Accuracy of ultrasound in a screening programme for abdominal aortic aneurysms.

Objectives: To assess the accuracy of ultrasound in the measurement of aortic diameter.

Setting: A general practice based screening programme for abdominal aortic aneurysm.

Design: (a) comparison of ultrasound with computed tomography (CT) measurement; (b) two period crossover study to assess interobserver error; (c) comparison of ultrasound measurements by technicians and radiologists.

Is surgery necessary for abdominal aortic aneurysm less than 6 cm in diameter?

During 8 years of an ultrasound screening programme for abdominal aortic aneurysm (AAA), 8944 people aged 65-80 years were scanned. 356 (4%) had AAA of diameter 3 cm or greater. Under our criteria repair was indicated if the aortic diameter reached 6 cm, if expansion reached 1 cm per year, or if the AAA caused symptoms; 124 patients met these criteria.

Identification of the infected target cell type in spongiform myeloencephalopathy induced by the neurotropic Cas-Br-E murine leukemia virus.

The Cas-Br-E murine leukemia virus (MuLV) induces a progressive hindlimb paralysis accompanied by a spongiform myeloencephalopathy in susceptible mice. In order to better understand the pathological process leading to these neurodegenerative lesions, we have investigated the nature of the cell type(s) infected by the virus during the course of the disease in CFW/D and SWR/J mice. For this purpose, we used in situ hybridization with virus-specific probes in combination with cell-type-specific histochemical (lectin) and immunological markers as well as morphological assessment.

Hepatic tumors: role of computed tomographic arterial portography in surgical planning.

Various imaging modalities currently used to evaluate liver tumors include magnetic resonance imaging, ultrasonography, contrast-enhanced computed tomography, and computed tomographic arterial portography. In our review of 28 cases, we found CT arterial portography to be very sensitive, and in 5 of these 28 cases CT arterial portography was a key factor in altering the course of therapy.

Clinically diagnosed presenile dementia of the Alzheimer type in the Northern Health Region: ascertainment, prevalence, incidence and survival.

Potential cases of presenile dementia of the Alzheimer type (PDAT) in the Northern Health Region (estimated population aged 45-64, 655,800) were ascertained for the years 1979-86 from in-patient ICD-9 codes and other sources. An algorithm was applied to the casenote information to distinguish between Alzheimer-type and other forms of dementia. A search of the NHS central register was made to establish date and place of death.

Sperm antibodies in a patient with obstructive azoospermia.

An artificial spermatocoele was constructed at the level of the caput epididymis in a patient with obstructive azoospermia. Morphologically normal spermatozoa were harvested but motility and progression were inadequate for intra-uterine insemination or in vitro fertilisation. In addition, there was an antispermatozoal antibody response which transuded back into the reproductive tract and coated spermatozoa with antibody.

Death certification after a diagnosis of presenile dementia.

Study Objectives: To assess the value of death certification for the epidemiological study of dementia, the frequency with which the condition was recorded on death certificates of patients diagnosed with some form of dementia before the age of 65 years was studied. A further objective was to identify variables associated with failure to record dementia on the certificate.

Design: A cohort of patients with presenile dementia, differentiated by a clinical algorithm applied to hospital case records, was traced through the National Health Service Central Registry and details of certified causes of death were obtained.

Water and non-water-related risk factors for gastroenteritis among bathers exposed to sewage-contaminated marine waters.

All previously published epidemiological studies of the health effects of bathing in marine waters contaminated with domestic sewage contain three major methodological weaknesses in study design: (1) failure to control for the substantial amount of temporal and spatial variation in indicator organism densities shown to occur within just a few hours at marine water bathing locations; (2) failure to relate indicator organism density directly to the individual bather; and (3) failure to rigorously control for non-water-related risk factors on previously reported associations between bathing in marine waters and illness among such bathers. We report the results of two intervention follow-up studies specifically designed to address these methodological weaknesses. We restricted study outcome to bathing-associated gastroenteritis since this is the illness most consistently reported to be associated with bathing in marine waters, and upon which both current US Marine Water Quality Criteria and other standards used worldwide are based.

