[Multisegmental posterior wedge osteotomies of the lumbar vertebrae for correction of kyphosis in ankylosing spondylitis. A report on 5 cases]

Operative treatment of Ankylosing spondilitis is usually performed in treatment of extraspinal pathology, i.e. in treatment of hip contractures. Operative treatment of fixed spinal kyphosis in AS is rarely indicated, and patients make their decision for the operation when deformation becomes extreme. Instead of several hundred of operated patients in foreign literature, authors describe only 5 operations from 1989 to 2000. Results suggest that multiple spinal osteotomy in AS is a time consuming operation with a significant intraoperative and postoperative blood loss. Mild, transient radicular irritations are noticed. However, reconstruction of lumbar lordosis significantly improve quality of life in operated patients. It is concluded that indication for the operation in AS should be indicated earlier. Better results with less risk would be achieved.

Attention deficity/hyperactivity in SLI children increases risk of speech/language disorders in first-degree relatives: a preliminary report

Specific language impairment (SLI) or developmental dysphasia denotes the inability to acquire normal expression and/or comprehension of language in the absence of peripheral hearing impairment, neurological disorder, and mental retardation. The presence of attention deficit/hyperactivity in some SLI children has previously been documented. This family history study used 27 SLI families, identified through the parents from the Dysphasia Association, to examine the relationship between attention deficit/hyperactivity in SLI children and the risk to first-degree relatives. All SLI children were clinically diagnosed with speech/language disorder; medical records were searched for the presence of any of the exclusion criteria noted above. The 13 SLI children with medical record of attention deficit/hyperactivity had a significantly higher chance of having first-degree relatives with speech/language disorders than 14 SLI children without such record (15/27 and 4/46, respectively). This preliminary report suggests that additional study is warranted to investigate the relationship between speech/language disorders and attention deficit/hyperactivity in families of SLI children.

LEARNING OUTCOMES

As a result of this activity, the participant will be able to describe the SLI phenotype, its prevalence, and complexity and to recognize the relationship between comorbid attention deficit/hyperactivity in SLI children and the risk of speech/language disorder in their relatives.

Evidence of linkage in subtypes of alcoholism

We believed that subtyping alcoholism might be an efficient strategy for mapping susceptibility genes. Cluster analysis is one of the possible statistical techniques for such a purpose. We required that, ideally, the variables to be used in cluster analysis should be: 1) related to alcoholism, 2) related to the severity of alcoholism, and 3) familial, i.e., correlated within families. Only three variables met all three conditions. Those included age of onset of ALDX1, smoking, and TPQ-HA. A global score of symptoms of alcoholism was systematically introduced as one of the variables composing a subset for cluster analysis, although this score did not show any familial aggregation. Our strategy led to a strong evidence of linkage at D15S230 in only 20 families whose members are mainly characterized by heavy smoking.

Exploring the impact of extended phenotype in stratified samples

We have performed initial nonparametric sib-pair genome scans in the early (N = 52) and late (N = 53) onset subgroups of the COGA pedigrees, stratified near the median value of pedigree mean age of onset for ALDX1 diagnosis of alcoholism. Because the early group contained a higher proportion of smokers, traits of alcoholism, smoking, and addiction (defined as either alcoholism or smoking) were examined. Subgroups and phenotypic definitions influenced initial linkage results, corrected for the number of analyzed traits. Evidence for linkage to the ALDX1 alcoholism phenotype at the ADH3 functional candidate gene was increased in the late onset subgroup (Bonferroni corrected significance level < 0.002), as compared with the unstratified sample that replicated COGA linkage obtained in the same analysis; there was no evidence for linkage at this locus in the early onset subgroup. The theoretical implication of this result is that the loss of power due to contracting sample size through stratification may in some cases be more than offset by extraction of a more homogeneous subgroup from the etiologically complex trait.

[Helicobacter heilmanni (Gastrospirillum hominis) as a new cause of gastritis--case report]

INTRODUCTION

During the course of research into Helicobacter pylori, further microorganisms colonizing the gastric mucosa have been detected. The large spiral-shaped bacteria deviating from Helicobacter pylori was originally described by Dent. The bacteria was initially named Gastrospirillum hominis, but after sequencing of 16S rRNA it was classified as Helicobacter and named Helicobacter Heilmannii in honour of the pathologist Prof. Dr. Konrad Heilmann. We report two additional cases.

