Newer emergency reperfusion techniques in acute myocardial infarction

We have given an overview of the management of the acute myocardial infarction patient utilizing the aggressive reperfusion techniques available today. Anatomic reperfusion rates have been over 95% with the combined methods described. The remaining problems technically are those of earlier reperfusion, methods to enhance myocardial recovery after ischemia, and prevention of restenosis or reocclusion. The use of laser methodology, coronary sinus retroperfusion, partial left heart bypass, and other innovative strategies may improve these results. The introduction of tissue plasminogen activator will affect our approach and will profoundly alter society's expectations of therapeutic success. Still, patients will die from acute myocardial infarction and its complications. The search for a prevention must, therefore, not be overshadowed by our current enthusiasm for reperfusion techniques. Hopefully, our current approach will become a historical footnote as breakthroughs in preventive strategies occur.     

‘How Do You Remember You Ate…?’: A Delphi Technique Study to Identify Retrieval Categories From Fourth-Grade Children

Objective To develop and validate a consensus set of retrieval categories for how children remember what they have eaten, and to relate retrieval categories to accuracy of reporting items eaten during school lunch.Design A Delphi technique study was conducted using 10 psychologists. The subject matter consisted of responses transcribed from interviews conducted with 89 randomly selected fourth graders within 90 minutes of eating. Retrieval categories were evaluated for accuracy by comparing students’ self-reported lunch intake with observation.Statistical analyses For round 1, a centroid hierarchical cluster analysis was used to identify common sets of rating pairs to propose categories for reaching consensus. For rounds 2 and 3, percent of agreement was calculated. Accuracy was tabulated across meal items and student use by retrieval category.Results After round 3, we found that 23 “near-consensus”categories were used by at least eight raters. Six categories were used 60% of the time, 4 were used 20% of the time, and 5 were used 15% of the time. Less frequently used categories were combined with similar, more frequently used categories for a total of 16 categories. Students used a large variety of retrieval categories when accurately reporting consumption. Of the 16 categories, 12 were used similarly by both accurate and inaccurate students. Where there were differences in accuracy by retrieval category, the more accurate students used “taste/smell/texture”and “visual”in deference to “order items consumed”and “oral cue still present.”Applications These categories provide insight into the broad range of retrieval categories that children use and provide direction for researchers to design and study specific cues to enhance the accuracy of children's self-reports of diet. J Am Diet Assoc. 1997;97:31–36.     

Deferred treatment for prostate cancer

The clinical outcome of 278 prostate cancer patients managed by a deferred treatment policy was analysed retrospectively. Following TURP or biopsy, all patients were asymptomatic and deemed suitable for management by a deferred treatment policy, i.e. hormone therapy or other forms of treatment were only initiated if and when symptomatic progression occurred. The overall 5-year survival rate was 30%; 18% of patients died from other causes without needing treatment for their prostate cancer; 11% were alive and untreated after 5 years' follow-up; 17% died from prostate cancer without further treatment. Poor tumour grade, anaemia, metastatic disease, a short history, presentation with retention, and a raised serum creatinine at presentation were associated with a poor prognosis.     

Ablation of the olfactory bulb up-regulates the rate of neurogenesis and induces precocious cell death in olfactory epithelium.

Young adult rats were unilaterally bulbectomized and tritiated thymidine ([3H]TdR) was injected at variable times following surgery to determine the effect of bulbectomy on the rates of cell proliferation and cell death in the olfactory epithelium. Removal of the olfactory bulb elicits a two- to fourfold increase in the proliferation rate of ipsilateral olfactory epithelial cells 7-50 days following surgery. On the contralateral side, there was a temporary twofold increase in the proliferation rate during the second week after surgery, but this returned to control values at 3 weeks. This temporary increase was in parallel with the response on the ipsilateral side so that the ratio between operated and unoperated sides remained at two. Cell death in olfactory epithelium is also up-regulated following bulbectomy. Death of cells can occur as early as 1 day following incorporation of [3H]TdR, i.e., well before the sensory neurons become mature. This means there is an over-production of sensory cells, and they die at all stages of their life cycle. The number of cells dying is greater after bulbectomy, indicating that the overproduction of olfactory cells is more pronounced after surgery.     

Role of topical lignocaine during carotid endarterectomy.

Forty carotid endarterectomies were undertaken in 34 patients. Operations were prospectively randomized to periarterial application of either 1 per cent lignocaine (n = 19) or normal saline (n = 21), and detailed measurements taken of intraoperative pulse rate and blood pressure. Patients receiving lignocaine demonstrated a lower pulse rate, and lower systolic and mean blood pressures than those receiving placebo, with significance in relation to clamp application and shunt removal (P < 0.05). It was particularly noticeable that patients receiving lignocaine demonstrated less intraoperative variation in pulse rate and blood pressure. Topical lignocaine stabilizes pulse rate and blood pressure during carotid endarterectomy.