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Orexin-A and orexin-B, via their receptors orexin-1 receptor (OX1R) and orexin-2 receptor (OX2R) have been shown to play a role in the regulation of feeding, body weight, and energy expenditure. Adipose tissue also contributes significantly to the maintenance of body weight by interacting with a complex array of bioactive peptides; however, there are no data as yet on the expression of orexin components in adipose tissue. We, therefore, analyzed the expression of OX1R and OX2R in human adipose tissue and determined functional responses to orexin-A and orexin-B. OX1R and OX2R mRNA expression was detected in subcutaneous (s.c.) and omental adipose tissue and in isolated adipocytes. Protein for OX1R and OX2R was also detected in whole adipose tissue sections and lysates. Treatment with orexin-A, and orexin-B (100 nM, 24 h) resulted in a significant increase in peroxisome proliferator-activated receptors γ-2 mRNA expression in s.c. adipose tissue (P < 0.05). Hormone sensitive lipase mRNA was significantly reduced in omental adipose tissue with orexin-A and orexin-B treatment (P < 0.05). Glycerol release from omental adipose tissue was also significantly reduced with orexin-A treatment (P < 0.05). These findings demonstrate for the first time the presence of functional orexin receptors in human adipose tissue and suggest a role for orexins in adipose tissue metabolism and adipogenesis.

Two hundred and fifty-six consecutive new patients seen in the weekly burns outpatient clinic were questioned, concerning details of their injury and first aid measures taken, and the information was recorded on a questionnaire. Following computer analysis, an interesting pattern of incidence, susceptible age groups, 'danger zones', and first aid given in the community emerged. Conclusions regarding burn prevention and first aid have been drawn.

The most effective technologies currently available for controlling NOx emissions from heavy duty industrial gas turbines are either diluent injection in the combustor reaction zone, or dry low NOx (DLN) combustion, coupled with selective catalytic reduction (SCR) De-NOx in the gas turbine exhaust. A competing technology with the potential for achieving comparable emissions levels at substantially lower capital investment and operating cost is catalytic combustion of lean premixed fuel and air within the gas turbine. A preliminary design of a catalytic combustion system using natural gas fuel has been prepared for the GE Model MS9001E gas turbine. A full scale test combustor has been constructed for a full pressure development test based upon this design work and was operated at the GE Power Generation Engineering Laboratory in Schenectady, New York. Discussion of the catalytic combustor design, the catalytic reactor design and laboratory development test results is presented.Copyright © 1995 by ASME

Background: Cardiac siderosis from transfused iron remains the major cause of death in thalassaemia major, despite iron chelation therapy with desferrioxamine. Aims: Our aim was to determine the nature and extent of cardiac involvement and its relationship to desferrioxamine use in a group with thalassaemia major. Methods: We reviewed 76 patients with thalassaemia major and performed multiple logistic regression to analyse factors affecting cardiac involvement. Factors studied included: patient sex, age, haemoglobin, serum ferritin, total transfusions, liver iron, duration of desferrioxamine use, electrocardiograms, echocardiograms and compliance to desferrioxamine treatment. Results: Thirty-seven patients developed heart disease. They were older (p < 0.001), began desferrioxamine later (p < 0.001), had more liver iron (p= 0.014), higher serum ferritin levels (p= 0.023) and received more blood (p = 0.018). Compared to those with optimal compliance the odds of developing heart disease were increased 10.7 times in fair compilers (p

Combination chemotherapy with cytosine arabinoside, cyclophosphamide and L-asparaginase (Asnase) was given to 22 children with acute lymphocytic leukaemia (ALL) with a white-cell count greater than 30 X 10(9)/1, and other features suggestive of poor prognosis. Complete remission was induced in all patients--in 19 after 2 courses of chemotherapy and in the remainder after a third course. During induction, neutropenia occurred in 18 and severe infection in 3. Anaphylaxis to Asnase occurred in 8 patients after the second course and one other had transient Asnase-induced diabetes. All patients received central-nervous-system prophylaxis after achieving remission, during which they were also treated with weekly vincristine and a 2-week course of prednisolone. Continuation therapy consisted of short cycles of intermittent chemotherapy and BCG inoculation or long cycles of intermittent chemotherapy +/- BCG. Life-table analysis shows 46% complete remission rate at 28 months, with 6 patients all in complete remission followed up between 28 and 41 months. There were minimal complications of continuation therapy, and BCG inoculation was well tolerated.

