Effect of overlaying rubber on fully slatted concrete floors on hoof health and lying postures in finishing dairy-origin bulls offered two contrasting diets.

Fully slatted concrete floors are labour-efficient, cost-effective and thus common in beef cattle housing. However, the welfare of cattle accommodated on them has been questioned. The objective of this study was to evaluate the effect of floor and diet on hoof health and lying behaviours of housed dairy-origin bulls, from a mean age of 8 months to slaughter at 15.5 months old. Forty-eight bulls, which had a mean initial live weight of 212 (SD = 23.7) kg, were allocated to one of four treatments, which consisted of two floors and two diets arranged in a 2 × 2 factorial design. The floors evaluated were a fully slatted concrete floor and a fully slatted concrete floor overlaid with rubber, while the diets offered were either a high concentrate diet or a grass-silage-based diet supplemented with concentrates. The mean total duration of the study was 216 days. Floor had no significant effect on claw measurements measured on day 62 or 139. However, bulls accommodated on slats overlaid with rubber had a tendency to have a higher front toe length measured pre-slaughter than those accommodated on concrete slats (P = 0.063). Floor had no significant effect on the net growth of toes or heels during the duration of the study. The number of bruises (P < 0.01) and the bruising score (P < 0.05) were significantly higher on day 62 in bulls accommodated on fully slatted concrete floors than on concrete slats overlaid with rubber, but there was no significant effect of floor on these parameters on day 139 or at the measurement taken pre-slaughter. There was a tendency for bulls accommodated on concrete slats to have a higher probability of having sole bruising at the end of the experiment than those accommodated on slats overlaid with rubber (P = 0.052). Diet had no significant effect on toe length or heel height, number of bruises, or overall bruising score at any time point of the study. There was little evidence in the current study to suggest that bulls lying on fully slatted concrete floors could not express lying postures similar to those on concrete slats overlaid with rubber.

The effect of diet and covering fully slatted concrete floors with rubber strips on the intake, performance and cleanliness of dairy-origin bulls.

Fully slatted concrete floors are prevalent in beef cattle housing. However, concerns have been raised about welfare of cattle accommodated on slats. The objective of this study was to evaluate the effect of diet and floor type on the intake, performance and cleanliness of dairy-origin bulls from a mean age of 8 months to slaughter at 15.5 months old. Forty-eight bulls, which had a mean initial live weight of 212 kg (SD = 23.7), were allocated one of four treatments which consisted of two floors and two diets, arranged in a 2×2 factorial design. The floors evaluated were a fully slatted concrete floor and a fully slatted concrete floor covered with rubber; while the diets offered were either a high concentrate diet or a grass silage-based diet supplemented with concentrates. Over the entire experimental period, floor type had no significant effect on intake. Interestingly, however, when bulls were offered concentrates ad libitum, those accommodated on rubber covered slats consumed more concentrates than those accommodated on concrete slats. No effect of floor type on intake was noted when bulls were offered the grass silage supplemented with concentrate diet. There were no significant interactions between floor and diet on animal performance. Animals accommodated on rubber covered slats had a significantly better performance than those accommodated on concrete slats, as assessed by live weight at slaughter and live weight gain/day (P < 0.01) and estimated carcass gain/day (P < 0.05). The diet offered had no significant effect on animal performance. Bulls accommodated on rubber covered slats were significantly cleaner than those accommodated on concrete slats on day 97 (P < 0.001), but there was no significant effect of floor type when measured at other time points in the experiment. It is concluded from this study that diet has an important role to play in assessing bulls' responses in performance to the effect of covering concrete slatted floors with rubber. Bulls offered a high concentrate diet had a higher concentrate intake, higher performance but a similar feed conversion ratio (FCR) when accommodated on rubber covered slats compared to those accommodated on fully concrete slatted floors. Animals offered this intensive diet were less efficient (as measured by a higher FCR) than those offered a supplemented grass silage-based diet.

The Jamaican Haemophilia Registry: Describing the burden of disease.

