Biotransformation and excretion of N,N'-bis(3-(2-ethoxyphenoxy)-2-hydroxypropyl)ethylenediamine dihydrochloride (Falirytmin) in rats

Falirytmin (1) was metabolized in rats almost completely. Besides small amounts of 1 in urine and feces 18 metabolites could be separated. The proposed structures of 14 compounds demonstrate aromatic hydroxylation, N- and O-dealkylation, side-chain oxidation, alcohol dehydrogenation and N-acetylation. The main route of excretion of 1 and metabolites was with the feces. After p.o. or i.v. administration of 14C-O-ethyl-1 the average excretion of radioactivity in urine, feces and expired air was about 75% in 96 h. The residual activity in organs was about 2-2.5%. Whole-body autoradiography confirms these results. Only slight 14C-activity was seen in muscle, fat, liver, bone marrow and gut.     

Effectiveness and efficacy of antenatal care

Antenatal care is recommended to pregnant women to improve the outcomes of childbirth. A common pattern of provision is seen in those parts of the industrialised world which have been influenced by British settlers. This paper presents the evolution of the current patterns of care, and the effectiveness and efficacy of the present system are discussed.     

Tassements vertébraux ostéoporotiques avec complications neurologiques sévères. À propos de six observations

Osteoporotic vertebral crush fractures with neurologic complications are rarely reported in the literature. We report six new cases particularly severe in which death occurred in two cases. The study group included four women and two men with a mean age of 75 years (range: 7 -79). Vertebral collapse causing neurological deficit was T5, T9, T in two cases, L and L. The mean number of vertebral collapses was three per patient (range: 9). Back pain appeared without traumatism 6 weeks before admission (range: ), Neurological complications appeared.5 weeks after back pain (range: 8). One patient suffered from a paraplegia, three front a paraparesia with bladder dysfunction (n =). In one case there was a severe weakness of the levator muscles of the foot and in another a L femoral neuralgia with severe bowel and bladder dysfunction. X-rays demonstrated backwards displacement of the posterior cortex in three cases, an intravertebral vacuum phenomenon in two cases and a heterogeneous appearance suggesting a malignancy in two cases. Computed tomography, performed in four patients and tomography in one patient, demonstrated fragmentation of the vertebral body in all the cases and vacuum phenomenon in four cases. Magnetic resonance imaging performed in four cases has confirmed the absence of epiduritis and a compression due to bony structures in two cases. A vertebral biopsy was performed in three cases. Osteoporosis was observed in all the cases and in two cases there was also an osteonecrosis. Surgical treatment was performed in three cases and conservative medical treatment in the other cases. After surgical treatment we have observed an absence of improvement of neurological complications in one case, an improvement in another and finally a full recovery in the last case. After conservative treatment we have noted in two cases an absence of improvement of neurological complications and in one case an improvement of neurological deficit. Two patients died (one after medical treatment and another after surgical treatment).     

Postgraduate education expectations: a survey of Hong Kong graduate nurses

Tertiary education for nurses in Hong Kong is in its early development With many overseas universities competing to secure Asian students, the need for locally developed programmes to meet Hong Kong's needs can be overlooked In this survey 705 nurses with degree level qualifications working for the major public and private employing agencies completed a questionnaire designed to obtain details of postgraduate study plans and preferences for the type, focus and mode of postgraduate programmes Analysis of responses showed 50% of the graduates surveyed intended to pursue further study in the next two years with a clear preference for course work masters, degree programmes (55%), studies with a specialist (71%) rather than a generahst focus, and programmes offered locally (85%) on a part-time basis (86%) Future educational needs were also found to vary according to gender, marital status, place of employment and nursing post The findings from this survey have considerable implications for educational and professional nursing developments and planning to meet the future health care needs of Hong Kong In addition, the information may inform the planning of other countries newly embarked on tertiary education for nurses     

Postoperative morbidity following Caesarean delivery

The current study was designed to determine the postoperative morbidity associated with Caesarean section and to compare the morbidity with the timing of the operation elective versus emergency Caesarean section, subgroups of women delivered by emergency Caesarean section, women delivered during the first stage of labour versus those delivered during the course of the second stage A retrospective review was conducted of the obstetric case record and the midwifery notes of all women delivered by Caesarean section over a 1-year period in a university teaching hospital ( n = 619) The variables used to measure postoperative morbidity included wound infection, intrauterine infection, urinary tract infection, chest infection, pyrexia, urinary catheterization and postnatal blood transfusion Only 9 5% of the women had no recorded morbidity in the postnatal period Women delivered by emergency Caesarean section experienced a greater number of postnatal problems, an increased incidence of febrile morbidity, more blood transfusions in the postnatal period and a higher proportion had a urinary catheter left in situ after surgery The incidence of wound infection, intrauterine infection and chest infection was higher in the emergency group and this resulted in an increased proportion of the women requiring antibiotic therapy in the postnatal period The study found that there was considerable postoperative morbidity associated with Caesarean delivery, particularly if the operation was carried out as an emergency procedure     

Purified chick-embryo-cell (PCEC) rabies vaccine: its potency performance in different test systems and in humans

The potency of purified chick embryo cell rabies vaccine Rabipur was evaluated by four different in vivo test systems: (1) NIH test with homologous strain LEP challenge; (2) intramuscular challenge of vaccinated laboratory animals; (3) postexposure vaccine treatment trials in laboratory animals; and (4) antibody induction tests in laboratory animals. These different test systems were compared with the Standard NIH test and an in vitro test, the modified ABT. Each of the four in vivo methods chosen demonstrated potency values superior to that of the Standard NIH test in which challenge was with CVS strain. Potency relations were: Standard NIH test versus alternative methods versus modified ABT 1.0-2.2-1.85 respectively. There was good correlation between alternative in vivo methods and the ABT. In addition examples of antibody induction in man following administration of various postexposure treatment regimens are presented which lead to the conclusion that postexposure vaccination method and composition of the study group play a more important role in achieving optimum treatment results than vaccine potency, provided that it corresponds to WHO requirements (minimum 2.5 IU per dose).     

Medical humanities in nursing: thought provoking?

Medical humanities is an innovative way of learning. Discussing literary texts of nursing practice has been used to help students analyse attitudes, values and ethics; it has also been used to help practitioners review and reflect on their own experience and philosophy of nursing. In nursing education, it has been used to explore difficult issues in a safe environment. The value of this approach in nursing education and practice is that it can encourage reflection, promote self-awareness and stimulate debate on difficult issues: for example, death and dying, power and institutionalization (of patients and staff) and pain. This paper gives a detailed worked example of how a literary text can be used in this way, the aim being to provide a resource which readers can then use with a group of students or colleagues. Finally, the authors explore the question of where medical humanities might have a place in the curriculum: as a lecture/tutorial in a course (e.g. Ethics), as a module in the curriculum, as a method of teaching nursing subjects (e.g. communication skills), as a discussion group (outside the curriculum), as a study guide, using literary texts alongside nursing text books. Any of these strategies can be a powerful vehicle for preserving the 'human factor' in both nursing education and continuing professional development.