Acute renal failure complicating nonfulminant hepatitis A

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High-fat and high-carbohydrate diets and energy balance

The current American Diabetes Association guidelines for nutrition recommend a moderate increase in monounsaturated fats and a reduced intake of carbohydrate in patients with diabetes in whom high-carbohydrate diets deteriorate glycemic control and lipoprotein levels. High-fat diets, however, are believed to promote obesity, and some investigators may have reservations recommending such diets. This review thus investigates the role of diet composition in promoting obesity or achieving weight loss and its implications in patients with diabetes. Epidemiological studies show some evidence that fat intake is more importantly related to body weight than carbohydrate intake, but conclusions are weak because confounding variables, such as physical activity, smoking, and energy intake, were generally not controlled for. Metabolic studies under isoenergic conditions report no change in energy balance when fat intake is increased, but report a negative fat balance with substantial increase carbohydrate intake. During overfeeding, excess fat intake is stored as fat, whereas excess carbohydrate is mostly oxidized in the short term but can lead to substantial gain in fat stores because of reduced fat oxidation and considerable de novo lipogenesis in the long term. Spontaneous energy intake, however, is higher on an unrestricted high-fat diet compared with a high-carbohydrate diet, but the long-term effects are not known. Weight-loss intervention studies show that a hypocaloric high-carbohydrate diet is not associated with more weight loss than a high-fat hypocaloric diet. In conclusion, a high-monounsaturated fat diet to control glycemic control and lipoprotein levels in patients with diabetes should not affect weight loss or maintenance, provided that energy intake is carefully controlled.

Contact allergy in patients with oral symptoms: a study of 47 patients

BACKGROUND

Patients may present with a range of unexplained oral symptoms, and there has been debate about the role of contact sensitivity in these patients.

OBJECTIVE

The aim of this study was to review patch test results in patients presenting with oral and perioral symptoms and to determine the relevance of positive reactions.

METHODS

Forty-seven patients with oral symptoms were studied. Patients were tested to the European Standard Series and a range of other allergens, including bakery products, dental materials, medicaments, and metals.

RESULTS

Sixty-four percent of the patients had one or more positive allergic reactions. In 14 patients (30%), the results were believed to be relevant to their clinical problem. Relevant allergens included metals, rubber chemicals, food additives, and dental products. Symptoms resolved rapidly in all of the 13 patients in whom the source of the offending allergen was removed.

CONCLUSION

Patch testing is a useful investigation in patients with unexplained oral and perioral symptoms. Avoidance of the relevant allergen can result in complete resolution of symptoms.

Delayed and immediate orofacial reactions following contact with rubber gloves during dental treatment

Allergic reactions during or after dental examination are uncommon. However, such reactions may be serious and distressing. Allergy to local anaesthetics and dental materials may be considered, but reactions to rubber in gloves worn by the dentist should be remembered. Two patients are reported who experienced symptoms following contact with rubber gloves worn by their dentists, with skin tests subsequently showing an allergic reaction to glove constituents, and in one case latex. With the increasing use of rubber gloves by dental and medical personnel, reactions in sensitised patients are likely to become more common. In patients with a history of symptoms related to dental work, it is important to remember delayed and immediate reactions to rubber.

Vulval involvement in lichen planus: a study of 37 women

The overall prevalence of vulval involvement in women with lichen planus is unknown. In a series of 37 women with lichen planus, we found vulval lesions in 19 (51%). Vulval lesions are often chronic and may undergo malignant change. All patients presenting with cutaneous or oral lesions of lichen planus should be questioned about, and examined specifically for, signs of genital involvement. Long-term follow-up of these patients is necessary.

Gastroesophageal reflux--how to mend it?

Gastroesophageal reflux (GER) is a common condition affecting children. The clinical presentation varies widely from innocuous spitting up to life threatening apnea. Various diagnostic tests are available to document the etiology, presence or complications of GER. In most cases, conservative approach is sufficient. In complicated cases, pharmacotherapy is indicated while surgical therapy is reserved for resistant cases with complications.

The ARP-1 orphan receptor represses steroid-mediated stimulation of human placental lactogen gene expression

Studies were performed to determine whether ARP-1, which is an orphan receptor of the steroid receptor superfamily, inhibits basal activity of the human placental lactogen (hPL) promoter and the increase in hPL promoter activity in response to the receptors for thyroid hormone (TR) and retinoic acid (RAR). Co-transfection of an ARP-1 expression vector into BeWo choriocarcinoma cells, along with an expression vector containing 1.2 kb of the hPL promoter coupled to a CAT reporter gene, resulted in a dose-dependent inhibition of basal CAT activity. In addition, ARP-1 inhibited the stimulation of CAT activity by RAR alpha and TR beta expression vectors. Mobility shift assays demonstrated that ARP-1 binds specifically to a composite steroid response element on the hPL promoter that confers retinoic acid and T3 responsiveness. The results implicate an inhibitory role for ARP-1 in the regulation of hPL gene expression and strongly suggest that hPL gene expression is regulated, at least in part, by the interaction of stimulatory and inhibitory members of the steroid receptor superfamily.

