Kinetics of paraprotein clearance after autografting for multiple myeloma

The kinetics of paraprotein clearance after autografting for multiple myeloma have not been described. We studied 33 myeloma patients in plateau phase with detectable paraprotein (3-34 milligrams, median 10 milligrams) at the time of ABMT who received melphalan (200 mg/m2) and methylprednisolone (1.5 g x 5) for conditioning. Fifteen patients received interferon-alpha post-transplant as part of a randomized study. Twenty-four of 33 (72.7%) patients eventually cleared the paraprotein at a median of 47 days (range 5-783) post-transplant. The probability of clearance was lower (46.7 vs 94.4%, P = 0.004) and the time taken to clear paraprotein longer (142 vs 29 days, P = 0.003) in patients with a higher level (> 10 milligrams) at the time of the transplant. However, clearance occurred within 6 months in 23 of 24 (95.8%) patients who ultimately cleared the paraprotein. Interferon-alpha did not influence the clearance of paraprotein. We conclude that after autografting for myeloma, the time taken to clear paraprotein is longer and the probability of clearance lower with higher levels at the time of ABMT, and most patients who eventually clear the paraprotein do so within 6 months. Because the probability of clearing paraprotein (and thus attaining remission) in patients with detectable paraprotein 6 months post-transplant is low, a decision about further treatment may be made at this point.

Neonatal infection with Streptococcus milleri

Streptococcus milleri is a known commensal of the female genitourinary tract, but its pathogenicity in neonates has been reported in only a few cases. During a period of one year in an obstetrical unit, Streptococcus milleri was isolated from nine neonates and from one foetus after a spontaneous abortion. In seven of the nine newborns, neonatal infection was assessed and Streptococcus milleri was the lone pathogen involved, associated with positive blood or vaginal cultures in four mothers. Because Streptococcus milleri requires special conditions for identification, it is probably underestimated as a cause of neonatal infection and septic abortion.

Clinical indicators associated with unintentional weight loss and pressure ulcers in elderly residents of nursing facilities

OBJECTIVE

To monitor adults older than 65 years living in nursing facilities and who experience unintentional weight loss of more than 10% of actual body weight in 6 months or more than 5% in 1 month or who have stage II, III, or IV pressure ulcers.

SUBJECTS

We reviewed 290 medical records for unintentional weight loss and 265 for pressure ulcers.

DESIGN

Two data-collecting instruments were used: one for pressure ulcers and one for unintentional weight loss. Indicators for each instrument were selected to monitor clinical conditions that tend to be problem-prone areas for these two populations.

STATISTICAL ANALYSIS

Descriptive statistics were used to calculate the frequency of each indicator for each population.

RESULTS

Of the 24 indicators for unintentional weight loss, the 6 indicators present most often, in descending order, were reduced functional ability, intake of 50% or less of food served for the past 3 consecutive days, chewing problems, serum albumin level less than 35 g/l with normal hydration status, cholesterol level less than 4.1 mmol/L, and refusal of 50% or more of food replacement for the past 7 days. For the residents with pressure ulcers, the indicator present most often was serum albumin level less than 35 g/L with normal hydration status. The three highest intervention indicators were receives 1.2 g protein per kilogram of actual body weight, receives 120 mg or more of vitamin C daily, and receives 1 1/2 times the energy required based on goal body weight. When serum albumin level was documented in the medical record, it was a valid indicator for both diagnoses.

CONCLUSIONS

Inappropriate dietary intake, disease, and disability place residents in nursing facilities at risk for malnutrition. Thus, it is important to obtain laboratory values when assessing elderly residents and determining their nutritional status.

Childhood actinomycosis: report of two cases

The authors report two cases of actinomycosis in children: one thoracic and the other retroperitoneal. They emphasize the difficulties of diagnosis before the stage of parietal extension with cutaneous fistula and characteristic yellow granular discharge. These difficulties are due to: The rarity of visceral actinomycosis, particularly in children. The lesion has a similar appearance to that of a tumor; an extensive pre-operative work-up is mandatory (ultrasound, computed tomogram scan, repeated ultrasound-guided needle biopsy), although this work-up may not necessarily lead to the correct diagnosis. A surgical biopsy will often confirm the diagnosis, provided the diagnosis has been previously considered. The necessity of using very specific tests for correct identification of the organism. Therefore, in a case of pseudo-inflammatory pseudotumor, visceral actinomycosis must be considered in order to guide microbiological and pathological studies, although this diagnosis is rare. Once the diagnosis has been made, prolonged treatment with penicillin is effective and complete recovery is generally obtained.

