Dietary risk factors for colon cancer in a low-risk population

Spontaneous EEG was registered under different activity conditions in 26 volunteers. The EEG synchronisation parameters were compared with the geomagnetic and solar activity on the day of experiment. A positive correlation of the EEG data with the geomagnetic activity was revealed, being most obvious in the frontal and central areas. A negative correlation between some local EEG synchronisation parameters and different indices of the solar activity, was also revealed. The degree of synchronisation of the spontaneous EEG seems to reflect sensitivity of the human nervous system to the Earth's magnetic field. A stressor response to strong short-term disturbances in the geomagnetic field reveals itself in the form of enhancement of the EEG global synchronisation. A sedative effect of slow magnetic oscillations is locally revealed in the parameters of the EEG synchronisation within the left hemisphere as well as the interhemisphere synchronisation.     

Drug abuse in an obstetric population of a midsized city

Drug abuse during pregnancy has attracted national attention, but most studies are from large cities. This study is concerned with the indigent pregnant patients in a midsized city in the southeastern United States. In a 23-month study, 2,442 patients were delivered of neonates. Using specific criteria, 511 patients were tested for drug abuse. A positive test was identified in 156 (31%), cocaine being the most common agent. During 2 months of random testing, 15 patients (16%) had positive drug screens. Comparison of drug-positive pregnant patients with general obstetric patients identified many adverse obstetric and perinatal outcome data. Drug-positive patients weighed less, were older, were prone to not seek prenatal care, and were more likely to deliver prematurely and have a growth-retarded infant. Drug abuse in this population had significant impact on the health of the patient and her unborn infant.     

Cervicovaginal foetal fibronectin in the prediction of preterm labour in a low-risk population

Ten groups of 14 immunosuppressed NMRI-mice (nu/nu) were raised and kept under germ-reduced conditions. The control animals were fed a germ-reduced diet, nine other groups received the same diet with selegiline (CAS 14611-51-9, Deprenyl) or lipoic acid (thioctic acid, CAS 62-46-4) admixed at various amounts. The 50% survival rate, the total life span of each group and the areas under the curves were determined to evaluate life expectancy as compared to the controls. The racemate of lipoic acid at high dosage (350 mg/kg body weight) reduced the life span significantly. The S(-)-enantiomer of lipoic acid (75 mg/kg body weight) increased the 50% survival rate, whereas the physiologic R(+)-enantiomer (9 mg/kg body weight) expanded the total life span of its group. Alteration of only one out of three parameters was not considered significant. All other groups except for one did not differ from controls: only animals which obtained 75 micrograms selegiline per kg of body weight and per day exerted increased life expectancies by all three parameters. This group exhibited also in statistical evaluation a significantly (p < 0.05) prolongated survival time up to about 200% as compared to the control animals.     

The diagnosis of "pathological hyperglycaemia' in gestational diabetes in a high risk obstetric population

In order to define a level of "pathological hyperglycaemia', i.e. glucose intolerance that predicts perinatal morbidity among the obstetric population, 100 g glucose tolerance tests (GTTs) were performed in 660 patients attending for antenatal care at the University Hospital in Jeddah. The results were analysed in two ways: (1) patients were stratified according to the number of abnormal glucose values on the GTTs and (2) patients were placed into one of three groups according to the 100 g GTT diagnostic criteria, i.e. normal (non-GDM), abnormal with fasting blood glucose (FBG) > or = 5.8 mmol l-1 (GDM), and abnormal with FBG < 5.8 mmol l-1 (gestational induced hyperglycaemia, GIH). Although there was a stepwise association between fetal/maternal morbidity with increasing number of abnormal glucose values, no level of glucose intolerance could be defined as a threshold level for normal response. However, when stratified by FBG, GDM patients were significantly heavier (78.5 kg +/- SD 14.9), had a higher incidence of both macrosomia (27.5%) and operative delivery (25.3%) than the other two groups (14.7%, 14.3%, and 15.4%, 12.8% in the non-GDM and GIH, respectively). It is suggested that among patients with abnormal GTT results a FBG > or = 5.8 mmol l-1 identifies a threshold for true "pathological hyperglycaemia'.     

