Effect of temperature on motor responses in organophosphate intoxication

We studied the effect of temperature on median motor responses in a 41-year-old man with organophosphate intoxication. At 32 degrees C, a normal amplitude compound motor action potential (CMAP) and a smaller spontaneous repetitive discharge (SRMAP) were present. With warming to 39 degrees C, the CMAP amplitude decreased 20%, while the SRMAP amplitude decreased 33%. With cooling to 14 degrees C, the CMAP amplitude decreased 9%, while the SRMAP became unobtainable. Possible mechanisms for these findings are discussed.     

Ultrasound screening for deep venous thrombosis after total knee arthroplasty. 2-year reassessment

The efficacy of ultrasound compared with ascending venography for the detection of deep venous thrombosis immediately after total knee arthroplasty was assessed after a 2-year interval. One hundred thirty-seven patients were eligible for the study; however, 31 patients received only one of the screening methods and a color Doppler examination was inconclusive in six patients. Therefore, 100 patients had a Doppler examination and a venogram. Overall, the sensitivity of ultrasound was 85%, the specificity 97%, the positive predictive value 85%, the negative predictive value 97%, and the accuracy 95%. The sensitivity in the calf was 83%, in the popliteal vein 86%, and in the femoral vein 100%. Two years ago, the initial assessment of ultrasound for the detection of deep venous thrombosis after surgery in patients who had total joint arthroplasty revealed a 75% sensitivity, 99% specificity, 91% positive predictive value, 97% negative predictive value, and 97% accuracy. The sensitivity in the calf was 83%; the sensitivity in the popliteal vein was 40%; and the sensitivity in the femoral vein was 50%. After 2 years of using this screening test with one technician and one radiologist, an improvement with this noninvasive technique was shown. However, it was found that Doppler imaging is not as sensitive as venography for detecting calf thrombi. Any imaging technique should be validated by each institution to determine the validity of the instrument and the learning curve of the technician administering the examination.     

How to assess a patient's support system and personal abilities prior to liver transplantation

Most liver transplant programs have come to accept the importance of evaluating the psychosocial status of potential liver transplant recipients prior to liver transplantation. The goal is to utilize a thorough assessment of the candidate's support system and personal abilities in order to predict post-transplantation compliance and overall medical-surgical outcome. To achieve this goal, it has been necessary to include a large number of multidisciplinary specialists including social workers, nurses, and psychologists as well as physicians in the evaluation process. Each disclipline contributes to the overall assessment and management of these candidates prior to and following liver transplantation. The purpose of this report is to describe how one spectrum of issues relating to a potential candidate's strengths and vulnerabilities are assessed in the liver transplant program at the University of Kentucky.     

Involvement of hormonal circadian secretion in the growth of HIV-infected children

A series of novel serine derived NK1 antagonists is described. The effect of variations in the N-benzyl, O-benzyl and serine groups are used to define the elements which are necessary for binding.