High-dose intravenous therapy with immune globulin before delivery for idiopathic thrombocytopenic purpura

A 15-year-old girl with a 9-year history of idiopathic thrombocytopenic purpura resistant to high-dose steroid therapy and to splenectomy was admitted to hospital at 35 weeks' gestation with a platelet count of 10 X 10(9)/L. The bleeding time was normal, and measures of platelet aggregation were nearly so. Treatment with high intravenous doses of polyvalent immune globulin led to a rise in the platelet count to more than 110 X 10(9)/L within 5 days. An elective cesarean section was performed through the lower uterine segment with good hemostasis. After delivery the platelet count fell to its former level, but no postpartum bleeding occurred. There was a brief episode of thrombocytopenia in the infant, with some petechiae but no other hemorrhagic manifestations. No untoward effects of the immune globulin infusion were observed in either mother or daughter.

31P NMR studies of resting muscle in normal human subjects

Study of human tissues using 31P topical Magnetic Resonance is completely atraumatic; it allows simultaneous measurement of the concentrations of many important metabolites and of intracellular pH. In some critical situations, TMR yields more accurate results than those obtained by chemical analysis of tissue biopsies. We have shown that TMR can be calibrated to obtain quantitative measurements in human subjects. We have also shown that theories of control of glycolysis based on regulation by key metabolites of rate-limiting enzymes are inconsistent with the observed changes in intact muscle.

Cytogenetic findings in over 2000 amniocenteses

Between 1971 and 1981, 58 (2.8%) of 2037 amniocenteses performed in Vancouver revealed chromosome abnormalities, 25 of which were trisomy 21. Of the 58 referrals that yielded abnormalities, 37 (63.8%) were for a maternal age of 38 years or more. The rates of detection of such abnormalities for single-year intervals of maternal age beyond 35 years were comparable to those calculated from pooled data obtained in multicentre studies in the United States, Canada and Europe.

A 31P topical magnetic resonance study of embryonic development in hens' eggs

A 31P topical magnetic resonance study of whole chicken's eggs in vivo is described. Resonances from adenosine triphosphate, phosphocreatine, inorganic phosphate and phosphorous storage protein were observed. These changed in relative intensity as the embryo developed. No ill effects due to exposure to radiofrequency radiation or magnetic fields were observed. It is concluded that topical magnetic resonance can make a useful contribution to the study of embryonic development in avian eggs.

Neuroepithelial tumor of the optic nerve in a horse

A nine-year-old horse was presented with severe exophthalmos of the right eye and a large mass in the vitreal cavity. The affected globe was enucleated and two months following surgery the horse was euthanized because of spread of the tumor into the calvarium producing compression of the brain stem and neurologic signs. Examination of tumor tissue by light and electron microscopic examination showed a mixed neoplasm of primitive neuroepithelium.

Colposcopy, conization, and hysterectomy practices: a current perspective

Data from the provincial cytology program has shown a progressive increase in the number of cases of cervical carcinoma in situ detected in the general population and a doubling of disease rate in third decade women, with most of the cases now in the 25- to 29-year-old age group. The introduction of a colposcopy service has led to a significant decrease in the number of diagnostic conizations performed over a 5-year period. Conization was still used for therapy in a substantial number of women despite the availability of cryotherapy and laser surgery. Eighty-five percent of all patients undergoing cone biopsy had sever dysplasia or carcinoma in situ (CIN III) on pathological examination. In 25% of patients, the conization specimen revealed either dysplasia or carcinoma in situ extending to resection margins. During review of 2249 patients, 1174 were spared a conization and were treated by either hysterectomy, cryotherapy, or laser surgery. It would appear that, although colposcopy can reduce dramatically the number of diagnostic cone biopsies, conization will still be required for therapy in a substantial number of patients.

Nortriptyline and EEG sleep in depressed patients

The effect of nortriptyline was assessed on the EEG sleep of 20 inpatients with major depressive syndrome. While 25 mg of nortriptyline had an immediate effect on REM sleep variables, relatively little influence on sleep continuity measures was noted. Subsequent administration of 75 and 100 mg of nortriptyline produced continued REM sleep suppression over several weeks. In summary, nortriptyline altered EEG sleep in a pattern similar to that of amitriptyline. REM latency and REM sleep time were consistently reduced by drug administration, while REM activity was only transiently altered as with amitriptyline. The comparison with amitriptyline showed, for the most part, similar influences on REM sleep without the sedative effects of amitriptyline.

