Acceptability of female condom use among women exchanging street sex in New York City

Greater access to alternative female-initiated barrier methods, such as the female condom, is needed among women exchanging street sex. This study describes knowledge of and experience with the female condom among 101 women exchanging sex for money and drugs on the streets of New York City, and examines the acceptability of female condom use as an alternative barrier method for HIV/STD prevention among this population. Female condom use among this sample of sex workers was found to be related to having a regular sexual partner, living with someone who is a drug or alcohol abuser, not being homeless, using alcohol or intravenous heroin, having heard of the device, and having discussed the device with other women or with a regular sexual partner. Despite decreased acceptability post-use, most sex workers indicated an intention for future female condom use.

Endogenous glucocorticoids released during acute toxic liver injury enhance hepatic IL-10 synthesis and release

Endogenous glucocorticoids are known to play a role in the regulation of the inflammatory response possibly by modulating pro- and anti-inflammatory cytokine expression. We examined endogenous glucocorticoid secretion, hepatic damage, tumor necrosis factor-alpha (TNF-alpha), and interleukin-10 (IL-10) mRNA expression and release in rats treated with carbon tetrachloride (CCl4) after treatment with vehicle or a glucocorticoid receptor antagonist (RU-486). Rats treated with CCl4 demonstrated striking elevations of plasma corticosterone levels. Inhibition of endogenous glucocorticoid activity by pretreatment with the glucocorticoid receptor antagonist RU-486 resulted in augmented CCl4-mediated hepatotoxicity, as reflected by histology and serum transaminase levels, which were independent of alterations in serum TNF-alpha levels or hepatic mRNA expression. CCl4 treatment resulted in enhanced hepatic IL-10 mRNA expression and elevated serum IL-10 levels, which were markedly attenuated by glucocorticoid receptor blockade. In summary, significant endogenous glucocorticoid release occurs during acute toxic liver injury in the rat and suppresses the inflammatory response independent of effects on TNF-alpha but possibly by upregulating hepatic IL-10 production.

Preventing disability and managing chronic illness in frail older adults: a randomized trial of a community-based partnership with primary care

BACKGROUND

Effective new strategies that complement primary care are needed to reduce disability risks and improve self-management of chronic illness in frail older people living in the community.

OBJECTIVE

To evaluate the impact of a 1-year, senior center-based chronic illness self-management and disability prevention program on health, functioning, and healthcare utilization in frail older adults.

DESIGN

A randomized controlled trial.

SETTING

A large senior center located in a northeast Seattle suburb. The trial was conducted in collaboration with primary care providers of two large managed care organizations.

PARTICIPANTS

A total of 201 chronically ill older adults seniors aged 70 and older recruited through medical practices.

INTERVENTION

A targeted, multi-component disability prevention and disease self-management program led by a geriatric nurse practitioner (GNP).

MEASUREMENTS

Self-reported Physical function, physical performance tests, health care utilization, and health behaviors.

RESULTS

Each of 101 intervention participants met with the GNP from 1 to 8 times (median = 3) during the study year. The intervention group showed less decline in function, as measured by disability days and lower scores on the Health Assessment Questionnaire. Other measures of function, including the SF-36 and a battery of physical performance tests, did not change with the intervention. The number of hospitalized participants increased by 69% among the controls and decreased by 38% in the intervention group (P = .083). The total number of inpatient hospital days during the study year was significantly less in the intervention group compared with controls (total days = 33 vs 116, P = .049). The intervention led to significantly higher levels of physical activity and senior center participation and significant reductions in the use of psychoactive medications.

CONCLUSIONS

This project provides evidence that a community-based collaboration with primary care providers can improve function and reduce inpatient utilization in chronically ill older adults. Linking organized medical care with complementary community-based interventions may be a promising direction for research and practice.

Centrosome defects and genetic instability in malignant tumors

Genetic instability is a common feature of many human cancers. This condition is frequently characterized by an abnormal number of chromosomes, although little is known about the mechanism that generates this altered genetic state. One possibility is that chromosomes are missegregated during mitosis due to the assembly of dysfunctional mitotic spindles. Because centrosomes are involved in spindle assembly, they could contribute to chromosome missegregation through the organization of aberrant spindles. As an initial test of this idea, we examined malignant tumors for centrosome abnormalities using antibodies to the centrosome protein pericentrin. We found that centrosomes in nearly all tumors and tumor-derived cell lines were atypical in shape, size, and composition and were often present in multiple copies. In addition, virtually all pericentrin-staining structures in tumor cells nucleated microtubules, and they participated in formation of disorganized mitotic spindles, upon which chromosomes were missegregated. All tumor cell lines had both centrosome defects and abnormal chromosome numbers, whereas neither was observed in nontumor cells. These results indicate that centrosome defects are a common feature of malignant tumors and suggest that they may contribute to genetic instability in cancer.

