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Volar plating of distal radius fractures was introduced as a means to circumvent some of the issues with dorsal-based plating but has been shown not to be a complete panacea, as other advantages and challenges have subsequently been discovered. Careful attention and proper technique must be utilized to restore and maintain volar tilt. This study reports a technique of using a locking screw as a proximal peg to reliably obtain the volar tilt in a simple fashion.

An experiment was conducted to determine the interactive effects of Eimeria acervulina infection and phytase in male broiler chicks. Chicks were standardized from 0 to 4 d posthatching, and the assay period was 5 to 15 d. Treatments were replicated with 6 pens of 5 chicks each. The initial and final BW were 67 and 363 g. A corn-soybean meal diet formulated to provide 1.26% total Lys and 3,200 kcal of ME/kg was used, and it was adequate in all other nutrients except Ca and nonphytate P (NPP) when appropriate. The treatments were in a 2 x 2 x 2 factorial arrangement: adequate Ca and NPP (1.0% Ca and 0.45% NPP) or inadequate Ca and NPP (0.80% Ca and 0.25% NPP), 0 or 600 phytase units/kg of diet, and uninfected or infected with 400,000 E. acervulina oocysts on d 0, 3, and 6 of the experiment. Daily gain, average daily feed intake, and gain:feed (GF) were reduced (P < 0.01) by the coccidial infection and the reduction in Ca and NPP. Phytase addition increased (P < 0.02) average daily gain and average daily feed intake, regardless of the Ca and NPP contents of the diet or the presence of coccidiosis. The GF was increased by phytase but only in uninfected chicks (phytase x coccidiosis, P < 0.02). Toe and tibia ash percentages were decreased (P < 0.01) in chicks fed diets deficient in Ca and NPP, but tibia ash was decreased more by Ca and NPP in healthy chicks than in infected chicks (coccidiosis x Ca and NPP, P < 0.02). Phytase increased (P < 0.02) toe and tibia ash but only in diets deficient in Ca and NPP (phytase x Ca and NPP, P < 0.01). Phytase increased toe ash percentage of healthy chicks fed diets deficient in Ca and NPP, but it had less of an effect in infected chicks fed diets deficient in Ca and NPP (coccidiosis x Ca and NPP x phytase, P < 0.08). Also, phytase was less effective in increasing tibia ash percentage in coccidiosis-infected chicks than in uninfected chicks (phytase x coccidiosis, P < 0.02). These data indicate that phytase is effective in the presence of a coccidial infection, but based on GF and tibia ash percentage, it may not be as effective as in uninfected chicks. Also, phytase increased average daily gain and average daily feed intake in uninfected chicks fed diets formulated to be adequate (or in excess) in all nutrients for male broiler chicks.

Patients undergoing procedures under general anaesthesia as day cases are routinely given a set of instructions regarding activities to avoid in the first 24 h after discharge. Day surgery units generally specify the need for a responsible carer from time of discharge for a period of 24 h. This study looks at the compliance of 240 patients with postoperative instructions. Of the patients studied, 4.1% drove, 1.7% made important decisions, 3.3% drank alcohol, 0.8% took sedatives and 10% cooked, ironed or looked after children. All patients were discharged into the care of a responsible adult. However, 13.3% failed to have a carer with them for 24 h and 1.3% spent the night alone at home. Of our cohort, 25% were unable to comply with the postoperative instructions in full. The majority of non-compliance occurred on the day following surgery, suggesting that patients may feel that the advice is excessively cautious.

An investigational tetravalent combined measles, mumps, rubella, and varicella vaccine and measles-mumps-rubella and varicella vaccines at separate injection sites given at the same visit were evaluated with respect to safety and cell-mediated and humoral immune responses at 6 weeks and 1 year after vaccination. Varicella seroconversion rates and lymphocyte proliferation responses were 100% for both vaccine groups at 6 weeks and 1 year. However, the antibody titer to varicella was lower in the combined vaccine group at 6 weeks, but there was no statistical difference in cell-mediated immune responses. One-year geometric mean titers were not statistically different. Seroconversion rates for measles, mumps, and rubella were 100% for both vaccine at 6 weeks and 1 year. Long-term follow-up of these immune responses is planned.

