Subcutaneous injection or infusion of gonadotropin releasing-hormone agonist buserelin in the treatment of enlarged uteri harboring leiomyomata

Thirteen women with symptomatic enlarged leiomyomatous uteri completed 6 months treatment with the gonadotropin releasing-hormone agonist (GnRH-a) buserelin, 600 μg daily subcutaneously (s.c.). Seven patients received injections (200 μg thrice daily, I-group) and six infusion by pump (50 μg · min⁻¹ · 2 h⁻¹, P-group). Residual uterine volumes after 6 months therapy were comparable in both study groups (I-group median 37%, range 23 to 74%; P-group median 49%, range 30 to 69%), as were estradiol levels. Symptoms were well controlled within short time. Six months posttreatment follow-up revealed uterine regrowth to pretreatment dimensions in all but 1 patient with recurrence of symptoms in most women. During therapy, several biochemical indices of bone metabolism were significantly elevated, reflecting an increased bone resorption; they were restored within 3 months after cessation of therapy, except for alkaline phosphatase. Triglycerides and HDL-cholesterol did not change during study; cholesterol was slightly, but significantly elevated after 6 months therapy.

GnRH-a buserelin, 600 μg daily by s.c. injection or infusion is equally effective in reducing enlarged leiomyomatous uteri. Discontinuation of therapy is followed by uterine regrowth with recurrence of symptoms in most women. The present mode of therapy seems to be beneficial as an adjunct before myomectomy, or in advancing menopause in symptomatic, climacteric women.     

An acardiac acephalic monster

A case of an acardiac acephalic monster is described, and the literature concerning the incidence, classification and etiology of acardia is reviewed. Acardia is a very rare congenital anomaly occurring in less than 1 in 34600 deliveries. The acardiac monster has been reported only in multiple, monochorionic pregnancies. This bizarre anomalous fetus is sustained in utero by parasitic anastomoses to the circulation of its usually normal co-twin and is therefore not compatible with extrauterine survival. Possibilities for prenatal diagnosis and complications during pregnancy and delivery are considered.     

Improved outcome prediction based on CSF extrapolated creatine kinase BB isoenzyme activity and other risk factors in severe head injury

The present study of 43 patients with severe head injury shows that outcome prediction can be markedly improved by combining an appropriate marker of the degree of initial brain damage and other risk factors. The patients were classified into three groups according to their actual outcome after 6 months: death (22 patients); persistent vegetative state or severe disability (eight patients); and moderate disability or good recovery (13 patients). By applying stepwise logistic discriminant analysis to the patients' data, five significant risk factors were selected: degree of neurological damage assessed by cerebrospinal fluid (CSF) extrapolated creatine kinase BB isoenzyme activity, Glasgow-Liège Coma Scale score, age, incidence of thoracic injury, and intracranial pressure (ICP). Extrapolated creatine kinase BB activity had the highest prognostic ability (67%). Uncontrollable elevated ICP proved to be systematically associated with death, whereas its absence was not necessarily indicative of a favorable outcome. The combination of the five variables yielded a total prognostic efficiency of 91%. The percentages of correctly predicted patients for the three outcome groups were, respectively, 100%, 50%, and 100%. Thus, half of the persistently vegetative and severely disabled patients were identified by the selected factors.     

Intravenous immunoglobulin treatment in lower motor neuron disease associated with highly raised anti-GM1 antibodies

The effect of intravenous immunoglobulin (IVIg) treatmentwas studied in five patients with lower motor neuron disease associated with highly raised anti-GM1 antibodies but without evidence of conduction block on neurophysiological examination. The patients received IVIg treatment (0.4 g/kg for five consecutive days) in an openstudy. Only one patient responded to IVIg treatment, which wasconfirmed in a double blind, placebo controlled study (two placebotreatments and two IVIg treatments in a randomised order). However,after six months of maintenance IVIg treatment (0.4 g/kg weekly) muscleweakness gradually deteriorated below pretreatment levels despitecontinued treatment. It is concluded that the presence of raisedanti-GM1 antibodies does not identify a subgroup of patients with lowermotor neuron disease who respond to IVIg treatment and although somepatients with lower motor neuron disease may initially respond, IVIgtreatment does not seem to be sufficient as long term treatment.

     

Simulating the straylight effects of cataracts

PURPOSE: To study the additional straylight falling on the retina (retinal straylight) caused by cataract and find commercially available filters to simulate the cataract straylight effects. SETTING: Research laboratory. METHODS: The retinal straylight addition of cataract was derived from straylight parameter data in the literature. The scattering characteristics of cataract-simulating filters were measured using a scatterometer. RESULTS: The straylight addition due to cataract follows a power law as a function of angle with power of -2.12 and straylight parameter log values of up to 1.6 for relatively mild cataract cases. Of the commercial filters that were tested, the Tiffen Black Pro Mist (BPM) filters resembled the straylight characteristics of cataracts fairly well. The filters had a limited effect on visual acuity and contrast sensitivity, which was also found for early cataracts. The BPM 2 followed a power law as a function of angle with power of approximately -2.21 and straylight log values of 1.12. CONCLUSIONS: The BPM 2 filter is a good early-cataract-simulating filter. Stacking such filters is a good way to increase the cataract density. A drawback is that the BPM 2 filter has a transmission of 66% so stacking filters reduces the overall transmission significantly.     

Adenosine and dialysis hypotension

In this issue, Imai et al. report the results of a double-blind placebo-controlled study on the effect of an adenosine A1 receptor antagonist, FK352, on the incidence of dialysis hypotension in hypotension-prone patients. This Commentary discusses the use of selective adenosine A1 receptor antagonists for the prevention of dialysis hypotension from the perspective of the potential role of adenosine in its pathogenesis.     

Mild increases in serum hepcidin and interleukin-6 concentrations impair iron incorporation in haemoglobin during an experimental human malaria infection

The correct selection of individuals who will benefit from iron supplements in malaria-endemic regions requires improved insight in the effects of malaria on host iron homeostasis and innovative biomarkers. We assessed sequential changes in serum hepcidin and in traditional biochemical iron status indicators during an experimental Plasmodium falciparum malaria infection with five adult volunteers. The haemoglobin content of reticulocytes (Ret-H_e) and of mature red blood cells (RBC-H_e) represented iron incorporation into haemoglobin. Low-density parasitaemia and its treatment induced a mild increase in interleukin (IL)-6 and serum hepcidin concentrations. Despite this only mild increase, a marked hypoferraemia with a strong increase in serum ferritin concentrations developed, which was associated with a sharp fall in Ret-H_e, while RBC-H_e remained unchanged. The ratio of soluble transferrin receptor (sTfR) to log ferritin concentrations decreased to an average nadir of 63% of the baseline value. We concluded that even mild increases in serum hepcidin and IL-6 concentrations result in a disturbed host iron homeostasis. Serum hepcidin, Ret-H_e and Delta-H_e (Ret-H_e minus RBC-H_e) are promising biomarkers to select those individuals who will benefit from iron supplements in malaria endemic regions, while the sTfR/log ferritin ratio should be used with caution to assess iron status during malaria.