Chemical immobilisation of lions: weighing up drug effectiveness versus clinical effects.

Selection of an effective drug combination to immobilise African lions (Panthera leo) requires balancing immobilisation effectiveness with potential side effects. We compared the immobilisation effectiveness and changes to physiological variables induced by three drug combinations used for free-ranging African lions. The lions (12 animals per drug combination) were immobilised with tiletamine-zolazepam-medetomidine (TZM), ketamine-medetomidine (KM) or ketamine-butorphanol-medetomidine (KBM). Induction, immobilisation, and recovery were timed, evaluated using a scoring system, and physiological variables were monitored. The drugs used for immobilisation were antagonised with atipamezole and naltrexone. The quality of induction was rated as excellent for all drug combinations and induction times (mean ± SD) did not differ between the groups (10.54 ± 2.67 min for TZM, 10.49 ± 2.63 min for KM, and 11.11 ± 2.91 min for KBM). Immobilisation depth was similar over the immobilisation period in the TZM and KBM groups, and initially light, progressing to deeper in lions administered KM. Heart rate, respiratory rate and peripheral arterial haemoglobin saturation with oxygen were within the expected range for healthy, awake lions in all groups. All lions were severely hypertensive and hyperthermic throughout the immobilisation. Following antagonism of immobilising drugs, lions immobilised with KM and KBM recovered to walking sooner than those immobilised with TZM, at 15.29 ± 10.68 min, 10.88 ± 4.29 min and 29.73 ± 14.46 min, respectively. Only one lion in the KBM group exhibited ataxia during recovery compared to five and four lions in the TZM and KM groups, respectively. All three drug combinations provided smooth inductions and effective immobilisations but resulted in hypertension. KBM had an advantage of allowing for shorter, less ataxic recoveries.

The effects of feeding and transport length on the welfare of white rhinoceroses (Ceratotherium simum simum) during long-distance translocations: a preliminary study.

Translocation is a valuable conservation tool, but poses significant risks for the transported rhinoceroses. Interventions reducing these risks are required to ensure positive welfare during transportation. The aim of this study was to evaluate the effect of journey duration and feeding during the transport of white rhinoceroses (Ceratotherium simum simum). A total of 32 animals were transported by road during two events, five days apart. Fifteen rhinoceroses in the first transport event (37.0 ± 2.4 hr duration) were not fed, while 17 rhinoceroses in the second event (32.2 ± 1.5 hr duration) were offered lucerne. Blood samples were collected at capture and after transport for the evaluation of changes in serum clinical chemistry analytes. The Wilcoxon rank-sum test was used to compare differences between the groups. In all rhinoceroses, transport resulted in changes in serum electrolyte, metabolite and enzyme concentrations, indicating a loss in total body water, nutritional shifts, stress and fatigue. Fed rhinoceroses, transported over a shorter time, displayed greater changes in osmolality (p < 0.006), serum sodium and chloride concentrations (p = 0.005 and = 0.001, respectively) indicating a greater degree of total body water loss than non-fed rhinoceroses. Feeding and a shorter transport duration reduced, but did not prevent, nutritional challenges. A greater increase in the muscle enzymes CK and AST (p = 0.027 and = 0.001, respectively), indicated greater fatigue in non-fed rhinoceroses transported over a longer time. Further work to distinguish the effects of feeding and journey duration is required to better understand the role feeding may play in mitigating welfare challenges during rhinoceros translocation.

A comparison of immobilisation quality and cardiorespiratory effects of etorphine-azaperone versus etorphine-midazolam combinations in blesbok.

