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PubMed1993

Ankylosing spondylitis: clinical course in women and men.

OBJECTIVE: To compare the clinical course; laboratory and radiological features of women and men with ankylosing spondylitis (AS). METHODS: Retrospective review of charts of 41 women and 41 men with AS (25 B27+ and 16 B27- in each group) individually matched for age at onset and disease duration. RESULTS: No differences were observed in the clinical picture in either sex, but the disease was less severe in women than in men with lesser duration of uveitis attacks, lower leukocyte counts (p < 0.05), lower levels of gamma-globulins (p < 0.05), and longer asymptomatic periods. At the end of the study, women had less restriction of spinal extension (p = NS), less sequelae of uveitis without significant visual loss (p = NS), required fewer hip replacements, had less frequency of bamboo spine (p < 0.02), and better functional class (p < 0.0027) than men. CONCLUSION: There are no significant clinical or radiographic differences between women and men with AS. However, the disease was more severe in men and these features may be due to sexual dimorphism.

Adolescent↗
PubMed1994

Bone mineral density in ankylosing spondylitis. DEXA comparison of control subjects with mild and advanced cases.

We have used dual-energy X-ray absorptiometry to measure bone mineral density (BMD) in patients with ankylosing spondylitis comparing 41 healthy control subjects and 33 patients with either mild or advanced ankylosing spondylitis. A Norland XR-28 bone densitometer was used to measure the BMD of the lumbar spine and that of the head, trunk, arms, femoral neck, Ward's triangle, legs, pelvis, and total body. Mild ankylosing spondylitis was defined as that showing no or incipient syndesmophytes between L1 and L5 vertebrae: we studied 16 men of mean age 37 years and six women of mean age 37 years. Advanced ankylosing spondylitis, in 11 men of mean age 42 years, showed a bamboo spine with bridging syndesmophytes across all disc spaces between L1 and L5. The mean BMD of the lumbar spine was significantly different in the patients and control subjects of the same sex (0.01 < p < 0.05, analysis of variance), being significantly reduced compared with control subjects in mild disease (0.001 < p < 0.01, t-test) and significantly increased in advanced disease over control subjects (0.01 < p < 0.05; t-test) and over patients with mild disease (0.001 < p < 0.01; t-test). The relevance of these findings to the aetiology and pathogenesis of spinal deformities and other complications in ankylosing spondylitis is discussed.

Absorptiometry, Photon↗
PubMed1993

A prospective study of patients with spondyloarthropathy with special reference to HLA-B27 and to gut histology.

Ileocolonoscopy was performed on 357 patients meeting the European Spondylarthropathy Study Group criteria for spondyloarthropathy. HLA loci A, B and C were determined in all patients; HLA-B27 was detected in 196 and was absent in the 161 remaining patients. A number of clinical, laboratory and radiological variables were determined before ileocolonoscopy and compared between the HLA-B27+ and HLA-B27- patients. The HLA-B27+ patients were mainly men, with significantly more family members with spondyloarthropathies. Clinical evidence of tendinitis and uveitis was more frequently found in these patients. Like several authors, we found that these patients were more severely affected since they presented more severe radiological involvement of the sacroiliac joints. Syndesmophytes, bamboo spine and erosive joint lesions were more frequent in this group, the hip involvement being of the concentric type. In HLA-B27+ patients ankylosing spondylitis was more prevalent, while in the B27- patients enterogenic, urogenital or undifferentiated spondyloarthropathy was diagnosed. The HLA-B27- patients experienced more episodes of diarrhea, and Crohn-like inflammatory gut lesions were more frequently seen on ileocolonoscopy. In this group a number of patients probably had a form of subclinical Crohn's disease of which the locomotor symptoms were the only clinical expression.

Adolescent↗
PubMed1993

Blood coagulation abnormalities associated with envenoming by Trimeresurus albolabris in Hong Kong.

