A systematic review of MR imaging as a tool for evaluating haemophilic arthropathy in children.

Our purposes were to determine: (i) whether there is direct evidence that currently available MRI techniques are accurate for early diagnosis of pathological findings in haemophilic arthropathy; (ii) whether there is an MRI scoring system that best correlates with clinical/radiological constructs for evaluation of haemophilic arthropathy; (iii) whether there is an MRI scoring system that best correlates with clinical/radiological constructs for evaluation of haemophilic arthropathy. Articles were screened using MEDLINE (n = 566), EMBASE (n = 201), and the Cochrane Library (n = 1). Two independent reviewers assessed articles for inclusion under the overarching purposes of the review by using the Standards for Reporting of Diagnostic Accuracy (STARD) tool, and the quality of the studies were graded using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. The electronic literature search retrieved 777 references (after duplicates were removed). A total of 32 studies were chosen for inclusion from the results of the search and review of bibliographical references. Using the STARD tool, seven studies were of excellent quality of reporting, and using the QUADAS-2 tool, 10 studies were judged to be of adequate quality. There is 'fair' evidence to recommend MRI as an accurate test for detecting evidence of haemophilic arthropathy and the use of second or third generation MRI scales for assessing haemophilic arthropathy. However, there is no evidence that screening of early intra-articular soft tissue bleed with MRI improves the functional status of joints over time.

Phyto- and Bio-Chemical evaluation of Diospyros kaki L. cultivated in Egypt and its biological activities.

Diospyros kaki L. or Costata cultivar is the main persimmon variety progressively consumed in the Egyptian market and exportation. The objective of this study was to investigate the bioprotective effects of the alcoholic extract of fruits as well as leaves of D. kaki using in-vivo rat models. Petroleum ether extracts of fruits and leaves were analytically characterized for saponifiable and unsaponifiable compounds by GC/MS. Main flavonoids were chromatographically isolated from 80% aqueous methanol extract of leaves. Chemical evaluation for fruits and leaves namely, content of moisture, ash, proteins, fatty acids, amino acids, fat and water soluble vitamins, minerals, carotenoids was carried out. Total antioxidant activity was determined by radical scavenging effects using DPPH assay. The effect on biochemical parameters and its biological activity were also performed. Results revealed the identification of the major compounds of saponifiable and unsaponifiable matters of fruits and leaves. Scopoletin, as well as, kaempferol, luteolin, rutin and apigenin 7-O-glucoside were isolated and identified. It showed that this plant can provide a good nutritional value and it is safe regarding the kidney and liver functions, good source that help in enhancing the antioxidant defense against free radicals. No abnormal effects were found in lipids profile on experimental animals and there were good results in the ratio of HDL and LDL cholesterol. Also, this plant can help in optimizing blood sugar, enhancing the level of blood haemoglobin. It is concluded that D. kaki displays a good source of nutrients and bioactive compounds that may contribute to its therapeutic benefits against the risk of disease complications.

Eastern Canadian Gastrointestinal Cancer Consensus Conference 2018.

The annual Eastern Canadian Gastrointestinal Cancer Consensus Conference was held in Halifax, Nova Scotia, 20-22 September 2018. Experts in radiation oncology, medical oncology, surgical oncology, and pathology who are involved in the management of patients with gastrointestinal malignancies participated in presentations and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses multiple topics in the management of pancreatic cancer, pancreatic neuroendocrine tumours, hepatocellular cancer, and rectal and colon cancer, including ■ surgical management of pancreatic adenocarcinoma,■ adjuvant and metastatic systemic therapy options in pancreatic adenocarcinoma,■ the role of radiotherapy in the management of pancreatic adenocarcinoma,■ systemic therapy in pancreatic neuroendocrine tumours,■ updates in systemic therapy for patients with advanced hepatocellular carcinoma,■ optimum duration of adjuvant systemic therapy for colorectal cancer, and■ sequence of therapy in oligometastatic colorectal cancer.

