The use of varicography to identify the sources of incompetence in recurrent varicose veins

We have studied patients with recurrent varicose veins which were incompletely controlled by a thigh tourniquet. We used varicography, (a phlebogram via the varices), to detect sites of incompetence. Thirty patients (mean age 46 years) were investigated, 38 limbs being subjected to varicography and surgery. A primary operation had been performed between 3 months and 30 years earlier. A non-thrombogenic contrast medium, sodium meglumine ioxaglate 320 (Hexabix 320) was used. Metal markers were placed alongside the limb to identify the site of perforating veins on the phlebograms. The principal value of the technique was in the identification of mid-thigh perforator incompetence (MTPI) as we cannot diagnose this accurately by clinical or Doppler-ultrasound examination. Varicography demonstrated MTPI in 15/38 limbs (39%) and in only one thigh was this not confirmed at exploration. Varicography can demonstrate short saphenous incompetence and this was mainly of value in 3 patients who had previously undergone attempted short saphenous ligation; in all 3 the short saphenous vein was present and had not been ligated. The technique was less useful in demonstrating recurrence in the groin. Overall varicography influenced the operation performed in 17/38 limbs (45%), its main value being in the diagnosis of MTPI.     

The graying of America: optometric considerations. Introduction

Normal and abnormal effects of aging impact greatly on individuals and their families. Health care providers must therefore be knowledgeable about how to care for elderly persons. In order to interact among elderly persons and within the aging network, optometrists need to have a broad understanding of gerontology.     

Plasma pyruvate kinase and creatine kinase activity in Becker muscular dystrophy

Plasma creatine kinase (CK) and pyruvate kinase (PK) were measured in 31 obligate carriers of Becker muscular dystrophy (BMD), 36 BMD patients and appropriate controls. Mean plasma CK was 108 U/l in obligate carriers and 62 U/l in 43 age- and sex-matched controls (P less than 0.001 carriers vs controls). Control CK reference range was 31-125 U/l (mean +/- 2 SD of log transformed values). Mean plasma PK was 40 U/l in obligate carriers and 34 U/l in 56 controls (P less than 0.02 carriers vs controls). Control PK reference range was 18-61 U/l. Values of CK above the reference range upper limit were found in 13 of 31 BMD obligate carriers but only 2 showed elevated PK values. The sensitivity of CK in determining BMD carrier status, although only 42%, was markedly better than PK at 6.5%. Mean plasma CK in BMD patients was 2366 U/l, a 19-fold increase over the control value of 127 U/l (P less than 0.001 patients vs controls). Control CK reference range was 40-316 U/l. In contrast, mean plasma PK in BMD patients was 353 U/l, only 7-fold higher than the mean control value of 57 U/l (P less than 0.001 patients vs controls). Control PK reference range was 22-126 U/l. Clearly, the estimation of plasma PK as a means of determining BMD carrier status is markedly inferior to CK. Previous reports of increased sensitivity of PK compared with CK may have been due to artefactually elevated PK levels produced during sample preparation.     

Maternal and paternal alcohol consumption and miscarriage

Summary. To explore the role of parental alcohol consumption in miscarriage we interviewed 80 women who miscarried about their own and their partners' drinking habits. A control group of 81 gestational-age-matched women whose pregnancy ended in the delivery of a healthy infant at term were similarly questioned. The use of alcohol by women and men was equally frequent in both groups. Before pregnancy, the mean alcohol consumption per week had been about 1–2 drinks for the women and 4–5 drinks for the men. During the presumed day of conception, 13% of the women who miscarried and 11% of the women in the control group had drunk on average 3–4 drinks; the other women had been abstinent at this time. Of the partners, 13% and 15%, respectively, had taken a mean of 4–5 drinks. In both groups 58% of the subjects continued to consume alcohol during pregnancy. The mean consumption was about one drink a week by the women who miscarried and half a drink a week in the control group. Of women who miscarried, 36 had a blighted ovum and in this subgroup alcohol consumption in both women and men was similar to that in the other women who miscarried and their partners, suggesting that alcohol is not causally related to the development of a blighted ovum. These results suggest that moderate maternal or paternal alcohol consumption does not increase the risk of miscarriage.     

The psychiatric patient's right to self-determination: a preliminary investigation from the professional nurse's point of view

The aim of this preliminary empirical investigation was to explore the concept of self-determination and to discuss its applicability to psychiatric nursing. The data were collected with a questionnaire submitted to professional nurses ( n =127) working on long-term wards in four Finnish hospitals. Data analysis combined the methods of content analysis and quantitative statistics. A tentative concept apparatus was created in order to provide nursing science with a broader understanding of the issue at hand. Nurses identified various factors that act to restrict and to support self-determination: the most common restrictive factor was the patient's illness or condition, and the most common supportive factor was nursing intervention. Views differed on the importance of self-determination in the case of psychiatric patients; over half of the nurses described the right to self-determination as very important. On the basis of the findings it is concluded that self-determination is a valid concept for the psychiatric patient. It was also thought to serve the needs of education as well as evaluation.