Separation of the Toxic and Glutathione-Enhancing Effects of the Naturally Occuring Nitrile, Cyanohydroxybutene

Cyanohydroxybutene (CHB) is reported to be hepatotoxic in maleFischer 344 rats at an oral dose of 300 mg/kg and, while nolonger hepatotoxic, pancreatotoxic at 200 mg/kg. In addition,the 200 mg/kg dose causes a persistent elevation in hepaticand pancreatic glutathione (GSH). This study was conducted tode termine if smaller doses of CHB could cause GSH elevationin the absence of toxicity. A single oral dose of 100 mg/kgor multiple lower doses (50 mg/kg daily for 3 days or 30 mg/kgfor 6 days) caused a significant and persistent increase inpancreatic GSH, although hepatic levels were unchanged. Tenmilligrams per kilogram, even daily for 24 days, was withouteffect on hepatic or pancreatic GSH. Neither a single oral doseof 100 mg/kg nor multiple lower doses were associated with toxicity.However, when either 100 or 50 mg/kg were administered intravenously,pancreatic apoptosis was observed. In animals dosed with 100mg/kg iv, mixed histiocytic and suppurative inflammation andfrank pancreatic necrosis also developed and were associatedwith elevated plasma lipase and amylase. The animals receivingCHB intravenously also exhibited elevated GSH levels in bothpancreas and liver. This study shows that oral doses between30 and 100 mg CHB/kg can be used to elevate GSH levels withoutany pancreatotoxicity. However, a single 50 mg CHB/kg dose givenintravenously causes apoptosis, while 100 mg/kg causes severepancreatotoxicity with necrosis.     

Predictors of cerebral palsy in very preterm infants: the EPIPAGE prospective population‐based cohort study

Aim The aim of this study was to assess the independent role of cerebral lesions on ultrasound scan, and several other neonatal and obstetric factors, as potential predictors of cerebral palsy (CP) in a large population‐based cohort of very preterm infants. Method As part of EPIPAGE, a population‐based prospective cohort study, perinatal data and outcome at 5 years of age were recorded for 1812 infants born before 33 weeks of gestation in nine regions of France in 1997. Results The study group comprised 942 males (52%) and 870 females with a mean gestational age of 30 weeks (SD 2wks; range 24–32wks) and a mean birthweight of 1367g (SD 393g; range 450–2645g). CP was diagnosed at 5 years of age in 159 infants (prevalence 9%; 95% confidence interval [CI] 7–10%), 97 males and 62 females, with a mean gestational age of 29 weeks (SD 2wks; range 24–32wks) and a mean birthweight of 1305g (SD 386g; range 500–2480g). Among this group, 67% walked without aid, 14% walked with aid, and 19% were unable to walk. Spastic, ataxic, and dyskinetic CP accounted for 89%, 7%, and 4% of cases respectively. The prevalence of CP was 61% among infants with cystic periventricular leukomalacia, 50% in infants with intraparenchymal haemorrhage, 8% in infants with grade I intraventricular haemorrhage, and 4% in infants without a detectable cerebral lesion. After controlling for cerebral lesions and obstetric and neonatal factors, only male sex (odds ratio [OR] 1.52; 95% CI 1.03–2.25) and preterm premature rupture of membranes or preterm labour (OR 1.72; 95% CI 0.95–3.14) were predictors of the development of CP in very preterm infants. Interpretation Cerebral lesions were the most important predictor of CP in very preterm infants. In addition, infant sex and preterm premature rupture of membranes or preterm labour were also independent predictors of CP.     

An Exploratory Study of Antenatal Preparation for Cesarean Birth

An exploratory study was designed to develop and test an antenatal education program of cesarean birth information. Eighty-one pregnant women and their husbands received the educational program. Eighteen couples experienced cesarean childbirth. Mailed questionnaires containing items dealing with reactions to the educational program and responses to cesarean birth were returned by 15 of these couples. Findings indicated that the educational program met most of the information needs of the study participants. Both mothers and fathers exhibited adaptive and ineffective responses to the cesarean, although the responses were more positive than previous studies have reported.     

Langerhans cells in human warts

Seventy-six warts (15 plantar, 38 hand, 16 miscellaneous and seven anogenital lesions) taken from 55 patients, were studied by indirect immunofluorescence with monoclonal antibodies specific for T-cell subsets, Langerhans cells (LC) and HLA-DR antigen. The results were related to the presence of viral antigen. Approximately 80% of the lesions showed an infiltrate. Only 19 lesions contained helper/inducer or suppressor/cytotoxic T cells. The distribution of LC was abnormal in 65% of biopsies which contained LC in the dermis, and 29% were devoid of LC in the epidermis. Many lesions had reduced numbers of LC in the epidermis. The disappearance of LC from the epidermis was related to the presence of viral antigen, but not to the presence of particular T-cell subsets. Infiltrating cells were sometimes HLA-DR-positive, whereas basal cells did not express HLA-DR antigen, irrespective of the density of the infiltrate.     

Attitudes of Physicians and Nurses Towards the Role of Social Workers in Primary Health Care: What Promotes Collaboration?

Many writers have indicated that the future of social work inprimary health care is dependent on the attitudes of physiciansand nurses. This article reviews the literature in the fieldand describes the results of a study of 95 physicians and 78nurses in Israel which found that physicians have a more positiveattitude towards social work intervention than nurses and exploresthe differences in these attitudes in relation to particularpersonal characteristics. Physicians who were young, had recently received their MD degreeand had been educated in Israel had by far the most positiveattitudes towards social workers. Those aged over 60 years old,who had received their MD degree in Western countries more than25 years ago were more positively inclined towards social workin the clinics than middle-aged physicians educated in EasternEuropean countries. The personal characteristics of the nursesmade little difference to their generally poor attitude towardssocial work in the clinics. Those who received their nursingeducation more recently were more positive than other nurses.     

Adult Acute Rheumatic Fever: A Rare Case Presenting with Left Bundle Branch Block

In contrast to the more common electrocardiographic patterns seen in acute rheumatic fever, such as first-degree heart block, the appearance of left bundle branch block is rare. An adult patient with acute rheumatic fever presented with left bundle branch block on admission, subsequently had sudden cardiac arrest. She was resuscitated successfully and required temporary pacing. An echocardiogram and radionuclide ventriculography were compatible with interventricular septal involvement in the rheumatic carditis. After 20 days of steroid therapy, the left bundle branch block pattern of the electrocardiogram disappeared. A possible mechanism for the development of complete heart block in acute rheumatic fever is discussed. It is suggested that patients with acute rheumatic carditis who have electrocardiographic manifestations of prolonged P-R interval and left bundle branch block should be managed with prophylactic pacing.