Nurses' confirming/disconfirming responses to patients diagnosed with borderline personality disorder

This study examines whether in group situations, patients with borderline personality disorder (BPD) received less empathic verbal responses from nurses than non-BPD patients. Nurses' feelings toward specific diagnoses were also examined. Twenty patient groups were observed involving 17 nurse leaders and 164 patients. Responses by the nurse leaders were rated using Heineken's Confirmation/Disconfirmation Rating Instrument. The staff response portion of Colson's Hospital Treatment Rating Scale was used to determine nurses's feelings toward specific diagnoses. The study provides some initial evidence that in actual practice situations nurses respond to BPD patients in a less empathic manner than to patients with other diagnoses.

Thoracic connections between crayfish giant fibres and motor giant neurones reverse abdominal pattern

The escape tail-flip of the crayfish is ‘commanded’ by two bilaterally paired sets of giant fibre (GF) interneurones, the lateral giant (LG) and medial giant (MG) (see e.g. Wine, 1984, for a review). The two classes of GF respond to different stimuli and initiate tail-flips with different kinematic forms. An arousal stimulus applied to the front of the animal initiates a spike in the MG system, and this causes a tail-flip that drives the animal directly backwards, away from the stimulus. An arousal stimulus applied to the rear of the animal initiates a spike in the LG system, and this causes a tail-flip that drives the animal upwards and forwards, again moving it away from the stimulus. The major motor output path from the GFs is through monosynaptic rectifying electrical connections to a class of powerful trunk flexor motor neurones called the motor giant (MoG) neurones (Furshpan and Potter, 1959a). There is one MoG neurone in each hemisegment of the thorax and abdomen.

ANATOMICAL AND PHYSIOLOGICAL IDENTIFICATION OF INHIBITORS OF THE MOTOR GIANT AND SEGMENTAL GIANT NEURONES IN THE CRAYFISH

We anatomically and physiologically identify four interneurones which inhibit the motor giant neurone (MoG) and an interneurone which inhibits both the MoG and the segmental giant (SG) neurone of crayfish. We term these the MoG-I1, -I2, -I3, -I4 and MoG/SG-I neurones. MoG-I1 is almost always very strongly dye-coupled to its bilateral homologue. It is one of the interneurones mediating recurrent feedforward inhibition from the giant fibres (GFs) to the MoG. The GFs activate MoG-I1 by a disynaptic path through the SGs (GF --> SG --> MoG-I1), which is entirely mediated by rectifying electrical synapses. The resulting trisynaptic path (i.e. GF --> SG --> MoG-I1 --> MoG), in which the first two synapses are electrical, ensures reliable and constant short-latency inhibition of the MoGs following their monosynaptic electrical activation by the GFs (GF --> MoG). The remaining MoG-Is receive input from the GFs and other sources through unidentified polysynaptic pathways. Each interneurone inhibits the MoG and/or SG through depolarising IPSPs, which can be as large as 25 mV in amplitude. These IPSPs can effectively block transmission from the GFs to the MoG. The unique morphology of the MoG allows the inhibitory connections from the MoG-Is to be visualised at the light microscope level following staining with Lucifer Yellow. The MoG-Is project a high-density cobweb-like network of fine synaptic branches over the surface of the MoG, which spread from the region of the electrical input from the GFs within the connectives, across the expanded integrating region of the MoG, and onto its axon in the proximal region of the third root. The extensiveness of this anatomical connection correlates well with the high effectiveness of the inhibition mediated by some of the MoG-Is.

Transluminal angioplasty for atherosclerotic disease of the vertebral and basilar arteries

Transluminal angioplasty for hemodynamically significant stenosis (> 70%) involving the posterior cerebral circulation is now being performed by the authors in selected cases. A total of 42 lesions affecting the vertebral or basilar artery have been successfully treated by percutaneous transluminal angioplasty techniques in 41 patients. The lesions involved the proximal vertebral artery in 34 cases, the distal vertebral artery in five, and the basilar artery in three. Patients were examined clinically at 1 to 3 and 6 to 12 months after angioplasty. Three (7.1%) permanent complications occurred, consisting of stroke in two cases and vessel rupture in one. There were four (9.5%) transient complications (< 30 minutes): two cases of vessel spasm and two of cerebral ischemia. Clinical follow-up examination demonstrated improvement of symptoms in 39 cases (92.9%). Radiographic follow-up studies demonstrated three cases (7.1%) of restenosis involving the proximal vertebral artery; two were treated by repeat angioplasty without complication, and the third is being followed clinically while the patient remains asymptomatic. In patients with significant atherosclerotic stenosis involving the vertebral or basilar artery territories, transluminal angioplasty may be of significant benefit in alleviating symptoms and improving blood flow to the posterior cerebral circulation.

