Collagen proportionate area predicts clinical outcomes in patients with alcohol-related liver disease

BACKGROUND

No prognostic tools are established for alcohol-related liver disease (ALD). Collagen proportionate area (CPA) measurement is a technique that quantifies fibrous tissue in liver biopsies using digital image analysis.

AIM

To assess the predictive value of CPA on hepatic decompensation and liver-related mortality in ALD METHODS: In a multicentre cohort study, we included 386 patients with biopsy-verified ALD and with long-term follow-up. In the development cohort of 276 patients, we assessed the predictors of hepatic decompensation and liver-related death in standard and competing risk multivariable Cox regression analyses. The results were validated in an independent prospective cohort of 110 patients, where CPA was also correlated with liver stiffness measurement (LSM).

RESULTS

In the development cohort, 231 (84%) patients had early/compensated ALD (non-cirrhotic or compensated cirrhosis) and 45 (16%) had decompensated cirrhosis. In the validation cohort, all patients had early/compensated ALD. Independent predictors of liver-related mortality were higher CPA values (HR = 1.04, 95% CI 1.02-1.04) and advanced fibrosis (HR = 2.80, 95% CI 1.29-6.05) with similar results in standard and competing risk multivariable Cox regression analysis. In early/compensated ALD, CPA was the only independent predictor of hepatic decompensation and liver-related death (HR = 1.08, 95% CI 1.06-1.11). In the prospective cohort, we validated that CPA independently predicts hepatic decompensation in early/compensated ALD. The predictive power of CPA and LSM was equally strong.

CONCLUSIONS

CPA predicts liver-related mortality in ALD and hepatic decompensation and/or liver-related death in early/compensated ALD. Traditional histological assessment may benefit from the addition of CPA to the evaluation of ALD.

Effect of overweight and obesity on weight loss and length of stay in patients with walled-off pancreatic necrosis

OBJECTIVE

The aim of this study was to assess the association between admission weight, weight loss, and length of stay (LOS) in patients with walled-off pancreatic necrosis.

METHODS

We classified the admission body mass index (BMI) of 18.5 to <25 kg/m² as normal weight, 25 to <30 kg/m² as overweight, and ≥30 kg/m² as obesity. The Nutritional Risk Screening score-2002 was calculated to identify patients at risk for undernutrition.

RESULTS

We included 38 patients (61% men, 68% with infected necrosis; 40% normal weight; 60% overweight/obesity). Four patients (11%) required treatment at the semi-intensive care unit, 11 (29%) developed pneumonia, and 10 (26%) developed septicemia. One patient died due to respiratory failure and hemorrhage. The remaining patients were discharged after a median of 49 d (36-64 d). During admission, 14 patients (38%) achieved an energy-protein intake of at least 75% and 17 (46%) achieved ≥70% coverage. The percentage weight loss was different (P < 0.01) for patients with normal weight (4%), overweight (9%), and obesity (14%). There was no difference between groups regarding percentage of energy or protein coverage. Patients with overweight/obesity had a longer hospital LOS (P = 0.016). In univariable regression analysis, overweight, obesity, energy, and protein coverage predicted weight loss. LOS did not predict weight loss. In multivariable regression analysis, overweight and obesity were the only remaining significant predictors of weight loss.

CONCLUSIONS

Patients with walled-off pancreatic necrosis are at considerable risk for undernutrition. A BMI >25 kg/m² predicts greater weight loss and longer LOS.

A short-term transition from a high-fat diet to a normal-fat diet before pregnancy exacerbates female mouse offspring obesity

BACKGROUND/OBJECTIVES

Recent findings have highlighted the detrimental influence of maternal overnutrition and obesity on fetal development and early life development. However, there are no evidence-based guidelines regarding the optimal strategy for dietary intervention before pregnancy.

