Preoperative assessment and consent for surgery: a role for the gynaecology nurse-practitioner.

Over the last decade, nurse-led services have been introduced as an alternative pathway of patient care, in part to undertake work performed by trainee medical staff before the reduction in working hours. In response to the loss of trainee hours resulting from implementation of the European Working Time Directive, we set up a new service with a highly experienced gynaecology nurse who underwent additional training in preoperative assessment and consenting. The service was founded on the nurse-practitioner's expertise, together with the use of an integrated care pathway and 12 preformatted consent sheets. We undertook a case note review of 100 consecutive patients. The review of the service showed a high level of compliance for performance of laboratory and radiological investigations, both in terms of completion and the avoidance of unnecessary tests. In addition, the nurse-practitioner was able to obtain written consent from almost 87% of women undergoing surgery using a range of just nine preformatted sheets. No serious medical issues were overlooked and no operations were cancelled on the day of surgery. The quality of documentation was exemplary and there were no complaints or clinical incidents related to the nurse-practitioner in 4 years of service. The quality of patient care can be maintained, if not improved, by integrating nurse-led preoperative assessment into the departmental clinical pathway for women choosing elective surgery.

Sterilisation counselling: a role for the gynaecology nurse-practitioner.

A recent publication of an evidence-based clinical guideline for male and female sterilisation by the Royal College of Obstetrics and Gynaecology (RCOG) created a stimulus for a review of our female sterilisation service. We arranged for a gynaecology nurse-practitioner (A.O.) with extensive experience in general gynaecology and contraception to undergo additional training in counselling female sterilisation. She then took over the daily running of the sterilisation clinic using a care pathway and pre-printed letters. She had open access to a consultant (R.F.) for advice. A review of 100 consecutive referrals showed that the nurse followed the guidelines extremely closely both in terms of referral to the medical team for advice and/or further counselling and quality of documentation. A total of 59% of the women attending the clinic were cared for by the nurse-practitioner alone. Only four had to see a consultant. All women questioned expressed very positive comments about the style and content of counselling and just one stated she preferred to see a doctor.

Rapid high-throughput assay for the measurement of amino acids from microdialysates and brain tissue using monolithic C18-bonded reversed-phase columns.

A rapid precolumn high-performance liquid chromatography method based on fluorescence detection has been developed for the measurement of multiple amino acids from both ex vivo and in vivo biological samples using monolithic C18 columns. A mixture of 18 primary amino acids were derivatised with napthalene-2,3-dicarboxaldehyde (NDA) in the presence of cyanide. The resulting isoindole derivatives were resolved within 10 min using a linear binary gradient elution profile with Rs values in the range 1.2-9.0. The limit of detection (LOD) was found to be between 6.0 and 60 fmol for 5 microl injection with a signal to noise ratio of 3:1. The NDA derivatives were found to be stable for 9 h at 4 degrees C. This assay has been employed for the rapid analysis of amino acids from brain tissue and microdialysis samples. Examples of application of the method are given.

Development and application of a sensitive high performance ion-exchange chromatography method for the simultaneous measurement of dopamine, 5-hydroxytryptamine and norepinephrine in microdialysates from the rat brain.

A high performance liquid chromatography (HPLC) method based on cation exchange separation has been developed for the measurement of dopamine (DA), 5-hydroxytryptamine (5-HT) and norepinephrine (NE) in microdialysates. The separation conditions have been optimised for using electrochemical detection. All three bioamines were resolved in less than 22 min using isocratic conditions. The optimum oxidation potential for the three bioamines was found to be +0.4 V vs. in situ Ag/AgCl reference electrode. Linear regression analysis of HPLC-peak area as a function of concentrations in the range 1-50 ng x ml(-1) gave coefficients of correlation between 0.998 and 0.999. The limit of detection for DA, 5-HT and NE was found to be between 50 and 100 pg x ml(-1) with a signal to noise ratio of 3:1. The method has been applied to the simultaneous measurement of the three monoamines in microdialysates from the medial prefrontal cortex under basal conditions and following the administration of the antipsychotic drug clozapine (10 mg x kg(-1) s.c.).

[The effect of acupuncture on the gastric acid-forming function in patients with duodenal peptic ulcer]. / Vliianie akupunktury na kislotoobrazuiushchuiu funktsiiu zheludka u bol'nykh iazvennoi bolezn'iu dvenadtsatiperstnoi kishki.

