A preliminary normative profile of mild traumatic brain injury diagnostic criteria

This study investigated how mild traumatic brain injury (MTBI) diagnostic and related variables present in a large, nonreferred MTBI sample. Participants were 119 adults with MTBI, drawn from consecutive admissions to two hospital emergency wards. Within 3 weeks of injury, they were asked how the 1993 American Congress of Rehabilitation Medicine MTBI diagnostic criteria and related phenomena presented in their particular cases. Results showed that retrograde amnesia was not reported or was generally very brief; retrograde amnesia was not reported unless posttraumatic amnesia was also reported; and the median ratio of posttraumatic amnesia to retrograde amnesia duration, when both were reported, was 300:1. These and other data provide a preliminary normative profile of such MTBI phenomena, and can help with differential diagnosis of MTBI in individual cases.

Immunoaffinity resin for purification of urinary leukotriene E4

Urinary leukotriene E4 (LTE4) has been used as an index of total leukotriene synthesis. A wide variety of methods have been applied to measure LTE4 which has made direct comparison of urinary levels reported by different laboratories difficult. A new peptidoleukotriene immunoaffinity resin was utilized for urinary LTE4 purification in a method that is easy and inexpensive, utilizing commercially available reagents. This method is described and compared to other methods. LTE4 (50-250 pg/mL) added to a urine extract was quantitatively recovered using the immunoaffinity resin. Similarly, LTE4 (50-400 pg/mL) added to urine was recovered between 63 and 76%. The coefficient of variation of samples purified and quantified on the same or on different days ranged from 8-10%. There was a strong correlation (r2 = 0.95) between LTE4 concentrations determined after immunofiltration and immunoaffinity purification. Although there was a good correlation between urinary LTE4 levels measured without purification compared to after immunoaffinity purification, the high y-intercept of 179 indicates the presence of interfering substances in unpurified urine. Urinary LTE4 in normal healthy adults was 80 +/- 7 pg/mg creatinine, similar to that previously reported following HPLC or immunofiltration purification. Urinary LTE4 was also measured in healthy children (age 3-12) and found to be 103 +/- 9.

The significance of variations in the angular correction factor in in situ gamma spectrometry

In situ gamma spectrometry is a powerful method of assessing radioactive contamination in soil. The most widely adopted calibration methodology relates the overall sensitivity of the detector system to the product of three calibration factors: (a) the flux at the detector per unit activity in the ground phi/S(A), (b) the detected count-rate per unit flux incident normally at the detector N0/phi and (c) a correction factor to take into account the angular non-uniformity in response of the detector (Nf/N0). The dependence of the latter factor on the activity distribution with soil depth is generally neglected despite the lack of published evidence to support this. By (i) modelling and (ii) use of published experimental profiles, this work examines the range of Nf/N0 values likely to be encountered in the field. It was found that the use of a fixed angular correction factor is justified given that the maximum errors in the derived activity concentration do not exceed 5% and are far outweighed by other uncertainties.

The choice of jet nebulizer, nebulizing flow, and addition of albuterol affects the output of tobramycin aerosols

The use of inhaled antibiotics in the treatment of cystic fibrosis has become widespread despite controversy in the literature as to the appropriate dosing regimen and its effectiveness. This study compared two tobramycin (T) preparations (one with and one without the addition of albuterol) using two different jet nebulizers in order to determine if drug output would be affected. Using calibrated flows from a dry compressed gas source of 6 and 8 L/min as well as a specific compressor (Pulmo-Aide), the Hudson 1720 nebulizer was compared with the newer disposable Hudson 1730. The albuterol preparation used in this study was the Ventolin (albuterol) Respirator Solution (VRS). The nebulizers were charged with (1) 2 mL T (80 mg/2 mL) with 0.5 mL VRS (5 mg/mL) and normal saline solution to make the total nebulizer charge of 3 or 4 mL, or (2) 2 mL T and either 1 or 2 mL normal saline solution. A laser diffraction analyzer (Malvern 2600) was used to determine the aerosol particle size distribution. From the distribution, the respirable fraction, which is the fraction of aerosol that could enter and remain in the lungs, was calculated. For all solutions and each particular flow, the Hudson 1730 had a larger respirable fraction of T. The addition of VRS lowered the surface tension of the solution in the nebulizer and resulted in a greater output of T. This effect was most apparent for the 3-mL volume fills of the Hudson 1720. The greatest differences were between the 3-mL nebulizer charges of T using the Hudson 1720 driven by a flow of 6 L/min, which produced 8 mg of T in the respirable fraction, compared with 35 mg produced by the Hudson 1730 driven by a flow of 8 L/min. These results suggest that different nebulizers, different nebulizer solutions, and different techniques of nebulization may result in very different amounts of T aerosol output in the respirable fraction.

