Left ventricular function in double inlet left ventricle before the Fontan operation: comparison with tricuspid atresia

Fourteen patients with double inlet left ventricle and nine patients with tricuspid atresia had biplane left ventricular angiography with simultaneous measurement of left ventricular pressure by micromanometer. Age distribution, haemodynamic function, and previous palliative operation were similar in the two groups. Left ventricular volumes were calculated frame by frame throughout the cardiac cycle by Simpson's rule. The end diastolic volume index was similar in the two groups, but the ejection fraction was significantly lower in tricuspid atresia. Left ventricular peak filling and emptying rates were also lower in tricuspid atresia, although heart rates in the two groups were similar. End diastolic shape index was significantly higher in patients with tricuspid atresia, indicating a more globular shape, and changed less during systole, suggesting differences in the mechanism of ejection between the two groups. Analysis of pressure-volume loops showed normal phase relations between pressure and volume, but systolic stroke work was reduced in tricuspid atresia and correlated with stroke volume and shape change. Left ventricular function was impaired in patients with tricuspid atresia when compared with those with double inlet left ventricle and this finding may reflect structural differences caused by the absence of one atrioventricular connection.

Factors influencing therapist-rated change in older adults

Current work on mental health treatment of elderly persons tends to implicitly assume that chronological age is the major determinant of outcome in the older adult population. This study compared chronological age within the older adult population with other client characteristics and with treatment process measures as factors influencing therapist-rated change during treatment in a community mental health outreach program. In addition, earlier findings that the elderly improved more than younger adults were replicated. Multivariate analysis found age and number of sessions in therapy predict change scores, with diagnosis alone being a good predictor of outcome with initial rating held constant. It is suggested that chronological age is neither the only nor the most important determinant of outcome in mental health treatment.

The evolution of methods for estimating the time of death from body temperature

A chronological survey is offered of the development of concepts and techniques to use body temperature in the estimation of time since death. For a century and a half, this method has been investigated, though accuracy still cannot be claimed, especially in operational conditions.

Fluorescence microscopy in the detection of early myocardial infarction

Fluorescent microscopy is amongst the many techniques devised for the post-mortem detection of early myocardial infarction. The method has the advantage of sensitivity, speed and simplicity, compared with more complex techniques such as enzyme histochemistry and electron microscopy. Disadvantages include the difficulty of permanent preservation of the sections and lack of sharp differentiation between normal and very early infarction--though the latter problem is common to most other methods, except enzyme histochemistry. There are two main techniques in fluorescent microscopy: The examination of sections specifically stained by fluorochrome dyes; The re-examination of haematoxylin-eosin sections for 'autofluorescence'.

Management variables as predictors of service utilization by the elderly in mental health

The problem of underservice to the elderly in mental health settings has been conceptionalized in terms of client variables, therapist variables, and systems variables. This investigation of management variables as a type of system level variable reveals that number of staff assigned to work with the elderly is strongly related to outpatient service use and that number of elders on the advisory board is an inverse predictor of inpatient use. It is recommended that future work on the underservice problem focus on system level analysis and intervention.

Forensic radiology

Like any branch of medicine, radiology has an interface with the law. This has two main facets: first the technical applications of radiology to forensic problems and secondly the legal aspects of radiological practice.

Therapists' attitudes as explanation of underservice of elderly in mental health: testing an old hypothesis

The literature in mental health and aging has long argued that the presumably negative attitudes of therapists toward the aged are a major barrier to the aged receiving psychotherapy services. This investigation compared two measures of attitudes in a college student sample in order to test the reliability and validity of two commonly used measures of attitude in the general population. The same scales were then used in a sample of sixty-six mental health workers. The results suggest that Likert ratings and semantic differentials, although tapping a common dimension, differ in sensitivity to personal experience with the aged, that therapists had more positive beliefs about the elderly than did college students, and that therapist attitudes were not correlated with either proportion of elderly clients seen or desire to work with elderly. Work site emerged as an important predictor of numbers of elderly seen by therapists. It is argued that future research ought to focus on systems level variables in seeking to overcome barriers to therapy.

Paratesticular rhabdomyosarcoma. Case reports

During the 30-year period 1955-1984, 9 cases of paratesticular rhabdomyosarcoma were seen in the pathology departments of the University of Cape Town, including the Red Cross War Memorial Children's Hospital. Three of these patients were lost to follow-up; 2 were alive at 6 months and 6 years after presentation. Two patients absconded with clinical disease and are presumed dead and 2 died of disease 6 and 18 months after presentation. Although rhabdomyosarcoma is known to be a disease of the young, none of the patients in this series was in the first decade of life and only 3 were below 20 years of age.

The history of child abuse

Though the child abuse syndrome is usually considered to have been first described in the middle of the present century, references to child abuse occur throughout history and in the 19th century, detailed descriptions were published in the French medical literature.

Driving and alcohol: a case report of a biological impossibility

The recent criticisms of breath analysis for alcohol make the following case of interest. In this instance, it is difficult to identify the source of the anomaly, but the case is thought worth reporting because although it was patently obvious that something was amiss, both the lower court and the appellate court refused to countenance the biological inconsistencies and imposed and upheld a conviction.

A self-contained method for determining time since death from temperature measurements

An equation suggested by Brown and Marshall that represented the cooling curve of the human corpse is modified in order to estimate the time of death without resource to lengthy mathematical techniques. A comparison with two other predictive procedures for estimating the time of death is given.