CASE REPORTS

In 1997 at the Department of Pathology of General Hospital in Senta 268 gastric biopsies (151 male, 117 female), average age of 50.4 were analyzed. Helicobacter pylori was identified in 176 biopsies (65.7%). Helicobacter Heilmannii was found in two cases (0.74%). The clinical details were as follows: Case 1. A 32-year-old male complained of dyspepsia. Esophagogastroduodenoscopy disclosed hyperemia and scattered erosions in the lower third of stomach. Case 2. a 55-year-old female was admitted at the hospital with lumbar pain, loss of appetite and body weight. Esophagogastroduodenoscopy findings were normal. The patient lived in rural household in contact with various domestic animals. In the biopsy specimens of both cases in the antral gastric mucosa large bacteria resembling a corkscrew were found, 6-10 microns length, consisting of 5-9 regular tight spiral. The bacteria were midly eosinophilic and Gram negative. The bacteria stained strongly with the Warthin-Starry silver stain, and with Giemsa stain. The distribution of Helicobacter Heilmannii was patchy in the central zones of the gastric pits, deep or more superficial including the foveolar opening on the mucosal surface. A mild degree of chronic gastritis characterized both cases, with, focally active inflammation and lymphoid aggregates. None of biopsies had atrophy, intestinal metaplasia or epithelial damage. There was a symptomatic improvement after a 4-week course with triple therapy (H2 antagonist & metronidazole & amoxycillin). After treatment rebiopsy specimens displayed mild chronic gastritis and no spiral organisms.

CONCLUSION

Our reported cases are the first described cases of gastritis caused by Helicobacter Heilmannii in our region with successful eradication after therapy. Morphologically similar bacteria have been found in the stomachs of domestic animals. It is a general opinion that Helicobacter Heilmannii is characteristic for animals but it is occasionally transmitted to humans.

Analysis of background-dependent genetic interactions without inbred strains

Experimental analysis of background dependent effects of genetic interactions can be designed using strains generated by introgression of small genetic regions containing identical genotypes at loci in question into different inbred strains. We use a novel multilocus paradigm, denoted conditional intergenic functional association (CIFA), to simulate this procedure, with the trade-off of power for convenience that is affordable when sufficiently strong effects are present. We analyze nine enzyme loci at three chromosomes in groups of D. melanogaster with different developmental rates that showed similar allelic frequencies at individual loci. Results obtained suggest the presence of adaptive interaction between particular alleles at two loci when genetic variation at seven background loci is eliminated. Biochemical considerations show that, in the resulting developmental context, strong interaction between these genes may emerge from shifted control of the pentose phosphate pathway, with cascading effects on the glycolysis, TCA cycle, and biosynthetic pathways: one gene may assume control of the irreversible rate-limiting step in the pentose phosphate pathway, whereas the other gene may assume control of the NADP+ level that regulates the same rate-limiting step as an electron acceptor. The newly developing functional genomics research and the absence of inbreeding make CIFA directly applicable to complex human traits in large samples.

Clinical study of recovery and half-life of vapor-heated factor VII concentrate

BACKGROUND

The in vivo recovery and half-life of intermediate-purity, vapor-heated factor VII (FVII) concentrate were determined in patients having a congenital deficiency for FVII according to the 1991 guidelines of the International Society for Thrombosis and Haemostasis.

STUDY DESIGN AND METHODS

A total of 11 patients received a single infusion of the FVII concentrate. Blood was drawn before infusion and 15 and 30 minutes and 1, 2, 4, 8, 12, and 24 hours after. Recoveries were calculated from the highest FVII activity of the first four blood samples drawn after infusion. The two-phase linear regression method was used to estimate the half-life according to the two-compartment model. In addition, a noncompartmental approach was applied.

RESULTS

The mean recovery value obtained for FVII concentrate, 110.53 percent (SD, +/- 26.37), indicates rapid and efficient incorporation into the blood stream. Equivalent results were obtained with both pharmacokinetics methods and indicate a very short half-life for FVII. A half-life of 6.49 hours (SD, +/- 2.42) was obtained with the compartmental method and a half-life of 5.25 hours (SD, +/- 2.42) with the noncompartmental method.

CONCLUSION

The half-life and recovery reported here, along with the specificity of the replacement therapy, the earlier anecdotal cases of clinical efficacy, and the clinical safety of the concentrate with regard to viral infections, recommend vapor-heated FVII concentrate for the treatment of patients with hereditary FVII deficiency.