Assessing the protective effect of cutoff walls on groundwater pumping against saltwater upconing in coastal aquifers.

Subsurface physical barriers are amongst the most effective methods to mitigate seawater intrusion in coastal aquifers. The main objective of this study was to examine the impact of cutoff walls on saltwater upconing using laboratory and numerical modelling experiments. Physical experiments were first completed to reproduce the saltwater upconing process in a laboratory-scale coastal aquifer model incorporating an impermeable cutoff wall. Numerical modelling was used for validation purposes and to perform additional simulations to explore the protective effect of cutoff walls against saltwater upconing. The results suggest that the cutoff wall did not substantially delay the saltwater upconing mechanism in the investigated configurations. Laboratory and numerical observations showed the existence of some residual saline water, which remained on the upper part of the aquifer on the seaward side of the wall following the retreat of the saltwater. The protective effect of cutoff walls was noticeably sensitive to the design parameters. Specifically, cutoff walls installed close to the pumping well enabled the implementation of higher pumping rates, therefore a more optimal use of the freshwater, especially for deeper wells. The results highlighted that the penetration depth of the cutoff walls may not necessarily need to exceed the depth of the pumping well to ensure effectiveness, which is of great importance from construction and economic perspectives.

Variation among nonclinical subjects on a line-bisection task.

Absence of leftward bias in a line-bisection task is often used as a clinical hemispheric indicator, but the effect is not uniform in a normal population. Sex, handedness, and strategy variables affect the strength and direction of any bias.

Infection complicating percutaneous liver biopsy in liver transplant recipients.

There is controversy about the frequency of and risk factors for infectious complications of percutaneous liver biopsy in liver transplant recipients. The aim of this study was to identify the incidence and nature of complications associated with liver biopsy after orthotopic liver transplantation (OLT), with particular emphasis on infection. The medical records of all patients undergoing OLT between January 1990 and August 1994 were reviewed retrospectively to identify complications requiring hospitalization within one week of percutaneous liver biopsy. The nature and severity of complications were recorded and possible risk factors for infectious complications were examined. One hundred ninety-eight patients underwent 1,136 percutaneous liver biopsies. There were eleven complications (0.96%), including as follows: 7 infections, 3 bleeding episodes, and 1 vasovagal reaction. Infections after percutaneous liver biopsy included fever and bacteremia (n = 6), and fever without bacteremia (n = 1). All infections developed only in patients with underlying biliary tract abnormalities; the frequency of infection was higher (9.8%) in patients with choledochojejunostomy when compared with those with choledochocholedochostomy (1.4%). Bacteremia was more likely caused by skin flora in patients with choledochocholedochostomy (CDC) and by enteric bacteria in patients with choledochojejunostomy (CDJ). All infections were treated successfully with parenteral antibiotics. We conclude that biliary tract abnormalities are the primary risk factors for infection after percutaneous liver biopsy, although the risk is higher in patients with CDJ than with CDC. These data support the use of antibiotic prophylaxis before percutaneous liver biopsy in OLT recipients with biliary tract abnormalities.

Failure to grow: lack of food or lack of love?

One of the most important criteria for good health in childhood is normal growth. Taking regular accurate measurements of length and plotting them on a centile chart is essential to spot early signs of growth disorders. Be alert for a "zig-zag" pattern on the chart: it could indicate psychosocial dwarfism (see opposite). Length is more important than weight for identifying growth disorders. Lack of love, or an adverse emotional or social environment, can cause growth failure even in a child who is eating enough. Such children have a condition called psychosocial dwarfism, which is due to hypopituitarism (too little growth hormone secretion from the pituitary gland). This condition does not respond to growth hormone treatment. Once the child is placed in an alternative environment, eg a good foster home, the hypopituitarism is reversed and rapid "catch-up" growth takes place. It often emerges that such children have been physically, emotionally or sexually abused.

Reversibility of physiological growth hormone secretion in children with psychosocial dwarfism.

