Stereoacuity levels and vision problems in children from 7 to 11 years

A longitudinal study of stereoacuity levels of 859 children at 7 years, 811 children at 9 years and 796 children at 11 years was conducted using the TNO random dot stereotest. The prevalence of defective stereoscopic vision was found to be between 2.1 and 3.2 per cent. A further 10-16 per cent of children had only moderate stereoacuity levels when compared with their peers. The stereoacuity levels achieved by most of the children improved with age, but the rank order correlations for the stereoacuity levels between ages 7 and 9, and ages 9 and 11, were small. Defective stereopsis and poor stereoacuity levels were clearly associated with manifest strabismus and problems of visual acuity, and if failure to pass the quantitative plates was a cut-off point for screening purposes most of the children with visual problems would have been identified.

Thermode for deep focal cooling

A cooling thermode is described that can be used to reversibly lesion deep structures with minimal penetration damage. Construction, associated equipment, and use of this thermode are simpler and less expensive, and it can be made smaller in size, than previously described thermodes. The user has a choice of a simple, inexpensive control arrangement that is somewhat more complicated to use, or a more expensive control system that is simpler to use. The diameter of this thermode can be at least as small as 0.3 mm, which is smaller than any previously described thermode. The cooling agent, Co2, is used in such small quantities that toxicity is no problem.

The treatment of chronic idiopathic thrombocytopenia with anti-D (Rho) immunoglobulin: its effectiveness, safety and mechanism of action

Twenty-three courses of i.v. anti-D (Rho) immunoglobulin were administered to 13 Rh D-positive patients with chronic idiopathic thrombocytopenia (ITP). Clinically significant responses were seen in a proportion of patients treated with 500-2500 i.u. anti-D, but all those treated with 12,500 i.u. (180 i.u./kg) responded. Patients refractory to other forms of treatment responded well to anti-D, and previous splenectomy did not influence the clinical response. No adverse reactions were observed. The anti-D response was preceded by a lag period of 3-16 days and was maintained for 14-145 days. Platelet-associated IgG was increased after treatment, due to improved survival of immunosensitized platelets or platelet Fc receptor binding of high molecular weight IgG in the therapeutic material. There was no clinical or biochemical evidence of haemolysis. The erythrocyte direct Coombs' test remained positive for 3-45 days, and histological examination of splenic material showed no erythrophagocytosis. We conclude that anti-D (Rho) immunoglobulin is a safe and effective treatment for chronic ITP and that the therapeutic dose is now established in standardized units. The mechanism of action appears to be complex and is probably not due to macrophage Fc receptor blockade with immunosensitized red cells.

Mammographic screening for breast cancer: prospects for New Zealand

The Cancer Society and the Department of Health invited a working group to make recommendations on screening by mammography. Mammography offers the best opportunity for preventing deaths from breast cancer. Randomised trials suggest that mortality can be reduced by about 30% in women over 50; the value of routine mammography in younger women is still uncertain. Apart from financial costs, the main drawback of mammography is that many women receive unnecessary investigation because of false-positive results. Careful design and monitoring of programmes is essential to ensure that the benefits of screening outweigh the disadvantages. In New Zealand there is a shortage of radiologists, pathologists, and clinicians who are skilled in the specialised techniques required for the screening of asymptomatic women. Decisions about routine screening should be delayed until pilot programmes have been established, with assessment of their effectiveness, economic efficiency, and social acceptability. Recommendations for the design of such programmes are made.

Isolation of a DNA fragment which complements glutamine synthetase deficient strains of S. pombe

From a gene bank of S. pombe DNA, a 5.6 kb clone was isolated which complemented mutants defective in glutamine synthetase (GS) activity. Sub-cloning fragments of this 5.6 kb clone showed that the complementing activity was localised in a 1.6 kb HindIII-AvaI fragment and a partial DNA sequence revealed an open reading frame preceded by TATA sequences and a TGACTA sequence. Plasmid constructs carrying up to 3.4 kb of DNA used to transform gln- strains gave transformants which showed a wide range of GS activity, in some cases 100 times the wild-type level. These constructs identify DNA sequences lying downstream from the putative coding sequence which have effects on the total amount of enzyme activity, but do not affect the control imposed by the nitrogen source on which the cells are grown.

