Totally implantable venous access systems in paediatric practice

Forty seven totally implantable venous access systems have been inserted in 45 patients for the management of malignant disease (n = 29), haematological disorders (n = 5), and cystic fibrosis (n = 11). We report our experience with them and discuss the problems we have encountered during the past three years.

Home intravenous antibiotic treatment in cystic fibrosis

The prognosis for patients with cystic fibrosis who are colonised with Pseudomonas aeruginosa has improved as a result of the regular use of intravenous antibiotics; however, this necessitates long periods of hospitalisation. Home intravenous antibiotic treatment has potential advantages over hospital treatment. We describe our experience during the first 20 months of using a system of home intravenous antibiotic treatment in which a cystic fibrosis liaison sister has an essential role. Thirteen patients have received 40 courses of treatment. There were highly significant improvements in weight, respiratory function, and white cell count during home treatment. There was no significant difference in weight and forced expiratory volume in one second between the end of home treatment and the end of hospital treatment while forced vital capacity was better after home treatment. All patients preferred home treatment. The advantages of home visits by the cystic fibrosis liaison sister during treatment are emphasised.

Comparison of four pancreatic extracts in cystic fibrosis

Four different pancreatin products, Pancrease, Creon, Pancrex V Forte, and Pancreatin Merck, were compared in a random crossover trial in children with cystic fibrosis. The results of our study showed that patients who received Creon and Pancrease had fewer gastrointestinal symptoms than patients who received Pancrex V Forte and Pancreatin Merck. Fat absorption was significantly improved with Pancrease when compared with Pancrex V forte and Pancreatin Merck. Also the fat absorption with Creon was superior to that with Pancrex V Forte. There was no significant difference in fat absorption between Pancrease and Creon. Pancrex V Forte and Pancreatin Merck, or Pancreatin Merck and Creon. Faecal nitrogen content was less with both Creon and Pancrease compared with Pancreatin Merck. Creon and Pancrease allow the patient with cystic fibrosis to take a high energy diet without any dietary restrictions.

gamma-Aminobutyric acid receptor complex of insect CNS: characterization of a benzodiazepine binding site

The specific binding of [N-methyl-3H]flunitrazepam ([3H]FNZP) to a membrane fraction from the supraoesophageal ganglion of the locust (Schistocerca gregaria) has been measured. The ligand binds reversibly with a KD of 47 nM. The binding is Ca2+-dependent, a property not found for the equivalent binding site in vertebrate brain. The pharmacological characteristics of the locust binding site show similarities to both central and peripheral benzodiazepine receptors in mammals. Thus binding is enhanced by gamma-aminobutyric acid (GABA), a feature of mammalian central receptors, whereas the ligand Ro 5-4864 was more effective in displacing [3H]FNZP than was clonazepam, which is the pattern seen in mammalian peripheral receptors. The locust benzodiazepine binding site was photoaffinity-labelled by [3H]FNZP, and two major proteins of Mr 45K and 59K were specifically labelled. In parallel experiments with rat brain membranes a single major protein of Mr 49K was labelled, a finding in keeping with many reports in the literature. We suggest that the FNZP binding site described here is part of the GABA receptor complex of locust ganglia. The insect receptor appears to have the same general organization as its mammalian counterpart but differs significantly in its detailed properties.

Computed tomography of rib hemangiomas

Hemangiomas of the rib may have confusing plain film findings. These tumors may be single or multiple and may remain stable or increase in size. The CT examinations reveal an expanded cortex and bone destruction with irregular trabeculation. An adjacent soft tissue mass may be present but pleural fluid is characteristically absent.

Role of the supraoptic decussation in the development of asymmetry of brain function in the chicken

The supraoptic decussation plays an important role in the development of asymmetry of brain function for visual discrimination learning in the chicken. Lesioning the decussation on day 2 has no effect on the asymmetry normally revealed by unilaterally treating either the left or right forebrain hemisphere with cycloheximide on day 4 of life. However, the lesion removes the asymmetry revealed by cycloheximide treatment on day 8 and reverses that revealed by treatment on day 10, albeit to a lesser extent. The asymmetry of learning performance between the left and right eyes present in untreated chickens tested monocularly in the second week of life is also removed by lesioning the supraoptic decussation. Thus, in the first week of life functional asymmetry is present but not dependent on left-to-right side coupling via the supraoptic decussation. The difference between lesioning during the first and second week of life may relate to the relative degree of maturation in the supraoptic decussation.

A therapeutic feeding programme. II: Links with language and learning

The feeding programme described in Part I of this study produced immediate change in the eating patterns of disturbed children, who then became available for learning and language development in a way they had not been previously. The authors give a broad outline of the principles and practice of functional learning, and the educational technique they used. They describe the language development of one child in detail, and the methods used. Follow-up details are also given for the three children described in Part I of the study.