Objective To evaluate the acceptability and feasibility of a scalable obesity treatment program integrated with pediatric primary care and delivered using interactive voice technology (IVR) to families from underserved populations. Design and Methods Fifty parent-child dyads (child 9–12 yrs, BMI >95th percentile) were recruited from a pediatric primary care clinic and randomized to either an IVR or a wait-list control (WLC) group. The majority were lower-income, African-American (72%) families. Dyads received IVR calls for 12 weeks. Call content was informed by two evidenced-based interventions. Anthropometric and behavioral variables were assessed at baseline and 3 mo follow-up. Results Forty-three dyads completed the study. IVR parents ate 1 cup more fruit than WLC (p < .05). No other groups differences were found. Children classified as high users of the IVR decreased weight, BMI and BMI z-score compared to low users (p75% agreed that the calls were useful, made for people like them, credible, and helped them eat healthy foods. Conclusion An obesity treatment program delivered via IVR may be an acceptable and feasible resource for families from underserved populations.

SummaryAn open, multi-centre study was carried out to assess the ease with which a patient could be instructed to use the terbutaline ‘Turbohaler’ ('Bricany1 Turbohaler7 and whether benefit was obtained and technique still satisfactory 4 weeks later. Asthmatic patients not receiving oral steroids were eligible; 1.38 completed the study. There were consistent increases in PEFR and FEV 1 at the start and end of the study on using the ‘Bricanyl Turbohaler’. Over 80% of patients used it correctly in every respect fulfilling each of 8 criteria and 96% found it easy to use. It was easy to instruct patients to use the ‘Turbohaler’. patients continued to use it correctly after a month and obtained sustained benefit.

Five experiments (Exp.) were conducted to determine the effects of phytase on growth performance and intestinal transit time in chicks fed nutritionally adequate diets and diets deficient in Ca and nonphytate P (nPP). In Exp. 1 and 2, chicks were fed a nutritionally adequate diet from 0 to 6 d or from 0 to 4 d posthatching; assay periods were 8 or 10 d; average initial BW were 98 or 79 g; and average final BW were 371 or 369 g, respectively. Treatments were replicated with 12 pens of 5 chicks each. Corn-soybean meal (C-SBM) diets were adequate in all nutrients except Ca and nPP where appropriate. The treatments were 1) C-SBM, 1.0% Ca, and 0.45% nPP; 2) C-SBM, 0.80% Ca, and 0.25% nPP; 3) Diet 1 + 600 phytase units/kg of diet; 4) Diet 2 + 600 phytase units/kg of diet. Experiments 3, 4, and 5 were conducted to determine the effects of phytase on intestinal transit time in broilers. Broilers were fed the same nutritionally adequate diet from 0 to 18, 27, or 23 d posthatching, and the assay periods were 7 d. Treatments were replicated with 18 individually penned broilers. Average initial BW were 768, 1,108, or 838 g, and average final BW were 1,299, 1,704, or 1,392 g in Exp. 3 to 5, respectively. Transit time data were collected on d 1 and 7 of the Exp. Diets were 1) C-SBM, 0.9% Ca, and 0.35% nPP; 2) C-SBM, 0.80% Ca, and 0.25% nPP + 600 phytase units/kg of diet. Transit time was calculated as the difference between the time feed was first ingested and the time of first appearance of solid feces. In Exp. 1 and 2, the reduction in dietary Ca and nPP reduced (P < 0.01) average daily gain (ADG), average daily feed intake (ADFI), and gain:feed. Phytase addition increased (P < 0.02) ADG and ADFI in diets deficient in Ca and nPP and in the nutritionally adequate diets. In Exp. 2, the reduction in Ca and nPP reduced (P < 0.01) toe and tibia ash percentage, but phytase addition increased (P < 0.01) toe and tibia ash percentage. The increase in toe ash percentage was greater in chicks fed the Ca and nPP deficient diet than in chicks fed the nutritionally adequate diet (Ca and nPP x phytase, P < 0.01). In Exp. 3, 4, and 5, transit time on d 1 was faster (P < 0.03) in chicks fed phytase. On d 7, transit time tended to be faster in chicks fed phytase, but the effect was not significant (P = 0.15). These data indicate that phytase increases ADG and ADFI in diets deficient in Ca and nPP and in diets formulated to be adequate (or excess) in all nutrients for broiler chicks. The increase in ADG and ADFI in chicks fed the nutritionally adequate diet may be due to a faster transit time of feed through the digestive tract, resulting in a greater feed intake and gain.

We describe a patient with the sudden onset of a painful, purely sensory, mononeuritis multiplex. Investigations showed no evidence for any underlying systemic condition. A nerve biopsy showed fascicular wallerian degeneration with perineurial thickening, inflammatory cells, and immunoglobulin G (IgG) deposition. His painful sensory deficits persisted, with no improvement after treatment with prednisone. The clinical characteristics in this case were very similar to those originally described by Wartenberg, and subsequently by other investigators. The investigations in our case strongly suggest that there may be an underlying immune pathogenesis for cases of Wartenberg's migrant sensory neuritis.

