Attitudes to contraception among Asian women in Britain

To understand the attitudes of a woman from the Indian subcontinent towards contraception, it is necessary to be aware of her religious and cultural background. A strict sexual morality is practised by Muslim, Hindu and Sikh women, for whom pre-marital and extra-marital sexual relationships are forbidden. Girls are brought up to be shy and modest, and submitting to a vaginal examination is regarded with abhorrence except as a matter of life and death. Large families, and particularly sons, are regarded as blessings from the Almighty. The condom and IUD are considered the least offensive methods, although among more enlightened women the pill is gaining ground.

Petrol octane booster and methaemoglobinaemia

We highlight the case of a 35-year-old male who suffered a respiratory arrest as a result of methaemoglobinaemia secondary to skin contamination and inhalation of petrol octane booster following a road traffic accident. It is important that petrol octane booster is stored safely in leak-proof containers and that suitable warnings are displayed to alert the user of potential toxicity.

EMG-force relationship of the cat soleus muscle studied with distributed and non-periodic stimulation of ventral root filaments

Distributed stimulation of ventral root (VR) filaments and pseudo-random interpulse intervals (based on a Gaussian distribution with a coefficient of variation of 12.5%) were used to modulate electromyographic activity (EMG) and force of the cat soleus muscle to assess the EMG-force relationship. A protocol consisting of addition and rate modulation of ten VR filaments that contain alpha motoneurones to the soleus muscle was adopted. EMG was measured using indwelling electrodes and forces were measured at the distal tendon using a strain transducer. EMG records obtained using this approach were similar in the time and frequency domains to those obtained during voluntary contractions. Force records obtained from stimulation of single VR filaments showed summation effects typical of irregular interpulse intervals. The overall relationship between integrated rectified EMG (IEMG) and mean force was found to be non-linear. At low and high stimulation levels, IEMG tended to increase proportionally more than mean force. In the intermediate stimulation region (i.e. producing forces between approximately 5% and 88% of the maximal tetanic force), the IEMG-mean force relationship was virtually linear. Muscles with a homogeneous fibre type composition, such as the cat soleus muscle, have been reported to have a linear EMG-force relationship.

Demonstration of Epstein-Barr viral DNA in paraffin-embedded tissues of Burkitt's lymphoma from Argentina using the polymerase chain reaction and in situ hybridization

Burkitt's lymphoma (BL) is the most frequent non-Hodgkin's lymphoma in children in Argentina. Although epidemiologic studies have linked Epstein-Barr virus (EBV) to more than 90% of African BL cases but to only 10-20% of American and French cases, increased EBV-specific antibody titers were demonstrated in 73% of Argentinian patients with BL. To characterize the relationship between EBV and BL in Argentina, we analyzed paraffin-embedded tissues from 16 cases of BL for the presence of EBV DNA using the polymerase chain reaction (PCR) and in situ hybridization (ISH). PCR analysis showed that only 4 of 16 specimens contained the EBV BamW fragment, and these specimens were all from cases diagnosed in 1984. Results of ISH performed with a specific biotinylated DNA probe against the NotI/PstI fragment of EBV correlated with the PCR findings. EBV sequences were detected with ISH in 70-90% of the tumor cells from the 4 positive cases. These data may suggest an epidemic outbreak of EBV-related BL in 1984 superimposed on sporadic cases of BL, for which EBV may not have been an essential factor. This study also demonstrates the value of using molecular techniques on archival tissue to track epidemiologic trends.

Idiopathic pulmonary fibrosis and hepatitis C virus infection

A possible role for hepatitis C virus (HCV) infection in the pathogenesis of idiopathic pulmonary fibrosis (IPF) has recently been suggested on the basis of an unusually high seroprevalence rate of anti-HCV in such patients from Japan. In an attempt to confirm these findings, we tested sera from 62 patients with IPF by two second-generation anti-HCV ELISAs. Only one serum was reactive. Serum from this patient gave an indeterminate result when tested by four-antigen RIBA (c22 band only), and it was negative for the presence of HCV RNA when tested by the reverse transcriptase polymerase chain reaction assay. HCV infection is thus no more prevalent in patients with IPF from the UK than in the general population.

