Correlation of surgeon-performed parathyroid ultrasound with the Perrier classification and gland weight.

BACKGROUND: Ultrasound localisation of parathyroid glands correlates with gland weight. We hypothesise that gland identification is also dependent on anatomical location. Perrier et al. have described a uniform and reliable nomenclature for parathyroid locations. We aimed to correlate surgeon-performed ultrasound (SUS) with intra-operative Perrier classification and gland weight. METHODS: Review of a prospectively maintained single operator SUS database of 194 patients referred with non-familial primary hyperparathyroidism (PHPT) at a tertiary centre between 2010 and 2015. Patients underwent MIBI localisation as well as on table SUS. Intra-operative pathological gland locations were classified according to the Perrier nomenclature. RESULTS: Mean weight of pathological glands found and missed by SUS was 1.07 ± 0.1 g and 0.48 ± 0.08 g respectively (p = 0.0001, unpaired t test). The weight of glands identified was greater than that of missed glands for each of the Perrier locations (p < 0.001, Mann-Whitney). The proportion of pathological glands found at each Perrier location varied significantly (p < 0.0001, Chi Square); so we find proportionally more B-, D-, E- and F-type glands and miss more A- and C-type glands. The median weight of glands missed on SUS varied significantly across the Perrier groups (Kruskal-Wallis, p = 0.0034) and suggests that SUS can miss quite large glands (> 0.5 g) in locations B, C and F; whereas missed glands in locations A, D and E were all small (< 0.5 g). CONCLUSION: Whilst gland identification correlates well with gland weight, anatomical location has a significant impact on failure of localisation irrespective of gland weight. For the surgeon operating on PHPT patients with negative US localisation, particular attention should be paid to locations C, D and A as these are the sites where pathological glands are most often missed on pre-operative US.

A comparison of patients' and physiotherapists' expectations about walking post spinal cord injury: a longitudinal cohort study.

STUDY DESIGN: A longitudinal cohort study. OBJECTIVE: The primary objective of this study was to compare the expectations that patients with recent spinal cord injury (SCI) had about walking 1 year from injury with the expectations of their physiotherapists. SETTING: Two Sydney SCI units. METHODS: A consecutive series of 47 patients admitted to the metropolitan SCI units was recruited. Using the mobility scale, expectations of the patients and their physiotherapists about walking at 1 year from SCI were recorded at the time of admission to rehabilitation. Ability to walk was then assessed at 1 year from the SCI. RESULTS: On admission to rehabilitation, 31 patients expected to walk about their homes at 1 year post SCI, but only 18 (58%) of these patients did so. In contrast, physiotherapists expected 21 patients to be able to walk about their homes at 1 year post SCI, with 17 (81%) of these patients doing so. Similarly, whereas 21 patients expected to walk about the community at 1 year post SCI, only 11 (52%) of these patients did so. Physiotherapists expected 8 patients to walk about the community at 1 year post SCI and 7 (88%) of these patients did so. The differences between patients' and physiotherapists' expectations about walking were statistically significant (P<0.001). CONCLUSION: There is a high degree of disagreement between patients' and physiotherapists' expectations about walking at 1 year post SCI. Differences between patients' and physiotherapists' expectations about walking are potentially problematic and requires research to identify appropriate management strategies.

How much equipment is prescribed for people with spinal cord injury in Australia, do they use it and are they satisfied 1 year later?

BACKGROUND AND PURPOSE: The purpose of this study was to determine the amount and type of equipment prescribed to aid mobility and self-care for patients with spinal cord injuries (SCI) in Australia and to determine how frequently the equipment is used 1 year later and whether patients are satisfied with it. METHODS: A consecutive series of 61 patients admitted for rehabilitation to two Sydney SCI units were recruited. All mobility and self-care equipment worth more than $AU50 prescribed by therapists before patients' discharge was recorded. This included wheelchairs, commodes, shower chairs, hoists, electric beds, pressure-relieving cushions, bed mattresses, slideboards, walking aids, orthoses, electrical stimulation systems and other pieces of notable exercise equipment. Patients were interviewed 1 year later and asked about each piece of equipment they had been prescribed. Specifically, they were asked about how frequently they had used each piece of equipment and whether they were satisfied with it. Data were analysed using descriptive statistics. RESULTS: Three hundred and fourteen pieces of equipment, including 68 wheelchairs, were prescribed for the 61 patients. Most of the equipment (226/314) was used more than 20 times in the 2 months preceding the 1-year review. Most patients were satisfied or highly satisfied with the majority of equipment prescribed, although patients were very dissatisfied or only partly dissatisfied with 18/314 pieces of equipment. DISCUSSION: Patients were generally satisfied with the equipment they were prescribed. There was a small amount of equipment prescribed that was not used 1 year later or with which patients were dissatisfied.

