A comparison of the accuracy of the Siemens injection vaporizer and the Enfluratec 3 vaporizer.

The accuracy of two Siemens injection vaporizers was examined under operating theatre conditions. For comparison, two Enfluratec 3 vaporizers were tested. The concentrations of enflurane produced by the vaporizers were measured both by an anaesthetic agent monitor and by chromatography. Five experimental modes were used with enflurane delivered either in air/oxygen or in nitrous oxide/oxygen mixtures and the experiments were repeated five times. In every case, the mean concentration values produced by the anaesthetic agent monitor were higher than those obtained by chromatography. The difference may have been due to leakage of the gas sample from the "gas-tight" syringes and/or improper calibration of either analyzer. The Siemens devices were less reliable than the Enfluratecs when enflurane was given in nitrous oxide/oxygen. The former vaporizers seem to be less robust than the Enfluratecs and should be used according to the manufacturer's recommendations. The pressures in the central system were higher than those called for. In addition, improper coupling of the Siemens apparatus to the ventilator may well have influenced the results.

Warts in general practice.

Eight hundred and ninety seven patients referred by their general practitioner to Health Centre Wart Clinics were interviewed. Seventy one patients (7.9%) were found to have lesions other than cutaneous warts. Females were significantly more likely to have plantar warts on their toes (p less than 0.002) and non-plantar warts on their fingers (p less than 0.03) and less likely to have non-plantar warts on the palms of their hands (p less than 0.03) than males. Patients living in large households (5+ persons) were more likely than patients living in smaller households (2-4 persons) to report an infected co-habitant (p less than 0.001). Patients with periungual warts were significantly more likely to be nailbiters. (p less than 0.001). Patients presenting with warts greater than two years in duration were more likely to have multiple warts than those with warts less than one month in duration (p less than 0.001). Patients who frequently immersed their hands in water were more likely to present with multiple warts on the hands (p less than 0.001). Multiple plantar warts were associated with moist or macerated feet (p less than 0.001). The role of the family doctor in diagnosing and preventing the spread of this infection is discussed.

Variations in the plasma concentration of atrial natriuretic factor across 24 hours.

There is little information available concerning the presence or absence of a normal variation in the circulating concentration of atrial natriuretic hormone throughout a 24 h period. We have examined this in 8 normal subjects (aged 23-35 years) on a fixed 120 mmol Na+ diet. Circulating levels of ANH, plasma renin activity, serum aldosterone and serum cortisol were determined two-hourly during 24 h in a supine position. There was a significant change in the concentration of each of these four hormones during the study period (P less than 0.05). ANH: peak 8.5 (22.00 h), nadir 4.0 (12.00 h) (pmol/l); PRA: peak 1.7 (04.00 h), nadir 0.8 (22.00 h) (microgram.l-1.h-1); aldosterone: peak 350 (14.00 h), nadir 143 (22.00 h) (pmol/l); cortisol: peak 346 (08.00 h), nadir 51 (22.00 h) (nmol/l). Peak plasma ANH occurred at 22.00 h and with the exception of times 20.00 h and 10.00 h this value was significantly higher than all the other time means (P less than 0.05). The only other significant differences were between plasma ANH at 20.00 h and 06.00 h, 08.00 h, 12.00 h and 14.00 h, respectively (P less than 0.05). From midnight until 18.00 h, there was no significant difference between any of the time means. There was a peak in PRA at 04.00 h, while peak serum aldosterone and serum cortisol occurred at 14.00 h and 08.00 h, respectively. This study suggests that ANH may display a diurnal rhythm. Our findings provide further physiological evidence that plasma ANH and PRA may have a reciprocal relationship.

A study of HPV 1, 2 and 4 antibody prevalence in patients presenting for treatment with cutaneous warts to general practitioners in N. Ireland.

Three hundred and seventy-six patients attending their general practitioner with cutaneous warts at five health centres in Northern Ireland were screened for human papilloma virus (HPV) types 1 and 2 IgM antibody using an indirect immunofluorescence test. Eight-eight (23.4%) patients were positive for HPV type 1 IgM and 156 (41.5%) for HPV type 2 IgM. HPV 1 IgM antibody was significantly more likely to be associated with plantar warts than warts elsewhere (P less than 0.0001). HPV 2 IgM was present in 45 (34.1%) patients with plantar warts and 99 (45.6%) patients with warts at other sites (P = 0.1). Evidence of multiple infection by HPV types 1 and 2 was demonstrated by the finding of HPV 1 and 2 IgM antibodies in the sera of 16 (4.3%). HPV 4 was found in only 1 out of 30 biopsies and HPV 4 IgM was undetectable in 50 randomly chosen sera.

