Comparison of Cytology and Cervkography in Screening a High Risk Australian Population for Cervical Human Papillomavirus and Cervical intraepithelial Neoplasia

Summary: Two different screening methods, the Papanicolaou (Pap) smear and cervigram were compared in screening 245 Sydney women over a 6-month period in 1988 at a city sexually transmitted diseases (STD) centre, for cervical human papillomavirus (HPV), cervical intraepithelial neoplasia (CIN) and cervical cancer. The Pap smear through the identification of cytologically abnormal cells correctly detected 54% of cases of histologically proven CIN and 39.2% of cases of HPV. The cervigram through the identification of acetowhite epithelium and/or abnormal vessels on the cervix correctly detected 64% of cases of histologically proven CIN and 70.6% of cases of HPV. However, when both tests were used together, 92% of CIN lesions and 82.4% of HPV lesions were correctly identified. Histology of a colposcopically directed biopsy was used as the 'gold standard'. The sensitivity and specificity of the Pap smear after correction for verification bias was 46% and 78% respectively, and for the cervigram was 49% and 60% respectively. Hence neither screening test appears adequate on its own, at least in an STD population.     

Clinical significance of anismus in encopresis

Treatments designed to relieve paradoxical contraction of the anal sphincters during defecation (anismus) have had limited success in children with encopresis. This has raised doubts as to the clinical relevance of this diagnosis in childhood as anorectal dysfunction. Our aim was to determine whether, in patients who had treatment-resistant encopresis, the presence of electromyographic anismus was associated with increased faecal retention. Sixty-eight children with soiling (mean age 8.7 ± 2.06 years) were assessed by clinical examination, abdominal radiography and then with anorectal manometry. Patients with electromyographic anismus (n= 32; 47%) had significantly increased radiographic rectal faecal retention and were significantly less likely to be able to defecate water-filled balloons. There were no significant differences in response to prior therapy, history of primary encopresis, behavioural adjustment or in sociodemographic data. Our results suggest that electromyographic anismus is associated with obstructed defecation and faecal retention.     

Mine Blast Injuries - Our Experience

Background

The sudden increase in incidence and magnitude of mine blast injuries prompted us to highlight the problem and its management.

Methods

The cases of mine blast injuries occurring during mining and demining in a particular geographical area were analysed. Total 27 cases of mine blast injuries occurred during mining or demining operations in a period of 13 months.

Results

Various body regions were involved in the mine blast injuries but the main brunt was borne by feet and legs followed by multiple body regions due to splinters. 14 patients underwent below knee (BK) amputation while 4 patients required through knee (TK) amputations. The effect of blast was so severe that most of the cases required 2 to 5 times wound debridements. The initial aggressive debridement / open stump amputation saved the limb and life of all patients.

Conclusion

A mine blast causes extensive injuries and psychological trauma. Management is needed urgently, surgery is difficult, and amputation is often inevitable. Maximum lives and limbs can be saved with aggressive debridement, repeated inspections and dressings under anaesthesia and definitive closure at optimum time.Key Words: Amputation, Antipersonnel mine, Crush syndrome, Debridements, Mine blast injury, Secondary missiles, Shrapenels     

Self-rated health in a longitudinal perspective: a 9-year follow-up twin study

OBJECTIVES: This study first considers age and cohort explanations for age-related changes in mean values and variance in self-rated health. Second, it evaluates the contributions of genes and environments to self-rated health measured longitudinally. METHODS: Subjects were participants in the Swedish Adoption/Twin Study of Aging. Self-rated health assessments were collected in four waves over a 9-year follow-up period, from one or both members of 788 twin pairs. Linear mixed effect models were used to test for differences in means and variances. Structural equation modeling provided estimates of genetic and environmental components of variance and contributions to stability. RESULTS: Changes in means and variance within cohorts seem to reflect illness. Earlier-born cohorts are more variable and have lower self-rated health. These cohort differences were not explained by childhood socioeconomic status. Correlations between time points reflect both environmental and genetic factors. DISCUSSION: Both genes and environments contribute to self-rated health longitudinally, and both age and cohort effects are seen. Age-related changes in self-rated health can be attributed to illness. Cohort differences are most likely attributable to socially mediated and individual-specific environmental factors.     

Prekallikrein-Kallikrein conversion rate as a predictor of contrast material catastrophies

An in vitro is described that attempts to detect patients with a potential for adverse systemic reactions to contrast material. This test involves measuring the rate of conversion of prekallikrein to kallikrein under certain standard conditions. In a preliminary retrospective study, the test could be used to identify such patients with a sensitivity of 88%, a specificity of 82%, and a predictive value of 79%.     

