Acoustic neuroma (schwannoma) surgery 1978-1990

A series of 151 patients with 154 acoustic schwannomas have been operated upon in Manchester Royal Infirmary by a joint Otological and Neurosurgical team, employing either the translabyrinthine or the suboccipital approach. The perioperative mortality rate was 3 per cent. Anatomical preservation of the facial nerve was achieved in 89 per cent of tumour removals and a good to normal functional result in 79 per cent of cases. Attempts at hearing preservation have been unsuccessful, largely because of the small number of patients in the series in whom useful hearing was present preoperatively. Complications included major brain stem ischaemia (1.2 per cent), CSF fistula (5 per cent) and facial dysaesthesia (7 per cent). The incidence of mortality and morbidity is directly related to tumour size and to the experience of the surgeons. A number of patients experienced an unusual type of post-operative dreamlike state which appeared to be a form of hypnagogic hallucination, and the possible neurophysiological mechanism responsible for this phenomenon is discussed. The continuing failure to attain the ideal of early diagnosis is lamented, and the importance of a flexible bidisciplinary surgical approach emphasized.

Limitations in the use of five French coronary catheters

Five french (5F) catheters are being widely promoted for use in patients undergoing day case angiography including coronary angiography. Although there are theoretical advantages to this practice there are also potential disadvantages. We reviewed various performance parameters of four different brands of 5F coronary catheter and compared them with performance of the six (6F) and eight french (8F) coronary catheters used in routine coronary angiography. All the 5F catheters performed significantly less satisfactorily than the 6F and 8F catheters. 5F coronary catheters cannot be recommended for routine transfemoral coronary angiography.

Improved arterial oxygenation with feed restriction in rapidly growing broiler chickens

1. Rapidly growing broiler chickens fed ad lib. until 56 days, but feed restricted until 60 days of age, had higher arterial oxygen saturations, lower respiratory frequencies, total ventilations that were not different, and higher tidal volumes compared to those fully fed for 56 days. 2. Arterial oxygen saturation correlated negatively with respiratory frequency, but was not related to total ventilation or tidal volume. 3. Hypoventilation appeared not to be the cause of arterial oxygen desaturation. 4. Arterial oxygen desaturation correlated with the degree of right ventricular hypertrophy.

Enteric adenovirus type 40: expression of E1B mRNA and proteins in permissive and nonpermissive cells

The enteric adenovirus type 40 (strain Dugan) grows well in tissue culture only when the E1B 55K protein of Ad5 or Ad12 is supplied in trans, either constitutively expressed in an established cell line or by coinfection with an appropriate helper virus (V. Mautner, N. Mackay, and V. Steinthorsdottir, 1989, Virology 171, 619-622). The synthesis of Ad40 E1B mRNAs and proteins has been examined under permissive and nonpermissive conditions: At late times postinfection in permissive cells, E1B-specific mRNA species of 22 and 13-14 S are made, as well as 15 and 9 S messages for the late IVa2 and ppIX proteins. None of these are detected before the onset of DNA replication and none of them accumulate in the presence of a cytosine arabinoside block to DNA replication. The failure to detect cytoplasmic mRNAs as early times cannot be attributed to a failure of mRNA transport from the nucleus as there is no accumulation of nuclear E1 RNA. In nonpermissive Hela cells only traces of E1B- and ppIX-specific mRNAs are detectable, at very late times postinfection. Antibodies raised to synthetic oligopeptides corresponding to the N- and C-terminal domains of the putative E1B 19K and 55K proteins show a high titer against the cognate peptide by ELISA, but only the E1B 19K C-terminus-specific sera have detected a unique polypeptide in Ad40-infected cells, at late times postinfection. There is no shut-off of host protein synthesis in permissive cells, despite the expression of Ad2 55K protein.

