Effect of synchronous and asynchronous pulsatile flow during left, right, and biventricular bypass

Ventricular assist devices augment aortic or pulmonary flow while the patient's heart recovers from surgery or infarction. Most are used in the asynchronous full-to-empty mode, but they also may be used in a synchronous counter-pulsation mode. This study examines which assist mode optimally reduces myocardial oxygen consumption (MVO2). Eighteen pigs were instrumented with pulmonary artery, carotid artery, and coronary sinus catheters for determination of MVO2. Pierce-Donachy Ventricular Assist Devices (VAD) were used in left, right, or biventricular assist mode. Fifteen minute periods each of control, synchronous, and asynchronous bypass were randomly instituted. The mid-left anterior descending coronary artery was then ligated, and the sequence repeated. At the end of each period, MVO2 was determined. In comparison with controls, MVO2 was statistically significant in the BIVAD asynchronous mode only. Synchronized counterpulsation did not decrease MVO2. When ventricular assist devices are used to aid in cardiac recovery postoperatively or postmyocardial infarction, biventricular assist should be used.

Hemoperitoneum secondary to traumatic rupture of an adrenal tumor in a dog

Hemoperitoneum secondary to traumatic rupture of an adrenocortical adenocarcinoma was diagnosed in a 10-year-old male dog. Immediate surgical attention was required to remove the tumor and to control hemorrhage. The dog appeared to develop transient hypoadrenocorticism after surgery, but recovered with short-term exogenous corticosteroid administration. At 6 months after surgery, the dog was clinically normal.

Physical determinants of the endocardial P wave

Reliable atrial sensing of intrinsic P wave activity is important to ensure optimal atrial or dual chamber pacemaker function. Various physical factors (e.g., posture, respiration, exercise) may influence P wave characteristics and impair adequate sensing. To investigate this phenomenon, we measured the average of three P wave amplitudes (PWA) and calculated slew rates from telemetered printouts acquired from Pacesetter pacemakers in 32 patients. These measurements were performed in various body positions, with upright exercise and in varying stages of respiration.

RESULTS

the mean supine PWA increased on full inspiration (3.56 +/- 1.3 mV versus 3.25 +/- 1.2 mV during quiet respiration, P less than 0.001), and also increased significantly with full expiration. The mean PWA increased on assuming the erect position (3.25 +/- 1.2 mV increasing to 3.49 +/- 1.3 mV, P less than 0.001); in the upright position, the mean erect PWA during quiet respiration was not significantly influenced by the stage of respiration. The mean upright exercise PWA did not differ significantly from the preexercise erect PWA (3.50 +/- 1.2 with exercise, and 3.47 +/- 1.5 before exercise; P = NS). Calculated slew rates were not different lying versus standing.

CONCLUSIONS

the mean supine PWA increases significantly at the extremes of respiration and on assuming the erect body position; upright exercise results in no appreciable change in the erect PWA. Atrial sensitivity adjustments based on standard supine testing should be adequate for all body positions.

True incidence of pacemaker syndrome

Although the purported incidence of pacemaker syndrome according to the literature is only 5%-15%, this is based on a series of patients with VVI pacing. Increasing numbers of studies are being reported in which patients prefer the dual chamber mode despite little benefit being demonstrated on objective testing, suggesting that pacemaker syndrome may be more common than is generally reported. This study was designed to evaluate the reported symptoms in a series of patients programmed to both the VVI and one or more dual chamber modes. Forty unselected patients with dual chamber pacemakers were entered into a blind, randomized trial comparing the symptoms associated with VVI pacing to those associated with dual chamber pacing. Patients were randomized to either VVI or dual chamber pacing. At the end of 1 week, questionnaires rating 16 different symptoms were completed. Blood pressure, LV function, presence of ventriculoatrial conduction, and ability to override the pacemaker were evaluated. The pacemaker was then programmed to the other mode. Overall, 12 of 16 symptoms were significantly worse in the VVI as compared to dual chamber mode. The most highly significant (P less than 0.005) were shortness of breath, dizziness, fatigue, pulsations in the neck or abdomen, cough, and apprehension. Pacemaker syndrome was clinically recognized in 83% of patients paced in the VVI mode with 65% of patients experiencing moderate to severe symptoms. There were no readily identified clinical, hemodynamic, or electrophysiological parameters that predicted which patients would develop pacemaker syndrome. Thus, when patients have an opportunity to experience both pacing modes in close proximity to one another, there is a high incidence of pacemaker syndrome in the VVI mode.