Monoclonal antibodies to human antigens recognise feline myeloid cells

Immunological techniques have been used to study the expression of a series of cell surface antigens in cat haemopoietic tissues. Forty-two monoclonal antibodies raised against well-defined antigens of human origin were tested by indirect immunofluorescence on feline blood, bone marrow, spleen and thymus. Myeloid cells from all tissues reacted with antibodies to CD9, CD10 and CD18 antigens. No antibodies specific for T or B lymphocytes were found to react with cat lymphoid cells. Osteoclasts, isolated from juvenile bone marrow, were found to express the 23C6 human osteoclast-specific antigen. The potential use of such antibodies in experimental and diagnostic veterinary haematology are discussed.

Central control of gastric acid secretion by extralateralhypothalamic nuclei

Whether secretion of gastric acid (GAS) is in response to peripheral and/or central administration of chemical or electrical stimuli can be differentiated by vagotomy. GAS has been shown to be controlled by specific lateral hypothalamic (LHA) neurons. Application of 2-deoxy-D-glucose (2-DG) or insulin to the LHA by microinjection or iontophoresis has experimentally induced GAS. The paraventricular nucleus (PVN) has now been found to also affect GAS. GAS was produced more copiously and more quickly by rostral PVN lesion than by lesion of the ventromedial (VMH) or dorsomedial (DMH) nucleus, and nearly as much by caudal PVN lesion. Microinjection of 2-DG into the LHA induced GAS more potently in animals with rostral PVN lesions than in those with caudal PVN, VMH or DMH lesions, or in intact animals. Results indicate that the PVN may be an additional central site from which GAS is affected.

Variations in operation rates in New Zealand

The standardised rates of nine common operations in the seven largest hospital boards in New Zealand varies markedly with the ratio of highest/lowest ranging from 1.2 for cholecystectomy to 2.9 for tonsillectomy. There were also marked variations between New Zealand, Scotland, USA and England and Wales with the ratio of high/low ranging from 1.2 for appendicectomy to 4.5 for haemorrhoidectomy. The New Zealand rates tended to be higher than the English but lower than the USA rates. Several operation rates were correlated with the size of waiting lists but there were no other consistent relationships with any of the other variables studied - hospital board funding, percentage of operations performed in private hospitals, and rates of general practitioners, specialist surgeons, and acute surgical beds in public hospitals per 100,000 population.

The in situ saphenous vein bypass graft: radiologic aspects

The use of the in situ saphenous vein for bypassing arterial occlusions in the lower extremities appears to have a higher patency rate than other bypass procedures but presents unique technical problems, such as lysing valves and occluding venous tributaries. Forty-four patients undergoing in situ bypasses had preoperative arteriograms. Special attention was paid to the small runoff vessels around the ankle, which are not suitable for reversed bypass procedures but may be adequate for in situ bypasses. Eight patients also had preoperative saphenous venograms, which revealed surgically important abnormalities in six cases. Postoperative arteriograms obtained within 2 weeks in 10 patients and within 2-12 months in 15 patients revealed persistent arteriovenous fistulas in four patients, stenoses in nine, occlusions in five, and progressive disease in the nonbypassed arteries in five patients. Early recognition of these problems led to 11 surgical repairs; nine repairs used the interventional radiologic procedures of balloon angioplasty, transcatheter embolization, and catheter thrombolysis. In this group of 44 patients, five patients died with patent bypasses and three patients required amputation despite functioning bypasses. Only four amputations were attributed to bypass failure. This low figure may be due to the close cooperation of the vascular surgeons and the vascular radiologists in dealing with these complicated cases.

Structural evaluation of anorectic action induced by 1,5-anhydro-D-glucitol

In previous studies, 1,5-anhydro-D-glucitol (1-DG), an endogenous glucose analog, was found to significantly influence physiological feeding behavior. The relationships between the hydroxyl group positions on the pyranose ring carbons and the anorectic action induced by 1-DG and its analogs are discussed. To investigate the effects of these glucose analogs on ingestive behavior, 24 mumole of test solution was injected into the rat third cerebral ventricle immediately before normal eating time, which starts at the beginning of the dark. After initial transient hyperphagia, 1-DG suppressed feeding during the first 12-hr dark period. It prolonged postprandial intermeal interval beginning shortly after injection, but eating rate was not affected and meal size did not decrease until near the end of the normal feeding period. The incidence of drinking episodes decreased concomitant with feeding suppression. Feeding and drinking suppression were also produced by 1,2-dideoxy-D-glucose, 1,3-dideoxy-D-glucose, and 1,4-dideoxy-D-glucose, although they were less potent than 1-DG. They suppressed feeding by prolonging the postprandial intermeal interval, but did not change meal size or eating rate. The anorectic effects of 1-DG were abolished by removal of the hydroxyl group at carbon 6 and by epimerization at carbons 2, 3, and 4. These findings indicate that feeding suppression induced by 1-DG and its analogs is induced mainly by prolongation of the postprandial intermeal interval, and the presence or absence of a hydroxyl group on each carbon of 1-DG is important for its feeding suppression.

