Bone cyst in the cervical spine due to secondary amyloidosis. A case report.

A patient who had been on hemodialysis for 20 years developed an amyloid bone cyst in the cervical spine. The cyst collapsed resulting in neurologic damage to the cervical spinal cord. He was known to have high circulating levels of beta-2-microglobulin.     

The homograft department.

Perfusionists are highly skilled professionals providing essential life support, enabling patients to undergo open heart surgery. Although this is the main function at the Royal Liverpool Children's Hospital, Alder Hey, they also manage a Homograft bank. Also known as a heart valve bank, this is a completely independent branch of the perfusion department.     

Extracranial approaches to the repair of cerebrospinal fluid rhinorrhea.

This paper presents a review of the extracranial evaluation and treatment of cerebrospinal fluid (CSF) rhinorrhea. Diagnosis with attention to a careful history and physical with maneuvers which exacerbate drainage and thorough physical exam along with imaging techniques are discussed. The common etiologies of CSF rhinorrhea including trauma, spontaneous leakage, tumor, and iatrogenic injury are included. Management consists of conservative measures including the avoidance of straining maneuvers which increases intracranial pressure. Periodic drainage of CSF via lumbar puncture or continuous drainage via flow-regulated systems may also be of benefit in attempts of conservative management. Failure of conservative management, constant leakage, pneumocephalus, and recurrent meningitis are indicators for surgical repairs. Ethmoid-cribiform plate region repairs are generally approached by external ethmoidectomy and the development of mucoperiosteal flaps from various donor sites which are then rotated to the leak area to seal the defect. Frontal sinus leaks are usually repaired via an osteoplastic flap technique with direct repair of the dural defect or the use of fascial graft tucked under the bony defect, then obliterated with abdominal fat. CSF rhinorrhea presents a diagnostic and surgical challenge to the otolaryngologist. After diagnosis and localization, operative repair using extracranial approaches is accepted as the initial method of intervention in these cases.     

Diet and disadvantage: observations on infant feeding from an inner city

Background: There are few detailed nutritional studies analysing dietary intakes and weaning practices of inner city infants aged 0–12 months. Pasteurized cow's milk (PCM) is not recommended as a main drink until after 1 year of age, although early usage is still common. Premature introduction of pasteurized cow's milk is associated with increased risk of iron deficiency anaemia. Methods: We therefore prospectively examined the dietary effect of early introduction of pasteurized cow's milk on the nutritional intake of 100 infants (mean age at recruitment 7.8 months), whose mothers had already elected to introduce cow's milk before the recommended age of 12 months in a deprived inner city area. In addition, a retrospective questionnaire on feeding practices and food choices was administered and information on parental education and employment was collected, together with a 3-day dietary diary of weighed intakes at recruitment. Results: The results indicate that weaning practices are handed down from family and friends and are intuitive rather than informed. Over 80% of the infants had intakes of iron, zinc and vitamin D below the reference nutrient intake (RNI) and a further 41% had low vitamin C intakes. Prior to introduction of PCM, there was also misuse of infant formula. Twenty per cent added an extra scoop of powder to the feeds, 10% added milk powder to the bottle before addition of water and 30% used microwave ovens to heat the infant bottle. Conclusion: Feeding practices in a deprived inner city area differed substantially from guidelines and infants were at risk of developing nutrient deficiencies as well as poor feeding practices.     

Pharmacology of the alkaloid pumiliotoxin-B. II. Possible involvement of calcium and sodium-dependent processes in nerve and skeletal muscle

The mechanism of the twitch potentiating action of pumiliotoxin-B (PTX-B), an indolizidine alkaloid from the skin of the frog Dendrobates pumilio, was studied on frog skeletal muscles. In the presence of PTX-B, a single stimulus to the muscle produced either a burst of repetitive action potentials superimposed on a depolarizing afterpotential or a single potential with a prolonged afterpotential at junctional as well as extrajunctional regions of the frog skeletal muscle fibers. The alkaloid did not cause repetitive activity in quiescent cells or spontaneous contractions. The duration of the burst of action potentials was related inversely and the amplitude and duration of postburst depolarizing after-potential was related directly to the concentration of PTX-B. The typical pattern of repetitive action potentials and postburst depolarization induced by PTX-B could be mimicked by depolarizing the muscle membrane with current pulses of long duration (150-470 ms). Lowering the external calcium or sodium concentration reduced the ability of PTX-B to initiate repetitive action potentials, whereas a low external chloride concentration had no effect. The frequency of MEPPs evoked by potassium, but not the spontaneous MEPP frequency, was increased by PTX-B, suggesting a selective effect on evoked transmitter release. PTX-B evoked repetitive EPPs in response to a single stimulus applied to the nerve, which was dependent upon the external calcium ion concentration. The amplitudes of EPPs in the train were facilitated, and their amplitude increased linearly at the lowest calcium concentration, but not at concentrations from 0.45 to 1.8 mM.(ABSTRACT TRUNCATED AT 250 WORDS)     

Maternal satisfaction following post-shelter family reunification

The purpose of this study was to examine the correlates of post-shelter maternal family satisfaction in a group of youth who were reunified with their families following a shelter stay. Findings indicated that higher ratings of family satisfaction were related to greater maternal problem solving skill and less family conflict.