Health response of two communities to military antennae in Cyprus

OBJECTIVES

This study investigated concerns that have been raised about past and future health effects caused by high power transmissions of high frequency (7-30 MHz) radio waves from military antenna systems at Akrotiri, Cyprus.

METHODS

A cross-sectional study of three villages (two exposed, one unexposed) collected longitudinal and short-term radiofrequency measurements. Health data were collected using questionnaires containing information on demographic factors, specific illnesses, general health (SF-36 well-being questionnaire), reproductive history, childhood illnesses, risk perception and mortality. Analysis was with SPSS v11.5 using cross tabulations of non-parametric data and tests for significance. Key health outcomes were subjected to logistic regression analysis.

RESULTS

Field strengths within the two "exposed" villages were a maximum of 0.30 (Volts/Vm(-1) metre) from the 17.6 MHz military transmissions and up to 1.4 Vm(-1) from unspecified sources, mainly cell phone frequencies. The corresponding readings in the control village were <0.01 Vm(-1). Compared with the control village there were highly significant differences in the reporting of migraine (OR 2.7, p<0.001), headache (OR 3.7, p<0.001), and dizziness (OR 2.7, p<0.001). Residents of the exposed villages showed greater negative views of their health in all eight domains of the SF-36. There were also higher levels of perceived risk, particularly to noise and electromagnetic "pollution". All three villages reported higher values of risk perception than a UK population. There was no evidence of birth abnormalities or differences in gynaecological or obstetric history. Numbers of cancers were too small to show differences.

CONCLUSION

It was clear that even this close (1-3 km) to powerful transmissions, the dominant sources of radiofrequency fields were cell phone and national broadcast systems. There was no excess of cancer, birth defects or obstetric problems. There was heightened risk perception and a considerable excess of migraine, headache and dizziness, which appears to share a gradient with radiofrequency exposure. The authors report this association but suggest this is unlikely to be an effect of radiofrequency and more likely to be antenna visibility or aircraft noise.

Molecular mechanisms involved in the resistance of fibrin to clot lysis by plasmin in subjects with type 2 diabetes mellitus

AIMS/HYPOTHESIS

The aim of this study was to determine the influence of type 2 diabetes on fibrinolysis by assessing interactions between the regulatory components of fibrinolysis and the fibrin clot, using fibrinogen purified from 150 patients with type 2 diabetes and 50 matched controls.

METHODS

Clot lysis rates were determined by confocal microscopy. Plasmin generation was measured using a plasmin-specific chromogenic substrate. Surface plasmon resonance was used to determine the binding interactions between fibrin, tissue-type plasminogen activator (t-PA) and Glu-plasminogen; cross-linkage of plasmin inhibitor to fibrin by factor XIII was determined using a microtitre plate assay.

RESULTS

Lysis of diabetic clots was significantly slower than that of controls (1.35 vs 2.92 microm/min, p<0.0001) and plasmin generation was significantly reduced. The equilibrium binding affinity between both t-PA and Glu-plasminogen and fibrin was reduced in diabetic subjects: t-PA, K (D)=0.91+/-0.3 micromol/l (control subjects), 1.21+/-0.5 micromol/l (diabetic subjects), p=0.001; Glu-plasminogen, K (D)=97+/-19 nmol/l (control subjects), 156+/-66 nmol/l (diabetic subjects), p=0.001. Cross-linkage of plasmin inhibitor to fibrin by factor XIII was enhanced in diabetic subjects, with the extent of in vitro cross-linkage correlating with in vivo glycaemic control (HbA(1c)) (r=0.59, p=0.001).

CONCLUSIONS/INTERPRETATION

These results indicate that impairment of the fibrinolytic process in diabetic patients is mediated via a number of different mechanisms; these may be a consequence of post-translational modifications to fibrinogen molecules, resulting from their exposure to the abnormal metabolic milieu associated with diabetes.

