Extensive Treatments Research Articles

Gendered Border Crossings: The Films of Division in Divided Germany

Gendered Border Crossings:The Films of Division in Divided Germany Mark A. Wolfgram (bio) This article uses the respective national cinemas of the German Democratic Republic (GDR) in the east and the Federal Republic of Germany (FRG) in the west to access the national discussion of Germany's division. I use cinema as a location for constructing a national narrative within which the defining of distinct East and West German identities took place. The division became not only geopolitical but also cultural, with a clear gendering of the east as female and the west as male. Traditional scholarship on nationalism has largely ignored the role of gender and has instead focused on class, ethnicity, and modernization.1 More recently scholars have begun to take gender into account and the role gender plays in the formation of national identities. For example, Koester looks at the feminine in Icelandic history and how this became a symbolic resource used by feminists in present-day politics. Marakowitz examines the position of women in Finnish society and how the welfare state ideology is tied to feminine identity. The linkages that Marakowitz draws between the welfare state and the feminine in the Finnish state are worth noting, as these feminine images come to represent socialist East Germany in German cinematic culture. More recently, Jeffrey has used the role of prostitution in Thailand and state policies to control its practice as an example of how sexuality and gender are tied to the formation of a Thai national identity. The German case adds to our understanding of how gender can be used to create social divisions and represent national boundaries. As Cold War politics led to the division of an already clearly articulated national community, gender became a powerful symbolic marker with which to define the new German-German border. [End Page 152] In conducting this research, I viewed a wide variety of films that make the division of the country central to the film's narrative. I then compared and contrasted these "films of division" looking for similarities and differences in their narration and representation of the division. Although there have been limited and more extensive treatments of some of the films mentioned here, there is no exclusive study of division as a theme in German cinema covering the entire time of the separation, nor have scholars paid specific attention to the role of gender in these films of division.2 The films of division include those within which the crossing of the border plays a central role. There are certainly other films within which the nation's division played a role, but I am particularly interested in the discussion of the border and attempts by various characters to transcend it, as I discuss further below. The nature of this border changed over time, from one that was highly permeable prior to 1949, at which point German leaders on both sides declared two separate sovereign states, to one which was firmly sealed and controlled after the building of the Berlin Wall in August 1961. Although German films continued to discuss east and west differences after the opening of the wall in 1989, I am only interested in the narratives between 1945 and 1989. Although the nature of the border was ambiguous between 1945 and 1949, one can still view in these films an attempt to define east and west, especially in the eastern cinema. Although the social, political, and economic context for film production differed in both halves of Germany, there are a number of similarities in the portrayal of Germany's division, which I discuss below. In the east, the authoritarian-socialist state dominated the film industry through direct ownership of the only film company, DEFA. Although the level of state control over the industry varied over time, with the early postwar years offering the greatest flexibility, state censors eventually had direct oversight of production and distribution. The opportunity for filmmakers to critique socialist society in eastern Germany also changed over time with the door being slammed firmly shut in December 1965 at the Eleventh Plenary of the SED, the communist party. Almost an entire year's production was barred from public showings at that time...

<i>Brazilian Popular Music: Caetano Veloso and the Regeneration of Tradition</i> (review)

