bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantitative determination of plasma phenylalanine and tyrosine by electrospray ionization tandem mass spectrometry
Authors: Hardy D. T. , Hall S. K. , Preece M. A. , Green A
Published: October 2002

Background Phenylketonuria patients on protein-restricted diets require monitoring of their blood phenylalanine concentrations. Small sample volumes are essential for neonates and infants, with the need for results to be generated in a timely manner by robust methods. We present a tandem mass spectrometry assay for phenylalanine (and tyrosine) which fulfils these criteria. Methods Plasma samples were deproteinized using a methanolic solution of phenylalanine-d5 and tyrosine-d4 that served as the internal standards for the assay. Following centrifugation each liquid phase was dried in a well of a microtitre plate and the amino acids converted to butyl esters using butanolic hydrogen chloride. After drying again and reconstituting in 80% acetonitrile in water, the samples were analysed using electrospray ionization tandem mass spectrometry. Results For both phenylalanine and tyrosine the limit of detection was 1 μmol/L and the carry-over less than 1%. The assay was linear to 3000 μmol/L in both amino acids (phenylalanine: r = 0·999; tyrosine: r = 0·992). Inter-sample precision varied with concentration but was 3·4-5·2% for phenylalanine and 4·3-7·6% for tyrosine. Between-batch precision was more variable, being 4·1-12·9% for phenylalanine and 8·4%-10·5% for tyrosine. Conclusions Good agreement was found between the assay and results from existing ion-exchange chromatography and high performance liquid chromatographic assays in this department. Carry-over and precision were acceptable for monitoring work and the linearity allowed most specimens to be analysed without dilution. Where available, tandem mass spectrometry offers a convenient means of transferring the routine work for both neonatal screening and monitoring to one instrument.
Triploid pregnancy detected incidentally by Down's syndrome screening
Authors: Hanning Ian , Mires Gary J
Published: October 2002

Maternal serum screening for Down's syndrome and trisomy 18 identifies pregnancies with a greater risk of these abnormalities, which are then followed-up by karyotyping of cells collected either by amniocentesis or by chorionic villus sampling. These techniques complement ultrasonography, which gives accurate gestational dating as well as identifying structural abnormalities. Other chromosomal abnormalities are sometimes detected by virtue of atypical maternal screening results. This report illustrates a case of triploidy, a lethal abnormality, detected incidentally due to an exceptionally high human chorionic gonadotrophin result identified during Down's syndrome screening. This allowed appropriate counselling of the parents followed by a decision to terminate the pregnancy, avoiding the potential trauma of a spontaneous miscarriage or, if born live, death of the baby. Termination of the pregnancy also resolved associated maternal hyperthyroidism.
Optimizing the availability of 'stat' laboratory tests using Shewhart 'c' control charts
Authors: Burnett Leslie , Chesher Douglas , Burnett John R
Published: October 2002

Background: We describe a general strategy for optimizing the availability of 'stat' out-of-hours laboratory tests to the particular clinical needs of health care institutions. Methods: We initially introduced a consensus menu of 'stat' tests and prospectively monitored for 5 years all additional requests for 'stat' clinical biochemistry tests in a metropolitan tertiary referral university teaching hospital. Laboratory staff triaged 'stat' requests, and clinical biochemistry consultants reviewed requests not already performed routinely. The frequency of these requests was monitored on a Shewhart 'c' control chart. A quality system certified to ISO 9001 was used to assure laboratory compliance with procedures. Various interventions were tested using the Shewhart 'c' control chart to monitor their effectiveness. Results: Matching the timing of analytical assays with the time of sample collection had no significant effect on the number of 'stat' requests. Implementation of a hospital-wide laboratory information system also had no significant effect on the number of 'stat' requests. The most effective strategy consisted of optimization of the test menu to match request patterns, combined with the introduction of a laboratory quality system. Conclusions: Within our institution, this strategy resulted in a sevenfold reduction in 'stat' requests, from one per 2200 specimens to fewer than one per 32 000 specimens.
Evaluation of a rapid micro-scale assay for tacrolimus by liquid chromatography-tandem mass spectrometry
Authors: Keevil BG , McCann SJ , Cooper DP , Morris MR
Published: October 2002

Background: The immunosuppressive drug tacrolimus has complex and unpredictable pharmacokinetics, therefore regular monitoring is required in patients receiving tacrolimus therapy. We have developed a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for measuring tacrolimus concentrations in whole blood and have compared it with a microparticle enzyme immunoassay.

Methods: For the LC-MS/MS assay, samples were prepared in a 96-deep well microtitre plate by adding 10 µL of blood to 40 µL of 0·1 mol/L zinc sulphate solution. Proteins were precipitated by adding 100 µL acetonitrile containing ascomycin internal standard. After vigorous mixing and centrifugation, 20 µL of the supernatant was injected into the LC-MS/MS system. A C18 cartridge (3 mm × 4 mm) was eluted with a step gradient of 50% to 100% methanol containing 2 mmol/L ammonium acetate and 0·1% (v/v) formic acid, at 0·6 mL/min. The column was maintained at 55°C.

Results: The retention times were 0·98 min for ascomycin and 0·98 min for tacrolimus. Cycle time was 2·5 min, injection to injection. The analytes were monitored using a Quattro micro tandem mass spectrometer operated in multiple reaction monitoring mode using the following transitions: m/z821 > 768 (tacrolimus) and m/z809 > 756 (ascomycin). The limit of quantitation was 0·5 µg/L and the assay was linear up to 30 µg/L. Precision of the method, over the concentration range 2·5-15·0 µg/L, was < 7% within-batch and < 6% between-batch. Total time to analyse 24 samples including result generation was 90 min.

