Spatio-temporal dynamics in maturation and spawning of Patagonian toothfish Dissostichus eleginoides on the sub-Antarctic Kerguelen Plateau.

This study investigated maturation and spawning of Patagonian toothfish Dissostichus eleginoides in the Heard Island and McDonald Islands (HIMI) fishery on the Kerguelen Plateau in the Indian Sector of the Southern Ocean based on gonads and otoliths collected between 2004 and 2015 and using histological analyses and calibration of macroscopic staging criteria. Dissostichus eleginoides at HIMI spawn throughout the austral late autumn and winter months of May-August and spawning activity is concentrated on slopes along the west and south of the plateau around HIMI at depths of 1500-1900 m. Comparison between histological analyses and macroscopic gonad staging indicated that many fish that had spawned, as indicated by the presence of post-ovulatory follicles, returned to a resting stage which was macroscopically indistinguishable from maturing fish. Furthermore, the occurrence of females of all size classes with low gonado-somatic index and low macroscopic gonad stage during the spawning season suggested that a proportion of mature females did not spawn every year. Age-at-maturity estimates, based on the assumption that fish of macroscopic stages ≥2 were mature, decreased between the 2004-2009 and 2010-2015 periods for both sexes. The magnitude of this temporal variation in age at maturity, however, varied between gear types and fishing depths and variable sampling regimes probably influenced these variations. This study highlights the importance of correct interpretation of macroscopic gonad stages and understanding the influence of fishery operations on estimations of life-history parameters.

Survival after embolization of the internal iliac arteries in ten patients with severe haematuria due to recurrent pelvic carcinoma.

Therapeutic embolization of the internal iliac arteries is a well established technique for controlling severe haematuria caused by malignant disease, but there are few reports of the long term outcome. We performed iliac artery embolization procedures on 10 patients with severe haematuria secondary to widespread inoperable pelvic carcinoma, between 1979 and 1992, and have followed these patients until death. Prior to embolization, the mean transfusion requirement was 12 units (range 2-39 units). Survival ranged from 12h to 31 months (median 3.84 months). Five of the nine patients who survived more than 12h had complete relief of haematuria until their deaths, and only two patients required further blood transfusions. Our conclusions are that haematuria from inoperable pelvic carcinoma is usually controlled by therapeutic arterial embolization and that the duration of haematuria relief is usually life long.

The effect of long-term thyroxine on bone mineral density and serum cholesterol.

The effect of thyrotrophin suppression on bone mineral density (BMD) and serum cholesterol concentration was assessed in 31 treated hypothyroid women. Measurements of the BMD of the lumbar spine and femoral neck were repeated in seven of those with the lowest value after an average period of 22.7 months. Final cholesterol concentrations were compared with values before thyroxine was started. The dose of thyroxine was based on clinical assessment, serum triiodothyronine concentrations kept within the normal range, and thyrotrophin values within the normal range or suppressed. The patients had taken thyroxine replacement for a mean of 12.7 years. Two-thirds (21 subjects) had suppressed thyrotrophin concentrations, and it was normal in one-third (10). Fifteen subjects had a past history of thyrotoxicosis. BMD and cholesterol concentrations were compared between those with suppressed and normal thyrotrophin concentrations and between those with and without a past history of thyrotoxicosis. No patient had a pathological fracture. One had a Z value for the femoral neck of -1.6, denoting early but definite osteoporosis, and five had borderline osteoporosis with Z values for one or other site between -1.1 and -1.5. None of the seven with the lowest BMDs had any significant change when measurements were repeated. The difference in Z values between subjects with suppressed and normal thyrotrophin concentrations was not significant for either the lumbar spine (p = 0.68) or the femoral neck (p = 0.28). A past history of thyrotoxicosis had a greater effect on BMD for both sites than thyrotrophin suppression, but again the difference between those with and without a past history of thyrotoxicosis was significant neither for the lumbar spine (p = 0.18) nor for the femoral neck (p = 0.34). The combination of thyrotrophin suppression and a past history of thyrotoxicosis also failed significantly to reduce the BMD of the lumbar spine (p = 0.38) or femoral neck (p = 0.30) in comparison with those who had neither thyrotrophin suppression nor a past history of thyrotoxicosis. The mean fall in serum cholesterol concentration was 2.1 mmol/l (SD 1.78) (p = 0.001) in those with a suppressed thyrotrophin concentration taking a mean daily dose of thyroxine of 171 micrograms (SD: 34.7), compared with a fall of 0.89 mmol/l (SD: 1.04) (p = 0.065) in those whose thyrotrophin concentration was not suppressed on a mean daily thyroxine dose of 140 micrograms (SD: 50). No patient had atrial fibrillation or cardiographic evidence of coronary artery disease (CAD). The serum cholesterol concentration should play at least as important a part in influencing the dose of thyroxine as a fear of osteoporosis. Fractures are not a feature in the natural history of treated hypothyroidism, whereas CAD is a common cause of death in these patients.

