In vitro bacterial contamination of amniotic fluid: effects on fluorescence polarization lung maturity testing

Objective: We sought to determine the effect of bacteria on fluorescence polarization (FPOL) testing of amniotic fluid.Methods: Fusobacterium necrophorum and Escherichia coli were inoculated at concentrations of 10(3) and 10(6)/ml in amniotic-fluid specimens from 4 patients with no clinical or laboratory evidence of infection. The FPOL results were obtained at inoculation and again at 24 h of incubation. The results were compared using analysis of variance (ANOVA).Results: The FPOL results from inoculated specimens were all within 2% of the uninoculated controls. The specimens incubated with bacteria showed a < 1-19% variation when compared with the time-zero uninoculated controls. However, uninoculated controls incubated for 24 h exhibited a 2-12% variation when compared with the time-zero controls, suggesting that the variation present was not secondary to the bacterial co-incubation.Conclusions: In vitro, neither bacterial inoculation nor prolonged co-incubation influences FPOL results beyond the effect of incubation alone. FPOL appears to be an appropriate test to assess fetal lung maturity in patients in whom intraamniotic infection is a concern.     

Teicoplanin vs. vancomycin for the treatment of serious infections: a randomised trial

A prospective, randomised study of 56 patients comparing teicoplanin with vancomycin for suspected or proven severe Grampositive infection was conducted. The majority of infections were soft tissue infections (8 teicoplanin; 16 vancomycin) and by chance a significantly higher number of Hickman catheter-related infections occurred in the vancomycin arm (4 vs. 14, P < 0.01). Teicoplanin was administered as a single daily dose of 400 mg iv or im; 5 patients received 200 mg following the initial dose of 400 mg. Vancomycin was given 1 g every 12 h. Fifty-four patients were evaluable for efficacy (26 teicoplanin, 28 vancomycin). Of these, 18 episodes in 17 patients (teicoplanin) and 19 episodes in 18 patients (vancomycin) gave an evaluable clinical response, the success rates being similar (76% teicoplanin; 68% vancomycin). Staphylococcus aureus was the most common pathogen isolated; all pathogens were susceptible to both glycopeptides with MICs < 4 mg/l. Bacteriological elimination rates were similar in both groups (71% teicoplanin; 78% vancomycin). Significantly more patients given vancomycin experienced adverse events (7 teicoplanin; 16 vancomycin; P = 0.03). This caused treatment to be discontinued in 4 cases, compared with only one receiving teicoplanin. The most common vancomycin-related events were histamine-associated reactions (15 patients), including 2 cases of Red Man Syndrome, and nephrotoxicity (5 patients). There were no histamine-mediated events and only one case of nephrotoxicity with teicoplanin. Teicoplanin and vancomycin show similar clinical and bacteriological efficacy and teicoplanin is significantly less toxic and easier to use in patients with severe infection.     

Occupational class and ischemic heart disease mortality in the United States and 11 European countries.

OBJECTIVES: Twelve countries were compared with respect to occupational class differences in ischemic heart disease mortality in order to identify factors that are associated with smaller or larger mortality differences. METHODS: Data on mortality by occupational class among men aged 30 to 64 years were obtained from national longitudinal or cross-sectional studies for the 1980s. A common occupational class scheme was applied to most countries. Potential effects of the main data problems were evaluated quantitatively. RESULTS: A north-south contrast existed within Europe. In England and Wales, Ireland, and Nordic countries, manual classes had higher mortality rates than nonmanual classes. In France, Switzerland, and Mediterranean countries, manual classes had mortality rates as low as, or lower than, those among nonmanual classes. Compared with Northern Europe, mortality differences in the United States were smaller (among men aged 30-44 years) or about as large (among men aged 45-64 years). CONCLUSIONS: The results underline the highly variable nature of socioeconomic inequalities in ischemic heart disease mortality. These inequalities appear to be highly sensitive to social gradients in behavioral risk factors. These risk factor gradients are determined by cultural as well as socioeconomic developments.     

Cancer incidence among first generation Scottish, Irish, West Indian and South Asian migrants living in England and Wales

Objectives. To examine the incidence of cancers among persons born in Scotland, Northern Ireland, the Irish Republic, Caribbean Commonwealth and Indian subcontinent and living in England and Wales. Methods. Longitudinal Study of 1% of population of England and Wales followed from 1971 to 1989. Standardised incidence ratios (SIRs) were derived for commonly occurring cancers and all cancers using the age-sex-specific rates for all females and all males in the Longitudinal Study. Results. The incidence of all malignant neoplasms among West Indians (females SIR = 67, male SIR = 70) and Indians (female SIR = 32, male SIR = 52) was low. Among South Asians, this pattern was consistent for Hindus, Sikhs and Moslems. Scottish females showed raised incidence of lung cancer (SIR = 149) and those from the Irish Republic of oral cavity and pharynx (SIR = 321), oesophageal (SIR = 219) and liver (SIR = 373) cancers. Among Northern Irish females, incidence of lung cancer (SIR = 193) was raised. West Indian and South Asian females showed low incidence of breast cancer (SIR = 55 and 45, respectively). High incidence of laryngeal (SIR = 229) and renal (SIR = 203) cancers was observed for Scottish males and of oral cancer (SIR = 259) for males from the Irish Republic. At ages 15-64, raised incidence of prostate cancer (SIR = 129) and of leukaemia (SIR = 252) was also observed for men from the Irish Republic. Northern Irish males showed raised incidence of stomach cancer (SIR = 200). Conclusion. This study describes patterns of cancer incidence among migrant groups, most of which reflect environmental influences. This has challenging implications for sensitive targeting of primary interventions. It is important not to be complacent about lower risks of main cancers among West Indians and South Asians. In all Longitudinal Study members, breast cancer was the most common malignancy among females and lung cancer among males. This was also true for all migrant groups with the exception of Northern Irish women for whom lung cancer was the most common.     

