The effects of biofeedback assisted breathing retraining on lung functions in patients with cystic fibrosis.

This study examines the effects of respiratory muscle feedback and breathing retraining (BRT) on lung function in patients with cystic fibrosis (CF). Twenty-six patients with CF were matched for age and severity of disease. Standard respiratory spirometry was performed on all subjects before and after biofeedback training. Thirteen experimental subjects underwent eight sessions of pneumographic or strain-gauge feedback from the abdominal muscles and electromyogram feedback from accessory respiratory muscles to assist in learning diaphragmatic and pursed-lips breathing maneuvers. Control subjects received biofeedback-assisted (hand warming) relaxation training. Results revealed a significant improvement in FEV1 and mean forced expiratory flow during the middle half of forced vital capacity (FVC) for the biofeedback group, while the control group showed no change. A similar trend was noted for FVC. These data suggest that respiratory muscle feedback and BRT may improve lung function in patients with CF.

A comparison audit of a genitourinary medicine colposcopy service against nationally agreed quality standards.

The National Health Service Cervical Screening Programme (NHSCSP) recently published their document Standards and Quality in Colposcopy outlining recommendations for standards in the service provided by colposcopists. In this first audit of colposcopic practice measured against these agreed UK national guidelines, the authors discuss the standards, their attainability, and their relevance to genitourinary medicine (GUM) colposcopy services.

Colposcopy services provided by Genito-Urinary Medicine clinics in the United Kingdom--British Society for Colposcopy and Cervical Pathology/National Co-ordinating Network Survey, 1993.

Postal questionnaires were circulated to all Genito-Urinary Medicine (GUM) clinics in the UK (in parallel with questionnaires circulated to gynaecologists) on behalf of British Society for Colposcopy and Cervical Pathology (BSCCP) and National Co-ordinating Network (NCN) to audit colposcopy services. Information was sought on colposcopy workload, referral criteria, treatment method and followup, waiting times, staffing and training. A similar but less comprehensive survey of colposcopy services in GUM was undertaken in 1990 enabling direct comparison of some but not all aspects of the service in the last 3 to 4 years. One hundred and forty-two GUM Clinics replied. Of those who replied, 70 (49.3%) clinics provided a colposcopy service; an increase from 60 to 70 clinics since 1990. However, only 66 clinics provided detailed information for analysis. Forty-six out of 66 (69.7%) clinics performed treatment for some or all of their patients and the most frequent methods of treatment used were loop excision and cold coagulation. One hundred and seventy-two (range 8-1982) patients were seen per annum with a mean of 7 (range 1-68) colposcopy sessions per month. Sixty-four per cent of these sessions were undertaken by consultants, 14% by training grades and the rest by Clinical Assistants and Associate Specialists. Fifty-three per cent of all patients with abnormal smears were colposcoped within 2 weeks and the maximum waiting period was less than 8 weeks for all severe dyskaryosis/malignant cells cytology reports; 1.6% of clinics admitted to having cases of invasive cervical cancer following previous treatment of cervical intraepithelial neoplasia (CIN) and 96% of clinics had a protocol in place for defaulters. The default rate was 12% both for new and follow-up patients. Thirty out of 70 (43%) clinics were computerized and 50/66 (75.8%) of clinics collected accurate statistics.

Comparison of the influence of spermicidal and non-spermicidal contraception on bacterial vaginosis, candidal infection and inflammation of the vagina--a preliminary study.

This preliminary study compared the signs, symptoms and prevalence of bacterial vaginosis (BV) and candidal infections in women using spermicides, with those using other forms of contraception, to establish whether nonoxynol-9 had any therapeutic value against BV or gave rise to vaginal candidiasis and inflammation. Overall results showed that the prevalence of BV in non-spermicide users was 35/113 (31%) but was significantly less in spermicide users, 10/66 (15%), P < 0.05. Nonoxynol-9 was not associated with increased isolation of Candida albicans, which was found in 16/113 (14%) of non-spermicide users, and in 8/66 (12%) of those using spermicides, P > 0.1. Vaginal inflammation and discharge were significantly less in spermicide users, 19/66 (29%) than in the non-spermicide group, 50/113 (44%), P < 0.05. Nonoxynol-9 contraception was associated with a significantly reduced prevalence of BV, but not with increased candidiasis or vaginal inflammation.