The value of an erect abdominal radiograph in the diagnosis of intestinal obstruction

The value of an erect abdominal radiograph in the diagnosis of acute intestinal obstruction has been studied. Four observers independently assessed 100 supine abdominal films and then reassessed them in combination with an erect film. The addition of the erect film did not significantly increase the accuracy of diagnosis of obstruction or help in the correct identification of its level. The presence or absence of gas in the rectum was of no diagnostic value.

Vision and eye problems in seven year olds: a report from the Dunedin Multidisciplinary Health and Development Research Unit

An eye examination, including tests of distance visual acuity, near visual acuity, cover tests, and an examination of pupils, eyes, adnexia, and eye movements, was carried out on 988 Dunedin children within approximately one month of their seventh birthday. Information concerning glasses and patching of one eye was obtained by questionnaire. Eye defects were noted in 9.4% of the children with several having more than one problem. Eye defects noted included 5.1% with unaided distance visual acuity of 6/12 or worse in one or both eyes, 4.4% with near visual acuity of the equivalent of N8 or worse in one or both eyes, 3.9% had manifest strabismus, 2.9% had had occlusion of one eye for amblyopia, and 1.2% had other important eye defects. Glasses had been prescribed for 3.6%.

Conformational changes and loss of opsonic function in frozen or heat-treated plasma fibronectin

Using human peripheral blood monocytes to assay opsonic protein activity, we have examined the efficiency of various procedures for isolating fibronectin from plasma for experimental or therapeutic use. In addition, we have assessed the protein's opsonic activity after cold storage, and after heat treatment to inactivate hepatitis virus. The purification procedures recovered only 30% of available plasma fibronectin whilst cold storage and heat treatment of the purified protein removed all of its remaining opsonic activity. This was associated with no alteration in overall molecular weight or in subunit size but was accompanied by changes in ultraviolet spectrum, suggesting a conformational change in the protein structure. Initial experiments to protect the purified protein against these changes were unsuccessful and unless further attempts are more encouraging, fresh-frozen plasma may be the only current economic source of opsonically active fibronectin. Since this would waste other valuable proteins required for other purposes, the widespread use of plasma fibronectin outside of clinical trials may be unjustified at this present time.

The concentration of plasma fibronectin in burns patients treated with fresh frozen plasma or plasma protein fraction

A group of 10 patients with 30-70% burns were given intravenous infusions during the first 48 h following hospital admission either with fresh frozen plasma (FFP) or human plasma protein fraction ( HPPF ). FFP contained 300-400 mg/dl plasma fibronectin whereas none was detectable in HPPF . Circulating plasma fibronectin levels fell quickly in those patients receiving HPPF and levels remained low for 2-3 weeks. In those receiving FFP, plasma fibronectin remained normal during the 48-h transfusion period but fell subsequently. Fibronectin may be an important determinant in the resistance to shock and infections. Consideration should therefore be given to the use of blood products which contain fibronectin and to the monitoring of plasma levels both during the acute and recovery periods after burn injury.

A longitudinal study of enuresis from five to nine years

The prevalence of primary and secondary enuresis was examined longitudinally in a large sample of New Zealand children at ages 5, 7, and 9 years. While the prevalence of primary enuresis fell over time, secondary enuresis increased in prevalence between 5 and 7 years. There were no sex differences. An examination of some of the developmental and background characteristics of the sample indicated that enuresis was not associated with neurodevelopmental delay or 'psychosocial' factors. However, there were strong, long term associations between secondary enuresis and behavioural deviance. The behavioural results suggested that behaviour problems did not arise as a consequence of enuresis, but rather preceded it.

A preliminary evaluation of the use of an automatic impedance tympanometer in the diagnosis of otitis media with effusion in children: a report from the Dunedin Multidisciplinary Health and Development Research Unit

Microscopic examination by two trained examiners, conventional impedance tympanometry by a trained audiometrist, automatic impedance tympanometry by a person with minimal training and puretone audiometry by trained audiometrists were compared in 468 ears, studied blind. There was complete examiner agreement in microscopic examination in 465 (99.3%) ears, minor disagreement in three (0.7%) ears. There was a more complex relationship between examination methods, with microscopic evidence of effusion being present in 88.2% of ears showing B tympanograms to conventional tympanometry and in 66.7% of ears to automatic tympanometry. Automatic tympanometry provides a reasonably accurate method of detecting middle ear effusion, but tends to overdiagnose this condition compared to alternate methods.

