Tuberculous osteitis of the talus.

A case of tuberculous osteitis of the talus in a 6-year-old white male is reported. Osteitis of the talus is uncommon and tuberculous disease of this bone is now rare. There was a delay of 5 weeks between presentation and final diagnosis and the reasons for this delay are discussed. Further investigation showed the presence of tuberculosis of the fifth lumbar vertebra and of the left kidney. With prompt chemotherapy and early surgery, the long term results of this once crippling disease are now excellent.     

High gastric ulcer after Nissen fundoplication.

Three of 100 patients who underwent Nissen fundoplication developed gastric ulcers, all high on the lesser curve. Two patients presented one year after, and the third seven years after fundoplication. All healed with medical therapy, but a relapse in one patient necessitated partial gastrectomy. The pathogenesis, is not known, but vascular factors may be relevant. Patients complaining of epigastric pain after fundoplication require careful endoscopic examination for ulcer, especially near the cardia, since this may be a site of predilection.     

The role of the paediatric surgeon in alleged child sexual abuse

Two hundred ninety cases of alleged child sexual abuse (CSA) were reported in Edinburgh and the Lothian region over the 7-year period from 1982 through 1988. We have found an increase in the incidence of alleged CSA, which has resulted in greater involvement of the paediatric surgeon. CSA was found to be occurring with increasing frequency in younger children. The physical examination and the role of general anaesthesia are discussed together with the data about the collection of forensic material.     

A possible conformation for double-stranded polynucleotides.

A model is presented for double-stranded polynucleotides which involves side-by-side meshing of the two strands rather than double helical intertwining. The sugar-phosphate backbone has a twisted strip-like character, yet base-pairing of the Watson-Crick type is still possible. Structural features of the basic model are described and coordinates are presented for a representative example. The structure has, on the whole, reasonable sterochemical contacts, and can be shown to produce a fiber diffraction pattern with x-rays not unlike that of the B form of DNA.     

Effect of parental age on fertilization and pregnancy characteristics in couples treated by intracytoplasmic sperm injection

The purpose of this study was to investigate any influence of maternal and/or paternal age on gamete characteristics and pregnancy outcomes in intracytoplasmic sperm injection (ICSI) cycles. In all, 821 consecutive ICSI cases were analysed retrospectively. While a significant linear decline in semen volume was detected, no significant differences in the concentration, motility or morphology of the spermatozoa were found with paternal ageing. A significant decline in the number of oocytes retrieved and the number of mature oocytes obtained was found with advancing maternal age. An increase in the occurrence of digyny was noted with parental ageing, while no difference in single or bipronuclear fertilization was found. Older women had a decreased incidence of single pronucleus formation and an increase in digyny, but no significant difference in the percentage of oocytes that underwent two-pronuclear fertilization was detected with regard to maternal ageing. Pregnancy outcomes were not influenced by the age of the male partner, while a strong negative correlation was found with maternal ageing. To better analyse male partner ageing as a factor affecting pregnancy outcome, we analysed a subgroup of patients with a female partner aged <35 years who underwent ICSI. No paternal influence on ICSI pregnancy outcome was found in this subgroup of patients. We conclude that the influence on pregnancy outcome after ICSI is related mostly to maternal and not paternal age.