F reticulocyte response in sickle cell anemia treated with recombinant human erythropoietin: a double-blind study

Studies on baboons and preliminary observations in three patients with sickle cell anemia (SS) suggested that high doses of pulse administered recombinant human erythropoietin (rHuEPO) stimulate F-reticulocyte production. We now report on the administration of rHuEPO in a double-blind format to ascertain frequency of response and potential precipitation of side effects. Ten patients were enrolled, but one was discontinued due to the indication of a blood transfusion. Of the other nine, five received rHuEPO in escalating doses (from 400 to 1,500 U per kg twice daily [BID] per week), alternating with a placebo, in blinded fashion. The second group, consisting of four patients, followed an identical protocol (except starting dose was 1,000 U/Kg, BID per week) and were iron supplemented during treatment. The criterion of response was a transient doubling (as a minimum) of the steady-state F-reticulocyte level. We found that none of the five patients in the first group responded to rHuEPO, and two of them became iron deficient, as judged by a significant decrease in ferritin. Of the second group, four patients responded with F-reticulocyte increases. In three patients, open label administration of rHuEPO confirmed the effect. We observed seven painful episodes during this study, two during the EPO administration and five during the placebo arm. Three patients were phlebotomized because the hemoglobin level increased 1.5 g/dL more than steady-state levels. Of the six patients followed-up by percent dense cell determinations, one exhibited increased levels during periods of the treatment, whereas the other five showed no change. No anti-rHuEPO antibodies were detected. We conclude that rHuEPO can stimulate F-reticulocyte response in some patients with sickle cell anemia, without apparent negative clinical side effects. The state of iron stores may be critical. Whether higher doses of rHuEPO and/or a different regimen might induce sustained F cells and fetal hemoglobin increases remains to be determined.

Volume T1-weighted gradient echo MRI in multiple sclerosis patients

Three-dimensional (3D) volume turbo fast low angle shot (FLASH) techniques have become available which produce heavily T1-weighted images, similar to inversion recovery scans, utilizing the appropriate flip angle and inversion time. The purpose of this study was to compare the sensitivity of a rapid volume gradient echo technique [3D magnetization prepared rapid acquisition gradient echo (MP RAGE)] in identifying multiple sclerosis (MS) plaques with a conventional T2-weighted spin echo (SE) sequence. Ten patients with clinical MS were evaluated. Patients underwent a routine examination consisting of an axial T2-weighted SE sequence (2,500,22/90) and a coronal 3D MP RAGE, 10/4/10, acquired as 128 two mm partitions. In six patients, area measurements of 22 plaques were determined on both the axial T2-weighted SE examinations and the axial reformatted MP RAGE examinations. The overall number of plaques utilizing each technique was approximately the same. One hundred twenty-two plaques were visualized for the 3D MP RAGE sequence, and 128 plaques for the T2-weighted SE sequence. There were differences in detection of plaques in different regions, with plaques in gray matter better demonstrated utilizing the conventional T2-weighted SE sequence. Plaques in the corpus callosum, pons, and brachia pontis were better demonstrated utilizing 3D MP RAGE. No significant difference was found between the areas measured on the MP RAGE sequence and on the T2-weighted SE sequence. Three-dimensional MP RAGE provides a sensitive and complementary method to conventional T2-weighted SE sequences in the evaluation of patients with MS.

Causes of conjunctivitis and keratoconjunctivitis in Karachi, Pakistan

The causes of conjunctivitis and keratoconjunctivitis in 388 patients who attended eye casualty departments in Karachi, Pakistan, during a 5 month period were investigated. Most of these infections were diagnosed as adenovirus (291, 75%) or bacterial (71, 18.3%). Of the remainder, 9 cases (2.3%) were caused by herpes simplex virus and 7 (1.8%) by Chalmydia trachomatis. There was no evidence of typical active trachoma in this urban population. Bacteria or Candida albicans were also grown from 44 of the adenovirus cases (15%). Many of the bacteria grown from eyes in this study were resistant to antibiotics, probably because of inadequate and/or inappropriate self-medication with antibiotics in this community.

