bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative Bioavailability of Oral Sugar-Coated and Plain Formulation of Chloroquine Phosphate Marketed in Tanzania
Authors: Rimoy G H , Moshi M J , Massele A Y
Published: January 2017

The bioavailability of chloroquine from a single oral dose (10 mg/kg body weight) of a sugar-coated (DawaquinR) and a plain formulation (ShellyquineR) of chloroquine phosphate were compared in two groups of 10 volunteers each, following an overnight fast. Whole blood chloroquine concentrations were measured using high-performance liquid chromatography (HPLC) and bioavailability was determined by measuring area under the blood chloroquine concentration curve (AUC ng mL−1 h) and the peak blood chloroquine concentration (Cpmax ng/mL). The AUC and Cpmax for Shellyquine were 4396.3 ± 833 ng mL−1 h and 162 ± 14 ng/mL, respectively. The AUC and Cpmax for Dawaquin were 2060 ± 339 ng mL−1 h and 56.6 ± 5.2 ng/mL, respectively. Shellyquine was significantly more bioavailable than Dawaquin ( P<0.001). Although the Cpmax for Dawaquin was higher than the required therapeutic level for sensitive Plasmodium falciparum of 30 ng/mL, its blood levels may not guarantee a rapid clearance of parasites. The differences between the two formulations point to a problem in the quality of pharmaceuticals marketed in this country, whose extent need to be ascertained further. Failure of chloroquine phosphate in this country has already been declared by the Ministry of Health, and the potential contribution of poorly formulated products remains a subject of debate.
Urinary Pathogens' Resistance to Common Antibiotics: A Retrospective Analysis
Authors: Navaneeth B V , Belwadi Sandhya , Suganthi N
Published: January 2017

The susceptibility of urinary pathogens to common antibiotics was investigated and the results analysed retrospectively using the WHONET computer program. Of 1776 urine samples (44 catheterized) processed, 510 (28.7%) urinary pathogens were isolated. Of these 510 positive cultures, 455 (89.2%) were Gram-negative bacilli, 45 (8.8%) Candida species and 10 (1.9%) Gram-positive cocci. Of the 44 catheterized samples, 32 (72.7%) yielded significant bacteriuria and these were mainly Gram-negative bacteria (24/32). The commonest pathogen isolated was Escherichia coli (47.3%) followed by Klebsiella species (10.3%), non-fermenters other than Pseudomonas species (9%), Candida species (8.8%), Providentia species (7%), Pseudomonas species (5.6%), Citrobacter species (3.7%), Enterobacter species (3.3%) and Proteus species (2.5%). The isolation of Gram-negative bacteria among inpatients and outpatients was 71.6% and 28.3%, respectively. The critical care unit, nephrourology, obstetric and gynaecology, medical and surgical wards were found to be high-risk areas constituting 58.7% of the major isolates. The highest and lowest mean resistance among Gram-negative bacteria to common antibiotics was 93.5% to ampicillin and to 61% gentamicin. The mean resistance to norfloxacin, amoxy-clavulanic acid, nitrofurantoin, trimethoprim-sulfamethoxazole and cefazolin was 65%, 67%, 75.5%, 76% and 77.5%, respectively. The most resistant pathogen to common antibiotics was found to be Proteus species (resistance 80% and above). Overall susceptibility testing demonstrated decreased usefulness of common antibiotics and demonstrates a need for a re-evaluation of common antibiotics used in the therapy for urinary tract infection.
Echocardiographic Features of Peripartum Cardiac Failure: The Zaria Syndrome
Authors: Danbauchi S S
Published: January 2017

Zaria has the highest incidence of peripartum cardiac failure, a syndrome of unsettled aetiology. Over the years it has been noted that there has been a decrease in the period of treatment by traditional methods from an average of 90 days to 30 days and with a complete avoidance of hot bed treatment. Twenty-one subjects with the syndrome were studied: they exhibited the same clinical findings as evinced in previous reports from our centre. Echocardiography findings of dilated heart with depressed left ventricular function were noted. There was a statistically significant relationship between the duration of practice and ejection fraction (EF), r=0.36 and P<0.05, duration of practice and left ventricular internal diameter in diastole (LVIDd), r=0.28, P<0.05.

Were these subjects suffering from a quiescent heart muscle disease from a previous viral myocarditis and did they require an expanded volume as a trigger? Or are they intolerant of salt requiring only a small increase from the traditional method of treatment to precipitate cardiac failure? Further investigation in the field of molecular biology is required.
Experience with Unoperated Cleft Lip and Palate Patients in a Nigerian Teaching Hospital
Authors: Olasoji Oladapo , Arotiba Toyin , Dogo Dilli
Published: January 2017

A review of 31 cases of unoperated cleft lip and palate patients aged 10 years and above managed over a 6 years period at a suburban Nigeria teaching hospital is presented. There was an overall preponderance of the female gender and isolated cleft lip (58%) was the most predominant. Although clefts were very wide on presentation, there was adequate well-developed soft tissue in adults to achieve a cosmetically and functionally acceptable repair. This study also confirms the views that late primary repair of facial cleft is less likely to produce impaired growth of the maxilla as is commonly observed in early repair. However, the advantages of early repair cannot be over-emphasized.
Infective Endocarditis: Report of a Prospective Study in an Indian Hospital
Authors: Khanal B , Harish B N , Sethuraman K R , Srinivasan S
Published: January 2017

