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PubMed1998

Seroepidemiology of ocular toxoplasmosis-profile of an urban population.

200 uveitis cases and 100 controls were serologically analysed for Toxoplasma antibodies (Ab) using indirect fluorescent antibody test (IFAT-IgG, Igm) and enzyme linked immunosorbent assay (ELISA IgG, IgM). Ophthalmologically cases were segregated into 4 groups anterior uveitis, posterior uveitis, pan uveitis and varied presentation uveitis. Toxoplasma seropositivity of 32% in cases and 4% in controls was established. IHA, IFAT, ELISA detected 20%, 18% and 32% cases as seropositive respectively, IFAT being most specific (100%) and ELISA most sensitive (41.37%). Insignificant change in Ab titre was observed in sequential samples of seropositive cases. Posterior Uveitis cases had the maximum seropositivity (41.7%). Highest seropositivity was in 16-25 years age group with no sex preponderance. Dietary habits and occupational history had no bearing on Toxoplasma infection. Results indicate that serology in mandatory for diagnosing Toxoplasma as a cause of uveitis, 2 or more tests on a single serum sample detecting IgG and Igm Ab are the best indicators of infection.

Animals↗
PubMedDate not supplied

How the surveillance system may bias the results of analytical epidemiological studies on BSE: prevalence among dairy versus beef suckler cattle breeds in France.

Until recently, epidemiological studies on Bovine Spongiform Encephalopathy (BSE) were based on Mandatory Reporting Systems (MRS) of clinically suspect bovines only, but rapid diagnostic tests were validated in 1999 and are used for targeted surveillance in Switzerland, France and other countries, as a complementary and secondary tool. Data on 30491 cattle issued from a French pilot program targeted at cattle having died on the farm, subjected to euthanasia or sent for emergency slaughter, did not show any significant difference in BSE risk between dairy and beef suckler breeds. The data also revealed that part of the clinical cases of BSE escaped the MRS, which permitted to detect more dairy than beef suckler affected cattle compared to the targeted surveillance in the same period (from August to December 2000) and region (Bretagne, Pays de la Loire and Basse Normandie regions). Analyzing together the data of the targeted surveillance and mandatory reporting system programs with a non-conditional logistic regression, we found that the odds of a dead cow being a BSE case among all dead cattle was 3.2 times higher for dairy breeds compared to beef suckler breeds. This confirmed British findings but points out to the fact that considering either MRS or targeted surveillance data alone may possibly create biases in epidemiological studies on BSE.

Animals↗
PubMed1996

Distribution of hemoglobinopathy variants by ethnicity in a multiethnic state.

It has been well known for many years that Black Americans are at increased risk for sickle cell disease and that individuals of Mediterranean ancestry are at increased risk for thalassemias. Beyond this, however, complete assessments of the epidemiology of hemoglobinopathies in Americans have been constrained by lack of large enough sample size, incomplete diagnostic work or testing inadequacies, or missing or misleading ethnicity data. California began universal, mandatory screening of all infants born in the state in 1990, and by January 1996, had screened over 3.3 million infants of various ethnic backgrounds. New information is now available on groups at increased risk for disease, as well as carrier status. The overall prevalence of sickle cell disease (all types) remains high in Blacks at 1 per 396 births, but is lower than expected (from east coast/ Caribbean published data) for Hispanics at 1 m 36,000 births or from previously published data on other higher risk groups such as Middle Eastern (no cases in over 22,000 screens) or Asian Indian (1 case in 16,000 screens). The distribution of different types of sickle cell disease has also changed, with increased numbers of Hb SE disease resulting from multiethnic partnerships. Demographic trends in California have led to a major sift in the at-risk groups for major beta thalassemias, with the majority of cases detected in families of Asian, Southeast Asian, and Asian Indian ancestry. The "new" hemoglobinopathy condition in California, Hb E/Beta. Thalassemia, is found almost exclusively in Southeast Asians with a prevalence of 1 in every 2,600 births. Carrier conditions are found in virtually every ethnic category, with higher than expected rates in non-Hispanic Whites (1 per 600 births).

