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Madison Hardware Co. in New York City acquired flawed body shells and rejected models from the Lionel factory in the 1950s and '60s, which they modified and sold as finished products. They created special "road name pieces" by repainting old Lionel body shells and producing custom-made items to move damaged or lackluster production. Madison Hardware also transformed some modified Lionel heavyweight coaches into multiple-unit interurban cars and created a range of single and double dome tank cars. The close connection between Madison Hardware and the original Lionel Corp. gives these custom models a sense of collectible value among postwar enthusiasts. [Extracted from the article]

OBJECTIVE--Recent studies suggest that chronic exposure to air pollution can promote the development of diabetes. However, whether this relationship actually translates into an increased risk of mortality attributable to diabetes [...]

The following pieces are edited transcripts from the Research & Education Networking Conference, held March 7-8, 1991. This article examines the origin of advanced networks and explores why there is […]

Patients with inflammatory bowel disease (IBD) suffer from various symptoms, impairing their quality of life and often affecting psychosocial issues. This may lead to the need for additional psychological care. This study investigated patients' subjective need for integrated psychosomatic support and psychotherapy and indicators for it. This is a cross‐sectional multicentre study in Austrian IBD patients who were in routine care at 18 IBD outpatient clinics. Patients filled in an anonymous, validated questionnaire (Assessment of the Demand for Additional Psychological Treatment Questionnaire [ADAPT]) assessing the need for psychological care. The ADAPT gives two separate scores: the need for integrated psychosomatic support and for psychotherapy. In addition, health‐related quality of life and the use of complementary and alternative medicine as well as clinical and socio‐demographic variables were queried. Multivariable regression analysis was performed to estimate the effect of the previously mentioned variables on the need for additional psychological care. Of 1286 patients, 29.7% expressed a need for additional psychological care, 19.6% expressed a need for integrated psychosomatic support and 20.2% expressed a need for psychotherapy. In the multivariable analysis, the two strongest indicators for the need for both types of psychological care were the use of complementary and alternative medicine (for integrated psychosomatic support: odds ratio = 1.64, 95% confidence interval 1.13–2.39, p= 0.010; for psychotherapy: odds ratio = 1.74, 95% confidence interval 1.20–2.53, p= 0.004), and a low health‐related quality of life score (for integrated psychosomatic support: odds ratio = 0.95, 95% confidence interval 0.94–0.96, p< 0.001; for psychotherapy: odds ratio = 0.96, 95% confidence interval 0.94–0.97, p< 0.001). About 30% of the Austrian IBD patients expressed a need for integrated psychosomatic support and/or psychotherapy. The most important indicators for this need were the use of complementary and alternative medicine and low quality of life. What is already known? Despite ongoing improvement of treatment options, patients may not respond to treatment or may develop side effects. Due to this burden of disease, patients may also suffer from psychological symptoms, such as depressionIn our previous study in 2008, we found that 31% of patients with inflammatory bowel disease (IBD) expressed a subjective need for psychological interventions Despite ongoing improvement of treatment options, patients may not respond to treatment or may develop side effects. Due to this burden of disease, patients may also suffer from psychological symptoms, such as depression In our previous study in 2008, we found that 31% of patients with inflammatory bowel disease (IBD) expressed a subjective need for psychological interventions What are the significant and/or new findings of the study? Despite improvements in therapy, around 30% of patients with IBD express a subjective need for psychological interventionsThis subjective need for psychological interventions is associated with complementary and alternative medicine use and low quality of life Despite improvements in therapy, around 30% of patients with IBD express a subjective need for psychological interventions This subjective need for psychological interventions is associated with complementary and alternative medicine use and low quality of life

To investigate the effect of accelerometry-based navigation (ABN) on early clinical outcomes after TKA.

Investigate the efficiency/accuracy of surgical automation versus manual component implantation in DA THA.

