Implementation of Ultrasound in Anatomy Education

The use of different ways to view the body has always been associated with anatomy. With advancing technology, the use of ultrasound has become more portable and accessible as a way for students to learn anatomy. Moreover, ultrasound's direct clinical context makes it an important skill that students need to acquire and be competent in, not only after graduation but on clinical placements as a student. There does appear to be a learned skill in being able to interpret ultrasound images and to be able to relate the anatomy seen to existing anatomical knowledge. In addition, there is a learned skill in being able to correctly hold the ultrasound probe and gain clear images. Because ultrasound use and interpretation is a skill it therefore needs to be taught as part of undergraduate medical and allied health care professional education. A key to successful training is regular teaching sessions distributed longitudinally throughout the curriculum with active, hands-on learning time being the focus of any teaching session.

Venom Complexity in a Pitviper Produced by Facultative Parthenogenesis

Facultative parthenogenesis (FP) is asexual reproduction in plant and animal species that would otherwise reproduce sexually. This process in vertebrates typically results from automictic development (likely terminal fusion) and is phylogenetically widespread. In squamate reptiles and chondrichthyan fishes, FP has been reported to occur in nature and can result in the production of reproductively viable offspring; suggesting that it is of ecological and evolutionary significance. However, terminal fusion automixis is believed to result in near genome-wide reductions in heterozygosity; thus, FP seems likely to affect key phenotypic characters, yet this remains almost completely unstudied. Snake venom is a complex phenotypic character primarily used to subjugate prey and is thus tightly linked to individual fitness. Surprisingly, the composition and function of venom produced by a parthenogenetic pitviper exhibits a high degree of similarity to that of its mother and conspecifics from the same population. Therefore, the apparent loss of allelic diversity caused by FP appears unlikely to have a significant impact on the prey-capturing ability of this snake. Accordingly, the pitviper offspring produced by FP retained complex phenotypic characteristics associated with fitness. This result reinforces the potential ecological and evolutionary importance of FP and questions our understanding of the inheritance of venom-associated genes.

The role of anatomy demonstrators: A surgical trainees' perspective

Core Surgical Trainees (CST) in the London (UK) Postgraduate School of Surgery receive clinical anatomy teaching in their first year of training, and, in their second year, give 30 sessions of anatomy teaching to medical and other students. This study set out to investigate the role of demonstrators from the perspective of the trainees. A focus group was convened to ascertain trainees' perspectives on demonstrating anatomy and to identify problems and improvement strategies to optimize their ability to enhance students' learning. A questionnaire was formulated and all second-year CST (n = 186-from two cohorts) in the London Postgraduate School of Surgery were invited. A total of 109 out of 186 trainees completed the questionnaire. A high percentage (98%) of trainees that completed the questionnaire responded that demonstrating was an invaluable part of their training. Sixty-two per cent responded that anatomy teaching they received in their first year of core surgical training helped them in their teaching role and 80% responded that it helped them prepare for surgical training. The study also revealed the need for improved communication between trainees and the London Postgraduate School of Surgery/Medical Schools/National Health Service Trusts to address issues such as trainees' perceived difficulty in fulfilling their teaching session requirement. The stakeholders have acknowledged and addressed the outcomes to improve the experience for both surgical trainees and students. The results indicate that anatomy demonstrating delivers important benefits to early surgical trainees, in addition to those received by the students that they teach. Clin. Anat. 31:409-416, 2018. © 2017 Wiley Periodicals, Inc.

Anatomical Society core regional anatomy syllabus for undergraduate medicine: the Delphi process

A modified Delphi method was employed to seek consensus when revising the UK and Ireland's core syllabus for regional anatomy in undergraduate medicine. A Delphi panel was constructed involving 'expert' (individuals with at least 5 years' experience in teaching medical students anatomy at the level required for graduation). The panel (n = 39) was selected and nominated by members of Council and/or the Education Committee of the Anatomical Society and included a range of specialists including surgeons, radiologists and anatomists. The experts were asked in two stages to 'accept', 'reject' or 'modify' (first stage only) each learning outcome. A third stage, which was not part of the Delphi method, then allowed the original authors of the syllabus to make changes either to correct any anatomical errors or to make minor syntax changes. From the original syllabus of 182 learning outcomes, removing the neuroanatomy component (163), 23 learning outcomes (15%) remained unchanged, seven learning outcomes were removed and two new learning outcomes added. The remaining 133 learning outcomes were modified. All learning outcomes on the new core syllabus achieved over 90% acceptance by the panel.

