Severe bronchopulmonary dysplasia increases risk for later neurological and motor sequelae in preterm survivors

Preterm children who develop severe chronic lung disease may be developmentally compromised by exposure to hypoxic episodes. This study aims to determine if children with severe bronchopulmonary dysplasia (BPD) who required home oxygen therapy were at greater risk for neurological and motor deficits at school age than preterm peers without BPD. This study evaluated 27 subjects with BPD and 27 preterm control infants matched for gestational age, birthweight, sex, and year of birth at a mean age of 9.9 years (2.0 SD) using standardized neuromotor outcome measures. Pair-matched comparisons and regression analyses were used to determine if subjects with BPD were at increased risk for neuromotor sequelae. Neurological abnormalities, including subtle neurological signs, cerebral palsy, microcephaly, and behavioral difficulties were highly prevalent in the BPD group (71% compared with 19% in control group, P<0.005). Over half the BPD cohort had difficulties in gross and/or fine motor skills. There were significant differences in postural stability between groups. Duration of hospitalization and home oxygen treatment, and decreased lung function at school age, markers of severity of illness, correlated with motor outcomes. The findings underline the importance of preventing the cardiorespiratory complications associated with chronic lung disease to minimize disability in preterm children. For children with severe BPD, better recognition and subsequent remediation of neuromotor impairments that manifest at school age may help maximize their functional potential.

The HAND1 basic helix-loop-helix transcription factor regulates trophoblast differentiation via multiple mechanisms

The basic helix-loop-helix (bHLH) transcription factor genes Hand1 and Mash2 are essential for placental development in mice. Hand1 promotes differentiation of trophoblast giant cells, whereas Mash2 is required for the maintenance of giant cell precursors, and its overexpression prevents giant cell differentiation. We found that Hand1 expression and Mash2 expression overlap in the ectoplacental cone and spongiotrophoblast, layers of the placenta that contain the giant cell precursors, indicating that the antagonistic activities of Hand1 and Mash2 must be coordinated. MASH2 and HAND1 both heterodimerize with E factors, bHLH proteins that are the DNA-binding partners for most class B bHLH factors and which are also expressed in the ectoplacental cone and spongiotrophoblast. In vitro, HAND1 could antagonize MASH2 function by competing for E-factor binding. However, the Hand1 mutant phenotype cannot be solely explained by ectopic activity of MASH2, as the Hand1 mutant phenotype was not altered by further mutation of Mash2. Interestingly, expression of E-factor genes (ITF2 and ALF1) was down-regulated in the trophoblast lineage prior to giant cell differentiation. Therefore, suppression of MASH2 function, required to allow giant cell differentiation, may occur in vivo by loss of its E-factor partner due to loss of its expression and/or competition from HAND1. In giant cells, where E-factor expression was not detected, HAND1 presumably associates with a different bHLH partner. This may account for the distinct functions of HAND1 in giant cells and their precursors. We conclude that development of the trophoblast lineage is regulated by the interacting functions of HAND1, MASH2, and their cofactors.

Treatment of lesions of osteomyelitis in the hind flippers of six grey seals (Halichoerus grypus)

Six rescued grey seal (Halichoerus grypus) pups had traumatic injuries to their hind flippers; three had osteomyelitis without fractures, one had a single fracture and associated osteomyelitis, and two had multiple compound fractures and large open wounds. The medical and surgical methods used to treat these lesions are described. A proprietary waterproof covering appeared to be a better method for dressing the wounds than conventional bandaging.

Deletion of the Cul1 gene in mice causes arrest in early embryogenesis and accumulation of cyclin E

The stability of many proteins is controlled by the ubiquitin proteolytic system, which recognizes specific substrates through the action of E3 ubiquitin ligases [1]. The SCFs are a recently described class of ubiquitin ligase that target a number of cell cycle regulators and other proteins for degradation in both yeast and mammalian cells [2] [3] [4] [5] [6]. Each SCF complex is composed of the core protein subunits Skp1, Rbx1 and Cul1 (known as Cdc53 in yeast), and substrate-specific adaptor subunits called F-box proteins [2] [3] [4]. To understand the physiological role of SCF complexes in mammalian cells, we generated mice carrying a deletion in the Cul1 gene. Cul1(-/-) embryos arrested around embryonic day 6.5 (E6.5) before the onset of gastrulation. In all cells of the mutant embryos, cyclin E protein, but not mRNA, was highly elevated. Outgrowths of Cul1(-/-) blastocysts had limited proliferative capacity in vitro and accumulated cyclin E in all cells. Within Cul1(-/-) blastocyst cultures, trophoblast giant cells continued to endocycle despite the elevated cyclin E levels. These results suggest that cyclin E abundance is controlled by SCF activity, possibly through SCF-dependent degradation of cyclin E.

