Biomedical subjects
Publications and source records attributed to A Hussein.
The authors report one case of cervical Pott's disease located in C5 and associated with neurological disorders. Following corrections of the spinal disaxation, they advocate a per priman posterior fixation which will ensure spinal stability. This will be followed secondarily by an operation through an anterior approach.
Despite the importance of endothelial cells little is known about their metabolic fuel requirements. To provide some information in this area, the maximum catalytic activities of key enzymes of important metabolic pathways have been measured in bovine pulmonary endothelial cells. The results suggest that both glucose and glutamine are important fuels for these cells: in addition, the oxidation of fatty acids may also be of quantitative significance. The activity of glutaminase in these cells was about 20-fold higher than that in lymphocyte, a cell which exhibits high rates of glutaminolysis. It is suggested that a high rate of glutamine metabolism by endothelial cells is important not only for energy provision but also for provision of nitrogen for biosynthetic purposes including production of local messengers.
Primary treatment of 123 children with joint conditions up to referral to the rheumatological outpatient department of an university hospital was investigated. Only 81 (66%) of the children were referred with a diagnosis. This could in turn be confirmed only in 24 children (20%). The most frequent false diagnoses were "infection arthritis" (18%) and "rheumatic fever" (7%). Inadequate therapies were likewise frequent during primary care: 30 children (24%) received plaster casts which in five children (17%) led to a contracture which was difficult to influence. Only 21 children (17%) received physiotherapy. Twenty-one children (17%) were treated with corticoids, 16 children (13%) with pyrazolidine derivatives and 33 (27%) were treated with antibiotics. Further treatment in the clinic then revealed that corticoids were indicated in only five cases and pyrazolidine derivatives in no case. Acetylsalicylic acid was generally sufficient to eliminate symptoms. Our results indicate that in terms of the early correct diagnosis and commencement of adequate therapy which is important for the prognosis, primary treatment of children with rheumatic diseases is inadequate. Appropriate training and postgraduate education of the doctors concerned is necessary in order to improve the situation.
Disease activity in 31 children with JRA and 12 with JSA was investigated clinically and by serial measurements of serum CRP and ESR over a one-year period. Prior mean duration of disease was 4.3 years. There was a significant correlation of CRP with ESR and both parameters correlated significantly with clinical disease activity. CRP concentrations and ESR in active disease were significantly higher than in moderately active and inactive disease, though neither parameter showed any significant difference between moderately active and inactive disease. Clinical scoring was more sensitive in detection of moderate disease activity than were CRP and ESR. However, in systemic JRA without articular involvement, laboratory parameters were more useful for assessing disease activity.
The glutamine analogue, methionine sulphoximine, has been used to develop Chinese hamster ovary cell lines which overproduce the enzyme glutamine synthetase. Southern and Northern blot hybridization studies showed that this overproduction is due to gene amplification of a region of DNA containing the glutamine synthesis gene coding sequences, with a corresponding increase in glutamine synthetase mRNA and protein. This amplification has increased the glutamine synthetase gene copy number to approximately 1000 copies per cell. Genomic DNA sequences from the amplified region have been cloned and the structure of the glutamine synthetase gene within this region is being analysed.
Eleven children (7 boys and 4 girls) suffered from reactive arthropathies following an enteritis. Mean age at onset of disease was 9.7 years (range 3.3-14.5 years). Six children had a classical Reiter's syndrome and two a juvenile spondyloarthritis diagnosed earlier. In 10/11 children, onset of disease was within 5 weeks following a febrile enteritis. The enteritis was confirmed in all 6 cases examined during the first three months after onset of disease. The arthritis was predominantly oligoarticular and affected mostly the joints of the lower extremities and toes. Recurrent enthesopathies and arthralgias occurred in most children. HLA-B27 was positive in 9 (82%). During a follow-up of 0.9 to 6.7 years, arthritis relapsed in most of the patients and 4 children had severe arthritis, and 5 sacroiliitis. Urethritis and occular signs relapsed frequently, but there were no noticeable disabilities. Two other girls had self-limited arthralgia and erythema nodosum following a febrile enteritis. This disease may represent the first stage of the broad clinical spectrum of the reactive arthropathies. In our outpatient clinic of paediatric rheumatology, 9% of 127 patients had reactive arthropathies. They show close relationships to each other and to other HLA-B27-associated spondyloarthropathies. The differentiation of this group of diseases from the juvenile rheumatoid arthritis is possible and relevant.
