Defecography

Defecography is a technique of examining the rectum and anal canal in which the patient is studied while sitting down rather than recumbent and recordings are obtained both at rest and during straining. The authors describe their findings in 83 patients with dyschezia. Defecation was normal in 28 patients. Prolapse of the anal mucosa was seen in 13 patients and internal procidentia in 23, 12 of whom also had intussusception manifested as rectal prolapse. A deep rectogenital fossa associated with an enterocele was seen in 16 patients; 13 had a proctocele, while fecal retention was seen in 5. Descent of the pelvic floor and changes in the angle between the rectum and anal canal were assessed. The authors recommend defecography as a more physiological means of assessing rectal dysfunction.     

Pulmonary metastases, a potential biologic consequence of anesthetic-induced immunosuppression by thiopental.

This set of experiments was devised to determine the effects of the commonly employed anesthetic induction agent, thiopental, on the incidence of pulmonary metastases in a murine fibrosarcoma system. A correlation was made with cell-mediated immune responses in vivo and in vitro. In two separate experiments, thiopental-treated mice had a significantly increased incidence of pulmonary metastases. This was correlated with an impaired delayed hypersensitivity reaction to the de novo antigen. 2,4-dinitrochlorobenzene (DNCB) and a suppressed mixed leukocyte culture (MLC) reaction. However, if animals were sensitized with DNCB 5 days prior to receiving pentothal, no impairment of DNCB reactivity was noted. This suggests strongly that the observed defect is in the afferent arm of the immune response. Thiopental suppresses cell-mediated immune responses in this system, and the observed biologic consequence is an increase in pulmonary metastases.     

The effect of thiabendazole in a mixed leukocyte culture.

The effect of thiabendazole (TBZ), an anthelmintic, on a mixed leukocyte culture was assessed. Following i.p. administration of TBZ at a dose of 20 mg/kg to C57BL/6 mice, spleen cells were harvested and reacted in a one-way mixed leukocyte culture with irradiated BALB/c stimulator cells. When TBZ was administered 24 hr before the animals were killed, the proliferative response of spleen cells after 5 days in culture was greater than two times that of responder cells from normal, untreated C57BL/6 mice; the reactivity of spleen cells harvested 48 hr after TBZ administration was not statistically different from controls. Although proliferative response of normal responder cells reached a peak on day 6, TBZ treatment 24 hr before the mice were killed caused spleen cells to reach a proliferate peak on day 3. The magnitude of this peak was three times the normal proliferative peak on day 6. The population of spleen cells affected by TBZ is in the plastic-adherent fraction, and the drug effect can be transferred to normal responder lymphocytes by the addition of peritoneal exudate cells from TBZ-treated mice.     

Using an eclectic model to educate students about cultural influences on the nurse-patient relationship

This article describes how the concepts of cultural awareness, cultural sensitivity, and cultural competence are integrated into the nursing curriculum at Lehman College, City University of New York. A culturally diverse student population engaged in lectures, classroom exercises, and clinical experiences in order to learn the ideas and imperatives of cultural diversity in nursing care. The exercises were problem-based learning experiences guided by a university-developed model for teaching students to understand cultural diversity. The model is derived from Leininger's comparative cultural caring model and Paterson and Zderad's humanistic nursing model. By observing differences and similarities among diverse cultures, students learned that the assignment of cultural attributes is an inexact process and should be organized as hints rather than as certainties. Students also learned the importance of integrating cultural awareness, cultural sensitivity, and cultural competence into their nursing care.     

Sjögren's syndrome: a condition with features of chronic graft-versus-host disease: does duct cell adhesion or permeability play a role in pathogenesis?

Primary and Secondary Sj?gren's syndrome are disease complexes characterized by periductal inflammatory cell infiltration of the salivary and lacrimal glands and manifest as dry mouth and dry eyes. Secondary Sj?gren's syndrome may be associated with a connective tissue disorder. Additional extraglandular features in Sj?gren's syndrome include a generalized inflammatory exocrinopathy that might be associated with abnormalities of both humoral and cellular mediated immunity. Similar inflammatory changes and extraglandular features, including an altered immune response, have been reported in patients developing graft-versus-host disease after bone-marrow transplantation and in patients with primary biliary cirrhosis. The periductal nature of the inflammatory response involving minor salivary and other glands raises the possibility of altered duct cell adhesion or permeability in playing a role in the aetiopathogenesis of Sj?gren's syndrome. The paper pulls together evidence that could be interpreted in this light. Evidence for bacterial or viral factor(s) altering the antigenicity of the histocompartibility (HC) complex on ductal cells in Sj?gren's syndrome patients is also described. A hypothesis is proposed for Sj?gren's syndrome in which the principal feature is an alteration in salivary gland duct cell adhesion or permeability. A re-evaluation of current knowledge of these two conditions from a clinical and experimental context are interpreted in this light.