Conclusion: We conclude that the LC-MS/MS method is quick, precise and robust and will provide a fast turn around of results for the transplant physician.
Stability of ascorbic acid in serum and plasma prior to analysis
Authors: Ching Simon YL , Prins Alex W , Beilby John P
Published: October 2002

Introduction: The stability of ascorbic acid in serum and plasma prior to analysis was studied.

Methods: Blood samples were collected from ten healthy subjects into Vacutainer tubes containing either dipotassium EDTA, lithium-heparin or no additive. Ascorbic acid was analysed following immediate separation and preservation of samples, following delayed separation for 2 h and after delayed deproteinization and preservation for 2, 5 and 8 h. Deproteinization and preservation were achieved using a solution containing perchloric acid, EDTA and dithiothreitol. Ascorbic acid was analysed by high-performance liquid chromatography.

Results: Blood collected into EDTA and separated, deproteinized and preserved immediately gave the highest yield of ascorbic acid. Loss of analyte after delayed separation was least for EDTA tubes (median 7%, range 4-13%), followed by lithium-heparin (median 18%, range 10-32%) and serum (median 26%, range 14-50%). Immediate separation of samples but delayed deproteinization and preservation also resulted in substantial losses of ascorbic acid.

Conclusion: Minimum loss of ascorbic acid is achieved if blood is collected into tubes containing dipotassium EDTA and separated within 2 h, followed by immediate deproteinization and preservation.
Glossopharyngeal neuralgia following foreign body impaction in the neck
Authors: Webb C. J. , Makura Z. G. G. , McCormick M. S.
Published: October 2002

Glossopharyngeal neuralgia is rare, typically idiopathic and treated with carbamazepine. Surgery to decompress or transect the glossopharyngeal nerve root may be performed if conservative management fails. We present a case following trauma to the neck with foreign body impaction. To our knowledge this is the first case of glossopharyngeal neuralgia due to neck trauma.
Cosmetic tracheostomy locket: an attempt to improve the aesthetic component of tracheostomy tubes
Authors: Tzifa K. T. , Jeynes P. J. , Shehab Z. P. , Proops D. W.
Published: October 2002

This paper demonstrates the need for a cosmetic device as a necessary adjunct to long-term tracheostomy care. Such devices are not available, at present, from tracheostomy tube manufacturers. The cosmetic tracheostomy cover plate is based on a silver Negus tracheostomy tube, to which the silver chain and cover plate (locket) are attached. The result, for the patient who tried it, was excellent.
Mycotic pseudoaneurysm of common carotid artery mimicking parapharyngeal abscess
Authors: Constantinides H. , Passant C. , Waddell A. N.
Published: October 2002

In this case a secondarily infected pseudoaneurysm of the common carotid artery presented with clinical features suggestive of a parapharyngeal abscess. The causative organism was identified as community-acquired methicillin-resistant Staphylococcus aureus. To the authors’ knowledge this condition not previously been reported.
Myringoplasty: update on onlay pedicle skin flap and temporalis fascia sandwich graft
Authors: Raghavan U. , Malki D. S. I. , Mahmoud N. A.
Published: October 2002

The technique of onlay sandwich grafting of tympanic membrane perforations fashioned by the use of pedicle flap raised from the posterior deep meatal skin and autologous temporalis fascia is described. The results of a series of 124 ears operated between 1987 and 1999 are the basis of this report. Of these 106 patients had myringoplasty for the first time. The operation was successful in 102 (96.23 per cent) patients. Eighteen patients had revision myringoplasty, with a successful result in 14 (77.78 per cent). None of the patients developed complications usually associated with onlay grafting. A preliminary report of this work was presented at the XVI World Congress of Otolaryngology Head and Neck Surgery at Sydney in 1997.
Oculomotor nerve palsy following submucosal diathermy to the inferior turbinates
Authors: Green K. M. J. , Board T. , O’Keeffe L. J.
Published: October 2002

Submucosal diathermy to the inferior turbinates is a common surgical procedure performed to improve the nasal airway. We present the case of a previously well six-year-old boy who underwent submucosal diathermy and developed the unusual complication of a left oculomotor nerve palsy. The possible aetiology is discussed.
Medial displacement of grommets: an unwanted sequel of grommet insertion
Authors: Kumar Manoj , Khan Anwar M. , Davis Sinead
Published: October 2002

Grommet insertion is one of the commonest surgical procedures performed in the UK. We have come across three cases in which grommets have displaced medially in the middle ear after establishing a satisfactory postinsertion position. We suggest that an abnormally long myringotomy incision and improper placement of the grommet are responsible for this unwanted outcome.
Simple device for chemical cauterization of posterior bleeding points in the nose
Authors: Alderson David
Published: October 2002

Epistaxis in adults often arises from a posteriorly-placed bleeding point. This paper describes a method of cauterizing these vessels under endoscopic control using simple materials found in most ENT departments, thus avoiding the need for more specialist equipment.
Plexiform neurofibroma of the submandibular gland
Authors: Dereköy Sefa , Sefali Mükerrem
Published: October 2002