Reproducibility of thoracic aortic diameter measurement using computed tomographic scans

OBJECTIVES

Decisions to recommend elective surgical repair of thoracic aortic aneurysms (TAA) may be based on size or expansion rate, which are used as indices of the risk of rupture. Measurement error may thus affect clinical decision-making. In order to evaluate the reproducibility of aortic diameter measurements of TAA, we assessed departmental inter- and intra-observer variability of measurement of pre-selected computed tomographic scan images of aneurysmal segments of the thoracic aorta.

METHODS

We compared measurements of minimum aortic diameter made by four observers in 50 pre-selected scans and at different times by two observers using a calliper method and a measurement tool within the scan. Differences in measured dimension were analysed using Wilcoxon's signed ranks test and the repeatability assessed using the method of Bland and Altman.

RESULTS

There were no significant inter-observer differences among three observers but there were significant differences between another observer and two other observers (P < 0.05). No significant intra-observer differences existed. The best intra-observer repeatability was 2.25 while the worst inter-observer repeatability was 4.37. The mean and maximum difference in measurement were +/-0.88 mm and +/-8.0 mm, respectively. Variability of measurement increased with aortic diameter.

CONCLUSIONS

Calliper measurement of TAA is an acceptable measurement method for surveillance of TAA but appears most accurate with a single observer. Increasing error is seen with increasing diameter which may compound error in estimation of expansion rate. Standardisation of technique is advisable for multiple observers and aortic units should adopt quality assurance protocols to minimise error.

The neonatal presentation of Prader-Willi syndrome revisited

We describe 6 newborns evaluated for hypotonia, later diagnosed with Prader-Willi syndrome despite the absence of the classical neonatal features of this syndrome. Specific genetic testing for Prader-Willi syndrome should be considered for all neonates with undiagnosed central hypotonia even in the absence of the other major features of this syndrome.

The association of asymptomatic bacterial vaginosis with upper genital tract infection

Objective: To determine whether asymptomatic bacterial vaginosis (BV) is associated with upper genital tract inflammation or bacterial colonization.Methods: Fifty nonpregnant women with intact uteri who planned to undergo gynecologic surgery and had no recent symptoms of vaginal infection were enrolled. We obtained a vaginal swab for Gram stain, endocervical swab for chlamydia and gonorrhea DNA probe testing, and Pipelle endometrial biopsy for aerobic and anaerobic cultures and histology. We correlated surgical findings and histology of available surgical specimens with the microbiologic results. The diagnosis of BV was made according to Speigel's criteria. Bacteria isolated from the uterus were classified as high virulence versus low virulence. Contingency tables were analyzed using the chi-square or Fisher Exact tests.Results: Twenty-one of 50 patients had BV on Gram stain, 3 had intermediate BV, and 3 had unreadable slides. Eleven patients had histologic endometritis, including 7 of the 21 with BV. The association between BV and endometritis was not statistically significant. Thirty-eight patients had a positive endometrial culture; 18 of these also had BV and 3 had intermediate BV. Of patients with a positive endometrial culture, isolates from those who also had BV or intermediate BV were more likely to be highly virulent pathogens compared to those who tested negative for BV (P <.05). No patients had positive gonorrhea or chlamydia tests. Of the 37 patients who underwent abdominal surgery, 20 had visible adhesions. The association between adhesions and endometritis, BV, or positive endometrial cultures was not significant.Conclusion: Patients with asymptomatic BV are more likely than patients without BV to have highly virulent bacteria isolated from the endometrium. BV may predispose to upper genital tract infection.

Demonstration projects in community-based prevention

Community-based demonstration projects represent the translation of research findings into practice. This article discusses the scientific basis for demonstration projects and illustrates various principles through two large-scale programs: the Health Promotion and Disease Prevention Research Centers and the Community-Based Public Health initiative. These programs have shown several key components for success, including: building effective partnerships, using existing data effectively, adopting a causal model in intervention design, employing appropriate evaluation techniques, using policy change as an intervention, and utilizing the potential of community groups to foster change among professional partners.

