Colonic spreading of a non-chlorofluorocarbon mesalazine rectal foam enema in patients with quiescent ulcerative colitis.

BACKGROUND: Rectal foam enemas provide for drug delivery to the distal colon for treatment of left sided ulcerative colitis. However, currently available formulations contain chlorofluorocarbons which are due to be phased out in the near future. The objective of this study was therefore to determine the degree of dispersion of a newly developed non-chlorofluorocarbon rectal foam preparation in ulcerative colitis patients. METHODS: This was an open label non-controlled study of a single administration of a mesalazine foam enema (two actuations containing 2 g of mesalazine in approximately 120 mL foam) in 10 patients with quiescent ulcerative colitis. Spreading of the 99mTc-labelled foam enema was assessed over a 4-h period by the non-invasive technique of gamma scintigraphy. RESULTS: All patients retained the enema for the full 4-h imaging period. In nine out of the 10 patients, the enema was observed to spread as far as the descending colon and on average 23% of the dose was present in the descending colon at 4 h post-dose. CONCLUSIONS: The extent of spreading observed in the study supports the use of the formulation in the treatment of left sided ulcerative colitis.

A comparative study between the use of analgesia/anaesthesia and of episiotomy in women delivered under consultant supervision or general practitioner care.

A retrospective cohort study based on obstetric records was performed, to compare the use of analgesia/anaesthesia during labour by consultants and general practitioners. The episiotomy rates for the two groups were also compared. 111 general practitioner patients were identified and these were matched with 111 consultant patients. No difference was found between the two groups for duration of stages I or II. The rates for episiotomy, 1 degree or 2 degrees tear or intact perineum were the same in each group. Women delivered under consultant supervision used more entonox than women delivered under general practitioner care, but this was counterbalanced by an increased use of pethidine in the latter group. No difference was found between the two groups with regard to the use of epidurals. There was an increased use of local anaesthetic by general practitioners. This was due to general practitioners preferring to use local anaesthetic for suturing after an epidural had worn off, whereas hospital doctors preferred to top-up the epidural to provide anaesthesia for suturing. This study supports the view that women delivered under the care of their own general practitioner in a hospital obstetric unit fare no worse than similar women delivered under consultant supervision. The former group have the advantage of continuity of care from their general practitioner.

Psychological intervention in civilian flying phobia. Evaluation and a three-year follow-up.

Thirty-eight people with a moderate to severe degree of aerophobia self-referred themselves to a course designed to help them travel by air. The course involved three long sessions based on giving information, graded exposure without avoidance, and group support with natural coping models. Measures of self-reported anxiety levels were taken at regular intervals. The results showed that being given information or undergoing a simulated flight had little effect on perceived anxiety. Prolonged exposure to flying had a marked effect on reducing anxiety and anticipated apprehension about future flying. At one-year and three-year follow-up, 40% and 60% of participants had flown commercially, although there was some minor restoration of anticipated anxiety associated with flying; 84% showed less anxiety about flying. Psychological intervention, in collaboration with airlines, may have marked benefits in reducing fear of flying.

Major ambulatory surgery of the ophthalmic patient.

Ophthalmology, by means of its increased technologic abilities, has been a driving force in the movement toward ambulatory surgery over the past decade. In appropriate situations, nearly any ophthalmic procedure can be done in an outpatient setting. However, even though ophthalmic advances have helped the push toward ambulatory procedures, the future cohesiveness, as well as the superb patient care of ophthalmology, may be threatened in the pressure for cost reductions and efficiency.

Prospective study of the aetiology and outcome of pneumonia in the community.

A prospective one-year study of community pneumonia was conducted in Nottingham. 236 of 251 episodes of pneumonia (defined as an acute lower respiratory tract infection, for which antibiotics were prescribed, associated with new focal signs on examination of the chest) were investigated. Acute radiographic changes were present in 93 (39%). A pathogen was identified in 129 (55%) episodes, with Streptococcus pneumoniae, Haemophilus influenzae, and influenza viruses those most frequently identified. Mycoplasma pneumoniae was uncommon and infection with Legionella pneumophila was found in only 1 episode. Hospital admission was required in 52 (22%) episodes. 7 patients died (3%), all but one of the deaths occurring in patients who had been admitted to hospital. Pneumonia in the community is common but few people die of it. Initial antibiotic therapy should always cover S pneumoniae and H influenzae.

