Anaemia in young primigravidae in the guinea savanna of Nigeria: sickle-cell trait gives partial protection against malaria

Haematological indices, malarial parasitaemia, serum and red cell folate (SFA, RCF), serum vitamin B12 and haemoglobin (Hb) electrophoretic patterns were studied in 228 non-elite young Hausa primigravidae at less than 24 weeks of gestation. The study was conducted in the guinea savanna of Nigeria, where malaria is hyperendemic. Ninety-nine (43%) were anaemic (Hb less than 11.0 g dl-1). The commonest cause of anaemia was malaria, in 28% of all and 40% of anaemic subjects. Plasmodium falciparum was predominant; P. malariae was seen in 1.3% and P. ovale was not recorded. Parasitaemia was more frequent and more dense in the wet than the dry season. Iron deficiency was diagnosed in 18% of all and 25% of anaemic women; 14% of all patients were folate-deficient; high MCV and MCH correlated with anaemia, and low SFA was associated weakly with anaemia and malaria. Serum vitamin B12 was normal or high in all 145 in whom it was measured; 3% had congenital elliptocytosis, but this did not contribute to the anaemia. Sickle-cell trait was present in 26% and Hb-AC in less than 1%. Hb-AS was associated with significantly lower frequency and density of P. falciparum; this has not been demonstrated in pregnancy in Africa previously. However, the parasitological advantage was not reflected in any haematological advantage. The roles of malaria, folate-deficiency and iron-deficiency in the causation of anaemia in Hausa primigravidae will be defined further by a double-blind trial of antimalarial prophylactics, iron supplements and folic acid supplements.

Intestinal calcium absorption and vitamin D status in chronic cholestatic liver disease

Metabolic bone disease is common in patients with cholestatic liver disease. The importance of vitamin D status and calcium malabsorption in the pathogenesis of bone disease in these patients remains undefined. We have measured intestinal calcium absorption in relation to vitamin D status in 14 patients with chronic cholestatic liver disease including 11 with primary biliary cirrhosis. Fractional calcium absorption was determined from radioactive counts in the right forearm after separate oral and intravenous doses of 47CaCl2 in the fasting state. Eight of 14 patients (57%) had a decreased calcium absorption compared to controls. A significant correlation was observed between serum 25-hydroxyvitamin D levels and fractional calcium absorption (r = 0.623, p less than 0.02). Treatment with oral 25-hydroxyvitamin D3 in three patients with low serum 25-hydroxyvitamin D levels resulted in correction of serum 25-hydroxyvitamin D levels and improvement in fractional calcium absorption. No correlation was found between serum 1,25-dihydroxyvitamin D levels and fractional calcium absorption (r = 0.221). Calcium malabsorption was common in this series of patients, and serum 25-hydroxyvitamin D levels were useful in predicting fractional calcium absorption. Treatment with oral 25-hydroxyvitamin D3 was accompanied by improved calcium absorption.

Oropharyngeal Kaposi's sarcoma. Report of two cases and review of the literature

Two cases of Kaposi's sarcoma involving the oropharynx are described. The pathology of the condition is reviewed and the problems of treatment outlined.

Effect of dietary fiber components on fecal nitrogen excretion and protein utilization in growing rats

The effects of purified fiber components and wheat bran on several indices of protein utilization were determined in growing rats. A control diet containing 10% casein was diluted with either cellulose (C), pectin (P), lignin (L), guar gum (G), or wheat bran (W) at fiber levels ranging from 3% to 20%. All fibers except C caused a decrease in net protein ratio (NPR) as compared to the control casein diet. This depression in NPR increased as the dietary fiber level increased. Apparent and true nitrogen digestibilities also decreased with all fibers at all levels. At the highest level of fiber (20%) the depression was greater for G and W and was least for C. NPR when divided by digestibility (analogous to biological value) decreased with P,L, W (all levels) and G (20% level) but not with C. When rats were fed fiber without protein, there was increased excretion of endogenous fecal nitrogen with all fibers at all levels. The results demonstrate that fiber(s) affected protein utilization as measured by NPR, digestibility and endogenous fecal nitrogen excretion and that the negative effect increased with the level of fiber consumed.

