An epidemiological profile of in-patient workload in dermatology

Trends in admission rates, patterns of readmission, lengths of stay and clinical caseload for in-patient dermatology from 1976 to 1985 are described using data from the Oxford record-linkage study. Age-specific admission rates were considerably higher in people aged 50 years and over than in younger people. Admission rates declined over time in most age-sex groups below the age of 70 years, but increased over time for the over 70s. In dermatology, unlike most other specialties, the length of patients' stay did not decrease substantially over the 10 years. In-patient workload consisted predominantly of leg ulcers, psoriasis, and eczema. This did not change appreciably over time. New out-patients at dermatology clinics rose by 41% from 1976 to 1985, and all out-patient visits rose by 20% during the 10-year period. Because the profile of in-patient workload changed relatively little over time, we speculate that the impact of innovations in dermatological practice has been much greater in the ambulatory setting than in the management of those patients requiring prolonged in-patient care. Future routine measures of workload in dermatology should include demographic and clinical data on out-patients.     

Phenotypically normal individuals with an inversion (X) (p22q13) and the recombinant (X), dup q

Two families are described in which there is an inv(X) (p22ql3) which has been transmitted for three generations. In one family (K482), no recombinants have been recovered and the inversion can be traced to a female born in 1839. In the second family (K491), a recombinant (X), dup q, has been recovered in a normal fertile woman. In both families the inverted X appears to be carrying the Xg allele. Despite extensive family studies no common ancestor has been found for the two families.
The pattern of DNA synthesis has been studied in those individuals who are karyotypically 46, X, inv(X) (p22ql3) and 46, X, rec(X)dup q, inv(X) (p22ql3); the selection of the abnormal as the late synthesizing X chromosome is random in the former and total in the latter. In some cells the two long arms of the recombinant X chromosome showed asynchrony of DNA replication.     

STEREOPHOTOGRAMMETRIC ANALYSIS OF CHANGES IN BODY VOLUME ASSOCIATED WITH THE INDUCTION OF ANAESTHESIA

Changes in the volume of the trunk were measured in seven supinepatients, when anaesthesia was induced with thiopentone i.v.Stereophotograms were taken before and after induction and measurementsof volume calculated from contour plots of a reconstructed stereoimage. The changes in volume of the visible part of the trunkwere between –846 and + 505 ml. No systematic change intotal or lower trunk ("abdominal") volume was evident, but therewas a significant negative linear relationship (r = –0.87)between upper trunk ("ribcage") volume change and obesity (expressedas actual weight/expected weight). Changes in volume were moreevident in the upper parts of the supine subject, in both ribcageand abdomen (P < 0.05).     

Subchronic and Chronic Inhalation Toxicity of Antimony Trioxide in the Rat

Fischer 344 rats were exposed by inhalation to Sb₂O₃ (antimonytrioxide) dust at exposure levels of 0, 0.25, 1.08, 4.92, and23.46 mg/m³ for 6 hr/day, 5 days/week for 13 weeks followedby a 27-week observation period. Subsequently, an inhalationon-cogenicity study was conducted at exposure levels of 0, 0.06,0.51, and 4.50 mg/m³ for 12 months followed by a 12-month observationperiod. The Sb₂O₃ in the subchronic study had a mass medianaerodynamic diameter (MMAD) of 3.05 ± 0.21 microns (mean± SD) with a geometric standard deviation (GSD) of 1.57± 0.06. In the chronic study, the MMAD was 3.76 ±0.84 and the GSD was 1.79 ± 0.32. Except for the eyes,no adverse clinical observations were attributed to Sb₂O₃ ineither study. In the subchronic study, corneal irregularitieswere seen after about 2 weeks of exposure and did not abateduring the observation period. In the chronic study, ophthalmoscopicevaluation at 24 months revealed a dose-related increase incataracts of 11, 24, 28, and 32% (both sexes combined) for eachgroup, respectively. Body weights were significantly lower (6%)than the control group's weights in the 23.46 mg/m³ males inthe subchronic study. These rats did not recover this weightduring the 27-week observation period. Body weights of the femalesin both studies and males in the chronic study were unaffected.There were no Sb₂O₃ effects on clinical chemistry or he-matologyin either study. Mean absolute and relative lung weights weresignificantly increased in the 4.92 and 23.46 mg/m³ groups inthe subchronic study. The 23.46 mg/m³ group's lung weights didnot recover to control levels during the 27-week observationperiod. Lung weights for rats in the chronic study were unaffected.Microscopic changes in the lungs in the subchronic and chronicstudy were limited to subacute-chronic interstitial inflammation,increased numbers of alveolar-in-traalveolar macrophages, foreignmaterial in the alveolar-in-traalveolar macrophages in the peribronchialand perivascular (chronic study only) lymphoid aggregates andin the peribronchial lymph nodes, granulomatous inflammation/granulomas,and fibrosis. In the chronic study, any observed neoplasms occurredwith comparable incidence among all groups and were within thehistorical range for controls. Clearance of Sb₂O₃ from the lungwas burden dependent and was reduced by 80/ in the 4.50 mg/m³group in the chronic study. The previously reported studies,which found Sb₂O₃ to be a carcinogen, were run at higher lungburdens. Under the exposure conditions of the current study,Sb₂O₃ was not a carcinogen.     