A therapeutic feeding programme. I: Theory and practice of feeding

Feeding problems are often commented on in the literature, but very little has been reported on the systematic examination of these problems. In the present study feeding disturbances were treated as part of a full diagnostic and treatment programme for disturbed children in a small residential psychiatric unit. The feeding programme was based on the early work of Clancy and colleagues in Australia, and consisted of offering the child food in a set situation by the same 'feeder'. A one-way screen was used for observation and video-recording. Three children are described in detail, and a striking effect was the immediacy of change in their feeding disturbances. It is stressed that early feeding difficulties of disturbed children can give rise or contribute to ever-widening faulty development.

Juvenile xanthogranuloma of the testis

A 7-month-old boy presented with numerous xanthomatous skin lesions and a hard irregular swelling of the right testis. Clinically, the testicular lesion was impossible to distinguish from a malignant neoplasm. Histological examination of a skin biopsy and of the testis following orchiectomy showed lesions typical of juvenile xanthogranuloma.

Complement-activating immune deposits in systemic lupus erythematosus skin

Immune deposits at the cutaneous basement membrane zone are a characteristic feature of systemic lupus erythematosus. Previous studies using immunofluorescent methods to detect complement components have provided evidence that some deposits contain immune complexes capable of activating complement. However, this important biologic property of complexes has not been detected or measured using functional assays, and it has not been determined whether immune deposits can activate complement at the basement membrane zone. In this study immune deposits in biopsies of lupus skin have been examined using direct immunofluorescence for the third component of complement (C3) to detect complement deposited in vivo. In addition, the deposits have been studied using the leukocyte attachment assay and indirect C3 binding immunofluorescence to detect and measure complement activation at the basement membrane zone in vitro. The results show that complement activation occurs at the basement membrane in some but not all lupus skin containing immunoglobulin deposits, that deposits differ quantitatively in their ability to activate complement, and that direct C3 immunofluorescence is a relatively insensitive method for detecting complement-activating complexes. The results provide functional evidence suggesting that immune deposits in some lupus skin are complement-activating complexes and potentially capable of activating complement at the basement membrane in vivo. Furthermore, the results suggest functional assays for evaluating complement-activating complexes may be valuable supplements to immunofluorescence in exploring the relationship between immune deposits and systemic and cutaneous disease.

Double immunofluorescence microscopy: a method for localizing immune deposits in skin diseases associated with linear basement membrane zone immunofluorescence

Direct immunofluorescence microscopy has shown that a linear pattern of immunoglobulin and/or complement deposition at the cutaneous basement membrane zone is a characteristic feature in a number of acquired bullous diseases and is occasionally observed in systemic lupus erythematosus. Immunoelectron microscopy has shown the linear pattern of immunofluorescence may be produced by immune deposits located either above the basal lamina (in the lamina lucida) or below the basal lamina (in the upper dermis). Distinguishing between these sites of immune reactant deposition may be of value in differential diagnosis. In this study we report a double immunofluorescent method by which skin biopsies with linear IgG immunofluorescence due to deposits above the basal lamina (bullous pemphigoid) could be distinguished from biopsies with deposits beneath the basal lamina (bullous systemic lupus erythematosus and epidermolysis bullosa acquisita). When skin sections were treated sequentially with rhodamine-labeled anti-human IgG followed by fluorescein-labeled antilamina lucida (pemphigoid) antibody and examined by fluorescence microscopy, the following results were obtained. In biopsies with IgG deposits in the lamina lucida, a single green fluorescent band was observed. In tissues with subbasal lamina deposits, either parallel and contiguous bands of green and yellow-orange fluorescence or a single band of yellow-orange fluorescence was observed. The method is simpler, quicker, and less expensive than immunoelectron microscopy and should be a useful technique for evaluating skin diseases with linear immunofluorescence at the basement membrane zone.

Clinical comparison of high-speed rare-earth screen and par-speed screen for diagnostic efficacy and radiation dosage

One hundred patients underwent excretory urography and a comparison was made of ten-minute, well-collimated images that were obtained with both par-speed and rare-earth screens, the latter being 6.5 times faster than the par-speed calcium tungstate screens. Radiation dose was greatly reduced with the rare-earth screens. There were fewer inferior examinations, even though fine detail was imaged poorly, and there was a slightly increased quantum mottle, which was only a minor problem at this low 65 kVp. Since quantum mottle increases with kVp, however, our results are not applicable to higher kVp examinations. Despite reduced detail and increased mottle, the overall image quality obtained with the rare-earth screen was superior to the image quality obtained with the par-speed screen.