Size and number of epithelial cells washed from the cornea after contact lens wear

Using the technique of Fullard and Wilson, tear samples were collected atraumatically from the corneas of 14 rigid gas permeable (RGP) contact lens wearers, 14 soft contact lens (SCL) wearers, and 22 controls who did not wear contact lenses. Samples were analyzed for the number, size, and contiguity of the cellular contents. Both RGP and SCL groups had, on average, significantly fewer cells per sample than controls (median values were 11 and 12 cells vs. 44). The difference remained significant even after a correction of three cells was applied to account for cells adherent to the lenses. Approximately 80% of epithelial cells from both lens wear and control eyes were found in isolation, whereas 20% were contiguous with 1 or 2 other cells. This result is compatible with the majority of epithelial cells having exfoliated from the surface of the cornea after detaching from their neighbors, rather than detaching in sheets of cells. The cell length and cell area were analyzed. RGP wearers had significantly smaller cells than controls, whereas SCL wearers had slightly (but significantly) larger cells. These results may reflect changes in the exfoliation mechanism of the corneal epithelium in contact lens wear.

Sometimes it really is appendicitis: case of a CML patient with acute appendicitis

We report on the case of a 24-year-old white man with a history of chronic leukemia treated with unrelated bone marrow transplantation and chemotherapy who was correctly diagnosed with appendicitis rather than typhlitis. The approach to diagnosing an acute abdomen in the leukemic patient is discussed, with particular focus on appendicitis vs. typhlitis. A focused CT scan proved to be instrumental in making the correct diagnosis of appendicitis in our patient. The literature on this topic for the past 30 years is reviewed. The purpose of our report is to demonstrate that despite the recent trend toward diagnosing RLQ pain as typhlitis which requires medical management, there are still instances where it 'really is' appendicitis. Appendicitis, therefore, must always be ruled out in the leukemic patient.

Genomic organization, chromosomal mapping, and promoter analysis of the mouse dentin sialophosphoprotein (Dspp) gene, which codes for both dentin sialoprotein and dentin phosphoprotein

Our laboratory has reported that two major noncollagenous dentin proteins, dentin sialoprotein and dentin phosphoprotein, are specific cleavage products of a larger precursor protein termed dentin sialophosphoprotein (MacDougall, M., Simmons, D., Luan, X., Nydegger, J., Feng, J. Q., and Gu, T. T. (1997) J. Biol. Chem. 272:835-842). To confirm our single gene hypothesis and initiate in vitro promoter studies, we have characterized the structural organization of the mouse dentin sialophosphoprotein gene. This gene has a transcription unit of approximately 9.4 kilobase pairs and is organized into 5 exons and 4 introns. Exon 1 contains a noncoding 5' sequence, and exon 2 contains the transcriptional start site, signal peptide, and first two amino acids of the NH2 terminus. Exons 3 and 4 contain coding information for 29 and 314 amino acids, respectively. The remainder of the coding information and the untranslated 3' region are contained in exon 5. Chromosomal mapping localized the gene to mouse chromosome 5q21 in close proximity to other dentin/bone matrix genes. Computer analysis of the promoter proximal 1.6-kilobase pair sequence revealed a number of potentially important cis-regulatory sequences; these include the recognition elements of AP-1, AP-2, Msx-1, serum response elements, SP-1, and TCF-1. In vitro studies showed that the DSPP promoter is active in an odontoblast cell line, MO6-G3, with basal activity mapped to -95 bp. Two potential enhancer and suppresser elements were identified in the regions between -1447 and -791 bp and -791 and -95 bp, respectively. The structural organization of the dentin sialophosphoprotein gene confirms our finding that both dentin sialoprotein and dentin phosphoprotein are encoded by a single gene with a continuous open reading frame.

Pellagra in a woman using alternative remedies

A young woman presented with pellagra. Dietary intake of niacin was in excess of recommended guidelines. She had a low body mass index and was taking a number of alternative remedies. Resolution was rapid with oral nicotinic acid and discontinuation of the remedies.