Objective Racial/ethnic disparities in the prevalence of psychiatric disorders have been reported, but have not accounted for the prevalence of the traits that underlie these disorders. Examining rates of diagnoses in relation to traits may yield a clearer understanding of the degree to which racial/ethnic minority youth in Canada differ in their access to care. We sought to examine differences in self/parent-reported rates of diagnoses for obsessive-compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD) and anxiety disorders after adjusting for differences in trait levels between youth from three racial/ethnic groups: White, South Asian and East Asian.Method We collected parent or self-reported ratings of OCD, ADHD and anxiety traits and diagnoses for 6- to 17-year-olds from a Canadian general population sample (Spit for Science). We examined racial/ethnic differences in trait levels and the odds of reporting a diagnosis using mixed-effects linear models and logistic regression models.Results East Asian (N= 1301) and South Asian (N= 730) youth reported significantly higher levels of OCD and anxiety traits than White youth (N= 6896). East Asian and South Asian youth had significantly lower odds of reporting a diagnosis for OCD (odds ratio [OR]East Asian= 0.08 [0.02, 0.41]; ORSouth Asian = 0.05 [0.00, 0.81]), ADHD (OREast Asian= 0.27 [0.16, 0.45]; ORSouth Asian = 0.09 [0.03, 0.30]) and anxiety (OREast Asian= 0.21 [0.11, 0.39]; ORSouth Asian= 0.12 [0.05, 0.32]) than White youth after accounting for psychiatric trait levels.Conclusions These results suggest a discrepancy between trait levels of OCD, ADHD and anxiety and rates of diagnoses for East Asian and South Asian youth. This discrepancy may be due to increased barriers for ethnically diverse youth to access mental health care. Efforts to understand and mitigate these barriers in Canada are needed.

Introduction Patients with inflammatory bowel disease suffer from various symptoms, impairing their quality of life and often affecting psychosocial issues. This may lead to the need for additional psychological care. This study investigated patients’ subjective need for integrated psychosomatic support and psychotherapy and indicators for it.Materials and methods This is a cross-sectional multicentre study in Austrian inflammatory bowel disease patients who were in routine care at 18 inflammatory bowel disease outpatient clinics. Patients filled in an anonymous, validated questionnaire (Assessment of the Demand for Additional Psychological Treatment Questionnaire, ADAPT) assessing the need for psychological care. The Assessment of the Demand for Additional Psychological Treatment Questionnaire gives two separate scores: the need for integrated psychosomatic support and for psychotherapy. In addition, health-related quality of life and the use of complementary and alternative medicine as well as clinical and sociodemographic variables were queried. Multivariable regression analysis was performed to estimate the effect of the previously mentioned variables on the need for additional psychological care.Results Of 1286 patients, 29.7% expressed a need for additional psychological care, 19.6% expressed a need for integrated psychosomatic support and 20.2% expressed a need for psychotherapy. In the multivariable analysis, the two strongest indicators for the need for both types of psychological care were the use of complementary and alternative medicine (for integrated psychosomatic support: odds ratio?=?1.64, 95% confidence interval 1.13–2.39, p?=?0.010; for psychotherapy: odds ratio?=?1.74, 95% confidence interval 1.20–2.53, p?=?0.004), and a low health-related quality of life score (for integrated psychosomatic support: odds ratio?=?0.95, 95% confidence interval 0.94–0.96, p?

Assessing financial effects of removal of TKA from CMS inpatient-only list on physician-owned bundles.

I can't get anything done at work now ... thanks to your June 2006 cover photo. That is the best cover I have ever seen. A great article goes along [...]

Due in large part to specific enabling tax legislation, QTE is one of the hottest cross-border/tax exempt leasing structures in the market today. As the telecommunications industry (historically the predominant [...]

Findings from published studies suggest that exposure to and interactions with green spaces are associated with improved psychological wellbeing and have cognitive, physiological, and social benefits, but few studies have examined their potential effect on the risk of mortality. We therefore undertook a national study in Canada to examine associations between urban greenness and cause-specific mortality.

Welders are exposed to many known and suspected carcinogens. An excess lung cancer risk among welders is well established, but whether this is attributable to welding fumes is unclear. Excess risks of other cancers have been suggested, but not established. We investigated welding cancer risks in the population-based Canadian Census Health and Environmental Cohort.

OBJECTIVES:The purpose of this project was to evaluate how changes to the sale of alcohol in New Brunswick would be distributed across urban and rural communities, and low- and high-income neighbourhoods. The study objectives were to 1 ) estimate the population living close to alcohol outlets before and after liquor distribution reforms, 2) identify communities or regions that would be more or less affected, and 3) determine whether expanding access to alcohol products would reduce school proximity to retailers.

