Functional blockage of open comedones

Sebum excretion rate was measured by a photometric technique. We demonstrated a high correlation between sebum excretion rates on the left and right sides of the upper back and between back and forehead skin. Sebum excretion rate measurements overlying an open comedone (blackhead) were significantly lower than those obtained from normal skin. This observation demonstrates a functional obstruction to the outflow of sebum and would suggest that the lack of involvement of open comedones in inflammatory acne is not because of the maintenance of a free flow of sebum.     

COMPARISON OF THE EFFECTS OF ATROPINE AND GLYCOPYRROLATE ON COGNITIVE FUNCTION FOLLOWING GENERAL ANAESTHESIA

Tests of orientation, concentration and shortterm visual memorywere used to assess 72 patients 1 day before, and 2 days after,elective major surgery. Patients were premedicated with papaveretumand either atropine or glycopyrrolate, before receiving a standardgeneral anaesthetic. Those who had received atropine showedsignificant postoperative short-term memory deficit (P< 0.01),but no change in orientation or concentration. Those who hadbeen given glycopyrrolate showed no significant cognitive changesafter surgery. As glycopyrrolate does not cross the blood-brainbarrier freely, these findings support the involvement of centralcholinergic mechanisms in the deterioration of cognitive functionin the postoperative period.     

A Randomized‐Controlled Pilot Study Comparing ICD Implantation with and Without Intraoperative Defibrillation Testing in Patients with Heart Failure and Severe Left Ventricular Dysfunction: A Substudy of the RAFT Trial

Comparing ICD Implantation with and Without Intraoperative Defibrillation Testing. Introduction: The need to perform defibrillation testing (DT) at the time of implantable cardioverter defibrillator (ICD) insertion is controversial. In the absence of randomized trials, some regions now perform more than half of ICD implants without DT. Methods: During the last year of enrolment in the Resynchronization for Ambulatory Heart Failure Trial, a substudy randomized patients to ICD implantation with versus without DT. Results: Among 252 patients screened, 145 were enrolled; 75 randomized to DT and 70 to no DT. Patients were similar in terms of age (65.9 ± 9.3 years vs 67.9 ± 8.9 years); LVEF (24.7 ± 4.6% vs 23.6 ± 4.6%), QRS width (154.8 ± 23.5 vs 155.8 ± 23.6 ms), and history of atrial fibrillation (5% vs 6%). All 68 patients in the DT arm tested according to the protocol achieved a successful DT (≤25 J); 96% without requiring any system modification. No patient experienced perioperative stroke, myocardial infarction, heart failure (HF), intubation or unplanned ICU stay. The length of hospital stay was not prolonged in the DT group: 20.2 ± 26.3 hours versus 21.3 ± 23.0 hours, P = 0.79. One patient in the DT arm had a failed appropriate shock and no patient suffered an arrhythmic death. The composite of HF hospitalization or all‐cause mortality occurred in 10% of patients in the no‐DT arm and 19% of patients in the DT arm (HR = 0.53, 95% CI: 0.21–1.31, P = 0.14). Conclusions: In this randomized trial, perioperative complications, failed appropriate shocks, and arrhythmic death were all uncommon regardless of DT. There was a nonsignificant increase in the risk of death or HF hospitalization with DT. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1313‐1316, December 2012)     

Capecitabine and oral cyclophosphamide: A novel oral treatment combination for advanced cancer

Background: This dose escalation study assessed feasibility of a totally oral chemotherapy regimen using cyclophosphamide and capecitabine. The rationale for this combination was based on the observation that preclinical models of cyclophosphamide up‐regulated tumor thymidine phosphorylase and increased the activation of capecitabine. Methods: Eligible patients with advanced cancer were treated with oral cyclophosphamide and capecitabine on a 28‐day cycle. If no dose limiting toxicities (DLT) were encountered during the first two treatment cycles, the next patient group was assigned to the next highest dose level until the maximum tolerable dose (MTD) was determined. Results: Twenty‐seven patients entered treatment. The majority of non‐DLT were grades 1 and 2. DLT experienced in the first 8‐week observation period were grade 3 diarrhea (one patient, level III) and grade 3 emesis (two patients, level V). MTD was observed at level 5, 1331 mg/m²/day capecitabine days 1–28 with 125 mg/m²/day cyclophosphamide days 1–14 of the 28‐day cycle. The recommended phase II dose is therefore 1331 mg/m²/day capecitabine with 100 mg/m²/day cyclophosphamide. The best response evaluation showed four partial responses (breast, colon, ovary and pancreas). Conclusion: Cyclophosphamide and capecitabine can be combined at their full oral single agent dose with promising tolerability and activity.     

A comparison of the effects of maternally administered meptazinol and pethidine on neonatal acid-base status

Summary. A randomized double-blind study compared the effects of equi-analgesic doses of maternally administered meptazinol (1.5 mg/kg) and pethidine (1.5 mg/kg) on neonatal acid-base status. Heel-prick samples were taken for assessment of acid-base status at 10 and 60 min after delivery. Maternal antenatal history, details of labour and neonatal status at delivery were also recorded. Meptazinol produced less neonatal respiratory depression than pethidine: the mean 10 min acid-base data from 16 infants whose mothers received pethidine were indicative of a respiratory acidosis (pH 7.13, SD 0.08, P co₂,9.11, SD 2.2 kPa; standard bicarbonate 22.3, SD 3.1 mmol/1). This was not evident in the mean acid-base data from 16 infants whose mothers received meptazinol (pH 7.23, SD 0.07; P co₂ 6.83, SD 1.6 kPa; standard bicarbonate 20.9, SD 4.2 mmol/1). The mean pH and P co₂ in the two treatment groups were significantly different (P<0.002) at 10 min but not at 60 min after delivery.     

The management of acute abdominal pain in children

Objective : Acute abdominal pain is a common problem in childhood, and appendicitis is frequently diagnosed by general practitioners and doctors working in emergency departments. The objective of the present report was to determine the frequency of appendicitis in a group of children with acute abdominal pain presenting to the emergency department of a general hospital, as well as attempting to analyse the manner in which these patients were managed.
Methodology : The initial assessment in hospital (by resident hospital staff) of the study group of patients was analysed and their subsequent clinical progress documented.
Results : The present report shows that the vast majority of children with acute abdominal pain do not have appendicitis and that appendicitis is significantly over-diagnosed by junior hospital doctors.
Conclusions : Appendicitis is a clinical diagnosis, best made by an experienced member of the paediatric surgical team. Frequent review, with a minimum of investigations, provides the best means of making a rational decision regarding surgery.     

Use of a super active luteinizing hormone releasing hormone (LHRH) agonist in the treatment of menorrhagia

Summary. A luteinizing hormone releasing hormone agonist, d-Ser(But)⁶des Gly¹⁰-LHRH ethylamide, was administered intranasally to four women with unexplained ovulatory menorrhagia. Dramatic reductions in excessive menstrual blood losses were induced without significant side-effects, although the pattern of loss returned to pretreatment levels within 2 months of ceasing therapy.