Percutaneous retrieval of an impacted ureteric T-tube

An impacted ureteric T-tube was removed percutaneously, using an Amplatz goose-neck snare. This new snare has advantages over conventional snares, particularly in situation where atraumatic manipulation is essential. Correspondence to: R. D. Edwards     

Educational and geographic career pathways of rural vs. urban hospital administrators

Information on academic and geographic career patterns was obtained through a survey of 93 urban and rural hospital administrators in the State of Washington in 1990 (90 percent response rate). A greater proportion of urban than rural administrators had advanced degrees (93 versus 74 percent). While the most common career pathways were "always urban" (39 percent) and "always rural" (20 percent), there was little support for the presumption that hospital administrators use rural positions as stepping stones into urban careers.     

A double-blind controlled comparison of fluoxetine and lofepramine in major depressive illness

One hundred and eighty three patients with DSM-III-R major depressive illness were allocated randomly to treatment with one of two new generation antidepressants, fluoxetine and lofepramine. Both patient groups had significantly lower mean scores on the Hamilton Depression Rating Scale (HDRS) 6 weeks after entry to the trial (p < 0.001), but there were no differences between the groups, either at baseline or after 6 weeks, in total HRDS score or in subscores for anxiety or suicidality. Anticholinergic side effects were commoner with lofepramine; adverse effects were on the whole mild and few patients dropped out because of them. This study does not support previous claims of specific adverse effects of fluoxetine on anxiety and suicidality.     

Intracerebral haemorrhages in surfactant treated neonates with severe respiratory distress syndrome: age at diagnosis,severity and risk factors

Within a randomized European multicentre trial the time of onset, severity and progression of intracerebral haemorrhages (ICH) were investigated prospectively by serial cranial ultrasonography in 343 ventilated infants with severe respiratory distress syndrome (RDS) following instillation of single or multiple doses of a natural porcine surfactant (Curosurf). In 148/343 infants (43%) ICH was diagnosed (grade I or II: 22%, grade III or IV: 21%). In 26 cases (8%) ICH was present on the ultrasound scan prior to surfactant instillation at a median age of 6h. Incidence and severity of ICH was similar after single- or multiple-dose surfactant treatment. Using a logistic regression model the following risk factors predictive of ICH were defined: low birth weight, allocation to certain hospitals, vaginal delivery, Apgar score6, rectal temperature on admission 36°C, primary anaemia, acidosis prior to treatment, RDS grade IV in pre-treatment chest films and poor response to surfactant treatmentOur study provides supportive evidence that multiple doses of Curosurf do not increase the risk for ICH as compared to single-dose administration.A preliminary report of this work was presented at 8th International Workshop on Surfactant Replacement, Oslo, Norway, May 21 1993. The study was supported by grants of the German government (BMFT 93 607 27) and the German Research Council (Deutsche Forschungsgemeinschaft He 2072: 1–2). The surfactant used in the trial was prepared ang tested in Stockholm with the skilful technical assistance of Elin Arvesen, Bim Linderholm. Eva Lundberg, Gunhild Nilsson and Petru Popa (supported by the Swedish Medical Research Council (Project No. 3351) and Oscar II:s Jubileumsfond)Dedicated to the memory of Edgar (Eddi) Laufkötter, one of the most active trial collaborators, who died under tragic circumstances on April 10, 1994.     

The National Human Exposure Assessment Survey (NHEXAS) study in Arizona--introduction and preliminary results.

The objective of the National Human Exposure Assessment Survey (NHEXAS) in Arizona is to determine the multimedia distribution of total human exposure to environmental pollutants in the classes of metals, pesticides, and volatile organic compounds (VOCs) for the population of Arizona. This was accomplished by studying a probability-based sample of the total population in Arizona with a nested design for the different stages of sampling (954 Stage I, 505 Stage II, and 179 Stage III participants). This report compares the study population demographics with those from the U.S. Census and provides preliminary data on the distributions of the example pollutant for each class, lead for metals, chlorpyrifos for pesticides, and benzene for metals. The probability-based sample age and gender demographics compare reasonably well with the Census data (1990 Census and 1996 Census Estimate). The race/ethnicity compared less well with 21% Hispanics in the 1996 Census Estimate and 42% Hispanics in the entire NHEXAS-Arizona sample and 30% Hispanics as Stage III participants for this study. The chemical analyses of the various media (yard soil, foundation soil, house dust, indoor air, outdoor air, drinking water, food, and beverage) show generally low levels of the representative pollutants. The 50th percentiles of the distributions are generally near or below the analytical detection limits, and applicable Federal action limits were rarely exceeded.     