Access for peritoneal dialysis in neonates and infants

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Spontaneous hypoxaemia and right ventricular hypertrophy in fast growing broiler chickens reared at sea level

1. At 6 weeks of age, the time of most rapid body growth, fast growing broiler chickens showed more right ventricular hypertrophy than slower growing chickens. 2. The degree of right ventricular hypertrophy was directly related to blood haematocrit and indirectly related to arterial oxygen saturation (estimated in the chickens using an ear oximeter designed for man). 3. When oxygen saturation was estimated sequentially from 6 to 17 weeks of age, mean oxygenation improved with age, partly due to the death of the chickens with the worst saturations, but also because of an improvement in oxygenation of the survivors.

Wood-burning stoves and lower respiratory tract infection in American Indian children

Some studies suggest that home use of wood-burning stoves is an independent risk factor for lower respiratory tract infection in young children. To test this hypothesis in a population with a high prevalence of wood-burning stove use, we studied Navajo children with diagnosed pneumonia or bronchiolitis. We matched each case (less than or equal to 24 months of age) with a child of identical sex and age who was seen for well-child care or a minor health problem, and we interviewed an adult caretaker about family history and environmental exposures. Analyzing 58 case-control pairs, we found that home wood-burning stove use, recent respiratory illness exposure, family history of asthma, dirt floors, and lack of running water in the home increased the risk of lower respiratory tract infection. On multiple logistic regression analysis, however, only wood-burning stove use and respiratory illness exposure were independently associated with higher risk.

The relationship between rapid growth and pulmonary hemodynamics in the fast-growing broiler chicken

Very fast-growing (VFG) broiler chickens tend to have marked right ventricular hypertrophy when compared with slower growing chickens. We hypothesized that, in the setting of rapid growth, a hypoxic stimulus would cause greater pulmonary hypertension and right ventricular hypertrophy (RVH). We have studied the relationship between artial oxygenation (SaO2), RVH, and pulmonary artery pressure (Ppa) in 28 awake VFG chickens. We found that the hypoxemic chickens had pulmonary hypertension and that the Ppa was linearly related to the SaO2. The relationship between Ppa and RVH, however, was best described by a broken line (p less than 0.05). Thus, at higher pressures, the RVH seemed excessive for a given Ppa. We have also studied the effects of reducing FIO2 on Ppa, systemic pressure, cardiac output, and calculated total pulmonary resistance (TPR) in lightly anesthetized fast-growing and normal chickens. We found that normal chickens and fast growers had similar TPR in room air, but that the fast growers had a greater increase in TPR than did the normal chickens in response to hypoxia (p less than 0.05). Finally, we placed 2-wk-old normal and VFG chicks in a hypobaric chamber set at "10,000 feet" for 2 wk and found that the VFG but not the normal chickens developed marked RVH in response to the hypoxia. However, the RVH in the fast-growing chickens could be prevented by restricting their diet, and hence their growth. We conclude that hypoxemia probably caused the pulmonary hypertension and RVH in the fast-growing chickens, but that the rapid growth appeared to act as an important amplifier of this response.

Clinical chemistry outside laboratories: report of a second survey

The growth in the use of small portable analysers outside hospital laboratories has been a cause of concern to laboratory practitioners. This has been partly because of a perceived threat to laboratory careers and partly because of fears that the quality of testing would be poor, with a consequent danger of patients being placed at risk. The evidence in this paper indicates that the use of equipment outside laboratories is still increasing in many areas. Despite the fears which have been expressed, little attention is being given to operator training, service costs, safety and many other aspects; only rarely has responsibility for the quality of results been accepted.

Blood glucose levels in Malawian children before and during the administration of intravenous quinine for severe falciparum malaria

