Mineral-cholesterol concentrations of the aortic aneurysmatic wall

Mineralogical investigations were performed on specimens from the aneurysmatic wall of ascending and descending thoracic and abdominal aortas collected intraoperatively from 10 patients (8 male, 2 female) aged 40-80 years. Scanning electron microscopy with energy dispersive x-ray analyses (microprobe-SEM/EDXA), and atomic absorption spectroscopy (AAS) showed incipient mineral and cholesterol depositions in the tissues of the patients when compared with the normal aorta of the young individual. Grains and crystals of cholesterol, and spherulitic mineralization, probably apatitic, were detected. It is suggested that localized cations imbalance precedes mineralization and is the potential co-factor of aortic wall pathology and aneurysm formation.

HIV positive patients first presenting with an AIDS defining illness: characteristics and survival

OBJECTIVES

To study the presentation and survival of patients who present with their first diagnosis of being HIV positive at the same time as their AIDS defining illness.

DESIGN

Retrospective study of patients presenting with AIDS between 1991 and 1993.

SETTING

Department of genitourinary medicine, St Mary's Hospital, London.

MAIN OUTCOME MEASURES

AIDS defining illness at presentation and survival after diagnosis of AIDS.

RESULTS

Between January 1991 and December 1993, 97 out of 436 patients (22%) presented with their first AIDS defining illness coincident with their first positive result of an HIV test (group B). The remaining 339 patients (78%) had tested positive for HIV-1 infection within the previous eight years and had consequently been followed up in clinics before developing their first AIDS defining illness (group A). The two groups of patients did not differ in age and sex distribution, risk factors for HIV-1 infection, nationality, country of origin, or haematological variables determined at the time of the AIDS defining illness. However, the defining illnesses differed between the two groups. Illnesses associated with severe immunodeficiency (the wasting syndrome, cryptosporidiosis, and cytomegalovirus infection) were seen almost exclusively in group A whereas extrapulmonary tuberculosis and Pneumocystis carinii pneumonia were more common in group B. The survival of patients in group B after the onset of AIDS was significantly longer than that of patients in group A as determined by Kaplan-Meier log rank analysis (P = 0.0026).

CONCLUSIONS

Subjects who are HIV positive and present late are a challenge to the control of the spread of HIV infection because they progress from asymptomatic HIV infection to AIDS without receiving health care. The finding that presentation with an AIDS defining illness coincident with a positive result in an HIV test did not have a detrimental effect on survival gives insights into the effects of medical intervention on disease progression after a diagnosis of AIDS.

Safety and activity of saquinavir in HIV infection

We evaluated saquinavir, an orally active, selective inhibitor of HIV proteinase, in a randomised, double-blind, dose-ranging study in 49 zidovudine-naive HIV-positive patients with few or no symptoms and CD4 cell counts of 500 or less. The study was designed to assess the antiviral activity and tolerability of saquinavir. Patients were randomised to receive 25, 75, 200, or 600 mg of saquinavir three times daily for 16 weeks. No serious adverse events occurred. CD4 cell counts showed a trend indicative of a dose response in favour of the 600 mg dosage, the maximum increase being seen around week 4. In none of the 8 patients with positive plasma viraemia at baseline did cultures become negative after treatment; peripheral blood mononuclear cell and plasma-viral load by culture and DNA and RNA PCR all showed a trend towards reduction at higher doses of saquinovir. Saquinavir was well tolerated in this group of previously untreated patients with few or no symptoms; this study shows that an HIV-proteinase inhibitor is active in HIV-infected patients.

Molecular analysis of G1B and G3A IFN gamma mutants reveals that defects in CIITA or RFX result in defective class II MHC and Ii gene induction

Class II major histocompatibility complex (MHC) genes and the invariant (Ii) gene are inducible by interferon-gamma (IFN gamma) but not by interferon-alpha and interferon-beta. The promoter regions of these genes contain three regulatory elements that mediate constitutive and IFN gamma-induced expressions; however, none of the DNA-binding proteins that interact with these elements are regulated by IFN gamma. Recently, a gene coding for a transactivator (CIITA) of class II MHC genes that complements a HLA-DR-negative immunodeficiency has been isolated. Using one IFN gamma mutant cell line (G3A) that is selectively defective in HLA-DR and Ii induction, four lines of evidence are presented to show that CIITA mediates the IFN gamma induction of HLA-DR and Ii genes. Analysis of another mutant line, G1B, indicates that the lack of DRA and Ii gene induction by IFN gamma is correlated with the lack of RFX DNA binding activity, thus providing the link between RFX and an IFN gamma response.

