Comparing Effectiveness of a Generic Oral Nutritional Supplement With Specialized Formula in the Treatment of Active Pediatric Crohn's Disease

BACKGROUND

Exclusive enteral nutrition (EEN) is the recommended induction treatment of mild to moderate active pediatric Crohn's disease (CD). This study compared outcomes of 2 proprietary polymeric formulas. Treatment effectiveness was examined along with practical aspects of formula delivery and differences in estimated treatment costs.

METHODS

Data were retrospectively collected from patients with CD who received a generic oral nutritional supplement (Fortisip) across 2 centers (RCH, Melbourne and RHSC, Edinburgh). This was compared with a prospective cohort (RHC, Glasgow) that used a specialized formula (Modulen IBD). The data collected included patient demographics, remission rates, biochemical markers, administration method, and anthropometrics. The estimated treatment cost was performed by comparing price per kcal between each formula.

RESULTS

One hundred seventy-one patients were included (106 Fortisip, 65 Modulen IBD, 70 female; median age 13.3 yrs). No difference was demonstrated in remission rate (Fortisip n = 67 of 106 [63%] vs Modulen IBD n = 41 of 64 [64%], P = .89), nonadherence rate (Fortisip n = 7 of 106 [7%] vs Modulen IBD 3 of 64 [5%], P = .57) or method of administration (NGT Fortisip use n = 16 of 106 [12%] vs Modulen IBD 14 of 65 [22%]; P = .31). There was no difference in reduction of biochemical disease markers between the groups (C-reactive protein , P = .13; erythrocyte sedimentation rate, P = .49; fecal calprotectin, P = .94). However, there was a cost-saving of around £500/patient/course if the generic oral nutritional supplement was used.

CONCLUSIONS

The generic oral nutritional supplement and specialized formulas both had similar clinical effectiveness in induction of remission in pediatric CD. However, there is considerable cost-saving when using a generic oral nutritional supplement.

Qualitative Ampule and Multitest for Beta-Lactam Residues in Fluid Milk Products: Collaborative Study

A collaborative study was performed on a rapid Bacillus stearothermophilus agar diffusion ampule method to detect low levels of penicillin G in 7 types of fluid milk products. A multitest technique for processing a large number of samples simultaneously was also studied. Slight modifications were made in the original method to establish more uniformity and to eliminate doubtful responses by specifying a confirmation procedure. Twenty samples spiked with penicillin G (0.000 to 0.008 IU/mL) and tetracycline hydrochloride were frozen and sent to 20 laboratories in the ampule test, and 16 laboratories in the multitest. Each analyst was asked to do a screening run and a confirmation run. Results were reported by color reaction and also as positive or negative for β-lactam inhibitors. The concentrations (penicillin G) where percent positive results equal 100 or not significantly less than 100 (α = 0.05) ranged from 0.005 to 0.007 IU/mi in the ampule test and from 0.004 to 0.007 IU/mL in the multitest. Both techniques have been adopted official first action.

Upper extremity injured workers stratified by current work status: an examination of health characteristics, work limitations and work instability

BACKGROUND

Upper extremity injured workers are an under-studied population. A descriptive comparison of workers with shoulder, elbow and hand injuries reporting to a Canadian Workplace Safety and Insurance Board (WSIB) clinic was undertaken.

OBJECTIVE

To determine if differences existed between injury groups stratified by current work status.

METHODS

All WSIB claimants reporting to our upper extremity clinic between 2003 and 2008 were approached to participate in this descriptive study. 314 working and 146 non-working WSIB claimants completed the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH); Short Form health survey (SF36); Worker's Limitations Questionnaire and the Work Instability Scale. Various parametric and non-parametric analyses were used to assess significant differences between groups on demographic, work and health related variables.

RESULTS

Hand, followed by the shoulder and elbow were the most common site of injury. Most non-workers listed their current injury as the reason for being off work, and attempted to return to work once since their injury occurrence. Non-workers and a subset of workers at high risk for work loss showed significantly worse mental functioning. Workers identified physical demands as the most frequent injury-related on the job limitation. 60% of current workers were listed as low risk for work loss on the Work Instability Scale.

CONCLUSION

Poorer mental functioning, being female and sustaining a shoulder injury were risk factors for work instability. Our cohort of injured non-workers were unable to return to work due to their current injury, reinforcing the need to advocate for modified duties, shorter hours and a work environment where stress and injury recurrence is reduced. Future studies examining pre-injury depression as a risk factor for prolonged work absences are warranted.

