Pre-Christmas traumas: the guillotine letter box.
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Accidents, Home↗
Biomedical subjects
D Wilson
Publications and source records attributed to D Wilson.
Intravitreally injected platelet activating factor induces retinitis in experimental animals.
PURPOSE: Platelet activating factor is a lipid which has been strongly implicated in anterior uveitis. In order to investigate further the role of platelet activating factor in intraocular inflammation, we have characterized the histological changes associated with the intravitreal injection of platelet activating factor, PAF analogs, or lyso-PAF in laboratory rabbits and rats. METHODS: Initial studies utilized a PAF analog (rac 1-0-octadecyl 2-0-ethyl glycero phosphoryl choline or ethoxy PAF), because this compound is relatively resistant to degradation by hydrolase, the major degradative enzyme for PAF. Doses ranging from 1 ug to 5 mg and time points from 6 hours to 7 days after injection were studied. RESULTS: In either rats or rabbits, 100 ug of ethoxy PAF consistently induced a marked uveitis with the predominance of inflammation focused in the retina and choroid. Retinitis was also induced in rabbits by either 1 mg PAF injected intravitreally or a similar dose of the PAF precursor/metabolite, lyso PAF. Retinal inflammation was not induced by an inactive lipid, 1,1-0,0-dihexadecyl-rac-glycero-3-phosphocholine, although this compound resulted in mild vitreous inflammation. The histological changes induced by PAF could be readily distinguished from the predominantly anterior inflammation induced by intravitreal injections of substances such an interleukin-1 or endotoxin. CONCLUSIONS: Recent studies indicating that PAF antagonists inhibit a variety of retinal toxicities and our own observations suggest that PAF could be a major mediator of retinal inflammation.
Animals↗
Health hazards at an egg farm.
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Animal Husbandry↗
The use of skin grafts in postburn contracture release: a 10-year review.
Postburn scarring and contracture affecting function remain the most frustrating late complications of burn injury. Various techniques are used to release contractures; the choice depends on their location and/or the availability of unaffected skin adjacent to the contracture or elsewhere. A retrospective review was carried out of the case notes of patients who had skin grafting for the release of postburn contracture at the Burns Unit, City Hospital, Nottingham between May of 1984 and August of 1994 to evaluate the experience over this period. Information was obtained about the burn injury, contracture site, interval between burn and release of contracture, indication, age at first release, intervals between releases, operative details (donor and graft sites), complications and nonoperative treatment, and follow-up to the end of the study period. A total of 129 patients underwent skin grafting for release of contractures as opposed to any other method of correction. Full-thickness skin grafts were used in 81 patients (63 percent) and split-thickness skin grafts in 26 (20 percent). Twenty-two patients (17 percent) had both types used on different occasions. Flame burns (41 percent) were the most common causes, followed by scalds (38 percent). Two hundred thirty-nine sites of contracture were released, with the axilla (59) and the hand/wrist (59) being the most common sites involved, followed by the head/neck region (42). It was found that for the same site, release with split-thickness skin grafts was associated with more rereleases of the contracture than with full-thickness skin grafts. Also, the interval between the initial release and first rerelease was shorter than with full-thickness skin grafts (p < 0.048). It was also noted that children required more procedures during growth spurts, reflecting the differential effect of the growth of normal skin and contracture tissue. Patients reported more satisfaction with texture and color match with the full-thickness skin grafts. There was comparable donor-site and graft morbidity with both graft types. The use of skin grafts is simple, reliable, and safe. Whenever possible, the authors recommend the use of full-thickness skin grafts in preference to split-thickness skin grafts in postburn contracture release.
Adolescent↗
The epidemiology of lip cancer: a review of global incidence and aetiology.
Lip cancer (140 ICD-9) is a form of oral cancer that has a distinctive global epidemiology. This review summarises global incidence rates for male and female lip cancer with the aid of cancer atlases. High male lip cancer rates are reported for regions of North America (12.7 per 100 000 per annum), Europe (12.0 per 100 000 per annum) and Oceania (13.5 per 100 000 per annum), while it is virtually unknown in parts of Asia. Factors commonly cited as important in the aetiology of lip cancer include solar radiation, tobacco smoking and viruses. An attempt is made to summarise the evidence for factors that may be important in lip carcinogenesis. While incidence rates are generally stable or falling among males worldwide, they are rising in many female populations. The aetiology of the disease is far from established and much information regarding its pathogenesis is based on anecdotal rather than case-controlled epidemiological evidence. The epidemiology of lip cancer supports the proposal that the lip should be considered as a distinct cancer site, rather than being included with other forms of intraoral cancer.
Asia↗
Improvement of nebulised antibiotic delivery in cystic fibrosis.
