Noninvasive assessment of the visual system and ophthalmic and visual optics: an introduction to the joint vision features

This is an introduction to the joint feature on noninvasive assessment of the visual system and ophthalmic and visual optics.

Cloning and sequence of a beta-tubulin cDNA from Pneumocystis carinii: possible implications for drug therapy

This work describes the isolation and characterization of a full-length cDNA clone encoding beta-tubulin from the pathogen Pneumocystis carinii. P. carinii contains a single gene encoding beta-tubulin. The complete sequence of this cDNA has been determined and its inferred amino acid sequence compared with the beta-tubulins from other organisms. This analysis augments the data indicating that P. carinii should be classified as a fungal organism. Further comparisons between the P. carinii beta-tubulin and those of fungal beta-tubulins resistant to benomyl, a beta-tubulin-binding drug, indicate a difference which may be exploited in the development of a new drug therapy for P. carinii pneumonitis. These results suggest that, theoretically, a drug presently administered for treatment of nematode worm infections may be an effective agent against P. carinii, without being toxic to the mammalian host. This possibility is currently being investigated.

The spectrum of chest infections in HIV positive patients in Edinburgh

In a retrospective analysis of all known HIV-positive patients admitted to the City Hospital before November 1989, 208 patients accounted for 612 admissions, 72% being injection drug users (IDUs). One hundred and eighty admissions (29%) were for chest-related disorders, and this was the commonest reason for admission. Unlike other U.K. centres where more than 50% chest problems are due to Pneumocystis carinii pneumonia (PCP), only 27% of our chest admissions were for PCP. Fifty-four percent of chest admissions were for bacterial chest infections (BCIs), the commonest organism isolated being Haemophilus influenzae. Despite the fact that most (50/97) of these admissions were in patients with 'asymptomatic' HIV disease (CDC classification 2 and 3), 50% had radiological pneumonia, 43% were hypoxic, 28% were hypercapnic and the average duration of hospitalisation was 10 days. BCIs were more common in HIV-positive IDUs when compared with HIV-negative IDUs, other HIV-positive patients and the general age-matched population. Medical provision for IDU-related HIV disease should take into account the high rate of BCIs and of hospital admissions in patients who do not yet have CDC stage 4 disease.

HIV-1 associated cognitive/motor complex in an injecting drug user

The clinical and social consequences of AIDS dementia complex/HIV-1 associated cognitive/motor complex (ADC/HACC) in drug users have not been well documented. The value of prospective serial neuropsychological, neuroradiological and neurophysiological measurements to assist diagnosis of ADC/HACC in patients with premorbid personality disorder and intercurrent drug use is demonstrated. The psychosocial problems resulting from ADC/HACC with respect to community care and the location of hospitalization is considered. The relevance of the 1984 Mental Health Act (Scotland) with regard to drug users with ADC/HACC is discussed.

The spirituality of dying. Pastoral care's holistic approach is crucial in hospice

Attention to the spiritual dimension of a person is essential in a holistic approach to hospice care. Although other hospice team members may be involved in matters of faith with patients, chaplains are the primary professionals concerned with the transcendent nature of life and the integrative role that spirituality plays in care for the dying. Understanding spirituality in a person's living and dying requires an understanding of religion and theology. Religion is meant to connect us to a caring community and to give us a place on which to stand--a tradition. Theology is a search for meaning. Spirituality is "the life principle that pervades a person's entire being ... and generates a capacity for transcendent values." The body cannot be touched without the spirit's being affected, and vice versa. Efforts to help patients toward wholeness necessitate helping them accept freely their whole lives. The chaplain is not limited to nor bound by religious language. The needs of the patient should determine the use of prayer or God-talk. Listening is one of the greatest spiritual gifts a chaplain can give a suffering patient. Being a companion is often all the chaplain can do. Pastoral care personnel are also sensitive to the needs of the hospice staff. The chaplain does not so much fulfill a role as represent a perspective based on concern and solicitude for the whole person, the whole family unit, the whole staff.

