Persistent nocturnal cough: randomised controlled trial of high dose inhaled corticosteroid.

Objective: To investigate the effect of a short course of inhaled corticosteroid in the treatment of isolated and persistent nocturnal cough in children.

Design: Randomised double blind placebo controlled study.

Setting: Subjects' homes in east London, England.

Outcome after severe head injury treated by an integrated trauma system.

Objectives: To describe outcome after treatment of severe head injury within an integrated trauma system.

Methods: A retrospective analysis of all patients with severe head injury admitted to the Royal London Hospital by the Helicopter Emergency Medical Service (HEMS) between 1991 and 1994. Type of injury was defined on initial computed tomography of the head and outcomes assessed 12 months after injury using the Glasgow outcome score.

Diabetes and the heart.

Diabetes mellitus adversely affects the pathology, presentation and outcome of patients with coronary artery disease. Knowledge of the risks and benefits of medical and mechanical therapies particular to diabetic patients is useful in the optimal management of diabetic heart disease.

The hormonal response to a d-fenfluramine challenge in trained and sedentary men.

Purpose: The purpose of the present study was to examine the responsiveness of serotonergic receptors in endurance trained and sedentary men.

Methods: The serum prolactin and cortisol responses to the oral administration of 30 mg of the serotonin releaser and reuptake inhibitor d-fenfluramine were determined in eight male endurance-trained subjects and seven male sedentary controls.

Results: A Friedman's repeated-measures test for both the endurance-trained (P = 0.

Routine receiver operating characteristic analysis in mammography as a measure of radiologists' performance.

A system for calculating receiver operating characteristic (ROC) curves from routine audit data is described. Both diagnostic opinion and pathology outcome data from the symptomatic mammography department were recorded in an audit database, from which ROC curves were calculated. A comparison of overall radiologists' performance was made and the appropriate performance indices discussed.

Medical rapid prototyping and 3D CT in the manufacture of custom made cranial titanium plates.

This report describes a new method of custom making cranial titanium plates for the repair of skull defects. We have combined 3D CT imaging and surface modelling with rapid prototyping (RP) technology to produce physical models of our patients' skulls from which custom titanium plates were made. We have expanded the use of image processing tools applied to the CT image data to fabricate a representation of the skull defect.

Partial lipodystrophy presenting with myopathy.

A girl with partial lipodystrophy is described presenting with muscle weakness and developmental delay several years before lipoatrophy became apparent. The patient subsequently developed epilepsy, fatty liver, secondary amenorrhoea, hirsutism, insulin-resistant diabetes mellitus, hyperlipidaemia, and hypothyroidism. She remains weak with poor exercise tolerance.

Clinical characteristics determining the mode of presentation in patients with acute coronary syndromes.

Objectives: The purpose of this study was to examine clinical characteristics of patients with acute coronary syndromes to identify factors that influence the mode of presentation.

Background: In acute coronary syndromes, presentation with myocardial infarction or unstable angina has major prognostic implications, yet clinical factors affecting the mode of presentation are not well defined.

Methods: A prospective cohort study was made of 1,111 patients with acute coronary syndromes.

Circadian activity of the endogenous fibrinolytic system in stable coronary artery disease: effects of beta-adrenoreceptor blockers and angiotensin-converting enzyme inhibitors.

Objectives: To examine circadian changes in the sympathovagal balance, the activity of the renin-angiotensin system and hemostatic variables in patients with stable coronary artery disease, and the effects of beta-adrenoceptor blockade and angiotensin-converting enzyme inhibition.

Background: Sympathovagal balance and key components of the fibrinolytic system show circadian variability. The effects of beta-adrenergic blocking agents and angiotensin-converting enzyme inhibitors on these autonomic and hemostatic rhythms are not well defined.

Thiopurine methyltransferase genotype predicts therapy-limiting severe toxicity from azathioprine.

Background: Substantial hematologic toxicity limits the use of azathioprine.

Objective: To evaluate 1) polymorphic inactivation of azathioprine by thiopurine methyltransferase and 2) clinical toxicity.

Design: Prospective cohort study.

Effect of faecal consistency on virological diagnosis.

A study was set up to investigate the effect of consistency of routine faecal specimens on the diagnostic yield by electron microscopy (EM) and virus isolation. A total of 3078 specimens were characterized as solid, semisolid, or liquid. Of 2568 specimens processed by EM a virus was demonstrated in 8.

Thoracic electrical bioimpedance: a non-invasive measure of cardiac output for porcine research.

A comparison of two techniques for measuring cardiac output, thermodilution (TD) and thoracic electrical bioimpedance (TEB), was undertaken in a porcine model. Eight anaesthetized large white pigs were studied. A total of 436 paired measurements were performed over a range of cardiac outputs from 1.

Prescribing for persistent cough in children.

To identify the medications general practitioners consider for the treatment of persistent isolated cough, we undertook a postal questionnaire survey of a sample of general practitioners in east London. Fewer than 10% indicated that they never prescribed for such cough. About 70% sometimes considered antibiotics and/or bronchodilators in all age groups.

Orbital rhabdomyosarcoma--the radiological characteristics.

We reviewed computed tomography (CT) studies in 30 patients with histologically confirmed orbital rhabdomyosarcoma. There were 17 male and 13 female patients, mean age 8.8 years (median age 7 years, age range 1 month to 51 years).

Measles virus infection and replication in undifferentiated and differentiated human neuronal cells in culture.

Measles virus (MV) infection of the human central nervous system (CNS) typically involves widespread infection of neurons. However, little is known about how they become infected, how defective virus arises and accumulates, or how virus spreads among the cells of the CNS. In vitro studies of viral interactions with human neuronal cells may contribute to the resolution of such issues.

Instantaneous lead entrapment: successful percutaneous removal using the cook workstation.

An unusual complication of transvenous endocardial lead placement is reported in which an electrode became entrapped within the vicinity of the tricuspid valve apparatus, resisting all initial attempts at removal. The lead was subsequently successfully removed percutaneously via the right femoral vein.

How do patients' views about medication affect their self-management in asthma?

Successful management of asthma increasingly depends on decisions by patients about when and how to use inhalers and tablets prescribed for their asthma control. Patients with negative attitudes to asthma medication may not be willing to follow their management plan's advice to increase medication when their symptoms worsen. Patients do not always believe their doctors' reassurance about side effects.

Effects of intravenous methylprednisolone therapy on leukocyte and soluble adhesion molecule expression in MS.

Intravenous methylprednisolone (IVMP) may inhibit inflammatory cell recruitment to active MS lesions by effects on leukocyte or endothelial cell adhesion molecule expression. We investigated 15 MS patients in relapse receiving a 5-day course of IVMP (500 mg/day) and 15 normal subjects. Patients' blood samples were obtained pretreatment, at 6 and 24 hours after the first dose, and 48 hours after completion of therapy.

A regional audit of perinatal and infant autopsies in Northern Ireland.

Objective: To investigate the rate and quality of perinatal/infant autopsies and their contribution to the final diagnosis.

Methods: The anonymised reports of autopsies performed on 174 of the 367 cases reported to the Northern Ireland Regional Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI) coordinator in 1993 were reviewed. They were scored using a modification of the CESDI Pathology Audit Form 93 and, based on the score obtained, ascrined to one of three groups: good, adequate or inadequate.

Working hours. Hardy annuals.

Employing nurses on annual-hours contracts which include on-call and stand-down duties has led to more efficient deployment of staff in relation to workload. The system has cut the use of agency nurses and bank staff and reduced staffing costs. The majority of staff who took part in the pilot scheme have chosen to remain on annual-hours contracts.