Clinical outcome of hypogammaglobulinaemic patients following outbreak of acute hepatitis C: 2 year follow up

In 1994, an outbreak of hepatitis C virus (HCV) infection, genotype 1a, occurred in 30 hypogammaglobulinaemic patients in the UK from one batch of contaminated anti-HCV screened intravenous immunoglobulin. This study aimed to study prospectively the outcome of HCV in hypogammaglobulinaemic patients, and to assess the response to early treatment with interferon-alpha, 6 million units three times weekly for 6 months. Data were collected using standardized questionnaires. Five patients with secondary hypogammaglobulinaemia due to lymphoid malignancy were not treated and all have died of their primary malignancy. Of 25 patients with primary hypogammaglobulinaemia, one resolved HCV infection before treatment, 17 commenced on treatment, and seven declined or treatment was contra-indicated. Thirteen of 17 patients completed therapy and seven (54%) have a sustained response (normal transaminases, negative serum HCV RNA) at 6 and 12 months after treatment. Two of the 12 patients with primary hypogammaglobulinaemia, who were not treated or failed to complete treatment, have cleared the virus. Liver biopsy was performed in patients not clearing HCV and was abnormal in all. Four patients developed liver failure within 2 years, of whom three have died and one has been successfully transplanted. In conclusion, HCV can cause rapid severe liver disease in hypogammaglobulinaemic patients. Early treatment with high-dose interferon-alpha results in a high clearance of HCV.     

INFERTILITY MAY SOMETIMES BE ASSOCIATED WITH NSAID CONSUMPTION

Non-steroidal anti-inflammatory drugs are widely used in thetreatment of inflammatory joint diseases. Many patients sufferingfrom these disorders are young women during their childbearingyears. We report three cases of infertility where the causemay have been NSAID-induced ‘luteinized unruptured follicle’syndrome. This phenomenon is well recognized in obstetric circles,and we would like to bring it to the attention of rheumatologistssince it is not documented in the rheumatological literature. KEY WORDS: NSAID, Infertility, Luteinized unruptured follicle syndrome     

24 hours of sleep deprivation in the rat increases sleepiness and decreases vigilance: introduction of the rat‐psychomotor vigilance task

A novel animal‐analog of the human psychomotor vigilance task (PVT) was validated by subjecting rats to 24 h of sleep deprivation (SD) and examining the effect on performance in the rat‐PVT (rPVT), and a rat multiple sleep latency test (rMSLT). During a three‐phase (separate cohorts) crossover design, vigilance performance in the rPVT was compared with 24 h SD‐induced changes in sleepiness assessed by polysomnographic evaluation and the rMSLT. Twenty‐four hours of SD was produced by brief rotation of activity wheels at regular intervals in which the animals resided throughout the experiment. In the rPVT experiment, exercise controls (EC) experienced the same overall amount of locomotor activity as during SD, but allowed long periods of undisturbed sleep. After 24 h SD response latencies slowed, and lapses increased significantly during rPVT performance when compared with baseline and EC conditions. During the first 3 h of the recovery period following 24 h SD, polysomnographic measures indicated sleepiness. Latency to fall asleep after 24 h SD was assessed six times during the first 3 h after SD. Rats fell asleep significantly faster immediately after SD, than after non‐SD baseline sessions. In conclusion, 24 h of SD in rats increased sleepiness, as indicated by polysomnography and the rMSLT, and impaired vigilance as measured by the rPVT. The rPVT closely resembles the human PVT test widely used in human sleep research and will assist investigation of the neurobiologic mechanisms that produce vigilance impairments after sleep disruption.     

ON THE EARLY SIGNS OF TOXEMIA OF PREGNANCY IN CHINESE PATIENTS

When one speaks of a patient suffering from toxemia in pregnancy, one always has in mind a pregnant woman who bears the text book eannarks of the disease. That is to say, the patient is complaining of headache, visual disturbances, lassitude, and edcma; objectively she has a decrease in urinary output, high blood pressure, albuminuria. together with a retention of nitrogenous products in her blood. The purpose of this paper is not to deal with toxcmia of pregnancy in such an advanced stage, but to discuss the significance of two early signg of the ciiscase; rlamely, the elevation of blood pressure, and the pathological changes in the fundus of the eyes. In February of this year Browne of London called attention to the fact that raised blood pressure is an early sign of toxemia of pregnancy, and cited cases to show that this change is followed by albuminuria in from eleven to eighty-nine days.     

MISSED ABORTION

Missed aoortion is a very interesting disease from the etiological. diagnostic, and medico-legal points of view. :It has been considered to be a rare cWldition; however, while it may not be very common, certainly it is not rare. This subject has not been given the attention it deserves, and has ''ocen neglected by the obstetricians and gynecoIo- gists of the past and present. This fact was pointcd out by Litzenberg in igu, who found only 139 articles available in the liferature, of which io were credited to American writers. Since therl, there have been not more than a few articles added; and vcry few of these are written in the English language. Chinese :medical literature practically has no men- tion of the disease. For this reasori, the writer desires to record the cases of missed abortion treated in this clinic, in the hope of calling our medical colleagues'' attention to the fact that it is worth while recording their cases. The writer also Wisheg to jmpress upon readers the advantages of using the X-ray and Zondek-Aschheim tests, in establish- ing the diagnosis of this condition.     

多孔钽假体治疗早期股骨头坏死的生物力学和临床评价

简介 股骨头坏死是因股骨头血运破坏所导致的一种影响功能的疾病。其主要在年轻人中发病。病因包括酗酒、激素药物应用史、创伤、血液系统病、放射治疗以及气压1-30在美国，估计每年有10,000到30,000例发生。其中5％到10％须用人工关节置换术治疗。对股骨头和软骨下板塌陷前的早期坏死进行手术治疗似更有效。早期阶段，病理改变通常局限于股骨头上方负重部位的楔形坏死区。随着疾病的进展。坏死区将塌陷并在存活骨和坏死骨接合处发生骨折。