Forty-six patients who fulfilled the Duke's clinical diagnostic criteria for infective endocarditis (IE) were evaluated. Thirty-five (76%) patients were below 40 years of age with rheumatic heart disease being the most common underlying heart lesion affecting 26 (56%). An obvious predisposing cardiac lesion could not be ascertained in 22%. Blood culture positivity was 44% with streptococcus heading the list. The incidence of the staphylococcal (25%) and Gram negative bacillary endocarditis (15%) were found to be increasing. Streptococci were susceptible to penicillin with minimum bactericidal concentration:minimum inhibitory concentration within acceptable limits. However, the appearance of methicillin resistant staphylococcus aureus and high level gentamicin resistant enterococcus as aetiological agents of infective endocarditis were found to add to the complexity of the problem. With the emergence of drug-resistant organisms as causative agents of IE, whenever medical therapy is the primary method of treatment of this condition, the selection of antibiotics should depend upon extensive in vitro testing and in vivo monitoring of clinical efficacy.
Brucellosis: A Retrospective Evaluation
Authors: Taşbakan Meltem Işikgöz , Yamazhan Tansu , Gökengin Deniz , Arda Bilgin , Sertpolat Mahmut , Ulusoy Sercan , Ertem Ekin , Serter Demir
Published: January 2017

One hundred and sixty-six presumed brucellosis patients were included in the study. These patients were classified as primary (91), relapse (18) and suspected (57) cases according to their clinical presentations, and serologic and microbiologic test results. Primary and relapse cases were evaluated retrospectively according to age, sex, residence, routes of transmission, clinical and laboratory findings, treatment regimens, duration of treatment, and relapse rates. Of the 109 primary and relapse patients, 57 were male and 52 female. The ages of the patients ranged between 16–75 (mean age 40.2). The percentages of the urban and rural residence of the patients were 41.3% and 58.7%, respectively.

The most common mode of transmission was consumption of unpasteurized milk and milk products (67.9%). Malaise, fever and sweating were the most frequently observed symptoms (96.3%, 95.4%, 91.7%, respectively). The most common signs were fever (97.2%), splenomegaly (59.6%), and hepatomegaly (37.6%). The liver was the most frequently involved organ (21.1%).

Almost all (99.1%) patients were serologically positive. However, the positivity rate of culture was low (15.6%). The most frequently preferred antimicrobial regimen was rifampin and doxycycline combination. The relapse rate was 8.3%.

Brucellosis is still prevalent in Turkey as in many other countries in the Mediterranean basin. The clinical presentation of the disease may show regional variations. Patients with a history of occupational or nutritional contact with the bacterium and with a compatible clinical picture should be examined using appropriate diagnostic techniques before any attempt to prescribe an antimicrobial.
Vernal Keratoconjunctivitis in Nigerians: 109 Consecutive Cases
Authors: Ukponmwan Catherine U
Published: January 2017

Vernal keratoconjunctivitis was the most common conjunctival disease seen over a 2 year period (January 1997–December 1998) at the University of Benin Teaching Hospital, Benin City, Nigeria. One hundred and nine consecutive patients were seen with vernal keratoconjunctivitis. There was a male to female ratio of 1:1.3. The age range of the patients was 5 months to 38 years with a mean age of 15.5 ± 8.3 years (SD). Of the patients 54.1% were children.

Itching was the most common symptom, followed by redness, tearing, aching eye and photophobia. Ninety patients (82.6%) had predominantly tarsal papillae, while the others had mixed and limbal papillae. A history of atopic diseases such as asthma and rhinitis was present in only five patients (4.5%). There was no patient with corneal ulcer or scarring. Although the complications were few, health education of the patients about the dangers of self medication with steroids should be emphasized.
Accessory Breast in the Perineum
Authors: Basu Somprakas , Bag Tarasankar , Saha Sudip Kumar , Biswas P C
Published: January 2017

A rare case of functional accessory breast in the perineum presenting in labour is reported. It showed a well-formed nipple and pregnancy induced changes. The organ was completely excised postpartum. Histopathology confirmed normal breast tissue.
Paramedicals' Clinical Accuracy
Authors: Pust Ronald E , Burrell J Michael
Published: January 2017

A random sample of 102 cases referred in 1983 by paramedicals to the Southern Highlands Provincial Hospital, Papua New Guinea, was analysed for agreement with the final hospital diagnosis and with standardized primary care therapies. Health centre diagnosis was judged accurate in 45% of cases; inaccuracies in a further 17% had no projected health consequences. However, resulting serious sequelae could be projected in half of the incorrect diagnoses. Diagnosis of surgical cases was more often accurate (P<0.05) than in medical cases.