Enhanced LTP in mice deficient in the AMPA receptor GluR2

AMPA receptors (AMPARs) are not thought to be involved in the induction of long-term potentiation (LTP), but may be involved in its expression via second messenger pathways. However, one subunit of the AMPARs, GluR2, is also known to control Ca2+ influx. To test whether GluR2 plays any role in the induction of LTP, we generated mice that lacked this subunit. In GluR2 mutants, LTP in the CA1 region of hippocampal slices was markedly enhanced (2-fold) and nonsaturating, whereas neuronal excitability and paired-pulse facilitation were normal. The 9-fold increase in Ca2+ permeability, in response to kainate application, suggests one possible mechanism for enhanced LTP. Mutant mice exhibited increased mortality, and those surviving showed reduced exploration and impaired motor coordination. These results suggest an important role for GluR2 in regulating synaptic plasticity and behavior.

Evaluation of surfactant treatment strategies after prolonged graft storage in lung transplantation

We have previously documented alterations in endogenous surfactant after lung transplantation and improved graft function in some dogs after instillation of bovine lipid extract surfactant (bLES) into the recipient. To determine the effect of bLES delivery method and timing of treatment on physiologic response and surfactant recovery, 21 canine left lung grafts were divided into four groups: (1) Treatment of the donor for 3 h with aerosolized bLES prior to graft storage (Donor Aerosol); (2) Treatment of the recipient with instilled bLES immediately after transplantation (Recipient Instilled); (3) No bLES treatment (Control); and (4) Aerosolized bLES in donors and instilled bLES in recipients (Combined Therapy). Aerosolized bLES was labeled with [3H]-dipalmitoylphosphatidylcholine (DPPC) and instilled bLES with [14C]-DPPC. Grafts were stored for 36 h, transplanted and reperfused for 6 h. The native right and transplanted left lungs were then lavaged and protein yield, surfactant aggregates, and bLES recovery were measured. After 6 h of reperfusion, PO2/FlO2 ratio was significantly better after Combined Therapy (372 +/- 52 mm Hg) than in the Recipient Instilled (117 +/- 47 mm Hg) and Control groups (87 +/- 26 mm Hg), with intermediate values in Donor Aerosol dogs (232 +/- 64 mm Hg). The recovery of donor aerosolized bLES from transplanted lungs was increased in dogs given Combined Therapy versus Donor Aerosol treatment alone (p = 0.03). Furthermore, with Combined Therapy there was an increased percentage of instilled bLES recovered from transplanted lungs compared with the Recipient Instilled group. We conclude that surfactant treatment strategies influence physiologic response and bLES recovery after prolonged lung preservation. Treatment of lung donors with exogenous surfactant prior to graft storage was associated with less severe lung injury. Combined donor and recipient bLES therapy resulted in a superior physiologic response during reperfusion in this model.

Learning opportunities for internal medicine residents: comparison of a tertiary care setting and a regional setting

PURPOSE

To compare the learning opportunities for internal medicine residents in tertiary care and community hospital settings.

METHOD

Two sites were studied: Victoria General Hospital, a teaching hospital affiliated with the Dalhousie University Faculty of Medicine, staffed by five general internists and serving Halifax County (population of 420,000); and South Shore Regional Hospital, serving the community of Bridgewater (with a catchment area of 50,000) and staffed by three general internists. All in- and outpatients seen in the two settings over a one-year period (1993) were described in accordance with the Canadian Institute for Health Information's major clinical categories, as well as a case mixture recommended as providing appropriate learning experiences for internal medicine clerks. Over a one-month period (August 1993), consecutive patients were interviewed, completing a health status questionnaire, the Medical Outcome Study Short Form 36 (SF-36).

RESULTS

Data were collected from the records of 2,763 patients, and the SF-36 questionnaire was administered to 406 patients. The data indicate that the settings were relatively similar except that there was more case variety in the tertiary care setting, and that more patients with cardiovascular disease and no patient with acquired immune deficiency syndrome were seen in the regional setting. Quality-of-life scores showed similarities to norms in the United States and United Kingdom, except that the ambulatory patients in the regional setting had rather lower scores.

