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Interruption
Kinds of Interruption Selected AbstractsAcquired Thoracic Aortic Interruption: Percutaneous Repair Using Graft StentsCONGENITAL HEART DISEASE, Issue 1 2009Lucy E. Hudsmith MA, MRCP ABSTRACT Two adult patients with isolated, aortic interruption were successfully treated by percutaneous insertion of graft stents. Prior to the intervention, both patients were hypertensive and on medication. In both cases, an ascending aortogram demonstrated a blind ending of the thoracic aorta distal to the left subclavian artery with a large gradient across the interruption and with multiple collaterals. A graft stent was successfully deployed across the interrupted segment in both cases. We believe that this is one of the first reported cases of percutaneous stenting of aortic interruption and represents a promising new therapeutic option for these adult patients. [source] Interruption and Imagination in Curriculum and Pedagogy, or How to Get Caught Inside a Strange LoopCURRICULUM INQUIRY, Issue 3 2010RUBÉN A. GAZTAMBIDE-FERNÁNDEZ First page of article [source] Worsening of Left Ventricular End-Systolic Volume and Mitral Regurgitation without Increase in Left Ventricular Dyssynchrony on Acute Interruption of Cardiac Resynchronization TherapyECHOCARDIOGRAPHY, Issue 7 2009Suman S. Kuppahally M.D. Background: Responders to cardiac resynchronization therapy (CRT) have greater left ventricular (LV) dyssynchrony than nonresponders prior to CRT. Aim: We conducted this study to see whether the long term responders have more worsening of LV dyssynchrony and LV function on acute interruption of CRT. Materials and Methods: We identified 22 responders and 13 nonresponders who received CRT as per standard criteria for 23.73 ± 7.9 months (median 24.5 months). We assessed the acute change in LV function, mitral regurgitation (MR) and compared LV dyssynchrony in CRT on and off modes. Results: On turning off CRT, there was no significant worsening of LV dyssynchrony in both responders and nonresponders. The dyssynchrony measurements by SPWMD, TDI and 3D echocardiography did not correlate significantly. LVESV increased (p = 0.02) and MR (p = 0.01) worsened in CRT-off mode in responders only without significant change in LVEF or LV dimensions. Discussion and Conclusion: In long-term responders to CRT, there is alteration in the function of remodeled LV with acute interruption of CRT, without significant worsening of LV dyssynchrony. The role of different echocardiographic parameters in the assessment of LV dyssynchrony remains controversial. Even after long-term CRT reversely remodels the LV, the therapy needs to be continued uninterrupted for sustained benefits. [source] Rectal Absorption of Lamotrigine Compressed TabletsEPILEPSIA, Issue 7 2000Angela K. Birnbaum Summary: Purpose: Interruption of oral drug administration poses a significant clinical problem for antiepileptic drugs that have no parenteral formulation. If a drug is absorbed rectally, rectal administration can be a useful alternative when the oral route of administration is not possible. The purpose of this study was to compare the single-dose pharmacokinetics of la-motrigine (LTG) compressed tablets after rectal and oral administration in healthy volunteers. Methods: A single LTG compressed tablet (100 mg) was administered orally and rectally to 12 volunteers in this single-dose, two-period, crossover study with a 2-week washout between doses. For rectal administration, tablets were crushed and suspended in 10 mL of water. Plasma samples were collected from 0 to 120 hr after each dose and analyzed for LTG by an HPLC method developed for this investigation. Results: LTG plasma concentrations were lower after rectal administration versus oral administration. The average area under the curve was 28.90 ± 9.5 ,g/mL/hr after rectal administration and 51.71 ± 19.2 ,g/mL/hr after oral administration. The average maximum LTG concentration was 0.53 ± 0.14 ,g/mL after rectal administration and 1.45 ± 0.35 ,g/mL after oral administration. The relative bioavailability for LTG compressed tablets was 0.63 ± 0.33 for rectal administration. There were no drug-related rashes or serious side effects. Conclusions: LTG suspension prepared from LTG compressed tablets is absorbed rectally, although not to the same extent or rate as when given orally. [source] Maternal Encounters: The Ethics of Interruption.HYPATIA, Issue 3 20101995: A Study in Transformative Politics., By LISA BARAITSER, Feminist Mothering in Theory, Practice First page of article [source] An empirical test of source,sink dynamics induced by huntingJOURNAL OF APPLIED ECOLOGY, Issue 5 2005ANDRÉS J. NOVARO Summary 1Under the source,sink model, persistence of populations in habitat sinks, where deaths outnumber births, depends on dispersal from high-quality habitat sources, where births outnumber deaths. The persistence of the regional population depends on the proportion of sink relative to source habitat. 2Hunting that occurs in some parts of the landscape and not in others can create patches where deaths outnumber births. We tested whether hunting of culpeo foxes Pseudalopex culpaeus, which is patchily distributed in relatively homogeneous habitat in Argentine Patagonia, induces source,sink dynamics. 