State University Health Sciences Center Research Articles

Surgical Outcome of Ulnar Nerve Lesions: Not Always Disappointing

Background: This study was embraced to examine surgical outcomes for ulnar nerve repairs, so as to help for the optimal management of these lesions. Methods: We identified 116 patients with ulnar nerve injury who were referred to our brachial plexus and peripheral nerve Injury center and underwent surgery. The demographic data about age, gender, level of injury (arm, elbow or wrist level), type of injury (penetrating or blunt), mechanisms of injury, time interval between onset of injury and surgery and functional outcomes were recorded. The functional outcomes were scored, taking into account Louisiana State University Health Sciences Center criteria, prior and then afterward the surgery. Type of repair (neurolysis, direct repair, or repair using graft), and length of graft (if any) were gathered. Results: The most widely recognized mechanism of injury was laceration in all levels. In 95 cases (81%) good functional outcome (Grade 3 or better) was achieved. The best prognosis achieved in the neurolysis (86%) and direct suture (84%), respectively. Good functional outcome was achieved in 86% of patients with nerves in continuity, and 80 % of lesions not in continuity. Overall good functional outcome was achieved in 81% (95 cases) of procedures. Conclusion: Ulnar nerves injuries are inclined to recuperate if undergo proper surgical intervention, and surgical results were for the most part better for lesions in continuity. In lesions not in continuity end-to-end direct suture showed a better prognosis than nerve graft repairs. Knowing the internal topography of ulnar nerve helps to suture more precisely which in turn may be the cause for achieving the best outcome at each level.

Osteoporosis Diagnosis and Management in Long-Term Care Facility

Contemporary estimates of the prevalence of diagnosed osteoporosis among long-term care facility residents are limited. This chart review collected data between April 1, 2012 and August 31, 2013 for adult (age ≥ 30 years) residents of 11 long-term care facilities affiliated with the Louisiana State University Health Sciences Center in the New Orleans metropolitan area. Data (demographics; comorbidities; osteoporosis diagnosis, risk factors, diagnostic assessments, treatments; fracture history; fall risk; activities of daily living) were summarized. Data for residents with and without diagnosed osteoporosis were compared using χ tests and t tests. The study included 746 residents (69% women, mean [SD] age: 76.3 [13.9] years, median length of stay approximately 18.5 months). An osteoporosis diagnosis was recorded for 132 residents (18%), 30% of whom received a pharmacologic osteoporosis therapy. Fewer than 2% of residents had bone mineral density assessments; 10% had previous fracture. Calcium and vitamin D use was more prevalent in residents with diagnosed osteoporosis compared with other residents (calcium: 49% versus 12%, vitamin D: 52% versus 28%; both P < 0.001). Over half (304/545) of assessed residents had a high fall risk. Activities of daily living were similarly limited regardless of osteoporosis status. The prevalence of diagnosed osteoporosis was higher than previously reported for long-term care residents, but lower than epidemiologic estimates of osteoporosis prevalence for the noninstitutional U.S. In our sample, osteoporosis diagnostic testing was rare and treatment rates were low. Our results suggest that osteoporosis may be underdiagnosed and undertreated in long-term care settings.

Psychiatrists Who Volunteered After Katrina Look Back on Lessons

Psychiatrists Who Volunteered After Katrina Look Back on Lessons

Surgical outcomes of 156 spinal accessory nerve injuries caused by lymph node biopsy procedures.