OBJECTIVE: Reversibility of GH insufficiency with a change of environment is characteristic of psychosocial dwarfism, and excludes an organic endocrinopathy. However, the change in GH pulsatility has not previously been described. We therefore wished to study spontaneous GH secretion before and after change to a more favourable environment in 11 children with psychosocial deprivation and short stature in order to evaluate if separation from the families can modify their patterns of GH secretion. PATIENTS AND DESIGN: We describe 11 prepubertal children (6 M and 5 F; 2.2-13.5 years of age) who had growth failure and psychosocial deprivation. They were diagnosed by a multidisciplinary team as having environmental growth failure after admission to hospital for 3 weeks. Six of them were discovered to have been sexually abused. During the uninterrupted hospital admission parental access was restricted. Three sets of 18-hour GH profiles were performed on each child, except one child who had only two, during the 3-week admission. MEASUREMENTS: Pulse analysis of GH profiles was by Fourier transformation. RESULTS: On the first day of admission spontaneous GH secretion demonstrated a spectrum of abnormalities in the pattern of basal values, pulse frequency and pulse amplitude. Such GH insufficiency showed reversibility during the 3 weeks in hospital. Indeed, there was a significant increase in GH secretion which was amplitude modulated without any significant modification in pulse frequency. CONCLUSION: Our data indicate that there is abnormal physiological GH secretion in children with psychosocial deprivation, which is associated with growth failure. Despite a pathological situation, each child retained his own characteristic pattern of GH pulsatility. The pattern of reversibility of abnormal GH pulsatility provides information for the mechanism of the control of GH secretion.

The fornix in patients with seizures caused by unilateral hippocampal sclerosis: detection of unilateral volume loss on MR images.

OBJECTIVE: Because some of the axons of the fornix originate in the pyramidal cells of the hippocampus, we hypothesize that neuronal loss within the hippocampus may result in wallerian degeneration and subsequent atrophy of the ipsilateral fornix. Using high-resolution MR imaging, we evaluated the size of the fornix in patients who had lateralizing partial complex temporal lobe seizures after unilateral hippocampal sclerosis. The expectation is that unilateral forniceal atrophy will provide an additional, objective imaging criterion for determining the side of seizure involvement. MATERIALS AND METHODS: We retrospectively reviewed preoperative MR images of 13 patients with temporal lobe epilepsy who subsequently had unilateral hippocampal sclerosis proved surgically. The images were obtained with specially designed bilateral phased-array coils that permitted high-resolution (512 x 512, 16-cm field of view) T2-weighted fast spin-echo imaging of oblique coronal sections. The width of each rostral crus of the fornix was measured by three neuroradiologists who did not know the patients' history and surgical findings, and consensus measurements were obtained. The side with the smaller fornix was interpreted as abnormal. All 13 patients had lateralizing findings on EEG, unilateral anterior temporal lobectomy, and histologic findings of hippocampal sclerosis. RESULTS: The fornix was smaller on the side of hippocampal sclerosis in 12 (92%) of 13 patients. The percentage of asymmetry between the fornices (smallest/largest x 100) varied from 41% to 82% (mean, 68%). CONCLUSION: Our experience indicates that volume loss in the ipsilateral crus of the fornix can be seen on MR images in patients with unilateral hippocampal sclerosis. The size of the fornices should be analyzed in all patients being examined for temporal lobe epilepsy, as asymmetry in the size of the fornices may reveal the side of hippocampal sclerosis. Such knowledge can assist in the preoperative workup of patients with intractable temporal lobe epilepsy related to hippocampal sclerosis.

Optimum method for administration of biosynthetic human growth hormone: a randomised crossover trial of an Auto Injector and a pen injection system.