Incidence of Chlamydia antibody in patient groups, as measured by the ELISA technique.

An ELISA technique has been used to study the incidence of antibody against Chlamydiae: the results obtained with a panel of control sera were compared with those for the complement fixation (CF) and whole inclusion immunofluorescence (WIF) tests. The results indicate that the ELISA results correlate well with the WIF test but poorly with the CF test; and the correlation allows ELISA results to be directly related to WIF antibody titres. Using the ELISA test, the incidence of antibody to Chlamydiae by age was determined in sera collected in Great Britain and Iraq; and in sera collections made at three periods during the last 30 years in Great Britain: the results indicate the higher incidence of antibody in this country compared to Iraq, but do not suggest an increased incidence of antibody in Great Britain during the last 30 years. Studies on sera collected from patients with non-gonococcal urethritis and pelvic inflammatory disease indicate significantly higher titres and incidence of antibody compared to controls, which suggest a contiguous spread of infection for the primary genital lesion to involve more distant tissues and organs. A higher incidence of antibody was also seen in patients with cervical intraepithelial neoplasia (CIN) which may be interpreted as either indicating a causal relationship between Chlamydiae and CIN or indicating the importance of a venereal infection in this condition.

Long-term follow-up of infants and children treated with extracorporeal membrane oxygenation (ECMO): a preliminary report.

Extracorporeal Membrane Oxygenation (ECMO) has been used clinically as a life-saving treatment modality in infants and children who are dying of respiratory insufficiency. From 1973 to 1980 47 children less than 10 years of age were treated in a study to determine the feasibility and effectiveness of ECMO in the pediatric population. Despite a predicted mortality of 90% or greater, 24 patients survived. Eighteen of those patients have been seen in long-term follow-up. Thirteen patients (72%) demonstrate basically normal growth and development. Five patients (28%) have definite handicaps which are severe in two. Despite ligation of one common carotid artery and systemic heparinization, the risk of intracranial hemorrhage and/or neurodevelopmental problems appears to be no higher in this ECMO group and may even be lower than in the high-risk population treated with conventional therapy. The incidence of chronic respiratory problems, especially bronchopulmonary dysplasia, is zero in this group of patients. Only one patient (4%) has a defect that lateralizes to the right hemisphere which may have been affected by ligation of the carotid artery. Further study is required; however, it appears that ECMO offers life-saving intervention without increasing morbidity in select children with severe respiratory insufficiency.

Ligation of the patent ductus arteriosus in newborn respiratory failure.

Patent ductus arteriosus (PDA) is commonly associated with respiratory disease in newborn infants and may require ligation. Surgical ligation of the PDA can be done in small infants with low operative risk and minimal complications. The outcome of patients after ligation depends primarily on the severity of the underlying pulmonary disease. One hundred fifty-one patients have undergone ligation in an eight-year period at this center. A simplified technique performed in the neonatal intensive care unit with the use of local anesthesia and conventional ventilator management is described.

Implications of inflammatory changes on cervical cytology.

OBJECTIVE: To assess premenopausal women with inflammatory changes on cervical cytology for genital infections and cervical abnormalities. DESIGN: Prospective study of women attending general practice and family planning clinics who had a recent cervical cytology result with inflammatory changes. SETTING: Department of genitourinary medicine. PATIENTS: 102 Premenopausal women with recent cytology result showing inflammatory changes and with no history of antibiotic or antifungal treatment since their smear. INVESTIGATIONS: Genital examination and microbiological screening for genital infections; colposcopic examination about six weeks later. MAIN OUTCOME MEASURES: Detection of genital infections, particularly those sexually acquired, and abnormalities on colposcopy. RESULTS: Genital infections were isolated in 77 patients, and one or more sexually acquired infections were found in 22. Prevalence of sexually acquired infections was significantly correlated with younger age (particularly being under 25), being single, separated, or divorced; using non-barrier contraception; and recent change of sexual partner. An abnormality on colposcopy was found in 36 women. There was a strong correlation of a sexually acquired infection with an abnormality at colposcopy; hence younger women were more likely to have a colposcopic abnormality. CONCLUSIONS: Inflammatory changes on cytology are often associated with the presence of a sexually acquired infection and premalignant disease of the cervix, particularly in younger, single women using non-barrier contraception.

