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The survival of patients undergoing liver resection for colorectal metastases is poor in the presence of extrahepatic disease. Therefore identification of periportal and celiac lymph node metastases is central to proper patient selection. In this study we examined the technique of intraoperative hepatic lymphatic mapping with isosulfan blue dye in humans. Intrahepatic dye injection was performed in patients undergoing surgical exploration for colorectal liver metastases. The location of all blue-stained lymphatics and lymph nodes was recorded. All stained and unstained lymph nodes were biopsied for pathologic examination. Thirteen intraoperative lymphatic mapping procedures were performed in 11 patients. A blue-stained lymphatic was visualized in 11 of 13 injections (85%). A blue lymph node was visualized in seven of 13 injections (54%). Three of the seven blue nodes (43%) were not detected by the surgeon before the mapping procedure. There were no complications associated with the intrahepatic dye injections. All biopsied lymph nodes were negative for metastatic tumor. We conclude that intraoperative hepatic lymphatic mapping with isosulfan blue dye is a simple, rapid, and safe technique in humans. It may serve as an adjunct to random lymph node biopsy for the identification of periportal and celiac nodal metastases before liver resection in patients with metastatic colorectal carcinoma.

In August 1996, President Clinton signed the Personal Responsibility and Work Opportunity Act, fulfilling his campaign promise to "end welfare as we know it". The legislation replaces the six-decade-old Aid To Families With Dependent Children programme (AFDC) with so-called workfare under which recipient parents may no longer receive financial assistance indefinitely. Instead, they must obtain employment or other means of support within two years, after which benefits are reduced or cease entirely. There is broad consensus that workfare is a step in the right direction. This paper challenges that consensus. The programme will intensify the plight of welfare children and deepen the economic problems of America in future years. We propose instead a programme that also promotes the work ethic as a basic premise of reform, but that seeks to reduce welfare rolls by making the education and development of assisted children the central obligation of AFDC parents.

Little attention has been paid to the use of laboratory tests in psychiatric hospitals. This paper reviews studies of the use and abuse of laboratory tests in general medicine. It examines five different sets of test results performed over a three month period at a mid-sized psychiatric hospital. The paper concludes that, on the whole, the laboratory was used efficiently and effectively. However, some testing patterns need to be re-evaluated.

This was a pilot project set up to test the feasibility of effectively and inexpensively treating agoraphobic patients who had not responded to adequate trials of behaviour therapy (and other therapy) in the past. We employed a quantitatively intensive program of exposure therapy, calisthenics and muscular relaxation, and have explained the rationales for the choice of each treatment. The results were gratifying in four of the five patients, with follow-up to three years. This pilot project enabled us to set up a cost-effective treatment for all forms of agoraphobia which is as efficient as other programs described. It has also highlighted the fact that some patients exist who may do poorly on schedules of behaviour therapy which are adequate for some patients, and yet may do well if the amount of treatment is drastically increased.

This paper describes the operation of a psychiatric intensive care unit in a provincial psychiatric hospital. Its introduction led to a decrease in staff and patient accidents, a decrease in constant observation and seclusion hours, and a decrease in the number of nursing hours lost to injuries at work. It had no effect on nursing absenteeism. The ICU was well liked by nursing staff who preferred to work in its more consistent and controlled environment. In addition, it was also felt that the ward environment in other parts of the hospital became more therapeutic. We therefore conclude that psychiatric ICU's are useful additions to psychiatric settings with important cost and patient care implications.

Cognitive therapy embraces the theory and practice of a number of skilled and productive clinicians and researchers, and is being used increasingly. This essay has explained the core idea behind cognitive therapy, differentiated it from other standard forms of therapy, supplied some clinical examples, and attempted an early evaluation. The cognitive therapy idea is in its ascendency, and a more definitive evaluation will be possible only some years hence.

Ethical problems in clinical practice arise when clinicians confront competing value systems. Historically, behaviour therapy has been criticized because of alleged special ethical, moral and legal problems. These problems are no greater or smaller than in other forms of psychotherapeutic practice. But they can differ in emphasis. This article describes partial responses to selected ethical dilemmas facing general psychotherapy, and outlines relatively novel issues raised by certain features of behavior therapy practice.

It has been shown by Golden and Sevring-haus1 that rats in which the ovaries have been transplanted to the mesentery remain anestrous, owing to inactivation in the liver (previously reported by Zondek2) of the estrogen thus secreted into the portal circulation. Thereafter for approximately 11 monthsThis phenomenon was more extensively studied by G. R. Biskind3, 4, 5, 6 using pellets of crystalline steroids implanted in another organ in the portal circulation, the spleen. Castrate rats on a complete diet with pellets of estrone or estradiol thus implanted likewise remained anestrous. During the course of an investigation on the effect of nutritional deficiency on the estrogen-inactivating function of the liver,7-9 M. S. Biskind and Shelensyak10 demonstrated that animals with one ovary removed and the other transplanted to the spleen showed no estrual reactions so long as the diet was adequate to maintain the functional integrity of the liver.This observation seemed to provide an excellent means of ascertai...

Psychoactive drug combinations continue to be controversial. The concept of “polypharmacy”, a pejorative and meaningless term, nevertheless gave rise to useful surveys on combined drug use, to methods of monitoring and controlling multiple drug use, and to a small number of studies which imply that a few psychoactive drug-drug combinations are rational. This paper updates the contributions to these areas since two major reviews of the subject were published in the early 1980's. It highlights common pitfalls in the survey-taking process. Finally, it suggests future useful avenues of study and research, wherein it, is hoped that the studies will be more rational than the term “polypharmacy”.

Fifty outpatients in a ‘schizophrenia clinic’ were examined, and sixteen were found to be suffering from periodic affective disorders. Nine of these were given lithium carbonate, and eight responded well. Case histories illustrate three separate reasons for incorrect diagnosis. Examination of extensive old clinical notes of five of these patients suggests that the problems of diagnosis which have been described in the literature in the past, continue to represent obstacles to correct diagnosis. Suggestions for improvement are offered.