THE INFLUENCE OF THE ADRENAL GLANDS ON RESISTANCE : I. THE SUSCEPTIBILITY OF ADRENALECTOMIZED RATS TO MORPHINE.

1. The majority of rats (Mus norvegicus), because of accessory cortical tissue, will survive double adrenalectomy indefinitely under optimum conditions. 2. Resistance to morphine is greatly diminished in healthy adrenalectomized rats tested before hypertrophy of the accessories occurs. 3. This greater sensitiveness seems to be due to some fundamental alteration in metabolism dependent on a partial adrenal insufficiency. Protocol 1.—Rat 13; brown and white, male. Sept. 15, 1922. In stock. Sept. 18. Active, vigorous, and very vicious. Weight 281 gm. Operation, double adrenalectomy. Prompt recovery. Sept. 21. Very active and vicious. Sept. 22. Jumps viciously this morning on opening the cage. This afternoon, quiet and marked diarrhea. Transferred to individual cage. Eating nothing. Sept. 23, Diarrhea. Quiet, Sept. 24. Diarrhea diminished, more active, but is not vicious. Appetite poor, ate 5 gm, Sept. 25. Diarrhea, ate nothing. Sept. 26. Diarrhea still marked, ate nothing. Died this afternoon. Autopsy.—Weight 215 gm. Thyroid, heart, and lungs normal. Abdomen: intra-abdominal fat almost completely gone. Adrenals absent. Stomach: definite multiple minute hemorrhages in the mucous membrane throughout the pyloric part. Intestines: several loops of small gut deep red in color. Liver: nutmeg color. Protocol 2— Rat 43; white, male. Oct. 20, Active. Weight, 236 gm. Operation, excision of right adrenal and excision of piece of pancreas near left adrenal. Moderate bleeding. Oct. 22. Has not eaten since operation. Oct. 23. Active, beginning to eat. Oct. 27. Active,, eating well now. Slight diarrhea. Weight, 222 gm. At 11:10 a.m. injected subcutaneously with 1.78 cc. of 1 per cent morphine sulfate solution ( = 80 mg. per kg.). 1:30 p.m., quiet. 6 p.m., recovering. Oct. 28. Active, eating well. Nov. 10. In good condition. Sacrificed Jan. 8. Right adrenal absent, left adrenal intact. Protocol 3.— Rat 42; white, male. Oct. 20, Active. Weight, 320 gm. Operation, excision of both adrenals, much abdominal fat. Oct. 21. Ate 10 gm. of food. Oct. 22. Active, ate all of food (15 gm.). Oct. 27. Active. Weight, 310 gm. At II a.m. injected subcutaneously 0.62 cc. of 1 per cent morphine sulfate solution (= 20 mg. per kg.). 1:30 p.m., marked pilomotor effect. Did not move. 6 p.m., very quiet. Oct. 28. Very quiet, not eating. Oct. 29. Quiet. Ate a little today. Oct. 30. Very dull, not eating. 5 p.m., comatose. 9:30 p.m., found dead. Autopsy.—Weight 277 gm. Diarrhea. Thyroid large and dark red. Heart and lungs normal. Abdomen: scant fat. Both adrenals absent. No accessories seen. Right testicle congested. Liver and spleen normal. Stomach: one hemorrhage beneath mucosa near fundus. Prolocol4.—Rat 21;white and brown,male. Sept-27. Active. Weight345gm. Operation, excision of left adrenal, easy operation. Oct. 4. Active, eating well. Weight 333 gm. At 10:48 a.m. injected 0.75 cc. of 2 per cent morphine sulfate intravenously ( = 45 mg. per kg.). 10:50 a.m. respirations imperceptible. Board-like rigidity. 11:10 a.m. respirations very shallow. Complete coma. 1 p.m. condition gradually improving. Oct. 5. Alert and active, eating well. Oct. 11. Active, eating well (15 gm. per day). Weight 335 gm. Operation, excision of right adrenal. Easy operation, no hemorrhage. Moderate fat. Oct. 18. Excellent condition, active, good appetite. Weight 321 gm. At 3:50 p.m. injected 0.74 cc. of 1 per cent morphine sulfate intravenously ( = 23 mg. per kg.). 3:52 p.m. respirations imperceptible for a minute, and rat is stiff. 3:57 p.m. voluntary movement. Oct. 19. 9 a.m. very quiet. Marked ruffling of fur. Not eating. 6 p.m. very quiet and dopey. Oct. 20. Found dead this morning. Autopsy.—Well preserved fat. Diarrhea. Thyroid rather large and red. Heart and lungs normal. Abdomen: both adrenals absent. No accessories seen. Stomach: five distinct hemorrhages into mucous membrane, one is 3 x 4 mm. Protocols 5.—Rat 24; white and gray, male. Sept. 27. Active. Weight 320 gm. Operation: double adrenalectomy. Easy operation. Sept. 29. Eating well, alert. Oct. 2. Active, ate 12 gm. Weight 318 gm. Oct. 3. Ate 10 gm. Oct. 4. Active. Weight 311 gm. Ate 12 gm. At 10:30 a.m. injected 0.28 cc. of 1 per cent morphine sulfate intravenously (= 9 mg. per kg.). Became quiet but did not stop breathing. 5 p.m. quiet and fur ruffled. Oct. 5, very quiet. Eyes closed most of time. Hunched up, fur ruffled. Drinks with eyes closed. Not eating. Oct. 6. Head between front paws most of time. Pilomotor reaction marked. Oct. 7. Condition about the same. Has eaten nothing since operation. Oct. 8. Seems slightly more active, not eating. Oct. 9. Ate 5 gm. of food, first since injection. Oct. 10. Very drowsy. Stools firm and white. Not eating. Oct. 14. Very weak. Has not eaten 10 gm. since injection. Oct. 15. Found dead this morning. Autopsy.—Weight 240 gm. Thyroid moderate size. Heart in systole. Lungs normal. Abdomen: adrenals absent. No accessories seen. Left testis converted into a sack filled with dark red grumous material. Right testis atrophied. Stomach: postmortem change.     