3On Patagonian sheep ranches, culpeos are hunted for fur and to protect sheep, and on cattle ranches hunting is usually banned. We monitored culpeo densities using scent stations and estimated survival, fecundity and dispersal by radio-tracking 44 culpeos and analysing carcasses collected from hunters on two cattle and four sheep ranches between 1989 and 1997. 4Survival of juvenile culpeos was lower on hunted than unhunted ranches, mainly as a result of hunting mortality. Reproduction could not compensate for high mortality on hunted ranches. Interruption of hunting led to an increase in juvenile survival, indicating that hunting and natural mortality were not compensatory. We concluded that sheep ranches were sinks because of the high mortality and that sink populations may be maintained by dispersal from cattle ranches. 5We used a simulation model to assess implications of changes in the proportion of source and sink areas on population dynamics. The percentage of land on cattle ranches in the study area was 37%. Current hunting pressure on culpeos would not be sustainable if that percentage fell below 30%. 6Synthesis and applications. Source,sink dynamics may occur in landscapes where hunting is intense and spatially heterogeneous. Wildlife management traditionally monitors demographic rates to evaluate the sustainability of hunting, but our results suggest that the size and spatial arrangement of areas with and without hunting should be considered as well. In regions where enforcement and monitoring are limited, securing large and regularly distributed source areas for hunted species may be more effective than trying to regulate harvest size. [source] Discontinuation of penicillamine in the absence of alternative orphan drugs (trientine,zinc): a case of decompensated liver cirrhosis in Wilson's diseaseJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 1 2007C. C. Ping MPharm Summary Objectives:, To report a case of early-decompensated liver cirrhosis secondary to discontinuation of penicillamine therapy in a patient with Wilson's disease. Case summary:, A 33-year-old Chinese female patient was diagnosed with Wilson's disease, for which penicillamine 250 mg p.o. once daily was prescribed. However, the patient developed intolerance and penicillamine was discontinued without alternative treatment. Five months later, she developed decompensated liver cirrhosis with hepatic encephalopathy. Eventually, the patient died because of the complications of sepsis and decompensated liver failure. Discussion:, Chelating agent is the mainstay of treatment in Wilson's disease, which is an inherited disorder of hepatic copper metabolism. Therapy must be instituted and continued for life once diagnosis is confirmed. Interruption of therapy can be fatal or cause irreversible relapse. Penicillamine given orally is the chelating agent of first choice. However, its unfavourable side-effects profile leads to discontinuation of therapy in 20,30% of patients. In most case reports, cessation of penicillamine without replacement treatment causes rapid progression to fulminant hepatitis, which is fatal unless liver transplantation is performed. Conclusion:, In this, we highlight a case of discontinuation of penicillamine in a patient with Wilson's disease without substitution with alternative regimen. This was caused by unavailability of the alternative agents such as trientine in our country. Consequently, the patient progressed to decompensated liver cirrhosis with encephalopathy and eventually passed-away within 5 months. One recent study supports a combination of trientine and zinc in treating patient with decompensated liver cirrhosis. This combination is capable of reversing liver failure and prevents the need of liver transplantation. Both trientine and zinc are not registered in Malaysia. Therefore, liver transplantation was probably the only treatment option for this patient. Hence, non-availability of orphan drugs in clinical practice is certainly a subject of serious concern. Systems for better management of patients with rare diseases need to be instituted by all the institutions concerned. [source] Sonography of thyroid nodules with peripheral calcificationsJOURNAL OF CLINICAL ULTRASOUND, Issue 6 2009Minjung Park MD Abstract Purpose. This study was designed to assess the role of sonography (US) in the differentiation of benign from malignant thyroid nodules with peripheral calcifications. Methods. Sixty-four thyroid nodules with peripheral calcifications that were detected on US were included in the study. Nineteen nodules (30%) were benign, and 45 nodules (70%) were malignant. We retrospectively compared the US findings of the benign and malignant nodules, including interruption, thickening (,0.5 mm and over more than 50% of the circumference) of calcifications, internal echogenicity, margin, and presence of cystic change, size, and shape. Univariate and multivariate logistic regression analyses were performed. Results. Interruption of peripheral calcifications was more common in malignant nodules (84%) than in benign nodules (53%) (OR, 7.9; 95% CI, 1.3,48.4; p < 0.05). Thickening of the peripheral calcification was seen more frequently in malignant nodules (64%) than in benign nodules (11%) (OR, 14.7; 95% CI, 1.8,117.5; p < 0.05). For internal echogenicity, malignant nodules (58%) were more often hypoechoic than benign nodules (OR, 23.6; 95% CI, 2.2,256.3; p < 0.01). The mean tumor size was 1.1 cm for malignant nodules and 1.2 cm for benign nodules (p > 0.05). There were no significant differences for the presence or absence of cystic change, size, shape, and margin between malignant and benign nodules. Conclusion. Interruption and thickening of peripheral calcifications and decreased internal echogenicity of a thyroid nodule with peripheral calcifications are in favor of malignancy. