The workload of trainees in general practice

During their first training period in general practice the authors felt that they did not encounter the balanced workload which is the foundation for learning to be a GP. Previous studies confirmed the existence of differences in overall and specific workload between trainees and trainers. From their own experience and from the relevant literature they addressed several factors which might affect the workload of trainees. A study was undertaken to determine differences in workload between trainees and trainers, and to investigate whether certain characteristics of practice and of trainees affect the workload of trainees. Details of surgery consultations with 34 trainee-trainer partnerships were recorded in the north of the Netherlands over 2 weeks. Questionnaires were filled in by trainers, trainees and practice assistants from these 34 general practices. The total number of contacts recorded was 10,103. It was found that trainees see fewer elderly and female patients, less chronic and oncological conditions, but more minor illnesses. They see only 30% of patients with problem behaviour. Factors that influence the trainees' workload, as compared to their trainers' are: list size; selection in the allocation of patients; trainee's experience prior to starting the training stage, and the trainee's sex. Except for problem behaviour, trainees generally see a cross-section of their trainer's practice population. Selection would provide a more balanced workload for trainees.     

Prostate cancer is part of the hereditary non-polyposis colorectal cancer (HNPCC) tumor spectrum

The recognized urologic tumor spectrum in hereditary non-polyposis colon cancer includes ureteral and renal pelvis malignancies. Here, we report a family in which the proband, who had three metachronous adenocarcinomas of the colon and rectum (at ages 54, 57, and 60), presented with an adenocarcinoma of the prostate at age 61. Immunohistochemical (IHC) staining of colonic, rectal, and prostatic tumor tissues demonstrated lack of expression of both MSH2 and MSH6. Accordingly, microsatellite instability (MSI) was found in the rectal, colonic, and prostatic tumors. The kindred complies with the Amsterdam criteria for HNPCC, as five members over three generations had colorectal cancer. Molecular investigations were initiated when the proband's son presented with an adenocarcinoma of the colon at age 35. Southern blotting analysis of genomic DNA led to identification of a novel genomic deletion encompassing exon 5 of the MSH2 gene. Although prostate cancer has occasionally been described in HNPCC families, to the best of our knowledge, this is the first report where the MSI and IHC analysis of the prostatic adenomcarcinoma clearly link its aetiology to the germline mismatch repair mutation. Hence, prostate cancer should be included in the HNPCC tumor spectrum.     

Cathepsin L plays an active role in involution of the mouse mammary gland.

Involution of the mammary gland after weaning occurs in two stages. The first stage is reversible, whereas the second stage is characterized by the irreversible collapse of the alveolar structure. A differential display analysis using cDNAs from tissues obtained at various times after forced weaning of pups identified cathepsin L as up-regulated during early involution. Levels of cathepsin L mRNA were dramatically increased within 24 hr after weaning. Cathepsin L protein detected by immunoblot was also increased during involution, reaching near maximal levels by 36 hr after weaning. In situ immunohistochemistry detected pronounced cathepsin L protein in the cytoplasm and cell periphery. Mice treated with a specific inhibitor of cathepsin L exhibited substantially reduced numbers of apoptotic cells at times up to 72 hr after weaning when compared with untreated animals. The cathepsin L inhibitor did not alter levels of cathepsin L detected in immunoblots or influence molecular weight of the cathepsin L species detected. These data suggest that cathepsin L plays a regulatory role early in the process of mammary gland involution.     

Action of some foreign cations and anions on the chloride permeability of frog muscle

1. Evidence for the existence in skeletal muscle of a specific cation binding system capable of lowering the chloride permeability was obtained by testing the effect of several metal ion species upon the efflux of (36)Cl from frog muscles equilibrated in high-KCl solution.2. Cu(2+), Zn(2+) and UO(2) (2+) ions, when present in concentrations of approximately 10(-4)M in inactive wash solution at pH 7.4 slowed the efflux of (36)Cl to half its original value. At pH 5.0, when the chloride permeability was already low as a consequence of hydrogen ion binding, these metal ions had little further effect.3. Presence of Ni(2+), Co(2+), Pb(2+), Ce(3+) and La(3+) in 10(-4)M or higher concentrations had no detectable influence on the (36)Cl efflux. Wide variations in Ca(2+) concentration were similarly ineffective.4. The influence of more adsorbable anions on the chloride permeability was examined at different pH values. Extracellular iodide greatly slowed the rapid efflux of (36)Cl into alkaline solution. In acid solutions, when the chloride permeability was already low, the effect of iodide was less pronounced, but still demonstrable. The chloride permeability was consequently increased to a lesser extent by a rise in pH in the presence of iodide.5. The efflux of iodide and bromide was measured at different pH values under conditions of self exchange. In alkaline solution the permeabilities to iodide and bromide were considerably lower than that to chloride. In acid solution the membrane differentiated less between anion species of different adsorbability.     

Radon progeny unattached fraction in an atmosphere far from radioactive equilibrium

It is often assumed that the unattached fraction of the exposure to suspended radon progeny activity can be predicted from particle concentration measurements. While this may be true in many circumstances, there are important exceptions to this rule. In particular, in an atmosphere far from radioactive equilibrium, such as a working area in a mine close to a source of radon and supplied with fresh air, the unattached fraction can be a factor of ten or more greater than indicated by a simple particle concentration measurement. Recent measurements made in a diesel powered uranium mine are presented to illustrate this effect.     

Mechanical properties of normal andmdx mouse sarcolemma: Bearing on function of dystrophin

Summary The tensile strength of the muscle fibre surface membrane was estimated (1) from the suction required to burst membrane patches and (2) by aspiration of sarcolemmal vesicles into micropipettes of uniform bore. Each method gave an average value close to 60 N cm^–1 for the maximum tension sustainable by normal mouse sarcolemma and only slightly lower values for sarcolemma frommdx mice which lack dystrophin. The elastic modulus of area expansion, as measurable by pipette aspiration of sarcolemmal vesicles, was found to have an average value of 3160 N cm^–1 for normal and 2770 N cm^–1 formdx mouse sarcolemma.The tensile strength of the sarcolemma is much too small for any differences in it to be the basis for the different osmotic behaviour of normal andmdx muscle fibres reported recently (Menke & Jockusch, 1991). By analogy with the better understood origin of the osmotic fragility of different types of red blood cells, the higher osmotic fragility ofmdx muscle fibres is suggested to be of morphological origin. We postulate that dystrophin functions as an element of the submembrane cytoskeleton so as to maintain the normal folding which safeguards the sarcolemma against mechanical damage.