Cent Of Group Research Articles

Does intraoperative electrohydraulic lithotripsy improve outcome in the surgical management of chronic pancreatitis?

Lateral pancreaticojejunostomy (LPJ) is the cornerstone of surgical management of pain associated with chronic pancreatitis (CP) and ductal dilation. The pathologic key to failure of LPJ is disease confined to the head of the pancreas. Intraoperative pancreatoscopy with electrohydraulic lithotripsy (EHL) is a novel technique that avoids resection and eradicates intraductal lithiasis in the head of the gland. This study was undertaken to compare outcome of LPJ alone and LPJ with intraoperative EHL in the surgical management of CP. The records of patients undergoing LPJ with intraoperative EHL between 1996 and 1998 (Group A) were reviewed and compared with our historical data of patients who underwent LPJ alone from 1977 through 1991 (Group B). Quality-of-life questionnaires were administered in person or by telephone. Fisher's exact and Mann-Whitney statistical tests were used where appropriate. Twenty patients (12 men, 8 women; mean age 51 years, range 29-68) in Group A underwent LPH with EHL versus 85 patients in Group B (65 men, 20 women; mean age 43.6 years, range 24-73) who had LPJ only. The etiology of CP was attributed to alcohol abuse in 85 per cent of patients in Group A and 96 per cent in Group B. Mean follow-up for Group A was 2.7 years (range 1-4 years) and 6.3 years (range 1-15 years) for Group B. Complications occurred in four patients (Group A) and five patients (Group B) perioperatively. There were no deaths in either group in the early postoperative period. Subsequent operations for complications of CP were significantly fewer in Group A than in Group B (P < 0.05). Rehospitilizations were required in 35 and 60 per cent of patients in Group A and B respectively (P < 0.05). Postoperative insulin and enzyme supplementation requirements were unchanged in Group A and continued or worsened in Group B. Ninety per cent of patients in Group A viewed their health status as good or fair compared with 55 per cent in Group B (P < 0.05). Postoperative narcotic use was present in both groups, although the number of pain pills used decreased considerably from 25 per week to fewer than five in Group A. Intraoperative EHL may represent an alternative to resection of the head of the pancreas or may be used as an adjunct to LPJ in the surgical management of chronic fibrocalcific pancreatitis.

Fatigue, sexual function and mood following treatment for haematological malignancy: the impact of mild Leydig cell dysfunction.

Fatigue, sexual dysfunction, anxiety and depression are all more common in patients who have previously been treated with cytotoxic chemotherapy and radiotherapy (XRT) for haematological malignancies. Following therapy, a significant proportion of men have biochemical evidence of Leydig cell dysfunction, defined by a raised luteinizing hormone level in the presence of a low/normal testosterone level. We postulated that mild testosterone deficiency may account for some of the long-term side-effects of treatment, and we have therefore assessed fatigue, mood and sexual function by questionnaire in 36 patients with Leydig cell dysfunction (group 1), and also in a group of 30 patients (group 2) with normal hormone levels who underwent the same treatment for cancer. There was no significant difference in anxiety and depression scores between the two groups although anxiety scores were higher than those previously reported for normal men. Eighty-seven per cent of group 2 were sexually active compared with only 69% of group 1 (P = 0.1), and patients in group 1 engaged less in sexual activity than those in group 2 (mean of 1.8 times per week compared with 3.2 times per week;P = 0.02) Fatigue scores were significantly higher in both groups compared with normal men, but there were no significant differences in any of the fatigue subscales between the two groups. We conclude that mild Leydig cell insufficiency following treatment with cytotoxic chemotherapy ± XRT is not associated with higher levels of fatigue and anxiety but may result in reduced sexual function. These results do not provide a convincing argument that androgen replacement therapy is mandatory to improve quality of life in the majority of these patients, although it may be beneficial in a minority. To establish criteria for selection of patients for a trial of androgen therapy a randomized placebo-controlled study will be necessary. © 2000 Cancer Research Campaign