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2009 [source] Enamel Fluorosis Prevalence after a 7-year Interruption in Water Fluoridation in Jaú, São Paulo, BrazilJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 4 2004Manila A. R. Buzalaf DDS ABSTRACT Objectives: This paper analyzes the impact of a 7-year interruption in water fluoridation on the prevalence of enamel fluorosis in Jaú, state of São Paulo, Brazil. Methods: Fluorosis prevalence (TF index) was evaluated in permanent maxillary central incisors of children (9,14 years old) that were 36 (n=81; cohort -36), 27 (n=81; cohort -27), and 18 months old (± 1 month; n=89; cohort,18) in October 1991, when the break started, and 18 months old (± 1 month; n=70; cohort 18) after that date. Children brushed their teeth prior to examination, which was conducted under natural light by three calibrated examiners (agreement 87.8,93.8%, kappa 0.72,0.85). Results: The fluorosis prevalence (TF,1) was 7.41 percent, 3.70 percent, 7.87 percent, and 18.57 percent, respectively, for cohorts -36, -27, -18, and 18. The difference between cohort 18 and the other groups was statistically significant (Kruskall-Wallis test, P=.05). Conclusions: These results suggest that the fluoridated water is not an important risk factor for enamel fluorosis, since the prevalence of enamel fluorosis was low in the cohorts -36, -27, and -18 when fluoridated water was used. [J Public Health Dent 2004;64(4):205,8]. [source] Administration of 5% human serum albumin in critically ill small animal patients with hypoalbuminemia: 418 dogs and 170 cats (1994,2008)JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 2 2010Fabio Viganó DVM, SCMPA Abstract Objectives , To describe the administration of 5% human serum albumin (HSA) in 588 critically ill hypoalbuminemic dogs and cats, and report outcome to discharge, changes in albumin concentration, and adverse effects during hospitalization. Design , Retrospective clinical study. Setting , Private emergency and general veterinary center. Animals , Client-owned dogs and cats. Interventions , None. Measurements and Main Results , The medical records of 588 critically ill hypoalbuminemic animals (418 dogs and 170 cats) were reviewed. All animals had hypoalbuminemia (serum albumin <20 g/L [2.0 mg/dL]) at admission, received an infusion of 5% HSA, and received no other colloid infusion. The HSA solution was administered through a peripheral vein at 2 mL/kg/h for 10 h/d (total volume 20 mL/kg/d) until albumin reached 20 g/L. The number of days of HSA infusion (median and range) was 4 days (2,11 d) for dogs and 3 days (2,7 d) for cats. Three hundred and sixteen dogs (75.6%) survived to discharge; 56 of 418 (13.4%) died in hospital. One hundred and twenty-three cats (72.3%) survived to discharge; 21 of 170 (12.4%) died in hospital. Severe hypersensitivity reactions such as anaphylaxis, angioedema, and urticaria were not noted. Interruption of albumin infusion and specific treatment of reactions were not required in any animal. Conclusions , In this study, administration of 5% HSA appeared to be safe in a large group of critically ill, hypoalbuminemic dogs and cats. The results should be interpreted with caution due to the retrospective, descriptive nature of the study, the absence of control groups and the lack of follow-up data, as well as the potentially life-threatening complications of HSA administration. [source] Impact of Temporary Interruption of Right Ventricular Pacing for Heart Block on Left Ventricular Function and DyssynchronyPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1 2010WEN-JING HONG M.D. Background:The increasing data suggest an association between chronic right ventricular (RV) and left ventricular (LV) dysfunction. We sought to determine the effect of temporary interruption of long-term RV pacing on LV function and mechanical dyssynchrony in children and young adults with complete heart block. Methods:Twelve patients aged 20.0 ± 7.4 years with congenital heart block (group I) and six patients aged 22.7 ± 11.0 years with surgically acquired heart block (group II) with RV pacing were studied. The pacing rate was reduced to less than patient's intrinsic heart rate and maintained for 5 minutes. The LV ejection fraction (EF), three-dimensional systolic dyssynchrony index (SDI), two-dimensional global longitudinal strain and strain rate, and Doppler-derived isovolumic acceleration before and after interruption of RV pacing were compared. Results:The LVEF and GLS increased while QRS duration decreased after the pacing interruption in both the groups (all P < 0.05). While SDI decreased in both groups I (6.8 ± 2.3%, 3.8 ± 0.8%, P = 0.001) and II (9.2 ± 4.1%,5.0 ± 1.6%, P = 0.032), it remained higher in group II than in group I (P = 0.046) after the pacing interruption. The prevalence of LV dyssynchrony (SDI > 4.7%) decreased in group I (83%,25%, P = 0.006) but not in group II (67%,50%, P = 