Multicenter clinical laboratory evaluation of a beta-lactamase disk assay employing a novel chromogenic cephalosporin, S1

S1, a new chromogenic cephalosporin (International BioClinical, Inc., Portland, Oreg.), was used to detect beta-lactamase production among a variety of commonly encountered bacteria in a four-center collaborative study. Results of an S1 disk assay were compared with those obtained by a nitrocefin-based disk procedure (Cefinase; Becton-Dickinson Microbiology Systems, Cockeysville, Md.), with repetitive testing of five quality control organisms and with individual tests of recent clinical isolates of Neisseria gonorrhoeae (162 strains), Haemophilus influenzae (162 strains), Moraxella catarrhalis (155 strains), Staphylococcus aureus (161 strains), and Bacteroides fragilis (164 strains). The performances of the two beta-lactamase disk assays were comparable for the first three species cited above. However, the S1 assay appeared to be a more sensitive procedure than the Cefinase assay when applied to S. aureus and B. fragilis, with respect to both total numbers of positive results and length of time to a definitive positive endpoint.

[Eradication of asymptomatic carrier state of non-typhoid Salmonella with two doses of pefloxacin]

BACKGROUND

The carrier state of Salmonella may represent a source of contamination for other people. Its treatment is unsatisfactory so that a carrier may shed organisms for numerous months.

POPULATION AND METHODS

From 1990 to 1993, 17 children aged 1.5 months to 8 years were seen because they were asymptomatic carriers of non-typhoid Salmonella, confirmed by three successive stool cultures. All had presented earlier acute severe infection having required treatment with amoxicillin (13 cases) and ceftriaxone or cefotaxime (four cases). They were given one dose of pefloxacin, 12 mg/kg, 4 to 8 weeks after the initial episode. This unique dose was administered again 4 days later. Stool cultures were performed before the first administration and 10, 30, 45 and 60 days after, with a last control 3 to 4 months later.

RESULTS

Eradication of the Salmonella was obtained by the 10th day in 13 patients and within the 3 following weeks in 2 others. Those children who excreted a few number of organisms were early eradicated while the 2 patients who did not respond to pefloxacin shed larger number of bacteria. There was no side-effects of treatment.

CONCLUSION

A short treatment with pefloxacin appears to be effective and safe in eradicating the carrier state when stool excretion of Salmonella is moderate.

[Failure of the treatment with antibiotics in severe Salmonella infections in children and use of quinolones]

BACKGROUND

Quinolone antibiotics are effective in the treatment of Salmonella infections in adults. Their use in children is limited by their side-effects.

POPULATION AND METHODS

Forty-two patients (21 girls and 21 boys), aged 1 month to 12 years (mean 3.3 yrs) were admitted from September 1991 to June 1993 for severe Salmonella infections. Criteria of severity were persistent diarrhea and fever for more than 3 days. Thirty-one of these patients were less than 5 years of age. Blood culture was positive in 7 out of 35 patients: culture of the stools was positive in all patients. Five of the 42 patients had presented an acute episode of Salmonella infection a few weeks earlier and had remained asymptomatic carriers until the new acute and severe episode of diarrhea. All patients were given usual antibiotics, mainly ampicillin, amoxicillin, trimethoprime-sulfamethoxazole. Twenty-five of these patients were then given pefloxacin, 12 mg/kg/day, since the 5th day, for 7 days, because persistence of diarrhea and fever.

RESULTS

Diarrhea and fever disappeared within less than 2 days in the group of patients given pefloxacin, even though in 6 patients the infecting Salmonella was in vitro resistant to beta-lactamins. Twenty % of patients remained asymptomatic carriers of Salmonella in the group treated by pefloxacin vs 47% in the group without it. There was no difference in species of Salmonella between both groups. None of the patients treated by pefloxacin developed side-effects during the six months following its administration.

CONCLUSIONS

Short treatment by pefloxacin may be an alternative choice for treating severe Salmonella infections in children.

