Prenatal sonographic appearance of persistent cloaca

A case of fetal persistent cloaca is presented. The intra-uterine sonographic appearance at 30 weeks' gestation is described. The clinical and ultrasonic differential diagnosis is discussed.

Traumatic chylous knee effusion

A 47-year-old patient presented with a chylous knee effusion and traumatic infected skin lacerations. The diagnosis of septic arthritis was considered because of purulent looking joint fluid, spuriously high synovial fluid white cell count, and signs of acute knee synovitis. Synovial fluid lipid analysis showed increased total lipids due to high concentration of neutral lipids, mainly triglycerides, and repeated knee radiographs showed a small fracture of the tibial spine. Joint trauma with subchondral fracture can be associated with frank chylous effusion, which may mimic acute septic arthritis.

Microphthalmia--prenatal ultrasonic diagnosis: a case report

Prenatal real-time ultrasonographic diagnosis of microphthalmia is presented. Diagnosis was made at 18 weeks' gestation in a fetus of a patient with a previous infant affected with the syndrome of cryptophthalmia with absence of septum nasi and ambiguous genitalia (Fraser syndrome). Recognition of microphthalmia as a part of Fraser syndrome and the easy visualization of fetal facial bones and orbits in the second trimester made the diagnosis possible.

Assessment of gestational age by ultrasonic measurement of the femur length

The effectiveness of ultrasonic femur length measurement from 12 to 40 week's gestation, as a means of assessing fetal age, was tested and compared with that of biparietal cephalometry. The femur length and biparietal diameter (BPD) were obtained from 471 measurements, from pregnant women with confirmed datings, using real-time scanning with a 3,5 mHz transducer frequency. Using a freeze frame and electronic calipers, the mean value of three consecutive measurements of the femur, when visualized with its characteristic appearance, was recorded. Linear regression analysis with the correlation coefficient of the femur growth-curve (r = 0.989, p less than 0.001) and that of the BPD (r = 0.985, p less than 0.001) showed that the former is as good as the latter. The femur growth-curve from 12 to 40 week's gestation with a mean +/- 2 SD was constructed. Estimation of fetal age by femur length measurement was compared with that assessed by the BPD in a further 54 women. A close correlation was found (r = 0.993, p less than 0.001). Measurement of the fetal femur appears to be a reliable method for assessing gestational age, which can compensate for the limitations of the BPD method.

[Measurement of the biparietal diameter before and after external version of the fetus]

In 52 cases of breech presentation, the biparietal diameter of the fetal head was measured before and after external version of the fetus. There was no significant statistical difference between these two measurements.

Prenatal diagnosis of placental hemangioma--clinical implication: a case report

Placental hemangioma is considered to be associated with a high rate of maternal and fetal complications. We report a case where ultrasonography revealed the placental tumor at 28 weeks gestation. The patient was kept under strict surveillance which permitted diagnosis of pre-eclampsia at 34 weeks gestation with successful termination of pregnancy at 37 weeks. The ultrasonic features of the tumor are described and the clinical implication discussed.

Personal characteristics of health professionals: can they be changed by an educational program?

The objectives of many graduate programs in the health sciences include the development of various personal characteristics, attitudes, and beliefs. A study was carried out to assess whether personal characteristics of graduate students could be affected by program participation and, if so, which specific personal characteristics could be changed. Three attitude tests were administered to three consecutive classes of mature health professionals, using a repetitive pre-post design. Results showed no difference from pre- to posttesting on the California Personality Inventory; a positive difference on one main scale and two subscales of the Personal Orientation Inventory (inner directedness, flexibility in application of values, and self-acceptance); and a negative difference on the Health Professional Survey (attitude toward working in teams). These findings suggest that many personal characteristics deemed important by program planners in the health sciences may more appropriately be criteria for admission than objectives of the program.

The influence of in vitro caffeine treatment on human sperm morphology and fertilizing capacity

After publication in the literature that in vitro caffeine treatment causes damage of the normal shape of the sperm head and thereby decreases fertilizing capacity, we carried out a clinical and electron microscopic study to determine the influence of caffeine on the fertilizing capacity and sperm cell morphology. Sixty women (with infertile husbands) underwent artificial insemination by donor with frozen/thawed semen over a period of 12 months, using randomized addition of caffeine in alternate months. Fourteen women became pregnant during the 6 months they received caffeine-treated semen, whereas only 7 pregnancies occurred during the 6 months the women received semen without caffeine. Scanning electron microscopic examinations of fresh proven donor semen showed no morphologic changes caused by the in vitro caffeine treatment. However, quantitative morphologic analysis of the frozen/thawed semen was unsatisfactory because of the freezing technique and the masking effect of the protective medium. It is concluded that in vitro caffeine treatment of fertile donor semen does not damage the spermatozoa; furthermore, it seems to improve the fertilizing capacity.

External bladder--amniotic fluid shunt for fetal urinary tract obstruction

Ultrasound diagnosis of bilateral hydronephrosis, hydroureters, and megacystis together with oligohydramnios secondary to urethral stenosis was made in a male fetus at 29 weeks' gestation. In utero decompression of the obstructed urinary tract and expansion of the amniotic fluid was achieved by placing an external bladder-amniotic fluid shunt using two catheters, one inserted into the fetal bladder and the other placed in the amniotic sac. The infant was delivered by cesarean section at 35 weeks' gestation and had a favorable outcome.

