Abnormal facial features and extremities in human trisomy syndromes: prenatal US appearance

Twelve cases of fetal trisomy syndromes are reported in which prenatal sonographic findings were highly suggestive of the chromosomal abnormality. The abnormal appearance on the sonogram led to karyotype studies in ten fetuses and to appropriate obstetrical management. The sonographic abnormalities pertained to the extremities and face of the fetus.     

Serum aminoterminal type III procollagen peptide reflects repair after acute myocardial infarction

In 16 patients with acute myocardial infarction and in 15 controls, procollagen type III aminoterminal peptide in serum (PIIINP) was measured consecutively. Serum PIIINP was increased on the second to third postinfarction day (p less than 0.01) and remained elevated for more than 4 months. Peak values were observed on the third to seventh postinfarction day. The individual peak changes were correlated to infarction size calculated from serum CK-MB and serum lactate dehydrogenase (p = 0.60, p = 0.02). The changes in distribution of PIIINP-related antigens in serum after gel chromatography were similar to changes observed during wound healing in humans. PIIINP is cleaved off procollagen type III during the biosynthesis of type III collagen, which characterizes the early stages of repair and inflammation. Our findings suggest that serum PIIINP reflects the repair processes and scar formation following acute myocardial infarction. The serum PIIINP alterations in acute myocardial infarction differ essentially from the changes in myocardial enzymes reflecting myocardial injury. Serum PIIINP may therefore provide new and clinically relevant information on the healing of myocardial infarction.     

Urinary peptides in schizophrenia and depression

Increased levels of benzoic acid-precipitable aromatic compounds and glycoprotein-associated peptide material are found in the urines of patients with schizophrenic psychoses and endogenous depressions. Factors with regulatory effects on aminergic transmission have been found. A working hypothesis is proposed whereby genetically determined peptidase insufficiency interacts with increased peptide levels of either endogenous and/or exogenous origin to cause the psychotic state. These disorders are probably multifactorial syndromes, displaying changes in several factors with bioactive effects.     

Outcome of extremely low-birth-weight infants: 1980–1990

Neonatal and follow-up data of infants from the special care nursery whose birth weights were < 750 g, born between 1980 and 1990, were reviewed. There was a 20% relative improvement in the odds of surviving the neonatal period, a 16% improvement in the odds of being discharged and a 19% improvement in the odds of surviving until 2 years of age with each consecutive year. Home oxygen use increased significantly over the study period. The neurodevelopmental outcomes of infants were similar over the 11-year period, with 53% being classified as neurologically normal, with a mean developmental index of 83 at 1 to 2 years of age. We conclude that there has been an improved survival of infants with birth weights < 750 g in our institution, and that the overall incidence of serious neurodevelopmental deficits among survivors has remained stable.     

Effect of epidurally administered bupivacaine on atracurium-induced neuromuscular blockade

The effect of epidurally administered bupivacaine on duration, intensity and reversal characteristics of atracurium-induced neuromuscular blockade was studied in 30 healthy patients anaesthetized with thiopentone, fentanyl, midazolam and nitrous oxide. Fifteen patients received, in addition, epidural anaesthesia with bupivacaine. The remaining patients served as controls. The ulnar nerve was stimulated at the wrist and the evoked twitch response from the adductor pollicis was measured with a force displacement transducer. Neuromuscular blockade was induced with atracurium 0.5 mg i.v. and maintained with repeated doses of atracurium 0.15 mg/kg whenever the twitch height had recovered to 15% of the initial twitch height. After operation, the neuromuscular blockade was reversed with neostigmine when the twitch height had recovered to 15%. In the epidural group the clinical duration of neuromuscular blockade, time until first response to train-of-four (TOF) and reversal time were all significantly prolonged (P less than 0.05). Post-tetanic count (PTC) after 20 min was also significantly lower in the epidural group (P less than 0.05). It is therefore concluded that epidurally administered bupivacaine prolongs atracurium-induced neuromuscular blockade. The clinical implication of the modest prolongation is, however, limited.     

Crowding as a risk factor of meningococcal disease in Danish preschool children: a nationwide population-based case-control study

Meningococcal disease (MD) remains an important health problem. Crowding has been suggested to be a risk factor for MD in children, but the evidence is relatively sparse. We performed a nationwide nested case-control study comprising 1222 children with MD and 24,549 population controls. We identified MD cases younger than 6 y in the Danish National Hospital Discharge Registry from 1980 to 1999, and obtained information on household density as a measure of crowding, per capita income and other potential confounders through The Danish Civil Registration System and social registries. The risk of MD associated with household density was estimated by conditional logistic regression for children less than 1 y of age (infants) and children aged 1 to 5 y, respectively. The risk of MD increased with increasing household density. In both age groups, the crude OR was 1.8 (95% confidence interval [CI]: 1.4-2.3) at a density of less than 20 m2 per person compared with the reference of more than 50 m2 per person. The adjusted OR for MD was 1.5 (95% CI: 1.1-1.9) for infants, and 1.5 (95% CI: 1.1-2.0) for children older than 1 y. Household density appears to be a risk factor of MD in preschool children.