Household carbon monoxide (CO) concentrations in a large African city: An unquantified public health burden?

Carbon monoxide (CO) is a poisonous gas produced by incomplete combustion of carbon-based fuels that is linked to mortality and morbidity. Household air pollution from burning fuels on poorly ventilated stoves can lead to high concentrations of CO in homes. There are few datasets available on household concentrations of CO in urban areas of sub-Saharan African countries. CO was measured every minute over 24 h in a sample of homes in Nairobi, Kenya. Data on household characteristics were gathered by questionnaire. Metrics of exposure were summarised and analysis of temporal changes in concentration was performed. Continuous 24-h data were available from 138 homes. The mean (SD), median (IQR) and maximum 24-h CO concentration was 4.9 (6.4), 2.8 (1.0-6.3) and 44 ppm, respectively. 50% of homes had detectable CO concentrations for 847 min (14h07m) or longer during the 24-h period, and 9% of homes would have activated a CO-alarm operating to European specifications. An association between a metric of total CO exposure and self-reported exposure to vapours >15 h per week was identified, however this were not statistically significant after adjustment for the multiple comparisons performed. Mean concentrations were broadly similar in homes from a more affluent area and an informal settlement. A model of typical exposure suggests that cooking is likely to be responsible for approximately 60% of the CO exposure of Nairobi schoolchildren. Household CO concentrations are substantial in Nairobi, Kenya, despite most homes using gas or liquid fuels. Concentrations tend to be highest during the evening, probably associated with periods of cooking. Household air pollution from cooking is the main source of CO exposure of Nairobi schoolchildren. The public health impacts of long-term CO exposure in cities in sub-Saharan Africa may be considerable and should be studied further.

Non-attendance at diabetes outpatient appointments: a systematic review

BACKGROUND

Non-attendance at diabetes outpatient appointments is a sizeable problem worldwide and has been associated with suboptimal health outcomes. We aimed to describe the characteristics, health outcomes and reasons given for non-attendance at doctor- or nurse-led diabetes appointments, and interventions to improve attendance.

METHODS

PubMed, EMBASE, CINAHL and PsychInfo were searched from database inception to February 2019. Included articles were peer-reviewed, published in English, related to adults or young people with type 1 or type 2 diabetes, and addressed one of the above aspects of non-attendance. Studies were excluded if reporting on other types of diabetes or reviewing attendance at structured education, retinal screening, paediatric, antenatal, podiatry or dietetic clinics.

RESULTS

Thirty-four studies of varied designs were identified (15 observational, 1 randomized control trial, 9 qualitative, 5 surveys, 4 service improvements). The definition of non-attendance varied. Younger adults, smokers and those with financial pressures were less likely to attend. Non-attendance was associated with higher HbA_1c ; other outcomes were varied but typically worse in non-attenders. Reasons for non-attendance in qualitative studies fell into three categories: balancing the costs and benefits of attendance, coping strategies, and the relationships between the person with diabetes and healthcare professionals. Interventions included appointment management strategies, service improvements, patient navigators and WebCam appointments.

CONCLUSIONS

Non-attendance is only partially explained by logistical issues. Qualitative studies suggest complex psychosocial factors are involved. Interventions have progressed from simple appointment reminders in an attempt to address some of the psycho-social determinants, but more work is needed to improve attendance.

