Familial blepharophimosis: an uncommon marker of ovarian dysgenesis

We report on six young female patients from two families who were found to have a very rare form of ovarian failure. Hypogonadism is inherited with an ocular abnormality consisting of a congenital dysplasia of the eyelids. In one family inheritance is autosomal dominant and in the other it is a de novo mutation. The patients have no other dysmorphic features and are of normal intelligence. Plasma levels of follicle-stimulating and luteinizing hormones are significantly elevated. Examination of the internal genitalia by laparoscopy was performed in four cases with ovarian biopsy in one case; the results are compatible with gonadal dysgenesis. Cytogenetic studies indicate the absence of chromosomal defects.

Very low maternal serum unconjugated estriol and prenatal diagnosis of steroid sulfatase deficiency

Twenty-four women out of 7,875 pregnant women who enrolled in a prenatal screening program showed extremely low levels of unconjugated estriol (< 0.15 MOM). In 19 cases, intrauterine fetal death was reported. In 1 case anencephalus was detected. In the remaining 4 cases apparently normal healthy babies (1 female and 3 males) were born following uneventful pregnancies. Physical examination of the 3 boys at 4-6 weeks revealed mild ichthyosis compatible with the X-linked type. Two of them had a positive family history of X-linked ichthyosis. The examination of the girl did not reveal any significant findings. In both cases in which amniocentesis was performed, low levels of steroid sulfatase and arylsulfatase C were found. The prevalence of X-linked ichthyosis in this study is higher than previously reported, i.e. 1:1,300 males. Our results suggest that the prenatal screening program for neural tube defects and for Down's syndrome is useful for the prenatal detection of X-linked ichthyosis as well. These results are in accordance with two recent reports. The implications regarding genetic counseling are discussed.

Transcription factors in interferon signaling

Interferons (IFNs) comprise a family of polypeptides that exhibit diverse biological effects such as inhibition of cell growth and protection against viral infection. These activities are based mainly on the transcriptional induction of cellular genes by both type I (IFN-alpha and IFN-beta) and type II (IFN-gamma) interferons. Several of these IFN-induced early response genes have been cloned and common elements within their promoters defined. Transcription factors, such as interferon-stimulated gene factor-3, IFN-gamma activation factor and FcRF gamma, that bind to these enhancers subsequently have been isolated and their components identified. This review shall provide an overview of the DNA response elements, the components of the IFN-induced transcription factors and their mechanism of action.

A clinical screening cooperative group phase II evaluation of lobaplatin (ASTA D-19466) in advanced head and neck cancer

We evaluated the efficacy and tolerability of lobaplatin, a new platinum compound, given at the dose of 50 mg/m2 by i.v. bolus every 4 weeks, in 49 patients with advanced and/or metastatic squamous cell carcinoma of the head and neck (SCCHN). One complete and 2 partial responses were observed in 43 eligible patients for an overall response rate of 7% (95% confidence interval: 1-19%). The duration of responses was 11, 16 and 32 weeks. Toxicities of WHO grade > or = 3 were hematologic: thrombocytopenia in 26%, granulocytopenia in 12% and anemia in 12% of patients. There was no therapy-related death. Nausea/vomiting, diarrhoea and paresthesia were mild and rare. In conclusion, lobaplatin was well tolerated, but its efficacy in advanced SCCHN at the presented dose and schedule, was marginal.

[Purulent pericarditis in dermatopolymyositis]

The authors report the case of a 33-year-old patient with dermatopolymyositis, admitted to hospital for acute cystic pericarditis with fever and deterioration of the general state. The aetiological diagnosis was obtained by analysis of the pericardial fluid after surgical drainage, revealing purulent Staphylococcus aureus pericarditis. This case emphasises that, despite the marked rarity of pericardial effusion in the course of dermatopolymyositis, due to the steroid sensitivity of this disease, the possibility of septic contamination should be considered in the presence of persistent pericarditis in the context of this disease.

