A Self-Contained Method of Evaluating the Provision of Preventive Care in General Practice

In an earlier paper a method was described by which generalpractitioners are able to obtain dissatisfaction data from theirpatients by means of questionnaires. A similar approach hasbeen used to study preventive care activities of general practitioners.We have found it to be practicable and acceptable to patientsand surgery personnel. It also yields results which are consistentand which have apparently stimulated some practitioners to altertheir practice behaviour by increasing their preventive careactivities.     

Guidelines for the management of chronic venous leg ulceration. Report of a multidisciplinary workshop

This document is the product of a multidisciplinary workshop held in November 1991 between the audit subcommittee of the British Association of Dermatologists and the Research Unit of the Royal College of Physicians. Partieipants included dermatologists, vascular surgeons, general practitioners, community nurses and physicians involved in care of the elderly. The text is based on papers submitted to, and presented and discussed at, the workshop, and on comments received in response to subsequent wide dissemination of the proceedings to speciality associations. Participants in the workshop, and contributors to the guidelines are: Dr B.R.Allen (Nottingham), Sister S.Bainsborough (Exeter), Professor K.Burnand (London), Professor D.Burrows (Belfast), Mr M.J.Caflam (Bedford), Dr G.W.Cherry (Oxford), Dr R.P.R.Dawber (Oxford). Dr W.S.Douglas (Airdrie), Dr A.Y.Finlay (Cardiff), Dr D.Gawkrodger (Sheffield), Dr D.J.Gould (Truro), Dr A.Hopkins (Royal College of Physicians, London), Dr D.McGibbon (London), Dr A.M.Middleton (London), Dr L.Millard (Nottingham), Dr L.Rhodes (Liverpool), Professor T.J.Ryan (Oxford), Dr N.B.Simpson (Newcastle), Dr F.D.Skerrett (Fowey). Dr J.M.Sowden (Nottingham), Miss L.A.Stone (London), Dr R.Williams (Rhyl). Papers presented to the workshop (copies available from the Royal College of Physicians of London):     

Exteroceptive suppression of temporalis and masseter muscle activity is enhanced in offspring of hypertensives

Exteroceptive suppression of temporalis and masseter muscle activity was examined in young men with and without a parental history of hypertension. Recent clinical studies suggest that the second exteroceptive suppression period is attenuated in several chronic pain disorders and that this brainstem reflex may serve as a noninvasive index of endogenous pain control. In the present study, offspring of hypertensives exhibited a significant protraction of the late exteroceptive suppression period for both muscle sites, suggesting that the decreased pain sensitivity previously observed in individuals at risk for hypertension may be related to enhanced central pain modulation.     

Induced Cytotoxicity and Cell Proliferation in the Hepatocarcinogenicity of Chloroform in Female B6C3F1 Mice: Comparison of Administration by Gavage in Corn Oil vs ad Libitum in Drinking Water

Chloroform increases the incidence of liver tumors in B6C3Fmice when administered in by gavage in corn oil, but not whengiven in the drinking water at similar daily doses. Since cytotoxicityand regenerative cell proliferation have been implicated inthe tumorigenic process for this nongenotoxic agent, these effectsof chloroform in corn oil and drinking water were evaluatedunder conditions similar to the two bioassays. Female B6C3Fmice were administered oral doses of 0, 3, 10, 34, 90, 238,or 477 mg/kg chloroform dissolved in corn oil 5 days/week forperiods of 4 days or 3 weeks, or were continually exposed tochloroform in the drinking water at concentrations of 0, 60,200,400, 900, or 1800 ppm for 4 days or 3 weeks, at which timethey were necropsied. 5-Bromo-2'-deoxyuridine (BrdU) was delivered via osmotic pumps implanted 3.5 days prior to necropsy.Cell proliferation was evaluated as the percentage of hepatocytes that entered S-phase over 3.5 days (labeling index, LI),measured by immunohistochemical detection of BrdU incorporatedinto the DNA. Dose-dependent changes included centrilobularnecrosis and markedly elevated LI in mice given 238 or 477 mg/kgchloroform in corn oil (the average daily doses that producedtumors in the cancer bioassay). The no-observed-effect levelfor histopathological changes was 10 mg/kg/day and for inducedcell proliferation was 34 mg/kg/day for chloroform given incorn oil. Chloroform given in the drinking water did not increasethe hepatic LI after either 4 days or 3 weeks in any of thedose groups, nor were any microscopic alterations observed inthe livers, even though the cumulative daily amount of chloroform ingested in the 1800-ppm exposure group was 329 mg/kg/day. The sustained increase in LI in the livers of mice administeredhepatocarcinogenic doses of chloroform in corn oil, but notfor chloroform in drinking water, is evidence that chloroform-inducedmouse liver cancer is secondary to events associated with inducedcytolethality and cell proliferation. The triggering of theseeffects appears to be dependent on both the rate and durationof chloroform delivery to the target tissues. Thus, the moststraightforward risk assessment for chloroform for this tissuewould assign no increased cancer risk for dosing regimens thatdo not induce cytolethality and cell proliferation.     

COMPARISON OF I.M. KETOROLAC TROMETAMOL AND MORPHINE SULPHATE FOR PAIN RELIEF AFTER CHOLECYSTECTOMY

I.m. ketorolac trometamol 30 mg was compared with morphine sulphate10 mg after chole-cystectomy in a double-blind, multiple dose,randomized study of 100 patients. Assessments of pain were madeimmediately after operation (day 1), and the next morning (day2). Pain intensity (verbal response score and visual analoguescale) was recorded before injection and then over a 6-h period.Pain relief was assessed also. The effect of ketorolac on operativeblood loss and platelet function was examined. Time to commencingoral intake and the duration of administration of i.v. fluidswere recorded. Adverse events were noted. Ketorolac producedsignificantly less analgesia than morphine on day 1, but onday 2 the two drugs produced a similar effect. Blood loss wasnot increased by ketorolac, although platelet function was impaired.Repeated i.m. administration of ketorolac did not produce anyserious adverse effects.