INTRODUCTION: Jamaica has an estimated 200 persons with haemophilia (PWH), who face significant constraints in access to specialized haemophilia care, including access to clotting factor concentrates. AIM: The aim of this paper is to establish the current burden of disease in PWH in Jamaica. METHODS: PWH were enrolled through the University Hospital of the West Indies, Jamaica. The impact of haemophilia was assessed using a comprehensive battery of heath outcome measures that included the following: laboratory, clinical information and validated outcome measures of joint structure and function, activity, and health-related quality of life (HRQoL) to provide a health profile of the Jamaican haemophilia population. RESULTS: In all, 45 PWH were registered (mean age: 29, range: 0.17-69 years), including 13 children (<18 years of age) and 32 adults. In this sample, 41 had haemophilia A (30 severe) and 4 had haemophilia B (3 severe); 10 patients with haemophilia A were inhibitor positive. The results indicate that adults with haemophilia in Jamaica have significant joint damage: mean Haemophilia Joint Health Score (HJHS) = 42.1 (SD = 17.3); moderate activity levels - mean Haemophilia Activities List (HAL) score = 64.8 (SD = 17.8); and low HRQoL scores - mean Haemo-QoL-A score = 62.3 (SD = 19.4). Results for children are also reported but should be interpreted with caution due to the small sample size. CONCLUSIONS: There is a very high burden of disease in PWH in Jamaica. The health profiles reported in this paper are an essential first step in advocating for a multidisciplinary Comprehensive Care Program for assessment and care of PWH in Jamaica.

The Patient Concerns Inventory integrated as part of routine head and neck cancer follow-up consultations: frequency, case-mix, and items initiated by the patient.

Introduction The National Institute for Health and Care Excellence guidance Improving Supportive and Palliative Care for Adults with Cancer (2004) and the Cancer Reform Strategy (2007) support the premise that assessment and discussion of patients' needs for physical, social, psychological, and spiritual wellbeing should be undertaken during oncology follow-up. We report the use of the Patient Concerns Inventory in a routine head and neck cancer clinic setting over a seven-year period, summarising the number of available clinics, the number of patients completing the inventory within a clinic, the range of clinical characteristics and the concerns they wanted to discuss. Methods The data were analysed from oncology follow-up clinics between 1 August 2007 and 10 December 2014. Audit approval was given by the Clinical Audit Department, University Hospital Aintree. Results There were 386 patients with 1198 inventories completed at 220 clinics, median 6 (range 4-7) per clinic. The most common concerns raised by patients across all the clinic consultations were dry mouth (34%), fear of recurrence (33%), sore mouth (26%), dental health (25%), chewing (22%) and fatigue/tiredness (21%). Conclusions The incorporation of the Patient Concerns Inventory as part of routine oncology clinics allows for a more patient initiated and focused consultation available to the majority of patients throughout their follow-up. The inventory allows for greater opportunity to provide holistic targeted multiprofessional intervention and support.

Is routine holistic assessment with a prompt list feasible during consultations after treatment for oral cancer?

The head and neck cancer Patient Concerns Inventory (PCI-HN) is a holistic, self-reported list of items that can help patients to disclose their needs and concerns during routine follow-up consultations. The aim of this study was to report how often it was used during the first three years of follow up after treatment for oral cancer, and the range of issues that were raised. The sample comprised consecutive patients treated over a three-year period with curative intent. All clinic attendances were reviewed until October 2015 or until patients had a recurrence, a subsequent primary, metastases, or were discharged home or to follow up at a peripheral hospital, or started palliative care. We identified 92 patients and data were available for 88 of them. The median (IQR) age at the time of treatment was 65 (57-76) years, and 48 (55%) were men. Reviews alternated between the surgeon and oncologist, and typically there were 4.4 surgical reviews in year one, 2.8 in year two, and 1.6 in year three. The inventory was completed 157 times; at least once by 71% (55/77) during year one, 57% (29/51) during year two, and 37% (13/35) during year three. Of those who completed none, nearly half (7/17) died within 12 months, and another six were over 80 years of age. In conclusion, the diversity of concerns raised by patients highlights the need for holistic assessment during follow up, and integration of the inventory into routine consultations will mean that we can repeat it.

Suitability of the Patient Concerns Inventory as a holistic screening tool in routine head and neck cancer follow-up clinics.

