RESUMO
OBJECTIVE: To determine women's preference towards Thermachoice being performed either awake in the outpatient setting or under general anaesthetic (GA) as a day case. DESIGN: Questionnaire. Setting Large teaching hospital. POPULATION: One hundred women. METHODS: The questionnaire was developed from prior research on factors associated with preference for procedures performed in the outpatient versus day case setting. MAIN OUTCOME MEASURES: (1) Describe women's preference towards outpatient versus day case Thermachoice and other menorrhagia treatments. (2) Identify variations in preference by demographic characteristics and prior experience of anaesthesia. Results There was an exact split in preference with 50% preferring Thermachoice as an outpatient and 50% as a day case. The mean age of women preferring outpatient Thermachoice was significantly higher (41.5 years) than those preferring day case (33.5 years) (P < 0.005). Women with children and a higher qualification were more likely to opt for outpatient Thermachoice. A previous bad experience of GA was associated with preference for outpatient Thermachoice. Spending less time in hospital, attending for one visit, feeling well straight after treatment and choosing the treatment setting were important factors to the majority of women. Most women (70%) who opted for Thermachoice as a menorrhagia treatment would prefer to have it performed in the outpatient setting. CONCLUSIONS: If the Department of Heath is to target services towards women's choice, there is a need to increase the provision of outpatient menorrhagia treatments, such as Thermachoice, to more women in the UK.
Assuntos
Assistência Ambulatorial/psicologia , Procedimentos Cirúrgicos Ambulatórios/psicologia , Endométrio/cirurgia , Menorragia/cirurgia , Satisfação do Paciente , Adulto , Anestesia Geral/psicologia , Anestesia Local/psicologia , Ablação por Cateter , Feminino , Hospitais de Ensino , Humanos , Inquéritos e QuestionáriosRESUMO
Cocaine-induced hepatotoxicity is well known in animal models, and many cases of it have been reported in human beings. We reviewed the results of liver function tests performed on admission in 71 randomly selected hospitalized nonparenteral cocaine abusers. We found 11 patients to have elevated levels of aspartate aminotransferase that were less than 28 U above the upper limit of normal. Five of them also had elevated levels of alanine aminotransferase that were less that 12 U above the upper limit of normal. Two patients had isolated elevations in alanine aminotransferase (less than 9 U above the upper limit of normal), and two patients had elevations in alkaline phosphatase (less than 50 U above the upper limit of normal). There was not correlation with regard to age, sex, duration of drug use, last dose, amount of use, or timing of blood tests. This minimal elevation of liver enzyme levels is common, but severe hepatotoxicity is uncommon.
Assuntos
Cocaína , Testes de Função Hepática , Fígado/enzimologia , Transtornos Relacionados ao Uso de Substâncias/enzimologia , Adulto , Alanina Transaminase/metabolismo , Fosfatase Alcalina/metabolismo , Aspartato Aminotransferases/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição AleatóriaRESUMO
Opioids cause constipation by binding to specific opioid receptors in the enteric and central nervous systems. First-pass glucuronidation limits systemic bioavailability of oral naloxone. This study was designed to determine if oral naloxone could reverse opioid-induced constipation without precipitating abstinence or recrudescence of pain in opioid-dependent individuals. Concentrations of unmetabolized and total naloxone, including naloxone glucuronide, were measured by radioimmunoassay. A dose-related increase in symptoms of laxation resulted in all three opioid-dependent patients studied that paralleled the increase in active and total naloxone plasma levels. Withdrawal symptoms occurred with plasma naloxone area under the plasma concentration-time curves above 550 ng.min/ml and with dosing intervals less than 3 hours. Peak plasma levels did not predict withdrawal. Oral naloxone ameliorates opioid-induced constipation in opioid-dependent persons. Titration of dose to a maximum of 12 mg at least 6 hours apart may be needed to avoid adverse reactions.