Different types of rectification at electrical synapses made by a single crayfish neurone investigated experimentally and by computer simulation

The rectification properties of electrical synapses made by the segmental giant (SG) neurone of crayfish (Pacifastacus leniusculus) were investigated. The SG acts as an interneurone, transmitting information from the giant command fibres (GFs) to the abdominal fast flexor (FF) motoneurones. The GF-SG (input) synapses are inwardly-rectifying electrical synapses, while the SG-FF (output) synapses are outwardly rectifying electrical synapses. This implies that a single neurone can make gap junction hemichannels with different rectification properties. The coupling coefficient of these synapses is dependent upon transjunctional potential. There is a standing gradient in resting potential between the GFs, SG and FFs, with the GFs the most hyperpolarized, and the FFs the most depolarized. The gradient thus biases each synapse into the low-conductance state under resting conditions. There is functional double rectification between the bilateral pairs of SGs within a single segment, such that depolarizing membrane potential changes of either SG pass to the other SG with less attenuation than do hyperpolarizing potential changes. Computer simulation suggests that this may result from coupling through the intermediary FF neurones.

Photoinactivation of the crayfish segmental giant neuron reveals a direct giant-fiber to fast-flexor connection with a chemical component

The escape tail flip of the crayfish is "commanded" by 2 sets of giant-fiber (GF) interneurons. In each hemisegment, these drive the motor giant (MoG) abdominal flexor motor-neuron through a monosynaptic electrical connection, but the remaining 8 or 9 fast-flexor (FF) motorneurons receive most of their input via a disynaptic electrical pathway through the segmental giant (SG) neuron. We have investigated a monosynaptic GF-FF pathway, which operates in parallel to the disynaptic GF-SG-FF pathway, by using dye-mediated photoinactivation to remove the SGs from the tail-flip circuit. SG photoinactivation involves an initial broadening of the spike, leading to a long-duration, massively depolarized plateau. This is followed by loss of spike capability, a gradual reduction in the resting potential, and eventual total loss of electrical responsiveness. After bilateral photoinactivation of the SGs, a spike in one set of GFs, the medial giants (MGs), produces little if any effect in FFs in any ganglion. A spike in the other set, the lateral giants (LGs), produces an EPSP in FFs with a declining anterior-to-posterior segmental gradient in amplitude. These differences in LG and MG outputs, which are obscured in the intact circuit by the common MG/LG-SG-FF pathway, give clues to a probable early evolutionary form of the circuit. The LG-FF connection in anterior ganglia has a significant electrical component. However, it also has an apparent monosynaptic chemical component, as revealed by the response to saline containing cadmium ions, and to cooling the preparation. This is the first physiological evidence for chemical output from a crayfish GF.

Conservation and variation in orf virus genomes

The genomes of several orf virus strains were analyzed with the restriction endonucleases EcoRI, HindIII, BamHI, and KpnI, and cleavage site maps were deduced. In general, the right half of the genome showed conservation of restriction sites compared with the left half. Variations in size of up to 0.5 kbp were found within an inverted terminal repetition, and a 1-kbp deletion was detected in some strains in a subterminal fragment at the left end. A region of approximately 20 kbp, some 12 kbp in from the left end, showed the greatest cleavage site variability although there was no evidence of large deletions in this region. A 1.55-kbp cloned DNA fragment from the internal variable region of NZ2 failed to hybridize to the DNA from three other strains. A fragment in the variable region of strain NZ7 was cloned and compared by hybridization and restriction endonuclease analysis with cloned NZ2 fragments from the same region. The region of nonhomology extended for at least 2.75 kbp. It is suggested that this internal variable region may provide sites for the insertion of foreign genes.

The structure and cloning of orf virus DNA

A map of cleavage sites for the restriction endonucleases EcoRI, HindIII, BamHI, HpaI, and KpnI for a New Zealand strain of orf virus (NZ2) DNA has been deduced. Also, the entire genome, apart from approximately 0.1 kbp at each end, has been cloned into various vectors. The genome is 139 kbp in length and, in common with other poxviruses, has inverted terminal repetitions and crosslinked ends.

The Segmental Giant Neurone of the Hermit Crab Eupagurus Bernhardus

The anatomy and physiology of the segmental giant (SG) neurone of the fourth abdominal ganglion of the hermit crab is described. The SG has an apparently blindending axon in the first root and a small cell body in the anterior ipsilateral ventral quadrant of the ganglion. There is a large ipsilateral neuropile arborization with prominent dendrites lined up along the course of the ipsilateral giant fibre (GF). The SG receives 1:1 input from the ipsilateral GF via an electrical synapse which is usually rectifying. SG activation produces a large EPSP in all ipsilateral and some contralateral fast flexor excitor (FF) motor neurones. The major input to FFs resulting from GF activation appears to be mediated via the SG. It also produces a small EPSP in ipsilateral and contralateral motor giant neurones. The properties of the hermit crab SG are compared to those of the crayfish SG, and the implications of the SG for the possible evolutionary paths of the giant fibre system are discussed.