In patients with cancer of the head and neck, efficient screening for problems can improve care and the management of resources. We explored use of the Patient Concerns Inventory (PCI-HN) as a holistic screening tool in the follow up of these patients. Between August 2007 and January 2013, 464 patients completed the PCI-HN and the University of Washington Quality of Life questionnaire version 4 (UWQoL) immediately before their routine follow-up consultations. The median (IQR) number of items selected on the inventory was 3 (1-6). This was associated (p<0.001) with the number of serious problems (dysfunction) in the 12 UWQoL domains (Spearman's correlation, rs=0.51), overall QoL (rs=-0.41), and the 2 UWQoL subscale scores of physical (rs=-0.46) and social-emotional (rs=-0.53) function. Binary regression to predict an overall outcome of "less than good" indicated that use of the PCI could be better than just recording clinical characteristics. Some patients however, chose few PCI items and had numerous problems. The inventory may have a role in the screening of patients with cancer of the head and neck, particularly in relation to social-emotional function and overall QoL, and may have added value when used with the UWQoL-v4. The total number of PCI items selected is a useful predictor of QoL. Further research is required to confirm suitable limits, and to find out whether additional support and repeated use of the inventory over time improve QoL.

Patients concerns inventory highlights perceived needs and concerns in head and neck cancer survivors and its impact on health-related quality of life.

Currently, the head and neck cancer Patients' Concerns Inventory (HNC-PCI), a holistic, self-reported tool to help patients disclose needs and concerns during consultations, is not organised into domains. We used a Delphi approach to generate domains and applied them to an existing HNC-PCI database to assess association with health-related quality of life (HRQoL). The expert panel comprised 10 experts in head and neck cancer who were selected ad hoc. The HNC-PCI checklist was analysed and fed back to the panel for 3 rounds until consensus was achieved. Five domains were generated (A=Physical and functional; B=Psychological and emotional or spiritual well-being; C=Social care and well-being; D=Treatment-related; and E=Other) and were applied to a database compiled from 674 patients who had completed the PCI on 1276 occasions. On first completing the inventory (median 32 months after treatment) 81% selected items under domain A and 58% under domain B. Fewer items were selected/domain thereafter. Younger patients were more likely to select from domains B and C. Those treated by radiotherapy and adjuvant radiotherapy were more likely to select from domains A and C, respectively. Patients with laryngeal cancer tended to select from domain C, and those with poor HRQoL outcomes were significantly more likely to indicate more items of concern. The items selected under the HNC-PCI domains showed that certain clinical, pathological, and HRQoL factors were associated with specific patterns of needs or concerns.

Changing trends and the role of medical management on the outcome of patients treated for osteoradionecrosis of the mandible: experience from a regional head and neck unit.

This study is a retrospective review of treatment outcomes of osteoradionecrosis (ORN) of the mandible with specific reference to the evolving role of medical management with pentoxifylline, tocopherol, and doxycycline. We reviewed the presentation and management of 71 patients treated for ORN of the mandible at the regional head and neck unit during a 15-year period to January 2011, and categorised them into three grades using the Notani classification: grade I (n=28), grade II (n=16), and grade III (n=27). Twelve patients with grade I ORN, 3 with grade II, and 10 with grade III, were prescribed medical treatment. Of these, three with grade I, and two with grade II ORN were cured, and progression of the disease had halted and there was satisfactory control of symptoms in eight with grade I and four with grade III disease. Patients who failed to respond to conservative treatment were further analysed for the need for free flap reconstruction. Medical management was introduced as a standard treatment in January 2006. Of the 39 patients diagnosed before this, 20 (51%) required resection and free flap reconstruction compared with only 8/32 (25%) after it had been introduced.

Issues patients would like to discuss at their review consultation: variation by early and late stage oral, oropharyngeal and laryngeal subsites.

