Low adrenal androgen output in patients with abnormal laryngeal epithelium

We present 16 new patients who had abnormal vocal cord biopsies. Each had a serum sex hormone profile performed on the morning of the procedure. The striking abnormality was that 12 (75%) had low dehydroepiandrosterone sulphate (DHEAS), the main adrenal androgen, and four of these had prepubertal levels.     

Fetal abdominal protuberance ratio throughout pregnancy

We defined ``fetal abdominal protuberance ratio' as the ratio between the abdominal circumference (AC) and the distance between the anterior border of the fetal aorta and the posterior surface of the fetal skin (AO-P) and measured it in a total of 358 fetuses between 13 and 40 weeks. The AC and AO-P diameters both grew with gestational age but the increment was steeper for the AC which means a higher protuberance ratio with advancing gestational age. Received: 7 June 1995 / Accepted: 29 May 1996     

Child day care and home injuries involving playground equipment

Abstract The increasing number of children attending child day care has led to a corresponding concern for their safety in the absence of parental care. Previous studies have documented that the majority of injuries occurring in child day care involve falls, and that the most common consumer product associated with such falls is playground equipment. This study describes New Zealand children less than 5 years of age admitted to hospital between 1979 and 1988 for injuries associated with playground equipment located at home or a child care facility. There were 528 hospitalized home injuries involving playground equipment, and 145 such day care injuries. Fractures were the most common injury, and the head was the most commonly involved body region. Lower limb injuries were the most severe. Among the differences between home and day care injuries were the type of equipment involved. Swings were disproportionately associated with head injuries.     

Performance and standards for the process of head and neck cancer care: South and West audit of head and neck cancer 1996-1997 (SWAHN I). South and West Regional Cancer Organisation Tumour Panel for Head and Neck Cancer

Evidence suggests wide variation in cancer care between different hospitals in the UK. To establish bench-marking data, we designed a prospective, 1 year regional study comparing key performance measures with established standards for the 28 hospital Trusts in the South and West of England involved in head and neck cancer care. 566 sequential patients with a newly-diagnosed head and neck cancer were included. Numbers referred and treated per hospital Trust were 1-58 and 1-65 respectively. 59% of patients received a pretreatment chest X-ray (standard 95%). 45% of patients were seen in a multidisciplinary clinic pretreatment (standard 95%), and this was proportional to the frequency of clinics held (P<0.0001). Median number of cases treated per surgeon was 4 (1-26), and by radiotherapist was 10 (1-51). Times between parts of the process of oral cancer care were closer to the standards than those for laryngeal cancer. Two patients were entered into a clinical trial. One had a quality-of-life score. Thus, in 1996-1997, in the South and West of England, there were major discrepancies between actual performance and established standards in many fundamental aspects of head and neck cancer care. Re-audit is essential to determine if the implementation of the Calman-Hine report has resulted in improvements.     

The prognostic value of the tumour marker Cyfra 21-1 in carcinoma of head and neck and its role in early detection of recurrent disease

This study examines a new tumour marker, Cyfra 21-1, as a prognostic marker in predicting the survival of H&N cancer patients, and its correlation with clinical outcome during prolonged follow up of these patients. The study included 67 patients with primary detection of carcinoma of H&N. The survival of these patients was evaluated in correlation with the disease stage and Cyfra 21-1 levels at initial diagnosis. 38 patients were followed clinically and with serial assays for at least 12 months, or until recurrence was diagnosed. Cyfra 21-1 levels were determined periodically, using an Elisa kit. Patients with Cyfra 21-1 < 1.5 ng ml(-1)had a higher survival rate compared to patients with Cyfra 21-1 > or = 1.5 ng ml(-1)(63% vs. 20%, respectively). The risk ratio of Ln(Cyfra 21-1) is 1.62 (P = 0.028). In a Cox regression model that included the disease stage and Ln(Cyfra 21-1), Ln(Cyfra 21-1) was preferred as the main parameter for predicting patients survival. In 83% of the 12 patients with recurrent or residual disease, Cyfra 21-1 was elevated before or during clinical detection of the recurrence. Cyfra 21-1 was found to be a prognostic marker for carcinoma of H&N, unrelated to the stage of the disease. Elevated levels of Cyfra 21-1 without clinical evidence of disease can be attributed to the marker's mean lead-time as compared to the clinical appearance of the disease.     

STUDIES ON MATURITY IN NEWBORN INFANTS

Five anthropometric measurements, birth weight, crown-heel length, head circumference, occipito-frontal diameter, and bi-parietal diameter were recorded in a group of 174 newborn infants of various gestational ages. The material was selected to contain a relatively large number of infants with extreme birth weights and/or gestational ages. Head circumference was better correlated to gestational age than were the other four measurements. Birth weight and crown-heel length had the same degree of correlation to gestational age. The two skull diameters showed significantly lower correlations to gestational age. The confidence limits for estimating gestational age on the basis of the mean value for head circumference were ±26.1 days in this material. In SGA infants, crown-heel length and head circumference were not significantly greater than in pre-term infants of the same birth weight.     