The effect of a teledermatology program on rural referral patterns to dermatologists and the management of skin disease

Teledermatology can be defined as the use of imaging and telecommunications technologies to provide skin care services at a distance. The potential value of teledermatology is especially great in rural and medically underserved areas that do not have, or cannot support, providers specializing in the diagnosis and management of skin diseases. Rural patients and primary care providers should be able to use teledermatology as a greatly simplified and potentially less expensive means of referral to an urban dermatologist. In an effort to gauge the impact of a simple teledermatology system on referral patterns and the management of rural patients with skin disorders, we studied baseline rates of referral to dermatologists from five primary care clinics in rural Oregon. Economical, easy-to-use teledermatology systems were subsequently installed, and the effects on patient referral and management were recorded over time. The interim results suggest that primary care providers (PCPs) are reluctant to refer patients with skin conditions, even when the primary care providers confidence in the correct diagnosis and treatment plan for that condition are relatively low. The installation of a teledermatology system increases the number of patients referred for specialist evaluation dramatically, even while the number of in-person visits to specialists fell. Although diagnostic agreement between dermatologists and primary care providers was mixed, a marked difference was found in their recommended treatment plans. A number of cases were found in which use of the telemedicine technology system resulted in reversing conditions that had been poorly controlled for a number of years prior to teleconsultation. This work is important as an indicator that referral rates to dermatologists may be inappropriately low in rural areas of the U.S., and that use of teledermatology may improve this trend.

Inadequate calcium, folic acid, vitamin E, zinc, and selenium intake in rheumatoid arthritis patients: results of a dietary survey

OBJECTIVES

To determine the adequacy of calcium, folic acid, vitamin E, zinc, and selenium intake in patients with rheumatoid arthritis (RA).

METHODS

We conducted an observational study on 48 patients (13 men, 35 women; mean age, 64.5 years) with RA attending a specialty clinic in New Zealand comparing their dietary intake as measured by a 5-day dietary survey with recommended dietary intake (RDI) guidelines. Information on disease activity, functional ability, and drug therapy also was obtained.

RESULTS

The percentage of patients who achieved the RDI was 23% for calcium, 46% for folic acid, 29% for vitamin E, 10% for zinc, and only 6% for selenium. Patients on methotrexate had a significantly reduced intake of folic acid as a percentage of RDI (P < .05) compared with those on other therapies. In contrast, dietary intake of iron and protein was largely adequate and unrelated to anemia.

CONCLUSIONS

Patients with RA should receive dietary education or supplementation to bring their intake of calcium, folic acid, vitamin E, zinc, and selenium up to the RDI.

Evaluation of laparoscopic Toupet fundoplication as a primary repair for all patients with medically resistant gastroesophageal reflux

BACKGROUND

This prospective study assesses the outcome results in 100 consecutive patients with gastroesophageal reflux disease (GERD) treated with a laparoscopic Toupet fundoplication.

METHODS

GERD was confirmed by 24-h pH study and/or esophagogastroduodenoscopy (EGD). Pre- and postoperative symptoms, operative times, and perioperative complications were recorded on standardized data forms. Early follow-up was at 3 months and late follow-up, including 24-h pH, manometry, and EGD was at 22 months.

RESULTS

Preoperative symptoms included heartburn (92%), regurgitation (58%), water brash (39%), and dysphagia (39%). Mean operative time was 3.2 hours. There were no conversions to celiotomy and there were no mortalities. The perioperative complication rate was 14%; 6% (5/83) of patients reported heartburn at 3 months and 20% (15/74) at 22 months. Early and late dysphagia was 20% (17/83) and 9% (7/74), respectively; 24-h pH testing was abnormal in 90% of symptomatic patients (9/10), 39% of asymptomatic patients (12/31), and 51% overall.

CONCLUSIONS

Despite early improvement in reflux symptoms following laparoscopic Toupet fundoplications, there is a high incidence of recurrent GERD. Symptomatic follow-up underestimates the true incidence of 24-h pH-documented reflux. Based on these results we cannot recommend the laparoscopic Toupet repair for GERD patients with normal esophageal motility.

