Hormone implants and tachyphylaxis

The serum oestradiol levels of 1388 women treated with hormone implants at a menopause clinic were reviewed in 1988. Thirty-eight (3%) were found to be above 1750 pmol/l. Of these 38 women with supraphysiological oestradiol levels 23 had started therapy for menopausal symptoms and 15 for the premenstrual syndrome (PMS). Of the 23 women treated for menopausal symptoms 11 had a history of psychiatric referral for depression and nine had undergone a surgical menopause. Nine of the 15 women with PMS had a history of psychiatric referral for depressive symptoms. We conclude that the women who attain supraphysiological levels of oestradiol on implant therapy have a high frequency of psychopathology or surgical menopause and may require higher oestradiol levels for adequate control of symptoms.

Descriptive analysis of the developmental progression of grip position for pencil and crayon control in nondysfunctional children

This study was designed to investigate the developmental progression in pencil and crayon grip. The subjects were 320 nondysfunctional children aged 3.0 to 6.11 years, with 20 boys and 20 girls at each 6-month age interval. On the basis of a review of the literature, developmental pencil and crayon grips were defined for the study, and the type of grips each child used to perform a drawing task and a coloring task were recorded. Many children at each age level used mature pencil grips. A developmental progression, however, was shown by the percentage change of children at each age level who used mature grips. Forty-eight percent of the youngest group used mature grips, compared with 90% of the oldest children. Two pencil grips-dynamic and lateral tripod-appear to be common in older children. Differences in the developmental progression of pencil grip were noted between boys and girls and between a drawing task and a coloring task.

Neonatal hormone manipulations and the maintenance of perineal muscles and their motor neurones in Albino Swiss rats

Newborn female Albino Swiss rats received testosterone propionate, dihydrotestosterone benzoate or oestradiol benzoate for 4 days after birth. The neonatal administration of all three hormones maintained neurones of the spinal nucleus of bulbocavernosus (SNB) complex in adulthood at levels intermediate between those found in normal females (approximately 40 neurones) and those found in normal males (approximately 220 neurones). Dihydrotestosterone benzoate was the most effective treatment. Oestradiol benzoate, while as potent as testosterone propionate in maintaining SNB neurone numbers, could not maintain the perineal muscles which are their normal target. Dihydrotestosterone benzoate and testosterone propionate maintained both neurones and muscles. Newborn male Albino Swiss rats received either the aromatase inhibitor 4-OH-androstenedione, or the 5 alpha-reductase inhibitor aza-steroid 17 beta-N,N-diethylcarbamoyl-4-methyl-4-aza-5 alpha-androstan-3-one(4-MA). Only neonatal treatment with 4-MA led to reduced SNB neurone numbers in adulthood, but the reduction was modest (-16%). The results of the two experiments suggest that several hormones can maintain SNB neurone numbers in Albino Swiss rats, but that 5 alpha-reduced metabolites of testosterone may be particularly effective.

Case registers

This article describes the important steps that need to be taken when introducing and operating a case register system. Emphasis is placed on the need for a system which is dynamic and pays as much attention to the organisation and communication with case managers, as to the collection of data about patients.

Changes in levels of c-myc and histone H2B following exposure of cells to low-frequency sinusoidal electromagnetic fields: evidence for a window effect

Human HL-60 cells were exposed for 20 min to an electromagnetic field at frequencies ranging from 15 to 150 Hz and at densities from 0.2 to 2.3 mT (2 to 23 gauss). Following each exposure, quantitative levels of c-myc and histone H2B transcripts were determined by dot-blot hybridization analyses and compared with unexposed control samples. The most pronounced increase in each transcript occurred after exposure at 45 Hz, with levels more than four times that found in unexposed controls.

