bluuebunny/crossref_metadata_2025 huggingface dataset:
Spot urine analysis: acidification does not increase calcium recovery
Authors: McConnell William , Vasikaran Samuel D
Published: October 2002

Introduction We investigated the effects of acidification and storage on calcium recovery in spot urine samples. Methods In a retrospective study, 43 spot urine samples from patients with metabolic bone disease, which had been previously analysed fresh for calcium and creatinine, were acidified and incubated for 2 h at room temperature and re-analysed. In a prospective study, fresh spot urine samples from 15 volunteers were split into two aliquots - one left unacidified and the other acidified with 6 mol/L HCl to pH< 2. Both aliquots were analysed immediately and after storage at 4°C for 24 h. Results In both studies, the calcium creatinine ratios obtained on acidified and non-acidified spot urine samples were not different, both when measured immediately as well as after storage at 4°C for 24 h. Conclusions The acidification of spot urine samples would thus appear to be unnecessary for calcium/creatinine measurements in metabolic bone disease if they were undertaken within at least 24 h.
Biological variation in sweat sodium chloride conductivity
Authors: van der Merwe Da-elene , Ubbink Johan B , Delport Rhena , Becker Piet , Dhatt Gurdeep S , Vermaak Wj Hayward
Published: October 2002

Background Sweat conductivity, which is equivalent to sweat NaCl concentration, is used as a screening test to identify possible cystic fibrosis (CF) patients. No data exist on the biological variation of this variable and the influence it may have on the interpretation of sweat testing. The aim of this study was to determine the components of biological variation for sweat sodium chloride conductivity and to apply biological variation parameters in the interpretation of sweat conductivity. Methods Sweat conductivity was determined once a week for 5 consecutive weeks on 15 healthy volunteers, 20 healthy infants and 20 known CF patients. Results The analytical coefficient of variation (CVA) was 1·15% for the high-level control material, with a value of 123 mmol/L, and 1·32% for the normal-level control material with a value of 40 mmoL/L. The within-subject (CVI) and between-subject (CVG) biological variations were 12·0% and 30·0%, respectively, for healthy controls; 18% and 20% for healthy infants; and 7·3% and 6·5% for CF patients, respectively. Using the CVA, CVG and CVI, the 95% reference ranges were determined for the above-mentioned three groups. The calculated 95% ranges for the healthy babies and CF patients were 18-60 mmoL/L and 96-144 mmoL/L. Conclusions Our data support a decision level of > 60 mmoL/L for confirmatory CF testing. A lower decision level will result in an unacceptable high rate of unnecessary confirmation testing.
Stains, labels and detection strategies for nucleic acids assays
Authors: Kricka Larry J
Published: October 2002

Selected developments and trends in stains, labels and strategies for detecting and measuring nucleic acids (DNA, RNA) and related molecules [e.g. oligo(deoxy)nucleotides, nucleic acid fragments and polymerase chain reaction products] are surveyed based on the literature in the final decade of the 20th century (1991-2000). During this period, important families of cyanine dyes were developed for sensitive detection of double-stranded DNA, single-stranded DNA, and oligo(deoxy)nucleotides in gels and in solution, and families of energy transfer primers were produced for DNA sequencing applications. The continuing quest for improved labels for hybridization assays has produced a series of candidate labels including genes encoding enzymes, microparticles (e.g. quantum dots, nanocrystals, phosphors), and new examples of the fluorophore (e.g. cyanine dyes) and enzyme class of labels (e.g. firefly luciferase mutants). Label detection technologies for use in northern and southern blotting assays have focused on luminescent methods, particularly enhanced chemiluminescence for peroxidase labels and adamantyl 1,2-dioxetanes for alkaline phosphatase labels. Sets of labels have been selected to meet the demands of multicolour assays (e.g. four-colour sequencing and single nucleotide primer extension assays). Non-separation assay formats have emerged based on fluorescence polarization, fluorescence energy transfer (TaqManTM, molecular beacons) and channelling principles. Microanalytical devices (microchips), high-throughput simultaneous test arrays (microarrays, gene chips), capillary electrophoretic analysis and dipstick devices have presented new challenges and requirements for nucleic acid detection, and fluorescent methods currently dominate in many of these applications.
Biochemical investigations in patients with dementia
Authors: Green Alison
Published: October 2002

The recent development of acetylcholinesterase inhibitors to treat patients with Alzheimer's disease has increased interest in the use of biochemical markers for the early detection and diagnosis of dementia, but only the measurement of the protein 14-3-3 in cerebrospinal fluid (CSF) to help diagnose sporadic Creutzfeldt-Jakob disease has become accepted clinical practice. CSF concentrations of t protein and β-amyloid peptide 42 have been widely investigated as potential diagnostic tests for Alzheimer's disease, but neither has shown sufficient sensitivity and specificity for clinical use. Preliminary investigations suggest that β-amyloid peptide 42 may be useful in monitoring disease progression, but this needs to be verified. In addition, biochemical investigations may help to identify the small number of patients with treatable causes of dementia such as hypothyroidism and vitamin B12 deficiency, as well as any other compounding condition such as anaemia or diabetes mellitus that increase morbidity.
Living on the edge of the post-nasal space: the inhaled foreign body
Authors: Ross G. L. , Steventon N. B. , Pinder D. K. , Bridger M. W. M.
Published: October 2002

