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Abstract  This paper explores the potential for use of an unaugmented commodity technology—the mobile phone—as a health promotion tool. We describe a prototype application that tracks the daily exercise activities of people, using an Artificial Neural Network (ANN) to analyse GSM cell signal strength and visibility to estimate a user’s movement. In a short-term study of the prototype that shared activity information amongst groups of friends, we found that awareness encouraged reflection on, and increased motivation for, daily activity. The study raised concerns regarding the reliability of ANN-facilitated activity detection in the ‘real world’. We describe some of the details of the pilot study and introduce a promising new approach to activity detection that has been developed in response to some of the issues raised by the pilot study, involving Hidden Markov Models (HMM), task modelling and unsupervised calibration. We conclude with our intended plans to develop the system further in order to carry out a longer-term clinical trial. [ABSTRACT FROM AUTHOR]

Lichen sclerosus commonly affects the genitalia of post-menopausal women. We describe a woman with painful, disseminated, bullous, extragenital lichen sclerosus that responded to oral acitretin and topical calcitriol and triamcinolone.

This study compared patient outcomes of a single surgeon experience between those with inferior and medial pedicle breast reductions. A cohort of 84 patients was analyzed. In all, 49 inferior pedicle reductions and 35 medial pedicle reductions were performed. The average weight of tissue removed per breast was 639 g with the inferior pedicle technique and 450 g with the medial pedicle technique. Nipple transposition distance averaged 8.6 cm for the inferior pedicle group and 6.3 cm for the medial pedicle group. Scar revision surgery within 18 months was required in 5.7% of the medial pedicle group as compared with 0% in the inferior pedicle group. The overall complication rate was higher for the inferior pedicle group (28.6%) compared with the medial pedicle group (14.3%). In this study, medial pedicle reductions resulted in lower complication rates. The amount of tissue removed was less with medial pedicle reductions. Hypertrophic scarring was reduced in the medial pedicle reduction mammoplasty.

On November 5, 2009, a US Army psychiatrist allegedly opened fire with one or more handguns, killing 12 military personnel and one civilian at Fort Hood in Killeen, Texas. The most severely wounded casualties were transported to Scott and White Memorial Hospital, a Level I trauma center and tertiary care teaching hospital in Temple, Texas associated with the Texas A&M University College of Medicine. Ten victims arrived in a 1-h period with another two arriving in the second hour, necessitating an emergency response to a mass casualty event. Our radiology department's response was largely unplanned and was therefore the result of many spontaneous actions and ideas. We share our experiences and from them formulate guidelines for a general radiology surge model for mass casualty events. It is our hope to raise awareness and help other radiology departments to prepare for such an unexpected event.

Leadership can be defined as not only the position of a leader, but the ability to function as one. This brief review of leadership is focused on what is involved in leading a plastic surgery unit in an institution. Characteristics of a good leader, identified by those who are being led, are discussed. In addition to that, the character of the individual leading is also reviewed, because it is such a critical ingredient in a person's capacity to lead others. Leadership characteristics can be learned and opportunities for growth in this area are discussed. The result of good leadership of a plastic surgery unit will indubitably result in the enhancement of the plastic surgery unit in an institution and plastic surgery as a specialty.

Immunoglobulin A nephropathy is now recognized as the glomerular disease most often associated with progressive renal failure in patients around the world. In many cases it is not known when the disease starts to inflict glomerular injury, but recent studies that have shown genetically determined abnormalities in glycosylation of the IgA molecule suggest that this may begin in early life. This review focuses on recent advances in our understanding of IgA nephropathy, with special emphasis on clinical aspects of the disease when it presents in children and adolescents. In addition, the sections dealing with therapeutic options for patients with IgA nephropathy concentrate on studies that have been carried out on children. Whenever possible, data from randomized controlled clinical trials have formed the basis for recommendations. Unfortunately, this is not always possible, because of the lack of such trials in patients with IgA nephropathy.

