Spontaneous Regression of Budd-Chiari Syndrome (Hepatic Venous Occlusion) in a Young Female

ABSTRACT. Hultcrantz R, Angelin B, Einarsson K, Friman L (Departments of Internal Medicine and Roentgenology, Serafimer Hospital, and Department of Internal Medicine, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden). Spontaneous regression of Budd-Chiari syndrome (hepatic venous occlusion) in a young female. Acta Med Scand 1987; 221:503–7. A case of occlusion of the hepatic veins in an 18-year-old girl is presented. The onset was sudden with massive ascites and markedly impaired general condition. The diagnosis was based on liver biopsy and angiograms of the caval and hepatic veins as well as of the celiac artery. No predisposing factors could be found. The patient was treated conservatively with laparo-centesis and diuretics. Clear improvement was seen after two weeks, and after four weeks she had no ascites and could be discharged. All liver function tests were then normalized. After three months, all diuretics could be withdrawn, and in the following 11 years she has remained completely recovered. The case illustrates that also widespread thrombi of the hepatic veins may sometimes rapidly dissolve spontaneously, with apparent total reconstitution of hepatic function. This case is unusual since previously reported cases have had high mortality rates and, in surviving cases, operative procedures or large doses of diuretics have been required to control the ascites.     

IL-10-driven immunoglobulin production by B lymphocytes from IgA-deficient individuals correlates to infection proneness

In search for a possible explanation of the phenotypic heterogeneity in IgA deficiency, we studied the function of B cells from IgA-deficient (IgAd) individuals. Two groups of IgAd individuals, one frequently infected and one clinically apparently healthy, as well as normal controls, were studied. Peripheral blood mononuclear cells (PBMC) and B cells from IgAd individuals and controls were cultured with Staphylococcus aureus Cowan I strain and with anti-CD40 MoAb presented on the CD32-transfected fibroblast cell line in the presence of IL-10. In this experimental system PBMC and B cells from the infection-prone IgAd individuals produced only minute amounts of IgA. In contrast, PBMC and B cells from healthy IgAd subjects secreted significantly more IgA1 and IgA2 in comparison with infection-prone IgAd patients (P < 0.05). These data suggest that the abnormalities of B cell differentiation in IgAd could be of heterogeneous origin. Thus, whereas in healthy IgAd subjects IgA production may be efficiently up-regulated in vitro by addition of IL-10 to CD40-activated B cell culture, the corresponding B cell differentiation does not occur in infection-prone IgAd patients. These observations provide a conceptual framework for phenotypic heterogeneity in IgAd subjects.     

CONTRACEPTIVE PRACTICE IN WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Since there are few data on the use of various birth controlmethods in systemic lupus erythematosus (SLE), we performeda cross-sectional study of the actual contraceptive practicesin a group of 85 Finnish female SLE patients of reproductiveage. We also recorded side-effects experienced during the useof oral contraceptives (OCs) and intrauterine devices (IUDs).The use of contraception was lower in SLE patients than in healthywomen of the same age (59 vs 77%, P<0.001). Sexually activeSLE patients requiring contraception used more often barrierand natural methods (P<0.001) and less often OCs (P<0.05)than the corresponding healthy women. The risk of deep venousthrombosis in SLE patients while using oestrogen-containingOCs was slightly increased (RR 2.3, 95% CI 0.5 to 10.3). Twenty-five(78%) of the 32 patients, who had used progestagen-only contraceptivesdiscontinued them because of side effects, which were mainlygynaecological. Major bleeding or pelvic infection did not occurduring the use of IUDs. KEY WORDS: Systemic lupus erythematosus, Oral contraceptives, Intrauterine devices, Tubal ligation, Barrier and natural contraceptive methods     

Intellectual Impairment with Regional Cerebral Dysfunction after Low Neonatal Cerebral Blood Flow

Lou, H. C., Skov, H. and Henriksen, L. (Department of Neuropaediatrics, J. F. Kennedy Institute, Glostrup, and Departments of Paediatrics and Neurology, Rigshospitalet, Copenhagen, Denmark). Intellectual impairment with regional cerebral dysfunction after low neonatal cerebral blood flow. Acta Paediatr Scand Suppl 360: 72, 1989.
12 children, in whom neonatal CBF had been measured, were examined at the age of 9 to 10 years by means of clinical neurological examination, neuropsychologic tests and observations, and ¹³³Xe single photon emission computed tomography (SPECT). Performance on most neuropsychologic tests or observations correlated with neonatal CBF but only rarely with other neonatal parameters (birthweight, gestational age, Apgar score at 5 min). Poor performance on each test or observation was in most instances correlated with a distinct pattern of regional cerebral dysfunction as assessed by SPECT. The dysfunctional region tended to be located periventri-cularly and in the watershed regions between major cerebral arteries. It is concluded that low neonatal cerebral perfusion may be an indicator, and possibly a determinant, of later intellectual dysfunction in stressed neonates, and that specific neuropsychologic deficits are associated with specific patterns of cerebral dysfunction in the present patient group.     