Type 2 diabetes: an atherothrombotic syndrome

Insulin resistance is found in around 80-90% of subjects with older onset (type 2) diabetes and in approximately 25% of the general population. Insulin resistance prior to the development of frank type 2 diabetes and type 2 diabetes itself is associated with a significant increase in the risk of atherothrombotic disease, which is due in part to a disruption in the balance of factors regulating coagulation and fibrinolysis. Both insulin resistance and type 2 diabetes are associated with the development of endothelial dysfunction, and enhanced platelet aggregation and activation. Whilst the plasma levels of many clotting factors including fibrinogen, FVII, FVIII, FXII, FXIII b-subunit are elevated, the fibrinolytic system is relatively inhibited as a consequence of an increase in plasminogen activator inhibitor type-1 (PAI-1) levels. These changes favour the development of a hypercoagulable pro-thrombotic state, which may in turn enhance cardiovascular risk by increasing the likelihood of developing an occlusive thrombus within a coronary/cerebral artery, and/or contributing to the development of atherosclerotic lesions. This article reviews the current published evidence of the pro-thrombotic changes that occur in association with type 2 diabetes and insulin resistance, and the putative underlying mechanisms which lead to these changes.

The influence of type 2 diabetes on fibrin structure and function

AIMS/HYPOTHESIS

The precise mechanisms underlying the increased risk of cardiovascular disease (CVD) in type 2 diabetes are unclear. Fibrin clot structure has been related to CVD risk in the general population. We therefore assessed this in type 2 diabetic patients as a potential mechanism whereby diabetes influences CVD risk.

METHODS

Fibrin clots were formed from fibrinogen purified from 150 subjects with type 2 diabetes and varying degrees of glycaemic control (assessed by HbA1c), and from 50 matched control subjects. Clot structure was assessed by turbidity, permeation and confocal microscopy. The specific effect of glucose itself was assessed by analysing the structure of clots formed from purified fibrinogen in the presence of increasing concentrations of the sugar.

RESULTS

Clots formed by fibrinogen purified from type 2 diabetic subjects had a denser, less porous structure than those from control subjects. The structural changes found were related to the individual's glycaemic control; HbA1c correlated negatively with permeation coefficient (Ks) values (indicates clot pore size) (r = -0.57, p < 0.0001) and positively with maximum absorbance (indicator of fibre size) (r = 0.33, p < 0.0001), branch point number (r = 0.78, p < 0.0001) and fibre density (r = 0.63, p < 0.0001). The ambient glucose level influenced clot structure; hypo- (< 5 mmol) and hyperglycaemia (> or = 10 mmol/l) were both associated with a reduction in Ks values and maximum absorbance, and with increased fibre density and branch point number within clots.

CONCLUSIONS/INTERPRETATION

The structural differences found to occur in type 2 diabetes and in association with hypo- and hyperglycaemia may confer increased resistance to fibrinolysis, and in consequence contribute to the increase in CVD risk in diabetic patients.

Effect of 902 MHz mobile phone transmission on cognitive function in children

We examine whether a standard mobile exposure at 902 MHz has a significant effect on cognitive function in 18 children 10-12 years of age. These were in a single group in which each child was given a single training session and then three test sessions in a randomized, three-way crossover design, using the cognitive drug research (CDR) cognitive assessment system. Exposures were 0, 0.025, or 0.25 W from a standard Nokia 3110 mobile phone handset mounted on a plastic headset in normal use position. The results of testing showed that the baseline (0 W) performance for the reaction time measurements was considerably slower than for the comparable measures in adult. There was a tendency for reaction time to be shorter during exposure to radiation than in the sham (baseline) condition, an effect that was most marked for simple reaction time. However, no effects reached statistical significance after Bonferroni correction. Therefore, we conclude that this study on 18 children did not replicate our earlier finding in adults that exposure to microwave radiation was associated with a reduction in reaction time. It should be noted that the present study investigated the effects of radiation from a GSM handset, whereas in our previous study the effect on reaction time was observed only with a more powerful analogue handset.

Exogenous lipid pneumonia related to smoking weed oil following cadaveric renal transplantation

A 30-year-old female presented shortly after cadaveric renal transplantation with respiratory distress typical of a bacterial infection. Following initial improvement, she developed progressive respiratory failure, initially felt to be secondary to cytomegalovirus infection. Two bronchoalveolar lavages were nondiagnostic, and an open lung biopsy was performed, which revealed a pulmonary alveolar proteinosis (PAP) reaction and exogenous lipid pneumonia (ELP). The ELP was considered to be secondary to the use of marijuana, in the form of weed oil, that was smoked daily for over 10 years and stopped just before renal transplantation. This is the first description of both PAP and ELP following renal transplantation, and the first description of ELP related to smoking weed oil. Physicians should be aware of the different forms of marijuana available and of their potential medical complications.