Background and Objectives: Bochdalek hernias are congenital diaphragmatic defects resulting from the failure of posterolateral diaphragmatic foramina to fuse in utero. Symptomatic Bochdalek hernias in adults are infrequent and may lead to gastrointestinal dysfunction or severe pulmonary disease. We describe our experience with this rare entity., Methods: A retrospective chart review was performed on a single patient for data collection purposes., Results: The patient is a morbidly obese 53-year-old female who presented with epigastric pain and diffuse abdominal tenderness. Computed tomography scans of the chest and abdomen revealed a small posterior diaphragmatic defect containing gastric fundal diverticulum. Laboratory work and imaging revealed no other findings. Laparoscopic repair of the Bochdalek hernia was done via an abdominal approach and utilized primary closure with an AlloDerm patch apposed to the defect. The patient has had significant clinical improvement and continues to do well at 9 months postoperatively., Conclusion: Laparoscopic repair of symptomatic adult Bochdalek hernias can be performed successfully and may result in significant clinical improvement.

A case of alopecia areata followed by relapsing polychondritis is presented. Similar cases from the literature are reviewed and speculation about the relationship of these diseases is offered. Although the occurrence of these diseases together could be coincidental, an association seems immunologically plausible. Thus, relapsing polychondritis might be an unusual systemic manifestation of alopecia areata.

The authors report the first case of perineurioma of the adrenal gland. The tumor was composed of elongated wavy spindle cells focally arranged in a fascicular pattern. It was positive for epithelial membrane antigen (EMA) and claudin-1, and was negative for S-100 protein and glial fibrillary acidic protein (GFAP). Electron microscopy showed long, slender cytoplasmic processes coated by discontinuos basal lamina and presence of many pinocytotic vesicles.

Objective: To validate a vasoepididymostomy (VE) predictor nomogram., Design: Data were collected prospectively. A previously published VE predictor model was then applied to all patients. Predicted outcomes were analyzed with respect to outcomes with consideration of actual procedures performed. The maximum follow-up was 30 months, with a median follow-up of 16 months., Setting: A tertiary referral center in central Texas., Patient(s): One hundred fifteen consecutive patients who underwent vasectomy reversals by the fibrin glue technique were included., Result(s): Forty patients who would have been predicted to require VE on one or both sides by the predictor model actually underwent vasovasostomy (VV) bilaterally. Follow-up data were available in 62% of these patients, of which 88% were patent and 52% have achieved pregnancies thus far. Seventy patients who would have been predicted to only require VV by the predictor model underwent VV. Follow-up data were available in 60% of these patients, of which 98% were patent and 36% have achieved pregnancies thus far. The five patients not accounted for included two who would have been predicted to require VV and underwent VE because of intraoperative decision making and three who were predicted to require VE and underwent VE., Conclusion(s): The predictor model designed to identify which patients need VE versus those who will need simply VV is not a reliable predictor in our patient population of patients seeking a fibrin glue vasectomy reversal.

The objective of this pictorial essay is to review uncommon abdominal hernias, many of which present to the Emergency Department with abdominal pain. These hernias may be congenital, post-traumatic, or iatrogenic in origin. They may present as an acute (surgical) abdomen without localizing signs or symptoms. They may present with an obvious antecedent event such as motor vehicle trauma or simply present as an incidental finding. Multi-detector computed tomography is currently the study of choice to diagnose abdominal hernia and to evaluate the possible complications such as small bowel obstruction and/or strangulation. This modality can delineate a "zone of transition" (abnormally dilated bowel transitioning to normal or decreased bowel caliber) or identify the involved anatomy. It can also suggest compromised blood supply.

Background: Surgical-site infection is a common postoperative nosocomial infection. Surgeons frequently treat operative patients with protective antibiotics and often choose cefazolin as the drug. Treatment schemes include both preoperative intravenous dosing and intraoperative dosing by irrigation. This study was designed to measure cefazolin concentrations both in serum and in wound drain fluid after intravenous dosing and after irrigation., Methods: The authors conducted an institutional review board-approved study involving randomized allocation of breast reduction patients to group 1 (preoperative intravenous dosing) or group 2 (intraoperative dosing by irrigation). Each patient had serum and wound drainage specimens measured over time for cefazolin concentrations. Cefazolin dosing was based on preparations commonly used in the authors' hospital. Results from 24 patients are reported., Results: Patients treated by conventional preoperative intravenous dosing displayed the expected serum degradation curve. These patients also demonstrated wound drainage concentrations (peak, 22.49 microg/ml) for approximately 4 to 5 hours. Measured concentrations were above the minimum therapeutic concentration (8 microg/ml) for Staphylococcus aureus. Patients treated by wound irrigation also demonstrated serum concentrations above minimum therapeutic concentration. In addition, these patients' wound drain fluid demonstrated very high cefazolin concentrations (peak, 4185.93 microg/ml), which remained high for 24 hours., Conclusions: Protective cefazolin concentrations in the wound can be achieved by both intravenous and irrigation delivery. Wound irrigation produces higher concentrations for longer periods of time.

