Neonatal cleft lip repair: a retrospective review of anaesthetic complications

A retrospective analysis of the first 50 cases of neonatal cleft lip repair performed at the Hospital for Sick Children is presented. The patient population included 11 expremature infants of less than 45 weeks postconceptual age. There was no mortality at the time of follow-up. There was one case of peroperative hypoxaemia. There was one case of postoperative laryngospasm requiring reintubation. Postoperatively there were four cases of mild hypoxaemia and one patient with transient apnoea. No patients required blood transfusion. Seventy-six percent of patients did not require opioid analgesia. The remainder received a single dose of intramuscular codeine phosphate. The advantages and risks of anaesthesia for cleft lip in the neonatal period are reviewed. Recommendations for safe practice include the selection of gestationally mature infants with no intercurrent illness, avoidance of opioid analgesia, adequate staffing ratios of experienced postoperative nursing care, appropriate monitoring including oximetry and apnoea detectors.

Evidence that glyceraldehyde-3-phosphate dehydrogenase is involved in age-induced apoptosis in mature cerebellar neurons in culture

Under typical culture conditions, cerebellar granule cells die abruptly after 17 days in vitro. This burst of neuronal death involves ultrastructural changes and internucleosomal DNA fragmentations characteristic of apoptosis and is effectively arrested by pretreatment with actinomycin-D and cycloheximide. The level of a 38-kDa protein in the particulate fraction is markedly increased during age-induced cell death and by pretreatment with NMDA, which potentiates this cell death. Conversely, the age-induced increment of the 38-kDa particulate protein is suppressed by actinomycin-D and cycloheximide. N-terminal microsequencing of the 38-kDa protein revealed sequence identity with glyceraldehyde-3-phosphate dehydrogenase (GAPDH). A GAPDH antisense oligodeoxyribonucleotide blocks age-induced expression of the particulate 38-kDa protein and effectively inhibits neuronal apoptosis. In contrast, the corresponding sense oligonucleotide of GAPDH was completely ineffective in preventing the age-induced neuronal death and the 38-kDa protein overexpression. Moreover, the age-induced expression of the 38-kDa protein is preceded by a pronounced increase in the GAPDH mRNA level, which is abolished by actinomycin-D, cycloheximide, or the GAPDH antisense, but not sense, oligonucleotide. Thus, our results suggest that overexpression of GAPDH in the particulate fraction has a direct role in age-induced apoptosis of cerebellar neurons.

Depression in life-threatening illness and its treatment

Health-care professionals may feel at a loss when caring for the individual faced with a life-threatening illness who is also depressed, and may even consider that depression in such circumstances is inevitable. Assessment of the individual's mental state may be made difficult by physical symptoms and other factors, meaning that the individual does not always receive the necessary care. This paper hopes to show how simple, humanistic nursing interventions may help to improve the quality of life of such individuals.

Encouraging patients to take part in their own care

The patient is now being seen as a consumer of health care and as having certain rights. At the same time, the development of primary nursing and nursing theories, with their basis in the ethos of self-care, is also encouraging patient participation in decision-making and care-giving with the results that it is now viewed as being essential in providing individualised nursing care in the 1990s. This paper discusses some of the issues.

Cloning and expression of a rat placental cDNA encoding a novel cathepsin L-related protein

Cathepsin L is a major lysosomal cysteine protease produced by mouse placenta and fibroblasts. This study characterizes a novel cathepsin L-related mRNA expressed in rat placenta. Immunological and nucleotide screening of a rat placenta library identified six positive clones, the largest, pCLRP-9, being 924 base pairs in length. The combined sequences of all the clones contain an open reading frame of 711 nucleotides, a termination codon, a polyadenylation site, and 197 nucleotides of 3' untranslated region, but lack the 5' translation initiation codon. The pCLRP nucleotide sequence showed 60-64% identity to those of mouse, rat, and human cathepsin L. The deduced amino acid sequence of pCLRP codes for 237 amino acids, which align with the carboxy-terminal sequence of cathepsin L and has the active site residues characteristic of the cysteine protease family. Northern blot analysis showed hybridization of pCLRP with a major mRNA transcript of 1.3 kilobases expressed in placenta, but not kidney or liver. In contrast, a cDNA for mouse pro-cathepsin L hybridized with a transcript of 1.7 kilobases expressed in rat kidney, as well as placenta. During late gestation, steady-state levels of rat placental pCLRP mRNA were highest on day 18, whereas those of mouse procathepsin L were greatest on day 20 of gestation. Antiserum to mouse cathepsin L cross-reacted with four proteins of molecular weights 36,000 to 42,000 in rat placental culture medium, of which two were absent in the kidney. These data indicate that rat placenta expresses several species of cathepsin L-type proteins, which may be involved in placental function and nutrient supply.

