Physiological analysis of simple rapid movements in patients with cerebellar deficits.

Patients with cerebellar deficits made elbow flexion movements as rapidly as possible for three different angular distances. Electromyographic activity of biceps and triceps and the kinematics of the movements were analysed. Results were compared with those of normal subjects making both rapid and slow movements. In the patients, the first agonist burst of the biceps was frequently prolonged regardless of the distance or speed of the movement. The most striking kinematic abnormality was prolonged acceleration time. The pattern of acceleration time exceeding deceleration time was common in patients but uncommon in normal subjects. The best kinematic correlate of the duration of the first agonist burst was acceleration time. Altered production of appropriate acceleration may therefore be an important abnormality in cerebellar dysfunction for attempted rapid voluntary movements.     

Pharmacy customers’ views and experiences of using pharmacies which provide needle exchange services in Aberdeen and Glasgow, Scotland

Community pharmacists contribution to the management of drug problems is considerable. As the use of illicit drugs has increased, pharmacists have come under increasing pressure to offer services to problem drug users. However, there is concern among some pharmacists that offering such services may deter other customers. There is particular concern among some pharmacists about needle exchange services. Only 9.5% of Scottish pharmacies offer needle exchange services compared to 69% which are dispensing methadone (57% of which supervise methadone consumption). Qualitative interviews were used in a purposive sample of 10 pharmacies in Scotland. Eight customers were interviewed in each pharmacy to ascertain pharmacy customers’ views on these services. The majority of customers were supportive of these services. Customers were often unaware that the pharmacy they were interviewed in was offering services for people with drug problems. Pharmacy customers were more knowledgeable about, and more supportive, of needle exchange services than they were of methadone. This was because they believed needle exchange services helped to reduce the amount of discarded needles in public places. Pharmacy customers also recognised that needle exchange helped reduce the spread of disease. These findings should be used to encourage more pharmacists to offer needle exchange services.     

31P NMR of electrically stimulated rectus femoris muscle: an in vivo graded exercise model.

This study reports on the development of a model for studying skeletal muscle metabolism in humans using NMR spectroscopy. Graded exercise was simulated using electrical stimulation in 10 healthy, fit subjects (mean VO2max = 53 +/- 4 ml.kg-1.min-1). The effects of varying the stimulation parameters, namely, the stimulation frequency, the stimulation intensity, and the duty cycle, as well as the spectral interrogation volume, were compared using data acquired from the rectus femoris muscle. With stimulation, the inorganic phosphate to phosphocreatine concentration ratio ([P(i)]/[PCr]) and the intracellular pH both follow curvilinear relationships over the stimulation frequencies from 3 to 30 Hz, with the magnitude of the observed change related closely to stimulation intensity and duty cycle. Oxidative phosphorylation predominates at stimulation frequencies below 12 Hz, while anaerobic metabolism increases sharply above 12 Hz. Our findings show clearly the interdependence of the effects of the various stimulation parameters and emphasize the care that must be exercised in interpreting the physiological significance of the biochemical data obtained from electrical stimulation models used to study skeletal muscle metabolism.     

Surgical morbidity and mortality in one hundred and twenty-nine patients with obstructive jaundice

One hundred and twenty-nine jaundiced patients were operated upon for the relief of benign and malignant bile duct obstruction during a 10-year period, 1977-86. The overall mortality was 4.7 per cent but increased to 9.1 per cent in patients with a serum bilirubin greater than 300 mumol/l. In all, 46.5 per cent of patients had a rise in postoperative creatinine but renal dysfunction occurred in only 4.7 per cent. Wound infection developed in 3.1 per cent of patients and appeared unrelated to infected bile; 3.9 per cent of patients were treated for postoperative septicaemic episodes. The low morbidity and mortality observed suggests that preoperative biliary drainage need not be considered in routine surgical practice if simple measures to maintain urine flow and prevent postoperative sepsis are used.     

Sexual assault: review of a national model protocol for forensic and medical evaluation. New Hampshire Sexual Assault Medical Examination Protocol Project Committee.

