Calvary Riverina Hospital

Pro-inflammatory cytokines such as tumour necrosis factor alpha (TNF alpha) have been implicated in the pathogenesis of rheumatoid arthritis (RA), and have therefore become therapeutic targets. An engineered human antibody, CDP571, that neutralizes human TNF alpha was administered intravenously in single doses of 0.1, 1.0 or 10 mg/kg to patients with active RA (n = 24). The effects of the antibody were compared in a double-blind fashion with those of placebo (n = 12). In an open continuation phase patients were given either 1.0 or 10 mg/kg. We found that CDP571 was well tolerated and caused reductions in markers of disease activity such as erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP): this was confirmed by a reduction in the disease activity score (DAS). There was a reduction in the number of tender joints, maximal in degree and duration after 10 mg/kg. Patients also documented a reduction of pain and relief of arthritis symptoms. The effects of 10 mg/kg CDP571 on ESR, CRP, tender joints, pain and symptom relief compared to placebo were statistically significant at weeks 1 or 2. The continuation phase, although open, confirmed both the safety and the beneficial effects of CDP571 in active RA. In conclusion CDP571, an engineered human anti-TNF alpha antibody, is well tolerated and, after a single dose of 10 mg/kg, provides improvements in symptoms, signs and serological markers of disease activity in patients with active RA.

The momentum transfer cross section for electron-argon collisions in the range 0–4 eV has been derived from an analysis of recent measurements of DT/μ as a function of E/N at 294 K (Milloy and Crompton 1977a) and W as a function of E/N at 90 and 293 K (Robertson 1977). Modified effective range theory was used in the fitting procedure at low energies. An investigation of the range of validity of this theory indicated that the scattering length and effective range were uniquely determined ,and hence the cross section could be accurately extrapolated to zero energy. It is concluded that for ε ≤ 0.1 eV the error in !he cross section is less than ± 6 % and in the range 0.4 ≤ ε (eV) ≤ 0.4 the error is less than ± 8 %. In the range 0.1 < ε (eV) < 0.4 the presence of the minimum makes it difficult to determine the errors in the cross section but it is estimated that they are less than −20 %, +12 %. It is demonstrated that no other reported cross sections are compatible with the experimental results used in the present derivation.

A randomised prospective study of 407 primiparous patients compared the consequences of midline and mediolateral episiotomies. The patients' estimates of the pain from their episiotomies were similar. Anal sphincter injury was significantly more common after a midline procedure but no rectovaginal fistulae occurred. Scarring was less noticeable after the midline incision and intercourse began earlier.

Abstract This paper describes the morphology, sequential development and general sedimentology of concave‐bank benches on the Murrumbidgee River of southeastern Australia, and also notes their important role in floodplain formation on certain meandering rivers in western Canada. Benches form against the concave bank (cut‐bank) of abruptly curving bends immediately upstream of the point of maximum curvature. As a result of flow deflection against the upstream limb of the convex bank, the channel widens here and produces a zone of expanded flow facilitating flow separation near the upstream limb of the concave bank. Sedimentation within this zone starts with a longitudinal‐shaped bar of medium sand forming a platform isolated even at low flow by a narrow secondary channel against the concave bank. Aggradation of the longitudinal‐shaped bar with fine sand, mud and organic matter permits the establishment of trees. Further sedimentation, particularly around the young trees, results in the formation of a fully developed bench isolated by the secondary channel from the remainder of the floodplain only during high flows. Observations on confined meandering rivers in western Canada provide evidence of substantial floodplain formation by concave‐bank bench accretion, a process distinctly different in character to the more familiar mechanism of lateral point‐bar accretion. Furthermore, the preservation of abundant organic debris means that extensive bench deposits may be a source of locally useful natural gas from within floodplain sediments.

Occupational repetition strain injuries (RSI) are a major, unchecked source of disability in industry and commerce, and have considerable social and economic consequences. The long-term morbidity associated with these injuries is preventable, but a coordinated approach to awareness, diagnosis, management, and prevention has been lacking. Confusing diagnostic terminology on medical certificates makes it difficult to obtain accurate data on the incidence and prevalence of different types of repetition injury. The terminology in use at present includes RSI, "tenosynovitis" and "overuse injury". Uniformity of diagnosis on an anatomical basis in relation to repetition or static load would greatly assist in epidemiological study, and improve notification and the impact of prevention programmes. Therefore, the Occupational Repetition Strain Injuries Advisory Committee, which was convened by the Division of Occupational Health, New South Wales Government Department of Industrial Relations, has prepared a set of guidelines for the diagnosis and management of these injuries.

