Attitudes toward prevention of cardiovascular diseases among first-year students at eight American medical schools, 1983-1985

First-year medical students at eight U.S. medical schools were surveyed by written questionnaire in 1983-1985 to determine their attitudes toward cardiovascular diseases prevention at medical school entry. An overall response rate of 92% was achieved (2,654 questionnaires), and 97% of responders provided complete and analyzable survey data. Response rates at five of eight medical schools were 98-100%, and one school each had rates of 67, 84, or 90%. Differences in mean attitude responses from school to school were small, as were differences between men and women or between blacks and whites. This survey found that entering medical students have generally positive attitudes toward the effectiveness of preventive cardiology practice as well as toward the importance of research efforts in cardiovascular disease prevention. Students frequently indicated, however, that it is "extremely difficult" to change patients' unhealthful habits and that "physician encouragement" may not be sufficient to help patients achieve more healthful behaviors. These findings could be helpful in directing educational efforts for medical students. The data suggest that major emphasis should be placed on conveying facts regarding the physicians' efficacy in clinical preventive cardiology and on teaching the skills of preventive cardiology practice. Less emphasis appears to be necessary on encouraging positive attitudes about the importance of prevention since current students' attitudes appear to be already positive in this dimension.     

An update on digoxin

This review deals briefly with recent developments in the therapeutic drug monitoring of digoxin. Strategies for decreasing the interference by digoxin metabolites, digoxin-like factors, and spironolactone metabolites in immunoassays of digoxin are discussed. Other issues addressed include the development of alternative methods of analysis, such as receptor assays and "high-pressure" liquid chromatography; digoxin-like factors in hypertension; drug-drug interactions; redistribution of digoxin stores in the body; and forensic considerations.     

Effects of lung hyperinflation on mean arterial pressure and postsuctioning hypoxemia

Our purpose was to determine the effect of five different lung hyperinflation volumes (tidal volume, 12 cc/kg, 14 cc/kg, 16 cc/kg, and 18 cc/kg lean body weight) on mean arterial pressure and postsuctioning hypoxemia (arterial blood gases). Subjects received three consecutive lung hyperinflations at one of the five randomly ordered volumes in 15 seconds via a ventilator "sigh" control at a fraction of inspired oxygen of 1.0. The three lung hyperinflations were followed by 10 seconds of continuous suction (flow rate 16 L/min). The procedure was repeated three times. The sample consisted of eight men and women 4 hours after coronary artery bypass graft surgery. Data indicated a statistically significant (by analysis of variance, p = 0.000) mean increase of 15 mm Hg in mean arterial pressure over the three lung hyperinflation sequences that was not volume dependent. There was a significant increase (p = 0.0001) in arterial oxygen pressure at 0 seconds after suctioning that increased with each increasing lung hyperinflation volume.     

Individual psychotherapy with victims of incest

In treating victims of incest, therapists need to be aware of the gamut of symptoms, personality traits, interpersonal difficulties, and clinical syndromes that occur with special frequency in this population. A list of these features is provided. Vignettes with typical therapist-patient dialogue are offered, demonstrating techniques for handling the initial consultation and opening phase of treatment. During later phases of treatment the focus will usually shift to the discussion of the pertinent symptoms (such as suicidal feelings, substance abuse, dissociative phenomena, sexual disturbances, and distorted self-image). Further on, therapy will focus on abnormal personality traits and attitudes that the incest experience may have set in motion. Examples include mistrustfulness, jealousy, seductiveness, hostility, impulsivity, defiance and emotional volatility. Many incest victims develop borderline personality disorder. Highly polarized attitudes ("splitting") toward sexual partners are characteristic of this group. Therapy relies upon supportive, re-educative, and interpretive work designed to help the victim develop more realistic and integrated views of self and other.     

