Medicine taking in Southampton: a second look

1. A 1 in 200 sample of the Southampton electorate were sent a postal questionnaire in January 1993. Of the 756 adults surveyed, 400 (52.9%) returned completed questionnaires. One hundred and eighty-eight (47.0%) of the respondents had been prescribed a medicine within the previous month. 2. Compared with a survey 9 years earlier, medicine taking had increased amongst men (44.1% vs 33.7% NS) and drugs acting on the respiratory system were in more widespread use (19 vs 7 patients P < 0.05). 3. Patterns of storage of medicines were almost identical to those found in 1984. However, methods of disposal were significantly different with 34% of the respondents stating that they would return left-over medicines to the Doctor or Pharmacist compared with 17% in the previous study (P < 0.01). 4. Of those taking medicines 120 (63.8%) had received a manufacturers' information leaflet. Medicines used to treat disorders of the respiratory and cardiovascular systems were most likely to be accompanied by such a leaflet (74% and 70% respectively). 5. Those who received a leaflet were almost all satisfied by it. However, patient awareness of potential side effects remained poor with only 30% being aware of any which their medicine might cause. 6. Despite improvements in attitudes towards medicine taking over time patients awareness of potential adverse effects remains limited. Further research is necessary in order to determine how best to educate patients on this topic.     

May-Thurner syndrome: management by endovascular surgical techniques

In the winter of 1996, a total of 71 working adults from 20 to 60 (m = 37.3) years of age were immunized with one or two doses of inactivated influenza vaccine formulated in Japan. The reciprocal geometric mean hemagglutination inhibition antibody titers [mean HI] and the percentage with a hemagglutination inhibition titer of > or = x 128 [percent > or = x 128], against A/ Yamagata/32/89 (H1N1), A/Uhan/359/95 (H3N2), and B/Mie/1/93 were significantly elevated by either doses. The pre-/post-vaccination mean HI of H1N1 were 61.5/668.4 with one dose, and 85.7/637.3 with two doses. The percent > x 128 were 36.5/96.2 with one dose, and 47.4/94.7 with two doses. No significant differences were apparent between one and two doses. Similarly, nonsignificant differences were observed for the other two antigens contained in the vaccine. We observed the sufficient immune response to only one dose of inactivated influenza vaccine, which emphasizes the merit of one dose method of influenza immunization.     

Environmental factors in cancer of the larynx: a second look

During a retrospective case-control study of recent laryngeal cancer patients, several associated factors were studied to determine possible changes in the epidemiology of laryngeal cancer between 1956 and 1974. The large sex difference noted in the early survey (male: female ratio of 14.9:1) diminished considerably in the present sample (4.6:1) because more women are cigarette smokers in the cancer age group today than was the case 20 years ago. Laryngeal cancer patients tended to be less educated than the controls and included a smaller proportion of Jews and more Catholics than the control group. The risk for developing laryngeal cnacer was considerably lower for exsmokers and long-term (10+ years) filter cigarette smokers as compared with non-filter smokers. At each level of alcohol consumption, the risk increased as exposure to tobacco increased. Occupations associated with wood exposure were found to affect the development of laryngeal cancer, independently of smoking status. Future studies should include an extensive study of nutritional deficiencies associated with alcoholism to determine if a correlation exists between such deficiencies, socioeconomic status, and an increased risk of laryngeal cnacer.     

Technical advances in the surgical management of thoracoabdominal aortic aneurysms]

Thoracoabdominal aortic aneurysmectomy ranks among the major cardiovascular surgical procedures. During the last two decades perioperative results have improved to the point that surgery should be discussed in the vast majority of patients seen with a thoracoabdominal aortic aneurysm. This progress is largely attributable to a variety of technical improvements including: aortic reconstruction using the graft inclusion technique, usually with direct reattachment of aortic branches to the prosthetic graft; distal aortic perfusion; selective use of deep hypothermic circulatory arrest in anatomically complex situations; preoperative visualization of arterial blood supply to the spinal cord using selective arteriography of intercostal and lumbar arteries. Current perioperative mortality is around 10% whereas the spinal cord complication rate is between 5% and 20% according to clinical and anatomical conditions. Future efforts should concentrate on the prevention of spinal cord complications.     

Comparison of two surgical techniques for the management of cervical spondylomyelopathy in dobermanns

A study was undertaken to compare the efficacy of two surgical techniques for the treatment of caudal cervical spondylomyelopathy (CCSM): ventral decompression (slot) and vertebral distraction and stabilisation with a screw and washer (screw/washer). Twenty-eight dobermanns managed surgically for disc-associated CCSM during a four-year period were studied retrospectively. The maximum postoperative period was 40 months. Cases were excluded if a minimum follow-up of 24 months after surgery could not be made. A 'slot' took a longer time to perform and had a higher rate of immediate postoperative deterioration. Duration of hospital stay was similar for both procedures. At six months after surgery the two techniques were comparable; 12/14 (screw/washer) and 13/14 (slot) patients were deemed to have a satisfactory outcome. Recurrence of cervical spinal cord disease was higher in the screw/washer dogs. At one year after surgery the recurrence rate was zero (slot) and 5/14 (screw/washer), respectively. At two years after surgery 4/14 of the slot dogs had deteriorated compared to 7/14 of the screw/washer dogs. Where investigated, the cause of deterioration was either a domino disc lesion or vertebral endplate collapse and dorsal displacement of the screw and washer.     