A rare plexiform neurofibroma of the submandibular gland in a patient with neurofibromatosis is presented. The clinical manifestations of the disease are reviewed. The need for early diagnosis of neurofibroma is emphasized because of malignant tranformation.
Sensory deprivation as a consequence of severe head and neck lymphoedema
Authors: Withey S. , Pracy P. , Vaz F. , Rhys-Evans P.
Published: October 2002

We report a case of sensory deprivation that occurred as a consequence of progressive head and neck lymphoedema, following combined surgery and radiotherapy for squamous cell carcinoma. The management of head and neck lymphoedema is discussed and measures are suggested for improving the sensory deprivation experienced by the worst affected patients.
Survey of computed tomography scanning and endoscopic sinus surgery in a group of District General Hospitals in South Essex
Authors: Hill David , Ayra Ajay , Solieri Ashley , Gatland David
Published: October 2002

The management of chronic sino-nasal disease has changed significantly in the last 15 years with the advent of topical nasal steroids and minimally invasive endoscopic surgery, but survey data from district hospitals in the UK have not been published to date. We examined the current management of 383 consecutively scanned patients with sino-nasal symptoms in three district hospitals. Survey standards were set, and were attained in 56 per cent for symptom recording, 60 per cent for pre-scan diagnosis, 62 per cent for endoscopic examination in out-patients, and 73 per cent for topical steroid use before scanning. The variability of sinus disease makes it difficult to be dogmatic about proper indications for surgery, but subsequent surgical management, as ascertained from the notes, showed large differences between consultants in the three hospitals. The rate of minor complications was 2.2 per cent, there were no major complications, and the vast majority of patients stated that their nasal symptoms were improved by surgery. The survey showed that endoscopic sinus surgery is safe and effective when practised in a district hospital setting.
Inflammatory myofibroblastic tumour of larynx
Authors: Martínez S. , Bosch R. , Pardo J. , Salvadó M. T. , Alvaro T.
Published: October 2002

Inflammatory myofibroblastic tumour (IMT) is a benign pseudoneoplastic proliferation, mainly developing in the lung and extremely rare in the larynx. A patient with a two-month history of dysphonia and
a polypoid left true vocal fold tumour is presented. Histological and clinical knowledge of this lesion is important to exclude a misdiagnosis (e.g. malignant epithelial or mesenchymal tumours) and an inappropriate treatment.
In vitro evaluation of a malleus head to stapes head ‘incus replica’ prosthesis
Authors: Mills Robert , Abel Eric , Lord Richard
Published: October 2002

An ossicular prosthesis produced by making a mould from a cadaveric incus and injecting ionomeric cement into it (incus replica prosthesis, IRP) has been cemented to the malleus head and stapes head and evaluated in fresh human temporal bones using a laser vibrometer. Stapes velocity was recorded under acoustic stimulation and foot plate displacements were derived. Fourteen frequencies between 125 Hz and 8000 Hz have been used. Measurements were made with the ossicular chain intact, following removal of the incus, with the prosthesis cemented to the malleus, but not the stapes, and with the incudo-stapedial joint cemented. In a second series of experiments the performance of the IRP was compared with that of a Causse partial ossicular replacement prosthesis, using the same experimental set-up. The results indicate that the prosthesis performs almost as well as the intact ossicular chain and that cementing the incudostapedial joint gives better sound transmission than leaving it uncemented. In addition the IRP outperforms the conventional partial ossicular replacement prosthesis.
Temporal bone dissection: a possible route for prion transmission?
Authors: Scott A. , Sadek S. A. A. , Garrido M. C. , Courteney-Harris R. G.
Published: October 2002

The aim of this study was to determine whether neural tissue is present in the bone ‘dust’ given off during temporal bone drilling. Bone ‘dust’ from three temporal bone dissections was collected and examined. Evidence of neural tissue was present in two out of the three specimens. Neural tissue is present in the bone dust given off during temporal bone drilling. This poses the question as to the risk of prion transmission during such dissection.
Morphometric analysis of anatomical relationships of the facial nerve for mastoid surgery
Authors: Aslan Asim , Goktan Cihan , Okumus Mevlut , Tarhan Serdar , Unlu Halis
Published: October 2002

Surgical anatomical relationships of the facial nerve (FN) with several landmarks used in mastoid surgery were studied in temporal bone axial high resolution CT scans of 90 patients (180 ears). The shortest distances between the FN and external auditory canal (EAC), sigmoid sinus (SS), posterior fossa dural plate (PFD), and joint of the bony EAC with the lateral surface of the mastoid (M) were measured. These measurements were also analysed in respect of pneumatization and side differences. On average, it was found that FN–EAC was 2.9 mm, FN–SS was 10.5 mm, FN–PFD was 7.3 mm and FN–M was 15.3 mm. FN–EAC was found to be longer in poorly pneumatized bones whereas other distances were longer in pneumatized bones. FN–M was found to be longer on the right side.
Management of paediatric otitis media with effusion in the UK: a survey conducted with the guidance of the Clinical Effectiveness Unit at the Royal College of Surgeons of England
Authors: Ryan Rowena , Harkness Paul , Fowler Sarah , Topham John
Published: October 2002