Snake bites in Hong Kong are most commonly due to Tr. albolabris (White-lipped pit viper, bamboo snake). We studied 21 cases of envenoming by Tr. albolabris prospectively in order to document the incidence and severity of associated coagulation abnormalities. Eighteen patients (86%) had increased blood concentrations of fibrin degradation products (FDP) ranging from 10-40 micrograms/l to greater than 200 micrograms/l (normal: less than 10 micrograms/l), the majority of whom also had detectable soluble fibrin monomers. Among these 21 patients, 10 had decreased blood concentrations of fibrinogen ranging from 0.3 kg/l to 1.9 g/l (normal: 2-4 gl/l). In 11 cases (52%), the euglobulin clot lysis time was shortened (less than 150 minutes) in association with elevated blood concentrations of FDP (n = 10) and decreased circulating fibrinogen levels (n = 8). Thrombocytopenia and/or prolongation of prothrombin time (PT), activated partial thromboplastin time (APTT) and/or thrombin time (TT) were present in 10 patients (28%). Increased blood concentrations of FDP and decreased circulating fibrinogen levels were present in most of these cases. Envenoming by Tr. albolabris is therefore frequently associated with a coagulopathy compatible with increased fibrin/fibrinogenolysis. Measurement of blood concentrations of FDP is the most sensitive test for detecting the coagulopathy. There is, however, little correlation between the patterns of clinical manifestations and coagulation abnormalities although more severe clinical features were usually associated with high circulating FDP levels. Only one patient developed systemic bleeding but no fatality was observed. The coagulation abnormalities are usually correctable by replacement therapy. Further studies are required to study the mechanisms of this coagulopathy and its relationship with venom antigenaemia.

Adult↗
PubMed1995

[Sudden unexpected natural death from a viewpoint of forensic pathology].

Sudden unexpected natural death (SUND) has several characteristics, such as unknown clinical history, very short course to death, evidence of trauma, interference of postmortem changes and social implications of diagnosis. From these points, SUND involves important challenges in forensic pathology. Presented here are the highlights of our SUND studies which allow scientific speculation into the antemortem pathophysiological course to death and a subsequent accurate diagnosis of the cause of death in SUND cases. 1. Forensic problems of SUND of unknown etiology 1) Do sudden infant death syndrome (SIDS) studies continue endlessly? In Japan there are many cases of sudden unexpected infant death (SUID) which were regarded as SIDS, often without postmortem examination. Pure SIDS should be a diagnosis of exclusion under thorough postmortem examination. Additionally, many SIDS studies have focused on pathogenesis of pure SIDS based on the analysis of so-called SIDS cases described above. In this sense, SIDS studies may continue forever. To clarify whether SIDS is an onion type, that is a heterogeneous disease entity, or bamboo shoot type, a single disease entity with a single cause, it is more vital to accurately search autopsy findings to exclude the cause of death, rather than to study pathogenesis of SIDS. Thereafter, pure SIDS will be carved in relief and we could study the pathogenesis, if it remains in the future. Present in 40% of our SUID cases examined was the existence of viral infection as a cause of death. 2) Pokkuri disease It has long been believed that the main branches of coronary arteries in Pokkuri-disease cases are macroscopically hypoplastic and cause sudden cardiac death. However, our two-dimensional morphometric analysis of the main branches, such as wall thickness, degree of stenosis, lumen area, area within internal elastic lamina, showed no significant differences between Pokkuri-disease cases and age and sex-matched control cases. 2. Information for grasping antemortem pathophysiological state in SUND cases 1) Standardization of the degree of cardiac hypertrophy based on heart weight. In the course of our preliminary examination, we found that heart weight correlates significantly with body length and weight. Therefore, we tried to standardize the range of normotrophy, hypertrophy and hypoplasia/atrophy of the heart based on the correlation between heart weight and body type index calculated by body length and weight (Broca's index). 2) Evaluation of the clinical laboratory data in cadaveric blood. We examined 32 clinical laboratory parameters in cadaveric blood samples obtained from 192 autopsy cases. Behaviour of the laboratory parameters in cadaveric blood in relation to postmortem interval was divided into four types: increased, decreased, no particular tendency and remaining between upper and lower normal value. Parameters included in the last type, which is a useful tool for speculation of antemortem pathophysiology were T-Bil, TTT, ZTT, BUN, Cre, UA, alpha 1- and beta 2-microglobin, T-Chol, GHA1c, TP, A/G, Hb and Hct. A case was demonstrated in which values of clinical laboratory parameters in agonar stage were the same as in cadaveric blood obtained at autopsy. This indicates that caution is necessary in evaluating clinical laboratory data in agonar patients in the emergency room. 3) Diagnostic evaluation of immunohistochemical myoglobin staining in the kidney In order to evaluate the diagnostic value of myoglobin (Mb) staining in the kidney in medicolegal autopsy cases, Mb staining was carried out on the kidney sections of 141 victims, including 59 natural and 82 unnatural deaths. At the same time, Serum and Urine GFR parameters were measured and systemic histological changes were observed on some sections of each kidney. The incidence of Mb positive cases was 74.6% in unnatural, and 25.4% in natural death, indicating the importance of nontraumatic rhabdomyolysis in natural death cases.

