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BACKGROUND: Oxygen consumption after surgery is increased in response to the tissue trauma sustained intra-operatively and the subsequent systemic inflammatory response that ensues. The cardio-respiratory system must match the tissue oxygen and metabolic requirements; otherwise, peri-operative complications may occur. Existing data is several decades old. The primary objective of this feasibility study was to determine the ease of recruiting participants and collecting relevant data to assess the extent and duration of increased oxygen consumption and post-operative complications after major abdominal surgery in contemporaneous times. METHODS: One hundred patients scheduled for elective colorectal surgery requiring a bowel resection were screened to test specific feasibility criteria relating to ease of recruitment, duration of post-operative stay, ease of data collection, and drop-out rates. A calibrated metabolic cart was used to obtain unblinded pre-operative resting oxygen consumption recordings. The metabolic cart was then used to obtain post-operative oxygen consumption readings on days 1 to 5 as long as the participant remained as an inpatient. At the time of the oxygen consumption reading, a Post-Operative Morbidity Survey score (POMS) was calculated. Feasibility outcomes chosen a priori were that at least one participant would be recruited every 2 weeks from the pre-admission colorectal clinic, at least 10% of potential subjects screened would be enrolled, at least 80% of recruited participants would have a minimum post-operative stay of 2 nights, a minimum of 3 consecutive days of oxygen consumption data would be collected for each subject, at least 8 of 9 POMS score domains would be completed per participant per day and the drop-out rate would be no greater than 10%. We deemed that screening 100 patients would be sufficient to test our feasibility outcomes. RESULTS: Twelve participants completed the protocol. All pre-specified feasibility criteria were met. No increase in post-operative oxygen consumption was observed in this feasibility cohort. CONCLUSIONS: The protocol and experiences gained from this feasibility study could be used to plan a larger study to better define changes in post-operative oxygen consumption after major abdominal surgery utilizing current surgical techniques.

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INTRODUCTION: Participation rates and quality-of-life (QoL) have been a major focus of rehabilitation programmes and outcome studies following traumatic brain injury (TBI). The extent to which mobility limitations impact on participation rates and QoL has not been thoroughly explored. The main aim of this study was to investigate the relationship between mobility limitations, participation rates and QoL following TBI. METHODS: Thirty-nine people who had sustained an extremely severe TBI were recruited from a major rehabilitation facility. Mobility was quantified using the high-level mobility assessment tool (HiMAT). The Brain Injury Community Rehabilitation Outcome (BICRO-39) and Community Integration Questionnaire (CIQ) were used to measure participation rates and the shorter version of the World Health Organization Quality of Life (WHOQoL-BREF) and Assessment of Quality-of-Life (AQoL-2) were used to measure QoL. RESULTS: Mobility was most strongly correlated with the total BICRO-39 score (r = -0.60, p < 0.001) and the mobility domain (r = -0.59, p < 0.001) of the BICRO-39. Although mobility had a significant relationship with health-related QoL, AQoL-2 (r = 0.60, p < 0.001), it was most strongly related to the AQoL-2 independent living domain (r = 0.79, p < 0.001). CONCLUSION: Greater capacity to mobilize was associated with higher participation rates and better QoL.

