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Notes: Objective To test the hypothesis that prilocaine with felypressin causes fewer side effects than lignocaine with adrenaline when performing large loop excision of the transformation zone of the cervix.Design Randomised trial.Setting Colposcopy clinic in a large district general hospital.Participants Two hundred consecutive women undergoing large loop excision of the transformation zone of the cervix.Methods Two different local anaesthetic combinations (prilocaine with felypressin and lignocaine with adrenaline) were compared in women undergoing large loop excision of the transformation zone. Prospective collection of clinical and treatment data was undertaken with scoring using an ordinal scale of pain experienced by the women during the procedure. Peri-operative blood loss and any side effects were also recorded.Main outcome measures Side effects associated with the local anaesthetic agents.Results Lignocaine with adrenaline resulted in less blood loss (P= 0.006) but was more likely to cause side effects, such as feeling faint (P= 0.017) and shaking (P 〈 0.001).Conclusion Prilocaine with felypressin causes fewer side effects than lignocaine with adrenaline and is therefore the preferred local anaesthetic combination for large loop excision of the transformation zone.

Notes: Objective To analyse biopsies of large loop excision of the transformation zone of the cervix; to identify factors associated with negative histology; and to develop predictive models in order to reduce the number of negative loop excisions.Design Retrospective analysis of patient notes and audit database.Setting Colposcopy clinic of a large district general hospital in North Staffordshire.Population Four hundred and fifty-two women who underwent a large loop excision of the transformation zone (LLETZ) procedure for suspected cervical intraepithelial neoplasia.Methods Women who underwent a LLETZ procedure were placed in two different groups, one positive for cervical intra epithelial neoplasia and the other negative for cervical intra epithelial neoplasia. Information was obtained on a number of clinical and colposcopic variables. Analysis was undertaken to determine if there were any differences between the two groups. These factors were then identified and three predictive models generated. Receiver-operator characteristic curves were used to assess and test these models.Main outcomes measures To identify factors associated with negative histology on a LLETZ specimen. To predict how to reduce the number of negative LLETZ specimens.Results Four hundred and fifty-two women underwent a LLETZ procedure, 88 were negative (19%) and 364 were positive (81%). In women who were treated at their first visit, 56/316 (18%) had negative histology. There were significant associations between negative histology in the LLETZ and negative or low grade cytological atypia, negative colposcopic findings and years of age 〉 50 in both bivariate analysis and stepwise logistic regression. In the predictive models, the sensitivity ranged between 72% and 80%, the specificity 59%–72%, and the area under the receiver-operator characteristic was 0.75–0.77. If we had used the predictor models and managed women with negative or low grade cervical atypia and negative colposcopy findings conservatively, we would have reduced the negative biopsy rate from 19% to 14%, but five cases of high grade disease and 25 cases of low grade disease would have been missed. If we had also included women aged 〉 50 years in this model, the negative biopsy rate would have dropped from 19% to 15%, with only one case of high grade disease and 11 cases of low grade disease missed. All these women would require continued cytological and colposcopic surveillance. Importantly, no cases of invasion would have been missed.Conclusion Using a predictive model can reduce the number of negative LLETZ specimens, but at the expense of continued cytological and colposcopic surveillance and cannot be recommended in normal practice. This raises the question whether current standards for negative histology in LLETZ specimens are set unrealistically high.

Notes: The Mersey Estuary has suffered a legacy of abuse and neglect since the beginning of the Industrial Revolution. The discharge of effluents from manufacturing processes, together with wastewater from the burgeoning centres of population, resulted in the estuary gaining the unenviable reputation of being one of the most polluted rivers in Europe.As a result of the long-awaited remedial action which has been implemented over the last fifteen years, there is now unequivocal evidence that the water quality of the river and the biology of the system have improved significantly and will continue to do so as further planned alleviation schemes are completed.This paper reviews the achievements which have been made at the half-way stage in the 25-year multi-billion pound ‘clean-up’campaign.

Notes: Juvenile Cherax destructor (commonly called the yabby) (mean weight 48.3 mg) were cultured intensively (stocking density 360/m2) under controlled conditions for 48 days. The animals were provided with a combination of food (high protein pellets and/or natural feed organisms attached to a conditioned synthetic substrate) and refuge. Fastest growth and highest yield was recorded when both pellets and the conditioned synthetic material were provided. Although the yabbies sheltered in the synthetic substrate, it did not increase survival. Juvenile yabbies (〈 200 mg) were able to graze on small organisms attached to the synthetic material but this ability appeared to decline as the yabbies grew to a larger size. The use of artificial substrates in the intensive nursery phase production of juvenile freshwater crayfish is discussed.

Notes: Aims:  To investigate the cells of the inner annulus and to demonstrate that differences in disc pathology can be identified at the cellular level.Methods and results:  Annulus tissue taken from scoliotic, degenerate and prolapsed human disc tissue was processed for histology and transmission electron microscopy. Ki67 antibody was used to identify cells in the active part of the cell cycle and cell surface receptors for the matrix-degrading enzyme urokinase were immunolocalized. More chondron clusters were observed in tissue from prolapsed discs than in degenerate and scoliotic discs. Positive Ki67 staining was detected in cells within chondron clusters. Most cells observed from scoliotic and prolapsed annulus contained distinctive nuclei and organelles, whereas cells from degenerate discs contained very few well-defined organelles but abundant glycogen deposits. Immunolocalization identified urokinase receptors on the surface of cells from degenerate discs but not in the other pathologies.Conclusions:  Cellular differences appear to underlie different types of disc pathology. The annulus tissue taken from prolapsed discs appeared to contain more chondron clusters and more active cells than scoliotic and degenerative tissue, suggesting a possible wound repair response. In contrast, cell and matrix degeneration appeared to be the most significant underlying processes in degenerate discs.