Control of scarring in adult wounds by neutralising antibody to transforming growth factor beta

Adult wounds heal with scar-tissue formation, whereas fetal wounds heal without scarring and with a lesser inflammatory and cytokine response. We injected the margins of healing dermal wounds in adult rats with neutralising antibody (NA) to transforming growth factor-beta (TGF-beta). All control wounds (irrelevant antibody, or TGF-beta, or no injection) healed with scarring, whereas the NA-treated wounds healed without scar-tissue formation; NA-treated wounds had fewer macrophages and blood vessels, lower collagen and fibronectin contents, but identical tensile strength and more normal dermal architecture than the other wounds. Early manipulation of the concentrations of selected cytokines may be a new approach to the control of scarring.

Secular trend in body mass index in the adult population of three communities from the upper mid-western part of the USA: the Minnesota Heart Health Program

Secular trend in body mass index (BMI) over 7 years (1980-1987) was examined in the upper mid-western part of the USA using annual cross-sectional data collected by the Minnesota Heart Health Program. Significant secular increase in BMI adjusted for age and education was found in both men (0.08 kg/m2/year, P less than 0.02) and women (0.19 kg/m2/year, P less than 0.0001). In women, the secular increase occurred throughout the distribution of body weights but the change in the upper end was two to three times greater than that in the other parts of the distribution. In men, most of the increase in BMI occurred in the upper end of the distribution. Prevalence of obesity (defined as BMI greater than or equal to 85th percentile at year 1: men, 30.16 kg/m2; women, 29.94 kg/m2) increased by 0.6 percent/year (P = 0.1) in men and by 1.0 percent/year (P = 0.002) in women. The results indicate that body weight is increasing in upper mid-western adults, probably largely as a result of already overweight individuals becoming more obese. The secular increase in BMI was not accompanied by systemic change in reported food intake and exercise, and could not be explained by decreased prevalence of smoking. Large increases in body weight, especially among those who are already overweight, may have a significant public health impact.

Facial anthropometry in newborns in Pondicherry

Two hundred term healthy neonates were examined and 14 anthropometric measurements were taken in the face and ear region. Difference between the sexes was observed in ear length, ear breadth, and philtrum. Significant correlation was found between ear placement and ear length; and outer and inner canthal distances (p less than 0.001). The paper provides baselines data for facial growth measurements and discusses the utility of these measurements in detecting dysmorphogenesis in neonates.

Use of gadolinium-enhanced MR imaging for differentiating mucoceles from neoplasms in the paranasal sinuses

The purpose of this study was to determine whether additional clinically useful information could be obtained from gadolinium-enhanced magnetic resonance (MR) imaging compared with the information obtained from nonenhanced MR imaging and computed tomography (CT). Therefore, the authors selected 41 patients, whose results at CT examinations demonstrated a variety of pathologic conditions of the paranasal sinuses, to undergo MR imaging both with and without the use of gadopentetate dimeglumine for contrast enhancement. In 22 of 35 cases of neoplasms and mucoceles occurring separately, the lesions were correctly differentiated by established MR signal criteria alone. However, 32 of these 35 cases were accurately differentiated when gadolinium-enhanced MR images were obtained. Six cases demonstrated co-existing neoplasm and mucocele: Gadolinium-enhanced MR enabled correct differentiation of five of these lesions, while unenhanced MR enabled correct differentiation of three. On the basis of these results, the authors conclude that the use of gadopentetate dimeglumine for contrast enhancement at MR imaging is useful for differentiating mucoceles from neoplasms in the sinonasal tract.

Infarction of the left hepatic lobe in a neonate on serial CTs: evolution of a pseudomass to atrophy

We report a case of "hepatic mass" in a neonate caused by infarction of the left hepatic lobe with later atrophy. It is hoped that serial imaging can lead to recognition of this entity with avoidance of angiography and laparotomy.