We present a previously undescribed event where an inhaled foreign body was propelled into the post-nasal space by the Heimlich manoeuvre. We present figures showing a drop in the mortality following inhaled foreign bodies since the introduction of the Heimlich manoeuvre.
Accuracy of patient self-medication with topical eardrops
Authors: England R. J. A. , Homer J. J. , Jasser P. , Wilde A. D.
Published: October 2002

Topical eardrops are commonly prescribed by otolaryngologists and general practitioners and many believe that patient compliance is poor, although this has not been studied in a properly controlled manner. Thirty-nine patients with otitis externa were reviewed four times during a two-week course of topical eardrops and their treatment compliance studied. The patients tended to undermedicate themselves, and this tendency increased over the two-week period. Patients were administering significantly fewer drops by the end of day 11 than by the end of day 3 (p = 0.2). Compliance patterns were extremely poor, in that only 40 per cent of patients were managing to self-medicate within a 25 per cent error margin by the end of day 3. These findings may have future implications in the ongoing debate on eardrop use.
Bilobed pharyngeal pouch: a very rare finding
Authors: Izzat A. B. , Dezso A. , Hardingham M.
Published: October 2002

A bilobed pharyngeal pouch is a very rare finding. One such case is reported here, and is the first to be treated successfully by endoscopic division and stapling.
Bilateral defects of the tegmen tympani associated with brain and dural prolapse in a patient with pulsatile tinnitus
Authors: Cradwick  , Kale S. U. , Pfleiderer A. G.
Published: October 2002

A pulsating ear drum is a rare otological finding and usually indicates a vascular pathology. We report the case of a woman who presented with pulsatile tinnitus following an upper respiratory tract infection. She was found to have bilateral pulsating tympanic membranes on otological examination, in association with bilateral dehiscence of the tegmen tympani and a spontaneous encephalocele on the right side and a meningocele on the left side, demonstrated on computerized tomography (CT) scan of her temporal bones.
Convergent validity of the tinnitus handicap inventory and the tinnitus questionnaire
Authors: Baguley David , Humphriss Rachel , Hodgson Catriona
Published: October 2002

For research into tinnitus to be robust and credible, the use of well – validated instruments of self – perceived tinnitus handicap as outcome measures is essential. The tinnitus handicap inventory (THI) and the tinnitus questionnaire (TQ) are two such instruments which are in widespread use. Both questionnaires were administered by mail to 100 consecutive new patients of the Cambridge Tinnitus Clinic, and completed in randomized order. These patients had been referred by the otolaryngology team and had not undergone any tinnitus therapy. The response rate was 78 per cent, neither questionnaire being more acceptable to patients than the other. The convergent validity of the instruments was high, with total and subscale scores all being significantly correlated at the five per cent level (Spearman correlation coefficients). A number of subscale scores were not significantly correlated at the one per cent level however. In particular, the sleep disturbance element of the TQ was demonstrated to have some discriminant validity from the THI and from other elements of the TQ at the one per cent significance level. The THI and TQ have been demonstrated to have high convergent validity and are both suitable for tinnitus outcome studies involving the quantification of self – perceived tinnitus handicap. For research that aims to determine the specific effect of an intervention on tinnitus – related sleep disturbance, the TQ sleep subscale has potential utility. The hypothetical constructs of tinnitus handicap underlying the psychologist developed TQ and the audiologist – developed THI have been shown to be convergent.
Idiopathic familial facial nerve paralysis
Authors: Clement W. A. , White A.
Published: October 2002

A 26-year-old man was seen one day after developing a left facial palsy of unknown aetiology. He had previously had a left facial palsy at age 14 and a right facial palsy at 19, both with minimal residual paresis. Both his mother and grandmother have had facial palsies. The role of hereditary influences in idiopathic facial paralysis, as well as the treatment of this condition, is discussed.
The management of dysphasia in skeletal hyperostosis
Authors: Akhtar S. , O’Flynn P. E. , Kelly A. , Valentine P. M. W.
Published: October 2002

Diffuse idiopathic skeletal hyperostosis (DISH), or Forestier’s disease, is an ossifying condition frequently encountered in otolaryngology as it affects 12–28 per cent of the adult population. This form of hyperostosis can manifest clinically with dysphagia, food impaction, hoarseness, stridor, myelopathies and other neurological problems. Judicious management of severe dysphagia proves challenging. The failure of conservative care often leaves surgery as the only option. In this report an anterolateral transcervical surgical approach to the confluent osteophytes is discussed and the value of videofluoroscopic swallow highlighted
Spindle cell angiosarcoma of the oropharynx
Authors: Maheshwar A. , Barnes M. D. , Douglas-Jones A. G. , Nind N. R. , Burroughs S. H.
Published: October 2002

Angiosarcomas are uncommon malignant tumours of vascular endothelium. In the head and neck, the scalp is the commonest site of origin. A rare case of spindle-cell angiosarcoma of the oropharynx, treated by surgery and post-operative radiotherapy, is reported. We discuss the clinical presentation and histopathological diagnosis of this lesion.
Abductor vocal fold palsy as a manifestation of type one Arnold Chiari malformation
Authors: Allsopp G. M. , Karkanevatos A. , Bickerton R. C.
Published: October 2002