Quality of care in adult heart surgery: proposal for a self-assessment approach based on a French multicenter study

A prospective study was carried out from January to April 1993 in 42 centers to assess the quality of care in adult heart surgery in France. One hundred eight parameters were collected (i.e., risk factors, surgery, postoperative course) for 7181 patients. Eight simple, objective factors were selected using a multivariate analysis. Point weighting was assigned to each factor. A simple cumulative score was thereby established to classify patients within four incremental risk groups (respective distribution of patients and mortality were 38.6%, 26.5%, 21.3%, 13.5% and 2%, 3.9%, 6.1%, 21.4%). This score was highly predictive for mortality and severe morbidity. Objectivity and independence of the observer, coupled with a reliable score, are needed for meaningful assessment of the quality of care. Administrative supervision and/or comparison of raw center results therefore remain controversial. A national data base was developed as a part of this study, that includes anonymous information from two-thirds of all cardiac surgery cases. Nation-wide results for France allow each center freely to assess its results. This self-assessment approach is, in our view, the most accurate way of quality of care assessment. A pan-European system using a similar approach should be developed.

[Cutaneovisceral leishmaniasis following severe nervous depression]

Leishmania is considered an opportunistic agent during cellular immunodeficiency. The authors report the case of a patient living in the south of France presenting visceral leishmaniasis with cutaneous manifestations in the course of a severe nervous depression. This case report illustrates the possible relationships between stress and immunity.

[Undesirable effects of drugs. Epidemiologic study at a psychiatric service of a university hospital]

The authors reviewed the drug side effects observed in their ward during the 5 last years (1988-92). These alleged effects occurred at a very low incidence, 3 per cent, (116 cases on 3809 hospitalizations). As mentioned in the literature, the occurrence was higher in females (60 per cent), than in males. The age seemed not to be a risk factor in that population, the mean age being 44 for the men and 45 for the women. All side effects disappeared after decreasing or stopping the suspected drug. In 6 cases the suspected drug was not a psychotropic agent. The authors presented some of the more often reported cases, and some of the more recently known, such as extrapyramidal side effects with antidepressants, increase of the libido with serotonergic antidepressants. The problem fo polytherapy is discussed. In half (59/116) of the cases there was a psychotropic association. The side effect may be due to a pharmacokinetic interaction in 16 cases, either with enzymatic inhibitors like dextropropoxyphene, valpromide, valproic acid, fluvoxamine and fluoxetine, or with enzymatic inducers like carbamazepine. The authors compared the side effects of the antidepressants mainly used in their ward (amitriptyline, clomipramine, fluvoxamine and fluoxetine).

Clinical performance of the TCu 380A and TCu 220C IUDs in four developing country family planning clinics

The clinical performance of the Copper T 380A (TCu 380A) and the Copper T 220C (TCu 220C) intrauterine devices (IUDs) were evaluated for 12 months in a group of women who had one of the two IUDs inserted. Results are from a randomized clinical trial conducted at four collaborating research sites located in two developing countries. The gross cumulative life-table pregnancy rate of the TCu 380A IUD was found to be lower than that of the TCu 220C IUD at 12 months (0.3 and 0.8, respectively), although this difference was not statistically significant (p > 0.05). Statistically significant differences between the two study IUDs were not found with regard to IUD expulsion or IUD removal due to bleeding/pain, personal reasons, medical reasons, or planned pregnancy. No statistically significant differences were observed in the frequency of experiencing menstrual disturbances (i.e., dysmenorrhea, intermenstrual pelvic pain or intermenstrual bleeding) between the two IUD groups. These data suggest that the TCu 380A and TCu 220C IUDs are both appropriate options for contracepting women. The TCu 380A IUD, however, may be a more appropriate option for those women wishing to space births over a longer period of time.

