bluuebunny/crossref_metadata_2025 huggingface dataset:
An improved instrument mounting arm
Authors: Gendeh B. S. , Khalid B. A. K. , Alberti P. W.
Published: October 2002

Although some form of commercial instrument mounting arm is available, a paucity of information in the literature may cause problems in selecting the most appropriate model for an ENT department wishing to trial their invention for use in the clinic or operating theatre.

The instrument mounting arm described here is based on existing designs used by hobbyists and model makers for many years but the main benefit of this innovation is its multi-purpose use in the operating theatre and cost effectiveness since it is made of aluminum alloy. It is compact, stable and easily adjustable and can incorporate an endoscope holder or an operating end piece to mount various ENT instruments that offers considerable advantages to the unassisted operator.
Tubular e-PTFE implants in glottal and neoglottal insufficiency: tolerance and stability in an animal model
Authors: Tamplenizza Paolo , Acocella Fabio , Addis Flaminio , Bolandrini Enrico
Published: October 2002

The aim of our research is to develop a laryngeal tissue augmentation technique that will be useful in treating glottal and neoglottal insufficiency.

In a previous study the feasibility of insertion of tubular expanded polytetrafluoroethylene (e-PTFE) tissue implants into the larynx of a porcine model was demonstrated. In this paper we report the clinical, endoscopic, computed tomography (CT) and magnetic resonance image (MRI) and histopathological follow-up findings. These results demonstrate host tolerance of the implant over the period of study (six months) with little tissue reactivity to tubular e-PTFE implants in the porcine model. The tubular shape of the implant enhances stabilization by the rapid and complete host tissue penetration of the implant’s interstices, making tubular e-PTFE a potentially useful soft tissue augmentation material for larygneal incompetence.
The ‘double bag’: a device for protection against blood spray in the management of epistaxis
Authors: Ku Peter , Marshall John , van Hasselt Charles Andrew
Published: October 2002

Nasal bleeding is one of the commonest emergencies that place medical staff at risk of blood contamination during management. A sizeable proportion of incidents have been reported where blood splashes in the facial area caused such contamination, and the exposed conjunctivae are potential sites for transmission of human immunodeficiency viruses (HIV). We present a simple self-made device named the ‘Double Bag’, which is highly effective in preventing blood spraying during the management of epistaxis. It was designed to be used while treating epistaxis or removing nasal packing after surgery, when transient bleeding is expected.
Stapedectomy following tympanoplasty
Authors: Berenholz Leonard , Lippy William , Burkey John , Schuring Arnold , Rizer Franklin
Published: October 2002

The aim of this study was to evaluate the success of stapedectomy in patients who have previously had a tympanoplasty because of chronic otitis media (COM). Fourteen patients from a private otology practice had undergone tympanoplasty for COM and subsequently underwent stapedectomy. Measurements were taken of the air-bone gap (ABG) closure and pure tone average (PTA) which showed hearing improvement. Patients had a mean 36.9 dB PTA hearing gain with 79 per cent closing the ABG to within 20 dB. The need for stapedectomy alone is a rare occurrence for patients with a history of COM requiring a tympanoplasty. Hearing improvement following stapedectomy in these cases was significant, although somewhat less than following traditional stapedectomy in otosclerosis alone.
Community ear care delivery by community ear assistants and volunteers: a pilot programme
Authors: Shrestha Ramesh , Baral Kamal , Weir Neil
Published: October 2002

Hearing impairment is a major public health problem in Nepal. The present service delivery, however, is mainly hospital based and is limited to large towns. Those people residing in rural areas lack many basic needs including ear care services. The collaborative community volunteer-based ear care pilot programme implemented in Banke, Nepal aims to reach out to those rural areas by establishing sustainable primary ear care services, empowering and utilizing local resources. The focus of the programme is to promote multi-sector improvement in sanitation, nutrition, immunization, breast-feeding and timely care and support to ear patients to help prevent hearing impairment mainly from the sequelae of otitis media.
Tardive dystonia of the larynx in a quadriplegic patient: an unusual cause of stridor
Authors: Rowley H. , Lynch T. , Keogh I. , Russell J.
Published: October 2002

We describe a case of a quadriplegic brain-damaged man with severe upper airway obstruction. A diagnosis of tardive dystonia affecting the vocal folds was made and confirmed by flexible nasopharyngoscopy. Emergency tracheotomy was required. The tardive movement disorder resolved with discontinuation of thioridazine. This case serves to heighten awareness of potentially serious airway complications associated with the use of anti-psychotics and anti-emetics particularly in those with organic brain disease.
Bilateral cortical blindness: an unusual complication following unilateral neck dissection
Authors: Raj P. , Moore P. L. A. , Henderson J. , Macnamara M.
Published: October 2002

We present the case of a 50-year-old man who developed bilateral cortical blindness and confusion following a seemingly uneventful right-sided radical neck dissection. Computed tomography (CT) scans confirmed bilateral occipital lobe infarctions.

To our knowledge, there are no previously documented reports of this clinical event following head and neck surgical procedures. Although this is a rare occurrence, otolaryngologists should be aware of this potential post-operative complication.

