Isolated torsion of the fallopian tube. A case report.

BACKGROUND: While torsion of the adnexa is relatively common, isolated torsion of the fallopian tube alone remains a rare occurrence. Diagnosis and surgical intervention are often delayed. CASE: A 38-year-old woman presented with acute lower right abdominal pain initially managed as renal colic. She returned to the emergency department three days later. After surgical consultation, a computed tomography scan and ultrasound showed a cystic pelvic mass with normal ovarian flow studies. Ultimately, the gynecology team performed laparoscopy with the suspicion of intermittent adnexal torsion. A 6 x 8-cm, twisted, dusky purple right fallopian tube was noted. A laparoscopic salpingectomy was performed. CONCLUSION: In the differential diagnosis of acute lower abdominal pain, isolated torsion of the fallopian tube should be considered. A timely diagnosis and surgical intervention may allow preservation of the tube. Even when irreversible damage has occurred, laparoscopic management is recommended.

A pseudo-cell based approach to efficient crystallographic refinement of viruses.

Strategies have been developed for the inexpensive refinement of atomic models of viruses and of other highly symmetric structures. These methods, which have been used in the refinement of several strains of poliovirus, focus on an arbitrary-sized parallelepiped (termed the 'protomer' box) containing a single complete averaged copy of the structural motif which forms the protein capsid, together with the fragments of other symmetry-related copies of the motif which are located in its immediate neighborhood. The Fourier transform of the protomer box provides reference structure factors for stereochemically restrained crystallographic refinement of the atomic model parameters. The phases of the reference structure factors are based on the averaged map, and are not permitted to change during the refinement. It is demonstrated that models refined using the protomer box methods do not differ significantly from models refined by more expensive full-cell calculations.

Psychoactive medications in the long-term care setting: differing perspectives among physicians, nursing staff, and patients.

Differences in perceptions among nursing home patients, nursing staff, and physicians were compared in this preliminary study regarding nighttime disorders and psychoactive medications. Nighttime disorders, including both insomnia and behavior problems, are prevalent among institutionalized elderly and are frequently managed with psychoactive medications. All nursing home patients receiving psychoactive medications, the nursing staff, and the physicians involved in their care were interviewed regarding the description, etiology, management, and impact of the nighttime disorder including side effects of the prescribed medications. Overall, the differences in responses among the three groups ranged from 47% to 63%. While both physicians and nurses reported problems more often than did the patients, nurses reported problems more frequently than did physicians. This preliminary study suggests that patients, nursing staff, and physicians perceive nighttime disorders and their management differently. These differences point to the need for improved methods of communication and education to mutually identify the targeted disorder and develop appropriate management.

Three-dimensional structure of a mouse-adapted type 2/type 1 poliovirus chimera.

The crystal structure of V510, a chimeric type 2/type 1 poliovirus, has been determined at 2.6 A resolution. Unlike the parental Mahoney strain of type 1 poliovirus, V510 is able to replicate in the mouse central nervous system, due entirely to the replacement of six amino acids in the exposed BC loop of capsid protein VP1. Significant structural differences between the two strains cluster in a major antigenic site of the virus, located at the apex of the radial projection which surrounds the viral five-fold axis. Residues implicated in the mouse-virulence of poliovirus by genetic studies are located in this area, and include the residues which are responsible for stabilizing the conformation of the BC loop in V510. Despite evidence that this area is not involved in receptor binding in cultured primate cells, the genetic and structural observations suggest that this area plays a critical role in receptor interactions in the mouse central nervous system. These results provide a structural framework for further investigation of the molecular determinants of host and tissue tropism in viruses.

Nutritional intake in patients with senile dementia of the Alzheimer type.

The dietary intake of 29 healthy controls was compared with that of 35 community-dwelling patients with probable or definite senile dementia of the Alzheimer type (SDAT), based on NINCDS-ADRDA criteria. The control subject or the caregiver of the SDAT patient completed a 3-day estimated-dietary-intake record. Foods offered to patients were chosen, for the most part, by caregivers, but SDAT patients were allowed to eat ad libitum from those choices, and food consumed was recorded. Dietary intake was evaluated against the 1989 Recommended Dietary Allowances (RDA). Dietary intakes did not differ significantly between control and SDAT patients for any of the 32 nutrients analyzed. The controls and SDAT patients met the RDA guidelines for intake of total energy, protein, and micronutrients, with the exception of female SDAT patients, who did not consume a minimum of two thirds of the RDA for vitamin D. All biochemical indices of nutritional status were within normal limits for the SDAT patients. In addition, cognitive function did not correlate with intake of any nutrient studied. We conclude that moderately impaired, community-dwelling patients with SDAT do not differ from healthy controls in nutritional status or nutrient intake. Neither general nor nutrient-specific malnutrition was present in this population. Based on this cross-sectional study, malnutrition does not appear to be a major contributor to the pathogenesis of Alzheimer disease. However, this investigation examined only a single point in time, when patients were being fed by caregivers, so that the role of malnutrition at the beginning of the disease was not addressed.

Diagnosis and management of endocrine ophthalmopathy.

Most patients with Graves' hyperthyroidism have mild or inapparent ophthalmopathy. For the unusual patient with severe ophthalmopathy, a generally successful, coordinated, combined interdisciplinary medical and surgical management program is outlined.