Biodistribution, tissue reaction, and lung retention of pentamidine aerosolized as three different salts

Aerosolized pentamidine isoethionate is retained in the lung and appears to prevent Pneumocystis carinii pneumonia (PCP) in many AIDS patients. We evaluated alternative formulations of pentamidine that might reduce the airway irritation associated with aerosolized pentamidine isoethionate. Specifically, we assessed the biodistribution, histologic response, and lung retention of the isoethionate, gluconate, and lactate salts of pentamidine after aerosol administration to mice. For each of the three aerosolized salts tested, greater than 50% of the pentamidine initially recovered from the lungs after one dose was still retained there 14 days later. Thus, significant levels of pentamidine, aerosolized as three different salts, are retained in the lung for at least 2 wk after a single dose. The three salts of pentamidine each produced high lung to extrapulmonary drug ratios, the converse of that produced by intravenous injection of pentamidine isoethionate. At very high aerosol doses, the ability of the lung to retain pentamidine appeared saturable. Even aerosolized daily for 2 wk at very high doses, none of the three pentamidine salts produced histologic evidence of organ toxicity. A Phase 1 trial of aerosolized pentamidine gluconate in AIDS-PCP patients is now in progress to determine if this approach can reduce airway irritation.

Expression and secretion of rice alpha-amylase by Saccharomyces cerevisiae

We report the high level expression and secretion of rice alpha-amylase isozyme by Saccharomyces cerevisiae. Transcription of this gene was under control of the yeast enolase promoter. The synthesized protein had an approximate molecular size of 45 kDa and a pI of approx 4.7 to 5.0. The rice alpha-amylase signal peptide was recognized and efficiently processed by yeast and the active, glycosylated enzyme was secreted into the culture media. This enzyme was purified to homogeneity by affinity chromatography and its enzymatic properties were characterized. The Km and Vmax were found to be similar to those of alpha-amylases from other organisms. The high level of secretion observed in these studies may be due to the unique features of the rice signal peptide and/or to the glycosylation of the recombinant enzyme.

The effect of pre-anaesthetic fasting on blood glucose level in children undergoing surgery

Blood glucose concentrations were measured in 104 children aged 6 months- 10 years (mean 3.1 years) undergoing inpatient anaesthesia. The mean fasting period was 10.87 +/- 2.68 hours. Mean preanaesthetic and 1/2 hour post-anaesthetic blood glucose levels were 4.8 +/- 0.8 and 6.1 +/- 1.9 mmoles/L respectively. Pre- anaesthetic low blood glucose level (2.7-3.3 mmoles/L) could only be detected in 3.8% cases. Post-anaesthetic increase in blood glucose level was the same as reported in adults.

Laser action from 2,6,8-position trisubstituted 1,3,5,7-tetramethylpyrromethene-BF(2) complexes: part 1

Of the four new pyrromethene derivatives studied, 1,3,5,7,8-pentamethyl-2,6-diethylpyrromethene-BF(2) complex lased ~3 times more efficiently than rhodamine 560 under flashlamp excitation.

Immediate exposed skin grafting in children's burns

The technique of immediate exposed skin grafting following early tangential excision of burns in children overcomes the difficulties of applying dressings with the attendant risk of graft loss from shearing forces. We report on 36 patients treated by this method. Wound healing was achieved in all patients without the need for further surgery.

Chronic postoperative endophthalmitis from Staphylococcus aureus

We recently treated a patient with chronic postoperative endophthalmitis caused by Staphylococcus aureus, which usually presents with a fulminant clinical course. Because of the chronic course, the initial treatment was high dose steroids followed by lensectomy and vitrectomy. However, this was not effective, and intravitreal antibiotics and steroids were ultimately required. We now recommend that in patients with chronic postoperative inflammation unresponsive to high dose steroids, intraocular cultures followed by injection of intraocular antibiotics be considered.

Polyethylene glycol-electrolyte solution for rectal sunflower seed bezoar

We describe the successful use of polyethylene glycoelectrolyte solution (Golytely) in the management of a child who developed a rectal phytobezoar after ingestion of unshelled sunflower seeds. A brief review of the literature regarding the management of rectal phytobezoar is discussed.