A modified coaxial compound micropipette for extracellular iontophoresis and intracellular recording: fabrication, performance and theory

Investigation of the identity and modes of action of neurotransmitters in the mammalian central nervous system can be facilitated by simultaneous intracellular recording of membrane potential and extracellular iontophoresis of agonists and antagonists. We describe here techniques for conveniently constructing a compound microelectrode, originally described by Sonnhof (Pflugers Arch 341, 351-358, 1973), suitable for such studies. The Sonnhof electrode consists of two components, a centraxial micropipette for recording membrane potential surrounded by a cylindrical array of 6 pipettes for iontophoresis. The cylindrical array tapers coaxially and terminates in 6 contiguous, crescent-shaped orifices surrounding the terminal portion of the central pipette, 25 - 50 microm from the tip. Pipettes were constructed from borosilicate glass tubing of 1-mm wall thickness having a 10-mm or 16-mm outer diameter. The resistances, flux and transport numbers for iontophoresis of glycine were measured for pipettes constructed from both sizes of glass. Flux increased with increasing levels of current, and transport number decreased with increasing micropipette resistance. A spherical diffusion model points out the steep dependence of steady state concentration on diffusional distance, stressing the importance of diminishing the distance between the iontophoresis source and the recording site. This is particularly true when brief pulses of current are used.

Healthy aging. A women's issue

The life expectancy of women currently exceeds that of men by almost seven years, yet women spend approximately twice as many years disabled prior to death as their male counterparts. The diseases that account for death and health care utilization in older women (heart disease, cancer, stroke, fracture, pneumonia, osteoarthritis, cataracts) are also major contributors to disability. This paper reviews the scientific evidence that supports specific recommendations for older women that may prevent or delay these conditions for as long as possible. Risk factors for falls and fractures should be assessed and, where possible, modified. Adequate intakes of calcium, vitamin D, fruits, and vegetables should be encouraged. Weight should be monitored and weight loss discouraged for most women. Screening for B12 deficiency is recommended. Engaging women in a shared decision-making process about the use of hormone replacement therapy for longterm prevention of heart disease and fractures is important, as is regular screening for breast and colo-rectal cancer. Women should be encouraged to engage in enjoyable physical activities, including walking, for 30 minutes daily. These interventions have the potential to delay the onset and improve the course of many chronic conditions that prevail in later life.

Cancer incidence among an HIV-infected cohort. Pulmonary Complications of HIV Infection Study Group

Malignancies, particularly Kaposi's sarcoma and non-Hodgkin's lymphoma (NHL), are associated with human immunodeficiency virus (HIV) infection. Cancer incidence among 1,073 asymptomatic HIV-infected individuals from the Pulmonary Complications of HIV Infection Study cohort, persons from six states followed from 1988 to 1994, was examined. Total cancer incidence was 3.99/100 person-years; for Kaposi's sarcoma, incidence was 2.64 cases/100 person-years, and for NHL, it was 1.18 cases/100 person-years. Total cancer (n = 156 cases) was higher among nonblacks than among blacks (rate ratio = 2.8, 95% confidence interval 1.3-6.1), with similar results for Kaposi's sarcoma and NHL. The rate of lung cancer (n = 5) among white, homosexual/bisexual males was 0.18 per 100 person-years, suggesting a high risk of lung cancer.

Reduction of exposure to laboratory animal allergens in the workplace

OBJECTIVES

Evidence is now accumulating that the prevalence of allergy to laboratory animals is related to the intensity of exposure to animal allergens. Whilst airborne animal allergen concentrations may be influenced by the litter type, cage design and stock density, the effectiveness of methods to reduce personal exposure has not been objectively assessed.

METHODS

Air samples were collected at 2 L/min and 180 L/min onto polytetrafluoroethylene (PTFE) filters and the rat urinary aeroallergen (RUA) and mouse urinary aeroallergen (MUA) concentrations were measured by radioallergosorbent test (RAST) inhibition.

RESULTS

When 545 mice (11.l mice/m3) were housed in ventilated cages (Thoren Maximiser cage system) operated at positive pressure to the environment, the static MUA concentration (n = 24, median = 0.10 microg/m3) was reduced sevenfold when compared with conventional cage systems (n = 12, median =0.67 microg/m3, P< 0.001). MUA could be further reduced if the ventilated cage system was operated at lower pressure; static samples (n = 1) collected at 180 L/min at negative, ambient and positive pressure registered < 0.003, 0.02 and 0.28 microg/m3, respectively. During cleaning out, the intensity of personal exposure to RUA was apparently reduced twofold when soiled litter was removed by vacuum (n = 17, median = 22.87 microg/m3) when compared with tipping (n = 18, median = 38.15 microg/m3), P = 0.002) although the task took twice as long to perform. The RUA exposure associated with handling rats was'reduced 25-fold when performed in a ventilated cabinet (n = 21, median = 2.67 microg/m3) compared with handling of rats on an open bench (n = 17, median = 54.39 microg/m3, P = 0.0001).

