Search

To help new part-time lecturers to develop skill in undergraduate small group teaching, videorecorded seminars conducted by each lecturer were reviewed at a series of staff meetings using analyses produced by experienced full-time staff. One year later a second series of comparable seminars was recorded and, using a simple method of communication analysis, the lecturers were found to be less opinionated and more non-directive towards students.

An enzyme-linked immunosorbent assay (ELISA) using a double-antibody sandwich tecnhique has been developed to serotype isolates of herpes simplex virus from clinical sources. The results obtained using this procedure were in agreement with those obtained with a standard neutralization test in typing stock cultures and 32 clinical isolates of herpes simplex virus. Clear differentiation between the two viral serotypes was obtained using rabbit immunoglobulin cross-absorbed with heterologous virus antigen. The ELISA procedure described appears to be a convenient and accurate substitute for the neutralization test in typing herpes simplex viruses. ELISA techniques require relatively small amounts of antigen and antibody and can be performed with very simple equipment.

We have reviewed our experience with 10 patients who had leukemia and prostatic obstruction. Most of these patients had chronic lymphocytic leukemia, and all were stable. Following routine preoperative evaluation all underwent transurethral resection of the prostate (TURP). Two patients (20 per cent) had leukemic infiltration of the prostate. Our series confirms that TURP does not present undue risk to the patient with leukemia if the disease is stable and preoperative evaluation normal.

Unilateral injection of kainic acid (2.5-25 nmol) into rat anterior caudate putamen induced dose-related circling behaviour. Kainic acid (10 nmol) consistently caused initial weak ipsiversive circling lasting 1 h followed by prolonged strong contraversive rotation lasting in excess of 10 h. Unilateral intrastriatal administration of L-glutamic acid, or of monosodium L-glutamate, to normal rats, or administration of monosodium L-glutamate to rats with extensive decortication, did not induce circling behaviour. The simultaneous unilateral injection of monosodium L-glutamate (1 mumol) with kainic acid (10 nmol) did not modify circling behaviour induced by kainic acid. However, extensive decortication greatly reduced circling induced by unilateral intrastriatal kainic acid (10 nmol), and effect not reversed by the simultaneous administration of monosodium L-glutamate (1 mumol). Unilateral 6-hydroxydopamine lesions of the left nigrostriatal pathway abolished the initial ipsiversive rotation and potentiated the subsequent contraversive rotation for up to 4 h after intrastriatal injection of kainic acid (10 nmol). Peripheral administration of haloperidol (1 mg/kg i.p.) also abolished initial ipsiversive rotation and decreased the subsequent contraversive rotation. Electro-coagulation of the ipsilateral strio-nigral pathway prolonged the initial ipsiversive rotation produced by kainic acid, but markedly attenuated contraversive rotation. These findings suggest that circling induced by intrastriatal administration of kainic acid depends on intact corticostriate pathways, but it cannot be reproduced or modified by intrastriatal administration of glutamate. Kainic acid circling appears to be mediated via strio-nigral pathways, and to be modulated by dopaminergic function.

Retrograde pyelography to demonstrate the renal pelvis and ureters is a common urologic procedure. Newer contrast materials and better radiographic techniques have obviated many of the previous indications for retrograde studies were independently reviewed by two urologists and a radiologist to determine if the studies were indicated, appropriately timed, informative, and complete. Our results indicate a high percentage of these examinations are incompletely performed and uninformative and could have been replaced by noninvasive studies. What constitutes a complete retrograde study and when to utilize this examination is discussed.

From July 1977 to January 1980, 5 cases of pneumonia owing to Pittsburgh pneumonia agent and 4 cases owing to Legionella pneumophila occurred in our renal transplant population. Comparison of the clinical manifestations, laboratory features an radiographic changes demonstrated no unique characteristics that allowed differentiation from other bacterial pneumonias. Diagnosis in all cases required histologic or serologic identification of the infecting organism. We herein present our protocol for establishing rapidly the diagnosis of pneumonia in renal transplant patients with emphasis on the use of open lung biopsy.

