Variability in the number of tests used in children with acute gastroenteritis in two hospitals

The objective of the study was to determine whether rates ofdiagnostic test use varied between one US and one Spanish hospital.Retrospective chart review in the hospital's emergency departments,recording patient and illness characteristics and laboratorytests were performed. Adjustment was performed by multivariatelogistic regression analysis. After controlling for patientand severity of illness, US children remained more likely toundergo more than one laboratory test [0R=4.8 (3.5–;6.6)]than Spanish children. It was concluded that physicians at theUS hospital ordered more tests than providers at the Spanishhospital when treating patients with comparable level of illness.Cross-national comparisons may be useful in efforts to identifyappropriate cost-effective care.     

Effect of maternal cholestasis on the kinetics of bile acid transport across the canalicular membrane of infant rat livers

A reversible impairment in the ability of the liver to secrete cholephilic compounds has been reported to exist in infant rats born from mothers with surgically induced complete cholestasis during the last third of the pregnancy. Canalicular plasma membranes (CPM) were purified from livers obtained from 4 and 8 week-old offspring of healthy or cholestatic rats. Using radiolabelled glycocholic acid (GC) and a rapid filtration technique, bile acid transport by CPM vesicles in the presence of 3 mM ATP plus an ATP-regenerating system was measured at varying substrate concentrations. Kinetic parameters were calculated by nonlinear regression analysis. Similar values for the apparent affinity constant (Kt) were found in all experimental groups (approximately 350 μM ). The value of the maximal velocity of the transport (V_max) was similar for CPM obtained from control animals at 4 or 8 weeks of age (approximately 1.5 nmol/20 s/mg protein). In the offspring of cholestatic mothers the V_max value was not different from that found in control animals as far as 4 week-old rats were concerned. However, V_max in the 8 week-old group from cholestatic mothers was two-fold higher than that found in the rest of the experimental groups. Thus, the efficiency of transport, defined as V_max/Kt, was very similar in all experimental groups, except in the group of 8 week-old offspring of cholestatic mothers, where this value was 60% higher. Isolated livers obtained from this group were able to secrete a tracer dose of radiolabelled GC (11.25 nmol) into bile significantly faster than isolated livers obtained from control animals of the same age (8 weeks). In sum, these results indicate that, in young infant rats (4 week-old), in which the maximal secretion rate for bile acids was reduced by maternal cholestasis during pregnancy, the kinetics of ATP-dependent bile acid transport across the canalicular membrane were not affected. By contrast, in older infant rats (8 week-old), in which the overall ability of the liver to secrete bile acids seems to be restored to normality, the efficiency of the canalicular transport system was actually enhanced. This suggests the existence of compensation at the level of the canalicular membrane transfer and thus that there is another hitherto unidentified mechanism involved in bile acid secretion.     

Flow cytometric analysis of decay-accelerating factor (CD55) on neutrophils from aplastic anaemia patients

Summary. Using a flow cytometric analysis, CD55 (decay-accelerating factor), CD59 and CD58 have been measured on neutrophils from 12 aplastic anaemia (AA) patients who were long-term survivors after immunosuppressive therapy (IS), 17 healthy individuals, four patients with PNH, and six patients with other haematological disorders.
The neutrophils from normal control patients and the six patients with other haematological disorders showed 98 ±2% (mean ±SD) positive granulocytes for CD55. Corresponding values were low (12%, 26%, 51% and 58%) on the primarily PNH patients. Among the 12 AA patients examined, seven had normal and five low values (59% in two, 70%, 71% and 82%).
Among the five A A patients who showed CD 5 5 neutrophil deficiency, four had showed an incomplete response after the initial IS treatment and the other relapsed following an initial haematological complete response; three cases had a positive Ham's test and two were negative.
Our data suggest that the development of PNH clones is a frequent finding in A A long-term survivors, mainly in those who had shown an incomplete response following IS. Neutrophil CD55 expression analysis by flow cytometry could be useful to detect clonal evolution in these patients.     

Certain Aspects of Glycine and Histidine Metabolism in Patients with Sprue

1. The administration of serine to seven patients with megaloblasticanemia due to sprue produced a suboptimal but definite reticulocytosis infour, and an equivocal reticulocyte elevation in two. It is believed that serineserved as a formylating agent, leading to the formation of CF from THFA.Two subjects excreted normal quantities of folic acid in the urine duringserine therapy.