Acupuncture of points E36 Zusanli and auricular points is shown to influence acid production in the body of the stomach and alkalinization in the stomach antrum in patients with duodenal ulcer and hyperacidity. 20-min acupuncture on points E36 intensifies acid production while 40-min procedure inhibits acid production. Combination of auricular and corporal acupuncture enhances acid production suppression in gastric body and improves alkalinizing function of the antrum.

High throughput liquid chromatography/mass spectrometric analyses using a novel multiplexed electrospray interface.

A novel four- channel multiplexed electrospray liquid chromatography interface is described. This device has been used to analyse both single components and mixtures by liquid chromatography/mass spectrometry (LC/MS) as well as synthetic samples prepared by automated procedures. These data provided unambiguous molecular weight assignments to both major components and synthetic by-products in these samples. In this work particular attention has also been paid to the elimination of interchannel crosstalk. Copyright 1999 John Wiley & Sons, Ltd.

A chromatographic and mass spectrometric strategy for the analysis of oligosaccharides: determination of the glycan structures in porcine thyroglobulin.

Oligosaccharides released from porcine thyroglobulin were first derivatised with 2-aminoacridone (2-AMAC) and analysed by capillary electrophoresis to determine the complexity of this glycan pool. The same glycan mixture was then subjected to either a sialidase digest or a sialidase and fucosidase digest prior to derivatisation with 2-AMAC and analysis by normal phase high pressure liquid chromatography (HPLC). Comparison of the three chromatographic profiles with known standards allowed an initial identification of the glycan structures. The 2-AMAC derivatised glycans were then collected from HPLC for matrix-assisted laser desorption/ionisation time-of-flight (MALDI-TOF) analysis and the molecular weights of predicted structures were confirmed. This study demonstrates that a two enzyme array and subsequent MALDI-TOF analysis can be used successfully to assign the major glycans present in a complex mixture.

High-performance liquid chromatographic analysis of complex N-linked glycans derivatized with 2-aminoacridone.

2-Aminoacridone (2-AMAC) has been used to derivatize mixtures of N-linked oligosaccharides released from alpha(1)-acid glycoprotein and immunoglobulin G. In each case, the HPLC profile obtained for the derivatized glycans was compared to that obtained after digestion with sialidase and a two-enzyme array system made up of sialidase and alpha-fucosidase, prior to derivatization by 2-AMAC. These studies are rapid and provide a wealth of preliminary information about the degree of sialylation and core fucosylation in the corresponding parent glycans. Moreover, collection of glycans from one single injection has provided enough material for molecular weight determination by MALDI-MS analysis. In this study we have also carried out limited MS-MS studies on enriched fractions of 2-AMAC-glycans using a nanospray orthogonal quadrupole time-of-flight mass spectrometer.

Separation of immunomodulatory and cholesterol-lowering activities of heterocyclic azaspiranes.

Azaspiranes are novel immunomodulators which are effective in a variety of autoimmune diseases. One azaspirane analog, SK&F 105685 (N,N-dimethyl-8,8-dipropyl-2-azaspiro [4.5] decane-2-propanamine dihydrochloride), caused a decrease in total serum cholesterol in dogs after oral administration. To determine whether an effect on cholesterol was common to this class of compounds, the immunomodulatory activity was compared with the cholesterol-lowering activity of six azaspirane analogs. The compounds were given to beagles at a dose of 1 mg/kg p.o. for 28 days, and the effect on serum cholesterol was determined. The results from this study showed a clear dissociation between the immunomodulatory and hypocholesterolemic activities of these compounds. Studies performed to determine the mechanism of the decrease in serum cholesterol caused by SK&F 105685 indicated that it was not due to inhibition of 3-hydroxy-3-methylglutaryl coenzyme A reductase or acyl-CoA:cholesterol acyltransferase activities, or to a potentiation of cholesterol-7 alpha-hydroxylase activity. In addition, analysis by gas chromatography of the nonsaponifiable sterol fraction in dog plasma after treatment with SK&F 105685 or SK&F 106333 showed a decrease in cholesterol and an accumulation of lathosterol and an unknown sterol, indicating that the conversion of these sterols is inhibited and cholesterol synthesis is blocked at these steps. SK&F 105685 affected the sterol profile in human hepatoblastoma cells (Hep G2) in a similar way. Characterization of the unknown sterol by gas chromatography and mass spectrometry indicated that the unknown sterol is very similar to cholesterol and lathosterol, but its identity has yet to be established. These results show that the hypocholesterolemic effects of azaspiranes are related to inhibition of one or more of the final steps in the biosynthetic pathway of cholesterol.