Characterizing Pork Quality of Carcasses with an Average Weight of 119 Kg

ObjectivesBetween 1995 and 2018, average hot carcass weight of U.S. pork carcasses increased from 82 kg to 96 kg, which is an increase of approximately 17%. At current rates, pork carcasses in the U.S. will weigh on average, 105 kg by the year 2030 and over 118 kg by 2050. Although this represents an increase in throughput efficiency due to increases in economy of scale, projecting continued increases in the future raises some concerns. Therefore, the objective was to characterize pork quality of carcasses ranging from 78 to 145 kg with a mean weight of 119 kg.Materials and MethodsCarcass composition, such as hot carcass weight (HCW), back fat depth and loin depth were measured on 666 carcasses. Additionally, loin quality measurements, such as pH, loin instrumental and visual color, and iodine value of clear plate fat were measured on approximately 90% of the total population. Ham quality, 14 d aged loin and chop quality measurements, and loin chop slice shear force (SSF) were evaluated on approximately 30% of the total population. Finally, myosin heavy chain fiber type determination was completed on approximately 50 carcasses selected from carcasses ranging from 97 to 133 kg. The slope of regression lines and coefficients of determination between hot carcass weights and quality traits were calculated using the REG procedure in SAS and considered significantly different from 0 at P ≤ 0.05.ResultsAs HCW increased loin depth (b1 = 0.2496, P < 0.0001), back fat depth (b1 = 0.1374, P < 0.0001), loin weight (b1 = 0.0345, P < 0.0001), chop weight (b1 = 1.6626, P < 0.0001), and ham weight (b1 = 0.1044, P < 0.0001) increased. There was a decrease in estimated lean (b1 = –0.0751, P < 0.0001) and iodine value (b1 = –0.0923, P < 0.0001) as carcass weight increased, however, HCW only accounted for ≤ 24% (R2 = 0.24) of the variation in estimated lean and iodine value. Additionally, there were no significant differences in gluteus medius pH (b1 = 0.0009, P = 0.30) or instrumental lightness (b1 = 0.0301, P = 0.15), redness (b1 = –0.0036, P = 0.73) or yellowness (b1 = 0.0058, P = 0.57) of the ham as carcass weight increased. As carcass weight increased, 1 d loin instrumental yellowness (b*) increased (b1 = 0.0092 P < 0.01), however HCW only explained 1% of the variation in b*. Heavier carcasses were more tender (decreased SSF of chops cooked to 71°C, (b1 = –0.0674, P < 0.0001), although HCW only explained 9% of the variation in SSF. Total cook loss of chops used for SSF determination decreased as HCW increased (b1 = –0.0512, P < 0.0001), and HCW explained 15% (R2 = 0.15) of the variation in total cook loss. There were no significant differences in fiber type percentage, type 1 (b1 = –0.0170, P = 0.81), 2a (b1 = –0.0786, P = 0.23), 2x (b1 = –0.0201, P = 0.80), or 2b (b1 = 0.1224, P = 0.37), or fiber type area, type 1 (b1 = –26.6331, P = 0.22), 2a (b1 = –40.7257, P = 0.07), 2x (b1 = –46.9459, P = 0.25), or 2b (b1 = –26.2537, P = 0.38) as HCW increased.ConclusionDue to the lack of variation explained by HCW (≤ 15%), pork quality traits are not expected to be compromised as HCW continues to increase. The results suggest that increasing HCW to 119 kg did not have detrimental effects on pork quality attributes.

Demonstrating PM2.5 and road-side dust pollution by heavy metals along Thika superhighway in Kenya, sub-Saharan Africa

This study assessed the level of heavy metal in roadside dust and PM_2.5 mass concentrations along Thika superhighway in Kenya. Thika superhighway is one of the busiest roads in Kenya, linking Thika town with Nairobi. Triplicate road dust samples collected from 12 locations were analysed for lead (Pb), chromium (Cr), cadmium (Cd), nickel (Ni), zinc (Zn), and copper (Cu) using atomic absorption spectrophotometry (AAS). PM_2.5 samples were collected on pre-weighed Teflon filters using a BGI personal sampler and the filters were then reweighed. The ranges of metal concentrations were 39-101 μg/g for Cu, 95-262 μg/g for Zn, 9-28 μg/g for Cd, 14-24 μg/g for Ni, 13-30 μg/g for Cr, and 20-80 μg/g for Pb. The concentrations of heavy metals were generally highly correlated, indicating a common anthropogenic source of the pollutants. The results showed that the majority of the measured heavy metals were above the background concentration, and in particular, Cd, Pb, and Zn levels indicated moderate to high contamination. Though not directly comparable due to different sampling timeframes (8 h in this study and 24 h for guideline values), PM_2.5 for all sites exceeds the daily WHO PM_2.5 guidelines of 25 μg/m³. This poses a health risk to people using and working close to Thika superhighway, for example, local residents, traffic police, street vendors, and people operating small businesses. PM_2.5 levels were higher for sites closer to Nairobi which could be attributed to increased vehicular traffic towards Nairobi from Thika. This study provides some evidence of the air pollution problem arising from vehicular traffic in developing parts of the world and gives an indication of the potential health impacts. It also highlights the need for source apportionment studies to determine contributions of anthropogenic emissions to air pollution, as well as long-term sampling studies that can be used to fully understand spatiotemporal patterns in air pollution within developing regions.