Rectal biopsy for Hirschsprung's disease--are we performing too many?

BACKGROUND

Rectal biopsy is considered the gold standard for the diagnosis of Hirschsprung's disease. The aim of this study was to evaluate the outcome of rectal biopsies performed in our institution, and to determine whether we are performing an adequate number of biopsies in patients presenting with features suggestive of this disease.

METHODS

A retrospective analysis was conducted of patients who underwent rectal biopsy to exclude Hirschsprung's disease over a seven year period between 2000 and 2006. The histological diagnosis of Hirschsprung's disease was made using haematoxylin and eosin as well as acetylcholinesterase on frozen section. Patients were grouped into three age categories: neonates (group A), infants (group B) and those over 1 year of age (group C). The results of the biopsies were compared between groups.

RESULTS

A total of 668 patients underwent rectal biopsy. 18 samples were insufficient. Based on the histological studies of 650 suitable samples, 73 (11%) were positive and 577 (89%) were negative for Hirschsprung's disease. Of the 73 positive biopsies, 34 (47%) were from group A, 20 (27%) from group B and 19 (26%) from group C. The percentage of positive biopsies was much higher in group A with 29% (34 out of 118) compared to group B with 15% (20 out of 135) and group C with 5% (19 out of 395). Three complications of minor rectal bleeding occurred.

CONCLUSIONS

With 3 complications and 18 insufficient samples out of 668, rectal biopsy is a safe procedure and remains the gold standard for the diagnosis of Hirschsprung's disease, despite the large number of negative biopsies. Contrary to some reports in the literature which question the need for rectal biopsy in those presenting after the neonatal period, 53% of our positive diagnoses were made in children presenting after this period, with 19 positive biopsies out of 395 (5%) performed in children above the age of 1 year.

Adhesional small bowel obstruction following anti-reflux surgery in children--comparison of 232 laparoscopic and open fundoplications

AIM

Adhesions are a major cause of morbidity following abdominal surgery. There is debate whether laparoscopic abdominal surgery results in a lower incidence of adhesional small bowel obstruction (ASBO) compared with the equivalent open procedure. The aim of this study was to study the incidence of ASBO following laparoscopic and open anti-reflux surgery.

METHODS

The case notes of all patients undergoing fundoplication (open or laparoscopic) between November 1997 and November 2005 were reviewed retrospectively. Laparotomy due to ASBO was chosen as the endpoint as it was a clearly identifiable and incontrovertible endpoint. The incidence of ASBO following each operation was compared using Fisher's exact test (p<0.05 was considered significant).

RESULTS

A total of 232 patients were analysed. There were no ASBO following 170 laparoscopic fundoplications. There were 5 episodes (8.1%) of ASBO in 3 patients (4.8%) following 62 open procedures. Two of the three patients who developed ASBO after open fundoplication had undergone concomitant Ladd's procedure. There was no significant difference in the rate of ASBO following laparoscopic and open fundoplication alone.

CONCLUSIONS

ASBO is a serious complication following any abdominal surgery. The data from this study indicate that the risk of ASBO following laparoscopic fundoplication is negligible. Although there is a suggestion that the risk of ASBO is lower following laparoscopic fundoplication compared with open fundoplication, there was no significant difference between the two groups as Ladd's procedure was performed in 2 of the open cases.

Putting the Diabetes Prevention Program into practice: a program for weight loss and cardiovascular risk reduction for patients with metabolic syndrome or type 2 diabetes mellitus

BACKGROUND

The increasing incidence and prevalence of metabolic syndrome and type 2 diabetes mellitus (DM) have significant implications on health world-wide. Large clinical trials have demonstrated the effectiveness of a comprehensive lifestyle program with a goal of moderate weight loss (5-7%) and regular exercise (150 minutes/week), resulting in a significant decrease in the incidence of type 2 DM and cardiovascular risk.

METHODS

This study reports on the translation of the multi-center Diabetes Prevention Program (DPP) into a cardiac rehabilitation program, utilizing the expertise and experience of a cardiac rehabilitation program staff. The study adapted materials from the DPP to develop a program that fit local needs for diabetes prevention.