Feery, B. J., Matthews, R. N., Evered, M. G., and Gallichio, H. A. (1979).Aust. Paediatr. J., 15, 177–180. Antibody responses to influenza virus vaccine in children with acute lymphocytic leukaemia. Antibody responses to influenza immunization in children with acute lymphocytic leukaemia in remission were studied in two successive years. Initial antibody levels, the response to immunization, and final antibody levels were lower than in a group of children with cystic fibrosis. The results indicate that both primary and anamnestic antibody responses are depressed in children with acute leukaemia when they are on immunosuppressive therapy. Despite this depression the majority of the patients reached protective antibody levels to the A/Victoria/3/75 and A/Texas/1/77 (H3N2) antigens but not to the recent A/USSR/90/77 (H1N1) antigens.

We present in this paper the indications for bony reconstruction following mandibular resection, together with evaluation of the reconstructive techniques available. Case reports illustrate methods we have found satisfactory and are followed by our recommendations for their specific use.

Three cases are reported illustrating serious problems which may follow the use of the transverse lower abdominal rectus abdominis myocutaneous flap. In the first two cases the flap was used for breast reconstruction, and in the third case it was used to reconstruct an anterior chest wall defect following radiotherapy. The reliability of the blood supply is discussed and a fourth case presented to demonstrate the comparative safety of a similar flap supplied by the deep inferior epigastric vessels. It is concluded that the flap should be used with discretion and reserved for use following the failure of simpler and established methods of breast and chest wall reconstruction.

Stricture formation may occur after pharyngolaryngectomy it less than one half of the circumference of the pharynx is available for primary closure. However, the alternative of total pharyngectomy with skin flap or visceral replacement carries with it a high mortality and morbidity rate. In an attempt to overcome these problems, a policy of patch grafting the paryngeal defect with a myocutaneous flap or segment of free vascularised jejunum has been adopted whenever a strip of pharyngeal mucosa greater than one centimetre in width remains after excision of the tumour. A good post-operative smallow has been achieved in all cases.

Twelve children with acute lymphocytic leukemia who had been in complete remission on continuous chemotherapy for at least 12 months, were treated with intermittent courses of chemotherapy alternating with BCG inoculation during the drug-free intervals. Measurements were made of leukocyte populations in blood and bone marrow leukemic blastogenic responses of blood lymphoid cells to phytohemmagglutinin and soluble leukemic blast cell membrane antigen. Antibody titers to a soluble leukemic blast-cell membrane-derived antigen were determined. Comparison was made with similar measurements during a second phase of intermittent chemotherapy without BCG inoculation (phase II). Two children showed bone-marrow relapse and two developed central nervous system leukemia during the study. Rises in blood and bone-marrow lymphoid cell numbers were found during both phases of the study. Blastogenic responses to phytohemagglutinin, depressed at the start of the study following at least 12 months of continuous chemotherapy, rose during intermittent chemotherapy and BCG and remained within normal ranges during phase II. Antibody titers and blastogenic responses to leukemia blast-cell membrane antigens increased in eight of twelve and six of seven children respectively during the BCG phase and were maintained during phase II. Only one child showed further increases in phase II. The combination of BCG and intermittent chemotherapy may increase leukemia-associated immunity in some patients with acute lymphocytic leukemia in remission. The separate contributions of either BCG or intermittent chemotherapy in producing this effect cannot be determined by this study.

Approaches to reconstructing floor of mouth defects are reviewed including methods of bony reconstruction following mandibular resection. The place of the free radial forearm flap, incorporating vascularized hemiradius if necessary, is described together with the anatomy, operative technique and a review of seven cases. It is concluded that this flap is an important addition to current methods of reconstructing substantial intraoral soft tissue defects alone or associated mandibular defects as well, owing to the high quality of results and to its low morbidity.