Treatment which was adequate or standard for the diagnosis made at the health centre had been given there in 80% of cases. However, there were serious diagnostic inaccuracies in 38% of all referral cases; this study suggests a need for problem-based paramedical education in diagnosis, especially in non-surgical problems. Visits by doctors to health centres could reinforce this diagnostic teaching and better evaluate paramedicals' clinical accuracy in the health centre.
Influence of Health Education on Local Beliefs
Authors: Stefanini Angelo
Published: January 2017

Health education can sometimes lead to unexpected results when people adapt their beliefs to new ideas being taught. Recent experience of the department of health education at St Mary's Hospital Lacor is presented to illustrate this phenomenon.

The Acholi practice of removing children's unerupted deciduous canine teeth is reviewed, and the results of a retrospective study of hospital admissions of children with complications following the operation are analysed.

The increased number of such admissions following a health education campaign is discussed, and it is concluded that a more radical approach is needed to counteract the harmful belief. Partial success and indirect positive results should not satisfy health workers whose main goal must be to make people fully understand what is dangerous to their wellbeing.
Training of Village Health Workers in Tanzania; a Comparison of Two Approaches
Authors: Mayombana C , Jenkins J , de Savigny D , Tayari S , Lubomba G , Burnier E , Tanner M
Published: January 2017

The paper compares the costs of training for two groups of Village Health Workers (VHWs) Tanzania, where the policy of developing a system based on Primary Health Care principles will require the training of more than 16 000 VHWs during the next decade. In the Kilombero District, one group of VHWs was trained according to the guidelines of the National Programme of the Ministry of Health, and another group followed the training programme of the Kilombero Project, based on the Swiss Tropical Institute Field Laboratory. The training scheme of the Kilombero project cost almost 80070 less for one VHW, largely because it depended on on-the-spot training by local staff. The results of a first investigation of the efficacy of the training were encouraging; a longterm evaluation is in progress.

The curricula for the two programmes also differed; the Kilombero programme had shorter blocks of theory, interspersed with supervised practical work, and introduced curative medicine earlier in the course. The advantages and disadvantages of the two programmes are discussed, not only in terms of cost but also in terms of their efficacy in training VHWs who will be motivated, efficient and accepted by the community.
Managing Common Oral Problems: Some Considerations
Authors: Dickson Murray
Published: January 2017

In the absence of early interventions, incipient dental problems can progress to destructive and even fatal outcomes.

It is particularly important that primary health personnel correctly diagnose a presenting condition and provide care as early as possible. Some considerations are presented to assist in recognizing and managing common mouth problems.
Ciguatera Fish Poisoning: Treatment with Intravenous Mannitol
Authors: Stewart M P M
Published: January 2017

Intravenous mannitol was given to 16 patients with acute ciguatera fish poisoning requiring hospital admission. Thirteen patients (81%) presented with sensory and neuromuscular symptoms; paraesthesiae and pain and weakness in the lower limbs were predominant features. Mannitol had little effect upon gastrointestinal manifestations, but a marked reduction was observed in the expected duration of neurological symptoms. Although these results are empirical and uncontrolled, they suggest that mannitol infusion may be effective in altering the clinical course of acute ciguatera fish poisoning.
Prescribing Pattern in Acute Diarrhoea in Three Districts in Bangladesh
Authors: Chowdhury A K Azad , Matin M A , Islam M Amirul , Khan Omar Faruk
Published: January 2017

Irrational use of drugs is a serious problem in the management of diarrhoea in developing countries. Many studies have been conducted in many different countries to document the prescribing pattern in diarrhoeal diseases in the hope of promoting rational use of drugs and thereby improve patient care. In only a few of these studies have standard drug use indicators been used to quantify the extent and nature of irrational prescribing. We report here the findings of a prescribing survey in acute diarrhoea (prescriptions written by graduate doctors) in the government health facilities (GHF) and private dispensaries (PD) in the districts of Dhaka, Tangail and Serajgonj of Bangladesh. In the study a set of standard indicators concerning prescribing, patient care and drug supply developed by the International Network for Rational Use of Drugs (INRUD; and later adopted by WHO) has been employed. Twelve prescriptions given in acute diarrhoea cases in children under 5 years old were prospectively collected on a random basis from each of the 10 centres from three districts. They were analysed by the methods suggested in the INRUD manual.
Significance of Bronchial Washings Smear Negativity in ‘Suspect’ Pulmonary Tuberculosis
Authors: Rao Sukhesh
Published: January 2017

The role of bronchial washings in patients with ‘suspect’ pulmonary tuberculosis was studied in 55 patients. Bronchial washings increased the diagnostic yield of tuberculosis by 28%. It was also able to accurately exclude active tuberculosis in 94% patients. Hence it is inferred that absence of acid-fast bacilli in smears of bronchial washings is equally important to exclude active tuberculosis.
The Hospital Water Still
Authors: Awojobi Oluyombo A
Published: January 2017

We have been producing our normal requirements of saline since 1984. Over the years, the irregular supply of electricity from the national grid for operating the hospital water still has prompted us to fabricate one that functions with a gas burner.
Abdominal Tuberculosis in Ahmadi, Kuwait: A Clinico-Pathological Review
Authors: Abdul-Ghaffar Naser UAMA , Ramadan Ibrahim Tarif , Marafie Amin Ali
Published: January 2017