A survey was undertaken of the practice of all Otorhinolaryngologists in England and Wales looking both at practice in general and at management of individual patients, including a patient satisfaction questionnaire, under the auspices of the Clinical Effectiveness Unit at the Royal College of Surgeons. Postal questionnaires enquired about practice in general and management in particular of 20 sequential patients per consultant. Parent questionnaires were sent six weeks and one year post-operatively. Ninety consultants took part and 1503 individaul patient proformas were returned. Results showed that these consultants are managing children with otitis media with effusion (OME) in a manner very close to the recommendations of the Effective Healthcare Bulletin (1992) and consistent with the recent Clinical Effectiveness Statement of the BAOHNS, and that the intervention is popular with parents.
Primary malignant melanoma of the pharynx
Authors: Öztürk Özcan , Özek Hüsnü , Cansiz Harun , Karakullukçu Bariş
Published: October 2002

Primary mucosal malignant melanomas are rare. They appear late in life and their prognosis is grave. Although there is no consensus on therapy, wide surgical resection followed by radiotherapy, chemotherapy and immunotherapy are treatment modalities. In this report we present a case of widespread primary mucosal malignant melanoma located in the pharynx. After immunotherapy (four cycles of interleukin-2 and interferon-alpha) and chemotherapy (four cycles of cisplatin and dacarbazine) has been applied as primary therapy for suppression of the mass, transoral total pharyngeal resection was performed. After surgery three cycles of immunotherapy and three cycles of chemotherapy were administered followed by radiotherapy (total dose of 6600 cGy). An additional three cycles of immunotherapy and chemotherapy were administered. Although no local recurrence was observed during the 14 months of follow-up after the completion of radiotherapy, cranial and lung metastasis were detected in the 12th month.
Spherical foreign bodies in the oesophagus removed by balloon angiographic catheter
Authors: Reddy N. Vishnu Swaroop , Bhatt C. , Vaughan-Jones R. H. , Reddy T. N.
Published: October 2002

Two children aged three and seven years presented to the department of Otolaryngology with total dysphagia following the accidental swallowing of a steel ball bearing and a plastic ball. These rare spherical foreign bodies were removed successfully by oesophagoscopy under general anaesthesia using an innovative method involving a balloon angiographic catheter.
Primary aspergillosis of the larynx associated with CD4+ T lymphocytopenia
Authors: Nakahira Mitsuhiko , Matsumoto Shuji , Mukushita Naoko , Nakatani Hiroaki
Published: October 2002

The purpose of this study was to report the first case (to our knowlege) of primary laryngeal aspergillosis in a patient with underlying CD4+ T lymphocytopenia. Laryngeal involvement of Aspergillus is more commonly seen as a part of a wider infection involving the respiratory system in an immunocompromised host. However, primary infection of the larynx is extremely rare. Although there were 12 cases of primary laryngeal aspergillosis previously reported in healthy subjects, there is no known study describing immunological findings in detail. We report a case of primary laryngeal aspergillosis in a healthy 79-year-old male. The examination of his immunity subsequently revealed that there was a marked decline in the number of CD4+ T lymphocytes and a decrease in the ratio of CD4+ to CD8+. It is suggested that it is essential to examine the defence mechanisms, specifically cell-mediated immunity in a patient showing primary laryngeal aspergillosis.
Respiratory epithelial adenomatoid hamartoma of the maxillary sinus
Authors: Himi Yuji , Yoshizaki Tomokazu , Sato Katsuaki , Furukawa Mitsuru
Published: October 2002

A case of respiratory epithelial adenomatoid hamartoma of the maxillary sinus is reported. Glandular hamartomas involving the sinonasal tract have received only limited documentation in the literature. The differential diagnosis of adenomatoid hamartoma includes schneiderian papilloma of the inverted type and adenocarcinoma. Limited but complete surgical resection is the treatment of choice.
Surface structures of aural polyps: a scanning electron microscopic study
Authors: Skladzień J. , Litwin J. A. , Nowogrodzka-Zagórska M. , Miodoński A. J.
Published: October 2002

Surfaces of aural polyps collected from 30 patients were examined by scanning electron microscopy. In the polyps not associated with cholesteatoma, the epithelial lining showed individually variable metaplasia towards cuboidal ‘cobblestone’-type and squamous epithelium covered with microvilli of various shapes and sizes. Squamous epithelium was present on the surface of all polyps with underlying cholesteatoma, with superficial cells possessing elongated microvilli, microplicae of different sizes, grooves and pits. Such surface structures reflect different stages of the keratinization process that seems to becharacteristic for the epithelial lining of polyps with underlying cholesteatoma. Incomplete epithelium accompanied by granulation tissue was found in several polyps; in two cholesteatoma-associated polyps plate-likecholesterol crystals were observed.
Correlation between bacteriology of the middle meatus and ethmoid sinus in chronic sinusitis
Authors: Jiang Rong-San , Lin Jen-Fu , Hsu Chen-Yi
Published: October 2002

