Phrenic Nerve Paralysis, Vegetative Symptoms and Restrictive Cardiomyopathy in a Case of Poems Syndrome

OBJECTIVE: To study the effectiveness and safety aspects of sodium valproate in the management of painful neuropathy in patients of type 2 diabetes mellitus. MATERIAL AND METHODS: A randomized double‐blind placebo controlled trial of sodium valproate was done in type 2 diabetic patients to assess its efficacy and safety in the management of painful neuropathy. We screened 60 patients but eight patients could not complete the study; hence, the present study was done on 52 patients. Each patient was assessed by clinical examination, pain score by short form of the McGill pain questionnaire (SF‐MPQ) and electrophysiological examination, which included motor and sensory nerve conduction velocity, amplitude and H‐reflex initially and at the end of 1 month of treatment. RESULTS: Significant improvement was noticed in the pain score of patients receiving sodium valproate in comparison to patients receiving placebo at the end of 1 month (P < 0.05). The changes in electrophysiological data were not significant. The drug was well tolerated by all patients except one who developed a raised aspartate transaminase (AST)/alanine transaminase (ALT) level after 15 days of treatment. CONCLUSION: Sodium valproate is a well‐tolerated drug and provides significant subjective improvement in painful diabetic neuropathy. These data provide a basis for future trials of longer duration in a larger group of patients.     

Comparison of cytopathic changes in oral hairy leukoplakia with in situ hybridization for EBV DNA

OBJECTIVE: It has been observed that the cytopathic changes in hairy leukoplakia (HL) correlate with ultra-structural evidence of intra-keratinocyte herpes-type viral particles. In situ hybridization is considered to be the definitive confirmation of Epstein-Barr virus (EBV)-induced HL. This study evaluated the consistency of histopathological findings, which many believe to be diagnostic, with in situ hybridization for EBV-DNA in 60 patients with lesions clinically suggestive of HL.
MATERIALS AND METHODS: Hematoxylin and eosin (H&E)-stained sections were reviewed independently by three oral pathologists who did not know the hybridization results. The presence in keratinocytes of nuclear inclusions and/or homogenization, believed to be specific for EBV in these lesions, was used as an indicator for infection. Cytoplasmic changes were evaluated separately.
RESULTS: With in situ hybridization, 48 cases were positive and 12 were negative. When the two methods were compared, pathologist concurrence ranged from 83% to 92%. False negatives ranged from 6% to 19%, and false positives ranged from 8% to 25%. Cytoplasmic ballooning, homogenization, and perinuclear clearing were evident in all cases of hybridization-confirmed HL; however, these changes were also noted in 75% (9/12) of the cases with negative hybridization results. Most confirmed HL cases exhibited both nuclear homogenization and inclusions, although the former was more consistently seen.
CONCLUSION: Cytoplasmic changes did not agree well with EBV-DNA hybridization results, whereas nuclear changes demonstrated good, but not complete, agreement. In appropriate clinical settings, the finding of nuclear inclusions and/or homogenization may be of diagnostic value. However, because the potential for false positives and negatives is high, H&E cytopathology should not be used as a substitute for in situ hybridization in the definitive diagnosis of oral hairy leukoplakia.     

Spontaneous Peritonitis in Cirrhotic Hospital In-patients: Retrospective Analysis of 101 Cases

One hundred and one patients with cirrhosis resulting from alcoholabuse, admitted to Broussais University Hospital, Paris, betweenJanuary, 1986 and December, 1989 were assessed for infectionof the ascitic fluid using clinical and cytobacteriologicalcriteria. All of 46 patients (45.5%) with clinical signs andsymptoms of peritonitis had an ascitic fluid polymorphonuclear(PMN) count > 250 cells/mm³. Bacteria could be isolated fromthe ascitic fluid of 23 patients (50%). Twenty-six bacterialstrains were isolated(there was more than one strain in twosamples). Escherichia coli was found in 14 cases. It is noteworthythat no anaerobes were grown. Mortality, biochemical parametersand clinical features correlated significantly with an asciticfluid PMN count > 250 cells/mm³. High mortality correlatedwith a PMN count > 1000 cells/mm³ (70% vs. 33%).     

