Co-dominant inheritance of hyperekplexia and spastic paraparesis

In four generations of a family with autosomal dominant hyperekplexia (startle disease), untreated affected adult members had pes cavus and extensor plantar responses, as well as hyper-reflexia. Electroencephalography during a startle, electromyography, nerve conduction velocities and somatosensory evoked potentials were normal. Genetic studies showed linkage to the CSF1R locus on chromosome 5q33-q35, which includes the glycine receptor. This either represents a variant of hyperekplexia with spasticity or suggests that genes for hyperekplexia and a form of hereditary spastic paraparesis may be closely linked.

A randomized controlled trial of laparoscopic extraperitoneal hernia repair as a day surgical procedure

BACKGROUND

A randomized controlled trial was conducted in a day surgery setting comparing a standardized variant of the Shouldice hernioplasty with extraperitoneal laparoscopic herniorrhaphy.

METHODS

The laparoscopic repair was technically challenging, evidenced by conversion from extraperitoneal to transabdominal repairs in 6.25% of patients. It was free from the inherent dangers of intraperitoneal laparoscopy. Surgical morbidity was low and comparable to that for patients randomized to the open repair.

RESULTS

Outcome following laparoscopic extraperitoneal herniorrhaphy varied depending on the parameter measured. It was comparable to the open repair with respect to postoperative activity levels and the number of days required for return to work but inferior to the open repair in terms of operation time and time to hospital discharge. The extraperitoneal approach was superior to the open repair with respect to postoperative pain levels and analgesic requirements. No attempt was made to compare recurrence rates due to the short follow-up period.

CONCLUSIONS

Laparoscopic extraperitoneal herniorrhaphy should not supercede conventional hernia repair until subjected to further trials with the aid of larger study populations and greater technical expertise; the results of long-term recurrence rates are awaited.

An epidemic of optic neuropathy and painful sensory neuropathy in Cuba: clinical aspects

An epidemic of bilateral optic neuropathy and painful sensory neuropathy occurred in Cuba in 1991-1993. Over 45,000 individuals were stated to have been affected. We report a clinical study on 25 patients seen in Cuba in 1993-1994. Affected patients showed either bilateral optic neuropathy with caecocentral scotomata or a distal predominantly sensory neuropathy sometimes associated with deafness, or a combination of both optic and peripheral sensory neuropathy. The nature of the epidemic is discussed. The clinical features in patients with confirmed neurological deficits were consistent with a diagnosis of Strachan's syndrome, probably related to nutritional deficiency. Other patients with similar symptoms showed no evidence either of optic or peripheral neuropathy and were considered to represent disease mimicry on a psychoneurotic basis.

Congenital livedo reticularis and recurrent stroke-like episodes

Three children with pronounced livedo reticularis present since birth (cutis marmorata-telangiectasia congenita) have been followed to the ages of eight, 17 and 21 years. During childhood they developed frequent recurrent transient stroke-like hemipareses, affecting either side of the body, associated with ipsilateral pain, headache, visual symptoms, dysphasia, fits and confusion. Intellectual failure and, in one, progressive spasticity have followed. Attacks were more frequent in winter. Other problems have included abnormal peripheral vascular responses to temperature change, gastro-intestinal bleeding, glaucoma, local tissue hypertrophy and, in the two older patients, renal involvement with hypertension. Their condition represents a form of congenital vasculopathy. Anticonvulsants, anti-migraine agents, anti-platelet drugs and flunarizine have been ineffective. Nifedipine prevented further attacks in one patient and reduced attacks in another, but has not helped the third child. Adequate clothing and warmth may also be important.

Oral absorption and bioavailability of fenbendazole in the dog and the effect of concurrent ingestion of food

Fenbendazole was administered orally without food to six beagle dogs at 2.5, 5.0, 10, 20, 40 and 80 mg/kg of body weight. Increasing the dose rate did not significantly increase the amount of fenbendazole absorbed. In a separate study fenbendazole was administered to the same six beagle dogs at a dose rate of 20 mg/kg of bodyweight in food with high, medium and low fat content. The food provided 1.52, 0.70 or 0.34 g of fat per kg of body weight. Administration of fenbendazole in food with different fat contents did not affect its relative bioavailability. Administration of fenbendazole at a dose rate of 20 mg/kg in food, irrespective of fat content, did however significantly increase its bioavailability when compared to administration of the same dose as a bolus on an empty stomach.

