Modern turtle origins: the oldest known cryptodire.

The discovery of a turtle in the Early Jurassic(185 million years before present) Kayenta Formation of northeastern Arizona provides significant evidence about the origin of modern turtles. This new taxon possesses many of the primitive features expected in the hypothetical common ancestor of pleurodires and cryptodires, the two groups of modern turtles. It is identified as the oldest known cryptodire because of the presence of a distinctive cryptodiran jaw mechanism consisting of a trochlea over the otic chamber that redirects the line of action of the adductor muscle. Aquatic habits appear to have developed very early in turtle evolution. Kayentachelys extends the known record of cryptodires back at least 45 million years and documents a very early stage in the evolution of modern turtles.

Paleogene terrestrial vertebrates: northernmost occurrence, ellesmere island, Canada.

Recently discovered Paleogene land vertebrates from the Eureka Sound Formation at about latitude 78 degrees north in Arctic Canada include fish, turtles, an alligatorid, and several taxa of mammals. The assemblage, which is probably early or middle Eocene in age, adds to previously known paleobotanical evidence in suggesting temperate to warm-temperate climatic conditions.

The natural history of bacterial colonization of the newborn in a maternity hospital (Part II).

The object of this study was to determine the sources from which the newborn infant derives his bacterial flora during the first 5 days after birth. Detailed bacteriological data was obtained from 193 mothers antenatally and during labour, and from their infants on the day of birth and on Day 5. Organisms were typed by appropriate methods and the 193 mother-baby pairs declared to be a 'match' or a 'non-match' according as to whether or not identical bacteria were isolated from both members of the pair. Weekly swabs from hands and noses of staff were taken throughout the 12 months of the study. Swabs were also taken from the environment and air samples from different areas in the hospital. In approximately one third of infants the colonizing bacteria are derived from their mothers, in over 70 per cent of instances from the mother's rectum. The mother's birth canal is not a common source of bacteria and there is no direct relationship with the noses or hands of staff. Artificial feeds are not a source of the colonizing bacteria. The overall distribution of the bacterial species in the infants differed from that found in the hospital environment but this does, none the less, constitute a reservoir of bacteria which is being continually replenished from human sources. Pathogens such as Staph, aureus and Strep. pyogenes are no longer commonly found in newborn infants in the modern maternity hospital, but the need for continual vigilance and an efficient bacteriological service in all maternity units has been in no way diminished.

Raised serum TSH in hypothyroidism.

It is desirable to detect early hypothyroidism of the mildest degree even before conventional tests of thyroid function become abnormal. Serum TSH levels (normal: undetectable to 4 muU/ml) rise in patients with mild hypothyroidism long before serum T4 and T3 levels fall. In the patient described the serum TSH level was 310 muU/ml, while other tests of thyroid function gave normal results. After treatment with thyroxine, serum TSH returned to normal. It should now be accepted that patients with mild hypothyroidism have a raised serum TSH and that thyroid insufficiency can be confidently excluded if the serum TSH concentration is normal. It is thus important to assay serum TSH when suspicion of hypothyroidism is aroused.

Dublin-Johnson syndrome with some unusual features in a Chinese family.

Three cases of chronic nonhaemolytic jaundice with conjugated bilirubin in the serum are described in a Chinese family. Bromsulphthalein excretion tests gave results typical of the Dubin-Johnson syndrome. Liver histology in the proband showed cytoplasmic pigment of the lipofuscinmelanin variety, and intravenous cholecystography failed to show visualisation of the gallbladder. Unusual findings included onset during the neonatal period in the proband and the presence of some iron pigment in the hepatic cells with a little canalicular cholestasis. It is suggested that the infant may have had a concomitant nonspecific hepatitis. These cases are regarded as belonging to a disease group in which the Dubin-Johnson syndrome is at one end of a spectrum. The mode of inheritance is discussed.

Medical undergraduate teaching of paediatrics in the community.

The undergraduate teaching of childhood illness in the community is described. This teaching includes a cross-section of acute childhood illness together with some contact with handicapped children in their own homes. Although there were only four teaching sessions, the frequency of conditions studied approximated to that in general practice

Massive subaponeurotic haemorrhage in infants born by vacuum extraction.

Nine out of 232 infants on whom the vacuum extractor was employed developed subaponeurotic haemorrhage and two of these infants died. In a further 78 infants born by vacuum extraction, all of whom received intramuscular vitamin K(1), four sustained subaponeurotic haemorrhage and one died. This type of haemorrhage was not encountered in over 12,000 infants born by other methods. Its relationship to vacuum extraction was found to be significantly more frequent when the thrombotest level was 10% or below of normal adult activity. It is suggested that infants born by vacuum extraction and with a thrombotest level of 10% or below might be protected from subaponeurotic haemorrhage by the transfusion of fresh frozen plasma.

Thyroid-stimulating immunoglobulins in neonatal Graves's disease.

Two patients with neonatal Graves's disease are reported. One of them had a delayed onset because of suppression of the fetal thyroid gland by antithyroid drug taken by the mother during pregnancy. Thyroid-stimulating immunoglobulins (TSAb), measured by a receptor assay, were present in both babies when they were thyrotoxic, and also in their mothers. TSAb were undetectable in both babies 1 year after birth. This strongly supports a pathogenetic role of TSAb in this condition through transplacental transfer of maternal TSAb.

Calcium, phosphorus, and magnesium concentrations in plasma during first week of life and their relation to type of milk feed.

Serial changes in plasma levels of calcium, phosphorus, magnesium, alkaline phosphatase, and total proteins have been investigated in 138 healthy, term Caucasian infants. Blood samples were obtained for each infant from cord blood and on day 1 and day 6. The infants were studied in three groups according to whether they were breast fed, received 'Ostermilk No. 1' or 'Cow and Gate V' formulas. Levels of calcium, phosphorus, magnesium, alkaline phosphatase, and total proteins did not differ between the groups at birth or on day 1. By day 6 calcium levels were higher and phosphorus levels lower in the breast-fed infants compared with either of the artificially-fed groups. Phosphorus levels were lower in the V Formula group compared with the Ostermilk group but the mean calcium levels of these two groups did not differ significantly. However, only 2-8% of the V Formula group developed hypocalcaemia compared with 18-2% of the Ostermilk group. The only infant developing clinical tetany belonged to the group fed Ostermilk. Evidence is also given which suggests that those infants with low calcium levels on day 1 who were fed the high-solute milk tended to show a fall in calcium by day 6. This did not apply to the two other groups. It is concluded that the use of adapted cows' milk preparations for infant feeding should lead to a reduction in the incidence of neonatal tetany.