January 17, 2002
Outcomes in Young Adulthood for Very-Low-Birth-Weight Infants
Survivors of very low birth weight who were born during the early years of neonatal intensive care are now young adults. This study compared the level of education and other outcomes at 20 years of age among 242 very-low-birth-weight participants and 233 controls with normal birth weight. As compared with the controls, very-low-birth-weight participants had lower educational achievement and IQ scores and higher rates of subnormal height and chronic illness, including neurologic disorders. However, they reported lower rates of alcohol or illicit drug use than normal-birth-weight controls, and the men had lower rates of contact with the police. Because the rates of neurodevelopmental sequelae in very-low-birth-weight children have not changed substantially since the 1970s, these findings are likely to be relevant to very-low-birth-weight infants born in recent years.
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Abnormalities on MRI and Long-Term Disability from Multiple Sclerosis
Serial T2-weighted magnetic resonance imaging (MRI) studies were performed in 71 patients who first presented with optic neuritis or brain-stem or spinal cord syndromes suggestive of multiple sclerosis. After a mean follow-up of 14 years, multiple sclerosis had developed in 88 percent of those in whom the results of the MRI were abnormal at presentation, as compared with 19 percent of those in whom the results of the MRI were normal. The volume of the lesions on MRI correlated with the degree of disability over the course of this longitudinal study. Abnormalities on MRI in patients with neurologic syndromes that are the first sign of multiple sclerosis may help in the selection of patients for early disease-modifying therapy.
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Oligodendrocytes in Chronic Lesions of Multiple Sclerosis
Detailed studies were performed on 48 chronic lesions from 10 deceased patients with multiple sclerosis. Most of the lesions contained oligodendrocytes, the cells that produce myelin. The processes of the oligodendrocytes extended along demyelinated axons but had failed to produce myelin. Except in the patients with disease of very long duration, the number of oligodendrocytes appeared adequate. This morphologic analysis shows that in multiple sclerosis, most of the chronic lesions contain an adequate number of oligodendrocytes in close association with axons. These findings suggest that the failure of remyelination is due to factors in the microenvironment or in the interactions between the axons and the cells that should be producing new myelin.
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Clinical Practice: Chronic Urticaria
A 35-year-old woman presents with a three-month history of daily generalized hives. She has also had swelling of her lips and tongue, with associated tightness of the throat. How should she be evaluated and treated? This article reviews the approach to chronic urticaria and angioedema. Chronic urticaria consists of hives that persist for more than six weeks. Angioedema occurs in just under half the patients. Various therapies may be beneficial, including histamine-receptor antagonists, leukotriene antagonists, and corticosteroids. The use of cyclosporine in refractory cases is still considered experimental. The article provides practical information about diagnosis and management.
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Current Concepts: Celiac Sprue
Celiac sprue, or gluten-sensitive enteropathy, has a wide spectrum of manifestations and is more common than was previously recognized. New, accurate serologic tests make it easier to diagnose this disease and have led to changes in the strategies for clinical management.
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Personal Privacy in Medical Research
The American people generally support and encourage medical research, but they also place a high priority on the privacy of personal medical information. The Health Insurance Portability and Accountability Act of 1996 imposed new restraints on the use of medical information, with the intent of protecting patients' privacy. A side effect of the act is its application to clinical research. In a Legal Issues in Medicine article, Annas discusses the legal underpinnings and implications of the act, and in a Sounding Board article, Kulynych and Korn argue that the act will make the conduct of clinical research more burdensome and costly.
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