Hypophysectomy for palliation of breast cancer with especial reference to surgical technique

In a series of 19 patients who had hypophysectomy for palliation of cancer of the breast, all had striking relief of pain. Objective evidence of remission of disease was observed in ten patients. The survival time after operation averaged 19.8 months for patients who had remission and 2.1 months for patients who did not. Results were better in patients who had had cancer for a long time before operation than in those who had had the disease a relatively short time. Also it was noted that results were better in patients who had had preoperative response to endocrine therapy than in those who had not. Hence these factors may be considered in selection of patients for hypophysectomy.     

Gonadal function in young adults after surgical treatment of cryptorchidism.

In a follow-up study of 48 young men who had been surgically treated for cryptorchidism before puberty testicular function was assessed by examining the genitalia, testicular volume, secondary sex characteristics, semen, plasma luteinising hormone (LH) and follicle-stimulating hormone (FSH) concentrations after luteinising hormone-releasing hormone stimulation, and plasma testosterone concentrations. Clinical androgen effects were normal. The mean testicular volume of both testes was in the low normal range in those who had had unilateral cryptorchidism and below normal in those who had had bilateral cryptorchidism. Of 37 patients whose sperm counts were recorded (14 bilateral) six showed azoospermia (all bilateral), five had severe oligospermia (four bilateral), and 10 had moderate oligospermia (one bilateral). In nearly all those who had had bilateral cryptorchidism and most of those who had had unilateral cryptorchidism plasma gonadotrophin levels were increased. Four cases of possible partial LH deficiency were identified. Plasma testosterone concentrations were normal in all except two patients.     

宁夏六盘山国家自然保护区蝶类群落结构和多样性

对宁夏六盘山国家自然保护区蝴蝶群落的结构组成和多样性进行了研究.结果表明：六盘山保护区有蝴蝶5科68属130种,其中,蛱蝶科的属数和物种数最多,为33属68种;凤蝶科最少,为2属2种.灰蝶科的物种丰富度和均匀度指数最高,分别为1.75和0.84;蛱蝶科的多样性指数最高,为3.01;粉蝶科的优势度指数最高,为0.90;凤蝶科的物种丰富度、多样性和优势度指数均最低,分别为0.37、0.40和0.蛱蝶科中,眼蝶亚科的属数和种数最多,为13属24种;喙蝶亚科最少,仅1属1种;闪蛱蝶亚科的物种丰富度和均匀度指数最高,分别为1.11和0.84;线蛱蝶亚科的多样性指数最高,为2.04;眼蝶亚科的优势度指数最高,为0.96.     

Cholecystitis in Teenage Girls

Cholecystectomy was carried out in 17 teenage girls for cholecystitis at Virginia Mason Hospital, Seattle, between 1971 and 1980. The incidence increased with increasing age. Gallbladder disease was associated with recent pregnancy or birth control pill use (71%), obesity (65%) and family history of gallbladder disease (47%). All but one patient had at least one of these risk factors. No patient had congenital anomalies, blood dyscrasias or other underlying illness. Patients most commonly had recurrent attacks of abdominal pain; seven had symptoms for more than six months. Although the clinical presentations were often mild, six patients had jaundice, three had chemical pancreatitis, one had hemorrhagic pancreatitis, one had pancreatic pseudocyst and abscess and one had a common duct stone. One patient had cholesterosis and 16 had cholelithiasis. All patients were cured by operation. During the same time period, only two boys, both aged 14 years, nonobese and with no family history of gallbladder disease, underwent cholecystectomy, both for acaculous cholecystitis.     

特种稻谷蛋白亚基的研究

以陕西红香米、绿香米、紫糯、茉莉香米、黑帅、黑宝为实验材料,采用SDS-PAGE方法在pH为8.9,电流为15mA条件下,对其种子的谷蛋白进行了电泳分析,寻找其特征及其之间的差异。结果表明绿香米、黑帅都具有9条特征谱带;茉莉香米具有7条特征谱带;紫糯具有6条特征谱带;黑宝具有5条特征谱带;红香米具有4条特征谱带。分子量较高、蛋白谱带较多的品系为绿香米和黑帅(6～5条);分子量较高、蛋白谱带较少的品系为茉莉香米(2条)。     

Subjective Follow-up of Patients from a Surgical Intensive Therapy Ward

One-hundred consecutive patients who had been treated in the surgical intensive therapy ward completed a form recording their impressions of their stay. Most patients had a reasonable idea of how long they had spent in the ward and few remembered being in pain or excessively worried by any of the procedures carried out. Those who had been artificially ventilated had little recollection of this period; most either did not realize that their breathing had been artificially maintained or had no idea of the duration of ventilatory support. Very few of the patients who had tracheal suction via endotracheal or tracheostomy tubes were unduly worried by this, but 60% of the patients who needed nasopharyngeal suction to help sputum clearance had been considerably worried by this.Most of the patients were very pleased with the medical and nursing attention they had received and did not find the “intensive” nature of their care unduly disturbing.     