Contraceptive care and family planning in an urban general practice.

PIP: This study analyzed contraceptive practices among the 1465 women 15-49 years of age in an urban UK general practice. At the time of the survey, 75% of these women were either married or cohabitating. 99% of contraceptive users 15-19 years of age compared with only 6% of those 35-39 years of age had selected oral contraceptives (OCs). The proportion of IUD users increased steadily with age. Use of Depo-Provera and the diaphragm was nonsignificant. Sterilization showed a steady increase with age, and vasectomy (of the male partner) represented 1/3 of all methods of contraception recorded among women aged 35 years and over. 4% of study subjects were pregnant at the time of the survey and 1% were infertile. The general fertility rate in this population was 56.6/1000. 9 (10%) of the 87 pregnancies occurring in the study period were terminated through induced abortion. Studies conducted in general practice settings as opposed to family planning clinics have the advantage of providing data on the contraceptive behavior of women in older age groups who do not attend the latter clinics. Family planning clinic surveys tend to overestimate the prevalence of OC use because they serve a younger population. Of note is the finding of this survey that surgical sterilization accounted for 83% of contraceptive use among women over 35 years of age; even among those 30-34 years of age, it accounted for 33% of contraceptive use.^ieng

Morphologic observations on experimental corneal vascularization in the rat.

The morphologic evolution of the early events of corneal vascularization in the rat cornea induced by silver nitrate cautery were followed by light and electron microscopy. An initial acute inflammatory response occurred within the first 6 hours after cautery as evidenced by vascular dilation, diapedesis of leukocytes, and an increased vascular permeability, as manifested by distended lymphatics and the presence of extravascular fibrin. At 24 hours after injury, the hypertrophy and the prominence of nucleoli and the presence of abundant polyribosomes were the initial suggestion that vascular endothelial cells and pericytes had entered the mitotic cycle. Nine hours later, at 33 hours after cautery, the first new vessels were observed as sprouts from the capillary arcade and postcapillary venules. The experiments reemphasize the association of acute inflammation and corneal vascularization in this model and underscore the early occurrence of vascular endothelial cell replication.

Corneal edema in essential iris atrophy.

In a clinical study of the essential iris atrophies, corneal edema occurred in 49 of 90 patients, and a characteristic hammered-silver appearance of the posterior cornea was visible in 54 cases. Intraocular pressure in the eyes with corneal edema ranged from normal to extreme elevation with glaucomatous damage, and lowering the pressure relieved the corneal edema in many cases with penetrating keratoplasty being effective when other measures failed. Electron microscopy of two keratoplasty specimens revealed extremely few, distinctly abnormal cells lining a collagenous layer posterior to Descemet's membrane.

Ultrastructural observations on experimentally produced melanin pigmentation of the corneal epithelium.

Melanin pigmentation of the corneal epithelium was induced in pigmented guinea pigs by the topical application of colchicine to their eyes or by corneal cauterization with silver nitrate. With colchicine the pigmentation was preceded by the development of an abnormal corneal epithelium in which numerous cells became arrested in cell division. The corneal melanosis resulted largely from the migration of melanocytes into the corneal epithelium from the normally pigmented contiguous conjunctiva and to a lesser extent from the presence of melanin granules within corneal epithelial cells. In both models a leukocytic and vascular invasion of the cornea proceded and accompanied the migration of melanocytes into the corneal epithelium. Electron microscopy disclosed cells with the same morphology as conjunctival melanocytes between the epithelial cells of the cornea. Mature melanin granules were also present within some squamous epithelial cells as individual granules or as clusters. The ultrastructural findings are viewed in relation to how melanin granules are transferred from melanocytes to epithelial cells. Evidence is presented which suggests that malanin granule transfer may follow the fusion of the membranes of the melanocytes and epithelial cells.