The possible aetiologies of this condition are discussed.
‘Horseshoe-shaped’ post-operative alopecia following lengthy head and neck surgery
Authors: Bruce I. A. , Simmons M. A. , Hampal S.
Published: October 2002

We report a case of ‘horseshoe-shaped’ pressure-induced post-operative alopecia following a lengthy head and neck procedure. Post-operative hair loss is rare and to our knowledge has only previously been found in fields of surgery where careful head positioning is not an inherent part of the procedure. In these cases there has been a single area of hair loss from the central occipital area and per-operative pressure effects of the head resting on the operating table have been postulated as the likely cause. The case presented shows an area of hair loss closely corresponding to the shape of the head rest used during a long procedure. This strongly supports the theory that prolonged pressure is the likely cause. The mechanism of pathogenesis is discussed together with a suggested strategy for its avoidance. The single most important aspect of prevention of this complication of surgery is the knowledge of its existence and aetiology.
Lack of Bcl10 gene mutations in laryngeal squamous cell carcinoma
Authors: Ronchetti Domenica , Intini Daniela , Pruneri Giancarlo , Neri Antonino , Pignataro Lorenzo
Published: October 2002

The Bcl10 gene encodes a protein probably involved in some apoptotic regulatory pathways. Bcl10 mutations lead to the translation of truncated proteins that show gain-of-function transforming activity; it has been suggested thaBcl10 may represent a major target gene for inactivation in many human cancers. To define the frequency of Bcl10 mutations in laryngeal squamous cell carcinoma and their possible association with tumour progression, we investigated a large panel of tumours representative of all grades and stages of malignancy.

To detect pathogenic mutations in exons 1, 2 and 3 of the Bcl10 gene, we performed a silver-staining polymerase chain reaction – single-strand conformation polymorphism (PCR-SSCP) analysis followed by direct DNA sequencing. We revealed the presence of SSCP variants in 18 out of 91 laryngeal tumours. Direct DNA sequencing showed previously described polymorphisms but no pathogenic mutations. We have strong evidence that the Bcl10 gene is not involved in laryngeal carcinogenesis.
Mesenchymal chondrosarcoma of the vagus nerve
Authors: Jamal W. , Rhys Evans P. , Sheppard M. N.
Published: October 2002

Mesenchymal chondrosarcoma is a rare, aggressive, malignant neoplasm, which arises from extraskeletal sites in 30–40 per cent of cases. It is extremely rare in children. We present a novel case of childhood mesenchymal chondsarcoma arising from the vagus nerve in the neck, resulting in paralysis of the right vocal fold. The clinicopathologic features and management of this case are described along with a brief discussion on the aetiology of vocal fold paralysis in this age group. Current literature on extraskeletal presentation of mesenchymal chondrosarcoma is reviewed.
The impact of reduced frequency of cage changes on the health of mice housed in ventilated cages
Authors: Reeb-Whitaker C. K. , Paigen B. , Beamer W. G. , Bronson R. T. , Churchill G. A. , Schweitzer I. B. , Myers D. D.
Published: October 2002

Our purpose in this investigation was to determine if we could reduce cage changing frequency without adversely affecting the health of mice. We housed mice at three different cage changing frequencies: 7, 14, and 21 days, each at three different cage ventilation rates: 30, 60 and 100 air changes per hour (ACH), for a total of nine experimental conditions. For each condition, we evaluated the health of 12 breeding pairs and 12 breeding trios of C57BL/6J mice for 7 months. Health was assessed by breeding performance, weanling weight and growth, plasma corticosterone levels, immune function, and histological examination of selected organs. Over a period of 4 months, we monitored the cage microenvironment for ammonia and carbon dioxide concentrations, relative humidity, and temperature one day prior to changing the cage. The relative humidity, carbon dioxide concentrations, and temperature of the cages at all conditions were within acceptable levels. Ammonia concentrations remained below 25 ppm (parts per million) in most cages, but, even at higher concentrations, did not adversely affect the health of mice. Frequency of cage changing had only one significant effect; pup mortality with pair matings was greater at the cage changing frequency of 7 days compared with 14 or 21 days. In addition, pup mortality with pair matings was higher at 30 ACH compared with other ventilation rates. In conclusion, under the conditions of this study, cage changes once every 14 days and ventilation rates of 60 ACH provide optimum conditions for animal health and practical husbandry.
Strain differences in some immune parameters can be obscured by circadian variations and laboratory routines: studies of male C57BL/6J, Balb/c and CB6 F1 mice
Authors: Kolaczkowska E. , Chadzinska M. , Seljelid R. , Plytycz B.
Published: October 2002

