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This paper is concerned with the starlikeness of certain normalized functions, analytic in the open unit disk, defined by integral representations. Results due to Caplinger and Singh are extended.

Studies evaluating the relative importance of the upper and lower canaliculi in tear drainage have been many and varied, and at times the application of the data to clinical situations is difficult. In order to evaluate the relative tear flow in the upper and lower canaliculi and to quantitatively evaluate the different tear flow rates by a physiologic method, we have studied 11 patients using partial canalicular obstructions and dacryoscintigraphy. The authors found no statistical difference in tear flow between the upper and lower canalicular systems. This information has clinical application when deciding whether to repair an isolated canalicular injury.

Careful surgery, a precise dressing technique with prolonged immobilization, and the utilization of designs borrowed from the glove industry are integral aspects in our attempts to resufrace the dorsal surface of the hand. One case is presented to demonstrate our method.

Among 169 adult pathologically staged patients with Hodgkin's disease who were treated at the Mayo Clinic between 1974 and 1978, we identified four cases of second malignant lesions that developed. The median duration of follow-up after diagnosis for the entire population was 4.1 years. Of the 169 patients, 73 received irradiation only, 19 received chemotherapy only, and 77 received both chemotherapy and radiation therapy. In all four patients with second malignant lesions, Hodgkin's disease was in apparent remission at the time of diagnosis of the second tumor. These four patients had received either total nodal irradiation or six or more cycles of chemotherapy as initial treatment (and one of them had received both treatment modalities). Thus, intensive therapy might be hypothesized to have played a role in the development of the second malignant tumor. To our knowledge, the development of non-Hodgkin's lymphoma within a previously irradiated field after treatment of Hodgkin's disease with radiation therapy only has not been reported previously. Although further studies with longer follow-up should be conducted, our analysis supports a definite risk for development of a second malignant lesion not only after combined-modality treatment or chemotherapy for Hodgkin's disease but also after irradiation only.

A previously described thermal diffusion flow probe was used to monitor cortical blood flow in over fifty craniotomies for treatment of aneurysms. Hypotension, retractor pressure, vascular manipulation, and temporary vessel occlusion can be seen to affect cortical blood flow. By monitoring cortical blood flow, anesthetic and surgical techniques may be altered to prevent ischemic complications. We have only limited experience with early operation and with craniotomy in the face of vasospasm. Monitoring cortical blood flow may eventually allow operations in these instances to be accomplished more safely.

Regional cortical blood flow was monitored at craniotomy in 32 patients with a thermal diffusion flow probe in an attempt to assess the effects of surgical conditions on flow. Changes in flow due to vascular manipulation, retraction, hypotension, and hyperventilation were readily apparent. Eleven patients with supratentorial tumors had intermittent measurements of cerebral blood flow; the expected differences in blood flow with halothane anesthesia and hyperventilation were observed. Fourteen patients with aneurysms were monitored continuously and demonstrated a reduction in flow during hypotension; in two of these cases, the reduction was to disastrously low levels. Flow reduction occurred secondary to branch occlusion by the aneurysm clip in a patient with three middle cerebral artery aneurysms and was corrected by changing the clip position. Direct measurement of regional flow may be of value in estimating the safety of temporary clips and the degree of hypotension that can be tolerated.

This investigation of the dangers of the rotary mower reveals that injuries are common due to inadequate safety features, lack of understanding of the hazards involved, and carelessness. The injuries appear to follow definite patterns from the standpoint of anatomic location, type and severity. Eightynine rotary mower injuries are reviewed.

In an attempt to hasten the transfer of pedicle grafts from the torso to the upper extremity and to provide a greater element of patient comfort, cross chest flap procedures have been used. It has been found that the technic is particularly contraindicated in those persons with barrel chests. Otherwise the method provides excellent tissue for transfer, greatly relieves patient discomfort and allows outpatient care in the later days of flap attachment. While the incidence of ten failures among sixty flaps is unreasonably high, the method offers enough promise to warrant its continued use in carefully screened patients.

