Hyperemesis gravidarum: is an ultrasound scan necessary?

BACKGROUND: Traditionally, in cases of hyperemesis gravidarum (HG), an ultrasound evaluation is recommended to confirm viability and to exclude multiple pregnancies and gestational trophoblastic disease (GTD). Our aim was to perform a case-control study to evaluate the incidence of these findings. METHODS: Each case of HG was matched for gestational age with the next ultrasound examination performed in an asymptomatic pregnancy. The findings were compared between the two groups. RESULTS: Two hundred and eighty-six cases of HG were matched with 286 asymptomatic women. The total number of viable pregnancies was higher in the HG group (280/286, 97.9%) than that in the control group (265/286, 92.6%; P = 0.006). The incidence of twins was 3.1% in each group (P > 0.999). The incidence of early pregnancy failure was 0.7% in women with HG compared to 7.0% in asymptomatic women (odds ratio 0.09, 95% CI 0.01-0.04, P < 0.0001). The one case of GTD was in the HG group; however, this case also presented with vaginal bleeding. CONCLUSIONS: Pregnancies complicated by HG had a similar risk of twin pregnancy, and a lower risk of early pregnancy failure compared to controls. In the absence of vaginal bleeding, there was no increase in GTD in women with HG. We conclude that an ultrasound scan is not clinically necessary in women presenting with HG, other than for maternal reassurance.     

Tuberculosis in the course of sarcoidosis treatment: is genotyping necessary for personalized therapy?

Pathological similarities between sarcoidosis (SA) and tuberculosis (TB) suggest that mycobacterial antigen(s), in genetically different predisposed hosts, may be a cause of SA. The authors’ work and other published comparative analyses of HLA and non-HLA alleles in patients with SA or TB from different ethnic groups in the world revealed that some antigens were connected with high risk of SA or TB development, but others were comparable in both patient populations. The authors also showed a possibility of predominant occurrence of HLA alleles characteristic for TB as a cause of TB in patients with SA on corticosteroid therapy. It is possible that an analysis of SA and TB patient’s genetic background may be helpful for protection from TB in SA patients on corticosteroids, especially on anti-TNF-α treatment. The authors suggest that the consideration of an immunosuppressive therapy in SA patients will need more attention and individual therapy based on genotyping study.     

HPLC--how necessary is it for haemoglobinopathy diagnosis in India?

Cation exchange high performance liquid chromatography (HPLC) is emerging as the method of choice for the initial screening of thalassemias and haemoglobinopathies and quantification of Haemoglobins (Hbs) like HbA, HbA2 and HbF. Since it is expensive, the present study was conducted to evaluate the need for HPLC in Indian laboratories and identify situations where it would be imperative. Eighty three patients suspected to have thalassemia and haemoglobinopathies were analysed. Both HPLC and alkaline gel electrophoresis detected 14 cases of HbE syndrome and 14 cases of HbS syndrome. However of the 14 cases diagnosed as HbD syndrome by alkaline electrophoresis, eight cases were diagnosed as Hb Q India, 1 case as HbD Iran and 5 cases of HbD Punjab on HPLC. Thirty-one cases were detected to have beta heterozygous thalassemia based on the high HbA2 levels (>3.9%) and eight cases were diagnosed as beta homozygous thalassemia by both HPLC and gel electrophoresis. One of them had an unknown Hb migrating in F-A region. Her mother also had same unknown Hb variant. In view of electrophoretic migration and retention time (RT) on HPLC, possibility of HbG-San Jose was considered. HPLC being an automated instrument is highly sensitive and specific, has high resolution and helps in quantification of various haemoglobins. However in a developing country like India where economical factors play a major role in planning for management of patients, the role of HPLC is limited.     

Flavour-nutrient learning in humans: an elusive phenomenon?

One widely cited model of how humans acquire liking for different foods is flavour-nutrient learning, where associations between the orosensory properties of the ingested food or drink (the flavour CS) and positive consequences of nutrient ingestion (the UCS) lead to acquired liking for the flavour (flavour-nutrient hedonic learning: FNL-H). Likewise, an association between the CS and the post-ingestive effects of ingested nutrients has been suggested to lead to learning about how satiating a particular food is (flavour-nutrient satiety learning: FNSH). However, whereas there is evidence for both FNL-H and FNL-S in experimental studies with non-human animals, evidence in humans is less convincing, with many failures to find the predicted changes in liking, preference or intake following repeated flavour-nutrient pairings. The present short review considers how subtle differences in experimental design might underlie this inconsistency, and identifies key design features which appear to increase the likelihood of success in human flavour-nutrient learning studies. Key factors include CS novelty, the level of nutrients ingested during training, the appetitive state of the consumer and individual consumer characteristics. A further complication is competition between FNL-H and FNL-S, and with other associations such as flavour-flavour learning. From this it is possible to make important inferences about the nature of human flavour-nutrient learning which firstly suggest that it has important similarities to that seen in other species, but secondly that the laboratory investigations of both FNL-H and FNL-S in humans can be compromised by subtle but important variations in experimental design.     