Partizipative Entscheidungsfindung als neuer Qualit?tsindikator in der Nephrologie

Zusammenfassung Hintergrund und Ziel:   Partizipative Entscheidungsfindung (Shared Decision-Making) gewinnt als Modell der Arzt-Patienten-Beziehung auch im deutschen Gesundheitssystem zunehmend an Bedeutung. Insbesondere im Bereich chronischer Erkrankungen erwartet man sich von diesem Konzept mittel- bis langfristige Verbesserungen der Behandlungsergebnisse. Bislang liegen der deutschen Versorgungsforschung jedoch kaum empirische Daten zum Stand und zu den Entwicklungstendenzen der partizipativen Entscheidungsfindung vor. Diese Studie liefert aktuelle Ergebnisse zu dieser Fragestellung aus einer deutschlandweiten Befragung von terminal niereninsuffizienten Patienten. Methodik:   Im Rahmen des Programms Qualität in der Nephrologie (QiN) wurden in einer schriftlichen, deutschlandweiten Erhebung 6 614 Patienten mit terminaler Niereninsuffizienz befragt. Der Fragebogen enthielt ein zuvor übersetztes und validiertes Instrument zur Erfassung der wahrgenommenen Einbeziehung in die Therapie (PICS). Ergebnisse:   82% der Befragten fühlen sich durch ihre Ärzte für eine Beteiligung an Entscheidungen motiviert. 81% der Patienten informieren sich aktiv bei ihren Ärzten über ihre Erkrankung und Behandlungsmöglichkeiten. 69% geben an, dass eine gemeinsame Entscheidungsfindung von Arzt und Patient stattgefunden hat. Das Lebensalter, die Dialysejahre und das Geschlecht stehen im Zusammenhang mit der wahrgenommenen Einbeziehung. Schlussfolgerung:   Dieser Aufsatz bietet eine valide Grundlage für die prospektive Erforschung der partizipativen Entscheidungsfindung in der Behandlung der terminalen Niereninsuffizienz. Die Ergebnisse der vorliegenden Studie deuten auf eine hohe Bereitschaft von Dialysepatienten hin, sich aktiv am Prozess der Entscheidungsfindung zu beteiligen. Spezifische Patientencharakteristika und die Präferenzen der Patienten sollten nicht nur bei der alltäglichen klinischen Interaktion mit den Patienten Berücksichtigung finden. Sie könnten darüber hinaus im Rahmen der Qualitätssicherung systematisch erfasst und als Verbesserungspotential genutzt werden.und ärztliche Leiter der teilnehmenden KfH-Nierenzentrenkooperierende Nierenzentren (4. Quartal 2003): Prof. Dr. W. Pommer (Berlin Nordgraben), Prof. Dr. H.-H. Neumayer, Dr. R. Krause (Berlin Turmstraße), Prof. Dr. E. Scheuermann, Prof. Dr. H. Geiger, V. Belwe (Frankfurt Schleusenweg), Dr. H. Militzer (Hof ), Priv.-Doz. Dr. T. Marsen (Köln Gleueler Straße), Dr. T. Eich, Dr. N. Bröker (Köln Urbacher Weg), Dr. G. Junker, Dr. W. Hoffmann, Dr. A. Fritz (Linnich), Prof. Dr. R. Goerig, Dr. M. Leidig (Nürnberg Kreuzburger Straße), Prof. Dr. J. Braun (Nürnberg Virnsberger Straße), Dr. P. Jatzwauk, Dr. K. Burkhardt (Weißenburg), Dr. G. Janning, Dr. D. Bröckner (Dortmund), Dr. E. Braasch (Eberswalde), Dr. J. Nikolay (Fürth), Dr. D. Dorn (Kassel Mittelstraße), Dr. W. Gerding, Dr. W. Klimkait (Köln Graseggerstraße), M. Fey, Dr. J. Bargfrede (Köln Böckingstraße), Dr. M. Nebel (Köln Ostmerheimer Straße), Dr. M. Holzner-Achenbach, Dr. W. Böttcher (Köln Venloer Straße), Dr. B. Gmelin, Dr. P. Spiegel (Nürnberg Grossweidenmühlstraße), Prof. Dr. J. Zehner, Dr. H. Leitl (Passau), Dr. M. Eichhorn (Regensburg Plato-Wild-Straße), Dr. M. Gottsmann (Traunstein), Dr. A. Weber-Knorr (Trostberg), Dr. K. Lukowski, Dr. G. Meider (Bergisch-Gladbach), Priv.-Doz. Dr. D. Bokemeyer, V. Klüsener, Dr. O. Laue (Bochum Castroper Straße), Dr. C. Striebing (Dessau), Dr. R. Krämer, Dr. D. Bundschuh (Ehingen), Dr. G. Prager, Dr. G. Strack (Erbach), Priv.