In this study we report on the correlation between the bacteriology of the middle meatusand ethmoid sinus in chronic sinusitis. When patients with chronic sinusitis underwent functional endoscopicsinus surgery (FESS), swab specimens were taken from the middle meati before surgery. After removing the ethmoid bullae, swab specimens were taken from the ethmoid sinuses. Between November 1998 and February 2001, 186 pairs of middle meatal and ethmoid sinus specimens were collected from 186 patients. No bacteria were cultured from either specimen in 32 patients. The same bacteria were cultured from both specimens in another 60 patients. The culture results differed between the middle meatal and ethmoid sinus specimens in the remaining 94 patients. There was a significant difference between culture rates of 63.4 per cent for middle meatal specimens and 76.3 per cent for the ethmoid sinus specimens. In analysing bacterial species, significantly more aerobic Gram negative bacteria were cultured from the ethmoid sinus specimens than from the middle meatalspecimens. This study shows that the bacteriology of the middle meatus was different from that of the ethmoid sinus. Therefore, the bacteriological findings in the middle meati may not reflect the real bacteriology in chronic sinusitis.
Th1 and Th2 CD4+ T cells and Tc1 and Tc2 CD8+ T cells of patients with Wegener’s granulomatosis
Authors: Ohta Nobuo , Fukase Shigeru , Fuse Takeo , Aoyagi Masaru
Published: October 2002

A Th1/Th2 cytokine imbalance with a predominance of Th1 cytokines has been suggested to be of pathogenic importance in Wegener’s granulomatosis. To evaluate the role of Th1/Th2 cytokines in Wegener’s granulomatosis, the subsets of Th1, Th2, Tc1 and Tc2 cells from patients with active Wegener’s granulomatosis were examined by intracellular cytokine flow cytometry. The population of Tc1 cells (72.0 ± 14.4 per cent) in Wegener’s granulomatosis was significantly increased compared with Tc1 cells (37.3 ± 14.6 per cent) in control (p<0.05). Th1, Th2 and Tc2 cells in Wegener’s granulomatosis were not significantly increased compared with the control cells. These results indicate that the predominance of Tc1 cells might contribute to the mechanism of the pathogenesis of Wegener’s granulomatosis.
Acoustic neuroma presenting as exercise-induced vertigo
Authors: Chee Nelson Wang Cheng , Tong Helen Mui Huey
Published: October 2002

We present two subjects with previously undiagnosed acoustic neuromas who complained of vertigo whenever they ran. One had normal hearing while the other already had a unilateral sensorineural deafness. Hyperventilation for 30 seconds provoked an ipsilateral beating nystagmus and reproduced the vertiginous sensation in both subjects. Hyperventilation is a simple bedside test that should be performed when assessing a subject with vertigo or when there is a clinical suspicion of an acoustic neuroma.
Medullary thyroid carcinoma: a rare presentation as a hypervascular tumour
Authors: Li W. Y. , Tomlinson M. A. , Bryson J. M. , Hopkins N. F. G.
Published: October 2002

Sporadic medullary thyroid carcinoma (MTC) usually presents with a thyroid mass, cervical lymphadenopathy or other local cervical symptoms. Often the diagnosis is unsuspected pre-operatively. We report a unique case of a mixed follicular medullary thyroid carcinoma presenting as a tumour with extreme vascularity. The management of hypervascular thyroid tumours is discussed together with current controversies regarding persistent hypercalcitoninaemia.
Paediatric revision myringoplasty: outcomes and prospects
Authors: Berger Gilead , Berger Sivan
Published: October 2002

Paediatric revision myringoplasty has received little attention. This study addressed the issue exclusively and reviewed the short- and long-term results of surgery in children between the ages of five and 15. Twenty-six out of 38 operated ears (68.4 per cent) were initially intact. The causes of immediate failure in decreasing order were: infection with graft necrosis, complete no-take of the graft and poor anterior adaptation of the graft. Age, size and site of perforation and surgeon’s experience did not significantly affect the initial outcome of surgery. Six ears developed delayed re-perforations, thus decreasing the overall success rate to 52.6 per cent. The latter were attributable to either episodes of acute otitis media or to insidious atrophy of the tympanic membrane. Notably, none developed post-operative sensorineural hearing loss. It is concluded that the results of paediatric revision myringoplasty are rather disappointing, yet arguments encouraging its practice are favourably presented.
Assessing day-case septorhinoplasty: prospective audit study using patient-based indices
Authors: Georgalas Christos , Paun Santdeep , Zainal Azida , Patel Nimesh N. , Mochloulis George
Published: October 2002

The objective of this study was to evaluate the safety, efficacy and acceptability to patients of day-case septorhinoplasty. Twenty-nine patients undergoing elective septorhinoplasty in a dedicated teaching hospital day-case unit were asked to complete day surgery questionnaires (DSQ) at six weeks post-operatively. Details of surgery performed, demographic data, readmission rates and complications were collected prospectively. No major complications were recorded. One patient had to be admitted for overnight observation following post-operative bleeding. The DSQ showed that the great majority of patients were satisfied from the day-case setting (satisfaction score 81). This preliminary study showed that day surgery septorhinoplasty was acceptable to the patient and was associated with a very low readmission rate. We believe that in carefully selected young healthy patients it is an acceptable alternative to an in-patient procedure.
Evaluation of individually ventilated cage systems for laboratory rodents: occupational health aspects
Authors: Renström Anne , Björing Gunnar , Höglund A. Urban
Published: October 2002

New ventilated caging systems for laboratory animals were compared with conventional caging regarding allergen distribution, ergonomic suitability, cage environment and animal welfare. This paper presents occupational health evaluations.

Mice were placed in individually ventilated cage (IVC) systems, a ventilated cabinet, and in cages on open shelves (conventional husbandry). The IVC systems were studied at negative and positive airflow. Aeroallergens were sampled on filters ( n = 204, including controls) in undisturbed rooms and during cage changing. Concentrations of mouse urinary allergen (Mus m 1) in filter eluates were measured using sandwich ELISA. An ergonomic evaluation was performed with measurement of traction forces.