Brain↗
PubMedDate not supplied

[Entrapment of the ulnar nerve at the elbow caused by repetitive movements: description of a clinical case].

The paper describes a case of ulnar neuropathy in a man who made household fittings and toys using bamboo. Several years after starting the job he showed symptoms and physical signs of ulnar nerve entrapment at the elbow, which were confirmed by electrophysiological findings. Job analysis revealed biomechanical risk factors consisting of a high repetition of forceful flexion and extension of the elbow, wrist and fingers without sufficient rest periods. Chronic musculoskeletal overuse gradually leads to tendon and nerve disorders. The ulnar neuropathy described can be classed under cumulative occupational trauma, which is the most important cause of musculoskeletal disorders among the working population.

Adult↗
PubMed1996

Application of deltamethrin-impregnated bednets for mosquito and malaria control in Yunnan, China.

The results of research in China in recent years show that: 1) Different laboratory sensitivity of adult Anopheles minimus, An. sinensis and Culex pipiens quinquefasciatus to deltamethrin exist in Yunnan. Although the range and duration for the use of permethrin and deltamethrin was limited, resistance of An. minimus, An. sinensis and Cx. pipiens quinquefasciatus to different extent in some areas existed. 2) On walls built with cement and covered with a thin layer of lime on which deltamethrin at a dosage of 0.025 g/m2 was sprayed, 100% of the mosquitos were stricken down within 3 days, 80% at the 15th day, 50% at the 20th day. The residual effectiveness on the bamboo and wood walls was good and could last for over 40 days, but on the mud walls a mortality of only 40% on the spraying day was observed, indicating that deltamethrin was not suitable for this purpose. Deltamethrin spraying reduced total caught mosquitos within 30 days, but there was no difference between the effects of deltamethrin (0.025 g/m2) and DDT (2 g/m2) at the 60th day. Deltamethrin effect on reducing densities of endophilic An. vagus, An. culicifacies and exophilic An. philippinensis was better than that of DDT (lasting over 60 days), but its effect on semi-endophilic An. sinensis lasted only 15 days. Against An. mininus, it showed good effects within 20 days but did not last as long as DDT (60 days). Residual deltamethrin and DDT spraying could both control malaria vectors, reduce the infection of infants by malaria, and reduce malaria parasite carrier rates (within 50 days). 3) Laboratory experiments showed that deltamethrin-impregnated bednets at a dosage of 0.015 g/m2 had a positive effect on An. minimus. The residual effect of unwashed deltamethrin-impregnated bednets at a dosage of 0.015 mg/m2 against An. sinensis was apparent and could last for 13 months. When an impregnated bednet was washed for the first time at the 12th month, its mortality effect on An. sinensis was reduced quickly to lower than 50%. The residual effect could last for 2-3 months when washed at the 6th month, but was lost when washed for the second time at the 12th month. 4) The effects of the impregnated-bednets on An. sinensis were different, even opposite, between different investigations. However, the treated bednets caused the density of An. minimus in houses to fall by 67.94%, and the total density in houses and cattle shelters by 67.91%. Moreover, it could shorten the life span of An. minimus. It did not work on the outdoor density of An. minimus. It is necessary to integrate with other measures, for achieving the desired effect.

