Drivers' differential perceptions of legal and safe driving consumption

UK drink-drive countermeasures have been grounded in deterrence theory and more specifically through per se legislation. Education and information campaigns to stimulate inhibitory behavioural systems have emphasized the legal limit in terms of “driving safeness”. This study examined the relationship between subjective perceptions of safe driving and legal driving consumption limits and other factors important in the decision to drive after drinking. Responses from over 900 drivers established that those who perceived safe consumption levels to be greater than that required to break the law indicated reduced moral commitment to present and possible future countermeasures. These drivers also had previous experience of being breath tested (but not charged with a drink-driving offence), reported comparatively lower estimates of their chances of apprehension and accident involvement when over the legal limit, showed higher consumption levels on a driving trip and greater self-reported driving while impaired by alcohol. The implications of the findings for the development and delivery of measures to counter drink-driving are discussed.     

Non-prescribed drug use during methadone treatment by clinic- and community-based patients

We investigated the efficacy of methadone maintenance treatment in clinic-based (n= 10) and community-based (n= 10) patients by studying the relationships between dose, plasma concentrations of methadone and non-prescribed drug-use using logistic regression. We found that clinic-based patients had significantly reduced odds of having a urine sample test positive for illicit drugs when compared to community-based patients (OR = 0.20; 95% confidence interval 0.10–0.38: p < 0.001). There was no relationship between either methadone dose or plasma methadone concentration and testing positive for non-prescribed drugs (including cocaine, cannabis, amphetamine, ecstasy, benzodiazepines). We looked specifically at the misuse of opiate drugs. Location was again important and clinic-based patients had significantly reduced odds of having a urine sample test positive for opiate drugs (OR= 0.36, 95% confidence internal 0.13–0.71: p～0.004). Opiate drug use in our patients was also significantly related to plasma methadone concentration, increasing noticeably when the drug concentration < 0.48 nmol/L (p～0.04). We found no relationship between methadone dose and odds of having a positive urine drug test in either clinic- or community-based patients.     

Technique and Results of Cardiac Transplantation Using "Domino-Donor" Hearts

Heart-lung transplantation is now well established for treatment of patients with terminal cardiopulmonary disease. More than 50% of heart-lung transplant recipients have normal or near normal hearts, with the majority having some degree of right ventricular hypertrophy. This potential source of "prepared" cardiac allografts remained untapped until the introduction of the "domino-donor" operation, a procedure in which the heart-lung recipient serves as a cardiac donor. The implantation of these available allografts contributes to the alleviation of the short supply of donor organs for cardiac transplantation. Aspects of the surgical technique, results, and potential benefits of this procedure are presented.     

Unilateral groin surgery in children: will the addition of an ultrasound‐guided ilioinguinal nerve block enhance the duration of analgesia of a single‐shot caudal block?

Background: Inguinal hernia repair, hydrocelectomy, and orchidopexy are commonly performed surgical procedures in children. Postoperative pain control is usually provided with a single‐shot caudal block. Blockade of the ilioinguinal nerve may lead to additional analgesia. The aim of this double‐blind, randomized controlled trial was to evaluate the efficacy of an adjuvant blockade of the ilioinguinal nerve using ultrasound (US) guidance at the end of the procedure with local anesthetic vs normal saline and to explore the potential for prolongation of analgesia with decreased need for postoperative pain medication. Methods: Fifty children ages 1–6 years scheduled for unilateral inguinal hernia repair, hydrocelectomy, orchidopexy, or orchiectomy were prospectively randomized into one of two groups: Group S that received an US‐guided ilioinguinal nerve block with 0.1 ml·kg^?1 of preservative‐free normal saline and Group B that received an US‐guided nerve block with 0.1 ml·kg^?1 of 0.25% bupivacaine with 1 : 200 000 epinephrine at the conclusion of the surgery. After induction of anesthesia but prior to surgical incision, all patients received caudal anesthesia with 0.7 ml·kg^?1 of 0.125% bupivacaine with 1 : 200 000 epinephrine. Patients were observed by a blinded observer for (i) pain scores using the Children and Infants Postoperative Pain Scale, (ii) need for rescue medication in the PACU, (iii) need for oral pain medications given by the parents at home. Results: Forty‐eight patients, consisting of 46 males and two females, with a mean age of 3.98 (sd ± 1.88) were enrolled in the study. Two patients were excluded from the study because of study protocol violation and/or alteration in surgical procedure. The average pain scores reported for the entire duration spent in the recovery room for the caudal and caudal/ilioinguinal block groups were 1.92 (sd ± 1.59) and 1.18 (sd ± 1.31), respectively. The average pain score difference was 0.72 (sd ± 0.58) and was statistically significant (P < 0.05). In addition, when examined by procedure type, it was found that the difference in the average pain scores between the caudal and caudal/ilioinguinal block groups was statistically significant for the inguinal hernia repair patients (P < 0.05) but not for the other groin surgery patients (P = 0.13). For all groin surgery patients, six of the 23 patients in the caudal group and eight of the 25 patients in the caudal/ilioinguinal block group required pain rescue medications throughout their entire hospital stay or at home (P = 0.76). Overall, the caudal group received an average of 0.54 (sd ± 1.14) pain rescue medication doses, while the caudal/ilioinguinal block group received an average of 0.77 (sd ± 1.70) pain rescue medication doses; this was, however, not statistically significant (P = 0.58). Conclusions: The addition of an US‐guided ilioinguinal nerve block to a single‐shot caudal block decreases the severity of pain experienced by pediatric groin surgery patients. The decrease in pain scores were particularly pronounced in inguinal hernia repair patients.     

Review: Glial lineages and myelination in the central nervous system

Oligodendrocytes, derived from stem cell precursors which arise in subventricular zones of the developing central nervous system, have as their specialist role the synthesis and maintenance of myelin. Astrocytes contribute to the cellular architecture of the central nervous system and act as a source of growth factors and cytokines; microglia are bone-marrow derived macrophages which function as primary immunocompetent cells in the central nervous system. Myelination depends on the establishment of stable relationships between each differentiated oligodendrocyte and short segments of several neighbouring axons. There is growing evidence, especially from studies of glial cell implantation, that oligodendrocyte precursors persist in the adult nervous system and provide a limited capacity for the restoration of structure and function in myelinated pathways damaged by injury or disease.     

Skin changes caused by d-penicillamine treatment of arthritis

The clinical, histological and immunopathological details of three cases with a d -penicillamine-induced eruption are presented. The skin changes included (1) pemphigus erythematosus, (2) pemphigus foliaceus, (3) a bizarre localized pruritic papular eruption, the immunopathology of which was characteristic of lupus erythematosus and (4) fragility due to loss of dermal collagen. Circulating IgA was abnormally low in two cases and circulating immune complexes were demonstrated in the third case.