Study of intellectual performance of children in ordinary schools after certain serious complications of whooping cough. Swansea Research Unit of the Royal College of General Practitioners.

In a case-control study 27 index children from ordinary schools who had had convulsions or apnoea as a complication of whooping cough about eight years previously were compared with 27 children who had never had whooping cough and 15 who had had whooping cough without complications. Other factors likely to cause intellectual impairment after conception were considered. The index group had a significantly lower median intelligence quotient and poorer school attainment than either of the control groups. The results support the hypothesis that convulsions or apnoea as a complication of whooping cough may be associated with subsequent intellectual impairment.     

Burden of Illness,Annual Healthcare Utilization,and Costs Associated with Commercially Insured Patients with Cushing Disease in The United States

ObjectiveTo describe the burden of illness, healthcare utilization, and costs associated with Cushing disease (CD), a rare disorder resulting from adrenocorticotropic hormone-secreting pituitary tumors, in commercially insured patients in the U.S.MethodsPatients with CD were identified in 2010 in the IMS Health PharMetrics and Truven Health Analytics MarketScan claims databases. Because there is no diagnosis code for CD, patients were identified with a claim for Cushing syndrome and either benign pituitary adenoma or hypophysectomy. We estimated total sand CD-related utilization and costs using pharmacy and medical claims.ResultsWe identified 685 CD patients (81% female; mean age, 41.7 years; mean Charlson comorbidity index, 1.6; mean number of chronic conditions, 4.2); 30.5% of the patients had diabetes, 22.5% had psychiatric disturbances, 21% had infections, 8.6% had osteoporosis, 8% had cardiovascular disease/stroke, 5.5% had kidney stones, and 0.7% had compression fracture of a vertebra. Patients had a mean of 19.8 office visits per year; 38.4% had inpatient hospitalizations and 34.2% visited the emergency department (ED). Patients had a mean of 3.2 CD-related office visits per year; 26.9% had CD-related hospitalizations, 0.9% had CD-related ED visits, and 36.8% had CD treatments. Mean annual total costs were $34,992 (pharmacy, $3,597; medical costs, $31,395). CD-related costs accounted for $14,310 of total costs (CD treatment costs, $9,353; other CD-related costs, $4,957).ConclusionCD patients have a high burden of illness. Among CD patients in this study, 30.5% had diabetes, 22.5% had psychiatric disturbances, 21% had infections, 8.6% had osteoporosis, 8% had cardiovascular disease/ stroke, and 5.5% had kidney stones. Patients had 19.8 office visits per year, and > 34% of patients were hospitalized. Mean total cost of care was approximately $35,000 per year. (Endocr Pract. 2015;21:77-86)     

Effectiveness of pain relief in labour: survey of 1000 mothers

The amount of pain that had been experienced by 1000 women during vaginal delivery of a live child was determined by interview within 48 hours of delivery. Patients had been offered a choice of analgesia, and 536 had received epidural analgesia: pain relief was greatest in this group, just over half having had a painless labour. The duration of pain was also reduced by a third in this group even though patients who had received an epidural block had tended to have longer labour and an incidence of assisted delivery of 51% compared with 6% in the remainder. Seventy-two per cent of the patients receiving an epidural had had as much pain as they had expected. A similar proportion (70%) was reported with simpler analgesic methods, suggesting that women may expect a certain amount of pain in labour and request further analgesic treatment when this is exceeded.     

Viral infections in renal allograft recipients treated with long-term immunosuppression.

