Increased fetal nuchal translucency: possible association with esophageal atresia.

We describe a case in which in-utero diagnosis of an esophageal atresia with a tracheo-esophageal fistula in the third trimester followed the finding of an increased nuchal translucency in the first trimester and suggest a mechanism by which these two findings might be associated.

Subclinical seizure activity and prophylactic phenytoin infusion in acute liver failure: a controlled clinical trial.

Subclinical seizure activity in the patient with encephalopathy and on ventilation with acute liver failure (ALF) is a poorly recognized entity. Its importance lies in the likely exacerbation of cerebral hypoxia and the contribution of such seizure activity to the development of cerebral edema. The aim of the present study was to document the frequency of subclinical seizure activity in a cohort of patients with ALF by using a cerebral function and activity monitor that allows continuous recording of electroencephalogram activity at the bedside and to determine whether the prophylactic administration of the antiepileptic agent phenytoin would reduce its occurrence.

Adult T-cell leukemia/lymphoma in London: clinical experience of 21 cases.

Adult T-cell leukemia/lymphoma (ATLL) is uncommon in the United Kingdom and has so far been restricted to people of Afro-Caribbean extraction. Between 1981 and 1995, 21 cases presented to 2 inner London teaching hospitals where 17% of the population are of Afro-Caribbean origin. Clinical presentations were similar to those of the disease in HTLV-I-endemic areas.

Guided tissue regeneration using a bioabsorbable membrane in the treatment of human buccal recession. A re-entry study.

A surgical technique involving a bioabsorbable membrane was used to treat localized buccal recession defects of between 2 and 5 mm on 17 sites in 13 patients. A conventional flap for coronal repositioning was raised consisting of a trapezoid flap with de-epithelialization of papillae, and the root surface planed back to reduce its convexity. The polylactate membrane with internal spacer bars was placed over the root surface with its coronal edge as near to the cemento-enamel junction (CEJ) as possible.

Effects of neonatal immunization and repeated allergen exposure on airway responsiveness in the rabbit.

Neonatal immunization of rabbits has previously been shown to enhance airway responsiveness to inhaled histamine. We investigated the influence of this immunization protocol on pulmonary parameters after inhalation of histamine in littermate allergen-immunized, sham-immunized, and saline-injected rabbits. In spontaneously breathing rabbits, inhalation of histamine caused a concentration-dependent increase in total lung resistance (RL) and respiratory rate (RR) and a reduction in dynamic compliance (Cdyn).

A personal view of pharmacology.

This essay is an account of the author's experience in trying to interpret the action of drugs as seen in in vitro bioassays. The central theme is how the development of simple mathematical models has assisted in the interpretation of drug actions. Starting from encounters with partial agonists, the essay describes the development of an operational model of agonist activity, the significance of receptor distribution, the analysis of indirect competitive antagonism and various two-receptor systems, followed by examples of pharmacological resultant activity.

Importance of time-window overlap in the detection and analysis of embolic signals.

Background And Purpose: The detection of asymptomatic embolic signals by Doppler ultrasound may offer a powerful investigational tool in the management of cerebrovascular disease. However, early studies, particularly in patients with carotid artery disease, have reported very different frequencies of embolic signals. While this may reflect differences in patient groups and the criteria used for embolic signal identification, the degree of time-window overlap may be important.

HIV-associated renal disease in London hospitals.

We report experience from London hospitals which further illustrates the heterogeneous nature of HIV-associated nephropathy (HIVAN). Nineteen HIV-positive patients underwent renal biopsy from 1992 to 1994. Fourteen were male, five female.

Description of circadian rhythm in uterine artery blood flow during the peri-ovulatory period.

Uterine artery blood flow was assessed by transvaginal colour and pulsed Doppler ultrasound prospectively in six women during the peri-ovulatory period. All patients had regular ovulatory menstrual cycles and a mid-luteal serum progesterone consistent with spontaneous ovulation in the preceding cycle. Each patient underwent serial transvaginal ultrasound examination and Doppler assessment of blood flow in the uterine arteries.

Pharmacological analysis of the interaction between purinoceptor agonists and antagonists in the guinea-pig taenia caecum.

1. In the absence of adenosine uptake inhibition, adenosine produced a concentration-dependent (threshold 30 microM) relaxation of the 5-methylfurmethide pre-contracted guinea-pig taenia caecum. The relaxation was not blocked by 8-phenyltheophylline (8-PT, 3 microM) or 1,3-dipropyl, 8-cyclopentylxanthine (DPCPX, 30 microM).

