Pelvic ultrasound measurements in normal girls

Pelvic ultrasound scans were carried out in 153 normal girls aged between 3 days and 14.9 years, in order to obtain reference data for ovarian volume, uterine length and uterine configuration. The right ovary was significantly larger than the left (by about 17%). Ovarian volume increased exponentially with age, over this age range. No relationship with pubertal stage (independent of age) could be demonstrated. Uterine length decreased from birth to 4 years, before steadily increasing. The fundalcervical ratio (FCR) decreased initially then increased to lie above 1.0 by 15 years of age. A midline endometrial echo was seen in half of the subjects aged less than 6 months, but otherwise it was not seen before 11.8 years of age or at Tanner stage B2. Smoothed reference centile curves for uterine length, right and left ovarian volume were produced, allowing z scores (or SD scores) to be calculated for each measurement.     

Duration of growth suppressive effects of regular inhaled corticosteroids

The growth of 50 children receiving regular inhaled corticosteroids was segregated into divisions of six weeks from the start of treatment and compared with their growth when not receiving regular corticosteroids using a random effects regression model. Growth suppression was most marked during the initial six weeks after starting treatment, with most suppression occurring during the initial 18 weeks. Thereafter the children's growth was similar to their growth when not receiving treatment. These findings have important consequences for patterns of treatment of asthma in children.     

Do sequence variants in the major non-coding region of the mitochondrial genome influence mitochondrial mutations associated with disease?

Several different mutations in human mitochondrial DNA (mtDNA) have been associated with disease, but their origins and the basis of the wide phenotypic variability remain to be elucidated. We initially investigated three patients with heteroplasmic disease associated mutations of mtDNA for the presence of cis mutations in the major non- coding region that might influence their origins or pathology. A T --> C transition at nt 16 189 previously identified in one patient with the 3243 G:C mutation was associated with heteroplasmic length variation. Identical length variation was found in patient-derived cybrid lines containing 0-97.5% 3243 G:C. Similarly, heteroplasmic length variation was demonstrated in 2/6 other probands with both the 3243 mutation and the 16,189 polymorphism. The distribution of length variants in probands and in asymptomatic family members was identical in all cases. Thus length variation appears to be independent of the level of 3243 mutant mtDNA and hence probably arose within both 3243 G:C and 3243 A:T mtDNAs. We suggest that the 16,189 polymorphism reflects a predisposition to the formation or fixation of several different mutations in mitochondrial tRNA-LeuUUR.      

Ear-related problems among children attending the paediatric and otorhinolaryngology out-patients clinics of the University of Nigeria Teaching Hospital,Enugu

BackgroundEar related diseases are commonly seen in clinics worldwide especially among children. They are associated with significant morbidity and frequent hospital visits. Limited data exists regarding the burden of ear disease among Nigerian children.ObjectiveTo determine the prevalence of ear-related problems among children presenting at the Paediatric and Otorhinolaryngology clinics of the University of Nigeria Teaching Hospital, Enugu.ResultsThree thousand and twenty-one children were seen during the study period. Out of these, 248 children (8.2%) presented with ear-related problems. Chronic otitis media (30.5%), acute otitis media (29.9%), cerumen auris (11.3%), otitis externa (10.1%), hearing impairment (7.3%) and foreign body in the ear (5.7%) were the most commonly diagnosed ear-related problems.ConclusionEar-related problems among children presenting at the UNTH Enugu were not uncommon. However, otitis media was the most commonly diagnosed ailment affecting the ears in children.     

Pilot Trial Evaluating Mid-Regional Pro-Atrial Natriuretic Peptide as a Marker of Sepsis after Abdominal Surgery

Introduction

Mid-regional pro-atrial natriuretic peptide (MR pro-ANP) has been shown to be a diagnostic marker for sepsis. The objective of this pilot study was to evaluate the potential of MR pro-ANP in the diagnosis of postoperative sepsis.

Methods

We enrolled 18 patients with postoperative sepsis, 19 patients who underwent major abdominal surgery without sepsis and 9 healthy individuals as control subjects. MR pro-ANP, interleukin-6 (IL-6) and procalcitonin (PCT) were measured on the day of inclusion in the study, and at days 3, 7 and 10.

