Neuro-ophthalmological Complications of Chronic Inflammatory Demyelinating Polyradiculoneuropathy.

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) can lead to prominent nerve hypertrophy, which can mimic other forms of neuropathy radiologically. Neuro-ophthalmological complications can also occur in CIDP, either at presentation or chronically in the disorder. This can also cause diagnostic difficulties. We report three cases of neuro-ophthalmological complications of CIDP: two cases of papilloedema and one case of proptosis. In all three cases cranial nerve hypertrophy was present. CIDP should be considered in neuro-ophthalmological presentations associated with cranial/spinal nerve root hypertrophy.

Fine-scale population genetic structure and sex-biased dispersal in the smooth snake (Coronella austriaca) in southern England.

Human-induced alteration of natural habitats has the potential to impact on the genetic structuring of remnant populations at multiple spatial scales. Species from higher trophic levels, such as snakes, are expected to be particularly susceptible to land-use changes. We examined fine-scale population structure and looked for evidence of sex-biased dispersal in smooth snakes (Coronella austriaca), sampled from 10 heathland localities situated within a managed coniferous forest in Dorset, United Kingdom. Despite the limited distances between heathland areas (maximum <6 km), there was a small but significant structuring of populations based on eight microsatellite loci. This followed an isolation-by-distance model using both straight line and 'biological' distances between sampling sites, suggesting C. austriaca's low vagility as the causal factor, rather than closed canopy conifer forest exerting an effect as a barrier to dispersal. Within population comparisons of male and female snakes showed evidence for sex-biased dispersal, with three of four analyses finding significantly higher dispersal in males than in females. We suggest that the fine-scale spatial genetic structuring and sex-biased dispersal have important implications for the conservation of C. austriaca, and highlight the value of heathland areas within commercial conifer plantations with regards to their future management.

Alpha-particle emissivity of the moon: an observed upper limit.

Measurements made by the moon-orbiting spacecraft Explorer 35 during 1967-1968 show that it is unlikely that the alpha-particle emissivity of the moon is greater than 0.064 per square centimeter per second per steradian and exceedingly unlikely that it is greater than 0.128, these values being respectively 0.1 and 0.2 of the provisional estimates made by Kraner et al. in 1966. This result implies that the abundance of uranium-238 in the outer crust (approximately a few meters thick) of the moon is much less than that typical of the earth's lithosphere, though it is consistent with the abundance of uranium-238 in terrestrial basalt or in chondritic meteorites.

Venus: an upper limit on intrinsic magnetic dipole moment based on absence of a radiation belt.

On the basis of the absence of energetic electrons (E(e) 45 kiloelectron volts) and protons (E(p) 320 kiloelectron volts) associated with Venus to within a radial distance of 10,150 kilometers from the center of the planet and using a physical similitude argument and the observational and theoretical knowledge of the magnetosphere of Earth, we conclude that the intrinsic magnetic dipole moment of Venus is almost certainly less than 0.01 and probably less than 0.001 of that of Earth. Corresponding upper limits on the magnetic field at the equatorial surface of Venus are about 350 and 35 x 10(-5) gauss, respectively.

Energetic electrons in the magnetosphere of jupiter.

Observations of energetic electrons ( greater, similar 0.07 million electron volts) show that the outer magnetosphere of Jupiter consists of a thin disklike, quasitrapping region extending from about 20 to 100 planetary radii (R(J)). This magnetodisk is confined to the vicinity of the magnetic equatorial plane and appears to be an approximate figure of revolution about the magnetic axis of the planet. Hard trapping is observed within a radial distance of about 20 R(J). The omnidirectional intensity J(0) of electrons with energy greater, similar 21 million electron volts within the region 3 r 20 R(J) is given by the following provisional expression in terms of radial distance r and magnetic latitude theta: J(0) = 2.1 x 10(8) exp[-(r/a) - (theta/b)(2)]. In this expression J(0) is particles per square centimeter per second; a = 1.52 R(J) for 3

Saturn's Magnetosphere, Rings, and Inner Satellites.

