Resurgence of congenital syphilis in Trinidad

Twenty-eight cases of congenital syphilis (CS) were diagnosed shortly after birth at the Mount Hope Women's Hospital, Trinidad, during the period January 1985 to December 1988. The average annual incidence of CS was 115 per 100,000 live births, and the absolute number of cases and annual incidence doubled in the latter 2 years of the study. Diagnostic criteria used were a positive VDRL test in the 23 liveborn infants (100 per cent), signs suggestive of CS and confirmatory post-mortem findings. All mothers attended antenatal clinic at least once and 18 (64 per cent) were 25 years or younger. Only 17 (68 per cent) of the 25 gravidae with a positive VDRL test received treatment. Of 11 untreated gravidae, two did not have a VDRL test done, one had a negative VDRL test, three delivered before test results became known, one went into labour before going for treatment, and four (two of whom were substance abusers) did not comply with instructions to obtain treatment. There were five stillbirths and five neonatal deaths. There was no perinatal mortality when treatment was given earlier than 5 weeks before delivery, but mortality increased steeply if treatment was delayed or not given at all during pregnancy. Factors which contributed to this rise in the incidence of CS were an increased incidence of syphilis in females and failure to treat infected pregnant women.

Occurrence of diabetes mellitus after gestational diabetes mellitus in Trinidad

We undertook this study to determine the incidence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) after gestational diabetes mellitus (GDM). It is a follow-up study of a consecutive sample of women with GDM in a tertiary care center in Trinidad, West Indies. The cohort was a consecutive sample of 157 women with GDM who delivered in the hospital between June 1981 and December 1984. Of these, a volunteer sample of 60 women (38%) consented to participate 3.5-6.5 yr later. The two groups were remarkably similar in ethnic composition, mean age at index delivery, marital status, and family history of DM. Interviews revealed that 26 women (43%) had already developed DM for which they were receiving treatment. The remaining 34 women (57%) were given a 2-h 75-g oral glucose tolerance test, and fasting and half-hourly venous blood samples were obtained and analyzed for plasma glucose. Based on accepted diagnostic criteria, 11 (32%) of 34 had DM, 10 (29%) had IGT, and 13 (38%) had normal glucose tolerance. A total of 37 (62%) of 60 women had developed DM, and another 10 (17%) had IGT in the intervening 3.5-6.5 yr. The results support findings that GDM is associated with an increased risk of mothers developing DM in later life.

Replacement of histone H1 by H5 in vivo does not change the nucleosome repeat length of chromatin but increases its stability

In vivo competition between histones H1 and H5 for chromatin has been studied in rat sarcoma XC10 cells transfected with a glucocorticoid responsive MMTV-H5 gene. Activation of H5 expression results in accumulation of H5 in the nuclei where it partially replaces H1. H5 displaces H1 from its primary binding sites presumably during chromatin replication and also binds with high affinity to secondary chromatin sites normally not occupied by H1. Replacement of H1 by H5 to levels similar to those of mature chicken erythrocytes does not alter the nucleosome repeat length of chromatin. This indicates that H5 is not solely responsible for the increase in nucleosome spacing of maturing erythroid cells. Exchange of H1 by H5 in vivo or in vitro results in a higher compaction/stability of chromatin.

A review of 36 babies with necrotizing enterocolitis

The clinical features, management, and outcome of 36 babies with necrotizing enterocolitis seen over 5 years at the Neonatal Unit, Mount Hope Women's Hospital, Trinidad, are described. The crude overall mortality rate was 25 per cent. The results suggest that prematurity, sepsis, and umbilical catheterization, but not enteral feeding or polycythaemia may be involved in the aetiology of this disease.

Patterns of engrailed protein in early Drosophila embryos

By the onset of gastrulation during nuclear cycle 14 of Drosophila embryogenesis, the engrailed gene is expressed in fourteen one-cell-wide stripes. Each stripe defines the anlagen of the posterior compartment of a metameric segment. We report here several observations relating to the role and disposition of the engrailed protein during the embryonic stages that precede cellularization. We demonstrate that in embryos mutant for the engrailed gene, there were characteristic morphological abnormalities as early as the 6th cleavage cycle. In addition, the engrailed protein was detected in pre-cycle-9 embryos by Western blot analysis. When localization of engrailed protein begins during cycle 14, engrailed expression was first present in broad anterior and posterior regions before the fourteen-stripe pattern appeared.

The extent of small fibre sensory neuropathy in diabetics with plantar foot ulceration

Thresholds for cutaneous warming and cooling stimuli were measured in 20 diabetics with neuropathic foot ulcers. All patients had a profound disturbance of sensory perception in the ulcerated foot with complete loss of perception of warming; thresholds for vibration and cooling were highly abnormal in all but two patients. Measurements of thermal threshold were made on both feet in 10 patients: warming was lost bilaterally in all, and cooling was bilaterally absent in six. There was no clear pattern of sensory loss in those diabetics with unilateral foot ulceration to suggest that sensory impairment was the determining factor for the development of a plantar ulcer. Measurements of thermal thresholds were made at additional sites in 13 patients and although the most marked abnormalities of sensation were always found in the feet, in some severe neuropaths, abnormal thresholds on the hand and even the face were demonstrated. Thresholds for warming were invariably more abnormal than thresholds for cooling. The diabetics with neuropathic ulceration in this study all had severe generalised peripheral nerve disease involving large myelinated as well as both small myelinated and unmyelinated sensory fibres. The quantitative evidence on the distribution of sensory loss for thermal sensations supports the hypothesis that the neuropathic process affecting the small myelinated and unmyelinated fibres is length dependent.

