Case Control Study of Chronic Bronchitis in glass Bangle Workers

Eighty-nine cases of chronic bronchitis were matched against167 asymptomatic controls from the glass bangle industry ofFirozabad. Factors of age, social status, smoking habit andduration of exposure were studied. Duration of exposure wasfound to be a factor contributing significantly to the causationof disease. Requests for reprints should be addressed to: Dr B. N. Gupta, Division of Epidemilogy, Industrial Toxicology Research Centre, Mahatma Gandhi Marg, Lucknow P.O. Box 80, 226001, India     

Alfentanil or fentanyl during isoflurane–based anaesthesia for day–care knee arthroscopy?

Forty patients agreed to participate in a study to compare whether fentanyl or alfentanil used as analgesic is associated with quicker recovery following anaesthesia for outpatient arthroscopy procedure. Psychomotor tests including choice reaction time (CRT), perceptive accuracy test (PAT) and finger tapping test (FTT) were done prior to induction of anaesthesia with propofol (2–3 mg–kg^-1). Patients were then divided into two groups: Group F (fentanyl) received 0.1 mg fentanyl prior to start of surgery and thereafter 0.05 mg every 30 min during the procedure. Group A (alfentanil) received 0.5 mg alfentanil prior to the onset of surgery and 0.25 mg every 15 min thereafter. Anaesthesia was then maintained using isoflurane (0.5–2%) in oxygen and air (Fio₂ 0.33) during spontaneous respiration with a face mask in a Bain's system. Psychomotor tests were repeated every 45 min postoperatively. Clinical recovery, visual analogue pain intensity score (VAS) and time to discharge home were also assessed by a nurse blind to the method used. Patients in Group A returned to baseline values on the FTT after 90 min while those in Group F did not return to baseline values until 135 min after the end of the operation. Clinical recovery and time to discharge home ("home ready") were also significantly longer in Group F. There was no difference in recovery as seen in the PAT and CRT between the groups. Also, there was no difference in the incidence of side effects and the pain intensity (VAS) scores were similar in the two groups at all time periods. We conclude that recovery following alfentanil is quicker compared to fentanyl when anaesthesia is based on isoflurane.     

Survey of postoperative analgesia following ambulatory surgery

Background: The quality of pain relief during the first 48 hours following ambulatory surgery has been poorly documented. This questionnaire study was performed to evaluate the nature and severity of pain after the patient leaves the hospital. Methods: 1100 patients in the age group 5–88 years who underwent ambulatory surgery during a period of 6months were asked to complete a questionnaire 48 h after the end of the operation. In thecase of children, parents were asked to complete a similar questionnaire. The questions were related to pain experienced during the first 48 h after surgery and to the nature andseverity of postoperative complications. Results: A total of 1035 out of the 1100 patients returned the questionnaire, 94.1%. Overall the majority (65%) of patients had only mild pain at home; however, patients undergoing certain types of surgery had moderate-to-severe pain: inguinal hernia surgery (62% patients), orthopaedic surgery (41%), hand surgery (37%) and varicose vein surgery (36%). In these patients the severity of pain did not decrease during the 2-day study period. About 10% patients had more severe pain than they had anticipated, and 20% had difficulty in sleeping at night due to severe pain. Despite this, over 95% of patients were satisfied with man-agement of postoperative pain. Nausea (20%), tiredness (20%) and vomiting (8%) were the commonest complications reported during the first 48 h. A significant association was found between the administration of a general anaesthetic and the incidence of nausea postoperatively. A large number of patients were alone at home after the operation (28.4%); some (3.8%) had no access to a relative or friend in case of need. Conclusion: Our results show that about 35% of day-surgery patients experience moderate-to-severe pain at home in spite of analgesic medication. About 20% of patients had sleep problems due to severe pain. However, only 5% of patients were dissatisfied. Better analgesic techniques are necessary for patients undergoing certain types of surgery. Patient information and follow-up routines need to be improved.     

Outcome of live related and live unrelated renal transplants

Summary: This study compares the outcomes of 229 renal transplants, of which 156 were live related renal transplants done at our centre and 73 unrelated transplants done at other centres but followed up at our centre. All the patients were on triple immunosuppression for periods varying between 9 months and 1 year. Patient characteristics, rejections, infections and 1 and 5 years patient and graft survival were analyzed in the two groups. the outcome of patients who continued on cyclosporine beyond 1 year was compared to those who discontinued cyclosporine at 1 year. Males predominated (191 vs 38) in both groups, while younger patients (<50 years) predominated in live related group (152 vs four). There was no difference in the incidence of infection, rejection, graft dysfunction, graft loss or death between the two groups. the 1 and 5 year patient survival in the related and unrelated group, (93.7% and 71.4% vs and 85% and 66%) and graft survival (90.4% and 69.4% vs 83.3% and 65.4%) were similar. However, in the unrelated group, patients who discontinued cyclosporine had a higher incidence of rejections (38% vs 14%) and graft loss (43% vs 11.8%), while in the related group no such difference was found. It is concluded that 1 and 5 year patient and graft survival is comparable between live related and live unrelated transplantation. However, in the unrelated group it is necessary to continue cyclosporine beyond 1 year in order to achieve comparable results.     

