Thermal lattice boltzmann simulation for multispecies fluid equilibration

The equilibration rate for multispecies fluids is examined using thermal lattice Boltzmann simulations. Two-dimensional free-decay simulations are performed for effects of velocity shear layer turbulence on sharp temperature profiles. In particular, parameters are so chosen that the lighter species is turbulent while the heavier species is laminar-and so its vorticity layers would simply decay and diffuse in time. With species coupling, however, there is velocity equilibration followed by the final relaxation to one large co- and one large counter-rotating vortex. The temperature equilibration proceeds on a slower time scale and is in good agreement with the theoretical order of magnitude estimate of Morse [Phys. Fluids 6, 1420 (1963)].

Prion protein immunoreactivity in brain samples from an unselected autopsy population: findings in 200 consecutive cases

Immunostaining for prion protein (PrP) using the KG9 monoclonal antibody was undertaken on brain sections from an unselected group of 200 post-mortem cases. One case of clinically diagnosed vCJD was confirmed and showed widespread abundant PrP immunostaining with KG9 and somewhat less abundant PrP with another monoclonal antibody, 3F4. PrP immunostaining seen with KG9 was insensitive to proteinase K pretreatment in sections from this case of vCJD. Among the remaining 199 cases, sections from 84 (42%) showed small amounts of PrP immunoreactivity with the KG9 antibody, mainly localized to neurones, neural processes and argyrophilic plaques of the type seen in ageing and Alzheimer's disease. Purkinje cells, swollen (ischaemic) axons, macrophages and microglials cells were also occasionally labelled with this antibody in non-CJD cases. Pre-treatment of adjacent sections from non-CJD cases with positive KG9 staining abolished this staining, indicating that it represented the cellular form of PrP. There were differences in age, sex and cause of death in non-CJD cases with some PrP immunostaining patterns compared with cases lacking any staining. Specifically, a younger mean age, more females and fewer cardiac deaths were found among those with neuronal PrP staining patterns. Staining of some features was also significantly associated. These findings need to be taken into account when PrP immunostaining is used to diagnose prion diseases. They may indicate that cellular PrP is increased in the human brain under some circumstances and provide insight into the handling of this protein by human brain cells.

Aggressive endometriosis: report of a case

A 54-year-old premenopausal woman presented with abdominal pain, constipation, and raised serum CA-125 levels during routine follow-up of a low-grade endometrial stromal sarcoma with prominent sex cord-like features, which had been treated by vaginal hysterectomy 4 years previously. The findings at laparotomy included: a 100-mm unilocular thick-walled right ovarian cyst, a solid 25-mm nodule in the left meso-ovarium, and a phlegmonous mass in the wall of the sigmoid colon, which proved to be a pericolic abscess due to diverticular disease. The ovarian cyst was a histologically benign endometrioid cystadenoma with stromal luteinization in the wall. Small islands of morphologically benign endometrial tissue were present in vessels of the meso-ovarium. The left adnexal nodule exhibited florid morphologically benign endometriosis, much of which was within and occluding large vascular spaces, and of apparently recent onset. No lesions resembled, in any way, the original stromal sarcoma. There was no evidence of endometriosis elsewhere in the pelvis or abdomen. The patient has made an uneventful recovery and is being monitored, as before, by tumor markers only. The discordance in morphology between the uterine sarcoma and the subsequent pelvic lesions was so complete as to raise doubts about any pathogenetic relationship between them. We propose the use of the term aggressive endometriosis to describe the changes observed.

