Nuclear medicine in district general hospitals.

Nuclear medicine is a recognised clinical specialty both nationally and internationally. Compared with other countries, it is inadequately developed in Britain, particularly in district general hospitals. To create clinical radioisotope services at district level physicians or radiologists with experience in nuclear medicine need to be trained and appointed. Such appointments would allow facilities to evolve that would provide either a comprehensive nuclear medicine service formed around a physician or an imaging service based on a radiologist. Such units would improve the care of patients at a reasonable recurring cost of 15 pounds--30 pounds per investigation.     

Aspects of audit. 2. Audit in British hospitals.

British hospitals have advantages over other areas of health care for developing and evaluating audit: more uniform and comprehensive medical records, statistical and diagnostic data, fewer patient contacts, more time to examine patients and record information. Although little has been published, a few studies show the extent to which formal audit has been developed in Britain.     

Surgical audit: one year's experience in a teaching hospital.

For 12 months the surgical staff at Hope Hospital have operated a form of audit. The monitored information included work load, methods of treatment, complications, misdiagnoses, and deaths. The method described is suitable for any district general or teaching hospital provided adequate secretarial help is available. In addition to helping to maintain standards, an audit of this type has a positive educational role.     

Comparison of cobalamin-independent and cobalamin-dependent methionine synthases from Escherichia coli: two solutions to the same chemical problem.

In Escherichia coli, two enzymes catalyze the synthesis of methionine from homocysteine using methyltetrahydrofolate as the donor of the required methyl group: cobalamin-dependent and cobalamin-independent methionine synthases. Comparison of the mechanisms of these two enzymes offers the opportunity to examine two different solutions to the same chemical problem. We initiated the research described here to determine whether the two enzymes were evolutionarily related by comparing the deduced amino acid sequences of the two proteins. We have determined the nucleotide sequence for the metE gene, encoding the cobalamin-independent methionine synthase. Our results reveal an absence of similarity between the deduced amino acid sequences of the cobalamin-dependent and cobalamin-independent proteins and suggest that the two have arisen by convergent evolution. We have developed a rapid one-step purification of the recombinant cobalamin-independent methionine synthase (MetE) that yields homogeneous protein in high yield for mechanistic and structural studies. In the course of these studies, we identified a highly reactive thiol in MetE that is alkylated by chloromethyl ketones and by iodoacetamide. We demonstrated that alkylation of this residue, shown to be cysteine 726, results in complete loss of activity. While we are unable to deduce the role of cysteine 726 in catalysis at this time, the identification of this reactive residue suggests the possibility that this thiol functions as an intermediate methyl acceptor in catalysis, analogous to the role of cobalamin in the reaction catalyzed by the cobalamin-dependent enzyme.     

龈下菌斑涂片两种染色分类方法的比较

目的:用革兰染色和刚果红负染两种不同的染色方法对同一龈下菌斑样本进行分类计数,比较两种分类方法的优缺点,提出应用中的问题以及解决方法.方法:随机抽样采集40例牙周病患者的80个位点龈下菌斑,同一标本进行生理盐水涂片革兰染色和刚果红负染.光学显微镜油镜(15×100)镜检共计数200个细菌,包括5种不同形状细菌.采用SPSS 10.01统计软件,对数据进行分析.结果:两种染色分类方法计数统计结果为螺旋体、弯曲菌、梭形菌3种菌数值P＞0.05无统计学意义,而球菌、杆菌2种菌数值经统计P＜0.01有高度统计学意义.结论:刚果红负染简便易行,但龈下菌斑球菌、杆菌进行百分计数时,不适宜用刚果红负染法,应根据实验目的选择恰当的方法.     

Retrospective audit of different antenatal screening policies for Down's syndrome in eight district general hospitals in one health region

ObjectiveTo compare the effectiveness of different screening policies for the antenatal detection of Down''s syndrome.DesignRetrospective six year survey.SettingMaternity units of eight districts.ParticipantsWomen who completed their pregnancies between 1 January 1994 and 31 December 1999 (155 501 deliveries).Results335 cases of Down''s syndrome were identified, 323 in continuing pregnancies or liveborn children. Of these, 171 were identified antenatally. Seven different screening policies were used, in three principal groups: serum screening offered to all mothers, maternal age with serum screening or nuchal translucency available to limited groups, and maternal age combined with anomaly scans. The districts that used serum screening detected 57%, those using maternal age plus serum or nuchal translucency screening 52%, and those using a maternal age of ⩾35 and anomaly scans detected 54%. The least successful district, which offered amniocentesis only to women aged over 37 years, detected only 31%. If amniocentesis had been offered from 35 years, as in all other districts, the detection rate would have risen to 54%. Across the region 15% (range 12-20%) of pregnant women were 35 years or more at delivery, and 58% (33-69%) of infants with Down''s syndrome were born to women in this age range.ConclusionsCurrent additional serum or nuchal translucency screening techniques for antenatal detection of Down''s syndrome are less advantageous than previously supposed. More pregnant women were aged over 35 than has been presumed in statistical models used in demonstration projects of serum screening and, as a result, the proportion of affected fetuses in this age group is much greater than predicted.

