The management of orbital cysts associated with congenital microphthalmos and anophthalmos

AIMS

To study the management of the orbital cysts present in a group of patients with anophthalmos and microphthalmos.

METHODS

A retrospective study of 34 patients (40 orbits) treated for orbital cyst associated with microphthalmos and anophthalmos.

RESULTS

The two largest treatment groups comprised 17 orbits (42.5%) where the cyst was removed surgically and 17 orbits (42.5%) where the cyst was retained and conformers were used. The remaining cases comprised two orbits (5%) where the cyst was aspirated initially; two orbits (5%) with large cysts which will need to be excised after further orbital growth; one orbit (2.5%) in which a silicone expander was used initially, and one orbit (2.5%) in which a mildly microphthalmic eye had some vision and was monitored but required no surgery.

CONCLUSION

In this study 33 out of 34 patients had a good cosmetic result which illustrates that the orbital cyst in microphthalmos or anophthalmos performs a useful role in socket expansion and that the majority of patients with this condition can expect a good cosmetic outcome.

Nonmyeloablative allogeneic hematopoietic stem cell transplantation for congenital sideroblastic anemia

Congenital sideroblastic anemia (CSA) is a dyserythropoietic disorder that leads to transfusion dependency and subsequent iron overload. Nonmyeloablative allogeneic hematopoietic stem cell transplantation (NST) was performed for a patient with CSA, who had contraindications to conventional allografting. Conditioning was fludarabine, low-dose total body irradiation and antithymocyte globulin, followed by peripheral blood stem cell transplant. Cyclosporine and mycophenolate mofetil were used for graft-versus-host disease prophylaxis. Complete donor chimerism was observed day +131. Early after transplant, the patient became transfusion independent, allowing a regular phlebotomy program. On day +190, refractory lactic acidosis followed by fatal cardiovascular collapse developed, without evidence of infection. Data from this case demonstrates that NST may correct the erythropoietic defect of CSA.

Early T-maze behavior and broiler growth

In the laboratory and at a commercial farm in Argentina, chicks that showed a short latency to exit a T-maze (LEX) (HP, high performance) gained more weight than those with a longer LEX (LP, low performance). The present study re-examined this relationship and evaluated additional T-maze measures using broilers reared in quasi-intensive, environmentally controlled conditions. In the T-maze, a mirror strategically placed at the end of a corridor stimulates the test chick to leave the isolation chamber (start box) and to move toward its reflection. Having done so, it can then see other birds and thereby be further stimulated to completely exit the maze. However, when a test bird hesitates or stops at the mirror, its performance categorization may be confounded. Herein, the T-maze performance of 3-d-old broiler chicks was assessed using three different measurements: 1) the latency to exit the start box (LEB), 2) the latency to reach the mirror section of the maze (LRM), and 3) LEX. The fastest (top 25%) and slowest (bottom 25%) of the birds within a sex and within each of the three T-maze criteria were classified as HP and LP chicks, respectively. The relationships between these measures and body weight were examined in 4-, 42-, and 56-d-old males and females. Irrespective of the T-maze classification criteria used, HP and LP chicks had similar body weights at 4 d of age. However, chicks classified as HP according to LEB or LRM measures were heavier at 42 and 56 d of age than LP ones (P < 0.02 for all comparisons). These differences were apparent in both sexes. On the other hand, there were no detectable differences in body weight at the latter ages between chicks categorized as HP or LP according to their LEX scores. The present results indicate that 1) broiler chicks that exit the T-maze start box and reach the mirror quickly subsequently grow faster than their slower LP counterparts and 2) LEB and LRM are better predictors of growth than the LEX value used in previous studies.

