Impact of effective health care bulletin on treatment of persistent glue ear in children: time series analysis.
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Child↗
Biomedical subjects
G Browning
Publications and source records attributed to G Browning.
Metabolism of gibberellins A1 and A3 in fruits and shoots of Prunus avium.
Isotope-labelled GA metabolites were identified by GC--MS, following HPLC fractionation of extracts derived from fruits or shoots, that had been incubated with [2H]- and [3H]- GA1 or [2H]- and [3H]- GA3. GA1 (1) was converted into GA8 (10) by developing fruits and vegetative shoots of sweet cherry (Prunus avium cv. 'Stella'), while GA3 (4) was converted into GA3-isolactone (17). Other metabolites of each GA were detected but were not identified unequivocally. These included a metabolite of GA1 (1) in fruitlets that was more polar (by reverse phase HPLC) than GA8 (10) and a metabolite of similar polarity to GA87 (6), was obtained after incubating fruitlets with GA3 (4). However, no evidence was obtained to suggest that GA87 (6) was a metabolite of GA3 (4) or that GA85 (2) was a metabolite of GA1 (1) in these tissues, under the conditions used. The pattern of metabolites obtained from vegetative tissues was similar to that from fruitlets. However, the results suggested that GA1 (1) and GA3 (4) were metabolised at a greater rate in shoots from mature trees than in shoots from seedlings, and that GA1 (1) was metabolised more rapidly than GA3 (4) in juvenile and mature shoots. We conclude from these observations that GA3 (4) is not a precursor of GA87 (6) and GA32 (5), also, that GA1 (1) is not a precursor of GA85 (2) and GA86 (3) in developing fruits or in vegetative shoots of sweet cherry.
Gas Chromatography-Mass Spectrometry↗
Gibberellins in seedlings and flowering trees of Prunus avium L.
Extracts of acids from mature seeds, germinating seeds, first, second and third year seedlings as well as mature, flowering trees of sweet cherry (Prunus avium L. cv. Stella) were analysed by gas chromatography-mass spectrometry. The presence of the known gibberellins (GAs) GA1 (1), GA3 (4), GA5 (7), GA8 (11), GA19 (14), GA20 (12), GA29 (13), GA32 (5), GA85 (2), GA86 (3) and GA87 (6) was confirmed by comparison of their mass spectra and Kovats retention indices with those of standards or literature values. In addition, 16alpha,17-dihydrodihydroxy GA25 (16) was identified and its stereochemistry confirmed by rational synthesis. The 12alpha,13-dihydroxy GAs, GA32 (5), GA86 (2), GA86 (3) and GA87 (6), were detected in mature seeds, germinating seeds and young seedlings, but not in flowering plants. The 13-hydroxy GAs, GA1 (1) and GA3 (4), were present in germinating seeds and, in addition to these, GA5 (7), GA8 (11), GA19 (14), GA20 (12) and GA29 (13) were detected in seedlings and mature flowering plants. In germinating seeds and seedlings (while the plants were growing actively), concentrations of the 12alpha,13-dihydroxy GAs, measured by bioassay, declined and those of the 13-hydroxy GAs increased. The results are discussed with reference to the known and predicted effects of the GAs on the vegetative growth and flowering of P. avium plants.
Chromatography, High Pressure Liquid↗
Centralisation of oesophageal cancer services; the view from the periphery.
There is debate as to whether patients requiring resection for oesophageal cancer should be referred to specialist centralised units rather than being managed by general surgeons in district general hospitals (DGH). The aim of this study was to determine the effects of centralising oesophageal cancer surgery on outcome and quality of service for patients with oesophageal cancer in a peripheral region. Patients with biopsy proven oesophageal cancer diagnosed over a 4 year period were identified from pathology records. Patients were divided into two groups; Group 1 (n = 60) from the first two years of the study who had any surgery performed by a general surgeon within the DGH and Group 2 (n = 53) from the latter two years of the study who had any surgery performed in a regional cardiothoracic unit. The post-operative mortality rate was lower in the specialist unit, 5.6% vs. 12.5%, but this was not statistically significant. There were no significant differences in survival rates; 3 month, 1 year, 2 year and 3 year survival rates were 63% vs. 62%, 24% vs. 25%, 12% vs. 8% and 7% vs. 6% in Groups 1 and 2, respectively. Referral rates for a surgical opinion were significantly lower in Group 2--92% vs. 63% p < 0.01 by Chi-squared test. Patients waited significantly longer from diagnosis to definitive treatment in Group 2--median 15 days vs. 23 days p = 0.17 by Mann-Whitney test. In conclusion, survival rates are not necessarily improved by centralisation of oesophageal cancer surgery and quality of service may be poorer.
