Showing papers by "Leicester Royal Infirmary published in 1991"
TL;DR: It is confirmed that cyclosporin is a safe and effective short-term treatment for severe, refractory atopic dermatitis.
371 citations
TL;DR: The condition is genuine and distressing and the cause lies in some localised musculoskeletal abnormality in the coccygeal region and there is no evidence of neurosis in patients.
Abstract: A five-year prospective trial involving 120 patients was undertaken to investigate the aetiology and treatment of coccydynia. The cause lies in some localised musculoskeletal abnormality in the coccygeal region. Lumbosacral disc prolapse is not a significant factor. The condition is genuine and distressing and we found no evidence of neurosis in our patients. Physiotherapy was of little help in treatment but 60% of patients responded to local injections of corticosteroid and local anaesthesia. Manipulation and injection was even more successful and cured about 85%. Coccygectomy was required in almost 20% and had a success rate of over 90%.
153 citations
TL;DR: Five antibodies directed against the whole or part of p53 protein have been used to detect the protein immunohistochemically in 70 infiltrating breast carcinomas and 10 ductal carcinomas in situ.
Abstract: Five antibodies directed against the whole or part of p53 protein have been used to detect the protein immunohistochemically in 70 infiltrating breast carcinomas and 10 ductal carcinomas in situ. Mutations are known to occur in different conserved domains, and the antibodies employed spanned the expected sites. p53 protein was identified in 53 per cent of infiltrating carcinomas using the antibodies PAb 240, PAb 1801, C19, and JG8. The antibody PAb 421 detected the protein in 31.5 per cent; all positive with the other antibodies. Well-differentiated oestrogen receptor-positive tumours had a low incidence of p53 detection. Variation in the percentage of reactivity was seen between carcinomas and in some cases between different antibodies in the same cancer. Those carcinomas with a high percentage of positive cells with all antibodies were more likely to have metastasized to nodes, be at an advanced stage, and be oestrogen receptor-negative/epidermal growth factor receptor-positive. There was no significant correlation with c-erbB-2 protein expression or retinoblastoma protein loss. p53 protein was detected in a high proportion of cells in three of the six comedo ductal carcinomas in situ studied but either not at all or at a lower level in tumours of the cribriform type. p53 mutations are common in breast carcinomas, but heterogeneity within individual tumours is frequent. Marked expression of p53 appears to relate to tumour progression.
148 citations
01 Jul 1991
TL;DR: It is shown that Asian subjects have a higher prevalence of SLE with greater systemic disease and mortality than white subjects, and nineteen Asian subjects were positive for extractable nuclear antigens as well, at some stage of their disease.
Abstract: All patients with systemic lupus erythematosus (SLE) (American Rheumatism Association criteria with positive antinuclear antibody titre) and who attended any of the three general hospitals in Leicester over a 10 year period were ascertained using several complementary sources Eighty seven subjects (26 Asian, 61 white) were identified The estimated prevalence of SLE in Leicester is 04/1000 for Asian and 02/1000 for white subjects Mean age of onset of the disease was 24 years in Asian and 31 years in white subjects, with both groups showing a female preponderance Proteinuria (greater than 1 g/24 h) was noted in 15 (58%) Asian and 21 (35%) white subjects; neuropsychiatric disease in 10 (38%) Asian and 8 (13%) white subjects; myalgic symptoms with raised muscle enzymes in 9 (35%) Asian and 3 (5%) white subjects Nineteen (73%) Asian subjects were positive for extractable nuclear antigens as well, at some stage of their disease, compared with 6 (10%) white subjects Immunosuppressive treatment was required in 12 (46%) Asian and 12 (20%) white subjects, and deaths of seven Asian and five white subjects were attributed to SLE These findings show that Asian subjects have a higher prevalence of SLE with greater systemic disease and mortality
147 citations
TL;DR: The degree of response was not affected by capsule composition in the renal subcapsular space, but in the peritoneum, the high mannuronic acid alginate capsules provoked the weakest response, and this type of capsule will be used for future transplantation work.