Hip screening in children. Comparison of various ultrasonographic methods

BACKGROUND: Aluminum oxide crystal microdermabrasion, a newly developed technique, has the advantages of less bleeding, fewer complications, better compliance, and no need for local anesthesia or high surgical skill in comparison with traditional dermabrasion. OBJECTIVE: To demonstrate the effectiveness of this new technique in the treatment of facial scarring. METHODS: A total of 41 patients were treated by this technique during the past 2 years (July 1992 to June 1994). RESULTS: All patients treated had good to excellent clinical improvement with 9.10 mean treatment sessions. CONCLUSION: From our experience and results, we think aluminum oxide crystal microdermabrasion is a safe surgical procedure and will be a good supplement to traditional dermabrasion especially in this era of HIV infection.     

Nuchal translucency screening for chromosomal abnormalities in a routine ultrasound practice

Endometriosis is a benign condition with an aggressive behaviour defined by the presence of ectopic endometrial tissue, outside the uterus. It occurs in 15-20% women with child bearing potential. Most commonly it affects organs such as the ovaries, uterine ligaments, fallopian tubes, rectum and the cervico-vaginal region. Involvement of the urinary tract, however, is rare. It can be seen in just about 1% cases, vesical location being the most frequent of these presentations (84% cases). We describe one case of vesical endometriosis that developed after a cesarean section. The intra-operative findings confirmed the existence of infiltration of the detrusor muscle and the vesical mucosa by endometrial tissue from the area of the uterine incision. A discussion of the different diagnostic and therapeutic options is also included.     

Angiotensin I-converting enzyme gene polymorphism in a low-risk European population for coronary artery disease

PURPOSE: Physiologic and non-physiologic tumor motion complicates the use of tight margins in three-dimensional (3D) conformal radiotherapy. Setup reproducibility is an important non-physiologic cause of tumor motion. The objective of this study is to evaluate and compare patient setup reproducibility using the reusable T-bar and the disposable expanded foam immobilization device (EFID) in radiation therapy for lung cancer. METHODS AND MATERIALS: Two hundred forty-four portal films were taken from 16 prospectively accrued patients treated for lung cancer. Patients were treated with either a pair of anterior and posterior parallel opposing fields (POF), or a combination of POF and a three-field isocentric technique. Each patient was treated in a supine position using either the T-bar setup or EFID. Six patients were treated in both devices over their treatment courses. Field placement analysis was used to evaluate 3D setup reproducibility, by comparing positions of bony landmarks relative to the radiation field edges in digitized simulator and portal images. Anterior-posterior, lateral, and longitudinal displacements, as well as field rotations along coronal and sagittal planes were measured. Statistical analyses of variance were applied to the deviations among portal films of all patients and the subgroup treated with both immobilization methods. RESULTS: For the T-bar immobilization device, standard deviations of the setup reproducibility were 5.1, 3.7, and 5.1 mm in the anterior-posterior, lateral, and longitudinal dimensions, respectively. Rotations in the coronal plane and the sagittal plane were 0.9 degrees and 1.0 degrees, respectively. For the EFID, corresponding standard deviations of set up reproducibility were 3.6 mm, 5.3 mm, 5.4 mm, 0.7 degrees and 1.4 degrees, respectively. There was no statistically significant difference (p = 0.22) in the 3D setup reproducibility between T-bar and EFID. Subgroup analysis for the patients who were treated with both immobilization devices did not reveal a difference either. There was no consistent systematic error from simulator to treatment unit identified for either immobilization device. CONCLUSION: Although the optimal immobilization technique and patient positioning for thoracic radiotherapy have yet to be determined, this study indicates that T-bar is comparable with EFID in its setup reproducibility. In view of the inherent advantages of T-bar, it has become a standard immobilization device at our institution. The observed range of displacements in field positioning with either immobilization device implies that one cm (two standard deviations [SD] of setup error) will be a more appropriate margin to allow for setup variability in radiation therapy for lung cancer.     

