A hoarse voice: atypical mycobacterial infection of the larynx

Myobacterium malmoense is a non-tuberculous mycobacterium that most commonly causes pulmonary infection, particularly in patients with underlying pulmonary disease or immunodeficiency. We describe a case of Mycobacterium malmoense infection of the larynx in a previously well middle-aged woman, which has previously not been reported. The case highlights the importance of considering atypical mycobacterial infection in the differential diagnosis of laryngeal lesions.

Parapharyngeal abscess: a rare complication of elective tonsillectomy

We report a case of parapharyngeal abscess complicating an elective tonsillectomy in a healthy thirty-three-year-old woman. The clinical features and management of this very rare complication are discussed. In addition, we review the possible aetiology and pathogenesis of this potentially life-threatening condition.

Long-term use of depot-norethisterone enanthate: effect on blood lipid fractions

This is the third report of a metabolic study on 56 long-term users (24 for 2-5 yr; 32 for over 5 yr) of the injectable contraceptive norethisterone enanthate (Net-En) and deals with the effects on the blood levels of lipoprotein fractions. There was no significant difference between this group and a group of 30 non-users in serum concentrations of triglycerides, total cholesterol, low density and very low density lipoproteins. There was a significant reduction in mean high density lipoprotein levels between the controls and the user groups (16% for the intermediate duration and 12% for the longer duration). Age, ethnic group, body-mass index and a close family history of cardiovascular disease were taken into account, as were various lifestyle factors: diet, exercise, alcohol consumption and smoking. In a smaller group, levels of apoproteins A and B were also assayed. There was a significant reduction in apoprotein A between controls and all users, but the significance was lost on adjusting for confounding variables. Consideration was given to the ratio of total cholesterol to high density lipoprotein cholesterol as an index of coronary risk. There were no significant differences in the total cholesterol:HDL-C ratio between controls and user groups. There was a significant interaction with ethnic group (Caucasian or Afro-Caribbean) in the response to duration of use.

Long-term use of depot-norethisterone enanthate: effect on blood coagulation factors and menstrual bleeding patterns

Fifty-six women using depot-norethisterone enanthate injections for contraception for 2 years or more were compared with a control group of 48 women not using hormonal contraception. No significant difference was found between the study group and controls for Factors VIIc and Antithrombin III. Factor Xc was reduced in women who had used the injections for over two but less than five years [controls: mean 90.3% SD31.2 vs users for 2-5 yr: 78.7% SD17.1, 95%CI difference in means -0.3, -22.9]. In the group using Net-En for five years or more, Factor Xc was significantly higher than in the control group, but only by 14% of the mean control value [users for over 5 yr: 103.2% SD15.2, 95%CI difference in means 3.1, 22.7]. Haemoglobin levels, red cell count and packed cell volume were higher in those using the injections than in the control group. Changes in the platelet count were not statistically significant. Twenty-three women using the injection agreed to keep menstrual diaries. Of these, 20 experienced amenorrhoea for more than two consecutive injection intervals (112 days). It is concluded that long-term use of norethisterone enanthate is not associated with any markedly deleterious effects on Factor VIIc, Xc, or antithrombin III or haemoglobin levels. Amenorrhoea of 4 months or more can be expected after two years of continuous use.

Phaeochromocytoma and abdominal aneurysm: confirmation of diagnosis after aortic surgery using mIBG imaging

Four cases of dissecting thoracic aneurysm associated with phaeochromocytoma have been reported in the World literature, of which only one survived surgery. We report what we believe to be the first case of intra-adrenal phaeochromocytoma presenting as a leaking abdominal aneurysm; which is of further interest as post-reconstruction 131-I meta-Iodobenzylguanidine (mIBG) imaging confirmed the existence of the tumour, despite equivocal urinary metanephrines.

An application of the repertory grid method to investigate consumer perceptions of foods

This paper describes the development of a method for investigating consumer perceptions of foods. Each of 46 subjects independently used a version of Kelly's repertory grid method to elucidate the attributes (constructs) perceived in 25 meat products. Subjects then scaled the individual products with respect to each of their own constructs. Data were input to generalized Procrustes analysis to obtain a perceptual map of the products for each subject and a consensus product map. The principal components of the consensus map, and hence the important perceptual attributes, were interpreted by identifying the constructs which were most heavily weighted by individual subjects.

Long-term use of an injectable contraceptive: effect of depot-norethisterone oenanthate on carbohydrate metabolism

In order to determine the metabolic effects of long-term use of the injectable contraceptive norethisterone oenanthate, plasma glucose and serum insulin concentrations were studied in two groups of women who had used the method continuously for at least five years. Group 1 comprised 24 subjects, from whom only fasting blood samples were taken. Despite similar plasma glucose concentrations to those of the controls, the subjects had significantly increased serum insulin concentrations (164.5 (39.9) v 120.3 (34.3) pmol/l, p less than 0.01). In addition the insulin:glucose ratios were also significantly increased (34.3 (8.5) v 24.6 (6.7), p less than 0.01), consistent with decreased insulin sensitivity. Group 2 comprised 13 of the original 24 subjects who also had an oral glucose tolerance test. Basal plasma glucose concentrations were similar in the subjects and their controls, whilst the significantly increased insulin:glucose ratios (35.0 (7.7) v 28.7 (5.6), p less than 0.05) were consistent with the results of the larger group. Following oral glucose challenge, plasma glucose concentrations, serum insulin concentrations and insulin:glucose ratios were similar in the subjects and their controls throughout the test. Thus, long-term use of norethisterone oenanthate injections is associated with a decrease in peripheral insulin sensitivity. However, these changes are not associated with any evidence of oral glucose intolerance.

Pregnancy in girls under 17; a preliminary study in a hospital district in South London

Pregnancy occurring in girls under the age of 17 is of particular interest to those providing obstetric care and family planning services, as well as to the social welfare services in the community. Childbirth in girls of this age carries greater risk to mother and child than in the immediately older age groups and a young mother having a baby, whether married or not, may face social and economic difficulties. This study is designed to find out basic facts about girls having terminations of pregnancy or continuing to have a baby in this young age group, relating to: parents and family of origin, housing, education, religion, knowledge of sex and fertility, use of contraception and nature of the relationship with the father of the child.

The findings suggest that there is an urgent need for improving the provision and effectiveness of sex education, that the provision of contraceptive advice to the very young should be reviewed and improved, and that the type of relationships between boys and girls leading to the pregnancies described in this study are neither casual nor ‘promiscuous’. The findings that those conceiving under the age of 15, and keeping the baby, made their first attendance at the antenatal clinic very late in the pregnancy suggests that these girls take an undue risk with their health, possibly due to the present state of the law regarding sexual intercourse in young people. The ideas of ‘wantedness’ and ‘planning’ in relation to conception are discussed.