Associations of osteoprotegerin with coronary artery calcification among women with systemic lupus erythematosus and healthy controls

Objective We tested the hypothesis that higher circulating levels of osteoprotegerin (OPG) are related to higher levels of coronary artery calcification (CAC) among women with systemic lupus erythematosus (SLE) compared with healthy controls (HCs). Methods Among 611 women in two age- and race-matched SLE case-control studies, OPG was assayed in stored blood samples (HEARTS: plasma, n cases/controls = 122/124, and SOLVABLE: serum, n cases/controls = 185/180) and CAC was measured by electron beam computed tomography. Results In both studies, SLE patients had higher OPG and CAC levels than HCs. Higher OPG was associated with high CAC (>100 vs.100) among SLE, and with any CAC (>0 vs. 0) among HCs. Multivariable-adjusted OR (95% CI) for OPG tertile 3 vs. 1 was 3.58 (1.19, 10.76), p trend = 0.01 for SLE, and 2.28 (1.06, 4.89), p trend = 0.04 for HCs. Associations were attenuated when age-adjusted, but remained significant for HC women aged ≥ 40 and SLE women aged ≥ 50. ROC analyses identified 4.60 pmol/l as the optimal OPG cutpoint for predicting high CAC (>100) among SLE patients with sensitivity = 0.74 and specificity = 0.61, overall, but 0.92 and 0.52, respectively, for SLE patients aged ≥ 50. Conclusion Our cross-sectional results suggest that higher OPG levels are related to higher CAC levels among women with SLE vs. healthy controls.

Screening for asymptomatic lymphogranuloma venereum co-infection in men who have sex with men newly diagnosed with HIV, hepatitis C or syphilis

Patients diagnosed with lymphogranuloma venereum have high rates of co-infection with HIV, syphilis and hepatitis C. The aim of this enhanced surveillance was to screen all men who have sex with men (MSM) newly diagnosed with HIV, syphilis or hepatitis C for co-infection with asymptomatic lymphogranuloma venereum as part of the recommended sexual health screen. Of the 145 patients screened, 21 patients were diagnosed with rectal Chlamydia trachomatis, one with both rectal and urethral chlamydia and six with urethral chlamydia. One rectal chlamydia-positive sample, when tested, was equivocal for lymphogranuloma venereum. Our data suggested that there was not a pool of asymptomatic lymphogranuloma venereum infection in MSM recently diagnosed with HIV, hepatitis C and syphilis. However, there have been recent reports of an increased incidence of asymptomatic lymphogranuloma venereum, raising the question whether lymphogranuloma venereum should be screened for in high risk asymptomatic MSM. The prevalence of asymptomatic rectal chlamydia infections was 19%.

Macrophage solubilization and cytotoxicity of indium-containing particles as in vitro correlates to pulmonary toxicity in vivo

Macrophage-solubilized indium-containing particles (ICPs) were previously shown in vitro to be cytotoxic. In this study, we compared macrophage solubilization and cytotoxicity of indium phosphide (InP) and indium-tin oxide (ITO) with similar particle diameters (∼ 1.5 µm) and then determined if relative differences in these in vitro parameters correlated with pulmonary toxicity in vivo. RAW 264.7 macrophages were treated with InP or ITO particles and cytotoxicity was assayed at 24 h. Ionic indium was measured in 24 h culture supernatants. Macrophage cytotoxicity and particle solubilization in vitro were much greater for InP compared with ITO. To correlate changes in vivo, B6C3F1 mice were treated with InP or ITO by oropharyngeal aspiration. On Days 14 and 28, bronchoalveolar lavage (BAL) and pleural lavage (PL) fluids were collected and assayed for total leukocytes. Cell differentials, lactate dehydrogenase activity, and protein levels were also measured in BAL. All lavage parameters were greatly increased in mice treated with InP compared with ITO. These data suggest that macrophage solubilization and cytotoxicity of some ICPs in vitro are capable of predicting pulmonary toxicity in vivo. In addition, these differences in toxicity were observed despite the two particulate compounds containing similar amounts of indium suggesting that solubilization, not total indium content, better reflects the toxic potential of some ICPs. Soluble InCl3 was shown to be more cytotoxic than InP to macrophages and lung epithelial cells in vitro further suggesting that ionic indium is the primary cytotoxic component of InP.

