Morphological and molecular characteristics of living human fetuses between Carnegie stages 7 and 23: ultrasound scanning and direct measurements

The developmental age of an embryo in the first trimester ofpregnancy is generally determined by ultrasound scanning and/orby calculation from menstrual age. In the original studies,validation of the estimate of gestational age by ultrasoundwas not possible as the exact date of conception was unknown.Variation in growth rates of identically aged fetuses has previouslybeen reported after assisted conception and with the use ofultrasound scanning. As these pregnancies were ongoing the accuracyof the scanning results could not be determined. Comparisonof scanning and direct measurements after termination of pregnancyand menstrual age were carried out to determine the accuracyin fetal dating. The results suggest that the use of ultrasoundscanning to determine gestational age is of less use than previouslythought, and that the use of menstrual age is severely limited.     

Dimensional accuracy and stability of polymethyl methacrylate reinforced with metal wire or with continuous glass fiber

The aim of this study was to determine the dimensional accuracy and stability of denture base polymethyl methacrylate (PMMA), which was reinforced in various ways. Autopolymerizing PMMA and heat-cured PMMA were reinforced either with semicircular steel wire or with a prefabricated experimental reinforcement made of continuous E-glass fiber. Control specimens had no reinforcement. The width of each U-shaped test specimen was measured with a digital micrometer under a light microscope immediately after the test specimen was cured and when stored in water for 1, 2, 7, and 14 days. The results revealed that both the type of PMMA and the type of reinforcement affected the dimensional accuracy of the test specimens, especially after 7 and 14 days in water storage (p < 0.001). The greatest dimensional accuracy was found with the unreinforced test specimen made from autopolymerizing PMMA and with test specimens reinforced with the metal wire made from heat-cured PMMA. In terms of the width of the test specimens, the lowest dimensional accuracy was found in unreinforced and glass fiber reinforced specimens made from heat-cured PMMA. Storage in water did not affect the stability of the width (p> 0.1). The results suggest that the polymerization shrinkage of PMMA causes lower dimensional accuracy of the test specimens reinforced with glass fiber. This should be considered when glass-fiber reinforcement is used clinically.     

Congenital central hypoventilation syndrome and Hirschsprung's disease

Five cases of the Hirschsprung's disease-congenital central hypoventilation syndrome (CCHS) association are presented and 41 other published cases reviewed. These children have a distinct pattern of associated features, an equal sex incidence, and a characteristic spectrum of disease severity which suggests that the condition is genetically distinct from other cases of Hirschsprung's disease. While approximately 1.5% of Hirschsprung's disease patients, and 10% of those with total colonic aganglionosis, will have CCHS, up to 50% of CCHS patients will have Hirschsprung's disease. Approximately 20% of CCHS/Hirschsprung patients will also have neuroblastoma or ganglioneuroma, usually multiple. Abnormalities of the eye and autonomic nervous system are also common. The ventilatory abnormality is usually evident on the first day of life. The aganglionosis is also severe, with more than half (59%) of the patients having aganglionosis extending into the small bowel.     

Routine vaccination and vaccine-preventable infections in children born to human immunodeficiency virus-infected mothers

Information on vaccinations and vaccine-preventable infections collected in a prospective study of children born to human immunodeficiency virus (HIV)-infected mothers was analysed for reports of adverse reactions and to estimate the clinical efficacy of vaccines. No vaccinated, HIV-infected child developed measles (56 child-years'follow-up), mumps (33), rubella (33) or pertussis (239), and only one adverse reaction - to Bacillus Calmette-Guerin (BCG) - was reported. These findings provide limited evidence of the safety and efficacy of routine vaccination of HIV-infected children.     

Oral manifestations of secondary syphilis in the elderly – a timely reminder for dentists

Syphilis is a sexually transmitted infectious disease caused by Treponema pallidum. Cases of syphilis have increased in frequency and are challenging when affecting the elderly. The main causes of increased prevalence of syphilis are sexual promiscuity, lack of knowledge about the disease and decreasing use of barrier protection. Clinically, the oral manifestation of syphilis may resemble other entities, which hampers the correct diagnosis. We report a case of a 79‐year‐old male with weight loss and feeding difficulties. In the oral cavity there were ulcerative lesions in the hard palate and bilaterally in the buccal mucosa. The incisional biopsy revealed only a non‐specific ulceration of the oral mucosa. After 20 days, the patient was re‐evaluated and presented maculopapular lesions in the palmar and plantar areas. Positive serological venereal disease reference laboratory (VDRL) tests confirmed the diagnosis of secondary syphilis. The patient was treated with Benzathine penicillin G. After two weeks of treatment the oral lesion disappeared and the patient returned to normal feeding and gained weight. This case report reinforces the need to alert physicians and dentists to include sexually transmitted infections such as syphilis in the differential diagnosis of oral ulcerative lesions in elderly sexually active patients.     

Identification of normal human peripheral blood monocytes and liver as sites of synthesis of coagulation factor XIII a-chain

Factor XIII is the fibrin-stabilizing factor that covalently cross- links fibrin monomers to form a highly organized, stable fibrin clot. The plasma form of factor XIII is a heterodimer, a2b2, consisting of two a-chains and two b-chains; the intracellular form, such as in platelets and placenta, is a dimer, a2, consisting of a-chains only. The catalytic function of factor XIII, a transglutaminase, resides in the a-chain. To address questions regarding sites of synthesis of factor XIII a-chain, an EcoRI restriction fragment from the protein- coding region of the factor XIII a-chain cDNA was used as a probe for Northern blot analysis. The cDNA probe showed hybridization with a single approximately 4.0-kilobase (kb) message in poly (A)+ mRNA prepared from normal human peripheral blood monocytes and normal human liver. The results demonstrate conclusively that factor XIII a-chains are actively synthesized in circulating monocytes and in liver. To our knowledge, these data represent the first demonstration of synthesis of any blood coagulation factor in primary uncultured and unstimulated monocytes or macrophage cells.