Muscular dystrophy misdiagnosed as hepatic disease in a child with coeliac disease

A 13-month-old boy presented with elevated serum aminotransferases and a flat small bowel mucosa indicating coeliac disease. He improved clinically on a gluten-free diet but serum aminotransferases continued to increase. This was found to be caused by an occult Duchenne muscular dystrophy. The case illustrates the fact that the finding of elevated serum aminotransferases in a coeliac child on a gluten-free diet should indicate that further investigations are needed to exclude coexisting disease.     

4-甲氧羰基芬太尼非芳基类似物的合成及镇痛作用

报道了某些4-N-苯基或4-N-苯基与1-β苯基同时被某些非芳香基团替代的4-甲氧羰基芬太尼衍生物的合成及其镇痛活性。结果表明,4-N-苯基和1-β-苯基被某些适宜非芳香基团替代可保持强效镇痛活性。分子中不含苯(或芳)基的化合物4和6的镇痛活性分别是吗啡活性的695倍和818倍。讨论了结构与镇痛活性之间的关系。     

Intracervical versus vaginal misoprostol for cervical dilatation prior to operative hysteroscopy—a comparative study

Background

Hysteroscopic surgery requires pre-operative cervical ripening to facilitate adequate dilatation of the cervix for insertion of operative hysteroscope. This study was conducted to compare the efficacy of intracervical misoprostol with vaginal misoprostol in achieving cervical ripening before operative hysteroscopy.

Methods

In this randomised comparative study conducted at a tertiary care teaching hospital, 56 patients needing operative hysteroscopy were divided into two groups of 28 patients, one for intracervical misoprostol and the other for vaginal misoprostol. Four hundred microgram of misoprostol was inserted on the night before and in the morning of operative hysteroscopy intracervically in group I and vaginally in group II.

Results

Primary outcome measure was number of patients achieving 7 mm preoperative dilatation of cervix. Largest Hegar dilator that could be passed into the uterine cavity past the internal optic sheath without resistance was noted in each case. Mean cervical dilatation prior to operative hysteroscopy was calculated. In addition, incidence of slipping of vulsellum and cervical laceration was also noted. Time to achieve full cervical dilatation was recorded. In 23/28 cases of group I and 5/28 in group II, size 7 Hegar dilator could be passed without effort. Mean cervical dilatation was 7.5 mm in group I and 5.7 mm in group II. Slipping of the vulsellum and cervical lacerations were seen in significantly less patients in group I. Mean time to achieve cervical dilatation to 10 mm was 43.39 seconds in group I and 103.96 seconds in group II (P<0.0001).

Conclusion

Intracervical administration of misoprostol is an effective method of achieving cervical ripening for easy cervical dilatation up to 10 mm prior to operative hysteroscopy.     

Test pattern for video displays and hard-copy cameras

Members of a Subcommittee of the Society of Motion Picture and Television Engineers, with the cooperation of other professional societies, have developed specifications for an operational test pattern for evaluation of television monitors and film recording cameras used in medical diagnostic imaging. The purpose of this test pattern and the associated recommended practice is to provide the users of the medical diagnostic display systems with a comprehensive test for set-up, acceptance testing, and day-to-day operational checks. Details of the test pattern, examples of the system problems diagnosed by use of the pattern, and methods for optimizing display devices with the pattern are presented.     

Total body irradiation and high-dose etoposide: a new preparatory regimen for bone marrow transplantation in patients with advanced hematologic malignancies [published erratum appears in Blood 1987 Jun;69(6):1789]

In a phase I/II study, 47 patients (median age, 24 years) with hematologic malignancies (33 patients with acute leukemia not in first remission and 14 patients with other advanced malignant hematologic disorders) were treated with total body irradiation and high doses of etoposide (VP16-213) followed by bone marrow transplantation. At the time of analysis, 21 patients were alive, and 19 of them were in continued complete remission for 101 days to greater than 40 months (median, 12 months). The actuarial disease-free survival rate of the 33 acute leukemia patients is 43% (2 SEM, 18%) and the actuarial relapse rate is 32% (2 SEM, 20%). Five of the 14 patients with the other hematologic malignancies are alive, and four of them continue to be free of disease for 8 to 27 months. Pharmacokinetic studies established a strong correlation between the administered drug doses and their plasma levels and also demonstrated complete drug clearance prior to marrow grafting. An etoposide dose of 60 mg/kg body weight was found to be the maximum tolerated dose. This new preparatory regimen was well tolerated and was not associated with specific acute or long-term regimen-related toxicities. Our data suggest that total body irradiation with high-dose etoposide presents a viable alternative to other preparatory regimens. The role of this novel combination remains to be defined by future prospective randomized trials.     

