Acute admissions to medical departments. A comparison between an urban and a rural district

To compare hospitalization into medical departments, acute admissions into a city hospital and into a district hospital were compared prospectively over a two-week period. Patients referred to the city hospital were on average older, were more frequently living alone and they had a greater amount of social care attendance in their homes. On the other hand, distribution of referral diagnoses, overall patient activity, occupational status and contact with relatives were similar in the two areas. Sub-acute or acute illness was considered the main cause of admission in both areas; the amount of admissions for social reasons was 13 percent to the city hospital versus 3 percent to the district hospital. Relevant alternatives to hospitalization seemed to exist in 50 percent of the admissions to the city hospital versus only 3 percent to the district hospital. Since patients admitted for social reasons block hospital beds for a longer time period than those admitted for other reasons, these differences may to some extent explain why length of hospital stay is longer in city hospitals than in rural ones.

A stereologic study of postmature placentas fixed by dual perfusion

OBJECTIVE

Placental insufficiency has been considered the cause of increased morbidity in infants delivered postmaturely. Former quantitative studies have indicated a decrease in some placental structures just before term. In this study we describe a method of dual perfusion fixation to provide tissue for stereologic examination. Postmature placentas were examined with this method.

STUDY DESIGN

Eleven postmature placentas and 14 placentas delivered at term were fixed by dual perfusion. The volume and the surface area of villi, the trophoblast volume, and the volume, surface area, and length of villous capillaries were estimated by stereologic examination. The Mann-Whitney test (p < or = 0.05) was used for statistical analysis.

RESULTS

Morphologic features were normal in all placentas. No significant differences were disclosed in the stereologic estimates of placentas delivered at term and postmature placentas.

CONCLUSION

No morphologic or significant quantitative changes were found in postmature placentas.

Plasma cholecystokinin in obese patients before and after jejunoileal bypass with 3:1 or 1:3 jejunoileal ratio--no role in the increased risk of gallstone formation

BACKGROUND AND AIM

Jejunoileal bypass surgery for obesity increases the risk of gallstone formation, and, contrary to expectations, the incidence is greater in patients with a long as compared to a short ileum left in continuity. Impaired gallbladder motility due to reduced cholecystokinin (CCK) stimulation could be an explanation. The aim of this study was to investigate the CCK levels in such patients.

SETTING

The randomized trial of bypass surgery named The Danish Obesity Project.

DESIGN AND METHODS

We compared plasma levels of CCK in obese patients at three, nine or 15 months after jejunoileal bypass surgery with either a 1:3 jejunoileal ratio (n = 14) or a 3:1 ratio (n = 15), and in unoperated obese patients (n = 7). Plasma CCK levels were determined during fasting and during 150 min following ingestion of a liquid test meal.

RESULTS

There were no significant changes over time following surgery. Basal CCK levels were significantly increased after surgery, and significantly higher in those with a 3:1 than in those with a 1:3 jejunoileal ratio. The postprandial AUC (mean +/- SEM) was 935 +/- 71 pM x min in the 3:1 ratio group and 891 +/- 100 pM x min in the 1:3 ratio group. This difference was not significant, but both bypass groups were significantly higher than the unoperated group (515 +/- 79 pM x min). The integrated increase in plasma CCK above basal level showed a similar pattern, but the difference between the unoperated and the bypass groups was insignificant.

CONCLUSION

Postoperative changes in plasma CCK levels neither explain the increased risk of gallstone formation after bypass surgery nor the higher incidence with a long compared to a short ileum left in continuity in the bypass.

Rapid assessment of mycobacterial growth inside macrophages and mice, using the radiometric (BACTEC) method

SETTING

Conventional methods of determining the growth and drug susceptibility of mycobacteria either in macrophages or in vivo are time consuming and laborious.

OBJECTIVE

We sought to develop a simple and rapid method for assessing growth and susceptibility of mycobacteria in macrophages and in vivo.