肩インピンジメント症候群の肩峰下滑液包鏡視所見とＭＲＩ所見の比較検討

It is difficult to objectively diagnose certain painful conditions of the shoulder such as impingement syndrome. Magnetic resonance imaging and arthroscopy of shoulder impingement syndrome excluding rotator cuff tear were evaluated in 40 patients. Patients who underwent magnetic resonance imaging before arthroscopy were reviewed after the operation. The high intensity area of T2* weighted images in subacromial bursa and rotator cuff tendon was checked as a sign of subacromial impingement.The high intensity area of T2* weighted images in the subacromial bursa and rotator cuff tendon was 80 and 17.5 per cent in the whole group. When the whole group was classified according to arthroscopic findings, the high intensity area of T2* weighted images in the subacromial bursa and rotator cuff tendon were 74 and 22 per cent in the group of significant subacromial frayed findings, 90 and 10 per cent in the group of rotator cuff tendon frayed findings without significant subacromial fraying, 100 and 0 per cent in the group of thickend coracoacromial ligament.

Trends in Indications and Outcomes in the Whipple Procedure over a 40-Year Period

There have been increasing changes in the role of pancreatoduodenectomy (PD) in the management of benign and malignant pancreatic disease. The aim of this paper was to compare the current role of PD with that of our earlier experience. The records of patients undergoing PD at our institution between 1983 and 1996 (Group A) were reviewed and compared with cases between 1956 and 1982 (Group B). Student's t test was used to analyze differences between groups. A total of 153 PDs were performed with 98 (64%) in Group A (88% of these in the last 6 years) and 55 (36%) in Group B. Carcinoma of the head of the pancreas was the most common indication for surgery in both periods (43% and 47% for Groups A and B, respectively). In Group A, the next most common indication was chronic pancreatitis, accounting for 28 per cent versus 13 per cent in Group B. Carcinoma of ampulla of Vater was also a common indication, making up 21 per cent of the cases in Group A and 20 per cent in Group B. Preoperative biliary drainage was performed in 62 per cent of Group A and 3 per cent of Group B patients (P < 0.001). Postoperative complications were comparable in both groups: delayed gastric emptying (22%), wound infection (17%), pancreatic fistula (13%), gastrointestinal bleeding (8%), and intestinal obstruction (3%). The perioperative mortality rate was significantly different between the two groups: 1 per cent in Group A versus 16 per cent in Group B (P < 0.001). Mean postoperative length of stay was 17 days in Group A (22 days for benign disease) and 25 days for Group B (P < 0.01). In the last 40 years, there has been a rise in the use of PD for chronic pancreatitis and a significant decrease in postoperative mortality and hospital length of stay. These data support the safety of PD in the management of patients with both benign and malignant periampullary disease.

Intraoperative Angiography

Intraoperative angiograms were performed on 131 patients. There were 23 aortoiliac procedures (Group I); 20 aortofemoral procedures (Group II); 25 femoral artery reconstructionellaneous operative angiograms (Group V) were included; examples of this group were renal artery and brachial artery reconstructions. Ten intraoperative carotid angiograms comprised Group VI. Twenty-three patients (17.5%) showed abnormalities which required correction. These were the presence of thrombus in 11 (47.8%) and anastomotic stricture in nine (39.1%); the remaining 13.1 per cent consisted of one kinked graft, one vessel disruption, following embolectomy, and one false aneurysm. The incidence of defects was 4.3 per cent in Group I; 15 per cent in Group II; 16 per cent in Group III; 21.6 percent in Group IV, and 25 per cent in Group V. A 30 per cent incidence was found in Group VI. Technical defects in vascular reconstructions are revealed by intraoperative angiography in a significant number of cases and their incidence is directly related to the size of the vessel being operated on. Recognition and repair of these defects should result in a reduction in the rate of early occlusion.

Factors associated with utilization of specialist palliative care services: a population based study.

