Effect of dipyridamole with or without aspirin on urine protein excretion in patients with membranous glomerulonephritis

Summary The antiproteinuric effect of the antiplatelet agent dipyridamole has been assessed after inhibiton of thromboxane B₂ (TxB₂) synthesis in 8 patients with confirmed membranous glomerulonephritis. There were three study periods, each of 30 days, and 45 days apart, namely a washout period, treatment with dipyridamole 300 mg/d, and dipyridamole 225 mg/d plus aspirin 150 mg/d. On Days 1 and 30 of each study period serum and urine creatinine, 24-h excretion of protein, creatinine clearance, platelet aggregometry on whole blood and serum TxB₂ were measured. Treatment with dipyridamole alone or with aspirin produced significant inhibition of platelet aggregation and a fall in 24-h protein excretion; the latter amounted to 54% with dipyridamole alone and 56 % with dipyridamole plus aspirin (NS). Dipyridamole plus aspirin caused an 82 % reduction in serum TxB₂.     

Teaching medical students about the appropriateness of social and sexual contact between doctors and their patients: evaluation of a programme

The purpose of this study was to assess the impact of an educational intervention on medical students' attitudes toward social and sexual contact with patients by doctors from three medical specialties (general practice, obstetrics/gynaecology and psychiatry). Medical students from two consecutive fifth year classes at one medical school participated in one 3 hour session that included instruction on the standards of the profession that prohibit doctor–patient sexual contact. Students were assigned to either intervention groups or control groups and responded to an anonymous questionnaire (overall response rate 66·8% ; n=141). As many as 14·5% of control group students thought it was (sometimes or usually) appropriate for general practitioners to date their own patients and at least 3% thought it appropriate for members of any of these three medical specialties to engage in sexual contact with their own patients. However, there were no significant differences in attitudes toward hugging, dating or sexual contact with current patients between those who had attended the seminar and the control groups. The session significantly influenced attitudes regarding obstetrician/gynaecologists and psychiatrists hugging and having sexual contact with former patients. These findings are discussed in relation to a need for expansion of such instruction.     

Flow dynamics through spinal needles

We examined the flow pattern produced when liquid dye was actively injected into a fluid medium at various flows through five different commonly used spinal needles. At all flows, the Whitacre-type needles produced a directional stream exiting at an angle from the longitudinal axis. At intermediate rates the stream developed tracks which disappeared at faster rates. The Quincke needle always produced an undeviated stream of dye and did not form tracks at any flow rate. When a perspex plate (representing the spinal cord) was interposed in front of the needle, the dispersion of dye was always unidirectional from the Whitacre needle and bidirectional from the Quincke needle. The dye adhered to the surface of the plate as a concentrated film at slow rates and at faster rates it dispersed turbulently for both types of needle.     

In vivo comparison of two through-plane MR velocity mapping methods: Fast fourier encoding and phase mapping

Magnetic resonance imaging maps of velocity were acquired with a 1.5-T system in 10 subjects in a plane perpendicular to the main pulmonary artery. Velocity images were successively acquired with a method developed from Fourier-encoding velocity imaging (FEVI) principles with eight gradient steps and one excitation, and with two-point phase-subtraction mapping. Reconstruction in FEVI was implemented by zero-filling interpolation around the eight gradient steps and then around the four central steps. The methods were compared by using estimates of noise in velocity measurements based on the difference between the experimental map and a smooth fitted map. For the same acquisition time, FEVI with four encoding steps was more precise in velocity measurements than phase mapping. Precision was further increased by the use of eight encoding steps, but acquisition time was doubled.     

MR imaging of the brain in patients with hepatic form of Wilson''s disease

The aim of this study was to detect the sites and frequency of possible lesions by brain magnetic resonance imaging (MRI; 1,5T) in a group of 16 neurologically asymptomatic patients with hepatic form of Wilson's disease (WD; seven untreated and nine under treatment). Abnormal MR findings of the brain were found in 75% of patients. Lesions in brain parenchyma were detected in all untreated, drug-naive patients and in 44% of treated patients. Abnormal signal in globus pallidus, putamen, and caudate nucleus was revealed in 86, 71 and 71% of treated and in 33, 33 and 22% of untreated patients, respectively. In five of eight patients with putaminal pathology (62.5%) and in four of seven patients with caudate nuclei involvement (57%), only proton density 2-weighted sequence (PDW) exhibited sensitivity for lesion detection, with both T1W and long echo T2W sequences being insensitive. This superiority of PDW sequence was even more pronounced in the group of untreated patients in whom 80% of putaminal pathology was visible exclusively on this sequence. The lower frequency of lesions in the group of treated in comparison with untreated patients indicated that they might be reversible in the course of chronic chelating therapy.     