The British Society of Gastroenterologists suggests that dyspeptic patients under 45 years of age should be screened serologically for Helicobacter pylori infection, to reduce endoscopy workload. We have compared the sensitivity, specificity, and predictive value of six commercial serological kits intended for pre-endoscopy screening for H. pylori with histopathology and culture in 82 dyspeptic patients, 35 of whom were H. pylori positive. The kits' sensitivities were as follows: Bio-Rad GAP 100%, Helico-G 100%, Premier 97%, and Pyloriset EIA-G 94%. Poor specificity of the ELISA kits--Bio-Rad GAP 67%, Helico-G 67%, Premier 85%, and Pyloriset EIA-G 76%--was due to previous treated or cleared H. pylori infection. Allowing for previously documented H. pylori infection or peptic ulcer improved specificity--Bio-Rad GAP 84%, Helico-G 84%, Premier 100%, and Pyloriset EIA-G 90%. The Pyloriset Dry latex kit had a higher specificity (86%) but a lower sensitivity (75%) than the Oxoid latex kit (specificity 70%, sensitivity 94%). The qualitative Premier Launch kit had the best overall results (and was the easiest ELISA to perform). Reliable serological diagnosis of H. pylori is now suitable for screening dyspeptic patients.

We have investigated the effect of four doses of remifentanil on the incidence of respiratory depression and somatic response at incision. Remifentanil was administered as a loading dose of 0.125, 0.25, 0.375 or 0.5 microgram kg-1 and at a maintenance infusion rate of 0.025, 0.05, 0.075 or 0.1 microgram kg-1 min-1, respectively, with an infusion of propofol 6 mg kg-1 h-1. Responses occurred in 88% of patients with remifentanil 0.025 microgram kg-1 min-1 compared with 30-40% in the other groups. Respiratory depression after incision increased from 6% with remifentanil 0.025 microgram kg-1 min-1 to 73% with 0.1 microgram kg-1 min-1. Increases in propofol infusion rate to 7.2-8.4 mg kg-1 h-1 produced adequate maintenance of anaesthesia. Reductions in remifentanil doses to 0.025-0.05 microgram kg-1 min-1 resulted in adequate respiration at the end of surgery in 88% of patients. Maintenance infusions of the two drugs for spontaneous ventilation are likely to be in these ranges. However, the ideal loading doses and infusion rates for induction remain to be established.

Occupational exposure to blood and body fluids and the prevalence of serological markers of hepatitis B virus (HBV) infection were studied in Gloucestershire firemen to assess the occupational risk of HBV infection. A high compliance was achieved (472/503, 94 per cent). Cumulative occupational exposure to blood or body fluids rose progressively to 68 per cent after 24 years' service. No sera were positive for hepatitis B surface antigen (HBsAg). Six sera were positive for hepatitis B surface antibody (anti-HBs) and were tested for hepatitis B core antibody (anti-HBc). The four subjects who were positive for anti-HBs alone had all received HBV vaccine. Two sera contained both anti-HBs and anti-HBc. Therefore, 2/472 firemen (0.42 per cent) showed evidence of previous HBV infection, a similar proportion to that found in a recent study in UK blood donors (0.49 per cent). Despite considerable exposure to blood and body fluids, an occupational risk of hepatitis B infection was not found in Gloucestershire firemen.

The consequences of acute amphetamine administration on the metabolic responsiveness of the cerebral cortex to physiologic activation were studied in normal and infarcted rats. Treated rats received a 4 mg/kg intravenous injection of d-amphetamine 1 hour before unilateral vibrissae stimulation and 2-deoxyglucose study. In nontreated normal rats, metabolic activation was restricted to the major relay stations of the vibrissae-barrel circuit. In amphetamine-treated rats, stimulation-induced increased glucose utilization was widespread, including ipsilateral and contralateral cortical regions outside the barrel field circuit. For example, an 84% increase in glucose utilization above control was seen in cortical areas anterior to the barrel field region. Increased glucose utilization induced by stimulation was severely depressed in nontreated rats that had undergone infarction of the left cortical barrel field 2 weeks previously. Vibrissae stimulation failed to increase glucose utilization significantly in cortical areas remote from the infarct. In contrast, bilateral increases in glucose utilization were observed within cortical regions of treated infarcted rats. For example, a 50% increase in glucose utilization was detected in cortical areas bordering the infarct. Thus, in the normal and infarcted rat, amphetamine appears to promote alternate circuit activation--a pharmacologic property that may be advantageous for recovery after injury.