SUMMARY Ammonia volatilization from granular urea applied at 10gNm −2 to pasture was investigated using an enclosure method. Misting 0, 4 or 16 mm of water on to the soil at field capacity within 3 h of urea application resulted in total NH 3 losses of 2.81, 0.92 and 0.18 g N m −2 respectively. Further delaying the watering reduced this effect until at 48 h, volatilization was lowered from 3.33 to only 3.09gNm −2 with 16mm of water. Hydrolysis and NH 3 loss were rapid. Similar trends occurred at a lower initial soil moisture content. On air‐dry soil (0.06 g H 2 O/g soil), hydrolysis was slow (73 ± 14% of the urea remained after 30 days) and volatilization, while gradual, accounted for 33% of applied urea‐N after 30 days. Addition of 16 mm of water 48 and 96 h after urea application was followed by a period of rapid hydrolysis and volatilization, resulting in a total loss of 2.59 and 2.40gNm −2 respectively. Repeated addition of 2mm of water produced bursts of hydrolysis and NH 3 loss until completion of hydrolysis when additional water had no effect. A total loss after 30 days of 3.94 g N m −2 occurred in this 2 mm treatment.

The importance of the direct perforating veins of the lower leg in the aetiology of venous ulceration is supported by the results of a 6-year study of 77 patients with 109 ulcerated legs. Incompetent perforating veins were demonstrated by examination and Doppler ultrasound, and confirmed at operation, in 108 legs. Subfascial ligation of these veins, with stripping of incompetent saphenous veins when necessary, was followed by elastic compression stockings in 44 legs (40 per cent) in which deep vein incompetence was demonstrated by non-invasive methods and phlebography. Some 91 ulcers (84.3 per cent) remain healed (76 per cent greater than 3-year follow up). Eight patients with rheumatoid arthritis in addition to venous incompetence had a 75 per cent failure rate. If these patients are excluded, 88 (92 per cent) of 96 ulcerated legs remain healed. It is submitted that these results support the argument for the importance of perforating vein incompetence in the aetiology of venous ulceration. They also suggest that a more optimistic attitude towards treatment is justified.

A simple method of assessing 'index of disease activity' (IDA) in rheumatoid arthritis (RA) using a multivariate analysis (MVA) comprising morning stiffness (MS), pain scale (PS), grip strength (GS), articular index (AI), haemoglobin (Hb) and erythrocyte sedimentation rate (ESR) is described. The IDA of 99 patients with RA was assessed using MVA. The method could be used reliably and readily for random or longitudinal assessment, in drug trials and for comparing disease activity with other objective indices.

Seventy eight schoolboys became ill after eating potato at lunch on the second day of the autumn term. Seventeen of the boys required admission to hospital. The gastrointestinal, circulatory, neurological and dermatological findings and the results of laboratory investigations were in keeping with solanine poisoning. The illness affected the junior boys and all the monitors but no other senior boys or staff. This pattern was compatible with the consumption of a relatively small number of toxic potatoes believed to have come from a bag (A) left in the stores since the summer term. The amount of solanine in potato waste recovered after the meal was excessive as assessed by its anticholinesterase activity. The amount of alpha-solanine and alpha-chaconine in the flesh and peel of potatoes from a bag (B) known to have been left from the previous term was high. The anomalously narrow margin between the solanidine alkaloid content reported for normal and toxic potatoes might perhaps result from an excessive synthesis by the latter of additional, related steroids, such as sapogenins and saponins, which, by promoting gastrointestinal absorption or other means, might enhance the toxicity of solanidine alkaloid.