Quantitation of vesico-ureteral reflux by radionuclide cystography and urodynamics

A method is described for the quantitation of vesico-ureteral reflux by synchronous combined direct radionuclide cystography and urodynamics. Intravesical pressures and volumes are co-ordinated with volumes of reflux. Peak reflux volumes in 11 children diagnosed as having severe (grades 3-4) reflux on conventional contrast cystography ranged from 1 to 50 ml/kidney. A number of different patterns of reflux were observed. Reflux may occur progressively throughout low pressure filling or incrementally with unstable bladder contractions. Reflux during voiding may be maximal as detrusor pressure falls. The method requires wider application to explore the potential for a functional classification of the reflux problem.

Impact of new radiotherapy modalities on the surgical management of cancer of the esophagus and cardia

At the Cancer Control Agency of British Columbia, 483 patients with cancer of the esophagus and cardia were seen from 1970-1980. Four hundred and one out of 483 (83%) had tumors larger than 5 cm (T2) and in 288/483 (60%) the disease had extended beyond the esophageal wall (T3). The overall 5-year survival rate was only 9% for all patients treated by external irradiation. The 5-year survival for a selected group having esophagectomy was 20%. Most patients died of persistent cancer at the primary site (83%); the cause of death was aspiration pneumonia (82%) due to obstruction caused by the persistent cancer. Our most recent experience using intracavitary irradiation either prior to or after external irradiation in 211 patients has been safe and simple and preliminary analysis of treatment results suggests that it has improved the therapeutic ratio. The analysis of quality of life at 6 months following therapy as it relates to performance status, swallowing ability, weight, and pain indicated significant improvement in all of these parameters. Of 171 patients, 33% were still alive at 1 year, 26% at 2 years, and 19% at 3 years following treatment. Of 43 patients suitable for preoperative irradiation, only 26 patients were actually resected and 19 of them are still alive with no evidence of disease, 8 to 30 months. The rationale and technical aspects of the combined treatment are described in detail. Treatment results, complications and an outline for future programs based on this experience are also described.

Two routes for 99mTc-DMSA uptake into the renal cortical tubular cell

Critical factors determining the renal handling of 99mTc-dimercaptosuccinic acid (DMSA) are protein binding in plasma and the renal 99mTc-DMSA extraction efficiency. Comparison of the count rate over soft tissue with that over the cardiac blood pool about 1 h after injection demonstrated that 99mTc-DMSA is not exclusively an intravascular label. 99mTc-DMSA was 76% protein bound in plasma as demonstrated by HPLC and gel filtration. Assuming that the 24% that is not protein bound is filtered at the glomerulus, the renal extraction efficiency of 99mTc-DMSA by glomerular filtration is about 5%. Since the total renal extraction efficiency was also found to be about 5%, the majority of the activity that becomes fixed in the renal cortex arrives there as a result of filtration followed by tubular reabsorption rather than by direct extraction from peritubular blood. However, discordant changes in DMSA and DTPA uptake induced by captopril in renovascular hypertension (RVH) suggested that a minority of uptake was by direct peritubular extraction. This kinetic model was supported by indirect measurement of protein binding and extraction efficiency based on the kinetics of 99mTc-DMSA disappearance from plasma and kinetics of uptake in the kidneys. Furthermore, differential functional studies based on 99mTc-DMSA and 99mTc-DTPA before and after captopril in patients with RVH due to unilateral renal artery stenosis confirmed filtration followed by tubular reabsorption as the predominant route for DMSA uptake by the kidney.

Background in 99Tcm DTPA renography evaluated by the impact of its components on individual kidney glomerular filtration rate