A prospective study of 18 patients with cholestasis of pregnancy

In this prospective study we evaluate the role of serum bile acids in the investigation and management of cholestasis of pregnancy in a detailed study of 18 patients. Bile acids were the most sensitive diagnostic test. The increased incidence of fetal distress (33.3% in this series) and meconium-stained fluid (58.3%) did not correlate with very high values of bile acids in maternal serum, umbilical cord serum, or amniotic fluid. Treatment of pruritus with cholestyramine and/or phenobarbital is ineffective in this condition, induction of labor is suggested once fetal lung maturity is established.

REM sleep, naps, and depression

Continued interest in rapid eye movement (REM) sleep abnormalities in depression stimulated comparative studies on daytime naps versus nighttime sleep. In a group of 15 depressed patients, REM latencies in morning and afternoon naps were similar to the shortened REM onset at night. Although REM latency did not vary across the three times, the propensity for REM sleep appeared to be greater in the morning nap than in the afternoon nap and the early portion of nocturnal sleep. Finally, the data suggest that responders to tricyclic treatment tend to be poor sleepers during daytime naps.

Ocular manifestations of low level phenothiazine administration to cattle

Feeding white face Hereford cattle a high protein dietary supplement containing 1.25% phenothiazine resulted in severe corneal edema when the cattle were exposed to sunlight. The corneal edema was located in the inferior two-thirds of the cornea. In one animal a severe secondary ulcerative keratitis developed. The corneal edema resolved in about 60-90 days after the phenothiazine containing concentrate was removed and the cattle not exposed to bright sunlight.

31P-NMR investigation of solid tumours in the living rat

The 31P-NMR spectra of living tumours (Walker 256 carcinosarcomas) have been obtained using surface coils and found to be unlike those of normal tissues. Contrary to expectations, their intracellular pH (measured from the chemical shift of the inorganic phosphate peak) was only slightly more acid than that of normal rat muscle, and glucose infusion did not depress it. However, when deoxyglucose was infused, the tumour intracellular pH measured from the chemical shift of the deoxyglucose-6-phosphate peak was much lower (6.44 +/- 0.02) than that measured from the phosphate peak (7.14 +/- 0.01).

Molar pregnancy: early diagnosis by ultrasound

This report reviews four cases with vaginal bleeding and early ultrasound diagnosis of abnormal pregnancy before nine weeks gestation, who were followed by serial ultrasound examinations and subsequently diagnosed as hydatidiform mole. The findings support the view that hydatidiform mole may arise from a blighted ovum. It is concluded that vaginal bleeding in the first trimester should be investigated by diagnostic ultrasound, and the pregnancy by terminated if an abnormal development has been confirmed.

Localization of metabolites in animals using 31P topical magnetic resonance

High-resolution phosphorous (31P)-NMR spectra of biological molecules provide detailed information about the metabolism of living systems. Although the NMR method is non-destructive, all studies so far, with two exceptions, have been carried out on excised, perfused organs and tissues or have required some form of surgery for in situ measurements. The use of 'surface' radiofrequency coils does not require surgery, but is best suited for tissues close to the surface of the animals. We describe here 'topical magnetic resonance'--a new, non-surgical method for acquiring 31P-NMR spectra from a selected, localized place deep within an animal by modifying the main magnetic field, B0, using only static-field gradients. The method is conceptually similar to one spin-imaging method but primarily provides biochemical rather than spatial information. This new technique can be used in fundamental investigations into living systems, clinical diagnosis and the estimation of the efficacy of drug therapy.

Oleander poisoning

The two common oleanders, Thevetia peruviana and Nerium oleander, contain a mixture of poisons including cardiac glycosides, and are extremely toxic. They are cultivated universally throughout Australia, and rank equally with mushrooms as the major cause of children's admission to hospital after accidental plant ingestions. A seven-year total population survey from south-east Queensland has revealed that, in practice, the rate of clinical poisoning due to oleander is inconsequential, and mortality is negligible. The annual age-specific admission rate for children (aged from birth to 12 years of age), for all plant ingestions is 2.33 per 100 000, and 0.62 per 100 000 specifically for oleander. Oleander ingestion causes a syndrome of combine cardiac and gastrointestinal symptoms and signs. A case series of 13 children is described, and the clinical features summarized. After accidental oleander ingestion, current experience indicates that the prognosis is excellent.

