Monitoring of skin response to sodium lauryl sulphate: clinical scores versus bioengineering methods

The present trial was designed to evaluate clinical scores (single observer) of sodium lauryl sulphate (SLS)-induced skin irritation in a group of subjects (n = 10) over a 10-day period along with various skin function parameters. In order to avoid significant variations due to secondary phenomena, the following parameters were recorded with non-invasive instruments in this order: skin capacitance (C1; arbitrary units; CM420 Corneometer), transepidermal water loss (TEWL; g/m2.h; Evaporimeter) and laser Doppler flowmetry (CBFV: cutaneous blood flow values; Periflux). All examinations were performed during winter on reclined relaxed subjects present for at least 10 min in a test room with controlled temperature and relative humidity (t degrees: 19.5-20.7 degrees C and RH: 47.3-60.3%). The analysis of differential data (delta = value at tx-value before test; 2-way ANOVA) was made on single parameters as a function of site (volar forearm versus neck) and time (from 24 h after 48-h occlusion with 5% SLS up to 10 days later). The profile of erythema scores over time differed between neck and forearm, but the delta CBFV readings with the laser Doppler instrument did not detect significant site-time interactions. Roughness (blind evaluation with palpating finger) and capacitance readings (delta C1) showed significant differences between sites, but the profile over time was similar in both locations. delta TEWL did not differ according to anatomical location. The reason for different erythema scores on neck and forearm might be related to inherent regional variation of optical properties of the skin or to a substantial contribution of SLS-induced roughness to the readings of erythema.(ABSTRACT TRUNCATED AT 250 WORDS)     

Diagnostic sonography of the fetal genitourinary tract

Fetal diagnosis has vastly improved over the last decade. Ultrasound has become the imaging modality of choice. As real-time equipment has improved technologically, the ability to deduce subtle abnormalities has greatly increased. The fetal genitourinary tract may be evaluated for renal dysplasias, anomalies, or obstruction. Points of obstruction and, at times, the exact cause of obstruction may be deduced. Abnormalities of the ureter, bladder, urethra, scrotum, or reproductive system can be detected.     

Pharmacokinetics of famotidine in patients with cirrhosis and ascites

Summary The pharmacokinetics of famotidine has been investigated in ascitic cirrhotic patients. 10 decompensated cirrhotic patients were studied (9 m, 1 f), who had normal renal function, and six healthy control subjects (4 m, 2 f), matched for age, sex and weight. Each subject received on two occasions, at least four days apart, a single oral (40 mg) or intravenous dose (20 mg) of famotidine, at 21.00 h in a randomised manner. Serial blood samples were collected and famotidine in plasma was determined by a HPLC/UV method. Plasma data were subjected to non compartmental pharmacokinetic analysis.There were no statistically significant differences in pharmacokinetic parameters between the two groups after either the intravenous or oral administration of famotidine.The findings suggest that the dose of famotidine may not require any adjustment in ascitic patients without renal failure.     

Anaesthesia for primary repair of cleft lip and cleft palate: a review of 244 procedures

The peri-operative course of 194 patients undergoing 244 procedures for primary repair of cleft lip and palate over an 8-year-period was studied. A marked increase in the extent of intra-operative monitoring was noted during this period. The Pierre Robin syndrome was the most common associated abnormality and was found in 17% of patients in this series. There were no deaths. A total of 101 procedures were undertaken in infants with cleft lip of whom 10% received an intra-operative blood transfusion. Post-operative opiate analgesics were administered following 97% of these procedures and profound respiratory depression was observed in three children. The use of lignocaine and noradrenaline did not significantly reduce the operative blood loss. A post-operative pyrexial illness was significantly associated with the presence of a positive pre-operative nasal and throat swab and this could be significantly reduced by pre-operative antibiotic treatment. A total of 143 children underwent repair of cleft palate and of these 16.8% received an operative blood transfusion. An elective tracheostomy was required in one patient because of unsuccessful attempts at endotracheal intubation. One patient developed a respiratory arrest after two doses of diamorphine peri-operatively. The use of lignocaine and noradrenaline significantly reduced the operative blood loss. The presence of a positive bacteriological nose or throat swab did not influence the development of a post-operative pyrexia which could however be significantly reduced by the use of pre-operative antibiotics.     

