Extremes of foetal birthweight for gestation in infants of diabetic mothers

100 patients were registered at the Diabetic Clinic in 1981, where they were managed by a team of physician, obstetrician and paediatrician, based on a preset protocol. Only 92 patients were eventually analysed. The study showed a 1.3% incidence of pregnancies complicated by diabetes mellitus. The mean birthweights of infants of both gestational and established diabetics were heavier than that of the general population by race and gestation. 25% of the 92 infants of diabetic mothers have birthweight exceeding the 90th centile of population. Further division of the 92 patients into the "true gestational" diabetics, as shown by an oral glucose tolerance test performed 6 weeks post-natally, also showed a 25% incidence of macrosomia. Late antenatal booking, delayed detection of abnormal glucose tolerance and treatment attributed to the high incidence of macrosomia. Only one infant had birthweight below the tenth centile. There were no perinatal mortality in the 92 patients studied. Macrosomia is a common complication in infants of diabetic mothers despite a physician-obstetrician joint-care system. Also, the risk of having macrosomia amongst gestational diabetics is high.

Combined team management of diabetes mellitus in pregnancy

225 women with diabetes in pregnancy were managed by a team of obstetricians, physicians (endocrinologists) and paediatricians from the National University of Singapore. A protocol of management was formulated and followed. The incidence of 1.1% or 1 in 90 pregnancies was found, with significantly higher incidence in Indians and lower in Malays. There were 37 established diabetics and 188 diagnosed during pregnancy. Of these (188), 74 were gestational diabetics. All the women were treated with Insulin and Diet or Diet alone. 177 (79%) were treated with Insulin and Diet. Blood sugar profiles were done for monitoring diabetic control. 72.8% of the women were between para 0 and 1 and 85.2% between the ages of 20 and 34. 72.5% of the women delivered at 38 weeks gestation or later. 48.9% went into spontaneous labour, 32.4% were induced and 18.7% had elective caesarean section. 62.2% of the women had labour of less than 12 hours. The overall caesarean section rate was 41.7%. There were 3 stillbirths and 2 neonatal deaths. The perinatal mortality rate was 2.2%. Thirteen babies had congenital malformations (5.8%). 77.8% of the babies had Apgar score of 7 or more at 5 minutes after delivery. 79.1% of the babies weighed between 2.5 kgm and 3.9 kgm. Pre-eclamptic toxaemia was the commonest complication in pregnancy followed by Urinary Tract Infection and Polyhydramnios. Postpartum complications in the mother were confined to 14 women (6.2%), and wound infection or breakdown was the commonest cause.

Two brains, one child: interhemispheric information transfer deficits and confabulatory responding in children aged 4, 7, 10

In an investigation of developmental trends in the ability to transfer information between the cerebral hemispheres, 138 children, ages 4, 7, and 10, viewed pictures presented to either the right or left hemisphere and were asked to describe what was viewed. Responses were socored for the number of accurate pictorial features reported (inclusion score), confabulation (erroneous embellishment), perceptual, semantic, and syntactic errors. Misses (failure to provide a response) were also noted. A preponderance of errors were found, such that 4-year olds engaged in a significant degree of confabulatory responding following right vs. left presentation. A significant inverse relationship was found between inclusion and confabulation such that the larger the gap in information reported the greater was the tendency to insert (confabulate) erroneous material. In addition, all children were given a tactile-shape recognition task employing both transfer and non-transfer conditions and requiring tactile exploration and visual recognition. Significantly more errors were found on the transfer vs. non transfer task among the 4-year olds only. In that deficits in information transfer were not complete but only partial, and given that significant intra-hemispheric (non-transfer) errors were also discovered, it was concluded that the hemispheres of children age 4 are not completely but only partially disconnected, and that intra-hemispheric (cortical) immaturity plays a significant role in the production of processing deficits.

An evaluation of tamoxifen as a partial agonist by classical receptor theory--an explanation of the dual action of tamoxifen

Tamoxifen is known to have both agonist and antagonist properties. Classical receptor theory predicts that given the relative concentrations of a partial agonist and full agonist acting on the same receptor, the partial agonist may reduce the effect of the full agonist. The immature rat uterine model is an excellent system to evaluate the interactions of estradiol and tamoxifen by application of receptor theory. Using this model, tamoxifen demonstrates both additive and antagonistic effects to estradiol in the fashion predicted by theory. The effects of tamoxifen are additive at low doses of estradiol and antagonistic over higher estradiol doses. It is possible that the dualism of agonism and antagonism seen in other target organs and species is a function of these basic characteristics of a partial agonist.

