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Introduction The Malone antegrade continence enema (MACE) procedure is an established treatment option for children with constipation or fecal incontinence. This study retrospectively analyses the management and outcomes of children who underwent MACE procedures at a regional pediatric surgery unit. Patients and Methods Children who underwent a MACE procedure in our unit between 1998 and 2012 were identified. Demographic and clinical data were obtained from contemporaneous records. Using the continence scale described by Malone, overall outcomes were categorized as full, partial, or failure (full: totally clean or minor rectal leakage on night of washout; partial: clean but significant stoma or rectal leakage, occasional major leak and/or still wearing protection but perceived by child or parent to be an improvement; failure: regular soiling or constipation persisted, no perceived improvement, procedure was abandoned). Data entry and statistical analysis were performed using Excel and SPSS (IBM Corp., Armonk, New York, United States). Results A total of 40 children (29 male) were identified for inclusion. Underlying diagnoses were idiopathic constipation (16), anorectal anomalies (14) and Hirschprung's disease (10). The MACE procedure was performed laparoscopically in 26 cases and using an open technique in 14 cases. Mean age at the time of surgery was 8.9 years (range, 3–19 years) and mean follow-up time was 6.5 years (range, 1–10 years). Outcomes categorized as full were 62.5% for chronic idiopathic constipation (CIC), 71.4% for anorectal malformation (ARM), and 70% for Hirschsprung disease (HD). Overall success rates (full and partial outcomes combined) were 87.5% for CIC, 92.8% for ARM, 100% for HD, and 92.5% for all diagnoses taken together. Eleven MACE procedures (27.5%) were reversed, in seven (17.5%) due to the return of spontaneous and regular bowel movements and in four (10%) due to stomal problems. Conclusion This study identified a high success rate (combining full and partial outcomes) of 92.5% for MACE procedures within our unit. An encouraging finding is that the procedure was reversed in a significant proportion of patients following the return of normal bowel habits.

Carbon dioxide (CO2) rebreathing has been recognised as a concern regarding respirator use and is related to symptoms of discomfort, fatigue, dizziness, headache, muscular weakness and drowsiness. Previous investigations are limited by small sample size and have not evaluated the relationship between CO2 inhalation and phonic respiration (breathing during speech) in respiratory protective devices (RPDs). A total of 40 workers trained in the use of RPDs performed a graded exercise test on a cycle ergonometer that increased in workload every 5 min. During the third minute of each stage, participants read aloud a prepared text. Measures of mixed expired CO2 (PECO2), mixed inspired CO2 (PICO2) and respiration were monitored. The results showed that phonic respiration and low work rates contributed to significantly higher levels of CO2 rebreathing. Aiming to reduce CO2 exposure may result in improved wear time of RPDs. It is recommended that these findings be incorporated in technical specifications regarding human factors for RPDs.Carbon dioxide (CO2) rebreathing in respiratory protective devices (RPDs) has been highlighted as a key concern regarding respirator use. However, the problem is relatively under researched. This paper presents novel findings on the impact of phonic respiration (breathing during speech) and CO2 concentrations in RPDs.

We investigated the role and outcome of a planned second-look laparotomy (SLL) in preserving bowel in extensive necrotizing enterocolitis (NEC). Extensive NECs managed surgically in a tertiary centre in 2006–2009 were retrospectively studied to include patients planned for an SLL. End points were bowel salvage rate and survival outcomes. Results were median (ranges), and statistical significance was P

Clinical trials of PROBOT, a robotic system for prostate surgery, have shown that robotic surgery of soft tissue can be successful. Monitoring of the progress of the resection has shown to be a necessary feature of an effective robotic system for prostate surgery. It should provide the surgeon with a reliable method of assessing the cavity during resection. An automatic system for intraoperative monitoring of the progress of the resection during robotic prostatectomy consists of two subsystems: real-time intraoperative imaging of the prostate and automatic identification of the contour of the gland on each image. The development of a fully automatic scheme for prostate recognition on transurethral ultrasound scans is reported. A genetic algorithm has been developed to automatically adjust a model of the prostate boundary until an optimum fit to the prostate in a given image is obtained. An analysis of its performance on 22 different ultrasound images showed an average error of 6.21 mm. Use of a genetic algorithm and a constrained prostate model have shown to be a robust way to automatically identify the prostate in ultrasound images. The scheme is able to produce approximate prostate boundaries, without any human intervention, on ultrasound scans of varying quality. In addition to soft tissue robotic surgery, the genetic algorithm technique is also applicable to a wide range of computer assisted surgical techniques.