This is a report on the potential influence of circadian changes and laboratory routines on some immune parameters (thymic and splenic weights, the numbers of bone marrow, peripheral blood, and peritoneal leukocytes) in: (1) males of C57BL/6J, Balb/c, and CB6 F1 mice kept under identical laboratory conditions; (2) males of CB6 mice kept under the same laboratory conditions, except for opposite light/dark regimes, either light/dark (LD) or dark/light (DL). All the animals were purchased from the same supplier and adapted for 4-5 weeks to strictly controlled housing conditions. Some parameters were similar at certain time points but statistically significantly different at others due to strain-specific daily variations. In order to make the interstrain comparisons more reliable, the data collected around the day/night cycle were pooled for calculations of mean values. Several immune parameters of CB6 mice kept under DL conditions were significantly different than those in mice under the conventional LD conditions. In conclusion, the extrapolation of results (especially in the field of neuroimmunology) to other strains (or species) should be done with great caution; and all interstrain (interspecific) comparisons, especially those from various laboratories, should always be related to specific time points and laboratory conditions.
Blood sampling from the retro-orbital plexus, the saphenous vein and the tail vein in rats: comparative effects on selected behavioural and blood variables
Authors: van Herck H. , Baumans V. , Brandt C. J. W. M. , Boere H. A. G. , Hesp A. P. M. , van Lith H. A. , Schurink M. , Beynen A. C.
Published: October 2002

We compared the behaviours of rats, and measured various blood parameters, after three blood sampling techniques: orbital puncture while they were under diethyl-ether anaesthesia, blood collection by tail vein puncture under O2-N 2O-halothane anaesthesia and puncture of the saphenous vein without anaesthesia. Twelve rats were subjected to the three treatments according to a Latin square design. After each treatment, the behaviour of the rats was automatically monitored using the so-called LABORASTM method, which discriminates between grooming, locomotion and inactivity in rats. Based on excitation scores and urine production, it was found that induction of diethyl-ether anaesthesia combined with orbital puncture caused more distress than did the other two blood sampling techniques. The three techniques had no differential effects on the behaviours of grooming, locomotion and inactivity. Collecting 0.5 ml of blood by orbital puncture was ± 7 times faster than doing so by saphenous vein puncture and ± 15 times faster than collecting blood by tail vein puncture while the rats were under O2-N 2O-halothane anaesthesia. The levels of some haematological and plasma variables differed significantly between the three blood collection techniques. These observations may help to select the most appropriate technique of blood sampling with respect to anticipated discomfort in the animals.
Effect of pre-analytical handling on haematological variables in minipigs
Authors: Olsen A. K. , Bladbjerg E. M. , Jensen A. L. , Hansen A. K.
Published: October 2002

Pre-analytical handling may be an important determinant of haematological variables, if analysis is delayed. We investigated the effect of anticoagulants, i.e. tripotassium ethylenediamine-tetraacetic acid (EDTA) and citric acid, theophylline, adenosine, dipyridamole (CTAD), storage time (0.5, 1.5, 3.5, 5.5, 7.5, 25.5 and 27.5 h after blood sampling), and storage temperature (5°C and 20°C) on the variation in haemoglobin (HGB), red blood cell count (RBC), haematocrit (HCT ), white blood cell count (WBC), and platelet count (PLT) in minipigs. Medians of HGB, RBC, HCT, WBC and PLT were significantly higher in EDTA tubes than in CTAD tubes due to the dilution effect of the anticoagulant. We found a minor significant increase in HCT after 25.5 h in blood stored at 20°C, and at the same time a minor significant increase in WBC in EDTA tubes stored at 20°C. We found a significant decrease in PLT in blood stored at 5°C, especially in EDTA tubes. Minor variations were also observed in HGB and RBC. Our results indicate that PLT should only be measured in tubes placed at room temperature. If HCT or WBC analyses are to be performed on the day after blood sampling, the samples must be stored in a refrigerator until analysis. Our studies underline that time delay before analysis of haematological variables can cause increased variation, and should therefore be limited as far as possible in order to reduce the number of animals needed to make reliable conclusions.
Induction of anaesthesia with desflurane and isoflurane in the rabbit
Authors: Hedenqvist P. , Roughan J. V. , Antunes L. , Orr H. , Flecknell P. A.
Published: October 2002

The characteristics of two techniques of face-mask induction of desflurane anaesthesia (rapid or slow) were compared with the effects of slow isoflurane induction in five New Zealand White (NZW) rabbits. Slow induction used stepwise increments in vapour setting of 2% for desflurane and 0.5% for isoflurane at 30 s intervals. All animals were anaesthetized using each technique according to a randomized block design with one week between treatments. Observations were made of the quality of induction (any struggling or periods of apnoea) and the latency to, and the duration of loss of the righting and toe pinch reflexes recorded. Changes in respiratory rate, arterial blood gas and cardiovascular parameters were also recorded. Induction and recovery times were shorter with rapid desflurane induction in comparison to isoflurane (loss of righting reflex: 139 ± 27 s cf. 205 ± 48 s), but both techniques were associated with struggling and long periods of apnoea (> 1 min) during the first 4 min after administration. During this period a significant degree of bradycardia, hypercapnia and hypoxaemia occurred with both techniques, but these and the subsequent effects of rapid desflurane administration were less severe than with isoflurane. Slow induction with desflurane was tolerated best, with little or no deleterious behavioural or physiological effects, however excessively prolonged induction times (loss of righting reflex 337 ± 160 s) limits the application of this method. Desflurane, administered rapidly, appears to be a more suitable agent than isoflurane. However, as with isoflurane, anaesthesia should only be induced following oxygen supplementation.
Ntau;-methylhistidine excretion is a valid index of myofibrillar protein breakdown in the guineapig (Cavia porcellus)
Authors: Rogers P. F. , Tomas F. M.
Published: October 2002

