Histomorphometric analysis of aplastic bone disease in chronic renal failure at initiation of haemodialysis: Relation to aluminum and parathormone

SUMMARY: We studied bone histology of 134 uraemic patients without a history of vitamin D administration at the start of haemodialysis. Patients were categorized according to bone histology as follows: aplastic bone disease (ABD), ostitis fibrosa, mixed type, mild hyperparathyroidism and osteomalacia. On initiation of haemodialysis, ABD was observed in 48.5% of patients. the average age of the ABD group (50.8 ± 12.5 years) was significantly higher than that of patients with other histologies ( P <0.01). Serum parathyroid hormone (PTH) and alkaline phosphatase (ALP) concentrations were lower ( P <0.01) in the ABD group, especially in patients with diabetes mellitus. Patients with diabetes mellitus and ABD had lower serum concentrations of PTH and ALP than non-diabetic patients, suggesting that depressed PTH may be related to ABD. Eleven (55%) of the 20 patients who were receiving A1(OH)₃ also had ABD. A direct relationship was observed between serum aluminum concentration and aluminum-positive bone surface ( r =0.60; P <0.01). Aluminum staining was more frequently observed in the ABD group than in the non-ABD group ( P <0.01). Because serum intact-PTH concentrations correlate with osteoid surface area, fibrosis volume and bone formation rate, it may be a useful marker of bone histology in renal osteodystrophy. These results suggest that, in addition to conservative treatment with A1(OH)₃, other factors may be involved in the formation of ABD which is often present at the start of haemodialysis.     

The Kallmann syndrome gene product expressed in COS cells is cleaved on the cell surface to yield a diffusible component

Kallmann syndrome is characterized by hypogonadotropic hypogonadism and anosmia and caused by a defect of migration and targeting of gonadotropin-releasing hormone-secreting neurons and olfactory axons during embryonic development. We previously cloned the gene responsible for the X-linked form of the disease encoding a 680 amino acid protein, KAL, which displays the unusual combination of a protease inhibitor domain with fibronectin type III repeats. Previous expression studies by northern blot and RNA in situ hybridization in human and chick indicated that the gene is expressed at very low levels in the olfactory bulb during development. Therefore, low abundance of the protein has hampered a detailed biochemical characterization. By overexpressing both the human and chick KAL cDNAs in eukaryotic cells, we now provide evidence that KAL is a glycosylated peripheral membrane protein with an apparent molecular weight of approximately 100 kDa. We show that this 100 kDa protein is proteolytically processed on the cell membrane to yield a 45 kDa diffusible component, which is detectable with an antisera against the C-terminal part of the protein and binds tightly to cell surfaces. These data provide a first step toward understanding KAL function in neuronal interactions and neurite extension in the olfactory bulb and suggest that KAL might be a diffusible chemoattractant molecule for olfactory axons.      

Endoscopy for the Diagnosis of Acute Upper Gastrointestinal Bleeding

Background: Owing to overgrowth and definitional problems in classification, the cancer of gastric cardia may affect significantly the epidemiological analysis of oesophageal adenocarcinoma. The purpose of the present study was to evaluate the changes in the incidence of all the adenocarcinomas near the gastro-oesophageal junction. Methods: Trends in the incidence rates of adenocarcinoma of the oesophagus and the gastric cardia were described through the Finnish Cancer Registry. The annual age-standardized incidence rates during 1976-95 were analysed by a linear regression technique. Results: The total incidence of oesophageal carcinoma remained around 3.5/100,000 in men, and decreased from 2.8 to 1.3/100,000 in women. The incidence of oesophageal adenocarcinoma increased from 0.28 to 0.77/100,000 (nearly 300%) in males, and from 0.08 to 0.11 per 100,000 in females. There were no significant changes with time in the incidence rate of gastric cardia cancer in either sex. Combined gastric cardia and oesophageal adenocarcinoma incidence rates remained stable in women, and increased slightly, but significantly, from 2.4 to 2.9/100,000 in men. Conclusion: Oesophageal adenocarcinoma has increased significantly in men in Finland, but the combined incidence of cancers of the gastro-oesophageal junction has increased only slightly. To overcome the difficulties in classification of oesophageal adenocarcinoma and the cancer of gastric cardia in the epidemiological studies, the focus should be on all adenocarcinomas at or near the oesophagogastric junction.     

