Functional characterisation of letter-specific responses in time, space and current polarity using magnetoencephalography.

Recent neurophysiological evidence suggests that a hierarchical neural network of low-to-high level processing subserves written language comprehension. While a considerable amount of research has identified distinct regions and stages of processing, the relations between them and to this hierarchical model remain unclear. Magnetoencephalography (MEG) is a technique frequently employed in such investigations; however, no studies have sought to test whether the conventional method of reconstructing currents at the source of the magnetic field is best suited for such across-subject designs. The present study details the results of three MEG experiments addressing these issues. Neuronal populations supporting responses to low-level orthographic properties were housed posteriorly near the primary visual cortex. More anterior regions along the fusiform gyrus encoded higher-level processes and became active ~80ms later. A functional localiser of these early letter-specific responses was developed for the production of functional regions of interest in future studies. Previously established response components were successfully grouped based on proximity to the localiser, which characterised location, latency and functional sensitivity. Unconventional anatomically constrained signed minimum norm estimates of MEG data were most sensitive to the primary experimental manipulation, suggesting that the conventional unsigned unconstrained method is sub-optimal for studying written word processing.

Topical capsaicin in painful diabetic neuropathy. Effect on sensory function.

OBJECTIVE: To examine the effect of capsaicin on sensory function in painful diabetic neuropathy. RESEARCH DESIGN AND METHODS: We examined the effects of topical 0.075% capsaicin cream on thermal and vibration thresholds in 22 subjects with painful diabetic neuropathy who participated in a double-blind vehicle-controlled therapeutic trial. RESULTS: After 8 wk of use, there was no significant change in warm and vibration thresholds, but the cold threshold was significantly reduced by capsaicin and vehicle creams to an equal degree. In fewer subjects who used capsaicin cream in an open-label study, there was no significant effect on sensory thresholds after up to 32 wk of use. CONCLUSIONS: Although our results and those of others show no adverse effects of topical 0.075% capsaicin on human sensory function, even in subjects with preexisting neuropathic sensory impairment, the small number of subjects tested does not justify an inferential statement on safety. Further studies in more subjects are warranted to ensure the long-term safety of capsaicin for pain relief in humans.

Topical capsaicin in painful diabetic neuropathy. Controlled study with long-term follow-up.

OBJECTIVE: We conducted an 8-wk controlled study with topical 0.075% capsaicin in subjects with chronic severe painful diabetic neuropathy who were unresponsive or intolerant to conventional therapy. Capsaicin is an alkaloid found in capsicum peppers and produces desensitization to noxious thermal, chemical, and mechanical stimuli when applied topically. RESEARCH DESIGN AND METHODS: In 22 randomly assigned subjects, either capsaicin or vehicle cream was applied to painful areas 4 times/day. Pain measurements were recorded at baseline and at 2-wk intervals for 8 wk. RESULTS: Capsaicin treatment was more beneficial than vehicle treatment in the overall clinical improvement of pain status, as measured by physician's global evaluation (P = 0.038) and by a categorical pain severity scale (P = 0.057). Decrease in mean pain intensity by a visual analogue scale was 16% in capsaicin-treated and 4.1% in vehicle-treated subjects. Mean pain relief on visual analogue scale was 44.6 and 23.2%, respectively. In a follow-up open-label study, approximately 50% of subjects reported improved pain control or were cured, and 25% each were unchanged or worse. A burning sensation at the application site was noted by some subjects but both its magnitude and duration decreased with time. CONCLUSIONS: Results from this preliminary study suggest that topical 0.075% capsaicin may be of value in subjects with diabetic neuropathy and intractable pain.

Dissolution of renal calculi with dicloxacillin.

A patient with multiple left renal calculi and Staphylococcus epidermidis urinary tract infection is described. Subsequent treatment consisted of dicloxacillin which resulted in complete dissolution of all renal calculi. The rationale, supporting data, and potential therapeutic uses are reported.

Long-acting contraceptive agents: the influence of pharmaceutical formulation upon biological activity of esters of norethisterone.