Following injection for renography, 99Tcm-labelled diethylenetriamine-pentacetic acid (DTPA) rapidly enters the extravascular space. Background therefore comprises two components, a falling intravascular signal and an extravascular signal which initially rises. We estimated the relative magnitudes of these two components in terms of their impact on the calculation of differential renal function and individual kidney glomerular filtration rate (IKGFR) from the second phase of the 99Tcm-labelled DTPA renogram in 56 paediatric kidneys. We expressed each of the two background signals as a GFR equivalent. The GFR equivalent of the intravascular signal recorded from a peri-renal background region of interest (ROI), scaled by a factor equal to the ratio of the pixel numbers in the renal and background ROIs, was -39 (S.D. 14) ml min-1. The GFR equivalent of the extravascular signal was smaller than this and opposite to it at 23 (S.D. 10) ml min-1, giving a median ratio for the two equivalents of -1.68. Because of the opposing effects of the two background components on the second phase of the renogram, techniques recently described for the quantification of IKGFR from the renogram, and which eliminate the intravascular component, offer no theoretical advantage over a method of analysis which uses 'direct' subtraction of the total background signal. In practice, however, these new techniques are superior in their handling of 'noisy' data, consistently giving a lower coefficient of variation in their estimation of IKGFR.

The biodistribution and pharmacokinetics of meta-iodobenzylguanidine in childhood neuroblastoma

MIBG is generating considerable interest for the treatment of neuroblastoma. This study has investigated the biological variation in handling of the compound in children with neuroblastoma. The biodistribution of the compound has been characterised in children undergoing tracer administrations of 123I and 131I-mIBG. Estimates of hepatic and whole body radiation dose delivery have been made. The results indicate substantial interpatient variation in hepatic dose delivery. This organ may be critical in some patients undergoing targeted radiotherapy with mIBG.

Abnormalities of copper in Gilles de la Tourette syndrome

The Gilles de la Tourette syndrome is a disorder whose etiology and pathogenesis are little understood. The number of biochemical abnormalities described in this disorder is minimal. Ten of a total of 80 patients were found to have an abnormally low serum copper. A report is presented on two patients who consented to further detailed investigation and in whom copper radioisotope studies were carried out. Both exhibited abnormalities of copper handling, in that we observed an abnormally fast disappearance of copper from the plasma and an abnormally slow uptake by the liver. The rates of intestinal absorption and urinary excretion were normal. We did not identify an abnormal site of sequestration of the metal in the body.

Laser treatment of obstructive endobronchial tumors: factors which determine response

To investigate whether computerized tomography (CT) and radionuclide quantitative ventilation-perfusion lung scan add any useful information to a carefully performed endoscopic examination in determining the response of patients with obstructive endobronchial tumors to laser treatment, the findings in 40 patients treated with photodynamic therapy (PDT) or the Nd:YAG laser were analysed. Endoscopic laser treatment was found to be most effective when the tumor was polypoid in appearance bronchoscopically, with little or no submucosal invasion or peribronchial extension seen on CT. When bronchoscopy and CT showed increasing submucosal and/or peribronchial disease, the immediate and long-term response to treatment was poorer. CT provided valuable information regarding the extent of the peribronchial involvement and airway distortion which were often underestimated by bronchoscopy alone. Reduction of regional perfusion out of proportion to ventilation on scintigraphy in the involved lung zone was found to be associated with extensive peribronchial involvement. We conclude that the addition of CT and radionuclide quantitative ventilation-perfusion lung scan to bronchoscopic examination is useful in predicting the response of patients with obstructive endobronchial tumors to laser treatment. Whether PDT or YAG laser is more effective in relieving endobronchial obstruction by tumor awaits a randomized controlled trial.

Children's pain vocabulary

This paper will address children's pain vocabulary, that is, the self-reported words provided by the children, in a descriptive study carried out to examine how a group of school-age children view their pain. This was an initial step to demonstrate that children can describe pain and do possess a pain vocabulary. Our aim was to determine the feasibility of achieving a meaningful grouping of children's pain words and the pain intensity implied by the words. A sample of 40 school-age children were the subjects for this study. All the pain word descriptors used by the children in response to the question 'Can you think of words to describe what pain feels like?' were categorized on the basis of the Melzack classification.

Isolation of a cDNA clone coding for a possible neural nicotinic acetylcholine receptor alpha-subunit

We have isolated a complementary DNA clone containing sequences homologous to those encoding the alpha-subunit of a mouse muscle nicotinic acetylcholine receptor. Based on the structural similarities between the encoded protein and the muscle acetylcholine receptor alpha-subunit, and the presence of hybridizing RNA species in the brain, we propose that this clone codes for a neural nicotinic acetylcholine receptor alpha-subunit.

