Contemporary wound infection surveillance issues

Contemporary wound infection surveillance is inexact. Tracking down suspicious incisions with maximal accuracy to isolate the subset of healing failures attributable to established tissue invasion by infecting pathogens has a solitary purpose: to learn how to improve one aspect of surgical practice. Wound infection is always the result of complex, probabilistic interplay of numerous concealed variables. A wound infection rate, whether determined for a hospital, a specialty, a risk class, an operation type, or a surgeon, only approximates a degree of failure to achieve one kind of surgical perfection. Interpretation of any rate will be flawed if issues of accuracy and meaning are suppressed. Gathering and revealing circumstances of individual infections may heuristically affect surgical teams. Interpretation of surveillance wound infection rates, infection rate comparisons to standards as a means of performance measurement, and particularly the meaning of rate changes over time in a hospital are matters of more than academic importance. Given current health care reform and a widespread fascination with industrial process-improvement philosophy, wound infection surveillance programs may be natural test platforms for probing surgical relevance of several quality-improvement methodologies. It is not a trivial fact that wound infection shares important prototypical features with most contemporary surgical care process flaws: rare, random, multifactorial in cause, costly, and impossible to uniformly preclude or predict.

Development and validation of the Migraine-Specific Quality of Life Questionnaire

This paper describes the development and validation of a migraine-specific quality-of-life instrument that is capable of measuring health-related quality-of-life impairments attributed to migraine. Item selection, item reduction, and pretesting and finalization of items during the instrument development phase resulted in a total of 16 questions which were incorporated into the Migraine-Specific Quality of Life Questionnaire (Version 1:0) (1992 Glaxo Wellcome Inc). Three meaningful dimensions were hypothesized: Role Function-Restrictive, Role Function-Preventive, and Emotional Function. In the instrument validation phase, the Migraine-Specific Quality of Life Questionnaire was mailed to 1109 migraine patients, providing a response rate of 45% (n = 458). Initial psychometric evaluation of the questionnaire indicated that it possessed adequate reliability with Cronbach's alpha for the three dimensions ranging between 0.70 to 0.85. The Migraine-Specific Quality of Life Questionnaire possessed adequate content and criterion validity. All but three items satisfied the test of construct validity. In conclusion, the Migraine-Specific Quality of Life Questionnaire has acceptable psychometric properties and can be used to estimate the effect of migraine and its treatment on the patient's health-related quality of life.

Bone marrow immunoscintigraphy (BMIS): a new and important tool for the assessment of marrow fibrosis in renal osteodystrophy?

One of the classic histologic forms of renal osteodystrophy is osteitis fibrosa, and its distinguishing characteristic is bone marrow (BM) fibrosis, caused by the activation of marrow parenchymal cells. A bone biopsy must be performed in order to establish the diagnosis of renal osteodystrophy. The clinical use of bone biopsy is restricted, however, due to the invasiveness of the procedure. In recent studies, bone scans have provided information useful for the differential diagnosis between osteomalacia and osteitis fibrosa. However, bone scans can not provide information on the bone marrow status. Bone marrow immunoscintigraphy (BMIS) using Tc-99m anti-granulocyte antibody (AGA), a highly sensitive test for the detection of bone marrow abnormalities which is also a noninvasive method, has rarely been reported in chronic renal failure (CRF). BMIS can provide information in patients with myelofibrosis. The purpose of this study was to evaluate the usefulness of BMIS in CRF patients with special regards to biochemical parameters. Nineteen CRF patients (13 men, 6 women; mean age: 48 +/- 11 years) in whom bone scintigraphy using Tc-99m MDP (methylene diphosphonate) showed the so-called superscan pattern were included in the study. Their primary renal diseases were chronic glomerulonephritis (n = 14), diabetes (n = 4), and polycystic kidney disease (n = 1). Modes of therapies were continuous ambulatory peritoneal dialysis (CAPD) (n = 13; mean duration: 9.5 months), HD (n = 5; mean duration: 7.8 months), and conservative treatment (n = 1). BMIS using Tc-99m labeled anti-granulocyte monoclonal mouse antibody BW250/183 was performed, and the results were compared with the biochemical parameters of the patients. According to the presence of BM expansion, which may represent marrow fibrosis, the 19 patients were divided into two groups: Group I (n = 7) with BM expansion and Group II (n = 12) with normal marrow distribution. The biochemical parameters and bone markers of Group I were compared with those of Group II. There was no significant difference in biochemical parameters (blood hemoglobin, serum ferritin, erythropoietin, BUN, creatinine) between the two groups. There were no significants difference in serum calcium, phosphorus, tartate-resistant acid phosphatase (TRAP), and intact parathyroid hormone (iPTH) between the two groups. Serum alkaline phosphatase (ALP) and osteocalcin were significantly (P < 0.05) higher in Group I than in Group II. These results suggest that patients with bone marrow expansion in BMIS have increased levels of ALP and osteocalcin, indicating an increased osteoblastic activity. BMIS may be useful for the detection of bone marrow expansion due to marrow fibrosis in renal osteodystrophy, and for the evaluation of the extent of bone marrow fibrosis.

