Propofol as an anaesthetic agent for ECT: effect on outcome and length of course

Recent reports of reduced seizure duration with ECT under propofol anaesthesia have led to concerns that propofol may diminish the efficacy of this treatment. To investigate the effect of propofol on the response to ECT, we reviewed records of 66 patients with primary depression treated with ECT, 37 of whom had been assessed prospectively with pre- and post-ECT Hamilton and Zung depression severity ratings. Despite demonstrating that the individual seizure duration was significantly reduced with propofol compared to thiopentone we found no evidence of reduced ECT efficacy with propofol. Courses under propofol anaesthesia were on an average two treatments longer than with thiopentone. Although this difference was not statistically significant this may have been due to a type II error. These results suggest that it is premature to abandon the use of this new anaesthetic agent in ECT without controlled prospective outcome studies.     

Increased access to evidence-based primary mental health care: will the implementation match the rhetoric?

There is clear evidence that coordinated systems of medical and psychological care ("collaborative care") are superior to single-provider-based treatment regimens. Although other general practice-based mental health schemes promoted collaborative care, the new Medicare Benefits Schedule payments revert largely to individual-provider service systems and fee-for-service rebates. Such systems have previously resulted in high out-of-pocket expenses, poor geographical and socioeconomic distribution of specialist services, and proliferation of individual-provider-based treatments rather than collaborative care. The new arrangements for broad access to psychological therapies should provide the financial basis for major structural reform. Unless this reform is closely monitored for equity of access, degree of out-of-pocket expenses, extent of development of evidence-based collaborative care structures, and impact on young people in the early phases of mental illness, we may waste this opportunity. The responsibility for achieving the best outcome does not lie only with governments. To date, the professions have not placed enough emphasis on systematically adopting evidence-based forms of collaborative care.     

Polymorphisms in Toll-like receptors-2 and -4 are not associated with disease manifestations in acute Q fever

Coxiella burnetii is a macrophage-tropic, Gram-negative organism, which causes acute Q fever infection in humans. This zoonotic infection causes illness ranging from asymptomatic seroconversion to severe and protracted disease featuring hepatitis and pneumonia. Interactions between C. burnetii lipopolysaccharide (LPS) and host Toll-like receptors (TLR)-2 and -4 have been implicated in pathogen recognition, phagocytosis and signaling responses. Nonconservative single nucleotide polymorphisms in the coding regions of TLR-2 (Arg677Trp and Arg753Gln) and TLR-4 (Asp299Gly) have been found to correlate with mycobacterial infections and Gram-negative sepsis respectively. Associations between the TLR-2 and -4 polymorphisms, illness characteristics and immune response parameters were examined in subjects with acute Q fever (n=85) and comparison subjects with viral infections (n=162). No correlation was demonstrated between these polymorphisms and susceptibility to Q fever, illness severity or illness course.     

Acute severe cardiac failure complicating myocardial infarction. Experience with 100 patients referred for consideration of mechanical left ventricular assistance.

One hundred patients were referred with suspected acute cardiac failure following acute myocardial infarction. The diagnosis was confirmed in 72: 31 of these patients underwent elective medical treatment, with 2 survivors (6%); 41 were accepted for counter pulsation, but 9 died before this could be initiated and another 2 died shortly after vain attempts to pass the balloon catheter were abandoned; 30 patients underwent counterpulsation with 14 hospital survivors (47%). Survivor status was usually good. Results of counter pulsation were better in patients who were not shocked (with 5/5 survivors) than in those who were in shock (with 9 of 25 survivors). Results support the view that counterpulsation (alone or combined with corrective surgery) may play an important role in the complications of myocardial infarction provided intervention is early.     

Radiographic identification of simulated carious lesions in relation to fillings with Adaptic Radiopaque®

The purpose of the present study was to elucidate the possible significance of the radiopacity of a composite restorative material for the radiographic identification of filling deficiencies. Class III cavities of varied size and shape were prepared at 28 proximal surfaces of 14 extracted human canines. All cavities were filled with Adaptic Radiopaque®. Simulated secondary or recurrent carious lesions were produced in 16 of the cavities by insertion of small amounts of radiolucent wax prior to filling. Each tooth was radiographed under standardized conditions using 15 different angulations. The 210 radiographs were interpreted by three observers without knowledge of the distribution of the deficiencies. They made 78.7% correct diagnoses, 18.7% false positive and 2.6% false negative diagnoses. The sensitivity of the method was 95.4, but the specificity was only 56.5. The results indicate that radiopacity of a composite resin is of a certain, although limited, value in detecting secondary and recurrent carious lesions. Regarding the high number of false positive diagnoses the radiographic findings should as far as possible be verified by a clinical examination. A majority of the false positive diagnoses could be explained by an inhomogeneous structure of the fillings.     

Inhibition of human breast cancer colony formation by anticalmodulin agents: Trifluoperazine,W-7, and W-13

Cancer Chemotherapy and Pharmacology - The effects of anticalmodulin agents, namely trifluoperazine (TFP) and two naphthalene sulfonamide derivatives (W-7 and W-13), were tested on the growth of a...     

Mechanical Wear of Pacemaker Lead Insulation. A Cause of Loss of Pacing

A pacemaker-treated patient is described in whom lead insulation defect caused sudden loss of capture. The defect was caused by mechanical wear of the posterior leaflet of the tricuspid valve and resulted in shunting of the pulse generator with a current drain exceeding the capacity of the pacemaker. In three further cases a similar explanation to sudden loss of pacing was highly suspected.