Online Medical Database Searching

A wide range of databases and databanks are presently availableto medical researchers. This paper outlines the scope of thedatabases available through a commercial host system and describesthe procedures required for their access and use. A discussionof some of the limitations and likely future developments ispresented in the context of our experience of their use. Requests for reprints should be addressed to: Dr N. Wood, Department of Epidemiology and Community Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK     

Principles and strategies of effective community participation

A framework is offered for understanding the conceptual basisand the strategic implications of community participation, inachieving Health for All goals. Special focus is given to themeaning, settings and levels of participation in official decision-makingstructures and at the community level. Questions such ‘howis participation facilitated?’, ‘who participates?’and ‘what are the benefits and obstacles to participation?’are geared primarily towards the needs of individuals who functionat the city level and expect practical strategic advice andguidance. The structure of the 1989 WHO Healthy Cities Symposiumwhich was devoted to community action was based on the frameworkand conceptual approach of this paper.     

LICHEN PLANUS SUBTROPICUS: DIRECT IMMUNOFLUORESCENCE FINDINGS AND THERAPEUTIC RESPONSE TO HYDROXYCHLOROQUINE

A 32-year-old black woman presented with the complained of a l-year history of asymptomatic “dark areas” on her face and neck. New lesions developed throughout this time and, once present, slowly increased in size and persisted. She denied systemic symptoms, including arthralgias and myalgias. Her occupation as a real estate agent involved frequent outdoor work. The family history was noncontributory. On physical examination there were multiple hyperpig-mented round-to-oval macules and papules measuring from 0.5 to 2.0 cm in diameter and located over the photoexposed lateral aspects of the face and neck (Figs. 1 and 2). New lesions were papules characterized by a subtle, raised “thread-like” border (Fig. 1, arrow). Older lesions were mac-ular, some with a slightly atrophic, hypopigmented center (Fig. 1, Flesh-colored polygonal papules were present in the V-shaped area on the anterior neck (Fig. 2). The remainder of the cutaneous examination, including the oral mucosa, was unremarkable. Histopathologic examination of a flesh-colored papule viewed on low power revealed a bandlike lymphohistiocytic infiltrate that focally obscured the dermoepidermal junction. Numerous homogenous eosinophilic bodies (Civatte bodies, cytoid bodies, apoptotic cells) and scattered melanophages were identified. In addition, there was epidermal hyperplasia, overlying orthokeratosis, and V-shaped hyper-granulosis. The rete was jagged and possessed a slightly eosinophilic hue (Fig. 3). Hyperpigmented, oval macules had a more patchy lichenoid infiltrate, less epidermal hyperplasia, but possessed a greater number of melanophages in the papillary dermis than new lesions. Periodic acid-Schiff (PAS) stained sections of either type of specimen were negative for basement membrane thickening and also negative for dermal mucin using the colloidal iron reagent. No deposits of immunoglobulin or complement were identified at the dermoepidermal junction by direct immunofluorescence microscopy, but numerous immunoglobulin-coated cytoid bodies were present. Laboratory testing was significant for a negative antinu-clear antibody (ANA) reaction and RPR. A complete blood cell count, results of serum chemistry, and the angiotensin converting enzyme level were within normal limits. Chest roentgenogram revealed no active cardiopulmonary disease. Based on the distinctive histopathology and the impressive, characteristic clinical presentation, the diagnosis of lichen planus subtropicus was made. Therapy with hydroxy-chloroquine 200 mg per day, topical hydrocortisone valerate 0.2% cream b.i.d. to inflammatory lesions, 3% hydroquinone solution b.i.d. to hyperpigmented lesions, and photoprotection were initiated. Partial resolution of the lichenoid lesions has occurred, new lesions have ceased to appear, and the hyperpigmentation has slightly improved.     

The Association of Different Measures of Insulinaemia with Vascular Risk Factors in Healthy Normoglycaemic Normotensive Non-obese Men and Women

Hyperinsulinaemia is said to be a risk factor for cardiovasculardisease, but the extent to which different insulinaemic measuresare associated with vascular risk factors in ostensibly healthyindividuals, and whether they operate independently in men andwomen, remains uncertain. The association between risk factors and various insulinaemicmeasures was examined in 148 men and 118 women who were normoglycaemic,normotensive, and non-obese (body mass index in men <27,in women <25). A 75 g glucose tolerance test was administeredafter blood sampling for fibrinogen, lipids, lipoproteins andinsulin. Insulin was also measured after 1 and 2 hours. Significantunivariate correlations (p<0.01) were most consistently recordedbetween insulinaemic measures and fasting serum triglyceridesin men and women, whilst systolic blood pressure only correlatedwith insulinaemia in women, and diastolic blood pressure correlatedwith fasting and 2 hour insulinaemic measures in men and women.Inconsistent associations were noted with total serum cholesterolin men and women, with high density lipoprotein cholesterol,body mass index, apoprotein B and A1 in men, and with fibrinogenin women. Age was not correlated with any insulinaemic measurein men or women. Differences in vascular risk factors between quintiles of theinsulinaemic measures were examined, after correction for bodymass index. The dominant association with fasting and post-glucoseload insulinaemic measures was with triglycerides, especiallyin women, with less frequent graded differences between quintilesobserved for total cholesterol, and diastolic and systolic bloodpressures in men and women. The incidence of other risk factors often only differed in thelowest or highest quintile in comparison to other quintiles,suggesting a threshold rather than a graded effect. Furthermore,differences in HDL cholesterol and apoprotein B were only recordedfor top quintiles of post-glucose challenge/integrated insulinaemicmeasures in men, whilst serum fibrinogen concentrations onlydiffered significantly in women in the top insulinaemic areaunder the curve quintile. In the absence of additional risk factors such as diabetes,hypertension and obesity, insulinaemic measures are not consistentlyrelated to blood pressure and measures of lipid metabolism andcoagulation, and are thus a weak predictor of other cardiovascularrisk factors. The vascular risk profile associated with insulinappears somewhat different in apparently healthy men and women.     