Effect of coronary artery recanalization on right ventricular function in patients with acute myocardial infarction.

The effects of coronary artery recanalization by intracoronary administration of streptokinase on left ventricular function during acute myocardial infarction have received increasing attention in recent years. Although myocardial dysfunction is often more pronounced in the right ventricle than in the left ventricle in patients with acute inferior wall myocardial infarction, the effect of coronary artery recanalization on right ventricular dysfunction has not been previously addressed. Accordingly, in this investigation, 54 patients who participated in a prospective, controlled, randomized trial of recanalization during acute myocardial infarction were studied. Among 30 patients with inferior wall infarction, 19 had right ventricular dysfunction on admission; 11 of these 19 had positive uptake of technetium-99m pyrophosphate in the right ventricle, indicative of right ventricular infarction. Patients with successful recanalization (n = 6) exhibited improved right ventricular ejection fraction from admission to day 10 (26 +/- 7 to 39 +/- 14%, p less than 0.03). However, control patients (n = 6) and patients who did not undergo recanalization (n = 7) also exhibited improvement (20 +/- 7 to 29 +/- 11% [p less than 0.02] and 30 +/- 8 to 40 +/- 6% [p less than 0.03], respectively). Improvement in several other variables of right ventricular dysfunction evolved at an equal rate with the ejection fraction changes. Patients with or without right ventricular infarction improved similarly. These data indicate that the right ventricular dysfunction commonly associated with inferior wall infarction is often transient, and improvement is the rule, irrespective of early recanalization of the "infarct vessel."

Transluminal coronary angioplasty in the elderly.

The safety and clinical efficacy of percutaneous transluminal coronary angioplasty (PTCA) in elderly patients has not been established. Of 639 PTCAs performed between March 1980 and May 1984, 119 patients were 65 years or older (mean 70 years). On angiography, elderly patients differed only in the more frequent occurrence of visible calcific deposits (26% vs 8% in younger patients, p less than 0.01). Primary success was achieved in 81%, vs 80% in patients younger than 65 years. Major complication rates were comparable to those of younger patients: emergency coronary artery bypass surgery, 4.1% vs 4.7%; acute myocardial infarction, 2.5% vs 2.9%; and death, 0.8% vs 0. Late clinical follow-up ranging from 5 to 50 months (mean 18) showed that symptomatic improvement was achieved in 91% of patients in whom PTCA was successful, with 55% being asymptomatic. Seventy percent of patients were as active or more active (30%) than before PTCA and 47% were taking fewer medications. Four late deaths occurred, none from cardiac causes. These data support the safety and clinical effectiveness of PTCA in elderly patients and justify the extension of indications for PTCA to selected patients with multivessel disease in this age group.

The effects of p-chlorophenylalanine, fenfluramine and alpha-methyltyrosine on marking responses in the male Mongolian gerbil (Meriones unguiculatus).

Marking behavior was maintained by testosterone propionate treatment in castrated Mongolian gerbils. p-Chlorophenylalanine (PCPA) enhanced and alpha-methyltyrosine (alpha-MT) inhibited responses. No effect was seen by PCPA in non-TP-treated subjects. Fenfluramine inhibited the response in intact gerbils. The data suggest that serotonergic inhibitory mechanisms exist which are implicated in testosterone dependent marking behavior in the Mongolian gerbil.

Effects of PCBs (Aroclor 1254) on reproduction and growth rate in Mongolian gerbils (Meriones unguiculatus).

Groups of female Mongolian gerbils were subcutaneously administered 2mg or 4mg PCBs (Aroclor 1254) in 0.1ml oil or vehicle only after pairing for two days with untreated males. No effects were found on the number of pairs breeding, birth intervals, number of pups per litter or percentage of male offspring. The preweaning growth rates of the PCBs exposed first litter offspring was retarded, but second litters showed no differences compared to controls. No other differences in growth were observed.

