The limerick leg-ulcer project: Early results

Nurse led clinics in joint hospital and community settings are now being advocated as the most effective and economic way of dealing with leg ulcers. However, little information exists on the profile and outcome of patients with venous ulcers treated either in the community or in the hospital setting. Over a 2 yr period we assessed 134 patients with leg ulcers of whom 122 were deemed suitable for compression bandaging therapy. Thirty-four patients (28 per cent) were treated by the newly developed community service and 88 (72 per cent) were treated at the hospital clinic. Our overall healing rate for venous ulcers was 50 per cent @ 40 weeks. This probably reflects the long duration (48 per cent >2 yr) and large size (0.5–600 cm²) of ulcer prior to treatment. There were no differences in outcome between hospital (50 per cent @ 40 weeks) and community (35 per cent @ 40 weeks) based treatment (p>0.05). We conclude that most venous ulcers can be effectively treated in the community and resources should be provided to achieve this goal.     

RADIOIODINE THERAPY FOR DIFFERENTIATED THYROID CARCINOMA : INHS ASVINI EXPERIENCE

During last 17 years, 175 patients of carcinoma thyroid were treated in this centre. Hundred patients (57%) of papillary carcinoma formed majority. Fifty four patients (31%) were follicular carcinoma and 15 (8.5%) were mixed variety. Two (1.3%) were medullary carcinoma, 3 (1.7%) anaplastic type and 1 (0.5%) hurthle cell carcinoma. After surgery these patients were assessed for radio iodine uptake, residual thyroid tissue and distant metastasis which determined the dose of radioiodine for ablation. Fifty two per cent (91) patients presented as multi nodular goitre, 22.3 per cent (39) as solitary nodule, 13.7 per cent (24) had lymph node metastasis, 5.7 per cent (10) bone metastasis, 2.5 per cent (4) had lung metastasis and 3.8 per cent (7) presented as thyrotoxicosis. Average number of therapy for complete ablation in papillary carcinoma was 1.5, follicular 1.78 and mixed variety 1.5. 72.6 per cent cases (127) needed single dose for ablation, 14.9 per cent (26) needed 2 doses and 5.7 per cent (10) required 3 doses. Only 6.8 per cent (12) cases needed 4 to 8 doses. Average dose of I⁻¹³¹ administered for ablation was 157 mci in males and 124 mci in females of papillary carcinoma thyroid. Males in follicular variety required 204 mci and females needed only 120 mci. In mixed variety males required 177 mci and females required 62.5 mci for complete ablation. 144 patients (82.3%) were followed up to 5 years and remaining patients from 6 to 17 years. These patients are followed up once in a year or alternate years. Follow-up and medical record keeping for defence personnel is done with meticulous care, therefore followup results are very encouraging.KEYWORDS: Differentiated thyroid cancer, Radio iodine therapy, Thyroid ablation     

Gallium scans for staging small cell lung cancer.

The high incidence of gallium 67 accumulation in lung cencer has made radioistope scanning with this agent useful in identifying the extent of cancer locally. However, we investigated the usefulness of whole-body gallium 67 scanning, compared with physical examination, bone, liver and brain scans, and bone marrow aspirate and biopsy, in detecting metastases outside the chest in 47 patients with small cell lung cancer. In each case whole-body scanning with gallium 67 was inferior to the other methods used to detect extrathoracic tumor deposits.     

Measurement Accuracy of Aluminium Content in Bone

Abstract

The aluminium content in bone has been related in several ways: to the weight of wet bone, to the weight of dry bone, to the weight of bone-ash and to the calcium content of bone. We determined the accuracy and precision of measurement (using an inductively coupled mass-spectrometer) in 30 bone samples taken from one patient. The coefficient of variation of the aluminium/weight-quotient was 12.4 per cent for wet bone, 4.7 for dry bone and 5.0 for bone ash; and the coefficient of variation of the aluminium/calcium-weight-quotient was 7.5 per cent. Thus, the aluminium content in bone seems to be best related to the weight of dry bone.     

