Calcium intake in children with positive IgG RAST to cow's milk

Objective: This study was made to: (i) identify the prevalence of low calcium intakes in a paediatric population with loosely defined 'milk allergy'; and (ii) assess long-term (mean 21 months later) changes in calcium intake following a single nutrition counselling session with those patients initially found to have a low intake.
Methodology: Calcium intake was assessed in a cross-sectional study of 58 patients ages 5–16 years (mean 9.9 years) with IgG radioallergosorbent test (RAST) class II or higher for cow's milk protein. Those 31 patients found to have a low calcium intake were prospectively re-evaluated 12–30 months later following a single nutrition counselling session.
Results: Calcium intake was < recommended dietary allowance (RDA) for 31 of 58 (53%) patients. The patient's perception of their intake was unreliable; 44% of those who rated their calcium intake fair or good did not meet their RDA. Taking a calcium supplement did not ensure adequate intake; 21% of those taking supplements still did not meet their RDA. Milk intake predicted calcium intake; 8% of those who did not drink milk vs 68% of those who did drink at least some milk met their RDA without supplementation. The 31 patients with low intakes received counselling and were re-evaluated at an average follow-up of nearly 2 years. Calcium intake was increased a mean of 360 mg/day and use of supplements increased from 10 to 52% of the group. Despite these positive changes, 48% still did not meet their RDA.
Conclusion: Limited milk intake is likely to be associated with suboptimal calcium intake. Efforts should be made to educate the family about the importance of calcium and its non-dairy sources. With many families repeated discussions of this issue may be necessary to influence calcium intake.     

Early postoperative mortality following hysterectomy. A Danish population based study, 1977–1981

Summary. The main objective of this cohort study was to analyse the early postoperative mortality after 'simple' hysterectomy for benign indications and to compare it with that of a randomly selected reference group of women matched for age. Registry data covering the entire Danish female population were used. Included in the study were all patients operated in the period 1977–1981. Patients were only included if no cancer was diagnosed and if no major co-surgery was performed (29 192 patients). Cancer patients were also excluded in the reference group (16182 women). Mortality was studied according to characteristics of patients, their residential area, the surgical approach and operating hospital. Overall 47 patients died within 30 days of admission for hysterectomy (overall mortality 16.1 per 10000). Only seven deaths were expected on the basis of the population sample, and adjusted for age, the relative risk (RR) for hysterectomy patients was 6.38 (95% CI 4.33–9.39). Early postoperative mortality increased with age, and the risk was elevated among emergency patients (  RR = 3.22  ; 1.72–6.04). Patients with more than one diagnosis at discharge (  RR = 4.53  ; 2.12–9.70) were at high risk, but early postoperative mortality was independent of surgical approach. Causes of death are discussed. Compared to the general population, patients who undergo 'simple' hysterectomy are faced with a sixfold risk of dying within 30 days, but a complete assessment of the risks and benefits of hysterectomy requires prospective studies of survival and morbidity, including quality of life for longer periods of time following operations.     

Bromocriptine Treatment for Male Infertility

4 Männer mit Oligozoospermie und leicht erhöhtem Serumprolaktinspiegel wurden mit Bromocriptin (2 mal 2,5 mg) über 3 Monate behandelt. Wir sahen keine Veränderungen der Spermaqualität.     

Biliary Cystadenoma of the Common Bile Duct with Secondary Biliary Cirrhosis

Abstract A case of cystadenoma of the common bile duct is described. An erroneous diagnosis made in a young woman caused secondary biliary cirrhosis with fatal outcome. The diagnosis of cirrhosis should never be established without thorough visualization of the entire biliary tract in patients with biochemical or clinical jaundice of unknown origin.     

Clones of Human Cytotoxic T Lymphocytes Derived from an Allosensitized Individual: HLA Specificity and Cell Surface Markers

By planned immunization of a volunteer, two stable (greater than or equal to 6 months), specific, alloreactive cytolytic T-cell clones have been established from his peripheral blood lymphocytes. One clone reacts with all serologically defined HLA-Cw3 cells from our panel, whereas the other defines a split within the serological HLA-B40 specificity. The two cytotoxic clones are SmIg-negative, E-rosette positive, EA and EAC rosette-negative, HLA-A, -B and -C- positive, and also HLA-DR- or 'Ia like'-positive. In addition, they present very similar patterns of iodinated cell surface molecules as analysed by sodium dodecylsulphate polyacrylamide gel electrophoresis (SDS-PAGE), contrasting with that of an EBV cell line derived from the same donor.     

Effect of carbenoxolone on gastric prostaglandin E2 levels in patients with peptic ulcer disease following vagal and pentagastrin stimulation

The influence of oral carbenoxolone sodium (50 mg X 3 daily) on prostaglandin E2 release into gastric juice has been examined in nine peptic ulcer patients (duodenal ulcer, n = 6; prepyloric ulcer, n = 1; gastric ulcer, n = 2) during modified sham feeding and following bolus stimulation of acid secretion by pentagastrin (6 micrograms/kg). Carbenoxolone increased the overall mean of prostaglandin E2 concentrations in gastric juice following modified sham feeding by 32 +/- 9% (mean +/- SEM; P less than 0.02) and decreased the acidity slightly but significantly (P less than 0.05). A marked rise in prostaglandin E2 levels (46 +/- 11%; n = 5; P less than 0.02) was observed in for duodenal ulcer patients and the patient with a prepyloric ulcer responding to therapy (i.e., pain relief and ulcer healing within 4 weeks of treatment). A significant peak (P less than 0.05) related to modified sham feeding was observed only during medication, while a late gradual increase in prostaglandin E2 levels--not associated with vagal stimulation--occurred both in control and carbenoxolone experiments. No significant differences were observed following pentagastrin stimulation. The initial peak in prostaglandin E2 levels observed during medication favours the notion that the mechanism of drug action relies on inhibition of enzymatic degradation while the late increase in prostaglandin E2 levels may be explained by artificial prostaglandin formation during the aspiration procedure.     

Independent prognostic risk factors for patients referred because of suspected acute myocardial infarction without confirmed diagnosis. Prognosis after discharge in relation to medical history and non-invasive investigations

Variables associated with risk of cardiac events, i.e. acutemyocardial infarction (A MI) or cardiac death after discharge,were studied in patients who had been referred to coronary careunits because of suspected AMI due to chest pain, but in whomthis was not confirmed. The patients were all under 76 yearsof age, and were followed from 12 to 24 months, median 14 months.The estimated percentage without a cardiac event in 257 patientsafter one year was 91·3. On the basis of prognostic andclinical importance the analyzed variables included selectedaspects of the medical history, electrocardiogram on admissionin all 257 patients, subsequent electrocardiogram at rest, exercisetest, thallium scintigraphy, chest X-ray, echocardiography,systolic time intervals and Holter monitoring when possiblein 217 patients. Multivariate analysis identified combined electrocardiogramat rest and during exercise as the only variable with independentprognostic information. The presence of ST segment deviation,Q-wave, negative T-wave or intraventricular block in the electrocardiogramat rest or an abnormal ST segment response during exercise,increased the hazard of a cardiac event by a factor of 11·8. It is concluded that patients without confirmed AMI are at riskfollowing discharge. These patients should undergo an exercisetest and those with an abnormal electrocardiogram at rest and/orduring exercise should be followed closely after discharge.