The numbers of vaginal swabs, faecal specimens, throat swabs, and urine specimens submitted by 104 city general practitioners to the bacteriology laboratory at Aberdeen differed widely. The doctors who made most use of the laboratory service rarely did so equally for all four investigations but usually for only one or two. Similarly, those who used the service least often made frequent use of one particular investigation. Further studies are needed to identify and evaluate the reasons for the apparently substantial disagreement among general practitioners concerning the value of these diffferent bacteriological investigations in general practice.

103 patients with acute airflow obstruction (56 asthma, 47 chronic obstructive pulmonary disease [COPD]) completed a double-blind trial of nebulised bronchodilator treatment in a hospital accident and emergency department. Each patient was randomised to receive either 10 mg of salbutamol nebuliser solution in 2 ml of saline or 10 mg of salbutamol in 2 ml (0.5 mg) of preservative-free ipratropium bromide. Peak flow rate (PFR) was recorded before treatment and 1 hour after beginning nebulised treatment. In 23 asthmatic patients given salbutamol alone PFR rose by a mean 31% 1 hour after treatment whereas in 33 such patients given combined treatment it rose by a mean 77% (95% confidence interval for the difference 8-84%). Patients whose PFR was below 140 l/min at entry gained maximum benefit from the combined treatment. For COPD patients the PFR rise was almost identical for both treatments. In acute asthma the immediate PFR response to a mixture of salbutamol and ipratropium bromide was better than the response to nebulised salbutamol alone. For COPD patients, the two treatments were of equal benefit.

Modification of the en bloc resection of kidneys for cadaveric kidney transplant patient is described. A median sternotomy and division of the portal triad provide excellent exposure of the upper aorta above the celiac axis. This approach has been used in 40 cadaveric donors with no complications.

A retrospective analysis of 300 consecutive cadaveric renal allografts performed at our institution between August 1, 1981, and December 1, 1983, was performed to evaluate the influence of DR typing on graft and patient survival. All patients were treated with low-dose steroids and cyclosporine as the only means of immunosuppression. The group included 246 primary graft recipients and 54 retransplants. DR information was available on the donor and the recipient in 225 of these patients, and it was unavailable on the donor and/or recipient in 75 patients. In 49% of the cases in which information was available, 2 alleles were identified in the donor and in the recipient; in the remainder only 1 allele was identified in either the donor or recipient. The results were analyzed according to HLA/DR match and mismatch. Twelve-month graft survival for the 2-DR-match recipients was 67%, versus 78% for the 1-DR match and 76% for the O-DR match. These differences were not significant. For the O-DR mismatch, the one-year actuarial graft survival was 74%, for the 1-DR mismatch 78%, and for the 2-DR mismatch 79%. Again, there was no significant difference. There was no impact of DR matching on patient or graft survival up to 18 months. Additionally, no difference was found in any of the groups regarding the number of treated rejection episodes per patient or the amount of steroid received per patient at the end of a year. These results suggest that cyclosporine negates the effect of DR matching in cadaveric renal transplantation.

To assess the safety of the calcium channel blocker nitrendipine, data from 61 clinical studies conducted in the United States and involving 1,245 patients were reviewed. The drug appeared to be tolerated in the majority of patients and the dropout rate was low. The most common side effects associated with nitrendipine administration were headache and edema. Most side effects were mild and were tolerated or disappeared with continued therapy. No serious adverse biochemical, hemodynamic, renal, or humoral effects of nitrendipine were apparent. Nitrendipine produced a prompt, smooth, and sustained reduction in systolic and diastolic blood pressures in both the supine and standing positions. The blood pressure response was maintained for six months to one year with no evidence of resistance or tachyphylaxis. Sex and race had no influence on the antihypertensive effect of nitrendipine, but patients sixty years of age and older appeared to respond better to the drug than younger patients.

Research on the informal support networks of older persons recognizes that network size and composition (i.e., family vs. nonkin) may have important consequences for care. Factors that determine these aspects of networks among older blacks, however, have not been explored systematically. The present study examined the relationship of a group of sociodemographic, health, family, and availability factors to the size and composition of the informal support network. The data were taken from the National Survey of Black Americans and constitute a nationally representative sample (N = 581) of older blacks (55 years and older). The results for several of the sociodemographic factors (i.e., sex and marital status) are consistent with previous work. Regional differences in network dimensions, however, suggest new areas of inquiry. The findings underscore the importance of availability and family factors in support relationships and the relative ineffectiveness of health factors as predictors of network size and composition.