RESULTS

Most participants completed the program (11 months) and their moderate weight loss was maintained for 11-12 months. At 11-12 months, waist circumference was reduced by approximately 2 inches, percent body fat was reduced by 5% (11% relative decrease, p<.05), weight was decreased by 10.1 pounds (p<.05), and blood pressure was reduced 8/3 mm Hg (p<.05). Exercise, nutrition, glucose, triglycerides, LDL-cholesterol and HDL cholesterol were all were significantly improved at 11-12 months (p<.05).

CONCLUSIONS

Efforts to improve lifestyle and reduce body weight are important to patients at risk of developing diabetes. This program demonstrates that an intensive effort can significantly improve lifestyle and reduce body weight in patients with DM or at risk for DM. A program that simulates cardiac rehabilitation, translated from a successful clinical trial into practice, resulted in significant reduction and improvement in metabolic outcomes and cardiovascular risk. Support for cardiac rehabilitation from insurers to develop similar programs is encouraged and deserves further study.

Does gastrostomy tube feeding in children with cerebral palsy increase the risk of respiratory morbidity?

BACKGROUND

Children with severe neurological impairment may have significant oral motor dysfunction and are at increased risk of nutritional deficiencies, poor growth, and aspiration pneumonia. Gastrostomy tube feeding is increasingly being used for nutritional support in these children.

AIM

To examine the occurrence of respiratory morbidity before and after gastrostomy feeding tube insertion in children with severe neurological disabilities.

METHODS

This study was nested in a longitudinal, prospective, uncontrolled, multicentre cohort study designed to investigate the outcomes of gastrostomy tube feeding in 57 children with severe neurological disabilities. Parents completed a questionnaire prior to (visit 1) and 6 and 12 months (visits 2 and 3) following the gastrostomy, detailing number of chest infections requiring antibiotics and/or hospital admission.

RESULTS

Mean number of chest infections requiring antibiotics was 1.8 on visit 1 and 0.9 on visit 3. Hospital admissions for chest infections fell significantly from 0.5 to 0.09.

CONCLUSION

This study provides no evidence for an increase in respiratory morbidity following insertion of a feeding gastrostomy in children with cerebral palsy.

Anxieties and attitudes towards abortion in women presenting for medical and surgical abortions

OBJECTIVE

To examine the differences in anxiety levels and attitudes towards abortion between women having an early medical abortion and women having a surgical (manual vacuum aspiration) abortion.

METHODS

Women who presented for an early medical abortion or a surgical abortion at an urban, free-standing abortion clinic were invited to participate in this study. Fifty-nine women having a medical abortion and 43 women having a surgical abortion answered questionnaires before their scheduled abortion, and again 2 to 4 weeks after the abortion. Thirty women were interviewed about their answers.

RESULTS

Anxiety levels were similar in both groups before the abortion procedure. Anti-choice views about abortion were seen in 60.5% of women having a medical abortion and in 37.3% of women having a surgical abortion (P = .027). Women who were pro-choice had a mean anxiety score of 5.0 (range, 0-10) before and 2.7 after the abortion, whereas women who were anti-choice had a mean anxiety score of 5.2 before and 4.4 after the abortion (P = .005).

CONCLUSION

It is important for providers of abortion care to understand that women undergoing a medical abortion may be more ambivalent about abortion than women undergoing a surgical abortion, and women who are anti-choice but having an abortion may have unresolved anxiety after the procedure.

Use of human lice in forensic entomology

Hematophagus arthropod bloodmeals may be useful in identifying individual hosts. To examine the application of human lice as a forensic tool, that is, as evidence of physical contact between individuals, body lice from a laboratory colony and head lice, collected from the head of infested children, were studied. The DNA profile of an individual was detectable in the pooled bloodmeals of two body lice, up to 20 h postfeeding. A mixed DNA profile of two hosts was identifiable in the pooled bloodmeals of three lice, for 3 h postfeeding. By pooling the bloodmeals of three adult and three nymphal head lice, a mixed DNA profile was obtained. These results indicate that, in criminal cases where there has been close contact between assailant and victim, louse bloodmeals should not be overlooked as potentially critical evidence.

