Familial puerperal alactogenesis: possibility of a genetically transmitted isolated prolactin deficiency

Isolated prolactin deficiency is a rare disorder of which only few cases have been reported. In this study we report a woman and her mother who during their eight pregnancies had puerperal alactogenesis. Hormone evaluation revealed isolated prolactin deficiency in both of them. This report demonstrates the dominant role played by prolactin in puerperal lactation. We postulate the possibility of a genetically transmitted isolated prolactin deficiency.     

Diabetes mellitus in Kuwait incidence in the first 29 years of life

The annual incidence of diabetes mellitus among Kuwaiti subjects 0-29 years of age during 1980-1981 was found to be 22.09 per 100,000. There was a very low incidence in the 0-14 and 0-19 year age groups (3.96 per 100,000 and 5.61 per 100,000, respectively). The age distribution at onset shows an increase in incidence with age without exhibiting any remarkable peaks. The total number of female diabetic patients exceeded the number of males by 32%, the male/female sex ratio being found to be 0.68, which is significantly less than that of the same age group in the general population.     

Selective lymphoid irradiation and cyclosporin A in rat heart allografts

Short-term peritransplant treatment utilizing 2-dose ALG and 1-dose Palladium-109-hematoporphyrin (PD-H) for selective lymphoid irradiation (SLI) leads to donor-specific permanent acceptance of heart allografts in the Fisher to Lewis rat model. The same treatment significantly prolongs survival of hearts transplanted to strongly histoincompatable, presensitized, and xenogeneic recipients. The purpose of this study was to evaluate synergistic effects of short-term, low-dose cyclosporin treatment and SLI in an attempt to develop a nontoxic protocol utilizing peritransplant treatment for immune preconditioning with minimal subsequent immunosuppression. Single-agent treatment alone with cyclosporin, ALG, or Pd-H resulted in a maximal mean graft survival time (MST) of 33 days. Immunosuppression with 1-dose Pd-H, 2-dose ALG, and low-dose cyclosporin (5 mg/kg) for 14 days doubled the MST to 78 days. Use of therapeutic-dose cyclosporin (20 mg/kg), given for just 3 days, was also quite effective, MST of 57 days with SLI and 43 days with ALG, but toxic; 3 of 12 recipients died of infection with functioning grafts. These results demonstrate that the use of low-dose cyclosporin over a short interval, when combined with peritransplant SLI, is a highly effective and safe method for prolonging heart allograft survival.     

Subcutaneous technique for saphenous vein harvest

A subcutaneous technique of saphenous vein harvesting is described, and the results of its use in 37 consecutive patients requiring two or more grafts are presented. The technique minimizes the handling of the vein and reduces leg wound complications and patient discomfort.     

Intracranial tumours in the first year of life

Summary Twenty-five infants with histologically verified brain tumours presenting during the first year of life and diagnosed by computed tomography (CT) were studied. The clinical features are presented, the results of surgery assessed and the CT findings analysed and compared with the macroscopic appearance of the tumours. Since the introduction of CT, the number of intracranial tumours diagnosed in infancy has increased, particularly in the supratentorial location. In our study, astrocytomas were the most common, followed by choroid plexus papillomas, ependymomas and primitive glial tumours. At diagnosis, many tumours had become large, but usually had a well-defined edge, suggesting expansion rather than infiltration. The CT features generally corresponded to the macroscopic appearance of the tumours. The operative mortality in the series was 20%.     

Plasma membrane extensions in intercalated discs of human myocardium and their relationship to partial dissociations of the discs

Examination of myocardium from 14 patients with idiopathic hypertrophic subaortic stenosis and from 31 patients with non-obstructive cardiomyopathies of various types revealed the consistent presence of plasma membrane processes in intercalated discs. These processes extended for variable distances into the cytoplasm of adjacent cells, contained small nexuses and small knob-like endings, and sometimes terminated in the vicinity of longitudinally oriented T tubules. In three patients (one with polymyositis and congestive cardiomyopathy, one with polymyositis, congestive cardiomyopathy and chronic alcoholism, and one with congestive cardiomyopathy of unknown cause) some of the intercalated discs showed areas of dissociation which involved the undifferentiated regions and myofibrillar insertion sites. Vesicles of various sizes filled many of these areas of dissociation and appeared to be derived from swelling of the plasma membrane processes of intercalated discs.     

早期复发-缓解型多发性硬化症患者的持续脊髓萎缩：一项为期3年的研究

目的：以前的研究表明多发性硬化症（MS）患者出现上颈部脊髓萎缩（UCCA），尤其是残疾和原发或继发性进行性疾病患者更易出现UCCA。关于复发-缓解型（RR）MS患者何时表现出UCCA以及患者早期的脊髓萎缩是否与现在或将来的临床病程有关尚不清楚。方法：27例RRMS患者（中位病程为1．7年，所有病例的发病时间〈3年）和20例对照者纳入本研究。对患者随访3年，每年1次采用扩展残疾状态量表（EDSS）和MS综合功能评分法（MSFC）对UCCA和患者的临床功能进行评价，同时探讨患者的临床表现与MRI的相关性。根据协变量（包括脑内容积）对统计模型进行校正。结果：纵向分析结果显示，患者队列内部（P〈0．001）以及与对照者进行比较时的UCCA显著下降（P=0．001）。EDSS评分显著升高（P=0．008），但MSFC评分无显著变化。UCCA的丢失比与临床表现或脑容积的改变不相关。结论：总之，连续的UCCA测量显示了早期RRMS患者脊髓萎缩的进展情况。     

Accessibility to medical care among urban American Indians in a large metropolitan area

Federal health and medical care programs recently mandated for American Indians living in cities are predicted upon information pertaining to their unmet health needs and assessments of their accessibility to medical care. Based upon a household survey conducted among a representative Indian population living in a large metropolitan area, an evaluation is made of the accessibility experience of this population as it pertains to primary medical care. Using measures of accessibility including travel time, appointment delay time, and waiting room time, the experiences of Indian residents of major residential sections of the area are illustrated. Comparative assessments are made on the basis of the individual convenience factors as well as on the basis of an aggregate index of accessibility that has been proposed for health planning and evaluation. Significant differences in accessibility to primary care between residents in certain residential areas are demonstrated and suggestions for revision of the accessibility standards are offered.     

C‐reactive Protein: Repeated Measurements will Improve Dialysis Patient Care

Systemic inflammation is a common feature in the uremic phenotype and associates with poor outcomes. The awareness regarding the importance of inflammation assessment in chronic kidney disease (CKD) patients has risen in recent years, and despite the development of novel biomarkers, C‐reactive protein (CRP) is still the most measured inflammatory parameter. Notwithstanding, the possible weak points of CRP determination, this biomarker has demonstrated being useful both for guidance in clinical practice and for risk estimation. In addition, regular determination of CRP among dialysis patients has been associated with better outcomes in different dialysis facilities. Because persistent inflammation may be a silent reflection of various pathophysiologic alterations in CKD, it is crucial that inflammatory markers are regularly monitored and therapeutic attempts be made to target this inflammation.