Perfluorochemicals as US contrast agents for tumor imaging and hepatosplenography: preliminary clinical results

In animals, perfluorochemicals (PFCs) are effective ultrasound (US) contrast agents that produce hepatic, splenic, and tumor enhancement. The use of Fluosol-DA 20%, an emulsion of perfluorodecalin and perfluorotripropylamine, was studied in nine non-critically ill patients with cancer who had liver lesions. US studies without Fluosol were compared with studies obtained 24, 48, and 72 hours after Fluosol infusion. Vital signs and extensive laboratory analyses are performed before and after Fluosol infusion. Liver metastases from colonic, pancreatic, and gastric carcinoma exhibited rim or diffuse enhancement after a Fluosol dose of 1.6 g/kg or greater. Fluosol produced echogenic enhancement of the liver and spleen relative to kidney at a dose of 2.4 g/kg, allowing the detection of nonenhancing lesions. In addition, Fluosol at a dose of 1.6 g/kg or greater allowed detection of lesions not seen before contrast medium was administered in three of the seven patients studied. There was a mild increase in the level of serum glutamic oxaloacetic transaminase in two patients, one given 2.4 and the other 3.2 g/kg of Fluosol. Mild and transient allergic reactions without change in vital signs were experienced by two patients.     

Classical and anaplastic seminoma: difference in survival

Classical and anaplastic seminoma are traditionally treated with radiation therapy and are said to have the same prognosis. A retrospective study was undertaken of 90 seminoma patients treated with radiation therapy between 1961 and 1985. The classical group consisted of 71 patients of whom 50 had stage I and 21 had stage II disease. The anaplastic group consisted of 19 patients of whom ten had stage I and nine had stage II disease. The median follow-up time was 64 months for the entire group. The 10-year relapse-free survival rate for the classical group was 94% and for the anaplastic group was 70% (P less than .05). For patients with classical stage I disease, the relapse-free actuarial survival rate was 98%; for patients with anaplastic stage I disease, it was 64% (P less than .02). For the classical stage II disease group, the relapse-free actuarial survival rate was 84% and for the anaplastic stage II disease group, 75% (P less than .70). Four patients in the classical group (6%) had relapses; of these, one patient had local recurrence of tumor, and three had distant metastases. In the anaplastic group, four patients (21%) had relapses; two patients had local recurrence of tumor, and two had distant metastases. Therefore the data suggest a difference in survival and relapse rates between classical and anaplastic seminoma.     

Elastin point mutations cause an obstructive vascular disease, supravalvular aortic stenosis

Supravalvular aortic stenosis (SVAS) is an inherited obstructive vascular disease that affects the aorta, carotid, coronary and pulmonary arteries. Previous molecular genetic data have led to the hypothesis that SVAS results from mutations in the elastin gene, ELN. In these studies, the disease phenotype was linked to gross DNA rearrangements (35 and 85 kb deletions and a translocation) in three SVAS families. However, gross rearrangements of ELN have not been identified in most cases of autosomal dominant SVAS. To define the spectrum of ELN mutations responsible for this disorder, we refined the genomic structure of human ELN and used this information in mutational analyses. ELN point mutations co-segregate with the disease in four familial cases and are associated with SVAS in three sporadic cases. Two of the mutations are nonsense, one is a single base pair deletion and four are splice site mutations. In one sporadic case, the mutation arose de novo. These data demonstrate that point mutations of ELN cause autosomal dominant SVAS.      

HOW SAFE IS YOUR HOSPITAL - DOCTOR?

The use of disposable syringes, needles and other ‘disposable’ items has gained wide popularity in hospital practice. The supposed advantages are ensuring sterility and preventing the spread of infection from patient to patient. However are these aims really being met? In the present state of awareness and disposal procedures being followed we are not achieving aims and it may even be more prudent to go back to the glass syringes with proper autoclaving facilities. Alternatively there is the need to improve the disposal facilities in hospitals for the disposable articles.KEY WORDS: Disposable equipment, Syringes, Infection controlUse of needles and syringes has revolutionized the medical practice. It is amazing that syringe was used for the first time by Alexander Fleming in 1910 to administer Salvarasan nicknamed ‘606’ for the treatment of syphilis. We have come a long way since. Today we cannot imagine a modern hospital without syringes and needles. Every medical practitioner frequently uses needles and syringes either for drug administration or to obtain a specimen of blood, fluid or tissue for diagnostic tests.In not so distant past, glass syringes were the norm - the user being responsible for its proper sterilization and maintenance. Some practitioners still use them, though, these are now near extinct species. The plastic age, with the advent of plastic syringes, shifted the onus of sterilization from the user to the manufacturer. Doctors were more than happy to cast off the responsibility of sterilizing the syringes and needles and grabbed the plastic syringes. The genie of “disposable” articles was thus unbottled. The catalog of so called disposables now includes syringes, needles, catheters, cannulae, gloves, intravenous drip sets, blood taking sets, the tiles and tubes used in labs, specimen collection containers, and others. These “disposable” plastic articles have some distinct advantages :

