US of the upper abdomen: factors influencing image quality

A controlled blind study of 226 patients was performed to determine the advantages of fasting prior to upper abdominal ultrasonography (US) as well as the influence of other factors on image quality. The ratio of weight to height (a reflection of body build) was found to most often correlate negatively with image quality for all organs, followed by age for the biliary tract, pancreas, and kidneys and sex (in males) for the pancreas. Only the biliary tract was shown slightly better as the result of fasting. Images obtained during the afternoon tended to be somewhat better. The authors conclude that upper abdominal US can be performed at any time in patients who have not fasted, as it is primarily other factors that determine image quality. Only if evaluation of the biliary tract is inconclusive need the patient be reexamined after fasting.     

Fetal lung development: compressibility as a measure of maturity

Fetal lung maturation involves a number of separate developmental processes. An ultrasonic technique is reported for grading the dynamic behavior of the right middle lobe or lingula in the second or third trimesters on ultrasound (US) study. Fetal lungs are stiff initially. Lung compressibility during diastole is typical after 36 weeks' gestational age, when phospholipid profiles of the amniotic fluid also indicate lung-tissue maturity. Compressibility also occurs earlier in the third trimester and has indicated, in preliminary observations on a small subgroup of infants delivered prematurely, a low risk of subsequent neonatal respiratory distress syndrome. High-speed magnification US study of fetal lung compressibility can be used to evaluate fetal lung development, possibly independently of gestational age and of conventionally measured lecithin/sphingomyelin values in amniotic fluid.     

Dedifferentiated chondrosarcoma: radiographic features

Dedifferentiated chondrosarcomas, unlike ordinary chondrosarcomas, are highly aggressive tumors that frequently metastasize. The lesion is characterized by a lytic intraosseous or extraosseous soft-tissue mass that is devoid of the calcifications that are usually associated with a chondroid tumor. We describe the radiographic and pathologic features of five cases involving dedifferentiated chondrosarcoma.     

Isolation of functionally different human monocytes by counterflow centrifugation elutriation

Human peripheral blood monocytes were isolated by counterflow centrifugation elutriation (CCE). This technique was modified in such a way that various monocyte fractions (viability greater than 99%) could be elutriated by increasing the density of the CCE-medium in steps of 0.0027 g/ml. All monocytes showed the same size distributions as determined by electronic sizing, which indicated that they differed in their density only. Both cytoplasmic esterase and peroxidase activity increased with the density of the cells. Furthermore, the monocytes with the highest density were 2.3-4 times more active in an antibody- dependent cellular cytotoxicity (ADCC) assay than those with the lowest density. In contrast, the monocyte with the highest density were less capable to induce the proliferation of lymphocytes in mixed leukocyte cultures (MLC) than those with the lowest density. This observation could not be attributed to differences in the expression of HLA-DR determinants, since a monoclonal antibody directed against HLA-DR antigens reacted equally well with the monocytes in different fractions. These results provide evidence for the existence of functionally different subsets of monocytes or different states of differentiation or maturation.     

Evaluation of antiretroviral therapy results in Blantyre,Malawi

We performed a cross sectional study to evaluate treatment results of the paying antiretroviral therapy clinic of Queen Elizabeth Central Hospital, Blantyre. The only antiretroviral therapy was a fixed drug combination of stavudine, lamivudine and nevirapine.

Methods

Interviews, laboratory tests (CD4 count, viral load, nevirapine plasma levels, transaminases) and data extraction from files. 422 (59 %) of the patients who started antiretroviral therapy since 2000 were lost to follow up. The 176 patients enrolled in the study had good virological and excellent clinical treatment results. The most common side effect was peripheral neuropathy. Nevirapine plasma levels were remarkably high and associated with successful virological treatment results. Two simple adherence questions pertaining to the use of medication in the previous 8 days corresponded well with nevirapine levels. The most important reasons for non-adherence were shortage of drugs in the hospital pharmacy and personal financial constraints.

Conclusions

1. Many patients were lost to follow up.
2. High nevirapine levels contributed to good therapy results in those studied.
3. Simple adherence questions predicted sub-therapeutic nevirapine levels.
4. Antiretroviral drug supply needs to be uninterrupted and free of charge, to prevent avoidable non-adherence.

     

Prevalence of alcohol use among school children and vocational school students in Murmansk

Anonymous questionnaires were distributed among 1564 schoolchildren in Murmansk for the study carried out in accordance with the method recommended by Center for Monitoring Harmful Habits among Children and Adolescents at Ministry of Health of Russia. The data indicate alcoholization of adolescents in the city. The results were used for planning and implementation of preventive measures within the framework of the SOS! complex regional program.