[Effects of microgravity on indices of hemodynamics in monkeys during postural tests]. / Vliianie mikrogravitatsii na pokazateli gemodinamiki u obez'ian pri postural'nykh vozdeistviiakh.

Effects of the 6-day flight on board Cosmos 1667 on the dynamics of arterial pressure (AP) and the linear velocity of blood flow in the common carotid artery were studied with modified postural tests in the experiment with Macaca mulatta No. 18933. Initially, the postural test procedure and the method of mitigating the psychoemotional stress due to transition of the tilt-table were tried out on 21 primates. Administration of the functional test in microgravity was found to exert both qualitative and quantitative effects. The last mentioned were registered only in the primates tilted downward and included lowered AP vs. elevated AP in the control, and absence of typical bradycardia.

Palpable abnormalities of the breast not requiring excisional biopsy.

The evaluation of a patient with a palpable abnormality of the breast typically includes physical examination, mammography and fine needle aspiration biopsy (FNAB) with cytologic interpretation of the aspirate. If the findings of these three diagnostic modalities are negative for malignancy, the current standard of care is to proceed to surgical biopsy to confirm the benign nature of the lesion. The current study was done to identify a subset of patients who could be safely observed without surgical (histologic) biopsy. These patients fulfilled specified criteria on physical examination, mammogram and needle sensation when the FNAB needle entered the lesion. Results of the cytologic studies of the FNAB were used as a corroborative rather than as a diagnostic test. Of 305 patients with mammary abnormalities, 106 were identified with "subsuspicious" lesions. Seven of the latter patients underwent surgical biopsy, four because the results of cytologic studies of FNAB revealed cytologic atypia. One of the four patients had infiltrating ductal carcinoma. All other patients have had follow-up evaluation for a mean of 61 months (range of 43 to 74 months). No carcinomas have developed at the subsuspicious site. The current study is the first to clearly define a subset of patients with palpable abnormalities of the breast who do not require surgical biopsy.

The use of closed suction drainage after lumpectomy and axillary node dissection for breast cancer. A prospective randomized trial.

Closed suction drainage has been used to prevent seroma formation after lumpectomy and axillary node dissection for breast cancer. To study the efficacy of closed suction drains, the authors conducted a prospective randomized study from 1987 to 1990 of 227 axillary dissections. One hundred eight were randomized to a drain group (DG) and 119 to a no drain group (NDG). Drains were removed on the first postoperative day just before patient discharge. Postoperatively, all palpable axillary collections were aspirated on each follow-up visit. The volume aspirated, the number of aspirations, the time to seroma resolution, and all complications were recorded. The mean number of aspirations in the DG was significantly lower than the NDG (2.2 +/- 2.2 versus 3.3 +/- 2.1; p less than or equal to 0.002). Mean volume aspirated in the DG (146.3 +/- 181.1 mL) was less than the NDG (266.1 +/- 247.6 mL; p less than or equal to 0.003), and the time to seroma resolution was decreased in the DG as compared with the NDG (11.5 +/- 10 days versus 18 +/- 10.1 days; p less than or equal to 0.0002). Closed suction drainage after lumpectomy and axillary node dissection is advantageous in decreasing the incidence and degree of seroma formation and need not delay early hospital discharge.

South Africa: self-medication.

PIP: The majority of blacks living in South Africa have either limited or no access to professional medical or pharmacy services. Therefore, self medication is an essential aspect of their health care. Pharmacists are often the 1st line of advice for patients using over-the-counter (OTC) medicines, but studies have shown that 25-33% of all patients do not buy OTC medicines from pharmacists because of higher cost and lack of accessibility. In Soweto, sparsas ("secret" shops) and local traders sell most of the OTC drugs which deprives the patients of a pharmacists expert advice on proper medicine usage and their potential referral to a physician in extreme cases. The Institute for Non-formal Education of Southern Africa, which deals with health needs of rural South Africa, believes that the improvement of community education at the grass roots level can be obtained by such means as mobile video units, each supported by community health workers. An additional suggestion includes involving the "traditional" healers in the application of relevant primary health care.^ieng

[Hemodynamics in monkeys in the initial period of adaptation to weightlessness]. / Gemodinamika u obez'ian v nachal'nom periode adaptatsii k nevesomosti.

