Tight nuchal cord and neonatal hypovolaemic shock.

Two neonates who went into acute hypovolaemic shock due to a tight nuchal cord were successfully resuscitated. The occurrence of this life threatening complication in two low risk pregnancies emphasises the importance of having staff trained in resuscitation immediately available in the delivery unit.     

The problem of the perforating veins

Any obstacle slowing down or blocking the venous return, causes hypertension, then dilatation which destroys the valves of the perforating or muscular veins. The superficial veins become flooded. A symptomatic treatment with sclerosis or stripping is not sufficient. The valve is of crucial importance and varices represent a symptom indicating a snag in the venous return. The phlebologist's role is to look for and identify the snag as well as finding a treatment.     

Cardiovascular risk factor profile on a population basis: Results from the Lipid Study Leipzig (LSL)

Population-based lipid screening studies were initiated in the city of Leipzig, Germany, and included more than 30,000 subjects. The objectives of the Lipid Study Leipzig (LSL) were to evaluate the cardiovascular risk factor profile and its dependence on age, nutrition and social factors. In addition, the study results were compared with those of other population-based studies, and the development of cardiovascular risk factors over a 10-year period was evaluated. LSL data were obtained from subjects recruited at community centres, work sites, schools and the University of Leipzig, Germany. Capillary blood cholesterol and high-density lipoprotein-cholesterol levels were measured using the Reflotron dry-chemistry system (Roche Diagnostics, Germany). Study data also included blood pressure, body mass index, waist-to-hip ratio, and the evaluation of dietary and lifestyle factors. The results of LSL show an age-dependent increase in cardiovascular risk, which may have been partly preventable. Furthermore, LSL showed an improvement in cardiovascular risk, with respect to plasma cholesterol, over the past 10 years in men and women older than 30 and 50 years, respectively. The known age dependence of total cholesterol and non-high-density lipoprotein-cholesterol is less pronounced for those following a healthy lifestyle and for vegetarians. This suggests that the age-dependent rise of these parameters is partly preventable.     

The Copper-Fix (Cu-Fix): a new concept in IUD technology

The Copper-Fix (Cu-Fix) is a thread-type copper-bearing device designed to overcome the most common IUD-related problems: bleeding and pain. Two distinctive features—virtual absence of a frame and provision of an anchoring system—make this new intrauterine device the first radical departure from current IUD technology. The Cu-Fix 390 was inserted at intervals in 382 women, and 4851 woman-months of experience had been accumulated at 18 months. The device was exceedingly well retained by the uterus (expulsion rate 0.6 at 18 months) and the removal rate for bleeding/pain was low (3.1 at 18 months). Serious complications did not occur; the pregnancy rate amounted to 0.3 at 18 months, with a continuation rate of 87.6%, which includes an 8.1% removal rate for pregnancy wish. Cardinal event rates were not influenced by the age or gravidity status of the recipient.

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Resumen El Copper-Fix (Cu-Fix) es un dispositivo portante de un hilo cobre, diseñado para corregir los problemas más comunes relacionados con los DIU: sangrado y dolor. Dos características sobresalientes — virtual ausencia de un esqueleto y de provisión de un sistema de fijación — hacen que este nuevo dispositivo intrauterino difiera radicalmente de la tecnología actual de DIU. El Cu-Fix 390 fué insertado a intervalos en 382 mujeres y en 18 meses se acumularon 4851 meses-mujer de experiencia. El dispositivo fué retenido notablemente bien por el útero (tasa de expulsión 0,6 an los 18 meses) y la tasa de remoción por sangrado/dolor fué baja (3,1 a los 18 meses). No ocurrieron complicaciones serias; la tasa de embarazo fué de 0,3 a los 18 meses con una tasa de continuidad de 87,6% la que incluye una tasa de 8,1% de remoción por deseo de embarazo. Las tasas de eventos pricipales no estuvieron influenciadas por la edad ni por la gravidez previa de las mujeres.

