Recovery from rhabdomyolysis after allogeneic BMT: report of a case with speculation on causation

A case of fulminant rhabdomyolysis occurring 4 months after allogeneic BMT for CML is reported. The patient developed rhabdomyolysis following the empiric institution of antibacterial and anti-tuberculous medication. His inpatient course was complicated by the development of acute anuric renal failure and a severe myopathy. With aggressive supportive care, both of these complications resolved, making this patient the only reported survivor of rhabdomyolysis occurring after BMT.

Serial reaction time learning and Parkinson's disease: evidence for a procedural learning deficit

This paper presents evidence in support of a serial reaction time (SRT) deficit associated with Parkinson's disease, and related to the acquisition or execution of serial-order information. Eleven patients with idiopathic Parkinson's disease, and 10 age-matched but otherwise healthy control subjects, were compared on a variant of the SRT task introduced by Nissen and Bullemer (Cognit. Psychol. 19, 1-32, 1987). The results of this study clearly demonstrate that PD patients produce a quite different pattern of RT performance to that of control subjects. Such a pattern of results may reflect either: (1) a deficit in the patients' ability to learn the temporal order information provided by a repeating sequence of target locations in the SRT task; or (2) a deficit in the patients' ability to express temporal order information provided by the repeating sequence of target locations in the SRT task.

Are non-relevant objects represented in working memory? The effect of non-target objects on reach and grasp kinematics

The role of visual information and the precise nature of the representations used in the control of prehension movements has frequently been studied by having subjects reach for target objects in the absence of visual information. Such manipulations have often been described as preventing visual feedback; however, they also impose a working memory load not found in prehension movements with normal vision. In this study we examined the relationship between working memory and visuospatial attention using a prehension task. In this study six healthy, right-handed adult subjects reached for a wooden block under conditions of normal vision, or else with their eyes closed having first observed the placement of the target. Furthermore, the role of visuospatial attention was examined by studying the effect, on transport and grasp kinematics, of placing task-irrelevant "flanker" objects (a wooden cylinder) within the visual field on a proportion of trials. Our results clearly demonstrated that the position of flankers produced clear interference effects on both transport and grasp kinematics. Furthermore, interference effects were significantly greater when subjects reached to the remembered location of the target (i.e., with eyes closed). The finding that the position of flanker objects influences both transport and grasp components of the prehension movement is taken as support for the view that these components may not be independently computed and that subjects may prepare a coordinated movement in which both transport and grasp are specifically adapted to the task in hand. The finding that flanker effects occur primarily when reaching to the remembered location of the target object is interpreted as supporting the view that attentional processes do not work efficiently on working memory representations.

Desmopressin in the treatment of nocturia and enuresis in patients with multiple sclerosis

OBJECTIVES

To assess whether the synthetic vasopressin analogue desmopressin [1-desamino 8-D-arginine vasopressin] is efficacious and safe in the management of nocturia +/- enuresis in patients with multiple sclerosis.

PATIENTS AND METHODS

Twenty-two women and 11 men, under 65 years of age, with clinically definite multiple sclerosis and nocturnal frequency +/- enuresis were entered into the study. A two week placebo run-in, to establish normal voiding patterns, followed by a double-blind, placebo-controlled, cross-over study of 20 micrograms intranasal desmopressin at night-time was carried out.

RESULTS

Desmopressin caused a significant decrease in nocturnal urinary frequency, nocturnal urinary volume and the percentage of total daily urine passed at night. There was no significant fall in plasma sodium with desmopressin although there were two cases of asymptomatic hyponatraemia.

CONCLUSION

Desmopressin is an efficacious and safe treatment for nocturia +/- enuresis in patients with multiple sclerosis.

Vocal rehabilitation after pharyngo-laryngectomy--the Provox valve

We describe our experience using the Provox voice prosthesis in patients undergoing free jejunal loop transfer following total pharyngo-laryngectomy. From our series and the few reports in the literature, the use of a voice prosthesis appears to be an effective method of speech rehabilitation in this group of patients.

Hepatitis C seroprevalence in bone marrow transplant recipients and haemophiliacs

AIM

To determine the prevalence of antibodies to hepatitis C (anti-HCV) in patients who have undergone bone marrow transplantation in Wellington, prior to the introduction of hepatitis C screening, and to contrast these results with the prevalence of anti-HCV in the Wellington haemophiliac population.

