Ping pong patches

Unique, specific lesions due to contact with a table tennis ball are described. These have not previously been reported in the literature.

Reproducibility of systolic and diastolic time intervals in normal humans: an important issue in clinical cardiovascular pharmacology

The purpose of this study was to evaluate the long-term variability and reproducibility of systolic and diastolic time intervals in human subjects. Ten healthy volunteers underwent serial determinations of systolic and diastolic time intervals and, as internal physiologic standards, heart rate (HR), systemic blood pressures, and resting oxygen consumption (VO2). The protocol lasted 1 month and measurements were made on days 1, 2, and 30. No statistically significant differences were found in the various systolic time interval parameters, percentage of diastolic time, heart rate, systolic blood pressure (SBP) and resting oxygen consumption for the 3 study days. Diastolic blood pressure tended to rise slightly (p = 0.07) from day 1 to day 30. The average coefficients of variation for systolic and diastolic time interval parameters in individual study subjects ranged from 1.2 to 7.0%, whereas those for resting physiologic data ranged from 5.3 to 8.5%. In normal human subjects, systolic and diastolic time intervals are highly reproducible, with acceptable variation over time; these measurements should be thought of as possessing reproducibility equal to or greater than the resting physiologic parameters of HR, systemic blood pressure and oxygen consumption.

Idiopathic megacolon presenting with fatal inferior vena caval obstruction and colonic perforation. Case report

A 73-year-old woman with chronic constipation and associated megarectum and megacolon presented as an emergency with colonic perforation, inferior vena caval obstruction and urinary retention. Soon after admission the patient sustained a massive feculent vomit and died. Intractable constipation demands referral for further investigation, if similarly neglected cases are to be avoided. Idiopathic megacolon presenting in this way has not been previously reported.

Deoxyribonuclease I sensitivity of the ovomucoid-ovoinhibitor gene complex in oviduct nuclei and relative location of CR1 repetitive sequences

The location of CR1 middle repetitive sequences within or near the boundaries of the ovalbumin DNase I sensitive domain has suggested that CR1 sequences may play a role in defining transition regions of DNase I sensitivity in hen oviduct nuclei. We have examined this apparent relationship of CR1 sequences and transitions of chromatin structure by determining the DNase I sensitivity in oviduct nuclei of a 47-kilobase region that contains five CR1 sequences and the transcribed ovomucoid and ovoinhibitor genes. We find that three of the CR1 sequences occur within a broad transition region of decreasing DNase I sensitivity downstream of the ovomucoid gene. Another CR1 is in a region of decreased DNase I sensitivity within the ovoinhibitor gene. The fifth CR1 sequence is in a DNase I sensitive region between the two genes but which is less sensitive to DNase I digestion than the region immediately upstream from the ovomucoid gene. Thus, the CR1 sequences occur within regions of reduced relative DNase I sensitivity, suggesting that CR1s could facilitate the formation of a chromatin conformation that is less sensitive to DNase I digestion. Unexpectedly, the noncoding strand of sequences within and immediately adjacent to the 5' end of the actively transcribed ovomucoid and ovalbumin genes was less sensitive to DNase I digestion than their respective coding strands.

Ovoinhibitor introns specify functional domains as in the related and linked ovomucoid gene

We have isolated cDNA clones and determined the gene structure of chicken ovoinhibitor, a seven domain Kazal serine proteinase inhibitor. Using RNA blot hybridization analysis, the gene was identified initially as a region 9-23 kilobases upstream of the gene for the related inhibitor ovomucoid. Ovoinhibitor RNA appears in oviduct and liver. cDNA clones were identified by screening an oviduct cDNA library with a nick-translated DNA restriction fragment which contained an exon of the gene. The mature protein sequence derived from a cDNa clone is in excellent agreement with that which we obtained from direct sequencing of purified ovoinhibitor. The protein-sequencing strategy is reported. The P1 amino acids of the Kazal domains are consistent with the known broad inhibitory specificity of ovoinhibitor. The gene is about 10.3 kilobases in length and consists of 16 exons. Each Kazal domain is encoded by two exons. Like ovomucoid, introns fall between the coding sequences of the ovoinhibitor domains, an arrangement which may have facilitated domain duplication. The intradomain intron occurs in an identical position in all of the ovoinhibitor and ovomucoid Kazal domains, suggesting that this intron was present in the primordial inhibitor gene. We discuss the location of the intradomain intron in relation to the known structure of four Kazal inhibitors and suggest a scheme for the evolution of the ovoinhibitor gene.