Abstract: The encapsulation of islets of Langerhans in alginate-poly-1-lysine has been proposed as a method for the immunoprotection of transplanted islets. Although several capsule compositions have been reported, there has been no published study concerning the effect of capsule composition on the severity of the foreign body reaction.Empty capsules were prepared from high mannuronic acid alginate and were coated with: (1) poly-1-lysine alone, (2) poly-1-lysine plus high guluronic acid alginate, or (3) poly-1-lysine plus high mannuronic acid alginate. The capsules were placed in the renal subcapsular space or the peritoneal cavity, and retrieved after three weeks for histological examination. The recipients were WAG/01a, nude (athymic), diabetic BB, and non-diabetes prone BB rats. The severity of reaction to the capsules was determined by measuring the thickness of the pericapsular cell infiltrate or by a scoring system.The severity of the reaction to the capsules was strain-dependent in both the renal an...
112 citations
01 Nov 1991
TL;DR: In incidence estimates for amblyopia are presented using data from a study of a cohort of 364 children from a single English county who were referred during 1983 for occlusion therapy, finding that 3.0% of the county's children develop the condition.
Abstract: We present incidence estimates for amblyopia using data from a study of a cohort of 364 children from a single English county who were referred during 1983 for occlusion therapy. Using a criterion of a visual acuity of 6/12 or worse to define amblyopia, we estimate that 3.0% of the county's children develop the condition. Successful treatment of some of these children means that 1.9% will remain amblyopic as adults.
110 citations
TL;DR: The current state of undergraduate education in British medical schools is examined and a fundamental rethink of the role of medical schools in producing the doctors of tomorrow is needed.
Abstract: There is a growing concern that all is not well with undergraduate medical education. Indeed, repre? sentatives of 67 countries at the world conference on medical education in 1988 were in little doubt that medical education is in a poor state.1 Furthermore, one medical dean has referred to a crisis in undergraduate education,2 and some of the shortcomings of medical education have been referred to as scandals.3 In 1987 and again in 1988 the General Medical Council (GMC) education committee reported that British medical schools were having difficulty in achieving their educational objectives.45 (The claim that medical schools actually had educational objectives came as a considerable surprise to many working within them.) The GMC blamed reductions in funding of the university system and the financial constraints on the NHS. Loss of academic staff between 1981 and 1987 was equivalent to the closure of two medical schools.6 I believe that the responsibility for this unhappy state of affairs resides within the medical schools. Although a squeeze on resources has not helped, it has not been the critical factor. I do not believe that improvements in student selection procedures would have a major impact. There is no denying, however, the striking difference between the bright, interesting 18 year olds seen at interview and the weary, dis? illusioned, unquestioning absorbers of information seen during the clinical years. The most influential factor in this change must be medical school. Undergraduate teaching is uneven in quality, variable in commitment, and lacking in coordinated objectives.2 The main problem is that British medical schools are attracting some of the most able young people in the country and simply boring them to death. The consequence is that the students are the losers. And if medical students are losing out today, patients will lose out tomorrow.2 I think that patients are already losing out. Indeed, a large proportion of graduates have a poor grasp of clinical logic, are uncertain in their choice of diagnostic tests, make poor decisions in prescribing, have limited communication skills, and have a poor grasp of ethical principles (D Metcalfe, unpublished work). Even more alarmingly, studies have shown that a significant minority of senior medical students and house officers are deficient in the basic clinical skills of taking a history and making a physical examination.7 If matters are to be rectified we need a fundamental rethink of the role of medical schools in producing the doctors of tomorrow. In this paper I examine the current state of undergraduate education.
86 citations
01 Dec 1991
TL;DR: A single‐blind, randomised, controlled study was undertaken to compare the efficacy of three methods of preventing pain during injection of propofol on induction of anaesthesia and found prior injection of cold saline reduced the incidence of pain and discomfort significantly.