Disappearance of phantom limb pain following hyperbaric oxygen therapy

A 67 year old man with severe peripheral vascular disease and subsequent bilateral below knee amputations was treated with hyperbaric oxygen therapy for non-healing ulcers on his right leg stump. After one treatment on a 10 metre table (105 minutes) his previously severe phantom limb pain resolved and has since not returned. This has not previously been described and warrants further study.     

A simple in vitro model for investigating epithelial/mesenchymal interactions: keratinocyte inhibition of fibroblast proliferation and fibronectin synthesis

Hypertrophic scarring and graft contracture are major causes of morbidity after burn injuries. It is well established that application of a split-thickness skin graft reduces scarring and contraction, and cultured epithelial autografts have a similar effect. To investigate the influence of keratinocytes on fibroblast proliferation and fibronectin synthesis, we used an in vitro separated co-culture model in which epithelial sheets were cultured above fibroblast monolayers without physical contact. We also investigated the response of fibroblasts to keratinocyte-conditioned medium (KCM) obtained from confluent and subconfluent keratinocyte monolayers. Both cultured epithelial sheets, composed of adherent fully confluent keratinocytes, and their conditioned medium, reduced fibroblast proliferation. However, KCM from subconfluent keratinocytes stimulated fibroblast proliferation at low concentrations while inhibiting it at higher concentrations, indicating that keratinocytes can produce both mitogenic and growth-inhibiting factors for fibroblasts. KCM, but not epithelial sheet co-culture, also inhibited fibroblast fibronectin synthesis. This indicates regulation of fibroblast phenotype by soluble factors released by the keratinocyte and also suggests that there is a dialogue between keratinocytes and fibroblasts with respect to fibronectin production. We conclude that this separated co-culture model is a simple way to study epithelial/mesenchymal communication particularly with respect to the role of the fibroblast in wound healing.     

The cold pressor test: Vascular and myocardial response patterns and their stability

The purposes of the present study were to compare the cardiovascular response patterns evoked by three versions of the cold pressor test (either forehead stimulation or hand or foot immersion) and to determine the reproducibility of the responses over a 2-week interval. Blood pressure, heart rate, stroke volume, cardiac output, total peripheral resistance, and systolic time intervals were obtained during rest and during the cold pressor test in 42 young men. Across conditions, the pressor response was supported by peripheral resistance increases with concomitant stroke volume decreases. Although the response panerns were generally similar across sites, exceptions were apparent for heart rate. Forehead stimulation was characterized by no significant change in heart rate, whereas limb (hand or foot) immersion was associated with significant heart rate acceleration. The responses elicited by the three cold pressor test conditions were reliable and showed little evidence of attenuation over the test-retest interval.     

All is Not Lost: Utilizing Continuous Remote ILR Monitoring to Diagnose Syncope

A 63‐year‐old man with frequent unexplained syncope was implanted with a second generation remotely monitored implantable loop recorder for continuous electrocardiogram (ECG) monitoring. He had a subsequent syncopal episode and despite accidental destruction of his patient activator, vital ECG data from the event were transmitted wirelessly, enabling a cardiac arrhythmia to be excluded. This case highlights the benefit of remote monitoring in syncope assessment, as well as a transmission system that ensures prompt analysis of the ECG data and therefore rapid optimal patient management. (PACE 2010; 33:763–765)     

MICROVASCULAR ANGIOPATHY IN ADVANCED PERIODONTAL DISEASE

Previous studies have shown a perivascular hyaline thickening affecting restricted regions of the microcirculation in gingivitis and moderate periodontitis and in the pulpal vessels in chronic pulpitis. In the present study of the lesion of advanced periodontitis, immunostaining for type IV collagen and laminin demonstrated widespread deposition of basement membrane material, with manifest involvement of the venous network. Some vessels were associated with an increased deposition of both basement membrane proteins, while others showed preferential deposition of either laminin or type IV collagen. Immunostaining also revealed an extensive trabecular network of type IV collagen throughout the affected gingival tissue that was not related to recognizable vessels but was co-extensive with less intense staining for laminin. This network was not associated with viable endothelial cells demonstrable by staining with the endothelial marker Ulex agglutinin (UEA-1). The results indicate extensive vascular pathology in advanced periodontitis that could explain the attenuation of the inflammatory reaction and the restricted ability to develop reparative granulation tissue in this disease.