To document the clinical features and complications of fulminant hepatic failure in childhood, 31 consecutive cases (of whom only 9 survived) were reviewed. Of 26 children with acute hepatitis (HbSAg-negative), liver function steadily deteriorated in all but 2, and encephalopathy occurred within 3 weeks of the onset of symptoms in all except 3 of them. Eight of these patients survived, as did one of 3 in which this deterioration was caused by paracetamol overdosage. Single cases due to <i>Amanita phalloides</i> and halothane died. Encephalopathy lasted from 2 to 16 days in the survivors, and from one to 20 days in the fatal cases. The severity fluctuated by more than one grade in 9 patients. The outcome was not related to the age or sex of patient, clinical or biochemical abnormalities at presentation, or to the duration of the encephalopathy. Prothrombin time was prolonged by more than 90 seconds in 10 fatal cases, but in none of the survivors. The outcome was related to the severity of the encephalopathy, only one (6%) of 19 children in grade 4 coma surviving, and to the occurrence of neurological complications—particularly brain stem dysfunction (9 cases), decerebrate posturing (12 cases), and convulsions (7 cases). Massive gastrointestinal bleeding (14 cases) and renal failure (10 cases) were confined to the fatal group. At necropsy 7 (54%) of 13 had cerebral oedema. Hypoglycaemia, septicaemia, respiratory tract infections, ascites, and haemopoietic complications occurred both in fatal cases and survivors. Although liver function tests and liver biopsy appearances remained abnormal in survivors for 24 and 30 months respectively, these children developed normally without evident disease during or after this period. Children with fulminant hepatic failure and severe encephalopathy develop major pathophysiological complications affecting almost every system. Such complications must be prevented or vigorously treated. The mortality is no lower than in adults. Effective treatment must be instituted before grade 4 coma is established.

This paper reports on a study of psychiatric morbidity in 920 patients attending 18 General Practitioners in Lewisham, South East London. Two indices of morbidity were computed on the basis of the patients responses to the General Health Questionnaire (GHQ) and the GPs' own estimates. Indices of the GPs' detection ability were found by comparing questionnaire and GP rating. The results are compared to those obtained by other workers in a sample of Manchester GPs. The GHQ gave a prevalence estimate of 42.9% which is comparable to that of 39.6% obtained in the Manchester study. In addition, the variation in caseness across sociodemographic groups was consistent with the Manchester findings. The GPs' estimates of morbidity, while much lower than those obtained in Manchester, have similar sociodemographic profiles. The results support the use of the GHQ as a screening device in epidemiological studies, and suggest the need for further investigation of the individual GP's performance as a case detector.

Not all laterally accreting facies are point bar in origin. On confined meandering rivers where concave benches are commonly associated with rapid channel migration, appreciable amounts of fine sand and mud can be deposited by within-channel lateral accretion of concave benches. Concave benches develop against the upstream limb of the concave bank of abruptly curving meander bends, and are formed of mainly fine suspended load deposited within the channel below the riffle in the upstream end of the pool. Erosion of the upstream limb of the convex bank widens the channel, producing a zone of expanded flow which facilitates flow separation near the upstream limb of the opposite concave bank. A platform of sand in the form of a longitudinal-shaped bar is deposited in this zone, followed by further aggradation with fine sand, mud and organic matter. Even when fully formed, at high flow the concave bench remains isolated from the rest of the floodplain by a secondary channel around the margin of the original concave bank of the main channel. With the continued downvalley migration of the meander bend, another concave bench is formed, and this process continues until eventually a new floodplain surface is locally created by the lateral accretion of these benches.

Two established methods (active posterior and passive anterior rhinomanometry) and 2 new methods (peak nasal inspiratory flow rate and apparent nasal volume) were used in 12 volunteers to assess the patency of the nasal airways under each of 4 conditions (baseline, post-exercise, nasal histamine and nasal cocaine). All methods showed the congestant effect of histamine but the peak nasal inspiratory flow and apparent nasal volume techniques were more sensitive to the 'decongesting' manoeuvres, (exercise and cocaine). Useful objective quantitative data on the patency of the nasal airways and its changes in response to stimuli can be obtained by simple, cheap and readily available techniques. Subjective sensation is a poor guide to the state of patency of the nasal airways.

