Whispering Tuberculosis.

Presentation We describe a case of reactivation of latent pulmonary tuberculosis (TB) invading the larynx and causing dysphonia. Diagnosis A previously healthy 30-year old woman was found to have bilateral pulmonary TB 5-months after being thoroughly investigated for hoarseness. Initial chest x-ray (CXR) and CT-neck were normal. Vocal cord biopsies were negative for granulomata. Treatment The patient was commenced on standard four drug Anti-TB treatment (ATT) and completed a one-year course. Unfortunately, the development of a laryngeal web caused persistent dysphonia. Discussion Patients with laryngeal TB are more likely to present to ENT surgeons, because of the initial symptom of hoarseness. Multiple tests must be completed before out-ruling TB. HRCT or sputum culture is recommended, as TB may not be evident on initial CXR. A collaborative approach between Respiratory and ENT teams is required. Prompt diagnosis is essential. Speech therapy input will be important in our patient's recovery.

Assessment of the significance of respiratory culture of Aspergillus in the non-neutropenic patient. A critique of published diagnostic criteria.

Assessment of the significance of isolation of Aspergillus sp. from respiratory culture in patients who are not neutropenic is a continuing problem in respiratory medicine. In recent years a number of criteria for defining patients with invasive or chronic pulmonary aspergillosis in this group have been proposed. This study sought to assess the value of three sets of these criteria in distinguishing between colonisation and aspergillosis requiring therapy when applied retrospectively to 121 patients with positive sputum or BAL culture for Aspergillus sp. Two patients (1.6%) were identified as having proven or probable aspergillosis by the EORTC criteria, two different patients fulfilled the criteria for invasive aspergillosis in the 62 patients with chronic obstructive pulmonary disease (3.2%), and yet another two different patients met the criteria for chronic pulmonary aspergillosis (1.6%). It is suggested that difficulties in the application of some of these criteria may prevent the accurate diagnosis of aspergillosis in the non-neutropenic patient setting.

Dicer is required for proliferation, viability, migration and differentiation in corticoneurogenesis.

In mice, microRNAs (miRNAs) are required for embryonic viability, and previous reports implicate miRNA participation in brain cortical neurogenesis. Here, we provide a more comprehensive analysis of miRNA involvement in cortical brain development. To accomplish this we used mice in which Dicer, the RNase III enzyme necessary for canonical miRNA biogenesis, is depleted from Nestin-expressing progenitors and progeny cells. We systematically assessed how Dicer depletion impacts proliferation, cell death, migration and differentiation in the developing brain. Using markers for proliferation and in vivo labeling with thymidine analogs, we found reduced numbers of proliferating cells, and altered cell cycle kinetics from embryonic day 15.5 (E15.5). Progenitor cells were distributed aberrantly throughout the cortex rather than restricted to the ventricular and subventricular zones. Activated Caspase3 was elevated, reflecting increased cortical cell death as early as E15.5. Cajal-Retzius-positive cells were more numerous at E15.5 and were dysmorphic relative to control cortices. Consistent with this, Reelin levels were enhanced. Doublecortin and Rnd2 were also increased and showed altered distribution, supporting a strong regulatory role for miRNAs in both early and late neuronal migration. In addition, GFAP staining at E15.5 was more intense and disorganized throughout the cortex with Dicer depletion. These results significantly extend earlier works, and emphasize the impact of miRNAs on neural progenitor cell proliferation, apoptosis, migration, and differentiation in the developing mammalian brain.

Smoking profile of non-consultant hospital doctors.

BACKGROUND: In 1994 Doll and colleagues published smoking mortality figures for British doctors over 40 years. AIMS: To assess smoking prevalence among junior doctors in a major Dublin teaching hospital. METHODS: One hundred and fourteen non-consultant doctors (NCHDs) at St James's Hospital received a confidential smoking questionnaire. RESULTS: One hundred and six NCHDs responded (93%). Three refused, five were not available. Ninety per cent were aged 24-35 years. Twenty-six per cent of the doctors had smoked for 10 to 15 years. Seventy-five per cent were smoking more than 10 cigarettes daily. Ninety-seven per cent (20) of smokers wanted to stop smoking. Seventy-four per cent (17) had unsuccessfully attempted to quit. The smoking cessation method most commonly used was'cold turkey' in 60%. Others included nicotine replacement, bupropion and hypnotherapy. CONCLUSION: A significant per centage of NCHDs (22%) continue to smoke, despite overwhelming evidence that this causes health problems. The prevalence in our study is lower than the national figure of 29%.

The information needs of cancer patients in the Pretoria and Witwatersrand area.

More than 48,500 South Africans annually are confronted with the diagnosis of cancer. (Sitas, 1994) Judging from the literature it would seem that the acquisition of information about the various aspects of their disease is a very important coping mechanism for the cancer patient. Various studies concerning the information needs of cancer patients have been published in the USA, the UK and Australia. Similar studies have not yet been published in South Africa. In this article the information needs of cancer patients in South Africa are tabulated based upon research done for the fulfillment of requirements for a Masters degree in Information Studies at the Rand Afrikaans University. Information Services available to these patients are then also described in detail. Because of the sensitive nature of the subject questionnaires were compiled in co-operation with medical professionals who treat cancer patients. The questionnaire mainly concentrates on the physical and therapeutic aspects of the disease. Surgery, radiation therapy and chemotherapy are looked at. The research population consisted of 200 cancer patients who were receiving treatment at various treatment centres in the Pretoria-Witwatersrand area. The statistical processing of the results confirmed that the majority of the cancer patients need detailed information about the various aspects of their disease. For example more than 75% of respondents indicated that they would like to receive detailed information about reasons and possible side effects as well as ways of minimising the side effects of all the treatment methods ranging from diagnostic tests to surgery as well as radiotherapy and chemotherapy. Above 80% of respondents wanted to be informed about the possible success rate of surgery, radiation therapy and chemotherapy in their specific cancer. It is interesting to note that 78.5% of the respondents wished to be informed about the prognosis/survival rate of their specific cancer. The two preferred methods of communication indicated were firstly personal contact and then a combination of personal contact and booklets. An important conclusion which can be reached is that co-operation between the medical professionals, the information services and the patient and his family is essential if the information needs of the cancer patient are to be met satisfactorily.

