A comparison of maternal calcium and magnesium levels in pre-eclamptic and normotensive pregnancies: an observational case-control study.

OBJECTIVE: Supplementing pregnant women at high risk of developing pre-eclampsia with calcium may reduce the incidence of the disease. This study examines differences in serum and hair concentrations of calcium and magnesium between women with pre-eclamptic and normotensive pregnancies. DESIGN: Observational case-control study. SETTING: Two teaching hospitals in Cape Town, South Africa. POPULATION: Women with pre-eclamptic (N = 96) or normotensive (N = 96) pregnancies, who delivered a single, live infant. METHODS: Demographic and current pregnancy details were retrieved from clinical notes. Each participant completed a dietary questionnaire. Venous blood samples were taken from each participant to assess serum calcium and magnesium concentrations. Hair samples were obtained from all participants and calcium and magnesium levels were measured by inductively coupled plasma optical emission spectrometry (ICPOES). MAIN OUTCOME MEASURE: Hair and serum calcium and magnesium concentrations were compared between women with pre-eclamptic and normotensive pregnancies. RESULTS: Diet and socio-economic status in the two groups were similar. There was no significant difference in the hair calcium level between women with pre-eclamptic [1241 parts per million (ppm); range, 331-4654 ppm] and normotensive (1146 ppm; range, 480-4136 ppm) pregnancies (P = 0.5). Hair calcium levels in both groups were not affected by HIV infection. CONCLUSION: Woman with pre-eclampsia showed no difference in chronic calcium status relative to normotensive women. This finding does not support the current belief that the mechanism by which calcium supplementation reduces the risk of developing pre-eclampsia is by correcting a nutritional deficiency.

Gastrointestinal bleeding in a pregnant woman: mucinous cystic neoplasm of pancreas mimicking gastrointestinal stromal tumor of stomach.

A 38-year-old woman presented in early pregnancy with anemia due to an ulcerated gastric tumor which had the typical clinical presentation and endoscopic appearance of a gastric leiomyoma or gastrointestinal stromal tumor. At surgery this was subsequently found to be a mucinous cystic tumor of pancreas. Review of the literature shows that both gastrointestinal hemorrhage and infiltration of stomach are infrequent complications of this tumor.

Nucleon axial charge in full lattice QCD.

The nucleon axial charge is calculated as a function of the pion mass in full QCD. Using domain wall valence quarks and improved staggered sea quarks, we present the first calculation with pion masses as light as 354 MeV and volumes as large as (3.5 fm)3. We show that finite volume effects are small for our volumes and that a constrained fit based on finite volume chiral perturbation theory agrees with experiment within 7% statistical errors.

Endoscopic placement of fibrin sealant as a treatment for a long-standing Boerhaave's fistula.

A 64-year-old man suffered a spontaneous rupture of the esophagus (Boerhaave's syndrome) after an episode of severe retching. He underwent attempted primary repair of the esophageal defect, but unfortunately the repair failed with the development of a persistent esophago-bronchial fistula resistant to extended conservative management. Three hundred and nineteen days after the initial rupture, the fistula was successfully treated with endoscopic placement of fibrin glue. We believe this to be the first reported case of fibrin sealant being used in the treatment of a long-standing fistula resulting from Boerhaave's syndrome.

Objective evaluation of ERCP procedures: a simple grading scale for evaluating technical difficulty.

BACKGROUND: and objective: Endoscopic retrograde cholangiopancreatography (ERCP) is a technically demanding endoscopic procedure that varies from a simple diagnostic to a highly complex therapeutic procedure. Simple outcome measures such as success and complication rates do not reflect the competence of the operator or endoscopy unit, as case mix is not taken into account. A grading scale to assess the technical difficulty of ERCP can improve the objectivity of outcome data. METHODS: A I to IV technical difficulty grading scale was constructed and applied prospectively to all ERCPs over a 12 month period at a single centre. The procedures were performed by two senior trainees and two experienced consultants (trainers). The grading scale was validated for construct validity and inter-rater reliability at the end of the study using the chi(2) test and kappa statistics. RESULTS: There were 305 ERCPs in 259 patients over the 12 months study period (males: 112, females: 147, age range 17-97, mean 70.3 years). There was overall success in 244 (80%) procedures with complications in 13 (4%): bleeding in five (1.6%), cholangitis in one (0.3%), pancreatitis in five (1.6%), and perforation in two (0.7%). Success rate was highest for grade I, 49/55 (89%), compared with grade IV procedures, 8/11 (73%). There was a significant linear trend towards a lower success rate from grade I to IV (p=0.021) for trainees, but not for trainers. Complications were low in grade I, II, and III procedures, 12/295(4%), compared with grade IV procedures, 1/11(9%). The inter-rater reliability for the grading scale was good with a substantial agreement between the raters (kappa=0.68, p<0.001). CONCLUSION: Success and complications of ERCP by trainees are influenced by the technical difficulty of the procedure. Outcome data incorporating a grading scale can give accurate information when auditing the qualitative outcomes. This can provide a platform for structured objective evaluation.

