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Objective: To examine the impact of polycystic ovaries (PCO) on bone mineral density in amenorrheic women of reproductive age., Design: A retrospective analysis and comparison of polycystic ovarian syndrome (PCOS) with non-PCOS amenorrheic women. A subgroup of patients with ultrasound (US)-diagnosed PCO was also investigated., Setting: Specialist clinic in reproductive endocrinology., Patients, Participants: Six hundred ten consecutive cases, mean age of 29.8 +/- 7.5 years, with current history of amenorrhea of various causes., Main Outcome Measure: Bone mineral density in the lumbar spine (L1 to L4) as measured by dual energy x ray absorptiometry, in relation to PCOS, US-diagnosed PCO, and US findings of normal ovaries., Results: Amenorrheic patients with PCOS were found to be younger (P less than 0.001), with higher body mass index (P less than 0.001), were more estrogenized, as measured by endometrial thickness and uterine cross-sectional area (P less than 0.001), and had higher bone mineral density (P less than 0.001) compared with non-PCOS amenorrheic patients., Conclusions: Patients with amenorrhea because of PCOS and those with US-diagnosed PCO have a higher bone density compared with amenorrheic patients with normal ovaries as detected by US scan.

Salmonella arizonae are rarely isolated in the UK. Since 1966 there have been sixty-six isolates from humans of whom 35% gave a recent history of foreign travel. Terrapins and snakes are potential sources of infection.

Aims: To report the incidence of nontyphoidal salmonellas in England and Wales and identified in the Division of Enteric Pathogens, London between 1981 and 1990., Methods: Strains were serotyped and phage typed for Salmonella typhimurium, S enteritidis, and S virchow, using established methods., Results: Overall, less than 2% of nontyphoidal salmonellas isolated from humans were from blood culture. The highest numbers of bloodstream isolates were from infections caused by S enteritidis and S typhimurium, but the highest incidence of septicaemias was attributable to infections with S cholerae-suis, S dublin, and S virchow. 2.2% of S typhimurium isolates phage type 204C were from blood culture; likewise, 5.5% of S virchow phage type 19. This could be a cause for concern as most isolates of both these phage types are multiresistant to antimicrobial drugs., Conclusions: Salmonella septicaemia is rare in England and Wales in other than a few serotypes of limited epidemiological importance.

Sixteen plasmid profile types have been identified in drug-sensitive isolates of Salmonella berta isolated from humans and human food in England and Wales in the ten-year period 1981-1990. Since 1988 six profile types of epidemiological importance have caused infections in widely-separated geographical areas and of these, four types have been identified in S. berta isolated from chicken carcasses imported from Denmark. The findings suggest that imported Danish poultry has substantially contributed to a recent upsurge of S. berta in humans in England and Wales.

Osteoporosis is a recognized complication following partial gastrectomy and is more common than osteomalacia. Recent improvements in the measurement of bone mineral status (dual energy X-ray absorptiometry, DEXA) have assisted in measuring osteoporosis. Sixteen men who had undergone gastrectomy more than 30 years previously were examined. This study reports the effect of calcium supplementation in six patients in whom osteomalacia had been excluded and who showed abnormally low bone mineral densities on DEXA scanning. Calcium supplementation for 6 months (microcrystalline hydroxyapatite, Ossopan 8-32 g per day) produced no significant advantage for the treatment group at any site measured.

A national outbreak of salmonellosis caused by a rare serotype occurred between July and November 1989. A total of 40 cases of Salmonella manchester infection were identified by the PHLS Division of Enteric Pathogens with a further 7 cases reported from Scotland. The median age of those affected was one year. All strains from the outbreak carried a 70mDal plasmid with a distinctive restriction endonuclease. A statistical association was found between infection and consumption of nationally distributed savoury corn snacks. Samples of autolysed yeast powder and flavourings used in the manufacture of many processed foods were also found to be positive for S. manchester.

