A case of deficiency of N-hydroxylation of amobarbital

It has been shown recently that the overall metabolism of amobarbital in man is essentially under genetic control. The drug normally undergoes two hydroxylation reactions, leading to 3'-hydroxyamobarbital (C-OH) and N-hydroxyamobarbital (N-OH). This paper describes a sibship in which two mothers who are identical twins show a gross deficiency on N-OH elimination in urine. The whole set of sibship data suggests that this deficiency represents a recessive trait controlled by a single pair of allelic autosomal genes which regulate N-OH formation. Several methodical approaches to assess an individual's capacity for N-OH formation are illustrated. There was no evidence of compensatory or concordant regulation of the two hydroxylation reactions. The case of this family illustrates that the functional lack of a biotransformation reaction is almost certain to be overlooked if one measures only the disappearance of a multimetabolized drug and not the appearance of metabolites.     

Decision modelling of economic evaluation of intervention programme of breast cancer

Objectives Economic appraisal of an intervention is a complex and multivariable problem, with probabilistic issues related not only to clinical outcomes but also to costs and willingness to pay. Methods We provide a comprehensive framework for economic appraisal of a health intervention to prevent beast cancer mortality, involving probabilistic model of costs as well as of aspects of the disease process. The economic appraisal can give a range of probabilities of cost‐effectiveness depending on willingness or ability to pay. Results We apply the method to the example of polychemotherapy for early breast cancer. Results indicate a 30% probability of cost‐effectiveness for a willingness to pay of $60 000 per quality‐adjusted life‐year and around 50% for a threshold of $100 000. Conclusion The comprehensive economic appraisal model is a powerful tool for decision making over a range of economic environments.     

Analysis of the Concept of Quality of Life

ABSTRACT. Nurses provide the constant human care that can make the difference between a life that is valuable to the last and a life that ends in humiliation, deprivation and suffering. Nurses, therefore, more than other health professionals, need a deep and reflective view of patients' value and quality of life. In this paper the concept of quality of life is analysed from a philosophical and scientific perspective. Quality of life in connection with treatment of a disease has its roots in the philosophical conception of the value of human life in general. Characteristics such as happiness, physical activity and interpersonal relations are what give life value and meaning. From the scientific viewpoint, it seems difficult to define the concept, given its multidimensional characteristics. However, the analysis indicates a growing interest among health-professionals to develop scientific intersubjectivity of the concept in terms of measurable parameters.     

Determination of loss of quality of life

Physiatrists are a valuable resource in legal settings, where assessment of functional capacity to perform work and of future medical needs must be determined. Physiatrists help determine what future medical care is needed to restore and maintain an individual at the maximum level of life function. This article focuses on the use of a quality of life (QOL) rehabilitation model, rather than a medical model, for enhancing functional performance, modifying environments, and facilitating patient coping. We discuss use of the QOL model to describe and influence a patient's physical, psychological, cognitive, vocational/economic, and social/leisure domains.     

Sonographic evaluation of a leiomyoma of the broad ligament of the uterus.

Leiomyomas of the uterus generally have a characteristic ultrasound appearance. We present a case of leiomyoma of the broad ligament of the uterus. A 46-year-old woman who had previously undergone a hysterectomy had a pelvic mass with a whorled appearance and acoustic shadowing suggestive of a leiomyoma on sonography. Based on the sonographic appearance, a preoperative diagnosis of a leiomyoma was made despite the unusual location. Histologic examination of the excised mass revealed leiomyoma originating from the broad ligament.     

Automatic detection of landmarks for the analysis of a reduction of supracondylar fractures of the humerus

An accurate identification of bone features is required by modern orthopedics to improve patient recovery. The analysis of landmarks enables the planning of a fracture reduction surgery, designing prostheses or fixation devices, and showing deformities accurately. The recognition of these features was previously performed manually. However, this long and tedious process provided insufficient accuracy. In this paper, we propose a geometrically-based algorithm that automatically detects the most significant landmarks of a humerus. By employing contralateral images of the upper limb, a side-to-side study of the landmarks is also conducted to analyze the goodness of supracondylar fracture reductions. We conclude that a reduction can be classified by only considering the detected landmarks. In addition, our technique does not require a prior training, thus becoming a reliable alternative to treat this kind of fractures.     