Phyto- and Bio-Chemical evaluation of Diospyros kaki L. cultivated in Egypt and its biological activities / Avaliação fito e bioquímica de Diospyros kaki L. cultivado no Egito e suas atividades biológicas

Abstract Diospyros kaki L. or Costata cultivar is the main persimmon variety progressively consumed in the Egyptian market and exportation. The objective of this study was to investigate the bioprotective effects of the alcoholic extract of fruits as well as leaves of D. kaki using in-vivo rat models. Petroleum ether extracts of fruits and leaves were analytically characterized for saponifiable and unsaponifiable compounds by GC/MS. Main flavonoids were chromatographically isolated from 80% aqueous methanol extract of leaves. Chemical evaluation for fruits and leaves namely, content of moisture, ash, proteins, fatty acids, amino acids, fat and water soluble vitamins, minerals, carotenoids was carried out. Total antioxidant activity was determined by radical scavenging effects using DPPH assay. The effect on biochemical parameters and its biological activity were also performed. Results revealed the identification of the major compounds of saponifiable and unsaponifiable matters of fruits and leaves. Scopoletin, as well as, kaempferol, luteolin, rutin and apigenin 7-O-glucoside were isolated and identified. It showed that this plant can provide a good nutritional value and it is safe regarding the kidney and liver functions, good source that help in enhancing the antioxidant defense against free radicals. No abnormal effects were found in lipids profile on experimental animals and there were good results in the ratio of HDL and LDL cholesterol. Also, this plant can help in optimizing blood sugar, enhancing the level of blood haemoglobin. It is concluded that D. kaki displays a good source of nutrients and bioactive compounds that may contribute to its therapeutic benefits against the risk of disease complications.

Resumo Diospyros kaki L. ou Costata é a principal variedade de caqui progressivamente consumida no mercado e exportação egípcia. O objetivo deste estudo foi investigar os efeitos bioprotetores do extrato alcoólico de frutos e folhas de D. kaki utilizando modelos de ratos "in vivo". Extratos de éter de petróleo provenientes de frutos e folhas foram caracterizados analiticamente para compostos saponificáveis ​​e insaponificáveis ​​por GC/MS. Os principais flavonoides foram isolados cromatograficamente, a partir de 80% de extrato aquoso de folhas de metanol. Foi realizada avaliação química de frutos e folhas, ou seja, de teor de umidade, cinzas, proteínas, ácidos graxos, aminoácidos, vitaminas lipossolúveis e solúveis em água, minerais, carotenoides. Foi caracterizada a atividade antioxidante, utilizando ensaio (DPPH). O efeito nos parâmetros bioquímicos e sua atividade biológica também foram analisados. Os resultados revelaram a identificação dos principais compostos saponificáveis e insaponificáveis de frutos e folhas. Escopoletina, bem como kaempferol, luteolina, rutina e apigenina 7-O-glicosídeo foram isolados e identificados. Também demonstraram que esta planta pode proporcionar um bom valor nutricional e é segura em relação às funções renais e hepáticas, boa fonte que ajuda a melhorar a defesa antioxidante contra os radicais livres. Não foram encontrados efeitos anormais no perfil lipídico em testes em animais, e houve um efeito satisfatório na relação de colesterol HDL e LDL. Além disso, esta planta pode ajudar na otimização do açúcar no sangue, aumentando o nível de hemoglobina. Conclui-se que o D. kaki apresenta uma boa fonte de nutrientes e de compostos bioativos que contribuem para seus benefícios terapêuticos e contra o risco de complicações de doenças.

Long-term antihypertensive therapy with captopril.

Most forms of hypertension require life-long treatment; thus, it is important to determine the continuing effectiveness and safety of any new therapeutic agent. While participating in various investigational studies, 7103 hypertensive patients received captopril, of whom 4397 were treated for 3 months to 4 years. The 4-year patients included 2498 with mild or moderate essential hypertension (diastolic pressure less than 120 mm Hg), 893 with severe essential hypertension, and 517 with renovascular hypertension. Repeated examinations of these long-term therapy patients, the majority of whom also were receiving a diuretic, indicated no drug tolerance to the combination, i.e., there was continuing control of the blood pressure without significant increases in dosage or addition of other drugs. Side-effects occurring during the first few months of captopril administration (rash, taste disturbances, and, rarely, neutropenia) were not a problem during prolonged therapy. A few patients (70/7,103, or 1.0%) developed proteinuria, usually reversible and seldom associated with any deterioration of renal function. The proteinuria occurred most often in patients who had preexisting renal disease and were receiving high doses of the drug. There were no significant changes in key biochemical parameters. A total of 230 patients discontinued treatment for failure to maintain adequate blood pressure reduction, and 397 for side-effects. The estimated 4-year cumulative frequency of drug discontinuance for side-effects was 11.6% (life table method), which compares favorably with other classes of antihypertensive drugs.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of left ventricular diastolic function as determined by nuclear cardiac probe, radionuclide angiography, and contrast cineangiography.

