Gender representation in trials

The perception is that women have been understudied relative to men. It has been sufficient to cause Congress to enact legislation to require that a clinical trial must be "designed and carried out in a manner sufficient to provide for a valid analysis of whether the variables being studied in the trial affect women ellipsis differently than other subjects in the trial." We looked for evidence as to whether the perception has a basis in fact by looking at measures of gender-based research effort. Clinical trials, published between 1966 and 1998 in U.S. journals and indexed in MEDLINE, were classified by gender. Reports of trials appearing in five widely circulated medical journals (Annals of Internal Medicine, British Medical Journal, Journal of the American Medical Association, Lancet, and New England Journal of Medicine) in 1985, 1990, and 1995 were retrieved and read to obtain counts of the numbers of males and females represented in trials published in those journals. For reports of trials published in U.S. journals, the percent involving males and females, males only, females only, and those where gender was not specified were 55.2%, 12.2%, 11.2%, and 21.4%, respectively. Counts of males and females represented in the reports of trials appearing in the five aforementioned journals were 355,624 and 550,743, respectively. We did not find evidence of systematic effort bias against females.

Effect of Carbon Amendment and Soil Moisture on Tylenchorhynchus spp. and Hoplolaimus galeatus

The effect of amending soil held at 3 different moisture levels with glucose, unsulfured molasses, or nutrient broth (0.3, 0.7, 3.2, 7.1 g carbon/100 g) on Tylenchorhynchus claytoni and T. dubius was investigated. When soil was held under saturated or flooded conditions in the absence of carbon amendments for 7 days, Tylenchorhynchus populations were 19% and 16%, respectively, of the controls. Carbon amendments at all levels tested precipitated a further decline in the nematode population to 1% or less of the unamended controls in 7 days. Two applications of molasses (7.4%, w/w) 3 days apart to nematode-infested soil held in Conetainers under mist for 7 days reduced Tylenchorhynchus spp. and Hoplolaimus galeatus densities to 7% and 3%, respectively, of the controls. Nematode densities in turfgrass field plots also declined following irrigation and repeated drenching with a molasses solution. Based on the observed decline in redox potential and pH in saturated soil, especially following carbon amendment, we propose that the activity of anaerobic fermentative bacteria was responsible for the reduction in nematode densities.

Use of health and human services by community-residing people with dementia

This article reports on the use of and need for health and human services by community-residing people with dementia. Telephone interviews were conducted with a sample of 608 caregivers of such individuals who were randomly selected from a dementia registry. Caregivers reported using an average of 3.2 health services and 3.7 human services to assist them in the care of the person with dementia. Despite the high level of services use, 73 percent of the caregivers indicated a high need for at least one additional service, and 72 percent indicated that additional services would reduce the likelihood of institutionalization of the recipient. Although services use was more frequent than expected, many caregivers lacked knowledge about services, a fact that suggested that social workers have a vital information and referral role to play.

Heat transfer through penguin feathers

Morphological measurements of penguin feathers are used to construct a thermal model of heat transfer through the coat. Assuming uniform distribution of the feathers and their associated afterfeathers, it is possible to model heat transfer through the coat of the penguin using standard theory. It is shown that convection does not occur in the coat of the penguin and that radiative heat loss is minimized. The theory predicts a thermal conductivity of 2.38 W m(-2)K(-1)which compares well with an empirically measured value of 1.93 W m(-2)K(-1). Copyright 1999 Academic Press.

Global elimination of trachoma: how frequently should we administer mass chemotherapy?

The World Health Organization has recommended repeat mass drug administration as part of their global initiative to eliminate blinding trachoma by the year 2020. The efficacy of repeat treatment will be tested empirically, but the results will not be available for many years, and recommendations for the necessary frequency of treatment are needed immediately. We have developed a mathematical model that uses available epidemiological data from a variety of countries. We recommend, based on our analysis, that in areas where trachoma is moderately prevalent (<35% in children), it should be treated annually, but hyperendemic areas (>50% in children), it should be treated biannually.