Abstract: A single-blind, randomised, controlled study was undertaken to compare the efficacy of three methods of preventing pain during injection of propofol on induction of anaesthesia. Patients were allocated randomly to receive unmodified propofol, propofol with 0.05% lignocaine, propofol at 4 degrees C and unmodified propofol preceded by 10 ml of 0.9% saline at 4 degrees C. Prior injection of cold saline reduced the incidence of pain and discomfort significantly (22%) compared with unmodified propofol (75%; p less than 0.005) and was similar to that after cold propofol (33%) and propofol with lignocaine (44%). There was no significant difference between the treatment groups.
75 citations
TL;DR: Marked heterogeneity in the complications of diabetes in the two ethnic groups studied was found, but must be confirmed from population-based studies.
74 citations
TL;DR: It is concluded that the medial content and maximal contractile responses of femoral resistance arteries from SHR and WKY rats are mainly determined by the local perfusion pressure and that normalization of perfusions pressure in SHR normalizes resistance artery structure.
Abstract: The effects of regional hypotension on femoral resistance artery reactivity and morphology were investigated in spontaneously hypertensive rats (SHR) and control Wistar-Kyoto (WKY) rats. A partially constricting ligature (0.4 mm i.d.) was placed around the left external iliac artery at 5 weeks, which resulted in significantly reduced femoral mean arterial pressures distal to the ligature at 12 and 24 weeks. The femoral mean arterial pressure distal to the ligature in SHR was similar to that in WKY unprotected hind limbs. Resistance arteries (approximately 200 microns i.d.) were taken from unligatured and protected hind limbs and mounted in a myograph for reactivity and morphological measurements. Each experiment therefore utilized one artery distal to a ligature and one from the control hind limb. Histological examination revealed that nuclear density differed neither between strains nor between arteries from protected and unprotected femoral beds. Media thickness, media cross-sectional area, and media/lumen ratios were reduced in arteries from the hypotensive hind limb in SHR and WKY rats at 12 and 24 weeks. Arteries from the protected hind limbs of SHR were structurally indistinguishable from those from the normally perfused WKY vasculature. It is concluded that the medial content and maximal contractile responses of femoral resistance arteries from SHR and WKY rats are mainly determined by the local perfusion pressure and that normalization of perfusion pressure in SHR normalizes resistance artery structure.
74 citations
TL;DR: Two short screening tests for dementia, the Information/Orientation (IO) sub-test of the Clifton Assessment Scale (CAPE) and the Mini-Mental State Examination (MMSE) were included in a survey of 1579 elderly people of a large general practice.
Abstract: Two short screening tests for dementia, the Information/Orientation (IO) sub-test of the Clifton Assessment Scale (CAPE) and the Mini-Mental State Examination (MMSE) were included in a survey of 1579 elderly people of a large general practice. All those scoring 21 and under on the MMSE, a one in two sample of those scoring 22, 23 and a one in ten sample of the remainder were investigated further using the Cambridge Examination for Mental Disorders of the elderly (CAMDEX). The prevalences of moderate to severe dementia and mild to severe dementia determined from the CAMDEX interview were 4.8% and 14.2%, respectively. For detection of moderate to severe dementia, a cut-point of 21/22 on the MMSE gave a sensitivity of 100%, specificity of 85% and an overall prevalence of 19.7%; mild to severe dementia was best detected by a cut-point of 23/24 giving a sensitivity of 89%, specificity of 81% and prevalence of 28.5%. A cut-point of 7/8 on the IO sub-test gave a sensitivity and specificity for detecting moderate to severe dementia of 87% and 97%, respectively, with a prevalence of 7.3%; for mild to severe dementia a cut-point of 10/11 gave a sensitivity of 67%, specificity of 94% and prevalence of 14.7%.
TL;DR: On a weight‐adjusted basis statistically significant differences in morphine consumption were demonstrated, although these may not be clinically important, according to the analysis of the cumulative hourly morphine consumption.
