Spinal CSF-Venous Fistulas in Morbidly and Super Obese Patients with Spontaneous Intracranial Hypotension.

BACKGROUND AND PURPOSE: Spinal CSF-venous fistulas are increasingly recognized as the cause of spontaneous intracranial hypotension. Here, we describe the challenges in the care of patients with CSF-venous fistulas who are morbidly or super obese. MATERIALS AND METHODS: A review was undertaken of all patients with spontaneous intracranial hypotension and a body mass index of >40 who underwent digital subtraction myelography in the lateral decubitus position to look for CSF-venous fistulas. RESULTS: Eight patients with spontaneous intracranial hypotension with a body mass index of >40 underwent lateral decubitus digital subtraction myelography. The mean age of these 5 women and 3 men was 53 years (range, 45 to 68 years). Six patients were morbidly obese (body mass indexes = 40.2, 40.6, 41, 41.8, 45.4, and 46.9), and 2 were super obese (body mass indexes = 53.7 and 56.3). Lumbar puncture showed an elevated opening pressure in 5 patients (26.5-47 cm H2O). The combination of an elevated opening pressure and normal conventional spine imaging findings resulted in a misdiagnosis (midbrain glioma and demyelinating disease, respectively) in 2 patients. Prior treatment included surgical nerve root ligation for suspected CSF-venous fistula in 3 patients. Digital subtraction myelography demonstrated a CSF-venous fistula in 6 patients (75%). Rebound high-pressure headache occurred in all 6 patients following surgical ligation of the fistula, and papilledema developed in 3. CONCLUSIONS: In our series, opening pressure was generally elevated in patients with morbid or super obesity. The yield of identifying CSF-venous fistulas with digital subtraction myelography in this patient population can approach that of the nonobese patient population. These patients may be at higher risk of developing rebound high-pressure headaches and papilledema.

A controlled trial of high-intensity double-surface phototherapy on a fluid bed versus conventional phototherapy in neonatal jaundice.

OBJECTIVE: To evaluate a simple, relatively inexpensive method using the fluid bed to provide high-intensity double-surface (HIDS) phototherapy and to confirm that the method described is more effective than conventional phototherapy (CPT) in the treatment of neonatal hyperbilirubinemia. DESIGN: Prospective controlled study. METHOD: HIDS phototherapy (26 to 30 microW/cm2 per nanometer) on the fluid bed (n = 22) versus conventional (7 to 10 microW/cm2 per nanometer) phototherapy (n = 28) was used to treat neonates weighing more than 1500 g with hyperbilirubinemia. RESULTS: After 24 hours of therapy, the bilirubin in the group receiving HIDS phototherapy was significantly lower. The mean rate of fall of bilirubin was 5.34 mumol/L per hour in the group receiving HIDS phototherapy versus 0.7 mumol/L per hour in the group receiving CPT. HIDS phototherapy on a fluid bed was well tolerated. CONCLUSION: HIDS phototherapy on the fluid bed is significantly more effective in reducing bilirubin than CPT. It can be easily and economically provided using equipment currently available in most neonatal units.

A new non-hormonal antifertility drug DL 111-IT: I. Effects on testes and accessory glands of reproduction in male rats.

Effect of DL-111, 3-(2-ethylphenyl)-5-(3-methoxyphenyl-1H-1,2,4-triazole, a non-hormonal postimplantational antifertility agent, on testicular and accessory reproductive organ weights and total protein, RNA and DNA concentrations were evaluated in immature and adult rats. Treatment of 21-day-old rats at doses of 2.5 mg and 5 mg/kg body weight decreased body weight, weights of testes and accessory glands of reproduction. RNA and protein concentrations decreased significantly with significant increase increase in DNA concentration in testes, epididymis, ventral prostate and seminal vesicles. DL-111 treatment of adult rats at doses of 5 mg and 10 mg/kg body weight had no effect on body weight, but significantly decreased weights of testes and accessory glands of reproduction. RNA and protein concentrations decreased significantly in all tissues studied while DNA concentration was not altered. RNA/DNA ratio decreased significantly, reflecting ribosomal loss and cytoplasmic shrinkage. These effects of DL-111 are comparable to post-castrational changes in accessory glands of reproduction. We presume that these changes are mediated by blocking the androgen biosynthesis and/or by interfering with normal function of hypothalamo-pituitary-gonadal axis.

