A retrospective study into the occurrence of cervical glandular atypia in cone biopsy specimens from 1977–1978 with clinical follow-up

Cervical glandular atypia (CGA) is now increasingly recognized in cone biopsy specimens removed for suspected cervical intra-epithelial neoplasia, although little is known of its natural history or pre-malignant potential. One hundred and eighty-three cone biopsy specimens received in our department during 1977 and 1978 from the City and Women's hospitals, Nottingham were reviewed and assessed for the presence of squamous CIN and CGA. One hundred and sixty-seven cone biopsies contained CIN and 28 of these also contained CGA. Ten cone biopsies contained high-grade CGA, the remaining 17 containing low-grade CGA. One cone biopsy contained high-grade CGA only. Twenty-one of the 28 cases of CGA had been followed up by annual pelvic examination and cervical cytology. None of these cases have developed abnormal cervical cytology or invasive cervical carcinoma after 13 years follow-up, even though 13 cone biopsies contained CGA which appeared to be incompletely excised. We concluded that if CGA is pre-malignant, the latent period for its progression to invasive carcinoma is in excess of 13 years. CGA of either grade is not, in itself, an indication for hysterectomy, allowing a conservative approach to management in the first instance.     

A phase II study of biochemotherapy for the treatment of metastatic malignant melanoma

The use of interleukin-2 (IL-2) and interferon-alpha (IFNalpha) in combination with chemotherapy for the treatment of advanced malignant melanoma has generated considerable interest. In particular, the relatively high number of durable complete responses has suggested this may be a significant advance in the treatment of malignant melanoma. We report our experience at the University of Colorado in 43 patients, including many with poor prognostic factors. Patients received cisplatin 20 mg/m2 on days 1-4, vinblastine 1.6 mg/m2 on days 1-4, dacarbazine 800 mg/m2 on day 1, IL-2 9 x 10(6) IU/m2 per day intravenously over 24h on days 1-4 and IFNalpha 5 x 10(6) IU/m2 per day subcutaneously on days 1-5 every 3 weeks. The median follow-up for all patients was 34 months. Responses were seen in 20 patients (47%, 95% confidence interval 31-62%) and comprised five complete responses (CRs) (12%) and 15 partial responses (PRs) (35%). Two patients achieving a CR remain disease free at 45 and 47 months follow-up. In addition three patients who obtained a surgical CR and another with only minor residual changes on computed tomography scan have not progressed at 27, 30, 40 and 27 months, respectively. Toxicity was manageable, but all patients had at least one grade 3 or 4 toxicity, predominantly hypotension and neutropenia. There were no treatment-related deaths. In conclusion, the response rate and duration is within the range previously reported for biochemotherapy. The results of ongoing randomized studies are awaited to better define the value of biochemotherapy in the treatment of advanced melanoma.     

Low-level lead exposure alters morphine antinociception in neonatal rats

Administration of lead (at 300 and 1000 ppm) in the maternal drinking water from conception to weaning impaired the antinociceptive activity of morphine in 10-day-old neonatal rats. Blood lead levels in these animals were below 50 μ/100 ml in the high lead dose group and below 35 μg/100 ml in the low lead dose group. The differences in the antinociceptive potency of morphine between normal and lead-exposed animals were not observed at later time points (21 and 30 days). It is suggested that lead disrupts the development of opioid receptor systems in the central nervous system and that this disruption occurs early in development.     

Biodynamic response at the palm of the human hand subjected to a random vibration

This study investigated the biodynamic response (BR) distributed at the palm of the hand subjected to a random vibration. Twelve male subjects were used in the experiment. Each subject applied three coupling actions (grip-only, push-only, and combined grip and push) on a simulated tool handle at three different levels (50, 75, and 100 N) of palm force. This study found that the hand-arm system resonated mostly in the frequency range of 20 to 50 Hz, depending on the specific test treatment and individual characteristics. The maximum vibration power transmission through the palm occurred at the resonant frequency. Increasing the effective palm force generally increased the BR magnitude and resonant frequency. The apparent stiffness measured at the middle frequencies (80-100 Hz) is correlated to the BR in almost the entire frequency range (20-1,000 Hz). Under the same palm force, the push-only action corresponded to the highest BR values while the grip-only action generally produced the lowest values. Since the resonant frequency range matches the dominant vibration frequency range of many percussive tools, it is anticipated that the palm BR and vibration power transmission may have an association with vibration-induced injuries or disorders in the wrist-arm system among the workers using these tools.     

Evaluation of nonculture methods for the detection of prosthetic hip biofilms

Authors of previous studies have found that culture-based detection of prosthetic hip infections can be improved by adherence to strict anaerobic protocols and mild ultrasonication of retrieved prostheses to remove bacteria growing as an adherent biofilm. Furthermore, direct analyses of sonicate samples by immunofluorescence microscopy (with genus-specific and species-specific monoclonal antibodies or polyclonal antisera) produces significantly greater and more rapid detection rates for infection compared with culture alone. Despite its diagnostic value within a research setting, the practical advantages and limitations of immunofluorescence microscopy for a busy diagnostic laboratory needs consideration. In addition, the method must be evaluated against other nonculture-based techniques that may prove more appropriate. In this review, we describe how immunofluorescence microscopy presents an attractive and reliable method for routine detection of prosthetic hip biofilms compared, primarily, to polymerase chain reaction, although other nonculture methods of diagnosis based on fluorescent in situ hybridization and serologic analysis are considered. We describe how the immunofluorescence microscopy technique is robust, relatively simple and, in contrast to broad-range 16S recombinant-deoxyribonucleic-acid-based polymerase chain reaction, does not require a separate clean-room facility or strict adherence to aseptic techniques. More importantly we highlight how dislodged biofilm, which appears as large aggregates of bacteria, easily can be identified from skin contaminants that occur as single cells or small aggregates of only a few cells.     

US demographic trends in mid-arm circumference and recommended blood pressure cuffs: 1988-2002

Mid-arm circumference (AC) measurement is a prerequisite for the selection of properly sized blood pressure (BP) cuffs and accurate BP readings. This study examined trends in the frequency distribution of mid-AC and corresponding recommended BP cuff sizes using National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and NHANES 1999-2002 data. Both surveys used a complex sample design to obtain nationally representative samples of the civilian noninstitutionalized US population. The sample consisted of 7453 men and 8372 women from NHANES III and 4295 men and 4838 women from NHANES 1999-2002. Mean mid-AC (cm) and associated American Heart Association-defined cuff sizes were assessed. Variables were analysed by gender, age, race/ethnicity, and by hypertension or diabetic co-morbidity. Mid-AC increased significantly between surveys for all age groups; the greatest increase in mid-AC occurred in the 20-39 year age group. Data from NHANES 1992-2002 show that among nonHispanic white and nonHispanic black men aged 20-59 years, the mean mid-AC was >34 cm. Among NHB women aged 40 years and above, the mean mid-AC was greater than or equal to 34 cm. In all, 42% of all men and 26% of all women aged 40-59 years required large BP cuffs. In all, 39% of individuals classified as hypertensive and 47% of self-reported diabetics required a BP cuff greater than the standard adult size. In conclusion, mean mid-AC has increased across many demographic subgroups in the US with implications for the accuracy of BP measurement in clinical practice.