The binding of blood-borne estrogens in normal vegetarian and omnivorous women and the risk of breast cancer

Serial blood samples were taken at two-hour intervals over a 24-hour period from 25 premenopausal vegetarians (12 vegans and 13 ovolactovegetarians) and from 21 omnivorous controls. All members of the former group had been on a vegetarian diet for a minimum of three years. The mean proportion of estradiol unbound to blood proteins was similar in both vegetarians (1.26%) and meat eaters (1.16%). However, the amount bound to albumin was significantly raised in vegetarians (50.1% vs. 43.1%, p less than 0.009), whereas that bound to sex hormone-binding globulin (SHBG) was correspondingly lower (48.7% vs. 55.8%, p = 0.01). Mean levels of SHBG were similar in vegetarians (59.9 nmole/l) and omnivores (62.0 nmole/l), as was the total amount of free fatty acid (0.42 mmole/l for both). Within the vegetarian group, no differences were detected between vegans and ovolactovegetarians.     

Primary adenocarcinoma of the appendix

Thirteen cases of primary appendicular adenocarcinoma are reported. This rare tumour usually presents as acute appendicitis. The correct diagnosis is rarely entertained before or during surgery. The main treatment choice lies between appendicectomy alone and appendicectomy followed by right hemicolectomy. There are anatomical reasons for advising the latter and survival figures from the literature tend to support this preference. The cases reported here indicate that in the period 1972-1984, in the North West Region, there was a slight preference for appendicectomy alone. The additional procedure of right hemicolectomy did not confer any clear-cut survival advantage.     

Allosteric Modulators of Class B G-Protein-Coupled Receptors

Class B GPCR’s are activated by peptide ligands, typically 30-40 amino acid residues, that are involved in major physiological functions such as glucose homeostasis (glucagon and glucagon-like peptide 1), calcium homeostasis and bone turnover (parathyroid hormone and calcitonin), and control of the stress axis (corticotropin-releasing factor). Peptide therapeutics have been developed targeting these receptors but development of nonpeptide ligands, enabling oral administration, has proved challenging. Allosteric modulation of these receptors provides a potential route to developing nonpeptide ligands that inhibit, activate, or potentiate activation of these receptors. Here the known mechanisms of allosteric modulators targeting Class B GPCR’s are reviewed, particularly nonpeptide antagonists of the corticotropin-releasing factor 1 receptor and allosteric enhancers of the glucagon-like peptide-1 receptor. Also discussed is the potential for antagonist ligands to operate by competitive inhibition of one of the peptide binding sites, analogous to the Charniere mechanism. These mechanisms are then used to discuss potential strategies and management of pharmacological complexity in the future development of allosteric modulators for Class B GPCR’s.     

Milk nasendoscopy in the assessment of dysphagia.

The bedside assessment of dysphagia may be difficult, due to the inability to witness the act of swallowing directly. The milk test described in this paper gives a good assessment of swallowing, is cheap and easily portable and allows an instant decision to be made without recourse to special investigations.     

Bell's palsy associated with IFN-alpha and ribavirin therapy for hepatitis C virus infection.

First-line therapy for hepatitis C virus (HCV) infection comprises interferon-alpha (IFN-alpha) and ribavirin for 6 or 12 months. Mild complications of therapy are common, but more serious complications are rare. Three patients with chronic HCV infection, acquired through injecting drug use, developed idiopathic facial paralysis (Bell's palsy) during therapy, with spontaneous resolution after withdrawal of treatment. Large-scale cohort studies reveal that IFNs are associated rarely with neurologic complications, and only one previous report has linked IFN-alpha therapy and Bell's palsy. We postulate that IFN-alpha therapy led to a breakdown of peripheral tolerance to myelin sheath antigens, leading to neuropathy, just as IFN-alpha therapy can cause autoimmune thyroiditis through breakdown of tolerance to native thyroid antigens.     

Plastic surgery

Plastic surgery is all too often thought of as an indulgence of the rich and famous with little attention paid to the repair of bodies and limbs disfigured or deformed by accident or illness. Surgeons look to management to address those issues that create an insecure base for planning the service and for its organisation nationwide.     