AIM: To investigate deposition patterns and to assess the delivery rate of two nebuliser systems in children with cystic fibrosis (CF). METHODS: Thirty three children with CF on regular treatment with nebulised antibiotics had radioisotope scans performed using technetium-99m labelled aerosol antibiotic generated by a Ventstream nebuliser (median mass diameter (MMD), 3.3 microm; delivery rate, 0. 075 ml/min) under conditions similar to their routine home practice. The inhomogeneity of the images was scored on a 1-10 rating scale (a low score indicating even distribution of the antibiotic), and stomach deposition was measured as a percentage of overall deposition. Twenty patients had a repeat scan using an Optimist nebuliser (MMD, 1.8 microm; delivery rate, 0.02 ml/min). RESULTS: The mean inhomogeneity scores were 5.4 in the Ventstream group and 3. 5 in the Optimist group. Mean stomach deposition was 17.3% in the 33 patients using the Ventstream nebuliser. There was an inverse relation between height and stomach deposition (r = 0.69). In the 20 patients who had both nebulisers, the mean percentages of stomach deposition for the Ventstream and Optimist nebulisers were 11.8% and 1.6%, respectively. The Ventstream nebuliser delivered antibiotic at an average 2.8 times faster rate than the Optimist nebuliser. IMPLICATIONS: A smaller particle size results in a more homogenous distribution of the antibiotic in the lungs with decreased stomach deposition. This should not be seen as a recommendation to use the Optimist nebuliser because more antibiotic was delivered to most parts of the lung with the Ventstream because of its increased delivery rate.
Administration, Inhalation↗
Hepatic lesion detection: comparison of MR imaging after the administration of superparamagnetic iron oxide with dual-phase CT by using alternative-free response receiver operating characteristic analysis.
PURPOSE: To compare the performance of magnetic resonance (MR) imaging after the administration of superparamagnetic iron oxide (SPIO) and dual-phase computed tomography (CT) in the depiction of liver metastases. MATERIALS AND METHODS: Fifty-one hepatic resection candidates with known colorectal metastases were examined. MR imaging comprised fast spin-echo (SE) T2-weighted imaging, T1-weighted gradient-echo (GRE) fast low-angle shot imaging before SPIO enhancement, dual-echo SE imaging, T2-weighted fast low-angle shot imaging, and T1-weighted GRE imaging after SPIO enhancement. CT was performed with 8-mm collimation and 1:1 pitch; imaging commenced 20 seconds and 65-70 seconds after injection of 150 mL of contrast medium. All images were reviewed independently by four blinded observers. The alternative-free response receiver operating characteristic (ROC) method was used to analyze the results, which were correlated with findings from surgery, intraoperative ultrasonography, and histopathologic studies in 31 patients and with consensus review together with all other imaging and clinical follow-up in 20 patients. Sensitivities were also calculated. RESULTS: The mean sensitivity of MR was significantly higher than that of CT (p < .02): 79.8% for MR and 75.3% for CT for all lesions, and 80.6% for MR and 73.5% for CT for malignant lesions. The mean areas under the alternative-free response ROC curves were 0.83 for MR and 0.78 for CT (difference not significant). CONCLUSION: SPIO-enhanced MR imaging was more sensitive than dual-phase CT in the depiction of colorectal metastases.
Colorectal Neoplasms↗
An international trial demonstrates suitability of a newly developed whole-blood ELISA kit for multicentre platelet HPA-1 phenotyping.
BACKGROUND: Neonatal alloimmune thrombocytopenia (NAIT) is in most cases due to pregnant women with HPA-1b platelet phenotype producing antibodies to HPA-1a platelets of the fetus, which may lead to intracranial haemorrhage with subsequent death or life-long morbidity. The availability of sensitive, reliable, straightforward, and inexpensive assays would enable large-scale screening in pregnancy and may help avoid NAIT. METHODS: A recently developed enzyme-linked immunosorbent assay (ELISA) was produced in kit form incorporating modified reagents and enabling distribution to 21 international Platelet Immunology and Blood Centres (see Acknowledgements). The kits were assessed using anticoagulated whole-blood samples stored up to 10 weeks at 4 degrees C. Each centre tested its own blood samples most of which had been previously typed by established assays. RESULTS: Of the 152 samples that were tested, all 31 HPA-1b phenotypes were correctly identified by the kit. The respective mean +/- standard deviation of the specific absorbances of HPA-1b and HPA-1a samples were: 0.52+/-0.15 and 0.12+/-0.06 (p<0.0005). In addition, the modified ELISA showed 100% concordance with PCR-SSP in the phenotyping of 93 donors. Finally, a comparison between freshly prepared and stored kits showed that the kit was stable for at least 2 years at 4 degrees C. CONCLUSIONS: The international trial showed that the modified whole-blood ELISA kit is very well suited for wide-scale screening in pregnancy. Moreover, the ELISA kit could be used for large-scale phenotyping of blood donors, with HPA-1b-typed individuals getting invited to become apheresis platelet donors for patients with NAIT.