The Hand1 bHLH transcription factor is essential for placentation and cardiac morphogenesis

The placenta and cardiovascular system are the first organ systems to form during mammalian embryogenesis. We show here that a single gene is critical for development of both. The Hand1 gene, previously called Hxt, eHAND and Thing1, encodes a basic helix-loop-helix (bHLH) transcription factor that starts to be expressed during pre-implantation development. After implantation, Hand1 expression is restricted to placental trophoblast cells and later to embryonic cardiac and neural crest cells. We generated Hand1-null mutant mice by gene targetting. Homozygous mutant embryos arrested by embryonic day (E) 7.5 of gestation with defects in trophoblast giant cell differentiation. This early mortality could be rescued by aggregation of mutant embryos with wild-type tetraploid embryos, which contribute wild-type cells to the trophoblast, but not the embryo. By E10.5, however, the Hand1-null fetuses derived from tetraploid chimaeras died due to cardiac failure. Their heart tubes showed abnormal looping and ventricular myocardial differentiation. Therefore, Hand1 is essential for differentiation of both trophoblast and cardiomyocytes, which are embryologically distinct cell lineages.

Enhancement of aminolevulinic acid based photodynamic therapy by adriamycin

This paper reports on studies that evaluate the interaction between delta-aminolevulinic acid (ALA)-based photodynamic therapy (PDT) and adriamycin (ADM) in an animal model system. Two groups of mice bearing a transplantable mammary adenocarcinoma received ADM i.p. in a single dose of 5 mg (low dose) and 30 mg (high dose) per kg body weight. Sixteen or 40 h after administration of the drug, mice were sacrificed, tumours, livers and hearts were removed and porphyrins, enzyme activities and malondialdehyde content were determined. Tumour explants of ADM-treated mice were incubated with ALA and irradiated with an He-Ne laser. Re-implantation of these in vitro PDT-treated explants into test animals showed that inhibition of tumour growth was significantly enhanced by combined treatment when the low dose of ADM was used. There were no significant changes in porphyrin content, ALA dehydratase and porphobilinogenase activities in the tissues analyzed after ADM treatment as compared with control values. ADM toxicity is thought to be related to semiquinone free radical formation with subsequent generation of reactive oxygen species such as peroxide and hydroxyl radical. These species are considered to initiate lipid peroxidation (LPO) and cause DNA damage. In the case of low-dose treatment with ADM a significant increase in the LPO product, malondialdehyde, was observed after PDT whereas with the high-dose regimen no changes were observed. In the case of explants of (non-irradiated) cardiac tissue malondialdehyde production was also found to be dependent on the dose and time of administration of adriamycin. In our in vivo/in vitro model system we have shown that pre-treatment with ADM increased the cytotoxicity of ALA-PDT at a dosage level of ADM which did not raise LPO levels in heart tissue. The mechanism of this effect has not been clearly elucidated but our data suggest that the observed enhancement of PDT may be attributed in part to the weakening of cellular defence mechanisms by the pre-treatment involving free radical generation by ADM.

Beyond law and ethics: an interdisciplinary course in family law and family therapy

The professions of family therapy and law share many clients and areas of overlap. Law-related coursework in family therapy programs is typically limited to legal, ethical, and professional issues. However, students can also benefit from understanding other areas of overlap, such as divorce, child custody, and mediation. This article discusses the curriculum for an interdisciplinary course that educates both family therapy and law students. The course provides: (1) a substantive education about similarities and differences between the professions, how they operate as systems, and specific areas of overlap, (2) opportunities to learn clinical skills, and (3) opportunities for personal insight about skills, personality types, and negotiation styles, and how these may differ between the professions.

Stimulation of tetrapyrrole synthesis in mammalian epithelial cells in culture by exposure to aminolaevulinic acid

Tetrapyrrole synthesis in CNCM-1221 cells exposed to 0.6 mM aminolaevulinic acid (ALA) was found to be approximately linear over a 6-h period of incubation. The rate was not significantly affected by cell density over a range of 0.015 to 0.15 x 10(6) cells cm(-2) (final cell density). Tetrapyrrole synthesis was not affected by GABA or glutamic acid in concentrations up to 6 mM and 2.72 mM respectively, suggesting that these amino acids, which are similar in structure to ALA, do not competitively inhibit the ALA uptake pathway in these cells. Pre-exposure to haem arginate (up to 100 microM) was inhibitory, presumably by suppression (through the inhibition of ALA synthase) of an endogenous component of the response. The ALA-stimulated response was not modified by co-exposure to AIA (up to 100 mg ml(-1)). Despite significant reduction of protein synthesis, the porphyrinogenic response of cells exposed to ALA was unaffected by cycloheximide (10 microg ml(-1)) or actinomycin D (10 microg ml(-1)) even when cells were preincubated with these agents for 3 h before ALA exposure. Fetal bovine serum (10%) inhibited tetrapyrrole synthesis by 30% but increased the rate of porphyrin export by cells by a factor of 1.5. The uptake of [14C]ALA was shown to be strongly influenced by the density of the cultures. In dense cultures (final cell density of approximately 0.15 x 10(6) cells cm(-2)), the ALA uptake rate was less than 0.8 compared with a maximum rate of 4.2 fmol per cell h(-1) at a cell density of 0.02 x 10(6) cells cm(-2). Since tetrapyrrole synthesis is less affected than ALA uptake by cell density, the resultant discrepancy in ALA incorporation occurring in dense cultures implies that endogenous ALA synthesis is induced in these cells. ALA uptake was not affected by cycloheximide or actinomycin D in serum-free conditions. However, fetal bovine serum decreased external ALA uptake by about 50%. This effect was abrogated by preincubation with cycloheximide.