-Doz. Dr. A. Samizadeh, Dr. G. Weber (Essen Alfried-Krupp-Straße), Dr. T. Siegert (Görlitz), Dr. T. Lazarus, Dr. C. Mrowka (Ingolstadt), Dr. C. Blaser, Dr. U. Grunewald (Lohr), Dr. M. Heydenreich, Dr. G. Hillebrand (Neuried), Dr. C. Kuhlmann-Eilers, S. Abshagen (Oldenburg), Dr. L. Musselmann, Dr. A. Thiele (Rosenheim), Dr. P. Thon (Rotenburg), Dr. D. Bundschuh, Dr. R. Krämer (Ulm Eberhard-Finck-Straße), Dr. R. Krämer, Dr. D. Bundschuh (Ulm Magirusstraße), Prof. Dr. W. Schulz, Famira (Bamberg), Dr. C. Naoum (Berlin Große Hamburger-Straße), Dr. M. Buhl, Dr. L. Preuschhof (Berlin Teltowkanalstraße), Dr. B. Oser, Dr. S. Herrnberger (Bernkastel-Kues), J. Rieger (Bielefeld), Dr. N. Meyer, Dr. K. Anding-Rost (Bischofswerda), Dr. J. Geyer, Prof. Dr. W. Riegel (Darmstadt), Dr. M. Goller (Deggendorf ), Dr. W. Bihlmaier (Donauwörth), Dr. W. Bagnewski (Dülmen), Dr. Ch. Ambrecht, Dr. A. Heinig (Düsseldorf Kronenstrasse), Dr. K. Lange (Ebersberg), Dr. C.C. Haufe (Erfurt), Dr. H. Urzowski, Dr. G. Moser (Finsterwalde), Dr. R. Krallinger (Fürstenzell), Dr. T. Wichelhaus (Gummersbach), Dr. U. Hildebrand, Dr. C. Clemens (Hann.-Münden), Dr. P. Schulz (Haßfurt), Prof. Dr. D. Bach, Dr. E. Frank, Dr. F. Witsch (Krefeld), Priv.-Doz. Dr. H. Achenbach, Dr. L. Windgassen (Leipzig Philipp-Rosenthal-Straße), Dr. D. Soreth-Rieke (Miesbach), Dr. P. Roemisch, Dr. A. Hallwachs (München Isenschmidstraße), Dr. T. Leingärtner, Dr. R. Liebl (Regensburg Günzstraße), Dr. C. Dasch, Dr. M. Ballmann (Saarburg), Dr. B. Schober, A. Schober (Sulzbach-Rosenberg), Dr. V. Schulz (Annweiler), Dr. A.K. Mehlhorn (Aue), Dr. G. Prager, Dr. G. Strack (Bad König), Dr. D. Bleyl, Dr. T. Bleyl (Bautzen), Dr. H. Fischer (Berlin Bismarckstraße), Dr. T. Leimbach (Berlin Erwin-Bock-Straße), Dr.F. Himelsbach(Bingen), Priv.-Doz. Dr. M. Hollenbeck (Bottrop), Prof. Dr. H. Hennemann (Coburg), Dr. U. Bechtel, Dr. H. Lotz (Dillingen), Prof. Dr. P. Gross (Dresden), Dr. H. Spiegelberg (Düsseldorf Zeppenheimer Weg), Dr. R. Hasselbacher, H. Rau (Eisenach), Dr. U. Bunnemann (Erlangen), Priv.-Doz. Dr. R. Schäfers, Priv.-Doz. Dr. A. Kribben (Essen Eleonorastraße), Dr. A. Baus (Frankfurt/Oder), Dr. O. Wildgruber (Freising), Prof. Dr. W. Fassbinder, Dr. S. Graf (Fulda), Dr. F. Diekämper (Greven), Dr. H. Anschütz (Groß-Gerau), Dr. B. Spohn, Dr. H. Winter (Günzburg), Dr. L. Flitsch- Kiefner (Hagen), Prof. Dr. B. Osten, Dr. C. Wand, Dr. R. Fiedler (Halle), Dr. E. Wilbrandt, Dr. M. Schulz (Heringen), Dr. H. Strauss, Dr. B. Rendenbach (Hermeskeil), Dr. F. Himmelsbach (Ingelheim), Dr. A. Klemm, Dr. M. Gerold, Prof. Dr. H. Sperschneider ( Jena), Dr. H.W. Huhn (Kassel Oberzwehrener Straße), J. Kopp, Dr. M. Marx (Kelheim), Prof. Dr. M. Vlaho, Dr. W. Wessely (Kirn ZH zu Bad Kreuznach), Dr. K. Bausewein, Dr. H. Ehrich (Kitzingen), Dr. J. Hafels (Köln Barbarossaplatz), Dr. N. Thaller (Kreuth), Priv.-Doz. Dr. J. Beige, Dipl.-Med. G. Glombig (Leipzig Delitzscher Straße), Dr. M. Sommer (Lichtenfels), Prof. Dr. T. Lenz (Ludwigshafen), Dr. C. Brendel (Müchen Elsenheimer Straße), Dr. B. Zangerl (Münster), Dr. G. Richter, Dr. S. Guwa (Neuwied), Dr. G. Huss, Dr. U. Rothenpieler (Nördlingen), Dr. B. Bautsch (Norderney), Dr. N. Bockreiss (Oberschleißheim), Dr. D. Becker (Oberstaufen), Dr. H. Baudenbacher, Dr. D. Herrmann (Ochsenfurt), Dr. H. Lange (Pfaffenhofen), Dr. A. Baus (Seelow), Prof. Dr. M. Haag-Weber, M. Geyer (Straubing), Dr. R. Strupp (Trier Friedrich-Wilhelm-Straße), Dr. B. Rendenbach (Trier Kutzbachstraße), Dr. B. Gieshoff (Wesel), Dr. W. Haaf (Wismar)     