Scrotal pyoderma gangrenosum associated with dermatomyositis

Pyoderma gangrenosum (PG) of the scrotum is extremely rare. We report a case of scrotal PG associated with dermatomyositis. Initial healing was slow despite the use of oral prednisolone and azathioprine. Healing was accelerated by the local use of a potent topical corticosteroid. PG should be considered in the differential diagnosis of ulcerating lesions of the genitalia.

Detection of RNA polymerase II promoters and polyadenylation sites in human DNA sequence

Detection of RNA polymerase II promoters and polyadenylation sites helps to locate gene boundaries and can enhance accurate gene recognition and modeling in genomic DNA sequence. We describe a system which can be used to detect polyadenylation sites and thus delineate the 3' boundary of a gene, and discuss improvements to a system first described in Matis et al. (1995) [Matis S., Shah M., Mural R. J. & Uberbacher E.C. (1995) Proc. First Wrld Conf. Computat. Med., Public Hlth, Biotechnol. (Wrld Sci.) (in press).], which predicts a large subset of RNA polymerase II promoters. The promoter system used statistical matrices and distance information as inputs for a neural network which was trained to provide initial promoter recognition. The output of the network was further refined by applying rules which use the gene context information predicted by GRAIL. We have reconstructed the rule-based system which uses gene context information and significantly improved the sensitivity and selectivity of promoter detection.

Nutrient and food intake in obese women on a low-fat or low-calorie diet

The low-fat group consumed significantly fewer calories from fat and more calories from carbohydrate at both 6 and 12 months than the low-calorie group, but their fat intake was still about twice their goal at both 6 months (39 gm per day) and 12 months (46 gm per day). The low-calorie group achieved their fat goal of 30% of calorie intake, but they consumed from 300 to 700 kcal more than their calorie goal. Caloric intake, physical activity, palatability, satiety, quality of life, and weight loss were not significantly different by treatment. Two studies, which gave patients hypocaloric diets of varying fat and carbohydrate content (fat calories 10% to 45%) for from 10 to 12 weeks, found no effect of diet composition on weight loss. In addition, one study, which gave patients a low-fat, energy-unrestricted diet (fat calories 19%), reported a weight loss of 10.1 lb at 16 to 20 weeks and 5.7 lb at 9 to 12 months, which is similar to that seen in the low-fat group in the this study. Most of the decrease in fat intake (90%) in the low-fat group resulted from a reduction in intake of fat from fat and oils; meat, fish, and poultry; dairy products; and sweets. The dietary changes in the low-fat group are consistent with those found in one study, which prescribed a 15% fat calorie diet to women with breast cancer. Intake of vitamin C increased in the low-fat group and decreased in the low-calorie group. This difference was significant and was caused by an increased intake of fruits and vegetables in the low-fat group and a decreased consumption of fruits in the low-calorie group. Calcium intake decreased significantly more in the low-calorie group because of a decreased intake of dairy foods.

Synthesis of some novel pyrazoline and cyanopyridine derivatives as antimicrobial agents

Substituted chalcones 2a-j prepared by the treatment of 4'(p-chlorophenylsulphonamido)acetophenone 1 with araldehydes, on condensation with hydrazine hydrate in ethanol and acetic acid provided the desired pyrazolines of the type 3a-j and 4a-j. The same chalcones 2a-j made to react with malononitrile in the presence of ammonium acetate yielded cyanopyridines 5a-j. The structure was confirmed by elemental analyses, IR, NMR and MS spectral studies. The pharmacological profile of the compounds synthesised is described. Most of the compounds displayed their maximum activity against E. coli. Compounds 2b, 2d, 5b, 5d, 5e, 5h and 5i have been selected for their agrochemical screening by DuPont Agricultural Products, U.S.A.