Byline: Charles S. Roberts, Paul Peters, Christopher Lincoln Abstract: J Thorac Cardiovasc Surg 1997;114:297-8 Author Affiliation: London, United Kingdom Article History: Received 22 January 1997; Accepted 10 February 1997 Article Note: (footnote) [star] Address for reprints: Christopher Lincoln, FRCS, Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom., [star][star] 0022-5223/97 $5.00 + 0 12/54/81122 , a Copyright A[c] 1997 by Mosby-Year Book, Inc.

ABSTRACTInfective endocarditis (IE) is a life-threatening infection of the heart endothelium and valves. Staphylococcus aureusis a predominant cause of severe IE and is frequently associated with infections in health care settings and device-related infections. Multilocus sequence typing (MLST), spatyping, and virulence gene microarrays are frequently used to classify S. aureusclinical isolates. This study examined the utility of these typing tools to investigate S. aureusepidemiology associated with IE. Ninety-seven S. aureusisolates were collected from patients diagnosed with (i) IE, (ii) bloodstream infection related to medical devices, (iii) bloodstream infection not related to medical devices, and (iv) skin or soft-tissue infections. The MLST clonal complex (CC) for each isolate was determined and compared to the CCs of members of the S. aureuspopulation by eBURST analysis. The spatype of all isolates was also determined. A null model was used to determine correlations of IE with CC and spatype. DNA microarray analysis was performed, and a permutational analysis of multivariate variance (PERMANOVA) and principal coordinates analysis were conducted to identify genotypic differences between IE and non-IE strains. CC12, CC20, and spatype t160 were significantly associated with IE S. aureus. A subset of virulence-associated genes and alleles, including genes encoding staphylococcal superantigen-like proteins, fibrinogen-binding protein, and a leukocidin subunit, also significantly correlated with IE isolates. MLST, spatyping, and microarray analysis are promising tools for monitoring S. aureusepidemiology associated with IE. Further research to determine a role for the S. aureusIE-associated virulence genes identified in this study is warranted.

We assessed midterm outcomes, predictors of mortality, and residual defects after repair of post-infarction ventricular septal defect in 10 patients (mean age, 65.3 years; range, 50–78 years) who were operated on between 2000 and 2008. Mean time from onset of symptoms of myocardial infarction to diagnosis of ventricular septal defect was 3.5 days. Time from diagnosis to surgery ranged from 6?h to 84 days. The defects were located anteriorly in 4 patients and posteriorly in 6. Patch reconstruction of the septum was used in 6 patients and the infarct exclusion technique in 4. Hospital mortality was 60%. The only predictor of mortality was tricuspid valve competence (p?=?0.048). There was no correlation between location of the defect or type of repair and operative mortality. Residual or recurrent ventricular septal defect was noted in 6 patients. Location of the defect and type of repair were not predictors of residual or recurrent defects. Residual ventricular septal defect was not associated with increased short-term mortality or reduction of functional status. Early mortality associated with post-infarction ventricular septal defect repair is significant. Discharged patients continue to have good functional capacity and quality of life, as well as favorable midterm survival.

Background: It may be possible to avoid malleolar osteotomy for treatment of osteochondral talar lesions with chondrocyte transplantation techniques, where perpendicular approach to the talar surface is not required. We hypothesized that limited anterior distal tibial plafondplasty would allow access to most of the talar surface. We compared talar access with soft tissue exposure versus plafondplasty. Methods: Two soft tissue exposures (anteromedial and anterolateral) and two limited anterior distal tibial plafondplasties (anteromedial and anterolateral) were used on 12 cadaver lower-extremity specimens. Digital analysis was used to assess the accessible area. Results: Percentage of total talar dome surface area access increased significantly between soft tissue exposure and limited plafondplasty medially (22.3 ± 6.3% versus 37.9 ± 4.6%; p < 0.001) and laterally (22.4 ± 7.7% versus 37.9 ± 7.7%; p < 0.001). Percentage sagittal plane access also increased significantly between soft tissue exposure and limited plafondplasty medially 54.4 ± 12.0% versus 81.3 ± 9.7%; p < 0.001) and laterally (53.3 ± 14.5% versus 80.9 ± 12.8%; p < 0.001). Limited exposure to an additional 14.2 ± 5% of the total talar surface area was possible. The posterior 10.6 ± 8% was inaccessible. Conclusions: A soft tissue approach with limited plafondplasty provided adequate exposure for the majority of the medial and lateral talar surface. Only the central posterior 10% of the talus was not accessed by this method. Clinical Relevance: It may be possible to avoid malleolar osteotomy by using limited plafondplasty to access the talar dome for treatment of osteochondral lesions if perpendicular access to the talus is not required.

