The price of a drink: levels of consumption and price paid per unit of alcohol by Edinburgh's ill drinkers with a comparison to wider alcohol sales in Scotland

Aim To compare alcohol purchasing and consumption by ill drinkers in Edinburgh with wider alcohol sales in Scotland. Design Cross‐sectional. Setting Two hospitals in Edinburgh in 2008/09. Participants A total of 377 patients with serious alcohol problems; two‐thirds were in‐patients with medical, surgical or psychiatric problems due to alcohol; one‐third were out‐patients. Measurements Last week's or typical weekly consumption of alcohol: type, brand, units (1 UK unit 8 g ethanol), purchase place and price. Findings Patients consumed mean 197.7 UK units/week. The mean price paid per unit was £0.43 (lowest £0.09/unit) (£1 = 1.6 US$ or 1.2€), which is below the mean unit price, £0.71 paid in Scotland in 2008. Of units consumed, 70.3% were sold at or below £0.40/unit (mid‐range of price models proposed for minimum pricing legislation by the Scottish Government), and 83% at or below £0.50/unit proposed by the Chief Medical Officer of England. The lower the price paid per unit, the more units a patient consumed. A continuous increase in unit price from lower to higher social status, ranked according to the Scottish Index of Multiple Deprivation (based on postcode), was not seen; patients residing in postcodes in the mid‐quintile paid the highest price per unit. Cheapness was quoted commonly as a reason for beverage choice; ciders, especially ‘white’ cider, and vodka were, at off‐sales, cheapest per unit. Stealing alcohol or drinking alcohol substitutes was only very rarely reported. Conclusions Because patients with serious alcohol problems tend to purchase very cheap alcohol, elimination of the cheapest sales by minimum price or other legislation might reduce their consumption. It is unknown whether proposed price legislation in Scotland will encourage patients with serious alcohol problems to start stealing alcohol or drinking substitutes or will reduce the recruitment of new drinkers with serious alcohol problems and produce predicted longer‐term gains in health and social wellbeing.     

Laser Ablation Facilitates Closure of Chronic Enterocutaneous Fistulae

This report describes the use of laser ablation for treatment of chronic enterocutaneous fistulae (ECFs) after failure of conservative therapy. Three patients underwent laser ablation for treatment of 8 ECFs. Mean duration of fistula patency was 28 months with mean fistula output of 134 mL/day. The initial technical success was 100% with no major or minor complications. Three ECFs required repeat treatment. At mean follow-up of 53 days, 7 of the fistulae were occluded. One fistula showed a markedly reduced output of 10 mL/day.     

Fistulography of a Patent Hemodialysis Access: When Not to Treat and Implications for Establishing a Nontreatment Rate

Purpose

To establish a rate of nonintervention in patients referred for hemodialysis access fistulography and to report clinical and fistulographic variables associated with nonintervention.

Laparoscopic appendectomy in young female patients: Should we remove the normal-looking appendix?

Objective : This study evaluated whether a significant reduction in unnecessary appendectomies is possible by performing diagnostic laparoscopy before appendectomy in female patients of child-bearing age, leaving behind the normal-looking appendix. Materials and methods : Sixty-one consecutive female patients between the ages of 15 and 45 years with clinical diagnosis of acute appendicitis were studied prospectively. Diagnostic laparoscopy was performed to detect whether the appendix was inflamed. The appendix was then removed and the result of laparoscopic diagnosis was matched with histological diagnosis. Results : Ten out of the 42 laparoscopically diagnosed appendicitis cases had normal appendices on histological examination. Six out of the 19 laparoscopically diagnosed normal appendices had histological evidence of appendicitis. The sensitivity of laparoscopy was 84% and the specificity was 56.5%. Conclusions : Discrepancies existed between laparoscopic appearance and histological examination in acute appendicitis. The appendices of all those with clinically suspected appendicitis should be removed and sent for histological confirmation.      

The effect of temperature on contractile activation of intact and chemically skinned ‘catch’ muscle fibre bundles of Mytilus edulis

Summary The effect of temperature (5–35° C) on maximum force production was examined in intact and chemically skinned muscle fibre bundles (10–25 fibres) from the anterior byssus retractor muscle of Mytilus edulis. In intact fibre bundles, 10 m acetylcholine induced a tonic contraction which had a magnitude of 65.4±4.0 N cm^-2 (n=30) at 23° C. Activation by caffeine (20 mm) produced a force response which was 157.1±7.9% (n=16) of the acetylcholine response at 23° C and acetylcholine and caffeine together produced force which was not significantly different from the response to caffeine alone. At 5° C the acetylcholine and caffeine responses were decreased by 9.6±3.4% (n=6) and 14.6±2.8% (n=8) compared with the respective responses at 23° C. However, there was no significant reduction of the response induced by the combined action of acetylcholine and caffeine when the temperature was decreased from 23° C to 5° C. The 20–80% of peak force activation time increased by about one order of magnitude for all acetylcholine, caffeine and combined acetylcholine-caffeine-induced responses when the temperature was decreased from 23–5° C. Repeated exposure of the intact preparation to caffeine caused a marked decrease in the caffeine-induced response (complete abolition of force after the third exposure to caffeine), but the response to caffeine could be fully restored following one acetylcholine-induced activation. The maximum Ca²⁺-activated force after skinning the preparation with saponin was not significantly different from the caffeine or combined acetylcholine-caffeine-induced responses before skinning. In the saponin skinned fibre preparation a drop in temperature from 23° C to 15° C or 5° C decreased the maximum Ca²⁺-activated force by 13.2±1.4% (n=8) and 41.4±3.1% (n=5) respectively. The activation time between 20–80% of the peak Ca²⁺-activated force increased at 15° C and 5° C by a factor of 1.5±0.1 (n=5) and 6.8±1.1 (n=5) respectively when compared to corresponding values at 23° C. The relaxation half-time decreased by a factor of 1.7±0.2 (n=5) and 3.0±0.2 (n=5) at 15° C and 5° C respectively compared with that at 23° C. It was possible to distinguish between the temperature effects on the contractile apparatus per se and the Ca²⁺ regulatory system with the results indicating that the contractile apparatus was more sensitive to a change in temperature than the Ca²⁺-regulatory system. Increasing the temperature to 35° C irreversibly affected the ability to develop and maintain force in both intact and skinned muscle preparations. These results indicate that: (1) acetylcholine does not fully activate the intact catch muscle at 23° C; (2) acetylcholine is able to replenish the internal stores after depletion by caffeine; (3) compensatory mechanisms which oppose the inhibitory effect of lower temperatures on the contractile apparatus and the Ca²⁺-regulatory system must be operating in the intact fibre preparations.     

双氯芬酸钠经皮电穿孔及电离子导入的研究

目的：考察离子导入和电穿孔对双氯芬酸钠经皮渗透的影响。方法：采用双室扩散池和SD大鼠皮、进行双氯芬酸钠饱和水溶液经皮被动扩散、离子导入（0．5mA/cm^2)和电穿孔导入（130V,740ms或100ms,200个脉冲,方波,占空比1：1）的 研究。结果：电穿孔和离子导入均能显著促进双氯芬酸钠的经皮渗透,其增渗倍数分别为25．1和7．5。延长脉冲7时间将改善电穿孔的促渗效果,初步研究表明本实验条件的电穿孔及离子导入未引起皮肤的损伤。结论：电穿孔技术可用于促进小分子解离型药物的经皮渗透。