Relationships between duration of asthma and asthma severity among children in the Childhood Asthma Management Program (CAMP)

BACKGROUND

Many factors, including heredity, atopic status, and environment, have been implicated in the determination of asthma severity. Relatively little is known about the degree to which asthma duration influences asthma severity.

OBJECTIVE

The Childhood Asthma Management Program (CAMP), consisting of 1041 children (age 8. 9 +/- 2.1 years at enrollment) with mild-to-moderate asthma, offers an opportunity to examine the relationship between asthma duration and asthma severity.

METHODS

By using the extensive CAMP baseline cross-sectional data on asthma duration, spirometry, bronchial responsiveness, symptomatology, and markers of atopy, univariate and multivariate regression models were used to evaluate whether asthma duration is associated with asthma severity.

RESULTS

Duration of asthma in the study cohort from time of diagnosis until randomization into CAMP ranged from 0.3 to 12.1 years (mean, 5.0; SD, 2.7; median, 4.8). Asthma duration is associated in univariate analyses both with lower levels of several lung functions (P <.001), including methacholine bronchial reactivity (natural log [ln] FEV1 PC20, mg/mL; r = -0.112), prebronchodilator and postbronchodilator percent predicted FEV1 (r = -0.176 and r = -0.130, respectively), and prebronchodilator and postbronchodilator FEV1 /forced vital capacity (FVC) (%) (r = -0.237 and r = -0.211, respectively), as well as higher levels of symptoms (symptom score: r = 0.147, P <. 001) and borderline greater use of albuterol for symptoms (r = 0.058, P =.064) during a 28-day screening period before randomization. Simple linear regression detected the following differences in lung functions per year of asthma duration: ln FEV1 PC20, -0.050 mg/mL/y; prebronchodilator FEV1, -0.907 percent predicted/y; and prebronchodilator FEV1 /FVC, -0.729 percent predicted/y. After controlling for potential explanatory variables (atopy, inflammatory markers, household Der p 1 levels, anti-inflammatory medication use, and clinical center), regression models revealed that the duration of asthma remained significantly and independently associated with ln FEV1 PC20 (P =.004), prebronchodilator percent predicted FEV1 (P =.043), and prebronchodilator and postbronchodilator FEV1 /FVC (%) (P <.001), as well as being positively associated with mean daily symptom score (P <.001) and albuterol use for symptoms (P =.003) during a 28-day screening period. Duration was also found to be significantly associated with physician/nurse assessment of asthma severity and other historical measures of medication use.

CONCLUSIONS

These data demonstrate that asthma duration is associated with lower lung function, greater methacholine responsiveness, more asthma symptomatology, and greater use of as-needed albuterol, which are all measures of asthma severity. As such, early diagnosis and intervention may be necessary to ameliorate these adverse effects of persistent asthma.

Chronic follicular conjunctivitis associated with Chlamydia psittaci or Chlamydia pneumoniae

We determined whether patients with chronic conjunctivitis in whom direct fluorescent antibody (DFA) tests revealed genus-specific chlamydial antigens (but not species-specific Chlamydia trachomatis antigens) were infected with Chlamydia psittaci or Chlamydia pneumoniae. Patients were divided into a case group of possible non-trachomatis chlamydial conjunctivitis and a control group of nonchlamydial conjunctivitis on the basis of examination and DFA testing. Species-specific primers were used to amplify C. trachomatis, C. psittaci, and C. pneumoniae DNA with polymerase chain reaction (PCR). Four (27%) of 15 samples from the case group were positive for C. psittaci or C. pneumoniae DNA, whereas none of 24 control samples were positive. Sequencing revealed a C. pneumoniae, an avian C. psittaci, and two mammalian C. psittaci strains. A short course of oral antibiotic treatment appears to be inadequate for patients with non-trachomatis chlamydial conjunctivitis. Ocular infections due to C. pneumoniae and C. psittaci may be more common than previously recognized and can be identified by DFA and PCR.

Design of a 2 T multipole wiggler insertion device for the SRS

Two new identical insertion devices have been designed for the Daresbury SRS. They are 2 T permanent-magnet multipole wigglers that will provide high flux in the X-ray region. This paper describes the magnetic and mechanical design of the arrays of steel pole pieces and permanent-magnet blocks. Also given is the engineering design of the support structure that will cope with the very large forces present while maintaining high levels of precision in gap setting and parallelism. The engineering design has been fully assessed using finite-element techniques to predict the deflections of critical parts of the structure. These two devices are due to be installed into the SRS by the end of 1998.

