Morbid obesity treated by gastroplasty: radionuclide gastric emptying studies

Mechanisms by which gastroplasty for morbid obesity causes weight loss are poorly understood. We studied the role of altered gastric emptying in 50 patients before surgery, 1-4 weeks after surgery, and 2-24 months after surgery using technetium-99m pentetate in water for liquid meals and a Tc-99m styrene divinylbenzene copolymer resin in oatmeal for semisolid meals. We determined the emptying half-times of the stomach before and after surgery in the proximal and distal compartments. The proximal compartment emptied promptly in the early and late postoperative periods. The distal compartment emptied liquids at rates similar to those before surgery, while the late postoperative emptying of semisolids was significantly faster. The stoma connecting the two compartments thus permits rapid transit of liquids and semisolids without delay of distal compartment emptying. No correlation was seen between the emptying half-times or changes thereof and eventual weight loss. Delayed gastric emptying is therefore not the mechanism for satiety and weight loss after gastroplasty has been performed.     

An evaluation of a workshop for teachers of nursing by comparing the members' expectations with their opinions of the outcome

Fifty-seven teachers of nursing, who comprised 42 women and 15 men and who also comprised 12 senior tutors, 16 nurse tutors and 29 clinical teachers, participated in a study to evaluate a workshop which they attended.
The method of inquiry used was that of a survey by questionnaire. Two questionnaires were used, one being set at the beginning of the workshop and the other at the end of the proceedings. The learning objectives for the workshop were used as the questionnaire items and comprised 20 in all. When the before and after scores relating to the questionnaire items were compared through the use of t tests significant differences were found on 12 out of the 20 objectives. In the course of the paper the differences found are identified and discussed. Some of the limitations of the method of inquiry used are discussed and finally some conclusions are reached.     

Haemodynamic Studies During the Management of Severe Tetanus

Detailed invasive haemodynamic studies were performed in 27of 32 patients with severe tetanus. Nineteen had severe uncomplicatedtetanus and eight had associated major complications, chieflyinfection and pulmonary complications. The results were comparedwith those obtained from 15 healthy male volunteers who servedas controls. There were two deaths in 32 patients (mortality6.25 per cent). Severe tetanus without major complications wascharacterized by a high output hyperkinetic circulatory statewith tachycardia (heart rate 131 (19.2) beats/minute), increasedstroke volume index (43.1 (10.7) ml/m²), increased cardiac index(5.48 (0.94)1/min/m²) and a normal left ventricular stroke workindex (60.5 (15.9) g/m/m²). Volume loading demonstrated a significanthaemodynamic response and increased vascular capacitance. Evenso the maximum percent rise from baseline values of these indicesafter volume load was significantly higher in controls (p <0.001). Autonomic cardiovascular disturbances affected bothsympathetic and parasympathetic activity. Hypertension and tachycardiaalternating with hypotension and bradycardia were related tosudden fluctuations in systemic vascular resistance. Our studiessuggested some degree of myocardial dysfunction in patientswith severe uncomplicated tetanus. The haemodynamics of severetetanus were masked and altered by complicating infection, pneumonia,and atelectasis.     

Surgical bacterial infections and antimicrobial susceptibility patterns at Lilongwe Central Hospital

A cross sectional study was done between October 1999 and February 2000 to determine antimicrobial susceptibility patterns of consecutive bacterial isolates of 102 clinical samples among surgical in-patients at Lilongwe Central Hospital (LCH), Malawi. Antimicrobial susceptibility was determined using comparative disc diffusion techniques. 83 (81.4%) samples were culture positive for bacterial growth while 19 (18.6%) grew nothing. Of the 93 culture positive specimens, Staphylococcus aureus was the predominant organism 43(51.8%) followed by Proteus species 8(9.6%) and E. coli 7(8.4%). Overall, 98.6% of all isolates tested against ciprofloxacin were susceptible, and against gentamicin and flucloxacin were 84.8% and 66.7% respectively. 59.3% of isolates tested against chloramphenicol were resistant. We recommend a review on the use of chloramphenicol as first-line antimicrobial therapy among surgical in-patients at Lilongwe Central Hospital. We also recommend restricted use of antimicrobials so as to minimise development of drug resistance. Periodic susceptibility studies are necessary to guide judicious use of antibiotics.     

d-生物素的立体专一性全合成研究

对confaione的d-生物素(1)全合成进行了改进,从半胱氨酸计算,总收率3.7%。5与4-溴代三苯膦丁酸甲酯进行Wittig-Schlosser缩合反应可立体专一性地转化成反式-烯(6)。以叠氮三甲基硅烷代替叠氮化锂亲核进攻9分子中C3-溴原子,可显著地提高顺式-叠氮内酰胺10的收率。     

侵及眶部脑肿瘤的临床特征与显微手术处理

目的 研究侵及眶部的脑肿瘤临床特征与显微外科手术治疗效果。方法 对58例本病经临床分析与影像学检查而获诊断，采用不同手术入路及显微外科技术切除肿瘤。全组病例中，肿瘤位于前颅凹50例，中颅窝8例，均侵及眶腔。其中39例（67．2％）有头痛、头晕等颅内压增高表现，54例（93．1％）出现视器症状。结果 本组46例肿瘤（79．3％）获手术全切除，12例（20．7％）为次全切除，无死亡。对48例经信访或门诊随访6个月-9年（平均3．6年），39例（81.3％）恢复满意，余9例（18．7％）有不同程度后遗症。结论 脑肿瘤侵及眶部多以视器改变为主要临床表现。采取不同手术入路、以显微外科技术切除本类肿瘤，预后良好。     

Vertebral Body Infarct and Ventral Cauda Equina Enhancement: Two Confirmatory Findings of Acute Spinal Cord Infarct

Two valuable confirmatory MRI findings of acute spinal cord infarct are highlighted and discussed: concomitant vertebral body infarct and ventral cauda equina nerve root enhancement.