Green urine after surgical treatment of pressure ulcer.

We describe a 58-year-old man who developed green urine after operation on a pressure ulcer. The discolouration disappeared gradually after two days. We think that the use of methylene blue dye during the revision of the wounds and the use of the sedative propofol could have caused it.     

The philosophical and sociological context of mental health care legislation

This paper explores mental health legislation from a philosophical and sociological perspective. It is argued that mental health law exists primarily as a coercive social control instrument and that the maintenance of a separate legislative framework for the mentally ill is based upon dubious legal and philosophical grounds. The need for changes in mental health law has been accelerated by the move in Britain toward care in the community. One of the most important issues at the centre of the debate revolves around the concept of 'dangerousness' and mental disorder. The research into the extent to which the risk of violence can be predicted appears problematic from a reform perspective. Prediction is considered to be the overriding problem that leads to a violation of patients' civil rights, especially in relation to black and ethnic minority groups. Equity in law is necessary for the protection of patient's rights and particularly for the protection of those people who enter mental health care systems concerned with issues of control at the expense of care.     

Stimulation with human menopausal gonadotropin versus follicle-stimulating hormone after pituitary suppression in polycystic ovarian syndrome

Stimulation with human menopausal gonadotropin (hMG) or follicle-stimulating hormone (FSH) was compared in 34 patients with polycystic ovarian syndrome after pituitary gonadotrope suppression with buserelin acetate. No differences were seen in the hormone parameters observed. Also, the duration of the stimulation period and the dose of gonadotropin used were the same. In both groups a multifollicular response was seen. Oocyte retrieval and in vitro fertilization resulted in identical ratios of mature to total oocytes and cleavage rates. Nine pregnancies occurred, four in the hMG group and five in the FSH group. Of the nine pregnancies, two were the result of transfer of frozen-thawed embryos in estradiol and progesterone substituted cycles.     

The origins of insane asylums in England during the 19th century: a brief sociological review

This paper explores the origins of insane asylums in 19th century England by comparing the official 'received' medically dominated perspective with an alternative sociological perspective The major structural changes in provision are addressed as the focus for analysing the differing histories A brief review is presented of the responses to insane people prior to the national asylum programme following the 1845 Lunacy Act, and of the reform logic that underpinned asylum care The alternative sociological perspective presents the origins of psychiatric asylums as part of the social and economic changes occuring generally at that time As such the origins of insane asylums are presented as part of a state-guided 'sanitary'movement which included poor, criminal and insane people within its remit The effect of state-guided correction was the segregation of insane people from both the general population and other deviants who were formerly classed together Insane people are thus presented as a group of deviants who departed most radically from the 'rational individualist' qualities of self-control, predictability and responsibility required in the industrialized world of capital social relations that emerged during the last century     

No effect of an oleoylethanolamide-related phospholipid on satiety and energy intake: a randomised controlled trial of phosphatidylethanolamine

Background  

Phosphatidylethanolamine (PE) is a phospholipid which is biosynthesized into long chain N-acylethanolamines (NAEs) including oleoylethanolamide (OEA), a known inhibitor of food intake. The aim of this study was to investigate whether PE-containing lipids can also inhibit intake. This was a 4 treatment intervention where 18 male participants were given a high-fat test breakfast (2.5MJ, 53 en% fat) containing (i) high-phospholipid, high-PE lipid (ii) high-phospholipid, medium-PE lipid (iii) no-phospholipid, no-PE control lipid or (iv) water control, in a randomised cross-over. Visual analogue scales (VAS) were used to assess post-ingestive hunger and satiety, and energy intake (EI) was measured at an ad libitum lunch meal after 3.5hours.     

Cleft lip and palate versus cleft lip only: are they distinct defects?

Cleft lip defects are usually regarded as a single entity, with the assumption that an accompanying cleft palate represents the more severe form. The authors linked data from the Medical Birth Registry of Norway with medical records from two centralized centers to provide a population-based data set. They assessed the distribution of cleft lip only and cleft lip with cleft palate by covariate. Among 1.8 million Norwegian livebirths between 1967 and 1998, there were 1,572 cases of cleft lip with cleft palate and 1,122 cases with cleft lip only. Seventeen percent of those with cleft lip and palate had another defect compared with 9% of those with cleft lip only. For boys, the risk was greater for cleft lip and palate than for cleft lip only (odds ratio=2.4 vs. 1.8, p<0.001 for difference). The risk of cleft lip only, but not of cleft lip and palate, was increased for twins (odds ratio=1.6 vs. 1.1, p=0.11) and infants whose parents were first cousins (odds ratio=2.7 vs. 0.7, p=0.07). Although cleft lip with cleft palate may simply represent a more severe form of the defect, epidemiologic assessments of cleft lip should, when possible, include separate analyses of these two groups.     

Variants of developmental genes (TGFA,TGFB3, and MSX1) and their associations with orofacial clefts: a case-parent triad analysis

We selected 262 case-parent triads from a population-based study of orofacial clefts in Norway, and examined variants of developmental genes TGFA, TGFB3, and MSX1 in the etiology of orofacial clefts. One hundred seventy-four triads of cleft lip cases (CL+/-P) and 88 triads of cleft palate only cases (CPO) were analyzed. There was little evidence for an association of any of these genes with CL+/-P. The strongest association was a 1.7-fold risk with two copies of the TGFB3-CA variant (95% CI=0.9-3.0). Among CPO cases, there was a 3-fold risk with two copies of the TGFA TaqI A2 allele, and no increase with one copy. Assuming this to be a recessive effect, we estimated a 3.2-fold risk among babies homozygous for the variant (95% CI=1.1-9.2). Furthermore, there was strong evidence of gene-gene interaction. While there was only a weak association of the MSX1-CA variant with CPO, the risk was 9.7-fold (95% CI=2.9-32) among children homozygous for both the MSX1-CA A4 allele and the TGFA A2 allele. No association of CPO with the TGFA variant was seen among the other MSX1-CA genotypes. In conclusion, no strong associations were found between CL+/-P and variants at these three genes. There was a possible recessive effect of the TGFA TaqI variant on the risk of CPO, with a 3-fold risk among children homozygous for the variant. The effect of this TGFA genotype was even stronger among children homozygous for the MSX1-CA A4 allele, raising the possibility of interaction between these two genes.     

Serum prolactin and radiological skull examinations in infertile men with azoospermia or severe oligozoospermia

Measurements of serum prolactin, FSH, LH, testosterone, and oestradiol and radiological examinations of the skull were carried out in 142 infertile men with sperm counts below 10 millions/ml. The prolactin levels were compared to those observed in 27 fertile men. Six of the infertile men showed high levels of prolactin. Two of these men had earlier been hypophysectomized, and the sella turcica was found to be abnormal on the roentgenograms. In the remaining four men the sella turcica was normal, and serum gonadotrophins, testosterone and oestradiol were within normal range, except for one man who displayed a very high FSH. The testis biopsies from these four men showed severe hypoplasia, signalling that treatment of the infertility with bromocriptine may be of limited value.