Enlargement of cisterna magna as an indicator of chromosomal abnormalities in a low-risk Asian population

BACKGROUND: Segmental hyperhidrosis is an uncommon finding which is usually associated with irritation or infiltration of pre-ganglionic sympathetic fibres or the sympathetic chain. METHODS: We report two cases of segmental hyperhidrosis with striking clinical features. RESULTS: In one case, a mesothelioma produced ipsilateral simultaneous underactivity and overactivity of sympathetic outflow and in the other case a thoracic central disc herniation was probably responsible for a band of sweating which clearly extended beyond the segmental level of injury. CONCLUSION: Segmental hyperhidrosis should trigger a search for structural disease in the spinal and paraspinal region.     

Adverse psychological impact of operative obstetric interventions: a prospective longitudinal study

OBJECTIVE: This paper reports the findings of a prospective longitudinal study of 272 nulliparous pregnant women, which investigated as one of its objectives the psychological sequelae of obstetric procedures. METHOD: Participants completed structured interviews and standardised, published psychometric questionnaires, including the Rosenberg Self-Esteem Scale and the Profile of Mood States late in pregnancy and again early in the postpartum period. RESULTS: Little evidence was found to support the notion that the total number of obstetric interventions was linked to a deterioration in postpartum mood. Significant adverse psychological effects were associated with the mode of delivery. Those women who had spontaneous vaginal deliveries were most likely to experience a marked improvement in mood and an elevation in self-esteem across the late pregnancy to early postpartum interval. In contrast, women who had Caesarean deliveries were significantly more likely to experience a deterioration in mood and a diminution in self-esteem. The group who experienced instrumental intervention in vaginal deliveries fell midway between the other two groups, reporting neither an improvement nor a deterioration in mood and self-esteem. CONCLUSIONS: The findings of this study suggest that operative intervention in first childbirth carries significant psychological risks rendering those who experience these procedures vulnerable to a grief reaction or to posttraumatic distress and depression.     

The impact of HIV on Streptococcus pneumoniae bacteraemia in a South African population

OBJECTIVES: To determine the impact of HIV infection on Streptococcus pneumoniae bacteraemia in adults and children by analysing the prevalence and clinical features of such diseases and determining the prevalent serotypes/serogroups and susceptibility patterns of isolates. DESIGN: Patients were identified prospectively from January to October 1996. SETTING: Chris Hani Baragwanath Hospital, Soweto, a tertiary referral hospital treating adults and children, in an urban district near Johannesburg, South Africa. PATIENTS AND METHODS: All patients with S. pneumoniae isolated from blood culture by the Microbiology Department, Chris Hani Baragwanath Hospital were studied. Clinical and microbiological features were recorded. RESULTS: A total of 178 patients with S. pneumoniae were investigated as part of the study; 49 were aged < 13 years. HIV seroinfection was present in 25 (51%) children and 58 (45%) adults. The incidence of S. pneumoniae bacteraemia was 36.9-fold increased in HIV-seropositive children and 8.2-fold increased in HIV-seropositive adults compared with HIV-seronegative individuals. Both adult and paediatric HIV-seropositive patients with S. pneumoniae bacteraemia were significantly younger than HIV-seronegative patients. Pneumonia was a significantly more common presentation in HIV-seropositive children, otherwise the spectrum of disease and outcome were similar in HIV-seronegative and positive groups. Serotype 1 S. pneumoniae isolates were significantly less common in HIV-infected individuals (both adults and children). Resistance to penicillin was increased in S. pneumoniae isolates from HIV-infected patients (significant in adults). Patients with penicillin-resistant isolates did not have a poorer outcome. The potential coverage of serotypes/serogroups included in the proposed nine-valent conjugate pneumococcal vaccine was 88% in HIV-seronegative children and 83% in HIV-seropositive children. The potential coverage of the currently available 23-valent pneumococcal vaccine for adults was 98.2 and 100)% for HIV-infected and HIV-uninfected adults, respectively. CONCLUSION: The burden of bacteraemia due to S. pneumoniae in HIV-seropositive individuals admitted to our hospital is considerable. Differences in the S. pneumoniae serotypes/serogroups in HIV-infected patients have been demonstrated with resultant differences in antibiotic susceptibility patterns. Excellent potential for vaccine coverage was demonstrated for both HIV-seronegative and HIV-seropositive individuals. Further studies are necessary to test the clinical efficacy of pneumococcal vaccination of HIV-seropositive adults and children as a potential preventative measure against this prevalent disease.     

