A pressing diagnosis - a compromised testicle secondary to compartment syndrome.

Hydrocoeles are a common cause of scrotal swelling and discomfort in a significant proportion of men. We report a case of compartment syndrome within the tunica vaginalis. This is an unusual and previously unreported complication of a hydrocoele.

The effects of electric field-mediated transfer of nonpermeable molecules of meiosis, fertilization, and early embryo development.

Currently there is no simple method of introducing nonpermeable molecules into oocytes or embryos. A technique that would allow direct access to the cytosol with minimal cell damage would be an extremely useful tool in gamete and embryo research. This study investigates the use of electric field-mediated transfer of nonpermeable molecules into mouse oocytes and embryos. Meiosis II stage oocytes, pronuclear stage zygotes, and two-cell embryos were used to determine optimal voltage settings needed for molecular transfer, viability, and blastocyst transformation in culture. Our highest voltage setting (7.0 kV) yielded molecular transfer, viability, and blastocyst transformation rates of 68%, 73%, and 46%, respectively, in two-cell embryos, whereas our lowest setting (3.75 kV) yielded rates of 28%, 90%, and 47%, respectively. Blastocyst transformation rates for control embryos not exposed to the electric field were significantly higher at 69% (p less than 0.01). Meiosis, as assessed by germinal vesicle breakdown, was not affected when compared with controls, 78% versus 83%, respectively. We conclude that electric field-mediated transfer of nonpermeable molecules into oocytes and embryos is a simple, relatively atraumatic technique that can be used to study intraoocyte physiologic characteristics and embryo development.

Electric field mediated transfer of enzymes into human oocytes.

In an attempt to develop a simple, atraumatic technique of introducing macromolecules and enzymes into human oocytes, we have investigated the use of electric field mediated transfer. Eighty-seven percent of human oocytes showed cytochemical evidence for the transfer of the enzyme horseradish peroxidase (HRP). The cell viability after this procedure was 89% as determined by the vital dye rhodamine-123. This study demonstrates that the enzyme HRP can be transferred into human oocytes using the electric field mediated method. Functional activity of the enzyme was maintained after this transfer.

Serum CA-125 in women with endometriosis and chronic pelvic pain.

Since serum CA-125 concentrations are increased in women with endometriosis, the authors evaluated CA-125 levels to determine whether this serum test would be useful in differentiating between pelvic pain due to endometriosis and other causes. During a 30-month period, 163 women who had had pelvic pain for at least 3 months had a CA-125 level obtained prior to surgery. Serum CA-125 was measured by an immunoradiometric assay. Of the 82 women with endometriosis, 66 (80%) had CA-125 concentrations greater than or equal to 16 U/ml (95% upper limit). The frequencies of elevated levels in minimal, mild, moderate, and severe endometriosis were 52, 86, 100, and 100%, respectively. Of the 81 women without endometriosis, 5 (6%) had elevated concentrations. With the use of serum CA-125 determinations for the detection of endometriosis, the sensitivity was 80%, the specificity was 94%, and the accuracy was 93% when the prevalence of endometriosis was 50%. The authors conclude that determination of CA-125 levels may assist in the evaluation and treatment of women with chronic pelvic pain.

Serum CA-125 in the evaluation of benign adnexal cysts.

Because serum CA-125 concentrations are increased in women with endometriosis, our objective was to determine whether CA-125 levels could be used to differentiate endometriotic from nonendometriotic benign cysts. During a 2-year period, all women who had an endometrioma (n = 33) or a nonendometriotic cyst (n = 27) that was greater than or equal to 4 cm were included. Serum CA-125 levels were measured by an immunoradiometric assay, and the mean concentrations in women with an endometriotic cyst increased as the diameter of the cyst increased. The mean CA-125 concentrations in women with cysts greater than or equal to 4 cm were 53 +/- 2 U/ml in 19 women with an endometriotic cyst, 11 +/- 1 U/ml in 20 women with a nonendometriotic cyst, and 15 +/- 1 U/ml in 7 women with a nonendometriotic cyst and endometriosis. In the fluid of 10 endometriomas, the mean CA-125 concentration was 290 +/- 94 X 10(3) U/ml (range 10 to 900 X 10(3) U/ml). With cysts diameters greater than or equal to 4 cm, 19 of 19 women with endometriotic cysts, zero of seven women with nonendometriotic cysts and endometriosis, and zero of 20 women with nonendometriotic cysts had CA-125 concentrations greater than or equal to 20 U/ml (99% upper normal limit). We conclude that serum CA-125 determinations offer an excellent method to differentiate endometriotic from nonendometriotic benign cysts.

Longitudinal study of obesity in the National Survey of Health and Development.

In a nationally representative cohort of 5362 children born in one week in March 1946 weights and heights were recorded at 6, 7, 11, 14, 20, and 26 years. Overweight was defined as a weight that exceeded the standard weight for height, age, and sex by more than 20% (relative weight greater than 120%). The prevalence of overweight was 1.7% and 2.9% in boys and girls respectively at 6 years; 2.0% and 3.8% at 7 years; 6.4% and 9.6% at 11 years; 6.5% and 9.6% at 14 years; 5.4% and 6.5% at 20 years; and 12.3% and 11.2% at 26 years. The risk of being overweight in adulthood was related to the degree of overweight in childhood and was about four in 10 for overweight 7-year-olds. Analysis of the data in the reverse direction showed that 7% and 13% respectively of 26-year-old overweight men and women had been overweight at the age of 7. These results suggest that there is no optimal age during childhood for the prediction of overweight in adult life and that excessive weight gain may begin at any time. Overweight children are more likely to remain overweight than their contemporaries of normal weight are to become overweight.

