The Surgical Treatment of Duodenal,Gastric and Anastomotic Ulcer

The surgical significance of the anatomic structure and the physiologic function of the various divisions of the stomach are presented, together with a discussion of the relative merits of the most commonly employed surgical operations for duodenal, gastric and anastomotic ulcer.     

Organised Assistance to Suicide in England?

Guidelines provided by the Director of Public Prosecutions suggest that anyone assisting another to commit suicide in England and Wales, or elsewhere, will not be prosecuted provided there are no self-seeking motives and no active encouragement. This reflects the position in Switzerland. There, however, no difference is made between assistance and inducement. In addition, the Swiss approach makes it possible to establish organisations to assist the suicides of both their citizens and foreign visitors. It should not be assumed that this approach is without controversy in Switzerland. Proposals for reform continue to be debated there, not least because of the concern about some of the actual practices of certain end-of-life organisations. It is likely that a few English citizens will continue to avail themselves of these services in Switzerland if they cannot find the help they require here. This paper explores the legitimacy of the current restrictive position adopted towards assisted suicide in England. It argues that the provisions within the guidelines prohibiting organisations that assist suicides, leaves some without the help they need. While legislative decriminalisation of assisted suicide and the establishment of state-sponsored suicide centres would represent the most permissive regime, this paper proposes that this would be a step too far. The preference here is for decriminalisation but adopting a ‘middle way’ between the two extremes: the more permissive approach provided by the ‘Swiss model’ is one that could be employed here, albeit within a more robust regulatory regime.     

Rebuilding health systems to improve health and promote statebuilding in post-conflict countries: A theoretical framework and research agenda

Violent conflicts claim lives, disrupt livelihoods, and halt delivery of essential services, such as health care and education. Health systems are often devastated in conflicts as health professionals flee, infrastructure is destroyed, and the supply of drugs and supplies is halted. We propose that early reconstruction of a functioning, equitable health system in countries recovering from conflict is an investment with a range of benefits for post-conflict countries. Building on the growing literature about health systems as social and political institutions, we elaborate a logic model that outlines how health systems may contribute not only to improved health status but also potentially to broader statebuilding and enhanced prospects for peace. Specifically, we propose that careful design of the core elements of the health system by national governments and their development partners can promote reliable provision of essential health services while demonstrating a commitment to equity, strengthening government accountability to citizens, and building the capacity of government to manage core social programs. We review the conceptual basis and extant empirical evidence for these mechanisms, identify knowledge gaps, and suggest a research agenda.     

The surgical treatment of adrenal disease

Since the advent of cortisone replacement therapy in 1950 made adrenal surgery possible, it has had the reputation of being fraught with medical and technical difficulties. However, with good endocrine medical cooperation, expert anaesthesia and sound technical expertise, excellent results are obtainable.     

Challenges facing general internal medicine in the 99th Congress

Since 1976, federal support for training in general internal medicine has been provided through the primary care residency programs under Title VII of the Public Health Service Act. Continuation of these programs is now in jeopardy because of severe fiscal pressures and the response of Congress to the resulting budgetary stringency. General internal medicine faces immediate problems in the budgetary, authorization, and appropriations arenas. However, Congressional proposals for changing the method by which Medicare pays for all graduate medical education may provide an important opportunity. Under a revised method of financing graduate medical education, general internal medicine could eliminate its historical dependence on increasingly unstable federal grant funds and could contribute to the development of new federal incentives for training in the primary care specialties.     

The structural characterization of endogenous factors from Vinca rosea crown gall tumors that promote cell division of tobacco cells.

The ability of two compounds, a cytokinin and an auxin, to stimulate tobacco cell growth and differentiation has been known for greater than 30 years, but the molecular mechanism of this activation is still unknown. Previous reports of factors endogenous in crown gall tumors of Vinca rosea that could replace the cytokinin requirement in tobacco cell culture has motivated an investigation of these tissues. The optimization of a reverse-phase isolation scheme has led to the purification of sufficient material to allow for the identification of six different related compounds. The structures of two of these compounds have been assigned as a set of epimeric dehydrodiconiferyl alcohol beta-D-glycosides. The structure of these compounds suggests that they would most likely be derived from the plant cell wall.     

Association of mesenchyme with attenuated basement membranes during morphogenetic stages of newt limb regeneration

The interface between epithelium and mesenchyme may be involved in inductive interactions which occur during development. This interface within the growth bud, or blastema, of a regenerating limb has been examined to determine whether changes in basement-membrane structures are visible in regions of putative epithelial-mesenchymal inductive interaction. Regenerating forelimbs of adult newts were fixed by perfusion with osmotically balanced aldehydes. Late-bulb to early-digit stage regenerates were collected and processed either for light and transmission electron microscopy or for scanning electron microscopy. Light microscopy confirmed that regions characterized by increased numbers of subepithelial mesenchymal cells were covered by a diffusely stained basement membrane. Transmission electron microscopy of these regions revealed two structural components of the basement membrane. The thin basal lamina was continuous in all regions of all stages examined, but it was attenuated apically in areas of mesenchymal cell accumulation. The thicker underlying reticular lamina was markedly attenuated in these regions near the blastemal apex. Scanning electron microscopy of de-epithelialized blastemas revealed that, apically, the reticular lamina formed only a delicate lacelike network. On the base of the blastema, it formed a dense fibrillar meshwork which was further organized into a geometric pattern in the adjacent stump skin. Cumulatively, these observations suggest that physical contact between epithelial and mesenchymal cells is not essential at these stages, but that regions of putative epithelial-mesenchymal interaction are characterized by a distinctly diminished reticular lamina. Structural changes in basement-membrane components may be related to termination of local inductive events.     

The etiology of medical gridlock: Causes of emergency department overcrowding in New York City

Overcrowding of emergency departments in New York City is the most apparent symptom of a crumbling health care system. There is a growing need for the care of a largely impoverished population suffering from an increasing prevalence of AIDS, substance abuse, and psychiatric disease. Institutions crippled by critical shortages of inpatient beds and nurses lack the resources to meet this rising demand. Although the epidemic of medical gridlock began in New York City, it is spreading rapidly to involve other areas of the country. Short-term efforts to resolve this crisis have thus far been unsuccessful. Long-range solutions are likely to be costly and may require a reconfiguration of societal health care priorities.     

Storytelling, hypnosis and the treatment of sexually abused children

The present article describes an assessment and therapy program for sexually abused children using hypnotherapeutic techniques which center on storytelling. Storytelling presents the therapist with an opportunity to use comforting suggestions, symbolism, and metaphor to provide the emotional distance necessary to deal with the trauma of abuse. Hypnotherapy proceeds in a stepwise fashion from the building of a sense of safety and security; to imaginative sharing; to the introduction of reality events; to the final step of addressing complex emotional issues of loss, trust, love, and guilt brought about by the abuse.