Culture and disease

Both art and the kinds of life styles which predispose one to disease reflect the culture of an era. Might the history of art give some insight into the origins of behaviors which are conducive to particular diseases? An attempt is made to answer this question by looking at the perception of time and space in modern and contemporary art and in the behaviors which lead to coronary proneneses and anorexia nervosa.     

SURGERY OF PERIURETERIC OBSTRUCTION IN 101 CHILDREN OVER ONE YEAR OF AGE

One hundred and one children over 1 year of age have had surgery for pelviureteric obstruction over an 11 year period. The common clinical features were abdominal pain, urinary infection or haematuria, but number presented as an incidental finding. Less commonly, the patients presented with an abdominal mass or with hypertension. The diagnosis was usually made on intravenous pyelography (IVP) but in the latter part of the series, renal nuclide scan (RNS) and ultrasonography (US) were preferred. Ninety–three patients had unilateral pyeloplasty, three had bilateral pyeloplasty and five had nephrectomy or heminephrectomy. Whereas initially nephrostomy drainage was used in the majority of patients after pyeloplasty, trend away from nephrostomy evolved in the latter part of the series. With experience, the incidence of postoperative complications was also reduced and there was reduction in the period of hospitalization. Clinical results were consistently satisfactory. Postoperative assessment after pyeloplasty was made by IVP and/or RNS and also US. A review of these investigations showed that RNS provided more factual information of the result when compared with the IVP.     

A method for evaluating antianginal drugs in experimental animals: assessment of myocardial ischemia by myocardial pH

This paper describes a method by which antianginal drugs can be evaluated in the dog heart in situ. Myocardial pH was measured continuously by a micro glass pH electrode inserted in the left ventricular endocardial layers of the dog anesthetized with pentobarbital. Occlusion of the left anterior descending coronary artery (LAD) decreased myocardial pH, and release of the LAD restored the pH. The myocardial acidosis induced by ischemia was metabolic in nature and accompanied by a decrease in the levels of adenosine triphosphate and creatine phosphate and an increase in the levels of lactate in the myocardium. Drugs were injected intravenously 30 min after incomplete (partial) occlusion ot the LAD, lasting until 60 min after drug injection. Propranolol, atenolol, and sotalol markedly attenuated the myocardial pH that had been decreased by LAD occlusion. Nitroglycerin, diltiazem, and nicorandil also attenuated the pH, but these drugs were less active in attenuating myocardial acidosis. Dipyridamole, nifedipine, and beta-2 adrenoceptor antagonists were least active in this regard. It is concluded that myocardial pH can be used as an indicator of myocardial regional ischemia and utilized for evaluation of antianginal drugs.     

Sexuality during the menopause

Although the evidence is not conclusive, overall many sexual changes seem to occur in the climacteric years. It would be easy to propagate and perpetuate longstanding beliefs and myths that would do a great disservice to all of the women to whom our care is dedicated. In the coming years it is hoped that we shall learn more about how to understand these changes. In recent years the International Menopause Society has actively encouraged work in this area. An entire issue of its journal Maturitas is devoted to a series of scientific papers on sexuality in the climacteric years. For those who desire further reading that issue is strongly recommended. All medical professionals who come into contact with women during the climacteric years should be prepared to ask about sexuality and to deal with any concerns that arise. Taking a good sexual history along with a good general medical history and full social background is the best starting point for coping with these concerns. How to take a comprehensive sexual history is well described by Munjack and Oziel. Of course, it is not usual to take this full history on every woman with menopause symptoms. A few key questions should identify the woman who has sexual problems and facilitate selection of appropriate questioning for each patient (Table 2). Often, taking such a history allows the physician to identify a problem area that may be helped by medication or, more often, by education and simple office counseling. When it is clear that these simple approaches will not be adequate, the physician should have good resources for referral to the appropriate specialist, whether it be gynecologist, menopause center, psychologist, family therapist, or sex therapist.