Faculty Bibliography

Background Intraoperative technology (IOT) is an expanding field designed to produce better patient outcomes and decrease iatrogenic injury. Neurosurgical residents often encounter these machines in the operating room. Therefore, our primary objective was to assess the influence of IOT on neurosurgery residents' surgical skills and training. Methods An electronic survey was created and sent to the neurosurgical residency programs in the state of California. The data were collected and analyzed. Results A majority of residents agreed that IOT helps in learning new concepts important for patient safety. 38% agreed that IOT helps to improve the motivation level of residents. 35% agreed that IOT makes the resident more productive. 31% felt that IOT helped them refine their surgical skills. 54% did not find IOT too stressful. 34% said that IOT helps in learning new concepts important for patient safety. 50% agree that IOT is a valuable tool in training. 42% affirmed that IOT provides good learning experience for clinical skills and knowledge. Conclusion Surgical training and IOT have evolved substantially over the last decade and resulted in increased intraoperative accuracy. Residents agreed that evolving technology improves surgical skills. Further studies elucidating patient outcomes are warranted.

Pregnant Fischer rats injected with cocaine in a 'binge' pattern (3x15 mg/kg, i.p.) from gestational days 8 through 17, had significantly higher levels of progesterone (212.12+/-22.50 vs. 91. 99+/-15.41 ng/ml) and corticosterone (257.99+/-21.76 ng/ml vs. 31. 70+/-7.93, respectively) than saline-treated dams. No significant differences in prolactin were observed (2.36+/-0.17 vs. 2.17+/-0.19 ng rPrl132/ml). Correlation analysis indicated that there is a significant relationship between plasma levels of progesterone and corticosterone and the quality of nests built by the dams. No correlation was found within animals between prolactin plasma levels and the nest quality. Thus, cocaine's effect on progesterone and corticosterone may contribute to the series of behavioral alterations associated with cocaine exposure during pregnancy.

Twelve healthy subjects with no history of substance abuse participated in a placebo-controlled single-blinded study of subjective response to acute i.v. administration of placebo and two doses of the natural shortened peptide sequence of the kappa-opioid agonist, dynorphin A(1-13) (low dose 120 micrograms/kg, high dose 500 micrograms/kg). Visual analog scales showed small but significant negative mood and positive drug effect 10 min post infusion in the high dose dynorphin compared to placebo infusion. The differences were no longer apparent at 30 min. These results show that dynorphin A(1-13), shown previously to have both neuroendocrine and modest analgesic effects, was well tolerated and produced modest transient subjective responses.

GT1-7 cells respond to treatment with the phorbol ester, phorbol 12-myristate 13-acetate (PMA), with an inhibition of transcription of the proGnRH gene and decreases in GnRH mRNA levels. However, the timing of this decrease in GnRH mRNA levels suggests that a decrease in GnRH mRNA stability may be involved in addition to an inhibition of transcription of the proGnRH gene. To address this possibility, we treated GT1-7 cells with 100 nM PMA for 4 h and then monitored GnRH mRNA levels over time after blockade of GnRH gene transcription with DRB. PMA treatment caused GnRH mRNA half-life to decrease from 30 to 11 h. Then, to verify this observation, we examined changes in GnRH mRNA poly (A) tail length, which may be a reflection of mRNA turnover, following treatment of GT1-7 cells with PMA or vehicle for 0, 4, 8 or 24 h. The poly (A) tail was removed from half of the GT1 cytoplasmic RNA sample by digestion with RNase H and the difference in GnRH mRNA size with and without RNase H treatment was determined by Northern hybridization. PMA treatment (4 and 8 h) resulted in a significant decrease in the length of the GnRH mRNA poly (A) tail, consistent with a decrease in GnRH mRNA stability. This finding suggests that GnRH mRNA turnover is inducible by substances such as PMA. Our study indicates that a change in mRNA stability is one of a multiplicity of levels at which GnRH gene expression is regulated.

Computed tomographic (CT) studies in 39 patients with advanced ovarian carcinoma were retrospectively evaluated to assess their accuracy in detection of persistent or recurrent disease as seen at second-look laparotomy (SLL). Twenty patients were studied before June 1983 (group 1), and 19 patients were studied afterward (group 2). There were 16 true-positive, ten true-negative, two false-positive, and 11 false-negative examinations. Five false-negative studies resulted from microscopic disease found at SLL. In group 1, there were eight false-negative studies. In five, macroscopic disease was not recognized. In group 2, there were three false-negative studies; in one, macroscopic disease was not recognized. Statistical analysis showed an observable improvement in the accuracy in group 2. The differences included use of faster scanners, routine use of thin sections for the pelvis, and air-contrast colonic opacification in group 2. These results suggest that carefully performed scanning on state-of-the-art equipment may have a higher accuracy in documenting persistent or recurrent macroscopic tumor

Thirty-nine patients with stage III and IV epithelial ovarian cancer who underwent second-look laparotomy (SLL) at New York University Medical Center and 11 eligible patients who did not undergo reexploration were retrospectively studied with follow-up from 24 to 105 months after diagnosis. Sixteen patients (41%) were found to have macroscopic disease, six (15%) microscopic tumor, and 17 (44%) no disease at SLL. Five of 22 patients who received further therapy based on positive SLL findings have remained without clinical evidence of disease 17 to 65 months after SLL. Nine of 17 patients with negative SLL, in whom treatment was stopped, recurred 8 to 52 months after SLL, five in extraperitoneal sites only. Five of 11 patients not undergoing SLL recurred 16 to 39 months after diagnosis, four intraperitoneally. There was no significant difference in survival between the second-look and no second-look groups for the period of study. Clinical trials are needed to determine if SLL influences longer-term survival and if continued treatment is indicated in a high-risk subgroup despite negative SLL. The value of SLL is limited by the efficacy of second line therapy. The role of routine SLL outside an investigational setting is questioned