Abdominal and hepatic uptake of 99mTc-pyrophosphate in neonatal necrotizing enterocolitis

Abdominal 99mTc-pyrophosphate (99mTc-PYP) scans were obtained in 15 neonates: 12 with neonatal necrotizing enterocolitis (NEC), two with osteomyelitis, and one with myocarditis. Ten of the babies with NEC had at least one positive scan; of these 10 studies, seven (Group A) showed both diffuse abdominal uptake and localized hepatic activity, two (Group B) showed abdominal uptake and questionable hepatic uptake, and one (Group C) demonstrated diffuse abdominal uptake only. The other two babies with NEC had normal scans (Group D). Pneumatosis intestinalis was unquestionably present in two patients from Group A and one from Group B. Upon resolution of the clinical findings, all NEC patients had normal scans. A patient with myocarditis had hepatic uptake of 99mTC-PYP while the abdominal scan in the two infants with osteomyelitis was normal. These preliminary observations suggest that further study of a relationship between abdominal scan findings and the course of NEC is warranted.     

Ultrastructural features of giant cell tumors in Paget's disease

Giant cell tumor is a rare complication of Paget's disease. This association is especially notable in patients originating from Avellino, Italy. Many types of evidence point to a viral etiology for Paget's disease and giant cell tumors arising in it. Three patients who had giant cell tumors and Paget's disease were studied. Two of the patients have a connection to Avellino (one was born in Avellino, and one descended from natives of Avellino). Distinctive light microscopic and ultrastructural features common in these three patients were identified. In all three patients, the giant cell tumors had peculiar irregular aggregates of microfilaments of uncertain genesis. The possibility that these reflect viral infection is discussed.     

Treatment of osteoporosis with sodium fluoride and calcium: effects on vertebral fracture incidence and bone histomorphometry

This article contains a report of the results of a study of 10 postmenopausal women with uncomplicated osteoporosis who were treated with sodium fluoride, calcium supplementation, and vitamin D. Spinal fractures ceased by 18 months, trabecular bone mass increased 26 per cent per year, and patients reported symptomatic improvement.     

Morton neuroma: sonographic evaluation

One hundred consecutive patients with symptoms suggestive of Morton neuroma were examined with sonography, and 134 intermetatarsal masses were demonstrated. Forty-five patients underwent surgical exploration, which revealed Morton neuromas. The typical sonographic appearance is that of an ovoid, hypoechoic mass oriented parallel to the long axis of the metatarsals. Most masses were between the second and third or third and fourth metatarsals and seemed to produce symptoms when reaching a diameter of 5 mm.     

Postoperative radionuclide evaluation of osteoid osteomas

Five cases of clinically suspected osteoid osteomas were studied by preoperative injection of technetium-99m methylene disphosphonate, intraoperative localization with a radiation-sensitive scintillation probe, and postoperative examination of the entire tissue specimen (including the presumed nidus and surrounding bone). Microradiography and light microscopy were also used. In addition, a new autoradiography technique was introduced in which the excised surgical specimen was placed on undeveloped x-ray film for pathologic localization, diagnosis of the lesions, and a study of the relative intensity of radioactive uptake in the nidus vs. surrounding bone. Autoradiography revealed that the nidus showed the greatest concentration of radioactivity, followed by the surrounding bone. The authors conclude that 99mTc can be used clinically in localizing osteoid osteomas and that preoperative and intraoperative scanning can assist in conservative surgical excision, e.g., minimal extirpation of bone in delicate areas such as the spine. For small lesions, autoradiography assists the pathologist in identifying an osteoid osteoma.     

Adenosine receptors on human leukocytes IV. characterization of an A1/Ri receptor