Prevalence and causes of vision loss in Southeast Asia and Oceania: 1990-2010

BACKGROUND

To assess prevalence and causes of vision impairment in Southeast Asia and Oceania in 1990 and 2010.

METHODS

Based on a systematic review of medical literature, prevalence of moderate and severe vision impairment (MSVI; presenting visual acuity <6/18 but ≥3/60 in the better eye) and blindness (presenting visual acuity <3/60) was estimated for 1990 and 2010.

RESULTS

In Oceania, the age-standardised prevalence of blindness and MSVI did not decrease significantly (1.3% to 0.8% and 6.6% to 5.1%) respectively, but in Southeast Asia, blindness decreased significantly from 1.4% to 0.8%, a 43% decrease. There were significantly more women blind (2.18 million) compared with men (1.28 million) in the Southeast Asian population in 2010, but no significant gender differences in MSVI in either subregion. Cataract was the most frequent cause of blindness in Southeast Asia and Oceania in 1990 and 2010. Uncorrected refractive error, followed by cataract, macular degeneration, glaucoma and diabetic retinopathy were the most common causes for MSVI in 1990 and 2010. With the increasing size of the older population, there have been relatively small increases in the number of blind (2%), and with MSVI (14%) in Southeast Asia, whereas increases have been greater in Oceania of 14% for blindness and of 31% for MSVI.

CONCLUSIONS

The prevalence of blindness has reduced significantly from 1990 to 2010, with moderate but non-significant lowering of MSVI. Cataract and uncorrected refractive error are the main causes of vision impairment and blindness; cataract continues as the main cause of blindness, but at lower proportions.

Hepatitis C in men who have sex with men in London--a community survey

Objectives

For the last 10 years there has been an epidemic of hepatitis C virus (HCV) infection in men who have sex with men (MSM) in Europe, North America and Australia. The majority of those infected are also HIV-positive and it is unclear to what extent HIV-negative MSM are also at increased risk of infection with HCV. This study provides the first examination of the association between HIV and hepatitis C serostatus in a sample of MSM recruited in community settings.

Methods

A total of 1121 participants completed a short questionnaire in 2008/2009 giving demographic and behavioural data, and donated a sample of oral fluid that was subsequently tested for antibodies to selected pathogens (HIV, syphilis and HCV).

Results

The seroprevalence of hepatitis C antibody was 2.1% [95% confidence interval (CI) 1.4–3.2%]. It was more common in those with HIV infection [7.7% (95% CI 4.2–12.9%) vs. 1.2% (95% CI 0.6–2.1%) in those without HIV infection; P < 0.001], those with a history of syphilis [12.2% (95% CI 4.6–24.8%) vs. 1.7% (95% CI 1.0–2.6%) in those without such a history; P < 0.001] and those who reported casual unprotected anal intercourse in the previous year [4.1% (95% CI 2.0–7.4%) vs. 1.2% (95% CI 0.5–2.2%) in those who did not report such intercourse; P = 0.01]. There was no relationship between hepatitis C antibody (anti-HCV) status and other demographic variables (age, ethnicity, employment status or education).

Conclusions

The seroprevalence of anti-HCV in HIV-negative MSM (1.2%) was higher, but not significantly higher, than that in the general population (0.67%). The prevalence was significantly higher in those infected with HIV or with previous syphilis infection and in those reporting unprotected anal intercourse. Our findings support current British Association for Sexual Health and HIV guidelines recommending the provision of selective HCV testing in MSM according to individual risk profile.

