Changing pattern of respiratory tuberculosis in the UK in adult patients from the Indian subcontinent

BACKGROUND: Clinical observations over a 12 year period have suggested a changing pattern of adult respiratory tuberculosis in patients from the Indian subcontinent in two districts of the United Kingdom with a high incidence of tuberculosis. METHODS: Details of all patients for the period 1981-92 residing in the Newham and Blackburn districts aged 15 and over whose ethnic origin was from the Indian subcontinent (n = 1308) were analysed by stepwise logistic regression to determine the relationship between sputum smear positivity, sputum culture positivity, and isolated mediastinal lymphadenopathy, year of notification, age, sex, ethnic group (Indian or Pakistani), and whether the patient had visited the Indian subcontinent within the last three years. RESULTS: The proportion of cases who were smear positive rose over the 12 years of the study, as did the proportion of culture positive cases. The proportion with isolated mediastinal lymphadenopathy fell. These changes took place in both districts. They were not explained by demographic changes in age, sex, or ethnic group, nor was there evidence that smear and culture positivity increased in those who had recently visited India or Pakistan. CONCLUSIONS: The pattern of tuberculosis in adult patients originating from the Indian subcontinent has altered over time towards that seen in the white population in the UK.     

Management of the short stature due to pubertal delay in boys

Boys with constitutional pubertal delay who present with decreased growth rate pose diagnostic and therapeutic problems. Ninety-one boys seen after the age of 14 yr for height for age less than -2 SD, growth rate less than 5 cm/yr, and pubertal delay were evaluated. The GH peak after the arginine-insulin stimulation test was less than 10 micrograms/L in 35 of the subjects; these boys differed from the 56 others in having a GH peak of 10 micrograms/L or more, their higher body mass index (-0.27 +/- 0.2 vs. -0.85 +/- 0.1 score; P < 0.05), and lower plasma insulin-like growth factor-I (IGF-I; 1.2 +/- 0.2 vs. 1.8 +/- 0.2 U/mL; P < 0.05). The GH peak correlated negatively with the body mass index (P < 0.01), but not with plasma levels of testosterone and IGF-I or its GH-dependent binding protein (BP-3). At a second GH evaluation, performed with testosterone priming (21 boys; 100 mg testosterone heptylate/15 days, im; four doses) or without (6 boys), 23 patients had increased their GH peak to above 10 micrograms/L, and 4 had not. Three of these were treated with human (h) GH, and a third GH evaluation, performed after full pubertal development, showed a normal GH peak. The growth rate during the year preceding the GH evaluation was 3.8 +/- 0.1 cm (1-7 cm). During the year after the GH evaluation, it was 6.8 +/- 0.3 cm in the 32 patients followed without therapy, 7.3 +/- 0.3 cm in the 25 patients given testosterone (25 mg testosterone heptylate/15 days, im), and 7.3 +/- 1.4 cm in the 3 treated with hGH. Spontaneous growth during the 2 periods was correlated with testicular volume (P < 0.01) and the plasma testosterone level (P < 0.05), but not with the GH peak, plasma IGF-I, or BP-3. The final height (n = 49) was -1.0 +/- 0.1 SD, below target height (-0.4 +/- 0.1 SD; P < 0.0001). It was similar in patients with a GH peak below or equal to or above 10 micrograms/L and in those given or not given testosterone therapy. We conclude that the growth rate of boys with constitutional pubertal delay depends on the testicular volume and plasma testosterone level, but not on the GH peak, plasma IGF-I, or BP-3 levels. Final height is not altered by a transient drop in GH or by low dose testosterone therapy.     