Use of information technology in diabetes management has been shown to improve self-care. We determined whether enhancing type 2 diabetes (T2DM) self-care with a personal digital assistant (PDA) by patients in the ambulatory setting would improve glycemic control. A pretest/posttest intervention study was conducted in four family practice clinics in a large multispecialty group practice associated with an 186,000-member Health Maintenance Organization. Adults with T2DM and last measured glycosylated hemoglobin (HbA1c) of > or = 8.00% received one-on-one training on the use of a loaned PDA pre-installed with "Diabetes Pilot." Changes in HbA1c and other outcomes were assessed at 6 months from baseline for all participants and by participant-reported PDA use patterns, dichotomized into high PDA users (> or =3 days in past 7) and low PDA users (< 3 days). Of 43 subjects enrolled, 18 (41.90%) completed the 6-month intervention. Their mean HbA1c decreased 17.50% from 9.70% at baseline to 8.00%, a significant mean HbA1c change of -1.7% (95% CI = -2.60 to -0.90). The mean HbA1c change was higher among reported high PDA users (n = 9, mean difference = -1.90, 95% CI = -3.20 to -0.50) than among reported low PDA users (n = 9, mean difference = -1.50, 95% CI = -2.80 to -0.30). Significant increases were reported for the foot care and general diet subscales of the Summary of Diabetes Self-Care Activities from 3 to 6 months. Enhancing T2DM self-care by adults with a PDA was associated with significant reductions in HbA1c; the reductions were greater among reported high PDA users.

Background: A recently published study from our laboratory demonstrated that morphine sulfate (MS) attenuates microvascular hyperpermeability after hemorrhagic shock in rats. MS binds to the mu receptors located on the surface of endothelial cells. Activation of the endothelial cell mu receptors has been shown by several investigators to stimulate adenylate cyclase. We hypothesize that MS binding to the mu receptor on endothelial cells increases cyclic adenosine monophosphate via adenylate cyclase activation. Cyclic adenosine monophosphate inhibits the phosphoinositide/MAP kinase hyperpermeability pathway via the protein kinase A (PKA)-dependent inhibition of Raf-1., Methods: Studies were conducted in five groups of urethane-anesthetized Sprague-Dawley rats: Group 1--control group, Group 2--a non-receptor-blocking adenylate cyclase inhibitor: SQ22536, at 100 microg/kg (n = 5), Group 3--a PKA inhibitor: H89, at 10 microg/kg, Group 4--a morphine sulfate (10 microg/kg) and PKA inhibitor group, and Group 5--an adenylate cyclase inhibited and morphine (10 microg/kg) group. Intravital microscopy in mesenteric postcapillary venules and rat lung microvascular endothelial cell monolayers were used to measure permeability., Results: Adenylate cyclase and PKA inhibition resulted in vascular hyperpermeability., Conclusion: Our data demonstrated an increase in vascular hyperpermeability after inhibition of adenylate cyclase via SQ22536, a nonreceptor inhibitor. This increase in hyperpermeability was attenuated when treated with MS. Morphine did not attenuate hyperpermeability after blockage following PKA with H89 suggesting the action of MS is upstream of PKA and PKA dependent.