Prognosis of occupational hand dermatitis in metalworkers

Hand dermatitis is common in workers employed in the cutting and grinding of metals. Previous studies have given conflicting results on the prognosis of this common occupational disease. This study was designed to determine the prognosis of hand dermatitis in metalworkers and the responsible allergens. A questionnaire survey was conducted on 64 patients seen between 1 and 5 years previously in the contact dermatitis clinic. Of the 51 patients responding, 82% still had hand dermatitis. There was no difference in outcome between those who continued to work with metals and oils, and those who had changed their occupation. Hand dermatitis in metalworkers carries a poor prognosis, with most workers remaining symptomatic even if they no longer had occupational exposure to metals or oils. This study also demonstrates that biocides are the most important allergen group in the aetiology of hand dermatitis in metalworkers.

Eruptive pyogenic granulomas: a successfully treated patient and review of the literature

Pyogenic granuloma, also known as lobular capillary haemangioma, is a solitary, benign vascular skin tumour. Although a single pyogenic granuloma is common, multiple eruptive pyogenic granulomas are extremely rare. We report the occurrence of multiple, eruptive pyogenic granulomas in a previously healthy 17-year-old girl. Over 200 lesions appeared spontaneously over an 8-month period. Lesions were initially treated with cryotherapy, and then with the pulsed dye laser, resulting in their complete clearance.

Quantitative analysis of wound healing

In this article, we initially review several problems associated with the design and interpretation of certain types of experiments currently used to study wound healing, drawing attention to the fact that applications for standard statistical techniques in the analysis of the experimental results are often of limited value. We then argue that, because of the special nature of wound healing data, curve fitting of empirical model equations can often provide a convenient way to summarize treatment effects with large data sets. The various ways in which this technique could be used to facilitate the interpretation of experimental wound healing results are then explored. To illustrate this approach, we then took several wound healing experiments and introduced possible models that could be used, paying particular attention to simple equations with the smallest possible number of parameters. For each equation, the way that the parameters of the model could be interpreted with regard to the biologic effects represented is given. Examples are given to show the application of each model discussed theoretically in the interpretation of some typical experimental data sets.

Maternal and umbilical serum concentrations of granulocyte colony-stimulating factor and its messenger RNA during clinical chorioamnionitis

OBJECTIVE

To determine whether women with chorioamnionitis developed elevated serum granulocyte colony-stimulating factor (G-CSF) concentrations and, if so, whether the G-CSF crossed to the fetus.

METHODS

We quantified G-CSF before, during, and after delivery and in the cord blood of 12 women with clinical chorioamnionitis and 12 matched controls. We also measured G-CSF messenger RNA (mRNA) transcripts in mononuclear cells isolated from maternal and cord blood at delivery.

RESULTS

At study entry, G-CSF concentrations were much higher in women with chorioamnionitis (1397 +/- 950 pg/mL, mean +/- standard error of mean) than in controls (17 +/- 5 pg/mL, P < .05). At delivery, concentrations had increased in both groups (2752 +/- 1100 pg/mL in the chorioamnionitis group, 165 +/- 61 pg/mL in controls; P < .05). After delivery, G-CSF concentrations had diminished to 839 +/- 594 pg/mL in women with chorioamnionitis and to 83 +/- 16 pg/mL in controls (P < .05). Concentrations in the cord blood were 2729 +/- 974 pg/mL for the chorioamnionitis group and 51 +/- 17 pg/mL for controls (P < .05). Granulocyte colony-stimulating factor mRNA transcripts were more abundant in women with chorioamnionitis than in controls but were scarce in all matched cord blood samples tested.

CONCLUSION

Serum G-CSF concentrations were elevated during clinical chorioamnionitis, and similar levels were found in maternal and cord serum. Because G-CSF mRNA levels were very low in cord mononuclear cells, the G-CSF in cord serum might be maternal in origin.

Intestinal endometriosis masquerading as common digestive disorders

Intestinal endometriosis mimics a wide variety of inflammatory, infectious, or neoplastic digestive diseases. To alert clinicians to its diverse manifestations, we describe nine patients who required laparotomy. The underlying diagnosis was elusive initially. In no case were symptoms clearly cyclic or temporally related to phases of the menstrual cycle. Presenting complaints included acute or subacute lower abdominal pain (three patients), hematochezia (two patients), signs or symptoms of small-bowel obstruction (two patients), peritonitis (one patient), and a partially obstructing sigmoid lesion (one patient). The findings of barium enema were nondiagnostic in the five cases in which it was performed. Surgery was needed in each case; indications included inability to exclude carcinoma (two patients), small-bowel obstruction (two patients), diffuse peritonitis (one patient), persistent colonic obstruction (one patient), pericolonic abscess (one patient), and intractable pain (one patient). Intestinal endometriosis has a diverse clinical spectrum, with nonspecific features in many patients. This disease should be considered during the evaluation of unexplained digestive complaints in women of childbearing years.