Palliative care services have been criticized for providing specialist care for a privileged few but there is no routinely available information to prove or refute these criticisms. Our survey aimed to identify and describe the patients using specialist palliative care services in a Health District and identify whether any factors distinguished them from other eligible patients who did not use these services. Clinical and demographic data were collected retrospectively for all residents of the Health District who died of cancer during 1991. Comparisons were made between those who used specialist palliative care services and those who did not. A total of 521 cases were studied of which 157 (30 per cent) had used the specialist palliative care services. These cases (Group 1) compared with the remainder (Group 2) were statistically significantly (p < 0.05) different in terms of their age at death (mean age for Group 1 was 66.6 years, compared with 73 years for Group 2), survival times from diagnosis (median number of days for Group 1 was 242, compared with 110 days for Group 2) and general practitioner practice. There were no significant differences between the two groups for all other variables, i.e. ward of residence, social class, cancer site and gender. Cases in Group 1 were more likely to die at home (39 per cent compared with 27 per cent in Group 2). Effectiveness studies in the field of palliative care are essential but difficult. We suggest that there is an important place for local studies of needs and utilization for guiding sensitive contracting.

Femoral lengthening over an intramedullary nail. A matched-case comparison with Ilizarov femoral lengthening.

Twenty-nine patients (thirty-two femora) had femoral lengthening over an intramedullary nail, with the nail and the external fixator applied concomitantly at the time of the femoral osteotomy. After gradual distraction at a rate of one millimeter per day, the nail was locked and the fixator was removed. The mean age was twenty-six years (range, ten to fifty-three years), and the mean amount of lengthening was 5.8 centimeters (range, two to thirteen centimeters). For comparison, thirty-one patients (thirty-two limbs) who had had standard Ilizarov femoral lengthening were matched with the group that had had lengthening over an intramedullary nail; the matching was performed on the basis of the amount of lengthening, the age of the patient, the etiology of the indication for lengthening, and the level of difficulty of the procedure. Lengthening over an intramedullary nail reduced the average duration of external fixation by almost one-half. The radiographic consolidation index (the number of months needed for radiographic consolidation for each centimeter of lengthening) for the limbs that had had lengthening over an intramedullary nail was reduced significantly (p < 0.001) compared with that for the matched-case group. The range of motion of the knee returned to normal a mean of 2.2 times faster in the group that had had lengthening over an intramedullary nail. There were six refractures of the distraction bone in the matched-case group. In the group that had had lengthening over an intramedullary nail, one nail and one proximal locking screw failed. The over-all rate of complications was 1.4 per cent in the group that had had lengthening over an intramedullary nail compared with 1.9 per cent in the matched-case group. With the numbers of patients available for study, we could not detect a significant difference between the groups with respect to the operative time (p = 0.124); however, the cost of treatment and the estimated blood loss were higher in the group that had had lengthening over an intramedullary nail. On the basis of clinical and radiographic criteria, there were twenty-three excellent, seven good, and two fair results in the group that had had lengthening over an intramedullary nail compared with twenty-six excellent, four good, and two fair results in the matched-case group (p = 0.37). The advantages of lengthening over an intramedullary nail include a decrease in the duration of external fixation, protection against refracture, and earlier rehabilitation.

Anoabdominal rectal resection and colonic J pouch-anal anastomosis: 10 years' experience

Coloanal anastomosis and radiotherapy for the treatment of lower rectal carcinoma have been receiving increasing attention. Patients with rectal cancer were divided into two groups: anoabdominal rectal resection and colonic J pouch-anal anastomosis (CAA) plus preoperative intraluminal brachytherapy (IBT) (group 1; 68 patients) and CAA without IBT (group 2; 23 patients). Group 3, comprising 59 patients who underwent abdominoperineal excision (APE), was examined as a control group. Comparative results were reviewed. Postoperative complications occurred more frequently in group 1 than in group 2. Actuarial 5-year survival rates were 73 per cent in group 1, 64 per cent in group 2 and 63 per cent in group 3. Cumulative local recurrence rates at 5 years were 11 per cent in group 1, 38 per cent in group 2 and 21 per cent in group 3. Intestinal continuity breakdown was seen in 14 per cent of all patients at 5 years after initial operation. The combination of CAA and preoperative IBT resulted in decreased local recurrence. IBT followed by CAA can be a good restorative option for combating lower rectal cancer.

