Different strategies for convective O2 transport in high altitude birds: A graphical analysis

For illustrative purposes, in this article we use "Johansen Plots" as a graphical way of simultaneously visualizing the inter-connected variables that compose the convective steps of the gas transport cascade. These plots are used to reflect on some of the physiological characteristics seen in five species of birds, four of which sojourn to, or are native to, high altitudes (the barnacle goose, bar-headed goose, Andean goose, speckled teal and ruddy duck). These species were chosen to emphasize the diversity of responses to hypoxia that can exist within a single family. This diversity likely arose for many possible reasons, including local adaptation to hypoxia, differences in flight or diving abilities, or as a result of other phylogenetically-based differences across waterfowl in physiology, behaviour, and/or life style.

Characterizing the influence of chronic hypobaric hypoxia on diaphragmatic myofilament contractile function and phosphorylation in high-altitude deer mice and low-altitude white-footed mice

Deer mice, Peromyscusmaniculatus, live at high altitudes where limited O₂ represents a challenge to maintaining oxygen delivery to tissues. Previous work has demonstrated that hypoxia acclimation of deer mice and low altitude white-footed mice (P. leucopus) increases the force generating capacity of the diaphragm. The mechanism behind this improved contractile function is not known. Within myocytes, the myofilament plays a critical role in setting the rate and level of force production, and its ability to generate force can change in response to changes in physiological conditions. In the current study, we examined how chronic hypobaric hypoxia exposure of deer mice and white-footed mice influences the Ca²⁺ activation of force generation by skinned diaphragmatic myofilaments, and the phosphorylation of myofilament proteins. Results demonstrate that myofilament force production, and the Ca²⁺ sensitivity of force generation, were not impacted by acclimation to hypobaric hypoxia, and did not differ between preparations from the two species. The cooperativity of the force-pCa relationship, and the maximal rate of force generation were also the same in the preparations from both species, and not impacted by acclimation. Finally, the relative phosphorylation of TnT, and MLC was lower in deer mice than white-footed mice, but was not affected by acclimation. These results indicate that species differences in diaphragm function, and the increase in force production with hypoxia acclimation, are not due to differences, or changes, in myofilament function. However, it appears that diaphragmatic myofilament function in these species is not affected by chronic hypobaric hypoxia exposure.

Unilateral absence of mandibular condyle in a Bronze Age male skeleton from Portugal

In 2009, a pit burial dated to the Bronze Age was excavated in Monte do Gato de Cima 3 (Portugal). The purpose of this paper is to describe the pathological absence of the left mandibular condyle noted in an adult male skeleton and to discuss possible diagnoses, including subcondylar fracture, cystic defect, congenital absence, condylar aplasia and mandibular condylysis. The most likely explanation for the pathological alteration is subcondylar fracture with non-union. Although the occurrence of non-union and slight osteoarthritic alterations in the left glenoid fossa were evident, this mandible was likely functional, as can be inferred from dental wear and muscle attachment sites. This trauma probably occurred before adult age when remodelling capacity is still high. Thus, bones and muscles adequately compensated for the trauma and only minor asymmetry developed. Consequently, this injury seems not to have greatly influenced masticatory functions. This is in accordance with clinical data, which demonstrate that, in growing patients, conservative treatment (non-surgical) results in good remodelling and patient recovery. In addition, in the few paleopathological cases published, the healing capacity of these types of mandibular fractures seems to be good, as can be inferred by evidence from the bone.

Effects of chronic hypoxia on diaphragm function in deer mice native to high altitude

AIM

We examined the effects of chronic hypoxia on diaphragm function in high- and low-altitude populations of Peromyscus mice.

METHODS

Deer mice (P. maniculatus) native to high altitude and congeneric mice native to low altitude (P. leucopus) were born and raised in captivity to adulthood and were acclimated to normoxia or hypobaric hypoxia (12 or 9 kPa, simulating hypoxia at 4300 and 7000 m) for 6-8 weeks. We then measured indices of mitochondrial respiration capacity, force production, and fatigue resistance in the diaphragm.

RESULTS

Mitochondrial respiratory capacities (assessed using permeabilized fibres with single or multiple inputs to the electron transport system), citrate synthase activity (a marker of mitochondrial volume), twitch force production, and muscle fatigue resistance increased after exposure to chronic hypoxia in both populations. These changes were not well explained by variation in the fibre-type composition of the muscle. However, there were several differences in diaphragm function in high-altitude mice compared to low-altitude mice. Exposure to a deeper level of hypoxia (9 kPa vs 12 kPa) was needed to elicit increases in mitochondrial respiration rates in highlanders. Chronic hypoxia did not increase the emission of reactive oxygen species from permeabilized fibres in highlanders, in contrast to the pronounced increases that occurred in lowlanders. In general, the diaphragm of high-altitude mice had greater capillary length densities, produced less force in response to stimulation and had shorter relaxation times. The latter was associated with higher activity of sarcoplasmic reticulum Ca²⁺ -ATPase (SERCA) activity in the diaphragm of high-altitude mice.