Whole blood staining in suspension for nonspecific esterase and alkaline phosphatase analyzed with a Technicon H-1

We adapted previously published methods for nonspecific esterase and alkaline phosphatase staining of white blood cells in suspension for use on a Technicon H-1 hematology analyzer. The objective was to develop a semiautomated method using whole blood that could be employed on a large scale for hematology laboratory applications, including toxicology studies, measurement of neutrophil left shift, and cytochemical classification of myeloid leukemias. The nonspecific esterase method uses the pararosaniline stain, generating the unstable substrate from two stable precursors. Whole blood is added to the substrate plus dye mix. Next, acid lysis and fixation steps destroy red cells and stabilize the monocyte staining. The alkaline phosphatase stain employs a stable naphthyl phosphate substrate and fast blue B coupling dye. The red cells are lysed with a pH 10.3 propanediol buffer, and the white blood cells are then stabilized with formalin fixation. For both methods the staining is performed off-line, and the sample is then diluted with propanediol to match the refractive index of the sheath on the H-1 analyzer, before aspiration into the direct cytometry port. A cytogram of scattered versus absorbed light is obtained. The number of cells staining and the intensity of the stain can be quantified from the cytogram.

Exposure of human cells to low-frequency electromagnetic fields results in quantitative changes in transcripts

The exposure of human cultured cells to electromagnetic signals with extremely low repetition rates resulted in an increased level of selected RNA transcripts. RNA with homology to beta-actin, histone H2B, and v-myc DNA was monitored by dot blot hybridization following 20 min exposures of HL60 cells to five different electromagnetic signals. The experiments used three asymmetric electromagnetic signals with different repetition rates, and two symmetric sinusoidal signals, delivered at 60 and 72 Hz. The degree of increase in homologous transcripts was dependent on the signal characteristics.

A descriptive study of the clinical practice patterns of occupational therapists working with infants and young children

This investigation was designed to gather descriptive data on the clinical practice patterns of occupational therapists working with infants and young children. One hundred nineteen therapists entered the study, and 118 completed the interview, yielding a response rate of 99.4%. The therapists were highly experienced, with a mean of 9.47 years working in pediatrics. The school setting was the most common type of facility in which therapists served infants and young children and accounted for 37.3% of the sample. The majority of the respondents (67.8%) were members of formally identified teams. Although 80.5% of the therapists served very young children (aged birth to 12 months), no therapists served this population exclusively. Considerable variability in models of service provision, team structures, and assessment and treatment practices were found. Additionally, there was a lack of consensus on the unique contributions of occupational therapy and diverse opinions regarding the importance of selected frames of reference. Implications of the findings on professional initiatives to enhance practice are discussed.

Occupational therapy knowledge: from practice to theory. 1988 Eleanor Clarke Slagle lecture

This paper discusses the place of occupational therapy technology in practice and the growth of scientific technology. It is suggested that practice is an important source for the development of technological theory. A historical review of the treatment of hand dysfunction in cerebral palsy is presented as an illustration of the development of a specific occupational therapy technology.

The fetal femur/foot length ratio: a new parameter to assess dysplastic limb reduction

The relationship between growth of the fetal femur and foot length was examined between 14-40 weeks' gestation in 182 normal singleton pregnancies. A significant correlation was demonstrated (r = 0.98; P less than .0001). The femur/foot length ratio was found to be approximately 1 throughout this age range. The fifth and 95th percentile confidence intervals of the femur/foot length ratio versus gestational age were then defined. The femur/foot length ratio was also measured directly in 12 fetuses after second-trimester abortion; these measurements compared favorably with the ultrasound femur/foot length ratio nomogram. The discriminatory power of the femur/foot length ratio chart to differentiate fetuses with skeletal dysplasias from those with pseudo-limb reduction due to constitutional factors or intrauterine growth retardation (IUGR) was tested in 16 sequential cases with femur measurements below the fifth percentile. Two cases suspected of having symmetrical IUGR and five cases suspected of being constitutionally small were found to have femur/foot length ratios within the 90th percentile range. Limb reduction deformities were suspected in the nine remaining cases, and the femur/foot length ratios in these fetuses were all found to be less than the fifth percentile. The femur/foot length ratio nomogram appears to be a useful parameter to help differentiate fetuses that have dysplastic limb reduction from those whose limbs are short because of constitutional factors or IUGR.

Controlled trial of psychotherapy for bulimia nervosa

In a randomised controlled trial of different types of psychotherapy for bulimia 92 women were assigned to receive cognitive-behaviour therapy (n = 32), behaviour therapy (30), or group therapy (30) for 15 weeks and a further 20 (controls) assigned to remain on a waiting list for 15 weeks. Eating behaviour and psychopathology were assessed by standard methods. At the end of the trial the controls had significantly higher scores than the treated groups on all measures of bulimic behaviour. In terms of behavioural change all three treatments were effective, 71 (77%) of the 92 women having stopped bingeing. In addition, scores on eating and depression questionnaires were reduced and self esteem improved. Follow up was continuing, but of 24 women available at one year, 21 were not bingeing and had maintained their improved scores on psychometric scales. Bulimia nervosa is amenable to treatment by once weekly structured psychotherapy in either individual or group form.