PURPOSE: The patient concerns inventory (PCI) was developed to help patients raise issues/concerns during routine follow-up and to indicate team members they want to see. This paper reports the use of the PCI across various H&N Cancer sub-sites (oral, oropharyngeal and laryngeal) and stages of disease (early and late) and describes the main concerns that patients want to discuss using a cross-sectional survey comprising the PCI with the University of Washington Quality of Life questionnaire. Patients treated for primary H&N squamous cell carcinoma, 1998-2009, were identified from the University Hospital Aintree H&N Cancer database. 447/775 (58 %) patients responded. Fear of recurrence concerns was common to all clinical groups (range 32-67 %). Speech issues were more common with laryngeal tumours, and saliva issues with oropharyngeal tumours (32 % early, 48 % late). Apart from early-stage laryngeal tumours, patients consistently reported issues concerning dental health/teeth and chewing. The median (IQR) number of concerns overall was 4 (2-7), with significant variation (p < 0.001) between clinical groups ranging from 2 (1-6) for early-stage oral to 6 (2-10) for late-stage oropharyngeal and 7 (5-9) late-stage laryngeal. The results indicated that PCI can be readily incorporated into managing HNC patients and supports a holistic multidisciplinary approach to clinic consultations. It accommodates difficult issues such as fear of recurrence and intimacy. Completion of the PCI by patients before consultation can highlight problems and concerns that doctors can target for discussion, thereby streamlining consultations, and ensuring that patient needs are better met, thus creating a more effective service.

Use of the Patient Concerns Inventory to identify speech and swallowing concerns following treatment for oral and oropharyngeal cancer.

BACKGROUND AND AIMS: The Patient Concerns Inventory is a holistic, self-reported screening tool for detecting unmet needs in head and neck cancer patients. This study aimed to assess its value in screening for self-perceived swallowing and speech concerns, and in facilitating multidisciplinary supportive care. METHODS: The Patient Concerns Inventory and the University of Washington Quality of Life questionnaire were completed by 204 post-treatment patients attending routine out-patient review clinics, and those with speech or swallowing issues were identified. RESULTS: Swallowing and speech issues were respectively reported by 21 and 7 per cent of University of Washington questionnaire respondents and by 17 and 13 per cent of Patient Concerns Inventory respondents. The two surveys combined indicated that speech or swallowing issues arose in 39 per cent of consultations (n = 178), involving 48 per cent of patients (n = 97). Of these 97 patients, 74 were known to the speech and language therapist. The remaining 23 patients had their concerns discussed in the clinic; three were referred on, and were assessed by the speech and language therapist and given appropriate interventions. CONCLUSION: The use of both surveys concurrently enabled all patients with swallowing or speech issues to discuss these concerns in the clinic and to access appropriate multidisciplinary interventions.

How is agitation and restlessness managed in the last 24 h of life in patients whose care is supported by the Liverpool care pathway for the dying patient?

BACKGROUND: Guidance regarding the patient centred management of agitation and restlessness reinforces the importance of considering underlying causes, non-pharmacological approaches to treatment and judicious use of medications titrated to patient need. In contrast, recent reports in the literature suggest that the practice of continuous deep sedation until death is prevalent in the UK. AIM: To use data from the National Care of the Dying Audit-Hospitals (NCDAH) to explore the administration of medication for management of agitation and restlessness in the last 24 h of life. METHODS: Hospitals submitted data from up to 30 consecutive adult patients whose care in the final hours/days of life was supported by the Liverpool Care Pathway for the Dying Patient (LCP). Data on the total dose received in the last 24 h of life PRN and the last dose prescribed for administration via continuous subcutaneous infusion (CSCI) for agitation and restlessness were submitted. RESULTS: 155 hospitals provided data from 3893 patients. Median total doses in the last 24 h for midazolam, haloperidol and levomepromazine, respectively, were: PRN only, 2.5, 1.5 and 6.25 mg; CSCI only, 10, 3 and 6.25 mg; PRN+CSCI, 15, 3 and 12.5 mg. CONCLUSION: Only 51% of patients received medication to alleviate agitation and restlessness in the last 24 h of life. Median doses were low in comparison to doses recommended for continuous deep sedation, suggesting that there is no 'blanket' policy for continuous deep sedation at the end of life for patients whose care is supported by the LCP.

In vitro erythrocytic membrane effects of dibenzyl trisulfide, a secondary metabolite of Petiveria alliacea.