Isolation and sequence of cDNA clones coding for the precursor to the gamma subunit of mouse muscle nicotinic acetylcholine receptor

cDNA libraries have been constructed in plasmid (pBR322) and bacteriophage lambda gammagt10) vectors with poly (A+) RNA isolated from the nonfusing mouse muscle cell line BC3H-1. The libraries were screened with a restriction fragment derived from a genomic clone coding for a human acetylcholine receptor gamma subunit. Several clones were obtained whose cDNA inserts possessed nucleotide and deduced amino acid sequence homology with acetylcholine receptor gamma subunits from Torpedo californica, chick, calf, and human. One isolate, lambda BMG419, has 88 nucleotides of 5'-untranslated sequence, an open reading frame of 1,557 nucleotides coding for the precursor to the mouse acetylcholine receptor gamma subunit, and 144 nucleotides of 3'-untranslated sequence. Alignment of the lambda BMG419-deduced amino acid sequence with homologs from other species predicts a precursor peptide of 519 amino acids and a mature protein of 497 amino acids, with nonglycosylated molecular weights of 58,744 and 56,424 daltons, respectively. Comparison of the deduced amino acid sequence of the mouse gamma subunit with Torpedo, chick, calf, and human sequences showed overall homologies of 54%, 67%, 90%, and 90%, respectively; however, significantly higher homologies were found in several putative functional domains. Radiolabeled lambda BMG419 has been used to identify homologous RNA species, one of approximately 2 kb and one of about 3.5 kb, in poly (A+) RNA prepared from BC3H-1 cells and denervated mouse limb muscle. gamma Subunit-coding RNA species are considerably more abundant in denervated than in innervated muscle, suggesting that neural regulation of the abundance of the gamma subunit is exerted through regulation of the amount of its mRNA.

Autoreactive rat T-cell lines: establishment and cellular characteristics

Stable self-reactive T-cell lines were established from the draining lymph nodes of Buffalo rats primed with rat thyroglobulin (Tg) in complete Freund's adjuvant. Following two rounds of in vitro selection with Tg or with purified protein derivative (PPD) of Mycobacterium tuberculosis, Tg- or PPD-specific lines were selected. Self-reactivity, manifested by a potent proliferative response of these lines to syngeneic stimulators in the absence of the selecting antigen (Tg or PPD), emerged by 3-4 weeks after the establishment of the lines. This proliferation could not be attributed to reactivity against heterologous serum components. Despite this syngeneic mixed-leukocyte reaction (SMLR) which was readily detectable, specific stimulation by Tg or PPD over the level of the SMLR could still be demonstrated. These lines also responded to concanavalin A but not to allogeneic stimulator cells. More than 95% of T cells of these lines displayed the rat T-helper-cell-specific (W3/25) marker and they secreted a defined lymphokine, T-cell growth factor (TCGF), upon stimulation with syngeneic stimulator cells, independent of the presence of soluble antigen. T-Cell lines such as the ones described here will be useful in elucidating the biological significance of the AMLR/SMLR and its relation to nominal antigen reactivity.

Pyloric stenosis: children vs sibs

Images

Successful medical management of bilateral ureteral obstruction due to acute uric acid nephropathy

Images

Carbohydrate malabsorption in infants with diarrhea studied with the breath hydrogen test

Fermentation of malabsorbed carbohydrate (CHO) reaching the colon was studied by measuring peak breath hydrogen (H2) production between feedings in 28 H2-producing hospitalized infants with diarrhea. Patients who required fewer than six days of hospitalization had lower breath H2 values when tested soon after admission than those who required longer stays. Patients hospitalized for more than five days had lower H2 amounts at discharge than on admission. Peak breath H2 values decreased when glucose was substituted for glucose polymers in formulas, or when the formula was fed by continuous drip via a nasogastric tube instead of by orally administered bolus. Glucose-positive and acidic stools were encountered occasionally and were associated with decreased H2 levels. The responses of H2 levels, stool pH, and glucose excretion after changes in patient management or intestinal metabolism of CHO reflect alterations in the balance between proximal intestinal absorption and distal colonic fermentation. Malabsorbed CHO that reaches a competent colon is utilized via microbial conversion, as indicated by high H2 levels, in the absence of glucose-positive and acidic stools. The presence of glucose in the feces or acidic stools indicates an inability of the colon to completely metabolize and absorb CHO or its products of fermentation.

