Paediatric vertebral marrow signal: defining a normal reference range for the marrow-to-disc signal ratio.

AIM: To establish a normal reference range of bone marrow from birth to 16 years of age. MATERIALS AND METHODS: Two independent observers performed region-of-interest measurements of the magnetic resonance imaging (MRI) signal on sagittal non-contrast T1-weighted images of the spine of paediatric patients collected from a 12-year picture archiving and communication system (PACS) archive. The mean signal of the bone marrow and adjacent intervertebral disc were recorded. The mean marrow signal of the L1-L5 vertebrae was expressed as a ratio to the mean signal from the adjacent disc. RESULTS: Two hundred and ninety-seven MRI studies (149 males, 148 females) met inclusion criteria. The ratio of the signal from the vertebral marrow to disc increased with age. The normal reference range was calculated for each of six age groups and defined as two standard deviations above and below the mean. The lower limit of the reference range crossed the isointense line at the age of 2 years. CONCLUSION: The ratio of disc to marrow signal increases until the age of 2 years, after which it remains stable. It can be normal to see a bright disc on T1 below the age of 1 year, but after the age of 2 years a hyperintense disc on T1 is outside the 95% reference range.

Services for children with developmental co-ordination disorder: the experiences of parents.

BACKGROUND: Parents provide valuable information on their experiences of engaging with therapy services for their children, which can inform the future development of these services. The aim of this study was to explore the views and experiences of parents who had accessed therapy services for their child with developmental co-ordination disorder (DCD). METHODS: Seven focus groups were conducted incorporating 52 parents who had a child diagnosed with, or fitting the diagnostic criteria for DCD. Focus groups were audiotaped, transcribed and analysed thematically. FINDINGS: Parents reported struggling to gain access to therapy services. When they gained access, they found the services beneficial for their child but continued to experience difficulties regarding the quality of service delivery. CONCLUSIONS/IMPLICATIONS: The study suggests that parents thought some health-care professionals lacked knowledge and understanding of DCD, which they believed impacted upon early recognition and access to services. They perceived that therapy at an early age was vital for children's development, and indicated that a clearer path for accessing these services was necessary in addition to improved service quality. They called for an increase in awareness of DCD by all therapy service professionals to aid early recognition and improved treatment.

The effect of short chain fatty acid supplementation on membrane electrolyte transport and blood pressure.

Eleven normotensive subjects with no family history of essential hypertension took part in a double-blind randomized placebo-controlled crossover study to examine the effects of supplementing a normal omnivore diet with miglyol. This resulted in a fall in diastolic blood pressure in both the supine and standing positions, achieving statistical significance for the standing diastolic pressures, following miglyol treatment. Miglyol is rich in caprylic (8:0) and capric acids (10:0), both short chain saturated fatty acids, and supplementation with this produced a significant fall in erythrocyte membrane oleic and linoleic acid (P less than 0.01 compared to placebo for each fatty acid), as well as a fall in the saturated fat palmitic acid (16:0) (P less than 0.01). These changes were not associated with any alterations in total erythrocyte sodium influx, bumetanide sensitive influx or sodium red cell intracellular or potassium content. In addition, body weight and urinary excretion of sodium and potassium did not change. These data indicate that this dietetic manipulation with an oil rich in short chain saturated fatty acids lowers diastolic blood pressure but not as a result of changes in membrane sodium handling. It is possible that the short chain fats displace the longer carbon chain fatty acids which are metabolically important to cellular integrity and it is in this way that blood pressure falls.

Heavy rainfall and waterborne disease outbreaks: the Walkerton example.

