Monitoring trends in prenatal diagnosis of Down''s syndrome in England and Wales, 1989-92

A prospective and multicenter study was performed to determine the efficacy and tolerance of ursodeoxycholic acid (UDCA) in the treatment of gallstones and biliary sludge. Criteria for entry into the trial were radiolucent gallbladder stones; until 20 mm of size and visualization of the gallbladder by oral cholecystography. Too were treatment the patients with persistent biliary sludge (PBS) defined by the persistence of the biliary sludge in two consecutive echography along three months. Without severe gallbladder disease. Then daily UDCA doses of 600 mg were suminstred divided in two postprandial times for a six months period. The control to the treatment were: basal ultrasonography (US) of the gallbladder and by follow-up gallbladder US for six months; clinical examination every month and cholecystography before and after the treatment. Of 110 admitted patients, 19 (17%) stopped the treatment for no-medical reasons and 91 (83%) arrived to the and point. After six months of treatment, complete dissolution was observed in 50% of the patients (46/91), partial in the 43% (39/91) and failed the treatment in 6.5% (6/91) who presented high density stones for computed tomography, CT (greater than 60 UH). According to pattern of lithiasis dissolution was complete in 100% (22/22) of the patients with PBS; 71.4% (10/14) in microlithiasis and 25% (14/55) in macrolithiasis. Minor adverse effects were acidism in the 7.7% (7/91) and diarrhea in the 1.1% (1/91). In the other hand, one patient presented acute pancreatitis (1/91; 1.1%), it must be discussed if was a complication of the lithiasis or an therapeutic effect. The UDCA was a safe and effective treatment without lethality in PBS and in microlithiasis while in case of macrolithiasis must be standardized response criterion, for example density stones for CT.     

Trends in glove use by dentists in England and Wales: 1989-1992

The routine wearing of gloves during the dental treatment of patients forms an integral part of the recommended guidelines of many authorities worldwide. Compliance has been variable but there is evidence to show that this is increasing, as are other cross-infection control measures. A survey of glove use by general dental practitioners in England and Wales was carried out in 1989. This paper reports a follow up study in 1991/2 which aimed to identify any differences that had occurred in the interim. The results indicated that there was increasing compliance with recommended cross-infection control measures, although only one fifth of respondents were found to change gloves between patients. Of those practitioners who did not change gloves between patients, half considered that blood contact was not a reason for changing gloves. Comparisons are made with compliance rates in other countries and recommendations made for further education within the dental profession on the subject of cross-infection control.     

Trends in suicide in England and Wales, 1982-96

This article, the first of two, updates previous analyses of suicides published in Population Trends. Suicide trends in England and Wales are analysed by age and sex. Analyses by method and occupation suggest a link between suicide rates and easy access to effective means of committing suicide. The steadily growing number of cars with catalytic converters may go some way to explain the decreasing suicide rates from 'other gas poisoning' for both men and women since the early 1990s. Indeed, it may also explain to some extent the decline in overall suicide rates for men since this time.     

Effect of allowing for ethnic group in prenatal screening for Down's syndrome

We conducted a study to investigate ethnic group differences in levels of serum markers used in screening for Down's syndrome [serum alpha-fetoprotein (AFP), unconjugated oestriol (uE3), total human chorionic gonadotrophin (hCG), free alpha- and free beta-hCG, and dimeric inhibin-A], to estimate the extent to which maternal weight differences between ethnic groups explain these differences, and to estimate the effect of adjusting for ethnic group and maternal weight on screening performance. Serum measurements were taken from women who were screened prenatally for Down's syndrome. AFP, uE3, and hCG concentrations were available from 9462 white, 4215 black, and 4392 South Asian women with singleton pregnancies without Down's syndrome or neural tube defects between 15 and 22 weeks' gestational age. Frozen serum samples were available from a subset of 922 white, 449 black, and 135 South Asian women and were used for measurement of free alpha-hCG, free beta-hCG, and inhibin. Values were expressed as multiples of the median (MOM) for women of the same gestational age. There were statistically significant differences in the serum marker levels between ethnic groups that were not explained by differences in maternal weight. The main differences were found in black women compared with white women; black women had serum AFP levels 22 per cent higher (95 per cent confidence interval 20-24 per cent), total hCG levels 19 per cent higher (16-22 per cent), and free beta-hCG levels 12 per cent (3-21 per cent) higher. The other differences were less than 10 per cent. Adjusting for ethnic group only had a small estimated effect on screening performance: a maximum of about 0.5 per cent extra detection at a 5 per cent false-positive rate. At a fixed risk cut-off level, the false-positive rate will not be materially different between different ethnic groups. Adjusting serum markers for ethnic groups improves Down's syndrome screening performance to a very small extent. It is worthwhile because of its established value in AFP screening for open neural tube defects.     