Stability of Octastatin, a somatostatin analog cyclic octapeptide, in aqueous solution

In this study, the degradation of Octastatin, a cyclic octapeptide analog of somatostatin, was examined as a function of pH, temperature, buffer, and ionic strength by reversed-phase gradient high-performance liquid chromatography. Degradation of Octastatin followed a first-order kinetics. Various buffer species such as acetate, ammonium acetate, citrate, glutamate, phosphate, and borate showed differing effects on the degradation of the octapeptide. Good stability was found in glutamate and acetate buffer of pH 4.0. Degradation of Octastatin was greater in citrate- or phosphate-containing buffers than in glutamate or acetate buffers. With phosphate buffer, higher buffer concentration caused greater degradation, while in acetate buffer, the effect of buffer concentration and ionic strength was negligible. In addition, the degradation of Octastatin was markedly inhibited by increasing the concentration of glutamate buffer. This study allows the prediction of good stability in acetate buffer (0.01 M, pH 4.0) with a t90% of 84.1 days at 20 degrees C.

Optic nerve hypoplasia secondary to intracranial teratoma

PURPOSE

To postulate a causal relation between optic nerve hypoplasia and a suprasellar teratoma.

METHOD

Case report.

RESULTS

A 6-month-old infant with suprasellar teratoma was visually inattentive and had searching nystagmus. He had moderately severe, bilateral optic nerve hypoplasia with the left eye being somewhat worse than the right eye.

CONCLUSIONS

Optic nerve hypoplasia is a major cause of impaired vision in children and rarely has been attributed to an intracranial tumor. Our case, involving a patient with a suprasellar teratoma and optic nerve hypoplasia, supports a causal relation between the two.

Epibulbar hemangiopericytoma

PURPOSE

To report a case of an epibulbar hemangiopericytoma that appeared clinically as a firm nodule.

METHODS

We examined a 28-year-old man with a 5-year history of a gradually enlarging red, firm epibulbar nodule. Excisional biopsy was performed.

RESULTS

Histopathology identified an encapsulated hemangiopericytoma. Eight-year follow-up showed no recurrence postresection.

CONCLUSIONS

Epibulbar hemangiopericytoma is rare and has a good prognosis after resection. The smaller size and more conspicuous location of epibulbar hemangiopericytomas may lead to relatively early treatment and account for a more favorable prognosis.

PET study of the localization and laterality of lingual somatosensory processing in humans

Regional cerebral blood flow (rCBF) was measured using positron emission tomography (PET) during four tasks in right-handed volunteers with eyes closed: resting, protruding the tongue, stroking the left side of the protruding tongue, and stroking the right side of the protruding tongue. The primary somatosensory tongue representation (S1) mapped to the contralateral central sulcus (Brodmann (BA) 3/4) at approximately 28 mm above the intercommissural plane. Of note, stimulation of the left side of the tongue produced also an ipsilateral S1 response. Analysis of variance (ANOVA) of rCBF at S1 across all four conditions yielded only a significant effect for tongue stimulation, with no effect of laterality; the usually large asymmetries (contralateral >> ipsilateral) in S1 did not surface. We hypothesize that this atypical activation pattern arises from the tongue's specialization for language.

Sonographic findings in tuberculous epididymitis and epididymo-orchitis

PURPOSE

This paper presents the sonographic findings in scrotums of patients affected with tuberculous epididymitis or epididymo-orchitis.

METHODS

Eighteen patients with a total of 22 abnormal hemiscrotums (4 patients had bilateral lesions) underwent scrotal sonography. Pathologic confirmation was obtained via epididymectomy in 10 cases, epididymo-orchiectomy in 7 cases, and scrotal exploration and biopsy in 3 cases. The histopathologic diagnosis was tuberculous epididymitis in 12 cases and epididymo-orchitis in 8 cases.

