9p- in a girl with acute lymphocytic leukemia and sickle cell disease

A 4 year old girl with sickle cell disease developed acute lymphocytic leukemia null cell type. The bone marrow karyotype was 46,XX,del(9)(p13). This girl is among the few patients with acute lymphocytic leukemia and abnormalities of #9 to have an isolated 9p-.     

Prevalence of Asherman's syndrome after secondary removal of placental remnants or a repeat curettage for incomplete abortion

This prospective study assesses the prevalence of intrauterine adhesions among women undergoing secondary removal of placental remnants after delivery, or a repeat curettage for incomplete abortions, and evaluates risk factors associated with the presence of intrauterine adhesions. In 50 women, undergoing either a secondary removal of placental remnants more than 24 h after delivery, or a repeat curettage for incomplete abortions, ambulatory hysteroscopy was performed 3 months after the intervention. Intrauterine adhesions were found in 20 of the women (40%): five patients had Asherman's syndrome grade I, six had grade II, six had grade III and three had grade IV. In women with menstrual disorders a statistically significant 12-fold increased risk for Asherman's syndrome grade II-IV was found. Previous abortion as well as infection during surgery were associated with a mildly but non-significant increased risk. Based on our findings, hysteroscopy is recommended only in those patients who develop menstrual disorders, either after secondary intervention for placental remnants after delivery or after a repeat curettage.      

Cryptic structural lesions in refractory partial epilepsy: MR imaging and CT studies

Results of contrast material-enhanced computed tomography (CT) and T2-weighted spin-echo magnetic resonance (MR) imaging were correlated with pathologic findings in 25 patients treated surgically for refractory partial epilepsy. Of 12 lesions present, ten (83%) were detected by MR imaging and seven (58%) by CT scanning. Of nine low-grade gliomas, eight were detected by MR imaging and four by CT scanning. One posttraumatic scar and one case of temporal lobe atrophy were better demonstrated by MR imaging. A small, thrombosed arteriovenous malformation was the only lesion detected by CT scanning but not by MR imaging. No lesions were detected in 13 patients with mild gliosis and one patient with a 1.2-cm grade 1 astrocytoma. Although more sensitive than CT for detection of structural lesions in patients with refractory partial epilepsy, MR imaging resulted in a 25% false-negative diagnostic rate when a repetition time of 2,000 msec and echo time of 60 msec were used. Multi-echo imaging with at least one long echo time may be needed to increase the sensitivity of MR imaging in these patients.     

The etiology of anorectal infections in homosexual men

The infectious etiology of symptomatic anorectal disease was studied in 52 homosexual men who did not have gonococci on initial Gram stain of anorectal exudate. Herpes simplex virus (HSV) was isolated from the anal canal or rectum in 15 of the 52 (29 percent) men and characteristically caused severe anorectal pain and focal ulcerations visible on sigmoidoscopy. Despite negative initial Gram stains, seven men (14 percent) had anorectal gonococcal infection. Six (12 percent) had syphilis, including two with dark-field positive anal lesions. Four were infected with enteric pathogens, including Giardia lamblia, Entamoeba histolytica or Campylobacter fetus ssp. jejuni. Chlamydia trachomatis (LGV 2 strain) was isolated from one patient with severe granulomatous proctitis. One or more etiologic pathogens were identified in 28 (67 percent) of 42 men who had anorectal leukocytic exudate and in two of 10 who did not (p = 0.01). A review of the prominent features of different etiologic forms of anorectal infection in homosexuals is presented.     

The effect of subdermal testosterone filled polydimethylsiloxane implants on spermatogenesis in rhesus monkeys (Macaca mulata).

Previously it was reported that testosterone-filled polydimethyl silicone (PDS) implants induced azoospermia in male rabbits without chronically altering plasma testosterone concentration or the weight or secretory activity of accessory sex glands. Assayable serum luteinizing hormone (LH) and testicular testosterone secretion were completely suppressed. Testosterone emanating from the PDS capsule maintained libido but failed to support spermatogeneis in the rabbits. To test results in subhuman primates, 40 rhesus monkeys were used. Testosterone PDS capsules were prepared so that in groups of 6 each monkey received a daily dose of 0, 9.4, 16, 34, 67, or 150 mcg/pound of body weight. Capsules were implanted sc. After 70 days, animals were sacrificed. Body weights did not change significantly in any treatment group. Seminal vesicle weights increased significantly (p .01) with increased testosterone dosage. prostate gland weights also increased somewhat. Plasma testosterone concentrations were similar to control values with lower doses but increased significantly (p .01) in monkeys receiving the higher doses. Median doses failed to suppress immunoreactive LH concentrations in serum. However, it is thought that immunoreactive LH, as measured by methods used, may not always reflect biologically active LH. The testosterone synthesizing apparatus was not completely inhibited as it had been in rabbits and as shown by in vitro perfusion of tests. Failure to achieve azoospermia in 4 of 6 monkeys receiving 34 mcg of testosterone per pound of body weight per day suggested that species differences exist in the feedback of testosterone regulating LH release. However, spermatogenesis was depressed 5 times below normal in these monkeys. Data suggest that the dose of testosterone needed to induce azoospermia in rhesus monkeys is highly variable and that the effective dose is so narrow that it prevents the use of this testicular androgen as the sole constitutent of a contraceptive formulation for rhesus monkeys. Assuming that the same applies to humans, present results indicate the need for a contraceptive formulation containing not only a potent androgen but also an effective inhibitor of pituitary gonadotropin secretion.