Thirty-nine renal allograft recipients who had received continuous immunosuppression for six to 13 years were examined clinically and virologically for evidence of past or present viral infection. Twenty-five had common warts, usually on the hands. In most the warts had appeared about one year after transplantation; once present, they never disappeared. Six patients had had a zoster rash from two months to four years after transplantation. None had had jaundice, and there was no change in the frequency of colds or non-specific fibrile illness. Four patients had no cytomegalovirus complement-fixing antibodies throughout the observation period; in the other 35 the antibody titre had risen appreciably during the first three to four months after transplantation. Antibody titres were high (mean 64) at follow-up, being only slightly lower than the highest titres achieved during the immediate postoperative period. None of the patients had had symptomatic cytomegalovirus infection, and in only two was the virus isolated from the urine at follow-up; the titres were extremely low. No changes occurred in the frequency of herpes simplex eruptions. Although all patients had herpes simplex humoral antibody, none excreted the virus. Although cytomegalovirus antibody titres were high, virus excretion was rare, indicating that chronic cytomegalovirus infection in these patients is immunologically well controlled.     

Alcoholic doctors can recover.

A survey of doctors with alcohol and drug dependence who joined a self help group was carried out to find out whether they had recovered and whether their lifestyles and careers had been affected. After the group had been meeting for eight years 100 doctors had attended for over six months, and they were sent a questionnaire. Sustained recovery from dependence was achieved by 76 doctors for an average of nearly five and a half years. Among 15 who had not recovered, seven had died of causes directly related to alcohol misuse. Nearly a fifth of those surveyed had been assessed by the medical committee of the General Medical Council, and nearly half had lost their job but were in satisfactory employment again at the follow up survey. Those who recovered had contributed nearly 500 years of service to health care since contacting the group.     

Distribution of three alpha-chain beta-hexosaminidase A mutations among Tay-Sachs carriers.

DNA from 176 carriers of the Tay-Sachs gene was tested for the presence of the three mutations most commonly found among Ashkenazi Jews: the so-called insertion, splice junction, and adult mutations. Among 148 Ashkenazi Jews tested, 108 had the insertion mutation, 26 had the splice junction mutation, five had the adult mutation, and nine had none of the three. Among 28 non-Jewish carriers tested, most of whom were obligate carriers, four had the insertion mutation, one had the adult mutation, and the remaining 23 had none of the three.     

Candida pneumonia: experience with 20 patients

Case reports of 20 patients with histologic evidence of Candida pneumonia at autopsy were studied retrospectively. Most of the patients had had malignant conditions or immunosuppressive disorders, or had been treated by immunosuppressive agents such as steroids. Clinical findings included cough, purulent sputum and invariable hypoxia. Of the 20 patients, 14 had positive sputum cultures, 6 had positive blood cultures and 6 had positive urine cultures for Candida organisms. Findings on chest radiographs of most of the patients showed diffuse bronchopneumonia with confluent areas of air space consolidation. Five patients had been suspected of having Candida pneumonia and were treated empirically with amphotericin B, but none survived.     

Sexual behaviour of young and middle aged men in England and Wales.

Establishing patterns of sexual behaviour is essential in predicting the future spread of HIV. The sexual behaviour patterns of a randomly selected sample of 480 white men aged 15 to 49 were obtained by interview and analysed in relation to age, social class, and area of residence. Over half of the men had first had intercourse before the age of 18 and over three quarters had done so before the age of 20. Age at first intercourse tended to be lower in more recent birth cohorts and in social classes III, IV, and V. Men in earlier birth cohorts tended to have had fewer heterosexual partners, both regular and casual, than those born more recently, but there were no social class or regional differences in the number of partners. Eight of the 480 men (1.7%, 95% confidence interval 1.1 to 2.3%) stated that they had had homosexual intercourse, four of whom had had one casual homosexual partner. Only one man had had more than 25 homosexual partners. The number of men having had homosexual intercourse was lower than is widely thought. When possible, data were checked with national data or other surveys and thought to be accurate. The difficulties in collecting data of this nature are discussed.     

Glycosylated haemoglobin concentrations in mothers of large babies.

Mothers who have big babies may have had abnormal glucose tolerance during pregnancy. Glycosylated haemoglobin (HbA1) concentrations were measured on the first or second day after delivery in 50 women who had had babies weighing over the 95th centile for gestational age and in 50 women who had had normal-sized babies (controls). Nine of the mothers of big babies but only one of the controls had an HbA1 concentration above the normal range. All the women had normal glucose tolerance and HbA1 concentrations six weeks after delivery. Measuring HbA1 concentration in the first two days after delivery in mothers of large babies may identify gestational diabetics.     

Cervical Cancer Screening among University Students in South Africa: A Theory Based Study

Introduction

Cervical cancer is a serious public health problem in South Africa. Even though the screening is free in health facilities in South Africa, the Pap smear uptake is very low. The objective of the study is to investigate the knowledge and beliefs of female university students in South Africa.