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OBJECTIVES: Most previous studies evaluating the use of methylphenidate following traumatic brain injury (TBI) have been conducted many years post-injury. This study evaluated the efficacy of methylphenidate in facilitating cognitive function in the inpatient rehabilitation phase. METHODS: 40 participants with moderate-severe TBI (mean 68 days post-injury) were recruited into a randomised, crossover, double blind, placebo controlled trial. Methylphenidate was administered at a dose of 0.3 mg/kg twice daily and lactose in identical capsules served as placebo. Methylphenidate and placebo administration was randomised in a crossover design across six sessions over a 2 week period. Primary efficacy outcomes were neuropsychological tests of attention. RESULTS: No participants were withdrawn because of side effects or adverse events. Methylphenidate significantly increased speed of information processing on the Symbol Digit Modalities Test (95% CI 0.30 to 2.95, Cohen's d = 0.39, p = 0.02), Ruff 2 and 7 Test-Automatic Condition (95% CI 1.38 to 6.12, Cohen's d = 0.51, p = 0.003), Simple Selective Attention Task (95% CI -58.35 to -17.43, Cohen's d = 0.59, p = 0.001) and Dissimilar Compatible (95% CI -70.13 to -15.38, Cohen's d = 0.51, p = 0.003) and Similar Compatible (95% CI -74.82 to -19.06, Cohen's d = 0.55, p = 0.002) conditions of the Four Choice Reaction Time Task. Those with more severe injuries and slower baseline information processing speed demonstrated a greater drug response. CONCLUSIONS: Methylphenidate enhances information processing speed in the inpatient rehabilitation phase following TBI. This trial is registered with the Australian New Zealand Clinical Trials Registry (12607000503426).

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The immunoglobulin heavy chain gene locus on 14q32 is known to be involved in translocations that are associated with B-lymphoproliferative disorders, typically Burkitt lymphoma and B-cell acute lymphoblastic leukemia. Several cytogenetic abnormalities have been described in post-transplant lymphoproliferatve disease (PTLD), some of which include this locus. To our knowledge, we report the first case of translocation t(9;14)(p11-12;q32) in a PTLD that developed after orthoptic liver transplantation.

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BACKGROUND: The impact of mild head injury is variable and determinants of outcome remain poorly understood. Results of previous intervention studies have been mixed. OBJECTIVES: To evaluate the impact on outcome of the provision of information, measured in terms of reported symptoms, cognitive performance, and psychological adjustment three months postinjury. METHODS: 202 adults with mild head injury were studied: 79 were assigned to an intervention group and were assessed one week and three months after injury; 123 were assigned to a non-intervention control group and were seen at three months only. Participants completed measures of preinjury psychological adjustment, concurrent life stresses, post-concussion symptoms, and tests of attention, speed of information processing, and memory. Subjects seen at one week were given an information booklet outlining the symptoms associated with mild head injury and suggested coping strategies. Those seen only at three months after injury did not receive this booklet. RESULTS: Patients in the intervention group who were seen at one week and given the information booklet reported fewer symptoms overall and were significantly less stressed at three months after the injury. CONCLUSIONS: The provision of an information booklet reduces anxiety and reporting of ongoing problems.

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OBJECTIVE: The impact of mild head injury or mild traumatic brain injury (TBI) in children is variable, and determinants of outcome remain poorly understood. There have been no previous attempts to evaluate the impact of interventions to improve outcome. Results of previous intervention studies in adults have been mixed. This study aimed to evaluate the impact of providing information on outcome measured in terms of reported symptoms, cognitive performance, and psychological adjustment in children 3 months after injury. METHODS: A total of 61 children with mild TBI were assessed 1 week and 3 months after injury, and 58 children with mild TBI were assessed 3 months after injury only. They were compared with 2 control groups (N = 45 and 47) of children with minor injuries not involving the head. Participants completed measures of preinjury behavior and psychological adjustment, postconcussion symptoms, and tests of attention, speed of information processing, and memory. Children with mild TBI seen at 1 week were also given an information booklet outlining symptoms associated with mild TBI and suggested coping strategies. Those seen 3 months after injury only did not receive this booklet. RESULTS: Children with mild TBI reported more symptoms than controls at 1 week but demonstrated no impairment on neuropsychological measures. Initial symptoms had resolved for most children by 3 months after injury, but a small group of children who had previous head injury or a history of learning or behavioral difficulties reported ongoing problems. The group not seen at 1 week and not given the information booklet reported more symptoms overall and was more stressed 3 months after injury. CONCLUSIONS: Providing an information booklet reduces anxiety and thereby lowers the incidence of ongoing problems.