Interaction of hepatitis B and hepatitis C infection in haemophilia

The management of haemophilia has been greatly complicated by the clinical sequelae of viral infection acquired through contaminated blood products. Many haemophiliacs have been infected by several viruses and the interaction between these viruses may be complex. In a cohort of 42 anti-HCV positive haemophiliacs, five were also found to be positive for HBsAg. All five were HCV reverse transcriptase/PCR negative compared to the 4/37 (11%) anti-HCV positive haemophiliacs who were HBsAg negative (P = 0.0001). We have identified a striking interaction between hepatitis C (HCV) and hepatitis B (HBV) in haemophiliacs co-infected by these agents, suggestive of the phenomenon of viral interference.

Prostitution and risk of HIV: male partners of female prostitutes

OBJECTIVE

To describe risk behaviours for infection with HIV in male sexual partners of female prostitutes.

DESIGN

A cross sectional study.

SETTING

Genitourinary medicine clinic, St Mary's Hospital, London.

SUBJECTS

112 self identified male sexual partners of female prostitutes: 101 who reported commercial sexual relationships only, five who reported non-commercial relationships only, and six who reported both commercial and non-commercial relationships.

MAIN OUTCOME MEASURES

Reported risk behaviours for infection with HIV.

RESULTS

Of the 40 men who had had previous HIV tests or were tested during the study, two (5%) were infected with HIV. Of the men who would answer the questions, 34/94 reported having sex with other men, 2/105 reported using injected drugs, 8/105 had a history of blood transfusion, 14/108 reported a past history of gonorrhoea, 44/102 reported paying for sex abroad, and 8/92 said that they had also been paid for sex. Of the 55 men who reported paying for vaginal intercourse in the past year, 45 (82%) said that they had always used a condom. In contrast, of the 11 non-paying partners of prostitutes, only two (18%) reported ever using a condom with their partners.

CONCLUSIONS

Men who have sex with female prostitutes cannot be assumed to be at risk of infection with HIV only by this route: homosexual contact may place them at greater risk. Despite the heterogeneity among male sexual partners of prostitutes, patterns of use of condoms were uniform when they were considered as a reflection of the type of relationship a man had with a female prostitute rather than a consequence of an individual's level of risk.

Prostitution and risk of HIV: female prostitutes in London

OBJECTIVE

To measure the prevalence of HIV and to describe established risk factors in female prostitutes.

DESIGN

A cross sectional survey.

SETTING

A genitourinary medicine clinic, streets, and magistrates' courts in London.

SUBJECTS

280 female prostitutes recruited between April 1989 and August 1991.

MAIN OUTCOME MEASURES

Infection with HIV-1, reported risk behaviours, and prevalence of sexually transmitted infections.

RESULTS

228 of the women had HIV tests, and two (0.9% (95% confidence interval 0% to 2.1%)) were infected with HIV-1. Reported use of condoms was high for commercial clients and low for non-paying partners: 98% (251/255) of women used condoms with all clients and 12% (25/207) with non-paying partners for vaginal intercourse. Twenty two women were current or past injecting drug users. Of the 193 women examined for sexually transmitted infections, 27 had an acute infection (gonorrhoea, chlamydia, trichomonas, or primary genital herpes) at the time of interview. Infection was associated with younger age and increasing numbers of non-paying sexual partners, but not with duration of prostitution, numbers of clients, or reports of condom failures. When age and numbers of non-paying partners were analysed by logistic regression they remained significantly associated with sexually transmitted infections.

CONCLUSIONS

A large and diverse sample of prostitutes had a low prevalence of infection with HIV and high levels of use of condoms in commercial sex. There was a significant risk of other sexually transmitted infections associated with prostitutes' non-commercial sexual relationships, in which unprotected sex is common. Interventions to reduce the risk of sexually transmitted infections in prostitutes should address both commercial and non-commercial sexual partnerships.