The Anatomical Society core regional anatomy syllabus for undergraduate medicine

The Anatomical Society's core syllabus for anatomy (2003 and later refined in 2007) set out a series of learning outcomes that an individual medical student should achieve on graduation. The core syllabus, with 182 learning outcomes grouped in body regions, referenced in the General Medical Council's Teaching Tomorrow's Doctors, was open to criticism on the grounds that the learning outcomes were generated by a relatively small group of anatomists, albeit some of whom were clinically qualified. We have therefore used a modified Delphi technique to seek a wider consensus. A Delphi panel was constructed involving 'experts' (n = 39). The revised core syllabus of 156 learning outcomes presented here is applicable to all medical programmes and may be used by curriculum planners, teachers and students alike in addressing the perennial question: 'What do I need to know ?'

Comparison of the measurement of heart rate in adult free-range chickens (Gallus domesticus) by auscultation and electrocardiography

OBJECTIVE

To compare the heart rates of adult free-range chickens (Gallus domesticus) measured by auscultation with a stethoscope with those measured simultaneously using electrocardiography (ECG).

METHODS

With each bird in a standing position, estimation of the heart rate was performed by placing a mark on paper for every 4 beats for roosters and 8 beats for hens as detected by auscultation over 30 s, while simultaneous ECG was performed.

RESULTS

Heart rates measured by auscultation showed a high correlation (r = 0.97) with those measured by ECG.

CONCLUSION

There was a high correlation between the heart rates of adult free-range chickens measured by auscultation with a stethoscope and those measured simultaneously using ECG.

Anthelmintic resistance survey in New Zealand

The prevalence and level of thiabendazole resistance of sheep nematodes in the North Island of New Zealand was investigated by means of an in vitro egg-hatch technique; samples from sheep on 52 properties in six country areas were examined. Resistance of Haemonchus contortus and Trichostrongylus spp. was identified on the basis of egg hatch in 0.1 ppm thiabendazole. Evidence of resistance was obtained on 11(21.2%) of the properties. LD 50's and resistance ratios were calculated for the resistant nematode populations found.

Development and evaluation of an ultrasonic ground water seepage meter

Submarine ground water discharge can influence significantly the near-shore transport and flux of chemicals into the oceans. Quantification of the sources and rates of such discharge requires a ground water seepage meter that provides continuous measurements at high resolution over an extended period of time. An ultrasonic flowmeter has been adapted for such measurements in the submarine environment. Connected to a steel collection funnel, the meter houses two piezoelectric transducers mounted at opposite ends of a cylindrical flow tube. By monitoring the perturbations of fluid flow on the propagation of sound waves inside the flow tube, the ultrasonic meter can measure both forward and reverse fluid flows in real time. Laboratory and field calibrations show that the ultrasonic meter can resolve ground water discharges on the order of 0.1 microm/sec, and it is sufficiently robust for deployment in the field for several days. Data from West Neck Bay, Shelter Island, New York, elucidate the temporal and spatial heterogeneity of submarine ground water discharge and its interplay with tidal loading. A negative correlation between the discharge and tidal elevation was generally observed. A methodology was also developed whereby data for the sound velocity as a function of temperature can be used to infer the salinity and source of the submarine discharge. Independent measurements of electrical conductance were performed to validate this methodology.

Cautious surgery for discoid menisci

This retrospective study reviewed the outcomes of 43 knees in 38 patients with discoid menisci treated from 1977 to 1989. Patients underwent either no treatment, trimming, or subtotal or total resection. Approximately 40% of patients who underwent meniscectomy or partial meniscectomy had a fair or poor rating after an average follow-up of 6.5 years. Pathology demonstrating mucoid fibrinous degeneration within the discoid meniscus was found in many cases, showing abnormal meniscal tissue. Only one third of these knees had symptoms of locking, and only 20 (63%) of 32 had a positive arthrogram, demonstrating the diagnostic difficulties encountered with the discoid meniscus. Patients with a discoid meniscus who are symptomatic should undergo arthroscopy. A partial meniscectomy should be performed to achieve a smooth meniscus and a strong, stable peripheral rim.

The perceived relative worth of reaching and maintaining goal weight

OBJECTIVE

To examine the perceived relative worth of reaching and maintaining a self-selected goal weight, for obese and non-obese individuals.

DESIGN

Cross-sectional study.

SUBJECTS

Twenty-five obese treatment-seekers (age 41.0 y, BMI 42.5) and a community sample of 31 obese (age 40.8 y, BMI 32.2) and 64 non-obese participants (age 32.4 y, BMI 23.4).

MEASUREMENT

An 18-item forced-choice questionnaire evaluating what participants would hypothetically sacrifice to reach and maintain their goal weight.

