A program to help interns cope with stresses in an internal medicine residency

A program in personal and professional development for interns was developed six years ago for the residency program in internal medicine of the University of Connecticut Affiliated Hospitals to reduce maladaptive responses to the stresses of medical training. The principal goals of the program are to provide a supportive atmosphere in which interns can discuss common concerns, build mutual trust among themselves, promote deeper self-understanding and sensitivity, develop coping strategies, and examine difficult situations in training. Sessions are scheduled regularly throughout the year and take place outside the hospital; interns are excused from their service responsibilities for the duration of the meeting. Participants focus equally on issues of professional concern (for example, relationships with staff members, peers, and attending physicians or bureaucratic problems such as lack of ancillary help) and personal concern (for example, making necessary life-style adjustments and handling family crises). A variety of techniques are used in the program, but small-group discussions and individual tasks are particularly emphasized. Participants have generally reported satisfaction with the program and positive effects upon their behavior at work and at home.     

Epidural fentanyl for shaking in obstetrics

This study assesses the efficacy of epidural fentanyl in the relief of shaking associated with epidural analgesia. Fifty mothers whose shaking was sufficient to cause distress were divided randomly to receive either fentanyl 25 micrograms in 5 ml sterile normal saline or 5 ml of saline through their in-situ epidural. Shaking stopped within 15 minutes in 18 out of 25 (72%) of those given fentanyl but in only 4 out of 25 (16%) of the saline group and this is statistically significant (p less than 0.01). Fentanyl can be recommended in this context.     

Differences between serum and urinary LH in hypergonadotropic states

In an attempt to investigate the relationship between molecular configuration, immunoreactivity, radioligand binding, and biological activity, we compared the elution profiles of immunoreactive and radioligand receptor-active LH following gel filtration over Sephadex G-100 (1.6 X 100 cm column). Samples of sera and urinary acetone-insoluble material from normal cycling women during the LH surge (n = 4) and postmenopausal (n = 2) and castrate women (n = 2) were examined. One major peak of LH immunoreactivity was present in the sera and the urinary samples from all subjects. However, this peak of immunoreactive LH in the urinary precipitate consistently occurred 8-10 fractions later than the peak activity observed in the sera. Despite the differences in the profiles of immunoreactivity between sera and urinary precipitates, the major peak of radioligand receptor activity for LH was observed in the same fractions in all samples and corresponded to the major peak of immunoreactivity observed in the sera. Thus, binding activity was sometimes observed in urinary fractions containing little immunoreactivity for LH. Bioassay of selected fractions using the rat interstitial cell-testosterone assay revealed good agreement between receptor activity and bioactivity but not between immunoreactivity and bioactivity. The ratios of total radioreceptor-active to total immunoreactive LH were consistently higher in the sera than in the urinary precipitates. These data suggest alterations in molecular form during metabolism and/or excretion of LH. Whether these alterations represent differences in peptide structure or merely carbohydrate moieties remains to be determined.     

Prognostic nutritional index in gastrointestinal surgery

Based on assessment of 161 nonemergency general surgical patients, a multiparameter index of nutritional status was defined relating the risk of postoperative complications to baseline nutritional status. When applied prospectively to 100 gastrointestinal surgical patients, this index provided an accurate, quantitative estimate of operative risk, permitting rational selection of patients to receive preoperative nutritional support.     

Leaching of zinc compound from rubber stoppers into the contents of automatic atropine injectors

This report describes how a material within the cartridge of an automatic injector contaminated its contents. On prolonged storage, a formulation that contained atropine produced lethality in mice. The toxic material originated from zinc compounds that were present in the rubber stopper and plunger of the container and that subsequently leached into the formulation. The contents of cartridges that contained greater than or equal to 0.75 mg/mL of solubilized zinc were lethal to at least 20% of the mice tested; those that contained 0.42 mg/mL showed no lethality. The problem resulted from the physicochemical properties of the rubber, not the concentration of zinc used in the vulcanization process.     

CO2 cystoscopy using a flexible fibreoptic endoscope

Flexible carbon dioxide cystoscopy has been carried out in 65 patients using an Olympus BF type 1 TR endoscope (usually used for bronchoscopy). Good views were obtained and comparison with standard cystoscopy confirmed that no lesions were missed. The procedure was well tolerated under local anaesthesia. The flexible cystoscope was particularly useful in examining patients with diverticula, anterior bladder neck lesions or the post-radiation fibrotic pelvis.     

Biological and immunological luteinising hormone-releasing hormone (LH-RH) activity of the ovine pineal.

An acid extract of ovine pineal tissue inhibited luteinising hormon (LH) release in ovariectomized oestrogen and progesterone (OEP) pre-treated female rats, and did not exhibit any LH-RH-like immunoreactivity in vitro.