For studying abdominal tuberculosis (TB) in Ahmadi, files of all patients admitted to our hospital with abdominal TB over 15 years (1981–1996) were reviewed. Nineteen patients are reported here. Young adults were predominant in our study. The non-Arab Asians were the most frequently affected group in relation to their population in Ahmadi, and Kuwaitis were the least frequently affected group. Abdominal pain, sweating, anorexia and fever were the most frequent presenting symptoms. Ascites and intestinal obstruction were the most frequent clinical presentations. Two patients presented with acute appendicitis and one patient had tuberculous pancreatitis. Abdominal lymph nodes, peritoneum, ileum and caecum were the most frequently affected abdominal structures. We found laparoscopy very helpful in the diagnosis of abdominal TB and we recommend it as the diagnostic method of choice. All our patients responded well to antituberculous chemotherapy. It should be kept in mind that abdominal TB still affects the indigenous and expatriate population of Kuwait.
Introduction of a Simplified round Partogram in Rural Maternity Units: Seno Province, Burkina Faso, West-Africa
Authors: Wacker J , Utz B , Kyelem D , Lankoande J , Bastert G
Published: January 2017

After a 3-day seminar on the utilization of a rectangular World Health Organization (WHO) version of the partogram and the round partogram, both versions were used under supervision in the maternity rooms of the Seno province, Burkina Faso, West-Africa, for 3 months. After this period a semi-standardized questionnaire was distributed among the partogram users.

Using the round partogram with a plastic dial (dilatation indicator for the assessment of labour — DIAL), the two most common errors in the utilization of the rectangular partogram, incorrect recording at the initial examination and at the transition from latent to active phase, were largely avoided. Although the partogram was used in only 46.6% of all deliveries at the health unit level, 86% of the maternity staff using the partograms preferred the round partogram because of its time-saving and user-friendly qualities. Eighty-six per cent of its users felt that by starting the alert- and action-lines at a point later than that in the WHO partogram they would be able to avoid transferring patients unnecessarily.

The wide acceptance of the simplified round partogram among the peripheral health units surveyed shows that the partogram would be an attractive tool for its users when it is made easy to use and a useful indicator for determining whether a patient transfer is necessary.
The ‘Growth Monitoring Teaching Aid’ Rapidly Improves Mothers' Understanding of Growth Curves
Authors: Sohal Hardip , Wilkinson David , Morley David
Published: January 2017

Most growth monitoring programmes in developing countries have not been successful in reducing malnutrition. This is due, at least in part, to the exclusion of mothers from the process of growth monitoring. An essential requisite for greater participation is for mothers to understand the meaning of a growth chart. The ‘Growth Monitoring Teaching Aid’ (GMTA) is an educational game which attempts to expedite the process of understanding growth curves by simulating the growth curve of a child using water added to a bucket suspended below the direct recording scales. Thirty mothers were divided into an experimental group who used the GMTA for 2–4 h and a control group who did not use it. Six questions were used to test each subject's understanding of growth curves. Paired t tests revealed that the experimental group significantly increased their understanding of growth, whereas the control group did not. The mean score for the experimental group prior to playing the game was 1.43; this increased to 5.27 after playing the game ( P < 0.0001). The GMTA by rapidly improving the present poor level of understanding of growth curves, may allow greater maternal participation in growth monitoring.
Hypoglycaemic Shock: Normal or Abnormal Response to Injury?
Authors: Ofiaeli R O , Anyaegbu C C , Dioka C E
Published: January 2017

We report a case of hypoglycaemic shock which occurred in a patient 18 h after injury. The patient was involved in a road traffic accident and sustained multiple rib fractures and bruising in the (R) lumbar region. Eleven hours after his last meal he developed sudden weakness, profuse sweating, air hunger, thirst, disorientation and suddenly lapsed into coma 18 h after admission. Administration of 50 ml of 50% dextrose resulted in immediate restoration of consciousness. This case shows that this complication can occur in trauma patients even though the metabolic response to trauma is usually assumed to be hyperglycaemic.
The Differential Diagnosis and Management of Breast Lumps in the Tropics
Authors: Holcombe C , Weedon R , Llwin M
Published: January 2017

Breast cancer is less common in the Tropics than in the West, but presents a formidable challenge due to late presentation. Public education is vital if the outcome is to be improved. There are many benign pathologies which present similarly to cancer — this underlines the need for proper diagnosis, as mastectomy is often not necessary. It is important to remember that non-peurperal breast abscesses may be the first sign of HIV infection.
Iron Status of Pregnant Women at First Antenatal Booking in Mbarara University Teaching Hospital
Authors: Kiwanuka Gertrude N , Isharaza W K , Mahmoud S
Published: January 2017

An assessment of iron status was made on 96 pregnant women and 29 non-pregnant, non-lactating menstruating women of comparable age group as controls. Anaemia (haemoglobin < 110 g/l) was present in 84.4% of the pregnant women and in 48.3% of the control group. Iron deficiency (serum ferritin < 12.0 μg/l) was present in 51.1% of the pregnant group and 37.9% of the control group. Prevalence of anaemia with iron deficiency was 54.7% in anaemic pregnant women. Serum ferritin correlated significantly with low haemoglobin ( P < 0.05). Median serum ferritin declined progressively until 31 weeks of gestation. Preliminary studies on their dietetics showed that low animal protein consumption and poor dietary iron bioavailability were associated with anaemia.
Dietary Supplement Labeling: Cognitive Biases, Market Manipulation & Consumer Choice
Authors: McCann Michael A.
Published: January 2017

There exists increasing concern that the Dietary Supplements Health and Education Act (“DSHEA”) has proven ineffective and perhaps counterproductive. Most illustratively, consider a recent and remarkably candid remark from Tommy Thompson, then Secretary of Health and Human Services: “I really think Congress should take a look at the food supplement law again.It doesn't make any sense to me.”

