Morbidity pattern, health care utilization and per capita health expenditure in a rural population of Tamil Nadu

This retrospective analysis intends to evaluate by histeroscopy the endometrial findings in a group of 63 patients in post-menopausal treated with tamoxifen for breast cancer. Our patients assumed tamoxifen for a different period between 6 and 120 months. Patients have been divided in two groups: I) patients undergoing hysteroscopy because of some clinical symptoms; II) patients who undergoing hysteroscopy as a routine examination. The most important observation of this work is the correlation between the presence of negative endometrium and low risk hyperplasia (LRH) associated to: symptomatology and duration of therapy. In the group of asymptomatic patients the LRH is found only after 3 years of treatment, while in the group of symptomatic patients, LRH is present within the first two years of treatment; beyond this period high risk hyperplasia (HRH) and endometrial carcinoma have been diagnosed. We also observed a higher incidence of endometrial polyps in this population than among the non treated group and among the symptomatic patients. From these data we conclude that hysteroscopy follow-up has to be performed in the group of patients treated with tamoxifen and that it would be necessary to have a hysteroscopy before the beginning of therapy and that this one has to be repeated once a year through the treatment. Obviously the symptomatic patients have to undergo hysteroscopy as soon as possible as a higher incidence of HRH and endometrial carcinoma has been detected in this group of patients.     

A comparison of a 30-cluster survey method used in India and a purposive method in the estimation of immunization coverages in Tamil Nadu

The reaction mechanisms of p-nitrophenyl phosphate hydrolysis catalyzed by two rat liver isoenzymes of the low M(r) phosphotyrosine protein phosphatase (AcP1 and AcP2) were compared. Furthermore, the effect of some heterocyclic compounds on their activities were tested. Cyclic GMP and guanosine causes a particularly high activation of the isoenzyme AcP2, whereas its effect on AcP1 is very poor. A study on the mechanism of cyclic GMP activation was carried out. The results suggest that cyclic GMP activates the AcP2 isoenzyme by increasing the rate of the step that leads to the hydrolysis of the covalent enzyme-substrate phosphorylated complex formed during the catalytic process. The physiological significance of cyclic GMP activation of only one of the two isoenzymes (AcP2) remains uncertain.     

Allele frequency distribution for the variable number of tandem repeat locus D10S28 in Tamil Nadu (south India) population

Allele frequencies were determined in unrelated individuals of Tamil speaking population from the Madras City (Tamil Nadu, South India) area for the polymorphic DNA locus D10S28 using the probe TBQ7. Membranes hybridized with the probe YNH24 were subjected to deprobing and were subsequently hybridized with random priming - labeled, purified inserts of TBQ7. The sizes of the fragments were grouped to 100 bp as well as to arbitrary fixed bins (Federal Bureau of Investigation / Royal Canadian Mounted Police). There were 14 bins in the latter with the most common bin being 11 (1789-1924 bp) with a frequency of 9.8%. We observed a heterozygosity of 92% comparable to Caucasian populations. The data presented here can be used as the basis for utilizing this variable number of tandem repeats (TNTR) DNA marker for paternity determinations and forensic investigations.     

Reproductive pattern, perinatal mortality, and sex preference in rural Tamil Nadu, south India: community based, cross sectional study

OBJECTIVES: To study reproductive pattern and perinatal mortality in rural Tamil Nadu, South India. DESIGN: Community based, cross sectional questionnaire study of 30 randomly selected areas served by health subcentres. SETTING: Rural parts of Salem District, Tamil Nadu, South India. SUBJECTS: 1321 women and their offspring delivered in the 6 months before the interview. MAIN OUTCOME MEASURES: Number of pregnancies, pregnancy outcome, spacing of pregnancies, sex of offspring, perinatal and neonatal mortality rates. RESULTS: 41% of the women (535) were primiparous; 7 women (0.5%) were grand multiparous (> 6 births). The women had a mean age of 22 years and a mean of 2.3 pregnancies and 1.8 live children. The sex ratio at birth of the index children was 107 boys per 100 girls. The stillbirth rate was 13.5/1000 births, the neonatal mortality rate was 35.3/1000, and the perinatal mortality rate was 42.0/1000. Girls had an excess neonatal mortality (rate ratio 3.42%; 95% confidence interval 1.68 to 6.98; this was most pronounced among girls born to multiparous women with no living sons (rate ratio 15.48 (2.04 to 177.73) v 1.87 (0.63 to 5.58) in multiparous women with at least one son alive). CONCLUSIONS: In this rural part of Tamil Nadu, women had a controlled reproductive pattern. The excess neonatal mortality among girls constitutes about one third of the perinatal mortality rate. It seems to be linked to a preference for sons and should therefore be addressed through a holistic societal approach rather than through specific healthcare measures.     