Iatrogenic injuries to the spinal accessory nerve (SAN) are not uncommon during lymph node biopsy of the posterior cervical triangle (PCT). In this study, the authors review the operative techniques and surgical outcomes of 156 surgical repairs of the SAN following iatrogenic injury during lymph node biopsy procedures. This retrospective study examines the authors' clinical and surgical experience with 156 patients with SAN injury between 1980 and 2012. All patients suffered iatrogenic SAN injuries during lymph node biopsy, with the vast majority (154/156, 98.7%) occurring in Zone I of the PCT. Surgery was performed on the basis of anatomical and electro-physiological findings at the time of the operation. The mean follow-up period was 24 months (range 8-44 months). Of the 123 patients who underwent graft or suture repair, 107 patients (87%) improved to Grade 3 functionality or higher using the Louisiana State University Health Science Center (LSUHSC) grading system. Neurolysis was performed in 29 patients (19%) when the nerve was found in continuity with recordable nerve action potential (NAP) across the lesion. More than 95% of patients treated by neurolysis with positive NAP recordings recovered to LSUHSC Grade 3 or higher. Forty-one patients (26%) underwent end-to-end repair, while 82 patients (53%) underwent graft repair, and Grade 3 or higher recovery was assessed for 90% and 85% of these patients, respectively. The average graft length used was 3.81 cm. Neurotization was performed in 4 patients, 2 of whom recovered to Grade 2 and 3, respectively. SAN injuries present challenges for surgical exploration and repair because of the nerve's size and location in the PCT. However, through proper and timely intervention, patients with diminished or absent function achieved favorable functional outcomes. Surgeons performing lymph node biopsy procedures in Zone I of the PCT should be aware of the potential risk of injury to the SAN.

Routine Echo Follow-Up of the Patient after Transcatheter Aortic Valve Replacement.

EchocardiographyVolume 32, Issue 10 p. 1572-1574 Echo Rounds Section Editor: Edmund Kenneth Kerut, M.D. Routine Echo Follow-Up of the Patient after Transcatheter Aortic Valve Replacement Josh Grant D.O., Corresponding Author Josh Grant D.O. Department of Medicine, Section of Cardiology, Louisiana State University Health Sciences Center, New Orleans, LouisianaAddress for correspondence and reprint requests: Josh Grant, Department of Medicine, Section of Cardiology, 533 Bolivar St Box CSRB 3-42, New Orleans, LA 70112. Fax: 504-568-2127. E-mail: [email protected]Search for more papers by this authorHiren Patel M.D., Hiren Patel M.D. Department of Medicine, Section of Internal Medicine, Baton Rouge General Medical Center, Baton Rouge, LouisianaSearch for more papers by this authorFrederick R. Helmcke M.D., Frederick R. Helmcke M.D. Department of Medicine, Section of Cardiology, Louisiana State University Health Sciences Center, New Orleans, LouisianaSearch for more papers by this authorEdmund K. Kerut M.D., Edmund K. Kerut M.D. Heart Clinic of Louisiana, Marrero, LouisianaSearch for more papers by this author Josh Grant D.O., Corresponding Author Josh Grant D.O. Department of Medicine, Section of Cardiology, Louisiana State University Health Sciences Center, New Orleans, LouisianaAddress for correspondence and reprint requests: Josh Grant, Department of Medicine, Section of Cardiology, 533 Bolivar St Box CSRB 3-42, New Orleans, LA 70112. Fax: 504-568-2127. E-mail: [email protected]Search for more papers by this authorHiren Patel M.D., Hiren Patel M.D. Department of Medicine, Section of Internal Medicine, Baton Rouge General Medical Center, Baton Rouge, LouisianaSearch for more papers by this authorFrederick R. Helmcke M.D., Frederick R. Helmcke M.D. Department of Medicine, Section of Cardiology, Louisiana State University Health Sciences Center, New Orleans, LouisianaSearch for more papers by this authorEdmund K. Kerut M.D., Edmund K. Kerut M.D. Heart Clinic of Louisiana, Marrero, LouisianaSearch for more papers by this author First published: 25 June 2015 https://doi.org/10.1111/echo.12980Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume32, Issue10October 2015Pages 1572-1574 RelatedInformation

Treatment of vertebrobasilar fusiform aneurysms with Pipeline embolization device.

