Primary association of HLA-DQw8 with type I diabetes in DR4 patients

DNA from 164 Caucasian type I (insulin-dependent) diabetic patients and 200 Caucasian nondiabetic control blood donors were analyzed by the polymerase chain reaction technique for HLA-DR4 and the associated Dw and DQB subtypes of DR4. The DQw8 subtype of HLA-DR4 was associated with type I diabetes in all DR4 subgroups (DR4/3 and DR4/non-3). Dw subtypes of DR4 other than DW10 did not confer additional association with type I diabetes. Thus, the DQ region appears to provide the primary major histocompatibility association with type I diabetes in most DR4 patients.     

DELAY IN THE DIAGNOSIS OF OSTEOMYELITIS PUBIS

SUMMARY The pubis is an uncommon site for osteomyelitis, which fact may contribute to difficulty in establishing the diagnosis. Two cases of osteomyelitis pubis in children are presented in which the diagnosis and definitive treatment were delayed.     

Differentiation of biologically distinct cucumber mosaic virus isolates by PAGE of double-stranded RNA.

Electrophoresis on 5% polyacrylamide was used to analyze dsRNAs of 26 cucumber mosaic virus isolates propagated in Nicotiana tabacum. There was variation between isolates in the migration of each of the dsRNAs 1, 2, and 3. Comparison of the dsRNA profiles enabled each isolate to be allocated to 1 of 7 distinct dsRNA profile types. Two distinct and readily distinguishable isolates were mixed in planta and dsRNA from these infected plants compared with in vitro mixtures of them. All bands from both types were present, indicating that the differences were real and reproducible. This method is of value as a means of classifying cucumber mosaic virus isolates, as it more closely reflects a range of biological characteristics than do other methods currently used.     

The behaviour of the thyroidal iodide trap after subtotal thyroidectomy for thyrotoxicosis and its implication for the T3-suppression test.

It is important to distinguish between symptomatic response and immunological cure in thyrotoxicosis because it has been suggested that surgery, in addition to providing a rapid symptomatic response, may also cause the disappearance of thyroid-stimulating antibodies. The evidence, however, is based largely on suppression tests which we argue may not be valid in the post-operative period. Seventy thyrotoxicosis patients were treated for 6 months with a standard course of carbimazole and T3, at the end of which each patient was classified as suppressor (S) or non-suppressor (NS) according to the fall in radioiodine uptake. Group I (18 patients) and group II (18 patients) were then randomly selected for immediate surgery while group III (34 patients) continued on antithyroid drugs. All groups were reviewed every two months from the 6th month for 12 months, during which time group I was drug-free and groups II and III received T3. Twenty-min iodide uptakes were performed in all patients at each visit to compare the serial changes in mean iodide trapping capacity between treatment groups. Despite 10-fold differences in TSH levels between groups I and II, and irrespective of suppressibility before surgery, the mean uptakes in both these groups remained basal (less than 4%) throughout the period of study, while the serial mean uptakes in group III S (no TSH, by implication no TSAB, but intact iodide trap) were consistently higher than those of group I NS (high TSH, by implication TSAB as well, but reduced iodide trap size). The data points to an absence of dose-responsiveness between TSH and the surgical-remnant's iodide trap, implying that post-thyroidectomy suppression tests (at least during the first year) cannot measure changes in iodide trapping, and therefore do not measure the same phenomenon after subtotal thyroidectomy as they do before operation when the thyroid is intact. We therefore question the validity of comparing suppressibility before and after surgery and basing the frequency of surgical cure on the result.     

Prospective, randomized trial of hypertonic sodium lactate versus lactated Ringer's solution for burn shock resuscitation

We prospectively randomized 51 adult burned patients on admission to study fluid, electrolyte, and physiologic parameters during burn resuscitation with the use of hypertonic saline (HSL, Na 250 mEq/L, 514 mOsm) or lactated Ringer's solution (LR, Na 130 mEq/L, 268 mOsm). Patients suffered at least 20% total body surface area burns (BSA); the mean BSA injury was 36.7% BSA, with a range of 20 to 74% BSA. All patients were admitted to our Burn Center within at least 12 hours of injury. Laboratory studies included frequent determinations of serum chemistries including osmolalities, and continuous 24-hour urine collections for electrolytes and osmolality determinations. Fluid requirements (cc/kg/% BSA), urine output (cc/kg/hr), sodium intake and excretion (mEq/kg/% BSA), serum and urine osmolality (mOsm/kg), serum creatinine (mg/dl), body weight (kg), and enteral intake (cc/24 hrs and calories/24 hrs) were analyzed for comparison at 24-hour intervals following burn injury. Using Student's t-test, significance was attributed to a p less than 0.05. Nonparametric methods were used to compare non-normalized data. Regression analysis was used to compare sodium intake (mEq/kg) and fluid intake (cc/kg) between the HSL and the LR groups in relation to % BSA. Our data show no advantage of HSL over conventional therapy with LR for burn resuscitation. We were not able to demonstrate decreased fluid requirements, improved tolerance of feedings, or decrease in per cent weight gain.(ABSTRACT TRUNCATED AT 250 WORDS)     

The management of Frey's syndrome with aluminium chloride hexahydrate antiperspirant.

Nine patients suffering from gustatory sweating (Frey's syndrome) following parotidectomy have been treated by topical applications of aluminium chloride hexahydrate. Treatment has successfully controlled gustatory sweating using application intervals varying from 1 to 50 days.     

Orbital lymphomas and pseudolymphomas: treatment with radiation therapy

A retrospective analysis of 16 patients with orbital lymphoma or pseudolymphoma from 1961-1984 was undertaken to evaluate the use of radiation therapy. Pathologic assessment confirmed that four patients had benign pseudolymphoma, and 12 patients had true malignant lymphoma, including two with advanced disease at presentation. With a median follow-up of 4 years, the local control rate with radiation therapy was 100%, although the two patients with advanced disease died of lymphoma 26-33 months after irradiation. While doses of 1,600-2,000 cGy appear adequate for pseudolymphoma, for lymphoma a dose of 3,000-4,000 cGy is necessary. Subconjunctival lesions can be treated in a single anteroposterior field; retroorbital lesions require an additional lateral field.