Distribution of calretinin mRNA in the vestibular nuclei of rat and guinea pig and the effects of unilateral labyrinthectomy: a non-radioactive in situ hybridization study

We examined the localization of neurons expressing mRNA for calretinin, a cytosolic EF hand calcium-binding protein, throughout the vestibular nuclei of rat and guinea pig by non-radioactive in situ hybridization, using an alkaline phosphatase labeled oligonucleotide probe. Labeled cells were particularly numerous in the medial vestibular nucleus (mVN) and their distribution was similar in rat and guinea pig, and presented a characteristic rostrocaudal and mediolateral pattern. The effects of hemilabyrinthectomy were assessed at various times post lesion from 10 h to 30 days by comparison of the pattern of labeling in the ipsi- and contra-lateral vestibular nuclei of guinea pig. After up to 48 h no modification in the calretinin mRNA distribution was detected. After 3 to 30 days of survival, there was a decrease (about 30%) of the calretinin expressing neurons in the nucleus on the side of the lesion. The unilateral sensory deprivation seemed to induce a permanent asymmetry in the expression of calretinin which was not abolished after vestibular compensation. These results suggested that the calretinin expression in these neurons depends upon the integrity and activity of sensorineuronal peripheral vestibular influences.

[Helicobacter pylori gastric infections in children]

OBJECTIVES

Numerous reports have established the association of Helicobacter pylori and recurrent abdominal pain in children. We investigated the clinical, bacteriological and therapeutic features of our patients seen over a 1 year period.

METHODS

We investigated 121 children during 1992 in Hospital Saint Vincent-de-Paul, Paris. At endoscopy, biopsies were taken and sent for histology and bacteriology and urease testing. A decision regarding treatment by amoxicillin and metronidazol was made after positive results of bacteriology and/or histology.

RESULTS

Heliobacter pylori was found in 47 antral biopsies after pathology examination with Giemsa staining alone 16 times, bacterial culture 9 times and both methods 22 times. Abdominal pain was the prominent symptom, occurring in 35.5% of Helicobacter pylori+patients. In 25 of the positive negative patients, a nodular gastritis was observed (53.1%) and in 27.6% of them a weight loss or a delay in weight gain. Few patients became after combined treatment with amoxicillin and metronidazol whereas eradication rates after triple therapy with amoxicillin-metronidazol and H2 antagonist or proton pump blocker were higher.

CONCLUSION

Helicobacter pylori related gastritis is a common cause of abdominal complaints in children. The most common symptom is recurrent abdominal pain. Antral nodularity is a peculiar endoscopic finding in children. Two-drug therapy associating amoxicillin-metronidazol is often ineffective to eradicate the bacteria whereas eradication rates after triple therapy amoxicillin-metronidazol and H2 antagonist or proton pump blocker are higher.

Radiation doses to patients in neurointerventional procedures

PURPOSE

To evaluate stochastic and deterministic risks associated with neurointerventional procedures for the patient.

METHODS

Eight neurovascular interventional procedures were evaluated to determine the entrance skin dose and effective dose for the patient. Dosimetry was done with thermoluminescence dosimeters. The highest dose on the patient's head was recorded as the maximum entrance skin dose. The equivalent dose was obtained by conversion of the dose-area product using published conversion tables.

RESULTS

The maximum entrance skin dose varied from 129 to 1335 mGy. The mean effective dose was 1.67 mSv with a range of 0.44 to 3.44 mSv. No deterministic effect has been encountered. Stochastic risk linked to the highest effective dose value was approximately one death by fatal cancer for every 6000 procedures, according to the new International Commission on Radiological Protection coefficient.

CONCLUSIONS

Because no deterministic effect has been detected, and stochastic risks were very low, radiation hazard to the patient is a minor consideration in deciding whether to undertake a neurointerventional procedure.