Thrombocytosis, thrombocythaemia and iron deficiency in patients with polycythaemia vera

6 patients with polycythaemia vera who also developed concomitant iron deficiency are reported. When oral iron therapy was given, there was a marked reduction in the previously elevated platelet counts in 4 patients; during 2-9 years of observation of these patients there was a significant inverse relationship between haemoglobin concentration and platelet count. In the other 2 patients the elevated platelet counts did not fall when iron therapy was given. The significance of these different patterns of response in relation to the causal mechanism of elevated platelet counts in patients with polycythaemia vera is discussed.

Benzopyrones. 14. Synthesis and antiallergic properties of some N-tetrazolylcarboxamides and related compounds

A series of chromones containing an acidic group has been synthesized and screened for the ability to inhibit passive cutaneous anaphylaxis and the release of histamine from mast cells of the rat. Many of the chromones contain the N-(5-tetrazolyl)carboxamido group, a novel source of acidity. Others contain a carboxyl, C-(5-tetrazolyl), 5-(4H)-oxotetrazolinyl, or N-(5-tetrazolyl)sulfonamido function. The compounds were compared with cromolyn sodium (sodium cromoglycate) and many were found to be powerful inhibitors of anaphylaxis. The most potent was 7-methoxy-4-oxo-N-(5-tetrazolyl)-4H-1-benzopyran-2-carboxamide (15). Structure-activity relationships among the chromones and also some related compounds are discussed.

Intrachromosomal gene mapping in man: assignment of nucleoside phosphorylase to region 14cen leads to 14q21 by interspecific hybridization of cells with a t(X;14) (p22;q21) translocation

The structural gene for purine-nucleoside phosphorylase (NP) has been assigned to a subregion of chromosome 14 by somatic cell hybridization of male and female cells containing the balanced translocation t(X;14) (p22;q21). Peripheral lymphocytes were fused to a pseudodiploid HPRT-deficient established Chinese hamster cell line. 23 primary hybrid clones (10 derived from male and 13 from female cells) were isolated and maintained in HAT selective medium. Parallel subcultures from generations 16, 24, and 40 after clonal isolation were fully karyotyped and analyzed electrophorectically for expression of the human types of NP, HPRT, G6PD, and PGK. The human NP phenotype segregated discordantly with each human chromosome except chromosome 14 and the der(14),t(X;14) translocation chromosome. In all, 8 hybrids which had retained the der(X), t(X;14) translocation chromosome under HAT selective pressure and expressed human HPRT had lost the human NP phenotype. These results indicate localization of the NP gene in region 14pter leads to 14q21.

Evaluation of left ventricular performance in acutely ill patients with chronic obstructive lung disease

Among 28 patients with chronic obstructive pulmonary disease (COPD) with increasing dyspnea, the resting mean pulmonary arterial wedge pressure was elevated (greater than 12mm Hg) in 4 and became abnormal with exercise in 3 other subjects. Stroke volume index was reduced (less than 36 ml/beat/M2) in 16 of 26 patients (62 percent). The resting pre-ejection period index was prolonged (greater than 144 msec) in 17 patients (65 percent), while the left ventricular (LV) ejection time index was reduced (less than 408 msec) in 23 patients (88 percent). The ratio of the pre-ejection period to the LV ejection time was within the normal range (0.309 to 0.381) in only 3 of 26 patients (12 percent). Echocardiographic measurements of LV function were normal in nine patients, seven of whom had one or more abnormal values for systolic time intervals (STIs). These data suggest that reduced LV filing results in abnormal values for STIs in patients with COPD, and therefore that in such patients STIs are not accurate indices of LV function.

Effects of protriptyline and perphenazine in neurotic depressed outpatients

A four-week comparison of protriptyline 10 mg three times a day and perphenazine 2 mg three times a day, alone and in combination, and a placebo in a group of nonpsychotic depressed outpatients showed no significant differences among any of the treatment groups after both two and four weeks, and a slight trend in favor of the placebo group. A significant positive correlation was observed between changes in hostility and changes in depression, contrary to many commonly held assumptions regarding the relationship between hostility and depression.