Burkitt's lymphoma presenting with blindness: a case report

A 10-year-old schoolboy was referred to the Ophthalmic Unit of Ahmadu Bello University Teaching Hospital because of sudden loss of sight following 5 days of severe frontal headache. The child had bilateral ptosis with internal and external ophthalmoplegia and fixed and dilated pupils. There was no papilloedema. Eight days later, a jaw tumour and a rapidly enlarging abdominal tumour appeared. A fine needle aspiration biopsy of the jaw tumour confirmed Burkitt's lymphoma. Combination chemotherapy with cyclophosphamide, vincristine and methotrexate (COM) led to a rapid resolution of the jaw and abdominal tumour but the child never regained his sight. Cerebrospinal fluid examination was not helpful in reaching a diagnosis.

The outcome of head injuries: the Saudi experience

One analysis of the outcome of 159 cases of head injuries was based on patients' admission Glasgow Coma Scale (GCS), score, age, CT scan findings and uniform protocol of management. Fifty-three percent of the patients were children below the age of 10 years and 70% of all patients were Saudis. Eighty-point-five percent (80.5%) of the patients had a GCS score of 8 or more and their outcome was favorable. By contract, the 19.5% who had an initial GCS score of 7 or less tended to be older and had a worse prognosis (mortality 68%). A high initial GCS score, old age, associated multiple injuries and a shift of more than 4 mm of the midline structures on CT scan of the brain are useful prognostic indices in predicting the outcome of head injury.

Familial hyperphosphatasaemia in a Nigerian child

A 5-year-old Nigerian girl of normal intelligence had grotesque crippling skeletal deformities, multiple pathological fractures and dwarfism dating back to the end of the first year of life. She also suffered from recurrent lower respiratory tract infection since infancy. The clinical, biochemical and radiological profile were compatible with the diagnosis of familial hyperphosphatasaemia.

Traumatic respiratory insufficiency: comparison of conventional mechanical ventilation to high-frequency positive pressure with low-rate ventilation

Eleven patients suffering severe traumatic respiratory insufficiency were mechanically ventilated using a new system which combined high-frequency positive-pressure ventilation (HFPPV) with low-rate conventional mechanical ventilation (LRCMV). Ten similar patients were ventilated by conventional mechanical ventilation (CMV) with PEEP. HFPPV patients were fully conscious and cooperative during ventilation and did not need sedatives or muscle relaxants. Arterial oxygenation was significantly (p less than .005) better in HFPPV than CMV patients (89.91 +/- 10.24 vs. 78.43 +/- 11.13 torr, respectively), and pulmonary shunt was also better in the HFPPV group (13.1 +/- 4.7% vs. 20.4 +/- 6.4%, p less than .01). Moreover, inspired oxygen concentrations were lower (PaO2/FIO2 197.8 +/- 51.3 in the HFPPV group vs. 130 +/- 46.6 in the CMV group, p less than .005) and the time required for mechanical ventilation was shorter (4.2 +/- 0.91 vs. 6.1 +/- 0.8 days, p less than .1). All HFPPV patients immediately began breathing spontaneously when they were disconnected from the ventilator. We suggest this method as a better ventilatory mode for patients suffering traumatic respiratory insufficiency.

The effect of labetalol on contractility of human myometrial preparations

Because of results in animal experiments which demonstrated a partial beta 2-adrenoceptor activity of labetalol on rat uterine smooth muscle the present study was conducted in human preparations. The following results were obtained: 1. Rhythmic uterine contractions with a defined steady-state amplitude and frequency were elicited spontaneously and after methylergometrine. 2. Labetalol reduced amplitude of contractions dose-dependently after 3 h of incubation. Frequency was unaffected. 3. The tocolytic effect of labetalol is apparent only at high concentrations, above those used in the treatment of hypertension. 4. Neither beta 2-specific adrenoceptor blockade with ICI 118,551 nor alpha-blockade with phentolamine changed amplitude of contraction, either alone or in combination with labetalol. 5. Labetalol has little tocolytic effect on human myometrium in vitro. This effect is unrelated to alpha- or beta-antagonism, but seems to depend on a direct smooth muscle depressant effect. In conclusion, from the present in vitro experiments using human myometrial preparations, it seems unlikely that labetalol would interfere with the normal process of labor when used for the treatment of pregnancy hypertension.

[Significance of fluorescence spectra for the evaluation of lens opacities]

The fluorescence spectra of nucleus and cortex material from human lenses obtained as a result of extracapsular cataract extraction were observed. With advancing cataract formation the fluorescence spectra changed in a very characteristic way. The changes in ascorbic acid were compared with those caused by cataract development. Clinical application of corresponding measuring instruments would appear to make sense.

