi-CE. Utilizou-se o delineamento experimental de blocos casualizados e dois sistemas de irrigação localizada (gotejamento e microaspersão) dispostos em faixas verticais. Dentro de cada faixa foram distribuídos os blocos com as parcelas dos cincos níveis de irrigação correspondentes à aplicação de frações da evapotranspiração de referência FAO (ETo) de 40%, 60%, 80% 100% e 120%. Para o sistema de irrigação por microaspersão as lâminas correspondentes foram: 109,3 mm, 135,8 mm, 187,9 mm, 227,8 mm e 297,7 mm e para sistema de irrigação por gotejamento: 83,4 mm, 1237 mm, 166,5 mm, 204,7 mm e 254,4 mm, respectivamente. Foram utilizadas cinco repetições. O desenvolvimento vegetativo de plantas de noni foi influenciado tanto pelos sistemas de irrigação, quanto pelas lâminas d´água aplicadas. A lâmina de irrigação equivalente a 227,8 mm, correspondente a 100% da ETo, na irrigação por microaspersão, proporcionou maiores ganhos de diâmetro do coleto, altura da planta, e diâmetro de copa.

Noni is a crop of Asian origin that has piqued the interest of Brazilian farmers because of its properties in herbal folk medicine and its high commercial value. However, there is little information about the crop management in general, and particularly on the irrigation of the crop in Brazil. The objective of this study was to define what localized irrigation system (drip or micro sprinklers) and water depth that provide the best vegetative growth of noni plants. The experiment was conducted from May 2009 to March 2010 in the city of Trairi, Brazil. We used a split block experimental design, with two irrigation systems (drip and micro sprinklers) arranged in vertical lines. Within each line, five irrigation levels, corresponding to the application of fractions of the reference evapotranspiration (ETo) 40% 60% 80% 100% and 120%, were distributed in five blocks. For the micro sprinkler irrigation system, the corresponding slides were: 109.3 mm, 135.8 mm, 187.9 mm, 227.8 mm and 297.7 mm, respectively, and for the drip irrigation system, they were: 83.4 mm, 123.7 mm, 166.5 mm, 204.7 mm and 254.4 mm, respectively. The noni vegetative growth was influenced both by the irrigation systems and the depths of irrigation applied. The application of irrigation depths equivalent to 227.8 mm, which corresponds to 100% of ETo with the use of micro sprinklers, provided the largest gains in stem diameter, plant height and canopy diameter.

9 Years after the first laparoscopic adjusted gastric banding (LAGB) in adolescents: the Portuguese experience.

INTRODUCTION: Children all over the world are increasingly becoming overweight and obese. The experience with adults has demonstrated that surgery is the only effective way of achieving sustained weight loss in obese patients. Simultaneously, it has been proposed that bariatric surgery in the adolescent period would be a more effective treatment for childhood-onset extreme obesity rather than delaying surgery for extremely obese youth until adulthood. Nevertheless, the optimal surgical option for both adults and adolescents has yet to be established. The aim of our study was to evaluate the results of 9 years of laparoscopic adjusted gastric banding (LAGB) performed in our hospital for obesity-associated comorbidities (OAC), weight loss and surgical morbidity. METHODS: A prospective study of all patients who underwent LAGB at our hospital between July 2001 and May 2010 was carried out. Patient selection was by a multidisciplinary team and based on the "IPEG Guideline for the Surgical Treatment of Extremely Obese Adolescents". Data were reviewed retrospectively. RESULTS: 14 patients underwent LAGB (10♀; 4♂; average age: 16 years). Preoperative BMI ranged between 41.4 and 54.6 kg/m (2). Prior to surgery, 8 different OACs were identified. 6 months later, 4 types of OAC had resolved completely and the other 4 had improved, and the improvement was maintained over time. The average excess weight (EW) loss increased from 25.7 to 48.2% at 6 and 36 months of follow-up, respectively (10 patients). At 60 and 106 months of follow-up it was 41.5% (5 patients) and 31.8% (1 patient), respectively. There were no complications arising from the surgery itself. Long-term complications were few and easily managed. CONCLUSIONS: LAGB seems to be a good option to treat obese adolescents, as it is a minimally invasive procedure that does not radically change the patient's anatomy and is associated with minimal morbidity. It leads to a sustained improvement/resolution of OAC, and although weight loss is not continuous, it is maintained over time.

