QTL for body weight and condition factor in Atlantic salmon (Salmo salar): comparative analysis with rainbow trout (Oncorhynchus mykiss) and Arctic charr (Salvelinus alpinus).

Genotypes at 91 microsatellite loci in three full-sib families were used to search for QTL affecting body weight (BW) and condition factor in North American Atlantic salmon (Salmo salar). More than one informative marker was identified on 16-18 linkage groups in each family, allowing at least one chromosomal interval to be analyzed per linkage group. Two significant QTL for BW on linkage groups AS-8 and AS-11, and four significant QTL for condition factor on linkage groups AS-2, AS-5, AS-11, and AS-14 were identified. QTL for both BW and condition factor were located on linkage groups AS-1, 6, 8, 11, and 14 when considering both significant and suggestive QTL effects. The largest QTL effects for BW (AS-8) and for condition factor (AS-14) accounted for 20.1 and 24.9% of the trait variation, respectively. Three of the QTL for BW occur on linkage groups where similar effects have been detected on the homologous regions in either rainbow trout (Oncorhynchus mykiss) or Arctic charr (Salvelinus alpinus).

A comparison of transnasal and transoral oesophagogastroduodenoscopy.

Transnasal oesophagogastroduodenoscopy (OGD) with a narrow-bore endoscope has been demonstrated to be feasible in unsedated volunteers. The aim of the study was to compare efficacy, safety, patient tolerance and costs between this novel approach to OGD and standard sedated OGD. Sixty day patients were enrolled for either sedated transoral endoscopy with a standard calibre endoscope or for unsedated transnasal endoscopy with a narrow-bore (5.3 mm diameter) endoscope. Visualization was unsatisfactory in one examination in each group. The only complications were minor epistaxis in four of the transnasal group and oxygen desaturation below 90% in two of the sedated transoral group. On a 1 (very uncomfortable) to 5 (very comfortable) visual analogue scale, the mean transnasal group score was 3.09, compared with 3.86 in the transoral group (P = 0.013). In the transnasal group, mean procedure room time was 15 min compared with 20 min in the transoral group (P < 0.0003), and mean recovery room time was 7 min compared with 37 min (P < 0.0001). Consumable and pharmaceutical costs were reduced by 65 and 92%, respectively. This study demonstrates that unsedated transnasal OGD is a safe and effective route for OGD and has acceptable patient tolerance. The safety and decreased recovery times offer major cost savings and the potential for this method of OGD to become an office procedure for the investigation of the upper gastrointestinal tract.

Withholding cardiopulmonary resuscitation: one hospital's policy.

We investigated prospectively the current "do not resuscitate" policy at the Royal Adelaide Hospital, to assess the success of the policy in limiting cardiopulmonary resuscitation and to review how orders to withhold resuscitation were documented. We studied the medical records of 272 patients who died in hospital wards over a three-month period in 1987, and found that in 61% of patients a "do not resuscitate" order had been written, including in 75% of those patients who died with a malignant disease. "No resuscitation" was the most common wording, which occurred in 23% of the orders, whereas only 16% of orders used the terminology "for ordinary measures"--the wording that is recommended in the hospital policy. We conclude from this study of hospital deaths that "do not resuscitate" orders are used frequently and serve to limit the use of cardiopulmonary resuscitation in patients who die in hospital, but are documented without regard to official policy.

Legionella longbeachae pneumonia: report of two cases.

Legionella longbeachae serogroup 1 was isolated from the respiratory secretions of two patients with community-acquired pneumonia. One patient had a mild infection without evidence of the involvement of other organs and recovered, in spite of inappropriate antibiotic therapy. The other patient was severely-ill on presentation with multisystem failure and died soon after admission to hospital. The organisms were identified by the immunofluorescence technique and by quantitative DNA-hybridization studies. The sources of the infection in these patients are unknown as the organism has never been isolated from the SA environment.

An audit of surgery in 100 patients over 75 years in a private hospital.

OBJECTIVE: To determine what operations are being done on patients over 75 years in a private hospital, to observe performance in terms of justification, morbidity and mortality. METHOD: Retrospective audit of 100 patients over 75 years having surgery at an Adelaide private hospital. RESULTS: Cystoscopy, inguinal herniorrhaphy, cataract and colon surgery were the most common procedures. One patient died--probably from a leaking aortic abdominal aneurysm. Four patients had significant morbidity in the form of burst abdomen, ruptured femoral-popliteal bypass graft, biliary collection requiring reoperation and cardiac arrhythmia requiring a pacemaker. Twenty three other patients had minor morbidity. No unnecessary operations were detected.

The value of the autopsy in medical audit--a combined clinical and pathological assessment of 100 cases.