Transdermal scopolamine decreases nausea and vomiting following cesarean section in patients receiving epidural morphine

The authors evaluated the antiemetic properties of transdermal scopolamine (TDS) in healthy patients undergoing elective cesarean section and receiving epidural morphine for postoperative analgesia. Prior to administration of anesthesia, 203 patients had either TDS or a placebo study patch applied behind one ear. All patients were hydrated with lactated Ringer's solution iv and given 2.0% lidocaine with 1:200,000 epinephrine epidurally for surgical anesthesia. Following delivery of the infant, 4 mg of morphine sulphate was injected through the epidural catheter. After the operation patients were evaluated by "blinded" observers at 2, 4, 6, 8, 10, 24, and 48 h for nausea, vomiting, retching, pain relief, itching, and adverse effects. In addition, medications received were noted. No differences were found between the groups in terms of severity or incidence of pain, or requests for analgesic or antipruritic medication. Although there was no difference between the groups in the first 2 h, patients with TDS had significantly less nausea, vomiting, and retching than patients in the placebo group in each time interval between 2 and 10 h. Additionally, the TDS group required less antiemetic medication. There was no difference in the frequency of retching or vomiting between groups. Side effects were minimal and equal in both groups. The authors conclude that TDS results in a decreased incidence of nausea and vomiting in patients who have delivered by cesarean section and received epidural morphine. TDS appears safe for continuous antiemetic administration.     

Some factors affecting the strength of the cement-metal interface

A manufacturing technique to increase the bonding between bone cement and metal prostheses has been assessed in the laboratory by "push-out" tests, and the effects of contamination of the cement and of the prosthesis with blood and intramedullary contents have been studied. The technique, known as pre-coating, increases bond strength; this increase is preserved after contamination of the cement which does, however, cause some lowering of interface shear strength. The implications for clinical practice are discussed.     

Laboratory diagnosis of variant Creutzfeldt-Jakob disease

The neuropathological and biochemical features of 33 cases of variant Creutzfeldt-Jakob disease (vCJD) diagnosed up to the end of 1998 are analysed in relation to the 646 cases of suspected CJD referred to the CJD Surveillance Unit laboratory from 1990 to 1998. Morphological studies of the central nervous system, lymphoid tissues and other organs were accompanied by immunocytochemistry; Western blot analysis of PrPRES was performed on frozen brain tissue. The findings were analysed in relation to clinical and genetic data. The pathology of vCJD showed morphological and immunocytochemical characteristics distinct from other cases of CJD. PrP accumulation was widespread in lymphoid tissues in vCJD, but was not identified in other non-neural tissues. PrPRES accumulation in vCJD brain tissue showed a uniform glycotype pattern distinct from sporadic CJD. All analysed cases of vCJD were methionine homozygotes at codon 129 of the PrP gene. No evidence currently exists to suggest that cases of CJD diagnosed in individuals who are MV or VV at codon 129 of the PrP gene represent 'human bovine spongiform encaphalopathy (BSE)'. Continued surveillance is required to further investigate this possibility, with the need to investigate autopsy tissues from suspected cases by histological and biochemical techniques.     

The effect of 2,4-dinitrophenol and related compounds on bile secretion

1. 2,4-dinitrophenol, 2,4-dinitrophenetole, 2,4-dinitronaphthol, 4,6-dinitro-o-cresol, and to a lesser extent picric acid, produced an increase in bile flow and a rise in body temperature in the anaesthetized dog. The total biliary bromsulphalein (BSP) excretion in unit time was either slightly reduced, increased or remained at its pre-injection level.2. Picramic acid, the nitrochlorophenols and 2,4-dinitrobenzaldehyde caused a moderate increase in bile flow without an effect on the temperature of the animal.3. The three mononitrophenols, the five remaining isomeric dinitrophenols, isopicramic acid, the aminonitrophenols, phenol, 2,4-dinitroanisole, 2,4-dinitrobenzoic acid, 2,4-dinitrobenzene sulphonic acid, 2,4-dinitroresorcinol and 4-nitracatechol had little effect on bile secretion or body temperature.4. It thus appears that, in order for a compound of this type to have a pronounced effect on bile secretion, it is necessary to have nitro groups in positions 2 and 4 of the benzene ring, and a free or potential hydroxyl group.     

Responses to intensive training and methandrostenelone administration: II. Hormonal,organ weights,muscle weights and body composition

The hormonal levels of the gonadotropins, the weight of selected organs and of the triceps surae as well as body composition were determined in Sprague Dawley rats at 3 and 6 weeks after intensive training with or without a methandrostenelone (Dianabol) supplement (0.35 mg/kg/day). The controls were sedentary rats of similar age and weight at the start of the experiment. The dianabol treated rats in the sedentary and exercise groups had a depression of plasma LH levels. There were no differences in body weight, specific gravity, lean body weight, fat or % fat between the two trained groups. Dianabol had no apparent effect on the measured parameters other than a depression of LH.