Perinatal risk factors for necrotizing enterocolitis

The perinatal histories of 50 very low birthweight infants weighing 1500 g, or less, with necrotizing enterocolitis were compared with those of the remaining 325 very low birthweight infants who were admitted to this hospital during a four year study period. Many factors previously reported to be associated with necrotizing enterocolitis were found with equal frequency in both groups of babies. The only adverse factor which was more frequently present in patients with necrotizing enterocolitis was hypothermia on admission to hospital. Those infants who developed severe necrotizing enterocolitis also had a higher incidence of polycythaemia. A further controlled study which examined feeding practices showed that the timing, type, and volume of milk feeding were not different in infants with necrotizing enterocolitis and matched controls. Prematurity is clearly the greatest risk factor which predisposes to the development of necrotizing enterocolitis and most of the factors previously implicated in the aetiology may simply represent the descriptive characteristics of a population of sick, very low birthweight infants.

Necrotizing enterocolitis in very low birthweight infants: a four-year experience

Fifty (13%) of 375 infants who weighed 1500 g or less at birth had necrotizing enterocolitis (NEC). Haematological changes suggestive of sepsis occurred in 83% and positive bacteriological cultures were found in 38%, the most common organism isolated being Clostridium perfringens. Complications included intestinal perforation in six patients and recurrence of NEC in five, of whom one subsequently developed an intestinal stricture. Five of the eight nursery deaths were secondary to peritonitis and overwhelming sepsis from NEC. In spite of the discontinuation of milk feeds for prolonged periods, satisfactory caloric intake and weight gain were achieved with parenteral nutrition in the survivors. Of the 41 long-term survivors, six (15%) were found to have a disability at 2 years of age, corrected for prematurity, compared with 48 (20%) of 241 very low birthweight survivors from the same study period who did not have NEC. None had evidence of gastrointestinal dysfunction. Six (15%) children remained below the 10th percentile for both weight and height. This study showed that early diagnosis and therapy for NEC in very low birthweight infants were associated with a favourable short- and long-term outcome.

Erythrocyte choline concentrations and cluster headache

Erythrocyte choline concentrations were measured in patients with cluster headache and age related control subjects. Concentrations were significantly reduced in the patients with headache both during a cluster period and between clusters, being 58% and 55% of the control value, respectively. After two weeks' treatment with lithium, choline concentrations in the patients with cluster headache increased to 78 times the control value (mean 369.2 mumol/l (3840 micrograms/100 ml) compared with 4.7 mumol/l (49 micrograms/100 ml]. The presence of depressed erythrocyte choline concentrations during and between cluster attacks indicates that this may be a predisposing condition which results in a cluster attack only when associated with a trigger factor.

Single endometrial aspiration for determination of ovulation

The possibility of utilizing a single endometrial aspiration for the determination of ovulation was explored and compared with endometrial histology, serial vaginal cytology and plasma progesterone. A total of 180 women with normal, regular cycles and no pelvic pathologic conditions were studied. A correlation of 90.5% was observed between aspiration smears and histology. Vaginal cytology and histology agreed in 71.7% of the cases, while plasma progresterone and endometrial histology correlated in 95% of the women. Endometrial aspiration appeared to be an accurate, quick, inexpensive, convenient and a one-time method, which could be repeated in successive cycles without any patient discomfort.

Parental age and birth order in Chinese children with congenital heart disease

Parental age and birth order were studied in 100 Chinese children with congenital heart disease (proven by cardiac catheterisation) and in 100 controls. A higher incidence of congenital heart disease was present in the children with higher birth orders. No relationship was found between the incidence and the paternal or maternal ages. Using the method of multiple regression analysis this birth order effect was significant (p less than 0.01) and independent of parental age. This finding provides indirect evidence of environmental influence in the causation of congenital heart disease, which is known to be inherited in a multifactorial manner. Family planning to limit the size of the family may possibly contribute to the reduction of the incidence of congenital heart disease.

Purification and properties of extracellular xylan hydrolases of Streptomyces exfoliatus

Fractionation of extracellular xylan hydrolases of a strain of Streptomyces exfoliatus MC1 (by salting out, molecular sieving and ion exchange chromatography) revealed the presence of five species of the enzyme. Three major fractions could be purified to homogeneity; two were apparently endohydrolases and the third an exo-xylan hydrolase. The three fractions showed different degrees of affinity to the substrate and differed considerably in their substrate specificities. One of the endo-enzymes was specific to xylan while the other could also attack cellulose, inulin and pectin. The exo-enzyme showed xylanolytic and cellulolytic functions only. The three fractions further differed in their response to the presence of metal ions, mercapto reagents and compounds. Although the pH and temperature optima were different, the three fractions functioned synergistically in the hydrolysis of xylan.