An analysis of the concept of pain

This paper presents a conceptual analysis of the phenomenon of pain. The strategic process of developing a conceptual analysis is a cognitive exercise of critical thinking applied to a very common, but complex and poorly understood, experience. Within the classic framework developed by Walker & Avant (1995), pain is analysed and critical attributes are distilled. A model case, a related case and a contrary case are constructed in the course of creating conceptual clarity. Empirical referents that exemplify the concept of pain are identified. The concept analysis provides a forum for dialectics, offering one defensible interpretation of a complex human occurrence. Nursing implications are discussed in the conclusion.     

A comparison of methods of evaluating cervical range of motion

OBJECTIVE: To determine whether there are differences in results when evaluating cervical range of motion (ROM) with radiographic analysis, a bubble goniometer, and a dual inclinometer and whether particular physical parameters are related to cervical ROM. METHODS: We evaluated the cervical ROM of 115 volunteers with each of the 3 clinical methods. Tape measurements of neck girth, distance from chin to sternal notch, and distances from ears to acromion were also recorded, along with sex and age. Interrater and intrarater reliabilities were determined, and the Pearson product moment correlation test and t test were performed on all data. RESULTS: Cervical ROM as determined by radiographic analysis was greater than that obtained with either a dual inclinometer or a bubble goniometer. All tape measurements were weakly correlated with all 3 means of cervical ROM evaluation, with the exception of the measurement of ear lobes to acromion, which did not correlate with radiographic analysis. There were also differences found in cervical ROM by sex and by age, with female subjects and younger subjects having a greater ROM. CONCLUSION: Compared with a dual inclinometer and a bubble goniometer, radiographic analysis provides a more accurate evaluation of cervical ROM.     

Prenatal diagnosis of thrombosed aneurysm of vein of Galen.

Aneurysm of the vein of Galen in the fetus is a rare malformation that has been described in a small number of case reports. Thrombosis of aneurysm of the vein of Galen is a rare occurrence reported in postnatal cases. We report a case of thrombosis of vein of Galen aneurysm occurring in a fetus of 21 weeks' gestation. The fetus showed an echogenic mass posterior and superior to the thalamus. It also showed dilated dural venous sinuses, dilated neck vessels, cardiomegaly and minimal ascites. The pregnancy was terminated and autopsy confirmed the diagnosis. The present case is the first report of the prenatal sonographic features of this condition in the literature.     

The acquisition of a mature understanding of three components of the concept of death

This study focuses on the acquisition of three key components of a mature concept of death: universality, irreversibility, and nonfunctionality. Ninety-one children, grades K-3, were interviewed individually using a structured interview. Although a majority of children from kindergarten on understood each component, less than half achieved a mature understanding of all three components. This suggests that the process of achieving such an understanding continues at least through age 10. Statistical analysis indicated that universality is understood before either irreversibility or nonfunctionality (sequential acquisition), and that irreversibility and nonfunctionality are understood at about the same time (concurrent acquisition). The theoretical issues involved in empirically differentiating concurrent and sequential acquisition and a measurement model for making that discrimination are discussed.     

An evaluation of quality of life of mothers of children with cerebral palsy

Purpose: To evaluate the quality of life of mothers with children suffering from cerebral palsy compared with those who have children with minor health problems. Method: Forty mothers with a child suffering from cerebral palsy and 44 mothers with a child suffering from minor health problems participated in a comparative study. The Turkish version of the Medical Outcomes 36-Item Short Form Health Survey (SF-36) was used to assess a mother's quality of life. The severity of a child's motor disability was assessed using the Gross Motor Function Classification System (GMFCS). Results: With the exception of the SF-36 physical functioning subscale, the mean scores on the SF-36 subscales were significantly lower in mothers of children with CP than those of the comparison group. The quality of life scores of mothers were significantly correlated with the severity of a child's motor disability (except physical functioning subscale). Significant correlations were found between GMFCS and the role physical; vitality; role emotional; and mental health subscales of the SF-36. Conclusions: The quality of life profile of mothers of children with cerebral palsy is different from those who have a child with minor health problems. Different coping strategies and psychosocial programmes must be designed and implemented to decrease the burden of care.     