Cortical function was evaluated in 26 subjects with spasmodic dysphonia. Quantitative topographic electrophysiologic mapping (QTE) was employed to provide quantitative analyses of EEG spectra and auditory and visual long-latency evoked potentials. Single-photon emission computed tomography (SPECT) of the cerebral transit of Xenon-133 was used to evaluate regional cerebral blood flow. Left hemispheric abnormalities in cortical function were found by both techniques in 10 subjects and by at least one technique in 18 subjects. Right hemispheric abnormalities were observed by both techniques in 8 subjects and by at least one technique in 18 subjects. Most patients with cortical dysfunction in one hemisphere had cortical dysfunction in the other, while only 4 subjects had unilateral lesions as found by one of the two techniques. Eight subjects were normal by all measurements. Underlying structural abnormalities were detected by magnetic resonance imaging in 5/24 subjects. However, functional abnormalities (SPECT or QTE) were not observed at sites of structural abnormalities. SPECT and QTE were significantly related in identification of left hemispheric dysfunction (p = .037) with a trend in the right hemisphere (p = .070), and a significant congruence of SPECT and QTE findings occurred in the left anterior cortical quadrant (p = .011). These findings indicate that dysfunction of cortical perfusion and/or cortical electrophysiology is associated with spasmodic dysphonia in the majority of subjects studied.

Oesophageal achalasia is uncommon in children and in its familial form it is a rarity. The presentation and management of two male siblings who presented with oesophageal achalasia as infants are reported. A high degree of consanguinity in the parents of the children existed, suggesting autosomal recessive transmission.

Two mothers who had asymptomatic rubella infection in pregnancy gave birth to severely affected infants. In both, the presence of preexisting antibody was well documented, although it could not be established whether it was the result of vaccine or natural infection.

Summary Rapid recognition and appropriate therapy will prevent or remediate most of the complications occurring in children after cataract aspiration and IOL implantation. Some of the complications of pediatric IOL implantations are related to the increased scleral pliability and decreased rigidity which predispose scleral collapse, vitreous loss, flat anterior chamber and corneal endothelial damage. A second group of complications is associated with the enhanced inflammatory and fibrotic responses peculiar to a child's eye. This group includes operative striate keratitis and iridocyclitis, late IOL precipitates, secondary and postpseudophakos membranes, iris erosion and synechiae formation, and IOL tilt and displacement. Although the intraocular lens is a possible means of visual rehabilitation for children with traumatic cataracts or unilateral infantile cataracts, its long-term risk/benefit ratio must still stand the test of time.

Four cases of malignant hyperphenylalaninemia (MHPA) are described. Pretreatment serum phenylalanine levels were 1.5, 3.0, 2.4, and 0.9 mmoles/l. Dihydropteridine reductase (DHPR) deficiency was proven in one patient by assays on cultured fibroblastic cells and was presumed in her sibling and in another deceased patient whose parents' fibroblastic cells show approximately 50% of normal enzyme activity. DHPR and phenylalanine hydroxylase deficiency were excluded by assays on liver obtained at autopsy in the 4th patient. Parenteral administration of tetrahydrobiopterin (BH4) corrected the hyperphenylalaninemia and increased the levels of catecholamines and 5-hydroxy-indoles in the one patient studied in life, but BH4 did not reach the cerebrospinal fluid. A 3-wk course of BH4 therapy had no clinical effect. Oral biopterin was absorbed and excreted in the urine, but did not alter the serum phenylalanine level. The frequency of MHPA in Australia was estimated as 7 in 258 patients with phenylketonuria.

The effects of various psychomotor stimulant drugs and drugs outside this class were examined on the efficacy of stimuli previously paired with reinforcement or reward (conditioned reinforcers, CR) in controlling responding. Pipradrol (5-45 mumol/kg), d-amphetamine (1.25-15.0 mumol/kg), and the cocaine analogues WIN 35,428 (0.1-30.0 mumol/kg) and in one of two determinations WIN 35,065-2 (0.1-29.0 mumol/kg) all generally increased responding on a lever providing CR, but did not change or decreased responding on a lever providing no CR (NCR). Cocaine (5-125 mumol/kg) and chlordiazepoxide (3.75-60.0 mumol/kg) had no significant effects. Morphine (3.2-32.0 mumol/kg) and alpha-flupenthixol (0.02-2.0 mumol/kg) generally reduced responding on both levers. Apomorphine (0.1-1.0 mumol/kg) generally increased responding on both levers. Neurochemical data showed that d-amphetamine was generally more potent than pipradrol in its effects on in vitro monoamine uptake and release.

