Incontinentia pigmenti in four generations

Clinical and genetical aspects of a family with incontinentia pigmenti (IP) in 5 female members belonging to four successive generations are reported. In 4 individuals IP was associated with dental anomalies and partial hypodontia. Three of them also had convulsive disorders.     

Avascular necrosis of the femoral head: high-field-strength MR imaging with histologic correlation

Magnetic resonance (MR) images, contact radiographs, and histologic sections of six femoral head specimens with avascular necrosis were correlated. A low-signal-intensity band or ring represented the repair tissue interface surrounding a high-signal-intensity necrotic marrow segment. Large segmental areas of low signal intensity were observed on T1-weighted images when the lesion consisted of necrotic bone with amorphous marrow debris and adjacent thickened trabecular bone with mesenchymal repair tissue infiltration. On intermediate-weighted images, however, mesenchymal repair tissue, which was located inferior to the necrotic zone, increased markedly in signal intensity, permitting distinction from low-intensity necrotic bone with amorphous marrow debris. When trabecular thickening with collapse predominated, segmental areas of low signal intensity with both sequences were found. MR signal intensities used in combination with anatomic configuration and location may provide information of potential therapeutic importance regarding tissue composition and stage of disease.     

Oxygen manipulation as an ergogenic aid

The benefits of living and training at high altitude (HiHi) for an improved sea-level performance have been questioned because controlled studies have shown contradictory results. HiHi increases red blood cell mass (RCM), but training in hypoxia may be either an inadequate (low-intensity) or even harmful (to heart, muscle, and brain) stimulus. Recent studies indicate that the best approach to attain the benefits and overcome the problems of altitude training is to sleep at a natural or simulated moderate altitude and train at low altitude or sea level (HiLo). HiLo training increases RCM, as well as sea-level VO2max and performance (at least in responders), if certain prerequisites are fulfilled. The minimum dose seems to be more than 12 hours per day for over 3 weeks at an altitude or simulated altitude of 2100 to 2500 m. The effects of exposure to hypoxia seem to persist for a short period during the subsequent training or racing in normoxia.     

Analysis of particle and vapour phase PAHs from the personal air samples of bus garage workers exposed to diesel exhaust

The levels of particle and vapour phase polycyclic aromatic hydrocarbons (PAHs) derived from the diesel exhaust compounds in bus garage work were measured in winter and in summer. Five personal air samples were collected from the breathing zones of 22 garage workers every other day of consecutive weeks. Control samples (n = 22) were collected from office workers in Helsinki. Fifteen PAHs in the air samples were analysed by HPLC using a fluorescence detector. Statistically significant differences were observed between total PAH levels of the exposed workers (2241 and 1245 ng/m(3)) and the control group (254 and 275 ng/m(3)) in both winter (P < 0.001) and summer (P < 0.001). Phenanthrene, pyrene, benzo[ghi]perylene and fluoranthene were the major compounds in the particle phase, and naphthalene, phenanthrene and fluorene in the vapour phase. About 98% of PAHs measured were related to the vapour phase compounds, whereas the high molecular weight PAH compounds were detected only in the particle phase. The PAH levels in the garages were twice as high (P < 0.001) in winter as in summer. Even though the exposure levels were low in the bus garages, the low level does not allow conclusions to be drawn about the possible adverse health effects due to exposure to diesel exhaust.     

Elimination of epidemic methicillin-resistant Staphylococcus aureus from a university hospital and district institutions,Finland

From August 1991 to October 1992, two successive outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) occurred at a hospital in Finland. During and after these outbreaks, MRSA was diagnosed in 202 persons in our medical district; >100 cases involved epidemic MRSA. When control policies failed to stop the epidemic, more aggressive measures were taken, including continuous staff education, contact isolation for MRSA-positive patients, systematic screening for persons exposed to MRSA, cohort nursing of MRSA-positive and MRSA-exposed patients in epidemic situations, and perception of the 30 medical institutions in that district as one epidemiologic entity brought under surveillance and control of the infection control team of Turku University Hospital. Two major epidemic strains, as well as eight additional strains, were eliminated; we were also able to prevent nosocomial spread of other MRSA strains. Our data show that controlling MRSA is possible if strict measures are taken before the organism becomes endemic. Similar control policies may be successful for dealing with new strains of multiresistant bacteria, such as vancomycin-resistant strains of S. aureus.     

