Would primary health care workers give appropriate dietary advice after cholesterol screening?

The purpose of this study was to obtain information on the dietary knowledge of primary health care workers and on their ability to apply this knowledge in practice. A total of 128 primary health care workers (53 general practitioners and 61 nurses) in 12 practices and 14 primary care facilitators were surveyed by questionnaire between December 1987 and June 1988. All of the practices were participating in a project to promote prevention in primary care and offered health checks designed to identify and deal with cardiovascular risk factors. The questionnaire focused on issues related to managing patients with moderate hypercholesterolaemia. The results of the study showed some important gaps in the health workers' knowledge--for example, only 91 understood that dietary intake of polyunsaturated fatty acids as a proportion of total fat intake should be increased in a diet designed to reduce serum lipid concentrations. Appreciable gaps in their ability to give practical and appropriate dietary advice were also identified: 35 gave advice that would have led to the patient losing weight (although his history indicated that he was not overweight), and 27 gave only negative advice, offering no suggestions about substituting healthy foods for unhealthy ones. The demand for primary health care workers to give dietary advice is increasing and is likely to increase further if a national screening programme for hypercholesterolaemia is recommended. The results of this survey point to a need for improved nutritional education and training in dietary counselling for general practitioners, nurses, and primary care facilitators.

[Diffuse malignant peritoneal mesothelioma: apropos of a new case, review of the literature]

The authors discuss epidemiological, clinical, diagnostic, and therapeutical facts in relation to a new case history of diffuse malignant mesothelioma, and to this rather rare pathology, in general, with special emphasis on the important role of radioimmunoassays in histological diagnosis.

Evaluation of a hospital teaching program for breast self-examination

The purpose of this study was to evaluate the results of a hospital teaching program for breast self-examination. The retention of breast self-examination knowledge and the frequency and accuracy of breast self-examination of 50 subjects 9 months after hospitalization were examined. Findings of the study were that the majority of patients believed they had adequate knowledge to perform breast self-examination following the instructional program and 76% reported performing breast self-examination on a regular basis 9 months post hospitalization. Confidence in their knowledge and ability to perform breast self-examination as well as perceived susceptibility to breast cancer and perceived benefits of breast self-examination were positively related to subjects' breast self-examination practices.

[Action of adenosine on intestinal motility after experimental mesenteric ischemia in dogs]

The purpose of the present work was to demonstrate beneficial action of adenosine on intestinal motility in the dog after experimental ischemia and to establish the role of A1- and A2-purinergic receptors. Adenosine was compared to an A1-agonist (N6-cyclohexyl-adenosine or CHA), an A2-agonist (5'-(N-ethyl) carboxamido-adenosine or NECA) and an inhibitor of adenosine cellular uptake (dipyridamole). Motility was analyzed by recording the electromyogram with intraparietal electrodes. Experimental ischemia was obtained by clamping the superior mesenteric artery during two hours. Under physiologic conditions, adenosine (1 mg.kg-1.i.v.) increased myoelectric complexes frequency by 49 p. 100 and the jejunal motility index by 46 p. 100. CHA (1 microgram.kg-1.i.v.) and dipyridamole (0.5 mg.kg-1.i.v.) increased myoelectric complexes frequency by 42 p. 100 and 67 p. 100 while NECA (1 microgram.kg-1.i.v.), increased the motility index by 30 p. 100. Adenosine and NECA increased mesenteric arterial blood flow by 35 p. 100 and 57 p. 100 respectively. After a two hours ischemia the return to normal electromyogram was 10.1 +/- 5.7 h. Adenosine (administered 10 min after the end of ischemia) reduced this recovery period to 3.3 +/- 0.8 h, NECA to 1.3 +/- 0.8 h and dipyridamole to 5.0 +/- 2.6 h. We conclude that, under physiological conditions, adenosine modifies jejunal motility directly via A1-receptors of smooth muscle and indirectly via A2-receptors of mesenteric vessels. On the other hand, after experimental ischemia, adenosine improves the post-ischemic restoration via vessels A2-receptors only.

Relationships between electromyographic ileal and colonic motility patterns in cats during fasting and feeding

The relationship between ileal and colonic electromyographic motility patterns were investigated in six awake cats chronically fitted with subserosal electrodes implanted in the smooth muscles of the ileum and colon. Smooth muscle electrical activity (electromyogram) was recorded in both fed and fasted conditions under a 12-12 hours dark-light schedule. It consisted of electrical long spike bursts having two different patterns for each condition. Short sequences of three to five long spike bursts were propagated either aborally or orally from any part of the colon; they were most frequent during the interdigestive or fasting period and no relationship was observed between these long spike bursts and the electrical activity of the ileum. During the digestive or feeding period, the colonic activity was organized in long sequences of 10-15 long spike bursts, termed migrating spike bursts, which started near the caecal junction and propagated aborally to the distal colon. These migrating spike bursts were correlated with the ileal motility. This relationship demonstrated between ileum and colon after feeding is dependent upon the amount of food intake.