The conduction velocities of peripheral nerve fibres conveying sensations of warming and cooling

With the current practice of measuring thresholds for warming and cooling separately, the question of the exact nature of afferents subserving these sensations assumes new importance. Experiments to measure reaction times to warming and cooling stimuli at two sites on the lower limb are described. The conduction velocity for each sensation was estimated from the conduction distance and conduction time in the limb. The estimated mean conduction velocity for warming was 0.5, SD 0.2 m/s and cooling 2.1, SD 0.8 m/s. These figures confirm that the sensation of warming is conveyed in unmyelinated and cooling in small myelinated peripheral nerve fibres.

The value of testing for unmyelinated fibre, sensory neuropathy in diabetic impotence

Measurement of thermal thresholds provides a means of assessing neurological deficit and in particular of recognising a neuropathic process affecting unmyelinated and small myelinated fibres of the peripheral nerve. These groups of fibres cannot be tested by nerve conduction studies but are particularly susceptible to disease in diabetes. Thresholds for thermal sensation on the sole of the foot were measured in 33 men presenting with erectile dysfunction. All 15 men with erectile dysfunction, which had been considered on clinical grounds to be neuropathic, had abnormal thermal thresholds. Diabetics with non-neuropathic erectile dysfunction had normal results. Whereas tests of unmyelinated sensory fibre function were abnormal in all those with neuropathic erectile dysfunction, electrophysiological measurement of the bulbocavernosus reflex was normal in five of nine men with diabetic neuropathic impotence.

Placebo-controlled, double-blind evaluation of the efficacy and safety of yellow mercuric oxide in suppression of eyelid infections

We tested an over-the-counter ophthalmic ointment, yellow mercuric oxide 1%, for safety and efficacy in decreasing eyelid-margin bacterial-colony counts. Of 150 patients screened for high bacterial levels, 78 were randomized in double-blind fashion to either yellow mercuric oxide bid (41 patients or 53%) or a placebo (37 patients or 47%). Bacterial-colony counts were determined at outset and at days 4 and 7 of treatment. At the conclusion of treatment on day 7, 87% of patients in the mercuric oxide group were successful in decreasing bacterial counts, compared with 59% of patients treated with placebo (P = .01). Side effects were no higher in the active group than in the placebo group. We have shown mercuric oxide 1% to be safe and effective in reducing eyelid bacterial-colony counts in patients with hordeolum and blepharitis.

Binding of linker histones to the core nucleosome

Binding of chicken erythrocyte linker histones H1/H5 to the core nucleosome has been studied. Histones H1/H5 bind very efficiently to the isolated core nucleosome in vitro. The binding of linker histones to the core nucleosome is associated with aggregation of the particles. Approximately one molecule of linker histone binds per core nucleosome in the aggregates, irrespective of the concentration of the linker histones and the salt used. Histone H5 shows greater binding affinity to the core nucleosome as compared to H1. The carboxyl-terminal fragment of the linker histones binds strongly to the core nucleosome while the binding of the central globular domain is weak. Each core nucleosome is capable of binding two molecules of carboxyl-terminal fragment of linker histone. The core nucleosome containing one molecule of carboxyl-terminal fragment of linker histone requires higher salt concentration for aggregation while the core nucleosome containing two molecules of carboxyl-terminal fragment of linker histone can self-associate even at lower salt concentrations. On the basis of these results we are proposing a novel mechanism for the condensation of chromatin by linker histones and other related phenomena.

The transcription unit of the Drosophila engrailed locus: an unusually small portion of a 70,000 bp gene

Transcripts from the engrailed gene of Drosophila melanogaster have been characterized by Northern, S1 nuclease sensitivity, and primer extension analyses. The engrailed gene encodes three poly(A)+ transcripts (3.6 kb, 2.7 kb, and 1.4 kb) that derive from a 3.9-kb portion of the genome. No other transcribed regions were found up to 16 kb downstream and 48 kb upstream of the engrailed transcription unit, the portion of the genome to which engrailed mutations have been mapped. The structures of the engrailed transcripts are unaffected by lethal engrailed mutations that break the locus at points in the transcriptionally silent regions. Transcripts expressed by 145 kb of DNA that surround the engrailed locus were also identified by Northern analysis. In contrast to the large portion of the engrailed gene that is transcriptionally inactive, most of the surrounding regions are 10-fold more densely populated with transcripts. We presume that the unusually large silent region at the periphery of the engrailed transcription unit signify the presence of special mechanisms that regulate its expression.

