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Candida albicans lung abscess is a rare entity. We present a case in a patient who suffered from Hodgkin's disease and was receiving immunosuppressive therapy. The patient responded to treatment with 5-fluorocytosine. [ABSTRACT FROM PUBLISHER]

, , 703-709. A study of 36 patients was undertaken to evaluate the role of raised blood and CSF ammonia in the production of central nervous manifestations in chronic obstructive pulmonary disease (COPD) with special reference to congestive right ventricular failure (CRVF). The patient material comprised five categories: 11 controls, seven mentally alert patients with COPD, eight with COPD and CRVF, four with primary cardiac disease and CRVF, and eight with cirrhosis of the liver. Each patient was examined clinically especially for neurological manifestations such as asterixis, confusion, and drowsiness. Each patient also had measurement of venous pressure, bromsulphthalein, ECG, chest radiograph, and spirometry. The mean values of CSF-glutamine, CSF and arterial blood-ammonia, pH, , and for each group were compared and statistically analysed. The results indicate that no correlation existed between central nervous manifestations acid-base balance or . Ammonia-glutamine levels were found to relate to hepatic congestion whether it was caused by primary cardiac or pulmonary heart disease. [ABSTRACT FROM PUBLISHER]

Pronounced tonsilar hypertrophy was found in two obese patients suffering from hypersomnolence, periodic attacks of apnea and disturbing snoring at night. Both patients underwent tonsillectomy. Immediately after the operation the hypersomnolence disappeared, the breathing became normal, and the disturbing snoring at night ceased. Follow-up over a period of three years did not reveal any recurrence of these symptoms, even though the patients had not lost any weight during this period. [ABSTRACT FROM AUTHOR]

The combination of systemic lupus erythematosus, Sjögren's disease and severe diffuse glomerular nephritis has only rarely been reported. A 14-year-old girl is described with lupus nephritis in whom co-existent clinical and histological features of Sjögren's syndrome were found. These include bilateral parotid enlargement, xerostomia, increased serum amylase, reduced salivary secretion and lymphocyte infiltration of both salivary glands and kidneys. The co-existence of systemic lupus erythematosus with Sjögren's syndrome is discussed together with a consideration of pathogenesis. [ABSTRACT FROM PUBLISHER]

The reported incidence of skin changes in ulcerative colitis varies. They usually occurred during the active stage of the disease, and less frequently they may precede a relapse of the colitis. Instances where the cutaneous manifestations preceded the occurrence of the disease have been reported but very rarely. We are reporting three cases where the skin lesions apparently preceded the gastrointestinal symptoms by 4, 13 and 23 months. It is, therefore, of interest to report three cases with ulcerative colitis in which the skin symptoms apparently preceded the gastrointestinal by 4, 13, and 23 months. [ABSTRACT FROM AUTHOR]

The extra-intestinal complications of inflammatory bowel disease (IBD) usually appear in patients with long standing active intestinal disease. A patient with Crohn's colitis is described, in whom extra-intestinal symptoms, some of which were unusual, preceded the definitive diagnosis by 9 years. [ABSTRACT FROM PUBLISHER]

This cross-cultural study was designed to compare the attitudes of physicians and nurses toward physician-nurse collaboration in the United States, Israel, Italy and Mexico. Total participants were 2522 physicians and nurses who completed the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration (15 Likert-type items, (Hojat et al., Evaluation and the Health Professions 22 (1999a) 208; Nursing Research 50 (2001) 123). They were compared on the total scores and four factors of the Jefferson Scale (shared education and team work, caring as opposed to curing, nurses, autonomy, physicians' dominance). Results showed inter- and intra-cultural similarities and differences among the study groups providing support for the social role theory (Hardy and Conway, Role Theory: Perspectives for Health Professionals, Appelton-Century-Crofts, New York, 1978) and the principle of least interest (Waller and Hill, The Family: A Dynamic Interpretation, Dryden, New York, 1951) in inter-professional relationships. Implications for promoting physician-nurse education and inter-professional collaboration are discussed. [ABSTRACT FROM AUTHOR]

Background: Many patients encounter problems in the first weeks after discharge from hospital. Telephone follow-up (TFU) is reputed to be a good tool for providing medical advice, managing symptoms, identifying complications and giving reassurance after discharge. Therefore, we aimed to study whether tight TFU would increase patient satisfaction, improve compliance and reduce re-hospitalization rate., Methods: The study population included 400 patients, hospitalized in an Internal Medicine Department, randomly divided into two groups; TFU and control. TFU took place one week and one month after discharge. Three months later, members of both groups were contacted by telephone., Results: Satisfaction was increased in the TFU group compared with control group by 6-12% in most fields. Notably, 87% of patients in the TFU group indicated that earlier telephone contact increased their satisfaction. In addition, 78.2% of the patients in the control group reported that they performed the tests that were recommended at discharge and 86.5% reported that they received explanations regarding their medications. In the TFU group, this percentage was increased significantly to 86.9% (P=0.02) and 96.7% (P<0.0001), respectively. As to treatment results, 93% of the patients in the TFU group as compared to 84% in the control group reported improvement in their symptoms. A non-significant trend towards fewer readmission was observed in the TFU group (26% vs. 35% P=0.062)., Conclusions: TFU can improve medical treatment by increasing satisfaction and compliance. A trend towards decreased readmission rates was observed, which may lead to a reduction in the burden on the medical system.