[Association of thrombopenia due to platelet alloimmunization with galactosemia in the neonatal period]

The authors report on a newborn with two uncommon causes of bleeding. Platelet alloimmunization in PLA system was associated with galactosemia proved by the galacto uridyltransferase assay. The immediate outcome was favourable. The authors discuss the problem of diagnosis raised by this association.

[Electromyographic profile of the human jejunum after abdominal surgery]

The purpose of this work was to describe the electromyographical profile of the jejunum observed after various types of abdominal operations. The electromyogram of the first 140 centimeters of the small intestine was recorded on a continuous basis by an intraluminal tube between the 6th and 20th day after abdominal surgery in twenty patients. Results allow us to describe a profile of the patient's intestinal electromyogram after abdominal surgery. It was characterized by three consecutive periods: a) early reappearance of migrating myoelectric complexes occurring during the first period; b) a very short second period beginning immediately before the expulsion of gases; during this period the electrical activity fluctuated and appeared disorganised; c) finally, during the third period, after gas expulsion, peristaltic rushes were associated with normalized migrating myoelectrical complexes. Both early and permanent migrating myoelectrical complexes characterize the normal postoperative period. Continuous linear integration of the jejunal electromyogram might be a useful tool for the monitoring of postoperative intestinal motility as a routine procedure.

Juvenile periodontitis: healing following autogenous iliac marrow graft, long-term evaluation

A case of juvenile periodontitis treated by autogenous bone grafting is reported. The patient, an 18-year-old female, presented with periodontal lesions around the incisors and the first lower left molar. The first molar was severely affected with bone defects at the mesial aspect and in the furcation region and, for this reason, was selected for grafting. Minced fragments of bone with its marrow, obtained from the patient's iliac crest, were implanted into the diseased periodontium. 1 year after treatment, clinical and radiological inspection revealed the presence of bone. This bone completely filled the furcation area of the tooth but only partially the mesial aspect. There was, also, significant bone fill in the supracrestal region.

[Prevention of gas microemboli during cardiac surgery. Numerical control of cardiac cavity purging by an ultrasonic detector]

Despite all precautions taken by cardiac surgeons to eliminate air remaining in the cardiac cavities and pulmonary veins at the end of cardiopulmonary bypass, many micro bubbles probably remain and pass into the systemic circulation with a risk of deteriorations of cerebral or myocardial function. Over the last four years we have used ultrasound to try to prevent the risk of preoperative gas microemboli: the machine is equipped with a detector (a quartz oscillator coupled to a piezoelectric transducer emitting a continuous beam of ultrasound at a frequency of 5 Mhz) which allows the following variables to be determined: the time interval from the onset of detection, the total quantity of bubbles (arbitrary units) in the examined regions, the quantity of bubbles detected over a given time interval which can be adjusted from 15 to 120 seconds. The passage of bubbles is also indicated by light and sound alarms. The smallest diameter of bubbles which can be detected is about 10 mu. There are periaortic probes adaptable to the calibre of the ascending aorta, transcutaneous probes for carotid artery detection and a left ventricular probe. In a preliminary series of 74 valve replacements in adults, this apparatus was used immediately after terminating cardiopulmonary bypass after we had thought that the cardiac cavities had been satisfactorily purged of air, and whilst active aspiration was continued in the ascending aorta distal to the periaortic probe: the total quantity of bubbles detected varied from less than 50 to more than 2000 AU, over a variable period of time which may exceed 20 min after termination of cardiopulmonary bypass. The total quantity of bubbles recorded after mitral valve (582 +/- 154 AU) or combined mitral and aortic valve replacement (685 +/- 167 AU) was generally greater than after isolated aortic valve replacement (335 +/- 126 AU). Therefore, after cardiopulmonary bypass, and despite all efforts at purging the air, we showed that numbers of microbubbles were ejected into the ascending aorta for a variable period of time: only some of them were eliminated by active aspiration through a trocar placed distal to the periaortic probe. The right coronary ostium was poorly protected against microbubbles because of its anatomical situation (6 cases in this series). We therefore established a protocol for the use of this apparatus to aid the purging of the cardiac cavities and pulmonary veins before stopping cardiopulmonary bypass: the manoeuvres, guided by the ultrasound probes, are performed before the left ventricle is allowed to eject blood into the ascending aorta.(ABSTRACT TRUNCATED AT 400 WORDS)

[Effects of lidocaine at the plasma concentrations obtained by peridural injection on atrioventricular conduction disorders]

