Effect of lidocaine on ventricular conduction in acutely ischemic dog hearts

The effect of graded doses of lidocaine (1.25-10 mg/kg) on endocardial Purkinje and transmural conduction at different heart rates as well as during extrasystolic stimulation was studied in dogs, 30 min after ligation of the anterior descending coronary artery. The drug had no effect on endocardial conduction within the ischemic zone except at the highest dose. Transmural conduction time was increased by ischemia in only 50% of dogs. Transmural conduction time was increased further at high heart rates but not by short coupled extrasystoles. Lidocaine slowed conduction further in the ischemic myocardium by a process that was both rate and interval dependent. "Apparent" supernormal transmural conduction was observed during short coupled extrasystoles but not at fast drive rates. This phenomenon was blocked only by administration of high doses of lidocaine.     

A new technique of harvesting patellar tendon autografts for anterior cruciate ligament reconstruction.

A new surgical technique to uniformly harvest the middle one-third of the patellar tendon for anterior cruciate ligament reconstruction is described. The technique uses a guide system of 8 templates of varying widths to guide the saw cuts and "collared," depth-controlled saw blades and drill bits to produce a standard cutting and drilling depth. This kind of template system lessens the risks of graft harvesting complications such as patella fracture, bone graft fragmentation, suture pull out, and judgment errors pertaining to graft depth, length, or width. The Patellar Tendon Graft Guide was used to obtain a patellar tendon graft in 65 patients. Fifty-nine arthroscopic-assisted and 6 open anterior cruciate ligament reconstructions were performed. Of the 65 grafts harvested, 63 consistently demonstrated bone portions 20 mm in length, 7 mm in depth, and a width corresponding to the template chosen (usually 10 mm). Two grafts supposed to be 10 mm in width turned out to be 9 mm in width because of a technique related problem.     

Effects of lidocaine on conduction of extrasystoles in the normal canine heart

The effect of lidocaine on the conduction of extrasystoles was studied in 8 open-chest dogs after atrioventricular nodal block. Simultaneous recording of endocardial and epicardial activation provided separate measures of endocardial (Purkinje) conduction as well as myocardial (muscle) conduction. Lidocaine (1.25--10.0 mg/kg) caused a dose-dependent slowing of conduction of midrange extrasystoles (250--400 ms) in both the Purkinje system and the myocardium, which became statistically significant at doses larger than 1.25 mg/kg. On the other hand, low doses of lidocaine caused speeding of early extrasystoles, i.e., coupling intervals (less than 250 ms) in the Purkinje system but not in the myocardium. Measurement of transmural conduction time as a function of coupling interval revealed a period of "apparent" supernormal conduction through ventricular muscle that was eliminated at high doses of lidocaine.     

Female doctors in Victoria, 1977

A survey of medical manpower in Victoria in 1977 revealed that 17% of registered medical practitioners were female and that the proportion of females was much higher among younger graduates. Seventy-eight per cent of female doctors were currently working in Victoria, compared with 82% of male doctors; 3.8% were "not working temporarily" compared with 0.6% of male doctors; and 3.9% were "retired" compared with 1.9% of male doctors. Female doctors accounted for only 8% of specialists in private practive, compared with 15% of general practitioners, more than 20% of salaried staff members of hospitals and other semigovernment and government bodies, and 40% of the staff members of community health centres. Thirty-eight per cent of female doctors were working part time. The need for part-time training programmes and part-time work, and the difficulties of female graduates becoming specialists are discussed. The implications of increasing proportions of female doctors entering the medical work force during the next decade, and the lower average working hours of female doctors compared with those of males, are considered in relation to the increasing supply of medical manpower in Australia.     

Replantation of the penis: a patient report

Replantation of the penis is an unusual case in this country and it is unlikely that most plastic and reconstructive surgeons or urologists will see one during their career. A successful repair of a self-inflicted amputation of the penis is presented. The unique anatomy of the penis pertinent to replantation is reviewed, and current concepts and recommendations in performing replantation of the penis are presented.     

AUTOPSY FINDINGS IN THE WOLCOTT-RALLISON SYNDROME

Wolcott-Rallison syndrome is a rare autosomal recessive condition characterized by diabetes mellitus arising in early infancy and multiple epiphyseal dysplasia. To date, nine cases have been described in the world literature. We report an affected girl who died at the age of 4 years and on whom a full autopsy was performed. In addition to neonatal diabetes mellitus and epiphyseal dysplasia, this child had mental retardation and recurrent episodes of self-limiting hepatic failure. Autopsy revealed severe pancreatic hypoplasia and markedly abnormal pancreatic histology, while histology of the bone was consistent with epiphyseal dysplasia. There was laryngeal stenosis and pulmonary hypoplasia. The heart was enlarged with mitral valve dysplasia and stenosis, left atrial dilatation, left ventricular hypertrophy, and endocardial fibroelastosis. Examination of the central nervous system showed arrhinencephaly and cerebellar cortical dysplasia. The liver showed minor histological abnormalities but no features were present to account for the recurrent hepatic failure. In addition to Wolcott-Rallison syndrome this child had a deletion at 15q11-12 in 65 of her cells.     

Female genital tract bacterial coisolates with Candida albicans in patients without clinical vaginitis.

OBJECTIVE: In vitro, Candida albicans has demonstrated the ability to inhibit replication of selected bacteria. Little information exists on the impact of C. albicans on the vaginal bacterial flora in vivo. The purpose of this study is to identify the coexisting bacterial flora when C. albicans is isolated from vaginal cultures submitted to a hospital-based testing facility for reasons other than vulvovaginitis. METHODOLOGY: All specimens (240) received from ambulatory care clinics over a six-month period were cultured for aerobic and anaerobic bacteria and Candida species. Those specimens submitted for cervicitis, vaginitis, or vaginal discharge and those from which yeasts other than C. albicans were isolated were eliminated. To control for sample biases, a subgroup composed of all pregnant women for whom cultures were done as screening procedures was similarly studied. Chi-square analyses, comparing the prevalence of individual bacteria isolated with and without the presence of C. albicans, were done for all study populations using SPSS for Windows software (1994). RESULTS: Two hundred and forty consecutive specimens were bacteriologically analyzed. Of the 220 vaginal samples used in the study, C. albicans was isolated in 44 instances (20%). Neither the presence of the lactobacilli nor the presence of Gardnerella vaginalis markedly influenced the isolation rate of C. albicans. The group B streptococci had a greater probability of coisolation when C. albicans was present (27.3% verses 16%), but this was not statistically significant (P < 0.8). Dissociation between the presence of C. albicans and the coisolation of Peptostreptococcus species and anaerobic gram-positive cocci and/or bacilli was noted (P < 0.0819), while the incidence of gram-positive aerobic bacilli was reduced in the presence of C. albicans (30/176 [17.1%] versus 6/44 [13.6%]), this reduced incidence was not statistically significant. Isolation data of the subgroup of pregnant women supported these observations. CONCLUSION: Within the limitations of the study, statistically, the data suggests that an inverse relationship exists between the presence of C. albicans and recovery of Peptostreptococcus and anaerobic gram-positive cocci and bacilli.     

PET physiological measurements using constant infusion

A wide range of study designs can be used with positron emission tomography methods to provide quantitative measurements of physiological parameters. While bolus injection of tracer is the conventional approach, use of combined bolus plus constant infusion provides a number of advantages for receptor-binding tracers. Of recent interest is the use of this approach to dynamically follow the displacement of tracer during in vivo changes in neurotransmitter concentrations. This paper provides an overview of the tradeoffs in using bolus/infusion methods versus conventional bolus injection for receptor binding studies.