A comprehensive clinical validation of the nuclear stethoscope

Five studies were conducted to examine the degree of variability to be expected during the use of the non-imaging nuclear probe (BIOS Inc.) under a variety of clinical conditions. Comparison of the ejection fraction (EF) readings between the nuclear probe and a gamma camera showed good agreement, with the nuclear probe tending to underestimate lower, and overestimate higher camera EF values [mean (S.D.) difference, 0.84% (6.06)]. A comparison of two nuclear probes showed a small mean (S.D.) difference of EF readings of 0.063% (2.26). EF readings obtained in normal subjects 6 weeks apart were reproducible and differed by a mean (S.D.) of 0.23% (4.42). The administration of placebo to 10 normal subjects followed by sequential measurements for 4 h produced EF changes large enough to mimic a clinical effect, the largest hourly change observed being 5.4%, indicating the need for strict placebo control in interventional experiments. Data on four patients with heart failure showed small non-significant EF changes in the 1 h after placebo administration but a wide intra-subject range of ejection time and time to peak filling measurements. This highlights the problem of accurate, reproducible cursor placement in such patients. The nuclear probe is a portable, low cost instrument which produces accurate EF measurements when compared with the gamma camera.     

Effectiveness of needle and syringe programmes for preventing HIV transmission

Objective: To examine the effectiveness of needle and syringe programmes (NSPs) in preventing HIV transmission among injecting drug users (IDUs).Methods: An ecological study design was used to determine change in HIV prevalence among injecting drug users between cities with and without NSPs. Several data sources, such as electronic journal databases, surveillance reports, websites, and index review of relevant journals, were used to identify studies of HIV seroprevalence among IDUs, and presence of NSPs. The rate of change in HIV prevalence was estimated by regression analysis.Results: There were 778 years of data from 99 cities globally included in the analysis. HIV prevalence decreased by 18.6% per annum in cities that introduce NSPs, and increased by 8.1% in cities that had never introduced NSPs (mean difference −24.7% [95% CI: −43.8, 0.5%], P=0.06). The mean difference was –33% when comparison was weighted to one over the variance of the regression estimator (29% decrease in cities with NSPs and 5% increase in cities without NSPs, P<0.001). When analysis was restricted to cities with first HIV seroprevalence less than 10%, the average annual change in seroprevalence was 18% lower in cities with NSPs (P=0.03).Conclusions: Despite the inherent limitations within an ecological study design, the study provides additional evidence that NSPs reduce transmission of HIV infection. The rapid spread of HIV among IDU populations and increasing rates of injecting in many countries calls for scaling up of NSPs as well as other harm reduction strategies.     

Effect of the Medicare prospective payment system on the utilization of physical therapy

The purpose of this study was to examine the effect of the Medicare prospective payment system on the utilization of physical therapy for patients served by Medicare. The total number of inpatient and outpatient physical therapy referrals and the percentage of physical therapy Medicare referrals from January 1981 through May 1985 for the 336 acute care beds in the county selected for this study were analyzed. The results indicated that acute care inpatient and outpatient physical therapy Medicare referrals have increased significantly since the implementation of the diagnostic related group system. The results indicate that physical therapy is being used increasingly to rehabilitate patients within the time and economic constraints established by the Medicare prospective payment system.     

Computed tomography and tumor markers as diagnostic alternatives to second-look surgery in the treatment of malignant ovarian tumors]