Ultrastructural changes in rat kidney mitochondria in response to the oxygen- or calcium-paradox.

Isolated, perfused rat kidney released lactate dehydrogenase in response to the protocol of a standard oxygen-paradox or calcium-paradox. The results are comparable to those found with rat heart. The mitochondria of the proximal tubule cells at the end of the calcium-paradox were swollen, had mitochondrial bars and were subdivided with internal septa; after the oxygen-paradox they exhibited, in addition, many myelin figures. Such ultrastructural changes were characteristic of the mitochondria of skeletal and cardiac muscles damaged by a rise in [Ca2+]i. It is concluded (i) that typical calcium- and oxygen-paradoxes can be produced in kidney, (ii) that these are associated with a rise in [Ca2+]i and (iii) the proximal tubules, in particular, are damaged.

Encapsulated nerve endings in murine dorsal ear skin.

Encapsulated nerve endings in the hairy skin of mice were identified by means of cholinesterase histochemistry. They were especially numerous in the dorsal skin of the ear and where totals ranged from 150 to 597; clustering of corpuscles was an obvious feature. The use of silver impregnation as a counterstain revealed that clusters comprised one or more sets of lamellated corpuscles, each being attached to a single parent axon. The members of each set resembled one another morphologically. Corpuscles from different sets could be classified as simple, branched or coiled. In the hairy skin of cheek, trunk and hindlimb a much lower density of corpuscles was observed; they were all simple in form and occurred in small clusters.

Serogenetic studies on the Kamea (Kapau) Anga of the interior of the Gulf Province of Papua.

Though the Anga or Kukukuku of Papua New Guinea have been the subjects of occasional human biological investigations in the past, these have all been directed from the north, and their largest division, the Kamea or Kapau, who occupy the southeastern half of their territory, have been substantially neglected. The present paper describes the results of sero-genetic investigations of a small sample of Kamea, who are shown to resemble their fellow-Anga closely in the distribution of their genetic markers, though there are indications that the Kamea have received some gene flow from the south. On the whole, though, the relative uniformity of gene marker distribution throughout the Anga points strongly to their common origin, and the paucity of signs of immigrant gene flow from their neighbours, the victims of their raids, tends to confirm that they practised cannibalism rather than the genetic incorporation of captives.

Causes of death of blue-collar workers at a Dublin brewery, 1954--73.

The suggested association between high consumption of beer and an increased risk of death from cancer of the colon and rectum was investigated among blue-collar workers at a Dublin brewery, who consume more than average amounts of beer, usually in the form of stout. A study of their mortality between 1954 and 1973 showed that they had as good an expectation of life as all Dublin males, with no increased risk of death from cancer of the oesophagus, pharynx, liver or of cirrhosis of the liver, accidents or suicide, conditions normally associated with the high consumption of alcohol. They had significantly increased risk of death from cancer of the rectum and also from diabetes mellitus. Twenty per cent of the workers, differentiated by their place of work within the brewery, had a much higher risk of death from cancer of the rectum.

Motor neurone disease and multiple sclerosis among immigrants to Britain.

Hospital discharge rates for various immigrant groups resident in Greater London and the West Midlands were studied to compare the incidence of two diseases of the nervous system-motor neurone disease (MND) and multiple sclerosis (MS). For both these conditions immigrants from Europe, Ireland, America and from the old commonwealth countries of Canada, Australia, and New Zealand had discharge rates that were similar to those for people born in the United Kingdom. In contrast, immigrants from the new commonwealth countries of Asia, Africa, America (including the West Indies), and Europe (Gibraltar, Malta, and Gozo) had a greatly reduced risk of MS but a very similar risk of MND compared with those born in the United Kingdom. MS but not MND was rare among immigrants of Asian or African ethnic origin and uncommon among immigrants from the West Indies. Deaths attributed to MS and MND have also been studied. During a three-year period there were no deaths reported for MS among immigrants of Asian and African ethnic origin and 14 were expected. There were two deaths from MND among these immigrants and five were expected. Among the immigrants from the West Indies two deaths were attributed to MS and 13 were expected, and there were three deaths attributed to MND and four were expected. The contrast between MND and MS in hospital morbidity and mortality confirms that MS among immigrants to Britain is rare in those of Asian and African ethnic origin.

Multiple sclerosis among immigrants in Greater London.

Among immigrants resident in greater London from Europe, Ireland, the USSR, the old Commonwealth countries of Australia, Canada, and New Zealand, North and South America, Egypt, Turkey, and Iran the incidence of admission to hospital for probable multiple sclerosis (MS) between 1960 and 1972 was high or moderately high. The incidence was the same order as that found in those born in the United Kingdom. Immigrants from India, Pakistan, and other Asian countries and from new Commonwealth Africa and America, which includes the West Indies, had a low incidence of hospital admission for MS. Immigrants from countries where the risk of MS is low whose parents were born in Europe had a reduced incidence of admission to hospital but not the very low incidence found in those parents were also born in these countries. Emigrating to England from low risk parts of the world did not seem to increase the risk of developing MS.