AN EPIDEMIOLOGICAL STUDY OF SCLERODERMA IN THE WEST MIDLANDS

A population based study of the occurrence of scleroderma wascarried out on the 4.1 million adult residents of the West MidlandsRegion. Seven separate sources were used to obtain cases. Thisfirst epidemiological study of scleroderma in the UK suggestsprevalence rates of 13 and 48 per million in males and femalesrespectively, with annual incidence rates of 1 and 6 per million.The peak age of onset is between 45 and 54 but new cases continueto arise even during the eighth decade. There is a pronouncedfemale excess, with a ratio of 6:1, this excess being particularlymarked in those under 45. It is difficult to assess the completenessof notification and thus the estimates should be consideredas minimum. There are, however, suggestions in these data thatthe completeness of recording was high. KEY WORDS: Prevalence, Incidence, Limited scleroderma, Diffuse scleroderma, CREST syndrome, Mixed connective tissue disease, Sex, Age     

The Effect of Methadone on the Immune Status of B6C3F1 Mice

Previously, morphine has been shown to elevate corticosteronevia the hypothalamic–pituitary–adrenal axis andto suppress the immune system. The present investigation soughtto determine if the µ-opiate receptor agonist methadoneincurred a similar immune suppression in B6C3F1 mice. Serummethadone and corticosterone levels peaked 1 hr following asingle subcutaneous injection of 20 mg/kg methadone HCl. Indeed,the rise in corticosterone levels paralleled that of methadone.After a single injection with 20 mg/kg methadone a pharmacokineticanalysis revealed a serum half-life of 2 hr. Following fiveinjections of methadone over a 24-hr period (every 6 hr), methadonelevels were elevated as would be expected; however, corticosteronelevels did not become elevated. This suggests that the abilityof methadone to elevate corticosterone becomes uncoupled followingrepeated dosing, indicative of either a tolerance or an increasedcatabolic mechanism. Moreover, dosing every 6 hr for 5 daysinduced an increase in the catabolism of methadone itself. Therefore,all assays were begun 1 hr after subcutaneous administrationof methadone HCl, a time at which both methadone and corticosteroneserum levels were elevated. The primary IgM antibody responseto sheep red blood cells (sRBC) was suppressed when splenocyteswere immunized in vitro. In contrast, animals immunized withsRBC and assayed for the primary IgM antibody response 4 dayslater were not suppressed. The activity of the resident macrophagesof the liver and spleen as measured by the uptake of ⁵¹C-sRBCwas suppressed in a dose-dependent manner. Previously, it hasbeen demonstrated that morphine suppresses hepatic and splenicphagocytic activity through an opiate receptor-mediated pathway that involves the release of corticosterone. It would appearthat methadone plays a similar role in the suppression of hepaticand splenic phagocytosis.     

Time of day effects in, and the relationship between, sleep quality and movement

The study aimed to measure the effects of a 27-h 'day' sleep-wake regime on actigraphic and subjective sleep variables, and to examine the relationships between these variables. Nine subjects spent 30 days and nights in the laboratory. After sleeping 8 h for each of 8 nights, the subjects had an imposed 27-h 'day', for 18 'days', remaining in bed for 9 h on each sleep period. Sleep periods therefore started 3 h later each day, although subjects' circadian rhythms stayed entrained to 24 h, because subjects were not isolated from the natural light-dark cycle. Time asleep, subjective sleep efficiency and subjective sleep quality, but not movement during sleep, were found to be significantly affected by time of going to bed. There were significant decreases in movement during recovery sleeps following each of two episodes of 26 h sleep deprivation. Over the study there were significant within-subject correlations between subjective sleep quality and subjective sleep efficiency (r_av=0.65), movement during sleep and subjective sleep efficiency (r_av=−0.48), and movement during sleep and subjective sleep quality (r_av=–0.26). We conclude that sleep movement, despite its low within-and between-subjects variability, is nevertheless a statistically reliable, but weak, indicator of subjective sleep efficiency and quality.     

INCREASED URINARY HYALURONIC ACID AND INTERSTITIAL CYSTITIS

Purpose

We compared urinary levels of hyaluronic acid in patients who met the National Institute for Diabetes, and Digestive and Kidney Diseases criteria for interstitial cystitis and in age matched healthy female controls.