Immortalization of human fibroblasts transformed by origin-defective simian virus 40

Simian virus 40 (SV40)-mediated transformation of human diploid fibroblasts has provided an effective experimental system for studies of both "senescence" in cell culture and carcinogenesis. Previous interpretations may have been complicated, however, by the semipermissive virus-cell interaction. In earlier studies, we previously demonstrated that the human diploid fibroblast line HS74 can be efficiently transformed by DNA from replication-defective mutants of SV40 containing a deletion in the viral origin for DNA synthesis (SVori-). In the current study, we found that such SVori- transformants show a significantly increased life span in culture, as compared with either HS74 or an independent transformant containing an intact viral genome, but they nonetheless undergo senescence. We have clonally isolated six immortalized derivatives of one such transformant (SV/HF-5). Growth studies indicate that the immortalized cell lines do not invariably grow better than SV/HF-5 or HS74. Genetic studies involving karyotypic analysis and Southern analysis of integrated viral sequences demonstrated both random and nonrandom alterations. All immortalized derivatives conserved one of the two copies of SV40 sequences which expressed a truncated T antigen. These cloned SV40-transformed cell lines, pre- and postimmortalization, should be useful in defining molecular changes associated with immortalization.

Malaria in Papua New Guinea. Implications for the British Army

Malaria poses the greatest health threat to British soldiers engaged in jungle training in Papua New Guinea. This paper provides detailed epidemiological information gained following a visit to the Papua New Guinea Malaria Research Unit in January 1986.

Hilar gland tuberculosis in Nepalese adults masquerading as malignant lymphoma

We report two Nepalese patients with tuberculosis, in whom the sole chest X-ray abnormality was hilar lymphadenopathy. This rare variant of tuberculosis, not previously described in Nepalese patients, may easily be mistaken for malignant lymphoma.

Children's skiing injuries in Australia

Skiing is one of the most popular winter sports for adults and children in Australia. While much is known about the epidemiology of skiing trauma in adults, little has been written about the patterns of skiing injury in children in Australia. During the 1984 ski season, the injuries and risk factors of 149 children were compared with those of 1093 adults who were injured over the same period. Although Australian children were found to be possibly less prone to injury than were adults, they did sustain more serious injuries, in particular, fractures of the tibia. The significantly different associated risk factors that are thought to be responsible were the greater number of children who were injured in collisions and ski-lift accidents, and inadequate bindings on their skis. Such shortcomings are correctable; children require better boot-bindings and greater supervision on the ski-slopes.

In vivo calibration of a transcutaneous oxygen electrode in adult patients

Transcutaneous oxygen tension (tcPO2) has been compared with arterial oxygen tension (PaO2 in 14 haemodynamically stable patients in an intensive care unit. Two calibration methods have been compared: (1) "In vitro" calibration, a two point calibration procedure carried out before attachment to the skin. (2) "In vivo" calibration, calibration using a single arterial sample, to recalibrate the upper point after attachment of the electrode to the skin and stabilisation of the electrical output. After "in vitro" calibration the regression equation was given by tcPO2 (mmHg) = 0.58 PaO2 + 13.4 (95% confidence limits +/- 19.6). After "in vivo" calibration, the regression equation for 55 comparisons over the range 50 to 120 mmHg was given by: tcPO2 (mmHg) = 0.98 PaO2 + 1.6 (95% confidence limits +/- 6.6). The "in vivo" calibration method therefore allows a close estimate of PaO2 to be made from tcPO2 values in adult patients providing strict operating criteria observed.

The malaria threat to the Army in Hong Kong

Changes in mosquito ecology and active anti-vector measures abolished endemic malaria transmission in Hong Kong by 1969. Unfortunately, endemic transmission of P. vivax reappeared in 1977. The threat posed to the British Army in Hong Kong however, appears to be small (5 cases since 1983), and restricted to areas close to the border with the Peoples Republic of China. Malaria biology and protective measures are discussed.

