An efficient one-flask synthesis of N-confused tetraphenylporphyrin.

[formula: see text] N-Confused meso-substituted porphyrin is a porphyrin isomer previously available from one-flask porphyrin syntheses as a low-yield byproduct (< 7.5%). We have found that methanesulfonic acid catalyzed condensation of pyrrole and benzaldehyde followed by DDQ oxidation provides N-confused tetraphenylporphyrin (NC-TPP) in up to 39% yield in analytical scale experiments. Preparative synthesis provided an isolated yield of 35% (800 mg). This represents a > 5-fold yield improvement and makes significant quantities of NC-TPP readily available.

A survey of acid catalysts for use in two-step, one-flask syntheses of meso-substituted porphyrinic macrocycles.

[reaction: see text] Diverse Lewis acids and Bronsted acids were examined in the two-step, one-flask synthesis of meso-tetraphenylporphyrin, N-confused tetraphenylporphyrin, and tetraphenylsapphyrin. The scope of acid catalysis was found to be very broad, with 35 of 45 acids providing TPP in yields ranging from 5% to 58%. NC-TPP was also widely observed in yields of 1-40%, and TPS was infrequently observed in yields of <1%. Additionally, conditions were found for direct preparation of magnesium TPP and copper TPP.

Patient knowledge of upper respiratory infections: implications for antibiotic expectations and unnecessary utilization.

BACKGROUND: Upper respiratory infections (URIs) account for many of the visits in primary care and are commonly treated with ineffective antibiotic therapy. The purpose of this study was to examine patient beliefs in the effectiveness of antibiotics and the likelihood of seeking care for normal presentations of URIs. METHODS: We conducted a survey of 961 adults (> or = 18 years of age) from an undifferentiated patient population in a university-based family practice residency clinic in metropolitan Kentucky, a private internal medicine practice in nonmetropolitan Kentucky, and, in metropolitan Louisiana, an emergency department and a convenience sample from the community. RESULTS: Seventy-two percent of the sample reported that they would seek care with a condition of 5 days' duration with cough, sore throat, and discolored nasal discharge. Sixty-one percent of the sample expressed their belief that antibiotics are effective for a condition of 5 days' duration with cough, sore throat, and clear nasal discharge; 79% said that they believed antibiotics are effective when there is discolored discharge (P = .0001). Medicaid recipients were most likely to seek care across the symptom complexes. Higher education was related to a decreased belief in the effectiveness of antibiotics for the scenario with clear discharge (P .001), but to an increased belief in the effectiveness of antibiotics in the scenario with discolored discharge (P = .003). The strongest predictor of both likelihood of utilization and belief in effectiveness of antibiotics was usual use of antibiotics for the URI symptom complexes. CONCLUSIONS: Patients lack understanding of the normal presentation of a URI and the effectiveness of antibiotics as a treatment. A confusion about the meaning of discolored nasal discharge is particularly evident, and past antibiotic use may contribute to inappropriate utilization and expectations for antibiotics.

Framing tropical disease in London: Patrick Manson, Filaria perstans, and the Uganda sleeping sickness epidemic, 1891-1902.

Much of the historical literature on tropical medicine represents the periphery as the chief site for the production of western knowledge about disease in the British empire. This study on the Filaria perstans-sleeping sickness hypothesis revises this perspective by showing how the imperial metropole functioned as a culture space for the construction of knowledge about the empire. Beginning in 1891, Patrick Manson used the publicity resources of London to generate a rhetorical imperative for the confirmation of his hypothesis without ever leaving Britain. Later, while he was medical adviser to the imperial state, the 1900 sleeping sickness epidemic in Uganda presented Manson with a unique opportunity to determine the validity of his hypothesis. By exaggerating the possible spread of the epidemic privately among Foreign Office personnel and publicly in the medical press, he succeeded in mobilizing the first Royal Society sleeping sickness research expedition to Africa in 1902. While this expedition ultimately disproved Manson's hypothesis, this outcome ironically created the very conditions for the identification of the actual causal agent (Trypanosoma gambiense) and its vector (tsetse fly) by Aldo Castellani and David Bruce respectively.

Cesarean hysterectomy: a twenty-five-year review.

This article analyzes cesarean hysterectomies performed at Louisville General Hospital on clinic patients for the 25 year period 1953 through 1977. During this time there were 63,259 deliveries, of which 2417 were cesarean sections and 149 were cesarean hysterectomies. Twenty-six of the latter were classified as emergency operations done for urgent medical indications; in the remaining 123 patients the indications were elective to some degree. Operative and postoperative complications and morbidity are discussed, and changing trends regarding the place of cesarean hysterectomy in obstetrics over the years are evaluated.

Tubal sterilization in an indigent population. Report of fourteen years' experience.

PIP: Clinical data on 790 women who underwent tubal sterilization over a 14 year period (1955-1968) were analyzed. Incidence was 2.1 percent of all deliveries. Median age was 29, median parity was seven. Indications were multiparity, previous caesarean section and socioeconomic reasons. All patients were at high risk of subsequent gynecologic disease. Most operations were performed during the puerpurium and a number were done at the time of caesarean section. Standard and modified Pomeroy and Madlener techniques were used as well as Uchida, Irving and some atypical techniques. Among the 489 patients who were followed longer than 3 1/2 years there were 10 failures of the operation, most of them following Madlener type operations, and 178 patients underwent some form of gynecologic operative procedure, 63 of whom required total hysterectomy. Fifteen patients developed carcinoma of the cervix, two died. This study as well as data reviewed in the literature are used to support hysterectomy as the method of choice for sterilization rather than caesarean section and tubal ligation in patients who are at high risk of subsequent gynecologic disease, in general, and of carcinoma of the cervix, in particular, and who require abdominal delivery.^ieng