A health law that makes no sense to the Secretary of Health of Health and Human Services should certainly draw the attention of academics and policy-makers alike. Much of the debate concerning DSHEA regards the disparity in legislative treatment between dietary supplements, foods, and pharmaceutical drugs. Specifically, while pharmaceutical drugs must undergo years of costly pre-market testing, most dietary supplements—like most foods—can immediately enter the market, and only after repeated instances of adverse reactions can the Food and Drug Administration (“FDA”) remove them.
Towards a New Moral Paradigm in Health Care Delivery: Accounting for Individuals
Authors: Katz Meir
Published: January 2017

For years, commentators have debated how to most appropriately allocate scarce medical resources over large populations. In this paper, I abstract the major rationing schema into three general approaches: rationing by price, quantity, and prioritization. Each has both normative appeal and considerable weakness. After exploring them, I present what some commentators have termed the “moral paradigm” as an alternative to broader philosophies designed to encapsulate the universe of options available to allocators (often termed the market, professional, and political paradigms). While not itself an abstraction of any specific viable rationing scheme, it provides a strong basis for the development of a new scheme that offers considerable moral and political appeal often absent from traditionally employed rationing schema.

As I explain, the moral paradigm, in its strong, absolute, and uncompromising version, is economically untenable. This paper articulates a modified version of the moral paradigm that is pluralist in nature rather than absolute. It appeals to the moral, emotional, and irrational sensibilities of each individual person. The moral paradigm, so articulated, can complement any health care delivery system that policy-makers adopt. It functions by granting individuals the ability to appeal to an administrative adjudicatory board designated for this purpose. The adjudicatory board would have the expertise and power to act in response to the complaints of individual aggrieved patients, including those complaints that stem from the moral, religious, ethical, emotional, irrational, or other subjective positions of the patient, and would have plenary power to affirm the denial of access to medical care or to mandate the provision of such care. The board must be designed to facilitate its intended function while creating structural limitations on abuse of power and other excess. I make some specific suggestions on matters of structure and function in the hope of demonstrating both that this adjudicatory model can function and that it can do so immediately, regardless of the underlying health care delivery system or its theoretical underpinnings.
Oversight of Marketing Relationships between Physicians and the Drug and Device Industry: A Comparative Study
Authors: Jost Timothy Stoltzfus
Published: January 2017

Throughout the world, complex mutually-dependent relationships exist between physicians and pharmaceutical and medical device companies. This article focuses on one particular aspect of these relationships—payments made by drug and device companies to physicians and their organizations and institutions to market drugs and devices. It is widely believed that drug and device company marketing to physicians creates conflicts of interest that corrupt physician judgment and increase the cost of medical care. This article examines first the economic basis of physician/industry relationships that causes conflicts to arise. It next considers the measures that a number of developed countries have taken to respond to these relationships. Finally, it proposes an approach that would comprehensively address the problems caused by drug and device company marketing to physicians.
For Profit Enterprise in Health Care: Can it Contribute to Health Reform?
Authors: Kinney Eleanor D.
Published: January 2017

Since the demise of the last major health reform initiative in 1994, health coverage for the American people has deteriorated. Private insurance costs have risen, and coverage under private insurance became less comprehensive, with higher deductibles and copayments. Many new treatments for serious diseases and associated provider compensation have become more and more unaffordable, even for those with health insurance coverage. Recent reports document the challenges for cancer patients faced with the soaring cost of cancer treatment. Public programs, such as Medicare and Medicaid, have picked up some slack and have grown in numbers. But gaps remain. Approximately 16 percent of the U.S. population is uninsured. Annual U.S. spending for health care was $2 trillion in 2005, and is estimated to reach $4 trillion by 2015.
Prediction of Intestinal Recovery after Ischaemic Injury Due to Arterial, Venous and Mixed Arterial and Venous Occlusions
Authors: Gorey Thomas F
Published: January 2017

Methods to predict intestinal viability after release of vascular occlusion were evaluated in a rat model of reversible segmental strangulation. Visual criteria of colour, pulsation and peristalsis in the ischaemic intestine were applied both in the immmediate period after restoration of the circulation and at ‘second-look’ 24 hours later. In addition two simple tests using a Doppler probe and surface fluorescence were evaluated. As a test in identifying nonviable intestine the fluorescent method had an overall sensitivity of 96% with a specificity of 95% for all types of vascular occlusion, which compared favourably with the other methods tested.
Salivary and Urine Theophylline Levels in Management of Childhood Asthma
Authors: Goldsworthy S J , Kemp M , Warner J O
Published: January 2017