Our 31 August to 5 September 1979 observations together with those of the other Pioneer 11 investigators provide the first credible discovery of the magnetosphere of Saturn and many detailed characteristics thereof. In physical dimensions and energetic charged particle population, Saturn's magnetosphere is intermediate between those of Earth and Jupiter. In terms of planetary radii, the scale of Saturn's magnetosphere more nearly resembles that of Earth and there is much less inflation by entrapped plasma than in the case at Jupiter. The orbit of Titan lies in the outer fringes of the magnetosphere. Particle angular distributions on the inbound leg of the trajectory (sunward side) have a complex pattern but are everywhere consistent with a dipolar magnetic field approximately perpendicular to the planet's equator. On the outbound leg (dawnside) there are marked departures from this situation outside of 7 Saturn radii (Rs), suggesting an equatorial current sheet having both longitudinal and radial components. The particulate rings and inner satellites have a profound effect on the distribution of energetic particles. We find (i) clear absorption signatures of Dione and Mimas; (ii) a broad absorption region encompassing the orbital radii of Tethys and Enceladus but probably attributable, at least in part, to plasma physical effects; (iii) no evidence for Janus (1966 S 1) (S 10) at or near 2.66 Rs; (iv) a satellite of diameter greater, similar 170 kilometers at 2.534 R(s) (1979 S 2), probably the same object as that detected optically by Pioneer 11 (1979 S 1) and previously by groundbased telescopes (1966 S 2) (S 11); (v) a satellite of comparable diameter at 2.343 Rs (1979 S 5); (vi) confirmation of the F ring between 2.336 and 2.371 Rs; (vii) confirmation of the Pioneer division between 2.292 and 2.336 Rs; (viii) a suspected satellite at 2.82 Rs (1979 S 3); (ix) no clear evidence for the E ring though its influence may be obscured by stronger effects; and (x) the outer radius of the A ring at 2.292 Rs. Inside of 2.292 Rs there is a virtually total absence of magnetospheric particles and a marked reduction in cosmic-ray intensity. All distances are in units of the adopted equatorial radius of Saturn, 60,000 kilometers.

Pioneer 11 observations of energetic particles in the jovian magnetosphere.

Knowledge of the positional distributions, absolute intensities, energy spectra, and angular distributions of energetic electrons and protons in the Jovian magnetosphere has been considerably advanced by the planetary flyby of Pioneer 11 in November-December 1974 along a quite different trajectory from that of Pioneer 10 a year earlier. (i) The previously reported magnetodisc is shown to be blunted and much more extended in latitude on the sunward side than on the dawn side. (ii) Rigid corotation of the population of protons E(p) approximately 1 million electron volts in the magnetodisc is confirmed. (iii) Angular distributions of energetic electrons E(e) > 21 million electron volts in the inner magnetosphere are shown to be compatible with the Kennel-Petschek whistler-mode instability. (iv) A diverse body of magnetospheric effects by the Jovian satellites is found. (v) Observations of energetic electrons in to a radial distance of 1.59 Jovian radii provide a fresh basis for the interpretation of decimetric radio noise emission.

Hot Plasma and Energetic Particles in Neptune's Magnetosphere.

The low-energy charged particle (LECP) instrument on Voyager 2 measured within the magnetosphere of Neptune energetic electrons (22 kiloelectron volts /=0.5 MeV per nucleon) energies, using an array of solid-state detectors in various configurations. The results obtained so far may be summarized as follows: (i) A variety of intensity, spectral, and anisotropy features suggest that the satellite Triton is important in controlling the outer regions of the Neptunian magnetosphere. These features include the absence of higher energy (>/=150 keV) ions or electrons outside 14.4 R(N) (where R(N) = radius of Neptune), a relative peak in the spectral index of low-energy electrons at Triton's radial distance, and a change of the proton spectrum from a power law with gamma >/= 3.8 outside, to a hot Maxwellian (kT [unknown] 55 keV) inside the satellite's orbit. (ii) Intensities decrease sharply at all energies near the time of closest approach, the decreases being most extended in time at the highest energies, reminiscent of a spacecraft's traversal of Earth's polar regions at low altitudes; simultaneously, several spikes of spectrally soft electrons and protons were seen (power input approximately 5 x 10(-4) ergs cm(-2) s(-1)) suggestive of auroral processes at Neptune. (iii) Composition measurements revealed the presence of H, H(2), and He(4), with relative abundances of 1300:1:0.1, suggesting a Neptunian ionospheric source for the trapped particle population. (iv) Plasma pressures at E >/= 28 keV are maximum at the magnetic equator with beta approximately 0.2, suggestive of a relatively empty magnetosphere, similar to that of Uranus. (v) A potential signature of satellite 1989N1 was seen, both inbound and outbound; other possible signatures of the moons and rings are evident in the data but cannot be positively identified in the absence of an accurate magnetic-field model close to the planet. Other results indude the absence of upstream ion increases or energetic neutrals [particle intensity (j) < 2.8 x 10(-3) cm(-2) s(-1) keV(-1) near 35 keV, at approximately 40 R(N)] implying an upper limit to the volume-averaged atomic H density at R 22 keV) input on Neptune is approximately 3 x 10(7) W, surprisingly small when compared to energy input into the atmosphere of Jupiter, Saturn, and Uranus.