Protective effect of breastfeeding against urinary tract infection

Aim: To assess the possible protective effect of exclusive breastfeeding against first‐time febrile urinary tract infection (UTI) in children. Methods: Two children's hospitals and local child health centres in the Göteborg area, Sweden, participated in a prospective case‐control study. In total, 200 consecutive cases (89M, 11 1F), aged 0–6 y, presenting with first‐time febrile UTI were enrolled. The mean ± SD age was 0.98 ± 1.15y. As control subjects, 336 children (147M, 189F) were recruited from the child health centre of the case, matched for age and gender and included consecutively for each case during the first days after diagnosis. The duration of exclusive breastfeeding was obtained from the case and controls by a standardized procedure. Results: Ongoing exclusive breastfeeding gave a significantly lower risk of infection. A longer duration of breastfeeding gave a lower risk of infection after weaning, indicating a long‐term mechanism. The protective role of breastfeeding was strongest directly after birth, then decreased until 7 mo of age, after which age no effect was demonstrated. Conclusion: A protective role of breastfeeding against UTI was demonstrated. The study provides statistical support to the view that breast milk is a part of the natural defence against UTI.     

Emission of hexanal and carbon monoxide from storage of wood pellets, a potential occupational and domestic health hazard

OBJECTIVES: The objective of the present study was to investigate and describe the emissions of volatile compounds, particularly hexanal and carbon monoxide, from large- and small-scale storage of wood pellets. METHODS: Air sampling was performed with Fourier transform infrared spectroscopy and adsorbent sampling in pellet warehouses, domestic storage rooms, lumber kiln dryers and experimental set-ups. Literature studies were included to describe the formation of hexanal and carbon monoxide and the toxicology of hexanal. RESULTS: A arithmetic mean aldehyde level of 111 +/- 32 mg/m(3) was found in one warehouse, with a peak reading of 156 mg/m(3) [correction]. A maximum aldehyde reading of 457 mg/m(3) was recorded at the surface of a pellet pile. Hexanal (70-80% w/w) and pentanal (10-15% w/w) dominated, but acetone (83 +/- 24 mg/m(3)), methanol (18 +/- 7 mg/m(3)) and carbon monoxide (56 +/- 4 mg/m(3)) were also found. The emissions in a domestic storage room varied with the ambient temperature and peaked after 2 months storage in the midst of the warm season. Aldehyde levels of 98 +/- 4 mg/m(3) and carbon monoxide levels of 123 +/- 10 mg/m(3) were recorded inside such storage rooms. Elevated levels of hexanal (0.084 mg/m(3)) were recorded inside domestic housing and 6 mg/m(3) in a room adjacent to a poorly sealed storage area. Experimental laboratory studies confirmed the findings of the field studies. A field study of the emissions from industrial lumber drying also showed the formation of aldehydes and carbon monoxide. CONCLUSIONS: High levels of hexanal and carbon monoxide were strongly associated with storage of wood pellets and may constitute an occupational and domestic health hazard. The results from lumber drying show that the emissions of hexanal and carbon monoxide are not limited to wood pellets but are caused by general degradation processes of wood, facilitated by drying at elevated temperature. Emission of carbon monoxide from wood materials at low temperatures (<100 degrees C) has not previously been reported in the literature. We postulate that carbon monoxide is formed due to autoxidative degradation of fats and fatty acids. A toxicological literature survey showed that the available scientific information on hexanal is insufficient to determine the potential risks to health. However, the data presented in this paper seem sufficient to undertake preventive measures to reduce exposure to hexanal.     

Using Standardized Oral Examinations to Evaluate General Competencies

Emergency medicine residency programs are required by the Accreditation Council for Graduate Medical Education (ACGME) to formally evaluate each resident with oral and written examinations. The Michigan State University Emergency Medicine Residency Program in Lansing conducts monthly standardized oral examinations (SOEs) as part of each resident's evaluation. Recently, the ACGME has advanced six areas, termed "general competencies," that should be acquired during graduate medical education. According to the ACGME, these competencies should be included in the educational process of all residency programs. In promulgating these competencies, the ACGME did not provide examples of core content, strategies for implementation, or methods of evaluation; rather, individual residency programs are required to develop their own methods. The authors describe a modification of an existing SOE strategy that assesses residents' knowledge, skills, experiences, and attitudes as reflected in the general competencies.