Summary Adenosine (10⁻⁹–10⁻⁶ mol/l) andR-phenylisopropyladenosine (10⁻⁹–10⁻⁷ mol/l) partially inhibited the intracellular accumulation of cyclic AMP induced by isoproterenol, prostaglandin E₁, histamine and 5′-N-ethylcarboxamidoadenosine in lymphocytes. In contrast,S-phenylisopropyladenosine, which is a poor agonist of the adenosine A₁/R_i receptor, had essentially no inhibitory effect. 8-Phenyltheophylline, in low concentrations that do not inhibit cyclic AMP phosphodiesterase, completely blocked the inhibitory effect ofR-phenylisopropyladenosine on the increase in cyclic AMP induced by prostaglandin E₁.R-Phenylisopropyladenosine (10⁻⁸–10⁻⁶ mol/l) also inhibited the cyclic AMP accumulation in lymphocytes induced by forskolin (10⁻⁵ mol/l), which activates adenylate cyclase through direct interaction with the enzyme. We also investigated the presence of the adenosine A₁/R_i receptor on human polymorphonuclear leukocytes.R-Phenylisopropyladenosine (3×10⁻⁹–10⁻⁷ mol/l) abolished the stimulating effects of prostaglandin and forskolin on cyclic AMP accumulation in polymorphonuclear leukocytes. This effect was blocked by 8-phenyltheophylline and was not observed with the stereoisomerS-phenylisopropyladenosine. The results support the existence of an A₁/R_i receptor that regulates cyclic AMP metabolism of human lymphocytes and polymorphonuclear leukocytes.     

Indications for induction of labour: a best-evidence review

Background  Rates of labour induction are increasing.
Objectives  To review the evidence supporting indications for induction.
Search strategy  We listed indications for labour induction and then reviewed the evidence. We searched MEDLINE and the Cochrane Library between 1980 and April 2008 using several terms and combinations, including induction of labour, premature rupture of membranes, post-term pregnancy, preterm prelabour rupture of membranes (PROM), multiple gestation, suspected macrosomia, diabetes, gestational diabetes mellitus, cardiac disease, fetal anomalies, systemic lupus erythematosis, oligohydramnios, alloimmunization, rhesus disease, intrahepatic cholestasis of pregnancy (IHCP), and intrauterine growth restriction (IUGR). We performed a review of the literature supporting each indication.
Selection criteria  We identified 1387 abstracts and reviewed 418 full text articles. We preferentially included high-quality systematic reviews or large randomised trials. Where no such studies existed, we included the best evidence available from smaller randomised trials and observational studies.
Main results  We included 34 full text articles. For each indication, we assigned levels of evidence and grades of recommendation based upon the GRADE system. Recommendations for induction of labour for post-term gestation, PROM at term, and premature rupture of membranes near term with pulmonary maturity are supported by the evidence. Induction for IUGR before term reduces intrauterine fetal death, but increases caesarean deliveries and neonatal deaths. Evidence is insufficient to support induction for women with insulin-requiring diabetes, twin gestation, fetal macrosomia, oligohydramnios, cholestasis of pregnancy, maternal cardiac disease and fetal gastroschisis.
Authors' conclusions  Research is needed to determine risks and benefits of induction for many commonly advocated clinical indications.     

模拟教学在继续医学教育中的应用探讨

目前,模拟技术在院校医学教育和毕业后医学教育以及其他医疗卫生专业人员的个人训练和评估中有广泛的应用,模拟技术能给各种技术水平的医疗卫生专业人员提供安全、有效的实践机会,帮助他们学会治疗患者所需的临床技能.有越来越多的研究证实了模拟技术对于医疗卫生专业人员的培训效果.然而,在继续医学教育领域,模拟技术还未得到广泛的应用.     

Abdominal aortic aneurysm repair results in aortic stiffening

Long-term follow-up studies show that all-cause mortality remains unchanged after repair of abdominal aortic aneurysm (AAA), possibly because of an increased cardiovascular risk in this high risk group. Repair of the AAA introduces a semirigid conduit into the circulation with unknown effects on the central aortic haemodynamics, such as pulse-wave velocity (PWV). One recent study revealed that a 1 m/s increase in PWV confers a 15% increased risk of cardiovascular events. We investigated whether central aortic haemodynamic changes resulting from AAA repair could be contributing to this excess cardiovascular risk.In nine patients undergoing endovascular aneurysm repair of infrarenal AAA who were assessed for changes in carotid-femoral PWV (cfPWV), mean cfPWV (n=9) was 10·3 m/s (SD 1·0) preoperatively. 1 week and 6 weeks postoperatively, mean cfPWV was 10·2 m/s and 11·2m/s, respectively (mean difference at 6 weeks 0·9m/s [95% CI 0·1–1·8], p=0·03).AAA repair appears to result in a functional stiffening of the aorta. A larger powered study is in progress to confirm this finding and also investigate whether this phenomenon is sustained in the long term. Intensive cardiovascular risk monitoring and pharmacomodulation may be indicated in this high-risk population.FundingBritish Heart Foundation.