Combined androgen blockade in the management of advanced prostate cancer: A sensible or ostensible approach

BACKGROUND: To compare the efficacy of orchiectomy alone and orchiectomy plus flutamide in treating patients with advanced carcinoma prostate. MATERIALS AND METHODS: The study was initiated on 1 July 1997 and closed after enrolling 100 patients on 30 June 2000. Patients were prospectively randomized to orchiectomy alone (O) and orchiectomy plus flutamide (OF). A complete response (CR) was defined as the normalization of bone scans and serum prostate-specific antigen (PSA) levels returning to normal (< 4 ng/mL). A partial response (PR) was defined as a 50% reduction in metastasis mass compared to the initial study or a decrease in the PSA level of 50% of the initial value. Progressive disease (PD) was defined as the development of any new hot spot on bone scan or any increase in previously existing PSA level by 25%. RESULTS: A total of 100 patients were entered in the study. The maximum percentage change in PSA levels in both groups was found in the first 3 months after orchiectomy, that is, 95% and 97% for the O and OF groups, respectively. In more than 80% of the patients this decrease in PSA was maintained for 3 years. The mean percentage change at 3 years in the O and OF groups was 70% and 75% (P = 0.95), respectively, and the overall response rate (CR + PR) was 88.50% and 86.53% in the two groups, respectively (P = 0.85). The follow-up period ranged between 3 and 5 years (mean, 3.5 years). The mean time to progression was 27 and 29 months in the O and OF groups, respectively. The overall survival rate at 3 and 5 years in two treatment groups was 45.83% and 48.07%, 20.83% and 23.07% in the O and OF groups, respectively (P = 0.75). CONCLUSIONS: Maximum percentage decrease in PSA is seen within the first 3 months of therapy. Orchiectomy alone is as effective as combination therapy in decreasing serum PSA. Overall survival at 3 and 5 years in the orchiectomy only group was as good as that of combination therapy. These data suggest that the routine addition of flutamide to orchiectomy is not advisable.     

Autologous Mixed Lymphocyte Reaction in Man

Human peripheral T cells and T-cell Subpopulations defined with monoclonal antibodies of the OKT series were studied for the proliferative response on stimulation with autologous non-T cells or mitogen-activated T cells as stimulators in autologous mixed lymphocyte reaction (AMLR). T cells exhibited a vigorous proliferative response when stimulated with autologous non-T cells or activated T cells but not with unactivated T cells. The stimulatory capacity of non-T cells or activated T cells in AMLR was inhibited by prior treatment of stimulator cells with 7, 2 anti-human Ia framework-specific monoclonal antibody in the absence of complement. A BUdR and light technique was used to ablate proliferating T cells in response to either non-T cells or activated T cells in AMLR. The removal of T cells responding to autologous non-T cells left the responsiveness to autologous activated T cells relatively intact. Conversely, the removal of T cells responding to autologous activated T cells left the responsiveness 10 autologous non-T cells relatively intact. Thus T cells responding to autologous non-T cells appear to be distinct from those responding to autologous activated T cells in AMLR. Further analysis with OKT4 and OKT8 monoclonal antibodies showed that the major population responding to autologous non-T cells was contained in OKT4⁺ T cells and that responding to autologous activated-T cells was contained in OKT8⁺ T-cell subset. However, both OKT4⁺ and OKT8⁺ T-cell subsets responded by proliferation to non-T cells and activated T cells in allogeneic MLR. T cells selected after AMLR between T and non-T cells or T and activated T cells were treated with mitomycin and examined for their regulatory influence on the proliferative response of fresh autologous responder T cells. T cells selected from T and non-T AMLR augmented and those obtained from T and activated T AMLR suppressed the proliferative responses of fresh autologous T cells to phytohaemagglutinin and to autologous or allogeneic non-T cells in AMLR or allogeneic MLR. These findings indicate that in AMLR between T and non-T cells or T and activated T cells phenotypically distinct Subpopulations of T lymphocytes respond by proliferation and express distinct immunoregulatory functions.     

SCREENING PROCEDURES IN PEDIATRICS

Pediatric health screening procedures, both prenatal and postnatal, have a tremendous potential in improving the health status of children and in turn reducing the resource burden on the parents and the State. The existing recommendations, inherent problems and different screening procedures are discussed. The need for suitable mass screening pediatric procedures in the Indian context is stressed.KEY WORDS: Pediatric screening procedures