On the pathogenesis of focal nodular hyperplasia of the liver

Fifty-one focal nodular hyperplasia lesions from 36 patients were examined histologically. Serial sections and three-dimensional models were studied in selected cases. Lesions were multiple in 19% of patients. Thirty-four patients were female. One case had 11 focal nodular hyperplasia lesions and 7 hemangiomata in the liver. Three had astrocytoma and one had anomalous pulmonary venous drainage. Morphometric analysis revealed that the lesions were supplied by an anomalous artery larger than expected for the locale in the liver. This artery branched to form a spider-like structure and was usually not accompanied by a portal vein or duct. Each terminal arterial branch supplied a separate nodule 1 mm in diameter; adjacent nodules coalesced to form the focal nodular hyperplasia lesion. The arterial blood appeared to drain directly into the sinusoids of the nodule. We propose that focal nodular hyperplasia is an hyperplastic response of the hepatic parenchyma to a preexisting arterial spider-like malformation. The frequent coexistence of focal nodular hyperplasia with other vascular and neuroendocrine anomalies suggest that the malformations are developmental in origin. The basic requirement for development of hepatic hyperplasia may be greater blood flow to a region compared to the adjacent parenchyma. This requirement appears to be met in the other forms of nodular transformation of the liver, i.e., nodular regenerative hyperplasia and partial nodular transformation.

Urinary gamma-glutamyl transpeptidase activity in dogs with gentamicin-induced nephrotoxicity

Serum creatinine concentrations, 24-hour endogenous creatinine clearance, and 24-hour urinary gamma-glutamyl transpeptidase (UGGT) activity were measured daily in 6 dogs given nephrotoxic dosages of gentamicin (10 mg/kg of body weight) every 8 hours for 10 days. Mean UGGT activity was significantly increased by day 5 (P less than 0.05) and preceded significant increases in serum creatinine values (greater than 2.0 mg/dl) observed on day 9. Endogenous creatinine clearance remained within normal limits (2.98 +/- 0.96 ml/min/kg) until day 8. Urinalyses performed 8 days after initiation of gentamicin treatment indicated renal tubular damage (granular casts) in 1 of the 6 dogs, and glucosuria in 3 of the 6 dogs. Measurement of UGGT activity was a more sensitive and reliable method of assessing acute renal tubular damage induced by gentamicin than were serum creatinine concentrations or 24-hour endogenous creatinine clearance.

Computerization of patient acuity and nursing care planning. New approach to improved patient care and cost-effective staffing

Patient classification systems are essential for nurse administrators to justify nursing staff and to project budget. To answer these needs effectively, a computerized patient classification system must be customized to existing physical and human resources within each health care facility. Nursing administrators at Riverside Medical Center met this need by developing a computerized patient classification system that integrates patient acuity with patient care plans and nursing diagnoses. Direct cost accounting of nursing care according to patient needs and outcomes can be justified by correlating this management and practice data.

Neurologic diseases

The responses of apparently healthy newborn foals to neurologic testing differ significantly from those of adult horses. These responses and the diagnostic techniques pertinent to neurologic problems are reviewed as a basis for evaluation of the compromised neonatal foal. The more frequently encountered neurologic diseases are discussed in a problem-oriented format. These clinical problems include behavioral abnormalities, convulsions, changes in consciousness, blindness, ataxia without loss of strength, ataxia with weakness and paralysis, and the floppy foal.

Evaluation of a technique for measurement of gamma-glutamyltranspeptidase in equine urine

gamma-Glutamyltranspeptidase (GGT) activity in equine urine was measured, using an assay developed for use with serum and was found to be reproducible. The GGT activity was measured in samples prepared by serial dilution of exogenous GGT with equine urine, and the activity was determined to be linear between 21 IU/L and 407 IU/L. The behavior of exogenously added GGT was compared in equine serum and urine. The enzyme behaved similarly in both fluids. The GGT activity was measured in serum and urine samples after storage at -20, 4, and 25 C for 24 and/or 72 hours. Enzyme activity decreased after storage at all temperatures and times, but the decrease was greatest and most variable at -20 C. The urine GGT: urine creatinine ratio was calculated on serial urine samples collected over 24 hours. Although the urine GGT activity and creatinine concentration had significant variation, the ratio remained constant. The urine GGT: urine creatinine ratio was calculated from random urine samples collected from 27 clinically healthy adult horses and was found to be 10.52 +/- 4.78 (mean +/- SD).