Staff exposure during cage changing was high in all systems, range 116-4430 ng Mus m 1/m3. In undisturbed animal rooms, allergen levels were orders of magnitude higher when using conventional caging compared with ventilated systems; P < 0.001. At positive pressure, both IVCs leaked allergen (median Mus m 1 concentration was < 0.08 ng/m3 at negative, but 6.5 ng/m3 (IVC1) and 0.8 ng/m3 (IVC2S) at positive pressure). The IVC systems had ergonomic disadvantages compared with the conventional husbandry and the ventilated cabinet, for instance with cages in unsuitable working heights.

Ventilated husbandry solutions reduce levels of airborne allergen substantially at negative pressure, but are ergonomically less suitable. To prevent allergen exposure during cage changing, we propose that this procedure should be performed under ventilated conditions. Producers and users must cooperate in optimizing animal caging systems for both animals and staff.
Metabolic flux measurements across portal drained viscera, liver, kidney and hindquarter in mice
Authors: Hallemeesch M. M. , Ten Have G. A. M. , Deutz N. E. P.
Published: October 2002

A method was developed to measure metabolic fluxes across either portally-drained viscera (PDV) and liver or kidney and hindquarter (HQ) in anesthetized mice. The method includes a primed-constant infusion of ketamine-medetomidine anaesthesia to stabilize the mice for the surgical procedures. For measurement of metabolic fluxes across PDV and liver, blood sampling catheters were inserted in the carotid artery, portal vein and hepatic vein and infusion catheters in the jugular vein and mesenteric vein. For measurement of metabolic flux across kidney and HQ, blood sampling catheters were inserted in the carotid artery, renal vein and caval vein and infusion catheters in the jugular vein and abdominal aorta. 14C-PAH was infused to enable plasma flow measurement using an indicator dilution method. In addition, we developed a blood sampling procedure without waste of blood.

We measured plasma flow and metabolic fluxes across PDV, liver, kidney and HQ. Mean plasma flow in post-absorptive mice was: PDV: 0.9 ± 0.2, liver: 1.2 ± 0.3, kidney:1.0 ± 0.1, HQ: 1.1 ± 0.3 ml/10 g body weight (b.w.)/min. Significant glutamine release by the HQ and uptake of glutamine by the kidney and PDV was observed. In PDV, citrulline is produced from glutamine and is in turn used by the kidney for the production of arginine. In conclusion, the described model enables measurement of metabolic fluxes across PDV, liver, kidney and HQ in mice. The availability of such a small animal model allows the potential for measuring metabolic parameters in transgenic and knockout mice, and therefore may lead to an important refinement in metabolic research.
The selection of marmoset monkeys (Callithrix jacchus) in pharmaceutical toxicology
Authors: Smith D. , Trennery P. , Farningham D. , Klapwijk J.
Published: October 2002

Prior to controlled clinical trials in human volunteers or patients it is required that novel pharmaceuticals are evaluated for pre-clinical safety in a rodent and a non-rodent ('second') species. In most cases the rodent species used has been the rat and the second species has been the dog or macaque (usually cynomolgus or rhesus) monkey. However, there is an increasing trend within the United Kingdom (UK) pharmaceutical industry to use the common marmoset ( Callithrix jacchus) for pre-clinical toxicology programmes.

This paper examines the practicality of using the common marmoset (henceforth referred to as 'the marmoset') in toxicological testing and reviews metabolic and pharmacodynamic similarities between this species and humans. It then discusses some of the advantages and disadvantages of the use of this species when compared with two other alternatives to the dog and macaque, namely the ferret and minipig. In particular, the marmoset has clear advantages over the macaque in terms of animal welfare and practicality. There is regulatory acceptance of this species for Investigational New Drug (IND), Clinical Trial Exemption (CTX), New Drug Application (NDA) and Marketing Authorization Application (MAA) registrations. Whilst the dog is likely to be maintained as the primary non-rodent species in toxicology, the marmoset has been, and will likely continue to be, adopted as an additional non-rodent species in pre-clinical toxicology programmes where appropriate.
Insights from animal models for growing intestinal neomucosa with serosal patching - a still untapped technique for the treatment of short bowel syndrome
Authors: Freud E. , Eshet R.
Published: October 2002

The aim of surgical treatment of short bowel syndrome is to increase the intestinal absorptive capacity by increasing the area of absorption or by slowing intestinal transit. The use of serosal patching to grow new intestinal mucosa is a technique for enlarging the intestinal surface. The regenerated intestine develops by lateral ingrowth from the neighbouring mucosa and is functionally similar to normal intestinal mucosa. The present review summarizes the main contributions of the rabbit, the rat and the canine models used to date for growing neomucosa using the serosal patch technique, as well as examining the influence of some growth factors on the development of neomucosa.
The use of diagnostic radiology to detect shell irregularities in the New Zealand paua (abalone) Haliotis iris
Authors: Schofield John C. , Grindley Roseanne M. , Keogh Jonathan A.
Published: October 2002

