Prevention of spinal anaesthesia-induced hypotension in the elderly: i.m. methoxamine or combined hetastarch and crystalloid.

We have compared two methods of reducing hypotension during spinal anaesthesia in elderly patients, 6% hetastarch and crystalloid or methoxamine 10 mg i.m., in terms of haemodynamic stability and requirements for additional vasopressors.

Surgery for severe COPD. Lung volume reduction and lung transplantation.

A management strategy for patients with severe emphysema is shown in figure 2 on page 199. Although the reported physiologic improvements after LVRS are significantly less than those seen after lung transplantation, LVRS has the potential to improve functional performance in a larger number of patients because of wider availability. Moreover, it accomplishes these goals without the attendant risks associated with transplantation and immunosuppression.

Probabilities associated with counting average motor unit firing rates in active human muscle.

Motor unit firing rates in human muscle can be determined from recordings made with small-diameter microelectrodes inserted directly into the muscle during voluntary contraction. Frequently, these counts are pooled to give an average motor unit firing rate under a given set of conditions. Since the fibers of one motor unit are dispersed among the cells of several others, it is conceivable that discharge rates can be measured in more than one cell from the same unit.

Is there a comorbid relationship between hyperactivity and emotional psychopathology?

Some of the early literature implied that emotional disorders were almost incompatible with hyperactivity in childhood. The paper addresses this issue using a large epidemiological data base--of two cohorts of 7- & 8-year-old and 11- & 12-year-old children from the North of England. There are two themes, first, the paper reports on the prevalence of emotional symptoms and disorder among hyperactive children.

Stability of improvements in exercise performance and quality of life following bilateral lung volume reduction surgery in severe COPD.

Study Objective: To evaluate the long-term stability of improvements in exercise capacity and quality of life (QOL) after lung volume reduction surgery (LVRS).

Design: Case-series analysis.

Setting: University hospital.

Use of the ED as a regular source of care: associated factors beyond lack of health insurance.

Study Objective: To determine the characteristics and health care experiences of patients who identify the ED as their usual source of care.

Methods: We conducted a cross-sectional survey in a Level I trauma center ED at an urban teaching hospital. Our population comprised 892 adults who presented to the ED over the course of 30 days.

Learning disabilities: moving forward--a focus on epilepsy, Birmingham, England, 29 June 1996.

On 29 June 1996 a conference was held in Birmingham to highlight the status of epilepsy in people with learning disabilities. The conference consisted both of seminars and workshops. Dr Tim Betts, Birmingham; Dr Greg O'Brien, Northumberland; and Dr Mike Kerr addressed issues of assessment, diagnosis and drug treatment of epilepsy in this population.

Do internists and emergency physicians agree on the appropriateness of emergency department visits?

The purpose of this study was to determine the levels of agreement between three methods of assessing appropriateness of emergency department (ED) visits. In particular, we tested the agreement between internists and emergency physicians reviewing the ED nurses' triage notes, containing information that might be available by telephone to an internist. For 892 adult patient ED visits reviewed, we found only moderate agreement (kappa = 0.

Surveillance bronchoscopy in lung transplant recipients.

Study Objectives: To establish whether a consensus exists among active transplant centers regarding the use and interpretation of information obtained by surveillance bronchoscopic lung biopsy (SBLB).

Design: Prospective standardized questionnaire answered via mail and telephone communications.

Participants: A five page, 18-question survey was sent to all lung transplant programs listed by the United Network of Organ Sharing in North America, as well as eight selected international programs.

A heterologous assay for measuring prolactin in pituitary extracts and plasma from Australian flying foxes (genus Pteropus).

A sensitive heterologous assay was developed to measure prolactin-like activity in Pteropus alecto, P. poliocephalus, and P. scapulatus, Australian flying foxes.

Phosphatidylserine externalization during CD95-induced apoptosis of cells and cytoplasts requires ICE/CED-3 protease activity.

Phosphatidylserine (PS), a lipid normally confined to the inner leaflet of the plasma membrane, is exported to the outer plasma membrane leaflet during apoptosis to serve as a trigger for recognition of apoptotic cells by phagocytes. The mechanism of PS export during apoptosis is not known nor is it clear whether the nuclear changes that typify apoptosis contribute in any way to this event. Here, we demonstrate that ligation of the CD95 (Fas/APO-1) molecule on Jurkat cytoplasts induces dramatic PS externalization similar to that observed during apoptosis of intact cells.

Detection of pulmonary aspiration of gastric contents in an animal model by assay of peptic activity in bronchoalveolar fluid.

Objective: To determine whether peptic activity in bronchoalveolar fluid, due to the presence of the gastric proteolytic enzyme pepsin, could serve as a biochemical marker for pulmonary aspiration of gastric contents.

Design: Prospective, experimental trial.

Setting: A university animal research laboratory.

Lung volume reduction surgery in ventilator-dependent COPD patients.

Background: Lung volume reduction surgery has been advocated recently as adjunctive surgical therapy to improve lung and chest wall mechanics in selected patients with diffuse emphysema. Although clear-cut guidelines to select candidates have not been fully established, patients decompensated with significant pulmonary artery hypertension and hypercapnic respiratory failure are currently not considered suitable subjects. Accordingly, ventilator-dependent COPD patients are not considered candidates for this procedure.

