Botanical DNA evidence in criminal cases: Knotgrass (Polygonum aviculare L.) as a model species.

The possibilities and strategies for using DNA characteristics to link a botanical sample to a specific source plant or location vary with its breeding system. For inbreeding species, which often form small patches of identical genotypes, knotgrass (Polygonum aviculare L.) is a suitable model species because of its (1) occurrence in a wide range of natural environments, (2) abundant presence in pieces of evidence, and (3) ease in molecular processing. The value of knotgrass for forensic casework was demonstrated using data from a homicide case. Using the DNA fingerprinting technique AFLP(®) we were able to identify the knotgrass population at the crime site as the most likely origin of the botanical evidence. We expect that the development of tailored marker systems for knotgrass and other frequently occurring (model) species will considerably accelerate the use of botanical DNA evidence in criminal cases.

Case report: ureteric obstruction secondary to contralateral hydronephrosis.

Giant hydronephrosis is a rare condition, defined in the adult as a kidney containing more than 1 l of fluid. It is usually secondary to pelvi-ureteric junction obstruction. We describe a case where giant hydronephrosis caused contralateral ureteric obstruction. The radiological findings are described and the literature is reviewed.

A nursing intervention strategy to foster patient involvement in treatment decisions.

This article describes an intervention strategy designed to provide decisional support for patients with cancer who want to participate in medical-treatment decisions. This strategy is based on the concepts of commitment and control and on a simple technique for determining the degree of involvement the patient desires. It has been tested on women with a confirmed diagnosis of breast or gynecologic cancer and on women referred for a second opinion and diagnostic workup for suspicious lesions. The emphasis is on the patient's agenda, including assessing to what extent she wants to participate, helping her to identify questions, and supporting her in obtaining the information she wants and needs. The strategy has been incorporated successfully into a busy oncology clinic schedule. The next challenge is to conduct research to evaluate the effect of providing decisional support on quality of life.

The significance of irregular opacities on the chest roentgenogram.

Scanty irregular opacities are not uncommonly observed on the chest roentgenogram in the absence of interstitial fibrosis of the lungs. In such circumstances the irregular opacities, when present, tend to be relatively scanty and seldom, if ever, exceed an ILO category of 1/1. They are found in association with cigarette smoking, especially when emphysema is also present. The development of irregular opacities is also related to exposure to various mineral and other dusts, and although their prevalence increases with cumulative dust exposure, in general the type of dust, whether fibrogenic or relatively inert, seems to be of little moment. The presence of irregular opacities remains a troublesome confounding factor in epidemiologic studies of both dust-exposed and nonexposed populations. The morbid anatomic changes that occur in the lungs of nondust-exposed workers and which are responsible for the development of irregular opacities in the chest roentgenogram remain unknown.

Piezo-ceramic lithotripsy of gallbladder stones: initial experience in 38 patients.

The efficacy, safety, and side-effects of a piezo-ceramic system for extracorporeal shock-wave lithotripsy of gallbladder stones were assessed in the first 38 patients treated. Gallstone fragmentation was achieved in 34 patients; 25 required more than 1 treatment session (range 1-5). Extracorporeal shock-wave lithotripsy, conducted without sedation, analgesia, or anaesthesia, was well tolerated by all patients; no patient reported pain or discomfort either during or after the procedure. Side-effects were negligible: transient microscopic haematuria in 2 patients, transiently abnormal liver function tests in 1, and short-lived cutaneous petechiae in 4. Initial experience shows that lithotripsy with this system is effective, safe, and well tolerated.

Irregularly shaped small shadows on chest radiographs, dust exposure, and lung function in coalworkers' pneumoconiosis.