It is not possible to predict the plasma theophylline levels that can be achieved using slow-release aminophylline based on body weight or surface area. Improvement in FEV1 is directly related to increasing serum theophylline level, justifying the need for measuring levels in order to optimize therapy. As repeated venesection in children is unpleasant we have studied a simple method using saliva. Simultaneous blood and salivary theophylline levels correlated sufficiently well for salivary levels to be used for monitoring purposes. Urine levels did not correlate as well, but could be used for checking compliance.
Altered Drug Binding to Serum Proteins in Pregnant Women: Therapeutic Relevance
Authors: Peruccam E , Ruprah M , Richens A
Published: January 2017

The binding of diazepam, phenytoin and valproic acid to serum proteins in vitro has been compared in pregnant women of different gestational ages and in controls. The unbound fraction of each of the three drugs was elevated during pregnancy (particularly during the last 8 weeks) probably due, at least in part, to a fall in serum albumin concentration. These findings may provide a partial explanation for the increase in the clearance of certain drugs during pregnancy and need to be taken into account when interpreting serum drug levels in clinical practice.
Cryosurgery for the Urethral Syndrome
Authors: Boreham Peter
Published: January 2017

A technique is described for treating the urethral syndrome in ambulant women by cryosurgery under local anaesthesia using a specially devised guard or applicator. This follows a trial study (Parkes & Boreham 1980) in which a modified guard was used. Experience with over 350 cases and detailed follow up of 111 of them has confirmed improvement in 95% (93 of 111). No patient was made worse, only 10 required second treatments and the majority, when asked, said they thought the treatment was of value and that they would be prepared to have the same treatment again if necessary.

This is a simple, safe and harmless technique for the treatment of the female urethral syndrome. It can be carried out under local anaesthesia as an outpatient or under general anaesthesia following cystoscopy. It causes few complications and relieves the symptoms in the majority of such patients.
Postanal Repair for Faecal Incontinence
Authors: Keighley M R B
Published: January 2017

Between 1977 and 1983, 105 patients had a postanal repair for the treatment of faecal incontinence. All except 8 patients were women. The principal reasons for operation were: persistent incontinence after rectopexy (n = 25), obstetric trauma (n = 18), anal dilatation (n = 12) and pelvic floor neuropathy (n = 41). One patient died after operation. Of 89 patients followed up for at least six months after operation, 56 (63%) have complete control of faeces and flatus, but 19 have control of solid faeces only and 14 are no better. The poor results were associated with wound sepsis and previous operations particularly in men.
Variations in Perinatal Mortality in Gloucestershire: Preliminary Communication
Authors: Shaw Charles D
Published: January 2017

The perinatal mortality rate (PNMR) was calculated for each rural parish in Gloucestershire for the years 1968–79. The characteristics of high- and low-rate parishes (each set comprising about 10% of all births) were contrasted according to routinely recorded fetal, maternal and environmental variables. The overall PNMR in the high-rate set was six times higher than in the low-rate set; congenital malformations and low birth weight distribution could explain about one-third of this difference but the residue wás not attributable to fetal gestation, maternal age or parity or social class as may have been expected. However, there was a strong association with population and housing density. It is suggested that comparisons within districts may provide more sensitive associations with PNMR than comparisons between districts, regions and countries.
Juvenile Onset Systemic Sclerosis
Authors: Burge S M , Ryan T J , Dawber R P R
Published: January 2017

A case of progressive systemic sclerosis (CREST syndrome), which began in childhood, is described. Juvenile onset CREST syndrome is extremely rare; there are few well documented cases and no published series of children with this form of progressive systemic sclerosis. An anticentromere antibody was recently detected in this case and its significance is discussed.
Experimental Colon Neoplasia Enhanced by Extract of Sperm (Protamine)
Authors: Phillips R K S , Quill D S , Dudley H A F
Published: January 2017

An experimental study of colorectal tumorigenesis in inbred rats given the potent carcinogen dimethylhydrazine has shown that protamine, given before any tumours had developed, significantly enhanced the development of large bowel tumours (100% incidence). Those animals having no adjuvant therapy or who received either heparin or 5-fluorouracil (alone or in combination) had an approximate 50% incidence of such tumours.
Cardiopulmonary Resuscitation: A Survey of Standards among Junior Hospital Doctors
Authors: Casey William F
Published: January 2017

The theoretical knowledge of cardiopulmonary resuscitation of 50 junior hospital doctors was examined, and an attempt made to assess their practical ability to manage a collapsed patient. Major defects were found in both the doctors' theoretical knowledge and their practical abilities. Only 8% were able to manage a cardiopulmonary arrest adequately. Suggestions are made as to how standards might be improved.
Psychological Factors in Recovery from Myocardial Infarction: Preliminary Communication
Authors: Kincey J , Wade E Geoffrey
Published: January 2017

A small consecutive series of 27 myocardial infarction patients were interviewed at approximately 10 and 40 weeks after infarction to obtain data concerning the psychological aspects of rehabilitation. The results emphasized the need for consistency in imparting information and advice, and suggested the value of joint cardiological and clinical psychological assessment where patients fail to make expected progress. They pointed to a simple framework for intervention which is capable of further development and evaluation.
Morbidity of Simple Cholecystectomy and Cholecystectomy with Transduodenal Sphincteroplasty
Authors: Antrum Ralph M , Hall Robert
Published: January 2017