RESULTS

Lesions involved the head of the epididymis in 8 cases, the tail in 5 cases, and the entire epididymis in 9 cases. The enlarged epididymis was hypoechoic in 13 cases, hyperechoic in 2 cases, and of mixed echogenicity in 7 cases. The echotexture was heterogeneous in 17 cases and homogeneous in 5 cases. Testicular involvement in 7 cases appeared as a diffusely enlarged hypoechoic testis in 2 cases, an ill-defined hypoechoic lesion in 1 case, a well-demarcated hypoechoic lesion in 2 cases, and multiple small hypoechoic nodules in an enlarged testis in 2 cases. Hydrocele, sinus tract, and extratesticular calcifications were seen in 12, 4, and 2 cases, respectively.

CONCLUSIONS

The heterogeneous and hypoechoic swelling of the epididymis or the concomitant hypoechoic lesion of the testis with associated sinus tract or extratesticular calcifications may be helpful in the diagnosis of tuberculous epididymitis or epididymo-orchitis, especially in patients with known genitourinary tuberculosis.

In vivo antitumor effect of cationic liposomes containing diphtheria toxin A-chain gene on cells infected with bovine leukemia virus

A plasmid pLTR-DT which contained a gene for diphtheria toxin A-chain (DT-A) under the control of the long terminal repeat (LTR) of bovine leukemia virus (BLV) (BLV-LTR) in the multicloning site of pUC-18 was entrapped in cationic liposomes composed of N-(alpha-trimethylammonioacetyl)-didodecyl-D-glutamate chloride (TMAG), dioleoyl phosphatidylethanolamine (DOPE) and dilauroyl phosphatidylcholine (DLPC) (1:2:2, molar ratio) (TMAG-liposome), and their antitumor effect on BLV-infected tumor cells was examined in vivo. The cationic TMAG-liposome containing pLTR-DT was successively injected into the tumor transplanted to nude mice. The growth of tumor was significantly inhibited by the injection of cationic TMAG-liposome containing pLTR-DT. On the other hand, TMAG-liposome containing pUC18 plasmids showed no such effect. These results suggest that a DT-A expression plasmid under the control of BLV-LTR is highly toxic to the BLV-infected tumor cells, and that the cationic liposomes, such as TMAG-liposome, may be efficient transfection reagent for BLV-infected tumor cells and can be utilized for DT-A gene delivery into BLV-infected tumor cells in vivo.

Reversed-phase high-performance liquid chromatography of radioiodinated salmon calcitonins

Reversed-phase HPLC conditions for simultaneous separation of salmon calcitonin, mono- and di-radioiodinated salmon calcitonins and their tryptic digested fragments have been developed. Salmon calcitonin was radioiodinated with Na125I by the iodo-beads method. After solid-phase extraction from the reaction mixtures using C18 Bond Elut cartridges, mono- and di-radioiodinated salmon calcitonins were separated from each other, as well as from unlabeled salmon calcitonin, on a Bondclone 10 C18 column (300x7.8 mm I.D.) by isocratic elution with 0.1% trifluoroacetic acid in 34% aqueous acetonitrile. The characteristics of either iodinated peptides or unlabeled salmon calcitonin were evaluated on the basis of UV absorbance (215 and 280 nm), fluorescence (lambda(ex)=282 nm, lambda(em)=310 nm) and measurement of specific radioactivity by means of a flow-through radio-isotope detector. HPLC separation of a tryptic digest of iodinated salmon calcitonin fraction on a W-porex 5 C18 300 A column (250x4.6 mm I.D.) and subsequent amino acid analysis, led to the conclusion that radioiodination took place at the Tyr residue and not at the His moiety.

Small arterial-portal venous shunts: a cause of pseudolesions at hepatic imaging

PURPOSE

To compare hepatic angiographic findings of small arterial-portal venous shunts with those of other imaging modalities, and to determine whether these shunts are related to hepatocellular carcinoma.

MATERIALS AND METHODS

At hepatic angiography in 223 patients, small arterial-portal venous shunts not directly related to hepatocellular carcinoma and focal areas of parenchymal contrast material enhancement more than 1 cm in diameter were found in 28 patients. These 28 patients were prospectively evaluated with computed tomography (CT) during arterial portography (CTAP) (n = 12), CT after iodized oil administration (n = 23), intraoperative ultrasonography (n = 5), or follow-up hepatic angiography (n = 13). Magnetic resonance (MR) images (n = 10) and dynamic CT scans (n = 4) in these patients were retrospectively reviewed.