Pregnancy after uterine artery embolization to control haemorrhage from gestational trophoblastic tumour.

Gestational trophoblastic tumour (GTT) of the uterus can cause severe and even life threatening haemorrhage in patients who may be contemplating future pregnancy. Three cases of successful pregnancy after uterine artery embolization to control severe haemorrhage from uterine GTT are reported. Both uterine arteries had been selectively catheterized and embolized in these patients. The areas of pathological circulation measured on the pre- and post-embolization films had been reduced by over 80%. Embolization failed to control haemorrhage in another four patients in whom the uterine arteries had not been selectively catheterized and embolized and where the embolization procedures had reduced the areas of pathological circulation by less than 65%. The conclusions are that control of severe haemorrhage from uterine GTT is likely if both uterine arteries are selectively catheterized and embolized. Patients thus treated can become pregnant.

Inspiratory coactivation of the genioglossus enlarges retroglossal space in laryngectomized humans.

To investigate the relationship between the electrical activity of the genioglossus (GG-EMG) and associated tongue movement, seven laryngectomized subjects breathing through a tracheal stoma (without pressure or flow change in the upper airway) were studied in the supine position. Tongue movement, with the use of lateral fluoroscopy, and GG-EMG expressed as a percentage of maximum voluntary genioglossal activation were monitored simultaneously during 1) spontaneous inspiration (SI), 2) resistive loaded inspiration (LI), and 3) rapid inspiration (RI). Tongue position during each maneuver was compared with its position during spontaneous expiration. Peak GG-EMG during the three maneuvers was significantly different from each other (SI: 5.4 +/- 1.6, LI: 11.9 +/- 1.8, and RI: 51.6 +/- 9.4 (SE) %, respectively). Associated forward movement of the posterior aspect of the tongue was minimum during SI; however, significant movement was observed during LI, and this was increased during RI. Significant covariance existed between peak GG-EMG and this movement. Genioglossal coactivation with inspiration enlarges the glossopharyngeal airway, particularly in its caudal part. In subjects with intact upper airways, this activation may protect or enhance upper airway patency in an effort-dependent manner.

Ultrasonography in developmental hip dysplasia.

With the evolving use of ultrasonography, there has been an increasing emphasis on the technically oriented diagnosis of developmental hip dysplasia. Graf's alpha and beta angles and Harcke's bony rim percentage are two of the more common criteria, but their repeatability and reliability have not been well documented. Fifty-eight hip ultrasounds of 29 infants were measured independently by three physicians, and statistical analysis was performed. It was concluded that Graf's and Harcke's methods could be repeatable with training and frequent use of ultrasonography. Harcke's guidelines have a large equivocal zone, which limited their clinical usefulness. Graf's angles gave a better classification, but their clinical relevance has not been proven.

Renal artery embolization with ethanol and gelfoam for the treatment of ureteric fistulae with one year follow-up.

