Vertical transmission of hepatitis. 3 years' follow-up

An infant with an acute hepatitis B infection developed the chronic aggressive form of the disease. The immunoserologic findings in the child and his mother suggest a vertical hepatitis B virus transmission. The mother was found to be an asymptomatic HBs-Ag carrier but HBe-Ag negative. The importance of a screening program for HBs-Ag in pregnant women is discussed. It is suggested that newborns at risk should get passive-active immunisation post partum as early as possible.     

Mitochondrial myopathy with lactic acidosis and deficient activity of muscle succinate cytochrome-c-oxidoreductase

A male infant had severe muscular hypotonia from birth. Recurrent vomiting with dehydration and severe metabolic acidosis complicated the course. Elevated lactate (up to 12.3 mmol/l; n<2), pyruvate (0.4 mmol/l; n<0.05) and alanine levels were found in serum with an abnormal lactate/pyruvate ratio (>30; n<15). In urine the concentrations of lactate, pyruvate, alanine and of several intermediates of the citric acid cycle were increased. In muscle, numerous disseminated ragged red fibres were found by light microscopy; muscle fibres were found to contain subsarcolemmal aggregates of mitochondria, lipid droplets and glycogen by electromicroscopical methods. More-over, mitochondria with a typical circular arrangement of cristae were noticed.In liver homogenates normal activities of pyruvate carboxylase and pyruvate dehydrogenase complex were found; in liver mitochondria also succinate-cytochrome-c-oxidoreductase activity was normal. However, in muscle no succinate-cytochrome-c-oxidoreductase activity was detectable.The patient became increasingly lethargic and died because of sepsis at 5 months of age.     

Histopathologic comparison of normal and hyperplastic condyles

OBJECTIVE: The aim of this study was to compare normal and hyperplastic mandibular condyles using two different histopathologic staining techniques. STUDY DESIGN: Nine cases of condylar hyperplasia and 13 normal cases were studied after hematoxylin and eosin and silver staining. RESULTS: There was a significant difference between the two groups in the thickness of the hyperplastic cartilage layer of condylar soft tissue (P = 0.017). Also, the number of argyrophilic nucleolar organizer regions was significantly higher in the condylar hyperplasia case group (P = 0.0001). No significant differences could be demonstrated in cartilage island frequency, penetration depth, and distribution in the cancellous bone of condyles. CONCLUSION: The thickness of the hyperplastic cartilage layer appears significantly increased in condylar hyperplasia. In addition, argyrophilic nucleolar organizer region count may be useful in histopathological identification of condylar hyperplasia.     

Symphysiotomy: a viable approach for delayed management of posterior urethral injuries in children

PURPOSE: The outcome of symphysiotomy for accessing pelvic fracture related, obliterative urethral strictures is described. MATERIALS AND METHOD: In 7 boys and 3 girls 4 to 13 years old (mean age 6) surgical correction of a pelvic fracture related, obliterative urethral stricture was achieved through symphysiotomy. The stricture involved a prostatomembranous location in boys and complete vesicourethral distraction in girls. Patients were followed an average of 2.5 years (range 6 months to 4 years) by physical examination, urethrography and endoscopy. RESULTS: The stricture was successfully corrected in all patients and all void with a normal flow. All boys are continent but 2 of the 3 girls had early incontinence, which resolved with time in 1. In 2 of the 10 cases a previous attempt at perineal repair had already failed. No patient required urethrotomy or dilation and none had significant hemorrhage, fistulization, bladder hernia, chronic pain or secondary gait disturbance. CONCLUSIONS: Symphysiotomy is hereby revisited as a simple and effective approach for repairing traumatic posterior urethral injuries in the pediatric population. It can be performed instead of transpubic urethroplasty to manage long or otherwise complicated strictures.     