The neuropsychology of development hemispheric laterality, limbic language, and the origin of thought

Discussed evidence and assumptions that concern hemispheric laterality and asymmetrical functional representation. It is hypothesized that the asymmetrical linguistic-motor vs. sensory-spatial-affective representation of function may be a result of differential rates of cortical, subcortical and spinal motor-sensory maturation. Evidence with regard to embryological and early postnatal neurological development is reviewed. It is argued that motor areas mature before sensory and that the left hemisphere develops prior to the right, such that the left hemisphere gains a competitive advantage in the acquisition of motor representation, whereas the later maturing right has an advantage in the establishment of sensory-affective synaptic representation, including that of limbic mediation. The influences of these differing maturational events on cognitive and psychic functioning are examined, particularly with regard to limbic influences on the development of language, thought, and mental imagery, and the effects of early emotional experience on later behavior. Thinking is viewed in part as a left hemisphere internalization of egocentric language, the internalization of which corresponds to the increasing maturation of intra-cortical and subcortical structures and fiber pathways, and the myelination of the callosal connections that subserve information transfer between the hemispheres. It is argued that thought is a means of organizing, interpreting, and explaining impulses that arise in the non-linguistic portions of the nervous system so that the language dependent regions may achieve understanding. In addition, the neurodynamics and mechanisms involved in the mislabeling, misinterpretation, and inhibition of impulses, desires, and emotional expression are discussed in relation to disturbances in psychic functioning.

Attitudes of medical students and residents toward cancer

Attitudes toward cancer and heart disease were evaluated in 99 freshmen medical students, 76 seniors, and 66 residents using the Cancer Attitude Survey and a Semantic Differential test. The Survey revealed a rise in positive attitudes towards patients' inner resources to cope with serious illness and toward personal immortality and a rise in negative attitudes toward early diagnosis of cancer as students progressed in their training. The Semantic Differential test demonstrated more negative attitudes toward cancer than heart disease in all groups (freshman, seniors, and residents in medicine, psychiatry, or surgery). The seniors had the most positive attitudes toward cancer and freshman the least positive attitudes. The residents had more positive attitudes than the freshmen but less positive attitudes than the seniors. The residents in psychiatry had more positive attitudes than the residents in medicine, who had more positive attitudes than the residents in surgery.

Morphological effects of monocular deprivation and recovery on the dorsal lateral geniculate nucleus in galago

The effects of monocular lid-suture deprivation on development were evaluated by measurement of cell sizes in the lateral geniculate nuclei of six deprived and three normally reared galagos. In all animals autoradiographic demonstration of the retino-thalamic projections from one eye was used to define the lamination and distinguish the monocular from the binocular segment of the nucleus. Our results indicate that monocular deprivation significantly affects cell growth in both the binocular and monocular geniculate segments, with the greater change occurring in the binocular segment, suggesting that both visual experience and binocular competitive interactions influence geniculate cell growth in these primates. In animals forced to use their deprived eye for 2 months or more by reverse suturing, disparity of cell sizes is reduced in the monocular segment, while differences in binocular segment cell sizes are maintained. Our results also show that monocular deprivation with or without later reverse suture has an unequal influence on different geniculate layers, such that cells in laminae 4 and 5 are not as severely affected as the remaining layers. This differential influence could relate either to the unique pattern of projection of these layers to cortex or to functional differences between layers.

Gender and early environmental influences on activity, overresponsiveness, and exploration

One hundred eighty-five rats reared in either an enriched or restricted environment were tested during adulthood to determine the influence of gender and rearing environment on 3 related response characteristics, activity, overresponsiveness, and exploratory behavior. Eight experiments were performed. It was found that although females are more active than males, rearing environment does not influence behavior in the running wheel or open field. When tested in a complex compartmentalized open field, females in general and restricted rats are significantly more active than enriched males. In addition, over subsequent testing, restricted animals are increasingly responsive and fail to habituate to the testing stimuli. When tested and retested for maze learning ability, males excel over females; enriched rats maintain their ability to outperform restricted rats, although both groups had previously learned the problem. Moreover, enriched rats demonstrate a greater tendency to explore and make irrelevant section entries on a maze that is problem free. Restricted rats, specifically, and females generally, have difficulty suppressing a learned repetitious pattern of rewarded responding when it is subsequently punished; restricted rats were deficient in the ability to passively avoid or escape noxious stimuli. These experiments, as well as supporting evidence in the literature, indicate that rats reared in a restricted environment develop a limited behavioral repertoire which is characterized by a generalized tendency to overrespond, a propensity towards perseverating in repetitious patterns of limited and circumscribed responding, and a failure to habituate to repeated contact with novel stimuli.

