Effects of the angiotensin converting enzyme (ACE) inhibitor, captopril, on the cardiovascular, endocrine, and renal responses to furosemide in conscious lambs

Data were prospectively collected on 306 Kenyan children, including blood gases in 258 (75%). Severe malaria caused a predominantly high-anion-gap metabolic acidosis in at least 43% of children. Children with coma and respiratory distress (CM + RD) had greater evidence of renal dysfunction, lower mean pH and higher mean plasma osmolality than those with respiratory distress (RD) or coma (CM) as isolated findings (mean urea 10.7 vs. 6.0 vs. 4.3 mmol/l; mean creatinine 97 vs. 74 vs. 58 mumol/l; mean osmolality 301 vs. 288 vs. 283 mosmol/l; and mean pH 7.16 vs. 7.29 vs. 7.39, respectively, p < 0.001 for each comparison of CM + RD vs. RD or CM). In addition, children with CM + RD had a higher mean blood lactate (6.7 vs. 3.3 mmol/l, p < 0.001), a lower mean haemoglobin (5.5 vs. 7.0 g/dl, p = 0.002) and a lower mean age (26.4 vs. 41.9 months, p < 0.001) than children with CM and accounted for 15/24 (63%) of all deaths. These and previous data implicate hypovolaemia and renal impairment in the pathogenesis of metabolic acidosis in severe childhood malaria. In children who are acidotic, anaemia is strongly associated with lactic acidaemia and may therefore contribute to its pathogenesis. These data also imply that coma in acidotic children (CM + RD) and those with an isolated encephalopathy (CM) may result from quite different pathophysiological mechanisms.     

Multiple axonal tracing: simultaneous detection of three tracers in the same section

It is appropriate that this Special Section in Journal of Adolescence should focus on the needs of adolescents within the care system. The year 1998 marks the fiftieth anniversary of the passing of the Children Act (1948), which established the modern structure of services in England and Wales for children and adolescents deprived of adequate parenting in their own homes. Anniversaries are an opportunity for reflection. Are our current services an improvement on the past? In learning new lessons have we possibly lost sight of things we knew better, and did better, previously?     

Two cold legs

Bilateral acute lower limb ischaemia is rare. Usually the diagnosis is based on clinical findings. In four patients, three women aged 51, 48, and 72 and a man aged 64 years, bilateral acute ischaemia of the lower limbs was diagnosed, due to different causes: arterial cardiac myxoma embolism, arterial thrombosis probably due to paraneoplastic coagulopathy, aortic dissection, and arterial thrombosis due to cardiac insufficiency, respectively. The management of these conditions includes restoring the circulation as soon as possible. Reperfusion can be achieved by thromboembolectomy or thrombolysis. In patients with underlying atherosclerosis angiography is useful, but time loss must be avoided. The outcome in patients with bilateral ischaemia of the lower limbs depends on the preoperative ischaemia time and the cardiac situation. The mortality varies between 20 and 50%.     

The mutual relations of structures in the growing bill of chick (Gallus domesticus L.) and duck (Anas platyrhynchos L.) Embryos. IV. The size, shape, and position of the upper and lower bills in unilaterally microphthalmic duck embryos

Unilaterally microphthalmic duck (DUM) embryos studied in stage 39 were obtained by damaging the right eye in stage 17. The development between stages 19 and 39 was observed in samples. After prolonged incubation, one duck hatched and reached adulthood. In DUM embryos partial crossbeak develops. Both the upper and lower bills deviate lateralwards, the upper bill more than the lower. In stage 39 a small orbit is present on the treated side. In stained and cleared heads most of the elements of the skull (the bones surrounding the orbit, the brain-case, and the upper and lower bill elements) are translated in the direction of the rudimentary orbit on the treated side. The bills are twisted around each other at the tip. Measurements of external dimensions as well as those made in stained and cleared stage-39 DUM heads show elongation of the left part of the lower bill. Except for the crossed bills, the changes found in the embryos persisted in the adult. The findings support a hypothesis concerning the mutual influence of bills during morphogenesis. The coherence of the functional cranial components in the embryo is discussed.     

Double outlet right ventricle with L-position of the aorta, D-loop, subaortic VSD, and pulmonary stenosis

We describe a case of double outlet right ventricle with subaortic ventricular septal defect and pulmonary stenosis treated successfully with cardiopulmonary bypass. We consider the clinical history and angiocardiographic and surgical findings of this rare anomaly. We stress the difficulties of reconstruction of the outflow tract of the right ventricle, because of the anomalous pathway of the right coronary artery, the posterior situation of the pulmonary artery, and the abnormal anatomy present in the outflow tract of the right ventricle.     

Remote results of surgical treatment of chronic suppurative lung diseases

The work was undertaken to study late results of surgical treatment of suppurative lung diseases during 1950-1974. Questionaries were sent to 420 operated patients. Answers were received from 328 (78%) patients, 86% of them were examined clinically, 14%--were estimated according to questionaries and their physician findings. 50 per cent of patients were followed up for 10-24 years. A positive effect was gained in 94.8%. 82 per cent of the operated patients have practically recovered well. The causes of poor issues are described, and trends for their improvement are delineated.