Prospective randomized trial of LLETZ versus laser ablation in patients with cervical intraepithelial neoplasia

Three hundred seventy-five patients with CIN on referral Pap and with a distinct cervical lesion on colposcopy were prospectively randomized to treatment with LLETZ or to standard colposcopic evaluation with directed cervical biopsies, endocervical curettage, and laser ablation of the transformation zone for biopsy proven CIN. Of the 195 patients that randomized to treatment with LLETZ, 32.5% had no evidence of dysplasia, 26.5% had CIN 1, 17.3% had CIN 2, 22.7% had CIN 3, and 0.5% had microinvasive carcinoma on final histologic evaluation. Of the 180 patients randomized to laser ablation, initial cervical biopsies demonstrated no evidence of dysplasia in 52.8% of patients, CIN 1 in 22.0%, CIN 2 in 18.3%, and CIN 3 in 5.7%. Only 114 (63.3%) of the women in the laser group required therapy. Complications were comparable for each treatment arm. Only 6.7% of patients randomized to LLETZ and 4.4% with laser ablation had persistent CIN on follow-up Pap. LLETZ appears to be effective, well tolerated, and less expensive, but the cost savings advantage of LLETZ over laser ablation may not apply to patients with CIN 1 on referral Pap smear since many do not require treatment.

MRI of female uterine and juxta-uterine masses: clinical application in 25 patients

The clinical utility of magnetic resonance imaging (MRI) in the diagnosis of gynecologic masses was evaluated in 25 patients. In each patient the final pathologic diagnosis was semiquantitatively correlated with the diagnostic impressions from pelvic examination, ultrasound and MRI. There were 9 uterine, 11 ovarian and 5 nonovarian pelvic masses. Pelvic examination correlation with final diagnosis was 26%, consistent with the literature. Ultrasound fared surprisingly poorly, with only 44% correlation. MRI showed an 87% correlation with the final diagnosis. MRI was able to accurately identify masses, discriminate adnexal masses from fluid-filled bowel, identify dermoids, and in one case obviated surgery in a pregnant patient. MRI provided significant clinical management information with greater accuracy than did ultrasound or pelvic examination.

Magnetic resonance imaging to diagnose a müllerian anomaly during pregnancy

An adolescent woman presented with a paravaginal mass during pregnancy. Magnetic resonance imaging was useful in diagnosing a müllerian anomaly consisting of a double uterus and cervix and blind vaginal pouch. Magnetic resonance imaging can be an important modality in the diagnosis of gynecologic conditions in the obstetric patient.

Enhanced endocytosis by aging chondrocytes and fibroblasts

We have compared the uptake of latex beads by cultures of old and young chondrocytes and fibroblasts. In each case, their phagocytic rates increased with cellular age.

A longitudinal analysis of torque and its relationship to achievement and educational classification among normal, disturbed, and learning-disabled children

Torque (clockwise circlings with either hand on a visual-motor task) has been shown to be related to a variety of academic, personal, and adjustment difficulties (Blau, 1977b). A longitudinal analysis was conducted for 948 third-grade students, selected randomly from various special and nonspecial education programs from a large, urban/suburban school system. Current measures of achievement, grade retention, and special education categorization were related to torque data obtained 4 years previously. Only grade retention was found to differ significantly between the torque and no torque groups. While the overall findings indicate no clear relationship between torque and various academic variables, some significant findings and trends in the data warrant further investigation.

A comparison of verbal, sign, and simultaneous systems for the acquisition of receptive language by an autistic boy

The effectiveness of verbal, sign, and simultaneous systems for the acquisition of receptive language by an autistic boy was investigated. The subject received training in all three methods by three teachers on each of 18 days. The order of methods and teachers was counterbalanced daily. The study incorporated a 27-word vocabulary composed of nouns, adjectives (colors), and verbs. The dependent variable was the number of correct responses during three daily sets of 20 assessment trials. Results suggest nonsignificant differences among the three methods. A secondary purpose was to investigate systematically the concomitant increases in subject-initiated interactions and eye contact accompanying the language training. The subject was observed during 10-min rest periods following each of the three daily language sessions; the occurrence of behaviors during timed intervals served as the dependent variables. Significant increases for subject-initiated interactions involving physical contact were observed.