0.50). The %increase in LVEF correlated positively with %reduction of LV SDI (r = 0.80, P = 0.001). Conclusions:Temporary interruption of chronic RV pacing acutely improves LV dyssynchrony and systolic function in children and young adults, the magnitude of which is greater in patients with congenital than those with surgically acquired heart block. (PACE 2010; 41,48) [source] Xylem sap flow as a major pathway for oxygen supply to the sapwood of birch (Betula pubescens Ehr.)PLANT CELL & ENVIRONMENT, Issue 11 2003D. GANSERT ABSTRACT The role of xylem sap flow as an aqueous pathway for oxygen supply to the wood parenchyma of Betula pubescens saplings was investigated. Using micro-optode sensors the oxygen status of the sapwood was quantified in relation to mass flow of xylem sap. Sap flow was gradually reduced by an increasing oxygen depletion in the root space. The effect of sap flow on radial O2 transport between stem and atmosphere was assessed by a stoichiometrical approach between respiratory CO2 production and O2 consumption. Restriction of sap flow set in 36.5 h after the onset of O2 depletion, and was complete after 71 h. Interruption of sap flow drastically increased the O2 deficit in the sapwood to 70%. Sap flow contributed about 60% to the total oxygen supply to the sapwood. Diurnal O2 flow rates varied between 3 and 6.3 nmol O2 m,2 leaf area (LA) s,1 during night- and daytime, respectively. Maximum O2 flow rates of 20 nmol O2 m,2 LA s,1 were reached at highest sap flow rates of 5.7 mmol H2O m,2 LA s,1. Sap flow not only affected the oxygen status of the sapwood but also had an effect on radial O2 transport between stem and atmosphere. [source] Infection of onion leaves by Alternaria porri and Stemphylium vesicarium and disease development in controlled environmentsPLANT PATHOLOGY, Issue 3 2000H. Suheri Infection of onion by Alternaria porri and Stemphylium vesicarium was investigated under a range of controlled temperatures (4,25°C) and leaf wetness periods (0,24 h). Conidia of A. porri and S. vesicarium germinated within 2 h when incubated at 4°C. Terminal and intercalary appressoria were produced at similar frequencies at or above 10°C. The maximum number of appressoria was produced after 24 h at 25°C. Penetration of leaves by both pathogens was via the epidermis and stomata, but the frequency of stomatal penetration exceeded that of epidermal penetration. There was a strong correlation (R2 > 90%) between appressorium formation and total penetrations at all temperatures. Infection of onion leaves occurred after 16 h of leaf wetness at 15°C and 8 h of leaf wetness at 10,25°C, and infection increased with increasing leaf wetness duration to 24 h at all temperatures. Interruption of a single or double leaf wetness period by a dry period of 4,24 h had little effect on lesion numbers. Conidia of A. porri and S. vesicarium separately or in mixtures caused similar numbers of lesions. Alternaria porri and S. vesicarium are both potentially important pathogens in winter-grown Allium crops and purple leaf blotch symptoms were considered to be a complex caused by both pathogens. [source] Interruption of SOX10 function in myelinopathies,ANNALS OF NEUROLOGY, Issue 2 2010James R. Lupski MD No abstract is available for this article. [source] A child with laryngo-onychocutaneous syndrome partially responsive to treatment with thalidomideBRITISH JOURNAL OF DERMATOLOGY, Issue 6 2006R.M. Strauss Summary Laryngo-onychocutaneous syndrome (LOCS) is a condition characterized by erosive or ulcerative skin lesions associated with excessive granulation tissue, at sites of trauma such as the digits, elbows and knees. Similar lesions can occur within the conjunctival mucosa, leading to corneal scarring and blindness. The main complications, however, occur in the respiratory tract, where a similar process of erosions and subsequent formation of granulation tissue causes airway obstruction which may lead to premature death. LOCS is now believed to be a nonblistering variant of junctional epidermolysis bullosa and to date there are no efficacious treatments available. We report a 16-year-old girl with LOCS who failed to respond to methylprednisolone and cyclophosphamide, but had a partial response to oral thalidomide with marked decrease in granulation tissue and tracheal secretions. Interruption of treatment resulted in prompt resurgence of the granulation tissue which was again controlled by reintroduction of thalidomide. We propose that in the absence of effective therapies for LOCS, a trial of thalidomide in these patients should be considered. [source] Non-medically supervised treatment interruptions among participants in a universally accessible antiretroviral therapy programmeHIV MEDICINE, Issue 5 2010DM Moore Background We examined clinical outcomes, patient characteristics and trends over time of non-medically supervised treatment interruptions (TIs) from a free-of-charge antiretroviral therapy (ART) programme in British Columbia (BC), Canada. Methods Data from ART-naïve individuals ,18 years old who initiated triple combination highly active antiretroviral therapy (HAART) between January 2000 and June 2006 were analysed. Participants having ,3 month gap in HAART coverage were defined as having a TI. Cox proportional hazards modelling was used to examine factors associated with TIs and to examine factors