A comparison of therapeutic bandage lenses, tarsorrhaphy, and antibiotic and hypertonic saline on corneal epithelial wound healing

Bandage lenses, a complete tarsorrhaphy, chloramphenicol 0.5%, and sodium chloride 2% were tested for their effect on corneal epithelial wound healing in rabbits. The healing rate was decreased with bandage lenses and increased by tarsorrhaphy. There was no significant effect on healing rate with either chloramphenicol or hypertonic saline.

The engrailed locus of D. melanogaster provides an essential zygotic function in precellular embryos

Early embryonic development in Drosophila depends on genes expressed during oogenesis or after zygote formation. We show that the engrailed gene is needed for the processes that organize the embryo during the nuclear divisions that precede cellularization. During the precellular blastoderm stages engrailed mutant embryos show several notable anomalies: the pole cells form at a position slightly displaced from the posterior pole; yolk nuclei continue to divide after the tenth nuclear division cycle, when wild-type yolk nuclei have stopped dividing mitotically; and somatic nuclei are not positioned uniformly along the embryo periphery and do not undergo mitotic divisions in regular waves. This early requirement for engrailed does not appear to be a maternal function, and only genetically engrailed embryos displayed these precellular phenotypes. Synthesis of a 2.7 kb poly(A)+ transcript of the engrailed region was found in precellular embryos.

Two cases of vallecular cyst presenting with acute stridor

Acute airway obstruction is a rare presentation of vallecular cysts in adults. In the two cases presented this probably reflected infection and responded well to a trial of conservative treatment.

Early maternal-child contact: effects on later behaviour

Fifty normal, healthy, full-term infants were allowed 45 minutes contact with their mothers immediately after birth at Victoria Jubilee Hospital, Kingston, Jamaica. The behaviour of these infants and their mothers was compared with matched controls at six and 12 weeks in a hospital follow-up interview. More early-contact mothers solely breast-fed their infants than did control mothers. Early-contact infants were less likely than controls to be restless or crying during the interviews. At 12 weeks, early-contact mothers were more likely than control mothers to rise and follow when their babies were taken from them, gazed more frequently at their infants, and were more likely to vocalise to their infants during the interview. These differences indicate that early contact promotes a closer relationship between a woman and her infant. Given the importance of breast-feeding as protection against gastro-enteritis and malnutrition, this closer relationship may be especially valuable in developing countries where such diseases are common.

Pituitary function tests in Sheehan's syndome

Fourteen patients with a typical history of Sheehan's syndrome underwent pituitary function tests with simultaneous injections of 100 micrograms LH-RH, 200 micrograms TRH and 0.05--0.1 units of soluble insulin per kg body weight. Serum prolactin levels remained unchanged in all of eleven subjects given TRH. GH levels did not rise after hypoglycaemia in five subjects. In contrast serum LH and FSH rose significantly in twelve out of fourteen subjects given LHRH and serum TSH rose significantly in five out of seven subjects given TRH. It is concluded that pituitary function is relatively preserved for LH and FSH but not for prolactin and GH in Sheehan's syndrome. It is further suggested that absence of a rise in prolactin following TRH stimulation may provide the most sensitive test of pituitary hypofunction in postpartum haemorrhage.

The binding of berenil to Escherichia coli ribosome

The binding of the nonintercalating dye berenil to the 70S ribosome of Escherichia coli has been demonstrated by spectrophotometric measurements and gel filtration through Biogel P100 column. The berenil spectrum is gradually shifted towards the red region with the increasing amount of ribosome added, the isosbestic point being at 375 nm. There is positive cooperativity in the binding of berenil to the ribosome as demonstrated by the equilibrium dialysis. On binding with berenil, the ribosome is degraded faster by RNase I especially at low Mg++ concentration and its capacity to inhibit RNase I catalysed hydrolysis of ribopolymers is decreased. These indicate the unfolding of the structure of the ribosome.

Regional cerebral blood flow by 133xenon inhalation

Repeated measurements of regional cerebral blood flow (rCBF) were made by the short (ten minutes) 133Xenon inhalation technique and bicompartmental analysis in 11 patients with cerebrovascular disorders, mainly acute cerebral infarction. rCBF was measured 3 to 11 times during one to two weeks. The blood flow of the fast compartment (f1) was calculated as well as the relative weight of this compartment (w1, assumed to correspond to gray matter). In addition a new flow index, the Initial Slope Index (ISI) modified for the inhalation technique, was used. This index of predominantly gray matter flow was calculated from a one-minute epoch of the early part of the clearance curve corrected for recirculation. In three of the patients the f1 and ISI varied in parallel and the w1 showed generally only minor variations from one measurement to the other. However, in the other eight patients fluctuation of the w1 and f1 values were seen which often showed no meaningful relation to the clinical course. The observed w1 changes indicated that some tissues (slowly perfused gray matter and/or rapidly perfused white extracerebral tissues) fluctuate between the fast and the slow compartment. In such cases the f1 values obtained cannot be used for comparison between measurements, since they represent flow rates of varying tissues and do not always represent a true gray matter blood flow. In these patients the ISI, which is independent of such weight changes, showed moderate and clinically likely variations.