The Composition of State Certification Boards.

Argues that although certification legislation has been largely the program of clinical psychologists, other practitioners--and particularly industrial psychologists--have become increasingly interested and involved in the problem. That industrial psychologists have not participated in certification or licensing until recently, in comparison with clinicians, is not surprising. The number of psychologists employed in industry was, until the postwar period, very small. Three decades ago there were barely two dozen full-time psychologists in industry. In spite of this history, however, industrial--and other--psychologists have already attained a significant and somewhat proportionate degree of representation in the administration of such legislation. To measure this participation, an analysis was made of the membership of existing certification and licensing boards. Data is presented that suggest that while industrial psychologists (and other nonclinicians) have played only a secondary role so far in the area of certification, they may not have lagged too far behind in proportionate participation in the administration of certification and licensing programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Management of gallstones in pregnancy

BACKGROUND: Biliary disease during pregnancy is rare and the management of cholecystitis during pregnancy is controversial. Cholecystectomy in the pregnant patient has generally been avoided because of the reported high incidence of associated fetal loss. Recent developments relating to diagnostic and anaesthetic management have altered the overall approach to symptomatic biliary tract disease in pregnant patients. METHODS: The literature was reviewed using Medline searches for cholelithiasis in pregnancy, to include pathophysiology, diagnosis and management. RESULTS AND CONCLUSION: Surgery should be performed only for complicated non-resolving biliary tract disease during pregnancy as in over 90 per cent of patients the acute process will resolve with conservative management. For patients requiring operative intervention, laparoscopic cholecystectomy has emerged as a safe and effective method of treatment.     

Conservative therapy of gallstones]

In recent years, open cholecystectomy has increasingly been replaced by laparoscopic cholecystectomy, and the latter is now regarded as the standard procedure. As a result of this development, the modalities of conservative treatment of gallstones have lost importance overall, although they may still be of use in the individual case. The following modalities are described, and the indications for their use discussed: litholysis with the aid of bile acids, contact litholysis with ether, ESWL.     

Prevalence of gallstones in the neonatal period]

The prevalence of infection with Mycobacterium avium complex (MAC) has increased since the outbreak of the HIV pandemic. This complex comprises two organisms: M. avium (mostly) and M. intracellulare (rarely). The source of MAC infection is not known. The principal risk factors for disseminated MAC infection in a patient with HIV infection are a low CD4 count and a previous opportunistic infection. The symptoms of disseminated MAC infection resemble those of HIV wasting; a positive culture of normally sterile tissue confirms a MAC infection. There is reserve with regard to routine prophylaxis in HIV-infected persons because of the possible development of resistance, interaction with other drugs used in AIDS, toxicity and possible absorption disorders which might cause prophylaxis to fail. For the treatment of disseminated MAC infection, a combination of at least two medicaments (macrolides and ethambutol) is recommended.     

Fundoplication for major reflux in patients with gallstones

Patients referred with gallstones were screened for symptoms of reflux. Positive clinical history led to investigation with an upper gastrointestinal series as well as esophageal pH and manometric studies to identify and quantify reflux. Selected patients with symptomatic reflux in whom major or surgical reflux was discovered underwent the combined procedures of cholecystectomy and fundoplication. In all, 250 patients with gallstones were screened. Sixty patients with symptoms of reflux were considered for further study; of that group, 48 patients had major reflux, 38 of whom underwent the combined operative procedures. Fundoplication alone or in combination with cholecystectomy was carried out on 126 occasions upon 121 patients without a death. The combination of fundoplication and cholecystectomy did not prolong the hospital stay significantly, did not materially increase the incidence of postoperative complications and did not compromise the control of reflux symptoms. The postfundoplication syndrome did not occur following the combined procedures and was observed in only one patient in the entire series. Results of our study justify the liberization of indications for fundoplication in selected patients with gallstones who fulfill the criteria of major reflux, as already outlined.     