Primary, nonsyndromic vesicoureteric reflux and its nephropathy is genetically heterogeneous, with a locus on chromosome 1

Primary vesicoureteric reflux (VUR) affects 1%-2% of whites, and reflux nephropathy (RN) causes up to 15% of end-stage renal failure in children and adults. There is a 30-50-fold increased incidence of VUR in first-degree relatives of probands, compared with the general population. We report the results of the first genomewide search of VUR and RN; we studied seven European families whose members exhibit apparently dominant inheritance. We initially typed 387 polymorphic markers spaced, on average, at 10 cM throughout the genome; we used the GENEHUNTER program to provide parametric and nonparametric linkage analyses of affected individuals. The most positive locus spanned 20 cM on 1p13 between GATA176C01 and D1S1653 and had a nonparametric LOD score (NPL) of 5.76 (P=.0002) and a parametric LOD score of 3.16. Saturation with markers at 1-cM intervals increased the NPL to 5.94 (P=.00009). Hence, VUR maps to a locus on chromosome 1. There was evidence of genetic heterogeneity at the chromosome 1 locus, and 12 additional loci were identified genomewide, with P<.05. No significant linkage was found to 6p, where a renal and ureteric malformation locus has been reported, or to PAX2, mutations of which cause VUR in renal-coloboma syndrome. Our results support the hypothesis that VUR is a genetic disorder.

The London handicap scale: a re-evaluation of its validity using standard scoring and simple summation

OBJECTIVE

To assess the validity of the London handicap scale (LHS) using a simple unweighted scoring system compared with traditional weighted scoring

METHODS

323 patients admitted to hospital with acute stroke were followed up by interview 6 months after their stroke as part of a trial looking at the impact of a family support organiser. Outcome measures included the six item LHS, the Dartmouth COOP charts, the Frenchay activities index, the Barthel index, and the hospital anxiety and depression scale. Patients' handicap score was calculated both using the standard procedure (with weighting) for the LHS, and using a simple summation procedure without weighting (U-LHS). Construct validity of both LHS and U-LHS was assessed by testing their correlations with the other outcome measures.

RESULTS

Cronbach's alpha for the LHS was 0.83. The U-LHS was highly correlated with the LHS (r=0.98). Correlation of U-LHS with the other outcome measures gave very similar results to correlation of LHS with these measures.

CONCLUSION

Simple summation scoring of the LHS does not lead to any change in the measurement properties of the instrument compared with standard weighted scoring. Unweighted scores are easier to calculate and interpret, so it is recommended that these are used.

Surgery and post-operative radiotherapy for early stage cervical cancer

The use of post-operative radiotherapy in the treatment of cervical cancer is controversial. The aim of this study was to document the results and toxicity of adjuvant irradiation in patients with Stage 1B and 2A cervical cancer. We performed a retrospective review of all patients treated with post-operative radiotherapy at Royal Prince Alfred Hospital between 1986 and 1993. Patient, tumour and treatment factors and late toxicity were recorded. Relapse-free and overall survival were calculated. Eighty-one patients form the study population. The median follow-up was 6.1 years. Fifty-eight patients (72%) had stage 1B cervical cancer and 23 (28%) stage 2A. The 5 year relapse-free and overall survival were 78% and 80% respectively. Six patients (7%) had late toxicity requiring inpatient medical treatment and 6 patients (7%) required surgery. The survival was comparable to other series reported in the literature. There was an incidence of 14% late toxicity requiring medical or surgical intervention which is greater than with hysterectomy or pelvic irradiation alone. Clinical prognostic factors should be used to select patients for either surgery or radiotherapy alone to minimise the increased toxicities associated with a combination of surgery and radiotherapy.

Production of live foals from sperm-injected oocytes harvested from pregnant mares

In vitro fertilization in horses has been less successful than anticipated owing to: (i) the inability to collect large numbers of good quality oocytes; (ii) alterations in the zona pellucida that occur during in vitro maturation of equine oocytes; and (iii) inadequate preparation of equine sperm cells. In addition, studies in humans, mice and cattle have indicated that high concentrations of glucose in culture media may inhibit embryonic development in vitro and this may also be a problem for development of equine embryos in vitro. The aims of the present study were: (i) to achieve fertilization of equine oocytes by sperm injection; and (ii) to determine whether culture media containing low concentrations of glucose are beneficial for the development of early stage equine IVF-derived embryos. In Expt 1, in vitro matured oocytes obtained from pregnant mares were subjected to intracytoplasmic sperm injection (ICSI), subzonal sperm injection (SUZI) or one of three control treatments. The cleavage rates were greater for oocytes subjected to ICSI (39%) than for oocytes subjected to SUZI (6%) (P < 0.05). The transfer of two embryos into one recipient mare resulted in the presence of an embryonic vesicle in the uterine body at day 14 after ICSI, but it was lost subsequently between days 16 and 18 after ICSI. In Expt 2, oocytes were subjected to ICSI and cultured for 48 h in either TCM-199 or P-1(TM) medium (glucose- and phosphate-free) supplemented with 15% fetal bovine serum. The cleavage rates for embryos cultured in the two culture media were different (47% and 63% in TCM-199 and P-1(TM), respectively; P < 0.10). In addition, four grade 1 embryos were transferred surgically into the oviducts of four recipient mares 48 h after ICSI. Three pregnancies were identified by ultrasonography by the presence of an embryonic vesicle in the uterine body by day 16 after ICSI. Two of these pregnancies proceeded to term, resulting in the birth of two healthy fillies, one at day 319 and the other at day 328 of gestation.