Attempts were made to identify, and include in a two-year follow-up study, every patient living in the catchment area of the Mapperley group of psychiatric hospitals in Nottingham (population 390,000) who made their first-ever contact with the psychiatric services for a potentially schizophrenic illness during a two-year period (1 August 1978 to 31 July 1980). Screening was based upon symptoms rather than diagnosis, covering both in-patient and out-patient services; a consensus diagnosis using ICD-9 was made by the project team. The Nottingham Psychiatric Case Register was used in a retrospective Leakage Study which added nine cases to the 99 identified by the screening procedures. Incidence rates are given for both broad and narrow concepts of schizophrenia, and for DSM-III diagnosis. The Nottingham incidence rates are similar to those reported from other UK centers, and are near the middle of the range found in the other collaborating centres in the WHO study on Determinants of Outcome of Severe Mental Disorders. At entry to the study, 27 patients were out-patients, and 11 were never admitted to hospital at any time in the two-year follow-up period. Reasons for believing that the Nottingham administrative incidence may be close to the incidence in the community are discussed.

BACKGROUND AND AIMS: Dietary microparticles, which are bacteria-sized and non-biological, found in the modern Western diet, have been implicated in both the aetiology and pathogenesis of Crohn's disease. Following on from the findings of a previous pilot study, we aimed to confirm whether a reduction in the amount of dietary microparticles facilitates induction of remission in patients with active Crohn's disease, in a single-blind, randomized, multi-centre, placebo controlled trial. METHODS: Eighty-three patients with active Crohn's disease were randomly allocated in a 2 x 2 factorial design to a diet low or normal in microparticles and/or calcium for 16 weeks. All patients received a reducing dose of prednisolone for 6 weeks. Outcome measures were Crohn's disease activity index, Van Hees index, quality of life and a series of objective measures of inflammation including erythrocyte sedimentation rate, C-reactive protein, intestinal permeability and faecal calprotectin. After 16 weeks patients returned to their normal diet and were followed up for a further 36 weeks. RESULTS: Dietary manipulation provided no added effect to corticosteroid treatment on any of the outcome measures during the dietary trial (16 weeks) or follow-up (to 1 year); e.g., for logistic regression of Crohn's disease activity index based rates of remission (P=0.1) and clinical response (P=0.8), in normal versus low microparticle groups. CONCLUSIONS: Our adequately powered and carefully controlled dietary trial found no evidence that reducing microparticle intake aids remission in active Crohn's disease.

Summary The blood of a Puerto Rican, of a West Indian Negress and of several members of a Baltimore Negro family is described. The red cells of these people are apparently of the phenotype i and their serum contains anti‐I. The samples differ somewhat from that of the English i donor of Jenkins et al . (1960): their red cells are not quite so weak in I antigen and the anti‐I in their serum is more restricted in range. The anti‐I in the serum of the Puerto Rican is outstanding because it contains what may be called a pseudo anti‐A 1 . None of the five anti‐I sera described in this paper agglutinates cord cells. I seems to be a graded character, in this respect somewhat like H; its possible relationship to other systems is discussed. The Baltimore family provides the first evidence that the I antigen is under genetic control. Résumé Les auteurs décrivent les sangs d'un portoricain, d'une femme de race noire de l'Inde occidentale et de plusieurs membres d'une famille de race noire de Baltimore. Les érythrocytes de ces personnes sont vraisemblablement du phénotype i et leur sérum contient de l'anti‐I. Ces sangs diffèrent quelque peu de celui du donneur anglais de phénotype i décrit par Jenkins et al. (1960): la contenance en anti‐gène I e leurs érythrocytes n'est pas aussi faible et l'anti‐I présent dans leur sérum se révèle avoir un champ d'activité de moindre importance. En outre, l'anti‐I du sérum du sujet portoricain présente la particularité de contenir ce que Yon peut appeler un pseudo anti‐A 1 . Aucun des cinq anti‐I décrits clans ce travail n'agglutine les érythrocytes provenant du sang du cordon. L'antigène I semble être un caractere se manifestant à des degrés de force diverse, comme l'antigène H; les auteurs discutent des rapports possibles de cet antigène avec les antigènes d'autres systèmes. La famille de Baltimore apporte pour la première fois la preuve que l'antigène I est conditionné selon les lois de la génétique. Zusammenfassung Die Blutproben eines Spenders aus Puerto Rico, einer westindischen Negerin und diejenigen einer Negerfamilie aus Baltimore werden beschrieben. Die Erythrozyten dieser Individuen weisen offensichtlich den Phänotypus i auf; ihr Serum enthält Anti‐I‐Antikörper. Die Blutproben zeigen gegenüber derjenigen des englischen von Jenkins et al . (1960) beschriebenen Spenders gewisse Unterschiede. Der Gehalt an I‐Antigen dieser Zellen war nicht ganz so gering wie beim erwähnten englischen Spender. Auch war der Wirkungsbereich ihrer Anti‐I‐Seren geringer als beim englischen Spender Als Besonderheit enthielt das Anti‐I‐Serum des Spenders aus Puerto Rico eine Antikörperfraktion, welche als Pseudo‐Anti‐A 1 zu bezeichnen ist Keines der 5 in dieser Arbeit erwähnten Seren vermochte Nabel‐schnurerythrozyten zu agglutinieren Beim I‐Antigen handelt es sich ähnlich wie beim H‐Antigen um eine Blutgruppeneigenschaft, die in den Erythrozyten in wechselnder Stärke enthalten ist. Die Familie aus Baltimore bot erstmals einen Hinweis dafür, daß das I‐Antigen genetisch determiniert ist