Hypertension detected in young black women by routine screening in a family planning clinics

The prevalence of hypertension, defined as a diastolic blood pressure over 100 mmHg, among young Black women who attended a family planning clinic in Johannesburg, was 2,85%, while in those over 35 years of age it was 8,5%. There was no correlation between hypertension and urbanisation, occupation or urinary sodium output. Within 6 months of diagnoisis, 84% of the women with hypertension had defaulted from the treatment clinic. Family planning clinics can economically screen patients for hypertension, but in this community a separate screening programme would not succeed until patient compliance has improved.     

ALATOP-RIA in the screening of atopy in a non Caucasian population

ALATOP is an "in vitro" radioimmunoassay screening test for atopy, previously validated in a caucasian population. The aim of the study was to assess the usefulness of a screening test of atopy in a non caucasian population. We select a non caucasian population (n = 208), from hospital immunoallergy consultations, Cape Verde Republic (Africa). It was determined the sensitivity, specificity and predictive values comparing with skin prick tests (SPT) results for the 208 patients, and with clinical data (Clin) in 115 patients. It was also determined the levels of total IgE, done by IRMA. RESULTS: Using different corrections factors, 0.85 gives the best results: ALATOP/SPT-Sensitivity-88.5% +/- 4.34; Specificity-73.8% +/- 8.41; Positive predictive value-66.9%; Negative predictive value-91.4%; Efficiency of the test-79.3%. ALATOP/CLIN-Sensitivity-95.2% +/- 3.89; Specificity-71.2% +/- 12.07; Positive predictive value-65.6%; Negative predictive value-96.2%; Efficiency of the test-80.0%. The mean values of total IgE were-406 IU/ml. CONCLUSIONS: The mean value of total IgE was significantly increased even in the ALATOP-/SPT-not saw in caucasian populations. The use of a different correction factor (0.85) for ALATOP, optimize the test, showing a good negative predictive value, but raises the question of adapted compositions of screening tests for different populations.     

The 75-g glucose tolerance test in pregnancy: a reference range determined on a low-risk population and related to selected pregnancy outcomes

OBJECTIVE: To determine a reference range for the 75-g glucose tolerance test (GTT) in pregnancy using a group of women at low risk for gestational diabetes mellitus (GDM) and to determine the validity of this reference range by examining selected pregnancy outcomes for glucose-tolerant women with a 2-h result on the GTT up to 1.0 mmol/l below the diagnostic level for GDM compared with treated women with GDM. RESEARCH DESIGN AND METHODS: The reference range for the GTT was determined in 573 Caucasian women with an age <25 years and a BMI of <25 kg/m2. Selected pregnancy outcomes were compared between 272 treated women with GDM (diagnosed on the basis of a 2-h glucose level > or =8.0 mmol/l) and 308 women with a 2-h glucose level of 7.0-7.9 mmol/l. RESULTS: There was 95% confidence that at least 95% of all the fasting glucose levels are < or =5.1 mmol/l(92 mg/dl) and 95% confidence that at least 95% of all the 2-h glucose levels were < or =7.8 mmol/l (140 mg/dl). Treated women with GDM had a significantly reduced rate of large-for-gestational-age infants compared with glucose-tolerant women, without any increase in the rate of small-for-gestational-age infants or obstetric interventions. CONCLUSIONS: The reference range for the GTT in pregnancy should be determined on a low-risk population rather than on a total population. Consideration should be given to lowering the fasting glucose level to 5.0 mmol/l (90 mg/dl) and the 2-h level to 7.8 mmol/ (140 mg/dl). Glucose-tolerant women below this relatively low reference range have an increased rate of large-for-gestational-age infants and may benefit from treatment.     