HIV opt-out increases HIV testing in low-risk patients

We audited the effect of introducing HIV opt-out in a genitourinary medicine clinic in central London, UK. We found that opt-out increased the rate at which HIV testing was offered to low-risk patients and that more tests were done.

An analysis of an inflammatory bowel disease practice in an urban community hospital

OBJECTIVES

To review an individual community gastroenterologist's experience with inflammatory bowel disease (IBD). The aspects studied were distribution of disease, need for hospital admission, immunosuppressants, systemic steroids, and surgery and its indications. The incidence of cancer was also reviewed.

PATIENTS AND METHODS

The charts of all IBD patients (n=373) seen between 1993 and 1996 by an individual gastroenterologist in an urban community hospital were reviewed for the aforementioned information. Patients seen during this period may have been diagnosed with IBD before or during the period of 1993 to 1996.

RESULTS

Of the 373 patients, 219 had Crohn's disease (CD) and 154 had ulcerative colitis (UC). The most common age of onset for both groups was 20 to 29 years. Distal UC and distal Crohn's colitis patients rarely required surgery, hospitalization, systemic steroids or immunosuppressants. Eighty per cent of patients with small bowel CD and 51% of those with ileocolonic CD required at least one operation. Of the UC patients, 10.4% required surgery. Of the UC patients undergoing surveillance for cancer, none developed cancer but one developed significant dysplasia.

CONCLUSIONS

In both CD and UC the site of the inflammation plays a major role in determining the need for hospitalization, surgery, systemic steroids and immunosuppressants. Distal UC, the most common form of UC in this group of patients, is a very benign disease. Of all forms of IBD, small bowel CD had the greatest need for hospitalization, surgery and systemic steroids.

Research capacity in UK primary care

BACKGROUND

Moves towards a 'primary care-led' National Health Service (NHS) and towards evidence-based care have focused attention upon the need for evaluative research relating to the structure, delivery, and outcome of primary health care in the United Kingdom (UK). This paper describes work carried out to inform the Department of Health Committee on Research and Development (R&D) in Primary Care (Mant Committee).

AIM

To describe the extent and nature of current research capacity in primary care in the UK and to identify future needs and priorities.

METHOD

Funding data were requested from NHS National Programmes, NHS Executive Regional Offices, the Department of Health (DoH), Scottish Office, Medical Research Council, and some charities. A postal survey was sent to relevant academic departments, and appropriate academic journals were reviewed from 1992 to 1996. In addition, interviews were conducted with academic and professional leaders in primary care.

RESULTS

Overall, total annual primary care R&D spend by the NHS and the DoH was found to be 7% of the total spend, although annual primary care R&D spend differs according to funding source. Journals relating to primary care do not, with some notable exceptions (e.g. British Journal of General Practice, Family Practice), have high academic status, and research into primary care by academic departments is, with perhaps the exception of general practice, on a small scale. The research base of most primary care professions is minimal, and significant barriers were identified that will need addressing if research capacity is to be expanded.

CONCLUSION

There are strong arguments for the development of primary care research in a 'primary care-led' NHS in the UK. However, dashes for growth or attempts to expand capacity from the present infrastructure must be avoided in favour of endeavours to foster a sustainable, long-term research infrastructure capable of responding meaningfully to identified needs.

Neuromolecular computing: a new approach to human brain evolution

Evolutionary approaches in human cognitive neurobiology traditionally emphasize macroscopic structures. It may soon be possible to supplement these studies with models of human information-processing of the molecular level. Thin-film, simulation, fluorescence microscopy, and high-resolution X-ray crystallographic studies provide evidence for transiently organized neural membrane molecular systems with possible computational properties. This review article examines evidence for hydrophobic-mismatch molecular interactions within phospholipid microdomains of a neural membrane bilayer. It is proposed that these interactions are a massively parallel algorithm which can rapidly compute near-optimal solutions to complex cognitive and physiological problems. Coupling of microdomain activity to permenant ion movements at ligand-gated and voltage-gated channels permits the conversion of molecular computations into neuron frequency codes. Evidence for microdomain transport of proteins to specific locations within the bilayer suggests that neuromolecular computation may be under some genetic control and thus modifiable by natural selection. A possible experimental approach for examining evolutionary changes in neuromolecular computation is briefly discussed.