associated with resumption of treatment. Results A total of 1707 participants were study eligible and 643 (37.7%) experienced TIs. TIs within 1 year of ART initiation decreased from 29% of individuals in 2000 to 19% in 2006 (P<0.001). TIs were independently associated with a history of injection drug use (IDU) (P=0.02), higher baseline CD4 cell counts (P<0.001), hepatitis C co-infection (P<0.001) and the use of nelfinavir (NFV) (P=0.04) or zidovudine (ZDV)/lamivudine (3TC) (P=0.009) in the primary HAART regimen. Male gender (P<0.001), older age (P<0.001), AIDS at baseline (P=0.008) and having a physician who had prescribed HAART to fewer patients (P=0.03) were protective against TIs. Four hundred and eighty-eight (71.9%) participants eventually restarted ART with male patients and those who developed an AIDS-defining illness prior to their TI more likely to restart therapy. Higher CD4 cell counts at the time of TI and unknown hepatitis C status were associated with a reduced likelihood of restarting ART. Conclusion Treatment interruptions were associated with younger, less ill, female and IDU participants. Most participants with interruptions eventually restarted therapy. Interruptions occurred less frequently in recent years. [source] Reduction of sidelobe levels in interrupted phased array antennas by means of a genetic algorithm,INTERNATIONAL JOURNAL OF RF AND MICROWAVE COMPUTER-AIDED ENGINEERING, Issue 2 2007David A. Tonn Abstract Interruptions in the regular lattice of a phased array antenna can lead to elevated sidelobe levels in the resulting antenna pattern. A method for reducing the sidelobe level in such an array is presented, based on the use of a genetic algorithm that modifies the element weights in the array. Results are presented for both scanned and unscanned arrays. © 2007 Wiley Periodicals, Inc. Int J RF and Microwave CAE, 2007. [source] Nursing Time Devoted to Medication Administration in Long-Term Care: Clinical, Safety, and Resource ImplicationsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2009Mary S. Thomson PhD OBJECTIVES: To quantify the time required for nurses to complete the medication administration process in long-term care (LTC). DESIGN: Time-motion methods were used to time all steps in the medication administration process. SETTING: LTC units that differed according to case mix (physical support, behavioral care, dementia care, and continuing care) in a single facility in Ontario, Canada. PARTICIPANTS: Regular and temporary nurses who agreed to be observed. MEASUREMENTS: Seven predefined steps, interruptions, and total time required for the medication administration process were timed using a personal digital assistant. RESULTS: One hundred forty-one medication rounds were observed. Total time estimates were standardized to 20 beds to facilitate comparisons. For a single medication administration process, the average total time was 62.0±4.9 minutes per 20 residents on physical support units, 84.0±4.5 minutes per 20 residents on behavioral care units, and 70.0±4.9 minutes per 20 residents on dementia care units. Regular nurses took an average of 68.0±4.9 minutes per 20 residents to complete the medication administration process, and temporary nurses took an average of 90.0±5.4 minutes per 20 residents. On continuing care units, which are organized differently because of the greater severity of residents' needs, the medication administration process took 9.6±3.2 minutes per resident. Interruptions occurred in 79% of observations and accounted for 11.5% of the medication administration process. CONCLUSION: Time requirements for the medication administration process are substantial in LTC and are compounded when nurses are unfamiliar with residents. Interruptions are a major problem, potentially affecting the efficiency, quality, and safety of this process. [source] Interruptions create prospective memory tasksAPPLIED COGNITIVE PSYCHOLOGY, Issue 1 2009Rahul M. Dodhia When the theory of prospective memory is brought to bear on the ubiquitous experience of failing to resume interrupted tasks, the cognitive reasons for these failures may be understood and addressed. We examine three features of interruptions that may account for these failures: (1) Interruptions often abruptly divert attention, which may prevent adequate encoding of an intention to resume and forming an implementation plan, (2) New task demands after an interruption's end reduce opportunity to interpret resumption cues, (3) The transition after an interruption to new ongoing task demands is not distinctive because it is defined conceptually, rather than by a single perceptual cue. Hypotheses based on these three features receive support from two experiments that respectively manipulate encoding and retrieval conditions. The data support our contention that interrupted tasks are a special case of prospective memory, and allow us to suggest practical ways of reducing vulnerability to resumption failure. Copyright © 2008 John Wiley & Sons, Ltd. [source] Assessment of Teacher Interruptions on Learners during Oral Case PresentationsACADEMIC EMERGENCY MEDICINE, Issue 6 2007Glen Yang BA Background:Studies have only recently begun to investigate the effects of interruptions on physicians in the emergency department (ED). Objectives:To determine the frequency and nature of interruptions by the training