Abstract: The analgesic efficacy of subcutaneous wound infiltration with 20 ml of 0.5% bupivacaine after elective lower segment section Caesarean section was studied in 28 patients in a double-blind randomised controlled manner using a patient-controlled analgesia system. The mean 24-hour morphine consumption of the placebo group and the bupivacaine group was similar (76 mg and 68 mg respectively). Analysis of the cumulative hourly morphine consumption failed to show any statistically significant differences between the groups. However, on a weight-adjusted basis statistically significant differences in morphine consumption were demonstrated, although these may not be clinically important. Subjective experiences of pain, nausea and drowsiness assessed by linear analogue scoring were similar in both groups.
TL;DR: It is proposed that metabolic acidosis impairs growth by stimulating skeletal muscle protein catabolism, which forms part of a co-ordinated multi-organ homoeostatic response to acidosis, skeletal muscle and down-regulated urea production supplying the nitrogen required for renal ammoniagenesis.
Abstract: 1. Chronic metabolic acidosis is associated with impaired growth and negative nitrogen balance, suggesting that it promotes endogenous protein catabolism. 2. Skeletal muscle is the major repository of body protein and is a potential target for stimuli of protein catabolism. 3. This study in vivo examines the effects of chronic metabolic acidosis on the relationship between growth, nitrogen disposal and skeletal muscle catabolism in the rat. 4. Growth, nitrogen utilization and acquisition of body mass were significantly impaired in acidotic animals compared with pair-fed controls. 5. Total nitrogen excretion was significantly increased in acidotic rats despite decreased urea production. The time course of this response to acidosis was synchronous with that of accelerated protein catabolism in skeletal muscle. 6. It is proposed that metabolic acidosis impairs growth by stimulating skeletal muscle protein catabolism. It is suggested that this forms part of a co-ordinated multi-organ homoeostatic response to acidosis, skeletal muscle and down-regulated urea production supplying the nitrogen required for renal ammoniagenesis.
TL;DR: The data show a significant difference in the number of residual pellets in the small bowel of the treated group (n=40), when compared with the control group (P < 0.0001), and the inefficiency of gastric-emptying procedures is highlighted.
Abstract: A prospective, randomized, single-blind study was carried out to determine whether gastric content is forced into the small bowel when gastric-emptying procedures are employed in self-poisoned patients. They were asked to swallow barium-impregnated polythene pellets, immediately prior to either gastric lavage or ipecacuanha-induced emesis. A second group of patients, who did not require treatment, were used as controls. Sixty patients were recruited to the study. The data show a significant difference in the number of residual pellets in the small bowel of the treated group (n = 40), when compared with the control group (P less than 0.0001). There was no statistical difference in the number of pellets in the small bowel when the treated groups were compared with each other. In addition, the inefficiency of gastric-emptying procedures is highlighted; 58.5% of the total number of pellets ingested were retained in the gastrointestinal tract of the ipecacuanha-treated group, while 51.8% of total pellets ingested were retained in the gastric lavage-treated group.
TL;DR: It is concluded that Breslow depth and Clark's level should not be the sole basis of wide excision protocols because of the high degree of observer variation and where surgical management is potentially disfiguring it is not high enough.
Abstract: We have assessed the degree of observer variation of both Breslow depth and Clark's level in a series of 50 thin malignant melanomas. Our findings are similar to those of previous international studies in the Breslow depth is the more reproducible measure. Significant intra- and inter-observer variation exists and in some cases it was up to +/- 0.86 mm. Even small differences will potentially affect patient management at our centre and this was analysed using kappa statistics. Good agreement was found between observers and this could be improved by comparing the mean of two or more measurements. This removes larger errors, but smaller observer errors and differences in subjective interpretation of the deepest malignant cell mean that agreement will never be more than 90 per cent. This is high compared with studies of observer variation in other pathological conditions, e.g., dysplasia of the cervix, but where surgical management is potentially disfiguring it is not high enough. We conclude that Breslow depth and Clark's level should not be the sole basis of wide excision protocols.