Platelet-rich plasma (PRP) contains growth factors derived from venous blood. Bone marrow concentrate (BMC) is an analogous platelet-rich product that is generated from bone marrow aspirate and might have the added advantage of containing mesenchymal stem cells. The active growth factors are platelet-derived growth factor, transforming growth factor β, vascular endothelial growth factor, hepatocyte growth factor, fibroblast growth factor, and epidermal growth factor. It is probable that a multitude of factors and cells play a role in inducing healing of hard or soft tissues that have been acutely or chronically injured or diseased. PRP can be used alone or in conjunction with surgical reconstruction to achieve better healing of tissues. Our group has treated 634 patients with PRP or BMC for nonunions, malunions, arthritis, malalignments, tendinopathies, tendon ruptures, plantar fasciitis, fractures, or ligament injuries that were performed in a variety of healthy and unhealthy patients. Overall, the results were favorable with very limited morbidity. In general, healing was more complete and rapid compared with historic norms, but failures can still occur. Condition-specific retrospective and prospective studies are underway to further establish the role of PRP in foot and ankle conditions and reconstructions. [Copyright &y& Elsevier]

The objective of this report is to share our experience with the different types of cardiac tumors, surgical management, postoperative complications and mid-term outcome of patients in an Australian tertiary hospital. Nineteen patients underwent cardiac surgery for tumors between 2001 and 2008. Their data was prospectively collected and retrospectively analyzed. The mean follow-up was 17 months. The follow-up was 100% through telephone interviews. There were multiple presenting symptoms with shortness of breath (7/19) as the most common. The tumors were atrial myxoma (14/19), fibroelastoma (2/19), angiosarcoma (1/19) and intravascular leiomyomatosis (1/19). A calcified thrombus (1/19) was misdiagnosed as a tumor. The fibroelastomas were shaved preserving valvular function. The angiosarcoma was incompletely resected with palliation intent. The leiomyomatosis and atrial myxoma were completely resected with satisfactory outcome. There was no in-hospital mortality. All patients were alive and were in New York Heart Association (NYHA) class I, except for the patient with a high-grade angiosarcoma who died eight months postoperatively. There was no evidence of recurrence in follow-up echocardiograms. Our experience and outcome is consistent with current literature. Atrial myxoma is the most common cardiac tumor and is curable with complete surgical resection. Fibroelastomas can be shaved off with low-risk of recurrence. Surgical management of angiosarcoma is palliative.

Objectives.The objective of this article is to measure the contributions of age groups and causes of death to differences in mortality and life expectancy between residents of Inuit Nunangat and the rest of Canada.Study design.The geographic area of coverage includes communities within Inuit Nunangat, with the addition of Inuvik in the Northwest Territories. Deaths were compiled for 2 5-year periods, 1994 through 1998 and 1999 through 2003, with the mid-year centred on the 1996 and 2001 censuses.Methods.Abridged life tables were constructed according to the revised Chiang method. Age decomposition of differences in life expectancy and cause-deleted life tables were calculated using a discrete approach. The age groups and causes contributing to differences in life expectancy between Inuit Nunangat and the rest of Canada were calculated.Results.Specific age groups contribute more to the difference in life expectancy between Inuit Nunangat and the rest of Canada. For males, over 50% of the difference in life expectancy is due to excess mortality before 25 years of age, while for females nearly 65% is due to excess mortality after the age of 60.Conclusions.Cancer is a major contributor to the difference in life expectancy between residents of Inuit Nunangat and the rest of Canada; reduction in cancer rates would make the greatest contribution to gains in life expectancy. There are clear gender differences in life expectancy and mortality, with the total effect of mortality being greatest for males between 15 and 25 years of age and for females over the age of 60.