Neurological examination of newborn foals

Behaviour and response to neurological testing of apparently healthy newborn foals differed significantly from the adult in several ways. Foals responded to external stimulation with exaggerated movements although they tended to sink into a relaxed state when restrained. They had a more angular head position and assumed a base wide stance. The menace reflex developed during the first two weeks post partum. In general, the foals' gait was choppy or dysmetric. In lateral recumbency the foals had increased extensor tone, hyperreflexive tendon reflexes, crossed extensor reflexes as well as recumbent extensor thrust reflexes in all four limbs.

Suggested revision of NEMA standards

The purpose of the NEMA Standards is to "eliminate misunderstandings between the manufacturer and the purchaser and to assist the purchaser in selecting the proper product for its particular need" (NEMA Bylaw Art. V, Sec. 1). The sections on count-rate performance, however, have caused considerable misunderstanding of NEMA specifications by salespersons and users, many of whom fail to distinguish between input and observed count rates and between intrinsic and system (extrinsic) performance. The "maximum count rate" is shown to be an unreliable index of camera performance at useful count rates, and is misconstrued by some users to mean the maximum clinically useful count rate. The sections on count-rate performance can be made more meaningful to users by substituting "observed count rate" for "input count rate," by deleting the section on "maximum count rate," and by adding a section on system count-rate performance.

For debate . . . medical research output 1973-81: a romp around the United Kingdom research centres

In order to measure output of medical research in the United Kingdom, the computerised database of Excerpta Medica was used to count the number of publications emanating from each centre of research based on a medical school in 1973-81. Data were amalgamated for the first four years (1973-6) and the final four years (1978-81) and the two sets of data were compared. Eight centres showed a substantial change (20% or more) between the first and second periods. In London three medical schools showed an increase in output and one showed a decrease in output. Elsewhere Leicester, Nottingham, and Southampton schools showed an increase and Bristol showed a decrease. The overall contribution of Cambridge did not increase over the decade but the proportion of clinical papers among those produced at Cambridge did increase. There are deficiencies in this type of exercise as all articles are treated equally, but probably some of these problems could be overcome in a more sophisticated analysis. Some measure of weighting of the importance of each paper needs to be devised.

Influence of personal and academic experiences on formation of attitudes toward mentally retarded adults

Attitudes toward mentally retarded adults of 135 students majoring in special education, education, and social work were studied. Educational and personal experiences having to do with mentally retarded adults were compared. Correlations were low to moderate for the personal and academic experiences of the three groups as well as with their attitudes toward mentally retarded adults. Differences in attitude could not be explained by statistically controlling any variables.

Pathology as "personal growth": a participant-observation study of lifespring training

This paper presents an overview of a Lifespring Basic Training workshop from a psychoanalytic perspective. Basing our conclusions on a participant-observation study, we argue that the impact of the training was essentially pathological. First, in the early period of the training, ego functions were systematically undermined and regression was promoted. Second, the ideational or interpretive framework of the training was based upon regressive modes of reasoning. Third, the structure and content of the training tended to stimulate early narcissistic conflicts and defenses, which accounted for the elation and sense of heightened well-being achieved by many participants.

Communication. Say what you mean!

The following suggestions are offered to improve your communication with coworkers and patients: 1. Don't use jargon when it isn't necessary. 2. Use feedback when seeking the meaning to a secondary message. 3. Key your messages to the level of understanding the receiver possesses. 4. Always realize your abstracting. 5. Do not always interpret message literally. Yes, in the beginning was the word. But when we interpret all words literally, we miss much of what is really being said. Ultimate meaning and awareness can only take place if we allow our intuition to come into focus. Sometimes it's best to literally "lose your mind" and "come to your senses."

Activated charcoal in tricyclic antidepressant poisoning: pilot controlled clinical trial

1 A randomised clinical trial was carried out to assess the effects of activated charcoal in the management of suspected tricyclic antidepressant poisoning. 2 Forty-eight patients entered the study, twenty receiving supportive care plus activated charcoal (10 g) and twenty-eight supportive care alone. 3 Drug screening showed that only seventeen patients had taken tricyclic antidepressants alone. 4 Activated charcoal had no effect on either the rate of lightening of coma or the fall in plasma antidepressant concentration in the 'pure' tricyclic antidepressant poisoning group. 5 No serious side-effects of activated charcoal were reported.