DESIGN

The radiometric (BACTEC) method was compared with the conventional method for rapid assessment of growth and susceptibility of Mycobacterium avium complex (MAC) to clofazimine (CFM) and its two analogues (B4100 and B4101) in macrophages and in beige mice.

RESULTS AND CONCLUSIONS

A linear relationship was observed between growth index (GI) readings by the BACTEC method and the colony forming unit (CFU) counts obtained by conventional plating on 7H11 agar in vitro of lysates from infected macrophages and of homogenates from the infected organs. There was also a good agreement between the two methods with respect to susceptibility of MAC to CFM and its analogues both in macrophages and in spleen. The BACTEC method, in addition to being quick and simple, was found to be more consistent. Our studies thus demonstrate that the radiometric method has potential application in rapid screening of drugs for antimycobacterial activity in macrophages and in animals besides its established value in in vitro screening.

Mast cells in the placenta. Is there a relation to the development of atopic disease in infants before 18 months of age?

OBJECTIVE

To disclose a relation between the amount of mast cells in placenta and the development of atopic disease in children before 18 months of age.

DESIGN

A prospective, descriptive study.

SETTING

Two obstetric departments at university hospitals.

SUBJECTS

67 pairs of mothers and their newborn infants.

MAIN OUTCOME MEASURES

Family history of atopic disease was taken. The amount of mast cells in placenta was counted. Follow-up questionnaires of the children were evaluated after 18 months.

RESULTS

The follow-up rate was 84%. The number of mast cells in placenta did not differ between atopic and non-atopic children.

CONCLUSION

A new predictor, the amount of mast cells in placenta was evaluated. In this study the amount of mast cells, in placenta was not predictive of the development of atopic disease before 18 months of age.

Sperm 1: a POU-domain gene transiently expressed immediately before meiosis I in the male germ cell

Members of the POU-domain gene family encode for transcriptional regulatory molecules that are important for terminal differentiation of several organ systems, including anterior pituitary, sensory neurons, and B lymphocytes. We have identified a POU-domain factor, referred to as sperm 1 (Sprm-1). This factor is most related to the transactivator Oct-3/4, which is expressed in the early embryo, primordial germ cells, and the egg. However, in contrast with Oct-3/4, rat Sprm-1 is selectively expressed during a 36- to 48-hr period immediately preceding meiosis I in male germ cells. Although the POU-domain of Sprm-1 is divergent from the POU-domains of Oct-1 and Oct-2, random-site-selection assay reveals that Sprm-1 preferentially binds to a specific variant of the classic octamer DNA-response element in which the optimal sequence differs from that preferred by Oct-1 and Pit-1. These data suggest that the Sprm-1 gene encodes a DNA-binding protein that may exert a regulatory function in meiotic events that are required for terminal differentiation of the male germ cell.

[Chylous ascites after surgery on the abdominal aorta]

Chylous ascites is a rare clinical condition and especially rare as a complication of surgical intervention. Its pathophysiology is poorly understood. We report a case of chylous ascites following aortic femoral bypass managed by conservative approaches involving multiple paracenteses, dietary restriction of fat and parenteral nutrition. We suggest that cases of surgically induced chylous ascites which do not respond to conservative treatment within a few weeks should have a laparatomy to close the fistula.

Brn-5 is a divergent POU domain factor highly expressed in layer IV of the neocortex

We have identified rat cDNA clones that encode a POU domain protein, referred to as brain-5 (Brn-5). During embryogenesis in the rat, Brn-5 is widely expressed with highest levels in the developing brain and spinal cord from embryonic day 12.5. In the adult, Brn-5 mRNA is most abundant in the brain, where it is diffusely expressed with the exception of an enrichment in layer IV of the neocortex. However, Brn-5 is also found in multiple adult tissues outside the central nervous system, including kidney, lung, heart, adrenal, skin, testis, and anterior pituitary. This expression pattern contrasts with that of most other POU domain genes that are expressed predominantly in the developing nervous system and are progressively restricted to discrete regions of the brain. The predicted amino acid sequence of Brn-5 is considerably divergent from previously described POU domains and thus defines a new POU domain subclass (class VI). Consistent with its divergent sequence, the DNA-binding characteristics of Brn-5 overlap with, but are clearly distinct from, that of Oct-2. Although Brn-5 can bind to non-octamer sites, a random site selection indicates that its preferred binding site contains a variant octamer core motif. Finally, we show that the amino terminus of Brn-5 contains a transactivation domain.