Interferon-gamma for delayed pulmonary toxicity syndrome resistant to steroids

Delayed pulmonary toxicity syndrome, characterized by interstitial pneumonia and pulmonary fibrosis, is common following high-dose bischloroethylnitrosourea (BCNU) (carmustine, [1,3-bis (2-chloroethyl)-1-nitrosourea]) containing chemotherapeutic regimens. Depending upon the treatment protocol, it may develop in over 70% of patients. Early and aggressive corticosteroid treatment leads to improvement in the majority of patients. However, up to 8% of affected patients may fail to respond to corticosteroids and develop progressive respiratory failure leading to death. No alternatives to corticosteroids have thus far been shown useful. We report the symptomatic and physiological improvement of a patient with severe steroid-resistant delayed pulmonary toxicity syndrome, following treatment with interferon-gamma.

Components of feed efficiency in broiler breeding stock: is improved feed conversion associated with increased docility and lethargy in broilers?

Two trials were conducted to test the hypothesis that broilers classified as good rather than poor feed converters (low vs. high feed-to-gain ratios, respectively) would show decreased activity (increased lethargy) and reduced fear of human caretakers. In both trials birds were reared to juvenile selection age when the 192 males with the "best" breast and leg conformation were placed into individual bird cages (46 x 60 cm), and their feed conversion ratio (FCR) was measured. In trial 1, birds remained in the cages for 7 d for assessment of feed conversion. During the feed conversion testing period, the birds were subjected to three behavioral tests. First, approach-avoidance responses to a novel object placed in the feeder were observed when feeding would be expected. Second, behavior patterns of individual birds were assessed by recording feeding, drinking, walking pecking, preening, standing, and resting. Third, the 20 birds showing the best FCR and the 20 showing the worst were induced into tonic immobility (TI). Feed conversion was not related to either the novel object or the TI measures of fearfulness. Neither was FCR related to feeding, drinking, walking, or pecking. However, FCR was positively correlated with both standing and preening and negatively correlated with resting behavior. In trial 2, the FCR test lasted for 11 d. The birds were assessed for behavioral patterns (feeding, drinking, walking, pecking, preening, standing, and resting) as in the previous trial. As in trial 1, FCR was positively correlated with standing and negatively correlated with resting behavior. Contrary to expectations, the results of these two studies suggest that broilers with good FCR were actually less lethargic and no more fearful than those that showed poor FCR values.

The familial contribution to non-syndromic ocular coloboma in south India

AIMS

To identify the proportion of familial cases of isolated ocular colobomatous malformations in a case series from south India.

METHODS

Children with ocular coloboma without systemic features were recruited from multiple sources in Andhra Pradesh, India. Their families were traced, pedigrees drawn, and family members examined.

RESULTS

56 probands, 25 females (44.6%) and 31 males (57.4%) with a colobomatous malformation were identified. In 12 cases (21.4%) another family member was affected. The risk to siblings was 3.8%. The parents were consanguineous in 25 cases (44.6%).

CONCLUSIONS

21.4% of cases of isolated ocular coloboma in this highly consanguineous population of south India were familial, with both autosomal dominant and autosomal recessive mechanisms likely in different families.

Pecking at other birds and at string enrichment devices by adult laying hens

1. Bunches of white string (polypropylene twine) are particularly attractive pecking stimuli for both chicks and adult laying hens. Furthermore, these devices can retain the birds' interest over lengthy periods. It has also been demonstrated that birds with trimmed feathers elicit feather pecking. The present study was designed to determine whether string devices would retain their attractiveness in the presence of a competing stimulus: a trimmed hen. 2. Lohmann Brown hens were reared in 20 groups of 5 in floor pens with perches from 17 weeks of age. They were exposed to one of two treatments when they were 23 weeks old. One hen was removed from every pen and the feathers on her rump were trimmed. Immediately before her return two string devices were suspended from a perch in treatment 1 whereas no devices were included in treatment 2. Pecking behaviours were immediately observed for 30 min; this procedure was repeated later that day. The devices remained in the pens used in treatment 1 and these birds were observed again for 15 min after 14 d. 3. The string devices were pecked earlier and more than either the trimmed or untrimmed hens. Furthermore, the devices were still being pecked 2 weeks after their introduction. 4. The virtual absence of severe feather pecking and of aggressive head pecks precluded test of our hypothesis that the devices would divert potentially injurious pecking away from other birds. However, the fact that the birds showed sustained interest in the devices, even in the presence of a competing stimulus, supports our proposal that string may represent a practicable and effective form of environmental enrichment.