Physical Activity for Patients Wearing Spinal Orthoses

In brief: If idiopathic scoliosis and Scheuermann's kyphosis are diagnosed while a patient still has significant growth remaining, spinal bracing may be necessary to prevent progression of the deformity. Noncompliance to a brace-wearing regimen is a major impediment to effective treatment. At the Children's Rehabilitation Center a special program to help patients through the initial adjustment period starts with a three-to five-day inpatient stay. The program has achieved a 78% compliance record for kyphosis patients and 95% compliance for scoliosis patients.

The case study approach to understanding learning disabilities

A case study can help to clarify for the student the puzzling contradictions and the range of irregularities that characterize the learning disabled child. This approach can be illustrated through analysis of the case of Jeffry, a third grader who was highly verbal, while at the same time demonstrating immaturities and/or deficits in other areas of functioning. Evaluation indicated four vulnerable areas, which were later handled during the course of remediation. Different frameworks for analyses can be generated from the case study. It offers an opportunity to use inductive reasoning in uniting theory and practice.

Prepuce restoration seekers: psychiatric aspects

A new subgroup of patients within the homosexual community has been identified who are characterized by preoccupation with their absent foreskins. They associate their circumcised status with a sense of incompleteness, anger over a lack of choice, and their sense of masculinity. Four patients who sought surgical reconstruction are reported. None were Jewish or psychotic. All tolerated surgery well. Preliminary etiologic hypotheses are advanced, emphasizing psychodynamic and imprinting possibilities.

A precision pump for simulated cardiographic studies

A system simulating physiologic and pathologic changes in left-ventricular volume is presented. Its purpose is to provide a model to establish the accuracy of current equipment for assessing a heart's performance where the actual volume and size are measurable. The versatility of the model allows a wide range of variability of various parameters for simulation of many clinical situations.

Development of maternal and child health services in the minority communities of Israel

TO get to the maternal and child health station in Mahamadia, a Moslem Arab village, you alight from the bus at the foot of Mount Tabor, slide down a hill, and find yourself in a courtyard with children and sheep. Bahija, the practical nurse, greets you and laughs as she tells of the Jewish paediatrician who, because of religious tenets forbidding touching a strange woman, refused to take her helping hand and proceeded to fall all the way. From the entrance shed you are led to two rooms with light coming from the open doors. The rooms are clean with stone floors that are easily washed and with the standard blue and white furniture seen in every Ministry of Health or Kupat Holim (General Sick Fund of the Federation of Labor) station in Israel.

BRH test pattern for the evaluation of gamma-camera performance

A transmission test pattern has been developed for the simultaneous evaluation of intrinsic resolution, field uniformity, and spatial distortion of gamma cameras of any model and age. Holes 2.5 mm in diameter are drilled with high precision through a 3.2-mm thick lead-alloy plate, forming an orthogonal array of holes. The minimal lead spacing separating adjacent holes is a constant 2.5 mm in th Y direction, but varies along the X axis, in groups of six holes, from 1.5-7 mm in steps of 0.5 mm. The performance of gamma cameras has been investigated with the gamma rays of Tc-99m and the low-energy photons from Xe-133 and Tl-201. Images of the test pattern provide a simple, rapid, and sensitive method for gamma camera quality control, acceptance testing of new instruments, and checking of a camera's operating and maintenance procedures.

Clonal characteristics of experimentally induced "atherosclerotic" lesions in the hybrid hare

The female hybrid hare (Lepus timidus x Lepus europaeus) is heterozygous for electrophoretically separable, X-linked isoenzymes of glucose-6-phosphate dehydrogenase. The isoenzymes of this animal have been used as cellular markers in the study of the clonal origins of experimentally induced atherosclerotic lesions. Aortic lesions produced in the hybrid hare by feeding cholesterol and injuring the aortic wall with a catheter have been shown to have polyclonal characteristics and in this way are fundamentally different from atherosclerotic fibrous plaques in man.