The recovery of radioactivity in the urine of guineapigs following a bolus intravenous dose of chromatographically pure 14C-Nτ-methylhistidine was measured in order to test whether the excretion of Nτ-methylhistidine (Nτ-MH) is a valid index of myofibrillar protein breakdown in these animals. Four male and four female guineapigs were dosed and after 7 days, 91.65 ± 2.82% and 3.58 ± 0.91% of injected radioactivity was recovered in the excreta and tissues, respectively. The average total recovery of 95.2 ± 3.0% was not significantly different from 100%. Male guineapigs excreted the radioactivity more slowly than females (70% of the dose excreted within 74 h vs 39 h, respectively) but cumulative excretion at 7 days was the same for each sex. Chromatographic analysis of the urine showed almost all of the radioactivity to be associated with a single peak corresponding to Nτ-MH, indicating a lack of significant metabolism. These data show that although the clearance of 14C-Nτ-MH is slower than in rats or humans the urinary excretion of Nτ-MH is a valid index for myofibrillar protein degradation in the guineapig.
Use of score sheets for welfare assessment of transgenic mice
Authors: van der Meer M. , Rolls A. , Baumans V. , Olivier B. , van Zutphen L. F. M.
Published: October 2002

The use of transgenic mice has increased dramatically in recent years and continues to increase further. However, because transgenesis may alter a balanced genotype and produce unpredictable effects, careful monitoring of health and welfare of the transgenic animal is advised. The present study assessed the feasibility of the use of score sheets for monitoring transgenic mice, as part of daily routine, in a transgenic unit. The score sheets used were based on parameters which are sensitive and easy to determine. The score sheets were used by two animal technicians and a thorough evaluation showed that the score sheets, as described in this paper, are useful for routine monitoring in a transgenic unit and may result in the early detection of animal welfare problems. However, notwithstanding the limited number of parameters included and the restricted age-span covered by the screening, the monitoring system was considered to be time consuming. Large-scale implementation of such a scoring system during the first weeks of life would increase daily care time by at least 15-20 min for an average litter of 4-6 pups. Nevertheless, the use of score sheets seems to be a prerequisite for monitoring the animal's welfare in the course of producing transgenic lines.
A novel bile duct cannulation method with tail cuff exteriorization allowing continuous intravenous infusion and enterohepatic recirculation in the unrestrained rat
Authors: van Wijk H. , Donachie P. , Mann D. L. , McMahon H. , Robb D.
Published: October 2002

A variety of bile duct cannulation methods have been used in the study of biliary excretion in the rat. We now report the validation and use of one such method. In this method, the common bile duct and duodenum were cannulated, the free ends of the cannulae tunnelled through the abdominal wall, passed through a trochar and exteriorized at the ventral aspect of the tail. A purpose-designed stainless steel tail cuff was then attached, to protect the cannulae from the rat. The cannulae were passed through the top of a metabolism cage and attached to a dual swivel that allows the rat freedom of movement within the metabolism cage. Where necessary an additional cannula could be placed in the femoral vein to allow infusion of test material or blood sampling. The results demonstrate that the method is robust and that its use allows a reliable correlation between surgically prepared and intact animals, as physiological parameters are allowed to return to normal prior to inclusion of the animals in the study. The technique allows the animals a great deal of freedom and, as such, is considered to minimize stress associated with the procedure. This fact is reflected in the reliability and reproducibility of the data obtained over the wide range of studies that have been conducted using this method. This method has been in use for over 4 years at Inveresk and this paper describes the authors' experience with the method to date.
The toe-spreading reflex of the rabbit revisited-functional evaluation of complete peroneal nerve lesions
Authors: Schmitz H. Cristina , Beer G. M.
Published: October 2002

Although a variety of electrophysiological and morphological tests are available for studying nerve regeneration in animals, these endpoints do not necessarily correlate with the return of muscle function. Recent efforts have focused on the assessment of function as the endpoint of nerve regeneration. One of the best known of these tests is the sciatic function index in rats. For rabbits, the toe-spreading reflex has been suggested as a valuable index of peroneal function. We examined the reliability and sensitivity of the toe-spreading reflex in a study of nerve regeneration of the peroneal nerve in 10 New Zealand White rabbits. Eleven weeks after the transection and immediate suturing of the peroneal nerve in both hind legs (at two slightly different sites), a toe-spreading reflex could always be elicited on that side where the level of the severed nerve was closer to the dependent muscles. Also on this hind leg the muscle weight of the peroneal target muscles was significantly higher ( P = 0.031) than on the contralateral side, which corresponds well to the results of the toe-spreading reflex.

The toe-spreading reflex is an excellent and sensitive indicator of the onset of motor recovery in the peroneal nerve-dependent muscles of rabbits. Even small differences in the localization of lesions in both hind legs can be differentiated with this test.
Macroscopic and roentgenographic anatomy of the skull of the ferret (Mustela putorius furo)
Authors: He T. , Friede H. , Kiliaridis S.
Published: October 2002

Normal macroscopic and roentgenographic features of the skull of the ferret ( Mustela putorius furo) were examined and described. Data were based on a sample of 100 (50 male and 50 female) adult ferrets of known body weight and age. The skull was described macroscopically according to six standard views, i.e. dorsal, lateral, ventral, caudal, cranial and midsagittal. The mandible was described separately. The roentgenographic characteristics of the ferret skull were demonstrated only in lateral and dorsoventral projections.

