Star Formation in W49A: Gravitational Collapse of the Molecular Cloud Core Toward a Ring of Massive Stars

High-resolution molecular line and continuum radio images from the Hat Creek Radio Observatory and the Very Large Array suggest that the core of the W49A star-forming region is undergoing gravitational collapse. The radio continuum shows a 2-parsec ring of at least ten distinct ultracompact H-II regions, each associated with at least one O star. The ring is a region of large-scale, organized massive star formation. Recombination line velocities and HCO(+) excitation requirements indicate that the ring is rotating around 50,000 solar masses of material. Because the HCO(+) (1-0) line shows red-shifted absorption but blue-shifted emission, the molecular cloud core is believed to be collapsing toward the center of the ring. The HCO(+) radial velocities, as well as H-I, H(2)CO, and magnetic-field measurements, fit a simple model of inside-out gravitational collapse of a once magnetically supported cloud.

External quality assurance in hematology. The programme of the Royal College of Pathologists of Australasia

The Royal College of Pathologists of Australasia introduced a comprehensive national external quality assurance programme (QAP) in hematology in 1979. This now provides regular monthly trials of full blood counting, supplemented by 3-monthly sets of samples for a large variety of other tests for "state of the art" studies, together with case slides for diagnosis for 294 participants. In addition educational supplements are provided, based on one or other aspect of each major quarterly trial. The frequency and variety of tests and analysis of participants' results conform to suggested standards for similar national schemes elsewhere in the world. There is evidence that the programme has helped raise the standards of hematopathology in Australasia and has identified areas which require improvement. It is envisaged that the scheme will satisfy the requirements of state legislation designed to accredit pathology laboratories. Future development should include a refinement of objective methods of scoring performance, especially in areas such as morphology where participants' results cannot readily be expressed numerically.

A reappraisal of pre-transfusion testing procedures in a hospital blood bank

In recent years, experience with screening protocols for the detection of red cell antibodies has led to a reappraisal of pre-transfusion testing procedures. In the U.S.A. in particular, it has become accepted practice to perform only an antiglobulin crossmatch when an antibody screen has been negative. There is now debate in that country regarding the necessity of retaining even the antiglobulin crossmatch. In this laboratory, as is usual in Australia, room temperature, enzyme and antiglobulin tests are used for both antibody screening and crossmatching. A review was therefore conducted of the results of screening 58,227 samples from approximately 40,000 patients, involving 126,771 crossmatched blood units over a 53 mth period. Eight hundred and seventy-two red cell antibodies were detected in 718 patients. Forty-four of these antibodies were detected only in the crossmatch, and of these 23 were of potential clinical significance. Fourteen of the 23 were detected by the antiglobulin test, 8 by an enzyme test and only 1 by the saline method. Of 107 antibodies detected only in the room temperature phase, none were of clinical significance. The results indicate that exclusion of room temperature tests from all pre-transfusion testing, and deletion of enzyme tests from the crossmatch will not compromise patient safety.

Sex ratio and sibship size in juvenile rheumatoid arthritis kindreds

In a study of sibship size and sex ratio in juvenile rheumatoid arthritis, the anticipated sex ratios, including a marked female predominance in early onset pauciarticular disease and in polyarticular disease, were found. The size of the sibship showed a progressive increase with increasing age of the proband at onset of disease. In addition, the sex ratios of the sibs deviated from expected, among families where the proband's disease was characterized as either early onset pauciarticular or polyarticular in its presentation.

Complementation with HLA-A and HLA-D locus alleles in ankylosing spondylitis with peripheral arthritis

Fifty-nine patients with HLA-B27 positive ankylosing spondylitis were HLA genotyped to look for immunogenetic differences between patients with associated peripheral arthritis and those with disease limited to the axial skeleton. An association was found between the peripheral arthropathy and 2 antigens, HLA-A11 and HLA-DR7 at the p less than 0.05 level. Complementation between these 2 alleles and HLA-B27 occurred in both the cis and trans positions. Four patients with peripheral arthritis had a rare HLA-B27 haplotype (HLA-B27, HLA-DR7) which was not found in the group with axial disease alone.