A family study of isolated cleft palate

A family study was based on 245 boy and 329 girl patients treated surgically for non-syndromic cleft palate between 1920 and 1929; 86 and 81 respectively were traced and had had children. These 167 were the probands for the family study and were interviewed in their homes. None was born to a consanguineous marriage. Altogether they had had 384 children of whom 11 had cleft palate (2.9 +/- 0.9%). They had 398 sibs of whom five had cleft palate, 117 grandchildren of whom one was affected, and 517 nephews and nieces of whom one was affected. This is the largest series yet available on which to base an estimate of the risks to children of patients with non-syndromic cleft palate. The risk is probably increased where a parent or sib of the proband is affected and increased to a lesser degree where a second or third degree relative is affected. The family patterns in these and other studies suggest that the aetiology of cleft palate is heterogeneous, with some families showing modified dominant inheritance. This is in contrast to cleft lip (+/- cleft palate) where the data are consistent with a multifactorial threshold model.

Local cerebral glucose utilization in the symptomatic thiamine-deficient rat: increases in fornix and pyramidal tract

Local cerebral glucose utilization (LCGU) was measured in asymptomatic rats on a thiamine (B1)-deficient diet for 70 days and in symptomatic rats on a B1-deficient diet for 98 days. LCGU increased in postcommissural fornix (F), pyramidal tracts (P), and inferior internal capsule (CAI) of symptomatic, compared with asymptomatic B1-deficient rats but decreased in thalamic nuclei, auditory structures, and lesioned vestibular nuclei. B1 administration to symptomatic rats improved symptoms; decreased LCGU in F. P, and CAI; increased LCGU in the lesioned vestibular nuclei; but decreased LCGU in mammillary nuclei, anteroventral nucleus of thalamus, and medial raphe. The results indicate that B1 deficiency symptoms correlate with LCGU changes in F and P and vestibular nuclei.

A three generation family study of cleft lip with or without cleft palate

A family study of cleft lip, with or without cleft palate, was based on those treated by operation at The Hospital for Sick Children, London, between 1920 and 1939 in order to give information on the proportion affected of children and grandchildren. The probands were those who had survived, were successfully traced, and found to have had at least one child. Care was taken to exclude patients who were traced through a child, whether normal or affected, and not through the usual tracing procedure. Patients with recognised syndromes were also excluded. Because the series was based on patients who had survived and reproduced it was biased in favour of those with milder degrees of the malformation, and against those with any severe associated malformation. The proportion affected of children of probands was 3.15% (+/- 0.56), of sibs 2.79% (+/- 0.52), and of parents 1.18% (+/- 0.37), respectively. The lower proportion of parents affected is attributed to reduced reproductive fitness of patients born two generations ago. The proportion affected of nephews and nieces, aunts and uncles, and grandchildren was 0.47% (+/- 0.18), 0.59% (+/- 0.13), and 0.8% (+/- 0.6) respectively. The proportion affected of first cousins was 0.27% (+/- 0.08). The birth frequency of cleft lip (+/- cleft palate) is estimated to be about 0.1% in England. There were two first cousin and one second cousin marriages among the marriages of the parents. There was no increase of cleft palate among the relatives of the probands. The proportion of sibs affected increased with increasing severity of the malformation in the proband, where the proband was female, and where the proband had an affected parent or already had one affected sib. It was not, however, increased where a more remote relative was affected. The proportion of children affected was not increased when the proband had an affected parent or sib, but few families provided information. The most economical hypothesis to explain the findings is the multifactorial threshold model. The birth frequency of the malformation and the family patterns found make it improbable that one single mutant gene makes a major contribution to the liability to develop the condition.

Regional (14C) 2-deoxyglucose uptake during vibrissae movements evoked by rat motor cortex stimulation