We report a rare case of type 1 Chiari malformation which presented to the Otolaryngology department with abductor vocal fold palsy following an aspiration pneumonia secondary to absent laryngeal sensation. Chiari malformations and related cases are discussed.
Global Training in ORL-HNS: The training of otorhinolaryngologists in Asia
Authors: Wei William , Ho
Published: October 2002

Asian nations differ from one another in population, cultural background, ethnic tradition and economic situation. The training of otorhinolaryngologistsin Asia is not in any way uniform. A questionnaire survey of 26 leading institutions in 12 countries/regions was carried out. The emphasis of investigation is towards the training programme for specialists in Otorhinolaryngology and continuous medical education (CME). The response rate of the survey was 100 per cent. The duration of training for otorhinolaryngologists ranges from three to seven years and an exit assessment is held in seven countries/regions. The training programmes are modifications of either the British or the American pattern depending on tradition. Documentation of CME is available in eight countries/regions while a defined cycle has been established in only three. Medical/health authorities or professional societies in each country contribute towards its monitoring. Better communication and sharing of experience will improve the training of otorhinolaryngologists in Asia.
Plasmacytoma of the mastoid bone: solitary and systemic
Authors: Engelsma R. J. Y. , De Bree R. , Janssen J. J. W. M. , Scheeren R. A.
Published: October 2002

Plasma cell tumours of the mastoid are rare malignancies of haematological origin. Two patients are described with a plasma cell tumour in the mastoid bone. In one patient it concerned a solitary plasmacytoma of the bone and in the other a focus in the mastoid of a recently diagnosed multiple myeloma. Symptoms in these patients were non-specific. Computed tomography (CT) and magnetic resonance image (MRI) scanning showed a nonspecific space-occupying lesion in the mastoid. The diagnosis was made on immunohistological examination, that showed diffuse sheets of monoclonal plasma cells in a clear matrix. When a plasmacytoma lesion is found multiple myeloma should always be excluded. Treatment in case of solitary plasmacytoma of the mastoid bone consists of radiotherapy. In case of localization in the mastoid of multiple myeloma the treatment consists of palliative chemotherapy.
Novel method for the application of anti-mist solution to surgical endoscopes
Authors: Sandhu G. , Bleach N.
Published: October 2002

Endoscopes require repeated cleaning and application of antimist solution during surgery. A novel, simple and inexpensive method of application of the antimist solution is described.
Z-meatoplasty technique in endaural approach mastoidectomy
Authors: Murray D. P. , Jassar P. , Lee M. S. W. , Veitch D. Y.
Published: October 2002

Creating an adequate meatoplasty is an important and integral part of a mastoidectomy. It allows ventilation of the ear canal but also provides for an easy access for visualizing and cleaning the mastoid cavity. There are numerous techniques for performing a meatoplasty. We describe our method of utilizing the endaural incision and superiorly based tympanomeatal flap incision to create an easy and effective Z-meatoplasty.
Does vestibular habituation still have a place in the treatment of benign paroxysmal positional vertigo?
Authors: Banfield G. K. , Wood C. , Knight J.
Published: October 2002

Particle repositioning procedures such as the Epley manoeuvre have become popular in the management of benign paroxysmal positional vertigo (BPPV) at the expense of more traditional therapies such as vestibular habituation.

We prospectively analysed the response of consecutive patients presenting with BPPV to treatment with vestibular habituation exercises using a symptom score sheet before and after treatment. This same patient group was then followed up, on average three years, eight months after discharge, to determine their long-term response to treatment.

The results of the study demonstrated an excellent short-term response rate to treatment but a high level of recurrence after discharge. Most patients who experienced further symptoms following discharge were however self-reliant and were able to return to their habituation exercises without the need for further medical input.

The aim in the management of these patients must be to provide long-term self reliance as well as shortterm cure and it may be that this has not yet been well demonstrated with the Epley manoeuvre. It must also be remembered that particle repositioning manoeuvres cannot be used in all patients for example those who suffer with cervical or thoracic spine pathology and that some will fail to respond at all.

We believe that vestibular habituation retains a useful role in the treatment of BPPV.
Rare case of naso-oral fistula with extensive osteocartilaginous necrosis secondary to cocaine abuse: Review of otorhinolaryngological presentations in cocaine addicts
Authors: Lancaster J. , Belloso A. , Wilson C. A. , McCormick M.
Published: October 2002

We report what we believe to be only the 10th case of palatal necrosis secondary to cocaine abuse in a 33-yearold female patient. Extensive necrosis also involved the cartilaginous and bony septum and paranasal sinuses. Following exclusion of other mid-line destructive diseases her treatment involved saline douches and cessation of cocaine. She remains under review within the department with no evidence of progressive disease. We present a review of the other nine cases of palatal necrosis reported in the world literature and demonstrate a greater incidence in female users. The various presenting conditions of cocaine abuse encountered within the head and neck region by the otorhinolaryngologist are then discussed.
Pleomorphic adenoma causing acute airway obstruction
Authors: Moraitis D. , Papakostas K. , Karkanevatos A. , Coast G. J. , Jackson S. R.
Published: October 2002