physician that occur when medical trainees do oral case presentations (OCPs) in the ED. Methods:This was an observational study. Learner OCPs to attending emergency physicians were observed in the ED of an urban Level 1 trauma center at a major teaching hospital. A single investigator followed attending physicians blinded to the study objective in a nonrandomized convenience sampling of all ED shifts, recording information regarding teacher interruptions during new patient presentations. Learners completed a brief questionnaire after each OCP. Results:A total of 196 OCPs were observed. The mean (±SD) duration of OCPs was 3.30 (±1.85) minutes, and the mean (±SD) number of interruptions was 0.75 (±0.60) per minute and 2.49 (±1.95) per OCP. The number of interruptions (per OCP) and duration of OCP varied by learner level of training, with more experienced learners giving shorter presentations and being interrupted less often. Frequency (per minute) of interruptions did not vary by learner level. In 40.3% of OCPs, attending physicians interrupted to give an assessment and/or a plan before the learner had done so, but 8.3% of interrupted learners believed that teacher interruptions were "disruptive" to their OCP. Conclusions:Attending emergency physicians frequently interrupt learners during new patient OCPs, with the number of interruptions varying by learner level of training. Teacher interruptions appear to have minimal, if any, detrimental effect on the perceived effectiveness of OCPs as a learning experience. [source] Teratogenic effect of bis-diamine on embryonic rat heartCONGENITAL ANOMALIES, Issue 3 2000Masao Nakagawa ABSTRACT, Bis-diamine induces conotruncal anomalies including persistent truncus arteriosus, tetralogy of Fallot, interruption of the aortic arch, and ventricular septal defect in rat embryos when administered to the mother. Bis-diamine also induces extracardiac malformations including thymic hypoplasia, facial dysmorphism, forelimb anomalies and diaphragmatic hernia. However, the teratogenic mechanisms of this chemical in early developing rat hearts have not been fully established. Chimeric studies in chick and quail embryos demonstrated that the cranial neural crest cells reached the cardiac outflow tract, contributing to aorticopulmonary and truncal septation. Since an ablation of the cranial neural crest also produced the conotruncal anomalies, bis-diamine is proposed to disturb the normal migration of cardiac neural crest cells to the heart. Based on our data concerning cardiac anomalies induced by bis-diamine, we reviewed how the cardiac malformations were morphologically established in early developing rat hearts. Our data showed that 1) cardiovascular anomalies induced by bis-diamine are time- and species or strain- dependent. 2) bis-diamine reduces the number of neural crest cells migrating to participate in the conotruncal septation, 3) bis-diamine induces anomalous coronary arteries, thin ventricular walls and epicardial defects, and 4) some embryos cultured in the medium containing bis-diamine had extra-cardiac abnormalities including abnormal location of the otic placodes and delay in mid brain closure. Conclusively, bis-diamine does not appear to merely affect the cardiac development, but rather disturbs normal development of all the organs contributed to by neural crest cells. [source] Left Ventricular Non Compaction in ChildrenCONGENITAL HEART DISEASE, Issue 5 2010Sara H. Weisz MD ABSTRACT Left ventricular non compaction (LVNC) is a myocardial disease characterized by a hypertrabeculated myocardium. The hypertrabeculations in the left ventricular wall define deep recesses communicating with the left ventricular chamber where blood penetrates with increased risk of blood clots in the meshwork of the prominent trabeculations. The left ventricular apex and the free wall are particularly affected. During in utero ventriculogenesis, myocardial blood supply is initially linked to the presence of sinusoids, in which blood penetrates and diffuses nutriments and oxygen to myocardial cells. Progressively, with the development of the heart and the increase of cells demand of blood, coronary arteries system develops. This step is associated with myocardial modification that leads to compaction of hypertrabeculated myocardial net. Probably, the premature interruption of this process leads to ventricular noncompaction. Many studies have been conducted in adults with hypertrabeculated myocardium. To date, data regarding childhood LVNC are sparse. The aim of this review is to summarize the clinical and preclinical knowledge about LVNC in children. [source] Acquired Thoracic Aortic Interruption: Percutaneous Repair Using Graft StentsCONGENITAL HEART DISEASE, Issue 1 2009Lucy E. Hudsmith MA, MRCP ABSTRACT Two adult patients with isolated, aortic interruption were successfully treated by percutaneous insertion of graft stents. Prior to the intervention, both patients were hypertensive and on medication. In both cases, an ascending aortogram demonstrated a blind ending of the thoracic aorta distal to the left subclavian artery with a large gradient across the interruption and with multiple collaterals. A graft stent was successfully deployed across the interrupted segment in both cases. We believe that this is one of the first reported cases of percutaneous stenting of aortic interruption