Acute stimulation of glucose uptake by leptin in l6 muscle cells

The adipocyte hormone, leptin, acts via the central nervous system to modulate glucose metabolism by skeletal muscle, but the direct effects of leptin on glucose metabolism by skeletal muscle are unclear. In this study, we have examined effects of leptin on glucose uptake by cultured L6 muscle cells assessed with the non-metabolised glucose analogue 2-deoxy-D-glucose. Reverse-transcriptase polymerase chain reaction (RT-PCR) analysis of RNA showed that L6 muscle cells express a short isoform of the leptin receptor (ObRa), but not the long isoform (ObRb). In the absence of added insulin, incubation of L6 muscle cells with murine leptin (10( -11)-10( -8) M) for 10 min and 1 h increased glucose uptake by 15 % - 23 %. This effect of leptin was lost by 4 h. Leptin (10( -10) - 10( -9) M) initially (after 10 min) suppressed insulin-stimulated glucose uptake by 14 - 16 %, but had no effect in the longer term. Leptin-stimulated glucose uptake was inhibited by the phosphatidylinositol 3-kinase (PI3K) inhibitor wortmannin, but not by the janus kinase-2 (JAK-2) inhibitor tyrphostin AG490. The results suggest that leptin can act directly on L6 muscle cellsvia a short leptin receptor isoform to acutely stimulate basal (but not insulin-stimulated) glucose uptake via a PI3K-dependent pathway.

The accessibility of computer-based health information for patients: kiosks and the web

The Internet is a rich source of health information but it is not as accessible as many claim. This paper brings together three projects to illustrate technical and cost barriers and some options to overcome them. (1) A survey amongst a representative sample of 180 patients in rural Spain showed a marked age gradient in computer access. None over the age of 50 had, and less than 10% planned, access to the Internet whereas a quarter were prepared to use health centre based touchscreen kiosks. (2) Half the commonly used search engines did not include the two most relevant websites for Glasgow colorectal cancer patients in the first ten documents listed, showing the difficulty facing patients in finding relevant information. Selection of information would help patients avoid being overwhelmed with information. (3) One method to improve accessibility is to download websites to kiosks but two projects showed that considerable work is required to reformat the information. Public access computing, such as kiosks, could help make the Internet more accessible. We discuss whether Web sites which structure their information according to method of access, place and person provide a way forward.

Maillard reaction induced lactose attachment to bovine beta-lactoglobulin: electrospray ionization and matrix-assisted laser desorption/ionization examination

Nonenzymatic attachment of lactose to beta-lactoglobulin (beta-Lg) was investigated under different conditions. Solubilized conditions, dry environment, and a combination of dry and solubilized environments, were examined for their effects on lactosylation. Temperatures ranging from 50 to 65 degrees C and time intervals between 1 h and 4 days were used. Electrospray ionization (ESI) and matrix-assisted laser desorption/ionization (MALDI) mass spectrometry were implemented to examine the reaction products. Maximum attachment efficiency occurred at 65 degrees C held for 3 h in dry-way conditions. Incubations held for long periods of time under dry-way conditions suggest possible denaturation. Both ESI and MALDI data suggest beta-Lg removal in the solubilized samples held for long periods of time. A combination of solubilized and dry environments led to very similar mass spectrogram results over time.

