Serum enzymes in heat stroke: prognostic implication

We measured serum creatine kinase (CK), lactate dehydrogenase (LD), aspartate aminotransferase (AST), and serum alanine aminotransferase (ALT) in 26 heat stroke (HS) victims and 10 control (non-heat-exhausted) subjects during annual Hajj in Makkah, Saudi Arabia. On admission to the HS treatment unit, serum CK, AST, ALT, and LD were higher in HS victims than controls (P < 0.05), and at 6, 12, and 24 h were higher than baseline concentration. The patient group was divided into three groups, (a) those who had a quick recovery, (b) those who were critically ill until the end of the Hajj period (7 days), and (c) those who died. Serum enzymes at the time of admission were significantly higher (P < 0.05) in the nonsurviving group (n = 6) and the severely ill (n = 9) than in those who had a quick recovery (n = 11). ROC curves were plotted for each enzyme. The most useful indicator was LD, as it could distinguish significantly between the groups who died and those who had a quick recovery (area under the curve = 0.991 +/- 0.0286). It was followed by CK and AST as useful prognostic factors. When compared with ROC curves for body temperature, anion gap, and serum potassium, the enzyme results were superior prognostic indicators.     

Stereotactic and ultrasound core needle breast biopsy performed by surgeons

BACKGROUND: The authors evaluated outcomes and treatment costs of stereotactic core needle biopsy (SCNB) and ultrasound core needle biopsy (UCNB), and needle localization biopsy (NLB) in managing patients with mammographic abnormalities presenting to the surgeon. METHODS: Data for all patients with mammographic lesions who underwent SCNB or UCNB since their introduction at this institution were prospectively collected over 17 months. Mean inclusive costs of the three procedures were accumulated and compared. RESULTS: Stereotactic core needle biopsy was performed for 342 lesions in 319 women, for a malignancy rate of 19%; UCNB was performed for 157 lesions in 144 patients, yielding a malignancy rate of 17%. With a mean follow-up of 13.5 months, 1 patient with in situ carcinoma was diagnosed late. Absolute cost savings for the period studied was $721,963. CONCLUSIONS: Minimally invasive breast biopsy procedures can safely and reliably be performed by surgeons in clinical practice with increased patient convenience and decreased costs.     

Role of the surface electrocardiogram in the diagnosis of patients with supraventricular tachycardia

In this era of interventional electrophysiology, the accuracy of the electrocardiogram in diagnosis of supraventricular tachycardia could be improved by detailed endocardial mapping and confirmed by results of radiofrequency catheter ablation. This article describes the electrocardiographic characteristics for different types of supraventricular tachycardia: atrial fibrillation, atrial flutter, atrial tachycardia, atrioventricular reciprocating tachycardia using an accessory pathway, and atrioventricular node reentrant tachycardia. Several limitations, including the identification of P wave morphologies and polarities and separation between the terminal part of T wave and P wave during tachycardia, should be resolved before an accurate algorithm of the 12-lead surface electrocardiogram is developed for the diagnosis of supraventricular tachycardia.     

Tracheal ligation: the dark side of in utero congenital diaphragmatic hernia treatment

This retrospective study investigates the clinical characteristics of gestational diabetes mellitus (GDM) (time of diagnosis, different treatment, metabolic parameters, etc.) in relation to prepregnancy body mass index (BMI) and the influence of BMI on neonatal outcome. 93 GDM women and 110 control subjects were divided into three groups in relation to their prepregnancy BMI: normalweight (Nw), overweight (Ow) and obese (Ob). GDM was diagnosed significantly (p < 0.01) earlier in Ow and Ob than in Nw. Preterm deliveries and cesarean sections resulted significantly (p < 0.01) increased in all BMI categories of GDM respect to matched controls. Prevalence of neonatal macrosomia was higher in GDM patients (44.6%) compared with normal controls (15.4%) and correlated (p < 0.01) with prepregnancy BMI in both groups. Nevertheless in each BMI category the prevalence of macrosomia was significantly higher in GDM patients. The body weight increase during pregnancy was not associated with neonatal macrosomia. This study shows that prepregnancy BMI is an important risk factor for GDM and is predictive for macrosomia specially in women suffering from GDM.     

Clinical aspects and diagnostic characteristics of nontraumatic intracerebral hemorrhage

The results of treatment of 235 young and middle age patients with nontraumatic intracerebral haemorrhage were analyzed. Diagnosis was verified with the help of computer tomography, magnetic-resonance tomography, angiography and basing on operational and autopsy data as well. Three main symptoms, reflecting the dislocational changes dynamics, were assigned.     

