The relationship between patients' perception of the effects of neurofibromatosis type 2 and the domains of the Short Form-36.

OBJECTIVES: To investigate the relationship between those issues concerning quality of life in patients with neurofibromatosis type 2 (NF2) as identified by the closed set NF2 questionnaire and the eight norm-based measures and the physical component summary (PCS) and mental component summary (MCS) scores of the Short Form-36 (SF-36) Questionnaire. DESIGN: Postal questionnaire study. SETTING: Questionnaires sent to subjects' home addresses. PARTICIPANTS: Eighty-seven adult subjects under the care of the Manchester Multidisciplinary NF2 Clinic were invited to participate. MAIN OUTCOME MEASURES: Sixty-two (71%) completed sets of closed set NF2 questionnaires and SF-36 questionnaires were returned. RESULTS: Subjects with NF2 scored less than the norm of 50 on both the physical component summary and mental component summary scores and the eight individual norm-based measures of the Short Form-36 questionnaire. Correlations (using Kendall's tau) were examined between patients' perceptions of their severity of difficulty with the following activities and the eight norm-based measures and the physical component summary and mental component summary scores of the Short Form-36 questionnaire: Communicating with spouse/significant other (N = 61). The correlation coefficients were significant at the 0.01 level for the mental component summary score, together with three of the norm-based scores [vitality (VT), social functioning and role emotional]. Social communication (N = 62). All 10 correlations were significant at the 0.01 or 0.001 level. Balance (N = 59). All 10 correlations were highly significant at the P < 0.001 level. Hearing difficulties (N = 61). All correlations were significant at either the 0.01 level or less apart from the mental component summary score and three of the norm-based scores (role physical, VT and mental health). Mood change (N = 61). All correlations were significant at the 0.01 level or less, apart from one norm-based score (role physical). CONCLUSIONS: The Short Form-36 questionnaire has allowed us to relate patients' perceptions of their difficulties, as identified by the closed set NF2 questionnaire, to the physical and mental domains measured by this validated and widely used scale, and has provided further insight into areas of functioning affected by NF2.

Relative clinical usefulness of glycosylated serum albumin and fructosamine during short-term changes in glycemic control in IDDM.

Serial changes in glycosylated blood proteins and direct measures of glycemia were studied in 100 subjects with insulin-dependent diabetes mellitus (IDDM) over a 6-wk period while attempts were made to improve glycemic control. All measures of glycemic control improved significantly (P less than .001). Mean +/- SE glycosylated hemoglobin (HbA1) fell from 9.1 +/- 0.2 to 8.0 +/- 0.1%, glycosylated serum albumin (GSA) from 9.8 +/- 0.4 to 7.3 +/- 0.3%, and fructosamine from 3.92 +/- 0.08 to 3.42 +/- 0.07 mM. Fasting blood glucose levels fell from 11.1 +/- 0.6 to 8.1 +/- 0.7 mM mean blood glucose levels from 12.5 +/- 0.3 to 8.8 +/- 0.03 mM, and the M value from 118 +/- 7 to 40 +/- 3 U. Mean percentage changes in direct measures of glycemia (32-66%) and GSA (29%) were greater than for fructosamine (11%) or HbA, (12%) levels (P less than .001). Furthermore, the correlation between the change in GSA and changes in direct measures of glycemia over the initial 2-wk period was significantly different from the corresponding correlations between direct measures of glycemia and fructosamine over this period (P less than .05-.01). Changes in GSA also correlated more closely than HbA1 or fructosamine did with direct measures of glycemia after 4 and 6 wk. The Spearman rank-correlation coefficient (rs) of absolute changes in GSA, fructosamine, and HbA1 after 2-6 wk ranged from 0.27 to 0.57, confirming that the three measures responded differently to changing glycemic control.(ABSTRACT TRUNCATED AT 250 WORDS)

Definitions of mania: concordance and prediction of outcome.

The authors compare several definitions of mania in three series of patients. All the definitions were successful in selecting patients with a favorable outcome, but there were large differences in the number of patients diagnosed, ranging from 17 to 55. The Research Diagnostic Criteria (RDC) distinction between mania and schizoaffective mania proved useful in that the schizoaffective patients continued to show schizophrenic and paranoid symptoms, had more manic episodes, and had a poorer social outcome. The DSM-III tripartite division into nonpsychotic mania and two subgroups of psychotic mania did not appear to have a clear advantage over the RDC dichotomy in the prediction of outcome.

Definitions of depression: concordance and prediction of outcome.