RESULTS

Arterial-portal venous shunts noted at angiography manifested as perfusion defects at CTAP in 10 patients and as an area of arterial contrast enhancement at dynamic CT in three patients. No lesion was seen at MR imaging, and no persistent iodized oil uptake was seen at CT. There was no evidence of hepatocellular carcinoma tumor growth around the shunts at follow-up angiography, and no tumor was present at surgery.

CONCLUSION

Understanding of the hemodynamic changes caused by these small shunts can aid in the interpretation of vascular imaging findings.

Gene transfection by cationic liposomes: comparison of the transfection efficiency of liposomes prepared from various positively charged lipids

We compared the transfection efficiency of four types of positively charged liposomes composed of (i) N-(alpha-trimethylammonioacetyl)-didodecyl-D-glutamate chloride (TMAG), dilauroylphosphatidylcholine (DLPC), and dioleoylphosphatidylethanolamine (DOPE) (1:2:2 molar ratio); (ii) 3 beta [N-(N', N'-dimethylaminoethane)-carbamoyl] cholesterol (DC-Chol) and DOPE (3:2 molar ratio); (iii) dimethyldioctadecylammonium bromide (DDAB) and DOPE (1:2.2 molar ratio); (iv) N-[1-(2,3-dioleyloxy) propyl]-N,N,N-trimethylammonium chloride (DOTMA) and DOPE (1:1, w/w; lipofectin). Luciferase gene was used as a reporter gene. Among the cationic lipsomes used, the liposomes composed of TMAG, DOPE and DLPC showed a much higher efficiency of plasmid DNA entrapment than the other cationic liposomes tested. In the absence of serum, the cationic multilamellar vesicles (MLV) and small unilamellar vesicles (SUV) composed of TMAG, DOPE and DLPC gave highly efficient transfection. On the other hand, MLV, dehydration-rehydration vesicles (DRV), and SUV liposomes prepared with the mixtures of DC-Chol and DOPE showed similar levels of transfection efficiency. However, the cationic liposomes composed of DDAB and DOPE showed inferior efficiency, whether in the form of DRV, SUV or MLV. The transfection efficiency of lipofectin was also low. In the presence of serum, on the other hand, a considerable (about 30-50%) amount of transfection activity was still observed at 10% fetal calf serum in the cationic MLV and SUV composed of TMAG, DOPE and DLPC. Cationic MLV, composed of TMAG, DOPE and DLPC, Cationic MLV, composed of TMAG, DOPE and DLPC, can transfect plasmid DNA, not only in the adherent cell lines but also, in the suspension cell lines. These findings indicate that the transfection efficiency of cationic liposomes is affected by the lipid composition, the type of liposome, or the presence or absence of serum. They also indicate that the cationic liposomes containing TMAG, DOPE and DLPC are efficient vectors for gene transfer into cells.

Comparison of the use of the transrectal surface coil and the pelvic phased-array coil in MR imaging for preoperative evaluation of uterine cervical carcinoma

OBJECTIVE

The purpose of this study was to compare the accuracy of fast spin-echo MR imaging that uses a transrectal surface coil with the accuracy of fast spin-echo MR imaging that uses a pelvic phased-array coil for preoperative local staging of uterine cervical carcinoma.

MATERIALS AND METHODS

Sixty-two patients with pathologically confirmed invasive cervical carcinoma who underwent MR imaging using both a pelvic phased-array coil and a transrectal surface coil were retrospectively evaluated. Both sets of images were reviewed in random order by three observers who then reached a consensus opinion at a second session. Among the 28 patients who underwent radical hysterectomy, findings from MR imaging and pathologic staging were compared. In the remaining nonsurgical cases, findings from MR imaging using a transrectal surface coil and MR imaging using a pelvic phased-array coil were compared with findings from pelvic examinations under general anesthesia.

RESULTS

MR imaging using a transrectal surface coil revealed 50 (88%) of the 57 tumors found at surgery, and MR imaging using a pelvic phased-array coil revealed 44 (77%) of the 57 tumors, resulting in a statistically significant (p < .05) difference. In patients who underwent surgery (n = 28), the accuracy of the overall staging and the parametrial evaluation were not significantly different for MR imaging using a transrectal surface coil and MR imaging using a pelvic phased-array coil (89% and 96%, respectively, on MR imaging using a transrectal surface coil; 89% and 93%, respectively, on MR imaging using a pelvic phased-array coil). For the patients who did not undergo surgery (n = 34), MR imaging using a transrectal surface coil and MR imaging using a pelvic phased-array coil corresponded in 82% for overall staging and in 92% for parametrial invasion.

