Nontraumatic terminal ileal perforation

Background  

There is still confusion and controversy over the diagnosis and optimal surgical treatment of non traumatic terminal ileal perforation-a cause of obscure peritonitis.     

Opportunistic and systematic screening for chlamydia: a study of consultations by young adults in general practice

BACKGROUND: Opportunistic screening for genital chlamydia infection is being introduced in England, but evidence for the effectiveness of this approach is lacking. There are insufficient data about young peoples' use of primary care services to determine the potential coverage of opportunistic screening in comparison with a systematic population-based approach. AIM: To estimate use of primary care services by young men and women; to compare potential coverage of opportunistic chlamydia screening with a systematic postal approach. DESIGN OF STUDY: Population based cross-sectional study. SETTING: Twenty-seven general practices around Bristol and Birmingham. METHOD: A random sample of patients aged 16-24 years were posted a chlamydia screening pack. We collected details of face-to-face consultations from general practice records. Survival and person-time methods were used to estimate the cumulative probability of attending general practice in 1 year and the coverage achieved by opportunistic and systematic postal chlamydia screening. RESULTS: Of 12 973 eligible patients, an estimated 60.4% (95% confidence interval [CI] = 58.3 to 62.5%) of men and 75.3% (73.7 to 76.9%) of women aged 16-24 years attended their practice at least once in a 1-year period. During this period, an estimated 21.3% of patients would not attend their general practice but would be reached by postal screening, 9.2% would not receive a postal invitation but would attend their practice, and 11.8% would be missed by both methods. CONCLUSIONS: Opportunistic and population-based approaches to chlamydia screening would both fail to contact a substantial minority of the target group, if used alone. A pragmatic approach combining both strategies might achieve higher coverage.     

The relationship between social support and health-related quality of life in patients with antiphospholipid (hughes) syndrome

Objective: Antiphospholipid (Hughes) syndrome (APS) is recognised as a systemic autoimmune disease defined by recurrent thromboembolic events and/or pregnancy morbidity. Little is known about the psychological burden of this long-term condition. This study aims to explore the relationship between social support and health-related quality of life (HRQoL) in patients with APS.

Methods: A total of 270 patients with a clinical diagnosis of APS participated in a cross-sectional online questionnaire survey. Data included demographics, disease-related information, social support and HRQoL.

Results: Both perceived and ideal social support were associated with HRQoL in APS. Patients reported receiving insufficient social support. Perceived emotional support was related to physical functioning (B?=?7.77, p?=?.006, 95% CI: 2.25, 13.29); perceived instrumental support was associated with bodily pain (B?=?17.52, p? .001, 95% CI: 11.15, 23.90) and perceived informational support with physical and social functioning (B?=??6.30, p?=?.05, 95% CI: ?12.52, ?0.08; B?=?8.06, p?=?.02, 95% CI: 1.17, 14.94). Ideal emotional support was related to physical and social functioning (B?=?5.80, p?=?.04, 95% CI: 0.26, 11.34; B?=?7.53, p?=?.04, 95% CI: 0.55, 14.51); ideal instrumental support was associated with mental health (B?=?4.73, p?=?.03, 95% CI: 0.38, 9.07) and ideal informational support with vitality (B?=?5.85, p?=?.01, 95% CI: 1.23, 10.46).

Conclusion: Social support was linked to HRQoL in patients with APS. Insufficient social support was associated with limitations in various HRQoL domains. Increasing social support especially through provision of disease-specific education might contribute to improving HRQoL in patients with APS. Patient-tailored interventions addressing psychosocial aspects of living with APS are needed to improve patients’ psychological and physical status.     

The risk of prostate cancer amongst South Asian men in southern England: the PROCESS cohort study

OBJECTIVE

To reinvestigate whether South Asian men in the UK are at lower risk of being diagnosed with prostate cancer in a UK‐based retrospective cohort study and to examine possible reasons that may explain this.

PATIENTS AND METHODS

The catchment areas were predefined in four areas of southern England, and age‐ and race‐specific populations for those areas taken from census data. Cases were ascertained through review of multiple hospital sources, while race, other demographic factors, and medical history were determined using questionnaires sent to the men, hospital records review and death certificates. The South Asian group included men of Indian, Bangladeshi and Pakistani origin.

RESULTS

There was modest evidence of lower prostate cancer rates in South Asian men compared with their White neighbours (age‐adjusted rate ratio 0.81; 95% confidence interval 0.65–1.00). This difference did not reflect less use of prostate‐specific antigen (PSA) testing or differences in clinical features at presentation.

