Diagnosis of Hirschsprung's disease by punch biopsy of rectum

234 punch biopsy specimens of rectal tissue were taken from 112 children. In 94% of the patients the diagnosis of Hirschsprung's disease was confirmed or refuted by the first biopsy. There were no false-positive or false-negative results. One patient developed a serious complication, a pelvic haematoma.     

Relationship between clinical severity of respiratory syncytial virus infection and subtype

The relationship between clinical severity of respiratory syncytial virus (RSV) infection and distribution of subtype A or B was investigated. The data of 232 children, who were admitted with RSV infection or diagnosed in the outpatient department of the Sophia Children's Hospital, Rotterdam between 1992 and 1995, were studied. The diagnosis of RSV was confirmed by a direct immunofluorescence assay. Subtyping was performed by an indirect immunofluorescence assay using specific monoclonal antibodies. Gender, age at diagnosis, gestational age and birth weight, the presence of underlying diseases, feeding difficulties, the presence of wheezing and retractions, respiratory rate, temperature, clinical diagnosis at presentation, oxygen saturation (SaO2), carbon dioxide tension (PCO2), and pH, characteristics of hospitalisation, and the need for mechanical ventilation were observed. Analysis was performed on data from all patients diagnosed with RSV infection in the period between 1992 and 1995 spanning three RSV seasons, and separately on the RSV season 1993-4. The outcome of the three year analysis (150 (64.7%) subtype A v 82 (35.3%) subtype B) was compared with the outcome of the season 1993-4, a mixed epidemic with 37 (60.7%) subtype A and 24 (39.3%) subtype B isolates. None of the variables observed in the season 1993-4 differed significantly between RSV subtype A and B. Similar results were obtained from the analysis in the period 1992 until 1995, with the exception of PCO2 (a higher PCO2 was found in subtype A, p < 0.001) and retractions (more retractions were noted in patients with subtype A, p = 0.03). After correcting for possible confounders using regression analysis, these differences were not significant anymore. The data indicate that there is no relationship between clinical severity of RSV infection and subtype.     

Results of ovulation induction using human menopausal gonadotropin or purified follicle-stimulating hormone in hypogonadotropic hypogonadism patients.

OBJECTIVE: To compare ovarian performance and hormonal levels, after ovulation induction, in patients with isolated hypogonadotropic hypogonadism, using two different gonadotropin drugs. DESIGN: Patients were treated during consecutive cycles, using the same stimulation protocol, with human menopausal gonadotropin (hMG) in the first treatment cycle and purified follicle-stimulating hormone (FSH) in the second one. SETTING: Specialist Reproductive Endocrine Unit. PATIENTS, PARTICIPANTS: Nine patients with isolated hypogonadotropic hypogonadism. MAIN OUTCOME MEASURE: Duration of stimulation, number of leading follicles, serum estradiol (E2) concentration and endometrial thickness at the time of human chorionic gonadotropin administration, and the occurrence of ovulation. RESULTS: Compared with hMG, treatment with purified FSH required significantly more ampules of drug (P less than 0.04) but resulted in a significant reduction in the number of leading follicles (P less than 0.05), serum E2 concentrations (P less than 0.002), endometrial thickness (P less than 0.02) and the occurrence of ovulation (P less than 0.05). CONCLUSION: This study in isolated hypogonadotropic hypogonadism patients is consistent with the two-cell two-gonadotropin hypothesis, that both gonadotropins are required to accommodate their synergistic action for appropriate steroidogenesis. In treating this group of patients, the superior efficacy of hMG compared with purified FSH preparation is beyond question.     

Antibodies to Cardiolipin in Stroke: Association with Mortality and Functional Recovery in Patients Without Systemic Lupus Erythematosus

Antibodies to cardiolipin were measured in 100 consecutive patientswith first ever stroke, on admission and at three and six monthsafter the acute event. One hundred healthy, age-and sex-matched,British elderly individuals were also screened for antibodiesto cardiolipin as a control group. Elevated levels of anticardiolipin antibody (i.e. 5SD abovethe laboratory control mean) were present in none of the controlgroup, but in 21 per cent of the patients with stroke. Thirteenof these 21 patients (62 per cent) died within three months,compared to 17 (21.5 per cent) of the seventy-nine patientswithout elevated levels of anticardiolipin antibodies (p<0.001).Six of the eight survivors with persistently elevated anticardiolipinantibodies had significant residual disability following stroke(Barthel score 0–9) compared to 11 of the 62 without (p<0.001).Two patients with initially raised anticardiolipin antibodieswho became independent at six months showed a progressive declinein the level of these antibodies to normal. The presence of high levels of anticardiolipin antibody didnot correlate with other recognized prognostic indices of stroke,except for incontinence. No correlation was noted between levelsof antibody to cardiolipin, antinuclear factor, antibody todouble-stranded DNA and C-reactive protein, either in the strokepatients or in the elderly control population. Hypertensionwas significantly more common in the patients with high anticardiolipinantibodies than in the rest of the patients in the stroke population(p=0.33). There was no correlation between levels of anticardiolipinantibody and age. Anticardiolipin antibody may be consideredas an independent prognostic marker for both mortality and clinicaloutcome after acute stroke.