Malaysian Dialysis and Transplant Registry Report

This report summarizes data for dialysis and transplant patients up to the end of 1995. We estimate coverage to be about 30% of dialysis patients and near complete ascertainment of transplant patients. On the 31 December 1995, there were 2224 patients on renal replacement therapy (RRT), comprising 50% on haemodialysis (HD), 12% on continuous ambulatory peritoneal dialysis (CAPD) and 38% with functioning transplants. The prevalence rate for dialysis was 68 per million population (p.m.p.) and that of transplant 42 p.m.p. The new dialysis acceptance rate was 15 p.m.p. and transplant 5 p.m.p. Forty-seven per cent of new patients had unknown primary renal disease and 30% was due to non-insulin dependent diabetes mellitus. Mean age of prevalent HD patients was 42 years, CAPD 46 years and 34 years for transplant. Patient survival on CAPD was 85% at 1 year and for HD was 88%. One year transplant patient survival was 94% and graft survival 91%.     

Cognitive deficits associated with frontal-lobe infarction in children with sickle cell disease

This study examined the cognitive manifestations of frontal-lobe infarction in a population of children with sickle cell disease (SCD). Forty-one patients with SCD underwent MRI. Five patients with stroke symptoms had large infarcts encroaching on the tissue of the frontal lobes. Four patients without symptoms had smaller frontal-lobe infarcts. The patients with stroke were significantly impaired on measures of intelligence, memory, and frontal-lobe function (Wisconsin Card Sorting Test, WCST) compared with both the patients with normal MRI scans ( N = 30) and a group of sibling controls ( N = 15), who did not differ from each other. Patients with covert infarction obtained scores on the intelligence tests and the WCST that fell in between those of the stroke patients and the other two groups. This trend toward impairment suggests that patients with covert infarction are at similar risk for cognitive deficits to those with stroke.     

Blood lipid concentrations and other cardiovascular risk factors: distribution, prevalence, and detection in Britain

To establish the distribution of blood lipid concentrations and the prevalences of other risk factors for cardiovascular disease in Britain 12,092 men and women aged 25-59 in Glasgow, Leicester, London, and Oxford were studied. Subjects were selected by opportunistic case finding, in which patients consulting their general practitioner for any reason were offered a health check by appointment, or random selection from age-sex registers, in which an invitation for a health check was posted. The overall rate of response was 73%, being 91-94% by opportunistic case finding and 36-63% by random selection. At the health check subjects answered a brief questionnaire about risk factors for cardiovascular disease, and their height, weight, and blood pressure were recorded; a blood sample was taken for measuring plasma concentrations of cholesterol, triglyceride, high density lipoprotein cholesterol, and glucose. The mean cholesterol concentrations were 5.9 (SD 1.2) and 5.8 (1.2) mmol/l in men and women, respectively. In London the mean value was 5.5 (1.2) mmol/l for both men and women and was significantly lower than mean values in the three other centres, among which there were no significant differences. In men and women aged 25-29 concentrations were similar but they increased in men until the age of 45-49, after which they showed no further increase; in women concentrations did not increase until the age of 40-44 and by the age of 50-59 values were higher than in men. Mean triglyceride concentrations were significantly higher in men than in women (1.8 (1.4) v 1.3 (0.9) mmol/l, respectively), and trends with age were similar to those for cholesterol concentrations, except that at no age were values higher in women than in men. Mean triglyceride values overall were higher in Glasgow and London than in Oxford and Leicester. Body mass index was higher in Glasgow and London than in the other two centres and correlated with systolic and diastolic blood pressures and triglyceride concentration. In addition, subjects in Glasgow smoked significantly more than those in the other centres. These observations could contribute to the higher rate of coronary heart disease in Glasgow. Plasma lipid concentrations and the prevalences of other risk factors for cardiovascular disease were similar in subjects selected by opportunistic case finding and by random selection. In Britain cholesterol values have changed little during the past 12 years despite dietary recommendations and health education.(ABSTRACT TRUNCATED AT 400 WORDS)     

Circle of Willis in newborns: color Doppler imaging of 53 healthy full- term infants

To establish the usual pattern of flow in the circle of Willis in newborns, the authors scanned 53 healthy full-term infants within 3 days of birth with color Doppler imaging. All examinations were performed and images interpreted by the same experienced individuals. The basilar, internal carotid (ICA), and anterior and middle cerebral arteries were seen in all infants. Vertebral, posterior cerebral, superior cerebellar, and posterior communicating (PCoA) arteries were seen in most infants. PCoA flow was from the ICA toward the posterior cerebral artery in 73 (98.6%) of the 74 vessels that were seen. Flow in the anterior communicating artery was seen in six infants, indicating dependence of an anterior cerebral artery on contralateral ICA perfusion. Two pitfalls involving the distal portion of the ICA were noted: This vessel could be confused with the proximal portion of the anterior cerebral artery or cavernous sinus if real-time images were not interpreted carefully. Variant patterns of flow included tortuous basilar arteries (n = 2), reversed PCoA flow (n = 1), and inferior angulation of the proximal portions of the anterior cerebral arteries (n = 2). Color Doppler imaging allows a detailed analysis of the circle of Willis in newborns and detection of some anatomic variations.     

Blood MR signal suppression by preexcitation with inverting pulses

A cardiac-gated sequence has been developed for functional cardiac imaging. It uses a nonselective 180 degrees preinverting pulse before a spin-echo (SE) readout sequence with an echo time (TE) of 28 msec. In seven healthy volunteers this sequence provided superior wall-to-chamber contrast in end diastole and end systole when compared with the following sequences: SE, TE = 28 msec; SE, TE = 28 msec with dephasing gradients; and SE, TE = 28 msec with presaturation bands.