Enhanced emigration of crevicular leukocytes mediated by factors in human dental plaque

abstract – The present investigation was performed to study whether a filtrate from human dental plaque when applied topically to the gingival margin enhances gingivitis. Four-day-old plaque was sampled from 20 dental students. The plaque samples were pooled, suspended in NaCl, homogenized, centrifuged and filtered. The capacity of the plaque filtrate to attract neutrophil leukocytes was determined by measuring the number of leukocytes (a) which migrated into wound chambers containing the filtrate and (b) which could be sampled from the gingival crevices of dogs and monkeys after repeated topical application of the filtrate to the gingival margin. Gingivitis was assessed by gingival exudate measurements. The results showed that substances present in human dental plaque are highly chemotactic for neutrophil leukocytes. The filtrate stimulated enhanced emigration of leukocytes into the gingival crevices and enhanced gingival exudation. The observations indicate that a plaque filtrate may enhance vascular and cellular changes similar to those seen in incipient gingivitis.     

An Incidence Peak of Juvenile Diabetes. Relation to Coxsackie B Virus Immune Response

ABSTRACT. All new eases of insulin dependent diabetes mellitus (IDDM) in children below 15 years of age were recorded prospectively during a 21–year period 1964–1984 in a defined uptake area with a relatively constant child population. The total number of children recorded was 222–111 boys and 111 girls. The number of new cases varied between 4 cases in 1968 and 20 in 1984; in 1983 seventeen new caw were recorded. Specific IgM antibodies against Coxsackie B virus (CBV), types 1–5 were measured by a reverse radioimmunoassay (RIA) technique in 24 consecutive patients collected during the period March 1982–January 1984, some of whom represented the recent period of a very high incidence of diabetes. Sixteen patients (67%) exhibited CBV IgM responses, strongly suggesting a current or recent CBV infection. The titres declined during the first few months of diabetes and seemed to be absent after the first half-year period. Among age-matched non-diabetic children scheduled for elective procedures during the same period, no cases with CBV-IgM antinbodies were detected. Only three of the 16 IgM-RIA-positive patients showed a signircant rise in the neutralising antibody titre against the same Coxsackie B type. It is concluded that CBV may play a pathogenetic role in induction of IDDM, and possibly more frequently so during periods with a high incidence of diabetes, at least in children below 15 years of age.     

The establishment of a national safety promotion programme for prevention of accidents and injuries-- the first Swedish 'Health For All'--programme implemented in practice

According to the Swedish Health and Medical Services Act of1983 the Health Services have to be more involved in not onlydisease prevention but also health promotion. The first ‘HFA-2000’oriented programme covering all areas and all levels of injuryprevention and safety promotion was established in 1986. Itwas based on intersectorial cooperation and participation ofa number of popular organizations on all levels. It has alsobeen an inspiration for a general health promotion orientationof many societal sectors.     

Effect of immediate calcium hydroxide treatment and permanent root-filling on periodontal healing in contaminated replanted teeth

Abstract – The effect of immediate permanent root-filling and immediate intracanal calcium hydroxide treatment on experimentally contaminated and necrotized periodontal membranes (PDM) in avulsed and subsequently replanted monkey teeth was studied. Almost the entire root surface in the non-endodontically treated control teeth were covered with inflammatory resorp-tion, A significant shift towards ankylosis not associated with root resorption (> 80% of the total root surface area) was noted following calcium hydroxide treatment. About two thirds of the root surfaces from the teeth with permanent root fillings showed surface resorptions or ankylosis preceded by root resorption. The root surface area which would have been covered by inffammatory resorption, unless endodontic treatment had been implemented, were instead predominantly covered by either surface resorption (permanent root filling) or ankylosis (calcium hydroxide treatment), Ankylosis compared with surface resorption may in the long term lead to progressive loss of root substance due to replacement resorption. It was concluded that calcium hydroxide may be an excellent initial intracanal treatment in teeth with healthy PDM, but care should be taken not to risk unnecessary development of ankylosis by prolonged treatment of teeth with compromised PDM.     

Full Ventricular Capture Indicated by the QT Interval Function

The atrioventricular (AV) interval is critical in dual chamber (DDD) pacing in patients with hypertrophic obstructive cardiomyopathy (HOCM) to obtain full ventricular capture (FVC) with maximal reduction of the left ventricular (LV) outflow gradient and optimal LV diastolic filling. We studied the relationship of FVC, fusion, spontaneous AV conduction, and the QT interval. Methods: 11 patients with various cardiac diseases and stable AV conduction received a QT sensing Diamond (tm) Vitatron, DDD pacemaker. Software was downloaded into the pacemaker. In the DDD pacing mode, with the QT interval measured from the ventricular pacing stimulus to the end of the T wave, the AV interval was shortened from 400 ms, in 20-ms steps, to 90 ms. At 90 ms the stimulation rate was increased by 30 beats/mm and the AV interval was increased stepwise. FVC and fusion was examined on the surface ECG, Results: At 400 ms interval, spontaneous AV conduction inhibited the pacemaker. Shortening the AV interval resulted in pacing with a short QT interval. Further reduction of the AV interval resulted in a longer QT interval up to a point where the QT interval became stable. This point, the bending point in the plot of measured QT interval versus shortened AV intervals, coincided with the point of FVC. The relation of the QT-AV interval plot and the point of fusion was comparable when lengthening the AV interval at a 30 beats/mm faster stimulation rate. Conclusion: The bending point in the QT interval versus AV interval plots showed a good correlation with the FVC and fusion points observed on ECG. The results suggest that automatic discrimination between fusion and full capture using QT interval measurements may be feasible.