Uterine arteriovenous malformation successfully embolized with a liquid polymer, isobutyl 2-cyanoacrylate

A uterine arteriovenous malformation was diagnosed angiographically in a 27-year-old woman presenting with recurrent menometrorrhagia. Bilateral hypogastric artery embolization with a liquid polymer, isobutyl 2-cyanoacrylate (Bucrylate), resulted in subsequent normal menses. Bucrylate offers a number of advantages over other agents previously used to embolize uterine arteriovenous malformations.     

Heroin detoxification with acupuncture and electrical stimulation

Acupuncture with electrical stimulation is a feasible nonchemical method for detoxification of heroin addicts, with particular limitations as regards to heavy users. Short-term follow-up seems to indicate reversion to heroin is comparable to other detoxification methods. It could be of great interest to study the effect of easily available postdetoxification maintenance acupuncture as an alternative to heroin. Withdrawal symptoms are relieved in a hierarchial manner with apparent parasympathetically mediated symptoms subsiding first, and frequently with incomplete resolution of bone and joint pain.     

Discharge of the Asthmatic patient

Summary Asthma continues to be a challenging disease to treat in both the inpatient and outpatient settings. The growing database on therapeutic interventions at the time of transition from the acute to chronic phase of this disease is encouraging. Glucocorticoids and inhaled \-agonists clearly reduce readmission and relapse. Other medications and educational interventions also appear effective. Still, no true discharge guidelines have been established. Multiple statements by consensus panels have recommended using FEV₁ or PEFR as indicators of readiness for discharge, but this has not been prospectively validated from either the emergency department or inpatient setting. In contrast, some studies argue that pulmonary functions do not accurately predict relapse and readmission, so the usefulness of these discharge recommendations is debatable. Large studies, especially in the adult asthmatic population, are needed to validate these recommendation.     

Spectrum of molecular defects and mutation detection rate in patients with mild and moderate hemophilia A

The amount of residual F8 (FVIII:C) determines the clinical severity of hemophilia A. Recently, we showed that the mutation detection rate in severely affected male patients (FVIII:C<1% of normal) is virtually 100% when testing for the common intron 22-/intron 1- inversions and big deletions, followed by genomic sequencing of the F8 gene. Here we report on the spectrum of mutations and their distribution throughout the F8 gene sequence in 135 patients with moderate (n=23) or mild (n=112) hemophilia A. In contrast to the severe form of the disorder, analysis on the genomic level failed to detect the molecular defect in approximately 4% of the moderately and in approximately 12% of the mildly affected patients. A total of 36 of the mutations identified in this study are novel. The vast majority of the detected changes were missense. The newly detected amino acid substitutions were scored for potential distant or local conformational changes and influence on molecular stability for every single F8 domain with available structures, using homology modeling. Two molecular changes in the promoter region of the factor VIII gene (c.-112G>A and -219C>T), affecting the core segment (minimal promoter) were detected in two patients with mild hemophilia A. To our knowledge this is the first report on promoter mutations in the F8 gene.     

Neurologic disease associated with 17D-204 yellow fever vaccination: a report of 15 cases

Yellow fever (YF), can be prevented by an attenuated vaccine (YEL). We reviewed neurologic adverse events (AE) following YEL that were reported to the national Vaccine Adverse Events Reporting System (VAERS). VAERS is a passive reporting system with inherent limitations for causality assessment. Based on defined criteria, five cases of encephalitis were classified as 'definitely' and one of acute disseminated encephalomyelitis (ADEM) as 'probably' caused by YEL. Six cases of Guillain-Barre Syndrome (GBS), one of encephalitis, and two of ADEM, were classified as 'suspect' vaccine-associated disease. Laboratory and epidemiological evidence suggests that YEL caused encephalitis. Additional studies will be required to confirm whether YEL can rarely result in GBS and/or ADEM.