Early Fetal Corpus Callosum: Demonstrating Normal Growth and Detecting Pathologies in Early Pregnancy.

BACKGROUND AND PURPOSE: A malformed corpus callosum carries a risk for abnormal neurodevelopment. The advent of high-frequency transducers offers the opportunity to assess corpus callosum development in early pregnancy. The aim of the study was to construct a reference chart of the fetal corpus callosum length on ultrasound between 13 and 19 weeks of gestation and to prospectively examine growth patterns in pathologic cases. MATERIALS AND METHODS: We performed a prospective cross-sectional study between 2020 and 2022 in well-dated, low-risk, singleton pregnancies between 13 and 19 weeks of gestation. A standardized image was obtained in the midsagittal plane. Imaging criteria were used as a confirmation of the early corpus callosum. Measurements were taken by 4 trained sonographers. Intra- and interobserver variability was assessed. Corpus callosum length in centiles were calculated for each gestational week. RESULTS: One hundred eighty-seven fetuses were included in the study. All cases met inclusion criteria. At 13 weeks of gestation, the margins of the early corpus callosum were sufficiently clear to be measured in 80% (20/25) of fetuses. A cubic polynomial regression model best described the correlation between corpus length and gestational age. The correlation coefficient (r 2) was 0.929 (P < .001). Intra- and interobserver variability had high interclass correlation coefficients (>0.99). Presented is the earliest published case of agenesis of corpus callosum and a case of dysgenetic corpus callosum in Rubinstein-Taybi syndrome. CONCLUSIONS: Provided is a nomogram of the early fetal corpus callosum. Applying imaging criteria helped to identify a case of complete agenesis of the corpus callosum as early as 14 weeks.

Sexing domestic chicken before hatch: a new method for in ovo gender identification.

Male chicks are an unwanted by-product when producing laying hens. The common practice to kill them directly after they have hatched gives rise to ethical concerns worldwide. The aim of this study was to develop an endocrine method to determine the sex of domestic chicken before hatch. On Days 7 to 10 of incubation, the allantoic fluid from brown layers' eggs (n = 750) was analyzed via enzyme immunoassay for their content of estradiol, estrone sulfate, and testosterone in order to detect gender differences. We successfully established a reliable method for in ovo sex identification on Day 9 of incubation by estrone sulfate measurement in the allantoic fluid. Female embryos displayed significantly higher hormone levels in the allantoic fluid than males (female: median = 0.312 ng/mL; male: median = 0.110 ng/mL; P ≤ 0.001). Our method allows the sexing of domestic chicken at a very early stage of embryonic development, even before the onset of pain perception. The possibility to eliminate eggs containing male embryos on Day 9 of incubation represents a vast improvement compared with culling day-old chicks.

Prognostic factors in patients with advanced hepatocellular carcinoma treated with sorafenib.

BACKGROUND: Sorafenib is the new reference standard for patients with advanced hepatocellular carcinoma (HCC). AIM: To identify prognostic factors in sorafenib-treated HCC patients and to evaluate outcomes with respect to liver function. METHODS: In this retrospective study, 148 HCC patients received sorafenib 400 mg b.d. across 11 Austrian institutions. Seventy-eight HCC patients who received best supportive care (BSC) in the pre-sorafenib era served as a control. RESULTS: In sorafenib-treated patients, low baseline α-fetoprotein, low Child-Pugh (CP) score, compensated cirrhosis, and low baseline aspartate aminotransferase (AST) were associated with significantly longer overall survival (OS) on univariate analysis. CP score and baseline AST remained independent prognostic factors on multivariate analysis. In patients with Barcelona Clinic liver Cancer (BCLC) stage B or C HCC (sorafenib: n = 139; BSC: n = 39), CP-A patients had a median OS of 11.3 (sorafenib [n = 76]) vs. 6.4 (BSC [n = 17]) months (P = 0.010), and CP-B patients had a median OS of 5.5 (sorafenib [n = 55]) vs. 1.9 (BSC [n = 22]) months (P = 0.021). In the sorafenib group, median OS according to baseline AST was 11.8 (<100 U/L [n = 58]) vs. 3.9 (≥100 U/L [n = 15]) months for CP-A patients (P = 0.127), and 6.5 (<100 U/L [n = 33]) vs. 2.1 (≥100 U/L [n = 21]) months for CP-B patients (P = 0.011). There was no survival difference between sorafenib and BSC in patients with BCLC stage D HCC (1.5 vs. 1.4 months; P = 0.116). CONCLUSIONS: Sorafenib was associated with improved survival in both CP-A and CP-B patients. In CP-B patients, baseline AST may be helpful in determining which patients are most likely to benefit from sorafenib.

