LECTURES ON THE THEORY AND PRACTICE OF MEDICINE;: NOW IN COURSE OF DELIVERY AT THE THEATRE OF ANATOMY AND MEDICINE,WEBB-STREET,SOUTHWARK

DISEASES OF THE CIRCULATING SYSTEM.— Physiology of the heart. The pulmonic and systemic hearts. Explanation of the sounds of the heart. Tabular view of diseases of the heart. History, signs, and termination of cardiac complaints in general. Effects of remedies. Hypertrophy ; dilatation. Carditis and pericarditis. Endocarditis. Diseased valves. Aneurysm of the aorta. Symptomatic affections of the heart.     

A comparative study of the relative efficacy of pyrantel pamoate, bephenium hydroxynaphthoate and tetrachlorethylene in the treatment of Necator americanus infection in Ceylon.

The clearance of hookworm (Necator americanus) ova by a single dose of tetrachlorethylene (T.C.E.) was compared with that produced by single and multiple dose regimes of bephenium hydroxynaphthoate and pyrantel pamoate. Single doses of bephenium and pyrantel were inferior to T.C.E. Three daily doses of bephenium or pyrantel produced effects comparable with a single dose of T.C.E. Because of the low cost and lack of side effects, T.C.E. remains the drug of choice in the treatment of N. americanus in infections; the only disadvantage of T.C.E. is its unnoticed deterioration under tropical conditions.     

LECTURES ON THE THEORY AND PRACTICE OF MEDICINE;: NOW IN COURSE OF DELIVERY AT THE THEATRE OF ANATOMY AND MEDICINE,WEBB-STREET,SOUTHWARD

DISEASES OF THE LIVER, PANCREAS, AND SPLEEN.—Frequency of disease of the liver; it is greatly susceptible of changes in form and size. Nerves of the gall-ducts. Inflammation of the liver; its history, symptuss, and treatment. Venous and bilious congestion of the liver. Encephalonis. Tubercles. Hydatids. Fatty liver. Cirrhosis. Diseases of the biliary ducts ; obstruction; calculi ; rupture of the gallbladder. Diseases of the pancreas. Diseases of the spleen; inflammation; organic disease.     

Sex steroid hormones in natural populations of a sexual whiptail lizard Cnemidophorus inornatus, a direct evolutionary ancestor of a unisexual parthenogen

The lizard genus Cnemidophorus consists of both sexual species and unisexual, all-female species. We characterized changes in circulating levels of gonadal sex steroid hormones in males and females in one of the sexual species, C. inornatus, to compare them to previously measured levels in a unisexual, parthenogenetic species, C. uniparens. Reproductively active male C. inornatus have high levels of dihydrotestosterone and somewhat lower levels of testosterone. These levels are highest immediately after females become sexually receptive and decrease later at the onset of testicular regression. Female C. inornatus have high levels of estradiol and low levels of progesterone during the previtellogenic and vitellogenic phases of the ovarian cycle. During the postovulatory phase, they have low levels of estradiol and high levels of progesterone. We could not detect circulating levels of androgen at any phase of the ovarian cycle. The patterns of hormone secretion in the female C. inornatus are virtually identical to those of its direct evolutionary descendant, C. uniparens. This confirms our previous conclusion that the evolution of the parthenogenetic mode of reproduction and expression of male-like pseudosexual behavior that are characteristic of the unisexual C. uniparens has not been accomplished by evolutionary modifications in the pattern of sex steroid hormone secretion. Rather it is the response to this pattern of secretion that has been modified.     

