Danazol for treatment of refractory autoimmune hemolytic anaemia

Autoimmune hemolytic anemia (AHA) is uncommon in childhood. A female child presented with severe and chronic clinical course. She was refractory to steroid and the response to splenectomy was poor. She showed excellent remission of hematological condition with Danazol. Danazol may be the drug of choice for refractory autoimmune hemolytic anemia.

Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Surgical techniques and a review of 70 patients

We report the use of a free tendon graft in 70 patients to repair lesions of the capsuloligamentous complex of the metacarpophalangeal joint of the thumb. Of these 37 had a lesion of the ulnar collateral ligament, 18 of the radial collateral and 11 of the volar plate. Four patients had combined lesions. We outline our techniques and review 51 of the patients. Of those 47 (92%) were satisfied, and all but one had regained full stability. Pinch grip strength was normal in 48. About one-third of the patients had some loss of flexion/extension; this was seldom noticed by the patients and caused no significant disability. Free tendon graft reconstruction is indicated for severe fresh lesions, for old lesions with chronic disability and for lesions which have not responded to conservative management.

Feedforward inhibition of the rat entorhinal cortex and subicular complex

We used in vivo intracellular recording techniques in order to provide evidence about the source of postsynaptic inhibition in the rat entorhinal cortex and subicular complex. Several different structures in the basal forebrain and hippocampus were electrically stimulated in order to activate inhibition by different pathways. This allowed a test of 2 different neuronal circuit models: feedback inhibition, in which recurrent collaterals from principal cell axons excite a local population of inhibitory neurons, and feedforward inhibition, in which excitatory afferents activate the inhibitory neurons. In both models, inhibitory cell axons branch and contribute to the inhibition of a population of principal cells. In the feedback model, a good correlation between antidromic and inhibitory response latencies is predicted. The feedforward model predicts independent antidromic and inhibitory response latencies. In one particular model of feedforward inhibition, afferents excite both local inhibitory cells and principal cells. This model predicts a high correlation between principal cell EPSP and IPSP latencies. The results showed no consistent relationship between the presence of antidromic action potentials and the presence of inhibition in response to stimulation of different sites. In addition, there was no correlation between antidromic and inhibitory response latencies. These results provide no clear support for the feedback model of inhibition. By contrast, there was a highly significant correlation between the latency of principal cell EPSPs and IPSPs, in support of a feedforward model of inhibition. Response latencies of candidate inhibitory neurons were also consistent with the feedforward model. The results provide evidence that an excitatory relay function of the entorhinal cortex and subicular complex is modified temporally by local, extrinsically activated inhibitory circuits.

Hypereosinophilia syndrome with pneumonia in acute lymphoblastic leukaemia

Eosinophilic pneumonia in association with acute lymphoblastic leukaemia (ALL) is very rare. A teenage boy is described with eosinophilic pneumonia which preceded by several months the onset of ALL. Prior to establishment of the diagnosis he had been treated with corticosteroids with a transient response only. This delayed his final diagnosis until there were haematologic features of leukaemia. The leukaemic blasts were cALLA (CD10) positive and had a normal chromosome number with no translocations on banding studies. The pneumonia remitted rapidly when his leukaemia responded to chemotherapy.

Carpal tunnel syndrome. An evaluation of the provocative diagnostic tests

In order to evaluate the usefulness of provocative tests (wrist-flexion test, nerve-percussion test, and tourniquet test) in the diagnosis of carpal tunnel syndrome, the results of provocative testing were evaluated in a group of patients (sixty-seven hands) with electrodiagnostically proved carpal-tunnel syndrome and in a group of fifty control subjects. The sensitivity and specificity of each test were calculated. The wrist-flexion test was found to be the most sensitive while the nerve-percussion test, although least sensitive, was most specific. The tourniquet test was quite insensitive and not very specific, and should not be used as a routine screening test in the diagnosis of carpal tunnel syndrome.

Kawasaki disease--case reports and review of literature

Three cases of Kawasaki disease are described. One had coronary aneurysms detected by 2D Echogram. The pathogenesis and aetiology of Kawasaki disease are still unknown. Kawasaki disease is a clinical diagnosis made by exclusion and occurs mainly in infants and young children below the age of 5 years. Fever and at least 3 of the other 4 frequent features are essential for diagnosis. Acute cardiovascular complications vary from 30-60%, being mainly coronary artery aneurysms and thrombosis. Mortality rate is 1-2%. Aspirin is presently used.