Use of anti-GOR testing in the screening of blood donors for hepatitis C virus infection

Sera from 12/1,155 (1%) anti-HCV-negative (Elisa) UK blood donors were found to be anti-GOR positive. None out of 12 of those sera were positive for HCV RNA by the reverse transcriptase/polymerase chain reaction (RT/PCR). In a cohort of 316 anti-HCV Elisa-positive sera, 27/57 RIBA-positive, and 1/188 RIBA-negative sera were anti-GOR positive, resulting in a sensitivity of 47% and a specificity of 99.5% for anti-GOR as a marker for RIBA-confirmed HCV infection. Four out of 71 (6%) of RIBA-indeterminate sera were anti-GOR positive. Donors with anti-GOR reactivity were more likely to have antibodies against each of the individual HCV antigens represented in the RIBA, and those antibodies were of greater intensity, when compared to the anti-GOR negative cohort. Twenty out of 36 (55.6%) of RT/PCR-positive sera were anti-GOR positive, compared to 1/7 (14.3%) of RT/PCR-negative sera (p = 0.09). The usefulness of anti-GOR testing of UK blood donors is discussed in the light of these results.

A comparison between commercial kits and conventional methods for enumeration of salivary mutans streptococci and lactobacilli

Mutans streptococci (ms) and lactobacilli levels were determined by conventional and commercial dip-slide methods in three groups of young subjects, aged 5-6 years (93 subjects), 12-13 years (78 subjects) and 18-20 years (81 subjects). Using the same paraffin-stimulated saliva samples, ms and lactobacilli were estimated by conventional viable counts on modified mitis-salivarius agar (MSB) and Rogosa agar plates, and by inoculation of Dentocult SM and Dentocult LB dip-slides (Orion Diagnostica, Finland). The salivary ms and lactobacilli counts obtained from conventional agar plates were significantly correlated (P < 0.0001) with the dip-slide estimates of these organisms (Kendal Tau = 0.56, 0.71 respectively). Subjects in Group 2 showed the highest proportion (77 per cent) of individuals with salivary ms levels above 2.5 x 10(5) cfu/ml saliva; 99 per cent of that group had detectable levels of lactobacilli. Significantly different median salivary ms and lactobacilli levels were demonstrated between all groups except for lactobacilli levels between Groups 2 and 3. These dip-slide tests provided suitable and simple methods for screening salivary lactobacilli and ms levels which may have a useful role in the assessment of caries risk.

Modulation of human upper intestinal nutrient transit by a beta adrenoreceptor mediated pathway

To explore the role played by beta adrenoreceptor mediated pathways on human upper gut function a series of studies were conducted into the effects of beta adrenoreceptor agonists and antagonists on orocaecal and duodenocaecal transit and on antral and duodenal motor activity. Under control conditions orocaecal transit was consistent within individuals (mean coefficient of variation (18.0%) but varied widely between individuals (median transit 63 minutes, range 33-164). Prior administration of the non-selective beta adrenergic antagonist propranolol consistently hastened orocaecal transit (median transit 51:25-93, v control p < 0.005). The selective beta-1 antagonist, atenolol, also hastened transit (median transit 50:35-93 minutes, v control p < 0.01). The magnitude of an individual's response to beta blockade correlated closely with the orocaecal transit (Tau = 0.54, p < 0.01). Duodenocaecal transit was also hastened by propranolol from control values of 66:45-107 minutes to 50:16-62 minutes, p < 0.025). In contrast neither duodenal nor antral motility were consistently altered by beta blockade. The beta adrenoreceptor agonist, isoprenaline, delayed both orocaecal transient (97:55-178 minutes, v control p < 0.005) and also duodenocaecal transit (160:45-215 minutes, v 73:40-133) (p < 0.025). Isoprenaline also reduced antral motility by an effect which appeared to occur predominantly through a reduction in contraction amplitude (from a median amplitude of 27:5.39 mm Hg to 14:3-24 mm Hg, p < 0.03) rather than an effect on the interval between contractions. No effect on either amplitude or frequency of duodenal motor activity was observed. A beta adrenoreceptor mediated pathway thus appears to exert a biologically relevant effect on gut function not only under conditions of sympathetic stimulation, but also at rest when a basal beta adrenergic tone appears to influence the speed of nutrient transit through the human upper gut.