ABSTRACT: The study compared immobilisation of blesbok (Damaliscus pygargus phillipsi) with etorphine and azaperone vs etorphine and midazolam. Twelve female blesbok, weighing 59.4 ± 2.8 kg, were used. Each animal randomly received Treatment 1 (T1) (etorphine, 0.07 ± 0.003 mg/kg + azaperone, 0.36 ± 0.02 mg/kg) and Treatment 2 (T2) (etorphine, 0.07 ± 0.003 mg/kg + midazolam, 0.20 ± 0.01 mg/kg) with a one-week washout period between treatments. Induction times were recorded followed by physiological monitoring for 45 minutes of immobilisation. Immobilisation was reversed with naltrexone (20 mg per mg etorphine). Recovery times were also recorded. Induction, immobilisation and recovery were scored with subjective measures. Inductions and recoveries did not differ between combinations, but the quality of immobilisation was significantly better with T1. Rectal temperature and blood pressure were significantly lower during T1. Both treatments resulted in severe hypoxaemia and impaired gas exchange, although overall hypoxaemia was more pronounced for T1. Animals treated with T2, however, exhibited a deterioration in respiration as the monitoring period progressed, possibly as a result of impaired ventilatory muscle function due to the effects of midazolam. Both combinations are suitable for adequate immobilisation of blesbok and should be selected based on the specific capture situation. Supplementation with oxygen is highly recommended.

An HPLC-DAD validated method for the detection and quantification of cortisol, corticosterone and melatonin in plasma samples of two different animal species.

The monitoring of endogenous hormone plasma levels could be valuable in biomedical, veterinary and pharmaceutical research. A specific high performance liquid chromatography method with diode array detection, for the assay of cortisol, corticosterone and melatonin in animal plasma was developed and validated. The chromatographic separation was achieved on a C8 reversed phase column with a mobile phase consisting of HPLC-grade water and 35% v/v acetonitrile (pH ± 3.36). The detection was achieved through diode array detection, with two set wavelengths; 245 and 275 nm. The flow rate was at 1 ml/min and the total run time was 50 min. The method was validated according to validation guidelines (Shabir, 2006; US FDA, 2013). The method was found to be linear (R² > 0.99) over the analytical range (10 to 500 ng/ml) for all three analytes. All the other validation parameters were acceptable and within range. The method was applied to plasma samples from Sprague-Dawley rats and white rhinoceros.

Assessment of the use of temperature-sensitive microchips to determine core body temperature in goats.

Body temperature was measured at five different body sites (retroperitoneum, groin, semimembranosus muscle, flank and shoulder) using temperature-sensitive microchips implanted in five female goats, and compared with the core body and rectal temperatures. Body temperature was measured while the goats were kept in different ambient temperatures, with and without radiant heat, as well as during a fever induced experimentally by injection of bacterial lipopolysaccharide. Bland-Altman limit of agreement analysis was used to compare the temperature measurements at the different body sites during the different interventions. Temperatures measured by the microchip implanted in the retroperitoneum showed the closest agreement (mean 0.2 °C lower) with core and rectal temperatures during all interventions, whereas temperatures measured by the microchips implanted in the groin, muscle, flank and shoulder differed from core body temperature by up to 3.5 °C during the various interventions.

Uterine torsion in a Sprague Dawley rat (Rattus norvegicus).

Uterine torsion is a twisting of the uterus or uterine horn perpendicular to its long axis. We report a case of uterine torsion in an adult breeding Sprague Dawley rat. The rat died a month after her last recorded delivery. Post mortem examination of the rat revealed 270 degrees torsion of the right uterine horn. The uterus contained a single foetus. The liver was pale and enlarged. The rest of the viscera appeared normal. Histopathological examination showed acute hepatic necrosis and pulmonary congestion with mild lymphocytic infiltrates peribronchially. The acute hepatic necrosis may have been associated with septicaemia due to compromised blood vessels following the uterine torsion. The presence of a single foetus could have resulted in foeto-maternal disproportion with resultant uterine torsion. Torsion of the uterus can be accompanied by haemostatic and metabolic complications, which could have caused the death of the rat. Although uterine torsion is a rare condition in rats, it should be considered as a potential complication of gestation in animal breeding units.

Shearing at the end of summer affects body temperature of free-living Angora goats ( Capra aegagrus) more than does shearing at the end of winter.