A new non-hormonal antifertility drug DL 111-IT: II. Effects on testicular hyaluronidase activity in male rats.

Effects of DL-111, [3-(2-ethylphenyl)-5-(3-methoxyphenyl-1H-1,2,4-triazole] a non-hormonal antifertility agent, on testicular hyaluronidase activity, an accurate biochemical marker for testicular function, were evaluated in male rats. Treatment of 21-day-old rats with DL-111 sc for 7 or 15 days resulted in a significant fall in testicular weight and complete suppression of hyaluronidase activity. During the 30-day post-treatment the enzyme activity was restored to normal levels. Treatment of 40-day-old rats for 7 or 15 days also produced a significant decrease in testicular weight and hyaluronidase activity. Simultaneous administration of LH, PMSG or T with DL-111 to 21-day-old rats blocked the inhibitory activity of the drug as the enzyme activity was restored to untreated control levels. Administration of FSH along with DL-111 had no effect on suppressive action of the drug. These results suggest that in male rats DL-111 inhibits testicular activity by reducing LH levels, thereby reducing T levels as observed by reduced weights of testes and accessory glands of reproduction and hyaluronidase activity.

A new non-hormonal antifertility drug DL-204: II. Effect on testicular hyaluronidase and gamma-glutamyl transpeptidase in male rats.

Effects of DL-204, 2-(3-ethoxyphenyl)-5,6-dihydro (5,1-a)-isoquinoline, a non-hormonal antifertility drug on testicular hyaluronidase and gamma-glutamyl transpeptidase levels, biochemical markers for testicular function, were evaluated in male rats. Treatment of 21-day-old rats with DL-204 for 7 or 15 days produced cryptorchid condition. Testicular hyaluronidase and gamma-glutamyl transpeptidase levels reveal that DL-204 acts on the testes, possibly in two ways; one, by reducing the gonadotropin levels thereby reducing the levels of androgens as reflected by reduced accessory reproductive organ weights and, secondly, by a direct action on the testes. Thus, we conclude that DL-204 is acting as an antispermatogenic agent, possibly acting in more than one way on the testes.

A new non-hormonal antifertility drug DL-204: I. Effects on testes and accessory glands of reproduction in male rats.

The effect of DL-204, 2-(3-ethoxyphenyl)-5,6-dihydro-5-triazole (5,1a)-isoquinoline, a non-hormonal post-implantational anti-fertility drug, on tissue weights, nucleic acids and total protein concentrations in the testes, ventral prostate and seminal vesicles were evaluated in immature and sexually mature rats, while changes in DNA synthesis were studied only in the immature rats. Treatment of 21-day-old rats at doses of 5mg and 10mg/kg bw once daily for 15 days had no effect on body weight but reduced the weights of testes and accessory glands of reproduction. The concentration of DNA increased while RNA and protein decreased significantly. Treatment of adult rats with DL-204 at a dose of 10mg/kg bw had no effect on body and testes weights but reduced ventral prostate and seminal vesicle weights. The concentration of RNA and protein decreased significantly, while DNA concentration was not altered. DL-204 treatment resulted in drastic decrease of RNA/DNA ratio, reflecting ribosomal loss and cytoplasmic shrinkage. The effects observed after DL-204 treatment are comparable to post-castration changes. DL-204 may be acting on testes and accessory reproductive organs by blocking androgen biosynthesis and/or by antagonizing the action of androgens. It may be acting directly on the normal function of the hypothalamo-pituitary-gonadal axis.

Development of the HIV/AIDS Q-sort instrument to measure physician attitudes.