A successful education program for parents of infants with newly diagnosed sickle cell disease

The most dramatic recent advance in the care of young children with sickle cell disease was the demonstration by a cooperative study that the use of oral penicillin prophylaxis is highly effective in decreasing the risk of pneumococcal sepsis. Subsequently, the need for more comprehensive education of the parents of these children to ensure compliance with penicillin administration has become apparent. Over the past 4 years, the Mid-South Sickle Cell Disease Program has used a seven-phase educational process for the parents of more than 200 infants with newly diagnosed sickle cell disease. This has resulted in excellent compliance and a marked decrease in the incidence of pneumococcal sepsis among sickle cell patients at our center.

An evaluation of potential prognostic indicators in cardiac patients

Cardiovascular disease results in more deaths and higher medical costs than any other medical problem. Cardiac patients may be transported to centers for specialized care. We evaluated historical, current event, and physiologic items (n = 32) for ability to predict use of specialized care and hospital costs. For 199 patients studied, seven items were prognostic. A model classifying patients by presence of predictors was developed. For the group without predictors and the group with multiple predictors, sensitivity and specificity were respectively very good. For 125 (63%) of the patients in middle categories, the model was not sufficiently sensitive to be prognostic. A scoring system for all cardiac patients could not be developed. Patients requiring only diagnostics were responsible for financial deficits, as were all Medicare patient groups. Patients staying longer than seven days, or having surgery, or both, were responsible for the largest deficits (if on Medicare) and the highest profits (if not on Medicare). Advance validation of the need to transport is difficult, with far-reaching medical and financial implications.

Pediatric interhospital critical care transport: consensus of a national leadership conference

As pediatric interhospital critical care transport has evolved toward a distinct discipline, practitioners in this field have recognized the need for guidelines for transport program development and patient care. At a gathering of medical directors of pediatric transport programs, the following topics were discussed: team composition and transport staffing, training requirements for pediatric and nonpediatric transport teams, goals and design of a transport data base, and medical-legal issues, including the responsibilities of the referring and receiving institutions. Consensus recommendations were made for the major issues in each of these areas. Several questions were raised which may be answered by multiinstitutional studies.

In vitro translation of hepatitis A virus subgenomic RNA transcripts

A subgenomic cDNA clone from hepatitis A virus strain HM175, composed of the last eight nucleotides of the 5' non-translated region and the first 2248 nucleotides of the coding sequence (P1 region), was inserted into a vector under the control of the T7 promoter. Restriction enzyme digestion at sites within the structural region and subsequent transcription in vitro yielded RNA products which were translated efficiently in rabbit reticulocyte lysates to produce proteins of the predicted sizes. The translation products were specifically precipitated with antipeptide antisera; these reactions were not affected by denaturation of the antigens by boiling in 1% SDS. The translated proteins were also precipitated by antivirion antisera, but recognition was totally abolished following denaturation. Thus antivirion antisera recognized conformation-dependent epitopes expressed on the translated products exclusively.

Scales for rating motor impairment in Parkinson's disease: studies of reliability and convergent validity

Study 1 examined the reliability of the ratings assigned to the performance of five sign-and-symptom items drawn from tests of motor impairment in Parkinson's disease. Patients with Parkinson's disease of varying severity performed gait, rising from chair, and hand function items. Video recordings of these performances were rated by a large sample of experienced and inexperienced neurologists and by psychology undergraduates, using a four point scale. Inter-rater reliability was moderately high, being higher for gait than hand function items. Clinical experience proved to have no systematic effect on ratings or their reliability. The idiosyncrasy of particular performances was a major source of unreliable ratings. Study 2 examined the intercorrelation of several standard rating scales, comprised of sign-and-symptom items as well as activities of daily living. The correlation between scales was high, ranging from 0.70 to 0.83, despite considerable differences in item composition. Inter-item correlations showed that the internal cohesion of the tests was high, especially for the self-care scale. Regression analysis showed that the relationship between the scales could be efficiently captured by a small selection of test items, allowing the construction of a much briefer test.