Manifestations of Whipple's disease in the posterior segment of the eye

Ocular manifestations of Whipple's disease result from CNS involvement, direct intraocular involvement, or both. Ocular signs caused by CNS involvement occurred in 30 of the 34 patients with ocular manifestations described in the literature. In only four of the 34 cases were ocular manifestations due solely to intraocular involvement. Two cases reported herein had unique intraocular involvement, manifested as diffuse chorioretinal inflammation. Fluorescein angiography showed diffuse vasculitis, with hemorrhages, exudates, retinal capillary occlusion in the perifoveal and midperipheral areas, capillary dilation at the optic disc, and choroidal folds. Proper antibiotic treatment resulted in ocular and systemic recovery. Follow-up is mandatory because of possible recurrences, which may start with intraocular signs, followed by systemic manifestations. Some cases progress to fetal CNS involvement. Therefore, when intraocular signs recur in treated patients, antibiotic therapy should be restarted or dose should be increased.

Prospective study of school injuries: incidence, types, related factors and initial management

The rates of school injuries were examined by means of a prospective study of 212 schools during the 1981-82 school year. The results showed an annual incidence rate of 5.4 injury events/100 children, which appears to be an underestimate of the actual rate. Of all the injury events 28.7% resulted in serious injuries. Injuries were significantly more frequent in the elementary as opposed to the secondary schools, and the boys were injured significantly more often than the girls. Most of the injuries occurred during athletic activities. Most of the children with either serious or minor injuries were sent to the school office or returned to the classroom, which indicates that the present level of first-aid training among school personnel is inadequate.

Activity patterns and time budgeting of Aplysia fasciata under field and laboratory conditions

Activity patterns of Aplysia fasciata were observed in a protected port environment and in an aquarium. In both, major activities were feeding and mating, which collectively took up about 45% of the total time of the animals. Active behaviors occurred primarily at night; much of the day was spent in the inactive state. Activities were highly synchronized, with large numbers of animals performing the same behaviors simultaneously at a specific time. Mating and eating occurred primarily at different times; relatively few animals were observed performing these behaviors simultaneously. Many animals laying eggs were simultaneously mating as females.

Micrognathia-prenatal ultrasonographic diagnosis

The first case of prenatal real-time ultrasonographic diagnosis of micrognathia is presented. Diagnosis was made at 17 weeks' gestation in the fetus of a patient with previous infant affected with the syndrome of thrombocytopenia with absent radii (TAR). Recognition of micrognathia as a part of TAR syndrome and the easy visualization of fetal facial bones in the second trimester made diagnosis possible.

Altered immunoregulation in Waldenström's macroglobulinemia. I. The absence of Con A-induced and spontaneous T suppressor cell activity in a patient and his kindred

In vitro lymphocyte functions in a patient with Waldenström's macroglobulinemia and his kindred were examined. The percentage and number of total peripheral blood T cells and the absolute number of FC gamma bearing T cells were decreased in the patient and family members compared to controls but the B cells and monocytes were normal. In addition, PHA and PWM stimulated proliferation were decreased. Decreased responsiveness to PWM was abrogated by preculturing PBMC in media alone before PWM stimulation. Decreased responsiveness to PHA was not reversed by a similar period of preculture. To further define the above abnormalities in immunoregulation we examined mononuclear subpopulations. In controls, adding purified T cells or Con A activated lymphocytes to autologous cultures which had been stimulated with PHA and PWM significantly decreased proliferative activity. No such suppressive activity of T cells or Con A activated cells from the patient or family members was noted. These data demonstrate an absent or functionally inactive spontaneous and Con A activated T suppressor cells in the family of a patient with Waldenström's macroglobulinemia.

Bullous pemphigoid and ulcerative colitis

A 21-year-old white woman, who had ulcerative colitis for 14 years, developed generalized severe bullous pemphigoid. Following the resection of her colon, her skin showed marked clinical improvement, but this was only temporary. Direct immunofluorescence was performed on the surgical specimen and no antibodies (BMZ) to colonic mucosal cells were evident. Anti-basement membrane zone antibodies were found on direct and indirect immunofluorescent studies and have persisted. Sera from 15 patients with ulcerative colitis and 11 patients with Crohn's disease, evaluated for the presence of an anti-basement membrane zone antibody did not contain any demonstrable levels of anti-BMZ antibodies. The co-existence of ulcerative colitis and bullous pemphigoid is more likely incidental rather than etiopathologic.

The McMaster CME Society

Registration for continuing medical education (CME) at McMaster University Faculty of Health Sciences may be achieved in two ways: by separate registration for each course or by prepaying an annual fee that enables the physician to attend all or parts of any CME activities in a 12-month period. The latter method also provides membership in the McMaster Continuing Medical Education Society. This society, in operation at McMaster for the past three years, was conceived with the following objectives: to decrease the cost per course to the physician; to allow for selectivity in course material; and, perhaps most importantly, to increase the motivation of physicians to attend CME activities. Achievement of the objectives has provided a funding base on which to build CME events and has permitted the use of input of members of the society as a planning guide.

Euryblepharon: a case report with photographs documenting the condition from infancy to adulthood

A case of euryblepharon with lateral ectropion is reported, with photographs from infancy to adult life. The value of obtaining photographs, if available, in cases such as this is stressed, to avoid unnecessary clinical studies being done. The photographs indicate the stability of the condition. They also indicate that, at least in some cases, the ectropion will become less apparent with body growth and may need no therapy.

A disease in dogs resembling human pemphigus vulgaris: case reports

A pemphigus-like disease occurred in 5 dogs. The canine disease closely resembled pemphigus vulgaris in man and was characterized by ulcerative lesions in the oral cavity, on the skin, and at mucocutaneous junctions. Histologically, the first sign of the disease was disappearance of the intercellular bridges in the lower epidermis. The resulting acantholysis was diagnostic for pemphigus. Antibodies to the intercellular space substance were detected by immunofluorescent staining in serum of 4 of the dogs. High doses of corticosteroids were effective in controlling the disease.