Non-cirrhotic portal hypertension entity in South Africa? A report of 6 cases

Six patients with portal hypertension and well-preserved liver function as well as classic features of non-cirrhotic portal hypertension on histological examination of biopsy specimens are described. Three of these patients also had extrahepatic portal vein occlusion. All patients had varying degrees of portal hypertension and hypersplenism. Three patients underwent splenectomy and the remainder had sclerotherapy to control variceal bleeding. The overall prognosis is excellent if variceal bleeding can be controlled by appropriate measures. Hence recognition of this infrequently diagnosed entity is important for an accurate prognosis and appropriate therapeutic interventions

Explaining international variations in self-employment : Evidence from a panel of OECD countries

Organisation for Economic Cooperation and Development (OECD) data from 1972 to 1996 reveals substantial differences in the levels and trends of self-employment rates across countries. This article uses recently developed panel integration and cointegration techniques to explore the determinants of aggregate self-employment rates. We find that within the panel, self-employment rates are positively and significantly related to personal income tax rates and negatively and significantly related to the unemployment benefit replacement rate. This accords a central role to government tax and transfer policies, in contrast to nonrobust influences from macroeconomic variables, which have been widely used in previous studies

Treatment of tuberculosis in patients with pre-existing liver disease or following hepatotoxic drug reactions

No Abstrac

Viral hepatitis B - an overview

Worldwide the hepatitis B virus (HBV) is responsible for a large proportion of all forms of liver disease and is probably the most frequent cause of chronic viral disease in man. The economic and human cost of HBV is further exacerbated by its association with hepatocellular carcinoma (HCC), one of the ten most common malignant human tumours

Serial measurements of circulating tissue plastninogen activator and fibrin(ogen) degradation products predict outcome in gestational proteinuric hypertension

Gestational proteinuric hypertension (GPH), a major cause of maternal death, may be characterised by hypertension and proteinuria alone or may progress to disturbed coagulation and multiorgan failure. Since the condition can only be reversed by termination of pregnancy, there is a need for reliable indicators of severity. We found circulating levels of tissue plasminogen activator (tPA)(27,98 ± 2,12 v. 7,17 ± 0,81 ng/ml, mean ± SEM), fibrin(ogen) degradation products (FDP) (7,55 ± 1,99 v. 1,92 ± 0,47 μg/ml) and fibronectin (221 ± 15,2 v. 120 ± 15,2 μg/ml) to be significantly increased in 21 patients with severe GPH when compared with 21 normotensive, age- and gestational age-matched pregnant controls. More importantly, patients who developed severe GPH showed a progressive increase in tPA and FDP levels with time. This was in contrast to patients who had hypertension and proteinuria alone, in whom tPA and FDP concentrations did not increase. Parallel measurements did not reveal a fall in platelet count or an increase in urinary protein excretion in patients who subsequently progressed to severe disease. Our findings may be of assistance to clinicians faced with the need to prolong pregnancy in patients with GPH in order to ensure fetal viability

Childhood and the politics of scale: Descaling children's geographies?

This is the post-print version of the final published paper that is available from the link below. Copyright @ 2008 SAGE Publications.The past decade has witnessed a resurgence of interest in the geographies of children's lives, and particularly in engaging the voices and activities of young people in geographical research. Much of this growing body of scholarship is characterized by a very parochial locus of interest — the neighbourhood, playground, shopping mall or journey to school. In this paper I explore some of the roots of children's geographies' preoccupation with the micro-scale and argue that it limits the relevance of research, both politically and to other areas of geography. In order to widen the scope of children's geographies, some scholars have engaged with developments in the theorization of scale. I present these arguments but also point to their limitations. As an alternative, I propose that the notion of a flat ontology might help overcome some difficulties around scalar thinking, and provide a useful means of conceptualizing sociospatiality in material and non-hierarchical terms. Bringing together flat ontology and work in children's geographies on embodied subjectivity, I argue that it is important to examine the nature and limits of children's spaces of perception and action. While these spaces are not simply `local', they seldom afford children opportunities to comment on, or intervene in, the events, processes and decisions that shape their own lives. The implications for the substance and method of children's geographies and for geographical work on scale are considered

Use of MRI in the diagnosis of fetal brain abnormalities in utero (MERIDIAN): a multicentre, prospective cohort study.