Is admission chest radiography of any clinical value in acute stroke patients?

Chest radiographs are frequently requested on admission of patients with a clinical diagnosis of acute stroke. This study assesses their value in subsequent management of these patients. A retrospective analysis of 435 patients with a clinical diagnosis of acute stroke was made. All admission chest radiographs were reviewed to document both radiographic quality and any radiological abnormality. In those patients with an abnormal radiograph, clinical records were reviewed to assess their impact on clinical management. Eighty-six percent of patients had a chest radiograph performed on admission. 77.5% of these films were deemed to be technically unsatisfactory, the commonest problems being positioning and suboptimal inspiration. Radiological abnormality was demonstrated in 61 patients (16.4% of radiographs obtained). Clinical management was altered in 14 of the 61 patients (3.8% of the total number of patients radiographed). Radiological abnormality was missed by the admitting clinicians in four radiographs (1 hilar mass, 2 cases of consolidation, one of pulmonary oedema). One abnormality not clinically suspected was recorded (multiple metastases). We conclude that admission chest radiographs in patients with an acute stroke are not indicated in the absence of appropriate clinical indications.

Student Perceptions of Changing Answers on Multiple Choice Examinations

The belief that changing answers on examinations is detrimental persists in spite of empirical research which does not support that belief. While the research in education has consistently shown that changing answers is beneficial, few studies have been done on the behavior and psychological process of changing answers. This qualitative study found that students prefer not to change answers and do not believe it is advantageous to do so. Most students took tests in such a manner that at least a portion of the questions were re-read. Reasons given for changing answers included reconsidering the answers after re-reading the question, mismarking the answer sheet, re-guessing, and receiving a clue later in the test. The students who changed answers often found they had misread the questions initially when they re-read it. Re-reading the question was most likely to result in a change from wrong to right. Re-guessing was not found to be as beneficial to the student scores.

A fluoroscopy credentialling programme for orthopaedic surgeons

We have developed a teaching programme for non-radiologists who use fluoroscopy, which includes techniques for reducing the radiation received by the patient and the surgeon during orthopaedic procedures. The techniques resolve around the radiation protection concepts of time, distance and shielding. The programme has been very successful in reducing the total fluoroscopy times of orthopaedic surgeons; in our institute, durations have been reduced to about 10% of those before the training started. We review the aims and content of our programme.

Creating a culture of change

The objective of this presentation is to assist companies in creating a culture of change. In the 1970s our manufacturing companies pursued planning as the answer to competitive strength. Throughout the 1980s, we networked with suppliers and customers and smoothed the product flow. Now, in the 1990s, we are focused on the end customer to drive our programs to simplify the process to gain a competitive edge! Each of these answers was correct for its time. Stepping back from it all, however, we can see that the only lasting advantage is the underlying ability to adapt and change; to reinvent our companies again and again amid a rapidly changing, increasingly competitive environment.

A fluoroscopy credentialling programme for orthopaedic surgeons

We have developed a teaching programme for non-radiologists who use fluoroscopy, which includes techniques for reducing the radiation received by the patient and the surgeon during orthopaedic procedures. The techniques resolve around the radiation protection concepts of time, distance and shielding. The programme has been very successful in reducing the total fluoroscopy times of orthopaedic surgeons; in our institute, durations have been reduced to about 10% of those before the training started. We review the aims and content of our programme.

