Graduates' comments on the training and examination programme of the Australasian College for Emergency Medicine

A survey instrument was mailed to 85 candidates who were successful at the Fellowship Examination of the Australasian College for Emergency Medicine in 1986 to 1991. They were asked to comment on the College Training and Examination Programme. The comments have been edited and reproduced for information and critical appraisal by both Trainees and Fellows of the College.     

UF-100全自动尿沉渣分析和Uritest-300干化学分析结合用于尿液分析研究

目的：探讨UF-100尿沉渣全自动分析仪与Uritest-300尿干化学分析仪结合应用于尿液常规分析的临床应用价值。方法：随机选择300份住院病人尿标本，同时用UF-100尿沉渣分析仪、尿干化学分析仪及显微镜检测，分析多个参数指标。建立UF-100与Uritest-300结合的显微镜筛选方案。并对680份随机样本进行分析。结果：红、白细胞检测在三种方法中符合率很高，UF-100与镜检比较，红细胞符合率90．3％，Cohen’sκ值0．847，白细胞符合率92．0％，Cohen’s κ值0．876。管型检测一致性较差；采用UF-100与Uritest-300结合的显微镜筛选方案，复检率为17．5％。结论：UF-100全自动尿沉渣分析和Uritest-300干化学分析对照用于尿液分析，可提高检测结果的精确度和准确度，降低劳动强度，提高检验效率。     

以需求为导向的全科医师师资培训方法探索--模块教学的应用

目的 探讨规范、有效、可行、实用的全科医师师资培训的内容与方法。方法 采用实地考察、专业人员研讨会、文献法等多种方法相结合的研究方法。结果 全科医师师资应具备医生和教师的双重条件，并积极提供相应的培训课程；当前及今后一段时期我国师资团队仍将由高校理论师资、专科医生和全科医生3类人员组成；全科医师师资培训内容应以需求为导向、自下而上地确定，总体涵盖“一理论四技能”，但可依据师资类别选用；模块教学使培训更具针对性和灵活性，便于培训的组织与实施。结论 模块教学是适应我国当前全科医师师资培训现状的、具有较大实用价值的培训策略和方法。     

Arthritis induced in cat by sodium urate: a possible animal model for tonic pain

An attempt has been made to determine whether cats rendered arthritic by the injection of monosodium urate (MSU) crystals (rod-shaped 40-130 micrometers length) into one knee joint capsule can be used as animal model of tonic (chronic) pain. A limp and a decrease in body weight supported by the injected hind leg's paw occurred approximately 1 h after the MSU (20 mg) injection, reached a maximum at 2-3 h, and lasted for more than 6 h before a gradual return to pre-injection levels. They were diminished by systemic administration and local (the dorsal part of the nucleus raphe dorsalis) application of morphine, this effect being blocked by naloxone. This suggests that the limping and the paw pressure decrease are the reflexion of pain. It is suggested that the animal model of the MSU-induced arthritis is useful for the study of tonic pain.     

Quantitative evaluation of opsonin-independent phagocytosis by alveolar macrophages in monolayer using polystyrene microspheres

Macrophages can bind and engulf a variety of particles in the absence of specific opsonins. Polystyrene-type microspheres are often employed to quantitate opsonin-independent phagocytic activities of macrophages in vitro. Reliable measurement of this cell function, however, requires the ability of the investigator to distinguish between particles that are merely attached to the cell surface and those that are actually internalized. We have developed a simple, rapid, and reproducible method for quantitating phagocytosis using polystyrene microspheres and adherent alveolar macrophages. Basically, particles associated with macrophages after a given incubation time are microscopically quantitated on a cell-by-cell basis before and after toluene dissolution of external particles. Particle/macrophage values obtained after toluene treatment exclusively index phagocytosis.     

Measurement of left ventricular ejection fraction in pediatric patients using the nuclear stethoscope

Left ventricular (LV) ejection fraction (EF) was measured in 25 patients, aged 2 weeks to 20 years (mean 8.6 years), using a portable nonimaging scintillation stethoscope. Technically satisfactory studies were obtained in 23 patients. LVEF was validated by cineangiography in 19 patients and by standard gated blood pool scintigraphy in 4. EF measured by the nuclear stethoscope correlated well with values obtained by cineangiography or scintigraphy (r = 0.869, p less than 0.001) over a wide range of EF values (18 to 79%). In children younger than 5 years (n = 11), the correlation (r = 0.728, p less than 0.02) was less satisfactory than in those older than 5 years (r = 0.926; p less than 0.001). Although modifications in the instrument and further clinical trials with the stethoscope are needed before the device becomes clinically useful to pediatric cardiologists, our data indicate that the nuclear stethoscope can provide reliable assessment of LVEF in pediatric patients.     

Ovarian carcinoma: Management of stress in patients and physicians

A discussion of the management of ovarian cancer invariably involves the problems of death and dying faced by the patient, her family, and her physician. This paper attempts to deal with the general fears, anxieties, and problems of terminality, and also places attention on specific issues involved in living with the ongoing disease and its treatments. Focus is on the effects of the disease on the woman's self-image, on her family and relationships, on life outside the hospital, and on her relationship with her attending physician. Specific problems relating to the periods of (1) diagnosis, (2) operative management and treatment, and (3) terminality are discussed. Understanding the psychosocial realities of the patient provides the physician with added insights into methods to assist the patient in adaptation and coping with this ultimately fatal disease.     

Ear lobe crease and coronary artery disease. 1,000 patients and review of the literature

One thousand unselected patients admitted to large urban medical centers were examined for the presence of a diagonal ear lobe crease and evaluated for the presence of coronary artery disease. A high degree of correlation between the two was seen, using both clinical and angiographic criteria for the diagnosis of coronary artery disease. The association between the ear lobe crease and coronary artery disease was independent of patient age. Prospective analysis of single risk factors in 112 consecutive patients subjected to coronary cineangiography revealed that demonstrable coronary artery disease was correlated only with the ear lobe crease and with previous acute myocardial infarction (although less strongly with the latter). These conclusions are consistent with those of the world's literature, which also finds a strong correlation between coronary artery disease and the ear lobe crease, with the exception of Oriental patients, native American Indian patients, and children with Beckwith's syndrome.     

Stiff-man syndrome and dementia

Stiff-man syndrome is characterized clinically by fluctuating muscular stiffness and spasm, and electromyographically by continuous motor unit activity at rest, which is abolished by sleep, general anesthesia, nerve block, curare, and several centrally-acting medications. A spinal or supraspinal origin has been proposed for this disorder. Some clinical and electrophysiologic features, along with an occasional association with encephalopathy, may support a proposed supraspinal cause. An elderly man with progressive dementia and concomitant development of stiff-man syndrome is described. He had not had stiff-man syndrome one year earlier, when he had only mild dementia. An association between stiff-man syndrome and dementia has not been previously described. Increased muscle tone and muscular rigidity is frequently encountered in patients with dementia, however, and pathologic reflexes involving neck and proximal musculature have been described in dementia. It is possible that this patient represents an exaggerated form of such motor disturbances in dementia, and that clinical and electromyographic features of stiff-man syndrome may be present with increased incidence in patients with dementia.