CONCLUSION

This study provides evidence of a lower incidence of prostate cancer amongst South Asian men living in England, in comparison with their White counterparts. If anything, South Asian men presented with clinical features of earlier disease suggesting that the reduced risk is unlikely to be an artefact of poorer access to health care.     

Quantifying leukocytes in first catch urine provides new insights into our understanding of symptomatic and asymptomatic urethritis

We quantitatively investigated inflammatory cells in the male urethra. Leukocytes in the first catch urine (FCU) from 87 men with and without urethritis were quantitated using haemocytometer counts and stained with an anti-CD45 pan-leukocyte antibody. An increased number of leukocytes in FCU specimens was associated with urethritis (P > 0.002), the presence of discharge and/or dysuria (P < 0.001), and detection of Chlamydia trachomatis (P < 0.001) and Neisseria gonorrhoeae (P < 0.001). In men with urethritis, higher leukocyte counts were also observed in the above groups (P = 0.07, 0.03 and P < 0.0001, respectively). As leukocyte number increased, the likelihood of detecting either pathogen increased. This study suggests that symptoms and signs are a surrogate marker for the degree of inflammation present, and that as urethral inflammation increases, the likelihood of detecting a sexually transmitted pathogen also increases. This would explain why men with asymptomatic urethritis are less likely to have a sexually transmitted infection detected than those with discharge and/or dysuria.     

Continuous Observation of Rabbit Preimplantation Embryos In Vitro by Using a Culture Device Connected to a Microscope

We developed a compact culture device that maintains developing embryos in vitro under constant temperature and CO₂ concentration. Using this device, we cultured rabbit embryos from the pronuclear stage to the hatched blastocyst stage and recorded their development digitally for 7 d. Recorded images were converted to a movie, and the developmental movement of individual embryos was analyzed. With this culture system, we can observe embryonic development in a suitable environment continuously for several days; similar long-term observation is not possible in the conventional system. The proportion of embryos that developed from the pronuclear stage to the blastocyst stage was the same in the new system (73.1%; 38 of 52) as in the conventional (control) system (77.6%; 38 of 49). Compaction of embryos occurred from the 8-cell to the morula stage at 32.5 ± 0.71 h after insemination. The time of blastocyst formation (77.2 ± 3.2 h after insemination) varied somewhat between embryos. Average hatching time was 98.7 ± 4.4 h after mating. Therefore, the cleavage, blastomere movement, and hatching processes of blastocysts can be followed clearly and recorded by using this new culture system.Reproductive characteristics of the rabbit, such as easy manipulation of ovulation and the formation of blastocysts with far more inner cell mass cells than those of mice, make the rabbit an excellent model for the study of embryology, developmental biology, and genetic engineering.²⁶ The preimplantation rabbit embryo undergoes a rapid series of cell divisions resulting in a blastocyst with 128 cells by day 3 after fertilization.^1,5,11 Rabbit 1-cell embryos have successfully been cultured to blastocysts in a variety of complex media, including largely defined conditions.^4,12,13 Embryonic cells are sensitive to environmental changes: during in vitro culture of mammalian embryos, even a slight change in the culture conditions has lasting effects on the offspring.²¹ In addition to the medium composition, the gas phase and temperature of the medium are important factors influencing embryo development.Continuous observation of developing embryos in vitro is difficult. Heat stress during the critical stage of early embryo development increases the incidence of early embryonic death.²³ Therefore, a suitable atmospheric environment is necessary for normal embryonic growth in vitro.^12,14,23 An effective gaseous environment for culturing rabbit zygotes in synthetic medium is 10% CO₂ combined with 5% O₂.⁶ In conventional culture systems, cells and tissues are maintained in culture dishes, which are not airtight, in an incubator filled with an appropriate mixture of O₂ and CO₂. However, when the culture dish is removed from the incubator for examination of embryos, the CO₂ in the embryos’ environment is lost rapidly, thus increasing the pH of the medium, an effect that is likely to be detrimental to embryos. Continuous observation or recording of embryo growth requires maintaining a constant CO₂ concentration of the culture medium under the microscope.Here we describe a small airtight chamber that fits over the stage of the microscope and provides CO₂ gas perfusion. The incoming gas is humidified and warmed to the desired temperature before being passed over the cells. This apparatus, combined with a computerized digital image analysis system, enabled us to record the cell movement of rabbit preimplantation embryos continuously for 7 d. The device can be used for examination of virtually any type of cell over extended periods of time. Therefore, preimplantation embryos that are suitable for embryo transfer can be selected by close examination of the developmental pattern of the embryos.