Octreotide in the management of treatment-related diarrhoea.

Octreotide appears to have a major therapeutic effect in the management of diarrhoea related to cancer therapy. This effect is seen in the acute diarrhoea following radiation therapy and chemotherapy, and also in late radiation enteritis. As well as providing improved symptom control, early treatment can prevent potentially important morbidity in patients who are vulnerable to infection and fluid loss. Patients who suffer diarrhoea as a complication of AIDS, graft-versus-host disease and tumour-related diarrhoea can also obtain major benefit from treatment with octreotide. It should be considered as a first-line treatment in patients for whom diarrhoea may be a serious complication.

Adynamic ileus associated with invasion of the myenteric nerve plexus by a peritoneal mesothelioma.

Adynamic ileus due to invasion of the myenteric plexus of the small and large intestine was a significant symptom in a patient with a peritoneal mesothelioma. A record of this unusual complication was not found in the medical literature surveyed.

A novel roentgenographic observation in a hemangiopericytoma.

Hemangiopericytoma, an unusual tumor, is best demonstrated by angiography. A serendipitous observation was made during angiography in the case presented, which established the diagnosis of a blood vessel tumor before the ultimate biopsy was done.

La ensenanza y capacitacion del personal que atiende a los ancianos

Este trabajo examina diversos aspectos de la formacion acadmica y la capacitacion del personal que atiende a los ancianos. Se discute en particular: programas educaciónales, capacitacion de campo, formacion de los educadores, la investigación cientifica y su efecto en políticas y programas para el anciano. Por ultimo este trabajo presenta un numero de recomendaciones para mejorar la calidad de lea formacion del personal dedidacao al campo del envejecimiento, y enfeztiza la necesidad de que los organismos gubernamentales trabajen estrechamente con las organizaciónes profesionales y educaciónales que regulan los programas de adiestramiento

Needless deaths.

Over a period of 22 years, a number of needless deaths have been investigated in this institution following diagnostic and therapeutic procedures. These include fatalities associated with endoscopic examination and biopsies, complications in relation to indwelling tubes and radiological examinations. It is important that these catastrophies must be fully investigated. In this regard, it is essential to ensure that informed consent has been obtained, that an experienced independent pathologist conduct the investigations and that every effort must be made to get at the truth.

Deaths in police custody in England and Wales.

Worldwide deaths in police custody are causing public disquiet. An account is given of all the deaths occurring in police custody in England and Wales over a ten-year period from 1970-1979 with details of the causes of death and inquest verdicts.

The weight of the human thymus gland at necropsy.

The wet, lipid and lean dry weights of 574 thymus glands from Coroner's necropsies were examined for age-related changes. Despite enormous variation in wet and lipid weights at all ages there was a gradual decrease in wet weight with age and a significant increase in lipid weight until 40--50 years of age, with little change thereafter. There was a small decrease in lean dry weight with age, but it is not known if this reflects a change in cellularity. Multiple regression analysis showed that lower wet and lipid thymic weights were associated with long-term stressful conditions, and higher weights with deaths from asphyxia (largely in younger persons) and five groups of cardiovascular conditions. The percentage of lipid in these groups was not increased.

Traumatic dissecting aneurysm of the middle cerebral artery.

The clinical course and postmortem findings in a case of fatal traumatic dissecting aneurysm of the right middle cerebral artery in a 12-year-old boy are described. Possible mechanisms and predisposing causes leading to this injury are discussed, with reference to similar cases described in the literature.

Aging in the rhesus monkey: debilitating effects on short-term memory.

The performance of aged rhesus monkeys (18 years and older) was compared to that of young control monkeys (three to five years old) in three experiments designed to define and evaluate the presumed short-term memory impairment associated with aging. An automated, indirect delayed-response procedure was used with special emphasis directed toward controlling or eliminating potentially confounding variables such as attention, motivation, learning disabilities, etc. It was shown that the aged monkeys do suffer from a profound a specific impairment in short-term memory (STM), performing normally on the shortest dealy interval and showing progressively greater impairment as the retention interval was increased. A subsequent study varied deprivation level and demonstrated that it is unlikely that differences in motivation could account for the age-related STM deficits observed on the delayed-response task. Further studies indicated that alterations in stimulus availability did not differentially affect the performance of the two age groups to any measurable extent, suggesting that differences in stimulus processing abilities are neigher necessary nor sufficient conditions for the deficit found in the first experiment. These results suggest that the delayed-response deficity in old monkeys is directly related to age-associated changes in those areas of the nervous system which are important for the expression of short-term memory.

Primate information processing under sodium pentobarbital and chlorpromazine: differential drug effects with tachistoscopically presented discriminative stimuli.

Sodium pentobarbital and chlorpromazine were evaluated for the degree to which they differentially reduce the speed or efficiency with which sensory information can be processed. Rhesus monkeys were tested under comparable doses of sodium pentobarbital and CPZ on a visual discrimination problem with varying durations of tachistoscopically presented stimulus information. When unlimited stimulus information was available, no effects of the two drugs were observed at the doses used, but as the duration of stimulus presentation was progressively decreased, the effects of sodium pentobarbital became more severe, whereas CPZ did not differe from the saline control an any presentation duration. While previously published literature indicates that CPZ impairs performance by intermittantly blocking sensory input or transmission, the present data provide the first direct behavioral confirmation that barbiturates impair performance by retarding the rate at which sensory stimuli can be processed and utilized.

Complications of cardiac surgery.

With the increasing use of surgical procedures in cases of heart disease it was decided to review the more common complications of cardiac surgery including pre-operative investigations, based on 17 years experience of autopsies on fatal cases. The problems associated with valve replacement and coronary artery bypass grafting are dealt with in particular detail.

Short-term memory in the rhesus monkey: disruption from the anti-cholinergic scopolamine.

Two separate experiments were conducted to evaluate the effects of the anti-cholinergic scopolamine on primate visual discrimination and short-term memory (STM). In the first experiment it was shown that relatively mild doses of scopolamine severly impaired visual discrimination performance, even though the test procedure provided strong stimulus control. This deficit in visual discrimination suggested that previous research which used the delayed matching to sample procedure (DMS) to evaluate the role of cholinergics in primate STM may have confounded an accurate measure of specific STM effects because the DMS is inherently dependent on accurate visual discrimination. Therefore, the second experiment evaluated the effects of scopolamine on STM, using an automated apparatus and test procedure designed to minimize the discrimination component and other confounding variables present in the earlier research. In this second experiment, an indirect delayed response (DR) procedure was used, measuring the monkeys' ability to recall simple stimulus events over retention intervals of 0, 2.5, 5, and 10 sec. The monkeys were tested under 2 doses of the anti-cholinergic scopolamine and their performance was compared to that obtained on several nondrug control days. Contrary to earlier reports using the DMS, a clear interaction of drug and retention interval occurred in this situation. Under scopolamine, greatest impairments occurred on the longest delays, with little or no effect with zero second retention. Furthermore, the impairments observed on the longer delays were even greater with the highest dose of scopolamine. These data, therefore,support the notion that cholinergic mechanisms play an important role in the expression of STM in primates.