SUBJECTS/METHODS

We used a murine model to study whether switching from a high-fat (HF) diet to a normal-fat (NF) diet (H1N group) 1 week before pregnancy could lead to in utero reprogramming of female offspring obesity; comparator groups were offspring given a consistent maternal HF group or NF group until weaning. After weaning, all female offspring were given the HF diet for either 9 or 12 weeks before being killed humanely.

RESULTS

H1N treatment did not result in maternal weight loss before pregnancy. NF offsprings were neither obese nor glucose intolerant during the entire experimental period. H1N offsprings were most obese after the 12-week postweaning HF diet and displayed glucose intolerance earlier than HF offsprings. Our mechanistic study showed reduced adipocyte insulin receptor substrate 1 (IRS1) and hepatic IRS2 expression and increased adipocyte p-Ser(636/639) and p-Ser(612) of H1N or HF offspring compared with that in the NF offspring. Among all groups, the H1N offspring had lowest level of IRS1 and the highest levels of p-Ser(636/639) and p-Ser(612) in gonadal adipocyte. In addition, the H1N offspring further reduced the expression of Glut4 and Glut2, vs those of the HF offspring, which was lower compared with the NF offspring. There were also enhanced expression of genes inhibiting glycogenesis and decreased hepatic glycogen in H1N vs HF or NF offspring. Furthermore, we showed extremely higher expression of lipogenesis and adipogenesis genes in gonadal adipocytes of H1N offspring compared with all other groups.

CONCLUSIONS

Our results suggest that a transition from an HF diet to an NF diet shortly before pregnancy, without resulting in maternal weight loss, is not necessarily beneficial and may have deleterious effects on offspring.

Aquatic Risk Assessment of Enzymes used in Household Detergents

Exposure and effect assessment including risk characterisation of enzymes used in household detergents were conducted. Predicted environmental concentrations were calculated by use of traditional methods and detailed transport and fate modelling. Predicted no effect concentrations were derived from the results of ecotoxicological studies conducted with subtilisin and other available information on the acute and chronic aquatic toxicity. Risk characterisation ratios were defined as the ratio between the predicted environmental concentration and the predicted no effect concentration. Risk characterisation ratios were calculated for fresh and marine water and were found to be between 0.0002 and 0.06, i.e. all well below 1. This shows that under the given conditions, the use of enzymes in household detergents does not present a risk to the aquatic environment.

Aquatic Risk Assessment of Alcohol Ethoxylates, Alcohol Ethoxysulphates and Linear Alkylbenzene Sulphonate used in Household Detergents

Exposure and effect assessments including risk characterisation of the surfactants alcohol ethoxylates, alcohol ethoxysulphates and linear alkylbenzene sulphonates used in household detergents were conducted. Predicted environmental concentrations were calculated by use of traditional methods and detailed transport and fate modelling. Predicted no effect concentrations were derived from the available information on the acute and chronic aquatic toxicity. Risk characterisation ratios were defined as the ratio of the predicted environmental concentration to the predicted no effect concentration. Risk characterisation ratios were calculated for fresh water and marine water and were below 1. This indicates that based on the methods employed in this study the use of alcohol ethoxylates, alcohol ethoxysulphates and linear alkylbenzene sulphonate in household detergents does not appear to present a risk to the aquatic environment.

Fruit tree model for uptake of organic compounds from soil

Apples and other fruits are frequently cultivated in gardens and are part of our daily diet. Uptake of pollutants into apples may therefore contribute to the human daily intake of toxic substances. In current risk assessment of polluted soils, regressions or models are in use, which were not intended to be used for tree fruits. A simple model for uptake of neutral organic contaminants into fruits is developed. It considers xylem and phloem transport to fruits through the stem. The mass balance is solved for the steady-state, and an example calculation is given. The Fruit Tree Model is compared to the empirical equation of Travis and Arms (T&A), and to results from fruits, collected in contaminated areas. For polar compounds, both T&A and the Fruit Tree Model predict bioconcentration factors fruit to soil (BCF, wet weight based) of > 1. No empirical data are available to support this prediction. For very lipophilic compounds (1ogK(ow) > 5), T&A overestimates the uptake. The conclusion from the Fruit Tree Model is that the transfer of lipophilic compounds into fruits is not relevant. This was also found by an empirical study with PCDD/F. According to the Fruit Tree Model, polar chemicals are transferred efficiently into fruits, but empirical data to verify these predictions are lacking.

