Radiological diagnosis of foreign bodies in the pharynx and oesophagus

For the purpose of this paper the data of about five hundred X -ray examinations have been investigated, but only those having a particular bearing on the subject will be classified. In cases where no direct confirmation is possible,the author has adopted the following expedient.If the patient did not return to hospital following a negative X -ray examination (or examinations) this is considered as substantial proof that the X -ray report was correct. In no case was oesophagoscopy deemed necessary when the X -ray report was negative, and in no such case was an oesophagoscopy performed subsequently. A few cases originally reported as negative were re- examined,but in none was a foreign body found. The cases may be classified as follows:-a) In 98 cases,the X -ray report was negative, and no oesophagoscopy was performed. b) In 63 cases,the X -ray report was positive, but the location of the foreign body rendered interference unnecessary. c) In 15 cases,the X -ray report was positive, and the foreign body was confirmed and removed by oesophagoscopy. d) In 5 cases,the X -ray report was positive, but no foreign body was found on oesophagoscopic examination. e) In 3 cases,the X -ray report was positive, and in addition a co- existent organic lesion was reported. In these,both the foreign body and the organic lesion were confirmed by oesophagoscopy. Total number of cases investigated - 184It will be seen from these figures that a complete X -ray examination as outlined in the foregoing, performed with due care,gives extremely accurate results. In only five cases was a needless oesophagoscopy performed,thus erring on the side of safety, from the patient's point of view. In no case did the much more serious error occur of overlooking a foreign body when one was present. A closer analysis of these five failures (from the oesophagoscopic standpoint) emphasises the fact that a foreign body may pass downwards in the interim between the X -ray examination and the oesophagoscopy,and therefore the interval should be as short as conveniently possible. In four out of the five cases (Cases 30,31,33,and 34) a foreign body was indisputably present at the time of the X -ray examination,and though not found on oesophagoscopy,confirmatory evidence in the form of mucosal injuries was discovered in one of them. (Case 31). In the remaining case,the X -ray examination raised the possibility of a mucosal injury,bút could not completely exclude the presence of a foreign body. As the other evidence was in favour of a foreign body, an oesophagoscopy was performed but only a mucosal tear was found,and this was confirmed by subsequent X -ray examination. (Case 32). Taking these explanations into account,thersfore,one may take it that four out of five cases were correctly diagnosed and that the fifth failed only in being unable to exclude the presence of a foreign body in the mucosal tear that was found as reported. This standard of accuracy seems to the author to justify complete reliance on the X -ray examination

Accidental Haemorrhage

Edward Rigby of Norwich, in a treatise on uterine haemorrhage published in 1776, first shed light on the problem of bleeding from the vagina during later pregnancy. In this essay he differentiated between an accidental haemorrhage and the haemorrhage of a placenta praevia. From his observations accidental haemorrhage was defined as "bleeding from a normally situated placenta, after the 28th week of gestation, and up to the end of the second stage of labour."Accidental haemorrhage is divided into three varieties:1. Revealed Accidental Haemorrhage.-where the bleeding is entirely external;2. Concealed Accidental Haemorrhage.-where there is no sign of blood externally;3· Mixed or Combined Accidental Haemorrhage.-which shows features of both concealed and revealed.The most important of these is the concealed variety and there are four ways in which a haemorrhage may remain concealed:1. A retroplacental haemorrhage occurs in the central area of the placenta, but the margins of the placenta remain adherent to the uterine wall.2. If the placenta becomes completely separated the membranes remain attached to the uterine wall.3· The blood may burst through the membranes into the amniotic sac mingling with the liquor, and   immersing the foetus in a blood bath (Lesser 1951).4· When the foetal head is accurately applied to the lower uterine segment so that the blood cannot make its way past it into the vagina.In spite of these mechanisms it is much more common for blood to escape externally ; a concealed accidental haemorrhage thus becomes a mixed accidental haemorrhage

Engendering the future : divination and the construction of gender in the late Roman Republic

Ph. D. ThesisThis study brings together constructions of divination and gender in the Late Roman Republic, and argues how each influenced the performative nature of the other. Divination is usually understood as a standardised process of interpreting varying signs, through which a person can gain access to knowledge otherwise unattainable, often relating to the future. To construct divination as performative considers how the different elements of divinatory traditions, including, but not limited to, the identity of the divinatory actors, are the very factors that confirm the correctness of the interpretation and thus the reality of divination. This thesis argues how the performativity of gender informed, but was also informed by, the performativity of divination in the Roman world, in a reciprocal and inseparable relationship. The first chapter focuses on Cicero’s De Diuinatione, a mid-first century BC text that presents two sets of opposing views for and against divination. My reading shows how gender is axiomatic to – but never explicit in – these opposing viewpoints. Four chapters follow, each taking a specific divinatory tradition as a case study, and exploring constructions of gender across them: the Sibylline Books, as written prophetic guides for the State; the construction of the birth of an intersex child as a prodigy under the Republic, and the ritual response it garnered; the sacrificial specialism of individual diviners, specifically through the story of a woman named Martha; and, finally, the construction of prophetic dreaming in the Roman Republic. Although the chapters in this thesis advance different arguments, taken as a whole they enhance the understanding of the relationship between gender and divination in the Roman world. Roman women – and men – succeeded in being able to construct a performative identity within a diverse body of divinatory traditions, enabling them to communicate with the supernatural and assert a distinctive relationship with it.Max-Weber-Kolleg, Universität Erfurt