The use of optimum conventional growth hormone administration, using a growth hormone vial combined with an Auto Injector, was compared with a pen injection system using a cartridge of growth hormone. In both methods of administration the concentration of growth hormone was 16 IU/ml. Thirty patients (22 boys, eight girls) who had all previously been treated with growth hormone (4 IU/ml) administered using needles and syringes (without an Auto Injector) were randomised into receiving one of either treatment for three months and then crossed over for a further three months. Fourteen patients (10 boys, four girls) initially received KabiVial 16 IU/ml combined with an Auto Injector while 16 patients (12 boys, four girls) were treated with KabiPen 16 IU/ml. Mean age in both groups was 9.6 years. The majority of patients in both groups were treated with a regimen of either 15 or 20 units/m2/week as a daily subcutaneous injection. Of the 30 patients who started in this trial, two who commenced using an Auto Injector refused to change to a pen system and were excluded from further analysis. When scored on a scale of -5 to +5 general convenience when changing from an Auto Injector to the KabiPen decreased from +4.7 to +1.0. When assessed for pain, the Auto Injector group scored +4.7, which decreased to -0.2 (more painful) for the pen. At the end of the trial 23 patients (82%) chose to continue with the KabiVial/Auto Injector combination as they found this less painful and the child did not see the needle or need to insert the needle manually. Five patients (18%) continued with the KabiPen as they considered the device smaller and easier to use. The accuracy of dosing using KabiVial was 100% compared with the range of 88% to 111% using KabiPen as the latter was available only in 0.5 unit increments. No growth hormone was wasted using KabiVial, although a mean of 0.6 units was wasted with every 16 IU cartridge in the KabiPen system. It is concluded that patients should be able to contribute to the choice of growth hormone delivery systems and that newer methods need careful assessment.

"Catch-up" growth in steroid dependent dermatomyositis treated with cyclosporin-A.

OBJECTIVE: To improve the short-term growth, and hopefully final height attainment, of children with dermatomyositis treated with chronic daily corticosteroid regimens. METHODS: We have examined the growth of nine pre-pubertal children (7F, 2M), mean age 8.9 (range, 5.7-12.3) years, who had severe juvenile dermatomyositis and required persistent corticosteroid therapy. All were treated with cyclosporin-A. RESULTS: During a mean period of 1.3 years (range 1.0-1.7) cyclosporin-A treatment was associated with a marked decrease in the dosage of prednisolone, from a mean of 12.4 to 6.6 mg/day (p < 0.02), and an increase in height velocity standard deviation score from a mean of -1.37 to +1.39 at 6 months (p < 0.02) and -0.33 at one year. During the first year of treatment with cyclosporin-A, seven patients were able to either withdraw or reduce their prednisolone dose. No side effects of treatment were observed. CONCLUSIONS: Cyclosporin-A was a useful treatment modality in juvenile dermatomyositis and allowed a decreased dose of corticosteroids and associated "catch-up" growth.

Pulsatile growth hormone secretion in peripubertal patients with chronic renal failure. Cooperative Study Group on Pubertal Development in Chronic Renal Failure.

The pubertal growth spurt has been associated with changes of physiologic pulsatile growth hormone (GH) secretion, and abnormalities of the central regulation of GH release have been found by pharmacologic testing in patients with chronic renal failure. To assess the characteristics of GH pulsatility in chronic renal failure and their relationship to pubertal growth, we studied spontaneous nighttime GH plasma profiles in 80 patients (61 boys) aged 10 to 20 years receiving conservative treatment (n = 29) or dialysis (n = 18) or after renal transplantation (n = 33). Tanner genital stages 1 to 4 in boys and breast stages 1 to 3 in girls were represented. Growth hormone pulse analysis was performed by the PULSAR algorithm. Growth hormone concentration profiles were pulsatile in each patient. Growth hormone mean and baseline levels and pulse amplitudes were higher in patients receiving conservative or dialysis treatment than in patients who had undergone renal transplantation. Peak frequency was similar in all treatment groups in boys but higher in girls who had undergone transplantation than in girls receiving conservative or dialysis treatment. Growth hormone peak amplitude and mean levels were lowest in patients in late puberty. The physiologic elevation of GH amplitudes around midpuberty was observed in boys receiving conservative and dialysis treatment but not after transplantation. Growth hormone mean and baseline levels were positively correlated with plasma androgen levels in boys. Growth hormone peak amplitude was correlated with 6-month height velocity after transplantation but not in patients receiving conservative treatment or dialysis. A strong inverse relationship was observed between GH peak amplitude and corticosteroid dosage in patients undergoing transplantation. The lack of relationship between circulating GH levels and growth in patients receiving conservative or dialysis treatment is compatible with end-organ hyporesponsiveness to GH. Pubertal growth failure despite successful transplantation appears to be related to steroid-induced GH hyposecretion.

