The Oxford club-foot programme

We treated 63 club feet in 44 patients by a defined programme of strapping from birth followed by one of two operations performed at six weeks, either a simple calcaneal tendon lengthening or a subtalar realignment, and reviewed them prospectively. The decision as to which operation to perform was taken at four weeks after radiographic measurement of the talocalcaneal angle. All but eight patients (ten feet) were followed for a mean of 8.7 years. The overall results after calcaneal tendon lengthening were satisfactory. The re-operation rate after subtalar realignment was high (39%) due to over or undercorrection of the deformity.

Comparison of an EBV transformed cell line and an EBV hybridoma cell line producing the same human anti-HBs monoclonal antibody

A stable human-mouse heterohybridoma secreting human anti-HBs monoclonal antibody in continuous culture for 12 months was generated. It grew faster than the parent EBV transformed lymphoblastoid cell line (LCL) but produced the same level of specific antibody. The LCL was positive for the Epstein-Barr Virus Nuclear Antigen (EBNA), human CD 23 and contained a diploid number of human chromosomes. The heterohybridoma was negative for EBNA, CD 23 and mouse Ly-1 mouse, despite retaining a full complement of diploid mouse chromosomes and a limited number of human chromosomes.

Brucellosis induced avascular necrosis of the femoral head in a 7 year old child

The case is reported of a 7 year old Bedouin girl who presented with a three week history of fever and limp. Initial tests for rheumatoid factor, antinuclear antibodies, and brucella were negative. Two weeks after admission Brucella melitensis was cultured from bone marrow and synovial fluid samples. The patient improved after treatment with doxycillin and streptomycin, but radiographs of the right hip showed avascular necrosis of the right femoral head. A mild limp and limitation of motion in the right hip persisted 18 months after admission.

Case report: mixed-field agglutination in a patient with a weak D antigen presenting as a possible fetal-maternal hemorrhage

A gravida 1, para O, 17-year-old black female was found on prenatal testing to be group O, Du+, the latter test showing many unagglutinated cells. Because of the mixed-field appearance, the patient was thought initially to have bad a fetal-maternal hemorrhage. Additional red cell typings were performed, but no other apparent mixed-field reactions were observed. The Kleihauer- Betke test and hemoglobin electrophoresis indicated that the mixed-field agglutination was not due to a fetal-maternal hemorrhage. Thus, the finding of a mixed-field D typing could he explained best by a weak D antigen.

Development and characterization of human anti-HBs antibodies

Peripheral blood mononuclear cells (PBMC) from 13 healthy hepatitis B vaccines were transformed with the Epstein-Barr virus (EBV) and lymphoblastoid cell lines (LCL) producing antibodies to hepatitis B surface antigen (anti-HBs antibodies). Seven LCL and two clones secreting human anti-HBs monoclonal antibody were generated and their antibodies purified. One clone was fused with a mouse myeloma and the antibody from a cloned anti-HBs secreting heterohybridoma purified. One of the 10 purified human anti-HBs antibodies was characterized as IgG4, the remainder were IgG1. The antibodies had either kappa or lambda light chains. Five of the antibodies which were conjugated to horseradish peroxidase recognised the "a" group determinants.

Epitope mapping of HBsAg using a panel of human anti-HBs antibodies

Mapping of B cell epitopes on HBsAg was performed using a panel of human anti-HBs antibodies. Synthetic peptides representing different regions of HBsAg failed to inhibit the binding of two antibodies which recognized non-conformational HBsAg determinants in dot-blot ELISA and HBsAg polypeptide bands in immunoblot analysis. Cross-inhibition studies using five of the antibodies conjugated to horseradish peroxidase suggested that at least three different epitopes are recognised by the panel of antibodies, two of which are within the 'a' group determinant.

Compartmental syndrome due to high velocity missile injury of the calf: use of immediate mesh skin grafting

Two patients with high velocity missile injury to the soft tissues of the calf without major fractures are presented. Both of them developed compartmental syndrome and were treated by debridement, fasciotomy, and immediate mesh split thickness skin graft. The mechanisms of such injury and the advantage of immediate skin grafting are discussed.

