Pesticide poisoning in the developing world--a minimum pesticides list

In parts of the developing world, pesticide poisoning causes more deaths than infectious diseases. Use of pesticides is poorly regulated and often dangerous; their easy availability also makes them a popular method of self-harm. In 1985, the UN Food and Agriculture Organisation (FAO) produced a voluntary code of conduct for the pesticide industry in an attempt to limit the harmful effects of pesticides. Unfortunately, a lack of adequate government resources in the developing world makes this code ineffective, and thousands of deaths continue today. WHO has recommended that access to highly toxic pesticides be restricted--where this has been done, suicide rates have fallen. Since an Essential Drugs List was established in 1977, use of a few essential drugs has rationalised drug use in many regions. An analogous Minimum Pesticides List would identify a restricted number of less dangerous pesticides to do specific tasks within an integrated pest management system. Use of safer pesticides should result in fewer deaths, just as the change from barbiturates to benzodiazepines has reduced the number of deaths from pharmaceutical self-poisoning.     

The value of clinical, biochemical, ultrasound and liver biopsy data in assessing patients with liver disease

To determine the value of clinical, biochemical, ultrasound and liver biopsy data in the management of patients with liver disease, eight doctors each assessed 75 case histories. With clinical and biochemical data alone, the predictive accuracy was significantly higher when identifying patients as 'medical' rather than 'surgical' (97 compared with 79%, p less than 0.001). However, when making a specific diagnosis as opposed to classifying into medical and surgical categories, clinical and biochemical information resulted in a much lower predictive accuracy for both medical (67%) and surgical (56%) patients. With ultrasound data the predictive accuracy increased to 91% when identifying patients as 'surgical'; with liver biopsy it increased to 99% when identifying patients as 'medical'. The value of the different data assessed involves more than an evaluation of diagnostic accuracy, and in this study the relative worth of each test was therefore assessed on a five point scale based on the effect of the information on the doctors. This included a willingness to give specific treatment and make a specific diagnosis, as well as classifying patients into medical and surgical categories and the confidence they felt in their diagnoses. After clinical, biochemical and ultrasound information the doctors were only prepared to give specific treatment to 11.9% of the medical and 9.3% of the surgical patients. After liver biopsy data, however, they were willing to give specific treatment to an additional 66.6% of the medical patients and 25% of the surgical patients. Further evidence of the value of liver biopsy information came from an analysis of the changes in the doctors' confidence in a diagnosis. Thus, 96 patients were assigned a correct specific diagnosis with clinical and biochemical data alone but none were considered as 'definitive' by the doctors; when liver biopsy information was provided 59 (61%) were placed in this category.     

Use of polyunsaturated phosphatidyl choline in HBsAg negative chronic active hepatitis: results of prospective double-blind controlled trial

In a prospective double-blind trial, polyunsaturated phosphatidyl choline therapy (3 g/day) was given in addition to normal maintenance immunosuppressive therapy to 15 patients with HBsAg negative chronic active hepatitis. Histological evidence of disease activity was significantly reduced in the phospholipid-treated group. The results indicate that polyunsaturated phosphatidyl choline is of value as additional treatment in the management of patients with HBsAg negative chronic active hepatitis whose disease is inadequately controlled with conventional doses of immunosuppressive therapy.     

The M22 antibody identifies highly activated reactive astrocytes responding to central nervous system disease

Astrocytes respond vigorously to diverse neurological insults. It is still not clear, however, whether this response is stereotypic following different insults or varies according to the injury. We have used a novel immunocytochemical marker of reactive astrocytes, termed M22, together with antibodies to glial fibrillary acidic protein (GFAP), to analyze region- and insult-specific differences in reactive astrocytosis in the murine central nervous system (CNS). Pathology was variously induced by (1) infectious agents, (2) transgenic overexpression of a viral glycoprotein or cytokine, or (3) focal trauma. Scrapie infection induced high levels of both GFAP and M22 epitope expression by hippocampal reactive astrocytes, but neither scrapie nor wild mouse retrovirus infection induced detectable M22 staining in reactive astrocytes of the caudal brain. Focal trauma and human immunodeficiency virus gp120 overexpression induced M22 expression only in the hippocampus, while interleukin-6 overexpression induced it in cerebellar astrocytes. Although M22 expression was limited to areas with extensive damage, GFAP expression was induced in every region of the mouse brain displaying pathology. Staining of routinely fixed human brain tissue demonstrated that M22 also labeled reactive astrocytes in chronic human CNS disease. The restriction of M22 expression to areas of strongly GFAP-positive astrocytosis suggests that the M22 antibody identified highly activated reactive astrocytes. Because of this selective staining of activated astrocytes, the M22 antibody may provide neuropathologists with a good marker for qualitative analysis of the astrocytic response to different injuries. Received: 21 February 1995 / Revised, accepted: 25 September 1995     

Adenocarcinoma of rete testis

Adenocarcinoma of the rete testis is a very rare malignant neoplasm originating in the epithelium of the rete testis. Histologically, it appears as a papillary adenocarcinoma. The first case was reported in the literature in 1853 and since that time only 16 additional cases have been reported. This report represents the eighteenth case.     

ASSESSMENT OF ESOPHAGEAL LEAR WITH ORAL FLUORESCEIN

Esophageal perforation may occur spontaneously or as a complication of esophageal operations. Treatment often mandates emergency operative intervention to close the leak or to provide adequate drainage. Recurrent or persistent leak can lead to prolonged drainage before final heating. We describe herein a minimally invasive and inexpensive technique using fluorescein dye that can confirm the persistence of esophageal leak drained by tube thoractomy without requiring expensive and potentially morbid invasive or radiological techniques. Application of this technique assists in diagonosis when previously described minimally invasive techniques are impractical or yield inconclusive results.     

Asymptomatic proteinuria. Benign disorder or harbinger of disease?

Proteinuria may be an indication of underlying disease or may be found in various physiologic states. Careful quantitation of urinary protein and thorough patient evaluation are necessary to determine if proteinuria is cause for concern. Transient and orthostatic proteinuria appear to be benign, but persistent proteinuria may be a manifestation of serious disease.