CONCLUSION

Overall, our work suggests that exposure to chronic hypoxia increases the capacities for mitochondrial respiration, force production and fatigue resistance of the diaphragm. However, many of these effects are opposed by evolved changes in diaphragm function in high-altitude natives, such that highlanders in chronic hypoxia maintain similar diaphragm function to lowlanders in sea level conditions.

Control of breathing and ventilatory acclimatization to hypoxia in deer mice native to high altitudes

AIM

We compared the control of breathing and heart rate by hypoxia between high- and low-altitude populations of Peromyscus mice, to help elucidate the physiological specializations that help high-altitude natives cope with O₂ limitation.

METHODS

Deer mice (Peromyscus maniculatus) native to high altitude and congeneric mice native to low altitude (Peromyscus leucopus) were bred in captivity at sea level. The F1 progeny of each population were raised to adulthood and then acclimated to normoxia or hypobaric hypoxia (12 kPa, simulating hypoxia at ~4300 m) for 5 months. Responses to acute hypoxia were then measured during stepwise reductions in inspired O₂ fraction.

RESULTS

Lowlanders exhibited ventilatory acclimatization to hypoxia (VAH), in which hypoxia acclimation enhanced the hypoxic ventilatory response, made breathing pattern more effective (higher tidal volumes and lower breathing frequencies at a given total ventilation), increased arterial O₂ saturation and heart rate during acute hypoxia, augmented respiratory water loss and led to significant growth of the carotid body. In contrast, highlanders did not exhibit VAH - exhibiting a fixed increase in breathing that was similar to hypoxia-acclimated lowlanders - and they maintained even higher arterial O₂ saturations in hypoxia. However, the carotid bodies of highlanders were not enlarged by hypoxia acclimation and were similar in size to those of normoxic lowlanders. Highlanders also maintained consistently higher heart rates than lowlanders during acute hypoxia.

CONCLUSIONS

Our results suggest that highland deer mice have evolved high rates of alveolar ventilation and respiratory O₂ uptake without the significant enlargement of the carotid bodies that is typical of VAH in lowlanders, possibly to adjust the hypoxic chemoreflex for life in high-altitude hypoxia.

Audit on the management of epididymo-orchitis by the Department of Urology in Edinburgh

Epididymo-orchitis among men younger than 35 years is mainly caused by chlamydial infection. National guidelines for the management of this condition have been published. The aim of this study was to audit the management of epididymo-orchitis in a major teaching hospital. To this end we performed a retrospective study of patients with epididymo-orchitis admitted to the Department of Urology in the Western General Hospital, Edinburgh between 1998 and 2003. Case-notes of 108 cases of epididymo-orchitis were reviewed. The diagnosis was established by ultrasound in 94% of cases. Patients were not tested routinely for chlamydial infection and the majority of men younger than 35 years were treated inappropriately with ciprofloxacin. The management of patients younger than 35 years was not in accordance with the recommendations of national guidelines. Chlamydia trachomatis is sexually transmissible and is not responsive to ciproflcxacin. As a result of this audit, each patient will be tested for chlamydial infection and men younger than 35 years will be treated with ofloxacin. Sexual partners of patients with chlamydial infection will be treated in the department of genitourinary medicine.

What is the Role of Scrotal Ultrasound Scans in Genitourinary Medicine?

The objective of the study was to review the indications for scrotal ultrasound scans and to assess the impact on patient management.

We therefore performed a retrospective analysis. Case notes of all males referred for a scrotal ultrasound between April 1998 and March 2001 were studied. Data were extracted for the following: age, presenting complaints, physical findings on examination, results of a full sexual screen, treatment, ultrasound result and the designation of the person requesting the scan. All data were tabulated and summated using ‘Windows Excel’ software.

One hundred and fifteen men were referred for an ultrasound in this period of time. None had an ultrasound more than once. Of these, 25 subjects could not be included as they either failed to attend for their scan ( n = 8) or their notes could not be traced ( n = 17). Twelve subjects were excluded as they did not fit the selection criteria ( n = 12).