Comparative phenotype and immunogenicity of freshly isolated and immortalized rat hepatocytes

Immortalized hepatocytes are an attractive cell source for hepatocyte transplantation and gene transfer. We compared the phenotype and immunogenicity of freshly isolated (FIH) and immortalized (IMH) rat hepatocytes. Effect of culture and proinflammatory cytokines (TNF-alpha, IFN-gamma) was studied on phenotype. FIH were isolated by collagenase digestion. Two SV40 immortalized hepatocyte cell lines were tested (RH1 and P9). Immunophenotyping was performed by FACS analysis using anti-rat-specific antibodies. Immunogenicity was evaluated by a mixed lymphocyte hepatocyte reaction (MLHR). FIH suspension was an almost homogeneous parenchymal cell population with few (1-2%) CD8+ cells. FIH showed a positive staining for ICAM-1 (20-35%) and for Class I (RT1A, 30-60%) but no staining for Class II (RT1B). After 48 h of culture, the already ICAM-1-positive cells were more strongly stained and additionally 3.6% of the cells (possibly endothelial cells) were Class II positive. IMH showed a consistent expression of Class I (93-97%) and ICAM-1 (95-97%) but no expression of Class II. Culture of IMH for 48 h had no effect on Class II expression but increased ICAM-1 expression. Addition of TNF-alpha at 1000 UI/ml to cultures of FIH or IMH increased Class I and ICAM-1 expression whereas IFN-gamma (50 or 1000 UI/ml) had no evident effect. Hepatocyte immunogenicity, assessed in MLHR and appreciated by the stimulation index (SI) test/SI syngeneic control, was similar for IMH (RH1: 2.68+/-0.89; P9: 2.37+/-0.78) and FIH (2.52+/-0.18). In conclusion, despite some quantitative immunophenotypic differences, FIH and IMH induced the same proliferation rate of allogeneic T lymphocytes. Thus, immortalized hepatocytes may constitute an appropriate cellular model to study the prevention of hepatocyte rejection by gene transfer.

Wireless telephone-hearing aid electromagnetic compatibility research at the University of Oklahoma

A multiphase study examining electromagnetic compatibility (EMC) between wireless digital telephones and hearing aids has been under way at the University of Oklahoma EMC Center since May 1995. In a phase 1 clinical study involving 68 hearing aid wearers, interference varied significantly by telephone technology, hearing aid type, and hearing loss characteristics. More than 80 percent of the tests resulted in either no interference or a detection threshold distance less than 1 meter. Metallic shielding of the units yielded positive results. Various elements of phase 2 involved instrument-based tests of hearing aid interference using telephones in a sound-isolation chamber and radio frequency signals in a waveguide, along with clinical studies of speech-to-interference ratios, all leading to the development of standards of measurement and performance criteria for telephone emissions and hearing aid immunity. Results to date confirm that bystander interference is of less concern than user interference, which is the focus of continuing research.

Lymph node biopsies in HIV-infected and non-infected children with persistent lung disease

OBJECTIVE

The diagnosis of opportunistic infections in children with persistent lung disease (PLD) who are infected with the human immunodeficiency virus (HIV) is difficult to establish, especially in resource-poor countries. Lymphadenopathy is a frequent associated clinical finding among these children. We evaluated the usefulness of excision lymph node biopsies in determining an aetiological diagnosis in HIV-infected and non-infected children with PLD.

METHOD

Forty-five children with PLD and significant lymphadenopathy were subjected to lymph node biopsy. Of these, 27 were HIV-infected. All subjects had excision biopsies; 39 (86.7%) of these cases also underwent fine needle aspiration cytodiagnosis (FNAC) and trucut needle biopsies.

RESULTS

Tuberculosis was identified as the final diagnosis in 11 (40.7%) and 12 (66.7%) HIV-infected and noninfected children, respectively. Ancillary investigations (Mantoux, gastric washings) suggested a diagnosis of tuberculosis in eight (72.7%) and eight (66.7%) of the final diagnoses of tuberculosis among HIV-infected and non-infected children, respectively. Lymph node biopsies identified a further three (27.3%) and four (33.3%) more cases of tuberculosis as compared to ancillary investigations among HIV-infected and non-infected groups, respectively. Results of FNAC and trucut biopsy showed good correlation with excision biopsy: 96.4% and 97.4%, respectively. However, adequate samples were obtained in only 23 of 39 FNAC and 33 of 39 trucut biopsies.