Angora goats are known to be vulnerable to cold stress, especially after shearing, but their thermoregulatory responses to shearing have not been measured. We recorded activity, and abdominal and subcutaneous temperatures, for 10 days pre-shearing and post-shearing, in 10 Angora goats inhabiting the succulent thicket of the Eastern Cape, South Africa, in both March (late summer) and September (late winter). Within each season, environmental conditions were similar pre-shearing and post-shearing, but September was an average 5°C colder than March. Shearing resulted in a decreased mean (P < 0.0001), minimum (P < 0.0001) and maximum daily abdominal temperature (P < 0.0001). Paradoxically, the decrease in daily mean (P = 0.03) and maximum (P = 0.01) abdominal temperatures, from pre-shearing to post-shearing, was greater in March than in September. Daily amplitude of body temperature rhythm (P < 0.0001) and the maximum rate of abdominal temperature rise (P < 0.0001) increased from pre-shearing to post-shearing, resulting in an earlier diurnal peak in abdominal temperature (P = 0.001) post-shearing. These changes in amplitude, rate of abdominal temperature rise and time of diurnal peak in abdominal temperature suggest that the goats' thermoregulatory system was more labile after shearing. Mean daily subcutaneous temperatures also decreased post-shearing (P < 0.0001), despite our index goat selecting more stable microclimates after shearing in March (P = 0.03). Following shearing, there was an increased difference between abdominal and subcutaneous temperatures (P < 0.0001) at night, suggesting that the goats used peripheral vasoconstriction to limit heat loss. In addition to these temperature changes, mean daily activity increased nearly two-fold after March shearing, but not September shearing. This increased activity after March shearing was likely the result of an increased foraging time, food intake and metabolic rate, as suggested by the increased water influx (P = 0.0008). Thus, Angora goats entered a heat conservation mode after shearing in both March and September. That the transition from the fleeced to the shorn state had greater thermoregulatory consequences in March than in September may provide a mechanistic explanation for Angora goats' vulnerability to cold in summer.

Hepatic capillariasis in a Cape ground squirrel (Xerus inaurus).

We report, for the first time, an incidental finding of Calodium hepaticum infestation in a sub-adult female Cape ground squirrel (Xerus inaurus). Post mortem examination of the squirrel revealed severe haemoperitoneum, splenomegaly and hepatomegaly with miliary white spots distributed diffusely throughout the hepatic parenchyma. Histologically the portal tracts in the liver showed granulomatous inflammation with fibrosis and numerous giant cells. Occasional adult worms were identified and there were multiple C. hepaticum eggs distributed diffusely throughout the portal tracts and the parenchyma. The spleen also contained C. hepaticum eggs. The genus Rattus is the primary host and reservoir of C. hepaticum, but C. hepaticum infections have been reported previously in other Sciuridae. Based on our findings, people should be cautious of the zoonotic potential of C. hepaticum, when they come into contact with the Cape ground squirrel.

Thermal, cardiorespiratory and cortisol responses of impala (Aepyceros melampus) to chemical immobilisation with 4 different drug combinations.

Thermometric data loggers were surgically implanted in 15 impala (Aepyceros melampus) to investigate the consequences of chemical capture. Impala were darted and chemically immobilised for 30 min with each of the following drug combinations: etorphine and azaperone; etorphine and medetomidine; thiafentanil and azaperone, and a thiafentanil medetomidine combination. During immobilisation, pulse oximeter readings, respiratory rhythm, the plane of immobilisation and plasma cortisol concentrations were measured and recorded. The impala developed an extremely high rise in body temperature, which peaked 20-30 min after reversal of the immobilisation. The magnitude of the rise in body temperature was similar for all the drug combinations (F = 0.8, P = 0.5), but the duration of the hyperthermia was shorter when the thiafentanil and azaperone combination was used (F = 3.35, P < 0.05). Changes in body temperature were related to the time that it took for an animal to become recumbent after darting (r2 = 0.45, P = 0.006) and not to the effect of the drug combination on time to recumbency (r2 = 0.29, P = 0.46). The relationship between time to recumbency and body temperature change, and also to plasma cortisol concentration (r2 = 0.67, P = 0.008), indicated that physiological consequences of capture were related to the duration of exposure to a stressor, and not to the pharmacology of the capture drugs. Although shorter time to recumbency in individuals resulted in the benefit of smaller stress responses and body temperature changes, those individuals were predisposed to developing hypoxia and possibly induction apnoea. When animals are chemically immobilised, reducing the thermal consequences of capture requires limiting the exposure of the animal to a psychological 'fright stress'.

