Peptic ulcer disease following transplantation: the role of cimetidine

Of 253 consecutive renal transplants performed in 209 patients between January 1971 and December 1980, symptomatic gastroduodenal ulcerations developed in 22 (8.7 percent). Time of presentation ranged from 5 days to 9 years (mean 225 days) following transplantation with 16 of these patients presenting within the first 3 months. Nine (Group I) patients were diagnosed before the administration of H2 antagonist cimetidine. Mode of presentation in this group was upper gastrointestinal bleeding in each instance. Thirteen patients (Group II) were diagnosed after the clinical use of cimetidine was established. The mode of presentation in this group was bleeding in 11 patients and abdominal pain in 2 patients. In Group I, one patient died from liver failure and an ulcer was not contributory. The remaining eight patients were treated with antacids and blood transfusions (mean 12.7 units). Five patients in this group demonstrated ulcer healing, whereas three patients (37.5 percent) required emergency operations with two postoperative deaths. In Group II, one patient died from hemorrhagic shock before therapy could be instituted. In the other 12 patients treatment consisted of antacids, cimetidine, and blood transfusions (mean 6.8 units). Ten patients had relief of symptoms, whereas two patients (16.7 percent) required emergency operations with no deaths. During cimetidine therapy, two patients had rejection episodes that were reversible, and the remaining patients had no significant alterations in renal function. To conclude, cimetidine is a safe and effective adjunct in the treatment of peptic ulceration in renal transplant recipients.     

A computer-based test item-bank for cognitive assessment of medical students during a clinical medicine clerkship

The development and utilization of multiple-choice test items and the utilization of computer technology have significantly altered evaluation practices in medical schools. This paper describes the development and implementation of a computer-based multiple-choice test item-bank for use in a junior medicine clerkship. The computer program, ITEMBANK, is an interactive system that stores and edits test items and constructs and prints an original copy of each test. Tests can be produced almost immediately by the clerical staff and the total developmental costs have been minimal. The program has reduced the amount of teaching time required to develop tests, and has enhanced the learning of essential information by medical students and residents. Teaching staff and student response has been enthusiastic and positive. Statistically significant Pearson correlation coefficients have been obtained between student performance on these tests and clinical evaluation and NBME Part II scores. The program has made a valuable contribution to the improvement of evaluation procedures in the Internal Medicine clerkship.     

The effect of technical and purified pentachlorophenol on the rat liver

Dietary concentrations of 0, 20, 100, and 500 ppm of technical grade pentachlorophenol were fed to male and female Sherman strain rats for 8 months. The same experiment using purified pentachlorophenol was carried out. The food consumption was measured in all rats during the second week of exposure and for one week every 6 weeks thereafter. An autopsy was performed on all rats at the end of the experiment. The brain, lungs, spleen, liver, kidneys, heart, and testes were weighed and examined grossly and microscopically in all rats fed purified pentachlorophenol, all female rats fed technical pentachlorophenol, and in the male rats fed the highest dose of technical pentachlorophenol and the controls. Only the kidneys and livers were examined microscopically in the male rats fed 20 and 100 ppm of technical pentachlorophenol. Although the food intake was comparable, male and female rats fed 500 ppm of technical and male rats fed 500 ppm of purified pentachlorophenol gained less weight. The livers of the male and female rats fed 500 ppm technical pentachlorophenol weighed significantly more than those of the controls. The kidneys of all male rats fed purified pentachlorophenol weighed significantly more than those of the controls; however, there was no dose-related increase. No morphological changes were seen in the kidneys. At the 500-ppm dietary concentrations, technical pentachlorophenol produced a severe effect in the liver of female rats characterized by vacuolation of the hepatocytes, an increase in fibroblasts and other mononuclear cells within sinusoids, bile duct proliferation, periportal fibrosis, degenerated liver cells, increased mitotic figures, and an accumulation of brown pigment in macrophages and in Kupffer cells. In male rats at the 100- or 500-ppm dietary concentrations of technical pentachlorophenol, the predominant lesion consisted of enlarged pleomorphic hepatocytes which had foamy cytoplasm or cytoplasm with large vacuoles. The walls of the hepatic central veins of the livers in animals of both sexes were thickened. At the 100-ppm dietary concentrations similar but less pronounced effects were observed in the livers. Only mild alterations were noted at the 20-ppm dietary concentration. Purified pentachlorophenol caused slightly enlarged liver cells with occasional eosinophilic cytoplasmic inclusions at 500 ppm but no alterations were observed in the livers of rats fed the 100- and 20-ppm dietary concentrations. The results suggest that most of the toxicity associated with feeding technical grade pentachlorophenol to rats at these dietary concentrations stems from toxic contaminants rather than from pentachlorophenol.     

A quantitative relationship between the extent of localized cerebral lesions and the intellectual and behavioural deficiency in children

Summary In an investigation of 51 children with localized forebrain lesions (25 left hemispheric, 15 right hemispheric and 11 bilateral) a significant relationship between the extent of the cerebral lesion (quantitatively determined by means of computerized tomography scans) and the IQ was found, but only in children with lesions after age 5: there was a diminution of 3 (British Ability Scales and Porteus Mazes) to 4 (Wechsler test) points of 10 for a 1% increased brain lesion. There was no correlation between the extent of the lesion and IQ in children with early lesions. The IQ of the children with early lesions (up to year 4) was significantly lower than that of children with later lesions of the same extent.There was a highly significant correlation between behavioural problems (assessed by Conners Teacher Rating Scale) and diminution of IQ. There was a significant correlation between the extent of lesion and behavioural problems in lesions after year 5, but not in early lesions. While the correlation between intellectual-behavioural impairment and the extent of cerebral lesions can be explained by multiple localisation of functions, the lack of this correlation in early lesions and the more severe impairment by earlier lesions may be due to an interaction of brain development with social and lesional factors. Since each part of the brain may act as a stimulus for the development of other parts, even small differences in the lesions (and/or in the environment) may result in large behavioural differences (hypothesis of the developing brain as an amplifier for differences in the stimuli).     

