Endometrial adenosarcoma with adjuvant tamoxifen therapy for primary breast carcinoma

The first documented case of endometrial adenosarcoma associated with chronic tamoxifen usage is reported.     

Egg-adapted replication-restricted virus protects mice against lethal influenza

Infection of mice with the egg-adapted (EA) strain of influenza virus was studied as a murine model of human live attenuated virus vaccine. The growth and spread of the EA virus in the mouse lungs were restricted, and only small inflammatory changes were detected in the respiratory tracts. Deletion and substitutions of amino acids were found in the hemagglutinin molecule of the EA virus, which were attributable to the reduced envelope fusion activity in virus multiplication cycles. Intranasal inoculation of mice with the EA virus induced specific IgG and IgA antibody production together with a specific cytotoxic T lymphocyte response. Immunized mice showed a distinct resistance to subsequent lethal challenge with the virulent influenza virus. These results indicate that the mutant virus loaded with a growth restriction in the respiratory tract is an appropriate candidate for a live attenuated vaccine.     

Agnathia (severe microghathia), aglossia and choanal atresia in an infant

A neonate is reported here, who was born with severe mandibular hypoplasia, complete absence of the tongue, unilateral choanal atresia, contralateral choanal stenosis and developed severe airway obstruction at birth. Arrested development of the ventral first branchial arch most likely underlies the clinical deficits. Most reported cases of agnathia have been lethal but the infant reported here has survived into infancy with a tracheostomy and feeding gastrostomy. Her clinical features, assessment and management are discussed.     

Genital herpes simplex virus infections: laboratory confirmation in diverse patient groups

The laboratory diagnosis of genital herpes simplex virus (HSV) infections in various patient groups with diverse clinical manifestations including asymptomatic pregnant women with history of genital herpes and in a high prevalence group consisting of male patients with recurring genital ulcerations is described. HSV was detected by conventional cell culture and also by a CPE-enhancement technique using human embryonic lung fibroblasts (MRC-5) and Vero cells with subsequent typing of isolate by HSV type-specific monoclonal antibodies. A definite improvement in HSV diagnosis was noted by the use of the CPE-enhancement technique with the reduction of turn-around time to 24 h at which 61.1% and 50% isolation rates were detected in MRC-5 cells in comparison to 38.9% and 16.6% by conventional cell culture in the high prevalence patient population and asymptomatic pregnant women, respectively. Delayed development of CPE and reduced isolation rates were detected using Vero cells. Follow-up sampling of subsequent episodes of genital ulcerations in those with history of recurrence but an initial negative cell culture result, increased the isolation rate substantially and enabled the confirmation of diagnosis of genital HSV infection.     

Rubella and cytomegalovirus (CMV) infections: laboratory aspects of investigation of antenatal, congenital, persistent, and subclinical infections

Rubella specific IgM tests carried out on pregnant women with history of rubella contact or rubella-like rash indicated the presence of rubella-IgM by the second week after contact, persistence to 3-4 weeks followed by a decline and non-detectability around 8-9 weeks and at delivery. Laboratory investigation of cases of rubella infection in infants and children, including clinically proven and suspected congenital rubella revealed distinct patterns of combinations of positivity and negativity of IgM and IgG antibodies. Three cases of persistence of rubella specific IgM antibodies with one even up to 3 years in congenital rubella and a case of CMV-IgM persistence in congenital CMV are described. Rubella-IgM and CMV-IgM were detected in the serum of two patients aged 12 years and 24 years with CMV mononucleosis. Utilization of rubella-IgM/CMV-IgM tests enabled the identification of four cases of subclinical rubella and one of subclinical CMV in a pediatric population.     