Does growth hormone treatment improve final height attainment of children with intrauterine growth retardation?

Twenty four children (five girls, 19 boys) who had intrauterine growth retardation were treated with daily subcutaneous biosynthetic human growth hormone, initially in a dose of either 15 or 30 U/m2/week for the first year and in the latter dose for the next two years. Six patients (one girl, five boys) had no dysmorphic signs and 18 (four girls, 14 boys) had signs of Russel-Silver syndrome. All had birth weights below the third centile when adjusted for gestation age and all the children were below the third height centile at the start of treatment. Mean age was 6.3 years (range 2.1-9.7) when growth hormone treatment was started. All had normal growth hormone secretion to either a pharmacological or physiological test. In the first year of treatment, height velocity SD score increased from -0.75 to +3.6 in the group treated with 30 U/m2/week, and from -0.77 to +1.4 in the lower dose group. After three years of treatment, mean height velocity SD score was +1.1, irrespective of which initial treatment dose had been administered during the first year. There was no difference in the growth response of children with or without dysmorphic features. However, despite the sustained increase in growth rate, there was no significant change in height for bone age SD score, pointing to an unaltered final height outcome.

Growth hormone treatment of growth failure secondary to total body irradiation and bone marrow transplantation.

Growth hormone was given to 13 children (nine boys, four girls) with acute leukaemia who had undergone treatment with cyclophosphamide and total body irradiation before bone marrow transplantation. Mean age at total body irradiation and bone marrow transplantation was 9.0 years (range 3.7-15.8). Endocrinological investigation was carried out at a mean of 2.0 years (range 0.4-4.0) after bone marrow transplantation. Peak serum growth hormone responses to hypoglycaemia were less than 10.0 micrograms/l (less than 20.0 mU/l) in 10, 10.5 micrograms/l (21.0 mU/l) in one, greater than 16.0 micrograms/l (greater than 32.0 mU/l) in two patients. Mean age of the patients at the start of growth hormone treatment was 12.2 years (range 5.8-18.2). The mean time between total body irradiation and bone marrow transplantation and the start of growth hormone treatment was 3.2 years (range, 1.1-5.0). Height velocity SD score (SD) increased from a mean pretreatment value of -1.27 (0.65) to + 0.22 (0.81) in the first year, +0.16 (1.11) in the second year, and +0.42 (0.71) in the third year of treatment. Height SD score (SD) changed only slightly from -1.52 (0.42) to -1.50 (0.47) in the first year, to -1.50 (0.46) in the second year, and -1.74 (0.92) in the third year. Measurement of segmental proportions showed no significant increase in subischial leg length from -0.87 (0.67) to -0.63 (0.65) in the first year, to -0.58 (0.70) in the second year, and -0.80 (1.14) in the third year of treatment. Our data indicate that children who have undergone total body irradiation and bone marrow transplantation respond to treatment with growth hormone in either of two dose regimens, with an increase in height velocity that is adequate to restore a normal growth rate but not to 'catch up', and that total body irradiation impairs not only spinal but also leg growth, possibly by a direct effect of irradiation on the epiphyses and soft tissues.