Percutaneous dilatational tracheostomy.

This paper describes a method of tracheostomy using a percutaneous dilatational technique. The authors report their experience of 50 elective cases and discuss the technique as an alternative to formal surgical tracheostomy. They suggest that the lower complication rate associated with the percutaneous dilatational method makes feasible its extended use in elective head and neck surgery.

Haemophagocytic lymphohistiocytosis: experience at two U.K. centres.

Haemophagocytic lymphohistiocytosis (HLH) is a rare disorder of inappropriate macrophage activation. Both familial and sporadic forms, which may be infection-associated, are recognized. Between 1985 and 1991 we treated 23 cases of HLH (12 male, 11 female).

The rate of disease progression predicts the quality of remissions following intensive chemotherapy for myelodysplastic syndromes.

The use of intensive chemotherapy in the treatment of myelodysplastic syndromes (MDS) has met with some disappointment, although subgroups of patients have been identified in which the response approaches that of de novo acute myeloid leukaemia (AML). We hypothesized that it is not the FAB classification per se, but the biological behaviour of the blasts as shown by their rate of accumulation that influences the response. We have, therefore, included AML with trilineage dysplasia (AML/TLD) as it represents one extreme of the evolution of MDS to AML.

Arrest of preterm labour and prolongation of gestation with glyceryl trinitrate, a nitric oxide donor.

13 women admitted consecutively in preterm labour were recruited to an observational study of the effect of glyceryl trinitrate (GTN) patches on uterine contractions and prolongation of pregnancy. All twenty episodes of preterm labour (at 23-33 weeks' gestation) responded. 1 patient delivered because of cervical incompetence despite cessation of uterine contractions.

Anti-inflammatory effects of low-dose oral theophylline in atopic asthma.

Theophylline, in addition to its bronchodilator effect, may attenuate inflammation in asthma. We did a double-blind placebo-controlled study of the effect of oral theophylline on the inflammatory response of the bronchial mucosa to inhalation of allergen in 19 atopic asthmatic subjects. Bronchoscopy and bronchial biopsy were done 24 hours after allergen inhalation before and after six weeks of treatment with oral slow-release theophylline, 200 mg 12 hourly.

Maximum relaxation rate of the diaphragm during weaning from mechanical ventilation.

Background: The maximum relaxation rate (MRR; percentage fall in pressure/10 ms) of oesophageal (POES) and transdiaphragmatic (PDI) pressure slows under conditions of loaded breathing, and has been measured previously in normal subjects. MRR has not been measured in intubated patients weaning from mechanical ventilation.

Methods: Five postoperative patients who were expected to wean and nine patients who had previously failed were studied.

Dysphagia following bimaxillary osteotomy.

A case of complete dysphagia, requiring surgical intervention, which occurred following bimaxillary osteotomy is described. A brief resume of the relevant anatomy and physiology is included with a discussion of the possible aetiology of this complication.

Fetal plasma interferon gamma concentration in normal pregnancy.

Objective: Our purpose was to investigate changes with gestation in fetal plasma interferon gamma concentration.

Study Design: A cross-sectional study at the Harris Birthright Research Centre for Fetal Medicine, London, was performed. Enzyme-linked immunoassay was used to measure plasma concentration in 54 fetal blood samples obtained by cordocentesis or cardiocentesis at 12 to 37 weeks' gestation.

Loss of HBsAg with interferon-alpha therapy in chronic hepatitis D virus infection.

Eleven patients with chronic hepatitis D virus (HDV) infection who had chronic active hepatitis and HDV antigen on liver biopsy were randomised in a crossover therapeutic trial of interferon-alpha 2b vs. no therapy. Nine patients had a history of intravenous drug use (drug free > 6 months before therapy), 8 had histological evidence of cirrhosis, and 7 out of 10 tested were found to be seropositive for antibody to hepatitis C virus (HCV).

Resolution of danazol-induced cholestasis with S-adenosylmethionine.

In a case of danazol-induced cholestasis, the anti-cholestatic agent S-adenosylmethionine was given intravenously for 3 weeks and then orally for 6 weeks. This was well tolerated and led to prompt resolution of both jaundice and associated renal impairment.

Consistent interstitial chromosomal deletions in myeloid malignancies and their correlation with fragile sites.

Chromosomal deletions occurring in myeloid malignancies have sometimes been reported either with no breakpoints or as terminal deletions. It is of importance to deduce whether these deletions are actually terminal or interstitial because this has implications for their biologic consequences and the mechanism of their development. Chromosomal deletions have been observed in 38 patients with myeloid malignancies.