Reviewed by: Brazilian Popular Music: Caetano Veloso and the Regeneration of Tradition Krista Kateneva Lorraine Leu. Brazilian Popular Music: Caetano Veloso and the Regeneration of Tradition. Aldershot, England; Burlington, VT: Ashgate, 2006. 180 pp. During the last four decades, the Brazilian tropicalist movement, the MPB wave and a considerably restricted set of participating musicians have become a canon comparable to the rarely challenged reign of samba among scholars of Brazilian popular music. However, in spite of an already rich academic and popular literature on these themes, Lorraine Leu’s latest [End Page 279] book on Caetano Veloso and his role in shaping the landscape of Brazilian popular music may offer some interesting interpretations to readers of any background. The general impression of the work is that of a multifaceted inquiry into one artist’s contribution to the story and development of a nation’s production and perception of popular music with occasional detours into more general context and history in order to guarantee the text’s accessibility for those not specialized in Brazilian topics. I am particularly delighted by the author’s dedication to the multidisciplinary nature of her analysis. In an attempt to “contribute to an approach to studying Brazilian popular music informed by the diverse codes of performance that produce meaning in popular song” (146), Leu has reached beyond the limits of any one field of study, bringing together methodologies from literary analysis, music theory, ethnomusicology, and history. The result is a multidimensional inquiry into a musical moment that came to influence Brazilian musical life for decades. The book is divided into six considerably independent chapters and a brief conclusion that simultaneously serves as a late introduction to the motivations and background of the study. I call the chapters independent because they can be read and understood rather autonomously, each focusing on a distinct theme or method of inquiry. Additionally, the chapters do not follow a chronological or any other kind of clearly progressive order, suggesting the possibility of being read in a sequence different from the one they are presented in. Essay-like discussions of historical matters take turns with analyses of musical material, transporting the reader back and forth between different modes of investigation. While it is certainly not possible (or always advisable) to look for a linear narrative in every issue at hand, Leu’s thematic and methodological jumps may leave those looking for smooth and easy-to-follow transitions somewhat confused. Chapters 1 and 5 of the book provide most of the historical context to Leu’s analysis. The first section acts as a panoramic view of the 1960s in Brazil, with a focus on the political scene, experimental arts, cinematography, literary tradition, and social organization. While the first chapter provides a historical and ideological context to the analysis of Veloso’s innovative works, Chapter 5 revisits the earlier times in order to ground the discussion of his love songs. In this section Leu contextualizes her subsequent arguments by walking the reader through a brief history of Brazil’s romantic music from the 18th-century modinhas and lundus through to sambacanção and bossa nova. Although some of the information in those chapters is not essential to Leu’s arguments and could easily be omitted, I consider her decision to include the broader background a positive element. While some of the text may seem unchallenging to those well-acquainted [End Page 280] with Brazilian music, this approach keeps the book accessible for those new to the topic. Chapters 2, 3, 4, and 6 provide the meat and potatoes of this work through a closer discussion of specific musical examples. The bulk of the analysis in this book concentrates on the iconic Brazilian composer and performer Caetano Veloso. In fact, the deliberate disregard of Veloso’s contemporaries may perhaps be one of the greatest weaknesses of the study. Having taken notice of that, Leu’s analysis of Veloso’s repertoire is possibly one of the most extensive treatments of the icon’s works. Few authors have dared to approach his fertile discography with equal attention to such a high number of individual songs. While Leu does not cover Veloso’s entire career, her sample is...

Modification of the surface chemistry of TMP with enzymes

SUMMARY: The surface chemistry of thermomechanical pulp (TMP) was modified with specific enzymes and the effect of extensive enzymatic treatments was studied with surface-sensitive spectroscopic methods (ESCA and ToF-SIMS) and by contact angle measurements. Fibers and different types of fines, i.e. fibrils and flakes, were isolated from the enzymatically treated pulps and analyzed separately. Enzymatic treatment had a pronounced effect on surface extractives, especially those found on the surface of fibrils. All the enzymatic treatments decreased the surface coverage of extractives on fibrils, but ToF-SIMS results indicate that only lipase and laccase treatments selectively removed extractives from the surfaces of fibrils and that other treatments only made the film of extractives thinner. Laccase treatment also reduced the content of guaiacylic lignin units on the surface of fibers, fibrils and flakes. All the treatments studied here lowered the contact angle of water on pulp handsheets, probably due to removal of extractives from the surface. ESCA and ToF-SIMS gave complementary information about the surface chemistry of pulp fibers and fines. ToF-SIMS was found to be suitable for studying chemical modifications on the surface of mechanical pulp components. When these two analytical techniques are combined, it must be remembered that their analysis depth is different, that ESCA results are dependent on proper extraction, and that ToF-SIMS is not a quantitative analysis method for organics.