Detection and morphofunctional predictors of left auricular thrombosis in patients with atrial fibrillation

Atrial fibrillation significantly worsens quality and duration of patient's life because of frequent development of thromboembolic complications. The main cause of these complications is formation of intracardiac thrombosis. Prevalence of left atrial thrombosis in patients with atrial fibrillation varies from 8 to 24%. About 90% of thromboses are localized in left auricle. This paper contains review of different methods of detection of left auricular thrombosis. Main structural and functional predictors of thrombosis and possibilities of modern techniques of their visualization are also described. Different methods of echocardiography first of all transesophageal echocardiography are at present foremost in assessment of structural and functional predictors of thrombosis development. With the help of transesophageal echocardiography it is possible to accomplish functional monitoring of the state of left auricle during treatment with different drugs and/or after cardioversion. Detection of risk factors of left auricular thrombosis is an important clinical task because it allows to select a group of high risk patients in which long-term therapy with anticoagulants is indicated.     

Evaluation of the knowledge and manner of workers of workplaces in Tokat about the ban on restriction of indoor smoking

To evaluate the knowledge and manner of cafe, pub and restaurant (with/without alcohol) workers in our city center about the ban on restriction of indoor smoking. To determine the preparation about the ban, smoking characteristics of workers, the knowledge on passive smoking. A questionnaire was performed to workers. The type of workplace, the number of workers, existence of a restriction of indoor smoking, any preparation about the ban were asked. The job of worker, whether the worker has a knowledge on the ban or not, the idea of the workers on the necessity and practicability of the ban were asked. Smoking history and the knowledge about passive smoking of workers were recorded. Fagerstrom nicotine dependent test (FNDT) was performed to smokers. Eighty four work places with 568 workers included in the study. The questionnaire was performed to 337 workers whose mean age was 29.1/years. 292 of workers were male. 190 of cases were current smokers. 166 of cases (49.3%) know the meaning of passive smoking. Alcohol offering was made at 8 of workplaces. Smoking was forbidden in 20 of workplaces. A preparation was performed about the ban in 30 of (46.9%) other workplaces. 88.4% of workers have knowledge on the ban, 64.7% of them know the punishment of the noncompliance of the ban. 81.3% of the workers believe the necessity and 45.7% of them believe the practicability of the ban. Smokers and especially who's FNBT > 5 have a stronger belief on the necessity and practicability of the ban. We determined that the preparation about the ban was inadequate although there was an little time for the put into practice the law. So we think that the controls of workplaces should be happened frequent.     

The fundamentals of association of natural foci of zoonoses

Reports on the role of hydrological conditions in the functioning of parasitic systems are analyzed. The authors point out that a range of issues including different aspects of combination phenomena is discussed there. They suggest that a concept of combination shall be replaced by a concept of association of parasitic systems and their relevant natural foci of zoonoses, which is of a larger scope. The fundamentals of the formation and functioning of associated parasitic systems and natural foci of zoonoses are discussed. These include the hydrological conditions of floodplain-river regions, the multiparasitic capacity of hosts and vectors, the multihost pattern of causative agents, and a diversity of mechanisms of their transmission. The transmission mechanism without which movement of causative agents and the existence of parasitic systems and foci are impossible is shown to be a global combining onset of parasitic systems. The hydrological conditions of floodplain-river regions act as the universal mechanism of transmission of pathogens. The dynamics of the mechanism determines the functioning of all other mechanisms of transmission.     

The quality of alcohol treatment research: an examination of influential controlled trials and development of a quality rating system

Background. The importance of evidence-based practice has stimulated interest in the methodology of clinical trials. Various weaknesses of evaluation research in the alcohol field have been indicated previously. This study set out to develop a comprehensive system for the assessment of the methodological quality of outcome research for treatment of alcohol misuse and to apply the system to well-known trials in the area. Methodology. A sample of the most highly cited controlled trials of interventions for alcohol misuse was selected using the Science Citation Index. Thirty methodological criteria were formulated and a scoring system devised. Two raters applied this system to the sample of trials. Reliability testing was performed and used to refine the criteria. Results. Inter-rater reliability of the overall quality score was initially 0.85 and 0.92 after review and re-rating. Internal consistency was also high (0.87). Quality score correlated with year of publication. Certain areas of methodology were poorly addressed in the sample, including specification of main outcomes, documentation of recruitment and selection procedures, testing of blinding, analysis of withdrawals and reporting of results. Discussion. The methodology of this sample of trials was frequently deficient in ways which might bias results or compromise generalizability. It is recommended that the system of quality assessment described here is used to evaluate existing research and to inform the design of future studies.     