Randomized controlled trial of postoperative radiotherapy and short-term time-scheduled 5-fluorouracil against surgery alone in the treatment of Dukes B and C rectal cancer

Background The purpose of the present study was to investigate whether a 1-month regimen of postoperative radiotherapy combined with 5-fluorouracil could reduce the local recurrence rate and improve survival in patients with Dukes B and C rectal cancer. Methods One hundred and forty-four patients were randomized to surgery alone or surgery combined with postoperative radiotherapy (46 Gy) and bolus 5-fluorouracil 30 min before six of the radiotherapy fractions. One hundred and thirty-six patients were eligible. Results The adjuvant treatment was well tolerated. After an observation time of 4–8 years, patients in the adjuvant treatment group had a cumulative local recurrence rate of 12 per cent compared with 30 per cent in the group that had surgery only (P= 0·01). The 5-year recurrence-free and overall survival rate was 64 per cent in the adjuvant group compared with 46 per cent (P = 0·01) and 50 per cent (P = 0·05) respectively in the surgery group. The adjusted relative risk of recurrence and death for the adjuvant group was 0·48 (95 per cent confidence interval 0·28–0·82) and 0–56 (0·33–0·94) respectively. Conclusion The 1-month postoperative combination regimen improved treatment results in patients with Dukes B and C rectal cancer, in terms of local recurrence rate, recurrence-free survival and overall survival, without serious side-effects.

Randomized controlled trial of postoperative radiotherapy and short-term time-scheduled 5-fluorouracil against surgery alone in the treatment of Dukes B and C rectal cancer

The purpose of the present study was to investigate whether a 1-month regimen of postoperative radiotherapy combined with 5-fluorouracil could reduce the local recurrence rate and improve survival in patients with Dukes B and C rectal cancer. One hundred and forty-four patients were randomized to surgery alone or surgery combined with postoperative radiotherapy (46 Gy) and bolus 5-fluorouracil 30 min before six of the radiotherapy fractions. One hundred and thirty-six patients were eligible. The adjuvant treatment was well tolerated. After an observation time of 4-8 years, patients in the adjuvant treatment group had a cumulative local recurrence rate of 12 per cent compared with 30 per cent in the group that had surgery only (P = 0.01). The 5-year recurrence-free and overall survival rate was 64 per cent in the adjuvant group compared with 46 per cent (P = 0.01) and 50 per cent (P = 0.05) respectively in the surgery group. The adjusted relative risk of recurrence and death for the adjuvant group was 0.48 (95 per cent confidence interval 0.28-0.82) and 0.56 (0.33-0.94) respectively. The 1-month postoperative combination regimen improved treatment results in patients with Dukes B and C rectal cancer, in terms of local recurrence rate, recurrence-free survival and overall survival, without serious side-effects.

TUBERCULOSIS IN BCG VACCINATED AND UNVACCINATED CHILDREN

One hundred, non-consecutive, non-randomized, cases of tuberculosis divided in 2 groups i.e. Group A including 50 BCG vaccinated children and Group B including 50 unvaccinated children were studied to determine the pattern of tuberculosis and the role of protein energy malnutrition in the pathogenesis of tuberculosis. Thirty four per cent of Group A and 52 per cent of Group B had severe protein energy malnutrition. Sixty eight per cent in Group A and 76 per cent in Group B had intrathoracic forms of tuberculosis. Twelve (24%) patients in Group A and 11 (22%) in Group B suffered from serious forms of tuberculosis including tubercular meningitis, miliary tuberculosis and disseminated tuberculosis. The difference was not statistically different (p>0.05). However, in severe form of tuberculosis, the morbidity in vaccinated group was less. Sixty six per cent of vaccinated children with disseminated forms of tuberculosis had features of severe protein energy malnutrition. BCG is not effective in preventing tubercular infection in children of preschool age. It is effective to a certain extent in localizing the infection to a particular organ. Severe protein energy malnutrition is a contributing factor in the genesis of tuberculosis in preschool children vaccinated with BCG at or immediately after birth.

