Extremely low-frequency magnetic fields and survival from childhood acute lymphoblastic leukemia: an international follow-up study.

A previous US study reported poorer survival in children with acute lymphoblastic leukemia (ALL) exposed to extremely low-frequency magnetic fields (ELF-MF) above 0.3 µT, but based on small numbers. Data from 3073 cases of childhood ALL were pooled from prospective studies conducted in Canada, Denmark, Germany, Japan, UK and US to determine death or relapse up to 10 years from diagnosis. Adjusting for known prognostic factors, we calculated hazard ratios (HRs) and 95% confidence intervals (CI) for overall survival and event-free survival for ELF-MF exposure categories and by 0.1 µT increases. The HRs by 0.1 µT increases were 1.00 (CI, 0.93-1.07) for event-free survival analysis and 1.04 (CI, 0.97-1.11) for overall survival. ALL cases exposed to >0.3 µT did not have a poorer event-free survival (HR=0.76; CI, 0.44-1.33) or overall survival (HR=0.96; CI, 0.49-1.89). HRs varied little by subtype of ALL. In conclusion, ELF-MF exposure has no impact on the survival probability or risk of relapse in children with ALL.

Infectious exposure in the first years of life and risk of central nervous system tumours in children: analysis of birth order, childcare attendance and seasonality of birth.

BACKGROUND: An infective, mostly viral basis has been found in different human cancers. To test the hypothesis of a possible infectious aetiology for central nervous system (CNS) tumours in children, we investigated the associations with proxy measures of exposure to infectious disease. METHODS: In a large case-control study nested in the populations of Denmark, Norway, Sweden, and Finland of 4.4 million children, we studied the association of birth order and seasonal variation of birth with subsequent risk for CNS tumours. We identified 3983 children from the national cancer registries, and information on exposure was obtained from the high-quality national administrative health registries. We investigated the association between childcare attendance during the first 2 years of life and the risk for CNS tumours in a subset of Danish children with CNS tumours, using information from the Danish Childcare database. RESULTS: We observed no association between birth order and risk of CNS tumours overall (odds ratio (OR) for second born or later born vs first born, 1.03; 95% confidence interval (CI), 0.96-1.10) or by histological subgroup, and children with CNS tumours did not show a seasonal variation of birth that was distinct from that of the background population. Childcare attendance compared with homecare showed a slightly increased OR (1.29; 95% CI, 0.90-1.86) for CNS tumours, with the highest risk observed in children attending a crèche. The strongest association was observed for embryonal CNS tumours. We found no effect of age at enrolment or duration of enrolment in childcare. CONCLUSION: These results do not support the hypothesis that the burden of exposure to infectious disease in early childhood has an important role in the aetiology of paediatric CNS tumours.

Seasonality of birth in children with central nervous system tumours in Denmark, 1970-2003.

We investigated possible seasonal variation of births among children <20 years with a central nervous system tumour in Denmark (N=1640), comparing them with 2,582,714 children born between 1970 and 2003. No such variation was seen overall, but ependymoma showed seasonal variation.

Pain relief following breast augmentation surgery: a comparison between incisional patient-controlled regional analgesia and traditional oral analgesia.

BACKGROUND AND OBJECTIVES: Postoperative pain is a common problem following ambulatory breast augmentation surgery. This study was performed to compare standard of care (oral analgesics) with patient-controlled incisional regional analgesia (PCRA) for postoperative pain management at home for 48 h. A second aim was to compare the analgesic efficacy of ropivacaine 0.25% vs. 0.5%. METHODS: Surgery was performed under local anaesthesia and monitored anesthesia care. Sixty adults (ASA 1-2) were randomized to one of two groups. Patients in Group PCRA could self-administer ropivacaine 0.25% 10 mL in the left breast and ropivacaine 0.5% in the right breast. Patients in Group T (tablets) received our standard of care treatment, i.e. oral paracetamol 1 g four times a day and oral ibuprofen 500 mg three times a day. Parameters measured included: analgesic requirements (in post-anesthesia care unit, PACU and post-discharge), pain intensity (visual analogue scale), patient satisfaction, global analgesia, side-effects, and quality of recovery. RESULTS: Pain scores were significantly lower in Group PCRA compared to Group T at all time periods (P < 0.05). No differences were found in pain scores between the right and left breasts. Significantly more patients in Group T requested analgesics in the recovery unit (27 vs. 7; P = 0.001) and also at home (20 vs. 11; P < 0.02). More patients in the tablet group had nausea and vomiting (10 vs. 3; P < 0.05). Global analgesia on day 2 was significantly better in PCRA group; however, patient satisfaction was similar in both groups. More patients in the tablet group had sleep disturbance and woke up at night due to pain. CONCLUSIONS: Pain relief after ambulatory breast augmentation is superior with incisional PCRA when compared to oral analgesic combination of paracetamol and ibuprofen. Incisional PCRA was associated with minimal side-effects and less sleep disturbance. There was no difference in the analgesic efficacy between ropivacaine 0.25% and 0.5%.

