A portable system for the assessment of neuromuscular diseases with electrical impedance myography.

PRIMARY OBJECTIVE: To create a system for the acquisition of multi-angle, multifrequency muscle impedance data. RESEARCH DESIGN: Device development and preliminary testing. METHODS AND PROCEDURES: The system presented here employs an interrogating signal composed of multiple tones with frequencies between 10 kHz and 300 kHz. The use of a composite signal makes possible measurement of impedance at multiple frequencies simultaneously. In addition, this system takes impedance measurements at multiple orientations with respect to the muscle fibres by means of an electronically reconfigurable electrode array. The required measurement time is reduced by taking advantage of muscle's linearity with respect to the flow of electrical current. MAIN OUTCOMES AND RESULTS: The system was tested in normal subjects, a patient with amyotrophic lateral sclerosis, and one with inclusion body myositis; unique impedance signatures were identified the two patients. CONCLUSIONS: Early data suggest that this system is capable of high-quality data collection and may detect changes in neuromuscular disease; study of additional normal subjects and patients with a variety of neuromuscular diseases is warranted.

A concordance of nucleotide substitutions in the first and second hypervariable segments of the human mtDNA control region.

A new and easily accessible concordance of nucleotide substitutions in the hypervariable segments of the human mitochondrial DNA (mtDNA) control region has been constructed. The concordance indexes all population-specific mtDNA sequences in a standardized format. The first edition of the concordance includes 1,440 sequences representing 762 mtDNA types from over 65 populations for hypervariable region 1, and 520 sequences representing 260 mtDNA types from over 26 populations for hypervariable region 2. Investigators are invited to submit new sequences to the database, and details for doing so are given in the text.

Adverse life events and breast cancer: case-control study.

OBJECTIVE: To investigate the strength of association between past life events and the development of breast cancer. DESIGN: Case-control study. A standardised life events interview and rating was administered before a definitive diagnosis. SETTING: Breast Cancer Screening Assessment Unit and surgical outpatient clinics at King's College Hospital, London. SUBJECTS: 119 consecutive women aged 20-70 who were referred for biopsy of a suspicious breast lesion. MAIN OUTCOME MEASURES: Odds ratio of the risk of developing breast cancer after life events in the preceding five years after adjustment for confounders. RESULTS: 41 women were diagnosed as having malignant disease while the remainder had benign conditions. Severe life events increased the risk of breast cancer. The crude odds ratio was 3.2 (95% confidence interval 1.35 to 7.6). After adjustment for age and the menopause and other potential confounders this rose to 11.6 (3.1 to 43.7). Multiple logistic regression analysis showed that all severe events and coping with the stress of adverse events by confronting them and focusing on the problems significantly predicted a diagnosis of breast cancer. Non-severe life events and long term difficulties had no significant association. CONCLUSION: These findings suggest an aetiological association between life stress and breast cancer.

Surgical treatment of hepatic hydatid disease.

The results of surgery in 48 patients with hepatic hydatid disease are described. In 26 out of 32 patients with uncomplicated cysts, conservative surgery with obliteration of the cyst cavity by omentoplasty gave satisfactory results. In contrast, 16 patients with cysts complicated by pyogenic infection or cholangitis required a variety of surgical procedures, including prolonged tube drainage, exploration of the common bile duct, sphincterotomy/plasty and hepatojejunostomy to achieve a satisfactory outcome. The group with complicated cysts also had a much longer postoperative stay (median 30 days) than those with uncomplicated cysts (median 14 days). Two patients died: in one, post-mortem examination revealed carcinoma in the wall of the cyst.

Exploration of the common bile duct.

The main indication for exploration of the common bile duct is to remove stones. Diagnosis is by preoperative or peroperative cholangiogram or is self-evident because the patient has obstructive jaundice.

Internal biliary drainage and local radiotherapy with iridium-192 wire in treatment of hilar cholangiocarcinoma.

Curative surgery is not possible in the vast majority of patients who present with hilar cholangiocarcinoma. Palliative therapy to relieve jaundice, either at laparotomy or percutaneously, is therefore necessary. The mean survival of these patients is of the order of 8.5 months (Wheeler et al., 1981). We report a significant increase in mean survival to 16.8 months in patients treated with internal biliary drainage when combined with local irradiation to the tumour with iridium-192.

Diabetic gastroparesis from autonomic neuropathy: surgical considerations and changes in vagus nerve morphology.