Treatment of complex intracranial aneurysms with Pipeline embolization device (PED) (ev3/Covidien Vascular Therapies) has gained recent popularity. One application of PEDs that is not well described in the literature is the utility and long-term safety in treatment of vertebrobasilar fusiform (VBF) aneurysms. Despite the advancements in endovascular therapy, VBF aneurysms continue to challenging pathology. The authors provide long-term follow-up of VBF aneurysms treated with PEDs. We retrospectively reviewed four patients that were treated at Louisiana State University Health Sciences Center in Shreveport with PEDs for VBFs from 2012 to 2014. Each patient was discussed in a multidisciplinary setting between neurosurgeons and neurointerventionalists. Each patient underwent platelet function tests to ensure responsiveness to anti-platelet agents and was treated by one neurointerventionalist (HC). All patients were placed on aspirin and Plavix and were confirmed for therapeutic response prior to discharge. Follow-up ranged from 12 to 25 months, with a mean of 14.25 months. Two cases presented with a recurrence after the initial treatment, both of which required subsequent treatment. Of the four patients treated, one patient developed hemiparesis and three died. Despite reports describing successful treatment of VBF aneurysms with PEDs, delayed complications after obliteration and remodeling can occur. We describe our institutional experience of VBFs treated with PEDs. Treatment of holobasilar fusiform aneurysms may carry a worse prognosis after treatment. Further long-term follow-up will provide a better understanding of this pathology.

Relationship Between Hand‐Skill Exercises and Other Admissions Criteria and Students’ Performance in Dental School

The aim of this study was to investigate the existence of correlations between dental admissions criteria, including a chalk carving exercise, and students' subsequent academic performance. The retrospective cohort study examined the records of dental students at Louisiana State University Health Science Center School of Dentistry for the years 1998 to 2008. Only those students who could be categorized into the following four groups were included: 1) those who graduated in the top 10% of their class, 2) those who graduated in the bottom 10% of their class, 3) those who repeated a year of dental school, and 4) those who were dismissed or resigned. The study sample consisted of 176 students: 62 in the first group, 62 in the second group, 25 in the third group, and 27 in the fourth group. Data collected were each student's undergraduate grade point average (GPA); chalk carving score; undergraduate biology, chemistry, physics (BCP) GPA; Dental Admission Test (DAT) Academic Average; Perceptual Ability Test (PAT) score of the DAT; total DAT score; grade in preclinical operative dentistry class; grade in morphology and occlusion class; and dental school GPA at graduation. The results showed that only the undergraduate GPA and BCP GPA were significantly higher for students in the top 10% of their class than for other groups. The only positive correlation involving the chalk carving scores was with the preclinical operative dentistry course grade. This study thus found limited correlations between this institution's admissions criteria and its students' success in dental school.

Photographic art in exam rooms may reduce white coat hypertension

IntroductionBlood pressure (BP) elevation in medical office settings in patients who are normotensive in nonmedical settings is an effect known as ‘white coat hypertension’. This phenomenon is thought to be...

Evaluating the Efficacy of a Video Dissection Guide Tailored to the Louisiana State University Health Sciences Center Gross Anatomy Curricula

In an effort to close the educational gap caused by low instructor to student ratios in gross anatomy labs, a new video dissector based on the required written text used at Louisiana State University (LSU), Grant's Dissector 15th edition, is being created by the gross anatomy faculty. As currently available video guides are more demonstrative and less instructional, our goal is easing the perfunctory dissection burden by describing dissection techniques and characteristic structures so critical dissection of historically difficult‐to‐identify structures can be carried out more quickly with less dissection damage. It is hypothesized that these LSU‐specific videos will be of greater aid to students in identifying structures than guides already in existence or than written text alone. To test this hypothesis, the class will be divided into 3 groups: written dissector only, traditional anatomy video specifically Acland's Video Atlas of Human Anatomy, and LSU video dissection guide. Accuracy of structure identification will be assessed by a simple questionnaire administered to all 3 groups. Either the students will identify a given structure or it will be located by the faculty if they cannot. Also, video group assignation will be compared to gross anatomy practical exam scores for each dissection block. It is hypothesized that assignment to the LSU video dissection guide will result in higher practical exam scores than either traditional anatomy video or written dissector alone.Source of Support: Dept of Cell Biology and Anatomy, Louisiana State University Health Sciences New Orleans, LA