Naftidrofuryl and the nitrogen, carbohydrate, and lipid responses to moderate surgery

The effect of twice daily infusions of 200 mg naftidrofuryl on the six day cumulative losses of urinary nitrogen after moderate surgery was studied in 32 patients maintained on an intravenous infusion of 4% dextrose and saline. A previous report of the ability of naftidrofuryl to reduce loss of nitrogen was not substantiated, although changes in metabolism in the immediate postoperative period suggested that the drug might exert some advantageous metabolic effect. Further investigations with other nutritional regimens are warranted.

Inherited predisposition to iridocyclitis with juvenile rheumatoid arthritis: selectivity among HLA-DR5 haplotypes

HLA-DR5 is associated with a chronic iridocyclitis and juvenile rheumatoid arthritis with onset in early childhood. Previously published data provided indirect evidence for selective linkage between two HLA-B alleles and HLA-DR5. To test this observation further, 38 families, the probands of which have chronic iridocyclitis and juvenile rheumatoid arthritis, were HLA typed so that haplotypes associated with disease could be established. HLA-DR5 was linked to HLA-Bw44 or to HLA-Bw35 and to HLA-Cw4 in the majority of haplotypes obtained in the probands. Both HLA-Bw44, -DR5 and HLA-Bw35, -Cw4, -DR5 occurred more commonly in the proband haplotypes than in the control haplotypes. The frequency of the haplotype HLA-Bw44, -DR5 was 0.133 compared with 0.007 (X2 = 27.04, P less than 10(-6] and for HLA-Bw35, -Cw4, -DR5, it was 0.093 compared with 0.11 (X2 = 13.83, P = 0.0002). The relative risks were 20.77 and 9.23, respectively, versus 3.52 for HLA-DR5 alone. HLA-Bw44 occurred much more commonly in proband HLA-DR5 haplotypes (0.455) compared with control HLA-DR5 haplotypes (0.067) (X2 = 8.26, P less than 0.01). Not all HLA-DR5-bearing haplotypes predisposed equally to chronic iridocyclitis and early-onset pauciarticular juvenile rheumatoid arthritis.

The effect of probucol and cholestyramine combination therapy in severe familial hypercholesterolaemia

The relative effects of cholestyramine and probucol, alone and in combination, on serum total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and the ratio of TC to HDL-C (T/HDL-C) have been studied in a group of 10 subjects with severe familial hypercholesterolaemia. The combination of cholestyramine plus probucol was more potent than either agent alone in reducing TC. The use of probucol either alone or in combination reduced the HDL-C concentrations, but the ratio of T/HDL-C was not consistently affected. The effect of the combination therapy did not diminish after periods of at least 6 months and in some cases led to partial regression of long-standing xanthomata. The combination of probucol with cholestyramine did not give rise to additional side effects and it is considered to be a valuable addition to the regimens available for the treatment of severe familial hypercholesterolaemia.

Effects of subliminal stimulation of oneness fantasies on manifest pathology in male vs. female schizophrenics

This study examined the effects of subliminally activated fantasies of oneness with each parent on the manifest pathology of schizophrenic men and women. Subjects were seen individually for three subliminal stimulation sessions on different days. In each session, measures of pathological thinking and pathological behavior were obtained for a "baseline" assessment before subliminal stimulation, and a "critical" assessment after subliminal stimulation. All subjects received, in counterbalanced order, the two subliminal oneness stimuli ("mommy and I are one" and "daddy and I are one" plus congruent pictures) and a neutral-control message ("people are walking" plus a congruent picture). At the end of the last session, each subject was given a family interview and a family picture test (a card from the CAT depicting three bears at a tug of war). The aim of these procedures was to allow for an exploration of the relationship between the schizophrenic's perception of his or her early experience with each parent and his or her response to each oneness stimulus. Results for symbiotic stimulation showed, as hypothesized: a) the "mommy" stimulus reduced pathological behavior in males but not in females; b) the "daddy" stimulus reduced pathological thinking in females but not in males. Results of the family interview and picture test indicated that the more the male subjects experienced active involvement with one parent, the more they reduced pathology after the oneness stimulus involving that parent, and the less they did so after the stimulus involving the other parent. These results were discussed and suggestions for future research were offered.

Primary immunoglobulin deficiency and haematological disorders

Nine patients with immunoglobulin deficiency and various haematological disorders are presented. In all patients, recurrent infections had antedated the onset of the haematological disorder but, in most, the possibility of primary immunodeficiency had not been considered until after the haematological diagnosis had been established. The recognition of immunodeficiency is important since such patients may require steroids, immunosuppressive therapy or splenectomy. Gammaglobulin would appear to be the appropriate therapy in this situation. Infections were reduced in all 6 patients so treated.