Variation in the posterior vertebral contour line at the level of C-2 on lateral cervical roentgenograms: a method for odontoid fracture detection

As an aid to the assessment of alignment and lordosis, four contour lines can be drawn on the lateral radiograph of the cervical spine. One of these contour lines is the posterior vertebral contour line, in which a smooth, gentle curve, convex anteriorly, is formed by a line drawn along the posterior margins of the cervical vertebral bodies. It is unknown whether discontinuity in the posterior contour line at this level represents a pathologic process of the odontoid. We analyzed the posterior cortex of C-2 and the odontoid in 500 lateral cervical spine radiographs to determine the amount of step-off (deviation from the posterior contour line) seen in normal lateral cervical roentgenograms. Only 15% (n = 75) showed any step-off; none exceeded 3 mm. We recommend that patients presenting with a history of cervical spine trauma who have a step-off at the posterior contour line at the odontoid/C-2 level of > or =3 mm should have fine-cut tomography or multiplanar computed tomography scanning to further assess the odontoid process and rule out fracture.

The care of patients with diabetic nephropathy: audit, feedback, and improvement

Diabetic nephropathy is the commonest cause of end-stage renal failure in the developed world. The quality of care of 152 patients with diabetic nephropathy was assessed at the time of referral to a single nephrologist. The type II diabetics (62%) were older than the type I diabetics (38%) (mean 65 years vs. 48 years). The mean duration of diabetes was 17 years. Significant cardiovascular disease was present in 52%. There was diabetic retinopathy in 84% of the type I diabetics and 53% of the type II diabetics. Overall, 63% had hypertension at referral (St Vincent Declaration criteria), untreated in 25%. ACE inhibitors were not prescribed in 48% when no contraindications to their use were present. Glycosylated haemoglobin was > 9.1% in 29%. Twenty were prescribed medications inappropriate to their renal function. Of patients with ischaemic heart disease and serum cholesterol > 5.5 mmol/l, 82% were untreated; 82% of patients with secondary hyperparathyroidism were also untreated. At initial referral, many patients' care was sub-optimal. Referral was too late for adequate preparation for renal replacement therapy in 33%. Following a process of education and feedback of the results to referring practitioners, the timing of referral improved. We emphasize the need for closer co-operation between those managing diabetic patients with nephropathy to optimize their care.

Can intensive treatment alter the progress of established diabetic nephropathy to end-stage renal failure?

Diabetic nephropathy is now the leading cause of end-stage renal disease in the Western world, and is associated with a higher patient morbidity and mortality than other causes of renal failure, largely because of associated cardiovascular disease. Numerous studies have elucidated the factors which influence its onset and progression. The St Vincent Declaration in 1994 proposed standards for the appropriate management of patients with diabetic nephropathy. We assessed whether referral to a nephrology clinic attempting to apply these standards influenced the progression of diabetic nephropathy. The results show a significant improvement in blood pressure, glycosylated haemoglobin and serum cholesterol following referral. There was a significant reduction in the rate of decline of renal function following referral in 39% of patients. With the possible exception of diabetic control there were no significant differences in the management of those that did and did not show improvement. The results show that with intensive out-patient clinic monitoring it is possible to improve the quality of patient care, and that even in established diabetic nephropathy it is possible to slow the rate of progression to end-stage renal failure.

Metastatic disease of the cervical spine. A review

The treatment of cervical metastatic disease requires a multidisciplinary team approach to evaluation and management and demands consideration of multiple factors before a regimen is accepted. The patient's overall functioning and medical status, life expectancy, history of treatment, tumor type, and location within the cervical spine and individual vertebrae all must be evaluated carefully. The majority of lesions will be amenable to nonoperative aggressive modalities aimed at shrinking tumor size and halting growth. Surgical intervention is limited to specific indications, including spinal instability, progressive neurologic deterioration from bony collapse and compression, intractable pain, and failure of conservative means of treatment.

Serotonin and gender-specific psychiatric disorders

The serotonergic system has been linked to the etiology of several, albeit disparate, psychiatric disorders. The accumulation of many lines of evidence support the view that there are gender differences in the serotonergic system in humans. It is further proposed that a gender differentiated serotonergic system acts as the nidus for the development of gender-specific psychiatric disorders. Depression, anxiety and eating disorders are largely seen in females, whereas alcoholism, aggressivity and suicide predominate in males. Evidence from both animal and human studies suggesting that the serotonergic system mediates between social-environmental experience and biological states is presented and reviewed. A reconceptualization of the serotonergic system as a gender-specific psychobiological interface is proposed. (Int J Psych Clin Prac 1997; 1: 3-13).