2012年河南省疟疾标本的实验室检测分析

目的比较疟疾实验室检测方法,分析疟疾标本的检测结果。方法分别用吉氏染色镜检、巢氏PCR和序列分析方法对2012年河南省收集的165份疟疾标本进行检测,并对检测方法及结果进行分析比较。结果综合分析镜检、巢氏PCR和序列分析等3种方法的检测结果,165份疟疾标本的阳性率为93.94%,其中镜检和巢氏PCR阳性率分别为87.88%和90.30%;两种方法对疟原虫虫种的误判率为10.32%,其中对间日疟原虫、卵形疟原虫和三日疟原虫的误判率分别为42.86%、40.00%和28.57%,而对恶性疟原虫的误判率为0.85%。结论姬氏染色镜检和巢氏PCR两种方法在疟疾检测中各有优缺点,建议2种方法结合使用以提高疟疾诊断的准确率。     

Significance of red deer (Cervus elaphus) in the ecology of Borrelia burgdorferi sensu lato

BACKGROUND: Red deer (Cervus elaphus) is one of the most important host of the adult tick (Ixodes ricinus) which is the basic vector of the Lyme disease causative agent--Borrelia burgdorferi sensu lato in Europe. The aim of the present study was to establish the role of red deer in the transmission of B. burgdorferi s.1. Material and methods. Tissues from 74 red deers were evaluated and the presence of B. burgdorferi s.1 DNA was identified using nested PCR technique based on fla gene. The identification of species belonging to B. burgdorferi s.1 complex was performed after restriction digestion of nested PCR product with Ddel enzyme and sequencing of nested PCR product. The study included also 55 isolates of I. ricinus females removed from red deer and 466 ticks (73 adult and 393 nymphs) collected from the vegetation in the area where the red deer lives. RESULTS: There were no DNA of B. burgdorferi s.1 complex in the red deer tissues and in ticks removed from deer, however in one tick removed from deer the DNA of other Borrelia species--B. miyamotoi was identified. In ticks collected from vegetation 3 species belonging to B. burgdorferi s.1. complex were identified: B. garinii (3.2% ticks studied), B. afzelii (6.9%) and B. valaisiana (3.6%), however DNA of B. miyamotoi was absent. These results confirm inability of survival of B. burgdorferi s.1. species in tick I. ricinus feeding on red deer blood. However there is a possibility of survival of B. miyamotoi in presence of deer blood at least in ticks feeding on red deer. The main role of red deer in keeping the constant infection level of B. burgdorferi s.1. in the whole population of I. ricinus ticks does not concern B. miyamotoi.     

胃食管反流病问卷对胃食管反流病的诊断价值

目的 评价胃食管反流病问卷(GerdQ)在胃食管反流病(GERD)患者中的诊断价值,初步探讨中国GERD人群的症状特点.同时探索一种适合中国人群的质子泵抑制剂(PPI)试验的诊断标准.方法 在全国五家医院进行多中心研究.所有入组患者填写GerdQ问卷表.以胃镜检查、24 h食管pH监测和PPI试验其中任何一项阳性作为GERD的诊断标准,评价GerdQ的诊断价值.以拟定PPI试验诊断标准与胃镜和食管pH监测的诊断相比较,并优化PPI试验的诊断标准.结果 拟定PPI试验诊断的敏感度为0.6627,特异度为0.4872.经统计分析,以PPI治疗1周最后3 d烧心、反流症状总评分较治疗前相比下降3分为优化PPI试验诊断标准,诊断的敏感度为0.3787,特异度为0.8077,阳性预测值为0.8101,阴性预测值为0.3750,Youden指数最大为0.1864.经人群矫正,GerdQ取临界值为10分时,Youden指数达到最大0.1080,诊断的敏感度为0.6690,特异度为0.4390.50岁以上女性患者随着评分的增高,问卷诊断价值下降.结论 GerdQ具有肯定的诊断价值.但在临床工作中,对特殊人群中症状突出而PPI诊断性治疗反应不佳的患者,GERD的诊断应慎重.PPI试验的评分以治疗1周最后3 d为佳.     

