Difficulties in the Interpretation of Lung Function Tests in the Diagnosis of Asthma and Chronic Obstructive Pulmonary Disease

Objective. To ascertain differences in the interpretation of spirometry and peak flow measurement between primary care (several practioners and nurses) and specialists in patients with a pre-existing diagnosis of asthma and chronic obstructive pulmonary disease (COPD). Design. A randomized, prospective cohort study of 98 patients with a pre-existing diagnosis of asthma or COPD. Two chest specialists independently interpreted the peak flow and spirometric data and they were also blinded to the primary care results. Results. There was total agreement in interpretation of the data between general practitioners and specialists in only 20 (20.4%). Levels of diagnostic agreement were highest between the two chest specialists (55%) and lowest between the general practice records and the diagnosis assigned by general practitioners (16%). Disagreement between general practitioners and the two chest specialists was consistent (38%) indicating systematic differences in interpretation. Conclusions. This study raises concerns about differences in the interpretation of spirometry and peak expiratory flow rates in general and hospital practice and the guidelines on which these interpretations are based.     

High-density lipoprotein cholesterol and insulin resistance are independent and additive markers of left ventricular hypertrophy in essential hypertension.

We examined whether plasma high-density lipoprotein-cholesterol (HDL-C) levels and glucose metabolism parameters are independent or additive predictors of left ventricular hypertrophy (LVH) in patients with untreated essential hypertension. The study group consisted of 41 Japanese patients with untreated essential hypertension and LVH (left ventricular mass index [LVMI] >125 g/m2; age 58+/-6 years, mean+/-SD), and the control group consisted of 39 age-matched patients with untreated essential hypertension without LVH (LVMI 相似文献   

Up-regulation of 5-HT2 Serotonin Receptor: A Possible Mechanism of Transformed Migraine

SYNOPSIS
Transformation of episodic migraine to chronic daily headache (so called transformed migraine) ia now a well recognized phenomenon. Although several factors, i.e. analgesic overuse, increasing age, psychiatric disorders are reported to play some roles in this transformation, the precise cascade is still unclear. Further suppression of an already abnormal antinociceptive system with up-regulation of post-synaptic receptors is one of the possible explanation. In order to understand the mechanism underlying this condition, 5-HT₂ serotonin receptors on platelets were assayed by the radioligand binding technique. Six transformed migraine patients (67.67 ± 1.52 years) and seven healthy controls (72.86 ± 1.82 years) were studied. [³H]-spiperone and ketanserin were used to determine the specific binding. We found a significant increase (P <0.05) in the maximal receptor numbers (B_max ) on platelet membrane of the migraine patients when compared to the controls (64.31 ± 11.06 end 39.96 ± 5.42 fmol/mg protein, respectively), whereas the dissociation equilibrium constant (K D ) values remained unchanged (3.63 ± 0.78 nM and 2.84 ± 0.48 nM for the migraine patients and controls, respectively). The up-regulation of serotonin receptors found in this study provided further support to the "serotonergic hypofunction" theory of migraine pathogenesis and may explain the unusual loss of episodicity seen in the transformed migraine patients.     

Hepatitis C Virus Infection is Highly Correlated with Hepatocellular Apoptosis and Transforming Growth Factor‐β1 MRNA Expression in Patients with Chronic Hepatitis C

Introduction:  The cellular phases (granulation, reepithelialization, and dermal remodelling) of the healing process involve many cell types. Fibroblasts and myofibroblasts are the key cells in granulation tissue formation and wound contraction.
Objective:  To compare the effects on cultured human fibroblasts of a new nonadhesive lipidocolloid wound dressing, Urgotul^®, with five other wound dressings including impregnated gauzes and some other modern wound dressings.
Method:  Cultures in monolayer were used to study the morphology and growth of fibroblasts. The Bell model of cultured dermis equivalents was used to investigate myofibroblast differentiation. These cultures were labelled α‐SM actin and F‐actin.
Results:  Two of the tested dressings induced cytotoxic effects on the fibroblasts. They were found to inhibit cell growth (greater than 60%) and to disturb cell shape and cytoskeletal differentiation. Urgotul^® and the remaining three dressings showed no effect on proliferation. However some of them modified fibroblast morphology and affected F‐actin distribution.
Conclusion:  Depending on their nature and components, wound dressings may respect or affect in vitro fibroblast behaviour (proliferation, morphology, and α‐SM actin and F‐actin distribution). The observed in vitro findings require further investigations.     

Rosette formation of impacted molar teeth in mucopolysaccharidoses and related disorders.

The radiographic features of the jaws in the mucopolysaccharidoses and related disorders (MPS) have been reviewed and three further cases are reported here, with particular reference to a novel dental anomaly, not previously described in detail, in two of them. The dental changes appear to be fully developed by the third decade and are characterized by bilateral multiple impacted molar teeth, which conglomerate in a single follicle to form a characteristic rosette of teeth. Rosetting was present only in relatively mature cases of MPS. However, it was also seen in the fourth patient, where we could not detect any other abnormal clinical or radiographic features. We therefore propose that since multiple rosetting of molar teeth can also occur in an isolated form, it is only suggestive of MPS.     

Clinical study on myocardial imaging with beta-methyl-p-(123I)-iodophenyl-pentadecanoic acid in patients with mitochondrial myopathy]

Myocardial imaging with beta-methyl-p-(123I)-iodophenyl-pentadecanoic acid (123I-BMIPP), a new radiopharmaceutical designed to evaluate myocardial fatty acid metabolism, was performed in 7 patients with mitochondrial myopathy to detect their myocardial damages in comparison with 201Tl myocardial imaging. These patients were divided into 4 chronic progressive external ophthalmoplegia (CPEO) cases, 2 mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) cases and 1 myoclonus epilepsy with ragged-red fibers (MERRF). In visual assessment, we observed more myocardial segments with decreased uptake of 123I-BMIPP compared to 201Tl in MELAS cases than in CPEO cases. The mean myocardial uptake of 123I-BMIPP was higher than that of 201Tl in CPEO cases. On the other hand, in MELAS and MERRF cases, the mean myocardial uptake of 123I-BMIPP was lower than that of 201Tl. Abnormal findings suggesting myocardial damages were observed in echocardiogram and/or in electrocardiogram in MELAS and MERRF cases, while no such abnormal findings were observed in CPEO cases. Along with the previously reported experimental result that the impairment of rat myocardial mitochondria decreased myocardial uptake of 125I-BMIPP, these results suggest that 123I-BMIPP may be useful to detect myocardial damages in patients with mitochondrial myopathy.     

A study of image processing in CR mammography; gradation processing

CR image is made by several kinds of image processing. Gradation processing is most important to make images among them and its type can be decided by the kinds of x-ray examinations. 1.2 G gradation processing is generally recommended for CR-mammography by the CR maker, but it has not been fully studied that whether 1.2G was the ideal one or not to image masses and/or calcifications. So, we compared the image obtained by 1.2G gradation processing with one by 1.0 d gradation processing that we made about imaging sensitivity of them in 18 cases with breast cancer. 15 out of 18 cases had good mass images and all of 6 cases showed good calcified images in the latter condition due to its high declination ( = gamma). So, we have concluded that 1.0 d gradation processing was better than 1.2G in CR-mammography.