Serological evidence implicating Neospora species as a cause of abortion in British cattle

By means of an immunofluorescence antibody test (IFAT), using in vitro cultured parasites as antigen, antibodies to Neospora species at titres > or = 1/1280 were found in 11 of 120 Scottish cattle that had recently aborted but in only one of 97 cattle from herds in which there had been no recent abortions (P < 0.01). The specificity of the antibodies was confirmed by the lack of cross reactivity between samples with high titres to Neospora and toxoplasma antigen in a direct agglutination test, and by the absence of reactivity at > or = 1/640 in the IFAT of convalescent sera from cattle infected experimentally with Toxoplasma gondii, Sarcocystis cruzi, Eimeria bovis, E alabamensis, Cryptosporidium parvum and Babesia divergens. These results demonstrate that Neospora species infection occurs commonly in aborting cattle in Britain, and that the IFAT may be a useful tool for investigating the infection.

Survival following intentional massive overdose of 'Ecstasy'

A case of intentional overdose with 18 'Ecstasy' tablets is described. 'Ecstasy' is a semi-synthetic hallucinogenic amphetamine and acute adverse reactions follow from the effects of sympathetic stimulation. To our knowledge this is the first reported case of massive intentional overdose reported in the literature.

P300 differences between non-alcoholic young men at average and above-average risk for alcoholism: effects of distraction and task modality

1. P300 event-related electroencephalographic potentials were recorded from 79 young adult males, cross-classified with respect to the presence/absence of a family history of alcoholism (FHA) and the presence/absence of a personal history of antisocial personality (ASP) disorder. P300s were elicited using visual and auditory oddball tasks. Each oddball task was repeated with a tracking task added as a distractor. 2. In general, distraction increased the latencies and reduced the amplitudes of P300s elicited by the oddball stimuli. The P300 latency increase occurred only in low risk ASP- and FHA- groups. There was no adaptive increase in P300 latency in the higher risk ASP+ and FHA+ groups. 3. Group differences in P300 were restricted to visual tasks. No interpretable group differences in P300 latency or amplitude were found during the auditory tasks.

Single fibre EMG studies in chronic fatigue syndrome: a reappraisal

Single fibre EMG studies were carried out on the right extensor digitorum communis muscle in 30 subjects with chronic fatigue syndrome and in 30 age and sex matched controls. Abnormal jitter was seen in five patients with chronic fatigue syndrome. Slight but significant differences between the mean consecutive differences in the remainder of the chronic fatigue subjects and the control subjects were recorded. Overall the differences were so minor that it seems unlikely that a disturbance of neuromuscular function as reflected by jitter measurement has a pathogenetic role. It is suggested that the increased jitter seen may be explained by the effects of the variability of motor unit firing rates on the myogenic component of the jitter.

Prolonged pregnancy: two years experience of offering women conservative management

A prospective study of 199 patients over a two year period, 1 Jun 90 to 31 May 92 at the Louise Margaret Maternity Wing, Cambridge Military Hospital, Aldershot was undertaken to audit the uptake of an offer of conservative management of prolonged pregnancy to women at 42 weeks gestation. The labour outcomes of patients opting for conservative or induction management plans were recorded and the increased workload introduced to the Ultrasound Unit measured. Of the 91/199 (45.7%) patients who chose to be managed conservatively, 20 (22.0%) developed an abnormal result of a test of fetal surveillance, 16 (17.6%) were electively delivered because of an abnormal result. There were no significant differences in labour performance or neonatal outcome between those women opting for conservative management or induction of labour. 201 new ultrasound scans were booked, 129 were performed (0.4 scans/week/1000 deliveries).

Haptoglobin as an indicator of infection in sheep

An automated method for the estimation of the acute phase protein haptoglobin was developed and used to compare the blood haptoglobin concentrations of 42 sheep examined post mortem with other haematological findings in infectious and non-infectious conditions. Haptoglobin was also assayed in 863 sheep from nine apparently normal flocks; of these sheep seven per cent had significantly raised haptoglobin levels. The studies showed that haptoglobin was useful as a marker for the presence of bacterial infection in sheep, and was more sensitive, specific and efficient and less likely to give false positive and negative results than a haematological examination.

The AO classification of long bone fractures: an early study of its use in clinical practice

Over a period of 6 months, 543 long bone fractures were classified using the AO classification system. Factors important in determining the management of fractures occurring in three regions; hip, forearm and tibia, were identified. In hip fractures, we found that the anatomical configuration of the fracture, and therefore its classification, generally determined management. However, there were other factors that influenced the more specific form of surgical treatment used. In forearm fractures, the age of the patient was the most important factor determining treatment, while many factors, including consultant preference, determined the treatment of tibial fractures. While we found the system useful for audit purposes, we also found that it was unnecessarily complicated and often fell short of playing a useful role in the planning of management.

Unrecognized cocaine use among schizophrenic patients

OBJECTIVE

Unrecognized stimulant use could lead to the misdiagnosis of schizophrenia or the misunderstanding of its course and prognosis. This study was conducted to determine the prevalence of unrecognized stimulant use among patients with a clinical diagnosis of schizophrenia.