Ethnicity↗
PubMed2003

Identification of biologic markers of the premature rupture of fetal membranes: proteomic approach.

In obstetrics, premature rupture of the membranes (PROM) is a frequent observation which is responsible for many premature deliveries. PROM is also associated with an increased risk of fetal and maternal infections. Early diagnosis is mandatory in order to decrease such complications. Despite that current biological tests allowing the diagnosis of PROM are both sensitive and specific, contamination of the samples by maternal blood can induce false positive results. Therefore, in order to identify new potential markers of PROM (present only in amniotic blood, and absent in maternal blood), proteomic studies were undertaken on samples collected from six women at terms (pairs of maternal plasma and amniotic fluid) as well as on four samples of amniotic fluid collected from other women at the 17(th) week of gestation. All samples (N = 16) were analyzed by two-dimensional (2-D) high-resolution electrophoresis, followed by sensitive silver staining. The gel images were studied using bioinformatic tools. Analyses were focused on regions corresponding to pI between 4.5 and 7 and to molecular masses between 20 and 50 kDa. In this area, 646 +/- 113 spots were detected, and 27 spots appeared to be present on the gels of amniotic fluid, but were absent on those of maternal plasma. Nine out of these 27 spots were also observed on the gels of the four samples of amniotic fluids collected at the 17(th) week of pregnancy. Five of these 9 spots were unambiguously detected on preparative 2-D gels stained by Coomassie blue, and were identified by mass spectrometry analyses. Three spots corresponded to fragments of plasma proteins, and 2 appeared to be fragments of proteins not known to be present in plasma. These 2 proteins were agrin (SWISS-PROT: O00468) and perlecan (SWISS-PROT: P98160). Our results show that proteomics is a valuable approach to identify new potential biological markers for future PROM diagnosis.

Biomarkers↗
PubMed1998

[Reproducibility of the effectiveness of defibrillation for terminating induced ventricular fibrillation using intraoperatively measured defibrillation threshold energy in patients with implanted cardioverter-defibrillator].

The aim of the present study was to assess the long-term reproducibility of the defibrillation efficacy of energies set at the intraoperatively measured defibrillation threshold using a modified testing protocol. Between December 1993 and January 1996, 83 patients receiving an implantable cardioverter-defibrillator (ICD) in combination with a non-thoracotomy lead system and having an intraoperatively measured defibrillation threshold (DFT) < or = 15 J were enrolled in a substudy of a prospective, randomized multicenter trial ("Low Energy Endotak Trial" (LEET)). Step-down DFT testing was performed intraoperatively (15, 10, 8, 5 J). It was mandatory to reproduce a successful conversion of ventricular fibrillation at the DFT energy during implantation (DFT+). At the end of implantation, at predischarge, and after one year, assessment of the defibrillation efficacy of DFT+ energy was repeated (first shock: DFT+, second shock: 2 x DFT+). Mean DFT+ at implant was 9.6 + 3.3 J. Immediately after implantation, successful conversion of induced ventricular fibrillation was achieved in 70/79 (89%) patients using DFT+ energies. In 7/8 (89%) patients only the second shock set at 2 x DFT+ and in one patient only the third shock set at maximum energy (34 J) was successful. At predischarge, defibrillation efficacy of DFT+ was reproducible in 61/77 (79%) patients. The remaining 16 patients were successfully converted using a second shock set at 2 x DFT+. One year after implantation, conversion of ventricular fibrillation was achieved at energies set at DFT+ in 52/62 (84%) patients and in the remaining 10 patients at energies set at 2 x DFT+. A total of 183/218 (84%) episodes of induced ventricular fibrillation were terminated successfully using DFT+ energies. There was no correlation between the intraoperatively determined DFT+ or the underlying cardiac disease and the defibrillation efficacy. These results demonstrate that the defibrillation efficacy for termination of induced ventricular fibrillation using DFT+ energies is reproducible at implantation, at predischarge, and one year after ICD insertion. Energies set at twice DFT+ seems to allow for reliable defibrillation within the first year after ICD implantation.