Hypertonic saline treatment of hemorrhagic shock in awake rats

Hypertonic saline solution (HTS) treatment of uncontrolled hemorrhagic shock (UCHS) in anesthetized animals leads to increased bleeding, fall in mean arterial pressure (MAP), and increased mortality. To rule out the effect of anesthetic drugs on this response, HTS infusion in UCHS was studied in awake rats. 24 h prior to the experiment, the animals were cannulated under neurolidal-ketalar anesthesia and two major branches of the ileo-colic artery were encircled with a silk suture. On the next day the awake animals were randomly divided into two groups: in group 1 (n = 16) controlled hemorrhagic shock (CHS) was induced by arterial bleeding of 20 mL/kg; in group 2 (n = 16) UCHS was induced by transcutaneous tear of two branches of the ileo-colic artery. The animals in each group were then divided into two subgroups: group A was untreated and group B was treated with 5 mL/kg 7.5% NaCl (HTS) after 10 min. Arterial bleeding in group 1A was followed by a fall in MAP to 63 +/- 2 mmHg (p < .001), and the hematocrit decreased to 37 +/- 3% (p < .01) in 10 min. Injury to two branches of the ileo-coli artery was followed by intra-abdominal bleeding, fall in MAP to 87 +/- 6 mmHg (p < .01), and a decrease in hematocrit to 32 +/- 2% (p < .01) in 10 min. Infusion of HTS in group 1B was followed by an increase in MAP to 84 +/- 4 mmHg (p < .01) and a fall in hematocrit to 22 +/- 2% (p < .01) after 60 min, while in the untreated group 1A, the MAP was 65 +/- 4 mmHg (p < .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Localization of the gene for Darier disease to a 5-cM interval on chromosome 12q

Darier disease is an autosomal dominant abnormality of epidermal differentiation characterized clinically by the presence of hyperkeratotic papules on the skin and histologically by the loss of cell cohesion and by disorderly keratinization. Two groups recently found evidence that the gene whose mutations underlie this disease is located at chromosome 12q23-q24.1, a site on chromosome 12 that clearly is distal to the type II keratin gene cluster. We report here evidence for sublocalization to a 5-cM region of that site in an additional ten families of European and Middle Eastern ancestry with a combined lod score in excess of 20.

Functional characterization of the novel L108W and P186L mutations detected in the type II 3 beta-hydroxysteroid dehydrogenase gene of a male pseudohermaphrodite with congenital adrenal hyperplasia

Two isoenzymes are responsible for 3 beta-hydroxysteroid dehydrogenase/delta 5-delta 4-isomerase (3 beta-HSD) activity in humans. We analyzed the structure of types I and II 3 beta-HSD genes in a male pseudohermaphrodite suffering from a severe salt-losing form of congenital adrenal hyperplasia. We did not detect any mutation in the type I 3 beta-HSD gene, but we found two different missense mutations in exon IV of the type II 3 beta-HSD gene of the patient; a conversion of codon Leu108 into a Trp (L108W) inherited from his mother and a conversion of codon Pro186 into a Leu (P186L) inherited from his father. We assessed the effect of the L108W and P186L mutations on 3 beta-HSD activity by in vitro analysis of mutant enzymes expressed in heterologous COS-1 cells. Using homogenates from transfected cells, the Km values for PREG were 7 +/- 2 and 8 +/- 2 microM for the recombinant L108W and P186L enzymes, respectively, compared with 2.2 +/- 0.2 microM for the normal type II 3 beta-HSD enzyme. Moreover, Km values for NAD+ were much higher for the L108W and P186L proteins, being 678 +/- 166 and 920 +/- 351 microM, respectively, compared with 24 +/- 3 microM for the normal type II 3 beta-HSD enzyme. Vmax values for PREG and NAD+ were lower for both mutant enzymes; thus, the in vitro overall efficiency, relative to the normal enzyme, is approximate as 0.3% and 0.2% for the L108W and P186L enzymes, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Guidelines for measurement of blood pressure, follow-up, and lifestyle counselling. Canadian Coalition for High Blood Pressure Prevention and Control