Median age was 30 years (Range 19–61 years). The commonest reason for referral was testicular pain ( n = 43) followed by testicular lump ( n = 19). The commonest abnormality on examination was an inflamed epididymis ( n = 18). Forty-two of the ultrasound scans were normal. A testicular mass was detected in only five of the 78 patients (6.4%), of which one was a malignancy (1.2%). A direct referral to a urologist for further management was made in only nine patients.

Scrotal ultrasound for pain has limited impact on patient management apart from reassuring a worried patient. However, it remains an important investigation in the management of a suspected testicular lump.

The roller coaster flight strategy of bar-headed geese conserves energy during Himalayan migrations

The physiological and biomechanical requirements of flight at high altitude have been the subject of much interest. Here, we uncover a steep relation between heart rate and wingbeat frequency (raised to the exponent 3.5) and estimated metabolic power and wingbeat frequency (exponent 7) of migratory bar-headed geese. Flight costs increase more rapidly than anticipated as air density declines, which overturns prevailing expectations that this species should maintain high-altitude flight when traversing the Himalayas. Instead, a "roller coaster" strategy, of tracking the underlying terrain and discarding large altitude gains only to recoup them later in the flight with occasional benefits from orographic lift, is shown to be energetically advantageous for flights over the Himalayas.

The paradox of extreme high-altitude migration in bar-headed geese Anser indicus

Bar-headed geese are renowned for migratory flights at extremely high altitudes over the world's tallest mountains, the Himalayas, where partial pressure of oxygen is dramatically reduced while flight costs, in terms of rate of oxygen consumption, are greatly increased. Such a mismatch is paradoxical, and it is not clear why geese might fly higher than is absolutely necessary. In addition, direct empirical measurements of high-altitude flight are lacking. We test whether migrating bar-headed geese actually minimize flight altitude and make use of favourable winds to reduce flight costs. By tracking 91 geese, we show that these birds typically travel through the valleys of the Himalayas and not over the summits. We report maximum flight altitudes of 7290 m and 6540 m for southbound and northbound geese, respectively, but with 95 per cent of locations received from less than 5489 m. Geese travelled along a route that was 112 km longer than the great circle (shortest distance) route, with transit ground speeds suggesting that they rarely profited from tailwinds. Bar-headed geese from these eastern populations generally travel only as high as the terrain beneath them dictates and rarely in profitable winds. Nevertheless, their migration represents an enormous challenge in conditions where humans and other mammals are only able to operate at levels well below their sea-level maxima.

European guideline for the management of pediculosis pubis, 2010

Transmission of the crab louse Phthirus pubis generally occurs by close body contact. Diagnosis is usually clinical and screening for other sexually transmitted infections (STIs) is indicated. While most evidence is extrapolated from studies of head lice treatments, topical pediculicides are recommended and treatment of sexual contacts is indicated.

European guideline for the management of scabies, 2010

Transmission of the mite Sarcoptes scabiei generally occurs by protracted direct body contact; although in crusted scabies, transmission also occurs via infected clothing or bedding. Diagnosis is usually clinical and topical antiscabietics are the mainstay of treatment. Oral ivermectin is not licensed in most countries, but may have a role in certain patients. Treatment of sexual contacts is indicated.

General practitioner involvement and patient outcomes in HIV management

We undertook this study to try to determine whether disease outcomes were poorer in patients with HIV infection whose general practitioner (GP) was unaware of their status compared with those whose GP was aware. The notes of 375 HIV-positive patients attending Edinburgh's genitourinary (GU) medicine clinic were reviewed. The GPs of 292 patients (78%) had been informed of their patient's HIV infection. Advancing disease was associated with disclosure of the status to GPs (P = 0.037) but no significant association was found between informing GPs and the viral load results of treated (P = 0.389) and untreated patients (P = 0.070). Twenty-three percent of patients had had one or more bacterial sexually transmitted infections (STIs) while receiving their HIV care at a GU medicine clinic. Patients diagnosed with an STI were less likely to disclose their HIV status to their GP (P < 0.0005). Non-disclosure of the HIV status to a GP may be a predictor of unsafe sexual practices.