Jamaican patients' understanding of diabetes mellitus.

Ambulant and hospitalized patients with diabetes mellitus were interviewed by two trained interviewers to obtain information about their knowledge of the illness and the communication they had received about it. Sixty to seventy per cent of patients claimed that no explanation about the illness was given to them at the time of diagnosis. This poor communication occurred in both public and private medical services. Fifty-seven per cent of the patients scored no more than the 50th percentile on the knowledge rating score, reflecting that patients' knowledge of the illness was in general poor. The hospitalized patients did learn about the illness while there, but still claimed that they learnt nothing. These data are examined in the context of the nature of the doctor-patient communication style and effect. Jamaican diabetic patients need to be better informed about their illness; despite short patient-physician contact time, an effort to explain the nature of the illness at the time of diagnosis would be worthwhile. This will need subsequent assessment and reinforcement by involving a team approach.

Jamaican patients' understanding of diabetes mellitus

Ambulant and hospitalized patients with diabetes mellitus were interviewed by two trained interviewers to obtain information about their knowledge of the illness and the communication they had received about it. Sixty to seventy per cent of patients claimed that no explanation about the illness was given to them at the time of diagnosis. This poor communication occurred in both public and private medical services. Fifty-seven per cent of the patients' knowledge of the illness was in general poor. The hospitalized patients did learn about the illness while there, but still claimed that they learnt nothing. These data are examined in the context of the nature of the doctor-patient communication style and effect. Jamaican diabetic patients need to be better informed about their illness; despite short patient-physician contact time, an effort to explain the nature of the illness at the time of diagnosis would be worthwhile. This will need subsequent assessment and reinforcement by involving a team approach.(AU)

Jamaican patients' understanding of diabetes mellitus

Ambulant and hospitalized patients with diabetes mellitus were interviewed by two trained interviewers to obtain information about their knowledge of the illness and the communication they had received about it. Sixty to seventy per cent of patients claimed that no explanation about the illness was given to them at the time of diagnosis. This poor communication occurred in both public and private medical services. Fifty-seven per cent of the patients' knowledge of the illness was in general poor. The hospitalized patients did learn about the illness while there, but still claimed that they learnt nothing. These data are examined in the context of the nature of the doctor-patient communication style and effect. Jamaican diabetic patients need to be better informed about their illness; despite short patient-physician contact time, an effort to explain the nature of the illness at the time of diagnosis would be worthwhile. This will need subsequent assessment and reinforcement by involving a team approach.

An analysis of the origin of metazoans, using comparisons of partial sequences of the 28S RNA, reveals an early emergence of triploblasts.

In order to study the origin of metazoans, we have compared sequences from the 5' end of the large subunit ribosomal RNA of a number of protists, fungi, plants and metazoans, including all diploblastic phyla (sequences of 10 new species have been determined, including that of the placozoan, Trichoplax adhaerens). These sequences were analyzed using distance matrix, maximum parsimony and maximum likelihood methods, and the validity of the results was ascertained with bootstrapping and species removal or addition. Triploblasts and diploblasts formed two clearly separated monophyletic units; this divergence, which apparently preceded the diversification of diploblastic animals (i.e. the successive sponge, ctenophore, cnidarian radiations), showed a much more ancient origin of triploblasts with respect to diploblasts than classically assumed. These results do not exclude the possibility that triploblasts and diploblasts arose independently from different protists.

The ultrastructure of the plasmodial protist Leucodictyon marinum Grell.

Leucodictyon marinum Grell, obtained from tide pools near the Shimoda Marine Research Center (Japan), is a meroplasmodium with flattened cell bodies, enclosed in loricae, and a common reticulopodial network. The cell bodies have a single, excentrically located nucleus which contains a central nucleolus, several heterochromatic areas and a filamentous rodlet of unknown function. Plastids are lacking. The mitochondria have tubular cristae. Extrusomes, resembling discobolocysts, do occur, but are rarely met with. Many vacuoles with a homogeneous content indicate that the final part of digestion takes place in the cell bodies. The reticulopodia are slender threads, but show dilatations, caused by vesicles which transport food to the cell bodies. The reticulopodia contain microtubules. There are two types of cytokinesis: Equal division leads to enlargement of the meroplasmodium, unequal division to zoosporo-genesis. The development of the two flagella of the zoospore is described. The flagellar root system consists only of a short fibre connecting both basal bodies and some microtubules running to the plasmalemma. The difficulty to classify the recently investigated species Reticulosphaera socialis, Chlorarachnion reptans and Leucodictyon marinum is discussed. If the "reticulo-meroplasmodial complex" is a synapomorphy, indicating their affinity, they may derive from an early offshoot of the ancestral Heterokontophyta and can scarcely be affiliated to one of the established classes.

The ultrastructure of Reticulosphaera socialis grell (Heterokontophyta).

