Threatened abortion: sonographic distinction of normal and abnormal gestation sacs

In an attempt to determine whether sonographic evaluation alone can distinguish normal from abnormal gestation sacs, a retrospective analysis was performed of ultrasound (US) scans from 168 women with threatened abortion. Gestation sacs were judged to be abnormal on the basis of specific sonographic criteria including large size (greater than or equal to 25 mm mean sac diameter) without an embryo; distorted shape; thin (less than or equal to 2 mm), weakly echogenic, or irregular choriodecidual reaction; absence of a double decidual sac; and low position. Two criteria - large sac and distorted shape - had 100% specificity and were called major criteria. The remaining criteria were individually less specific, although 100% specificity was achieved when three or more of these minor criteria were demonstrated. When one major or three minor criteria were present, 53% of abnormal gestations were correctly identified without any false-positive diagnoses. The authors conclude that experienced sonographers can reliably identify many abnormal gestation sacs on a single examination.     

Prognostic significance of CEA immunoreactivity patterns in large bowel carcinoma tissue

In order to determine the clinical value of CEA detection in large bowel cancer tissue the patterns rather than the intensity of immunoreactivity of CEA reactive antibodies were analyzed in 312 large bowel cancer patients especially in relation to patient survival. CEA immunoreactivity appeared to be distinguishable into a predominantly apical/cytoplasmic and a predominantly membranous pattern. Twenty-four (7.7%) tumours were found to be CEA negative or only focally positive. Two hundred and eighty-three (90.7%) of the carcinomas showed a predominantly apical/cytoplasmic immunoreactivity pattern, whereas 5 (1.6%) of the tumours revealed mostly membranous CEA immunoreactivity. CEA negative or focally positive carcinomas and CEA positive tumours with membranous immunoreactivity were significantly more often observed in the group of poorly differentiated carcinomas (P greater than 0.001), but showed no significant correlation with stage of tumour extension (P = 0.11). Also, these carcinomas demonstrated a more aggressive course in patients compared to CEA positive tumours with an apical/cytoplasmic CEA expression pattern. We, therefore, conclude that determination of the pattern of CEA immunoreactivity in large bowel cancer tissue may enable the detection of subgroups of patients with a poor prognosis.     

Alzheimer's disease and cellular aging: membrane-related events as clues to primary mechanisms.

A fast-increasing number of data indicate that Alzheimer's disease is a systemic disease, not restricted to the central nervous system. The nature of Alzheimer-related changes in peripheral cells confirms and emphasizes indications from biochemical and morphological studies in brain for the involvement of cellular membranes in this disease. Analysis of membrane changes in erythrocytes from Alzheimer patients suggests that the normal aging process of these cells is disturbed. These conclusions may form the basis for further studies leading to a better insight into the etiology of Alzheimer's disease and to the development of diagnostic tools.     

Integrated oncology course for first-year medical students

In this report an oncology course for first-year medical students is described. The course is characterized by a high level of integration of the involved basic and clinical sciences and is designed according to the principles of problem-based learning. A limited number of lectures provides a frame of reference. A series of case histories introduces the students to various aspects of neoplastic disease and after group discussions leads the students to individual learning activities. During the course only general principles are touched upon. Students, as well as teaching staff, appear to be highly appreciative of the integrated approach.     

An autologous fibrinogen-based adhesive for use in otologic surgery

Successful middle ear surgery requires the availability of a safe, effective bonding material. Side effects caused by synthetic materials have led to the use of biologic adhesives; however, they carry the risk of transmission of infectious disease if they are prepared from pooled human blood. A procedure for the production of an autologous fibrinogen-based adhesive using polyethylene glycol to precipitate the fibrinogen-factor XIII component from plasma is described. This procedure requires 40 ml of whole blood and approximately 3 hours' preparation time, and it can be performed in any blood bank with the facilities for sterile techniques. This adhesive has been used successfully for otologic surgery in 12 patients, and further study of the use of this biologic adhesive for other microsurgical techniques should be undertaken.     

Amplification of the nephrotoxic effect of cyclosporine by preexistent chronic histological lesions in the kidney

In contrast to its importance in improving renal graft survival, nephrotoxicity is the most serious side effect of cyclosporine. Dosage reductions of CsA mitigate its nephrotoxic effect. However, CsA nephrotoxicity is still a problem in clinical transplantation. In this study the relationships among preexistent chronic histological lesions, donor age, and renal function after transplantation in 100 CsA treated renal allograft patients are described. Multivariate data analysis revealed a significant statistical effect of the presence of preexistent chronic histological lesions on nonimmediate function (-.42, less than 0.0001) that was relatively twice as large as the effects of cold ischemia time (-.21, less than 0.05). Also in predicting creatinine clearance at 1 and 3 months, preexisting chronic histological lesions had the most important effect (-.39, less than 0.0001; -.57, less than 0.0001, respectively), whereas the presence or absence of rejection episodes was less predictive (.24, less than 0.001; .20, less than 0.01, respectively). Preexistent chronic histological lesions had also significant effects in predicting conversion to azathioprine and prednisolone, because of CsA nephrotoxicity (-.42; less than 0.0001). The degree of CsA nephrotoxicity therefore varies according to the presence of preexistent chronic histological lesions. Because of the increase of these lesions with age, one has to be aware of an exaggerated CsA toxicity, especially in the older donor age group and in older patients treated with CsA for various reasons.