Fulminant Stenotrophomonas maltophilia soft tissue infection in immunocompromised patients: an outbreak transmitted via tap water.

Soft tissue infection caused by Stenotrophomonas maltophilia is uncommon, but nosocomial infections had been reported. We describe herein 2 young female patients, with severe neutropenia, on broad spectrum antimicrobial agents for neutropenic fever, with Hickman-type central venous catheter, who developed mucocutaneous and soft tissue infections with rapidly progressive and devastating course. Cultures from the skin of both patients and from blood of one of them grew S. maltophilia. Both patients died and post mortem examination of the patient with S. maltophilia bacteremia revealed extensive soft tissue necrosis and a vegetation on the mitral valve that grew S. maltophilia. The infection occurred in both patients at the same time and in the same ward. Epidemiological study was done, and surveillance cultures grew the organism from the faucets from the room of 1 patient and also from some of the neighboring rooms in our ward but not from any other ward nor in the water reservoir of the building.

[Organophosphate poisoning in inexperienced workers].

Organophosphates are frequently used as insecticides in agricultural areas, therefore they may pose a risk for accidental exposure by dermal contact or through inhalation. We present the cases of eight young men, who worked unprotected and inexperienced with organophosphates. They were exposed dermally and developed mainly gastrointestinal symptoms and also diaphoresis, hypersalivation, blurred vision and miosis. One patient developed severe weakness, fasciculations, disorientation and sleepiness. All had low levels of plasma acetylcholinesterase. All were admitted to the hospital and received antidotal treatment of atropine and toxogonin. They were released after 48 hours in good physical condition. The hospital staff rapidly diagnosed the organophosphate intoxication; additional doctors and nurses were called to the emergency department. The patients were decontaminated in showers within the hospital. This case emphasizes the need for workers handling pesticides, to be supervised by an experienced person and the advantages of hospital drills in rapid diagnosis and preparedness to provide treatment to many patients.

[The new German resuscitation guidelines in the context of international recommendations]. / Die neuen Deutschen Reanimationsrichtlinien im Spiegel internationaler Empfehlungen.

The German Guidelines for Cardiopulmonary Resuscitation were adapted to match the revised International Guidelines. The revised German edition was based both on the guidelines issued by the American Heart Association (AHA) in 1992 and on those of the European Resuscitation Council (ERC) of 1998, as well as on those released by the International Liaison Committee on Resuscitation (ILCOR) in 1997. Due to the diverging instructions for action the emergency physicians felt considerably unsafe as to what they should really do to achieve maximum results. Only 10.3 per cent of the german emergency physicians followed the recommendations given by the German Federal Chamber of Physicians. Innovations in respect of the basic checkup concern the time for controlling the respiration and circulation (ten seconds). Contrary to the international recommendations the "diagnostic block" is performed in Germany without interspersing basic reanimation. In artificial respiration the tidal volume has been reduced to 600 ml in accordance to the ERC and ILCOR guidelines. The search for the pressure point for cardiac pressure massage has also been adapted to the international recommendations. Also in accordance with the international recommendations defibrillation in case of ventricular fibrillation is now being performed only thrice in series without interspersed basic reanimation. There is some uncertainty with regard to choosing the requisite energy: 16.6% of the emergency physicians opt for less than 200 joule in primary defibrillation whereas 13% are in favour of more than 200 joule. Contrary to the international recommendations which prescribe peripheral venous access as application site for reanimation by drugs, the german guidelines favour the endobronchial path, which is already being practised by 57.4% of the emergency physicians. Hence, emergency medication can be effected in Germany 4 minutes earlier than in other countries. After three unsuccessful applications of 1 mg each of adrenalin the dosage is increased to 5 mg, and in agreement with the AHA guidelines escalating doses are also possible. Sodium bicarbonate is recommended only after more than 20 minutes of reanimation and if so, only in a reduced dose of 0.5 mval/kg body weight. In accordance with the international recommendations there is now a universal algorithm that decides on application only between ventricular fibrillation and nonfibrillation. The new german recommendations have adapted the reanimation procedure in agreement with ERC to national usage without abandoning any principles of the international guidelines.

Epidemiological study of classic Kaposi's sarcoma: a retrospective review of 125 cases from Northern Israel.

