Obesity: A public health problem in Ireland?

We examined the prevalence of different categories of body weight in a random sample of men and women aged 35 to 64 years studied in 1985 in County Kilkenny, Ireland. The largest group was those classified as overweight — 51.1% of men and 44.7 % of women. There were 13.7 % of men and 19.2% of women in the obese category. The obese were older but the distribution by social class did not differ significantly from the non-obese. Obese women had significantly more children born alive and a higher prevalence of positive angina questionnaire than those who were not obese. Serum total cholesterol was higher in obese men and HDL cholesterol was lower in obese men and obese women. Systolic and diastolic blood pressures were significantly higher in obese men and women but smoking status was similar. In a multiple logistic regression analysis, systolic blood pressure in men and diastolic in women remained significantly associated with obesity; there was an inverse association between obesity and HDL cholesterol in women and between obesity and HDL-cholesterol as a proportion of total cholesterol in men.     

Multidisciplinary preoperative assessment and late function in dysvascular amputees.

During a three-year period, 95 adults were treated by lower-extremity amputations for peripheral vascular insufficiency. A multidisciplinary team for presurgical evaluation determined all to be potentially independent walkers with a prosthesis. Patients were graded for level of independent walking before amputation and again at a minimum two-year follow-up examination using a seven-level functional grading system. Seventy-six of 90 patients (84%) ambulated within one functional level of their preamputation status. This return to preamputation level of function was maintained whether comparing preamputation functional level or surgical amputation level. Prosthetic use increased and the use of walking aids decreased with increased functional ambulation levels, but did not correlate with surgical levels. Peripheral vascular insufficiency patients can maintain walking independence. Multidisciplinary presurgical evaluation helps selection of the amputation level and correct prosthetic limb fitting.     

The relationship of proliferating cell density at the invasive tumour front with prognostic and risk factors in human oral squamous cell carcinoma

BACKGROUND: We hypothesise that the density of proliferating cells at the invasive tumour front (ITF) has a positive relationship with prognostic and risk factors in human oral squamous cell carcinoma (SCC). METHODS: Tissues from 47 human oral SCC specimens were collected and stained with a monoclonal antibody directed against the Ki-67 antigen using a horseradish peroxidase based two-step immunostaining method. Counting was performed on two parallel sections at the ITF using an image analyser. The Ki-67 labelling index (LI) was determined by measuring the number of nuclei/mm(2) of epithelium. RESULTS: Our results show that the density of proliferating cells is related to clinical staging, with advanced stage of disease having a significantly higher Ki-67 LI compared with early stage of disease (2111 +/- 905 vs. 1908 +/- 913; P = 0.03). Importantly, this study shows that tumours that have metastasised have a significantly higher Ki-67 LI than tumours where distant metastasis was not detected (3257 +/- 650 vs. 1966 +/- 881; P < 0.0001). CONCLUSIONS: Cell proliferation, as measured by the Ki-67 LI at the ITF, has a positive relationship with clinical staging, tumour thickness, smoking status of the patient and alcohol consumption. Further, we suggest that a multicenter study with a large cohort of patients is indicated to fully elucidate whether cell proliferation at the ITF is directly related to patient survival.     

Hypercholesterolaemia and a silent MI

Results of investigations in extraordinary patients should be dealt with cautiously; it is often prudent to repeat tests. Though the aims of treatment in such cases are often the same, differences in approach to the problem are illuminating.     

A model for sustainable short-term international medical trips.

The health status of many people in developing countries is often dismal compared with the norms in industrialized countries. Increasingly, medical practitioners in the United States and other industrialized countries have become interested in global health issues, an interest that often takes the form of short-term international medical trips. We discuss several ethical issues associated with participation in such trips and use our experiences in developing the Children's Health International Medical Project of Seattle (CHIMPS) to outline and illustrate a set of 7 guiding principles for making these trips. CHIMPS is a resident-run, faculty-supported international medical program founded in 2002 by pediatric residents at the University of Washington in Seattle. Members of CHIMPS work with a rural community in El Salvador to support ongoing public health interventions there and provide sustainable medical care in collaboration with the community and a local nongovernmental organization. The 7 principles developed as a result of this work-mission, collaboration, education, service, teamwork, sustainability, and evaluation-can be used as a model for health practitioners as they develop or select international medical trips. The importance of partnering with the community and working within the existing medical and public health infrastructure is emphasized. Many of the challenges of doing international medical work can be overcome when efforts are guided by a few specific principles, such as those we have outlined.     

Coagulopathy induced by aortoiliac aneurysms

Diffuse intravascular coagulopathy (DIC) or consumptive coagulopathy is infrequently associated with aortic aneurysms. When the two coexist, they create a difficult clinical problem that requires optimal medical and surgical care. Two cases of coagulopathy associated with aortoiliac aneurysm are presented to exemplify the broad clinical picture that can be present. The definitive treatment of DIC is removal of the underlying cause. The following recommendations are made for the management of patients with aortic aneurysms and possible coagulopathy: preoperatively examine the patient for hematomas and ecchymoses; measure levels of fibrinogen, platelets and fibrin degradation products and the prothrombin and partial thromboplastin times; perform arteriography and check puncture sites for spontaneous bleeding afterwards; at aneurysm repair ensure meticulous hemostasis and compensate for excessive blood loss by high-speed autotransfusion.     

Quantitation of photochemically induced focal cerebral ischemia in the rat

This study was carried out with a recently developed model of focal cerebral ischemia in the rat based on the photochemical induction of thrombotic stroke using the dye Rose Bengal. We examined the change in the volume of the lesion and brain water content, in separate groups of rats, at different times (1, 4, 24, 72, and 168 h) after the induction of the ischemic lesion. The volume of ischemic damage increased rapidly between 1 and 24 h after the ischemic insult and decreased between 24 and 168 h. The lesion at 168 h was significantly larger than that following 1 h of ischemia and similar to that obtained at 4 h, suggesting that the maximum extent of tissue damage (without the involvement of significant edema) was reached within the first 4 h in this model. The enlargement of the lesion after 4 h correlated closely with changes in brain water content.