SPORTING ‘GROIN STRAINS’: NOT ALWAYS MUSCULAR!

A gluteal artery pseudoaneurysm presenting as a ‘groin strain’ following minor trauma is reported. Diagnosis was made by CT scan and arteriorgraphy. Treatment was with superselective catheterization and microcoil embolization.     

Urine albumin creatinine ratio and clinical correlates in a diabetic population

The urine albumin/creatinine ratio was measured in random urine samples in a range of diabetic subjects as a guide to urinary albumin excretion rate in diabetic patients. In 74 control subjects the 95th percentile for the albumin/creatinine ratio was 1.3. In 39 diabetic patients the random urine albumin/creatinine ratio correlated highly with the 24 hour urine albumin excretion (r = 0.9371, p less than 0.001). In 337 insulin treated diabetic subjects 55% of the female and 39% of the male values exceeded 1.3. In 98 noninsulin treated diabetic subjects 67% of female and 62% of male values exceeded 1.3. Selecting albumin/creatinine ratios between 2.5 to 26.8 corresponding to albumin excretion rates between 20 mg and 250 mg/day, 26.1% of the insulin treated group were in this microalbuminuric range, and 8.7% had overt albuminuria. Higher figures were seen in the noninsulin treated group. Within these two large diabetic groups significant associations (p less than 0.005) were seen with glycaemia, blood pressure, body mass index, retinopathy and duration of diabetes. We believe that measurement of albumin/creatinine ratios on random urine samples offers a simple and convenient way of monitoring albumin excretion in large numbers of diabetic patients.     

Effect of chorionic villus sampling on utilization of prenatal diagnosis in women of advanced maternal age

The effect of the introduction of chorionic villus sampling on the utilization rate of prenatal diagnosis in advanced maternal age was studied during the period 1 January 1985-1 January 1991. On the first of January 1985, the age limit for prenatal diagnosis in The Netherlands was lowered from 38 to 36 years of age. The overall uptake rate during the studied period increased significantly, but only because of the increased uptake rate in the group 36 and 37 years. In the maternal age group of 42 years and older, an uptake rate as low as 15.9% was established. This was mainly determined by the relatively high percentage (73.0%) of women from ethnic minorities in this age group. The number of CVS procedures increased significantly during the study period, but the utilization rate was not influenced, since the number of amniocenteses decreased accordingly. An increase in acceptability of prenatal diagnosis by women of advanced maternal age due to early testing and early termination of pregnancy could not be substantiated in the present study.     

Incomplete antigenic cross-reactivity between platelets and megakaryocytes: relevance to ITP

Immune thrombocytopenias are usually associated with normal or increased numbers of megakaryocytes in the marrow. Therefore, the mechanism(s) responsible for the destruction of circulating platelets may not affect megakaryocytes in the same way. One of the possibilities which could account for the differential effect on the cells would be the development of antibodies to components of platelet membranes which are not exposed on the surface of all megakaryocytes. To investigate this possibility, a rabbit antiserum specific for mouse platelets was tested against fresh and cultured mouse megakaryocytes by indirect immunofluorescence. This antiserum cross-reacted with 46% of fresh murine megakaryocytes and 54% of cultured megakaryocytes. Phase- contrast microscopy revealed the reacting megakaryocytes to be fully granulated with irregular contours and in the process of releasing platelets. Nonreactive megakaryocytes demonstrated smooth contours and lacked morphological evidence of thrombocytopoiesis. Electron microscopy showed that only in megakaryocytes (MK) with an irregular contour had the demarcation membrane system (DMS) reached continuity with the plasma membrane. Ultrastructural analysis of megakaryocytes from patients with ITP showed approximately 25% to 50% of megakaryocytes without evidence of injury, whereas 50% to 75% had extensive damage. In undamaged cells, platelet territories had not yet reached the peripheral zone. The DMS of damaged megakaryocytes opened to the exterior elaborating platelets. The observations suggested that some platelet antibodies react only with megakaryocytes which have reached the stage of thrombocytopoiesis. Relevant target antigens may not be exposed on all megakaryocytes before cytoplasmic fragmentation occurs.     

Improved vessel dilator for percutaneous catheterization

Three commercial vessel dilators and a dilator of an improved design were tested during percutaneous catheterization in 16 mongrel dogs to evaluate arterial damage produced with their use. The results indicate that, although all dilators often produce arterial damage, the improved design produced much less damage. In addition, lesions were less severe overall. The dilator has been safely and successfully used in patients for percutaneous vessel catheterization for the past 30 years at the authors' institution.     

ISOLA器械治疗小儿脊柱侧凸

目的定期随访评价ISOLA器械治疗小儿脊柱侧凸.方法41例小儿脊柱侧凸患儿,特发性脊柱侧凸32例,神经肌肉性脊柱侧凸5例,其他类型的脊柱侧凸4例,术前、术中、术后均摄X线片,记录Cobb角,顶椎的移位及旋转,躯干偏离中线程度.结果Cobb角术前平均为66°,术后1年为36°,术后2年为36°.1年后,所有患儿的脊柱均完全融合.顶椎的偏离改善了14mm.躯干偏离改善了5mm.特发性脊柱侧凸患儿1年后有基本的正常活动.术后4例出现并发症,1例深部感染,1例骶尾部褥疮,1例横钩脱落,1例L3椎弓根螺丝钉脱落.结论目前有多种后路器械治疗小儿脊柱侧凸.严格掌握手术指征及ISOLA的原理,该术式能获得较为满意的疗效.     

Increased height in diabetes mellitus corresponds to the predicted and the adult height

This study was conducted to analyse the effect of childhood-onset diabetes mellitus on adult height. The height at time of diagnosis of 35 children with insulin-dependent diabetes mellitus (IDDM) was compared with growth reference data. Predictions of the adult height were made at the time of diagnosis using the target height and the Tanner-Whitehouse II method. The adult height was compared with both the predicted values and the height of healthy adults. The height at time of diagnosis of the prepubertal children was increased compared with growth reference data, in contrast to pubertal children who had normal heights. Only the prepubertal boys were taller at time of diagnosis. The adult height of the prepubertal patients was taller than growth reference data. The mean adult height in all patients did not differ significantly from the predicted heights. In conclusion, the increased height at the start of IDDM in prepubertal children persists until adulthood.     

Effects of short-term hypoxia on platelet counts of mice

Recent studies have shown that long-term hypoxia causes decreased platelet counts in mice and short-term hypoxia increased platelet counts. In an attempt to explain the mechanism that increases platelet counts of mice after exposure to short-term hypoxia, we measured platelet counts, total circulating platelet counts (TCPC), total circulating platelet masses (TCPM), percentages of 35S incorporation, and platelet sizes. Platelet counts, as well as TCPC and TCPM of mice, increased after 1-3 days of hypoxia, but these values were decreased after 6-7 days of hypoxia. Although platelet counts were increased in hypoxic mice, the percentage 35S incorporation into platelets and platelet sizes did not show a concurrent increase. After 6 days of hypoxia, average platelet diameters began to increase as platelet counts decreased. Splenic release did not account for the increase in platelet counts of mice after short-term hypoxia. It seems possible, therefore, that megakaryocytes "shed" platelets into the circulation in response to hypoxia. The platelets that enter the circulation in response to short-term hypoxia are smaller and incorporate less 35S than platelets that are produced in response to acute thrombocytopenia.