The impact of the amended Ontario Mental Health Act (Bill 7) on patients discharging themselves from hospital against medical advice (AMA): a preliminary study

Bill 7, the most recent amendment to the Ontario Mental Health Act was introduced in December 1986. It has resulted in some major changes to the practice of psychiatry, especially in provincial hospitals. We compared patients who had discharged themselves against medical advice (AMA) during the six months before the Bill was enacted, with those who discharged themselves AMA in the 12 months following. Significantly more patients discharged themselves AMA in the post- than the pre-Bill period. The majority of these were potentially treatable, acutely ill individuals with schizophrenia or affective disorder. We argue that Bill 7 has largely failed in its objective to improve the overall "quality of care" to psychiatric patients, at least in the short term.     

Head injuries coexistent with pelvic or lower extremity fractures-early or delayed osteosynthesis

Summary The authors compared the results of a retrospective analysis of two groups of head-injured patients who had coexistent pelvic or lower extremit fractures. One group was treated with early osteosynthesis within the first 12 hours after trauma, simultaneously with neurosurgical treatment, while the second group was treated neurosurgically and osteosynthesis was postponed for 4 to 10 days. The second group revealed a higher mortality, which was due to fat embolism. We conclude that early osteosynthesis is the treatment of choice in patients with coexistent head injury and lower extremity fractures.     

Direct stimulation of superoxide output in neutrophils by lipid A of Escherichia coli

Two different results have been published in regard to the superoxide-stimulating activity of lipopolysaccharide or Lipid A in neutrophils: first, a direct stimulation after a lag time of about 30-60 sec and second, the inactivity of Lipid A if applied alone, being able only to "prime" the cells for a second challenge during a longer incubation period. In order to achieve clarity regarding these two different opinions, we asked the questions whether: (a) Lipid A is able to stimulate PMN directly, i.e. without a preincubation and a second stimulus; (b) fMLP and Lipid A show a synergistic effect; (c) a preincubation ("priming") of the PMN with Lipid A really increases the superoxide output after a second challenge. We observed (a) a direct stimulation of the chemiluminescence with Lipid A without an additional second challenge, accompanied by a seemingly unimodal kinetics of the superoxide output, i.e. mainly the second phase of the usually bimodal kinetics has been stimulated. As for question (b), a clearly detectable synergism between Lipid A and fMLP could be measured. Regarding question (c), a preincubation ("priming") with Lipid A was of no beneficial effect; the chemiluminescence count could be equally well increased without a "priming" compound.     

The surgical treatment of predominantly venous defects

The predominantly venous defects consist of the truncular forms, as there is aplasia or obstruction in the truncular dilatation; and they consist of the extratruncular forms as there are the infiltrating ones and the limited ones, according to the Hamburg classification. The web or membranous obstruction of the inferior vena cava (IVC), dilatation or aneurysm of the jugular vein, infiltrating "cavernous angioma" and localized venous defects are the main lesions of those classifications reported in this communication. Jugular dilatation and localized extratruncular lesions have had good therapeutic results. Webs of the IVC can be treated by membranectomy, either by finger, transcardially, or balloon, percutaneously, and cavo- or mesoatrial shunt; however, membranectomy, along with cavoplasty as a radical treatment for such an entity, is advocated by the authors. The infiltrating extratruncular form is the unsolved important issue concerning its thorough resection. Skin graft taken from a resected tissue mass through a reversal split thickness skin graft by a drum type dermatome, removal of the lesion along with muscle layer(s), and staged operations are recommended.     

Chromosomal markers as prognostic indicators in transitional-cell carcinomas of the bladder

Clinical-cytogenetic correlations were assessed in 79 patients with transitional cell carcinomas of the bladder to whom cytogenetic analysis of the primary tumor had been successful. High-grade (G2+G3) and high-stage (T2-T4) tumors had in general a higher ploidy level and contained more marker chromosomes, including multiple markers, compared to low-grade (G0+G1) and low stage (Ta+T1) tumors. The early recurrence rate (within 7 months) was significantly higher (p<0.05) in patients whose tumors contained marker chromosomes compared to cases without markers. Also, a significantly higher proportion of patients with marker chromosomes died due to their disease during the study period (follow-up time 30 months) compared to those without markers (84% versus 16%, p<0.005). The results confirm and extend previous studies showing that cytogenetic findings may be an important prognostic indicator in bladder cancer patients.     

Involvement of antioxidant enzymes in multiple-drug resistance in a human T-lymphoblastic leukemia-cell line which over-expresses p-glycoprotein

We have compared the specific activities of Cu/Zn superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH-Px) in a vinblastine sensitive human T-lymphoblastic cell line (CCRF-CEM) and its multiple drug resistant (MDR) counterpart cell line (CEM/VLB100), which over-expresses P-glycoprotein (PGP). We have found that the specific activity Cu/Zn SOD was consistently 38% increased in CEM/VLB100 cells compared with CCRF-CEM cells. In contrast, the activities of CAT and GSH-Px were similar in the two cell lines. These results suggest that MDR in CEM/VLB100 is a complicated phenotype which not only involves a PGP mechanism, but also a SOD protection mechanism against drug-mediated O2.- cytotoxicity.