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 After three months, all diuretics could be withdrawn, and in the following 11 years she has remained completely recovered.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.     

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.     

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.     

Do women with epilepsy have increased frequency of menstrual disturbances?

PROBLEM: Menstrual disorders, reduced fertility and sexual problems seem to be more frequent in women with epilepsy than in the general population. Most investigations concerning menstrual disturbances in epilepsy patients, however, are small and based on selected materials. We therefore wanted to investigate the frequency of menstrual disturbances in a large, unselected population of epilepsy patients. METHODS: A retrospective, questionnaire study of a cohort of female outpatients, aged 18-45 was conducted. Each patient chose a close female friend who served as control, to optimise matching regarding age and lifestyle. RESULTS: Answers were received from 265 patients and 142 controls. Menstrual disturbances were more frequent in patients with epilepsy (48.0%) than in controls (30.7%) (P=0.004). Menstrual disturbances were more frequent in patients on polytherapy versus monotherapy (P=0.049) and more frequent in patients with high seizure frequency (>5seizures/year) compared to patients with a lower seizure frequency or those seizure free (P=0.006). The frequency of menstrual disturbances was higher in patients on valproate compared to carbamazepine monotherapy (P=0.045). CONCLUSION: This investigation confirms that women with epilepsy have an increased frequency of menstrual disturbances compared to women without epilepsy. In women with high seizure frequency and in those on polytherapy, the frequency of menstrual disturbances are further increased. The highest frequency of menstrual disturbances occurred in women using valproate.     

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.     

A Follow-up Study of 68 Patients with Anti-mitochondrial Antibodies (AMA)

ABSTRACT During the period 1976-83, anti-mitochondrial antibodies (AMA) were detected in 68 patients out of about 48 000 sera (0.14%) analyzed for a repertoire of autoantibodies at the Department of Immunology, University Hospital of Tromsø. Fifty-five of these patients were women, and only 10 had unequivocal primary biliary cirrhosis (PBC). At follow-up in 1984, 48 out of these 68 patients were accessible for complementary testing. The AMA test became negative in 17 of these 48 patients during the observation period. Eleven of these 17 had originally a titer of 50. Seven of the 31 patients with persistent AMA were without detectable liver pathology. One patient had antibodies against smooth muscle, one against cell nucleus, whereas 35 had an increased serum IgM level. In conclusion, most patients with AMA do not have obvious PBC, a low AMA titer is likely to be transient, and there is a strong association between AMA and an increased serum IgM level.     

Early and Late Efficacy of Three Types of Transvenous Atrial Leads

Experience with three transvenous atrial leads, representing different principles, is presented. The types were screw-in (Vitatron Helifix-12), J-lead (Intermedics Lifeline 483-01) and straight-tined (Medtronic 6961). The study comprised insertion of 86 leads (30 Helifix, 40 Lifeline, 16 Medtronic) in 76 patients. Atrial fibrillation occurred during insertion in two patients, and in two others stable electrode positioning in the right atrial appendage was not achieved. Stable position and acceptable intracardiac P-waves were obtained in all the other patients (in 5 after change to another type of lead). Atrial triggered ventricular pacing was used in 34 cases and atrial pacing was used in 38. The P-wave amplitude at insertion was significantly less with Helifix than with Lifeline or Medtronic. The stimulation thresholds (range 0.25-2.5 V) did not differ significantly between the electrodes. Dislodgement of the electrode occurred during the first week in seven cases (5 Lifeline, 2 Helifix), but no late dislodgement occurred. The mean follow-up was 14 months (range 1-31). All three atrial leads offer acceptable function with regard to electro-physiological properties and electrode stability.