A 3-Year Causative Study of Pompholyx in 120 Patients

To assess the relative frequency of the different causes of pompholyx evoked in the literature. Prospective survey. Clinical outpatient setting. A total of 120 consecutive patients with pompholyx referred to our department from 2000 through 2003. Systematic investigation of different causes of pompholyx: fungal intertrigo, hyperhidrosis, atopy, contact eczema, and internal reactions with systematic provocation tests to metals, balsam of Peru, and food allergen when suspected. The present study found the following causes of pompholyx in the 120 patients: mycosis (10.0%); allergic contact pompholyx (67.5%), with cosmetic and hygiene products as the main factor (31.7%), followed by metals (16.7%); and internal reactivation from drug, food, or haptenic (nickel) origin (6.7%). The remaining 15.0% of patients were classified as idiopathic patients, but all were atopic. (Percentages do not total 100 because of rounding.) Our data confirm the existence of reactional pompholyx to interdigital-plantar intertrigos and endogenous reactions to metals or other allergens, but they mainly point at the unexpected importance of a so-called contact pompholyx in which cosmetic and hygiene products play a preponderant role compared with metals. The great frequency of atopic conditions, even if idiopathic pompholyx is not inferred as an equivalent of atopy, should lead to further causative investigations before undertaking more expensive or extensive treatments of refractory pompholyx.

Craniofacial Anomalies and Quality of Life

The quality of life (QoL) is challenged in individuals with craniofacial anomalies (CFA) as a result of impaired function, appearance, and social integration as well as extensive treatments. Although psychopathology is not commonly associated with CFA, psychological problems have been reported. Problems causing the lack of scientific information on the QoL in CFA are the low prevalence of CFA and the use of different non-condition-specific measurement instruments. Recently an internationally validated condition-specific instrument (COHIP) has been developed to measure QoL in CFA, which will hopefully enhance the current status of information.

Landbird community composition varies among seasons in a heterogeneous ponderosa pine forest

There is growing recognition of the need to conserve areas used by birds during migration, including forest and upland habitats. Because extensive thinning and burning treatments are planned for ponderosa pine (Pinus ponderosa) forests in the southwestern United States, information on the use of these forests by landbirds during migration is needed for conservation planning. We compared species richness among spring, breeding, and fall seasons at 69 points in a ponderosa pine forest to assess changes in landbird communities and the role of different ponderosa pine cover types in habitat selection among seasons. We detected a total of 64 bird species. Bird community similarity was lowest between the breeding and fall seasons and highest between the spring and breeding seasons. Twenty percent of the species detected were present exclusively in the fall and, of these, over half were Neotropical migrants. Only two species (3%) were detected exclusively during the spring. Although we found little difference in bird species similarity among vegetative cover types during the breeding season, forests that contained a deciduous component exhibited higher bird species similarity with each other than with habitats that did not include a deciduous component in spring and fall. In addition, foliage foragers dominated the community in spring and fall, and all Neotropical migrants detected exclusively in fall were found in ponderosa pine forests with a deciduous component. Our results indicate that ponderosa pine forests may be important to migrating or dispersing landbirds in autumn, especially if there is a deciduous component.

Anal intraepithelial neoplasia

Anal intraepithelial neoplasia (AIN) is a well−recognized precursor of anal squamous cell carcinoma, and its incidence is reaching almost epidemic proportions in high−risk groups, particularly men who have sex with men (MSM), those infected with the human immunodeficiency virus (HIV), or immunosuppressed organ recipients. There is a clear aetiological association between AIN and human papillomavirus (HPV), but the natural history of AIN is unclear, although it is assumed that it resembles that of cervical intraepithelial neoplasia. Therefore, high risk individuals, and those healthcare professionals involved in their care should be made aware that the development of perineal warts or an intra−anal lump needs prompt referral for histological assessment. Non−surgical treatment of high−grade AIN and local excision of discrete lesions seems logical, as extensive prophylactic surgical treatments carry high morbidity, especially in immunocompromised patients, and the early removal of pre−malignant lesions, even if temporary, may impede progression to invasive cancer. Early detection of disease progression is essential to such a management strategy; as yet there is no standard surveillance protocol, but a reasonable approach is suggested.