Urban parks provide ecosystem services by retaining metals and nutrients in soils.

Urban greenspaces provide ecosystem services like more natural ecosystems do. For instance, vegetation modifies soil properties, including pH and soil organic matter content, yet little is known about its effect on metals. We investigated whether the accumulation and mobility of heavy metals, nutrients and carbon is affected by plant functional types (evergreen or deciduous trees, lawns) in urban parks of varying ages in southern Finland. Plant types modified soil physico-chemical parameters differently, resulting in diverging accumulation and mobility of metals and other elements in park soils. However, the effects of plant functional type depended on park age: lawns in parks of ca. 50 y old had the highest contents of Cr, Cu, Fe, Mn, Ni, and Zn, and in these, and older parks (>100 y old), contents of most metals were lowest under evergreen trees. The mobility of metals and other elements was influenced by the amount of water leached through the soils, highlighting the importance of vegetation on hydrology. Soils under evergreen trees in young parks and lawns in intermediately-aged parks were most permeable to water, and thus had high loads of Ca, Cr, Cu, Fe, Ni, tot-P and tot-N. The loads/concentrations of elements in the leachates was not clearly reflected by their content/concentration in the soil, alluding to the storage capacity of these elements in urban park soils. Our results suggest that in urban systems with a high proportion of impermeable surfaces, park soil has the potential to store nutrients and metals and provide an important ecosystem service particularly in polluted cities.

An investigation into the binding of the carcinogen 15,16-dihydro-11-methylcyclopenta[a]phenanthren-17-one to DNA in vitro.

After metabolic activation the carcinogen 15,16-dihydro-11-[3H]methylcyclopenta[a]phenanthren-17-one binds to DNA in vitro, and this binding is prevented by 7,8-benzoflavone. Radioactivity cannot be removed from the DNA with organic solvents or by chromatography on Sephadex G-50, even after heat denaturation of the DNA. Enzymatic hydrolysis yields radioactive fractions, which elute from a column of Sephadex LH-20 immediately after the natural nucleosides. At least two species of reactive metabolites are involved in this bending, those with a half-life of a few hr and others with greater stability. After extraction from the aqueous incubation mixture, they could be detected in discrete polar fractions from separations of the complex metabolite mixture by high-pressure liquid chromatography. Their ability to bind to DNA decreased with time at ambient temperature, and they were rapidly deactivated by acid. 7,8-Benzolflavone acted by suppressing the formation of polar metabolites derived from enzymatic oxidation of the aromatic double bonds. The inhibitor had no effect on the enzymes hydroxylating saturated carbon; hence it is unlikely that metabolism of the methyl group is important in conversion of this carcinogen to its proximate form, although the presence of the 11-methyl group is essential for carcinogenic activity in this series.

What's new in...obstetrics and gynaecology.

This article outlines some recent advances in both obstetrics and gynaecology. In obstetrics, the new screening tests for Down's syndrome and the introduction of computer analysis of the fetal ECG are discussed. Cervical screening and the role of human papilloma virus detection is examined and advances in the non-surgical management of menorrhaghia and improvements in the management of urinary stress incontinence are also reviewed.