TL;DR: Results support the policy that there should be a more centralised neonatal service for those infants at or below 28 weeks' gestation.
Abstract: In a one year prospective study in the Trent region we examined the short term outcome (survival to discharge) of all infants who required admission to a baby care unit. Infants of less than or equal to 28 weeks' gestation who received all their perinatal care in one of five large centres (each providing more than 600 ventilator days/year) showed significantly better survival rates than infants electively treated throughout their entire course at one of the 12 smaller units (34 survivors from 65 infants (52%) compared with eight survivors from 37 infants (22%). These differences occurred despite the elective transfer of many of the sickest infants from the smaller units to the larger. Differences in survival between more mature infants were not significant. These results support the policy that there should be a more centralised neonatal service for those infants at or below 28 weeks' gestation.
TL;DR: Study of the effect of varying the timing of a prior dose of intravenous lignocaine 1.5 mg/kg on the cardiovascular and catecholamine responses to tracheal intubation found a significant increase in heart rate and mean arterial pressure.
Abstract: Summary
We have studied the effect of varying the timing of a prior dose of intravenous lignocaine 1.5 mg/kg on the cardiovascular and catecholamine responses to tracheal intubation. Forty healthy patients were given an intravenous injection of either placebo or lignocaine 2, 3 or 4 minutes before tracheal intubation. There was a significant increase in heart rate of 21–26% in all groups. There was no significant increase in mean arterial pressure in response to intubation in any group of patients given lignocaine before intubation, but in the placebo group, mean arterial pressure increased by 19.1% compared to baseline values (p < 0.05).
TL;DR: The study provides direct evidence that the gastric decontaminating procedures employed, and especially gastric lavage, do not remove stomach contents completely.
Abstract: Flexible endoscopy was used to assess the intragastric residue after either ipecacuanha-induced emesis or gastric lavage in 30 self-poisoned patients. Of the 13 patients treated by induced-emesis, five (38.5%) had residual solid in the stomach; 17 patients were treated by gastric washout, and 15 (88.2%) of these had residual intragastric solid. The study provides direct evidence that the gastric decontaminating procedures employed, and especially gastric lavage, do not remove stomach contents completely.
TL;DR: The clinical features were diagnostic in all cases, although three had undergone vulval biopsy under general anaesthesia prior to being seen by a dermatologist, and there was a trend towards improvement with increasing age.
Abstract: We report a series of 15 girls who developed lichen sclerosus between the ages of 18 months and 9 years. Only five of these were initially referred to a dermatologist and the diagnosis was made promptly in these cases on the first visit to the clinic. The diagnosis was usually delayed under disciplines less familiar with the disease. We encountered a high level of parental anxiety regarding the possibility of misdiagnosis of lichen sclerosus as childhood sexual abuse. Dysuria and pain on defaecation were common and prominent symptoms which have not previously been stressed adequately. The clinical features were diagnostic in all our cases, although three had undergone vulval biopsy under general anaesthesia prior to being seen by a dermatologist. There was a trend towards improvement with increasing age.
TL;DR: In this article, the authors investigated the effect of these cytokines, alone or in combination, on the function and viability of human islet cells in vitro and concluded that the combination of IFN-γ and TNF-α exerts a cytotoxic effect on human β cells.
TL;DR: It is suggested that the test can predict dopa responsiveness in IPD and may be of help in confirming a doubtful diagnosis and it has potential value in differentiating IPD from PPS.