The aim of this study was to measure plasma concentrations obtained during lidocaine extradural blocks, and to determine whether these concentrations were able to induce high degree AV blocks in patients with impaired AV conduction. In a preliminary study, 12 patients were given an extradural block with an initial bolus of 3.4 mg . kg-1 lidocaine. After repeat injections, the mean total dose was 4.7 mg . kg-1. Plasma lidocaine concentrations were determined over an 8 h period after the first injection. The study itself was carried out in 14 patients with conduction disturbances undergoing His-bundle exploration. After informed consent had been obtained, the patients received an intravenous bolus of lidocaine (1.6 mg . kg-1 over 30 s). After baseline values had been measured. His conduction and lidocaine plasma concentrations were recorded 2, 5, 10, 30 and 60 min after lidocaine injection. In the preliminary study, the peak plasma lidocaine concentration was obtained at the 15th min (1.22 +/- 0.81 microgram . ml-1). In the second series, no clinical disturbance was seen after the i.v. injection of lidocaine. The peak plasma lidocaine concentration was obtained at the 2nd min (3.05 +/- 1.44 micrograms . ml-1). No significant alteration of conduction occurred after intravenous lidocaine. It is therefore possible to conclude that bifascicular AV disturbances do not constitute a contraindication to extradural anaesthesia with lidocaine.

Functional orthopedics: the "four pieces" and Class II treatment

The authors describe a new functional appliance called the Chateau four pieces, which is designed for the orthopedic treatment of Class II problems during growth. The versatility of the use of the four pieces simultaneously or separately, enables the practitioner to control treatment in three dimensions. The indications and the prescription are discussed, and the results are shown.

[Acute polyvisceral lupus erythematosus in a young 12-year-old girl. The value of plasma exchange]

The authors report on the case of a 12 year old girl, presenting with severe systemic lupus erythematosus. Skin, joints and kidney were involved. The treatment associated steroids, plasma exchanges and cyclophosphamide. Remission has been obtained and remains one year later.

Patterns of electrical activity in the digestive tract of the conscious cat

1. Bipolar electrodes were permanently implanted on the gastric antrum, and on the different portions of the small intestine of each of eleven healthy adult cats receiving one meal daily. All parts of the feline gut exhibited, as in several other species, regular slow waves and alternate periods of quiescence and electrical spiking activity during the recording sessions lasting from 10 to 30 d. 2. Patterns of electrical activity characteristic of this species were identified. Both the amplitude and frequency of the antral slow-wave were related to the presence of superimposed spike bursts during fasting. A decrease in the antral slow-wave frequency and increase in the length of the duodenal plateau of slow waves after the daily meal were related to its nature. 3. In fasted state, the electrical spiking activity of the small intestine occurred as fused spike bursts of large amplitude potentials migrating slowly over short distances only 24 h after feeding. They are interspersed with short periods of irregular spiking activity. 4. These findings suggested that, except the distal part of the small intestine which showed an activity which resembled partially the migrating myoelectric complex observed in other species during the fasting state, the motility patterns of the digestive tract in the cat were not comparable to those observed in the dog or sheep. In the cat, mixing of the contents seemed to result from more or less regular spiking activity allowing their propulsion distally. The propagation over distances varying from 200 to 1000 mm of nine to eighteen daily fused spike bursts in the fasting state remains unclear but they are related to the digestive function in accordance with the displacement aborally of their origin in a prolonged fasting condition.

Inotropic effects of potassium rich solutions of frog cardiac muscles

1. Inotropic effects of potassium rich solutions on frog cardiac muscle have been studied bith in current clamp and voltage clamp conditions, using a double sucrose gap apparatus. 2. Potassium rich solutions cause either a positive or a negative inotropic effect, together with an increase or a decrease in the duration of the action potential, according to the preparation. 3. The phasic phase of contraction and the slow inward current are decreased in amplitude; the reversal potential of the slow inward current is shifted towards more negative values. 4. The tonic phase of contraction is first decreased, the increased; the effects are correlated with modifications of the background current, initially in the inward, then in an outward direction. 5. The tension level obtained in contracture experiments is increased or decreased, according to the direction of the changes in the background current. 6. The effects of potassium rich solutions are still observed in he presence of ouabain, suggesting that they are independent of any effect on the sodium-potassium pump. 7. The effects of potassium rich solutions are still observed when external sodium is replaced by sucrose; they disappear (except the effect on the background current) when external sodium is replaced by lithium. 8. The results, which indicate that potassium ions play a role in the regulation of the intracellular concentration of calcium ions, are discussed in relation to a possible K/Ca exchange mechanism, to the Na/Ca exchange and to the role of intracellular calcium stores.

[S-adenosyl-L-homocysteine: 2. An anticonvulsant]

S-Adenosyl-L-homocysteine (SAH) decreases the epileptiform discharges induced by hippocampic stimulation. SAH reduces the pentetrazol convulsions, does not modify picrotoxine convulsions, and increases strychnine toxicity. These effects are not linked to gamma-aminobutyric acid metabolism perturbation or to the concentration of some amino acids known for their action in synaptic transmission.