Complete vertebral fracture/dislocation of the cervical spine with minimal neurologic deficit

Cervical spine fracture/dislocations without neurologic compromise are rare. We report the case of a complete fracture/dislocation from C-5 to C-6 with neurologic sparing and discuss the biomechanical pathogenesis and treatment of this injury.

Sternotomy infection: poor prediction by acute phase response and delayed hypersensitivity

Two hundred twenty-one consecutive adult cardiac surgical patients were examined prospectively for nutritional protein state, acute phase protein response, and delayed hypersensitivity reaction in an attempt to identify patients at high risk for the development of sternal wound infection, which occurred in 6 patients (2.7%). There was no significant correlation between preoperative nutritional protein concentrations (retinol-binding protein, prealbumin, and transferrin) and acute phase protein levels (C-reactive protein, alpha 1-acid glycoprotein, and complements B and C3), nor a statistically significant relationship between nutritional state or acute phase protein response and the development of sternal infection. Preoperative complement C3 levels were elevated, however, in 80.0% of those in whom sternal infections developed compared with 30.6% of those with well-healed wounds. Similarly, postoperative concentrations of alpha 1-acid glycoprotein were elevated in 80.0% of those in whom sternal infections developed compared with 28.6% of those with well-healed wounds. There was no correlation between delayed hypersensitivity and the risk of sternal infection, nor between preoperative nutritional protein and acute phase protein values. Seventy-three percent of patients were anergic on postoperative day 2. Stepwise logistic regression showed that age, body weight, preoperative intensive care unit stay, repeat median sternotomy, internal mammary artery grafting, postoperative hemorrhage, and postoperative cardiac arrest correlated with the development of sternal infection, whereas transfusion requirement, reexploration for bleeding, and the operation performed did not. We conclude that routine delayed hypersensitivity testing is of no value in predicting high-risk cardiac surgical patients when the anergy battery is placed on the preoperative day. Although statistically insignificant, possibly due to the small number of patients in whom sternal infection developed in this study (type II error), a larger study might find preoperative complement C3 and post-operative alpha 1-acid glycoprotein levels to be predictive of patients at risk for the development of sternal wound infection. The final logistic model for the predicted risk 2%) of sternal wound infection is: PREDSWC = exp(EQ)/1 + exp(EQ) where EQ = (0.38 x age) + (0.24 x weight) + (5.42 x preop ICU) + (4.39 x redo) + (7.14 x IMA) + (4.49 x hemorrhage) + (8.81 x arrest) - 62.72, and where preop ICU, redo, hemorrhage, and arrest are defined as yes (1) or no (0), IMA-is defined as 0, 1, or 2, age is in years, and weight is in kilograms.

Surgical implications of sclerosing mediastinitis. A report of six cases and review of the literature

Sclerosing mediastinitis is an uncommon disease associated with a multiplicity of clinical syndromes. The cause of this disorder is probably an abnormal fibroproliferative response to an inflammatory stimulus, most commonly a granulomatous infection secondary to Histoplasma capsulatum. The pathophysiology of this disease is predicated on the encasement of mediastinal vital organ structures within a dense fibrotic mass. This mass appears to emanate from an invasive chronic inflammatory process causing erosion as well as external compression of these structures. The following case reports illustrate the diversity of this disease entity, representing a patient population from the Ohio River Valley, endemic for histoplasmosis. The purpose of this report is to elucidate the various clinical manifestations of sclerosing mediastinitis and to correlate the pathologic process with a rational approach to treatment.

The relation of the Halstead-Reitan neuropsychological battery to functional daily living skills in geriatric patients

This study investigated the nature of the relationship between neuropsychological tests, the Halstead-Reitan Battery, and a measure of everyday living ability, the Community Competence Scale. The sample consisted of 40 geriatric patients referred for suspected dementia. The results indicated that neuropsychological tests were moderately predictive of measures of functional daily living skills. Although some specific neuropsychological measures, or combination of measures, were more predictive of particular functional daily living skills, their relationship did not necessarily follow logical or theoretical expectations. Thus, while it may be safe for neuropsychologists to make predictions about a patient's global capacity to function independently, predictions regarding specific functional daily living skills may be unwarranted.

