Pregnancy outcomes in severe hyperemesis gravidarum in a multi-ethnic population.

We evaluated pregnancy outcomes among women with hyperemesis gravidarum (HG) in a North London multi-ethnic population. A retrospective case-control study was performed on records of obstetric admissions during a 4-year period, at North Middlesex University Hospital in North London. A total of 208 women with HG were identified according to Fairweather's criteria occurring in the first 20 weeks of pregnancy, which is severe enough to require admission to hospital. The control study group consisted of 208 women without HG, matched for age, ethnicity and parity. Maternal characteristics as well as pregnancy outcomes were compared in the two groups. The incidence of a delivery of a small-for-gestational-age (SGA) neonate below the 10th per centile was significantly higher in the HG group compared with unaffected pregnancies (8.7% vs 16.8%, p = 0.01). Hyperemesis gravidarum in a multi-ethnic population in North London is associated with SGA neonates.

Zoledronic acid in metastatic bone disease: an audit based discussion.

BACKGROUND: Metastatic bone disease is a common problem in patients with advanced cancer causing significant morbidity and poor quality of life. Effective and less toxic treatments, like bisphophonates, can reduce morbidity in such cases. OBJECTIVES: The objectives of this study were to determine whether Zoledronic acid was administered in accordance with current recommendations for its prescribing and to produce protocols for improved patient outcomes. METHODS: The study was a retrospective audit of 39 consecutive patients with metastatic bone disease secondary to solid tumours who were treated with Zoledronic acid. The records were analysed to establish the administered dose of Zoledronic acid relative to creatinine clearance. The standards for Zoledronic acid therapy were defined from best practice guidelines. RESULTS: The commonest diagnosis in patients receiving Zoledronic acid was carcinoma prostate 19/39 (49%) followed by carcinoma breast 11/39 (28%), gastrointestinal malignancies 4/39 (10%) and renal cell carcinoma 3/39 (8%). Indications for therapy were metastatic bone disease alone 31 (79%), hypercalcaemia alone 0/39 (0%), metastatic bone disease with hypercalcaemia 5/39 (13%), and prevention of chemotherapy induced bone loss 1/39 (3%). The dose of Zoledronic acid was appropriate to the creatinine clearance in 25/39 (64%), inappropriate in 5/39 (13%) and unclear from the notes in 9/39 (23%). CONCLUSIONS: Majority of patients received Zoledronic acid for the appropriate indications. The dose of Zoledronic acid was appropriate to serum creatinine clearance in a majority of patients. Poor documentation of data pertaining to Zoledronic acid treatment is observed which can potentially lead to major errors in prescribing. We recommend using a standard form to document each episode of therapy with Zoledronic acid.

Imprint cytology of needle core-biopsy specimens of breast lesions: is it a useful adjunt to rapid assessment breast clinics?

This study aimed at assessing the practicability of imprint cytology (IC) of core biopsy (CB) specimens in order to achieve one-stop diagnosis of breast lesions. In total, 199 symptomatic patients underwent free-hand CB of the suspected breast lesions. The slides were stained by Diff-QuikO and reported independently of histological reporting. For practical reasons cytology specimens were graded as follows: C1=inadequate, as less than 4 groups of epithelial cells were seen, C2=benign, C3=probably benign, C4=probably malignant and C5=positive for malignancy. The results of IC were correlated with CB histology. Absolute sensitivity of the IC was 85.0% and complete sensitivity was 89.2% when correlated with CB. Specificity (biopsy cases only) of IC was 53.1% while full specificity was 53.1%. Positive predictive value of C5 was 99.3%, C4 55.6 % and C3 was 100%. Overall suspicious rate was 5.5%. It was concluded that IC is a reliable way of diagnosing symptomatic breast lesions in one-stop breast clinic and retains the advantage of pre-operative availability of detailed pathological characteristics of tumours for treatment planning.

How we do it: Switching from mechanical perforation to the CO2 laser; audit results of primary small-fenestra stapedotomy in a district general hospital.

The use of laser for stapedotomy was introduced in our department in the year 2002, and since then has taken over the mechanical technique. A total of 85 patients who had undergone primary stapedotomy with either technique are reported with regards to effectiveness and rate of side effects. Although footplate complications were reduced with the laser, short-term hearing outcomes were similar between the two techniques. In four occasions, the surgeon had to switch back to the mechanical technique unexpectedly. Stapedotomy will continue to be performed with the laser in our department, bearing in mind the occasional need for the older technique.

Can heterotopic gastric mucosa present as globus pharyngeus?

We present a series of four patients presenting with symptoms leading to a provisional diagnosis of globus pharyngeus. On further investigation, they were all found to have small areas of abnormal mucosa in either their hypopharynx or proximal oesophagus, which on biopsy were reported as containing gastric-type mucosa. Following anti-reflux treatment, all patients eventually reported a cessation of symptoms. All but one patient was followed up with repeat endoscopies. We highlight the fact that biopsies reporting gastric epithelium at this anatomical site are in keeping with the diagnosis of heterotopic gastric mucosa. We review the literature and report the high incidence and natural history of this condition. Heterotopic gastric mucosa can only be diagnosed on endoscopy and is easily missed, even during such an investigation. We raise the question of whether this condition may be one of a number of factors in the aetiology of globus pharyngeus.

Effect of aldrin on accessory sex glands and plasma testosterone levels in rats.

The effects of aldrin, an organochlorine insecticide, on accessory sex glands and plasma testosterone levels in rats were studied. The aldrin was administered i.p. for 13 days and 26 days at a dose of 150 micrograms/kg. Relative weights of prostate, seminal vesicles and coagulating glands were significantly decreased in the treated rats compared to those in controls. In addition, there was a significant fall in acid phosphatase activity in prostate and fructose content in accessory sex glands was also observed in treated animals. Plasma testosterone values showed a decrease with the duration of treatment. HCG supplementation with aldrin treatment prevented all those untoward effects of aldrin in experimental rats.

Studies on membrane ATPase activity and lipid level in vibrio el tor under normal and nitrofurantoin resistant conditions.

Nitrofurantoin resistance brought about decreased level of membrane bound ATPase activity in Vibrio el tor as compared to the normal strain while phospholipid as well as total lipid levels in the membrane fraction was increased. Mg++ was found to be the mose effective co-factor for ATPase. At higher concentrations of sodium and potassium ions, ATPase of normal and nitrofurantoin resistant Vibrio el tor responded quite differently. A soluble ATPase extract having low phospholipid content was found to be activated by the phospholipid extracts of Vibrio el tor, phosphatidyl ethanolamine, and also by phosphatidyl choline which is not a constituent of the membrane preparation of Vibrio el tor strains.