Skin prick test in duplicate: is it necessary?

BACKGROUND: Duplicate skin prick testing has previously been recommended because of reports that accidental negative tests are common. However, duplicate tests also mean an extra allergen load, which may increase the risk of inducing a generalized reaction at the test situation, at least in the youngest infants. OBJECTIVE: To investigate whether the occurrence of both a positive and negative test result is a common feature when performing duplicate skin prick tests and can therefore justify the duplicate method. METHODS: A retrospective analysis of all skin prick tests performed in duplicate at the pediatric clinic at University Hospital in Link?ping, Sweden, in 1997. RESULTS: Of 1,087 skin prick tests, 14 resulted in one positive and one negative test, or 1.3%. The corresponding figure in the youngest age group, (ie, <2 years of age) was 3 of 340 (0.9%). CONCLUSIONS: Considering the risk of inducing a summation of the reactions, and thereby a generalized allergic reaction, when applying an extra allergen load on the limited surface of the small arm, we conclude that the results of this study justify using single prick test, at least in the youngest age group and probably when testing children of all ages.     

Bronchial challenge testing in occupational epidemiology: is the diluent step really necessary?

BACKGROUND: There is no unanimous agreement on the use of a diluent step to preface methacholine challenge testing. The "pros" for this step are that it allows a better training of the patient; the "cons" are that it requires additional time and effort. OBJECTIVE: We examined if there were any systematic effects when either the baseline or postdiluent (saline) forced expiratory volume in 1 second (FEV1) was used to define the reactivity status. METHODS: All methacholine challenge tests performed during a 1-year period by a group of occupationally exposed workers (n = 183) were examined. RESULTS: The mean percentage change in FEV1 from baseline to postsaline was -1.44 (+/- 3.47)% and the mean absolute change was -0.043 (+/- 0.11) L (P < 0.0001 for both comparisons). The maximum decrease and increase in FEV1 from baseline were -12.7% and +10.9%, respectively. Three subjects had a fall in FEV1 after saline of 10% or more and were not given methacholine. From the remaining 180 subjects, 172 were equally classified as reactors (n = 67) or nonreactors (n = 105), both by baseline FEV1 and postsaline FEV1. Eight subjects were classified as reactors by baseline FEV1 but as nonreactors by saline FEV1. In these subjects, the average FEV1 dropped 4.9% from baseline to saline and 17.3% from saline to end-test; thus, the total FEV1 drop (22.5%) exceeded the 20% required for the test to be positive. Among reactors, no relationship was found between the response to saline and the subsequent response to methacholine (r = 0.13). CONCLUSIONS: Our data did not provide evidence to support the compulsory use of a diluent step when measuring bronchial responsiveness in populations. In general, the diluent step added time and expense to the test and, on occasion, forced a greater absolute drop in FEV1 than is needed to demonstrate bronchial hyperresponsiveness.     

Anticipatory grip adjustments are observed in both goal-directed movements and movement tics in an individual with Tourette’s syndrome

 We examined grip force adjustments during movements of a hand-held object in a young man (BF) with Tourette’s syndrome. We directly compared BF’s voluntary up and down movements with tics in the same directions. Movement tics were elicited by cueing BF to move either up or down on a GO signal which appeared after a variable delay. During the delay period, we observed frequent tics which were almost always in the cued movement direction. BF’s voluntary movements were well coordinated and featured precise and appropriate anticipatory grip force adjustments such that grip force was modulated in phase with movement-induced fluctuations in load. Precise anticipatory grip force adjustments were also observed in all of BF’s movement tics. These results support the hypothesis that tics in Tourette’s syndrome are purposeful voluntary movements that are well organized and coordinated. 10 August 1998 / Accepted: 29 January 1999     

Hand use for grasping in a bimanual task: evidence for different roles?