Cerebral cortical atrophy in alcoholic men

Sixteen alcoholic men under 50 with no gross evidence of intellectual impairment were evaluated by means of neurologic examination, neuropsychologic testing and computerized tomography. Computerized tomography demonstrated mild to moderate cortical atrophy in 11 of the 16 men when compared to an age-matched medical control group. The cortical atrophy was associated with evidence of memory and visual-motor impairment on neuropsychologic testing. The seriousness of the condition paralleled the length and intensity of alcohol abuse.

Comparison of the Goodenough-Harris Drawing Test and the WISC-R for children experiencing academic difficulties

100 students identified as experiencing academic difficulties were administered both the Draw-A-Person and the WISC-R. Analyses indicated significant correlations between the various scores obtained on the WISC-R and the drawings. These relationships were quite consistent with those previously reported for other subgroups within the school population. When correlational analysis was performed for each sex separately, consistently stronger relationships were found for 34 females than for 66 males.

Comparison of the Goodenough-Harris Drawing Test and the Wisc-R for Children Experiencing Academic Difficulties

100 students identified as experiencing academic difficulties were administered both the Draw-A-Person and the WISC-R. Analyses indicated significant correlations between the various scores obtained on the WISC-R and the drawings. These relationships were quite consistent with those previously reported for other subgroups within the school population. When correlational analysis was performed for each sex separately, consistently stronger relationships were found for 34 females than for 66 males.

Cardiovascular and neuromuscular effects of Org NC 45, pancuronium, metocurine, and d-tubocurarine in dogs

We compared the cardiovascular and neuromuscular effects of Org NC 45 with those of pancuronium, metocurine, and d-tubocurarine in six dogs anesthetized with halothane. The ED90 (dose of drug which produced a 90% depression of twitch tension) of Org NC 45, pancuronium, metocurine, and d-tubocurarine was 14 +/- 3, 22 +/- 3, 63 +/- 19, and 130 +/- 19 micrograms/kg, respectively. All subsequent neuromuscular and cardiovascular effects were determined from a dose equal to 3 times the ED90 of muscle relaxant. Org NC 45, pancuronium, metocurine, and d-tubocurarine produced a neuromuscular blockade with a during (time from relaxant administration until recovery 50% of the original twitch tension) of 42 +/- 2, 108 +/- 10, 109 +/- 21, and 100 +/- 19 minutes, respectively. Org NC 45 caused no significant cardiovascular changes. Pancuronium increased heart rate, mean arterial blood pressure, cardiac output, and pulmonary wedge pressure, and it decreased systemic vascular resistance (p less than 0.05). Although metocurine also increased heart rate and cardiac output (p less than 0.05), mean arterial blood pressure and pulmonary wedge pressure did not change. d-Tubocurarine decreased all cardiovascular parameters except heart rate which increased significantly (p less than 0.05). We conclude that Org NC 45 produces a neuromuscular blockade of shorter duration with fewer cardiovascular changes than that of pancuronium, metocurine, or d-tubocurarine.

Chance factors in studies of quantitative structure-activity relationships

Multiple regression analysis is a basic statistical tool used for QSAR studies in drug design. However, there is a risk or arriving at fortuitous correlations when too many variables are screened relative to the number of available observations. In this regard, a critical distinction must be made between the number of variables screened for possible correlation and the number which actually appear in the regression equation. Using a modified Fortran stepwise multiple-regression analysis program, simulated QSAR studies employing random numbers were run for many different combinations of screened variables and observations. Under certain conditions, a substantial incidence of correlations with high r2 values were found, although the overall degree of chance correlation noted was less than that reported in a previous study. Analysis of the results has provided a basis for making judgements concerning the level of risk of encountering chance correlations for a wide range of combinations of observations and screened variables in QSAR studies using multiple-regression analysis. For illustrative purposes, some examples involving published QSAR studies have been considered and the reported correlations shown to be less significant than originally presented through the influence of unrecognized chance factors.