BACKGROUND: Providers'attitudes about HIV/AIDS are an important dimension in the delivery of quality care to persons with HIV/AIDS. It is believed that education can alter attitudes, but there is a needfor a user-friendly instrument to measure the effect that HIV/AIDS educational programs have on attitudes. METHODS: A pool of HIV/AIDS attitude descriptors was collected through literature review and from individuals working in the HIV/AIDS field. Out of this pool of 90 descriptors, 48 descriptors with the highest face validity were selected through expert consensus ranking to create a preliminary survey instrument. Twenty-six physicians completed a pilot Q-Sort instrument with 48 descriptors. A variance analysis was conducted, and the top 28 descriptors with the most variability were selected for the final Q-Sort instrument, which was then completed by 191 physicians. A factor analysis was conducted to identify a small number of factors that explained the 28 descriptors. A subsample of 22 physicians repeated the test to establish test-retest reliability. RESULTS: Factor analysis revealed three factors: (1) emotionality, (2) ability, and (3) reluctance. The Q-Sort instrument demonstrated good test-retest reliability, with reliability for the three factors of .82, .80, and .88, respectively. CONCLUSIONS: This Q-sort instrument is a reliable method for measuring physician attitudes toward HIV/AIDS patients. Further studies can test its use for evaluating the effect of educational programs on changing provider attitudes.

Etretinate in the management of harlequin siblings.

Harlequin fetus is the severe form of congenital ichthyosis. There are very few reports of babies with this condition surviving the first few weeks of life. We treated two siblings who lived for 22 months and six weeks respectively. We started treatment with oral etretinate every early in their lives and achieved good improvement in the skin condition of these babies.

Artifical Blood.

Elimination of unwanted side-effects, especially transfusion-transmitted diseases (HIV and hepatitis) and leucocyte-mediated allosensitisation, is an important goal of modern transfusion medicine. The problems and high cost factor involved in collecting and storing human blood and the pending world-wide shortages are the other driving forces contributing towards the development of blood substitutes. Two major areas of research in this endeavour are haemoglobin-based oxygen carriers (HBOCs) and perfluorochemicals. Even though they do not qualify as perfect red blood cell substitutes, these 'oxygen carrying solutions' have many potential clinical and non clinical usages. These can reach tissues more easily than normal red cells and can deliver oxygen directly. These are not without adverse effects, and extensive clinical trials are being conducted to test their safety and efficacy. New understandings on the mode of action of these products will help to define their utility and application. Only after successful clinical trials can they be used for patient management, after approval by the FDA.

FINE NEEDLE ASPIRATION CYTOLOGY OF LYMPH NODES IN HIV INFECTED PATIENTS.

Lymphadenopathy is the commonest presentation in HIV positive individuals. Fine needle aspiration cytology of 196 HIV positive patients was studied during six monthly review. 75% paients in this study who were asymptomatic were detected to have lymphadenopathy during the surveillance. 82% had lymph nodes smaller than 1cm size. Lymphadenopathy at more than one site was observed in 46.8% cases. Commonest opportunistic infection noticed was tuberculosis (TB) in 34.2%. Cyto-morphologically reactive pattern with Add fast bacilli (AFB) positivity was observed in 16.4% of TB cases. In 2.9% cases AFB were detected even in the tissue fluid. Negative images of AFB were observed in the macrophages in 3 cases. TB was detected with equal frequency in both asymptomatic and symptomatic groups. Axillary nodes pose problem due to deeper location. False positives were a case of dermatopathic lymphadenopathy and a case of Kimura's disease. False negatives include two cases of TB lymphadenitis. Pathogens should be looked for irrespective of cyto-morphology. Biopsy should be done to confirm cases of lymphomas. Fine needle aspiration cytology should be included in the protocol of six monthly review of HIV infected cases.

Parotid lymphoepithelial cysts in human immunodeficiency virus: a review.

BACKGROUND: Many patients with human immunodeficiency virus present with atypical features. Early indicators of human immunodeficiency virus are scarce and hence most affected patients are diagnosed in the later stages of the disease, which is associated with poor prognosis. Salivary gland disease usually develops before acquired immunodeficiency syndrome, and is sometimes the first manifestation of human immunodeficiency virus infection. Salivary gland lesions include benign lymphoepithelial cysts of the parotid gland, which are seen in 3-6 per cent of patients. Many of the reported lesions are diagnosed on routine examination. OBJECTIVE: This review aimed to highlight the association between parotid gland benign lymphoepithelial cyst and human immunodeficiency virus infection, in order to aid early diagnosis and management of the disease. CONCLUSION: Human immunodeficiency virus testing is recommended for patients with benign lymphoepithelial cysts, as this can often be the first indication of human immunodeficiency virus infection. Benign lymphoepithelial cysts are important diagnostic and prognostic indicators in human immunodeficiency virus infection.