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Objective: Negative pressure wound vacuum therapy can expedite the healing of complex wound failures. Our aim was to evaluate the use of a vacuum-assisted closure (VAC) device to treat complex wound failures in gynecologic oncology patients., Methods: We retrospectively identified 27 patients with gynecologic malignancies in whom the device was used to treat complex wound failures from January 2001 to May 2002 at our institution. We analyzed operative data and information regarding the diagnosis and management of these complex wound failures and the length of time the device was used., Results: The procedures performed before wound VAC placement were total abdominal hysterectomy with bilateral salpingo-oopherectomy with or without tumor reductive surgery in 14 patients, vulvectomy with or without inguinal lymph node dissection in five patients, skin or myocutaneous grafting in three patients, parastomal herniorrhaphy in two patients, retroperitoneal lymph node dissection in two patients, and incision and drainage of a gluteal abscess after radiation therapy in one patient. Four of the 27 patients had the VAC device placed at the time of a reoperation, while the remaining 23 patients had the VAC device placed postoperatively for wound failures. Wound breakdown occurred at a median of 9 days (range: 0-88 days) postoperatively. Overall, there was a 96% reduction (range: 0-100%) in the median size of wound defects from 330 to 14.0 cm(3) with use of the VAC device. The median number of days of VAC therapy was 32 days (range: 3-88 days). Twenty patients used this device as outpatients, and the charge per day was approximately US$150.00. One patient experienced bleeding, and 26 patients experienced no complications. The only complaint was pain during dressing changes (67% of patients). The mean follow-up was 52 days (range: 0-270 days). At the time of last contact, 26 (96%) of 27 patients had complete wound healing., Conclusions: VAC therapy is a novel treatment using controlled negative pressure to evacuate wound fluid, stimulate granulation tissue, and to decrease bacterial colonization of the wound. Our experience indicates that this is a safe method to treat complex wound failures in gynecologic oncology patients.

Background: In today's mobile society, international travel and immigration are becoming increasingly more common. This poses an additional challenge to the clinician to expand the differential diagnosis to include diseases endemic to the area of travel., Observation: We present a case of malaria and tuberculosis in a 16-year-old African male immigrant. He had several encounters with the health care system for complaints of nonspecific symptoms for which he was treated with antibiotics without follow-up., Conclusion: Clinicians should take a complete history and expand their differential diagnosis to include diseases endemic to the country of origin and/or travel when treating an international patient. This not only will allow prompt treatment of the patient's condition but also will address public health concerns.

Although great progress in neuroanatomy and physiology has occurred lately, we still cannot go directly to those levels to discover the neural mechanisms of higher cognition and consciousness. But we can use neurocomputational methods based on these details to push this project forward. Here we describe vector subtraction as an operation that computes sequential paths through high-dimensional vector spaces. Vector-space interpretations of network activity patterns are a fruitful resource in recent computational neuroscience. Vector subtraction also appears to be implemented neurally in primate frontal eye field activity, which computes dimensions of saccadic eye movements. We use this apparent neural implementation as a model and construct from it a general neurocomputational account of an important type of sequential cognitive and conscious process. We defend the biological plausibility of all components of the general model and show that it yields testable anatomical and physiological predictions. We close by suggesting some interesting consequences for consciousness if our model characterizes correctly the neural mechanisms producing a common type of episode in our conscious streams., (Copyright 2000 Academic Press.)

The growth substance auxin mediates many cellular processes, including division, elongation and differentiation. PSIAA6 is a member of the Aux/IAA family of short-lived putative transcriptional regulators that share four conserved domains and whose mRNAs are rapidly induced in the presence of auxin. Here PSIAA6 was shown to serve as a dominant transferable degradation signal when present as a translational fusion with firefly luciferase (LUC), with an in vivo half-life of 13.5 min in transgenic Arabidopsis seedlings. In a transient assay system in tobacco protoplasts using steady-state differences as an indirect measure of protein half-life, LUC fusions with full-length PSIAA6 and IAA1, an Aux/IAA protein from Arabidopsis, resulted in protein accumulations that were 3.5 and 1. 0%, respectively, of that with LUC alone. An N-terminal region spanning conserved domain II of PSIAA6 containing amino acids 18-73 was shown to contain the necessary cis-acting element to confer low protein accumulation onto LUC, while a fusion protein with PSIAA6 amino acids 71-179 had only a slight effect. Single amino acid substitutions of PSIAA6 in conserved domain II, equivalent to those found in two alleles of axr3, a gene that encodes Aux/IAA protein IAA17, resulted in a greater than 50-fold increase in protein accumulation. Thus, the same mutations resulting in an altered auxin response phenotype increase Aux/IAA protein accumulation, providing a direct link between these two processes. In support of this model, transgenic plants engineered to over-express IAA17 have an axr3-like phenotype. Together, these data suggest that rapid degradation of Aux/IAA proteins is necessary for a normal auxin response.