It is commonly assumed that there is minimal variation between the hips in an individual, but is densitometry of one femur representative of the other? We performed bone mineral density (BMD) measurements of both hips using a Hologic QDR 1000 densitometer. There were 110 patients, all of whom were right handed, and three main groups of subjects: (1) normal volunteers (n = 36); (2) subjects with known hip pathology (n = 36); (3) subjects with medical conditions not affecting the hip (n = 38). The mean age of the subjects was 46 (21-87) years and a standard analysis protocol was followed in all patients. The coefficient of variation (COV) for femurs was 0.9-3%, depending upon the region studied and the BMD. The left femur had a greater BMD 48% of the time and there were variable differences between femurs in each group studied. While the greatest differences were found in people with unilateral hip pathology, all groups had mean differences greater than the COV. It may be acceptable to study only one hip, but the large variation between femurs in individuals should be borne in mind when interpreting data.

Objective: To examine the impact of amenorrhoea on bone mineral density in women of reproductive age., Design: Cross sectional study of 200 amenorrhoeic women compared with normally menstruating controls., Setting: Teaching hospital outpatient clinic specialising in reproductive medicine., Subjects: 200 Women aged 16-40 with a past or current history of amenorrhoea from various causes and of a median duration of three years, and a control group of 57 age matched normal volunteers with no history of menstrual disorder., Main Outcome Measure: Bone mineral density in the lumbar spine (L1-L4) as measured by dual energy x ray absorptiometry., Results: The amenorrhoeic group showed a mean reduction in bone mineral density of 15% (95% confidence interval 12% to 18%) as compared with controls (mean bone mineral density 0.89 (SD 0.12) g/cm2 v 1.05 (0.09) g/cm2 in controls). Bone loss was related to the duration of amenorrhoea and the severity of oestrogen deficiency rather than to the underlying diagnosis. Patients with a history of fracture had significantly lower bone density than those without a history of fracture. Ten patients had suffered an apparently atraumatic fracture., Conclusions: Amenorrhoea in young women should be investigated and treated to prevent bone mineral loss. Menopausal women with a past history of amenorrhoea should be considered to be at high risk of osteoporosis.

Dual energy x ray absorptiometry and a wide range of blood and urine tests were used to assess the propensity of patients with systemic lupus erythematosus to develop an impairment of bone mineral density. Surprisingly, in this preliminary study no significant differences in bone mineral density were found when patients taking 10 mg or more of prednisolone for six months or longer were compared with those who had never taken prednisolone.

A study to determine the range of bone density in British females was carried out on a group of 165 normal women. The results showed an increase in mineral content with peak values occurring in the fourth decade (mean 1.06 g/cm2; 95% confidence limits 0.783-1.343) and subsequent decline with increasing age. There was no significant effect from any risk factor but strict exclusion criteria were applied. The results from each age group were compared with those from the USA and showed a difference in the timing of peak bone density (third decade for the USA). Age-matched, clinically well-defined normal controls should be used for comparison with groups of patients in future studies.

Between 1969 and 1974, 1467 packets (3309 samples) of pork sausages and sausage meat produced by two large and two medium sized manufacturers and several local butchers were examined for the presence of salmonellas. Of these, 435 packets (786 samples) were found to contain salmonellas, but there was a wide variation in the isolation rates according to the producer. The salmonella incidence in samples from several small and two medium sized producers was low (0-11%) while the results from the two large producers investigated showed a striking difference, the rate of salmonella contamination in the product of one was low (about 2%) and in that of the other consistently high (40-60%). A comparison of liquid enrichment media, incubation temperatures and selective agar media was also carried out to determine the most efficient combination for the isolation of salmonellas from minced meat products. The results showed that (a) incubation of enrichment cultures at 43 degrees C. yielded a consistently greater number of salmonella isolations that at 37 degrees C., regardless of plating medium, (b) tetrathionate broth A (Rolfe) was superior to selenite broth as en enrichment medium at both 37 and 43 degrees C. and (c) brilliant green agar gave better results than deoxycholate citrate sucrose agar and bismuth sulphite agar as a selective medium.

Four distinctive plasmid profile types have been identified in strains of Salmonella gold-coast isolated in Britain. Strains of one type, designated plasmid profile type 4, caused an extensive outbreak of food-poisoning in 1984, and it has been confirmed that the vehicle of infection was imported French pâté.

Salmonella hadar is now the second commonest serotype isolated from cases of food poisoning in England and Wales. Turkeys are the main reservoir of the organism and there is an urgent need to eradicate it from the breeding stocks; though this would be expensive, the cost must be balanced against the cost of treating the human disease.

