Growth of abused children. Contrasted with the non-abused in an urban poor community

While the identification of a growth-retarded or otherwise undernourished child suggests a diagnosis of child abuse or neglect, it is not certain that abused children from poor communities are less well nourished than children living in similar environments. The setting of this study--day care centers in an urban poor city--provided an opportunity to make this comparison with appropriate community-based controls. Measures of height, weight, and weight/height (Body Mass Index (BMI] were compared for 196 children, 2 to 6 years of age, 53 of whom were victims of physical abuse. The data was adjusted for age, sex, and ethnicity using logistic regression analysis to determine occurrence of wasting (weight for height less than 5th percentile) and stunting (height for age less than 5th percentile). Significantly more abused children (16.3%) showed wasting as compared to non-abused (0.7%) with abused children 16.6 times more likely to show wasting than non-abused (95% confidence limits on the Odds Ratio 1.9-145.0). While 11.6 percent of abused children showed stunting compared to 5.6 percent of non-abused, this difference was not significant when the data was adjusted for demographic factors. The BMI (15.02 kg/m2) for abused children was significantly less than that (15.9 kg/m2) for non-abused children (F = 8.11; p = 0.0049). In the present study, significant wasting as seen in acute malnutrition was found among abused children at diagnosis, suggesting that within an urban poor community the growth of children so identified does differ from the growth of children who are not abused.     

Capacitated sperm cells react with different types of antisperm antibodies than fresh ejaculated sperm.

OBJECTIVE: To determine if sera of some women have antibodies against capacitated but not freshly ejaculated sperm. DESIGN: The sera of 66 women undergoing in vitro fertilization (IVF) were tested for sperm antibodies after 1 hour and 18 hours of sperm incubation in the maternal sera. Subsequently, 5 sera were tested with capacitated versus noncapacitated sperm cells. SETTING: The study was carried out in a university hospital department. PATIENTS, PARTICIPANTS: The patients were 66 consecutive couples undergoing IVF. INTERVENTIONS: Sera and semen that were taken for routine tests as part of the IVF procedures were used. MAIN OUTCOME MEASURES: A case with IVF failure associated with late appearance of sperm antibodies prompted us to study the detection of sperm antibodies after 1 hour and 18 hours incubation. RESULTS: Of 37 cases negative for sperm antibodies after 1 hour incubation, 7 demonstrated high levels of antibodies after 18 hours incubation. In 21 of 23 cases with low or intermediate levels of antibodies after 1 hour incubation, significantly higher levels (P less than 0.05) of antibodies were found after 18 hours. Different and higher levels of sperm antibodies were observed in five sera after incubation of 1 hour with capacitated sperm as compared with noncapacitated controls. CONCLUSIONS: Major antigenic differences may exist between capacitated and noncapacitated sperm. In some women sperm antibodies are reactive against capacitated sperm only. This has no certain clinical significance but may explain certain cases of IVF failure, unexplained infertility, and part of the variation in sperm antibodies testing methods.     

Novel colon cancer cell lines leading to better understanding of the diversity of respective primary cancers

A major obstacle to obtaining more detailed insights into the diversity of phenotypic and molecular changes occurring in colon cancer cells is the lack of low-passage colon cancer cell lines, which would still closely reflect the phenotype of the colon cancer cells in vivo. Here, we characterize eight novel, low passage number human colon carcinoma cell lines, originating from colorectal cancers extensively characterized in the clinics. All cell lines closely resemble the original tumors with respect to phenotype, markers and detectable genetic changes. Cell morphology and marker expression is highly variable, ranging from fully polarized cells correctly expressing all basolateral epithelial markers, to cells with mesenchymal characteristics and a complete loss of polarity due to delocalization or loss of junction complex proteins. The alterations in phenotype and epithelial marker expression correspond to changes already detectable in the primary tumor in vivo. Seven of the cell lines show chromosomal instability, while one cell line is characterized by microsatellite instability. p53 associated with K-ras mutations were detected in three cell lines. Hitherto non-described E-cadherin mutations were found at both alleles in one cell line whereas in another cell line the E-cadherin protein was down-regulated. A stabilizing beta-catenin mutation (S45F) appears in the same cell line that carried the mutated E-cadherin gene. Six cell lines carried APC mutations, which in five of the lines led to an activated beta-catenin/Tcf/LEF signaling pathway. In accordance with beta-catenin/Tcf/LEF activation, the cell lines show increased migration and invasiveness. Our results show that the characterized, low-passage cell lines mirror the diversity of the individual tumors from which they were derived. Through molecular analyses of these cell lines we demonstrate that tumorgenicity events are much more diverse in human colon cancer than expected, despite the common origin of the tumors from a small patient group with similar tumor grading and clinical prognosis.     

