Hartmann Stahelin (1925–2011) and the contested history of cyclosporin A

The aims of this study are twofold: (i) to pay tribute to Hartmann Stahelin for his scientific research on cyclosporin A; and (ii) to consider possible lessons for future pharmacological innovation by revisiting Stahelin's personal struggles to obtain fair recognition for his contribution to transplantation medicine.     

The Natural History of “Acute Pancreatitis”

A follow-up review of at least three years was carried out on 80 patients diagnosed as suffering from attacks of acute pancreatitis. Thirty had associated cholelithiasis, 28 were alcoholics, and in 22 instances the pancreatitis was classified as idiopathic. It is clear that there is a widely varying response to continued alcoholism; one group will suffer only a single episode of acute pancreatitis, a few patients will develop acute relapsing pancreatitis, and a smaller number will progress to gross pancreatic destruction associated with persistent low-grade pain, weight loss and endocrine insufficiency. In the group with gallstones, we were impressed by the association of stones with the recurrence of attacks, and in contrast the freedom from attacks endowed by a cholecystectomy or choledochotomy. In the idiopathic group, those patients aged over 50 years usually had one single attack without subsequent trouble; for patients aged below 50 years, the chances are highly in favour of further relapses. This series supports the view expressed by Howard and Jordan (1960) and Sarles et alii (1965) that pancreatitis associated with alcoholism, pancreatitis associated with gallstones and pancreatitis of unknown ?tiology have greatly differing natural histories and clinical patterns.     

Diallyl-Nortoxiferine (“Alloferin”): A Clinical Appraisal

The clinical use of the muscle relaxant diallyl-nortoxiferine (“Alloferin”) is discussed. The following features of the drug were studied: dosage, duration of action, effect on blood pressure and pulse rate and reversibility with neostigmine.     

“I Wouldn't Start From Here”—An Alternative Perspective on PTSD From the ICD‐11: Comment on Friedman (2013)

This commentary briefly summarizes some of the criticism directed at the diagnosis of posttraumatic stress disorder (PTSD) according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) including the issues of complexity and comorbidity, and offers a rationale for attempting a simpler approach to diagnosis that can be used in minimally resourced, non‐English‐speaking countries. Rather than describe comprehensively the features of PTSD, the World Health Organization in its upcoming edition of the International Classification of Diseases has opted to define a much smaller number of symptoms that will effectively discriminate PTSD from other related conditions. Parallel research on the two approaches to diagnosis promises to add greatly to our understanding of the condition.     

Wegener's granulomatosis and midline (nonhealing) “granuloma”

There has been considerable controversy over the years regarding the distinctions between various disorders characterized by a necrotizing and granulomatous inflammation of the tissues of the upper respiratory tract and oral cavity. It now seems clear that if infections and other known agents can be excluded, three clinicopathologic entities remain: Wegener's granulomatosis (a systemic disease), idiopathic midline (nonhealing) granuloma, and premalignant or malignant lymphoreticular lesions. The antigenic stimulus for all three may be related but remains unidentified.     

(ii) The “floating knee” in adults and children

The treatment of simultaneous ipsilateral femoral and tibial fractures is a therapeutic challenge, often complicated by concomitant multisystem injury. This combination necessitates vigilance in identifying and promptly treating associated neurovascular compromise. In the context of multiple trauma, a spanning external fixator could be considered to allow restoration of haemodynamic stability and to minimise the immuno-inflammatory response to injury. Definitive reconstruction can be performed at later stage. Intramedullary nailing appears to be the most common method of stabilisation.     

Comparison of “subjective” and “objective” measures of severity of urinary incontinence in women

The aims of this study were to compare “subjective” measures of severity of urinary incontinence to similar “objective” measures, establish their statistical correlation, and determine the effect of specific urodynamic diagnosis on such correlations. Baseline data was available from 265 women entered into a clinical trial studying pharmacologic and behavioral interventions for urinary incontinence. The “subjective” measures of incontinence were obtained by patient recall during history taking and included: the number of incontinent episodes in I week, the number of perincal pads used during I week, and the number ot clothing changes required due to wetness. The “objective” measures of severity included: the number of incontinent episodes per week as recorded on a 7-day diary, the number of perineal pads used per week, also recorded on a diary, and the amount of fluid lost during a standardized pad test Analysis consisted of Pearson correlations and linear regressions to determine equations for the prediction of objective measurement on the basis of the corresponding subjective measure. Significant positive correlations were seen between “subjective” and “objective” measurements for the comparisons of number of weekly incontinent episodes (R = 0.63), and tor the weekly number of pads used (R = 0.81). The comparison between the number of clothing changes and the amount of fluid lost during pad testing was also significantly but less strongly correlated (R = 0.24). For the correlations between subjective and objective determinations of urinary incontinent episodes and for those between clothing changes and pad testing, the urodynamic diagnosis had no effect on the correlation coefficients, but did have a statistically significant effect on the intercept. “Subjective” measures of severity of urinary incontinence will provide a reasonable estimate of “objective” measures of severity of urinary incontinence in women. Therefore in a clinical setting, it seems logical to use “subjective” measures to assess both baseline severity and response to intervention. © 1995 Wiley-Liss, Inc.