The code of conduct of the volunteer

 Voluntary service has experienced a considerable expansion and a substantial change over the last two decades. The role of the volunteer has gradually come to interact with activities undertaken by other professionals, but without interfering. Since the role of the volunteer naturally involves autonomy and discretion on his/her behalf, the associations concerned increasingly feel the need to refer to standards defining a voluntary service ethic. Within a refresher course with a set number of places for non-profit-making organisations, which was arranged by the Italian League against Cancer, Milan, a consensus conference for the ratification of a code of conduct on voluntary service was held. The aim was to reach a consensus together with others who work in an "organised" manner every day, on ethical concepts that should inspire voluntary service: the common good, mutual respect, freedom of choice, a non-profit-oriented vision. After exhaustive discussions by three panels, the text of a code of conduct unanimously approved was elaborated. All concerned with this code tried to avoid giving it a "sanitary" imprint. It is in fact our opinion that whatever the area covered by voluntary service, its aim and its final objective is to ensure the wellbeing of mankind and his environment.     

Mode of action of azthreonam

Azthreonam (SQ 26,776) is a member of a new class of monocyclic beta-lactam antibiotics. In Escherichia coli, azthreonam caused filamentation at its lowest effective concentration (0.2 microgram/ml), a morphological effect identical to that observed with cephalothin. The penicillin-binding protein (PBP) profile indicated a very high affinity for PBP3 (complete binding at 0.1 microgram/ml), a moderate affinity for PBP1a (complete binding at 10 micrograms/ml), and poor affinities for PBP1b, PBP2, PBP4, and PBP5/6 (complete binding at greater than or equal to 100 micrograms/ml). Accordingly, azthreonam had poor activity against Streptomyces R61 DD-carboxypeptidase (50% inhibition, greater than 100 micrograms/ml) and E. coli peptidoglycan transpeptidase (50% inhibition, 100 micrograms/ml). Azthreonam also showed very high affinity for PBP3 (complete binding at 0.1 microgram/ml) in Proteus vulgaris, Enterobacter cloacae, Klebsiella pneumoniae, and Pseudomonas aeruginosa. In all four organisms, its PBP profile was similar to that observed in E. coli. It is concluded that azthreonam, although of novel structure, has a mode of action similar to that of cephalosporins, affecting specifically septation in E. coli and most likely other gram-negative bacteria.     

Assessment of the distensibility of superficial arteries

Doppler signal processing cannot only be employed to detect the local blood velocity as function of time, but also to assess transcutaneously the displacement of the arterial walls during the cardiac cycle (distension waveform) and, hence, the time-dependent changes in arterial diameter relative to its initial diameter at the start of a cardiac cycle. The distension waveform normalized with respect to the local pulse pressure provides useful information about the local elasticity of the arterial wall. The displacement of the arterial wall can be obtained by processing the RF-signals within a sample volume coinciding with the arterial wall. To evaluate this method a dedicated high-speed memory system has been developed storing the RF-signal, as obtained with a conventional echo-imager in M-mode, over a number of successive sweeps covering a selected depth range. The data are transferred line after line to a personal computer (PC) and processed on the fly, thereby relieving the memory requirements of the PC. It can be concluded that a RF-signal memory in combination with a PC provides a useful tool to extract detailed diameter waveforms from the RF-signals obtained. Although the system does not process the signals in real-time the process can be considered to be on-line since the results become available within one minute after the acquisition of the data is completed.     

Automatic recognition of cortical sulci of the human brain using a congregation of neural networks

This paper describes a complete system allowing automatic recognition of the main sulci of the human cortex. This system relies on a preprocessing of magnetic resonance images leading to abstract structural representations of the cortical folding patterns. The representation nodes are cortical folds, which are given a sulcus name by a contextual pattern recognition method. This method can be interpreted as a graph matching approach, which is driven by the minimization of a global function made up of local potentials. Each potential is a measure of the likelihood of the labelling of a restricted area. This potential is given by a multi-layer perceptron trained on a learning database. A base of 26 brains manually labelled by a neuroanatomist is used to validate our approach. The whole system developed for the right hemisphere is made up of 265 neural networks. The mean recognition rate is 86% for the learning base and 76% for a generalization base, which is very satisfying considering the current weak understanding of the variability of the cortical folding patterns.     