GH and GnRH analog treatment in children who enter puberty at short stature

It is well known that height at the onset of puberty is closely related to final height. To improve final height of short children who enter puberty at short stature, twenty-one short boys and six short girls were treated with a combination of GH and GnRH analog. The boys started the combination treatment at a mean age of 12.0 years when their mean height was 128.5 cm (-2.74 SD) and the girls at a mean age of 10.68 years when their mean height was 126.4 cm (-2.23 SD). The boys discontinued GnRH at a mean age of 16.88 years after a mean treatment period of 4.89 years when their height was 153.7 cm (-2.75 SD), and the girls at a mean age of 13.89 years after a mean treatment period of 3.20 years when their height was 143.3 cm (-1.94 SD). Bone age maturation significantly decelerated during the combination treatment. Bone age rarely exceeded 14 years in boys and did not exceed 13 years in girls. Bone age maturation during combination treatment decelerated after bone age 12 years in boys and 10.5 years in girls. On average, bone age matured at a mean rate of 0.48 years a year in boys and 0.56 years a year in girls during the combination treatment. During the combination treatment, height velocity did not decelerate rapidly and remained at 3-5 cm/year for a longer duration because of the bone age deceleration, although a definite pubertal growth spurt was not observed. As a consequence, the mean projected height SDS for bone age increased 1.50 (+/- 0.76) SD in boys and 1.24 (+/- 0.49) SD during the combination treatment. Although most of the patients have not yet reached their final height, combined GnRH analog and GH treatment should increase the pubertal height gain and the adult height in short children who enter puberty early for height, when the post-GST growth is taken into account. The combination treatment seems more effective in boys than in girls. This improvement is attributed to the lengthening of the treatment period by slower bone maturation and maintained growth velocity.     

Serum growth hormone-binding protein is decreased in prepubertal children with idiopathic short stature

Every activity of a medical practitioner may be subjected to court control. This creates not only uncertainty gut also anger amongst most physicians. However, it is clear that no court judgement against a physician will be made without the competent support of independent medical experts. On the basis of the relevant legal literature and judgments, the present article is an attempt to consider medical errors in the administration of contrast media, to describe the required medical informed consent before such measures, and to discuss the ever increasing importance of adequate documentation in the light of malpractice proceedings. importance of adequate documentation in the light of malpractice proceedings. This is followed by a discussion of the very important medical necessity to inform the patient about recommended behaviour after injections of such contrast media, the responsibility question in both civil and criminal terms in case of an incident, and various tips for steps to be taken in the case of a liability action.     

Dental maturity in children of short stature, with or without growth hormone deficiency

Macrophages are important constituents of the immune system by exerting phagocytosis on invading pathogens as well as secreting various immunoregulatory factors. Generation of human macrophage hybridoma has not been possible so far due to the lack of an appropriate fusion partner cell line. In the present study, an 8'-azaguanine resistant cell line, termed HL-60R, was established by drug selection of the promyelocytic cell line HL-60. This novel cell line showed resistance to high concentrations of 8'-azaguanine and was sensitive to aminopterin. These characteristics make it suitable for serving as a potential fusion partner cell line in the development of macrophage hybridoma. Cell-surface analysis by FACS revealed that HL-60R cells per se do not express MHC-class II molecules or the macrophage marker, CD11b. PEG-mediated fusion of HL-60R was performed with PBMC-derived human macrophages. Fluorescence labelling of ex vivo isolated macrophages prior to fusion and subsequent FACS analysis showed that PEG-4000 is a more effective fusion agent than PEG-1500. The generation of this novel fusion partner cell line opens the possibility for development of human macrophage hybridoma or other cell lines from myelocytic origin. Such hybridoma clones will not only enable a more convenient study of these cell but will also provide an excellent host site for the proper production and expression of various recombinant proteins from myelocytic origin in vitro.     

Moral assessment of growth hormone therapy for children with idiopathic short stature

Subjects ranging in age from 50 to 89 years old, either with or without dementia were studied by both ELISA for anti-human T-cell lymphotropic virus type I (HTLV-I) gag 100-130 antibody and by cranial CT in order to clarify the relationship between HTLV-I infection and dementia. The frequency of anti-HTLV-I antibody was found to be significantly higher in the patients with dementia (24/130, 18.5%) than in those without dementia (11/139, 7.9%) (P=0.0169). Among the various types of dementia, HTLV-I seropositivity was found to be significantly associated with vascular dementia (11/48, 23%) (P=0.0087), but not with Alzheimer type dementia. In addition, HTLV-I seropositivity was also associated with Babinski sign, and the severity of cerebral infarction, ventricular dilatation and periventricular lucency on CT. The presence of HTLV-I therefore appears to be one of the risk factors for vascular dementia in HTLV-I endemic areas.     

