Self-ratings by phobic patients during dental treatment: Greater improvement with nitrous oxide than midazolam

The efficacy of intravenous midazolam and nitrous oxide inhalation at reducing self-rated mood and bodily symptoms was compared in patients referred to a dental sedation unit because their dental fears precluded treatment undrugged. Fifty-eight per cent of our patients could be randomly allocated to drug treatment, the others were assigned on clinical grounds. When they arrived for their first treatment, the clinically allocated patients (n = 40) were significantly more anxious, tense and restless than those randomly allocated (n = 61). Both drugs reduced ratings of anxious, tense, discontented and restlessness, but the improvements were greater with nitrous oxide. Nitrous oxide reduced ratings of irritable and depressed, but patients treated with midazolam only showed reductions when dental treatment was finished. The scores for 70 patients were analysed over two treatment days; their pre-sedation scores of tense, depressed and discontented were lower on day 2 than on day 1, with the randomly allocated group showing greater reduction. Nitrous oxide remained superior on day 2. Thirty-eight patients completed 3 days of treatment; there were no further reductions in baseline ratings and the superiority of nitrous oxide was maintained.     

Urea Kinetic Modeling: Comparing the Options

Abstract: In this study 6 commercially produced kinetic modeling packages utilizing a variable volume, single pool urea model, as well as formulae to determine the delivery of therapy, have been compared by applying to each the same set of rigorously collected data for a group of 12 patients. Comparison of the kinetically derived parameters (urea generation rate [ G ], urea distribution volume [ V ], delivery of therapy [ Kt/V ], and normalized protein catabolic rate [ nPCR] ) showed that the values obtained for both G and V differed between packages owing to the numerical methods and the clearance used in the solution of the differential equations. Although a broad agreement between the values established for Kt/V and nPCR was noted, the 95% limits of agreement indicated that it would be prudent to exercise caution when comparing results established by different modeling packages.     

The pathology of "sheep-associated" malignant catarrhal fever in the hamster

Lesions induced in hamsters by inoculation with the "sheep-associated" agents of malignant catarrhal fever (SA-MCF) isolated from a red deer (Cervus elaphus), designated D/1 and of bovine origin (C/2), are described. Clinical signs in hamsters inoculated with the D/1 isolate occurred as early as 13 days after infection although the mean incubation period in animals that developed signs was 27 days. Increased numbers of polymorphonuclear leucocytes were present in the blood of clinically affected hamsters. Gross lesions included erosions of epithelium in the buccal cavity, haemorrhage of the forestomach, dilated fluid-filled intestines and enlargement of the mesenteric lymph node. Microscopic lesions were widespread throughout the body but had a predilection for epithelial surfaces. They consisted of hyperplasia of certain lymph nodes, vasculitis and interstitial accumulations of mononuclear cells of lymphoid appearance in non-lymphoid tissues. Cytolysis was also seen. Lesions produced by the C/2 isolate were similar and both isolates produced disease comparable with that seen in naturally occurring cases in cattle and deer. It is suggested that disease might arise through a dysfunction of the immune system following infection of host large granular lymphocytes by the SA-MCF agent, in a way similar to that suggested for the rabbit.     

A student tutor's evaluation of his teaching placement

The teaching placement of a tutor student is described against a background of that student's comparative pre-course ignorance of teaching. An assessment of the organisation of the school of nursing where the teaching practice took place highlights its philosophy of centralised control over curriculum and examinations, and the consequent effects on teaching and timetable construction. Criticisms are made of the initial teaching style of the tutor student, and possible effects on the teacher's self-esteem of a problematic class are discussed. The usefulness of an evaluative work diary for both student and qualified tutor is stressed.     

Pneumatosis coli: Report of two cases

Conclusion Pneumatosis coli is the colonic manifestation of pneumatosis cystoides intestinalis, which is a rare condition in man: “...the rarity of the condition makes a local expert of the clinician with a single case.”¹⁶ The advent of oxygen therapy represents a major breakthrough in its treatment. Correct diagnosis is important to ensure that unnecessary and unsuccessful surgical treatment is avoided. After July 1978: Department of Surgery, Hope Hospital (University of Manchester School of Medicine), Eccles Old Road, Salford M6 8HD, England.