CONCLUSION

Excision lymph node biopsies form a useful adjunct investigation in children with PLD and generalised lymphadenopathy. The most common disease identified among HIV-infected and non-infected children in Durban, South Africa, is tuberculosis. FNAC and trucut biopsies may also be useful in the evaluation of lymphadenopathy when appropriate specimens are obtained.

Impact of CDMA wireless phone power output and puncture rate on hearing aid interference levels

Interference between digital wireless phones and hearing aids occurs when the radiofrequency bursts from the phone transmission are demodulated by the hearing aid amplifier. The amplified interference signal is heard as a "buzz" or "static" by the hearing aid wearer. Most research and standards development activity has focused on worst-case scenarios with the phone operating at its maximum power. Since this power level is often not typical in urban and suburban settings, it is of value to determine the impact of lower power levels on the overall level of audible interference. Using a frequency analyzer, and several hearings aids and code division multiple access (CDMA) phones, the audio frequency spectrum of interference was recorded for each phone-aid combination and for a range of power levels producing from no interference to maximum interference. As phone power is increased, the interference signal becomes distinguishable from the ambient noise level and a linear response region is observed in which a specified increase in power output results in a proportional increase in the overall input referenced interference level (OIRIL). As power is increased beyond the linear region, the hearing aid enters a saturation region where an additional power increase results in a reduction or no increase in the OIRIL. The numeric differences in interference documented in this study were used in conjunction with the results of a previous study by the authors to determine the impact of reduced power on speech intelligibility and annoyance. The amount of improvement for a given power reduction depends on the radiofrequency immunity of the hearing aid and is substantial for hearing aids with poor immunity. For high-immunity aids, the level of audible interference remains low even at high phone power levels.

An orientation anisotropy in the effects of scaling vertical disparities

Gårding et al. (Vis Res 1995;35:703-722) proposed a two-stage theory of stereopsis. The first uses horizontal disparities for relief computations after they have been subjected to a process called disparity correction that utilises vertical disparities. The second stage, termed disparity normalisation, is concerned with computing metric representations from the output of stage one. It uses vertical disparities to a much lesser extent, if at all, for small field stimuli. We report two psychophysical experiments that tested whether human vision implements this two-stage theory. They tested the prediction that scaling vertical disparities to simulate different viewing distances to the fixation point should affect the perceived amplitudes of vertically but not horizontally oriented ridges. The first used elliptical half-cylinders and the 'apparently circular cylinder' judgement task of Johnston (Vis Res 1991;31:1351-1360). The second experiment used parabolic ridges and the amplitude judgement task of Buckley and Frisby (Vis Res 1993;33:919-934). Both studies broadly confirmed the anisotropy prediction by finding that large scalings of vertical disparities simulating near distances had a strong effect on the perceived amplitudes of the vertically oriented stimuli but little effect on the horizontal ones. When distances > 25 cm were simulated there were no significant differential effects and various methodological reasons are offered for this departure from expectations.

The influence of medium composition on the maintenance of cytochrome P-450, glutathione content and urea synthesis: a comparison of rat and sheep primary hepatocyte cultures

Rat and sheep primary hepatocytes have been cultured in four different medium formulations: Williams' E, Chee's, Medium 199 and Modified Earle's. The total cytochrome P450 content, intracellular concentration of reduced glutathione, rate of urea synthesis and total protein content of cultures of cells from both species in each medium have been determined. Modified Earle's and Chee's medium proved to be the most favourable formulations for the culture of rat hepatocytes. After 48 h, cells cultured in Modified Earle's had significantly more cytochrome P450 and a significantly greater rate of urea synthesis than cells in any other medium. After 6 days in culture the difference in cytochrome P450 levels between rat hepatocytes in Chee's medium and those in Modified Earle's medium was abrogated. The difference in the rate of urea synthesis between rat hepatocytes cultured in each of these two media was shown to be more dependent on the medium in which the cells were maintained during the period of urea synthesis measurement than on the medium in which the cells had been previously cultured. Sheep hepatocytes cultured in Chee's medium ruptured and died within 24 h. Apart from this, sheep cells were less sensitive to changes in medium formulation than were rat hepatocytes. The initial plating efficiency was lower in sheep cells. Total cytochrome P450 content was the most discriminatory of the four parameters for evaluating the status of rat hepatocyte cultures. However, urea synthesis may be the most useful parameter for assessment of hepatocyte function in hybrid liver devices such as bioartificial liver support systems where access to the cells during operation of the device is restricted.

