Hematopoietic growth factors in drug-induced agranulocytosis

Drug-induced agranulocytosis (DIA) is a potentially fatal disorder. Hematopoietic growth factors have been used in the treatment of DIA. We report nine cases of DIA treated with granulocyte macrophage - colony stimulating factor (GM-CSF) in a dose of 300 microg/day. All the patients had evidence of systemic infection. Mean time to reach an absolute neutrophil count of 0.5 x 10(9)/L was three days. One patient succumbed to the disease. The cause of death was multiorgan failure. No adverse events were observed with GM-CSF. We conclude that hematopoietic growth factors are useful in shortening the period of neutropenia and reducing morbidity and mortality in these patients.

Airway resistance estimation by best fit analysis in very premature infants

Plethysmographic measurement of airway resistance (R(aw)) has been determined by single-point analysis, usually at 50% of maximum inspiratory flow (MIF). Computer-assisted (best fit) analysis, however, allows R(aw) to be calculated by applying a regression line to any portion of the plethysmograph pressure-flow loop. We determined whether the results of best fit analysis using a computer program, sampling at 200 Hz, were influenced by the portion of the inspiratory loop analysed and if best fit or single-point analysis gave more reproducible results. Twenty infants of median gestational age 26 (range 24-28) weeks, were studied at a median age of 12 (12-14) months corrected for prematurity. R(aw) was calculated by best fit analysis between 0 and 33% MIF, 0 and 50% MIF and 0 and 67% MIF and single-point analysis at 50% of MIF. Similar mean R(aw) values were obtained by best fit analysis between 0 and 33% MIF (2.79 kPa/(l/s)) and 0 and 50% MIF (3.01 kPa/(l/s)) and single-point analysis at 50% MIF (2.86 kPa/(l/s)), but best fit analysis between 0 and 67% gave higher results (3.60 kPa/(l/s)), p < 0.0001. Within the linear portion of the inspiratory loop, the mean intrasubject coefficient of variation was lowest for best fit analysis between 0 and 50% MIF. Best fit computerized analysis between 0 and 50% MIF is recommended as the analysis of choice.

[Pseudotumoral enterocolic phlebitis of the cecum and rutoside. A case report]

INTRODUCTION

Enterocolic phlebitis is an entity characterized by ischemic injury of the gastrointestinal tract caused by thrombophlebitis of the mesenteric veins without arterial involvement or systemic disease.

EXEGESIS

We report a case of enterocolic phlebitis in a 57-year-old female treated by rutoside, revealed by intestinal obstruction related to a pseudotumoral lesion of the caecum.

CONCLUSION

This case adds to the four cases of enterocolic phlebitis under rutoside already reported in the literature, suggesting a possible involvement of this drug in this rare disease.

Influences of parity and level of feed intake on reproductive response to insulin administration after weaning in sows

In three experiments, the influence of insulin administered after weaning was examined in primiparous sows given extra feed or in primiparous compared to multiparous sows. In Exp. 1, 171 primiparous and 231 multiparous crossbred sows on a commercial farm were injected with 0.4 IU/kg BW insulin (Eli Lilly Lente Iletin II) or saline for 4 d beginning the day after weaning (d 0) and were fed 2.3 kg/d until mating. In Exp. 2, 153 primiparous sows from the same farm as those in Exp. 1 were injected with insulin or saline as in Exp. 1 and were fed 2.7 or 3.6 kg/d until mating. In Exp. 3, 63 primiparous crossbred sows were injected with insulin or saline as described above and fed either 2.3 or 4.5 kg/d for 5 d after weaning and were remated. On the commercial farm (Exp. 1 and 2), insulin administration increased percentage in estrus for primiparous sows compared to multiparous sows (treatment x parity interaction, P < 0.02) but tended to lower litter size in primiparous sows (treatment x parity interaction, P < 0.06). In Exp. 2, insulin combined with extra feed increased (P < 0.05) litter size by two pigs but tended (P < 0.07) to decrease farrowing rate in that group (treatment x feed interaction). Weaning-to-estrus interval, pregnancy rate, ovulation rate, and embryo survival were not influenced by treatment or feeding level (Exp. 3); however, postweaning intake and embryo survival were negatively related for saline-treated sows only (r = -0.55; P < 0.01), and backfat depth at weaning and embryo survival were positively related for insulin-treated sows only (r = 0.44; P < 0.05). Overall, insulin administration differentially influenced reproduction in primiparous sows and may have interacted with metabolic or nutritional state of the animal.

Lipoprotein (a) does not participate in the early acute phase response to training or extreme physical activity and is unlikely to enhance any associated immediate cardiovascular risk

AIMS

To investigate the proposal that lipoprotein (a) (Lp(a)) contributes to the acute phase response and thus possibly to the acute cardiac risks associated with major physical effort.

