The effect of acidic fibroblast growth factor and live yeast cell derivative on tympanic membrane regeneration in a rat model

The current treatment of choice for chronic tympanic membrane perforations is surgery. Recent studies using various polypeptide growth factors to accelerate closure of tympanic membrane perforations in model systems have produced mixed results. This study evaluates the effect of acidic fibroblast growth factor (AFGF) and live yeast cell derivative (LYCD) on the rate of healing of acute tympanic membrane perforations in a rat model. Thirty-seven rats had both ears separately randomized in a blinded fashion to receive AFGF in one of three concentrations, LYCD, or a control solution. The rats initially underwent subtotal removal of the tympanic membranes bilaterally. Solutions were applied to the randomized ears daily for 3 days, starting at the time of the surgical perforation. The ears were photographed every 3 to 8 days for 35 days. The photographs were digitally scanned and a computer analysis was used to calculate the percentage of residual perforation. No significant difference in the rate of healing was observed for ears treated with AFGF or LYCD versus the controls. Given the potential advantages of medical treatment of tympanic membrane perforations and the established efficacy of growth factors in other model systems, however, further research is warranted. (Otolaryngol Head Neck Surg 1997;117:616-21.)     

DIFFERING EFFECTS OF CARBOHYDRATE, FAT AND PROTEIN ON THE RATE OF ETHANOL METABOLISM

The rate of metabolism of ethanol in humans has been assessedby intravenous infusion of ethanol/saline under feedback controlto maintain a constant blood alcohol concentration. After equilibration,meals consisting predominantly of carbohydrate, fat or proteinwere eaten and changes in ethanol metabolic rate were found.Carbohydrate caused a significant increase in this rate andfat or protein caused small but non-significant decreases. Infusionof ethanol/saline resulted in a temporary fall in plasma freefatty acid levels and a steady rise in plasma triglycerides.The changes in alcohol metabolism following carbohydrate cannotbe accounted for by changes in insulin, free fatty acid or lactate/pyruvatelevels.     

Effects of Dihydrotestosterone and Estradiol on Experimental IgA Nephropathy Induced by Vomitoxin

Ingestion of the trichothecene vomitoxin (VT) by mice induceseffects that mimic the common human glomerulonephritis, IgAnephropathy (IgAN). These include elevation of serum IgA, IgAimmune complexes, and mesangial IgA deposition. Based on previousobservations that male mice are more prone to VT-induced IgAN,the effects of castration of male and female B6C3F1 mice andsex hormone supplementation on several immunopathologic indicatorsof the disease were compared. In the first study, castratedand intact male and female mice were fed control AIN-76A dietor the same diet containing 10 ppm VT for 12 weeks. At Week12, all but the intact female group fed VT exhibited increasedserum IgA, with castrated female mice having greater levelsthan intact females. When microscopic hematuria was used asan indicator of disease severity in intact VT-fed mice, erythrocytecounts for males exceeded those for females at weeks 4 and 12.VT-fed, castrated females exhibited greater hematuria than intactcounterparts, whereas VT-fed, castrated males had lower urinaryerythrocyte counts than intact counterparts. In a second study,castrated male and female mice were implanted with controlledrelease pellets of placebo, 5-dihydrotestosterone (DHT), or17ß-estradiol (E₂) and then were fed either controldiet or a 10 ppm VT diet for 8 weeks. Castrated male and femalemice treated with VT and DHT pellet exhibited more severe hematuria,higher IgA levels, and greater mesangial IgA deposition thanmice exposed to the same diet with placebo or E₂ pellet at Week8. While VT-fed animals with an E₂ pellet exhibited greaterhematuria and mesangial IgA deposition at Week 8 than the placebogroups, their IgA levels were not significantly elevated overthose for VT-fed mice with a placebo pellet. Relative to twoother pathologic markers for IgAN, the aforementioned effectsin both studies were generally consistent with mesangial depositionof complement component C₃ but not IgG. The results suggestthat (1) enhanced male susceptibility to VT-induced IgAN maybe related to modulation by the biologically active androgenDHT and (2) while castration of females increased severity ofVT-induced IgAN, supplementation of castrated male or femalemice with E₂ did not reverse this effect but rather increaseddisease severity.     