In this investigation, determinations of peak diastolic filling rate (PDFR) and ejection fraction (EF) by two distinct nuclear techniques--gated radionuclide angiography (RNA) and nuclear cardiac probe (NCP)--were compared with contrast ventriculography in 44 patients with coronary artery disease (CAD). In addition, PDFR was tested as a potential index of the severity of disease. Good agreement in PDFR was found between NCP and contrast ventriculography (r = 0.83, p less than 0.001), but there was poor correlation between RNA and contrast ventriculography. Ejection fraction measured by either RNA or NCP correlated well with contrast ventriculography (r = 0.96 and r = 0.73, respectively). A positive correlation was found between PDFR and the EF measured by the NCP (r = 0.79) and by contrast ventriculography (r = 0.64), but poor correlation was found between these parameters by RNA. Patients with multivessel CAD had lower PDFR than patients with single vessel disease when studied by the NCP (1.6 +/- 0.4 versus 2.5 versus 0.6 EDV/sec [mean +/- s.d.], p less than 0.0001), but not by RNA. Thus, compared with contrast ventriculography, determination of PDFR is more accurate by NCP than by RNA. Furthermore, the PDFR measured by NCP, but not by RNA, may be a potentially useful index of the extent of CAD.

Relation of left ventricular dilation during acute myocardial infarction to systolic performance, diastolic dysfunction, infarct size and location.

The quantification of left ventricular (LV) volumes and assessment of their relation to systolic and diastolic dysfunction, infarct size and anatomic location were performed in 54 patients with a first acute myocardial infarction (AMI). Blood pool radionuclide angiography was used to assess LV end-diastolic, end-systolic, and stroke volume indexes, ejection fraction and peak diastolic filling rate. Infarct size was estimated from plasma MB creatine kinase activity. Substantial LV dilation occurred within the initial 24 hours of AMI. The peak diastolic filling rate was low, even in those patients with a normal ejection fraction. In comparison with inferior AMI (n = 25), patients with anterior AMI (n = 29) had a larger end-diastolic volume index (105 +/- 8 vs 81 +/- 4 ml/m2, p less than 0.01) and end-systolic volume index (64 +/- 7 vs 37 +/- 4 ml/m2, p less than 0.001), but similar stroke volume index (41 +/- 3 vs 43 +/- 2 ml/m2, difference not significant). No significant relation was noted between infarct size estimated by MB creatine kinase and any volumetric index. On repeat study (day 10 after AMI), end-diastolic and end-systolic volume indexes increased further (p less than 0.05 vs day 1) but ejection fraction and peak diastolic filling rate were unchanged. It was concluded that: (1) LV dilation occurs within hours of AMI in both inferior and anterior AMI, but is more marked in the latter; (2) significant LV diastolic dysfunction is the rule, even in patients with preserved LV systolic function; and (3) LV dilation is an early compensatory mechanism that maintains normal stroke volume, even in patients with severely reduced LV function.

Quantitative analysis of thallium-201 uptake and washout before and after transluminal coronary angioplasty.

Transluminal coronary angioplasty has become an important therapeutic modality in the treatment of coronary artery disease. The effects of coronary angioplasty on regional myocardial perfusion have been reported in only a small series of patients, employing subjective analysis of thallium-201 perfusion scintigrams. Thus, we studied 61 patients with quantitative analysis of thallium-201 uptake and washout before and after undergoing angioplasty. Prior to angioplasty, there were 105 areas in 47 patients with abnormal thallium-201 uptake during exercise, with a mean uptake of 49 +/- 1.3%. The uptake of thallium-201 in these same areas increased to 71.3 +/- 1.9% post angioplasty (P less than 0.0001), and 68 (65%) of the areas showing abnormal uptake returned to normal. Abnormalities in washout of thallium-201 before angioplasty were seen more frequently than in uptake (150 vs 105 areas, P less than 0.05), with 8 patients having abnormal washout in the presence of totally normal uptake. Thallium-201 washout in the abnormal areas improved from 16 +/- 2.8 pre angioplasty to -23 +/- 1.8% post angioplasty (P less than 0.001). Normalization resulted in 6 of the 8 patients with exclusively washout abnormality. Residual abnormalities in uptake and/or washout were seen in 53% of the patients, usually in areas with prior myocardial infarction or supplied by a vessel with significant stenosis which did not undergo angioplasty. Improved thallium-201 uptake and washout corresponded to reductions in percent coronary area stenosis (89 +/- 1.0 to 36 +/- 2.0%, P less than 0.001) and transstenotic pressure gradient (42 +/- 3.0 to 9.0 +/- 2.0 mm Hg, P less than 0.001). Thus, quantitative analysis of thallium-201 uptake and washout provided objective evidence for improved myocardial perfusion after coronary angioplasty. Due to a fairly high prevalence of residual perfusion abnormalities after this procedure, optimal assessment of benefits requires quantitative comparison of thallium uptake and washout before and after coronary angioplasty.

