Post-prandial lipoprotein metabolism in nephrotic syndrome

Post-prandial lipaemia was investigated in a group of nine subjects with nephrotic syndrome by following the concentrations of triglyceride and retinyl palmitate in the d < 1.006 g ml-1 fraction of plasma after a standard oral fat load containing vitamin A. Lipoprotein lipase and hepatic triglyceride lipase activities were measured in post-heparin plasma. Subjects with other renal disease but insignificant proteinuria acted as controls. The time course of the lipaemic response was similar in both groups although individual patients demonstrated a prolonged lipaemia. Overall, there were no significant differences in the rise in triglyceride at 6 h (nephrotic--median 2.53 mmol l-1; range 0.87-4.76 vs. control 1.88; 0.38-4.12, P = 0.34), the peak concentration of retinyl palmitate (nephrotic 0.87 mg dl-1; 0.27-2.16 vs. control 0.65; 0.24-1.89, P = 0.97) or the areas under the curve from 0-24 h for triglyceride (nephrotic 10.5 mmol. h l-1; 2.9-43.6 vs. control 9.7; 4.3-27.0, P = 1.0) or retinyl palmitate (5.5 mg.h dl-1; 1.0-23.4 vs. 4.3; 1.5-12.4, P = 0.7). At baseline, the particles in the d < 1.006 g ml-1 fraction of plasma from nephrotic subjects had a higher free cholesterol:phospholipid ratio but this difference was no longer apparent 6 h after the test meal. There were no differences in total heparin-releasable lipase, lipoprotein lipase or hepatic triglyceride lipase activities between the two groups. These data suggest that impaired clearance of chylomicrons is not a major contributor to nephrotic hyperlipidaemia in man.     

Ethical concerns in the management of pain in the neonate

The debate about the management of pain in the neonate has continued to evolve over the past 30 years. This controversy can be understood as evolving through now three eras of thought about the effect of pain and its management in newborns and infants. The first generation was characterized by a widespread belief that newborns lacked the complete development of the neuroanatomical and neuroendocrine components necessary to perceive pain. During this period, newborns often received inadequate anesthesia and analgesia for painful procedures, if not no treatment at all. The second generation was heralded by research that demonstrated that newborns did demonstrate similar or even exaggerated physiological and hormonal responses to pain compared with those observed in older children and adults and that exposure to prolonged or severe pain may increase neonatal morbidity. Controversy in this generation focused around the dosage of analgesia to newborns as well as the risks and benefits of pain management techniques. We are now in a third generation of thought about pain in the neonate, defined by intense debate over the significance of a growing number of studies in immature animal models that demonstrate degenerative effects of several anesthetics on neuronal structure. The challenge of this era is to integrate the advances in diagnosis and treatment achieved in previous generations with ongoing adaptation of clinical practice as dictated by research advances in the field. In this review, we examine the evolution of medical thought and ethical concerns regarding pain treatment in the neonate.     

PEER REVIEW OF UTILISATION OF MEDICAL BEDS AT FLINDERS MEDICAL CENTRE

A clinical audit of all medical inpatients was undertaken and the appropriateness of admissions and of length of stay was assessed from a clinical viewpoint on 4 separate days within an 11 day period. In addition, the mode of entry to hospital, length of stay of patients, occupancy rate, and the vacancy interval were analysed for all medical patients during the preceding three months. The mean length of stay of medical patients in hospital during this 3 month period was 5.6 days, with an occupancy rate of 93% and a vacancy interval of 0.43 days. Seventy-four percent of all medical inpatients were admitted through the Accident and Emergency Department (A&E). The short length of stay, high occupancy rate and low vacancy interval indicated that bed usage in the medical wards was efficient. A total of 493 reviews was carried out on 294 individual patients. In 87% of cases, both admission to hospital and length of stay were appropriate on clinical grounds alone. The number of patients whose admission to hospital (11), or length of stay (27) was not justified on medical grounds alone was 38 (13% of total patients). These patients were elderly, or had complex social and psychological problems contributing to their illness. It was concluded that stricter control of admissions or length of stay was unlikely to make a significant number of beds available for other admissions.     

Modification of brief cognitive assessments for use with elderly people from the South Asian sub-continent

Screening tests for the detection of mental health problems in elderly people from ethnic minority backgrounds in the UK need to be culturally sensitive but retain satisfactory diagnostic power in terms of definable mental illness. As part of a multi-disciplinary, multiethnic project in Manchester we present our experience in developing modified versions of the Mini-Mental State Examination (MMSE) and the Abbreviated Mental Test Score (AMTS). Several factors have been proposed as essential prerequisites before validating known tests in a new population. An amalgamation of methods from the literature was employed to modify the instruments. Culturally acceptable versions of the MMSE and AMTS have been developed for use in a wider two-phase study to validate the instrument. This information will provide those working with people from ethnic minority backgrounds, of all ages, with both a thorough and a pragmatic method for modifying and adapting instruments.     

SPONTANEOUS DISSECTION OF THE INTERNAL CAROTID ARTERY

Abstract: Spontaneous dissection of the internal carotid artery has been considered a relatively rare cause of carotid artery occlusion. It is postulated this condition may not be uncommon and that some cases are not recognised.
The condition is characterised by typical clinical and radiological features which should suggest the diagnosis. Despite these suggestive features it appears that recognition of this condition is not widespread and the diagnosis may not be made.
Three cases of spontaneous dissection are reported. The clinical and radiological features will be emphasised and pathogenesis and treatment discussed.     

Staining of Blood Cells with Periodic Acid/Salicyloyl Hydrazide (PA-SH): A Fluorescent Method for Demonstrating Glycogen

Stoward¹ conjugated acidified solutions of salicyloyl hydrazide with thedialdehydes formed from the periodic acid oxidation of vicinal glycols in guineapig tissue sections. The method has now been utilized, with minor modification, to demonstrate glycogen in blood and marrow cells, and it has beencompared with the periodic acid-Schiff reaction and with a fluorescent acriflavine Schiff-type method. It is felt that the PA-SH method will replace theexisting Schiff-type fluorescent methods and that it will prove to be a usefultechnic to aid in the diagnosis of blood conditions, such as acute leukemia,where PAS positivity is known to occur.

Submitted on December 27, 1965 Accepted on March 26, 1966