Quantitative assessment of salivary gland inflammatory infiltration in primary Sjogren's syndrome: its relationship to different demographic, clinical and serological features of the disorder

The aim of this study was to investigate the possible relationship between the degree of inflammatory infiltration of salivary glands in Sjogren's syndrome (SS) and the different demographic, clinical and serological features of the disease. A quantitative assessment of the extension of the infiltrates was performed on histology samples from the labial salivary glands (LSG) of 82 patients with primary SS, by calculating the ratio of the infiltrated area to the total area of glandular tissue in the samples. The correlations between the amount of inflammatory infiltrate and the main features of the disorder were then analysed. A significant negative correlation between the degree of LSG infiltration and the patient's age at disease onset was observed (P < 0.05). In contrast, the percentage of infiltrate did not correlate with the disease duration. A significant correlation was found between the degree of infiltration of the salivary tissue and (i) the total number of extraglandular features (P < 0.01) and (ii) the presence of specific extraglandular features such as Raynaud's phenomenon (P < 0.05), vasculitis (P < 0.0001), lymph node or spleen enlargement (P < 0.05) and leucopenia (P < 0.02). Finally, patients with antinuclear antibodies, anti-SSA/Ro antibodies, or anti-SSA/Ro plus anti-SSB/La antibodies showed a more widespread inflammatory infiltration in the LSG tissue than patients without these autoantibodies (P < 0.01). The degree of infiltration in the salivary tissue was significantly greater in those patients with anti-SSA/Ro plus anti-SSB/La antibodies in their sera than in patients with anti-SSA/Ro antibodies alone (P < 0.05). In conclusion, patients with SS and active inflammatory infiltration of the salivary glands usually experience an earlier disease onset and a larger number of systemic extraglandular manifestations. In addition, the antibodies directed against certain nuclear/cytoplasmic specificities, and particularly those which react with the SSB/La antigen, seem to play a key role in enhancing the autoimmune process in the salivary glands.      

Bone and soft-tissue lesions: diagnosis with combined H-1 MR imaging and P-31 MR spectroscopy

The feasibility of combined magnetic resonance (MR) imaging and surface coil phosphorus-31 MR spectroscopy at 1.5 T was examined in a clinical study of 34 patients before biopsy of bone or soft-tissue lesions of the extremity and trunk. The results confirmed the inability of MR imaging alone to distinguish most benign lesions from malignant ones. Malignant lesions were distinguished from benign lesions on the basis of significantly higher mean peak ratios of phosphomonoester (PME) to beta-nucleoside triphosphate (NTP) and of phosphodiester to NTP, a significantly lower mean peak area ratio of phosphocreatine to NTP, and a higher mean pH. The diagnostic performance of the PME/NTP peak area ratio is characterized by a sensitivity (true-positive fraction) of 1.00 and a specificity (true-negative fraction) of 0.93. This study provided preliminary evidence that P-31 MR spectroscopy may be used to improve diagnostic specificity in bone and soft-tissue lesions.     

氚标记(+)与(-)棉酚在大鼠主要脏器的亚细胞分布及共价结合

给大鼠腹腔及睾内注射氚标记的(+)与(-)棉酚后第7、18天,对主要脏器中各亚细胞组分的总放射活性及共价结合的放射活性进行了动态观察。结果表明,(-)棉酚在心肌线粒体共价结合放射活性较明显高于(+)棉酚;(+)及(-)棉酚在睾丸细胞膜、微粒体共价结合的放射活性随时间增高,且(-)棉酚较为明显。     

Missed fractures in the emergency department

This study analyses missed fractures in the emergency department of an Australian teaching hospital. The proportion of fractures not identified on initial presentation of 42,795 patients to Princess Alexandra Hospital in Brisbane over 18 months from July 1991 to December 1992 was 0.11% of attendances, 0.47% of patients with injuries and 2.1% of patients with fractures. These rates are considerably lower than those reported in past studies. The implications of this as a measure of quality of care are discussed. It is postulated that this may be related to 24 hour cover in the emergency department by emergency medicine registrars.     

Dose-ranging antiemetic trial of high-dose oral metoclopramide

The present trial with high oral doses of metoclopramide was undertaken to (a) determine a well-tolerated dosage of oral metoclopramide; (b) measure the blood levels achieved with these oral doses; (c) determine the side effects of high doses; and (d) observe for antiemetic efficacy. Thirty-six patients receiving emesis-producing chemotherapy consisting primarily of high intravenous (i.v.) doses of cyclophosphamide plus adriamycin or cisplatin received 48 courses of oral metoclopramide. The metoclopramide dosage was escalated in six steps from 0.5 to 3.0 mg/kg and was given 1/2 h before chemotherapy, then 1 1/2, 3 1/2, 7 1/2, 11 1/2, and 15 1/2 after chemotherapy. Diphenhydramine (50 mg orally) was given with the first, third, and fifth dosages. Toxicity was generally mild, not dose related, and similar to that observed with the i.v. drug with the exception of an increased incidence of acute dystonic reactions. Antiemetic effects were observed at each dose level. In patients receiving oral metoclopramide doses of 2 or 3 mg/kg, all achieved serum levels greater than 1,000 ng/ml. High-dose oral metoclopramide was well tolerated and demonstrated antiemetic effects at the dose levels explored. We recommend 2-3 mg/kg oral metoclopramide doses with 50 mg diphenhydramine for use in future trials.     

Décharges EEG localisées continues pendant le sommeil chez des enfants sans troubles neuropsychiques

After having reported continuous localized EEG discharge during slow sleep (CLEDS) in six children with congenital encephalopathy, we observed a similar EEG picture in six children free from both neuropsychological and neuroradiological defects. They suffered from partial idiopathic epilepsy; five presented a familial disposition towards febrile seizures. Continuous paroxysmal activity during sleep was observed from 4.8 yrs to 4.11 yrs (mean age: 4.9 yrs). Spontaneous remission of CLEDS was observed in three cases after 2-25 months, but one or more relapses occurred in two cases, and five children are still suffering from CLEDS. Seizures were controlled by drugs in all cases. Deterioration of intelligence level, although not severe, was observed in one case, after 24 months of CLEDS.     

Cost-effectiveness of a school-based Tay-Sachs and cystic fibrosis genetic carrier screening program.

PURPOSE: To explore the cost-effectiveness of school-based multi-disease genetic carrier screening. METHOD: Decision analysis of the cost-effectiveness of a school-based Tay-Sachs disease and cystic fibrosis genetic carrier screening program, relative to no screening. Data relating to ethnicity profile, test-accepting behavior, and screening program cost were sourced from an existing program in Sydney, Australia. RESULTS: Compared to no screening, the incremental cost-effectiveness of the screening program is A dollar 5,834 per additional carrier detected. This cost-effectiveness ratio is most sensitive to changes in genetic test accuracy, and the cost of laboratory assays. The results imply a cost per affected birth avoided of approximately A dollar 530,000 (approximately US dollar 371,000). CONCLUSIONS: This preconceptional genetic carrier screening program offers comparable cost-effectiveness to prenatal screening programs for cystic fibrosis.