Scrotal Involvement with Testicular Nonseminomatous Germ Cell Tumour.

A 37-year-old male presented with a traumatic injury to the scrotal region necessitating emergency surgery. Evacuation of a haematoma and bilateral orchidectomy were performed. A left sided nonseminomatous germ cell tumour (NSGCT), predominantly yolk sac, was identified. Microscopic margins were positive for tumour. Initial tumour markers revealed an AFP of 22,854 ng/mL, HCG of <1 mIU/mL, and LDH of 463 IU/L. Eight weeks after surgery, AFP levels remained elevated at 11,646 ng/mL. Computed tomography (CT) scanning demonstrated left inguinal adenopathy, 1.5 cm in max dimension. On review, extensive evidence of scrotal involvement was evident. His tumour was staged as stage IIIC, poor risk NSGCT. He was treated with 4 cycles of bleomycin, etoposide, and cisplatin over a 12-week period. His tumour markers normalised after 3 cycles. There was a marked improvement noted clinically. Follow-up CT scans demonstrated complete resolution of his tumour. He later underwent further surgery to remove a small amount of remaining spermatic cord. Histology revealed no malignant tissue. The patient suffered many complications including testosterone deficiency, osteopenia, infertility, and psychological distress. Discussion. A small proportion of testicular cancer may present in an atypical manner. The scrotum and testicle have markedly different embryonic origins and therefore a distinct anatomic separation. As a result the scrotum is not a typical site of spread of testicular cancer. Case reports have been described that were managed in a similar manner with good outcomes. Therefore, even with significant scrotal involvement, if timely and appropriate treatment is administered, complete resolution of the tumour may be achieved.

Autonomic function in neuropathic diabetic patients with foot ulceration.

OBJECTIVE: The aim of this study was to compare peripheral autonomic function in neuropathic diabetic subjects with and without foot ulceration. RESEARCH DESIGN AND METHODS: Measurements were made on 57 diabetic subjects; 35 subjects had evidence of peripheral neuropathy, 14 of these had a history of foot ulceration, and 22 subjects had no evidence of peripheral neuropathy. No patient had peripheral vascular disease. Measurements were made of motor and sensory nerve conduction. Autonomic function was investigated by using standard cardiovascular reflex tests and by measuring blood flow variability in the foot. The vasoconstrictor responses to deep breathing and body cooling were measured by using venous occlusion plethysmography. RESULTS: Peripheral sympathetic function was significantly worse in the DU group. The vasoconstrictor response to deep breathing in the DU group was significantly smaller than the response in the DN group (15.3 +/- 2.7 vs. 38 +/- 4%, P < 0.001). The response to body cooling in the DU group was significantly smaller than the response in the DN group (6.2 +/- 3.1 vs. 20.8 +/- 3.5%, P < 0.01). Tests of cardiac autonomic function and measurements of motor and sensory nerve conduction were similar in both neuropathic groups. CONCLUSIONS: Peripheral autonomic neuropathy is associated with the development of foot ulceration in diabetic subjects.

Peripheral autonomic impairment in patients newly diagnosed with type II diabetes.

OBJECTIVE: To measure both peripheral and central autonomic function in patients newly diagnosed with type II diabetes. RESEARCH DESIGN AND METHODS: Measurements were made on 49 diabetic patients (8 with long-standing diabetes and neuropathic complications, 41 with newly diagnosed type II diabetes) and on 49 healthy, age- and sex-matched, control subjects. Five of the 41 newly diagnosed type II diabetic patients had retinopathy, and 4 had clinical evidence of neuropathy. No patient or control subject had significant vascular disease. Cardiac autonomic function was investigated by using standard cardiovascular reflex tests. The digital vasoconstrictor responses to deep breathing and body cooling were measured using venous occlusion plethysmography. RESULTS: The vasoconstrictor responses to a deep breath and body cooling were significantly reduced (P < 0.001) in the fingers and toes of the neuropathic patients compared with their matched control subjects, as were the heart rate responses (P < 0.02). The vasoconstrictor responses were significantly reduced in the toes (P < 0.001) and fingers (P < 0.05, P < 0.01) of the newly diagnosed patients compared with the corresponding responses in the control subjects. There was no significant difference in the heart rate or blood pressure responses of these patients and control subjects during standard tests of cardiac autonomic function. CONCLUSIONS: Patients with type II diabetes may have impaired peripheral autonomic function at diagnosis.