Effect of exercise on the bone mineral density and bone remodelling indices in women with rheumatoid arthritis: 2 case studies.

Two premenopausal women with rheumatoid arthritis of 16 years' duration were enrolled in a one year conditioning exercise program consisting of walking and low impact aerobics. The effect of exercise on the markers of bone formation (serum bone specific alkaline phosphatase and osteocalcin), bone resorption (urinary calcium/creatine and serum tartrate resistant acid phosphatase), and vertebral bone mineral density as determined by dual photon absorptiometry are discussed.

Neurological disease induced in transgenic mice expressing the env gene of the Cas-Br-E murine retrovirus.

The Cas-Br-E murine leukemia virus induces a spongiform myeloencephalopathy in susceptible mice. We constructed transgenic mice harboring either the viral genome (in a replication-defective form) or only its env gene. Low levels of expression of either transgene resulted in mild neuropathology and/or signs of neurological disease in more than half of these mice.

Anti-sperm antibodies and semen profiles in re-anastomosed men.

A group of 29 re-anastomosed men were examined with respect to semen quality, anti-sperm antibody titres in serum and seminal plasma, presence of anti-sperm antibodies on sperm, and success rate in inducing pregnancy. Results indicated no association between pre-reversal serum anti-sperm antibody titres and post-reversal semen quality, but a pregnancy induction rate of zero was associated with serum anti-sperm antibody titres greater than 160. It is recommended that men considering reversal, with anti-sperm antibody titres of this level, should receive counselling about the possibility of post-reversal infertility.

An expert system for water quality modelling.

The RAISON-micro (Regional Analysis by Intelligent System ON a micro-computer) expert system is being used to predict the effects of mine effluents on receiving waters in Ontario. The potential of this system to assist regulatory agencies and mining industries to define more acceptable effluent limits was shown in an initial study. This system has been further developed so that the expert system helps the model user choose the most appropriate model for a particular application from a hierarchy of models.

Local immunity in the male reproductive tract.

In previous studies we have demonstrated that the male urinary tract forms part of the common mucosal immune system, and that the gut contributes to local defences at this site. The question arises as to the extent to which the reproductive tract also forms part of the common mucosal immune system. Rats were immunized by a variety of routes designed to stimulate a local response in the intestine and/or the reproductive tract.

Dysphoria: a major symptom factor in persons with disability or chronic illness.

Depression frequently is diagnosed in persons with chronic illness or following the onset of disability. The overlap of symptoms of many chronic illnesses and disabling conditions with depression may lead to an overestimation of depression in such populations. Some investigators have proposed revised criteria for diagnosing depression in these conditions without an understanding of the contribution of diagnostic criteria in disabling conditions.

Health effects of white-water canoeing.

There is little quantitative information on the relation between water quality and disease attack rates after recreational activities in fresh water. We conducted a prospective cohort study to measure the health effects of white-water and slalom canoeing in two channels with different degrees of microbial contamination. Site A, fed by a lowland river, showed high enterovirus concentrations (arithmetic mean 198 pfu per 10 litre and moderate faecal coliform concentrations (geometric mean 285/dl); at site B, from an upland impoundment, all samples were free of enteroviruses and the geometric mean faecal coliform concentration was 22/dl.

Methodological problems with diagnosis of dementia in community surveys: the choice of items to study higher functions.

The 'global' character of dementia distinguishes it from other organic syndromes but in community surveys memory impairment is the predominant early symptom and the aphasia, apraxia and agnosia triad characteristic of dementia of Alzheimer type disease (DAT) may be hard to demonstrate. Both the Mini-Mental State (MMS) and CAMDEX contain appropriate items but information about how elderly persons in general perform on these tests is limited. This paper examines the relative difficulty of the items in a general practice sample and compares their sensitivity and specificity taking AGECAT organic diagnosis as criterion.