Background: Sestamibi scanning is commonly used for preoperative localization in patients with hyperparathyroidism. However, 12% to 15% of these studies are equivocal or negative. Ultrasound may also be used to identify patients suitable for a minimally invasive parathyroidectomy., Methods: Data from patients treated for hyperparathyroidism between January 2000 and April 2006 were reviewed retrospectively. Sestamibi and ultrasound results were scored as definitive, suggestive, or negative. Patients with suggestive or negative sestamibi scans were included in the analysis., Results: A total of 261 patients underwent operation without a definitively localizing sestamibi scan. Preoperative neck ultrasound was performed in 80 of these patients. Overall, ultrasound was either conclusive or suggestive in 45 of 80 patients (56%) without a definitively localizing sestamibi scan and correctly correlated with the surgical findings in 38 of 45 (84%) of these patients., Conclusion: In patients with nonlocalizing sestamibi scans, neck ultrasound increases the number of patients suitable for minimally invasive parathyroidectomy.

A 56-year-old woman with right-sided trigeminal neuralgia (TN), who underwent technically uneventful percutaneous balloon rhizotomy, developed significant bilateral pulsatile tinnitus on the first post-operative day. Although the patient reported significantly improved neuralgia, auscultation revealed a right facial bruit. Magnetic resonance angiography (MRA) of the face and brain demonstrated prominent right facial and jugular venous vascularity. Catheter angiography confirmed the suspected facial arteriovenous fistula (AVF). A transarterial approach was used to explore the AVF which arose from a laceration of the right internal maxillary artery and which fistulized directly with the pterygoid venous plexus. Endosurgical repair utilizing three non-fibered platinum coils was done under conscious sedation at the same setting as the diagnostic angiogram. Angiographically, the fistula was obliterated, and the patient's bruit and tinnitus immediately resolved. Follow-up MRA at 3.5 months was normal, and, the patient had no clinical symptoms of recurrent AVF. In conclusion facial AVF can complicate percutaneous trigeminal rhizotomy. Iatrogenic facial AVF can be repaired via an endovascular approach.

Persistent hiccups have been reported to occur occasionally during rehabilitation hospitalizations. Hiccups can interfere with patient participation and progress, and this can lengthen and complicate the rehabilitation hospitalization. Chlorpromazine, the only Food and Drug Administration-approved agent specifically indicated for hiccups, is often chosen as a first-line treatment. However, chlorpromazine does not always provide favorable results. The intent of this paper is to (1) review hiccups and implications of persistent hiccups in the rehabilitation setting, (2) provide additional evidence that chlorpromazine is often not the best treatment choice for hiccups in rehabilitative patients, (3) report the effectiveness and favorable tolerability of modest doses of gabapentin in a small case series of three patients, and (4) review potentially effective treatment approaches for hiccups.

We report the first case of a leiomyoma of the urinary bladder studied by cytogenetics. In comparison with cytogenetic changes of leiomyomas of other sites, the karyotype of the tumor was unusual: 47,XX,+7/89 approximately 93,XXXX,-1,+7,+7,add(12)(q23.4),+add(12)(q23.4),-18,-21,+idic(21)(p11.2),-22.

Composite rhabdoid tumors are typically adult tumors that contain a component of rhabdoid cells, which are characteristic of the aggressive childhood malignant rhabdoid tumor. Pediatric rhabdoid tumors are characterized by the inactivation of the hSNF5/INI1/SMARCB1 gene, with subsequent loss of expression of the protein. In contrast, only a single composite rhabdoid tumor has demonstrated involvement of the INI1 gene. In our study, INI1 protein expression was studied in 2 uterine carcinosarcomas with rhabdoid components (composite rhabdoid tumors). The rhabdoid component of 1 tumor showed lack of immunoreactivity for the INI1 protein and strong positivity for cyclin D1, whereas the adenocarcinomatous component of the tumor and both components of the second tumor were immunoreactive for the INI1 protein and negative for cyclin D1. Loss of one INI1 allele and a mutation in exon 7 of the remaining allele were detected in the first tumor, consistent with the immunohistochemistry results. Our results demonstrate that deletions and mutations of the INI1 gene can occur also in rare composite rhabdoid tumors of adulthood. Further studies are necessary, however, to determine the prognostic significance of this finding.

