Evaluation of cardiac status in iron-loaded thalassaemia patients following bone marrow transplantation: improvement in cardiac function during reduction in body iron burden

Iron-induced cardiac disease is the primary cause of death in transfused patients with thalassaemia major. The beneficial effects of deferoxamine mesylate on clinical cardiac disease have been well described but the impact of therapy on subclinical cardiac dysfunction is unknown. To assess the reversibility of subclinical cardiac dysfunction we studied the cardiac status during iron depletion treatment (phlebotomy) in iron overloaded patients, cured of thalassaemia by marrow transplantation, without clinical manifestation of heart failure but with alteration in both left ventricular diastolic function and in contractility property. 32 patients were studied and demonstrated a slight but significant impairment in the morphology and function if compared with matched normal controls. 17 of these patients were submitted to sequential echocardiographic evaluations during the phlebotomy programme. Following completion of the programme, normalization of the indices of contractility and normalization of diastolic function were observed. This study indicates that transplanted thalassaemia patients with subclinical left ventricular diastolic dysfunction and impaired left ventricular contractility may reverse these processes with an effective regimen of iron reduction such as phlebotomy.

[Treatment of cancers limited to the uterine cervix with simple hysterectomy using a vaginal approach after brachytherapy]

PURPOSE

In patients with early cervix carcinoma, both radiotherapy and surgery or combined modalities provide effective therapies. In the two last modalities, recommended surgery is radical hysterectomy. The purpose of this prospective study was to assess the value of a limited vaginal hysterectomy after brachytherapy in patients without any unfavorable prognostic factor.

PATIENTS AND METHODS

Twenty-two patients (stage Ia2 with vascular invasion: three patients, stage Ib 1:19 patients) with 1 cm median maximal tumor size and with previous negative laparoscopic lymphadenectomy (median number of lymph nodes: 12) underwent a limited vaginal hysterectomy 6 weeks after utero-vaginal brachytherapy.

RESULTS

Two mild intra-operative complications were noted. Venous hemorrhage (100 mL) occurred in one patient during lymphadenectomy and another patient presented bladder injury during hysterectomy. These two complications were successfully controlled with no need for laparotomy. Only one late complication was observed: bladder grade G2 (b). With a 29 months follow-up (20-48 months), no recurrence was reported.

CONCLUSION

These results appear promising in patients with very early cervix carcinoma but remain to be confirmed on a larger scale.

[Sanitary conditions of community dining halls in greater Buenos Aires, Argentina]

Because of the importance of food safety for public health, a study was done to determine the microbiologic quality of foods provided to patrons of community dining halls in greater Buenos Aires, Argentina. The study was descriptive and was conducted in three municipalities with intermediate or high poverty indices; a sample of 52 dining halls was selected randomly from those municipalities. Information was collected from April 1994 through April 1995 by means of surveys, direct observations, and microbiologic analyses of the water and food served. Water and food analysis followed the recommendations of the Argentine Food Code and the International Commission on Microbiologic Specifications for Foods, respectively. The results were interpreted according to the values for cooked foods agreed upon by the Working Group on Food Monitoring. The microbiologic analysis revealed that 28 (54%) of the dining halls had food or water of inadequate quality and 11 (21%) had inadequacies in both. Bacillus cereus was the most commonly found pathogenic bacterium in the food samples analyzed. The factors that were significantly associated with unsatisfactory microbiologic conditions in the food and water were lack of disinfection of the water (P = 0.009), lack of hygiene in the environment (P = 0.03), the presence of rodents and insects (P = 0.05), the supply system for raw materials (P = 0.01), and a relatively small number of users, i.e., fewer than 100 (P = 0.0008). It was concluded that water disinfection and general clean-up of the dining halls were measures that could be put in place by providing education in the areas of hygiene and food handling to supervisors and employees. The results obtained also indicate the need to include a food safety evaluation among the general evaluation criteria for food assistance programs.

Peribulbar anesthesia in vitreoretinal surgery

BACKGROUND

Retrobulbar anesthesia is considered an effective method of obtaining anesthesia and akinesia in eye surgery. It can give rise to serious complications, however, and these complications could be considerably reduced with peribulbar anesthesia.

METHODS

After using peribulbar anesthesia for 2 years in surgical treatment of the anterior segment, the authors began a study to test its efficacy in posterior segment surgery. Retinal and vitreoretinal surgery with the peribulbar anesthesia technique were performed in 32 consecutive patients.

RESULTS

In all cases anesthesia was complete with one preoperative block. In 2 patients, however, completion of akinesia required a supplemental 2- to 3-cc injection of the anesthetic solution. Surgery was performed with preoperative block only in 31 cases. In the remaining case, a supplemental peribulbar injection of the anesthetic solution was given intraoperatively for pain. In 5 cases (15%) pain at the end of surgery from conjunctiva was controlled by anesthetic drops.