Bcl10 is involved in t(1;14)(p22;q32) of MALT B cell lymphoma and mutated in multiple tumor types

MALT B cell lymphomas with t(1;14)(p22;q32) showed a recurrent breakpoint upstream of the promoter of a novel gene, Bcl10. Bcl10 is a cellular homolog of the equine herpesvirus-2 E10 gene: both contain an amino-terminal caspase recruitment domain (CARD) homologous to that found in several apoptotic molecules. Bcl10 and E10 activated NF-kappaB but caused apoptosis of 293 cells. Bcl10 expressed in a MALT lymphoma exhibited a frameshift mutation resulting in truncation distal to the CARD. Truncated Bcl10 activated NF-kappaB but did not induce apoptosis. Wild-type Bcl10 suppressed transformation, whereas mutant forms had lost this activity and displayed gain-of-function transforming activity. Similar mutations were detected in other tumor types, indicating that Bcl10 may be commonly involved in the pathogenesis of human malignancy.

Safety profile of WinRho anti-D

WinRho anti-D is manufactured with multiple processes to minimize the risk of transmitting blood-borne diseases such as viruses. These safety features include donor selection, plasma testing, solvent-detergent viral inactivation, and nanofiltration. To date, there has not been any case of viral transmission in association with use of WinRho anti-D. Adverse drug reactions are infrequent and generally mild; the most common are headache, fever, and chills. Some degree of hemolysis is inevitable due to the mechanism of action of WinRho anti-D, but this is predictable and transient. A few cases of intravascular hemolysis have been reported; hypersensitivity reactions are very rare. WinRho anti-D has been shown in both clinical trials and postmarketing surveillance to be safe and effective in the treatment of idiopathic thrombocytopenic purpura (ITP) and in the prevention of Rh isoimmunization.

Collection of peripheral blood progenitor cells after the administration of cyclophosphamide, etoposide, and granulocyte-colony-stimulating factor: an analysis of 497 patients

BACKGROUND

There is great interpatient variability in the number of peripheral blood stem cells collected, as measured by CD34+ cell content, after the administration of chemotherapy and a growth factor. The ability to predict patients who fail to yield adequate quantities of CD34+ cells would be of value. However, very few reports include large numbers of patients treated in an identical fashion.

STUDY DESIGN AND METHODS

Between 1991 and 1995, 497 consecutive patients with a variety of malignant diseases received cyclophosphamide (4 g/m2), etoposide (600 mg/m2), and granulocyte-colony-stimulating factor (6 micrograms/kg/day) for mobilization and collection of a target dose > or = 2.5 x 10(8) CD34+ cells per kg. Multivariate analyses were performed to determine the factors associated with failure to achieve this target harvest.

RESULTS

A median of 14.71 x 10(6) CD34+ cells per kg (range, 0.08-137.55) was harvested with a median of 2 (range, 1-11) apheresis procedures. Ninety-one percent of patients yielded > or = 2.5 x 10(5) CD34+ cells per kg. Patients with Stage II-III breast cancer, who had pretreatment platelet counts > or = 150 x 10(9) per L and patients who underwent < or = 1 prior chemotherapy regimen had improved CD34+ cell yields. However, most patients with adverse risk factors yielded > or = 2.5 x 10(6) CD34+ cells per kg.

CONCLUSION

A regimen of cyclophosphamide, etoposide, and granulocyte-colony-stimulating factor led to the successful collection of adequate numbers of CD34+ cells in most patients without excessive toxicity. These observations confirm previous reports that intense prior therapy adversely affects the quantity of CD34+ cells harvested. Pretreatment and posttreatment variables did not predict with any certainty the small fraction of patients who fail to yield > or = 2.5 x 10(6) CD34+ cells per kg via multiple apheresis procedures.