Pharmacodynamics, pharmacokinetics and faecal persistence of morantel in cattle and goats

Morantel could not be detected (< 0.05 microgram/ml) in the plasma of cattle or goats following the oral administration of morantel tartrate at a dose rate of 10 mg/kg bodyweight. No morantel was detected in the milk of lactating goats except in one animal where a concentration of 0.092 microgram/ml was detected at 8 h after drug administration. Morantel was highly effective against Cooperia oncophora infections in calves treated 6, 9 or 18 days after infection; however, was highly effective against Ostertagia ostertagi only when treated 18 days after infection. Morantel did not affect the fecundity of adult O. ostertagi surviving treatment 18 days after infection which had similar average numbers of eggs in their uteri (range 13.4 +/- 0.73-16.8 +/- 0.98) as did parasites from control animals (range 12.0 +/- 0.70-13.6 +/- 0.66). Morantel could be detected at a concentration of 96 +/- 4.5 micrograms/g (dry weight) in the faeces of a calf 24 h after treatment with 10 mg/kg bodyweight of morantel tartrate. The concentration of morantel in replicate samples of this faeces exposed to natural atmosphere, but not to soil or soil organisms, declined slowly over the following 322 days. At day 322 after the start of the experiment 8.8 micrograms/g of morantel could be measured in the remaining faecal material. Throughout the faecal degradation study the concentration of morantel in the crusts of the replicate sample pats was lower than the concentration in the core samples.

Pharmacokinetics of carprofen administered intravenously to sheep

Carprofen was administered intravenously to sheep at two dose rates (0.7 and 4.0 mg kg-1), and the pharmacokinetics of the drug studied. Plasma concentrations of the drug were measured by high performance liquid chromatography. Carprofen had a small volume of distribution (Vd[area], 95.5 and 118.4 ml kg-1), a prolonged elimination half-life (t1/2 beta, 26.1 and 33.7 hours) and a slow body clearance rate (Clb, 2.5 ml kg-1 h-1) in sheep.

Encephalomyelitis with seroconversion to Listeria monocytogenes

A previously healthy girl recovered from a lymphocytic encephalomyelitis with brain stem involvement after antibiotic and steroid treatment. Cultures of blood and cerebrospinal fluid were negative, but she seroconverted to Listeria monocytogenes serotype 4. Antilisterial treatment should be considered in similar cases.

Fecundity of anthelmintic resistant adult Haemonchus contortus after exposure to ivermectin or benzimidazoles in vivo

A strain of Haemonchus contortus resistant to the benzimidazoles, ivermectin and salicylanilides was used to study the effect of exposure to ivermectin or oxfendazole on the number of eggs produced by adult female parasites. After anthelmintic administration there was a reduction in the faecal egg count of the infected lambs. Ivermectin caused a reduction in the number of eggs within adult parasites for up to 72 hours but this returned to higher than pre-treatment levels at 168 hours after treatment. After oxfendazole treatment there was an increase in the number of eggs stored in the adult parasites at 24 hours and then a significant reduction in the number of eggs for over 168 hours. This suggested that both ivermectin and oxfendazole have a deleterious effect on the reproductive potential of female H contortus although the parasites are resistant to these drugs. These results confirm the importance of allowing up to 10 days to elapse between the time of administration of an anthelmintic and the collecting of faecal samples when using the faecal egg count reduction test to identify anthelmintic resistance, especially when using benzimidazoles. The more prolonged effect on fecundity produced by oxfendazole may reflect the antimitotic action of the benzimidazole anthelmintics.

Enhanced intestinal glucose and alanine transport in cystic fibrosis

The rise in short-circuit current associated with the active transport of glucose and alanine was measured in intestinal biopsy samples from children with cystic fibrosis. The glucose-induced increase in the short-circuit current was greater in the cystic fibrosis tissues than in control samples over the whole range of concentrations tested (2.5-35 mM), a reflection of an increased maximum rate of transport. Similar results were obtained with alanine. These findings suggest that active Na(+)-linked nutrient transport is enhanced in cystic fibrosis.

Water secretion and embryological layers in cystic fibrosis

Cystic fibrosis primarily affects tissues containing secretory epithelia, but not all of them become diseased. The distribution of clinical disease corresponds closely to the effect on net anion-linked water secretion, which is reduced across epithelia of endodermal and mesodermal origin but not those of ectodermal origin. Although the gene is expressed in all secretory epithelia, its effects on water secretion are bypassed in those of ectodermal origin.