Mineral homeostasis in neonates of streptozotocin-induced noninsulin-dependent diabetic rats and in their mothers during pregnancy and lactation

To assess the affect of mild diabetes on calcium metabolism in an animal model, we evaluated calcium homeostasis before pregnancy and during gestation and lactation in non-insulindependent (NIDD) diabetic rat mothers and their neonates (NeoDM). Plasma glucose, calcium (Ca), magnesium (Mg), phosphate (Pi), and immunoreactive parathyroid hormone (iPTH) were measured in the NIDD rats and controls before pregnancy, during the first, second, and third gestational week, and during lactation 12, 24, 48 and 72 h postpartum. The same measurements were performed on NeoDM and controls 12, 24, 48, and 72 h after birth. In the mothers, plasma calcitonin was assayed before pregnancy and at 72 h postpartum. Higher plasma glucose values before pregnancy (216 +/- 9 mg/dl vs 126 +/- 4) and during the second (105 +/- 5 vs 73 +/- 6) and third (114 +/- 8 vs 91 +/- 3) gestational week were observed in diabetic mothers when compared to controls. Glucose values decreased during the second and third gestational week in both groups compared to pregestational values. Plasma Ca, Mg, and Pi were similar in both groups during gestation and lactation except for the third gestational week when plasma Mg was lower in the diabetic mothers (P less than 0.05). Plasma iPTH rose to similar values in both groups during pregnancy. During lactation, plasma iPTH levels were higher and plasma calcitonin levels were lower compared to controls (P less than .05, P less than 0.01, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

The structural organization of the chicken calmodulin gene

The structural organization of the entire chicken calmodulin (CaM) gene was determined by analysis of overlapping genomic clones obtained from Charon 4A and cosmid DNA libraries. These clones together span 39 kilobases of chicken genomic DNA. The CaM gene is 12 kilobases long and contains 8 exons interrupted by introns of highly variable size. The first intron (A) is only 19 base pairs (bp) long and divides the 5' untranslated region. Intron B separates the ATG from the first nucleotide of the triplet which encodes the NH2-terminal amino acid of CaM (Ala) whereas intron C separates the triplets encoding amino acids 10-11. Introns D, F, and G interrupt the Ca2+ binding subdomains II, III, and IV of CaM whereas intron E is localized in the linker region between the highly homologous NH2- and COOH-terminal halves of the protein. Primer extension studies using chicken brain poly(A+) mRNA and a fragment from the 5' untranslated region of a CaM cDNA identified the presumptive transcription initiation site (cap site) of the mRNA to be 103 bp 5' from the initiation condon ATG. A consensus sequence TATTTAA was localized 29 bp 5' from this cap site while a CCAAT sequence was located further 5' at position -58 bp. The structure of the CaM gene is strikingly similar to genes that encode other Ca2+ binding proteins from sea urchin, chicken, rat, and quail. These data suggest a conservation of genome organization related to the calcium binding and regulatory domains of Ca2+ binding proteins.

Changes in the management of severely Rh-immunized patients

Since July 1, 1978, we have instituted the following changes in the management of severely Rh-immunized patients: (1) serial amniotic fluid optical density (delta OD450 ) values and real-time ultrasound scanning beginning at 21 weeks' gestation, (2) fetal transfusions as early as the twenty-third week, (3) ultrasound surveillance during and after intrauterine transfusions, and (4) planned premature delivery with neonatal exchange transfusions for selected cases between 29 to 32 weeks and for all patients after 32 weeks' gestation. The perinatal survival rate (83.8%) in 37 isoimmunized pregnancies managed with this regimen was significantly higher (p less than 0.05) than in 34 such pregnancies (55.9%) managed according to the protocol utilized during the previous four years.