Manual medicine diversity: research pitfalls and the emerging medical paradigm.

Recent studies published in leading medical journals have concluded that chiropractic treatment is not particularly helpful for relieving asthma and migraine symptoms because even though study participants showed notable improvement in symptoms, those subjects who received sham manual medicine treatments also showed improvement. Yet the sham treatment received by control groups in these studies is reminiscent in many ways of traditional osteopathic manipulation. This seems to represent not only a failure to recognize the value of many manual medicine techniques but also an ignorance of the broad spectrum of manual medicine techniques used by various practitioners, from osteopathic physicians to chiropractors to physical therapists. Such blind spots compromise research methodology with regard to manual medicine studies, which could, in turn, diminish the role of manual medicine in clinical practice. Osteopathic manipulative treatment provides an excellent model for recognizing and integrating the full range of manual medicine techniques into research and clinical applications because of the wide range of techniques employed. The potential exists for these techniques to contribute much to medical research and clinical practice--provided that osteopathic physicians and other manual medicine practitioners work to alleviate ignorance about the efficacy of various forms of manipulation.

Long-term inhibition of tinnitus by UltraQuiet therapy: preliminary report.

Masking of tinnitus by noise can produce residual inhibition, a persistence in the reduction in tinnitus after the noise is removed. Typically, this relief is very short-lived, on the order of minutes. This report highlights long-term inhibition of tinnitus by UltraQuiet therapy, a new technique that employs patterned sound in the 10- to 20-kHz range, presented through bone conduction. Nine subjects participated in a study of the efficacy of this tinnitus suppression technique. Eight reported improvement in tinnitus symptoms; one did not complete the study. The duration of the improvement ranged from days to weeks. This long-term inhibition may involve a truly plastic change in the brain at the central level.

Endoscopic ultrasound in the staging of tumours of the oesophagus and gastro-oesophageal junction.

BACKGROUND: Modern management of upper gastro-intestinal cancer demands accurate pre-operative staging. In continental Europe and Japan, endoscopic ultrasound (EUS) is established as the investigation of choice for local staging of these cancers, but British experience with this technique is limited. METHODS: A retrospective review of the medical records of patients with oesophageal or gastro-oesophageal junction tumours during our first 3.5 years' experience with EUS was undertaken and the findings at EUS correlated with the pathology of the resected specimen. RESULTS: A total of 124 patients (86 males), with a mean age of 64.5 years, underwent EUS: 84 had adenocarcinoma and 26 squamous cell carcinoma. There were 3 failed EUS examinations, 42 patients did not have surgery for a variety of reasons, and 10 patients had pre-operative chemoradiotherapy. In the remaining 69 patients, correlation for T stage showed an accuracy of EUS of 80% and for N staging of 54% overall. Comparison of the initial 2 years with the final 18 months showed no change in the T staging accuracy but an improvement in the N staging accuracy from 50% to 60%. CONCLUSION: Once initial experience has been gained, EUS is an accurate procedure for T and N staging of tumours of the oesophagus and gastro-oesophageal junction. It should be included with other imaging modalities, such as CT scanning, in the pre-operative assessment of these tumours.

Single-strand restriction fragment length polymorphism analysis of the second internal transcribed spacer (ribosomal DNA) for six species of Eimeria from chickens in Australia.

Species of Eimeria from chickens from Australia were characterised using a polymerase chain reaction-linked restriction fragment length polymorphism (PCR-RFLP) approach. The ribosomal DNA region spanning the second internal transcribed spacer (ITS-2) was amplified from genomic DNA by PCR, digested separately with three restriction endonucleases (CfoI, Sau3AI and TaqI) and the fragments separated by denaturing gel electrophoresis. The PCR products amplified from the six species varied from approximately 70 to 620 bp on agarose gels, with differences in size and number of bands among species, but no apparent variation within a species. The PCR-RFLP analysis of ITS-2 amplicons on denaturing gels gave characteristic profiles for individual species (except for minor variation in profiles within some species). The results indicate that ITS-2 contains useful genetic markers for the identification of six Eimeria species occurring in Australia.