Differential RNA fingerprinting as a tool in the analysis of spermatozoal gene expression

The apparent decline in human male fertility and the concomitant increase in testicular pathology have prompted discussion of the underlying molecular mechanisms which may underpin these observations. While monitoring the expression of protamine-2 genes in the human ejaculate, we found a representative complement of sperm mRNAs following sequence-independent amplification of reverse-transcribed cDNAs with the polymerase chain reaction (RT-PCR). The revelation of unique sperm-derived PCR products using this method suggests that it should now be possible to investigate gene expression in human spermatogenesis by differential RNA fingerprinting of ejaculate spermatozoa. The identification of molecular markers and the corresponding genes associated with male infertility will be considerably enhanced by these investigations while obviating the requirement for invasive biopsy.

Intravenous immunoglobulin: implications for use in the neurological patient

The efficacy of intravenous immunoglobulin (IVIG) in the treatment of the autoimmune disease, idiopathic thrombocytopenic purpura (ITP), has been well documented in the literature. This has encouraged researchers to examine possible therapeutic uses of IVIG in other immune-mediated disorders. Recent clinical reports have suggested that IVIG may have a role in the treatment of neurological disorders with a possible immunopathogenic etiology. Intravenous immunoglobulin, a blood product which contains immunoglobulin G and a trace amount of immunoglobulin A, is believed to work as an immunomodulating agent. However, its mechanism of action is not well understood. Nurses involved with the administration of IVIG must be well informed about the manufacturing and regulation, proper dose and administration, adverse effects, appropriate assessments and related patient education.

Combined 17 alpha-hydroxylase/17,20-lyase deficiency caused by heterozygous stop codons in the cytochrome P450 17 alpha-hydroxylase gene

OBJECTIVE

To determine the genetic defect underlying congenital adrenal hyperplasia due to 17 alpha-hydroxylase deficiency in a genetic female.

DESIGN

Blood samples were used as a source of genomic DNA. A library of size selected genomic DNA sequences was prepared. In addition, portions of the 17 alpha-hydroxylase gene were amplified by the polymerase chain reaction and the gene products sequenced.

PATIENTS

Samples were obtained from a patient with sexual infantilism, lack of secondary sexual characteristics and hypertension. Streak gonads were found on laparoscopy.

RESULTS

Two point mutations were found, one in exon 3 and one in exon 4 which generate premature stop codons at codons 194 and 239 in place of glutamate and arginine respectively. The mutation in exon 3 has not previously been reported in patients with 17 alpha-hydroxylase deficiency.

CONCLUSION

The protein product of these defective genes could be expected to be severely truncated with no catalytic activity. This is in keeping with the complete lack of cortisol and sex steroid output in this patient. The polymerase chain reaction provides faster access to gene sequence information than previous procedures based on library screening prior to sequencing.

Life-threatening right ventricular thrombosis in association with phospholipid antibodies

An 18 year old man presented with cough and dyspnoea caused by pulmonary infarction. A large friable mass of organising thrombus in an anatomically normal right ventricle was identified as an embolic source. The acute illness was associated with raised titres of anticardiolipin antibodies, one of the antiphospholipid group. This thrombus recurred after surgical removal but subsequently was dissipated after treatment with oral corticosteroids and long-term oral anticoagulation.

Unusual spinal tuberculosis after adequate chemotherapy for lymph node tuberculosis in an immunocompetent man

A 35 year old man developed paraplegia due to an epidural mass 15 months after completion of a full chemotherapy course for pulmonary and lymph node Mycobacterium bovis infection. His cellular immune function was normal after treatment. It is suggested that the lesion was a granulomatous healing response rather than bacteriological recurrence.