CONCLUSION

Overall, the patients' problems in the regional and tertiary care settings offered similar learning opportunities.

The composition of glyphosate-tolerant soybean seeds is equivalent to that of conventional soybeans

One important aspect of the safety assessment of genetically engineered crops destined for food and feed uses is the characterization of the consumed portion of the crop. One crop currently under development, glyphosate-tolerant soybeans (GTS), was modified by the addition of a glyphosate-tolerance gene to a commercial soybean cultivar. The composition of seeds and selected processing fractions from two GTS lines, designated 40-3-2 and 61-67-1, was compared with that of the parental soybean cultivar, A5403. Nutrients measured in the soybean seeds included macronutrients by proximate analyses (protein, fat, fiber, ash, carbohydrates), amino acids and fatty acids. Antinutrients measured in either the seed or toasted meal were trypsin inhibitor, lectins, isoflavones, stachyose, raffinose and phytate. Proximate analyses were also performed on batches of defatted toasted meal, defatted nontoasted meal, protein isolate, and protein concentrate prepared from GTS and control soybean seeds. In addition, refined, bleached, deodorized oil was made, along with crude soybean lecithin, from GTS and control soybeans. The analytical results demonstrated the GTS lines are equivalent to the parental, conventional soybean cultivar.

The incidence of hyperemesis gravidarum is increased among Pacific Islanders living in Wellington

AIMS

To compare the incidence of hyperemesis gravidarum among Pacific Islanders living in Wellington with nonPacific Islanders and to investigate some properties of the disorder.

METHODS

Data were collected on all first time admissions to Wellington Women's Hospital for hyperemesis gravidarum over a 5-year period. Women were classified as having severe hyperemesis gravidarum if abnormalities of serum electrolytes and liver function tests results were present and as less severe if these abnormalities were absent. Almost all women had ketonuria. Mantel-Haenszel odds ratios, chi 2 analysis and Fisher's 2-tailed exact test were used for statistical analysis.

RESULTS

The proportion of hyperemesis gravidarum patients who were Pacific Islanders was significantly increased when compared to their proportion in a control group (p < 0.01). The difference remained significant when the hyperemesis patients were divided into less and more severe. Abnormal thyroid function test results were more common among Pacific Island patients than among nonPacific Island patients. This difference was significant (p < 0.01) only in the less severe group.

CONCLUSION

The incidence of hyperemesis gravidarum is significantly increased among Pacific Island women (especially Samoans) living in Wellington and is often associated with abnormalities of thyroid function test results.

Imaging strategies in the first 12 months after reduction of developmental dislocation of the hip

We have reviewed the records of 32 infants whose developmental dislocation of the hip (DDH) was treated by reduction and immobilization in a plaster cast. We examined 50 CT scans from 22 patients. The postreduction radiological studies led to a change of cast in 10 patients and, in five of them, the subluxation shown on CT scan was not seen in an earlier radiograph. Where reduction has been undertaken at the time of arthrography or in an older child, a plain radiograph may be adequate to confirm the position in the cast. In an infant, CT scans give superior information, have acceptable risks, and should be used in association with radiation protection measures.

The oral examination: a study of academic and non-academic factors

The oral examination in psychiatry for final-year medical students at Wellington and Dunedin School of Medicine, University of Otago, was studied. Between December 1989 and April 1990, 40 medical students were videorecorded during such an examination. The transcripts of the recording of each oral, and at a later date the videorecordings, were individually scored by a panel of six research psychiatrists who were experienced examiners. In addition verbal and non-verbal behaviour was rated using visual analogue scales and the students completed personality and anxiety questionnaires. There was a low level of agreement between research psychiatrists in the allocation of oral marks. The oral score was positively associated with the level of confidence of the student and negatively with anxiety in men.