Infection of the CD45RA+ (naive) subset of peripheral CD8+ lymphocytes by human immunodeficiency virus type 1 in vivo

To investigate the mechanism and functional significance of infection of CD8+ lymphocytes by human immunodeficiency virus type 1 (HIV-1) in vivo, we determined frequencies of infection, proviral conformation, and genetic relationships between HIV-1 variants infecting naive (CD45RA+) and memory (CD45RO+) peripheral blood CD4+ and CD8+ lymphocytes. Infection of CD3+ CD8+ CD45RA+ cells was detected in 9 of 16 study subjects at frequencies ranging from 30 to 1,400 proviral copies/10(6) cells, more frequently than CD3+ CD8+ lymphocytes expressing the RO isoform of CD45 (n = 2, 70 and 260 copies /10(6) cells). In agreement with previous studies, there was no evidence for a similar preferential infection of CD4+ naive lymphocytes. Proviral sequences in both CD4+ and CD8+ lymphocyte subsets were complete, as assessed by quantitation using primers from the long terminal repeat region spanning the tRNA primer binding site. In six of the seven study subjects investigated, variants infecting CD8+ lymphocytes were partially or completely genetically distinct in the V3 region from those recovered from CD4+ lymphocytes and showed a greater degree of compartmentalization than observed between naive and memory subsets of CD4+ lymphocytes. In two study subjects, arginine substitutions at position 306, associated with use of the chemokine coreceptor CXCR4, were preferentially found in CD4 lymphocytes. These population differences may have originated through different times of infection rather than necessarily indicating a difference in their biological properties. The preferential distribution of HIV-1 in naive CD8+ lymphocytes indeed suggests that infection occurred early in T-lymphocyte ontogeny, such as during maturation in the thymus. Destruction of cells destined to become CD8+ lymphocytes may be a major factor in the decline in CD8+ lymphocyte frequencies and function on disease progression and may contribute directly to the observed immunodeficiency in AIDS.

Antiretroviral therapy in HIV infection: are we using resources appropriately and cost effectively?

The provision of antiretroviral therapy to HIV-positive patients attending the Department of Genitourinary Medicine at the Royal Infirmary of Edinburgh was assessed, to examine whether clinicians were offering treatment in line with the departmental protocol. A total of 195 patients attended in 1998, of whom 169 fulfilled the protocol criteria for treatment. Although only 115 of these were on therapy, no patient who fulfilled treatment criteria and wished to be treated was denied treatment. Of the 26 patients not fulfilling any treatment criteria, 9 had transferred in from another unit already on treatment. The remaining 17 were not on treatment.

Infrequent detection of TT virus infection in intravenous drug users, prostitutes, and homosexual men

TT virus (TTV), a recently discovered DNA virus, has been implicated as a cause of non-A to non-C posttransfusion hepatitis. The frequency of TTV in persons considered at high risk for sexual and parenteral infection was investigated (52 prostitutes, 81 homosexual men, 65 intravenous drug users) to assess its mode of transmission. TTV DNA was assayed by polymerase chain reaction using primers from conserved regions in the N22 clone. Viremia frequency was 4.5%-13.0% in study subjects, not significantly different from that in low-risk controls (2 [4.5%] of 44). The frequency of TTV viremia increased significantly with age (P=.018) but was not associated with human immunodeficiency virus coinfection. The low frequency of infection detected in both risk groups suggests that spread by sexual contact or by intravenous drug use is relatively inefficient and unlikely to account for the high prevalence of TTV observed worldwide.

Historical disclosure of rape by women attending genitourinary medicine clinics

In a previous internal audit of women attending the department of genitourinary medicine following rape, we noted that data from diagnostic coding seemed to underestimate the problem and that anecdotally, a number of women had been seen with concerns relating to historical assault. We therefore decided to record attendance following rape prospectively. Between 1 June 1996 and 31 May 1997 staff at the Department of Genitourinary Medicine (GUM) at the Royal Infirmary of Edinburgh completed a data collection form for every female patient aged >15 years who attended the clinic and spontaneously disclosed a history of rape, either recent or historical. Seventy-five women attending GUM disclosed a history of rape. Sixty-six per cent were aged <25 years. Thirty women presented more than 12 months after the incidence, of whom 50% presented to the health adviser requesting HIV antibody testing. The incidence of sexually transmitted infections was low and in no case could be specifically attributed to the rape. None of the 38 HIV antibody tests performed were positive. A number of women present to GUM a long time after an incident of rape, most commonly due to concerns about HIV. They may have endured a great deal of mental anguish before summoning up the courage to seek help. This can have a substantial effect on workload, especially for health advisers.