Asthma in seven year old children: a report from the Dunedin Multidisciplinary Child Development Study

The prevalence of asthma between birth and seven years was determined by questionnaire in 875 children as part of the Dunedin Multidisciplinary Child Development Study. From the combinations of asthma and/or wheezing reported in association with bronchitis, hayfever, eczema and allergies, a diagnosis of certain or probable asthma was made in 12.6 percent of these children. A further 22.6 percent admitted to wheezing, but a diagnosis of asthma could not be made with any certainty. Bronchitis was reported frequently, usually associated with wheezing. Children with more obvious asthma showed a male preponderance and significant differences in body build and school attendance compared with asymptomatic children.

Some developmental and behavioral problems associated with bilateral otitis media with effusion

Results from otological and audiological examination of 879 children are reported. A group of 47 children with bilateral otitis media with effusion (OME) was compared with those who were otologically normal (N = 355) to determine whether they differed in background characteristics, speech articulation, language or motor development, and intelligence or reported behavioral problems. The results showed that while the children with bilateral OME did not differ in terms of background characteristics, they were significantly disadvantaged in speech articulation ability, verbal comprehension, motor development, and intelligence. They also had significantly more behavior problems. The finding that OME was associated with developmental and behavior problems in children suggests a need to identify this problem in children as a first step toward therapeutic intervention.

The Jk(a-b-) phenotype in New Zealand Polynesians

The Kidd locus phenotype Jk(a-b-) was detected in 0.9 percent of Polynesians living in New Zealand. Over a period of 13 years, nine examples of anti-Jk3 were detected, one of which caused a delayed hemolytic transfusion reaction. Other examples resulted in mild hemolytic disease of the newborn. The anti-Jk3 reacted as an inseparable antibody, confirmed that inheritance of the Jk(a-b-) phenotype was best explained by the presence of a silent Jk allele.

Plasma fibronectin in acute leukaemia

In acute leukaemia, low plasma fibronectin was seen at diagnosis and when the disease relapsed. This was not directly related to tumour load, chemotherapy or neutropenia, but correlated well with episodes of intercurrent infection. In severe infections, fibronectin fell rapidly to very low levels, and was sometimes not restored to normal up to 2 weeks later. Preliminary attempts at replacement therapy were successful and the possible importance of this is discussed.

Lateral hypothalamus neuron responses to electroosmotic 2-deoxy-D-glucose

Electroosmotic applications of 2-deoxy-D-glucose (2-DG) were made in the lateral hypothalamus (LHA). Changes in LHA unit activity and concomitant gastric acid secretion were then observed 2-DG responsive neurons tended to form two clusters in the LHA. Electroosmotic application induced four patterns of activity change in different LHA neurons. Gastric acid secretion increased when LHA unit activity increased. Results presented here agree with prior reports of hypophagia after precise lesions in this LHA region and other reports of 2-DG induced hyperphagia which might be mediated through central neurons.

Gastrin related peptide effects in lateral hypothalamus depend on food deprivation

Gastrin related peptides (PG) affected neurons in the lateral hypothalamus (LHA) differently in food deprived than in non-deprived rats. Electroosmosis and intravenous (IV) results agreed. Gastric acid secretion was also measured. Neural responses to PG were: transiently increased discharge rate followed by desensitization occurred equally in deprived and non-deprived rats; dose related decrease in discharge rate occurred significantly more often in non-deprived than in deprived rats. Observed LHA changes and gastric acid secretion occurred pari passu. It was concluded that PG could contribute to LHA control of feeding behavior. It was not determined whether the effects attributed to systemic injection and those attributed to electroosmotic application both had the same origin. The significant differences which were observed could have been either different reacttions by one neuron type, or responses of different neuron types.