Initiation of growth inhibition by TGF beta 1 is unlikely to occur in G1

Type beta transforming growth factors represent a family of polypeptides that modulate growth and differentiation. They exert their effect on target cells through interaction with multiple cell surface receptors. Transforming growth factor-beta 1 has a strong inhibitory action on cell division in mink lung CC164 cells, a process that is initiated by immediate induction of junB and phosphorylation of nuclear protein followed by a reduced expression of cdk4. However, its signal transduction pathways are still unresolved. In this study we report a detailed analysis of cell kinetic events following addition of transforming growth factor-beta 1 to mink lung CCL64 cells. We show that transforming growth factor-beta 1 reduces [3H]thymidine incorporation after a delay of 8 hours, which reaches its nadir at 16 hours. The reduced growth rate is maintained for at least 48 hours as shown by flow cytometric analysis of DNA content. Using time-lapse video microscopy it was shown that control cells double on average every 14.4 hours, whereas the transforming growth factor-beta 1-treated cells have a doubling time of on average 20.3 hours. The difference in intermitotic time is a consequence of a prolonged G1 phase (a shift from 7.5 to 13.5 hours on average). However, changes in intermitotic times occur only after cells have undergone division in the presence of transforming growth factor-beta 1 and treated cells finish the ongoing cell cycle exactly like control cells. From these findings we conclude that transforming growth factor-beta 1 may change cell cycle parameters by interfering with cellular events prior to G1.(ABSTRACT TRUNCATED AT 250 WORDS)

Predicting outcome in high-risk newborns with a neonatal neurobehavioral assessment

OBJECTIVES

Effective medical management and rehabilitation efforts in neonates at risk depend on early identification of underlying brain injury. The aim of this study was to determine the prognostic value of the Einstein Neonatal Neurobehavioral Assessment Scale (ENNAS) in high-risk neonates, and to compare its predictive validity at two stages in development (i.e., 1 and 3 years of age).

METHOD

Twenty-three healthy neonates (control group) and 51 high-risk neonates (high-risk group) were assessed at term and were followed longitudinally. At 1 and 3 years, subjects in both groups were evaluated in a blind fashion by a psychologist and a pediatric neurologist.

RESULTS

Developmental delays became more apparent as high-risk newborns matured; the percentage of subjects with an abnormal Griffiths general quotient increased from 1 year (13.7%) to 3 years (39%). Analysis revealed that a normal neonatal performance on the ENNAS in high-risk subjects accurately predicted a favorable outcome at 1 year and 3 years of age. Although an abnormal ENNAS was not consistently associated with a poor outcome, the positive predictive value improved markedly from 1 year to 3 years of age.

CONCLUSION

The findings indicate that a normal neonatal neurobehavioral assessment is reassuring, as most of these children are free of neurodevelopmental sequelae at 3 years of age. For many persons, the ENNAS may provide early evidence of a pattern of brain injury that is manifested only as the child is challenged by more complex skill acquisition such as language, memory, and perceptual-motor tasks. The ability of this assessment to predict behavioral and academic skills at school age remains to be determined. Early identification of developmental deficits enables occupational therapists to direct infants to appropriate early intervention programs, thus optimizing their functional potential.

Fruit and vegetable food frequencies by fourth and fifth grade students: validity and reliability

OBJECTIVE

Due to the increased emphasis on fruit and vegetable (F+V) consumption and a desire to use the simplest dietary assessment method appropriate to determine F+V intake, we assessed the reliability and validity of weekly and monthly fruit and vegetable food frequency questionnaires (F+V FFQ) among fourth and fifth grade students by comparing them to food records previously validated through school lunch observations.

METHODS

The multiethnic sample (primarily African-American and Caucasian) included predominantly lower-middle socioeconomic students from 10 classes at one elementary school. F+V FFQ were printed on optical scanning forms and classroom administered on two occasions. Students completed preprinted food record forms at school and received new forms weekly. To allow comparison between the F+V FFQ and food records, a dietitian abstracted information from the records according to a written protocol and transferred it to F+V FFQ forms covering respective time periods. F+V FFQ were converted to estimated daily servings and aggregated to create five F+V indices plus three summary indices. Statistical analyses included Spearman correlations and paired t-tests.

RESULTS

Students demonstrated acceptable reliability in completing food records as well as weekly and monthly F+V FFQ; however, validity was unacceptable for both F+V FFQ versions due to significant overreporting.

CONCLUSION

Of the two methods studied, the food record procedure is preferred over the FFQ procedure for collecting self-reported F+V consumption data among fourth and fifth grade students.

