Should diastasis recti be corrected?

From theoretical considerations animals with a higher protein-fat ratio in the body should have a higher maintenance energy requirement (MEm). The literature on this problem shows a non-uniform picture with deviating results. From the results of a series of experiments it is possible to compare the heat production (HP) of male and female animals of the Vietnamese Sway-back breed pigs which vary quite widely in their body composition. The protein-fat ratio was 1.2 for the male and 0.2 for the female animals. In the experiments 4 male and 4 female animals in the live weight range of 20-33 kg and 33-42 kg, respectively, were involved. The HP measurements were carried out in climatized respiration chambers on two levels of energy intake at ambient temperatures of 6 degrees C, 12 degrees C, 18 degrees C, 24 degrees C, 30 degrees C, and 35 degrees C. The dependence of HP on the ambient temperature has been described by a cubic regression function. Thermoneutral temperatures are lower in the female animals caused by the better insulation effect of the backfat. The difference in HP which was expected by the large difference in body composition, was not found. The absolute protein mass determined the correlation to HP. Certainly the difference increased after lowering the ambient temperature. The influence of different factors on HP is discussed.     

Tissue distribution and depuration kinetics of waterborne 14C-labeled light PAHs in mummichog (Fundulus heteroclitus)

Light polycyclic aromatic hydrocarbons (PAHs) of petrogenic origin are commonly found in estuaries and coastal areas. Though they are known to be toxic to fish, little is known about their uptake and tissue distribution. This paper reports on the results of a study on uptake, elimination, and tissue distribution of three waterborne 14C-labeled PAHs in the mummichog, Fundulus heteroclitus, using whole-body autoradiography. After a 24 h exposure to 1 μCi·L(-1) of 14C-naphthalene, 14C-1-naphthol, and 14C-phenanthrene, fish were transferred to clean water and tissue distribution examined after 0, 1, 3, 7, 14, and 21 days of depuration. All compounds were readily accumulated by fish and were also rapidly eliminated (t0.5 range=1.1 to 3.0 days). Most of the radioactivity in naphthalene- and phenanthrene-treated fish was found in gall bladder?liver>intestinal lumen. In naphthol-exposed fish, an important labeling of some brain areas was observed. Brain of naphthalene-exposed fish was also labeled after 24 h depuration, indicating that exposure to naphthalene may result in metabolite accumulation in the brain. This is the first study showing that naphthalene, naphthol, and/or unidentified metabolite(s) can accumulate in brain tissues, which may impair normal brain function.     

Response at three months is a good predictive factor for newly diagnosed chronic myeloid leukemia patients treated by recombinant interferon-alpha

In a single institution, we have used recombinant interferon- (IFN-) to treat 116 newly diagnosed Philadelphia-positive (Ph+) chronic myeloid leukemia (CML) patients and analyzed the predictive factors for response and survival. The patients whose median age was 50.3 years (range, 9 to 70) were administered IFN- (5 million units/m2/d) subcutaneously. The IFN- dose was subsequently adjusted to maintain the white blood cell and platelet counts between 1.5 and 5 x 10(9)/L, 50 and 100 x 10(9)/L, respectively. At diagnosis, the Sokal score was used to classify the patients into three groups: low (n = 57), intermediate (n = 42), and high risk (n = 16). A complete hematological response (CHR) was achieved in 93 cases (80.2%). Of the 116 patients, 113 were available for cytogenetic evaluation. Fifty patients (43%) achieved a major cytogenetic response (MCR) (=65% marrow Ph- cells), 37 of them having a complete cytogenetic response (CCR). The estimated 5-year survival of the 116 patients was 68% +/- 11% (95% confidence interval [CI]) with a median follow-up of 42 months (range, 3 to 114) and 85% +/- 11% (95% CI) with a median follow-up of 30.9 (range, 3 to 111) when patients were censored at the time of transplantation. Event-free survival at 5 years (adding death and transplant as event) was 46% +/- 11% (95% CI). Using proportional hazards regression to study time-dependent variables, we confirmed that the most significant factor associated with survival was the cytogenetic response (MCR or CCR) (P <.0001). This factor was independent compared with the Sokal score and baseline variables used to calculate the Sokal score. Moreover, using either univariate or multivariate analysis, the achievement of CHR within 3 months was strongly correlated with MCR (P <.0001). Minimum cytogenetic response (mCR, ie, at least 5% of Ph- metaphases) at 3 months was also a significant predictive factor for MCR (P <.0001). These results show that IFN- can induce a high rate of hematological and cytogenetic response when administered in doses leading to myelosuppression. Factors such as the achievement of CHR and mCR within 3 months could be useful to identify early those patients who will not respond to IFN- and who need alternative treatments such as stem cell transplantation.     