Double-blind paired comparison clinical trial of halcinonide and hydrocortisone.

Fifty patients with a diagnosis of psoriasis, eczematous dermatitis, atopic dermatitis, or neurodermatitis and with bilateral symmetric lesions of equal severity participated in this study. A double-blind paired comparison technique was used in which halcinonide-neomycin-amphotericin ointment was applied to the lesions on one side of the body and hydrocortisone ointment to similar lesions on the other side according to a randomized schedule. The halcinonide-containing combination was statistically superior (p less than 0.05) to hydrocortisone ointment in the treatment of psoriasis patients. No statistically significant difference between the two drugs was obtained for the three other indications studied. No side effects with either ointment were observed. Halcinonide as formulated in this combination is an effective and safe corticosteroid.

A comparative study of epicillin and chloramphenicol in the treatment of enteric fever.

One hundred patients with acute enteric fever were randomly assigned to treatment with either chloramphenicol 50 mg/kg body-weight or epicillin 1 g six hourly. Eighty-one patients had a positive blood culture for typhoid or paratyphoid bacilli and nineteen had a positive stool culture with a significant Widal titre. All fifty patients in the group treated with chloramphenicol responded, however there was one relapse with bacteraemia. In the group treated with epicillin, six from the total of fifty patients were considred treatment failures. Treatment was considred as a failure if the patient was febrile after ten days treatment or if there was a deterioration despite antibiotic therapy.

A comparative clinical evaluation of a new topical steroid 'halcinonide' and hydrocortisone in steroid-responsive dermatoses.

Fifty patients with symmetrical, bilateral lesions of psoriasis, eczematous dermatitis, atopic dermatitis, or neurodermatitis participated in a double-blind paired comparison study in which 0-1% halcinonide (in a cream formulation containing also neomycin and nystatin) was applied to the lesions on one side of the body and 1% hydrocortisone cream to those on the opposite side for two to three weeks. The number of excellent responses to therapy showed the halcinonide combination to be significantly superior (p less than 0-01) to the control cream in all diagnostic categories if considered collectively, and in psoriasis if the responses were grouped according to diagnosis. No adverse reactions occurred during the trial.

A double-blind comparison of a new combination (halcinonide-neomycin-amphotericin) and active controls in cutaneous candidiasis and steroid-responsive dermatoses.

One hundred patients participated in the studies of cutaneous candidiasis and steroid-responsive dermatoses. Seventy patients with the former diagnosis were treated with either halcinonide-neomycin-amphotericin or hydrocortisone-iodochlorhydroxyquin ointment combinations on a double-blind parallel comparison basis. Similar results were obtained after both therapies. Thirty patients with symmetrical bilateral lesions of steroid-responsive dermatoses were treated with halcinonide-neomycin-amphotericin cream on the lesions on one side of the body and hydrocortisone-iodochlorhydroxyquin cream on the opposite side. A double-blind design was used in directly comparing the response to each of the two drugs. Considering the results of all dermatoses together the test combination was statistically superior to the control cream (p less than 0-05). However, while numerical superiority of good responses to the halcinonide combination was recorded in psoriasis, no statistical significance could be derived due to the limited number of cases. No side-effects occurred with any drug combination use. In the opinion of the authors halcinonide-neomycin-amphotericin cream and ointment are safe and effective in the treatment of cutaneous candiasis and steroid-responsive dermatoses.

Long-term treatment of essential hypertension with Nadolol and Hydrochlorothiazide: a two-year follow-up.