Constipation in neurological diseases

Hippocrates noted that "it is a general rule, that intestines become sluggish with age", though the precise mechanisms for this association remains uncertain even today.

Patient outcomes after peripheral revascularization surgery

Acquired peripheral vascular disease (PVD) is a significant problem in the United States, resulting in both morbidity and mortality. The purpose of the pilot study was to determine patient outcomes after peripheral revascularization surgery. The specific aims of the pilot study were to examine peripheral revascularization surgical patient outcomes (PVD-related clinical symptoms, functioning, atherosclerotic disease risk factor reduction, and patient satisfaction) and to determine the influence of selected patient demographic characteristics (gender, age) on selected patient outcomes (PVD-related clinical symptoms, functioning, atherosclerotic disease risk factor reduction, and patient satisfaction). A prospective, repeated measures design was used for the study. A total of 39 patients, 18 women and 21 men, participated in the study, with a mean age of 68.86 years (SD = 13.61). The average length of hospitalization after surgery was 4.05 days. At 1 month after discharge, the majority of patients had relief from claudication and paresthesia. In regard to outcomes related to atherosclerotic risk factor modification, patients reported that they exercised on a routine basis, an average of 5.31 +/- 1.97 times per week. Before surgery, 21 patients reported that they smoked; 6 patients reported that they continued to smoke at follow-up. There were no significant differences in mean total scores of atherosclerotic risk modification by either gender or age groups (<65 or > or =65 years) with the use of one-way analyses of variance (ANOVAs). By using a Likert scale (ie, 0 to 10), the mean level of functioning was 8.18 +/- 2.76, with women having significantly higher mean levels of functioning (F = 4.26, P <.05). Comparing baseline scores of functioning on the Medical Outcomes Study Short-Form 36 (MOS SF-36), there was a significant improvement (F = 2.11, P <.05) in general health subscale scores at 1 month after surgery. Subjects' mean overall satisfaction with the results of surgery, with a 0 to 10 scale, was 7.33 +/- 2.84. Again, by using one-way ANOVAs, females had significantly higher mean satisfaction rating than males (F = 4.52, P <.05). Although findings from this pilot study are limited in their generalizability, clinicians need to continue to evaluate opportunities to further reduce variability in clinical practice patterns for optimal patient outcomes. Study findings also indicated that additional interventions are warranted to educate and provide rehabilitation for patients regarding an exercise program and overall behavior modification strategies to reduce risk for atherosclerotic disease.

Rural, urban and suburban comparisons of preventive services in family practice clinics

Numerous studies have compared health services provided in rural and urban areas, and overall they have found that utilization is lower in rural areas. A significant factor in lower utilization is that rural residents have less access to health services. Much less is known about rural and urban utilization differences once a patient has access to a service provider. This paper focuses on preventive services received when a patient is already in a clinic. Using data from an in-depth qualitative study of 16 family practice clinics in Nebraska, comparisons of physician-specific preventive service rates are made across three geographic categories: rural, urban and suburban. Results from a one-way multivariate analysis of variance show that preventive services rates for nine services examined were as high or higher in rural areas, suggesting that rural health services do not lag for patients with access.

Chest pain management: linking tertiary and rural settings

The Center for Advanced Nursing Practice Evidence-Based Model was the catalyst and driving force that guided the application of evidence-based practice across boundaries of tertiary health care settings to rural health care settings. The intent of this effort was to enhance knowledge and to streamline practice for the management of patients with chest pain. The model successfully supported practice changes and improved outcome management for this aggregate population.