METHOD

Serum specimens were obtained from 30 patients who had undergone bone marrow transplantation for the treatment of haematological disorders, and from 29 haemophiliacs. Specimens were analysed using a second generation HCV immunoassay.

RESULTS

Exposure to blood products was high in bone marrow transplant recipients with subjects receiving red cells or platelets from an average of 53 donors (range 15-100, SD 23.2) during their transplant procedure. Despite the high usage of blood products, only one of the 30 patients tested was positive for hepatitis C on the basis of second-generation antibody testing. Confirmatory testing in this patient, (anti-HCV immunoblot assay) was negative. In contrast, 26 of 29 (89%) haemophiliac patients tested were positive for anti-HCV.

CONCLUSION

Although the infective risk of blood products cannot be underestimated, the risk of patients contracting hepatitis C from multiple single-unit transfusions, prior to the introduction of screening for hepatitis C was low. This contrasts with the high risk of hepatitis C seroconversion in patients exposed to pooled plasma products.

Platelet volume: laboratory measurement and clinical application

Modern cell analyzers routinely produce platelet indices, but many clinicians do not utilize them in clinical decision-making. In part this can be attributed to difficulties with their laboratory measurement. The mean platelet volume is dependent on a number of variables, including time of analysis after venepuncture, method of analysis, anticoagulant used and specimen storage temperature. The influence of these laboratory variables is significant and reproducible mean platelet volumes are dependent on standardized laboratory methodology. When pre-analysis factors are controlled, alterations in platelet volume can be demonstrated in a number of disease states and assessment of platelet volume can be useful in the monitoring and diagnosis of patients. An understanding of the pathophysiology of alterations in platelet volume and of the inverse relationship between platelet volume and count is a prerequisite for the successful clinical application of platelet volume measurements.

Recurrent pleomorphic adenoma

Of 209 cases of pleomorphic adenoma treated in a 30 year period, 38 were secondary referrals with recurrent disease following surgery. Of these, 25 were women and 13 men with a mean time to recurrence of 9 years 4 months. Thirty-four recurrences were in the parotid gland, three in the submandibular gland and one in the anterior faucial pillar. Seven patients were untreated due to poor general condition or refusal of further treatment. Of the remainder, 15 had superficial parotidectomy and excision of the scar and nine a total parotidectomy. Three of these had extensive surgery with local flap repair. Of the patients with submandibular gland recurrence, two had local excision and one was treated with radiotherapy alone. One patient had a recurrence in the faucial pillar. Three patients developed malignant change in the recurrent tumour, of whom one died of disease.

Second radical neck dissection

We report a series of 96 patients (62 men and 34 women) undergoing a second radical neck dissection for enlarged contralateral cervical nodes after primary treatment of a squamous cell carcinoma of the head and neck, including an ipsilateral radical neck dissection. The proportion of patients requiring a second later neck dissection varied from 0% for tumours of the nasopharynx, nasal cavity and paranasal sinuses, to 5% for tumours of the hypopharynx. The incidence of second neck dissection was not determined by the original T stage of the primary tumour, but patients with enlarged nodes at presentation were 5 times more likely to need a second neck dissection than those with no palpable nodes at presentation. Also, patients with a poorly differentiated tumour were twice as likely to need a second neck dissection as those with a well differentiated tumour. The overall 5-year survival after second neck dissection was 35% and the perioperative mortality 1.92%. Significant factors predicting survival after a second neck dissection were the time to recurrence, the clinical neck node status at recurrence, the number of histologically invaded nodes in the neck and the presence of extra-nodal disease.

Vocal cord paralysis and tumour length in staging postcricoid cancer

The present UICC classification of postcricoid cancer is based on directions of tumour spread which are uncommon and difficult to assess clinically. The classification takes no note of spread into the cervical oesophagus and fails to correlate staging with survival. The aim of this study was to assess the value of other criteria, including vocal cord paralysis and tumour length, in staging 157 patients with postcricoid cancer. Both vocal cord paralysis and tumour length could be assessed in most patients, and correlated with the mode of treatment. Generalized Linear Interactive Modelling (GLIM) identified vocal cord paralysis (P less than 0.001), performance status (P less than 0.025) and the interaction of length and histological grade (P less than 0.05) as significant predictors of survival. None of these variables is included in the current UICC classification.