T-cell-mediated suppression of Epstein-Barr virus-induced B lymphocyte activation in multiple sclerosis.

Significantly reduced levels of T-cell-mediated "suppression" of numbers of Epstein-Barr virus (EBV)-activated B lymphocytes which secrete IgG or IgM were found in preparations of mononuclear cells (MNC) from peripheral blood of 28 patients with multiple sclerosis (MS) compared with 28 healthy subjects, all seropositive for EBV. A statistically significant correlation was not found between the suppression of EBV-induced activation of B lymphocytes and either EBV-specific T-cell-mediated cytotoxicity or numbers of T8-positive cells.

Monochloroacetic acid and 60% salicylic acid as a treatment for simple plantar warts: effectiveness and mode of action.

Monochloroacetic acid crystals and 60% salicylic acid ointment was found to be more effective than placebo as a treatment for simple plantar warts in a double blind study on 57 patients. Nineteen (66%) patients in the active treatment group compared with five (18%) patients in the placebo group were cured after 6 weeks (P = 0.002). The active treatment was associated with a significantly higher cure rate 6 months after entry (P = 0.04). Treatments were well tolerated. IgG or IgM antibodies or both to human papilloma virus (HPV) types 1 or 2 or both were detected significantly more frequently in the actively treated group 6 weeks after entry (P = 0.0005). Twelve (50%) patients considered to be cured had no detectable secondary immune response. Our results suggest that cure does not depend primarily on the humoral system but rather on mechanical destruction of wart tissue, or occurs as a result of cell mediated immunity.

Natural history of pancreatic islet B-cell function in type 2 diabetes mellitus studied over six years by homeostasis model assessment.

Islet B-cell function and insulin sensitivity were estimated with the aid of a mathematical model from repeated fasting plasma glucose and insulin measurements over a 6 year period in 131 patients with type 2 diabetes mellitus who could be managed satisfactorily on dietary therapy alone. They presented between the ages of 40 and 69 years, and were studied before and after one year of treatment, and then at regular intervals from 12 until 72 months later. A method of averaging the individual trends by means of a linear model regression technique was used to assess the progression of their diabetes. Dietary management over the first 12 months resulted in weight loss from 118% to 106% average body weight, and improved insulin sensitivity from 26% to 40% of normal (p less than 0.001). From 12 to 72 months, the fasting plasma glucose rose at a mean rate of 0.23 mmol/l per year (p less than 0.001) despite a rate of weight loss of 0.2% average body weight per year (p less than 0.01). The estimated islet B-cell function, expressed as a percentage of normal, decreased significantly (p less than 0.05) at a rate of 1.5% per year, with no statistically significant change in insulin sensitivity. Extrapolation suggests the reduction in B-cell function predated the departure of fasting plasma glucose from the normal range.

Viral antibody titers. Comparison in patients with multiple sclerosis and rheumatoid arthritis.

Higher titers of antibodies to measles virus envelope antigens, hemolysin and hemagglutinin, Epstein-Barr virus (EBV) capsid antigen and nuclear antigen, and rubella virus hemagglutinin were demonstrated in serum samples of patients with multiple sclerosis and rheumatoid arthritis than in age- and sex-matched control subjects. A significant correlation was observed between antibodies to measles and rubella viruses both in patients with multiple sclerosis and rheumatoid arthritis, but such a correlation was not observed between antibodies to EBV and measles or rubella viruses. Whether elevated levels of antibodies to EBV are due to reactivation of the virus, or elevated levels of antibodies to all the enveloped viruses result from cross-reactions between viruses and host tissue, or perhaps reflect defects in immunoregulation, needs further investigation.

Studies of hypothalamic pituitary structure and function in patients previously treated with bilateral adrenalectomy alone for Cushing's disease.

