ANISAKIASIS (‘HERRING WORM DISEASE‘) AS A CAUSE OF ACUTE ABDOMINAL CRISIS

SUMMARY A hazard associated with eating raw fish is presented. The larval nematode Anisakis marina (‘herring worm‘) is a recognised public health problem in Japan, and cases have been reported in the UK. The intestinal burrowing of the larval form causes acute abdominal symptoms clinically resembling acute appendicitis. Operation is required; no antiparasitic agent is available.     

Hepatic metastasis detection: comparison of three CT contrast enhancement methods

A prospective, blinded comparison of three methods of hepatic contrast enhancement in computed tomography (CT) was conducted in 15 patients with colorectal carcinoma metastatic to the liver. Arterial portography (AP-CT) was performed with injection of contrast material into the superior mesenteric artery during CT. Delayed scanning (DS-CT) was performed 4 hours after intravascular administration of contrast material (mean dose, 280 mL). CT with an ethiodized oil emulsion (EOE-CT) was performed 1 hour after slow intravenous infusion of the emulsion. All patients underwent laparotomy following imaging studies. A lesion-by-lesion analysis of 56 metastases showed no significant differences in sensitivity (AP-CT, 77%; DS-CT, 83%; EOE-CT, 82%), but the false-positive rate for AP-CT was significantly higher than that for DS-CT (P less than .001) or EOE-CT (P less than .01). False-positive rates for EOE-CT and DS-CT were not significantly different. The predictive value of a positive test was 63% for AP-CT, 90% for DS-CT, and 81% for EOE-CT. AP-CT does not appear to be clinically useful for detection of hepatic metastases because of the high false-positive rate. No difference could be demonstrated between DS-CT and EOE-CT. DS-CT is a valuable method for hepatic contrast enhancement.     

Kabuki syndrome: description of dental findings in 8 patients

The cardinal features of Kabuki (Niikawa-Kuroki) syndrome (KS) include characteristic facial dysmorphic features, mild to moderate mental deficiency, skeletal abnormalities, dermatoglyphic abnormalities, and postnatal growth retardation. We identified 8 patients with KS in a genetics clinic over the past 5 years. All were Caucasians, except for 2 who were of mixed Aboriginal and Caucasian descent. All had the facial gestalt, the dermatoglyphic abnormalities characteristic of the syndrome, and developmental delay. Dental abnormalities of permanent teeth were seen in all 8 cases; 6 had missing lower incisors. Five patients had uniquely abnormal upper incisor teeth shape; the upper incisors had a 'flat head' screwdriver-shaped appearance. Other dental abnormalities included missing lower lateral incisors, missing second premolars, and ectopic upper 6-year molars. We believe the presence of the unique dental findings will prove useful in the diagnostic assessment of individuals with KS.     

Nail alterations in 250 infant patients: a clinical study

Aims To investigate the frequency and the nature of nail alterations in infants. Study design A total of 250 infant patients from newborn to 2 years of age were evaluated from the outpatient clinics of paediatrics and dermatology departments, Fatih University Hospital. The nail alterations were documented. The data were presented as percentages, and for categorical comparisons, Chi‐squared or Fisher's Exact test were used. P < 0.05 was considered statistically significant. Results Of the 250 infant patients, nail alterations were seen in only 17 (6.8%). Most of the patients had toe nail involvement. In 12 of 17 (70.6%) infants, there was one type of nail alteration; in 4 of 17 (23.5%) infants, there was two type of nail alterations; and in 1 of 17 (5.9%) infants, there was three type of nail alterations. The most frequent diagnosis was onychoschizia in 6 of 17 (2.4%) and congenital hypertrophy of the lateral nail fold together with ingrown nail in 6 (2.4%) infants. Conclusion Because nail alterations could be a manifestation of systemic or dermatologic diseases in infants, fingernail and toenail examination should be a part of the paediatric dermatology examination.     