Using patient samples in London hospitals, the authors compared three methods of diagnosing and subdividing depressive illness in terms of their ability to predict outcome. The Catego class D+ selected patients who continued to suffer from episodes of psychotic depression. The Research Diagnostic Criteria selected patients with schizoaffective depressions whose outcome a completely different from that of major depressive disorder. DSM-III had advantages over the other systems, since it divides depression into three subtypes that differ from each other and from schizophrenia. Patients with a DSM-III diagnosis of mood-incongruent psychotic depression had persistent schizophrenic psychopathology, but their outcome differed from that of both schizophrenic and manic-depressive patients.

Multiple vascular profiles in the umbilical cord; an indication of maternal smoking habits and intrauterine distress.

A total of 644 umbilical cords were examined over a period of 5 years, 40 cords (6.2 per cent) showed more than the normal three vascular profiles on cross-section. Both the umbilical arteries and vein showed multiple profiles, although arterial profiles were far more commonly multiple. Clinical data were correlated with the histological findings. Heavy smoking was significantly associated with multiple vascular profiles. Maternal age and rhesus group were not significantly related however, but there was some association with primiparity. Fetuses with a gestational age between 33 and 38 weeks were significantly more likely to have multiple vessels than either fetuses beyond 38 weeks or less than 33 weeks gestation. Multiple channels also occurred significantly more frequently in still birth than in live birth cords. We suggest that multiple vascular profiles represent a response to intrauterine hypoxia. Inflammation of the cord was associated with multiple channels and suggests linkage between these two indications of fetal distress.

Adhesion of staphylococci to polyurethane and hydrogel-coated polyurethane catheters assayed by an improved radiolabelling technique.

Adhesion of Staphylococcus epidermidis NCTC 11047 to the external surface of polyurethane catheters was quantified by a radiolabelling assay. Maximum adhesion was achieved with an initial cell concentration of 3 x 10(8)/ml after incubation for 120 min. The assay was tested for reproducibility by analysis of variance. Adhesion of clinical strains of S. epidermidis and S. aureus to uncoated polyurethane and hydrogel (Hydromer)-coated polyurethane catheters was compared. Hydrogel coating significantly reduced adhesion for both S. epidermidis and S. aureus (mean percentage reduction 71% for S. epidermidis, 69% for S. aureus). Clinical isolates were also tested for adhesion to polystyrene by a modified microtitration well adhesion assay; there was no correlation between staphylococcal adhesion to polyurethane catheters and adhesion to polystyrene. Cell surface hydrophobicity values varied widely for both species. Positive correlations were found between cell surface hydrophobicity and adhesion to polystyrene and uncoated polyurethane catheters for S. epidermidis but not for S. aureus.

A comparison of direct measures of glycaemia and glycated blood proteins in insulin-dependent diabetes mellitus.

We have studied associations between various direct measures of glycaemia and glycated blood proteins in 113 subjects with insulin-dependent diabetes mellitus (IDDM), and examined whether or not the 'fructosamine' assay results were affected by differing patient serum concentrations of lipids, albumin or C peptide. Serum fructosamine correlated less closely with HbA1 (r = 0.44) than did HbA1 with glycated serum albumin (GSA) (r = 0.68). Serum fructosamine and GSA also were poorly correlated (r = 0.48). Although fructosamine, HbA1 and GSA correlated to a similar degree with fasting blood glucose (r range 0.34 to 0.37), GSA was most closely related to mean blood glucose (r = 0.39 vs. 0.30-0.35) and the M value (a marker of diurnal glycaemic instability) (r = 0.42 vs. 0.33-0.35). The serum concentration of fructosamine was not significantly affected by a variation in serum cholesterol, but tended to be lower in subjects with moderate hypertriglyceridaemia (p = 0.05). The fructosamine assay may be altered by moderately lipaemic serum but is not affected by serum albumin concentration in normoalbuminaemic patients with IDDM. Our study indicates, however, that GSA is a more reliable marker of short-term glycaemic control in IDDM than fructosamine.

Memory dysfunction in multiple sclerosis corresponds to juxtacortical lesion load on fast fluid-attenuated inversion-recovery MR images.