Early invasive (FIGO stage IA) carcinoma of the cervix: a clinico-pathologic study of 476 cases

The clinical and histologic features of 476 tumors fitting the 1995 FIGO definition of stage IA cervical cancer, treated at a Sydney tertiary referral hospital between 1953 and 1992, are reviewed. Five-year follow-up was complete with a median of 10 years. The diagnosis was increasingly made by histologic examination of colposcopically directed cone biopsy. The majority (88%) of tumors were squamous. The proportion of both younger women (</=35 years) and adenocarcinoma and adenosquamous tumors increased during the second half of the study. Nearly half invaded 1 mm; a third 1.1-3 mm and 20% 3.1-5 mm. Lymph vascular space invasion (LVSI) increased with increasing depth of invasion and was present in over half the tumors invading >3 mm. Treatment was surgical in 99% and was increasingly more conservative as the study progressed with no apparent increase in treatment failure. From 1973 treatment by cone biopsy rose from 6.5 to 35%, by radical hysterectomy fell from 51 to 21% and by lymphadenectomy from 53 to 26%. Only one of 115 patients treated by cone biopsy died. Positive lymph nodes were detected in 1.7% of 180 patients undergoing lymphadenectomy. There were 16 recurrences (3.4%); six vaginal with no cancer deaths, nine pelvic and one distant, with nine deaths and three new cancers (two deaths). Univariate analysis suggests that older age, glandular tumors and those invading 3 mm were associated with more treatment failures and multivariate analysis showed that both conservative hysterectomy and the omission of lymphadenectomy are associated with higher recurrence rates with >3 mm invasion. The study failed to resolve the dilemma of predicting those tumors with a poor prognosis.

Innovations in neonatal case management: an integrated, data-driven approach

The intent of this article is to provide one company's perspective on the challenging and complex care management of the high-risk neonate. The strategies presented herein should enable and encourage case managers to implement an integrated management process for the frail neonatal population.

Argument for the surgical staging of apparent early endometrial cancer

Cancer of the uterine corpus, commonly referred to as cancer of the endometrium or cancer of the uterus, continues to be the most common pelvic genital malignancy affecting western women (1). In 1998 in the United States 36,100 women were diagnosed with this cancer, and there were 6,300 deaths from this condition in that year. Of concern is that despite a relatively stable incidence over the last decade, the annual number of deaths since 1987 from endometrial cancer has more than doubled (2). Many controversies exist in the management of apparent early endometrial cancer. These include: 1. The role of surgical staging which includes pelvic lymphadenectomy. 2. The role of the subspecialist gynaecological oncologist in primary surgical treatment. 3. Indications for vaginal and external beam radiotherapy. 4. Who is at risk for recurrence? 5. The role of laparoscopic approach to the management of this disease. Despite their importance, these and other issues have not been appropriately addressed by prospective randomized studies. Treatment strategies and algorithms have thus been based upon a combination of clinicopathological studies and uncontrolled reviews. The views expressed in this clinical opinion are those of the Sydney Gynaecologic Oncology Group and reflect our philosophy on the current management of this tumour, supported by recent and appropriate peer reviewed scientific literature.

