Intensive bedside teaching of physical examination to medical undergraduates: evaluation including the effect of group size

The effectiveness of intensive bedside teaching of techniques of physical examination of the alimentary system to students commencing their clinical training was assessed. All students viewed a videotape demonstrating these techniques and then participated in a morning practice examination session but only half of the class received afternoon bedside teaching of physical examination in addition. Teaching in history taking was used as a 'placebo' for the control group, and half the students in each of the study and control groups were taught in units of four, the other half in units of eight. Thus the effect of group size could also be estimated. After 1 week, the Students' performance of a physical examination was assessed using a standardized scoring chart which demonstrated good reliability. The study group performed significantly better than the control and within the study group there was a trend for the students taught in smaller units to perform better.     

Clinical and immunological studies of beekeepers

Thirty-four beekeepers were interviewed and their blood assayed for the presence of antibodies reacting with bee venom, bee venom phospholipase A (PLA), and whole bee body extract. Following a bee sting, most beekeepers experienced only minimal local tissue reaction. Their serum contained high levels of total antibodies (primarily IgG) reacting to bee venom and phospholipase A. These antibody titres correlated with the frequency of bee stings. Bee venom and PLA specific IgE antibodies were present in serum of some beekeepers. Beekeepers who had experienced allergic reactions were characterized by low total antibody and high venom specific IgE antibody titres. Bee body IgE antibodies were found in varying degree and did not correlate with levels of venom IgE antibodies. There was no difference in the titres of bee body IgE in the sera of beekeepers with and without systemic reactions. The data suggest that allergic reactions are mediated by venom specific IgE and immunity is at least in part a function of other antibodies, probably primarily IgG.     

In situ analysis of ischaemia/reperfusion injury in rat liver studied in three different models

Animal models of liver ischaemia and reperfusion are frequently used to study the consequences on liver cells of transient oxygen deprivation. In 3 different rat models we studied ischaemia/reperfusion effects on liver cell membrane integrity, cytoplasmic enzyme proteins and enzyme activities by in situ histochemical techniques. In vivo ischaemia, as well as no-flow hypoxia, or N₂-induced hypoxia in isolated perfused livers, reduced the activity of 5'-nucleotidase, a sensitive marker for plasma membrane damage in hepatocytes. As little as 2 minutes of reoxygenation in each model resulted in leakage of soluble enzymes from parenchymal and non-parenchymal liver cells, as shown by decreased protein level and activity of cytoplasmic enzymes. Whereas a multifocal decrease was observed after in vivo reperfusion, a decrease was found in all periportal and midzonal cells after blood-free reoxygenation. As judged by alkaline phosphatase activity and immunohistochemistry, an influx of inflammatory cells was not found in the in vivo model. Our findings indicate that reoxygenation itself, rather than restoration of flow, accounts for the loss of soluble enzymes from liver cells after a period of hypoxia. In situ detection of enzyme protein and activity proved useful for the examination of very early ischaemia/reperfusion effects on rat liver cells.     

Aluminium concentrations in infant formulae

The aluminum concentrations in breast milk and in 25 commercially available infant formulae were measured. The mean concentration in breast milk was 49 micrograms/L while concentrations in most of the humanized formulae were less than 500 micrograms/L. Higher concentrations were found in Nan, Prem Enfamil and the three soya formulae. We suggest that all formulae have the potential to be contaminated with aluminium, and to varying degrees in different batches. Until it is known whether aluminium toxicity occurs in normal infants fed these formulae, it seems reasonable to expect manufacturers to routinely measure aluminium and keep aluminium contamination to a minimum. This may be especially important for formula fed to infants with compromised gastrointestinal and renal systems.     

Squamous cell carcinoma of the nail bed: a clinicopathological study of 12 cases

Twelve cases were reviewed of squamous cell carcinoma of the nail bed, with emphasis on the aetiological role of human papillomavirus (HPV) infection and radiation damage. Using a hybridization technique, similar HPV genomes were detected in a uterine cervical neoplasia and a subungual squamous cell carcinoma in the same patient.     

Histopathology of the human liver in yellow fever with special emphasis on the diagnostic role of the Councilman body

Liver specimens from 10 cases of yellow fever (YF) were studied by light and four by electron microscopy to review morphological aspects of the disease relevant to its diagnosis, with special emphasis on acidophilic bodies (AB) and on the possible presence of the virus within infected cells. The AB were compared with those found in 22 out of 69 liver specimens with other pathological processes. In YF the typical alteration was an acidophilic hepatocellular necrosis with a preferential midzonal distribution. Ceroid pigment was abundant, its amount was proportional to the degree of liver cell damage and it was found in altered hepatocytes and Kupffer cells in the most damaged areas. The inflammatory infiltrate was scanty, not only in portal tracts but also within the lobules. Electron microscopically, no viral particles were found in liver cells or AB. The latter appeared as round or elliptical cytoplasmic masses, surrounded by a conspicuous cellular membrane and densely packed with organelles, fat vacuoles and residual bodies. They differed from AB in other liver diseases by the presence of fat vacuoles and ceroid pigment. Some peculiarities of AB in other liver diseases such as presence of bile pigment and iron, would depend upon the presence of these pigments in the hepatocytes which originated them.     

Videotape demonstration of physical examination: evaluation of its use in medical undergraduate teaching

A videotape demonstration of the physical examination of the alimentary system was used, in place of a traditional lecture, in the first week of a teaching programme for half of a group of commencing, clinical students. At the end of the week, these students obtained higher scores than the matched controls in a clinical assessment which utilized an objective scoring-chart devised especially for this study.