Long term efficacy of cyclical etidronate therapy in postmenopausal osteoporosis

Sixty-two women (mean age 68.7 ± 0.9 yr) with postmenopausal spinal osteoporosis were treated with cyclical etidronate therapy (400 mg for 2 weeks alternating with 12 weeks of 1 gm elemental calcium and 400 IU Vitamin D3) for a minimum of 2 yr. Bone mineral density (BMD) of the lumbar spine (g/cm²) increased significantly (p<0.0001) after yr 1 (4.1 ± 0.5 per cent) and yr 2 compared with yr 1 (2.2 ± 0.5 per cent). The response rate was 89 per cent after yr 1 and 84 per cent after yr 2. BMD of the hip (30 patients) increased by 1.5 ± 0.9 per cent after yr 1 and 5.5 ± 1.1 per cent (p<0.0001) after yr 2 when compared with baseline. The response rate was 63 per cent after yr 1 and 80 per cent after yr 2. Smaller numbers of patients continued with treatment up to 4 yr with no adverse long-term effects.     

Role of carbon fibre implants in osteochondral defects of the knee

Articular cartilage defects of the knee are a common condition diagnosed at arthroscopy. The management of these osteochondral lesions is controversial. We present our experience using carbon fibre implants to repair these defects in 18 patients. Eleven patients (61 per cent) had an osteochondral defect of the medial femoral condyle. Two patients had isolated patellar defects. The mean knee assessment and functional scores were 75 and 80 respectively using The Knee Society Clinical Rating System. Serial post-operative M.R.I. scanning revealed that there was no loss of implant position with an extensive local tissue response and good joint congruity. Overall, 11 patients (61 per cent) returned to their normal sporting activity, while 3 patients (18 per cent) had a poor result. One of these underwent a patellectomy. We conclude that carbon fibre implants may have a role to play in the management of osteochondral defects of the femoral condyles.     

The benefit of lowering cholesterol:Relative risk can beabsolutely misleading!

The recent trials of cholesterol reduction using statins have been well designed and the findings deservedly well received^1–3. In each case, a reduction in serum LDL cholesterol of about 30 per cent has been associated with a reduction in cardiovascular mortality and morbidity of 25–30 per cent. In the Scandinavian Simvastatin Survival Study (4S)¹ and the West of Scotland Coronary Prevention (WOSCOP) study², total mortality was also reduced by about 20 per cent. These important trials have provided the evidence base for implementing changes in clinical practice with regard to the management of serum lipid levels in patients with established coronary heart disease (CHD) who have raised¹ and average³ cholesterol levels as well as in subjects with high levels who are at risk of developing CHD². However, the reporting of relative risk reductions in isolation may be misleading and may lead to inappropriate clinical decision-making.     

Dietary intakes in Ireland of a healthy elderly population

The aim of this paper is to assess the adequacy of the diet of individuals over 60 yr of age, participating in the 1990 Irish National Nutritional Survey. A nationwide random sample based on the most recently updated electoral register was used. Demographic information was collected. Anthropometric measurements were taken and nutrient intake was assessed using the 7-day dietary history method. The randomly selected sample of 1213 subjects was considered to be representative of the Irish population. Of those selected, 163 individuals were over 60 yr of age, 79 of whom were male and 84 female. Mean energy intakes including alcohol for males and females were 9.55 ±3.09MJ and 7.07 ±2.39MJ respectively. The main sources of energy were bread, meat and meat products, potatoes and milk. As percentage energy, protein, fat and carbohydrate intakes were 14.90 per cent, 33.97 per cent and 48.22 per cent for men and 15.39 per cent, 34.09 per cent and 49.37 per cent for women respectively. Except for vitamin D and folate, micronutrient intakes were adequate. The body mass index (BMI [weight/height²] kg/m²) for men was 25.6 and for women 26.4. Fewer than 27.8 per cent of the males and 20.2 per cent of females take part in regular physical activity. In conclusion, the diet of a healthy elderly population in Ireland is nutritionally adequate with macronutrient intake in keeping with the recommended guidelines. Overall energy intakes are lower than those of a younger age group and may account for the lower intakes of certain micronutrients. An increase in fruit and vegetable consumption would improve vitamin and mineral intake. In order to allow for a higher energy intake an increase in physical activity is desirable.     

