A randomized controlled trial of sedation in the critically ill

A randomized controlled trial comparing: a) a combination of oral chloral hydrate and promethazine to b) a continuous intravenous midazolam infusion, for maintenance sedation in critically ill children, was carried out. The level of sedation was assessed four hourly using a specifically devized sedation scale. Forty-four children entered the study of whom two were subsequently excluded. The number of satisfactory assessments (desired and actual levels of sedation equal) was significantly greater in the chloral hydrate and promethazine group (Chi-squared P <0.01; confidence intervals of the difference 0.06 to 0.20). The number of assessments at level 5 on the sedation scale (patient restless/distressed) was significantly greater in the midazolam group (Chi-squared P <0.05). The total number of satisfactory assessments in the two groups were only 61 and 48% respectively, suggesting that sedation can be considerably improved. Chloral hydrate and promethazine are more effective than midazolam as maintenance sedation in critically ill children. It is possible to prospectively study the efficacy of sedative drugs in critically ill children.     

Ultrastructural, Protein, and Lipid Changes in Liver Associated with Chlordecone Treatment of Mice

Pretreatment of mice with chlordecone (CD) reduced hepatic accumulationof a subsequent dose of [¹⁴C]CD without significantly changing[¹⁴C]CD biotransformation. To determine if CD-induced changesin hepatic [¹⁴C]CD accumulation were coincident with alteredcell composition, we examined the effects of CD on hepatic proteinand lipid content, on fatty acid profiles of liver and kidney,and on the ultrastructure of hepatocytes. SDS-polyacrylamidegel electrophoresis detected an apparent CD dose-related increasein a microsomal protein with a molecular weight of about 23kDa. Total liver or kidney lipid contents were not altered byCD but relative amounts of several hepatic fatty acids werechanged. CD caused marked hepatic mitochondrial swelling, increasedamounts of endoplasmic reticulum, apparently increased numbersof peroxisome-like structures, and decreased numbers of lipiddroplets in cytoplasm of hepatocytes. Numbers of lipid dropletswere not decreased in perisinusoidal fat storage cells. In addition,the numbers of cytoplasmic lipoprotein vesicles were apparentlyincreased in some hepatocytes. Overall these changes indicatedan increased hepatocyte secretory activity and suggested thatCD changed hepatocellular lipid transport, storage, and metabolismpathways.     

HIV risk-taking behaviour among injecting drug users currently, previously and never enrolled in methadone treatment

This study compares the injecting and sexual risk-taking behaviour among injecting drug users (IDUs) currently, previously and never enrolled in methadone maintenance treatment (MMT). All subjects had injected during the 6 months prior to the day of interview. The current MMT group showed significantly lower injecting risk-taking behaviour subscale scores on the HIV Risk-taking Behaviour Scale (HRBS) of the Opiate Treatment Index than the previous MMT and non-MMT groups together. The current MMT group differed from the other two groups in the frequency of injecting and cleaning of injection equipment with bleach. There was no difference between the current MMT group and the other two groups combined in sexual risk-taking behaviour scores on the HRBS. There were no differences between the previous MMT and non-MMT groups in injecting and sexual risk-taking behaviour. HIV seroprevalence was low and there was no difference in seroprevalence between groups. Thus, IDUs currently enrolled in MMT are at reduced risk for HIV infection when compared with IDUs who have previously or never been enrolled in MMT. However, the absence of a difference between the current MMT and other two groups in frequency of sharing behaviours suggests the need for additional strategies among MMT clients to reduce needle-sharing. Possible strategies include the application of relapse prevention interventions and the availability of sterile injecting equipment in MMT clinics. Further research is needed to identify factors which increase attraction and retention of IDUs to MMT.     