PCR testing of genital and urine specimens compared with culture for the diagnosis of chlamydial infection in men and women

Our aim was to determine the number of chlamydial infections detected by Cobas Amplicor CT/NG multiplex polymerase chain reaction (PCR) testing of genital and first-voided urine (FVU) specimens compared with routine culture. Two hundred and eighty-six female and 276 male patients attending the Genito-Urinary Medicine (GUM) Unit at Edinburgh Royal Infirmary were included in the study. Case notes were analysed retrospectively to determine how many infected patients would not have been treated had diagnosis relied on routine culture. Polymerase chain reaction on FVU from women had a sensitivity, specificity, positive and negative predictive value of 91%, 100%, 100% and 99.1%: corresponding values for genital PCR and culture were 96%, 100%, 100%, 99.6% and 65%, 100%, 100%, 96.7% respectively. PCR on FVU from men had a sensitivity, specificity, positive and negative predictive value of 96%, 99.1%, 92.6% and 99.5%: corresponding values for genital PCR and culture were 89%, 99.5%, 95.8%, 98.6% and 48%, 100%, 100%, 94.3% respectively. In both men and women genital PCR and urine PCR were significantly more sensitive than culture. PCR almost doubled the number of patients detected by culture (49 vs 27). Of the 22 cases detected only by PCR 8 would not have received treatment on the basis of clinic treatment policy.

Sexual transmission of GB virus C/hepatitis G virus

Although it is established that infection with GB virus C (GBV-C) or hepatitis G virus (HGV) can be transmitted parenterally, the prevalence of GBV-C/HGV viremia in the general population (2-5%) is relatively high compared with other parenterally borne viruses such as hepatitis C virus. To investigate the possibility of sexual transmission of GBV-C/HGV, we determined the frequency of viremia by the polymerase chain reaction and serological reactivity to the E2 protein by ELISA in samples collected from individuals at risk for sexually transmitted diseases attending a city genitourinary medicine clinic. GBV-C/HGV viremia was detected in 27 of 87 male homosexuals (31%) and 9 of 50 prostitutes (18%), frequencies significantly greater than those in matched controls (2/63) and local blood donors (2.3%). Among nonviremic individuals, a high frequency of serological reactivity to the E2 protein of GBV-C/HGV was also observed in the risk groups (male homosexuals: 14/60; prostitutes: 11/41), although these figures are likely to be underestimates of the frequency of past infection as detectable anti-E2 reactivity may attenuate rapidly over time following resolution of infection. Infection with GBV-C/HGV was more frequent among those coinfected with human immunodeficiency virus type 1. Among male homosexuals from whom retrospective samples were available, evidence for de novo infection was found in 9 of 22 individuals over a mean sampling time of 2.9 years, predicting an annualized incidence of GBV-C/HGV infection of approximately 11% in this group. The high prevalence and incidence of GBV-C/HGV infection in these individuals and prostitutes provides strong evidence for its spread by sexual contact. Further studies are required to investigate the mechanism of its transmission and the clinical significance of acute and persistent infection in these risk groups.

Global eradication of rinderpest. Yea or nay?

Rinderpest is a scourge continuing to change the course of history. The German "Rinderpest" in English fails to convey the spectre of Death, Despair and Desolation long associated with the disease. Although the causal morbillivirus cross-protects against other morbillivirus, there is only one rinderpest serotype which is both immuno-suppressive and immunogenic. Safe vaccines induce lifelong protection in cattle. Transmission follows close contact between sick and healthy artiodactyls. Infectious periods are short and deaths may be curtailed by liberal fluid replacement therapy. Carriers do not exist. In other words rinderpest is a prime candidate for eradication. Why has it not happened? The major obstacle is "man's inhumanity to man". Rinderpest thrives in a milieu of armed conflict and fleeing refugee masses. Until world peace is secured, the "Nays" win the argument.

Measurement of cardiac function by transthoracic echocardiography: day to day variability and repeatability in normal Thoroughbred horses

In order to assess the reliability and repeatability of transthoracic echocardiography for detecting serial changes in cardiac function in horses, day to day variability of a number of echocardiographic indices of ventricular function were studied. The variables investigated were, from 2-dimensional (2-D) and M-mode echocardiography - aortic diameter in systole (Aos), pulmonary artery diameter in systole (Pas), left ventricular internal diameter in systole (LLVIDs) and diastole (LLVIDd), and left ventricular fractional shortening (%FS) and estimated ejection fraction (EF). From pulsed Doppler echocardiography - maximum velocity (Vmax) and acceleration (dv/dtmax) of aortic and pulmonary arterial blood flow, left and right ventricular velocity time integral (AoVTI and PAVTI) and estimated cardiac output (COLV, and CORV), left and right ventricular ejection time (LVET and RVET) and pre-ejection period (LVPEP and RVPEP), and heart rate. Maximum velocity of early rapid right ventricular filling (ETV) and late right ventricular filling due to right atrial contraction (ATV) were measured. Maximum deceleration and time for deceleration of early rapid filling (dv/dtTV and dt TV) were also determined. Seven healthy mature Thoroughbred horses weighing 490-600 kg were studied. The horses' management regimes and environment were standardised and an echocardiographic examination was carried out on each horse at the same time every day for 6 consecutive days. Two statistical measures of repeatability were calculated for each variable: the intraclass correlation coefficient (rI) and the 95% confidence intervals for error free value of a single measurement. In general, the dimensions and indices of cardiac function derived from 2-D and M-mode echocardiography showed better repeatability for individual horses than did the indices derived from Doppler echocardiography. Overall the 95% confidence intervals for an error-free value of all variables derived from Doppler echocardiography were wide. This must be appreciated when attributing serial measured changes of Doppler echocardiographic variables in an individual animal to effects of a treatment or disease.