We retrospectively reviewed 100 consecutive autopsies performed at the Royal Adelaide Hospital in 1979. The review was made jointly by a clinician, surgical pathologist and forensic pathologist. The mean patient age was 64.5 years. Sixteen percent of premortem anatomical diagnoses were not confirmed at autopsy. Autopsy revealed 171 new anatomical diagnoses. Of these, 33 diagnoses in 27 patients were important in relation to the cause of death and if known premortem would have altered therapy and possibly outcome in two patients. In 11 cases the missed major diagnoses should have been entertained on the basis of available clinical data. Of the 19 sudden deaths, the cause of death was not included in the clinical differential diagnosis in seven cases. Autopsy resulted in a substantial change in the death certification of 43 cases. The data indicate that the autopsy has a great deal to offer in correcting clinical diagnoses and effecting scientific discipline for clinicians.

Publication of utilisation data. Its effect on clinical decisions.

During an 18-week period in 1978-1979, a weekly bulletin containing information about patients' stay in hospital and prescribing patterns in each unit was distributed to all doctors and senior nurses of six general medical and six general surgical units in the Royal Adelaide Hospital. For the first nine weeks, the bulletins contained information from half of the units, then crossed over in the second nine-week period. The mean stay in all units of 2251 persons discharged from hospital during the first nine weeks was 9.5 days, compared with 8.7 days for the 2234 patients in the second nine weeks (a reduction of more than 2000 bed-days (P less than 0.002)). The percentage of outpatients and discharged inpatients who were given prescriptions for more than two drugs fell from 15.3% to 13% (P less than 0.001). It is likely that publication of the bulletins influenced discharge and prescribing decisions by increasing general awareness that these matters were under review.

Alpha1-fetoprotein in the diagnosis of hepatoma: statistical and cost benefit aspects.

A rational comparison of different serum concentrations of alpha1-fetoprotein (S-AFP) in the diagnosis of hepatoma must be made. We took data on the sensitivity and specificity of different diagnostic S-AFP concentrations from the literature and evaluated them statistically and by Bayesian analysis. In our patients (hepatoma prevalence 0.028) a sensitive diagnostic concentration (30-50 ng/ml) will misdiagnose hepatoma so often that a positive test will indicate hepatoma in only 10% of cases. A positive test at a specific diagnostic concentration (500 ng/ml) indicates hepatoma in 100% of cases and is preferable in terms of cost benefit. Although the lower concentration will diagnose a larger proportion of patients with hepatoma (74% compared with 59%) the 'costs' of excluding false positives are considerable (A$2545 per extra case with 2.5% of patients suffering significant morbidity). In western societies, where the prevalence of hepatoma is low, a higher, less sensitive but more specific diagnostic S-AFP concentration is appropriate.

The significance of lowered jejunal disaccharidase levels.

Disaccharidase estimations on 115 consecutive jejunal biopsies are reported. The patients were divided into four groups: 1. Normal jejunal biopsy light microscopy, not milk intolerant, 82 cases. 2. Normal jejunal biopsy light microscopy, milk intolerant, eight cases. 3. Patients with giardiasis, 11 cases. 4. Coeliac disease patients, 14 cases. The lowest disaccharidase levels were found in coeliac disease, with giardiasis cases showing intermediate levels. Poor correlation of lactase levels with milk intolerance was found. Three cases in Group 1 showing lowered lactase levels were given metronidazole and showed remission of clinical symptoms, raising the possibility that they had undiagnosed infections with Giardia lamblia.

The diagnosis of giardiasis.

Four methods of diagnosing giardiasis are compared. Examination of smear preparations made from the jeunal biopsy specimen showed positive results in all of the 20 consecutive cases of giardiasis reported. The test was more reliable than examination of histological sections of the jejunal biopsy, wet preparations of jejunal aspirate, or faecal smears.

Effect of glucagon on esophageal motor function.

This study evaluates the effect of exogenous glucagon on esophageal motor function in man. Manometric studies were performed using an infused catheter system. Resting lower esophageal sphincter (LES) pressure was monitored before and after intravenous pulse doses of glucagon (1 to 100 mug). The effect of glucagon (0 mug ) on esophageal peristalsis was also studied. Multiple blood samples were taken for determination of glucagon, insulin, and glucose concentration. Glucagon effect on LES pressure was also evaluated after LES stimulation by continuous intravenous infusion and pentagastrin (0.04 mug per kg per min). Glucagon caused a transient significant decrease of LES pressure only at pulse doses (20 and 100 mug) which caused nonphysiological elevation of plasma glucagon levels. The temporal profile of decreased LES pressure correlated closely with maximal blood glucagon levels. Glucagon caused no demonstrable change in esophageal peristalsis. During LES stimulation by pentagastrin, glucagon caused significant transient decreases of LES pressure at doses as low as 1 mug per kg. We conclude that glucagon at sufficient dosage has an inhibitory effect on LES pressure. This inhibitory effect is not mediated through changes in serum insulin or glucose and appears to be pharmacological.