The drift velocity of electrons in argon has been measured at 90 K in the range 0·002 ,;;; E/ N (Td) :.;; 0·7 and at 293 K in the range 0·01 ,;;; E/N (Td) ,;;; 1·0. The high sensitivity of the drift velocities to the presence of small quantities of diatomic impurities, particularly nitrogen, was demonstrated by adding known but trace quantities of diatomic gases. In this way it was observed that the presence of 6 p.p.m. nitrogen in the argon gave errors in the drift velocity of up to 3 %. As a result it was necessary to purify research grade gas before use. A full discussion is given of the errors incurred in the measurements.

BACKGROUND: People with learning disabilities and mental health problems have complex needs. Care should be provided according to need. AIM: To develop a standardised needs-assessment instrument for adults with learning disabilities and mental health problems. METHOD: The Camberwell Assessment of Need for Adults with Developmental and Intellectual Disabilities (CANDID) was developed by modifying the Camberwell Assessment of Need (CAN). Concurrent validity was tested using the Global Assessment of Functioning (GAF) and the Disability Assessment Schedule (DAS). Test-retest and interrater reliability were investigated using 40 adults with learning disabilities and mental health problems. RESULTS: CANDID scores were significantly correlated with both DAS (P < 0.05) and GAF scores (P < 0.01). Correlation coefficients for interrater reliability were 0.93 (user), 0.90 (career), and 0.97 (staff ratings); for test-retest reliability they were 0.71, 0.69 and 0.86 respectively. Mean interview duration was less than 30 minutes. CONCLUSIONS: The CANDID is a brief, valid and reliable needs assessment instrument for adults with learning disabilities and mental health problems.

Solanidine, a steroidal alkaloid, and its glycosides have been reported to have caused poisoning in man and animals. These alkaloids are normally present in small amounts in potatoes. Measurement of solanidine in body fluid would be expected to establish the real incidence of acute toxicity and help to resolve the question of any chronic toxicity including teratogenicity. We report the detection of solanidine in the serum of 57 normal healthy volunteer subjects in whom it measured 4.0-56.3 nmol/l (1.6-22.5 ng/ml) before the midday meal. There was a significant correlation between serum solanidine concentration and normal dietary intake of potato by the individual concerned. When two subjects abstained from potato and its products serum solanidine fell markedly and became minimal after the second week onwards.

Radiotherapy is an available treatment for management of basal cell carcinoma (BCC). This study aims to analyse the published literature about radiotherapy in treatment of BCC. A focus of this study will be to compare the dosing regimens adopted in these studies. A search of the Medline database was conducted from 1984 to August 2013. Search terms used were 'basal cell carcinoma', 'radiotherapy', 'epithelial skin cancer' and 'external irradiation'. Fourteen studies on the use of radiotherapy for BCC were included. Seven studies included only cases of BCC, while six studies also included patients treated for squamous cell carcinoma. The overall cure rates ranged from 79·2% to 100%. More than 90% of the patients reported good or excellent aesthetic outcome from radiotherapy (three studies). There was a wide variation in the total dose and dose per fraction of radiotherapy used. Nine studies utilized dosing regimens within the recommended guidelines of the National Comprehensive Cancer Network. There are a limited number of high-quality prospective studies of radiotherapy for BCC. Based on the available evidence, radiotherapy provides a high rate of local control with low rates of complications that are comparable with surgery.