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This study investigated the relations between age at injury (AAI) and attentional functioning, and intellectual and academic achievement following pediatric head injury. The theoretical framework of attention proposed by Mirsky, Anthony, Duncan, Ahern, and Kellam (1991) provided the basis for this analysis, and the profile of attention found in uninjured children was evaluated for this sample. Thirty-three moderately head-injured individuals were recruited, with AAI ranging from 1 to 12 years. First, the development of attentional skills in this closed head injury (CHI) sample was found to be comparable to that of Mirsky et al.'s model. Second, AAI did not predict outcome and appeared not to be associated with the finding of mildly delayed acquisition of spelling and arithmetic skills. Also, AAI did not predict the behavioral symptoms of inattention present in this sample as indicated by parental report. It may be that AAI only influences development following severe CHI in which there is permanent cerebral pathology.

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This study aimed to investigate outcome in adults with mild traumatic brain injury (TBI) at 1 week and 3 months postinjury and to identify factors associated with persisting problems. A total of 84 adults with mild TBI were compared with 53 adults with other minor injuries as controls in terms of postconcussional symptomatology, behavior, and cognitive performance at 1 week and 3 months postinjury. At 1 week postinjury, adults with mild TBI were reporting symptoms, particularly headaches, dizziness, fatigue, visual disturbance, and memory difficulties. They exhibited slowing of information processing on neuropsychological measures, namely the WAIS-R Digit Symbol subtest and the Speed of Comprehension Test. By 3 months postinjury, the symptoms reported at 1 week had largely resolved, and no impairments were evident on neuropsychological measures. However, there was a subgroup of 24% of participants who were still suffering many symptoms, who were highly distressed, and whose lives were still significantly disrupted. These individuals did not have longer posttraumatic amnesia (PTA) duration. They were more likely to have a history of previous head injury, neurological or psychiatric problems, to be students, females, and to have been injured in a motor vehicle accident. The majority were showing significant levels of psychopathology. A range of factors, other than those directly reflecting the severity of injury, appear to be associated with outcome following mild TBI.

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OBJECTIVES: To investigate outcome in children with mild traumatic head injury (THI) at 1 week and 3 months postinjury and to identify factors associated with persisting problems. DESIGN: Postconcussional symptomatology, behavior ratings, and neuropsychological test performance were examined at 1 week and 3 months postinjury. SETTING: Participants were recruited from successive presentations to emergency departments of two major hospitals. PARTICIPANTS: 130 Children with mild THI were compared with 96 children having other minor injuries as controls. RESULTS: Children with mild THI experienced headaches, dizziness, and fatigue but exhibited no cognitive impairments, relative to controls, at 1 week postinjury. By 3 months, symptoms had resolved. However, 17% of children showed significant ongoing problems. They were more likely to have a history of previous head injury, learning difficulties, neurological or psychiatric problems, or family stressors. CONCLUSIONS: Persisting problems following mild head injury in children are more common in those with previous head injury, preexisting learning difficulties, or neurological, psychiatric, or family problems. These "at-risk" children should be identified in the emergency department and monitored.

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The effects of DNA gyrase and quinolone drugs on in vitro transcription of a template containing a preferred gyrase cleavage site have been investigated. We have found that gyrase-quinolone complexes with DNA lead to blocking of transcription by Escherichia coli and bacteriophage T7 RNA polymerases. Either gyrase or quinolone alone has no effect on transcription. With DNA gyrase containing a point mutation in the gyrase A protein, known to confer quinolone resistance, blocking was found to occur only at much higher concentrations of the drug. Other agents that inhibit gyrase-catalysed supercoiling (novobiocin and 5'-adenylyl-beta,gamma-imidodiphosphate) do not arrest transcription in the presence of gyrase. Mapping of the transcription termination sites in the presence of gyrase and quinolones shows that blocking occurs about 10 to 20 base-pairs upstream of the gyrase cleavage site. Analysis of transcription in the absence of drug suggests that RNA polymerase does not displace gyrase from the template. These results are discussed in the light of models for the bactericidal effects of quinolone drugs.

