Effects of the propofol combination anesthesia on the intrinsic blood-clotting system

Fat emulsions can cause changes in blood-clotting and fibrinolysis. The aim of this study was to examine the relation between the use of the short-acting hypnotic propofol and alteration of the blood clotting system. In a double-blind randomized study, 36 patients with an aortocoronary bypass operation were given either midazolam/fentanyl or propofol/alfentanil. Eleven blood samples were taken at fixed times pre-, intra- and postoperatively to determine changes caused by the anesthetic agents on the hemostaseologic parameters during the whole operation. Perioperative blood pressures of both groups were measured at seven fixed points. From the beginning of the extracorporeal circulation (ECC) to the end of the operation, the measured values of the factor XIIa- and kallikrein-like activity in the propofol group were significantly higher than those of the midazolam group. Also the values of the kallikrein inhibition capacity and the indicators of fibrinolysis (t-PA and D-dimers) suggest a stronger activation of the contact phase at the start of the recirculation and as a result of it a stronger fibrinolysis within the propofol group. Besides, the hypotensive side-effect in the propofol group was evident in contrast to the midazolam group. With this investigation, a correlation between the application of propofol/alfentanil, contact phase activation with activation of the kallikrein-kinin-bradykinin system and the observed hypotension can be set up.     

Class, perceptions of 'disordered' behaviour, and suggestions for therapy: a tri-cultural comparison

This paper presents findings from a tri-cultural study in which we argue that class differences pertain not only to rates of mental illness but also to recognition of symptoms of mental illness and to recommendations concerning what should be done by those exhibiting 'disordered behaviour'. It is hypothesized that regardless of respondent's cultural background, the extent to which a deviant behaviour will be defined as a mental health problem, and professional therapy will be suggested as a source of help for that problem, will be positively related to class. Findings from a sample selected from two small West Texas communities, and samples selected from Durango, Mexico, and Juiz de Fora, Brazil, indicate strong support for the first prediction only among the West Texas sample, whereas the second hypothesis concerning therapy suggestions is strongly supported among respondents in all three cultural settings. We conclude that these class differences in perceptions and suggestions concerning five examples of 'disordered' behaviours read to respondents relate to conditions of lower-class life in general. Particularly, structural support found for our hypothesis leads us to suggest a need for informal, nonbureaucratic mental health care systems created to serve lower-class populations residing in class-oriented societies, regardless of cultural differences which may exist among these societies.     

Responsibilities and training needs of mental health administrators

This paper reports findings of a needs assessment in the area of training programs for senior mental health administrators. Questionnaires (N=530) were sent; 169 to county and regional state mental health administrators; 331 went to community mental health administrators. The response rate was 43%. Thirty-four percent of the public sector respondents listed general administration as their first topic; fiscal issues were listed by 19%; 18% listed personnel administration first. Second topics chosen for training by the public sector administrators were general administration (17%), financial management (24%), and personnel (20%). As their first topics of choice for future training, 37% of the community mental health administrators selected general administration areas, 27% selected financial management, and 10% personnel. Training for mental health administrators has the potential for substantial enrichment through the design and implementation of carefully planned programs. Results from this needs assessment show the continued strong need for such training.     

Stated and actual management of acute myocardial infarction among different specialties

OBJECTIVES: To examine the variation in stated management of acute myocardial infarction (AMI) among clinicians of different specialties, and to compare stated with actual practice. DESIGN: Mail survey using a hypothetical case history, and review of medical records. SETTING: 47 public hospitals in New South Wales. SUBJECTS: 224 cardiologists, general/other physicians and general practitioners (GPs) who manage patients with AMI; 390 patients admitted for AMI between February and June 1996. OUTCOME MEASURES: Stated and actual use of treatments and investigations for AMI. RESULTS: Stated use of aspirin, thrombolysis and beta-blockers (95%-100%, 95%-100% and 80%-86%, respectively) was high in all three specialties. Cardiologists were significantly more likely than GPs to state use of heparin (87% v 57%; P < 0.001), ACE inhibitors (84% v 49%; P < 0.001) and echocardiography or gated pool heart scan (79% v 26%; P < 0.001). Stated use of nitrates by cardiologists was significantly lower compared with the other specialties (29% v 50% and 44%; P = 0.027). Actual use of aspirin was high (> 80%) in all specialties. Actual use of thrombolysis was similar to stated use after adjusting for factors such as time to hospital arrival and ST-segment elevation. There were substantial differences between stated and actual use. CONCLUSIONS: There were differences in practice patterns between and among clinicians of different specialties in NSW, consistent with findings from other countries. The high stated and actual use of aspirin and thrombolysis is encouraging.     

Preferential resistance of dopaminergic neurons to glutathione depletion in a reconstituted nigrostriatal system

Depletion of glutathione in the substantia nigra is one of the earliest changes observed in Parkinson's disease (PD), and could initiate dopaminergic neuronal degeneration. Nevertheless, we have previously demonstrated that mesencephalic dopaminergic neurons in primary monolayer cultures are more resistant to the toxicity of glutathione depletion than nondopaminergic neurons. To extend this finding to a system that more closely resembles the in vivo situation, we characterized the effects of glutathione depletion on reaggregate cultures derived from ventral mesencephalic and their striatal target neurons, as well as supporting elements including glia. Dopaminergic neurons were found to be more resistant to the toxicity of buthionine-(S,R)-sulfoximine, an inhibitor of glutathione synthesis, than other nigrostriatal neurons, while striatal target cells exhibited an intermediate susceptibility when examined after 48 h. Glutathione depletion, however, decreased the intracellular content of catecholamines after 48 h and eventually led to the loss of dopaminergic neurons after 7 days. Our data indicate that the intrinsic resistance of dopaminergic neurons to the toxicity of glutathione depletion occurs in a variety of experimental paradigms, and suggest that global glutathione depletion alone is unlikely to account for the selective loss of dopaminergic neurons in PD. Rather, it is more likely that either the selective loss of glutathione from dopaminergic neurons, or the combination of glutathione loss with other insults contributes to the preferential death of dopaminergic neurons in PD.