The relative effectiveness of symbols and words to convey photocopier functions

Two experiments have been conducted to examine preference patterns of inexperienced users for symbols intended to communicate photocopier functions and the relative effectiveness with which keywords, subject-generated symbols and industry symbols are matched to verbal descriptions of various photocopier operations. First, inexperienced photocopier users were asked to draw a set of symbols that they believed best represented 16 designated copier functions, and subsequently a second set of subjects compared these generated symbols with those currently used by the photocopier industry, and gave their preference. Inexperienced users generally preferred the subject-generated symbols, except for those involving the fairly complex 'sidedness' functions. Secondly, inexperienced users were asked to match keywords, generated symbols and industry symbols to verbal descriptions of the same 16 photocopier functions. Essentially, keywords and generated symbols did not differ in matching accuracy, while both were more accurately matched than industry symbols. However, the complexity of the photocopier function to be conveyed and the familiarity of the user with a given copier operation did produce several exceptions to this overall pattern. The results suggest that careful ergonomics research can produce symbols that are at least as effective as keywords in conveying photocopier functions. The universal nature of such symbols and their possibilities for cross-cultural use are also noted.

Quadriparesis in the Laurence-Moon-Biedl-Bardet syndrome: case report

A 36 year old patient known to suffer from the Laurence-Moon-Biedl-Bardet syndrome (LMBBS) developed spastic quadriparesis. The typical features of the syndrome, presented by this patient were polydactyly, obesity, hypogonadism, retinitis pigmentosa and relative mental retardation. Severe spinal cervical and lumbar canal stenosis imaged by plain X-rays and computerised tomography was found. Magnetic resonance imaging showed significant atrophy of the spinal cord, indicating that the cause of the quadriparesis was cervical myelopathy. The patient underwent laminoplasty with some improvement.

Correlation of the percent of positive Chlamydia trachomatis direct fluorescent antibody detection tests with the adequacy of specimen collection

Chlamydia trachomatis is an obligate, intracellular parasite infecting the columnar and transitional cells lining the endocervix, uterus, fallopian tubes, rectum, urethra, and epididymis. We determined if the percent of specimens positive for C. trachomatis in the Microtrak Direct Specimen Test depended on the quality of specimens obtained. Female genital slides (649) were evaluated by the direct fluorescent antibody (DFA) test for the presence and numbers of (a) C. trachomatis elementary bodies and (b) columnar, transitional and squamous epithelial cells, and polymorphonuclear neutrophils (PMNs). Only 138 (21.3%) of the 649 slides were considered to be adequately taken, that is, containing columnar/transitional cells either alone or in conjunction with squamous cells and/or PMNs. Of the 138 adequate slides, 10 (7.2%) were C. trachomatis positive. However, 511 (78.7%) of the 649 slides were judged inadequate; 395 contained only squamous cells and/or PMNs, 19 were too thick to determine cell types, 46 contained only cell debris, and 51 contained neither cells nor debris. Only four (0.78%) of 511 were C. trachomatis positive. Thus adequate specimens containing columnar/transitional cells for C. trachomatis detection had a tenfold increase in the percent of positive results compared to inadequately collected specimens. By using the DFA test, one has the advantage of determining the adequacy of the specimens obtained as well as the presence of chlamydiae.

The management of congenital dislocation of the hip in the newborn

We describe the results of a policy of highly selective splintage for CDH, using knee plasters. No child suffered because splintage was withheld. In those who were treated the results were satisfactory and the proportion who required a subsequent operation was extremely low. Avascular necrosis was not a significant problem. The method, although a little more time consuming, appears to offer significant advantages over current alternatives.

Fibrin seal adhesive versus nonabsorbable microsuture in peripheral nerve repair

Although nonabsorbable microsuture is the material most often used in human peripheral nerve repair, it is capable of eliciting a foreign body reaction, impairing vascularity, and potentially disrupting axonal regeneration. Sutureless methods, including fibrin seal adhesive, may offer an alternative to traditional suture techniques. This study compared the efficacy of fibrin seal with nylon microsuture in tibial microneurorrhaphy on 28 adult New Zealand white rabbits (14 with 10-0 monofilament nylon suture and 14 with fibrin seal). Each rabbit was reexplored at 1, 6, 12, and 18 weeks. The criteria used to compare the two methods were operative time, clinical function, electrophysiologic measures, and histologic findings. Fibrin seal repairs required less time to execute (p less than 0.01) but were inferior in mean conduction amplitude (p less than 0.01) and with respect to histologic criteria. Fibrin seal also appeared less effective in maintaining nerve approximation. We do not believe that fibrin seal provides a superior alternative to nonabsorbable suture in primary nerve repair in this experimental model.