Mouse alveolar surfactant: characterization of subtypes prepared by differential centrifugation

To characterize the properties of alveolar surfactant subfractions obtained from mouse lung by differential centrifugation, lavage fluid, following a preliminary centrifugation at 140 x g for 5 min to yield a cellular pellet (Pc), was sequentially centrifuged at 10,000 x g for 30 min, 60,000 x g for 60 min and 100,000 x g for 15 h; and the resultant pellets, respectively referred to as P10, P60 and P100, were harvested for electron microscopy, phospholipid analysis and surface tension measurements. Ultrastructural differences were observed, in that P10 contained large multilamellated structures which were typical of newly secreted surfactant, P100 contained small unilamellar vesicular structures, typical of catabolic end products of alveolar surfactant and P60 appeared to contain a mixture of structures present in P10 and P100 in addition to numerous, large unilamellar vesicles which were not present in either P10 or P100. Slight but significant differences were found in the phospholipid compositions of the three subfractions but not in the fatty acid composition of their phosphatidylcholine (PC) component. There were no significant differences in their disaturated PC/total PC ratios, but significant differences in their phospholipid/protein ratios. P60 had the highest proportion of phospholipid to protein. P10 and P60 demonstrated surface activity but P100 did not. Total alveolar surfactant phospholipid was evenly distributed among the three fractions. This pattern of distribution was significantly different from that observed in rabbit subfractions prepared by the same procedure. These data indicate that mouse alveolar surfactant consists of three distinct subfractions or subtypes which can be separately and quantitatively isolated by differential centrifugation.(ABSTRACT TRUNCATED AT 250 WORDS)

RTs performing venipuncture: a survey of state regulations

Venipuncture is an Essential component for nuclear medicine technologists and is expected to become an Essential for radiographers. A descriptive survey of radiation safety offices in the 50 states and the District of Columbia was conducted to determine which states license or certify nuclear medicine technologists, radiographers and/or radiation therapists and to identify specific statutory terminology relative to drug administration or venipuncture. Results showed only six states specifically addressed the issue of drug administration or venipuncture for radiographers and radiation therapists. With so few states addressing this issue, the question arises whether technologists who perform venipuncture or administer drugs are protected against litigation for performance of these procedures.

Lack of correlation between interspecific divergence and intraspecific polymorphism at the suppressor of forked region in Drosophila melanogaster and Drosophila simulans

Levels of DNA sequence polymorphism at the suppressor of forked [su(f)] region in natural populations of Drosophila melanogaster and Drosophila simulans are estimated by restriction map analysis. su(f) is located at the base of the euchromatic portion of the X chromosome where the level of crossing-over per physical length is extremely low. In a survey of 55 alleles from three natural populations of D. melanogaster, only 2 restriction sites of 27 hexanucleotide and 108 tetranucleotide restriction sites scored are polymorphic. Among 103 alleles from three natural populations of D. simulans, just one polymorphic restriction site is found in 109 tetranucleotide-recognizing restriction sites scored. The few polymorphisms in these surveys yield estimates of per site heterozygosities (0.00, 0.0002, and 0.0005, respectively) at least a factor of 10 less than the average observed at loci located in regions of the genome with normal levels of crossing-over. Because under a broad category of models of molecular evolution (including the neutral theory) a correlation between levels of polymorphism and interspecific divergence is expected, the DNA sequence divergence is examined for the su(f) region. Contrary to the predicted correlation, the estimated divergence (0.12 substitution per silent site) is, in fact, greater than that observed at loci in regions of normal crossing-over. According to an alternative hypothesis (hitchhiking effect model) intraspecific polymorphism is swept out of the population in regions of the genome closely linked to rare but selectively favored variants as they quickly go to fixation; the rate of divergence is, however, unaffected by these rare hitchhiking events. Thus, the observed paucity of polymorphism and lack of correlation with divergence are in accord with the theory of the hitchhiking effect and several recent reports of polymorphism and divergence in other genomic regions with reduced crossing-over per physical length.

A very unusual breast lump

A 77 year old woman presenting with a malignant phyllodes tumour of of the right breast with exclusively stromal metastases to axillary lymph nodes refractory to both radiotherapy and chemotherapy.

Molecular cloning and expression of ptxA, the gene encoding the 120-kilodalton cytotoxin of Actinobacillus pleuropneumoniae serotype 2

