Training psychiatric residents in the diagnosis and treatment of mental illness in mentally retarded persons.

A serious shortage of psychiatrists trained to care for mentally retarded patients exists. Based on a successful program that has been in place for more than a decade, the authors offer guidelines for training psychiatric residents in the diagnosis and treatment of mental illness in mentally retarded persons. They describe a model curriculum and suggest ways to modify existing four-year curricula. Special diagnostic skills for working with this population, such as posing questions in concrete terms and ruling out the effects of disabilities like seizure disorders, are reviewed. Important treatment issues include knowing the side effects of neuroleptics and understanding the stages through which families and other caregivers pass in accepting a person's mental retardation.     

Preoperative cardiac evaluation for noncardiac surgery: a functional approach.

The preoperative assessment of the high risk patient undergoing noncardiac surgery has traditionally been based on history, physical examination, and preoperative testing. We propose a method of assessing preoperative risk based on the presentation of coronary artery disease, exercise tolerance, and extent of the surgical procedure. Since this is an evolving field, as new information and perioperative management techniques become available, the preoperative evaluation of the high risk patient will change. We have presented one approach based on our interpretation of data from the current anesthesiology and cardiology literature. In the patient with a recent MI, the predischarge symptom-limited stress test and the electrocardiographic classification can be used to better stratify risk. In the patient with angina, testing should be reserved for those patients who are candidates for coronary revascularization or alternative surgical procedures. In the patient at risk of but without overt symptoms of coronary artery disease, the number of clinical risk factors can determine the probability of coronary artery disease in the individual patient. The decision to perform preoperative revascularization should be based on its anticipated improvement of both the short- and long-term prognosis of the patient considering the risk of such procedures. The objective assessment of LVEF should be performed in patients with a poor exercise tolerance with either a high risk of perioperative ischemia or a suspicion of cardiomyopathy.     

Circadian distribution of in-hospital cardiopulmonary arrests on the general medical ward.

BACKGROUND--A circadian pattern has been convincingly demonstrated for the onset of many outpatient ischemic vascular events. A morning peak exists for the onset of acute myocardial infarction, sudden cardiac death, reversible myocardial ischemia, and ischemic stroke. Data regarding circadian patterns of disease in hospitalized patients, however, are lacking. We examined in-hospital cardiopulmonary arrest (CPA) occurring on the general medical ward to determine if a circadian distribution existed in time of onset. METHODS--All CPAs that occurred during a 9-month period and met entry criteria were included for study. The day was divided into 4-hour intervals and analyses were performed for evidence of periodicity in time of onset. The CPAs were then divided into those that were "expected" and those that were "unexpected," and further analyses of periodicity were performed. RESULTS--For the total study population (137 patients), a primary peak frequency of CPA occurred during the interval from 4 to 7:59 AM, and a secondary peak frequency occurred during the 8 to 11:59 PM interval. A minimum frequency occurred during the midnight to 3:59 AM interval. The onset of unexpected CPA peaked during the 4 to 7:59 AM interval, and expected CPA followed no circadian pattern. CONCLUSIONS--Our analysis of CPA occurring in patients hospitalized on the general medical ward demonstrated a circadian pattern of onset that favored the early-morning hours. This pattern is predominantly due to unexpected CPA. If further study confirms our observations, changes in the prophylaxis of in-hospital CPA and adjustments in staff responses to its occurrence may be indicated.     

In vitro effect of alpha-interferon on mononuclear cells of normal and autoimmune patients

The effect of lymphoblastoid interferon (IFN-alpha) on cell-mediated and humoral immunity was studied in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). The base-line natural killer (NK) and antibody dependent cytotoxic cell (ADCC) activity was higher than normal in individuals with RA. The NK and ADCC activities were tested after IFN-alpha pretreatment and the augmentation of NK and ADCC activity was less in these patients than in normals. Lymphoblastoid IFN inhibited antigen induced T-cell proliferation in SLE to a lesser extent than in normal individuals. Finally, the addition of lymphoblastoid IFN was also less effective at suppressing in vitro polyclonal antibody formation by mononuclear cells from patients with SLE than from normals, with enhancement observed in some patients at the lower IFN-alpha concentrations tested.     

