Gastrointestinal autonomic nerve tumour presenting as small bowel volvulus: a rare disease with a rare presentation

A 78-year-old Chinese woman presented with recurrent postprandial abdominal pain. Computerised tomography revealed a small bowel tumour causing volvulus of a segment of the small bowel. Laparotomy confirmed an extraluminal ileal tumour with partial volvulus of the involved small bowel segment. Small bowel resection was done. Histological and ultrastructural studies confirmed a gastrointestinal autonomic nerve tumour. We review the medical literature on this rare tumour.     

Longitudinal bone mineral density changes in early rheumatoid arthritis

A prospective longitudinal study of patients with early RA was performed to examine the influence of disease duration, disease activity and physical activity on bone loss. Sixty-seven patients with non-steroid treated RA of less than 5 yr duration, including 16 patients with disease duration less than 6 months, had BMD measurements of the femoral neck and the lumbar spine over a 12-month period using dual energy X-ray absorptiometry. The BMD changes were compared with values from 72 control patients and were also correlated with serial measurements of disease activity (measured by the Stoke Index) and disability [measured by the Health Assessment Questionnaire (HAQ) score], at 3-monthly intervals over the 12-month period. No significant differences in BMD changes were found between RA patients and controls overall. Patients with disease duration of less than 6 months had significantly greater loss of BMD at the femoral neck (-3.9%, S.E.M. 1.5) than the remainder of the cohort (-0.2%, S.E.M. 0.7) (P = 0.02) and controls (-0.8%, S.E.M. 0.6). Lumbar spine BMD changes correlated with the initial Stoke Index (Rs-0.373, P = 0.01) but not mean Stoke Indices. There was no correlation of BMD changes with age or HAQ scores. These findings suggest that significant bone loss occurs within the first few months of disease in patients with RA.     

A genetic algorithm for multiple molecular sequence alignment

MOTIVATION: Multiple molecular sequence alignment is among the most important and most challenging tasks in computational biology. The currently used alignment techniques are characterized by great computational complexity, which prevents their wider use. This research is aimed at developing a new technique for efficient multiple sequence alignment. APPROACH: The new method is based on genetic algorithms. Genetic algorithms are stochastic approaches for efficient and robust searching. By converting biomolecular sequence alignment into a problem of searching for optimal or near-optimal points in an 'alignment space', a genetic algorithm can be used to find good alignments very efficiently. RESULTS: Experiments on real data sets have shown that the average computing time of this technique may be two or three orders lower than that of a technique based on pairwise dynamic programming, while the alignment qualities are very similar. AVAILABILITY: A C program on UNIX has been written to implement the technique. It is available on request from the authors.     

The relative contribution of selected carpal bones to global wrist motion during simulated planar and out-of-plane wrist motion

The present study assesses the endocrinological, endometrial histology and vaginal ultrasound profiles of nomegestrol acetate subdermal implant users at varying times after insertion. Follicle stimulatory hormone, luteinizing hormone, oestradiol, progesterone, vaginal ultrasound assessment of the ovaries and the histological dating of the endometrium were serially assessed for a period of 50 days immediately after the insertion, and after at 6 months and 12 months of use. The endocrinological results of this prospective observational clinical trial indicated that 75% of the cycles across the study period in Uniplant users were anovulatory, 63% showing development of a persistent non-luteinized follicle. Anovulatory cycles devoid of follicular development were seen primarily in the first months after Uniplant insertion. Ovulatory cycles represented 25% of the Uniplant cycles. Inadequate luteal phase or disregulation of follicular growth was a common feature of ovulatory cycles. In conclusion, these findings suggest that the contraceptive mechanisms of a single nomegestrol acetate subdermal implant involve prevention of follicular growth, development of a persistent non-luteinized follicle, inadequate luteal phase and disruption of the endometrial architecture.     

Transcutaneous balloon angioplasty in the treatment of subclavian steal syndrome. Characteristics of vertebral basal flow with transcranial Doppler technique

Subclavian steal syndrome (SSS) appears when the origin of the subclavian artery (SA) is occluded or stenosed. Introduction of transcranial Doppler sonography (TCD) provided an opportunity to evaluate parameters of the blood flow in the vertebral (VA) and basilar artery (BA). Measurements of blood flow velocities performed at rest and after the brachial hyperemia test allow one to classify hemodynamic types of SSS. The aim of the study was to categorize types of steal and to compare the differences of flow patterns before and after percutaneous transluminal SA balloon angioplasty (SA-PTA). Fourty-eight patients with angiographically confirmed SSS (aged from 27 to 68 years, mean 53; 2/1 f/m ratio) were examined with 2 MHz range-gated, pulsed transcranial Doppler device (TC 2-64B EME). Both VA and BA were evaluated by the transoccipital approach at rest and during the brachial hyperemia. In 5 cases (10.4%) permanent reversal blood flow in the BA was observed (complete basilar steal). In flow in the BA blood flow was in the normal direction at rest and altered (reversed or decreased) when induced with brachial hyperemia test (transient basilar steal). In the next 14 patients (29.2%) permanently reversed VA blood flow was observed with only a slight or no alterations of the BA flow after the hyperemia test (complete vertebral steal). In the last 19 cases (39.6%) alterations of the VA blood flow without changes in BA flow were observed (latent vertebral steal). Between 1991 and 1994 twenty seven symptomatic patients with different hemodynamic types of SSS were treated with SA-PTA. TCD evaluation of VA's and BA using the hyperemia test was performed before, 3 to 7 days and 3 months after morphologically and hemodynamically successful subclavian artery balloon PTA. Normal results of vertebrobasilar examinations were obtained in 26 cases after this procedure. In one case the latent vertebral steal was detected. The 28 months mean follow-up revealed no significant changes in TCD flow patterns recorded from VA's and BA. After collecting data of about 60 patients with SSS we examined with TCD we conclude that: in patients with a hemodynamically significant SA stenosis the presence of reversed ipsilateral VA blood flow (a radiologic steal) its not a good determinant of either the presence or type of presenting symptoms and after successful PTA or recanalisation and PTA of SA in almost all cases we examined close to normal TCD recordings in BA and VA.