Infection of red deer with lung nematodes in Polish and Belorussian parts of Białowieza Forest

Fecal samples from red deer from polish and belorussian parts of Bia?owieza Forest were examined by Baermann method. First stage larvae of three species of lung nematodes were found. In polish part in 100% of samples were larvae of E. cervi, in 50% V. sagittatus and in 21% D. noerneri, and in belorussian the level of infection was lower and larvae were in 92%, 36% and 12% of samples respectively. In significant part of samples were met mixtured invasion of two or three species. Finding of larvae of E. cervi is the first registration of this species in belorussian part of Bia?owieza Forest, and V. sagittatus is a new species for the fauna of Byelorussia. Nematodes E. cervi are dangerous for domestic ruminants.     

Prevention of myocardial infarction

The possible methods of preventing myocardial infarction have been discussed. The desirability of prevention in the total problem of myocardial infarction is stressed. The methods consist of the prevention of the underlying coronary atherosclerosis, and the secondary prevention of myocardial ischemia contributed by other factors than those presumed to relate to atherosclerosis. In the primary prevention of coronary atherosclerosis the two major risk factors are elevation of serum lipids and of blood pressure. The benefits to be achieved by reduction of elevation of both of these abnormalities are discussed. Both require a long-term approach starting as early in life as possible. The major methods of prevention or retardation of coronary ischemia irrespective of coronary artery disease involve discontinuance of cigarette-smoking and a program of increased physical activity. In addition, prevention or correction of polycythemia, anemia or hypercoagulability should be included. The use of oxygen, in higher percentage or at higher pressure than in the atmosphere, surgical intervention to improve the myocardial blood supply and pharmacologic agents to improve myocardial metabolism are also considered. Quantitation of the benefit of preventive programs is still impossible. Benefit from lowering blood lipids and blood pressure requires long-term therapy begun early in life. Discontinuance of cigarette smoking and increasing the amount of physical activity offer reasonable assurance of immediate benefit. So also does correction of hematologic abnormalities. Pharmacologic agents and surgery to improve coronary blood flow still require further evaluation.     

细菌DNA图谱分析幽门螺杆菌阳性病人治疗后的复发和再感染

目的：分析和比较幽门螺杆菌（Ｈｐ）感染病人前和治疗后胃内分离到的细菌ＤＮＡ图谱。方法：用随机扩增多形态ＤＮＡ技术（ＲａｎｄｏｍａｍｐｌｉｆｉｅｄｐｏｌｙｍｏｒｐｈｉｃＤＮＡ，ＲＡＰＤ）检测９对Ｈｐ菌株，多聚酶链反应采用１０个碱基对的随机引物。结果：不同Ｈｐ菌株ＤＮＡ图谱显示极大差异性。６对细菌ＤＮＡ图谱治疗前与治疗后相同，提示病人感染同一细菌，１对细菌ＤＮＡ图谱治疗前与治疗后相似，提示病人体内Ｈｐ的ＤＮＡ经抗生素治疗后可能发生变异，２对细菌ＤＮＡ图谱治疗前与治疗后显著不同，提示病人感染不同细菌。结论：Ｈｐ感染病人经抗生素治疗转阴后若又重复感染，多数情况是病人感染同一Ｈｐ菌株，有少数病人再感染不同株Ｈｐ。     

