HEART BLOCK FOLLOWING PROPOFOL: A CASE REPORT

We report two cases of ventricular arrest with persisting atrialactivity in association with propofol anaesthesia. In both cases,antichol-inergic agents corrected the arrhythmia. It is recommendedthat anticholinergic drugs be given routinely when propofolis used in association with vagal stimulants. ^*Address for Correspondence: Department of Anaesthesia, Universityof Cape Town School of Medicine, Anzio Road, Observatory 7925,South Africa.     

Structure and conformation of linear peptides XIII. Structure of l-phenylalanyl-glycyl-glycine

The crystal structure of a tripeptide, l -phenylalanyl-glycyl-glycine (C₁₃H₁₇,N₃O₄), molecular weight = 279.3, has been determined. The crystals are orthorhombic, space group P 2₁2₁2₁, with a= 5.462(1) A, b= 15.285(5), c= 16.056(4), Z = 4 , and P(calc) = 1.384 g. cm^-3. The final R-index is 0.052 for 866 reflections with θ/λ≤ 0.55 A^-1 and 1 > σ. The molecule exists as a zwitterion, with the N-terminus protonated and the C-terminus in an ionized form. Both the peptide units are in the trans configuration and planar, though one of them shows significant deviations from planarity (|Δ| = 5.1°). The peptide backbone is folded, with the torsion angles of ψ₁= 116.2(5)°, ψ₃₁= 178.8(4), φ₂=?89.7(5), ψ₂=?28.9(6), ω₂=?174.9(4), φ₃= 134.9(5), ψ₃₁= 7.8(6), ψ₃₂=?172.6(4). The terminal glycine adopts a “d -residue” conformation. For the sidechain of phenylalanine, χ₁= 175.5(4), χ₂= - 127.0(6).     

Symptoms and correlates of anabolic-androgenic steroid dependence

Forty-nine male weight lifters, all users of anabolic-androgenic steroids (AASs), completed an anonymous, self-administered questionnaire to investigate addictive patterns of use. At least one DSM-III-R symptom of dependence was reported by 94% of the sample. Three or more symptoms, consistent with a diagnosis of dependence, were reported by 57%. Dependent users (n=28) could be distinguished from non-dependent users (n=21) by their use of larger doses, more cycles of use, more dissatisfaction with body size, and more aggressive symptoms. Multiple regression analysis revealed that dosage and dissatisfaction with body size were the best predictors of dependent use. Patterns of other substances used, although not predictive of AAS dependence, revealed very low cigarette use and at the same time high alcohol consumption. These data support the notion that AASs are addicting, and suggest that dissatisfaction with body size may lead to dependent patterns of use. The implications for both prevention and treatment are discussed.     

Pedunculated hepatocellular carcinoma. Is it an entity?

Two cases of pedunculated hepatocellular carcinoma are reported. One of these was known to have been present for 5 years. Both patients are alive 1 and 2 years after surgery though the former has developed a solitary bone metastasis. The literature on 30 previously published cases is reviewed and it is concluded that, minor differences apart, this tumour is not substantially different from hepatocellular carcinomas in general. The slow growth and good prognosis relate to its extrahepatic location which may be explained by an origin from accessory lobes of the liver.     

Microcirculation and the Physiome Projects

The Physiome projects comprise a loosely knit worldwide effort to define the Physiome through databases and theoretical models, with the goal of better understanding the integrative functions of cells, organs, and organisms. The projects involve developing and archiving models, providing centralized databases, and linking experimental information and models from many laboratories into self‐consistent frameworks. Increasingly accurate and complete models that embody quantitative biological hypotheses, adhere to high standards, and are publicly available and reproducible, together with refined and curated data, will enable biological scientists to advance integrative, analytical, and predictive approaches to the study of medicine and physiology. This review discusses the rationale and history of the Physiome projects, the role of theoretical models in the development of the Physiome, and the current status of efforts in this area addressing the microcirculation.     

A Dietitian-Delivered Group Nutrition Program Leads to Reductions in Dietary Fat, Serum Cholesterol, and Body Weight: The Worcester Area Trial for Counseling in Hyperlipidemia (WATCH)

OBJECTIVE: To assess the effectiveness of a dietitian-based nutrition counseling and education program for patients with hyperlipidemia. DESIGN: A 4-session program implemented as a complement to a randomized physician-delivered intervention. SUBJECTS/SETTING: From 12 practice sites of the Fallon Clinic, 1,162 subjects with hyperlipidemia were recruited, 645 of whom had data sufficient for our primary analyses. INTERVENTION: Two individual and 2 group sessions conducted over 6 weeks. MAIN OUTCOME MEASURES: Total and saturated fat levels; serum low-density lipoprotein cholesterol levels; and body weight, measured at baseline and after 1 year. STATISTICAL ANALYSES: Multiple linear regression was used to evaluate changes in outcome measures. RESULTS: After 1 year, there were significant reductions in outcome measures for subjects attending 3 or 4 nutrition sessions vs subjects attending fewer than 3 sessions or those never referred to a nutrition session. Reductions (mean +/- standard error) in saturated fat (measured as percent of energy) were 2.7 +/- 0.5%, 2.1 +/- 0.5%, and 0.3 +/- 0.1%, respectively. These reductions correspond to roughly a 22% relative change from baseline in those attending 3 or 4 sessions. Corollary reductions were observed for total fat (measured as percent of energy): 8.2 +/- 1.4%, 5.0 +/- 1.4%, and 0.7 +/- 0.4%; low-density lipoprotein cholesterol: 0.48 +/- 0.11 mmol/L, 0.13 +/- 0.11 mmol/L, and 0.02 +/- 0.03 mmol/L; and body weight: 4.5 +/- 0.9 kg, 2.1 +/- 0.8 kg, and 1.1 +/- 0.2 kg. The specified changes were additive to those of the physician-delivered intervention. APPLICATIONS/CONCLUSIONS: This investigation provides empirical data demonstrating the effectiveness of a dietitian-delivered intervention in the care of patients with hyperlipidemia.