Application of the comet and micronucleus assays to butterfish (Pholis gunnellus) erythrocytes from the Firth of Forth, Scotland.

This report describes an investigation of genotoxic effects in an inter-tidal fish species sampled along a pollution gradient in the Firth of Forth, Scotland, UK. The comet assay is an electrophoretic technique for measuring DNA breakage in nuclei from individual cells and has only recently been applied to field investigations of genotoxicity. The measurement of nuclear anomalies (NA), such as the presence of micronuclei (MN) and 'lobes', has been successfully utilised in many field studies of genotoxic effects of contaminated sediments. These two techniques were applied to nucleated red blood cells (RBC) from the butterfish, Pholis gunnellus. The comet assay was adapted and validated for use in this species. Fish were sampled from the inner Firth of Forth, which has a legacy of industrial contamination and the outer Firth of Forth which is comparatively clean. The analysis of DNA strand breakage using this technique did not reveal any significant differences between animals sampled from inner and outer zones of the Firth. In contrast, MN and NA frequencies were elevated in the inner polluted zone of the Firth compared to the outer zone. This study suggests: (1) there are genotoxic effects associated with contaminants in the inner Firth of Forth, and (2) the comet assay may not be a suitable genotoxicity biomarker in fish.

An investigation of CYP2D6 genotype and response to metoprolol CR/XL during dose titration in patients with heart failure: a MERIT-HF substudy.

To explore the pharmacogenetic effects of the cytochrome P450 (CYP)2D6 genotype in patients with systolic heart failure treated using controlled/extended-release (CR/XL) metoprolol, this study assessed the CYP2D6 locus for the nonfunctional *4 allele (1846G>A; rs3892097) in the Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF; n = 605). Participants were characterized as extensive, intermediate, or poor metabolizers (EMs, IMs, or PMs, respectively), based on the presence of the CYP2D6*4 allele (EM: *1*1, 60.4%; IM: *1*4, 35.8%; and PM: *4*4, 3.8%). Plasma metoprolol concentrations were 2.1-/4.6-fold greater in the IM/PM groups as compared with the EM group (P < 0.0001). Metoprolol induced significantly lower heart rates and diastolic blood pressures during early titration, indicating a CYP2D6*4 allele dose-response effect (P < 0.05). These effects were not observed at maximal dose, suggesting a saturable effect. Genotype did not adversely affect surrogate treatment efficacy. CYP2D6 genotype modulates metoprolol pharmacokinetics/pharmacodynamics during early titration; however, the MERIT-HF-defined titration schedule remains recommended for all patients, regardless of genotype.

Five additional mobility and locomotor items to improve responsiveness of the FIM in wheelchair-dependent individuals with spinal cord injury.

STUDY DESIGN: Repeated-measures design. OBJECTIVES: To assess the validity and responsiveness of five additional mobility and locomotor (5-AML) items when used in conjunction with the Functional Independence Measure (FIM) for assessing the mobility and locomotor function of individuals with spinal cord injury (SCI). SETTING: Specialised acute spinal and rehabilitation units in Sydney, Australia. METHODS: A previously published scale comprising five key mobility and locomotor skills was further refined. The five items included a bed mobility and vertical (floor-to-chair) transfer item and three wheelchair propulsion items (pushing 200 m over flat ground, pushing up a ramp and negotiating a kerb). A total of 43 eligible patients with SCI (ASIA A-C impairment) admitted consecutively to two acute SCI units in Sydney between 1999 and 2002 were recruited, with four being lost to follow-up. Locomotor and mobility outcomes were measured at regular intervals for up to 6 months with the FIM and the 5-AML. Construct validity of the 5-AML was assessed by testing ability of items to discriminate between different impairment groups (tetraplegia and paraplegia). Item responsiveness was assessed by analysing ability to detect changes in mobility and locomotor function over time. Factor analysis techniques were used to test the hypothesis that the 5-AML, when used in conjunction with the FIM, provides a more sensitive measure of mobility and locomotor function than the FIM alone. RESULTS: The 5-AML items were shown to be valid and responsive, measuring aspects of 'real world' mobility and locomotor function not reflected by the FIM. The bed mobility item was highly responsive to change over time for the tetraplegic group, but quickly reached a ceiling in the paraplegic group. The vertical (floor-to-chair) transfer item showed greater responsiveness over time and less ceiling effect for the paraplegic group than any of the FIM locomotor or mobility items. The three wheelchair propulsion items better discriminated between people with tetraplegia and paraplegia, and were more sensitive to changes in locomotor ability over the 6-month period than FIM locomotor items. Results of a preliminary factor analysis indicated that the 5-AML items measure different aspects of mobility and locomotor function than the FIM. CONCLUSION: The 5-AML items, when used in conjunction with the FIM, provides better delineation of function between people with tetraplegia and paraplegia and provides a more responsive measure of change in function over time than the FIM alone.