A case is reported of a pleomorphic adenoma of the minor salivary glands of the oral cavity presenting with acute airway obstruction. This is the first reported case to our knowledge of a mixed salivary tumour of the upper respiratory tract causing upper airway obstruction and acute respiratory failure. The patient had to be intubated and transferred to the intensive care unit. After an elective tracheostomy was performed, the adenoma was excised from its fibrous capsule. It was found to originate from the soft palate and occupied the parapharyngeal space. A high index of suspicion should be kept in order to diagnose tumours of the parapharyngeal space with unusual presentation. These tumours which are usually benign should be considered in the differential diagnosis from more common infectious or traumatic conditions and surgical morbidity should be minimal.
Telescopic myringotomy and tube application
Authors: Abou-Elhamd Kamal-Eldin Ahmed
Published: October 2002

Otoendoscopy is a new technique in otological surgery. The traditional surgery for otitis media with effusion (OME) is myringotomy and tube insertion using an operating microscope. In 45 children and five adults presenting to our department with otitis media with effusion, rigid endoscopic myringotomy and grommet tube insertion were performed using 2.7 mm diameter and 0 and 30 angle telescopes under general anaesthesia for children and local anaesthesia for adults. The use of rigid endoscopes provides a large field of view, that is of excellent resolution and fidelity of colour as well as giving good side views. It can be performed in the out-patient clinic with little inconvenience to the patient and minimal risks.
Schwannoma of the chorda tympani
Authors: Biggs N. D. , Fagan P. A.
Published: October 2002

The authors present a rare clinical entity in a schwannoma of the chorda tympani. The case is discussed including the difficulty in making the diagnosis and management.
Traces of perilymph detected in epipharyngeal fluid: perilymphatic fistula as a cause of sudden hearing loss diagnosed with beta-trace protein (prostaglandin D synthase) immunoelectrophoresis
Authors: Bachmann Gregor , Nekic Marco , Michel Olaf
Published: October 2002

The incidence of perilymphatic fistula as cause of sudden hearing loss is not known. We present a case with sudden unilateral hearing loss associated with a positive β-trace protein test of an epipharyngeal fluid sample. The patient presented with sudden sensorineural hearing loss on the right side. A stapedotomy had been performed nine months previously due to otosclerosis. Intravenous therapy for the treatment of sudden hearing loss was unsuccessful. At the time of sudden hearing loss, epipharyngeal fluid was collected using a Raucocel sinus pack. Investigation using rocket immunoelectrophoresis showed the presence of β-trace protein. Upon repeating tympanoscopy there was no obvious labyrinthine fluid egress, but the oval window was sealed with fibrin sponge and fibrin glue. The patient’s hearing improved over a period of five months.
Safe and easy method for secondary tracheo-oesophageal puncture
Authors: Husband Andrew , Randall Christopher
Published: October 2002

We describe a method for performing secondary tracheo-oesophageal puncture in patients who have undergone total laryngectomy. The technique is straightforward and easy. It uses a minimum of readily available equipment with a simple modification to a standard pharyngoscope.
Actinomycosis of the post-cricoid space: an unusual cause of dysphagia
Authors: Syed M. A. , Ayshford C. A. , Uppal H. S. , Cullen R. J.
Published: October 2002

Cervicofacial actinomycosis is known to affect many soft tissues and bony structures in the head and neck. However to the authors’ knowledge, actinomycosis of the post-cricoid region has not been previously reported. A case of a 74-year-old male who developed actinomycosis of the post-cricoid region after radiotherapy for a laryngeal carcinoma is presented. Actinomycosis should be considered in the differential diagnosis of dysphagia following radiotherapy for squamous cell carcinoma of the larynx, as early treatment is likely to result in a favourable outcome.
Epithelial-myoepithelial carcinoma of the parotid gland: a case report and review of the cytological and histological features
Authors: Deere H. , Hore I. , McDermott N. , Levine T.
Published: October 2002

Epithelial-myoepithelial carcinoma (EMC) is a rare biphasic tumour of the salivary glands typically arising in the parotid. Fine needle aspiration cytology is widely used in the initial investigation of salivary gland swellings and whilst the cytological features of this tumour have been described they are not well recognized. This report describes the clinicopathological features of a case of epithelial-myoepithelial carcinoma of the parotid gland and highlights the importance of awareness of this tumour in the differential diagnosis of biphasic tumours on fine needle aspiration cytology.
Sudden hearing loss in chronic myelogenous leukaemia implicating the hyperviscosity syndrome
Authors: Chae Sung Won , Cho Jae Hoon , Lee Jang Hyuck , Kang Hee Joon , Hwang Soon Jae
Published: October 2002

Sudden sensorineural hearing loss that presents as the initial sign of haematological disease is very rare. Chronic myelogenous leukaemia has been implicated as a causative factor of sudden sensorineural hearing loss.

