Improvement of oral colonic lavage with supplemental simethicone

We have noted that colons of patients prepared for colonoscopy with Golytely, a nonabsorbable electrolyte lavage solution, frequently contain foam which may obscure small mucosal lesions. Therefore, a randomized, blinded controlled trial was performed to determine the prevalence of Golytely-induced foam and the effect of supplemental simethicone in decreasing the prevalence of foam. Foam was present in 32% of colons prepared with Golytely alone but in none of the colons prepared with Golytely supplemented with simethicone. In addition, only 5% of colons prepared with supplemental simethicone had residual stool noted at the time of colonoscopy, a significant improvement over the 39% prevalence of residual stool in colons prepared with Golytely alone. Addition of simethicone to Golytely lavage decreases the prevalence of colonic foam and residual stool.     

Effects of focusing attention on breathing with and without apparatus on the face

In an attempt to identify a cause for the alteration in breathing pattern seen when conventional respiratory apparatus is applied to the face, we have studied the effects of causing the subject to focus attention on breathing by counting breaths in threes for 5 min. We used the respiratory inductance plethysmograph in 18 naive subjects who were unaware that their breathing was being measured. In the control periods, distraction was provided by a recorded story played through head-phones. The experiment was repeated with the rim of a facemask applied to the face. Focusing attention on breathing caused a prolongation of inspiration at a constant mean inspiratory flow, and lengthening of expiration. Tidal volume but not ventilation was increased. The facemask rim caused no significant change. It is concluded that conscious awareness of breathing could account for a major part of the effect of conventional respiratory apparatus.     

Wolfe Tone’s death: Suicide or assassination?

The final events of Wolfe Tone’s short and stormy life are fairly common knowledge. He was captured on board the French flagshipHoche when the vessel surrendered to a superior British naval force off Lough Swilly on October 10, 1798. Despite his protests that he was entitled to normal prisoner-of-war treatment, he was brought in irons a month later to Dublin. A court martial was hurriedly convened and he was found guilty of treason on Saturday November 10 and condemned to be hanged two days later. According to the generally accepted version of subsequent events he cut his own throat early on the Monday morning. The assistant surgeon of the 5th Dragoon Guards dressed the wound “ — but only with a view to prolong life until the fatal hour of one o’clock”. This surgeon was Benjamin Lentaigne, a Royalist emigre from France. Despite the pleas of John Philpott Curran, a leading advocate of the day, the military authorities refused to allow any consultation with a civil surgeon. Was this just bloody mindedness or was there an even more sinister reason? Two possibilities come to mind. One was that the wound had been so incompetently treated that a consultant would have been forced to make adverse comments, the other that the throat wound was not due to a cutting injury but, to a bullet fired either deliberately or accidently and a knife or razor was then used to try and camouflage the original trauma. In 1812 Lentaigne published a pamphlet in Latin in which he made reference to an unusual neck would stating that “— the bullet passed through his throat...” There is no direct evidence that the victim was Tone, why did the writer not make this clear? It may be he was reluctant to expose the medico-military inefficiency or callousness or to jeopardise his son’s career. Whatever the true facts, the verdict must remain the Scots one of “Not proven”.     

Evolution of the sperm aster after microinjection of isolated human sperm centrosomes into meiotically mature human oocytes

This study examined the feasibility of isolating and transferringthe centrosome-containing region of spermatozoa to mature humanoocytes. The findings demonstrate that individual sperm centrosomescan be transferred and are capable of nucleating maternal tubulinto form a well-developed sperm aster in the recipient oocyte.The results are discussed with respect to centrosome functionin early human development and applications in clinical in-vitrofertilization in the treatment of certain forms of male factorinfertility.     

Fit and fill analysis of a newly designed femoral stem in cementless total hip arthroplasty for patients with secondary osteoarthritis

The fit and fill of the femoral canal are critical to the success of cementless femoral stems in total hip arthroplasty. It is difficult for conventional stems to provide a good fit and fill for the femora of patients with secondary osteoarthritis. Based on measurements of 100 femora of these patients, we designed two types of Fukui Medical School (FMS) stems with a proximal lateral flare that differed in the medial radius. We compared the fit and fill of the FMS stems with those of four conventional stems, using computer simulation. The mean proximal fit and total fit of the FMS stems were 46% and 53% respectively, a significant improvement compared with the other stems examined. The mean fill of FMS stems was 82% at the lower end of the lesser trochanter and 84% at the upper end of the isthmus, values that were significantly higher than those of the other stems. Since September 1995, we have implanted FMS stems in 15 hips with secondary osteoarthritis. Radiographic evaluations showed that the canal fill of the FMS stems was significantly greater in the proximal femur compared with other stems previously inserted at our department. A summary of this paper was presented at the 9th Symposium on Computer-Assisted Radiology; June 1995, Berlin, and at the 8th International Symposium on Technology in Arthroplasty; September 1995, Puerto Rico.     

Diagnosis of ligament rupture of the ankle joint: Physical examination, arthrography, stress radiography and sonography compared in 160 patients after inversion trauma

We prospectively enrolled 160 consecutive patients with inversion trauma of the ankle in a diagnostic protocol that included physical examination within 2 days and at 5 days after trauma, arthrography, stress radiography, and ultrasonography. 135 patients had pathological lateral ligament laxity on the later physical examination or lateral ligament rupture diagnosed on arthrography and they were operated on. 122 of these patients had ligament ruptures.

At clinical follow-up after a minimum of half a year, all of the patients who were not operated on had stable joints without signs of previous ligament ruptures.

Delayed physical examination at 5 days after the injury led to the highest overall sensitivity (96%) and specificity (84%) for the detection of a ligament rupture. Additional diagnostic procedures, at a considerable cost, yielded little additional information.