American academic headache specialists in neurology: practice characteristics and culture.

Headache diagnosis and treatment is the most important focus or concentration area for practising neurologists in America. The American Headache Society, formerly the American Association for the Study of Headache, is made up predominantly of neurologists. Recognition of the importance of the teaching and practice of headache medicine, especially migraine, is still incomplete at many academic teaching institutions. Suggestions that this results from inadequate academic hierarchies and education at graduate and post-graduate levels have been made. We therefore undertook a survey of academic practitioners of headache medicine in departments of neurology with membership of the American Headache Society. Subjects and addresses were identified using the 1999-2000 membership directory of the American Headache Society. Practice characteristics and time distribution were assessed. Teaching in undergraduate and resident programmes was also assessed. Fifty-five surveys from 46 institutions in 25 states were judged as adequate for this report. Academic neurologists with interest in headache medicine spent most of their time in clinic, with less than 25% spent doing either research or teaching. Medical schools had an average of 1 h of preclinical and 2 h of clinical teaching in headache. Neurology residents received an average of 3 h of didactic instruction in headache. This report is the first of its kind to review the practice characteristics and culture of headache medicine in the setting of academic departments of neurology. It describes a clinical practice similar to those of other non-academic American neurologists.

[Jejunostomy by Midle in patients with insufficiency of anastomotic sutures of upper parts of gastrointestinal tract]. / Midle ieiunistomiia v lechenii nesostoiatel'nosti shvov anastomoza verkhnikh otdelov zheludochno-kishechnogo trakta.

Insufficiency of anastomosis is one of the main causes of peritonitis. Progressed cachexia due to great losses through intestinal fistulas in combination with peritonitis was the indication to jejunostoma creation. Jejunostomy by Middle in the treatment of postoperative peritonitis due to sutures insufficiency of upper anastomosis of gastrointestinal tract permits to optimize treatment: to realize adequate enteral nutrition, intestinal decompression, to return fistula's losses. Polyorganic insufficiency, number of repeated surgeries and volume of loss through fistulas influence results of the treatment. Respiratory distress-syndrome and errosive bleeding have the most prognostic significance among the syndromes of polyorganic insufficiency.

A composite nuclear export signal in the TBP-associated factor TAFII105.

TAF(II)105 is a sub-stoichiometric subunit of TFIID important for activation of anti-apoptotic genes and B cell specific genes by the transcription factors NF-kappaB and OCA-B. This subunit is highly enriched in B and T lymphocytes, and its expression is regulated at a posttranscriptional level. In the present study we investigated the subcellular localization of TAF(II)105. In normal B cells, a significant portion of native TAF(II)105 protein is found in the cytoplasm. Treatment of these cells with B cell-specific stimuli decreased the level of cytoplasmic TAF(II)105. In adherent cultured cells, TAF(II)105 is predominantly nuclear; however, a small fraction of the cells showed either cytoplasmic or homogenous distribution of TAF(II)105. Analysis of different TAF(II)105 mutants and green fluorescence protein fusion proteins identified a region composed of two adjacent sequences displaying nuclear export activity, suggesting that nuclear export of TAF(II)105 is mediated by a composite nuclear export signal. TAF(II)105 nuclear export signal is leptomycin B-resistant indicating that it belongs to a CRM1-independent nuclear export pathway. These results reveal a novel mode of regulation of a specialized component of the general transcription apparatus that may affect the transcription of its target genes.

The electrophysiology setup.

This unit describes components and considerations that are common to all electrophysiology setups dedicated to measurement of electrical activity in cells. First, the basic concerns of setting up the equipment in a functional and accessible manner are described. Then two typical setups are briefly described: one for in vitro extracellular recording, the other for single-channel patch-clamping. An electrophysiological setup has four main requirements: (1) environment: the means of keeping the preparation healthy; (2) optics: the means of visualizing the preparation; (3) mechanics: the means of stably positioning the microelectrode; and (4) electronics: the means of amplifying and recording the signal. This unit addresses primarily the mechanics and electronics of the electrophysiological laboratory setup.