Using pre-implanted electrodes and transducers, arterial pressure and linear blood flow velocity in the common carotid artery of the rhesus-monkey Gordyi were measured during his space flight on a Cosmos biosatellite and ground-based control experiments. As compared to the prelaunch level, blood pressure remained unchanged, blood flow velocity increased significantly and blood flow resistance in the area decreased during the first hours after insertion into orbit. During subsequent flight days mean daily values of blood pressure increased and blood flow returned to the baseline level, although they showed distinct day-night variations. Daily variations of blood flow velocity and its ratio to cardiac output gave evidence that the circulation system of the rhesus-monkey under study rapidly adapted to microgravity conditions.

Domiciliary consultations: some facts and questions.

The domiciliary consultation scheme introduced at the start of the NHS enables joint consultation between a consultant and general practitioner in a patient's home when the patient cannot attend hospital on medical grounds. Consultants claim a fee from the NHS, general practitioners do not. Data from the Department of Health and Social Security on domiciliary consultations in England and Wales during 1981-6 were analysed. The number of domiciliary consultations fell during 1981-6 from 429,759 in 1981 to 387,394 in 1986, a fall of 10%, whereas the numbers of consultants and general practitioners increased by 1404 (12%) and 2400 (10%), respectively. The yearly rate of domiciliary consultation per consultant fell by 19% from 36 in 1981 to 29 in 1986 and that per general practitioner by 18% from 18 to 15. In 1986 geriatric medicine had the highest rate of domiciliary consultation per consultant (187) followed by psychiatry (89), general medicine (52), dermatology (49), rheumatology (42), general surgery (36), gastroenterology (35), thoracic medicine (34), and orthopaedics (30). In 1986 all specialties apart from clinical pharmacology and therapeutics and clinical genetics showed a decrease in the yearly rate of domiciliary consultation when compared with the rate for 1981. Domiciliary consultation seems to have become a domiciliary visit by the consultant alone. At an estimated cost of about 20m pounds for 1988 the scheme needs critical evaluation.

[Features of changes in blood pressure and blood flow in the common carotid artery of monkeys exposed aboard the biosatellite Cosmos-1514]. / Osobennosti izmeneniia arterial'nogo davleniia i krovotoka v basseine obshchei sonnoi arterii u obez'iany, éksponirovannoi na biosputnike "Kosmos-1514".

Preflight the rhesus-monkey Bion was implanted with sensors and transducers to measure blood pressure and linear flow velocity in the common carotid artery and to compare these parameters with central circulation. At the early flight stage blood pressure increased, blood flow decreased and resistance in the area grew. The last change can be regarded as a compensatory reaction that can provide rapid adaptation of regional circulation to changes in systemic circulation. At later flight stages blood pressure showed distinct circadian oscillations and blood flow, a significant increase when compared to the ground-based 36-hour control study. Regulatory mechanisms of the cardiovascular system changed to the greatest extent on flight day 2. This manifested as a decrease of the amplitude of circadian oscillations of the above circulation parameters. Signs of cardiovascular adaptation to the effects of microgravity were discerned on flight days 3 to 5.

Immediacy: speed of response from the point of view of the physician.

A study has been carried out to determine the value of some standard biochemical tests in the emergency management of 209 acute medical admissions. Of the 678 emergency tests done, only 17.5 per cent showed abnormal results and of these only 12 per cent were helpful in diagnosis although 66 per cent were of value in treating the patients. The tests were most helpful in treating diabetic patients where the blood-glucose level decided insulin dosage in every patient; the pO2 and pCO2 levels were of value in acute on chronic obstructive airways disease; and the serum electrolytes were helpful in managing dehydration due to vomiting and diarrhoea. The possible reasons for the large number of useless tests carried out in diagnosis of these emergency admissions are discussed, and it is suggested that the most important way of avoiding unnecessary tests is better doctor training both before and after qualification. The place of immediacy of tests in the medical out-patient department is also considered. It is concluded that immediacy is of little value in diagnosing and treating out-patients, but would be helpful in reducing unnecessary return visits.

Do emergency tests help in the management of acute medical admissions?