Medical manpower planning

Since 1980, numerous articles have discussed impact analysis; in addition, the Ontario Hospital Association and the Ontario Medical Association are about to publish guidelines to assess the impact of additional physician manpower and instructions on various techniques to conduct such an analysis. However, little has been published on medical manpower planning at the hospital level, in spite of the fact that a medical manpower plan is at the core of a successful hospital strategic plan. This article presents a population-service-based model of a medical manpower plan and reviews its use at Peel Memorial Hospital.

Comparative study: the effects of latex and vinyl gloves on the tactile discrimination of first year dental hygiene students

The purposes of this study were to determine 1) if there was a significant difference in the tactile discrimination of first year dental hygiene students wearing a vinyl glove as compared to a latex glove; 2) if the subjects' perceptions of their ability to accurately discriminate between surface textures differed when wearing either one of the two gloves; and 3) the individual characteristics of the gloves preferred by the subjects. Twenty-nine first year dental students were randomly assigned to one of the two glove treatment groups. The tactile discrimination ability of each subject was assessed at baseline and three weeks after using the Roughness Discrimination Test (RDT). The subjects wore their assigned gloves when performing laboratory and clinical procedures during the 3-week period. Following this period the RDT was again administered. Subjects then switched gloves for an additional 3-week period, at which time data were collected regarding perceived discrimination ability and glove preference. Data were analyzed using a repeated-measures analysis of variance. Results revealed no significant difference (p less than 0.05) in subject's tactile discrimination ability while 29% indicated that the latex glove had an inhibitory effect. The subjects most frequently preferred the latex glove, citing specific favorable characteristics such as size, fit, comfort and durability while performing clinical procedures. However, the vinyl glove was favored for durability after washing.

Study of the sympathetic effects of polocaine in a regional hallux block

This study was performed on 40 healthy volunteers, and examines the onset, duration, subjective pain on injection, and sympathetic effects of two strengths of Polocaine, a brand of mepivacaine hydrochloride. The study demonstrated that Polocaine is a safe and useful, short-acting, local anesthetic. Polocaine is also a useful agent in causing local vasodilation for periods of time as long as 24 hr.

Podiatric manifestations of AIDS

Dermatologic, vascular, neurologic, and musculoskeletal complications are common among persons with acquired immunodeficiency syndrome (AIDS). These manifestations frequently involve the lower extremities and may be the initial presenting symptoms of human immunodeficiency virus (HIV) infection. It is important that practitioners of podiatric medicine be aware of these syndromes to facilitate early diagnosis of AIDS and to provide the best possible care for immunodeficient patients. The author provides a review of the manifestations of AIDS frequently encountered in podiatric practice, along with guidelines for treatment.

Pressure pain threshold evaluation of the effect of spinal manipulation in the treatment of chronic neck pain: a pilot study

Nine subjects with chronic mechanical neck pain syndromes were evaluated for pressure pain threshold (PPT) over standardized tender points in the paraspinal area surrounding a manipulable spinal lesion. The subjects were then allocated randomly to an intervention consisting of either an oscillatory mobilization of the cervical spine (n = 4), which was designated as the control procedure, or a rotational manipulation of the cervical spine (n = 5). An assessor-blinded re-evaluation of the pressure pain threshold levels was conducted after 5 min. In the group receiving a manipulation the mean increases in pressure pain threshold ranged from 40-56% with an average of 45%. In the control group no change in any of the pressure pain thresholds was found. These results were analyzed using ANOVA and were found to be statistically significant (p less than 0.0001). This study confirms that manipulation can increase local paraspinal pain threshold levels. The use of the pressure pain threshold meter allows for the determination of such a beneficial effect in the deeper tissues.