We investigated the in vitro effect of dibenzyl trisulfide (DTS), a secondary metabolite of Petiveria alliacea, on erythrocyte elasticity, relaxation time and membrane morphology. Blood samples from 8 volunteers with hemoglobin AA were exposed to 100, 200, 400, 800 and 1000 ng/ml of DTS respectively and the elasticity and relaxation time measured. There were statistically significant, dose-dependent increases in elasticity and relaxation times. The changes in membrane morphology observed also increased with increased concentration of DTS. This suggests that DTS interaction with membrane protein resulted in increased elasticity, relaxation time and deformation of the erythrocyte membrane.

Care of patients with psoriasis: an audit of U.K. services in secondary care.

BACKGROUND: Medical professionals require data about the structure and delivery of dermatological services in primary and secondary care in order to identify and tackle variations in standards and monitor the impact of healthcare reforms. The British Association of Dermatologists (BAD) commissioned an audit of the provision of care for patients with psoriasis. OBJECTIVES: To assess the staffing and facilities in dermatology units in the U.K. with a focus on the provision of care for patients with psoriasis. METHODS: Data were collected from 100 dermatology units in the U.K. for 1 year using a questionnaire and a web-based collection system. RESULTS: Key results are as follows. Eighteen per cent (18/98) of units had fewer than 2.0 whole-time equivalent consultants and 20% had no specialist dermatology nurse. Only 23% of units collected diagnostic data on outpatients, and half were unable to supply details about the number of attendances for psoriasis. Seventy-seven units reported admitting patients to dedicated dermatology beds, general medical beds, or both; three-quarters of units had access to dedicated adult dermatology beds. Pharmacy services were not always available for dermatology patients. Only 21 units (21%) had dedicated clinics for patients with psoriasis and 56% of units lacked a clinical psychology service willing to accept adult dermatology patients; 59% (55/93) lacked psychological services for children. Fifty-five per cent had no systemic drug monitoring clinic. Phototherapy was run by dermatology nurses in 93% (88/95) of the units and by physiotherapists in 11% (10/94). Biologics for psoriasis were prescribed in 75% (73/97) of units and in 88% (64/73) of these the BAD guidelines for the use of biologics were known to be followed. Of the seventy-three units prescribing biologic therapies, 64% had a nurse trained in the assessment and administration of biologics, 71% had facilities for outpatient infusions (e.g. for infliximab) and 39% were restricted in prescribing biologic agents because of financial constraints. A quality-of-life score was either inadequately or never recorded in outpatient records in 81% of units, increasing to 88% for inpatient records. The Psoriasis Area and Severity Index score was inadequately or never recorded in 79% of outpatient records and 82% of inpatient records. CONCLUSIONS: Units varied in their capacity to meet BAD guidelines and standards. Among the most significant deficiencies identified were a shortage of specialist dermatology nurses, treatment delivery by untrained nurses and financial constraints on the prescription of biologics for psoriasis. Gaps in data collection and record keeping jeopardize efforts to improve standards of care.

The expression of the growth hormone secretagogue receptor ligand ghrelin in normal and abnormal human pituitary and other neuroendocrine tumors.

Ghrelin is a recently identified endogenous ligand of the GH secretagogue (GHS) receptor. It was originally isolated from the stomach, but has also been shown to be present in the rat hypothalamus. It is a 28-amino acid peptide with an unusual octanoylated serine 3 at the N-terminal end of the molecule, which is crucial for its biological activity. Synthetic GHSs stimulate GH release via both the hypothalamus and the pituitary, and the GHS receptor (GHS-R) has been shown by us and others to be present in the pituitary. We investigated whether ghrelin messenger ribonucleic acid (mRNA) and peptide are present in the normal human hypothalamus and in normal and adenomatous human pituitary. RNA was extracted from pituitary tissue removed at autopsy and transsphenoidal surgery (n = 62), and ghrelin and GHS-R type 1a and 1b mRNA levels were investigated using real-time RT-PCR. Both ghrelin and GHS-R mRNA were detected in all samples. Corticotroph tumors showed significantly less expression of ghrelin mRNA, whereas GHS-R mRNA levels were similar to those in normal pituitary tissue. Gonadotroph tumors showed a particularly low level of expression of GHS-R mRNA. Immunohistochemistry, using a polyclonal antibody against the C-terminal end of the ghrelin molecule, revealed positive staining in the homolog of the arcuate nucleus in the human hypothalamus and in both normal and abnormal human pituitary. Pituitary tumor ghrelin peptide content was demonstrated using two separate RIA reactions for the N-terminal and C-terminal ends of the molecule. Both forms were present in normal and abnormal pituitaries, with 5 +/- 2.5% octanoylated (active) ghrelin (mean +/- SD) present as a percentage of the total. We suggest that the presence of ghrelin mRNA and peptide in the pituitary implies that the locally synthesized hormone may have an autocrine/paracrine modulatory effect on pituitary hormone release.