Physiological growth hormone secretion and response to growth hormone treatment in children with short stature and intrauterine growth retardation.

Physiological growth hormone (GH) secretion was examined in 31 children (8 girls, 23 boys) with short stature secondary to intrauterine growth retardation (IUGR). Seventeen (4 girls, 13 boys) had dysmorphic features of Russell-Silver syndrome. Four of the 31 children had GH insufficiency with peak GH levels of less than 20 mU/l during the night. Nine of the patients (8 of whom had Russell-Silver syndrome) had a single nocturnal GH pulse. Twenty-three children (6 girls, 17 boys) were randomized into two groups treated with either 15 or 30 U/m2/week of GH by daily subcutaneous injections. Age, sex distribution, pretreatment height velocity SD score (SDS), and distribution of dysmorphic and non-dysmorphic children were similar in both groups. The group treated with 15 U/m2/week for a mean of 0.82 years showed an increase in mean height velocity SDS from -0.61 to +1.09, and the group treated with 30 U/m2/week for a mean of 0.92 years showed an increase in mean height velocity SDS from -0.69 to +3.48. The results suggest that physiological GH insufficiency is probably common in children with Russell-Silver syndrome and that both dysmorphic and non-dysmorphic children with short stature secondary to IUGR will respond to GH treatment. Initial evidence suggests that the increase in short-term growth velocity does not result in an improved final height prognosis.

Physiological growth hormone (GH) secretion during the recovery from psychosocial dwarfism: a case report.

We describe a 6.4 year old boy who had reversible GH insufficiency secondary to psychosocial dwarfism. On removal to a more favourable environment we observed the recovery of physiological GH secretion by progressive increase in GH pulse amplitude. These observations are relevant to our understanding of the control of GH secretion in that GH pulse frequency appears invariable and alteration in GH secretion is by pulse amplitude modulation.

Differential distributions of oxidative enzymes within subnuclei of the interpeduncular nucleus in rats.

Previous research has shown that neuropeptides, biogenic amines, and transmitter-related enzymes are differentially distributed between the subnuclei of the interpeduncular nucleus (IPN). The present study provides evidence that oxidative enzymes also are differentially distributed across IPN subnuclei. Histochemical staining for glucose-6-phosphate dehydrogenase (G6PDH) is most intense in the dorsal-medial subnucleus, followed in order of diminishing intensity by the rostral, rostral-lateral, dorsal-lateral, lateral, central, intermediate, and apical subnuclei. Succinate dehydrogenase (SDH) reaction product is most intense in the central and intermediate subnuclei, followed in order of diminishing intensity by the rostral, rostral-lateral, lateral, dorsal-medial, and apical subnuclei. Since few cell bodies contain reaction product, these enzymes probably are localized predominantly within dendrites and/or axon terminals in the neuropil of the IPN. The present findings suggest that the individual IPN subnuclei have their own distinctive endogenous level of oxidative and general metabolic activity.

Serotonergic and nonserotonergic projections from the rat interpeduncular nucleus to the septum, hippocampal formation and raphe: a combined immunocytochemical and fluorescent retrograde labelling study of neurons in the apical subnucleus.

This study examined the subnuclear distribution and transmitter content of neurons in the interpeduncular nucleus (IPN) that projected to the septum, dorsal hippocampal formation, and/or raphe. Following the injection of fast blue into the medial septum/diagonal band nucleus and rhodamine-conjugated microspheres into the dorsal hippocampal formation (or vice versa), retrogradely-labelled cells were found throughout the apical subnucleus of the IPN. Incubation of these sections with 5-hydroxytryptamine antiserum indicated that a small number of fast blue- or rhodamine-positive cells also contained serotonin. Occasional apical cells contained both fast blue and rhodamine, indicating a dual projection via collaterals to both the septum and hippocampus. Injection of either dye into the raphe also retrogradely labelled cells in the apical subnucleus, none of which contained serotonin. These results suggest that the IPN may function to integrate the activity within subcortical limbic nuclei via widespread serotonergic and non-serotonergic projections.