17 beta-esters of norethisterone (17 alpha-ethynyl-17 beta-hydroxyestr-4-en-3-one) have been formulated as aqueous microcrystalline suspensions and oily solutions for administration to rats to assess the length of progestogenic activity. Results show that, for some of the esters, the rate-controlling step in prolonging activity is the rate of drug release from the injected formulation. For these esters, when formulated as suspensions, it is proposed that crystal size and form will have a critical effect upon duration of estrus suppression. The influence of crystal form has been demonstrated with the 4-(butoxy)phenylacetate ester for which two different crystal forms have been identified. The lower melting point, more soluble crystal form shows marked prolongation of action, whereas the other form is ineffective.

Long-acting contraceptive agents: the influence of physico-chemical properties of some esters of norethisterone upon the plasma levels of free norethisterone.

Four 17 beta-esters of norethisterone (17 alpha-ethynyl-17 beta-hydroxyestr-4-en-3-one), formulated both as oily solutions and aqueous suspensions, were administered intramuscularly to rabbits and free plasma levels measured for periods up to 9 weeks. For all formulations of the compounds, the disappearance of norethisterone following peak plasma levels obeyed first-order kinetics. Since different slope values were obtained for different formulations of the same compound, the values reflected the release rates of the esters from the formulations. Fusion data, partition coefficients and solubilities of the compounds in 2,2,4-trimethylpentane and water were obtained and these properties were related to the biological activity of the formulations. For oily solutions, the differences in plasma levels were ascribed to the different partition coefficients of the esters between the oil and tissue fluids. For suspensions, the different activity in relation to an oily solution of an ester was related to the strength of intermolecular forces in the crystal lattice and to the relative thermodynamic activity in the two formulations. The results demonstrate that microcrystalline suspensions do not always have a longer duration of activity than oily solutions of the same compound after intramuscular injection.

Wandering spleen.

The spleen is rather firmly attached in the left upper quadrant by five ligaments or peritoneal reflections. With congenital failure or acquired laxity of these attachments, the genital failure or acquired laxity of these attachments, the spleen acquires a true vascular pedicle and becomes mobile. This rare condition, called wandering spleen, makes the organ subject to the complication of torsion, which usually produces an acute abdominal emergency and requires immediate surgical removal. Symptomatic patients display a characteristic constellation of findings that strongly suggests the correct diagnosis and can definitively be ascertained by isotopic imaging specific for the spleen or by ultrasonography. Splenectomy should be performed for all cases of wandering spleen with significant symptoms. A conservative, nonoperative approach in asymptomatic patients is indicated to avoid any chance of postsplenectomy septicemia.

Evaluation of a tubeless pancreatic function test in patients with steatorrhoea in a district general hospital.

The Pancreolauryl Test (PLT), a tubeless pancreatic function test, has been evaluated in an unselected series of outpatients with steatorrhoea presenting to a district general hospital (DGH). This is the first study of the PLT in a DGH, involving an unselected series of patients and not those from secondary or tertiary referral hospitals. Health controls (n = 15) and patients with self-limiting diarrhoea (n = 8) had normal urinary excretion indices (greater than or equal to 30). Coeliac disease (n = 13) and small bowel bacterial overgrowth (n = 12) were the commonest causes of steatorrhoea and there were no false-positive results in these patients. The mean urinary excretion index in patients with untreated coeliac disease (mean index = 38%) was lower than in healthy controls (n = 15, mean index = 53%; P less than 0.05 greater than 0.02). No patient with proven pancreatic steatorrhoea had a normal PLT result, confirming the high negative predictive value found by others. Low results in patients with steatorrhoea following gastric surgery indicate poor mixing of food with pancreatic juices. The PLT proved to be a simple, inexpensive and noninvasive outpatient screening test suitable for use in a DGH to exclude a pancreatic origin of steatorrhoea.

Beliefs and behaviour in disease.

Isolated tribal communities depend on the resources available where they live and on knowledge to use them well, which is passed on by education and training in cultural skills. Anthropological studies have recorded the successful adaptations achieved in some societies. This paper discusses notions akin to those of contagion and infection as they are understood by people in a community in New Guinea. Do they show in these ideas the accurate observation and deduction apparent in their other adaptive achievements? The people have approved patterns for behaviour to maintain health and heal illness. Is the behaviour seen to be effective by them? It may not seem so to the outside medical observer but it is not rejected by the people, who must use it in coping self-reliantly with their circumstances. The question of prognosis is discussed from their point of view so as to show problems which they face in responding to opportunities of modern medical care and in judging the efficacy of treatment.