An inexpensive device for perioperative positioning of pediatric patients

Intraoperative positioning of the pediatric patient during venous access procedures is crucial. Currently such patients are positioned with a sandbag beneath the shoulders and in a head-down position. This has significant limitations because the bag must be removed for subsequent on-table radiography. The authors have devised a simple inexpensive technique that obviates this need and facilitates the procedure. They have used the device in over 80 patients undergoing venous access. No problems relating to the device have been noted, and on-table x-rays are readily facilitated.

The epidemiology of dementia: GMS-AGECAT studies of prevalence and incidence, including studies in progress

The paper reviews the main studies using the AGECAT computerised diagnostic system for the diagnosis of dementia in community studies of prevalence and incidence. It is suggested that variations in reported rates may be due to the use of unstandardised methods, and the paper reviews the oldest established standardised interview: the Geriatric Mental State. The AGECAT system is outlined, and the studies of its diagnostic validity indicated. Arguments are presented against the inclusion of cognitive tests in such instruments, and for the critical evaluation of the concepts of mild dementia. The use of AGECAT in the US/UK Diagnostic Project, and in the Liverpool study of Continuing Health in the Community is described. In addition, preliminary information is given on the Liverpool ALPHA study, the MRC UK multi-centre study, studies organised by the Pan American Health Organisation (Argentina, Chile, Cuba), the Eurodem concerted action (based in Rotterdam) and the WHO multi-site studies. Individual studies in Spain and Portugal are also discussed.

Improvement of platelet counts in steroid-unresponsive idiopathic immune thrombocytopenic purpura after short-course therapy with recombinant alpha 2b interferon

In 13 patients with severe steroid-refractory idiopathic immune thrombocytopenia (ITP), a short course of recombinant alpha 2b interferon (IFN), given at a dose of 3 MU for 12 doses, caused a significant increase in platelet count in 11 patients. The rise in platelet count occurred following completion of the short course of IFN in 10 patients and occurred during therapy in one patient. Three patients showed an increase to normal platelet counts within 14 days of discontinuing the drug, eight showed a partial response, with a platelet count increase from 30 to 100 x 10(9)/L, and two patients showed minimal response. One complete responder relapsed at 5 months from initial response, and a further course of alpha 2b IFN caused a second prompt response with a rise of platelet count to supranormal levels. Short-course alpha 2b IFN can be recommended as a therapy for severe ITP. Responses are seen in splenectomized and nonsplenectomized subjects, and thrombocytopenia is not exacerbated during treatment.

A comparative study of combination chemotherapy versus marrow transplant in first remission in adult acute lymphoblastic leukaemia

The results of conventional chemotherapy in adult acute lymphoblastic leukaemia (ALL) have not improved substantially in recent years. The present study is based on a flexible policy of marrow transplantation (allograft and autograft without marrow purging) in first remission compared with a group treated with standard maintenance therapy after a common induction sequence. The actuarial disease free survival (DFS) and actuarial overall survival (OS) at 3 years for autologous marrow grafted patients was 30% and 65% respectively. The allogeneic transplant group had DFS of 30% and OS at 3 years of 38% compared with DFS (12%) and OS (12%) for patients on 6-mercaptopurine and methotrexate maintenance. The actuarial disease free survival calculations include patients on protocol not entering remission, therefore, giving the worst possible result. We conclude that high dose chemo/radiotherapy with autologous marrow rescue in first remission followed by no maintenance provides better results in terms of overall survival and quality of life than standard ALL maintenance in adult patients. Results for allogeneic transplant in ALL are less good in terms of duration and quality of survival and the majority of deaths are related to causes other than leukaemic relapse.

Inhibitors of inosinate dehydrogenase

Inosinate dehydrogenase (IMP-dehydrogenase) from Chinese Hamster Ovary cells was found to be inhibited by two types of inhibitors. One type of inhibitor binds competitively at IMP-binding site and other type at NAD-binding site of the enzyme. Some new inhibitors of both classes have been illustrated here and their inhibition constants and type of inhibition determined. NAD-analog of tiazofurin was found to bind with both the sites and this type of inhibitors were found to be non-competitive with IMP and NAD.

A new paradigm for evolution

Standard evolutionary theory sees little beyond the natural selection of random variation. Yet there is more to life.