Characterization of RNA synthesis in an Escherichia coli mutant with a temperature-sensitive lesion in stable RNA synthesis

Previous experiments with Escherichia coli strain 2S142 have shown that the synthesis of stable RNA is preferentially blocked at the restrictive temperature. In this paper, we have examined the capacity of this mutant strain to synthesize RNA in vitro. Growth of the strain for as short a period as 10 min at 42 degrees C resulted in a 40 to 60% loss of RNA synthetic capacity and a fourfold decrease in percent rRNA synthesized in toluenized cell preparations. The time course for the loss and recovery of this RNA synthetic capacity correlated very well with the changes in RNA synthesis observed in vivo. We found no difference in temperature sensitivity of the purified RNA polymerase from the mutant and the parental strains. Moreover, there was no detectable alteration in the amount of enzyme, specific activity of the enzyme, or electrophoretic mobility of the subunits when the mutant strain was grown at 42 degrees C. The capacity for rRNA synthesis was also measured with the Zubay in vitro system (Reiness et al., Proc. Natl. Acad. Sci. 72:2881-2885, 1975). Supernatant fractions (S-30) prepared from cells grown at 30 degrees C were capable of up to 31.2% rRNA synthesis, using phi 80d3 DNA as template. S-30 fractions from cells grown at 42 degrees C synthesized 8.6% rRNA. The bottom one-third of the S-100 fraction and the ribosomal salt wash from 30 degrees C cells contained one or more factors which partially restored preferential rRNA synthesis in S-30 fractions from cells grown at 42 degrees C. Preliminary evidence suggests that the factor(s) is protein in nature.

Metabolic studies with 'Nutrauxil', an enteral feed preparation

A metabolic study was carried out in 6 patients requiring enteral feeding to investigate the effectiveness and tolerance of 'Nutrauxil', a ready-made liquid nutritional preparation, over a period of 8 days. The results of anthropometric and laboratory measurements, made initially and at the end of two 4-day periods, showed that the basic provision of 2000 kcal and 60 g protein per day with 'Nutrauxil' maintained patients in metabolic, electrolyte and nitrogen balance. No adverse effects were noted and the preparation was easy to administer. It was concluded that 'Nutrauxil' compared favourably with other enteral feed preparations with respect to its nutritional effectiveness on clinical, biochemical and economic grounds.

The role of propranolol therapy and proteinuria in the etiology of post renal transplantation hyperlipidemia

The effects of propranolol and proteinuria on the fasting lipoprotein profiles of 33 male renal allograft recipients have been studied. By isolating the two variables by division of the patients into four groups according to propranolol dose and proteinuria, i.e. 1. propranolol = 0 mg/24 hr, proteinuria; less than 0.5 g/24 hr; 2. propranolol less than 0 mg/24 hr, proteinuria; less than 0.5 g/24 hr; 3. propranolol = 0 mg/24 hr, proteinuria; less than 0.5 g/24 hr; and 4. propranolol greater than 0 mg/24 hr, proteinuria; greater than 0.5 g/24 hr, it has been shown that propranolol treatment elevates the very low density lipoprotein triglyceride and decreases the high density lipoprotein cholesterol and that proteinuria (greater than 0.5 g/24 hr) increases low density lipoprotein cholesterol. The possible significance of these results in terms of transplantee management is discussed.

Cervical thymic cyst

Thymic derivatives should be included in the differential diagnosis of cystic masses in the neck. A classification of thymic cysts is proposed: namely, true mixed or false. A thymic cyst may contain cholesterol crystals in the luminal fluid, cholesterol clefts, granulomas and lymphocytic follicles as well as Hassall corpuscles in the wall. Treatment consists of simple excision of the cyst and its tract. The thirty-fifth case of cervical thymic cyst in the English Literature is reported.