Gastric ulceration caused by heater probe coagulation

A double-contrast upper gastrointestinal examination on a woman who had undergone endoscopic heater probe therapy one day earlier for multiple arteriovenous malformations revealed shallow, irregular, and linear ulcers at the sites of heater probe coagulation. Multiple shallow ulcers may therefore develop as a direct complication of heater probe therapy. Radiologists should be aware of this complication to avoid diagnostic confusion in these patients.     

Changes in UK ORL-HNS training scheme: Does the Indian trainee have a place anymore?

The determination of the UK Government to modernise medical careers, the shortage of training jobs for local medical graduates, the establishment of the Postgraduate Medical Training and Education Board (PMETB) and European Union rules have combined to change the scheme of surgical training in the United Kingdom. In the opinion of the author, the Indian Otorhinolaryngological (ORL) trainee can no longer aspire to reasonable higher training in the UK.     

前列腺素E1治疗慢性乙型肝炎黄疸的观察

目的观察前列腺素E1治疗慢性乙型肝炎重度黄疸的疗效。方法在综合治疗基础上，分别使用前列腺素E1（治疗组）和门冬氨酸钾镁（对照组）治疗慢性乙型肝炎重度黄疸患者各35例，并观察其症状、体征及肝、肾功能等，疗程4周。结果治疗组的症状、体征及肝功能指标及总有效率，均显著优于对照组，两组比较差异有显著意义（P〈0．05）。结论前列腺素E1治疗慢性乙型肝炎重度黄疸能显著地促进黄疸消退和改善肝功能。     

Assessment in undergraduate psychiatric education

An assessment of medical students' psychiatric performance demonstrated no association between the ability to rate psychopathology or to observe interview behaviour and traditional written methods of academic achievement. This is in accordance with those few studies which have addressed this issue and indicates that there may well be at least three independent skills involved in clinical decision-making: the ability to engage in interpersonal interaction and elicit information; and the ability to acquire and use academic knowledge. This is consistent with work suggesting that maturational and learning processes influence clinical reasoning, and demonstrates that each component should be addressed in assessing students in psychiatry.     

CD26及半乳糖凝集素3免疫组织化学染色在甲状腺癌诊断中的应用

目的探讨CD26／DPPⅣ、半乳糖凝集素3免疫组织化学染色及其联合检测在甲状腺癌诊断中的应用价值。方法采用免疫组织化学EnVision二步法检测了114例良恶性甲状腺肿瘤组织中CD26／DPPⅣ及半乳糖凝集素3的表达。结果CD26／DPPⅣ及半乳糖凝集素3在正常甲状腺组织中无表达，在甲状腺腺瘤及滤泡癌中少有表达，在大多数甲状腺乳头状癌中呈不同程度的阳性表达。相对于甲状腺腺瘤而言，CD26／DPPⅣ诊断乳头状癌的敏感性、特异性、诊断准确率、阳性预测值、阴性预测值及kappa值分别为86．8％、97．2％、90．4％、98．3％．79．5％及0．80，半乳糖凝集素3分别为97．1％、91．7％、95．2％、95．7％、94．3％及0．89。结论CD26／DPPⅣ及半乳糖凝集素3均是甲状腺乳头状癌较为可靠的标志物，可以辅助常规的病理检查进行乳头状癌与腺瘤的鉴别诊断，它们在甲状腺滤泡癌诊断中的应用价值尚有待于进一步的研究。     

先天性心脏病合并右上腔静脉缺如及永存左上腔静脉畸形的治疗

目的 探讨先天性心脏病合并右上腔静脉缺如及永存左上腔静脉畸形的治疗方法。方法 手术治疗2例，在全麻体外循环下行矫治术。1例采用左上腔静脉直接插管法，1例采用心内冠状静脉窦插管法。结果 2例均治愈，远期无心律失常发生。结论 先天性心脏病中，左上腔静脉合并右上腔静脉缺如非常少见，认识不足，是造成漏诊的主要原因。术中应根据情况酌情处理，但无论采取哪种方法，一定要注意对冠状静脉窦口的保护及左上腔静脉引流的通畅。