Primary assessment of the vertiginous patient at a pre-ENT balance clinic.

INTRODUCTION: Due to problems with long waiting times for assessment of vertiginous patients (more than 24 weeks), we changed practice and instituted a pre-ENT balance clinic assessment; we then audited the results. In particular, we looked at the subgroup with benign positional paroxysmal vertigo. METHODS: One hundred and fifteen patients were seen at the pre-ENT balance clinic from October 2003 to September 2004. Those diagnosed with benign positional paroxysmal vertigo received particle repositioning therapy at the same clinic and did not subsequently need ENT assessment. RESULTS: By the end of the audit period, waiting times were reduced to three weeks, and more than one-quarter of vertiginous patients (i.e. those diagnosed with benign positional paroxysmal vertigo) did not need to be reviewed at an ENT clinic. CONCLUSION: We believe this to be the first study to present prospective data showing that patients with benign positional paroxysmal vertigo may be safely diagnosed and effectively managed at a pre-ENT balance clinic.

Efficacy of prophylactic nimodipine for delayed ischemic deficit after subarachnoid hemorrhage: a metaanalysis.

The authors report findings from a metaanalysis of all published randomized trials of prophylactic nimodipine used in patients who have experienced subarachnoid hemorrhage (SAH). Seven trials were included with a total of 1202 patients suitable for evaluation. Eight outcome measures were examined, including good versus other outcome, good or fair outcome versus other outcome, overall mortality, deficit and/or death attributed to vasospasm, infarction rate as judged by computerized tomography (CT), and deficit and/or death from rebleeding. Nimodipine improved outcome according to all measures examined. The odds of good and of good plus fair outcomes were improved by ratios of 1.86:1 and 1.67:1, respectively, for nimodipine versus control(p<0.005 for both measures). The odds of deficit and/or mortality attributed to vasospasm and CT-assessed infarction rate were reduced by ratios of 0.46:1 to 0.58:1 in the nimodipine group (p<0.008 for all measures). Overall mortality was slightly reduced in the nimodipine group, but the trend was not statistically significant. The rebleeding rate was not increased by nimodipine. A metaregression yielded findings indicating that the treatment effect of nimodipine in individual trials was positively correlated with the severity of SAH in enrolled patients. Although the majority of individual trials examined did not have statistically significant results at the p<0.01 level according to most outcome measures, the metaanalyses confirmed the significant efficacy of prophylactic nimodipine in improving outcome after SAH under the conditions used in these trials.

The effect of chilli ingestion on gastrointestinal mucosal proliferation and azoxymethane-induced cancer in the rat.

Of the three main races of Singapore, Malays and Indians are less susceptible to gastric and colorectal carcinoma and peptic ulcer when compared with Chinese. Racial differences in dietary habits include a smaller amount of chilli consumed by the Chinese when compared with the other two races. Chilli may be expected to accelerate gastrointestinal transit and hence to inhibit colonic carcinogenesis, while its active ingredient capsaicin protects against experimental gastric mucosal injury. The effect of chilli consumption was studied in relation to: (i) gastrointestinal crypt cell production rate and nucleic acid content as indices of mucosal proliferation, which is related to the risk of development of gastrointestinal cancer and peptic ulcer; and (ii) azoxymethane-induced intestinal cancer. Sprague-Dawley rats (n = 102) received either standard powdered chow or chow supplemented with 100 or 200 mg of chilli powder daily for 1, 18 or 24 weeks. Gastric, small-bowel and colonic crypt cell production rates were studied at all three time periods, while mucosal DNA, RNA and protein contents were measured at 1 and 24 weeks. While crypt cell production rates were unaffected by chilli ingestion, mucosal contents of nucleic acid and protein were mostly increased in chilli-fed animals compared to controls, especially in the colon at 24 weeks. A further 99 rats received subcutaneous injections of either azoxymethane 15 mg/kg/week x 6 or sterile water and were randomized to the same three dietary groups for 26 weeks. The number, size and location of benign and malignant duodenal and colonic tumours were unaffected by chilli intake.(ABSTRACT TRUNCATED AT 250 WORDS)

Ocular effects of treatment with various psoralen derivatives and ultraviolet-A (UVA) radiation in HRA/Skh hairless mice.

Hairless (HRA/Skh) mice were administered one of four dietary concentrations (50, 100, 625 or 1250 ppm) of 8-methoxypsoralen (8-MOP) or 5-methoxypsoralen (5-MOP), or molar equivalent concentrations of 5-methylisopsoralen (5-MIP) or 3-carbethoxypsoralen (3-CPS) by 'pulse feeding' technique, 3 days per week for 13 weeks. For the final 11 weeks psoralen derivative administration was followed by exposure to 0.2 or 48 J/cm2 of unfiltered ultraviolet-A (UVA) radiant energy from FR74T12PUVA lamps. At 0 and 13 weeks eyes were dilated with 0.2% atropine solution and were examined using a binocular indirect ophthalmoscope with a +20.0 D condensing lens. The lids, cornea, anterior chamber and the lens were evaluated for pathological changes. Ocular damage consisting of dense central corneal opacification was seen at significant levels in animals given 8-MOP or 5-MOP and exposed to UVA. In addition, opacities in the area of the posterior lens were seen in all experimental groups and appeared to be related to drug treatment, independent of light exposure, and therefore appeared not to be related to drug-light interaction. Some corneal and lenticular opacification was seen at non-significant levels in all experimental and control groups.