BACKGROUND: In-utero MRI (iuMRI) has shown promise as an adjunct to ultrasound but the comparative diagnostic performance has been poorly defined. We aimed to assess whether the diagnostic accuracy and confidence of the prenatal diagnosis of fetal brain abnormalities is improved with iuMRI and assess the clinical impact and patient acceptability of iuMRI. METHODS: We did a multicentre, prospective, cohort study in the UK, at 16 fetal medicine centres, of pregnant women aged 16 years or older whose fetus had a brain abnormality detected by ultrasound at a gestational age of 18 weeks or more, had no contraindications to iuMRI, and consented to enter the study. Women carrying a fetus suspected of having a brain anomaly on ultrasound had iuMRI done within 14 days of ultrasound. The findings were reviewed by two independent panels and used to estimate diagnostic accuracy and confidence by comparison with outcome diagnoses. Changes in diagnosis, prognosis, and clinical management brought about by iuMRI and patient acceptability were assessed. FINDINGS: Participants were recruited between July 29, 2011, and Aug 31, 2014. The cohort was subdivided by gestation into the 18 weeks to less than 24 weeks fetus cohort (n=369) and into the 24 weeks or older fetus cohort (n=201). Diagnostic accuracy was improved by 23% (95% CI 18-27) in the 18 weeks to less than 24 weeks group and 29% (23-36) in the 24 weeks and older group (p<0·0001 for both groups). The overall diagnostic accuracy was 68% for ultrasound and 93% for iuMRI (difference 25%, 95% CI 21-29). Dominant diagnoses were reported with high confidence on ultrasound in 465 (82%) of 570 cases compared with 544 (95%) of 570 cases on iuMRI. IuMRI provided additional diagnostic information in 387 (49%) of 783 cases, changed prognostic information in at least 157 (20%), and led to changes in clinical management in more than one in three cases. IuMRI also had high patient acceptability with at least 95% of women saying they would have an iuMRI study if a future pregnancy were complicated by a fetal brain abnormality. INTERPRETATION: iuMRI improves diagnostic accuracy and confidence for fetal brain anomalies and leads to management changes in a high proportion of cases. This finding, along with the high patient acceptability, leads us to propose that any fetus with a suspected brain abnormality on ultrasound should have iuMRI to better inform counselling and management decisions. FUNDING: National Institute for Health Research Health Technology Assessment programme

Books

New BMJ ABC seriesABC of Spinal Cord Injury. 2nd ed. By D. Grundy and A Swain. Pp. 61. Illustrated. £11 London: BMJ 1993.ABC of Diabetes. 3rd ed. By Peter J. Watkins Pp. 56. Illustrated. London: BM]. 1993. Obtainable from IJbriger Book Distributors, Bloemfontein.ABC of Transfusion. 2nd ed. Ed by Marcela A. Contreras. Pp. 66. £14,50. London: BM]. 1993.ABC of Vascular Diseases. Ed by John H. N. Wolfe. Pp. 79. London: BM]. 1993.Female sterilisation Female Sterilization: A Guide to Provision of Services. Pp. x + 197. illustrated. Sfr. 41. Geneva: WHO. 1992.Cervical cancer Cervical Cancer Screening Programmes: Managerial Guidelines. By A. B. Miller. Pp. viii + 50. SFr.12. Geneva: WHO. 1992.Alcohol in southern Africa Liquor and Labor in Southern Africa. Ed by Jonathan Crush and Charles Ambler. Pp. 432. R99. Pietermaritzburg: Universiry of Tatal Press. 1992.Primary care in AIDS Primary AIDS Care. By Clive Evian. Pp. 267. Illustrated. R59,95. Joha=esburg: Jacana. 1993.Kliniese etiek Kliniese Etiek: 'n Christelike Benadering. 2de uitg. Deur Uys en Smit. Pp. 166. Kenwyn: Juta. 1992.Ovarian carcinoma Cancer of the Ovary. Ed by Maurice Markman and William J. Hoskins. Pp. xv + 442. Illustrated. $156,50. New York: Raven Press. 1992.Complications of cirrhosis Bailliere's Clinical Gastroenterology. International Practice and Research: Portal Hypertension. Ed by R. Shields. Pp. 208. Illustrated. £27,50. Kent: Harcourt Brace Jovanovich. 1992.Treating diarrhoea Readings on Diarrhoea. Pp. vi + 147. Illustrated. Sfr. 20. Geneva: WHO. 1992.Manual of arthroscopy Techniques in Therapeutic Arthroscopy. Ed by J. Serge Parisien. Pp. 385. Illustrated.$157,50. New York: Raven Press. 1993.Chemicals and birth defects Chemically Induced Birth Defects. 2nd ed. By James L. Schardein. Pp. xiv + 902. $250. New York: Marcel Dekker 1993.Virology Progress in Medical Virology. Vol. 40. Ed by J. L. Melnick. Pp. viii + 221. Illustrated. Sfr. 265. Basel: S. Karger. 1993.Perfused liver Perfused Liver: Clinical and Basic Applications. Ed by F. Ballet and R. G. Thurrnan. Pp. 398. Illustrated. £46. London: John Libbey. 1991

The average submillimetre properties of Lyman α blobs at z = 3

Ly α blobs (LABs) offer insight into the complex interface between galaxies and their circumgalactic medium. Whilst some LABs have been found to contain luminous star-forming galaxies and active galactic nuclei that could potentially power the Ly α emission, others appear not to be associated with obvious luminous galaxy counterparts. It has been speculated that LABs may be powered by cold gas streaming on to a central galaxy, providing an opportunity to directly observe the ‘cold accretion’ mode of galaxy growth. Star-forming galaxies in LABs could be dust obscured and therefore detectable only at longer wavelengths. We stack deep Submillimetre Common User Bolometer Array 2 (SCUBA-2) observations of the Small Selected Area 22h field to determine the average 850 μm flux density of 34 LABs. We measure S850 = 0.6 ± 0.2 mJy for all LABs, but stacking the LABs by size indicates that only the largest third (area ≥1794 kpc2) have a mean detection, at 4.5σ, with S850 = 1.4 ± 0.3 mJy. Only two LABs (1 and 18) have individual SCUBA-2 >3.5σ detections at a depth of 1.1 mJy beam−1. We consider two possible mechanisms for powering the LABs and find that central star formation is likely to dominate the emission of Ly α, with cold accretion playing a secondary role