Advanced malignant ovarian cancers are treated, after initial surgery, with first-choice mono/polychemotherapy, the response to which is evaluated by means of second-look laparotomy. The poor prognostic value of second-look results, the incidence of false negatives, the lack of valuable second-choice therapies, and the high incidence of complications after repeated interventions, lead to the testing of diagnostic imaging modalities--especially CT and tumor markers (Ca 125 and Ca 15-3). To define their actual clinical value, CT and serum assays of Ca 125 and Ca 15-3 have been performed on 32 treated patients affected with ovarian cancers (stages II-IV), who were clinically free of disease. The results have been compared with second-look pathology, but especially with patient follow-up (min. 24 months). Second-look laparotomy yielded a high number of false negatives (9/22 = 41%); moreover, many important/severe complications were observed. Thus, its value appears to be questionable. CT exhibited high positive predictive value (76.9% over the 24-month follow-up); high for both Ca 125 and Ca 15-3 (100% respectively, at 24-month follow-up) thus, few false positives were observed. Moreover CT, having higher sensitivity (55.5%) than Ca 125 (11.5%) and Ca 15-3 (27.7%), has greater diagnostic capabilities, especially when the lesion is in extraperitoneal location.     

Intraepithelial leucocytes in the bovine uterine tube

The epithelium of the uterine tube consists of ciliated cells and secretory cells. Basal cells are a third cell type observed in tubal epithelium and they are located principally in the basal part of the epithelium. The objectives of this study were to characterize these basal cells in normal and superovulated heifers and to determine whether they participate in the replacement of the ciliated and secretory cell populations. All heifers received cloprostenol (PG) to induce oestrus (day 0). Superovulated heifers received 24 mg pFSH at doses of 4.5, 3.5, 2.5 and 1.5 mg given twice daily. Control and superovulated heifers were slaughtered on days 1, 3, 5 and 7 of the oestrous cycle. Another group of normal cycling heifers was slaughtered on days 2-3 and 11-13 of the oestrous cycle and used for immunocytochemistry. Samples from ampulla, pre-isthmus and isthmus of the uterine tube were collected and processed for light and transmission electron microscopy. Quantitative examination by light microscopy showed that there was a significant difference in the number of basal cells between the regions of the heifers' uterine tube. On the basis of ultrastructure two populations of basal cells were observed. One (type I) had a nucleus with much condensed heterochromatin and very sparse cytoplasmic organelles. The second cell (type II) had a nucleus with heterochromatin typically clumped around the nuclear envelope. Its cytoplasm contained many organelles including a number of lysosomes. The ultrastructural features of these cells were similar in all regions and at all days of the oestrous cycle examined. Immunocytochemistry revealed that type I basal cells were lymphocytes and type II basal cells were macrophages.     

Febrile renal colic of pregnancy. A severe emergency

Among the so-called "gravidic pyelonephritis" a special place should be reserved for the retention of purulent urine upstream of an obstruction normally caused by stones. The restoration of the free flow of the urine by direct approach of the obstruction or a temporary stent is the main aspect of the treatment. Antibiotics only play a secondary role.     

Does epidural analgesia influence the mode of delivery in primiparae managed actively? A preliminary study of 1250 women

We studied 1250 primiparous women with a singleton pregnancy, gestational age at delivery of 37-42 weeks, with a single live fetus, vertex presentation whose first and second stages of labour were managed according to strict criteria for the active management of labour. 568 (45%) received epidural analgesia (bupivacaine 0.25%) during labour, and the other 682 (55%) received either Entonox, pethidine or no analgesia. The spontaneous vaginal delivery rate in the epidural group was 67% (95% confidence interval [CI] 63-71%), lower than that in the non-epidural group (87%, 95% CI 84-90%). All instrumental delivery rates were higher in the epidural group. However, the rotational forceps rate in the epidural group (2.5%, 95% CI 1.4-4.1%) was only marginally higher than in the non-epidural group (0.9%, 95% CI 0.3-1.9%). Women who were induced were more likely to request an epidural (56%: 95% CI 50-61%) than those with spontaneous onset of labour (41%: 95% CI 38-45%). Whether labour was spontaneous or induced, a higher proportion of women who received epidural required oxytocin augmentation. The effects of combinations of epidural analgesia, the need for oxytocin augmentation and induction of labour on mode of delivery were additive. This preliminary study suggests that a high rate of spontaneous vaginal delivery can be achieved with epidural analgesia when labour is actively managed.