Liver transplantation in tyrosinaemia type 1: the dilemma of timing the operation

Four children with tyrosinaemia type 1 received liver transplants. The metabolic disorder was corrected and all four had normal liver function on an unrestricted diet. Two children, transplanted at age five and seven years, proved to have occult hepatocellular carcinoma and both subsequently developed pulmonary metastases. One child was well 32 months after removal of a single pulmonary metastasis but the other child died with multiple metastases. The two younger children, transplanted at age 19 and 21 months, were well 28 and 44 months after operation, one after a second liver transplant. Our experience confirms the high risk of hepatocellular carcinoma in this disease and the potential value of early liver transplantation.     

Neurological crisis in hereditary tyrosinaemia and complete reversal after liver transplantation

A 19 month old Indian girl with tyrosinaemia developed a severe generalised neuropathy involving both phrenic nerves. Treatment with haemarginate failed to improve her condition. After liver transplantation the raised concentrations of the neurotoxin delta amino-laevulinic acid returned to normal and gradual but complete neurological recovery occurred over a period of 13 months.     

Microwaves from GSM mobile telephones affect 53BP1 and gamma-H2AX foci in human lymphocytes from hypersensitive and healthy persons

The data on biologic effects of nonthermal microwaves (MWs) from mobile telephones are diverse, and these effects are presently ignored by safety standards of the International Commission for Non-Ionizing Radiation Protection (ICNIRP). In the present study, we investigated effects of MWs of Global System for Mobile Communication (GSM) at different carrier frequencies on human lymphocytes from healthy persons and from persons reporting hypersensitivity to electromagnetic fields (EMFs). We measured the changes in chromatin conformation, which are indicative of stress response and genotoxic effects, by the method of anomalous viscosity time dependence, and we analyzed tumor suppressor p53-binding protein 1 (53BP1) and phosphorylated histone H2AX (gamma-H2AX), which have been shown to colocalize in distinct foci with DNA double-strand breaks (DSBs), using immunofluorescence confocal laser microscopy. We found that MWs from GSM mobile telephones affect chromatin conformation and 53BP1/gamma-H2AX foci similar to heat shock. For the first time, we report here that effects of MWs from mobile telephones on human lymphocytes are dependent on carrier frequency. On average, the same response was observed in lymphocytes from hypersensitive and healthy subjects.     

Homeopathy: A State of the Science Review With Recommendations for Practical Therapies in Midwifery Practice

A substantial proportion of adults and children in the United States use complementary and alternative health practices, including homeopathy. Many homeopathic therapies are readily available over the counter, and many individuals access and self-administer these therapies with little or no guidance from health care practitioners. In addition, patients and health care providers are often confused by terminologies associated with complementary practices and may be unable to distinguish homeopathy from naturopathy, herbalism, holistic medicine, Ayurveda, traditional Chinese medicine, or other forms of health care. Compared with European and Asian countries, education in the United States about complementary and alternative health practices is not typically found within traditional nursing, midwifery, or medical education curricula. Given this lack of education and the broad acceptance and popularity of homeopathy, it is necessary for health care practitioners to improve their knowledge regarding similarities and differences among therapies so they can fully inform and make appropriate recommendations to patients. The intent of this article is therefore to examine the state of existing science of homeopathy, distinguish it from other complementary methods, and provide midwives and women's health care providers with an introduction to common homeopathic therapies that may be recommended and safely used by persons seeking midwifery care. This review also presents the evidence base, pharmacology, manufacturing, and regulation of homeopathic therapies. We also consider controversies and misunderstandings regarding safety and efficacy of homeopathic remedies relevant to women and birthing persons. Examples of practical applications of homeopathic therapies for use in midwifery practice are introduced. Implications for practice and sample guidelines are included.     

Acute unilateral pulmonary nonventilation due to mucous plugs

Acute bronchial obstruction by mucous plugs may be manifested clinically by dyspnea, hypoxemia, and respiratory alkalosis mimicking pulmonary thromboembolism. In eight cases with complete interruption of ventilation to an entire lung, chest radiography failed to reveal the extent of the obstruction. Perfusion was substantially less affected than ventilation. Routine ventilation-perfusion scintigraphy with technetium-99m DTPA aerosol aids in the diagnosis of acute major bronchial obstruction in patients with suspected pulmonary thromboembolism.