Screening for tuberculosis in jail and clinic follow-up after release

OBJECTIVES

The purpose of this study was to describe tuberculosis (TB) screening and preventive therapy in the San Francisco County Jail and to measure the follow-up rate at the public health department TB clinic.

METHODS

The records of male inmates screened for 6 months in 1994 were reviewed. Those prescribed isoniazid and released before therapy ended were matched with TB clinic records. Inmates were considered to have followed up if they came to the TB clinic within 1 month of release.

RESULTS

Of 3352 inmates screened, 553 (16.5%) reported a prior positive skin test, and 330 (26.9%) of 1229 tests placed and read were positive. Of those with positive tests, 151 (45.8%) began isoniazid. Most of the inmates were foreign-born Hispanics (80.8%). Ninety-three (61.6%) inmates were released before completion, after an average of 68.5 days. Three (3.2%) went to the TB clinic within a month.

CONCLUSIONS

Jail represents an important screening site for TB, but care is not continued after release. Strategies are needed to enhance the continuity of isoniazid preventive care.

BHRF1, a viral homologue of the Bcl-2 oncogene, is conserved at both the sequence and functional level in different Epstein-Barr virus isolates

BHRF 1, a component of the restricted early antigen (EA) complex of the Epstein-Barr virus (EBV) lytic cycle, encodes a 17 kDa putative transmembrane protein with both sequence and functional homology to the Bcl-2 proto-oncogene. To determine whether there was any sequence variation over the BHRF1 open reading frame (ORF), 15 EBV isolates from different geographical regions and from both healthy donors and patients with EBV-associated diseases were sequenced. A small number of base changes which resulted in amino acid substitutions in the BHRF1 protein were found relative to the prototype B95.8 EBV sequence and these were predominantly clustered near the amino terminus of the BHRF1 protein outside conserved domains identified in the Bcl-2 homologues. In transient transfection assays none of the mutations in the BHRF1 ORF from eight different EBV isolates had a significant effect on BHRF1 protein localization compared to the B95.8 BHRF1 protein. However, transient expression of the adenovirus 12 19K protein or Bcl-2 resulted in localization patterns distinct from that observed with BHRF1 protein. Whilst all eight EBV isolates and E1B-19K gave comparable levels of protection to the DNA-damaging agent cis-platin, Bcl-2 did not afford significant protection. Thus, despite several amino acid changes in the BHRF1 ORF of some of the EBV isolates studied, the ability of the protein to protect against cis-platin induced apoptosis is conserved. The highly conserved nature of BHRF1 amongst different EBV isolates at both the sequence and functional level supports the proposed important role of BHRF1 in delaying cell death, thereby maximizing the production of progeny virus and facilitating the establishment of virus persistence.

Are outcome data regarding the survivors of neonatal care available from routine sources?

AIM

To determine whether existing information and surveillance systems can be used to provide follow up data on groups of infants at increased risk of disability--for example, the survivors of neonatal intensive care.

METHODS

A survey was made of maternity, neonatal, and community child health information systems and surveillance programmes in the Trent Regional Health Authority. Children known to have received neonatal intensive care in Trent between 1 August 1992 and 31 July 1993, and a random sample of normal children in two health districts (data quality check) were included. A data linkage study was made to determine whether follow up information about a random sample of infants, known to be at increased risk of poor outcome, could be identified on community child health databases. Two widely accepted datasets (birth and 2 years) were used as standards for this exercise. The quality of data was audited.

RESULTS

All clinical items of the birth minimum dataset were routinely recorded by at least one agency in each health district in Trent. Of the descriptive items, only the mother's age on leaving full time education was not collected. At 2 years, all clinical items were collected as part of the routine surveillance programme, but data were recorded using a system which severely limited interpretation. Data quality, in terms of the number of errors introduced at data entry, was very good with only 1.1% of the check items (4/368) incorrectly recorded. Only two districts had organised electronic transfer of data between maternity, neonatal, and community child health systems. The mother's NHS number, although available, was not routinely recorded by any system. The NHS number of the infant was routinely collected by six out of 12 community paediatric services. Data linkage was attempted in six districts with appropriate community child health databases. Just over 70% of the intensive care sample was successfully linked with follow up information on child health systems.