Background Dehydration is a health risk for miners in tropical regions of Australia. However, it is not known whether dehydration poses a health risk to miners working in temperate regions of Australia. Methods A cross-sectional study of 88 miners from two underground mines was undertaken in south-eastern New South Wales, Australia. Participants had their height, weight, waist circumference and hydration status measured and completed a self-administered questionnaire on fluid intake, access to water, and socio-demographic characteristics. Health and Safety managers were surveyed about guidelines relating to healthy work and lifestyle behaviours which impact/influence hydration. Results Hydration tests indicated that more than half of the miners (approximately 58%) were dehydrated (Urinary Specific Gravity (USG) >1.020) both before and after their shift, with three workers pre-shift and four workers post-shift displaying clinical dehydration (USG>1.030). Overall, 54.0% of participants were overweight and 36.8% were obese. Miners who commenced the shift with poor hydration status were 2.6 times more likely to end the shift with poor hydration, compared to those who commenced the shift with good hydration (OR 2.6, 95% CI 1.06, 6.44). Miners who had a mean USG result for the entire shift indicating dehydration were more likely to be obese (42.9%) and have a waist measurement in the high risk range for metabolic complications (40.8%) than those workers that were adequately hydrated for their entire shift (29.4% and 14.7% respectively). Some guidelines promoting healthy lifestyles and supportive work environments were in place, but there were limited guidelines on healthy weight and hydration. Conclusions Dehydration, being overweight and obesity were linked issues in this cohort of miners. Strategies are needed to: adapt the workplace environment to increase water accessibility; encourage appropriate consumption of water both at work and at home; and to promote physical activity and good nutrition to maintain healthy weight.

There is an unmet need for an intravenous (i.v.) neuraminidase inhibitor, particularly for patients with severe influenza who cannot take oral medication. Two phase I pharmacokinetic and safety studies of i.v. oseltamivir were carried out in healthy volunteers. The first was an open-label, randomized, four-period, two-sequence, single-dose trial of 100 mg, 200 mg, and 400 mg oseltamivir i.v. over 2 h and a 75-mg oral dose of oseltamivir. The second was a double-blind, placebo-controlled, parallel-group, multiple-dose study in which participants were randomized to 100 mg or 200 mg oseltamivir or placebo (normal saline) i.v. over 2 h every 12 h for 5 days. Exposure to the active metabolite oseltamivir carboxylate (OC) after dosing achieved with 100 mg oseltamivir administered i.v. over 2 h was comparable to that achieved with 75 mg administered orally. Single i.v. doses of oseltamivir up to 400 mg were well tolerated with no new safety signals. Multiple-dose data confirmed good tolerability of 100 mg and 200 mg oseltamivir and showed efficacious OC exposures with 100 mg i.v. over 2 h twice daily for 5 days. These results support further exploration of i.v. oseltamivir as an influenza treatment option for patients unable to take oral medication.

A new way of applying transurethral ultrasound scanning in the common surgical procedure of the transurethral resection of the prostate is described. The scanning is incorporated as part of a robotic procedure for surgery, so that the overall time spent in an operation can be further shortened, and a safe and accurate operation can be achieved. The prostate dimensions obtained pre-operatively by the transrectal method and those obtained operatively are compared. A robotic system, which was developed specifically to remove prostatic adenoma automatically, is discussed. The system, called a motorized frame, is briefly described, together with its predecessor, a manual frame, in relation to ultrasound measurements. Sizing of the prostate pre-operatively using transrectal ultrasound methods is discussed, using both the manual and the motorized frame. The shortcomings of transrectal ultrasound for use in a robotic procedure are highlighted.

Inhalation and nasal aspirin challenge has been investigated in asthma patients with co-existing rhinitis. Eight of 39 asthma patients were diagnosed as aspirin-sensitive on the basis of inhalation challenge. Seven aspirin-sensitive asthmatics were subjected to nasal aspirin provocation. During nasal challenge, all seven patients experienced a fall in FEV1 of at least 15%, two showed a significant increase (greater than 400%) in nasal airways resistance (NAR) and one developed urticaria. No significant changes in FEV1 or NAR were observed in nine normal subjects after aspirin inhalation and nasal challenge. There were no significant changes in FEV1 or NAR in six aspirin-tolerant asthmatics when aspirin was given intranasally. The results of this study show that aspirin nasal provocation impairs lung function in aspirin-sensitive asthmatics. In comparison with inhalation challenge responses are generally milder and easier to control. Nasal challenge is also less time-consuming than other methods of aspirin challenge and is therefore more suitable for routine use.