Predicted and Measured Muscle Forces after Recoveries of Differing Durations Following Fatigue in Functional Electrical Stimulation

Abstract: Using ³¹P nuclear magnetic resonance (NMR) spectroscopy, the bioenergetics of paralyzed muscles activated by functional electrical stimulation (FES) were studied in vivo during fatigue and recovery on paraplegic subjects. During the activation phase of the muscle, the muscle force was also monitored. The phosphorus metabolites were found to vary systematically during fatigue and to recover slowly to their rest state values after cessation of FES. During fatigue, a good correlation was found between the decaying force and each of the profiles of phos-phocreatine, inorganic phosphorus, and intracellular pH. A musculotendon 5 element model was proposed for the activated muscle to predict its force generation capacity. A fatigue recovery function, based on the metabolic profiles, was introduced into the model. This model allowed us to predict the force expected to be developed as a function of the time after recovery of given time durations. Validation experimental measurements of force were carried out and included recurrent fatigue tests, both in the initially un-fatigued state and at various times in the postfatigue stage of the muscle. Comparison of the predicted and measured forces indicated satisfactory agreement of the results. The developed model of muscle dynamics should help to design a strategy for reducing muscle fatigue under FES.     

A comparison of acceleromyography and mechanomyography for determination of the dose–response curve of rocuronium in children

In order to compare an acceleromyograph (TOF-Guard^TM) with a mechanomyograph (Grass FT03), the dose–response relationship of rocuronium was simultaneously determined in both arms of 15 children aged 3–11 years during anaesthesia with thiopentone, alfentanil and nitrous oxide. Three subgroups of five children received rocuronium 120, 180 or 240 μg.kg⁻¹ randomly. The effective doses to produce 50% and 95% depression of the first twitch of the train-of-four determined by acceleromyography were 206 and 337 μg.kg⁻¹, respectively, while these values determined by mechanomyography were 151 and 331 μg.kg⁻¹, respectively. The dose–response curve obtained by acceleromyography was steeper and shifted to the right compared with that obtained by mechanomyography (p < 0.0001). The difference between the effective dose producing 50% twitch depression determined by the two devices was highly significant (p < 0.0001). In 13 out of 15 children, the acceleromyograph control train-of-four ratio was significantly greater than unity. Although there was a good correlation ( r  = 0.85) between simultaneous pairs of measurements of neuromuscular block, the acceleromyograph exhibited a bias of −25% relative to the mechanomyograph with wide limits of agreement (−62 to +12%). We conclude that acceleromyographic and mechanomyographic measurements should not be used interchangeably when determining the potency of muscle relaxants.     

运动负荷~（201）Tl心肌断层显像对冠心病的诊断价值

以冠状动脉造影作对照，应用运动负荷２０１Ｔｌ心肌断层显像检查６７例冠心病患者和３４例健康人。结果显示，核素显像的灵敏度为９１％，特异性为７９％，检测左冠状动脉前降支（ＬＡＤ）、右冠状动脉（ＲＣＡ）和左冠状动脉回旋支（ＬＣＸ）的灵敏度和特异性分别为８９％和８０％、８９％和９８％及８１％和９７％；单支、双支和３支冠脉受累时显像的灵敏度分别为８５％、９２％和１００％。结果提示，心肌断层显像方法对冠心病患者心肌受累的部位、范围和程度、受累冠脉的判定提供了一种简便无创、灵敏有效的检测手段，具有较大的临床价值。     

A rapid solid-phase extraction and HPLC/DAD procedure for the simultaneous determination and quantification of different benzodiazepines in serum,blood and post-mortem blood

Summary A rapid and quantitative method for the determination of benzodiazepines using high-performance liquid chromatography (HPLC) with diode-array detection (DAD) is reported. The drugs were extracted from serum, blood or post-mortem blood using C₁₈ extraction columns. Brotizolam was used as internal standard. Experiments with spiked serum/blood samples resulted in recoveries between 75% and 94% for all investigated benzodiazepines. Excellent linearity was obtained over the concentration range 5–1500 ng benzodiazepine/ml. The limit of detection was approximately 2 ng/ml. The detection of low therapeutic serum levels of highly potent benzodiazepines is also possible.