Clinicians into management: on the change agenda or not?

This article examines the issue of drawing medical consultants into managerial decision making. It commences by examining both historically and comparatively the influences on doctors and their reluctance to adopt managerial roles and responsibilities. It progresses to an analysis of the impact of the NHS and Community Care Act particularly in relation to the separation of purchaser and providers and the development of contracting mechanisms. The argument presented suggests that the rapid adoption of the clinical directorate model, as the favoured mode of organisation in acute units, has led to clinicians assuming 'imitation' general manager roles. The authors question whether this is the best use of the unique skills and time of clinicians. They compare with experience in the USA and propose that collaborative working between doctors and general managers is essential in health care. The article suggests a set of tasks for clinician managers and then discusses the issues of training support and development which will be required if clinicians are to perform these tasks effectively.     

Prostaglandins in experimental syphilis: treponemes stimulate adherent spleen cells to secrete prostaglandin E2, and indomethacin upregulates immune functions.

Incubation of microorganisms with macrophages enhances the production of prostaglandin E2 (PGE2). Previous research had indicated that macrophages from syphilitic rabbits suppressed spleen cell synthesis of interleukin-2 (IL-2); this suppressive activity was reversed by indomethacin. Experiments were designed to further characterize the involvement of prostaglandins in immune processing. When Treponema pallidum was incubated with unfractionated spleen preparations, PGE2 production was accelerated, and within 24 h, pharmacologic concentrations of the prostaglandin were detected. When cytochalasin B was used to block phagocytosis, decreased levels of PGE2 were apparent. Commercial preparations of PGE2, in the range generated by macrophage-treponeme interaction, inhibited concanavalin A-induced IL-2 secretion by splenic cells. T. pallidum stimulated IL-1 production by adherent cells, and indomethacin markedly enhanced this effect. In vivo, indomethacin upregulated immune function. Two groups of rabbits were infected, and one was given daily injections of indomethacin for 18 days. Both groups were treated with penicillin to terminate infections. One week later, rabbits were challenged with viable organisms to determine their immune status. The indomethacin-treated group was more resistant to reinfection. In further research, indomethacin enhanced the immunogenicity of vaccine preparations containing heat-killed T. pallidum. Results are discussed in terms of the role of PGE2 as it impinges on immune functions involving macrophage activation (IL-1 production) and T lymphocyte activation (IL-2 production).     

乳酸脱氢酶实验检测细胞新陈代谢的实验研究

目的 探索LDH实验检测细胞活力的可行性。方法 原代培养骨髓细胞和软骨细胞，用LDH实验测定上述两组细胞的活力，并与镜下活体观察到细胞的生长状况相比较。与目前比较成熟的测定细胞活力的MTS实验的测得的值相比较。结果 LDH实验对上述两组细胞的活力的测定结果与镜下活体观察到的结果相符合。与MTS实验的测得的结果经统计学处理无显著差异。结论 LDH实验可用于细胞活力的直接测定，而对活细胞的生存、繁殖无影响。     

The choriocapillaris in spontaneously diabetic rats.

During diabetes in rats, the choroid of the eye shows increased permeability to albumin, basement membrane thickening, and decreased anionic charge sites on the abluminal surfaces of the choriocapillary microvessels. In other microvascular beds, permeability differences are correlated with differences in luminal membrane microdomains as indicated by the distribution of luminal membrane anionic charge. To see whether luminal surface charge distribution or other structural features of the choroidal microvasculature become altered during diabetes, we studied spontaneously diabetic and control rats using ultrastructural tracers and morphometric techniques. Rats were injected with horseradish peroxidase and perfused with aldehydes, and then retina-choroid tissue sections were incubated with cationized ferritin, reacted to visualize peroxidase, and prepared for electron microscopic study. The most striking alterations in the diabetic rats were vascular debris and migrating cells resembling vascular cells in the choriocapillaris stroma, suggesting an increase in capillary turnover. In addition, extracellular matrix material was increased, and peroxidase uptake and ferritin binding were low in some vessels of the diabetic rats compared with the controls. Variability was large in the diabetic animals, however, and other vessels remained apparently normal.     

Azygoesophageal recess: normal CT appearance in children.

The azygoesophageal recess is the interface of the subcarinal portion of the mediastinum and the right lower lobe. The configuration of the recess on CT can be used as a sensitive indicator of abnormality in the mediastinum. In normal adults the recess is concave. A convex contour is a normal variant, particularly in young adults. The normal appearance of the azygoesophageal recess in children has not been studied. Accordingly, we reviewed chest CT examinations performed in 253 children ranging from 1 month to 20 years old. Forty patients were excluded from further analysis either because the recess could not be evaluated properly or because underlying disease caused the mediastinum to have an abnormal configuration. An age-related spectrum of normal configurations was observed in the remaining 213 patients. A convex or straight contour was found in 96% of children less than 3 years old. Scans of children 3-12 years old revealed a spectrum of configurations. The typical adult concave configuration was seen in 78% of adolescents more than 12 years old. Overall, in only 90 (42%) of 213 children in this study was a concave recess observed on CT. Our experience shows a convex azygoesophageal recess on CT should be considered the normal configuration in infants and young children. Recognition of this age-related variation is useful in the CT evaluation of the mediastinum in children.     

Corrosive injury of the oesophagus in childhood

A 10-year retrospective review of 73 children who had ingested a corrosive agent was performed. Presentation, management, and eventual outcome were assessed, and comparisons were made between those who received early medical treatment and those who did not. Results suggested that immediate proper assessment of the oesophagus and institution of appropriate therapy may reduce the incidence of complications associated with treatment of subsequent stricture formation. The importance of oesophagoscopy in the direct visualization of the oesophagus within 24-48 h of the burn is stressed.     

Psychosocial factors, curative therapies, and behavioral outcomes. A comparison of testis cancer survivors and a control group of healthy men

In a retrospective study of 223 testis cancer survivors and 120 controls matched sociodemographically, we examined the relative impact of sociodemographic and clinical factors on long-term outcomes in the areas of sexual function, relationships, employment, and mental outlook. For most of the survivors, testis cancer did not lead to unemployment (4.5%), divorce (6.8%), or disabling psychological problems. Multivariate analysis results confirm that cancer survivors report significantly more infertility and sexual performance distress, but not more desire distress, than the control group. Survivors' sexual impairment varied according to treatment received (and therefore histologic factors) and sociodemographic variables. Parental status (not having children) and education (college or less) independently predict infertility distress, whereas education and lower occupational level independently predicted sexual performance distress. Adjusting for socioeconomic status (SES), the men with advanced testis cancer who received chemotherapy and standard retroperitoneal lymph node dissection (RPLND) had significantly more infertility and performance distress than those men who received other treatments. Neither the treatment or SES variables predicted disrupted relationships or a deteriorated mental outlook. However, men with sexual impairment distress were more likely to report strained relationships and a pessimistic mental outlook. These findings have implications for treatment decisions and can be used to identify subgroups of survivors who could benefit from counseling and sexual rehabilitation services.