Media Reviews Available Online

Book reviewed in this article:
Cardiac Emergencies. W. Frank Peacock IV and Brian R. Tiffany. Reviewed by Anthony M. Napoli.
An Introduction To Clinical Emergency Medicine: Guide For Practitioners In The Emergency Department. Edited by Swaminatha V. Mahadevan and Gus M. Garmel. Reviewed by Steven J. Vance and Mary Jo Wagner.
Accident And Emergency Radiology: A Survival Guide. Second Edition. Edited by Nigel Raby, Laurence Berman, and Gerald de Lacey. Reviewed by Eric C. Bruno.
Grief of My Heart: Memoirs of a Chechen Surgeon. By Khassan Baiev with Ruth and Nicholas Daniloff. Reviewed by Eric M. Maniago.
Surgical Critical Care. Second Edition. Edited by Jerome H. Abrams, Paul Druck, and Frank B. Cerra. Reviewed by Anuradha Subramanian, Jeffrey P. Salomone, and Joseph A. Salomone.
Emergency Echocardiography. Edited by Aleksandar N. Neskovic, Frank A. Flachskamf, and Michael H. Picard. Reviewed by Jill Corbo.
Capnography: Clinical Aspects. Edited by Joachim S. Gravenstein, Michael B. Jaffe, and David A. Paulus. Reviewed by Michael A. Bohrn.
History Of The Treatment Of Spinal Injuries. By John Russell Silver. Reviewed by Sunil Shroff and Rick Kulkarni.     

Book Review

Book reviewed in this article:
Text Book of Hospital Pharmacy. Editors M. C. Allwood and J. T. Fell.
The Pharmacology of Immunoregulation. Edited by G. H. Werner and F. Floc'h.
Drug-induced Emergencies. P. F. D'Arcy and J. P. Griffin. J. Wright (1979).     

Patient selection for intensive care: a comparison of New Zealand and United States hospitals

To examine how the use of intensive care varies, we compared 5,030 adult ICU admissions in 13 U.S. hospitals with 1,005 patients in two New Zealand (N.Z.) hospitals. Despite similar national demographic and hospital patient characteristics, there were substantial differences in the use of intensive care. The N.Z. hospitals designated 1.7% of their total beds for intensive care compared to 5.6% in the U.S. hospitals. The average age for N.Z. admissions was 42 compared to 55 in the U.S. (p less than .0001). The N.Z. ICUs admitted fewer patients with severe chronic failing health (N.Z. 8.7%, U.S. 18%) and following elective surgery (N.Z. 8%, U.S. 40%). Approximately half the N.Z. admissions were for trauma, drug overdose, and asthma while these diagnoses accounted for 11% of U.S. admissions. When controlled for differences in case mix and severity of illness, hospital mortality rates in N.Z. were comparable to the U.S. This study demonstrates substantial differences in patient selection among these U.S. and N.Z. ICUs that have equal technical and manpower capabilities and provide similar high-quality intensive care. Physicians from both countries justify the differences on medical criteria; however, both approaches to patient selection cannot be optimal. Additional outcome comparisons between acutely ill patients treated in the U.S. and N.Z. could help refine ICU selection criteria and improve the precision of clinical decision-making.     

