Spontaneous gastric rupture in the newborn: a clinical review of nineteen cases.

The term "spontaneous gastric rupture" is used to describe our cases of neonatal gastric perforation. Nineteen such neonates are reviewed. Current opinions regarding the possible etiology is included in the discussion. Neonatal asphyxia was the most commonly seen predisposing cause in our series (63%). Roentgenograms of the abdomen are most helpful in making a positive diagnosis. Surgical repair is the treatment of choice. All the surviving patients in our series underwent surgical repair. The need for gastrostomy during surgery should be individualized. The mortality was 27% in the cases operated since 1970; a significant improvement as compared to a mortality rate of 62% for the cases operated before 1970.     

Operative treatment and arthroscopic findings in chronic patellar tendinitis

Patellar tendinitis is a well-described clinical entity that usually responds well to conservative treatment. However, a subset of patients continue with symptoms despite exhaustive nonoperative means. The objective of the study was to review the treatment course and operative results of seven patients (eight knees) with chronic patellar tendinitis treated surgically. Five (70%) of these patients were either professional or collegiate athletes. The average age was 30 years (range, 20 to 45 years). Duration of symptoms averaged 1.4 years (range, 3 months to 4 years) before surgical correction. Operative treatment included knee arthroscopy and open repair consisting of excision of degenerated tissue and stimulation of a healing response of the patellar tendon pathology. Operative findings and pathology reports consistently showed marked fibrotendinous degeneration. Follow-up averaged 3.6 years (range, 4 months to 8.5 years). Outcomes were measured subjectively with SF36 results and objectively with Biodex testing (Biodex, Shirley, NY) and return to previous level of competition. Overall, 86% of patients achieved an excellent result and 14% had a fair result. We recommend operative intervention in a patient with chronic patellar tendinitis who does not improve with well-supervised, comprehensive conservative treatment. (Arthroscopy 1998 Nov-Dec;14(8):836-9.)     

精神分裂症患者血浆高香草酸浓度与临床症状、性别和药物治疗的关系

目的：通过分析精神分裂症患者中枢多巴胺代谢产物－血浆高香草酸浓度（ｐＨＶＡ）与临床指征的关系,进一步探讨多巴胺神经递质及其药物治疗在精神分裂症的作用。方法在４６例长期药物治疗、５８例未治疗精神分裂症患者中,采用高液相色谱连接电化学分析仪测定ＰＨＶＡ;测前评定阳性症状量表（ＳＡＰＳ）和阴性症状量表（ＳＡＮＳ）。结果（１）与６２例健康对照组比,治疗组ＰＨ－ＶＡ显著减低,未治疗组显著增高,以阴性症状组为     

Long chain N-3 polyunsaturated fatty acids in the prevention of allergic and cardiovascular disease

The diet is considered to have a major impact on human health. Dietary lipids including long chain polyunsaturated fatty acids (LCPUFA) possess potent immunomodulatory activities. Over the last decades the incidence of inflammatory disorders including allergic and cardiovascular diseases (CVD) has been rising. This phenomenon is associated with deficiencies in N-3 LCPUFA, found in fatty fish, and increased content of N-6 LCPUFA in the Western diet. LCPUFA act via different mechanisms including membrane fluidity, raft composition, lipid mediator formation, signaling pathways and transmembrane receptors. N-3 LCPUFA eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) can reduce the development of allergic disease by affecting both the innate and adaptive immune system involved in the initiation and persistence of allergic disease. Fish oil has been shown to be effective in the primary prevention of allergic disease in infants at risk when supplemented during pregnancy and lactation. Subtle effects of N-3 LCPUFA on the outcome of the immune response may underlie these protective effects. This review describes the currently reported effects of LCPUFA on dendritic cells, T cells, B cells and mast cells. Also CVD are positively affected by N-3 LCPUFA. Populations consuming high amounts of oily fish are protected against CVD. Moreover N-3 LCPUFA are effective in the secondary prevention of cardiovascular events. Amongst other effects, EPA and DHA have been shown to suppress endothelial cell activation hereby reducing adhesion molecule expression and endothelial cell - leukocyte interactions. This review describes the mechanistic basis of the preventive role for N-3 LCPUFA in allergic disease and CVD.     

Developing best practice for fungal specimen submission - fungal audit of general practice

The objective of this study was to investigate the management of suspected fungal nail infections by general practitioners (GPs) and determine whether guidance is sought when submitting specimens for investigation or treating cases. Questionnaires were sent to all GPs (n = 2420) served by five Health Protection Agency (HPA) collaborating laboratories in the South West of England. A total of 769 GPs responded – topical and oral antifungals were never used by 29% and 16% of GPs respectively. When antifungals were prescribed, topicals were normally given because of the severity of infection (32%); Amorolofine (53%) was the preferred choice. Oral antifungals were most often prescribed after receipt of a laboratory report (77%); Terbinafine was the preferred choice (86%). Seventy percent of GPs would only treat a suspected nail infection with oral antifungals after sending a sample for investigation, yet 27% never waited for a microscopy report before prescribing oral antifungal treatment. GPs routinely send specimens from suspected fungal nail infections for microbiological investigation, yet treatment is often prescribed before a result is received. With clinical signs of fungal infections often non‐specific, GPs should rely on laboratory results before prescribing expensive and lengthy antifungal treatments. Laboratories could further reduce antifungal use by including guidance on microscopy and culture reports.     

High folic acid increases cell turnover and lowers differentiation and iron content in human HT29 colon cancer cells

Folate, a water-soluble B vitamin, is a cofactor in one-carbon metabolism and is essential for DNA synthesis, amino acid interconversion, methylation and, consequently, normal cell growth. In animals with existing pre-neoplastic and neoplastic lesions, folic acid supplementation increases the tumour burden. To identify processes that are affected by increased folic acid levels, we compared HT29 human colon cancer cells exposed to a chronic supplemental (100 ng/ml) level of folic acid to cells exposed to a normal (10 ng/ml) level of folic acid, in the presence of vitamin B12 and other micronutrients involved in the folate-methionine cycle. In addition to higher intracellular folate levels, HT29 cells at 100 ng folic acid/ml displayed faster growth and higher metabolic activity. cDNA microarray analysis indicated an effect on cell turnover and Fe metabolism. We fully confirmed these effects at the physiological level. At 100 ng/ml, cell assays showed higher proliferation and apoptosis, while gene expression analysis and a lower E-cadherin protein expression indicated decreased differentiation. These results are in agreement with the promoting effect of folic acid supplementation on established colorectal neoplasms. The lower expression of genes related to Fe metabolism at 100 ng folic acid/ml was confirmed by lower intracellular Fe levels in the cells exposed to folic acid at 100 ng/ml. This suggests an effect of folate on Fe metabolism.     

Extensive tumoral melanosis associated with ipilimumab‐treated melanoma

Tumoral melanosis describes a pigmented lesion clinically similar to melanoma but on histology reveals dense aggregates of melanin‐laden, benign macrophages without malignant cells. In the few reported cases so far, tumoral melanosis has arisen in the skin or lymph node of a patient with a regressed melanoma or an epithelioid tumour. As a marker of regressed primary melanoma, its discovery may prompt investigation and surveillance for undiagnosed local or metastatic disease. Here, we present a unique case of extensive tumoral melanosis arising during ipilimumab treatment of in‐transit metastases from a previously excised melanoma.