The Impact of an Instant Pregnancy Test Kit on the Operations of a Major Hospital Casualty Department

The records of all patients on whom a casualty department pregnancy test was performed during the first 4 months of 1986 were retrospectively examined and compared with the records of all patients who in the first 4 months of 1987 had had an instant pregnancy test performed in the same casualty department, to determine the impact of such a kit on diagnostic accuracy, operative procedures and related economic factors. It was demonstrated that instant pregnancy testing significantly improved the accuracy of provisional diagnoses and appeared to help in reducing the number of surgical procedures performed. Furthermore, it was shown that a combination of careful clinical assessment plus the appropriate application of an instant pregnancy test kit could result in a cost saving to the hospital of over $41,000 per annum.     

Dose response relationship of Haemophilus pleuropneumoniae aerosols in pigs

The virulence of Haemophilus pleuropneumoniae was quantitated for ten and 12 week old pigs following aerosol exposure. The volume and concentration of culture aerosolized, the estimated numbers of organisms inhaled by the pigs and the mortality rates at 72 hours postexposure were computed and used to calculate the LD50. There was correlation between the concentration of culture aerosolized, the amount of the estimated inhaled dose and the mortality rates. The ten week old pigs were apparently more susceptible to aerosols of H. pleuropneumoniae than the 12 week old pigs. The LD50 value or a multiple of it appears to be a reasonable basis for a standardized aerosol challenge of the immunity of pigs vaccinated with experimental or commercial H. pleuropneumoniae vaccines.     

Methylprednisolone therapy in multiple sclerosis: a profile of adverse effects.

A retrospective analysis of 350 treatment courses using high dose pulsed intravenous methylprednisolone for relapses of multiple sclerosis revealed a low number of adverse effects. This study confirms that high dose methylprednisolone is a safe therapeutic option in multiple sclerosis.     

Primary tumor control after radiotherapy for carcinoma of the bronchus

The primary tumor control and the appearance of distant metastasis was observed closely in 62 patients entered into a randomized controlled trial of the radiosensitizing drug, misonidazole, in carcinoma of the bronchus. Sixty-one of the 62 patients are now dead; an autopsy examination was carried out in 42 (69%). Although survival was comparable to that observed in similar studies, tumor persisted or recurred at the primary site in 95% (58/61) while 39% (24/61) showed no evidence for distant metastasis. In these patients, improvement in the primary tumor control would be important in extending survival.     

Anesthesia in head and neck surgery. Head and neck cancer surgery and maxillofacial trauma

Safe anesthetic management of head and neck surgery and maxillofacial trauma depends on an accurate identification of ancillary problems, precise intraoperative monitoring, and treatment. Protocols facilitate thorough management, and a discussion is provided.     

Treatment of alcoholic liver disease

With advances in our understanding of the pathophysiology of alcoholic liver disease, pharmacological treatments of some of the basic disease processes are now in sight. The most notable development has been the introduction of propylthiouracil for the treatment of alcoholic hepatitis. In a recent trial the mortality rate of patients treated with this drug was 62% lower than that of a control group. Its beneficial effects may stem not from its anti-thyroid properties but rather from other actions such as free radical scavenging. Corticosteroids now appear to have no place in the treatment of alcoholic liver disease. Anabolic steroids, however, show promise, though longer term trials are required before this can be confirmed. Colchicine, too, has been reported to improve survival in patients with established cirrhosis. More experience is required with this and other anti-inflammatory and anti-fibrogenic drugs. beta Adrenergic blocking drugs, such as propranolol, reduce portal venous pressure. In a trial among patients with alcoholic cirrhosis who had oesophageal varices, 39% of those receiving propranolol had not experienced a haemorrhage by 2 years compared with 74% in the control group. The mortality rates at this time were 28% and 49% respectively. Results of treatment once the first haemorrhage has occurred are less impressive. Treatment of the alcohol withdrawal syndrome in patients with liver disease is often problematic. The dose of any sedative should be reduced to 25-50% of the usual dose and sedatives should be avoided in patients who are encephalopathic. Once the patient has recovered from the acute illness, abstinence from alcohol remains the single most important factor that determines long term survival.