Experimental autoimmune cystitis in the Lewis rat: a potential animal model for interstitial cystitis

To develop an autoimmune animal model for interstitial cystitis (IC), we injected rats with Freund's adjuvant (CFA) containing bladder homogenate (experimentals) or CFA alone (shams). We observed a doubling of urinary frequency in the experimental animals over the shams (P = 0.004) and histopathologic changes (venular congestion) consistent with IC. Statistically significant bladder capacity changes were not found. Mast cell (MC) number was not statistically different between experimentals and controls but the number of MCs from section to adjacent section within the same animal's bladder did vary markedly, indicating the MC counts are not a reliable measure of disease in the rat bladder. Splenocytes cultured from the experimental animals and transferred to naive syngeneic recipients were capable of transferring the urinary frequency changes and vascular congestion while splenocytes from animals which did not develop the condition were without effect. In summary, we have developed and autoimmune model for IC consistent with the clinical features of IC. The features of this model can be transferred to naive syngeneic recipients via adoptive splenocyte transfer. The model will permit us to ask and answer important questions about the pathogenesis and treatment of the human disease.

Chylopericardium after orthotopic heart transplantation

Chylopericardium is an infrequent cause of pericardial effusions after heart surgery and to our knowledge has not been reported after orthotopic transplantation. We report the occurrence of chylopericardium in a heart transplant recipient who was successfully treated with a pericardial window, pericardiocentesis, and a diet rich in medium-chain triglycerides.

Evolving patterns of tissue composition in benign prostatic hyperplasia as a function of specimen size

The tissue composition in 36 transurethral resections and four prostate enucleations for benign prostatic hyperplasia (BPH) was quantitated by computerized morphometric techniques using 15 morphologic categories. Data were compared between seven consecutive weight ranges. Nodules of glandular and/or stromal tissue comprised only 5% of tissue in the smallest resections, while bladder neck and anterior fibromuscular tissue represented more than half the specimen. Non-nodular prostatic tissue from the transition zone was the dominant resected component in all but the largest specimens (enucleations) where nodules comprised most of the tissue. Though nodules comprised only 22% of the largest transurethral resections, their contribution to hyperplasia increased more rapidly than any other component. Glandular nodules with a high ratio of epithelium to stroma dominated at all weight ranges. It was concluded that tissue resected for BPH is quite heterogeneous, that nodules comprise most of the tissue only in specimens over 50 g in weight, and that the most common hyperplastic component is histologically normal tissue. Benign prostatic hyperplasia undergoes morphologic evolution with increasing weight, and epithelial-rich nodules are the most rapidly evolving component.

Manual Determination of Minced Fish Flesh in Mixed Fillet-Minced Cod Blocks: Collaborative Study

A simple, rapid method for determining the amount of minced fish in mixed fillet-minced cod blocks was tested by 9 collaborators. Each collaborator first examined 2 practice blocks containing 20% mince, and then examined 6 blind duplicate samples of 5 lb cod blocks from each of 3 test lots containing, respectively, 26.25, 18.75, and 12.5% mince. The data from one of the 9 collaborators was not usable because of a malfunctioning scale. Standard deviations (SD) for the 3 lots (all 8 collaborators combined) were 1.77, 1.51, and 1.65, and coefficients of variation (CV) were 6.8, 8.9, and 16.2%, respectively. For comparison, the results of an informal collaborative study by 10 participants on 16.5 lb mixed cod blocks containing 20.1% mince were SD 2.72 and CV 0.136%. Collaborators reported no problems with the method, and statistical analysis shows the method to be sufficiently precise for this type of determination. The method has been adopted official first action for cod.

Detection of hepatic encephalopathy

The most sensitive index of hepatic encephalopathy in 29 patients following a porta-caval shunt appeared to be the assessment of a close relative who had known the patient pre-operatively. They noticed that 19 of the 20 patients were mentally slower; 11 were markedly aggressive and 8 had become placid and uncaring about family problems. Only 9 of these patients had clinical encephalopathy as judged by two independent observers, 14 had a prolonged trail test and 8 produced an abnormal five-pointed star. Eight patients were forced to retire prematurely after the operation due to ill health and 20 felt that their marriage had deteriorated. Eighteen of the 29 patients had a lie score on the Eysenck personality questionnaire (an index of 'social naïvety') which was more than one standard deviation above the mean value for a large control group (P less than 0.01). This did not correlate with other measurements of encephalopathy, but 8 out of the 11 patients who exhibited aggressive behaviour had an abnormal score.