Effect of breast-feeding on plasma cholesterol and weight in young adults.

The relation between breast-feeding and plasma cholesterol level in adult life was examined in a longitudinal study of a sample of people born in 1946. One hundred and seventy-two subjects whose breast-feeding history had been recorded during infancy were examined when they were 32 years old. Women who had been breast-fed had significantly lower mean plasma cholesterol than women who had been bottle-fed (5.4 mmol/l compared with 5.9 mmol/l). For men the difference was smaller and not significant. An unexpected finding was the higher mean weight and skinfold thickness in men who had been breast-fed. These results support the hypothesis that factors acting very early in life affect the risk of disease in adults.

Tonsillectomy and circumcision: comparisons of two cohorts.

Changes in the prevalence of tonsillectomy and circumcision in eleven year olds are described in two birth cohorts spaced 12 years apart. Both types of operation were less prevalent in the later (1958) cohort; tonsillectomy fell by a fifth and circumcision by more than half. These falls were confined to tonsillectomy before the age of six and circumcision under one year. Social class differences in tonsillectomy were found in both cohort studies but the strong social class gradient in circumcision reported in the 1946 cohort had vanished in the 1958. Regional and birth rank differences are found for both types of operation; these show substantial changes over time. These results are discussed in the context of changing professional opinions about the worth of these operations.

Children of low birthweight in the 1946 national cohort. Behaviour and educational achievement in adolescence.

Among 12 468 legitimate single births in the first week of March 1946, 163 weighed 200 g or less (LBW group) and of these 80 survived to 18 years. 6 of the LBW survivors emigrated with their families and 5 have not been traced since birth. The remaining 69 were followed up to the age of 15 at which time two early school leavers were lost to the study. There is evidence that none of the survivors who emigrated or left the sample and serious physical or mental impairment. Compared with individually matched controls, the LBW children showed similar proportions with severe physical, mental, or behavioural handicaps. There are small and statistically nonsignificant differences in favour of the controls in ability and attainment scores at 15 years and in the level of academic qualifications gained by the age of 18. If the mean ability and attainment scores are expressed as an "intelligence quotient" with a mean of 100 and a standard deviation of 15, the LBW group has an average IQ of 93 and the controls of 97. Hospital stay after childbirth was much longer in 1946 than today and many LBW children spent more than 3 weeks in hospital. There is no evidence that long hospital stay was associated with problems of behaviour or learning in adolescence.

Chronic cough in young adults in relation to smoking habits, childhood environment and chest illness.

A survey of the respiratory symptoms and smoking habits of a population of 20-year-olds- followed since birth- was repeated when they reached the age of 25. The association of cough prevalence with current smoking habits and with lower respiratory tract illness in childhood found in the survey at age 20 was confirmed and in each instance appears to have increased in strength over the 5 years. At age 25, however, the prevalence of cough was associated at a statistically significant level with fathers' occupation; and this association with social class of origin could not be explained by persisting differences in social status based on the educational levels attained by early adult life. The association with exposure to air pollution in childhood, although more obvious than before, could be due to chance. The prevalence of cough increased between the ages of 20 and 25 among those who smoked throughout or who started to smoke during this period. It declined for those who never smoked and for those who were smoking at 20 but had given up by 25. The implications of these changing patterns of respiratory disease behaviour at a crucial stage between adolescence and adult life are briefly discussed.

Early hospital admissions and later disturbances of behaviour and learning.

This study provides strong and unexpected evidence that one admission to hospital of more than a week's duration or repeated admissions before the age of five years (in particular between six months and four years) are associated with an increased risk of behaviour disturbance and poor reading in adolescence. The children who have experienced these early admissions are more troublesome out of class, more likely to be delinquent and more likely to show unstable job-patterns than those who are not admitted in the first five years. They include a high proportion of poor readers, though this is partly explained by poor application to work in the classroom. In contrast, nervous, shy or withdrawn behaviour is not more frequently reported in adolescence among children who have had early hospital-admissions. The association of troublesome and socially difficult behaviour with early admissions is explained neither by the initial selection of children for hospital nor by the physical disabilities they sometimes carry in later life. The interpretation of this association is complicated by the fact that some pre-school children appear to benefit from hospital stay. The children most vulnerable to early admission are those who are highly dependent on their mothers or who are under stress at home at the time of admission. There is evidence that early admissions to hospital are more frequent today than 25 years ago and that re-admissions are more frequent. Although the length of stay has been greatly reduced, the proportion of children who experience 'long or repeated' admissions is no less than in 1946 and may be greater.

Respiratory disease in young adults: influence of early childhood lower respiratory tract illness, social class, air pollution, and smoking.

The prevalence of cough during the day or night in winter has been studied in 3,899 20-year-olds. These were members of a cohort born in England, Scotland, and Wales in the last week of March 1946. The prevalence of cough and current smoking habits have been related to events recorded during infancy and childhood-that is, exposure to air pollution, social class of father, and lower respiratory tract illness under 2 years of age. At age 20, of these factors cigarette smoking was found to have the greatest effect on symptom prevalence, followed by a history of a lower respiratory tract illness under 2 years of age. Social class and air pollution had little effect.