Trends in survival of HIV infected patients attending the Department of Genito-Urinary Medicine, Royal Infirmary of Edinburgh

In the early 1980s, median survival for patients with the acquired immunodeficiency syndrome (AIDS) was only 11 months. Survival improved in the mid-1980s, reaching a median of 20 months. We have looked at the trends in survival of patients attending the Genito-urinary Medicine Department of Edinburgh Royal Infirmary between 1984 and 1996. Patients with an AIDS diagnosis between 1988 and 1991 had a median survival of 28 months, whereas patients given an AIDS diagnosis between 1992 and 1996 had a median survival of only 15 months (p = 0.01). However, survival from the point at which the CD4 lymphocyte count fell below 200 (CD4 200) remained unchanged. Patients diagnosed as AIDS after 1992 were more likely to have received prophylaxis against Pneumocystis carinii pneumonia or anti-retroviral therapy prior to an AIDS diagnosis. This may have resulted in the postponement of an AIDS defining diagnosis until the patients were more severely immuno-compromised, but has conferred no overall survival benefit.

Natural transmission of orf virus from clinically normal ewes to orf-naive sheep

The apparent natural transmission of orf virus from clinically normal ewes to susceptible sheep was observed during a border disease vaccine experiment. The 14 susceptible sheep were persistently infected with border disease virus and had been reared indoors in isolation from other sheep since birth. Their ages ranged from two to four years and they were housed in two groups; group 1 consisted of four sheep persistently infected with the Moredun strain of border disease virus and group 2 consisted of 10 sheep persistently infected with the Oban strain of the virus. On day 0, six sheep were removed from group 2 and rehoused. To the remaining four sheep in each group were added eight four- to six-year-old pregnant conventionally reared ewes at 48 days gestation. Fourteen days later the four sheep in group 1 were moved to another pen housing eight similar five-year-old pregnant ewes at 48 days' gestation, and the four sheep from group 2 were rehoused with their original stallmates. Twenty-one days later lip lesions typical of orf were first observed on the sheep from both groups and the disease spread to all the sheep persistently infected with border disease virus over the next four weeks. Virological and serological evidence demonstrated that the source of infection for the sheep was almost certainly the conventionally reared ewes, on which no lesions resembling orf were observed at any time during the study.

Technology transfer in tropical animal health and production at the Centre for Tropical Veterinary Medicine (CTVM)

Although this is an edition of the Journal celebrating the 25th anniversary of the Centre for Tropical Veterinary Medicine (CTVM), tropical veterinary medicine has been taught at the Edinburgh Veterinary School for 65 years. During that time the emphasis has changed from the training solely of British veterinarians for work in the tropics to training both veterinarians and those from other disciplines from the tropics and subtropics. As a result CTVM graduates now work in most countries of the world in many different roles. The CTVM was formed 25 years ago to meet the increased demand for inservice postgraduate training for veterinarians from tropical countries. These 25 years have seen considerable changes in the training programmes offered by the CTVM to meet the developing needs of these countries. During this period the original DTVM course has been replaced by five MSc courses some of which are open to non veterinarians. The profile of the students attending these courses has constantly changed with the result that more than 1,100 students from 108 countries have attended during the 25 year period. The courses are constantly developing and now most are offered in modular form, one is available as a bilingual course (English/French) and some modules can be taught as "turnkey" courses in tropical countries. The links with research workers at the CTVM and those in the Edinburgh Centre of Rural Research (ECRR) have ensured that teaching programmes have been and continue to be relevant to current needs. In addition the CTVM graduates have proved to be a successful way of channelling research findings from these programmes to the tropics. The CTVM has provided a unique environment 55 degrees N of the equator where veterinarians and others interested in animal production and health from six continents can have access to up-to-date information and to exchange ideas with each other. Many subsequently return for refresher courses or just to renew old acquaintances.

