The relative preservation (sparing) of sural sensory nerve action potentials (SNAPs) is a useful diagnostic finding in patients with acute inflammatory demyelinating polyneuropathy (AIDP). However, recording of sural SNAPs is not always technically feasible, especially in obese, edematous, or elderly individuals. Hence, we systematically evaluated the predictive values of the commonly employed SNAPs in the diagnosis of AIDP within 2 weeks from onset of symptoms. Sensory sparing patterns and sensory ratios of the sural, radial, median, and ulnar SNAPs of AIDP patients were included in a retrospective and blinded analysis, and compared to patients with diabetic polyneuropathy (DPN) and controls. Logistic regression models for the sural plus radial SNAPs/median plus ulnar SNAPs (sensory ratio) were constructed. A sural sparing pattern was present only in the AIDP group (34.4%, P < 0.001). A radial sparing pattern did not discriminate the AIDP from the DPN groups. The sural/radial sensory ratio was useful to ascertain DPN, but did not discriminate AIDP from controls. The sensory ratio was higher in AIDP compared to DPN and controls and was an independent predictor for AIDP. This study implies that the sensory ratio is a useful predictor for the diagnosis of AIDP and may substitute for sural sparing in technically difficult situations.

Ways of reducing the length of hospital stay have received increased attention in recent years. Both preoperative and postoperative anaemia have been implicated as causative agents in increasing postoperative length of stay (LOS). In a retrospective study, 317 patients that underwent lumbar decompression and fusion surgery were assessed. Two separate block multivariate linear regression analyses were performed to evaluate the impact of preoperative anaemia, postoperative anaemia, and the degree of perioperative haemoglobin drop on LOS. Other anaemia related factors were also assessed. Preoperative anaemia, postoperative anaemia, and the amount of perioperative haemoglobin drop were all shown to prolong the length of hospitalisation and therefore to increase overall healthcare costs. Following strict anaemia corrective maneuvers could reasonably be expected to reduce expenditure.

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Paediatric Research Society 151 considerable increase in the excretion of certain unidentified iodoplatinate reacting compounds in the first 6-hour urine. When plasma homocyts(e)ine level was high, cyst(e)ine levels after the load were significantly lower than those when homocyst(e)ine was much reduced following administration of betaine.The results suggest that when plasma homocyt(e)ine and methionine are raised, the low levels of cyst(e)ine are due to the incorporation of a very significant proportion of dietary cyst(e)ine into homocysteine-cysteinedisulphide and other sulphur compounds (as yet unidentified) which are derived from homocyst(e)ine or methionine.Temporary tyrosinosis. Douglas Pickering and Brian Bower (Radcliffe Infirmary Oxford). A term baby started to vomit at 4 weeks of age and on admission one week later was in hepatocellular failure with haemorrhage from hypoprothrombinaemia. Large amounts of tyrosine in the urine led to the diagnosis of tyrosinosis and treatment with a low phenylalanine, low tyrosine diet for 15 months (though increasing amounts of tyrosine had been introduced towards the end of the period). Initial complications were (1) oedema from hypoalbuminaemia, (2) drowsiness and apathy from hypermethioninaemia after starting the diet, and later (3) failure to gain weight due to a too drastic tyrosine reduction.The special diet was finally abandoned at the age of 16 months with no complications. When last seen at 3 years 4 months he was normal.A subsequent sib showed no clinical or biochemical features of tyrosinosis.Urinary excretion of immunoglobulin E. T. M. Barratt, M. W. Turner, and S. G. 0. Johansson (Department of Immunology, Institute of Child Health, London W.C.1, and The Blood Centre, University Hospital, Uppsala, Sweden). Immunoglobulin E (IgE) was measured by the radioimmunosorbent technique in sera and urine concentrates of healthy individuals. The urine: plasma ratio of IgE exceeded that of albumin about thirtyfold. As IgE is a considerably larger molecule and would not be expected to cross the glomerular basement as easily as albumin, the data suggest that most urinary IgE does not derive from glomerular filtration but is of local origin within the urinary tract.If this were so, the urinary excretion of IgE would be independent of the plasma IgE concentration and perhaps also of the alterations in glomerular permeability of the nephrotic syndrome. Urinary IgE excretion rates were therefore measured in individuals with the nephrotic syndrome and in patients with atopic eczema characterized by the very high levels of plasma IgE. The results did not differ from those observed in healthy individuals, and provide further support for the hypothesis that most urinary IgE is locally secreted.Maintenance of breathing in newborn lamb. P. Johnson, G. S. Dawes, and J. S. Robinson (introduced by P. M. Dunn) (Nuffield Institute for Medical Research, Oxford). It has been considered by many that the immersion of the fetus in liquid inhibits respiration. Our experiments show that the f...