Abstract: The dopamine receptor agonist apomorphine has been used successfully to treat on-off swings in Parkinson's disease. Its value as a predictor of dopa responsiveness in idiopathic Parkinson's disease (IPD) was assessed and its potential role in differentiating IPD from the Parkinsonian plus syndromes (PPS) of multisystem atrophy, progressive supranuclear palsy and olivopontocerebellar atrophy was investigated. The response to an injection of apomorphine was observed in 20 patients with IPD and eight with PPS after being off levodopa for 12 hours. Patients were reassessed after taking levodopa for one month. Nineteen of the 20 patients (95%) with IPD showed a positive response to apomorphine and 18 (90%) to oral levodopa. In the PPS group, two patients (25%) responded to the apomorphine injection but not to oral levodopa. Apomorphine produced severe drowsiness in the PPS patients. It is suggested that the test can predict dopa responsiveness in IPD and may be of help in confirming a doubtful diagnosis. It has potential value in differentiating IPD from PPS.
TL;DR: The results suggest that the technique is sufficiently sensitive to detect EBV in persistent latent infection in B‐lymphocytes, and distinguishes between virus present as a possible aetiological agent of malignancy or as a latent infection when PCR is used under these conditions.
Abstract: The presence of Epstein-Barr virus (EBV) DNA in biopsy tissues from patients with Hodgkin's disease (HD) was investigated by the polymerase chain reaction (PCR) using primers specific to a sequence within the EBV Bam H1W region. EBV genome was detected in 33 of 57 (58 per cent) cases of HD. Viral DNA was, however, also demonstrated in nine of 24 non-Hodgkin's lymphomas, in three of nine non-neoplastic lymph nodes and in seven of 12 normal peripheral blood samples used as controls. In all cases, the band obtained following PCR was verified using Southern blotting and hybridization with highly specific Bam H1W probes. The results suggest that the technique is sufficiently sensitive to detect EBV in persistent latent infection in B-lymphocytes. Distinction between virus present as a possible aetiological agent of malignancy or as a latent infection is not possible when PCR is used under these conditions. The possible role of EBV as an aetiological agent of HD remains unresolved.
TL;DR: A very worthwhile reduction of suxamethonium myalgia by pretreatment with a nondepolarising drug was demonstrated, and much additional information about other aspects of postoperative morbidity in daycase patients can be obtained which would be otherwise unobtainable by other methods.
Abstract: bothering to minimise morbidity from the anaesthetic, as the authors suggest. Our study,’ quoted by the authors as a failure of benzodiazepine pretreatment, demonstrated a very worthwhile reduction of suxamethonium myalgia by pretreatment with a nondepolarising drug. We had been careful to separate myalgia from obvious abdominal wall and shoulder tip pain caused by the laparoscopy itself, from that caused by suxamethonium. We do not believe postal questionnaire or telephone enquiry to be valid methods of postoperative assessment. Our recently completed study of daycase dental patients involved domiciliary postoperative assessment.** Only in this way is it possible to separate operative morbidity from that resulting from anaesthesia. Furthermore, much additional information about other aspects of postoperative morbidity in daycase patients can be obtained which would be otherwise unobtainable by other methods.
TL;DR: The topographical and age distributions of SNC, but not those of ENC, parallels the topography and age incidence of appendiceal carcinoid tamours, suggesting that most appendicea carcinoid tumours arise from SNC rather than ENC.
Abstract: In order to clarify the histogenesis of appendiceal carcinoid tumours, epithelial (ENC) and subepithelial (SNC) neuroendocrine cells were counted at four sites in 50 normal appendices stained by standard argyrophil and argentaffin techniques. In general, ENC were present in similar number at all sites within the appendix, whereas SNC were more numerous at the tip than at the base. The number of ENC was similar throughout life, apart from an increase in one neonate and some elderly patients, whereas SNC were maximal in young adults. Thus, the topographical and age distributions of SNC, but not those of ENC, parallels the topographical and age incidence of appendiceal carcinoid tumours, suggesting that most appendiceal carcinoid tumours arise from SNC rather than ENC.
TL;DR: In this paper, the intracellular pH and Na+/H+ antiport activity were determined by a fluorimetric method in cultured skeletal muscle cells (myoblasts) and aortic vascular smooth muscle cells from spontaneously hypertensive and normotensive Wistar-Kyoto rats.