Microbiological research at the Centre for Tropical Veterinary Medicine (CTVM)

The nature of the research carried out by the staff of the Microbiology Section of the Centre for Tropical Veterinary Medicine (CTVM) at home and abroad is illustrated by precis of projects on rinderpest, orf in goats and sheep, bovine dermatophilosis, contagious caprine pleuropneumonia, tick-borne fever in goats and sheep, bovine petechial fever, and caprine cowdriosis.

Factors affecting reattendance rates at genitourinary medicine clinics

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Outreach STD clinics for prostitutes in Edinburgh

This paper describes the establishment of Genito-Urinary Medicine outreach clinics based in 2 drop-in centres for female prostitutes in Edinburgh; 242 women have received medical care at these outreach clinics. STD screening has been carried out on 160 (63%), detecting one case of gonorrhoea, 11 cases of chlamydia, 11 cases of genital warts, and 2 cases of recurrent genital herpes. With regards to HIV serostatus, 8 women were already known to be HIV seropositive and 18 were known to be seronegative. One hundred and fifteen women have been tested at the outreach clinics, yielding one positive result. The serostatus of 91 women is unknown. There have been 42 pregnancies, some of which were conceived through client contact. The prevalence of STDs including HIV is low and would suggest that condom usage is high. However, this level of usage is associated with significant numbers of unwanted pregnancies. Prostitutes in Edinburgh do not appear to act as a significant focus for dissemination of HIV infection.

Lymphocyte proliferative responses and the occurrence of dermatophilosis in cattle naturally infested with Amblyomma variegatum

The proliferative response of lymphocytes from tick-infested Zebu type, N'Dama and Friesian cattle and acaricide-treated Zebu types and Friesians in concanavalin A (Con A) stimulated cultures was monitored regularly for periods ranging from 11 to 27 months. The numbers of ticks on the animals and the presence of dermatophilosis were also noted. The Friesian cattle carried most and the N'Dama fewest Amblyomma variegatum ticks. The tick-infested Friesians all developed severe clinical dermatophilosis within 5 months of becoming tick-infested. Dermatophilosis lesions on the tick-infested Zebu type and N'Dama cattle were less common and less severe especially in the N'Damas. The proliferative response of lymphocytes from tick-infested Friesians in Con A stimulated cultures fell to almost half that of the acaricide-treated Friesians soon after the former became tick-infested. The tick-infested Zebu types also developed a depressed response compared with the tick-free Zebu group over a 27 month study period. However, the responses of the N'Damas was similar to that of the tick-free Zebu types. The addition of autologous serum to Con A stimulated cultures of lymphocytes derived from the tick-infested Zebu types and N'Damas suppressed their proliferative response compared with that of similar cultures for the tick-free Zebu types.

Sequential pathology of tick-borne fever

The sequential pathology and clinical responses of 12 sheep infected with the Sourhope strain of Cytoecetes phagocytophila are described. During the experimental period of 3 weeks, the clinical effects were mild, as is usual. There was transient leucopenia, affecting mainly lymphocytes, eosinophils and neutrophils. Parasitaemia was detected from days 5 to 16, approximately. A mild but consistent histopathological response up to day 21 comprised (i) pulmonary alveolitis with minimal shedding of cells, (ii) follicular and especially parafollicular lymphoreticular reactions in lymph nodes and spleen, (iii) mesangial glomerulitis, and (iv) in the cranial nervous system marked choroiditis but minimal reaction in the brain. Two forms of intracytoplasmic inclusions were found, a smaller, granular basophilic structure occurring in clumps and an intravacuolar pleomorphic form. In tissue sections they were mainly associated with lymphoid and macrophagic cells. The significance of these findings is discussed including the problems of differential diagnosis in complex infections.

The association between HIV media campaigns and number of patients coming forward for HIV antibody testing

AIM

To assess the relationship between national and local media campaigns with respect to the number of patients requesting HIV antibody tests as a surrogate marker of the effectiveness of different campaign strategies.

METHODS

Analysis by month of the numbers of HIV tests performed in the regional genitourinary (GUM) clinic for Lothian over a 5 year period and in the whole of Lothian Region, Scotland over a 3 year period. Changes in testing rates were monitored with respect to media campaigns over the same time period.

RESULTS

Television based media campaigns produced the greatest increase in testing rates (average 46% increase over 2 months) compared with newspapers and poster campaigns (average 6% increase over 2 months). Regional HIV testing rates correlated significantly with GUM clinic testing rates. No increase in positive HIV tests was seen following media campaigns.