Heat illness. A report of 45 cases from Hong Kong

During the summer of 1985, 45 soldiers with heat illness were admitted to the British Military Hospital, Hong Kong. Twelve had severe heat stroke, the remainder heat exhaustion. This paper discusses the management and prevention of heat illness in the military context.

Characterization of the mechanical behavior of isolated papillary muscle preparations of the ferret

The characteristics of isometric and isotonic contraction were studied in isolated papillary muscle preparations from the right ventricle of the ferret and compared with those previously reported for comparable preparations from cat and rat. The effects of stimulation rate, temperature, extracellular calcium concentration, caffeine, verapamil, and ouabain were measured. Afterloaded contractions and load clamps were used to study the mechanics of relaxation. The contractile characteristics of ferret papillary muscle preparation appear to be intermediate in many respects between those reported for cat and rat preparations.

Polyresistant malaria in Gurkha soldiers returning from Papua New Guinea: treatment and prevention

Two company strength exercises to Papua New Guinea produced 21 malaria casualties of whom 16 had potentially fatal falciparum infections. The chemotherapy and prevention of polyresistant malaria from Papua New Guinea and the threat posed to the Hong Kong environment regarding malaria re-introduction are discussed.

Personal antimosquito measures plus proguanil for malaria prophylaxis in southern Malaysia

During the early months of 1985 and 1986, 408 non-immune British soldiers undertook training in the jungles north of Kota Tinggi, in southern Malaysia. In this geographical location, where malaria transmission is now light, a combination of strict personal antimosquito measures plus proguanil 200 mg daily produced effective, safe protection, with only a single case of vivax malaria occurring. Given the limited malaria risk, however, the results of this study should be extrapolated only with caution to other areas of Malaysia.

Failure of malaria chemoprophylaxis with a proguanil-chloroquine combination in Papua New Guinea

Proguanil 200 mg daily and chloroquine base 300 mg weekly were used as prophylaxis for 120 British Army soldiers from Hong Kong on a seven-week jungle exercise in the highly malarious Sepik district of Papua New Guinea. Compliance was rigidly enforced. Four men developed falciparum malaria whilst in Papua New Guinea and one within a few days of returning to Hong Kong. After stopping chloroquine four weeks after returning to Hong Kong 11 cases of mixed vivax and falciparum malaria and three cases of falciparum alone occurred within a 16-week period. This proguanil-chloroquine combination allows an unacceptably high level of breakthrough malaria and cannot be recommended for visitors to the highly malarious areas of Papua New Guinea.

Deletion in chromosome 11p associated with a hepatitis B integration site in hepatocellular carcinoma

Hepatitis B virus (HBV), a virus with known carcinogenic potential, integrates into cellular DNA during long-term persistent infection in man. Hepatocellular carcinomas isolated from viral carriers often contain clonally propagated viral DNA integrations. As small chromosomal deletions are associated with several types of carcinomas, the occurrence of chromosomal deletions in association with HBV integration in hepatocellular carcinoma was studied. HBV integration was accompanied by a deletion of at least 13.5 kilobases of cellular sequences in a human hepatocellular carcinoma. The viral DNA integration and deletion of cellular sequences occurred on the short arm of chromosome 11 at location 11p13-11p14. The cellular sequences that were deleted at the site of HBV integration were lost from the tumor cells, leaving only a single copy of the remaining cellular allele.

RNA-mediated gene duplication: the rat preproinsulin I gene is a functional retroposon

Rats and mice have two, equally expressed, nonallelic genes encoding preproinsulin (genes I and II). Cytological hybridization with metaphase chromosomes indicated that both genes reside on rat chromosome I but are approximately 100,000 kilobases apart. In mice the two genes reside on two different chromosomes. DNA sequence comparisons of the gene-flanking regions in rats and mice indicated that the preproinsulin gene I has lost one of the two introns present in gene II, is flanked by a long (41-base) direct repeat, and has a remnant of a polydeoxyadenylate acid tract preceding the downstream direct repeat. These structural features indicated that gene I was generated by an RNA-mediated duplication-transposition event involving a transcript of gene II which was initiated upstream from the normal capping site. Sequence divergence analysis indicated that the pair of the original gene and its retroposed, but functional, counterpart (which appeared about 35 million years ago) is maintained by strong negative selection operating primarily on the segments encoding the chains of the mature hormone, whereas the segments encoding the parts of the polypeptide that are eliminated during processing and also the introns and the flanking regions are evolving neutrally.