Effect of cross-bridge kinetics on apparent Ca2+ sensitivity

Three different ways of shifting the pCa/tension curve on the pCa axis have been studied and related to changes in the rate constants of the cross-bridge cycle. The curve midpoint shifts to higher pCa's when the substrate (Mg-ATP) is reduced from 5 to 0.25 mM, when the phosphate concentration is reduced from 7.5 mM to 0, and when the ionic strength is reduced from 0.200 to 0.120. The Hill coefficients of the pCa/tension curve in our standard saline (5 mM substrate, 5 mM free ATP, 7.5 mM phosphate, ionic strength 0.200, 15 degree C) are between 5.1 and 5.6 and fall to 3.0 with the left shift of the curve brought about by reducing both substrate and phosphate. Left shifts of the curve produced by reduction in the ionic strength do not result ina lower Hill coefficient. Reducing eigher substrate or phosphate is associated with a reduction in the optimal frequency for oscillatory work, but reduction in ionic strength is not so associated. Maximum tension increases with the left shift of the curve brought about by reducing phosphate concentration or ionic strength, but tension decreases with the left shift of the curve accompanying substrate concentration reduction in phosphate-free saline. We argue that one mechanism for the observed shift of the curve along the pCa axis is the relationship between the time a cross-bridge takes to complete a cycle and the time Ca2+ stays bound to troponin C (TnC). If the cycle rate is decreased, a smaller fraction to TnC sites must be occupied to keep a given fraction of cross-bridges active. To illustrate this concept, we present a simplified model of the cross-bridge cycle incorporating the kinetics of Ca binding to TnC.

Renal failure induced by contrast material

Transitory and occasionally irreversible renal failure secondary to parenterally administered iodinated contrast material is now well documented. Diabetes and pre-existing renal insufficiency are the two most important risk factors. Intravascular contrast examinations should be avoided whenever possible in high-risk patients, particularly diabetics with creatinine levels of 5 dl./ml. or higher. Alternative methods for the etiologic evaluation of renal failure or hematuria are suggested.

Sarcoidosis and mediastinal emphysema

Mediastinal emphysema developed in a 13-year-old boy with diffuse interstitial pulmonary disease, later proved to be sarcoid. No previous report was found.

Current concepts of treating vaginitis

Vaginitis can be a frustrating entity to treat, since the incidence of recurrence is high. This paper examines evidence from the literature concerning diagnosis and treatment of Candida albicans, Trichomonas vaginalis, Corynebacterium vaginale, herpes simplex type 2 and gonorrhea. A protocol based on these readings is outlined.

Pathogenesis of an unexpected sudden death: role of early cycle ventricular premature contractions

A 61 year old man who had been studied extensively died unexpectedly ("instantaneously") outside the hospital while wearing an electrocardiographic recorder. Death was caused by ventricular fibrillation, which was initiated by an early cycle ventricular premature contraction occurring in the vulnerable period of repolarization. Such early cycle ventricular premature contraction had been noted in recordings 4 years previously but had never been observed to encroach on the T wave until 5 minutes before death. In the intervening period, the patient had shown increasing evidence of myocardial ischemia and hypertrophy and congestive heart failure, which had been partly obscured by his concealment or denial of symptoms and refusal to change his pattern of activities. Autopsy revealed two old myocardial infarcts and pronounced left ventricular hypertrophy. There was advanced occlusive arteriosclerosis of the major coronary vessels with a recent thrombus in the right coronary artery.

On the evaluation of medical students in radiology

What a medical student has learned in radiology needs to be evaluated, not only to appraise the student's mastery of the subject but to determine the efficiency of teaching methods. A two-phase written/oral test for all students completing the fourth-year elective is described.

Participation of ethylene in common purslane response to dicamba

The responses of common purslane (Portulaca oleracea L.) plants to 2-methoxy-3,6-dichlorobenzoic acid (dicamba) were found to be similar in many respects to ethylene fumigation effects. Dicamba and ethylene increased the permeability of cell membranes in purslane tissues. An increased efflux of electrolytes was observed in the bending region of the stems of dicamba-treated plants. Epinastic leaves after dicamba (10 micrograms) and ethylene (microliter per liter) treatments showed an increased efflux of rubidium. The permeability effects were observable within 1 day after dicamba or ethylene application. Protein metabolism in purslane leaves was not influenced by dicamba until 2 days after treatment, as indicated by reduced nitrate reductase activity. Inhibition of phenylalanine-U-(14)C incorporation into protein was observed 3 days after treatment. Ethylene reduced both phenylalanine-U-(14)C incorporation into protein and nitrate reductase activity within 1 day. Dicamba caused a rapid increase in ethylene production in purslane plants to levels many times greater than those observed in untreated plants. It was concluded that the dicamba-enhanced production of ethylene is responsible for many of the observed effects of the herbicide.