Variations in hospitalization rates for asthma among black and minority ethnic communities

The European Suspension Test was used to assess the relative resistance of 19 individual Listeria monocytogenes genotypes, isolated from the poultry processing environment, to three commercially used disinfectants employed in the plant at the time of their isolation. To establish the relative resistance between the strains, the concentration of each disinfectant was reduced until inter-strain variation became apparent. For Darasan 214 and 7058, variation was detected at 0.1% and 0.5% v/v, respectively, while Daraclean 7361 had to be reduced to only 2.5% v/v. At these concentrations, the mean microbiocidal effect (ME) of each disinfectant ranged between 4.3 and 3.1 log10 reduction in cfu ml-1. Significant differences between the strains were obtained with respect to their resistance to the disinfectants employed (P < 0.01), but the overall log10 reduction for genotypes 'A1' and 'A2', which were found to persist in the poultry processing environment, were not found to be significantly different from the genotypes which had been isolated on a more sporadic basis (P > 0.05). The L. monocytogenes strains fell into four groups with respect to incidence and size of plasmids isolated. The first group contained strains which carried two plasmids (5 and 40 MDa) and the other three (groups 2, 3 and 4) comprised strains which carried a single plasmid (14, 47 and 52 MDa, respectively). There was no correlation between persistent and sporadic strains with respect to incidence and size of plasmids isolated. Moreover, the strains which carried no plasmids were found to be as resistant to the disinfectants as those which did carry plasmids, suggesting that the plasmids isolated did not confer resistance of L. monocytogenes planktonic cells to the disinfectants tested. Therefore, it is unlikely that the strains which had been found to persist in the poultry processing environment did so by means of plasmid-mediated resistance to the commercial disinfectants used.     

A new brain metalloendopeptidase which degrades the Alzheimer beta-amyloid 1-40 peptide producing soluble fragments without neurotoxic effects

A new metalloendopeptidase was purified to apparent homogeneity from a homogenate of normal human brain using successive steps of chromatography on DEAE-Trisacryl, hydroxylapatite and Sephacryl S-200. The purified enzyme cleaved the Gly33-Leu34 bond of the 25-35 neurotoxic sequence of the Alzheimer beta-amyloid 1-40 peptide producing soluble fragments without neurotoxic effects. This enzyme activity was only inhibited by divalent cation chelators such as EDTA, EGTA and o-phenanthroline (1 mM) and was insensitive to phosphoramidon and captopril (1 microM concentration), specific inhibitors of neutral endopeptidase (EC 3.4.24.11) and angiotensin-converting enzyme (EC 3.4.15.1), respectively. The high affinity of this human brain endopeptidase for beta-amyloid 1-40 peptide (Km = 5 microM) suggests that it may play a physiological role in the degradation of this substance produced by normal cellular metabolism. It may also be hypothesized that the abnormal accumulation of the amyloid beta-protein in Alzheimer's disease may be initiated by a defect or an inactivation of this enzyme.     

Distinct clinicopathologic characteristics of diffuse- and intestinal-type gastric cancer in Taiwan

The clinicopathologic features of 221 patients with intestinal-type (IT) gastric cancer were compared retrospectively with those of 290 diffuse type (DT). Intestinal type was characterized by an older mean age (65.0 +/- 10.8 years vs. 56.2 +/- 13 years), a higher male-female ratio (2.56 vs. 1.06), predominance of blood group O (46.2% vs. 31.1%), and frequent habitual smoking (50.7% vs. 31.4%) and drinking (28.5% vs. 17.6%) than did DT. In contrast, DT had a higher frequency of positive history of parent or sibling with gastric cancer (9.3% vs. 4.1%) and blood group A (40.3% vs. 27.6%) than did IT. The distinguishing histologic features of DT included more Borrmann type IV (13.1% vs. 1.3%) but less Borrmann type I (1% vs. 7.2%), more frequent involvement of middle third (26.9% vs. 15.9%) and whole stomach (4.1% vs. 0%), and more peritoneal seeding (15.5% vs. 9%), lymph node metastasis (67.2% vs. 51%), and nerve permeation (34.1% vs. 24.4%), but less Helicobacter pylori infection (55.9% vs. 69.2%) when compared with those of IT. There was no difference in depth of tumor invasion, venous permeation, duodenal involvement, and postoperative survival between IT and DT. These distinct clinicopathologic features between IT and DT in Taiwan suggest the presence of a different pathogenic process for these two histologic subtypes of gastric cancer.