The removal of prostatic tissue through transurethral resection of the prostate (TURP) is an operation that can require considerable skill from a surgeon as well as being a lengthy procedure. The potential for using robotic techniques was investigated in a preliminary feasibility study using a standard six axis ‘Puma’ robot. This led to the construction of a manually operated ‘safety frame’ which has been shown to be effective through clinical trials on 30 patients. A special-purpose robot, based on the design of the manual frame, has now been constructed. Some of the safety issues are discussed which make this procedure an ideal candidate for a robotic device.

The in vitro release of endogenous and exogenous PgF2α from plasma and serum proteins by aspirin and other analgesic drugs has been studied by RIA and equilibrium-dialysis techniques, respectively. Before aspirin addition, the mean plasma level of PgF2α mesured by RIA was significantly lower in aspirin-sensitive asthma (ASA) patients (11.3 ± 6.5 pg/ml; n = 8) than in aspirin-tolerant asthma (ATA) patients (25.0 ± 11.4 pg/ml; n = 21). After aspirin addition (50 μg/ml) the mean PgF2α level detected in plasma by RIA was higher in ASA patients (97.6 ± 5.5 pg/ml) than in ATA patients (66.9 ± 4.5). The binding of [3H]PgF2α to serum protein was significantly inhibited by NSAIDs but not by paracetamol (0.2–1.0 mM). These results implicate PgF2α and the protein-binding property of analgesic drugs in the pathogenesis of aspirin-sensitive asthma.

A primary means to reduce environmental levels of diesel particulate matter (DPM) exposure to miners is to reduce the amount of DPM emission from the engine. A quick and economic method to estimate engine particulate emission levels has been developed. The method relies on the measurement of pressure increase across a filter element that is briefly used to collect a DPM sample directly from the engine exhaust. The method has been refined with the inclusion of an annular aqueous denuder to the tube which permits dry filter samples to be obtained without addition of dilution air. Tailpipe filter samples may then be directly collected in hot and water-supersaturated exhaust gas flows from water bath-cooled coal mine engines without the need for dilution air. Measurement of a differential pressure (DP) increase with time has been related to the mass of elemental carbon (EC) on the filter. Results for laboratory and field measurements of the method showed agreement between DP increase and EC collected on the filter with R(2) values >0.86. The relative standard deviation from replicate samples of DP and EC was 0.16 and 0.11, respectively. The method may also have applications beyond mining, where qualitative evaluation of engine emissions is desirable to determine if engine or control technology maintenance may be required.

Dexamethasone pharmacokinetics were measured in 19 depressed patients, 10 dexamethasone suppression test (DST) nonsuppressors and nine suppressors, following a 1 mg oral dose in tablet form at 2300h. Median dexamethasone concentrations were significantly lower in the nonsuppressors from 3–16 hr post-administration. Nonsuppressors had a significantly lower area under the curve than suppressors, and plasma clearance was significantly faster in the nonsuppressors than in the suppressors. Eleven patients, six nonsuppressors and five suppressors, agreed to a repeat DST after clinical improvement when all six nonsuppressors had normal DST responses. There were no significant differences between the median dexamethasone concentrations, or any of the pharmacokinetic parameters measured, of the “normalising” nonsuppressors and the suppressors. Dexamethasone kinetics were altered in depressed nonsuppressors but became normal with remission of depressive symptoms and normalisation of the DST response.

The Soave endorectal pullthrough is a commonly performed procedure for the definitive management of children with Hirschsprung's disease (HD). Anastomotic stricture is a recognised complication of this procedure. There are multiple causes for these strictures, circular anastomosis being one of them. There are techniques described which alter the shape of the anastomosis of the pulled through bowel to decrease the incidence of strictures. These are oblique and heart-shaped anastomoses. We describe a new technique of oblique anastomosis where the pulled through bowel is anastomosed posteriorly 0.5 cm from the dentate line, and anteriorly 1.5 cm above this point. This oblique anastomosis is designed to lower the stricture rate. If a stricture does occur, an anastomosis near the anocutaneous junction on the posterior aspect also faciltates Y-V anoplasty. We present our experience using this technique. Seventeen consecutive children underwent the procedure at our institution between 2003 and 2006. Only one child developed an anastomotic stricture requiring anal dilatation.