Interaction of morphine with intrathecally administered calcium and calcium antagonists: evidence for supraspinal endogenous opioid mediation of intrathecal calcium-induced antinociception in mice

The interaction between morphine [i.p. and intrathecal (i.t.)] and calcium and its antagonists (i.t. and i.c.v.) was studied in the mouse tail-flick test for antinociception. Calcium (0.66 mumol i.t.) produced antinociception comparable to that of morphine (0.5 microgram i.t.) but had a significantly longer duration. A lower dose of calcium (0.16 mumol i.t.) significantly potentiated morphine (0.2 and 0.5 micrograms i.t.). The antinociceptive effect of i.p. morphine was also potentiated by i.t. calcium, but was antagonized by the i.t. administration of ethylene glycol bis(beta-aminoethyl ether)-N,N'-tetraacetic acid (3.7-7.5 nmol), verapamil (15 micrograms), magnesium (9.4 nmol) and barium (1-2 nmol). In contrast, i.t. calcium and i.p. morphine were significantly potentiated by the i.c.v. administration of verapamil (15 micrograms) and antagonized by i.c.v. calcium (0.33 mumol). The antinociceptive effect of i.t. calcium was antagonized by naloxone administered s.c. (1 mg/kg) or i.c.v. (0.5 microgram), but not i.t. (0.5 and 10 microgram). It is concluded that the antinociceptive effect of i.t. calcium is mediated, at least partly, by a reflex supraspinal release of endogenous opioids, and that the administration of calcium and its antagonists modify the antinociceptive effect of morphine in opposite directions, depending upon whether they are administered by the i.t. or i.c.v. routes. Calcium may serve as a useful adjunct for opioid-induced analgesia via the i.t. route.     

Book Reviews

Book reviewed in this article:
Medical Statistics. A Commonsense Approach. 2nd Edn. by M.J. Campell & D. Machin. John Wiley & Sons
Reflective practice in nursing edited by Anthony Palmer, Sarah Burns & Chris Bulman.
Financing Healthcare in the 1990s by J. Appleby.
Children's consent to Surgery by P. Alderson.
Professional and Ethical Issues in Nursing by P. Burnard and C. M. Chapman.
Mentoring and Preceptorship edited by A. Morton-Cooper & A. Palmer.
Writing for health care profesions by D.F.S. Cormack.
Learning Disabilities edited by Earnon Shanley & Thomas Starrs.     

Book reviews

Book reviewed in this articles:
Essentials of Nursing: An Introduction by S. Collins & E. Parker.
Lifelines: An Account of the Life Experiences of Seven People With a Mental Handicap Who Used the NIMROD Service edited by S. Humphries, G. Evans & S. Todd.
A History of the Queen's Nursing Institute by Monica E. Baly.
Nursing Care of Rheumatic Patients by J. M. H. Moll & M. V. Lee.
Practical Burns Management by J. Harvey Kemble & Brenda E. Lamb.
Decision Making in Emergency Nursing by M. E. Mancini.
Research Methods and Statistics in Health Care by Norma G. Reid & Jennifer R. Boore.
Psychology in Action. Nursing in the Community by Susan P. Llewellyn & Dennis R. Trent.     

Book reviews

Book reviewed in this article:
'Modern Obstetrics for Student Mid wives' — Towler & Butler-Manuel.
Seeing Theatre Nursing by F.T. Graves and D. Graves.
Cancer Care: a Guide for Patient Education edited by M. Donovan.
Medieval Woman's Guide to Health by Beryl Rowland.
The Cesarean Experience: Theoretical and Clinical Perspectives for Nurses edited by Carole Fitzgerald Kehoe.
Handbook of Intensive Care by R.S. Atkinson, J.J. Hamblin and J.E.C. Wright.
Poisoning: Diagnosis and Treatment edited by J.A. Vale and T.J. Meredith.
Sociology and Nursing by James P. Smith
Mathematics for Nurses by Grace G. Johnson.
Rehabilitation after Severe Head Injury edited by CD. Evans.
Mathematics for Nurses by Grace G. Johnson.
Handbook of Neonatal Intensive Care by Halliday, McClure and Reed.
Children with Handicaps by Loma Selfe and Lynn Stow.
Using Child Psychiatry by Derek Steinberg.
Nursing Science in Nursing Practice Edited by James Smith
All about Heart Attacks J.R. Hampton.
Aspects of Gastroenterology for Nurses edited by Mary Sykes.     

Book reviews

Book reviews in this article:
A Review of the Management of the Reorganized National Health Service
Treatment Room Nursing—A Handbook for Nursing Sisters working in General Practice, Schools or Industry by S. M. Jacka and D. F. Griffiths.
Comprehensive Psychiatric Care edited by A. A. Baker.
A Commonsense Approach to Coronary Care by M. O. Vinsant, M. I. Spence and D. C. Hagen.
Nursing Management of Renal Problems by Dorothy J. Brundage.
Paediatric Intensive Care by K. D. Roberts and J. M. Edwards.     

