Therapeutic advances in acute ischaemic stroke

No drug has yet been shown to be unequivocally effective for acute stroke. Over the past decade, however, there has been an explosion in stroke research resulting in the development of novel therapeutic approaches. Therapies to improve arterial recanalisation and agents used to protect the brain from neurotoxic cellular damage are currently being evaluated. Tight control of physiological parameters may also limit neuronal damage. It is likely that within the next few years effective therapy will become available that will need a major change in the way that services are provided for stroke patients in the acute phase of their illness.

MNNG-transformed Bloom syndrome B-lymphoblastoids for the detection of Hodgkin's lymphoma-associated antigen in 2D Westerns

Twenty-four hour MNNG-exposed Bloom syndrome (BS) B-lymphoblastoid cells with the potential to form single cell colonies in soft agar and nude mouse tumour (2/6 (33%) showed a simultaneous increase in the Ras-expressing cells (using monoclonal antibody to p21 transforming protein) from 20% (at 24 h) to 85% (on day 30). In contrast, there was an absence of Ras-positive cells in MNNG-exposed fresh lymphocytes (PBMCs) from a healthy subject and a presence of only 11-18% of Ras-positive cells in normal (GA3) and unexposed BS B-lymphoblastoid cells. The Western blot analysis using sera samples from Hodgkin's lymphoma patients showed the presence of proteins of 102 and 68 kDa which in 2D Westerns were observed to be unique to BS-MNNG cells with approximate pIs of 5.3 and 5.7, respectively. It is proposed that BS-MNNG cells provide an interesting in vitro human cell model to generate unique cancer-associated antigen(s) in addition to using this system to understand the primary events associated with neoplastic transformation.

T-cell receptor-gamma rearrangement and c-myb methylation in MNNG-exposed Bloom syndrome B-lymphoblastoid cells

The MNNG-exposed Bloom syndrome (BS) B-lymphoblastoid cell population (BS-MNNG), when analyzed for aberrant genetic variations, showed an illegitimate rearrangement at the TCR-gamma gene and hypermethylation at the c-myb protooncogene. The TCR-gamma rearrangement involved a Vgamma9 segment corresponding to a 4 kb band detected with a Jgamma-specific probe in HindIII-digested DNA samples from BS-MNNG cells only. These variations were not shown by unexposed BS cells or both MNNG-exposed and unexposed normal (GA3) B-lymphoblastoid cells.

Interobserver variations in clinical signs for diagnosis of pleuritis

A study was conducted on 150 patients admitted in a teaching hospital to find out reliable clinical signs for diagnosing pleuritis. Cases were selected based on suspicion of pleural involvement by history and examination. Final diagnosis was made by correlations with radiographic and ultrasonographic reports. Reliability of the signs was determined on the basis of high concordance of independently observed variations between two medical consultants. Inflammatory involvement of pleura was seen in 69.3% cases and 30.7% were due to oedema disorders. Concordance between observers was high for crepitations (95.5%) and pleural rub (93.8%) followed by vocal resonance (87.6%), dull percussion note (76.9%) and mediastinal shift (76.9%).

Morbidity and mortality in compensated cirrhosis type C: a retrospective follow-up study of 384 patients

BACKGROUND & AIMS

Few data are available concerning the long-term prognosis of chronic liver disease associated with hepatitis C virus infection. This study examined the morbidity and survival of patients with compensated cirrhosis type C.

METHODS

A cohort of 384 European cirrhotic patients was enrolled at seven tertiary referral hospitals and followed up for a mean period of 5 years. Inclusion criteria were biopsy-proven cirrhosis, abnormal serum aminotransferase levels, absence of complications of cirrhosis, and exclusion of hepatitis A and B viruses and of metabolic, toxic, or autoimmune liver diseases.

RESULTS

Antibodies against hepatitis C virus were positive in 98% of 361 patients tested. The 5-year risk of hepatocellular carcinoma was 7% and that of decompensation was 18%. Death occurred in 51 patients (13%), with 70% dying of liver disease. Survival probability was 91% and 79% at 5 and 10 years, respectively. Two hundred five patients (53%) were treated with interferon alfa. After adjustment for clinical and serological differences at baseline between patients treated or not treated with interferon, the 5-year estimated survival probability was 96% and 95% for treated and untreated patients, respectively.