CONCLUSIONS

The existing programmes for routine child surveillance could provide outcome data for high risk groups of infants, such as the survivors of neonatal intensive care. However, the present coding system used for data entry is inadequate. Furthermore, rates of identification, without the use of a unique identifier (NHS number) for each subject, are currently insufficient for monitoring health status in later life.

Social interaction alters attraction to competitor's odour in the mouse Mus spretus Lataste

When animals defend territories that are large and structurally complex, scent marks alone are unlikely to be reliable signals of a resident's dominance and competitors should require initial proof through direct interaction. This was tested using freshly captured Mus spretus which occupy large non-overlapping ranges in grassland but are strongly attracted to substrate odours from unfamiliar competitors. Choice tests measured time spent investigating and chewing to gain access to paired nestboxes when the entrances were blocked with mesh. Experiment 1 established that mice of both sexes were more strongly attracted to their own odour than to a clean site. Experiment 2 examined choice between the subject's own odour and that of an unfamiliar same-sex competitor both before and after meeting the competitor in a neutral (clean) arena. Prior to interaction, males exerted much effort to gain access to both their own and their unfamiliar competitor's odour. Once relative dominance had been established through agonistic interaction, subordinates avoided their dominant competitor's odour in favour of their own while dominants continued to be attracted to both. There was little aggressive competition between unfamiliar females and relative status did not affect their attraction to a competitor's odour. Females tended to be more attracted to a competitor's odour than to their own prior to interaction but showed less attraction to a competitor's odour post-interaction. A third experiment showed that the odour of an unfamiliar male was more attractive than that from an unfamiliar female, especially to males. The consequences of these responses for maintaining spatial dispersion in this species are discussed.Copyright 1997 The Association for the Study of Animal Behaviour1997The Association for the Study of Animal Behaviour

Serological prevalence of Hypoderma species in cattle in Great Britain (1995/96) and the relative value of serological surveillance over clinical observation

Sera from 100,400 cattle on 2850 farms in England, Scotland and Wales were tested for the presence of antibodies to Hypoderma species between the end of November 1995 and the end of February 1996. Twelve animals were resampled because the initial results were equivocal but only one of them was confirmed as seropositive. This animal was a bull imported from Belgium which had been treated with an approved warble fly treatment within 24 hours of arrival at its destination in Great Britain. No seropositive animals were confirmed within the native British cattle population. Statistical analysis of these data indicates that the probable maximum number of infested cattle herds in Great Britain is 112. To detect the disease by direct clinical observation would require more than 500 herds to be infested, indicating that the serological testing of this number of cattle and farms is more than four times as sensitive as clinical observation for the detection of hypodermosis.

Association between time homeless and perceived health status among the homeless in San Francisco

The purpose of this study was to describe the perceived health of the homeless, and to measure the effect of time homeless on perceived health status, after controlling for sociodemographic characteristics and health conditions. The design was cross-sectional; the population was a representative sample of homeless in San Francisco, interviewed on health issues. Analysis of predictors of poor or fair health status was by logistic regression. In this sample of 2780 persons, 37.4% reported that their health status was poor or fair as compared to good or excellent. Reporting poor or fair health status was significantly associated with time homeless, after controlling for sociodemographic variables and health problems including results from screening for HIV and TB (OR = 1.49, 95% CI 1.24-1.79). Comparisons with data from the National Health Interview Survey (NHIS) showed poorer health status among the homeless persons in this study. Standardized morbidity ratios were highest for asthma; there was twice the number of homeless persons reporting asthma, in younger as well as older adults, as would be expected using NHIS rates. There was also an excess of arthritis, high blood pressure and diabetes in those age 18-44 as compared to adults in the Health Interview Survey. The time spent homeless remains associated with self-reported health status, after known contributors to poor health are controlled. Persons who have been homeless for longer periods of time may be the persons to whom health care interventions should be aimed.