Magnitude and pattern of inner and outer hair cell loss in chinchilla as a function of carboplatin dose.

We examined the relationship between carboplatin dose and pattern of IHC and OHC loss in five groups of chinchillas treated with carboplatin: (I) single dose, 38 mg/kg, (II) double dose, 38 mg/kg, (III) double dose, 63 mg/kg, (IV) double dose, 75 mg/kg, and (V) double dose, 100 mg/kg. The pattern of IHC loss was relatively uniform along the length of the cochlea with all doses. Average IHC loss increased from approximately 20 per cent in group I to approximately 100 per cent in groups III, IV and V. Average OHC loss was small or negligible in groups I, II, III and IV; only group V consistently showed large (> 40 per cent) OHC losses. OHC loss progressed along a base-to-apex gradient. The dose of carboplatin which reliably destroyed OHCs was four to five times greater than that needed to damage IHCs.

Inpatient rehabilitation

The purpose of this study was to compare outcomes in stroke patients with two different methods of admission to an inpatient unit. Patients' outcomes were studied for 3 years. Admission screening was performed either by a physiatrist (group I, n = 93) or by a nurse practitioner (group II, n = 100). All admission decisions were made solely by the physiatrist. The outcome measures used were appropriateness of admission, discharge to home versus nursing home and functional gains measured on the Functional Independence Measure. The average length of stay was 28 days for group 1 patients and 29 days for group II. Ninety-seven per cent of group I and 94% of group II patients were considered appropriate for admission. The difference is not statistically significant (Z = 1.02). Ninety-six per cent of patients in each group were discharged home. Ninety-six per cent of group I and 89% of group II patients met the functional goals. Group I fared better than group II, and the difference between the groups (Z = 1.85) is statistically significant at p < 0.04.

Clean intermittent catheterisation from the acute period in spinal cord injury patients. Long term evaluation of urethral and genital tolerance.

Since its introduction by Lapides, clean intermittent catheterisation (CIC) has dramatically changed the urological management of spinal cord injury (SCI) patients. Since 1978 we have used CIC as a mode of drainage in the acute period, during the period of bladder retraining as a measurement of residual urine, and in some instances in the medium and long term. 12-14 Fr PVC catheters are used with lubricant. The objectives of this study were: first, in a population of 159 SCI patients (group 1), to evaluate the overall incidence of complications of CIC; Secondly to study two groups of patients: group 2 (n = 8) consisted of patients who had performed CIC for over 2 years before discontinuance; group 3 (n = 21) consisted of patients on CIC for over 5 years (mean length of use: 9.5 years). The reasons for acceptance of long term CIC, frequency of urinary tract infections, and rates of urethral strictures were evaluated. The analysis of group 1 showed a rate of lower urinary tract infection of 28% and of cytobacteriological infection of 60%. Chronic pyelonephritis was never observed and infection was always confined to the lower urinary tract which is in accordance with other studies. The rate of epididymitis and urethral stricture was 10% and 5.3% respectively. Sixty two per cent of group 2 remained incontinent, and 89% of group 3 showed a satisfactory degree of continence. The first factor for acceptance of long term CIC is continence, the second one is the ability to perform CIC independently. In group 3 we found a rate of urethral stricture of 19%, and of epidydimitis of 28.5%. These two complications (urethral tolerance and urethroprostatic infection) increased with the number of years on CIC. The method and the type of catheters used must also be considered. We need further studies of long term CIC in patients using non-reusable hydrophilic catheters from the acute period to see if these two complications can be prevented.

