An improved screening system for the early detection of congenital dislocation of the hip

A screening programme for congenital dislocation of the hip in which physiotherapists examine all neonates is described, together with the results over a 7-year period. All easily reducible dislocated and dislocatable hips are splinted within 2-5 days of birth. Subluxable or "slidey" hips are identified and followed up but not splinted. Risk groups are also identified and followed up. There was a progressive decrease in the number of late diagnosed cases, a result suggesting that even late-presenting acetabular dysplasia can be eliminated by neonatal screening.     

Severity of demyelination in vivo correlates with serum myelination inhibition activity in guinea pigs having a new form of experimental allergic encephalomyelitis

Guinea pigs received a suboptimal transfer of lymphocytes sensitized to myelin basic protein (BP) and were then immunized with guinea pig BP, BP plus chicken brain or chicken myelin, or chicken brain alone. Sera from these animals were tested for the presence of myelinotoxic antibodies, as detected by the myelination inhibition assay. Myelination inhibition activity correlated with the histologic severity of demyelination.     

Tumor nuclear grade,estrogen receptor,and progesterone receptor: Their value alone or in combination as indicators of outcome following adjuvant therapy for breast cancer

Summary Previous reports by us have shown that the outcome of breast cancer patients who have received systemic adjuvant therapy is influenced by tumor estrogen or progesterone receptor (ER or PR) content or by nuclear grade. This publication provides information regarding the relative merit of those three markers. Findings from patients receiving L-PAM plus 5-FU (PF) or PF plus tamoxifen (PFT) indicate that the disease-free survival and survival within each regimen was almost identical when related to either ER, PR, or nuclear grade. Those having tumors with either of the receptors 10 fmol or a good nuclear grade had a better outcome through five postoperative years than did those with ER or PR 0–9 fmol or poor nuclear grade. The magnitude of the difference was similar for each of the three discriminants. Since they were found to be of equal predictive value, one marker might well serve as a substitute for another. Cox regression analyses, however, clearly indicate that ER, PR, and nuclear grade have an independent influence on outcome and that a more accurate assessment of outcome is obtained when more than one marker is employed. Thus, information should be obtained on as many markers as possible. This conclusion is supported by observations presented which indicate that nuclear grade in combination with either or both of the receptors is a better predictor than either marker alone and that, as indicated by life table probability values and relative odds ratios, an increasing number of favorable tumor prognostic indicators results in a better patient outcome particularly in PFT-treated patients. A possible explanation is considered for why the separation of receptor/nuclear grade categories is more orderly and pronounced in PF-treated patients receiving tamoxifen than in those given PF alone. See Appendix I     

Jogging geht mit niedrigem Absentismus einher (Berner L?uferstudie'84)

Zusammenfassung 4358 männliche Läufer, Teilnehmer am 16-km-Lauf «GP von Bern» 1984, bilden die Studienpopulation einer Querschnittsuntersuchung, in welcher unter anderem die Beziehungen zwischen Jogging und Absentismus analysiert wurden. Die Laufzeit für die 16-km-Strecke und die Zahl der gefehlten Arbeitstage korrelieren positiv (p<0,001); die Laufaktivität (pro Woche im Mittel gelaufene Kilometer) und Absentismus korrelieren entsprechend invers, allerdings nur bis zu einem Trainingsumfang von nicht mehr als ca. 50 km/Woche. Zigarettenrauchende Läufer weisen über 50% mehr Absenzen auf als Nichtrauchende (p<0,001). Zunehmende Bedeutung des Joggingmotivs «als Ausgleich zum Berufsalltag» korreliert invers mit Absentismus (p<0,001), hohe Bedeutung wettkampforientierter Beweggründe für Jogging ist jedoch positiv mit Absentismus assoziiert (p<0,001). Eine multiple Regressionsanalyse mit insgesamt 8 Faktoren vermag lediglich 11% der Varianz der Arbeitsplatzabsenzen zu erklären, was auf die Komplexität der untersuchten abhängigen Variable hindeutet. Die Frage nach der Kausalität der Beziehung zwischen aktivem, regelmässigem (nicht übermässigem) Jogging und erniedrigtem Absentismus bleibt offen. Erst Interventions-studien würden eine bessere Beurteilung des vermuteten Potentials von Bewegung und Sport zur Reduktion von Absentismus erlauben.

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Jogging is related to reduced absenteeism (the Berne Grand-prix study'84)

Summary 4358 male runners over age 16, competitors of the 16 km race Grand-prix of Berne 1984, represent the study population of a cross-sectional survey. As a part of it, relationships between jogging and absenteeism were investigated. 16 km running time was positively associated with the number of missed work days (p<0,001); training activity (kilometers run per week, one-year's average) and absenteeism were related in an inverse way, but only up to a training distance of not more than 50 km/wk. Runners who smoked cigarettes missed over 50% more work days than nonsmokers (p<0,001). The relative importance of the motive for jogging as a balance to work was associated with decreased absenteeism (p<0,001), whereas relative importance of competition-orientated motives was associated with increased absenteeism (p<0,001). A multiple regression analysis involving 8 factors was not able to explain more than 11% of the observed variance in missed work days, which underlines the complexity of this dependent variable. The question concerning a possible causal relationship between active, regular, moderate jogging and reduced absenteeism remains unanswered.