Repetitive left mystacial vibrissae movements were produced by electrical stimulation of right motor cortex (MI) were a bipolar electrode in the alert, unanesthetized rat. Regional increases of (14C) 2-deoxyglucose (2DG) uptake were mapped autoradiographically during these left vibrissae movements. Uptake of 2DG increased in a 2-4-mm-diameter area about the stimulating electrode in right MI and in a smaller region in left MI cortex. Columnar increases of 2DG uptake occurred bilaterally in somatosensory cortex in the face region of somatosensory cortex (SI). Bilateral increases of 2DG uptake occurred subcortically in dorsolateral caudate-putamen (CP) and subthalamic nucleus. Primary right-sided increases of 2DG uptake occurred in other basal ganglia structures including dorsal globus pallidus (GP), posterior, entopeduncular nucleus (EPN), ventrolateral substantia nigra pars reticulata (SNr), and anterolateral substantia nigra pars compacta (SNc). Uptake of 2DG increased on the right side of the following thalamic regions: much of the ventrolateral (VL) nucleus, particularly dorsally; the anterodorsal reticular nucleus; dorsolateral posteromedial (POm) nucleus; the ventromedial nucleus; and dorsolateral parafasicular nucleus. The anterior and ventral posterior portions of VL were not activated. Caudal to thalamus right-sided 2DG uptake increased in the medial, ventral, and lateral pontine nuclei, deep layers of superior colliculus, lateral deep mesencephalic nucleus (DMN), and nucleus cuneiformis (NCU). UPtake of 2DG increased in right rostral parvocellular and red nucleus in a few animals. Discrete portions of the right internal capsule and right medial pyramidal tract increased 2DG uptake during MI stimulation. Uptake of 2DG increased on the left side of the brain during right MI stimulation in the left lateral nucleus (NL) of cerebellum and in several discrete regions of left cerebellar hemisphere granule cells including anterior paravermis, lobulus simplex, crus II, and the paramedian lobule. Uptake of 2DG increased in left nucleus of the spinal tract of the trigeminal nerve (ntV) ventrally in subnuclei interpolaris and oralis. Left lateral portions of the facial nucleus were activated in a few animals. The lateral portions of the facial nucleus are known to project to vibrissae musculature. All of the above structures may be involved in the motor-sensory processing responsible for vibrissae movements. Regions not previously suggested to play a major role in vibrissae movements include DMN and NCU. Though NCU has been called the "locomotor center" it may play a role in facial movements as well. Polysynaptic activation of GP, EPN, NL, and cerebellar hemisphere occurred since no connections between MI and these regions exist. A pathway from ntV to POm to MI and SI is suggested to provide proprioceptive input to motor-sensory cortex from the moving vibrissae since neither the principal trigeminal sensory nucleus nor the ventrobasal nucleus of the thalamus increased 2DG uptake during MI stimulation.

Effects of Host Variety, Photoperiod and Chemical Treatments on Hatching of Globodera rostochiensis

Golden nematode cysts were collected after they had completed one generation on an early, a mid-season, or a late-maturing potato variety ('Superior,' 'Katahdin,' and 'Sebago,' respectively). The plants were grown in 8.5- or 16-h photoperiods and treated with gibberellic acid (GA) or xylocaine or both. When treated subsequently with potato root-diffusate few (13.3%) juveniles hatched from cysts collected from Sehago, more (22.3%) from cysts collected from Katahdin, and most (36.0%) from cysts collected from Superior. Hatching was greater from cysts collected from plants treated with GA than from untreated plants. Short photoperiods decreased hatching from cysts collected from Katahdin but increased hatching from cysts collected from Superior and Sebago. Gibberellic acid had no detectable effect on hatching, but EDTA had some.

Survivors of neuroblastoma and ganglioneuroma and their families

The main purpose of this study was to see if the offspring of surviving neuroblastoma, ganglioneuroblastoma, or ganglioneuroma patients have themselves a risk for developing tumours. No such risk was found. There was a total of 45 liveborn children who were all healthy. These children have passed through about 37 lifetimes of risk for developing neuroblastoma and about six lifetimes of risk for developing ganglioneuroma. No excess of cancers was found among parents and sibs. It was interesting that there was a large female excess (35:12) among these survivors. One factor which may give rise to a better prognosis in females is the tendency of their tumours to mature to benign forms.

Thiamine deficiency limits glucose utilization and glial proliferation in brain lesions of symptomatic rats

The effects of thiamine (B1) deficiency on local CMRglu (LMCRglu) in the vestibular nuclei were studied with the 14C-2-deoxyglucose autoradiographic method in awake asymptomatic and symptomatic rats. Animals on the B1-deficient diet for 98 days developed symptoms of ataxia and opisthotonos. The results show that B1 deficiency produces: (1) bilateral vestibular nuclei lesions in symptomatic animals; (2) very low LCMRglu rates in these lesions; and (3) limitation of glial proliferation in the lesions. Giving B1 to B1-deficient symptomatic animals produced a cellular proliferation response consisting mostly of microglia in the lesioned areas of the vestibular nuclei and a high LCMRglu rate in the regions of microglial proliferation.

