Effects of social support on medical students' performances.

Background: Stress among medical students has been linked to poor academic performance, while supportive social relationships have been associated with the alleviation of psychological stress. This study examines social support as a potential buffer against stress and hence as a potential strengthener of students' academic performances.

Method: A cohort of 153 third-year students at the University of Illinois College of Medicine at Chicago was asked in the fall of 1990 to complete a questionnaire assessing role stress (stress involving competing demands between school and social and/or family life), social support, and sources of support (outside or inside medical school).

In vitro and in vivo synergistic effect of isoniazid with streptomycin and clofazimine against Mycobacterium avium complex (MAC).

Setting: Isoniazid (INH), the powerful antituberculosis drug, has also been used in regimens for treating disease caused by Mycobacterium avium complex (MAC), an important opportunistic pathogen encountered in AIDS patients. Its use for treatment of MAC disease has also been endorsed by the American Thoracic Society. However some controversy has emerged recently in medical literature, discounting its role and even implying that its use is contraindicated in chemotherapy of MAC disease.

Phorbol dibutyrate-specific protein phosphorylation in brush border membranes of chicken enterocytes.

We have demonstrated that phorbol esters such as phorbol dibutyrate (PhE) transiently inhibit Na/H exchange both in intact avian enterocytes and in brush border membrane (BBM) vesicles prepared from enterocytes treated with PhE (Chang et al., 1991, Am. J.

Use of electroconvulsive therapy during pregnancy.

Objective: Untreated major mood disorders during pregnancy pose significant risks. The author reviews case reports of the use of electroconvulsive therapy (ECT) during pregnancy to clarify potential risks and modifications of ECT techniques that make the procedure safer for pregnant women.

Methods: A total of 300 case reports of ECT during pregnancy drawn from the literature from 1942 through 1991 were reviewed.

Body iron stores and risk of colonic neoplasia.

Background: Body iron stores and dietary iron intake have both been shown to be positively associated with subsequent risk of colon cancer. This finding comes from a cohort study involving 14,000 men, but the positive association occurred in only 12 cases.

Purpose: We performed a case-control study of 264 men and 98 women to test for an association between serum ferritin levels and the presence of adenoma of the colon that would be independent of other known risk factors.

Treatment of fecal impaction with pulsed irrigation enhanced evacuation.

Purpose: A new method of treating fecal impaction is described, selecting patients that would otherwise have required operative disimpaction.

Method: Using the pulsed irrigation enhanced evacuation device, individuals were selected for treatment based on evidence of massive fecal impaction on physical examination or abdominal x-ray.

Results: Fourteen individuals were treated for fecal impaction.

Bioavailability and chemotherapeutic activity of clofazimine against Mycobacterium avium complex infections in beige mice following a single implant of a biodegradable polymer.

We have studied the bioavailability of clofazimine following administration of a single dose of the drug in the biodegradable polymer polylactic-co-glycolic acid (PLGA). We compared the levels of clofazimine achieved in the liver with single implants with those obtained with daily oral treatment. Even though the levels achieved with implants were much lower than those obtained after daily oral treatment, they were higher than the MIC of clofazimine for Mycobacterium leprae, Mycobacterium tuberculosis and Mycobacterium avium complex (MAC).

Experimental chemotherapy of tuberculosis using single dose treatment with isoniazid in biodegradable polymers.

In previous studies we showed that a single implant of polylactic-co-glycolic acid (PLGA) polymer as a film containing isoniazid ensured sustained release of the drug for up to 4 weeks. These studies have been extended to PLGA polymer as a rod which is retrievable. Both types of implant gave therapeutically active levels of free isoniazid in liver and urine for prolonged periods.

Injectable filler materials for soft-tissue augmentation.

The concept of non-surgical implantation of injectable filler materials for soft-tissue augmentation has always been an attractive option for the head and neck surgeon. The ideal injectable soft tissue filler material would be easy to use, biocompatible, nontoxic, and long-lasting. Presently available filler materials present significant drawbacks to their use.

Patient mix in the primary ambulatory care clinics of an academic medical center.

Background: The authors wished to learn whether the primary ambulatory care clinics of a university hospital had a sufficiently diverse patient mix for training in common medical problems.

Method: Claims data for all the ambulatory care clinics at the University of Illinois Hospital from June 1989 through June 1990 were examined for principal diagnoses. The diagnoses were grouped into common ambulatory care diagnosis clusters.

Use of NBME and USMLE examinations to evaluate medical education programs.

Criteria are presented for determining whether licensure and/or achievement test results should be used as a basis for making various types of comparisons and judgments about medical education programs for program evaluation purposes. United States Medical Licensing Examination (USMLE) examinations and National Board of Medical Examiners (NBME) subject tests are then considered as sources of evaluation data for medical education programs by evaluating these examinations in the light of the proposed criteria. It is concluded that NBME examination and USMLE results may properly be considered one of several tools to use in an evaluation of medical education programs but are not recommended as the sole basis for a judgment of program effectiveness.