After 3 weeks of placebo administration, thirty-two mildly or moderately hypertensive patients were treated with hydrochlorothiazide (HCZ) for 3 weeks, then with HCZ plus nadolol, a new beta-adrenergic blocker, for 2 years. The dose of HCZ was 50 mg once daily for all except two patients, who received 50 mg twice a day. The dose of nadolol ranged from 40 mg to 240 mg, once daily. The average supine blood pressure decreased from 182/110 mm Hg at the end of the placebo period to 170/104 mm Hg at the end of treatment with HCZ alone. Nadolol was added to the regimen, and the average supine blood pressure decreased further to 132/88 mm Hg at the end of 3 months of combined therapy. It remained essentially unchanged for the duration of the 2-year study, and no increases in the dosage of either drug were needed. Side-effects were mild, and none required a change in dosage. A once-daily dose of nadolol combined with HCZ appears to be safe and effective therapy for the long-term treatment of mild or moderate essential hypertension.

Nadolol and propranolol in the treatment of hypertension: a double-blind comparison.

Nadolol and propranolol were compared in seventy-five hypertensive patients in a double-blind randomized study conducted at Ain-Shams Hospital. After an initial wash-out period of 5 weeks, including 3 weeks of placebo administration, forty-five patients were given nadolol once daily and thirty patients received propranolol four times per day for 12 weeks, followed by a tapering-off period of 2 weeks. Both beta-blocking agents were effective in controlling hypertension with final daily doses ranging from 80 to 320 mg. Of statistical significance, however, were the better responses of supine systolic blood pressure elicited by nadolol. The only adverse reactions that occurred in this series were slight weight gains in two patients treated with nadolol and moderate dizziness in one patient treated with propranolol. Nadolol was proved to be a safe antihypertensive drug, at least comparable to propranolol in efficacy, with the advantages of a once-daily dose and a lack of direct depressant action on the heart.

Tympanic membrane retraction and middle-ear pressure.

MHA assessment and LR observation are poor indicators of MEP. Clinical assessment of the MHA in normal living ears, within the range 30 degrees to 75 degrees, correlates poorly with MEP measured by impedance tympanometry, within the range of -300 to +160 mm H2O. Variation of MEP in fresh temporal bones demonstrated that MHA, LR and postero-superior segment retraction remained unchanged between -50 and -400 mm H2O and between +50 and +400 mm H2O. The change in position of the TM over the range +50 to -50 mm H2O corresponded to the maximum compliance change on the tympanogram i.e. the width of the tympanometric notch.

Phyto- and Bio-Chemical evaluation of Diospyros kaki L. cultivated in Egypt and its biological activities

Abstract Diospyros kaki L. or Costata cultivar is the main persimmon variety progressively consumed in the Egyptian market and exportation. The objective of this study was to investigate the bioprotective effects of the alcoholic extract of fruits as well as leaves of D. kaki using in-vivo rat models. Petroleum ether extracts of fruits and leaves were analytically characterized for saponifiable and unsaponifiable compounds by GC/MS. Main flavonoids were chromatographically isolated from 80% aqueous methanol extract of leaves. Chemical evaluation for fruits and leaves namely, content of moisture, ash, proteins, fatty acids, amino acids, fat and water soluble vitamins, minerals, carotenoids was carried out. Total antioxidant activity was determined by radical scavenging effects using DPPH assay. The effect on biochemical parameters and its biological activity were also performed. Results revealed the identification of the major compounds of saponifiable and unsaponifiable matters of fruits and leaves. Scopoletin, as well as, kaempferol, luteolin, rutin and apigenin 7-O-glucoside were isolated and identified. It showed that this plant can provide a good nutritional value and it is safe regarding the kidney and liver functions, good source that help in enhancing the antioxidant defense against free radicals. No abnormal effects were found in lipids profile on experimental animals and there were good results in the ratio of HDL and LDL cholesterol. Also, this plant can help in optimizing blood sugar, enhancing the level of blood haemoglobin. It is concluded that D. kaki displays a good source of nutrients and bioactive compounds that may contribute to its therapeutic benefits against the risk of disease complications.