Posterior tibial somatosensory evoked potentials in very preterm infants

Cortical posterior tibial somatosensory (SSEP) responses were reliably recorded from 67 infants of 33 weeks gestation or less who had normal neurological outcome at 24 months corrected age. Cross-sectional and longitudinal data did not show a change in waveform morphology with advancing gestation or postnatal age. The latency of the first cortical component shortened as maturation increased. This study provides normative data for the peak component waveforms of the response in very preterm infants. The role of the posterior tibial SSEP in the prediction of functional brain injury in this high risk population can now be determined.

A competitive ELISA for the serodiagnosis of hypodermosis

Hypodermosis is a parasitic disease of cattle caused by Hypoderma lineatum and H. bovis. It is an important health and welfare problem of infested cattle and a cause of considerable economic loss. In live animals, detection can be either by direct clinical examination of infested cattle and palpation of second and third stage larvae in the back or by the use of serological methods. This paper describes a competitive ELISA for the detection of antibodies to Hypoderma species in cattle sera. It has been validated using a small panel of 40 samples from clinically positive cattle and 200 samples from clinically negative (unexposed) cattle from a warble free area. Sensitivity and specificity calculated from this panel were 100% and 92% respectively at 2 SD from the mean or 92.5% and 98.5% at 3 SD from the mean. The use of serology and direct clinical examination of affected cattle, are discussed as methods for monitoring hypodermosis. The competitive ELISA should prove a useful adjunct to the standard sandwich ELISA, particularly in the resolution of samples which display non-specific binding properties.

An evaluation of the utility of the Home Health Care Classification for categorizing patient problems and nursing interventions from the hospital setting

The purpose of this study is to evaluate the utility of the Home Health Care Classification for categorizing patient problems and nursing interventions from the hospital setting. The data set comprised 5,844 problem terms and 20,055 interventions terms. All terms could be categorized using the Nursing Components and Major Categories for Nursing Diagnoses and Interventions. A total of 1,767 (30.2%) patients problem terms could be placed into Major Nursing Diagnosis categories, but not subcategories even though there were subcategories related to the major category. All intervention terms whether they were classified at the Intervention Category or Subcategory could be coded according to Type of Nursing Action. These findings demonstrate that the Home Health Care Classification, at the level of Nursing Components and Major Categories, was domain complete for the data set. The fact that not all terms could be classified according to the existing subcategories suggests some areas for future development, but is also a reflection of the level of detail expressed in the data set itself. The results suggest that the Home Care Classification will be adequate and appropriate for categorizing problems and interventions across setting for the next phases of the research project.

Use of image enhancement during lithotripsy

Renal excursion during breathing is inevitable and is a cause of poor localization during extracorporeal shock-wave lithotripsy (SWL), which in theory might lead to poor treatment results. Eighty-one patients underwent lithotripsy treatment with and without the use of an image enhancement system designed for use with the Dornier MPL9000 lithotripter. This device contains a memory incorporated into a separate differential grayscale monitor, which allows the stone image to be stored. Shockwave release is enabled only when this image corresponds to the real-time image on the lithotripter ultrasound monitor. No improvement in success rates was found using this system, although upper-pole stones appeared to be fragmented more successfully. Overall, the results were favorable in both groups after a single treatment. Further work is needed to establish whether image enhancement is capable of improving the success rates and reducing the side effects of lithotripsy by better targeting.

Developing a cost-effective media campaign addressing unprotected anal sex among gay men

This paper describes the development and implementation of the Stella Seattle campaign, a media campaign targeting men who have unprotected anal sex with other men. Stella Seattle utilizes a serial cartoon strip format. Scenarios and characters in the strip are derived from local formative research on factors associated with unprotected anal sex in men who have sex with men, including depression, isolation, misinformation, and normative behavior. Weekly strips illustrating the struggles and hopes of gay men who are practicing unprotected anal sex are distributed in postcard form throughout the gay community and are placed in two weekly newspapers. Surveys conducted in the gay community and at an HIV test site indicate that 35% to 45% of men have seen Stella, and of these men about half have discussed it with their friends.