A 49-year-old male presented with unilateral sudden sensorineural hearing loss. The patient was found to have chronic myelogenous leukaemia during a work-up for his hearing loss. We present a case of a chronic myelogenous leukaemia patient whose first manifestation was sudden sensorineural hearing loss. We presume that cochlear vessel occlusion as a result of elevated blood viscosity was responsible for this patient’s hearing loss. Early onset of sudden deafness in a chronic myelogenous leukaemia patient may be due to the hyperviscosity syndrome and it may be possible to reverse hearing loss through early leukapheresis.
Impacted foreign body in the hypopharynx and oesophagus
Authors: Dhanasekar G. , Mohan A. R. C. , Kumar B. N.
Published: October 2002

We report a rare case of an unusual impacted foreign body (titanium mesh stent) in the hypopharynx and upper oesophagus of a 66-year-old gentleman. He was a known patient with carcinoma of the mid-oesophagus admitted under the gastroenterologists for dilatation of the carcinomatous stricture with a stent. During the procedure the titanium mesh spring coil got displaced and was impacted in the retropharyngeal space, submucosally in the hypopharynx and upper oesophagus. He was referred to us for surgical removal of the stent, which he underwent successfully. We believe this to be the first case of such an unusual foreign body to be reported in the literature.
Hairy polyps of the nasopharynx
Authors: Jarvis S. J. , Bull P. D.
Published: October 2002

Hairy polyps are rare tumours that can occur anywhere in the body. They are especially rare in the pharynx. We report two cases of hairy polyps which originated from the nasopharynx. One presentedwith intermittent obstruction of the airway and the second presented as a visible pedunculated mass protruding from the mouth of a neonate.
Closure of large tracheocutaneous fistula using turn-over hinge flap and V-Y advancement flap
Authors: Lee Byung-Joo , Goh Eui-Kyung , Wang Soo-Geun , Hwang So-Min
Published: October 2002

Tracheocutaneous fistula is a frequent sequel of long-term tracheostomy or tracheal fenestration. Closure of fistula is complicated by the presence of extensive scar tissue, mucopurulent secretions, and tension from insufficient advancement of adjacent soft tissue. We report two successfully closed cases of large tracheocutaneous fistulae using a hinge flap and a V-Y advancement flap.
A new technique (the NOW test) for the detection of Streptococcus pneumoniae in the effusions of otitis media
Authors: Faden Howard , Poje Christopher , Pizzuto Michael , Nagy Mark , Brodsky Linda
Published: October 2002

The presence of Streptococcus pneumoniae in chronic otitis media was determined with a new antigen detection kit, the NOW test. The NOW test was originally designed as a urinary antigen test but was adapted to middle-ear effusions for the present study. Middle-ear effusions from 52 children were studied. Streptococcus pneumoniae was cultured from 10 per cent of the effusions. The NOW test was positive in 23 per cent of the effusions, 80 per cent of culture positive and 17 per cent of culture negative effusions. The NOW test proved to be rapid, simple, reliable and relatively inexpensive for the detection of pneumococcal antigen in the middle-ear effusions. This test may prove valuable for the management of children with acute otitis media who undergo tympanocentesis.
Rhinologic changes in Wegener’s granulomatosis
Authors: Lloyd Glyn , Lund Valerie J. , Beale Tim , Howard David
Published: October 2002

Twenty-eight patients with a clinical diagnosis of sinonasal Wegener’s granulomatosis were referred for imaging during the period 1990-2001. Of these, 10 had clinical symptoms and signs confined to the nose and sinuses and 18 had classical systemic Wegener’s. The computed tomography (CT) and magnetic resonance (MRI) scans of the series were reviewed by a panel of one otolaryngologist and two radiologists. From the total of 28 patients, 85.7 per cent showed non-specific mucosal thickening in the nasal cavity or paranasal sinuses, 75 per cent showed evidence of bone destruction, and 50 per cent new bone formation in the walls of the sinus cavities. In addition the orbit was affected in 30 per cent of patients.

The diagnosis of systemic Wegener’s granulomatosis is made clinically but the condition may present characteristic features on imaging by CT and MRI. In a patient without a history of previous sinonasal surgery, a combination of bone destruction and new bone formation on CT is virtually diagnostic of Wegener’s especially when accompanied on MRI by a fat signal from the sclerotic sinus wall. These changes are important diagnostically in localized sinonasal Wegener’s granulomatosis where the clinical diagnosis may be uncertain and the cANCA test can be negative.
Abducens nerve palsy as the sole presenting symptom of petrous apicitis
Authors: Price T. , Fayad G.
Published: October 2002

Petrous apicitis as a potentially fatal complication of suppurative otitis media presents in a variety of forms. Gradenigo’s triad of abducens paralysis, deep facial pain due to trigeminal involvement and acute suppurative otitis media rarely occurs. The conflicting symptoms reported in the literature usually result in the delayed recognition of the condition with potentially disastrous consequences. The VIth nerve palsy is considered to be the least reliable sign as it is least often present. We present a case in which it was the sole presenting symptom.
Adenocarcinoma of the ethmoid sinuses: a case of two primary tumours
Authors: Mace A. D. , Lale A. M. , Capper J. W. R.
Published: October 2002

The authors present a case report of a retired furniture worker who initially presented with a mucin-secreting adenocarinoma of the right ethmoid sinus. He underwent surgical resection, leaving the nasal septum intact, and topical treatment with 5-fluorouracil. He remained disease free. Three years after his initial presentation he was found to have a left nasal polyp on routine examination. This subsequently proved to be a second primary adenocarcinoma. A review of the literature has not shown any other cases of a second primary adenocarcinoma of the ethmoid sinuses.
Lipoid proteinosis of the larynx
Authors: Öz Ferhan , Kalekoglu Nuran , Karakullukçu Baris , Öztürk Özcan , Öz Büge
Published: October 2002