• a)These are easy to store, nonbreakable, have long shelf life and are ready to use. It is common practice among doctors and nurses to carry such ready-to-use articles in their pockets.
• b)The needles accompanying these syringes are very sharp, easy to use and the jab is less painful to the patient. The reusable conventional all - metal hypodermic needles get blunted due to repeated use, and the jabs are distinctly painful.
• c)The cumbersome process of washing and sterilizing the glass syringes is eliminated.
• d)The plastic ware are the “in” thing, are extensively used in Western world, therefore, appear fashionable and glamorous to both, the patients and the medics.

These are some of the obvious reasons why plastic ware have become not only acceptable but almost a necessity in modern medical practice. The manufacturers promote and propagate their use with obvious eyes on the profit margins.But it all appears too good to be true and benign. Every leisure, every perk is counterbalanced by undeclared responsibility. Often we forget or disregard, sometimes unknowingly but mostly consciously, these coexisting additional responsibilities and the restraints.The privilege of use of plasticware thrusts upon us some such responsibilities. These are :

• a)Proper and safe disposal.
• b)Destruction of the “disposable” to prevent recycling.

The ideal way of disposal and destruction of these plastic ware involves following steps :

• a)All these articles after use must be dipped in suitable disinfectant solution for few hours to reduce the load of pathogens.
• b)These must then be shredded or incinerated to destroy the item completely to prevent recycling.

The ideal is defined as conjectural, therefore, unachievable - rightly so. Specially in our circumstances, safe disposal is almost unheard-of. Neither the paramedics are educated and motivated adequately nor are the wherewithal for such safe disposal available.Let us peep in one of the busy wards of our hospitals and see what really transpires. For the sake of simplicity let us take the case of syringes and needles. On an average, every patient in these wards needs two jabs a day - either to take the specimen or to administer a drug. It means about 100 jabs in a 50 bedded ward - and that many syringes and needles per day, which the ward never ever gets. But our staff is not deterred by such obstacles, the resident doctors and nurses have to be perpetually on syringe hunt - begging, borrowing AND (not or) lifting them from wherever they can - including consultants'' lockers or colleagues'' pockets. But there is never enough for everyone due to the prohibitive cost and enormous number of these syringes required.Ingenuity comes in handy in such circumstances. Following are some of the commonly resorted ways. Each patient is allotted a syringe - to be used repeatedly for few days before discarding. Or the patients are “pooled” around a syringe and needle, same needle and syringe being used on a group of them. Sometimes syringes are considered “superfluous” while collecting blood samples - or in dire circumstances the “flush” technique is followed. It is simple - just flush the used syringe with saline - and hopefully out go all those “bad” bugs, the syringe is ready for the next in line. Just pray that it is not you!! That much for the principles of asepsis and sterilisation. Some patients - the elite educated ones come with their own syringes and needles as a respite - though not often.After the poor syringe and needle have done their tour of duty through the ward or Out Patient Department (OPD), they go to their resting place - not an antiseptic container but usually a cardboard “khokha”. Such a “khokha” gallantly displays its scars and the blood of the victims on its walls. The “khokha” is also the resort of used bandages, dressings, gauze pieces, cotton swabs, used gloves, broken glass pieces of phials, empty vials and waste papers. The venerable Class IV employee, with his bare hands scoops up the contents for their onward journey to - incinerator? Well you missed it again. It is the garbage dump near the incinerator. It is obvious because the road to incinerator is paved with bramble, broken glass bottles, sharply cut tins etc and in any case - who remembers seeing any embers or smoke in the incinerator? The garbage dump is much easily approachable and magnanimous. In some places these used syringes and needles are returned to the medical store - the all encompassing accounting procedure must be followed before issuing the fresh indent! Despite this small detour, what ever the route may be, the ultimate destination is the garbage dump.We all believe in rebirth. From the soil unto soil - and from the soil again. In come our rag pickers. They too have their own specializations and hierarchy - some go only for papers, others for polythenes while the ones in higher echelons go only for hard plastic moulded wares - the syringes, the catheters and the like. These are value added items and fetch better returns than other items. But it is hard work - rummaging through these heaps braving the sun and competing the stray dogs, one manages a bagful of these goodies in a day. So what if in the course of such treasure hunt one gets few jabs from unsheathed needles or cuts due to sharp glass pieces? A severe cut is usually dressed with gauze and bandage readily available in the same dump! All that talk about HIV, hepatitis viruses and other germs getting through these pricks and cuts is only figment of someone''s imagination. The thought of contracting these diseases is a luxury the rag picker can ill afford. The effort is worth it, as a bagful of syringes and needles fetch handsome Rs 5–10 per kilo - enough for a meal to pull him through the night.A number of companies dealing with disposable plastic wares have sprung up in last few years. These are very kind in accepting all these syringes and needles from poor rag pickers. They contribute to the ever increasing industrial “production” by repacking and marketing these items. Since their inputs are minimal, they successfully bag most of the contracts on the basis of lowest quotation. And there comes the old syringe wrapped in stylish labels - “DISPOSABLE HYPODERMIC SYRINGE, STERILE, NONTOXIC, PYROGEN FREE” “Destroy after single use” is normally in the tiniest print and not readable. After all, how many of us can recount the birth and lives our souls have gone through? Why bother about a lowly syringe and needle?     