Furthermore, the skull length and width as well as the minimum frontal width were measured, and skull indices were derived from relevant measurements. Sexual dimorphism was examined both morphologically and craniometrically. Besides the common features of a carnivore skull, the ferret skull is relatively elongated and flat with a short facial region. The skulls of adult male ferrets are about 17% longer and 22% wider than those of the females. Significant sexual dimorphism also exists regarding certain skull indices. The general features and some dimensional parameters of the adult ferret skull support the contention that the ferret would be an interesting and workable alternative animal model in craniofacial research.
PCR for the detection of Streptobacillus moniliformis
Authors: Boot R. , Oosterhuis A. , Thuis H. C. W.
Published: October 2002

Streptobacillus moniliformis is a Gram-negative bacterium found in various laboratory animal species and is the cause of rat bite fever and Haverhill fever in man. In order to evaluate a polymerase chain reaction (PCR) for the detection of this zoonotic bacterium in animal tissues a set of primers was designed based on the DNA base sequence of part of the 16S rRNA gene from 11 S. moniliformis strains. The PCR detected as few as 2-6 copies of S. moniliformis DNA. A 296 bp DNA fragment was amplified from S. moniliformis strains from rodents, humans and turkeys. Amplicons of about the same size were obtained from Fusobacterium necrogenes and Sebaldella (Bacteroides) termitidis but Bfa I treatment of these amplicons did not result in the S. moniliformis specific 130 bp DNA fragment. The in silico evaluation of 14 additional Fusobacterium spp. and 12 unculturable phytoplasmas indicated that none is likely to give rise to confusing amplicons or DNA fragments. The PCR detected S. moniliformis infection in all four orally- and four intravenously-infected C57BL/6 mice and the bacterium was cultured from all but one mouse. The PCR detected S. moniliformis infection in all 12 orally-infected WU rats, and in five of eight rats exposed to natural infection. Enzyme linked immunosorbent assay (ELISA) and PCR were equally successful in detecting infection in rats but S. moniliformis was not detected by using culture.
Failure of liver cirrhosis induction by thioacetamide in Nagase analbuminaemic rats
Authors: David Pascale , Alexandre Eliane , Chenard-Neu Marie-Pierre , Wolf Philippe , Jaeck Daniel , Richert Lysiane
Published: October 2002

Repeated administration of thioacetamide (TA), either intraperitoneally or in drinking water, produced liver cirrhosis in normal Sprague-Dawley rats (SDR) with significant histological alterations similar to those observed in human cirrhosis. In the present study, we evaluated the ability of TA to induce liver cirrhosis in mutant Nagase analbuminaemic SDR. Thioacetamide was administered either intraperitoneally up to 4 months or in drinking water up to 6 months to normal and to Nagase analbuminaemic SDR. Nagase analbuminaemic rats (NAR) were also administered TA in drinking water up to 10 months. Liver cirrhosis development was determined by macroscopic and microscopic analysis. In contrast to normal SDR, no histological characteristics of cirrhosis could be observed in NAR submitted to a 4 or 6 months treatment with TA. Such failure to induce cirrhosis in Nagase rats was confirmed even after prolonged TA administration in drinking water for up to 10 months. In contrast, fibrosis and cholangiolar proliferation occurred in the 10-month TA-treated analbuminaemic rats, suggesting that the mechanisms involved in cirrhosis induction are different from those involved in fibrosis development and carcinogenesis. It is unlikely that the protective effect against TA-induced cirrhosis observed in analbuminaemic rats is related to the absence of albumin in this rat strain, since a co-administration of TA with albumin in analbuminaemic rats did not restore the potential for TA to induce cirrhosis in this rat strain. In conclusion, the fact that induction of cirrhosis by TA is prevented in the inherently hyperlipidaemic and hypercholesterolaemic analbuminaemic rats could be considered for potential application in the treatment of clinical cirrhosis.
A new animal model of femoral head necrosis induced by intraosseous injection of ethanol
Authors: Manggold J. , Sergi C. , Becker K. , Lukoschek M. , Simank H.-G.
Published: October 2002

There is no reliable animal model of the early stages of osteonecrosis of the femoral head (ONFH) for the evaluation of new therapeutic approaches. In this study, we propose a new animal model of femoral head osteonecrosis. Pure ethanol was injected into the centre of the femoral head in adult Merino sheep under fluoroscopic control. After 3, 6 and 12 weeks the animals were killed and the femoral heads were harvested. Microradiographic and histological changes were analysed and recorded. Partial necrosis was documented over a period of 12 weeks in all animals. The appearance of necrosis in combination with intact macrotexture, macrocirculation and joint cartilage is similar to the features described in early ONFH in humans. Due to its efficacy and its similarity to the early stages of ONFH in humans, this model may be suitable to evaluate new therapeutic techniques in the treatment of ONFH.
Microbial cell wall product contamination of bedding may induce pulmonary inflammation in rats
Authors: Ewaldsson B. , Fogelmark B. , Feinstein R. , Ewaldsson L. , Rylander R.
Published: October 2002