BACKGROUND: The morphology of Kaposi's sarcoma is clinically and histologically the same in all clinical forms of the disease. However, there is a difference in the clinical and biological behaviour of the different forms of the disease. The behaviour also differs among individuals with the same form. The factors involved in the initiation and prognosis of the disease are still unknown. The classical form is more common in middle-aged Jews of East European or Mediterranean origin, people of Italian and southern Greek origin. Classic Kaposi's Sarcoma is seen relatively more frequently in Israel than in many other countries. OBJECTIVE: The aim of this study was to examine risk factors that influence the development and course of the disease. METHODS: This retrospective study includes 125 patients with Kaposi's sarcoma, all diagnosed and followed in the Department of Dermatology at Rambam Medical Center in Haifa. RESULTS: The group included 85 (68%) men and 40 (32%) women. Fourteen subjects received corticosteroid therapy and three were kidney transplant recipients. Age at onset of the disease was 21-87 years, with a mean age of 67. A total of 121 patients (96.8%) were Jews and four (3.2%) were non-Jews. A majority (61.6%) were of East European origin. The number of new cases each year was constant in relation to the general population, except for two peaks, one in 1970 and another in 1986-89. The lower limbs were involved in most patients. Extracutaneous involvement was present in 18.4%. Of all the subjects, 28 (22.4%) had diabetes mellitus and 21 (16.8%) had a second primary malignancy. The malignancies were of lymphoreticular origin in 10 patients, four in the urinary bladder, three had carcinoma of the large bowel and one of the pancreas. CONCLUSION: Our study shows similar clinical findings to those described in other series. The relatively high frequency of carcinomas of the colon and urinary bladder was not reported elsewhere. We observed a consistent rate of new cases each year with two peaks in 1970 and 1986-1989, the cause of which deserves explanation. Of interest is the relative rise in the number of females with Kaposi's sarcoma. A relative high risk for developing Kaposi's sarcoma has been found among Jews of Ashkenazi origin compared to those of other ethnic groups. Israeli-born subjects presented a relatively more aggressive course of disease than others.

Treatment of fungal infections with ABLC in the home-care setting.

Invasive fungal infections are an important cause of morbidity and mortality in HIV-infected individuals. The management of opportunistic infections in a home-care setting offers many psychological and economic advantages over hospitalization. Amphotericin B, the gold standard treatment for invasive fungal infections, is associated with significant adverse reactions, particularly nephrotoxicity, that make it difficult to administer as home infusion therapy. Lipid formulations of amphotericin B offer therapeutic alternatives to the parent compound with comparable efficacy, significantly lower rates of nephrotoxicity, and decreased infusion times versus the conventional form. Clinical experience with amphotericin B lipid complex injection in the treatment of fungal infections demonstrates its usefulness as an effective alternative to conventional amphotericin B in home infusion therapy.

Isolation of the ALG5 locus encoding the UDP-glucose:dolichyl-phosphate glucosyltransferase from Saccharomyces cerevisiae.

UDP-glucose:dolichyl-phosphate glucosyltransferase is a transmembrane-bound enzyme of the endoplasmic reticulum involved in protein N-linked glycosylation. This enzyme catalyzes the transfer of glucose from UDP-glucose to dolichyl phosphate. The structural gene encoding this transferase from Saccharomyces cerevisiae was isolated by complementation of an alg5-1 mutation. DNA sequencing of ALG5 revealed an open-reading frame of 1002 bases encoding a transmembrane protein of molecular mass 38.3 kDa. Overexpression of Alg5p in both yeast and Escherichia coli results in an increase of UDP-glucose:dolichyl-phosphate glucosyltransferase activity, whereas a deletion of the yeast gene leads to a loss of this activity and a concomitant underglycosylation of carboxypeptidase Y. The ALG5 protein has sequence similarity to the GDP-mannose:dolichyl-phosphate mannosyltransferase (Dpm1p) from S. cerevisiae. Topological studies indicate that UDP-glucose:dolichyl-phosphate glucosyltransferase is a transmembrane protein that spans the membrane several times.

Results of the multicenter evaluation of the CEDIA cortisol assay.

The present paper describes the multicenter evaluation of the CEDIA Cortisol test for total cortisol. The observed linearity of the test was between 1.2 and 50 micrograms/dL cortisol. The limit of detection was calculated as 1.2/dL. Imprecision studies covering the diagnostically relevant range (5-20 micrograms/dL cortisol) yielded coefficients of variation between 1.7-8.9% (within-run) and 2.7-10.5% (between-day). An interlaboratory survey using 41 human samples and three control sera demonstrated that the new CEDIA Cortisol assay has a good interlaboratory transferability. Method comparison studies between the CEDIA Cortisol test and EIA, FIA, FPIA, and various RIAs yielded an acceptable level of agreement and concordant results in most cases. Low cross-reactivity of the antibody used in the new cortisol assay was observed with precursors or metabolites of cortisol. Especially, dexamethasone did not cross-react. However, prednisolone, 6-methylprednisone, and corticosterone showed cross-reactivities. No limitation by endogenous interferences was observed. The CEDIA Cortisol assay permits the precise, fast and sufficiently specific determination of cortisol. Furthermore, it offers the advantages of a non-radioactive assay and can be performed conveniently on Boehringer Mannheim/Hitachi analyzers in combination with routine clinical chemistry.