Structural basis for interaction of FGF-1, FGF-2, and FGF-7 with different heparan sulfate motifs

Stromal cell-derived FGF-7 binds and activates only the resident FGFR2IIIb in epithelial cells while FGF-1 and FGF-2 exhibit a broader interaction with multiple isoforms of FGFR. Here we report the structure of FGF-7 that has been solved to 3.1 A resolution by molecular replacement with the structure of a dual function chimera of FGF-7 and FGF-1 (FGF-7/1) which was resolved to 2.3 A. Comparison of the FGF-7 structure to that of FGF-1 and FGF-2 revealed the strongly conserved Calpha backbone among the three FGF polypeptides and the surface hydrophobic patch that forms the primary receptor-binding domain. In contrast, a decrease and dispersion of the positive surface charge density characterized the heparin-binding domain of FGF-7 defined by homology to that of FGF-1 and FGF-2 in complexes with heparin. A simple heparin hexasaccharide that cocrystallized with FGF-1 and FGF-2 and protected both against protease in solution failed to exhibit the same properties with FGF-7. In contrast to FGF-1 and FGF-2, protection of FGF-7 was enhanced by heparin oligosaccharides of increased length with those exhibiting a 3-O-sulfate being the most effective. Protection of FGF-7 required interaction with specifically the fraction of crude heparin retained on antithrombin affinity columns. Conversely, heparin enriched by affinity for immobilized FGF-7 exhibited anti-factor Xa activity similar to that purified on an antithrombin affinity matrix. In contrast, an FGF-1 affinity matrix enriched the fraction of crude heparin with low anti-factor Xa activity. The results provide a structural basis to suggest that the unique FGF-7 heparin-binding (HB) domain underlies a specific restriction in respect to composition and length of the heparan sulfate motif that may impact specificity of localization, stability, and trafficking of FGF-7 in the microenvironment, and formation and activation of the FGFR2IIIb kinase signaling complex in epithelial cells.

Intensive chemotherapy for progressive chronic lymphocytic leukemia administered early after a nonmyeloablative allograft

A 51-year-old patient with refractory CLL elected to participate in a trial of nonmyeloablative trans- plantation from an HLA-matched unrelated donor. He received low-dose fludarabine/TBI, with infusion of donor PBPC and cyclosporin (CsA)/MMF. Early post transplant he experienced explosive tumor growth with respiratory insufficiency. After immunosuppression discontinuation and rituximab administration, no response was observed. This prompted treatment with cyclophosphamide (2 g/m(2)/day x 2), paclitaxel (250 mg/m(2) over 24 h), doxorubicin (50 mg/m(2)), solumedrol (500 mg/day), and a second dose of rituximab, from days +11 to +14. A rapid response was achieved. Chemotherapy did not cause an obvious compromise of donor stem cell engraftment or establishment of stable donor chimerism.

Impairment, disability and handicap--old fashioned concepts?

The drawbacks of using the concepts of models in discussing the problems of disabled people are discussed. It is suggested that the terms "impairment", "disability", and "handicap" can unify the different models and enhance the position of people with disabilities in society.

Incidence of and risk factors for diabetic retinopathy in diabetic clinic attenders

The incidence and risk factors for the development of diabetic retinopathy during a mean (SD) follow-up period of 4.6 (2.9) (range 1-12.4) years have been examined among 3424 patients (1878 males and 1546 females) with diabetes mellitus from three outpatient clinics at the University Hospital, Nottingham. The mean (SD) age of participants was 49.2 (17.9) years with a mean (SD) duration of diabetes of 7.3 (9.0) years at initial registration. Among the 3424 patients free of retinopathy at initial registration who attended the clinic at least twice in the period 1979-1992, the incidence of any retinopathy was 59.6 (57.8 male and 61.8 female) per 1000 person-years based on 15,571 person-years of follow-up. The incidence rate of retinopathy was 72% higher among insulin-treated than among non-insulin-treated noninsulin-dependent diabetes mellitus (NIDDM) clinic attenders. Using a Cox's Proportional Hazards Model for insulin-dependent diabetes (IDDM) and NIDDM (insulin and non-insulin-treated) diabetes separately, longer duration of diabetes, higher systolic blood pressure and poor metabolic control were significant independent predictors of retinopathy for all three groups. Never smoking was a significant independent predictor of retinopathy for the insulin-dependent diabetes groups. Lower body mass index, proteinuria and age were predictors of retinopathy only for non-insulin-treated NIDDM patients. Gender and creatinine had no significant independent association with retinopathy when other covariates were considered. These findings will help the identification of those patients at particular risk of retinopathy so that clinic time for screening of eyes can be appropriately focused.