Comparison of clinical practice changes in a rapid recovery program for coronary artery bypass graft patients

The clinical exemplar reported in this article demonstrates the usefulness of the Center for Advanced Nursing Practice's Evidence-Based Practice Model in facilitating a structured approach to expanding outcomes management of rapid recovery for coronary artery bypass graft (CABG) patients. The evidence-triggered and evidence-supported components of the model were key in using research and evidence-based practices to analyze the current program of outcomes management used for CABG rapid recovery. The evidence-observed component further validated changes in clinical practice, which became part of the evolving outcomes management program.

Collaborative research: a community approach

Collaborative nursing research is an effective means to increase research productivity. The essentials of collaborative research are contribution, communication, commitment, consensus, compatibility, and a cohesive approach toward a positive outcome. The purpose of the demonstration project was to describe a collaborative process in one community, culminating in a research utilization study and development of nursing standards pertaining to an aggregate population of patients.

Comparison of two endotracheal tube securement techniques on unplanned extubation, oral mucosa, and facial skin integrity

OBJECTIVE

To determine the effect of 2 standard methods (i.e., twill tape versus adhesive tape) of securement on unplanned extubation, oral mucosa, and facial skin integrity of the orally intubated patient.

DESIGN

A prospective, quasi-experimental design was used for the pilot study.

SETTING

The setting for the pilot study included critical care units of 3 community hospitals and 1 veterans' hospital in a midwestern city.

SUBJECTS

A total of 52 orally intubated adult subjects were enrolled in the study from the 4 clinical sites over a 6-month period of time. The participants in the study consisted of 30 men and 22 women. The subjects ranged in age from 22 to 85 years, with a mean age of 62.3 years. The mean length of intubation was 89.6 hours.

OUTCOME MEASURES

The outcome measures of the study were (1) unplanned extubation, (2) oral mucosa status, and (3) facial skin integrity.

INTERVENTIONS

Endotracheal tube securement with either the twill tape or the adhesive tape securement method.

RESULTS

With use of multiple analysis of variances (MANOVA) and repeated analyses of variances (ANOVAs), there were no significant differences by time or type of endotracheal tube securement method on oral mucosa or facial skin integrity. A chi-square analysis demonstrated no significant association between the 2 types of endotracheal tube securement when comparing their efficacy in preventing unplanned extubation.

CONCLUSION

The findings of this pilot study demonstrated both methods of endotracheal tube securement to be comparable in preventing unplanned extubation and in maintaining oral mucosa status and facial skin integrity.

[Theophylline poisoning--clinical course and treatment]

After about half a century of treatment of asthma and chronic obstructive pulmonary disease, theophylline still occupies a central position in the treatment of these conditions. Severe poisonings are rare and may occur as a result of chronic over-medication or acute self-poisoning. The clinical course depends not only on the amount taken and the peak serum concentration, but also on whether the intoxication is acute or chronic. The therapeutic range is narrow (55-110 mumol/l). Total body clearance of theophylline varies considerably between individuals, and drug interactions are common. These circumstances lead to relatively high risk of poisoning. Clinical features vary from moderate gastrointestinal discomfort, particularly nausea, tremor and tachycardia, to life-threatening conditions affecting the cardiovascular and central nervous systems. Treatment is discussed in connection with a presentation of three case histories.

[CT in the prognostic evaluation of apoplexy]

The purpose of our prospective study was to determine whether cranial computed tomography in connection with neurological assessment was useful in prognostic evaluation of survival after acute stroke. Two-hundred and forty-five consecutive stroke patients were included. Each underwent detailed neurological assessment and cranial computed tomography without intravenous contrast injection. The lesions were divided according to neuroanatomic regions. In the statistical analyses we used a multiple logistic regression model. Computed tomography showed that 76% of the patients had infarcts. 11% had haemorrhages, and 13% had no acute lesion. Forty-three patients had more than one acute lesion, and 57 had one or more old infarcts. The temporal, parietal and frontal regions and the basal ganglia were most often affected. We concluded that age, level of consciousness, and involvement of the temporal lobe on computed tomography were factors of prognostic significance regarding survival in the acute phase.