Lipoid proteinosis is a rare disease that presents with hyaline deposits in many tissues. It involves predominantly the skin and upper aerodigestive tract, presenting with small yellowish papules and hoarseness. It may involve the central nervous system and cause intracerebral calcifications. Laryngeal lesions may resemble singer’s nodule or chronic laryngitis. The pathogenesis of the disease is not clear although several studies suggest a defective collagen production and/or lysosomal storage disease. In this article two cases with skin and larynx involvement are reported.
Survival and transmissibility of Pasteurella pneumotropica
Authors: Scharmann W. , Heller A.
Published: October 2002

Survival has been determined for Pasteurella pneumotropica on various surfaces found in an animal room at 23 ± 1°C and 50 = 10% relative humidity. Longest survival (120 min) was found on mouse hair, shortest (< 30 min) on laboratory coat fabric. Transmission experiments were performed using sentinel animals in order to evaluate the efficiency of their use for the detection of P. pneumotropica in quarantined mice. In sentinels exposed to infected mice by close contact, P. pneumotropica was detected by culture 2 weeks post-exposure and seroconversion 3 weeks after contact. Transfer of soiled bedding from Pasteurella-infected mice did not infect sentinels within a period of 12 weeks as tested by cultivation or serum antibodies.
Carbon dioxide concentrations in unventilated IVC cages
Authors: Krohn Thomas C. , Hansen Axel Kornerup
Published: October 2002

The use of individually ventilated cage (IVC) systems has become more common worldwide. The various systems are becoming more and more sealed in order to protect the animals against infections and the staff against allergens; which, however, may lead to problematic CO2 concentrations, if the cages are left unventilated. In this study it is shown that, depending on how tight the cage is and the number of animals housed in each cage, CO2 inside the cage within 2 h will increase to levels of between 2 and 8% .
Variations in health services utilization by primary care patients
Authors: Bolaños-Carmona Victoria , Ocaña-Riola Ricardo , Prados-Torres Alexandra , Gutiérrez-Cuadra Pilar
Published: October 2002

This study analyses how both ambulatory care groups (ACGs) and physician characteristics explain the variability in health-service use among primary care patients in Spain. During the period 1996-1997, data derived from 52 152 patients and their 38 respective primary care physicians were collected. The response variables were as follows: number of visits; diagnostic tests requested; and referrals to a specialist. ACGs are an important variable that should be taken into account in order to explain health-service utilization. As for professionals, age and the post they hold are essential factors. Most of the unexplained variability is caused by patient characteristics.
Psychosocial impact of type-specific herpes simplex serological testing on asymptomatic sexual health clinic attendees
Authors: Smith Anthony , Denham Ian , Keogh Louise , Jacobs Don , McHarg Virginia , Marceglia Alex , Wood Vanessa
Published: October 2002

The usefulness of type-specific testing for herpes simplex virus type 2 (HSV-2) is much debated with proponents arguing for likely change in the sexual behaviour of asymptomatic carriers and opponents suggesting that testing may have significant adverse psychological impact while not promoting behaviour change. In the present study we examine the impact of HSV-2 serological testing on psychological well-being, self-esteem, anxiety, sexual self-perceptions and sexual practices among a sample of 180 clients of a sexual health clinic. Of the participants, 21 (11.7%) were HSV-2 positive at entry to the study. No adverse psychological consequences of a positive test were observed among those participants followed for 3 months (n =124) or for 6 months (n = 97). There was little significant change observed in sexual behaviour although a general but not significant pattern of decreased sexual behaviour with casual partners was observed among participants who tested HSV-2 negative. While supportive of the value of HSV-2 testing, these findings require replication in larger samples and different populations.
Increase in plasma IL-10 levels and rapid loss of CD4+ T cells among HIV-infected individuals in south India
Authors: Srikanth Padma , Castillo Renan C , Sridharan Gopalan , John T Jacob , Zachariah Anand , Mathai Dilip , Schwartz David H
Published: October 2002

Increased levels of immune activation among HIV patients from developing countries are believed to accelerate and/or enhance the shift to a Th2 cytokine environment, which in turn may result in a more rapid progression to AIDS. In support of this hypothesis, we present data from a cohort of 35 HIV+ individuals in southern India. Among asymptomatic individuals in this cohort, a dramatic increase in plasma interleukin (IL)-10 coincided with rapid decrease in CD4 counts and progression to AIDS. Serum IL-10 levels were significantly higher after 6 months of follow up (P = 0.01), while CD4 counts declined at a rate of 280 cells/ul per year, roughly 3 times the rate of decline reported for HIV+ asymptomatic subjects in developed countries. Changes in serum IL-10 levels and CD4 counts fell short of statistically significant correlation (P = 0.1). Among AIDS patients in this cohort, the mean period from diagnosis of AIDS to death was < 5 months and is in agreement with an earlier report of rapid progression in India.
Neisseria gonorrhoeae in a London sexually transmitted infection clinic not fully sensitive to quinolones: are isolates imported and how effective is ciprofloxacin as a first-line therapy?
Authors: Ivens D , Martin I , Ison C
Published: October 2002