Measurement accuracy of aluminium content in bone

The aluminium content in bone has been related in several ways: to the weight of wet bone, to the weight of dry bone, to the weight of bone-ash and to the calcium content of bone. We determined the accuracy and precision of measurement (using an inductively coupled mass-spectrometer) in 30 bone samples taken from one patient. The coefficient of variation of the aluminium/weight-quotient was 12.4 per cent for wet bone, 4.7 for dry bone and 5.0 for bone ash; and the coefficient of variation of the aluminium/calcium-weight-quotient was 7.5 per cent. Thus, the aluminium content in bone seems to be best related to the weight of dry bone.     

Renal transplantation performed across a positive crossmatch: A single centre experience

The importance of certain positive crossmatches (CM⁺) in kidney transplantation remains controversial. Fifty consecutive kidney transplants were performed across a CM⁺ between Jan. 1990 – April 1994. In 19 cases there was an isolated B-cell CM⁺ (Group I), in 24 an historic T-cell IgM CM⁺ (Group II) and in 7 an historic T-cell IgG CM⁺ (Group III). Comparing groups I:II:III: early acute rejection affected 32%, 42%, 57% of grafts; mean serum creatinine at 3 months was 166, 150, 229 umol/l (p<0.05); 1 yr graft survival was 95 per cent, 96 per cent, 71 per cent (p=0.09). In group III both graft losses were in the setting of an additional current B-cell CM⁺. Conclusions: Transplantation performed in either the presence of an isolated B-cell CM⁺ or in the presence of an historic T-cell IgM CM⁺ was associated with acceptable outcomes at 1 yr. An historic T-cell IgG CM⁺ was confirmed as a contraindication to transplantation in most circumstances, especially when coupled with a current B-cell CM⁺.     

Acute bacterial meningitis in adults: Analysis of 218 episodes

A retrospective study was conducted to examine the laboratory, clinical features and outcome of 206 adult acute bacterial meningitis patients (218 episodes) during the years 1985–1996. Pneumonia (8.7 per cent), head trauma (7.8 per cent) and chronic otitis media (6.0 per cent) were identified as the main predisposing factors for acute bacterial meningitis. Aetiology was described only in 61 episodes (28.0 per cent). Streptococcus pneumonia was the most commonly identified pathogen overall, causing 33 of the 218 episodes (15.2 per cent). Antibiotic treatment before admission was given to 48.4 per cent of patients. On admission, the following symptoms of meningitis were predominant: 83 per cent had neck stiffness, 81 per cent had a headache and 73 per cent had fever. Case fatality rate was 27.1 per cent (59 patients). The important factors in mortality were as follows: old age, a long duration of symptoms before admission, a lack of neck stiffness, obtunded mental state on admission, low glucose levels in first CSF, low CSF/blood glucose ratio, and abnormality in computerised tomography scanning.     

有机镓治疗维甲酸诱导骨质疏松模型大鼠的实验研究

目的 对比研究有机镓和无机镓对维甲酸致大鼠骨质疏松模型骨代谢的影响及治疗作用.方法 用维甲酸按85mg/(kg·d)灌胃15 d,建立大鼠骨质疏松模型,经有机镓、氯化镓灌胃给药治疗4周后,应用生化、病理等方法研究其对骨代谢相关指标的影响,并比较其治疗效果.结果 维甲酸可引起大鼠骨结构、骨钙及其它元素含量的改变,血清抗酒石酸酸性磷酸酶(TRAP)、碱性磷酸酶(AKP)明显上升等改变.应用有机镓、氯化镓治疗后,可改善骨密度及骨形态计量学参数,增加股骨和牙齿中的镓、钙、磷含量,降低TRAP和AKP活性,其中以有机镓效果最明显,且用量最少.结论 在动物实验中,镓盐能通过降低骨转换率而改善骨质疏松,且有机镓较无机镓更安全、有效.     

Percutaneous aspiration versus catheter drainage of liver abscess: A retrospective review

Background

A review of the effectiveness and outcomes in liver abscess drainage performed by different operators using percutaneous aspiration (PA) and catheter drainage (PCD), respectively, from 2008–2013 at Sir Charles Gairdner Hospital, a tertiary hospital in Australia.

