Thymic Hassall's bodies of children with congenital heart defects

The development of the thymus and heart are closely related while in both, the neural crest cells play an important role. In our preliminary study, the thymic microscopic structures of the infant's thymuses with the congenital heart defects were observed. The study was conducted on 36 specimens of newborn thymuses removed due to surgery for cardiovascular malformations. Standard formalin-fixed paraffin-embedded tissue technique was used. Five-microm-thick sections were stained with hematoxylin and eosin and the microscopic examination was focused on the structure of Hassall's bodies. The Hassall's bodies showed considerable variations in size as well as in quantity. In most cases, the Hassall's bodies were large with the heterogeneous amorphous material enclosed in cystic dilatations. This type of Hassall's bodies is typical for adult thymuses. The most conspicuous changes (huge Hassall's bodies with the cystic dilatation filled up with cell detritus) were observed in patients with ventricular septal defect, atrioventricular septal defect and tetralogy of Fallot. Small-sized Hassall's bodies corresponding with infant age, were observed in cases with pulmonary valve atresia, atrial septal defect and in some cases of transposition of great arteries. We assume that the changes of microenvironment of the thymic medulla are associated with disrupted migration of the neural crest cells which are essential in the normogenesis of both heart and thymus (Tab. 1, Fig. 12, Ref. 33).

Anthropometry, nutrition status and thymic size of Gypsy newborns from southwestern Slovakia

Gypsy population represents a specific minority in Slovakia that differs from the majority population by its origin and genetic markers, as well as by generally lower social and economic status and lower hygienic standards of living. The aim of the present work is the analysis of anthropometric dimensions and indexes, as well as of thymus size, in the group of Gypsy and non-Gypsy newborns from the Southern Slovakia. Our group of 212 physiological newborns consisted of 33 Gypsy and 179 non-Gypsy newborns. All newborns were underwent anthropometric examination and their thymus size was assessed by ultrasonography and calculated as so-called Thymic Index". Gypsy newborns show statistically significant lower anthropometric dimensions (birth weight and birth body length, head and chest circumference) when compared to non-Gypsy newborns, however, they do not differ in the values of nutritional status indicators (arm circumference, Quételet index and Rohrer index). They do not differ even in the thymus size that can be regarded as a "barometer" of the nutrition and of some negative stimuli. In spite of generally deficient nutrition and lower health status of the Gypsy minority in Slovakia, we did not find any significant differences in the indicators of nutritional status or in thymus size (Tab. 2, Ref. 34).

DNA based prenatal testing for the skin blistering disorder epidermolysis bullosa simplex

Epidermolysis bullosa simplex (EBS) is a skin fragility disorder in which mild physical trauma leads to blistering. The phenotype of the disorder is variable, from relatively mild affecting only the hands and/or feet, to very severe with widespread blistering. For the severest forms of EBS there is a demand for prenatal diagnosis which until now has involved a fetal skin biopsy in the second trimester. The identification of mutations in the genes encoding keratins K5 and K14 as the cause of EBS opens up the possibility of much earlier diagnosis of the disease. We report here four cases in which prenatal testing was performed. In three of the cases the genetic lesions were unknown at the start of the pregnancy, requiring the identification of the causative mutation prior to testing fetal DNA. In two of the four cases novel mutations were identified in K14 and in the two remaining families, a previously identified type of mutation was found. Fetal DNA, obtained by chorionic villus sampling or amniocentesis, was analysed for the identified mutations. Three of the DNA samples were found to be normal; a mutant K14 allele was identified in the fourth case and the pregnancy was terminated. These results demonstrate the feasibility of DNA-based prenatal testing for EBS in families where causative mutations can be found.

The geriatric gravida: multifetal pregnancy reduction, donor eggs, and aggressive infertility treatments

OBJECTIVE

Recent technologic advances and societal acceptance have dramatically increased the use of donor eggs for infertile couples who require assisted reproductive technologies. Now many "older" couples can access assisted reproductive technologies to achieve pregnancies. We sought to evaluate the changing pattern of patients referred for multifetal pregnancy reduction as a result of donor eggs and age factors in aggressive infertility treatment.

STUDY DESIGN

Patients undergoing multifetal pregnancy reduction from 1986 to 1996 were included and categorized by year groupings, age, and the use of donor eggs.

RESULTS

A total of 523 patients were referred for and underwent multifetal pregnancy reduction. Before 1994, only 4 of 226 (1.8%) had received donor eggs, whereas in 1994 to 1996, 29 of 297 (9.8%) had received donor eggs (chi 2 = 12.6, p < 0.001). Eight of 9 patients aged > or = 45 years undergoing multifetal pregnancy reduction received donor eggs. There were no patients aged > or = 45 years before 1994 but 9 in 1994 to 1996. Four of 9 patients aged > or = 45 years with multifetal pregnancies chose reduction to singleton gestation. The proportions of patients aged > or = 40 years have increased from 0% to 11% in the last 8 years.