[Surgical treatment of postbulbar duodenal ulcer]. / Khirurgicheskoe lechenie postbul'barnykh iazv dvenadtsatiperstnoi kishki.

Potbulbar localization was observed in 115 of 2142 patient operated for duodenal ulcer (5.4%). In most of the patients the disease has a severe clinical course, does not lend itself to conservative treatment and is often complicated by bleeding, penetration, stenosis. In 90% of the cases postbulbar ulcers penetrate into the pancreas head and hepatoduodenal ligament. The experience has shown that wider introduction of Billroth-I resection is a prerequisit for the improvement of postoperative results.

The mechanism of the water expulsion vesicle of the ciliate Tetrahymena pyriformis.

Analysis of high-speed (150 frames/sec) cinematographs of the filling and expulsion of the water expulsion vesicle of Tetrahymena pyriformis shows that the vesicle fills as water is pumped into it by contractions of at least four ampullary sacs which are continuous with the endoplasmic reticulum. When filled, the vesicle is pressed against its two excretory pores by cyclotic movements of the cytoplasm. This pressure closes the apertures of the ampullae, preventing backflow from the vesicle into them, and also spreads the pellicle of and at the pore, thereby stretching and rupturing the pore-sealing membrane. The vesicle is then invaginated by the cytoplasmic pressure, driving fluid out of the pore. The pore-sealing membrane then reforms, apparently by constriction, and the vesicle is again filled. Electron micrographs show that crisscrossed pore-microtubules extend from the pore to the openings of the ampullae, anchoring the vesicle in place. Each pore is surrounded by a stack of at least 11 ring-microtubules, to which the anchoring pore-microtubules are attached. The pore-microtubules appear to exert tension which assists in spreading the pore, aiding cyclotic pressures in rupturing the pore-sealing membrane. A possible mechanism for the cyclotic pressure and ampullary contraction is proposed.

The mechanism of the nephridial apparatus of Paramecium multimicronucleatum. II. The filling of the vesicle by action of the ampullae.

Our recent analysis of the nephridial apparatus of Paramecium multimicronucleatum by high-speed cinematography (300 fps at X 250) indicates that before the water expulsion vesicle ("contractile vacuole") is completely voided of fluid during expulsion, the ampullae surrounding and confluent with the vesicle swell with fluid entering from their respective nephridial tubules. Once the membranes of the excretory pore at the base of the excretory canal (leading from the vesicle proper to the outside) have constricted and resealed the excretory pore, the up till then constricted injection tubules of the ampullae which conduct fluid to the vesicle open as waves of contraction along the coacervate gel around the ampulla and proceed along each ampulla from distal to proximal end. The coacervate gel around any one ampulla does not necessarily contract in phase with that of any other ampulla. Each ampulla acts independently. The fluid from the ampullae is thus pumped sequentially, but not in predetermined order, into the water expulsion vesicle, refilling and distending it. Our previous studies (Organ et al., 1968a) suggest that an actomyosinoid ATP-using mechanism may be functional in the ampullary contractions.

The mechanism of the nephridial apparatus of Paramecium multimicronucleatum. I. Expulsion of water from the vesicle.

Recent analysis of the mechanism of the nephridial apparatus of Paramecium multimicronucleatum by high-speed cinematography (300 fps at x 250) confirms the observations by electron microscopy (Schneider, 1960) that once the pore is opened, the vesicle is invaginated by adjacent cytoplasm and is emptied by collapsing under pressure from that cytoplasm, aided perhaps by pressure of the fibrils which anchor the ampullae to the excretory canal. There is no indication of active contraction of the vesicle or its membrane. There is no permanent pore to the vesicle. The vesicle is closed by a sealing of the ruptured membrane where it is in contact with the pellicular excretory canal. At onset of expulsion of vesicular fluid the membrane across the basal opening of the excretory canal is ripped along one semicircular portion of the excretory pore and is driven up against the opposite wall as a flap while the water rushes out. A constriction of the vesicular and cell membranes at the base of the excretory canal reseals the opening.