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Le jogging est associé à un absentéisme réduit (Berner Läuferstudie '84)

Résumé 4358 coureurs agés de 16 ans et plus, participants à la course de 16 km «Grand-Prix de Berne» en 1984, forment l'échantillon d'une étude transversale, à l'occasion de laquelle les relations entre le jogging et l'absentéisme ont également été analysées. Il existe une corrélation positive entre le chronométrage des 16 km et le nombre de jours de travail manqués (p<0,001); en plus, la distance parcourue (moyenne des kilomètres de jogging par semaine) et l'absentéisme sont correlés de façon inverse, mais seulement jusqu'à 50 km d'entraînement hebdomadaire. Les coureurs fumeurs de cigarettes ont plus de 50% d'absences de plus que les coureurs non-fumeurs (p<0,001). L'importance relative du motif pour le jogging «comme compensation au travail journalier» est associée de manière inverse à l'absentéisme (p<0,001), tandis que le contraire est le cas pour l'importance des motifs axés vers la compétition (p<0,001). Une analyse multivariée basée sur un total de 8 facteurs peut expliquer que 11% de la variance de l'absentisme, soulignant ainsi le caractère complexe de la variable dépendente analysée. La question visant la relation causale entre le jogging actif et régulier (mais non exagéré) et un absentisme diminué reste ouverte. Seule des études avec intervention permetteraient de mieux juger le potentiel supposé du sport et de l'activité physique en loisir de réduire l'absentisme.

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Der Autor dankt René Rehmann für die Durchführung sämtlicher Datenanalysen, Horst Noack für die kritische Durchsicht des Manuskripts sowie Theres Bietenholz und Christine Vauclair-Liniger für die sekretarielle Hilfe.     

Culture of epithelial cells derived from the oviduct of different species

This study proposes a procedure for the isolation and cultureof oviduct epithelial cells of several species. In-vitro cultureon such a feeder seems to allow full embryonic development andviability. The inner linings of Fallopian tubes from mouse,rabbit, cow and human were trypsinized and the epithelial cellswere enriched with Percoll gradient. Isolated cells, obtainedin high yield with good viability, were maintained in monolayerculture in B2-Menezo medium supplemented with serum, which alsosupports early embryonic development in vitro. The plated primarycultures reached confluence within 8 days, producting a monolayerof cohesive polygonalcells. Associated with this large epithelialcall population, ciliated cells as wellas polykaryotic cellsand few fibroblastic nestswere observed. After the first sub-culture,the ciliated cells disappeared and the epithelial cell monolayergrew rapidly to confluence with in 3 days and displayed contactinhibition. No epithelial cell growth could be obtained inculturein the absence of serum. The addition of oestrogens had no effecton any of the cultured oviductal epithelial cells. A sponotaneousalteration was observed in morphology and growth after severalpassages, the number of which depends mainly upon the species     

Recent advances in understanding the pathogenesis of the hemolytic uremic syndromes

One of the requirements for an agent to cause hemolytic uremic syndrome (HUS) is its ability to injure endothelial cells. Shiga-like toxin (SLT) can do this. SLT is produced byEscherichia coli andShigella dysenteriae serotype 1; both have been implicated as causes of typical HUS. Endothelial cells have receptors (GB₃) for SLT and the toxin can inhibit eukaryotic protein synthesis, thereby causing cell death. Glomerular endothelial cell injury or death results in a decreased glomerular filtration rate and many of the perturbations seen in HUS. It is no longer certain that hemolysis is the result of a microangiopathy. Cell injury results in release of von Willebrand multimers; if these are ultra-large, thrombosis may ensue. There is also increasing evidence that neutrophils have a role in the pathogenesis of typical HUS.Streptococcus pneumoniae can also cause HUS and care must be taken to avoid giving plasma to patients withS. pneumoniae-associated HUS. There is compelling evidence that types of HUS are inherited by autosomal recessive and autosomal dominant modes. Patients with autosomal recessive HUS may have recurrent episodes. Mortality and morbidity rates are high for the inherited forms.     

Intraoperative anaphylaxis to latex

This case report describes intraoperative anaphylaxis occurring in a fourteen-year-old female with spina bifida in which latex surgical gloves were incriminated as the aetiologic agent. The patient was non-atopic but since eight years of age she had developed localized angioedema and urticarial skin reactions on exposure to rubber. She had previously undergone several uneventful surgical procedures. Forty-five minutes following induction of anaesthesia and during laparotomy for elective cholecystectomy she experienced sudden onset of increased airway pressure, oxygen desaturation, tachycardia, profound hypotension and erythema consistent with an anaphylactic reaction. Resuscitation with manual ventilation and oxygen, intravenous fluids and an epinephrine infusion was successful. Subsequent investigations for allergies demonstrated a strongly positive skin prick test and RAST to latex antigen, with negative results to anaesthetic agents, antibiotics and inhalant allergens. During two later operations prophylaxis consisting of diphenhydramine, ranitidine and hydrocortisone appeared to prevent further reactions. Latex should be considered as a cause of life-threatening intraoperative allergic reactions in patients with a history of rubber allergy or frequent exposure to latex products.