1141612823Effect of recombinant ovine intereferon tau (IFN) on the ovine Mx1 promoter/enhancer region

Ovine Mx1 (oMx1) is expressed in the uterus during the estrous cycle and is strongly up-regulated during early pregnancy in the uterus and peripheral blood leukocytes. Mx proteins are GTPases which are important elements in innate immunity. Our results showed that steroids are required for oMx1 protein induction by IFN in the uterus. To addresses the role of IFN in regulating oMx1 expression, a 2.1 kb fragment containing 1.7 kb of the promoter/enhancer, exon1 and partial intron A was cloned. Serial deletions were prepared along with a clone that contained the 2 promoter-ISREs (-101 & −145) but not the intronic-ISRE (+224). An ovine uterine cell line was transfected with reporter plasmids driven by the oMx1 promoter deletion constructs. The full-length promoter was induced by IFN in a dose- and time-dependent manner. Treatment with 10,000 AVU/mL IFN increased luciferase activity 5- and 10-fold at 3 and 12 hr, respectively. Promoter deletions showed the 2 proximal ISRE (−101 and −145), but not an intronic ISRE (+244), were required for maximal response. Deletion of a distal region (−920 to −715) resulted in decreased luciferase activity (~4-fold). However, subsequent deletion of the −715 to −437 region restored maximal promoter response (~10-fold). Results suggest that regions −920 to −715 and −715 to −437 have positive and negative regulatory element binding sites, respectively. The importance of the 2 proximal ISRE sites for oMx1 promoter activation is consistent with results for the human MxA promoter. An intronic ISRE is present in the human MxA gene, however, this site may not be required for oMx1 promoter activation by IFN. Identifying positive and negative regulatory regions in oMx1 promoter may help elucidate the unique regulation of Mx1 during early pregnancy.     

The effect of various doses of mifepristone on endometrial leukaemia inhibitory factor expression in the midluteal phase--an immunohistochemical study

Leukaemia inhibitory factor (LIF) is a cytokine which plays an obligatory role in mouse blastocyst implantation. In human endometrium, LIF expression is significantly increased in the mid-luteal phase indicating that LIF may also play an important role in the human. We have previously shown that a single dose of 200 mg of mifepristone immediately post-ovulation is an effective contraceptive method, probably due to inhibition of endometrial development and function. The purpose of this study was to investigate the effect of various doses of mifepristone on endometrial LIF expression. A total of 22 fertile, regularly-menstruating women were studied during control and treatment cycles. The subjects were divided into four groups: group I received a single dose of 200 mg of mifepristone on cycle day LH + 2 (n = 7). The subjects in groups II and III were treated with either 5 mg (n = 5) or 2.5 mg (n = 5) once a week for 2 months. Group IV subjects received 0.5 mg per day (n = 5) of mifepristone for 3 months. LIF was measured immunohistochemically in endometrial tissue specimens taken on the corresponding day (cycle day LH + 6 to LH + 8) in hormonally- characterized control and treatment cycles. LIF immunostaining was observed in all controls and located to the cytoplasm of the luminal and glandular epithelial cells and stromal cells. In the treatment cycles the staining of luminal epithelium and stroma was similar to controls, while the glandular staining was reduced in all treatment groups. This study reveals that early luteal phase treatment as well as intermittent or daily low dose treatment with mifepristone reduces endometrial glandular LIF expression at the expected time of implantation. The results further support the contraceptive potential of mifepristone in low doses.      

Adhesion-dependent survival of normal and leukemic human B lymphoblasts on bone marrow stromal cells

We investigated the requirement for intimate contact between bone marrow stroma and B lymphoblasts from normal donors and children with leukemia. By scanning electron microscopy, both normal and leukemic cells seeded onto stroma were surrounded by folds of stromal cells or were linked to the stroma by fine tendrils and uropods. Separation of normal B progenitors from stroma by use of microporous membranes led to significantly lower cell recoveries compared with results when contact was unimpeded. For instance, 22.5% +/- 1.8% (mean +/- SEM) of CD19+, CD34+ cells (most immature subset) were recovered after a 7-day culture directly on stroma, compared with 5.2% +/- 0.7% after growth on membranes (P < .001 by Student's t test). In 6 of 11 cases of B-lineage acute lymphoblastic leukemia, separation of progenitors from stroma resulted in apoptosis and a greater than 60% reduction in cell recovery. In the remaining 5 cases, however, this effect was much less pronounced, with reductions in cell recoveries ranging from 48.5% to less than 1% (median, 39.0%) of control values. Inhibition of very late antigen-4, a surface molecule critical for adhesion of B lymphoblasts to stroma, was associated with a greater loss of normal CD34+ B progenitors compared with that for equivalent leukemic cells. These results establish direct contact with stroma as a survival requirement of normal B lymphoblasts and show marked heterogeneity in stromal dependency among B-lineage leukemic cells.