Taking account of vaginal bleeding in screening for Down's syndrome

OBJECTIVE: To derive a method for revising the risk of Down's syndrome in maternal serum marker screening when there is vaginal bleeding. The effect on screening performance of routinely allowing for the presence or absence of bleeding in all women is also assessed. DESIGN: Overview of published studies on the rate of reported vaginal bleeding in pregnancies with Down's syndrome, on the rate according to maternal age and on the association of bleeding with alpha-fetoprotein (AFP) level. The publications are supplemented with data on unconjugated oestriol (uE3), human chorionic gonadotrophin (hCG) and AFP levels in a consecutive series of screened women. SETTING: Routine Down's syndrome screening tests carried out on women having antenatal care at the St James's University Hospital, Leeds. SUBJECTS: Eight hundred and nine screened women. RESULTS: In five studies the rate of vaginal bleeding in Down's syndrome pregnancies was 1.7 times that in unaffected pregnancies on average. In three studies, the vaginal bleeding rate increased proportionally by 2.2% on average for each year of maternal age. Three studies and our own data were consistent with a 10% increase in the mean AFP level associated with vaginal bleeding, but it did not appear to materially alter uE3 and hCG levels or the standard deviations and correlation coefficients for any of the three analytes. An individual woman's risk was calculated by multiplying her age-specific odds of Down's syndrome by two likelihood ratios, one relating to the vaginal bleeding itself and one from the marker levels. Routine allowance for the presence or absence of vaginal bleeding was estimated to increase the detection rate by less than 1%. CONCLUSION: Our method is of clinical value in revising the risk when there is concern that vaginal bleeding might be responsible for a negative maternal serum Down's syndrome screening result. A policy of routinely incorporating information on vaginal bleeding in risk estimation for all women would have too small an effect on overall screening performance to recommend it.     

Nosocomial Legionnaires' disease in England and Wales, 1980-92

Two hundred and eighteen nosocomial cases of Legionnaires' disease with 68 deaths were reported to the National Surveillance Scheme for Legionnaires Disease between 1980 and 1992, representing 15% of the reported infections acquired in England and Wales. Twenty-two nosocomial outbreaks accounted for 135 (62%) of these cases, the remainder occurring as single cases either in hospitals where other single cases or outbreaks had been reported in different years or as 'sporadic' cases in hospitals from which no other cases were reported. A clinical history prior to onset of Legionnaires' disease was available for 124 patients, 61 of whom had undergone recent transplant therapy or were immunosuppressed for other reasons. Sixty cases (27%) were diagnosed by culture of the organism and isolates from 56 patients were typed; 25 (42%) were non L. pneumophila serogroup 1 infections. Methods for prevention and control of nosocomial outbreaks are discussed, in particular the susceptibility to Legionnaires' disease of certain groups of hospital patients.     

Rapid prenatal diagnosis of Down's syndrome in the first trimester of pregnancy by fluorescence in situ hybridization

OBJECTIVE: To assess whether fluorescence in situ hybridization (FISH) with chromosome 21, specific DNA probe is applicable as a prenatal diagnostic tool for Down's syndrome. METHOD: We used FISH with chromosome 21 specific probe on 30 uncultured chorionic villi cell samples to detect the Down's fetus, and we also performed the conventional chromosome analysis of chorion cells from parallel samples. RESULTS: In samples with disomic karyotype, an average of 1 percent (0-5 percent) of the nuclei had three hybridization signals. By contrast, in the samples of trisomy 21 fetus, an average of 86 percent (78-91 percent) of the nuclei displayed three signals. CONCLUSION: FISH can provide a rapid and accurate method for the first trimester prenatal diagnosis of Down's syndrome.     

Fryns syndrome: prenatal diagnosis and pathologic correlation

From 1988 to 1995, 96 patients (161 feet) underwent a modified Mitchell distal metatarsal osteotomy performed for mild-to-moderate hallux valgus. On AP x-rays of the standing foot, the average intermetatarsal angle was corrected from 15 degrees to 9 degrees, and the first metatarsophalangeal angles were corrected from an average of 41 degrees to 15 degrees. Criteria for evaluation of clinical results included relief of pain, appearance of foot, and shoe wear. After an average follow-up of 38 months, the overall satisfaction rate was 92.5%. Complications included 13 pin tract infections, two delayed unions, and two correction losses. The most common late sequela was transfer metatarsalgia of the lesser toes, which occurred in 20 feet (12.4%), leading to some dissatisfaction. The Mitchell osteotomy can be used on cases with less than 20 degrees of intermetatarsal angle, offering a stable construct with easy postoperative care.     