METHODS/RESULTS

Fit, healthy, British army recruits were reviewed at the beginning and the end of a 10 week programme of basic training concluding with an intense 48 hour military exercise. Final recruit assessment was staggered over the last week of training, giving rise to six recruit groups, with determination of Lp(a), C reactive protein (CRP), fibrinogen, albumin, and total creatine kinase values from 12 hours to five days after the final exercise. A clear acute phase response was seen following the final exercise, marked by a significant increase in circulating concentrations of fibrinogen and a reduction of albumin, and a trend with non-significant increases in CRP.

CONCLUSION

Lp(a) did not behave as an early marker of the acute response. Previous reports may have been confounded by concurrent disease in older subjects and by late sampling. Lp(a) determination for cardiovascular risk profiling is not confounded by associated physical effort. It is also unlikely that the acute risks of major physical effort are enhanced by any process involving Lp(a).

[Peritoneal tuberculosis: 27 cases in the suburbs of northeastern Paris]

SETTING

Peritoneal tuberculosis did not disappear from France during the 1990s.

OBJECTIVE

To determine the characteristics of peritoneal tuberculosis in the north-eastern suburbs of Paris.

METHOD

A retrospective study of cases diagnosed with peritoneal tuberculosis between 1990 and 1998 in five suburban hospitals in the north-east region of Paris.

RESULTS

Twenty-seven cases of adult peritoneal tuberculosis were diagnosed. There were nine women and 18 men, with a mean age of 37.5 years, 88.9% of whom were foreign born. General and digestive symptoms--abdominal pain and/or ascites--were present in 96.3% of the cases. The mean delay in treatment was 30 days. Peritoneal involvement was isolated in 25.9% of cases, and associated with pulmonary tuberculosis in 40.7% or hepatic tuberculosis in 25.9%. Co-infection with HIV (human immunodeficiency virus) was present 14.8% of cases. Culture of ascites fluid, laparoscopy and/or laparotomy (n = 17), with directed biopsy, aided in the formal diagnosis of peritoneal tuberculosis in 59.2%. One relapse and one case of multiresistance were observed. The mean duration of treatment was 9 months (range 6-12 months). Three patients received treatment with corticosteroids, and 91.2% of the patients achieved cure without sequelae.

CONCLUSION

Peritoneal tuberculosis is not rare in the Paris region. The diagnosis should be suspected in case with ascites and fever, and can be confirmed by laparoscopy with sampling for bacteriology and histology. The methods of treatment need to be standardised.

Influence of the charge of low molecular weight proteins on their efficacy of filtration and/or adsorption on dialysis membranes with different intrinsic properties

Hemodialysis membranes eliminate by filtration low-molecular-weight toxic metabolites (urea and creatinine) with minimum interactions between blood components and the membrane itself. However, the ability of a membrane to adsorb specific proteins could be beneficial if the accumulation of these same proteins is implicated in the genesis of a pathological condition. Beta-amyloidosis which accompanies the elevation of beta2-microglobulin (11.8 kDa) in the plasma of dialysed patients is one such condition (Biochem. Biophys. Res. Commun. 129 (3) (1985) 701-706: Lancet 1 (1986) 1240-1311). To determine whether increases in plasma beta2-microglobulin levels were due to differences in filtration efficacy of the membrane used and/or to certain characteristics of this protein, e.g. its charge (pI 5.7) the adsorption and filtration of [3H] beta2-microglobulin and [3H] lysozyme of similar MW 14.5 kDa, but pI: 10.8 were compared on different membranes. It was found that, neither [3H] beta2-microglobulin nor [3H] lysozyme are removed by cuprophan, whereas over 75% of beta2-microglobulin is removed by filtration on polyacrylonitrile, polyacrylonitrile-polyethyleneimine, polysulfone and >95% by adsorption to polymethylmethacrylate-BK. For lysozyme, removal by adsorption is >95% on polyacrylonitrile and polyacrylonitrile-polyethyleneimine, 72% on polymethylmethacrylate-BK and by filtration is 95% on polysulfone. Hemodialysis membranes must therefore not simply be considered as filters of low-molecular-weight metabolites but should be equally assessed for their capacity to eliminate potentially deleterious low-molecular-weight plasma proteins.