PMMA cementoplasty in symptomatic metastatic lesions of the S1 vertebral body

We describe a lateral transiliac direct puncture approach to the S1 vertebral body for polymethylmethacrylate (PMMA) cementoplasty of painful metastatic lesions. This approach was performed using a 15-cm-long trocar needle with 3-mm outer diameter, introduced under general anesthesia and fluoroscopic control. A lateral projection was used to center the needle just in front of the spinal canal and subjacent to the superior plate of the S1 vertebral body. Needle progression was controlled using anteroposterior and lateral fluoroscopic projections alternately with a needle course parallel to an axial plane, avoiding conflict with the S1 foramen. After needle tip placement in the center of the S1 vertebral body, diluted PMMA with a setting time of 8 min was delivered. Ipsilateral lesions of the lateral sacral compartment were filled with the same needle by stepwise withdrawal and continuous PMMA injection.     

Value of laparoscopic staging for Hodgkin disease

Because of the potential for complications with laparotomy and splenectomy, and the widespread use of combination chemotherapy as first-line treatment, surgical staging is now performed in only 30% of patients with Hodgkin disease. Laparoscopic staging has rarely been reported. Three patients with the nodular sclerosis cell type of Hodgkin disease underwent laparoscopic staging. Mean operative time was 207 minutes. No conversion to laparotomy was necessary. There were no peri- or postoperative complications and no deaths. Mean blood loss was negligible. The pathologist deemed all liver and lymph nodes biopsies adequate for histologic analysis. Stage IA and IIA were confirmed in two patients: one patient with stage IIA was upstaged to IIIA after surgery. Performed by an experienced team, laparoscopy is the procedure of choice for abdominal staging of patients with Hodgkin disease.     

Long-term prognosis of medically treated patients with vasospastic angina and no fixed significant coronary atherosclerosis

The clinical course of 48 consecutive patients with vasospastic angina and minor coronary atherosclerosis (no stenoses greater than 50%) was analyzed during an average follow-up period of 47 months. The study group consisted of 37 men and 11 women. Patients were treated with usual doses of calcium antagonists. One patient died (2%) and three had myocardial infarctions (6%). Seventy-one percent were asymptomatic or had infrequent angina; 13% had recurrences but had periods of remission lasting at least 10 months. Only 16% had persistent angina. None of the clinical or angiographic findings at the time of diagnosis were predictive of myocardial infarction or death, and they could not separate angina-free patients from those with recurrences. Thus, vasospastic angina without fixed coronary narrowing has a good prognosis despite the possibility of recurrences. However, there is a slight risk of myocardial infarction and death. This fact should be considered if there are plans to discontinue treatment.     

Comparative diagnostic performance of the Telemed computer ECG program

One thousand consecutive ECG's from an ambulatory population of patients with suspected or proven cardiac disease were evaluated using two versions of the Telemed computerized ECG system. Only minor differences were found between the two programs. In version 6 vs. version 5, 87% vs. 90% of 287 normal ECG's were correctly classified and 93% vs. 96% of abnormal ECG's were correctly classified; the percent of acceptable diagnostic agreement was 86.2% and 87.4% respectively (NS). The sensitivity for arrhythmia detection, transmural inferior infarction and ST-T wave abnormalities was slightly greater in version 6. The increased sensitivity was not accompanied by decreased specificity. The sensitivity for left ventricular hypertrophy decreased from 95.2% to 91.4% in version 6 with a slight increase in specificity (95.2% to 97.0%). In conclusion, criteria changes in the most recent version of the Telemed program have not resulted in a major change in diagnostic performance. Arrhythmia detection is slightly but not significantly improved.