RESULTS

Most obese treatment-seekers would hypothetically endure much to achieve their desired weight. For example, 88% or more would forego a job promotion, retiring with full-pay, eliminating the national debt, or winning their dream house or car or an all-expense-paid vacation, and smaller majorities would suffer loss of half their income or a job demotion. Many non-treatment-seeking obese would forfeit future rewards to reach goal weight, but fewer would incur negative events. About a third of non-obese participants would forgo certain positive events, but few would suffer an adverse event to achieve goal weight. Within the combined obese sample, females viewed attaining goal weight as more important than did males, but there were no significant racial differences. An index of overall worth of weight goal was related positively to current weight and BMI and negatively to goal weight as percentage of current weight (P<0.01).

CONCLUSION

Excessive value may be placed on attaining less than realistic weight goals, particularly but not exclusively by treatment-seeking and heavier obese people and those who desire greater weight loss. Clinicians should take this phenomenon into consideration, and public health initiatives should attempt to place body weight in a more balanced perspective.

Psychometric development of a multidimensional measure of weight-related attitudes and behaviors

Most weight control programs facilitate weight loss by encouraging participants to adopt healthy eating patterns and increase physical activity. There is a need for a relatively brief measure of eating habits and physical activity that could be used to evaluate changes in behavior during weight loss treatment. The purpose of this series of four studies was to develop and validate such a measure, which was subsequently named the Weight Loss Behavior Scale (WLBS). Study 1 (n = 533) included item and scale development and examination of the WLBS's factor structure and internal consistency. Study 2 (n = 226) evaluated the test-retest reliability and convergent validity of its subscales. Study 3 examined their reliability and internal consistency scales in a predominantly overweight sample (n = 36). Study 4 evaluated the WLBS as a treatment outcome measure in a weight loss intervention (n = 50). Study 1 found that the WLBS contained five internally consistent and stable factors: 1) Concern with Dieting and Weight, 2) Exercise, 3) Overeating, 4) Avoidance of Fattening Foods and Sweets, and 5) Emotional Eating. Study 2 found convergent validity for the WLBS by assessing the correlation of its factors/scales with established inventories of comparable constructs, e.g., dietary restraint, disinhibited eating, and physical activity. Test-retest reliability of the five scales was also supported in this second study. In Study 3, support for the internal consistency and test-retest reliability of the WLBS among overweight individuals was found. Study 4 found that all scales significantly changed in the expected directions after a 5-month behavioral weight loss treatment. The findings from this series of studies suggest that the WLBS is a reliable and valid self-report inventory of cognitive and behavioral scales associated with weight control that can be utilized as an outcome measure for weight loss interventions.

Vegetarian and weight-loss diets among young adults

OBJECTIVE

Young adults frequently experiment with vegetarian and weight-loss diets. Comparisons of their experiences on these two different diets may help in the development of approaches to improve long-term adherence to weight-loss regimens. In the current study vegetarian and weight-loss diets were compared on how long and how strictly they were followed, and reasons why they were initiated and discontinued.

RESEARCH METHODS AND PROCEDURES

From 428 college students surveyed, four groups were delineated: 1) 59 participants had been following a vegetarian diet but not a weight-loss diet (Vegetarian), 2) 117 participants had tried a weight-loss diet but not a vegetarian diet (Weight Loss), 3) 133 participants had followed both a vegetarian and a weight-loss diet (Both), and 4) 119 participants had not tried either diet (Neither).

RESULTS

Differences were examined by comparing the Vegetarian and Weight-Loss groups as well as by comparing the two diets within the Both group. Duration of the vegetarian diet was much greater than the weight-loss diet; most participants in the Vegetarian group (62%) remained on their diet for more than 1 year, whereas the majority of the Weight-Loss participants (61%) followed their diet for 1 to 3 months. Similar results were found when comparing the two diets within the Both group. How strictly the two diets were followed, however, did not differ. Analyses revealed that reasons for discontinuing a diet varied; participants were more likely to cite boredom as a reason for discontinuing a weight-loss diet than a vegetarian diet (53% vs. 5% between groups and 30% vs. 10% within the Both group).

DISCUSSION

The longer duration of the vegetarian diet relative to the weight-loss diet warrants further investigation. Results could possibly be applied to behavioral weight-loss treatment to improve long-term maintenance.