Recent research indicates that excessive rainfall has been a significant contributor to historical waterborne disease outbreaks. The Meteorological Service of Canada, Environment Canada, provided an analysis and testimony to the Walkerton Inquiry on the excessive rainfall events, including an assessment of the historical significance and expected return periods of the rainfall amounts. While the onset of the majority of the Walkerton, Ontario, Escherichia coli O157:H7 and Campylobacter outbreak occurred several days after a heavy rainfall on May 12, the accumulated 5-d rainfall amounts from 8-12 May were particularly significant. These 5-d accumulations could, on average, only be expected once every 60 yr or more in Walkerton and once every 100 yr or so in the heaviest rainfall area to the south of Walkerton. The significant link between excess rainfall and waterborne disease outbreaks, in conjunction with other multiple risk factors, indicates that meteorological and climatological conditions need to be considered by water managers, public health officials, and private citizens as a significant risk factor for water contamination. A system to identify and project the impacts of such challenging or extreme weather conditions on water supply systems could be developed using a combination of weather/climate monitoring information and weather prediction or quantitative precipitation forecast information. The use of weather monitoring and forecast information or a "wellhead alert system" could alert water system and water supply managers on the potential response of their systems to challenging weather conditions and additional requirements to protect health. Similar approaches have recently been used by beach managers in parts of the United States to predict day-to-day water quality for beach advisories.

Oesophageal foreign body: an unusual cause of respiratory symptoms in a three-week-old baby.

Impaction of a foreign body in the oesophagus is common in children. If the event is not witnessed by an adult or the object is radiolucent the diagnosis is difficult as respiratory symptoms may predominate. We report a three-week-old child with respiratory symptoms who had both a respiratory syncytial virus infection and a radio-lucent oesophageal foreign body. This case is the youngest yet reported and serves as a remainder of the difficulties in the diagnosis of this important condition.

Testing and comparison of non-opioid analgesics in amphibians.

Because of the lack of information about effective analgesics in non-mammalian vertebrates, the potency of various non-opioid agents were tested in a model of analgesia by using Northern grass frogs (Rana pipiens). This alternative model has been used widely for investigating opioid analgesic action. Potential non-opioid analgesics tested included antipsychotic, benzodiazepine, barbiturate, antihistamine, non-steroidal anti-inflammatory (NSAID), and partial opioid agents. Northern grass frogs were acclimated to lab conditions in individual cages. Drugs were administered systemically through the dorsal lymph sac, and analgesic effects were estimated by using the acetic acid test (AAT). The AAT is done by placing logarithmic dilutions of acid dropwise on the dorsum of the animal's thigh until a wiping response is obtained. At various doses, chlorpromazine and haloperidol (antipsychotics), chlordiazepoxide (a benzodiazepine), buprenorphine (a partial opioid agonist), and diphenhydramine (a histamine antagonist) produced moderate to strong analgesic effects. Indomethacin and ketorolac (NSAIDs), butorphanol (a partial opioid agonist), and pentobarbital (a barbiturate) produced weaker but noticeable analgesic effects. Our results are the first to document the effectiveness of a wide array of pharmacologically active agents in a novel amphibian model for analgesia. These findings provide needed data regarding the use of alternative, non-opioid agents for the treatment of pain in amphibians and other poikilothermic species.

A novel mechanism of heart failure with normal ejection fraction.

BACKGROUND: Patients with heart failure and a normal left ventricular ejection fraction have significantly reduced left ventricular long-axis function. This paper proposes an explanation for this apparent paradox and suggests a new mechanism of "diastolic" heart failure. METHOD: The effect of changes in left ventricular hypertrophy on stroke volume and ejection fraction in non-dilated left ventricles was calculated using the area-length method. Further, the effect of a reduction in long-axis shortening on these parameters was determined. RESULTS: Increasing left ventricular hypertrophy resulted in augmentation of systolic wall thickening and ejection fraction but not stroke volume when long-axis shortening was normal. In the presence of abnormal long-axis function, stroke volume was reduced but ejection fraction was preserved. CONCLUSION: The model predicts that the normal ejection fraction in patients with heart failure may be explained by the presence of left ventricular hypertrophy. The resulting amplified radial thickening in the setting of reduced long-axis shortening explains the preservation of ejection fraction. The reduced stroke volume in the precompensated state rather than diastolic dysfunction may be the cause of heart failure.