To test the hypothesis that airborne microbial cell wall components could induce an inflammatory response in the lungs, measurements were made of the amounts of bacterial endotoxin and (1→3)-ß→-D-glucan in laboratory animal bedding materials. Groups of rats were exposed by inhalation to airborne endotoxin, (1→3)-ß-D-glucan or a combination of the two for 5 weeks. The results demonstrated that measurable amounts of endotoxin and (1→3)-ß-D-glucan could be detected in the different bedding materials. In contrast to animals at delivery, those kept on bedding for 5 weeks showed moderate inflammatory reactions in the lung. These were most pronounced among animals exposed to endotoxin and (1→3)-ß-D-glucan. The results suggest that further studies need to be undertaken to elucidate the role of microbial cell wall products in the development of inflammatory lung responses among research animals.
Advantages of glutamate dehydrogenase as a blood biomarker of acute hepatic injury in rats
Authors: O'Brien P. J. , Slaughter M. R. , Polley S. R. , Kramer K.
Published: October 2002

In a recent study in rats, alanine aminotransferase (ALT), the preferred plasma biomarker of hepatocellular injury in rats, was ineffective at detecting marked hepatic necrosis produced by acetaminophen ( Human and Experimental Toxicology 19, 277-83, 2000). In contrast, glutamate dehydrogenase (GLDH) was markedly elevated. Accordingly, these enzymes were comprehensively evaluated as plasma biomarkers of hepatocellular injury in rats using several other models of hepatic injury, including partial hepatectomy and exposure to methapyrilene, dexamethasone, cyproterone, isoniazid, lead nitrate, and Wyeth-14643. Other enzymes also evaluated were aspartate aminotransferase (AST), sorbitol dehydrogenase (SDH), and the hepatobiliary marker alkaline phosphatase (ALP). Compared to plasma ALT increases, plasma GLDH increases were up to 10-fold greater, up to 3-fold more persistent, and occurred at times following hepatocellular injury when plasma ALT was not increased. Plasma GLDH activity was not inhibited by the test compounds, whereas ALT was substantially inhibited by both isoniazid and lead nitrate. While plasma GLDH activity was unaffected by induction, ALT was induced by cyproterone and dexamethasone, and ALP was induced by Wyeth-14643 and partial hepatectomy. GLDH was concluded to be a more effective biomarker of acute hepatic injury than ALT, AST, SDH or ALP in the rat, based primarily on the large increase following hepatocellular injury, prolonged persistence in the blood following injury, high sensitivity for detection of injury (including pre-necrotic injury), high tissue specificity, and lower susceptibility to inhibition or induction.
Colonizing the new world of NHS management: the shifting power of professionals
Authors: Thorne Marie L.
Published: October 2002

This paper explores the changing patterns of professional power and the struggle for control between doctors and managers in the UK NHS, by examining the role of clinical directors. Located at the nexus of managerial and professional power, clinical directors represent and embody the challenges to medicine through increased managerialism and the profession's response to it. An analysis of the role of clinical directors reveals the changes in power and jurisdiction that have been created through clinical management. A medical model of professional power illustrates how structural and ideological changes threaten medical dominance. However, clinical directors respond to the changes by creating new forms of expertise through managerial assimilation, to extend their jurisdiction and domain within the organization and in the market. This re-professionalization, rather than de-professionalization, by doctors raises questions about the shifting power balance between doctors and managers in the NHS and between doctors within the medical profession.
Emerging factors shaping the future of the Veterans Health Administration: a strategic analysis
Authors: Rivers P. A. , Glover S. H. , Agho A.
Published: October 2002

In response to societal and industry-wide forces, the Veterans' Health Administration (VHA) has undertaken a re-engineering process, changing the operational and management structure from individual, independent, and often competing large hospital centres into 22 integrated service networks or VISNs to provide structural incentives for efficiency, quality and improved access as well as transitioning the system to one that is grounded in ambulatory and primary care (Ashton et al., 1998). This paper presents a framework for evaluating the successes and/or failures of the recent re-organization efforts of the VHA in bringing together this multitude of medical care 'parts' or modules into an integrated, cost-effective healthcare delivery system. In total, this paper attempts to delineate an analytical framework by which the threats and opportunities as well as the strengths and weaknesses of the VHA are identified. More specifically, this paper addresses the external pressures driving reform in the VHA system and how the Veterans' Administration can respond to these pressures. Implications for the future of the VHA if its reform efforts are not successful are examined.
Estimation of the total number of hospital admissions and bed requirements for 2011: the case for Greece
Authors: Mouza Anna-Maria
Published: October 2002

In order to improve the existing situation in the Greek health sector, there is a pronounced need for flexible planning methods, together with the development of long-term perspectives on policy formulation. The team started with the collection of relevant data, since the first priority was to have a detailed knowledge of the current situation and conditions upon which projections of likely future developments can be based. The aim of this paper is to identify a reliable method for the estimation of future admissions to hospitals, by age groups and sex. These estimates have been used as the basis for projecting hospital bed requirements by the final year of the planning period (2011). Accurate knowledge and analysis of hospital bed requirements in the future would be a fundamental aid to health care planning given that the increase in the proportion of elderly people will lead to differences in the demand for health services. To reduce uncertainty, a main parameter has been introduced and used in all projections, with very limited total variation. Although all relevant studies resulted in a rigid, one estimation (projection) point, we have estimated upper and lower limits of projections, to make the corresponding plan more flexible.
Secondary HIV transmission rates in a mixed-gender sample
Authors: Pinkerton Steven D , Abramson Paul R , Kalichman Seth C , Catz Sheryl L , Johnson-Masotti Ana P
Published: October 2002