The treatment with biosynthetic growth hormone (GH) of familial short stature

The effect of growth hormone (GH) treatment in non-GH deficient subjects has been amply studied over the past few years. Although the results of these studies are encouraging, there are still no definitive data since the findings are not comparable due to the different characteristics of the populations examined. In the present study the authors examined the following parameters: stature, height SDS, growth rate, bone age and final height prediction according to Tanner, pubertal stage, before and after treatment with biosynthetic GH at a dose of 1.4 IU/kg of bodyweight for 12 months. The population treated consisted of 10 subjects (5 males and 5 females) aged between 7.3 and 9.5 years old, all prepubertal, with "familial short stature", selected according to the following criteria: stature below the 3rd centile, normal growth rate, normal GH response to stimuli using clonidine and insulin, correlation with parental stature between 25th and 75th centile, bone age correlated to chronological age, absence of other pathologies. After 12 months height SDS moved from -2.75 +/- 0.26 to -2.23 +/- 0.25 (p < 0.5); the growth rate changed from 5.75 +/- 0.63 to 6.66 +/- 0.56 (p < 0.05). No abnormal acceleration of bone age as observed: it moved from 8.2 +/- 0.62 to 9.5 +/- 0.72; all subjects continued to be prepubertal. The expected final stature changed from 154 +/- 2.38 to 159 +/- 0.7 (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Mental retardation, epilepsy, short stature, and skeletal dysplasia: confirmation of the Gurrieri syndrome

AIM: To study the relationship between the calcium and the release of platelet-activating factor (PAF) from rat peritoneal macrophages (PM?) stimulated by lipopolysaccharides (LPS). METHODS: The effects of tetrandrine (Tet), Fura 2-AM, and Bay k 8644 on the PAF release from rat PM? was investigated by the bio-assay of PAF. RESULTS: LPS stimulated PM? to release PAF, without increasing intracellular Ca2+ of PM?, Tet at 0.1, 1.0, 10, 100 mumol.L-1 and Fura 2-AM at 0.01, 0.1, 1.0, 10 mumol.L-1 could dose-dependently decrease the release of PAF (9.8 +/- 1.2, 6.5 +/- 1.6, 4.7 +/- 0.8, 3.4 +/- 0.4 microgram.L-1 and 9.2 +/- 1.7, 5.2 +/- 1.3, 3.7 +/- 0.4, 3.2 +/- 0.3 microgram.L-1, respectively, no drugs 11.8 +/- 1.2 micrograms.L-1), Bay k 8644 at 1.0, 5.0, 10 mumol.L-1 could dose-dependently increase the release of PAF (13.2 +/- 1.7, 16.2 +/- 1.4, 17.6 +/- 1.5 micrograms.L-1), and the effects of Tet and Fura 2-AM were completely or partly reversed by Bay k 8644 at 5.0 mumol.L-1. CONCLUSION: Although LPS did not increase intracellular Ca2+ of PM?, intracellular Ca2+ was necessary for PAF release from rat PM? stimulated by LPS.     

Apparently new syndrome of short stature, lumbar malsegmentation, and minor facial anomalies in two brothers

We describe a previously unrecognized syndrome in two brothers with short stature, webbed neck, unusual face, moderate malsegmentation of the lumbar spine, and unilateral Legg-Perthes-Calvé type "disease" of the hip. Autosomal recessive inheritance is proposed, although we cannot exclude the possibility of an X-linked recessive or an autosomal dominant condition with germinal mosaicism.     

Comparative study of bone mineralization in children and adolescents with familial short stature and a control group

Within the past year there has been a dramatic increase in the number of molecular epidemiologic studies reported in the literature, particularly those evaluating gene-gene and gene-environment interactions. Molecular epidemiologic studies have become more sophisticated owing to collaborations between laboratory scientists and epidemiologists, and because these studies are now conducted on well-characterized populations with appropriate study design. Although there continue to be inconsistencies across some studies, it is clear that the evaluation of gene-gene and gene-environment interactions can delineate portions of the population who are particularly sensitive to certain carcinogenic exposures, based on polymorphisms in genes involved in preventing and controlling carcinogenesis. Identification of these subsets of susceptible individuals can result in the design of preventive strategies targeting the most "at risk" populations.     

An epidemiologic study on the aetiological factors of primary liver cancer in Shunde City of Guangdong province

The F-type ATPase, TF0F1, from the thermophilic Bacillus PS3, which is free of nucleotides after isolation, was specifically loaded with one 2-azido ADP on a non-catalytic site. The enzyme was covalently modified to various extents and the rate of ATP synthesis and ATP hydrolysis was measured. Both ATP synthesis and ATP hydrolysis extrapolated to zero for covalently binding one nucleotide per enzyme. This was interpreted such that the non-catalytic sites are involved in the coupled catalytic process.     