激素治疗增加绝经后健康妇女尿失禁的发病率和严重程度

问题：在绝经后健康妇女中，激素治疗（hormone therapy，HT）对尿失禁（urinary incontinence，UI）的效果如何？     

Corticobasal and ataxia syndromes widen the spectrum of C9ORF72 hexanucleotide expansion disease

Recently, a hexanucleotide (GGGGCC) repeat expansion in the first intron of C9ORF72 was reported as the cause of chromosome 9p21‐linked frontotemporal dementia‐amyotrophic lateral sclerosis (FTD‐ALS). We here report the prevalence of the expansion in a hospital‐based cohort and associated clinical features indicating a wider clinical spectrum of C9ORF72 disease than previously described. We studied 280 patients previously screened for mutations in genes involved in early onset autosomal dominant inherited dementia disorders. A repeat‐primed polymerase chain reaction amplification assay was used to identify pathogenic GGGGCC expansions. As a potential modifier, confirmed cases were further investigated for abnormal CAG expansions in ATXN2. A pathogenic GGGGCC expansion was identified in a total of 14 probands. Three of these presented with atypical clinical features and were previously diagnosed with clinical olivopontocerebellar degeneration (OPCD), atypical Parkinsonian syndrome (APS) and a corticobasal syndrome (CBS). Further, the pathogenic expansion was identified in six FTD patients, four patients with FTD‐ALS and one ALS patient. All confirmed cases had normal ATXN2 repeat sizes. Our study widens the clinical spectrum of C9ORF72related disease and confirms the hexanucleotide expansion as a prevalent cause of FTD‐ALS disorders. There was no indication of a modifying effect of the ATXN2 gene.     

Frequency-plane analysis of normal and pathological ECG signals for disease identification

In this paper a frequency plane analysis of both normal and diseased ECG signals is performed specifically for disease identification. Image processing techniques are used to develop an automated data acquisition package of 12 lead ECG signals from paper records. A regeneration domain is also developed to check the captured pattern with the original wave shape. A QRS complex detector with an accuracy level ～98.4% in up to 30% signal to noise level is developed. Discrete Fourier transform (DFT) is performed to obtain the frequency spectrum of every ECG signal. Some interesting amplitude and phase response properties of chest lead V2, V3, V4, V6 and limb lead I, II, III, AVL, AVF are seen. Both amplitude and phase properties are different for normal and diseased subjects and can serve an important role in disease identification. A statistical analysis of amplitude property is carried out to show that this property is significantly different for normal and diseased subjects.     

Hemolytic Disease of the Newborn Apparently Caused by Anti-Lua

Report of the first example of pure anti-Lu^a associated with hemolytic disease of the newborn. Of special interest is the fact that this serum demonstrated a marked prozone reaction in saline, papain and indirect Coombs titrations, and is the first anti-Lu^a serum to react well by the indirect Coombs technic.