Capital planning is a necessary framework for ensuring the financial and strategic viability of a healthcare organization. The organization that can respond to the marketplace with logical and informed financial decisions will have a significant competitive edge. Internally, the capital plan can help to provide focus and momentum to the overall strategic plan by creating a bridge between strategies and action. Capital planning enables management to gain control of the capital acquisition process and proceed confidently toward its goals.

We describe a case of acute hemorrhagic pulmonary edema caused by aspiration of Adolph's meat tenderizer, used in an attempt to relieve an esophageal meat impaction. We performed an animal experiment in which bronchial instillation of a similar solution reproduced the clinical findings in our patient. This is a previously unreported and potentially lethal complication of a therapy that has never been submitted to clinical trials. We recommend against the use of this therapy for patients with complete esophageal obstruction or in those otherwise at risk for aspiration.

This paper was a review of 2,210 deliveries in a community hospital in which electronic fetal monitoring was used. Patients were evaluated from three different types of group practices-health maintenance organization, fee-for-service, and clinic populations. Electronic fetal monitoring was used in 48%, 41%, and 70% of these groups, respectively. The respective cesarean section rates were 13%, 20%, and 10%. Monitored and nonmonitored, high- and low-risk groups were identified. A higher cesarean section rate for cephalopelvic disproportion was found in the monitored groups. However, this difference was most marked in the fee-for-service group. Perinatal morbidity and mortality results did not differ significantly among the three groups despite differences in electronic fetal monitoring use and cesarean section rates. The use of electronic fetal monitoring did not correlate with the cesarean section rate. Reasonable perinatal morbidity and mortality are compatible with relatively high electronic fetal monitoring rates (70%) and low cesarean section rates (10%). Within certain groups, use of electronic fetal monitoring may increase the cesarean section rate because of an increased diagnosis of cephalopelvic disproportion.

Geological studies of Española (Hood) Island, Galápagos, Ecuador, indicate that the island had a subaerial rather than a submarine origin. Because the younger lava flows are dated at 3 million years, Española has apparently existed as an island for at least that long. Thus terrestrial life may have existed or arrived on the Galápagos Islands at least 3 million years ago, more than twice as long as had been assumed.

A total of 98 patients with chest pain and no prior history of organic heart disease underwent a structured psychiatric interview at the time of cardiac diagnostic testing, either coronary arteriography or exercise treadmill. Patients with negative cardiac test results were significantly younger and more likely to be female, endorsed a greater number of autonomic symptoms with their chest pain, and were more likely to report atypical chest pain. These patients had significantly higher scores on measures of anxiety and negative life events and significantly greater prevalences of DSM-III panic disorder (47% vs. 6%), major depression (39% vs. 8%), and two or more simple phobias (43% vs. 12%) than did patients with cardiac test results demonstrating coronary artery disease. Using logistic regression, a model was developed to estimate the probability of negative cardiac test results from patient characteristics and psychiatric diagnoses.

Of 120 specimens of garden fertilizers of animal origin purchased in retail shops, 40 (33.3%) were found to be contaminated with salmonella organisms. Untreated bone meal (53.1%) was the most heavily contaminated but 25% of specimens of this product classed as heat-treated or sterilized were positive. In all, 32 serotypes were identified.

Samples derived from farm livestock, an abattoir and a bone factory, were examined for salmonella. Twenty-seven serotypes were detected in 130 infected samples. A bone factory product was heavily infected. Salmonellosis is considered to be an important disease of dromedary calves and poultry in Ethiopia.

A new salmonella subgenus I serotype is described. Strein C.S. 1608/73, serotype 67:R:1, 2, was isolated from activated sewage sludge and was assigned the name S. crossness. The serotype is biochemically atypical in its ability to utilize sucrose and this ability appears to be controlled by a transferable plasmid.