Genetic analysis of the steroid 21-hydroxylase gene following in vitro amplification of genomic DNA

The 5' end of the steroid 21-hydroxylase B gene encompassing putative control regions and the first 3 exons, has been selectively amplified in vitro from a number of patients with congenital adrenal hyperplasia caused by a deficiency of this enzyme. Sequence analysis has revealed a number of isolated instances of gene conversion to the 21-hydroxylase A sequence. One mutation, a C to G transversion at the 3' end of the second intron, thought to lead to incorrect splicing of the mRNA, was found in 11 subjects all with the classical form of the disease.

A multipurpose teaching workstation using expert systems, CD ROM and interactive laserdisc

This demonstration shows a multipurpose workstation used in a clinical teaching application which combines currently available software suitable for clinical diagnosis and teaching. The medical software includes QMR, Scientific American Medicine, the Slice of Life and generic video laserdisc authoring software developed at the University of Ottawa. The system allows a clinical instructor either in an individual or in a small group teaching setting on a ward or in a classroom, to access high quality differential diagnosis information via QMR, which is then supplemented by the text components of Scientific American Medicine on CD ROM, with video laserdisc of the appropriate anatomy, imagery and pathology provided by one of the various laserdiscs. The generic authoring software allows the instructor or students to construct subject related tutorial or testing modules either with or without video laserdisc support. The workstation uses DESQview as the multitasking environment to control the various resources. This program allows easy transfer from one application to another and allows for marking and pasting of text material into a study document. DESQview can also be used to script a specific learning sequence. The demonstration will show the interaction required to study a specific clinical problem and how this can be made into a meaningful multimedia experience with hardcopy for study purposes.

Improved porcine renal preservation with a simple extracellular solution--PBS140

In this prospective randomized trial a porcine model of renal autotransplantation was used to compare quality of preservation, as reflected by detailed analysis of posttransplant renal function, following 24-hr cold storage in phosphate-buffered sucrose (PBS140), hyperosmolar citrate (HOC), and University of Wisconsin (UW) preservation solutions. There were 6 deaths with primary nonfunction: 3 of 5 HOC, 2 of 5 UW, but only 1 of 5 PBS140. Analysis of the whole group and separate analysis of the survivors demonstrated significantly better renal function following preservation with PBS140 when compared with both HOC and UW, with a lower peak serum creatinine (P = 0.02) and improved loop of Henle function (P = 0.02). The animals in the PBS140 group also demonstrated a more rapid return to normal creatinine, higher GFR, improved tubular function, and higher effective renal plasma flow, with figures approaching statistical significance (P = 0.06-0.07). The proposal of UW as a universal storage medium prompted this study, and its results suggest the need for a clinical comparison of renal preservation using UW and PBS140 in a prospective randomized trial.

The case for samples of anonymized records from the 1991 census

"The census of population represents a rich source of social data. Other countries have released samples of anonymized records from their censuses to the research community for secondary analysis. So far this has not been done in Britain. The areas of research which might be expected to benefit from such microdata are outlined, and support is drawn from considering experience overseas. However, it is essential to protect the confidentiality of the data. The paper therefore considers the risks, both real and perceived, of identification of individuals from census microdata. The conclusion of the paper is that the potential benefits from census microdata are large and that the risks in terms of disclosure are very small. The authors therefore argue that the Office of Population Censuses and Surveys and the General Register Office of Scotland should release samples of anonymized records from the 1991 census for secondary analysis."

Recent experience in the control and management of tuberculosis in a mental handicap hospital

Sixteen cases of tuberculosis (14 in inmates, only one of whom was female) occurred in a mental handicap hospital of some 400 inmates during the period 1973-85. This represents an annual incidence of 269 per 100,000, substantially higher than that in the surrounding community. In 1980, 29% of inmates had Grade 3 or 4 positive Heaf tests. Widespread chemoprophylaxis was successfully undertaken in 1980/81, the only problem encountered being interaction of isoniazid with carbamazepine. One Down's syndrome patient had recurrent disease, and a second developed disease despite chemoprophylaxis. Immunological investigation of a small number of Down's syndrome patients with tuberculosis showed no consistent defect.