Influence of neonatal injections of testosterone propionate on sexual behavior and plasma testosterone levels in the male house mouse.

The effects of neonatal testosterone injections on adult male sexual behavior and plasma testosterone levels were investigated in several strains of male house mice. Both sexual behavior and plasma testosterone levels were increased in the testosterone-treated groups from some strains, but the 2 variables did not change concomitantly.

Acute changes in plasma testosterone levels and their relation to measures of sexual behaviour in the male house mouse (Mus musculus).

There is an increasing amount of evidence, from several mammalian species, that plasma testosterone levels increase acutely when the male is exposed to sexual stimuli. Work reported here investigates whether such responses occur in male mice, and whether their incidence is related to measures of sexual behaviour. Close proximity of oestrous female mice was found to result in increased plasma testosterone levels in some strains within 15 min. Immediately after a sexual behaviour test, plasma testosterone levels were higher in males showing sexual responses. There were correlations between testosterone levels and mount latency, but none with ejaculation latency. Testosterone levels were greatest at the initiation of mounting responses, and declined during copulation, although not significantly.

Plasma levels of testosterone and male sexual behaviour in strains of the house mouse (Mus musculus).

This paper investigates whether differences in measures of sexual behaviour between strains of the house mouse (Mus musculus) are related to differences in the levels of plasma testosterone. There was found to be a significant negative correlation between measures of sexual behaviour and plasma testosterone. This correlation was not behaviourally mediated, and could be demonstrated for some of the behavioural measures in an F2 generation.

Morphological and reproductive characteristics of male mosquitofish (Gambusia affinis holbrooki) inhabiting sewage-contaminated waters in New South Wales, Australia.

The potential effects of exposure of fish to reproductive endocrine disruptors (REDs) is of major concern. This study reports on the effects of sewage effluent exposure on morphology of male mosquitofish (Gambusia a. holbrooki) in a tributary of the Hawksbury-Nepean River system in New South Wales, Australia. The growth and development of the modified anal fin (the gonopodium, GP) is a secondary sexual characteristic in males, forms under the influence of testosterone, and is critical for sperm transfer. The GP was reduced in length in males sampled downstream from a sewage treatment plant discharge point compared to GP fin length in males upstream or from other comparison sites. The reduction in size of this androgen-dependent structure suggests the presence of RED substances in the water. The presence or absence of spermatozeugmata (sperm packet) was not related to a reduction in GP length, which suggests spermatogenesis may not be reduced, but other measures of fertility remain to be evaluated. These results are discussed in the context of RED contaminants associated with sewage effluent.

Alveolar macrophages. V. Comparative studies on the antigen presentation activity of guinea-pig and rat alveolar macrophages.

The addition of syngeneic alveolar macrophages (AM) to mitogen-stimulated lymphocyte cultures from the rat and the guinea-pig resulted in markedly dissimilar effects upon in vitro blastogenesis, guinea-pig AM stimulating the response and rat AM exhibiting strong suppressive activity. The capacity of guinea-pig and rat AM to initiate antigen-specific blastogenesis was also examined. Ovalbumin-immune lymph node cells from guinea-pigs were passed through nylon wool columns to deplete macrophages. This process abolished their capacity to respond to the antigen via blastogenesis. The addition of ovalbumin-pulsed AM to these cultures restored their blastogenic responsiveness, and did so with considerably greater efficiency than was observed employing peritoneal macrophages from the same animals. Identical manoeuvres in the rat again yielded opposite results; the addition of rat AM to syngeneic antigen-stimulated lymphoid cell cultures consistently suppressed blastogenesis, an effect not seen employing peritoneal macrophages from the same species.