A randomised study of prophylactic G-CSF following MRC UKALL XI intensification regimen in childhood ALL and T-NHL.

BACKGROUND: Despite the current widespread use of prophylactic G-CSF in children with solid tumours and leukaemia, its effectiveness has not been clearly demonstrated. This randomised study evaluates the role of G-CSF given after a 5-day intensification block in children with acute lymphoblastic leukaemia (ALL). PROCEDURE: Forty-six children with ALL or T-Cell non-Hodgkins lymphoma (NHL) treated on MRC ALL 97, UKALL XI or UKCCSG 9504 NHL protocols were randomised to receive granulocyte colony-stimulating factor following either the first or the second block of intensive chemotherapy in a cross-over study to determine if the prophylactic administration of G-CSF could reduce the rate of readmission to hospital for management of febrile neutropenia. RESULTS: There was a statistically significant difference in the rate of hospital admission in the group receiving prophylaxis, with 34 of 46 being admitted, compared to 42 of 46 patients in the control arm (74 vs. 91%; P=0.0386). There were no differences found in duration of hospital admission, haematological toxicity, neutrophil recovery or duration of supportive care between the two groups. There was no demonstrable cost benefit derived from the prophylactic administration of G-CSF. CONCLUSIONS: This study shows that the prophylactic administration of G-CSF following intensification chemotherapy for childhood ALL and T-NHL produces a significant reduction in the rate of readmission to hospital for the management of febrile neutropenia.

Molecular markers for predicting prostate cancer stage and survival.

OBJECTIVE: To assess several molecular markers (detected by immunohistochemistry, IHC) to determine whether they can be used to improve the prognostic value of histological grade alone in predicting the behaviour of prostate cancer. PATIENTS AND METHODS: Tumour tissue was retrieved from 156 men in whom tumour grade, stage and survival were known. The outcome measures were: (i) local stage (T-stage, organ-confined vs extraprostatic); (ii) metastatic status (M-stage, bone metastasis vs no bone metastasis); and (iii) survival. The IHC markers used were chosen to provide a broad representation of various aspects of tumour biology, i.e. the androgen receptor (AR) and oestrogen receptor (ER), adhesion molecules (E-cadherin), proliferation markers (MIB-1), tumour-suppressor genes (TP53 and the retinoblastoma gene product, Rb) and other novel cancer-related proteins (cyclin D1 and the breast cancer susceptibility gene product, BRCA2). All factors were assessed using logistic regression and Cox proportional-hazards survival models for predictive value, after adjusting for effects. RESULTS: MIB-1, ER, cyclin D1 and E-cadherin all showed close statistically significant univariate associations with histological grade. Univariate analysis also identified close statistically significant associations between T-stage and both MIB-1 and E-cadherin. Likewise, there were close univariate associations for both M-stage and survival, and MIB-1, cyclin D1 and ER. Logistic regression modelling identified MIB-1, cyclin D1 and ER as statistically significant predictors of M-stage and, once MIB-1 was entered into the model, the effects of grade no longer made a significant contribution. MIB-1 was a significant predictor for T-stage, but the effects of grade remained significant in this model. Cox proportional-hazards modelling identified MIB-1, cyclin D1 and ER as being statistically significant predictors of survival, after adjusting for grade. After adjusting for both grade and MIB-1, the effects of cyclin D1 and ER were no longer statistically significant. Excess MIB-1, cyclin D1 or ER expression tended to be present within the most poorly differentiated and advanced-stage lesions; this provides an inherent instability to the models described. TP53, Rb, AR and BRCA2 were of limited prognostic value. CONCLUSIONS: MIB-1, ER and cyclin D1 provide prognostic information that is clearly independent of grade. However, their true clinical value is probably limited because they are expressed mainly in the most advanced lesions. Nevertheless, MIB-1 expression is of sufficient value to warrant inclusion in future prognostic models. Furthermore, the expression of cyclin D1 and ER may reflect aspects of tumour biology that individually are worthy of further investigation. However, none of the IHC markers used in this study can be recommended for use in routine histological preparations.