Double-blind placebo-controlled ultrasonographic confirmation of constriction of the common bile duct by morphine.

Although the increase in the common bile duct pressure in response to morphine has been repeatedly reported in experimental animals and humans, this is the first double-blind non-invasive, ultrasonographic study designed to demonstrate constriction of the common bile duct caused by i.v. administration of morphine in surgical patients.

Latex anaphylaxis.

Background: Unexplained vascular collapse, airway obstruction, shock, and death after procedures as innocuous as barium enema or anorectal manometry have recently been shown to be due to allergy to latex and anaphylactoid reaction.

Method: To review existing medical literature on latex anaphylaxis and to determine who is most at risk and what methods might best prevent morbidity from this condition.

Results: Those most at risk for this catastrophe are patients whose mucous membranes have been extensively exposed to latex, such as patients with spina bifida who frequently undergo urethral catheterization and individuals who have had many previous operative procedures:

Conclusions: Avoidance of latex exposure is the best prophylaxis in high-risk groups.

Neurocranial morphology in mandibulofacial dysostosis (Treacher Collins syndrome).

An abnormal cranial base could exert a negative influence on neurocranial development. Because patients with mandibulofacial dysostosis (MFD) present an abnormal cranial base (basilar kyphosis), a retrospective mixed longitudinal cephalometric study was designed with the purpose of ascertaining the presence of abnormalities of neurocranial form and size in this population of patients. The lateral and frontal cephalometric radiographs from 33 patients with MFD (15 males, 18 females) ranging in age from 3 years 4 months to 19 years 6 months were used.

Contribution of radiotherapy to the management of malignant melanoma. A ten year experience at the University of Illinois Hospital in Chicago.

Fraction size in radiotherapy of malignant melanoma remains a point of controversy. Among 139 patients treated at the University of Illinois Hospital in 1979-1988, 36 were considered potentially curable (not counting ocular melanomas); 20 were treated by the Princess Margaret Hospital (PMH) hypofractionated schedule using 800 cGy per fraction and achieved a permanency of local control lasting > 6 months since the beginning of radiotherapy in 10/22 (45.5%) courses.

Osteoinductive biomaterials for medical implantation.

The search for the ideal implant material continues since presently available implants all have significant drawbacks. This paper reviews three studies that we recently completed with bone-inducing implants. Long-term clinical follow-up of 75 allogeneic demineralized bone implants showed an average degree of resorption of 49%.

The septum pellucidum: normal and abnormal.

The common embryologic origin of the septum pellucidum, of the corpus callosum, and of the limbic system explains the anatomic basis of a varying degree of concurrent involvement of these structures in disease processes, both developmental and acquired. Developmental absence of the septum pellucidum portends a more generalized dysplasia that encompasses the corpus callosum and the limbic system. When considered in this context, it is easy to understand the limbic system dysfunction that is engendered by this anomaly.

A low-priced computer-assisted densitometer and analysis software for quantitative autoradiography.

A computer-assisted densitometer which consists of a darkroom enlarger, a black-and-white exposure meter, an amplifier, an analog-to-digital converter, and a microcomputer with a monitor and a graphic printer can be utilized for the quantitative analysis of autoradiograms. QUANTAR, a computer program written in BASIC, records the density measurements and stores the data in a file that can be easily retrieved by commercially available spreadsheet software. A spreadsheet template was designed to convert the digital readings into concentration of ligand in tissue.

Internal sclerostomy with the Nd: YAG contact laser versus thermal sclerostomy in rabbits.

The authors undertook an investigation to evaluate the efficacy and complications of performing internal sclerostomy with the synthetic sapphire contact neodymium:YAG (Nd:YAG) laser compared with standard external thermal sclerostomy. Fifteen rabbits underwent internal laser sclerostomy in one eye; 12 additional rabbits underwent a standard external thermal sclerostomy in one eye. The fellow eyes served as controls.

Mental and physical effects of being a gynecologic teaching associate.

Over 90% of medical schools in the United States and Canada use gynecologic teaching associate (GTA) programs to instruct medical students in breast and pelvic examinations. Concerns about possible deleterious emotional, psychosocial or physical effects of such teaching activities upon the GTAs were evaluated. No sustained deleterious mental or physical effects of working as a GTA were found, supporting the continued use of the GTA instructional methodology.

An interactive model eye for use with ophthalmic instruments.

A model eye was found to be a practical and versatile simulator of conditions present in the application of different surgical and diagnostic ophthalmic instruments. It realistically simulated the thermal and acoustic effects of lasers on tissues and thus could be used for teaching and practicing laser therapeutics. The geometric optics were similar to those of the human eye, and realistic conditions of scatter and fluorescence could be created.