Follow-up chest radiographs in Vietnam veterans: are they useful?

Agent Orange exposure and its long-term health consequences on Vietnam veterans have been widely discussed in the past few years. Myriad physical and mental disabilities have been studied with regard to exposure to various herbicides. The number of persons potentially exposed is large, since 2.4-2.8 million U.S. military personnel served in Vietnam. A case-control study was undertaken to determine if persons who served in the U.S. military in Vietnam have either cardiovascular or pulmonary effects that can be demonstrated on long-term follow-up chest radiographs. Information regarding military service in Vietnam was obtained from interviews and, in some cases, review of military records. Vietnam veterans did not have an increased prevalence of abnormalities on follow-up chest radiographs. A subset of Vietnam veterans who had greater estimated opportunities for Agent Orange exposure also did not appear to be at greater risk than the control population.     

Antimitotic drugs (cyclophosphamide and vinblastine) in the male rat. Deaths and behavioral abnormalities in the offspring

The spermatogenesis and the offspring of male rats treated either with cyclophosphamide alone, or with both cyclophosphamide and vinblastine were investigated. The offspring were evaluated for the mean number of pups per litter, sex ratio, the frequency of apparent external malformations and, within the first 4 months of life, growth and mortality. When they reached adulthood and were between 12 and 16 weeks of age, the offspring were also examined for spontaneous activity and learning capacity. Treatment with cyclophosphamide or cyclophosphamide and vinblastine resulted in a decrease in the number of both primary spermatocytes and spermatids; the effect, however, lasted longer for the combined drug regimen. At birth, the animals sired by the treated males did not show any apparent malformations. However, compared with the control population the mortality rate of the offspring was significantly higher within the first 40 days of life; at adult age, the proportion of animals that failed in the learning ability test was significantly increased and those that did succeed showed impaired learning capacity. The difference, however, was significant only in the male offspring. Finally, the offspring's spontaneous activity was significantly decreased. No difference was found in mortality or behavior between the animals born of the cyclophosphamide or cyclophosphamide plus vinblastine-treated males. The behavioral disorders shown in the adult offspring confirm the existence of a long-term risk of paternal origin. This risk, essentially functional and independent of any morphologic pathology, should be taken into account in the context of environmental genotoxicity.     

Dermatomyositis after interferon alpha treatment

An association between auto-immune disorders and interferon (IFN) has been reported. High levels of natural IFNα are present in the blood of patients with auto-immune disease and correlate with disease activity. In addition, IFNα treatment of humans has resulted in multiple reports of associatied auto-immune phenomena. We describe a patient who underwent resection of regionally metastatic melanoma, was given adjuvant high-dose IFNα2b, and subsequently developed dermatomyositis. To the author's knowledge this is the first report of dermatomyositis in association with IFNα treatment. We review the literature reporting associations between IFNα and auto-immune disease and discuss possible mechanisms by which IFNα may contribute to the development of auto-immune disease. High dose IFNα2b is more commonly prescribed since it was approved as an adjuvant treatment for patients with surgically resected high-risk melanoma. The potential for cases of IFN-associated autoimmune disease is therefore a clinical concern. Standard side effects of high-dose IFN therapy resemble symptoms of auto-immune diseases, which may make prompt diagnosis difficult. Therefore, it is important that auto-immune diseases such as dermatomyositis are recognized as potential side effects of treatment with high-dose IFNα.     

椎弓崩裂症的MRI诊断

目的：分析椎弓崩裂症的MRI表现，并探讨MR诊断椎弓崩裂症的价值。方法：笔者收集40例本室自1995年8月至2000年6月MR检查诊为椎弓崩裂的病例，使用SIEMENS IMPAC1．0TMR机，采用脊柱线圈，自旋回波和快速自旋回波序列扫描，结果：显示椎弓崩裂发生于腰4、5椎体，大部分双侧受累（35例），双侧受累者较单侧受累者滑脱的发生率高，椎弓崩裂均位于椎弓峡部，表现为椎弓峡部骨皮质及髓质信号均不连贯，显示如下MR征象：断裂处呈线状；断裂处上下两端分离；断裂处下端后移，部分病例成角移位。结论：MRI检查能显示椎弓崩裂的位置及上述相关的MRI征象，在日常腰椎MRI检查中，如加留意，可及早发现。     

Chronic illness perception in adolescence: Implications for the doctor-patient relationship

To describe the inter-relationship of chronic illness severity as perceived by adolescents with both psychosocial well-being and objective measures of illness severity. Additionally to compare the adolescents' perception of illness severity with how their physicians believe that the adolescents perceive their illness severity.

