Complications in tunneled CVL versus PICC lines in very low birth weight infants

OBJECTIVE

Comparison of complications associated with tunneled central venous lines (TCVLs) versus peripherally inserted central catheters (PICCs) in infants <1500 g.

STUDY DESIGN

A retrospective cohort study at a university medical center. A total of 96 catheters were placed in 60 infants between 4/94 and 3/99. A retrospective review of these infants' medical record was done to review associated complications of catheter placement.

RESULTS

Both groups had similar weights and gestational ages. The duration of catheterization was 28 days in TCVLs and 11 days in PICCs (p<0.05). Total, infectious, and mechanical complications between the two groups were similar. Survival function estimates showed no difference between the two groups up to the 15th day of catheterization.

CONCLUSION

There is no difference in efficacy or associated complications between the two groups. If one could anticipate needing a catheter longer than 15 days, then a TCVL might be the better choice.

When a hernia is not a hernia: the evaluation of inguinal hernias in the cirrhotic patient

Herniorrhapy in patients with advanced portal hypertension and ascites should be approached with caution, and treated conservatively whenever possible. Cirrhosis increases the risk of significant perioperative complications such as infection, recurrence, and ascites leak. This paper reports two patients operated on for suspected inguinal hernias. The first patient was referred for elective repair of a presumed inguinal hernia before liver transplantation. The second patient presented with a history of an incarcerated inguinal hernia that was previously reduced in the emergency center. After examination by residents and senior faculty the patients were scheduled for elective herniorrhaphy. Intraoperatively no inguinal hernia could be identified in either patient. However, massively dilated veins (1.5-2.0 cm in diameter) were noted entering with the spermatic cord at the internal inguinal ring. In both cases the veins were clamped, transected, and suture ligated at the internal ring. Given the unusual presentation of these dilated veins in both patients we advocate the use of preoperative Doppler ultrasound in patients with cirrhosis and suspected inguinal hernias.

The topography of tactile working memory

To investigate the contribution of topographically organized brain areas to tactile working memory, we asked human subjects to compare the frequency of two vibrations presented to the same fingertip or to different fingertips. The vibrations ranged from 14 to 24 Hz and were separated by a retention interval of variable length. For intervals <1 sec, subjects were accurate when both vibrations were delivered to the same fingertip but were less accurate when the two vibrations were delivered to different fingertips. For 1 or 2 sec intervals, subjects performed equally well when comparing vibrations delivered either to the same finger or to corresponding fingers on opposite hands, but they performed poorly when the vibrations were delivered to distant fingers on either hand. These results suggest that working memory resides within a topographic framework. As a further test, we performed an experiment in which the two comparison vibrations were presented to the same fingertip but an interference vibration was presented during the retention interval. The interpolated vibration disrupted accuracy most when delivered to the same finger as the comparison vibrations and had progressively less effect when delivered to more distant fingers. We conclude that topographically organized regions of somatosensory cortex contribute to tactile working memory, possibly by holding the memory trace across the retention interval. One stimulus can be accurately compared with the memory of a previous stimulus if they engage overlapping representations, but activation of the common cortical territory by an interpolated stimulus can disrupt the memory trace.

A comparison of the pentaammine(pyridyl)ruthenium(II) and 4-(dimethylamino)phenyl groups as electron donors for quadratic non-linear optics

Hyper-Rayleigh scattering and Stark spectroscopic studies show that the complex salts [1-4]PF6 have larger static first hyperpolarizabilities beta 0 than [5-8]PF6, because the higher HOMO energy of a (RuII(NH3)5)2+ centre more than offsets the superior pi-orbital overlap in the purely organic chromophores.

