Eye function and physiology following a 161-km foot race.

Significant visual impairment occurs in a small percentage of ultramarathon participants and is thought to be due to corneal edema. Yet, the usual effects of prolonged exercise on the eye have not been previously reported. Eight study volunteers who completed the 161-km Western States Endurance Run underwent pre-race and post-race binocular and monocular visual acuity, intraocular pressure, and corneal thickness measurements. None was symptomatic with visual impairment during the race and they demonstrated no changes from pre-race to post-race in visual acuity (p = 0.11-0.95 for right, left and combined), intraocular pressure (p = 0.11-0.43 for the both eyes) and corneal thickness (p = 0.30-0.99 for both eyes at three corneal areas). We conclude that there is no evidence that ultramarathon running has an acute effect on eye function or physiology when the runner has no symptoms or findings of visual impairment.

Effective communication enhances the patients' endoscopy experience.

BACKGROUND: Undergoing an endoscopy is a stressful experience for patients. AIMS: To audit the endoscopy pathway to improve patient satisfaction. METHODS: A prospective survey of endoscopy patients to identify system improvements that were then implemented. RESULTS: The survey was performed before (N = 71) and after (N = 60) process improvements identified by the initial survey. Information provision and staff communication skills were identified for optimisation. Patient anxiety at home was significantly reduced (median 2 vs. 1, p < 0.01). Education of endoscopy staff significantly improved the quality of information provided before and after the procedure with regard to sedation (median 4 vs. 5, p < 0.01), discomfort (median 4 vs. 5, p < 0.01), complications (28 vs. 82 %, p < 0.01), findings (89 vs. 100 %, p < 0.01) and follow-up (73 vs. 90 %, p = 0.015). Gloucester Comfort Scores during endoscopy improved (median 1 vs. 0, p < 0.01) without increasing sedation levels. Patient feelings of invasion/trauma significantly decreased. Overall 95 % of patients were satisfied. CONCLUSION: Structured information leaflets and improved staff communication skills reduce anxiety and enhance patients' experiences. They are now standard operating procedures.

Differences in reverse transcriptase activity versus p24 antigen detection in cell culture, when comparing a homogeneous group of HIV type 1 subtype B viruses with a heterogeneous group of divergent strains.

Failure to detect infection with HIV-1 non-B subtypes in some antibody screening assays has been shown. To date, however, no studies have been published evaluating the capacity of standard tests to quantify replication of divergent HIV-1 in cell culture. Reverse transcriptase (RT) activity and p24 antigen assays are the two methods most commonly used for this purpose. A homogeneous panel of HIV-1 subtype B viruses from northern Italy and a heterogeneous panel of diverse genetic subtypes (A to F and O) from different regions of the world were cultured under identical conditions. A new nonradioactive RT assay was used as a basis for comparison to evaluate the capacity of two p24 assays to quantify viral growth in both panels. Comparison of the p24 amount/RT activity (p24/RT) ratios showed that ratios in the subtype B panel tended to be markedly higher than in the diverse subtype panel. Greatest variation was seen with one of the subtype O isolates, where up to a 400 times lower ratio was obtained compared with the average ratio for the subtype B panel. In addition, one Thai subtype B virus also gave a markedly reduced ratio. Furthermore, comparison between the two p24 assays showed different abilities to detect p24 from different HIV-1 isolates. We discuss limitations for the use of anti-HIV-1 p24 antibodies produced by immunization with subtype B p24 in p24 assays.

Review article: interstitial nephritis associated with the use of mesalazine in inflammatory bowel disease.

5-Aminosalicylic acid (5-ASA) has replaced sulphasalazine as first line therapy for mild to moderately active inflammatory bowel disease and is widely used. A number of reports have linked oral 5-ASA therapy to chronic tubulo-interstitial nephritis and this relationship is now well established. Despite increasing recognition of the potential for this serious adverse event, guidelines for monitoring renal function in patients prescribed 5-ASA preparations are not widely employed. Whilst the incidence of this adverse event in the population of patients with inflammatory bowel disease treated with mesalazine is low, the morbidity in an affected individual is high with some cases progressing to end-stage renal disease. Routine monitoring of renal function is simple and inexpensive and could prevent this outcome. Based on the available data, serum creatinine should be estimated prior to commencing treatment, monthly for the first 3 months, 3-monthly for the next 9 months, 6-monthly thereafter and annually after 5 years of treatment.

