Evaluation of abdominal computed tomography findings in patients with COVID-19: a multicenter study

PURPOSE

To evaluate the frequency of abdominal computed tomography (CT) findings in patients with coronavirus disease-2019 (COVID-19) and interrogate the relationship between abdominal CT findings and patient demographic features, clinical findings, and laboratory test results as well as the CT atherosclerosis score in the abdominal aorta.

METHODS

This study was designed as a multicenter retrospective study. The abdominal CT findings of 1.181 patients with positive abdominal symptoms from 26 tertiary medical centers with a positive polymerase chain-reaction test for severe acute respiratory syndrome coronavirus 2 were reviewed. The frequency of ischemic and non-ischemic CT findings as well as the association between CT findings, clinical features, and abdominal aortic calcific atherosclerosis score (AA-CAS) were recorded.

RESULTS

Ischemic and non-ischemic abdominal CT findings were detected in 240 (20.3%) and 328 (27.7%) patients, respectively. In 147 patients (12.4%), intra-abdominal malignancy was present. The most frequent ischemic abdominal CT findings were bowel wall thickening (n = 120; 10.2%) and perivascular infiltration (n = 40; 3.4%). As for non-ischemic findings, colitis (n = 91; 7.7%) and small bowel inflammation (n = 73; 6.2%) constituted the most frequent disease processes. The duration of hospital stay was found to be higher in patients with abdominal CT findings than in patients without any positive findings (13.8 ± 13 vs. 10.4 ± 12.8 days, P < 0.001). The frequency of abdominal CT findings was significantly higher in patients who did not survive the infection than in patients who were discharged after recovery (41.7% vs. 27.4%, P < 0.001). Increased AA-CAS was found to be associated with a higher risk of ischemic conditions in abdominal CT examinations.

CONCLUSION

Abdominal symptoms in patients with COVID-19 are usually associated with positive CT findings. The presence of ischemic findings on CT correlates with poor COVID-19 outcomes. A high AA-CAS is associated with abdominal ischemic findings in patients with COVID-19.

Impact of non-pharmaceutical interventions on circulating respiratory viruses during the COVID-19 pandemic in Turkey

BACKGROUND

Non-pharmaceutical interventions (NPIs) applied to limit the SARS-CoV-2 pandemic also affect the circulation and seasonal characteristics of other respiratory viruses.

OBJECTIVES

Assess the impact of NPIs on the spread and seasonal characteristics of non-SARS-CoV-2 respiratory viruses and examine viral respiratory co-infections.

DESIGN

Retrospective cohort SETTING: Single center in Turkey.

PATIENTS AND METHODS

Syndromic multiplex viral polymerase chain reaction (mPCR) panel results of patients admitted to the Ankara Bilkent City Hospital with symptoms of acute respiratory tract infection between April 1, 2020 and October 30, 2022 were evaluated. Two study periods before and after 1 July 2021, when the restrictions were discontinued, were statistically analyzed and compared to determine the effect of NPIs on circulating respiratory viruses.

MAIN OUTCOME MEASURES

Prevalence of respiratory viruses as determined by syndromic mPCR panel.

SAMPLE SIZE

11300 patient samples were evaluated.

RESULTS

At least one respiratory tract virus was detected in 6250 (55.3%) patients. Of these, at least one respiratory virus was detected in 5% in the first period (between April 1, 2020 and June 30, 2021, when NPIs were applied), and in 95% in the second period (between July 1, 2021 and October 30, 2022, when NPIs were relaxed). After the removal of NPIs, there was a statistically significant increase in hRV/EV, RSV-A/B, Flu A/H3, hBoV, hMPV, PIV-1, PIV-4, hCoV-OC43, PIV-2 and hCoV-NL63 (P<.05). In the 2020-2021 season, when strict NPIs were applied, all respiratory viruses evaluated did not have the usual seasonal peak and there were no seasonal influenza epidemics during this period.

CONCLUSIONS

NPIs resulted in a dramatic decrease in the prevalence of respiratory viruses and notable disruption of seasonal characteristics.

LIMITATIONS

Single-center study and retrospective.

CONFLICT OF INTEREST

None.

High-dose interleukin-2 therapy related adverse events and implications on imaging

High-dose interleukin-2 (HDIL-2) therapy was initially approved by the U.S. Food and Drug Administration for metastatic renal cell carcinoma (mRCC) and metastatic melanoma. IL-2 is able to promote CD8+ T cell and natural killer (NK) cell cytotoxicity to increase tumoricidal activity of the innate immune system. HDIL-2 therapy is associated with a wide spectrum of immune-related adverse events (irAEs) that can be radiologically identified. HDIL-2 toxicity can manifest in multiple organ systems, most significantly leading to cardiovascular, abdominal, endocrine, and neurological adverse events. The collective impact of the irAEs and the rise of immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors led to the demise of HDIL-2 as a primary therapy for mRCC and metastatic melanoma. However, with innovation in ICIs and the creation of mutant IL-2 conjugates, there has been a drive for combination therapy. Knowledge of the HDIL-2 therapy and HDIL-2 related adverse events with radiology relevance is critical in diagnostic image interpretation.

Infections developing in patients undergoing liver transplantation: Recipients of living donors may be more prone to bacterial/fungal infections

BACKGROUND/AIMS

Despite surgical advances in liver transplantation and effective prophylactic strategies, posttransplant infections are the most important cause of morbidity and mortality. Diagnosis and management of infections because of developing immunosuppression is difficult and adversely affects mortality. This study aimed to review bacterial and fungal infections in patients after liver transplantation and to reveal the resistance rates.