CONCLUSION

The use of a transrectal surface coil improved detection of small tumors of the uterine cervix but did not significantly improve the accuracy of overall staging or the accuracy of assessment of parametrial invasion.

MR imaging of male infertility with an endorectal surface coil

The purpose of this study was to define the abnormal findings of the prostate and seminal tract on magnetic resonance (MR) imaging by using an endorectal coil in patients with suspected obstructive infertility. MR imaging of the seminal tract with an endorectal surface coil was performed on 20 consecutive patients who were suspected of having obstructive infertility. Diffuse atrophy of the seminal vesicles (SVs) was seen in eight patients (40%) and was the most prevalent abnormal finding. It was most often associated with an irregular thickening of the vasa deferentia and small prostate (n = 4; 20%). Other abnormal findings were two mullerian duct cysts; and four cases of the aplasia of SV and vasa deferentia, three of which were associated with rudimentary mesonephric duct. MR imaging of the seminal tract with an endorectal surface coil can clearly demonstrate the various abnormalities of the seminal tract in obstructive infertility.

Radionuclide therapy of skin cancers and Bowen's disease using a specially designed skin patch

Skin cancer is the most common malignancy in humans. Therapeutic modalities for skin cancer are local destruction, radiotherapy and surgery. External radiation therapy leads to good results, however, generally 5-6 wk of treatment is needed to deliver optimal radiation dose to tumors. In this study, a beta-emitting radionuclide, 166Ho, impregnated in a specially designed patch, was used on superficial skin cancers and Bowen's disease for local irradiation.

METHODS

Ten mice with chemically induced skin tumors were studied. Five-millimeter size patches containing 22.2-72.15 MBq (0.6-1.95 mCi) 166Ho were applied to the tumor surface for 1-2 hr. In a human trial, patients with squamous-cell carcinoma (n = 3), basal cell carcinoma (n = 1) and Bowen's disease (n = 1) were treated with patches containing 273.8-999 MBq (7.4-27 mCi) of 166Ho for 30 min to 1 hr. Pathologic examination was performed 4-7 wk after treatment in an animal model. Skin biopsy was performed 8 wk post-treatment in four patients.

RESULTS

Tumor destruction was seen 1 wk post-treatment, however, radiation dermatitis or ulceration developed at the site of radionuclide application. Those reactions healed gradually with fibrosis or epithelialization, which was confirmed pathologically. No significant adverse reaction to radiation except subcutaneous fibrosis was found.

CONCLUSION

Superficial skin tumors could be successfully treated by topical application of beta-emitting radionuclides.

The (epi)genetic control of mammalian X-chromosome inactivation

In mammals, the X chromosome is uniquely capable of complete inactivation. Research in the past two years has validated the long-held hypothesis that the 'X-inactivation center' (Xic) controls events of X inactivation and that its resident gene Xist is not only required but is at least partially responsible for the cis-restriction of X inactivation. Progress has also been made in identifying genes within the Xic. Although Xist remains the only known required element, evidence now suggests that a separate element for X counting must exist and that the Xic may be entirely contained within a 450 kb sequence. This small region may be sufficient for both initiation and establishment of X inactivation.

Long-range cis effects of ectopic X-inactivation centres on a mouse autosome

In mammals, the X chromosome is unique in being capable of complete inactivation. Such X inactivation evolved to compensate for gene dosage differences between females with two X chromosomes and males with one. Transcriptional silencing of a single female X chromosome is controlled in cis by Xist, whose RNA product coats the inactive X chromosome (Xi), and the X-inactivation centre (Xic). A transgenic study limited the Xic to 450 kilobases including Xist, and demonstrated that it is sufficient to initiate X inactivation. Here we report that ectopic Xist RNA completely coats transgenic chromosome 12. Expression of genes over 50 centimorgans was reduced two-fold and was detected only from the normal homologue in fibroblasts. Moreover, ectopic Xic action resulted in chromosome-wide changes that are characteristic of the X(i): DNA replication was delayed, and histone H4 was markedly hypoacetylated. Our findings suggest long-range cis effects on the autosome similar to those of X inactivation, and imply that the Xic can both initiate X inactivation and drive heterochromatin formation. Thus, the potential for chromosome-wide gene regulation is not intrinsic to X-chromosome DNA, but can also occur on autosomes possessing the Xic.