Hypoglycemia may develop in patients with severe untreated malaria and can complicate the course of treatment with parenteral quinine as a result of quinine-induced hyperinsulinemia. Intravenous quinine is used increasingly as the therapy of choice in patients with severe malaria, most of whom are children. To assess the importance of both pretreatment and quinine-related hypoglycemia in children in an area in which the disease is endemic, we prospectively studied 95 Malawian children with falciparum malaria and altered consciousness who were treated with intravenous quinine. Nineteen patients had hypoglycemia before treatment. Seven (37 percent) died, and five of the survivors (26 percent) had neurologic sequelae. The corresponding values for patients who were initially normoglycemic were 4 percent and 4 percent, respectively (P less than 0.0001). Hypoglycemia was associated with low plasma insulin concentrations and with elevated plasma concentrations of lactate, alanine, and 5'-nucleotidase--a finding that suggests that impaired hepatic gluconeogenesis but not hyperinsulinemia contributes to the pathogenesis of pretreatment hypoglycemia. All patients were given quinine dihydrochloride in a 5 percent dextrose infusion, and those with hypoglycemia received 50 percent dextrose. Hypoglycemia recurred in seven of the patients with pretreatment hypoglycemia, but these episodes were also not associated with hyperinsulinemia. Of the 76 children who were initially normoglycemic, none became hypoglycemic during the course of treatment with intravenous quinine. We conclude that hypoglycemia is a frequent complication of falciparum malaria in children and that it reflects severe disease and is associated with a poor prognosis. We did not find it to be a complication of quinine treatment.

Ependymoma of the fourth ventricle: an unusual presentation

The authors describe the case history of a patient who suffered a subarachnoid haemorrhage originating from an ependymoma of the fourth ventricle. The unusual nature of this presentation is emphasised in their review of a series of 22 patients with ependymomas of the craniocervical junction.

Antiarrhythmic agents diminish thiourea-induced pulmonary vascular protein leak in rats

Drugs possessing membrane stabilizing activity might act to diminish the augmented microvascular permeability resulting from acute lung injury. To test this rats were pretreated with quinidine, procainamide, or lidocaine and then given the lung injury-inducing agent thiourea. Vascular permeability, assessed as the extravascular accumulation of radiolabeled protein, was increased more than threefold by thiourea. This increase was diminished by 29, 34, and 43% after pretreatment with procainamide, quinidine, and lidocaine, respectively. Lidocaine also returned the thiourea-induced increase in lung wet weight-to-dry weight ratios to control levels. This protection was not likely due to hemodynamic effects of these agents, since no differences were noted in cardiac output between pretreated rats and those receiving thiourea alone and a small increase in mean pulmonary arterial pressure in the lidocaine-pretreatment group was the only difference noted. O2 metabolites have been implicated in the pathogenesis of thiourea-induced lung injury. None of these agents scavenged O2- or H2O2 directly, but quinidine and procainamide diminished in vitro neutrophil O2- and H2O2 production, and lidocaine inhibited neutrophil H2O2 production. However, neutropenia (PMN less than 100/ml) induced with either vinblastine or cyclophosphamide (Cytoxan) failed to prevent thiourea-induced increases in pulmonary vascular protein leak. In conclusion, procainamide, quinidine, and lidocaine diminished lung injury in rats after thiourea. Although these agents diminish PMN O2 metabolite production in vitro their salutary role in thiourea-induced lung injury appears to be through an unknown mechanism that is independent of their effects on neutrophil O2 metabolite-dependent toxicity.

Iatrogenic ex vacuo subdural hygroma: and a complication of the modified "Poppen" suture

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Lateralized interference in finger tapping: comparisons of rate and variability measures under speed and consistency tapping instructions

Forty right-handed college subjects tapped with and without a verbal task under two instructional conditions (tap as quickly as possible vs. tap as consistently as possible) and two levels of verbal production (silent vs. aloud). The tapping task consisted of the alternate tapping of two keys with the index finger of the left vs. right hands, while the verbal task was anagram solution. Three rate and four variability measures of tapping performance were evaluated in the identification of lateralized interference. The results indicate that reliable lateralized interference, more right-hand than left-hand tapping disruption, was observed only for variability measures under instructions to tap as consistently as possible. Furthermore, only one of these variability measures was sensitive to an increase in lateralized interference produced by verbal production. Because of the limited demonstration of verbal laterality effects with the two-key tapping procedure in this study, conclusions suggest that the simpler manual task of repetitive tapping of one key should be viewed as the method of choice in future dual-task studies.

