Gonad shield placement accuracy in pelvic radiographs for male patients: A prospective phantom study and survey of third year undergraduate diagnostic radiography students".

INTRODUCTION: Little research has focused on the accuracy of gonad shield placement, especially by students. While studies have investigated the presence of gonad shields they do not aim to measure accuracy but only look at repeatability. This study aimed to establish students' knowledge of gonad shields and their accuracy in placing it. METHODS: Following an invitation email and informed consent, students completed a 7-question questionnaire and placed a gonad shield on a Pixi full body adult phantom (male configuration). The phantom was x-rayed and images were assessed for gonad shield positioning in terms of obscuring bony anatomy, correct orientation and distance from a "gold standard" position. RESULTS: 36% of images displayed shields covering bony anatomy while 16% of shields were incorrectly orientated. All shields incorrectly orientated also covered bony anatomy. Statistical significance was seen between incorrect shield orientation and the obscuring of bony anatomy (p = 0.01). Dispersion of positioning error measurements ranged from -6.80 mm (better placed than the "gold standard") to 62.35 mm inferiorly, with an average 28.22 mm inferiorly. CONCLUSION: The average misplacement of 28.22 mm suggests participants placed the gonad shielding lower than necessary to avoid obscuring bony anatomy. The 36% of misplaced shields, while lower than in previous studies, is still a significant number of radiographs that would require repeats. IMPLICATIONS FOR PRACTICE: Given the associated difficulties surrounding gonad shields and their placement, this study supports previous research suggesting that the benefit of using gonad shielding is questionable.

The impact of gonad shielding in anteroposterior (AP) pelvis projections in an adult: A phantom study utilising digital radiography (DR).

INTRODUCTION: Positioning relative to the lateral automatic exposure control (AEC) chambers (cranial/caudal orientation) optimises dose and image quality in pelvic radiography. In the cranial orientation introducing gonad shielding (GS) in females may increase radiation dose. The aim of this study was to fully optimise the combination of pelvis orientation and use of GS in both male and females. METHODS: An anthropomorphic pelvis phantom was exposed, with dose area product (DAP) recorded, in both orientations without GS and four conditions with GS: cranial orientation (female/male), caudal orientation (female/male). A 4 cm × 4 cm grid incorporating thirteen positions for the GS resulted in 52 experimental settings. Blind image quality assessment, utilising a modified scale, was undertaken by two experienced observers. RESULTS: Comparing no GS (caudal orientation) to female GS, no significant change in DAP was seen (3.97 v 4.03 dGy*cm2; Mann-Whitney p = 0.060). Comparing no GS (cranial orientation) to male GS no significant change in DAP was seen (8.66 v 8.77 dGy*cm2; Mann-Whitney; p = 0.210). DAP increased significantly with introduction of female GS in the cranial orientation (23%: 8.66 v 10.65 dGy*cm2, Mann-Whitney; p < 0.001) and male GS in the caudal orientation (22.8%: 3.97 v 4.87 dGy*cm2, Mann-Whitney; p < 0.001). Significantly higher repeat rates (Chi-squared test; p < 0.001) were seen for GS in female (85-100%) compared to male (30.8%). CONCLUSION: The use of gonad shielding can increase DAP and lead to repeats being required, with more required for female GS usage, suggesting the utility of GS for pelvis examinations is questionable. IMPLICATIONS FOR PRACTICE: Optimisation of radiation dose in pelvic radiographic examinations utilising AEC terminated exposures requires consideration of AEC chamber position and GS usage.

Prophylactic treatment of seasonal allergic rhinitis.

The prophylactic effectiveness of the new, second-generation antihistamines cetirizine and terfenadine was evaluated in a double-blind, multicenter study of 487 patients with seasonal allergic rhinitis. The patients were randomly assigned to eight weeks of treatment with 10 mg of cetirizine given either in the morning or evening, or 60 mg of terfenadine twice daily. Success rates in the three treatment groups, as assessed by physicians, were 61%, 58%, and 56%, respectively. On a scale of 0 (no symptoms) to 100 (most severe symptoms), symptoms in the three regimens were rated by patients as 31, 34, and 41, respectively. A significantly greater alleviation of eye watering and irritation was noted in the morning cetirizine group than in the terfenadine group. No serious side effects were experienced. It is concluded that 10 mg of cetirizine once daily is as effective as 60 mg of terfenadine twice daily in the prophylactic treatment of seasonal allergic rhinitis.