A new medium for determining the total plate count in food

SimPlate for Total Plate Count-Color Indicator (TPC-CI, IDEXX Laboratories, Inc., Westbrook, Me.) is a new medium that incorporates the redox dye resazurin to detect and quantify bacteria in food. Enumeration is achieved by the most probable number method using a SimPlate device. Viable bacteria are detected in each well of the SimPlate device by the biochemical reduction of resazurin, which is blue, to the pink resorufin or the clear dihydroresorufin indicators. Results after 24 h of incubation for TPC-CI are highly correlated with standard plate count agar after 48 h of incubation. Correlation coefficients from studies conducted at five laboratories ranged from 0.94 to 0.98 in side-by-side comparisons against standard plate count agar. Four additional test sites, using alternative methods for determining the aerobic plate count in food, reported similar results in comparison studies (r = 0.91 to 0.97). The slopes from linear regression analysis at all sites ranged from 0.91 to 0.98, with y intercepts ranging from 0.11 to 0.84. Samples used for the validation of TPC-CI included raw food products (i.e., liver and grains), which may contain natural enzymes that interfere with enzyme-based detection methods. No interference was seen from the foods tested. These results suggest that TPC-CI is a suitable alternative to existing plate count methods and has reduced incubation time.

Arthroscopic laser surgery: a revisitation

Laser surgery has been known for 38 years-since 1961. In relative terms, this short period of existence has produced a dramatic effect on medicine. We would anticipate a geometrically progressive increase in the use of laser tools over the next 100 years. Lasers will probably be used at lower levels of intensity in the future for two reasons: absence of complications and effectiveness as a noninvasive anti-inflammatory tool. Other electroinductive energy tools and other wavelengths will become increasingly important in medicine. This is true particularly in repair, soft-tissue surgery, photochemical therapy, anti-inflammatory therapy, and inductive therapy. The future is bright for laser and laser-related tools. As the price comes down, usage will increase dramatically. Soon, tissue-specific wavelengths will be available.

Anatomy, function, and pathophysiology of the posterior tibial tendon

The posterior tibial tendon is vital for the structure and function of the foot and ankle. Dysfunction of the tendon can be debilitating and devastating. In recent years, much attention had been directed toward the diagnosis and treatment of PTTD. To properly diagnose and devise an appropriate treatment regimen, the anatomy, function, and pathophysiology associated with PTTD need to be thoroughly understood.

Flexible vs. Rigid dieting strategies: relationship with adverse behavioral outcomes

This study was designed to test the hypothesis that different types of dieting strategies are associated with different behavioral outcomes by investigating the relationship of dieting behaviors with overeating, body mass and mood. A sample of 223 adult male and female participants from a large community were studied. Only a small proportion of the sample (18%) was seeking weight loss treatment, though almost half (49.3%) of the subjects were significantly overweight (body mass index, BMI>30). Subjects were administered questionnaires measuring dietary restraint, overeating, depression and anxiety. Measurements of height and weight were also obtained in order to calculate BMI. Canonical correlation was performed to evaluate the relationship of dietary restraint variables with overeating variables, body mass, depression and anxiety. The strongest canonical correlation (r=0.65) was the relationship between flexible dieting and the absence of overeating, lower body mass and lower levels of depression and anxiety. The second strongest canonical correlation (r=0.59) associated calorie counting and conscious dieting with overeating while alone and increased body mass. The third canonical correlation (r=0.57) found a relationship between low dietary restraint and binge eating. The results support the hypothesis that overeating and other adverse behaviors and moods are associated with the presence or absence of certain types of dieting behavior.

Cognitive appraisals of dietary transgressions by obese women: associations with self-reported eating behavior, depression, and actual weight loss

OBJECTIVE

To identify three groups of obese people entering weight loss treatment, who have distinctly different cognitive appraisals of dietary transgressions and to compare these groups on self-report inventories of eating patterns, dieting, and depression, as well as on treatment completion rates and weight loss.

DESIGN

Retrospective review of clinical records. Using a measure which evaluates eating-related cognitive appraisals, participants were categorized into one of three cognitive groups (All-or-None, Rationalization, Matter-of-Degree).

SUBJECTS

289 treatment-seeking obese women (age: 40.9 y, body mass index (BMI): 34.7 kg/m2).

MEASUREMENTS

Self-reported eating and dieting behavior (Three-Factor Eating Questionnaire and Eating Behavior Inventory); depression (Beck Depression Inventory); attendance information and body weight obtained during treatment.

RESULTS

The cognitive group representing objective thinkers (Matter-of-Degree) reported significantly fewer problems with overeating and more personal control over eating than did the rigid, dichotomous thinkers (All-or-None). In addition, the Matter-of-Degree (MAT) group endorsed significantly less subjective hunger and fewer depressive symptoms than the other two cognitive groups. The Rationalization group was more likely to complete a treatment program than was the All-or-None group, with the MAT group not differing from either. Despite these findings, there were no significant differences among cognitive groups on total weight loss.