An effective therapy for both undifferentiated (including Burkitt's) lymphomas and lymphoblastic lymphomas in children and young adults

We have used a single intensive chemotherapy regimen in the treatment of young patients with diffuse, aggressive, malignant lymphomas. There were two major histologic types of lymphoma in our series: lymphoblastic lymphomas, which presented most often with mediastinal tumor (64%), and undifferentiated lymphomas (mostly Burkitt's lymphomas), which occurred predominantly in the abdomen (86%). Our objective was to examine the determinants of prognosis in a uniformly treated patient group that included 31 children (2-16 yr) and 34 young adults 17-35 yr). Patients with extensive bone marrow involvement (greater than 50% replacement by tumor cells) were included in the study. Treatment consisted essentially of a 4-drug combination (cytoxan, adriamycin, vincristine, and prednisone) alternating with a 42-hr methotrexate infusion, followed by leukovorin rescue, and included intrathecal prophylactic therapy against central nervous system (CNS) disease. Patients with localized or resected undifferentiated lymphoma received 6 therapy cycles; all other patients received 15 cycles. Radiation therapy was used only in exceptional circumstances. Fifty-eight of 65 patients (89%) achieved complete remission: 97% of children and 82% of adults. The estimated 3-yr survival was 60% (SE 6.4%) with a median follow-up of 3 yr. Analysis of factors associated with remission duration and survival indicated that bone marrow involvement at referral and extensive disease were poor prognostic variables. Patients with lymphoblastic lymphomas and patients with completely resected undifferentiated lymphomas had the best prognosis (81% +/- 12% and 94% +/- 6% estimated 3-yr survival, respectively). Patients with extensive intraabdominal undifferentiated lymphoma (stage D) had the worst prognosis (33% +/- 11% estimated 3 yr survival), but even in this subgroup, bone marrow involvement was an adverse factor (estimated survival in stage D patients with and without bone marrow involvement was 14% +/- 13% and 43% +/- 15%, respectively). Elevated uric acid and/or lactic dehydrogenase (LDH) were also of prognostic significance, but predominantly reflected state, i.e., extent of disease. Age did not significantly influence prognosis. In the undifferentiated lymphoma subgroup, histology (i.e., Burkitt's lymphoma versus non-Burkitt's lymphoma) was not of prognostic significance. Total white count was below 1,000/cu mm in 39% of cycles, and fever associated with granulocytopenia occurred in 17% of cycles. Stomatitis of moderate to severe extent occurred in 50% of cycles.(ABSTRACT TRUNCATED AT 400 WORDS)

Glycosylation of plasma protein and its relation to glycosylated hemoglobin in diabetes

Glycosylation of plasma proteins was studied in diabetic and normal subjects by an adaptation of a thiobarbituric acid method previously used for glycosylated hemoglobin. There was a highly significant correlation between the degree of glycosylation in vivo of plasma protein and hemoglobin. The process of glycosylation depended on time and temperature and was not mediated enzymatically. Plasma protein of all molecular sizes could be glycosylated. At 37°C, 4.6% of 14C-glucose became attached to plasma protein after 24 h of incubation in vitro; no difference between normal and diabetic plasma protein could be demonstrated. After glycosylation, glucose dissociated from protein slowly; 72% remained attached after dialysis for 24 h. As an estimate of diabetic control, measurement of glycosylation of plasma protein is a suitable alternative to determination of glycosylated hemoglobin. Results of each method correlated equally well with the degree of diabetic control when this was assessed by calculation of the M-factor, mean plasma glucose concentrations, or variance of the plasma glucose determinations. In hemolytic anemia, hemoglobinopathy, and recent transfusion, measurement of glycosylation of plasma protein may be more accurate than that of glycosylated hemoglobin. It may also provide an estimate of diabetic control between that provided by short-term blood glucose determination and long-term glycosylated hemoglobin.

Determining the Season of Death of Mammal Teeth from Archeological Sites: A New Sectioning Technique

Alternating translucent and opaque bands on the roots of mammal teeth are used to determine the age and season of death. These structures are preserved in teeth from archeological sites. However, the standard sectioning technique, which includes decalcification, often destroys archeological specimens. A new, less destructive technique provides analyzable solid sections at costs comparable to decalcification.