Demonstration of dilatation of peripheral airways

Summary. To investigate the ability of various lung-function tests to demonstrate dilatation of peripheral airways, ten asthmatics inhaled increasing doses of a f2-agonist by two different and controlled techniques. Low inspiratory flow with a long post-inspi-ratory pause favoured peripheral deposition, and a high inspiratory flow with a short post-inspiratory pause favoured central deposition of drug in the airways. Ordinary spirometry, maximum expiratory flow rates after breathing air as well as a helium-oxygen mixture, a single breath N₂-test and resistance of the respiratory system were obtained before and after each of five terbutaline doses with both inhalation techniques. By using a double-dummy technique, the study could be performed double blinded. Effects were compared at doses giving equal effects on PEF, assumed to represent equal deposition of bronchodilator and effects on central airways. At such ‘iso A PEF doses’, particularly FVC and the slope of phase III of the N₂-test improved more following the slow inhalation technique. It is concluded that changes in those tests reflect dilatation in peripheral airways in asthmatics.,     

Mechanisms of anti-inflammatory actions of glucocorticoids

Synthetic glucocorticoids display a consistent anti-inflammatory action which are composite mechanisms through genomic and non-genomic pathways, or different types of cells and molecules. Also a wide range of doses of glucocorticoids can be allowed to show a demanded anti-inflammatory effect in many inflammatory diseases.     

Reactions of the institutionalized elderly upon learning of the death of a peer

An exploratory study of 25 institutionalized elderly people who witnessed the death of a co-resident is reported. Two topics are examined: thoughts and feelings of the survivors about their own death and the climate surrounding the death of a peer. Data obtained through a semistructured interview reveal that learning of a peer's death leads more than one third of the elderly residents to consider their own death. Witnessing a peer's death seems to have little positive or negative influence. On one hand, 84% of them state that they want to be informed of the impending death of a well-known peer; on the other hand, 80% reported that the staff does not say when a peer is dying. Half of the respondents perceive the staff as indifferent to the death of an elderly person.     

Evaluation of the effectivenes of treatment of patients with renal arterial hypertension with carvedilol

The aim of the study was to compare the hypotensive effect and safety of carvedilol, a non-selective alpha-beta blocker, and monopril, an angiotensin-converting enzyme inhibitor (ACEi), in patients with arterial hypertension and a chronic renal disease. The main group (MG), 26 patients, was treated with carvedilol, which was administered as a hypotensive agent instead of the ACEi. The control group (CG) included 24 patients on a "standard" therapy with hypothiazide 12.5 mg a day, amlodipine 10 mg a day, and monopril 20 mg a day. Patients who received carvedilol displayed an earlier hypotensive effect (HE). Together with HE realization, the patients of both groups displayed a moderate increase in glomerular filtration (not more than by 10 ml/min), and an increase in creatinine blood level (not more than by 15%) during the first two weeks, which can be explained by a decrease in intraglomerular hypertension. A significant decrease in total cholesterol level and a more pronounced regress of left ventricular myocardial hypertrophy were noticed in the MG vs. the CG. Measurement of the serum levels of cortisol, aldosterone, and angiotensin I showed that the patients of the MG displayed a significant decrease in aldosterone level together with a clear tendency of cortisol level increase. The concentrations of these hormones in CG patients did not change significantly. The result demonstrate that prolonged administration of carvedilol leads to a noticeable decrease in the serum level of aldosterone, an increase in cortisol level, and electrolyte changes, such as an increase in sodium level and a decrease in potassium level in blood plasma.     

Return of the repressed: hypnoanalysis of a case of total amnesia

A case study is presented of a woman suffering from global amnesia so profound that she had lost all sense of personal identity. Hypnotherapy was used to establish, through imagery, a solid inner core on which to rebuild a sense of self. From the image of a strong column on which rested a book with a golden lock (her history), to reading about other lives, books and stories were utilized to establish a safe external environment in which the reawakening of repressed memories was no longer perceived as dangerous. A discussion of relevant literature on the subjects of global amnesia, loss of personal identity, and post-traumatic stress is offered as a basis for discussing the present case.