Quality of websites in Spanish public hospitals

The objectives were to assess the quality of websites in Spanish public hospitals by means of a validated system, also including measures of readability and accessibility. A scale was designed and validated to assess the quality (citizen-orientated) of the websites of hospitals. The quality of the of public hospital websites was evaluated by means of the results of the above evaluation scale, analysis of the readability of their contents, and the results of the accessibility test. The validated scale contains 73 elements or attributes. Analysis of the concordance of website evaluations shows average assessment values of between 0.80 and 0.81, which confirms a high degree of agreement among jurors. Twenty per cent of the attributes do not appear on any websites, and 14% are present on all of them. The average mark of the hospitals is 43%. The marks given for readability of tests show that it is satisfactory for 64% hospitals. None of the websites visited fulfilled the requirements necessary to be considered as accessible. The quality of the websites analysed by means of this scale varies from 23% to 62%. Differences in the size or location of the hospitals do not explain this high level of variability. The results suggest that the readability of websites should be improved and that such sites should be accessible to people with disabilities.     

Pneumatosis intestinalis complicating anorectal surgery; a case presentation

Summary A case of pneumatosis intestinalis, secondary to an anorectal surgical procedure is presented. This sequence of events has not been reported previously. The causative factors in this case appear to be the retention of flatus in the rectum thereby giving rise to increased intraluminal pressure in the presence of a defect in the rectal mucosa. The similarity to pneumatosis cystoides intestinalis is striking. A brief review of this rather rare condition has been provided. Read before The Brooklyn Surgical Society, May 3, 1956 as a preliminary report and in abbreviated form. From the Division of Proctology, Department of Surgery, William H. Field, M.D. (Retired), Director of the Department of Surgery; A. W. Martin Marino, M.D., Chief Attending Proctologist of the Department of Surgery; Ainsworth L. Smith, M.D., Director of the Department of Surgery; Kenneth H. MacGregor, M.D., Executive Director of the Department of Surgery, The Brooklyn Hospital, Brooklyn, New York.     

Rheological Properties of Red Cells in Haemoglobin Köln Disease

Summary . The rheological properties of erythrocytes of four patients with haemoglobin Köln (Hb Köln) disease were studied. Filtration of erythrocytes through polycarbonate sieves with a pore diameter of 5 μm and viscosity measurements of erythrocytes suspensions with a PCV of 80% were carried out. The rheological properties of erythrocytes of two of the patients were severely altered. In both patients an increased haemoglobin attachment to erythrocyte membranes resulting in a decreased filtration rate of erythrocytes was found. One of these cases had been splenectomized some years before. About half of the erythrocytes of this patient contained large Heinz bodies. Erythrocytes of this patient showed a decreased filtration rate and an increased viscosity. Moreover, erythrocytes of healthy adults containing Heinz bodies after incubation with acetylphenylhydrazine showed a decreased filtration rate as well as an increased viscosity. Membranes of erythrocytes of the other patients contained haemoglobin in an amount within the normal range of haemoglobin content of membranes of healthy adults. Erythrocytes of these patients showed normal rheological properties. The haemolytic process in these patients was only mild. We suggest that the amount of total haemoglobin attached to the erythrocyte membrane corresponds to the percentage of the unstable Hb Köln present in the erythrocytes of the particular patient.     

The mechanism of action of phenobarbital on the metabolism of 131J-B.S.P. in cholestasis induced by ANIT in isolated and perfused rat liver (author's transl)

In order to establish whether the increased B.S.P. secretion in the bile following phenobarbital administration is the consequence of change in the bile output or represents a consequence of the enzymatic induction, the dynamics of the elimination of 131J-B.S.P. was studied in animals treated with ANIT and Phenobarbital in the conditions of isolated perfused liver. At the same time the levels of the conjugation enzyme of B.S.P. were also determined. It was noted that after Phenobarbital the biliary elimination of 131J-B.S.P. is in correlation with the important increase of the output; in the animals treated with ANIT, on the other hand, the biliary excretion of B.S.P. is minimal. The biliary elimination is directly proportional to the increased of the bile output and reflects the changes found in the perfusate. Our findings allow us to assume that the increased of the bile output and in a smaller extent the result of the stimulation B.S.P. conjugation with Gluthation.