The population mean predicts the number of deviant individuals

OBJECTIVE

To examine the relation between the prevalence of deviation and the mean for the whole population in characteristics such as blood pressure and consumption of alcohol.

DESIGN

Re-examination of standardised data from the Intersalt study, an international, multicentre study on the determinants of blood pressure.

SETTING AND SUBJECTS

Samples of adults representing 52 populations in 32 countries.

MAIN OUTCOME MEASURES

The relations, expressed as correlation coefficients, between the mean population values for blood pressure, body mass index, alcohol consumption, and sodium intake and the prevalence of, respectively, hypertension (greater than or equal to 140 mm Hg), obesity (body mass index greater than or equal to 30 kg/m2), high alcohol intake (greater than or equal to 300 ml/week), and high sodium intake (greater than or equal to 250 mmol/day).

RESULTS

There were close and independent associations between the population mean and the prevalence of deviance for each of the variables examined: correlation coefficients were 0.85 for blood pressure, 0.94 for body mass index, 0.97 for alcohol intake, and 0.78 for sodium intake.

CONCLUSIONS

These findings imply that distributions of health related characteristics move up and down as a whole: the frequency of "cases" can be understood only in the context of a population's characteristics. The population thus carries a collective responsibility for its own health and well being, including that of its deviants.

Echo planar imaging of isolated perfused rat hearts at 4.7 T: a comparison of Langendorff and working heart preparations

The implementation of echo planar imaging at 4.7 T is demonstrated using a homebuilt gradient and radiofrequency assembly. The application of such a technique to the study of the isolated perfused rat heart is demonstrated. Langendorff and working heart perfusion preparations are compared and changes in the left ventricular volume shown are to be much larger in the working heart preparation. Such a methodology is expected to provide a useful model for the study of cardiac function and dynamics in the normal and diseased states under controlled perfusion conditions.

Integrating residency training in geriatrics into existing outpatient curricula

In recent years, the need for increasing the geriatrics component of residency training has been repeatedly addressed; however, there are still many programs that have been unable to meet this need. While alternative sites, such as geriatric evaluation units and nursing homes, may be the ideal sites to teach some aspects of geriatrics, this article argues that the ambulatory care program, required in all residency programs, is the appropriate setting for teaching many of the core skills needed to care for most older adults. Teaching geriatrics in the ambulatory setting, which eliminates the strategic and financial obstacles of developing non-hospital-based sites, can be accomplished with relatively modest additional resources. This article describes the methods used to integrate geriatrics into the ambulatory care component of one internal medicine residency program and the necessary faculty resources as well as the documentation, via chart audit, of the interns' compliance with recommended practice patterns in five categories. With the exception of vaccination status, interns documented 18% or less of possible pieces of information for their patients. While this assessment showed statistically significant improvement in interns' care of older patients after the program intervention, the overall level of performance was still low, underscoring the need for the integration of geriatrics principles in the ambulatory curriculum.

The chronotropic effect of acetylcholine in the presence of vecuronium and atracurium. A study in the isolated perfused rabbit heart

The bradycardia produced by 1 microgram acetylcholine in the isolated perfused rabbit heart, in the presence of vecuronium and atracurium, was studied and compared with control. Vecuronium at a concentration of 2.5 micrograms/litre and atracurium 6 micrograms/litre did not enhance the negative chronotropic effect of acetylcholine. Atracurium produced a statistically significant inhibition of the negative chronotropic effect of acetylcholine.

The Bain, ADE, and Enclosed Magill breathing systems. A comparative study during controlled ventilation

The Enclosed Magill, Humphrey ADE and the Bain breathing systems are all used for controlled ventilation of the lungs. This study compares the three systems in vitro with a lung model and in clinical practice. No difference was observed, with ventilatory variables commonly used in clinical practice, between the Bain and the ADE, while significantly lower end-tidal carbon dioxide values were observed with the Enclosed Magill (about 7%). Lower fresh gas flows can be used under these circumstances to maintain normocapnia with the Enclosed Magill than either the Bain or the Humphrey ADE.

