DOES LIVER DYSFUNCTION EXPLAIN NEUROPSYCHOLOGICAL STATUS IN RECENTLY DETOXIFIED ALCOHOL-DEPENDENT CLIENTS?

In the search for explanation of persistent cognitive impairmentassociated with alcohol dependence, the possible role of liverdisease has aroused considerable interest. However, review ofthe relevant literature provides only ambiguous support forany general relationship between neuropsycho-logical statusand laboratory tests of liver function. We tested the generalhypothesis, and also two specific hypotheses relating particularliver function parameters (     

Fetal heart rate monitoring by telephone. I. Development of an integrated system in Cardiff

Summary. We report the development of a practical dedicated system for domiciliary fetal monitoring integrated in a scheme for its rational application. From experience of 1120 domiciliary recordings in 74 women (64 with high-risk pregnancies), we suggest that domiciliary monitoring applied within a structured clinical context should be as safe as monitoring in hospital.     

Randomized Evaluation of an Inflatable Femoral Artery Compression Device After Cardiac Catheterization

Mechanical femoral artery compression devices have several limitations. We compared a novel disposable beltheld pneumatic compression device to manual compression alone in 213 patients randomized into two equal groups. Both were comparable for age, gender, current therapy with aspirin (ASA) and warfarin, diameter of the arterial sheath, previous procedures via the same artery, procedure duration, and blood pressure. Manual compression time was 12 ± 3 minutes. Pneumatic compression was reduced during 60 minutes. Patient discomfort was assessed as none (82% vs 88%), mild (13% vs 8%), moderate (3% vs 4%), or severe (2% vs 0%) for the manual versus pneumatic group, respectively. Bleeding and hematoma occurred in 7.5% of patients with no difference between the treatment groups. However, manual compression was significantly more effective in the higher range of systolic blood pressure, and pneumatic in the lower range, with a cut point of approximately 170 mmHg. Predictors for bleeding were systolic blood pressure and dose of ASA. Among 113 patients with systolic blood pressure < 160 mmHg and low dose (75 mg) or no ASA, only / patient (0.9%) experienced bleeding while 31% of 16 patients with both elevated systolic blood pressure and high dose ASA (150–330 mg) bled. We conclude that pneumatic femoral artery compression does not reduce bleeding and hematoma compared with manual compression. The use of low dose (75 mg) or no ASA, as well as giving special attention to patients with elevated systolic blood pressure, may reduce the risk of bleeding after cardiac catheterization .     

Surgical anatomy of the singular nerve*

The course of the posterior ampullary (singular) nerve has been studied in 30 preserved human temporal bones. In 17 dissections (57%), the nerve was readily accessible in the floor of the round window niche without undue risk to the round window membrane or the ampulla of the posterior semicircular canal. In 5 bones (16%), the nerve was closely related to the round window membrane and could not have been approached without significant risk of damage to the membrane. In 8 (27%), the nerve ran more or less directly medially to the internal auditory meatus without entering the round window niche. The ampulla of the posterior semicircular canal would therefore have been at risk if the nerve were approached surgically. Keywords anatomy singular neurectomy     

Is There a Relationship Between a Mother's Mental State and Consulting the Doctor by the Family? A Study in a Military General Practice

A total of 174 families of service personnel with children between3 and 6 years of age were studied over a 6 month period. Allcontacts with the general practitioner, both in and out of hourstogether with the local casualty department were recorded. Mothersof the children were posted a specialty designed questionnaireto measure how seriously they perceived various childhood symptomsto be and a copy of the general health questionnaire, 28 questionversion (GHQ 28). The perceived severity questionnaire had beenpiloted previously in a neighbouring practice. The overall responserate was 77%. Analyses of the data showed that the factors mostsignificantly associated with a child's consultation frequencywere the psychological state of the mother, the mother's ownconsultation frequency and the number of children in the family;the last being an inverse relationship. No evidence was foundto suggest that the perception of the severity of illness variedwith the psychological state of the mother. In addition, thechildhood consultation rate was not influenced by the mother'sperception of the severity of childhood illness as measuredby the perceived severity questionnaire. Other factors suchas the age of the mother or child, within the age range studied,were not found to be significantly related to the child's frequencyof consulting. A mother's own consultation frequency was highlycorrelated with her GHQ 28 score, but more specifically withthe subsections that scored for depression and somatic symptoms.From the study, doctors who see children should seriously considerthe main reasons for a child's consultation. In particular,as mothers often make the decision as to whether their childshould see the doctor, the main patient may be the parent notthe child. Mothers who present themselves frequently may alsohave a high level of psychological distress.     

Hydrodynamic Function of Second Generation Porcine Bioprosthetic Heart Valves

The hydrodynamic function and leaflet dynamics of second generation porcine valves prepared with low- or zero-pressure fixation have been studied and compared to first generation porcine bioprostheses, bileaflet, and tilting disc mechanical valves. The Carpentier-Edwards Supra-Annular and Hancock II valves showed lower pressure drops than the Medtronic Intact valve and first generation porcine valves, and comparable overall energy losses to mechanical valves at normal cardiac outputs. Only the zero-pressure fixed Intact valve showed synchronous leaflet opening. Delayed leaflet opening and high opening pressures were found in both low- and high-pressure fixed porcine valves. All porcine bioprostheses showed high open leaflet bending strains. Fixation of valve leaflets with "near zero" pressure fixation and a more physiological neutral geometry is necessary to ensure synchronous leaflet opening at low flows and a reduction in commissural bending strains.     

ANALYSIS OF SEROLOGICAL SURVEYS USING MIXTURE MODELS: APPLICATION TO A SURVEY OF PARVOVIRUS B19

A method for the analysis of age stratified antibody prevalence surveys is developed. The age specific distribution of the quantitative results of serological antibody tests is modelled as a mixture of seropositive and seronegative components. This yields maximum likelihood estimates of the prevalence at each age. The method is illustrated using data from a previously reported survey of antibody to parvovirus B19.