Two patients with ureteric fistulae who were unfit for reconstructive surgery were treated by renal ablation using intra-arterial ethanol, gelfoam fragments and in one case coils. In both cases the fistulae dried-up on the same day and both patients are well and normotensive a year later. Our conclusion is that renal ablation by arterial embolization with ethanol can be a valuable alternative to surgery to treat ureteric fistulae in patients who are poor surgical risks.

245 transaxillary arteriograms in arteriopathic patients: success rate and complications.

Two hundred and forty-five transaxillary arteriograms were attempted at Charing Cross Hospital between 1982 and 1991 on 195 arteriopathic patients (mean age 64 years) in whom the femoral route was contra-indicated due to absent pulses (94), previous surgery (108), femoral artery aneurysm (5), severe aorto-iliac disease (8) or previous failure by the femoral route (30). Most arteriograms (211) were carried out to investigate peripheral vascular disease, the others were carried out to perform transluminal angioplasty (16) to assess cerebrovascular disease (10) and to investigate arterial insufficiency of the kidneys, alimentary tract and upper limb (8). There were two (0.8%) technical failures where the axillary artery could not be punctured. Selective catheterization of the carotid, vertebral, axillary, lumbar, renal, superior mesenteric, inferior mesenteric, iliac, femoral or popliteal arteries was performed in the course of 38 procedures. There were three (1.2%) serious complications related to the puncture site, a large haematoma followed by a prolonged neurological deficit of the brachial plexus in a hypertensive patient receiving haemodialysis, and thrombosis of the axillary artery in two other patients both of whom responded to surgical thrombectomy. There were three (1.2%) serious systemic complications, two patients had a cardiac arrest and although both were successfully resuscitated one became anuric and died from renal failure and septicaemia 4 weeks later. One patient with a history of transient ischaemic attacks developed a similar transient episode at the end of the procedure. Compared with six series of 290 attempted brachial artery catheterizations in patients where the femoral route was contra-indicated which have been reported since 1986, our series of 245 attempted axillary artery catheterizations had a significantly higher incidence of technical success at the first attempt (P = 0.021) and a lower incidence of vascular complications requiring surgery or angioplasty which was not statistically significant. Our conclusion is that transaxillary arterial catheterization has a high rate of technical success (99%) and should be considered in patients where the femoral route is contra-indicated due to arterial disease.

Survival after transhepatic embolization of gastro-oesophageal varices.

Twenty-five transhepatic embolization procedures were carried out between 1984 and 1989 on 24 patients with life-threatening haemorrhage from gastric or oesophageal varices after conservative methods had failed. There were two deaths related to the procedure and another 17 patients died during the following year. There were five survivors at 1 year, four are alive and well 4 years later, the fifth was lost to follow-up at 2 1/2 years. Survival at 1 year was not affected by a number of factors present at the time of embolization including the underlying liver pathology, the patient's age, platelet count, blood urea, serum bilirubin or the embolization technique. However, survival at 1 year was related to more normal coagulation values (international normalized ratios, INR) P less than 0.005, normal serum aspartate aminotransferase levels (P less than 0.025) and Pugh's grade A (P less than 0.01). We conclude that this procedure can prolong the survival of a small proportion of good risk patients.

Thoracic lordosis in idiopathic scoliosis.

Lordosis, a significant aspect of thoracic scoliosis, is difficult to assess with routine clinical radiographs. Computerized analysis of 138 sets of standardized anteroposterior and lateral radiographs served to elicit the three-dimensional structure of scoliosis. Spinal curvatures in the usual anatomic planes and in the sagittal and frontal planes of the apical vertebrae were measured. Lordosis was present in 35% of curves greater than or equal to 40 degrees and in 50% of curves greater than 49 degrees. Lordosis may be a contraindication for brace treatment.

Radiological assessment of post laryngectomy speech.