Assuntos
Constipação Intestinal/induzido quimicamente , Metadona/efeitos adversos , Naloxona/uso terapêutico , Oxicodona/efeitos adversos , Adulto , Constipação Intestinal/tratamento farmacológico , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Naloxona/sangue , Naloxona/farmacocinética , Projetos Piloto , Transtornos Relacionados ao Uso de SubstânciasRESUMO
Relationships between chemical structure of androst-4-en-3-one derivatives and their affinity for putative progesterone receptors are described. The binding affinity for 55 derivatives can be expressed by the equation log relative binding affinity (rabbit receptor) = 1.79 + 0.18 (+/-0.11) pia + 1.45 (+/-0.21) pib + 0.010 (+/-0.002) (surface area in hydrophobic pockets) - 0.012 (+/-0.003) (surface area out of hydrophobic pockets) - 0.99 (+/-0.21) MK - 0.33 (+/-0.08) (conformational changes). For this equation, r=0.88. The equation successfully predicts the affinities of other compounds in the literature. The importance of the surface area terms is discussed.
Assuntos
Receptores de Progesterona , Esteroides , Androstenos , Animais , Cobaias , Humanos , Hidroxiprogesteronas , Ligação Proteica , Coelhos , Receptores de Progesterona/metabolismo , Ovinos , Esteroides/metabolismo , Relação Estrutura-AtividadeRESUMO
The synthesis and structure-activity relationship (SAR) studies of the effect of different polysubstitution patterns in the aromatic ring of 5-(acetamidomethyl)oxazolidinone antibacterials (I) on antibacterial activity are presented. Compounds I were prepared by the six-step synthesis described previously (Gregory, W. A.; et al. J. Med. Chem. [formula: see text] 1989, 32, 1673), electrophilic aromatic substitution reactions of 3-substituted compounds, and functional-group interchange reactions of 3,4-disubstituted compounds. Antibacterial evaluation of compounds I against Staphylococcus aureus and Enterococcus faecalis gave the following results. The 2,4- and 2,5-disubstituted derivatives have weak or no antibacterial activity. Antibacterial activities of 3,4-disubstituted compounds are comparable to those of the 4-monosubstituted analogues for small 3-substituents (smaller than Br), but decline rapidly for larger 3-substituents. 3,4-Annulated derivatives are comparable in activity to their open-chain analogues. 3,5-Disubstituted and 3,4,5- and 2,4,6-trisubstituted derivatives are devoid of antibacterial activity.
Assuntos
Antibacterianos/síntese química , Oxazóis/síntese química , Antibacterianos/química , Antibacterianos/farmacologia , Enterococcus faecalis/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Oxazóis/química , Oxazóis/farmacologia , Staphylococcus aureus/efeitos dos fármacos , Relação Estrutura-AtividadeRESUMO
To determine whether Escherichia coli in or near the urethra caused symptoms of abacterial cystitis, the results of serial cultures from the vaginal introitus of 92 patients with recurrent cystitis were compared with symptoms at clinic visits when they were abacteriuric. Similar comparisons were made in 15 of these patients using cultures from the external urethral meatus and proximal urethra. E coli were grown from the vaginal introitus, urethral meatus and proximal urethra at 41, 66 and 26% of visits respectively. Overall they were not significantly more often isolated when patients had cystitis, and the serotype was unrelated to symptoms. E coli was cultured significantly more often from the introital swabs of symptomatic intermittently bacteriuric (IB) women than from symptomatic persistently non-bacteriuric (NB) patients; and more often from symptomatic than from asymptomatic IB patients, although this difference was not significant. These findings were consistent with previous suggestions that symptoms of apparently "abacterial" cystitis in IB patients are due to occult coliform infection. We found no direct evidence that E coli were the cause of symptoms in persistently non-bacteriuric women, or that urethral colonisation caused them. However E coli were isolated from the introitus of control women only half as often as from both intermittently bacteriuric and persistently non-bacteriuric patients.
