Perinatal outcome after fetoscopic laser surgery for twin-to-twin transfusion syndrome in triplet pregnancies.

OBJECTIVES: The introduction of fetoscopic laser surgery of placental anastomoses has led to a significant improvement of perinatal outcome of twin pregnancies affected by twin-to-twin-transfusion syndrome (TTTS). To quantify the perinatal outcome and neurological morbidity in triplet pregnancies complicated by TTTS, which were treated with fetoscopic laser surgery. SEARCH STRATEGY: Medline, Embase, Cinahl and Cochrane were searched. SELECTION CRITERIA: The outcomes observed were: fetal and perinatal survival, preterm birth and abnormal neurological outcome. DATA COLLECTION AND ANALYSIS: Two authors reviewed all abstracts independently. Meta-analyses of proportions were used to combine data. MAIN RESULTS: Eight studies (126 triplet pregnancies, 104 dichorionic-triamniotic [DCTA] and 22 monochorionic-triamniotic [MCTA]) treated with fetoscopic laser surgery were included in this review. In DCTA and MCTA pregnancies, fetal losses were 18.9% and 28.9%, respectively; perinatal losses were 23.6% and 75.0%; preterm births <28 weeks of gestation were 16.9% and 37.1%; preterm births <32 weeks of gestation were 50.0% and 69.5%; at least one fetus survived in 95.4% and 88.9% of the pregnancies; at least two fetuses survived in 81.8% and 68.3% of the pregnancies; and in 55.9% and 48.4% pregnancies all triplets survived. Finally, the incidence of abnormal neurological outcomes ranged from 0 to 37% in DCTA and from 0 to 50% in MCTA triplets. CONCLUSIONS: Both DTCA and MCTA triplet pregnancies affected by TTTS are at high risk of adverse perinatal outcome. TWEETABLE ABSTRACT: Both DTCA and MCTA triplet pregnancies affected by TTTS are at high risk of adverse perinatal outcome.

Mind the gap: MIND, the mental hygiene movement and the trapdoor in measurements of intellect.

BACKGROUND: The National Association for Mental Health adopted the 'brand name' MIND as part of its transformation into a campaigning pressure group at the turn of the 1970s. This article examines the historical antecedents to key statements made by the organisation at this time regarding the relationship of mental health with, what was then called, 'mental handicap'. METHODS: The National Association is placed within the historical context of the movement for mental hygiene. The article traces how the movement theorised mental health as critically related to intellect and emotionality. RESULTS: The movement relegated people deemed 'mentally deficient' from therapeutic policies based on family relationships believed to promote mental health. However, a late 1950s experiment known as the Brooklands study subverted this discrimination. This was paradoxical since it built on mental hygiene theorising. CONCLUSIONS: Theorisations of the relationship between intellect, emotion and mental health are still potentially discriminatory.

Identification of RAPD markers linked to digestive amylase genes using near isogenic lines of the silkworm, Bombyx mori.

Digestive amylase has been identified as a useful marker for breeding in the silkwrom, Bombyx mori L (Lepidoptera: Bombycidae), due to its wide genetic divergence, its role in better digestibility and robustness. The low yielding indigenous B. mori breeds of tropics like India are characterized by high activity amylase genes controlled by Amy d(iv) or d(v) alleles, while the high yielding breeds of temperate origin are endowed with 'null' type (Amy d(n)) with low activity. For improving the digestibility and survival of temperate breeds of Japanese origin, Near Isogenic Lines (NILs) were developed introgressing the Amy d(iv) and d(v) alleles from the Donor Parents (DPs) into the genetic background of the Recurrent Parents (RPs) with 'null' type of amylase, which showed significant improvement in viability of the NILs. With the objective to know whether the amylase gene itself may confer higher survival by improving digestibility or some other closely linked genes flanking the amylase locus is responsible for better viability of the NILs, RAPD profiles among six B. mori breeds comprising of the DPs, RPs, and NILs developed through introgression of Amy d(iv) or d(v) alleles were analysed using 27 sets of RAPD primers. Out of the 27 primers, six (OPA01, OPA06, OPA09, OPA15, OPAH03, and OPAH05) showed RAPD products linked to the amylase genes of the DPs introgressed in the NILs, which were absent in their respective RPs. Three amplicons of 1584 bp, 1904 bp, and 1232 bp were specific to Amy d(iv) allele and one amplified product of 1776 bp was found to be linked with the Amy d(v) allele. Interestingly, two PCR products of 2628 and 1375 bp were associated with both Amy d(iv) and d(v) alleles. The results are discussed in light of further characterization of these amplified products leading to identification of DNA sequences that may be responsible for better digestibility and higher survival in B. mori.

[Central hemiparesis as manifestation of systemic vasculitis]. / Centrální pravostranná hemiparéza jako dominující projev systémové vaskulitidy.