Gonadotropin-releasing hormone agonists for prevention of postoperative adhesions: an overview

Adhesion formation is of major concern to the pelvic surgeon. Most patients develop postoperative adhesions regardless of whether the mode of access to the abdominal cavity is by laparoscopy or laparotomy. Infertility is related to adhesions in the pelvis in 15–20% of cases. Peritoneal adhesions are the main cause of mechanical bowel obstruction in 65–80% of cases and contribute to a large extent to health-care expenditures. To prevent the formation of postoperative adhesions, a variety of medications have been studied such as glucocorticoids, heparin, dextran 70, saline solution, antibiotics, promethazine, antihistamines, prostaglandin synthesis inhibitors, Ringer's lactate solution, calcium-channel blockers and barriers such as Interseed and Gore-Tex. Such adhesions can be induced when operating on myomas and endometriosis. Experimental and clinical studies have demonstrated various mechanisms of action to be involved in adhesion prevention when gonadotropin-releasing hormone agonists (GnRH-a) are used for treatment. The following have been demonstrated and suggested:

(1) Hypoestrogenic condition was found in rats to be associated with decreased adhesion formation. This could be related to the influence on estrogen-dependent growth factors and growth modulators by reliable and constant inhibition of ovarian estradiol biosynthesis and secretion, but also non-competitive estrogen antagonism seems to play a role.

(2) Treatment with GnRH-a reduces the growth hormone release stimulated by growth hormone-releasing hormone.

(3) GnRH-a treatment influences neoangiogenesis by affecting vascular endothelial growth factor and basic fibroblastic growth factor.

(4) GnRH-a reduce the basal rate of coagulatory processes. The frequency and extent of fibrin-generating and -degrading processes are reduced. Activity of the plasminogen activating inhibitor is reduced, suggesting an improvement in fibrinolytic reactivity.

(5) GnRH-a use alters the vascular resistance index, pulsatility index and vascular peak velocity, and possible immune response.

(6) Avoidance of bleeding can reduce fibrin and therefore decreases the matrix for invasion by fibroblasts.

(7) GnRH-a reduce the degree of inflammation postoperatively.

Adhesion prevention seems to be at its best when pre- and postoperative GnRH-a treatment is administered. At present, there are trends to operate without prior treatment with GnRH-a. Based upon the data available, it seems worthwhile to consider preoperative and also postoperative treatment with GnRH-a: pretreatment for at least 2–3 months seems to be indicated, and a similar time after operation, to block the events associated with adhesion formation.     

Assessment of motivations for return donation among deferred blood donors. American Red Cross ARCNET Study Group

BACKGROUND: The recent addition of a computerized donor deferral registry to American Red Cross blood donation procedures has enabled blood center staffs to identify, before donation, persons who attempt to donate despite previous deferral. The current study investigated reasons that deferred donors return to donate, despite having been notified that they are ineligible. STUDY DESIGN AND METHOD: Anonymous mail surveys requesting demographic information, details of last donation or attempted donation, and assessments of incentives for donating were sent to 311 donors presenting inappropriately at blood drives and 849 matched controls in three American Red Cross regions between April and July 1996. RESULTS: Responses were received from a total of 113 deferred donors and 388 matched controls. Analysis of the 49 permanently deferred donors indicated that they were more likely than controls to donate blood to receive test results or to be awarded community service credit. Responses also revealed that some deferred donors may return to donate blood because of a misunderstanding of the deferral message or erroneous recruitment by blood center staff. CONCLUSION: There is a need before donation for the provision of educational materials regarding the window period of infection and for careful consideration of the use of incentives to attract donors to blood centers. It is also important to provide to donors a clear and consistent message regarding their test results and deferral status.     

Multiple unconfirmed-reactive screening tests for viral antibodies among blood donors

BACKGROUND: In December 1991, the United States Food and Drug Administration received reports of blood donations with unconfirmed reactivity on screening tests for antibodies to human immunodeficiency virus, human T-lymphotropic virus type I, and hepatitis C virus (HCV). Of 91 donors with these test results, 57 (63%) reported a recent influenza vaccination. STUDY DESIGN AND METHODS: To determine the extent of unconfirmed reactivity, the time at which it began, and its association or nonassociation with specific manufacturers' tests, a nationwide survey of blood centers was conducted. A case-donation was defined as a blood donation that was repeatedly reactive, but not confirmed positive, on at least two of the three tests from May 1990 through December 1991. RESULTS: Among 14 million donations screened by 110 centers, 582 case-donations were identified. An increase in case- donations was evident in the fall of 1990 (2.8/100,000 donations). In 1991, rates increased from 0.9 per 100,000 donations in the first quarter to 1.3, 3.2, and 19.7 in subsequent quarters. A significantly higher rate of case-donations was observed among donations tested with one of the two available anti-HCV screening tests (8.0 vs. 1.2/100,000 donations; risk ratio = 6.8; 95% CI = 5.4-8.5). CONCLUSION: Although unconfirmed reactivity on multiple screening tests appeared to be seasonal, its documentation prior to the availability of influenza vaccine in 1991 and higher rates among donations tested with one manufacturer's anti-HCV test indicated that test-specific factors were also involved.