Visual evoked potentials to stimulus trains: normative data and application to photosensitive seizures

Visual evoked potentials (VEPs) to intermittent flash trains of various stimulus frequencies (VEP-T) were studied in 10 normal subjects and in 10 patients with photosensitive generalized seizures, 5 on medication and another 5 subjects without medication. In the normal group, early negative peaks were consistently demonstrated at 71 +/- 8 msec for monocular stimuli and 67 +/- 9 msec for binocular stimuli, regardless of different frequencies of stimuli. An oscillatory potential, poststimulus continuation of the oscillatory activity and damping out within 100 msec followed the initial peaks. The RMS values of the response epochs were stable and demonstrated consistent temporal changes at each stimulation frequency. In photoconvulsive seizures, the responses were facilitated with most marked changes over the second and third 125 msec epoch of the VEP-Ts with late slow negative deflections in some cases. These changes were pronounced in patients who were not taking anticonvulsant medication, but were not significantly different than controls in patients whose seizures were controlled with medication. It is suggested that the VEP-T is a more effective technique than single flash stimuli in consistently identifying early significant peaks and demonstrating neuronal excitability changes within the visual system.     

Median sternotomy dehiscence: a modified wire suture closure technique

Over a 7-year period, sternal wound dehiscences occurring in 26 patients were treated by a modified wire closure technique. This method is described and the results presented.     

Anaphylaxis following the use of bacitracin ointment. Report of a case and review of the literature

A 52-year-old woman suffered an acute anaphylactic reaction to topically applied bacitracin. An investigation disclosed the presence of concurrent type I and IV hypersensitivity to bacitracin. We review five other cases of anaphylactic reactions to topical medications and describe the clinical characteristics common to all six cases.     

Detection of acute inflammation with In-Labeled nonspecific polyclonal IgG

The detection of focal sites of inflammation is an integral part of the clinical evaluation of the febrile patient. When anatomically distinct abscesses are present, lesion detection can be accomplished by standard radiographic techniques, particularly in patients with normal anatomy. At the phlegmon stage, however, and in patients who have undergone surgery, these techniques are considerably less effective. While radionuclide methods, such as Gallium-67 (67Ga)-citrate and Indium-111 (111In)-labeled WBCs have been relatively successful for the detection of early inflammation, neither approach is ideal. In the course of studies addressing the use of specific organism-directed antibodies for imaging experimental infections in animals, we observed that nonspecific polyclonal immunoglobulin G (IgG) localized as well as specific antibodies. Preliminary experiments suggested that the Fc portion of IgG is necessary for effective inflammation localization. Since polyclonal IgG in gram quantities has been safely used for therapy in patients with immune deficiency states, we decided to test whether milligram quantities of radiolabeled IgG could image focal sites of inflammation in humans. Thus far, we have studied a series of 84 patients with suspected lesions in the abdomen, pelvis, vascular grafts, lungs, or bones/joints. In 48 of 52 patients with focal lesions detected by surgery, computed tomography (CT), magnetic resonance imaging (MRI), or ultrasound (US), the IgG scan correctly localized the site, while 31 patients without focal inflammation had no abnormal focal localization of the radiopharmaceutical. Four patients had false negative scans and one patient had a false positive scan. For this small series, the overall sensitivity and specificity were 92% and 95%, respectively. In this report, we review our experience with this exciting new agent.     

Indirect fluorescence test for the detection of anti-gonoccocal antibodies.

(1) An indirect fluorescence test for the detection of anti-gonococcal antibody is described. (2) Positive results at a serum dilution of 1 in 16 or above were obtained with sera from 20 per cent. of males and 61 per cent. of females with bacteriologically proven gonorrhoea. 3-8 per cent. of presumed false positive results were given by sera from patients presumed not to have gonorrhoea. (3) In different groups of sera, tests for IgM anti-gonococcal antibody were positive in 32 per cent. of those from males but in only 43 per cent. of those from females with positive cultures.     

The problems and the values of objective nursing observations in psychiatric nursing care

This paper describes a drug trial which illustrates the problems involved in objective nursing recordings to assess response to a specific treatment. It also highlights some difficulties in recording results. The paper briefly describes the history and diagnosis of a patient and the choice of treatment. The method of formulation of a checklist and the difficulties in completing a study are discussed. The results of the study and their value in planning future work are outlined. Conclusions are drawn about the feasibility of carrying out a controlled drug trial with a patient on a ward but the most important aspects are the ability of nurses to perform objective assessments and the value of this approach when assessing a patient and his response to treatment.