Calcium channel blocking activity of thioridazine,clomipramine and fluoxetine in isolated rat vas deferens: a relative potency measurement study

PURPOSE: We evaluated the calcium channel blocking activity of thioridazine, clomipramine and fluoxetine in isolated rat vas deferens and determined their relative order of potency. MATERIALS AND METHODS: Cumulative control concentration-response curves to calcium chloride were obtained in isolated rat vas deferens incubated in depolarizing calcium-free Krebs-Henseleit solution. Tissues were washed to baseline length and equilibrated with a given concentration of test drugs. After a 30-minute period a calcium concentration-response curve was repeated. The resulting rightward displacement of the concentration-response curve to calcium provided a dose ratio. The dose ratio was used in the Schild equation and the antagonism of calcium induced contractions was quantified by Schild analysis. RESULTS: The calcium channel blocking activity of thioridazine, clomipramine and fluoxetine was compared with nifedipine. All 4 drugs produced parallel rightward displacement of concentration-response curves to calcium. The potency of this effect was quantified by Schild analysis showing pA estimates, namely nifedipine 7, thioridazine 6.2, clomipramine 5.65 and fluoxetine 5. CONCLUSIONS: A characteristic profile of calcium channel blocking activity on the vas deferens was obtained for all test drugs. The relative order of potency was determined as thioridazine greater than clomipramine greater than fluoxetine. Differences in the potency of calcium entry blockade at peripheral end organs may contribute to differential effects of these drugs on delaying ejaculatory latency in patients with premature ejaculation.     

Parotid gland tumours: a 15-year experience.

Between 1973 and 1988, 302 patients underwent surgical operations for parotid gland swelling. Primary operations were performed in 293 cases, while secondary operations for recurrent tumour were performed in nine cases. A total of 244 patients (80.8%) were found histologically to have either a benign parotid tumour or a tumour-like lesion, while 58 patients (19.2%) were diagnosed as having malignant tumours. Two hundred and eighty-nine patients underwent superficial and total conservative parotidectomy and in 13 cases a radical parotidectomy was performed. The median follow-up was 5 years (range 1-15 years). Permanent facial nerve palsy, tumour recurrence, Frey's syndrome and parotid fistula were recorded as 0.7, 0.7, 2.1 and 0.4%, respectively. Thus, with full understanding of the surgical anatomy of the parotid gland and correct tumour identification, preservation of the facial nerve and serious postoperative complications can be minimized following superficial and/or total conservative parotidectomy.     

Role of Blink Reflex in diagnosis of subclinical cranial neuropathy in Diabetic Mellitus type II

BACKGROUND AND OBJECTIVES: Peripheral Neuropathy (PN) is one of the late complications of Diabetes Mellitus. Cranial nerves III, VII and V are among the most commonly affected in diabetic patients. Traditional Electrodiagnosis (Edx) studies are useful method for diagnosis of PN and symptomatic cranial neuropathy, and may not be useful for detecting subclinical involvement of cranial nerves. The main objective of this study is to evaluate the role of Blink Reflex (BR) for early diagnosis of cranial neuropathy in diabetic patients with PN. DESIGN: A prospective study was performed on NIDDM patients with a PN. 188 subjects were included in our study in which 142 acted as healthy subjects and 46 as diabetic patients. Patients were excluded with prior history of cranial nerve lesions, stroke, and other disease with polyneuropathy or drug-induced neuropathy. Routine nerve conduction studies were performed and only patients with PN were included in this study. RESULTS: Abnormalities were found in 54.4% of patients. R1, IR2 and CR2 were prolonged relative to healthy group. Statistically there was no significant difference in R/D ratio of patients (P = 0.201). Also there was a positive correlation between R1, IR2 and CR2 latencies with duration of diabetes and severity of polyneuropathy, but not for R/D. The greatest correlation was shown in R1 latency (69.9% abnormality). CONCLUSION: BR is a non-invasive and very useful method for evaluation and diagnosis of subclinical cranial nerve involvement in diabetic patients.     

Renal transport of aromatic acids in patients with phenylketonuria

Renal clearance of phenylpyruvic acid is maximal at a plasma concentration of 40–60 µmol/l. This concentration is obtained with plasma phenylalanine concentrations of 1.0–1.2mmol/l, the threshold for separating classical phenylketonuria from phenylketonuria variants.