The art and science of searching MEDLINE to answer clinical questions. Finding the right number of articles

The current medical environment makes information retrieval a matter of practical importance for clinicians. Many avenues present themselves to the clinician, but here we focus on MEDLINE by summarizing the current state of the art and providing an innovative approach for skill enhancement. Because new search engines appear rapidly, we focus on generic principles that can be easily adapted to various systems, even those not yet available. We propose an idealized classification system for the results of a MEDLINE search. Type A searches produce a few articles of high quality that are directly focused on the immediate question. Type B searches yield a large number of articles, some more relevant than others. Type C searches produce few or no articles, and those that are located are not germane. Providing that relevant, high-quality articles do exist, type B and C searches may often be improved with attention to search technique. Problems stem from poor recall and poor precision. The most daunting task lies in achieving the balance between too few and too many articles. By providing a theoretical framework and several practical examples, we prepare the searcher to overcome the following barriers: a) failure to begin with a well-built question; b) failure to use the Medical Subject Headings; c) failure to leverage the relationship between recall and precision; and d) failure to apply proper limits to the search. Thought and practice will increase the utility and enjoyment of searching MEDLINE.

Distribution of topiramate in a medical examiner's case

Topimarate (Topamax) is a novel antiepileptic drug. Its mode of action is multifactorial and involves blockage of voltage-dependent sodium channels. The drug was detected in a 15-year-old epileptic who died soon after switching seizure prescriptions. Topimarate was recovered by basic extraction with ethyl acetate and analyzed by gas chromatography-mass spectrometry using selected ion monitoring. Ions monitored were m/z 324 and m/z 110 for topiramate and m/z 98 for the internal standard mepivacane. The drug was quantitated in blood, vitreous humor, bile, stomach content, and liver: the concentrations were 8.9, 12.4, and 10.9 mg/L, 31 mg/total content, and 29 mg/kg, respectively. Topiramate was detected in urine but not quantitated. Other drugs identified in this case were 0.45 mg/L nordiazepam and 0.05 mg/L oxazepam in blood. No alcohol was detected in any of the specimens. The cause of death was seizure disorder with upper respiratory infection. The manner of death was determined as natural. To our knowledge, this is the first report of the presence of topiramate in postmortem specimens.

Whole abdominal radiotherapy following second-look laparotomy for ovarian carcinoma

AIM

The safety and efficacy of whole abdominal radiotherapy was evaluated as salvage or consolidation treatment for ovarian cancer patients treated with primary surgery and chemotherapy, followed by second-look laparotomy (SLL). Overall survival and acute and late toxicity of treated patients were assessed.

METHODS

Patients were recruited between April 1981 and June 1994. All patients had SLL performed at Royal Prince Alfred Hospital after completion of primary chemotherapy. Data collected included demographic details, diagnosis, tumor stage, histology, grade, adjuvant chemotherapy, and radiotherapy. Radiation dose and fractionation, field size, boost volume and dose, failure to complete treatment and treatment interruptions, renal dose, and acute and late toxicity were recorded.

RESULTS

Fifty-one patients were evaluated; the median age was 51 years. Median follow-up for patients still alive was 62 months. Prior to 1988, chemotherapy comprised oral chlorambucil, with or without cisplatin (n = 25), while after this date all patients (n = 26) received primary cisplatin-based therapy. A radiation dose of 22. 5 Gy over 22 fractions was planned to the whole abdomen followed by a pelvic boost of 22 Gy in 11 fractions. Radiotherapy was completed in 37 (73%) patients. Treatment interruptions were necessary in 12 (24%) patients. Thrombocytopenia, neutropenia, nausea, vomiting, and diarrhea were the main causes of incomplete or interrupted treatment. Late bowel toxicity was seen in 6 (12%) patients, 2 of whom required laparotomy to relieve obstruction. There were no treatment-related deaths. Seven of the 51 patients are alive and free of disease, 2 died from other causes, and 2 are alive with evidence of recurrent or progressive disease. Mean follow-up time for surviving patients is 78.5 months. Overall survival at 2, 5, and 10 years was 65, 27, and 10%, respectively. Residual disease after primary surgery, smaller preirradiation tumor residuum, and completion of radiotherapy were independently associated with improved overall survival.