Using a multidisciplinary follow-up program to assist patient adjustment following temporal lobectomy

A follow-up program for patients following temporal lobectomy for seizure control was established in 1983 at the UCLA Neuropsychiatric Hospital in response to patients' requests for information and assistance. The purpose of this program was to identify changes requiring adaptation and to offer assistance. Forty patients were contacted monthly by telephone for one year after surgery. They were interviewed by either a nurse or occupational therapist about medical and psychosocial issues. The information, support or referral needed were provided by the nurse, occupational therapist or social worker in consultation with appropriate member(s) of the multidisciplinary team. Problems encountered when beginning a less disabled lifestyle might not have been detected or resolved without active intervention through a multidisciplinary follow-up program.

A comparative evaluation of four hearing aid selection procedures. I--Speech discrimination measures of benefit

Speech discrimination measures of the benefit provided by four different hearing-aid selection procedures were determined on a group of experienced hearing-aid users. The results revealed that the advantages of prescriptive methods of selection (specifically the procedures of Berger et al., and of Byrne and Tonisson) over intuitive fitting (using an experience clinician) or 'fixed' selection (+ 6 dB/octave frequency response slope) are substantial in some circumstances. The effect of selection procedure on benefit was little influenced by degree of hearing loss but considerably influenced by configuration of loss (flat, sloping or irregular). For patients with gently to steeply sloping losses, the prescriptive methods of selection were shown to provide more benefit than the other methods studied.

A comparative evaluation of four hearing-aid selection procedures. II--Quality judgements as measures of benefit

Quality judgements by hearing-aid wearers were used to compare hearing-aid frequency responses selected by four different aid selection procedures: the methods of Berger et al. and Byrne and Tonisson, 'intuitive' fitting by an experienced clinician, and a fixed frequency response of + 6 dB/octave. A previous study had demonstrated that the two 'prescription' methods (of Berger et al. and Byrne and Tonisson) showed greater benefit as measured by speech discrimination tests, particularly for patients with sloping audiograms. The results of this study indicated that quality judgements did not appear to be significantly influenced by the fitting procedure used. The only significant factor was the order in which the patients listened to the hearing aids. The second aid was always preferred. This finding was confirmed by a second study in which the only experimental variable was order. Again the second aid was preferred. The implications of this finding for clinical hearing-aid evaluation are discussed.

A set of cell surface glycoproteins forms an early position, but not cell type, in the root apical carota L

A monoclonal antibody (JIM4) has been derived that series of glycoproteins associated with the plasma suspension-cultured carrot cell line and also an proteoglycan secreted by the cultured cells. indicated that the plasma membrane antigen(s) specific to certain cells of Daucus carota L. apex JIM4 labelled two segments of the stele. These the poles of the protoxylem. An axis of unlabelled two phloem regions. Two sections of the pericycle with oblique longitudinal divisions were particularly This pattern of reactive cells, reflecting cell specific future cell type, would appear to be a unique plants. The association of JIM4 antigens with these maintained through the transition from root to the cotyledons and the mature plant. Examination of JIM4 ultrathin frozen sections of the carrot seedling root indicated that the expression of the antigen is a very root development. Cells express the surface epitope, cells of the dome of apical initials, before the vascular tissue can be discerned and well before its differentiation.

Relationships between symptoms, menstrual cycle and orocaecal transit in normal and constipated women

Because severe constipation is a disorder largely confined to young women, the possibility that menstrually related factors contribute to disturbed gastrointestinal motor function has been raised. It has also been reported that normal menstruating women show changes in upper gut transit between the follicular and luteal phases of the menstrual cycle and that patients with constipation show prolonged transit. We therefore studied relationships between symptom severity and orocaecal transit during the menstrual cycle in a group of 14 constipated women and a series of control groups comprising seven normal menstruating women, five postmenopausal women, and eight normal men, to determine whether phases of the menstrual cycle were associated with alteration in symptoms or transit. A regular menstrual cycle was reported by 13 of the 14 patients (range 26-30 days) and by all the menstruating female volunteers. Seven patients noted variation in constipation during the menstrual cycle, in all cases this comprised an improvement in symptoms just before or during menstruation. No consistent relationship between symptom severity and follicular or luteal phase was noted. Repeated orocaecal transit measurements in the four study groups showed no consistent differences (greater than 0.05) between groups or during the menstrual cycle (mean change weeks 1-4, -10 +/- 20 min). These findings are inconsistent with the hypothesis of a progesterone related effect upon orocaecal transit in either normal or constipated women.