Correlation of two competence assessment methods in a geriatric population

A 10-subscale version of the Community Competence Scale, a structured interview, and the Scale of Competency in Independent Living Skills, a rating scale completed by a relative, were administered to 40 geriatric patients with suspected dementia. While the two assessments of competence appear to examine a common global domain, individual correlations between subscales of the two measures were only moderate. The findings provide limited support for the construct of competence.

Relation of cognitive functioning to daily living skills in a geriatric population

A modified version of the Community Competence Scale was administered along with the Wechsler Adult Intelligence Scale--Revised (WAIS--R) to 40 geriatric patients with suspected dementia. Scores on the Competence Scale, a measure of functional daily living skills, were correlated .72 with Full Scale IQs and .77 with Verbal IQs and moderately correlated (.55) with Performance IQs. A number of significant correlations were found between WAIS--R subtests and subscales of the competence instrument. Means and standard deviations for the 10 Competence subscale and total scores are presented.

The sensitivity of the Bender-Gestalt Test as a screening instrument for neuropsychological impairment in older adults

We investigated the sensitivity of the Bender (1938) Visual-Motor Gestalt Test (BGT) using the Halstead-Reitan Neuropsychological Battery (HRB) as the criterion for cortical dysfunction. We studied 95 subjects over age 55 who had been diagnosed as having dementia or pseudodementia. Subjects were classified as mild, moderately, or severely impaired on the HRB and as impaired or unimpaired on the BGT. The results indicated that the BGT is less sensitive (36%) than was expected when used on an impaired geriatric population. The data further indicated that false negatives occurred more frequently with the BGT when individuals had mild neuropsychological impairment. Less frequent misclassifications occurred as the severity of impairment on HRB indices increased.

Presentation of undiagnosed pheochromocytoma during coronary artery bypass surgery

Hypertension and tachyarrhythmias arising during an operative procedure are rarely caused by an unsuspected pheochromocytoma. However, when this tumor becomes clinically manifest under general anesthesia during a procedure for an unrelated condition, the mortality is high. An unusual case of a patient who developed episodes of catastrophic hypertension and tachyarrhythmias while undergoing a coronary artery bypass procedure is described. The subject of undiagnosed pheochromocytoma becoming clinically manifest under general anesthesia is discussed with a pertinent review of the literature.

Correlation of 31P nuclear magnetic resonance chemical shifts in aryl phosphinates with Hammett substituent constants: Inductive versus resonance interactions and relevance to pπ–dπ bonding

Substituent-induced chemical shifts and coupling constants in the 31P, 13C, and 1H nuclear magnetic resonance spectra of meta- and para-substituted phenyl dimethylphosphinates (1), methylphenylphosphinates (2), and diphenylphosphinates (3) have been determined in CDCl3 solvent. For all three series, a correlation of δ 31P with Hammett–Taft σ0 (or σ) constants is preferred over σ− on the basis of the correlation coefficient and standard deviations of the slope and intercept values. Electron-withdrawing substituents induce downfield shifts in δ 31P, in contrast to the inverse trends observed for structurally related series of oxyphosphorus acids and their derivatives. It is proposed that electron-withdrawing substituents act to deplete the electron density on the aryl oxygen, thereby weakening a pπ–dπ bonding interaction between the aryl oxygen and phosphorus. The resultants loss of d-orbital density on phosphorus causes a downfield shift in δ 31P in each of the phosphinate series. Phenyl substituents attached directly to phosphorus in series 2 and 3 increase the phosphoryl pπ–dπ back-bonding interactions, either through inductive or resonance effects, which leads to shielding of the phosphorus atom, overriding the anticipated downfield shift through inductive electron withdrawal of the phenyl substituents in series 2 and 3, relative to the methyls in series 1. Trends in Hammett ρ values for the plots of δ 31P and δ 13C versus σ0 and differences in the shielding of 13C and 1H nuclei of the methyl attached to phosphorus in series 1 and 2 suggest that the phenyl groups may interact in π bonding with the phosphorus atom through a resonance interaction.

Prosthetic replacement surgery for cervical spine metastasis

Since 1972, 18 patients suffering from metastatic cancer in the cervical spine were treated with prosthetic replacement surgery. The surgery enabled the authors to decompress the spinal cord and the nerve roots and at the same time restore stability in the affected spine. Patients suffering from severe pain and spinal cord and/or nerve root compression secondary to involvement of a single vertebral body particularly benefited from this surgery. The rates of positive recovery were as follows: 94.1% for pain relief, 91.7% for motor recovery, and 87.5% for ambulation. The surgical efficacy was maintained until the terminal stage. Tumor recurrence took place in five cases--two anterior, and three posterior. Anterior recurrence caused a marked instability, whereas posterior recurrence did not affect stability.