and represents a promising new therapeutic option for these adult patients. [source] Injection Necrosis of the Glabella: Protocol for Prevention and Treatment After Use of Dermal FillersDERMATOLOGIC SURGERY, Issue 2 2006ADRIENNE S. GLAICH MD BACKGROUND Injection of filler materials into the dermis is well tolerated with few mild and transient side effects. Injection necrosis is a rare but clinically important potential complication caused by interruption of the vascular supply to the area by compression, injury, and/or obstruction of the vessel(s). The glabella is a particular danger zone for injection necrosis regardless of the type of filler used. OBJECTIVE We recommend a protocol that may be used to help prevent and treat injection necrosis of the glabella after injection with dermal fillers. CONCLUSION Injection necrosis in the glabellar region may be prevented by a knowledge of the local anatomy and an understanding of its pathophysiology and treated by a suggested protocol. [source] Pilonidal Sinus Disease Treated by Depilation Using an 800 nm Diode Laser and Review of the LiteratureDERMATOLOGIC SURGERY, Issue 5 2005Anthony V. Benedetto DO, FACP background. Pilonidal sinus disease is a debilitating, disfiguring chronic ailment that is often resistant to therapy. Its etiology and treatment remain in question. objective. To assess the efficacy of an 800 nm diode laser in the treatment of recalcitrant pilonidal sinus disease. methods. Two patients with recalcitrant pilonidal sinus disease were treated in the lower back, buttocks, and perigluteal cleft area with an 800 nm diode laser with a spot size of 9 × 9 mm, fluences of 30 to 48 J/cm2, and pulse widths of 15 to 24 milliseconds. results. Long-term relief of pilonidal sinus disease was produced with as few as two treatments 2 months apart to as many as six treatments over a 2-year period. With each successive treatment, fewer pulses were needed and the interval between treatments increased. conclusion. The 800 nm diode laser may be an effective tool in the treatment of pilonidal sinus disease. By eliminating the source of hair and hair fragments that course along the surface of the lower back and buttocks, interruption of the etiologic source for pilonidal sinus disease can be accomplished. [source] Patterns of motor disability in very preterm childrenDEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 4 2002Melanie Bracewell Abstract Motor development in very preterm children differs in several important ways from that of children born at full term. Variability is common, although the anatomic and physiologic bases for that variability are often poorly understood. Motor patterns over the first postnatal year may depend on behaviours learned during often long periods of neonatal intensive care. The normal pattern of development may be modified by disturbances of brain function caused both by the interruption of normal brain maturation ex-utero and the superimposition of focal brain injuries following very preterm birth. Abnormal patterns of development over the first year may evolve into clear neuromotor patterns of cerebral palsy or resolve, as "transient dystonias." Cerebral palsy is associated with identified patterns of brain injury secondary to ischaemic or haemorrhagic lesions, perhaps modified by activation of inflammatory cytokines. Cerebral palsy rates have not fallen as might be expected over the past 10 years as survival has improved, perhaps because of increasing survival at low gestations, which is associated with the highest prevalence of cerebral palsy. Children who escape cerebral palsy are also at risk of motor impairments during the school years. The relationship of these impairments to perinatal factors or to neurological progress over the first postnatal year is debated. Neuromotor abnormalities are the most frequent of the "hidden disabilities" among ex-preterm children and are thus frequently associated with poorer cognitive ability and attention deficit disorders. Interventions to prevent cerebral palsy or to reduce these late disabilities in very preterm children are needed. MRDD Research Reviews 2002;8:241,248. © 2002 Wiley-Liss, Inc. [source] Functional analysis in Drosophila indicates that the NBCCS/PTCH1 mutation G509V results in activation of smoothened through a dominant-negative mechanismDEVELOPMENTAL DYNAMICS, Issue 4 2004Gary R. Hime Abstract Mutations in the human homolog of the patched gene are associated with the developmental (and cancer predisposition) condition Nevoid Basal Cell Carcinoma Syndrome (NBCCS), as well as with sporadic basal cell carcinomas. Most mutations that have been identified in the germline of NBCCS patients are truncating or frameshift mutations, with amino acid substitutions rarely found. We show that a missense mutation in the sterol-sensing domain G509V acts as a dominant negative when assayed in vivo in Drosophila. Ectopic expression of a Drosophila patched transgene, carrying the analogous mutation to G509V, causes ectopic activation of Hedgehog target genes and ectopic membrane stabilisation of Smoothened. The G509V transgene behaves in a manner similar, except in its subcellular distribution, to a C-terminal truncation that has been characterised previously as a dominant-negative protein. G509V exhibits vesicular localisation identical to the wild-type protein, but the