TWO CASES OF ATYPICAL MYCOBACTERIOSIS CAUSED BY MYCOBACTERIUM SZULGAI ASSOCIATED WITH MORTALITY IN CAPTIVE AFRICAN ELEPHANTS (LOXODONTA AFRICANA)

Mycobacterium szulgai was associated with mortality in two captive African elephants (Loxodonta africana) housed at Lincoln Park Zoo. The first elephant presented with severe, acute lameness of the left rear limb. Despite extensive treatments, the animal collapsed and died 13 mo after initial presentation. Necropsy revealed osteomyelitis with loss of the femoral head and acetabulum and pulmonary granulomas with intralesional M. szulgai. The second elephant collapsed during transport to another institution with no premonitory clinical signs. This animal was euthanized because of prolonged recumbency. Granulomatous pneumonia with intralesional M. szulgai was found at necropsy. Two novel immunoassays performed on banked serum samples detected antibody responses to mycobacterial antigens in both infected elephants. It was not possible to determine when the infection was established or how the elephants were infected. When reviewing the epidemiology of this organism in humans, however, transmission between elephants seemed unlikely because human-to-human transmission of this organism has never been reported and a third elephant in the herd was not affected. In addition to Mycobacterium bovis and Mycobacterium tuberculosis, atypical mycobacterial organisms need to be considered potentially pathogenic in elephants.

Study of the torsional potential energies of 2-methylpropane, n-butane, and 2-methylbutane with high-level ab initio calculations

An accurate representation of the torsional potential energies of alkanes and molecules containing alkane sequences, e.g. polyolefins, is essential for reliable force field modeling and simulation of these molecules. Therefore the torsional potentials of 2-methylpropane, n-butane, and 2-methylbutane as three major building blocks of polyolefins were studied at approximately the CCSD(T)/cc-pVQZ level. From previous studies it appears that calculations in the larger basis set and more extensive electron correlation treatments is more influential on the cis barrier in n-butane and transition state than other conformers. Larger basis set and level of calculations in this study show that the trans– gauche barrier in 2-methylbutane and rotational energy barrier in 2-methylpropane improves 10–13%, but the trans– gauche energy difference in n-butane and 2-methylbutane do not change significantly. The gauche energy, the trans– gauche barrier, and the cis barrier in n-butane were 0.628, 3.303, and 5.460 kcal/mol, respectively. These values were in good agreement with previous calculations from quantum mechanics. The calculated torsional energy barrier in 2-methylpropane, 3.373 kcal/mol, agreed satisfactorily with previous experimental measurement. For 2-methylbutane the greater gauche energy and trans– gauche barrier, 0.789 and 5.159 kcal/mol, indicated that the gauche conformer in n-butane is more stable than 2-methylbutane. On the other hand, from smaller barrier between two trans conformer in 2-methylbutane, 2.925 kcal/mol, compared with the trans– gauche barrier it is observed that the trans conformer has been the determiner conformer in the conformational characteristic and properties. Finally, approximate representations of the torsional potential term in empirical force fields of the calculated data are expressed as cosine series expansions.

Surgical intervention in children with Crohn’s disease

Crohn's disease (CD) causes chronic inflammation of the gastrointestinal tract leading to extensive medical treatments and surgery with two thirds of patients having surgery over their lifetime. In this study, we reviewed the pediatric population at the British Columbia Children's Hospital diagnosed with CD and examined their demographics and treatments, in particular assessing those who ultimately underwent surgery. Two hundred and eighty children (median age 11.9 years [CI 11.5-12.28]) diagnosed with CD from January 1994 to December 2003 were included. Demographic data were documented including age, ethnicity, duration of symptoms before diagnosis, treatment to date and surgical parameters. Comparison was made between operative and non-operative patients including involvement of disease, medical treatment, complications and recurrence of disease leading to repeat operations. Fifty-five (19.6%) children had surgical procedures. There was a significant increase in surgery in those patients who had not received immunomodulator therapy before surgery (odds ratio 1.95 [CI 1.02-3.73]). We also observed that those CD patients with extensive small intestinal involvement had lower likelihood of having surgery (odds ratio 0.386 [CI 0.145-1.033]). No significant difference was found between the two groups with regard to age of diagnosis (p = 0.41), duration of symptoms (p = 0.22), gender (p = 0.50) or ethnicity (p = 0.451). There was an increased incidence of surgery in those patients who were not treated with immunomodulator therapy. In addition, children with extensive as opposed to isolated small intestinal disease were less likely to have surgery in childhood.