Age incidence of meningococcal infection England and Wales, 1984-1991

Gene transfer with vectors derived from murine retroviruses is restricted to cells which are proliferating and synthesizing DNA at the time of infection. This suggests that retroviral-mediated gene transfer might permit targeting of gene integration into malignant cells in organs composed mainly of quiescent nonproliferating cells, such as in the brain. Accordingly, selective introduction of genes encoding for susceptibility to otherwise nontoxic drugs ("suicide" genes) into proliferating brain tumors may be used to treat this cancer. We investigated the efficacy and dynamics of in vivo transduction of growing brain tumors with the herpes simplex-thymidine kinase gene followed by administration of the antiviral drug ganciclovir. Ganciclovir is phosphorylated by thymidine kinase to toxic triphosphates that interfere with DNA synthesis, resulting in the preferential death of the transduced tumor cells. Rats inoculated with 4 x 10(4) 9L gliosarcoma cells into the frontal lobe were treated 7 days later with an intratumoral stereotaxic injection of murine fibroblasts (NIH 3T3 cells) that were producing a retroviral vector containing the herpes simplex-thymidine kinase gene. Controls received vector producer and nonproducer NIH 3T3 cell lines containing the Escherichia coli lacZ (beta-galactosidase) gene as well as nonproducer NIH 3T3 cells containing the thymidine kinase gene. The animals were rested for 7 days to allow time for in situ transduction of the proliferating tumor cells with the herpes-thymidine kinase retroviral vector. The animals were then treated with ganciclovir, 15 mg/kg i.p. twice a day for 14 days. Gliomas receiving an injection of 3-5 x 10(6) thymidine kinase producer cells regressed completely in 23 of 30 rats given ganciclovir therapy, while 25 of 26 control rats developed large tumors. Intratumoral injection of a lower concentration of thymidine kinase vector producer cells (1.8 x 10(6)) resulted in a lower frequency of tumor regression (5 of 13 rats). To estimate the efficiency of in vivo gene transfer, 9L brain tumors were given injections of 5 x 10(6) beta-galactosidase vector producer cells. 5-Bromo-4-chloro-3-indolyl-beta-D-galactopyranaside staining revealed maximal staining of beta-galactosidase within the tumor 7-14 days after injection of the vector producer cells. In vivo transduction rates in harvested tumors ranged from 10 to 70%. There was no evidence of transduction of the surrounding normal neural tissue. Occasional blood vessel endothelial cells within or adjacent to the tumor were observed to be 5-bromo-4- chloro-3-indolyl-beta-D-galactopyranaside positive.(ABSTRACT TRUNCATED AT 400 WORDS)     

Trends in stimulation and induction of labor 1989-1995

Between 1989 and 1995 the rates for stimulation and induction of labor rose every year, representing a 48 and 77 percent, respectively, total rise over the time period. In 1995 the rate of stimulation was 161 per 1,000 live births and of induction 160. Two percent, or 74,167, of the 3,899,589 births in 1995 had both procedures performed. While rates of stimulation decline with advancing maternal age, the induction rates tend to be higher for older women. Rates for both procedures increased between 1989 and 1995 for both black and white women in all age categories. Women whose pregnancies have extended beyond the expected gestation of 37 weeks consistently had much higher rates of both stimulation and induction. Rates for both procedures rose for doctors of medicine (MD's), doctors of osteopathy (DO's) and certified nurse-midwives (CNM's). DO's had the greatest increases in both stimulation and induction rates. Declines in the cesarean section rate were greater for births that were stimulated or induced than for those without either of these procedures. The rates for stimulated or induced vaginal birth after cesarean (VBAC) were double those of VBACs without such procedures.     

Trends in eye cancer mortality among adults in the USA and England and Wales

Trends in eye cancer mortality are presented for the USA and England and Wales during the period 1955-89. Mortality rates have fallen by 58% in the USA during this period. The fall in mortality is paralleled by an equal fall in incidence rates in the USA. In England and Wales, mortality rates and incidence rates have remained relatively constant during the last three decades. The explanation for these differences between the USA and England and Wales is unknown.     

A review of induced abortion rates in England and Wales, 1969-1994

This study examines trends in induced abortion rates in England and Wales, from 1969 to 1994. A comparison of the trends between the different age groups shows contrasting changes and interesting features. The only age group to show a continuous increase since 1969 has been females aged 11 to 14 years. This may be due to birth cohort effect, as younger women begin sexual activity in a social environment of higher risk than previous cohorts. These considerations have important implications for the organisation of preventive services particularly health education. In spite of the availability of improved and better contraceptive services and sex education, the cohort analysis suggests that induced abortion rates in each successive cohort was higher than the preceding cohort.     