Uptake of immunisations in low birthweight infants

The timing of immunisations for preterm infants is controversial. Because of the statement by the British Paediatric Association/Joint Committee on Vaccination and Immunisation Liaison group that immunisations should normally begin three months after the date of birth, the records of all infants born in 1984 and currently (June 1986) resident in the London Borough of Newham were studied to find out if this recommendation was being implemented. Subjects were divided into groups by birth weight and where possible by gestational age. Cumulative uptakes by age of any component of the first and third triple immunisations, and of the pertussis component, were plotted separately. Comparison of uptake of the first course showed a considerable initial delay for infants weighing less than 2000 g at birth compared with heavier babies, but by 18 months the coverage was almost identical. This difference was not evident for the third course. A similar delay was apparent when infants of 37 weeks' gestation or less were compared with babies born at full term, though recording of gestational age was incomplete. Final overall uptake was poor for all groups. Differences among groups in numbers consenting were not an important factor. Informing those responsible for giving the immunisations of these findings has stimulated their interest in improving practice by implementing the recommendations.

Range of movement poor index of hip function

Conventional systems of assessing the hip before and after surgery use the range of movement as an indicator of functional results. We found that the range of movement, defined as the flexion arc or the total range, is a poor indicator of function as measured by ability to reach the feet. A different and more direct basis for assessing function is proposed.

In vitro antimicrobial activity of diethyldithiocarbamate and dimethyldithiocarbamate against methicillin-resistant Staphylococcus

Staphylococcus aureus has appeared which is highly resistant to both methicillin and aminoglycosides. Current therapy involves long-term intravenous therapy of vancomycin. Since vancomycin is currently the only drug used to treat these patients, there is a need to develop additional antimicrobial therapy. The in vitro antimicrobial effect of the metal chelator, diethyldithiocarbamate (DDTC) and its structural analog dimethyldithiocarbamate (DMTC) were investigated. Both DDTC and DMTC were effective against S. aureus including methicillin-resistant S. aureus (MRSA). By agar diffusion, DDTC at 10 micrograms per disk produced zone sizes of 12 to 21 mm and at 100 micrograms per disk produced zone sizes of 26 to 34 mm against MRSA. The DMTC produced slightly greater zone sizes against MRSA of 16 to 24 mm and 24 to 37 mm for 10 micrograms per disk and 100 micrograms per disk, respectively. The minimum inhibitory concentration (MIC) for DMTC against MRSA was 6 micrograms per ml. Both DDTC and DMTC were also effective against enterococci, Proteus mirabilis, Klebsiella pneumoniae, Klebsiella oxytoca, Escherichia coli, Enterobacter cloacae, Enterobacter aerogenes, Salmonella species, Serratia marcescens and Citrobacter freundii at 100 micrograms per disk. The MICs of DMTC for Klebsiella pneumoniae, Klebsiella oxytoca, Escherichia coli, Salmonella and Citrobacter freundii were approximately 128 micrograms per ml while the MICs for Proteus vulgaris, Proteus mirabilis, Pseudomonas aeruginosa and Serratia marcescens was greater than or equal to 256 micrograms per ml. In addition, DMTC was synergistic with gentamicin against MRSA and coagulase-negative staphylococcus species, Enterobacter cloacae, Klebsiella pneumoniae and Pseudomonas aeruginosa. Additive and synergistic effects of DMTC were displayed with gentamicin against S. aureus including methicillin-resistant S. aureus.(ABSTRACT TRUNCATED AT 250 WORDS)