2. The administration of histidine to one patient led to an excessive urinaryexcretion of FIGLU. Three other subjects with sprue excreted increasedamounts of FIGLU in the urine without a prior loading dose of histidine.

3. Since the folic acid co-factors concerned with glycine and serinemetabolism appear to function adequately in sprue patients, and since similarco-factors are concerned with histidine metabolism, the urinary excretion ofFIGLU by these patients suggests an abnormality of the enzyme whichconverts FIGLU to glutamic acid (FIGLU transferase). Further studies willbe necessary to clarify this inference.

4. The findings are discussed, and the view that folic acid may have a"pharmacologic" effect in certain forms of megaloblastic anemia is considered.

Submitted on March 2, 1959 Accepted on May 23, 1959     

Unipolar Mapping and Magnetic Resonance Imaging of "Idiopathic" Right Ventricular Outflow Tract Ectopy

Unipolar Mapping and MRI of Ventricular Ectopy. Radiofrequency catheter ablation of symptomatic ventricular ectopy guided by bipolar mapping was successfully accomplished at the right ventricular outflow tract in a patient who did not exhibit apparent structural heart disease. A "QS" morphology with a fast slope of the downstroke deflection at the successful ablation site was observed on the unipolar electrogram. Focal thinning of the lateral wall of the right ventricular outflow tract was shown in the magnetic resonance image, similar to that reported in patients with "idiopathic" right ventricular outflow tract tachycardia.     

Effect of captopril infusion on systemic and renal haemodynamics in conscious hypertensive rats with chronic, progressive aortic ligation

The effect of the converting enzyme inhibitor captopril (5 mg (kg bwt)-1) on systemic and renal haemodynamics has been studied in conscious rats in which a progressive hypertension has been induced by progressive aortic ligation (AL) between the renal arteries, and in a sham-operated (SO) group. Cardiac output (CO), organ blood flow and vascular resistances have been measured using radioactive microsphaeres. Captopril infusion caused increases in CO in both groups of rats, but the increase was higher in SO (9.2 +/- 0.7%) than in AL rats (5.2 +/- 0.6%; P less than 0.005). Plasma renin concentrations were similar in both groups but increased more in AL (10.3 microIU +/- 1.0) than in SO (5.81 microIU +/- 0.62; P less than 0.05) after captopril. Captopril induced also a larger decrease in arterial pressure (36 +/- 4 mmHg), and of the pressure gradient across the stenosis (19 +/- 3) mmHg in AL than in SO rats (5.6 +/- 1.4 and 1.1 +/- 1.3 mmHg, P less than 0.005 for both cases). Vascular resistance of the kidney above the ligature decreased more in AL than in SO rats, but this difference was not observed in the other kidney. From these data it can be concluded that captopril has an acute hypotensive effect despite the normal renin levels of this model of chronic hypertension. In addition, blood flow to the high-pressure perfused kidney seems to be dependent on the increased renin production by the contralateral kidney.     

Occipital condyle syndrome guiding diagnosis to metastatic prostate cancer

Occipital condyle syndrome (OCS) results from a unilateral occipital pain associated with an ipsilateral paresis of the 12th cranial nerve (hypoglossal), and is typically caused by metastasis of the skull base. OCS diagnosis occurred, in all cases described in the published literature, when metastatic prostate cancer (MPC) was previously known. We present a case of a patient whose initial manifestation of MPC was OCS. The patient was treated with complete hormonal blockade and non-steroidal anti-inflammatory drugs as opposed to locoregional radiotherapy applied in other cases. After 18 month follow-up, the patient had a complete neurological and biochemical response.     

Rupture of ectopic pregnancy implanted in the bladder

A 34-year-old woman was diagnosed by ultrasound with a six-week ectopic pregnancy with implantation of the gestational sac in the bladder wall. She was initially treated with methotrexate 50 mg/m(2) i.m. Although a 22% reduction in the levels of beta-hCG was observed at first, there was a rupture of gestational sac. The patient underwent an emergency laparotomy with a resulting partial cystectomy, and made an uneventful recovery.