BACKGROUND While very low birth weight (VLBW) infants often require multiple red blood cell transfusions, efforts to minimize transfusion‐associated risks have resulted in more restrictive neonatal transfusion practices. However, whether restrictive transfusion strategies limit transfusions without increasing morbidity and mortality in this population remains unclear. Recent epidemiologic studies suggest that severe anemia may be an important risk factor for the development of necrotizing enterocolitis (NEC). However, the mechanism whereby anemia may lead to NEC remains unknown. STUDY DESIGN AND METHODS The potential impact of anemia on neonatal inflammation and intestinal barrier disruption, two well‐characterized predisposing features of NEC, was defined by correlation of hemoglobin values to cytokine levels in premature infants and by direct evaluation of intestinal hypoxia, inflammation and gut barrier disruption using a pre‐clinical neonatal murine model of phlebotomy‐induced anemia (PIA). RESULTS Increasing severity of anemia in the preterm infant correlated with the level of IFN‐gamma, a key pro‐inflammatory cytokine that may predispose an infant to NEC. Gradual induction of PIA in a pre‐clinical model resulted in significant hypoxia throughout the intestinal mucosa, including areas where intestinal macrophages reside. PIA‐induced hypoxia significantly increased macrophage pro‐inflammatory cytokine levels, while reducing tight junction protein ZO‐1 expression and increasing intestinal barrier permeability. Macrophage depletion reversed the impact of anemia on intestinal ZO‐1 expression and barrier function. CONCLUSIONS Taken together, these results suggest that anemia can increase intestinal inflammation and barrier disruption likely through altered macrophage function, leading to the type of predisposing intestinal injury that may increase the risk for NEC.

Two siblings with the classical phenotype of complete androgen insensitivity syndrome (CAIS) and increased total cellular androgen receptor concentrations in genital skin fibroblasts (GSF) are described. Testosterone biosynthesis was normal, and there was no evidence of 5 alpha-reductase deficiency. Specific binding of [3H]dihydrotestosterone ([3H]DHT) in GSF was 7 SD above the mean value in normal fibroblast strains [maximum binding, 775 +/- 185 X 10(-18) mol/micrograms DNA (mean +/- SD)]. Binding at 40 C was stable, and the androgen-receptor complex dissociated at a normal rate (t1/2, 85 min). The androgen-receptor complex from GSF cytosol sedimented at 5-6S on sucrose density gradients in the presence of sodium molybdate. In a whole cell binding assay, the percentage of [3H]DHT that bound to a crude nuclear pellet was 60%. Preincubation of GSF with 2 nM [3H]DHT for 20 h before the standard 1-h whole cell binding assay produced a further augmentation in elevated total cellular androgen receptor concentrations. A new variant of CAIS is described which is characterized by an increased concentration of androgen receptors that appear to be quantitatively and qualitatively normal. Augmentation of the receptor by androgen suggests that the gene coding for the androgen receptor is intact and does not account for the androgen insensitivity.

Medical Research Society 9P m: To evaluate the efficacy of an open access carotid duplex service in relation to the pattern of referral and outcome in a local population. Method: Review of patients attending Open Access Carotid Duplex Service in 1996197. &&&:There were 789 patients scanned (403 male, 386 female) with a mean age of 65 years and a mean waiting time of 10.9 days. The largest proportion of referrals was from physicians(39.9%) followed by vascular surgeons(22.3%), other feeder hospitals(2l.9%), general practitioners(6.6%) and others(9.3%). Of the patients referred for scanning, 623(78.90/0) had "hard symptoms" (hemimotorl hemisensory loss, dysphasia or amaurosis fugax) and of this group only 157(25.2%) had significant stenoses. The significant stenosis(>70 %) pick up rate for all groups was 25.6% (202 patients). Of the 89 patients referred by vascular surgeons, 49 (55%) underwent subsequent carotid endarterectomy. I 13 patients from other sources who had significant stenoses did not have any known vascular follow up. 46 asymptomatic high risk patients also had Transcranial doppler monitoring out of which 7 patients (15.2%) had evidence of ongoing embolisation. Conclusion: Open Access Carotid Duplex is an effective method of identifying a population at risk. This study has also identified a large subgroup that would not have seen a vascular specialist and may thus provide a safety net for such patients.

12that of the acid levels and also that they gave a more accurate confirmation of possible ulceration.Based on the study of these 64 persons it has been shown that a 95% accuracy is possible in placing individuals into the correct groups. It would seem that this method of examining the gastric secretion will aid in the diagnosis of duodenal ulceration and may prove most helpful in the X-ray-negative dyspepsias.

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