Epicuticular wax forms an outer coating on the aerial surfaces of many crop plants and is implicated in tolerance to several environmental stresses including drought. Advances in knowledge of biosynthesis and secretion of these leaf surface waxes could lead to improvements in crop‐stress tolerance. To study the genetics of epicuticular wax deposition, we screened for bloomless (bm) and sparse‐bloom (h) mutants with reduced glaucousness of abaxial sheath surfaces within chemically mutagenized populations of Sorghum bicolor(L.) Moench. We screened over 3974 segregating M2head rows with over 160,000 plants and identified 38 putative recessive epicuticular wax mutant alleles. We grouped 31 of these into allelic groups associated with one existing and 18 new epicuticular wax loci. The overall epicuticular wax mutation frequency was 0.88%. In addition, analysis of the mutant segregation frequencies within the M2rows allowed us to calculate the existence of five target meristem cells in a dormant (M0) seed embryo. The high epicuticular wax mutation rate and identification of 19 epicuticular wax loci indicate the presence of a complex genetic system of epicuticular wax production in sorghum as has been shown in other species. The new bloomless and sparse‐bloom mutants identified here have a wide range of phenotypes and constitute a valuable resource for studies of the genetics and biosynthesis of epicuticular waxes and their effects on tolerance to environmental stresses such as drought.

Several letters to the editor are presented in response to articles including "The U.S. Catholic Church Is Sinking Fast -- Part III," published in the May 2008 issue, "The Editor Replies to Donley Kuendel," published in the June 2008 issue and "Freeing Children From Limbo," by Hurd Baruc published in the April 2008 issue.

As the Hindawi Publishing Corporation approaches its tenth anniversary, the author looks back at the history of Hindawi and examines a number of challenges that the company has faced over the past decade. These challenges include the rapid expansion of the company's workforce, the establishment of a standard editorial system for its journals, and the conversion of Hindawi's entire operation to an open access publication model. Although some of Hindawi's characteristics may not be common among other publishers, many of the challenges that Hindawi has faced are the result of recent developments within the scholarly publishing market that have implications for the entire industry.

Volker Braun's career as a writer is intimately bound up with the transition, anticipated by Marx and hoped for by Braun, to the socialist human community. But since this transition has been blocked off, Braun's texts have been characterised by other attempted transitions. The following essay examines two such exemplary transitions in the context of a diverse selection of Braun's writings: the one from life to death and the other from text to life.

A retrospective experience with preoperative lower tract evaluation, bladder rehabilitation and transplant outcome in patients with major abnormalities of the lower urinary tract is presented. From more than 1000 renal transplants during a 23‐year period, 11 patients required either augmentation cystoplasty (7 cases) or supravesical conduit diversion (4 cases) in preparation for transplantation. The causes of bladder abnormality were neurogenic, dysfunctional voiding, posterior urethral valves, congenital atresia, and acquired contracture in 4, 3, 2, 1 and 1 cases respectively. Lower tract evaluation began with voiding history and voiding cystourethrogram. Patients with incontinence or near zero bladder capacity were managed with supravesical diversion. Continent patients were studied further with serial cystometrograms via percutaneous suprapubic catheters during trials of bladder cycling to study bladder compliance. Continent patients with abnormally high bladder pressure (greater than 75 cm water) and/or low bladder capacity (less than 100 ml) underwent augmentation cystoplasty with intestinal segments. To date, 10 renal transplants have been performed in 8 patients with a cumulative graft survival of 70%, with follow‐up of 13 months to 3 1/2 yr. Two patients with bladder augmentation are awaiting transplantation. The final patient died of suspected pulmonary embolus following bladder augmentation and subsequent development of a bowel obstruction. Additional morbidity consisted of 8 episodes of urinary infection in 6 patients and 1 case of bleeding at the augmentation cystoplasty suture line. These results suggest that, with careful lower tract evaluation, patients with major bladder abnormalities may safely undergo renal transplantation into a rehabilitated bladder in most cases, or into a supravesical conduit when necessary, and can achieve satisfactory graft survival and low morbidity. A prospective plan for pre‐transplant lower tract evaluation is offered.