胰岛素分泌细胞的干细胞来源及其移植后命运

目的:干细胞诱导分化成的胰岛素分泌细胞移植是治疗糖尿病的方法之一,但因其诱导方法尚未完善及植入体内后的存活分化命运不清等问题而未应用于临床。文章就胰岛素分泌细胞的干细胞来源及其植入体内的命运加以综述。资料来源:应用计算机检索PUBMED1998-01/2007-03期间的相关文章,检索词为“insulin producing cell,cell transplantation,survival”,并限定文章语言种类为English。同时计算机检索中国期刊全文数据库1996-01/2006-12期间的相关文章,检索词为“胰岛素分泌细胞,胚胎干细胞,成体干细胞”,并限定文章语言种类为中文。资料选择:对资料进行初审,并查看每篇文献后的引文。纳入标准:文章所述内容应与胰岛素分泌细胞的干细胞来源或其植入体内后的存活分化相关。排除标准:重复研究。资料提炼:共收集到264篇相关文献,30篇文献符合纳入标准,排除的234篇文献为内容陈旧或重复。符合纳入标准的30篇文献中,分别涉及诱导为胰岛素分泌细胞的干细胞来源、胰岛素分泌细胞移植后的有效性、安全性、解决方法等内容。资料综合:糖尿病是由于胰岛素分泌不足及胰岛素抵抗造成糖代谢紊乱影响人类健康的主要疾病。不管是采用胰腺移植还是胰岛移植都因各种原因而限制了其在临床的应用,因此焦点放在了胰岛素分泌细胞上,包括其来源及移植后的命运。胰岛素分泌细胞来源于胚胎干细胞和成体干细胞,干细胞是一种具有自我更新,能够持续分裂而保持未分化状态,从而诱导分化为各种类型的细胞,因此有“种子细胞”之称。随着研究的深入,发现胰岛素分泌细胞的来源并不是问题,而问题的关键在于如何提高分化率及其移植后的命运,包括有效性、安全性以及解决方法。诱导产生的胰岛素分泌细胞表达活性低下、移植后其再生增殖能力差及容易被诱导凋亡等问题成为有效性最大的威胁,移植后的细胞易受免疫攻击和致瘤等问题也不容忽视。目前已开始着手以基因手段,从信号转导水平对其进行研究解决。结论:由胚胎干细胞和成体干细胞诱导分化的胰岛素分泌细胞,植入体内后有可能通过导入基因GLP-1,用表达B7-H4蛋白的质粒转染293T细胞和激活胰岛素/胰岛素样生长因子1等信号转导途径来解决有效性问题,但仍存在着安全性隐患,无法排除免疫抑制和致瘤的可能性。     

Anastomotic devices for coronary artery bypass grafting: technological options and potential pitfalls

With the advent of off-pump coronary artery bypass grafting and minimally invasive coronary artery bypass grafting, significant efforts have been made to facilitate construction of the graft to coronary anastomosis. As a result, a number of anastomotic devices have been developed. While the ideal anastomotic device should be easy to use, to produce a geometrically optimal anastomosis with minimal endothelial damage and minimal blood-exposed non-intimal surface, a number of design constraints apply. This review collects the available pre-clinical and clinical data for some of the devices with special regard for surgical outcome, patency rate and the need for additional perioperative anticoagulation treatment.     

Radiotherapy for childhood cancer and risk for congenital malformations in offspring: a population-based cohort study

Offspring of childhood cancer survivors may be at risk of genetic disease due to the mutagenic cancer treatments received by their parents. Congenital malformations were evaluated in a population-based cohort study of 1715 offspring of 3963 childhood cancer survivors and 6009 offspring of 5657 survivors' siblings. The Danish Central Population Register, Cancer Registry and Hospital Register were used to identify study subjects and congenital malformations. Gonadal and uterine radiation doses were characterized based on standard radiation-treatment regimens. The prevalence of congenital malformations at birth in offspring of survivors (44 cases, 2.6%) was slightly higher but not statistically different from that of offspring of siblings (140 cases, 2.3%) [prevalence proportion ratio (PPR), 1.1; 95% confidence interval, 0.8–1.5] or of the general population (observed-to-expected ratio, 1.2; 0.9–1.6). Including malformations diagnosed later in life did not change the ratios appreciably. The risk for malformations was slightly higher in the offspring of irradiated parents than in that of non-irradiated parents (PPR 1.2 vs 1.0) but was unrelated to gonadal dose. This study provides evidence that cancer therapy of children does not increase the risk for malformations in their offspring. Continued monitoring of genetic risks among their offspring, however, is warranted.     

The impact of motherless paternity testing in a South African population

BackgroundPaternity investigations play an important role in determining biological relatedness, and in South Africa, the outcome of these investigations impacts medical, judicial and home affairs decisions. Short Tandem Repeat (STR) analysis is utilised to perform paternity and kinship analysis, due to the polymorphic nature of STR loci. The cost associated with paternity testing is high, and there is a demand for motherless testing.ObjectivesThis study aims to determine what the impact of motherless testing would have been by evaluating 6182 paternity trio cases.MethodsThe AmpFLSTR™ Identifiler™ PCR Amplification kit was used to profile each of the trio cases. A scenario was created where the mother was eliminated from the test results to determine if the paternity outcome would change.ResultsPutative fathers were excluded in 27% of all cases, and in 2.5% of those cases, putative fathers would have been falsely included, had the mother not been tested. These false inclusions are attributed to coincidental STR loci that are shared between the mother and the putative father. The addition of loci to the STR profiling kit may resolve the issue; however, comparable STR data with more loci will have to be evaluated to ensure it overcomes the issue of coincidentally shared loci between unrelated individuals.ConclusionWe would recommend that within our setup and within similar setups, the mother always be included for testing, except in extreme scenarios such as death. False inclusion of putative fathers could have serious legal implications for testing laboratories.