Epstein–Barr virus‐positive post‐transplant lymphoproliferative disorder of the central nervous system,after renal transplantation with a discrepancy in viral load between peripheral blood and cerebrospinal fluid

A 43‐year‐old female developed an Epstein–Barr virus (EBV)‐positive post‐transplant lymphoproliferative disorder (PTLD) in the central nervous system (CNS), 14 years after renal transplantation. One year prior to presentation, the patients’ treatment regimen was altered from cyclosporine, azathioprine, and prednisone to mycophenolate mofetil and prednisone. Magnetic resonance imaging of the brain revealed lesions suspect for malignant lymphoma. The EBV real‐time polymerase chain reaction (PCR) on peripheral blood was negative, but highly positive on cerebrospinal fluid. EBV‐positive PTLD was confirmed using histological analysis of cerebral biopsies. Despite tapering of immune suppressive medication and treatment with rituximab and chemotherapy, the patient deceased 50 days after presentation. This case illustrates that vigilance is required when presented with a negative EBV PCR result on peripheral blood when PTLD of the CNS is suspected. This late presentation suggests a relation to the switch in immunosuppressive regimen 1 year earlier.     

The additional effect of orthotic devices on exercise therapy for patients with patellofemoral pain syndrome: a systematic review

The aim of the study is to determine "the additional effect of... function" for patellofemoral pain syndrome (PFPS). The additional effect of orthotic devices over exercise therapy on pain and function. A systematic literature search was conducted in MEDLINE, CINAHL, EMBASE, Cochrane and PEDro. Randomised controlled trials and controlled clinical trials of patients diagnosed with PFPS evaluating a clinically relevant outcome were included. Treatment had to include exercise therapy combined with orthotics, compared with an identical exercise programme with or without sham orthotics. Data were summarised using a best evidence synthesis. Eight trials fulfilled the inclusion criteria, of which three had a low risk of bias. There is moderate evidence for no additive effectiveness of knee braces to exercise therapy on pain (effect sizes (ES) varied from -0.14 to 0.04) and conflicting evidence on function (ES -0.33). There is moderate evidence for no difference between knee braces and exercise therapy versus placebo knee braces and exercise therapy on pain and function (ES -0.1-0.10). More studies of high methodological quality are needed to draw definitive conclusions.     

Neonatal Maternally Deprived Rats have as Adults Elevated Basal Pituitary-Adrenal Activity and Enhanced Susceptibility to Apomorphine

Maternal deprivation of neonatal rats for 24  h enhances the adrenocortical response to stress and/or adrenocorticotropin hormone (ACTH) stimulation during the stress hyporesponsive period (SHRP). The present study tests the hypothesis that such maternally deprived neonatal male rats show altered hypothalamic-pituitary-adrenal (HPA) regulation not only immediately after deprivation but also in later life. In addition, we found previously that neonatal changes in HPA activity preceded modulation of nigrostriatal dopamine function. Therefore, we also measured dopamine responsiveness in adult rats which were deprived of their mother during infancy.     

Orthostatic blood pressure control in Marfan's syndrome

A 33-year old male patient, with Marfan's syndrome, reportedsymptoms of orthostatic intolerance and fatigue as a longstandingproblem. Orthostatic cardiovascular examination showed poororthostatic tolerance, with a rise in heart rate and a fallin arterial blood pressure and cerebral blood flow velocity.Self-discovered physical counterpressure manoeuvers improvedsymptoms, related to a substantial increase in arterial pressureand cerebral perfusion. When orthostatic complaints are reportedby patients with Marfan's syndrome, physical counterpressuremanoeuvers should be advised to reduce symptoms of posturalhypotension.     

Localization of phosphatidylserine in isolated chick epiphyseal cartilage matrix vesicles with trinitrobenzenesulfonate

Summary Rabbit serum albumin labeled with¹²⁵I was injected into rabbits (650–870 g). The incorporation pattern of the labeled albumin into the developing dentine and enamel matrix was studied 1 h, 6 h, and 3 days after the injection using autoradiography. Silver grains were observed over the predentine 1 h after the injection. They were found over the dentine matrix adjacent to the predentine-dentine junction at 6 h. The silver grain band was concentrated over the internal dentine matrix at 3 days. However, no appreciable amount of the silver grains could be seen over the enamel matrix at any time after the injection. It is possible that there might be some physiological barrier between the extravascular fluid and the enamel matrix. The role of the albumin in dentine is discussed.     