What is already known on this topic

Serum screening for Down''s syndrome has been presumed to be more effective than screening by maternal ageThere have been no controlled studies comparing serum screening with screening by maternal age, and its greater efficacy has been presumed from mathematical modelling, which assumed that only 5% of pregnant women were aged over 35 yearsThe modelling predicted that only 20-30% of cases of Down''s syndrome would arise in women aged over 35 and made no allowance for the effects of routine anomaly scanning

What this study adds

15% of pregnant women were aged over 35 years, more than double the 5-7% presumed in statistical models of screening58% of babies with Down''s syndrome were born to women aged 35 years or moreSerum screening and nuchal scanning did not achieve significantly higher antenatal detection rates of Down''s syndrome than the use of maternal age and routine anomaly scanning     

Cancerogenic effect of long-term benzene exposure. Occurrence at the same work place of a plasmacytoma and two solid carcinomas

A report is given on three different malignomas appearing after high inhalative exposure to benzene for many years at the same working place in a cable plant. The exposure to benzene amounted to 22 years in a 50 year old man with oesophagus carcinoma, 17 years in a 61 year old man with plasmocytoma and 10 years in a 45 year old man with embryonal carcinoma of the testicles. The malignomas appeared 5-7 years after the end of the exposure. The carcinogenity of benzene is discussed on the basis of a survey of medical literature on epidemiological studies, casuistic contributions and experimental investigations in animals. A direct and indirect mechanism of benzene inducing carcinogenity is discussed: Activation of normal cellular oncogenes in DNA molecules by changes directly caused by benzene and; Damage of the lymphatic cell particularly susceptible to benzene followed by a disturbance of immunological monitoring and defence reactions against tumour cells.     

Surgical correction of entropion and ectropion in the same lid

A patient with medial ectropion and lateral entropion of the same lower lid is presented, and the surgical management of this unusual condition utilizing a horizontal lid-shortening, orbicularis sling procedure, fixation of the posterior and anterior lamellae of the lid, and resection of the tarsal conjunctival layer is described. We believe that the key to the successful management of this condition lies in treating each component surgically as if it were a separate entity, and by using a combination of surgical techniques, both eyelid malpositions can be corrected.     

Vitamin B12 injections: considerable source of work for the district nurse.

Between June and September 1984, district nurses who worked in Coventry were asked to submit returns giving details of the patients for whom they administered vitamin B12 injections. Of 492 patients identified, 382 (78%) were receiving injections more frequently than the recommended three monthly dose of hydroxy-cobalamin. An extra 3751 injections are being administered a year. Four hundred and thirty (88%) of these patients have conditions for which the drug is of proven benefit, so the increased frequency of injections accounts for most of the observed excess. A total of 2000 hours a year of district nurse time is spent with these patients. The nursing service is under increasing strain. Changes in vitamin B12 prescribing alone could make between 600 and 1470 hours available for other patient needs.     

Comparison of two skin antiseptics in blood transfusion. Comparison with the results of the bacteriologic control of labile blood products

The comparison of two skin antiseptics (70 degrees alcohol and 0,5% alcoholic chlorhexidine solution) was carried out by the method of in vivo impressions. The study used 45 healthy volonteers from whom a bacteriological sample was taken from both bends of the elbow, without use of an antiseptic, and after the application of one according to usual sample taking methods. The subjects were divided into two sets according to the antiseptic being tested. The results of the cultures after 24 and 48 hours are expressed in the number of germs per cm2, which thus permits us to calculate a reduction in percentage or log 10 form, and to appreciate the efficiency of the antiseptic studied. Routine bacteriological inspection of labile blood products was carried out on products picked at random every week during 18 months of exclusive use of 70 degrees alcohol by the sample taking services. The results show a comparable in vivo effectiveness of the two antiseptics on the superficial aerobic flora of the bend of the elbow, and the ease of use of 70 degrees alcohol has led to its choice. This choice is confronted with the results of the inspection of blood products: out of 1 293 inspections, only one slight contamination (cocci gram+) was found on a unit of whole blood. These data as a whole can be compared with the work of various authors.