Open label, multi-centre phase II study of raltitrexed (`Tomudex') in patients with inoperable squamous-cell carcinoma of head and neck

Background:Raltitrexed (`Tomudex') is a folate based inhibitorof thymidylate synthase which has been registered in Europe and Australia forthe treatment of advanced colorectal cancer. In a European phase I trial ofraltitrexed anti-tumour activity was seen in two patients with head and neckcancer, prompting the current study. Patients and methods:From November 1996 to December 1998, 24patients with metastatic or recurrent squamous-cell carcinoma of the head andneck from 7 Australian centres received raltitrexed, 3 mg/m² givenintravenously over 15 minutes every 3 weeks, for a maximum of 6 cycles.Patients were required to be chemotherapy naïve and have measurabledisease, age >18 years, WHO performance status initially 2, nosignificant intercurrent illness or organ dysfunction and a life expectancy>12 weeks. Results:Twenty-two men and two women, median age 65 years, medianperformance status 1 were enrolled. Fifteen patients (63%) had receivedboth prior surgery and radiotherapy. In 15 patients (63%) there wasrecurrent locoregional disease only. Twelve patients (50%) received onecycle of treatment with only four patients (17%) receiving four or morecycles of treatment. No patient achieved a complete or partial response,although 5 patients experienced stable disease which lasted a median of 188days (range 61–436). The median survival for the whole group was 101days (range 20–436). Raltitrexed was generally well tolerated withminimal anti-proliferative toxicity. Conclusions:Single-agent raltitrexed does not demonstratesignificant anti-tumour response rates in patients with predominantly locallyrecurrent head and neck cancer.     

Influence of the femoral head size on early postoperative gait restoration after total hip arthroplasty

Background We investigated the effects of using large-diameter femoral heads in total hip prostheses on eady postoperative gait restoration in patients undergoing total hip arthroplasty (THA). Methods We collected data for 19 primary THAs using 28-mm metal-on-polyethylene heads (conventional group) and for 12 THAs (BHR group) using metal-on-metal femoral heads with an average size of 45 mm (range, 40-49 mm). All patients had unilateral femoral head avascular necrosis. All patients underwent Harris Hip Scores evaluation and gait analysis with the IDEEA device at the same 3 time points which were before surgery and then at 1 month and again at 3 months after surgery, and the parameters measured were walking speed, stride length (SL), single limb support (SLS), cycle duration (CD), and swing power (SP). Harris Hip Scores and gait analysis parameters for both groups were compared.Results Intraclass comparison indicated that Harris Hip Scores, speed scores, and gait parameter measures in both groups improved significantly with the passage of time; Interclass comparison showed no significance between Harris1m postop - Harrispreop and Harris3m postop- Harrispreop in both groups. The speed in the BHR group at 1 month and at 3 months after surgery was significantly higher than that of conventional group. At 1 month after surgery, each mean for SLnormal-SLaffected, (SLSnormal - SLSaffected)/CD, and SPnormal - SPaffocted in the BHR group was significantly lower than that for the conventional group. At 3 months after surgery, the differences between means for both groups for SLnormal - SLaffected.(SLSnormal- SLSaffected)/CD, and SPnormal - SPaffected were not significant, but the mean of SPnormal - SPaffected in the BHR group was significantly lower than that in the conventional group.Conclusions Our data suggest that large-diameter femoral heads in THA provide better early gait restoration than conventional-size femoral heads.     

中药对股骨头缺血坏死修复过程中血管内皮生长因子基因表达的影响

目的：探讨具有活血补肾作用的中药丹仙康骨胶囊对股骨头缺血坏死修复过程中血管内皮生长因子(VEGF)基因表达的影响。方法：采用手术方法制作兔股骨头缺血坏死模型，应用逆转录一聚合酶链反应(RT-PC=R)、免疫组化、微血管灌注及组织形态学方法观察中药丹仙康骨胶囊治疗兔股骨头坏死过程中血管内皮生长因子基因(VEGFmRNA)表达、血管生成及骨组织修复情况。结果：股骨头坏死模型组4周时可见有坏死骨周围VEGFmRNA表达呈阳性，但随着时间的推移而减少，至8、12周时VEGFFmRNA表达均为阴性，再生血管密度低，只见少量间充质细胞增生及新骨形成；丹仙康骨胶囊治疗组至8、12周时VEGFmRNA表达呈强阳性，并可见明显血管增生，血管密度显著增高，大量新骨形成。结论：活血补肾的丹仙康骨胶囊能促进股骨头缺血坏死修复过程中VEGFmRNA的表达、血管的再生和新骨的形成。     

新骨生胶囊治疗股骨头坏死的药理研究

目的探讨中药新骨生胶囊治疗无菌性股骨头坏死的机理。方法采用口服维甲酸致小鼠和大鼠骨质变性模型。 30只昆明小鼠分为 3组 ,未服药者作为正常组 ( 10只 ) ,模型组 ( 10只 )和治疗组 ( 10只 )均服维甲酸 ,治疗组同时服新骨生胶囊 ,观察时间为 3周。 18只Wistar大鼠分为 3组 ,未服药者为正常组 ( 6只 ) ,模型组 ( 6只 )和治疗组 ( 6只 )切除睾丸 ,并服维甲酸 ,治疗组同时服新骨生胶囊 ,观察 5周。观察小鼠自发活动变化 ,用双能X线检测大鼠的骨密度 ,并用HE染色观察病理改变。结果小鼠模型自发运动 (横向和纵向 )明显减少 (P <0 .0 1) ;模型大鼠平均骨密度、股骨重量及重量系数明显低于正常组 (P <0 .0 1)。病理切片可见股骨头关节软骨表层有缺损、骨化线紊乱、骨小梁变细 ,出现死骨。经新骨生胶囊治疗 5周后 ,治疗组与正常组相比未见显著性差异。结论新骨生胶囊具有促进骨质修复的作用