Use of routine computed tomography brain scanning of psychiatry patients*

The aim of this study was to evaluate the usefulness of CT of the brain in patients presenting with a psychiatric condition without focal neurological signs. The reports of 397 consecutive CT brain scans of patients presenting to two acute tertiary hospital psychiatric services over a 2‐year period were assessed retrospectively. Of the 397 patients, 241 had psychosis, 87 had depression, 44 had bipolar affective disorder, seven had alcohol dependence, five had dementia, and the remaining 13 had a variety of diagnoses including personality disorder and transient ischaemic attack. Findings on 377 (95%) of the CT scans showed no abnormality. Specific abnormalities were described in 20 (5%) of the CT scans. Three scans showed non‐specific minor abnormalities, which, when followed up by MRI, showed no relevant abnormality. All the abnormalities shown on CT were considered to be clinically unrelated to the patient's psychiatric condition. In conclusion, the pretest probability of finding a space‐occupying lesion or other pertinent abnormality in patients presenting with psychiatric illnesses in this retrospective study appears not to be greater than that of the general population. The outcome of this study could be implemented to develop a clinical pathway for limiting assessment by CT for possible organic pathology in acute psychiatric illness.     

Arterial blood pressure and heart rate discrepancies between handwritten and computerized anesthesia records

Previous publications suggest that handwritten anesthesia records are less accurate when compared with computer-generated records, but these studies were limited by small sample size, unblinded study design, and unpaired statistical comparisons. Eighty-one pairs of handwritten and computer-generated neurosurgical anesthesia records were retrospectively compared by using a matched sample design. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and heart rate (HR) data for each 5-min interval were transcribed from handwritten records. In computerized records, the median of up to 20 values was calculated for SAP, DAP, and HR for each consecutive 5-min epoch. The peak, trough, standard deviation, median, and absolute value of the fractional rate of change between adjacent 5-min epochs were calculated for each case. Pairwise comparisons were performed by using Wilcoxon tests. For SAP, DAP, and HR, the handwritten record peak, standard deviation, and fractional rate of change were less than, and the trough and median were larger than, those in corresponding computer records (all with P: < 0.05, except DAP median and HR peak). Considering together all the recorded measurements from all cases, extreme values were recorded more frequently in computerized records than in the handwritten records. IMPLICATIONS: The discrepancies between handwritten and computerized anesthesia records suggest that some of the data in handwritten records are inaccurate. The potential for inaccuracy should be considered when handwritten records are used as source material for research, quality assurance, and medicolegal purposes.     

Effect of rolipram, a phosphodiesterase IV inhibitor, on allergic footpad swelling using various adjuvants in mice

We studied the effect of rolipram, a phosphodiesterase (PDE) IV inhibitor, on allergic footpad swelling in mice. For this study, varying adjuvants including complete Freund's adjuvant (CFA), incomplete Freund's adjuvant (IFA) and Imject Alum (Alum) were used because the extent of antigen-specifically induced T helper type 1 (Th1) and Th2 responses had been shown to depend on adjuvants used. To induce allergic footpad swelling, we immunized mice with ovalbumin (OVA) emulsified in either CFA or IFA, dissolved in Alum or in phosphate-buffered saline (PBS) as a control (day 0), followed by subcutaneous injection of the antigen into footpads on day 21. Rolipram was given orally to the animals daily from days 0-20. Results showed that treatment with rolipram was followed by an increase in early swelling at 0.5 h and a decrease in late swelling at 6 and 24 h in the CFA group. In the IFA group, rolipram significantly enhanced swelling at, but not after, 30 min. In the Alum and the PBS groups, the PDE inhibitor failed to affect the OVA-specific footpad reaction at all times examined. Treatment of the CFA and IFA groups with rolipram significantly inhibited the production of the Th1 antibody anti-OVA immunoglobulin G2a (IgG2a), and the drug enhanced Th2 cell-dependent anti-OVA IgE production. In both groups, rolipram also enhanced the secretion of Th2 cytokines including interleukin-4 (IL-4) and IL-10. These findings suggest that rolipram may facilitate early allergic footpad swelling mediated by Th2 immune responses, while the late phase of swelling associated with Th1 responses may be attenuated by the PDE IV inhibitor.