Bone and Joint tuberculosis in Greater Manchester 1969-79

The records of 74 patients diagnosed as suffering from tuberculous (TB) bone or joint disease between 1969 and 1979 were analysed retrospectively. Most were resident in the Greater Manchester County. Thirty-eight patients were first-generation immigrants, and teenage males were particularly prominent in this group. In the indigenous patients the diagnosis was often delayed several months or years, and in a number of subjects there was a history of previous bone and joint tuberculosis. There was a wide range of affected sites, especially in the immigrant group, and evidence of nonarticular TB was found in only a minority of patients. Diagnosis is most satisfactorily based on open biopsy and submission of pathological material to culture and histology. British subjects were more likely to have to undergo remedial surgery for the disease, especially when weight bearing joints were involved. Antituberculous chemotherapy should be given for at least 1 year to prevent recurrence of the disease.

Abortion counselling by nurse specialists

This paper describes additional training given to nurse specialists in family planning to cover abortion counselling. The primary counselling was carried out by general practitioners or family planning clinic doctors, following this the patient was referred to hospital for counselling by nurse specialists. Of the first 742 patients seen, 3.2% were not pregnant and a further 25 patients (3.4%) decided against termination, 21 after counselling, and 4 because of advanced gestation. The interval between nurse counselling and termination (TOP) was 3 to 9 days, and of 682 TOPs 566 (83%) were in the first trimester. The additional training for nurse specialists prevented the unnecessary wastage of resources as only 42 (5.1%) required a second visit to confirm blood test results, e.g. rubella titres, and only a further 44 (5.3%) required referral to medical social workers.

Recurrent pulmonary thromboembolism presenting with cardiac arrhythmias

Pulmonary emboli seldom recur, and when recurrence does occur it is not associated with permanent sequelae unless there is progressive pulmonary arterial hypertension. Five patients with clinical and perfusion lung scan evidence of recurrent pulmonary embolism presented with abnormal cardiac rhythms without evidence of progressive pulmonary hypertension. Twenty-four-hour ambulatory electrocardiographic monitoring was valuable in diagnosis and in assessing the effectiveness of treatment. Although palpitation was the main complaint, other symptoms included tiredness, mild exertional dyspnoea, and chest discomfort unrelated to effort. Symptomatic improvement coincided with objective evidence of improvement from repeat lung scans and 24-hour ECG records. Antiarrhythmic agents controlled the arrhythmias but were subsequently withdrawn without the return of symptoms. Four of the five patients continued to take anticoagulants for two years. We believe that these five patients represent a group of patients with recurrent pulmonary emboli and a recognisable clinical picture dominated by arrhythmias unrelated to progressive pulmonary arterial hypertension. Long-term anticoagulant treatment was associated with clinical improvement.

Nurse specialists in family planning: the results of a 3-year study

In the first three years of a Nurse Specialist Clinic in Family Planning, 1422 new patients were seen. Oral contraception (OCs) was dispensed for 638 patients, 548 intrauterine devices (IUDs) were fitted and 126 patients received an injectable contraceptive. The continuation rate at thirty months was, 73.2 for OCs, and 68.6 for IUDs. The additional training received by the nurse specialists allowed them to practice comprehensive family planning safely and effectively, as shown by the low "problem" rate, 9.1% for OCs and 7.2% for IUDs. Continued use effectiveness, as shown by the second choice of contraception initiated in the clinic for those who stopped using their first method, was also high, 81.5% for OCs and 90.5% for IUD closures.

Use of amiodarone in bradycardia-tachycardia syndrome

Five patients with the bradycardia-tachycardia syndrome have been treated successfully with the antiarrhythmic agent amiodarone. Three patients were treated for over nine months and one of these patients had corneal micro deposits. One patient had to be taken off the drug because of side effects. Amiodarone should be tried in patients suffering from the bradycardia-tachycardia syndrome before resorting to cardiac pacing.

Cortical potentials associated with the detection of visual events

A positive-going potential, which reaches a maximum at the vertex and midline parietal scalp electrodes, occurs in the human being when an infrequent, significant event occurs in a continuously observed visual display. It is not time locked to eye movements or operant response and appears to be generated when the observer recognizes an event that he has been instructed to detect.

The membrane transport of ascorbic acid

A system for measuring the rate of transport of dehydroascorbate into human red blood cells shows Michaelis-Menten type kinetics with substrate inhibition at levels above 150 muM DHA. The addition of sugars impairs this transport in the diminishing hierarchy D-glucose, D-mannose, D-xylose, D-galactose, L-lyxose, D-araboascorbate, L-sorbose and 2-deoxy-D-ribose. The effect of glucose on transport of ascorbate is marked at physiological levels. Transport of DHA is accelerated by copper ion and allows dehydroascorbate to move against a concentration gradient. The evidence supports the hypotheses proposing that hyperglycemia will impair the intracellular availability of vitamin C.