Extra-abdominal pneumodissection after laparoscopic antireflux surgery

The presence of pneumoperitoneum during laparoscopic antireflux surgery can lead to the dissection of carbon dioxide into the mediastinum, retroperitoneum, subcutaneous tissues, and neck (pneumodissection). The purpose of this study is to describe the incidence, extent, duration and pathways of pneumodissection during laparoscopic antireflux surgery. Twenty patients who underwent laparoscopic antireflux surgery from August 1998 through May 1999 were studied. Physical examination and chest radiographs were performed in the recovery room and each day postoperatively. Noncontrast computerized tomography (CT) of the neck, chest, and upper abdomen was also performed on postoperative day one. Subcutaneous emphysema and radiologic evidence of pneumodissection occurred commonly and typically resolved within 4 days postoperatively. The incidence of pneumomediastinum (85%) seen on CT scan was similar to that of pneumodissection into the neck (80%). The most common pathway of dissection of gas was through the anterior mediastinum and into the neck through the carotid space. Other findings on CT scan revealed pneumoperitoneum in 70 per cent, pneumoretroperitoneum in 10 per cent, and pneumothorax in 0 per cent. The dissection of gas into the mediastinum, neck, and subcutaneous tissues is very common after laparoscopic antireflux surgery. Subcutaneous emphysema on physical examination and radiographic pneumodissection typically resolves within 3 to 4 days. After this time one should consider the presence of any substantial amount of gas as a potential complication related to the procedure.

Object orientation agnosia: a failure to find the axis?

A dissociation between the ability to recognize misoriented objects and to determine their orientation has been reported in a small number of patients with vascular lesions. In this article, we describe a 57-year-old man with probable Alzheimer' s disease who shows the same dissociation. Neuroimaging findings indicated marked hypometabolism in the posterior cortical regions, particularly the postero-superior parietal lobes. Clinically, the patient had good object recognition accompanied by severely impaired spatial abilities. The experimental investigations comprised a variety of tasks in which he identified misoriented objects, evaluated the orientation of single objects, or discriminated the orientation of simultaneously presented items. Results revealed that his object recognition was independent of orientation and was largely mediated by salient features. With respect to orientation judgements, the patient displayed a profound inability to judge the orientation of nonupright objects, but remarkably intact (though largely implicit) knowledge of the upright orientation. Strikingly, his orientation judgements were also more accurate for upside-down objects than for other orientations (i.e., 90 degrees ). We interpret these results as evidence that judgements about object orientation are facilitated when the orientation of the principal axis of the object matches that of an internal representation. We propose that the inability to determine other orientations may be due to the failure of an "axis-finding" mechanism implemented in the posterior parietal lobes, that translates between object-centered and eye-centered coordinates appropriate for guiding visual scanning.

trans-4-[(4-dimethylaminophenyl)-iminomethyl]-N-methyllpyridinium para-toluenesulfonate

In the title compound, C15H18N3+*C7H7O3S-, the phenylene and pyridyl rings are somewhat twisted with respect to each other, forming a dihedral angle of 23.49 (6) degrees. The compound contains a dipolar chromophoric cation, but crystallizes in the centrosymmetric space group P2(1)/n and is thus not expected to display quadratic non-linear optical effects.

Kappa opioid receptor density is consistent along the rostrocaudal axis of the female rat spinal cord

Kappa opioid receptors (KORs) were immunocytochemically localized at four different levels of the spinal cord of normally-cycling female rats in estrus or diestrus. KOR labeling was primarily observed in fine processes and a few neuronal cell bodies in the superficial dorsal horn and the dorsolateral funiculus. Quantitative light microscopic densitometry of the superficial dorsal horn revealed that there were no significant differences in KOR densities among spinal segments C1--C2, T2, T13--L1, and L6--S1 in either the estrus or diestrus phases. These results suggest that the potential for KOR-mediated antinociceptive responses is consistent along the rostrocaudal axis of the female rat spinal cord.

Contextual control over the expression of fear in rats conditioned under a benzodiazepine

RATIONALE

Benzodiazepines disrupt fear conditioning, but this disruption is context-specific; if rats have been conditioned under a benzodiazepine, their fear is recovered if they are tested in a different context. The present experiments investigated how the conditioning context controls fear in rats conditioned under a benzodiazepine.