Concomitant cerebral and myocardial revascularization

Patients who present with concomitant coronary artery disease and hemodynamically significant carotid artery occlusive disease represent a subset of individuals at high risk for myocardial infarction and stroke. Whether the combined surgical approach favorably influences the outcome of patients requiring major cardiovascular surgical procedures remains controversial. However, it is clear that coronary artery bypass procedure and carotid endarterectomy are each beneficial to patients who have the appropriate indications for each procedure individually. The coincidence of carotid and coronary occlusive disease varies with the type of diagnostic tests involved. Angiographic data suggest a coincidence in the range of 1 to 6 per cent, while vascular laboratory screening data in some studies have indicated a coincidence as high as 12 to 14 per cent--a range that appears to be higher than one might expect from clinical experience. It is clear from analyzing the patient profile of this subset of patients from large clinical reviews that in general they are older and sicker and have a higher incidence of cardiovascular risk factors representing more extensive atherosclerosis. It is also well documented that the neurologic complication rate for all patients undergoing coronary bypass is in the range of 2 per cent. Therefore, it should not be expected that the operative mortality rate and risk of perioperative stroke in patients undergoing the combined reconstructive procedure can equal those for either procedure alone. These patients represent a separate clinical subset at higher risk for perioperative complications and need to be evaluated individually.

The cost of simultaneous surgical standby for percutaneous transluminal coronary angioplasty

From November, 1980, to May 1985, 699 patients have undergone percutaneous transluminal coronary angioplasty of 784 lesions at our institutions. Simultaneous surgical standby was available on all cases. One hundred twenty-four patients (18%) underwent immediate myocardial revascularization; 45 (6%) were operated on because the lesion could not be dilated. Seventy-nine patients (11%) underwent immediate operation for an acute complication of angioplasty: coronary occlusion in 45, dissection in 29, coronary perforation in three, and atrial perforation in one. Fourteen patients (18%) required cardiopulmonary resuscitation en route to the operating room, and 10 patients (20%) had insertion of an intra-aortic balloon pump in the cardiac catheterization laboratory. The average time from complication to reperfusion was 87 minutes, ranging from 40 to 165 minutes. An average of 2.0 grafts per patient (ranging from one to five grafts per patient) were performed. Of those 79 patients who underwent operation for an acute complication, one died (1.3%), 31 patients (39%) had a myocardial infarction according to enzyme criteria (creatine kinase-myocardial band greater than 40 IU), and 17 patients (22%) had new Q waves on the electrocardiogram. Good results are related to minimizing the time the myocardium is ischemic. No patient in whom reperfusion was begun in less than 75 minutes had a Q wave infarction or a creatine kinase-myocardial band level greater than 40 IU. Simultaneous surgical standby is the only method allowing immediate access to surgical facilities. A standby team of eight persons and equipment were immediately available for emergency bypass grafting for an average of 3.6 hours (range 1.3 to 5.4 hours per angioplasty attempt). The patient charges for this simultaneous standby were $632.00 per angioplasty attempt, or $442,278.00 for the entire series. The actual cost of the standby was over $1,700.00 per attempt totaling $1,188,843.00 for the 699 patients. This underestimation of the cost of surgical standby has occurred in other series, because little mention has been made of this cost in the published reports on the cost effectiveness of angioplasty. In terms of time demands, over 2,500 hours were spent by surgeons standing by for the 699 attempts. Simultaneous surgical standby is the most effective means of limiting the time the myocardium is ischemic after an angioplasty complication. However, this method is costly, necessitating more of a financial and time commitment than generally anticipated. Future studies of the cost effectiveness of angioplasty should include the cost of surgical standby with accurate per-patient cost accountability.

Surgery of left atrial myxomas. Report of eleven cases and review of the literature

Eleven patients with left atrial myxoma in a ten-year period were reviewed. They ranged from 16 to 69 years old. Eight patients were female. All tumors were located in the left atrium; one patient had multiple tumors. The main clinical presentation was congestive heart failure seen in eight patients. Ten patients had a correct pre-operative diagnosis. Echocardiography confirmed the diagnosis in seven patients, angiocardiography in two and cardiac catheterization in one. All tumors were successfully removed with the aid of cardiopulmonary bypass and using a right atriotomy and trans-septal approach. Two patients underwent concomitant saphenous vein aortocoronary bypass. There were no operative deaths. Excision of the tumor resulted in marked symptomatic improvement. There have been no recurrences. A review of the pertinent literature is presented.