TP53 DNA contact mutations are selectively associated with allelic loss and have a strong clinical impact in head and neck cancer

Recent studies have suggested that different mutation types within the core domain of the tumour suppressor protein p53, i.e. DNA contact mutations and structural mutations, confer different biological properties. We have analysed in 86 head and neck squamous cell carcinomas (HNSCC), whether these p53 mutation types have a differential clinical impact. Thirty-seven missense mutations were identified. Thirteen of these (36%) were DNA contact mutations, occurring in the L3 loop, in the H2 loop sheet helix motif, in the S10 beta strand and in Zinc binding residues. Microsatellite marker analysis revealed a selective association between these mutations and the loss of wild-type alleles (100% LOH vs 50% LOH in tumours with structural mutations; P=0.0034, Fisher's exact, 2-tailed). In comparison to structural mutations or to the absence of mutations in the core domain, DNA contact mutations were associated with higher tumour stages (84.6% vs 62%), a higher incidence of lymph node metastasis (91.7% vs 56%; P=0.014, Fisher's exact, 2-tailed), a shortened recurrence-free survival (8.1 months vs 23.7 months, P=0.047, log rank test) and overall survival (11 months vs 29.2 months; P=0.003, log rank test). The latter was also the case when only stage IV tumours were analysed (P=0.0055, log rank test). These data indicate that in HNSCC, TP53 DNA contact mutations confer a strong selection pressure to eliminate wild-type alleles, and that they result in an accelerated tumour progression and reduced therapeutic responsiveness.     

HLA class II genes in soybean epidemic asthma patients

From 1981 to 1987, 26 outbreaks of asthma caused by the inhalation of soybean dust, affecting a total of 688 individuals, were detected in Barcelona, Spain. Because only a small proportion of asthmatic individuals living in Barcelona expressed the epidemic phenotype, it is hypothesized that a genetically determined human leukocyte antigen (HLA) Class II factor could have played a role in the susceptible individuals. Accordingly, we studied the distribution of both HLA-DR and HLA-DQ in soybean epidemic asthmatic patients. An analysis of the HLA-DR and HLA-DQ genes for genetic polymorphisms of the beta 1 chain was done with the polymerase chain reaction (PCR) in 78 soybean epidemic asthma patients, and the findings were compared with those for 67 nonepidemic asthmatic individuals and 168 individuals from the general population. An allelic disequilibrium could be established; the risk of epidemic asthma was particularly associated with the DRB1*13 gene (p value corrected for multiple comparisons < 0.02). The association observed for the DRB1*13 gene was stronger in individuals in the lowest tertile for total IgE, with an estimated risk with a 95% confidence interval (CI), of 14.5 (1.6 to 130.8). The combination of two genes from among the DRB1*05-05, DRB1*05-06, and DRB1*06-06 genes was present in epidemic asthmatic subjects only. No association with an HLA-DQB1 allele could be observed. Genetic predisposition could contribute to the response of some asthmatic patients to exposure to soybean dust, having led to their being affected during the epidemics of asthma in Barcelona.     

Physical parameters in the use of MRI tomography. Limitation due to physiologic reactions and guidelines. Radiation Protection Commission

PURPOSE: The standards and regulations concerning the protection of patients and operator staff within the context of MRI are compiled. Resulting consequences regarding physical parameters are evaluated. MATERIAL AND METHODS: The static magnetic field, heating effects caused by RF-fields and acoustical noise are outlined. The actual boundaries of these parameters are compared against the relevant published standards. Peripheral stimulation limits due to pulsed gradient fields have been determined in a new clinical study. RESULTS: Many parameters recommended for the normal operating mode are already exceeded during routine MRI. Referring to our clinical study, we found that limits recommended in the MRI relevant standards are unnecessarily conservative and can actually be doubled. CONCLUSIONS: The applicable national and international standards and regulations show (at least partly) that serious differences in the definition of terms and values exist. The application of these standards would be much easier if they were made uniform. The values defined in the MR-specific standards should be adapted to actual knowledge concerning patients' safety.     

Right-sided sciatalgia complicating Crohn's disease

Neurological complications of Crohn's disease due to involvement of the extradural space are extremely rare. A 40-yr-old woman with Crohn's disease affecting the terminal ileum presented with a right-sided sciatalgia. The patient did not complain of diarrhea or constipation. The serum fibrinogen and the C-reactive protein were elevated. Magnetic resonance imaging and computed tomography scan of the abdomen and pelvis demonstrated a mass in front of the sacrum up to but not including the first sacral vertebra. Surgical intervention, with resection of 15 cm of terminal ileum, led to the complete resolution of symptoms. In this case, the underlying cause of the neurological symptoms was most likely an infiltration of the right lumbosacral nerve caused by edema and inflammation of the terminal ileum in the vicinity of the presacral space. Unexplained lumbosacral neurological symptoms in a patient with Crohn's disease necessitate a magnetic resonance imaging or computed tomography scan to detect potential neurological compression.