In operating rooms, emergency rooms, outpatient departments, and doctors' offices, there is often need for a finger splint. Ideally, a finger splint should be simple, readily available, and malleable and should possess sufficient strength to immobilize the affected part. The encircling metallic bail bands found on bottles of many brands of commercial intravenous fluid can be shaped easily and quickly into satisfactory finger splints that will satisfy these demands. Since these splints can be made so easily and quickly and since the material is so abundant, it is usually quicker to make a new splint at each dressing than to salvage the original. The metal bands are about 0.5 in. wide and 12 to 13 in. long. They have a large perforation at one end and are tapered at the other end. Two convexities are present, each with a small perforation to accommodate the supporting wire loop. To fashion a

International guidelines recommend coeliac serology in iron deficiency anaemia, and duodenal biopsy for those tested positive to detect coeliac disease. However, pre-endoscopy serology is often unavailable, thus committing endoscopists to take routine duodenal biopsies. Some endoscopists consider duodenal biopsy mandatory in anaemia to exclude other pathologies. We hypothesise that using a point of care test at endoscopy could fill this gap, by providing rapid results to target anaemic patients who require biopsies, and save costs by biopsy avoidance. We therefore assessed three key aspects to this hypothesis: 1) the availability of pre-endoscopy serology in anaemia; 2) the sensitivities and cost effectiveness of pre-endoscopy coeliac screening with Simtomax in anaemia; 3) whether other anaemia-related pathologies could be missed by this targeted-biopsy approach.Group 1: pre-endoscopy serology availability was retrospectively analysed in a multicentre cohort of 934 anaemic patients at 4 UK hospitals. Group 2: the sensitivities of Simtomax, endomysial and tissue-transglutaminase antibodies were compared in 133 prospectively recruited patients with iron deficiency anaemia attending for a gastroscopy. The sensitivities were measured against duodenal histology as the reference standard in all patients. The cost effectiveness of Simtomax was calculated based on the number of biopsies that could have been avoided compared to an all-biopsy approach. Group 3: the duodenal histology of 153 patients presenting to a separate iron deficiency anaemia clinic were retrospectively reviewed.In group 1, serology was available in 361 (33.8 %) patients. In group 2, the sensitivity and negative predictive value (NPV) were 100 % and 100 % for Simtomax, 96.2 % and 98.9 % for IgA-TTG, and 84.6 % and 96.4 % for EMA respectively. In group 3, the duodenal histology found no causes for anaemia other than coeliac disease.Simtomax had excellent diagnostic accuracy in iron deficiency anaemia and was comparable to conventional serology. Duodenal biopsy did not identify any causes other than coeliac disease for iron deficiency anaemia, suggesting that biopsy avoidance in Simtomax negative anaemic patients is unlikely to miss other anaemia-related pathologies. Due to its 100 % NPV, Simtomax could reduce unnecessary biopsies by 66 % if only those with a positive Simtomax were biopsied, potentially saving £3690/100 gastroscopies.The group 2 study was retrospectively registered with clinicaltrials.gov. Trial registration date: 13(th) July 2016;NCT02834429 .

While it is increasingly recognized that recovery from dependent use of heroin or alcohol is possible, little is known about the long-term process of recovery. A study in Glasgow, Scotland used interviews and self-completed questionnaires to investigate the recovery journeys of former problematic users of heroin or alcohol. Qualitative data showed that recovery was understood as including but transcending freedom from dependence, and that most participants saw their own recovery as an ongoing process rather than a time-limited milestone. Motivating factors were usually negative personal experiences—with former heroin users more likely to cite “the lifestyle” and former alcohol users their behavior and health problems - and more positively around issues of personal identity. Social factors were often cited as key in sustaining recovery, especially peer support. An understanding of the views and perceptions of those who have experienced recovery from dependent use of alcohol or heroin can help to develop and improve recovery services and support.