Magnetic resonance imaging and placenta previa

Twenty-five women with diagnoses of placenta previa on ultrasound examination underwent magnetic resonance imaging examination. An assessment of placental position and the relationship of the lower placental edge to the internal os was made with both techniques and the results were compared. There was complete correlation of placental localization but significant differences were found in the determination of the degree of placenta previa. This occurred more often with posteriorly situated placentas. Magnetic resonance imaging directly affected management with regard to delivery in seven cases. Magnetic resonance imaging provides a technique capable of accurately assessing placental position and its relationship to the cervix, thereby leading to a reduction in hospitalization and inappropriate operations.

Bilateral enterobius vermicularis salpingo-oophoritis

Inflammatory pelvic disease secondary to infection with Enterobius vermicularis is rare in that pinworms are usually asymptomatic inhabitants of the terminal small bowel and cecum. When these parasites do cause symptoms, however, there is a spectrum of gastrointestinal and genitourinary complaints. A case is presented of a woman with bilateral abdominal pain that was found to be due to a combination of parasitic and bacterial (Bacteroides fragilis) infection. The parasitic fallopian tube infection may have predisposed the fallopian tubes to a microbial tuboovarian abscess.

Psychosocial aspects of cardiac pacing

The psychosocial effects of pacemaker implantation were analysed in 96 randomly selected patients receiving their first pacemaker at the Johannesburg General Hospital from August 1976 to December 1977. Premorbid personality together with emotional acceptance of the pacemaker was assessed by a social worker at interviews before implantation and 3 months and 1 year after implantation. Depression was measured by the Hamilton rating scale, and a psychosocial history was taken from each patient. The nature and severity of symptoms and associated diseases were assessed medically. Pacemaker implantation restores most patients to occupational, social, emotional and physical usefulness. The degree of relief of symptoms played an important part in rehabilitation. Inadequate adjustment and rehabilitation may occur in the presence of additional disease, unrealistic patient expectations, an inadequate, depressive personality type, poor doctor-patient communication, or in patients who have experienced symptoms for less than 1 month before the implantation. Adequate pre-operative preparation by a team of social workers and doctors together with public education and the provision of postoperative psychosocial support for the inadequate, depressive personality type and for patients suffering from additional disease is likely to enhance rehabilitation greatly.

The urographic signs of acute on chronic obstruction of the kidney

The signs of acute obstruction of the kidney and of chronic obstruction are well recognised and the combination of these signs enables a group of patients with acute-on-chronic obstruction to be recognised. The signs of acute obstruction are entirely nephrographic. They are manifested by an increasingly dense nephrogram, which may become striated, followed by an anatomically normal pyelogram. The signs of chronic obstruction are both pyelographic and nephrographic. The pyelographic signs are a dilated pelvicalyceal system. The nephrographic signs are a normal or low density nephrogram. Crescents may appear; these are due to opacification of the distorted medulla which retains its ability to concentrate the urine. In acute-on-chronic obstruction the signs of both conditions are present. Thus there is an increasingly dense nephrogram with a negative pyelogram. Crescents may appear. There is a slow flow in the dilated pelvicalyceal system.

Computed tomographic findings in orbital echinococciasis

Computed tomography findings in a proven orbital hydatid cyst are presented.

An analysis of 113 intracranial infections

The location, source of infection, and CT characteristics of 90 intracerebral abscesses and 23 subdural empyemas are reported with special regard to capsule enhancement and surrounding cerebral edema.

The evaluation of head trauma by computed tomography

A retrospective study of 133 patients with documented head trauma is presented. Computed tomography (C.T.) has replaced cerebral angiography in the evaluation of these patients at our institutions. C.T. provides a rapid noninvasive diagnosis, plus accurate localization of lesions; it also allows for the assessment of multiple lesions. The authors feel that C.T. should be the first neurological mode of investigation after plain skull radiographs. It is important to obtain good quality scans, and intravenous sedation or general anaesthesia may be required.