OBJECTIVES

The experiments had three aims: (1) to replicate the finding that fear is recovered when rats are tested in a different context, (2) to test whether the conditioning context reduces fear generally or only for the specific stimulus conditioned in that context and (3) to test whether latent inhibition of the conditioning context reduces its control over fear.

METHODS

Rats were injected with the benzodiazepine midazolam (1.25 mg/kg) or saline and exposed to a conditioned stimulus (CS) and shock in a distinctive chamber. Latent inhibition of the chamber was induced by extensively preexposing the rats to the chamber. The day after conditioning, fear was assessed by presenting the CS while rats were in either the conditioning chamber or a different chamber.

RESULTS

The midazolam-induced reduction of fear was reversed (i.e. fear was partially recovered) if rats were tested in the different context, and was completely prevented if the conditioning context had been latently inhibited. These two effects were not additive since, when the conditioning context had been latently inhibited, rats showed less fear in the different context than in the conditioning context.

CONCLUSIONS

We argue that midazolam does not disrupt conditioning, but imbues the conditioning context with control over retrieval of the CS-shock association. In this regard, the effects of midazolam closely parallel those of extinction.

The heritability of attitudes: a study of twins

The genetic basis of individual differences in attitudes was examined in a survey of 195 pairs of monozygotic twins and 141 pairs of same-sex dizygotic twins. A principal components analysis of the 30 attitude items in the survey identified 9 attitude factors, of which 6 yielded significant heritability coefficients. Nonshared environmental factors accounted for the most variance in the attitude factors. Possible mediators of attitude heritability were also assessed, including personality traits, physical characteristics, and academic achievement. Analyses showed that several of these possible mediators correlated at a genetic level with the heritable attitude factors, suggesting that the heritability of the mediator variables might account for part of the heritable components of some attitudes. There was also some evidence that highly heritable attitudes were psychologically "stronger" than less heritable attitudes.

The topography of tactile learning in humans

The spatial distribution of learned information within a sensory system can shed light on the brain mechanisms of sensory-perceptual learning. It has been argued that tactile memories are stored within a somatotopic framework in monkeys and rats but within a widely distributed network in humans. We have performed experiments to reexamine the spread of tactile learning across the fingertips. In all experiments, subjects were trained to use one fingertip to discriminate between two stimuli. Experiment 1 required identification of vibration frequency, experiment 2 punctate pressure, and experiment 3 surface roughness. After learning to identify the stimuli reliably, subjects were tested with the trained fingertip, its first and second neighbors on the same hand, and the three corresponding fingertips on the opposite hand. As expected, for all stimulus types, subjects showed retention of learning with the trained fingertip. However, the transfer beyond the trained fingertip varied according to the stimulus type. For vibration, learning did not transfer to other fingertips. For both pressure and roughness stimuli, there was limited transfer, dictated by topographic distance; subjects performed well with the first neighbor of the trained finger and with the finger symmetrically opposite the trained one. These results indicate that tactile learning is organized within a somatotopic framework, reconciling the findings in humans with those in other species. The differential distribution of tactile memory according to stimulus type suggests that the information is stored in stimulus-specific somatosensory cortical fields, each characterized by a unique receptive field organization, feature selectivity, and callosal connectivity.