Quantitative analysis of the anatomy of the epineurium of the canine recurrent laryngeal nerve

The purpose of this investigation was to determine the amount of epineurium surrounding the recurrent laryngeal nerve (RLN) compared with a limb nerve, that to flexor hallicus longus (NFHL). Nerve samples were obtained from 10 adult dogs and studied using scanning electron microscopy and light microscopy to measure the relative proportion of epineurium and the relative proportions of adipose and collagenous tissue comprising the epineurium in both nerves. Significantly greater relative epineurial cross-sectional areas and adipose content were found in the RLN than in the NFHL. Based on observations on noncranial peripheral nerves, the findings indicate that the RLN is better protected against deformational forces associated with compression than stretching forces. The RLN may not be structured well for successful reinnervation after injury. The patterns observed for adipose tissue in RLN epineurial tissue appeared unique compared with those previously reported in peripheral nerves. The primary role associated with adipose tissue is to 'package' the nerve for protection. The RLN is considered to be a vital nerve in the body, as are other cranial nerves. The large proportions of adipose tissue in the epineurium may relate to the importance of protecting this nerve from injury.     

The relationship of the number of Meissner's corpuscles to dermatoglyphic characters and finger size

This study investigated the relationships between the density of Meissner's corpuscles and the dermatoglyphic characteristics of human fingers. Dermatoglyphic prints and tissue samples were collected from the index (II) and ring (IV) fingers of 28 cadavers from the Medical School, University of Adelaide. Pattern types, pattern intensity, total ridge count and ridge breadth, were determined for each sample and the density of Meissner's corpuscles established by recording the mean number of Meissner's corpuscles underlying a 10 mm long line on the skin surface. No relationship was found between the density of Meissner's corpuscles and pattern type, pattern intensity or total ridge count. Negative correlations were found for the density of Meissner's corpuscles with both ridge width and size of fingers. Males were found to have significantly larger fingers, larger ridge breadth, and a lower density of Meissner's corpuscles per 10 mm compared with females. However, there was no difference between the total number of Meissner's corpuscles per finger in males and females. No significant differences were found in either the density of Meissner's corpuscles between antimeres or between the index and ring fingers. These results suggest that for both the left and right hand in males and females, there is a similar number of Meissner's corpuscles for both the index and ring fingers.     

Locus of control of behaviour: is high externality associated with substance misuse?

Personal control and responsibility are key themes in the therapeutic use of ‘motivational interviewing’. This popular method of counselling has suggested that clients need to believe they have a significant degree of control over their behaviour if they are to make progress. Using a well validated psychological test on locus of control of behaviour, our research sought to establish whether active misusers really believed that had less personal control than non-misusers. To establish this a sample of misusers was tested and compared with three diverse, comparable groups. Possible confounding factors such as age, sex and class were controlled for. T tests established a significant difference between the active misusers and the other sampled groups. Further, a regression analysis of variance, calculated to explain the differing external scores offered no reasonable explanation as far as age, sex and class were concerned. Alternatively, self diagnosed substance misuse accounted for 23% of the variation in scores. We concluded, therefore, that high externality scores are a good indicator of active misusing behaviour and that beliefs about personal control are important to address, if one is to increase the chances of a positive client outcome.     

Age‐Specific Differences in Women with Implantable Cardioverter Defibrillators: An International Multi Center Study

Background: Common psychological adjustment difficulties have been identified for groups of implantable cardioverter defibrillator patients, such as those who are young (<50 years old), have been shocked, and are female. Specific aspects and concerns, such as fears of death or shock and body image concerns, that increase the chance of distress, have not been examined in different aged female implantable cardioverter defibrillator (ICD) recipients. The aim of the study was to investigate these areas of adjustment across three age groups of women from multiple centers. Methods: Eighty‐eight female ICD patients were recruited at three medical centers: Shands Hospital at the University of Florida, Brigham and Women's Hospital in Boston, and Royal North Shore Hospital in Sydney, Australia. Women completed individual psychological assessment batteries, measuring the constructs of shock anxiety, death anxiety, and body image concerns. Medical record review was conducted for all patients regarding cardiac illnesses and ICD‐specific data. Results: Multivariate and univariate analyses of variance revealed that younger women reported significantly higher rates of shock and death anxiety (Pillai's F = 3.053, P = 0.018, η²_p= 0.067) and significantly greater body image concerns (Pillai's F = 4.198, P = 0.018, η²_p= 0.090) than middle‐ and older‐aged women. Conclusions: Women under the age of 50 appear to be at greater risk for the development of psychosocial distress associated with shock anxiety, death anxiety, and body image. Clinical‐based strategies and interventions targeting these types of adjustment difficulties in younger women may allow for improved psychosocial and quality of life outcomes.