Visual deficits and recovery following monocular lid closure in a prosimian primate

The behavioral consequences of long-term monocular lid closure in 6 deprived and 2 normal prosimian primates (Galago crassicaudatus) were examined using a visual field perimetry technique and a variety of visuomotor tests. Deprived galagos had their right lid sutured either within 8 (n = 4) or 38 (n = 2) days postpartum and were reared under these conditions for at least 8 months. Normal galagos responded briskly on all visuomotor tests including tracking, response to visual threat, ability to descend from a platform, and obstacle avoidance. Perimetry tests of these animals showed that the visual field with both eyes open was 180 degrees while each eye tested individually had a 135 degrees field. Deprived galagos tested with their experienced eye exhibited normal visuomotor behavior and normal visual fields. Following reverse suture all deprived animals behaved initially as if blind on all tests. Over the next 4-8 weeks these animals showed some limited recovery on the visuomotor tasks. Tests of perimetry indicated that by the end of four weeks of testing, vision was limited to the deprived monocular segment where it remained stable to the end of the testing period. With both eyes open, deprived galagos exhibited a normal 180 degrees visual field. Curiously, however, when stimuli were introduced simultaneously in corresponding points in both monocular segments of the field, the majority of orienting responses of deprived subjects favored the right deprived eye. Under similar testing conditions one normal subject favored its right eye and the other its left eye. The reversibility of monocular deprivation was explored further either by extending the period of forced use of the deprived eye in one animal or by removing the non-deprived eye in another animal. No further improvement in visual field perimetry was seen following a longer period of forced use of the deprived eye. In contrast, a substantial increase in the visual field could be demonstrated one month following removal of the originally experienced eye: the deprived eye field expanded to include the entire 90 degrees ipsilateral hemifield. The contralateral field of the deprived eye, however, continued to remain blind even after one year. These behavioral results suggest that although the original binocular competitive disadvantage suffered by the deprived eye during development is relatively permanent, it can partially be ameliorated by late removal of the non-deprived eye.

Subclavian artery injury and fracture of the scapula

A fracture of the scapula is frequently associated with other significant injuries. In the case described, a motorcycle accident victim sustained multiple injuries, including a scapular fracture associated with a tear of the subclavian artery, demonstrated by angiography and confirmed at operation. A literature review revealed no similar case.

Studies on xylan hydrolases from different strains of Streptomyces and their mutual influences in the breakdown of xylan

A good proportion of Sreptomyces isolates from natural sources produced extracellular xylan hydrolase. Nineteen isolated showing high activity were able to completely or partially degrade wheat bran in the growth medium. Chromatographic analysis of commercial xylan degradation products suggested that the isolates produced either endo- or exo-xylan hydrolases or their mixtures. Mixed additions of culture fluids showed a highly synergistic effect, up to an increase by 200%. In a few cases antagonism was seen which, however, could be removed by dialysis of the culture fluid.

Intrathecal antitetanus serum (horse) in the treatment of tetanus

In a two-year study of 322 conservatively treated, consecutive cases of tetanus in a rural hospital (all over twelve months old), intrathecal administration of 200 units of antitetanus serum (A.T.S.) (horse) reduced the overall mortality of 4-5% (5/110) compared with 14-5% (16/111) in the control series. 200 units intrathecal A.T.S. (horse) gave better results than 1500 units A.T.S. (horse). The results with lumbar and cisternal administration did not differ. It is suggested that tetanus is a polysystemic condition requiring polysystemic therapy. A regimen in which intrathecal A.T.S. is given as an adjunct to low-dosage systemic A.T.S., high levels of systemic betamethasone and diazepam, and careful nursing gave results which compare favourably with those of centres with more elaborate equipment and specialised staff.

Autolytic formation of protoplasts (autoplasts) of Streptococcus faecalis; location of active and latent autolysin

Over 80% of the active and porteinase-activatable, latent forms of the autolytic N-acetylmuramide glycanhydrolase of Streptococcus faecalis ATCC 9790 were released to the supernatant buffer during the autolytic formation of protoplasts (autoplasts) in the presence of absence of trypsin. Autolysin activity was not found in association with released mesosomal vesicles and had little affinity for binding to membranes or to the outer surface of the wall. Isolated walls were able to bind over four times as much autolysin activity as that present on wall exponential-phase cells. Using a rapid technique for wall isolation, evidence was obtained that the latent form (as well as the active form) was wall bound in intact cells. In addition, isotope labeling and ultrastructural studies were able to show that latent autolysin was concentrated in the newer, septally associated portion of the wall.