A review of the application of urological robots to the prostate is given, together with an examination of the conventional brachytherapy procedure for insertion of radioactive seeds to treat prostate cancer. The specification and design of a robotic system is provided, which can position a series of needles and radioactive pellets in accordance with a pre-operative plan. The needles can be withdrawn automatically, leaving the seeds in position.A separate motorised system is used to position a trans-rectal ultrasound (U/S) probe, which can be used to continually monitor the seed placement. The robot program can be updated intra-operatively if the U/S image shows this to be necessary. The demonstrator system has been demonstrated in-vitro using a variety of gel and animal tissue phantoms. The resulting robot performance shows this to be a viable approach.

The excellent soft tissue contrast of Magnetic Resonance Imaging (MRI) has encouraged the development of MRI compatible systems capable of combining the advantages of robotic manipulators with high quality anatomical images. Continuing this development, a new five DOF prostate biopsy manipulator has been designed for use inside a closed 1.5T MRI scanner. Space constraints in the bore and the current trend to restrict field strength exposure for operators indicate that a master-slave configuration is ideal for controlling the robotic system from outside the bore. This system has been designed to work with piezoceramic motors and optical encoders placed inside or near the field of view of the scanner, using real time image guidance for targeting biopsies to specific lesions in the prostate. MRI tests have been performed to prove the feasibility of this concept and a one DOF proof-of-concept test rig implementing closed loop position control has been tested and is presented here. A first prototype of the slave manipulator has been designed and manufactured incorporating this new technology.

We performed a prospective, randomised controlled trial of unicompartmental knee arthroplasty comparing the performance of the Acrobot system with conventional surgery. A total of 27 patients (28 knees) awaiting unicompartmental knee arthroplasty were randomly allocated to have the operation performed conventionally or with the assistance of the Acrobot. The primary outcome measurement was the angle of tibiofemoral alignment in the coronal plane, measured by CT. Other secondary parameters were evaluated and are reported. All of the Acrobot group had tibiofemoral alignment in the coronal plane within 2° of the planned position, while only 40% of the conventional group achieved this level of accuracy. While the operations took longer, no adverse effects were noted, and there was a trend towards improvement in performance with increasing accuracy based on the Western Ontario and McMaster Universities Osteoarthritis Index and American Knee Society scores at six weeks and three months. The Acrobot device allows the surgeon to reproduce a pre-operative plan more reliably than is possible using conventional techniques which may have clinical advantages.

A generic framework for a computer-assisted system for both soft tissue endoscopic surgery and surgical training is being researched and developed. The concept demonstrator is a specific system for transurethral prostatic resection (TURF). The main novelty of the research is that it is not confined to an in vitro trainer system. An in vivo monitoring version of the system, for use in the operating theater, is also being researched. This paper presents the framework's structure and design using the Unified Modeling Language. It also discusses and justifies the underlying information technologies chosen to implement this approach. Object-oriented concepts and well-proven mathematical tools have been adopted as the foundation of this research and development. The rationale for having chosen such tools is presented. The objectives are to arrive at a system which is modular, general, and reusable.

A brief introduction is given to the definitions and history of surgical robotics. The capabilities and merits of surgical robots are then contrasted with the related field of computer assisted surgery. A classification is then given of the various types of robot system currently being investigated internationally, together with a number of examples of different applications in both soft-tissue and orthopaedic surgery. The paper finishes with a discussion of the main difficulties facing robotic surgery and a prediction of future progress.

Of 14 patients taking tetrahydroaminoacridine (THA) for the trial treatment of Alzheimer's disease, five developed mildly abnormal liver function tests. Four asymptomatic patients with persistently abnormal serum transaminase levels underwent liver biopsy, in order to determine the nature of the hepatic lesions. One subject had granulomatous hepatitis while three showed focal, predominantly centrilobular, liver cell necrosis and mild fatty change. One of the latter showed both tissue and peripheral blood eosinophilia. The liver function tests of the fifth patient, who was symptomatic, became normal after reduction of the dose of THA so he did not undergo biopsy. These findings suggest that the pathogenic mechanisms for THA-induced liver injury are heterogeneous ranging from hypersensitivity reactions to direct injury, and including combinations of the two. Patients receiving THA for treatment of Alzheimer's disease need regular monitoring of liver function.