Laryngectomy for carcinoma of the larynx has a five year survival rate of approximately 80% but the operation has a high morbidity as most patients do not develop effective alaryngeal speech. The published literature states that poor speech is occasionally due to anatomical or physiological problems in the reconstructed pharynx but is usually due to psychological, sociological or educational difficulties. We devised a radiological technique using a combination of video-fluoroscopy and static or spot films to assess the anatomy and function of the reconstructed pharynx of post-laryngectomy patients, and investigated 24 good and 134 poor or failed speakers. We examined the pharynx during the acts of swallowing, attempted phonation and attempted phonation with air insufflation. A single vibrating segment (P-E segment) in an otherwise dilated pharynx was present in all good speakers, but was absent in poor or failed speakers whom we classified as hypotonic (19), hypertonic (40), spastic (62) and strictured (13) according to the radiological appearances. This classification has been used to plan subsequent clinical management and 46 of the 55 patients treated to date (84%) have developed effective alaryngeal speech.

A comparison of four computerized methods for measuring vertebral rotation.

The ability to measure vertebral rotation is particularly important in the assessment and treatment of scoliosis. We determined the accuracy and precision of four methods that may be used with routine anteroposterior (AP) spine radiographs. Two vertebrae were radiographed at 0 degrees and at 5 degrees intervals to 20 degrees and at 30 degrees, to the right and left. The radiographs were distributed to three members of the staff who marked the 14 points required for calculating rotation with the four methods. The points were digitized, and rotation calculated by computer. The results showed no significant difference in the calculated rotation of the two vertebrae, or between the results of the three markers. Stokes's method was significantly the least accurate. The other three methods were not significantly different but Bunnell's method appeared to give more consistent results.

Pharyngeal size and shape during wakefulness and sleep in patients with obstructive sleep apnoea.

Computed tomography has been used to study the pharyngeal airway during tidal breathing in wakefulness and during obstructive apnoeas in Non-REM sleep in patients with obstructive sleep apnoea. In supine subjects, contiguous transverse 10 mm sections were taken perpendicular to the posterior pharyngeal wall with a 2.1 s scan time. Studies during wakefulness showed that the narrowest section of the pharyngeal airspace was in the region posterior to the soft palate and that the minimal airway cross-sectional areas were significantly reduced in the group of patients with obstructive sleep apnoea compared to the group of control subjects without obstructive sleep apnoea. The studies during sleep showed that in all patients, the airspace posterior to the soft palate was a site of obstructive apnoeas. The length of the obstructed segment varied between patients, extending below the level of the soft palate in half the patient group. Airway narrowing and obstruction was due to posterior displacement of the soft palate and the tongue in the majority of patients, although lateral displacement of the pharyngeal walls was also observed. No occlusion was observed in the laryngopharynx although there was narrowing of oro- and laryngopharyngeal apertures below the site of obstruction during obstructive apnoeas. The size of the oropharyngeal airspace during wakefulness did not predict the presence of airway occlusion below the level of the soft palate when asleep. The variability between patients in the site(s) of upper airway obstruction during obstructive apnoeas have important implications for the choice of appropriate treatment in patients with obstructive sleep apnoea.

Orthopaedic complications of lumboperitoneal shunts.

Lumboperitoneal (LP) shunts performed for communicating hydrocephalus have been reported to lead to neurologic deficits in the lower limbs and spinal deformities as a result of arachnoiditis. A chart review of 375 children who underwent LP shunts between 1960 and 1981 at The Hospital For Sick Children in Toronto was undertaken. Of the 375 charts reviewed, evidence of shunt-induced neurologic deficits was seen in 63 patients. Thirty-four patients had back pain with or without sciatica, 45 patients had hamstring tightness, and 40 patients had foot deformities. Forty-nine patients had lumbar hyperlordosis, lordoscoliosis, and scoliosis. These deformities are postulated to be the result of arachnoiditis involving the conus medullaris and lower lumbar roots.

Direct percutaneous embolisation of a false aneurysm with steel coils.

A false aneurysm of the peroneal artery was catheterised directly through the calf and embolised with steel coils and gel foam. This technique has not been previously described.