Silicone disc for myringoplasty-tympanoplasty

A sterile, fenestrated, circular disc of silicone for use on the outer surface of the graft during myringoplasty-tympanoplasty is described. It allows effective firm packing in the canal without distortion, displacement or lateralization of the graft.

Premature labor treatment with ritodrine in multiple pregnancy with three or more fetuses

Modern treatment for anovulatory infertility increases the incidence of multiple pregnancies with three or more fetuses and predisposes to prematurity with high perinatal mortality and mortidity. Premature labor was successfully treated in four multifetal pregnancies with ritodrine hydrochloride, a beta-mimetic drug relaxing the uterus. Another patient misdiagnosed as false labor was not treated and lost three out of four premature babies. Beta-mimetic treatment is indicated in multiple pregnancies even in false labor, or when painless progress in cervical dilatation is observed, to avoid asymptomatic progression into true labor. In contrast to singleton pregnancies, advanced labor with more than four centimeters cervical dilatation should not preclude good chances for successful treatment. Persistence in treatment and repreated use of the most effective intravenous route combined with oral ritodrine administration is needed because of marked tendency to recurrences of premature labor. Progressive increase in the dose of oral ritodrine may be indicated by decrease in therapeutic response. Maternal tachycardia should be considered as an index of patient responsiveness to the beta-mimetic treatment. The therapy is most successful when the patient is hospitalized from the first episode of treatment until at least the 37th week of pregnancy. This is probably less expensive than prolonged hospitalization of several prematures in an intensive care nursery.

Diastolic intervals in cardiomyopathy and abnormal thyroid states: alterations in isovolumic relaxation time and rapid filling time of depressed and enhanced myocardial contractility

Diastolic and systolic time intervals were measured in 11 control subjects, 11 patients with cardiomyopathy, 7 hyperthyroid patients, and 5 hypothyroid patients. The isovolumic relaxation time (IVRT), rapid filling time (RFT), preejection period (PEP), left ventricular ejection time (LVET), and PEP/LVET ratio were found by simultaneously recording the ECG, phonocardiogram, external carotid pulse, and apexcardiogram. In cardiomyopathy the IVRT and RFT were prolonged (107.4 +/- 21.1 msec [P less than 0.01] and 111.0 +/- 10.0 [P less than 0.01] respectively) in comparison to the control subjects. (In the controls the IVRT was 85.7 +/- 18.4 msec and the RFT was 94.5 +/- 12.8 msec). In altered thyroid states the RFT was most affected; in hypothyroidism it increased to 123.9 +/- 25.2 (P less than 0.01) and in hyperthyroidism it decreased to 71.5 +/- 21.3 msec (P less than 0.01). In hyperthyroid patients the IVRT, although shorter than in control subjects, was not significantly altered, but it showed a significant increase after treatment. The RFT also returned toward normal after therapy in both groups (116.7 +/- 14.6 msec in hypothyroid patients and 89.0 +/- 23.1 msec in those with hyperthyroidism).

Diagnostic significance of levels of immunoglobulin A in seminal fluid of patients with prostatic disease

Immunoglobulin A (IgA) levels in semen and in prostatic fluid of 48 patients with benign and malignant diseases of the prostate were estimated. It is speculated from this small study that the IgA levels rise in benign prostatic hyperplasia; in early adenocarcinoma of the prostate (Stages A and B) the rise if furthered, while in the late stages (Stages C and D) the levels fall.

Is alcoholic acidic silver nitrate reagent really specific for the histochemical localization of ascorbic acid

The histochemical localization of ascorbic acid in plant tissues with the alcoholic acidic silver nitrate reagent is shown here to be not specific for ascorbic acid, since some of the polyphenolic substances, including flavonoids, which are known to be widely distributed in plant tissues, are also able to reduce the acidic alcoholic silver nitrate reagent at low temperature (0-4 degrees C) and at pH 2 to 2.5 in dark. This method may perhaps be used for animal tissues where flavonoid pigments do not occur in such large quantities as they do in plants. I therefore, come to the inevitable conclusion that the use of alcoholic acidic silver nitrate reagent in localizing ascorbic acid in plant tissues may be highly misleading.