The influence of race on the outcome of cadaver renal transplantation (CRT) continues to be controversial even in the cyclosporine era. The present study examines the effect of race in 343 adult CRT performed from 1/1/82 through 10/1/88 with regard to the incidence of delayed function (DF), graft survival (GS), and patient survival (PS). Blacks constituted 38 of the patients. A history of nephrosclerosis secondary to hypertension was more common in blacks, with 51 (67/130) vs. 8 (17/213) in whites, while glomerulonephritis and Type 1 diabetes mellitus were more common in whites. There was no significant difference in the number of HLA (A,B,DR) matches or DR mismatches between whites and blacks. With azathioprine immunosuppression DF was more common in blacks than in whites, 54 (14/ 26) vs. 20 (11/55) respectively (P<0.01). The higher incidence of DF in blacks than in whites on Aza was associated with a significantly lower dose of intraoperative albumin, 0.25 g/kg vs. 0.44 g/kg, respectively (P<0.01). Of the Aza treated black recipients who had DF, 79 (11/14) had graft loss within three months, significantly worse than 25 (3/12) with graft loss when immediate function was present (P<0.005). Currently, all patients receive at least 0.80 g/kg of albumin intraoperatively and CsA quadruple induction therapy. With the current regimen, black and white recipients of primary CRT recipients have a comparable low incidence of DF of 18 and 22, respectively. However, DF remains high among repeat black or white recipients: 33 (10/30) and 57 (8/14), respectively. The incidence of rejection within 30 days was similar for black and white recipients during the Aza and CsA eras, 62 vs. 75 and 34 vs. 42 respectively. GS and PS at three months for blacks on Aza were 54 and 89, respectively, reflecting the corresponding high incidence of DF. This compares with 71 and 97 GS and PS for whites on Aza. Blacks and whites receiving CsA had equivalent 1-year GS and PS: 76 and 92, respectively. We conclude that, in our center during the Aza era, blacks had a higher incidence of DF and lower GS than whites. With our current intraoperative fluid replacement and CsA immunosuppression, the incidence of DF and GS and PS are equivalent in black and white recipients.

The records of 280 patients who underwent pelvic lymphadenectomy and radical cystectomy for transitional cell carcinoma of the bladder between 1971 and 1986 were reviewed. A total of 42 patients had either 1 (stage pN1) or more than 1 (stage pN2) positive lymph nodes (20 and 22 patients, respectively). The over-all 3-year survival rate for patients with positive lymph nodes was 27%, and it was 30 and 18.5% for stages pN1 and pN2 disease, respectively. Kaplan-Meier survival curves revealed a sustained survival advantage for stage pN1 over pN2 disease for the first 3 years (p <0.05) but the difference was not significant at 5 years of followup. Eleven patients with negative lymph nodes but local extension of tumor into the prostatic stroma and/or ducts had a 5-year survival rate of 36%, which equaled the survival of 49 stage pT3b,pN0 cancer patients in the same series. Surgical mortality for the entire population of 280 patients was 2.1% and there was no increase in mortality or morbidity among the node positive patients. Based on the findings of improved survival of stages pN1 and pT3b,N0 cancer patients compared to stage pN2 cancer patients, the tumor, nodes and metastasis classification offers more specific prognostic information than does a single designation of Jewett stage D disease.

A temperature-controlled multi-layer coil planet centrifuge rapidly yields highly efficient preparative separations of polar compounds. Capability of the method was demonstrated on a one-step purification of crude synthetic bombesin with a two-phase solvent system composed of n-butanol/dichloroacetic acid/water (100:1:100). Under an elevated temperature at 45°C to 50°C, the bombesin peak was eluted within two hours. Reversed phase HPLC analysis of the bombesin fractions showed over 98% purity. The method may be applicable to many other peptides and polar compounds.

Blunt renal injuries tax our judgement of when to operate. Penetrating injuries of the kidney are usually explored because of the high incidence of associated injuries. Reconstructive techniques after early control of the renal vasculature have led to reduction in nephrectomy rates; nephrorrhaphy with absorbable suture and omentopexy when capsule is not available are among these techniques. Vascularized parenchyma fragments may be left undisturbed in patients whose cardiovascular system is stable; avulsed devascularized fragments should be removed at early exploration. A high index of suspicion that ureteral injury may occur in excising large pelvic masses (> 10cm) does not prevent injury, but may lead to early detection and repair by uretero-ureterostomy and proximal diversion by ureteral stenting. Laparoscopic injury and repair are becoming part of our daily experience.