Neural mechanisms of reflex facilitation and inhibition of gastric motility to stimulation of various skin areas in rats

1. Experiments were performed on chloralose-urethane anaesthetized rats to determine the involvement of extrinsic gastric autonomic nerves in reflex facilitation and inhibition of gastric motility when mechanical nociceptive stimulation was delivered to either hind paw or abdominal skin, respectively. 2. After bilaterally sectioning the splanchnic nerves in vagal intact animals, the reflex facilitation of gastric motility produced by hind paw stimulation persisted, but the reflex inhibition previously produced by abdominal skin stimulation disappeared. 3. Hind paw stimulation increased efferent activity of the gastric branch of the vagus nerve, but stimulation of abdominal skin had little influence. 4. Bilateral vagotomy in splanchnic nerve intact animals did not influence the gastric reflex inhibition by abdominal skin stimulation, but either abolished gastric reflex facilitation produced by hind paw stimulation or reversed the reflex facilitation response to slight reflex inhibition. 5. Efferent activity of the gastric sympathetic nerve was greatly increased by abdominal skin stimulation, and was either slightly increased or not influenced by hind paw stimulation. 6. It was concluded that reflex increase of efferent activity of the gastric vagi was responsible for the gastric motility facilitation produced by hind paw stimulation, and also that reflexly increased efferent activity of the gastric sympathetic nerves resulted in gastric motility inhibition produced by abdominal skin stimulation. It is suggested efferents are inhibitory. 7. After spinal transection at the cervical level, the reflex facilitation of gastric motility previously produced by stimulation of a hind paw was completely abolished, or reversed to slight reflex inhibition, while reflex inhibition of gastric motility produced by stimulation of abdominal skin remained. It was concluded that the gastric reflex inhibition was a spinal reflex. 8. Interaction between reflex facilitation and inhibition of gastric motility during simultaneous stimulation of both hind paws and abdominal skin was observed as partial cancellation of each effect by the other. However, sympathetic reflex inhibition of gastric motility seemed to be much stronger than the vagal reflex facilitatory effect.

Noninvasive diagnosis of left ventricular pseudoaneurysm: role of two dimensional echocardiography and radionuclide gated pool imaging

This report describes a case of left ventricular pseudoaneurysm diagnosed with two dimensional real time echocardiography. The two dimensional echocardiogram identified not only the pseudoaneurysmal sac but also the site of left ventricular rupture. When supplemented with radioisotope gated cardiac blood pool scanning, the noninvasive studies demonstrated combined true and false left ventricular aneurysms. Left ventricular pseudoaneurysm can be diagnosed using two dimensional echocardiography and nuclear imaging, permitting early operative intervention before fatal rupture.

Modified axial lead system in children

Preliminary studies have been made on the use of the modified axial lead system in infancy and childhood. A highly significant correlation between internipple distance and height suggested that internipple distance be used as an index for the selection of a template to facilitate placement of the chest electrodes (Z and X). A series of 4 triangular templates was designed. The use of a template one size too large or too small was shown not to lead to any significant error in waveform measurement. A further study showed that the reference level for the application of the praecordial electrodes should be the 5th intercostal space as for adults, but that no serious diagnostic error was likely to arise if the 4th or 6th intercostal space was chosen by mistake. A study of the Frank lead system suggested that the use of the 5th intercostal space as a reference level was more appropriate than the 4th intercostal space, which is generally adopted by users of that system. The conclusion reached was that the axial lead system is the preferred orthogonal lead system for children, with templates for 4 ranges of internipple distance (less than 10 cm; 15 to 20 cm; and less than 20 cm--adult build) being proposed to simplify electrode placement.

A simplified antepartum high-risk pregnancy scoring form: statistical analysis of 5459 cases

An antenatal high-risk assessment form has facilitated the identification of the fetus at risk, Although such a form in general has potential limitations its simplicity and demonstrated ability to assist in high-risk selection makes it worth including in an antenatal high-risk program.

Temporary transcaecal ileal diversion in prevention of anastomotic leak in planned colonic surgery (an alternative to proximal colostomy)

An alternative to proximal colostomy in planned colonic resection is reported in 30 patients. The physiopathological background for this procedure of temporary transcaecal ileal diversion is explained together with details of the operation and the results obtained.

Pseudocyst of the pancreas

An account of pseudocyst of the pancreas, which is a less common cause of abdominal swelling, is given. Various methods of treatment are described. A series of 8 patients with pseudocyst of the pancreas is reported. The treatment in each case is described.

The Efflux of Chloride from Cells of Nitella and Chara

The efflux of chloride across the plasmalemma of internodal cells of Nitella translucens and of Clwra australis has been measured under various conditions. It is large in the dark, and is reduced by light and by removal of the chloride ions from the external solution. Typical values for a chloride concentration of 1� 3 mM in the external solution are: light, 0�6 pmole cm-2 sec-t, rising in the dark to about 4�0 pmole cm-2 sec-1 for several hours, and finally steady in the dark at about 2� 5 pmole cm-2 sec-i. It is concluded that these changes are produced by changes in the permeability of the membrane to chloride ions. The two species give very similar results