Congenital Heart Disease in Liverpool: 1960-69

The incidence of congenital heart disease (C.H.D.) in Liverpoolfrom 1960 to 1969 inclusive has been determined from the LiverpoolCongenital Abnormalities Registry with a follow-up period of3 to 12 years. The incidence is 6.6 per 1000 total births andthis probably represents a very small degree of under-reporting. There is no consistent seasonal variation in the incidence ofany of the main congenital heart lesions. In general, infants with C.H.D. tend to be of lower birth weightand born after shorter gestation than controls. This is mostconspicuous with patent ductus arteriosus (P.D.A.). Females preponderate in P.D.A. and males in transposition. Thereis probably also a male preponderance in coarctation and aorticstenosis. Fallot's tetralogy is associated with increased maternal ageand parity. Pregnancies leading to the birth of a baby with C.H.D. are complicatedby threatened abortion more frequently than are controls. The concordance rate for C.H.D. in twins is low. Monozygotictwins are more liable to C.H.D. than are dizygotic twins. The incidence of C.H.D. in the siblings of affected propositiis 2–3 times that expected. Affected sibs often have thesame lesion. About 20 per cent of infants with C.H.D. have associated majordefects notably mongolism and defects of the alimentary, skeletal,genito-urinary and nervous systems. These are responsible forthe early death of about one quarter of all infants born withC.H.D. The data presented here suggest that environmental rather thangenetic factors are predominantly responsible for congenitalheart disease.     

BOOK REVIEWS

Books Reviewed in this Article:
Protocols for Nurse Practitioners in Gynecologic Settings 4th edn by J.W. Hawkins, D.M. Roberto & J.L. Stanley-Haney.
Professional and Ethical Issues in Nursing 2nd edn by Philip Burnard & Christine M. Chapman.
In Charge of the Ward by Arline Matthews & Janet Whelan.
Chemical Disinfection in Hospital by G. Aylie, D. Coates & P. Hoffman.
Conducing Research in the Practice Setting. Research Methods for Primary Care vol. 5 edited by M.J. Bass, E.V. Dunn, P.G. Norton, M. Stewart & F. Tudiver.
Theory-Directed Nursing Practice edited by S.M. Ziegler.
Self-Administration of Drugs: A Guide to Implementation by Carol Bird and Jane Hassall.
The Advanced Practitioner: Current Practice Issues 3rd edn by Joellen W. Hawkins & Janice A. Thibodeau.
Professional Burnout: Recent Developments in Theory and Research edited by W.B. Schaufeli, C. Maslach & T. Marek.
The Menopause and Hormone Replacement Therapy by Roger Smith & John Studd.
Mentoring and Preceptorship: A Guide to Support Roles in Clinical Practice by Alison Morton-Cooper & Anne Palmer.
Nursing Practice in the UK and North America by Eugene Levine, Peggy Leatt & Karin Poulton.     

Media Reviews

Book reviewed in this article:
Blueprints Clinical Cases Emergency Medicine. Second Edition Edited by Christine Tsien Silvers, Michael R. Filbin, Aaron B. Caughey.
Emergency Orthopedics—The Extremities. Fifth Edition Edited by R. Simon, S. Sherman, S. Koenigsknecht.
Current Medical Diagnosis and Treatment 2007. Forty-sixth edition Edited by Lawrence M. Tierney Jr., Stephen J. McPhee, Maxine A. Papadakis.
Bouncebacks! Emergency Department Cases: ED Returns Edited by Michael B. Weinstock, Ryan Longstreth, Gregory L. Henry.
Evidence-based to Value-based Medicine Edited by Melissa M. Brown, Gary C. Brown, Sanjay Sharma.
NMS Emergency Medicine, Second Edition (National Medical Series for Independent Study) Edited by S.H. Plantz, E.J. Wipfler.
The Airway.cam Guide to Intubation and Practical Emergency Airway Management Edited by Richard M. Levitan.     

Book reviews

Beyond All Pain: A Comparision for the Suffering and Bereaved by Cicely Saunder
Maternal Bonding by Wladyslaw Sluckin, Martin Herbert & Alice Sluckin. Basil Blackwell
Human Needs 3 and the Nursing Process edited by Helen Yura & Mary B. Walsh.
Practical Nursing 13th edition by M. Clarke. Balliére Tindall
Behavioural Science for Nurses by Henry Y. Akinsola.
Nursing Research: Ten Studies in Patient Care edited by Jenifer Wilson-Barnett. John Wiley & Sons
Clinical Pharmacology and Nursing Management by R.T. Spencer, L.W. Nichols, H.P. Waterhouse, F.M. West & E.G. Bankert. J.B.
Nursing Care of the Hemiplegic Stroke Patient by Freda Myco.
Psychiatric Nursing Described by Desmond F.S Cormack.
Ethical Dilemmas and Nursing Practice by Anne J. Davis & Mila A. Aroskar.
The Patient with a Psychiatric Disorder by Arnold Day
Nursing I by D. Middleton.
Learning to Nurse, Integrating Theory and Practise by Margaret F. Alexander.
The Little Brown Manual of Medical-Surgical Nursing edited by Etta Anne Hincker & Lois Malasanos.     