Reticulosphaera socialis GRELL, a protist from the Caribbean coast of Mexico, has a life cycle consisting of a benthic and a pelagic phase. The benthic phase is the dominating part. It is represented by the meroplasmodium, a cellular association which consists of the spherical cell bodies and a common reticulopodial network. Each cell body is surrounded by an ampulla-like wall, whose narrow part also protects the reticulopodial root connecting the cell body with the remaining network. A single nucleus with nucleolus is situated in the middle of the cell body. A centriole is attached to the nuclear envelope. In addition to the usual organelles (mitochondria, Golgi complexes, plastids), the cytoplasm includes many vesicles and a variable number of bacteria. The latter are probably parasites. The reticulopodial strands serve for capturing and digesting diatoms. Apart from the phagocytized food included in digestive vacuoles, the reticulopodia contain only mitochondria, bacteria and vesicles of different size. Bundles of microtubules extend in a longitudinal direction. The meroplasmodium grows by binary fission of its cell bodies. Mitosis is characterized by single centrioles at opposite poles of the spindle and partial dissolution of the nuclear envelope. At cytokinesis, which begins with an unequal division or budding, one of the daughter nuclei passes from the major part into the minor part. Later on, an equalization occurs, in which the minor part becomes supplied with cellular material by its reticulopodial root. When the diatoms become sparse and light intensity is sufficient, some of the cell bodies form clusters of yellow cells which carry out photosynthesis. Their plastids, also observable in life, show the ultrastructure typical for heterokont algae. The lamellae consist of three thylakoids. Girdle lamellae are lacking. Each plastid is surrounded by two membranes, but remnants of two additional membranes may also be present. Under moderate illumination the meroplasmodium disintegrates into single cells, the so-called transitional cells. They resemble amoebae and transform into the pelagic cells which float in the sea water. Although the pelagic cells look like small heliozoans, their ultrastructural analysis has shown that they have two flagella, inserted at an oblique angle to each other. Both flagella possess a "transitional helix". Whether they are of different length could not be clarified. It is certain, however, that they are heteromorphic: One flagellum bears a basal swelling, associated with a single layer of osmiophilic droplets (eyespot) in a nearby plastid. With respect to the root fiber system, it is of interest that a rhizoplast is lacking. The pelagic cell has only two plastids, associated with the nucleus. Except at the edge of the eyespot, both plastids have girdle lamellae. They show remnants of a periplastidial compartment. The flagellar and photoreceptor apparatus support the assumption that Reticulosphaera socialis has to be classified with the heterokont algae (Heterokontophyta). The color of the photosynthesizing cells and the lack of a rhizoplast during mitosis of the cell bodies and in the root fiber system of the pelagic cells suggest an affiliation to the Xanthophyceae (Tribophyceae).

Illness behaviour in patients with diabetes mellitus admitted to the University Hospital of the West Indies - abstract

We studied in all 105 patients with diabetes mellitus (DM) (48 M 57 F-aged 22 - 81 years) admitted over 6 months, the circumstances contributing to admission, patients,illness perception and behaviour, doctor-patient interaction and compliance. Thirteen new patients were admitted for stabilization, 71 old patients for complications and 21 for non-diabetes related problems. Twenty old patients were admitted for stabilization and 15 for severe infections. Lack of perception of the seriousness of DM was the main contributor to poor control and admission, followed by delay in seeking attention, changes in routine and financial problems. Diabetes was not taken seriously, at the onset, by 1/3 of patients irrespective of educational and social status: this changed only after a medical crisis or complications. Delay in seeking attention was up to 4 years. More males than females discovered their DM during routine check-up or admission for reasons unrelated to DM: delay in seeking attention was more common in females. Diagnosis was made by the first doctor in 75 percent of patients. One third of the patients used informal medication such as bush teas. Patients' understanding of DM was low at onset regardless of the type of medical personnel seen. Only 36 percent of patients had a full explanation of the treatment regime at the onset. Doctor/patient communication was poor; 23 percent gained no knowledge of the DM while in hospital; 63 percent appreciated the seriousness of DM only after admission; only 27 percent gained knowledge about diet and 16 percent knowledge about other medical mangement. Financial problems contributed to poor dietary practices in 65 percent of patients while 30 percent could not maintain the prescribed regime mainly because they ran out of medication. In 65 percent compliance was motivated by fear or the present experiences. Medical consultation after discharge motivated by fear or the present experiences. Medical consultation after discharge motivated only 12 patients. This study shows the negative effect of some social factors on diabetes control: there is a need for continous reinforcement for self-management of the condition in Jamaica (AU)

[The clininal management of breech presentation]. / Zum Klinischen Management bei Beckenendlagen

During the period 1969--1973, a total of 7933 deliveries was carried out at the First University Clinic of Obstetrics and Gynaecology in Vienna. Of these, 328 deliveries were breech presentations and 260 were single-born. The frequency of Caesarean sections in the case of breech presentations was 16,6%, i.e. about four times higher than the average frequency of Caesarean sections in relation to the overall number of obstetric patients of our clinic. The high frequency of premature deliveries in breech presentation (18,46%) is reflected in the perinatal mortality rate; 5,67% of all children born in breech position died sub or post partum. The net perinatal mortality rate was 1,15%.