Proximal tibiofibular bifurcation synostosis for the management of longitudinal deficiency of the tibia.

Three adults with severe longitudinal deficiency of the tibia (LDT), in which an unossified proximal tibial anlage was present, who had been treated with proximal tibiofibular bifurcation synostosis (PTFBS) in early childhood, were evaluated between 20 and 31 years after the index procedure. All three were found to be functioning well as below-the-knee (BK) amputees. Mediolateral stability and anteroposterior instability of the knee were present in all cases. Instrumented motion analysis revealed diminished loading characteristics of the prosthetic limb, similar to that described for BK amputees in general. The most significant gait deviations at the knee unique to this study group were a quadriceps-avoidance gait pattern and an increased dynamic varus alignment. Instrumented muscle testing suggested that these deviations were a consequence of ligamentous instability. This study supports the concept that the presence of a proximal tibial anlage in severe LDT is indication for a surgical strategy that preserves the biological knee joint. The PTFBS maintains the integrity of the knee-extensor mechanism, the fibular collateral ligament, the tibiofemoral joint capsule, and the medial collateral ligament, enhancing the long-term stability and function of the knee joint.

Telecommunications and disease management in the home environment: new strategies to improve outcomes.

This article provides an overview of the issues and effects of principle-centered health care within organized systems of care; portrays a comprehensive disease management framework for home health care; and offers virtual health management, telecommunications, and mobile computing strategies to enable health management enterprises to achieve health and outcomes maximization accountability demands in managed care.

Granulocyte colony-stimulating factor in established febrile neutropenia: a randomized study of pediatric patients.

PURPOSE: Infection in neutropenic patients is potentially life-threatening and carries important implications for hospital resource use. Prophylactic administration of cytokines may reduce the severity of neutropenia, but involves the treatment of all patients for the possible benefit of a minority. This study evaluates whether treatment with cytokines in the setting of established febrile neutropenia will influence outcome and be potentially more cost-effective. PATIENTS AND METHODS: In a double-blind study, pediatric patients with fever and severe neutropenia were randomized to receive granulocyte colony-stimulating factor ([G-CSF] filgrastim; 5 microg/kg/d) or placebo, in addition to antibiotics. The study protocol required a resolution of fever and a neutrophil count > or = 0.2 x 10(9)/L for hospital discharge. Patients could be randomized for up to four independent febrile episodes. A total of 186 episodes of febrile neutropenia were investigated. RESULTS: Patients randomized to G-CSF had a shorter hospital stay (median, 5 v 7 days; P = .04) and fewer days of antibiotic use (median, 5 v 6 days; P = .02). G-CSF-treated patients also had more rapid neutrophil recovery and higher neutrophil levels at discharge. The 2-day reduction in hospital stay reduced the median bed cost by 29% per patient admission (P = .04). CONCLUSION: Under the clinical guidelines of our institution, the use of G-CSF in the treatment of established febrile neutropenia produced a small but significant reduction in the time that children required antibiotics and hospital admission, with possible cost savings.

Acute toxicity in pelvic radiotherapy; a randomised trial of conformal versus conventional treatment.