As men age, their prostates can enlarge, causing urinary difficulty. Surgery to correct this [transurethral resection of the prostate (TURP)] is a skilled and time-consuming operation requiring many repetitive motions of a cutter. A robot has been developed to perform these motions, relieving the surgeon of much of the burden of surgery. This robot has been tried both in the laboratory and later on human subjects and has proved itself capable of performing prostate resection. The Probot system consists of on-line imaging and three-dimensional prostate model construction, an appropriate surgeon-computer interface, a counterbalanced mounting frame and a computer controlled robot.

Objective To compare the volumes and dimensions of the prostate gland as measured by transrectal and transurethral ultrasonography (TRUS and TUUS) and to study the prostatic changes that occur in the presence of an urethral instrument. Patients and methods Twenty men (mean age 71 years, range 43-85) with symptoms of prostatic enlargement underwent TRUS and the dimensions and volumes of their prostates were obtained by the dimensional method and by step planimetry. Within 24 h, all the men were examined cystoscopically under sedoanalgesia and underwent TUUS. Their prostatic volumes and dimensions were again measured by the dimensional method and by step planimetry. Step planimetry was carried out using a specially designed indexer firmly attached to the examination couch or operating table. All the static images and planimetry slices were video recorded for later computer enhancement and to study the three-dimensional changes occurring in the prostate. The volumes and dimensions obtained by TRUS and TUUS were compared. Results Volumes obtained by transurethral step planimetry were 22% greater than those from transrectal planimetry. Although there was a good correlation (r=0.984) between transurethral planimetry and the volumes derived using the transurethral dimensions with the prolate ellipsoid formula, the latter produced values 17% and 25% lower by the transurethral and transrectal routes, respectively. These volume estimates varied widely, indicating that the simple addition of a constant to the prolate ellipsoid formula would not correct the volume. Three-dimensional changes of the prostate occurred with TRUS and TUUS ; with TUUS, the craniocaudal and anteroposterior diameters were significantly larger (by 7% and 18%, respectively) while the transverse diameter was smaller by 20%. Conclusion The estimated volumes and dimensions of the prostate differed when measured by TRUS and TUUS and three-dimensional changes in the prostate occurred in the presence of an urethral instrument.

Plasma cortisol and 11-deoxycortisol were measured in 30 depressed patients and 110 normal volunteers before and after a 1.0 mg dexamethasone suppression test (DST). Post-dexamethasone plasma cortisol, 11-deoxycortisol and the cortisol/11-deoxycortisol ratio were significantly higher in the depressives compared to the controls, even when age and sex were taken into account. Pre-dexamethasone plasma cortisol, post-dexamethasone cortisol, 11-deoxycortisol and their ratio were significantly higher in the cortisol nonsuppressors than in the suppressors. The measurement of post-dexamethasone 11-deoxycortisol and the ratio did not differentiate between endogenous and reactive depression. Using the normative data, we explored several methods for determining a criterion value to define abnormal post-dexamethasone plasma 11-deoxycortisol and the cortisol/11-deoxycortisol ratio in depressed patients. All showed poor sensitivity and a low positive predictive value for depression. The measurement of 11-deoxycortisol thus does not enhance the clinical utility of the DST.

Levels of soluble interleukin-2 receptor (sol-IL-2R) in the bronchoalveolar lavage fluid (BALF) of pigeon breeders with hypersensitivity pneumonitis were compared with BALF levels in asymptomatic pigeon breeders who had been exposed to pigeon allergens for an equivalent length of time. No mean difference in sol-IL-2R levels was detected when these levels were expressed per milliliter BALF, epithelial lining fluid, or per T-lymphocyte. In sarcoidosis, the availability of sol-IL-2R per T cell was significantly higher for the group with inactive sarcoidosis compared with the group with active sarcoidosis. The results do not support the hypothesis that down regulation, in subjects exposed to allergens causing hypersensitivity pneumonitis, is a function of cell-free sol-IL-2R levels in BALF. In the dynamic situation, however, the hypothesis appears tenable.

The paper reviews articles in the field of research in medical education specifically dealing with the factors involved in the choice of Psychiatry as a medical specialty and describes three studies conducted in Melbourne. These studies focus on the relevance of personality factors in the psychiatrist's choice of a career. While they confirm other work in this field, it is felt that the emphasis should no longer be placed on single factors. Future investigations should be multifactorial in design and analysis to highlight the combination of factors underlying such choices.

(1975). Plasma Nortriptyline and Clinical Response. Australian and New Zealand Journal of Psychiatry: Vol. 9, No. 4, pp. 249-253.