The predominant shapes of small opacities on the chest radiographs of 895 British coalminers have been studied. The aims were to determine whether irregular (as distinct from rounded) small opacities can be identified reproducibly, whether their occurrence is related to dust exposure, and whether they are associated with excess prevalence of respiratory symptoms or impairments of lung function. Six of the doctors responsible for regular radiological surveys of all British coalminers each classified all 895 radiographs twice and independently, using the International Labour Organisation's 1980 classification system. The majority view was that 39 films showed predominantly irregular small opacities, 131 showed predominantly small rounded opacities, and 587 showed no small opacities. Readers' opinions varied about the presence and shapes of shadows on the other 138 films. In general, consistency between readers (and within readers on repeated viewings) was satisfactory. The occurrence and profusion of irregular shadows were related significantly both to the men's ages and additionally to their cumulative exposure to respirable coalmine dust as determined from 15 years' dust monitoring close to where the miners had worked. For any given level of exposure, the average level of profusion of the small irregular opacities was less than the corresponding profusion of small rounded opacities. The prevalence rates of chronic cough and phlegm, and of breathlessness, were higher in those with small irregular opacities than in those with no small opacities (category 0/0), but the differences were not statistically significant after adjustment for other factors including smoking habits. The presence of irregular (but not rounded) small shadows was associated with an impairment in respiratory function averaging about 190 ml deficits in both FEV1 and FVC. These deficits were not explicable in terms of the men's ages, body sizes, and smoking habits and they were in addition to the lung function losses attributable to the miners' dust exposure as such. It is concluded that the presence and profusion of small irregular opacities should be taken into consideration when assessing the severity of coalworkers' simple pneumoconiosis.

Minitracheostomy in the treatment of sputum retention.

Cricothyroid puncture in the process of minitracheostomy may encounter aberrant blood vessels and require surgical exploration.

Complex urinary undiversion.

Thirty-one previously diverted patients with various complex lower urinary tract problems have been undiverted with simultaneous reconstruction of the anorectum and vagina when these structures were also affected. No patient was denied undiversion on the basis of pelvic pathology. The only contraindications were a lack of motivation and when the patient's general condition, intelligence and mobility made it an unrealistic proposition.

Continence and potency preserving cystoprostatectomy and substitution cystoplasty for patients with bladder cancer.

Fifteen potent men with T3 M0 transitional cell carcinoma of the bladder underwent a technique for cystoprostatectomy designed to preserve the innervation of the distal sphincter mechanism and the corpora cavernosa, and substitution cystoplasty. All patients had previously had radiotherapy. When the neurovascular bundles were seen to be preserved all patients were continent by day (although one had objectively demonstrable stress incontinence) and 60% were potent. Damage to the neurovascular bundles was usually associated with impotence and a degree of stress incontinence, although the latter was correctable by implantation of an artificial sphincter. Cystectomy need not necessarily lead to an abdominal stoma or to impotence.

Quartz and pneumoconiosis in coalminers.

In a routine survey of 623 miners in one colliery, 21 men, an unusually high number, showed radiological progression of simple pneumoconiosis in spite of generally low exposures to mixed coalmine dust. Comparison of the dust exposures of the 21 men with those of matched controls without pneumoconiosis showed highly significant differences in the proportion of quartz in the mixed dust to which they had been exposed. Quartz exposure may be an important factor in the development and rapid progression of coalworkers' pneumoconiosis. Some indication of the levels of quartz exposure which are likely to be hazardous is given.

Factors predisposing to the development of progressive massive fibrosis in coal miners.

Altogether 238 759 miners employed by the National Coal Board were examined in the third of the Board's radiological surveys from 1969 to 1973 inclusive. Excluding those diagnosed as having progressive massive fibrosis (PMF) on that occasion, 210 847 were in collieries still operating at the time of the fourth survey four to five years later 132 728 attended for radiography at the same colliery on the second occasion, and were used to study the attack rate of PMF. In all groups in the age range 35-54 and having category 2 simple pneumoconiosis (SPN) or less, 80% or more had a second radiograph. It was found that the probability of developing PMF increased sharply with rising category of SPN; however, half the cases occurred in men having SPN categories 0 or 1, who were in the majority. Current coalface work had no significant effect on the attack rate. Age increased the attack rate of PMF within each major SPN category (0, 1, 2, and 3), especially the higher categories. All or part of this effect may have been due to the fact that SPN in younger men with categories 1 and 2 tends to lie in the lower range within these categories. Similarly, a lower distribution of SPN within each category associated with a low overall local prevalence may account wholly or in part for the great difference between the attack rates of PMF supervening on each category of SPN in Scotland and South Wales. The rank (quality) of coal mined had no effect on the attack rate.