The genetic determinants of the 120-kDa cytotoxin of Actinobacillus pleuropneumoniae serotype 2 were isolated from a lambda DNA library by a plaque immunoblot technique. Expression of the 120-kDa polypeptide was confirmed by Western immunoblot analysis of infected Escherichia coli cell lysates, which were shown to be toxic for porcine alveolar macrophages in vitro. The genetic determinants of the toxin were subcloned into the plasmid vector pUC18. This plasmid (pPTX1) directed the synthesis and secretion of the active 120-kDa cytotoxin in E. coli. The recombinant toxin was indistinguishable from native cytotoxin from A. pleuropneumoniae serotype 2 with respect to molecular size, reaction in Western blot analysis, heat lability, cytotoxic activity, and neutralization by serum antibody. A restriction endonuclease cleavage map of pPTX1 was prepared, and deletion mutants were used to locate the minimal region of DNA required for production of intracellular toxin; this gene was termed ptxA. Southern hybridization analysis with a 1.7-kb PvuII fragment located within the ptxA gene revealed sequences with a high degree of homology in serotype reference strains 2, 3, 4, 6, and 8. Other reference strains did not contain sequences that were recognized by this probe. However, related sequences (greater than 71% homology) were detected in Actinobacillus actinomycetemcomitans and A. equuli. Weak hybridization was observed between the ptxA probe and pLKT5, which carries the lktAC genes of Pasteurella haemolytica, and between the ptxA probe and pAPH1, which carries the structural gene for type II hemolysin from A. pleuropneumoniae. The isolation of the genetic determinants of this cytotoxin will enable investigations of the structure and organization of the ptx DNA region and further analysis of its role in the pathogenesis of pleuropneumonia.

An investigation of bacterial causes of arthritis in slaughter hogs

Joints from 153 arthritic and 80 normal slaughter hogs were examined by culture for presence of bacteria. Although none of the normal joints yielded bacteria, 37% of the disease joints were positive for bacterial growth. Of 67 bacterial isolates obtained, 45% were Erysipelothrix rhusiopathiae. Occurrence of other bacteria in order of their frequency was Streptococcus suis (16%), Actinomyces pyogenes (10%), Mycoplasma spp. including 3 M. hyorhinis isolates (7%), staphylococci (7%), Streptococcus spp. (6%), and organisms of uncertain significance (7%).

The history of ventriculoscopy: where do we go from here?

With the availability of better endoscopes, improved lighting and increased instrumentation, the use of ventriculoscopy and ventriculostomy in the management of hydrocephalus is becoming increasingly more common. Neurosurgeons recognized the potential for endoscopic surgery early in this century, but were frustrated in many of their attempts at treatment due to the poor quality of the instruments available. Nevertheless, much progress has been made, and the stage was set for better results with modern instrument design. This paper reviews the history of endoscopes in neurosurgery and ponders the direction these instruments will take us in the near future.

Projections of the tectospinal tract to the upper cervical spinal cord of the cat: a study with the anterograde tracer PHA-L

The goal of the present experiments was to re-examine the spinal projections of neurons in the superior colliculus (SC) of the cat by taking advantage of the high sensitivity of the anterograde tracer, phaseolus vulgaris leucoagglutinin (PHA-L). In seven experiments, multiple injections of PHA-L into different regions of the SC labelled a total of 172 axons in the predorsal bundle; yet only 11 tectospinal tract (TST) axons were found in the upper cervical spinal cord. Collaterals emerging from these axons were rare and arose exclusively from TST axons with a diameter of less than 1 micron. Individual collaterals had different termination zones: some terminated in the lateral part of lamina V and VI after taking a dorsolateral course through lamina VII and VIII; others terminated in the medial part of lamina VII. One collateral terminated within lamina IX and the ventral part of lamina VIII. The combined termination of all collaterals was densest in lamina VII and dorsal lamina VIII. A small number of boutons were also found in the lateral parts of laminae V and VI, and in lamina IX and immediately adjacent regions in lamina VIII. Compared to axons belonging to other spinal descending systems, individual TST axons give rise to much simpler intraspinal collaterals with relatively few boutons. This feature, together with the relative paucity of TST axons, suggests that direct connections from the SC to neurons in the upper cervical spinal cord are sparse. Furthermore, our results are consistent with electrophysiological studies that show that few, if any, neck motoneurons receive monosynaptic connections from TST neurons. Projections to neck motoneurons must therefore involve a relay, either through other descending pathways, such as the reticulospinal system, or via local segmental interneurons.