Salivary PAF in acute myocardial infarction and angina: changes during hospital treatment and relationship to cardiac enzymes.

Salivary levels of platelet activating factor (PAF) were measured together with serum CPK and interleukin 2 receptor in 30 patients admitted to the coronary care unit, 9 patients with pulmonary tuberculosis, 10 with acute severe asthma and 8 normal controls. 16 of the 30 C.C.U. patients had sustained a acute myocardial infarction (M.I.) 5 had acute angina and the remaining 9 had non cardiac chest pain. Salivary PAF on admission was significantly higher in the M.I. Patients than in the normal subjects, asthmatics, tuberculosis patients and those with non cardiac chest pain (p < 0.001 in all cases) but not those with angina. After 48 hours PAF levels fell in the subjects with M.I. (p < 0.01) and no significant difference was seen between any group. PAF levels did not show any relationship with CPK levels or site of infarct in the M.I. patients. Interleukin 2 receptor was not significantly raised in the M.I. group as a whole but some individual patients showed markedly increased serum levels, but these levels did not correlate with either salivary PAF or serum CPK.

Activities of enzymes of collagen biosynthesis and levels of type III procollagen peptide in the serum of patients with sarcoidosis.

Serum immunoreactive prolylhydroxylase (IRPH), galactosylhydroxylsyl glucosyltransferase activity (GGT) and amino-terminal propeptides of type III procollagen (Pro(III) peptide) were measured in fifty three patients with sarcoidosis (all having some degrees of pulmonary fibrosis). The levels of IRPH and Pro(III) peptide showed no relationships to the clinical assessment of the disease and while GGT activity was raised in approximately 80% of the patients there was no correlation between the size of the increases and the clinical activity of the disease. The results of this study would suggest that measurement of the above parameters offer no specificity in either diagnosing or assessing the clinical activity of sarcoidosis. The observed increases in serum GGT activity in affected patients would however suggest that measurement of this enzyme may be useful perhaps in more severe pulmonary fibrotic reactions.

Peripheral blood lymphocytes in sarcoidosis.

Sarcoidosis is characterised by changes in the lymphocyte subpopulations of the peripheral venous blood in the majority of patients. Thymus derived lymphocytes (T cells) are low whilst Bursa derived lymphocytes (B cells) are usually normal in number. The T cell lymphopaenia is best regarded as a "switching off" of available receptors as in vitro treatment with Levamisole restores this population to normal control values. A functional subset of T cells, T suppressor cells (T gamma) are activated, in sarcoidosis, in peripheral venous blood. Sarcoid sera is characterised by two inhibiting fractions; one, of low molecular weight (60 000 daltons) inhibits E rosette formation by normal T lymphocytes and may be a product of T suppressor cells or epithelioid/macrophage cells: the other is an immune complex which is capable of activating normal T suppressor cells and the serum immune complex concentration is positively correlated with suppressor cell activation in sarcoidosis.

A comparative trial of two slow-release theophylline tablets in the treatment of asthma; Nuelin S.A. and Theocontin Continus tablets.

Twenty-five adult asthmatic patients were entered into a double-blind random crossover comparison of Theocontin Continus tablets with Nuelin S.A. The patients received additional therapy with inhaled salbutamol and/or beclomethasone diproprionate. Four patients withdrew because of persistent unwanted side-effects, nausea and headaches in three, and mental confusion in one, and a fifth withdrew for non-medical reasons. Analysis of the results of the remaining twenty patients showed no difference between the effects of the two preparations in symptom scoring, reduction in salbutamol inhaler use and improvement in respiratory function as measured by daily PEFR, at similar serum levels. The same dosage per kilogram for either preparation gave virtually identical mean serum levels suggesting there is no difference in the rate of absorption between the two preparations.

Alternative pathways of spirilloxanthin biosynthesis in Rhodospirillum rubrum.

Detailed studies of the properties of carotenoids isolated from diphenylamine-inhibited cultures of Rhodospirillum rubrum have revealed a number of novel structures that indicate new features of carotenoid biosynthesis in the photosynthetic bacteria. Both neurosporene and 7,8,11,12-tetrahydrolycopene undergo hydration, methylation and dehydrogenation to yield spheroidene and 11',12'-dihydrospheroidene respectively; all the intermediates in these pathways have been identified. These pathways represent alternative routes of anhydrorhodovibrin and spirilloxanthin biosynthesis.

A novel sequence for phytoene dehydrogenation in Rhodospirillum rubrum.