Platypnoea-orthodeoxia syndrome in association with an ascending aortic aneurysm.

Platypnoea-orthodeoxia syndrome is a uncommon condition presenting with dyspnoea and cyanosis that are characteristically worse in the upright posture and improved by lying supine. We present the case of a patient with a thoracic aortic aneurysm and a patent foramen ovale who presented with platypnoea-orthodeoxia syndrome. Diagnosis was established using transoesophageal echocardiography. We suggest a mechanism for the development of dyspnoea and hypoxia in patients with this disorder.

Neuralgic amyotrophy as a presenting feature of infective endocarditis.

A 35 year old man presented to his general practitioner with severe right shoulder pain and subsequent weakness and wasting of the muscles in the affected shoulder girdle three weeks after a dental filling. His symptoms persisted despite standard treatment. He developed malaise, night sweats, weight loss, a petechial rash and a microcytic anaemia. On admission to hospital three months after the start of his symptoms he had also developed splenomegaly and the murmur of aortic regurgitation. Investigations confirmed the diagnoses of infective endocarditis and neuralgic amyotrophy. In this case neuralgic amyotrophy appears to have been the presenting feature of infective endocarditis. This association has not previously been described.

Constrictive pericarditis and pleuropulmonary fibrosis secondary to cabergoline treatment for Parkinson's disease.

A 63 year old man with a six year history of Parkinson's disease presented with signs of right heart failure following a knee replacement. Constrictive pericarditis was diagnosed and a radical pericardectomy performed. Six months later, the patient remained unwell with raised inflammatory markers. An inflammatory fibrotic reaction caused by cabergoline was diagnosed. He improved after cessation of cabergoline.

Induction and the acquisition of English auxiliaries: the effects of differentially enriched input.

Children aged 2;0 to 2;6 participated in a longitudinal study examining their acquisition of the English auxiliary system following a six-week period in which they were exposed to additional auxiliary input in varying sentence contexts. Groups of children received enrichment utterances with the auxiliary could either in first position in the sentence, in middle position, or in both positions. Children in the front position group were significantly advanced over the other experimental groups in acquiring modal auxiliaries but not non-modals. However, none of the experimental groups differed significantly from a baseline group which received no additional could input. The implications of these findings for understanding the mechanisms of auxiliary acquisition and the nature of children's grammatical categories are discussed.

A depressed myocardium.

BACKGROUND: Venlafaxine is a potent neuronal serotonin and noradrenaline re-uptake inhibitor, and to a lesser extent an inhibitor of dopamine reuptake. Paroxetine is a potent selective inhibitor of serotonin reuptake. CASE REPORT: A 27-year-old man ingested 1987.5 mg of venlafaxine and 360 mg of paroxetine. He subsequently developed systolic and diastolic hypertension, transient electrocardiographic abnormalities, and an area of persistent myocardial damage. He recovered from his overdose with his blood pressure and electrocardiogram returning to normal. The area of myocardial damage was documented on echocardiogram as an area of marked hypokinesia at the basal anterior septum. Despite the absence of confirming blood levels or the absolute exclusion of cocaine, this case indicates that venlafaxine and paroxetine have the potential for serious cardiotoxicity when taken in overdose.

Intracellular pH in rat resistance arteries during the development of experimental hypertension.