BACKGROUND AND PURPOSE: MR imaging is a sensitive diagnostic tool and paraclinical marker of disease activity and prognosis in multiple sclerosis (MS), yet the role of MR imaging of MS is controversial. The aim of this study was to describe the relationship between cognitive function and MS lesion size and position, as shown on comparative images from conventional spin-echo (CSE) and fast fluid-attenuated inversion-recovery (fast FLAIR) MR studies. METHODS: CSE and fast FLAIR sequences consisted of 40 noncontiguous, 3-mm-thick axial sections matched for geometric position in 18 patients with relapsing-remitting MS. Lesions were scored for size, anatomic position, and their comparative appearance on CSE and fast FLAIR images. The neuropsychological assessment tested general psychological performance, memory, and frontal lobe executive function. RESULTS: Fast FLAIR images showed significantly more small (146 versus six) and medium-sized (18 versus four) juxtacortical lesions than did CSE sequences. Small juxtacortical lesions displayed only on fast FLAIR images had a distinctive appearance, suggestive of small areas of perivascular inflammation. The number of these lesions corresponded to reduced performance on the fifth and delayed trials of the Rey Auditory Verbal Learning memory function test. CONCLUSION: Fast FLAIR images show small lesions at the juxtacortical boundary that are not seen on CSE studies. The presence of such lesions correlates with impaired retention of information in memory tasks, which is characteristic of cognitive problems in patients with MS.

Space-time interaction in Hodgkin's disease in Greater Manchester.

Knox's test for space-time interaction was applied to 922 cases of Hodgkin's disease which, according to the North Western Regional Cancer Registry, had presented in 1962-76 among the population of the region known before 1974 as the South East Lancashire Conurbation. In the series as a whole, there were statistically significant excesses of pairs of patients separated by time intervals of less than a year and distances of less than 1 km. Analysis by age and sex indicated that this clustering involved (a) a trio of young females and (b) pairs involving adults over 45 years old. No evidence was detected of any clustering by histological subtype or of any tendency for cases close in space to be separated by long time intervals of specific duration. These findings lend support to the idea that at least some cases of Hodgkin's disease may be induced by an infection or other environmental influence, but they do not suggest that such an infection has a long and specific incubation period.

Quantitative magnetic resonance imaging of vertebral bodies: a T1 and T2 study.

Multiple point T1 and T2 values of 424 vertebral bodies were measured and analysed. The influence of several factors including age, sex, location in the spine and status of neighbouring discs on the measured relaxation times were evaluated. The results indicate limitations in the region of interest approach. Vertebral bodies of different age, sex and location in the spine could not be distinguished. For heterogeneous tissues a more advanced form of image analysis appears to be essential. Diurnal factors resulting from the stress of normal ambulatory activity caused increased variation in vertebral body relaxation time values.

Simultaneous mapping of blood volume and endothelial permeability surface area product in gliomas using iterative analysis of first-pass dynamic contrast enhanced MRI data.

We describe a novel method for the calculation of endothelial permeability surface area product from dynamic contrast enhanced MRI. The technique uses iterative estimation to automatically decompose tissue residue function into intravascular and extravascular components, which are subsequently used to generate tumour blood volume, which is equal to relative cerebral blood volume calculated from T(1) weighted images and corrected for contamination by contrast agent leakage (rCBV(T1)(corrected), and endothelial permeability (k(fp)) maps. The technique was assessed in patients with cerebral glioma (n=5) by examining the reproducibility of endothelial permeability and rCBV(T1)(corrected) between two separate examinations conducted with a 2-day interval. The technique produces maps of endothelial permeability that appear to be free of any contribution from intravascular contrast agent. Maps of rCBV(T1)(corrected) show close correlation with maps of blood volume calculated from independently acquired dynamic susceptibility weighted MRI examinations, with no evidence of residual permeability effects. The results were highly reproducible with strong intra-class correlation between the two examinations for mean values and for 97.5 percentiles of endothelial permeability and rCBV(T1)(corrected). The excellent reproducibility of this technique and the ability to calculate endothelial permeability and rCBV(T1)(corrected) values from rapidly acquired data sets offer considerable advantages over conventional approaches and support the use of this methodology for therapeutic monitoring or trials of novel therapeutic agents.

Fetal and postnatal growth to age 2 years by mother's country of birth.

The objective of this study was to measure the physical growth of fetuses and infants in an inner city health district in the north of England and to compare their growth profiles according to mother's country of birth (British Isles or Indian subcontinent). The study was part of the Central Manchester Child Growth Project, a prospective longitudinal study of fetal and postnatal growth and development in a sample from the geographically-defined Central Manchester Health District. Data were collected from the beginning of the second trimester of pregnancy to the age of 2 years. One-hundred seventy-four singleton infants born at term ( > or = 37 weeks) had serial antenatal cephalometry every 3 weeks from the beginning of the second trimester and had serial head, length and weight measurements at birth and at the ages of 6, 13, 26, 52 and 104 weeks. Infants of Indian-born mothers tended to be lighter at birth than those of locally-born mothers, but the difference was not due to lower accumulation of soft tissue. Body length from 6 to 52 weeks in both groups of infants was similar. The major finding was the reduced head size in infants of Indian-born mothers, the difference being significant among boys, evident from mid-pregnancy and persisting postnatally to age 2 years. Reduced fetal growth is associated with the development of cardiovascular disease in adulthood, mortality from ischaemic heart disease being specifically linked with head size at birth. The reduced head size of boys of Indian-born mothers is of interest because male immigrants from the Indian subcontinent who live in England have an increased incidence of non-insulin dependent diabetes and a substantial excess mortality (standardised mortality ratio 313 at ages 20-29) from ischaemic heart disease.