Salivary flow rate, protein and electrolyte concentrations in chronic alcoholic patients

Stimulated and unstimulated parotid salivas were examined in a series of non-cirrhotic patients under treatment for alcohol dependence and in age-sex matched, non-alcoholic, healthy, control subjects. Resting salivary flow was raised threefold in the alcohol group and the protein and electrolyte concentrations were also altered in this saliva. However, there were no intergroup differences in parotid flow or composition following gustatory stimulation by 6% citric acid. The results contrast with the wide parotid functional changes known to occur in stimulated parotid saliva in alcoholic cirrhosis and suggest, therefore, that the direct salivary effects of chronic alcohol abuse may be less important than the damaged liver function in contributing to the salivary disturbance reportedly occurring in alcoholic cirrhosis.

Role of a separate subcutaneous cerebro-spinal fluid reservoir in the management of hydrocephalus

A retrospective survey has been carried out on 56 children with shunted hydrocephalus either with a primary idiopathic cause or as a result of a low spina bifida complex. In all 56 children, a separate reservoir has been inserted at some stage in the management of their hydrocephalus. There was no mortality. Morbidity was not increased from CSF infection or shunt blockage. There was less chance of the initial shunt blocking and there was a lesser incidence of visual and schooling handicap. Double cortical puncture did not result in an increased incidence of hemiplegia or epilepsy. We conclude that a separate reservoir greatly eases the management of these children and does not cause significant increased morbidity.

Penicillin therapy of spontaneous streptococcal meningitis in pigs

Oral prophylactic medication with either procaine penicillin G or a mixture of chlortetracycline, sulphadimidine and procaine penicillin G reduced the incidence of streptococcal meningitis in a herd of pigs with a high recorded prevalence of the disease, but to a significant extent (P less than 0.01) only in those pigs receiving procaine penicillin G. Subsequent studies showed that after oral administration of procaine penicillin G, benzylpenicillin was detectable in plasma only at very low concentration and similar results were obtained using the potassium salt of penicillin G. However, phenoxymethyl penicillin administered orally provided high plasma concentrations of this drug. A further investigation demonstrated that despite the low plasma concentrations of penicillin after oral administration of the procaine salt, gastrointestinal and urinary concentrations of the drug were relatively high for up to five hours.

Work therapy and return to work

In summary, data were selected for 1 year on patients treated in the Work Tolerance Program at the Hand Rehabilitation Center in Philadelphia. The type of information obtained has been used to obtain a profile of the patient population in the Work Tolerance Program. Statistical analysis was used, not only to formulate patient demographics, but also to evaluate the length of treatment of patients in the Work Tolerance Program. This period averaged 6 weeks. The statistical analysis also revealed there was significant interaction between the type of injury and the patient's diagnosis, and the rate of return to work. The patients with injuries to bone and nerve required longer periods of treatment until they returned to work than did patients with injuries to soft tissue or combination injuries. Our statistical analysis revealed that in 1982, 75 per cent of the patients in the Work Tolerance Program returned to work to regular or modified jobs. The length of time from injury to return to work was 63 per cent longer for patients with Workers' Compensation coverage than for patients with private insurance coverage. Because the statistical analysis that 60 per cent of the patients treated in the Work Tolerance Program were Workers' Compensation insured, and 80 per cent of the patients treated in the Work Tolerance Program were secondarily referred, it should be recognized that all patients with severe hand injuries would benefit from an immediate referral to a Hand Rehabilitation Center of excellence to facilitate their therapeutic management and expedite their recovery from time of injury to return to work. This study was restricted to the analysis of length of treatment and rate of return to work. Future studies should study the effect of early referral and the application of specific treatments.

Acute renal failure following cardiopulmonary bypass in children: results of treatment

Following open heart surgery using cardiopulmonary bypass, 18 (4%) of 441 operated children required treatment with peritoneal dialysis for acute renal failure or refractory oliguria. Nine recovered renal function (50%) and 5 (28%) survived. Only 2 died from renal causes. Despite both adequate symptomatic treatment of renal failure and few complications of dialysis itself, the prognosis remains poor, even with early treatment, but an aggressive approach is justified because some survivors can be expected.

Effect of feeding on the fate of orally administered phenylbutazone, trimethoprim and sulphadiazine in the horse

Phenylbutazone, sulphadiazine and trimethoprim were administered to three horses on two occasions, recently fed and unfed, and the effect of feeding on the pharmacokinetics of the three drugs assessed. The mean peak concentrations of phenylbutazone and trimethoprim were reduced by feeding by 34 and 75 per cent, respectively. The pharmacokinetics of sulphadiazine were not significantly affected.