Information about the sexual behaviour of HIV-infected individuals is needed to predict the course of the sexually transmitted HIV epidemic in the US. The present study provides model-based estimates of the secondary transmission rate (i.e. the number of infections expected among the sex partners of already infected individuals) for a sample of HIV-positive persons in Atlanta. A mathematical model was used to estimate the secondary transmission rate of HIV infection for a sample of HIV-positive men and women in Atlanta, based on their self-reported sexual behaviour, extrapolated over a 15-year horizon. Separate rates were calculated for different transmission routes, including: from women to men-who-have-sex-with women (MSW) and from men-who-have-sex-with-men (MSM) to other MSM. Sensitivity analyses were conducted to assess the impact of different parametric and modelling assumptions. Restricted to the sub-sample that reported transmission risk behaviours, the mean number of secondary infections was 0.14 for transmission from women to MSW; 0.31 for transmission from MSW to women; and 0.84 for MSM to MSM transmission. Bisexual men were at especially high transmission risk, with 1.59 and 0.54 secondary infections expected among their male and female partners, respectively. The main analysis indicates that, in this sample, each current infection will lead to fewer than one future infection for all groups other than bisexual men, which suggests that the epidemic is contracting in this community, although this analysis cannot rule out the possibility of a growing epidemic among MSM. This method can be used to identify groups at high risk for HIV transmission and thereby to better target HIV prevention resources.
Antiretroviral therapy for drug users
Authors: Clarke S M , Mulcahy F M
Published: October 2002

Injection drug use represents the primary risk factor for up to 40% of patients with HIV infection. Physicians are generally reluctant to prescribe antiretroviral therapy (ART) for these patients due to possible poor adherence, and the potential for complex drug interactions to occur. Providing daily observed ART in conjunction with methadone maintenance therapy (MMT) has significantly improved accessibility of ART for many drug users. Knowledge of potential drug interactions between methadone, ART, and both legally and illegally prescribed drugs has permitted such interactions to be anticipated and either avoided or treated appropriately. Optimizing ART for drug users therefore demands a multidisciplinary approach from medical, clinical pharmacology and psychiatric services.
Epoetin alfa therapy for anaemia in HIV-infected patients: impact on quality of life
Authors: Abrams Donald I , Steinhart Corklin , Frascino Robert
Published: October 2002

To evaluate the effect of epoetin alfa on the quality of life (QOL) of HIVinfected patients in the community setting, 221 anaemic (haemoglobin ≥11 g/dl) HIV-positive patients from community-based treatment centres and physicians' offices were treated with epoetin alfa (100-300 units/kg subcutaneously 3 times a week) in a 4-month, open-label, non-randomized, phase IV trial. Epoetin alfa therapy significantly ( P<0.01) increased and maintained haemoglobin levels (mean increase=2.5 g/dl; n =207); the improvement in haemoglobin levels was independent of changes in CD4+ cell counts. Transfusion requirements were also significantly reduced from 20% to 5% of patients ( P<0.01). Mean total QOL score measured by the Functional Assessment of HIV Infection (FAHI) scale and Physical Well-Being subscale score improved significantly ( P<0.05). QOL improvements associated with increases in haemoglobin were independent of changes in CD4+ counts and baseline anaemia severity. Adverse events observed during epoetin alfa therapy were consistent with HIV disease and not likely due to the drug. Epoetin alfa therapy should be considered a treatment option for HIV-infected patients with mild-to-moderate anaemia.
The use of D-dimers in the diagnosis of occult pulmonary emboli in HIV pulmonary disease — two case reports
Authors: Winston A , Baker R W , Nelson M , Gazzard B
Published: October 2002

Pulmonary thromboembolism is not considered a common cause of morbidity in HIV disease. Although anti-phospholipid antibodies are often seen in HIV disease, they are not associated with an increased thrombotic risk. Computed tomographic (CT) pulmonary angiography has been described as the imaging modality of first choice, as abnormal baseline chest X-rays may reduce the diagnostic utility of ventilation perfusion (VIQ) scanning. In HIV-negative individuals D-dimer testing has been shown to be a good screening tool in suspected pulmonary embolism. We present 2 cases where the diagnosis of pulmonary embolus was established using tests for the clotting degradation products D-dimers.
Selected Abstracts
Authors: Quah S P
Published: October 2002

The Royal Society of Medicine Press produce, as a regular feature of the Journal, a selection of abstracts from 60 of the leading journals which regularly publish in the field of sexually transmitted infections and HIV. The aim is to inform readers of recent advances, which they may otherwise have overlooked. The articles included are personal selections made by Dr W W Dinsmore (Editor) and myself. We hope that this will provide a valuable service.
The importance of psychosocial factors in the prevention of HPV infection and cervical cancer
Authors: Fernández-Esquer Maria Eugenia , Ross Michael W , Torres Isabel
Published: October 2002