Electrocardiography and echocardiography in patients with chest pain and mitral leaflet prolapse

34 patients with catheter verified, haemodynamically trivial mitral leaflet prolapse with chest pain and normal coronary arteries were studied. Nineteen had no auscultatory signs of MLP despite clear catheter or echocardiographic evidence of prolapse. Infero-lateral repolarisation changes on the resting electrocardiogram were present in 29%. 50% had false positive exercise tests. M-mode echocardiography proved diagnostically disappointing but sector scans revealed mitral leaflet prolapse in 62%. The apical 4 chamber acoustic window was markedly superior to the parasternal long axis acoustic window.

Frequency distribution and 95% range of a variety of commonly measured blood constituents in healthy Nepalese donors

The most frequently measured biochemical and haematological blood constituents were assayed in 431 healthy Nepalese blood donors. As only 19 subjects were female analysis of their data was confined to calculation of the geometric mean. For the 412 males frequency distribution, geometric mean and 95% range were calculated for each constituent. Male and female male values were compared. It is hoped that 95% normal ranges might provide a better standard against which to compare data from Nepalese patients than the previously used reference ranges derived from ethnically different populations.

Cardiac effects of sodium stibogluconate

Sodium stibogluconate although potentially cardiotoxic is the drug of choice for Kalaazar and cutaneous leishmaniasis due to Leishmania braziliensis. Increasing use of this drug in the British Army has necessitated a formal evaluation of its cardiac side-effects. Consequently a detailed study of the cardiac effects of sodium stibogluconate was undertaken in 22 male soldiers using for the first time modern non-invasive techniques. Intravenous sodium stibogluconate 600 mg daily for 10 days did not affect blood pressure, heart rate, left ventricular contractile function or rhythm. Electrocardiography showed a reversible reduction of T wave amplitude.

Severe tetanus complicating an open femoral fracture successfully managed using intrathecal human tetanus immunoglobulin and external fixation

We report here a case of severe tetanus, complicating a compound fracture of the femur, successfully managed without intensive care facilities, using intravenous sedation and intrathecal Human Tetanus Immunoglobulin (HTI). Substitution of conventional traction (Transtibial Steinman Pin and Thomas Splint) for a Day Frame External Fixation Device (EFD) provided excellent fixation and stability of the fracture in spite of severe tetanic spasms.

Typhoid masquerading as Japanese encephalitis

We describe a variant of typhoid which was clinically indistinguishable from Japanese Encephalitis (JE). The strongly encephalitic presentation led to a potentially serious delay in starting specific antibiotic therapy. Awareness of the usual form of typhoid is of great importance to Army doctors because of the presence of British soldiers and families in the Dharan area of southern Nepal where both typhoid and JE are endemic.

Immunisation against Japanese encephalitis in Nepal: experience of 1152 subjects

During the summer of 1983, 1152 subjects were immunized against Japanese Encephalitis at BMH Dharan. This was the first use of the BIKEN killed lyophilised vaccine in the British Army. Three doses of 1 ml (0.5 ml for children under 3 years) given 10 days apart produced a protective neutralizing antibody response (titre more than 1:10) in almost 90% of subjects. Two doses of vaccine however seemed inadequate in that less than 40% of subjects seroconverted. Side-effects were minimal and trivial. Studies of neutralizing antibodies before vaccination showed up to 30% of Nepalese subjects tested were already immune due to previous inapparent infection while all but one of the British Nationals were fully susceptible.

Ferritin levels in patients with microcytic anaemia complicating pulmonary tuberculosis

In a sample of 33 Nepali patients with microcytic, hypochromic anaemia complicating pulmonary tuberculosis, only 15% were iron deficient as judged by absence of stainable bone marrow iron. Individual ferritin levels in the iron deficient subjects were all within the normal range, although as a group their mean ferritin was significantly lower than in the non-iron deficient patients (104 micrograms/l v 349 micrograms/l p less than 0.05). It is suggested that in pulmonary tuberculosis ferritin synthesis is stimulated by the inflammatory process regardless of iron status and that the level of ferritin below which iron deficiency may be diagnosed is much higher than the accepted level of 15 micrograms/l.