Violence in sleep: medico-legal issues and two case reports

Reported cases of violence during sleep are reviewed. Two new cases are reported where the subjects were charged respectively with attempted murder and murder; both were acquitted on the grounds of non-insane automatism. Clinical features and aetiological factors are analysed. The legal concepts surrounding non-insane automatism are discussed and criticized.

Linear nevus sebaceous syndrome. A review

We report a case of linear nevus sebaceous syndrome with large areas of calcification involving multiple layers of the posterior aspects of both eyes. This patient had a normal neurological examination despite dysplastic brain changes. We discuss and review the multiple clinical presentation and embryopathogenesis of this disorder.

The role of high levels of dietary fat in 7,12-dimethylbenzanthracene-induced mouse mammary tumorigenesis: lack of an effect on lipid peroxidation

The effects of dietary fat on 7,12-dimethylbenzanthracene (DMBA)-induced mammary tumorigenesis were examined in BALB/c female mice. In the first experiment, BALB/c mice were treated with a total dose of 1, 3, or 6 mg DMBA to induce mammary tumors. One week after the last dose of DMBA, the mice were placed on a 5% (LF) or 20% (HF) corn oil semi-purified diet. The 20% corn oil diet resulted in a significantly decreased mean tumor latency period in each of the three groups of mice (p less than 0.05). However, the mammary tumor incidences at 11 months after DMBA treatment were the following: 6 mg DMBA (LF-14/32, HF-17/32); 3 mg DMBA (LF-13/50, HF-14/50); 1 mg (LF-2/50, HF-6/50). In the second experiment, prolonged hormonal stimulation by pituitary isografts, but not a HF diet, enhanced the incidence of mammary tumors in BALB/c mice given a threshold dose of DMBA (0.5 mg). In a further attempt to examine the mechanism of the enhancing effects of dietary fat, lipid peroxidation was measured in the microsomal-mitochondrial fractions of the mammary glands by two assays; measurements of conjugated dienes and TBA reactants (malonyldialdehyde). The high fat diet had no effect on the levels of conjugated dienes in mammary cell membrane preparations and decreased the levels of TBA reactants (malonyldialdehyde). The results indicated that a high fat diet did not lead to enhanced levels of lipid peroxidation in preparations of microsomal mitochondrial membranes from mouse mammary glands. The implications of these results are discussed with respect to the role of dietary fat as a promoter of mouse mammary tumorigenesis.

Glucose production and utilization in children with glycogen storage disease type I

Glucose turnover rates were estimated with [2H2]glucose in five children with glycogen storage disease type I (GSD I) during sequential withdrawal of an infusion of glucose to determine whether their hypoglycemia was the result of decreased glucose production or increased rates of glucose utilization. Plasma glucose concentrations were 78 +/- 5 mg/dl during infusion of glucose at 6 mg X kg-1 X min-1 and decreased to 53 +/- 3 and 45 +/- 7 mg/dl during the 3 and 1.5 mg X kg-1 X min-1 glucose infusions, respectively. Total glucose flux during the 6 mg X kg-1 X min-1 glucose infusion was 7.3 +/- 0.7 mg X kg-1 X min-1 and decreased with reduction in the rate of glucose infused. Endogenous glucose production increased with each decrease in the rate of exogenous glucose infused. Following discontinuation of glucose infusion, endogenous glucose production was 3.9 +/- 0.3 mg X kg-1 X min-1, a value that was lower (P less than 0.05) than that observed in overnight-fasted normal children (6.3 +/- 0.3 mg X kg-1 X min-1) but not statistically different from the Ra of normal children fasted for 30 h (4.1 +/- 0.5 mg X kg-1 X min-1). Thus, children with GSD have glucose production rates that are 40% lower than those of normal children fasted overnight but equal to those of normal children fasted 30 h. Rates of glucose utilization during the 6 mg X kg-1 X min-1 glucose infusion were higher (0.05 less than P less than 0.1) than those of overnight-fasted normal children, despite lower plasma glucose concentrations when expressed on a body weight basis but not when expressed on the basis of estimated brain weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Increased leucine flux in short-term fasted human subjects: evidence for increased proteolysis