Our objectives were to determine the prevalence of Neisseria gonorrhoeae not fully sensitive to ciprofloxacin from a sexually transmitted infection (STI) clinic in London and where the isolates were acquired from. Data of antibiotic sensitivities of N. gonorrhoeae from 292 patients were reviewed over a 6-month period at St Mary's Genitourinary Medicine (GUM) Clinic, London. Isolates which exhibited reduced susceptibility (minimum inhibitory concentration [MIC] 0.03-0.12 mg/l) and high level resistance (MIC>0.12 mg/l) to ciprofloxacin represented 10% and 1.3% of the total respectively. All patients infected with a high level resistant isolate to ciprofloxacin had had a recent sexual partner from abroad but 18 of the 28 patients infected with a reduced susceptibility isolate denied recent travel. None of the 20 patients with a non-sensitive isolate who re-attended for post treatment cultures had persistant gonococcal infection. From this study we concluded that although N. gonorrhoeae resistant to ciprofloxacin was rare and probably always acquired abroad, isolates exhibiting reduced susceptibility were more common and were mainly as a result of infection from the UK. A stat dose of ciprofloxacin 500 mg and doxycycline 100 mg twice a day for one week was effective treatment.
An audit of antiretroviral medication offered to patients with HIV attending a district general hospital for outpatient care
Authors: Ivens D , Brook G
Published: October 2002

In order to determine if antiretroviral prescribing for patients with HIV infection attending the Central Middlesex Hospital is according to current UK guidelines and effective at reducing the serum HIV viral load, 71 case notes were reviewed. All patients eligible for treatment according to the British HIV Association (BHIVA) guidelines were currently being offered triple therapy. The most recent serum HIV viral loads of patients taking at least 3 antiretrovirals were undetectable in 75% of the 20 patients on their first established regimen and 36% of 14 patients who had failed at least one drug according to previous surrogate marker results. Such work allows an individual clinic to monitor its antiretroviral prescribing practices in the face of constantly updated information and guidelines.
Psychosocial determinants for sexual partner referral in Uganda: qualitative results
Authors: Nuwaha Fred , Faxelid Elisabeth , Neema Stella , Eriksson Charli , Hojer Bengt
Published: October 2002

In order to understand and elicit the psychosocial factors influencing compliance with sexual partner referral, 10 focus group discussions (FGDs) and 40 individual interviews based on the attitude-social influence-self efficacy (ASE) model were held in Mbarara District of Uganda. The focus groups were derived from both rural and urban areas. Informal interviews were held with 20 men and 20 women presenting with symptoms of a sexually transmitted disease (STD) at the outpatient department of Mbarara Hospital. The emerging outcome of attitudinal beliefs regarding health consequences of partner referral were mainly positive. However, outcome beliefs relating to the relationship with the partners were mainly negative. Social influence for sexual partner referral was from health-care providers, partner(s), friends and relatives. The self-efficacy beliefs were mainly negative especially among women. Barriers hampering sexual partner referral were related to poor quality of health care, gender relations and type of sexual partners. There is a need to target these beliefs and self-efficacy expectations in health education and STD counselling and for more research to evaluate the psychosocial determinants of sexual partner referral quantitatively.
An audit of patients who have received Imiquimod cream 5% for the treatment of anogenital warts
Authors: Maitland J E
Published: October 2002

With the licensing of the new drug Imiquimod cream 5% (AldaraTM 3M Health Care) for the treatment of anogenital warts and its inclusion into clinic guidelines, a case note review audit was performed of its use. The treatment of 52 patients was audited. Results showed that clinic guidelines were being followed and that patient outcomes in terms of clearance were at least as good as the quoted rates in the literature. Significant issues included firstly patient education - especially for those who had previously received ablative therapy. Secondly the length of time that therapy would be continued before a patient was deemed to be a non-responder to Imiquimod cream 5%, and if this was the case should the frequency of application be amended from the manufacturer's recommended regime of 3 times a week.
Factors affecting attitudes towards mother-to-child transmission of HIV among pregnant women in a maternal and child hospital in Thailand
Authors: Hyodo Chika , Tanaka Tetsuro , Kobayashi Masako , Shimizu Midori , Prueksunand Panus , Nitithamyong Anuchit
Published: October 2002

This study determines the factors which correlate with attitudes towards mother-to-child transmission of HIV in pregnant women. Using a structured questionnaire, 527 pregnant women who visited a hospital to have prenatal checkups were interviewed. The survey items were: sociodemographic characteristics, experiences of pre-test counselling, knowledge of mother-to-child transmission, and attitude towards termination of pregnancy. Results showed that many pregnant women (80%) did not have proper knowledge of the possibility of mother-to-child transmission. Logisitic regression analysis also indicates that age and knowledge of the possibility of mother-to-child transmission were the significant determinants of attitudes towards termination of pregnancy. Older women who believe that all the babies of pregnant women with HIV will be infected are most likely to terminate their pregnancy when they are diagnosed as HIV positive. Considering the importance of informed decisions regarding pregnancy, this study must have important implications for future support progammes for HIV-positive pregnant women.
National assessment of PID diagnosis, treatment and management in general practice: England and Wales
Authors: Simms I. , Vickers M. R. , Stephenson J. , Rogers P. A. , Nicoll A.
Published: October 2002

