Intractable pain: a neglected area of medical education in the UK.

Unease over the previous management of 67 patients referred for treatment to 3 pain relief clinics led us to investigate the current state of education in pain and pain control in the UK. Twenty-seven medical schools provided data which revealed; (i) in 4 schools no teaching whatsoever is given in these subjects; (ii) in the remainder it is accorded an average of 3.5 hours during the 5 year course, with little evidence of multidisciplinary teaching; (iii) only 10 schools (37%) regularly set questions on pain control in formal examinations. A survey of 219 general practitioners revealed a wide-ranging lack of knowledge about the facilities and approach to treatment at their local pain relief clinic. These findings have wide reaching implications for medical education. At the undergraduate level they demonstrate a need for more multidisciplinary teaching and practical experience in specialist units. Thereafter specialists in pain control must enable practising doctors to keep abreast of new developments. This may require them to devote more time writing for a non-specialist audience and devising short, postgraduate courses.     

华蟾蜍毒素对离体豚鼠输精管的作用

华蟾蜍毒素(华蟾素)使离体豚鼠输精管产生剂量依赖性收缩反应,利血平化豚鼠输精管及冷藏输精管对华蟾素反应减弱。给酚妥拉明、维拉帕米后,输精管对华蟾素反应均受抑制,溴苄胺可使反应潜伏期缩短。结果提示华蟾素收缩输精管反应可能与其促进肾上腺素能神经末稍NA释放有关。     

Perfluorochemicals as US contrast agents for tumor imaging and hepatosplenography: preliminary clinical results

In animals, perfluorochemicals (PFCs) are effective ultrasound (US) contrast agents that produce hepatic, splenic, and tumor enhancement. The use of Fluosol-DA 20%, an emulsion of perfluorodecalin and perfluorotripropylamine, was studied in nine non-critically ill patients with cancer who had liver lesions. US studies without Fluosol were compared with studies obtained 24, 48, and 72 hours after Fluosol infusion. Vital signs and extensive laboratory analyses are performed before and after Fluosol infusion. Liver metastases from colonic, pancreatic, and gastric carcinoma exhibited rim or diffuse enhancement after a Fluosol dose of 1.6 g/kg or greater. Fluosol produced echogenic enhancement of the liver and spleen relative to kidney at a dose of 2.4 g/kg, allowing the detection of nonenhancing lesions. In addition, Fluosol at a dose of 1.6 g/kg or greater allowed detection of lesions not seen before contrast medium was administered in three of the seven patients studied. There was a mild increase in the level of serum glutamic oxaloacetic transaminase in two patients, one given 2.4 and the other 3.2 g/kg of Fluosol. Mild and transient allergic reactions without change in vital signs were experienced by two patients.     

An unusual association with Raynaud's phenomenon

A 36-yr-old lady with a year of typical Raynaud's and polyarthralgiahad a normal examination other than cold peripheries and bloodpressure of     

What factors distinguish probands from multicase rheumatoid arthritis same sex sibships from sporadic disease?

Thirty-two of 243 same sex sibships in which the proband had rheumatoid arthritis (RA) had at least one same sex sibling with RA ("familial" RA) and 211 did not ("sporadic" RA). The most important factors accounting for familial RA were the sibship size, and the proportion of siblings sharing both HLA haplotypes with the proband. Demographic and clinical details, autoantibodies and HLA-DR status were similar between the 2 groups, with the exceptions of regular use of artificial teardrops, and involvement of distal interphalangeal joints, which were both more prevalent in familial RA. The extrapolation of results from familial to sporadic RA appears to be justified.     

Surgical sperm retrieval and intracytoplasmic sperm injection as treatment of obstructive azoospermia

Male genital tract obstructions may result from infections, previous inguinal and scrotal surgery (vasectomy) and congenital bilateral absence of the vas deferens (CBAVD). Microsurgery can sometimes be successful in treating the obstruction. In other cases and in cases of failed surgical intervention, the patient can be treated by microsurgical or percutaneous epididymal sperm aspiration (MESA, PESA) or testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI). We present the results of 39 ICSI procedures for obstructive azoospermia in 24 couples. The aetiology of the obstruction was failed microsurgery in 11 patients, CBAVD in nine and genital infections in four. Sperm retrieval was accomplished via MESA in four cases, PESA in 18 cases and via TESE in 11 cases. TESE was only applied when PESA failed to produce enough spermatozoa for simultaneous ICSI. In six patients, the ICSI procedure was performed with cryopreserved spermatozoa after an initial PESA procedure. Fertilization occurred in 47% of the metaphase II oocytes; embryo transfer was performed in 92% of procedures and resulted in a clinical pregnancy in 13/39 procedures. Ongoing pregnancy was achieved in 10/39 procedures. One pregnancy was terminated early after prenatal investigation showed a cytogenetic abnormality (47,XX+18, Edwards syndrome). The other nine pregnancies resulted in the live birth of 10 children, without any congenital abnormalities. Epididymal and testicular retrieved spermatozoa were successfully used for ICSI to treat obstructive azoospermia, and resulted in an ongoing pregnancy in 10 of 24 couples (41.6%) after 39 ICSI procedures, a success rate of 25.6% per treatment cycle and of 27.7% per embryo transfer.