Startle potentiation in aversive anticipation: evidence for state but not trait effects.

The present study was undertaken to determine whether aversiveness contributes to startle potentiation in anticipation of affective pictures above and beyond the effects of emotional arousal. Further, participants high in trait anxious apprehension, which is characterized by worry about the future, were expected to show especially pronounced anticipatory startle responses. Startle blink reflex was measured during warning stimuli that predicted the valence of ensuing aversive/unpleasant, pleasant, or neutral pictures.

A randomized, controlled trial of high-dose dextromethorphan in facial neuralgias.

Background: NMDA glutamate receptor antagonists such as ketamine and dextromethorphan reduce pain in certain neuropathic pain conditions. However, there have been no controlled trials of NMDA antagonists in facial neuralgias.

Methods: A randomized, double-blind, crossover trial compared 6 weeks of oral dextromethorphan with active placebo (low-dose lorazepam) in 19 patients, stratified into three groups: 11 with facial pain and possible trigeminal neuropathy, five with anesthesia dolorosa, and three with idiopathic trigeminal neuralgia.

A comparison of ambulatory care and selected procedure rates in the health care systems of the Province of Manitoba, Canada; Kaiser Permanente Health Maintenance Organization; and the United States.

To determine if there are differences in physician services in different health care systems, we compared ambulatory visit rates and procedure rates for three surgical procedures in the province of Manitoba, Canada; Kaiser Permanente Health Maintenance Organization; and the United States. The KP system, with its single payer and low financial barriers, is not unlike the Canadian system. But, for most of the United States, the primary payment mechanism is fee-for-service, with the patient paying a significant amount, thereby militating against preventive and early primary care.

Telephone calls and appointment requests. Predictability in an unpredictable world.

HMO member-initiated requests for service, including telephone calls and appointments, were studied. Telephone calls to medical offices were found to be directly proportional by a constant factor to the number of members using the facility. The number of member requests for appointments for medical problems and routine physical examinations was also predictable.

Acute renal failure in legionnaires' disease: report of a case.

The renal insufficiency which has been described in some of Legionnaires' Disease, has not been characterized. We describe a patient who developed severe oligoanuric renal failure associated with Legionnaires' Disease. Renal biopsy revealed acute tubular necrosis.