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Resumé Le Copper-Fix (Cu-Fix) est un dispositif de type filiforme chargé de cuivre, qui a été étudié en vue de remédier aux problèmes les plus fréquents liés au port des DIU: pertes sanguines et douleurs. Les deux caractéristiques qui le distinguent — pratiquement absence de cadre et possibilité d'ancrage — apportent à ce dispositif intra-utérin le premier changement radical dans la conception actuelle des DIU. Le Cu-Fix 390 a été inséré par intervalles chez 382 femmes et une expérience de 4851 mois-femme a été accumulée en 18 mois. Ce dispositif a été extrêmement bien retenu par l'utérus (taux d'expulsion 0,6 à 18 mois) et le taux de retrait dû à des saignements ou des douleurs a été faible (3,1 à 18 mois). Il n'y a eu aucun cas de complications graves; le taux de grossesses a atteint 0,3 à 18 mois, avec un taux de continuation de 87,6% qui tient compte des 8,1% de retraits effectués en vue d'une grossesse désirée. Les taux d'événements importants n'ont été influencés ni par l'âge ni par l'état de gestation de l'utilisatrice.

     

Epidermal growth factor receptor regulates normal urothelial regeneration

Members of the epidermal growth factor (EGF) family and their receptors are involved in many cellular processes, including proliferation, migration, and differentiation. We have previously reported that these growth factors are expressed and have specific regulatory functions in an organ-like culture model of normal human urothelial cells. Here, we used this model to investigate the involvement of EGF receptor (EGFR) in human urothelial regeneration. Three 4-mm-diameter damaged areas were made in confluent normal human urothelial cell cultures with a biopsy punch. Regeneration was measured, on fixed stained cultures, with an image analyzer, at 4, 24, and 48 hours after injury. Cell proliferation was assessed by 5-bromo-2-deoxyuridine incorporation. To identify EGF family factors potentially involved in the healing process, we studied the effect of these factors on damaged confluent cultures and the level of expression of mRNAs extracted from these cultures. EGFR inhibition of the proliferation and migration of urothelial cells was tested with (1). a specific tyrosine kinase inhibitor (AG1478) and (2). a blocking anti-EGFR antibody (LA22). Exogenously added amphiregulin, EGF, transforming growth factor-alpha and heparin-binding EGF (HB-EGF) stimulated urothelial regeneration. The damaged areas were repaired by regrowth within 48 hours. Both AG1478 and LA22 inhibited the repair (by 50% and 30%, respectively), as well as proliferation and migration. This regeneration was accompanied by increased HB-EGF mRNA expression in cultures of cells from four of six subjects, but no corresponding change in EGFR protein level was observed. These results indicate that the EGFR signaling pathway is involved in urothelial regeneration. Our data support an autocrine role of HB-EGF in this process and suggest that the EGFR pathway is a potential therapeutic target for modulating urothelial cell proliferation.     

The prognostic value of hypocholesterolemia in hospitalized patients

Clinical observations show that severe illness often leads to hypocholesterolemia. To verify this finding and to define the relationship between serum cholesterol and a patient's prognosis, a study was conducted in two large hospital populations. Of 24,000 and 61,463 adult patients (populations I and II) an average of 3.8% and 3.6% died in hospital, respectively. The mean serum cholesterol levels of patients who died was significantly lower than that of those who survived (163.6 mg/dl versus 217.8 mg/dl;P < 0.0001). The average cholesterol of surviving patients was similar to that of 6,543 healthy controls. During hospitalization serum cholesterol levels of 100 mg/dl were encountered in 1.2% and 3.6% of patients of populations I and II, respectively. The mortality of these hypocholesterolemic patients was about tenfold higher than average and showed a strong, inverse, linear relationship with serum cholesterol concentrations. Patients whose serum cholesterol level dropped to less than 45 mg/dl did not survive. These data show that in severely ill patients serum cholesterol may decline to very low concentrations, and the prognosis is reflected by the degree of hypocholesterolemia, which thus may serve as a clinically useful prognostic parameter. Correspondence to: E. Windler     

Heterogeneity of human anti-MAG IgM as revealed by their reactivity on avian embryonic tissues

Monoclonal IgM from patients with peripheral neuropathies frequently have an antibody activity directed against myelin-associated glycoprotein (MAG). Reactivity of 19 of these sera with avian embryonic tissues was compared. Immunohistological studies allowed their classification into distinct groups according to the staining pattern. Both neural and non-neural cell lineages were recognized by these antibodies. The IgM specificities were also compared with those of the monoclonal antibodies HNK-1 and NC-1, which react with MAG and some cell adhesion molecules. Only one group displayed a pattern of staining similar to that observed with these monoclonals. The reactivity of these IgM paraproteins with two cell adhesion molecules, neural cell adhesion molecule and neuron-glia-cell adhesion molecule by immunoblotting confirmed the heterogeneity found in the histological study.     