Comparison of the effects of enteral feeding with continuous and intermittent parenteral nutrition on hepatic triglyceride secretion in human beings

Plasma triglyceride turnover was measured during steady-state conditions in 22 postoperative patients. Nine had received nutritional support with an enteral regimen, seven had received an equivalent regimen as continuous parenteral nutrition, and six received the same parenteral regimen as a cyclical infusion. After 5 days of nutritional support, each patient received an intravenous bolus of tritiated glycerol. Plasma radiolabeled triglyceride content was measured during the subsequent 24 hours. The data were analyzed by means of a simple deterministic model of plasma triglyceride kinetics and compared with the results obtained by stochastic analysis. The rates of hepatic triglyceride secretion obtained by deterministic analysis were higher than those obtained by the stochastic approach. However, the mode of delivery of the nutritional regimen did not affect the rate of hepatic triglyceride secretion regardless of the method of analysis. The results suggest that neither complete nutritional bypass of the gastrointestinal tract nor interruption of parenteral nutrition in an attempt to mimic normal eating has any effect on hepatic triglyceride secretion. Any beneficial effect that enteral feeding or cyclical parenteral nutrition may have on liver dysfunction associated with standard parenteral nutrition appears to be unrelated to changes in hepatic triglyceride secretion.

Behavioral and neurochemical effects of acute and daily cocaine administration in rats

Daily cocaine injection into rodents produces a progressive increase in the motor stimulant effect of acute cocaine administration. In this study it was found that daily cocaine injection (15 mg/kg i.p. x 3 days) produced an enhanced motor stimulant response to acute cocaine injection. The behavioral augmentation was linear with regards to dose in horizontal activity and behavioral intensity rating, but was biphasic in vertical activity. Augmented vertical, but not horizontal, activity in response to acute cocaine was found to persist for 2 weeks after the last daily injection of cocaine. Acute injection of cocaine was found to significantly decrease the level of dopamine (DA) metabolites in the nucleus accumbens, striatum and A10 DA region. In rats pretreated with daily injections of cocaine (15 mg/kg i.p. x 3 days), an acute challenge of cocaine 14 days after the last daily injection produced a more consistent decrease in DA metabolites in the nucleus accumbens, striatum and prefrontal cortex compared to daily saline-pretreated rats. In contrast, daily cocaine treatment abolished the decrease in DA metabolites produced in the A10 region by an acute cocaine challenge. Acute injection with cocaine was found to significantly depress dopa accumulation in the A10 region, nucleus accumbens and striatum. This effect was abolished in the A10 region in rats pretreated 14 days previously with daily injections of cocaine (7.5, 15.0 or 30 mg/kg i.p. x 3 days), but remained intact in the nucleus accumbens and striatum, except after daily pretreatment with the highest dose of cocaine.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of ketotifen on beta-adrenergic activity in asthmatics

In order to examine a possible mechanism of action of ketotifen in asthma, a double-blind study was undertaken to determine whether ketotifen showed any effects on the beta-adrenergic system in asthmatic patients. The effects of ketotifen 1 mg b.i.d. for one month on the changes in spirometry, plasma potassium and serum glucose nebulized salbutamol was compared with placebo. In addition the degree of inhibition caused by local salbutamol on the wheal volume due to intradermal prostaglandin E and bradykinin, was compared following ketotifen and placebo. Nebulized salbutamol produced consistent improvements in spirometry and changes in potassium and glucose levels. Local salbutamol significantly decreased the wheal volume induced by intradermal prostaglandin E and bradykinin. However, none of these salbutamol-induced effects were altered following ketotifen or placebo. Ketotifen, in the doses used, has no demonstrable effect on the beta-adrenergic system in asthmatic patients.

Effect of nifedipine on serum theophylline concentrations and asthma control

The effect of adding slow release nifedipine to oral theophylline has been studied in eight patients with stable but symptomatic asthma, a double blind placebo controlled crossover protocol being used. No change in asthma control occurred during the nifedipine treatment period as assessed by serial peak flow measurements and symptom scores. Serum theophylline concentrations were significantly lower after nifedipine than after placebo (6.8 v 9.7 micrograms/ml) and in three patients were well below the therapeutic range (less than 4 micrograms/ml).