Computed tomography in prognostic stroke evaluation

BACKGROUND AND PURPOSE

Computed tomography is now routinely used in many hospitals to investigate cerebrovascular disease. The purpose of our prospective study was to determine whether cranial computed tomography in connection with neurological assessment was useful in prognostic evaluation of survival after acute stroke.

METHODS

Two-hundred forty-five consecutive stroke patients were included in the project during a 1-year period. Each had a detailed neurological assessment 24-72 hours after stroke onset and underwent cranial computed tomography without intravenous contrast injection within the first week after admission. The lesions were divided according to neuroanatomic regions. In the statistical analyses we used a multiple logistic regression model with survival/death as the binary variable.

RESULTS

Computed tomography showed 76% of the patients had infarcts, 11% had hemorrhages, and 13% had no acute lesion. Forty-three patients had more than one acute lesion, and 57 had one or more old infarctions. The temporal, parietal, and frontal regions and the basal ganglia were most often affected.

CONCLUSIONS

We conclude that age, level of consciousness, and involvement of the temporal lobe on computed tomography were factors of prognostic significance regarding survival in the acute phase.

Phase II study of teniposide in advanced breast cancer

In a phase II study, 19 patients with previously treated, advanced breast cancer received 50 mg/m2 teniposide (VM-26) i.v. on days 1-5 every 3 weeks. One partial response (PR) (5%) was observed. Toxicity consisting of leukopenia and thrombocytopenia was frequent and severe. VM-26 has minimal therapeutic activity when given at this dose and on this schedule to patients with heavily pretreated metastatic breast cancer.

Behavioural pharmacology of the serenic, eltoprazine

In this paper the effects of serenics (eltoprazine and fluprazine) are described in several animal models for offensive agonistic, defensive agonistic and predatory behaviour. They are compared with the effects of a number of other putative anti-aggressive compounds or drugs used clinically in order to ameliorate aggressive behaviour of psychiatric patients. In isolation-induced offensive aggression in mice, eltoprazine has a marked and potent anti-aggressive activity, although numerous other psychoactive drugs also exert anti-aggressive effects. The behavioural specificity of this anti-aggressive profile was investigated using an ethologically derived animal model, social interaction in male mice. In this model, eltoprazine has a very specific anti-aggressive (serenic) profile, inhibiting aggression while social interaction and exploration are not decreased but even enhanced; inactivity, a measure for sedation, is not affected. Such a profile contrasts sharply with that of neuroleptics (chlorpromazine, haloperidol), psychostimulants (d-amphetamine) or benzodiazepines (chlordiazepoxide), which exert severe sedation (neuroleptics) or even aggression-enhancing effects (BDZ). After subchronic treatment no tolerance for the anti-aggressive effects of eltoprazine occurred. The specific anti-aggressive effects of eltoprazine were also found in rat models of offensive agonistic behaviour. In one such model - resident-intruder aggression - eltoprazine reduced offensive behaviour specifically, leaving social interactions and exploration intact, and did not induce sedation or other unwanted side-effects. The neuroleptic haloperidol was very sedative in this model, as was the 5-HT1A-agonist buspirone. Benzodiazepines (chlordiazepoxide) have a biphasic effect in this paradigm, enhancing offence at low doses and decreasing it at higher doses, due to muscle relaxation. In another offensive model, colony-aggression, in which a dominant and subordinate male in a colony are confronted with a male intruder, eltoprazine reduced offensive behaviour of both the dominant and the subordinate against the intruder. In contrast, chlordiazepoxide enhanced aggression, at least at lower doses, whereas alcohol had, up to very high doses, no effect on the offensive behaviour. In a brain-stimulation induced offensive model--hypothalamically-induced aggression in rats--eltoprazine specifically reduces offence. Locomotion, a measure for sedation, was either unaffected or even somewhat enhanced, indicating the absence of any sedatory activity of this serenic compound. In contrast, haloperidol heavily sedated animals, making them incapable of aggression.(ABSTRACT TRUNCATED AT 400 WORDS)