CONCLUSION

In this poor-prognosis group of patients, a combined approach of surgery, chemotherapy, and radiotherapy, while associated with acceptable toxicity, may not afford a prolongation of survival.

Seeking meaning and hope: self-reported spiritual and existential needs among an ethnically-diverse cancer patient population

Spiritual beliefs and practices are believed to promote adjustment to cancer through their effect on existential concerns, including one's personal search for the meaning of life and death, and hope. This study sought to identify the nature, prevalence, and correlates of spiritual/existential needs among an ethnically-diverse, urban sample of cancer patients (n=248). Patients indicated wanting help with: overcoming my fears (51%), finding hope (42%), finding meaning in life (40%), finding spiritual resources (39%); or someone to talk to about: finding peace of mind (43%), the meaning of life (28%), and dying and death (25%). Patients (n=71) reporting five or more spiritual/existential needs were more likely to be of Hispanic (61%) or African-American (41%) ethnicity (vs. 25% White; p<0.001), more recently diagnosed (mean=25.6 vs. 43.7 months; p<0.02), and unmarried (49% vs. 34%; p<0.05), compared with those (n=123) reporting two or fewer needs. Treatment status, cancer site, education, gender, age, and religion were not associated with level of needs endorsement. Discriminant analysis found minority status to be the best predictor of high needs endorsement, providing 65% correct classification, p<0.001. Implications for the development and delivery of spiritual/existential interventions in a multi-ethnic oncology setting are discussed.

The development of funding policies for hospices: is casemix-based funding an option?

The 1993 health reforms, with their emphasis on the purchasing of defined amounts or units of service, have led to the implementation of casemix-based funding for the acute medical and surgical services of the public hospitals. Despite growing interest in New Zealand in casemix-based funding for non-acute services such as palliative care, the nature of this service and the characteristics of its patient population pose particular difficulties for the development and implementation of casemix. This paper examines the feasibility of implementing casemix-based funding for hospice/palliative care services and discusses the development of casemix classification systems for palliative care. Problems associated with implementing casemix-based funding are considered including: the dual funding of hospices, the multi-agency nature of palliative care service provision and the need for the Health Funding Authority to identify and specify the hospice services it is willing to fund. While it is concluded that these problems will impede the introduction of casemix-based funding of hospice care, they highlight important issues that the hospice movement must address if it is to ensure its future within the new health environment.

Maternal and child health after assisted vaginal delivery: five-year follow up of a randomised controlled study comparing forceps and ventouse

OBJECTIVE

To undertake a five year follow up of a cohort of women and children delivered by forceps or vacuum extractor in a randomised controlled study.

DESIGN

Follow up of a randomised controlled trial.

SETTING

District general hospital in the West Midlands.

POPULATION

Follow up questionnaires were sent to 306 of the 313 women originally recruited at the North Staffordshire Hospital to a randomised controlled study comparing forceps and vacuum extractor for assisted delivery. Two hundred and twenty-eight women responded (74.5%) and all were included in the study; forceps (n = 115) and vacuum extractor (n = 113).

MAIN OUTCOME MEASURES

Bowel and urinary dysfunction, child vision assessment, and child development.

RESULTS

Maternal adverse symptoms at long term follow up were relatively common. Urinary incontinence of various severity was reported by 47%, bowel habit urgency was reported by 44% (98/225), and loss of bowel control 'sometimes' or 'frequently' by 20% of women (46/226). No significant differences between instruments were found in terms of either bowel or urinary dysfunction. Overall, 13% (20/158) of children were noted to have visual problems. There was no significant difference in visual function between the two groups: ventouse 11/86 (12.8%), compared with forceps 9/72 (12.5%); odds ratio 0.97, 95% CI 0.38-2.50. Of the 20 children with visual problems, a family history was known in 18, and 17/18 (94%) had a positive family history for visual problems. No significant differences in child development were found between the two groups.

CONCLUSIONS

There is no evidence to suggest that at five years after delivery use of the ventouse or forceps has specific maternal or child benefits or side effects.