An endovascular system for thoracoabdominal aortic aneurysm repair.

PURPOSE: To describe a stent-graft system for endovascular repair of thoracoabdominal aortic aneurysm (TAAA) that preserves side branch perfusion. TECHNIQUE: The modular endograft system includes 3 components. The primary stent-graft is custom-made from conventional graft fabric and Gianturco Z-stents. Covered nitinol Smart Stents are used for the visceral and renal extensions, and the distal extension is made from a modified Zenith system. With the supine patient under general anesthesia, the components are delivered sequentially through surgically exposed femoral and right brachial arteries in an operation that requires prolonged periods of magnified high-resolution imaging. This system was first used in a 76-year-old man with a contained rupture of a supraceliac ulcer and a large abdominal aortic aneurysm ending proximally at the celiac artery. The endograft was implanted successfully, but the patient developed paraplegia on day 2; imaging documented an excluded aneurysm and excellent flow through the endograft and all prosthetic branches. DISCUSSION: Endovascular repair of TAAA appears to be feasible. If there are no serious, specific, unavoidable complications, the potential advantages are enormous.

Analysis of the VIQ scores of families of three or more Orkney brothers.

Classification of the boys in 48 families of three or more brothers according to their Moray House Test (VIQ) scores awarded at age 11 +/- 1 1/2 years in 1947-75 confirms the postulated existence of a total of nine male phenotypes for this X-linked trait in the score range < 70 to 140 points. The phenotypic means lie close to the sequence 69(8)133. Recombination is shown to occur. An additive effect of three alleles at each of two X-chromosome loci is the most likely simple scheme. An iterative approach matching the observed mixtures of proposed genotypes in the families with probabilities for variable levels of homozygosity, non-crossover/crossover heterozygosity, and maternal meiotic recombination yields a best goodness of fit where this last is 20%.

X-linkage, lyonization and a female premium in the verbal IQ results of Orkney schoolchildren, 1947-75.

This paper reports the preliminary findings of an analysis of the Moray House (verbal IQ) results of a base sample of 4383 Orkney children due to be tested in the schools at age 11 +/- 1 1/2 years in 1947-75. Girls enjoy a 3.63% premium relative to phenotypically equivalent boys at test age. Relationships within the sample, which includes some members of the parental generation, are known. The trait is found to be X-linked, with nine phenotypes in the boys, and lyonization is involved.

Use of the CRIB (clinical risk index for babies) score in prediction of neonatal mortality and morbidity.

A prospective study of the outcome of care of a regional cohort of very low birthweight (< 1500 g) and very preterm (< 32 weeks) infants was carried out. Its aims were to assess the ability of the CRIB (clinical risk index for babies) score, rather than gestational age or birthweight, to predict mortality before hospital discharge, neurological morbidity, and length of stay, and to access CRIB score as an indicator of neonatal intensive care performance. 676 live births fulfilled the criteria and complete data were available for 643 (95%). Compared with gestation and birthweight, CRIB was better for the prediction of mortality, was as good for the prediction of morbidity, and was not as good for the prediction of length of stay. CRIB adjusted mortality did not demonstrate better performance in units providing the highest level of care. Either the CRIB score was not sensitive to performance or the level 3 hospitals in this study were performing badly. On the basis of this analysis purchasers and providers of neonatal intensive care cannot yet rely on the CRIB score as a performance indicator.

Patient acceptability of laser and cold coagulation therapy for pre-malignant disease of the uterine cervix.

OBJECTIVE: To determine patient acceptability of cold coagulation and laser treatment for cervical intraepithelial neoplasia (CIN). DESIGN: A prospective study with alternate allocation. SETTING: Teaching hospital in London. SUBJECTS: 155 women requiring treatment for CIN. MAIN OUTCOME MEASURES: Time taken to complete the treatment; visual analogue scores for pain experienced, anxiety felt and acceptability of the procedure; post treatment bleeding and discharge, and follow-up smear. RESULTS: Cold coagulation treatment was found to be quicker and less painful than laser treatment, there were no other significant differences between the two methods of treatment. CONCLUSION: Cold coagulation is a more acceptable form of treatment for CIN than laser.

Immunohistochemical study of cytoplasmic oestradiol receptor in normal, dysplastic and malignant cervical tissue.

Using a monoclonal antibody raised against an oestrogen receptor-related protein, p29, and an indirect immunoperoxidase technique to stain human tissue, the presence of the antigen was investigated in normal, dysplastic and malignant tissue of the uterine cervix. In normal tissue p29 was present throughout the ectocervix during the menstrual cycle and virtually absent from the endocervix. In dysplastic cervical tissue there was a decreasing p29 content with increasing severity of the dysplasia, and very low levels were seen in the carcinomatous tissues.

Intradecidual sign: a US criterion of early intrauterine pregnancy.

The uterine cavity appears on sonograms as a linear echo, which is usually visible during early pregnancy and remains straight until the eighth to ninth week of gestation. The early gestational sac is not enveloped by two layers of decidua, as suggested by descriptions of the double decidual sac sign; the sac (or echogenic area of early implantation) is actually located within a markedly thickened decidua on one side of the uterine cavity. The combination of these two sonographic characteristics is called the "intradecidual sign." An early implantation of 25 days gestational age can be detected by the presence of the intradecidual sign, which is sooner than a gestational sac can be seen. The implantation site can also be located by means of the intradecidual sign. In a study of 36 patients with early intrauterine pregnancy and five with ectopic pregnancy, the intradecidual sign was more sensitive (91.7% vs. 63.9%) and specific (100% vs. 60%) than the double decidual sac sign in the detection of early intrauterine pregnancy.

Peliosis of the spleen in a patient with cirrhosis of the liver.

Peliosis is a rare entity usually encountered in the liver and occasionally also found concurrently in the spleen. We studied a case of isolated peliosis of the spleen found incidentally at autopsy in a patient with hepatitis B virus-associated cirrhosis of the liver.

The duration of lochia.

The duration of lochia and its association with a number of obstetric variables was studied in 236 women. Each woman completed a diary sheet describing the colour and duration of her lochia for up to 60 days post partum. The phases of lochia were divided according to the classical description; lochia rubra, serosa and alba. The median total duration of lochia was 33 days, lochia rubra 4 days and lochia serosa 22 days. Lochia persisted to 60 days in 13% of women. The duration of lochia was shorter in parous women and women with smaller babies.

Crossed fused renal ectopia: sonographic diagnosis.

Five cases of crossed fused renal ectopia, all confirmed by either computed tomographic scan or intravenous urography, were diagnosed sonographically. The sonographic appearance of this entity consists of a characteristic anterior and/or posterior notch, difference in orientation of the 2 collecting systems in the fused kidneys, and absence of a kidney in the contralateral renal fossa, or elsewhere in the body, such as the pelvis. The inability to diagnose this condition correctly may lead to the misdiagnosis of a renal mass or infiltrative disease occupying the contralateral renal fossa. Computed tomographic scans will also identify the anomaly.