ABC of urology. Urological trauma and bladder reconstruction

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ABC of urology. Common paediatric problems

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ABC of urology. Urinary stone disease

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ABC of urology. Urological malignancy--III: Renal and testicular carcinoma

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ABC of Urology. Urological malignancy--II: Urothelial tumours

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ABC of urology. Urological malignancy--1: Prostate cancer

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ABC of urology. Urinary incontinence and urinary infection

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ABC of urology. Subfertility and male sexual dysfunction

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Low-angle X-ray scattering signatures of urinary calculi

This is the first reported use of low-angle X-ray scattering for the investigation of urinary calculi. Low-angle X-ray scattering (LAXS) measures the diffraction of a broad spectrum of X-rays at a single angle and uses a conventional diagnostic X-ray beam, and could thus be developed for use in vivo. A total of 45 calculi were investigated using this technique. Calcium oxalate stones showed a bimodal signature with peaks of almost even photon energies. Signatures for the other stone types were less well-defined. The results are discussed in more detail below. Our preliminary results show that the technique is capable of distinguishing between calcium oxalate stones and other stone types in vitro. Further work is in progress to correlate the results of this technique with objective parameters of stone hardness.

ABC of Urology. Urological emergencies in general practice

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ABC of urology. Bladder outflow obstruction

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ABC of urology. Urological evaluation

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ABC of urology. Introduction to urology

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Diarrhea associated with nasogastric feedings

PURPOSE/OBJECTIVES

To determine the difference in the incidence of diarrhea among subjects given one of three formulas with varying fiber concentrations administered by nasogastric (NG) tube, variables affecting incidence of diarrhea, discomforts other than diarrhea associated with NG tube feedings, and effects of changing from continuous to interval feedings on incidence of diarrhea and discomforts.

DESIGN

Prospective, double-blind, randomized study.

SETTING

Midwestern tertiary care center otolaryngology nursing unit.

SAMPLE

Eighty randomized subjects who were 18 years or older, English-speaking, and undergoing head and neck cancer surgery that required an NG tube postoperatively and who had no gastrointestinal (GI) illness within two weeks prior to surgery.

METHODS

Subjects received continuous administration of formula containing no fiber, 7 gms/L of fiber, or 14 gms/L of fiber until they reached the caloric intake goal and then were advanced to interval feedings. Patients' medical records provided past medical history and information on medication administration. A bedside flow sheet was used for documenting incidence of diarrhea and other GI discomforts.

MAIN RESEARCH VARIABLES

Amount of fiber in the formula administered, patient's genders and prior food aversions, and antibiotics' effect on diarrhea and other GI discomforts.

FINDINGS

Multiple logistic regression showed significant odds ratios (ORs) for developing diarrhea in female subjects (OR = 7.96), subjects who had prior food aversions (OR = 2.67), and subjects receiving broad spectrum antibiotics (OR = 3.22). Diarrhea was four times more likely to occur in males who received fiber-free formula. Of all subjects, 70% experienced GI discomforts with continuous feedings, and 50% experienced discomforts when advanced to interval feedings.

CONCLUSIONS

Fiber formulas reduced the incidence of diarrhea in male subjects but not in female subjects. Antibiotics' effect on diarrhea paralleled the findings of other studies.

IMPLICATIONS FOR NURSING PRACTICE

Use formulas with fiber for males. Liquid stools do not require interruption of tube feeding; GI discomforts warrant interruption. Interval feeding schedules require monitoring similar to continuous feeding schedules.

Cytochemical localization of glycogen in Chlamydia trachomatis inclusions

The origin and distribution of glycogen in inclusions of Chlamydia trachomatis were demonstrated with silver proteinate stain for electron microscopy. Glycogen particles were detected in all developmental stages of C. trachomatis, as well as free in the inclusions. Intrachlamydial glycogen was most common in elementary bodies but was also detected in intermediate forms and reticulate bodies (RBs). Abnormal divisions and breakdown of cytoplasmic membranes were common in RBs. Cytoplasmic contents, including glycogen particles, were released into the inclusions after rupture of the outer membranes of abnormal RBs and intermediate forms. From these observations, we conclude that glycogen in inclusions of C. trachomatis originates in the organisms themselves.