Resumo Diospyros kaki L. ou Costata é a principal variedade de caqui progressivamente consumida no mercado e exportação egípcia. O objetivo deste estudo foi investigar os efeitos bioprotetores do extrato alcoólico de frutos e folhas de D. kaki utilizando modelos de ratos in vivo. Extratos de éter de petróleo provenientes de frutos e folhas foram caracterizados analiticamente para compostos saponificáveis e insaponificáveis por GC/MS. Os principais flavonoides foram isolados cromatograficamente, a partir de 80% de extrato aquoso de folhas de metanol. Foi realizada avaliação química de frutos e folhas, ou seja, de teor de umidade, cinzas, proteínas, ácidos graxos, aminoácidos, vitaminas lipossolúveis e solúveis em água, minerais, carotenoides. Foi caracterizada a atividade antioxidante, utilizando ensaio (DPPH). O efeito nos parâmetros bioquímicos e sua atividade biológica também foram analisados. Os resultados revelaram a identificação dos principais compostos saponificáveis e insaponificáveis de frutos e folhas. Escopoletina, bem como kaempferol, luteolina, rutina e apigenina 7-O-glicosídeo foram isolados e identificados. Também demonstraram que esta planta pode proporcionar um bom valor nutricional e é segura em relação às funções renais e hepáticas, boa fonte que ajuda a melhorar a defesa antioxidante contra os radicais livres. Não foram encontrados efeitos anormais no perfil lipídico em testes em animais, e houve um efeito satisfatório na relação de colesterol HDL e LDL. Além disso, esta planta pode ajudar na otimização do açúcar no sangue, aumentando o nível de hemoglobina. Conclui-se que o D. kaki apresenta uma boa fonte de nutrientes e de compostos bioativos que contribuem para seus benefícios terapêuticos e contra o risco de complicações de doenças.

Interstitial fluid glucose dynamics during insulin-induced hypoglycaemia.

AIMS/HYPOTHESIS: Glucose sensors often measure s.c. interstitial fluid (ISF) glucose rather than blood or plasma glucose. Putative differences between plasma and ISF glucose include a protracted delay during the recovery from hypoglycaemia and an increased gradient during hyperinsulinaemia. These have often been investigated using sensor systems that have delays due to signal smoothing, or require long equilibration times. The aim of the present study was to define these relationships during hypoglycaemia in a well-equilibrated system with no smoothing. METHODS: Hypoglycaemia was induced by i.v. insulin infusion (360 pmol.m(-2).min(-1)) in ten non-diabetic subjects. Glucose was sequentially clamped at approximately 5, 4.2 and 3.1 mmol/l and allowed to return to normoglycaemia. Subjects wore two s.c. glucose sensors (Medtronic MiniMed, Northridge, CA, USA) that had been inserted for more than 12 h. A two-compartment model was used to quantify the delay and gradient. RESULTS: The delay during the fall in plasma glucose was not different from the delay during recovery (8.3+/-0.67 vs 6.3+/-1.1 min; p=0.27) and no differences were observed in the ratio of sensor current to plasma glucose at basal insulin (2.7+/-0.25 nA.mmol(-1).l) compared with any of the hyperinsulinaemic clamp phases (2.8+/-0.18, 2.7+/-0.021, 2.9+/-0.21; p=NS). The ratio was significantly elevated following recovery to normoglycaemia (3.1+/-0.2 nA.mmol(-1).l; p<0.001). CONCLUSIONS/INTERPRETATION: The elevated ratio suggests that the plasma to ISF glucose gradient was decreased following hypoglycaemia, possibly due to increased skin blood flow. Recovery from hypoglycaemia is not accompanied by a protracted delay and insulin does not increase the plasma to s.c. ISF glucose gradient.

Retroperitoneal perforation of the rectum during barium enema examination.

Colorectal perforation during barium enema examination is rare. The authors report the case of an 84-year-old woman in whom retroperitoneal perforation of the rectum occurred during barium enema examination. Potential mechanisms of injury include trauma, overinflation of the balloon, recent instrumentation and associated disease of the rectal mucosa. When the colon has been well prepared before examination, and air alone, not barium, has been insufflated into the retroperitoneum, then such injuries may be managed successfully without operation, as in this case.

Juglone concentration in soil beneath black walnut interplanted with nitrogen-fixing species.

Juglone concentration was measured in soils collected under a 14-year-old black walnut (Juglans nigra L.) plantation containing plots of pure walnut and of walnut mixed with either autumn-olive (Elaeagnus umbellata Thunb.) or European black alder (Alnus glutinosa (L.) Gaertn.). Juglone concentrations declined with soil depth and distance from the walnut tree. Concentrations in autumn-olive-walnut plots were statistically lower than concentrations in European black alder-walnut or pure walnut plots. The concentration of juglone in soil in European black alder-walnut plots was apparently sufficient to cause the onset of black alder mortality.