CONCLUSIONS

Cognitive appraisals of weight-control lapses appear to be associated with self-reported eating behavior, depressive symptoms and treatment completion rates, but not with treatment-induced weight loss. The relationship between long-term weight loss and cognitive appraisals of dieting lapses is yet to be determined. It appears necessary to assess empirically the validity of assumptions regarding factors associated with treatment outcome.

Perception of sweetness intensity determines women's hedonic and other perceptual responsiveness to chocolate food

This study tested 63 women for hedonic and other perceptual responsiveness to a chocolate food. Subjects tasted four chocolate puddings varying in sugar (high and low) and fat (high and low) content and rated them for pleasantness, caloric density, fillingness and flavor intensities. Results emphasised the importance of sweetness intensity in determining women's responses to the chocolate puddings. Women's perception of sweetness intensity was accurate to sugar content and results consistently indicated that their hedonic responses to the chocolate puddings were based on the perceived sweetness. Women's perception of the caloric density of the puddings was based on their perception of the fat content of the puddings; however, interpretation of that finding must be qualified because the subjects' perception of fat content was inaccurate. The women's perception of sweetness intensity accounted for 31% of the variability in fat perception. Women's perception of the intensity of chocolate flavor was also significantly associated with perceived sweetness of the puddings. These data suggest that the women's accurate perception of the sugar content of the chocolate puddings played a primary role in determining their hedonic and other perceptual responses.

Association of dietary restraint and disinhibition with eating behavior, body mass, and hunger

This study investigated the association of dietary restraint and disinhibition with self-reported and actual eating behavior, body mass, and hunger. A sample of 124 women were categorized into one of four groups based upon high and low scores on measures of Dietary Restraint and Disinhibition using the Three Factor Eating Questionnaire. Half of the participants in each group consumed a high sugar/high fat chocolate pudding as a dietary preload. All participants were given a meal comprised of a standard macaroni and beef product. The interaction of Dietary Restraint and Disinhibition was related to differences in body mass. The Dietary Restraint factor was related to self-reported pathological eating behavior and influenced both perceived hunger and subjective hunger ratings. However, actual eating behavior measured by calories consumed and rate of intake was unrelated to the Dietary Restraint factor. Disinhibition was associated with excessive eating, an increased rate of eating, self-reports of eating disorder symptomatology, and perceived hunger. Hence, actual eating behavior was significantly influenced by the ingestive motivational factor, Disinhibition, but not by the cognitive factor, Dietary Restraint. These data also suggest that the Disinhibition construct is measuring overeating rather than disinhibited eating which implies the disruption of Dietary Restraint.

Organizational restructuring: one HIM team's approach

Organizational restructuring offers a number of challenges--and opportunities--to employees. This article describes how members of one organization's HIM staff participated in a systemwide restructuring process, from planning to implementation to assessment of results.

Comparison of the SimPlate total plate count method with Petrifilm, Redigel, conventional pour-plate methods for enumerating aerobic microorganisms in foods

The SimPlate Total Plate Count (TPC) method, developed by IDEXX Laboratories, Inc., is designed to determine the most probable number of aerobic microorganisms in foods. The 24-h test was compared to the conventional plate count agar (PCA) method, the Petrifilm Aerobic Count plates, and the Redigel Total Count procedure for enumerating microflora in 751 food samples. Results using the SimPlate TPC method were highly correlated (r > or = 0.96) with results from other test methods. Slopes (0.96-0.97) were not significantly different from 1, and y intercepts (-0.03-0.08) were not different from O. The SimPlate has a high counting range (> 1600 most probable number per single dilution), thus requiring fewer dilutions of samples compared to other methods evaluated. Some foods, e.g., raw liver, wheat flour, and nuts, contain enzymes that gave false-positive reactions on SimPlates. Overall, however, the SimPlate TPC method is a suitable alternative to conventional PCA, Petrifilm, and Redigel methods for estimating populations of mesophilic aerobic microorganisms in a wide range of foods.

Force output and energy metabolism during neuromuscular electrical stimulation: a 31P-NMR study

The purpose of this study was to determine the acute physiologic effects of two electrical stimulation protocols commonly used for muscle rehabilitation. Surface electrodes were used to provide 12 stimulations of the calf musculature. In protocol A the duty cycle was fixed at 1:1 (10-second stimulation: 10-second rest); for protocol B it was 1:5 (10-second stimulation: 50-second rest). We continuously recorded isometric plantarflexor force in six healthy male subjects during stimulation using a load cell connected to a foot pedal ergometer. Metabolic changes in the stimulated gastrocnemius muscle were monitored in the supine position using 31P-NMR spectroscopy (Phillips 1.5 tesla NMR machine). Relative changes in phosphocreatine (PCr), inorganic phosphate (Pi), and intracellular pH (pHi) were obtained during stimulation and recovery, using a 1.5 cm RF surface antenna. Over the 12 stimulations, protocol A produced a significantly (p < 0.001), greater force decline (protocol A: 30.4 +/- 1.3%, protocol B: 13 +/- 0.8%); a significantly (p < 0.005), greater increase in Pi/PCr (protocol A: 210%, protocol B: 50%); and a significantly (p <0.001), lower pHi (protocol A: 6.8 +/- 0.16, protocol B: 7.03 +/- 0.12). We conclude that the shorter duty cycle produces more fatigue throughout the stimulation period, possibly as a result of greater intracellular acidosis and reduced availability of the high energy phosphate PCr. The clinical application of this finding relates to the selection of a stimulation protocol that maximizes strength gains in atrophic vs healthy muscle.