A two year combined retrospective and prospective study of 555 acute medical admissions to a district general hospital was carried out to assess the value of emergency biochemical, haematological, radiological, and electrocardiographic tests in diagnosis and treatment. For the study the tests were considered helpful only if they disclosed an abnormality and resulted in a definite diagnosis or change of treatment which would not have been possible from the history and examination alone. A total of 2372 emergency tests were carried out in the 555 patients who presented with 579 acute medical problems. Only 403 (17%) of the test results were abnormal and, of these, only one third helped in treatment and less than one third helped in diagnosis. The most useful diagnostic tests were serum amylase activity in abdominal pain, the electrocardiogram in chest pain, the chest radiograph in respiratory problems, and cerebrospinal fluid analysis in suspected meningitis or subarachnoid haemorrhage. The most useful tests in treatment were blood sugar value in diabetes, PCO2 in obstructive airways disease, and haemoglobin concentration in gastrointestinal haemorrhage. Of the tests requested by far the most often--blood urea and serum electrolyte concentrations--only 7% gave abnormal results and were rarely of any help in either diagnosis or treatment. Analysis of the reasons for the uncritical use of emergency tests by house officers suggested that better undergraduate training, regular audit by senior members of medical units, abolition of routine investigational procedures, and more selective laboratory reports would help to build up the house officer's confidence in his own skills of history taking and physical examination without recourse to indiscriminate use of laboratory and other investigations.

Electromagnetic measurements of metacarpal blood flow in nonanesthetized horses.

Blood flow (milliliter/minute) was measured in the medial palmar artery of 12 horses, using electromagnetic flow equipment. Extraluminal flow probes were surgically placed around the artery and base-line blood flows were recorded during surgical manipulation. After horses had recovered from anesthesia, blood flows were recorded each day for 11 days. According to mean average blood flows, horses were allotted to two groups: group 1--those with predominately normal flow characteristics, and group 2--those horses with predominately abnormal flow features. Average daily mean blood flows in the medial palmar artery (QPA) of group 1 horses were 103 ml/min (min-max, 10 to 210), and for group 2, 49 ml/min (min-max, 0 to 300).

Vascular responses in equine thoracic limb during and after pneumatic tourniquet application.

Vascular responses occurring with pneumatic tourniquet application were evaluated in the equine thoracic limb. Recordings of pressure (arterial and venous) and flow (arterial) distal to the tourniquet were made for 60 minutes. Reactive hyperemia was observed; however the increased flow was neither of a sufficient duration nor of a great enough volume for total repayment of flow loss.

Effect of pneumatic tourniquet application to the distal extremities of the horse: blood gas, serum electrolyte, osmolality, and hematologic alterations.

With 120 minutes of pneumatic tourniquet application to the distal extremity in the horse, the following effects were noted in the tourniqueted limb vein (TLV): (i) local venous acidemia, (ii) increase in serum K+ concentrations, (iii) minimal changes in plasma total solids, Na+, or osmolality, and (iv) apparent reduction in hematocrit values when compared with the same measurements in the control leg. Tourniquet release after 120 minutes produced a prompt return to base line for PCV and PO2 in the TLV; however, pH, PCO2 and K+ values in the TLV required 10 to 15 minutes to reach base line (TLV or control leg vein).

Rehabilitation of the coronary patient.

52 out of 56 patients with myocardial infarction completed a 6-week rehabilitation programme. The exercise programme started on the second day of admission and continued during the patient's stay in hospital and for 6 weeks thereafter, with weekly attendances at the hospital. All the patients were assessed monthly by a coronary rehabilitation team. 77% of the patients went back to work in an average time of 9.5 weeks after onset of the infarction; 61% went to their original jobs and 16% had to modify their jobs. The approximate hospital cost per patient for the complete course was 11.33 pounds.

Costs of unnecessary tests.

The relative importance of the history, examination, and routine and special investigations has been assessed in the diagnosis and management of 630 medical outpatients. The history was the most important factor in both diagnosis and management in cardiovascular, neurological, respiratory, urinary, and other miscellaneous problems, and decided 56% of all diagnoses and 46% of all management. Examination findings were of more limited value, accounting for only 17% of diagnostic and 17% of management decisions overall. Routine haematology and urine examinations were of minimal value, contributing to less than 1% of all diagnoses. Special investigations decided most of the diagnoses and management in alimentary and endocrine problems, but were less helpful in problems affecting all other systems. If a local survey in the Trent Region reflected the pattern of medical outpatient practice nationally, then pounds 1.25 million could be saved annually if routine investigation was discontinued on all patients whose problem had already been diagnosed on the basis of the history and the clinical examination.