Adoptive transfer of "persistent' IgE responses in mice in the absence of secondary antigenic stimulation.

Spleen cells were prepared from Balb/c mice immunized 30 days previously with alum-precipitated ovalbumin (OA), which manifested high, persistent titres of anti-OA IgE and IgG. The adoptive transfer of 5.0 X 10(7) such cells to X-irradiated syngeneic recipients produced comparable persistent IgE/IgG responses, in the absence of secondary antigenic challenge. Fractionation procedures indicated that the nylon-wool adherent population from the spleen was the most active in effecting transfer of the response. However, donor T-cells were also required, as pretreatment of the cellular inoculum with anti-Thy 1.2 antiserum ablated transfer. The inclusion of serum containing anti-OA IgG (but not IgE) in the cellular inoculum also blocked the transfer.

Inhibition of specific IgE responses in mice by pre-exposure to inhaled antigen.

Exposure of mice to aerosolized ovalbumin (OA) once weekly for 5 min, or once weekly to 10 microgram OA in PBS intranasally, elicited transient IgE responses which declined by the seventh week. When these animals were challenged intraperitoneally (i.p.) with soluble or alum-precipitated OA, their subsequent IgE responses were markedly suppressed relative to controls. In contrast, i.p. challenge provoked hemaagglutinating antibody (HA) responses to OA in the same animals which were considerably more vigorous than in controls. Adoptive transfer experiments employing splenocytes from mice repeatedly exposed to OA via the respiratory tract revealed the presence of suppressor cells active against OA-specific IgE but not HA responses. Radiotracer studies employing 125I-OA, administered intranasally and by aerosol, indicated that much of the antigen rapidly became associated with the gut.

Reliability of a tool for assessing mobility in wheelchair-dependent paraplegics.

The aim of this study was to design and test the reliability of an assessment tool that could be used by physiotherapists to quantify the mobility of wheelchair-dependent paraplegics. The assessment tool examined six key tasks fundamental to the mobility of wheelchair-dependent paraplegics, comprising moving from lying to sitting, completing a horizontal transfer, completing a vertical transfer, pushing on flat ground, pushing on ramps and negotiating kerbs. A six-point scoring system was used to assess the level of mobility attained by subjects on each task. The scoring system was different for each task and took into account the level of assistance and time required to complete the task or the complexity of the task. Twenty wheelchair-dependent paraplegics were assessed independently by two therapists using the assessment tool. The Cohen's Weighted Kappas describing inter-rater reliability of each task ranged between 0.82-0.96, indicating a high reliability between therapists. It was concluded that the assessment tool is a reliable way of assessing the mobility of wheelchair-dependent paraplegics.

Hand function of C6 and C7 tetraplegics 1 - 16 years following injury.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To quantify the hand function of C6 and C7 tetraplegics 1 - 16 years after injury. SETTING: Patients were assessed in their homes. METHODS: Medical records of patients admitted to the Prince Henry Hospital Spinal Injuries Unit between 1984 and 1999 were used to identify all patients with C6 or C7 tetraplegia at 3 months post injury. Sixty-five patients (107 hands) were identified in this way. Forty-seven patients (81 hands) were located and agreed to partake in the study, and seven (nine hands) had died. Thus 81% of patients (83% of hands) still alive at follow-up were assessed. MAIN OUTCOME MEASURES: Unilateral hand function was assessed with the Grasp and Release Test (GRT) and a 10 item Activities of Daily Living (ADL) Test. Prevalance and severity of contractures, lateral grasp (key grip) strength and extensibility of the extrinsic finger flexor muscles were also determined. RESULTS: All hands except one had been managed without surgical intervention. The median number of ADL tasks successfully completed was 9/10 (interquartile range=8 - 10) and the median number of objects successfully manipulated in the GRT was 3/6 (IQ range=3 - 5). Lateral grasp was poor (74% and 75% of hands could not use a lateral grasp to move the paperweight or depress the fork in the GRT, respectively), and the prevalence of contractures was low (53% of hands had full passive range of motion). CONCLUSION: In the long term, most C6 and C7 tetraplegics attain a high level of hand function despite poor lateral grasps.