Staff confidence in dealing with aggressive patients: a benchmarking exercise

Interacting with potentially aggressive patients is a common occurrence for nurses working in psychiatric intensive care units. Although the literature highlights the need to educate staff in the prevention and management of aggression, often little, or no, training is provided by employers. This article describes a benchmarking exercise conducted in psychiatric intensive care units at two Western Australian hospitals to assess staff confidence in coping with patient aggression. Results demonstrated that staff in the hospital where regular training was undertaken were significantly more confident in dealing with aggression. Following the completion of a safe physical restraint module at the other hospital staff reported a significant increase in their level of confidence that either matched or bettered the results of their benchmark colleagues.     

Radiation exposure of the families of outpatients treated with radioiodine (iodine-131) for hyperthyroidism.

Patients who receive radioiodine (iodine-131) treatment for hyperthyroidism (195-800 MBq) emit radiation and represent a potential hazard to other individuals. Critical groups amongst the public are fellow travellers on the patient's journey home from hospital and members of the patient's family, particularly young children. The dose which members of the public are allowed to receive as a result of a patient's treatment has been reduced in Europe following recently revised recommendations from ICRP. The annual public dose limit is 1 mSv, though adult members of the patient's family are allowed to receive higher doses, with the proviso that a limit of 5 mSv should not be exceeded over 5 years. Unless the doses received during out-patient administration of radioiodine can be demonstrated to comply with these new limits, hospitalisation of patients will be necessary. The radiation doses received by family members (35 adults and 87 children) of patients treated with radioiodine at five UK hospitals were measured using thermoluminescent dosimeters mounted in wrist bands. Families were given advice (according to current practice) from their treatment centre about limiting close contact with the patient for a period of time after treatment. Doses measured over 3-6 weeks were adjusted to give an estimate of values which might have been expected if the dosimeters had been worn indefinitely. Thirty-five passengers accompanying patients home after treatment also recorded the dose received during the journey using electronic (digital) personal dosimeters. For the "adjusted" doses to infinity, 97% of adults complied with a 5-mSv dose limit (range:0.2-5.8 mSv) and 89% of children with a 1-mSv limit (range: 0.2-7.2 mSv). However 6 of 17 children aged 3 years or less had an adjusted dose which exceeded this 1 mSv limit. The dose received by adults during travel was small in comparison with the total dose received. The median travel dose was 0.03 mSv for 1 h travel (range: 2 microSv-0.52 mSv for 1 h of travel time). These data suggest that hyperthyroid patients can continue to be treated with radioiodine on an out-patient basis, if given appropriate radiation protection advice. However, particular consideration needs to be given to children aged 3 years or younger. Admission to hospital is not warranted on radiation protection grounds.     

Voltage-dependent calcium channel subtypes controlling somatic substance P release in the peripheral nervous system

1. Isolated rat dorsal root ganglia (DRG) neurones support vesicular, non synaptic release of substance P in a depolarisation and Ca2+ dependent manner. 2. In vivo this process may mediate cross-communication between DRG cells in some neuropathological conditions and is therefore a putative area for drug intervention. 3. The authors investigated the voltage-dependent Ca2+ channel (VDCC) subtypes involved in somatic release of substance P. Fresh (< 1 day) cultures of DRG neurones were incubated with high K+ depolarising saline in the presence and absence of subtype selective VDCC blockers. Substance P released into the external media was collected and quantified using a radioimmunoassay. 4. The results show that L-type and N-type, but not P-type, VDCCs play an important role in high K+ evoked substance P release from rat DRG neurones.     

Experimental lead arthropathy: an animal model

BACKGROUND: We previously demonstrated short-term effects of intra-articular lead on joint structures in an animal model. We now present histopathologic findings in animals studied over a more extended period. METHODS: Twelve female New Zealand White rabbits had identical lead or stainless steel pellets, or a sham arthrotomy (without implant) inserted in both front knees. The rabbits were killed 4 at a time at 6, 10, and 14 weeks after implantation, and the knee joint structures were evaluated histologically for changes in the synovium, articular cartilage, and meniscus. RESULTS: Histology of the tibial articular surface, femoral articular surface, medial meniscus, lateral meniscus, and synovium showed greater signs of degeneration in the knees with lead implants than controls at all time periods. CONCLUSION: Intrasynovial lead, which does not undergo fibrous encapsulation, has been linked to lead intoxication. Clinical and experimental reports support removal of lead bodies from articular areas in an attempt reduce or slow the degeneration of affected joints. Nonmechanical effects of lead on intraarticular structures may lead to degenerative changes