Louisiana State University Health Sciences Center Katrina Inspired Disaster Screenings (KIDS): Psychometric Testing of the National Child Traumatic Stress Network Hurricane Assessment and Referral Tool

Post disaster psychosocial surveillance procedures are important for guiding effective and efficient recovery. The Louisiana State University Health Sciences Center Katrina Inspired Disaster Screenings (KIDS) is a model designed with the goal of assisting recovering communities in understanding the needs of and targeting services toward children and adolescents. As a critical, yet understudied, component to the KIDS model, the objective of this study is to test the psychometric properties of the National Child Traumatic Stress Network Hurricane Assessment and Referral Tool for Children and Adolescents. Exploratory factor analysis (EFA) was used to investigate the factor structure of the NCTSN Hurricane Assessment and Referral Tool. The convenience sample included 7530, 9–18 years old students who completed the school initiated screener in Southeastern Louisiana schools from December 2005 to December 2006. On a small treatment seeking population (N = 62), associations among the referral tool and the PTSD Reaction Index were also explored. EFA of the referral tool revealed a two factor solution, anxious and depressive reactions, that accounted for 45.8 % of model variance. Internal consistency was high and symptom scores were moderately associated with the PTSD Reaction Index. The cutoff score was also confirmed with scores ≥4 suggesting the need for referral. This study allows for the recommendation of the NCTSN Hurricane Assessment and Referral Tool as a reliable and valid part of the KIDS model; together they provide an initial step toward addressing the needs of child and adolescent disaster survivors.

Increase in NF-κB-sensitive miRNA-146a and miRNA-155 in multiple sclerosis (MS) and pro-inflammatory neurodegeneration.

OPINION article Front. Mol. Neurosci., 02 March 2015Sec. Brain Disease Mechanisms Volume 8 - 2015 | https://doi.org/10.3389/fnmol.2015.00005

A 2-year follow-up survey of 523 cases with peripheral nerve injuries caused by the earthquake in Wenchuan, China.

We performed a 2-year follow-up survey of 523 patients with peripheral nerve injuries caused by the earthquake in Wenchuan, Sichuan Province, China. Nerve injuries were classified into three types: type I injuries were nerve transection injuries, type II injuries were nerve compression injuries, and type III injuries displayed no direct neurological dysfunction due to trauma. In this study, 31 patients had type I injuries involving 41 nerves, 419 had type II injuries involving 823 nerves, and 73 had type III injuries involving 150 nerves. Twenty-two patients had open transection nerve injury. The restoration of peripheral nerve function after different treatments was evaluated. Surgical decompression favorably affected nerve recovery. Physiotherapy was effective for type I and type II nerve injuries, but not substantially for type III nerve injury. Pharmacotherapy had little effect on type II or type III nerve injuries. Targeted decompression surgery and physiotherapy contributed to the effective treatment of nerve transection and compression injuries. The Louisiana State University Health Sciences Center score for nerve injury severity declined with increasing duration of being trapped. In the first year after treatment, the Louisiana State University Health Sciences Center score for grades 3 to 5 nerve injury increased by 28.2% to 81.8%. If scores were still poor (0 or 1) after a 1-year period of treatment, further treatment was not effective.

Lower Extremity Nerve Compression Syndromes

Dr. Gevirtz is Associate Professor of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, and Medical Director, Somnia Pain Management, 627 West St, Harrison, New York, NY 10528; E-mail: [email protected]. The author and all staff in a position to control the content of this CME activity, and their spouses/life partners (if any), have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity. Dr. Gevirtz has disclosed that use of gabapentin, pregabalin, and lidocaine patches as discussed in this article has not been approved by the U.S. Food and Drug Administration. Please consult the product labeling for approved uses. Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation assessment survey on the enclosed form, answering at least 70% of the quiz questions correctly. This activity expires on December 31, 2015.