Plasma leucine concentration increases with short-term fasting in normal humans. In previous studies using an 18-h constant infusion of [2H3]leucine, a 15% decrease in the rate of appearance (Ra) of leucine was observed between 15 and 30 h of fasting. However, incorporation of labeled leucine into and subsequent release from body protein could result in an apparent decrease in leucine Ra. The present studies were undertaken to determine the rate of leucine N and carbon flux in short-term fasted human subjects in using an experimental design that would minimize potential recycling of label. Six normal subjects were infused with [15N]- and [2H3]leucine for two 4-h periods (0600 to 1000 h and 2000 to 2400 h) during a 30-h fast. Between the 15th and 30th h of fasting, plasma leucine concentration (102 +/- 10 to 169 +/- 18 microM, P less than 0.01) and leucine C (1.46 +/- 0.05 to 1.64 +/- 0.10 mumol X kg-1 X min-1, P less than 0.05) and leucine N (1.93 +/- 0.14 to 2.49 +/- 0.26 mumol X kg-1 X min-1, P less than 0.05) flux increased, whereas the metabolic clearance rates of leucine C and N decreased (P less than 0.01 and less than 0.05, respectively). Therefore, when isotope recycling is minimized with short periods of isotope infusion, leucine flux increases between 15 and 30 h of fasting. Because the only source of leucine in the postabsorptive periods is body protein, we conclude that the rate of whole-body proteolysis is increased in short-term fasting in humans.(ABSTRACT TRUNCATED AT 250 WORDS)

Natural frequency of fracture fragments in the assessment of tibial fracture healing

The natural frequency of fracture fragments has been measured at various times in the course of healing of 11 midshaft tibial fractures. The major fragments manifest different frequencies which are themselves distinct from that of the intact bone. It has been shown that the difference in frequency between the major fragments falls with time, so that the separate frequencies approach a common value which corresponds with the healed state. The results have been used to construct a model healing curve, against which other tibial fractures can be compared.

Effects of ketosis on glucose flux in children and adults

Sequential glucose flux studies were carried out in five normal and six epileptic children and ten adult volunteers using [6,6-2H2]glucose to determine the effect of ketosis on carbohydrate homeostasis in children and adults. All subjects were studied after 14 and 30-38 h of fasting while consuming a normal diet and the epileptic children under 14 h of fasting while consuming an isocaloric ketogenic diet (75% fat wt/wt). Glucose flux, when expressed per kilogram body weight, was inversely correlated with the degree of ketosis in children (P less than 0.001) and in adults (P less than 0.01), but not when both children and adults were considered together (r = 0.078). When glucose flux was corrected for estimated brain weight, the relationship between glucose flux and ketonemia was linearly related in children (P less than 0.001), in adults (P less than 0.02), and when all subjects were considered together (P less than 0.001). The inverse relationship between ketonemia and glucose flux corrected for estimated brain mass is consistent with a partial replacement of glucose by ketone bodies for cerebral metabolism and may provide a more rational means of expressing glucose flux data to take into account the higher brain-to-body ratio in children.

The role of mental concepts in explaining neurotic behaviour

This paper attempts to define the areas of applicability of behavioural and mentalistic explanations of neurotic behaviour. It is argued that intentional behaviour requires mental concepts for its explanation on the grounds that the statement of reasons which form the basis of intentions cannot be submitted to a stimulus-response analysis. This argument applies to situations in which the therapist uncovers the reasons for purposeful action of which the agent may initially be unaware. It is further argued that behaviour of this kind is rule-conforming and not law-abiding and therefore is not susceptible to explanations of the kind that are available in other areas of science. It is nevertheless argued that causal explanations can be given in terms of reasons for action.