Role of five platelet membrane glycoprotein polymorphisms in branch retinal vein occlusion.

To determine whether polymorphisms of platelet surface glycoprotein associated with arterial thrombosis are risk factors for branch retinal vein occlusion. A case-control study in which 69 patients with branch retinal vein occlusion and 147 controls who attended the eye clinic for nonvascular complications participated. DNA was extracted from whole blood and analyzed for genotyping of platelet glycoprotein polymorphisms by polymerase chain reactions and specific restricted enzymes. No relationship was found between the four platelet glycoprotein polymorphisms i.e. GPIa C807T, VNTR and Kozak of glycoprotein Ibalpha, the HPA-1 of glycoprotein IIIa and the occurrence of branch retinal vein occlusion. The HPA-2 polymorphism was found in 18 out 60 (30%) patients with branch retinal vein occlusion in comparison with 27 out 142 (19%) of controls, with an estimated odds ratio of 1.8 (95% confidence interval, 0.91-3.65). The four platelet glycoprotein polymorphisms are not risk factors for branch retinal vein occlusion and therefore it seems unnecessary to screen those patients for it. A larger study is required, however, to determine whether HPA-2 is a novel risk factor for branch retinal vein occlusion.     

Lymphangiomatosis presenting with bronchial cast formation.

Lymphangiomatosis is a rare disorder of the lymphatic system that is known to cause chylothorax. Chyloptysis may occur but chylous bronchial cast formation is rare. A case is reported of lymphangiomatosis in a 34 year old woman whose initial manifestation was cough productive of bronchial casts. Two years later the patient developed a chylothorax. Ligation of the thoracic duct through a low thoracotomy was curative.     

Mesenteric and retroperitoneal cysts.

Mesenteric and retroperitoneal cysts are rare intra-abdominal tumors. Ten new patients are presented as well as 152 other cases reported in the English literature. These 162 cases were then analyzed for significant trends. Patients under 10 years of age were significantly different from the older group with respect to a shorter duration of symptoms, a higher number of patients requiring an emergency operation, a lower number of recurrences and the location of the cyst. Patients with retroperitoneal cysts were more likely to have incomplete excision of the cyst and therefore had a higher incidence of recurrence. They also required marsupialization more often. Retroperitoneal cysts should be considered a different entity from mesenteric cysts even though they present clinically in a similar fashion. The outcome of surgical treatment is less satisfactory in patients with retroperitoneal cysts.     

Mental health issues in the workplace: maintaining a productive work force.

Occupational health nurses must intervene early and validate the conditions and experiences of employees with psychiatric disabilities. Occupational health nurses must ensure employees are receiving appropriate treatment. They must be aware of and prepared to mitigate iatrogenic influences. Occupational health nurses can facilitate resolution of workplace conflicts and issues regarding changing supervisors or departments. They can also facilitate return to work by establishing clear restrictions and coordinating accommodations. compassionate and supportive, yet assertive, approach is key to managing mental health disability. It will, in most cases, facilitate successful return to full-time work.     

Laser laparoscopic management of large endometriomas.

Forty-seven patients underwent laser laparoscopic management of endometriomas from 3 to 12 cm in diameter. Eighteen patients had infertility, 15 had pelvic pain, and 14 had both. The types of laser used were the carbon dioxide, argon, and potassium-titanyl-phosphate. There were no surgical complications. Twelve of 32 patients with infertility achieved pregnancy after the initial procedure. Subsequently, 2 patients conceived after a second-look procedure. Twenty-three of 30 patients with pelvic pain reported improvement or resolution. We confirm the efficacy of operative laparoscopy using lasers in the management of large ovarian endometriomas.     

Postures and abnormal paroxysmal movements during sleep: hypnogenic paroxysmal dystonia or partial epilepsy?

In recent years, a differentiation has been made between two syndromes that are characterized by brief abnormal paroxysmal movements occurring principally at night: 1, hypnogenic paroxysmal dystonia (HPD), sometimes considered a particular form of dystonia similar to paroxysmal kinesigenic choreoathetosis, and 2, mesiofrontal epilepsy. Whether HPD is a distinct syndrome is not clear. Twenty-three patients, 11 men and 12 women, were hospitalized between 1985 and 1989 for examination of this type of abnormal paroxysmal movements (APM) occurring at night. In order to clarify the physiopathology of these abnormal nocturnal movement as focal epilepsy or a particular form of dystonia, we analyzed the personal and familial antecedents of all 23 patients, the polygraphic records during waking and sleep periods, and the results of neuroradiological examinations. Four patients were examined by positron emission tomography (PET) using i8F deoxyglucose. Symptoms first appeared between 3 and 28 years of age (M, 10.1) and developed over 1 to 20 years (M, 10.1). APM clearly occurred more commonly (greater than 90%) during sleep, usually during phases of slow-wave sleep. The sleeping patient opened his eyes and the motor signs then variously associated affective facial expression; axial postural modifications; tonic, dystonic or choreic postural movements of the limbs; pedalling; automatisms; disordered agitation and vocalization. The seizure was abruptly interrupted after 10 to 60 seconds. There was usually no postictal confusion. Thirteen patients clearly had clear epileptic antecedents: in 9, generalized tonic-clonic seizures; in 4, focal epileptic status. During nocturnal polygraphic recording, 6 patients presented a generalized seizure following a period of APM.(ABSTRACT TRUNCATED AT 250 WORDS)     

Elevated alpha-fetoprotein and a normal fetal sonogram: association with placental abnormalities

This report documents the outcome of 25 pregnancies with elevated serum alpha-fetoprotein levels on two separate samplings despite normal anatomic appearance of the fetus on a detailed "consultative" sonographic examination. Six of these also had elevated amniotic fluid alpha-fetoprotein. All fetuses in this series were anatomically normal at time of delivery; one aborted fetus was triploid. Of the 25 pregnancies, 16 had sonographically demonstrable placental hemorrhage, eight retroplacental and eight subchorionic. One had hydropic changes in the placenta associated with triploidy. Of the subgroup of six pregnancies in which both serum and amniotic fluid values were elevated, one had a retroplacental hemorrhage, one had a subchorionic hemorrhage, and one had diffuse hydropic changes in the placenta. A control group of 112 patients with normal alpha-fetoprotein levels yielded four with small (less than 2 cm3) subchorionic hemorrhage. The occurrence rate of placental hemorrhage in women with elevated alpha-fetoprotein and normal fetus was 64%, whereas the control group of patients with normal alpha-fetoprotein had a 3.6% occurrence rate of placental hemorrhage. Sonographically detectable placental abnormalities may be associated with elevated alpha-fetoprotein in serum and/or amniotic fluid samples. Such abnormalities may occur because of fetomaternal admixture associated with placental hemorrhage and/or intraamniotic bleeding resulting from subchorionic hemorrhage.