Distribution and dosimetry of Thorotrast in USUR case 1001.

The distribution of radioactivity and the associated doses were evaluated postmortem for USUR Case 1001, a female who had been injected with Thorotrast some 36 y prior to death. The distribution was determined for four nuclides: 232Th and its decay products, 228Ra and 228Th; and 230Th, a contaminant associated with Thorotrast. More than 90% of the activity was associated with the reticuloendothelial system. Approximately 32% of the total activity was found in the total skeleton (mineral bone and bone marrow), which is somewhat higher than expected from the literature. The 44% found in the liver and 12% in the spleen were somewhat lower than expected. This difference may be attributable, in part, to the initial deposition as influenced by colloidal particle size and to the radiation-induced hyposplenism, splenic atrophy, and slight hepatic atrophy observed at autopsy. In addition, roughly 3% of the activity was found in the Thorotrastoma and surrounding carotid artery tissue. Estimated lifetime absorbed doses from the 232Th series were 15 Gy to the liver, 121 Gy to the spleen, 4 Gy to the skeleton, and 16 Gy to the Thorotrastoma. Comparable dose equivalents to these tissues are 300, 2420, 80, and 320 Sv, respectively, assuming a quality factor of 20 for alpha irradiation.     

Immunization coverage, infant morbidity and infant mortality in Freetown, Sierra Leone.

The study, which is based on data from a household level health survey conducted in 1990 in Freetown, Sierra Leone, examines the coverage of an Expanded Program on Immunization (EPI), infant mortality, and infant morbidity among children in Greater Freetown, capital of Sierra Leone. The results of the study indicate that there was a decline in infant mortality in the recent period of the survey, 1988-89, compared to earlier periods. This decline seemed to have been the result of immunization coverage, which considerably increased by 1989-90, reaching above 70% of the children under age 5. The study further reveals that the increased immunization coverage of children and their mothers might have considerably reduced the incidence of tetanus. While reduction of tetanus might have played the leading role in the latest reduction in infant mortality, the incidence of diarrhea, measles, and malaria continued to be high, suggesting that the increase in the quality and quantity of basic immunizations, oral therapy for diarrheal disease, and provision of chloroquine and improved drugs for malaria disease could further reduce most of the deaths from these prevailing diseases among children under age 5.     

Qualitative differences in [Ca2+]i increases and InsP3 generation following stimulation of N1E-115 cells with micromolar and millimolar ATP.

Addition of ATP (100 microM) to populations of the neuronal cell line N1E-115 caused a transient increase in intracellular calcium ([Ca2+]i) which rapidly reached a peak (maximum of 243 +/- 7 nM above basal) and returned to basal after approximately 50 sec. The response was concentration-dependent (EC50 21 +/- 4 microM) and was unchanged when calcium was omitted from the extracellular medium. Transient increases in D-myo-inositol-1,4,5-trisphosphate levels (InsP3) were also observed over a similar time period. Addition of millimolar ATP, however, produced characteristically different responses; [Ca2+]i again increased rapidly (reaching a maximum of 639 +/- 23 nM above basal) but returned to a new maintained plateau (274 +/- 34 nM) which was abolished by the inorganic calcium channel blocker, nickel (1 mM), and omission of calcium from the extracellular medium. InsP3 levels were also maintained but were, however, unaffected by nickel or removal of extracellular calcium. The qualitative difference in the mechanism of calcium elevation produced with millimolar ATP, compared with lower concentrations, suggests that the N1E-115 cells might also contain a low affinity P2 receptor coupled with a calcium channel.     

Improved detection of antibodies to hepatitis C virus in dialysis patients using a second-generation enzyme immunoassay.

We tested serum samples from 99 patients undergoing maintenance hemodialysis for hepatitis C virus (HCV) antibodies using a first-generation, licensed anti-HCV enzyme immunoassay (EIA) and a second-generation anti-HCV EIA that detect three gene products c100-3, NS3, and core. Specimens that were repeatedly reactive by either or both screening assays were further evaluated by testing with supplemental EIAs and a dot blot immunoassay. There was 87.9% agreement between the licensed HCV EIA and the HCV EIA second generation. HCV EIA Second Generation detected 10 more positive specimens than HCV EIA, for an increase in detection from 33.3% (33/99) to 43.4% (43/99). We conclude that HCV EIA Second Generation improves detection of HCV infection in hemodialysis patients.     

The Staffing of Inpatient Child and Adolescent Mental Health Services

Background:  There is a need for more accurate information regarding the staffing of Child and Adolescent Psychiatric inpatient units. This is both to facilitate clinical governance and to allow planning and focused further development of these services.
Method:  Postal surveys were sent to all units in England and Wales.
Results:  Seventy-three percent ( n  = 1060) of the 1460 staff employed by the units were nurses; 43% of nurses were unqualified. On average there was one consultant psychiatrist for every 25 patients. Only 12% of nurses working on a 'census' day held a specialist qualification in nursing children. The use of agency and bank staff was higher in independent sector units than in NHS units (37% vs 10% of all nurses who worked a shift on the census day).
Conclusions:  Some child and adolescent inpatient units are not staffed by a multi-disciplinary team. There is evidence of problems of recruitment and retention of nurses.     

Malignancy following surgery for benign peptic disease: a review.

Since 1986 there have been a number of large studies of cancer risk after surgery for benign disease involving over 20,000 patients followed for at least 20 years. All show that gastric surgery carries an excess risk of gastric cancer after a 15-20 year latency. There is less agreement about the excess risk at other sites. The size of such risks appears to depend on the size of cohort, type of ulcer, type of surgery, length of follow-up and level of analytical detail. Statistically significant excess risks have been reported for cancer of the colon (6/8 studies), biliary tract (4/5), lung (6/6), bladder (3/3), pancreas (4/7) and all sites (2/3). Our own study showed an excess risk of cancer of the gallbladder (14.3 fold), stomach (4.5), breast (4.0), bronchus (3.9), large bowel (1.6), oesophagus (2.3), pancreas (4.0), bladder (2.4) and all sites (3.3).