Does GH replacement therapy in adult GH-deficient patients result in recurrence or increase in size of pituitary tumours?

Objective: Hypopituitary GH-deficient patients have an increased cardiovascular mortality and GH replacement in this population has resulted in considerable therapeutic benefit. GH replacement involves administration of a potentially mitogenic substance to patients with a previous or residual pituitary tumour. Our objective was to evaluate whether GH replacement results in an increase in the size of pituitary tumours.

Mechanism for the transit-induced increase in colonic deoxycholic acid formation in cholesterol cholelithiasis.

Background & Aims: Many patients with cholesterol gallbladder stones (GBS) have a high percentage of deoxycholic acid (DCA) in gallbladder bile (all of which are in the conjugated form), probably as a result of prolonged large bowel transit times (LBTT). However, whether the prolonged LBTT increases DCA formation, solubilization, or absorption (or all 3) is not known.

Methods: In 40 subjects (20 with GBS; age range, 24-74 years), we measured LBTT using radiopaque markers, and intestinal luminal pH by radiotelemetry.

Why the government was right to change the 'Our Healthier Nation' accidental injury target.

We congratulate the current UK Government on their inclusion of accidental injury as one of the national targets in the White Paper: Saving Lives-Our Healthier Nation (OHN). We had concerns about the particular target that was proposed in the Green Paper: 'ellipsisto reduce the rate of accidents-here being defined as those which involve a hospital visit or consultation with a family doctor-by at least a fifthellipsis'. The limitations of this target were: firstly, it would focus attention on minor injury and so not reflect the main burden of injury; and secondly, that ascertainment of cases would be influenced by social factors as well as provision of service and access factors.

A role for alpha4-integrin in the pathology following Semliki Forest virus infection.

Migration of cells into the central nervous system (CNS) is a pivotal step in the pathogenesis of immune-mediated diseases such as multiple sclerosis (MS), experimental allergic encephalomyelitis (EAE) and virus-induced demyelinating diseases. Such migration is dependent on expression of adhesion molecules. The expression of adhesion molecules in the CNS was studied in Biozzi ABH mice infected with Semliki Forest virus (SFV) A7(74) - an important demyelinating model of MS.

Chronic urticaria.

Chronic urticaria remains a major problem in terms of etiology, investigation, and management. It is important to identify patients in whom physical urticaria is the principal cause of disability. Once confirmed by appropriate challenge testing, no further investigation is required.

Multiple N-acetyl neuraminic acid synthetase (neuB) genes in Campylobacter jejuni: identification and characterization of the gene involved in sialylation of lipo-oligosaccharide.

N-acetyl neuraminic acid (NANA) is a common constituent of Campylobacter jejuni lipo-oligosaccharide (LOS). Such structures often mimic human gangliosides and are thought to be involved in the triggering of Guillain-Barré syndrome (GBS) and Miller-Fisher syndrome (MFS) following C. jejuni infection.

Detection of a peripheral blood T cell clone is an independent prognostic marker in mycosis fungoides.

Unlabelled: T cell receptor gene analysis is a sensitive method for assessment of peripheral blood involvement in mycosis fungoides. This study uses polymerase chain reaction/single-strand conformational polymorphism (PCR/SSCP) analysis of the T cell receptor gamma gene and relates the results to skin stage and outcome in mycosis fungoides. Seventy-five peripheral blood samples from 66 patients were obtained from 1990 onwards and subjected to PCR/SSCP.

Tracheocarotid artery fistula infected with methicillin-resistant staphylococcus aureus.

Massive life-threatening haemorrhage from a fistula between the trachea and a major blood vessel of the neck is a rare complication of the tracheostomy procedure, well-recognized by anaesthetists and otolaryngologists. Although the lesion is likely to be encountered at autopsy, it is not described in histopathological literature. The possible causes are discussed together with the macroscopic and microscopic appearances of the lesion.

Inhalation sedation: a viable alternative to general anaesthesia?

This paper reports three cases in which young children were treated successfully using inhalational sedation instead of general anaesthesia.

Orthodontics in the adult patient, with special reference to the periodontally compromised patient.

There is increasing demand from adult patients for orthodontic treatment, either purely for aesthetics, to improve aesthetics or function following previous disease, or to facilitate the stabilization, restoration or replacement of teeth. Orthodontics may have a major role in the rehabilitation of patients suffering the effects of advanced periodontal disease, but there are a number of important factors to be considered in the management of such patients if the optimal outcome is to be obtained. This paper summarizes important aspects of treatment and the potential complications and how to avoid them.

Ethnic groups and our healthier nation: whither the information base?

The Government has made the health of minority ethnic groups a central part of its programme to reduce social exclusion and inequalities in health provision. It has also given a commitment in its 'contract for health' to provide the information that is needed to address inequalities, stating that it will be able to draw on a range of data sources, including mortality statistics, cancer registrations, hospital episode data, and general practitioner data. In reality, only one of these is a potential source of comprehensive information on minority ethnic groups and the information base needed to support Government policies is essentially unavailable.

A gene for lymphedema-distichiasis maps to 16q24.3.

Lymphedema-distichiasis (LD) is a dominantly inherited syndrome with onset of lymphedema at or just after puberty. Most affected individuals have distichiasis-fine hairs arising inappropriately from the eyelid meibomian glands-which is evident from birth. A study of three families with LD has shown linkage to chromosome 16q24.