Lower Extremity Nerve Compression Syndromes

Dr. Gevirtz is Associate Professor of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, and Medical Director, Somnia Pain Management, 627 West St, Harrison, New York, NY 10528; E-mail: [email protected]. The author and all staff in a position to control the content of this CME activity, and their spouses/life partners (if any), have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity. Dr. Gevirtz has disclosed that use of gabapentin, pregabalin, and lidocaine patches as discussed in this article has not been approved by the U.S. Food and Drug Administration. Please consult the product labeling for approved uses. Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation assessment survey on the enclosed form, answering at least 70% of the quiz questions correctly. This activity expires on November 30, 2015.

An evaluation of progressive amyloidogenic and pro-inflammatory change in the primary visual cortex and retina in Alzheimer's disease (AD).

James M. Hill , Prerna Dua, Christian Clement and Walter J. Lukiw* 1 Louisiana State University Neuroscience Center and Departments of Ophthalmology and Pharmacology, Louisiana State University Health Science Center, New Orleans, LA, USA 2 Department of Health Information Management, Louisiana State University, Ruston, LA, USA 3 Department of Natural Sciences, Infectious Diseases, Experimental Therapeutics and Human Toxicology Lab, Southern University at New Orleans, New Orleans, LA, USA 4 Department of Neurology, Louisiana State University Health Science Center, New Orleans, LA, USA *Correspondence: wlukiw@lsuhsc.edu

Osteopathic Manipulative Therapy in Pain Management

Dr. Gevirtz is Associate Professor of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, and Medical Director, Somnia Pain Management, 627 West St, Harrison, New York, NY 10528; E-mail: [email protected]. The author and all staff in a position to control the content of this CME activity, and their spouses/life partners (if any), have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity. Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation assessment survey on the enclosed form, answering at least 70% of the quiz questions correctly. This activity expires on July 31, 2015.

Contrast Agents in Pain Practice

Dr. Gevirtz is Associate Professor of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, and Medical Director, Somnia Pain Management, 627 West St, Harrison, New York, NY 10528; E-mail: [email protected]. The author and all staff in a position to control the content of this CME activity, and their spouses/life partners (if any), have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity. Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation assessment survey on the enclosed form, answering at least 70% of the quiz questions correctly. This activity expires on June 30, 2015.

Celiac Plexus Block

Dr. Gevirtz is Associate Professor of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, and Medical Director, Somnia Pain Management, 627 West St, Harrison, New York, NY 10528; E-mail: [email protected]. The author and all staff in a position to control the content of this CME activity, and their spouses/life partners (if any), have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity. Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation assessment survey on the enclosed form, answering at least 70% of the quiz questions correctly. This activity expires on May 31, 2015.

Lessons learned from yet another episode of diethylene glycol poisoning: it happened before and it happened again.

