Polyp Masquerading as Orbital Blowout Fracture

A case report is presented describing an orbital blowout fracture with a coincidental contra-lateral maxillary polyp masquerading as a second blowout fracture.     

Family health services authorities and community pharmacists at the purchaser-provider interface

The views of both purchasers (family health services authorities [FHSAs]) and providers (community pharmacists) were sought on the development of community pharmaceutical services in the light of the 1992 pharmaceutical care report. Questionnaires were posted to the 480 pharmacists in charge of all community pharmacies in Wessex and to the 98 general managers of FHSAs in England and Wales. The questionnaires focused on reactions to those recommendations of the pharmaceutical care report which, if implemented, would have significant implications for the community pharmacist's workload. Both the FHSAs and community pharmacists indicated that, in their view, the skills of the community pharmacist are currently underutilised. Both groups expressed enthusiasm for the pharmaceutical care report recommendations that the following services should be provided: domiciliary services, disposal of unwanted medicines, supply of aids for disabled people, supply of compliance aids and adverse drug reaction reporting. Neither group was enthusiastic about pharmacists providing a therapeutic drug monitoring service from community pharmacies. On other areas, pharmacists were more enthusiastic about the provision of health advice, diagnostic/screening services and treatment protocols, while FHSAs favoured distribution of welfare foods, needle exchange, instalment dispensing and referral forms. Overall, both the FHSAs and community pharmacists were receptive to the principle of the development of the role of the community pharmacist within the primary health care team but expressed concerns regarding the training and workload implications.     

EFFECT OF ANAESTHESIA AND SURGERY ON THE PRE-S-PHASE CELL CYCLE KINETICS OF MITOGEN-STIMULATED LYMPHOCYTES OF PREVIOUSLY HEALTHY PEOPLE

The influence of general anaesthesia, and of operative surgery,on immune responsiveness was studied in blood obtained from26 women undergoing laparoscopic sterilization (minor operationgroup) and in 14 women undergoing abdominal hysterectomy (majoroperation group). Since immunity depends ultimately on clonalexpansion of lymphocytes, the growth potential of peripheralblood lymphocytes was studied in tissue culture by mitogen stimulation.There was no evidence of any change in either the number ofresponding cells (those that have left the resting Go-phaseand responded to mitogen stimulation by entering the Gi-phaseof the first cycle of growth) or in the rate at which cellsgrow in volume during the period of study. It was concludedthat there was no evidence that anaesthesia, or surgery, impairedthis aspect of the immune response in our patients, but thedesign of the experiments does not allow comment on other aspectsof the immune response such as antigen presentation, immunoregulationand effector mechanisms, which are superimposed on the basicclonal expansion mechanisms studied in this investigation. Incidentally,we noted that the standard method for isolation of lymphocytesfrom peripheral blood frequently yielded highly contaminatedpreparations: if this fallacy was not appreciated, tests withcontaminated lymphocytes could be misinterpreted as showingdepression.     

Continuous Wave Ultrasound Measure of Neonatal Cerebral Blood Flow

ABSTRACT. We report cerebral blood flow (CBF) values for healthy neonates in five gestational age categories for 9 single and 7 combination measures of continuous wave Doppler ultrasound. Combinations of measures, particularly those from the anterior cerebral artery with a 5.0 MgH probe, increased the reliability and validity. The most reliable and valid single measure was mean flow velocity from the anterior cerebral artery (5.0 MgH probe). CBF values were lower for neonates with respirator support than for neonates without respirator support. No significant differences were found in CBF measures between intubated neonates who developed IVH and intubated neonates who did not develop IVH. Neonates who were intubated and developed intraventricular hemorrhage (IVH) were treated more vigorously than those who were intubated and did not develop IVH. By day 6, neonates with IVH had a significantly higher mean pH, mean serum bicarbonate, and mean positive base balance.     

The Patient-Centred Clinical Method. 1. A Model for the Doctor-Patient Interaction in Family Medicine

This article describes a patient-centred clinical method appropriatefor family medicine. The method is designed to attain an understandingof the patient as well as his disease. This two-fold task isdescribed in terms of two agendas: the physician's and the patient's.The key to an understanding of the patient's agenda is the physician'sreceptivity to cues offered by the patient, and behaviour whichencourages him to express his expectations, feelings and fears.The physician's agenda is the explanation of the patient's illnessin terms of a taxonomy of disease. In the patient-centred clinicalmethod, both agendas are addressed by the physician and anyconflict between them dealt with by negotiation. This is contrastedwith the disease-centred method in which only the doctor's agendais addressed. Further articles will describe the patient-centredmethod in operational terms.