Trends in mortality from tuberculosis in England and Wales: effect of age on deaths from non-respiratory disease

BACKGROUND: Although mortality from tuberculosis has continued to fall in recent years, there has been little change in the case fatality rate for tuberculosis over the same period. This has previously been shown to be due to the increasing proportion of cases of tuberculosis occurring in the elderly. Tuberculosis mortality and case fatality were therefore analysed to determine if this disappointing trend in case fatality rate has occurred from disease in all or only certain sites. METHODS: A retrospective analysis of the tuberculosis mortality and case fatality rates in England and Wales for the period 1972-92 was carried out. The average annual percentage change in tuberculosis was calculated for each disease site and by age group and the results were compared. RESULTS: The analysis showed that, although the mortality rate fell steadily by 5.6% per annum, the case fatality rate decreased by only 0.9% (95% CI -1.7 to -0.1) per annum. The case fatality rate for respiratory and central nervous system disease declined, but no decline in tuberculosis at "other" sites was observed (1.01% (+2.2 to -0.2) for all age groups combined). In the group aged 75 and over, however, the proportion of deaths due to disease at other sites increased by 3.2% (2.2 to 4.3) per annum whilst in the other age groups the mortality rate declined. CONCLUSIONS: This analysis suggests that clinicians may be becoming less able to recognise non-respiratory presentations of tuberculosis, particularly in the elderly, and underlines the need to consider tuberculosis as a diagnosis to avoid delay in treatment.     

Community screening for colorectal cancer in north-eastern New South Wales, 1987-1996

OBJECTIVE: To analyse results of Bowelscan, a community-based colorectal cancer screening program using Hemoccult II, and targeting people aged 40 years and over. DESIGN: Survey of data from medical practitioners on follow-up of positive tests. SETTING: North-eastern New South Wales (Rotary District 9650), 1987-1996. SUBJECTS: 3845 people with positive results for faecal occult blood. OUTCOME MEASURES: Investigations performed; final diagnoses; number, site and Dukes' stage of colorectal carcinomas; number and histological diagnosis of colorectal polyps. RESULTS: 239,500 Hemoccult II kits were distributed between 1987 and 1996, with an estimated return rate of 80%-85%. Positive results for faecal occult blood were reported for 3845 tests (1.6% of those distributed), with 78% of these investigated by colonoscopy and/or barium enema. Investigation resulted in diagnosis of 260 colorectal carcinomas in 252 people (6.7%); 74 of these (29%) were in the caecum or ascending or transverse colon. Dukes' tumour stages were: A, 107 (41%); B, 86 (33%); C, 49 (19%); D, 16 (6%); and unknown, 2 (0.8%). (Corresponding figures from the NSW Central Cancer Registry were: A and B, 48%; C, 26%; D, 14% and unknown 12%) [corrected]. Colorectal polyps were found in a further 819 people (21.3%), and were adenomatous in 577 (79% of the 733 in whom histological diagnosis was available). Other gastrointestinal conditions were found in 1343 people (34.9%), while no cause was found for the positive result, despite adequate investigation, in 873 (22.7%). CONCLUSION: Community-based screening with faecal occult blood testing detected colorectal carcinomas at earlier histological stages than colorectal carcinomas reported to the Cancer Registry and should reduce mortality from this disease. Treatment and follow-up of adenomatous polyps detected by such a program might minimise the incidence of colorectal carcinoma in this group.     

Meningococcal disease in England and Wales: 1995

The number of laboratory confirmed cases of meningococcal infection in England and Wales rose in 1995 for the first time since 1990. Culture confirmed cases rose to 1459, an increase of 29% over the 1994 total, due largely to increased disease activity in the last quarter of 1995. Cases diagnosed by non-culture methods totalled 431, giving a total of 1890 laboratory confirmed cases. Notifications reported to the Office of Population Censuses and Surveys also increased to a similar extent. Northern regions generally had higher rates of disease activity and greater increases in rates. Meningococcal disease caused by serogroup C strains accounted for the main increase in culture confirmed cases and made up 32% of the total in 1995. Disease caused by C2a strains showed a particularly large increase. A change in the age distribution was noted with a greater proportion of patients in older age groups. Among group B isolates, B4 P1.4 strains continued to be identified most commonly.     

A rapid micromethod for prenatal diagnosis of Lesch Nyhan syndrome

A method is described which enables prenatal diagnosis of Lesch Nyhan Syndrome (HGPRT deficiency) to be made within 7-10 days. The procedure is based on the direct cultivation of amniotic cells in microtest II plates; the HGPRT reaction is performed in individual wells containing between 500 to 10,000 cells, and is followed by separation of the radioactive reaction products by means of microchromatography on 3 cm x 5 cm PEI plates. This method permits determination of the actual HGPRT enzyme activity of the cell lines.