Characterization of different neuron populations in mouse statoacoustic ganglion cultures

Statoacoustic ganglion (SAG) cells were grown in primary culture and the appearance of different neuronal phenotypes was investigated. Analysis criteria were shape, size and staining for the immunocytochemical markers: neurofilament proteins (NF-200 kDa), neuron-specific enolase (NSE), calretinin, a calcium-binding protein and substance P, a neurotransmitter. Cultures were prepared from dissociated SAG cells of 13 gestation-day-old mouse embryos. Neurons were identified and counted after 7 days in vitro. At this stage, neurons were organized in small clusters forming an extensive network of neurites grown on a layer of fibroblasts and glia. Most neurons identified by NF or NSE immunoreactivity showed a typical adult-like bipolar profile. The diameters of the neurons were between 5.62 and 17.00 microns and displayed a normal distribution (mean: 10.6 microns). Two distinct subpopulations were identified by the expression of calretinin and substance P. Calretinin-immunoreactive neurons were large and very rare and had a mean diameter of 11.3 microns; the distribution of substance P was more extensive than that of calretinin and identified a population of small neurons with a mean diameter of 8.9 microns. The distributions of these two markers in SAG cultures were consistent with in vivo results. In conclusion, dissociated SAG cell cultures appear to be a suitable model for analyzing the development of the immunocytochemical and functional characteristics of the neurons of this inner ear ganglion.

Eradication of convalescent-phase Salmonella carriage in children with two oral doses of pefloxacin

Fifteen children (age range 1.5 months to 7.2 years), who were excluded from schools or nurseries due to asymptomatic convalescent-phase non-typhoidal Salmonella carriage, received two oral doses of pefloxacin (12 mg/kg on days 1 and 4) and were examined on days 10, 30, 45 and 60. Definitive eradication was observed in 13 patients, all of whom had initial low Salmonella counts in stools and were culture-negative by day 10. In the two patients who failed to respond, the same treatment was effective when repeated 4 and 6 months later respectively. No side-effects were observed. In six other children, considered as controls, eradication by day 10 was observed in only one case after administration of amoxicillin for eight days. Two oral doses of pefloxacin could be a useful and safe means for eliminating Salmonella carriage in young children.

Altered stability of etoposide-induced topoisomerase II-DNA complexes in resistant human leukaemia K562 cells

K562 leukaemia cells were selected for resistance using 0.5 microM etoposide (VP-16). Cloned K/VP.5 cells were 30-fold resistant to growth inhibition by VP-16 and 5- to 13-fold resistant to m-AMSA, adriamycin and mitoxantrone. K/VP.5 cells did not overexpress P-glycoprotein; VP-16 accumulation was similar to that in K562 cells. VP-16-induced DNA damage was reduced in cells and nuclei from K/VP.5 cells compared with K562 cells. Topoisomerase II protein was reduced 3- to 7-fold and topoisomerase II alpha and topoisomerase II beta mRNAs were each reduced 3-fold in resistant cells. After drug removal, VP-16-induced DNA damage disappeared 1.7 times more rapidly and VP-16-induced DNA-topoisomerase II adducts dissociated 1.5 times more rapidly in K/VP.5 cells than in K562 cells. ATP (1 mM) was more effective in enhancing VP-16-induced DNA damage in nuclei isolated from sensitive cells than in nuclei from resistant cells. In addition, ATP (0.3-5 mM) stimulated VP-16-induced DNA-topoisomerase II adducts to a greater extent in K562 nuclei than in K/VP.5 nuclei. Taken together, these results indicate that resistance to VP-16 in a K562 subline is associated with a quantitative reduction in topoisomerase II protein and, in addition, a distinct qualitative alteration in topoisomerase II affecting the stability of drug-induced DNA-topoisomerase II complexes.

A 2-year study of Helicobacter pylori in children

From September 1990 to October 1992, Helicobacter pylori was searched for in 426 children, 2 days to 16 years old, requiring upper fibroscopy for various symptoms. H. pylori was detected in 77 children (18.1%). Recurrent abdominal pain was present in 63.3% of the patients with H. pylori versus 48.6% of a control group of 74 age-matched children negative for H. pylori, weight loss was present in 6.5% of the patients versus 0% of the control subjects, and a family history of peptic ulcer was present in 14.2% of the patients versus 5.4% of the controls. Micronodular gastritis was observed in 31 children with H. pylori infection (40.2%). Among the 24 children (31.1%) with H. pylori infection and a normal mucosa at endoscopy, 18 (75%) complained of recurrent abdominal pain. H. pylori was also found in 21 of 38 children (55.2%) being examined because of short stature. These findings indicate that H. pylori should be looked for in children with recurrent abdominal pain with or without weight loss or a family history of peptic ulcer. Its relevance in short-stature syndrome requires further clarification.