Should individuals use influenza vaccine effectiveness studies to inform their decision to get vaccinated?

Studies on the effectiveness of seasonal influenza vaccine can affect an individual's perception of the ability of this vaccine to protect against influenza. However, vaccine effectiveness studies are designed to inform public health decisions rather than for individual decision-making. This overview explains what vaccine effectiveness means and why vaccine effectiveness estimates can vary. Individual variation in the response to seasonal influenza vaccine is based upon risk factors such as age, underlying health conditions, immune status and risk of infection and complications. Therefore, an individual's decision to get vaccinated should be primarily informed by their risk of influenza illness and their risk of transmitting influenza to vulnerable people.

Evolving practice: X-linked agammaglobulinemia and lung transplantation

X-linked agammaglobulinemia (XLA) is a rare primary humoral immunodeficiency syndrome characterized by agammaglobulinemia, recurrent infections and bronchiectasis. Despite the association with end-stage bronchiectasis, the literature on XLA and lung transplantation is extremely limited. We report a series of 6 XLA patients with bronchiectasis who underwent lung transplantation. Short-term outcomes were excellent however long-term outcomes were disappointing with a high incidence of pulmonary sepsis and chronic lung allograft dysfunction (CLAD).

Silver nitrate: histological effects of cautery on epithelial surfaces with varying contact times

Silver nitrate is used extensively in rhinological practice for the treatment of recurrent epistaxis. There are currently no recommendations in the literature regarding the optimum application time of this chemical for effective treatment. We assessed the histological effects of silver nitrate on mucosal tissue at varying contact times and made recommendations based on our findings. Silver nitrate was applied at predetermined contact times to tonsillar mucosa, immediately before tonsillectomy in subjects undergoing routine surgery. The cauterized areas were subsequently analysed histologically. The depth of tissue penetration by the silver nitrate was measured. The means for 5, 10 and 20 s were 0.44, 0.30 and 0.38, respectively, P = 0.3. Overall, there was no deeper penetration of the tissues with contact times over 5 s. We conclude that it is not necessary to apply silver nitrate for greater than 5 s to achieve maximal tissue penetration.

Ophthalmic complications of childhood medulloblastoma

BACKGROUND

To study the ophthalmic complications and sequelae in children surviving medulloblastoma in order to assess the need for therapeutic intervention by the ophthalmologist.

PROCEDURE

We identified all children attending the Leeds General Infirmary and St. James' University Hospital for treatment of medulloblastoma in the period January 1990 to March 1997, and the notes of all surviving patients were reviewed. Those patients who had not had an ophthalmic assessment within the last 6 months were recalled for examination.

RESULTS

Twenty-four surviving patients underwent full ophthalmic assessment. The follow-up period ranged between 6 months and 7 years (range 3.6 yr): 66% had ocular symptoms at presentation; 25% developed ocular complications following treatment; 50% were left with ocular sequelae; 41% percent required ophthalmic intervention (25% medical/orthoptic intervention; 16% surgical intervention).

CONCLUSIONS

Early (preferably preoperative) referral to the ophthalmology department is important in order to ensure appropriate management of diplopia, preservation of binocular single vision, and prevention of amblyopia in younger children.

Perivesical fat necrosis after adjuvant intravesical chemotherapy

OBJECTIVE

To document the presence of extensive transmural and perivesical fat necrosis in a series of radical cystectomies, and associate the surgical and pathological findings with the administration of intravesical chemotherapy.

PATIENTS AND METHODS

The study comprised 12 patients with pT2+ transitional cell tumours who were referred to the West Middlesex University Hospital and who proceeded to primary radical cystectomy between November 1996 and April 1998. The association between the presence of widespread transmural and extravesical necrosis and the administration of a single dose of intravesical epirubicin or mitomycin C in the 24 h after the initial transurethral resection of bladder tumour (TURBT) was analysed using the two-tailed Fisher's exact test.

RESULTS

The association between the presence of transmural and extravesical fat necrosis and administration of intravesical chemotherapy was highly significant (P=0.015).

CONCLUSIONS

The depth and extent of the mural muscle necrosis and perivesical fac necrosis in patients receiving intravesical chemotherapy within 24 h of TURBT is remarkable and more florid than the usual muscle necrosis seen after TURBT. Clinically, the necrotic tissue makes the cystectomy significantly more difficult technically, and may even mimic extravesical spread of malignant disease. This was not borne out by the histology of the specimens, which showed no extravesical spread of the tumour. Surgeons should be aware of the possibility that such operative findings might be the result of intravesical chemotherapy.

Discharging routine phacoemulsification patients at one week

The reduction of surgically induced astigmatism and rapid refractive stabilisation after phacoemulsification have been well studied and often lead to reduced follow-up. In this prospective study we reviewed a cohort of 100 patients discharged with a refractive prescription at their 1 week post-operative appointment following routine sutureless phacoemulsification through a corneal or scleral section. The aim was to assess the incidence of late pathology and need for review. Eighty-eight patients attended for review between 3 and 4 months post-operatively, of whom 8 (9.1%) who had been symptomatic had already visited ophthalmic casualty. Nine (10.2%) benefited from the follow-up appointment: 4 were given a new refractive prescription that increased their Snellen visual acuity by 1 line; the other 5 were all symptomatic or had incidental findings. We feel that provided there is easy access to the eye department, early discharge with or without refraction is justifiable as those with surgically related pathology at any stage are symptomatic.