Ligament strain and ankle joint opening during ankle distraction.

To determine the efficacy of ankle distraction and to investigate possible complications of the procedure, the strain on four ankle ligaments and the tibiotalar joint opening resulting from distraction force and various foot positions were studied. We mounted strain gauges on the deltoid, calcaneofibular, tibiofibular, and anterior talofibular ligaments of six fresh human cadaver ankles. An Acufex ankle distractor was used to apply forces of 45, 90, 135, and 180 N at 20 degrees dorsiflexion, neutral, and 10 degrees plantar flexion.

Comparison of the SpermMar test with currently accepted procedures for detecting human sperm antibodies.

To eliminate the possibility of immunological infertility in spontaneously infertile and re-anastomosed men, a screening test that can be applied directly to semen is desirable. The SpermMar test is one such possibility. In this study, indirect tests for sperm antibodies using the commercial SpermMar test have been applied to a panel of sera whose reactions in the tube slide agglutination test (TSAT), gelatin agglutination test (GAT) and sperm immobilization test (SIT) for sperm antibodies are well characterized.

The majority of cells infected with the defective murine AIDS virus belong to the B-cell lineage.

Murine AIDS (MAIDS) is caused by a defective retrovirus which encodes a gag fusion protein (Pr60gag). We previously reported that this virus induced an oligoclonal proliferation of infected cells and suggested that this cell expansion was an important event in the pathogenesis of MAIDS. To identify these target cells, we constructed novel defective viruses whose genomes could be detected with specific probes.

Abdominal aortic aneurysm in 4237 screened patients: prevalence, development and management over 6 years.

An ultrasonography screening programme for detecting abdominal aortic aneurysm (AAA) in the community is described in which 7200 men and women aged between 65 and 80 years were contacted by letter. Of these, 4237 were screened; the aorta was visualized in 4122 and 179 AAAs of 3 cm or more in diameter were detected (4.3 per cent).

The diagnosis of dementia in the elderly. A comparison of CAMCOG (the cognitive section of CAMDEX), the AGECAT program, DSM-III, the Mini-Mental State Examination and some short rating scales.

The performance of CAMCOG, the cognitive section of the CAMDEX, is compared in a non-random sample of 222 elderly people with diagnoses based on AGECAT and on DSM-III criteria, and with the MMSE and some short rating scales. With a cut-off point of 69/70 and AGECAT organic syndrome as the criterion, the sensitivity of CAMCOG was 97% and the specificity 91%. However, 21% of DSM-III diagnoses of dementia scored above this cut-off; these were mostly mild cases.

Development of intrapancreatic transplantable model of pancreatic duct adenocarcinoma in Syrian golden hamsters.

Intrapancreatic and subcutaneous (SC) inoculation of cultured pancreatic cancer cells, derived from an induced primary pancreatic cancer in a Syrian hamster, resulted in tumor take in all recipient hamsters. The intrapancreatic allografts grew rapidly, were invasive, and metastasized into the lymph nodes and liver in 2 of 9 cases. In comparison, SC tumors grew relatively slower and formed a large encapsulated mass without invasion and metastases.

Retrovirus-induced spongiform myeloencephalopathy in mice: regional distribution of infected target cells and neuronal loss occurring in the absence of viral expression in neurons.

The Cas-Br-E murine leukemia virus (MuLV) induces a spongiform myeloencephalopathy resulting in a progressive hindlimb paralysis. We have used in situ hybridization with a Cas-Br-E MuLV-specific probe to study viral expression in the central nervous system. Infected cells were concentrated in regions where spongiform lesions and gliosis are detected (lumbosacral spinal cord, brainstem, deep cerebellar regions), suggesting a causative link between the level of virus expression and the degree of pathological changes in this disease.