Food of the gods: cure for humanity? A cultural history of the medicinal and ritual use of chocolate.

The medicinal use of cacao, or chocolate, both as a primary remedy and as a vehicle to deliver other medicines, originated in the New World and diffused to Europe in the mid 1500s. These practices originated among the Olmec, Maya and Mexica (Aztec). The word cacao is derived from Olmec and the subsequent Mayan languages (kakaw); the chocolate-related term cacahuatl is Nahuatl (Aztec language), derived from Olmec/Mayan etymology. Early colonial era documents included instructions for the medicinal use of cacao. The Badianus Codex (1552) noted the use of cacao flowers to treat fatigue, whereas the Florentine Codex (1590) offered a prescription of cacao beans, maize and the herb tlacoxochitl (Calliandra anomala) to alleviate fever and panting of breath and to treat the faint of heart. Subsequent 16th to early 20th century manuscripts produced in Europe and New Spain revealed >100 medicinal uses for cacao/chocolate. Three consistent roles can be identified: 1) to treat emaciated patients to gain weight; 2) to stimulate nervous systems of apathetic, exhausted or feeble patients; and 3) to improve digestion and elimination where cacao/chocolate countered the effects of stagnant or weak stomachs, stimulated kidneys and improved bowel function. Additional medical complaints treated with chocolate/cacao have included anemia, poor appetite, mental fatigue, poor breast milk production, consumption/tuberculosis, fever, gout, kidney stones, reduced longevity and poor sexual appetite/low virility. Chocolate paste was a medium used to administer drugs and to counter the taste of bitter pharmacological additives. In addition to cacao beans, preparations of cacao bark, oil (cacao butter), leaves and flowers have been used to treat burns, bowel dysfunction, cuts and skin irritations.

LY354740 affects startle responding but not sensorimotor gating or discriminative effects of phencyclidine.

LY354740 ¿(1S,2S,5R,6S)-2-aminobicyclo[3.1.0]hexane-2, 6-dicarboxylate monohydrate¿, a selective group II metabotropic glutamate (mGlu) receptor agonist, was recently reported to attenuate the behavioral effects of phencyclidine (PCP) in rats. In the present study, LY354740 failed to attenuate the discriminative stimulus properties of PCP and its disruption of prepulse inhibition of the acoustic startle response, at a dose range which decreased startle responding. The suggestion that mGlu group II receptor activation induces antipsychotic effects may be premature.

Impact of the Sea Empress oil spill on lysosomal stability in mussel blood cells.

Coastal zones are among the most productive and vulnerable areas on the planet. An example of impact on these fragile environments was shown in the case of the "Sea Empress" oil tanker, which ran aground in the Bristol Channel in 1996, spilling 72,000 tons of "Forties" crude oil. The objective was to investigate the sub-lethal cellular pathology and tissue hydrocarbon contamination in marine mussel populations, 4 months after the initial spill, using the neutral red retention (NRR) assay for lysosomal stability in blood cells. NRR was reduced in mussels, and indicative of cell injury, from the two sites closest to the spill in comparison with more distant and reference sites. Lysosomal stability was inversely correlated with polycyclic aromatic hydrocarbon concentrations in mussel tissues. Reduced lysosomal stability has previously been shown to contribute to impaired immunocompetence and to autophagic loss of body tissues. The use of this type of technique is discussed in the context of cost-effective, ecotoxicological tools for Integrated Coastal Zone Management.

Cardiovascular effects of verapamil enantiomer combinations in conscious dogs.

