List sizes and use of time in general practice.

The claim that list sizes in general practice should continue to fall towards a national average of 1700 patients rests heavily on the assumption that the extra time available to doctors would be used mainly for longer consultations, resulting in better standards of care. Evidence suggests, however, that the time is more likely to be used to increase rates of consultation in surgeries and home visits and to reduce the length of the working week. A national, random sample of 2104 principals in general practice in England and Wales were questioned about their allocation and use of time. The response rate was 67%, and no large biases in response were detected. The smaller their personal list size the less time general practitioners spent on all aspects of their work and the higher their rates of consultation and home visiting. The effects of further reductions in list sizes would be haphazard, being differentially distributed across the range of list sizes. Longer consultations would probably result, but most of the extra time would probably be used in higher rates of consultation in surgeries and home visits and some would be taken as free time.     

Characterization of aminoalkylimidazol-4-one mutagens from liquid-reflux models

A new class of low molecular weight, aminomethylimidazol-4-one (IQ-"like") mutagens have been produced by the reaction of creatinine with the amino acid L-threonine, in liquid-reflux models, mimicking cooking, of diethylene glycol:5% distilled water (2 h at 150 degrees C). Two mutagens, 2-amino-1-methyl-5-propylideneimidazol-4-one (AMPI) and 2-amino-5-ethylidene-1-methylimidazol-4-one (AEMI) were isolated and characterized by UV absorption spectra, mass spectra, and 1H-NMR. The mutagen AEMI was identical to that obtained from the reaction of creatinine with acetaldehyde. These mutagens were positive in all IQ-sensitive Ames tester strains and were not inactivated by acidic nitrosation at pH 1.0. Products displaying mutagenicity were also obtained by refluxing creatinine with other hydroxyamino acids such as L-serine, L-homoserine, and L-4-amino-3-hydroxybutyric acid, and aldehydes such as glyoxal, methylglyoxal, glycolaldehyde, but not formaldehyde. Simple model systems such as creatinine and acetaldehyde may be useful in more clearly defining the exact mechanism of formation of IQ-type mutagens (aminomethylimidazo-quinolines and -quinoxalines) produced during cooking, as well as in screening for potential inhibitors of IQ-type mutagen formation, and elucidating the mechanism of such inhibition.     

Occurrence of bacterivory in Cryptomonas,a common freshwater phytoplankter

Summary Bacterivory was detected by incorporation of 0.57 m diameter, fluorescent polystyrene beads and fluorescently labeled bacteria (FLB) in two cultured species of Cryptomonas (C. ovata and C. erosa), and a population of Cryptomonas sp in a humic, mesotrophic lake. Rates of ingestion and clearance were very low, and similar for the cultures and the in situ population. The in situ population incorporated 0.7–1.7 bacteria cell^-1 h^-1, thereby ingesting 0.3%–2.0% of the total bacterial numbers present in the water per day, and receiving less than 2% of its carbon content per day through bacterivory. Thus, bacterivory by Cryptomonas was quantitatively important neither as a sink for bacterial biomass, nor as a carbon source for the algal cells. Possibly, it served in the uptake of essential nutrients.     

Seasonal changes in the pigments, carbohydrates and growth of red spruce as affected by ozone

Two-year-old red spruce seedlings were exposed to various levels ot ozone, from 0.4 to 3 times ambient levels, in open-top chambers in Ithaca, NY, USA. Exposures, which varied with changes in day length, commenced on May 30, 1987 and continued until December 14, 1987. Seedling biomass, carbohydrate contents, pigment contents, and rate of electron transport were assessed twice monthly during the fumigation period. Orthogonal quadratic or cubic polynomials were used to model the response through time each variable measured. A one-way analysis of variance model was fitted to every regression coefficient in each polynomial model to test for ozone effects on seasonal physiological patterns. Ozone did not influence growth, foliar pigment content, foliar starch content, root carbohydrate content, or rate of electron transport. The seasonal change of needle raffinose content differed between exposed to low (0.4 ×, 1×) and high (2×, 3×) ozone levels. There was also a trend towards reduced total soluble sugar content foliage during late autumn in higher ozone treatments.     

The mentalis muscle: an essential component of chin and lower lip position

The soft-tissue chin may become ptotic following surgery in this area. The mentalis muscles which are responsible for proper central lip motion and chin point position may be affected. The mentalis muscle origin may require resuspension at a proper level. This reattachment may be performed by means of an intraoral approach. Non-absorbable sutures are used to hold the soft-tissue chin upward. The exact method involves placing drill holes through the alveolar bone, into which sutures are passed. These sutures are then placed through the lower mentalis muscles and tightened. Chin and lip position may be corrected in certain cases. Ancillary procedures are required to correct vestibular scarring and submental scars.     

Use of a permanent tissue expander for breast reconstruction

The use of tissue expansion in breast reconstruction is a recognized alternative surgical approach. The second generation of tissue-expanding prostheses is the permanent reverse double-lumen expander. In a series of 100 breast reconstructions using a permanent tissue expander, the clinical benefits of producing a moderate degree of mound ptosis along with observed reduction in pain during expansion are discussed. Additional advantages to the use of the device are the cost savings realized, elimination of a second procedure and a second anesthetic exposure, and a high degree of patient acceptance and satisfaction. This study includes breast reconstruction following mastectomies for malignant and premalignant disease, as demonstrated in 75 delayed and 25 immediate reconstructions, with the longest follow-up being 3 years. Complications of infection (3 percent), significant capsular contracture (4 percent), and implant failure (3 percent) are the most frequent and major complications observed yet. In no instance was breast reconstruction rendered unachievable in the face of these complications. The demonstrated results achieved with permanent tissue-expanding prosthesis, complemented by the obvious benefits and a low rate of significant complications, endorse this method as a viable alternative approach in reconstructive breast surgery.