Prospective study of angiotensin II response to positional change in pregnancy-induced hypertension

The response of endogenous angiotensin II levels to positional change, lateral to supine recumbency, was investigated in a prospective study of 55 primigravid patients during the last half of pregnancy. Blood samples were obtained in the lateral and supine recumbent positions. The mean supine angiotensin II level was significantly higher between 29 and 34 weeks' gestation in those patients destined to develop pregnancy-induced hypertension than in those who remained normotensive (P less than 0.05). As gestation advanced, the mean per cent relative change of angiotensin II from the lateral to the supine position altered from negative to positive in those patients destined to develop pregnancy-induced hypertension, whereas it remained negative in those patients who remained normotensive. These findings are discussed in relation to pathophysiologic alterations in the development of pregnancy-induced hypertension.

Effect of time-specific sets and patients' personality style on state and trait anxiety

60 subjects representing equal numbers of repressors arid sensitizers were matched for age and sex and evaluated on three measures of anxiety which differed in time span in which anxiety was estimated. As expected, sensitizers reported significantly greater anxiety than repressors regardless of the proximity of the time on which they based their estimates. A significant interaction between reports of anxiety and repression-sensitization demonstrated that sensitizers report less anxiety when recording their current condition than remote remembrances, whereas repressors tend to report essentially the same level of anxiety regardless of whether they are estimating their anxiety over “a year or two,” “a month or two,” or “now.”

Competition for meat between chimpanzees and baboons of the Gombe National Park

Both chimpanzees (Pan troglodytes) and baboons (Papio anubis) at the Gombe National Park in Western Tanzania are know to catch and eat meat. There are five occasions recorded when chimpanzees were seen to seize prey from baboons and five other occasions when there was evidence strongly suggesting that an appropriation had taken place. This paper describes these observations.

Diagnostic criteria for computer-aided electrocardiographic 15-lead system. Evaluation using 12 leads and Frank orthogonal leads with vector display

The criteria for the diagnosis of myocardial infarction and ischaemic heart disease by an automated 15-lead computer-aided electrocardiographic system were examined using electrocardiograms of 543 patients. Errors in the electrocardiographic diagnosis were evaluated for each lead system (Frank orthogonal 3-lead, 12-lead, and hybrid 15-lead) using clinical and catheterization data for definitive diagnosis before review of the electrocardiograms and their reports. The effects of combinations of these diagnoses and additional ventricular conduction defects were also studied. Myocardial infarction and left ventricular hypertrophy were more reliably diagnosed using 3-lead and 12-lead systems together than with either system alone. The most sensitive criteria for anterior infarction were a Q/R ratio in Z less than 0-1 and loss of the first 20 ms of anterior forces in the horizontal and sagittal planes of the vectorcardiogram. However, false positive results were frequent, particularly in association with left ventricular hypertrophy, non-specific intraventricular conduction defects, and left bundle branch system block. Our V lead criteria were more specific whether or not these associated conditions were present. No single criterion with an acceptable false positive rate could be found to be sensitive for inferior infarction in all situations. Our most sensitive criteria were those based on the limb leads, and the presence of superior forces for the first 30 ms in the frontal plane of the vectorcardiogram, but these were better in combination. Limb lead criteria were the most specific. False positive results for inferior infarction were more frequent in the presence of left ventricular hypertrophy or ventricular conduction defects other than left anterior hemiblock. ST and T wave abnormalities were more apparent in the 12 leads than in the orthogonal leads. Specificity and sensitivity of criteria were poor, and specificity was decreased and sensitivity was not significantly improved by combining 3-lead with 12-lead criteria. Because of frequent measurement errors of ST, T, and also Q waves by the computer programme, in practice we have achieved increased sensitivity in the diagnosis of ischaemia and infarction with the combination of 3-lead and 12-lead systems. It is concluded that errors of diagnosis by a computer-aided system can be reduced by using multiple leads and that both 12-lead and orthogonal 3-lead systems are necessary for optimal computer diagnosis of left ventricular hypertrophy, myocardial infarction, and ischaemia.