CONCLUSIONS

Effective reduction of exposure to animal allergens can now be achieved by the use of ventilated systems both for housing and handling rats and mice providing safety equipment is used correctly. The vacuum removal of soiled litter during the task of cleaning out was less efficient and additional respiratory protection is therefore recommended for this procedure.

Promoting healthy bladder habits for seniors

Urinary incontinence (UI) effects people of all ages, but is especially prevalent in the elderly population. Also significant is a lack of knowledge about UI. A health promotion project was developed and implemented in six ethnically diverse, predominantly minority, inner city senior centers, a program designed to address an elder population, as they are very likely to be experiencing UI and lacking knowledge concerning healthy bladder habits. The project consisted of three phases: orientation/training of key staff members/peer educators at the six senior centers; educating elder consumers through four one-hour weekly sessions involving visual aids and completion of bladder records and quizzes, and follow-up sessions with senior staff/peer educators to reinforce previous training. One result was that training of peer educators needed further refinement to allow for a more significant role throughout the program. The program was very well received by the participants and roughly 80 percent felt they had more control over their bladder by the end of the last session. This project will continue into 1997 and in addition to information on UI, the project will include prostate health for men and gynecological health for women, as this need became evident throughout the program.

Girl Talk: development of an intervention for prevention of HIV/AIDS and other sexually transmitted diseases in adolescent females

The number of adolescent females between the ages of 13 and 19 who are contracting sexually transmitted diseases (STDs) is rising at an alarming rate. Although the issue of STDs has been overshadowed by continued public debate over adolescent pregnancy and childbearing, it demands attention. Particularly concerning is the fact that STDs increase the likelihood of transmitting HIV (N.E. MacDonald et al., 1990). To offset the growing incidences of STDs among female adolescents, gender-specific interventions are needed. Following is a description of the theoretical underpinnings that informed and guided the development of a gender-specific intervention titled Girl Talk. A two-stage creation and review process was used to design this 2.5-hr, four-session intervention. An overview of the quasi-experimental design that compared a nonequivalent comparison and two intervention groups (peer led and adult led) is presented. Baseline characteristics of the three groups are reported. Also described is how participant feedback and a design content analysis are used to evaluate the appropriateness of the intervention for adolescent females.

Overall and cause-specific mortality in a cohort of homo-/bisexual men, injecting drug users, and female partners of HIV-infected men. Pulmonary Complications of Human Immunodeficiency Virus Infection Study Group

OBJECTIVE

To study the overall and cause-specific HIV-related mortality in a cohort of HIV-seropositive subjects according to transmission category, race/ethnicity, sex and severity of immunosuppression.

DESIGN

A cohort of 1129 HIV-seropositive homo-/bisexual men, injecting drug users, and female partners of HIV-infected men were enrolled at six centers in San Francisco, Los Angeles, Chicago, Newark, Detroit and New York between 1 November 1988 and 1 November 1989. Subjects were evaluated every 6 months at least until 31 March 1994.

METHODS

The analyses of overall mortality for the subgroups of interest were performed with Kaplan-Meier plots and Cox proportional hazards models. Cause-specific analyses were performed on the primary cause of death using rates per 100 person-years of exposure.

RESULTS AND CONCLUSIONS

Baseline severity of immunosuppression is the strongest predictor of mortality. There were no statistically significant differences in overall HIV-related mortality among transmission categories, race/ethnicity groups or sexes. There were differences, however, in cause-specific mortality among the different risk groups.

Determinants of HIV risk among men who have homosexual sex and inject drugs

Men with histories of both homosexual contact and injecting drug use (IDU) are at increased risk of HIV infection over men who have only one such risk. Despite this, their special needs and circumstances have been neglected by AIDS prevention programmes. A survey of a wide spectrum of homosexual male IDUs was carried out in Melbourne and Sydney in 1993 to inform the development of specific policy and programmes for HIV prevention in these subcultures. Of 169 men, self-reported HIV prevalence was 27%. Decreasing compliance with safe sex guidelines (as measured by numbers of casual partners, participation in anal intercourse and use of condoms) was associated with HIV seropositivity, increased age, and increased participation in sex work; having a regular male partner was not protective against unsafe sexual behaviour, no matter the length of the relationship. A substantial proportion (15%) reported inconsistent condom use during anal sex with more than two partners in the preceding month: they were slightly more likely to be engaging in sex work, less 'stable' and more likely to be HIV infected. Sexual risk was not strongly associated with unsafe injecting, which was in general safe. Men who both have homosexual sex and inject drugs are groups at high risk of HIV, more from unsafe sex than from shared injecting equipment; men who believed themselves to be HIV infected were continuing to have sex in such a way that would allow transmission. These are clearly groups in need of priority targeted interventions.