In September 2006, aPanamanianphysiciannoted that there were an unusual number of mostly elderly patients presentingwith signs of acute kidney injury, gastroenteritis, and central andperipheralneurological effectsofunclear etiology. A cluster of this nature suggests a common-source etiology, which typically could be infectious or toxicological. This prompted the Panamanian Ministry of Health to seek investigative assistance fromtheUSCenters forDiseaseControl and Prevention (CDC). ByOctober, investigators from the CDC set upa case-control study,with casesdefined as individuals presenting, on or after August 2006, with apparent acute kidney injury of unknown etiology. Controls consisted of individuals admitted to the samehospital for reasons other than renal injury and were matched to cases by age and date of admission. Forty-two patients met the case definition. The evaluation of cases included a questionnaire assessing potential recentchemical exposures.Medications takenandurinesamples were sent to theCDC.Diethylene glycol (DEG), a knownnephrotoxin,wasquickly identifiedas theputativeculprit inacough syrup preparation.1 Fortuitously, DEG was prominent on the CDC’s radar screen. Theywere involvedwith similar outbreaks of poisonings from DEG-contaminated pharmaceuticals in Nigeria in 1990andHaiti in 1996. In these2outbreaks, theDEGwas found in acetaminophen syrups. Tragically, these are but three 3 of the 13 such episodes of mass DEG poisonings that have been identifiedsince 1938.Ofgreat concern is the fact that 12of these 13episodes involvedpharmaceuticalsofvariouskinds.Theone nonpharmaceutical episode involved DEG-tainted Austrian wines. Diethylene glycol is characterized by its sweet taste and aqueous miscibility. It has a relatively low order of toxicity but is hepatically metabolized by alcohol and aldehyde dehydrogenases to hydroxyethoxy acetic acid (HEAA), which can be further oxidized to diglycolic acid (DGA). Studies from Kenneth McMartin’s laboratory at the Louisiana State University Health Sciences Center have demonstrated that contrary to earlier beliefs, DGA, and not HEAA, appears to be the nephrotoxic metabolite, at least in rats.2 The nephrotoxic potential of DGA appears to derive from its ability to inhibit succinate dehydrogenase, causing mitochondrial dysfunction and consequently reduced energy production in the renal proximal tubule. Whether this same mechanism applies to humans has not been demonstrated. However, confidence that it might is heightened by the fact that the rat model is known to reasonably replicate the human pathophysiological changes induced by the related compound ethylene glycol. We have learned a number of lessons from the Panamanian DEG episode. It has provided an opportunity to characterize the concentrations of DEG and metabolites in the serum and urine of DEG-poisoned patients and corresponding control participants. Using biological samples from participants in the case-control study, investigators found that urinary DGA concentrations were significantly associated with being a case and were found in 100% of case samples despite being mostly collected days after exposure. Much smaller amounts ofDGAweredetected in 23%of the controls. The low level of DGA found in some control participantswas probably due to environmental exposure to DGA, which can be found in low concentrations in food, cosmetics, and dietary supplements, or perhaps low-dose exposure to the tainted cough syrup. Themedian serumDGAconcentration in the caseswas 41 μg/mL, which is almost 10 times higher than that reported to cause nephrotoxicity in the rat model of DEG poisoning.2,3 SerumHEAAconcentrationswere significantlyhigher in cases than in controls. The median serum DGA concentration was more than 14 times higher than that of HEAA.3 This contrasts sharplywiththeratmodelofDEGpoisoning, inwhichtheblood HEAAconcentrationwas 100 times thatofDGA.2However, the extended period between exposure and the collection of samples in the Panamanian cases could have allowed HEAA to be oxidized to DGA. In these cases, themedian HEAA concentrationswerebelow thedetection limit in theurine inboth cases and controls.3 These data support the concept that DGA appears to be the nephrotoxic metabolite after DEG poisoning. Given that the median serum DGA concentration was 41 μg/mL in cases, and below the limit of detection in controls, it couldbe reasonablyhypothesized that inhumans, as in rats, HEAA is converted to DGA, leaving the latter to interact with renal tissue. Diglycolic acid is concentrated in the kidney.2 If DEG poisoning is suspected, inhibition of its metabolism by inhibiting alcohol dehydrogenase enzymes is a logical treatment and has been shown to be effective in the rat model.2 Fomepizole is the preferred antidote for this purpose, although in situations where it is not available ethanol could be used.4 Diethylene glycol is excreted through the kidneys,5 so if renal function is intact, this might be the only treatment necessary. If renal function is compromised, hemodialysis could be used to clear DEG. However, there are no easily available biomarkers of DEG concentrations, and hence stopping therapy must be done using indirect indicators. It would be expected that DEG metabolism to significant quantities of its acidic metabolites would be accompaRelated article page 912 Research Original Investigation Outcomes Among Survivors of DEG Poisoning

Head and neck cancer (HN) characteristics and outcomes in a human immunodeficiency virus infected (HIV+) patient cohort: A 12-year experience of the Louisiana State University Health Sciences Center (LSUHSC) and Charity Hospital in New Orleans.

6069 Background: HIV+ patients (pts) are typically excluded from enrollment on randomized clinical trials for head and neck cancer. Data regarding clinical characteristics and outcomes for HIV+ pts...