Immobilization of pig liver microsomes. Stability of cytochrome P-450-dependent monooxygenase activities

Microsomes from pig liver were covalently coupled to Sepharose activated by CNBr and to Sephadex activated by 1,1'-carbonyldiimidazole. Microsomes were also entrapped inside Ca-alginate and kappa-carrageenan gels. The concentration of immobilized cytochrome P-450 was determined by CO-difference spectra. The activity of the monooxygenase system was demonstrated by the N-demethylation of aminopyrine, the O-demethylation of p-nitroanisole, and the hydroxylation of perhexiline maleate. Upon immobilization, a 30-40% and a 60-70% decrease in Vappmax for the O- and N-demethylations were respectively observed. The Vappmax values for the hydroxylation of perhexiline maleate were essentially the same for the different immobilized forms and for the freely suspended microsomal cytochrome P-450. Under storage at 4 degrees C, microsomes entrapped inside kappa-carrageenan and Ca-alginate were less stable than the free microsomes, whereas immobilization on CNBr-activated Sepharose improved the stability of the hepatic microsomal monooxygenase system at the same temperature. These types of immobilized microsomes have the advantage of being easily recovered and reused for other assays. Finally, microsomes entrapped inside kappa-carrageenan or Ca-alginate can be used to follow up the continuous metabolization of p-nitroanisole for several hours in a stirred-batch reactor.

Microcolumn high pressure liquid chromatography with a glass-frit nebulizer interface for plasma emission detection

Microcolumn high pressure liquid chromatography (micro-HPLC) is rapidly gaining recognition as a practical separation tool for organometallic compounds. The use of the inductively coupled plasma (ICP) as a detector for micro-HPLC is studied. Several miniaturized glass-frit nebulizers are investigated as interfaces between the output of the microbore column and the ICP torch. Their performance with aqueous and methanolic solutions is evaluated by direct nebulization and flow injection analysis. The most efficient of these nebulizers is used in the micro-HPLC/ICP study of some Cd, Pb, and Zn organometallic compounds. Detection limits of 1.92 ng of Pb for tetramethyllead and 5.01 ng of Pb for tetraethyllead are obtained and compared with regular HPLC/ICP of these same compounds. Approximately equivalent detection limits were obtained when using a microwave induced plasma as an alternate plasma source.

Respiratory insufficiency in a severe autosomal recessive form of muscular dystrophy

In a large Sudanese kindred of 176 individuals, 15 children developed a brief respiratory illness in the course of a severe autosomal recessive muscular dystrophy (MD) and eight of them died. The type of MD in this kindred delineates a newly recognized entity which has been described from Sudan, Tunisia, Libya and Qatar . To assess the role of pulmonary insufficiency in the fatal outcome of this disease, pulmonary function was studied in six of the survivors. Values of lung volume were grossly abnormal and revealed a restrictive pattern. The degree of lung volume restriction varied from 50 to 76% of predicted total lung capacity (TLC) and 31-55% of predicted forced vital capacity (FVC). The high FEV1/FVC ratio (80-100%) in all patients excluded airway obstruction and the elevated ratio of residual volume (RV) to TLC (51-68%) reflected loss of inspiratory capacity. FVC showed no correlation with the degree of muscular disability and did not seem to be affected by the mild scoliosis seen in five children. These results are discussed in view of similar studies in a variety of neuromuscular disorders.

Sepsis and hypothermia in the newborn infant: value of gastric aspirate examination

Bacteriologic examination of blood, urine, CSF, and gastric aspirate was performed in 88 babies admitted with hypothermia (rectal temperature less than 35 degrees C) during the neonatal period. Infection was common in infants older than 3 days (late-onset hypothermia). In 36 of the 44 (81.8%) infected babies, the gastric aspirate was abnormal, whereas it was abnormal in only three of the 23 (13%) not infected. Infection was much less common in babies younger than 3 days (early-onset hypothermia), and in these the gastric aspirate was mostly normal. Two babies had RDS-like symptoms, and streptococci were cultured from the gastric aspirate. Examination of the gastric aspirate is a quick, efficient method of diagnosing severe infection, not only immediately after birth but throughout the neonatal period.

Infection in neonatal hypothermia

Infection, particularly of the respiratory tract, was present in 80 of 138 children with neonatal hypothermia. The most common lesion was right upper lobe atelectasis and was probably due to aspiration pneumonia. In children older than 3 days infection elsewhere, mainly owing to Escherichia coli bacilli, was common.