In the light of the growing interest in professionalism and non-cognitive attributes in medical education, a focus group (FG) methodology was used to achieve a database of desired physician attributes. Ten FGs, consisting of medical faculty, service heads, residents, general practitioners, students and patients, took place, producing 169 desired attributes; further attributes were derived from a literature search, and the Mission and Vision Statement (MVS) of the authors' medical faculty. A total of 254 separate attributes finally emerged, after a process of combining and collapsing similar items. Attributes appearing with the highest frequency were: honest, empathic, patient, capacity to be an attentive listener, understanding, able to work in a team, intellectual curiosity, egalitarian. The high number of attributes generated in this study provides an indication of what the profession is wanting of itself. This database is multipotential and preliminary in nature and requires further processing before achieving full relevance.

Medical professionalism includes expert knowledge, self-regulation and fiduciary responsibility to place the needs of patients ahead of the self-interest of physicians. In teaching medical professionalism to our medical students only the behavioural elements are dealt with. One of the challenges facing medical educators today is how medical professionalism can be taught. At the authors' faculty of medicine brief videotapes (trigger films) of amateur actor physician-patient encounters in various clinical settings (taken from genuine encounters) are used as a stimulus for discussion and instruction of medical professionalism. A series of 16 trigger films has been produced that raise many medical professional issues. The films and the issues raised are described in brief. These trigger films are viewed by small groups of medical students together with a physician tutor facilitator at various stages of their studies. It is noteworthy how fast the transition occurs in students, from observing the trigger films in their pre-clinical stage as a client, to observing them in their clinical years from the angle of a provider; from identifying with the patient's concerns to identifying with the physicians' behaviour; from being a critical person to becoming a person who accepts the rules and regulations of the guild. Most probably the power of the teaching of ethical and professional rules is overruled by the power of everyday clinical experience during their clinical clerkships. It is planned to run a series of trigger film sessions with senior and junior physicians of the major clerkships, in an attempt to promote an institutional environment/atmosphere/culture of professional behaviour.

The generation of high-frequency spike bursts ("complex spikes"), either spontaneously or in response to depolarizing stimuli applied to the soma, is a notable feature in intracellular recordings from hippocampal CA1 pyramidal cells (PCs) in vivo. There is compelling evidence that the bursts are intrinsically generated by summation of large spike afterdepolarizations (ADPs). Using intracellular recordings in adult rat hippocampal slices, we show that intrinsic burst-firing in CA1 PCs is strongly dependent on the extracellular concentration of Ca(2+) ([Ca(2+)](o)). Thus, lowering [Ca(2+)](o) (by equimolar substitution with Mn(2+) or Mg(2+)) induced intrinsic bursting in nonbursters, whereas raising [Ca(2+)](o) suppressed intrinsic bursting in native bursters. The induction of intrinsic bursting by low [Ca(2+)](o) was associated with enlargement of the spike ADP. Low [Ca(2+)](o)-induced intrinsic bursts and their underlying ADPs were suppressed by drugs that reduce the persistent Na(+) current (I(NaP)), indicating that this current mediates the slow burst depolarization. Blocking Ca(2+)-activated K(+) currents with extracellular Ni(2+) or intracellular chelation of Ca(2+) did not induce intrinsic bursting. This and other evidence suggest that lowering [Ca(2+)](o) may induce intrinsic bursting by augmenting I(NaP). Because repetitive neuronal activity in the hippocampus is associated with marked decreases in [Ca(2+)](o), the regulation of intrinsic bursting by extracellular Ca(2+) may provide a mechanism for preferential recruitment of this firing mode during certain forms of hippocampal activation.

Trigger films or trigger videos that depict patient-physician encounters can be used to provoke reflection, stimulate discussion, help learners confront their feelings and give learners practice in responding to challenges. For more than 20 years at the B. Rappaport Faculty of Medicine, the authors have used trigger films to teach/demonstrate the doctor-patient relationship, medical ethics, diagnostic thinking, professional behavior, and the application of the principles of the Israeli Patient Bill of Rights, and have found them to be an excellent tool for provoking active participation in small-group discussions. The authors describe how they have effectively produced and used trigger films in an Introduction to Clinical Medicine course. They highly recommend the "homemade" production of trigger films.

The Rappaport Faculty of Medicine of the Technion established an Ethics in Medicine Forum in March 1993. The main objective of the forum was to increase awareness of the philosophical principles of ethics in medicine, as defined and developed in the western world during the last three decades. The multidisciplinary forum meets once a month during the academic year. Our 7 years experience is documented. Of the 45 meetings, 30 were clinically oriented and of these more than half were based on cases. Only 15 meetings were purely theoretical. Our principal assumption was that any and every topic could be discussed, including those covered by the law. We explored how well western philosophical principles and rules fit the Israeli picture. Many of the forum discussions related to the draft of the Patient's Bill of Rights, which came into effect on 12 May 1996. The role of the "legal" hospital ethics committees was compared to that of the "advisory" ethics committees whose members constituted a large share of our forum. The multicultural Israeli population and the practice of medicine therein raised many lively discussions. The principle of autonomy in the ultraorthodox and in the family setting was a highly controversial issue. The forum served as a workshop for examining traditional medical ethical principles, which we strongly feel needs to be amended in light of the 1996 Patient's Bill of Rights. From our 7 years experience with an Ethics in Medicine Forum we recommend that medical ethical deliberations focus on genuine medical cases.