A controversy still exists in regard to hypothalamic pituitary function long-term after cure of hypercortisolism due to Cushing's disease. In an attempt to resolve this controversy, we have studied 15 patients, treated at least 6 years previously, by bilateral adrenalectomy. None of these patients had had pituitary-directed therapy. The maximum increment response of serum TSH in response to TRH was greater than 5 mU/l in 13 of the 15. Serum PRL response to TRH, GH response to insulin-induced hypoglycaemia, gonadotrophin responses to LHRH and nocturnal PRL secretion were normal in all patients studied. When nocturnal GH secretion was corrected for age, body mass index and menopausal status it was definitely abnormal in only two patients. The mean nocturnal GH secretion did not differ from that measured in a control group of Addisonian patients. The series of patients also did not differ significantly from the Addisonian patients in relation to the pattern of changes in plasma ACTH, over 24 h after an 0800 h oral dose of hydrocortisone. There was a significant rise in plasma ACTH between 2200 h and 0600 h in both groups of patients. The plasma ACTH concentrations were significantly higher in post-adrenalectomy patients. Hypothalamic pituitary function is normal in the long-term in the majority of patients treated by bilateral adrenalectomy for Cushing's disease.

Availability and acceptance of health education among socially 'at risk' pregnant women attending health centres in Belfast.

This study highlights the large number of pregnant women in Belfast who fall into the 'at risk' category based on socioeconomic factors and suggests a need for greater emphasis on health education by professionals in both the fields of health and education in order to improve the knowledge and change the attitudes and behaviour of pregnant women; this could play an important part in reducing infant mortality and handicap in our society. The study showed that neither patients nor health care teams see health education as an integral part of antenatal and postnatal care and that little impact has been made in encouraging patients to plan their pregnancies, stop smoking and eat a more balanced diet.

Natural history of diabetes presenting age 40-69 years: a prospective study of the influence of intensive dietary therapy.

Two hundred and twenty-three newly-diagnosed symptomatic diabetic patients with onset age 40-69 years enrolled in a prospective study of intensive dietary management of diabetes were observed for a period of six years and the data obtained is analysed. The variables studied were weight and fasting levels of plasma glucose and insulin, and of serum total cholesterol and triglyceride. These tests were monitored throughout the study and in addition the oral glucose tolerance test was analysed at entry to the study, after six months intensive dietary management and again after 72 months. Blood pressure, electrocardiogram and the presence of posterior tibial artery pulsation were recorded at entry to the study and at 36 months and 72 months. Approximately 80 per cent of the patients were managed solely by dietary restriction for the entire six years, but 25 patients received oral hypoglycaemic drugs and 26 required insulin treatment. Weight, and fasting glucose and triglyceride values fell in the first few months of intensive dietary management. Analysis of possible risk factors in survivors and patients dead at six years showed no significant differences, apart from a higher mean age at diagnosis in those who died. During the six years of intensive dietary management the mortality from all causes in these diabetic patients was no greater than that for the general population of Northern Ireland.

Bromocriptine reduces growth hormone in acromegaly.

We assessed serum growth hormone (GH) levels in ten patients with acromegaly during a 24-hour profile and a 75-g oral glucose tolerance test (GTT). Serum GH levels were measured after five weeks of bromocriptine mesylate therapy, 20 mg daily (P1), after five weeks without bromocriptine mesylate therapy (P2), and again five weeks following restarting treatment with bromocriptine, 20 mg daily (P3). During the 24-hour profile, the following occurred: (1) mean serum GH level of the group was lower during P1 (20.5 mU/L) and P3 (20.8 mU/L) than P2 (49.6 mU/L); (2) in six individual patients during P1 and P3, there was a significant reduction in the mean serum GH value; and (3) a marked circadian variation in the serum GH value was present both with and without the drug therapy in five patients. During the GTT, the mean serum GH value was lower during P1 (18.4 mU/L) and P3 (16.7 mU/L) than P2 (43.3 mU/L), and in seven individual patients during P1 and P3, there was a significant reduction in the mean serum GH value. Overall, a clear reduction in serum GH values due to bromocriptine was demonstrated. In individual patients, serum GH values during a 24-hour profile and GTT gave similar indications of response.

Smoking in pregnancy--a health education problem.

The smoking habits and knowledge and demographic characteristics of 380 pregnant patients in Belfast were investigated. Over half of the women smoked but only 11.5% stopped smoking after becoming pregnant in spite of the fact that almost 65% of them knew that smoking could have an effect on the baby. The study showed that some smokers changed their attitude to smoking before and after delivery and that little effort is being made by general practitioners to dissuade their antenatal patients from smoking. More emphasis on health education for school children is required and also more individual effort on the part of health professionals to dissuade women from smoking, especially when they are pregnant.

Antibodies specific for measles virus envelope antigens and autoantibodies in patients with chronic active hepatitis.