Establishing priorities for European collaboration in communicable disease surveillance

Background: Several collaborations in communicable disease surveillancehave developed between European Union member states. Involvementin these activities takes time and money. It is vital that collaborationsare established in areas most likely to be beneficial. An exercisewas undertaken to inform national surveillance centres and theEuropean Commission as to priority areas for the developmentof collaborations. Methods: A modified Delphi exercise was undertakenamongst the heads of centres with responsibilities for surveillanceat national level in the member states of the EU. Participantsdeveloped, agreed and ranked criteria for developing collaborations.A list of communicable diseases and syndromes was then rankedusing a Likert-type scale. Three rounds were undertaken. Betweenrounds, scores and a ranking were fed back showing where participantshad ranked items, compared to the overall mean and rank distribution.For the third round participants were asked to use a categoricalscale, nominating six or ten high priority disease areas. Results:Response rates were 87.5% for round 1, 44% round 2 and 87% round3. The low round 2 response rate appeared to be because respondentsdid not wish to alter their rankings. The six high priorityareas were outbreaks of gastroenteritis/food poisoning, CID/otherslow virus infections, serious imported diseases, legionellosis,antimicrobial resistance and tuberculosis. When participantsgave ten high priority areas meningococcal disease, travel advice,vaccination/immunization and influenza were also included. Thefinal lists were accepted at the meeting of participants. Conclusions:The process was successful in developing both a priority listand consensus.     

CARBAMAZEPINE USE IN AGGRESSIVE BEHAVIOUR ASSOCIATED WITH SENILE DEMENTIA

In a randomized placebo crossover controlled study, six patients meeting DSM-III-R criteria for Alzheimer's disease and exhibiting significantly aggressive behaviour were administered carbamazepine (in doses up to 600 mg daily) and placebo, with each treatment period lasting 8 weeks. Levels of aggression as measured by the RAGE scale were significantly reduced compared with placebo (p<0.05). The results suggest that carbamazepine is an effective anti-aggressive agent in patients with dementia. Recommendations for further studies are made.     

EARLY CORTICAL AUDITORY EVOKED RESPONSE IN ANAESTHESIA: COMPARISON OF THE EFFECTS OF NITROUS OXIDE AND ISOFLURANE

Previous studies showing graded changes in the early corticalwaves Pa and Nb of the auditory evoked response (AER) with increasingconcentration of volatile anaesthetic agents demonstrated highamplitudes of these waves in the period immediately followinginduction of anaesthesia and tracheal intubation, when the patientbreathed nitrous oxide alone. These high amplitude waves werenot consistent with extrapolation of the data or observationsof patients under steady-state nitrous oxide anaesthesia. Inorder to discriminate between effects in the period immediatelyfollowing induction of anaesthesia and tracheal intubation,and effects caused by nitrous oxide alone, a randomized cross-overstudy was performed. Eight patients breathed either nitrousoxide or isoflurane at 0.6 MAC for three consecutive 10-minperiods following intubation and before surgery. The amplitudesof Pa and Nb were significantly less for isoflurane with respectto the same MAC fraction of nitrous oxide in all periods, butfor both agents the amplitudes were significantly greater inthe 10 min following intubation than in subsequent periods,presumably as a result of stimulation. ^*Present address: Hospital for Sick Children, Great Ormond Street,London WC1.     

A new detector for fully automatic peptide synthesis

A new method of monitoring the rate of reactions in solid phase peptide synthesis is described. A conductivity detector in the reaction cell enables the deprotection, washing, and subsequent coupling stages to be examined in detail. The half lives of the reactions can be calculated and hence the optimum reaction times predicted. The aggregation of peptide chains and subsequent collapse of the resin is observed. Difficult sequences are sensed and appropriate action taken completely automatically.