Aortic Valve Rheumatoid Nodules Producing Clinical Aortic Regurgitation and A Review of the Literature

The majority of cardiac involvement in rheumatoid arthritis (RA) is an incidental finding at postmortem, as less than 3% of patients with RA have clinical cardiac signs or symptoms. Most cardiac involvement in RA involves the pericardium and has been known since Charcot first described an RA patient with pericarditis in 1881. Cardiac involvement takes two different forms: non-specific inflammatory changes and specific granuloma formation. Specific rheumatoid nodules in the heart are an infrequent complication of RA. This is the first case report of a surgically excised heart valve with rheumatoid nodules. A 74-year-old RA patient with a high seropositive rheumatoid factor presented with severe aortic regurgitation and underwent a valve replacement. The native aortic valve showed significant stenosis with multiple, classic rheumatoid nodules. Cardiovas Pathol 1999;8: 333–338     

Perineal Pad Test in Evaluating Outcome of Treatments for Female Incontinence: A Systematic Review

Our objective was to systematically review clinical studies of incontinence treatments for women that used pad tests to assess outcome, to determine how closely the ICS guidelines had been followed. Our review (Medline 1988–2000, plus referenced studies) identified 75 relevant papers, carrying out pad tests in clinics (n= 53) or patients’ homes (n= 28). Clinic pad tests lasted between 60 seconds and 2 hours, with inconsistent starting bladder volumes, activities carried out, other test details and presentation of results. Home pad tests lasted between 1.5 and 48 hours: the conduct and reporting of these tests were also variable. Only 25 studies used pad tests that were apparently consistent with ICS guidelines. Pad tests are important in identifying urine loss in clinical evaluations; however, we found wide variations in their conduct and reporting. We recommend that the ICS should review the guidelines, and that further research should develop clinically valid pad tests. Authors and journal editors should ensure that pad test details are fully reported.     

SELECTIVE ENDOSCOPY IN MANAGEMENT OF INGESTED FOREIGN BODIES OF THE UPPER GASTROINTESTINAL TRACT: IS IT SAFE?

During a four-year period, 308 patients presented following ingestion of foreign bodies. Ingestion was accidental in 272 cases (88.3%) and deliberate in the remainder. Symptoms at presentation included dysphagia, odynophagia, nausea and vomiting, chest pain and pharyngeal discomfort. Sixty-eight patients were asymptomatic. A policy of expectant management and selective endoscopy was employed. Following initial assessment 202 patients (65.6%) were discharged without treatment, 30 (9.7%) of whom were later reviewed as outpatients and did not require admission. Forty-nine patients (16%) were admitted for treatment; 27 had oesophagoscopy, five bronchoscopy and two had foreign body extraction with direct laryngoscopy. In nine patients who were endoscoped, no foreign body was identified. Twenty-seven others were referred to the otorhinolaryngology service in another hospital. There were no deaths in the group and morbidity was 1.2%. We conclude that a policy of selective endoscopy is safe and effective in the management of patients following ingestion of foreign bodies.     

足部反射区推拿对白细胞介素-1β水平的影响

目的:观察足部反射区推拿疗法对不同年龄人群血清白细胞介素-1β(IL-1β)水平的变化及其可能的作用机制.方法:分别挑选24名健康年轻人、24名健康中年人和32名健康老年人.随机分为青、中、老年对照组和观察组.治疗组给予足部反射区推拿法治疗.分别于推拿前、后测定血清IL-1β水平.结果:中、老年组血清IL-1β水平较青年组明显为高,且两者之间有明显的秩和相关(P<0.05). 推拿前、后,中、老年观察组IL-1β水平明显降低(P<0.05);青年对照组和观察组无显著变化(P>0.05).结论:中老年人群血清IL-1β水平升高可能是老年人衰老神经内分泌和免疫机制改变的原因之一.足部反射区推拿法能一定程度降低IL-1β水平,推测足部反射区推拿法可能具有一定的抗衰老作用.     

Primary health care in Swaziland: is it working?

A historical picture of health services in Swaziland and an analysis of primary health care services from 1983 to 1995 are presented. The paper gives background information on health and health services, including education and training of health workers and health status indicators. Evaluations of the primary health care strategy since its inception in 1983 are discussed. Successes are identified and areas where improvement is needed to achieve the WHO goal of'Health For All'are suggested.     

A STUDY OF THE APPROPRIATENESS OF ANTIBIOTIC USE IN THE MEDICAL WARDS OF A TERTIARY TEACHING HOSPITAL IN MALAYSIA

A prospective study was conducted to determine the proportion of patients who received an antibiotic within 12 hours of admission to the medical wards. During the four-week study, 234 patients were admitted to medical wards from casualty; 68 patients (29%) received an antibiotic. The survey indicated that antibiotics were inappropriate in 22–65% of those treated. This study also shows that as many as 67% of patients who received intravenous antibiotics could have been equally well treated with oral preparations.     

The coexistence of thyroid autoimmunity in children and adolescents with various allergic diseases

The aim of our study was to investigate the coexistence of thyroid autoimmunity and allergic diseases. The prevalence of thyroid autoantibodies was studied in sera from 140 children with different kinds of allergic diseases, 370 11-13-y-old schoolchildren without allergic diseases serving as controls. The prevalence of thyroid peroxidase autoantibodies was found to be higher among the patients than in the control group, 11.4% vs 5.4% (p < 0:05). Ultrasound investigation identified autoimmune thyroiditis in 4.3% (6/140) of the series, which was later confirmed with fine needle aspiration in all six cases, four of which were unknown prior to the study. Our findings may be useful to alert clinicians that thyroid diseases may be superimposed on allergic children.