The mechanism of renal ablation by intra-arterial ethanol was studied in 16 mongrel dogs. Ethanol injection rates were varied, and light and electron microscopic studies were performed to detect early parenchymal changes in the kidneys. Pure ischemic injury was also studied as a control. Findings showed extensive parenchymal injury plays a significant role in renal ablation with permanent thrombosis as a delayed event. Acute arterial occlusion occurred with slow ethanol injection rates due to embolization by damaged blood components.

We evaluated 59 consecutive patients for obstructive voiding symptoms with physical examination, excretory urography, urethrocystoscopy, post-voiding residual volumes, uroflowmetry and transabdominal ultrasound of the prostate. Of the patients 53 underwent transurethral resection of the prostate and 6 underwent open prostatectomy. Followup uroflowmetry was done 4 weeks postoperatively. The best predictor of the actual prostatic weight was transabdominal ultrasound (r equals 0.975), and with digital rectal examination and urethrocystoscopy there was a tendency to overestimate small and underestimate large glands. Symptoms such as nocturia do not allow any conclusions about the size of the prostate. The correlation between post-void residual and specimen weight also is poor and only patients in retention (Foley catheter) have a significantly larger prostate. Preoperative uroflowmetry provides limited information about the prostatic size but, although the difference between the preoperative and postoperative flow rate index is highly significant (p less than 0.001, mean difference test), the correlation between specimen weight, and the difference between preoperative and postoperative flow rate index is not significant. We recommend transabdominal sonography of the prostate, a simple and noninvasive procedure, as a useful adjunct in the preoperative evaluation of patients with benign prostatic hypertrophy. In addition to the fact that only this method provides reliable and reproducible estimations of the weight of the prostate, further information, such as measurement of the post-void residual volume, can be obtained without additional costs or loss of time.

Toxicology embraces several disciplines such as carcinogenicity, mutagenicity and reproductive toxicity. Reproductive toxicology is concerned with possible effects of substances on the reproductive process, i.e. on sexual organs and their functions, endocrine regulation, fertilization, transport of the fertilized ovum, implantation, and embryonic, fetal and postnatal development, until the end-differentiation of the organs is achieved. Reproductive toxicology is divided into areas related to male and female fertility, and developmental toxicology. Developmental toxicology can be further broken down into prenatal and postnatal toxicology. Today, much new information is available about the origins of developmental disorders resulting from chemical exposure. While these findings seem to promise important new developments in methodology and research, there is a danger of losing sight of the precepts and principles established in the light of existing knowledge. There is also a danger that we may fail to correct shortcomings in our existing procedures and practice. The aim of this presentation is to emphasize the importance of testing substances for their impact in advance of their use and to underline that we must use the best existing tools for carrying out risk assessments. Moreover, it needs to be stressed that there are many substances that are never assessed with respect to reproductive and developmental toxicity. Similarly, our programmes for post-marketing surveillance with respect to developmental toxicology are grossly inadequate. Our ability to identify risks to normal development and reproduction would be much improved, first if a number of straightforward precepts were always followed and second, if we had a clearer understanding of what we mean by risk and acceptable levels of risk in the context of development. Other aims of this paper are: to stress the complexity of the different stages of normal prenatal development; to note the principles that are applicable in developmental and especially prenatal toxicology; to describe the different agents that might act as developmental toxicants or terato-gens; to show the broad scope of different effects caused by developmental toxic agents; and to indicate methods to detect and to recognise causes of developmental defects with the primary objective of preventing these disorders.

