Different models of delivery care: a panel discussion.
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Biomedical subjects
Publications and source records attributed to E Martin.
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An electrophysiological study in close to 1,500 cases of various lesions of the trigeminal nerve, the acoustico-facial complex and the brain stem was presented. It was concluded that following a detailed clinical examination which, most often, allows precise topographical diagnosis, the study of the trigemino-facial and facial reflexes appears to be an essential diagnostic tool to determine the topography of a lesion. Moreover, this method may give prognostic evaluation as well as facilitate the choice of surgical approach to the lesions of the acoustico-facial complex.
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Isocitrate lyase (EC 4.1.3.1) and malate synthase (EC 4.1.3.2), the two enzymes characteristic of the glyoxylate cycle, were demonstrated in promastigotes of five species of Leishmania (L. brasiliensis, L. donovani, L. mexicana, L. tarentolae, and L. tropica). Both enzymes were present in cells grown in a medium containing 10 mM glucose. Substitution of glucose with 20 mM acetate did not enhance enzyme levels. Acetate was readily taken up and metabolized by the cells. The distribution of label from acetate into various intermediary metabolites indicates a functional glyoxylate cycle and its role in gluconeogenesis/glyconeogenesis. The glyoxylate cycle in conjunction with alanine-glyoxylate aminotransferase and glyoxylate-aspartate aminotransferase could also be important in providing glyoxylate, the precursor for glycine biosynthesis.
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A new operative technique was designed combining an end-to-side portacaval shunt with arterialization of the intrahepatic portal vein by means of a saphenous vein graft between the right gastroepiploic artery and the stump of the portal vein. The objective of this operation is to perfuse the hepatic portion of the portal vein with a low volume of arterial blood to ameliorate the adverse metabolic consequences of portosystemic decompression. The procedure was performed upon 18 patients with one operative mortality. The mean follow-up period is 15.4 months. The benefits of this operation are evident in the prevention of hepatic decompensation and avoidance of encephalophy, thus permiting unrestricted protein intake. The operation is well tolerated, and the operative mortality appears to be less than that following conventional shunting procedures.
The purpose of this article is to present a new electrophysiological evaluation method to study facial nerve function. This technique studies the afferent sensory pathways and the efferent motor fibres. The study of the various parameters of those two functions allows us to draw certain conclusions relating to the prognosis and localization of facial nerve lesions.
The removal of phenytoin by hemodialysis was determined in seven uremic patients. Four patients were receiving phenytoin sodium for therapeutic purposes; three received one dose each intravenously to quantitate its disposition in uremia. The drug was measured in whole blood, plasma, saliva, and dialysate. Only 2% to 4% of the intravenous dose was recovered in the dialysate. Phenytoin clearance by dialysis was 7 to 14 ml/min; plasma clearance was 53 to 133 ml/min. Since hemodialysis contributes little toward shortening to 11-to-18-hour half-life of phenytoin in the uremic patients, no supplemental dose is necessary for uremic patients undergoing hemodialysis.
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Dissecting aneurysms of the renal artery are the most common site of peripheral dissections without aortic involvement. The problems posed by this condition are analysed in the light of a personal cases and 52 in the literature. The onset in a young man of sudden loin pain followed shortly after by hypertension is suggestive of obstruction of a renal artery. The diagnosis can be confirmed only by arteriography, if the findings are sufficiently clearcut, which is not invariably the case. Surgical treatment gives good results and our own case clearly indicates the immediate and definitive relief of hypertension by nephrectomy. However the decision regarding surgery must take into account the possibility of recurrent peripheral lesions and of the possible reversibility of hypertension under the influence of medical treatment.