Chromosomal organization of mammalian POU domain factors

We present the chromosomal locations in mouse of eight new members of the mammalian POU domain family of transcriptional regulators. Chromosomal assignments were made for Brn-1 (Chr 1), Brn-2 (Chr 4), Brn-4 (Chr X), Brn-3.0 (Chr 14), Brn-3.1 (Chr 18), Brn-5.0 (Chr 15), Skn-1a/i (Chr 9), and Sprm-1 (Chr 13) in addition to the previously reported Pit-1 (Chr 16), Tst-1 (Chr 4), Oct-3/4 (Chr 17), Oct-1 (Chr 1), and Oct-2 (Chr 7) genes. Several conclusions have emerged from this analysis. First, among the most highly related family members (Brn-1, Brn-2, Brn-4, and Tst-1; Brn-3.0 and Brn-3.1; Oct-1, Oct-2, and Skn-1a/i) no chromosomal linkage is noted. Second, no clusters of genes are observed, irrespective of homology. Finally, no obvious linkages to genes for known additional regulatory factors with a specific origin of cell type are apparent. Thus, members of this large gene family, presumably arising as duplication events from common ancestral genes, apparently function in distinct chromosomal milieu under independent regulation. Some of these newly localized genes map in close proximity to existing mouse mutations.

The PSI-K subunit of photosystem I from barley (Hordeum vulgare L.). Evidence for a gene duplication of an ancestral PSI-G/K gene

Photosystem I of barley contains a polypeptide with an apparent molecular mass of 7 kDa when isolated using the detergent n-decyl-beta-D-maltopyranoside. The 7-kDa polypeptide is lost from the PS I complex isolated using Triton X-100. The 7-kDa polypeptide and a corresponding full-length cDNA clone have been isolated. Based on high sequence similarity to an N-terminal sequence of PSI-K from spinach and to the deduced amino acid sequence of Psak from Chlamydomonas reinhardtii the 7-kDa barley polypeptide is identified as PSI-K. The cDNA clone encodes a precursor polypeptide of 131 amino acid residues with a calculated molecular mass of 13,726 Da. The transit peptide shows characteristics of polypeptides imported into the chloroplast. PSI-K has two hydrophobic regions predicted to be membrane-spanning alpha-helices. In vitro expressed prePSI-K polypeptide was imported into intact chloroplasts, whereas an in vitro expressed prePSI-K lacking 7 amino acid residues (Met-Ala-Ser-Gln-Leu-Ser-Ala) at the N-terminal end of the transit peptide failed to be imported. The mRNA encoding PSI-K increases during illumination. PsaK is located in a single locus in the genome. PSI-K has significant similarity to PSI-G. When comparing the barley PSI-K and PSI-G with the reported PSI-K sequence from Synechococcus vulcanus, the degree of similarity is equal, suggesting that an ancestral gene has been duplicated in a chloroplast progenitor but not in a cyanobacterial.

Skn-1a and Skn-1i: two functionally distinct Oct-2-related factors expressed in epidermis

Two forms of a member of the POU domain family of transcriptional regulators, highly related to Oct-2, are selectively expressed in terminally differentiating epidermis and hair follicles. One form, referred to as Skn-1i, contains an amino-terminal domain that inhibits DNA binding and can inhibit transactivation by Oct-1. A second form, Skn-1a, contains an alternative amino terminus and serves to activate cytokeratin 10 (K10) gene expression. The pattern of expression of the Skn-1a/i gene products and the effect of the alternative products on the expression of other genes suggest that these factors serve regulatory functions with respect to epidermal development.

