Prognostic value of certain enzymatic and hormonal assays in threatened abortion

The following biochemical indices were evaluated comparatively as predictors of the course of threatened abortion: serum oxytocinase, heat stable alkaline phosphatase, leucine aminopeptidase, urinary pregnanediol, and urinary estriol. 36 cases, grouped into controls and pathological cases, were studied. In normal pregnancy, there was a progressive rise in the levels of the serum oxytocinase, leucine aminopeptidase, urinary estriol, and pregnanediol. Serum heat stable alkaline phosphatase showed an undifferentiated range of results in nonthreatened pregnancies. In the group of threatened abortion cases, results were, therefore, considered abnormal if 2 or more successive determinations showed progressive reduction in enzyme or hormonal levels, and abnormality was also diagnosed if the results were below the normal range (published tabularly, per gestational week). The prognostic value of these biochemical indices was as follows: of 16 cases with normal serum oxytocinase values, 31.2% aborted, whereas of 10 with abnormal values, 70% aborted. Of 16 cases with serum leucine normal values, 37.5% aborted, whereas Of 10 abnormal cases, 60% aborted. Of 18 cases with normal heat stable alkaline phosphatase values, 55.5% aborted, whereas of 8 cases with abnormal values, 25% aborted. Of 17 cases with normal urinary estriol determinations, 45% aborted, whereas of 9 cases with abnormal values, 44.5% aborted. And of 17 cases with normal pregnanediol levels, 41% aborted, whereas of 9 cases with abnormal values, 55.5% aborted. These results show that combined estimation of serum oxytocinase and urinary pregnanediol is a reliable parameter in anticipating pregnancy outcome in cases of threatened abortion.     

Closure of a persistant femoral artery pseudoaneurysm complicating coronary angioplasty using the femostop compression device and direct ultrasound visualization

Nonsurgical closure of femoral artery pseudoaneurysm (PSA), using ultrasound guidance and compression with the ultrasound probe or a C-clamp, has been previously described. We report a patient in whom a different compression device was used (the Femostop ^TM ) which also allows direct ultrasound visualization of the PSA and femoral vessels at the site of compression. This resulted in adequate PSA with preservation of flow in both artery and vein throughout the procedure.     

Hla type as a predictor of mixed connective tissue disease differentiation ten-year clinical and immunogenetic followup of 46 patients

Objective. To determine any clinical or genetic markers of differentiation and outcome in a previously described cohort of 46 patients with mixed connective tissue disease (MCTD). Methods. Patients were clinically evaluated, chart notes reviewed, and HLA subtyping and immunology profiles performed where possible. Eleven had died and 7 were lost to followup. Results. MCTD had differentiated into systemic lupus erythematosus in 12 patients and into systemic sclerosis in 13. The latter was associated with HLA-DR5 (P = 0.038), and nondifferentiation was associated with HLA-DR2 or DR4 (P = 0.007). Three HLA-DR4 positive patients had MCTD that evolved into rheumatoid arthritis. Erosive and/or deforming arthritis was associated with HLA-DR1 or DR4 (P = 0.015). HLA-DR3 was associated with interstitial lung fibrosis (P = 0.044) and keratoconjunctivitis sicca (0.001 < P < 0.01). Severe Raynaud's phenomenon predicted higher mortality (0.01 < P < 0.05). Conclusion. We suggest that MCTD is, for most patients, an intermediate stage in a genetically determined progression to a recognized connective tissue disease. Those whose disease remains undifferentiated might be considered a distinct subset.     

The contributions of lesion laterality and lesion volume to decision-making impairment following frontal lobe damage

Lesions to prefrontal cortex (PFC) in humans can severely disrupt everyday decision-making, with concomitant effects on social and occupational functioning. Forty-six patients with unilateral lesions to prefrontal cortex and 21 healthy control subjects were administered three neuropsychological measures of decision-making: the Iowa Gambling Task, the Cambridge Gamble Task, and the Risk Task. Magnetic resonance imaging (MRI) scans were acquired from 40 patients, with region of interest (ROI) mapping of prefrontal subregions. The frontal patients showed only limited damage in medial and orbital prefrontal cortex, but greater damage in lateral prefrontal regions of interest. Patients with right frontal lesions preferred the risky decks on the Iowa Gambling Task, and differed significantly from left frontal and control subjects. Within the right frontal group, the preference for the risky decks was correlated with the total lesion volume and the volume of damage outside of the ventromedial prefrontal region. Right and left frontal groups did not differ significantly on the Cambridge Gamble Task or the Risk Task, and performance was not associated with lesion volume. The results indicate a laterality effect on the Iowa Gambling Task, and the contribution of prefrontal regions outside the ventromedial region to task performance. The Cambridge Gamble Task and Risk Task were less sensitive to the effects of unilateral frontal lobe lesions, and may be more selectively associated with ventral prefrontal damage.     