Parallel-form reliability of the Wechsler Memory Scale in a geriatric population with suspected dementia

The present study examined parallel-form reliability of the Wechsler Memory Scale (WMS) in a population where such forms are particularly useful, that is, among patients who are suspected of having some type of dementing illness. Comparative analyses were made for total raw scores. Memory Quotient (MQ) scores, and individual subtest scores. Thirty geriatric patients originally referred for neuropsychological testing because of suspected dementia were given both Forms 1 and 2 of the WMS. The results yielded high overall reliability coefficients for MQ and total raw scores. Individual subtest scores also yielded rather high coefficients, and only one subtest (Associate Learning) had a significant mean difference. Apparently, the two forms have sufficient parallel-form reliability to be considered clinically interchangeable. Thus, the WMS may be a useful tool for repeat evaluations of memory functioning in a demented population.

Coronary artery bypass surgery following thrombolytic therapy for acute coronary thrombosis

One hundred thirty-six patients underwent thrombolytic therapy for acute evolving myocardial infarction from June, 1981, through December, 1982. Of these patients, 51 underwent coronary bypass procedures from two hours to 90 days (average, 16 days) following thrombolytic therapy. Six (12%) had single-vessel disease, 15 (29%) had double-vessel disease, and 30 (59%) had triple-vessel involvement. Ejection fraction values ranged from 21 to 60%. The average number of grafts performed per patient was 3.4. There were no operative deaths in this series. Postoperative hemorrhagic problems were minimal, and the incidences were no different from those for other coronary bypass patients. In follow-up ranging from 2 to 18 months, there was no recurrence of severe angina or other clinical evidence of saphenous graft occlusion in the thrombolysed vessels. Of the 45 patients eligible to return to work, 40 (89%) have done so. The data from this series suggest that surgical myocardial revascularization after intracoronary thrombolytic infusion for acute myocardial infarction can be performed safely and that complete recovery and a high return-to-work ratio can be anticipated.

Yeast contains small nuclear RNAs encoded by single copy genes

We have identified a group of RNA molecules in Saccharomyces cerevisiae that appears to be equivalent to the U class of small nuclear RNAs previously described in other eucaryotes, resembling them in size, metabolic stability, 5' cap structure, presence of modified bases, and nuclear localization. However, the yeast snRNAs differ from their counterparts in several potentially important ways. First, they are present in very low abundance, less than 200 copies per cell, as compared to 10(5)-10(6) for mammalian U1-U6. Second, there appear to be more species in yeast than in any cell type previously examined. Finally, we have cloned five yeast snRNA genes, and find that each is present in a single copy per haploid genome, whereas all previously characterized snRNAs are encoded by multiple (5 to 100) gene copies. The presence of single copy genes in yeast will greatly facilitate the genetic analysis of snRNA function.

Alterations in pulmonary function following pneumonectomy for bronchogenic carcinoma

Twenty-one patients who underwent pneumonectomy for bronchogenic carcinoma at the Nashville Veterans Administration Hospital from November, 1977, to March, 1980, were evaluated with standard pulmonary function tests preoperatively and postoperatively. Twelve patients had Stage I disease, 4 patients had Stage II, and 5 patients had Stage III disease. The interval between the operative procedure and postoperative testing ranged from 2 to 33 months (mean, 12.4 months). Mean functional loss of pulmonary capacity after pneumonectomy was based on analysis of preoperative and postoperative forced vital capacity (FVC) and initial-second forced expiratory volume (FEV1) indices. The mean functional loss as expressed by FVC was 41.5% after right pneumonectomy and 34.0% after left pneumonectomy. The mean functional loss as expressed by FEV1 was 40.2% after right pneumonectomy and 38.3% after left pneumonectomy. The postoperative functional status of each patient was classified according to the New York Heart Association criteria. Nineteen of the 21 patients were in Class I or II preoperatively. Postoperatively, 10 patients were in Class I or II and 11 in Class III or IV. The results indicate that a postoperative FVC less than 2.5 liters and FEV1 less than 1.5 liters are not compatible with active life.

