Echoes from the Third World--two-dimensional echocardiography in a developing country

Cardiovascular disease is common in the developing world where lack of sophisticated diagnostic equipment may make adequate assessment of the disease impossible. Two-dimensional echocardiography has made a major contribution to the practice of cardiology in Transkei by improving diagnostic ability, aiding in the assessment of patients for surgery locally and for referral elsewhere for open-heart surgery, and in monitoring the progress of pericardial disease. It is cost-effective and appropriate technology for the developing world.     

Emotional and Social Aspects of Cancer Pain

The emotional and social consequences of pain were studied in 93 consecutive in-patients, 44 males and 49 females, suffering from cancer-related pain. The methods used were Visual Analogue Scales (VAS), standardized interviews and comprehensive self-questionnaires. Forty-seven patients (51%) experienced certain or pronounced anxiety (4-6 or 7-9 on a 9-grade scale) because of their pain and 66 patients (71%) expressed depressive pain-associated symptoms, which had a high correlation with the intensity of their pain. Physical activities such as movements, dressing/undressing, washing, cooking were hampered in about 2/3 of the patients and mental activities such as reading were significantly disturbed in 48% of the cases. For every social activity listed in the questionnaires (hobbies, seeing friends, etc) most patients reported a decreased activity because of pain and in most cases the decrease correlated significantly with the intensity of the pain. The family roles had changed since the patient could not participate in a usual manner. The study underlines the profound consequences of pain: physical suffering, emotional distress, social handicap and altered family roles. Thus, pain control should be a high-priority matter in palliative care.     

The bactericidal activity of pulsed Nd-YAG laser radiation in vitro

Pulsed Nd-YAG laser irradiation of bacteria has been suggested as a possible means of treating contaminated intra-oral sites although relatively few studies have been conducted. In this investigation, the antimicrobial activity of a pulsed Nd-YAG laser was assessed in vitro for a range of oral bacteria using several pulse energies and exposure durations. Pure cultures of each organism were lased in saline suspensions followed by standard colony counting techniques for test and control samples. Microbial inhibition was found to be organism-dependent and varied with energy dose and pulse energy. For all nine test species 120-mJ laser pulses proved more efficient than 80-mJ pulses, with 99.9% kills compared with around 90% kills after exposure to 1800 pulses. These killing activity levels compare favourably with those achieved with other lasers in vitro.     

Wavefront aberration and its relationship to the accommodative stimulus-response function in myopic subjects.

BACKGROUND: Autorefractors are increasingly used in myopia research because they are convenient tools to investigate aspects of the accommodation response. The degree to which the autorefractor measures are affected by ocular aberrations has been highlighted by studies that have shown changes in aberration levels through different parts of the pupil and with accommodation. We have compared accommodative accuracy as measured with a Shin-Nippon SRW 5000 autorefractor with wavefront error as measured with a Hartmann-Shack wavefront sensor to investigate how factors such as accommodation demand, ocular aberrations, and pupil size can influence autorefractor measures. METHODS: Accommodation stimulus-response curves were determined (using negative lenses) for 30 young healthy subjects (20 myopic [-0.75 to -6.00 D] and 10 emmetropic). Accommodation levels ranged from 0 to 4 D in 1 D steps. Wavefront aberrations were also determined for the same accommodation levels using a Hartmann-Shack wavefront sensor for both the subjects' natural pupil sizes and for a 2.9-mm pupil. RESULTS: For all subjects, there was a consistent increase in negative spherical aberration with increases in accommodative stimulus. However, there was no consistent change in paraxial spherocylindrical refractive correction with accommodation stimulus. For the emmetropic subjects, accommodation error as measured with the autorefractor was statistically similar to the total spherocylindrical correction for the eye as estimated by the Hartmann-Shack wavefront sensor, but only for a 2.9-mm pupil (the pupil size utilized by the autorefractor). For the myopic subjects, accommodation error as measured with the autorefractor was statistically similar to the higher-order aberrations, but only when measured for a natural pupil size. CONCLUSIONS: The relationship between the accommodation accuracy as measured with the autorefractor and the total wavefront aberration as measured with a Hartmann-Shack wavefront sensor is largely influenced by the higher-order (fourth and above) aberration levels. For the emmetropic subjects, the errors measured by the two methods agree when adjusted to measure at similar pupil sizes. For the myopic subjects with similar pupil sizes, however, the Hartmann-Shack wavefront sensor underestimates the accommodation error at higher accommodation levels (2 to 4 D) compared with the autorefractor.     

Changes in non-electrolyte permeability of alveoli and the absorption of lung liquid at the start of breathing in the lamb.

1. Experiments were done on mature foetal lambs, 135-145 days in gestation, exteriorized at Caesarean section, and on new-born lambs aged 12-60 hr. In the foetal lambs, test substances were added to lung liquid and then spontaneous ventilation was induced or the lungs were statically inflated with gas or saline. In the new-born lambs, the left lung was ventilated in order to maintain respiratory gas-exchange, while foetal lung liquid, taken from previous experiments and containing test substances, was introduced into the right lung, which was then inflated with gas and used for permeability measurements. In both foetuses and new-borns, the gas used was O2 or N2O and, at 20 min intervals, ventilation or static inflation was interrupted, the gas in the lungs absorbed into the circulation and the remaining liquid sampled through the trachea. The following test substances were used in various combinations: [14C]-erythritol, [3H]sucrose, [14C]inulin, [131I]albumin, and the polymer [131I]-PVP. The last of these was separated, after the experiments, by gel filtration with Sephadex G200 or G50, into fractions of defined molecular radius. [131I]albumin, or a large molecule fraction of [131I]PVP, was used as a volume marker. 2. Spontaneous ventilation was associated with the absorption of liquid and with an alteration in the foetal pattern of non-electrolyte permeability that could be characterized by postulating an opening up of water-filled cylindrical pores to 34-56 A in radium. In the new-born lambs, the results suggested pores 7-14 A in radius. 3. Static inflation of the foetal lungs with gas, to pressures of 25-35 cmH2O, gave permeabilities appropriate for pores 5-5-12 A in radius. Static inflation with gas, to pressures of 41-49 cmH2O, produced changes appropriate for much larger channels, more than 125 A in radius and possibly much larger. With one exception, expansion with saline produced changes similar to those obtained by gas inflation to 25-35 cmH20. 4. It was concluded that in the initial stages of pulmonary ventilation a change takes place in alveolar epithelial cells. The increase in size would be sufficient to allow for rapid liquid absorption, but is not so great as to permit significant penetration by plasma albumin. The results obtained in the lung of the new-born lamb statically inflated to 25-32 cmH2O suggest that, following the initial adaptation, alveolar permeability returns towards the foetal pattern, although the pores remain larger than in the foetus. The change in permeability pattern at birth appears to depend on the degree of lung expansion with gas.