Impact of hydration and nutrition on personal performance in the clinical workplace.

As clinicians we sometimes fail to look after ourselves at work. We often do not drink enough during the day or miss lunch breaks while caring for patients, and this can be particularly evident during an all-day operating list when procedures are long and complex. Some operating theatre staff do not even eat breakfast regularly. Inadequate intake of fluids or nutrition can impair performance, lead to tiredness and headaches, and may compromise both our own health and the care we provide to patients. Other high-risk organisations, including aviation, have recognised that employees must look after themselves if they are to optimise their performance. In this review, we discuss the importance of adequate hydration and nutrition at work to raise awareness that this is essential if we are to provide the best care for our patients.

A useful UV spectroscopic method for the determination of the concentration of diethylenetriamine (DETA) in aqueous mineral flotation solutions.

An alternative method for the determination of the concentration of diethylenetriamine (DETA) in aqueous mineral flotation solutions is described. This method is based on the formation of a DETA-Ni(II)-sulphite complex, which shows a UV absorption maximum at 285 nm that varies linearly with the concentration of DETA throughout the 0-50 mg l(-1) DETA range. A high concentration of Ni(II) is used to offset the effect of any Cu(II) or Ni(II) ions that may already be present in the industrial plant solutions under analysis. The intensity of the absorbance maximum is dependent on the sulphite ion concentration, but this problem is overcome by measuring the absorbances when the test solutions are spiked with different concentrations of DETA and then extrapolating the absorbance versus DETA concentration plot to zero absorbance to obtain the original concentration of DETA in the test solutions.

Evaluation of a displacement assay with tamoxifen as prognostic indicator in breast-cancer patients with estrogen-receptor-positive tumors.

A displacement assay with tamoxifen, based on the relative binding affinity of tamoxifen and estradiol for the estrogen receptor (ER), was proposed in 1990 as prognostic indicator for breast-cancer patients. Validation of its predictive results in relation to the outcome of 73 patients with ER+ tumors is analyzed. ER, progesterone receptor (PgR) determinations and other conventional prognostic factors in relation to the displacement assay, were considered. Displacement assay results allowed ER+ tumors to be grouped as displaceable (D) or weakly displaceable (WD), with the implication that D tumors should respond better to tamoxifen (Tam) administration. Survival and disease-free interval curves showed highly significant differences between patients with ER+ D and ER+ WD tumors. For survival, including all tumor stages, 73.9% of patients were alive at 9 years after surgery in the group with D tumors and 37.0% in the group with WD tumors (p < 0.005); relative contribution of the different stages is analyzed. Addition of axillary-node number increased the prognostic significance of displacement categories for survival and disease-free interval. PgR determination as another ER functional expression failed to show significant differences for survival and disease-free interval between ER+ PgR+ and ER+ PgR- tumors. Thus, results from the displacement assay and from PgR determinations reflect 2 independent ER functional expressions. Displacement assay data appear as reliable prognostic indicators of breast-cancer outcome, and contribute to more appropriate treatment decisions in this pathology.

Intestinal capillariasis in New World monkeys.

Two cases of intestinal capillariasis have been identified at necropsy in a squirrel monkey and a capuchin monkey born and raised in captivity. The parasites are described as far as possible from the histopathological slides or intestinal contents, and their relationship to other intestinal capillarids, especially those of primates, is discussed.

Hemidiaphragmatic paralysis: an unusual complication of cervical spondylosis.

Clinical investigations of a patient having shortness of breath and a paretic left hemidiaphragm revealed compromise of the left C3-4 neural foramen and signs of spondylitic spinal cord compression at that level. After laminectomy, the patient's symptoms and radiologic evidence of hemidiaphragmatic paralysis resolved. This case illustrates the importance of evaluating patients with hemidiaphragmatic paralysis for cervical spondylosis and of evaluating patients with cervical spondylosis for phrenic nerve compromise.

Lumboatrial shunt: case report.

Hydrocephalus without ventriculomegaly and pseudotumor cerebri may present special problems in its treatment. Lumboperitoneal shunting, although frequently effective, is not successful in all cases. A lumbar subarachnoid to venous shunt is described as an alternative to lumboperitoneal shunting. A case illustrating its use is reported.

Delayed complication of Matson operation for hydrocephalus: case report.

A 26-year-old woman had had a lumbar subarachnoid-ureteral shunt established at the age of 10 weeks for hydrocephalus. She developed normally and had no trouble until meningitis developed because of reflux from a urinary tract infection. The meningitis responded to antibiotic treatment, and the shunt was removed from the subarachnoid space. Subsequently, the patient deteriorated clinically, with ictal episodes of altered consciousness, headache, and signs of midbrain dysfunction. Despite normal size ventricles on serial computed tomographic scans, her intracranial pressure was markedly elevated, which was shown by spinal puncture pressure. A diversionary lumboperitoneal shunt was inserted. An immediate, sustained recovery followed. The recognition of increased intracranial pressure in the absence of ventriculomegaly led to management that averted a disastrous outcome.

Chronic lumbar extradural haematoma simulating disc syndrome.

Two patients presenting with a clinical picture of nerve root compression suggestive of the herniated disc syndrome are reported. In both the diagnosis proved to be chronic encapsulated extradural haematoma. Recognition of this entity at the time of surgical exposure should render the surgical dissection easier. The postoperative results in both were excellent. One of these patients was on chronic anticoagulant therapy and the unusual location and good prognosis of extradural haematoma in the lumbar spinal canal in such patients is emphasized. In the other, the haematoma developed after a minor back injury, which introduces medico-legal implications.