Assuntos
Cistite/etiologia , Escherichia coli/patogenicidade , Uretra/microbiologia , Adulto , Cistite/microbiologia , Escherichia coli/classificação , Escherichia coli/isolamento & purificação , Feminino , Humanos , Masculino , Sorotipagem , Vagina/microbiologiaRESUMO
Studies of bladder histology were made in patients with recurrent urinary infection or symptoms of cystitis, with a view to establishing its relationship to symptoms, cystoscopic appearance, and bacilluria. Bladder biopsies were taken from the patients and compared with control material obtained at necropsy. Acute inflammatory changes were inconstant and sometimes sparse. Chronic inflammatory changes were often marked, and were ranked by severity into four grades. There was a statistically significant correlation between the more severe grades and the finding of bacilluria, which was not dependent on sex or age. The grades in patients with recurrent non-bacterial dysuria (;urethritis') lay between those of the controls and the infected patients, and were statistically different from both. There was no correlation between these grades and either symptoms or the finding of trigonal hyperaemia during cystoscopy. However, heavy lymphocytic infiltration, and particularly germinal follicle formation, frequently resulted in macroscopic tubercle-like nodules which were visible on cystoscopy. Such germinal follicles may contribute to local antibacterial defences by their production of immunoglobulins, and may explain the high antibacterial antibody titres sometimes found in the sera of subjects with infection confined to the lower urinary tract.
Assuntos
Bexiga Urinária/patologia , Infecções Urinárias/patologia , Adulto , Idoso , Anticorpos Antibacterianos/análise , Autopsia , Bacteriúria/diagnóstico , Biópsia , Cistite/diagnóstico , Cistite/patologia , Cistoscopia , Edema/patologia , Epitélio/patologia , Feminino , Humanos , Linfócitos , Masculino , Pessoa de Meia-Idade , Uretrite/patologia , Cateterismo Urinário , Infecções Urinárias/diagnósticoRESUMO
To define the extent and nature of mycobacterial infection in patients on an adult dialysis unit whose catchment population contains a large proportion of non-Caucasian subjects, a retrospective survey of all new patients accepted onto our maintenance dialysis programme between January 1987 and December 1989 was carried out. Twenty-six Asian, 13 Afro-Caribbean, two Oriental and 170 Caucasian patients were accepted onto the dialysis programme in the three-year recruitment period. Eight of the 26 Asian patients, but none of the others, had developed mycobacterial infection by the end of December 1990. One patient had a cerebral tuberculoma with miliary mottling on chest X-ray, one pulmonary tuberculosis, one tuberculous adenitis and 5 tuberculous peritonitis (four due to Mycobacterium tuberculosis and one Mycobacterium kansasii). All the patients had been living in the UK for an average of 15 (range 6-24) years, with no known recent exposure to tuberculosis. Five patients are now alive and well, one developed malabsorption following M. kansasii peritonitis, but two with tuberculous peritonitis died before treatment could be instituted. Mycobacterial infections were associated with a high level of mortality and morbidity. No Asian patient developed mycobacterial infection during post-transplant immunosuppressive therapy in the study period, probably because of the routine anti-tuberculous chemoprophylaxis employed in this group of patients. The diagnosis of mycobacterial infection should be suspected when an Asian dialysis patient develops a pyrexia of unknown origin. It is likely, though not proven, that anti-tuberculous chemoprophylaxis might reduce this high incidence of tuberculous infection in Asian dialysis patients.
