Major Surgery in Hemophilia

The commercial development in Britain of antihemophilic factor (AHF) from ox and pig blood represents a notable advance in the treatment of hemophilia. With these materials, the hemostatic mechanism of even severe hemophiliacs may be made completely normal for a significant period of time, and major surgery safely undertaken. Nevertheless, in their present form the materials are antigenic and have other drawbacks. Each may therefore only be used for one period of treatment in any one hemophiliac, and should be reserved for life-saving procedures. Administration must be controlled by frequent assays of the AHF activity resulting in the patient's blood.
An illustrative case (a partial gastrectomy) is described and a number of practical details are discussed.     

The use of credit and experiential learning in nurse education. Exciting opportunities for student and tutor alike

This paper considers and analyses the use of Credit Accumulation and Transfer Schemes (CATS) and Assessment of Prior Experiential Learning (APEL) in nurse education. The Council for National Academic Awards (CNAA) initiative in higher education for CATS has opened up many new prospects for post registered nurse education linking 'Project 2000,' colleges of nursing and higher education and allowing nurses to show the qualitative values of their education rather than a quantitative approach. APEL has opened up opportunities for a move away from the traditional patterns of prerequisites for nurse education and openings for direct entry to both basic nurse education and also post registered courses. The recent document on The Report of the Post-registration Education and Practice Project (PREPP) shows that the UKCC are moving rapidly towards a similar programme of study for nurses, midwives and health visitors in line with those undertaken by undergraduate polytechnic students.     

MRI abnormalities in tardive dyskinesia

Most investigators studying tardive dyskinesia (TD) hypothesize that the condition is due to a neurochemical abnormality of the striatum. Recently, numerous CT studies have been done to verify brain abnormalities in patients with TD; the findings have, however, been conflicting. The present study was designed to detect possible neuropathological abnormalities in the basal ganglia in a young sample of schizophrenic patients with TD as compared with schizophrenic patients without TD and normal controls. Magnetic resonance imaging (MRI) was used to measure the volumes of the caudate, putamen, globus pallidus, lateral ventricle, and intracranium. The volumes of the caudate nuclei of the patients with TD were significantly smaller than the volumes of the caudate nuclei of the patients without TD and normal controls. This abnormality in the caudate may be related to some previous condition, which may prove a substrate that is necessary for TD to establish itself in association with neuroleptic use. Further studies are necessary to confirm our findings and to determine the pathophysiologic nature of these structural alterations and the role played by neuroleptics, whether primary or secondary.     

Olanzapine treatment of anorexia nervosa: a retrospective study

BACKGROUND: Recent reports raise the possibility that olanzapine, which commonly causes weight gain in non-eating-disordered subjects, assisted weight gain and mood during refeeding in anorexia nervosa (AN) patients. METHODS: Eighteen AN subjects who engaged in open treatment with olanzapine were retrospectively questioned about their response. RESULTS: Subjects reported a significant reduction in anxiety, difficulty eating, and core eating disorder symptoms after taking olanzapine. DISCUSSION: These data lend support to the possibility that olanzapine may be useful in AN patients. CONCLUSION: A controlled trial is necessary to prove that olanzapine is efficacious.     

The effect of dietary fat on metastasis of the Lewis lung carcinoma and the BALB/c mammary carcinoma

The effect of feeding mice diets high in beef tallow (high in saturated fat) or corn oil (high in polyunsaturated fat) on the production of lung metastases by the Lewis lung carcinoma and the BALB/c mammary tumor was determined. Diets were fed ad libitum, and the mice fed the high-fat (24.6%) diets consumed more calories and gained more weight than those fed the control (5%) diets. With the Lewis lung carcinoma, we found that both high-fat diets significantly increased the growth of the primary tumor in the footpad as well as the number of spontaneous metastases produced after the primary was removed; this was in comparison with results from the appropriate control diets. With the BALB/c mammary tumor, the high-fat beef tallow diet (but not the corn oil diet) significantly increased the number of lung metastases formed after tail vein injection. In addition, the group given the control corn oil diet had more metastases than the group given the control beef tallow diet. Overall, these studies showed that the consumption of high-fat/high-calorie diets increased metastasis compared to the consumption of high-fat/high-calorie diets increased metastasis compared to the consumption of low-fat diets. However, the results varied depending on the tumor model used and the type of fat.     

Complementary medicine: the need for audit

There is an increasing demand for complementary medicine. This paper reviews some of the audits that have been used within this area of medicine and suggests a strategic approach to the development of complementary medical audit within the National Health Service. It is hoped that this will allow purchasers and practitioners of complementary medicine to determine the effectiveness and cost-benefits of these therapies, at the same time as improving standards of practice.     

Pregnancy after autografting and allografting vascularized ovaries and en bloc vascularized ovaries with adnexa in rabbits

Summary. Initially, techniques for autografting ovaries with or without adnexa were developed but a 30% vascular failure rate was experienced by day 14. Of the technically successful grafts, 50% proved fertile. Single vascularized ovaries with their oviducts were then allografted into bilaterally ovariectomized rabbits by microsurgical techniques and the vascular failure rate was reduced to 5% of 40 grafts. The time-course of rejection in untreated recipients was mapped by histological examination and by 24-h culture of fallopian tubes after autopsy at different times after transplantation. Control allografts were consistently rejected by day 20. Striking prolongation of both types of graft was obtained with a short 17-day course of cyclosporin A at 10 or 15 mg day⁻¹kg⁻¹. Indeed, significant evidence of rejection was found in only two ovaries out of 20 so far examined histologically. Mating behaviour, ovulation, ciliary function and transport of ova appeared normal in 80% of the recipients as long as 18 weeks after stopping cyclosporin A treatment. Only one of the ovarian allografted rabbits has so far been mated and this produced seven normal young 126 days after transplantation. However, none of the five animals mated after being allografted with en bloc adnexa have so far become pregnant.