Dimethylarginine dimethylaminohydrolase-2 deficiency promotes vascular regeneration and attenuates pathological angiogenesis

AbstractIschemia-induced angiogenesis is critical for tissue repair, but aberrant neovascularization in the retina causes severe sight impairment. Nitric oxide (NO) has been implicated in neovascular eye disease because of its pro-angiogenic properties in the retina. Nitric oxide production is inhibited endogenously by asymmetric dimethylarginines (ADMA and L-NMMA) which are metabolized by dimethylarginine dimethylaminohydrolase (DDAH) 1 and 2. The aim of this study was to determine the roles of DDAH1, DDAH2, ADMA and L-NMMA in retinal ischemia-induced angiogenesis. First, DDAH1, DDAH2, ADMA and L-NMMA levels were determined in adult C57BL/6J mice. The results obtained revealed that DDAH1 was twofold increased in the retina compared to the brain and the choroid. DDAH2 expression was approximately 150 fold greater in retinal and 70 fold greater in choroidal tissue compared to brain tissue suggesting an important tissue-specific role for DDAH2 in the retina and choroid. ADMA and L-NMMA levels were similar in the retina and choroid under physiological conditions. Next, characterization of DDAH1+/− and DDAH2−/− deficient mice by in vivo fluorescein angiography, immunohistochemistry and electroretinography revealed normal neurovascular function compared with wildtype control mice. Finally, DDAH1+/− and DDAH2−/− deficient mice were studied in the oxygen-induced retinopathy (OIR) model, a model used to emulate retinal ischemia and neovascularization, and VEGF and ADMA levels were quantified by ELISA and liquid chromatography tandem mass spectrometry. In the OIR model, DDAH1+/− exhibited a similar phenotype compared to wildtype controls. DDAH2 deficiency, in contrast, resulted in elevated retinal ADMA which was associated with attenuated aberrant angiogenesis and improved vascular regeneration in a VEGF independent manner. Taken together this study suggests, that in retinal ischemia, DDAH2 deficiency elevates ADMA, promotes vascular regeneration and protects against aberrant angiogenesis. Therapeutic inhibition of DDAH2 may therefore offer a potential therapeutic strategy to protect sight by promoting retinal vascular regeneration and preventing pathological angiogenesis

HIF-1alpha and HIF-2alpha are differentially activated in distinct cell populations in retinal ischaemia.

BACKGROUND: Hypoxia plays a key role in ischaemic and neovascular disorders of the retina. Cellular responses to oxygen are mediated by hypoxia-inducible transcription factors (HIFs) that are stabilised in hypoxia and induce the expression of a diverse range of genes. The purpose of this study was to define the cellular specificities of HIF-1alpha and HIF-2alpha in retinal ischaemia, and to determine their correlation with the pattern of retinal hypoxia and the expression profiles of induced molecular mediators. METHODOLOGY/PRINCIPAL FINDINGS: We investigated the tissue distribution of retinal hypoxia during oxygen-induced retinopathy (OIR) in mice using the bio-reductive drug pimonidazole. We measured the levels of HIF-1alpha and HIF-2alpha proteins by Western blotting and determined their cellular distribution by immunohistochemistry during the development of OIR. We measured the temporal expression profiles of two downstream mediators, vascular endothelial growth factor (VEGF) and erythropoietin (Epo) by ELISA. Pimonidazole labelling was evident specifically in the inner retina. Labelling peaked at 2 hours after the onset of hypoxia and gradually declined thereafter. Marked binding to Müller glia was evident during the early hypoxic stages of OIR. Both HIF-1alpha and HIF-2alpha protein levels were significantly increased during retinal hypoxia but were evident in distinct cellular distributions; HIF-1alpha stabilisation was evident in neuronal cells throughout the inner retinal layers whereas HIF-2alpha was restricted to Müller glia and astrocytes. Hypoxia and HIF-alpha stabilisation in the retina were closely followed by upregulated expression of the downstream mediators VEGF and EPO. CONCLUSIONS/SIGNIFICANCE: Both HIF-1alpha and HIF-2alpha are activated in close correlation with retinal hypoxia but have contrasting cell specificities, consistent with differential roles in retinal ischaemia. Our findings suggest that HIF-2alpha activation plays a key role in regulating the response of Müller glia to hypoxia

Res Medica, May 1961, Volume II, Number 4

TABLE OF CONTENTSDEBILITY AND / OR LOSS OF WEIGHT Charles W. Seward, M.D., F.R.C.P.E.LEUKAEMIA James A. Barrowman, B.Sc.POISONING BY BRITISH PLANTS R. W. Corner, Esq.RES MEDICAAUSCULTATION OF THE HEART: Ill R. W. D. Turner, O.B.E., M.A., M.D., F.R.C.P.Ed., F.R.C.P.Lond. PARRY AND PARRY'S DISEASE R. I. Legge NUTRITIONAL BLINDNESS D. S. McLaren, M.D., Ph.D., D.T.M. & H.ACCIDENTAL HAEMORRHAGE James MowatEYE CHANGES IN DISSEMINATED SCLEROSIS A. D. ChalmersBOOK REVIEWSREFLECTIONS