I.v. immunoglobulin reduces circulating proinflammatory cytokines in Guillain-Barré syndrome.

Background: Treatment with human i.v. immunoglobulin (IVIg) modifies the course of Guillain-Barré syndrome (GBS), but its specific mode of action is unknown.

Variation in physical fitness between ethnic groups in nine year olds.

Background: There is little information on cardio-respiratory fitness of children, especially in ethnic minorities in Britain. In this study we assess the associations of social factors, ethnicity, parental health related factors, child's anthropometry, blood pressure and cholesterol measurements with cardio-respiratory fitness.

Methods: Power output against load at 85% of the maximum heart rate (PWC85%), was measured, using a cycle-ergometer test, in children aged 8-9 years in 22 randomly selected areas in England, 14 in Scotland and in 20 inner city areas in England.

Effects of smoking in pregnancy on neonatal lung function.

Aims: To assess the effects of smoking during pregnancy on lung mechanics and lung volumes in the immediate neonatal period, before infants are exposed to passive smoking.

Methods: Lung function tests were carried out within 72 hours of delivery in infants born to 100 non-smoking and 189 smoking mothers. Lung growth was assessed by plethysmography and lung mechanics using the single breath occlusion technique and oesophageal balloon/pneumotachography.

Assessment of effect of nasal continuous positive pressure on laryngeal opening using fibre optic laryngoscopy.

Aim: To assess the effect of nasal continuous positive airways pressure (CPAP) on the dimensions of the laryngeal opening.

Methods: Nine preterm infants who had previously received ventilatory support for respiratory distress syndrome (RDS) were studied. All were receiving nasal CPAP.

The United Medical and Dental School of Guy's and St Thomas' Hospitals' MSc in general practice: graduates' perspectives.

Aim: Higher degrees have been proposed as one means whereby general practitioners can continue their professional development and avoid a slow decline into professional isolation and burnout. The United Medical and Dental School of Guy's and St Thomas' Hospitals' MSc in general practice has been available to experienced general practitioners for over a decade. This study reports some of the outcomes of participation for the 76 graduates of the first nine cohorts.

Non-surgical periodontal treatment with and without adjunctive metronidazole in smokers and non-smokers.

Aim: To determine whether adjunctive metronidazole therapy would compensate for the poorer treatment response to scaling and root planing reported in smokers.

Method: A single-blind, randomised clinical trial of 28 smokers and 56 non-smokers, stratified for periodontitis disease severity and randomly allocated to 3 treatment groups: (1) Scaling and root planing using an ultrasonic scaler with local anaesthesia (SRP), (2) SRP+ metronidazole tabs 200 mg tds for 7 days, (3) SRP + 2 subgingival applications of 25% metronidazole gel. Probing depths (PD) and attachment levels (AL) were recorded with a Florida probe at baseline, 2 months and 6 months post treatment by a single examiner who was unaware of the treatment modality.

Operator agreement in the use of a descriptive index of edentulous alveolar ridge form.

CAWOOD & HOWELL have proposed a classification of the anatomical form of the residual alveolar processes of edentulous patients. The purpose of this study was to test observer agreement in the clinical assessment of edentulous alveolar ridge form using this classification. This was tested in a pilot study involving 57 edentulous patients, and subsequently in a study of 557 edentulous patients.

Effect of processing method on the dimensional accuracy and water sorption of acrylic resin dentures.

Statement Of Problem: Acrylic resin complete dentures exhibit certain unavoidable dimensional changes. Processing shrinkage and expansion due to water uptake are 2 important aspects influencing dimensional accuracy.

Purpose: This study investigated linear dimensional changes and water sorption of dentures processed by dry and wet heat with different rates of cooling.

Myocardial preconditioning: mechanisms and man.

Myocardial preconditioning describes the profound myocardial protection that follows a short episode of sublethal ischaemia. Adenosine is produced in ischaemic myocardium and is thought to be an important trigger of the protective mechanism. The exact pathway awaits full elucidation but activation of G proteins and subsequently protein kinase C appear to be important signals.

Cognitive effects of pituitary tumours and their treatments: two case studies and an investigation of 90 patients.

Objectives: Two case studies are reported of patients with pituitary adenomas who had been treated with trans-sphenoidal surgery, one with and one without adjunctive radiotherapy, in whom memory impairment was found. Further to this, neuropsychological investigations of 90 patients were carried out (1) to establish the prevalence of such deficits, and (2) to try to determine their cause.

Methods: Two case studies are described.

Patterns of expressions of transforming growth factor and epidermal growth factor receptor in squamous cell lesions of the urinary bladder.

Aim: To investigate the patterns of expression of transforming growth factor alpha (TGF-alpha) and epidermal growth factor receptor (EGFR) in squamous metaplasia and squamous cell carcinomas of the urinary bladder with and without schistosomiasis.

Methods: Immunohistochemical study of the expression of TGF-alpha and EGFR in squamous metaplasias (n = 12) and various grades of squamous cell carcinomas (n = 21) of the bladder with and without schistosomiasis.

Results: Focal cytoplasmic and membranous positivity for EGFR and TGF-alpha was seen in all cases of squamous metaplasia.