The rare event of simultaneous, spontaneous rupture of both flexor tendons in the mid-segment of one finger is described and discussed in relation to previous reports of tendon rupture in the hand.

From 1972 to 1977, 55 of 161 children with acute lymphocytic leukaemia discontinued treatment after being in continuous complete remission for three years. A low total white cell count as diagnosis (less than 10 X 10(9)/L) was significantly associated with cessation of therapy, but there was no significant association with age or sex. Nine patients have relapsed, all but one within 50 weeks of cessation of treatment. Testicular relapse occurred only in one patient. Actuarial complete remission rate with a median duration of follow-up 140 weeks was 76%, and there was no significant sex difference. It is proposed that the relatively good prognosis in boys after cessation of therapy may be related to limited use of steroids during induction chemotherapy.

Summary. Burns rarely cause problems in subsequently occurring pregnancies. Occasionally abdominal wall scarring is so dense and extensive that consequent maternal pain in the second half of pregnancy demands surgical decompression. This does not usually precipitate labour and the resultant raw areas should be covered with split skin autografts. It is exceptional for burns to destroy the entire breast disc; residual breast mound development occurs during puberty, and hypertrophy and engorgement during and after pregnancy. Although absence of the nipple-areola complex precludes breast feeding, distortion of it does not prevent feeding in all cases. Split skin autografting with customized pressure therapy is the best remedy for correction of contracture deformity.

With migration, beta-thalassaemia has become a world health problem. Research into its nature and management is being performed in many countries. Where transfusion services are readily available, new intensive transfusion programmes are being attempted and result in better general health, and inhibition or delay in the onset of bone changes and hepatosplenomegaly. Intravenous and subcutaneous infusions of desferrioxamine now offer possible reduction in transfusional haemosiderosis. Prenatal diagnosis of beta-thalassaemia is now possible. Techniques for fetal blood sampling and laboratory investigation are being perfected in a number of centres.

Conditions for the in vitro culture of multipotential and committed progenitor cells obtained from the peripheral blood of transfusion-dependent beta-thalassemic individuals have been determined. When stimulated by either human placental-conditioned medium (HPCM), phytohemagglutinin-stimulated leukocyte-conditioned medium (PHA-LCM), or U5637-conditioned medium and erythropoietin, colonies containing neutrophils, neutrophils and macrophages, macrophages, eosinophils, erythroid cells, or mixtures of erythroid cells and neutrophils, eosinophils, or macrophages were obtained in cultures of beta-thalassemic mononuclear cells. Removal of adherent cells from beta-thalassemic peripheral blood demonstrated the presence of cells capable of the autostimulation of all of the above colony types in the presence of erythropoietin. In addition, adherent cells also appeared to inhibit erythropoiesis in cultures stimulated with HPCM. In cultures of nonadherent beta-thalassemic mononuclear cells, one population of BFU-E was stimulated by erythropoietin and a second required both erythropoietin and HPCM. Titration of erythropoietin, in the presence of optimal stimulation by HPCM, showed that beta-thalassemic peripheral blood BFU-E were more responsive to erythropoietin than was normal peripheral blood BFU-E. Stimulation of multipotential cells in cultures of nonadherent mononuclear cells was dependent upon HPCM. Using these culture conditions, the studies show that, compared with normals, the peripheral blood of transfusion-dependent beta-thalassemic patients contain elevated numbers of multipotential and committed progenitor cells, and that splenectomy did not account for the elevated numbers of these cells.

The rare event of simultaneous, spontaneous rupture of both flexor tendons in the mid-segment of one finger is described and discussed in relation to previous reports of tendon rupture in the hand.