Uterine contractility data processing system

A versatile system has been developed for off-line computerized quantitation of uterine contractility. It includes tabulation and display of intensity, frequency, resting tone, uterine activity, cumulative area below the pressure curve, and average intrauterine pressure. Its advantages and drawbacks are compared with the conventional method and with an automated on-line labor surveillance system.

Diastolic time intervals in ischemic and hypertensive heart disease: A comparison of isovolumic relaxation time and rapid filling time with systolic time intervals

Isovolumic relaxation time (IVRT) and rapid filling time (RFT) were used to evaluate elasticity and compliance in 11 control subjects (Group 1), in nine patients with angina (Group 2), in 11 with hypertensive heasrt disease (Group 3), and in ten patients with healed myocardial infarction (Group 4). Pre-ejection period (PEP), pre-ejection period index (PEPI), left ventricular ejection time (LVET), left ventricular ejection time index(LVETI) and PEP/LVET ratio were all derived from simultaneous recordings of phonocardiograms, ECGs, apexcardiograms, and external carotid arterial pulses. No patients were in congestive heart failure and none were receiving medication. LVET and LVETI were the same in control patient groups; PEP was slightly increased in patients with healed myocardial infarctions (p smaller than 0.05); and PEPI was prolonged in the patients with angina (p = 0.001). THE PEP/LVET ratio too was different from the control group in patients with angina and hypertension (Groups 2 and 3-p smaller than 0.02 and smaller than 0.05 respectively). The diastolic time intervals were significantly altered in that the IVRT was prolonged in angina patients (113.4 equals or minus 28.3 msec), compared to control patients (85.7) equal or minus 18.4 msec). It was found that in 6 out of 9 patients with angina, this interval exceeded the highest normal value (108 msec), but that in only one out 11 patients with HCVD and in three out of ten with healed infarctions, was the interval prolonged. RFT was increased in HCVD (113.8 equals or minus 18.8 msec) and in healed myocardial infarction (123.8 equals or minus 30.0 msec) patients, compared to the control group (94.5 equals or minus 12.8 msec). Diastolic time intervals reflecting disorders in elasticity and compliance may occur in conjunction with alterations in systolic time intervals.

Glue ear: diagnosis and management

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Effect of streptozotocin-induced diabetes on pancreatic insulin content of the fetus

Diabetes was produced in five-day pregnant Sprague- Dawley rats by intravenous injection of 40 mg./kg. body weight of streptozotocin. Normal pregnant rats were used as controls. Pancreases of the mothers and their offsprings were extracted by acid-alcohol and the insulin measured by immunoassay using rat insulin as a standard.

Nonfasting blood sugar of the streptozotocin-treated pregnant rats was 285 ± 18 mg./100 ml. and their pancreatic insulin concentration was 5.9 ± 1 μg./gm. compared to 103 ± 3 mg./100 ml. and 44.2 μg./gm., respectively, in the normal rats.

Fetal pancreases of streptozotocin-induced diabetic pregnant rats and normal animals were obtained on Days 18, 19, and 21 of gestation, and on Day 4 after birth. The pancreatic insulin concentration of fetuses of diabetic mothers rapidly and progressively increased from 8.0 ± 0.9 μg./gm. on Day 18 to a peak of 63.0 ± 9.0 /μg./gm. on Day 21. On Day 4 after birth, the value was 312 ± 109 μg./gm. The total pancreatic insulin content also progressively increased to a prenatal peak of 0.84 ± 0.15 μg. on Day 21. The pancreatic insulin concentration of fetuses of normal mothers was not significantly different from those of diabetic mothers. There was no correlation between the elevation of maternal blood sugar and the insulin concentration of the fetal pancreas. The total pancreatic insulin content of fetuses of diabetic rats was less than those offspring of the normal rats on Day 18 and Day 4 after birth, but was not significantly different on Days 19 and 21. The lower insulin content found in fourday-old rats born of diabetic animals was probably related to their inability to obtain adequate nourishment from their very sick mothers.