Kinetic and kinematic evaluation of compensatory movements of the head, pelvis and thoracolumbar spine associated with asymmetric weight bearing of the pelvic limbs in trotting dogs.

OBJECTIVES: To determine ground reaction forces, head and pelvis vertical motion (HVM and PVM, respectively), and thoraco-lumbar lateral angular motion (LAM) of the spine using kinematic gait analysis in dogs with mild asymmetric weight-bearing of the pelvic limbs while trotting. METHODS: Twenty-seven hound-type dogs were fitted with reflective markers placed on the sagittal crest of the skull, the ischiatic tuberosity, and thoracolumbar spine of dogs to track motion while trotting. Kinetic and kinematic data were used to characterize asymmetry between the left and right pelvic limbs, and to describe HVM, PVM and thoraco-lumbar LAM. Maximum and minimum position and total motion values were determined for each measured variable. RESULTS: Dogs with asymmetric weight bearing of the pelvic limbs had greater PVM on the side with a greater peak vertical force (PVF), and greater thoraco-lumbar LAM toward the side with a lower PVF while trotting. No differences in mean HVM were detected, and there were no significant correlations between the magnitude of HVM, PVM and thoraco-lumbar LAM and the degree of asymmetric weight bearing. CLINICAL SIGNIFICANCE: Dogs with subtle asymmetric weight bearing of a pelvic limb had patterns of body motion that may be useful in identifying subtle lameness in dogs; greater PVM on the side with greater weight bearing and greater thoraco-lumbar LAM toward the side with less weight bearing while trotting. Description of these compensatory movements is valuable when evaluating dogs with subtle weight bearing asymmetry in the pelvic limbs and may improve the sensitivity of lameness detection during subjective clinical lameness examination.

Value of colposcopy in genitourinary departments.

During 18 months 237 colposcopies were performed on 227 patients in the department of genitourinary medicine, Sheffield. Histological evidence of cervical intraepithelial neoplasia was found in 118 patients (52%), of whom 104 (88%) were aged under 35, 93 (79%) under 30, and 64 (54%) under 25. Most were treated with local destructive treatment, only five (4%) requiring cone biopsy. Colposcopy in a genitourinary department has an important part to play in detecting cervical intraepithelial neoplasia, particularly in younger women. Early diagnosis may often facilitate using local destructive treatment, thereby reducing the numbers of patients needing cone biopsy.

Rectal spirochaetosis.

We report four cases of rectal spirochaetosis, one in an active male homosexual. One of the heterosexual patients was referred to the genitourinary clinic by a general surgeon after spirochaetes had been found on histopathological examination of a rectal biopsy specimen. We doubt that most of our cases represent sexual transmission of spirochaetosis, or that the condition causes disease in most people. Rectal spirochaetosis possibly occurs only when the normal flora of the gut are disturbed for other reasons. Most of our patients became asymptomatic after nonspecific treatment, although metronidazole appears to be specific.

"Attitudes" toward the elderly: a comparison of measures.

College students were presented five questionnaires traditionally used to assess attitudes toward old people. The intercorrelations among the measures were low, accounting for no more than 24% of the variance between any two measures. The results suggest that the measures are not equivalent; it was argued that the practice of utilizing a single instrument to measure attitudes toward the elderly may contribute to inconsistencies reported in the literature.

Primary cutaneous zygomycosis due to Absidia corymbifera in a patient with AIDS.

A case of primary cutaneous zygomycosis due to Absidia corymbifera in a patient with AIDS is described. The lesions, which were located on the forehead, jaw and chest, were intradermal, extending into the subcutaneous fat and did not appear to be associated with any trauma. No deep-seated infection was evident suggesting that the superficial lesions were exogenous in origin. The possible aetiology of this infection is discussed.