A double blind comparative study of amitriptyline and a new reversible MAO A inhibitor R011-1163 was conducted in 25 depressed inpatients over 4 weeks. Response to treatment was assessed with the Hamilton depression rating scale, the Carroll depression self rating scale and the Visual analogue scale. Both drugs produced significant changes in depressive symptomatology (P less than 0.01, MANOVA) and there were no statistically significant differences between drugs (P greater than 0.05 MANOVA). Side effects were of mild to moderate severity with dry mouth the most commonly reported side effect of amitriptyline and vague, generalised headache in patients, treated with R011-1163.

Changes in immunological measurements thought to be important in the mechanism of immunotherapy for hay fever were related to objective measurements of treatment outcome. Antigen-specific IgE and IgG, and T suppressor cell status, using monoclonal antibodies and a specific functional assay, were measured before and after immunotherapy. Treatment outcome was assessed using nasal and conjunctival challenge tests. Seventeen subjects received immunotherapy for 6 months. Nine showed a decrease in nasal and/or conjunctival sensitivity, compared with 2 of 13 control subjects (P less than 0.05). Subjects responding to immunotherapy had a significantly higher post treatment IgE level and a higher pre- and post-treatment IgG level than non-responders and controls. Immunotherapy had no effect on suppressor cell status.

Summary Histamine-induced suppressor cell function was measured in a group of twenty-five hay fever suffers and sixteen non-atopic controls. No difference was found in the suppression index between sufferers and controls. There was, however, a significant relationship between the suppression index and nasal sensitivity to grass pollen, whether measured pre- or post-season, but no correlation between specific or total IgE levels and the suppression index. Histamine-induced suppressor cell function may influence pollen sensitivity in the most sensitive subjects, but not via an effect on IgE production.

Fifty-three patients suffering from depressive illness were classified as 'responders' or 'non-responders' on the basis of an "amelioration score" of the Hamilton Rating Scale for depression after six weeks treatment with nortriptyline hydrochloride at 150 mgs. daily. A multivariate analysis of variance was performed on the four psychological rating scale scores used, to determine whether rating scales could predict treatment response to tricyclis antidepressants was found to be at 75% probability.ic anti-depressants was found to be at 757. probability.ic antidepressants. There was a significant difference between the two groups after adjustment for age. Subjects were then classified as 'non-responders' and 'responders' on the basis of their discriminant scores. The prediction of response to tricycl

Moclobemide is a reversible, short-acting monoamine oxidase inhibitor (MAO1), specific for MAO A. To study moclobemide effects on the tyramine pressor response, we gave 12 depressed patients (2 males, 10 females; mean age 47, SD 11 years) an i.v. tyramine test after 7 days drug free. The mean (+/- SD) tyramine dose to raise systolic blood pressure 30 mmHg was 5.6 +/- 2.5 mg. Repeat tyramine testing after 2 weeks of treatment with moclobemide (280 +/- 90 mg/d) showed the tyramine dose required was reduced to 2.5 +/- 1.6 mg (n = 8). The mean (+/- SD) increase in sensitivity to tyramine was 2.9 +/- 1.8. Four patients did not have repeated tyramine tests as testing was discontinued because of tyramine-induced cardiac arrhythmias. Moclobemide seems an effective antidepressant with less tyramine sensitivity than MAOIs in current use.

Cet article presente une etude de faisabilite concernant l'assistance d'un robot lors d'une intervention chirurgicale telle que la prostatectomie. L'instrument tranchant est le WELSA et il est adapte sur un robot 6 axis Puma Unimate. Le robot peut se positionner tres precisement sans endommager les tissus adjacents et peut couper plus rapidement qu'un chirurgien, le tout sans se fatiguer

— Two studies of zimeldine in depressive illness are reported, one a double-blind, placebo-controlled trial, the other an open evaluation. In both studies, zimeldine was shown to have antidepressant properties. No simple relationship between plasma zimeldine or norzimeldine and clinical effect was demonstrated in eight patients treated for 6 weeks. Minor changes in electrocardiographic parameters were noted in some zimeldine patients. Side-effects attributable to zimeldine treatment were generally of mild to moderate severity and the drug was well tolerated. During the studies, one patient overdosed on zimeldine (5.2 g) and, although plasma concentrations were excessive, minimum side-effects were recorded. Two cases of suspected adverse drug reactions with zimeldine are described.