Two cases with intractable vomiting due to gastroparesis, a rare feature of diabetic autonomic neuropathy, are described. Both required surgical treatment. In the first a gastroenterostomy was complicated by reflux gastritis requiring a revision operation; in the second a gastrojejunostomy was successful. Electron microscopic studies of the vagus nerve in one of the cases showed a severe reduction in the density of unmyelinated axons, the surviving axons tending to be of small calibre. The severity of the abnormalities supports the view that diabetic gastroparesis is related to vagal denervation.

Treatment of hilar carcinoma by bile drainage combined with internal radiotherapy using 192iridium wire.

Eighteen patients with a cholangiocarcinoma involving the hilum of the liver, and one patient with a carcinoma of the gall bladder causing obstruction of the common hepatic duct, have been treated with bile drainage using a U-tube (8 patients) or a percutaneous transhepatic catheter (11 patients) followed by internal radiotherapy with 192iridium wire. The median survival is 11 months, and 9 patients (47 per cent) have survived for 12 months or longer. The addition of internal radiotherapy may be beneficial to patients with hilar cholangiocarcinoma causing biliary obstruction in whom bile drainage can be established.

The effects of different types of neonatal feminization and environmental stimulation on changes in sex-associated activity/spatial learning skills.

This research programme commenced in West Africa, where it was found that individuals with kwashiorkor gynaecomastia were feminized. This was also reinforced by the interacting dominant maternal socialization practices (Dawson, 1966). This was confirmed with feminized responses for adult male rats, on the Tolman-Maze (Dawson, 1972), while as well confirmed neonatally, for both feminized male and female rats (Dawson, Cheung and Lau, 1973, 1975). The present experiment tests the interacting effects of various levels of environmental stimulation, high, normal and low (Levitsky and Barnes, 1972), using feminized male rats. Thus castration, oestrogen and castration, and oestrogen feminized males, were contrasted with male and female controls. The results confirmed the physiological growth curves and other anatomical differences. As well, the activity data confirmed the hypothesis, for the combined samples (where high Ns mean more reliability) and also the environmental stimulation (F ratio: d.f. 18 and 57, 11.37, p less than 0.001; low Ns here mean lower reliability). However, for the symmetrical maze, the results for the combined samples, were not as convincing as in Dawson et al. (1973, 1975), although the environmental stimulation produced significant results in many cases, including a significant interaction for the analysis of variance (F ratio: d.f. 18 and 57, 3.12 p less than 0.001).

The secondary management of complicated liver injuries.

A retrospective review of the management of 15 patients suffering from the complications of blunt hepatic trauma is presented. All but one were referred after receiving primary surgical care elsewhere. Seven of them were wrongly thought to have sustained a relatively minor degree of injury. Selective arteriography and grey-scale ultrasonography were of value in the localisation of intrahepatic filling defects. The presence of jaundice correlated closely with persisting sepsis. Biliary fistulas closed spontaneously in all cases.

Increased long-term survival in variceal haemorrhage using injection sclerotherapy. Results of a controlled trial.

Analysis of 107 patients with cirrhosis and recent variceal haemorrhage included in a prospective randomised trial of endoscopic injection sclerotherapy showed that in the sclerotherapy group 22 (43%) of the 51 patients had episodes of haemorrhage during the period of treatment, but in only 4 did bleeding occur after the varices had been obliterated. This contrasts with episodes of bleeding in 42 (75%) of the 56 patients receiving standard medical management-a highly significant difference. The overall risk of bleeding per patient-month of follow-up was reduced threefold with sclerotherapy. Of 22 patients followed up for at least one year after obliteration of varices, 14 had no evidence of reappearance of varices within this period and, by means of cumulative life-analysis tables, survival was shown to be significantly improved in the sclerotherapy group.

Difficulties in the diagnosis and management of pyogenic liver abscess.

Thirty patients with pyogenic liver abscess were admitted to King's College Hospital between 1967 and 1978. The overall mortality was 43 per cent (13 patients). The diagnosis was often difficult and in 10 patients the correct diagnosis was not made until post-mortem. Of the 20 patients diagnosed and treated, 17 had a unilocular abscess, of whom 16 survived. The remaining 3 had a multicentric abscess, and only 1 of them survived. Difficulty in diagnosis was sometimes increased by misleading results fom special investigations. Clinical awareness leading to early diagnosis, drainage and broad spectrum antibiotic treatment remain the prerequisites for cure.