甲基-β-环糊精对Ⅱ型肺泡上皮细胞增殖与转分化的影响

目的 观察甲基-β-环糊精(MβCD)破坏脂质微区结构对Ⅱ型肺泡上皮细胞(AEC Ⅱ)增殖、转分化及细胞周期的影响.方法 采用MβCD破坏体外培养的AEC Ⅱ细胞膜脂质微区(MβCD干扰组),以必需基本培养基(DMEM)作为对照.用血细胞计数器计数培养细胞,四甲基偶氮唑盐(MTT)比色法检测细胞增殖能力,流式细胞仪检测细胞周期,免疫荧光双标和蛋白质免疫印迹法(Western blotting)检测AEC Ⅱ特异性肺泡表面活性蛋白C(SP-C)及Ⅰ型肺泡上皮细胞(AEC Ⅰ)特异性水通道蛋白5(AQP5)的表达.结果 与对照组比较,MβCD组干扰后24、48、72 h细胞数及增殖能力显著降低[细胞数(×106/rml):2.74±0.56比8.05±0.92,4.45±0.68比10.52±0.81,7.82±0.59比11.39±0.81;MTT结果(A值):0.25±0.20比0.45±0.02,0.35±0.03比0.54±0.28,0.48±0.04比0.59±0.05,均P＜0.01＝;MβCD组干扰后24h G0/G1期细胞比例显著增多,S期细胞比例显著减少[G0/G1期:(60.06±1.65)%比(43.43±3.59)%;S期:(16.20±2.17)%比(34.07±2.63)%,均P＜0.05＝;MβCD组干扰后48 h、72 h SP-C蛋白表达明显增多(0.54±0.04比0.47±0.03,0.19±0.03比0.06±0.02),AQP5蛋白表达明显减少(0.30±0.04比0.43±0.06,0.39±0.04比0.59±0.04,P＜0.05或P＜0.01＝.结论 MβCD破坏体外培养AEC Ⅱ脂质微区结构后,细胞发生G1期阻滞,细胞增殖和转分化受到抑制.

Abstract：

Objective To study the destructive effects of the membrane lipid microdomain with methyl-β-cyclodextrin (MβCD) on the proliferation, transdifferentiation and cell cycle of type Ⅱ alveolar epithelial cell (AEC Ⅱ ). Methods The membrane lipid microdomain of AEC Ⅱ was destroyed by MβCD (MβCD interference group) in vitro, and then cultured with DMEM as control. Cell number was counted with hernacytometer; the proliferation rate was measured by methyl thiazolyl tetrazolium (MTT); flow cytometry was used to assay the cell cycle. The expressions of AEC Ⅱ -specific surfactant protein-C (SP-C)and AEC Ⅰ-specific aquaporin-5 (AQP5) were detected by immunofluorescence and Western blotting analyses. Results Compared with control group, cell number and the cell proliferation was decreased in MβCD interference group at 24, 48 and 72 hours after interaction [cell numbers (× 106/ml) : 2. 74±0. 56 vs.8. 05±0. 92, 4. 45±0. 68 vs. 10. 52±0. 81, 7.82±0. 59 vs. 11.39±0. 81; MTT results (A value) : 0. 25±0. 20 vs. 0. 45±0. 02, 0. 35±0.03 vs. 0. 54±0. 28, 0. 48±0. 04 vs. 0. 59±0. 05, all P＜0. 01]. MβCD could increase the percentage of cells in G0/G1 phases and decreased the percentage in S phases at 24 hours [G0/G1phases: (60. 06±1.65)% vs. (43.43±3. 59)% ; S phases: (16. 20±2.17)% vs. (34. 07±2. 63)%, both P＜0. 05]. Incubation of AEC Ⅱ with MβCD resulted in up-regulation of the expression of SP-C (0. 54±0. 04vs. 0. 47±0. 03, 0. 19±0. 03 vs. 0.06±0. 02) and down-regulation of AQP5 (0. 30±0. 04 vs. 0. 43±0. 06,0. 39±0. 04 vs. 0. 59±0. 04) at 48 hours and 72 hours after interaction (P＜0. 05 or P＜0. 01). Conclusion The destruction of membrane lipid microdomain by the MβCD can inhibi± proliferation and transdifferentiation of AEC Ⅱ , and induce cell cycle arrest in G1 phase.     

Macrophage inflammatory protein-1 alpha. A novel chemotactic cytokine for macrophages in rheumatoid arthritis.