The significance of the adrenergic nerves in the etiology of vesicoureteral reflux

We studied 40 puppies serially from birth to 6 months of age for the presence of vesicoureteral reflux. Of these dogs 36 underwent biopsy of the bladder dome and trigone in search of adrenergic fibers that could be identified by catecholamine fluorescence. The results show that the incidence of vesicoureteral reflux decreased dramatically as adrenergic fibers began to appear. This inverse relationship between reflux and adrenergic bladder fibers seems to suggest a cause-and-effect relationship.

Ultrastructure of the segmental giant neuron of crayfish

The ultrastructure of the crayfish segmental giant (SG) neuron is described, and compared to other identified and unidentified crayfish neurons. The SG was specifically stained by intracellular injection of horseradish peroxidase and is divided into four regions of interest. In the dorsal region, finger-like dendrites of the SG make contact with the through-conducting giant fibres (GF). These contacts are physiologically defined rectifying electrical synapses. They are characterized by the presence of 30-95 nm agranular vesicles in the presynaptic GFs, some postsynaptic density in the SG, and a narrowing of the intermembrane cleft to approximately 5 nm. There is little evidence for connecting cytoplasmic bridges. Unidentified neurons make chemical input with either round or elliptical vesicle types onto SG bottlenecks close to the electrical synapses. Ventral to the GFs, dendritic profiles of the SG make three sorts of contact with unidentified neurons. (a) Regions of close membrane apposition (approximately 5 nm) are presumed to be electrical output synapses, but there are no vesicles such as at the input synapses, and, again, little sign of connecting bridges. (b) Chemical input is received from unidentified presynaptic neurons containing either round or elliptical vesicles. These synapses are characterized by 30-75 nm presynaptic agranular vesicles, widened cleft (approximately 20 nm), granular cleft material and postsynaptic density. There is no sign of any presynaptic density. (c) Very occasional SG profiles containing vesicles and making output synapses to unidentified neurons occur. In the lateral neuropil at the edge of the ganglion the SG gives rise to a small tuft of very fine dendrites. These are nearly all laden with vesicles and ramify in a complex region of neuropil containing many small profiles which are also vesicle-laden. The SG axon diminishes in diameter as it progresses along its peripheral nerve root, and finally terminates at a blind ending near the base of the swimmerets. It is sheathed along its entire length, and there is no sign of vesicles within it. We conclude that the SG axon makes no peripheral output.

A bladder tumor model response to immunotherapy

The author presented results of BCG and Corynebacterium parvum treatment of the transplantable mouse FANFT bladder tumor carried in the host's leg. A comparison was made of the results of treatment with BCG alone and C. parvum alone or either used in conjunction with Cytoxan upon effectiveness in increasing animal survival and retarding tumor growth.

The place of surgery in the treatment of myasthenia gravis

The clinical conditions, operative and postoperative management of 64 pateints submitted to thymectomy from 1965 to 1976 have been reviewed retrospectively. The results of 11 thymectomeis done before 1965 have been previously reported (Fraser, 1966). We consider that the duration of illness is a more important criterion than the age or sex of the patient or the distribution of weakness, and we recognize three stages (Simpson, 1974). Stage I, the active stage, is characterized by remissions and best response to thymectomy. it normally lasts for 5-7 years and is followed by stage 2, the inactive stage. In stage 2 there is less risk of death but few spontaneous reminssions and less response to thymectomy. In stage 3, the burned-out stage, there may be steady improvement but thymectomy is without benefit and responsiveness to anticholinergic drugs becomes less.

It has been our policy to perform thymectomy as early as possible in stage 1. In addition, stage 2 patients have been advised operation if the response to anticholinesterase medication has been unsatisfactory, Although major improvement is not anticipated until 2-3 years after operation, we have felt justified in offering thymectomy because we have had no death as a direct result of the actual operative procedure. One patient died suddenly and unexpectedly on the tenth day postoperatively (1.7 per cent). At follow-up there were 6 late deaths. Of the 52 patients available for review, 92.3 per cent had no symptoms or only mild disability.

Second closed mitral valvotomy for recurrent mitral stenosis

Sixty-seven patients undergoing a second closed mitral valvotomy between 1957 and 1974 have been reviewed. Since 1951, 510 patients have had a primary closed valvotomy in the same unit. The incidence of restenosis severe enough to warrant further surgery is higher after a finger fracture procedure (40%) than after a Tubbs dilator valvotomy (9.2%). There is an operative mortality of 10.4%, and a further late mortality of 23.8% after a second closed valvotomy. Of the surviving patients, 70.5% have had a good or excellent result. The group with poor results is characterised by the presence of a calcified fixed valve, making valvotomy difficult and incomplete. In the presence of a non-calcified valve, a second valvotomy still has a place when surgery for restenosis is required.

Closed mitral valvotomy

The results of closed mitral valvotomy operations in 359 patients operated on from August 1957 to October 1974 were assessed at July 1975. About 60% of the patients were in good health. These results suggest that there is still a place for closed mitral valvotomy in carefully selected cases.