Chlamydomonas reinhardtii is a single-celled green alga that phototaxes toward light by means of a light-sensitive organelle, the eyespot. The eyespot is composed of photoreceptor and Ca(++)-channel signal transduction components in the plasma membrane of the cell and reflective carotenoid pigment layers in an underlying region of the large chloroplast. To identify components important for the positioning and assembly of a functional eyespot, a large collection of nonphototactic mutants was screened for those with aberrant pigment spots. Four loci were identified. eye2 and eye3 mutants have no pigmented eyespots. min1 mutants have smaller than wild-type eyespots. mlt1(ptx4) mutants have multiple eyespots. The MIN1, MLT1(PTX4), and EYE2 loci are closely linked to each other; EYE3 is unlinked to the other three loci. The eye2 and eye3 mutants are epistatic to min1 and mlt1 mutations; all double mutants are eyeless. min1 mlt1 double mutants have a synthetic phenotype; they are eyeless or have very small, misplaced eyespots. Ultrastructural studies revealed that the min1 mutants are defective in the physical connection between the plasma membrane and the chloroplast envelope membranes in the region of the pigment granules. Characterization of these four loci will provide a beginning for the understanding of eyespot assembly and localization in the cell.

This article will present a new soft tissue cephalometric analysis tool. This analysis may be used by the orthodontist and surgeon as an aid in diagnosis and treatment planning. The analysis is a radiographic instrument that was developed directly from the philosophy expressed in Arnett and Bergman "Facial keys to orthodontic diagnosis and treatment planning, Parts I and II" (Am J Orthop Dentofacial Orthod 1993; 103:299-312 and 395-411). The novelty of this approach, as with the "Facial Keys" articles, is an emphasis on soft tissue facial measurement.

We employ computer simulation to investigate the function of neural circuitries between thalamic sensory relay nuclei, primary sensory cortices, and the thalamic reticular nucleus (TRN). Computational similarities exist between these circuits and the architecture of a simple artificial neural network. We impose processing parameters on this network architecture in keeping with anatomical and physiological details of the mammalian geniculo-cortical visual pathway, and then run the simulation on a task involving multiple simultaneous inputs from the simulated visual field. After two to three loops through the simulation, activity in cortical and thalamic units whose receptive fields include the stronger stimulus remains constant, while activity in other cortical and thalamic units activated by weaker stimuli declines toward resting values. These results suggest that the modeled neural circuitry functions to "prime" selective attentional mechanisms further up the visual streams toward specific portions of the total visual stimulus. Besides extending existing models and evidence about the function of these neural circuits, our results also provide physiologists with predicted activity profiles of thalamic and cortical elements of the modeled neural system for a task not yet studied experimentally.

Mechanical stimulation of airway epithelial cells generates the Ca2+ mobilization messenger inositol 1,4,5-trisphosphate and the protein kinase (PK) C activator diacylglycerol. Inositol 1,4,5-trisphosphate diffuses through gap junctions to mediate intercellular communication of the mechanical stimulus (a "Ca2+ wave"); the role that diacylglycerol-activated PKC might play in the response is unknown. Using primary cultures of rabbit tracheal cells, we show that 12-O-tetradecanoylphorbol 13-acetate- or 1, 2-dioctanyl-sn-glycerol-induced activation of PKC slows the Ca2+ wave, decreases the amplitude of induced intracellular free Ca2+ concentration ([Ca2+]i) increases, and decreases the number of affected cells. The PKC inhibitors bisindolylmaleimide and Gö 6976 slowed the spread of the wave but did not change the number of affected cells. We show that ATP-induced [Ca2+]i increases and oscillations, responses independent of intercellular communication, were inhibited by PKC activators. Bisindolylmaleimide decreased the amplitude of ATP-induced [Ca2+]i increases and blocked oscillations, suggesting that PKC has an initial positive effect on Ca2+ mobilization and then mediates feedback inhibition. PKC activators also reduced the [Ca2+]i increase that followed thapsigargin treatment, indicating a PKC effect associated with the Ca2+ release mechanism.