Bilateral submandibulectomy for the treatment of drooling in children with neurological disability.

AIM OF THE STUDY: Drooling is common in children with neurological disabilities (ND), and constitutes an additional burden with many medical complications in an already socially disadvantaged patient. This study aims to evaluate the effectiveness of bilateral submandibulectomy (BS) to treat drooling with regard to the parental satisfaction grade, complications and recurrence of drooling in children with ND. PATIENTS/MATERIAL AND METHODS: A retrospective study was performed of all children with ND and drooling who underwent BS in our Department between January 1996 and November 2008. Data were taken from surgical records and patient files. Parental satisfaction was graded into four classes: A: 75-100% satisfaction (infrequent drooling, small amounts; absence of drooling); B: 50-75% satisfaction (occasional drooling, on and off all day; infrequent drooling, small amounts); C: 25-50% satisfaction (frequent drooling, but not profusely; occasional drooling, on and off all day); D: 0-25% satisfaction (constant drooling, always wet; frequent drooling, but not profusely). RESULTS: BS was performed in 85 patients (38% male; 62% female; median age, 9 years). 35 patients had to be excluded from our study because their medical records were unavailable. Only 3 out of the remaining 50 patients had recurrence. Parental satisfaction grade (PSG) was A in 26 cases (55.3%); B in 15 (31.9%); C in 3 (6.4%) and D in 3 (6.4%). The first follow-up was usually 1 week after surgery (median, 2 weeks). The incidence of post-surgery complications was 4% and all complications were minor. DISCUSSION/CONCLUSIONS: Assessment of the results achieved was subjective as it was not possible to quantify the amount of drooling precisely before/after surgery. Nevertheless, BS was found to be an easy and safe procedure as the low rate of complications demonstrates. It was also found to be an effective procedure; there were only 3 recurrences, and PSG in 87.2% of cases was either A or B, indicating a minimum improvement in drooling of 50%.

Antimicrobial and cytotoxic assessment of marine cyanobacteria - Synechocystis and Synechococcus.

Aqueous extracts and organic solvent extracts of isolated marine cyanobacteria strains were tested for antimicrobial activity against a fungus, Gram-positive and Gram-negative bacteria and for cytotoxic activity against primary rat hepatocytes and HL-60 cells. Antimicrobial activity was based on the agar diffusion assay. Cytotoxic activity was measured by apoptotic cell death scored by cell surface evaluation and nuclear morphology. A high percentage of apoptotic cells were observed for HL-60 cells when treated with cyanobacterial organic extracts. Slight apoptotic effects were observed in primary rat hepatocytes when exposed to aqueous cyanobacterial extracts. Nine cyanobacteria strains were found to have antibiotic activity against two Gram-positive bacteria, Clavibacter michiganensis subsp. insidiosum and Cellulomonas uda. No inhibitory effects were found against the fungus Candida albicans and Gram-negative bacteria. Marine Synechocystis and Synechococcus extracts induce apoptosis in eukaryotic cells and cause inhibition of Gram-positive bacteria. The different activity in different extracts suggests different compounds with different polarities.

Macroscopic and microscopic anatomy of the oviduct in the sexually mature rhea (Rhea americana).