In 14 cases aged 9-79 years the radial forearm flap has been used for reconstruction. Of 4 island flaps, 2 were distally based (1 with nerve anastomosis) and 2 proximally based (1 innervated). Of the free flaps, 7 were for intra-oral lining following major resection and 3 of these included hemi-radius for mandibular reconstruction. Most flaps were put into a hostile environment resulting from chronic infection and/or radiotherapy or fast neutron therapy. Two flaps failed including one osseocutaneous free flap. Important anatomical, pre-operative and operative aspects are considered, including a description of the timed Allen test, and potential pitfalls and refinements are described.

Continuation therapy using intermittent chemotherapy and BCG inoculation was commenced in 28 children with acute lymphocytic leukemia (ALL) immediately after remission induction and "CNS prophylaxis." At a median followup time of 17 months, 71% remain in total remission and 86% in bone marrow remission. Complications of the therapy were minimal. Major infections occurred on two occasions and there were no deaths in remission. Neutropenia, "minor" infections and postponement of chemotherapy occurred most often during the first three courses of treatment. There were no local or systemic BCG infections. Tuberculin sensitivity was tested in 25 patients. It was positive in 17 of 18 patients in total remission and all four patients with only CNS relapse, and was negative prior to relapse in three patients who developed bone marrow disease.

Thalassaemia is a significant public health problem in Australia. There is a need for improved patient education about the disease in order to prevent unnecessary anxieties. The recent advent of methods for antenatal diagnosis has given emphasis to a preventive approach. A screening and counselling service established at Queen Victoria Memorial Hospital, Melbourne, is described, and some of the problems encountered are discussed. Psychological problems are common, and these need to be managed carefully.

Results of treatment in 72 children with a relapse of acute lymphoblastic leukaemia were analysed. A second remission was induced in 57 children (79%). Remission rates were significantly higher in males, and in patients with white cell counts less than 30 X 10(9)/L. The median duration of the second remission was only four months, and the median duration of survival from the time of relapse was nine months. The median duration of survival from the time of diagnosis was 27 months. Among children who suffered a relapse was a small group who had prolonged survival and prolonged second remissions. It is uncertain whether some of these may have a chance of "cure".

Treatment of acute myeloid leukaemia in children. C. M. Paton, H. Ekert, K. D. Waters, R. N. Matthews and I. R. G. Toogood, Aust. N.Z. J. Med., 1982, 12, pp. 143–146. Complete remission was achieved in 11 of 22 children with acute myeloid leukaemia using at least two courses of a 24 hour infusion of cytosine arabinoside (Ara–C) 10 mg/kg, followed by push injections of daunorubicin (DNR) 45 mglm2, and adriamycin (ADR) 45 mglm2. Consolidation therapy consisted of three courses of Ara–C and 6–thioguanine (Tg) and one course of cyclophosphamide (CPA) and ADR. Central nervous system prophylaxis with intrathecal Ara–C was given in all patients and cranial irradiation in five. Maintenance therapy consisted of 5 day courses of Ara–C and Tg given 4 weekly with immunotherapy (BCG vaccine and subcutaneous leukaemic cells) between courses. Median length of first complete remission was 99+ weeks, and median survival of all patients was 44 weeks. Median survival of remitters was 195+ weeks and non–remitters, 28 weeks. Two patients developed central nervous system disease, one at presentation and the other 46 weeks from presentation. Five patients have ceased therapy and remain in remission from 32 to 142 weeks after ceasing treatment.

Analysis of 50 patients with burns in pregnancy has allowed the objective consideration of obstetric implications. Patients in the second and third trimester of pregnancy with burns of greater than or equal to 50% should be delivered immediately as maternal death is otherwise certain and fetal survival rate is not improved by waiting. Vaginal delivery has always proved possible, even in the presence of perineal burns but caesarean section should be considered and may be preferred. Patients in the first trimester may survive with more extensive burns and possible reasons for this are discussed. Pregnancy testing on admission should be mandatory in burns of women of reproductive age. In patients with burns of less than 40% in the second and third trimesters, spasmolytics should be used to suppress spontaneous labour and to cover operations. Greater fetal maturity without worsening maternal prognosis can thus be achieved. Insufficient data exist to recommend this for burns of between 40 and 50%.