The cytotoxic cell protease granzyme B initiates apoptosis in a cell-free system by proteolytic processing and activation of the ICE/CED-3 family protease, CPP32, via a novel two-step mechanism.

The major mechanism of cytotoxic lymphocyte killing involves the directed release of granules containing perforin and a number of proteases onto the target cell membrane. One of these proteases, granzyme B, has an unusual substrate site preference for Asp residues, a property that it shares with members of the emerging interleukin-1beta-converting enzyme (ICE)/CED-3 family of proteases. Here we show that granzyme B is sufficient to reproduce rapidly all of the key features of apoptosis, including the degradation of several protein substrates, when introduced into Jurkat cell-free extracts.

The association between colicinogenicity and pathogenesis among uropathogenic isolates of Escherichia coli.

Colicins have previously been thought to play an indirect role in bacterial pathogenesis. We describe here an association between colicinogenicity and pathogenesis among uropathogenic E. coli strains based on 568 clinical isolates.

"Inappropriate" emergency department use: a comparison of three methodologies for identification.

Objective: To determine the level of agreement between the rates of "inappropriate" ED visits assigned to a cohort of ambulatory patients based on three methods of defining ED use appropriateness.

Methods: Ambulatory adult patients seen at one urban, university-based teaching hospital ED between 8 AM and midnight during select days from April to June 1994 were assessed regarding the appropriateness of their ED visits. Patients triaged to acute resuscitation rooms in the ED were excluded.

Treatment of left pneumonectomy syndrome with an expandable endobronchial prosthesis.

Postneumonectomy syndrome has only been described after a right pneumonectomy except in cases of congenital mediastinal anomalies or right-sided aortic arch. Placement of Silastic prostheses into the empty hemithorax is the preferred surgical treatment; however, other nonsurgical options exist. Herein, we report a case of left postpneumonectomy syndrome in an adult who was successfully treated with the placement of an endobronchial stent.

Comparative morphology of the pituitary gland in Australian flying foxes (Megachiroptera: genus Pteropus).

Background: Investigations of reproductive endocrinology of flying foxes (genus Pteropus) have been hampered by inadequate information on the normal morphology of the megachiropteran pituitary.

Methods: The novel technique of graphical three-dimensional (3-D) reconstruction, supported by more traditional anatomical techniques, have now been used to examine the shapes of, the interrelations between, the lobes of the pituitary of the little red flying fox, Pteropus scapulatus. Statistical analysis of data from three species tested whether there were changes in pituitary size with annual cycles in function, particularly with key stages of reproduction.

Proteolysis of fodrin (non-erythroid spectrin) during apoptosis.

Several recent studies have implicated proteases as important triggers of apoptosis. Thus far, substrates that are cleaved during apoptosis have been elusive. In this report we demonstrate that cleavage of alpha-fodrin (non-erythroid spectrin) accompanies apoptosis, induced by activation via the CD3/T cell receptor complex in a murine T cell hybridoma, ligation of the Fas (CD95) molecule on a human T cell lymphoma line and other Fas-expressing cells, or treatment of cells with staurosporine, dexamethasone, or synthetic ceramide.

Hyperactivity: prevalence and relationship with conduct disorder.

This paper reports the prevalence of situational and pervasive hyperactivity using different definitions of 'caseness', and explores the relationship between situational and pervasive hyperactivity and conduct disorder, using a large data base from the North of England. The prevalence of hyperactivity, and its relationship with conduct disorder, varied according to whether hyperactivity was pervasive or situational, according to the age of the child and to the definition of hyperactivity 'caseness'. Among younger children only, school based situational and pervasive hyperactivity had comparable comorbidity with other available evidence of psychiatric disorder and hyperactivity was virtually a prerequisite for conduct disorder.

Comparative study of antirotational single tooth abutments.

Identifying the functional and mechanical limitations of single tooth implant systems is essential for the long-term success of the restoration. Three designs with different prosthetic connections were evaluated with their corresponding single tooth abutments for structural integrity and cyclic fatigue. The internal implant octagon was the weakest connection under off-axis impact loading and lateral loading, and the external hexagon implant was rendered unrestorable under lateral loading.

Coital behavior of male Pteropus scapulatus (little red flying foxes) in captivity.

Copulation in Pteropus scapulatus, the little red flying fox (suborder Megachiroptera), is characterised by brief orogenital grooming for 20 s; a single mount lasting 175 s; a single intromission, which includes a mean of 20 s thrusting in most copulations; ejaculation, lasting only about 9 s, observed in about 20% of copulations; and lock et copula, for about 155 s. In 65% of copulations, mating between the same pair resumes, usually after about 35 s. Each pair typically undertakes a series of two-three copulations at a time.

Evaluating health gains from restorative dental treatment.

A simulation of the caries process over time in posterior approximal tooth surfaces was modelled and tentative evaluations made of health gain from restorative treatment under two sets of assumed conditions. Using published data, the decision model allowed the influence of three variables to be reflected in sensitivity analysis, 1. caries progression, 2.

Chronic pulmonary disease in the trauma patient.

Despite a better understanding of the pathophysiologic changes that occur in the respiratory system as a result of trauma and surgery, pulmonary complications remain an important contributor of morbidity and mortality. Pre-existing pulmonary disease predisposes the patient to these complications and further complicates their management. Timely identification of chronic pulmonary dysfunction and the early institution of pharmacologic measures and respiratory care, as outlined, may reduce pulmonary complications in this high-risk group.