Methods

Forty-two patients (29 males and 13 females; aged between 28–93 years; median age of 67 years) with liver abscesses underwent either ultrasound or CT-guided PA (n=22) and PCD (n=20) in conjunction with appropriate antimicrobial therapy. A median of 18 Gauge needle and 10 French catheters were utilised.

Results

Nineteen (86.4 per cent) PA cases and 12 (60 per cent) PCD cases were successfully drained on a single attempt (p=0.08). More male patients (69 per cent) than females (31 per cent) were observed. Portal sepsis (42.9 per cent) was the most common cause identified. Fever (47.6 per cent) was the most frequent clinical presentation on admission. Thirty-two patients (76.2 per cent) had solitary abscesses with a right lobe (59.5 per cent) predilection. CRP was significantly raised. The PCD group observed a significantly larger abscess size (p=0.01). Klebsiella pneumoniae was the most common organism isolated in both pus (33.3 per cent) and blood cultures (11.9 per cent). Five procedure-related complications were noted, all in the PCD group. Thirty-day mortality was 2.4 per cent. No difference was observed in clinical and treatment outcomes in both groups.

Conclusion

The null hypothesis that both PA and PCD are equally effective in the drainage of liver abscess cannot be rejected. Apart from PA being simpler and safer to perform, the higher incidence of indwelling catheter-associated complications suggests that a trial of PA should always be attempted first.     

胎儿酒精中毒综合征

妊娠期间大量饮酒可损害胚胎及胎儿发育。胎儿酒精中毒综合征的特点为:生长缺陷,面部异常,心脏缺损,小关节和四肢异常,发育迟缓及精神缺陷等。酒精对胎儿的毒性作用可以是酒精本身,也可以是酒精的代谢产物。据某些作者报告(1977,1976),大量饮酒所生婴儿先天性畸形的发生率为32%,中等量饮酒者中为14%;慢性酒精中毒者中则为30～50%。     

In-vitro activity of piperacillin/tazobactam relative to other antibiotics against blood culture isolates

Resistance of bacteria to antibiotics is an increasing problem in many countries. Accurate locally relevant information is essential for detection and control of emerging resistance and to facilitate choice of empirical antibiotic therapy in the immediate management of seriously ill patients. We have determined the minimum inhibitory concentration of piperacillin/tazobactam for 97 strains of bacteria (55 Enterobacteriaceae, 13 non-fermentative Gram-negative bacilli, 22Staphylococcus aureus), 6Enterococcus faecalis and 1Bacillus cereus) isolated from blood cultures and compared its activity to that of amoxycillin, co-amoxiclav, cephalothin, cefotaxime, ceftazidime, ciprofloxacin, gentamicin, piperacillin, cefotaxime. The strains were consecutive non-fastidious isolates with the following qualifications: coagulase negative staphylococci and diphtheroids were excluded and the number of Staphylococcus aureus isolates was limited to 12 methicillin-resistant and 10 methicillin-sensitive strains. Multiple isolates of the same species from individual patients were not included. The minimum inhibition concentrations of methicillin, penicillin, teichoplanin and vancomycin were also determined for specific groups of organisms. MICs were determined by the Etest method (AB Biodisk, Solna, Sweden) on Mueller Hinton agar. The MICs of appropriate American Type Culture Collection control strains were determined. Based on the interpretative criteria of the National Committee for Clinical Laboratory Standards (USA), 87 per cent of Gram-negative bacilli were susceptible to piperacillin/tazobactam compared with amoxycillin 26 per cent, cephalothin 35 per cent, co-amoxiclav 54 per cent, piperacillin 56 per cent, cefotaxime 69 per cent, ceftazidime 84 per cent, gentamicin 85 per cent and ciprofloxacin 91 per cent. Of all isolates 75 per cent were sensitive to piperacillin/tazobactam, compared with amoxycillin 22 per cent, cephalothin 35 per cent, piperacillin 41 per cent, co-amoxiclav 52 per cent, cefotaxime 59 per cent, ceftazidime 60 per cent, gentamicin 74 per cent and ciprofloxacin 77 per cent. Two isolates (1E. coli and 1Klebsiella pneumoniae) with antibiograms consistent with the relatively new resistance phenomenon of extended spectrum beta-Iactamase production were identified. The spectrum of activity of piperacillin-tazobactam for empirical antibiotic therapy is significantly greater than that of piperacillin alone and is similar to that of ciprofloxacin and gentamicin.     