Ethnic Minority Elders in the UK

This article looks at the current literature on minority ethnic elders and mental health problems in the UK. It raises fundamental problems in definition, since the literature contains great variations in definitions of ethnicity and old age. It relates issues concerning ethnicity with gender, geography and family structure. In the second part of the article, the authors review the influential theory of triple jeopardy and discuss the interplay of views about cultural factors and medical responses to health and illness in this context. Communication is used as an example of a commonly held problem but it is argued that language problems are often over-simplified and over-generalized. The authors consider broad questions of access to psychiatric services for minority ethnic elders, then focus on diagnostic difficulties with dementia and depression to illustrate particular problems. The article concludes that there is a general lack of research from the UK about ethnic elders and mental health, in particular about coping strategies and strengths among individuals, families and communities. The authors argue that attention to definitions may also be fruitful for policy-makers and researchers.     

Nurse-led case management for community dwelling older people: an explorative study of models and costs

Aim To compare community matrons with other nurses carrying out case management for impact on service use and costs. Background In England, nurses working in general practice, as district nurses and disease-specific nurses, undertake use case management. Community matrons were introduced to case management to reduce unplanned hospitalizations of people with complex conditions. Methods Managers in three Primary Care Trusts (PCTs) identified four nurses/matrons engaged in case management. Nurses/matrons recruited five community-dwelling patients referred to them for case management. Patients reported use of health/social services for 9 months, 2008 to 2009. Nurses/matrons completed activity diaries. Results Service use data were available for 33 patients. Compared with other nurse case managers, community matrons had: smaller caseloads; more patient contact time (mean 364 vs. 80 minutes per patient per month); and older patients (mean age 81 vs. 75 years, P = 0.03) taking more medications (mean 8.9 vs. 5.6, P = 0.014). Monthly costs were significantly higher for patients managed by community matrons (add £861), and who lived alone (add £696). Hospitalizations were not associated with patient or service delivery factors. Conclusion Further research on cost-effectiveness of case management models is required. Implications for Nursing Management The case for continued investment in community matrons remains to be proven.     

Mitochondrial diseases in childhood: a clinical approach to investigation and management

Mitochondrial diseases are a common cause of inherited neurological disorders in children. Although dysfunction of the central nervous system is prominent, multisystem involvement also occurs. Diagnosis relies on characteristic clinical features, an understanding of mitochondrial genetics, and a logical, informed approach to investigations. There is a significant body of recent literature on advances in mitochondrial genetics and the investigation of mitochondrial diseases. However, to our knowledge there remains a paucity of published information on the management of these disorders. Management of the complex constellation of neurological and multisystem clinical features is challenging, and is reliant on a multidisciplinary approach. The care of the child and family is dependent on clear communication between health professionals from primary, secondary, and tertiary care as well as specialist input from quaternary services. The aim of this review is to provide paediatric neurologists, paediatricians, and allied health professionals with a structured approach to the diagnosis and management of children with suspected or confirmed mitochondrial disease.     

Professional integration within health centre pharmacies

□ The National Health Service plan proposes 500 new one‐stop centres to include pharmacy □ Little is known about current activities in health centre pharmacies □ A self‐completion survey of a sample of identifiable health centre pharmacies has been carried out □ There is some evidence of integration of pharmacists within the practice team □ Increased integration will require proactive external input     

MALIGNANCY GRADE and LONG-TERM SURVIVAL IN BRAIN TUMOURS of INFANCY and CHILDHOOD

281 histologically verified brain tumours in children were revised and reclassified according to degree of histological malignancy. Survival graphs based on 100 per cent follow-up after 15-40 years show that, of those who survived for more than 1 month after diagnosis and possible operation, 40 per cent were still alive more than 15 years later. There was a clear correlation between survival and degree of malignancy. Sixty-five per cent of those with tumours of malignancy grade I and only 3 per cent of those with malignancy grade IV were alive after 15 years.