Assesment of polyunsaturated fatty acids in cord blood of infants of diabetic mothers

Objective：To assess whether infants of diabetic mothers [ pre pregnancy diabetics （PPD） and gestational diabetics mellitus （GDM） ] have compromised arachidonic and docosahexaenoic acids in their plasma and the relationship with deficiency of the same compounds in their mothers. Methods： This study was conducted on 30 diabetic mothers （ both PPD and GDM） and their infants. Twenty healthy infants and their mothers with age and sex matched were included as controls. All infant （ of diabetic and non diabetic mothers） were subjected to assessment of APGAR Scoring, thorough history taking and anthropometric measures. Lipid profile components as well as polyunsaturated fatty acids（PUFA） were assessed in diabetic GDM and PPD and non diabetic mothers as well as in their babies. Results ： High-density lipoproteir（HDL） level was found to be significantly lower in diabetic mothers （specially those with PPD） compared to non diabetic ones, whereas no significant difference was found between babies of the two groups. Also, the current study revealed that diabetic mothers （ GDM and PPD） and their babies had significantly higher levels of PUFA precursors linoleic acids （LA） and alpha linoleic acids（ALA）. PUFA arachidonic acid（AA） and docosahexaenoic acids（DHA） were found to be significantly lower in diabetic mothers （GDM and PPD） compared to non diabetic mothers, and same results were found in the babies of the two groups. Conclusion： Neonates with diabetic mothers （both GDM and PPD） have highly compromised plasma levels of AA and DHA PUFA, which affects the child well being by far, and produces hazardous muhi-system complications on the long run.     

长春瑞滨联合顺铂治疗32例多柔比星耐药的晚期乳腺癌

目的：观察长春瑞滨(诺维本，NVB)联合顺铂(DDP)治疗多柔比星(ADM)耐药的晚期复发、转移乳腺癌的近期疗效和毒副反应。方法：用NP方案对曾用含多柔比星联合方案治疗大于2周期后进展或复发、转移的晚期乳腺癌32例，21～28天为1周期，完成2～4周期后评价疗效。结果：总有效率62．5％，主要限量毒性为消化道反应和骨髓抑制，其次为周围神经炎。结论：NVB加DDP治疗多柔比星耐药的晚期乳腺癌仍是可供选择的有效方案，毒副反应可耐受。     

内源性逆病毒癌基因V-erbB突变与白血病发生

目的：证明鸡原始红细胞增多症逆病毒癌基因V—erbB在人类白血病和骨髓增生异常综合征(MDS)急者基因组内的存在。方法：应用V—erbB PCR，V—erbB寡核苷酸(Oligo)原位杂交技术和PCR产物DNA测序，对84例MDS、可疑MDS和49例其他相关血液病进行检到。结果：2例患者骨殖细胞基因组内均存在V—erbB亚基因片段，同源性占99．5％，它们具有相同的限制性酶勿位点，因此可以在Southern印迹杂交条件下发生骨髓细胞C—erbB重排和重排／扩增。白前P1P2PCR产物有420bp，P1P3产物有650bp，而白血病(AL—M4)P1P2PCR产物仅390bp，P1P3PCR因P3无模板序列而无结果。提示从白前发展为白血病，可能发生V—erbB亚基因序列的缺失，即缺失突变。结论：大鼠和人白血病和食管癌等可能均起源于其基因组内存在V—erbB亚基因及其缺失突变。白血病发病中除了上述病因以外，骨髓细胞染色体不稳定性可能起协同作用。     

Self-medication with vaginal antifungal drugs: physicians' experiences and women's utilization patterns

BACKGROUND: In many countries, vaginal antifungal drugs have been released on over-the-counter (OTC) markets, yet little is known about women's management of their symptoms. OBJECTIVES: The aim of this study was to judge the appropriateness of self-medication with vaginal antifungal drugs by examining utilization patterns and physicians' experiences of women's self-medication. METHODS: An anonymous questionnaire survey was carried out in 20 pharmacies in Finland of women buying OTC vaginal antifungal drugs in 1997. Out of the 453 questionnaires distributed, 299 (66%) were returned. A survey of a random sample of gynaecologists (n = 169) and specialists in general practice (n = 288) was carried out in 1996. The response rate was 77%. RESULTS: Nearly all women had used vaginal antifungal drugs previously, 49% during the previous 6 months. Most women did not report any difficulties with treatment, but 44% of women used the drug against recommendations. Half of the women had symptoms that are more likely to be related to infections other than Candida. Physicians had observed several disadvantages of self-treatment, with unnecessary use and use for the wrong indications being the most often reported. In all, 31% of gynaecologists and 16% of GPs reported that these adverse events had been clinically significant, with delay in the treatment of other infections being the most common problem. CONCLUSION: The results raise concerns about inappropriate use and women's ability to self-diagnose correctly. Because vaginal antifungal drugs are likely to remain on OTC markets, two ways to address these concerns are for physicians and pharmacy personnel to provide spontaneous information and to have more informative advertisements on vaginal antifungal drugs.