The shoulder abduction test in the diagnosis of radicular pain in cervical extradural compressive monoradiculopathies

The authors have observed a series of patients with cervical monoradiculopathies due to extradural compressive disease in whom clinical signs included relief of radicular pain with abduction of the shoulder. Of 22 patients requiring myelography for unremitting radicular pain, 15 experienced relief of pain with shoulder abduction. Thirteen patients showing this sign required surgery and all achieved a good result. Two patients were relieved with additional conservative measures. Pain relief obtained with this maneuver seems to occur by decreasing tension on the nerve root. This shoulder abduction relief sign has not been commonly elicited in the past, and the authors wish to bring attention to its value as an indicator of significant cervical extradural radicular compressive disease.

Para-articular chondromas and osteochondromas: a report of three cases

Observations in 3 middle-aged patients demonstrate that solitary osteochondromas in para-articular locations can be confused with intrasynovial osteochondromatosis or osteochondromas arising from bone and extending into joint regions.

Parotid neoplasms: a report of 250 cases and review of the literature

A 25-year experience with parotid tumors was reviewed. From a total of 250 neoplasms, 173 were histologically benign and 77 were malignant. Benign mixed tumors accounted for 59% of all lesions. Clinical parameters used to diagnose parotid neoplasms were found to be unreliable in determining whether a given tumor was benign or malignant. The mean age for malignant lesions was 10 years greater than for benign lesions. The phenomenon of malignant transformation of a benign tumor was considered in four patients. Complete surgical excision is the safest and preferred method for diagnosis. Preoperative needle or incisional biopsy are associated with a high degree of local recurrence. The appropriate management of any parotid tumor is predicated on special histological type. Local excision or enucleation no longer have a place in the surgical management of benign parotid tumors. Postoperative tumor recurrence and morbidity are directly related to awareness of surgical anatomy and pursuit of correct surgical techniques for adequate resection. The five-year recurrence rate for 102 benign mixed tumors was 6%. Recurrence in malignant tumors varied with specific histological types but was generally high. Five-year survival for all malignant parotid tumors was 48%.

Pyogenic infections of the sacro-iliac joint

In 3 cases of pyogenic infection of the sacro-iliac joint, the diagnosis was difficult. Limp, buttock pain and upper sciatica were the most common presenting symptoms. Differential limitation of hip motion, positive straight leg raising, a positive Gaenslen test and pain on pelvic compression were frequent fingings. Increased E.S.R., W.B.C. count and fever were seen in 2/3 cases. Plain and tomographic X-rays are often helpful but bone scan has been helpful in localizing early lesions. Treatment after early diagnosis may consist of antibiotics and immobilization alone while in the more chronic cases surgical drainage and debridement may be necessary.

Ewing's sarcoma of the great toe. A case report

A case of Ewing's Sarcoma originating the great toe is reported. Because of the rarity of its appearance outside the pelvis and long tubular bones, Ewing's Sarcoma is often misdiagnosed when it occurs in the distal portion of the extremities. Ewing's Sarcoma may be difficult to distinguish from infection. Biopsy is recommended for any indolent or refractory lesions presumed to be infectious. Bone scanning with Technetium Polyphosphate is a useful tool for diagnosis and evaluation of this tumor. Vigorous integrated chemotherapy and radiotherapy had little effect in this patient with metastatic disease.

Lateral collateral ligament ankle injuries in young athletic individuals

1. Eleven cases of surgical repair of acute tears of the capsule, anterior talo-fibular, and calcaneo-fibular ligaments of the ankle in young athletic individuals are reported. 2. Diagnosis was made by clinical examination and stress X-rays and confirmed by arthrography in selected cases. All of the ligament ruptures were visualized at surgery. 3. Post-surgery, all of the patients had a stable ankle and were able to return to vigorous athletic endeavors without disability. 4. This study lends support to the impression that surgical repair of severe lateral collateral ankle ligament injuries in young athletic individuals leads to a functionally and mechanically stable ankle able to withstand severe stress without disability.

A simple vacuum cassette for microradiography

Microradiography has been found to be a useful research tool for the investigation of bone formation, resorption and mineralization. Since relatively thin (60-125 mum) embedded hard tissue sections are used for this procedure, great care must be taken to ensure that the specimen is placed firmly and flatly without buckling against the photographic emulsion during the period of x-ray exposure in order to avoid distortion in the final microradiograph. The construction and use of a simple and inexpensive vacuum cassette for this purpose is described. With the use of a portable vacuum reservoir, specimen mounting can be done in a darkroom some distance from the x-ray source, often permitting the use of already existing x-ray facilities in other laboratories.