Relaxation techniques for acute pain management: a systematic review

A papain-type cysteine endopeptidase with a molecular mass of 35 kDa for the mature enzyme, was purified from germinating castor bean (Ricinus communis L.) endosperm by virtue of its capacity to process the glyoxysomal malate dehydrogenase precursor protein to the mature subunit in vitro (C. Gietl et al., 1997, Plant Physiol 113: 863-871). The cDNA clones from endosperm of germinating seedlings and from developing seeds were isolated and sequence analysis revealed that a very similar or identical peptidase is synthesised in both tissues. Sequencing established a presequence for co-translational targeting into the endoplasmic reticulum, an N-terminal propeptide and a C-terminal KDEL motif for the castor bean cysteine endopeptidase precursor. The 45-kDa pro-enzyme stably present in isolated organelles was enzymatically active. Immunocytochemistry with antibodies raised against the purified cysteine endopeptidase revealed highly specific labelling of ricinosomes, organelles which co-purify with glyoxysomes from germinating Ricinus endosperm. The cysteine endopeptidase from castor bean endosperm, which represents a senescing tissue, is homologous to cysteine endopeptidases from other senescing tissues such as the cotyledons of germinating mung bean (Vigna mungo) and vetch (Vicia sativa), the seed pods of maturing French bean (Phaseolus vulgaris) and the flowers of daylily (Hemerocallis sp.).     

CTA-based angle selection for diagnostic and interventional angiography of saccular intracranial aneurysms

Coil embolization is a safe treatment for cerebral aneurysms only if the width of the neck in relation to the fundus of the aneurysm is small. Therefore, accurate visualization of the aneurysmal neck is required both in the diagnostic process and during the intervention. Conventional digital subtraction angiography (DSA) is still the preferred modality for the examination of cerebrovascular abnormalities like aneurysms, but it often does not provide the required morphological characteristics due to the suboptimal selection of projection angles and resulting overprojections of surrounding vasculature. This paper presents a method for performing a computer-assisted calculation of the optimal projection angles for DSA by post-processing computed tomographic angiography (CTA) volume data using ray-casting techniques and a combination of image processing algorithms. By means of phantom studies, retrospective simulations of angiograms, and in vivo applications of calculated optimal viewing angles, it is demonstrated that the proposed method results in better angiographic projections of the neck of saccular aneurysms with small neck-fundus ratio than those acquired at standard angles prescribed by clinical protocols.     

Review of Personnel management: Canadian second edition.

Reviews the book, Personnel management: Canadian second edition by Gary Dessler and John F. Duffy (1984). This book is directed at readers who have an interest in the practical aspects of personnel management. In the preface to the book, the authors state that the book "provides students in Human Resource Management and Personnel Management with a complete, comprehensive review of essential personnel management concepts and techniques in a highly readable and understandable form" (p. xiii). In the concluding chapter, they add that "throughout this book we have emphasised the nuts and bolts of personnel management by focusing mainly on the concepts and techniques all managers need to carry out their personnel related tasks" (p. 512). For the most part, the book appears to live up to the authors' claims. It is, in fact, very readable and is organized in such a way as to maximize learning. Each chapter begins with a list of the things students should know or be able to do after reading the chapter, as well as an overview of the material to be covered. The authors make frequent use of examples to illustrate major points, and the cases and exercises included at the end of each chapter will be helpful in allowing students to get some experience at the kind of activities involved in personnel management (e.g., constructing application forms, conducting interviews, dealing with motivation problems). Personnel Management probably comes about as close as a textbook can to providing both the background information and "hands-on experience" that are required of individuals aspiring to careers in the field of personnel management. Moreover, in this Canadian edition, Professor Duffy has revised Professor Dessler's earlier text to make it more relevant to the issues facing personnel managers in Canada. Although most of the issues dealt with in the book are relevant to personnel management in both Canada and the U.S., the reference to Canadian cases, research, and legal issues will probably be a refreshing change to many students. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vascular "tumors" and the rules of their surgical management

After defining vascular tumors and malformations, formerly called angiomas, the authors adopt the classification of the International Society for the Study of vascular Anomalies. The various groups of malformations, after definition of the subject and the problems raised, are illustrated by a number of clinical cases and the rules of surgical management are discussed. Capillary malformations, formerly called portwine stains, can be treated by dye laser, but sometimes tissue and orthognathic reconstructive surgery in the presence of a skeletal malformation. Lymphatic malformations (lymphangiomas), optimally assessed by CT or MRI, can be treated by a variety of approaches: sclerotherapy, surgery. Venous malformations raise very different problems in the cervicocephalic region and on the limbs and trunk, but always require a multidisciplinary approach with, according to the site, size and repercussions, Ethibloc percutaneous sclerotherapy, embolization, surgery. Arteriovenous malformations require complete surgical treatment, usually preceded by embolization; reconstruction consists of local flaps or skin expansion in simple cases, and revascularized free flaps in difficult cases. If the malformation is cosmetically and functionally acceptable, the authors propose conservative management. The first-line treatment of haemangiomas is pharmacological (corticosteroids, interferon), but surgery may be indicated in two situations: early and late. There is a renewed interest in early surgery, subtended by several factors including cosmetic concerns and the development of new technologies, including the Cavitron. Late surgery retains its classical cosmetic and functional indications. Two key-words dominate the rules of therapeutic management of all types of vascular malformations: a multidisciplinary approach and modesty.     