Exploration of the common bile duct via transduodenal sphincteroplasty is thorough and provides an opportunity for the natural passage of retained calculi. However, this procedure destroys both the sphincter ampulla and sphincter choledochus, the sequelae of which are unknown. Fifty patients who had a transduodenal sphincteroplasty performed between 1970 and 1980 were randomly selected and compared with 50 patients who only had cholecystectomy. They were all seen in the outpatient department, assessed on a modified Visick scale and had liver function tests performed. There was no statistical difference in the subjective quality of result or in the liver function of the sphincteroplasty group when compared with the cholecystectomy patients, which suggests that destruction of the sphincters does not appear to be harmful to the patient.
Multiple Pain Complaints in Amputees
Authors: Lindesay J E B
Published: January 2017

A group of amputees complaining of longstanding phantom pain was compared with another comparable group of non-complainers. It was found that those with phantom pain made significantly more complaints of other painful conditions, both related and unrelated to the amputation; they were also more depressed. It is suggested that this association is due to a lowered pain tolerance in the group with phantom pain complaints, and that depression is one factor contributing to this lowered tolerance.
Referrals to Psychiatrists in a General Hospital — Comparison of Two Methods of Liaison Psychiatry: Preliminary Communication
Authors: Sensky Tom , Cundy Tim , Greer Steven , Pettingale Keith
Published: January 2017

Patients on a general medical ward were offered a liaison psychiatric service with ‘unlimited’ access, in which referrals were accepted from nurses, other paramedical staff and junior doctors in addition to senior medical staff. This new service (method II) was compared with the usual liaison service (method I, referrals initiated or approved by senior medical staff only) which was continued in parallel on a comparable general medical ward. Method II resulted in a threefold increase in referral rate and led to a significant alteration in the types of problem attracting referral. Despite the much higher rate of method II referrals, however, similar percentages of referrals by both methods were offered psychiatric follow up. The results do not support the commonly held belief that it is the failure of ward staff to recognize psychiatric morbidity which accounts for the low rate of referrals to many psychiatric liaison services.
Aneurysms of the Abdominal Aorta: A 20-Year Study
Authors: Bowers Dorrance , Cave William S
Published: January 2017

One hundred and eighty-eight patients in whom the diagnosis of aneurysm of the abdominal aorta (AAA) was established after 1 January 1960 were followed until their deaths or to 31 December 1979. By the actuarial method, the cumulative 5-year risk of an intact aneurysm progressing to rupture was 35%; the observed 5-year survival rate for patients who had medical management for intact AAA was 33%, for patients who had elective surgery for AAA 74%, for patients who had emergency surgery for ruptured AAA 35%, and for those who did not have surgery for ruptured AAA 0%.

Comparison of the non-operated and electively-operated groups of patients showed that the former was disproportionately weighted with older higher-risk patients, suggesting that the difference in survival rates for the two groups might be a reflection of patient selection rather than of surgical intervention. Comparison of the cumulative 5-year risk of rupture of an intact AAA with the cumulative 5-year mortality rate associated with elective surgery for intact AAA showed that elective surgery for intact AAA might be expected to result in a reduction in the cumulative 5-year mortality rates of patients with intact AAA.
Hughes External Fixator in Treatment of Tibial Fractures
Authors: Court-Brown C M , Hughes S P F
Published: January 2017

The results of a prospective trial of the use of the Hughes unilateral external fixator in the management of 48 tibial diaphyseal fractures are presented. Good results were obtained in grade II and III fractures but not in closed and grade I fractures. The results and complication rates were comparable with those of other more complex external fixators. Good results were found to be dependent on the adequacy of the initial reduction and the duration of external fixation, but independent of alterations in pin angle, length and location as well as fixator location.
Management of Choledochal Cysts in Adults
Authors: Pain J A , Cahill C J , Bailey M E
Published: January 2017

The management of 7 adults with choledochal cysts is described. Three patients presented with abdominal pain, 3 with jaundice and one with cholangitis. Three patients underwent total or partial cyst excision and the remaining patients underwent cyst drainage into a Roux-en-Y jejunal loop. There was no operative mortality and all patients have remained well for up to 6 years following surgery. It is argued that total cyst excision is the treatment of choice, but where this is not possible a Roux-en-Y choledochocystojejunostomy is the recommended alternative.
Optic Nerve Hypoplasia in Infancy
Authors: Fielder A R , Levene M I , Trounce J Q , Tanner M S
Published: January 2017

Certain features of optic nerve hypoplasia (ONH), its systemic associations and investigation are exclusive to infancy. These include the facility to use cranial ultrasound, difficulties in assessing ocular features and visual function, and neonatal hypoglycaemia and jaundice. Six infants with ONH are presented; cerebral abnormalities were demonstrated by cranial ultrasound in five. Neonatal cholestatic jaundice and hypoglycaemia occurred in one infant. Two died and represent a group likely to remain undetected unless routine ophthalmic examination of neurologically abnormal neonates is undertaken. In infancy, both ocular and systemic aspects of ONH can be investigated simply and without sedation.
Achalasia following Gastro-Oesophageal Reflux
Authors: Smart H L , Mayberry J F , Atkinson M
Published: January 2017

Five patients initially presenting with symptomatic gastro-oesophageal reflux, proven by radiology or pH monitoring, subsequently developed achalasia, confirmed by radiology and manometry, after an interval of 2–10 years. During this period dysphagia, present as a mild and intermittent symptom accompanying the initial reflux in 3 of the 5, became severe and resulted in oesophageal stasis of food in all. Three of the 5 had a demonstrable hiatal hernia. In none was reflux a troublesome symptom after Rider-Moeller dilatation or cardiomyotomy undertaken for the achalasia.