CONCLUSIONS

Using HIV testing rates as a surrogate marker, television based media campaigns appear to be the most effective way of increasing awareness of HIV. The effect of media campaigns is short-lived indicating a need for constant reminder of the dangers of HIV infection. The increase in HIV testing occurs largely in the "worried well" with few additional HIV positive patients being identified.

Efficacy of epidural anesthesia in free flaps to the lower extremity

Epidural anesthesia is an effective means of providing pain control and chemical sympathectomy at the spinal nerve root level. The purpose of this study is to compare the efficacy of the combination of epidural and general anesthesia to general anesthesia alone in patients undergoing free flaps to the lower extremity. A retrospective review of 35 consecutive patients (36 operations) from November of 1988 to November of 1990 undergoing free tissue transfer to the lower extremity was undertaken. Sixteen patients had epidural and general anesthesia, and 19 (20 operations) had general anesthesia alone. There were no significant differences in the age or sex of the patients, the distribution between acute and chronic wounds, or the number of cigarette smokers in the two groups. There were no flap losses in the epidural group (100 percent success) and one major, but nonmicrovascular complication (6 percent). In the nonepidural group, there were one flap loss (95 percent success) and five major complications (25 percent). These included three microvascular complications (15 percent). There were significantly fewer patients with postoperative atelectatic fevers in the epidural group versus the nonepidural group. In this consecutive series of patients, epidural supplementation of general anesthesia for free flaps to the lower extremity was associated with uniformly successful flap survival and a lower rate of microvascular complications compared to general anesthesia alone.

Trichomonas vaginalis infection in pre-pubertal girls

This short paper discusses the implications of Trichomonas vaginalis infection of the genital tract in children with respect to suspected child abuse. Two case reports are described to illustrate the problems that can arise in the investigation of such cases T. vaginalis is usually transmitted sexually but the potential for non-sexual transmission does exist.

Condylomata acuminata in pre-pubertal children

The medico-legal significance of anogenital warts as a marker of sexual abuse in children is unclear. This review article presents three case reports and discusses the possible modes of transmission of papilloma virus in children. Although genital warts can indicate sexual abuse, non-sexual transmission may also occur.

Palatine torus in the Greenlandic Norse

Physical anthropologists have long been intrigued by the distinctive oral tori expressed by the medieval Norse populations of Iceland and Greenland. To assess the temporal and spatial variation of one form of oral tori, palatine torus, observations were made on all available Greenlandic Norse skeletons, as well as on samples of medieval Icelanders and Norwegians. In terms of temporal variation, 12th to 14th century (medieval) Greenlanders from the Eastern and Western settlements exhibited higher frequencies and more pronounced expressions of palatine torus compared with early 11th century Greenlanders. The early Greenlandic sample closely approximated the medieval Icelandic and Norwegian samples for total torus frequency, although the Norwegians exhibited the trait to a less pronounced degree. As degree of expression is the most distinctive aspect of torus variation among the Norse, some combination of environmental factors, including increased masticatory stress and chronic undernutrition, probably accounts for most of the difference between settlement period and medieval Greenlanders. Although palatine torus may be hereditary in part, environmental factors play a significant role in the expression of this trait.

Seasonal variation in gonorrhoea

Seasonal variations in the incidence of gonorrhoea were observed in the 1970's with a peak in the third quarter of the year and a trough in the first and fourth quarters. The aim of this study was to determine what, if any, seasonal trends were present in Scotland and Lothian between 1984 and 1989 and postulate mechanisms to explain our observations. We observed a change in the previously reported pattern with regular peaks of infection in the first and third quarters of the year for Scotland but no regular trend in the Lothian region. The most likely explanation for the observed trends are changes in sexual behaviour related to summer vacations and seasonal work patterns but other unidentified factors probably also contribute.

Rape and Sexually Transmitted Diseases: Patterns of Referral and Incidence in a Department of Genitourinary Medicine

A retrospective study was carried out of all women attending a Department of Genitourinary Medicine over a 3-year period. Note was taken of referring source, presenting symptoms, infection detected at STD screening and follow-up attendance. Comparison was also made between the number of women referred by the police surgeon and the number who actually attended.

We observed an overall incidence of STD of 35% and noted that many infections had a similar prevalence to that of our normal clinic population over the same time period. Only 13% of the women referred by the police attended although after the initial visit attendance was similar regardless of referral source. A number of asymptomatic women were noted to have infection with Neisseria gonorrhoeae and Chlamydia trachomatis.

Although the risk of significant STD following sexual assault is low greater efforts should be made to encourage women to attend for screening whether or not they are symptomatic.