A new colorimetric method for plasma fatty acid analysis

A colorimetric procedure for the determination of plasma long chain fatty acids is described. The method can be applied to the analysis of C₁₆-C₁₈ saturated and unsaturated acids and can detect 0.05 μequiv/ml of plasma. The assay can be performed also in the presence of lecithins, bilirubin, and lactic, caprylic, capronic, salicylic and nicotinic acids.For these characteristics, the method has been successfully applied to plasma fatty acids (FA) determination in human subjects and experimental animals.     

The changing role of surgery in the treatment of breast cancer

Approaches to the treatment of early breast cancer are undergoing changes and close scrutiny to be sure that they do not alter the chances curing the disease. Radical mastectomy has been replaced by modified mastectomy in almost all patients. In selected patients with small tumors, excision and radiation therapy is now being compared with modified mastectomy. The results of these trials will require a few more years for final evaluation. If excision and radiation therapy proves to be successful, it will provide a large scale incentive for early detection of breast cancer, particularly through self-examination. In the past, women who “did everything right” and found a small lump received a mastectomy. In the future, there may be a very real reward for the woman who finds a small tumor.     

Relevant and irrelevant anxiety in the reaction to pain

Despite its importance in pain perception, there is a paucity of research investigating the influence of anxiety. This study tested the proposition that anxiety can lead to the exacerbation of pain perception when the source of anxiety is related to the pain experience. When the source is related to something else, anxiety may even reduce the reaction to pain. Sources of anxiety were manipulated in the laboratory — anxiety related to pain and anxiety related to successful learning or the combination of anxiety related to both pain and learning. Verbal, physiological and behavioral differences were obtained showing that focus upon both the pain and the learning task yielded the strongest pain reactions, while focus upon the learning alone yielded the lowest pain reaction, but the largest learning errors. Focus upon pain was in-between. The theoretical implications of these data were discussed.     

Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale

The visual analogue scale (VAS) is a simple and frequently used method for the assessment of variations in intensity of pain. In clinical practice the percentage of pain relief, assessed by VAS, is often considered as a measure of the efficacy of treatment. However, as illustrated in the present study, the validity of VAS estimates performed by patients with chronic pain may be unsatisfactory. Two types of VAS, an absolute and a comparative scale, were compared with respect to factors influencing the reliability and validity of pain estimates. As shown in this study the absolute type of VAS seems to be less sensitive to bias than the comparative one and is therefore preferable for general clinical use. Moreover, the patients appear to differ considerably in their ability to use the VAS reliably. When assessing efficacy of treatment attention should therefore be paid to several complementary indices of pain relief as well as to the individual's tendency to bias his estimates.     

Serum squalene levels in hepatobiliary diseases

Serum squalene levels did not change in patients with acute hepatitis, chronic active hepatitis and liver cirrhosis, but were significantly reduced in patients with intra- and extrahepatic cholestasis. The ratio of cholesterol to squalene remained normal in patients with acute hepatitis as well as chronic active hepatitis, while being slightly decreased in patients with liver cirrhosis. On the other hand, in patients with cholestasis the ratio was markedly raised. From these observations we confirmed abnormal sterol metabolism in hepatobiliary diseases, and clinical usefulness of the ratio of cholesterol to squalene to distinguish hepatocellular injury and cholestasis.     

Improved urine screening using a combination of leukocyte esterase and the Lumac system

Three rapid urine screening tests, leukocyte esterase, nitrite, and the Lumac System for detection of bacterial ATP, were evaluated alone and in combination to determine their utility in screening urine specimens from male patients for bacteruria. The combination of leukocyte esterase and Lumac testing resulted in significant improvement in the sensitivity of urine screening over each test individually and the combination of leukocyte esterase and nitrite. The leukocyte esterase/Lumac combination detected 98% of those specimens with greater than or equal to 10(5) CFU/ml and had a negative predictive value of 99%. The results obtained from this type of testing can be used with confidence to minimize the number of urine specimens cultured and to provide rapid reporting of negative results.     

Impact of a Clinical Therapeutic Intervention on Pain Assessment,Management, and Nursing Practices in an Intensive Care Unit: A before-and-after Study

Background: Accurate pain assessment and management constitute a major challenge for medical and nursing staff in intensive care units (ICUs). A distinct recollection of pain is reported by high proportions of ICU patients. Purpose: A clinical therapeutic intervention directed at improving pain assessment and management in critically ill patients who are unable to communicate was implemented at an Italian ICU. Methods: In this before-and-after study, data were collected before (T₀) and after (T₁) the adoption of a protocol involving pain assessment with an ad hoc behavioral pain scale and the administration of analgesics, rather than sedatives, to patients with intermediate to high pain scores. Results: The main outcome measure was pain recollection a year after discharge; secondary outcome measures were the use and doses of sedatives and analgesics. A significantly (p = .037) smaller proportion of patients treated after protocol adoption recollected feeling severe pain compared with patients treated before the protocol was introduced. This group also received significantly (p < .001) fewer sedatives and significantly (p = .0028) more anti-inflammatory drugs and analgesics on an “as needed” basis. The administration of strong analgesics was similar in the two groups. The intervention was implemented in 70.5% of patients with intermediate to high pain scores. Conclusions: Appropriately trained ICU nurses have the potential to help adopt pain relief and prevention measures during nursing care and to contribute to the successful management of sedation and analgesia. Further studies of larger patient samples are needed to monitor the stability of results over time and to explore the efficacy of the approach in other populations, such as pediatric and neonatal ICU patients.     

Cryptococcal infection of the temporal bone

Cryptococcus neoformans is a yeast-like organism which, after inhalation, may cause pulmonary disease or a systemic fungemia associated with numerous extrapulmonary sites of infection, but most notably affecting the central nervous system. Despite this frequent involvement of the leptomeninges, only three cases of infection of the temporal bones have been previously described. We describe an additional case with comments on the possible significance of infection of this site.