The morphological characteristics of the oviduct of 12 sexually mature rheas (Rhea americana) were studied. Only the left oviduct is developed as a long tube with a length of 122 +/- 23.1 cm, and is subdivided into infundibulum (15.2 +/- 4.0 cm), magnum (63.3 +/- 9.4 cm), isthmus (5.6 +/- 3.1 cm), uterus (16.0 +/- 4.2 cm) and vagina (11.5 +/- 1.4 cm). The mucous membrane of the oviduct, as a whole, possesses luminal folds covered by ciliated columnar epithelium with secretory cells. The infundibulum part presents a cranial opening with thin and long fimbriae with few tubular glands in caudal tubular portion. In the magnum, the largest portion of the oviduct, the folds are thicker and are filled with tubular glands. The isthmus is short and presents less bulky folds and a few tubular glands. A bag-shaped uterus in the cranial area shows thin folds, and in the caudal region (shell gland) more ramified folds with few tubular glands. The vagina has long luminal folds and a thick muscular tunic; no glands with sperm-storage characteristics have been observed. In conclusion, the oviduct in sexually mature rhea has morphological similarities with the other species of birds already described; however it presents its own characteristics to produce a big egg.

Testículos no palpables: experiencia del Hospital Central Especializado de Crianças Maria Pia / Nonpalpable testes: experience from the Hospital Central Especializado de Crianças Maria Pia

La incidencia de criptorquidia es del 1% en niños de 1 año de edad, siendo en el 20% de los casos el testículo no palpable. El objetivo de este trabajo fue estudiar la contribución de la cirugía mínimamente invasiva en el diagnóstico y tratamiento de estos pacientes. Los autores realizaron un estudio prospectivo, analítico y longitudinal durante el período de enero de 2001 a diciembre de 2004, englobando 89 niños portadores de 98 testículos no palpables sometidos a laparoscopia. Los autores analizaron los siguientes parámetros: localización del testículo no palpable, examen objetivo bajo anestesia general, ecografía inguinoescrotal, edad de la intervención, hallazgos laparoscópicos, tratamiento efectuado, resultados anatomopatológicos de las piezas extirpadas y seguimiento después de la cirugía (AU)

The incidence of cryptorchidism in children at age of 1 year is 1%, and 20% of these cases represent nonpalpable testes. The aim was to evaluate the use of minimal invasive surgery for the diagnosis and therapy of these patients. The authors made a prospective, analytical and longitudinal study from January 2001 through December 2004 in 89 consecutive boys undergoing laparoscopy for 98 impalpable testes. The following details were analyzed: examination under general anesthesia, ultrasound examination, age at surgery, findings at laparoscopy, operative procedure, results of the histology and follow up (AU)

[Nonpalpable testes: experience from the Hospital Central Especializado de Crianças Maria Pia]. / Testiculos no palpables: experiencia del Hospital Central Especializado de Crianças Maria Pia.

The incidence of cryptorchidism in children at age of 1 year is 1%, and 20% of these cases represent nonpalpable testes. The aim was to evaluate the use of minimal invasive surgery for the diagnosis and therapy of these patients. The authors made a prospective, analytical and longitudinal study from January 2001 through December 2004 in 89 consecutive boys undergoing laparoscopy for 98 impalpable testes. The following details were analyzed: examination under general anesthesia, ultrasound examination, age at surgery, findings at laparoscopy, operative procedure, results of the histology and follow up.

Mechanical digestive anastomosis: a new technique to make it easier, quicker and more reliable.

In digestive circular mechanical anastomosis, a purse-string suture is normally performed in order to ensure that the anvil is securely fixed in place. We present a new technique where an adjustable plastic belt is used instead of the purse-string suture for the same effect. The procedure has been used on 10 patients with esophageal and gastric carcinomas. There was no difficulty in performing the anastomosis in any of the cases. We believe the procedure is technically simple and safe, and provides a significant advance in automatic digestive suturing.

[Use of transesophageal echocardiography during implantation of aortic endoprosthesis (stent). Initial experience].