Adult↗
PubMed2003

Putative role of epithelial sodium channels (ENaC) in the afferent limb of cardio renal reflexes in rats.

Recent studies suggest a role of ion channels of the DEG/ENaC family for mechanosensation in different species and in baroreceptor reflex control in rats. We tested the hypothesis that ENaC within the cardiac sensory network are mandatory for mechanosensation. Experiments were performed in male Sprague-Dawley rats, isolated nodose ganglion cells with cardiac afferents and isolated vagus nerves. Epicardial delivery of the amiloride analogue benzamil intended to specifically inhibit ENaC presumably located on cardiac sensory afferents indeed blunted the mechanosensitive (i. e., sympathoinhibition by intravenous volume loading [-32% and -42% in treated groups vs. -67% in controls; n = 7 each; p < 0.05]) as well as-though to a lesser extent-the 5-HT(3)-mediated chemosensitive cardiorenal reflex in vivo in a dose-dependent manner. Using patch clamp technique, however, it turned out that neither amiloride nor benzamil influenced mechanically induced currents in ganglion nodosum cells in vitro, stimulated by hypoosmotic stress. The unspecific stretch activated ion channel blocker gadolinium completely abolished mechanically induced currents, indicating respective cells were mechanosensitive. In isolated vagus nerves benzamil impaired action potentials obtained by electrical stimulation (C-spike amplitude [-33%]; latency [+12%]; n = 8; p < 0.05). Our findings at least cast doubt on ENaC exclusively playing a specific role as mechanotransducers within the cardiac sensory network. Other ion channels might be involved. Furthermore the observed findings in vivo could also be due to unspecific disturbance of afferent signal conduction.

Action Potentials↗
PubMed2006

Evaluation of type 1 diabetics for simultaneous pancreas-kidney transplantation with regard to cardiovascular risk.

The main cause of death for diabetic patients and patients on dialysis is coronary artery disease (CAD). The most common cause of graft loss following simultaneous pancreas and kidney transplantation (SPK) is death with a functioning graft due to CAD. Therefore, careful pretransplantation evaluation of CAD is mandatory. In our series, every patient undergoes a noninvasive cardiac function test like dobutamine stress echocardiography (DSE) or myocardial thallium scintigraphy using adenosine to induce medical stress. Thirty patients were evaluated for SPK: 15 patients with myocardial scintigraphy and 8 with DSE. Seven investigations showed pathological findings and we performed coronary angiograms, none of which showed coronary artery stenosis. Seven primary coronary angiograms were performed: four due to a history of CAD and three as a primary diagnostic. Following SPK one patient died at 21 days after transplantation due to myocardial infarction. He had a history of CAD with angioplasty and stent implantation. Noninvasive cardiac function tests like DSE or myocardial scintigraphy are reliable methods to evaluate CAD in patients with diabetic nephropathy awaiting SPK. In case of a suspicious finding or a history of CAD, a coronary angiogram should be performed to assess the need for revascularization. Following this algorithm we may further reduce the mortality of SPK.

Adult↗
PubMed2002

Adrenocortical tumors: clinical symptoms and biochemical diagnosis.

Patients who are suspected clinically to suffer from hypersecretory disorders of their adrenal(s) should undergo an appropriate endocrinological investigation to confirm or exclude the presence of such disorders prior to any radiological investigation. In those patients in whom an adrenal mass is found 'incidentally' on imaging clinical symptoms of hormonal activity should be carefully followed up. Asymptomatic patients should be screened biochemically for latent hormonal hypersecretion syndromes including pheochromocytoma (urine catecholamine excretion), hypercortisolism (overnight dexamethason suppression test) and aldosteronism (blood pressure and serum potassium). These investigations are mandatory in all patients scheduled for surgery. The decision to refer patients with inactive adrenal tumors to surgery is, in the absence of valid biochemical markers of malignancy, mainly influenced by tumor size but remains arbitrary. Patients who are not at first treated by surgery should be operated if follow-up indicates a progression in tumor size.

Adrenal Gland Neoplasms↗
PubMed1993

[Resorbable implant materials in retinal detachment surgery. Initial animal experiment studies].

