Section 1A: Rh serology. Coordinator's report.

One hundred forty-two Rh-specific monoclonal antibodies (Mabs) were evaluated by serology in 27 laboratories. Evaluators were asked to test each Mab at three dilutions in specified serological techniques against normal positive and normal negative phenotype cells, and any Rh variant cells that they had available. Raw data was submitted to the coordinator for overall analysis. Results were analysed by expressing the sum of reaction grades for each Mab with each variant cell as a percentage of the sum of reaction grades of that Mab with normal phenotype cells. Anti-D Mabs were sorted into 23 groups which had the same pattern of reactions with different partial D phenotype cells. Eighteen of these corresponded to previously defined patterns; five were new patterns. Combined with data from the previous workshop, this means that 30 different reaction patterns have been defined. A new nomenclature is introduced for numbering the epitopes. Reactions with new variants DNB, DNU and DAR indicated some further subsplits of these patterns. Reactions with Category Va cells indicated that there were five different types of Va cells that could be distinguished serologically with monoclonal antibodies. No patterns of reactivity corresponding to the epitope groups could be observed with the different types of weak D tested. Anti-E Mabs were sorted into 14 groups, and the E variant cells into seven groups.     

Northern Region Fetal Abnormality Survey results 1987

The UK Northern Region Fetal Abnormality Survey was notified of 572 suspected fetal abnormalities in 1987. Of these, 265 (46%) had pediatric surgical implications. Because the registry traces the postnatal outcome of each notification and records congenital abnormalities diagnosed postnatally, it is possible to measure both sensitivity and selectivity of antenatal diagnosis of fetal abnormalities. Cases were divided into five groups: diaphragmatic hernia, abdominal wall defects, intestinal anomalies, neural tube defects, and urological anomalies. Each group comprised cases that were unsuspected, suspected but not confirmed, and suspected and confirmed. Sensitivity was highest in the urological group, but 30% of the notified cases were unconfirmed so selectivity was higher in the abdominal wall and neural tube groups. None of the diaphragmatic hernias and only 14.3% of the intestinal anomalies were correctly suspected. Only 13.5% of all neural tube defects were treated surgically. The Survey has improved cooperation and communication between specialists concerned with the management of fetal abnormalities and this in turn has improved patient care.     

Influence of reboxetine on salivary MHPG concentration and cognitive symptoms among patients with alcohol-related Korsakoff's syndrome.

This study is based on the hypothesis of a paraventricular cerebral noradrenaline deficit in alcoholic Korsakoff's syndrome. In a randomized open study the effects of a 4-week treatment with the selective noradrenaline reuptake inhibitor reboxetine on (1) the salivary concentration of the noradrenaline metabolite MHPG and (2) changes in cognitive performance measured by the Mini Mental Status Test were examined. The study group consisted of 105 patients diagnosed with alcohol-related Korsakoff's syndrome (ICD-10: F10.6). Korsakoff's patients showed a reduced concentration of salivary MHPG compared to healthy controls; this reduction did not correlate with the results of the Mini Mental Status Test. An increase in salivary MHPG was found together with an improvement in the Mini Mental Status Test both in the verum group treated with reboxetine and in the control group upon completion of the 4-week study. However, a subgroup with a shorter duration of disease (<1 year) was found to profit significantly from reboxetine treatment, as shown by improvements in cognitive performance.     

Myelopathy presenting decades after surgery for congenital cervical cutaneous lesions

We report on two patients in whom cervical myelopathy developed decades after they had undergone surgery for congenital cervical cutaneous lesions. Preoperative magnetic resonance imaging demonstrated dorsal tethering and cavitation of the cervical cord in the area of the previous surgery and was helpful in decision making regarding surgical exploration and in planning for it. We stress the importance of long-term follow-up by both clinical examination and magnetic resonance imaging in children who have been operated on for cervical cutaneous masses that may have central connections.     

Evaluation of dietetic activity analysis (DAA)—a system for data collection in clinical dietetics

A system of data collection and analysis based on patient visits was evaluated over a four-week period in five districts and a six-month period in one district by twenty-five dietitians. Each patient visit was analysed by diagnosis (the problem), by diet (the treatment) and by nutritional care level (the action). The system was seen to encourage self analysis by dietitians and proved a useful educational tool in addition to providing dietetic managers with data on clinical dietetic activity. It was considered successful and well accepted in four of the six districts.     

Pregnancy following induced abortion: maternal morbidity, congenital abnormalities and neonatal death. Royal College of General Practitioners/Royal College of Obstetricians and Gynaecologists Joint Study

In a prospective cohort study of the long-term sequelae of induced abortion, a comparison is made between a group of 6418 women who had an induced abortion (cases) and a control group of 8059 women recruited with an unplanned pregnancy which was not terminated with an induced abortion (controls). The present paper reports on 729 cases and 1754 controls who had a post-recruitment pregnancy. In general, prior induced abortion had no material effect on the rate of pregnancy-related morbidity, nor on the rate of congenital abnormalities and neonatal death in the offspring. There was, however, a significant difference in two specific conditions. In the post-index pregnancy in the cases there was an increased relative risk (RR 2.26) of the occurrence of urinary tract infection and a decreased risk (RR 0.25) of pregnancy-related anaemia.     

Does an oral appliance reduce palatal flutter and tongue base snoring?

OBJECTIVES: Oral appliances are designed to treat snoring and sleep apnea by advancing the mandible and tongue. We test the hypothesis that an oral appliance affects palatal snoring as well as tongue base obstruction. METHODS: Prospective observational cohort study. Sixty patients with a chief complaint of snoring with or without apnea were enrolled. Each patient underwent a home sleep test followed by 3 weeks sleeping with an oral appliance. Each patient then underwent a repeat home sleep test while using the device. RESULTS: There was a statistically significant improvement in the snores per hour (P = 0.0005), the maximum snoring loudness (P = 0.0001), average snoring loudness (P = 0.00001), and the percentage of palatal snoring (P = 0.0007). There was also a significant decrease in oxygen desaturation events (P = 0.003). CONCLUSIONS: This study suggests oral appliances may be effective treatment for both palatal and tongue base snoring.