Continuing medical education using clinical algorithms. A controlled-trial assessment of effect on neonatal care.
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Biomedical subjects
Publications and source records attributed to M Turner.
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Plants of Sedum rubrotinctum R. T. Clausen were studied in a green-house over a 2-year period without watering. Only the apical leaves survived and were turgid at the end of the experiment. The midday leaf water potential of these apical leaves was -1.20 megapascals, while the leaf water potential of comparable leaves on well-watered control plants was -0.20 megapascals. The unwatered plants appear to have maintained turgor by means of an osmotic adjustment. After 2 years without water the plants no longer exhibited a nocturnal accumulation of titratable acidity. However, the daytime levels of titratable acidity of the unwatered plants were more than 2-fold greater than the levels in well-watered control plants. Well-watered plants of S. rubrotinctum exhibited seasonal shifts in biomass stble carbon isotope ratios, indicating a greater proportion of day versus night CO(2) uptake in the winter than in the summer. The imposition of water stress prevented the expression of this seasonal rhythm and restricted the plants to dark CO(2) uptake.
Sarcoid granulomatous nephritis was observed in 2 patients. Renal failure was present in both patients in the absence of hypercalcemia or nephrocalcinosis. Specific tubular dysfunction manifested as an acquired Fanconi syndrome in 1 patient. Steroid therapy was effective in causing regression of the renal granuloma, but there were significant interstitial changes on repeat renal biopsy which were accompanied by persistent tubular dysfunction. Sarcoid granulomatous nephritis may be a not infrequent cause of renal dysfunction in sarcoidosis.
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A radioimmoassay for digoxin is described which uses commercially available reagents. Two assay procedures are used, one for batch assays, and another, which needs a 5 minute incubation only, for 'stat' assays. The methods are shown to be simple, rapid, precise and inexpensive and the batch procedure compared well with the Amerlex digoxin method for 63 patient samples.
We used histochemical methods specific for carbohydrates on accurately timed endometrial biopsies to examine changes in quantity or electronegativity of the endometrium's luminal glycocalyx through the menstrual cycle in normal fertile women. Electronegative glycocalyx was detectable light-microscopically throughout the menstrual cycle. On the third day after the luteinizing hormone peak, a significant increase (P = 0.005) in endometrial surface glycocalyx was evident along with the appearance, in endometrial glands, of material having the staining properties of acid mucus glycoprotein (MGP), which implies that after this material's production by the glands or by the surface epithelium, it becomes adsorbed onto the surface glycocalyx. This phenomenon was accompanied by an apparent decrease in glycocalyceal electronegativity as indicated by a shift from high iron diamine (pH 1.0) to alcian blue (pH 2.5) staining reactivity. Because the timing of the appearance of endometrial moderately acid MGP coincides with or precedes the time that the early fertilized embryo enters the endometrial cavity, a role for the MGP in embryo nutrition or in implantation is suggested.
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Three cases of trisomy 18 are described, each with evidence of diminished fetoplacental function, specifically reduced 24-hour maternal urinary estrogen. All three infants died within three months and showed gross and microscopic evidence of hypoplasia of the fetal adrenal cortical zone. This abnormality is consistent with and helps explain the increased incidence of obstetric intervention and prolonged pregnancy in this syndrome.
Various options in the delivery of food to the elderly housebound are reviewed. These include precooked warm-held meals; precooked frozen meals reheated in a microwave oven en route, frozen meals or sterilised pouched meals for reheating at home, and packs of prepared raw ingredients for home cooking.
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The variant surface glycoproteins from two cloned populations of Trypanosoma brucei brucei which were known to migrate as multiple bands on SDS gels have been studied. The heterogeneity present was located in those oligosaccharide side chains the addition of which is tunicamycin-sensitive. The time required for the trypanosome to synthesize and express a variant surface glycoprotein molecule in vitro was found, from pulse-chase and limited trypsinisation experiments, to be approximately 40 min. In the light of these data, pulse-chase experiments on the two antigens known to have heterogeneity in their oligosaccharide side chains demonstrated that the heterogeneity probably arose by two different mechanisms. Pulse-chase experiments on three different clones of trypanosomes have also been used to investigate the timing of cleavage of the carboxyl-terminal extension, known to be encoded on variant surface glycoprotein mRNA. Similar pulse-chase experiments followed by immunoprecipitation using affinity purified antiserum have been used to investigate the addition of the cross-reacting determinant. The timing of both these events has been discussed in relation to the time necessary for the synthesis and expression of the variant surface glycoprotein on the surface of the trypanosome.
We report 4 infants with pyridoxine dependent seizures who had clinical features that led to diagnostic uncertainty. Their clinical course was unusual in 1 or more of the following: later onset of initial seizures; a seizure free period after taking of anticonvulsants, but before taking of pyridoxine; a long remission after withdrawal of pyridoxine; and atypical seizure type. This report illustrates a broader range of clinical features and highlights the need to consider the diagnosis of pyridoxine dependent seizures in any infant with intractable epilepsy, regardless of the pattern of seizures and the response to anticonvulsant medications. In such a case, 100 mg intravenous pyridoxine should be given and, if a definite clinical response is established, oral pyridoxine should be continued indefinitely.
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