Mycosis fungoides bullosa.

A case of mycosis fungoides bullosa is presented. The results in our study confirmed that the predominant atypical lymphoid cells in the bullae, peripheral blood, and involved lymph nodes expressed the T-cell helper phenotype using immunophenotyping techniques. The literature is reviewed, confirming that our case demonstrated cells of the T-helper phenotype, not only in the skin but also in the blood and lymph node tissue. Bullous lesions in mycosis fungoides are rare.

Infectious diseases of the skin.

Pathologic changes in the skin of elderly individuals increase their susceptibility to skin infections. These changes include thinning, decreased secretions, and reduced immune function. This paper will discuss the most important viral, fungal, bacteriologic, and parasitic infections of the skin in the elderly and the appropriate treatment of these infections.

Postmastectomy low-grade angiosarcoma. An unusual case clinically resembling a lymphangioma circumscriptum.

A 90-year-old white woman developed a low-grade cutaneous angiosarcoma arising on a chronically lymphedematous extremity 15 years after a radical mastectomy for breast carcinoma. This neoplasm had the clinical appearance of lymphangioma circumscriptum and was characterized by an unusually benign course with a 3-year follow-up.

Antiandrogenic effects of topically applied spironolactone on the hamster flank organ.

The effects of topically applied spironolactone on the sebaceous glands of flank organs in adult male golden hamsters were investigated. Daily treatment with spironolactone (0.3 mg and 3 mg) on one side only significantly reduced the size of the treated flank organs, while the contralateral flank organs remained unchanged. Lower doses of spironolactone and the vehicle had no effect. Cyproterone acetate therapy resulted in the bilateral reduction of flank organ sizes. In vivo measurement of the palpable bulk of the flank organs correlated with flank organ volumes as determined by computer-assisted planimetry of serial histologic sections. Dry weights of seminal vesicles in animals treated with spironolactone did not differ significantly from those of the control group, while topically applied cyproterone acetate significantly reduced seminal vesicle weight. Topically administered spironolactone appears to have only local antiandrogenic effects, as indicated by the lack of changes in the untreated contralateral flank organs and in the weights of seminal vesicles.

Morphometric studies of the hamster flank organ: an improved model to evaluate pharmacologic effects on sebaceous glands.

The Syrian golden hamster flank organ, composed of clusters of large sebaceous glands, has been used to investigate effects of systemically or topically applied hormones, antiandrogens, and retinoids. Accurate assessments of flank organ sebaceous gland volume and its correlation with in vivo measurements of flank organ size have not been reported. Sixty flank organs were examined. In vivo flank organ size was expressed as the product of the greatest longitudinal (DL) and greatest transverse (DT) diameters of the palpable bulk. Sebaceous gland volumes were calculated from planimetric analyses of serially sectioned specimens of flank organs using a computer-assisted planimetry system. In vivo measurements (DL X DT) were found to correlate with planimetrically determined flank organ volume. Planimetric analysis of every 10th section of a serially sectioned flank organ was almost as sensitive as analysis of every section in determining sebaceous gland volume. Computer-assisted planimetry of serially sectioned flank organs was found to be an accurate and reproducible method for assessing gland volume. In vivo measurements of the palpable bulk are a good indicator of sebaceous gland size and correlate well with planimetrically determined sebaceous gland volumes.

Prediction of lymph node metastases from the histologic features of primary cutaneous malignant melanomas.

Elective regional lymph-node dissection was performed on 98 patients with clinical Stage I cutaneous malignant melanoma and 26 of them were found to have microscopic evidence of metastases. The histology of the primary lesions was reviewed in order to find possible prognostic parameters that would allow prediction of nodal involvement. There was an increased risk of occult lymph node metastases with increasing thickness of the primary lesions. While this trend was not found to be statistically significant, no occult lymph node metastases were found for lesions less than 1.0 mm in thickness. Significant features included mitotic figures, "prognostic index," and plasma cells within the infiltrate. A multiple logistic regression analysis identified three groups of patients with low, medium, and high risk of occult metastases, based on thickness, location, and plasma cells. The correlation between plasma cells and the incidence of metastases in lymph nodes might represent an immunologic phenomenon.

Gentamicin-resistant staphylococci: genetics of an outbreak in a dermatology department.

The genetics of gentamicin resistance in Staphylococcus aureus strains isolated during an outbreak of infection in dermatology department have been studied. The predominant strain of S. aureus did not appear to possess a plasmid mediating gentamicin resistance though one isolate yielded a plasmid coding for penicillin and gentamicin. Three distinct plasmids were isolated from other phage types of S. aureus which appeared towards the end of the epidemic. There appeared to be a stepwise loss of gentamicin resistance in the predominant strain.