To determine production of interleukin-10 (IL-10) by interleukin-1β (IL-1β) in cultured decidual, chorion, and amnion cells and whether IL-10 is produced in gestational tissues under the setting of infection-associated preterm labor. Decidual, chorion, and amnion cells were isolated from term placentas and grown in primary culture. The cells were incubated with various concentrations of IL-1β and then culture supernatants were assayed for IL-10 by enzyme-linked immunosorbent assay. In subsequent studies, gestational membranes were isolated from a normal-term pregnancy and a preterm pregnancy complicated by chorioamnionitis. Tissues were evaluated for IL-10 expression by immunohistology and in situ hybridization. Human gestational tissues were collected from 38 women experiencing: 1) term cesarean delivery without labor; 2) normal-term vaginal delivery; 3) preterm cesarean delivery without labor; 4) preterm vaginal delivery without chorioamnionitis; and 5) preterm vaginal delivery with concomitant chorioamnionitis. Amnion, chorion, and decidua were isolated, total RNA from each tissue was extracted, and the presence of IL-10 mRNA was determined by reverse transcriptase-polymerase chain reaction (RT-PCR). Decidual cells in culture produced IL-10 in response to IL-1β, but chorion and amnion cells produced no IL-10 protein. In vivo protein expression by immunohistology showed that most protein was detected within decidua while cells within amnion and chorion rarely had detectable IL-10 protein. In vivo RT-PCR samples demonstrated the strongest IL-10 mRNA signal from decidua samples, although IL-10 mRNA was also noted in chorion and amnion of placentas obtained after preterm labor. Maternal decidual cells can potentially produce IL-10, but fetal membranes (amnion and chorion) appear to have limited capabilities to produce IL-10. The relative inability of fetal tissues to produce IL-10 may play an important role in the pathophysiology of infection-associated preterm labor.

• Between 1967 and 1979, 316 patients with Hodgkin's disease underwent staging laparotomy. Histologic examination demonstrated lymphocyte predominance in 40(12.7%) patients, nodular sclerosis in 178(56.3%), mixed cellularity in 80(25.3%), and lymphocyte depletion in seven (2.2%); results in 11 (3.5%) patients were considered unclassifiable. There were no deaths. Major complications occurred in 7.9% and required reoperation in 1.9%. Pathologic stage differed from clinical stage in 111 (35.1%) patients. In 90 (28.5%) patients, the stage advanced; in 21 (6.6%) patients, the stage was reduced; and in five (1.6%) patients, the histologic subtype was changed. Stage changes occurred in 40% of those with lymphocyte predominance, in 27.5% with nodular sclerosis, in 46.3% with mixed cellularity, and in 85.7% with lymphocyte depletion. The reliability of staging laparotomy for the determination of appropriate treatment favors its continued use. (Arch Surg1982;117:586-591)

Most attempts to measure the potentialities of a drug in wound infections, whether in terms of prophylaxis or of treatment, suffer from extreme degrees of variation in the lesions studied. The wound variations occur in respect to size, depth, anatomic location, inflicting agents, degrees of contamination, types and numbers of organisms present and the amount of contained foreign matter. Wounds also vary with the individual patient as to age, concomitant disease, nutrition, individual host resistance and healing capacity. Still another source of variation is the management of the wound, the time elapsed between injury and definitive treatment, the extent of debridement and of wound closure, the degree of tension in closed wounds, adequacy of immobilization, frequency of dressings and the duration of hospitalization. In established infection all of these variables are present plus the factors of bacterial invasion, bacterial toxins and bacterial symbiosis, which further complicate the picture. Hence it

IN your issue of November 5 (p. 19) information is given that a local Society is about to be inaugurated in Edinburgh, under the title “The Darwinian Society.”

The preparations of the pentafluoro-(1a) and 4-methoxy-2,3,5,6-tetrafluoro-(1b) analogues of (±)-amphetamine and of N-methyl-N-pentafluorobenzylprop-2-ynylamine (25) are outlined. The synthesis of salts of 1-methyl-2-pentafluorophenylethylhydrazine (10) and (12) and 2-pentafluorophenylcyclopropylamine (19) are described.

Airway obstruction, unconsciousness, and reduced respiratory tidal volume are the principle disturbances that give rise to airway complications. Of these, obstruction is the most frequently encountered and the most emergent. Airway difficulties may evolve from many sources, including the patient's disease, the administration of anesthetics, surgical procedures, the technique of tracheostomy, and the nursing care afforded the patient. During the past 14 years the plastic surgery service at the University of Pittsburgh has performed more than 25,000 surgical procedures involving the head and neck. Among the patients treated on this service we have encountered 31 serious airway problems, in the course of which 3 patients died of suffocation. Patients' Diseases In our experience, facial trauma with fractures involving the mandible, maxilla, or both provide the most frequent cause of airway complications that arise from the patient's disease. In many of these cases of traumatic disruption tracheostomy is mandatory if life