Mental status examination: Myth or method

Our clinical experience, as well as literature review, indicate that the MSE may be more myth than method in contemporary psychiatry. Given the current common language available through DSM (III) and the APA Glossary, the MSE may well have enhanced potential as a practical clinical tool because it can be transferable, affordable, portable, and not machine dependent. Having intervened, as noted above, we intend to follow-up via clinical records, interview and questionnaire to determine whether more consistent notation by trainees is present and whether trainees have a shared concept as to form and clinical utility of the MSE.     

A case of gastrojejunal rupture

Rupture of the stomach, duodenum and jejunum are well-recognized complications of non-penetrating abdominal trauma. This case is thought to be the first recorded injury of its kind.     

Early mobilization in the treatment of shin injuries.

The treatment of shin injuries requiring skin grafting by a method which included early mobilization is described.     

The management of fractures in Paget''s disease of bone

The results of the treatment of 89 fractures of bone affected by Paget's disease are presented. The typical features of these fractures, the common sites affected, the rate of healing and the complications involved, including the incidence of malignant change, are reviewed. The possible role of calcitonin in the prevention of these fractures is discussed.     

Aortic Valve Replacement with Starr-Edwards Valves over 14 Years

Three hundred thirteen patients underwent aortic valve replacement with 319 Starr-Edwards caged-ball prostheses and have been followed for 1 to 14 years. Hospital mortality (24.8%) and first-year mortality (4.8%) suggest that this is a high-risk group. Overall postoperative patient survival was 37.1%, with 18.8% free from any event, at 14 years. Thromboembolism was the most significant single event (a probability of 18.7% at 14 years), and the Series 2300/2320 valves were associated with a probability of hemolysis of nearly 80% over 13 years.Patients who underwent valve replacement before 1973 had a significantly greater probability of late death (31.1%) and of complications (47.1%) during the first 5 years. Those patients undergoing replacement after 1973 had a significantly greater probability of thromboembolic episodes (15.4%).Starr-Edwards caged-ball prostheses provide an acceptable valve replacement for high-risk patients. However, the overall complication rate of 81.2% over 14 years, compared with 78% for homograft valves for the same period, does not support the adoption of this prosthesis as the valve of first choice at this hospital.     

The slit catheter: a comparison with the wick catheter in the measurement of compartment pressure

The slit catheter, a new instrument for the measurement of compartment pressure, has been compared with the wick catheter in experimental conditions. The two catheters were inserted into the anterior tibial compartments of 8 human legs and controlled external pressures were applied by means of an inflatable limb bag. The mean resting intramuscular pressure of 8.5 ± 6.2 mmHg for the slit and 8.7 mmHg ± 6.2 mmHg for the wick catheter agrees with that of other workers, and the slit catheter records a pressure at all applied external pressures not significantly different from the wick catheter (paired t test).The slit catheter provides a simple and inexpensive way of estimating compartment pressure which is as accurate as a method widely used both experimentally and clinically in North America.     

Measurement of CBF and CMRO2 using the continuous inhalation of CO2 and O2: Experimental validation using CO2 reactivity in the anaesthetised dog

Experimental support for the steady state ¹⁵O inhalation technique, as used to measure cerebral blood flow (CBF) and oxygen utilisation (CMRO₂), was obtained by describing the response of the cerebral vasculature to variations in arterial P_CO2 in 6 anaesthetised dogs. Measurements were made using a positron emission tomograph (ECAT II) and arterial blood sampling, during the sequential constant inhalation of C¹⁵O₂ and ¹⁵O₂. Values of CBF and CMRO₂ were calculated for a mixture of white and grey matter, using the steady state tracer equations derived by Jones et al. (1976). The mean CMRO₂ was 3.58 ± 0.81 ml O₂ · 100 ml⁻¹ · min⁻¹, whilst the mean CBF and OER (oxygen extraction ratio) values (for an arterial P_CO2 of 40 mm Hg) were 39.9 ml · 100 ml⁻¹ · min⁻¹ and 0.50 ± 0.06, respectively. Arterial P_CO2 was varied between 20 and 150 mm Hg. CBF was found to correlate closely with arterial P_CO2, resulting in a mean slope (specific reactivity) of 1.52 ± 0.38 ml · 100 ml⁻¹ · min⁻¹ · mm Hg⁻¹. Pooling the flow data resulted in a linear relationship between CBF (% change) and arterial P_CO2 in the range 20–70 mm Hg, with a slope (% reactivity) of 3.2% mm Hg⁻¹ (2 P < 0.001). The oxygen extraction ratio (OER) fell with increasing values of arterial P_CO2 resulting in a stable CMRO₂ throughout each study. There was no correlation between CMRO₂ and artificially increased CBF.

These results support and give confidence in the use of the ¹⁵O inhalation technique for measuring CBF, OER and CMRO₂.     

A controlled trial of dextranomer (Debrisan) in burns of the hand

A preliminary trial of Dextranomer (Debrisan) in burned hands against a control of 1 per cent silver sulphadiazine cream (Flamazine) using the same type of occlusive dressing in each case is presented. Results suggest no advantage of Dextranomer over 1 per cent silver sulphadiazine cream.     

Isolated suprascapular nerve lesions

This paper shows how the suprascapular nerve is liable to isolated injury and where it is most vulnerable. Lesions of the suprascapular nerve are related to disorders of the shoulder. The management of isolated suprascapular nerve lesions is discussed.