Pancreatic insulin content of nonpregnant, pregnant and postpartum rats and the developing rat fetus

A study was made of the insulin content of pancreases of nonpregnant, pregnant and postpartum rats and of their developing fetuses. The insulin content of the extracts was measured by radioimmunoassay, using crystalline rat insulin as a standard. The mean concentration of insulin in the pancreas of nonpregnant animals was 43 ± 6 μg./gm. The insulin concentration did not change significantly during late pregnancy or on day 4 postpartum. However, the weight of the pancreas was significantly greater in the pregnant and the postpartum rats. Thus, the total insulin content of the pancreas was greater in the pregnant and postpartum rats, being 23 ± 1.4 μg. and 24 ± 1.9 ng. respectively, as compared to 15 ± 0.7 μg. in the nonpregnant rats.

The fetal pancreases were obtained at five periods of gestation: daily from day 18 to day 22, and on day 4 after birth. The mean weight of the fetal pancreases progressively and significantly increased from 4.4 ± 0.3 mg. on day 18 to 14.1 ± 1.5 mg. on day 20. On day 4 after birth, the mean pancreatic weight was 15.1 ± 0.5 mg. The fetal pancreatic insulin concentration rapidly and progressively increased from 14 ± 2 μg./gm. on day 18, to 80 ± 9 μg./gm. on day 21, and by day 4 after birth was 621 ± 103 μg./gm. By day 21 the fetal pancreatic insulin concentration had reached the prenatal peak and was already twice that of the mother. The total fetal pancreatic insulin content showed a progressive increase during the fetal life from 0.07 ± 0.01 μg. on day 18, to 1.23 μg. on day 21, a seventeen fold increase.

Disposable middle-ear aspirator

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Marine Phytoplankton Photosynthesis as a Function of Light Intensity: A Comparison of Methods

An apparatus is described in which the constant for exponential algal growth has been determined as a function of light at controlled temperature. Studies were made of bacteria-free cultures of Skeletonema costatum and Dunaliella tertiolecta grown at the optimum temperature for cell division in media with and without adequate nitrate and phosphate. Less complete studies were made of the behaviour of Monochrysis lutheri and Amphidinium carteri. In all experiments the growth constants were determined at known light intensities, expressed in the energy units, langlies/minute, using light of a known spectral distribution similar to sunlight shining through a few metres of coastal sea water.Growth constants were determined for the following processes: increase of cellular carbon, chlorophylls a, b or c, carotenoids, cell numbers and photosynthesis measured both by oxygen evolution (net and gross) and by the uptake of C-14 labelled carbonate.The rate of maximum photosynthesis occurred when the illumination reached about 0.1 ly/min and little or no light inhibition occurred when the intensity was increased to as high as 0.4 ly/min. Respiration was about 10% of maximum gross photosynthesis. This fraction increased when cells were nitrogen deficient but decreased in phosphate deficient cultures because a phosphate shortage inhibited respiration more severely than photosynthesis.Gross photosynthesis at low light intensities was proportional to the total number of molecules of all plant pigments added together, irrespective of species or of culturing conditions. By contrast, the rate of maximum gross photosynthesis was poorly related to pigment composition, the best correspondence being with the amount of chlorophyll a in the cultures.The uptake rate of C-14 varied with time. There was an apparent "leakage" of labelled organic matter which eventually reached a near-equilibrium with 14CO2 uptake, after which the C-14 method measured the production of particulate carbon but not necessarily net or gross photosynthesis. The rate of particulate carbon production was the same as that of cell division but about 40% less than net photosynthesis in cultures of Skeletonema. Agreement between C-14 rates and net photosynthesis was better in cool-white fluorescent light than in the imitation submarine sunlight used in this work. At high light intensities there was apparently no excretion from Dunaliella "shade" cells but when these became changed to "sun" cells they behaved more like Skeletonema.Various observations are recorded of the effect of growth conditions on cell composition, especially with regard to pigments.The relatively low C-14 rates found with Skeletonema costatum may be explicable in part by an abnormally low counting efficiency for this species even when present as a "weightless" source but the problem requires further study.