Boron neutron capture therapy of brain tumors: investigation of urinary metabolites and oxidation products of sodium borocaptate by electrospray ionization mass spectrometry

Boron neutron capture therapy (BNCT) is based on a nuclear capture reaction that occurs when boron-10, a stable isotope, is irradiated with low energy neutrons to produce high-energy alpha particles and recoiling lithium-7 nuclei. The purpose of the present study was to determine what urinary metabolites, if any, could be detected in patients with brain tumors who were given sodium borocaptate (BSH), a drug that has been used clinically for BNCT. BSH was infused intravenously over a 1-h time period at doses of 26.5, 44.1, or 88.2 mg/kg of body weight to patients with high-grade brain tumors. Electrospray ionization mass spectrometry has been used to investigate possible urinary metabolites of BSH. Chemical and instrument conditions were established to detect BSH and its possible metabolites in both positive and negative electrospray ionization modes. Using this methodology, boronated ions were found in patients' urine samples that appeared to be consistent with the following chemical structures: BSH sulfenic acid (BSOH), BSH sulfinic acid (BSO(2)H), BSH disulfide (BSSB), BSH thiosulfinate (BSOSB), and a BSH-S-cysteine conjugate (BSH-CYS). Although BSH has been used clinically for BNCT since the late 1960s, this is the first report of specific biotransformation products following administration to patients. Further studies will be required to determine both the biological significance of these metabolites and whether any of these accumulate in significant amounts in brain tumors.

Determination of body composition in conscious adult female Wistar utilising total body electrical conductivity

Total body electrical conductivity (TOBEC) is a noninvasive method for estimating fat free mass (FFM) in live animals. In this study, we have evaluated the use of the Em-Scan SA-3000, which is claimed by the manufacturers to perform better than earlier analysers. Previous studies in rats using these earlier versions of the TOBEC analyser have always used anaesthesia to minimise movement artefacts. As repeated anaesthesia also has the potential to induce artefacts by disrupting food intake, for example, we have also attempted to determine if this TOBEC analyser can be used to predict body composition in conscious adult weight-stable female Wistar rats. A simplified cafeteria diet was used to produce large variations in body composition (40-350 g fat/carcass) and a full chemical body composition analysis was performed to generate a TOBEC calibration equation. The TOBEC parameter was more strongly correlated to FFM (r(2)=.785) than it was to body weight (r(2)=.669) or other body composition parameters. Using the TOBEC calibration equation to predict fat mass on these data, there was an excellent correlation with the value obtained by chemical analyses (r(2)=.952, slope=0.958). To determine if the TOBEC calibration equation derived from this calibration study would then be useful for the routine estimation of body composition an additional, validation study was performed. This validation study was performed 6 months later, used an independent group of obese female Wistar rats and was undertaken by different TOBEC operators. This validation study, again, showed a good correlation between the TOBEC- and chemical-derived fat mass (r(2)=.918, slope=1.003) indicating stability of the calibration equation with time and independence from operator. We therefore conclude that it is possible to meaningfully estimate body fat changes in conscious rats using this TOBEC analysis system.