Role of incomplete dietary protein in experimental formation of gallstones

The influence exerted by the quality of alimentary protein on the composition of the secreted bile, morphology of the liver and gallbladder, as well as on the formation of gallstones was studied in experiments with rats and hamsters. It is shown that with inclusion in an experimental fat-free ration of qualitatively incomplete protein gelatin (instead of caseine) the frequency of the gallstones formation increases by almost 6 times. In animals this is attended by a reduced concentration of a number of major bile components. Upon feeding for 2 weeks on lithogenic ration with gelatin morphological investigations disclose inflammatory changes in the gallbladder wall, and after a lapse of 3 weeks--multiple exulcerations in the mucosa and a dense gross sediment in the gallbladder lumen.     

Computerized tomographic assessment of the composition of gallstones

We present the results of an in vitro study of biliary lithiasis (n = 106) with computerized tomography (CT). We analyzed the correlation between composition of gallstones (crystallographic analysis of thin sections and atomic absorption spectrophotometric analysis of total calcium content) with CT patterns (densitometry) and their corresponding attenuations. Six main CT patterns were distinguished: hypodense (homogeneous and heterogeneous), dense, homogeneous hyperdense, ringed hyperdense and irregular hyperdense. Statistically significant differences (p < 0.05) were found between attenuations for cholesterol (mixed and pure) and pigmentary stones. We found a good inverse correlation between attenuations and cholesterol content; the contents of pigment, inorganic calcic salts and total calcium content also showed significant direct correlations (p < or = 0.01). Of the samples classified as pure cholesterol type stones, 86.4% showed hypodense patterns, and the remaining 13.6% showed irregular hyperdense patterns. Of the pigmentary stones, 80% showed homogeneous hyperdense images. All stones that contained more than 3% calcium produced hyperdense patterns, whereas 72.4% of the stones that contained less calcium produced hypodense images. Tomodensitometric measurements provided more information than simple radiography, and made it possible to distinguish a greater variety of gallstone types based on structural complexity.     

Percutaneous and transpapillary laser lithotripsy of intrahepatic gallstones

PROBLEM AND OBJECTIVE: In the last few years several intra- and extracorporeal endoscopic methods have been developed for treating intrahepatic gallstones, but as yet no ideal instrumentation has been found. This study was undertaken to test the efficacy and possible complications of intracorporeal laser lithotripsy for intrahepatic gallstones. PATIENTS AND METHODS: 16 consecutive patients were included (13 women and 3 men, median age 64 [28-82] years) with intrahepatic biliary tract stones which could not be removed by conventional endoscopy. A rhodamine-6G-laser with an integrated stone recognition system was used. The glass fibres of the laser instrument were introduced perorally or percutaneously and placed at the stone. RESULTS: The percutaneous procedure under cholangioscopic control succeeded in four of the patients, while 12 were treated by a transpapillary approach (two under fluoroscopic, ten under cholangioscopic control). In eight of the latter group all stones were completely fragmented, i.e. 12 of the total were successfully treated. Of the remaining four patients two were cleared of stone by additional measures (extracorporeal shockwave lithotripsy and electrohydraulic lithotripsy, respectively), two were treated pallatively by endoprosthesis. One patient developed an acute cholangitis which was successfully treated with antibiotics and biliary drainage. There were no deaths. CONCLUSIONS: Particularly when performed transcutaneously, laser lithotripsy provides effective treatment of intrahepatic gall stones. Cholangioscopic monitoring, to place the glass fibre at the stone, is usually required in the transpapillary approach.     