A method is described for the non-destructive, non-invasive, detection of shell lesions in the New Zealand paua, a marine gastropod Haliotis iris using diagnostic radiology. The X-ray method reliably detected the presence of shell lesions in 96% of the cases examined once lesion dimensions exceeded 6.2 × 7.1 mm. The extent of lesions above this size can be reliably and accurately determined from X-ray images viewed on a video display unit (VDU). Biofouling on the outside of the shell can cause misdiagnoses. This method is a significant animal welfare refinement in the identification of marine gastropods with shell lesions, when compared with traditional techniques which kill the animals.
Fluctuating asymmetry in mice and rats: evaluation of the method
Authors: Stub C. , Ritskes-Hoitinga M. , Thon R. , Hansen C. K. , Hansen A. K.
Published: October 2002

Fluctuating asymmetry, which reflects small, random deviations from symmetry in otherwise bilaterally symmetrical characters, may be used as an indicator of developmental instability in humans and farm animals, and it may also be applicable as a stress indicator. We intended to find a method to allow the use of fluctuating asymmetry as a stress indicator in laboratory animals. That method had to be reproducible and reliable. Furthermore, its applicability in laboratory animals would be improved if it was possible to obtain measurements on the skin surface that correlated with results obtained by measuring the skeleton directly. Seven traits in mice and five traits in rats were evaluated for their applicability for measuring fluctuating asymmetry in mice and rats. Two out of the seven traits, i.e. the width of the joint between the third metatarsal bone and the digital bone on the hind paw, and the length of the incisor tooth at the top, were found to be reliable and reproducible for detecting fluctuating asymmetry in mice as well as in rats. Three out of the seven traits, i.e. the width of the carpal bones, the width of the joint between the tibia and the tarsal bones, and the length of the incisor tooth at the bottom, did express fluctuating asymmetry, but showed a poor day-to-day reproducibility. If the day-to-day reproducibility could be increased, these three traits might also be suitable for measuring fluctuating asymmetry in mice and rats. The last two traits, i.e. the length of ulna and the length of calcaneus plus metatarsal bone i.v., measured both on the skin surface and directly on the bone, did not express fluctuating asymmetry, and had a poor day-to-day reproducibility. These two traits are not suitable for measuring fluctuating asymmetry in mice and rats.
Regional distribution of glutamate in the central nervous system of rat terminated by carbon dioxide euthanasia
Authors: Gos T. , Hauser R. , Krzyzanowski M.
Published: October 2002

Carbon dioxide euthanasia is an established method for the termination of small laboratory animals. It has also been employed by the authors in neurobiological research on the post-mortem glutamate concentration in the structures of rat brains. The following investigations were aimed at optimizing the termination procedure based on the CO2 saturation rate of the inhaled air. Two rates of CO2 flow were applied, and the higher one significantly augmented the glutamate level in the hippocampus and cerebellum. The relationship between this finding and signs of central fear reaction is discussed. The authors conclude that lower rather than higher CO2 flow in euthanasia procedures is gentler and is therefore preferable for use with laboratory animals.
Buprenorphine: a reappraisal of its antinociceptive effects and therapeutic use in alleviating post-operative pain in animals
Authors: Roughan J. V. , Flecknell P. A.
Published: October 2002

Buprenorphine has been widely used for post-operative analgesia in laboratory animals. Clinical efficacy has been demonstrated in both subjective and objective pain assessment schemes, however doubts have been expressed as to its value as an analgesic. Initial dosage recommendations were based on analgesiometric studies. It is unlikely, however, that the pain elicited in analgesiometric tests is comparable to post-operative pain. This has resulted in recommendations of excessive dose rates and inappropriate clinical indications. Studies involving tests of the efficacy of buprenorphine for alleviating behavioural or other signs of tonic (post-surgical) pain provide a more appropriate estimation of the analgesic capabilities of the drug. However, buprenorphine also has major effects upon the behaviour of normal (unoperated) animals, and this makes assessments of efficacy difficult with some of the systems used for scoring clinical pain. Nevertheless, our most recent studies of the effects of buprenorphine upon pain-related behaviours in rats support the view that it is an effective post-operative analgesic. This short review critically reappraises the role of buprenorphine in this capacity and discusses a rational approach to the relief of pain in laboratory animals. We conclude that buprenorphine remains a valuable agent for pain relief in a wide range of animal species when used in an appropriate manner.
Public versus private hospital maternity length of stay: a gamma mixture modelling approach
Authors: Lee A. H. , Xiao J. , Codde J. P. , Ng A. S. K.
Published: October 2002

Application of a gamma mixture model to obstetrical diagnosis-related groups (DRGs) revealed heterogeneity of maternity length of stay (LOS). The proportion of long-stay subgroups identified, which can account for 30% of admissions, varied between DRGs. The burden of long-stay patients borne was estimated to be much higher in private hospitals than public hospitals for normal delivery, but vice versa for Caesarean section. Such differences highlights the impact of DRG-based casemix funding on inpatient LOS and have significant implications for health insurance companies to integrate casemix funding across the public and private sectors. The analysis also benefits hospital administrators and managers to budget expenditures accordingly.
Managing care and cure - up and down, in and out
Authors: Mintzberg Henry
Published: October 2002

Managing may be managing, but it is practiced in a wide range of ways in the so-called 'healthcare' system. All or in some cases part of a day in the life of seven managers is described and then analysed, separately and then together. This presents a consistent picture of the varieties as well as the discontinuities in managing this hopefully integrated system.
The effect of modest monetary incentives on follow-up rates in sexually transmitted disease studies
Authors: Kissinger P , Kopicko J J , Myers L , Wustrack S , Elkins W , Farley T A , Martin D
Published: October 2002