Patients with genital warts: how are they managed by general practitioners?

This study was carried out to assess the management by general practitioners of patients with genital warts. An anonymized postal questionnaire was sent to 2060 general practitioners in the north west of England; 1260 (61.2%) completed questionnaires were returned. A total of 76.69% of GPs saw one or more cases per quarter. Of 468 (37.1%) GPs who managed patients in-house, 393 (83.9%) used podophyllin of concentration between 0.5 and 50%; 169 (43%) did not specify the podophyllin concentration and 112(23.9%) used podophyllotoxin. Of 395 GPs (31.3%) prescribing patient self-treatment, 259 (65.6%) prescribed podophyllin, but 60.23% did not specify the concentration; 134(33.9%) prescribed podophyllotoxin. Screening for selected sexually transmitted infections (STIs) was performed by 258/618 (41.7%) GPs. Only 74 (11.97%) screened for Chlamydia trachomatis and Neisseria gonorrhoeae and Trichomonas vaginalis. Partner notification was advised by 1138 (90.3%) and condom use by 1027 (81.5%). Only 333 (26.4%) referred all patients to GUM departments. Many GPs manage patients in-house, most using podophyllin solutions which vary in concentration, are non-standardized and potentially hazardous. Most GPs who instigate patient self-treatment prescribe podophyllin which is not licensed for this usage. Podophyllotoxin 0.5% is a safe, effective alternative. Few non-referring GPs screened for the 3 common STIs, thus putting patients at risk of complications such as pelvic inflammatory disease. Non-referral of patients with genital warts to GUM departments may have costly medical and financial consequences.

In-vitro adherence of oral streptococci in the presence of sucrose and its relationship to cariogenicity in the rat.

Streptococcus sanguis I gave a significantly greater percentage coverage (cell-pellicle attachment) of saliva-coated glass in the presence of sucrose than did Strep. sanguis II (p less than 0.025), and both these gave greater percentage coverages than the other species tested, between which no significant differences were noted. There was a large number of significant differences in clump size (cell-cell attachment) between species-pairs. Among the mutans streptococci, there were significant differences in the percentage coverage between Streptococcus rattus/Streptococcus mutans (p less than 0.05) and Strep. rattus/Streptococcus sobrinus (p less than 0.01), and in clump size between all species-pairs with the exception of Streptococcus cricetus or Strep. sobrinus and Strep. mutans. The rank order of species in relation to fissure caries was mutans streptococci greater than Streptococcus salivarius greater than Streptococcus milleri greater than Strep. sanguis greater than Streptococcus faecalis greater than Streptococcus mitis greater than Streptococcus lactis. There was a significant correlation between percentage coverage in vitro and fissure caries in vivo for strains of Strep. sanguis (p less than 0.05) and pooled strains of Strep. mitis and Strep. sanguis (p less than 0.01). On comparing data for adherence in the presence or the absence of sucrose, the sugar had no effect on the percentage coverage of the seven species tested, but significantly increased the clump size of the mutans streptococci (p less than 0.01) and Strep. sanguis (p less than 0.05).

Relationship of adhesion in vitro and cariogenicity of oral Streptococcus species in germ-free rats.

Thirty-two strains of Streptococcus spp., of known cariogenicity in the gnotobiotic WAG/RIJ rat, were tested for their in vitro adhesion properties. Computerized image analysis measured percentage coverage by, and clump size of, cells adhering to saliva-coated glass. An analysis of variance revealed significant differences for percentage coverage for the majority of species-pairs. There were fewer significant differences for mean clump size between species-pairs. Within the Strep. mutans group there was a highly-significant difference between Strep. mutans/Strep. cricetus (p less than 0.01) with respect to mean clump size. There was a significant correlation between cariogenicity and percentage coverage (p = 0.05) but not clump size (p = 0.359) for pooled strains of Strep. mitis and Strep. sanguis combined.

The cariogenicity of sucrose, glucose and maize starch in gnotobiotic rats mono-infected with strains of the bacteria Streptococcus mutans, Streptococcus salivarius and Streptococcus milleri.

