The need for an outcomes research agenda for clinical laboratory testing

Aural papillomatosis has been infrequently reported in the English literature. It is a condition which can be very difficult to treat. We present the first reported case of aural papillomatosis successfully treated with the CO2 laser.     

Dinitrochlorobenzene skin test reactivity as a predictor of outcome in transplantation of juvenile onset diabetics

More than 50% of patients with chronic renal failure will be suppressed in their cell-mediated immune response to 2,4-dinitrochlorobenzene (DNCB). This applies in renal failure attributable to juvenile onset diabetes as well as other types of end stage renal disease. Significantly better kidney survival of both living related and cadaver grafts is seen in diabetic patients who are non-responsive to DNCB. Twelve-month kidney survival for DNCB-negative patients receiving living related allografts is 71% compared with 25% for DNCB-positive patients. Twelve-month kidney survival in cadaver recipients is 39% in DNCB-negative compared with 9% for DNCB-positive patients. Successful second grafts were done in DNCB-negative diabetic patients, however, all second grafts in DNCB-positive patients failed in less than 3 months. DNCB skin test reactivity as a measure of cell-mediated response is a valuable predictor of immunological outcome of transplantation in patients whose renal disease results from juvenile onset diabetes. Patient survival in DNCB nonresponders is nearly twice that of DNCB responders. Differences in outcome following transplantation could not be accounted for by HLA disparity, transfusion history, or other variables known to effect transplant outcome. Kidney and patient survival in DNCB-positive diabetic patients receiving either cadaver or living related allografts is sufficiently low as to identify them as a subpopulation of renal failure patients who should be treated by dialysis, or selected for special protocols which might provide immunological manipulation prior to transplantation to improve their treatment outcome.     

Costs of intrapartum care in a midwife-managed delivery unit and a consultant-led labour ward

OBJECTIVE: to investigate whether there are differences between the cost of intrapartum care for women at low obstetric risk in a midwife-managed labour and delivery unit and that in a consultant-led labour and delivery ward. DESIGN: cost analysis based on the findings of a randomised controlled trial comparing two alternative types of intrapartum care. SETTING: Aberdeen Maternity Hospital, Grampian. SUBJECTS: the number of women 'booked' for care in the Midwives' Unit in a standard year and a comparable group of women cared for in the consultant-led labour ward. PRIMARY OUTCOME MEASURE: the cost 'outcome' is the extra (or reduced) cost per woman resulting from the introduction of a midwife-managed delivery unit. FINDINGS: the baseline extra cost of the introduction of the Midwives' Unit was found to be 40.71 pounds per woman. Depending on the scenario used, this ranged from a cost saving of 9.74 pounds per woman to an additional cost of 44.23 pounds per woman. CONCLUSIONS: this study has shown that, in terms of costs incurred during the intrapartum period, the marginal cost of caring for women at low obstetric risk alongside women at high obstetric risk in a standard labour ward is small. However, the impact of establishing a separate midwife-managed delivery unit, requiring an increase in midwifery staffing levels, can be significant.     

Synthesis of conjugated bile acids by means of a peptide coupling reagent

The conditions for the preparation of conjugated bile acids by means of N-ethoxycarbonyl-2-ethoxy-1,2-dihydroquinoline are described. Conjugation is obtained in one step via the intermediary formation of mixed carbonic-carboxylic acid anhydrides.     

High-performance liquid chromatographic determination of L-aspartyl-L-phenylalanine methyl ester in various food products and formulations

A simple, rapid, and specific high-performance liquid chromatographic (HPLC) procedure is described for the analysis of the chemical sweetener L-aspartyl-L-phenylalanine methyl ester (aspartame). Using a strong cation exchange column and pressures less than 1000 psig, an analysis can be performed in less than 15 min. The technique has been applied to a wide range of food products and formulations. No interferences were found in the samples studied. Recoveries are quantitative, and the coefficients of variation for replicate analyses are less than or equal to 2.5%.