Dietary management of rumination: four case studies.

Four case studies are presented in which the amount of dietary intake directly affected the rate of post-meal ruminating in mentally retarded clients. In the first case small increases in meal size (8, 12, 16, and 24 oz) resulted in slight increases in rumination. When in the second and third cases, the dietary increases were larger (36, 42, and 50 oz) the results were rapid and significant decreases in rumination. In the final case study the subject was allowed to free feed to a satiation criteria that was continued for 196 days to determine the long-term effectiveness of treatment. The subject ceased ruminating until conditions were reversed. These studies are discussed in terms of treatment strategies and generality to other kinds of behavior.

The effect of -adrenoceptor blockade on human sweating.

1. Changes in cutaneous water loss were followed by continuously monitoring total body weight loss.2. Sweating was induced in normal subjects by raising the environmental temperature or by subjecting them to the emotional stress of mental arithmetic.3. Propranolol in a dosage of 0.15 mg/kg body weight intravenously had no significant effect on either thermal or emotional sweating, whereas thermal sweating was completely blocked temporarily by administration of atropine 2.4 mg intravenously.4. It is concluded that beta-adrenoceptor blockade has no effect on physiological sweating in normal people.

Treatment of newly diagnosed state D2 prostate cancer with leuprolide and flutamide or leuprolide alone, phase III, intergroup study 0036.

In order to test the hypothesis of complete androgen blockade for advanced prostate cancer (D2CaP), an intergroup trial was instituted in 1985 comparing leuprolide (L) alone to the combination of L with flutamide (F). Eligibility requirements included previously untreated histologically confirmed stage D2CaP, measurable bone or soft tissue metastases, performance status (PS) of 3 or better, acceptable renal and hepatic function, no severe cardiac disease, and no prior or concomitant endocrine therapy. Stratification at entry was on the basis of PS and none or minimal disease (MD) versus severe degree (SD) of bone metastases. Six hundred and seventeen patients were entered into this study between March 1985 and April 1986. At the present time, there is a 3-month difference in the median progression-free survival (13.9 vs 16.9 months; P = 0.039) and a 7.1-month difference in survival (27.9 vs 35.01 months; P = 0.035) favoring L + F. In L + F-treated patients with good PS-MD, the median survival recently has been reached and is 51.9 months vs 39.6 months for L + P patients. The 107 black patients in the study had median survival of 26.4 months vs 33.3 months for whites. Discussions of racial differences in survival as well as other prognostic factors will be presented. The combination of L + F is superior to treatment with L alone. The benefits appear greatest in patients with minimal disease.

Strawberry gums: a clinicopathological manifestation diagnostic of Wegener's granulomatosis?

AIMS: To highlight an uncommon but characteristic gingival lesion associated with Wegener's granulomatosis, emphasising the presence of pseudoepitheliomatous hyperplasia, microabscesses, and multinucleate giant cells; and the paucity of the currently accepted histopathological criteria of Wegener's granulomatosis--namely necrosis, vasculitis, and granulomata. METHODS: The histopathological features of a gingival biopsy specimen from a case of Wegener's granulomatosis limited to the upper aerodigestive tract in a 36 year old woman were compared with those of 14 similar reported cases. RESULTS: Pseudoepitheliomatous hyperplasia, microabscesses, and multinucleate giant cells were recorded as present in almost all cases of gingival Wegener's granulomatosis. Necrosis, vasculitis, and granuloma formation were present in only a few cases. CONCLUSIONS: The combination of pseudoepitheliomatous hyperplasia, microabscesses, and multinucleate giant cells in a gingival biopsy specimen from erythematous, swollen gums, clinically resembling over-ripe strawberries, in a patient with a severe systemic upset, is so typical of Wegener's granulomatosis as to be virtually diagnostic. Recognition of this characteristic lesion may aid early diagnosis and treatment in cases where other diagnostic variables are absent.