In detachment surgery after a mechanically stabile chorioretinal scar is at present full scleral indentation no longer mandatory. Following these considerations absorbable scleral implants have been developed and tested in an animal model. Cylindrical pieces of absorbable composite-material with a diameter of 5 mm were sutured as radial scleral explants in 18 rabbits. The composite material consisted of a polyglactin-polydioxanon ratio 7:1. The absorption time for polyglactin is 60 days, for polydioxanon 180 days. The explants produced initially in ultrasonographically measured buckle height between 3.2 and 4.0 mm. The clinical and ultrasonographical follow up study demonstrated a continuous decrease of buckle height. Two weeks after implantation there was a medium height of 2.0 mm after five weeks a medium elevation of 0.5 mm was found. Histopathological examinations showed incidence of a slight resorptive inflammation in the area of the buckle which was not evident after 12 weeks. No scleral infiltration or scleral thinning was found. The promising results have justified controlled clinical trials with the absorbable material which might allow to combine the advantages of silicone sponge explants (precise localization) with those of scleral buckles by inflatible balloons (reversibility).

Absorption↗
PubMed1983

The MIE Carden ventilator. A description and laboratory assessment.

The Carden ventilator is described and assessed when used in adult and paediatric modes against test lungs with varying compliance and airways resistance. The ventilator proved to have limited ability to compensate for changes in test lung compliance and resistance. Repeated confirmation of tidal volume is mandatory, but the Carden combines simplicity with flexibility of design and may prove useful as a theatre ventilator.

Adult↗
PubMed1992

Fixation of a single testis: always, sometimes or never.

If it is necessary to perform an orchiectomy for an intravaginal testicular torsion it is the usual practice of surgeons to fix the contralateral testis. When faced with a child with only one testis for another reason it is our practice to fix this single testis to eliminate the small but disastrous risk of a torsion. We were interested to see whether this practice was usual and therefore sent out a questionnaire to the 67 consultant paediatric surgeons and urologists in Great Britain. Sixty-six surgeons replied. Seven surgeons (11%) always fix the single testis, 28 (42%) sometimes and 31 (47%) never fix a single testis. Five surgeons had looked after 6 patients who had a torsion of a second unfixed testis after losing the first for a reason other than intravaginal torsion. Four of these patients had initially had a neonatal supravaginal torsion, 1 had a torsion of an undescended testis and the sixth had severe testicular atrophy following an inguinal herniotomy. In our opinion the devastating loss of these solitary testes makes contralateral testicular fixation after an orchiectomy for whatever reason mandatory.

Attitude of Health Personnel↗
PubMedDate not supplied

Neural tube defects in the offspring of thalassemia carriers.

OBJECTIVES: The risk of neural tube defects (NTDs) is negatively correlated with maternal folate levels in early pregnancy. Thalassemia carriers often have reduced red cell folate contents. The aim of this study was to verify whether thalassemia carriers are at increased risk of having offspring with a NTD. METHODS: We retrospectively evaluated the prevalence of thalassemia carriers among 75 women who had prenatal diagnoses of NTDs made at our center. RESULTS: The prevalence of beta-thalassemia carriers among the affected pregnancies was significantly higher than in the general population (22.5 versus 14%, p < 0.05, chi(2) test). CONCLUSION: Although inconclusive, these data indicate that folate supplementation is mandatory among women with thalassemia who are planning a pregnancy.

Female↗
PubMed1997

Recent developments in our understanding of adult coeliac disease.

Coeliac disease, previously regarded as unusual and florid, is now seen as having an extraordinary breadth of manifestations. Many cases are unrecognised or latent. Diarrhoea and abdominal complaints may be present in low key but chronic ill health; anaemia, endocrine and neurological changes are increasingly recognised. Suspicion should lead straight to serological tests, of which the antiendomysial antibody test is best. If suspicion is high, endoscopic duodenal biopsy is mandatory. A gluten free diet, while difficult to maintain, effectively cures and prevents complications.

Adolescent↗
PubMed2001

[Trauma of the knee joint--radiological diagnosis].