Characterization of prostate cancer, benign prostatic hyperplasia and normal prostates using transrectal 31phosphorus magnetic resonance spectroscopy: a preliminary report

We assessed the ability of 31phosphorus (31P) transrectal magnetic resonance spectroscopy to characterize normal human prostates as well as prostates with benign and malignant neoplasms. With a transrectal probe that we devised for surface coil spectroscopy we studied 15 individuals with normal (5), benign hyperplastic (4) and malignant (6) prostates. Digital rectal examination, transrectal ultrasonography and magnetic resonance imaging were used to aid in accurate positioning of the transrectal probe against the region of interest within the prostate. The major findings of the in vivo studies were that normal prostates had phosphocreatine-to-adenosine triphosphate (ATP) ratios of 1.2 +/- 0.2, phosphomonoester-to-beta-ATP ratios of 1.1 +/- 0.1 and phosphomonoester-to-phosphocreatine ratios of 0.9 +/- 0.1. Malignant prostates had phosphocreatine-to-beta-ATP ratios that were lower (0.7 +/- 0.1) than those of normal prostates (p less than 0.02) or prostates with benign hyperplasia (1.1 +/- 0.2, p less than 0.01). Malignant prostates had phosphomonoester-to-beta-ATP ratios (1.8 +/- 0.2) that were higher than that of normal prostates (p less than 0.02). Using the phosphomonoester-to-phosphocreatine ratio, it was possible to differentiate metabolically malignant (2.7 +/- 0.3) from normal prostates (p less than 0.001), with no overlap of individual ratios. The mean phosphomonoester-to-phosphocreatine ratio (1.5 +/- 0.5) of prostates with benign hyperplasia was midway between the normal and malignant ratios, and there was overlap between individual phosphomonoester-to-phosphocreatine ratios of benign prostatic hyperplasia glands with that of normal and malignant glands. To verify the in vivo results, we performed high resolution magnetic resonance spectroscopy on perchloric acid extracts of benign prostatic hyperplasia tissue obtained at operation and on a human prostatic cancer cell line DU145. The extract results confirmed the differences in metabolite ratios observed in vivo. We conclude that transrectal 31P magnetic resonance spectroscopy can characterize metabolic differences between the normal and malignant prostate.

Prospective evaluation of a totally implantable drug delivery system. Improved results at 4-year follow-up

Totally implantable drug delivery systems have facilitated chemotherapy in cancer patients. The incidence of complications has been acceptable but not optimal. A series of 140 consecutive implants over a 4-year period is presented. The total follow-up was 41,185 days. Reversible obstruction was present in 12.8% of portals. The infection-erosion rate was 4.2%; only 6.3% of patients required removal of the system because of failure. In the last 111 patients only one device failed (0.9%). The reasons for these improved results are analysed, and recommendations are made to improve the current management of these devices.

Control of embryonic motoneuron survival in vivo by ciliary neurotrophic factor

During development of the nervous system, neurons in many regions are overproduced by proliferation, after which the excess cells are eliminated by cell death. The survival of only a proportion of neurons during normal development is thought to be regulated by the limited availability of neurotrophic agents. One such putative trophic agent is ciliary neurotrophic factor (CNTF), a polypeptide that promotes the survival of ciliary, sensory, and sympathetic neurons in vitro. In contrast to the results of in vitro studies, however, the daily treatment of chick embryos in vivo with purified human recombinant CNTF failed to rescue any of these cell populations from cell death, whereas CNTF did promote the in vivo survival of spinal motoneurons. Thus, CNTF may not act as a neurotrophic agent in vivo for those embryonic neurons (especially ciliary neurons) on which it acts in vitro. Rather, CNTF may be required for in vivo survival of motoneurons.

Phase II study of pibenzimol in pancreatic cancer. A Southwest Oncology Group study

Twenty-three patients with advanced pancreatic adenocarcinoma were treated with Pibenzimol utilizing a daily intravenous schedule for five days. There were no objective responses seen. The major toxicity was pancreatic with grade 3 hyperglycemia in eleven patients. Pibenzimol is inactive in patients with advanced pancreatic adenocarcinoma.

Acardius anceps with evidence of intrauterine vascular occlusion: report of a case and discussion of the pathogenesis

An acardiac anomaly (holoacardius anceps) showed advanced development of the head and lower body parts in the absence of all thoracic and upper abdominal viscera. Large vascular anastomoses in the vertebral canal formed the only blood supply to the head. The two-vessel umbilical cord of the acardius contained calcified mural thrombi in both vessels. Severe fetal hydrops resulted in an exceptionally large birth weight of 3720 g. Fibroblasts from the acardius showed chromosomal mosaicism. The surviving co-twin was remarkable for a widely patent ductus arteriosus, unilateral multicystic renal dysplasia, and a normal chromosome complement. The circumscribed absence of organ development in the thorax and upper abdomen of the acardius and the vascular anatomy with thrombosis of the umbilical vessels suggest that an occlusion of thoracic and abdominal vessels was significant in the development of this acardiac malformation and should be considered as a possible pathogenetic mechanism in similar cases of acardia.