We examined the systemic and coronary hemodynamic effects of five combinations of R- and S-verapamil enantiomers (R/S; 100/0, 90/10, 80/20, 50/50, and 20/80%, respectively) in conscious dogs chronically instrumented for measurement of aortic and LV pressure, +dP/dt, subendocardial segment length, coronary blood flow velocity, and aortic blood flow. Dogs received escalating doses (0.1, 0.2, and 0.4 mg kg(-1)) of each verapamil combination over 2 min at 30 min intervals on different experimental days and peak changes in hemodynamics were recorded 2 min after each dose. All verapamil combinations increased heart rate, mean aortic blood flow, and coronary blood flow velocity and decreased calculated systemic and coronary vascular resistance. Alterations in coronary hemodynamics were most pronounced with 20/80 R/S verapamil. Racemic and 20/80 R/S verapamil decreased mean arterial and left ventricular systolic pressure, in contrast to combinations with greater concentrations of the R enantiomer. Left ventricular function was unchanged during administration of 100/0, 90/10, and 80/20 R/S verapamil. Direct negative inotropic and lusitropic effects occurred with 50/50 and 20/80 R/S verapamil. The high dose of 20/80 R/S verapamil also increased left ventricular end-diastolic pressure and the regional chamber stiffness constant, consistent with diastolic dysfunction. The results indicate that combinations of R- and S-verapamil produce differential hemodynamic and left ventricular functional effects in conscious, unsedated dogs that are dependent on the relative ratio of these enantiomers.

The secondary radiation grid; its effect on fluoroscopic dose-area product during barium enema examinations.

The secondary radiation grid is placed between the patient and the image intensifying screen, during fluoroscopy, to attenuate the incident forward scattered radiation. This reduction in scatter improves the radiographic contrast and hence image quality. However, this improved quality is achieved at the expense of greater radiation exposure to the patient, as this higher exposure is required to produce satisfactory image density. Patients scheduled to have a barium enema were randomly allocated into two groups. One group had the procedure performed with the grid in situ throughout the procedure. The second group was examined with the grid removed for fluoroscopy but returned for image acquisition. The fluoroscopic dose-area product (DAP) was recorded for both groups using a dose-area product meter. The DAP was not recorded for spot film acquisition. The results suggest that there is approximately a 50% reduction in DAP to the second group. We can be 95% certain that, on average, the ratio of doses in patients without the grid in situ to those screened with the grid is between 0.40 and 0.58, with the best estimate being 0.48. Multiple regression methods to take account of the effects of weight, sex and time, revised this estimate as 0.57, with 95% confidence interval from 0.52 to 0.63. Sex, weight and exposure time accounted for 61% of variation in dose-area products, with time alone accounting for 41%. Grid status accounted for another 22% of variation, which represents over a half of the remaining variation once sex, weight and exposure time have been allowed for. We therefore recommend that the routine use of an antiscatter grid during fluoroscopy should be abandoned. The use of a grid should be restricted to those patients (usually obese) when poor visualization is obtained in its absence.

Absence of skin sensitivity to oxides of aluminium, silicon, titanium or zirconium in patients with Crohn's disease.

BACKGROUND: Some metallic compounds, especially of zirconium, can cause cell mediated granulomatous inflammation of the skin. Pigment granules containing compounds of aluminium, silicon, and titanium have been observed within macrophages in the wall of the small intestine in health and in Crohn's disease. Zirconium compounds can be ingested in toothpaste. AIM: To determine in a pilot study if granulomatous sensitivity can be detected to compounds of these metals or silicon after injection into the skin of patients with Crohn's disease. SUBJECTS: Eight patients with Crohn's disease known to have had granulomata in the intestine and not currently treated with corticosteroids, and two healthy controls. METHOD: Two intradermal injections each of 0.1 ml of a 0.02% suspension of one of the compounds made in the abdominal wall of each subject. The site was marked and full thickness skin biopsy performed six weeks later. RESULT: A foreign body granuloma was observed on histological examination of two biopsy specimens but no evidence of a cell mediated response in any subject. CONCLUSION: No support was found for the hypothesis that Crohn's disease is due to a specific sensitivity to ingested metallic or silicon compounds.