Twenty-one-day-old weanling gnotobiotic WAG/RIJ rats were mono-infected with Streptococcus mutans NCTC 10832, Streptococcus salivarius JMB or Streptococcus milleri NCTC 11169, and maintained on a high carbohydrate diet containing sucrose, glucose or maize starch for 21-days. Fissure caries developed with all combinations of streptococcal strain and carbohydrate except maize starch/Streptococcus salivarius JMB. Caries incidence was highest with Streptococcus mutans NCTC 10832. For all species, the ranking of carbohydrates by cariogenic potential was sucrose greater than glucose greater than maize starch.

Young, scarred children and their mothers--a short-term investigation into the practical, psychological and social implications of thermal injury to the preschool child. Part II: implications for the child.

A short-term, prospective study, using both quantitative and qualitative methods, was designed to determine the practical, psychological and social implications of thermal injury resulting in scarring for children under 5 years of age, during the 6 months following the child's discharge from hospital. Mothers of 57 children (whose thermal injuries ranged from 1 to 41 per cent of body surface area and who all required skin grafting) were interviewed whilst the child was in hospital and at home, at 1 week, 2 months and 6 months following hospital discharge. From the mothers' descriptions, four categories of child behavioural response to thermal injury and hospitalization were identified. In the first week after discharge from the burns unit, 56 per cent (32/57) of children displayed minor or major disturbed behaviour, which had reduced to 19.3 per cent (11/57) by the 6-month interview. There were many reported physical and practical problems associated with the thermal injury and after-care. The MacGregor Deformity Scale was employed to assess the child's appearance. The child behaviour test scores (S. Jenkins et al. J. Child Psychol. Psychiatr. 1980; 21: 5; N. Richman et al. Pre-school to School-A Behavioural Study. 1982; Academic) demonstrated a similar progression of behavioural responses as the qualitative data, and, furthermore, indicated that the children under 2 years of age seemed to be affected for a more prolonged period.

Young, scarred children and their mothers--a short-term investigation into the practical, psychological and social implications of thermal injury to the preschool child. Part III: Factors influencing outcome responses.

The thermal injury, personal and social factors affecting the short-term outcome responses of thermally injured children under 5 years of age and their mothers are reported. Statistical analysis of factors influencing the mother and child outcome responses uses data from serial interviews with mothers of 57 thermally injured children which took place whilst the child was in hospital, and at home, at 1 week, 2 months and 6 months following hospital discharge. A relationship was found between the child's behaviour and the mother's outcome response at 6 months. Essentially, for the mother, the qualitative outcome response of the Maternal Thermal Injury Response Pattern was associated with the severity of the child's thermal injury and the quantitative General Health Questionnaire scores were associated with a previous tendency to depression and increased stress on the mother existing prior to the accident. For the child, no thermal injury factor appeared to affect behavioural outcome. The child was disturbed behaviour following a thermal injury, however, was more likely to have a mother with a history of depression, and added stress (lower socioeconomic status, and additional worries) and have a mother who was blamed for the accident. Thus, mothers whose child has a more severe thermal injury will take longer to come to terms with it ('rationalize' the thermal injury) and those mothers who were most stressed prior to the accident and who had a previous tendency to depression, will have more psychiatric morbidity (a higher GHQ score) as a result. Both these groups will require particular support.

Prescription of hearing aids for the elderly: the views of general practitioners.

A questionnaire survey was carried out to examine the views of general practitioners in one Northern city regarding whether or not they thought that hearing aids should be prescribed from general practice, who they thought should prescribe them and whether or not additional resources and training would be needed if the responsibility for hearing aid prescription for the elderly was placed upon general practitioners. The survey indicated that whereas many general practitioners would be in favour of prescribing hearing aids from Health Centres, many would need extra training and resources to enable them to do so.

A clinical, genetic and audiological study of patients and families with unilateral vestibular schwannomas. II. Audiological findings in 93 patients with unilateral vestibular schwannomas.

Nine-three patients with histologically or radiologically confirmed unilateral vestibular schwannomas were recruited. Audiological testing for retrocochlear pathology was undertaken. Patients' hospital records were examined for previous audiological and radiological results. The audiometric configuration was designated as one of the following: normal, sloping, low frequency, peak, trough or flat. A sloping sensorineural audiometric configuration was present in 68 per cent of cases. No significant correlation was found between tumour size and average pure tone threshold 500 Hz to 4000 Hz, optimum discrimination score or interaural differences for wave V. Ninety-one per cent of cases had abnormalities on auditory evoked potential; 92 per cent of cases showed abnormalities on stapedial reflex testing. The limitations of audiological testing in the investigation of patients with suspected unilateral vestibular schwannomas are discussed. A protocol for the investigation of such patients is presented.