Electron transfer in P450 mechanisms. Microsomal metabolism of cyclopropylbenzene and p-cyclopropylanisole

1. The metabolism of cyclopropylbenzene (1a) and 4-cyclopropylanisole (1b) was studied using liver microsomal preparations from control, phenobarbital- and beta-naphthoflavone treated rats. 2. With all three types of microsomes 1a was metabolized by benzylic hydroxylation to give 1-phenylcyclopropanol and by aromatic hydroxylation at C-4; the former predominated by a factor of 2-4. BNF-induced microsomes also formed 2-cyclopropylphenol. No cyclopropyl ring-opened metabolites of 1a, including benzoic acid, were detected in any of the incubations. 3. With PB-induced microsomes 1b underwent O-demethylation (90%) and benzylic hydroxylation; no other metabolites were detected. 4. Progress curves for metabolism of 1a are markedly nonlinear after only limited conversion of substrate, suggesting the possibility that 1a, like other cyclopropyl compounds, could be a suicide substrate for one or more isozymes of P450. 5. For both 1a and b, metabolite formation and enzyme inactivation can be explained by conventional P450 reaction mechanisms not involving electron abstraction.

Accuracy of fourth- and fifth-grade students' food records compared with school-lunch observations

Fourth- and fifth-grade students' food records completed by using a labor-intensive approach (with daily monitoring) or a less labor-intensive approach (with weekly monitoring) were compared with school-lunch observations. Records were completed at three elementary schools for 14-23 d by students in 26 classes. Record pages were printed forms with areas for recording items consumed, number of servings, and locations of meals. Students were randomly selected for lunch observation. Kappa coefficients and percent of agreement for interobserver reliability for both approaches combined ranged from 0.43 to 0.91 and 72.6% to 95.5%, respectively, on 24 observations. Pearson correlations for 117 record/observation matches were significant for eight and three of nine meal items for the daily and weekly monitoring approaches, respectively. Thus, students were reasonably accurate in keeping records and more accurate with the more labor-intensive approach. Researchers need to select an approach based on the degree of accuracy desired and available finances.

Measuring fruit and vegetable preferences among 4th- and 5th-grade students

BACKGROUND

Achievement of the nation's Year 2000 fruit and vegetable goal of five or more daily servings may relate to children's preferences for fruits and vegetables. There are, however, no easily administered instruments for measuring preferences for fruits and vegetables among children.

METHODS

An initial questionnaire systematically varied preparation methods after focus group discussions had indicated that this had an impact on fruit and vegetable preferences. The three-part questionnaire (fruits, vegetables, fruit and/or vegetable snacks) was classroom administered. Internal consistencies and test-retest reliabilities were acceptable. Principal components analyses, however, revealed food-specific rather than preparation factors; thus, preparation was eliminated from a revised questionnaire.

RESULTS

Repeat classroom administration of the revised questionnaire yielded acceptable internal consistencies and test-retest reliabilities. Preferences were higher for fruits than vegetables. Principal components analyses indicated single fruit and vegetable factors and a two-factor solution for snacks (vegetables, fruits). Pearson correlations between preferences and consumption were significant, but accounted for only a small fraction of the variance. Correlations between fruit exposure and preferences, and between vegetable exposure and preferences were 0.55 and 0.51, respectively.

CONCLUSION

The revised questionnaire provides a reliable, valid, and simple tool for assessing fruit and vegetable preferences of 4th- and 5th-grade students. The relationship between these preferences and actual consumption is weak; however, making fruits and vegetables more available may enhance preferences.

Nasopharyngeal grass foreign body in eight cats

Nasopharyngeal grass foreign bodies were diagnosed in 8 indoor/outdoor cats. Each cat was anesthetized with xylazine/ketamine, and the foreign bodies were extracted from the nasopharynx by use of mosquito forceps.

Transfer of embryos into the uterus: how much do technical factors affect pregnancy rates?

OBJECTIVE

Our objective was to identify the effect on outcome of (a) ultrasound-assisted embryo transfer, (b) the use of different embryo transfer catheters, and (c) the length of time the patients remain in the supine position after embryo transfer.

SETTING

The setting was a private fertility center.

SUBJECTS

This was a prospective study of 178 in vitro fertilization and embryo transfers (IVF-ET) and 63 frozen embryo replacements (FER).

RESULTS

The pregnancy rate was 28.7% following IVF-ET and 31.8% for FER. Ultrasound-assisted transfer did not affect the outcome (29 vs 30.3%). There was no difference in the performance of the Wallace and Frydman catheters with regard to outcome (30.3 vs 30.7%). Although there was an increase in pregnancy rate as the time interval in the supine position after ET increased, this needs a larger study.

CONCLUSION

The parameter studies did not affect the outcome of IVF/ET or FER. Some factors encouraged us to recommend ultrasound-assisted transfer in some cases, and the use of a Frydman catheter for transfer and to encourage the supine position after transfer for longer periods.