Ethopharmacology: a creative approach to identification and characterisation of novel psychotropics

The present contribution describes the basic fundamentals of animal models in ethopharmacology. After defining the role of ethopharmacology in the development of animal models of relevant human diseases, this methodology is used to classify different categories of aggression. Furthermore, the behavioural aspects of agonistic (aggressive) modelling are outlined and the various models used to describe offensive and defensive behaviours, and some miscellaneous models are summarized. Finally, some remarks on the new class of psychoactive drugs, serenics, are given.

Gated intracoronary thallium201 scintigraphy: feasibility and potential clinical advantages

Visualization of ventricular walls with true global motion and myocardial thickening is not possible with use of present scintigraphic techniques. When thallium 201 (201TI) is injected intravenously (IV), only about 5% reaches the myocardium. However, if 201TI is injected intracoronarily, 100% reaches, and approximately 88% localizes in, the myocardium, which results in higher count rates than when given IV, permitting acceptable acquisition times for gated true wall motion studies. The authors describe a new technique using intracoronary (IC) 201TI to acquire high count rate, high contrast, and short acquisition time in gated true wall motion studies. Thirteen patients were studied at rest with gated IC thallium. Six of these patients also had resting IV 201TI myocardial studies. After routine coronary angiography, 0.75 mCi of 201TI was injected into each coronary artery. Multiple sequential one-minute gated studies were obtained in LAO and RAO projections, followed by sequential five-minute images for two hours to determine 201TI redistribution kinetics. Regions of interest over segments of left and right ventricles and background permitted definition of temporal and spatial distributions. Three one-minute gated studies were summed with a total count of 2,100 K for a three-minute acquisition. Myocardium-to-background ratios were as high as 13:1 with a mean of 11.4:1 in the IC study compared with 2.3:1 in the IV studies. Washout half-time in normal myocardium was 95 +/- 5 min. The detectability and size of perfusion defects were different on gated diastolic and systolic, nongated, and IV studies. Questionable defects seen on nongated studies or after IV administration were easily noted on gated diastolic images.(ABSTRACT TRUNCATED AT 250 WORDS)

Focal intracerebral oedema in hypertensive encephalopathy visualized by computerized tomographic scan

A previously healthy man was admitted due to a severe rise in the arterial blood pressure. The patient was found confused and drowsy, but the neurological investigation was otherwise normal. A computerized tomographic scan of cerebrum showed widespread areas of diminished density in the brain. After normalization of the arterial blood pressure, a new computerized tomographic scan did not show any pathological enhancement. The total regression of signs and symptoms after the normalization of the blood pressure support the assumption that a severe increase in blood pressure leads to formation of focal cerebral oedema.

Elemental diet: a therapeutic approach in chronic inflammatory bowel disease

The therapeutic effect of an elemental diet (Pepti 2000) and blended normal diet (placebo) was investigated in 43 out-patients with chronic inflammatory bowel disease (IBD); 24 with ulcerative colitis (UC) and 19 with Crohn's disease (CD), in a mild to moderate state of disease activity. A pilot study on healthy volunteers was executed to investigate palatability of the two diets. The patients were randomized in a double-blind study to the two diet regimes for 14 d. A simultaneous determination of laboratory data including plasma C3c split product and urinary excretion of 51Cr-EDTA was carried out together with a careful registration of the clinical symptoms and signs. No significant effect on the stage of clinical activity was seen in CD. A significant effect on clinical activity was obtained in both UC groups. The clinical improvement was primarily due to a decrease in number of bowel movements both in the elemental diet group and in the group of patients on the blended normal diet. The gross appearance of rectal mucosa did not improve during the study period in the Pepti 2000 or in the placebo group. The concentration of complement split products in plasma remained unchanged. 51Cr-EDTA excretion, as an expression of a leaky bowel mucosa, also remained unchanged. It was concluded that an effect on inflammation could not be demonstrated even if both diets seem to have a beneficial effect on the stage of clinical activity, especially diarrhoea, in patients with UC.