Assuntos
Emigração e Imigração , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Diálise Renal/efeitos adversos , Tuberculose/epidemiologia , Adulto , Antituberculosos/uso terapêutico , Bangladesh/etnologia , Área Programática de Saúde , Feminino , Humanos , Incidência , Índia/etnologia , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Diálise Renal/estatística & dados numéricos , Estudos Retrospectivos , Tuberculose/tratamento farmacológicoRESUMO
As many UK renal units commence more patients on CAPD than hemodialysis (HD) as the first mode of therapy a retrospective study of long-term CAPD (greater than 4 years continuous CAPD) was performed in 4 centers with substantial CAPD programs. One hundred and seventy-seven patients (103M, 74F) started CAPD before December, 1981. There was no difference in primary renal disease. Age was significantly greater in 2 units (51.9 +/- 11.7 and 53.2 +/- 12.1 vs 40.6 +/- 16.2 and 42.5 +/- 14.6 years, p less than 0.05) and correlates with pre-CAPD activity scores (Scale 3-0). After 4 years: 34 patients (19.2%) remained on CAPD: the proportion was similar in all centers. Sixty-five percent of patients were alive but 54% transferred to HD mainly due to peritonitis (overall 2.0 episodes/intercenter variation p less than 0.001). Fourty-four patients were transplanted. Significant increases occurred in hemoglobin, albumin, calcium and creatinine; a decrease in activity score (2.4 +/- 0.7 to 1.5 +/- 0.9, p less than 0.005); no change in weight, BP, urea or bone disease. Thirty-eight patients died, mainly cardiac (14) or sepsis (11). Using Cox's method of analysis significant risk multipliers were age (2.07 per decade), male sex (2.18), frequency of peritonitis (1.36), activity score less than 2 (4.45) and amyloidosis (12.45). Despite differing techniques in different centers CAPD offered a satisfactory mode of therapy for many patients; peritonitis was the main reason for transfer to HD and several significant factors were identified.
Assuntos
Falência Renal Crônica/terapia , Diálise Peritoneal Ambulatorial Contínua , Adulto , Feminino , Humanos , Falência Renal Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Reino UnidoRESUMO
We have examined the effects on renal function of indomethacin and misoprostol, alone and in combination. Eight healthy volunteers took indomethacin 50 mg tds for one week, and indomethacin plus misoprostol (a synthetic PGE1 analogue) 200 micrograms qds for one week in a crossover design. A separate group (n = 5) took misoprostol alone for one week. 51Cr EDTA GFR rose significantly from baseline after the combination of indomethacin and misoprostol (from mean +/- SD 117 +/- 7.1 to 123 +/- 8.0 mls/min/1.73 m2, p = 0.05). When indomethacin alone was given 51Cr EDTA GFR did not change significantly (120 +/- 9.0 to 117 +/- 9.0 mls/min/1.73 m2). However in 4 of these subjects 51Cr EDTA GFR fell (range 7-19 mls/min/1.73 m2); in each of these the reduction was reversed when the indomethacin was given together with misoprostol. In the whole group the change in 51Cr EDTA GFR, from baseline, after indomethacin plus misoprostol was significantly different from that after indomethacin alone (+6 +/- 8 vs -3 +/- 5 mls/min/1.73 m2 p = 0.05). Misoprostol alone had no effect on GFR. We conclude that misoprostol and indomethacin in combination increase GFR in healthy volunteers, and further studies are now warranted to determine whether misoprostol is beneficial in the prophylaxis and treatment of NSAID-induced renal impairment.
Assuntos
Indometacina/farmacologia , Rim/efeitos dos fármacos , Misoprostol/farmacologia , Adulto , Radioisótopos de Cromo , Creatinina/metabolismo , Quimioterapia Combinada , Ácido Edético , Taxa de Filtração Glomerular/efeitos dos fármacos , Humanos , Indometacina/administração & dosagem , Masculino , Misoprostol/administração & dosagemRESUMO
We report on a 5-year, prospective, double-blind trial of 1,25 dihydroxycholecalciferol (calcitriol) versus placebo in 76 hemodialysis patients without biochemical or radiological evidence of bone disease. Calcitriol, 1 microgram daily, regularly induced hypercalcemia. Doses of 0.25 microgram daily or less proved satisfactory in most patients. During calcitriol treatment, plasma calcium concentration was significantly higher and serum parathyroid hormone concentration significantly lower than on placebo. There was no difference in the rates of development or of progression of vascular calcification in the two groups. Significantly more patients on placebo (17 vs. 6, p less than 0.05) developed a sustained elevation of plasma alkaline phosphatase concentration. Calcitriol appeared to protect against the development of histological evidence of osteitis fibrosa but not of osteomalacia, but accumulation of aluminum in bone occurred during the study. We conclude that calcitriol delays and may prevent the development of osteitis fibrosa in patients receiving regular hemodialysis and may reasonably be prescribed routinely in hemodialysis patients without biochemical or radiological abnormality, unless there is a substantial prospect of early renal transplantation.