Adult↗
'Face up to the truth': helping gay men in Vietnam protect themselves from AIDS.
Appropriate AIDS prevention information is not available in Vietnam for men who have sex with men. Current AIDS prevention messages can be misunderstood with potentially dangerous results. We outline some features of gay culture in a provincial city in Vietnam. We describe the activities of a peer educator who made contact with a small group of young gay men during 1996 and 1997. All the young men were ill-informed about AIDS. Their attitudes and sexual practices made them vulnerable to AIDS. The peer educator provided clear information and emotional support. The peer education was done without government endorsement and on a very low budget.
Acquired Immunodeficiency Syndrome↗
Variation between experienced observers in the interpretation of accident and emergency radiographs.
Skill mix and role extension initiatives have highlighted the difficulty of establishing quality standards for the accuracy of plain film reporting. An acceptable performance might be one which is indistinguishable from that of a group of experienced consultant radiologists. In order to assess the feasibility of setting such a standard, the variation between experienced observers must first be established. This study examines the variation found between three observers with the three major types of plain film examination. 402 plain film examinations (205 skeletal, 100 chest and 97 abdominal) performed on accident and emergency patients were reported retrospectively and independently by three experienced radiologists. The clinical data supplied on the request cards were available to the readers. Each examination was categorized by each reader as being normal, as showing significant abnormality relevant to the current clinical problem, or as showing insignificant or irrelevant abnormality. Concordance between all three readers was found in 51%, 61% and 74% of abdominal, chest and skeletal radiographs, respectively. Weighted kappa values confirmed that the level of agreement between pairs of observers was higher with skeletal radiographs (kappa w = 0.76-0.77) than with chest (kappa w = 0.63-0.68), or abdominal (kappa w = 0.50-0.78) examinations. However, the frequency of major disagreements (at least one reader reporting "normal" and one reporting "relevant abnormality") was similar for abdominal (11%), chest (12%) and skeletal (10%) radiographs. When the reports were reclassified into only two groups--either significantly abnormal or not--pairs of observers disagreed on 9-10% of skeletal, 11-19% of chest and 8-18% of abdominal cases. The average incidence of errors per observer was estimated to be in the range 3-6%. The magnitude of interobserver variation in plain film reporting is considerable, and must be taken into account when designing assessment techniques and setting quality standards for this activity.
Bone and Bones↗
Dynamic contrast-enhanced MR imaging and dual-phase helical CT in the preoperative assessment of suspected pancreatic cancer: a comparative study with receiver operating characteristic analysis.
OBJECTIVE: The purpose of this study was to compare dynamic contrast-enhanced MR imaging and dual-phase helical CT in the preoperative assessment of patients with suspected pancreatic carcinoma. SUBJECTS AND METHODS: Thirty-three consecutive surgical candidates (20 men, 13 women; 39-81 years old) were included. MR imaging comprised fast spin-echo (TR/TE 4000/91), fat-suppressed T1-weighted spin-echo (500/15), and T1-weighted breath-hold gradient-echo fast low-angle shot (100/4; flip angle, 80 degrees) images before and after the administration of gadopentetate dimeglumine. Helical CT used 5-mm collimation with a pitch of 1:1.5-1.7; images were obtained 20 and 65-70 sec after injection of 150 ml of contrast material. Two pairs of interpreters who were unaware of the results of the other imaging method independently scored each examination for the presence of a lesion and for surgical resectability using a five-point scale. Results were correlated with surgery (n = 25) or consensus review (n = 8). Receiver operating characteristic methodology was used to analyze the results for resectability, and positive predictive values were calculated. RESULTS: Both MR imaging and helical CT revealed 29 of 31 lesions. In determining lesion resectability, the mean areas under the receiver operating characteristic curves were 0.96 and 0.81 (p = .01) and the positive predictive values were 86.5% and 76% (p = .02) for MR imaging and helical CT, respectively. CONCLUSION: MR imaging and helical CT performed equally well in lesion detection. MR imaging was significantly better in the assessment of resectability of pancreatic tumors.
Adenocarcinoma↗
Genetic studies suggest a multicentric origin for Hb G-Coushatta [beta22(B4)Glu-->Ala].
