Pseudotumoral appearance of small bowel strictureplasty for Crohn's disease

In two patients with Crohn's disease, strictureplasties had been marked operatively by a metal clip, so that definitive location on subsequent small bowel examination was possible. Each stricture-plasty presented radiologically as a short annular constriction with apparently shouldered edges and parallel lumen. Similar radiological features were found in five other patients with strictureplasties, suggesting that a pseudotumoral appearance is characteristic of strictureplasty. Attention is drawn to this finding to avoid confusion with malignancy.     

Multiple Implants for First Molar Prosthodontics

Problems that can occur when single implants are utilized to restore first molar teeth include the frequent loosening of screws, as well as screws and/or implant breakage. These may result from torquing and rotational movements of the prosthesis during masticatory and parafunctional mandibular movements. When sufficient bone and mesio-distal restorative space is present, the placement of two implants should be considered.     

The role of ocular torsion in visual measures of vestibular function

This brief review highlights problems in the interpretation of results about perceived postural roll-tilt of human subjects undergoing roll-tilt around their naso-occipital axis, when visual stimuli are used as a means of indicating perception. The otolithic stimulus, which causes the changes in perceived posture, also causes the eyes to roll (or tort). In turn, the altered torsional position of the eye causes the perceived orientation of visual stimuli to change. Consequently, indicators of postural perception, which rely on visual stimuli, are a confounded combination of two factors; the person's perceived postural roll-tilt, and the effect of the otolithic stimulus on ocular torsional position. Consequently, setting of a visual stimulus do not permit direct unambiguous interpretation of a subject's perceived postural roll-tilt.     

North Carolina macular dystrophy, revisited

Progression of the maculopathy in North Carolina macular dystrophy (NCMD) was not well documented. Thus, the author recently examined 22 affected members of the original kindred. Evidence of progression of the macular disease was sought through comparison of the recent fundus findings with old fundus photographs and from subjective complaints of worsening visual acuity. Only 1 of the 22 affected subjects had evidence of such change. Additionally, two new findings of NCMD were observed: (1) severe macular lesions which were staphylomatous or excavated in appearance, not flat, and atrophic as previously described; and (2) peripheral retinal drusen variably present in affected subjects, in contrast to the "normal peripheral retina" originally described. These new findings, along with the generally stable course of the disease would seem to alter our understanding of the relationship of NCMD to other dominant macular dystrophies.     

Audit of support given to lay carers of the demented elderly by a primary care team

An audit was undertaken to determine how well a primary care team supported lay carers of the demented elderly. The following standards were set: (1) primary care teams should know of the existence of symptomatic demented elderly patients in the community; (2) lay carers should be knowledgeable about dementia; and (3) the resources which the lay carers felt they needed should be supplied unless they were unavailable.

The primary care team knew of the existence of all symptomatic demented elderly patients in the practice but lay carers lacked knowledge about dementia and had unmet needs. Giving lay carers a booklet about dementia and reporting their unmet needs to the primary care team led to improvements in standards 2 and 3. In addition, stress among lay carers was reduced. In spite of a reduction in the number of carers' unmet needs, there was no overall change in the use of available resources following intervention.

It is concluded that structured support is necessary and worthwhile in order to provide effective support for lay carers of the demented elderly in the practice.

     

Estrogen improves response accuracy and attenuates the disruptive effects of delta9-THC in ovariectomized rats responding under a multiple schedule of repeated acquisition and performance

Despite evidence of an interaction between cannabinoids and estrogen in the brain, little information is available regarding the consequences of this interaction on behavior. A within-subjects design was used to examine the effects of estrogen and delta9-tetrahydrocannabinol (delta9-THC) on learning and memory in ovariectomized rats responding under a multiple schedule of repeated acquisition and performance. Treatment with low physiological levels of estrogen, delivered in Silastic capsules, improved response accuracy without affecting response rate during acquisition. Estrogen also attenuated the ability of delta9-THC (0.56- 3.2 mg/kg) to decrease response accuracy and rate during acquisition and response accuracy during performance. Results indicate that estrogen can improve accuracy during acquisition of a nonspatial operant task and can attenuate delta9-THC- induced behavioral deficits.     

Inflammatory and immunological responses in skin and peripheral lymph of sheep following intracutaneous injection ofStaphylococcus aureus

The cellular response within lesions and in draining lymph was examined in sheep following a primary intracutaneous injection of live or killedS. aureus. Microscopic examination of sections from liveS. aureus lesions (12, 24, 48, and 96 h following vaccination) revealed a high ratio of neutrophils to macrophages at all times. This ratio was initially high following inoculation of killedS. aureus but decreased steadily at successive sampling times. Representative sections from lesions were subjected to indirect immunofluorescent staining to identify IgM-, IgG₁-, and IgG₂-containing cells. The ratio of IgG₂- to IgG₁-containing cells in lesions produced following liveS. aureus vaccination was significantly greater than the ratio in lesions produced by killed staphylococci. Lesions induced by liveS. aureus recruited significantly greater numbers of⁵¹Cr-labeled allogeneic neutrophils from blood than did lesions induced by killedS. aureus. During the first 6 h this difference was approx. 20-fold. The volume of lymph and the number of leukocytes draining liveS. aureus lesions was considerably greater than from lesions produced by killed staphylococci. The proportion of neutrophils in lymph draining both types of lesions increased markedly during the first two days of the response but was observed to be greater and remained higher for a longer period of time in lymph draining vaccine lesions produced following injection of live staphylococci. The increase in proportion of neutrophils in lymph was accompanied by a concomitant decrease in proportion of lymphocytes and macrophages. No immunoglobulin-containing cells or anti-staphylococcal antibody production was detected in lymph draining either type of lesion. These differences in inflammatory responses may contribute to the documented differences in immune responses to live and killed staphylococcal vaccines.     

Matched controls in surveys of the use of general practice: Another use for research practice age-sex registers

This paper describes how an age-sex register may be used as a sampling frame for the selection of matched controls in studies of the use of general practice. It discusses both the analysis of data collected in this way and the advantages and limitations of the method itself. The application of the method to a case-study suggests that patients who use hospital accident departments are also high users of general practice. Although care is needed in the interpretation of such results, it is concluded that matched controls can be used to ameliorate some of the problems of research in general practice.