Serum urate as a free radical scavenger in diabetics

We have looked at the relationship between serum urate and the molar equivalent serum antioxidant capacity (MESA) in diabetic and normal individuals who attended St Bartholomew's Hospital diabetic clinic and BUPA Health Screening Centre, London, and have compared serum antioxidant capacity between the two groups. Sample response curves showed less serum antioxidant potential in diabetics than in nondiabetics, and a linear relationship between serum urate and MESA. Simple regression analysis gave a correlation coefficient of 0.9 (p < 0.0001). Significant differences between the two groups were found for both mean MESA values (p < 0.0001) and mean uric acid levels (p < 0.005).

Carotid patch angioplasty: immediate and long-term results

To determine the benefit of carotid patch angioplasty, a retrospective study of 1000 consecutive carotid endarterectomies was done. Based on the type of carotid endarterectomy closure, patients were divided into four groups: 250 had primary closure, 250 had expanded polytetrafluoroethylene patch, 250 had Dacron patch, and 250 had saphenous vein patch. On the basis of operative technique or type of carotid artery closure, no statistical difference was found in the incidence of postoperative stroke (p greater than 0.25): primary closure 1.6% (4), expanded polytetrafluoroethylene 2.0% (5), Dacron patch 1.6% (4), and saphenous vein patch (0). Postoperative carotid patency was determined by B-mode ultrasonography, and 717 patients were evaluated in follow-up extending to 6 years (mean 37.8 months). Based on the method of carotid endarterectomy closure, no significant difference (p greater than 0.25) was found in the incidence of significant restenosis (greater than 50% diameter reduction): primary closure 4.0% (7), expanded polytetrafluoroethylene 4.0% (6), Dacron 5.4% (9), and saphenous vein 1.0% (2). Significant restenosis was most frequent in habitual smokers (93%, 25/28) and females (78%, 22/28) despite the method of carotid endarterectomy closure. No statistical difference was found in the incidence of late ipsilateral stroke either (p greater than 0.25): primary closure 2.9% (5), expanded polytetrafluoroethylene 2% (3), Dacron 5% (3), and saphenous vein 0%. These results indicate that the incidence of postoperative stroke, regardless of method of arterial closure, was not statistically different. The method of carotid closure did not appear to affect the occurrence of late ipsilateral stroke or restenosis; however, patch angioplasty with saphenous vein appears appropriate in habitual smokers, and likely in patients with small internal carotid arteries.

One path to a comprehensive district psychiatric service

Brighton, which never had its own large psychiatric hospital, now has a comprehensive community psychiatric service. Sarah Hood and Tony Whitehead describe the development of the service and argue that the closure of large hospitals need not and should not result in the neglect or exploitation of former patients.

Sequential development of aneuploidy, keratin modifications, and gamma-glutamyltransferase expression in mouse skin papillomas

To elucidate the role and timing of expression of different premalignant and malignant markers in tumor promotion, we correlated alterations in keratin patterns and gamma-glutamyltransferase (GGT) expression with the chromosomal status of individual mouse skin papillomas. Papillomas were induced by 7,12-dimethylbenz[a]anthracene initiation and 12-O-tetradecanoylphorbol-13-acetate promotion. Individual tumors were randomly sampled at 20 and 35 weeks of promotion. Each tumor was cytogenetically analyzed and serial paraffin sections were used for GGT detection, immunoblotting, and immunohistochemistry studies. Monospecific antibodies elicited against keratins K1 (Mr 67,000) and K14 (Mr 55,000) were used to analyze keratin modifications. Most tumors at 20 weeks of promotion, although exhibiting aneuploidy, still presented high levels of the K1 differentiation-associated keratin. Later during promotion those tumors bearing the highest aneuploidy indexes were those that showed a marked decrease in or absence of the K1 protein. Furthermore, those same tumors with the highest levels of genomic alterations also exhibited foci of GGT activity. These results support the idea that the majority of papillomas under continuous promotion are progressing toward malignancy. Aneuploidy seems to precede detectable keratin modifications, and GGT activity appears to be the latest marker to be expressed.

A novel technique for assessing the sources of dietary sodium

Li can be used to track Na during the cooking and eating process as it is handled by the body in a manner similar to Na. A new approach to study the sources of salt using Li is described. When this technique was applied in an epidemiological context using 12 consecutive 24-hour urine collections, we found that at least 83% of the salt ingested by a population in Cambridgeshire, England, was derived from processed food. Only a small amount of the total salt intake came from cooking or from using salt on the table. The total amount of salt eaten was not as high as was previously estimated indirectly. There was a clear sex difference in salt intake which in part related simply to the finding that salt intake correlates with body weight of an individual. This study implies that those who wish to advocate a reduction in salt intake in order to prevent hypertension must reconsider their approach. Any health education programme that is geared simply to reduce discretionary salt use in the home, will have little impact on the total amount of NaCl ingested by the population.

A single-ward approach to the elderly mentally ill

A service for the elderly mentally ill is described which is based in a general hospital complex and combines a heavy community commitment with the use of two all-purpose inpatient wards and two associated day hospitals. Each ward functions as an admission, treatment, rehabilitation, and medium- and long-stay facility. Experience suggests that this system makes it possible to cater for the elderly mentally ill in a population with many fewer beds than the recommended norm and is a better insurance against unnecessary prolonged hospitalization than "progressive patient care".