A comparison between digital examination and per-rectal ultrasound in the evaluation of the prostate

Three hundred and fifty-two patients have been examined by per-rectal ultrasound and histological confirmation of the diagnosis was obtained in 242 cases. Per-rectal ultrasound compared favourably with digital palpation both as a method of diagnosing prostatic cancer and also as a method of staging a primary tumour. Confirmation of the accuracy of this technique as a method of staging was gained by a study involving the use of cadaver material. Repeat examinations on patients with prostatic carcinoma have shown that per-rectal ultrasound is an ideal method for monitoring response of the primary tumor to treatment.

Per rectal ultrasound in the investigation of prostatic disease

Primary prostatic disease is usually assessed by digital palpation of the prostate. This method lacks objectivity and has been shown to be inaccurate, especially in the staging of primary prostatic cancer. This paper describes the investigation of 200 subjects using per rectal ultrasound. Of 70 patients with histological evidence of carcinoma of the prostate, 96% were correctly diagnosed ultrasonically and 87% correctly diagnosed by digital palpation. Of the 37 patients with ultrasonic evidence of a capsular breach, only 65% were diagnosed as such by digital palpation. A study of 10 cadaver specimens confirmed the accuracy of per rectal ultrasound as a technique for staging primary prostatic cancer . The ultrasonic appearances of the prostate, seminal vesicles and bladder base are described. Per rectal ultrasound is acceptable to patients, and its use is recommended in all cases where accurate assessment of primary prostatic cancer is required.

Canine ventricular arrhythmias in the late myocardial infarction period. 8. Epicardial mapping of reentrant circuits

We made simultaneous recordings from 48 bipolar electrodes to obtain epicardial isochronal maps during induced ventricular arrhythmias in dogs 3-5 days after ligation of the left anterior descending artery. There was strong evidence of a reentrant circuit (RC) that was discernible largely on the epicardial surface in 21% of ectopic beats that were analyzed. Epicardial recordings were of limited value in analyzing the arrhythmia in other beats. The reentrant circuit consisted of an arc of conduction block around which the activation front advanced in a circular fashion at slow but uneven speeds while the rest of the ventricle was activated by radial spread. The arc of conduction block around which the RC was formed was usually functional in nature, since the same area of myocardium was excitable at relatively long cardiac cycle lengths. Both the length of the arc of conduction block which defines the length of the reentrant circuit and the degree of conduction delay were crucial factors for the occurrence of reentry. A premature beat that initiated reentry resulted in a longer arc of conduction block and slower conduction compared to one that failed to induce reentry.

An X-linked disease of the nervous system with disordered copper metabolism and features differing from Menkes disease

We studied 2 of 4 affected boys with a new disease associated with abnormalities of copper metabolism. The four cases occurred in two generations of a family. This syndrome was similar to Menkes disease in some respects: X-linked recessive inheritance, marked psychomotor retardation with seizures, low serum copper and ceruloplasmin levels, and a block in gut copper absorption. There were also striking differences from Menkes disease. Patients had normal birthweight at term, no hypothermia, and survived beyond the usual Menkes age group with static neurologic disease including hypotonia and choreoathetosis. In addition, general examination of both children was unremarkable apart from undescended testes and growth retardation. The hair, facies, and skin were normal and there was no radiologic evidence of bony changes. Detailed studies of copper absorption were performed.

Children of those treated surgically for Hirschsprung's disease

The risk of recurrence of Hirschsprung's disease in sibs is reasonably well established. Survivors of early successful operations (rectosigmoidectomy) are now reaching adult life and are asking about risks to their children. The authors report a preliminary study on which to base a risk estimate. Studies on sibs show that for short segment index patients the risk to brothers is about 1 in 20 and for sisters about 1 in 100. For long segment patients the risk is about 1 in 10 irrespective of sex. In the present study it was found that one son in 52 was possibly affected, and one daughter in 47 was certainly affected, of short segment index patients. Of long segment index patients one son in three was probably affected, and the one daughter was certainly affected. One long segment patient had a child with a short segment affected and one short segment patient had a child with a long segment affected. This confirms the impression, given by single case reports of parent and child affected, that there is less likelihood of concordance in length of aganglionic segment in parent and child than in sibs. For the present it is appropriate to give an estimated risk of about 2% for offspring of short segment index patients, but a relatively higher risk for offspring of long segment index patients.