Passovoy factor deficiency in five Western Australian kindreds

Passovoy factor deficiency, a coagulation abnormality affecting the intrinsic coagulation system, was discovered in 5 Western Australian kindreds. The defect is inherited as an autosomal dominant and is associated with a clinical bleeding tendency characterized by easy bruising and undue blood loss following trauma such as dental extraction and tonsillectomy. Fresh frozen plasma appears to provide effective prophylaxis during surgery. The activated partial thromboplastin time (APTT) shows a prolongation which, in most patients, is of relatively slight degree, and this may be the reason for the paucity of reports in the literature. The discovery of 5 kindreds carrying the defect suggests that it may be relatively common in the Australian community and that care should be taken to identify and follow up minor grades of abnormality of the APTT where individuals suspected of having an inherited bleeding tendency are screened. A sample from one case was distributed, with a clinical history, to participants in the Royal College of Pathologists of Australasia 1980 Quality Assurance Programme in Haematology. Approximately one-third of 175 participants failed to detect the definite abnormality present.

The Oxfordshire mental handicap register

A total of 2027 moderately or severely mentally handicapped people in Oxfordshire considered likely to require special services at some time have been identified for the Oxfordshire Mental Handicap Register. Prevalence rates for those aged 5 to 14 years are estimated to be 3.9 per 1000 home population and 4.14 per 1000 total population when hospital residents are included. Entry criteria are less strict than in other registers, however, and people are identified by general practitioners, health visitors, and hospital staff as well as through the more usual sources. The register is already proving useful when planning and providing services to those in need.

Ethylene oxide sterilisation--is it safe?

Tests show that ethylene oxide penetrates and can sterilise long narrow tubes in a hospital ethylene oxide steriliser. Residual ethylene oxide levels in plastic tubing after sterilisation have been estimated. Although initially the levels were very high, storage for four days at room temperature reduced them to a safe level. If adequate controls of the sterilising process and storage are carried out, sterilisation by ethylene oxide is considered to be safe for new plastics and clean equipment.

Macrocytic anaemia

Macrocytosis of red cells is now more easily and precisely detected in the laboratory by the adoption of electronic methods of cell volume measurement. This means the practitioner will be more frequently faced with the problem of what an elevated mean corpuscular volume (MCV) means. Macrocytic anaemia is not synonymous with folate or cobalamin deficiency, there being many causes of non-megaloblastic macrocytosis including excess alcohol, hypothyroidism, and liver disease. The commonest cause is blood regeneration as after a bleed, or in response to a haematinic or in haemolysis, as reticulocytes are large red cells and will raise the MCV. Megaloblastic anaemia, as in folate or cobalamin deficiency, has a normal or low reticulocyte count and a multiplicity of causes which must be identified as the cause may require treatment in its own right as well as the prescription of the required vitamin.

Acquired haemoglobin H disease, complicating a myeloproliferative syndrome: a case report

A case of acquired haemoglobin H disease in association with a myeloproliferative disorder is described. Severe haemolysis with hypochromic microcytic anaemia was present. Haemoglobin H formed 18% of the circulating haemoglobin and 60% of the red cells showed multiple inclusions on incubation with brilliant cresyl blue. Blood film and absolute red cell values from a previous unrelated illness were normal, proving the acquired nature of the haemoglobin abnormality. Alpha/beta chain synthesis was measured in vitro and the degree of imbalance (alpha/beta ratio 0.39) was similar to that seen in the inborn thalassaemic disorder. A small proportion of red cells showed i-antigen reactivity but their haemoglobin H content was no different from the majority of cells which were l-antigen positive.

Feasibility of outpatient self-administration of parenteral antibiotics

It is customary to treat patients with infective endocarditis or osteomyelitis for a prolonged period in hospital with parenteral antibiotics. It was felt that it might be feasible to allow parenteral administration of antibiotics by the patients themselves at home. Results in 13 patients who administered antibiotics parenterally themselves (experimental group) were compared with those in 7 patients (control group) treated entirely within the hospital. Antibiotic-related complications were similar in both groups. There was no instance of infection of the intravenous cannula in either group. The average daily cost of antibiotic therapy decreased from $243.22 for inpatients to $69.35 for outpatients. The average cost of illness was $6,357.22 in the experimental group and $10,022.23 in the control group. If patients are carefully selected and well educated, the outpatient self-administration of antibiotics parenterally is both economical and safe.

Angioimmunoblastic lymphadenopathy with dysproteinemia

Three cases of angioimmunoblastic lymphadenopathy with dysproteinemia are reported which illustrate the characteristic clinico-pathological features. These cases also provide information relating to the ultrastructure of the interstitial acidophil material, the histopathological spectrum, where treatment has been attempted, and an incidence figure for an Australian community. Detailed immunological investigations in one case suggest that the disease is a primary B-lymphocyte abnormality.