Nontyrosine crystalloids in salivary gland lesions: report of seven cases with fine-needle aspiration cytology and follow-up surgical pathology

We report a series of seven patients who underwent fine-needle aspiration (FNA) for clinically apparent parotid gland lesions. In all seven cases, numerous to abundant polyhedral, multifaceted (nontyrosine) crystalloids were noted in the background of scanty cellular specimens composed predominantly of oncocytic cells. Subsequent surgical excision showed that three of the seven glands revealed sialolithiasis and sialadenitis without evidence of neoplasia. The histology of the remaining four cases consisted of two Warthin's tumor, one oncocytic papillary cystadenoma, and one cellular benign mixed tumor. In all seven cases the nontyrosine crystalloids were found in highest concentrations in cystic spaces lined with oncocytic metaplastic cells. We conclude that nontyrosine cystalloids can be associated with both neoplastic and nonneoplastic salivary gland disease, and they may be a product of oncocytic cell secretion. Diagn. Cytopathol. 2000;22:167-171.     

A “flipped” kidney in utero in an infant with a double collecting system and a Gartner's duct cyst with a vaginal ectopic ureter

We report an infant with two unique anatomic abnormalities. A flipped kidney in utero is described with the association of a Gartner's duct cyst and a vaginal ectopic ureter with a duplicated collecting system.     

Comparing methods of clinical measurement: reporting standards for bland and altman analysis

In this era of medical technology assessment and evidence-based medicine, evaluating new methods to measure physiologic variables is facilitated by standardization of reporting results. It has been proposed that assessing repeatability be followed by assessing agreement with an established technique. If the "limits of agreement" (mean bias +/- 2SD) are not clinically important, then one could use two measurements interchangeably. Generalizability to larger populations is facilitated by reporting confidence intervals. We identified 44 studies that compared methods of clinical measurement published during 1996 to 1998 in seven anesthesia journals. Although 42 of 44 (95.4%) used the limits of agreement methodology for analysis, several inadequacies and inconsistencies in reporting the results were noted. Limits of agreement were defined a priori in 7.1%, repeatability was evaluated in 21.4%, and relationship (pattern) between difference and average was evaluated in 7.1%. Only one of the articles reported confidence intervals. A computer macro for the Minitab statistical package (State College, PA) is described to facilitate reporting of Bland and Altman analysis with confidence intervals. We propose standardization of nomenclature in clinical measurement comparison studies. IMPLICATIONS: A literature review of anesthesia journals revealed several inadequacies and inconsistencies in statistical reports of results of comparison studies with regard to interchangeability of measurement methods. We encourage journal editors to evaluate submissions on this subject carefully to ensure that their readers can draw valid conclusions about the value of new technologies.     

高效液相色谱法测定四川粉葛中葛根素的含量

目的：采用HPLC法测定四川粉葛中葛根素的含量。方法：色谱柱为依利特C18柱（4．6min&;#215;150mm,5μm）,流动相为甲醇-水（25：75）,流速为0．8ml／min,检测波长为250nm,柱温为25℃。结果：葛根素在0．0880～0．7040μg范围内峰面积与进样量呈良好的线性关系,回归方程为A=336．35X-1．7716,r=1．0000,其平均同收率为100．01％,RSD为0．14％（n=6）。结论：该方法简便易行,结果准确,可用于四川粉葛药材的质量控制。     

术前血糖水平对糖尿病患者行输尿管软镜碎石术后发生感染相关并发症的影响

观察2型糖尿病（T2DM）患者行输尿管软镜碎石术（FURL）后出现感染相关并发症的影响因素,探讨T2DM患者术前血糖水平与发生术后感染相关并发症的关系,为T2DM患者在接受FULR术后发生感染相关并发症的早期预防及治疗提供参考。