Anthrax infections are frequently associated with severe and often irreversible hypotensive shock. The isolated toxic proteins of Bacillus anthracis produce a non-cytokine-mediated hypotension in rats by unknown mechanisms. These observations suggest the anthrax toxins have direct cardiovascular effects. Here, we characterize these effects. As a first step, we administered systemically anthrax lethal toxin (LeTx) and edema toxin (EdTx) to cohorts of three to twelve rats at different doses and determined the time of onset, degree of hypotension and mortality. We measured serum concentrations of the protective antigen (PA) toxin component at various time points after infusion. Peak serum levels of PA were in the microg/mL range with half-lives of 10-20 minutes. With doses that produced hypotension with delayed lethality, we then gave bolus intravenous infusions of toxins to groups of four to six instrumented rats and continuously monitored blood pressure by telemetry. Finally, the same doses used in the telemetry experiments were given to additional groups of four rats, and echocardiography was performed pretreatment and one, two, three and twenty-four hours post-treatment. LeTx and EdTx each produced hypotension. We observed a doubling of the velocity of propagation and 20% increases in left ventricular diastolic and systolic areas in LeTx-treated rats, but not in EdTx-treated rats. EdTx-but not LeTx-treated rats showed a significant increase in heart rate. These results indicate that LeTx reduced left ventricular systolic function and EdTx reduced preload. Uptake of toxins occurs readily into tissues with biological effects occurring within minutes to hours of serum toxin concentrations in the microg/mL range. LeTx and EdTx yield an irreversible shock with subsequent death. These findings should provide a basis for the rational design of drug interventions to reduce the dismal prognosis of systemic anthrax infections.

Fatalities due to anthrax are associated with severe hypotension suggesting that the toxins generated from Bacillus anthracis, lethal toxin (LeTx) and edema toxin (EdTx), have cardiovascular effects. Here, we demonstrate the effects of these toxins and characterize their effects by echocardiography. LeTx leads to a significant reduction in ejection fraction, decreased velocity of propagation (diastolic dysfunction), decreased velocity of circumferential fiber shortening (decreased contractility), and increased LV systolic area (pathophysiology). EdTx leads to a significant reduction in left ventricular volumes and cardiac output (reduced stroke volume) but does not cause significant change in ejection fraction or contractility. These results indicate that LeTx reduces left ventricular systolic function and EdTx reduces preload but does not have direct myocardial effects. Together, these findings suggest that LeTx and EdTx exert distinct hemodynamic dysfunction associated with anthrax infection.

Imiquimod, an immune response modifier approved for the treatment of external genital warts, actinic keratoses, and superficial basal cell carcinoma, can induce a severe local inflammatory response. This phenomenon can accompany inappropriately overzealous, as well as entirely conventional, drug utilization. Despite strikingly brisk reactions, the 9 patients reported herein ultimately experienced excellent cosmetic and clinical outcomes. We report this series to alert clinicians of the good prognosis for a satisfactory outcome even when faced with extreme imiquimod cream-induced inflammation.

A 9-month-old boy presented with multiple hemorrhagic subcutaneous nodules after treatment with oral antibiotics for an upper respiratory tract infection. Excessive bleeding after an incisional biopsy led to a diagnosis of hemophilia A. While this was an unexpected presentation of hemophilia, screening laboratory coagulation studies prior to biopsy would have revealed the etiology. Similar presentations should alert dermatologists to suspect an underlying coagulation defect prior to biopsy, thus averting bleeding complications.

A case of solitary fibrous tumor of the pleura with the karyotype 46,XY,t(8;12)(p11.2;q24.3) is reported. Although rearrangement of 12q15 approximately 24 is a recurring abnormality in solitary fibrous tumors, rearrangement of chromosome 8 was previously unreported in these tumors.

We present the first case of a vulvar leiomyoma studied by cytogenetics. The tumor formed a 3.0-cm periurethral nodule in a middle-aged woman and was positive for the muscle markers desmin and caldesmon, and for estrogen and progesterone receptors. Its karyotype was 46,XX,t(7;8)(p13;q11.2). This translocation has not been described in previously reported leiomyomas, regardless of their site of origin. The transcription factor PLAG1 gene at 8q12 was not altered by the translocation.