Evaluation of cationic liposomes for delivery of diphtheria toxin A-chain gene to cells infected with bovine leukemia virus

We investigated whether cationic liposomes are efficient at delivering the gene for diphtheria toxin A-chain (DT-A) under the control of the long terminal repeat (LTR) of bovine leukemia virus (BLV) (pLTR-DT) into BLV-infected cells and are also suitable for in vivo use. The transfection activity of the cationic liposomes composed of N-(alpha-trimethylammonioacetyl)-didodecyl-D-glutamate chloride (TMAG), dioleoyl phosphatidylethanolamine (DOPE) and dilauroyl phosphatidylcholine (DLPC) (1:2:2, molar ratio) (TMAG-liposome) and liposomes composed of phosphatidylserine (PS) (PS-liposome) was evaluated by the luciferase assay using a plasmid which contains the coding sequence of firefly luciferase under the control of the SR alpha promoter (pSR alpha/L-A delta 5). The TMAG-liposome gave highly efficient transfection in the presence of serum. On the other hand, PS-liposome showed inferior efficiency. When BLV-infected cells were co-transfected with a fixed amount of pSR alpha/L-A delta 5-entrapped TMAG-liposome and various amount of pLTR-DT-containing TMAG-liposome, the luciferase activity in the BLV-infected cells was inhibited by the addition of pLTR-DT-entrapped TMAG-liposome dose-dependently. The cationic TMAG-liposome containing pLTR-DT was successively added to BLV-infected cells in culture. The number of viable cells was markedly reduced by the cationic TMAG-liposome containing pLTR-DT. On the other hand, TMAG-liposome containing pSR alpha/L-A delta 5 showed no such effect. pLTR-DT entrapped by the cationic TMAG-liposome was not digested by the treatment with DNase I and with serum. These results suggest that the cationic liposomes, such as TMAG-liposome, may be efficient transfection reagent for the BLV-infected cells and can be utilized for DT-A gene delivery into the BLV-infected cells in vivo.

Nodular hepatocellular carcinomas: detection with arterial-, portal-, and delayed-phase images at spiral CT

PURPOSE

To evaluate the effectiveness of three-phase spiral computed tomography (CT) for the evaluation of nodular hepatocellular carcinoma (HCC).

MATERIALS AND METHODS

Images obtained at three-phase spiral CT in 45 patients with 81 nodular HCCs were reviewed. Images were obtained with 10-mm collimation and 10 mm/sec table speed during intravenous administration of 2 mL/kg 68% nonionic contrast material at a rate of 3 mL/sec. Hepatic arterial-phase (AP), portal-phase (PP), and delayed-phase (DP) images were obtained 25-30 seconds, 60-70 seconds, and 300 seconds, respectively, after injection of the contrast material. Lesion detectability and conspicuity were compared among these three protocols by two readers.

RESULTS

The AP images depicted a statistically significantly larger number of lesions (n = 67), although the differences in the number of lesions depicted between the PP and DP images were not statistically significant. Twenty-one lesions were detected only with the AP images, three with the PP images, and seven with the DP images. The most clearly visualized lesions were most commonly depicted on the AP images (n = 47) rather than the PP images (n = 11) or the DP images (n = 23).

CONCLUSION

Lesion detection and conspicuity were best with the AP images. However, some lesions were detected only with the DP and PP images, so that maximum lesion visualization is achieved by using all three phases.

Management of post traumatic stress disorder using combat stress treatment principles--a case report

Combat stress casualties are only generated by war. However, military psychiatrists need to acquire the experience and skills that they would need before they are ever faced with their first combat stress casualty. Non-combat post traumatic stress disorder patients present the best approximation to combat stress casualties. This case study demonstrates how combat stress treatment principles can be successfully applied to a case of non-combat post traumatic stress disorder patient. It is not the intention of this paper to demonstrate whether the combat stress management protocol is superior to other methods or protocols. Recommendations are made on methods to identify post traumatic stress disorder patients and how to seize every available opportunity to practise combat stress treatment principles.

A method for high efficiency YAC lipofection into murine embryonic stem cells

We describe a modified protocol for introducing yeast artificial chromosomes (YACs) into murine embryonic stem (ES) cells by lipofection. With a decreased DNA:cell ratio, increased concentration of condensing agents and altered culture conditions, this protocol reduces the requirement for YAC DNA to a few micrograms, improves the recovery of neomycin-resistant ES colonies and increases the yield of clones containing both flanking vector markers and insert. These modifications enable generation of sufficient 'intact' transgenic clones for biological analysis with a single experiment.