An assessment of the Doctorate of Medicine (Internal Medicine), University of the West Indies

The outcome is described of 48 entrants to a postgraduate degree course (DM) in Internal Medicine established at the University of the West Indies in 1974. Contact by postal questionnaire was established in 96% of 26 graduates and 82% of 22 non-graduates. 22 of 25 DM graduate responders have remained in the Caribbean, working in six Caribbean territories. All graduate responders developed a subspecialty interest. The graduates' primary employers are the University (9) and the Government (12). However, failure to graduate did not necessarily preclude qualification as consultant physician (7 of 18 responders). Major difficulties with the DM programme included: (1) in practice, lack of recognition by contributing territories of individual DM (Internal Medicine) graduates; (2) incomplete regional coverage; (3) lack of adequate funding for the programme; (4) an inadequate research training input; and (5) difficulties with seniority for staff who trained in Jamaica to go to work in another territory. All these problems have solutions. Overall, the international recognition of the new degree programme has been satisfactory and the graduates' own assessment of the training was complimentary. At last a system has been devised that enables postgraduates to train as internal medicine specialists in the Caribbean to practise effectively within the Caribbean health system.     

HORMONAL CHANGES IN POSTMENOPAUSAL WOMEN WITH BREAST CANCER TREATED WITH TRILOSTANE AND DEXAMETHASONE

Postmenopausal women with metastatic breast cancer were treated with trilostane, initially 240 mg daily increasing after 3 days to 480 mg daily and after a further three days to 960 mg daily. After 3 days at this dose dexamethasone 1 mg daily was added and this combination was continued until disease progression occurred. Partial remission was seen in 26% and stabilization of previously progressive disease in a further 13% of the first twenty-three patients studied. During therapy with trilostane alone significant increases in DHEAS, androstenedione, 17-hydroxypregnenolone, progesterone, testosterone and oestradiol were seen. A significant fall in oestrone concentration occurred at the same time. After dexamethasone was added the elevated steroid concentrations fell back to the baseline while oestrone remained depressed below this and testosterone was also significantly lowered. No change was seen in cortisol or ACTH concentration while patients were on trilostane alone but cortisol levels were undetectable after dexamethasone was added though, in most patients, ACTH remained detectable. There was no change in the ratio of delta 5:delta 4 steroids at any stage of therapy but a highly significant increase in the androstenedione: oestrone ratio was seen. We conclude that in long-term use in vivo it is difficult to demonstrate that trilostane inhibits 3 beta-hydroxysteroid dehydrogenase but it may produce inhibition of aromatase.     

Exudative lung injury is associated with decreased levels of surfactant proteins in a rat model of meconium aspiration

OBJECTIVE: Meconium aspiration syndrome remains a common cause of respiratory failure in neonates. The acute effects of meconium aspiration are inactivation of lung surfactant in vivo and in vitro. This study investigated the delayed effects of meconium on alveolar surfactant phospholipids and protein levels in spontaneously breathing animals. METHODS: Twenty-two adult rats were given 4.3 mg of dry weight human meconium after endotracheal intubation. Rats were briefly mechanically ventilated in room air, extubated, then killed after 16 (n = 6), 24 (n = 6), 48 (n = 6), and 72 hours (n = 4). Control animals received the same volume of normal saline (n = 7) or no meconium (n = 7). Bronchoalveolar lavage and tissue specimens were evaluated for inflammatory cells, total proteins, surfactant phospholipids, and surfactant proteins. RESULTS: Meconium caused exudative lung injury that was reflected in increased cell counts and proteins in alveolar lavage fluid. The peak injury occurred at 16 hours after instillation, whereas recovery occurred by 72 hours. Although total lavage fluid phospholipids did not change over time, phospholipid and dipalmitoyl phosphatidylcholine in large aggregates tended to decrease at 24 hours. Western blot analysis demonstrated time-dependent qualitative decreases in surfactant proteins A and B (SP-A, SP-B) in meconium-instilled animals compared with the controls. ELISA for SP-B confirmed the Western blot findings with total SP-B in large aggregate decreasing from 25 +/- 4 microg in controls to 6.6 +/- 0.8 microg at 24 hours of injury. CONCLUSIONS: Our study suggests that the exudative lung injury with meconium instillation is associated with decreased levels of SP-A and SP-B in the large aggregate fraction of lung surfactant. We speculate that decreased secretion and/or increased degradation accounts for lower levels of SP-B in bronchoalveolar lavage fluid.     

大鼠同种异体甲状旁腺脑室内移植后胶质细胞的c-fos表达

以Wistar大鼠为供体，SD大鼠为受体，在立体定向仪上将同种异体的甲状旁腺移植到SD大鼠的侧脑室。应用免疫细胞化学方法对移植后脑内c-fos的表达进行了研究。移植后24h，前脑内开始出现c-fos的表达，4d达到高峰，持续1周后逐渐减少。到移植后4周，c-fos表达基本消失。c-fos表达的部位主要出现在白质内（如胼胝体。前连合等）以及侧脑室周围的脑组织（如隔区、纹状体等）。诱导表达的c-fos阳性细胞呈簇状、大小不等，类似正在分裂增殖中的小胶质细胞和星形胶质细胞。本文结果提示，在同种异体甲状旁腺脑室内移植过程中c-fos的表达可能与胶质细胞的活化和增殖有关。     

THE DIAGNOSIS OF BLADDER OUTLET OBSTRUCTION IN MEN BY ULTRASOUND MEASUREMENT OF BLADDER WALL THICKNESS

Purpose

The objective of the study was to investigate specificity and sensitivity of bladder wall thickness in the diagnosis of bladder outlet obstruction.

Materials and Methods

The study included 174 patients referred to our prostate centers for lower urinary tract symptoms. Free uroflowmetry and pressure-flow studies were performed in duplicate as part of the diagnostic evaluation. After the 2 voiding studies were done the bladder was filled to 150 ml. and wall thickness was measured via suprapubic ultrasound. Bladder outlet obstruction was diagnosed and graded according to the Abrams-Griffiths and Schafer nomogram as well as to the group specific urethral resistance algorithm.

Results

A significant correlation (r>0.6, p ConclusionsMeasurement of bladder wall thickness appears to be a useful predictor of outlet obstruction with a diagnostic value exceeding free uroflowmetry although it does not represent a substitution to invasive urodynamics. These data support the hypothesis that the relationships between morphology and function are of clinical importance.