A comparison of methods of removing inhibitors to the chromogenic Limulus assay in normal and jaundiced blood

A comparative study was performed of methods of removing inhibitors to the quantitative chromogenic method of Limulus assay for endotoxin in normal and jaundiced plasma. Chloroform treatment failed to remove inhibitors in normal and jaundiced plasma and did not prevent inhibition of colorimetry by bilirubin. Perchloracetic acid (PCA) treatment decolourised jaundiced samples but gave unreliable results due to poor pH control. Boiling and dilution gave reliable results in jaundiced and normal plasma without significant loss of sensitivity and is the method of choice.

Percutaneous absorption of 7, 10 14C-benzo[a]pyrene and 7, 12 14C-dimethylbenz[a]anthracene in mice

The percutaneous penetration, tissue distribution and excretion of 14C-labeled benzo[a]pyrene (BP) and dimethylbenz[a]anthracene (DMBA) were studied in mice. Both BP and DMBA rapidly penetrated the skin and were excreted more in the feces than in the urine. The proportion of BP and DMBA absorbed was less with increasing applied dose due to apparent saturation of the uptake process. Uptake from the dorsal skin of the nose was similar to uptake from the dorsal nuchal skin.

Bromocriptine induced pleuropulmonary fibrosis

Images

[Cardiorespirography of the newborn infant at 12 hours of life]

The introduction of the cardiorespirogram more than twenty years ago provided a useful continous noninvasive monitoring technique of heart and respiratory functions. However, there are only few studies about recording of these parameters and the topic is often partially discussed. Thus, the aim of this paper is to analyze the cardiorespirograms from newborn infants, divided into three groups: 50 normal fullterm infants, 28 preterm and 16 fullterm low birth weight infants. The age at monitoring was 12 hours. The 50 normal newborns reveal patterns similar to those described by other authors. The preterm and fullterm low birth weight infants show a significantly higher baseline with less variability and reactivity, data which lead us to bear in mind gestational age and birth weight to evaluate the cardiorespirogram.

Extracellular fluid deficit following operation and its correction with Ringer's lactate. A reassessment

The changes in extracellular fluid volume (ECV) in two groups of surgical patients, one receiving Ringer's lactate solution intraoperatively and the other receiving only dextrose and water, were assessed. A deficit in the ECV, as measured by radioactive sulfate, of 1.9 +/- 0.8 l (p less than 0.003) compared to the preoperative volume was found in the dextrose group. This was accompanied by a decrease in the mean creatinine clearance (-13% p less than 0.01), the mean urinary sodium excretion (-57% p less than 0.05), and the mean rate of clearance of the sulfate tracer (-18% p less than 0.01). The use of intraoperative Ringer's lactate (1660 cc +/- 96 cc) resulted in no change in the ECV, an increase in the mean creatinine clearance (+10% p less than 0.05), and no change in sodium excretion or tracer clearance. As a result of these findings, it appears that postoperative sodium retention is a physiologic response to a decreased ECV, which can be prevented by the administration of Ringer's lactate.

Subcutaneous terbutaline and control of brittle asthma or appreciable morning dipping

In a pilot study two patients with brittle asthma and two with morning dipping received terbutaline or a placebo administered subcutaneously either by continuous infusion or in injections every six hours. In two patients brittle asthma was completely suppressed by terbutaline 1 mg/day given by either method. In the two others early morning dipping responded only to continuous subcutaneous infusions of terbutaline 12 mg/day. Terbutaline administered subcutaneously may be an effective treatment in asthmatic patients who show important diurnal variations in air flow.

Percutaneous absorption of [7.10-14C]benzo[a]pyrene and [7,12-14C]dimethylbenz[a]anthracene in mice

The percutaneous penetration, tissue distribution, and excretion of 14C-labeled benzo[a]pyrene (BaP) and dimethylbenz[a]anthracene (DMBA) were studied in mice. Both BaP and DMBA rapidly penetrated the skin and were excreted more in the feces than in the urine. The proportion of BaP or DMBA absorbed was less with increasing applied dose due to apparent saturation of the uptake process. Uptake from the dorsal skin of the nose was similar to uptake from the dorsal nuchal skin.

