Intraoperative imaging and navigation of the petrous apex by infralabyrinthine route.

Intraoperative imaging during skull-base surgery allows the operator to control surgical dissection and to tailor the approach, reducing morbidity due to inadequate resection or reintervention. The O-arm® (Medtronic, Fridley, MN, USA) navigation system is an intraoperative cone-beam CT device that was first designed for spinal surgery but now has applications in lateral skull-base surgery. In this technical note, we present a patient with petrous apex cholesterol granuloma located medial to the intrapetrous internal carotid artery and in the infralabyrinthine compartment. We report the possibility of natural drainage, using intraoperative imaging to guide resection, through a rapid, safe and minimally invasive approach.

Chloroplast transit peptide prediction: a peek inside the black box.

Previous work in predicting protein localization to the chloroplast organelle in plants led to the development of an artificial neural network-based approach capable of remarkable accuracy in its prediction (ChloroP). A common criticism against such neural network models is that it is difficult to interpret the criteria that are used in making predictions. We address this concern with several new prediction methods that base predictions explicitly on the abundance of different amino acid types in the N-terminal region of the protein. Our successful prediction accuracy suggests that ChloroP uses little positional information in its decision-making; an unexpected result given the elaborate ChloroP input scheme. By removing positional information, our simpler methods allow us to identify those amino acids that are useful for successful prediction. The identification of important sequence features, such as amino acid content, is advantageous if one of the goals of localization predictors is to gain an understanding of the biological process of chloroplast localization. Our most accurate predictor combines principal component analysis and logistic regression. Web-based prediction using this method is available online at http://apicoplast.cis.upenn.edu/pclr/.

Serological discrimination of dogs infected with gastric Helicobacter spp. and uninfected dogs.

Characterization of the humoral immune responses of people to Helicobacter pylori infection has facilitated the investigation of the host response to bacterial virulence factors and the development of sensitive and specific diagnostic tests. Dogs are commonly infected with gastric Helicobacter spp., but the presence of multiple Helicobacter spp. and possible coinfection in individual dogs have complicated serological evaluation. Evaluation of the antigenic homology of Helicobacter spp. revealed that the major protein bands of Helicobacter felis and Helicobacter bizzozeronii, two Helicobacter spp. that infect dogs, were very similar to UreA (29 to 31 kDa), UreB (63 to 66 kDa), and HSP (58 to 60 kDa) of H. pylori, and sera from infected and uninfected dogs bound in a similar way to each antigen. Immunoblotting and an enzyme-linked immunosorbent assay (ELISA) with H. felis ATCC 49179 antigen were performed with 101 serum samples (from 78 infected dogs and 23 uninfected dogs). Samples from uninfected dogs (median = 8) had fewer bands on immunoblotting than samples from infected dogs (median = 16) (P < 0.05). Combinations of the presence of any two of the low-molecular-mass bands (19, 25, 30, 32, and 37 kDa) or the high-molecular-mass bands (86 and 94 kDa) were found almost solely in samples from infected dogs (P < 0.0001). Kinetic ELISA results were significantly higher for samples from infected dogs (median = 0. 0802 optical density unit [OD]/min) than for samples from uninfected dogs (median = 0.01428 OD/min). The combination of ELISA and immunoblotting results gave a specificity of 95.6% and a sensitivity of 79.8%. No correlation between ELISA results, colonization density, degree of inflammation, and presence of lymphoid follicles was observed. The results indicate substantial antigenic homology between H. felis, H. pylori, and H. bizzozeronii. The combination of ELISA and immunoblotting was a highly specific and moderately sensitive indicator of infection. The degree of seropositivity assessed by ELISA was not related to bacterial colonization density, the degree of gastric inflammation, or the presence of lymphoid follicles.

Pregnancy prevention using emergency contraception: efficacy, attitudes, and limitations to use.

Emergency contraception, also called postcoital contraception, is the use of hormonal or mechanical methods to prevent pregnancy after an episode of unprotected intercourse. Although a number of methods of emergency contraception exist, its use in the United States is not widespread. This report reviews studies on the efficacy of hormonal methods of emergency contraception, as well as the literature on women's and physicians' knowledge of and attitudes toward this method of preventing pregnancy. Articles were selected for this review from a MEDLINE search using the term "postcoital contraception." These studies show that a variety of hormonal regimens are effective in reducing the chance of pregnancy when administered within 72 hours of an episode of unprotected intercourse. Failure rates range from 0%-4.66%, depending on the regimen and the study, although some controversy exists about how to calculate efficacy. Recent studies indicate that mifepristone (RU486) may be more effective than other methods, with fewer side effects. However, the more significant issue surrounding emergency contraception may be the reasons for its infrequent use in this country. A number of limitations to use have been identified in the literature, including lack of knowledge of the method among patients and physicians, inadequate counseling, and fears that widespread use of emergency contraceptives would lead to less consistent use of other methods of contraception.

Emergency contraception: a national survey of adolescent health experts.

In a survey of 167 physicians with expertise in adolescent health, 84% said they prescribe contraception to adolescents, but only 80% of these prescribe emergency contraception, generally a few times a year at most. Some 12% of respondents said they believe that providing emergency contraception to adolescents would encourage contraceptive risk-taking, 25% said they think it would discourage correct use of other methods and 29% said they think repeated use of the method could post health risks. Physicians who were more likely than their colleagues to prescribe emergency contraception included obstetrician-gynecologists (92%), those who graduated from medical school after 1970 (77%) and those who describe their practice as being in an "academic" setting (76%). Physicians may restrict use of the method by limiting treatment to adolescents who seek it within 48 hours after unprotected intercourse (29%), by requiring a pregnancy test (64%) or an office visit (68%), or by using the timing of menses as a criterion for providing the method (46%). While 41% of physicians who provide emergency contraception counsel adolescents about the method during family planning visits, only 28% do so during visits for routine health care; 16% counsel women who are not yet sexually active about the method.

Local benefit of prostaglandin E2 in radiochemotherapy-induced oral mucositis.

In 15 patients suffering from maxillofacial cancer with radiochemotherapy-induced oral mucositis the local application of prostaglandin E2 (PGE2) tablets, 0.5 mg four times a day at a 4-h interval was performed. Plasma determination of the bicyclo-prostaglandin E2 metabolite showed no significant amount of the locally applied substance in the circulation. It is claimed that for this particular indication, PGE2 is a potent locally acting compound without affecting circulating levels.

Rectus femoris muscle: an obstacle in reduction of acute traumatic anterior dislocation of hip in an adult.

A case of traumatic anterior dislocation of the hip that could not be reduced closed is described. On exploring the hip, the rectus femoris muscle was found to be buttonholed by the head of the femur, resulting in failure of closed reduction. Release of the muscle from its origin resulted in easy reduction.

Ender's flexible intramedullary pins for the treatment of pertrochanteric hip fractures: preliminary report of the first 100 cases.

A series of 100 consecutive patients with pertrochanteric hip fractures treated by the Ender method of intramedullary nailing is reported. The average age of the patients was 77.26 years (range, 34 to 94 years). Followup of the patients was from 4 to 15 months, with an average of 7 months. The mortality rate was 9% and the rate of serious complications was 8%. All fractures of the 50 patients followed were healed at 4 months and the functional results were generally good. This method appears to offer excellent results and may be the result of fast operating time, minimal surgical trauma, and ease of performance.