This paper has reviewed research and other papers that have furthered our understanding of the impact of the presence of a child with sickle cell disease on the family. The research suggests that the primary parent in such a family experiences additional emotional strain much like primary parents of children with other chronic illnesses have been found to exhibit. The research also suggests that the ill child's presence influences interpersonal relationships within the family. Specifically, there is some evidence that the relationship between the parents and the relationship between the parent and other offspring may be affected adversely. The only evidence for an adverse impact on the relationship between the parent and the chronically ill child was in our research when considering only single-parent families. The research also suggests that the family environment is affected. In particular, the research suggests that the level of conflict and organization within the family was less favorable than within the control families. Moreover, the research suggests that the child's presence reduces the ability of the primary parent to participate in social activities outside of the family. Secondary parents, on the other hand, report less satisfaction with the extent to which their own individual needs are being met within the family. The available research also suggests that other factors mediate the impact of the child's illness on the family. In particular, parents with more knowledge about the illness and more social support available appear to cope more favorably with the illness. Moreover, the available research also suggests that the family also impacts on how the patient responds to the illness. Specifically, the more psychosocial stressors within the family, the less effectively the patient copes with the illness. In addition, the more social support available to the patient from the family and other significant others, the more likely the patient is to comply with the treatment regimen. Finally, two methodological issues have been discussed. First, a tendency is evident for parents to deny any impact on the family when asked directly but to demonstrate the impact when the responses of these parents are compared to the responses of a comparison group. This suggests a need for more studies that involve a comparison group in the design. Second, the small sample sizes in many of the studies reflect the lack of adequate sample in individual geographic locales. This suggests a need for more collaborative research projects such as the CSSCD project to increase sample size.

Since a number of renal-cell carcinomas regress with hormonal manipulation, we have identified and measured the levels of estrogen, progestin and glucocorticoid receptors in 47 autologous pairs of normal and neoplastic kidney tissues. High-affinity receptors for these hormones were detected in kidney tissues of both sexes by means of a dextran-coated charcoal assay. Glucocorticoid receptors were demonstrated in renal cancer tissues for the first time, and were higher in the tumor (mean 31.3 +/- SEM 5.6) than in the normal tissue (mean 18.5 +/- 3.1 fmol/mg cytosol protein). There was a significant difference in the quantities of progestin receptors (expressed as fmol/mg cytosol protein) in normal (mean 18.4 +/- SEM 3.3) versus neoplastic (mean 10.4 +/- SEM 4.0) kidney specimens (p less than 0.007). There was a significant difference between the binding affinity of the progestin receptor in the male tumors (Kd = 2.2 +/- SEM 0.9 nM, n = 10) and that of the females, (Kd = 9.3 +/- SEM 6.5 nM) (p less than 0.04). When an affinity of less than 9.9 X 10(-9) M and greater than 10 fmol/mg cytosol protein were used as criteria for classifying a tissue as positive for progestin receptors, only 17% of tumors contained these receptors while 45% of normal tissues exhibited them. According to these criteria, no differences were observed in the frequency of occurrence of either estrogen receptors or glucocorticoid receptors in tumor versus normal kidney. Data from this study suggest that the use of endocrine therapy should be re-examined in the treatment of renal-cell carcinoma.

Seventy-four patients with chest pain and no prior history of organic heart disease were interviewed with a structured psychiatric interview immediately after coronary arteriography. The majority of patients with both negative and positive coronary angiographies had undergone previous exercise tolerance tests, but the patients with angiographic coronary artery disease were significantly more likely to have had positive results on a treadmill test. Patients with chest pain and negative coronary arteriograms were significantly younger; more likely to be female; more apt to have a higher number of autonomic symptoms (tachycardia, dyspnea, dizziness, and paresthesias) associated with chest pain, and more likely to describe atypical chest pain. Patients with chest pain and normal coronary arteriographic results also had significantly higher psychologic scores on indices of anxiety and depression and were significantly more likely to meet criteria of the Diagnostic and Statistical Manual of Mental Disorders, third edition, for panic disorder (43 percent versus 6.5 percent), major depression (36 percent versus 4 percent), and two or more phobias (36 percent versus 15 percent) than were patients with chest pain and a coronary arteriography study demonstrating coronary artery stenosis.

Isolations of subgenus III salmonellas (arizonas) made in the regional Public Health Laboratory, Cardiff, between 1959 and 1971 are reviewed. The techniques of isolation are listed for the various materials examined. The necessity of using bismuth sulphite agar as a plating medium is stressed, as some strains might appear on brilliant green MacConkey agar as rapid lactose fermenters and be missed. The serotypes isolated in Cardiff are discussed with reference to isolations by other authors. The culture of a subgenus III salmonella from pig faeces is described. It is thought that this is the first record of such an isolation from a pig in the United Kingdom.