1. In order to examine the effects of experimental hypertension on intracellular pH in mesenteric resistance arteries, intracellular pH was measured in mesenteric resistance arteries from rats with coarctation 72 h, 9 days and 28 days after the aorta was partially constricted between the origins of the renal arteries. Carotid arterial pressure was significantly raised at all time points. 2. Second-order mesenteric resistance arteries were mounted in a myograph and were loaded with the acetoxymethyl ester of the pH-sensitive dye 2',7'-bis(carboxyethyl)-5,6-carboxyfluorescein. Morphological measurements demonstrated that arteries from rats with coarctation had an increased media volume at 9 days and at 28 days compared with vessels from sham-operated control animals, but this was only statistically significant at 28 days. 3. Resting intracellular pH was not significantly different at any time point in arteries from rats with coarctation compared with control animals, although there was a rise in intracellular pH in both groups of rats between 72 h and 9 days. The application of 4,4-di-isothiocyanatostilbene-2,2'-disulphonic acid produced a fall in intracellular pH which was significantly greater in the sham-operated rats at 9 days; this difference was not found at 28 days. Blockade of Na+/H+ exchange with 60 mumol/l ethylisopropylamiloride led to a similar fall in intracellular pH in both groups of rats at 9 days but a significantly greater fall in intracellular pH in arteries of rats with coarctation at 28 days. Activation with noradrenaline (10 mumol/l) induced acid changes in intracellular pH that were similar in both groups of rats.(ABSTRACT TRUNCATED AT 250 WORDS)

High-resolution MR imaging of the anal sphincter in children: a pilot study using endoanal receiver coils.

OBJECTIVE: The purpose of this study was to obtain high-resolution MR images of the various components of the anal sphincter complex in children who have anorectal disorders. We therefore used dedicated endoanal receiver coils for MR imaging. CONCLUSION: Our pilot study suggested that MR imaging that uses a dedicated endoanal coil may have considerable diagnostic potential in children who have anorectal disorders.

Percutaneous stone and stent removal from renal transplants.

Techniques developed for removal of stones from normally sited kidneys can be safely employed in the transplanted kidney. We describe our experience in removing stones, stent material and organised blood clot from renal transplant collecting systems, using modified percutaneous techniques.

Predicting future treatment of diabetes mellitus from characteristics available at presentation.

This study was designed to identify the clinical features of a newly diagnosed diabetic patient that are most useful in deciding treatment. A secondary aim was to formulate a statistical model for predicting subsequent treatment. The following features were considered in 289 patients: age, sex, severity and duration of symptoms, degree and duration of weight loss, glycosuria, ketonuria, blood glucose concentration, body mass index (BMI), and family history of diabetes. Three treatment groups, 6 months after diagnosis, were defined: diet alone, diet with oral hypoglycaemic agent(s), and insulin-treated. Univariate analysis showed that symptom severity, glycosuria, ketonuria, glucose concentration, weight loss, and BMI were significantly different between the three groups. Age and rate of weight loss were significantly different between the insulin-treated and non-insulin-treated groups. Multivariate analysis gave a model to calculate the probability of requiring each of the three treatments given certain characteristics. A second cohort of 174 patients was used to assess the accuracy of the model. The model predicted the actual treatment at 6 months correctly in 72%.

Effect of experimental hypertension on phosphoinositide hydrolysis and proto-oncogene expression in cardiovascular tissues.

Products of inositol lipid hydrolysis and levels of c-myc, c-fos and H-ras mRNAs were measured in rat left ventricle and vascular tissues 72 h and 9 days after the induction of aortic coarctation in order to examine inositol phosphate and proto-oncogene signals during the development of pressure-related cardiac and vascular structural changes. There was a significant increase in left ventricular and proximal aortic mass at both time points but no change in mesenteric resistance artery morphology in rats with coarctation. At 72 h there was a significant increase in c-myc, c-fos and H-ras mRNAs in the left ventricle of rats with coarctation, and this was accompanied by increased levels of inositol (1,4,5)-trisphosphate. Similar results were obtained in the proximal but not the distal aorta. In resistance arteries inositol phosphate production and proto-oncogene mRNA expression were unchanged. The results indicate that at 72 h aortic coarctation induced structural thickening in the left ventricle and proximal aorta and was associated with increased inositol phosphate production and stimulation of specific proto-oncogene mRNAs. By 9 days following surgery much of the structural change in these tissues was completed, and these raised cellular signals were no longer observed. The results suggest that both increased inositol lipid hydrolysis and a rise in the expression of these proto-oncogenes are important processes in the development of vascular hypertrophy seen in this model of hypertension.