Effectiveness of customary use of phytosterol/-stanol enriched margarines on blood cholesterol lowering.

Postlaunch monitoring of functional foods can encompass monitoring of effectiveness under conditions of customary use. To this end, the effectiveness of phytosterol/-stanol enriched margarine consumption in free-living conditions was investigated with data from the Dutch "Doetinchem cohort study". In total, 4,505 subjects (aged 26-70 years) were examined in 1994-1998 and re-examined during 1999-2003. A general and a food frequency questionnaire and non-fasting blood samples for total and HDL cholesterol determination were obtained. Subjects were stratified into phytosterol/-stanol enriched margarine users (n = 84) and non-users (n = 4,421) based on the re-examination data, as these margarines were available on the Dutch market from 1999 onwards. Mean spontaneous daily use (g +/- SD) of phytosterol-containing margarine (n = 71) was 15 +/- 8 and of phytostanol-containing margarine (n = 13) 9+/-6. After five years, total blood cholesterol had increased with 0.26 mmol/l in non-users while it had not significantly changed in users. The difference in total blood cholesterol change in users versus non-users was -0.30 mmol/l (p < 0.001). The beneficial effect of the phytosterol/-stanol enriched margarine, used under customary conditions can be characterized as a stabilization of cholesterol levels. This is the first report finding a modest beneficial effect on blood cholesterol level under customary conditions thereby partly confirming findings from clinical trials.     

Epidemiological disaster research: the necessity to include representative samples of the involved disaster workers. Experience from the epidemiological study air disaster Amsterdam-ESADA

OBJECTIVE: To study whether the methods used to select participants in research on prevalence rates of the health effects of exposure to a disaster may cause bias. This study compared background characteristics, disaster exposure, and complaints reported by (1) police officers who participated in an epidemiological study and underwent a medical examination, and (2) police officers who only participated in an epidemiological study. DESIGN AND SETTING: In 2000, an epidemiological study was started to investigate the health status among police officers who were involved in assistance work related to the air disaster in Amsterdam: the epidemiological study air disaster Amsterdam (ESADA). These police officers were personally invited to participate in the epidemiological study and were additionally offered a medical examination, providing them with the opportunity to have their health checked by a medical doctor. PARTICIPANTS: Of the total group of involved police officers who were invited, 834 (70%) participated in the ESADA: 224 (26.9%) only participated in the study, but 610 (73.1%) also underwent the medical examination. MAIN RESULTS: Police officers who underwent a medical examination significantly more often reported one or more musculoskeletal complaints, skin complaints, general or non-specific complaints, had more often experienced an event with potentially traumatic impact, or had performed one or more potentially traumatic tasks. CONCLUSIONS: The methods of selection of participants are important in research on health effects after disasters and can result in an overestimation of some of the effects, on average, by a factor of 1.5 to 2.     

Continuous indomethacin infusion may be less effective than bolus infusions for ductal closure in very low birth weight infants

The effectiveness of continuous indomethacin (INDO) infusion versus bolus infusions for closure of patent ductus arteriosus (PDA) was investigated. The study design was an open-label case series (continuous INDO) with historic controls matched for gestational age (bolus INDO). Ductal closure rates were determined in two groups: 16 preterm infants with PDA treated with continuous INDO infusion (CONTIN group) and 16 control patients, matched for gestational age, who received bolus INDO infusions (BOLUS group). The total dosage was the same for both groups. PDA closed in seven of 16 preterm infants in the CONTIN group and in 13 of 16 in the BOLUS group ( p = 0.033, Fisher's exact test). In infants < 1000 g it was two of eight in the CONTIN group and 10 of 10 in the BOLUS group ( p = 0.002). Continuous INDO infusion was more likely than bolus infusion to be associated with failure of ductal closure (odds ratio, 19; 95% CI, 1.5 to 247; p = 0.023). This indicates that continuous infusion of INDO may be less effective in closing PDA than bolus infusions, especially in extremely low birth weight infants.