Changes in fetal and maternal heart rate during abdominal radiography in late pregnancy

Continuous recordings of maternal and fetal heart rate were made in 30 antenatal patients during simulated abdominal radiography in late pregnancy. Transient changes in fetal heart rate occurred in 43 per cent of patients in the supine position compared with 27 per cent in the prone position. Transient increase of maternal heart rate occurred in 37 per cent of patients. There was no evidence of revealed or concealed caval occlusion.

The clinical diagnosis of major congenital abnormalities of the fetal central nervous system

During the ten years between 1965 and 1974, 207 infants with a major congenital abnormality of the central nervous system were born at Mill Road Maternity Hospital, Liverpool; open neural tube defects occurred in 92 per cent of cases. Only cases of anencephaly were frequently diagnosed clinically before labour and this was rarely so for spina bifida alone. Only 11 patients (5-3 per cent) had previously been delivered of an affected infant. The routine screening of pregnant patients is briefly discussed.

A case report of an autistic boy. Selective responding to components of bidimensional visual and auditory stimuli

A case study was reported in which a 9-year-old male autistic boy was initially trained to discriminate between two auditory stimuli and two visual stimuli. He was then tested for overselective responding to bidimensional combinations of the four stimuli. It was hypothesized that the overselectivity results reported in previous studies were partially a function of a procedure in which autistic children were reinforced for responding in the presence of a multidimensional stimulus complex and then tested with individual stimuli. The child in the present investigation, with the alternative procedure, did not demonstrate overselective responding. Two interpretations of the results were presented, neither of which was consistent with an overselectivity theory. Future research should delineate the specific conditions which produce overselective responding, and suggest methods to facilitate more adaptive responding of autistic children.

Plasma oestriol and human placental lactogen measurements in patients with high risk pregnancies

Maternal plasma oestriol and human placental lactogen (HPL) were measured serially in 383 at-risk pregnancies. Eight-five infants were growth retarded and 122 developed fetal distress or neonatal asphyxia. Of the infants whose mothers had either abnormal plasma oestriol or HPL levels, 58 per cent were growth retarded, while 65 and 73 per cent in each group respectively developed fetal distress. The incidence of fetal complications when both plasma oestriol and HPL were abnormal was consistently greater than 66 per cent.

An ultrastructural study of neuromuscular spindles in normal mice: with reference to mice and man infected with Mycobacterium leprae

Mycobacterium leprae have been found within muscle spindles in mice, using electron microscopy, and in man, using light microscopy. Their mode of entry clearly is important. It may be via capsular cells, capillaries or nerves. For this reason muscle spindles from normal mice were studied by electron microscopy with special reference to the capsule and the relationship of it with capillaries and nerves, as well as details of the intrafusal fibres and capsular space. A fenestrated capillary was found between the capsular cell layers and outside the capsule in one spindle and in another spindle both a fenestrated and a continuous type of a capillary were found between the capsular cells; this may be of interest for pharmacological studies. However, the muscle spindles of the mouse were in the main similar to muscle spindles studied by other workers in man and other mammals.

Long-spacing collagen in skin biopsies from patients with lepromatous leprosy

In the course fo evaluating the effect of different drugs on the morphology of Mycobacterium leprae (Edwards, Draper & Draper, 1972) and on the phagocytic cells containing these organisms (Edwards, 1973), an unusual feature was observed in the dermal connective tissue of skin biopsies obtained from some of the patients. Variable amounts of an extracellular, cross-striated osmiophilic material were present in the dermis. The purpose of this communication is to describe the banded substance observed in the extracellular space of the lepromatous skin and to compare it briefly with similar substances and structures reported to occur elsewhere.