Age-related changes in fear, sociality and pecking behaviours in two strains of laying hen

1. Two lines of commercial hybrid layers (Tetra and ISA Brown) were reared from hatch to 30 weeks of age in groups of 8. The objectives of the experiment were to evaluate the significance of the different selection practices involved in the development of the lines and to assess the potential association between selected behavioural states and the potential for feather damage and cannibalism. 2. Behavioural tests related to fear (tonic immobility, novel object, open field), sociality (runway, proximity in the home pen) and pecking (feather bunch and focal observations of inter-bird and environmental pecking) were conducted at 0 to 2, 5 to 7, 12 to 14, 19 to 21 and 29 to 31 weeks of age. Scan sampling of general behaviour was also conducted at these ages. 3. Underlying sociality was greater in Tetras than in ISA Brown hens. 4. There were no apparent overall strain differences in fearfulness although ISA Brown hens showed significantly longer tonic immobility fear reactions than Tetras at 31 weeks of age. 5. ISA Brown hens gave and received more gentle pecks than Tetra hens whereas preening was commoner among Tetras. There were no strain differences in the number of pecks at litter or food. 6. As birds aged they showed less avoidance of novel objects and Tetras, though not ISA Browns, showed progressively shorter tonic immobility responses. Birds of both strains spent less time resting, more foraging (pecking and scratching) and pecked more at the feather bunch at older ages. 7. Measures taken in the TI, open field, runway (social affiliation) and feather bunch tests were stable over time whereas focal observations of pecking at hens and the environment were not. 8. Factor Analysis showed that 3 factors defined by the novel object test, environmental pecking and pecking ata feather bunch explained most of the variation in the correlation matrix between summary measures for the 8 behavioural traits.

5'- and 3'-terminal nucleotides in the FGFR2 ISAR splicing element core have overlapping roles in exon IIIb activation and exon IIIc repression

The cell type-specific, mutually-exclusive alternative splicing of the fibroblast growth factor receptor 2 (FGFR2) pre-mRNA is tightly regulated. A sequence termed ISAR (intronic splicing activator and repressor) has been implicated as an important cis regulatory element in both activation of exon IIIb and repression of exon IIIc splicing in epithelial cells. In order to better understand how this single sequence could have dual roles, we transfected minigenes containing a series of 2-bp mutations in the 18 3'-most nucleotides of ISAR that we refer to as the ISAR core. Transfection of cells with dual-exon (IIIb and IIIc) minigenes revealed that mutation of terminal sequences of the core led to decreased exon IIIb inclusion and increased exon IIIc inclusion. Transfection of cells with single-exon IIIb minigenes and single-exon IIIc minigenes revealed that mutation of terminal sequences of the ISAR core led to decreased exon IIIb inclusion and increased exon IIIc inclusion, respectively. Nucleotides of the ISAR core responsible for exon IIIb activation appear to overlap very closely with those required for exon IIIc repression. We describe a model in which ISAR and a 5' intronic sequence known as IAS2 form a stem structure required for simultaneous exon IIIb activation and exon IIIc repression.

Enhancing the specificity of the COBAS AMPLICOR CT/NG test for Neisseria gonorrhoeae by retesting specimens with equivocal results

The COBAS AMPLICOR CT/NG test for Neisseria gonorrhoeae cross-reacts with certain strains of nonpathogenic Neisseria species. In some strains, the target sequence is identical to that of N. gonorrhoeae, whereas other strains have a small number of mismatches within the regions recognized by the primers or probe used in the COBAS AMPLICOR NG test. These cross-reactive strains are occasionally present in urogenital specimens, causing false-positive results in the COBAS AMPLICOR NG test. Analysis of the data generated in a large multicenter clinical trial showed that 2.9% of the specimens gave signals between A(660)s of 0.2 and 3.5 but that one-half of these equivocal specimens did not contain N. gonorrhoeae. Most of these equivocal specimens were correctly classified as true positive or true negative by retesting in duplicate and defining a PCR-positive result as two of three results with an A(660) of > or =2.0. If specimens had been classified as positive or negative based on a single test result using a cutoff of an A(660) of 0.2, specificity would have ranged from 96.2 to 98.9% depending on specimen type, sex, and presence of symptoms. By employing the equivocal zone-retesting algorithm, specificity increased to 98.6 to 99.9% with little effect (0.1 to 4.9% decrease) on sensitivity in most specimen types, enabling the test to achieve a positive predictive value of at least 90% in populations with a prevalence of 4% or higher. In lower-prevalence populations, the test could be used to screen for presumptive infections that would have to be confirmed by an independent test.