BACKGROUND: A prospective, randomized clinical trial to assess the effect of reducing the volume of irradiated normal tissue on acute reactions in pelvic radiotherapy accured 266 evaluable patients between 1988 and 1993. PURPOSE: This is the definitive analysis to assess the differences between the conformal and conventional arms of the trial. MATERIALS AND METHODS: In both arms, patients were treated with 6 MV X-rays using a 3-field technique (in all but 5 cases) consisting of an anterior and two wedged lateral or posterior oblique fields; in the conventional arm, rectangular fields were employed, whereas in the conformal arm, the fields were shaped with customized blocks drawn according to the beam's-eye-view of the target volume. The most common dosage was 64 Gy in 2-Gy fractions 5 times a week, although a subgroup (of ca. bladder patients) were treated with 30-36 Gy in once-a-week 6 Gy fractions. Each patients completed a comprehensive acute toxicity scoring questionnaire concentrating on bowel and bladder problems, tiredness and nausea, before the start of treatment, weekly during and for 3 weeks after the end of treatment and then monthly for a further 2 months. compliance was excellent. RESULTS: There were no differences between the patients in the two arms with respect to age, gender, tumour type (52% prostate, 41% bladder, 5% rectum, 2% other) fractionation/dosage, anterior field size, weight, or baseline symptoms. Substantial differences in normal-tissue volumes (rectum, bladder, etc.) were achieved: median high-dose volume (HDV) of 689 cm3 for the conformal technique versus 792 cm3 for the conventional. A clear pattern of an increase in symptoms during RT, followed by a decrease after RT, was observed for the patient group as a whole. However, a very extensive analysis has not revealed any (statistically) significant differences between the two arms in level of symptoms, nor in medication prescribed. The disparity between our findings and those of other, non-randomized studies is discussed. CONCLUSIONS: The data on late effects must be collected and analyzed before any definite conclusions can be drawn on the benefits of conformal therapy in the pelvis.

The Fasting Hyperglycaemia Study: I. Subject identification and recruitment for a non-insulin-dependent diabetes prevention trial.

Subjects at increased risk for developing non-insulin-dependent diabetes mellitus (NIDDM) were encouraged via a public awareness campaign, general practitioners, or a direct approach (in the case of women with previous gestational diabetes) to attend one of three English and two French centers for fasting plasma glucose (FPG) measurement. Of 1,580 subjects (mean +/- SD age, 47 +/- 10 years), 29% were male, 56% had a diabetic relative, 20% had a history of elevated blood glucose or glycosuria, and 9% previously had gestational diabetes. Thirty-one percent (493) had an initial increased fasting glucose ([IFG] 5.5 to 7.7 mmol.L-1), 3% (41) a diabetic fasting glucose ([DFG] > or = 7.8 mmol.L-1), and 66% (1,046) a normal fasting glucose ([NFG] < 5.5 mmol.L-1). Four hundred forty-one of the 493 returned for a second FPG measurement, and 67% (293) of these had a similar value on repeat testing 2 weeks later. A 75-g, 2-hour oral glucose tolerance test (OGTT) in 223 of these subjects showed that 37% (83) had impaired glucose tolerance (IGT), 26% (58) diabetes mellitus (DM), and 37% (82) normal glucose tolerance (NGT). Seven percent of self-referred patients had NIDDM by World Health Organization (WHO) criteria. Eighty-eight percent of those with an initial DFG had an increased glycated hemoglobin (> 6.2%), and 75% an increased fructosamine (> 282 mumol.L-1). While these two glycemic measures provided good discrimination for diabetes, neither were reliable in detecting those with increased but not diabetic FPG values. In conclusion, 293 (19%) of 1,580 self-referred subjects were identified as having persistently increased FPG, and 227 have been entered into a randomized NIDDM prevention trial evaluating healthy-living advice and sulfonylurea therapy.

Centers of excellence: a medical measurement or marketing myth?

Managed care organizations, physician groups and hospital systems are all increasingly pressured to identify new modes of treatment that produce verifiable outcomes while reducing the revolving door pattern of health care for the chronically ill. Providers are also faced with creating systems of care to differentiate themselves from the competition in the marketplace. Disease-specific health management programs are being used to address both issues. When used properly, they can be promising tools in the battle to maintain health care quality while containing costs. Skillful balancing of these two important factors can ensure maximum value for both patients and payers. Are centers of excellence the critical pathway of the future? Or are they merely a marketing ploy to generate incremental growth and profitability for savvy business executives and medical group management entrepreneurs? This article provides an overview of the center of excellence concept, addresses its misuse in the industry and discusses the strategic and marketing implications for organizations considering this approach as a tool to demonstrate full accountability and meritorious outcomes.