Eight-parameter automated hematology analyzers: comparison of two flow cytometric systems.

The performance of two high-speed 8-parameter automated hematology analyzers (Coulter Counter S-plus and ELT-8) were compared with that of reference instruments (Coulter Counter S Sr and Technicon Autocounter). The precision, linearity, and lack of carry-over of both instruments were superior over that of existing equipment. The especially noteworthy feature of the instruments was their excellent performance in the range of extreme values of both white blood cells and platelets. This enhanced performance, and the fact that all presently known relevant hematologic parameters can be measured by a single instrument on a single sample, make the contribution of these two flow cytometric-based instruments a significant advance in the field of automated laboratory medicine.

Alcoholic head trauma triad.

An initial description of the alcoholic head trauma triad (fatty liver, acute pneumonia and acute subdural hematoma) is presented. The basic nosological features and pathophysiological interrelationships are discussed and areas for further study delineated.

Potential complications of nonsteroidal anti-inflammatory drug therapy.

Since indomethacin was first marketed, some 40 years ago, the class of nonsteroidal anti-inflammatory drugs has grown larger than any other drug class in history. At present, there are at least 25 such drugs being used in the US and abroad, both clinically and in research. Despite their widespread use, their implications to health care are just beginning to be understood. The authors review updated theories on the mechanism of action, side effects, and drug interactions of nonsteroidal anti-inflammatory drug therapy. Proposed guidelines for monitoring their use are given. A more thorough understanding of the risks-to-benefits ratio is provided in an effort to achieve maximum patient satisfaction and safety.

Measurement of long lived radioactive impurities retained in the disposable cassettes on the Tracerlab MX system during the production of [18F]FDG.

Using a High- Purity Germanium gamma-ray spectrometer, a number of radioisotopes have been identified within Tracerlab MX radiochemistry system cassettes used to synthesise [18F]FDG. Twenty radiochemistry cassettes were measured and the average total activity of each radioisotope was determined. Using these values and decay correction, the minimum time the cassettes should be left in a decay store before the specific activity falls below 0.4B q/g, the limit for disposal alongside Clinical Waste was found to be 24 months.

Evidence of inward toroidal momentum convection in the JET tokamak.

Experiments have been carried out on the Joint European Torus tokamak to determine the diffusive and convective momentum transport. Torque, injected by neutral beams, was modulated to create a periodic perturbation in the toroidal rotation velocity. Novel transport analysis shows the magnitude and profile shape of the momentum diffusivity are similar to those of the ion heat diffusivity. A significant inward momentum pinch, up to 20 m/s, has been found. Both results are consistent with gyrokinetic simulations. This evidence is complemented in plasmas with internal transport barriers.

Contemporary work-related environmental diseases.

This paper is a general review of occupational diseases with particular emphasis on contemporary work-related diseases. Reasons for the difficulties in diagnosis and treatment of industrial disease are given. The basic principles of occupational health are reviewed. The particular occupational diseases discussed in detail are the clinical pneumoconioses, and the contemporary diseases: angiosarcoma from exposure to vinyl chloride and respiratory carcinoma from bichloromethyl ether exposure. Numerous other environmental hazards are mentioned. The role of the Occupational Safety and thealth Administration (OSHA) is discussed, as is the role of the physician from the point of view of taking an appropriate medical history from an occupational vantage and medical diagnosis of occupational disease. Attitudinal aspects are emphasized.

Modification of the total first metatarsophalangeal joint implant arthroplasty.

The Swanson Silastic HP 100 Flexible Hinge Toe Implant (Dow Corning Wright, Arlington Tennessee) displays superior tensile, elongation and tear propagation strength in comparison to other silicone implant materials. It is, however, subject to many factors which may shorten its life-span. One reason for such failure has been attributed to the irregular contour of bone ends created after metatarsophalangeal joint arthroplasty, resulting in abrasion shards and shearing fractures of the implant stems and hinge. Titanium grommets were developed to alleviate this factor. This case report demonstrates a complication subsequent to total first metatarsophalangeal joint implant arthroplasty and the effectiveness of the Swanson Flexible Hinge Toe Joint Grommet. (Dow Corning Wright, Arlington, Tennessee).