Non-sphenopalatine dominant arterial supply of the nasal cavity: an unusual anatomical variation.

OBJECTIVE: We present a rare and clinically relevant anomaly of the sphenopalatine artery in relation to its blood supply of the nasal mucosa, with implications for the management of epistaxis. METHOD: Case report and review of the world literature, using Medline through Pub Med (1950-2005), EMBASE (1980-2005) and Ovid (1958-2005), searching for papers using a combination of terms including 'spheno-palatine artery', 'anterior ethmoidal artery' and 'epistaxis'. RESULTS: In the presented case of refractory epistaxis, endoscopic and subsequent endovascular management failed to identify a significant supply from the sphenopalatine arteries bilaterally. The main supply was found to be from the anterior ethmoidal arteries. CONCLUSION: After a detailed search, the authors failed to locate any similar case in the English literature.

The clinical nurse specialist's role in school health.

This article explores the role of the clinical nurse specialist (CNS) in school health. School nurse roles and responsibilities are expanding from their original emphasis on providing direct care and education to children and their parents to community-oriented care. CNS roles and practice areas have expanded to fill needs in a variety of settings, with a variety of clients. The identified CNS roles of clinician, educator, consultant, researcher, and leader/manager provide a comprehensive approach to providing school health services directly to individuals and indirectly through community-oriented care. A CNS's expertise is essential to assist with providing comprehensive care to students, their families, and the community through comprehensive school health services.

Body fatness and increased injury rates in high school football linemen.

OBJECTIVE: To determine whether associations exist between body fatness and injury rates in high school football linemen. DESIGN: Prospective, injury surveillance study during a 2-week preseason and 10-week regular season. SETTING: 10 public high schools in Texas. PARTICIPANTS: Two hundred fifteen varsity and junior varsity high school football linemen. MAIN OUTCOME MEASURES: Injury rates (injuries per 1000 hours of playing time) for groups of players above a given body fat level and at or below a given body fat level. Rates were computed as the number of injuries per group divided by the group's aggregate playing time (practice + game time). The null hypothesis was that there is no difference in injury rates between players above a given level of body fat and those at or below that level of body fat. Body fat was determined from chest, abdomen, and thigh skinfold measurements using standard conversion equations. Body mass index (BMI) (kg/m2) was also calculated for each player. RESULTS: The overall injury rate was 5.66 injuries per 1000 hours of playing time. Percent body fat ranged from 9.3% to 40.2%. BMI ranged from 19.9 to 46.6 kg/m2. Sixty-seven players sustained 86 injuries, the most common of which were ankle sprains and medial collateral ligament sprains. No difference in overall injury rates between higher and lower fat groups was seen at any body fat level. Players in higher body fat groups, however, had significantly greater lower extremity injury rates than did players in lower fat groups between 18% and 27% body fat and again 32% to 33%, but not at intermediate levels or >33%. Players in higher BMI groups had significantly greater lower extremity injury rates than did players in lower BMI groups throughout the range from 24 to 36 kg/m2, except at 34 kg/m2. CONCLUSION: Both higher body fatness and BMI were associated with increased rates of lower extremity injury among high school football linemen. BMI appears to be associated more consistently with increased lower extremity injury rates than is body fat.

Cervical cytology screening and government policy.

OBJECTIVE: To assess the coverage of cervical cytology screening in one general practice surgery according to the criteria in the new Scottish general practitioner contract and to explore the difficulties of defining performance in such screening. DESIGN: Review of annual analysis of uptake of screening during 1984-8. SETTING: Suburban general practice surgery in Glasgow serving 3000 patients. PATIENTS: All women aged 35-64 registered in 1984 increasing in 1988 to all women aged 20-64. MAIN OUTCOME MEASURE: Assessment of uptake of smear tests and reasons for smear not being taken and of the effect of these outcomes on the new general practitioner contract. RESULTS: The numbers and percentages of women having a smear test in the previous five and three years were recorded, and the reasons why a smear was not taken were defined in the remainder (hysterectomy, test not offered, risk not known, test declined, patient moved away, and patient unaccounted for). In 1988, 85% (608/719) of the women aged 30-64 and 80% (693/870) of those aged 20-64 had had a smear test in the previous five years. An appropriate or irreducible reason for the lack of a smear test was defined in all the others. CONCLUSIONS: The population studied contained a substantial number of women in whom cervical smear was unnecessary, inappropriate, or refused. These factors and the likely demographic variation in the uptake of smear tests have important implications for the setting and achieving of the government's targets for cervical cytology screening.

Australia antigen and primary biliary cirrhosis.

Sera from 64 patients with primary biliary cirrhosis have been examined for Australia antigen (Au). On immunodiffusion and immunoelectrophoresis all sera were negative. Using a radioimmunoprecipitation technique 15.6% of sera contained antigen compared with an incidence of 3.1% in matched controls, a significant difference (p = 0.015). Anti-Au was found in 9.4% of patients and in 7.8% of controls. In lymphocyte transformation studies lymphocytes from one of 24 patients with primary biliary cirrhosis transformed on stimulation with an Au-rich serum.