Measurements of the total duration, tA, of the action potential for canine papillary muscle in the temperature range 25-45 degrees C are shown to follow the law ta = tau exp (Q/kBT), with tau and the activation energy Q independent of temperature, T, and kB equal to Boltzmann's constant. The value obtained for Q = 0.65 +/- 0.10 eV. Results are also presented for the temperature dependence of points V(x) on the action potential curve, where x is the percentage of repolarisation within the range 30% less than x less than 100%.

Radiotelemetry was used to determine changes in extracellular pH and tissue temperature during tumor development in rats of an inbred WAB substrain. A progressive decrease in the pH of the tumor tissue compared with the pH level in control tissue was observed, so that by 4 days after tumor implantation the tumor tissue was about 0.4 pH units lower than control values. Thereafter, tumor pH rose progressively to reach a value comparable with control levels at 8 days, when the experiment was terminated. No significant difference was detected between the temperature in the tumor tissue and the temperature in the control tissue. Therefore, the observed changes in pH appeared to be independent of temperature. Studies on the rate of tumor cell proliferation during the experiments demonstrated a significant inverse relationship between tumor cell mitotic rate and pH, with the highest rates of cell proliferation occurring at the time of lowest pH values.

Seven patients with bronchial asthma requiring continuous medication were subjected to eight weeks of nocturnal exposure to negatively ionized air, and their progress was followed using objective tests of lung function and clinical assessment. During exposure, four patients showed significant increases in morning PEFR, which in two of these patients was not sustained when exposure ceased. In two patients the observed increase in PEFR was accompanied by subjective improvement. From the results of all our assessments we conclude that, although this treatment may lead to an improvement in some patients with asthma, further objective studies are required to determine the value of negatively ionized air in the routine management of asthma.

Rats were hypophysectomized, and 2 hr later one adrenal was excised. An intravenous infusion was then carried out for 1 hr followed by the removal of the remaining adrenal. Assay of the 2 adrenals revealed that infusion of 30 mg dibutyryl cyclic AMP resulted in a decrease in ascorbic acid concentration of 20±2% (mean±SEM, 17 rats), while 5 U of ACTH produced a decrease of 28±3% (11 rats). Saline controls exhibited an increase of 6±3%. During 1-hr incubations of rat adrenals, 10 mM cyclic AMP produced a 13±3% decrease in ascorbic acid levels, a result similar to that produced by ACTH. These results suggest that cyclic AMP mediates the ascorbic acid depleting effect of ACTH. Cycloheximide in quantities sufficient to block adrenal protein synthesis and the stimulation of steroidogenesis also impaired the ascorbic acid depleting effects of ACTH and cyclic AMP in vivo and in vitro. An NADPH generating system produced a significant increase in corticosterone production, but failed to bring about ascorbic acid r...

The organisation of an electronics department required to support the work of a large teaching hospital is described. The research and development programme involves the interaction of graduates from many disciplines since problems can emerge from any of the specialities, for example general surgery, obstetrics and gynaecology, clinical neurophysiology. Examples from the research and development programme of the department are described in order to illustrate the range of medical electronic techniques needed to provide adequate support for the clinical research programmes which have received support from the Joint Research Board of the Hospital and Medical College.

A method was designed to control the insulin infusion given to diabetic patients at the time of open-heart surgery. Excellent control of the blood glucose concentration was achieved, with eighty-four percent of blood glucose values falling between 4 and 8 mmol/l.

Two children with food allergy could not be successfully managed on dietary restriction alone. There was a good response to treatment with oral sodium cromoglycate but none to placebo treatment. The use of sodium cromoglycate in the management of food allergy should be studied further.

This study reports the practical problems involved in the use of a miniature Geiger counter to detect the site of bleeding into the intestine. The observations so far have been made in dogs but its possible application in man is proposed.

Neutral insulin and biphasic insulin have been used in the past five years in seven patients suffering from localized subcutaneous fat atrophy as a complication of the injection of other insulin preparations. In all cases marked improvement of the atrophy occurred.

In the treatment of aphonia after surgical treatment of carcinoma of the larynx, pharynx and oesophagus, amplification of the oesophageal speech has been described (Greene, 1967 and Watson, 1967).