Principles of signal conditioning.

It is rare for biological, physiological, chemical, electrical, or physical signals to be measured in the appropriate format for recording and interpretation. Usually, a signal must be conditioned to optimize it for both of these functions. This overview describes the fundamentals of signal filtering, how to prepare signals for A/D conversion, signal averaging to increase the signal-to-noise ratio, line frequency pickup (hum), peak-to-peak and rms noise measurements, blanking, audio monitoring, testing of electrodes and the common-mode rejection ratio.

Methadone in the treatment of chronic nonmalignant pain: a 2-year follow-up.

OBJECTIVE: To examine the longitudinal use of methadone in a pain clinic. DESIGN: Follow-up study of 40 patients initially treated with methadone and re-evaluated 2 years later, comparing those maintained on methadone with those who were switched to other opioids. SETTING: Pain clinic at a university hospital. RESULTS: The 14 patients (35%) who stayed on methadone for the duration of the study, had higher employment rates (P <.05) and higher functional ratings (P <.02) than those on other opioids. Side effects were the most common reason (33.4%) for discontinuation of methadone. Dose escalation occurred in 11 of 14 patients (78.6%). CONCLUSIONS: Chronic pain patients may be safely and effectively treated with methadone. Those not responding or tolerating methadone may be benefited by treatment with other opioids.

Body CT and oncologic imaging.

The most commonly used imaging modality in patients with cancer is computed tomography (CT). Whether to evaluate primary tumor or metastases to the neck, chest, abdomen, or pelvis, oncologic body CT has become invaluable to medical, gynecologic, and radiation oncologists. CT is the principal tool used to stage tumor, assess response, and guide radiation therapy. This review provides a discussion of how we optimize oncologic CT to best meet the needs of the patient with cancer.

Successful treatment of headache related to intravenous immunoglobulin with antimigraine medications.

In order to investigate headache related to intravenous immunoglobulin, we studied a 36-year-old woman with a history of migraine receiving weekly intravenous immunoglobulin for refractory myasthenia gravis who experienced severe headaches with each treatment. Neurological examination, CT scan of the head, and a lumber puncture after the first headache were normal. Significant therapeutic response was based upon 50% reduction in pain and associated features. Headache features included throbbing pain which worsened with head movement and was associated with severe photophobia and nausea. Sumatriptan, 6 mg subcutaneous, reduced headache significantly with resolution of associated complaints. Treatment prior to intravenous immunoglobulin with dihydroergotamine mesylate resulted in development of only a mild dull ache without further development of severe head pain. Dihydroergotamine mesylate was also abortive in the few instances when the headache worsened. Headaches associated with intravenous immunoglobulin may have features of migraine and may be successfully prevented and/or treated with 5-HT1D receptor agonists.

Successful outcome of idiopathic nonimmune hydrops fetalis treated by maternal digoxin.

Nonimmune hydrops fetalis (NIHF), occurring in 1 in 2,500-3,000 live births has a reported mortality rate of 50-98%. A similar mortality rate for intrauterine death of fetuses with NIHF probably exists. Many fetal pathological entities have been implicated as causing the condition, but to date, treatment has only been found for cases of fetal tachycardia complicated with hydrops. During a routine ultrasonographic survey of a woman at 32 weeks of gestation, we detected a fetus with severe ascites. There was no apparent etiology, and although no tachycardia was evident, low dosage transplacental digoxin therapy was immediately initiated. The hydropic condition completely resolved within 17 days and at 39 weeks of gestation, a perfectly normal baby was born after a spontaneous and uneventful labor. This is the first report of successful treatment of idiopathic NIHF with maternal digoxin.

Toward less misleading comparisons of uncertain risks: the example of aflatoxin and alar.