Teaching teachers in general practice

A short, intensive, teacher training course for general practitioners is described. The assessment techniques used indicate that it went some way towards achieving predetermined goals. Set alongside the limited time available to practitioners for attending training courses, and the logistic problems of training an adequate supply of teachers, this experience suggests that short intensive courses may have an important role in professional education.     

Predictors for negative attitudes toward subjects with epilepsy: a representative survey in the general public in Austria

PURPOSE: To assess knowledge of and attitudes toward epilepsy in the Austrian general public and to identify independent predictors of negative attitudes. METHODS: A survey consisting of a representative sample of 2,128 Austrian adults was commissioned. A questionnaire similar to the ones used in earlier studies in other countries was used. The independent influence of socioeconomic variables and of knowledge and concepts about epilepsy on attitudes were analyzed by using logistic stepwise regression procedure. RESULTS: Nearly 10% of respondents expressed negative attitudes toward people with epilepsy. These figures are similar to those of other studies performed in comparable societies. In addition to being male and of low socioeconomic background, having little theoretical knowledge about epilepsy, misconceptions of epilepsy as a form of insanity, and no personal acquaintance with someone with epilepsy independently predispose to unfavorable attitudes toward epilepsy. CONCLUSIONS: Information campaigns on epilepsy are likely to improve attitudes toward epilepsy when they target misconceptions about epilepsy and when they offer opportunities for personal acquaintance with people with epilepsy.     

Diagnostic imaging in undergraduate medical education: an expanding role

Radiologists have been involved in anatomy instruction for medical students for decades. However, recent technical advances in radiology, such as multiplanar imaging, "virtual endoscopy", functional and molecular imaging, and spectroscopy, offer new ways in which to use imaging for teaching basic sciences to medical students. The broad dissemination of picture archiving and communications systems is making such images readily available to medical schools, providing new opportunities for the incorporation of diagnostic imaging into the undergraduate medical curriculum. Current reforms in the medical curriculum and the establishment of new medical schools in the UK further underline the prospects for an expanding role for imaging in medical education. This article reviews the methods by which diagnostic imaging can be used to support the learning of anatomy and other basic sciences.     

The scope of educational resources for radiologists on the internet

The quantity of radiological educational resources available via the internet is enormous and is constantly increasing. The quality is variable, and much time can be wasted trying to find what is required. Web-based learning is highly attractive as it is widely available, cheap, accessible at any time and frequently updated (in contrast to conventional study materials). We present an introduction to the scope and diversity of educational websites in radiology. Effective evaluation of web-based material is essential to maximize the benefit to the user: a suitable method of evaluating radiological educational websites is described.     

A new challenge in teaching radiology to dental students

In 2001 The Faculty of Dentistry, Sydney University, Australia embarked upon a New Dental Curriculum. This curriculum is a four year program which is integrated with the Faculty of Medicine four year Graduate Medical Program. The dental program aims to produce dentists capable of meeting the changing aspects of dentistry and to be committed to maintaining the highest professional standards. The program has few lectures, is web based, integrates the different disciplines traditionally found in dentistry and aims to produce a General Dental Practitioner whose aim is self-directed life-long learning. The challenge faced was to change the teaching and assessment to accommodate the new curriculum and to develop the necessary clinical radiological skill within each student using problem based learning (PBL) and web based technology. Structured, Clinical, Objective, Referenced, Problem orientated, Integrated, Organized (SCORPIO) was the method of choice and proved in the case of radiology to be a very effective way of presenting a large amount of information in a short time frame and was, based on evaluation findings, well accepted by the students.     

Contrasting prevalence of and demographic disparities in the World Health Organization and National Cholesterol Education Program Adult Treatment Panel III definitions of metabolic syndrome among adolescents

OBJECTIVE: To determine prevalence of metabolic syndrome (MS) among adolescents by using definitions from the National Cholesterol Education Program Adult Treatment Panel III (NCEP) and World Health Organization (WHO) guidelines and to compare the populations identified by these definitions. STUDY DESIGN: School-based, cross-sectional study of 1513 black, white, and Hispanic teens who had a fasting morning blood sample drawn and a physical examination. RESULTS: Overall, the prevalence of NCEP-defined MS was 4.2% and of WHO-defined MS was 8.4%. MS was found almost exclusively among obese teens, for whom prevalence of NCEP-defined MS was 19.5% and prevalence of WHO-defined MS was 38.9%. Agreement between definitions was poor (kappa statistic=0.41). No race or sex differences were present for NCEP-defined MS. However, nonwhite teens were more likely to have MS by WHO criteria (RR, 1.40; 95% CI, 1.04, 1.87), and MS was more common among girls if the WHO-based definition was used (RR, 1.26; 95% CI, 1.08, 1.88). CONCLUSIONS: Among adolescents, obesity is a powerful risk for MS. Important demographic and clinical differences exist in the typology of MS, depending on the definition. Such discrepancies suggest that the concept of a common pathologic syndrome or etiologic mechanism underlying MS as defined by these guidelines may be flawed.