As part of the Coalition's mandate to promote the prevention and control of high blood pressure in Canada, an interdisciplinary Workgroup was established to review and update the existing standards (1987) for blood pressure measurement and referral guidelines. The intent was to prepare a scientifically based document which contained practical guidelines for the measurement of blood pressure and criteria for follow-up, and one which promoted the concept of cardiovascular health in the assessment and interpretation of blood pressure readings. These guidelines were primarily developed to assist primary health care providers and/or clinicians to assess, monitor, counsel, refer, and develop treatment plans for adults-at-risk for high blood pressure or those with the confirmed diagnosis of hypertension. Readers are referred to The Canadian Hypertension Society Consensus Conference series (Canadian Medical Association Journal 1993) for specific guidelines on the evaluation, diagnosis, and treatment of hypertension. The document is divided into three sections: 1. Measurement of blood pressure 2. Criteria for follow-up 3. Guidelines for lifestyle counselling Each section cites the references used in developing the guidelines and where relevant, identifies other resources which can be used in clinical practice.

[Doppler ultrasound study of a twin pregnancy with feto-fetal transfusion syndrome]

A report is made on a typical case of twin-twin transfusion syndrome of monozygotic twins with severe polyhydramnios. By treatment with decompression amniocentesis, we achieved prolongation of the pregnancy by 10 weeks. Daily performed Doppler velocimetry showed, that the resistance values did not differ before and after amniocentesis. We found the greatest differences between the pulsatility indices of the umbilical cords and the aortae. The arteriovenous anastomosis was visualized by colour flow mapping.

Bullous morphea: a distinct entity?

A 57-year-old woman who had undergone lumpectomy for infiltrating duct-cell carcinoma of the right breast was found to have morphea after receiving radiation therapy. Three years later she developed a vesicular eruption on the area of the morphea, which was diagnosed as bullous morphea. The histologic findings of the vesicular component were characteristic of lichen sclerosus et atrophicus. It is suggested that in some cases bullous morphea represents a secondary appearance of bullous lichen sclerosus et atrophicus on a lesion of morphea.

[Fathers in the delivery room--an East/West comparison]

The attendance of fathers in the delivery room to accompany the women giving birth is in Germany quite common. In this study we wanted to compare the results of a questionnaire on feelings, intention an anxiety of attending fathers in an east and west German maternity hospital. Although social acceptance of fathers in the delivery room in the eastern part of Germany is delayed by 10 years (compared to western clinics) the over all impression of attending fathers was similar. We aid find differences concerning the expectations, the way of mental preparing and considerations participating the approaching birth in east and west questionared fathers. The results also showed variable knowledge in respect of pregnancy and birth. We do think that after a time of ("father") experience in the east part of Germany the expression of opinion will adjust.

Prolactin activates the interferon-regulated p91 transcription factor and the Jak2 kinase by tyrosine phosphorylation

The prolactin (PRL) receptor is a member of the family of cytokine receptors that lack intrinsic tyrosine kinase activity but contain two conserved cysteines in their N-terminal regions and a WSXWS motif adjacent to their transmembrane domains. In a manner similar to the interferons (IFNs), exposure of cells to PRL results in tyrosine phosphorylation of several cellular proteins and the rapid transcriptional induction of the IFN regulatory factor 1 gene. In this communication, we demonstrate that treatment of rat Nb2 lymphoma cells with PRL activates a latent protein factor so that it binds to an enhancer in the IFN regulatory factor 1 gene. This enhancer has been shown to be required for IFN-gamma-activated expression of this gene. PRL-induced assembly of the DNA binding complex, PRL-stimulated factor, required tyrosine phosphorylation. PRL-stimulated factor contained at least one protein that was antigenically similar to the p91 transcription factor, a component of several transcription complexes required for cytokine-activated gene expression. PRL not only induced the tyrosine phosphorylation of p91 but also induced tyrosine phosphorylation of Jak2, a tyrosine kinase required for IFN-gamma-activated gene expression. These results provide evidence for a signaling mechanism, some of whose components are shared by both PRL and IFN-gamma receptors, that results in the expression of early response genes.