[Neurological complications of herpes zoster in the central nervous system]

The Varicella zoster virus may affect the central nervous system (CNS) as a complication of herpes zoster (HZ). A series of neurological syndromes are described and, on the basis of a review of the literature and two illustrative case histories, the symptomatology, pathogenesis, therapeutic possibilities and the diagnostic difficulties in HZ-associated cerebral vasculitis and HZ-associated encephalitis are reviewed. Progressive multifocal encephalopathy in immune-insufficient individuals is briefly mentioned. The diagnosis is most frequently established on the basis of the clinical picture when the characteristic symptoms develop in connection with cutaneous HZ. A long latent period may result in defective recognition of the connection. Immuno-suppression and dissemination are critical determinants for the course of the condition but, in immune-competent individuals, the morbidity and mortality are low. Treatment with acyclovir is employed to an increasing extent with good results but the conditions are rare and clinically controlled investigations are not available. It is important that the possibility of HZ-associated CNS-disease is borne in mind, in view of the therapeutic possibilities. The pathogeneses of these complications is little understood but there is increasing evidence that a direct viral invasion is the mechanism responsible. A post-infectious immune-mediate mechanism is also another popular opinion.

Modelling long-term cation supply in acidified forest stands

A dynamic soil chemistry model was used to explain the observed decrease in soil base saturation between 1949 and 1984 at three stands in southern Sweden. The results show that acid deposition has caused soil acidification. The model, SAFE (Soil Acidification in Forest Ecosystems), includes the fundamental physical processes such as leaching and accumulation, and chemical processes such as cation exchange, mineral weathering, nutrient uptake and solute equilibrium reactions. The sources and sinks of base cations in the soil system were quantified, showing that weathering, deposition of base cations and depletion of exchangeable base cations supply cations to the soil solution in similar amounts in the upper 1 m during the acidification phase. This demonstrates that budget studies alone cannot be used to distinguish between long-term capacity to resist acidification, represented by weathering, from short-term buffering caused by cation exchange.

A double-blinded multicenter trial of somatostatin in the treatment of acute pancreatitis

To evaluate the effect of somatostatin in the treatment of acute pancreatitis, 63 patients were randomly allocated to continuous intravenous infusion for three days of 250 micrograms of somatostatin (Dura Scan, Odense, Denmark) per hour (n = 33), or placebo (n = 30). Patients with a first attack of pancreatitis, serum amylase level of more than 450 units per liter and symptoms for less than 24 hours were eligible for participation in the study. Apart from a slightly significant faster decrease in serum amylase concentrations, we were unable to demonstrate any significant benefit from somatostatin with regard to paraclinical values and clinical course.

The PSI-E subunit of photosystem I binds ferredoxin:NADP+ oxidoreductase

A photosystem I complex containing the polypeptides PSI-A to PSI-L, light-harvesting complex I and ferredoxin:NADP+ oxidoreductase has been isolated from barley using the non-ionic detergent n-decyl-beta-D-maltopyranoside. The ratio between bound ferredoxin:NADP+ oxidoreductase and P700 is 0.4 +/- 0.2. The complex is highly active in catalyzing light-induced transfer of electrons from plastocyanin to NADP+ at rates of 280 +/- 150 and 1800 +/- 800 mumol NADPH/(mg chl.h), without and in the presence of saturating amounts of exogenously added ferredoxin:NADP+ oxidoreductase, respectively. Endogenously bound ferredoxin:NADP+ oxidoreductase interacts with the PSI-E subunit as demonstrated by cross-linking experiments using two different types of cross-linkers and identification of the products by Western blotting and the use of monospecific antibodies.

Morbidity after immediate and delayed opening of sigmoid end colostomy: a randomised trial

OBJECTIVE

To see if sigmoid end colostomies that were opened immediately carried a higher early morbidity than those in which opening was delayed for 10 days.

DESIGN

Randomised trial.

SETTING

University department of surgical gastroenterology.

SUBJECTS

All patients for whom a temporary or permanent end sigmoid colostomy was done between December 1986 and May 1989.