Induction of glomerulosclerosis by dietary lipids. A functional and morphologic study in the rat

Clinical and experimental data indicate that glomerular function and morphology may be influenced by plasma lipids. In familial lecithin-cholesterol-acyltransferase (LCAT) deficiency and in Fabry's disease, lipids accumulate in glomeruli and are assumed to induce sclerosis. The present study was undertaken to examine if dietary lipids could exert effects on the glomeruli of normal, unilaterally nephrectomized rats, and of rats with two-kidney, one clip (2-K,1C) hypertension. In rats with two kidneys on a diet rich in fat and cholesterol, cholesterol concentrations in very low density lipoproteins increased. In these rats the number of glomeruli with sclerotic foci was significantly higher than in rats on a low fat, cholesterol free diet. After 6 months on the diet the percentage of glomeruli with sclerosis (SC) was 13.2 +/- 4.1 (N = 9) in rats with a cholesterol diet and 1.8 +/- 0.6 (N = 11) in control rats (p less than 0.05). The fat and cholesterol diet exacerbated glomerular lesions in the remnant kidney model of uninephrectomized rats. The sclerosis in rats with only one kidney was 38.2 +/- 9.5 (N = 6) on a cholesterol diet compared with 8.7 +/- 3.0 (N = 6) in control rats after 6 months (p less than 0.05). After 3 to 4 months on a fat rich diet cholesterylester was increased in isolated glomeruli. The composition of the dietary lipids influenced the development of glomerular lesions. A linseed oil diet that is rich in unsaturated fatty acids, especially linolenic acid, did not cause major plasma lipid abnormalities and was accompanied by a low sclerosis (1.2 +/- 0.3; N = 9) for rats with two kidneys. In rats with chronic 2-K, 1C hypertension the percentage of glomeruli with partially sclerosed tufts in the unclipped kidney was significantly higher on a fat and cholesterol diet (F) than on a control diet (N) (SC: diet F 31.0 +/- 4.0, N = 13; diet N 12.2 +/- 2.6, N = 12; P less than 0.05). In the clipped kidney, protected against the arterial hypertension, only an increased number of glomeruli with mesangial expansion was noted in rats with the cholesterol diet. Glomerular hemodynamic factors seem to play an important pathogenetic role in the induction of glomerular sclerosis by a lipid rich diet. The fact that dietary lipids can aggravate glomerular lesions in states of arterial hypertension and nephron loss may have implications for the progression of renal disease in humans.     

Chromosomes in Ewing's sarcoma. I. An evaluation of 85 cases of remarkable consistency of t(11;22)(q24;q12)

Since our initial reports on chromosomal studies in eight Ewing's sarcomas (ES), we have carried out similar investigations on 23 additional ES specimens following short-term culture of tumor cells (16 cases), and established in vitro cell lines (three cases) and on xenografted tumors in nude mice (four cases). We demonstrated the presence of the reciprocal t(11;22)(q24;q12) in every case except one that exhibited a complex t(11;22;14)(q24;q12;q11). On the basis of results from these additional 23 cases, we confirm the consistency of the t(11;22)(q24;q12) in ES. Moreover, we reviewed 54 ES cases reported by other investigators; when added to our 31 cases, this brings the total number to 85 unrelated cases of ES available for an evaluation of the frequency of involvement of bands 11q24 and 22q12 in translocations in ES. The standard t(11;22)(q24;q12) proved to be a remarkably consistent event, present in 83% of the cases. Five percent of the cases exhibited complex translocations involving a third chromosome in addition to chromosomes #11 and #22. In 4% of the cases variant translocations involved 22q12 but with a chromosome(s) other than #11. The breakpoint on chromosome 22q12 appears to be the most consistently observed event in 92% of the cases, whereas, the breakpoint at chromosome 11q24 was observed in 88% of the cases.