Diffuse esophageal leiomyomatosis: another cause of pseudoachalasia.

The patient was a 22-year-old woman who had presented in early childhood with gastroesophageal reflux and who subsequently underwent surgery. It was commented upon by the surgeons at that time that the esophagus was abnormally thickened. The patient subsequently presented during her first pregnancy with a vulval tumor, which proved histologically to be a leiomyoma. She was also found to have a grossly dilated esophagus and was thought to have achalasia. However, endoscopic ultrasound imaging showed gross hypertrophy of the mid- and distal esophageal wall, with only mild symptoms of dysphagia, which had been long-standing. The appearance of the esophagus was consistent with diffuse esophageal leiomyomatosis. In view of the associated vulval leiomyoma, the patient demonstrated esophagovulvar syndrome.

The abdominal brain and enteric nervous system.

Conventional medical treatment for neurologic disorders such as epilepsy, migraine, and autism focuses on the brain. Although standard medical treatment is often helpful, the underlying causes of these disorders are not well understood. Furthermore, some individuals respond poorly or not at all to regular medicine. Evidence is accumulating in the medical literature that the enteric nervous system (ENS)-that part of the nervous system associated with the alimentary canal-also plays a role in these disorders. Historically, the concept of an autonomous abdominal nervous system was advocated by Byron Robinson, Johannis Langley, and Edgar Cayce. The work of these three prominent historical figures is considered along with modem view-points on the abdominal nervous system. Complementary therapies that address the nervous system of the abdomen have potential as useful adjuncts to conventional treatment for certain neurologic disorders.

Household migration in the Southern Cone: the case of Paraguay.

PIP: This study of migration from Paraguay to Argentina focuses on urban to urban migration and uses about 1300 interviews collected during September 1983 to May 1984 for constructing a profile of the migrants. Paraguayan migration to Argentina has historical roots. The first flows were in 1936 and 1947 and were due to war. Migrants tended to settle in Formosa and Misiones provinces in the northern region. The second waves that occurred during the 1950s, 1960s, and 1970s were to Buenos Aires. Most migration during the more recent years was motivated by economics. It is likely that the key factors were push factors in Paraguay. Migration policies in sending and receiving countries are lax. Half of the interviews were conducted among families in Gran Buenos Aires, and half were conducted among families in Asuncion, Paraguay. 33% of migrants in Argentina reported Asuncion as their last residence. Many migrants were from departments bordering on Argentina. Only 222 of the 543 heads of household who had been employed prior to departure reported that farm work had been their employment. Migration is precipitated by both economic and noneconomic factors. Logistic model findings indicate that urban migrant heads of households tended to be younger and less educated than nonmigrants. Migrants tended to be single heads of households with relatively few children. Rural migrants were less likely to be female and were more likely to have a larger family size than urban migrants. Heads of household with fewer continuous years of employment were more likely to migrate. Findings from data at the time of the interview suggest that higher relative wages were a pull force, when age, sex, education, marital status, size of business, and job seniority were controlled for. The recent democratization in Paraquay is like to attract return migrants, if urban employment opportunities are available.^ieng

Laxatives prior to small bowel follow-through: are they necessary for a rapid and good-quality examination?

Fifty-six patients undergoing small bowel follow-through examination were randomly allocated to two groups to assess the effect of preparation with laxative on the speed and quality of the examination. We found that laxative had no effect on either speed of the examination or quality of visualization of small bowel. However, the latter was dependent on the degree of supervision and technique of the examining radiologist.

Colorectal polyps: a correlation of radiological and pathological findings.

Ninety colorectal polyps seen on double contrast barium enema were reviewed and note was made of surface and base characteristics, size, site and the presence of associated disease. Results were then correlated with the histology. The radiological characteristics of each histological type of polyp encountered are described. Because of the variation in radiological appearance of each histological type and similarities in appearance between these types, we conclude that radiology cannot accurately predict the histology of a colorectal polyp.

Cow's milk protein/soy protein allergy: gastrointestinal imaging.

Positive radiologic findings were identified in the small and large bowels in three infants with various gastrointestinal manifestations of cow's milk protein/soy protein allergy, which was diagnosed on the basis of clinical features and histologic findings. Small bowel findings were thickened valvulae conniventes (plicae circulares), a ribbon-like ileum, and a thickened bowel wall. Narrowing, thumbprinting, and spasm were seen in the large bowel. These cases were seen at intervals far enough apart to exclude an endemic infection. The diagnosis of food protein allergy should be considered when diffuse small bowel disease or colitis is identified in an infant.