"Right" stay in hospital after sugery: randomised controlled trial.

A randomised controlled trial was carried out on 100 patients to compare the effects of discharge after certain pre-specified clinical criteria had been fulfilled--"right" stay--with those of discharge at an arbitrary 10 days after surgery--"fixed" stay. The operations concerned (cholecystectomy and vagotomy) were more hazardous than those previously included in studies of early discharge. Patients in the right-stay group were discharged, on average, 7-6 days after operation--that is, two days earlier than those in the fixed-stay group. In terms of clinical progress, social factors such as return to work, and the acceptability to patients and relatives of the implications of right stay, patients in this group fared as well as those in the fixed-stay group, and in some respects slightly better. Right stay entailed the transfer of some work from hospital to community medical and nursing staff, but this also was acceptable. The concept and use of the right-stay principle is of value in planning the postoperative discharge of suitable patients.     

Pressure effects on the distribution of extracellular materials in the rhesus monkey outflow apparatus

Summary An electron-microscopic investigation was conducted to determine the distribution of extracellular materials in the rhesus monkey outflow apparatus at various maintained levels of intraocular pressure. Intraocular pressure was maintained at either 0,8, 15, 22, 30, or 50 mm Hg, by an intracameral needle attached to a reservoir system for a period of 1 h. Thereafter the eyes were fixed either by intracameral perfusion of glutaraldehyde at the appropriate pressure level, or by carotid perfusion of the fixative, or by rapid enucleation and immersion fixation. The electron-dense cationic stains, colloidal thorium and colloidal iron were used to indicate the presence of carbohydrate-rich extracellular materials in the drainage tissues.In the control tissue (15 mm Hg), heavy concentrations of stain were detected within the cores of the trabeculae and in the extracellular spaces of the endothelial meshwork. With pressure elevation there was a progressive decrease in the surface staining on the meshwork cells, an increase in staining intensity within the trabecular cores, and a washout of extracellular materials from the spaces of the endothelial meshwork. The washout was thought to occur via giant vacuoles up to 30 mm Hg, but at 50 mm Hg the process was accelerated by loss of association between the cells of the canal endothelial monolayer. Over the entire pressure range 0 to 50 mm Hg, there was an increase in the staining on the apical surface of the canal endothelium which was associated with a decrease in the incidence of micropinosomes.This paper was presented at the Fifth Annual Meeting of the European Club for Ophthalmic Fine Structure in Zurich, Switzerland on March 25 and 26, 1977     

The porcine ovarian follicle: III. Development of chorionic gonadotropin receptors associated with increase in adenyl cyclase activity during follicle maturation.

Specific binding of human chorionic gonadotropin (hCG), and the hCG-sensitive adenyl cyclase of granulosa cells from small (1-2 mm), medium (3-5 mm), and large (6-12 mm) porcine ovarian follicles have been studied. The number of hCG-binding sites per cell (n) increases during follicle maturation without a change in the binding affinity. The values for n were 300-400 for small, 1,000-1,600 for medium, and 8,200-10,000 for large-follicle cells. The dissociation constant is 2.4 X 10(-10)M for all cells. hCG-sensitive adenyl cyclase was demonstrated in porcine granulosa cells. The adenyl cyclase system of granulosa cells becomes increasingly responsive to hCG stimulation during follicle development. Maximal adenyl cyclase activation by hCG (1 mug/ml) was 240, 750, and 7,000 molecules of cyclic AMP formed/sec/cell, respectively, for small, medium, and large follicle cell. The concentration of hCG giving half-maximal stimulation (1.0 X 10(-9)M) was similar for both large and medium follicle cells. It is concluded that: 1) an increase in hCG receptor sites per cell occurs during maturation of the porcine ovarian follicle without change of binding affinity, and 2) the increase in the number of hCG receptors correlates well with hCG-sensitive adenyl cyclase activity during follicle development.     

Scrub typhus encephalomyelitis with prominent focal neurologic signs

BACKGROUND: Encephalomyelitis with prominent focal neurologic signs and associated neuroradiologic abnormalities has not been previously described in scrub typhus. CASE DESCRIPTION: A 22-year-old woman was admitted because of fever and an altered mental state. Neurologic examination revealed bilateral sixth and seventh nerve palsies, bilateral gaze evoked nystagmus, anarthria, dysphagia, quadriparesis, and sensory level at T1. Serum and cerebrospinal fluid samples were positive for tsutsugamushi antibody. The patient's magnetic resonance images demonstrated the lesions responsible for the neurologic dysfunctions: in the lower brainstem, cerebellar peduncles, and spinal cord. It was interesting that the gray matter of the spinal cord was predominantly involved. CONCLUSIONS: The recognition of unusual manifestations and the clinical suspicion of this treatment-responsive disease may be important, particularly in the face of increasing international and intranational travel.     

Psychiatric morbidity and illness experience of primary care patients with chronic fatigue in Hong Kong

OBJECTIVE: The authors' goal was to examine the prevalence and experience of psychiatric morbidity among primary care patients with chronic fatigue in Hong Kong. METHOD: One hundred adult patients with medically unexplained fatigue for 6 or more months were assessed with the Explanatory Model Interview Catalogue, psychopathological rating scales, and an enhanced version of the Structured Clinical Interview for DSM-III-R. RESULTS: The lifetime prevalence of DSM-III-R depressive and anxiety disorders was 54%. Current depressive and anxiety disorders were identified in 28 patients, who exhibited more psychopathology and functional impairment than other patients. Thirty-three patients had somatoform pain disorder, and 30 had undifferentiated somatoform disorder, but most of them could also be diagnosed as having shenjing shuairuo (weakness of nerves) and, to a lesser extent, ICD-10 neurasthenia. Chronic fatigue syndrome diagnosed according to the 1988 Centers for Disease Control criteria was rare (3%) and atypical. Generally, patients mentioned fatigue if asked, but pains (36%), insomnia (20%), and worries (13%) were the most troublesome symptoms. Most patients attributed illness onset to psychosocial sources. CONCLUSIONS: Psychiatric morbidity was common among primary care patients with chronic fatigue. Subthreshold psychiatric morbidity was very common and was more validly represented by the disease construct of shenjing shuairuo or neurasthenia than somatoform disorder.