METHOD

The subjects were 108 schizophrenic patients admitted consecutively to a Veterans Affairs psychiatric hospital. Admitting psychiatrists supplemented routine clinical evaluations with a semistructured interview regarding recent and lifetime use of alcohol, cocaine, amphetamine, marijuana, and opiates. A urine specimen was assayed for the four illicit drugs.

RESULTS

Of the 103 patients who provided a urine specimen, 37 (36%) used cocaine during the 6 months before admission, including 31 who used the drug in the week before admission. Because of the poor reliability of negative self-reports of recent cocaine use, clinicians failed to recognize cocaine use in one-third of the patients with a urine toxicology positive for cocaine metabolites. Two other groups of patients were identified; schizophrenic patients without substance abuse (including alcohol) and schizophrenic patients with substance abuse other than stimulants. Both substance-abusing groups were younger than the nonabusing group, but the three groups had similarly high rates of recent psychotic symptoms, homelessness, and unemployment.

CONCLUSIONS

Among schizophrenic patients who require hospitalization, clinicians should not rely solely on self-reported stimulant use. Recognition of stimulant use could be improved through routine urine toxicologies for all psychotic patients. The authors suggest that recognition of stimulant use among schizophrenic patients may identify a population with a better prognosis for schizophrenia and different treatment needs.

Outcome at 8 years for children with birth weights of 1250 g or less

The educational, motor, and behavioural performance of a hospital based cohort of 51 children aged 8 years with birth weights of 1250 g or less is reported, as part of a longitudinal study. Compared with age, race and sex matched classmates, who were examined at school at the same visit, the very low birthweight (VLBW) group performed less well on the basic mathematics test A, the Schonell spelling test, and the test of motor impairment. Reading performance was also poorer in this group. Twenty three (45%) VLBW children were having difficulty with one or more school subjects compared with 11 (19%) controls, and 15 (26%) had difficulties in two or more areas, compared with three (5%) controls. Parents of VLBW children reported a similar frequency of behavioural problems to controls but teachers identified characteristics typical of emotional disorders and overactivity more frequently among the VLBW group. Motor testing at 6 years of age was the best predictor of school problems at 8 years, correctly identifying 15/16 children with multiple problems with a low (33%) positive predictive value but a high (98%) negative predictive value. Children with birth weights of 1250 g or less and no major impairment have a high frequency of learning difficulties that become more apparent with advancing age. Such problems may be predicted at an earlier age by detailed motor testing.

Elder abuse: raising the awareness of nurses working in A & E units

Despite a growing literature, many professionals have a limited knowledge of elder abuse. This article highlights some of the conceptual and practical problems surrounding the topic in order to raise awareness and provide some indication of the nurse's role.

Longitudinal hand grip and pinch strength recovery in the child with burns

Hand strength of seven patients was evaluated prospectively. A range-of-motion exercise program, compression therapy, and splinting schedules were provided. Fine prehension; lateral, tip-to-tip, and tripod pinch were measured by pinch meter. Grip strength was measured by dynamometer. Comparisons were made between test strengths and published norms for age and sex with analysis of variance. Significance was accepted at p < 0.05. At discharge, all four strength measurements were significantly less than normal for age and sex. Grip and tripod strengths were improved by 6 weeks. All measurements were improved at 6 months after discharge, although grip and lateral pinch remained significantly less than norms. In conclusion, the measurements of tip-to-tip and tripod pinch at 6 months may not signify limitations in performance of activities of daily living. In spite of significantly lower than normal grip and lateral strength measurements at 6 months, it cannot be determined whether this hinders performance of daily living skills.

Clinical evaluation for sinusitis. Making the diagnosis by history and physical examination

OBJECTIVE

To identify the most useful clinical examination findings for the diagnosis of acute and subacute sinusitis.

DESIGN

Prospective comparison of clinical findings with radiographs.

SETTING

General medicine clinics at a university-affiliated Veterans Affairs Medical Center.

PATIENTS

Two hundred forty-seven consecutive adult men with rhinorrhea (51%), facial pain (22%) , or self-suspected sinusitis (27%) (median age, 50 years; median duration of symptoms, 11.5 days).

MEASUREMENTS

Patients were examined by a principal investigator (86%) or by a staff general internist, internal medicine resident (postgraduate year 2 or 3), or physician assistant, all blinded to radiographic results. All examiners recorded the presence or absence of 16 historical items, 5 physical examination items, and the clinical impression for sinusitis (high, intermediate, or low probability). The criterion standard was paranasal sinus radiographs (4 views), which were interpreted by radiologists blinded to clinical findings.

RESULTS

Thirty-eight percent of patients meeting entrance criteria had sinusitis. Sensitivity, specificity, and likelihood ratios were measured for clinical items. Logistic regression analysis showed five independent predictors of sinusitis: maxillary toothache (odds ratio, 2.9), transillumination (odds ratio, 2.7), poor response to nasal decongestants or antihistamines (odds ratio, 2.4), colored nasal discharge reported by the patient (odds ratio, 2.2), or mucopurulence seen during examination (odds ratio, 2.9). THe overall clinical impression was more accurate than any single finding: high probability (likelihood ratio, 4.7, intermediate (likelihood ratio, 1.4), low probability (likelihood ratio, 0.4).

CONCLUSIONS

General internists, focusing on five clinical findings and their overall clinical impression, can effectively stratify male patients with sinus symptoms as having a high, intermediate, or low probability of sinusitis.