Jejunal angiomatoses causing small bowel obstruction in a patient with Down syndrome: a case report

Gastrointestinal vascular anomalies are extremely uncommon. We describe a patient with Down syndrome who presented with acute abdominal pain due to a mixed capillary and venous vascular malformation involving the proximal jejunum.     

Bronchoconstriction following nebulised colistin in cystic fibrosis

Nebulised colistin is regularly used as antipseudomonal therapy in children with cystic fibrosis. We assessed bronchoconstriction in response to nebulised colistin in 58 children. Nebulised colistin significantly reduced FEV(1), MEF(25%), and SaO(2) for 15 minutes. In 20 children the reduction was greater than 10% from baseline FEV(1), and was still at that level in five at 30 minutes. Subjective assessment, baseline FEV(1), and serum IgE were unable to identify susceptible children. It is recommended that children receiving colistin should be carefully assessed for bronchoconstriction.     

Congenital malformations in the newborn

Summary 5,376 consecutive births were examined for the presence of congenital malformations, to find out its incidence and to determine the role of environmental factors in the causation of these anomalies. The incidence was 13.76 per one thousand births. Males dominated among the malformed infants with an incidence of 67.56 per cent. The maximum number of malformed children were born to mothers in the third pregnancy, constituting a percentage of 37.83. Prematures accounted for 17.56 per cent of all the malformed births. The incidence of congenital malformations among prematures was 3.8 per cent. Infants with central nervous system anomalies formed the major group with an incidence of 40.54 per cent among the affected infants. 31 per cent resulted in still births. The incidence of congenital malformations among still-births was 7.58 per cent. Hydramnios during pregnancy was observed in five cases (6.75 per cent). A history of chicken pox and measles in the first trimester of pregnancy was elicited in two mothers (2.7 per cent). Advanced maternal age and parity were linked in six cases of mongolism. A history of increased vaginal bleeding in early pregnancy was obtained in four cses (5.4%). A history of consangunity was present in two infants. No other significant etiological factors could be determined in any case. From the Department of Pediatrics, Patna University and Medical College Hospital, Patna.     

Spirometric studies of the subjects in an active area of Hyderabad A.P

Study area is the "All India Industrial Exhibition", Hyderabad in the heart of the Hi-tech city with 2000 stalls/pavilions. It is visited by nearly 20 lakh people every year in 45 days of exhibition. Persons actively involved in All India Industrial Exhibition are selected for the spirometric studies. Selected subjects were administered the ATS Questionnaire. Data pertaining to age sex status, occupation, general health, family background for allergy, asthma, lung cancer, etc. Their lung efficiency is spirometrically studied. They were also administered 2.5 mg Salbutamol. People complaining about cough, sputum, wheeze, running nose/stuffy nose, sneeze, dyspnoea were categorized as suffering from sinusitis, rhinitis and chronic bronchitis. People from Salbutamol reversibility of airflow obstruction were diagnosed as asthmatics. Analysis of variance, multiple comparison test, student-t-test and normal curve test were used for statistical analysis. Present study reveals a direct relation between polluted air and respiratory morbidity.     

Nutrition and brain function: a multidisciplinary virtual symposium

A few months ago, the Brazilian Society for Neuroscience and Behavior (SBNeC) promoted a "virtual symposium" (by Internet, under the coordination of R.C.A. Guedes) on "Nutrition and Brain Function". The discussions generated during that symposium originated the present text, which analyzes current topics on the theme, based on the multidisciplinary experience of the authors. The way the brain could be non-homogeneously affected by nutritional alterations, as well as questions like early malnutrition and the development of late obesity and hormone abnormalities were discussed. Also, topics like the role of essential fatty acids (EFAs) on brain development, increased seizure susceptibility and changes in different neurotransmitters and in cognitive performance in malnourished animals, as well as differences between overall changes in nutrient intake and excess or deficiency of specific nutrients (e.g. iodine deficiency) were analyzed. It was pointed out that different types of neurons, possibly in distinct brain structures, might be differently affected by nutritional manipulation, including not only lack-but also excess of nutrient intake. Such differences could help in explaining discrepancies between data on humans and in animals and so, could aid in determining the basic mechanisms underlying lesions or changes in brain function and behavior.     