Dysphonia caused by inhaled steroids: recognition of a characteristic laryngeal abnormality

Nine of 14 asthmatic patients who presented with persistent dysphonia while taking inhaled corticosteroids had a bilateral adductor vocal cord deformity with bowing of the cords on phonation. This causes the dysphonia and usually occurs without candidiasis. It was seen with beclomethasone dipropionate (in both pressurised aerosol and dry powder preparations), betamethasone valerate, and budesonide. It was related to the dose and potency of inhaled steroid and may represent a local steroid myopathy. It was reversed when the inhaled steroid was stopped, although resolution sometimes took weeks. Laryngeal candidiasis may have contributed to the vocal cord abnormality in two of these nine patients. Of the five patients without vocal cord deformity, laryngeal candidiasis was the sole cause of dysphonia in three. In the remaining two dysphonia was thought to be psychogenic. The vocal cord deformity may exist subclinically. Of nine patients who started to take aerosol steroid and who were examined monthly for one year, three developed vocal cord deformity but only one had persistent dysphonia. Vocal abuse did not appear to contribute to dysphonia.

Effects of naftidrofuryl on breathlessness and exercise tolerance in chronic bronchitis

Naftidrofuryl enhances oxidative phosphorylation and might therefore be expected to improve exercise tolerance and breathlessness in advanced chronic bronchitis. This hypothesis was tested in a four-week placebo-controlled trial in 11 bronchitic patients. Seven patients completed the study. There was no evidence of any benefit from naftidrofuryl either subjectively or after a 12-minute walking test.

Warfarin-induced vasculitis: a dose-related phenomenon in susceptible individuals?

A case of warfarin-induced skin vasculitis in a 52-year-old female is reported. Bilateral breast involvement occurred but without progression to necrosis as in previously described cases. The pathogenesis is discussed and prescribing recommendations made in an attempt to avoid the complication in susceptible individuals.

The bronchitic patient: a study of his employment problems

Ninety-three male chronic bronchitics aged 40-64 years, 41 employed and 52 unemployed, were studied by structural interviews to evaluate factors leading to unemployment. Age was not important. Those employed were a little less disabled, and more were skilled, married, had working wives, had given up smoking, had tolerant employers and had suitable jobs, and fewer had travel problems. Of those unemployed most were not actively seeking work and, in half, income had not fallen with unemployment. Those interviewed felt that the Disablement Resettlement Officer, Industrial Rehabilitation Unit and their trade union did little to help with their problems. Ways to improve employment prospects for bronchitics are discussed.

[Complete triploidy in a liveborn premature (author's transl)]

Authors describe the clinical, pathological and cytogenetic data of a polymalformed premature with a complete a triploidy 69,XXY). This rare condition (30 cases in the literature) may be suspected in a premature with broad posterior fontanella, eye and ear anomalies, syndactily between IV and III fingers/toes, intersexual status and mielomeningocele. Frequently the placenta presents a molar or micromolar degeneration.

Reinfection tuberculosis: two cases in the family of a patient with drug-resistant disease

A 42-year-old housewife died of drug-resistant pulmonary tuberculosis. Two sons had earlier completed a course of treatment for drug-sensitive disease. Six months after her death both sons developed sputum-positive tuberculosis with a drug resistance pattern identical to that of their mother during her last year of life, and including resistance to drugs which neither son had received. In both cases immunocompetence to tuberculin was shown so that reinfection arose purely as a result of heavy exposure.

Hyposensitisation with house dust mite vaccine in bronchial asthma

In a double-blind placebo-controlled trial of tyrosine-absorbed Dermatophagoides pteronyssinus vaccine no improvement was seen in 45 patients with asthma sensitive to house dust mite. In particular there was no significant improvement in symptom scores, spirometry, and skin and nasal challenge test results. Some patients in other studies have benefited from doses of vaccine much stronger than those now commercially available, but the incidence of side effects has also been high.

Carcinoid lung: diffuse pulmonary infiltration by a multifocal bronchial carcinoid

A 20-year-old student presented with diarrhoea and miliary mottling in the chest radiograph. Biopsy specimens of lung and cervical lymph node showed diffuse multifocal carcinoid tumour. No deterioration in clinical state, radiographic appearances or lung function has occurred after two years' treatment with melphalan.