OBJECTIVE: To report the role played by transesophageal echocardiography during implantation of self-expanding aortic endoprostheses (stent) at a hemodynamics laboratory. METHODS: Thirteen patients underwent stent implantation in the descending thoracic aorta with the aid of transesophageal echocardiography during the entire procedure. Indications for stenting were as follows: 8 aortic dissections, 2 true aneurysms, 2 penetrating atherosclerotic ulcers, and 1 traumatic pseudoaneurysm. RESULTS: No complications resulting from the use of transesophageal echocardiography were observed. In 12 patients, the initial result was considered appropriate, with total or partial resolution of the major lesion confirmed by a posterior examination. In 1 patient, the procedure was suspended after transesophageal echocardiography and angiography showed that the proximal aortic diameter was inappropriate. Transesophageal echocardiography contributed to clarifying relevant points, such as aortic diameter, anatomic detail of the intimal lesion, and location and size of the communicating orifice. In addition, it facilitated placing the stent in the target lesion, reduced the time of exposure to radiation and the use of contrast medium, and provided rapid identification of intercurrent events, possibly reducing the total duration of the procedure. CONCLUSION: The use of transesophageal echocardiography during placement of aortic stents seems appropriate. The actual advantages of the procedure will be defined in a comparative prospective study.

Evaluation of monoclonal antibody MIB-1 in the mammary epithelium adjacent to fibroadenomas in premenopausal women treated with tamoxifen.

The purpose of this study was to study the monoclonal antibody MIB-1 in the normal breast epithelium adjacent to a fibroadenoma in women in the luteal phase of the menstrual cycle who were treated with tamoxifen at doses of 10 and 20 mg for 22 days. The proliferative activity of the mammary epithelium adjacent to the fibroadenoma was studied by immunohistochemistry on the basis of the monoclonal antibody MIB-1 (Immunotech, catalog No. 0505, lot 001). The study was randomized and double blind and was conducted on 44 women with fibroadenomas divided into three groups: A (n=16, placebo), B (n=15, tamoxifen, 10 mg), and C (n=13, tamoxifen, 20 mg). Tamoxifen was administered for 22 days starting on the 2nd day of the menstrual cycle, and a biopsy was taken on the 23rd day. Serum estradiol, progesterone, sex hormone binding globulin, follicle-stimulating hormone, luteinizing hormone, and prolactin were measured before treatment (21st and 24th day of the previous menstrual cycle) and on the day of the biopsy. The mean percentage of stained nuclei per 1,000 cells was 9.2 in group A, 4.5 in group B, and 3.2 in group C. The Fisher's test revealed that tamoxifen significantly reduced MIB-1 at doses of 10 and 20 mg compared with the placebo group (p < 0.0001), with no significant differences between doses in terms of proliferative activity (p=0.21). Groups B and C presented a significant increase in progesterone (p=0.038), estradiol (p < 0.001), and sex hormone binding globulin (p=0.001) levels. Elevation of serum follicle-stimulating hormone concentration (p=0.0045) and a fall in prolactin levels (p=0.0055) were observed. We conclude that tamoxifen significantly reduced the proliferative activity of the mammary epithelium at the doses of 10 and 20 mg/day.

Retrograde endopyelotomy using an original home-made diathermy probe.

PURPOSE: To describe an easily home-made diathermy probe for the performance of retrograde endopyelotomies using a small-caliber rigid ureteroscope. METHODS: The diathermy probe is easily built by putting a rigid guidewire through a 5F ureteral catheter, the distal tip being naked and slightly bent. The other end is linked to the electric generator. Among a total of 24 retrograde endopyelotomies performed to treat ureteropelvic junction obstruction in the last 7 years, five were done using this device. RESULTS: Surgery with the probe took an average of 30 minutes. There were no complications, and, as of today, all cases are successes. CONCLUSION: This device allows the performance of retrograde endopyelotomy using a small-caliber ureteroscope. Long-term results will presumably match the good results obtained using the larger-caliber ureteroscopes with the classic cold knife.

Microaspiración del esperma para estudio seminal en ratas / Microaspiration of sperm for seminal studies in rats

Los intentos de medir la función exócrina testicular en modelos animales de experimentación resultaron en una diversificación de métodos de muy difícil comparación y reproducibilidad.La presente investigación tiene como objetivo verificar el valor de la técnica de muicroaspiración del esperma en la cola del epido de la rata,evaluando sus parámetros seminales.Fueron utilizadas 35 ratas albinas,de la variedad de Wistar de 150 días de edad.Se desarrolló una técnica para la microaspiración del esperma en la cola del epidimo.La motilidad y concentración de los espermatozoides de ambos testículos de cada animal fueron analizados con el test T de Student para las muestras dependientes(p<0.05)según la concentración y motilidad espermática.La técnica de microaspiración de la cola del epídimo permite un adecuado acceso,confiable y de fácil ejecución