Abstract: 1. Intracellular pH and Na+/H+ antiport activity were determined by a fluorimetric method in cultured skeletal muscle cells (myoblasts) and aortic vascular smooth muscle cells from spontaneously hypertensive and normotensive Wistar-Kyoto rats. 2. The intracellular pH was significantly more alkaline at three different extracellular pH values in both myoblasts and vascular smooth muscle cells from the spontaneously hypertensive rats than in those from the normotensive control rats. 3. A kinetic analysis of the Na+/H+ antiport activity in these cells showed that the raised activity in the spontaneously hypertensive rats was due to an increased maximal transport capacity in vascular smooth muscle cells and to an increase in the affinity of the antiport for internal H+ in the myoblasts. 4. When the extracellular pH was reduced in the skeletal muscle cells of both types of rat, the intracellular pH fell. However, in vascular smooth muscle cells, a reduction in the extracellular pH was not associated with a fall in the intracellular pH. This resistance of the intracellular pH to changes in the extracellular pH differentiates vascular smooth muscle cells from other cells that have been studied in this way.
Journal Article•
TL;DR: A case of human polyomavirus-associated HC is reported, in whom treatment with vidarabine was associated with a dramatic response and may persist for many months.
Abstract: The human BK and JC polyomaviruses are known to be reactivated and excreted in the urine following bone marrow transplantation (BMT). A proportion of patients who excrete BK virus following BMT experience a haemorrhagic cystitis (HC), which may persist for many months. We report a case of human polyomavirus-associated HC, in whom treatment with vidarabine was associated with a dramatic response.
TL;DR: It was concluded that the cytoplasmic immunoglobulin frequently detected within these cells by immunocytochemistry is present not as a result of synthesis, but as a results of some other mechanism.
Abstract: In situ hybridization techniques were used to detect immunoglobulin light chain messenger RNA (mRNA) in 28 formalin-fixed, paraffin-embedded samples of Hodgkin's disease. Cocktails of biotinylated oligonucleotide probes specific for the constant regions of kappa and lambda light chain mRNA were used. None of the Reed-Sternberg cells or their variants in any of the cases studied showed positive staining with either probe, in contrast to normal plasma cells which showed strong staining in the same sections. It was concluded, therefore, that the cytoplasmic immunoglobulin frequently detected within these cells by immunocytochemistry is present not as a result of synthesis, but as a result of some other mechanism.
TL;DR: There were no significant differences between the two groups in mean 24 hour postoperative morphine consumption, subjective experience of pain, nausea and sedation assessed by visual linear analogue scoring, and the postoperative requirements for antiemetic therapy.
Abstract: Summary
The incidence of nausea and vomiting following patient controlled analgesia and intramuscular morphine injections on demand was compared in a double-blind randomised study of 32 healthy patients undergoing elective cholecystectomy. There were no significant differences between the two groups in mean 24 hour postoperative morphine consumption, subjective experience of pain, nausea and sedation assessed by visual linear analogue scoring, and the postoperative requirements for antiemetic therapy.
TL;DR: Better patient education may minimize misuse of the service allowing better care for those who need it, according to a study of why patients reattend an A&E department.
Abstract: To determine why patients reattend an A&E department we surveyed 235 patients who returned unscheduled in a one-month period Sixty-two per cent returned because of persistent symptoms Sixty-three per cent presented within a week of their initial visit Only 32% had attempted to see their GP Thirty-five per cent of all patients claimed that A&E staff had advised them to return if they had problems Half of the patients did not require treatment and 61% were discharged home Twenty-one patients had pathology that had been missed on their first visit Better patient education may minimize misuse of the service allowing better care for those who need it
TL;DR: The establishment of a human endocrine pancreatic cell line obtained by transfection using a plasmid containing the early region of SV40 viral DNA indicates the feasibility of immortalizing human islets by transinfection with viral oncogenes.