Split-hand and split-foot deformity inherited as an autosomal recessive trait

A intermarried consanguineous family with split-hand and -foot deformity occurring in two sibship is presented. Both the sibship resulted from marriage between first cousins. This report, together with those of Ray (1960) and Freire-Maia (1971), further demonstrates that split-hand and -foot deformity can be inherited as an autosomal recessive trait.

Synthesis and excretion of glycerol teichoic acid during growth of two streptococcal species

Examination of both supernatant culture medium and cell pellets after exponential- and stationary-phase growth of Streptococcus mutans strain FA-1 and Streptococcus faecalis ATCC 9790 (S. faecium) showed the presence of [-3H]glycerol-labeled material that possessed several of the properties of glycerol teichoic acid. In the supernatant medium of S. mutans FA-1, an apparently large-molecular-size material, which eluted from agarose columns with the Kd value expected of a lipoteichoic acid, was observed. Large amounts of this material were present in supernatants during the stationary phase. In contrast, with S. faecalis only an apparently lower-molecular-weight form, with a Kd consistent with deacylated glycerol teichoic acid, was found in the growth medium. Both organisms had high-molecular-weight lipoteichoic acid in the cells along with the deacylated glycerol teichoic acid. The presence of relatively large amounts of glycerol teichoic acids in the medium was considered to be a result of excretion of these compounds rather than a result of cellular lysis.

Cellular localization of lipoteichoic acid in Streptococcus faecalis

The release of lipoteichoic acid and mesosomal vesicles to the supernatant buffer during the formation of spherical, osmotically fragile bodies was studied using Streptococcus faecalis ATCC 9790. Autolytic N-acetylmuramidase action was permitted to take place in exponential-phase cells incubated in a buffer which provides an exceptional degree of osmotic stabilization. Both lipoteichoic acid and mesosomal vesicles were relatively rapidly released to the supernatant buffer. Most of the cellular content of lipoteichoic acid (and mesosomal vesicles) was found in the supernatant buffer at incubation times when the cells still retained over 75% of their cell wall. [14-C]- or [3-H]glycerol was used as a label for both cellular lipoteichoic acids and lipid-glycerol. Glycerol in lipoteichoic acid was quantitated after phenol-water and chloroform-methanol treatments and identified by products of acid hydrolysis and its ability to be precipitated by (i) antibodies specific for the polyglycerol-phosphate backbone, (ii) antibodies to the streptococcal group D antigen, and (iii) concanavalin A. Evidence was obtained that lipoteichoic acid was not associated with isolated mesosomal vesicles. Centrifugation of supernates at 200,000 X g sedimented membranous (mesosomal) vesicles and nearly all of the lipid-glycerol present, whereas essentially all of the lipoteichoic acid remained in the supernatant. The sedimented mesosomal vesicles differed from protoplast membrane in their higher lipid-phosphorus to protein ratio and in the absence of detectable levels of two enzymatic activities found in protoplast membranes, adenosine triphosphatase and polynucleotide phosphorylase. Both types of membranes were found to contain DD-carboxypeptidase and LD-transpeptidase activities at nearly the same specific activities. No evidence was obtained for the association of autolytic N-acetylmuramidase activity with either type of membrane preparation.

Autolytic formation of protoplasts (autoplasts) of Streptococcus faecalis 9790: release of cell wall, autolysin, and formation of stable autoplasts

A system for the formation of apparently wall-free protoplasts from exponential-phase cells of Streptococcus faecalis ATCC 9790 in the absence of added lytic enzymes was developed. Exponential-phase cells suspended in 0.04 M ammonium acetate, pH 6.7, 1 mM magnesium acetate, and 0.5 M sucrose become osmotically fragile within 1 to 1.5 h due to the action of the native, autolytic enzyme on the cell wall peptidoglycan. However, maximal cell wall loss occurred much more slowly, being complete only after 3 to 6 h. Under these conditions, the autolytically formed protoplasts (autoplasts) remained intact for prolonged periods (up to 24 h) with less than 5% of their deoxyribonucleic acid, ribonucleic acid, and protein lost during the first 6 h. During dissolution of the cell wall, release of autolytic enzyme to the supernatant fluid began after 60% of the wall was lost. The addition of trypsin to the incubation mixture increased the rate of attainment of osmotic fragility and cell wall loss two- to threefold, apparently due to the activation of the latent form of the autolysin. Electron microscopy was used to confirm cell wall loss and the presence of intact protoplasts at the end of the incubation periods.