Macular corneal dystrophy in Iceland. A clinical, genealogic, and immunohistochemical study of 28 patients

BACKGROUND

The frequency of different types of macular corneal dystrophy (MCD) was determined in Iceland where MCD accounts for one third of every penetrating keratoplasty.

METHODS

The authors determined the serum levels of antigenic keratan sulfate (aKS) in 27 patients with MCD and 53 unaffected family members by an enzyme-linked immunosorbent assay that uses an anti-KS monoclonal antibody (5-D-4). The authors also stained sections from 37 corneal buttons (including 2 regrafts) from 23 patients with MCD by the avidin-biotin complex method using the same anti-KS monoclonal antibody.

RESULTS

Based on the serum analyses, 22 patients had MCD type I and 5 had MCD type II. The corneas from patients without detectable KS in the serum lacked immunohistochemical reactivity to the anti-KS antibody. Every MCD cornea examined from individuals with normal serum KS levels showed KS reactivity. All 53 unaffected siblings and parents carrying the recessive gene had normal serum KS levels.

CONCLUSIONS

Macular corneal dystrophy types I (78.6%) and II (21.4%) both occur in Iceland. Members of affected sibships had only one of these types, not both. Nine patients with MCD type I and four persons with MCD type II belonged to a large pedigree in which individuals have been traced as far back as the beginning of the 16th century. The linking of patients with MCD types I and II in an inbred pedigree suggests that both types may be manifestations of the same abnormal gene rather than independent entities. The serum KS levels were not helpful in detecting heterozygous MCD carriers.

Infantile Blount disease: long-term follow-up of surgically treated patients at skeletal maturity

Seventeen patients with infantile Blount disease who were treated by surgical correction and followed up to skeletal maturity were reviewed by clinical and radiographic examination. Patients with symptomatic knees or significant ligament instability or both underwent further evaluation by magnetic resonance imaging (MRI) or arthroscopy or both. Average age at time of initial surgery was 5.5 years and at final follow-up was 20.5 years. Average length of follow-up was 15 years. Recurrence of the deformity requiring repeated osteotomy occurred more frequently in children who underwent initial osteotomy at > 4 years of age or at Langenskiöld stage > or = III or both. Patients who underwent a single osteotomy for correction of their deformity had significantly decreased pain in the affected knee at maturity. All patients who were symptomatic or had significant knee instability or both had abnormal ligamentous, meniscal, or bony changes (or more than one of these) on MRI, which were confirmed by arthroscopy. Early surgical intervention during initial stages of the disease process will result in a decreased incidence of recurrence of deformity and decreased symptoms and knee pathology at skeletal maturity.

Arthroscopic shoulder surgery with three different laser systems: an evaluation of laser applications

Twelve cadaveric shoulder arthroscopies were performed to evaluate the use of lasers as an adjunctive tool in arthroscopic shoulder surgery. The three most common lasers historically used in orthopedic surgery were examined: Holmium:YAG, Neodymium:YAG, and the CO2. The following parameters were evaluated for each laser system: (1) ease of use of the laser system and handpiece; (2) ability to excise and trim bursae, synovium, ligament, tendon, bone, and articular cartilage; and (3) ability to contract ligaments and capsule by heat transfer. None of these lasers efficiently cut bone, whereas all three systems readily debrided the soft tissues around the shoulder. The free-beam Ho:YAG and CO2 systems heat contracted soft tissues with more control than the contact Nd:YAG. The fiberoptic delivery system of the Neodymium:YAG and Holmium:YAG laser performed well in the saline arthroscopy, and the CO2 delivery system was cumbersome. Overall, the CO2 system removed tissue better than the others, but its difficult use favored the Holmium laser as the best overall current laser system for shoulder arthroscopy.