[Is hepatitis B antigenemia a risk in adjuvant cytostatic treatment of breast cancer?]

One-hundred and fifteen consecutive patients with breast cancer were examined for hepatitis B. All the patients received adjuvant chemotherapy. The median age was 46 years (range 26-54 years). None of the patients were found to be HBsAg-positive. The prevalence of HbsAg was within the limits of 0-0.026 (95% confidence interval). Vaccination of patients receiving chemotherapy is not indicated. Furthermore, regular HBsAg screening among patients under 55 years cannot be recommended.

Life events and social support in prediction of stroke outcome

A prospective study of 252 patients (average age 73, range 26-95) admitted to a regional general hospital over a 12-month period was carried out. 241 patients had stroke verified by the initial neurological examination and CT scan, and of these baseline data were not available on 27%. 34% died before or were not willing or able to provide data at follow-up. 39% survived and completed the study. Prestroke life events and social support could not predict the outcome of stroke rehabilitation measured as survival, length of stay, functional recovery (Barthel's Index) or placement at the follow-up 12 months after the onset of stroke. Age and arteriosclerotic heart disease predicted poor survival at follow-up. Premorbid hypertension, stroke, diabetes, obesity, tobacco smoking, and alcohol consumption did not significantly influence the outcome. Problems in stroke rehabilitation research are discussed.

Bone metastases in primary operable breast cancer. The role of a yearly scintigraphy

In 231 patients with primary operable breast cancer bone scintigraphies were performed yearly from the second to the 6th year until recurrence irrespective of localization was diagnosed, another cancer was detected, or the patient refused further follow-up or died. During the observation period (from 2 up to 7 years after surgery) 13 patients (5.6%) had bone metastases verified by X-ray or histology within 12 months after the last bone scintigraphy. The scintigraphy was positive in only 7 of these patients. The yearly incidence of bone metastases varied between 0.6 and 2.6%. Due to this low incidence and a low cost/benefit, we conclude that a fixed schedule of repeated scintigraphies in primary operable breast cancer patients otherwise free of apparent disease is not justified.

Treatment of serious urological infections with cefotaxime compared to ampicillin plus netilmicin

Fifty-nine patients with severe urinary tract infections were treated with either cefotaxime or ampicillin plus netilmicin in a controlled, open randomised study of the clinical and bacteriological effects. The patients responded favourably in both groups. The minimum inhibitory concentrations of cefotaxime against the isolates from blood were low for all bacterial strains except one (Streptococcus faecalis). Time to normalisation of temperature was significantly shorter in the cefotaxime group. The results suggest that cefotaxime is an effective and well-tolerated agent in the treatment of serious infections. However, the difference between the two groups was too small to allow preference of one procedure over the other.

Glucagon in acute ureteral colic. A randomized trial

The effect of glucagon administered as a bolus (1 mg) followed by a continuous infusion (2 mg/h) for 8 h and a placebo was compared in 37 adults with urographically demonstrated ureteral calculi less than 6 mm. The bolus injection was given 20 min after start of intravenous urography, and the infusion was initiated immediately afterwards. No effect on pain relief or passage of calculi was found. Nausea and/or vomiting were recorded significantly more frequently in patients who had glucagon than in patients who had the placebo. It is concluded that glucagon is of no value in acute ureteral colic.

Soft tissue response to Proplast: quantitation of scar ingrowth

We compared, histologically and biochemically, the effects of blood pretreatment vs. no pretreatment on the ingrowth of scar into subcutaneously implanted blocks of Proplast in rats. No significant differences were found.