Comparisons were made between the overall scores on the Beck, Hamilton, Zung and a visual analogue rating scale in a group of depressed patients. The comparisons were made initially and at one, two and three weeks. Significant correlations between the global scores were found on these depression scales. The value of these scales in clinical research studies in depression is discussed with special mention of the value of the visual analogue scale.

synopsisThe daily excretion of adenosine 3′5′ cyclic monophosphate (c-AMP) in a group of 19 patients with a severe depressive illness was found to be significantly decreased when compared with that from a group of euthymic patients being treated for other disorders in the same ward. The daily excretion of the depressed patients increased during the period of treatment and recovery from the illness. Treatment with a tricyclic antidepressant caused a greater increase than electroconvulsive treatment (ECT). There was no difference between the mean plasma c-AMP concentration of the depressed and euthymic groups. The mean CSF c-AMP concentration was not different from the mean plasma c-AMP concentration in 12 patients with severe depression. There was no direct correlation between the CSF and plasma concentrations within patients. It was concluded that there may be a reversible disturbance in the renal metabolism of c-AMP in patients with severe depression.

Summary Two cases are described of severe Mycoplasma pneumoniae infection in whom cross-reacting antibodies developed to a glycopeptide antigen of Micropolyspora faeni. The antibodies were predominantly IgG, although some IgM was detected. Precipitin responses to M. faeni were detected for 4 months after the initial illness in one case, and 1 month in the second case. The cross-reacting antibodies were closely related to the antibodies responsible for the complement fixation reaction to M. pneumoniae. It is suggested that a common potysaccharide antigen may exist on the surface membranes of M. pneumoniae and M. faeni. Initial studies of the frequency of the development of cross-reacting antibodies in M. pneumoniae infection suggest it is uncommon. Atypical cases of farmer's lung should be investigated to exclude M. pneumoniae infection.

The relation between plasma-nortripty-line levels and clinical response has been examined in thirty-two patients with depressive illness on an oral dose of 150 mg. nortriptyline daily. There was no significant correlation between the plasma level and clinical response at 4 or 6 weeks. The patients with a significant clinical response at 4 weeks (59%) and at 6 weeks (79%) had similar plasma-nortriptyline levels to those patients who did not respond. The results show that on a fixed oral dose of 150 mg. per day, it is not possible to predict the clinical response from the plasma-nortriptyline level. However, the clinical response seen in most patients on this dose indicates that it is a suitable daily dose for the initial treatment of depressive illness.

Twelve pairs of severely depressed patients, matched for age, sex, and severity of symptoms were treated with either electroconvulsive treatment or L-tryptophan for three weeks in a sequential trial. Contrary to a previous report, no evidence was found that L-tryptophan has antidepressant properties. The implications of the findings are discussed.

Fifty patients with severe depression were separated into two groups by the responses of their plasma 11-hydroxycorticosteriod levels to a midnight dose of 2 mg. of dexamethasone. Clinical and questionary comparisons were made between the two groups of patients, who were similar as regards age, sex, and length of symptoms before admission to hospital. No differences were found between the groups of severely ill patients as regards the severity of their depression and anxiety assessed by questionary. Nevertheless, agitation was significantly greater in the patients whose corticosteroid levels were not suppressed by dexamethasone and adverse childhood experiences in those whose levels were suppressed.

Use of the midnight dexamethasone suppression test showed that the plasma 11-hydroxycorticosteroid (11-O.H.C.S.) level did not undergo its normal reduction in 14 out of 27 patients with severe depression. Resistance to dexamethasone suppression correlated with the clinical rating of the severity of depression, while recovery from depression was associated with return of normal responsiveness to dexamethasone. The explanation of these findings is unknown.

One hundred healthy, non-depressed volunteers were given a standard dexamethasone suppression test (DST) to determine the appropriate criterion values of plasma cortisol to define suppression or nonsuppression. By radioimmunoassay (RIA) of cortisol, the criterion value for 5% nonsuppression was plasma cortisol greater than 187 nmol/l, and for suppression less than 153 nmol/l, with an indeterminate range between these values. Use of the widely accepted pre-determined criterion value of 138 nmol/l gave a significantly greater frequency of nonsuppression. Values of cortisol measured by two RIAs in a subset of 43 volunteers were not equivalent. With the experimentally determined criterion value, no significant differences between nonsuppressors and suppressors were found for any measured physical or psychological parameters. Women taking oral contraceptives had significantly higher plasma cortisol pre-dexamethasone and post-dexamethasone. Their exclusion did not alter the calculated criterion value for the remainder, but their separately estimated criterion value was significantly higher. Caution should be exercised when classifying the DST status of women on oral contraceptives, particularly when values are at the lower end of the nonsuppressor range. Determination of a separate normal range for them may be warranted.