Severe ornithine transcarbamylase deficiency. Two and a half years' survival with normal development

The clinical course and management of a boy with severe ornithine transcarbamylase deficiency are described. In addition to treatment with sodium benzoate and amino acid keto analogues, mannitol may be useful in hyperammonaemia and nocturnal gavage feeding aids maintenance treatment.

The pharmacokinetics of meclofenamic acid in the horse

The pharmacokinetics of meclofenamic acid were studied in Thoroughbred horses and in ponies. After intravenous (i.v.) administration of either 2 mg/kg or 4 mg/kg sodium meclofenamate the elimination half-life was of the order of 0.9 h while the volume of distribution was found to be 0.128 litre/kg. Elimination was in accordance with a one-compartment model. Following oral administration of either meclofenamic acid (4 mg/kg) or sodium meclofenamate (4 mg/kg) a much longer terminal half-life than that calculated for Kel from i.v. data was found. This anomaly indicated that the 'flip-flop' phenomenon was present, i.e. Ka exceeded Kel. More rapid and higher peak levels occurred following sodium meclofenamate than meclofenamic acid, although total bioavailability was similar. Studies in ponies with meclofenamic acid showed a lower absorption than that found in Thoroughbreds. Overnight fasting before meclofenamic acid administration did not alter the rate or extent of absorption. Intramuscular administration of sodium meclofenamate resulted in low plasma concentrations and after 25 h only 46% of the drug had been absorbed.

Muscle fibre composition and glycogen depletion in horses competing in an endurance ride

An investigation into fibre composition and glycogen depletion pattern within the middle gluteal of 16 horses participating in an 80 km endurance ride was carried out. Although the proportion of slow twitch high oxidative (ST) fibres in the horses varied between 7 and 38 per cent, it was found that the horses with the highest proportion of these fibres usually had the best performance records. The cross-sectional area of the fast twitch low oxidative (FT) fibres was greatest, with the ST and fast twitch high oxidative (FTH) being similar in size. Most marked histological evidence of glycogen depletion after the ride was in the ST fibres, which were apparently totally depleted. A variable degree of depletion was found in both the FTH and FT fibres. Biochemical measurement of muscle glycogen showed a 56 +/- 7.2 per cent (mean +/- SEM) decrease in content.

Splenic size and function in adult coeliac disease

Splenic scintigraphy was performed after measurement of 99Tcm-labelled heat-damaged red cell clearance in 29 patients with treated coeliac disease. Good correlation was found between splenic size and function using these techniques. 99Tcm-labelled sulphur colloid scintiscans were also performed in 24 coeliacs. Splenic volumes computed from colloid scans correlated well with those computed from red cell scans. Almost 50% of adult patients with treated coeliac disease have impaired splenic function, the incidence rising with increasing age of starting treatment. Sulphur colloid scintigraphgy provides a simple quantitative method of assessing splenic function in treated coeliac disease which can be used in exploring the possibilities of avoidance of the adverse effects of hyposplenism.

Orchard soil management trials. 2. Effect of herbicides and nitrogen on growth and yield of young apple trees in permanent pasture

On two cultivars of young apple trees growing in a permanent pasture, a narrow strip was kept bare with herbicide sprays used either during spring and summer or during the entire year. This increased tree growth, fruit set, fruit yield, and fruit size. Using more nitrogen fertilizer did not compensate for the grass competition and did not increase growth or yield as much as did the herbicide sprays. Most of the applied nitrogen could be accounted for in the increased growth of grass. The herbicide simazine increased tree growth more than other herbicides.

Orchard soil management trials. 1. Effect of a weed-free or straw mulched strip on the growth and yield of young fruit trees

The effects of keeping a strip along the tree row bare with herbicide sprays or mulched with weed-free straw were compared with either permanent pasture or cultivation. Peach trees growing in the straw mulched strips from their second year onwards grew bigger, made more growth, and produced twice as many fruit of larger size in their fourth and fifth seasons. Apple trees growing in a 1 1/2 metre wide mulched strip also made more total growth and yielded twice the weight of fruit in their fifth and sixth seasons than trees growing under cultivation. Mean fruit size of the apples from the mulched trees was larger, and the mulched apple trees carried more blossoms following a heavy crop than did the cultivated trees. Growth and fruit bearing of the peach and apple trees in the herbicide treated plots was intermediate between the control and mulch treatments.