The role of grazing management for the net biome productivity and greenhouse gas budget (CO 2, N 2O and CH 4) of semi-natural grassland

Over a 3-years period, the CO 2, N 2O and CH 4 fluxes exchanged with the atmosphere were studied in an upland semi-natural grassland site which was divided at the start of the experiment in two large paddocks continuously grazed by cattle. The soil at the site is an Andosol with high organic matter content. The intensively managed paddock was supplied with mineral N fertilizer and was grazed at a target sward height of 6 cm. The extensively managed paddock received no N fertilization and was stocked at half the stocking density of the intensive paddock. The net ecosystem exchange of CO 2 was continuously measured in each paddock using the eddy covariance technique. Nitrous oxide emissions were measured fortnightly in both paddocks using static chambers. Methane emissions by the grazing cattle were measured four times per year in each paddock using the SF 6 tracer method. Averaged across the 3 years, the two paddocks were net sinks of atmospheric CO 2 (97 and 75 g CO 2-C m −2 year −1 in the intensive and extensive treatments, respectively). Taking into account the LW gain of the cattle and the C loss through methane emissions, the net C storage was estimated at 87 and 69 g C m −2 year −1 in the intensive and extensive treatments, respectively. Emissions of nitrous oxide and methane reduced by 89 and 55% the atmospheric sink activity of the intensive and extensive treatments, respectively. The average greenhouse gas (GHG) balance across the 3 years was −10 and −31 g CO 2-C equivalents in the intensive and extensive treatments, respectively. However, the net biome productivity (NBP) and GHG sink activities increased over time in the intensive grazing treatment, whereas they declined after 1 year in the extensive treatment, possibly as a result of a reduced nitrogen status of the vegetation. It is concluded that the suppression of fertilizer N supply combined with a strong reduction in grazing pressure may not be able to increase in the short term the GHG sink per unit land area of managed grasslands.

The Boy Genius and the Bard: Orson Welles, Childhood, and Everybody's Shakespeare

While in his teens, in 1934, with the assistance of his former teacher Roger Hill, Orson Welles produced Everybody's Shakespeare, a three-volume work comprising acting editions of Julius Caesar, The Merchant of Venice, and Twelfth Night and designed as a guideline for staging Shakespeare for use in schools. These early works usually receive little attention, merely treated as evidence of Welles's early genius. More extensive treatments tend to either minimize his contributions to the texts, or look amusedly at his youthful energy. This essay suggests that they offer more than insight into the developing mind of Welles, but also represent a culmination of his adolescent genius, as he strove both to enliven textbook Shakespeare for a young audience, and to appropriate this adult territory for other children. Welles's editorial appropriation of Shakespeare intersected with his conflicted real childhood, and with his theatrical childhood; in which he acted, directed, produced, and communicated through Shakespeare. Welles was at once a child engaging with his own world through Shakespeare, and an advocate of Shakespeare as the possession of children, as well as adults.

α-Chitin Nanocrystals Prepared from Shrimp Shells and Their Specific Surface Area Measurement

Alpha-chitin was isolated from shrimp shells. The chitin was subjected to extensive treatments of acid hydrolysis and mechanical disruption to yield nanocrystals. The goal of this article is to characterize alpha-chitin nanocrystals produced from shrimp shells in regard to crystallite properties and the specific surface area of the chitin nanoparticles. X-ray diffraction data indicate an increase in chitin crystallinity after hydrolysis, as less-ordered chitin domains are digested. Line broadening data were used to measure crystallite size and particle size in the hydrolyzed chitin nanocrystals. Dye adsorption with Congo red was used to measure the specific surface area of the particles, indicating values near 350 m2/g. This value was supported with calculations derived from X-ray crystallite size measurements. Particle surface area measurements were compared with similarly prepared cellulose nanocrystals.