A clonal deletion (21)(q21.2q22.12) was detected as a sole cytogenetic abnormality in a lobular capillary hemangioma (pyogenic granuloma) of the nasal cavity. This finding supports a neoplastic, rather than reactive, nature for this lesion. To our knowledge, these rare lesions have not previously been studied by cytogenetics.

Extramedullary plasmacytomas in posttransplant patients are rarely encountered. We present the fifth case of a primary cutaneous plasmacytoma (posttransplant lymphoproliferative disorder, plasmacytoma-like) that developed in a heart transplant patient. The tumor presented as a solitary nodule of the skin 10 years after transplantation. It subsequently involved 2 other cutaneous sites and remained confined to the skin for 5 years. The neoplastic cells were Epstein-Barr virus small RNAs (EBER 1,2) positive and EBV-latent membrane protein 1 (LMP 1) negative, corresponding to type I EBV latency. The direct role of EBV in the development of the tumor remains uncertain.

Introduction: We determined whether family physicians (FPs) who distribute free sample medications are more likely to prescribe those medications than physicians who do not., Methods: We reviewed administrative health plan prescription data of three similar clinics with 23 FPs within a comprehensive health care delivery system. Only clinic X physicians dispensed free sample medications. To determine which prescribed medications to study, the sample medications log from clinic X was categorized. The 25 sample medications most frequently dispensed by category were selected as study medications. Outcome measures included the number, proportion, cost, and formulary status of study medications prescribed and the average 30-day prescription costs., Results: Physicians at clinic X prescribed the largest proportion of prescriptions for study medications, the smallest proportion of preferred name brands among study medications, and had the highest costs for prescriptions of non-listed formulary study medications (P < .0001). The average 30-day prescription costs differed significantly by clinic (P < .0001), with clinic X being the highest. There was a significant association between the number of samples dispensed and the number of prescriptions written for study medications by physicians at clinic X (P = .006)., Conclusions: Our data support the conclusion that FPs who distribute free samples are more likely to prescribe those medications than their counterparts who do not.

This report describes a family demonstrating an unusual association of retinitis pigmentosa and hypogammaglobulinemia. The proband in this family suffered from another rare illness, ie, Sertoli cell only syndrome. The incidence of retinitis pigmentosa is 1 in 5,000 and that of common variable immunodeficiency state is 1 in 100,000, making a chance association of these illnesses very unlikely.

Morphine sulfate is often administered for patients requiring surgical intervention for the control of hemorrhage. Recent data implicate morphine as an immune modulator that affects white blood cells and increases infection rates. In addition, morphine releases histamine, an inflammatory mediator that increases microvascular permeability. Both of these actions of morphine could aggravate the inflammatory progress after hemorrhagic shock. In this study, we evaluated the role of morphine sulfate on microvascular permeability and its effects on leukocyte adherence after hemorrhagic shock. After a control period, blood was withdrawn to reduce the mean arterial blood pressure to 40 mm Hg for 1 h in urethane-anesthetized Sprague-Dawley rats. Mesenteric postcapillary venules in a transilluminated segment of small intestine were examined to quantify changes in permeability and leukocyte adherence. The rats received an IV injection of fluorescein isothiocyanate-bovine albumin during the control period. The fluorescent light intensity emitted from the fluorescein isothiocyanate-bovine albumin was recorded with digital microscopy within the lumen of the microvasculature and compared with the intensity of light in the extraluminal space over time. These images were downloaded to a computerized image analysis program that quantitates changes in light intensity. This change in light intensity represents albumin extravasation. In addition, bright-field images were recorded on compact disk for playback to determine leukocyte adherence. Leukocytes stationary for more than 30 s or longer in a 100-micron segment of venule was considered adherent. Our results demonstrated a marked increase in fluorescein isothiocyanate-bovine albumin leakage into the extravascular space after hemorrhagic shock. Hemorrhagic shock was also associated with an increase in leukocytes adhering to the postcapillary venular endothelium. Morphine sulfate 10 microg/kg given before the shock period, attenuated both the hyperpermeability (P < 0.05) and the increase in leukocyte adherence (P < 0.05) after hemorrhagic shock. These results suggest that instead of aggravating the inflammatory response after hemorrhagic shock, morphine may provide protection to the microvasculature.