The grandchildren of patients with pyloric stenosis

Of 138 grandchildren of patients, four had pyloric stenosis confirmed at Ramstedt's operation. For the four categories of grandchildren of male index patients the proportion affected was 0/27, 1/17, 1/41, and 0/35 for sons' sons, sons' daughters, daughters' sons, and daughters' daughters, respectively. For the four categories of grandchildren of female index patients the proportion affected was 0/5, 1/3, 0/5, and 1/5, respectively. Though numbers are small certain findings are noteworthy. The relatively high risk to the relatives of female index patients appears even more marked in the grandchildren than the children. The grandchildren of male index patients show the sharp decrease in proportion affected that one would expect with a multifactorial threshold model, but of the few grandchildren born so far to female index patients, as many are affected as the children. In only one of the four instances was the affected grandchild born to an affected child. There is no support for the hypothesis that the higher risk to the children of female index patients is the result of a direct maternal effect on the developing fetus.

Offspring of patients with tracheo-oesophageal fistula

One previous study has shown that the proportion affected of sibs of index patients with tracheo-oesophageal fistula is low. The survivors of the first successful operations for tracheo-oesophageal fistula are now reaching adult life, thus making possible a preliminary estimate of the proportion affected of children of index patients. From the records of two London hospitals a list of 99 consecutive patients was compiled; they were alive after operation and not known to have died since. Of these, 7 were living abroad, 4 were not willing to co-operate, and 9 (alive when last seen at hospital and probably still living) were not traced. The families of the remaining 79 were visited.

Of the 79, 15 were found to have had children; 13 of these had the common type 3b oesophageal atresia (with a fistula between the trachea or main bronchus and lower segment of the oesophagus) and the other two probably had the same lesion. These 15 patients have so far had 28 children and only one had tracheo-oesophageal fistula (again type 3b).

The 79 patients had had 130 sibs, of whom one had oesophageal atresia (without fistula), 3 had neural tube defects, and 2 had pyloric stenosis.

The series, though small, already indicates that the proportion affected of children of patients is too small for the disorder in the parents to have been caused by a dominant mutation. For genetic counselling it is, perhaps, reasonable for the present to assume that the risk to children is similar to the risk for sibs and may not be more than 1%.

A family study of renal agenesis

A family study of bilateral renal agenesis was undertaken based on 103 patients with bilateral renal agenesis, ascertained through stillbirth and neonatal death certificates, and confirmed by necropsy reports; 28 were ascertained through paediatric pathologists. The families of 108 of these were traced and visited.

The birth frequency in the year in which ascertainment was likely to be most complete, 1974, was estimated to be 0·12 per 1000 total births, but it is recognised that this will be an underestimate. No significant variation was found by geographical region, parental birth place, socioeconomic class, maternal age, or birth order. There was, however, an excess of conceptions in the spring quarter (March, April, and May), similar to, but in this series more marked than, that seen in neural tube malformations.

The proportion of sibs affected was 7 in 199 (3·5%); of these, 6 were bilaterally and 1 was unilaterally (with an enlarged contralateral cystic kidney) affected. This is rather too high to be explained by multifactorial inheritance unless the estimate of the birth frequency is much too low. The proportion of sibs affected was similar for index patients with `single' bilateral renal agenesis, with only embryologically related malformations, and for index patients with associated malformations of unrelated bodily systems. Of the 199 sibs, 5 had neural tube malformations, but in 3 of these instances the index patient also had a neural tube malformation as well as renal agenesis. Where the index patient had ureteric remnants, 1 in 12 sibs were affected, but this high proportion may well just be a chance effect.

Coincidence within families suggests that unilateral renal agenesis is genetically related to bilateral renal agenesis, and that cases of bilateral renal agenesis without ureters are not genetically different from those with ureteric remnants.

An unusual neurological disorder of copper metabolism clinically resembling Wilson's disease but biochemically a distinct entity

A patient with progressive neurological disease resembling Wilson's disease but in whom Kayser-Fleischer rings were absent, was given 67Cu and 64Cu, orally and intravenously, to measure the rate of absorption of copper using a convolution integral. The data show an abnormal distribution of body copper resulting in low copper concentrations in plasma, urine and liver but with an accumulation in the lower bowel probably due to a defect in mucosal transport. The importance of differentiating this condition from Wilson's disease is stressed.