CONCLUSIONS

The availability of donor eggs has dramatically increased the use of assisted reproductive technologies and subsequent use of multifetal pregnancy reduction in older patients. Older patients are more inclined to want reduction to singleton gestation; they cite parental demands, financial issues, and their ability to parent in their 60s and 70s as reasons for reduction to singleton gestation.

Molecular epidemiology of HIV in Israel

The aim of this study was to identify the HIV types and subtypes prevalent in Israel among different populations in terms of risk or geographic origin of the HIV infection. A total of 149 blood samples were collected from HIV-positive persons from different risk groups for HIV infection who were living in Israel. HIV subtyping was performed by a V3-based peptide enzyme immunoassay, supplemented by direct sequencing of polymerase chain reaction products from the V3 region. Multiple HIV-1 subtypes were shown to circulate in Israel; whereas most of the infections among Israelis and Palestinians were of subtype B, infections among the large Ethiopian population in Israel were caused by HIV-1 subtype C. Occasionally, we found HIV-1 subtypes A and D and a putative B/C recombinant. No HIV-2 infection was identified. Sequence comparisons and phylogenetic tree analyses point at multiple introductions of HIV into the country. The presence of mainly two different HIV-1 subtypes, B and C, in two separated populations in Israel may result in two distinct epidemiologic patterns among HIV-infected individuals in Israel. Subtype C infection among the Ethiopians in Israel opens new research avenues toward better understanding the natural history of infection with HIV-1 subtype C in Ethiopians living in a Western society compared with those living in Ethiopia.

[Problems in carrying out baroreflex sensitivity measurements in clinical routine practice: practicability and complications]

Measurement of baroreflex sensitivity is a new method to identify patients after myocardial infarction with a high risk for sudden cardiac death, ventricular tachycardia or ventricular fibrillation. In this retrospective study the baroreflex sensitivity was obtained noninvasively by measuring the systolic blood pressure blood pressure with a FINAPRES-device and correlating this with the R-R intervals of the ECG after raising blood pressure with an intravenous dose of Norfenefrin-hydrochloride (Novadral). According to other investigators a correlation of > 0.7 with a significance of p < 0.05 was recommended for evaluable results with a baroreflex sensitivity < 3 ms/mm Hg being judged as decreased. We investigated 302 patients (mean age 59 +/- 17 years, 224 males, 78 females). 75% of the investigations showed acceptable results. In 77 cases (25%) reasonable results could not be achieved. We found premature ventricular beats to be responsible in 18 investigations (6% of all investigations). 41 (13.1%) of all investigations were not evaluable because of bad correlation for unknown reason. When we looked closely at these nonevaluable results, we found a significantly higher number of patients with impaired left ventricular ejection fraction (< 40%), diabetes or inducible sustained ventricular tachyarrhythmia in the electrophysiologic study in this group. During all investigations no severe side effects were observed. We conclude that the noninvasive measuring of the baroreflex sensitivity is a save method and leads to reasonable results in 75% of the investigations. In 13.1% it is not possible for unknown reason to achieve sufficiently correlating values. These measurements cannot be evaluated from nowadays' standards and have to be further investigated as they may indicate a population at high risk.

Divergent views--patient, career and staff perceptions of diagnosis and reasons for psychiatric admission to a district general hospital

This study explores the differing perceptions of patients, carers, and professional staff in relation to psychiatric admission. There is poor to moderate agreement between lay people and professional beliefs about diagnosis or purpose of admission, although good agreement about the necessity of admission. The chronicity of symptoms in admitted patients and a rural-urban divide in rates of admissions are also noted.

[SP-1 and beta-HCG in suspected ectopic pregnancy (author's transl)]

Serum levels of SP-1 and beta HCG as Trophoblastic Markers were measured in 31 women operated on suspected ectopic pregnancy. In all 24 patients with tubal pregnancy SP-1 levels estimated by enzyme immunoassay Enzygnost were higher than 5 ng/ml, whereas SP-1 levels in 7 cases with benign ovarian cysts were less than 2 ng/ml. Beta-HCG in serum was analysed by radioimmunoassay (Serono-Biodata): in cases with ectopic pregnancy serum levels were between 113 mIU/ml and 1040 mIU/ml, in the 7 nonpregnant cases the highest concentration was 7 mIU/ml. There was no correlation between serum concentration of SP-1 and beta-HCG (r = 0,571). In view of clinical practice preference is given to estimation of SP-1 by enzyme immunoassay over estimation of beta-HCG by radioimmunoassay, the reasons are discussed.

[Concentration of pregnancy-specific-beta-1-protein sp1 in amniotic fluid in normal and pathologic pregnancies (author's transl)]

The concentration of the pregnancy specific protein SP-1 in amniotic fluid was determined in normal and pathologic pregnancies. SP-1 concentrations in amniotic fluid of normal pregnancies amounted to one percent of the maternal serum concentrations. In cases with diabetes mellitus intrauterine death and rhesus incompatibility SP-1 levels were increased significantly.