CONCLUSION

It is recommended that this method be used only when the duration of the operation is expected to be brief.

Frequency of HLA DQA1 alleles in an Italian population

A sample of 103 Italians was tested for HLA-DQA1 polymorphism using the polymerase chain reaction (PCR) and dot blot hybridization. Results were in Hardy-Weinberg equilibrium. The power of discrimination was 0.91 and the rate of exclusion 56.7. The frequencies of the DQA1*0201 and DQA1*0301 alleles were found to be significantly different from other Caucasian populations.

Attentional scanning and space errors

Using the method of paired comparisons, pairs of simultaneous horizontal or vertical lines, with one line above and one below or one on the left and one on the right of a fixation point, respectively, were presented tachistoscopically for length comparison. Space errors were found to have a pattern similar to that of time errors. The tendency to guess the comparative response from the absolute magnitude of stimuli is proposed as a basis for time and space errors. Manipulation of attentional scanning, which implies a more frequent usage of this guessing strategy for one of the two lines in a pair, was shown to affect space errors.

Suitability of PCR methods for forensic investigation. Analysis of the 3'apoB VNTR system in an Italian population sample

The PCR method has been applied to amplify a Variable Number Tandem Repeat (VNTR) sequence located at the 3' end of the apolipoprotein B (ApoB) gene. The study was conducted on an Italian population sample and in a 3-generation family of 13 members, whose relationships were previously established using conventional blood systems. The allele frequencies found were compared with those reported in the literature. The results also confirmed the Mendelian inheritance of the alleles and the suitability of the PCR method for forensic purposes.

[Why do they enroll in nursing school? A study of the motivations of the enrollments in the School for Professional Nurses of Veneto Province]

A longitudinal investigation developed in the Regione Veneto has focused on the motivations which lead 2,500 young people per year to choose the nursing school and on the information on the school and the profession which are available for them. The ground motivations which seem to guide to choice appear to be mostly of the idealistic-humanitarian type, while the image of the nursing profession shares the characteristics of a low professional and social role. The investigation has also explored the motivations which lead 15% of the candidates to leave the school very early on, and provides a profile of those characteristics of the Regional Schools which are judged by the young candidates as positive or negative.

Megathrombocytes, platelet regeneration time and platelet associated IgG in idiopathic thrombocytopenic purpura and in thrombocytopenia associated with chronic liver disease

Percentage of megathrombocytes, platelet regeneration time (PRT) and platelet-Associated IgG (Pl-A-IgG) were investigated in 12 patients with clinical features consistent with idiopathic thrombocytopenic purpura and in 11 patients with thrombocytopenia associated with chronic liver disease. Bone marrow smears were also examined and megakaryocytes classified into stages I-III according to the current principle. Of 12 patients with idiopathic thrombocytopenic purpura the percentage of megathrombocytes was increased in 9, PRT reduced in 10, and Pl-A-IgG increased in 8 patients. A statistically significant correlation was found between the percentage of megathrombocytes and the level of Pl-A-IgG. A slight correlation was also found between PRT and the percentage of megathrombocytes, while a significant correlation was found between megakaryocytes in stage I and the percentage of megathrombocytes, suggesting that growth of megakaryocytes probably contributes to platelet heterogeneity. In patients with thrombocytopenia and chronic liver disease, the percentage of megathrombocytes was in the normal range. A moderately increased level of Pl-A-IgG was found only in patients with active chronic hepatitis, PRT was reduced only in a few patients, while most of them also showed an increase of Pl-A-IgG.

[Budd-Chiari syndrome and oral contraceptives. Report of a case and review of the literature]

One case of Budd-Chiari syndrome is described in a woman taking for 10 months oral contraceptive. The diagnosis was established by liver biopsy and inferior cavography. A review of the pertinent literature was made and the causal relationship between Budd-Chiari syndrome and oral contraceptive was considered.

Platelet heterogeneity. Relationship between buoyant density, size, lipid peroxidation and platelet age

Human platelets were separated into 2 density populations by repeated centrifugations of platelet-rich plasma at increasing gravitational force. The heaviest platelet fraction was rich in larger platelets. The lightest platelet fraction was rich in smaller platelets. In both fractions and in the platelet button, lipid peroxidation (malonaldehyde-MDA-production after addition of thrombin) was measured at basal condition, on the 1st, 3rd, 5th, 7th and 9th day after aspirin ingestion. At basal conditions and after ingestion of aspirin, MDA production was higher in the heavy-large platelets than in light-small ones, but a parallel increase of MDA production was observed in the light and in the heavy population and in the platelet button. The data are not compatible with the hypothesis that platelet density and size are age-related. Aspirin inhibits platelet lipid peroxidation by permanently acetylating their cyclooxygenase and if the heaviest platelets were the young ones, lipid peroxidation should reappear sooner in them.