Assuntos
Doenças Ósseas/prevenção & controle , Calcitriol/uso terapêutico , Diálise Renal , Adolescente , Adulto , Fosfatase Alcalina/sangue , Doenças Ósseas/etiologia , Doenças Ósseas/patologia , Osso e Ossos/patologia , Calcinose/prevenção & controle , Calcitriol/administração & dosagem , Cálcio/sangue , Ensaios Clínicos como Assunto , Método Duplo-Cego , Humanos , Pessoa de Meia-Idade , Osteíte/prevenção & controle , Osteomalacia/prevenção & controle , Hormônio Paratireóideo/sangue , Estudos Prospectivos , Diálise Renal/efeitos adversos , Fatores de TempoRESUMO
Neurofibrillary material was found in cortical neurons in two patients who died with dialysis encephalopathy. The cytoplasm of these neurons contained large amounts of aluminum and whole-brain and blood aluminum levels were high. These findings suggest that in dialysis encephalopathy aluminum has a specific effect on neuronal protein synthesis, resulting in the accumulation of neurofilaments in cortical neurons. This neurofibrillary neuronal degeneration resembles that found in experimental aluminum toxicity, but differs in several respects from the neurofibrillary tangles characteristic of Alzheimer's disease.
Assuntos
Alumínio/intoxicação , Encefalopatias/etiologia , Demência/etiologia , Degeneração Neural , Neurofibrilas/patologia , Diálise Renal/efeitos adversos , Adulto , Alumínio/análise , Encefalopatias/patologia , Córtex Cerebral/análise , Córtex Cerebral/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Neurônios/análiseRESUMO
Achieving a moral informed consent from a patient is certainly no easy task for the physician. Patient autonomy has become a watchword of the medical profession and has promoted to some extent an emphasis on the idea of noninterference with the patient as the essential feature of the physician's respect for this autonomy. This is unfortunate because noninterference in many instances really does not take into account the transforming effects of illness and their impact on informed consent. In illness, the body is interposed between us and reality, and it impedes our choices and actions and is no longer fully responsive. Illness forces a reappraisal and in doing so opens up old anxieties and imposes new ones, often including the real threat of death or drastic alterations in lifestyles, such as becoming ventilator-dependent. Fear alone may cripple the ability of the patient to choose. In any consideration of informed consent, the extent of the patient's illness and suffering must always be considered. Adequate interaction with the elderly patient that is necessary for an informed consent consists of a combination of "objectivity" and "cooperation." Cooperation is shown by psychologically reproducing in the mind of the doctor, insofar as possible, the meaning the patient's illness has for him. Without such knowledge, the physician cannot assist a patient in restoring some control over his life, or in understanding his values, both of which are so essential in the decision-making process. The meaning of informed consent is vacuous at best without this objectivity and cooperation. Along with this interaction, the elderly patient must be placed in such a position that throughout his illness he maintains a free choice to decide while he is mentally able to do so. Simply knowing that this freedom exists removes many of the doubts and fears constraining the patient's own sense of autonomy. As a final statement regarding informed consent, we should note that any success by the physician in dealing with problems surrounding the patient's informed consent is always central to the strength of the physician's relationship with the patient. Because of the changing features of this relationship today, the physician should always be ready to implement the steps necessary to maintain the integrity of that relationship. The covenant of faithfulness demands nothing less.