Hypertension screening in schools: results of the Dallas study

The purpose of this study was to determine the prevalence of persistent blood pressure elevations in an eighth-grade population composed of three ethnic groups, and to determine the feasibility of using school health facilities for hypertension screening. Blood pressure was recorded in 10,641 subjects (90% of the total eighth-grade population) in the Dallas Independent School District. Blacks made up 46% of the population; non-Latin whites, 40.1%; and Latin-Americans, 13.9%. On the first blood pressure screening, 8.9% had systolic or diastolic pressures or both at or above the 95th percentile. Of those whose blood pressures were elevated on the first examination, 98.3% were reexamined. After the third examination, 1.2% continued to have systolic hypertension, and 0.37% diastolic hypertension. No student had diastolic pressure above 90 mm Hg on all three examinations. The prevalence of persistent hypertension was similar for the three ethnic groups. Analysis of variation in blood pressure measurements revealed that the school nurses introduced a relatively small increase in variability. These data indicate that although school screening initially identifies large numbers of students as having inconstant pressure elevations, subsequent follow-up examinations show that less than 2% have persistent hypertension.

Origins of public health nursing in Israel

Israel is now thirty years old, but its community health services date back to the early years of this century when the land was still under Turkish rule. The first written reports on the nursing services appeared in 1912 in New York City in the minutes of a group of Jewish women later known as Hadassah Women’s Organization. Some of the members had visited the Holy Land and, shocked by the state of health of the Jewish poor, saw the urgent need for improving care. It was decided to start with a system of community maternity nursing which would be carried out along the lines of the New York State Legislation. The nurses would be given funds to employ midwives, to supply linen to mothers and babies, and to distribute money for medicine and food to the poor. Furthermore, the nurses were to train probationers for community nursing, give talks to mothers and girls and nursing care to the sick poor. They were to be in contact with Hadassah by letters, monthly reports, and were to use an approved system of bookkeeping.

Human interaction as a type of variable

A review of empirical findings which differentiated between the effects of social and non-social variables in the determination of human conduct found non-social variables most frequently to have been superior. A two-factor comparision of the impact of money and social cues, discriminative stimuli, and rewards from delinquent peers on incarcerated juvenile delinquents found money to be the more powerful determinant of cheating behaviour (P < 0.001). It is suggested that explanations of human behaviour should not ignore the effects of non-social variables.

Deadtime measurements in scintillation cameras under scatter conditions simulating quantitative nuclear cardiography

Deadtime performance of scintillation cameras is sensitive to such factors as scatter fraction and analyzer window width. Data from manufacturers and previous investigators do not predict counting-rate losses under clinical conditions. Scintillation cameras used with Tc-99m for quantitative nuclear cardiology should be evaluated for deadtime performance by the two-source method using a scatter phantom designed to simulate the spectrum from Tc-99m in the heart. Under these conditions, scintillation cameras were found to follow the paralyzable model; accurate estimates could be obtained for data losses and maximum useful counting rates in a clinical setting. A survey of 39 contemporary scintillation cameras yielded a range of paralyzing deadtime values of 4.3 to 10 musec, with a 20% window centered on the Tc-99m photopeak. For an average deadtime of 6 musec, counting rates should be maintained below 36,000 cps to avoid undue data losses in excess of 25%.

Changes in canine bladder perfusion with distension

Using a radioisotope-labeled microsphere technique, canine bladder perfusion was investigated. Blood flow was measured in in flaccid and distended conditions. A slight decrease in total bladder blood flow was recorded. There was a relative decrease in bladder mucosal flow with distension. There was no difference in perfusion of dome versus trigone.

Comparison of tympanometry and otoscopy in establishing pass/fail referral criteria

Impedance tests, pure tone screening, and pneumatic otoscopy were performed on two groups of children. For the second group, two physicians, one an otolaryngologist and the other a pediatrician, performed the otoscopic examination. Agreement between tympanometry and otoscopy was not influenced by the presence or absence of acoustic reflexes or passing or failing the pure tone screening, but did depend on the criteria used in classifying the tympanograms. Tympanograms classified as having significant negative pressure were those showing the poorest agreement between tympanometry and otoscopy. Between examiners, agreement in otoscopic findings was generally poor. Results are discussed as they apply to establishing pass/fail criteria for screening with impedance.