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The role of attention and the resolution of coding conflicts in hand-hemispace spatial-compatibility effects was examined in a precueing experiment in which visual and vibrotactile precues, with various stimulus-onset asynchronies (SOAs), were presented in blocked and random order. It was expected that precues at the shorter SOAs would fail to facilitate the shifting of attention, as they occur too close to the imperative stimulus to be informative. The task would therefore approximate one of choice reaction time (RT), resulting in a hand-hemispace spatial-compatibility effect. Conversely, the longer SOAs would provide the subject with sufficient time in which to shift attention fully, and would therefore result in a task more like that of simple reaction time (SRT). It was expected that the hand-hemispace spatial-compatibility effect would then be absent. As was expected, this effect was present at the shorter SOAs, and absent at the longer SOAs. In Experiments 2 and 3, provision of a visual precue further facilitated attentional deployment, as did blocking the presentation of various SOAs in Experiment 3. Vibrotactile and visual precues did not differ in their ability to direct attention, implying that these modalities orient attention and precue location in essentially similar ways. These findings are discussed within the context of the mechanisms though to underlie the time course of spatial compatibility and the dissipation of a fading trace of interfering spatial codes.

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Binding of the quinolone drug norfloxacin to gyrase and DNA has been investigated. We have detected binding to gyrase-DNA complex but find no significant binding to either gyrase or DNA alone. Enzyme containing gyrase A protein with the mutation Ser-83 to Trp (conferring quinolone resistance) showed greatly reduced drug binding.

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OBJECTIVE: To examine the sexual behaviour and the prevalence of sexually transmitted diseases among adolescent girls who attended the Genito-Urinary Medicine Clinic in Birmingham. DESIGN: Retrospective case control study. SETTING: The Genito-Urinary Medicine Clinic (Ward 19), General Hospital, Birmingham. SUBJECTS: 159 adolescent girls aged 13-16 years; 215 female clinic attenders older than 16 years and 55 male partners of the adolescent girls. OUTCOME MEASURES: Number of sexual partners; contraceptive practice, and prevalence of sexually transmitted infections. RESULTS: The number of sexual partners was similar among the girls and controls. More girls than controls did not use any form of contraceptives, 49% versus 33.5% (p less than 0.01). The prevalence of bacterial vaginosis and gonorrhoea was significantly higher in the girls than in the controls (p less than 0.05). Compared with the girls and controls, the male partners of the adolescents had more sexual partners, and a higher prevalence of sexually transmitted infections--92.7%, 78.6% and 76.7% in the males, controls and girls respectively. CONCLUSION: The adolescent girls were associating with older men who had many sexual partners, and a higher prevalence of infections. By targetting these girls and their partners for counselling and health education the genitourinary medicine specialty can play a significant and positive role in adolescent sexuality.

PIP: This study examined the sexual behavior and prevalence of sexually transmitted diseases among adolescent girls who attended the Genito-Urinary Medicine Clinic in Birmingham. 159 adolescents who participated were between 13-16, 215 were female clinic attenders older than 16, and 55 male partners of adolescent girls also were involved in this retrospective case control study. Outcome measures examined were: number of sexual partners, contraceptive practice, and the prevalence of sexually transmitted infections. The number of sexual partners was similar among the girls and the controls. More girls than controls did not use any form of contraceptives, 49% vs 33.5% (p0.01). The prevalence of bacterial vaginosis and gonorrhea was significantly higher among the girls than the controls (p0.05). Compared with the girls and controls, the male partners of adolescent girls had more sexual partners and a higher prevalence of sexually transmitted infections, 92.7%, 78.6%, and 76.6% in the males, controls, and girls, respectively. Results indicate that adolescent girls associated with older men who had many sexual partners and thus a higher prevalence of infections. By targeting this group of girls and their partners for counselling and health education, the genitourinary medicine specialty can play a significant and positive role in adolescent sexuality.

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