The purpose of the study was to determine if follow-up rates in sexually transmitted disease (STD) research could be improved by offering modest monetary incentives. Women aged 14-34, infected with Chlamydia trachomatis, and enrolled in either of 2 studies between May 1995 and January 1999 were included. Beginning in March 1996 participants were offered a $20 incentive to return to both the one - and four month follow-up visits. Data were analysed using polychotomous logistic regression. Of 962 women followed, the majority (74.7%) received monetary incentives and 66% returned for at least one visit. Women who received the incentive were more likely (OR 1.9, CI 1.2-2.9) to return for either one or both of their follow-up visits after adjusting for interviewer and the months of work experience of that interviewer. Age and method of birth control were not associated with return rates. The study provides evidence that modest monetary incentives can improve follow-up rates.
Disease prevalence in women attending the STD clinic in Mumbai (formerly Bombay), India
Authors: Divekar Anagha A , Gogate Alka S , Shivkar Lata K , Gogate Sharad , Badhwar Vandana R
Published: October 2002

Our objectives were to determine the prevalence of Neisseria gonorrhoeae and its association with other STD causing organisms. Three hundred and thirty-six consecutive women (female sex workers (FSWs) and married contacts), attending a sexually transmitted disease (STD) clinic in Mumbai, were screened for N. gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis. Per speculum examination was performed and clinical signs were recorded. Symptoms perceived by the women were also recorded. The mean age for married contacts, FSWs and gonorrhoea-positive women was 27.9, 29.7 and 27.5, respectively. 9.7% of the women were positive for N. gonorrhoeae, 23.2% were chlamydia-positive and 5.9% had trichomoniasis. N. gonorrhoeae was isolated more frequently from FSWs as compared to the married contacts. The prevalence of HIV was significantly higher among women with multiple sex partners (FSWs) (P < 0.001). Gonococcal infection is significantly associated with the presence of HIV. A significant association between sexual habits and prevalence of gonorrhoea, trichomoniasis and HIV was observed. The prevalence of gonorrhoea over 1988 to 1996 remained approximately the same.
Safety of oral versus intravenous hydration during induction therapy with intravenous foscarnet in AIDS patients with cytomegalovirus infections
Authors: Cheung Tony W , Jayaweera Dushyantha T , Pearce Daniel , Benson Paul , Nahass Ronald , Olson Carolyn , Wool G Michael
Published: October 2002

We undertook a study to compare the safety of intravenous (i.v.) versus oral hydration to prevent nephrotoxicity associated with the use of foscarnet for induction therapy of cytomegalovirus (CMV) infection in HIV-infected persons. Patients, given foscarnet at a dose of 90 mg/kg every 12 h, were randomized to receive either i.v. or oral hydration. Thirty-seven patients were given i.v. hydration and 44 were given oral hydration. Median duration of therapy for both groups was 17 days. There was no difference between the 2 groups in either serious adverse events or rise of creatinine to ≥2.0 mg/dl. However, serum creatinine, while generally remained within normal limits, increased more in patients who received oral hydration after 10 days of therapy (significant only by slope analysis, P <0.05). Although i.v. hydration provided better protection against nephrotoxicity, oral hydration was relatively safe and convenient provided that creatinine clearance (CrCl) is monitored closely.
Disseminated Mycoplasma fermentans in AIDS patients: several case reports
Authors: Ainsworth J G , Clarke J , Goldin R , Taylor-Robinson D
Published: October 2002

We describe the clinical course of 2 HIV-positive patients in whom Mycoplasma fermentans was disseminated and persistent. We identified individuals in whom M. fermentans had been detected in a peripheral blood mononuclear cell (PBMC) or bronchoalveolar lavage (BAL) specimen. Of this group a number had archival specimens of interest: liver and/or bone marrow, taken to investigate a systemic illness, and a few had M. fermentans positive tissues. Two patients, NC and DP, had recurrent episodes of lower respiratory tract infection and fever and both had been investigated by bronchoscopy on 4 occasions. M. fermentans was detected in specimens taken 18 and 27 months apart for NC and DP respectively, and in between, and repeatedly in respiratory tract tissues of DP. Granuloma were identified in the liver of NC that was M. fermentans positive but no further evidence of opportunistic infection was found during his illness. Both patients had M. fermentans positive bone marrow specimens. Assessment of the patients' records suggested that in one patient M. fermentans may have contributed to the respiratory disease and in the other to the systemic disease.
Syphilis in Slovenia — on the threshold of the European Union
Authors: Potocnik M , Butina M Rogl , Bartenjev Igor , Waugh M A
Published: October 2002

The epidemiological situation of early syphilis (ES) in Slovenia is the subject matter of this report. After almost 25 years of decrease in Slovenia, ES is increasing again. The incidence of ES increased from 0.10 per 100,000 inhabitants in 1992 and 1993 to 1.82 in 1994 and 1.90 in 1995. In the years 1996-1998 there was a slight decrease at 1.25-1.45. The higher incidence of infections with ES is presumably the consequence of changed social conditions in the states of the former Eastern bloc and Yugoslavia, and of changing living conditions, and illegal prostitution in Slovenia. AIDS and HIV in Slovenia is still at an early stage and there is no apparent link into the same social groups as syphilis. The current epidemiological situation of sexually transmitted infections (STIs) in Slovenia and the conditions existing to the south and east of Slovenia warrant strict surveillance of STIs by the medical services.