C-terminal truncated Patched molecule is localised predominantly to the plasma membrane. This finding suggests that dominant-negative function can be conferred by interruption of different aspects of Patched protein behaviour. Another mutation at the same residue, G509R, did not exhibit dominant-negative activity, suggesting that simple removal of the glycine at 509 is not sufficient to impart dominant-negative function. Developmental Dynamics 229:780,790, 2004. © 2004 Wiley-Liss, Inc. [source] Abnormalities in cardiac and respiratory function observed during seizures in childhoodDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 1 2005Mary E O'Regan MRCP MRCPCH The aim of this study was to observe any changes in cardiac and respiratory function that occur during seizures. Thirty-seven children (20 males, 17 females; median age 7y 6mo, range 1y 6mo to 15y 6mo) were studied. We recorded electroencephalograms, respiratory rate, heart rate, electrocardiograms, blood pressure, oxygen saturation, heart rate variability (time domain analysis), and cardiac vagal tone. A respiratory pause was defined as an interruption in respiration lasting more than 3s but less than 15s. Apnoea was defined as absence of respiration for more than 15s. Tachypnoea was defined as a 10% increase in respiratory rate from the pre-ictal baseline. Bradypnoea was defined as a 10% decrease in respiratory rate from the pre-ictal baseline. Significant hypoxia was defined as a saturation of less than 85%. A significant change in heart rate was taken as a 10% increase or decrease below the baseline rate. Data were obtained from 101 seizures: 40 focal seizures, 21 generalized seizures, and 40 absences. Focal seizures were frequently associated with significant respiratory abnormalities, tachypnoea in 56%, apnoea in 30%, frequent respiratory pauses in 70%, and significant hypoxaemia in 40%. The changes seen in respiratory rate were statistically significant. Changes in cardiac parameters, an increase or decrease in heart rate, were observed in only 26% of focal seizures and 48% of generalized seizures. We conclude that seizure activity can disrupt normal physiological regulation and control of respiratory and cardiac activity. [source] Continuous subcutaneous insulin infusion with short-acting insulin analogues or human regular insulin: efficacy, safety, quality of life, and cost-effectivenessDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 3 2004Régis Pierre Radermecker Abstract Portable insulin infusion devices are effective and safe insulin delivery systems for managing diabetes mellitus, especially type 1 diabetes. Rapidly absorbed insulin analogues, such as insulin lispro or insulin aspart, may offer an advantage over regular human insulin for insulin pumps. Several open-label randomised crossover trials demonstrated that continuous subcutaneous insulin infusion (CSII) with insulin lispro provided a better control of postprandial hyperglycaemia and a slightly but significantly lower glycated haemoglobin level, with lower daily insulin requirement and similar or even less hypoglycaemic episodes. A CSII study comparing insulin lispro and insulin aspart demonstrated similar results with the two analogues, and better results than those with regular insulin. Because these analogues have a quicker onset and a shorter duration of action than regular insulin, one might expect an earlier and greater metabolic deterioration in case of CSII interruption, but a more rapid correction of metabolic abnormalities after insulin boluses when reactivating the pump. These expectations were confirmed in randomised protocols comparing the metabolic changes occurring during and after CSII interruption of various durations when the pump infused either insulin lispro or regular insulin. The extra cost resulting from the use of CSII and insulin analogues in diabetes management should be compensated for by better metabolic control and quality of life. In conclusion, CSII delivering fast-acting insulin analogues may be considered as one of the best methods to replace insulin in a physiological manner by mimicking meal and basal insulin requirements, without higher risk of hypoglycaemia or ketoacidosis in well-educated diabetic patients. Copyright © 2004 John Wiley & Sons, Ltd. [source] AORTO-DUODENAL FISTULA: MULTIDETECTOR COMPUTED TOMOGRAPHY AND GASTRODUODENOSCOPY FINDINGS OF A RARE CAUSE OF UPPER GASTROINTESTINAL HEMORRHAGEDIGESTIVE ENDOSCOPY, Issue 3 2007Massimo De Filippo An aorto-enteric fistula is a serious complication of abdominal aortic aneurysm. Acute upper gastrointestinal bleeding may be a life-threatening condition that calls for immediate diagnosis and action. Morbidity and mortality remain high despite progress in diagnosis and therapeutic procedures. In the literature, the aorto-enteric fistula diagnostic suspicion by multidetector computed tomography scan is assumed on the basis of the interruption of the aortic wall, with the presence of duodenal gas situated to tightened contact with the aorta. We report a patient with an aorto-duodenal fistula associated with inflammatory abdominal aortic aneurysm detected by gastro-duodenoscopy and multidetector computed tomography scan, with gas found in the lumen of the abdominal aorta, between the aneurysm wall and the thrombus. [source] | ||||||||||||||||||||||||||||||||||||||||||||||||||||