Intracellular compartmentation of Na+, K+ and Cl- in the Ehrlich ascites tumor cell: correlation with the membrane potential

The intracellular distribution of Na+, K+, Cl- and water has been studied in the Ehrlich ascites tumor cell. Comparison of the ion and water contents of whole cells with those of cells exposed to La3+ and mechanical stress indicated that La3+ treatment results in selective damage to the cell membrane and permits evaluation of cytoplasmic and nuclear ion concentrations. The results show that Na+ is sequestered within the nucleus, while K+ and Cl- are more highly concentrated in the cell cytoplasm. Reduction of the [Na+] of the incubation medium by replacement with K+ results in reduced cytoplasmic [Na+], increased [Cl-] and no change in [K+]. Nuclear concentrations of these ions are virtually insensitive to the cation composition of the medium. Concomitant measurements of the membrane potential were made. The potential in control cells was -13.7 mV. Reduction of [Na+] in the medium caused significant depolarization. The measured potential is describable by the Cl- equilibrium potential and can be accounted for in terms of cation distributions and permeabilities. The energetic implications of the intracellular compartmentation of ions are discussed.

Particulate myocardial perfusion scintigraphy: its clinical usefulness in evaluation of coronary artery disease

The determination of myocardial viability is a crucial parameter in the evaluation of a patient with coronary artery disease. Particulate myocardial perfusion scintigraphy (PMPS) is one of several methods available for this determination. A brief comparison between PMPS and two other commonly used methods is described in this review. The technique and analysis are described and applied to 194 patients with 366 surgically bypassed regions. The patients are analyzed for postoperative regional wall function and for total ventricular function as expressed by ejection fraction. PMPS is a highly accurate and unique study for clinically predicting myocardial viability.

Residual effects of hypnotic drugs: evidence for individual differences on vigilance

Twelve healthy volunteers were given butobarbitone 100 and 200 mg, nitrazepam 5 and 10 mg and 2 lactose dummy treatments, at 23.00 hours at weekly intervals over 6 weeks according to a balanced design and using double blind conditions. Performance was studied between 09.00 hours and 17.00 hours the following day. Significant (P is less than 0.05) impairment of tapping rate and digit symbol substitution occurred. No significant differences occurred between performance after active drug and dummy in auditory vigilance, and subjective effects. Examination of individual differences in the response of subjects to the 4 hypnotic drug treatments, compared with their responses after dummy, indicated that subjects could be divided into two groups. One group consistently rated themselved as more alert after hypnotics and their vigilance performance improved. The other group consistently were more drowsy after hypnotics and their performance was impaired. It is suggested that the improvement in the first group resulted from improved sleep quality sufficient to counteract the residual effect of the hypnotic, whereas the second group merely showed the residual effects of the drugs.

Passive cation movements in the Ehrlich ascites tumor cell: the effects of 2,4,6-trinitrobenzene sulfonic acid

We have investigated the effects of 2,4,6-trinitrobenzene sulfonic acid (TNBS), an amino reactive reagent, on passive cation movements in Ehrlich ascites tumor cells. Incubation of tumor cells with TNBS (3 mM) results in a two phase association of TNBS with the cells. An initial, rapid phase, presumably at the level of the membrane, is independent of temperature, while the second phase increases linearly in time and is temperature dependent. Kinetic analyses of Na+ movements indicate that TNBS: (1) inhibits Na+ movement from a slowly exchanging cellular compartment, but is without effect on a more rapidly exchanging compartment; (2) does not alter net Na+ accumulation in transport-inhibited cells; and (3) is without effect on non-exchange Na+ efflux at 0 degrees C. The actions of TNBS on K+ movements depend upon temperature and the continued presence of TNBS in the environment. At 22 degrees C two minute exposure of the cells to TNBS leads to 77% inhibition of K+ efflux. With continued exposure to TNBS, the inhibition is only 42%. Reduction of the temperature to 0 degrees C decreases K+ efflux in control cells by 82%. Two minute exposure to TNBS enhances K+ efflux by 50%, while continuous exposure increases it by 144%. These results suggest: (1) TNBS interacts with several classes of membrane sites which are involved with the regulation of passive cation movements; and (2) passive Na+ and K+ movements across the cell membrane proceed by different pathways.