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Seventy-five patients with suspected testicular torsion who had scintiscans and adequate clinical follow-up were analyzed retrospectively. The scintiscans diagnosed 12/13 cases of surgically proven missed torsion and 3/3 cases of surgically proven acute complete torsion. The scintiscans successfully distinguished all 35 cases of epididymo-orchitis, 14 cases of torsion of the appendix testes and 8 other miscellaneous conditions from testicular torsion. The incidence of testicular torsion in our patients undergoing scrotal scintigraphy was approximately 24%.

Proximal muscular weakness is a feature of many metabolic bone diseases but is not well recognized in spinal osteoporosis. Thirty-six post-menopausal women presenting with back pain, with or without osteoporosis, were therefore studied in order to define the relationship between abnormal electromyographic findings and disturbed vitamin D metabolism, as both low plasma 1,25 dihydroxy vitamin D concentrations and malabsorption of calcium have been reported in osteoporosis. Patients with abnormal electromyograms had lower concentrations of plasma 1,25 dihydroxy vitamin D (mean 78.3 pmol/l, SD 20.5, n = 15) than normal subjects of similar age (mean 110.4 pmol/l, SD 39.4, n = 21; P less than 0.01), but electromyographic abnormality was not associated with changes in radiocalcium absorption, plasma 25 hydroxy vitamin D, plasma calcium or phosphate or urinary calcium or hydroxy-proline excretion or impaired renal function. There was no relationship between abnormal electromyography and osteoporosis assessed by spinal radiographs and iliac crest biopsy. These findings are consistent with our previous suggestion that muscle weakness in many unrelated bone disorders is related to low plasma 1,25 dihydroxy vitamin D concentrations, but suggest that there is no relationship between proximal myopathy and spinal osteoporosis in post-menopausal women.

In reply to Krueger, we address the issues of lowercase versus uppercase letter strings, words versus pseudowords, repeated letters in the test string, descriptions of orthographic structure, similarity effects, apples and oranges, and interactions of age with other variables.

31P NMR spectroscopy was used to analyzed the in vivo metabolism of reticulum cell sarcoma of mice. The ratio of high- to low-energy phosphates ATPB/(Pi + PME) was measured to reflect the relative metabolic state in the tumor. Of the 34 mice studied, 26 were treated with an antiangiogenesis regimen of heparin and cortisone. Eighty-two percent of the tumors treated eventually decreased in volume (P less than 0.01). Volumes and spectroscopic information of 20 tumors were analyzed. Although the average untreated volume was similar to the volume after 3 days of treatment, the average ATPB/(Pi + PME) ratio rose from 0.34 +/- 0.10 to 0.47 +/- 0.07 (P = 0.02). However, after 6 days of treatment, the volume significantly decreased (P less than 0.0001) but the ratio did not significantly rise further (P = 0.06). The rise in the high-energy phosphate preceded a significant decrease in volume of the tumors. In addition, the replenishment of high-energy stores with tumor regression coincided with the histologic findings of a decrease in the number of tumor cells, a decrease of the mitotic index, and a decrease of the number of necrotic cells present with ongoing treatment. Our data suggest that noninvasive methods of assessing early biochemical response of tumor regression may be possible.

Because no large series of perforated peptic ulcers has been reported from Canada, 402 cases from the Ottawa Civic Hospital were reviewed to study this dramatic disorder.The incidence was 15 per 100,000 population annually, or one in every 1000 hospital admissions.The incidence in females and the elderly in this series was higher than reported elsewhere. The risk of perforation increased with age, being greatest after 55; this was not due to an excess of chronic ulcers in older patients, indicating that ageing is an etiological factor.As the mortality of perforated peptic ulcer-20%-had remained unchanged over the years, fatal cases were studied to see if changes should be made in the management of this condition. The mortality for patients undergoing operation was 7.5%. Patients treated conservatively because their general condition was poor, died. Fifteen patients, in whom an incorrect diagnosis was made, died. More aggressive therapy and greater efforts at diagnosis might have saved some of these patients.