We have shown that human macrophages (m phi s) play an important role in the elaboration of chemotactic cytokines in rheumatoid arthritis (RA) (Koch, A. E., S. L. Kunkel, J. C. Burrows, H. L. Evanoff, G. K. Haines, R. M. Pope, and R. M. Strieter. 1991. J. Immunol. 147:2187; Koch, A. E., S. L. Kunkel, L. A. Harlow, B. Johnson, H. L. Evanoff, G. K. Haines, M. D. Burdick, R. M. Pope, and R. M. Strieter. 1992. J. Clin. Invest. 90:772; Koch, A. E., P. J. Polverini, S. L. Kunkel, L. A. Harlow, L. A. DiPietro, V. M. Elner, S. G. Elner, and R. M. Strieter. 1992. Science (Wash. DC). 258:1798). Recently, m phi inflammatory protein-1 (MIP-1 alpha), a cytokine with chemotactic activity for m phi s and neutrophils (PMNs), has been described. We have examined the production of MIP-1 alpha using sera, synovial fluid (SF), and synovial tissue (ST) from 63 arthritic patients. MIP-1 alpha was higher in RA SF (mean, 29 +/- 8 ng/ml [SE]) compared with other forms of arthritis (2.8 +/- 1.7), or osteoarthritis (0.7 +/- 0.4; P < 0.05). RA SF MIP-1 alpha was greater than that found in either RA or normal peripheral blood (PB) (P < 0.05). Anti-MIP-1 alpha neutralized 36 +/- 3% (mean +/- SE) of the chemotactic activity for m phi s, but not PMNs, found in RA SFs. RA SF and PB mononuclear cells produced antigenic MIP-1 alpha. Mononuclear cell MIP-1 alpha production was augmented with phytohemagglutinin or LPS. Isolated RA ST fibroblast production of antigenic MIP-1 alpha was augmented upon incubation of cells with LPS, and to a lesser extent with tumor necrosis factor-alpha. Isolated RA ST m phi s expressed constitutive MIP-1 alpha mRNA and antigenic MIP-1 alpha. Using ST immunohistochemistry, MIP-1 alpha+ cells from RA compared with normal were predominantly m phi s and lining cells (P < 0.05). These results suggest that MIP-1 alpha plays a role in the selective recruitment of m phi s in synovial inflammation associated with RA.     

Book Review

Book Review in this Article
Mezey, M., & McGivern, D. (1986). Nurses, nurse practitioners: The evolution of primary care. Boston: Little Brown.
Birmingham, J. J. (1986). Home care planning based on DRGs: Functional health pattern model. New York: J. B. Lippincott; co-published by Fleschner Publishing Co., Bethany, CT.
Hein, C. C, & Nicholson, M. J. (Eds.) (1986). Contemporary leadership behavior: Selected readings , 2nd ed. Boston: Little, Brown.
Nicoll, L. H. (Ed.) (1986). Perspectives on nursing theory. Boston: Little, Brown.
Chenitz, W. D. and Swanson, J. M. (1986). From Practice to Grounded Theory: Qualitative Research in Nursing. Menlo Park, CA: Addison-Wesley.
Amenta, M. O., and Bohnet, N. L. (1986). Nursing Care of the Terminally III. Boston: Little Brown and Company     

Congenital heart disease in Liverpool: 1960--69.

The incidence of congenital heart disease (C.H.D.) in Liverpool from 1960 to 1969 inclusive has been determined from the Liverpool Congenital Abnormalities Registry with a follow-up period of 3 to 12 years. The incidence is 6-6 per 1000 total births and this probably represents a very small degree of under-reporting. There is no consistent seasonal variation in the incidence of any of the main congenital heart lesions. In general, infants with C.H.D. tend to be of lower birth weight and born after shorter gestation than controls. This is most conspicuous with patent ductus arteriosus (P.D.A.). Females preponderate in P.D.A. and males in transposition. There is probably also a male preponderance in coarctation and aortic stenosis. Fallot's tetralogy is associated with increased maternal age and parity. Pregnancies leading to the birth of a baby with C.H.D. are complicated by threatened abortion more frequently than are controls. The concordance rate for C.H.D. in twins is low. Monozygotic twins are more liable to C.H.D. than are dizygotic twins. The incidence of C.H.D. in the siblings of affected propositi is 2-3 times that expected. Affected sibs often have the same lesion. About 20 per cent of infants with C.H.D. have associated major defects notably monogolism and defects of the alimentary, skeletal, genito-urinary and nervous systems. These are responsible for the early death of about one quarter of all infants born with C.H.D. The data presented here suggest that environmental rather than genetic factors are predominantly responsible for congenital heart disease.     

The media exchange

COPING WITH CHILDHOOD CANCER: Where Do We Go From Here? by David W. Adams and Eleanor J. Deueau Reston, Va.: Reston Publishing Company, 1984. Reviewed by Sharon McBride Valente, R.N. M.N. C.S. P.N.P. University of Southern California Department of Nursing, Los Angeles, California.

HOSPICE U.S.A. by Austin Kutscher New York: Columbia University Press, 1983.     

Penicillin V therapy for streptococcal pharyngitis: comparison of dosage schedules.

Two dosage regimens of penicillin V were compared in 327 patients with mild to moderately severe streptococcal pharyngitis. Patients fulfilling study criteria were randomly assigned to a b.i.d. or a t.i.d. dosage schedule. Those in the b.i.d. group were given 500 mg twice daily; those in the t.i.d. group were given 250 mg three times daily. Duration of therapy was ten days for both groups. Cure was based on prompt symptomatic improvement, subsidence of clinical signs, and negative throat cultures for group A beta-hemolytic streptococci. Both dosage schedules yielded similar cure rates, indicating that with penicillin V, a b.i.d. regimen is as effective as a t.i.d. regimen in treating streptococcal pharyngitis.