Resuscitation in northern Iraq.

The principles of Advanced Trauma Life Support (ATLS) were adopted by a Royal Navy surgical team deployed to northern Iraq. Over a 6-week period, 18 casualties of both military and civil trauma required active resuscitation, 10 being under the age of 16 years. Triage of multiple casualties was necessary on three occasions. Two patients died. It was difficult to exclude cervical spine injury. Venous cut-down was frequently unsuccessful, so that internal jugular vein cannulation was life-saving. Crystalloid was used as the primary infusion without apparent disadvantage. Cross-matched blood was unavailable and one patient died with haemolysis after massive transfusion. Hypothermia was a problem despite the high environmental temperature. Laboratory and radiological facilities were extremely limited. Non-medical staff were trained most effectively to assess vital signs, although sophisticated monitors became available. These problems are discussed and compared with previous experience. Recommendations are made to improve future outcome.     

Nitric oxide: a revolution of free radicals theory of aging

There are two kinds of free radicals in the aging process, 'bad' and 'good'. Nitric oxide is a good free radical.     

Suppression of human ovarian carcinoma metastasis by the metastasis-suppressor gene, BRMS1

Metastasis-suppressor genes, by definition, suppress metastasis without affecting tumorigenicity and, hence, present attractive targets as prognostic or therapeutic markers. BRMS1 (breast cancer metastasis suppressor) has recently been identified as a metastasis-suppressor gene for human breast cancer and melanoma. Expression of BRMS1 messenger RNA (mRNA) in multitissue including normal prostate, ovarian, testis, and colon has been detected by northern blot analysis. We hypothesize that the role of BRMS1 in tumor progression may not be limited to breast cancer and melanoma. We previously found that BRMS1 mRNA levels in primary ovarian epithelial carcinomas were significantly lower than that in normal ovarian and benign tumors (P < 0.05), and statistical analysis of BRMS1 mRNA levels revealed that BRMS1 mRNA levels were significantly higher in early tumor stages (I, II) compared with advanced tumor stages (III, IV) in which lymph node or distant metastases were present (P < 0.01). Our data showed that reduced BRMS1 mRNA seems to influence ovarian carcinoma metastatic ability. Therefore, we transfected BRMS1 plasmid into highly malignant ovarian carcinoma cell line, HO-8910PM, and examined cell biologic behaviors including proliferation, adhesion, invasion, and metastasis in vitro and in vivo. BRMS1 expression did not alter the proliferation of HO-8910PM cells in vitro and primary tumor formation in vivo. But, BRMS1 expression significantly suppressed the cell adhesion to extracellular matrix components and in vitro cell invasion in BRMS1-transfected HO-8910PM cells compared to parental HO-8910PM and vector-only transfectants (HO-8910PM-vect). Furthermore, motility of BRMS1 transfectants was inhibited. lung colony formation of intravenously injected BRMS1 transfectants in nude mice was significantly reduced. Also, BRMS1 transfectants form significantly less metastatic to organs of peritoneal cavity in orthotopically implanted ovarian tumor nude models. We further discovered that BRMS1 expression did downregulate expression of an actin-bundling protein associated with cell motility -fascin, which perhaps is the mechanism underlying BRMS1 suppression of metastasis. These data suggested that in addition to its already described role in breast cancer and melanoma, BRMS1 functions as a metastasis-suppressor gene in ovarian carcinoma by modifying several metastatic-associated phenotypes, offering a new target for therapeutic intervention.     

慢性肾功能衰竭非少尿型220例临床总结

慢性肾功能衰竭非步尿型是肾功能衰竭早中期出现的一组症状。常因多种因素损伤肾小管一间质而致，临床表现出三阳（三种消化热能）失调，七素（七种体索）毫损，瘀血内阻等多种症状。我们用荣医浆药为主治疗本病220例，取得了较满意的近期疗效。     

Further studies on interactions between periaqueductal gray, nucleus accumbens and habenula in antinociception.

Previous findings from this laboratory with the intracerebral microinjection technique suggested that the periaqueductal gray (PAG), nucleus accumbens, and habenula might constitute a unidirectional loop to play their roles in pain modulation. In the present study we demonstrate that intra-habenular injection of naloxone antagonizes the analgesia elicited by morphine injected into the periaqueductal gray (PAG) and that intra-accumbens injection of naloxone is capable of attenuating the analgesic effects of morphine injected into the habenula. These results indicate that the relationships between these nuclei may be more complex than the putative unidirectional loop.     

Trephine craniotomy in neurosurgery]

For three years, we have performed craniotomy with a 5 cm diameter trephine through a linear incision. 53 craniotomies were done in 49 patients. This simple and time-saving method produced little bleeding and slight injury to the brain. The technique allowed the surgeon to spend most of his time at the management of lesion. Healing of wound was rapid and brain edema was minimal.     

The efficacy and limitations of percutaneous endoscopic gastrostomy.

We analyzed 64 percutaneous endoscopic gastrostomy procedures performed by us between 1986 and 1990. Thirty patients had neurologic disease; 16 had head and neck cancers; eight had other malignancies; two had acquired immunodeficiency syndrome; and eight had other problems. Seven patients died within 30 days of complications (n = 4) or the primary illness (n = 3). Mean follow-up was 6 months; an additional patient died of aspiration and eight others died of their underlying illness. There were 19 complications (32%). Four wound complications occurred. Nine patients developed aspiration pneumonia within 3 days of the procedure, four of whom died in the hospital. Of the 24 patients with a history of aspiration, nine experienced aspiration during or after percutaneous endoscopic gastrostomy. Patients with a history of aspiration were more likely to have perioperative aspiration pneumonia, and patients who experienced aspiration were more likely to die.     

Mortality and survival of the Down's syndrome population in Western Australia

ABSTRACT. From 1976 to 1984, there were 149 Down's syndrome live births in Western Australia. Where previously the coexistence of congenital heart disease was a major determinant of early mortality, current survival rates do not reflect this. Survival rates have significantly increased over the last decade: particularly so for those with coexistent congenital heart disease. Projected frequencies for Down's syndrome persons in Western Australia are expected to significantly increase. This rise in prevalence will have major economic effects on the planning and delivery of health care for this population.     

RETINOBLASTOMALACTIC DEHYDROGENASE OF AQUEOUS HUMOUR AND ITS ISOENZYMES

Lactic dehydrogenase (LDH) activity in aqueoushumour and serum was measured of 24 patients withretinoblastoma, senile cataract, glaucoma, and cho-roid melanoma in addition to LDH isoenzyme fractions. The results were compared with those of the20 normal children. The ratio of aqueous humourLDH to serum LDH was 4.32+2.80, and that ofisoenzymes LDH4 to LDHl was greater than l. Theresults of our study suggested that the total LDHactivity and isoenzyme fractions in the aqueoushumour is of value in the diagnosis of retinobla&toma.