Cytoprotective effects of CI-959 in the rat gastric mucosa: modulation of leukocyte adhesion

BACKGROUND & AIMS

CI-959 is an anti-inflammatory agent that inhibits neutrophil adhesion, respiratory burst, and mast cell histamine release in vitro. In view of the emerging role of neutrophils in gastric erosive damage, the goals of this study were to assess the gastric cytoprotective effects of CI-959 and identify the mechanism responsible for this action.

METHODS

Cytoprotective effects in the rat nonsteroidal anti-inflammatory drug and ethanol erosion models were assessed using image analysis. The in vivo effects of CI-959 on gastric acid secretion, arachidonic acid metabolism, and intracellular sulfhydryl and leukocyte adhesion were also examined.

RESULTS

CI-959 protected prophylactically against the erosive damage induced by aspirin, indomethacin, and ethanol with 50% effective doses (ED50s) of 0.05, 1.0, and 0.07 mg/kg administered orally, respectively. When administered after indomethacin or ethanol, CI-959 had no effect on the healing of erosive damage. CI-959 did not alter gastric acid secretion, arachidonic acid metabolism, or intracellular sulfhydryl levels. In vivo, CI-959 blocked leukocyte adhesion in intravital microscopy studies using indomethacin (ED50, < 5 mg/kg orally) or platelet-activating factor (50% inhibiting concentration, approximately 10 mumol/L) as the adhesion stimulus.

CONCLUSIONS

The most likely mechanism responsible for the cytoprotective effects of CI-595 is its inhibitory effects on leukocyte trafficking and/or adhesion.

A positive, individually ventilated caging system: a local barrier system to protect both animals and personnel

Most local barrier systems are designed primarily either to protect animals from airborne contamination (exclusion) or to ensure the safety of personnel (hazard containment). Few, other than isolators, are able to cope with the often conflicting demands to do both. The Positive Individually Ventilated system (PIV), which provides pressure adjustable, individual supply and exhaust ventilation to each cage has been tested with this in mind as well as the need to ensure that environmental conditions comply with the requirements of the Home Office Code of Practice (CoP). The results indicate that when compared with traditional open racking the system can reduce both the risk of animals becoming contaminated by airborne infection from the room and the risk of aeroallergens escaping from the cages into the room air. At the same time, environmental conditions within the cages are both less variable and less stressful to the occupants. Conditions of air temperature, relative humidity, ventilation rates, light intensity and (with appropriate air handling) sound levels, all comply with or are better than those required by the CoP. Even with the room air change rate set at only 8/h (8 ac/h) the air distribution system results in draught-free cage ventilation rates of around 50-120 ac/h. This means that with at least the PIV exhaust(s) linked directly into the air conditioning system of the building, the size of the latter and its associated running costs can be reduced by around 50%; this energy saving concept has been approved in principle by the Home Office. Additional benefits include the fact that bedding is kept much drier allowing further cost savings in bedding and associated labour costs. The system is thus beneficial to the animals in protecting them from airborne infection and other stresses. By providing a less variable environment it also helps to minimise the sort of interference with experiments which can arise from that source. Similarly, in accordance with the aims of 'The Control of Substances Hazardous to Health Regulations' (COSHH 1988) and the Health & Safety Executive (HSE 1990), by reducing dust levels in the room air, including allergens, it is also beneficial to the personnel working in the animal rooms.

Complications of bush thoracotomy in the Highlands of Papua New Guinea

Bush thoracotomy is still practised in the South Western Highlands of Papua New Guinea, by traditional bush doctors. These bush thoracotomies are performed with the aim of letting out the 'bad blood' that is believed to have collected in the body cavities following injuries. During a 3 year period between 1989 and 1992, 183 patients with complications of bush thoracotomy were treated at the Sopas Hospital in the Highlands of Papua New Guinea. Of these patients, 55 had chest wall infections only, without any pleural involvement. Of the patients with empyemas, 14 were treated by decortication of the empyema with one death and all remaining patients were treated by drainage procedures with one death. We recommend early treatment by adequate drainage of the empyema and, where feasible, early decortication. Continuing education to eradicate the procedure, and provision of adequate surgical facilities for management of complications, should be the long-term aim for this continuing problem.