Factors predicting long-term outcome after chronic benzodiazepine therapy

41 patients who took part in a withdrawal programme from long-term treatment with diazepam in a controlled clinical trial were followed up five years later. Assessments were made of outcome derived from clinical symptomatology, formal psychiatric diagnosis, psychotropic drug use and frequency of contact with both primary care and psychiatric services. Using discriminant function analysis it was found that better outcome was associated with younger patients, fewer symptoms at time of withdrawal and, more particularly, six months later, less personality disturbance, and longer duration of diazepam use before withdrawal. The implications are discussed with particular reference to policies for withdrawing benzodiazepines.

Contact burns due to thermoplastic road paint

Thermoplastic road markings are used at similar temperatures to tar and bitumen and spillage onto skin causes similar contact burns. Most of these occupational burn injuries can be avoided by adherence to the manufacturer's recommendations about the wearing of protective clothing. Management and foremen of contractors using these materials need to ensure that their workers comply with safe procedures and wear the specified protective clothing.

Ritual burns--the Buddhist tradition

The mystical significance of fire is common to many cultures and religions. For the Buddhist community acts of self-mutilation by burning reflect a tradition for which the direct precedent is set in the ancient scriptures of the Lotus Sutra. Burns are produced by contact with incense and treated with oil and vegetable dressings. Two cases are presented and discussed with reference to early Buddhist beliefs.

Ice-skating injuries to the hand

166 patients with injuries due to ice-skating were seen in the local accident and emergency department over a six-month period; 60% of these involved the upper limb. 28 of the upper limb injuries were closed fractures and 24 were lacerations, almost all to the dorsum of the hand. The use of protective gloves would help to prevent these potentially avoidable injuries. "On-site" first-aid facilities help to reduce the demand on the local accident service.

Ice-Skating Injuries to the Hand

166 patients with injuries due to ice-skating were seen in the local accident and emergency department over a six-month period; 60% of these involved the upper limb. 28 of the upper limb injuries were closed fractures and 24 were lacerations, almost all to the dorsum of the hand. The use of protective gloves would help to prevent these potentially avoidable injuries. “On-site” first-aid facilities help to reduce the demand on the local accident service.

The Benzodiazepine Withdrawal Symptom Questionnaire

A self-report questionnaire is described which records the main symptoms experienced during withdrawal from benzodiazepines in pharmacologically dependent patients. The questionnaire consists of 20 items; evidence is given that these are reasonably independent and are sensitive in detecting withdrawal symptoms from a study of 68 patients undergoing slow withdrawal from benzodiazepines.

A longitudinal study of short latency somatosensory evoked responses in healthy newborns and infants

Maturational changes in short latency somatosensory evoked responses (SERs) were studied in 18 healthy full-term newborns in the first week of life and consequently repeated at 2-3 and 6-7 months of age. Both median nerves were electrically stimulated individually and evoked responses were recorded at 3 levels: Erb's point (EP), second cervical vertebra (CII), and contralateral parietal scalp (C'c). In the neonatal period, results of 32 stimulated nerves were obtained in all cases at the EP and CII levels. At the parietal level, potentials were present in 85% of cases, absent in 9% and questionable in 6%. Parietal potentials were occasionally noted on one side only. Repeat examinations at 2-3 and 6-7 months of age demonstrated significant maturational changes in the SERs. These changes were most prominent in the neonatal period and 2 months of age. They included decreased interpeak latencies, increased amplitude and markedly diminished dispersion of parietal potentials. Minimal changes in wave form configuration and latency were noted at the EP and CII level. These findings most likely reflect myelination and increased synaptic efficiency predominantly in the central sensory pathway. The purpose of this investigation was to delineate a reliable technique for SERs in newborns and infants that could be applied both to research and clinical settings. Normative data were established in newborns and infants as this will help us in accurately differentiating a normal from an abnormal group of neonates and infants.

Prognostic significance of the auditory brainstem evoked response in high-risk neonates

The prognostic significance of the auditory brainstem evoked response (ABR) was examined in this prospective study of neonates at risk for neurodevelopmental sequelae. ABR testing was performed in the neonatal period (37 to 45 weeks conceptional age) and at two and/or six months corrected age. 34 high-risk newborns and 14 controls were followed to one year of age, when they received neurological and developmental assessments. Increased I to III and I to V interwave latencies predicted gross motor delay at one year, with a positive predictive power of 83 per cent and a specificity of 94.7 per cent. Increased brainstem conduction, dispersal of waves III to V and V/I amplitude ratio abnormalities predicted abnormal neurological findings at one year, with positive predictive values of 100, 100 and 80 per cent, respectively. A standard clinical examination of the newborn, performed on the at-risk and control infants at 40 weeks conceptional age, was not found to be strongly predictive of neurodevelopmental deficits at one year.