Methods:

The psychological well-being of 48 adolescents with either cystic fibrosis (CF) or insulin-dependent diabetes mellitus (IDDM) was measured by four standardized questionnaires. The adolescents' perception of severity of illness was measured using an original instrument (PSCI), and this measure was compared to their physicians' estimates of how the adolescents perceived the severity of their illness and clinical illness.

Results:

There were 24 patients in both the CF and IDDM groups. Both groups were found to function well psychosocially; although, there were more patients with low self image compared to normative values. Depression and low self image were associated with a greater adolescent perception of illness severity. For both chronic illness groups, physicians' assessment of assumed adolescent perception of disease severity correlated with clinical indices of disease severity and was higher than the perception of illness severity reported by the adolescents. For adolescents with CF, but not with IDDM, perception of severity of chronic illness correlated with clinical indices.

Conclusions:

For adolescents with chronic illness, their perception of illness severity is an important indicator of psychosocial well-being. Physicians do not accurately infer their patients' perception of illness severity.     

Community study of toxoplasma antibodies in urban and rural schoolchildren aged 4 to 18 years

To estimate the prevalence of toxoplasma antibodies in schoolchildren and their association with clinical and environmental data, antibody titres were measured in 1276 children aged 4 to 18 years attending primary and secondary schools. Environmental and clinical data were obtained by questionnaire. Altogether 12.8% (163/1276) of children had antibodies to Toxoplasma gondii with no difference between the sexes. Seroprevalence was higher in country children (16.6% (50/302)) than town children (10.2% (75/737)). The proportion testing positive increased with age in both town and country children. No association with cat ownership was found. Toxoplasma seropositivity was associated with a positive toxocara titre, having had a bitch whelp in the past two years, and having an unwormed dog at home. Lack of energy or tiredness in the last 12 months were the only clinical features associated with a positive titre.     

Cryopreserved Immature Mouse Oocytes: A Chromosomal and Spindle Study

Purpose: Cryopreservation of human oocytes might provide an alternative approach to freezing supernumerary embryos obtained during IVF. This process, performed on immature denuded prophase I mouse oocytes, was investigated. Methods: We first investigated the capacity of frozen, immature, murine oocytes to continue in vitro maturation after thawing. We then evaluated the risk to offspring from chromosomal damage by cytogenetical and cytological (spindle) analysis. Finally, we attempted to determine the reasons for and the stage of maturation failure. Results: A total of 700 immature oocytes was frozen, 629 (90%) were recovered intact after thawing, and 53% extruded the first polar body, versus 74% for the control group. Freezing was not accompanied by an increase in aneuploidy in maturing oocytes (18 and 15% for thawed and control oocytes, respectively). Consequently, the first meiotic division occurred normally, without an increase in nondisjunction. Spindle analysis demonstrated only a few abnormalities (15 and 2% for thawed and control oocytes, respectively) incompatible with further development. Oocytes arrested during in vitro maturation were mainly at the metaphase I stage (64 and 76% for thawed and control oocytes, respectively). Whereas 17% of thawed oocytes were blocked before the formation of the first meiotic spindle, this never occurred in the control group. Conclusions: Immature murine oocytes can withstand cryopreservation, which is encouraging for future human application of this technique.     

INTRACARDIAC TUMOURS – EXPERIENCE WITH 12 CASES

Twelve cases of intracardiac tumours operated during the period 1975 to 1994 are presented. There were 8 males and 4 females in the age range of 18 years to 64 years. Tumours were located in the left atrium in 10 patients and in the right atrium in 2 patients. Standard cardiopulmonary techniques were followed. The right atrial tumours were approached through a right atrial incision while the left atrial tumours were approached through a bi-atrial trans-septal approach. One patient underwent a perineal urethrolithotomy for an impacted urethral calculus at the same sitting. Eleven of the tumour masses excised were myxomas confirmed on histopathology. The last patient, operated for synovial sarcoma of the left knee 2 years before, presented with a metastatic tumour mass in the left atrium. No deaths occurred in the series.KEY WORDS: Heart neoplasms, Heart surgery, Myxomas