基于城镇医保数据库骨关节伤病的流行病学研究

目的 了解我国骨关节伤病的患病率及三间分布特征。方法 采用横断面设计,回顾性分析2013—2017年中国城镇基本医疗保险抽样数据库中骨关节伤病的流行病学特征。以市为单位抽样,首先计算各城市骨关节伤病的患病率,使用Meta分析对城市患病率进行加权,获得各区域以及全国的患病率及其95%CI,并进一步描述其空间(区域)、时间(年份)和人群(年龄、性别)等的分布特征。结果 纳入研究对象28 419 264人,其中骨关节伤病患者705 793人。2013—2017年城镇医保数据库中,骨关节伤病的患病率为141.5(95%CI:90.4~203.7)/万人,其中非特指或多关节疾病、膝关节疾病和肩关节疾病的患病率依次为101.6(95%CI:63.5~148.4)/万人,22.5(95%CI:15.1~31.4)/万人和10.9(95%CI:6.4~16.4)/万人;就空间分布而言,骨关节伤病在不同地区的患病率差异较大,华北地区最高,达310(95%CI:12.6~989.7)/万人、西南地区最低,为59.0(95%CI:37.5~85.2)/万人;就时间分布而言, 2013—2017年骨关节伤病的患病率逐年上升, 从2013年的111.1(95%CI:56.0~182.5)/万人上升至2017年的175.5(95%CI:116.8~245.5)/万人;就人群分布而言,女性人群的患病率为149.1(95%CI:94.2~215.9)/万人,高于男性133.6(95%CI:86.2~190.9)/万人,膝关节疾病、非特指或多关节疾病,以及骨关节伤病整体在较大的年龄组中患病率较高,而肩关节疾病的患病率在40~59岁达到峰值[20.6(95%CI:12.5~30.5)/万人]。结论 2013—2017年城镇医保数据库中,骨关节伤病的患病率较低,但呈现逐年上升的变化趋势。骨关节伤病的患病率在华北地区最高,且在不同年龄和性别的人群中具有差异,女性高于男性,在0~17岁人群中最低,而在60岁及以上人群中最高。     

基于城镇医保数据库骨关节伤病的流行病学研究

目的 了解我国骨关节伤病的患病率及三间分布特征。方法 采用横断面设计,回顾性分析2013—2017年中国城镇基本医疗保险抽样数据库中骨关节伤病的流行病学特征。以市为单位抽样,首先计算各城市骨关节伤病的患病率,使用Meta分析对城市患病率进行加权,获得各区域以及全国的患病率及其95%CI,并进一步描述其空间(区域)、时间(年份)和人群(年龄、性别)等的分布特征。结果 纳入研究对象28 419 264人,其中骨关节伤病患者705 793人。2013—2017年城镇医保数据库中,骨关节伤病的患病率为141.5(95%CI:90.4~203.7)/万人,其中非特指或多关节疾病、膝关节疾病和肩关节疾病的患病率依次为101.6(95%CI:63.5~148.4)/万人,22.5(95%CI:15.1~31.4)/万人和10.9(95%CI:6.4~16.4)/万人;就空间分布而言,骨关节伤病在不同地区的患病率差异较大,华北地区最高,达310(95%CI:12.6~989.7)/万人、西南地区最低,为59.0(95%CI:37.5~85.2)/万人;就时间分布而言, 2013—2017年骨关节伤病的患病率逐年上升, 从2013年的111.1(95%CI:56.0~182.5)/万人上升至2017年的175.5(95%CI:116.8~245.5)/万人;就人群分布而言,女性人群的患病率为149.1(95%CI:94.2~215.9)/万人,高于男性133.6(95%CI:86.2~190.9)/万人,膝关节疾病、非特指或多关节疾病,以及骨关节伤病整体在较大的年龄组中患病率较高,而肩关节疾病的患病率在40~59岁达到峰值[20.6(95%CI:12.5~30.5)/万人]。结论 2013—2017年城镇医保数据库中,骨关节伤病的患病率较低,但呈现逐年上升的变化趋势。骨关节伤病的患病率在华北地区最高,且在不同年龄和性别的人群中具有差异,女性高于男性,在0~17岁人群中最低,而在60岁及以上人群中最高。     