Effect of fibrin glue on lymphatic drainage after modified radical mastectomy: a prospective randomized trial

Fibrin as a tissue sealant has been used since the turn of the century for hemostasis. The development of cryoprecipitate and the resultant availability of higher concentrations of fibrinogen have led to a resurgence of interest in this material. Fibrin glue has since been shown to be effective for numerous applications throughout the field of surgery. Animal studies have shown fibrin glue to be effective at reducing drain output after mastectomy. Human studies, however, have been equivocal. Our objectives were to determine whether the use of fibrin glue would decrease lymphatic drainage after modified radical mastectomy and subsequently reduce time to drain removal. A prospective randomized trial was conducted consisting of 27 women. All women received modified radical mastectomy. At the completion of the mastectomy they were randomized to receive either standard closure or the application of fibrin glue before standard closure. Patients were then monitored for daily drain output, time to drain removal, and wound complications. A total of 14 women received fibrin glue and 13 received no glue. Those patients receiving fibrin glue had a significantly higher average drain output than patients who did not receive glue (1308 vs 754 cm3; P = 0.012). Time to drain removal was also increased by 4 days, although this did not reach statistical significance. The overall complication rate was higher for the fibrin glue group, although again, this did not reach significance. The application of fibrin glue significantly increased drain total drain output after modified radical mastectomy. Time to drain removal was increased as was the complication rate. On the basis of these data fibrin glue cannot be recommended for routine use in modified radical mastectomy.

Suprachiasmatic nucleus projections to the paraventricular thalamic nucleus in nocturnal rats (Rattus norvegicus) and diurnal nile grass rats (Arviacanthis niloticus)

The circadian pacemaker of the suprachiasmatic nucleus (SCN) is likely to control the timing of the sleep-wake cycle in mammals by modulating the daily activity patterns of brain regions important in sleep and wakefulness. One such brain region is the paraventricular nucleus of the thalamus (PVT). In both nocturnal rats and the diurnal rodent Arvicanthis niltoicus (Nile grass rat), expression of Fos (the product of the immediate-early gene c-fos) in the PVT increases at times of day when the animals are most active. To compare the projections of the SCN to the PVT in these two species, the retrograde tracer cholera toxin (beta subunit; CTbeta) was microinjected into the PVT and the SCN was examined to identify labeled neurons. Further, the PVT-projecting SCN cells containing either arginine vasopressin (AVP) or gastrin releasing peptide (GRP) were also compared between species. In both nocturnal rats and diurnal Nile grass rats, the SCN sends a substantial projection to the PVT. In both species, many PVT-projecting SCN neurons contain AVP, and few contain GRP. Other work has shown that some AVP-containing neurons of the SCN function differently in rats and Nile grass rats. Projections from functionally distinct SCN neurons to the PVT may contribute to the difference in the temporal distribution of sleep and wakefulness seen between these two species.

Contextual control over conditioned responding in a latent inhibition paradigm

We used 1-, 2-, and 3-context designs to study the control exerted by contexts over freezing in rats exposed to a conditioned stimulus (CS) in advance of its pairing with a shock unconditioned stimulus. The latent inhibition observed when preexposure, conditioning, and testing occurred in the same context was attenuated if preexposure occurred in a different context to conditioning and testing. Latent inhibition (i.e., attenuated performance) was restored in a CS-specific manner if preexposure and testing occurred in the same context and conditioning in a different one. Latent inhibition was also reduced by a long retention interval but remained specific for a particular context-CS relation. Finally, CS preexposure resulted in contextual control over the expression of excitatory conditioned performance. The results are discussed in terms of memory, associative, and associative-performance models of CS-preexposure effects.

Contextual control over conditioned responding in an extinction paradigm

Four experiments studied contextual control over rats' freezing to conditioned stimuli (CSs) that had been paired with shock and were then extinguished. In Experiment 1, rats were exposed to a CS A-shock and a CS B-shock pairing in Context C. CS A was then extinguished in Context A, and CS B in Context B. Freezing was renewed when each CS was presented in the context where the other CS had been extinguished. In Experiments 2-4, rats were exposed to a CS A-shock pairing in A and a CS B-shock pairing in B. They were then exposed to Context C where one, both, or neither of the CSs were extinguished, or where both CSs continued to be reinforced. On test, the rats froze more to CS A than to CS B in Context A, and more to CS B than to CS A in Context B, but only if the CSs had been extinguished. Thus, after extinction, rats use contexts to regulate retrieval not only of their memory for extinction, but also of their memory for the original conditioning episode.