We present a case report of patient with systemic vasculitis with affection of heart, skin, gastrointestinal tract and rare involvement of central nervous system. Diagnosis of systemic vasculitis was based on clinical manifestations, blood hypereosinophilia and brain magnetic resonance imaging. Immunosuppressive therapy led to regression of symptoms including initially present neurologic manifestation.

[Myopathy and mixed hyperlipoproteinemia as the first symptom of systemic AL-amyloidosis]. / Myopatie a smísená hyperlipoproteinemie jako první projev systémové AL-amyloidózy.

Systemic AL-amyloidosis is a disorder brought about by the over-production and deposition of fragments of light immunoglobulin chains in tissues, the consequence of which is their functional impairment. The most often affected are the kidneys, the heart, the gastro-intestinal tract and the nervous system. We describe the case of a 57-year-old patient in whom a rare disorder of the striated muscle (am yloid myopathy) was present, as the first clinical indication of systemic AL-amyloidosis. The main symptoms were muscle weakness and an increase in laboratory signs of muscle lesion. The patient was monitored for several years and treated with a diagnosis of primary idiopathic polymyositis (the likely diagnosis according to the diagnostic criteria of Bohan and Peter). Only after some years did hepatomegaly appear with elevated liver transaminases and a diagnosis of systemic AL-amyloidosis was established on the basis of a liver biopsy. By additional staining of striated muscle preparations with a dye for amyloid (in accordance with Maldyk) amyloid myopathy was confirmed. In addition to muscle affection, mixed hyperlipoproteinemia was present from the beginning. This was probably the first indication ofamyloidosis. The case description points out the justified inclusion of systemic AL-amyloidosis in differential diagnosis of muscle weakness and signs of muscle lesion. Amyloidosis must be considered if in addition to myopathy there is also present a problem with any organ which can typically be affected by amyloidosis.

Morphology of the posterior junctional area in atrioventricular septal defects.

The location and size of the coronary sinus in hearts with atrioventricular septal defect were investigated in relation to the known disposition of the atrioventricular conduction axis. We examined the morphology in 40 hearts and supplemented this series with two other hearts that had been serially sectioned previously. The coronary sinus received drainage from a persistent left superior caval vein in 5 hearts. Six cases of 40 had malalignment of the septal structures relative to the crux of the heart. In these, the conduction axis was anticipated to course in the position where the inlet ventricular septum met the atrioventricular junction. The coronary sinus terminated in the left atrium in 4 hearts: 2 in the morphological series and 2 that were sectioned for histological studies. The sectioned hearts showed the atrioventricular conduction axis in the usual position for the defect, unrelated to the coronary sinus. The principle that the node and penetrating bundle are located at the intersection of the ventricular septum with the atrioventricular junction holds good despite the variability of the coronary sinus.

Teledermatology in the Highlands of Scotland.

A pilot study of telemedicine consultations of 51 dermatology patients showed that the technology worked well, with the diagnosis being able to be made in most patients and over half of the patients being able to be dealt with through this medium only. It could therefore have a valuable screening role. However, many of the patients, in spite of the obvious advantage of an immediate consultant opinion, felt it would be more appropriately used as a review technique.

Hand, foot and mouth disease.

Standardisation is vital if the clinical images are to be used for monitoring any changes in the patient's condition. The two images can be cut and mounted in one 35 mm mount for comparison.

Randomized clinical trials of cancer treatment--a public opinion survey.

An interview survey was carried out among 1022 adults, representative of a cross-section of the population aged 16-70, to find out how people reacted to the idea of participating in randomized clinical trials of cancer treatment. A secondary purpose of the survey was to learn whether or not people wanted their doctor to give them information about their illness, the treatment and the trials. Overall, there was no evidence of antipathy to the concept of randomized trials. Two out of three of those interviewed were prepared to participate, except in the most demanding situations when just over half wished to choose their own treatment. There was a strong response in favour of being given information and a very high level of confidence in doctors. Both respondents and interviewers were enthusiastic about participating in the survey.

Deletion of Dad1 in mice induces an apoptosis-associated embryonic death.

Dad1 is a putative anti-apoptosis gene identified in several distantly related organisms. Expression of Dad1 in transfected cells inhibits apoptosis in vitro. To determine whether Dad1 has a similar function in vivo, we used gene targeting to delete Dad1. Heterozygous adult mice (+/-) show no obvious phenotype or abnormalities, but genotype analysis of over 100 offspring from heterozygous matings detected no weanling, homozygous Dad1 null (-/-) mice. Subsequent analysis of embryos from heterozygous matings detected Dad1 null (-/-) embryos at E3.5 but no later, suggesting Dad1 is required for development beyond the late blastocyst stage. Increased levels of apoptosis were observed in cultured embryos lacking a functional copy of the gene, consistent with an anti-apoptotic role for Dad1.