Bacterial carriage by artificial versus natural nails

Although health care workers are following fashion trends when they wear artificial nails, the implications of these nails for infection control is unknown. Cultures were obtained before and after handwashing from the fingertips of 56 nurses with artificial nails and 56 nurses with natural nails. After handwashing there were higher numbers of colony-forming units of gram-negative rods cultured from the fingertips of nurses with artificial nails than from nurses with natural nails. There were no significant differences in carriage of gram-positive cocci or normal flora. Because of the number of nosocomial infections caused by gram-negative rods, health care workers who wear artificial nails should consider the potential risk of increased carriage of gram-negative rods.

Herpes simplex virus, Candida albicans and mouth ulcers in neutropenic patients with non-haematological malignancy

Mouth ulcers are a frequent cause of morbidity in patients rendered neutropenic as a result of chemotherapy. We report here a series of 28 such patients from whom swabs were taken for viral isolation and mycological culture. In 13 patients, herpes simplex virus (type I) was isolated and in 17 patients Candida albicans was cultured. Both organisms were isolated in 9 patients. Our results suggest that both a viral and fungal element may be important in the aetiology of oral ulceration and that antiviral and antifungal agents may each have a role in the prophylaxis and treatment of such patients.

The spinal accessory nerve plexus, the trapezius muscle, and shoulder stabilization after radical neck cancer surgery

A clinical and anatomic study of the spinal accessory, the eleventh cranial nerve, and trapezius muscle function of patients who had radical neck cancer surgery was conducted. This study was done not only to document the indispensibility of the trapezius muscle to shoulder-girdle stability, but also to clarify the role of the eleventh cranial nerve in the variable motor and sensory changes occurring after the loss of this muscle. Seventeen male patients, 49-69 years of age, (average of 60 years of age) undergoing a total of 23 radical neck dissections were examined for upper extremity function, particularly in regard to the trapezius muscle, and for subjective signs of pain. The eleventh nerve, usually regarded as the sole motor innervation to the trapezius, was cut in 17 instances because of tumor involvement. Dissection of four fresh and 30 preserved adult cadavers helped to reconcile the motor and sensory differences in patients who had undergone loss of the eleventh nerve. The dissections and clinical observations corroborate that the trapezius is a key part of a "muscle continuum" that stabilizes the shoulder. Variations in origins and insertions of the trapezius may influence its function in different individuals. As regards the spinal accessory nerve, it is concluded that varying motor and sensory connections form a plexus with the eleventh nerve, accounting, in part, for the variations in motor innervation and function of the trapezius, as well as for a variable spectrum of sensory changes when the eleventh nerve is cut. For this reason, it is suggested that the term "spinal accessory nerve plexus" be used to refer to the eleventh nerve when it is considered in the context of radical neck cancer surgery.

The routine profiling of forensic heroin samples

A method for the routine profiling of illicit heroin samples received in casework has been developed which depends on simple and straightforward sample pretreatment, followed by gas chromatography on a capillary column using flame-ionization detection. The factors affecting the choice of each aspect of the procedure are discussed, as are the statistical data for sampling and the chromatography. Components of illicit heroin derived from opium and other adulterants have been identified. The significance of data from samples examined in 1986 is discussed.

Human immunodeficiency virus and drug misuse: the Edinburgh experience

During 1985 many drug abusers who lived in Edinburgh were found to be infected with the human immunodeficiency virus (HIV). As a result an alternative counselling and screening clinic for testing for antibodies to HIV was established for use by drug abusers. Four hundred and forty one patients were counselled in the first year, and over 60% were either drug abusers or their sexual contacts. One hundred and fourteen (26%) patients were positive for HIV antibody, and 100 (88%) of these were current or former drug abusers. The HIV seropositivity rate in drug abusers was 52% but was only 7% in their sexual contacts. Services were provided for these people as well as counselling before and after the test. The cost of this counselling service for the first year was 27,000 pounds or 61.22 pounds per patient. The unexpected mobility of 23% of the Edinburgh drug abusers, particularly to other areas of Britain, suggests that similar services need to be set up elsewhere.