Cooperative study on the radioimmunological thyrotropin determination (hTSH) in serum (author''s transl)

The increased incidence of drowsiness in hypoalbuminemic patients administered diazepam and more rapid clearance of tolbutamide in cirrhotics may be due to changes in plasma protein binding. The binding of diazepam and tolbutamide was studied by equilibrium dialysis at 37degreesC over a total drug concentration range of 1 to 10 mug/ml and 50 to 300 mug/ml, respectively, in plasma from 21 normal and 14 alcoholic subjects. At 1 mug/ml, diazepam plasma protein binding (+/- S.D.) was 98.5+/-0.4 per cent in normals and 97.8+/-1.2 per cent in alcoholics; at 100 mug/ml, tolbutamide binding was 97.8+/-0.3 per cent in normals and 95.1+/-4.2 per cent in alcoholics. For both agents at all concentrations, the binding to plasma from alcoholics was significantly decreased (P less than 0.01-less than 0.02). The extent of binding of both drugs was dependent on the albumin concentration. These findings suggest that important changes in pharmacologic effect, distribution, and clearance of diazepam and tolbutamide can be anticipated in alcoholics with hypoalbuminemia.     

Basic laparoscopic knowledge among gynecologic laparoscopists

OBJECTIVE: Our purpose was to assess the basic knowledge of laparoscopy and laparoscopic sterilization among gynecologic laparoscopists. STUDY DESIGN: A four-part multiple-choice test designed for use in residency training, covering basic aspects of laparoscopy and laparoscopic sterilization, was distributed to 155 registrants at a gynecologic surgery postgraduate course. Test results were compared among subgroups, as well as with results for 23 residents who had taken the test before their rotation in laparoscopic sterilization. RESULTS: Residents scored higher than practitioners on all test segments. No practitioner achieved the 85% correct passing score required of residents. Practitioner scores did not increase as the number of laparoscopic sterilizations performed per year increased, but higher test scores were associated with more recent completion of residency. CONCLUSION: Basic knowledge of laparoscopic sterilization among practicing gynecologists, as measured by a test designed for residents, is less than that of the residents.     

Public health risks of ostrich and crocodile meat

This paper discusses the infectious agents and chemical substances potentially capable of contaminating the meat of ostriches and crocodiles and which thus pose a danger to human handlers and consumers. For ostrich meat, there is no danger from Crimean-Congo haemorrhagic fever or spongiform encephalopathy. Contamination of ostrich meat with salmonellae, chlamydia, pasteurellae, mycobacteria and erysipelas might be possible, but has never been reported. No parasites are known which could be transmitted through ostrich meat to human consumers. Residues from growth hormones, antibiotics and acaricides are potential public health hazards. For crocodile meat, there is a distinct possibility of contamination with salmonellae, depending on housing, feed, slaughter technique and hygiene practices under which the animal is reared. Chlamydial infections are common on some crocodile farms in southern Africa. Mycobacteriosis is extremely rare. Tapeworm cysts have been found in crocodile meat in two cases only. Trichinellosis has been reported on several crocodile farms in Zimbabwe. A generalised coccidiosis with invasion of organs and tissues has been seen in several species of crocodiles, but should present no danger to consumers.     

Resynchronisation of a diurnal rodent circadian clock accelerated by a melatonin agonist

Using 'jet lag' paradigms involving phase shifts in the light-dark (LD) cycle, we studied the effects of S-20098 on the circadian clock of a diurnal rodent. Arvicanthis mordax, entrained to a regular LD cycle, were subjected to advance shifts (i.e. 4, 6 or 8 h) in the LD cycle and injected with vehicle or the melatonin agonist S-20098 (20 mg/kg) the day of the shift (and also on subsequent days in the 6 h or 8 h shift paradigms). In each condition, S-20098 accelerated by about 30% resynchronization to the new LD cycle. These data, which are the first to demonstrate the chronobiotic effects of a melatonin agonist in a diurnal rodent, provide new insights for the design of human chronopharmacological protocols.     

Enlarged hilar and mediastinal nodes (and especially lower right hilar node enlargement) as a sign of metastasis of a renal tumour

Hilar and mediastinal node enlargement may be a manifestation of the spread of renal tumours. However, the author believes the spread to these nodes may occur either via the upper para-aortic nodes or directly by way of lymphatic vessels from the kidneys by-passing the upper abdominal nodes. It seems that in some cases the hilar node may even be acting as a regional lymph node for the kidney. Thus an enlarged hilar node and especially a lower right hilar node may be the presenting feature of a renal tumour.     

Prognostic value of myoclonus status in comatose survivors of cardiac arrest

Generalized myoclonus status is common in comatose patients after cardiac resuscitation, but its prognostic value is uncertain. We studied the clinical, radiologic, and pathologic findings in 107 consecutive patients who remained comatose after cardiac resuscitation. Myoclonus status was present in 40 patients (37%). Features more prevalent in patients with myoclonus status were burst suppression on electroencephalograms, cerebral edema or cerebral infarcts on computed tomography scans, and acute ischemic neuronal change in all cortical laminae. All patients with myoclonus status died. Of 67 patients without myoclonus, 20 awakened. We conclude that myoclonus status in postanoxic coma should be considered an agonal phenomenon that indicates devastating neocortical damage. Its presence in comatose patients after cardiac arrest must strongly influence the decision to withdraw life support.     

Computer-assisted video evaluation of surgical skills

Compact video cameras have allowed the review of operations in self-directed learning sessions. Controlling the video viewing process by computer allows the selection of specific videotape segments containing the desired psychomotor skills to be evaluated--in this study, the steps involving laparoscopic tubal banding. Six faculty members were able to evaluate 23 videotapes efficiently without knowledge of the resident operator's identity. Because the computer allowed selection of only those frames of the videotape containing the skills to be evaluated, the duration of videotape seen was reduced by an average of 34% from the actual surgical time, with an increase in time saved as experience with the system was gained. Faculty members evaluated these events using a self-made checklist. It was possible to calculate the performance scores of each resident for the individual psychomotor skill components of the reviewed procedure. Computer-assisted video evaluation of surgical skills is technically feasible, allowing time-efficient review by multiple evaluators. With the development of psychometrically valid checklists for use with this technology, computer-assisted video evaluation of surgical skills may provide a new, innovative means of assessing surgical skills and training.