Rapid identification of Candida albicans using 4-methylumbelliferyl N-acetyl-beta-galactosaminide

Rapid identification of Candida albicans is performed mainly by the germ-tube test. However, recent reports have suggested that up to 5% of C. albicans species can give false negative results. We describe the use of 4-Methylumbelliferyl N-acetyl-beta-D-galactosaminide (4-MAG) conjugate as an alternative to the germ-tube test. Our results indicate that, in comparison to the germ-tube test, the 4-MAG test has a sensitivity of 100% and a specificity of 92%. Candida tropicalis can give false-positive results, and that a further screening test is required to identify this species. Problems reading end-points were not encountered.

To what extent should a hospital ethics committee be involved in hospital policy formation?

The extent to which a HEC becomes involved with policy formation depends in large measure on the credibility the committee has within the institution. Although on the basis of training, insight, or experience the HEC is in an ideal position to formulate policy, premature involvement in this area can jeopardize the effectiveness of the HEC in other areas which are equally if not more important. To the extent that the HEC does engage in policy formation it must do so with considerable political as well as ethical acumen.

Prevalence of clinically significant depressive symptoms in black and white patients in family practice settings

The authors administered the Zung Self-Rating Depression Scale to 764 black and 773 white adult outpatients in primary care settings. There was no significant difference between the races in prevalence of depressive symptoms or distribution of symptom severity levels.

Multiple sclerosis in the Shetland Islands: an update

Annual incidence rates of multiple sclerosis (MS) in the Shetland Islands have been updated from 1938 to 1986. These reveal a significant decline in MS incidence beginning between 1951 and 1968. No significant change in prevalence, age-specific prevalence, duration of MS, or mean age of the MS population in Shetland has been found since the last survey in 1974, although a trend towards an older MS population was noted.

Treatment of unresectable pancreatic carcinoma using irradiation with concurrent intravenous 5-FU infusion therapy

Ten patients with unresectable carcinoma of the pancreas who had only bypass surgery to relieve biliary obstruction were treated with radiation therapy to the pancreas and liver with concurrent 5-fluorouracil (5-FU) intravenous infusion therapy. Treatment regimen was three cycles of chemoradiotherapy with a two week rest period between cycles. 5-FU (1,000 mg/m2 per day) was administered by continuous infusion for the first five days of each cycle. In the first cycle radiotherapy was given to the pancreas to 2,000 cGy/10 fractions using 6 to 10 mV x-rays. In the second cycle 2,400 cGy/160 rads/fraction radiation was delivered to the pancreas and whole liver. In the third cycle, 1,600 cGy/160 rads/fraction to a total dose of 6,000 rads, was administered to the pancreatic tumor. All ten patients completed the treatments without interruption. No major side effects were noticed during the course of treatment. Survival ranged from 9 to 16 months and median survival was 11 months. Symptomatic relief was obtained in all 10 patients. One patient who lived for 16 months developed duodenal stenosis and underwent gastrojejunostomy.

Biochemical and biological activities of 2,3-dihydro-6-[3-(2-hydroxymethyl)phenyl-2-propenyl]-5-benzofuranol (L-651,896), a novel topical anti-inflammatory agent

The biochemical and biological profile of a topical anti-inflammatory agent, 2,3-dihydro-6-[3-(2-hydroxymethyl)phenyl-2-propenyl]-5-benzofuranol (L-651,896 inhibited the 5-lipoxygenase of rat basophilic leukemia cells with an IC50 of 0.1 microM and leukotriene synthesis by human PMN and mouse macrophages with IC50 values of 0.4 and 0.1 microM respectively. L-651,896 also inhibited prostaglandin E2 synthesis by mouse peritoneal macrophages (IC50 = 1.1 microM). This compound inhibited ram seminal vesicle cyclooxygenase activity at considerably higher concentrations, and this effect was directly related to substrate concentration. When applied topically to the mouse ear, L-651,896 lowered elevated levels of leukotrienes associated with arachidonic acid-induced skin inflammation and delayed hypersensitivity induced by oxazolone. However, while L-651,896 inhibited the increased vascular permeability induced by arachidonic acid, it had no effect on the edema associated with the immune-based response to oxazolone in the same tissue. Thus, it is possible that leukotrienes may play a role in some but not all inflammatory responses.