Splitting birth defects into dysmorphologically homogeneous groups might improve the ability to detect a genetic risk factor or teratogenic exposure. With regard to spina bifida, recent studies suggest that etiologic heterogeneity exists within the group of spina bifida, although exogenous risk factors have been sparsely evaluated for subgroups. In the present study, 210 spina bifida patients were classified into relatively homogeneous groups, based on retrospective information on appearance and functional aspects of the lesion abstracted from medical records of the patients. We compared high with low spina bifida, and open with closed spina bifida, and investigated whether risk factors for spina bifida such as maternal age, antiepileptic drug use, parental occupation, and genetic factors were specifically associated with these homogeneous subclasses. For these comparisons, a referent group of 671 children was used. Although classifying spina bifida into homogeneous subclasses presented some difficulties and numbers were small, this study provides some evidence for different risk profiles for subclasses of spina bifida. The sex ratio, the proportion of miscarriages of siblings, and maternal age did not differ among the different subclasses of spina bifida. However, children with a positive family history of neural tube defects (NTDs) had a higher risk of high spina bifida [odds ratio (OR) = 6.3, 95% confidence interval (CI): 1.7-19.2] than of low spina bifida (OR = 2.1, 95% CI: 1.0-4.2). Siblings with NTDs were more common in cases with high spina bifida and cases with open spina bifida. A strongly increased risk of high spina bifida was found for male welders (OR = 12.1, 95% CI: 1.5-64.2), whereas the risk of low spina bifida was much lower (OR = 1.6, 95% CI: 0.2-7.9). For mothers with agricultural occupations, a strongly increased risk was observed for open spina bifida (OR = 14.3, 95% CI: 2.9-77.7), whereas none of 107 cases with closed spina bifida had a mother with an occupation in agriculture. Due to small numbers, the results must be interpreted with caution. Teratology 55:224-230, 1997. © 1997 Wiley-Liss, Inc.

Hypertension is common in patients following renal transplantation. Chronic rejection, native end-stage kidneys, and transplant renal artery stenosis may all contribute to hypertension through the renin-angiotensin system. We believe renin measurements are of interest and that the renin-angiotensin system mediates hypertension associated with native end-stage kidneys and transplant renal artery stenosis. However, our ability to interpret renin levels in transplant recipients is limited. Native bilateral nephrectomy should be considered in the rare transplant recipient with medically uncontrollable hypertension and no transplant renal artery stenosis. Major transplant renal artery stenosis should be repaired. At this time, percutaneous transluminal angioplasty of the renal artery appears to be a reasonably safe and efficacious first-line therapy. Surgical repair may be reserved for failures by the percutaneous method. Longer follow-up and larger numbers are required to determine if this optimism in percutaneous angioplasty of transplant renal artery stenosis is justified.

Skinner and deKernion's datum, like ours, suffers from the fact it is retrospective and not randomized. Therefore, it provides suggestive but not conclusive evidence that lymphadenectomy enhances the chances for survival of a patient with a given stage and grade of renal cell carcinoma. In our study, lymphadenectomy was defined as removal of the regional lymph nodes from the diaphragm to the bifurcation of the common iliac artery on the homolateral side, which was the usual type of lymphadenectomy performed in this retrospective analysis. Because information may be obtained from lymphadenectomy alone which allows a more accurate estimate of the patient's prognosis in 8 per cent of the cases, and because our data suggest a statistical improvement in survival in patients with stage C and D disease if lymphadenectomy is performed, it is recommended that patients undergoing radical nephrectomy for renal cell carcinoma have a regional lymphadenectomy performed at the same time. It is also recommended that a prospective randomized study of the role of lymphadenectomy in patients with a given stage and grade of renal cell carcinoma be undertaken.

Eleven patients with bladder cancer underwent radical cystoprostatectomy and urinary diversion by means of an ileal reservoir attached directly to the membranous urethra as described by Camey and Le Duc. There were no postoperative deaths and only one serious complication. Subsequent assessment of these patients revealed that they exhibited adequate urine storage capacity, were able to develop normal urinary continence during the day, and could empty their reservoir to less than two ounces residual urine by voluntary urination, but that they tended to wet themselves at night. Technically, the operation was not difficult, but attention to the urethroileal anastomosis and good drainage were important in avoiding troublesome collections of urine in the deep pelvis.

Of 505 consecutive renal transplants urologic complications occurred in 4.1 per cent of cadaver, 2.6 per cent of living related, 1.9 per cent of diabetic and 3.8 per cent of nondiabetic allografts. Over-all, patient survival and graft salvage rates were 94 and 83 per cent, respectively. Principles of prevention, diagnosis and management of these complications are discussed. In contrast to prior standards the bladder catheter was removed within 36 hours postoperatively in nearly all cases without any increase in morbidity.