A national hospital/community model protocol was developed for the forensic and medical examination of victims of sexual assault. This review is designed to assist states in the development of sexual assault protocols. Controversial issues were addressed, including the collection of hair evidence, the importance of semen, mandatory reporting, pregnancy testing and prophylaxis, and sexually transmitted diseases including human immunodeficiency virus. The current role of DNA profiling is reviewed. These issues at the interface of medicine, forensic science, victim advocacy, and the law are analyzed. Representatives of the medical, legal, law enforcement, victim advocacy, and forensic science communities contributed to the development of the protocols at the national and state levels. The importance of a collaborative effort is emphasized. The broad protocol goals are to minimize the physical and psychological trauma to the victim while maximizing the probability of collecting and preserving physical evidence for potential use in the legal system.     

Heterogeneity of HLA-A2 in Asia-Oceanic populations

HLA-A2 is one of the most common yet most diversified HLA antigens with 17 subtypes so far identified at the molecular level. A2 subtyping may have significant impact on clinical medicines. We developed a PCR/SSO-based comprehensive typing protocol for HLA-A and investigated the distribution of A2 alleles in regional ethnic groups. A2 was detected with high frequencies in most study populations. A total of 480 A2+ samples were identified and subtyped. The gene frequencies of A2 ranged from 34% in Chinese, 29% in Australian Caucasoids, 21% in Polynesians, 14% in Javanese and 13% in Australian Aborigines. However, in Melanesians and Micronesians A2 was absent. Six A2 alleles were found in the present experiments including A^*0201, 0203, 0205, 0206, 0207 and 0210. In Aborigines all the A2+ donors were typed as 0201. In Caucasoids A^*0201 accounted for 95% of A2+ samples though other three subtypes A^*0203, 0205 and 0207 were also detected. Extraordinary A2 heterogeneity was observed in Asia-Pacific populations where A^*0201 has become a minority. In Chinese all the six A2 alleles were discovered with A^*0201, 0203, 0206 and 0207 as the four major ones. In Javanese A2 was equally divided into A^*0201, 0203 and 0206 while in Polynesians A2 is overwhelmingly dominated by the oriental A^*0206 (71%). Our study also showed that comprehensive DNA matching for A2 would eliminate most A mismatches in the unrelated-donor transplantation in study populations.     

Endometrial fluid collection in women with hydrosalpinx after human chorionic gonadotrophin administration: a report of two cases and implications for management

The impact of hydrosalpinx (HSPX) on in-vitro fertilization (IVF) outcome has recently been the subject of intense debate. Most, but not all, studies have reported decreased implantation and pregnancy rates and increased early pregnancy loss in HSPX patients. This has led to prophylactic salpingectomies prior to IVF in HSPX patients despite the lack of any prospective studies to suggest that any improvement will occur. Women with HSPX constitute a heterogeneous population because some conceive easily with IVF while others do not until after surgical correction. HSPX also increases in size with ovarian stimulation, and can cause implantation failure by fluid reflux into the uterine cavity. Careful assessment of the endometrial lining is mandatory in HSPX to rule out fluid reflux from the HSPX. We present two case reports of patients whose HSPX enlarged with ovarian stimulation, causing fluid reflux into the uterine cavity which was only noted after human chorionic gonadotrophin (HCG) administration.      

Immunologic studies of patients with diabetes mellitus who have received long term insulin therapy: lymphocyte reactivity to insulin is correlated with impaired immunoglobulin secretion in vitro

To investigate the influence of chronic antigen stimulation on immune response, 31 diabetics who had been treated from 4 to 39 years with various types of insulin were studied. Of the 31 patients, 22 had an elevated lymphocyte blastogenic response to insulin (beef/pork regular or protamine containing types). There were approximately equal numbers of patients with insulin dependent and noninsulin dependent diabetes whose lymphocytes reacted to the insulin. Of 24 patients who were also studied for the ability of their lymphocytes to secrete immunoglobulin secondary to pokeweed mitogen, 14 were significantly depressed compared to normal controls. Depressed responses tended to occur in both IgG and IgM secretion. Average immunoglobulin secretion of the diabetics' lymphocytes was 1843 and 2667 ng/ml, whereas for the normal subjects, the lymphocyte secretion was 3175 and 6013 ng/ml of IgG and IgM, respectively. (The normal secretion was based on the testing of 64 normal individuals.) Interestingly, 13 of 14 patients with impaired immunoglobulin secretion had a positive lymphocyte proliferative response to insulin (P less than 0.01). This statistically significant correlation between lymphocyte proliferative response to insulin and impaired polyclonal immunoglobulin secretion suggests the possibility that chronic antigen stimulation by insulin alters the normal immune response.