One-stage operation for bilateral bullous lung disease

Sixteen patients with bilateral bullous lung disease have been operated on. One-stage surgical interventions--bullectomy and parietal pleurectomy--have been performed on both sides through a transsternal approach. There was a complication in one case: relaxation of the right hemidiaphragm as a result of phrenic nerve injury. Expansion of compressed lung tissue was achieved in all cases. Long-term follow-up for 5 years showed that perfusion and ventilation of lung parenchyma improved. Pneumothorax did not occur in any case. We concluded that the transsternal approach is the method of choice in the surgery of bilateral bullous lung disease, and parietal pleurectomy prevents spontaneous pneumothorax. Organ-sparing operations improve pulmonary function in patients with bullous lung disease.     

Risk factors for suicide attempts among alcohol dependent patients.

Suicidal behavior is a common and important problem among alcohol dependent patients. The study was designed to examine risk factors for attempting suicide in 499 alcohol dependent patients. Those who had attempted suicide (N = 198) were more likely to be female, report a family history of suicidal behavior, report more childhood trauma, report greater levels of aggressive behavior, began heavy drinking earlier, and were more likely to have received antidepressant medication. Logistic regression analysis showed that gender, family history, and childhood sexual abuse history made significant and independent contributions to the risk of a suicide attempt. Thus, developmental, personality, family history, social, and comorbidity risk factors may differentiate alcohol dependent patients who have attempted suicide from those who have not.     

Intuition and problem solving

General practitioners use the hypothetico-deductive method of scientific reasoning to solve problems. In the first few minutes of their consultations physicians form initial hypotheses about their patients' problems. This process has childlike, imaginative qualities based on intuition. It is often outside consciousness and probably based on pattern recognition. It has been neglected from study and analysis because of these `mystical' qualities. Yet it is the key to fast and efficient problem solving. If the process could be understood, its efficiency would be improved. This paper is an attempt to explore the nature of general practitioners' intuition.     

Food-anticipatory activity and liver per1-luc activity in diabetic transgenic rats

The mammalian Per1 gene is an important component of the core cellular clock mechanism responsible for circadian rhythms. The rodent liver and other tissues rhythmically express Per1 in vitro but typically damp out within a few cycles. In the liver, the peak of this rhythm occurs in the late subjective night in an ad lib-fed rat, but will show a large phase advance in response to restricted availability of food during the day. The relationship between this shift in the liver clock and food-anticipatory activity (FAA), the circadian behavior entrained by daily feeding, is currently unknown. Insulin is released during feeding in mammals and could serve as an entraining signal to the liver. To test the role of insulin in the shift in liver Per1 expression and the generation of FAA, per-luciferase transgenic rats were made diabetic with a single injection of streptozotocine. Following 1 week of restricted feeding and locomotor activity monitoring, liver was collected for per-luc recording. In two separate experiments, FAA emerged and liver Per1 phase-shifted in response to daytime 8-h food restriction. The results rule out insulin as a necessary component of this system.     

A canine model for reaginic hypersensitivity and allergic bronchoconstriction

Immunization of neonatal dogs with a conjugate of 2,4-dinitrobenzene and ovalbumin (DNP₂-OA), using aluminum hydroxide as the adjuvant, elicited long-lasting (over 30 wk) anti-DNP and anti-OA IgE antibody responses of high titers as determined by homologous passive cutaneous anaphylaxis. Low antigen doses of 10 or 50 μg were more effective than the higher doses of 250 or 1,250 μg in inducing high IgE antibody levels. However, this method of immunization failed to elicit any detectable IgE antibody response in adult dogs. Bronchoprovocation with antigen of sensitized animals having IgE antibody titers in excess of 64 resulted in a marked increase in airflow resistance, which could be corrected by the administration of nebulized isoproterenol. On the other hand, sensitized animals with IgE antibody titers in the order of 64 did not manifest significant bronchoconstriction on inhalation challenge but developed anaphylaxis following intravenous injection of the antigen.