Adenocarcinoma↗
Surgical treatment of chronic otitis media with effusion.
Otitis media with effusion is the most frequent reason for admission to hospital for surgery in children. There are worldwide differences in the management of the condition. Recent studies have evaluated indications for surgery, surgical treatment methods, outcome measures following surgery and sequelae. The present report defines the increased risk of behavioural problems in pre-school children with persistent disease. Factors affecting the outcome of surgery with ventilation tubes are discussed. Assessment is made of the complications due to the disease and those resulting from treatment with ventilation tubes. Finally, a review is made of the various international guidelines for the management of persistent disease as a basis for good clinical practice.
Child↗
Restriction fragment length polymorphisms of virulence plasmids in Rhodococcus equi.
Virulent Rhodococcus equi, which is a well-known cause of pyogranulomatous pneumonia in foals, possesses a large plasmid encoding virulence-associated 15- to 17-kDa antigens. Foal and soil isolates from five countries-Argentina, Australia, Canada, France, and Japan-were investigated for the presence of 15- to 17-kDa antigens by colony blotting, using the monoclonal antibody 10G5, and the gene coding for 15- to 17-kDa antigens by PCR. Plasmid DNAs extracted from positive isolates were digested with restriction endonucleases BamHI, EcoRI, EcoT22I, and HindIII, and the digestion patterns that resulted divided the plasmids of virulent isolates into five closely related types. Three of the five types had already been reported in Canadian and Japanese isolates, and the two new types had been found in French and Japanese isolates. Therefore, we tentatively designated these five types 85-kb type I (pREAT701), 85-kb type II (a new type), 87-kb type I (EcoRI and BamHI type 2 [V. M. Nicholson and J. F. Prescott, J. Clin. Microbiol. 35:738-740, 1997]), 87-kb type II (a new type), and 90-kb (pREL1) plasmids. The 85-kb type I plasmid was found in isolates from Argentina, Australia, Canada, and France. Plasmid 87-kb type I was isolated in specimens from Argentina, Canada, and France. The 85-kb type II plasmid appeared in isolates from France. On the other hand, plasmids 87-kb type II and 90-kb were found only in isolates from Japan. These results revealed geographic differences in the distribution of the virulence plasmids found in the five countries and suggested that the restriction fragment length polymorphism of virulence plasmids might be useful to elucidate the molecular epidemiology of virulent R. equi in the world.
Plasmids↗
Efficacy of low load resistive muscle training in patients with rheumatoid arthritis functional class II and III.
OBJECTIVE: To determine the effect of a low load resistance exercise training program on muscle strength, functional outcome, and cardiovascular endurance. METHODS: Forty-nine patients, 37 women and 12 men between the ages of 35-76 yrs (mean 60.5 yrs), with definite rheumatoid arthritis (RA) functional class II and III (mean disease duration of 10.5 yrs) were randomly assigned to exercise and control groups for a 12 wk resistive muscle training program. A circuit weight bearing form of training was incorporated using light loads with high repetitions. A video tape demonstrating the exercises was given to all exercising participants to enable them to continue the program at home at least 3 times per wk with a biweekly self-report evaluation. Baseline and post-intervention evaluations included joint activity, muscle strength, endurance, functional outcome, and self-report. Cardiovascular fitness measured by treadmill time, anaerobic threshold and peak oxygen consumption (VO2) in this group were assessed at baseline and 12 wks. RESULTS: A significant improvement at 12 wks was noted in the exercise group for self-reported joint count (p = 0.02), number of painful joints (p = 0.004), HAQ (p = 0.012), sit-to-stand time (p = 0.02), grip strength (p = 0.05) knee extension 60 degrees (p = 0.03), Arthritis Impact Measurement Scales dexterity (p = 0.02), and time to anaerobic threshold (p = 0.03). Significant improvement in the exercise group compared to the control group was noted for self-reported joint count (p = 0.02), night time pain (p = 0.05), and sit-to-stand time (p = 0.02). Increase in treadmill time was not statistically significant nor was a change in peak oxygen consumption (VO2) noted. Abnormalities on initial treadmill screening were detected in 2 of 49 asymptomatic patients. They were excluded from the study and subsequent workup revealed significant coronary artery disease. CONCLUSION: Low load resistive muscle training increased functional capacity as reported by patients and is a clinically safe form of exercise in functional class II and III RA. Screening this population for dormant coronary artery disease is recommended.
Adult↗
An instrument for dissecting the esophagus.