In vitro analysis of laser meniscectomy

Partial meniscectomies were performed on 32 fresh human meniscal autopsy specimens. The following laser systems were tested: carbon dioxide (CO2), neodymium:yttrium aluminum garnet (Nd:YAG), potassium titanyl phosphate (KTP), holmium:YAG (Ho:YAG), and excimer. Meniscectomies with these lasers were compared with scalpel, mechanical, and electrocautery meniscectomies. Lasers were applied to specimens in and out of normal saline. Routine hematoxylin and eosin and sirius red sections were prepared for each specimen, and the depths of thermal changes were analyzed. Scanning electron microscopy was used to visualize the meniscectomy interface. Among these specimens, the scalpel and mechanical meniscectomies showed the least extension of cellular changes (range, 10-15 nm). The excimer laser caused the least tissue changes of the lasers tested. Tissue changes were less extensive with the pulsed CO2 laser than with the holmium:YAG, neodymium:YAG, and KTP lasers. Scanning electron microscopy showed that use of the scalpel meniscectomy resulted in the smoothest meniscectomy edge, followed by use of the excimer, CO2, holmium:YAG, neodymium:YAG, and KTP lasers. The most surface disruption occurred with electrocautery. Meniscectomies under saline required more energy and took longer in each case, with the holmium:YAG, neodymium:YAG, and CO2 laser cutting the best. Saline meniscectomies showed less thermal change. The CO2 and KTP lasers cut best in air.

The biological effects of carbon dioxide laser surgery on rabbit articular cartilage

A pulsed carbon dioxide laser made predetermined superficial and deep (subchondral) lesions through arthrotomies on the femoral condyles of adult New Zealand rabbits. Twenty rabbits, including controls, were divided into acute, 1-, 3-, 6-, and 12-month sacrifice groups. Early sacrifice groups showed some fibrous ingrowth from the deep lesions, but not the superficial lesions, and this was not seen in the 6- or 12-month groups. Cells below and adjacent to the laser lesions appeared viable when compared with controls. In each group studied, no histologic evidence of healing or fibrous covering in the superficial or deep laser lesions was found. No adverse clinical effects (synovitis, infection) were found in the laser groups, and the laser permitted excellent depth control during vaporization. However, the authors caution against irradiating articular cartilage.

The effects of the neodymium laser on meniscal repair in the avascular zone of the meniscus

Thirty mature New Zealand white rabbits were divided into four surgical groups, and a 3- to 4-mm incision was made in the inner avascular zone of the central third of the medial meniscus. In group I, the tear was not treated by lasering or suturing. In group II, the tear was sutured. Group III was given four different doses of the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser irradiation with no suturing. Group IV underwent meniscal suturing followed by the same four different laser irradiation doses. The animals were killed at 2, 4, and 6 weeks, with gross and histologic evaluation of the healing responses by group and time. The overall results showed no healing of this meniscal tear in the avascular zone. Suturing generally showed increased cellular infiltration. The varying doses of the Nd:YAG lasing demonstrated no gradient effect, and no "welding" of menisci was noted. The maximum cellular inflammatory response was noted in the sutured and lased menisci, reinforcing the importance of a stable meniscal environment for healing meniscal tears.

Discovery and characterization of an inhibitory angiotensin receptor in the guinea-pig ileum

Using nitrendipine to block the smooth muscle contractile effects of angiotensin II, it has been shown that the agonist produces a dose-related inhibitory effect on the electrically stimulated, longitudinal smooth muscle, myenteric plexus preparation from the guinea-pig. In the absence of stimulation, there is no detectable direct relaxant effect of angiotensin II on the preparation, even when it is partially contracted with carbachol, leading to the conclusion that the inhibitory effects of angiotensin are mediated via prejunctional receptors on the neuron. A number of angiotensin antagonists, including DUP753, saralasin, SKB108566 and several nonpeptide antagonists synthesized at ZENECA, have been investigated vs (1) the inhibitory effects of angiotensin II and (2) the direct contractile effects produced in unstimulated tissues in the absence of nitrendipine. A correlation curve comparing the results from the two sets of experiments gave a slope of 1.05 and a correlation coefficient of 0.99, providing very strong evidence that the two receptor systems are pharmacologically identical. The antagonists were further evaluated vs angiotensin II in the rat fundic strip in order to (1) determine whether there was any species variation in the receptor systems and (2) provide an example of a smooth muscle preparation uncomplicated by indirect effects of transmitters released by angiotensin, as has been reported in the guinea-pig ileum. An excellent correlation was obtained between the Ke values in the fundus and the guinea-pig ileum, indicating no difference in receptors between species or between neurons and smooth muscle.

