Mortality from coronary heart disease and stroke for six ethnic groups in California, 1985 to 1990

Coronary heart disease and stroke death rates were compared for six ethnic groups (non-Hispanic white, Hispanic, African-American, Chinese, Japanese, and Asian Indian) by sex and age (25 to 44, 45 to 64, 65 to 84, and 25 to 84 years old) using California census and 1985 to 1990 death data. African-American men and women in all age groups had the highest rates of death from coronary heart disease, stroke, and all causes (except for coronary heart disease in the oldest men). Hispanics, Chinese, and Japanese in all age-sex groups had comparatively low death rates for coronary heart disease and stroke, although stroke was proportionally an important cause of death for Chinese and Japanese groups. Coronary heart disease was an important cause of death for Asian Indians although death rates were generally not higher than those for other ethnic groups. Ethnic differences were most marked for women and younger age groups.     

High-intensity focused ultrasound treatment of liver tumours: post-treatment MRI correlates well with intra-operative estimates of treatment volume

Objectives To assess the safety and feasibility of high-intensity focused ultrasound (HIFU) ablation of liver tumours and to determine whether post-operative MRI correlates with intra-operative imaging. Methods 31 patients were recruited into two ethically approved clinical trials (median age 64; mean BMI 26 kg m(-2)). Patients with liver tumours (primary or metastatic) underwent a single HIFU treatment monitored using intra-operative B-mode ultrasound. Follow-up consisted of radiology and histology (surgical trial) or radiology alone (radiology trial). Radiological follow-up was digital subtraction contrast-enhanced MRI. Results Treatment according to protocol was possible in 30 of 31 patients. One treatment was abandoned because of equipment failure. Transient pain and superficial skin burns were seen in 81% (25/31) and 39% (12/31) of patients, respectively. One moderate skin burn occurred. One patient died prior to radiological follow-up. Radiological evidence of ablation was seen in 93% (27/29) of patients. Ablation accuracy was good in 89% (24/27) of patients. In three patients the zone of ablation lay ≤2 mm outside the tumour. The median cross-sectional area (CSA) of the zone of ablation was 5.0 and 5.1 cm(2) using intra-operative and post-operative imaging, respectively. The mean MRI:B-mode CSA ratio was 1.57 [95% confidence interval (CI)=0.57-2.71]. There was positive correlation between MRI and B-mode CSA (Spearman's r=0.48; 95% CI 0.11-0.73; p=0.011) and the slope of linear regression was significantly non-zero (1.23; 95% CI=0.68-1.77; p<0.0001). Conclusions HIFU ablation of liver tumours is safe and feasible. HIFU treatment is accurate, and intra-operative assessment of treatment provides an accurate measure of the zone of ablation and correlates well with MRI follow-up.     

A study of incidence and relationship of intestinal metaplasia of gastric antrum and gastric metaplasia of duodenum in patients with nonulcer dyspepsia

The incidence and relationship of intestinal metaplasia of the gastric antrum and gastric metaplasia of the first part of the duodenum were studied in endoscopic biopsies from 120 patients with nonulcer dyspepsia. Intestinal metaplasia was present in 29% of antral biopsies and gastric metaplasia in 39% of duodenal biopsies, with 9% of patients having both. Intestinal metaplasia was not related to alcohol consumption, but was significantly higher in patients who smoked 10 cigarettes or more daily. (P<0.002). Gastric metaplasia was associated with duodenitis. Its incidence was significantly higher in males (P<0.001) and in patients with a history of high/moderate alcohol intake (P<0.02); these findings are reminiscent of the presence of a similar relationship between these factors and duodenal ulcers and support the suggestion that duodenitis and duodenal ulcers probably represent different parts of a single disease spectrum. The presence of both types of metaplasia in 9% of the patients suggest that factors other than gastric acidity may influence the development of metaplasia.Dr. S. Khan is supported by the Cancer Research Campaign.     

Relationship between Autonomic Innervation in Crista Terminalis and Atrial Arrhythmia

Background : The crista terminalis (CT) is known to initiate and maintain atrial arrhythmia, and is affected by autonomic tone, but the underlying mechanisms are poorly understood. This study sought to study the relation between autonomic innervation in CT and atrial arrhythmia.
Methods: Thirty adult canines were used in the present study. Tissues of the CT and the pectinate muscles (PM) were obtained from 10 dogs for electrophysiology studies. Furthermore, tissues of the superior CT, the inferior CT, and the PM were obtained from 10 dogs for immunohistochemistrical studies. Anti-growth-associated protein 43 (GAP43), anti-tyrosine hydroxylase (TH), and choline acetyltransferase (ChAT) antibodies for immunocytochemical staining of cardiac nerves were performed to test the densities of autonomic nerve. Densities of I_K,ACh in the superior CT, the inferior CT, and the PM cells were measured by patch clamp in the other 10 dogs.
Results: With the pacing cycle length decreased, the amplitude of delayed after depolarization (DAD) increased and DAD-induced triggered activity was induced in the CT but not in PM with norepinephrine administration. GAP-43 and TH-positive nerves in the superior CT and the inferior CT were all significantly higher than in the PM (GAP-43: 6,250 ± 1,928 vs 1,247 ± 747, 2,855 ± 1,579 vs 1,247 ± 747; TH: 3,140 ± 1,240 vs 690 ± 720, 1,210 ± 980 vs 690 ± 720; P < 0.01). Furthermore, the GAP-43 and TH-positive nerves in the superior CT were higher than in the inferior CT. However, there were no significant differences in ChAT-positive nerves and I_K,ACh in the superior CT, the inferior CT, and the PM.
Conclusions: The higher densities of adrenergic nerve in the CT play an important role in the genesis of atrial arrhythmia.     

Does Gender or the Menstrual Cycle Affect Colonic Transit?

Controversy exists as to whether slowing of colonic transit occurs in the high progesterone luteal phase of the menstrual cycle. To clarify this issue, colonic transit studies using radiopaque markers were performed on 10 women in the follicular phase, 10 women in the luteal phase of the menstrual cycle, and five women on oral contraceptives, and the results were compared with transit times in 11 male controls. No significant differences in colonic transit were found between either phase of the menstrual cycle. Colonic transit in women was slower than in men, but this was not statistically significant. In the clinical setting, therefore, colonic transit studies can be performed throughout the menstrual cycle or when taking oral contraceptives. In addition, a single standard for normal values can be used for both men and women.     

Why parents do not provide automobile restraints for their children

If children in cars were adequately restrained many deaths and injuries would be prevented. Currently in New Zealand only 17% of children 0–8 years are appropriately restrained. Questionnaires about child car restraints were completed by 3,288 mothers who had a child 0 to 8 years of age. Eighty-six per cent of the mothers drove at least twice a week while the child was with them. Overall, 52% claimed to always or usually use some form of approved child car restraint. The numbers varied with the age of the child. The reasons parents gave for not using a child car restraint could be place in 2 groups — those which could be changed through altering public attitudes (58%), and those which suggest a need for co-operation between government, car manufacturers and car seat manufacturers (42%). A significant association (P<0.001) was found between people who claimed to use restraints and those who favoured the compulsory use of restraints.