Objective: The purpose of this study was to assess changes in knowledge and attitudes before and after a large-scale sex education curriculum that was implemented by an academic medical center., Study Design: Middle school students were surveyed regarding demographics, knowledge, attitudes, and behaviors. All grade levels at each campus completed a presurvey on the same day before any of the 2-week curricula were received. Postsurveys were taken on the day after the last lesson., Results: Surveys were completed by 26,125 students before and 24,550 students after a sex education curriculum. Knowledge improved (P < .001) for all grades, based on paired comparisons for each group. Although most students chose the option to wait until after high school graduation to have sex, significantly more students held this opinion after the program (P < .0001). Variables that were associated with the attitude of delaying sex included making a pledge (odds ratio, 7.4; 95% CI, 6.7-8.2), original parents still married (odds ratio, 1.6; 95% CI, 1.1-2.1), attending weekly religious/church services (odds ratio, 1.5; 95% CI, 1.3-1.6), and watching 0 to 2 hours of television on school nights (odds ratio, 1.4; 95% CI, 1.2-1.5). Self-reported "less than C" students showed the least knowledge improvement and the belief that teens should "have sex whenever they want" at a greater percentage than other academic levels., Conclusion: Implementation of a sex education curriculum by an academic medical center to adolescents resulted in increased knowledge and a shift in attitude toward delaying sexual activity.

Many cases of testicular trauma secondary to munitions have been reported. We report a case of a 37-year-old man who suffered testicular trauma as a result of a less-lethal munition projectile. With the advent, and increased use, of less-lethal munitions by the military and law enforcement agencies, more of these new subsets of genitourinary trauma patients who will require care are sure to result.

Background: Cervical cancer screening guidelines were created to help healthcare professionals in appropriate screening utilizing the PAP test. However, significant variation in cervical cancer screening among primary care physicians has been noted. Knowledge of the awareness of and adherence to cervical cancer screening guidelines by primary care physicians will help determine how best to disseminate and educate these physicians regarding the guidelines in hopes of reducing unnecessary screening and improving screening for under screened populations., Methods: A cross-sectional, mailed survey involving Family Medicine (FP), Community Internal Medicine (CIM), and Obstetrics/Gynecology (OB) physicians practicing in a large University-affiliated, multi-specialty group practice associated with an 186,000-member HMO in Central Texas (n = 177) was conducted in 2001-2002., Results: Most physicians performed PAP testing (50.4%). PAP screening was noted to vary significantly by specialty (P < 0.0001). All OBs were aware of at least one published guideline, compared to 96% of FPs and 91% of CIMs (P < 0.05). A wide variation was reported regarding adherence to published guidelines. In addition, there was significant intraspecialty variation regarding adherence to the physicians' own specialty's guidelines., Conclusions: While most physicians in the primary care setting perform PAP tests and are aware of published guidelines for PAP screening, adherence to the published guidelines varies considerably even in the same clinical setting.

A retrospective chart review was performed on 54 patients with positive urine cultures during a 1-year period to assess the clinical significance of Aerococcus urinae. Based on predetermined criteria, patients were classified into 2 groups: those with urinary tract infections (UTIs) and those who were considered colonized. The majority of the patients were > or =65 years old and were female. Only 31% of patients with UTI and 45% of colonized patients had A. urinae isolated in pure cultures. Both groups had significant but similar underlying medical conditions, with urologic conditions being predominant. Significantly more patients in the UTI group had urinary catheters (P < .01). No direct complications or invasive disease was recognized in either group regardless of whether patients were treated with antibiotics. Apparently, A. urinae is a relatively avirulent organism when cultured from urine.

Objective: To assess changes in knowledge and attitudes of adult groups before and after attending an educational presentation on adolescent sexual health., Study Design: A diverse group of adults attended the presentations and completed a presurvey and postsurvey containing 10 knowledge questions, 3 opinion questions, and demographics., Results: Survey forms were completed by 3661 participants before and 3605 participants after 62 educational programs during the 2002 to 2003 school year. Adult participants consisted of school employees, adults attending parent presentations, health care professionals, adults at community presentations, and teachers. Presurveys revealed a significant lack of information by all groups, with health care professionals answering 37.9% and other adults answering 30.2% correct. All groups demonstrated significant (P = .0005) improvements in knowledge and a shift in attitude, favoring the delay of sexual activity until at least after high school from 94% before the survey to 98% after the survey (P < .0001) and the delay until marriage from 77% to 91.5% (P < .0001)., Conclusion: Educating adults on the ramifications of adolescent sexual activity results in significant increases in knowledge and the proportion who think teens should delay sexual activity.