Imaging the vertebral artery

Although conventional intraarterial digital subtraction angiography remains the gold standard method for imaging the vertebral artery, noninvasive modalities such as ultrasound, multislice computed tomographic angiography and magnetic resonance angiography are constantly improving and are playing an increasingly important role in diagnosing vertebral artery pathology in clinical practice. This paper reviews the current state of vertebral artery imaging from an evidence-based perspective. Normal anatomy, normal variants and a number of pathological entities such as vertebral atherosclerosis, arterial dissection, arteriovenous fistula, subclavian steal syndrome and vertebrobasilar dolichoectasia are discussed.     

Multifocal pyomyositis: report of two cases

Pyomyositis is a primary infection of the striated muscles. We describe the clinical and imaging features of pyomyositis in two patients, one diabetic and the other immunocompetent. Treatment with incision, drainage and antibiotics was successful and resulted in full recovery. Increased awareness, especially in immuno‐competent patients, should lead to earlier diagnosis, correct treatment and a better outcome.     

A comparison of the Addenbrooke's Cognitive Examination (ACE), conventional neuropsychological assessment, and simple MRI-based medial temporal lobe evaluation in the early diagnosis of Alzheimer's disease.

OBJECTIVE: To examine the contribution of the Addenbrooke's Cognitive Examination (ACE), neuropsychological assessment, and a magnetic resonance imaging (MRI)-based temporal lobe rating scale to the prediction of which patients with questionable dementia will progress to Alzheimer's disease (AD). METHODS: Fifty subjects (19 early AD, 31 questionable dementia [QD]) underwent the ACE, a neuropsychological evaluation, and a volumetric MRI. The degree of atrophy of hippocampal, parahippocampal, and other temporal lobe structures was assessed using a validated visual rating scale. Subjects were followed 8 monthly for an average of 19.1 months. RESULTS: Of the 31 QD subjects, 11 converted to AD within 24 months of follow-up (another 2 developed dementia with Lewy bodies) and 18 were nonconverters. Converters were impaired relative to nonconverters at baseline on measures of episodic and semantic memory (category fluency and naming) and the ACE. Converters also had a greater degree of hippocampal and parahippocampal atrophy. Discriminant analysis demonstrated that the best single test for distinguishing converters was the ACE. In combination, the hippocampal rating and category fluency were also contributory. CONCLUSIONS: Progression to AD in patients with QD is best predicted by neuropsychological measures, particularly those that assess episodic and semantic memory, although simple rating methods based on MRI may have an adjunctive role.     

A simple method for the early detection of pregnancy: (A) Comparative study with radioimmunoassay of beta-HCG: and (B) Fallacies compared to other immunological pregnancy tests

A simple, sensitive and reliable non-radioactive method for the detection of hCG in concentrated urine for the diagnosis of early pregnancy is reported. Twenty ml of urine were sampled, filtered and concentrated by ultrafiltration with ultra-microporous membrane under reduced pressure (Immersible Molecular Separator, Millipore Co) and the hCG in the concentrate was detected by the ordinary latex agglutination inhibition method using beta-hCG antiserum to avoid cross-reaction with high levels of hLH and hMG. Concentrated and unconcentrated urine samples taken at different periods of amenorrhoea (1, 2 and 3 weeks) were also tested by two-slide pregnancy tests and one-tube pregnancy test. Blood and urine samples taken at one and two weeks amenorrhea were assayed for beta-hCG by a specific RIA. Results were compared to the new method. Retention characteristics and concentration efficacy of the ultra-microporous membrane were checked by performing recovery experiments using commercial hCG and lyophilization procedure. The new test proved to be more sensitive, specific and reliable than other nonradioactive methods in detecting low levels of urinary hCG for diagnosing pregnancy as early as one week after missed period in regularly menstruating women. In addition, it is simpler and safer than the serum RIA presently used to detect low levels of hCG.