"Let us go into the house of the Lord": participation in African American churches among young African American men who have sex with men.

Describes the church involvement of young African American men who have sex with men (MSM). Reports data secured from 76 individual semistructured interviews with men between the ages of 18 and 29 who reported recent sexual behavior with other men in Atlanta and Chicago that revealed high levels of involvement in African American churches and its impact on self-esteem and sexual behavior. Notes that participation in African American churches encourages sexual secrecy and is associated with decreased frequencies of same-sex contacts. Suggests that African American clergy and other church leaders can initiate dialogue with church-going MSM and redirect ministerial efforts to foster inclusive, nurturing religious communities that no longer marginalize these African American men.

Orthopaedic negligence: the tip of the iceberg?

Doctors seem helpless to stem the rising tide of negligence cases. This is partly because we practice in a generally more litigious society, but also because we only look superficially at negligence. We have traditionally looked only at the negligent act--in this paper the causes of such acts are explored.

The effect of in vivo T helper and T suppressor lymphocyte depletion on wound healing.

The role of T lymphocytes in wound healing is still not well-defined. Because it had been previously shown that in vivo depletion of T cells leads to impaired wound healing, the effect of depleting T cell subsets on subsequent fibroplasia was studied. T helper/effector cells were depleted by the use of the monoclonal antibody GK1.5, reactive against the L3T4 antigen (CD4). T suppressor/cytotoxic lymphocytes were depleted by using the 2.43 monoclonal antibody reactive against the Lyt 2 antigen (CD8). In the first experiment, Balb/c mice were treated with the antibodies starting at 24 hours before wounding was performed, and weekly thereafter. Depletion of the T helper/effector cells had no effect on wound-breaking strength or hydroxyproline deposition in sponge granulomas, whereas depletion of T suppressor/cytotoxic cells significantly enhanced both of these healing parameters. In a second experiment, T cell subset depletion was started on Days 0, 3, 7, 10, and 14 postwounding, and treatments were continued weekly thereafter. Once again, depletion of T helper/effector cells had no effect on wound healing, whereas depletion of T suppressor/cytotoxic cells markedly increased both wound-breaking strength and collagen synthesis. In conclusion, the data show that T suppressor/cytotoxic cells have a counter-regulatory role in wound healing, whereas the T cell subset responsible for up-regulating wound healing remains to be identified.

Caffeine alters ventilatory and gas exchange kinetics during exercise.

The purpose of these experiments was to determine the effects of oral caffeine ingestion on the kinetics of oxygen uptake (VO2), expired carbon dioxide output (VCO2), and expired ventilation (VE) in the transition from rest to exercise. Nine male subjects underwent three repetitions of constant load cycle ergometer exercise (approximately 80% ventilatory threshold) on two occasions. A single blind experimental procedure was followed, with one trial being performed 60 min after the subject ingested caffeine (7 mg X kg-1), while the second trial required the subject to ingest a placebo with the treatment order being counterbalanced. Ventilation and gas exchange were monitored by open circuit techniques. The data from three repetitions of the same protocol were pooled and modeled with a single-component exponential function incorporating a time delay: (formula; see text) Kinetic analysis of VO2 revealed no significant difference (P greater than 0.05) in the mean response time between treatments. In contrast, the mean response time for VCO2 and VE were longer (P less than 0.05) for the caffeine trial when compared to the control experiment. These data suggest that caffeine will influence both VCO2 and VE kinetics in the transition from rest to work and should be considered by investigators when planning experiments to study ventilatory and gas exchange kinetics during exercise.

Long-term results of Geomedic total knee replacement.

Seventy-one Geomedic total knee replacements were reviewed retrospectively at a maximum of eight and a half years. The prosthesis was found to be successful in its primary aim of relieving pain. However, there was an overall failure rate of 18.3%. Analysis of the results by an actuarial method allowed comparison with other prostheses. The factors involved in failure are discussed.

Haemoglobin saturation during incremental arm and leg exercise.

There are few reports concerning the alterations in the percent of haemoglobin saturated with oxygen (%SO2) during non-steady state incremental exercise. Further, no data exist to describe the %SO2 changes during arm exercise. Therefore, the purpose of this study was made to assess the dynamic changes in %SO2 during incremental arm and leg work. Nine trained subjects (7 males and 2 females) performed incremental arm and leg exercise to exhaustion on an arm crank ergometer and a cycle ergometer, respectively. Ventilation and gas exchange measurements were obtained minute by minute via open circuit spirometry and changes in %SO2 were recorded via an ear oximeter. No significant difference (p greater than 0.05) existed between arm and leg work in end-tidal oxygen (PETO2), end-tidal carbon dioxide (PETCO2), or %SO2 when compared as a function of percent VO2 max. These results provide evidence that arterial O2 desaturation occurs in a similar fashion in both incremental arm and leg work with the greatest changes in %SO2 occurring at work rates greater than 70% VO2 max.

Diagnosis and prognosis in compensation claims.

Psychiatric syndromes following compensable injury are not unusual in surgical practice. All such patients show exaggeration of their symptoms; compensation neurosis and malingering in particular are difficult to separate clinically. The signs and symptoms are reviewed. The prognosis has been assessed in 52 cases of compensation neurosis/malingering; remission of symptoms was usual except for spinal injuries, but return to previous occupation was not common and, despite the triviality of 70% of the injuries, 73% of the patients were off work for more than 6 months. The factors affecting prognosis are discussed, but the effect of legal settlement of claims could not be assessed accurately.

Negligence and the surgeon.

Increasing litigation in recent years makes it more and more necessary for the surgeon to be on his guard against actions or omissions that might be construed as professional negligence. Some of the more common causes of such negligence and their avoidance are discussed. If the current tendency of the courts to interpret mistakes and errors of judgment as negligence continues some change in the law will be essential if the practice of defensive medicine is to be avoided.

New compounds: synthesis of para-substituted nortropanyl benzoates.

The syntheses of the p-methyl-, p-tert-butyl-, p-chloro-, p-cyano, p-amino-, and unsubstituted benzoate esters of nortropine are reported. These compounds were characterized by their NMR, IR, and mass spectra and analytical data.