Exploring the safety measures by doctors on after-hours house call services

Background

Aggression against doctors involved in after-hours house calls (AHHC) is widely perceived to be high. It is, however, unclear how doctors who perform this service manage the risk of aggressive patients during home visits.

Aims

The aim of this paper is to explore if and how doctors manage the risk of violence against them during AHHC.

Methods

A survey was designed and administered to all 300 Australian-based doctors engaged in AHHC under the National Home Doctor Service (NHDS). The survey was conducted from September 2014 to November 2014.

Results

There were 172 responses (57.3 per cent). Only 43 per cent of respondents adopted personal protective measures. The remaining 57 per cent had none; of those 6 per cent had never considered protective measures, and 31.8 per cent were aware of the risk of violence, but were unsure of what to do. Measures adopted include the use of chaperones/security personnel (34.1 per cent), dependence on surgery policies (31.2 per cent), de-escalation techniques (15.2 per cent), panic buttons (7.2 per cent), personal alarms (6.1 per cent), and others (6.5 per cent). Females were more likely to adopt personal protective measures than males (OR 4.94; p<0.01; CI 1.70–14.34), and Australian-trained doctors were less likely to do so relative to overseas-trained doctors (OR 0.35; p=0.04; CI 0.12–0.99).

Conclusion

Just over half of the doctors involved in AHHC took no precautions against aggressive attacks while on duty, and nearly one-third relied on the policies of their employing surgeries.     

Multi-drug resistant Acinetobacter species from various clinical samples in a tertiary care hospital from South India

Background

Acinetobacter species are gram-negative coccobacilli belonging to the group of Non-Fermenting Gram-Negative Bacilli, which are ubiquitous in nature. They cause outbreaks in intensive care units and healthcare settings, and are becoming increasingly drug resistant.

Aims

To determine the prevalence of multi-drug resistant Acinetobacter species from various clinical samples.

Method

Clinical samples were processed as per standard microbiological techniques. Antibiotic susceptibility testing was carried out on all the Acinetobacter isolates by Kirby- Bauer disc diffusion method as per CLSI guidelines.

Results

A total of 122 Acinetobacter spp. were isolated. 110 (90.16 per cent) were from inpatients, and 12 (9.83 per cent) were from outpatients. Out of 122 isolates, 44 (36.06 per cent) were from the ICU. The majority of the isolates, 47 (38.52 per cent), were from pus samples followed by 25 (20.49 per cent) from endotracheal tube aspirate. Out of 122 isolates, 87 (71.31 per cent) were multi-drug resistant of which 15 (12.29 per cent) were resistant to all drugs tested.

Conclusion

Acinetobacter infections associated with multi-drug resistant and pan-resistant strains have emerged as important nosocomial pathogens in our setting.     

同位素骨显像对肺癌骨转移的诊断价值

目的 用^99mTc—亚甲基二磷酸盐(MDP)对肺癌患者进行全身骨显像，以探讨不同细胞类型的肺癌骨转移的特点、规律及核素骨显像对骨转移诊断的价值。方法 总结我院自1996--1998年收治的162例肺癌骨转移阳性病例，对肺癌骨转移的部位、病理类型、症状进行回顾性分析。结果 肺癌骨转移以胸部骨转移最多见，其他依次为脊柱、骨盆、四肢和颅骨。肺腺癌较其他病理类型更易发生骨转移。多发性转移占72．2％，孤立性占27．8％。骨扫描阳性的病例中，有骨痛症状者为58％(94/162例)；68例无痛病例中，有ll例被证实为假阳性。骨扫描可于症状出现前5d-7个月诊断骨转移。结论同位素骨显像对肺癌骨转移具有临床诊断价值，肺癌患者应常规行骨扫描检查。