The knee, the largest joint in the human body, is composed of the distal femur, the proximal tibia, the patella, and a complex arrangement of ligaments and menisci. This joint is particularly vulnerable because of its anatomic, functional, and mechanical characteristics. Depending on the severity and the specific mechanism of the trauma, injuries of soft tissue structures or bony elements or even a combination of both may be present. In case of severe pain caused by traumatic events clinical tests may be insufficient for exact diagnosis and radiological examinations are mandatory for an effective planing of the therapeutic management.

Cartilage, Articular↗
PubMed2003

Mandibular condyle osteochondroma. Review of the literature and report of a misdiagnosed case.

Temporomandibular disorders can usually be diagnosed on the basis of a thorough history and a comprehensive examination of the patient. Additional diagnostic tests, such as imaging of the temporomandibular joint (TMJ) area, are mandatory and must be flawless in case of atypical findings. The aim of this report is to illustrate pitfalls in clinical reasoning and in imaging procedures in the diagnosis of temporomandibular pain and dysfunction. A case report of a patient with osteocartilaginous exostosis of the mandibular condyle, which was erroneously diagnosed and treated as an internal derangement of the TMJ for half a year, is presented.

Adult↗
PubMed2004

Testicular, other genital, and breast cancers in first-degree relatives of testicular cancer patients and controls.

Previous studies showed an increased prevalence of testicular cancer among fathers and brothers of testicular cancer patients. We examined whether testicular, other genital, and breast cancers aggregate in parents and siblings of testicular cancer patients in a population-based case-control study, including males, ages 15 to 69 years at diagnosis, with primary malignant tumors of the testes or extragonadal germ cell tumors. Controls were ascertained through the mandatory registries of residents and frequency matched to the cases by age and region of residence. In a face-to-face interview, 269 cases and 797 controls provided health-related information on parents and siblings. We calculated odds ratios (OR) and corresponding 95% confidence intervals (95% CI) based on the generalized estimating equations technique, adjusting for the matching variables and relatives' age. Three (1.1%) fathers and eight (3.2%) brothers of cases were affected with testicular cancer compared with four (0.5%) fathers and two (0.2%) brothers of controls. The OR (95% CI) of familial testicular cancer was 6.6 (2.35-18.77). Only nonseminoma patients had fathers with testicular cancer, whereas the affected brothers were all related to seminoma patients. Overall, we found an increased risk for genital other than testicular cancers (OR 2.5, 95% CI 1.43-4.43). For breast cancer, we detected an increased risk in sisters (OR 9.5, 95% CI 2.01-45.16, adjusted for age of study participant and age of sister) but not in mothers. Our findings support the hypothesis that testicular and other genital cancers have a common familial component that may be due to genetic and shared exogenous factors such as estrogen exposure during fetal development.

Adolescent↗
PubMedDate not supplied

Acute renal failure related to rhabdomyolysis: pathophysiology, diagnosis, and collaborative management.

Acute renal failure related to exertional rhabdomyolysis is a medical condition that, if not diagnosed correctly and treated aggressively, can lead to serious dysfunction and may result in death. Although the history is invaluable in diagnosing this condition, it must be confirmed by laboratory testing. The sometimes subtle manifestations of exertional (nontraumatic) rhabdomyolysis make it mandatory that the health care team is able to recognize the signs and symptoms and understand the pathophysiology for prompt treatment and referral.

Acute Kidney Injury↗
PubMed1985

[Physical characteristics of stripping veins preserved at 4 degrees C and usable as artery substitutes].

The mechanical behavior of varicosis veins harvested during stripping and preserved at 4 degrees C has been investigated by measuring the compliance, the yield strain, the yield stress and the longitudinal Young's modulus. No relationship has been demonstrated between those parameters and external factors such as age, sex, storage duration and bacteremic contamination. The mechanical behavior of such veins is unpredictable. Therefore, it is mandatory to proceed through individual and non-destructive quality control tests to obtain a selection of grafts suitable for implantation. Moreover, implantation should be oriented towards patients who are able to visit the hospital frequently since the healing capacity of the venous homograft is unpredictable.

Arteries↗