Epidermolysis bullosa acquisita and inflammatory bowel disease

Three patients had epidermolysis bullosa acquisita in association with Crohn's disease. We believe that epidermolysis bullosa acquisita should be included among the extraintestinal manifestations of inflammatory bowel disease. This article describes the diagnostic criteria, treatment, and other systemic diseases associated with epidermolysis bullosa acquisita.

Björnstad syndrome and pili torti

Two children with pili torti (twisted hairs) are reported, one of whom had sensorineural hearing loss. This combination of pili torti and deafness was described as a new genetic entity by Björnstad in 1965. Although light microscopy demonstrated variable numbers of twists along the shafts of hairs obtained from both patients, scanning electron microscopy in both cases revealed flattening and diagonally arranged scalloped defects on only one side of the involved hair shafts rather than true twists. Early auditory testing should be performed in children with pili torti in order to secure early treatment of possible associated hearing loss.

Ipsilateral deafness and herpes zoster ophthalmicus

Three cases of ipsilateral deafness occurred in association with herpes zoster ophthalmicus. Although our review of the literature did not disclose any identical cases, we believe that this complication may not be rare. If vertigo, tinnitus, abnormal auditory sensations, or ear pain occur with herpes zoster of any cranial nerve, an audiogram is indicated immediately to detect possible hearing loss. There is no known satisfactory treatment for sudden deafness due to herpes zoster infection.

Hair casts: classification, staining characteristics, and differential diagnosis

Considerable confusion exists in the literature regarding hair casts. A variety of different disorders have been grouped and reported as if they were a single entity. This nonspecificity in terminology accounts for the vast discrepancy in their reported incidence, size, configuration, etc. A specific classification for hair casts is proposed to clarify the situation. This article presents a practical staining technic, which readily differentiates peripilar keratin casts from other hair disorders. Clinical and microscopic characteristics of peripilar keratin casts and peripilar nonkeratin casts are illustrated.

Perinatal death recording: time for a change?

The new perinatal death certificate proposed by the World Health Organisation was examined in relation to existing measures for recording perinatal death statistics and also with regard to new information gathered. Present procedures appear to underestimate the number of perinatal deaths by roughly 10%, though late registrations may lower this figure slightly. The use of a minimum birth weight as the criterion for inclusion in perinatal statistics removed much of the uncertainty associated with definitions of live birth and stillbirth. The new certificate led to duplication of some information already recorded through birth notification yet failed to provide information on some other factors generally considered relevant to perinatal mortality. The format proposed for recording cause of death provided a more logical presentation of events. Standardizing birth information recorded on all infants, modifying death certificates, and developing efficient record-linkage schemes would be more valuable than introducing the WHO certificate. Useful interpretation of the meaning of the characteristics of infants dying in the perinatal period awaits these timely changes.

Adenocarcinoma of the breast

This brief case report illustrates the predicament facing the practicing physician who encounters a patient in whom psychgological barriers equal or outweigh the presenting physical ailment. Although the patient presented herein had an adenocarcinoma of the breast, her psychological barriers proved a more frustrating problem.

Cutaneous odontogenic sinus

A case report and discussion of cutaneous odontogenic sinus tracts, frequently encountered but often misdiagnosed and mistreated, are presented. Awareness that periapical dental abscesses are the most common etiologic factor of cutaneous sinus tracts involving the face and neck will facilitate their early diagnosis and prevent needless treatment or anxiety for the patient. These lesions are often misinterpreted as chronic, resistant to therapy, pyogenic nodules, or granulomas. A high degree of suspicion is required for making the correct diagnosis, and dental roentgenographic studies should routinely be obtained in all such lesions. Permanent healing cannot be achieved unless the original site of infection is located and eradicated.

Ungual lichen planus. Lichen planus of the nail

Although reports in the literature are sparse, a definite relationship exists between nail anomalies and lichen planus. Ungual lichen planus may occur without any mucocutaneous signs, as has been documented by histologic studies. It may be the initial and most important clinical manifestation of the disease process, and permanent anonychia may result unless corticosteroid therapy is initiated promptly. Increased awareness of nail involvement will result in a more frequent diagnosis and better understanding of the disorder.