The modification and standardisation of the Harter self-esteem questionnaire with Scottish school children

This paper describes a study to modify an American questionnaire measuring self-esteem in children for use in the United Kingdom and also to obtain normative values for this questionnaire with Scottish school children aged 8–15 years. Five thousand children resident in the Lothian Region of Scotland, a 5% sample of the age group, were identified using a cluster sampling technique in order to provide a random sample of the general population for this age group. The main findings were as follows: children usually rated themselves higher than the midpoint on most subscales, indicating that they have a positive regard for themselves; boys tended to rate themselves higher than girls on most subscales except behaviour; scores tended to decline as children get older, especially for girls; global or overall self-esteem was highly correlated with the other subscales, especially physical appearance or attractiveness; self-esteem scores were not influenced by social class, school or religion. The modified Harter questionnaire can be used to measure self-esteem in several situations. These include comparisons between different groups of children, changes in self-esteem following treatment interventions or the effects of illness on children's psychological adjustment. Finally, the study has provided normative values for a Scottish population of school children aged 8–15 years.

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Zusammenfassung Die vorliegende Arbeit beschreibt eine Studie, die es sich zum Ziel setzt, einen amerikanischen Fragebogen zum Gebrauch für 8–15jährige Schüler in Großbritannien zu modifizieren. Der Fragebogen mißt das Selbstwertgefühl der Kinder und ein Hauptziel der Studie war die Erlangung von normativen Basiswerten.Die wichtigsten Ergebnisse waren wie folgt: Kinder schätzen sich auf den meisten Unterskalen höher ein als der Mittelwert, was auf ein allgemein positives Selbstwertgefühl schließen läßt; Jungen tendieren sich auf allen Unterskalen mit Ausnahme der behaviour-Skala höher einzuschätzen als Mädchen; die Werte nehmen im Allgemeinen ab, wenn die Kinder älter werden, was vor allem für Mädchen deutlicher ist; globalses Selbstwertgefühl ist stark korreliert mit den Ergebnissen der Unterskalen, vor allem solchen die körperliches Erscheinungsbild oder Atraktivität beschreiben; die Ergebnisse sind nicht mit Faktoren wie sozialer Schicht, Schule oder Religion korreliert.Der modifizierte Harter-Fragebogen für die Bestimmung des Selbstwertgefühls kann in mehren Situationen Verwendung finden: Kinder verschiedener Altersgruppen können verglichen werden; Veränderungen nach Behandlungseingriffen oder der Einfluß von erkrankungen auf diesen Aspekt der Psyche können gemessen werden. Und schießlich hat der Fragebogen normative Grundwerte für eine Population von schottischen 8–15jährigen Schülern geliefert.

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Résumé Cet exposé décrit une étude faite pour apporter des modifications à un questionnaire américain sur l'évaluation du Respect de Soi ches les enfants, afin qù'il puisse être utilisé au Royaume Uni et aussi afin de normaliser ce questionnaire pour les écoliers écossais âgés de 8 à 15 ans.Cinc mille enfants de la région écossaise de Lothian, une section représentative de 5% du groupe d'âge, one été identifiés, en se servant d'un groupe de techniques d'échantillonnage afin d'obtenir un échantillon prélevé au hasard, de la population générale dans ce group d'âge.Les conclusions principles sont les suivantes: Les enfants se classent eux-mêmes généralement plus haut que la moyenne dans la plupart des cas de figures analysés, indiquant ainsi qu'ils ont une opinion positive d'eux mêmes. Les garçons ont tendance à avoir une plus haute opinion d'eux mêmes que les filles dans tous les cas de figures excepté la conduite. Les résultats obtenus ont tendance à diminuer en fonction de l'âge plus élevé des enfants, particulièrement pour les filles. Globalement ou en général le respect de soi était mis plus en corrélation avec les autres cas de figures, tout spécialement l'apparence physique ou l'attrait feminin. Les évaluations du respect de soi n'ont pas été influencées par la classe sociale, l'institution scolaire ou la religion.Le questionnaire Harter modifié peut être utilisé pour évaluer le respect de soi dans plusieurs situations. Celles-ci comprennent des comparaisons entre différents groupes d'enfants, des changements dans le respect de soi intervenant après un traitement ou les effets de maladie sur l'adaptation psychologique des enfants.Pour terminer, cette étude a permis d'obtenir des valeurs normalisées pour une population d'écoliers écossais âgés de 8 à 15 ans.