Ten patients who suffered from a primary depressive illness were treated with a new antidepressant drug butriptyline (150 mg/day). Six of the patients showed marked clinical improvement, as judged by depression rating scores, at the end of 22 days of treatment. No simple relationship was found between clinical response and plasma butriptyline concentration. Butriptyline is an effective antidepressant agent, well tolerated and with few side effects.

Cigarette smoking was found to have no effect on the steady-state plasma levels of nortriptyline in a group of 22 smokers and 31 nonsmokers. Smokers achieved a mean steady-state nortriptyline concentration of 191.2 +/- 141.3 ng/ml; nonsmokers had a level of 169.3 +/- 92.4 ng/ml. Age, sex, and number of cigarettes smoked had no effect on the plasma concentrations achieved.

The helper/suppressor T cell ratio, as defined by monoclonal antibodies, was significantly higher in hay fever sufferers compared with controls (P less than 0.05), but only during or shortly after the pollen season. This was due to a reduction in the suppressor subset, which returned to control values in the winter. There was no significant difference in the non-specific concanavalin A-induced suppressor cell function compared with controls. The mean summer value was significantly lower than the winter value (P less than 0.05), but we cannot be sure that this was not the result of changes in laboratory conditions. No relationship was found between T cell subsets or suppressor cell function and total or specific IgE levels, or between T cell subsets and suppressor cell function. Our findings suggest that in hay fever, reduction in suppressor cell numbers and function is a secondary phenomenon.

90 patients with a primary depressive illness, admitted consecutively to one psychiatric ward were studied. All patients had the dexamethasone suppression test (DST) done before initial treatment. First treatment response was correlated with the DST results. The non-suppressors, as a group, improved with treatment better than the suppressors. However, unlike in previous studies, no relationship was found between non-suppression and poor response to antidepressant medication.

The relationship of plasma nortriptyline levels to the clinical response of 80 depressed patients was studied. Plasma nortriptyline levels were estimated 4 weeks after commencing treatment. Percentage change in the Hamilton Depression Rating Scale was used to measure clinical response. There was no simple relationship between these two measures. Twelve of the 80 patients were studied further. Clinical response to variations of plasma nortriptyline levels was studied. Calculation of regression coefficients showed a positive relationship between clinical change and plasma nortriptyline levels in all. Comparison of the regression coefficients showed that they differed significantly among themselves and were not related to age or sex.

SynopsisIn a 5-week study of 22 depressed patients treated with nortriptyline, significant changes in plasma levels, both elevated and reduced, were deliberately produced in the third and fourth weeks of each patient's treatment. Correlation of plasma nortriptyline levels and changes in the severity of depression, as measured by the Hamilton Depression Scale, showed no significant relationships. The implications of the study are discussed.

Pairs of depressed patients were matched for age, sex, and severity of depression, and treated for four weeks with nortriptyline so that plasma levels of below 49 ng/ml and above 140 ng/ml were, obtained. Comparisons of pairs of patients as regards to improvement of depression, using a sequential skew restricted design, suggested that it was unlikely that a significant difference between the two treatment regimes would be detected.

Ten patients suffering from primary depressive illness were treated with 150 mg/d of dothiepin for 4 weeks. Blood and plasma concentrations of dothiepin and two metabolites, dothiepin S-oxide and northiaden were measured by gas chromatography-mass spectrometry. Severity of depression was assessed using the Hamilton Depression Rating Scale. No significant correlation was found between amelioration score or percentage change and either blood or plasma concentrations of dothiepin, its metabolites or total drug and metabolite concentrations at week 4.

Summary A number of food additives and industrial chemicals, responsible for inducing symptoms of intolerance in some individuals, have been studied in tests measuring platelet activation by noradrenaline. All the investigated agents inhibited platelet aggregation and this was associated with inhibition of the cyclo-oxygenase-thromboxane pathway. Suboptimal inhibitory concentrations of the agents studied had additive inhibitory effects on platelet aggregation when they were tested in pairs, or when tested with salicylate or aspirin. The results support the theory that some food additives and industrial chemicals induce intolerance because of their aspirin-like properties.