The effects of fuels treatments on soil carbon respiration in a Sierra Nevada pine plantation

Fire-prone forests in the American west are presently slated for extensive fuels reduction treatments, yet the effect on soil CO 2 efflux rates, or soil respiration, has received little attention. This study utilizes the homogeneity of a Sierra Nevada ponderosa ( Pinus ponderosa Dougl. ex P. & C. Laws)–Jeffrey pine ( Pinus jeffreyi, Grev. & Balf.) plantation to investigate changes in soil respiration following mechanical shredding of understory vegetation, or mastication, in 2004; mastication coupled with prescribed burning in 2005; and burning alone also in 2005 as measured over the growing seasons from 2003 to 2005. Soil respiration, soil temperature and soil moisture were measured in two masticated stands which were burned the following year, and in one burned stand; the three of which were compared with two controls stands. Soil respiration response to treatments was detectable even though spatial variability within sites was high (coefficients of variation of 39–66%). Mastication produced short-term reductions in respiration rates, reduced soil moisture by 20%, and mitigated a year-to-year reduction in soil temperature evidenced by controls. Prescribed fire in masticated stands lowered soil respiration from 3.42 to 2.68 μmol m −2 s −1 while fire in the untreated stand raised rates from 3.41 to 3.83 μmol m −2 s −1, although seasonal increases in control sites were greater than those in the untreated stand. Masticated then burned site soil moisture increased by 52% while soil temperature decreased over the span of the growing season. Microclimate variables were not consistently effective in explaining spatial trends. Exponential models using soil temperature and/or moisture to predict temporal trends in respiration were only significant in treated stands, suggesting that treatment implementation increased sensitivity to environmental factors. These results imply that fuels reduction practices in water-stressed forests may have important consequences for ecosystem carbon dynamics.

Mediastinitis Following Coronary Artery Bypass Graft Surgery

The incidence of mediastinitis following coronary artery bypass graft surgery is less than 5%; however, this devastating complication results in significant mortality and morbidity. Reoperation, prolonged ventilation, increased length of stay in intensive care unit, and extensive wound treatments contribute to patient, family, and institutional burdens. Modifiable risk factors should be corrected whenever possible. Adherence to evidence-based guidelines for the prevention of deep surgical site infections is essential. In addition, recognition and aggressive clinical management of this life-threatening condition have been found to improve patient outcomes. The purpose of this article is to review the pathophysiology, clinical presentation, perioperative risk factors, and current treatment recommendations for mediastinitis following coronary artery bypass graft surgery.

Pelvic exenteration for gynaecological tumours: achievements and unanswered questions

Pelvic exenteration has been used for 60 years to treat cancers of the lower and middle female genital tract in radiated pelves. The mainstay for treatment success in terms of locoregional control and long-term survival is resection of the pelvic tumour with clear margins (R0). New ablative techniques based on developmentally derived surgical anatomy and laterally extended endopelvic resection have raised the number of R0 resections done, even for tumours that extend to the pelvic side wall, which were traditionally judged a contraindication for exenteration. Although mortality has fallen to less than 5%, treatment-related severe morbidity of pelvic exenteration still exceeds 50%, possibly because of compromised healing of irradiated tissue and use of complex reconstructive techniques. The benefits of exenteration for patients who have advanced primary disease or recurrent tumours after surgery, versus those who have chemoradiotherapy, are not proven by results of controlled trials, but can be assumed from retrospective data. Comparative findings are missing, and arguments are unconvincing to favour pelvic exenteration over less extensive treatments and best supportive care for palliation of cancer symptoms in most patients.