Assuntos
Serviços de Saúde para Idosos , Consentimento Livre e Esclarecido , Relações Médico-Paciente , Idoso , Compreensão , Comportamento Cooperativo , Tomada de Decisões , Revelação , Humanos , Masculino , Participação do Paciente , Autonomia Pessoal , Risco , Medição de RiscoRESUMO
The decision regarding refusal of treatment ultimately rests with competent adult patients. When the elderly patients is an inadequate or incompetent decision-maker, in order to protect the interests of the patient, the physician should have some knowledge of the way decisions are and ought to be made, particularly when a decision to forgo life-sustaining treatment is being deliberated. In acquiring this knowledge, the physician needs to develop clear understanding about who has the authority and responsibility to speak for the patient and what standards are to guide the decision-making process involving the incompetent patient. This is not an easy task for any physician. In many instances, the process can become clouded by a host of complex ethical and legal issues that make any decision a questionable one. A beginning point might be the acceptance of the fact that every elderly patient possesses values and goals that are quite unique to him, even though they might seem identical to those held by many other patients. This fact, more than anything else, will help to remove many of the impediments that face the physician during the decision-making process.
Assuntos
Serviços de Saúde para Idosos , Cooperação do Paciente , Idoso , Beneficência , Tomada de Decisões , Feminino , Humanos , Consentimento Livre e Esclarecido , Cuidados para Prolongar a Vida , Participação do Paciente , Autonomia Pessoal , Relações Profissional-Família , Medição de Risco , Valores Sociais , Valor da Vida , Suspensão de Tratamento , Prevenção do SuicídioRESUMO
We studied purine metabolism in gouty patients from three categories: primary gout, familial juvenile hyperuricaemic nephropathy (FJHN) and partial HPRT deficiency.
Assuntos
Alopurinol/efeitos adversos , Hipersensibilidade a Drogas , Supressores da Gota/uso terapêutico , Gota/terapia , Erros Inatos do Metabolismo da Purina-Pirimidina/terapia , Adolescente , Adulto , Idoso , Benzobromarona/uso terapêutico , Creatinina/sangue , Gota/sangue , Gota/tratamento farmacológico , Supressores da Gota/efeitos adversos , Humanos , Hipoxantina Fosforribosiltransferase/deficiência , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Ácido Úrico/sangueRESUMO
Twenty-seven consecutive admissions from nursing homes who underwent a gastrointestinal (GI) consult for coffee ground vomitus or occult GI bleeding to evaluate the outcome were reviewed retrospectively to determine whether a GI work-up was or would have been useful. There were 15 deaths, all associated with severe infection or respiratory failure. Endoscopy, barium studies, and a history of nonsteroidal anti-inflammatory drug use or peptic ulcer disease did not affect the management or outcome. No patient developed major GI bleeding. When nursing home patients present with coffee ground vomitus or newly found occult blood in the stool, efforts should be made to identify and vigorously treat any acute underlying infection or respiratory failure. Endoscopy is not helpful in this clinical situation. Both the primary care physician and the GI consultant should be aware of these associations and should focus on the underlying etiology.
Assuntos
Hemorragia Gastrointestinal/etiologia , Avaliação Geriátrica , Admissão do Paciente , Idoso , Demência/terapia , Feminino , Instituição de Longa Permanência para Idosos , Humanos , Masculino , Casas de Saúde , Equipe de Assistência ao Paciente , Estudos RetrospectivosRESUMO
A case of acute pancreatitis, complicated by pseudocyst formation, is described in a patient with sickle cell crisis. The differential diagnosis is discussed and the literature reviewed.