Materials and Methods

Urinary hyaluronic acid was measured by solid phase radiometric assay using hyaluronic acid binding protein. Hyaluronic acid and symptom scores were compared in interstitial cystitis patients who gave multiple urine samples during treatment. Since hyaluronic acid changed with treatment in some patients, 17 samples from untreated interstitial cystitis patients were selected and compared with 17 control samples.

Results

Mean plus or minus standard deviation urinary hyaluronic acid concentrations were similar in the 2 groups (interstitial cystitis group 574 ± 496, controls 512 ± 324 ng./ml., p = 0.77). When normalized to creatinine urinary hyaluronic acid was significantly higher in interstitial cystitis patients (interstitial cystitis group 674 ± 220, controls 446 ± 220 ng./mg. creatinine, p = 0.0019). Urinary creatinine concentrations did not differ significantly (interstitial cystitis group 842 ± 715, controls 1,162 ± 516 mg./l., p = 0.12).

Conclusions

Urinary hyaluronic acid was higher in interstitial cystitis patients than healthy controls. Since bladder hyaluronic acid is below the epithelium, this finding may indicate leakage across the epithelium into the urine in interstitial cystitis patients.     

National survey of pediatric breathing systems use in the UK*

Aims: To determine current practice in the use of pediatric breathing systems in the UK. Background: Whilst the Ayres T‐Piece has been used extensively in pediatric anesthesia for nearly six decades, the circle system has undergone recent modifications. These have enhanced its suitability for pediatric use. Methods: A postal questionnaire was sent to all consultant members of the Association of Paediatric Anaesthetists (APA). This asked about standard breathing systems for induction, maintenance, and ventilation during anesthesia in three groups of children (neonates, infants, and older children less than 20 kg). Additional questions included if anesthetic rooms were used and scavenging routinely employed. Results: Replies were received from 337 members, giving a response rate of 75%. The T‐Piece was the predominant breathing system for induction in all age groups but the circle appears popular for maintenance, particularly in older children. Anesthetic rooms were used by 97% for induction and scavenging used by only 60% when using a T‐Piece. Conclusions: Despite significant improvements to the pediatric circle system and its practical advantages, the T‐Piece remains the commonest breathing system used in smaller children by UK members of the APA.     

Treadmill training with partial body-weight support in children with cerebral palsy: a systematic review

Aim  The aim of this systematic review was to examine the literature on the effects of partial body-weight support treadmill training (PBWSTT) in children with cerebral palsy (CP) on functional outcomes and attainment of ambulation.
Method  We searched the relevant literature from 1950 to July 2007. We found eight studies on the use of PWSBTT on functional outcomes in children with CP. The methodology to develop systematic reviews of treatment interventions as suggested by the American Academy of Cerebral Palsy and Developmental Medicine and the Critical Review Form-Quantitative Studies Methodological Quality was used to evaluate each article.
Results  As two of the eight published articles reported on different outcomes of the same study, this review reports on seven studies with a total of 41 children. The evidence for the functional effects is limited. Statistical significance is not demonstrated in several of the studies, despite reported improvements in gross motor function, functional status, walking performance, and gait parameters.
Interpretation  This systematic review is limited by the small number of participants, the heterogeneous level of abilities of participants from Gross Motor Function Classification System levels I to IV, and the low quality of trials. Because of these limitations, we cannot conclude that PBWSTT results in improvements for children with CP. Additional studies and well-established randomized controlled (or clinical) trials are clearly needed before determining the benefits and efficacy that would support continued use of this intervention in the clinical setting.     

Spontaneous Rupture of the Liver during Pregnancy: A Case Report

Hepatic congestion resulting in hepatic rupture during pregnancy is a rare yet catastrophic event carrying a 60 to 70% maternal mortality rate. With preeclampsia and associated epigastric pain continuing to be a major problem confronting pregnant women, hepatic congestion may be more prevalent than believed. Current etiology, treatment, and characteristics of women who experience hepatic rupture are examined. A case report and nursing protocol are presented.