We sought to evaluate the clinical and radiographic outcomes in patients treated with a medial displacement transverse osteotomy of the second metatarsal to correct transverse hammer toe deformities. Eighteen patients underwent 20 procedures in 3 years. Each patient had a transverse plane deformity of the second metatarsophalangeal joint. Evaluation consisted of clinical examination, radiographic examination, and self-reported pain and function parameters. Mean +/- SD follow-up was 2.5 +/- 1.0 years. Radiographic joint congruence improved from 20% before surgery to 95% after surgery. Clinical examination revealed a rectus digit in 85% of cases, a transverse plane deviation in 10%, and a residual hammer toe deformity in 5%. At follow-up, the mean +/- SD visual analog scale score for pain with activity was 2.2 +/- 2.8 and for pain at rest was 0.6 +/- 1.4. Ninety-five percent of the patients said that they would undergo the procedure again. Medial displacement osteotomy for transverse plane deformity of the second metatarsophalangeal joint is a reliable procedure, with substantial improvement in joint congruence and self-reported pain.

One of the most common causes of small bowel obstruction in newborns is ileal atresia, and one of the most common causes of colonic obstruction in neonates is aganglionic megacolon (Hirschsprung disease). However, atresias of the small intestinal tract associated with Hirschsprung disease are extremely rare. We describe an infant born with both ileal atresia and Hirschsprung disease. This is the 19th known report of the case of an infant who had ileal atresia associated with Hirschsprung disease.

Chronic fatigue is considered a complex symptom for which currently there is no curative treatment available. Oxidative stress plays an important role in the etiology of fatigue and antioxidant treatment might be a valuable therapeutic approach. The Kani, a tribal high altitude living population in southern India, traditionally use the seeds of Trichopus zeylanicus to combat fatigue. In this study, the antioxidant properties of Trichopus zeylanicus were established on free radicals (DPPH and ABTS), its ability to reduce iron, lipoxygenase activity and hydrogen peroxide-induced lipid peroxidation. The effects of Trichopus zeylanicus on reactive oxygen species induced plasmid DNA (pBR322) cleavage were also investigated. Trichopus zeylanicus significantly scavenged free radicals, reduced lipid peroxidation and inhibited lipoxygenase activity. Trichopus zeylanicus also exhibited iron-chelating activity and inhibited reactive oxygen species induced DNA damage. Trichopus zeylanicus contains NADH, polyphenols and sulfhydryl compounds, which have the ability to scavenge reactive oxygen species suggesting that the antioxidant activity may be an important mechanism of action of Trichopus zeylanicus to combat fatigue., (Copyright (c) 2005 John Wiley & Sons, Ltd.)

Background: Sweet's syndrome, originally described as an acute febrile neutrophilic dermatosis, belongs to a class of skin lesions that histologically have intense epidermal and/or dermal inflammatory infiltrate of neutrophils without evidence of infection or vasculitis. Skin lesions of Sweet's syndrome most commonly present on the face, trunk, upper extremities, and hands. The presenting lesions are often confused with infections because of their clinical appearance., Methods: A retrospective search of the electronic medical record was performed to identify patients with Sweet's syndrome from 1996 to the present. These records were then reviewed to identify those patients who had Sweet's syndrome that involved the hands., Results: A total of 103 patients with Sweet's syndrome have been seen and treated at Scott and White Memorial Hospital since 1996. Of these, 49 patients had lesions on the hands. The presentation, treatment, and outcomes of several of these patients are presented., Conclusions: As physicians responsible for the treatment of hand lesions, it is important to consider the diagnosis of Sweet's syndrome because these wounds are unresponsive to antibiotics, do not benefit from débridement, and instead, require treatment with steroids.