Results

The mean levels of MR pro-ANP were significantly higher in patients with postoperative sepsis than in patients without sepsis (two-way ANOVA p <0.0001). The best cut-off level for MR pro-ANP was determined to be 162.5 pmol/l, with a sensitivity of 100% and specificity of 68%. On the day of inclusion in the study, MR pro-ANP detected postoperative sepsis equally as well as PCT (Youden test P = 0.17). MR pro-ANP levels in patients with postoperative sepsis remained significantly elevated for 10 days, regardless of the clinical state, whereas falling levels of IL-6 and PCT indicated improvement of sepsis. The overall correlation of MR pro-ANP with IL-6 and PCT was therefore low (Pearson´s r 0.15 and 0.36, respectively).

Conclusions

MR pro-ANP may contribute to the diagnosis of postoperative sepsis, as its level can differentiate between elevation of other inflammatory markers due to abdominal surgery alone or postoperative sepsis.

     

Myocardial reperfusion injury and oxidative stress: Therapeutic opportunities

Acute myocardial infarction(AMI) is the leading cause of death worldwide. Its associated mortality, morbidity and complications have significantly decreased with the development of interventional cardiology and percutaneous coronary angioplasty(PCA) treatment, which quick-ly and effectively restore the blood flow to the area previously subjected to ischemia. Paradoxi-cally, the restoration of blood flow to the ischemic zone leads to a massive production of reactive oxygen species(ROS) which generate rapid and severe damage to biomolecules, generating a phenomenon called myocardial reperfusion injury(MRI). In the clinical setting, MRI is associated with multiple complications such as lethal reperfusion, no-reflow, myocardial stunning, and reperfusion arrhythmias. Despite significant advances in the understanding of the mechanisms accounting for the myocardial ischemia reperfusion injury, it remains an unsolved problem. Although promising results have been obtained in experimental studies(mainly in animal models), these benefits have not been translated into clinical settings. Thus, clinical trials have failed to find benefits from any therapy to prevent MRI. There is major evidence with respect to the contribution of oxidative stress to MRI in cardiovascular diseases. The lack- of consistency between basic studies and clinical trials is not solely based on the diversity inherent in epidemiology but is also a result of the methodological weak-nesses of some studies. It is quite possible that pharmacological issues, such as doses, active ingredients, bioavailability, routes of administration, co-therapies, startup time of the drug intervention,and its continuity may also have some responsibility for the lack- of consistency between different studies. Furthermore, the administration of high ascorbate doses prior to reperfusion appears to be a safe and rational therapy against the development of oxidative damage associated with myocardial reperfusion. In addition, the association with N-acetylcysteine(a glutathione donor) and deferoxamine(an iron chelator) could improve the antioxidant cardioprotection by ascorbate, mak-ing it even more effective in preventing myocardial reperfusion damage associated with PCA following AMI.     

The nitric oxide hypothesis of migraine and other vascular headaches

The molecular mechanisms of migraine pain remain to be determined. Our studies of glyceryl trinitrate (GTN)-induced and histamine-induced headaches have led us to propose that nitric oxide (NO) may be the causative molecule in migraine pain. We also propose that substances capable of inducing experimental vascular headache do so with NO as the common mediator. Finally, we suggest that drugs with antimigraine activity inhibit NO and the cascade of intracellular reactions triggered by NO. We believe these observations provide new insight into the mechanisms of vascular headache. The importance of NO as a potential initiator of the migraine attack indicates new directions for the pharmacological treatment of migraine and other vascular headaches.     

电解治疗慢性前列腺炎8例

目的 观察电化学治疗慢性非细菌性前列腺炎的临床效果。方法 将前列腺电化学治疗仪电极经尿道留置在前列腺尿道部，膀胱内持续灌注生理盐水，以提供电化学反应之电解质及冲洗膀胱，通电后在电极周围形成电场，产生的电化学(强碱)反应使部分前列腺组织变性坏死，破坏膀胱颈部及前列腺部尿道丰富的α-肾上腺素能受体，解除痉孪，达治疗目的。结果 8例慢性非细菌性前列腺炎患者经电化学治疗后，尿路刺激等临床症状缓解，前列腺液涂片镜检示白细胞数量恢复正常。结论 电化学治疗慢性非细菌性前列腺炎的疗效有临床意义。