Visceral anatomy of the Amphisbaenia

Study of the visceral anatomy of 41 specimens of amphisbaenians representing 13 genera shows that they share a very distinct structure which differs from that found in either snakes or typical lizards. The left lung is large while the right is rudimentary or absent (unique); the kidneys are freely suspended in the coelom by a mesentery (unique); the spleen is usually embedded in the anterior end of the pancreas (as in snakes); the gall bladder lies in a notch in the liver, and the kidneys lie opposite each other (as in lizards). The distinctness of this pattern supports the recognition of the Amphisbaenia as a separate suborder of the Squamata.     

Clinical discrepancy between Schi?tz and Perkins Tonometry in juvenile glaucoma

BACKGROUND: In infantile glaucoma Schiotz and Perkins tonometry are often divergent. However, empirical data about the quantitative relation of Schiotz' and Perkins' measurements are lacking for this group of patients. PATIENTS AND METHODS: 363 comparative IOP measurements by applanantion and indentation tonometry under general anesthesia were performed in 51 children (0-10 years) with infantile glaucoma during 01/01/88 and 30/06/95 at the University Eye Clinic Cologne. RESULTS: Correlation coefficient of both methods was 0.75 (p < 0.001). Schiotz tonometry surmounted Perkins tonometry in 78.8% of measurements. Differences of Schiotz and Perkins IOP measurements showed a normal distribution with mean value 4.37 +/- 5.8 mm Hg. Discrepancy between both methods increased significantly (p < 0.001) in eyes with corneal opacities (5.29 +/-6.35 mm Hg) compared with clear cornea (3.40 +/- 4.98 mm Hg). Discrepancy of Schiotz-Perkins tonometry was not influenced by axial length of the eye, corneal diameter and age of the patient. DISCUSSION: Marked discrepancy of applanation and indentation tonometry in infantile glaucoma is frequent. Decision for surgery should not base on tonometry alone, but on evaluation of additional clinical criteria like optic disc cup, corneal morphology and individual anamnesis.     

Jugular bulb oximetry for the monitoring of cerebral blood flow and metabolism

Jugular bulb oximetry can be used to assess the balance between oxygen supply and demand to the brain, measure metabolic byproducts, and determine cerebral blood flow. It has been useful in guiding the management of patients who are at risk of developing global ischemia. In this article, the principles upon which this monitor is based are discussed. Technical considerations such as placement techniques, factors affecting accuracy, limitations of the technique, and proper interpretation of oximetric values are reviewed. Lastly, specific clinical applications are presented.     

Motivation of general practitioners attending postgraduate education

BACKGROUND: The 1990 Contract encouraged general practitioners to participate in continuing medical education by providing a financial incentive. AIM: The study was designed: to determine the motivation of general practitioners attending education events; and to compare motivation and reasons for attendance pre- and post-Contract at commercial and non-commercial meetings, and at the different educational categories of Disease Management (DM), Health Promotion (HP) and Service Management (SM). METHOD: Two structured questionnaires were used. The first was sent to all general practitioners in the West of Scotland and asked about motivation pre-1990 Contract and the second, post-Contract, looked at motivation and reasons for attending a course as part of post course assessment. This latter was part of a much larger study evaluating continuing medical education. RESULTS: A total of 1161 practitioners responded to questionnaire I and 552 general practitioners attended 27 randomly selected postgraduate meetings. Finance was a motivator in 3.8% pre-Contract, and this increased to 33.3% post-Contract and was the most commonly stated reason for attendance in 81.3%. Financial incentive had the biggest influence on those attending HP sessions (91.5%), then SM (87.2%) and finally DM (78.6% (chi 2 = 8.68; P < or = 0.013). It was also important to 73% attending drug-company-sponsored meetings compared with 83.7% going to non-commercial ones. Interest was a good motivator both pre- and post-Contract, but more so for DM than other categories and drug company as opposed to non-commercial meetings (chi 2 = 9.4; P < 0.002). Lack of knowledge became a less-important motivator post-Contract, and doctors felt least knowledgeable in SM (62.2%), as opposed to DM (57.9%) and HP (23.6%) (chi 2 = 38.8; P < 0.001, with each differing significantly from both others). Doctors found the topics provided by the pharmaceutical companies more interesting (chi 2 = 9.4; P < 0.002) and the hospitality provided more alluring than scheme meetings (chi 2 = 28.6; P < 0.001). CONCLUSIONS: Finance has a major effect on attendance at postgraduate meetings but may not be a good incentive for learning. Planning for education must take into account the different motivational factors for the different categories. Reasons for attending commercial meetings differ from non-commercial ones and these events should be closely monitored.