O.031 Augmentation rhinoplasty using tibial bone graft en bloc

In 2015, the Nobel Committee for Physiology or Medicine, in its only award for treatments of infectious diseases since six decades prior, honoured the discovery of ivermectin (IVM), a multifaceted drug deployed against some of the world’s most devastating tropical diseases. Since March 2020, when IVM was first used against a new global scourge, COVID-19, more than 20 randomized clinical trials (RCTs) have tracked such inpatient and outpatient treatments. Six of seven meta-analyses of IVM treatment RCTs reporting in 2021 found notable reductions in COVID-19 fatalities, with a mean 31% relative risk of mortality vs. controls. During mass IVM treatments in Peru, excess deaths fell by a mean of 74% over 30 days in its ten states with the most extensive treatments. Reductions in deaths correlated with the extent of IVM distributions in all 25 states with p < 0.002. Sharp reductions in morbidity using IVM were also observed in two animal models, of SARS-CoV-2 and a related betacoronavirus. The indicated biological mechanism of IVM, competitive binding with SARS-CoV-2 spike protein, is likely non-epitope specific, possibly yielding full efficacy against emerging viral mutant strains.

Chronic Pain Disorder Manifesting as Dental Pain: Case Report

Chronic pain disorder is a challenging presentation for the dental surgeon, and carries considerable impairment for the affected individual. Patients undergo extensive unnecessary investigations and treatments before the correct diagnosis is reached. It is frequently a diagnosis of exclusion. We report the case of a 46-year-old man who experienced persistent severe orofacial pain superimposed upon pain involving other anatomical regions for more than 20 years. He received treatment by eight specialties and at five national centres with increasingly poor outcome. The importance of early recognition of medically unexplained pain will be discussed. Dentists should have a high index of suspicion of pain disorder in those with multiple complaints of chronic pain in order to avoid unnecessary investigation and treatment.

Correlation of initial emergency department pulse oximetry values in asthma severity classes (steps) with the risk of hospitalization

Background The oxygen saturation (OSAT) of wheezing children presenting to an emergency department has been shown to be a predictor for hospitalization. The purpose of this study is to determine if hospitalization predictive power can be increased by further stratifying this by the step severity categories (based on chronic symptoms). Methods Data were collected prospectively at 6 centers over a 22-month period on 1219 pediatric patients. Asthma step severity categorization was determined by chronic symptom history. Presenting ED OSAT values, extensive clinical histories (obtained in the ED and during several telephone follow-up calls by study personnel), treatments, and disposition were recorded for each study subject. Results The overall hospitalization rate was 15%. Hospitalization rates in severity step categories 1, 2, 3, and 4 were 13%, 16%, 13%, and 22% ( P = .008), respectively. Hospitalization rates by presenting OSATs were 98% or higher (6%), 95% to 97% (12%), 93% to 94% (28%), 90% to 92% (45%), 85% to 89% (65%), and 80% to 84% (100%). From 95% to 100% OSAT values, hospitalization rates are similar between the severity groups. In the 93% to 94% OSAT group, the hospitalization rate is 43% in step category 4 patients, compared with 27%, 24%, and 13% for step categories 1, 2, and 3, respectively, but this difference was not statistically significant. At presenting OSAT values of 90% and below, the hospitalization rates are higher but did not differ significantly between the severity step groups. No recognizable trend was present to suggest that the hospitalization predictive value is increased by adding the step severity categories. Conclusions The presenting OSAT is the dominant initial predictor of hospitalization. The step severity categories do not appear to provide substantial additional predictive value for hospitalization.

Treatment of Cystic Epithelial Downgrowth With Intralesional Administration of Mitomycin C

To report a case of postoperative cystic epithelial downgrowth treated with needle aspiration and intralesional administration of mitomycin C. Case report. A 60-year-old woman with a history of right cataract surgery 7 years ago presented with decreased vision of 1/60. The reduced vision was diagnosed secondary to a large acquired cystic epithelial downgrowth on the surface of the iris occluding the pupil. The cystic epithelial downgrowth was treated with aspiration and intralesional administration of mitomycin C solution. There was no evidence of recurrence on follow-up 1 year after the procedure. Treatment of acquired cystic epithelial downgrowth with needle aspiration and intralesional administration of mitomycin C resulted in a satisfactory outcome without undertaking more extensive and invasive surgical treatments.