Validation of Web-based questionnaires regarding osteoporosis prevention in young British women

OBJECTIVES

The aim was to assess the content, validity and reproducibility of web-based questionnaires, for a study on osteoporosis prevention among young British women. Twenty-two questionnaires to assess knowledge, self-efficacy, physical activity, calcium intake, health beliefs and stages of change relevant to osteoporosis prevention were identified. Nine were selected and modified to compensate for cultural differences, to suit young women, for completion on the Web.

DESIGN

Subjects were recruited by e-mail and asked to complete the web-based questionnaires. Subjects completed the questionnaires again, on paper and were asked to assess the content validity, at least seven days later.

SETTING

University of Glasgow, Scotland.

SUBJECTS

Sixteen female students and staff aged 19-49.

RESULTS

The questionnaires' reproducibility, as measured by the intraclass correlation coefficient was significant at p < 0.01 and acceptable, i.e. above 0.70 for knowledge, 0.85; for self-efficacy, 0.72; for exercise stage of change, 0.79; for exercise benefits, 0.89 and for exercise barriers, 0.82. The intraclass correlation coefficient was significant at p < 0.01 for health belief, 0.43, for weight-bearing physical activity, 0.67, for calcium barriers, 0.48, for 'others around you', 0.65, for calcium stage of change, 0.50 and for calcium intake, 0.56. The intraclass correlation coefficient was not significant for calcium benefits.

CONCLUSIONS

Assessing content validity was valuable in ensuring questionnaires were relevant and interpreted correctly by the sample population. Nine web-based questionnaires suitable for, and validated with, young British women are now available for use as outcome measures in studies of health education to prevent osteoporosis.

Effect of distal fibular resection on ankle laxity

Ten cadaver specimens were used to study the effect of distal fibular resection and ligamentous repair on ankle laxity. The distal fibula was resected sequentially at three levels. Talar tilt and anterior drawer were measured on stress radiographs after resection and then after ligament repair. Sequential resection of the distal fibula caused a progressive increase in talar tilt and anterior drawer at each cut level (p < 0.5), regardless of whether the ligaments were repaired or not. Ligament repair significantly decreased talar tilt at cuts above the ATFL insertion and decreased anterior drawer at cuts at the tibiotalar level, but these values did not approach control values.

Tonsillar metastasis: A rare presentation of gastric carcinoma

Metastatic carcinoma of the tonsil is uncommon. Tonsillar metastases rarely become apparent before the diagnosis of the primary neoplasm. We describe only the second reported case of tonsillar metastasis as a presenting feature of gastric carcinoma. A review of the literature is also discussed.

Clinical findings, consanguinity, and pedigrees in children with anophthalmos in southern India

This study aimed to describe clinical findings, pedigrees, and possible environmental risk factors in children with clinical anophthalmos and remnant microphthalmos in either eye in southern India. Twenty-four children (14 male, 10 female; mean age 10.3 years, age range 1.3 to 18 years,) were recruited from schools for the blind, hospitals, and community-based rehabilitation programmes in Andhra Pradesh, India, over 1 year. Family members were examined, and mothers interviewed. Fifteen children had anophthalmos and nine had remnant microphthalmos in one or both eyes. Twelve children had associated systemic findings, of which six were major and six were minor abnormalities. Information on consanguinity was available in 19 children, 12 of whom had consanguineous parents. Five children had a positive family history. Two mothers had a history of night blindness, and one had a history of pesticide exposure during pregnancy. High rates of consanguinity suggest a genetic recessive aetiology.