Bacterial adherence to titanium surface coated with human serum albumin.

HYPOTHESIS: An albumin coating on titanium implants will inhibit bacterial adhesion on the implant surface. BACKGROUND: Bacterial, protein, and platelet adhesion on otologic implants and tympanostomy tubes is a major reason for implant sequelae and can eventually lead to implant removal. The role of albumin coating of the implant in prevention of protein adhesion on implant surface has already been tested by the authors. In the present study the authors examined the in vitro adherence of Staphylococcus aureus and Pseudomonas aeruginosa on an albumin-coated and uncoated titanium surface. METHODS: Human serum albumin (HSA)-coated and uncoated titanium surfaces were exposed to viable S. aureus and P. aeruginosa and, after washings, photographed by fluorescence microscopy to quantify the adhered bacteria, which was stained with acridine orange. RESULTS: Bacteria in the suspension adhered at a significantly lesser rate to the coated surfaces than to the uncoated surfaces, with overall bacterial adhesion dependent on bacterial concentration. Binding of S. aureus on HSA-coated surfaces was inhibited significantly (from 82 to 95% depending on concentration). Binding of P. aeruginosa was inhibited from 29 to 37%. CONCLUSION: Because albumin coating can reduce bacterial adherence on titanium surfaces in vitro, reduction is possible in bacterial contamination and infection of the HSA-coated titanium implant in vivo.     

Recurrent hepatocellular carcinoma after liver transplantation mimicking post‐transplantation lymphoproliferative disorder

Approximately 5% of patients with end‐stage cirrhosis undergoing orthotopic liver transplantation have occult hepatocellular carcinoma. Careful follow up is required to detect recurrent tumour, and knowledge of the patterns of recurrence may avoid diagnostic confusion with other malignancies, such as post‐transplantation lymphoproliferative disorder. This case report illustrates an unusual presentation of recurrent hepatocellular carcinoma in a 56‐year‐old man presenting with a para‐aortic soft tissue mass, thought clinically and radiologically to represent lymphoma or post‐transplantation lymphoproliferative disorder. This case demonstrates that recurrent hepatocellular carcinoma can present late after transplantation as retroperitoneal lymphadenopathy, and should alert physicians and radiologists to be aware of the radiological appearances of recurrence and of the need for early biopsy to avoid diagnostic confusion with other malignancies.     

Three-year data from a comparative study with recombinant human growth hormone in the treatment of short stature in young children with intrauterine growth retardation

Growth acceleration and bone maturation were studied for 3 y in 69 children with severe short stature and a history of intrauterine growth retardation (IUGR), to determine the effect of treatment with recombinant human growth hormone (r-hGH). The patients were enrolled in an open, multicentre trial and were randomly allocated to either the treated group (Group 1) or the control group (Group 2). The children in Group 1 were treated daily with 0.2 IU/kg/body weight (0.067 mg/kg) s.c, during 3 y and the children in Group 2 started the study with a 1-y observation period followed by a 3-y treatment period. At birth, their mean weight standard deviation score (SDS) was -2.5 and their mean length SDS -3.5. At baseline, the patients were prepubertal, non-GHdeficient, with no known dysmorphic features. Mean age was 4.5 y, bone age was 3.3 y, height SDS was -3.4, height velocity (HV) SDS was -1.6, and body mass index SDS was -1.4. After 1 y of treatment, linear HV in Group 1 increased in comparison with the pre-treatment period (from 5.7 ± 2.0 to 10.1 ± 1.7cm/y; p < 0:001)and with the firstyear of observation in Group2( p < 0:001). Increased HV was sustained during the second and third year of treatment and was significantly higher than at baseline. A similar growth pattern was seen during the 3y of GH treatment in Group 2. Mean height SDS for chronological age increased by 2.0 ± 0.7 in the two groups after 3 y of treatment. HV after 1 y of treatment was negatively correlated with growth velocity at baseline. Bone age remained retarded but increased with a mean of almost 4 y after 3y of treatment in both groups. Even at a dose that is three times the replacement dose treatment with r-hGH was well tolerated. From these results, we conclude that r-hGH treatment over 3 y can induce sustained catch-up growth in young children with severe short stature and a history of IUGR. Long-term studies are needed to assess ultimate effects on final height.