INTERVENTIONS

51 patients had their colostomies opened immediately, and in 49 opening was delayed.

MAIN OUTCOME MEASURES

Presence of ischaemia, retraction, separation or infection, and length of stay in hospital.

RESULTS

Two patients from each group died within the first week; none of the deaths was associated with complications of the colostomy. One patient whose colostomy had been opened immediately developed gangrene of the stoma, and one in whom the opening had been delayed developed retraction. There was no difference between the groups in length of stay in hospital.

CONCLUSION

As we could find no differences in morbidity whether the colostomy was opened immediately or whether it was delayed, we now recommend that it should be done immediately. The question of late complications (stenosis and hernia), however, cannot be answered yet.

RXR beta: a coregulator that enhances binding of retinoic acid, thyroid hormone, and vitamin D receptors to their cognate response elements

The retinoic acid receptor (RAR) requires coregulators to bind effectively to response elements in target genes. A strategy of sequential screening of expression libraries with a retinoic acid response element and RAR identified a cDNA encoding a coregulator highly related to RXR alpha. This protein, termed RXR beta, forms heterodimers with RAR, preferentially increasing its DNA binding and transcriptional activity on promoters containing retinoic acid, but not thyroid hormone or vitamin D, response elements. Remarkably, RXR beta also heterodimerizes with the thyroid hormone and vitamin D receptors, increasing both DNA binding and transcriptional function on their respective response elements. RXR alpha also forms heterodimers with these receptors. These observations suggest that retinoid X receptors meet the criteria for biochemically characterized cellular coregulators and serve to selectively target the high affinity binding of retinoic acid, thyroid hormone, and vitamin D receptors to their cognate DNA response elements.

Surgical treatment of morbid obesity. A survey of overall outcome 1968-1989

This survey evaluates benefits and costs from a policy of employing surgical treatment in selected cases of morbid obesity. Between 1968 and 1978, we used end-to-side jejunoileal bypass. Despite many satisfied patients, complications were frequent and severe. For the next decade, we employed various types of gastric surgery. We eventually assessed a gastric balloon, but without success. Median duration of follow-up was 132 months in 145 patients with jejunoileostomy, 103 months in seven gastric bypass patients, and 36 months in 108 gastroplasty patients. Three patients were lost to follow-up. There have been four deaths after intestinal shunt and one after gastroplasty. The median re-admission rate was 1.6 per patient, while the median number of re-operations was 2.0 after intestinal shunt and 0.8 after gastric interventions. The median weight loss in our 260 patients was 32.1% of the preoperative weight. Outcome was good in 38.8%, acceptable in 40.4% and poor in 11.5% while there were 9.2% failures. Truly satisfactory outcomes, however, were rare, owing possibly to a negative relationship between weight loss and complications. Only 8.8% have obtained a stable normal weight without any side-effects.

Consistent production of phenolic compounds by Penicillium brevicompactum for chemotaxonomic characterization

A consistently produced group of fungal secondary metabolites from Penicillium brevicompactum has been purified and identified as the Raistrick phenols. These compounds are shown to exist separately as an equilibrium mixture in aqueous solutions. The Raistrick phenols have all been included in the metabolite profile of P. brevicompactum. By means of thin layer chromatography-scanning and high performance liquid chromatography-UV diode array detection, the chromatographic and spectroscopic data can be used in the chemotaxonomic characterization of the fungus.

The effect of the benzodiazepine antagonist flumazenil on the sequels of diazepam given before upper gastrointestinal endoscopy. A double-blind randomized trial

The prolonged sedation of benzodiazepines may be inconvenient for the patient. Reversal of sedation, therefore, would be desirable. Accordingly, we assessed the efficacy of the benzodiazepine antagonist flumazenil in a placebo-controlled randomized trial including 40 adults undergoing upper gastrointestinal endoscopy under diazepam (Diazemuls) sedation. We found no significant differences between groups with regard to either performance (two tests) or duration (within 240 min) of sedation. There were no noticeable side effects.