Gastro-oesophageal reflux does not protect against the subsequent development of achalasia. It is suggested that the autonomic damage eventually leading to achalasia may in its initial phases cause gastro-oesophageal reflux.
Familial Retrocaecal Appendicitis
Authors: Shperber Y , Halevy A , Oland J , Orda R
Published: January 2017

Four members of the same family operated on for acute retrocaecal appendicitis are reported. It is suggested that they provide further support for the hypothesis that an hereditary factor might be involved in the pathogenesis of acute appendicitis.
Vascular Compression of the Duodenum
Authors: Moskovich R , Cheong-Leen P
Published: January 2017

Compression of the third or fourth part of the duodenum by the superior mesenteric artery or one of its branches is the anatomic basis for some cases of duodenal obstruction. Two cases of vascular obstruction of the duodenum after surgical correction of scoliosis are presented. The embryologic and pathoanatomic bases for this condition, and the rationale for treatment, are described.
Incidence of Conjunctival Colonization by Bacteria Capable of Causing Postoperative Endophthalmitis
Authors: Walker C B , Claoué C M P
Published: January 2017

Increased awareness of the range of pathogens capable of causing postoperative endophthalmitis prompted a study of the conjunctival flora in 100 patients admitted for intraocular surgery. Bacteria capable of causing endophthalmitis were present in 74% of these patients, a much higher proportion than previously documented. No correlation was found with blockage of the nasolacrimal duct.
Adrenal Suppression following Low-Dose Topical Clobetasol Propionate
Authors: Ohman E M , Rogers S , Meenan F O , McKenna T J
Published: January 2017

The use of topical steroids is associated with adverse systemic effects such as suppression of the hypothalamic-pituitary-adrenal (HPA) axis, and application of more than 50 g per week of clobetasol propionate cream has been shown to cause secondary adrenal failure. We describe 4 patients who used clobetasol propionate cream over a prolonged period; 3 patients used less than 50 g per week (7.5, 25 and 30 g per week) and yet all developed secondary adrenal failure for up to 4 months after cessation of therapy. Adrenal insufficiency following prolonged use of clobetasol propionate in moderate dosages may therefore be more common than previously recognized. It is suggested that the metyrapone test, which conveniently examines the entire HPA axis, should be employed in patients receiving long-term topical clobetasol propionate cream and that glucocorticoid supplementation should be given during episodes of stress, such as infections and surgery, for up to 4 months after cessation of therapy.
Pericardial Effusion Complicating Breast Cancer
Authors: Woll Penella J , Knight R K , Rubens R D
Published: January 2017

Thirty-five patients with metastatic breast cancer and pericardial effusions are described. They were treated with specific endocrine or chemotherapy. Twenty-two (63%) had presented in cardiac tamponade and were rapidly relieved by pericardiocentesis. Eighteen (82%) of these required no further local treatment, 2 obtained relief from a second aspiration and 2 needed additional treatment (intrapericardial bleomycin instillation and surgical pleuropericardial window). The median survival was 13.2 months. No patient relapsed again in the pericardium, suggesting that their prognosis was that of the underlying disease.

Cardiac tamponade should be considered in any breathless patient with malignancy. In breast cancer, pericardiocentesis is lifesaving and systemic treatment can usefully prolong life.
Evaluation of a Tubeless Pancreatic Function Test in Patients with Steatorrhoea in a District General Hospital
Authors: Gould S R , Chinn G L , Nobbs B T , Lewis G A
Published: January 2017

The Pancreolauryl Test (PLT), a tubeless pancreatic function test, has been evaluated in an unselected series of outpatients with steatorrhoea presenting to a district general hospital (DGH). This is the first study of the PLT in a DGH, involving an unselected series of patients and not those from secondary or tertiary referral hospitals. Healthy controls ( n=15) and patients with self-limiting diarrhoea ( n=8) had normal urinary excretion indices (≥30). Coeliac disease ( n=13) and small bowel bacterial overgrowth ( n=12) were the commonest causes of steatorrhoea and there were no false-positive results in these patients. The mean urinary excretion index in patients with untreated coeliac disease (mean index=38%) was lower than in healthy controls ( n=15, mean index=53%; P < 0.05 > 0.02). No patient with proven pancreatic steatorrhoea had a normal PLT result, confirming the high negative predictive value found by others. Low results in patients with steatorrhoea following gastric surgery indicate poor mixing of food with pancreatic juices. The PLT proved to be a simple, inexpensive and noninvasive outpatient screening test suitable for use in a DGH to exclude a pancreatic origin of steatorrhoea.