In vivo cellular tropism of human T-lymphotropic virus type II is not restricted to CD8+ cells

We have examined the in vivo and in vitro susceptibility of lymphocyte subpopulations to human T-lymphotropic virus type II (HTLV-II) to determine the cellular tropism for this virus. Monoclonal antibodies to T-cell subsets were used to separate highly purified CD4+ and CD8+ cells from peripheral blood lymphocytes of 35 individuals previously shown to be infected with HTLV-II. The purified T-cell subsets were analyzed for HTLV-II provirus (pol and tax gene sequences) by polymerase chain reaction (PCR) and cultured to determine virus expression by p24gag antigen detection. On the basis of PCR amplification in the pol and tax gene regions, both CD8+ subsets (89 to 91%) and CD4+ subsets (54 to 80%) from most infected subjects demonstrated HTLV-II provirus, irrespective of the viral genotype. Analysis of cultured lymphocytes demonstrated a higher spontaneous lymphocyte proliferation (17,986 +/- 4675 cpm) and p24gag antigen production (median 115 pg/ml; range 14-1360 pg/ml) in CD8+ cells compared to CD4+ cells (2333 +/- 826 cpm; p24gag antigen; 9 pg/ml; 2-250 pg/ml), suggesting a higher proviral load in CD8 cells. Limiting cell-dilution PCR analysis indicated that the CD8+ subset carried a higher HTLV-II provirus burden than the CD4+ subset. In vitro infection of purified CD4+ and CD8+ lymphocytes with irradiated HTLV-II cell lines resulted in productive infection of both subsets. Cell sorting and PCR analysis of lymphocyte subsets from 4 HTLV-II-infected subjects further demonstrated that in addition to CD4+ and CD8+ subsets, both CD45RO+ and CD45RO- and non-T-cells (CD14, CD16, and CD19) carried HTLV-II provirus. Taken together, these data suggest that HTLV-II possesses a broad tropism for peripheral blood mononuclear cells.

Choosing the correct pain relief for extracorporeal lithotripsy

OBJECTIVES

To determine the best choice of analgesic for patients undergoing lithotripsy, and to attempt to identify factors which might predict which patients are most likely to find the procedure painful.

PATIENTS AND METHODS

Sixty patients with stones in the pelvicalyceal system of the kidney were randomized prospectively to undergo lithotripsy with the Dornier MPL9000 lithotripter (Dormier Medical Systems, Marietta, GA, USA) after receiving either diclofenac 100 mg per rectum (n = 30) or pethidine 50 mg intravenously (n = 30) for analgesia. The patients completed a detailed questionnaire prior to treatment, and the level of pain perceived during lithotripsy was monitored using visual analogue scales (VASs). Arterial oxygen saturation (SaO2) was monitored before analgesia was given, throughout the treatment and for 30 min after cessation of treatment.

RESULTS

The VASs were available for 56 patients and the results of pulse oximetry for 51 patients. Although a higher kilovoltage was recorded in the group who received pethidine this difference was not significant. Patients who received diclofenac or pethidine alone, showed a non-significant fall of SaO2 30 minutes after the end of treatment, although the largest fall in SaO2 observed with pethidine was 10%. Patients who received diclofenac and pethidine similarly showed a non-significant fall in SaO2. Four patients received intravenous benzodiazepines in addition to pethidine, and in this group there was a dramatic fall in SaO2 which persisted more than 30 min after the end of treatment (P < 0.0027). Diclofenac provided effective analgesia for most of the patients who underwent lithotripsy. Overall 11 patients (18%) required additional analgesia. Diclofenac or pethidine alone, in the doses used in this study, did not cause a significant drop in SaO2 during ESWL. The only response found to be of value in predicting a painful experience was fear of the dentist.

CONCLUSIONS

This study shows that modern lithotripsy, in addition to being safe and effective, can be performed as an out-patient procedure using simple non-opiate analgesics. The need for stronger analgesia and/or sedation should be tailored to the needs of the individual patient, although it remains difficult to predict which patients will require such measures.