A confidential comparative audit of stapedectomies: results of the Royal College of Surgeons of England Comparative Audit of ENT surgery 1994

This paper presents the results of a national confidential comparative audit of stapedectomy: 185 operations by 28 consultants over a two-year period were retrospectively analysed. This included 10 revision procedures. Small fenestra stapedectomies accounted for 63 per cent of the total. Thirty-nine per cent of consultants operated on the second ear. Of the 168 stapedectomies in which the hearing change was known at six months, 87 per cent achieved improved hearing, eight per cent had no change and five per cent were worse. The overall complication rate was 30 per cent with a 'dead ear' rate of two per cent.

Mastoidectomy audit: results of the Royal College of surgeons of England comparative audit of ENT surgery

This paper presents the results of a national comparative audit of mastoid surgery, retrospectively analysing 611 operations by 55 consultants. Confidentiality for both patient and surgeon was assured. For cholesteatoma 80% of mastoidectomies performed were open cavity procedures and for other middle ear disease 58% used an intact canal wall technique. Thirty-two surgeons used only an open cavity mastoidectomy for cholesteatoma during the period of the audit. There was a statistically significantly greater number of wet ears with open cavities than with closed cavities, but the frequency of the operator did not correlate with the dry ear rate. Ten serious complications (facial palsy and dead ear) were recorded. All occurred in open cavity mastoidectomies. The post-operative hearing status was unknown in 40% of patients.

Yersinia pseudotuberculosis affecting the appendix

Yersinia pseudotuberculosis is an uncommon cause of abdominal pain. It has a much lower incidence than Yersinia enterocolitica, and most reports have emanated from Europe or North America. This report is about a patient with Yersiniosis affecting the appendix alone, in contrast to the usual picture of mesenteric adenitis or septicemia associated with this organism.

Microvascular free flaps in head and neck surgery

This study is a retrospective review of 60 patients who had microvascular free flap reconstructions in the head and neck region. They were all performed over a 10-year period by a single surgeon. The series includes a wide range of flap types and analyses pre-operative risk factors for flap failure as well as complications and outcome. Smoking and advanced age did not appear to prejudice flap survival but peripheral vascular disease, cardiac disease and alcohol withdrawal were found to increase the likelihood of flap failure. The most frequent complications encountered were thrombosis of one of the anastomosis and haematoma. The most successful flap in terms of survival and function was the fasciocutaneous radial forearm flap. The literature is reviewed in relation to the general principles of microvascular free flap surgery and the results of this series are placed in context.

Expression of liver functions in immortalised rat hepatocyte cell lines

The differentiated hepatic function of two rat liver cell lines, P9 and SV40RH1, immortalised by transfection with SV40 DNA has been investigated in terms of the glutathione synthesis, and the activities of gamma-glutamyltransferase, glutathione-S-transferase and UDP-glucuronosyltransferase. SV40RH1 is a highly differentiated cell line at early passage, but the expression of some aspects of its differentiated phenotype is unstable and some functions are lost by passage 12-13. P9 is a less-well differentiated cell line, with relatively stable expression of functions between passages 4 and 13. In terms of differentiated function both cell lines represent a marked improvement over primary cultures of rat hepatocytes which de-differentiate rapidly within 24-48 h in culture. This retention of liver function in proliferating cell lines offers the opportunity to use such cells in in vitro toxicological studies.

Potential danger of 'trial of life' approach to congenital diaphragmatic hernia

This is the report of a newborn girl who was treated by "trial of life" before surgical repair of her left-sided diaphragmatic hernia. Surgery was performed 60 hours after birth, at which time she was found to have an organo-axial volvulus of the stomach. Her postoperative course was complicated by a jejunal perforation on the fourth postoperative day, necessitating another laparotomy.

Tracheal reconstruction using a composite microvascular temporoparietal fascia flap and nasal septal graft

The successful repair of a crushed cervical trachea using a composite microvascular graft is presented. The patient has been without a tracheostomy for four years.

Osteoma of the incus

Osteomas of the temporal bone are rare. Osteomas of the middle ear have been reported but none involving an ossicle. We describe a case of a 28-year-old man who had a conductive hearing loss caused by an osteoma of the incus.

