The role of psychiatrists in family medicine training

The authors surveyed 356 family medicine residency training directors to determine the role of psychiatrists in family medicine training. Two hundred five responses were received, covering the training experiences of 3696 residents. Psychiatrists were actively involved in the training programs, but their role was circumscribed to areas of traditional, demonstrated expertise. Most of the program directors rated psychiatrists as highly useful. Programs rating psychiatrists highly useful differed from low usefulness raters only in having both general psychiatry and consultation-liaison rotations available. This lends support to the hypothesis that consultation-liaison activities provide the most useful method of integrating psychiatrists into family medicine training programs.     

Release of endogenous catecholamines from isolated rat brain tissue by fenfluramine and N-ethylamphetamine—effects of pargyline

The influence of the monoamine oxidase inhibitor, pargyline. upon the release of endogenous norepinephrine from chopped rat cerebral cortex and endogenous dopamine from chopped rat corpus striatum by fenfluramine and N-ethylamphetamine was examined. Endogenous norepinephrine and dopamine were measured using an enzymatic-isotopic assay. Both fenfluramine and N-ethylamphetamine released significant amounts of each catecholamine. Fenfluramine-induced catecholamine release was associated with the decrease in the total content (i.e. catecholamine in media + catecholamine in tissue) of both cortical norepinephrine and striatal dopamine; N-elhylamphetamine decreased only total striatal dopamine content. In brain tissue obtained from rats pretreated with pargyline HCl (100 mg/kg, 12 hr prior to sacrifice), total cortical norepinephrine content was approximately twice that in the absence of pargyline: striatal dopamine was unchanged. Pargyline pretreatment also resulted in a marked potentiation of the amounts of both catecholamines released by each drug. and in an antagonism of the above drug-induced reductions in catecholamine content. Additionally, after pargyline pretreatment. N-ethylamphetamine reduced total cortical norepinephrine content. When pargyline (2.56 × 10^?1 M) was added to the media containing chopped cortical tissue from unpretreated animals, control content was slightly increased. Only fenfluramine-induced norepinephrine release was potentiated and the degree of potentiation was less than that observed after pargyline pretreatment. As with pargyline in vivo, pargyline in vitro also resulted in an antagonism of the fenfluramine-induced decrease in total norepinephrine and was associated with an N-ethylamphetamine-induced decrease in norepinephrine content. Since the locomotor stimulant effects of both fenfluramine and N-ethylamphetamine are potentiated after pargyline. the data are consistent with the importance of catecholamines to these effects. The data also suggest that pargyline potentiates the behavioral effects of fenfluramine and N-ethylamphetamine in part by increasing the pool of norepinephrine available for release by these drugs and in part by inhibiting the deamination of the released norepinephrine and dopamine by monoamine oxidase. Decreases in total norepinephrine produced by N-ethylamphetamine may reflect alterations in the formation of O-methylated amines.     

Innovations in skin suture removal

A cutting forceps and suture removal scissors have been specially designed for removal of percutaneous sutures. Our clinical experience with these instruments indicate that they facilitate removal of percutaneous sutures in the surgical patient.     

Relation between QRS changes and left ventricular function after coronary artery bypass grafting

Preoperative and serial postoperative electrocar-diograms (ECGs) were reviewed in 104 patients undergoing rest and exercise radionuclide angiocardiography before and 1 to 12 months after coronary artery bypass grafting (CABG). Five patient groups were defined by ECG findings before and after CABG: Group I—normal ECG before and no ECG change after CABG; Group II—prior myocardial infarction by ECG before but no QRS change after CABG; Group III—all patients with a minor QRS change (< 0.04-second Q wave, loss of R-wave amplitude) after CABG; Group IV—all patients with a major QRS change (≥ 0.04-second Q wave) after CABG; Group V—all patients without new Q waves or loss of R-wave amplitude but with a major QRS change (conduction disturbance) after CABG. Mean resting ejection fraction changed little after CABG in all groups, although the 0.03 increase in Group I was significant (p < 0.05). Group IV had the largest decrease in resting ejection fraction after CABG (0.04), but this was not statistically significant. Mean exercise ejection fraction increased significantly (p < 0.0001) in Groups I, II and III but not in Groups IV and V. QRS changes do not consistently reflect impairment of left ventricular (LV) function after CABG.     

Abnormal biomechanics of feet and their cause of hyperkeratoses

A brief review of pedal anatomy and the mechanisms enabling feet to function as organs of locomotion is presented. The importance of the subtalar joint is emphasized. Four major abnormalities disturbing normal foot function are noted, and the most commonly encountered of these alterations, rearfoot varus, is discussed in some detail. A series of pedal abnormalities in rearfoot varus occurs because in the foot's attempt to overcome its imbalance, it pronates excessively and causes development of callus, corn, hallux valgus, and even ingrown toenail. Haglund's deformity, soft corn, and tailor's bunion are also secondary to the abnormality. Attempts to restrict the germinal compensatory pronation by various forms of padding of the medial aspect of the foot are frequently rewarded by restoration of asymptomatic feet. Surgical means of restoring normal function are briefly discussed.     

Electrolysis and thermolysis for permanent hair removal

The historical, legal, and theoretical aspects and clinical technics of both electrolysis and thermolysis are critically reviewed. The pitfalls of electronic tweezers and the dangers of self-electrolysis are discussed. Complications of electrolysis and thermolysis and the pathophysiology of hair regrowth are presented. In the United States, the lack of uniform training requirements and standards for electrologists may pose an unrecognized risk to public health. It is suggested that more responsible state legislation be enacted in order to decrease the present potential threat to the public health and safety.     

Standardized intracardiac measurements of two-dimensional echocardiography

Thirty-five healthy adults were studied by two-dimensional echocardiography to attempt to standardize a simple method for measurement of intracardiac dimensions. Both ventricles and the atria and aorta were measured in five different views: parasternal long-axis, parasternal short-axis at the level of the aortic valve, the chordae tendineae and the papillary muscles and an apical four chamber view. The minor axis of each chamber was measured in all five views; the major axis in the apical four chamber view also was measured. All measurements are presented as a range of values (mean and 2 standard deviations about the mean); the mean value is given as well as the absolute range of values measured. Normalization according to body surface area is also presented. Data from these multiple views allow assessment of asymmetry of cardiac chambers in normal subjects. The mean minor axis dimension at end-diastole of the right ventricle in the parasternal long-axis view (1.9 to 3.8 cm) was 13.6% smaller than in the four chamber view (2.2 to 4.4 cm), whereas the minor axis dimension of the left ventricle in the parasternal long-axis view (3.5 to 6.0 cm) was only 1.1% larger than in the four chamber view (3.3 to 6.0 cm). Therefore, the right ventricular minor axis dimensions are not interchangeable. Reproducibility in 10 subjects for all dimensions showed a maximal variability of 4.8%. These values permit a standardized and expeditious method for measuring intracardiac dimensions by two-dimensional echocardiography.