Critics of comparative risk assessment (CRA), the increasingly common practice of juxtaposing disparate risks for the purpose of declaring which one is the "larger" or the "more important," have long focused their concern on the difficulties in accommodating the qualitative differences among risks. To be sure, people may disagree vehemently about whether "larger" necessarily implies "more serious," but the attention to this aspect of CRA presupposes that science can in fact discern which of two risks has the larger statistical magnitude. This assumption, encouraged by the indiscriminate calculation of risk ratios using arbitrary point estimates, is often incorrect: the fact that environmental and health risks differ in unknown quantitative respects is at least as important a caution to CRA as the fact that risks differ in known qualitative ways. To show how misleading CRA can be when uncertainty is ignored, this article revisits the claim that aflatoxin contamination of peanut butter was "18 times worse" than Alar contamination of apple juice. Using Monte Carlo simulation, the number 18 is shown to lie within a distribution of plausible risk ratios that ranges from nearly 400:1 in favor of aflatoxin to nearly 40:1 in the opposite direction. The analysis also shows that the "best estimates" of the relative risk of aflatoxin to Alar are much closer to 1:1 than to 18:1. The implications of these findings for risk communication and individual and societal decision-making are discussed, with an eye toward improving the general practice of CRA while acknowledging that its outputs are uncertain, rather than abandoning it for the wrong reasons.

Evaluation of combinations of procedures in cesarean section.

OBJECTIVE: To evaluate a procedure for cesarean section, consisting of a number of surgical techniques adopted from various sources and further developed. METHODS: The principal elements of the cesarean section procedure followed were: the Joel-Cohen method for opening the abdomen, suturing the uterus in one layer, and non-closure of the visceral and parietal peritoneal layers. The postoperative recovery of women who underwent this procedure (JCl--group) was compared with that of women who had undergone a Pfannenstiel incision, in which the uterus is sutured in two layers, and both peritoneal layers sutured (Pf2++ group). RESULTS: The incidence of postoperative febrile morbidity was 7.7% in the JCl--group compared with 19.8% in the Pf2++ group (P < 0.05). Adhesions were found in 6.3% of repeat operations after the JCl--operation compared with 28.8% after the Pf2++ operation (P < 0.05), and there was a non-significant trend toward fewer postoperative analgesics in the JCl--group. CONCLUSION: The cesarean section procedure we have devised is not only safe, but has a lower risk of long- and short-term complications.

Comparison between the Joel-Cohen and Pfannenstiel incisions in cesarean section.

Most surgeons adopt the Joel-Cohen method for opening the abdomen once they have become familiar with it. We present here, for the first time, a study comparing the post-operative outcome between the Joel-Cohen and the Pfannenstiel methods for opening the abdomen in cesarean section.

Optimizing planar lipid bilayer single-channel recordings for high resolution with rapid voltage steps.

We describe two enhancements of the planar bilayer recording method which enable low-noise recordings of single-channel currents activated by voltage steps in planar bilayers formed on apertures in partitions separating two open chambers. First, we have refined a simple and effective procedure for making small bilayer apertures (25-80 micrograms diam) in plastic cups. These apertures combine the favorable properties of very thin edges, good mechanical strength, and low stray capacitance. In addition to enabling formation of small, low-capacitance bilayers, this aperture design also minimizes the access resistance to the bilayer, thereby improving the low-noise performance. Second, we have used a patch-clamp headstage modified to provide logic-controlled switching between a high-gain (50 G omega) feedback resistor for high-resolution recording and a low-gain (50 M omega) feedback resistor for rapid charging of the bilayer capacitance. The gain is switched from high to low before a voltage step and then back to high gain 25 microseconds after the step. With digital subtraction of the residual currents produced by the gain switching and electrostrictive changes in bilayer capacitance, we can achieve a steady current baseline within 1 ms after the voltage step. These enhancements broaden the range of experimental applications for the planar bilayer method by combining the high resolution previously attained only with small bilayers formed on pipette tips with the flexibility of experimental design possible with planar bilayers in open chambers. We illustrate application of these methods with recordings of the voltage-step activation of a voltage-gated potassium channel.