HIV postexposure prophylaxis for children and adolescents

HIV postexposure prophylaxis (PEP) is now a well-established part of the management of health care workers after occupational exposures to HIV. Use of PEP for adults exposed to HIV after sexual contact or injection drug use in nonoccupational settings remains controversial with limited data available. There is even less information available concerning HIV PEP for children and adolescents after accidental needlestick injuries or sexual assault. The objective was to describe the current practice of and associated problems with HIV PEP for children and adolescents at an urban academic pediatric emergency department. A retrospective review of all children and adolescents offered HIV PEP between June 1997-June 1998 was conducted. Ten pediatric and adolescent patients were offered HIV PEP, six patients after sexual assault, four patients after needle stick injuries. There were two small children 2 and 3 years of age and eight adolescents. Of these 10 patients, eight were started on HIV PEP. The regimens used for PEP varied; zidovudine, lamivudine, and indinavir were prescribed for in seven patients and zidovudine, lamivudine, and nelfinavir for one other. All 10 patients were HIV negative by serology at baseline testing and all available for follow-up testing (5 of 10) remained HIV negative at 4 to 28 weeks. Only two patients completed the full course of 4 weeks of antiretroviral therapy. Financial concerns, side effects, additional psychiatric and substance abuse issues as well as the degree of parental involvement influenced whether PEP and clinical follow-up was completed. HIV PEP in the nonoccupational setting for children and adolescents presents a medical and management challenge, and requires a coordinated effort at the initial presentation to the health care system and at follow-up. The difficulties encountered in the patients in our series need to be considered before initiating prophylaxis. A provisional management approach to HIV PEP in children and adolescents is proposed.

Lymphoma arising in an S-pouch after total proctocolectomy for ulcerative colitis: report of a case

The gastrointestinal tract is the most common extranodal site of primary non-Hodgkin's lymphoma. We present a case of a 50-year-old male with primary B cell lymphoma arising in an S-pouch eight years after a total proctocolectomy for ulcerative colitis. After chemoradiotherapy the patient remained asymptomatic, with an intact S-pouch. Pouch conservation is feasible in patients with primary lymphoma of the pouch, using chemoradiotherapy and close follow-up examinations.

Contextual control over conditioned responding in an extinction paradigm

Four experiments studied contextual control over rats' freezing to conditioned stimuli (CSs) that had been paired with shock and were then extinguished. In Experiment 1, rats were exposed to a CS A-shock and a CS B-shock pairing in Context C. CS A was then extinguished in Context A, and CS B in Context B. Freezing was renewed when each CS was presented in the context where the other CS had been extinguished. In Experiments 2-4, rats were exposed to a CS A-shock pairing in A and a CS B-shock pairing in B. They were then exposed to Context C where one, both, or neither of the CSs were extinguished, or where both CSs continued to be reinforced. On test, the rats froze more to CS A than to CS B in Context A, and more to CS B than to CS A in Context B, but only if the CSs had been extinguished. Thus, after extinction, rats use contexts to regulate retrieval not only of their memory for extinction, but also of their memory for the original conditioning episode.

Contextual control over conditioned responding in a latent inhibition paradigm

We used 1-, 2-, and 3-context designs to study the control exerted by contexts over freezing in rats exposed to a conditioned stimulus (CS) in advance of its pairing with a shock unconditioned stimulus. The latent inhibition observed when preexposure, conditioning, and testing occurred in the same context was attenuated if preexposure occurred in a different context to conditioning and testing. Latent inhibition (i.e., attenuated performance) was restored in a CS-specific manner if preexposure and testing occurred in the same context and conditioning in a different one. Latent inhibition was also reduced by a long retention interval but remained specific for a particular context-CS relation. Finally, CS preexposure resulted in contextual control over the expression of excitatory conditioned performance. The results are discussed in terms of memory, associative, and associative-performance models of CS-preexposure effects.