SCREENING FOR ALCOHOLISM IN GENERAL MEDICAL PATIENTS

Medical patients (N = 108) were administered a brief screeninginstrument (LAMSI) and a structured diagnostic interview (SUDDS).Twenty-five patients met DSM-III criteria for an alcohol usedisorder, 20 current, five in remission. The four-item scaleembedded in the screen identified the alcoholics with 88% sensitivityand 96% specificity.     

SPECTRUM OF THYROID FUNCTION ABNORMALITIES IN GESTATIONAL TROPHOBLASTIC NEOPLASIA

The relative influences of the putative thyroid stimulator, pregnancy state and non-thyroidal illnesses, were assessed in 52 patients with gestational trophoblastic neoplasia (GTN). In this study biochemical thyroid status was assessed with the aid of thyrotrophin (TSH) measurements by a sensitive immunoradiometric assay and measurement of total and free thyroid hormone concentrations. The reference group consisted of 63 patients with normal pregnancy. Thyroid function in the GTN patients was also compared with that in 36 female patients with Graves' disease and 34 female patients with non-thyroidal illnesses. We found the major influence on thyroid functions in Group I ('Hyperthyroid') patients with GTN to be the presence of the thyroid stimulator, while non-thyroidal illnesses played an important role in Group II ('High T4 syndrome') and III ('euthyroid') patients with GTN. Thyroid function was also stimulated in Group II patients. The influence of pregnancy was seen in all three groups of patients with GTN, who had higher TBG concentrations than non-pregnant patients. We conclude that there is a spectrum of thyroid function abnormalities in GTN, and that thyroid function in an individual patient is determined by the relative influence of the thyroid stimulator, non-thyroidal illnesses and the pregnancy.     

A Group-Based Training Programme for General Practitioners: A Norwegian Experience

Westin S, stensen A I, Lvslett K, Prytz J, Telje J, TelstadW and Lie A. A group-based training programme for general practitioners:a Norwegian experience. Family Practice 1988; 5: 244–252. There are approximately 3000 general practitioners in Norway,serving a population of slightly above four million people.A three year postgraduate education scheme for general practitionershas been in effect since 1973, to be replaced by a five yearvocational training programme from January 1985, making generalpractice a fully recognized specialty from that date. The educationalrequirements consist of one year of hospital training, fouryears of training in general practice, and a total of 400 hoursof course education, mainly in clinical subjects. The core elementof the training is attendance at a group-based structured educationalprogramme of two years' duration. This article describes theconcepts and content of this decentralized group-based education,as well as some of the conflicting considerations which eventuallyled to this new Norwegian model of general practice training.The first evaluation studies indicate that the educational programmehas met a long standing need among general practitioners.     

The effect of high-intensity training on purine metabolism in man

The effect of intermittent high-intensity training on the activity of enzymes involved in purine metabolism and on the concentration of plasma purines following acute short-term intense exercise was investigated. Eleven subjects performed sprint training three times per week for 6 weeks. Muscle biopsies for determination of enzyme activities were obtained prior to and 24 h after the training period. After training, the activity of adenosine 5′-phosphate (AMP) deaminase was lower (P < 0.001) whereas the activities of hypoxanthine phosphoribosyl transferase (HPRT) and phosphofructokinase were significantly higher compared with pre-training levels. The higher activity of HPRT with training suggests an improved potential for rephosphorylation of intracellular hypoxanthine to inosine monophosphate (IMP) in the trained muscle. Before and after the training period the subjects performed four independent 2-min tests at intensities from a mean of 106 to 135 % of Vo_max. Venous blood was drawn prior to and after each test. The accumulation of plasma hypoxanthine following the four tests was lower following training compared with prior to training (P < 0.05). The accumulation of uric acid was significantly lower (46% of pre-training value) after the test performed at 135% of Fo_2mM (P < 0.05). Based on the observed alterations in muscle enzyme activities and plasma purine accumulation, it is suggested that high intensity intermittent training leads to a lower release of purines from muscle to plasma following intense exercise and, thus, a reduced loss of muscle nucleotides.     

HLA27 and Anterior Uveitis

HL-A types were determined in 90 successive patients with non-granulomatous uveitis. Fifty-one were HL-A27 positive (55.7%) compared to 8.2% of controls. Of 16 patients with ankylosing spondylitis, 13 were HL-A27 positive, as were two patients with a history of Reiter's syndrome.
Twenty-eight patients were HL-A27 positive but had no evidence of rheumatic disease. The findings are discussed in relation to the possible pathogenesis of uveitis.     

Choline acetyltransferase activity of rat synaptosomes is sensitive to enflurane, but not halothane or isoflurane

We have examined the activity of choline acetyl-transferase(ChAT) in rat cortical synaptosomes in the presence of threevolatile anaesthetic agents: enflurane, halothane and isoflurane.The Michaelis constant K_m for choline was reduced significantly(P = 0.012) in the presence of 6.5% enflurane (3 rat MAC) comparedwith control samples exposed to carrier air only, while maximumreaction velocity (Vmax) remained unaltered. The reduction inK_m was also significant at enflurane concentrations of 4.4%(2 rat MAC) (P = 0.043) and 2.2% (1 rat MAC) (P = 0.043). Halothane3% (2.5 rat MAC) and 4.5% isoflurane (3 rat MAC) had no effecton either kinetic property. If present in vivo, an enflurane-inducedalteration in acetylcholine metabolism, through modified ChAT,may contribute to the convulsive properties of this anaesthetic.(Br. J. Anaesth. 1994; 72: 577–580) Presented in part to the Anaesthesic Research Society, CambridgeMeeting, November 22–23, 1991 (British Journal of Anaesthesia1992; 68: 445P).