Dynamic redistribution of glycoprotein Ib/IX on surface-activated platelets. A second look

The present study has re-evaluated the mobility of glycoprotein Ib/IX (GPIb/IX), the von Willebrand factor receptor, on surface-activated platelets. A previous report employing immunogold cytochemistry with monoclonal and polyclonal antibodies specific for GPIb/IX concluded that the receptor remained stabilized in plasma membranes and did not move during platelet attachment and spreading on formvar grids, despite the observation that immunogold particles marking GPIb/IX were missing from peripheral margins and pseudopods of the surface-activated platelets. Addition of thrombin to surface-activated, spread platelets freed GPIb/IX from its anchor to the membrane and stimulated movement of receptor-ligand complexes into caps over centers of spread platelets. In our investigation, surface-activated platelets, stimulated or not by thrombin, were fixed in a higher concentration of glutaraldehyde than used by the earlier workers before exposure to monoclonal or polyclonal antibody to GPIb/IX, after incubation with the antibody, but before treatment with the immunogold marker, protein A gold (PAG), or after both antibody and PAG. When fixed before exposure to antibody and PAG, GPIb/IX receptors were dispersed evenly over dendritic and spread platelets from edge to edge, including peripheral margins and pseudopods. Thrombin had no influence on distribution of the receptors. Exposure to antiglycocalicin antibody before fixation caused movement of GPIb/IX receptors from peripheral margins of spread cells and pseudopods of dendritic forms. Thrombin treatment did not enhance the movement. Fixation after exposure of surface-activated platelets, treated or not with thrombin, to antibody and PAG caused movement of GPIb/IX receptors into caps over cell centers. Results indicate that central movement of GPIb/IX receptors is unrelated to surface activation, spreading, or thrombin stimulation. Rather, the translocation is caused by the antiglycocalicin antibody and accentuated by PAG.     

Rorschach prediction of success in clinical training: A second look.

Reports the development of a Rorschach Index based on an ego-psychological conceptualization of an optimal personality picture of the successful trainee in clinical psychology. Rorschach Index prediction for 155 trainees of the Veterans Administration assessment project were compared with dichotomous predictions from the Miller Analogies Test (MAT) and the SVIB. The Rorschach Index predicted success and failure and identified failures for personality reasons more effectively than the MAT or the SVIB. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A second look at the personality/disease specificity hypothesis: A response to Friedman and Booth-Kewley.

While presenting persuasive evidence of the functional integrity of an interactive mind/body system, H. S. Friedman and S. Booth-Kewley's (see record 1987-31704-001) meta-analysis of the personality/disease relationship does injury to the specificity hypothesis, which contends that there may be emotion-specific/disease-specific linkages in the etiology and progress of certain stress-responsive syndromes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological training in medical school departments of pediatrics: A second look.

Surveyed individuals at 100 medical schools concerning academic and clinical training for psychologists in pediatric facilities during 1970–1971 as a follow-up to a survey by D. K. Routh (1970). There was an increase in the number of pediatric departments and associated facilities that were the site of some type of psychological training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Metopic synostosis: in favour of a "simplified" surgical treatment

Metopic synostosis is a relatively simple form of craniosynostosis, resulting from premature fusion of the metopic suture. In this pathology different degrees of dysmorphia of the anterior cranial fossa and the presence of associated anomalies of the skull might enable specific subgroups to be identified. Since most functional and cosmetic anomalies benefit from early surgical treatment, over the last few years neurosurgeons have been forced to elaborate less drastic, but nonetheless effective, surgical techniques. In the present report we analyze the surgical results obtained in a series of 62 infants with trigonocephaly operated on within their 1st year of life. Patients were subdivided into two groups (group I: 8 patients; group II: 54 patients) according to the specific dysmorphic characteristics of the frontal bone and anterior cranial fossa, and the presence of compensatory deformities affecting the anterior cranial base and temporo-parietal region. All the patients were treated using one of two relatively simple surgical techniques (procedure A: inversion of two hemifrontal bone flaps--48 cases; procedure B: the "shell" operation--14 cases). Both surgical procedures appeared to be effective, allowing adequate functional and cosmetic correction of the cranial deformity. In patients operated on following procedure B surgical time and blood loss were dramatically reduced. Long-term outcomes were satisfactory in all cases, irrespective of the surgical technique used. In the group II patients, however, progressive normalization of the interorbital distance was constantly observed, suggesting a different degree of stenotic involvement at the level of the anterior cranial base in these patients.