Microaspiración del esperma para estudio seminal en ratas / Microaspiration of sperm for seminal studies in rats

Los intentos de medir la función exócrina testicular en modelos animales de experimentación resultaron en una diversificación de métodos de muy difícil comparación y reproducibilidad.La presente investigación tiene como objetivo verificar el valor de la técnica de muicroaspiración del esperma en la cola del epido de la rata,evaluando sus parámetros seminales.Fueron utilizadas 35 ratas albinas,de la variedad de Wistar de 150 días de edad.Se desarrolló una técnica para la microaspiración del esperma en la cola del epidimo.La motilidad y concentración de los espermatozoides de ambos testículos de cada animal fueron analizados con el test T de Student para las muestras dependientes(p<0.05)según la concentración y motilidad espermática.La técnica de microaspiración de la cola del epídimo permite un adecuado acceso,confiable y de fácil ejecución

Modulation of hypersensitivity reaction by lipids given orally.

The effect of lipids administration by gavage (0.4% body weight) given daily during four weeks on the hypersensitivity reaction in trachea, upper and lower bronchi, liver, kidney, mesentery, and pancreas was investigated in male rats. The plasma exudation was assessed by using Evans blue (EB) dye extravasation method. There was a significant difference in the permeability of the organs in nonimmunized rats. The immunization increased the vascular permeability and the response with the organs varied greatly. The effect of lipids on anaphylactic reaction was compared to those of untreated rats (control group). The EB extravasation was significantly increased in the trachea obtained from rats treated with cocoa butter and soybean oil. In the upper bronchi of rats treated with soybean oil, the EB extravasation was increased. However, in the lower bronchi, none of the treatments with lipids changed the extravasation of EB. The same was observed in the liver and kidney. The animals treated with lipids by gavage did not present differences in EB extravasation in the mesentery. However, in the pancreas and duodenum, the treatment with fish and soybean oils and cocoa butter markedly lowered EB extravasation.

Randomized prospective study of local transdermic anesthetic in fine needle aspiration biopsy for breast lumps.

AIM: To evaluate the use of local transdermic anesthetics in fine needle aspiration biopsy (FNAB) in breast lesions. METHODS: Prospective randomized study of 119 patients having breast lesions, all being indicated for FNAB. The patients were divided into three groups: 40 patients entered in the active group (lidocaine + prilocaine); 40 patients underwent the placebo group (aqueous extract of Triticum vulgaris); and a control group of 39 women in whom FNAB was performed without the administration of any substance. Both the anesthetic and placebo were administered an hour before FNAB. Pain was quantified through a visual analogic scale of pain. The type of pain was also classified in terms of occurrence: only during the puncture, only during the movements and both. RESULTS: The visual linear analogic scale of pain showed an average of 3.3 in the active group, 3.5 in the placebo and 4.0 in the control group (NS). Analysis of the type of pain which was referred by the patient showed that 15% of the patients in the active group, 12.5% of those in the placebo group and 5.1% in the control group did not refer to any sensation of pain. Pain, when felt, was similar in all three groups (p < 0.4). CONCLUSIONS: Both the quantification and the type of pain referred to were similar in all three groups. However, there was a tendency of the patient to refer to less pain when the active substance or the placebo were used, when results were compared to the control group.

Extortion in the emergency department.

We present the case of a 33-yr-old female patient who, along with members of her family, attempted to extort approximately $6000.00 from our institution and her insurance company. This attempted extortion was done under the guise of a missed retained foreign body. The patient initially presented to our emergency department with a laceration to her right forearm; X-ray studies obtained after the wound had been sutured revealed no foreign body. Several days later, the patient and family members approached our administrative staff demanding recompense for metal fragments discovered in the patient's wound at another facility. Comparison of radiographs revealed that the metallic fragments were placed in the wound after she was treated and released from our emergency department, and monetary compensation was denied.