Assuntos
Anemia Falciforme/complicações , Hemoglobinas Anormais , Pancreatite/complicações , Doença Aguda , Humanos , Pseudocisto Pancreático/complicações , Pseudocisto Pancreático/diagnóstico por imagem , RadiografiaRESUMO
A case of a middle-aged African-American woman with weight loss, ascites, a bilateral pleural effusion with no infiltrate, and a clinical diagnosis of a metastatic gynecological tumor is presented. Her carcinoembryonic antigen (CEA) and CA-125 levels were elevated (400 micrograms/L and 331 micrograms/L, respectively). She underwent an exploratory laparotomy and a dilation & curettage for biopsies and cultures. Pathological examination showed Langhans' type giant cells on peritoneal biopsy. An endometrial curette biopsy showed granulomatous endometritis and acid-fast bacilli. Cultures grew Mycobacterium tuberculosis. The patient presented with a fibroid tumor that could have contributed to her elevated CA-125 level, but after antituberculous treatment was started and tumor markers were repeated after 1 year, the CEA level decreased to 1.2 micrograms/L and CA-125 to 9 micrograms/L without surgical resection of the tumor. A review of the literature revealed only three cases in which patients had elevated CA-125 in multivisceral tuberculosis. No cases were reported in which both CEA and CA-125 levels were elevated in multivisceral tuberculosis. Possible causes of elevated CEA and CA-125 levels are discussed.
Assuntos
Antígeno Ca-125/sangue , Antígeno Carcinoembrionário/sangue , Tuberculose Gastrointestinal/sangue , Antituberculosos/uso terapêutico , Feminino , Humanos , Leiomioma/sangue , Leiomioma/complicações , Pessoa de Meia-Idade , Tuberculose Gastrointestinal/complicações , Tuberculose Gastrointestinal/tratamento farmacológico , Neoplasias Uterinas/sangue , Neoplasias Uterinas/complicaçõesRESUMO
OBJECTIVE: To establish whether people exposed to drinking water contaminated with 20 tonnes of aluminium sulphate in the Camelford area of Cornwall in the south west of England in July 1988 had suffered organic brain damage as opposed to psychological trauma only. DESIGN: Retrospective study of affected people. PARTICIPANTS: 55 affected people and 15 siblings nearest in age to one of the group but who had not been exposed to the contaminated water were studied. MAIN OUTCOME MEASURES: Various clinical and psychological tests to determine medical condition and anxiety levels in affected people. Assessment of premorbid IQ (pFSIQ) with the national adult reading test, a computerised battery of psychomotor testing, and measurement of the difference in latencies between the flash and pattern visual evoked potentials in all participants. RESULTS: The mean (SE) pFSIQ was above average at 114.4 (1.1). The most sensitive of the psychomotor tests for organic brain disease was the symbol digit coding (SDC) test (normal score 100, abnormal <85). PARTICIPANTS performed less well on this test (54.5 (6.0)) than expected from their pFSIQ (P<0.0001) and a little less poorly on the averaged less discriminating tests within the battery (86.1 (2.5), P<0.0001). In a comparison with the 15 sibling pairs (affected people's age 41.0 (3.3) years v sibling age of 42.7 (3.1) years (P=0.36) the exposed people had similar pFSIQ (114.7 (2.1)) to their siblings (116.3 (2.1), (P=0.59) but performed badly on the symbol digit coding test (51.8 (16.6)) v (87.5 (4.9) for siblings, P=0.03). The flash-pattern differences in exposed people were greater than in 42 unrelated control subjects of similar age (27.33 (1.64) ms v 18. 57 (1.47) ms, P=0.0002). The 15 unexposed siblings had significantly better flash-pattern differences than their affected siblings (13.4 (2.4) ms v 29.6 (2.9) ms, P=0.0002). No effect of anxiety could be shown on these measurements from the analysis of the anxiety scores of exposed people. CONCLUSION: People who were exposed to the contaminated water at Camelford suffered considerable damage to cerebral function, which was not related to anxiety. Follow up studies would be required to determine the longer term prognosis for affected individuals.