CONCLUSIONS

In this cohort of patients, life expectancy is relatively long, in agreement with the morbidity data showing a slowly progressive disease.

Childhood growth, physical activity, and peak bone mass in women

Peak bone mass is an important determinant of the risk of osteoporotic fracture, and preventive strategies against osteoporosis require a clear understanding of the factors influencing bone gain in early life. We report a longitudinal study aiming to identify the relationships between childhood growth, lifestyle, and peak bone mass in women. One hundred and fifty-three women born in a British city during 1968-1969 were traced and studied in 1990. Data on their growth in childhood was obtained from linked birth and school health records; current bone mineral measurements were made by dual X-ray absorptiometry. There were statistically significant associations between weight at 1 year and BMC (but not BMD) at the lumbar spine (r = 0.32, p < 0.01) and femoral neck (r = 0.26, p < 0.01). These remained significant after adjusting for current weight. There were also strong relationships between childhood height measurements and adult BMC at the two skeletal sites. Physical activity was the major lifestyle determinant of BMD after allowing for body build. We conclude that infant growth and physical activity in childhood are important determinants of peak bone mass in women. Growth primarily determines the size of the skeletal envelope, and its trajectory is established by age 1 year. Activity, in contrast, modulates the mineral density within the skeletal envelope and may contribute to the consolidation of bone following the end of linear growth.

Limited forms of Wegener's granulomatosis presenting as polymyalgia rheumatica

The spectrum of Wegener's granulomatosis is broad, ranging from rapidly progressive disease to more indolent and limited forms. We report two cases with later onset disease who presented with polymyalgia rheumatica. Diagnosis of Wegener's was delayed but was ultimately aided by the demonstration of antineutrophil cytoplasmic antibodies.

A neutron powder diffraction study of short range order in ferroelectric Pb(Mg(1/3)Nb(2/3))O(3)

The structure of Pb(Mg(1/3)Nb(2/3))O(3) (PMN) was investigated using pulsed neutron powder diffraction. Rietveld analysis suggests small displacements of Pb and O atoms, with anomalously large thermal factors. The pair-distribution function (PDF) derived from experiment indicates the presence of short range order. Modeling in real space by fitting to the experimental PDF suggests displacements of lead and oxygen atoms of much larger magnitude than those indicated by the Rietveld analysis. Correlation of these displacements may be related to the onset of bulk ferroelectricity in this material.

Factitious haematuria. A report of two cases

Two patients who presented with recurrent gross haematuria are described. Both underwent extensive invasive investigations including renal biopsies before it was discovered that they had factitious haematuria produced by contaminating urine with blood from self inflicted skin wounds.

Acute renal failure following multiple hornet stings

Five patients who developed acute renal failure due to acute tubular necrosis following multiple hornet (Vespa orientalis) stings are described. All of them had intravascular hemolysis. Evidence for rhabdomyolysis was present in 2 patients. Two patients had elevated transaminase and alkaline phosphatase levels and in 1 of these, liver biopsy showed centrilobular necrosis. Two patients had thrombocytopenia in the absence of disseminated intravascular coagulation. Two patients died of infections while the remaining 3 recovered completely. Acute renal failure following multiple hornet stings appears to result mainly from intravascular hemolysis or rhabdomyolysis although a direct nephrotoxic effect of venom cannot be excluded.

Behaviour disturbances during recovery from herpes simplex encephalitis

Bizarre behaviour disturbances in four patients occurring during incomplete recovery from herpes simplex encephalitis are described. Some aspects of their behaviour were similar to that originally described by Klüver and Bucy in monkeys following bilateral temporal lobectomy. Previous reports of behavioural disturbances in man after herpes simplex encephalitis are reviewed and attention drawn to the aggressive and disruptive behaviour that is often seen. With the reduced mortality in herpes simplex encephalitis in recent years it is possible that behaviour disturbances such as those described here will be seen more frequently.