Methods

A cross sectional study was conducted among university women in South Africa to elicit information about knowledge and beliefs, and screening history.

Results

A total of 440 students completed the questionnaire. The average age of the participants was 20.39 years (SD  = 1.71 years). Regarding cervical cancer, 55.2% (n = 243) had ever heard about it. Results indicated that only 15% (22/147) of the students who had ever had sex and had heard about cervical cancer had taken a Pap test. Pearson correlation analysis showed that cervical cancer knowledge had a significantly negative relationship with barriers to cervical cancer screening. Susceptibility and seriousness score were significantly moderately correlated with benefit and motivation score as well as barrier score. Self-efficacy score also had a moderate correlation with benefit and motivation score. Students who had had a Pap test showed a significantly lower score in barriers to being screened compared to students who had not had a Pap test.

Conclusion

This study showed that educated women in South Africa lack complete information on cervical cancer. Students who had had a Pap test had significantly lower barriers to cervical cancer screening than those students who had not had a Pap test.     

Vaccinations and the physically handicapped child.

The vaccination status of 98 physically handicapped children was examined to identify factors associated with an inadequate vaccination status. Of the 98 children, 57 had cerebral palsy, 14 had myelomeningocele, 3 had muscular dystrophy and 24 had myelomeningocele, 3 had muscular dystrophy and 24 had other motor disabilities. According to the available vaccination records, only 17 children had received all the recommended injections on schedule; 26 had missed at least one injection, and 3 of them had never been vaccinated. The overall rate of vaccination in our study group (63%) was lower than expected. The children with moderate to severe limitation of function due to cerebral palsy were significantly less likely (P less than 0.05) than those with less severe limitations to have received a basic series of vaccinations. Health departments must ensure that physically handicapped children receive the preventive health measures viewed normal and appropriate for other children.     

Hemoglobinopathies in the Hamilton region. II. Thalassemia traits and iron therapy.

Between July 1973 and July 1974 all adult patients with hypochromic anemia and a mean corpuscular volume of 75 mum3 or less were screened for hemoglobinopathies. Of the 490 patients 105 had beta-thalassemia trait, 11 had alpha1-thalassemia trait, 4 had hemoglobin Lepore trait and 1 had hemoglobin H disease. Of 48 inpatients whose charts were reviewed 19 had been on oral iron therapy and 7 of them had been given iron intramuscularly. Of 27 outpatients interviewed 10 had been on intermittent iron therapy for 18 months or more; 4 had been given at least 1 g of intramuscular iron. Iron deficiency was not documented in any of these patients. Iron deficiency should be diagnosed by means other than the presence of a hypochromic picture in the peripheral blood before iron therapy is instituted, particularly in communities with a large population of Mediterranean or South-East Asian origin.     

Oesophageal cancer treatment in North East Thames region, 1981: medical audit using Hospital Activity Analysis data.

Figures from the Hospital Activity Analysis in the North East Thames region in 1981 were used to perform a medical audit on oesophageal cancer treatment. Four hundred and forty four patients were admitted with this diagnosis; 80 had been intubated without a thoracotomy or laparotomy, and 73 had had surgery (two thirds radical and one third palliative) with an overall operative mortality of 33%. Fifty five patients had had radiotherapy and 179 patients had no recorded operation or investigation. One hundred and seventy seven different consultants had looked after all these inpatients, most being general surgeons. Only five consultants had looked after 10 or more patients each year. From a calculated estimate of a total 286 patients in the region, 28% had palliative intubation and 25% had surgery; 20% of all the patients had radiotherapy either as a radical or palliative treatment, the remainder having no recorded therapeutic procedure. One hundred and eighty seven patients (66% of the calculated total) died in hospital. Investigation and treatment do not seem to be limited by lack of money, but money is being wasted by admitting patients for terminal care into acute hospital beds. It would be more humane for these patients to die at home or in a hospice if they wished.     

Value of Mammary Thermography in Differential Diagnosis

Thermographic examinations of the breasts were carried out in 359 women, most of whom had mammary symptoms. Of the 195 patients with abnormal thermograms, 27 had cancer of the breast, 53 had benign lesions, and 115 had no confirmed organic disease. The incidence of false-positive thermograms was 59%. Of the 164 patients with normal thermograms, 116 had no confirmed organic disease, 41 had benign lesions, and 7 had cancer. The incidence of false-negative mammary thermograms was 29%.We conclude that mammary thermography is of no practical value in the differential diagnosis of symptomatic mammary disease.