It has been proposed that the two hands play different roles during bimanual object interaction. The right hand takes on an explorative, highly precise, manipulative role while the left hand supports and stabilizes the object. Does this division of labour influence hand use during visually guided grasping? Three experiments were designed to address this question: right-handed individuals put together 3D models using big or small building blocks scattered across a tabletop. Participants were free to build the models; however, it felt comfortable (Experiment 1) or they were required to build on a large (Experiment 2) or small (Experiment 3) base plate. In Experiment 1, the right hand was preferred for grasping while the left hand stabilized the building model. When participants used the large base plate (Experiment 2), right hand use for grasping decreased and left hand use increased. The plate provided freedom to the left hand from having to stabilize the building model, but it also interfered with right/left hand movements directed towards the opposite side of the grasping hand (contralateral movements). To investigate which of these two factors would explain the change in hand use for grasping, a very small base plate was used in the last experiment. Results showed similar right hand use values to those seen in the first experiment (without the use of a plate), even though the left hand was ‘released from its stabilizing duties.’ The results predict a left-hemisphere right hand advantage in the control of grasping.     

BNP/NT-proBNP: what is the best choice in an emergency laboratory?

BNP and NT-proBNP are both well established as diagnostic and prognostic markers for congestive heart failure (CHF). However it remains for the biologist to choose between these two biomarkers depending on his equipment availability. The aim of this study was to compare results obtained with the Biosite Triage BNP assay and the Dade Behring NT-proBNP assay with regards to the clinical status. One hundred twelve patients (average age 76 +/- 13 years) with acute dyspnea were including and stratified by diagnosis at presentation into 3 groups: patients without acute CHF (group I, n=50), patients with non-cardiac dyspnea and CHF history (group II, n=22) and patients with acute CHF (group III, n=40). Levels of both BNP and NT-proBNP were higher among patients with cardiac dyspnea (group III) than among patients with a non-cardiac dyspnea (BNP=740 pg/mL versus 84 pg/mL; p<0.001 / NT-proBNP=7.502 pg/mL versus 499 pg/mL; p<0.001). ROC analysis for BNP or NT-proBNP were not statistically different in patients with acute CHF (group III) compared with patients with a non-cardiac dyspnea (group I + II) (AUC=0.927 versus AUC=0.930, p=0.90). Neither there was a difference between ROC analysis for BNP or NT-proBNP in patients with cardiac dyspnea (group III) compared to patients with a non cardiac dyspnea (group I) (AUC=0.981 versus AUC=0.975, p=0.76).Measurement of BNP or NT-proBNP is of identical interest for the diagnosis of acute CHF in acute dyspnea. The BNP Biosite assay was faster because analysis is performed on whole blood. With regards to analytical performance, the NT-proBNP Dade Behring assay had a higher accuracy and is highly recommended for the follow-up of CHF treatment.     

Haemorrhaging lesion in the breast: is there a role for embolisation?

Angiosarcoma of the breast is an extremely rare condition. This case illustrates the use of embolisation as a modality of treatment for primary breast angiosarcoma. No other case has been reported on the use of embolisation for this disorder.     

Malaria in Vietnam: what is the awareness of risk for travel in 2000?

Increasing numbers of people are travelling to Vietnam. From december 1st 1998 to april 31 1999, we surveyed by questionnaire 191 travellers who consulted at health centres attached to French diplomatic representations (Hanoi, Ho-Chi-Minh Ville) in order to evaluate their prophylaxis practices with regard to malaria; 59% of these travellers were taking no preventive measures whatsoever, while the rest were following an often ill-adapted treatment.     

Observation learning of a motor task: who and when?

Observation contributes to motor learning. It was recently demonstrated that the observation of both a novice and an expert model (mixed observation) resulted in better learning of a complex spatiotemporal task than the observation of either a novice or an expert model. In experiment 1, we aimed to determine whether mixed observation better promotes learning due to the information that can be gained from two models who exhibit different skill levels or simply because multiple models, regardless of their level of expertise, better promote learning than would a single model. The results revealed that the observation of both an expert and a novice model resulted in better short-term retention than the observation of either two novice or two expert models. In experiment 2, we wanted to determine whether these benefits would last longer if physical practice trials were interspersed with observation. Mixed and (to some extent) expert observations resulted in better long-term retention than observation of a novice model. We suggest that alternating mixed/expert observation with physical practice trials makes one’s error more salient than when all observation trials are completed before one first starts performing the experimental task, which increases activation of the action observation network.