Clinical significance of hematuria in patients on anticoagulant therapy.

We evaluated 29 consecutive patients in whom gross or microscopic hematuria developed while they were on heparin or warfarin anticoagulant therapy. Patients who had bleeding as a result of anticoagulant overdosage and/or from an additional organ system(s) other than the urinary tract were excluded from this review. Significant pathological findings consisting of carcinoma, calculi, renal infarction, infection, benign prostatic hyperplasia and/or adult polycystic renal disease were identified in 17 patients. Insignificant or incidental pathological findings classified as posterior urethritis, simple renal cyst or renal scarring were noted in 6 patients. No pathological condition was found in the remaining 6 patients. We conclude that a thorough and appropriate evaluation of the urinary tract should be conducted in patients on anticoagulant therapy who have gross or microscopic hematuria, since a pathological lesion of variable clinical significance often is discovered.

Induction of labour with vaginal prostaglandin E2 pessaries.

Wax-based pessaries, each containing 3 mg of prostaglandin E2 (PGE2), were administered intravaginally for the induction of labour. The induction to delivery intervals were shorter than those in a control group induced by amniotomy and intravenous oxytocin. There was a remarkable reduction in the Caesarean section rate from 12 per cent in the control group to 2.4 per cent in the study group in primiparae, and from 8 per cent to 1.6 per cent in multiparae. Side effects associated with the PGE2 were rare, as were complications.

Minitracheotomy. A report of its use in intensive therapy.

Minitracheotomy is a simple percutaneous technique of tracheal cannulation using a small bore tube. It allows efficient tracheobronchial toilet while preserving glottic function. Examples of its use in the intensive therapy unit are described.

Preparation of outpatients for excretory urography: is bowel preparation with laxatives and dietary restrictions necessary?

OBJECTIVE: The purpose of this study was to determine whether routine bowel preparation with laxatives and dietary restrictions (liquid supper and fasting after midnight) are necessary for satisfactory visualization of the urinary system during excretory urography in outpatients. SUBJECTS AND METHODS: Two hundred and four consecutive patients who had excretory urography were randomly placed in one of four groups before the examination. Eleven patients were excluded from the study for various reasons. The remaining 193 were divided into four groups. Groups 1 (50 patients) and 2 (45 patients) had bowel cleansing; groups 3 (49 patients) and 4 (49 patients) did not. Groups 1 and 3 were allowed to eat; groups 2 and 4 were given a liquid supper and fasted beginning at midnight the night before the examination. Standard radiographs and tomograms were obtained. Upon completion of excretory urography, the radiographs were reviewed and graded by one radiologist, who did not know to which group each patient belonged. A detailed, anatomically based grading system was developed and used to grade the radiographs. The radiographs of the kidney were divided into upper, middle, and lower margins; images of the calices were divided into upper, middle, and lower segments; images of the renal pelvis were divided into central and medial margins; images of the ureter were divided into upper abdominal, lower abdominal, upper pelvic, and lower pelvic categories; and images of the bladder were divided into full and empty categories. A score of 1 was given to each section visualized. The right and left sides of the urinary system were scored separately but added together for statistical analyses; therefore, the highest total score possible was 28. RESULTS: In the ability to visualize the anatomic structures on excretory urograms, there was no statistically significant difference (p = .06) between images of patients who were allowed to eat (groups 1 and 3, 99 patients, mean score = 27.49 +/- 0.92) and images of patients who were given a liquid supper and then fasted from midnight the night before excretory urography was performed (groups 2 and 4, 94 patients, mean score = 27.16 +/- 1.45). Moreover, there was no statistically significant difference (p = .16) between those patients given laxatives before the examination (groups 1 and 2, 95 patients, mean score = 27.45 +/- 0.93) and those not given laxatives (groups 3 and 4, 98 patients, mean score = 27.20 +/- 1.43). CONCLUSION: Our results show that bowel preparation with laxatives and dietary restrictions do not improve visualization of the urinary tract on excretory urograms obtained in outpatients. We conclude that such preparation in this group of patients was unnecessary and that it need not be performed routinely.

Elevated serum prostate-specific antigen and pancreatic carcinoma.

We report a case of elevated serum prostate-specific antigen-like immunoreactivity in a man with a disseminated pancreatic carcinoma.