Alterations of neuronal activity in the superior colliculus of rotating animals

We have investigated the relationship between alterations in neuronal activity in the superior colliculus and behavioral responses which occur following disruption of basal ganglia circuitry. These changes were analysed following unilateral suppression of the immediate early genes, c-fos and ngfi-a, in the striatum and/or the globus pallidus. Animals with unilateral suppression of immediate early gene expression in the striatum exhibited robust circling activity, following administration of D-amphetamine, that was directed towards the side of suppression. The intensity of rotation was inversely related to the length of the recovery period following antisense infusion and increased significantly when the globus pallidus was infused simultaneously with the striatum. The difference between ipsiversive (towards the antisense-infused hemisphere) and contraversive rotations was calculated and animals were grouped by number according to their ipsiversive bias: I, <50 turns; II, 50-500 turns; III, 500-1000 turns; IV, >1000 turns. Immunohistochemical localization of Fos was used as an indicator of neuronal activity in the superior colliculus. While group I animals showed diffuse Fos-like immunoreactivity throughout the intermediate layers of the superior colliculus, those animals in groups II-IV showed increasing suppression of Fos-like immunoreactivity in the stratum album intermediale and marked enhancement in the stratum griseum intermediale. Correlation and regression analysis revealed a significant positive relationship between the number of ipsiversive rotations and the number of Fos-positive nuclei in the stratum griseum intermediale of the ipsilateral superior colliculus. These data suggest that the degree of rotation elicited in an animal may depend on reciprocal suppression/stimulation of adjacent intermediate strata of the superior colliculus. This study provides the first demonstration, using Fos immunohistochemistry, of changes in tectal activity produced by alterations in basal ganglia function. These findings support previous electrophysiological studies in this region and suggest that the nigrotectal projection may be an important site of altered basal ganglia output.     

The prevalence of Gilles de la Tourette syndrome in children and adolescents with autism: a large scale study

BACKGROUND: An earlier small-scale study of children with autism revealed that 8.1% of such patients were co-morbid for Gilles de la Tourette syndrome (GTS). The present study is a large scale test of whether this result replicates. METHOD: Four hundred and forty-seven pupils from nine schools for children and adolescents with autism were screened for the presence of motor and vocal tics. RESULTS: Subsequent family interviews confirmed the co-morbid diagnosis of definite GTS in 19 children, giving a prevalence rate of 4.3%. A further 10 children were diagnosed with probable GTS (2.2%). CONCLUSIONS: These results indicate that the rate of GTS in autism exceeds that expected by chance, and the combined rate (6.5%) is similar to the rates found in the smaller-scale study. Methodological considerations and alternative explanations for an increased prevalence are discussed.     

The views and outcomes of consenting and non-consenting patients receiving ECT

BACKGROUND: Current mental health legislation in the UK makes provision for the use of certain treatments in severely ill patients who are unable, or unwilling, to give informed consent. Under the terms of this legislation, electroconvulsive therapy (ECT) may be used, usually to treat severely depressed patients. A number of organizations have challenged this practice, stating that ECT should only be given with fully informed consent: it has been implied that patients receiving compulsory ECT (given without the patient's consent, under the terms of mental health legislation) find the treatment damaging and unhelpful. METHODS: A series of 150 patients receiving ECT in Aberdeen was studied. A proportion of the series (approximately 7%) received compulsory ECT. The views and treatment outcomes of compulsory patients were compared with those of patients giving informed consent for treatment. RESULTS: More than 80% of patients in both consenting and compulsory groups considered ECT to have helped them. Clinical outcome did not differ between the groups. Patients' views showed marked concordance with independent medical evaluation of outcome. CONCLUSIONS: Outcome following ECT in non-consenting patients is equivalent to that seen in consenting patients whether rated by the patients themselves or by clinicians. Overall outcome is good, with more than 80% of patients benefiting from treatment. A ban on compulsory ECT would deny the access of seriously ill patients to an effective and acceptable treatment.