Development of self-assessment skills in medical students

The purpose of this study was to examine the ability of third-year medical students to evaluate accurately their own level of knowledge and performance of skills associated with anaesthesia. A total of 130 students participated in the project by completing a self-assessment form which was later matched with the corresponding instructors' evaluation. Analysis of the data identified only 4.6% of the students' self-assessments to be in general agreement with those evaluations prepared by their instructors. When the data was divided according to the placement of the anaesthesia clerkship within the third-year curriculum no significant trends of any type were shown. Students did not improve in the course of the year in their ability to evaluate themselves accurately according to the objectives established by their clinical instructors. The nature of the evaluations prepared by the clinical instructors remained fairly constant, indicating that their objectives and criteria for acceptable performance remained unchanged throughout the year.     

MALIGNANT SYPHILIS (LUES MALIGNA) AND CONCURRENT INFECTION WITH HIV

Background. During the past 2 1/2 years we observed six patients who had a reactive serology for syphilis, of which four developed widespread noduloulcerative and two vesiculonecrotic lesions. The purpose was to report the occurrence of lues maligna, a rare form of secondary syphilis, in five patients infected with the human immunodeficiency virus (HIV) and in one patient with risk factors for infection. Methods. Tzanck preparations, viral cultures, and skin biopsies were performed to evaluate the etiology of the lesions. Results. Syphilis serology titers ranged from 1:32 to 1:128 and in one instance was as low as 1:8. Such titers can also be found in patients with the latent form of syphilis. Therefore, confirmation of the clinical diagnosis of lues maligna was dependent on skin biopsies that were compatible with secondary syphilis and negative viral studies that excluded varicella, disseminated varicella-zoster or herpes simplex. Lues maligna takes an aggressive course in HIV-infected patients since four of the patients required hospitalization and the two patients who refused to complete treatment, subsequently developed more severe skin and constitutional symptoms. Conclusions. HIV-infected patients are at risk for developing lues maligna. Despite its malignant presentation, lues maligna lesions respond rapidly to treatment with penicillin. Secondary syphilis should be added to the list of diseases known to be more aggressive in HIV-infected patients.     

Follow-Up of a Minute Ventilation Rate Adaptive Pacemaker

Although rate adaptive pacemakers are now frequently prescribed, there is limited information regarding long-term follow-up of patients with a pacemaker capable of rate adaptation. We have examined our patients in whom a pacemaker capable of rate adaptation via a sensor that determines minute ventilation has been implanted. After following a group of 42 patients for a mean of 13.2 months we have found this to be a reliable rate adaptive pacing system. The sensor was reliable long term, the system is easy to program, and sensor settings were changed infrequently.     

Functional neuroanatomy of visually elicited simple phobic fear: Additional data and theoretical analysis

We investigated central nervous system correlates of simple phobie fear, Regional cerebral blood flow (rcBF) was measured using position emission tomography(PFT) in eight volunteers with symptomatic spider phobia that were exposed to visual phobogenic and neutral stimuli Diazepam (0.1 mg/kg body weight i.v.) or placebo was administered under double blind conditions after initial PFT scans. The PFT scans were then repeated. The presence of fear was confirmed by rating procedures and increased number of nonspecific electrodermal fluctuations and by higher heart rate during phobic than during neutral stimulation. Phobic as compared to neural stimulation elevated the retional to whole brain (relative) CBF in the secondary visual cortex but reduced relative rCBF in the hippocampus, prefrontal, orbitofrontal, ttemporopolar, and posterior cingulated cortex. Dia/epam treatment did not affect the relative rCBF or the subjective or physiological fear indices. The observed rCPF pattern replicates our previous findings in snake phobics (M. Fredrikson et al.[1993] Psychophysiology, 30 , 127, 131 G. Wik et al. [1993] Psychiatry Research (Neuroimaging), 50 , 15–24) and indicated that fear and anxiety affect cortical areas outside the classic limbie system areas.     

GAIT ANALYSIS: A PILOT STUDY--A POSSIBLE MODE OF ASSESSMENT OF LOWER LIMB FUNCTION IN JUVENILE CHRONIC ARTHRITIS

There is a need for some form of objective assessment of gaitwhich can be used clinically. A method which measures the temporaland distance factors has been employed to assess the gait ofpatients. Variables have been selected which reflect the gaitsymmetry and others have been chosen which show the speed ofwalking and how this is achieved. The method of presentationof results is discussed with particular attention to the useof these results in monitoring the progress of the patient.     

AN EXAMINATION OF AUTONOMIC NERVOUS FUNCTION IN GENETICALLY DIABETIC MICE

1 This study was designed to determine whether the autonomic innervation of the heart and vas deferens in genetically diabetic mice exhibited dysfunction similar to those seen in chemically diabetic animals and diabetic patients. 2 Diabetic mutant mice (outcrossed from the C57 BL/KS db/db strain) were compared with their non-diabetic litter-mates at age 20 to 22 weeks. Right and left atria and vasa deferentia were removed from freshly killed animals and subjected to nerve stimulation and treatment with noradrenaline (NA) or acetyl-choline (ACh) in organ baths. 3 Right atria from diabetic animals were less responsive to noradrenergic nerve stimulation than control preparations but there was no such difference between the noradrenergic responses of left atria from the two groups of mice. Both atria were hypersensitive to exogenous NA. 4 Atria from diabetic mice responded to cholinergic nerve stimulation and exogenous ACh in a fashion similar to those of non-diabetic mice. Likewise the responses of vasa deferentia to nerve stimulation were similar in the two groups. These findings are indicative of some autonomic nervous dysfunction characteristic, to an extent, of diabetes mellitus.     

Acetone Potentiation of Rat Liver Injury Induced by Trichioroethylene-Carbon Tetrachionde Mixtures

Acetone Potentiation of Rat Liver Injury Induced by Trichloroethylene-CarbonTetrachloride Mixtures. CHARBONNEAU, M., OLESKEVICH, S., BRODEUR,J., AND PLAA, G. L.(1986) Fundam. Appl. Toxicol. 6, 654–661.Acetone potentiation of haloalkane-induced hepatotoxicity iswell recognized. Others reported that trichloroethylene (TCE)can potentiate the hepatotoxicity induced by CCl₄ The purposeof the present study was to determine if acetone (A) can potentiatethe hepatotoxicity of haloalkane (HA) mixtures. We derived dose-responsecurves for the potentiation of TCE, CCl₄ and TCE-CCl₄ inducedhepatotoxicity by acetone. Male Sprague-Dawley rats receivedacetone (0.25-1.5 ml/kg, po); 18 hr later, they received anip injection of either TCE, 0.25 ml/kg; CCl₄ 0.1 or 0.6 ml/kg;or a mixture of TCE and CCl₄. Rats were killed 24 hr later,the livers excised, and plasma ALT activities and bilirubinconcentrations determined. Histological evaluations were alsoperformed. Neither A, TCE, or both in combination modified thebiochemical indices. Acetone potentiation of CCl₄ liver injurywas greater than TCE-potentiation of CCl₄ Acetone enhanced thehepatotoxic response of the TCE-CCl₄. mixture. Thus, CCl₄ hepatotoxicitywas enhanced by the simultaneous administration of TCE, andthis response was potentiated by the previous administrationof acetone.