A questionnaire based audit was used to evaluate the diagnosis and management of suspected pelvic inflammatory disease (PID) cases by general practitioners (GPs) in England and Wales. Responses were compared against a clinical management 'gold standard' devised by an independent group of GPs and specialists. Two hundred and ninety-seven (38%) of the 781 questionnaires were returned. Only 21 (7%) had all 'gold standard' sections correct. Diagnostic quality was significantly higher when the clinician was female compared with male (odds ratio [OR] = 2.34; 95% confidence limits [CL] = 1.19-4.63) and diagnostic quality increased with increasing socioeconomic deprivation. This is the first evaluation of the diagnosis and management of PID by GPs in England and Wales. The unusually poor response rate to a Medical Research Council General Practice Research Framework (MRC GPRF) study may reflect low disease awareness and sub-optimal management. This represents a fundamental obstacle to effective intervention and surveillance. Effective intervention will only be possible if diagnostic practice and management are improved substantially.
Resistance patterns of urinary tract infections diagnosed in a genitourinary medicine clinic
Authors: Newell A , Riley P , Rodgers M
Published: October 2002

We aimed to assess the prevalence of antibiotic resistance amongst urinary tract isolates within our clinic. Local protocol has been to prescribe a 3-day course of trimethoprim for uncomplicated urinary tract infections (UTIs). Notes of all culture-proven UTIs (October 1998 to September 1999) were examined. Eightysix urinary isolates were identified in 84 patients. Seventy-three of the isolates were coliforms with 46 being Escherichia coli . Of the 86 urinary isolates 28 (32.6%) were resistant to trimethoprim, 37 (43.5%) to amoxycillin, 5 (5.8%) to cephradine and 3 (3.5%) to nitrofurantoin. Seventy-four (86%) of the UTIs were known to have been treated; 41 at initial presentation and 33 once sensitivities were available. Of the 41 patients who received treatment initially, 11 needed to return to the clinic for a further course of antibiotics. To try and reduce the number of inappropriate treatments and unnecessary visits a number of options regarding clinic protocol were explored.
Bacterial vaginosis and smoking
Authors: Hellberg D , Nilsson S , Mårdh P-A
Published: October 2002

This study aimed to investigate if there is an association between bacterial vaginosis (BV) and smoking. This cohort study included 956 randomly chosen, apparently healthy women at 2 family planning and one youth clinic. Of the 956 women, 131 women fulfilled the criteria for BV and the remaining 825 served as a control group. BV, BV-associated bacteria and gynaecological infections were diagnosed. Structured personal interviews concerning, smoking, alcohol and drug habits, sexual behaviour and reproductive history were made. Before and after adjustment for possible confounding factors, smoking, but not alcohol and drug use, was significantly associated with BV. Of the women with BV 52% were smokers versus 32% in the control group. Age-adjusted odds ratio (OR) for smokers was 2.3 before, and 3.0 (95% confidence interval [CI] 1.3-6.9) after adjustment for sexual risk behaviour, reproductive history, and alcohol use. There was also a significant dose-response relationship between BV and smoking habits. The data suggest that there might be a causal association between BV and smoking.
An audit of the 'two-glass' test for urethritis
Authors: Dinsmore W W , McBride M , Alderdice D K
Published: October 2002

Five hundred consecutive male patients with suspected urethritis were studied using the two-glass test for posterior urethritis. During the study period no cases of urethritis would have been missed using one glass only and clinical policy was changed following this audit. The two-glass test is traditionally used in genitourinary medicine clinics but we are unable to find evidence of a scientific basis for its use.
Observations of the management of sexually transmitted diseases in the Russian Federation: a challenge of confidentiality
Authors: Platt Lucy , McKee Martin
Published: October 2002

The clinical management of sexually transmitted diseases (STDs) in Russia has long been characterized by coercion and social control. A nationwide network of dermatovenereology clinics was established in the 1920s. Patients were required, by law, to disclose details of contacts and were subject to lengthy inpatient treatment and to long-term surveillance. In 1993 the Russian Ministry of Health issued a new order designed to reduce barriers to seeking care, in particular by improving the quality of care and enhancing confidentiality. One element was the establishment of clinics offering a degree of anonymity. We report a study combining a review of available literature, interviews with patients and physicians, and non-participant observation. This indicates that the concept of confidentiality is poorly understood among physicians and accorded little priority. It is, however, valued by patients and aspects of the system related to confidentiality act as barriers to access.
Reliability and validity of self-reported CD4 lymphocyte count and viral load test results in people living with HIV/AIDS
Authors: Kalichman Seth C , Rompa David , Cage Marjorie
Published: October 2002

Self-reporting is a common, convenient, and inexpensive method for collecting health status information in HIV/AIDS research, but the reliability and validity of these data remain suspect. HIV-positive persons ( n = 174) completed self-report measures of demographics, health status, and health literacy, and provided permission to collect CD4 cell counts and viral load results from provider charts. Clinically meaningful categories of CD4 cell counts were reliably and validly assessed using self-report measures. Self-reported viral load, however, demonstrated only marginally acceptable reliability and validity, with the greatest validity occurring for recall of undetectable viral load. Self-reported health status was most reliable and valid for persons with higher levels of education and literacy. CD4 cell counts can therefore be reliably and validly assessed through self-reporting, particularly when collected in clinically meaningful units from persons with higher education. Self-reported viral load should be interpreted with caution and is most reliable when dichotomized into detectable/undetectable categories.