Neurological Manifestations of Systemic Lupus Erythematosus: A Prospective Study

SUMMARY A prospective study of the neurological manifestations in allpatients with systemic lupus erythematous (SLE) was conductedbetween February 1985 to January 1989. Excluding herpes zosterinfection of peripheral or cranial nerves, post-herpetic neuralgiaand migraine, 36 neurological episodes occurred in 33 patients.The presenting symptoms were mental confusion (10), psychosis(five), seizures (six), focal neurological deficit (three),coma (two), headache (five), blurring of vision (three), neuropathy(one) and myelopathy (one). Of these manifestations, only eight episodes were due to primaryinvolvement by SLE: psychosis (two), seizure (two), multiplecerebral infarcts (one), papillitis (one), neuropathy (one)and myelopathy (one). Infection was the most common secondarycause of neurological episodes: all 10 episodes of mental confusion(fungal seven, pyogenic two, tuberculous one, nocardial one);two of six seizures (tuberculous one, pyogenic one); all fiveheadaches (tuberculous meningitis three, cryptococcal meningitistwo). The other secondary causes included steroid psychosis(two), hypertensive encephalopathy with seizure (one) and hypertensiveretinopathy (one). Three of five cases of focal neurologicaldeficit were due to macrovascular disease rather than to vasculiticinfarction. We concluded that cerebral psychosis was a relatively rare presentationin our patients with SLE. In patients who presented with a neurologicalproblem, especially mental confusion, efforts should be madeto ascertain the underlying cause, especially if this may bean infection.     

On the action of nifedipine under conditions of variable stimulation patterns and [Ca2+]0 in guinea-pig atrium

Summary The effect of nifedipine is studied in perfused isolated guinea-pig left atrium at a temperature of 37° C and a stimulation rate between 60 and 240/min. Rhythmical stimulation at 240/min was interrupted by interposed stimulus intervals (test intervals) in a range of 0.1–4 s. The pressure amplitudes developed during subsequent test contractions rise up to a maximum with increasing test intervals. This time course is described as restitution in contractile response.A preliminary report of this study has already been presented to the 45th meeting of the Deutsche Physiologische Gesellschaft, Wien, September 1975 (Pflügers Arch., Suppl. 359, R24, 1975)     

Synthesis of fjord region tetraols and their use in hepatic biotransformation studies of dihydrodiols of benzo[c]chrysene, benzo[g]chrysene and dibenzo[a,l]pyrene

Metabolic activation of the racemic benzo[c]chrysene-trans-9,10-, benzo[g]chrysene-trans-11,12- and dibenzo[a,l]pyrene-trans-11,12- dihydrodiols to fjord region syn- and anti-dihydrodiol epoxides by microsomes of Aroclor 1254-treated Sprague-Dawley rats has been examined. Since the fjord region dihydrodiol epoxides were hydrolytically unstable under the experimental conditions, their enzymatic formation was determined by analyzing the tetraols as their products of acidic hydrolysis upon addition of perchloric acid. The various stereoisomeric tetraols formed were separated by HPLC and identified by co-chromatography with authentic tetraols, which had been prepared by acidic hydrolysis of synthetically available syn- and anti- dihydrodiol epoxides and characterized by NMR and UV spectroscopy. Under standardized conditions the acidic hydrolysis of syn-dihydrodiol epoxides of benzo[c]chrysene, benzo[g]chrysene and dibenzo[a,l]pyrene resulted in the formation of two tetraols with cis/trans ratios of 81:19, 77:23 and 80:20, respectively, whereas the anti-dihydrodiol epoxides underwent almost exclusively trans hydrolysis. The proportion of the stereoisomeric tetraols obtained from microsomal incubations indicates that all three dihydrodiols are predominantly oxidized at the adjacent olefinic double bond to the anti-diastereomers of the corresponding fjord region dihydrodiol epoxides accounting for 4-35% of the ethyl acetate-extractable metabolites. To allow quantitative assessment of the metabolites 3H-labeled trans-dihydrodiols were synthesized by reduction of the corresponding o-quinones with sodium borotritide. Metabolic conversion of benzo[c]chrysene-trans-9,10- and dibenzo[a,l]pyrene-trans-11,12-dihydrodiol by rat liver microsomes were in a similar low range during the first 10 min of incubation (6.2 +/- 1.2 and 3.4 +/- 1.0 nmol substrate/nmol cytochrome P450/10 min, respectively), whereas the conversion of benzo[g]chrysene-trans-11,12- dihydrodiol was much higher (20.6 +/- 2.2 nmol substrate/nmol cytochrome P450/10 min). Given the strong intrinsic mutagenic and carcinogenic activity of the fjord region dihydrodiol epoxides, our data indicate that their formation, even at a relatively low level, may contribute significantly to the biological activity of the parent hydrocarbons.      