Differences between the absorption spectra of zeta-carotene (7,8,7',8'-tetrahydrolycopene) and the corresponding conjugated heptaene from diphenylamine-inhibited cultures of Rhodospirillum rubrum have been rationalized by the identification of the latter compound as the unsymmetrical isomer, 7,8,11,12-tetrahydrolycopene. The structures of the other conjugated polyene hydrocarbons, phytoene, phytofluene and neurosporene, have been confirmed and a novel pathway for the dehydrogenation of phytoene to lycopene in these bacteria is described.

The triterpenoid carotenoids and related terpenoids in Staphylococcus aureus 209P.

The carotenoids of Staphylococcus aureus 209P have been identified as triterpenoid (C30) carotenoids. The pigments include members of a carotene dehydrogenation sequence with C30 analogs of phytoene, phytofluene, zeta-carotene, and neurosporene. The major xanthophyll present under the cultural conditions used is a carotenoic acid derived from the C30 analog of neurosporene. A cis-isomer of this major xanthophyll has also been characterized, as have four other xanthophylls. Of the latter xanthophylls, two have been identified as the hydroxy and glycosyloxy derivatives of the major xanthophyll, while the remaining two xanthophylls are carotenoid esters. Squalene and menaquinone MK-8 have also been identified in the bacterium.

Modulation of lymphocyte adrenergic receptors by hormones and anti-asthmatic drugs.

Viable lymphocytes were used to investigate the binding of physiological concentrations of hormones and therapeutic concentrations of anti-asthmatic drugs to [3H]dihydroalprenolol (DHA, beta antagonist) and [3H]prazosin (alpha antagonist) receptor sites. All studied drugs and hormones inhibited the specific binding of prazosin to receptors identified with 10(-4)M phentolamine. Similar concentrations of drugs and hormones, with the exception of prostaglandin F2 alpha and cimetidine, inhibited the specific binding of DHA to lymphocyte receptors identified with 10(-7)M propranolol. These results confirm current mechanisms of hormone and drug action in asthma.

Modulation of lymphocyte adrenergic receptors and transformation responses by therapeutic drugs.

Lymphocyte transformation responses and adrenergic receptor (adrenoceptor) binding have been studied in the presence of therapeutic drugs. Chloroquine, propranolol and trifluoperazine were the most potent drugs investigated, inhibiting lymphocyte responses and the binding of adrenergic antagonists at 10(-5)M. Drugs such as salicylate and chlorpropamide, with little affinity for adrenoceptors but with a high capacity for binding to albumin, inhibited lymphocyte transformation at 10(-3)M; probably by displacing protein-bound ligands with an affinity for adrenoceptors. Metronidazole and allopurinol had no significant effect on lymphocyte transformation, or on adrenoceptor antagonist binding at 10(-3)M. Adrenoceptor affinity or receptor numbers and lymphocyte responses were increased by non-inhibitory concentrations of most drugs. We conclude that most drugs modify lymphocyte responses by interacting directly or indirectly with adrenoceptors. This modulation of adrenoceptors may have important implications, relating to the induction and control of asthma by drugs.

Pseudo-leptospires in broncho-alveolar lavage fluid and blood cell cultures.

Two types of microscopic filaments were observed in mucous and fluid obtained by broncho-alveolar lavage (BAL). Filaments in mucous smears were probably cilia from desquamated ciliated epithelial cells. Those in BAL fluid, resembling leptospira, may originate from platelets as similar filaments were produced in vitro by exposing platelets to thrombin.

Familial pulmonary fibrosis associated with oculocutaneous albinism and platelet function defect. A new syndrome.

A family was studied in which four siblings had oculocutaneous albinism. In three of these a platelet function defect characterized by poor response to collagen was found. The fourth had previously died from cryptogenic fibrosing alveolitis. Two of the survivors had cryptogenic fibrosing alveolitis and the third had physiological lung function disturbance. Bone marrow examination of one showed pigment laden macrophages (Hermansky-Pudlak Syndrome). Three other normally pigmented family members were found to have normal platelets and no evidence of cryptogenic fibrosing alveolitis, although one had pulmonary disease attributable to occupational dust exposure. To elucidate the aetiological factors involved, three unrelated normally pigmented patients with known platelet function defect were studied. One proved to have cryptogenic fibrosing alveolitis. Four unrelated albinos were also studied and had normal lungs and platelets. It is suggested that, in addition to the known association between platelet function defect and albinism, there is an association between a platelet function defect and cryptogenic fibrosing alveolitis.