Physiological growth hormone secretion in children with short stature and intra-uterine growth retardation.

31 prepubertal children with short stature [mean height standard deviation score (SDS) -2.84] and low birth weight (mean -2.82 SDS) were studied. Mean age was 6.0 years and mean height velocity SDS was -0.76. Patients were classified as having either the clinical characteristics of Russell-Silver syndrome (RSS) (4 F, 13 M) or not (4 F, 10 M). All children had an overnight profile of spontaneous growth hormone (GH) secretion. 4 children achieved a maximum GH concentration of less than 20 mU/l. 9 children with RSS secreted only one large GH peak during the night. Most of the non-RSS group had normal GH pulse frequency but 3 boys had a fast-frequency pattern. Abnormal GH secretion may contribute towards growth failure in children with low birth weight/RSS.

Prenatal and postnatal development of substance P immunocytochemistry within subnuclei of the rat interpeduncular nucleus.

In the present study, the temporal appearance and distribution of substance P within individual subnuclei has been examined during the development of the rat interpeduncular nucleus (IPN). The prenatal organization as well as migration pattern of individual IPN subnuclei are also described. The IPN was distinguishable on embryonic day (E) 19, near the ventral mesencephalon. At this age, the IPN was organized into individual subnuclei like the adult, except for a bilateral distribution of presumptive rostral neurons. Rostral neurons were merged into a single, midline subnucleus by the day of birth, thereby completing an adult pattern of subnuclear organization. SP immunoreactivity, restricted to the lateral subnuclei, was first detected at E20. The intensity of SP-positive fibers in the lateral subnucleus increased with age, and appeared to become selectively distributed along both the medial and lateral borders of this subnucleus. Additional SP-positive fibers became evident postnatally in a thin band overlying both central and intermediate subnuclei, and within the dorsal medial, central and apical subnuclei. SP-positive cell bodies were present in the rostral subnucleus on postnatal day 28, thereby completing the development of an adult pattern of SP immunoreactivity within the IPN.

3H-nicotine and 125I-alpha-bungarotoxin-labeled nicotinic receptors in the interpeduncular nucleus of rats. I. Subnuclear distribution.

The distribution of nicotinic receptors within the interpeduncular nucleus (IPN) was determined in male rats following in vitro labeling with the cholinergic ligands 3H-nicotine and 125I-alpha-bungarotoxin (BTX). Autoradiographic images of two rostrocaudal levels of IPN were analyzed by computer-assisted densitometry and the optical density contributed by displaceable labeling was determined in the rostral, central, intermediate, and lateral subnuclei. 3H-nicotine labeling density within the four subnuclei differs significantly at both levels of IPN. The greatest density of labeling is localized in the rostral subnucleus, followed in order of diminishing density by the central, intermediate, and lateral subnuclei. Labeling within the rostral subnucleus is prominently localized within its central zone. In the central subnucleus, a dense concentration of binding sites is apparent in the middle region, adjacent to less dense vertically oriented columns; 3H-nicotine binding sites in the lateral subnuclei appear to be most concentrated medially, adjacent to the intermediate subnuclei. 125I-BTX labeling density within the four subnuclei also differs significantly at both levels of IPN. The greatest density of labeling is found in the rostral subnucleus, followed in order of decreasing density by the lateral, central, and intermediate subnuclei. The ovoid regions of the rostral subnucleus contain dense 125I-BTX labeling. In the lateral subnuclei, 125I-BTX binding appears to be predominantly along the lateral margins of the subnucleus. The present data indicate that the IPN contains two distinct populations of putative cholinergic nicotinic receptors identified, respectively, by 3H-nicotine and 125I-BTX labeling. Each population of labeled receptors is uniquely localized in patterns that suggest differences in density within and across subnuclei.