The Treatment Motivation Survey questionnaire is presented as a treatment planning tool designed to assist the patient and doctor in defining treatment expectations. With the Treatment Motivation Survey, motivation and expectations are mutually understood, and the treatment plan is successfully designed. Responses to the Treatment Motivation Survey questionnaire can also reveal patients whose expectations are unrealistic.

The ubiquitin pathway targets proteins for degradation through the post-translational covalent attachment of the 76 amino acid protein ubiquitin to epsilon-amino lysyl groups on substrate proteins. Two instability determinants recognized by the ubiquitin pathway in Saccharomyces cerevisiae have been identified. One is described by the N-end rule and requires specific destabilizing residues at the substrate protein N-termini along with a proximal lysyl residue for ubiquitin conjugation. The second is a linear uncleavable N-terminal ubiquitin moiety. The ability of these two determinants to function in higher plants was investigated in tobacco protoplast transient transfection assays using DNA encoding variants of well characterized reporter enzymes as substrates: firefly luciferase that is localized to peroxisomes (pxLUC), a cytosolic version of LUC (cLUC), and Escherichia coli beta-glucuronidase (GUS). cLUC with phenylalanine encoded at its mature N-terminus was 10-fold less abundant than cLUC with methionine at its mature N-terminus. GUS with phenylalanine encoded at its mature N-terminus was 3-fold less abundant than GUS with methionine at its mature N-terminus. The presence of a uncleavable N-terminal ubiquitin fusion resulted in 50-fold lower protein accumulation of cLUC, but had no effect on GUS. Both instability determinants had a much larger effect on cLUC than on pxLUC, suggesting that these degradation signals are either unrecognized or poorly recognized in the peroxisomes.

Based on the content of this article, the reader should be able to (1) describe the symptoms of malignant hyperthermia (MH); (2) describe the use of dantrolene in the treatment of MH; (3) explain the history of the Malignant Hyperthermia Association of the United States; (4) list the recommended contents of an MH emergency cart; and (5) explain how to plan a mock MH crisis drill.

We present the radiographic findings of six patients with central cementoossifying fibromas of the maxilla. CT typically demonstrated large, spherical tumors in the maxillary alveolar ridge, filling and expanding the maxillary sinus and extending to involve the ipsilateral hard palate. The central tumors ranged from having soft-tissue density with scattered foci of high density to being heavily calcified.

Pedicled transfer of the temporalis muscle has proven to be a reliable and versatile procedure in reconstructive craniomaxillofacial surgery. Excluding those complications related to the coronal incision, little specific attention has been given in the literature to the prevention or treatment of the esthetic defect that remains after muscle transfer. This article describes a case in which block porous high-density polyethylene was used to eliminate the residual defect of the anterior temporal fossa after transmaxillary pedicled transfer for closure of a large oral-antral communication. The implant provided an esthetically pleasing augmentation of the defect. A discussion and analysis of the implant materials available for reconstruction of this region is also presented.

For a 'control' week, all bleep calls a surgical house officer received were charted without the nurses' knowledge and graded according to an arbitrary scale of usefulness. Also recorded were time of day, the person bleeping and whether the house officer was involved in patient care. A system was then tried in a later 'test' week, whereby only the nurse in charge would bleep the house officer and a board was placed on the house officer's own two wards where tasks could be written. Again all calls were recorded. This led to a decrease in inappropriate bleep calls from the nurses (58 per cent falling to 15 per cent p < 0.01) and a fall in numbers of nurses' bleep calls by two-thirds before 5 pm (p < 0.01). There was also a decrease in the number of bleeps when the house officer was directly involved in patient care (46 per cent falling to 28 per cent). The nurses in charge were agreeable to the changes. The entire study was repeated by another house officer with similar results. There has been little research on the disruption caused by the bleep and we believe that by this simple policy the house officers' day can be disrupted far less.