The effect of opioid drugs on the release of dopamine and 5-hydroxytryptamine from rat striatum following activation of nicotinic-cholinergic receptors

The effect of (Met5)enkephalin, (D-Ala2,D-Met5)enkephalin, (Leu5)enkephalin, (D-Ala2,D-Met5)enkephalin and morphine on the release of [3H]dopamine, endogenous dopamine and [3H]5-hydroxytryptamine produced by the nicotinic-cholinergic agonist, dimethylphenyl piperazinium iodide (DMPP), was examined in rat striatal slices. The DMPP-induced release of [3H]dopamine and endogenous dopamine was reduced by the presence of (Met5)enkephalin, (D-Ala2,D-Met5)enkephalin (1-10 microM) or morphine (10 microM) but not by (Leu5)enkephalin or (D-Ala2,D-Leu5)enkephalin. The DMPP-induced release of [3H]5-hydroxytryptamine was reduced by (Leu5)enkephalin, (D-Ala2,D-Leu5)enkephalin, (Met5)enkephalin, (D-Ala2,D-Leu5)enkephalin (1-10 microM), and morphine (10 microM). All three opioids failed to alter the release of [3H]dopamine induced by field stimulation or potassium depolarization (30 microM). The inhibitory effects of opioid peptides and morphine demonstrated in the present study appear to be due to an initial interaction with nicotinic-cholinergic receptors in the striatum.

Release of dopamine and 5-hydroxytryptamine from rat striatal slices following activation of nicotinic cholinergic receptors

1. The administration of the nicotinic cholinergic agonists dimethylphenylpiperazinium iodide (DMPP) or nicotine caused a concentration dependent release of [3H] dopamine, [3H]5-hydroxytryptamine as well as endogenous dopamine and 5-hydroxytryptamine from superfused slices of rat striatum. 2. Release of both labelled and non-labelled transmitter was antagonized by the nicotinic antagonist, hexamethonium but not the muscarinic antagonist, atropine. 3. The present study provides additional evidence that nicotinic-cholinergic receptors are present in the mammalian central nervous system. 4. Activation of these nicotinic-cholinergic receptors in the striatum results in the release of both dopamine and 5-hydroxytryptamine.

Bacillus stearothermophilus Disc Assay for Detection of Inhibitors in Milk: Collaborative Study

A 2-part (A and B) collaborative study was conducted on a Bacillus stearothermophilus paper disc (12.7 mm) method to detect residual inhibitors in milk. The 18 participating collaborators assayed raw milk samples spiked with a beta-lactam (penicillin G). Of the 18 collaborators, 14 participated in part A and 16 in part B. Part A demonstrated that either Antibiotic Medium No. 4 or PM Indicator Agar is suitable for use in the assay. The lowest concentration detectable, not significantly different from 100% at the α = 0.05 level, was 0.008 unit/mL with either medium. Part B demonstrated that the sensitivity of the method is equal to that of the current AOAC method (16.131- 16.136). The concentration of beta-lactam detected by 50% of the analysts was 0.003-0.005 unit/mL in this study, compared with 0.005 unit/mL reported in an earlier collaborative study on the current AOAC method. No false positive results were reported in part A or part B. All samples found positive by the confirmatory test in part B were correctly identified as a beta-lactam with commercial Penase discs. The lowest concentration detectable by the method, not significantly different from 100% at the α = 0.05 level, was 0.008 unit/mL. The method was adopted official first action.

Cerebral damage in paraquat poisoning

This is the first report on cerebral changes in eight patients who died of paraquat poisoning. These included generalized oedema, haemorrhages (both subependymal and subarachnoid), glial reactions (microglial activity and astrocytic response) and meningeal inflammation. Oedema and haemorrhage were the most consistent and significant findings; they suggest that paraquat may damage the cerebral blood vessels. The distribution of haemorrhages was unusual and resembled that seen in thiamine deficiency.

Severe head injuries in three countries

Methods for assessing early characteristics and late outcome after severe head injury have been devised and applied to 700 cases in three countries (Scotland, Netherlands, and USA). There was a close similarity between the initial features of patients in the three series; in spite of differences on organisation of care and in details of management , the mortality was exactly the same in each country. This data bank of cases (which is still being enlarged) can be used for predicting outcome in new cases, and for setting up trials of management.

Differential diagnosis of neuroblastoma and Burkitt's tumour

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