Longitudinal deficiency of the fibula. Operative treatment.

We reviewed the results of early amputation and prosthetic fitting in twenty-five children (thirty-one extremities) who had longitudinal deficiency of the fibula and were managed between 1977 and 1992. The median age at the time of the initial operation was thirteen months (range, eight months to nine years and eight months). The median duration of follow-up was eight years and ten months (range, two years and six months to sixteen years and eleven months). A Syme amputation was performed on fifteen extremities (thirteen children), and a modified Boyd amputation (which included resection of the distal tibial physis) was performed on sixteen extremities (thirteen children). (One child had a Syme amputation on one side and a Boyd amputation on the other and is thus included in both groups). In twenty-seven extremities, simultaneous excision of the fibular anlage was performed to prevent the development of a deformity secondary to the potential tethering effect. In twelve extremities, a diaphyseal osteotomy of the tibia also was performed to correct tibial bowing and to improve the mechanical alignment of the extremity. At the time of follow-up, the patients who had had a Syme amputation had more problems related to reformation of the calcaneus, instability of the heel pad, prosthetic suspension, and excessive length of the residual extremity. The modified Boyd amputation improved the function of the heel pad and the prosthetic suspension and provided the optimum length of the residual extremity. We also found that an early diaphyseal osteotomy of the tibia to correct severe bowing improved prosthetic fitting. This study did not support the concept that early resection of the fibular anlage or a diaphyseal osteotomy of the tibia prevents the development of hypoplasia of the lateral femoral condyle and associated genu valgum deformity.

Operative treatment of bone overgrowth in children who have an acquired or congenital amputation.

Fifty-three children who were less than thirteen years old were followed for a median of seven years and ten months (range, two years and nine months to fourteen years and six months) after operative treatment for overgrowth of the tibia or humerus after amputation. During the thirty-one years in which these children were managed, three operative techniques were used in successive periods. Thus, the fifty-three children could be divided into three groups: thirty-one who had had a resection and revision, nine in whom the bone had been capped with a synthetic device, and thirteen in whom the bone had been capped with an autogenous tricortical bone graft from the iliac crest. A retrospective review was performed to determine the result and complications associated with each of these techniques. Survival analysis revealed that subsequent procedures were performed in twenty-six (84 per cent) of the thirty-one patients who had had a resection and revision, in seven of the nine in whom the bone had been capped with a synthetic device, and in four of the thirteen in whom the bone had been capped with an autogenous bone graft. The estimated mean survival time (that is, the time to a subsequent procedure) was five years in the group that had had the bone capped with an autogenous graft and three years and six months in the group that had had resection and revision; the difference is significant (p = 0.003).(ABSTRACT TRUNCATED AT 250 WORDS)

Symptoms and health problems in pregnancy: their association with social factors, smoking, alcohol, caffeine and attitude to pregnancy.

This paper describes the prevalence and correlates of symptoms and health problems in pregnancy using data from a prospective population study in London. Data on the prevalence of 11 symptoms and 12 health problems were obtained at three points in pregnancy from a consecutive sample of 1513 white women. Relationships were examined between these symptoms and a range of psychosocial factors including social class, education, marital status, income, smoking, alcohol, caffeine, attitude to pregnancy and whether the pregnancy was planned. Most women reported nausea and breast tenderness in early pregnancy. Heartburn, backache, constipation and headaches were also common. The prevalence of symptoms tended to increase with gestation except for nausea and vomiting. Women with manual occupations, minimum education, low income, single marital status and unplanned pregnancy reported more of most symptoms except nausea which was associated with higher social status. A negative attitude to pregnancy was associated with more headaches but was unrelated to nausea. Women who smoked reported more 'nerves and depression' but less nausea. In general, nausea and vomiting showed a different pattern of associations from all other symptoms.