Adult↗
PubMedDate not supplied

Netherton's syndrome and neonatal hypernatremia. A case report.

Netherton's syndrome is characterized by ichthyosiform desquamation, bamboo hair and often atopic diathesis. It is transmitted as an autosomal-recessive trait. In this paper we report a baby with Netherton's syndrome who developed hypernatremia during the neonatal period. This complication should be remembered in erythrodermic infants as a preventable cause of neonatal morbidity.

Fatal Outcome↗
PubMed1998

Natural habitats of Aedes Aegypti in the Caribbean--a review.

Natural breeding habitats of Aedes aegypti in the Caribbean region were reviewed by conducting larval surveys in Trinidad. Puerto Rico, and the U.S. Virgin Islands and referring to records from the Mosquitoes of Middle America project. Twelve types of natural habitats were recorded: rock holes (9.7%), calabashes (2.4%), tree holes (19.5%), leaf axils (4.8%), bamboo joints (14.9%), papaya stumps (7.3%), coconut shells (4.8%), bromeliads (7.3%), ground pools (14.9%), coral rock holes (9.7%), crab holes (2.4%), and conch shells (7.3%), of which the coconut shell and calabash habitats were new to the Caribbean. The countries having the highest prevalence of natural habitats were Trinidad. Puerto Rico, and Jamaica, with 9 types (22.0%), 7 types (17.0%), and 6 types (14.6%), respectively. The distribution of natural habitats of Ae. aegypti in the Caribbean region is discussed in relation to vector control measures.

Aedes↗
PubMed1997

A field trial with etofenprox (OMS 3002) as a residual insecticide against malaria vectors, in Tanjung Bunga district, east Flores, Indonesia.

An operational trial of Vectron (Etofenprox, OMS 3002) was conducted in East Flores Regency, Nusa Tenggara Timur Province. The compound (Etofenprox 10EW) was applied as indoor residual spray and as an impregnation treatment for bednets in two separate areas. Dosage in both cases was 0.2 g/m2. A third area, designated as control, was untreated. In bioassay tests, bamboo surfaces gave 100% mortality for 150-160 days post spray, while wooden surfaces and treated bednets both gave complete mortality for at least 120 days. Malaria cases monitored by successive malariometric surveys showed steady declines in positivity rates, particularly in children.

Adolescent↗
PubMed1998

Simplified solid-phase membrane immunobead assay (MIA) with monoclonal anti-ciguatoxin antibody (MAb-CTX) for detection of ciguatoxin and related polyether toxins.

The development of a simplified and modified procedure for the assessment of ciguatoxin (CTX) and related polyethers from ciguateric contaminated fish tissues is presented in this study. The previous method, stick-enzyme immunoassay (S-EIA) used an organic correction fluid-coated bamboo paddle stick for the solid phase; this new procedure, membrane immunobead assay (MIA), uses a plastic stick with a synthetic membrane laminated onto one end. The membrane is hydrophobic and serves as the solid-phase receptor for the binding of methanol-extracted CTX or its related polyether lipids from fish tissues. Detection of the bound polyether toxin(s) on the membrane is carried out with colored polystyrene beads coated with monoclonal antibody to CTX (MAb-CTX). Intensity of the color on the membrane is proportional to the amount of toxic polyethers on the membrane. The MIA is compared with previous procedures developed for CTX detection (S-EIA and solid-phase immunobead assay, SPIA) using State of Hawaii Department of Health (DOH) implicated ciguateric fishes, and reef fishes from Hawaii and Kwajalein. The data presented show good correlation between the three test systems, especially with ciguatera implicated fish and toxic, routinely assessed fishes in the mouse toxicity (MT) bioassay. Variations between MT results and those of the S-EIA, SPIA, and MIA of routine fishes are generally attributable to diverse toxins present in the fish species examined. The MIA is a simple, rapid, sensitive, and specific detection method for CTX and its related polyethers, with no reported false negative results. The test is useful for field and personal use and can be adapted to the laboratory for large-scale screening of potentially ciguateric fishes.

Animals↗