The value of screening for Down's syndrome in a socioeconomically deprived area with a high ethnic population

OBJECTIVE: To assess the utility of biochemical antenatal screening for Down's syndrome in a socioeconomically deprived area with a high proportion of Asian women from the Indian Subcontinent. DESIGN: Audit of Down's syndrome biochemical screening service over a four-year period. SETTING: Teaching hospital and community antenatal clinic in inner city Birmingham. POPULATION: Women booked between October 1992 and December 1996. METHODS: Blood for screening was collected between 14 and 21 weeks gestation, alpha-fetoprotein and intact human chorionic gonadotrophin were measured in serum and the risk of Down's syndrome was calculated. MAIN OUTCOME MEASURES: Uptakes of screening and amniocentesis, screen positive rate, odds of being affected given a positive result, miscarriages associated with amniocentesis offered following a high risk result, detection rate, number of Down's cases prevented and a cost analysis. Outcome measures were compared between Asians and Caucasians. RESULTS: Overall 11,974 women (71%) accepted serum screening. The screen positive rate was 8.3% in Asians and 5.0% in Caucasians. The uptake of amniocentesis in women following a high risk result was 54% overall (35% Asian, 67% Caucasian). Nineteen cases of Down's syndrome were identified, of which 13 occurred in women who opted for biochemical screening. The detection rate of the biochemical screening programme was 85% (11/13). Of these 11 cases, six (none of whom were Asian) elected to have an amniocentesis, of whom four thereafter had a termination. CONCLUSION: In this study the public health benefits of screening for Down's syndrome in a socioeconomically deprived area with a high Asian population, were small.     

False-positive HIV-1 test results in a low-risk screening setting of voluntary blood donation. Retrovirus Epidemiology Donor Study

CONTEXT: Persons at risk of human immunodeficiency virus 1 (HIV-1) infection, have been classified incorrectly as HIV infected because of Western blot results, but the frequency of false-positive Western blot results is unknown. OBJECTIVES: To determine the frequency of false-positive HIV-1 Western blot results in US blood donors and to make projections to other screened populations. Secondarily, to validate an algorithm for evaluating possible false-positive cases. DESIGN: A retrospective cohort study of HIV-1 enzyme immunoassay (EIA) and Western blot results from large blood donor screening programs in which donors with suspected false-positive Western blot results underwent HIV-1 RNA polymerase chain reaction (PCR) testing and follow-up HIV-1 serology. SETTING: Five US blood centers participating in the Retrovirus Epidemiology Donor Study. PARTICIPANTS: More than 5 million allogeneic and autologous blood donors who successfully donated blood at 1 of the 5 participating centers from 1991 through 1995. MAIN OUTCOME MEASURES: Rate of false positivity by Western blot and true HIV-1 infection status as determined by HIV-1 RNA PCR and by serologic follow-up of blood donors more than 5 weeks after donation. RESULTS: Of 421 donors who were positive for HIV-1 by Western blot, 39 (9.3%) met the criteria of possible false positivity because they lacked reactivity to p31. Of these, 20 (51.3%) were proven by PCR not to be infected with HIV-1. The false-positive prevalence was 4.8% of Western blot-positive donors and 0.0004% (1 in 251000) of all donors (95% confidence interval, 1 in 173000 to 1 in 379000 donors). CONCLUSIONS: A false diagnosis of HIV-1 infection can result from the combination of EIA and Western blot testing in blood donor and other HIV-1 screening programs. Individuals with a positive Western blot result lacking the p31 band should be counseled that, although they may be HIV infected, there is uncertainty about this conclusion. These individuals should be further evaluated by RNA PCR testing (if feasible) and HIV serologic analysis on a follow-up sample.