Outcomes of extremely premature infants related to their peak serum bilirubin concentrations and exposure to phototherapy

OBJECTIVES: To analyze, in extremely low birth weight infants, associations between peak bilirubin concentration and evidence of brain damage, and between peak bilirubin concentration and blindness attributable to retinopathy of prematurity. METHODS: Retrospective study of 128 infants of /=9.4 mg/dL (odds ratio [OR] confidence interval [CI] 4.48 [1.15-17.43])), low gestational age (OR [CI] per week 1.95 [1.05-3.63]), and longer duration of phototherapy (OR [CI] per 10 hours 1.17 [1.02-1.33]). The association of neurodevelopmental impairment with grades 3 and 4 intraventricular hemorrhage was statistically significant (OR 5.39 [1.83-15.84]), but with high-peak serum bilirubin concentration >/=11.7 mg/dL (>/=200 micromol/L), was not significant (OR 2.89 [0. 87-9.53]). CONCLUSIONS: In these infants, prolonged phototherapy and low-peak serum bilirubin concentrations were associated with severe visual loss attributable to retinopathy of prematurity. The findings should be interpreted with caution until the evidence is reinforced in other patient populations.     

Paediatric medical outpatients: are all those reviews necessary?

The value of and need for paediatric outpatient review attendance as perceived by parents, children, consultants, and general practitioners (GPs) were assessed. One hundred and ninety one parents of 239 children over 7 years of age undergoing review were randomly selected for a semistructured interview. For each parent interviewed, an audit questionnaire was completed after case note review by another paediatrician. A random sample of the patients' GPs was surveyed by postal questionnaire. Twenty per cent of parents and 26% of GPs felt that the GP could care for the child as well as or better than the hospital, whereas only 6% of consultants felt this to be so. Regarding future attendance of the child at the hospital, 48% of parents and 32% of GPs felt the child could either be discharged or seen when parents were worried, whereas consultants felt 24% of patients should have been discharged.     

6Effect of a water load test on gastric myoelectrical activity and upper gastrointestinal symptoms in patients with nausea and vomiting of pregnancy

Nausea and vomiting of pregnancy (NVP) is a common syndrome in which symptoms predominate in the first trimester of pregnancy. Symptoms range from mild to severe and afflict up to 80% of pregnant women. The underlying mechanisms of NVP remain poorly understood. Provocative gastric function testing has not been performed in these patients. Aims: The aim of this study were to determine the effects of the water load test (WLT) on gastric myoelectrical activity, nausea, and other upper gastrointestinal symptoms in pregnant women. Method: 46 women with NVP were studied prospectively. Gastric myoelectrical activity was recorded throughout the study by electrogastrography (EGG). A 15 min baseline period was followed by a WLT during which patients ingested water until full over a 5 min period. After the WLT, an additional 30 min of EGG was recorded. EGG responses were categorized into four groups: normal (2.5–3.7 cpm), bradygastria (1.0–2.5 cpm), tachygastria (3.7–10.0 cpm), and mixed gastric dysrhythmia (tachygastria and bradygastria). Nausea, bloating, stomach fullness, and abdominal discomfort were recorded before, and 10, 20, and 30 minutes after the WLT on 100 mm visual analogue scales. Results: In response to the WLT, 14% of the women exhibited normal EGG responses, while significantly more (86%) exhibited gastric dysrhythmias (p < 0.01). Of the dysrhythmic EGG responses, 57% were tachygastria, 11% were bradygastria, and 18% were mixed gastric dysrhythmia. Patients with tachygastria ingested less water (338 ml) than patients with normal (371 ml), bradygastria (415 ml), or mixed gastric dysrhythmia (394 ml) patterns, but the differences were not statistically significant. 46% of the women reported nausea at baseline; significantly more women (72%) reported nausea after the WLT (p < 0.05). At 20 min after the WLT, a significant, direct relationship was observed between nausea severity and tachygastria (p < 0.05). The other upper gastrointestinal symptoms were not significantly increased by the WLT. Conclusions: (1) 86% of the pregnant women in this sample developed gastric dysrhythmias in response to the WLT. (2) Tachygastria was the most common dysrhythmia, and increased tachygastria was correlated with increased nausea. Gastric dysrhythmias are evoked by the WLT in women with NVP, suggesting these dysrhythmias have a pathophysiological role in the mechanism of NVP, and are a target for future therapies.     

粒细胞输注

20世纪70-80年代应用粒细胞输注治疗患严重中性粒细胞减少症的患者受到了很大的限制,其原因是当时难以从健康献血者体内采集到足够数量的粒细胞。然而,自1995年以来, 随着连续采集粒细胞的离心技术和重组人-粒细胞集落刺激因子(rHuG-CSF)的临床应用,粒细胞输注再次受到人们的关注。应用G-CSF动员采集献血者粒细胞的研究显示G-CSF动员能使粒细胞采集量平均达到4．1×10 10,而使用类固醇作为动员剂只能采集到1．5-2．5×10 10个粒细胞。目前临床输注经G-