Angiography and magnetic resonance imaging of aortic dissection

This review article describes and illustrates the role of angiography and magnetic resonance imaging in the evaluation of aortic dissection. Clinical findings, complications, classification, and treatment of dissection are reviewed as well.     

The epidemiology of severe injuries to children in northern Manhattan: methods and incidence rates

The epidemiology of injury incidence in inner-city children has not previously been described. This study presents the methods used and the incidence rates found for severe injury (causing hospitalisation or death) in a population of 89,000 children under age 17 years in northern Manhattan, a largely poor area of New York City. The average annual incidence rate (measured from 1983 to 1987) for severe injuries to children under 17 was 846/100,000 a year. The vast majority (79%) were classified as unintentional. Nine per cent were due to assault, 3% were self-inflicted and in an additional 9% the intention was unclear. Classified by cause, the highest incidence (per 100,000/year) was found for falls (218), vehicle-related (141, primarily pedestrian), ingestion (119) and burns (110). Guns caused 3% of the injuries (27). The death rate from injury was 18.7/100,000, 36% of which was due to homicide. In an additional 28%, intentional injury was suspected. The suicide rate was 0.4/100,000. The leading causes of injury death included guns and burns (both 2.7/100,000). Compared with childhood injury rates in predominantly rural and suburban populations, the rates reported here for northern Manhattan are higher for overall injury incidence (fatal and non-fatal) and for homicide, but lower for injury mortality not due to homicide.     

Complex Genetic Disease: Can Genetic Strategies in Alzheimer's Disease and New Genetic Mechanisms Be Applied to Epilepsy?

Summary: Strategies used in molecular genetics have changed modern neurology. The gene or genes responsible for several major neurologic diseases have now been identified using "reverse" or positional genetics. Unexpected new genetic mechanisms have been discovered in human neurologic diseases, including (a) identical mutations of the prion protein gene in Creutzfeldt-Jakob disease and fatal familial insomnia with the phenotypic expression directed by an accompanying polymorphism; (b) stable duplications of chromosome 17 in Charcot-Marie-Tooth disease (type 1 A) that involve many genes, only one of which appears to cause neuropathy; and (c) highly variable, dynamic mutations in myotonic dystrophy, fragile X syndrome, and Kennedy's syndrome that modulate variable expressivity in multiple tissues. There is growing recognition that neurologic diseases are often complex genetic diseases with multifactorial rather than simple modes of inheritance. For example, genetic association/linkage strategies have interacted with biochemistry and immunopathology studies to produce new insights into the disease mechanism of late-onset Alzheimer's disease. The role of apolipoprotein E in late-onset Alzheimer's disease is an example of how new analytical techniques of genetic disease can be applied to dissect multiple genes. Similar research strategies are suggested for the study of epilepsy as a complex disease.     

Alcohol and Platelet Function

Epidemiological studies have shown that moderate consumption of alcoholic beverages is inversely related to the incidence of the complications of coronary artery disease. The protective effect of ethanol may be partially attributable to an inhibitory effect of ethanol on platelets. This article summarizes the experimental observations that ethanol inhibits platelet responses to specific physiological agonists. In alcoholics, various platelet defects have been observed, but these may be influenced by metabolic factors rather than the presence of ethanol alone. The acute effects of ethanol on platelet functions both in vivo and ex vivo will be reviewed. Evidence will be presented demonstrating that ethanol added acutely in vitro inhibits phospholipase A₂ in stimulated platelets. The interaction of ethanol with other signal transduction pathways will also be discussed.     

Image-guided aspiration of solitary occult breast 'cysts'.

During the 30-month period from March 1, 1988, through August 31, 1990, image-guided aspirations of 183 solitary occult breast masses, which were considered possible cysts, were performed. Indications for aspiration included (1) mass on mammography, either invisible on ultrasonography or with features atypical of a cyst, in 111 patients; (2) enlarging solitary mass on mammography with ultrasonic features suggesting a cyst in 45 patients; and (3) mammographic mass with features typical of a cyst in 27 patients, with confirmation requested by the referring physician. Of the group, 151 (83%) lesions were fluid-filled and 32 (17%) were solid. All aspirates had normal cytologic features. Of the 32 aspirates found to be solid, 19 were subsequently removed after wire localization and 13 were unchanged on mammography for a minimum of 6 months after aspiration. This is a simple and safe procedure, confirming the innocuous nature of an occult solitary breast cyst, and obviates the need for surgical biopsy.