Intense muscle uptake of gallium-67 in a patient with sarcoidosis

Sarcoidosis has been associated with muscle involvement. In general, this involvement remains asymptomatic. The following case report demonstrates a patient with a 4-mo history of sarcoidosis who reported severe fatigue and slight muscular complaints at a regular checkup. Gallium scintigraphy indicated unexpected and unusually extensive muscular localizations of the disease. The latter findings were confirmed by examination of biopsy specimens. The importance of gallium scintigraphy lies in the possibility of wholebody screening for inflammation localizations, particularly when physical, laboratory, lung function and radiographic examinations fail to provide convincing evidence of active sarcoidosis. Furthermore, it can be helpful in the follow-up of the effect of supportive treatment.     

Immunology of papillomavirus infection

Studies of the immunology of papillomavirus infection have come of age. Synthetic virus-like particles have been validated as vaccines for several animal papillomaviruses, and have been used to map the sero-epidemiology of human papillomavirus infection and to define papillomavirus neutralizing antibodies. Induction of cell-mediated immunity to papillomavirus early proteins is poised to become a therapeutic approach to papillomavirus infection. Studies on the immune response to papillomavirus proteins in keratinocytes are shedding light on the immunological consequences of antigen presentation by epithelial cells.     

Acute ischaemic lesions in death due to ischaemic heart disease. An autopsy study of 333 cases of out-of-hospital death

The frequency of acute coronary artery thrombus and myocardial infarction in subjects dying suddenly or unexpectedly from ischaemic heart disease (IHD) is still unclear, with previous autopsy studies reporting an incidence between 4% and 100%. In this study of 333 randomly selected out-of-hospital deaths, detailed autopsy showed IHD as the sole cause of death in 206 (62%). One hundred and seventeen acute coronary thrombi were present in 96 cases whilst four had an established acute infarct without an identifiable coronary thrombus. Thus 100 (48.5%) IHD deaths had evidence of an acute ischaemic lesion. Acute lesions were equally prevalent among males and females, but the incidence declined with increasing age and they were less frequent among those with a prior clinical history of heart disease. One hundred and forty-seven IHD deaths were witnessed. The proportion of cases with an acute ischaemic lesion increased with the duration of pre-morbid symptoms. Of those with an acute lesion, only 17% died without symptoms compared to 63% of those without an acute lesion. All cases with symptoms lasting more than 3.5 h had an acute lesion. Overall, almost half out-of-hospital IHD deaths in this study were related to an acute ischaemic lesion. Differences in the detail of the pathological examination and examination of differing sub-groups of the out-of-hospital death population probably account for the differing results of previous studies.     

Climate change and the incidence of food poisoning in England and Wales

A study was undertaken to determine the susceptibility or resistance of 9 outbred experimental or commercial poultry lines to Salmonella enteritidis PT4. Young chicks were inoculated either intramuscularly or orally just after hatching. After intramuscular challenge the lines could be divided into susceptible lines (LD 50% < or = 10(2) Salmonella per animal), intermediate lines (LD 50% about 10(4) Salmonella) and resistant lines (LD 50% > 10(5) Salmonella). The results obtained after oral challenge confirmed these 3 groups for both mortality rates and the probability of the presence of salmonellae in the spleen and liver. There was no difference between lines concerning caecal carriage.     

Private practitioners in the slums of Karachi: what quality of care do they offer?

Private health services have expanded in many developing countries over the last 10 yr. Qualified private practitioners provide basic health care for poorer groups in urban areas, although health care planners frequently criticize them for providing poor quality of care, charging high fees and failing to provide preventive health advice. In Karachi, a large city with more than 400 slums, private practitioners are important providers of care to the poor. This study assessed the nature and quality of care provided by 201 practitioners selected from four districts of the city. Vignettes of specific medical problems were used to assess their knowledge and their practice was measured by observing 658 doctor-patient contacts. The results show that knowledge was closer to accepted medical management than was their actual prescribing practice. On the other hand, their manners and interpersonal behaviour were good. Thus poor prescribing practice, which might equally stem from market influences as lack of knowledge, is the cause of low standards of care. In these circumstances, didactic in-service training to improve prescribing practice is unlikely to be successful.     

Persistence of fetal cardiopulmonary circulation: one manifestation of transient tachypnea of the newborn

Five cyanotic newborn infants underwent cardiac catheterization between 8 and 36 hours of age with a tentative diagnosis of cyanotic congenital heart disease. All had normal cardiovascular anatomy. Cyanosis was the result of persistence of fetal cardiopulmonary circulation with right-to-left shunting across the ductus arteriosus. In all infants, cyanosis resolved spontaneously and the infants survived without sequelae. Admission chest roentgenograms of all infants showed marked hyperinflation of the lungs. Except for severe hypoxemia, the clinical presentation, chest films, and course of illness of these infants were consistent with transient tachypnea of the newborn. It is proposed that an increase in pulmonary vascular resistance, due to hyperinflation of the lungs, was the mechanism which reopened the fetal cardiopulmonary circulatory channels and produced hypoxemia, and that these infants suffered from a rare manifestation of a usually benign newborn respiratory condition. Further, given these pathophysiologic mechanisms, the use of continuous transpulmonary pressure gradients in the management of such infants would be contraindicated.     

Leucocyte-migration inhibition induced by uveoretinal antigen in patients with diabetic retinopathy

Leucocyte-migration inhibition was to determine the state of hypersensitivity in 65 diabetic patients with different stages of retinopathy and 21 nondiabetic controls. About one third of the patients with simple or proliferative retinopathy exhibited significant leucocyte-migration inhibition of 0.2 mg/ml. protein concentration of uvreoretinal antigen. In contrast, only one of 15 patients with minimal retinopathy and none of the controls showed significant leucocyte-migration inhibition. Corneal and lenticular antigens did not evoke a cellular immune response in any of the tested individuals. These findings suggest that cell-mediated hypersensitivity to uveoretinal antigen may develop in diabetic patients with prolonged, progressive, simple or proliferative retinopathy.     

Regulation of the immune system by synthetic polynucleotides. VI. Amplification of the immune response in young and aging mice

Model systems for study of the action of adjuvants in immunodeficient states were developed in 10- to 14-day-old BALB/aj mice and aging BALB/aj mice (12 to 16 months). With sheep red blood cells as antigen polyadenylicpolyuridylic acid complexes (poly A:U) were found to be stimulatory in both the neonatal and aging mice. The effect of poly A:U was similar to that seen when 5 X 10(6) thymocytes from immunologically mature mice were given with antigen. Cell-free supernatant fluids induced by incubation of poly A:U with thymocytes likewise were capable of restoring the number of antibody-forming cells to normalcy in aging mice.     

Hypertension--the fledgling of modern medical practice

The treatment of hypertension was discovered long before the mechanisms of the disease became known. Only recently has it been appreciated that blood pressure is controlled physiologically in many ways. Hypertension has suddenly achieved celebrity status. It is now recognized as the second leading cause of death in the United States. New programs have made the public aware of it and have prompted many individuals to have their blood pressure checked. Office diagnostic measures usually suffice to determine the presence of the disease. Treatment should generally be initiated with a slow-acting diuretic or with propranolol; other drugs may be added later. Treatment is a lifelong undertaking, and engaging the patient as a partner in the venture by means of home blood pressure measurements and an educational program contributes to its success. Treatment of hypertension is the first step in the prophylaxis of atherosclerosis.