Changes in serum IGF-I and IGFBP-3 concentrations during the IGF-I generation test performed prospectively in children with short stature

The fractions of antibodies (Abs) containing only sIgA and IgG were purified from human breast milk by Protein A-Sepharose chromatography and they catalyzed phosphorylation of casein in the presence of [gamma-32P]ATP. Also, 32P-labeled low-molecular-weight non-protein products are formed which are visible as radioactive background on the polyacrylamide gel lanes during electrophoresis of Abs under denaturing conditions. Separation of sIgA from IgG using a DEAE-sorbent with subsequent gel-filtration in 0.05 M NaOH indicates that the low-molecular-weight substances partially remain tightly bound to sIgA and are separated only by gel-filtration in a buffer containing 5% dioxane (non-denaturing resolution) or by extraction of the sIgA pellet with the chloroform--methanol mixture (2:1). The 32P-labeled substances were separated by TLC in the system used for phospholipid chromatography forming two fractions (Rf 0.83 and 0.66) that were stained with iodine. The data suggest that the substances co-isolated with sIgA are phospholipids. At 25 nM ATP, casein and lipids are 32P-labeled. At 1 microM ATP, the sIgA polypeptides are also phosphorylated. Gentle removal of the lipids from Ab preparation enhanced 32P incorporation into casein and sIgA polypeptides. Considering the heterogeneity of polyclonal sIgA in protein and ATP affinity, it is suggested that phosphorylation of casein and sIgA polypeptides is catalyzed by abzymes of different clonal origin.     

The Wolfram syndrome: diabetes mellitus, hypacusis, optic atrophy and short stature in STH deficiency

HISTORY AND CLINICAL FINDINGS: A 43-year-old man was known for 3 years to have diabetes mellitus. For 2 months before admission he had symptoms of hyperglycaemia with polyuria, polydipsia, weight loss, as well as impairment of vision and declining fitness. In addition to bilateral deafness he was clearly of normally proportioned short stature (150 cm). INVESTIGATIONS: The levels of blood sugar (221 mg/dl), HbA1c(10.2%), triglycerides (496 mg/dl) and cholesterol (323 mg/dl) were raised, while the concentration of somatotropic hormone was diminished, both before and after arginine administration. Fundoscopy revealed concentric diminution of the visual fields with left amblyopia. Visual evoked potentials and colour sense testing revealed bilateral optical atrophy, and the audiogram demonstrated deafness. These findings provided the diagnosis of Wolfram syndrome, namely insulin-dependent diabetes mellitus, deafness, optical atrophy and small stature with somatotropic hormone deficiency. TREATMENT AND COURSE: On insulin treatment the metabolic state became normal (HbA1c 7.5%, normal lipid profile). It was decided that the deficiency in somatotropic hormone regulation did not require treatment. CONCLUSION: Cardinal symptoms of the autosomally recessive Wolfram syndrome are insulin-dependent diabetes and optic nerve atrophy. Several types of hormonal abnormalities are associated with it, including a deficiency in the somatotropic axis. To obtain early and adequate hormonal substitution requires extensive endocrinological diagnosis of a disease which frequently becomes manifest in childhood or adolescence.     

An exploratory profile of the Anti-Drug Authority coordinator in Israel

During the past decade, there has been a proliferation of alcohol and other drug use in Israel. In order to combat this problem, the Israeli government, in 1988, created the National Anti-Drug Authority, a government agency whose responsibilities include the coordination of all prevention, treatment, and research activities that are directed towards the goal of fighting the war against drugs. As part of its mandate, the National Anti-Drug Authority created local anti-drug authority coordinators to fulfill its goals. The study described in this paper presents a preliminary picture of the role profile of the anti-drug authority coordinator worker in Israel. Five major direct practice role categories were revealed in the study with the community assessment and social broker role identified as the most active practice component followed by the community coordinator role, supervision and consultation, planning and conducting anti-drug prevention services, and assisting in community intervention the least active role component. In order to understand the findings, the role categories are classified according to their frequency of practice by the anti-drug coordinators along with the goals, focal systems, and the major tasks toward which each role category is directed. Finally, the study showed a high level of social work involvement as anti-drug authority coordinators.