The brainstem auditory evoked potential asymmetry is replicable and reliable

Lateralization of neural function is generally thought to occur only at the level of the cerebral cortex and perhaps the thalamus. Levine and McGaffigan [EEG Clin. Neurophysiol. 55, 532-537, 1983] challenged this view by identifying a neural asymmetry at the level of the brainstem. They analyzed brainstem auditory evoked potentials (BAEPs) and found that peak III(+) amplitude (baseline-to-peak) was significantly larger in response to right than to left ear stimulation. The current paper demonstrates that this BAEP asymmetry is (a) reliable within and between subjects, (b) present for 33/sec and 10/sec click rates, and (c) more reliable when amplitude is measured peak-to-peak. This brainstem asymmetry may reflect the general tendency of humans to orient rightward and/or may be a precursor of higher level asymmetries.

Somatosensory evoked response abnormalities in high-risk newborns

In a previous study from our laboratory, the prognostic significance of the auditory brainstem evoked response was assessed in high-risk neonates. An abnormal auditory brainstem evoked response predicted neurologic deficits at age 1 year; however, a normal result did not predict a normal outcome. In order to evaluate the prognostic utility of examining other sensory pathways, somatosensory evoked responses were elicited following median nerve stimulation. Testing was performed at 37-44 weeks conceptional age (defined as gestational age plus chronologic age) and at 2 and 6 months conceptional ages. Those patients studied included 34 high-risk neonates and 18 healthy, term infants as controls. Ten of the 34 patients had abnormal somatosensory evoked responses. Abnormalities included increased absolute (N19, P22) and interwave (N13-N19, N19-P22) latencies and flat potentials, alone or in combination. Three children with flat potentials demonstrated a persistence of this abnormality on subsequent examination and they later presented clinically with spastic quadriparesis. Four infants with increased latencies manifested normal responses on subsequent examination. Recently, these 4 patients exhibited tone abnormalities and mild developmental deficits; developmental outcome, however, will be assessed in a blind study at 1 year of age as part of this ongoing prospective study. Preliminary results suggest that somatosensory evoked responses may be valuable as an electrophysiologic predictor of outcome.

Computer aids to mammographic diagnosis

The improvement of mammographic specificity was investigated by means of identifying specific radiological features. Data are presented on the first 500 patients studied who had previously undergone mammography followed by biopsy. The presence of specific mammographic features on each radiograph, first determined by retrospective examination, was entered into a computer database. Subsequent discriminant function analysis demonstrated the importance of a small number of features whose presence could be used in an algorithm to predict diagnostic outcome. Using this algorithm, this feature-identification approach correctly identified 87.6% of benign and 79% of malignant cases. Specificity was improved to 88% as compared with the original radiological diagnosis of 49%. It is argued that this approach is very promising and a computer-assisted diagnosis based on these findings is described.

Relationship between neurotic symptoms and neurotic diagnosis: a longitudinal study

Symptoms of anxiety, panic, depression, hypochondriasis and phobias were recorded serially over a 2-year period in 78 psychiatric patients with depressive, anxiety and phobic neuroses. It was hypothesised that if there was a clear-cut relationship between symptom type and diagnosis the current classification of neurotic disorder would be supported. The results showed great temporal variability of anxiety and depressive symptoms. These symptoms were also poorly related to diagnosis. Phobic symptoms, however, were relatively consistent over time. The findings suggest that classifications of neurotic disorder based on presenting anxiety and depressive symptoms are unsatisfactory and that many patients could be classified as a single mixed disorder.

Disembowelment--a retrospective study of patients suffering evisceration following penetrating abdominal injury

Details are presented of 104 patients admitted over a 1-year period with evisceration following penetrating abdominal wounds. Stabbing was the most common cause of injury. Small bowel was the most commonly eviscerated organ, as well as the organ most frequently injured. Exploratory laparotomy was performed on all the patients who survived to reach the operating theatre. The negative laparotomy rate was 12 per cent, and a further 3 per cent had such mild visceral injuries that they did not require operative repair. For comparison a group of 111 patients admitted over the same period, but suffering only omental protrusion, was also examined. The rate of visceral injury in this group was slightly lower. Wound complications, including breakdown, were more commonly seen in the eviscerated patients, but the mortality was 8 per cent in both groups.