Cellular benign fibrous histiocytoma of the external auditory meatus

A rare case of cellular benign fibrous histiocytoma (BFH) of the external auditory canal is presented with a discussion of its pathology and management.

Late sino-nasal metastasis from follicular thyroid carcinoma

We report a rare case of metastasis of a follicular carcinoma of the thyroid to the sino-nasal cavity 12 years after diagnosis and treatment of the primary malignancy and review the literature of previously reported cases.

Congenital hereditary endothelial dystrophy associated with nail hypoplasia

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Exercise-related potassium and free fatty acid level changes in coronary artery disease. Responses after moderate intensity training

Exercise produces changes in circulating levels of potassium and free fatty acids which may provoke arrhythmias in patients with coronary artery disease. Twenty patients participating in 6 weeks of training were studied; 9 of these patients took part in 4 more weeks of training and a third exercise test. After 6 weeks, potassium levels were higher at submaximal levels of exercise, free fatty acid levels were reduced at rest, and at 5, 15, and at 30 min post-exercise. Norepinephrine levels were reduced at submaximal work loads after 6 weeks and increased at maximal work loads. The extra 4 weeks had no additive effect on these metabolic changes. Participation by coronary artery disease patients in a short-term, moderate intensity, exercise training program increases potassium levels at submaximal work loads and reduces levels of free fatty acids at rest and after exercise. The arrhythmogenic relevance of these findings deserves further consideration.

Bovine neurophysin-II stimulates prolactin release without involvement of dopaminergic prolactin-release inhibiting factor receptor in the estradiol-primed male rat

Neurophysins have been considered to be physiologically inert carrier proteins for the neurohypophysial hormones, oxytocin and vasopressin. We have observed that bovine neurophysin-II indirectly stimulates prolactin release in estradiol-primed male rats. The release of prolactin is regulated by a dual hypothalamic control system, the prolactin-release-inhibiting factor and the prolactin-releasing factor. We have tried to clarify whether neurophysin-II is acting through stimulation of prolactin-releasing factor by eliminating the possibility of dopaminergic prolactin release-inhibiting factor release. Male rats were primed with estradiol and functional dopaminergic prolactin release-inhibiting factor receptors were completely blocked by pretreatment with a large dose of pimozide (3 mg/kg), a dopaminergic receptor blocking agent. The neurophysin-II stimulated prolactin release in the rats which did not have any functional dopaminergic prolactin release-inhibiting factor receptors suggesting that neurophysin-II likely initiates a chain of events which eventually stimulates prolactin-releasing factor release since the possibility of involvement of the dopaminergic prolactin release-inhibiting factor system is eliminated. Opioids are known to be one of a chain of events which transmit external stress into a stimulation of prolactin release. Naloxone, a mu-receptor antagonist, was injected 20 min before neurophysin-II administration into rats which were primed with estradiol and pretreated with pimozide (3 mg/kg), but the naloxone administration did not block the prolactin release stimulated by neurophysin-II injection. This result indicates that opioids are not one of the chain of events between initiation of stimulation by neurophysin-II and prolactin release.

Ascorbic acid potentiates the inhibitory effect of dopamine on prolactin release in primary cultured rat pituitary cells

The chemical structure of dopamine includes an ortho-catechol group which is labile to oxidizing agents. Ascorbic acid, a reducing agent, has in the past been added to the incubation medium in order to protect dopamine against oxidation. However, there has been no thorough examination of the biological effect of ascorbic acid on prolactin release. In this present study we have shown that ascorbic acid has neither a stimulatory nor an inhibitory effect on prolactin release but reduces by approximately two orders of magnitude the concentration of dopamine necessary to inhibit prolactin release from cultured anterior pituitary cells. The strong potentiation effect of ascorbic acid was reproduced using apomorphine. We compared the effect of ascorbic acid and isoascorbic acid on dopamine inhibition of prolactin release. Isoascorbic acid is an epimer of ascorbic acid, having the same reduction-oxidation potential as ascorbic acid, but is less biologically active. Isoascorbic acid was less effective in potentiating the dopaminergic effect than was ascorbic acid, which supports the notion that potentiation by ascorbic acid is not entirely due to its reducing property. In order to dissociate further the chemical protection of dopamine from the biological potentiation, the inhibitory effects of freshly made and 3-h-old dopamine solutions were compared. Neither one of the two solutions contained any ascorbic acid, yet the two solutions did not show any difference in their ability to inhibit prolactin release during the 3-h incubation period, indicating that no significant amount of dopamine was oxidized.(ABSTRACT TRUNCATED AT 250 WORDS)