A detailed anatomical description of the subvastus region and its clinical relevance for the subvastus approach in total knee arthroplasty

The subvastus region and its anatomical contents are important when performing a total knee replacement via a subvastus approach. Thirty-two human cadaver thighs were studied to provide a detailed anatomical description of the subvastus region and its contents, namely the descending genicular artery and its branches, and the saphenous nerve proximally. In 24 specimens the descending genicular artery arose from the femoral artery and divided into osteoarticular and saphenous branches, while in eight specimens it was absent. The osteoarticular and saphenous branches arose independently from the femoral artery. On the basis of these distribution patterns nine variations with regard to the number and origin of the muscular, musculoarticular and saphenomusculoarticular branches arising from these vessels could be identified. The musculoarticular branch should be preserved wherever possible; however, if it must be sacrificed to improve exposure of the knee joint via a proximal extension of the incision, the passage of the saphenous nerve and the saphenous branch through the vastoadductor membrane are additional structures which must be considered. The proximal limitation for the mobilisation is the adductor hiatus, with further mobilisation increasing the risk of damaging the femoral artery and vein.

Chronic myeloid leukemia presenting as gout

A 53-year-old man presented with gouty arthritis. A physical examination and haematological and biochemical tests showed that he had chronic myeloid leukemia. He was treated with allopurinol, hydroxyurea and analgesics. The arthritis subsided completely within 2 weeks. He continues in haematologic remission (on interferon) with no further recurrence of the gout.

Nitrogen removal in a SBR using the OGAR process control system

OGAR is an industrial process control system that utilises on-line redox measurements to control the aeration sequence in an activated sludge process. Compared to conventional process control systems that use dissolved oxygen, OGAR makes use of redox as a control parameter during both aerobic and anoxic conditions. This paper reports on its first application in a sequencing batch reactor. The principal aim of this project is to demonstrate the capability of OGAR to achieve concentrations of total nitrogen in the treated effluent of less than 10 mg/L, which are typically stipulated by Queensland's Environmental Protection Agency (EPA). In this study the use of the control system resulted in the following SBR performance: consistent effluent total nitrogen less than 5.0 mg/L; ammonia concentration reduced from 31.6 mg/L to 0.32 mg/L, effluent nitrate 2.8 mg/L; DO setpoint 1.5 mg/L had 10% higher effluent total nitrogen compared to DO setpoint 4.0 mg/L and redox end-points for nitrification 400 mV, denitrification 150 mV.

Treatment of reflex sympathetic dystrophy with pamidronate: 29 cases

OBJECTIVE

To evaluate the efficacy of treatment with pamidronate in reflex sympathetic dystrophy (RSD) refractory to previous treatment.

METHODS

We studied the response (disappearance of pain and functional improvement) to pamidronate (60 mg/day for 3 days) in 29 patients with RSD refractory to previous treatment for at least 14 days.

RESULTS

On day 45, complete pain disappearance was observed in 86.2% of patients and functional improvement in 70%. The mean delay until the pain disappeared was 20+/-14 days and the delay until functional improvement was observed was 29+/-18 days. The mean delay of functional improvement was shorter in patients with post-traumatic RSD. Multivariate analysis did not reveal any factor predictive of response to treatment. Six (20.7%) patients suffered from side-effects (fever, diarrhoea).

CONCLUSION

Pamidronate appeared to be effective in the treatment of refractory RSD; however, these results need to be confirmed by a controlled placebo study.

Mental disorder in adults with intellectual disability. 2: The rate of behaviour disorders among a community-based population aged between 16 and 64 years

Despite the difficulty of defining behaviour disorder, most previous studies have reported a high rate of behaviour disorders in people with intellectual disability (ID). The aim of the present study was to establish the overall rate and types of behaviour disorders in a population-based sample of adults with ID. The other aim was to explore the possible risk factors that are associated with the overall rate as well as different types of behaviour disorders. One hundred and one adults with ID aged between 16 and 64 years were randomly selected from a sample of 246 such adults, i.e. those who were known to the Vale of Glamorgan Social Services Department in South Wales, UK. Thirteen behaviour disorders were rated according to the Disability Assessment Schedule. Background data on subjects were also collected, and were subsequently analysed to assess the relationship between different risk factors and behaviour disorders. Sixty-one subjects (60.4%) had at least one behaviour disorder of any severity or frequency. Twenty-three per cent of subjects showed aggression, 24% self-injurious behaviour, 36% temper tantrum, 26% overactivity, 29% screaming, 38% attention-seeking behaviour, 20% objectionable habits, 18% night-time disturbance and 12% of subjects showed destructiveness. Statistically significant associations were seen between the rate of overall behaviour disorder and the use of psychotropic medication, and between family and group home residence. The rate of aggression was significantly associated with the use of psychotropic medication. The rate of self-injurious behaviour was significantly associated with the severity of ID, female gender and poor communication abilities. The rate of temper tantrum was significantly associated with the use of psychotropic medication. Twenty-four subjects showed severe or frequent aggression, destructiveness, self-injury or temper tantrum, and 11 individuals showed real challenging behaviours. Severe behaviour problems were significantly associated with female gender, severity of ID, the presence of a history of epilepsy and attendance at day activities.