Serum thyroxine and triiodothyronine levels in newborns: effect of gestational age

Serum T₄ and T₃ were measured in 31 newborns of gestational ages 32–43 weeks. Out of 31, 11 were term, 12 preterm and 8 postterm. Blood samples were taken from cord blood and from peripheral vein at 24 and 72 hours of age. Serum T₄ and T₃ values were low in cord blood samples, raised in 24 hours samples and then declined in 72 hour samples. In pretern newborns cord T₄ and T₃ values were significantly lower and there was a blunted rise and fall in 24 and 72 hours samples as compared to term newborns. In post term newborns cord serum T₄ and T₃ values were significantly raised while in peripheral vein samples difference was statistically insignificant as compared to term newborns. This high incidence of low cord values and transient hypothyroxinemia observed in preterm and postnatal surge of T₄ may give rise to false results while screening for hypothyroidism.     

Preoperative angiotensin-converting enzyme inhibition can cause severe post CPB vasodilation--current UK opinion

Preoperative use of angiotensin-converting enzyme inhibitors in cardiac surgery patients is thought to cause extreme vasodilatation in post cardiopulmonary bypass period. Opinions are divided as to whether it is beneficial or not to stop it prior to operation. A national survey in the UK was carried out on this issue. Questionnaires were sent to 167 currently practicing UK cardiac surgeons, out of which 105 (62%) replied back. Their responses were analyzed. Among the surgeons who replied to the questionnaires, the majority (63%) were of the opinion that the use of angiotensin-converting enzyme inhibitors leads to vasodilatation resulting in increased usage of fluids, inotropes and vasoconstrictors. However, there was no agreement on the issue of stopping it prior to surgery. Forty one (39%) felt it was beneficial to stop the angiotensin-converting enzyme inhibitors prior to surgery whereas 40 (38%) of them thought it was harmful to stop it. Twenty one (20%) were of the opinion that it made no difference. 39% of respondents practiced stopping the drug prior to planned operation. This national survey revealed differences in management of patients on angiotensin-converting enzyme inhibitors undergoing cardiac surgery. Recommendations from available literature are equally varied, highlighting the need for multicenter randomized trials to address this clinical problem.     

Alpha 1A-adrenergic receptor polymorphism and vascular response

OBJECTIVE: The alpha(1A)-adrenergic receptor is highly expressed in human vasculature including resistance arteries and veins, and its stimulation is primarily responsible for adrenergically mediated smooth muscle contraction. Variability in sensitivity to phenylephrine, an alpha(1A) adrenergic agonist, has a large genetic component. We examined the hypothesis that a common polymorphism of alpha(1A)-adrenergic receptor (Arg347Cys) affects in vivo response. METHODS: We measured vascular sensitivity to phenylephrine using the dorsal hand vein linear variable differential transformer technique and determined alpha(1A)-adrenergic receptor genotype in 74 healthy, nonsmoking adults (28 Arg/Arg, 30 Arg/Cys, and 16 Cys/Cys). RESULTS: Sensitivity to phenylephrine, expressed as the dose of phenylephrine resulting in 50% venoconstriction (Phe(50)), was not significantly different in subjects with the 3 alpha(1A) adrenergic receptor genotypes: Phe(50) geometric mean (95% confidence interval) was 513 ng/min (287-918 ng/min) for Arg/Arg, 431 ng/min (274-680 ng/min) for Arg/Cys, and 471 ng/min (197-1124 ng/min) for Cys/Cys (P =.90). CONCLUSION: We conclude that the Arg347Cys receptor polymorphism does not alter agonist-mediated venoconstriction in vivo.