BACKGROUND: We describe an instrument for mobilizing the normal esophagus without thoracotomy. It is essentially a metal ring introduced through the neck that encircles the esophagus, separating it from surrounding tissues. METHODS: Preliminary studies of 12 cadavers were followed by clinical application in 18 patients with esophageal carcinoma and two with benign esophageal lesions. RESULTS: Pneumothorax occurred in 20%, recurrent laryngeal nerve palsy in 25% (4 of 5 were transient), and thoracotomy for postoperative bleeding from the tumor bed in two cases. No anastomotic leakage occurred. Mortality rate at 30 days after operation was 15%, with an in-hospital mortality rate of 20%. Use of the instrument did not cause any of the described complications. In one patient the esophageal carcinoma was adherent to the trachea, which was injured. No incidence of hypotension or arrhythmia was observed during thoracic esophageal dissection. Blood loss from the mediastinum wa unremarkable. The treatment by stripping is a palliative treatment and precludes a radical curative attempt. The use of this instrument is contraindicated in lesions of the upper and middle parts of the esophagus, and it is not intended to strip a bulky esophagus as in achalasia. CONCLUSIONS: The esophageal dissector made mobilization of the normal thoracic esophagus easier and less time consuming, and yielded no episodes of hypotension or arrythmia.
Adult↗
Fortress Bethesda.
Critics within and outside the National Institutes of Health say that NIH's central administration is hostile and defensive and needs to be shaken up. They hope a new director will do just that.
Administrative Personnel↗
The use of do-not-hospitalize orders by family physicians in Ohio.
A sample of Ohio family physicians was surveyed by mail questionnaire regarding physician attitudes and practices concerning do-not-hospitalize (DNH) orders. One hundred seventy-three of the 210 physicians who completed the survey provided care for patients in nursing homes. Fifty-eight percent of physicians caring for nursing home patients were familiar with the concept of do not hospitalize, and 42% had utilized a DNH order. The most commonly named reasons for using a DNH order were patient's terminal condition and patient's request. The most common reasons physicians did not use a DNH order were because of family objections and the inability of nursing homes to deliver intravenous antibiotics and fluids. Almost all physicians had encountered a clinical situation where a DNH order might be appropriate, and 73% of physicians familiar with the DNH concept had utilized the order. Familiarizing more physicians with the concept of DNH orders may have great potential for reducing health care costs and preserving patient autonomy. Future studies are needed to validate the concept of do not hospitalize.
Adult↗
Repair of old complete perineal lacerations.
Our subjects were 32 patients whose old complete perineal lacerations were repaired in the 10 hospitals in the South Hampton Roads Metropolitan area over a 20-year period. The layer technique of repair (26 patients) and the Warren flap procedure (6 patients) were used. Function improved in 24 of 26 patients (92%) with adequate follow-up. Function was completely restored in 22 of 26 patients (85%). The use of a careful mechanical and antimicrobial bowel prep is emphasized, as is the debatable use of the paradoxical incision (Miller).
Adolescent↗
Treatment limitations in nursing homes in northwest Ohio.
Eighty-eight nursing homes in northwest Ohio were surveyed by telephone regarding the acceptance of "do not resuscitate" (DNR) and "do not hospitalize" (DNH) orders. Written protocols addressing these issues were requested, if available. Eighty-three of the 88 homes participated in the survey. Seventy-five percent of nursing homes accept DNR orders, while 35% accept DNH orders. The most common qualifying condition for a DNR/DNH order was the approval of the family. Although 32 homes stated that they have written protocols, only eight were made available for review. The authors concluded that DNR orders are widely accepted in nursing homes in northwestern Ohio. However, DNH orders are less likely to be accepted in northwest Ohio long-term facilities and the use of written protocols is even more limited.
Clinical Protocols↗
Identification and quantitation of indole-3-acetic and abscisic acids in the cambial region of Quercus robur by combined gas chromatography-mass spectrometry.
A technique is described for the rapid purification of indole-3-acetic acid (IAA) and abscisic acid (ABA) from small quantities of the basal trunk cambial region tissues of 34-year-old trees of Quercus robur L. Mass spectra of IAA and ABA obtained from the purified extracts provide the first reported unequivocal identification of endogenous IAA and ABA in the cambial region of a hardwood species. By use of the combined gas chromatography-mass spectrometry technique of multiple ion monitoring, with deuterated analogs as internal standards, it was shown that the levels of IAA in the cambial region tissues varied from ~1 to ~20 microg g(-1) and those of ABA from ~1 to ~5 microg g(-1) dry weight during the growing season. The high levels of IAA are similar to those found in the newly differentiating xylem tissues of softwoods.
Journal Article↗
Joint practice: a rural hospital can make it work.
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Cooperative Behavior↗