Predictive value of, and observer variability in, several ways of reporting antepartum cardiotocographs

Summary. Each of three scoring systems, and oscillatory frequency, had significantly poorer correlation with fetal outcome than reporting the cardiotocograph (CTG) as either 'reactive' or 'non-reactive'. There was no significant difference in the intra- and inter-observer variability when the CTG was reported in this way.     

Patterns of cerebral activation while mental images are rotated and changed in size

Event-related brain potentials were recorded while subjects performed either a rotation or a size scaling transformation of a mental image. Images had to be rotated 0°, 60°, or 120° or their size had to be enlarged by factors of 1:1, 1:3, or 1:5. Both tasks were accompanied by pronounced negative slow potentials, which extended over several seconds. The relative maximum of these shifts emerged at central to occipital leads. Over the occipital cortex, the negative potential had a similar amplitude level in all conditions and both tasks. However, at parietal and central areas, the negative slow wave changed in relation to the difficulty of the task. The amplitude increased with increasing rotation demands and if the scaling operation required an exact computation of the coordinates of the image. None of these effects could be attributed to an inverse change of P300.     

Development and exploratory trials of a cognitive preference inventory for medical students

A medical cognitive preference inventory was developed and tested with two samples, one in Israel and the other in the United States. Acceptable levels of internal consistency of the whole test and of its three subtests were demonstrated. Direct and indirect evidence for the validity of the test was provided. The potential uses of the test for student selection and evaluation as well as for programme evaluation were discussed. Two forms, E and F, each consisting of eighteen items, are recommended for use with medical students. A combination of these two forms is designed as form G. Administration of one form to half of a sample and the other form to the other half, followed by pooling the individual scores, thereby obtaining results comparable to those of form G, is recommended when time to administer the inventory is limited.     

Renal Kallikrein Excretion in Alcoholic Cirrhosis

Severe liver disease is often associated with renal hemodynamic changes, and these changes may involve vasoactive hormones. The vasodilatory renal kallikrein-kinin system has received little previous study in these patients. We measured urinary kallikrein in nine patients with alcoholic cirrhosis under rigid metabolic conditions and simultaneously evaluated renin, aldosterone and urinary prostaglandins. Plasma renin und aldosterone were generally increased as expected but urinary kallikrein was surprisingly diminished (13.3 ± 3.7 vs. 38.8 ± 11.1 SE, E.U./day. P < 0.05). despite adequate creatinine clearance (81 ± 9 ml./min.). Administration of prostaglandin inhibitors reduced urinary prostaglandin E by 72% and creatinine clearance by 56% but did not alter urinary kallikrein. Mineralocor-ticoid inhibition by spironolactone induced a natriuresis in four patients with ascites (from 1.4–140 mEq. Na⁺/day) but also failed to alter kallikrein. Thus, kallikrein excretion is paradoxically reduced and seemingly unresponsive to alterations in the prostaglandin and renin-aldosterone systems. If urinary kallikrein quantitatively reflects intrarenal kallikrein-kinin activity, the impairment in this vasodilatory system may mediate the altered renal hemodynamics of severe liver disease.     

CONFORMATIONAL ANALYSIS OF N-(tert.-AMYLOXYCARBONY-l-PROLINE IN THE SOLID STATE AND IN SOLUTION

The solid-state conformational analysis of t-AOC-l -Pro-OH** has indicated that the molecules are not folded up to form an oxy-C₇ peptide conformation, but rather that they are held together through intermolecular O-H. 0 = C (urethane) hydrogen bonds. The tertiary amide bond is in the cis configuration. In solvents of high polarity strongly solvated species largely predominate. In cyclohexane solution non-associated and associated (involving the carboxyl C = O as the proton acceptor) species are simultaneously present. Obviously, the extent of association increases with increasing solute concentration. The amount of the oxy-C₇ form, if any, should be extremely small. It is also demonstrated that CD measurements alone can lead to an incorrect picture of the conformational preferences of amino acid derivatives and small peptides in solution.     

Problem orientated medical records—all or none?

Junior hospital doctors from different medical schools were asked about their experience of the Problem Orientated Medical Record. Few had been introduced to this method of writing notes by their teachers when they were undergraduates, though more had learned about it from other sources. The majority of those with experience of the method found it preferable to the more conventional one. The advantages and disadvantages of the method are discussed and it is suggested that a less rigid format might make it more acceptable. This can be achieved by writing follow-up notes in the usual way and using the problem orientated approach only when the patient is assessed for the first time or when information is passed from one team of doctors to another.     

Characterization of circulating immune complexes by nephelometry in acute leukaemia

Summary Circulating immune complexes were isolated from 15 patients with acute leukaemia and 13 healthy blood donors by PEG precipitation. These were analysed according to their IgG, IgM and C4 content by optical rate nephelometry. Immune complexes of leukaemic patients contained higher amounts of IgM as compared to those from normal subjects. The clinical relevance of IgM containing immune complexes in leukaemia is discussed.     

Frequency and Clinical Manifestations of Patients with Primary Immunodeficiency Disorders in Iran: Update from the Iranian Primary Immunodeficiency Registry

Primary immunodeficiency disorders (PID) are a heterogeneous group of diseases, characterized by an increased susceptibility to infections. A total of 930 patients (573 males and 357 females) are registered in Iranian PID Registry (IPIDR) during three decades. Predominantly antibody deficiencies were the most common (38.4%), followed by congenital defects of phagocyte number and/or function (28.3%), other well-defined immunodeficiency syndromes (17.7%), combined T- and B-cell immunodeficiencies (11.0%), complement deficiencies (2.4%), and diseases of immune dysregulation (2.3%). Common variable immunodeficiency was the most frequent disorder (20.8%), followed by chronic granulomatous disease, ataxia-telangiectasia, btk deficiency, selective IgA deficiency, and T-B-severe combined immunodeficiency. The frequency of other PID disorders was less than 50 in number (<5%). There is an increasing trend in recognition of more PID in the recent years. Construction of such registry is not only important for its epidemiological aspect but also for its role in increasing the physician's knowledge about such disorders.