Ankylosing spondylitis, indefinite juvenile spondyloarthritis (JSA), reactive arthritides, psoriasis arthritis, arthritis of inflammatory bowel disease, and probably other rare diseases, such as the Behçet-syndrome, are sharing several distinctive features which discriminate them as a group from other arthritides, particularly from the rheumatoid arthritis in children (JRA) and adults. These distinctive features are: familial aggregation; association with HLA-B27; enthesopathy, sacroiliitis; predominance of Lower-Limb-arthritis; onset mostly after the age of 10 years, and typical manifestations of the skin and mucous membranes. Based on these characteristics and the probability of a later involvement of the spine, this group of diseases has been designated "HLA-B27-associated spondyloarthritides". Two thirds of all cases do not fit in any of the well-known spondyloarthritides. In this subgroup, designated as JSA, the disease begins usually with oligoarthritis and/or enthesopathy, and based on further clinical criteria it can early be distinguished from the JRA. The diagnosis of the other spondyloarthritides can be established primarily or later on follow-up, based on further characteristic symptoms and findings. In the differential diagnosis of arthritis in children, one third do have a spondyloarthritis and about one half do have JRA. This differentiation is of an important therapeutic and prognostic value, e.g. the slow-acting drugs are effective in JRA but not in spondyloarthritis, and in patients with axial manifestations, the early education and training for correct posture is important to prevent the development of kyphosis.
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20 children (age range 0.8-14.7 years) with acute severe asthma were alternately randomized to receive one of two different treatment regimes. 10 children (control-group) received Salbutamol inhalation (75 micrograms/kg in 2 ml Saline every two hours). 10 children (reproterol-group) received reproterol infusion (0.2-2.0 micrograms/kg/min in Saline) and inhaled Saline only. Other therapy regimen were identical in both groups: Theophylline infusion, i.v. Prednisolone, adequate fluids intake and oxygen insufflation. Age, severity and maintenance therapy of asthma, and severity of the acute episode, were not significantly different in both groups. Treatment efficacy, assessed with a simple clinical score, the heart and respiratory rates, the peak expiratory flow (PEF) and the blood gases, was comparable in both groups. Side effects, i.e. tachycardia, blood pressure changes and tremor, were also similar and clinically not relevant in both groups. In two children, who previously needed repeated mechanical ventilation, severe respiratory failure could be successfully controlled only when the reproterol dose was raised 10 folds (2.0 micrograms/kg/min). Reproterol infusion can be recommended in children with acute severe asthma, who do not respond satisfactorily to current therapy regimen, particularly in children who previously experienced numerous intubations.
The present review summarizes the results of C-reactive protein determinations in the serum of 9100 infants and children and gives a survey on data presented in the literature. Quantitative estimations of CRP are a useful screening method for the evaluation of infections and the activity of inflammatory processes in chronic diseases. In a variety of diseases CRP correlates well with erythrocyte sedimentation rate. CRP is, however, superior to ESR in showing faster dynamics and being uninfluenced by anemia, nephrotic syndrome or renal insufficiency. Marked elevations of CRP concentration may help to differentiate between viral and bacterial infections. It can be concluded that the determination of CRP in the serum must be added to the list of standard investigations in acutely and chronically ill infants and children.
Sixteen goats were inoculated subcutaneously or intraperitoneally with cultured Pseudomonas pseudomallei isolated from a goat. They showed either acute or chronic phase of disease. When inoculated intraperitoneally, animals suffered from a septicemic illness of short duration accompanied with micro-abscesses scattered widely throughout the body. In animals subcutaneously inoculated no clinical signs were exhibited, but the disease was of rather long duration, and lesions were large and localized in the spleen and lungs. Coincident with lesions, a large number of Pseudomonas pseudomallei organisms were isolated from abscesses in the spleen and lungs. Ultrastructurally, numerous bacilli could be detected in the cytoplasm of macrophages in the abscesses. They had an electron-dense cell wall. Most of them were surrounded by electron-dense substance.
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A new operation is described for the treatment of progressive infantile hydrocephalus. A pericranial flap with intact blood supply is introduced into the right lateral ventricle and fixed in place by suture to the dura or the skull. Twenty cases were subjected to the new operation with four deaths. The operation was successful in causing the arrest of the hydrocephalus and changing the mental state of early and mild cases.
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The purpose of this study was to investigate the prognostic importance of clinical and histopathologic factors, including malignancy grading systems (MGS), partial index (PI), invasive front grading (IFG), and microvessel density. A complete geographic series of 172 early stage (FIGO I-II) cervical carcinomas treated by Wertheim-Meigs surgery during the period 1965-1990 was studied. The patients were followed up for at least 10 years. Significant prognostic factors for disease-free survival were lymph node status (P < 0.0000001), radical surgical margins (P = 0.00003), and tumor size (P = 0.008). In a multivariate Cox analysis it was shown that lymph node status was the single most important prognostic factor with regard to disease-free survival. The total MGS and the PI scores were highly significantly (P = 0.0001) associated with pelvic lymph node metastases and disease-free survival rate in squamous cell carcinomas. The MGS and the PI systems were superior to the IFG system in predicting lymph node metastases. The total IFG score was also a statistically highly significant (P = 0.003) prognostic factor with regard to disease-free survival in both univariate and multivariate analyses. Microvessel density was a nonsignificant prognostic factor. There was a highly significant (P = 0.002) association between vascular space invasion of tumor cells and the presence of lymph node metastases. In conclusion, histopathologic malignancy grading systems provide valuable prognostic information in patients with early stage squamous cell carcinomas of the uterine cervix.