Pathophysiology of spinal cord injury. Recovery after immediate and delayed decompression.

We evaluated the effect of the timing of decompression of the spinal cord after compression of 50 per cent of the diameter of the spinal cord at the fourth lumbar level in thirty purebred dogs. The dogs were divided into five groups of six dogs each on the basis of the duration of the compression. Decompression was performed immediately (Group I), one hour (Group II), six hours (Group III), twenty-four hours (Group IV), or one week (Group V) after the compression. Monitoring of somatosensory evoked potentials, daily neurological examinations, and histological and electron microscopic studies at the time of the autopsy were performed for all of the dogs. Initially, all of the dogs were paraplegic after the compression of the spinal cord. The dogs that had immediate decompression or decompression after one hour of compression recovered the ability to walk (grades 4 and 5, according to Tarlov's system) as well as control of the bowel and bladder, and the somatosensory evoked potentials improved an average of 85 and 72 per cent, respectively. However, when compression lasted six hours or more, there was no neurological recovery and there was progressive necrosis of the spinal cord. Somatosensory evoked potentials improved 29 per cent in Group III, 26 per cent in Group IV, and 10 per cent in Group V. The percentage of recovery of the somatosensory evoked potentials by six weeks after the decompression was significantly related to the duration of the compression (p < 0.0008).

Characteristics of acromegalic patients with a good response to octreotide, a somatostatin analogue

In GH-secreting pituitary tumours somatostatin receptor density has been correlated with octreotide responsiveness. Little is known about the other endocrine characteristics of patients with good responses to octreotide. The purpose of this study was to determine the characteristics of these patients. We studied 30 patients with active acromegaly. Five had been treated with either transsphenoidal adenomectomy or conventional radiotherapy without cure of GH excess. Patients were divided into good or poor octreotide responders. Patients whose GH level decreased to less than 20% of basal and below 20 mU/I after a subcutaneous injection of 100 micrograms of octreotide were defined as good octreotide responders. We compared tumour size, basal GH secretory pattern, responses to TRH, GnRH and bromocriptine, and mutation of the alpha-subunit of stimulatory GTP-binding protein (G alpha s) between the two groups. Tumour size was determined by CT or MRI. Basal GH level was measured hourly between 0800 and 1600 h. GH responses to TRH and GnRH were measured every 30 minutes for 2 hours, and the GH response to oral bromocriptine was measured hourly for 6 hours. The mutation of G alpha s gene between codons 184 and 251 was examined by direct sequencing using PCR in 5 patients of each group whose tumour tissues were available for the genomic DNA extraction. Seventeen patients (57%) were good octreotide responders (group I) and 13 (43%) were poor responders (group II). The mean age, sex, tumour size, tumour grade and the basal GH secretory pattern were not significant different between the two groups. Group I responded more frequently than group II to TRH (65 vs 25%). Fifty-three per cent of group I patients and none of group II were good bromocriptine responders. Forty-one per cent of group I patients responded to both TRH and bromocriptine. Three of 5 group I tumours had point mutations at codon 201 of the G alpha s gene, none of 5 group II tumours had mutations. CGT(Arg) was replaced with TGT(Cys) in two tumours and with AGT(Ser) in one. No mutations were found at codon 227. All three tumours with mutations were from patients responsive to TRH. Two of the three were also good bromocriptine responders. These data suggest that good octreotide responders are more likely to respond to TRH or bromocriptine. Good octreotide responders may include subgroups with different levels of TRH and dopamine receptor expression. A possible relation between octreotide response and the mutation of G alpha s gene should be investigated.