This article presents a review of psychosocial factors associated with the primary and secondary prevention of cervical cancer. Current research evidence convincingly links the presence of the human papillomavirus (HPV) to the development of cervical cancer suggesting that bringing together knowledge from the Papanicolau smear screening and HPV infection research may help formulate a new approach that bridges primary and secondary prevention strategies. Bringing together these 2 areas of research involves an understanding of the psychosocial factors that underlie both. This review will specifically focus on 3 areas of psychosocial research: (1) sexual behaviours associated with HPV infection; (2) knowledge, attitudes and beliefs associated with Pap smear and HPV screening; and (3) the role of the medical provider in facilitating prevention activities.
Evaluation of a peer education programme for female sex workers in Bali, Indonesia
Authors: Ford K , Wirawan D N , Suastina W , Reed B D , Muliawan P
Published: October 2002

The objective of this paper is to evaluate a peer education programme for female sex workers in Bali, Indonesia. Sex workers participated in face-to-face interviews and STD exams in August-September 1998. In October 1998 one woman from each of 30 clusters was selected to be a peer educator and received a 2-day training on AIDS, STDs, condom use, and condom negotiation. After training, the peer educators were visited twice a week by field workers to answer questions and offer support. All sex workers received group education every 2 months. In January-February 1999, the sex workers again participated in face-to-face interviews and examinations. One month after peer education training, only 50% of the peer educators were still working in the clusters where they were trained. To evaluate the impact of the peer educators, sex workers in clusters where a peer educator continued to work were compared with sex workers in clusters where women did not continue to work ( n = 189). In clusters where women continued to work, there were higher levels of AIDS knowledge ( P < 0.05), STD knowledge ( P < 0.05) and condom use (82 vs 73%, P = 0.15). The prevalence of Neisseria gonorrhoeae infection was also lower in clusters with a peer educator (39% vs 55%, P = 0.05) than in clusters without a peer educator.
The relationship of psychological variables and disease progression among long-term HIV-infected men
Authors: Thornton S , Troop M , Burgess A P , Button J , Goodall R , Flynn R , Gazzard B G , Catalán J , Easterbrook P J
Published: October 2002

This study investigated the contribution of psychological factors to disease progression among long-term HIV-1 infected gay men. Participants completed self-report measures including coping strategies, life events, social support, personality and psychological morbidity and were followed clinically for up to 30 months. Cox proportional hazards survival analyses were carried out to CD4 < 200 × 106/l and AIDS-related complex (ARC) or AIDS diagnosis controlling for viral load, antiretroviral drug use and CD4 count. Only acceptance coping was a significant predictor of time to ARC or AIDS diagnosis: the risk of ARC or AIDS was almost 5 times greater for those scoring within the lowest tertile compared with those scoring in the highest tertile (HR = 4.7, 95% CI 1.8-12.3).
HIV-positive women and cervical screening
Authors: Vonau Barbara , Boag Fiona
Published: October 2002

To date the management of HIV-positive women regarding the prevention of cervical cancer remains controversial. There are different approaches to cervical screening in different health authorities in the UK and worldwide due to different funding and healthcare provision in general, the official disease prevalence and the attempt to tailor the screening programme according to a perceived risk for the population covered, but most of all in the diverse evidence provided to aid the development of a screening programme. The advent of high active antiretroviral therapy (HAART) may also have altered the natural history of cervical intraepithelial neoplasia (CIN) before it became sufficiently understood and future studies have to take this into account when investigating the impact of human papillomavirus (HPV) and CIN on the risk of developing cervical cancer. This article aims to summarize the available evidence to date and provide a basis on which an effective and acceptable screening programme for HIV-positive women can be developed.
An audit of isolation rates of Candida species from vulval and vaginal sampling
Authors: Rodgers C A
Published: October 2002

The clinical features of vulvovaginal candidiasis are the result of the inflammatory response of the vulva and vagina to Candida overgrowth. Topical treatments comprise intra-vaginal pessaries or cream used in combination with a similar azole-based cream for external application. In this audit Candida isolation rates from vulval and vaginal samples were strongly concordant confirming that combined topical treatments should be used for the recommended treatment time to ensure mycological cure.
Evaluation and lessons learned from a lay health advisor programme to prevent sexually transmitted diseases
Authors: Thomas James C , Earp Jo Anne , Eng Eugenia
Published: October 2002

We implemented a lay health advisor (LHA) intervention to decrease rates of sexually transmitted disease (STD) among rural low income African-Americans. Twenty-one women identified by their peers as natural helpers were trained as LHAs to disseminate information, change attitudes, and improve skills among their social networks in the neighbourhoods with the highest STD rates. The behaviours they targeted involved care-seeking and condom use. The outcome evaluation included cross-sectional household surveys conducted before the intervention and after 18 months of activity. The proportion seeking prompt care for an STD increased 60%; those seeking screening for infection after suspecting exposure increased 25%. Consistent condom use with main partners increased by 23%. An LHA intervention in this population appears efficacious for improving STD-related care seeking behaviours but the effect on condom use with main partners is less clear.