Hb G-Coushatta [beta22(B4)Glu-->Ala] is found in geographically separated ethnic groups. Commonest along the Silk Road region of China but also present in the North American Coushatta, we sought to determine whether this variant had a unicentric or multicentric origin. We examined the haplotype of the beta-globin gene cluster in two Chinese families and in five Louisiana Coushatta heterozygous for this mutation. Chinese and Louisiana Coushatta had different haplotypes associated with the identical Hb G mutation. These haplotypes were defined by the presence of a HindIII restriction site in the Agamma-globin gene and AvaII restriction site in the beta-globin gene in Chinese subjects and their absence in the Louisiana Coushatta. We found a CAC at codon beta2 (beta-globin gene framework 1 or 2) linked to the Hb G-Coushatta gene in Chinese, and a CAT (framework 3) in Louisiana Coushatta, indicating different beta-globin gene frameworks. Both the Hb G-Coushatta mutation (GAA-->GCA) and the codon 2 CAC-->CAT polymorphism are normal delta-globin gene sequences, suggesting the possibility of gene conversion. We conclude that Hb G-Coushatta had at least two independent origins. This could be due to separate mutations at codon beta22 in Chinese and Louisiana Coushatta, a mutation at this codon and a beta-->delta conversion, or two beta-->delta gene conversion events.
China↗
A double-blind placebo-controlled trial of paroxetine in the management of social phobia (social anxiety disorder) in South Africa.
BACKGROUND: Social phobia, also known as social anxiety disorder, is a highly prevalent disorder with significant morbidity. Patients with social phobia frequently develop co-morbid psychiatric disorders such as depression and substance abuse, and the disorder impacts significantly on social and occupational functioning. It has been suggested that the selective serotonin reuptake inhibitors (SSRIs) are useful in the management of this disorder, but few controlled trials have been undertaken in this regard. There are also few data on the pharmacotherapy of social phobia in South Africa. METHODS: A double-blind randomised placebo-controlled multi-site flexible-dose trial of paroxetine was undertaken over 12 weeks among patients with a primary diagnosis of social phobia. Primary response measures were the Global Improvement item on the Clinical Global Impression scale (CGI) and mean change from baseline in the patient-rated Liebowitz Social Anxiety Scale (LSAS) total score. Ninety-three patients participated at 9 South African sites; their data are reported here. RESULTS: There was a significant drug effect on both the CGI Global Improvement score and the LSAS at 12 weeks. In addition, there was no significant difference in overall rate of adverse experiences between those on paroxetine and those on placebo. CONCLUSIONS: Paroxetine is both effective and safe in the acute treatment of social phobia. The findings here are consistent with those of previous controlled studies of the SSRIs as well as with previous work done in the USA on the use of paroxetine in the treatment of this disorder. Early diagnosis and treatment of social phobia should be encouraged. However, further research on long-term pharmacotherapy of social phobia is needed.
Adult↗
Preferred provider organizations: "Top 10" trends for PPOs in the new millennium.
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Choice Behavior↗
A comparison of the clinical and laboratory features of thin basement membrane disease (TBMD) and IgA glomerulonephritis (IgA GN).
AIM: The aim of this study was to determine the clinical and laboratory characteristics that distinguished thin basement membrane disease (TBMD) from IgA glomerulonephritis (IgA GN) at presentation and at follow-up. PATIENTS AND METHODS: Seventy-one patients with TBMD and 31 with IgA GN were studied. Males accounted for 11/71 (15%) patients with TBMD, and 20/31 (65%) of those with IgA GN (p < 0.001). RESULTS: At presentation, patients with TBMD had hematuria (42%) or proteinuria (42%), and sometimes both (24%), while those with IgA GN usually had both hematuria and proteinuria (71%, p < 0.0001). Furthermore, patients with IgA GN were more likely to have higher urinary RBC counts (p < 0.001), and more proteinuria (p < 0.001) than those with TBMD. An elevated serum creatinine or blood pressure did not distinguish between TBMD and IgA GN at presentation. At review, fewer individuals with IgA GN had elevated levels of urinary RBC and protein, and the proportions were not different from those in patients with TBMD. This was presumably because the acute episode had resolved. CONCLUSION: The outcome was worse in patients with IgA GN, with 8/31 (26%) having an elevated serum creatinine and 3/31 (10%) with end-stage renal failure, compared with an elevated serum creatinine in 3/61 (5%) patients with TBMD (p < 0.02) and no patients with renal failure (p < 0.05).
Adolescent↗
Common source outbreak of salmonellosis in a food factory.
Seventy-three employees at a food processing factory employing 2700 staff reported vomiting, diarrhoea, or abdominal pain between 30 July and 3 August 1997. Salmonella enteritidis phage type (PT) 4 was isolated from 47 symptomatic cases and five asymptomatic canteen staff. The epidemic curve suggested a point exposure to a common source: 60% of cases reported illness on 31 July. An uncooked dessert containing raw shell eggs was identified as a possible vehicle of infection. Caterers are reminded that pasteurised egg should be substituted for shell egg in dishes that are eaten raw or only lightly cooked.
Disease Outbreaks↗
The cycle of violence: important considerations for EMS providers.
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Domestic Violence↗
Routine screening tests for alcoholism.
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Alcohol Drinking↗