Grain-Size Composition and Coercive Force of Nd2Fe14B Alloy Powder in a Finely Divided State

The change in grain-size composition and magnetic properties of powder prepared by grinding cast alloy Nd₂Fe₁₄B in a ball mill for different times is studied. It is shown that during grinding the coercive force of the powder increases uniformly at first reaching a maximum, and then it decreases. It is established that this phenomenon is not due to powder oxidation during grinding but a reduction in the level of particle uniaxial anisotropy caused by deformation of their surface layer during grinding. The change in coercive force of Nd ₂Fe₁₄B alloy powder on grinding obeys the same features that are observed with mechanical grinding of other uniaxial magnetic materials.     

青岛城阳财贝沟东周墓出土青铜容器的成分与金相分析

利用手持X射线荧光光谱仪、金相显微镜对青岛城阳财贝沟东周墓出土11件青铜容器进行成分和金相分析。结果表明,11件青铜容器均为Cu-Sn-Pb三元合金,且含有少量铁、锑、银等杂质金属元素。大多数青铜容器为铅锡青铜材质,铅含量普遍较高,平均约为17.58%,青铜容器均为铸造成形,未见铸后加工工艺。同一墓葬中青铜容器的合金成分相近,不同墓葬中的同一器型的青铜容器在合金技术上表现出明显差异。财贝沟东周墓出土青铜容器多为素面,基体普遍锈蚀严重,不少金相组织中还发现有自由铜晶粒,与青铜容器的合金成分、铸造工艺及埋藏环境影响下的电化学腐蚀有关,但其出土青铜容器的合金配比、成型技术与机械性能间接反映出当时工匠拥有成熟的青铜铸造技术和陪葬青铜容器的礼器功能趋于淡化,为全面认识东周时期齐国青铜冶铸业的发展状况以及当下对青铜容器的保护与修复提供重要的科学依据。     

Perihepatic abscess formation in diabetes: a complication of silent gallstones

Perforation of the gallbladder is a serious complication of acute cholecystitis, with significant morbidity and mortality rates. We present the case of a diabetic adult in whom the usual signs and symptoms of acute cholecystitis were obscured. A high index of suspicion at the time of admission prompted emergent evaluation. Computerized axial tomography revealed a large perihepatic abscess extending from a perforated gallbladder. Fourteen hundred milliliters of malodorous brown fluid were drained by ultrasound-guided percutaneous aspiration from the collection. Early clinical suspicion combined with conservative surgical management may prevent serious morbidity and/or mortality in diabetic patients with complicated cholecystitis.     

Behavior of various cholesterol crystals in bile from patients with gallstones

Besides classical plate-like cholesterol monohydrate crystals, a variety of crystal shapes have recently been described in model biles but their relevance for human gallstone formation is unknown. We therefore studied crystallization behavior in gallbladder bile from cholesterol stone patients (54 untreated, 13 ursodeoxycholate-treated) and 6 pigment stone patients. Bile preparation by ultrafiltration or ultracentrifugation left biliary lipid composition unchanged but plates and their aggregates, and arcs and needles crystallized more extensively while spirals and tubules crystallized less extensively in ultra-centrifuged bile than in ultrafiltered bile. Plates, aggregates, and arcs/needles were seen in 90 percent, 36 percent, and 18 percent of the cases respectively of fresh unfiltered biles of untreated cholesterol stone patients, while spirals and tubules were always absent. In ultrafiltered biles arcs/needles, plates and aggregates progressively developed as persistent forms. Spirals and tubules occurred transiently and were associated with increased deoxycholic acid (+41 percent, P = .039) and with more extensive cholesterol crystallization. Rate/extent of crystallization of all crystal forms was higher (P < .0001) for multiple than solitary cholesterol stone patients. Ursodeoxycholate-treated patients had atypical platelike cholesterol crystals in fresh unfiltered biles that decreased in size at prolonged observation and in 2 cases even dissolved after 15 and 20 days. No crystals ever developed in ultra-filtered bile of ursodeoxycholic acid (UDCA)-treated patients during 21 days. Pigment stone patients seldom developed crystals. Thus, plates, aggregates and arcs/needles are persistent forms with high crystallization rate in multiple cholesterol stone patients. Tubules and spirals are transient forms that are associated with more extensive crystallization. Patients treated with ursodeoxycholate often have atypical crystals in their fresh bile.