The acoustic stimulation test and antenatal cardiotocography as diagnostic tools in high risk pregnancies

SummaryA prospective random allocation clinical trial was undertaken to compare standard antenatal cardiotocography with the fetal acoustic stimulation test. Two hundred and twenty-five patients with high risk pregnancies at term had either standard cardiotocography (group I) or an acoustic stimulation test (group II). The incidences of non-reactive tests was 10 per cent in group I and 15 per cent in group II did not differ statistically. Fetal distress occurred during labour in 13 per cent in patients with reactive cardiotocograms and 75 per cent if the record was unreactive (P < 0˙001); and in 12 per cent with reactive and 81 per cent with non-reactive acoustic stimulation tests (P < 0 ˙001). Standard antenatal cardiotocography and the acoustic stimulation test are equally valuable in detecting fetal distress in high risk term pregnancies. The acoustic stimulation test offers the advantage of reducing testing time and can be used to confirm a non-reactive standard test.

Comparative evaluation of the two positions used for imaging of trochanteric fractures

This study evaluates and compares the efficacy of the two positions used for imaging of the hip in trochanteric fractures. One hundred patients with grade I or grade II trochanteric fractures were divided into two equal groups. In group I the fracture was reduced and the opposite hip was brought to full abduction, neutral flexion and neutral rotation. In group II, the fracture was reduced and the opposite hip was flexed beyond 90 °, abducted and externally rotated. Only patients with minimal or no comminution were included in this study. The radiation exposure time was considerably less in group II. The abduction angle between the two limbs of the fracture table was higher in group II and it was possible to visualize the femoral head completely in the lateral view in 96 per cent of patients in group II and 76 per cent in group I. We strongly recommend that the opposite hip should be flexed to about 90 °, abducted and externally rotated if it is not possible to see the femoral head completely in the lateral view.

An Increase in Giardia duodenalis Infection among Children Receiving Periodic Anthelmintic Treatment in Bangladesh

During a deworming study in northern Bangladesh, the prevalence of Giardia duodenalis increased significantly among three groups of children receiving periodic treatment with mebendazole. This was first observed in the treatment group (Group A) of a 12-month study. Giardia increased from 5 to 31 per cent in Group A (n = 49 chi 2 = 10.42, P < 0.005), but did not increase significantly in the placebo group (Group B) (11 to 18 per cent; chi 2 = 0.4, P = NS). The prevalence of Giardia in the treatment and placebo groups was not significantly different at the beginning of the study (n = 89, chi 2 = 0.8, P = NS). During a 6-month follow-up study, children in Groups A and B received 2-monthly treatment with mebendazole. Within 6 months the prevalence of Giardia increased significantly in Group B from 18 to 44 per cent (chi 2(1) = 6.14, P < 0.05). The prevalence of Giardia was also examined in 265 children at the end of an 18-month deworming study in the same area and found to be significantly higher among the treatment group (Group C) compared with the placebo group (Group D) (38 v. 21 per cent, chi 2 = 8.87, P < 0.005). Finally, the prevalence of Giardia was significantly higher in Group B after being treated than in Group D which had not been treated (44 and 21 per cent, respectively, chi 2 = 9.08, P < 0.005). These children were from the same villages and measured during the same month of the monsoon season.(ABSTRACT TRUNCATED AT 250 WORDS)

Is there a relationship between the degree of nasal obstruction and snoring?

The possible connection between snoring and nasal obstruction was studied in three groups of adult patients. In group 1, comprising 112 unselected patients, 36% snored, and 50% of the snorers suffered from nasal obstruction. The other two groups consisted of selected patients: group 2 (n = 41) and group 3 (n = 40) all of whom suffered from nasal obstruction. In group 2 nasal airway resistance was normal both before and after decongestant treatment, and in group 3 nasal airway resistance was pathologically high even after decongestant treatment. No difference was found between groups 2 and 3 regarding snoring. Sixty-six per cent in group 2 and 78% in group 3 snored. There was a correlation between snoring and the subjective nasal obstruction, but none between snoring and the degree of nasal obstruction expressed as nasal airway resistance.