Distinctly increased levels of antibodies to measles virus envelope antigens haemolysin and haemagglutinin were found in the sera of patients with chronic active hepatitis compared with a normal control group, using immunofluorescence and functional tests. Similarly, a higher incidence of smooth muscle antibody of both IgG and IgM classes was observed in the patients and an important correlation was found between haemolysin antibodies specific for measles virus and smooth muscle antibody of IgG and IgM classes. In contrast, there was no such correlation between the virus specific haemolysin antibodies and antinuclear antibodies. The increased levels of antibodies to measles virus envelope antigens and of autoantibodies may reflect defects in immunoregulation rather than persistent infection with measles virus.

Subsets of T lymphocytes in relation to T lymphocyte function in multiple sclerosis.

T lymphocyte control of Epstein-Barr virus (EBV) infection of autologous B lymphocytes was examined in parallel to the enumeration of subpopulations of mononuclear cells in 22 multiple sclerosis (MS) patients and in 22 healthy individuals. All were seropositive for EBV. The incidence of lack of T cell control was significantly higher in patients than in controls, confirming previous published work. In the present study, we have shown in addition a significantly reduced proportion of OKT8+ cells and a significantly increased ratio of OKT4/OKT8 cells in the group of patients with lack of control. The findings point to abnormal immunoregulation in MS.

Factors influencing the survival of patients with testicular teratoma.

The histology of 51 cases of testicular teratoma, with or without seminoma, was reviewed and classified according to the World Health Organization criteria. Full pathological and clinical details were obtained, and patients were followed up for periods varying from one to 10 years from orchidectomy. Multiple factors were studied in order to discover which affected prognosis. The pathological stage of the tumour proved to be the most important indicator. The previously described poor prognosis associated with yolk sac tumour was not confirmed.

Sexually transmitted diseases, T cell subsets, and sexual practices in homosexual men attending an STD clinic.

Sixty three homosexually active men and 42 heterosexual men answered questionnaires regarding aspects of their social life and sexual practices. Assessment of past sexually transmitted disease showed the homosexual group to have had a significantly greater incidence of syphilis, gonorrhoea, perianal warts, and cytomegalovirus infections. T cell subset counts were carried out, and results for 60 of the homosexual men and 39 of the heterosexual men showed that the homosexuals had a significantly greater mean T cell suppressor cell count (p = 0.0019). The mean T helper cell count was not significantly different between the two groups, but it was significantly more (p = 0.033) in the more promiscuous homosexuals (who had more than 20 sexual partners a year) than in the heterosexuals. No relation was found between T cell subset counts and evidence of past cytomegalovirus infection. The practice of passive anal intercourse, oroanal sex, and swallowing semen during oral sex did not appear to influence T cell subset counts in the homosexuals.

Respiratory symptoms and lung function in a group of solderers.

A total of 1611 women working in a large electronics company were interviewed using a modified version of the Medical Research Council's questionnaire on respiratory symptoms, and their lung function was tested using a Vitalograph dry wedge spirometer. When the prevalence of symptoms was compared using the chi 2 test among four occupational groups--namely, solderers, ex-solderers, non-solderers, and office workers--few significant differences were found. The group of ex-solderers tended to have a greater prevalence of symptoms than the other three groups. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were measured, and when these were compared for smokers, the office workers were found to have a greater mean age adjusted FVC and FEV1 than the three other groups. The pattern was less distinct for non-smokers. When duration of exposure to solder fumes was allowed for, differences in lung function were more suggestive of being related to smoking habit than occupational exposure to solder fumes.

Pre-transplantation immunological monitoring and graft survival in recipients of renal allografts.

Various immunological parameters were measured pre-transplantation in 82 renal transplant recipients. The results were compared with the clinical course of the recipient post-transplantation and with the results of 40 controls. Only one test C3 inactivation products (C3i) was associated with transplant outcome in that 0/30 patients with no rejection episodes had C3i whereas 9/38 patients with rejection episodes, including 3/12 patients whose graft failed, had C3i.

Influence of laryngoscope design on heart rate and rhythm changes during intubation.

One hundred and twenty adult patients about to undergo surgery were premedicated with either meperidine or meperidine and atropine. After anaesthesia was induced with thiopentone and succinylcholine given, tracheal intubation was performed with the use of either a Magill or a Macintosh laryngoscope. There were no statistical differences in changes of heart rate and rhythm between the groups, as regards the type of premedication given or the design of laryngoscope used.