Synthesis and structure-activity relationships of some 6 beta-acrylamido penicillins

Syntheses are described for penicillins (4b approximately 4i, 5a and 5b) which possess a 6 beta-(2-heteroaryl-3-substituted)-propenamido side-chain of fixed geometry. In vitro results for these compounds against a range of Gram-positive and Gram-negative bacteria showed in most cases good stability against both penicillinase and TEM-1 beta-lactamase; analogues (4b approximately 4i) bearing a 2-(2-aminothiazol-4-yl) unit showed the best intrinsic activity, the cyclohexyl compound (4b) being the most promising. The 1-acetoxyethyl ester (6) of 4b was also prepared; in experimental animal studies the in vivo properties of this compound compared favourably with cefuroxime axetil and are reported together with selected in vivo data for the other compounds.

Selectivity profile of the α2-adrenoceptor antagonist efaroxan in relation to plasma glucose and insulin levels in the rat

The effects of efaroxan (RX 821037A; 2-[2-(2-ethyl-2,3-dihydrobenzofuranyl)]-2-imidazoline HCl) at alpha 1- and alpha 2-adrenoceptors were investigated in isolated tissues, pithed rats and conscious rats. In isolated tissues, efaroxan competitively antagonised the inhibitory effects of p-aminoclonidine in the electrically stimulated (0.1 Hz) rat vas deferens, (pA2 = 8.89) and the contractile effects of phenylephrine on the rat anococcygeus muscle (pA2 = 6.03). Efaroxan had a selectivity ratio (alpha 2/alpha 1) of 724 compared to a value of 182 for idazoxan. In pithed rats, the i.v. doses of efaroxan (mumol/kg) producing 2-fold shifts in dose-response curves for UK-14,304 at prejunctional cardiac alpha 2-adrenoceptors and postjunctional vascular alpha 2-adrenoceptors, and for cirazoline at postjunctional vascular alpha 1-adrenoceptors, were 0.05, 0.13 and 2.96, respectively. In conscious fasted rats, prazosin (5 mg/kg p.o.) increased resting glucose levels and exacerbated the hyperglycaemic effects of UK-14,304 and adrenaline. In contrast, efaroxan (1-5 mg/kg p.o.) had little effect on resting plasma glucose but markedly antagonised the hyperglycaemic actions of UK-14,304 and adrenaline. Efaroxan increased resting plasma insulin levels and markedly potentiated the rise in insulin levels produced by adrenaline; this latter effect was prevented by the co-administration of propranolol. These results demonstrate that efaroxan is a potent and selective alpha 2-adrenoceptor antagonist and provide further support for the involvement of alpha 2-adrenoceptors in glucose homeostasis.

The effect of total-body irradiation on corneal neovascularization in the Fischer 344 rat after chemical cauterization

Previous investigations of corneal neovascularization after irradiation yielded discordant results. Most studies indicated that new blood vessel formation in the cornea is inhibited by irradiation. However, others reported that angiogenesis after corneal cauterization is similar in both irradiated and nonirradiated animals. To assess the effect of total-body irradiation on neovascularization further, the amount of angiogenesis was determined in irradiated rats after chemically induced corneal injury. Corneal tissue was evaluated quantitatively with computerized image analysis 2, 3, or 4 days postcautery in rats perfused with India ink and gelatin immediately after death. The rats were exposed to a single dose (9 Gy) of total-body irradiation 6 days before corneal cauterization. In both the nonirradiated and irradiated rats, neovascularization increased with the duration of the postcautery interval. The amount of corneal neovascularization was not significantly different in the irradiated and nonirradiated rats at any of the postcautery intervals studied. This investigation suggests that endothelial cell migration plays a more important role than cell replication in the pathogenesis of corneal angiogenesis in the Fischer 344 rat. Moreover, the suppression of corneal angiogenesis by irradiation may be dependent on the experimental conditions and species examined.

Synthesis and biological evaluation of 14-alkoxymorphinans, V: 6-Deoxyocyprodime, an opioid antagonist with decreased mu receptor selectivity in comparison to cyprodime

N-Cyclopropylmethyl-4,14-dimethoxymorphinan (4) and N-cyclopropylmethyl-4-hydroxy-14-methoxymorphinan (5) have been prepared from cyprodime (1) by Wolff-Kishner reduction. Pharmacological studies (mouse vas deferens and guinea pig ileum preparations) revealed that there was no significant decrease of 4 in antagonist activity but in mu selectivity when compared with 1. The phenol 5 showed partial agonism at mu, kappa and delta receptors.

(-)-N,N'-but-2-ene-1,4-diylbimorphinans

N,N'-But-2-ene-1,4-diylbimorphinans 1-3 have been synthesized and pharmacologically evaluated. Bimorphinans 1 and 3 show opioid antagonist activity and preference for mu and kappa opioid receptors in mouse vas deferens and guinea pig ileum preparations.