MATERIALS AND METHODS

A total of 107 patients who underwent liver transplantation between January 2017 and February 2018 were evaluated retrospectively with regard to demographic characteristics, causes of transplantation, conditions that may lead to infection, postoperative infections, pathogens, and resistance patterns.

RESULTS

Of the 107 patients who underwent liver transplantation, 48 (44.8%) had an infection. Bacterial infections were detected in 41% of the patients, and fungal infections were found in 13%. When we compared living and cadaveric transplants in terms of infection development, these rates were found to be 53% and 33%, respectively (p=0.034). No statistically significant results could be obtained when evaluating conditions such as sex, presence of underlying primary disease, Model for End-Stage Liver Disease MELD score, diabetes status, total parenteral nutrition, and risk factors for infection.

CONCLUSION

After liver transplantation, infections are often seen in the first month of the postoperative period. Knowing the most common pathogens and resistance states in this process reduces infection-related deaths by providing appropriate treatment regimens at the right time.

Characterization of adrenal lesions on chemical shift MRI: comparison of 1.5 T and 3 T MRI

PURPOSE

To compare three chemical shift MRI techniques [two-dimensional (2D) dual gradient echo (dGRE), 3D VIBE, and 3D VIBE-Dixon] at 3 T and 2D dGRE technique at 1.5 T to assess their ability of detecting microscopic fat in adrenal adenomas and differentiating between adenomas and non-adenomas.

METHODS

Seventy-eight patients with 97 lesions (78 adenomas, 19 non-adenomas) underwent both 1.5 T and 3 T chemical shift MRI. The Wilcoxon signed-ranked test was used to determine if there was significant difference between the signal intensity index (SII) values of each technique to assess their ability to detect microscopic fat in adrenal adenomas. ROC analysis was performed for the SII values of each technique, the adrenal-to-spleen SI ratio of 2D dGRE technique at 3 T, and the fat fraction values of the 3D VIBE-Dixon technique to identify the optimal threshold for differentiation of adrenal adenomas from non-adenomas.

RESULTS

For detection of microscopic fat, the mean SII value of 2D dGRE technique at 1.5 T was significantly higher than that of the chemical shift imaging techniques at 3 T (p = 0.001). For discrimination of adenomas from non-adenomas, the area under the curve (AUC) and 95% confidence interval values of 2D dGRE technique at 1.5 T and 2D dGRE, 3D VIBE, 3D VIBE-Dixon techniques at 3 T were calculated as 1.00 (1.00-1.00), 0.991 (0.978-1.00), 0.999 (0.995-1.00), 0.993 (0.979-1.00), respectively, for the SII.

CONCLUSION

Chemical shift MRI at 1.5 T using the 2D dGRE technique provided the most accurate differentiation between adenomas and non-adenomas. However, there was no statistically significant difference between chemical shift imaging techniques at 1.5 T and 3 T.

Discrimination of oncocytoma and chromophobe renal cell carcinoma using MRI

PURPOSE

We aimed to evaluate magnetic resonance imaging (MRI) features, including signal intensities, enhancement patterns and T2 signal intensity ratios to differentiate oncocytoma from chromophobe renal cell carcinoma (RCC).

METHODS

This retrospective study included 17 patients with oncocytoma and 33 patients with chromophobe RCC who underwent dynamic MRI. Two radiologists independently reviewed images blinded to pathology. Morphologic characteristics, T1 and T2 signal intensities were reviewed. T2 signal intensities, wash-in, wash-out values, T2 signal intensity ratios were calculated. Sensitivity and specificity analyses were performed.

RESULTS

Mean ages of patients with oncocytoma and chromophobe RCC were 61.0±11.6 and 58.5±14.0 years, respectively. Mean tumor size was 60.6±47.3 mm for oncocytoma, 61.7±45.9 mm for chromophobe RCC. Qualitative imaging findings in conventional MRI have no distinctive feature in discrimination of two tumors. Regarding signal intensity ratios, oncocytomas were higher than chromophobe RCCs. Renal oncocytomas showed higher signal intensity ratios and wash-in values than chromophobe RCCs in all phases. Fast spin-echo T2 signal intensities were higher in oncocytomas than chromophobe RCCs.

CONCLUSION

Signal intensity ratios, fast spin-echo T2 signal intensities and wash-in values constitute diagnostic parameters for discriminating between oncoytomas and chromophobes. In the excretory phase of dynamic enhanced images, oncocytomas have higher signal intensity ratio than chromophobe RCC and high wash-in values strongly imply a diagnosis of renal oncocytoma.

Results of 1001 liver transplantations in 23 years: Ege University experience

BACKGROUND/AIMS

Liver transplantation (LT) is now the standard of care for most end-stage liver diseases. Over the next 30 years, advances in medicine and technology will greatly improve the survival rates of patients after this procedure. The aim of the present study was to analyze retrospectively the results of 1001 patients withLT.

MATERIALS AND METHODS

Medical reports of 989 patients were analyzed retrospectively. Data were obtained from the patient's data chart. Descriptive statistics were used to describe continuous variables (mean, median, and standard deviation).

RESULTS

A total of 1001 LTs for 989 recipients were performed at Ege University Organ Transplantation and Research Center between 1994 and 2017. Therewere 639 male and 350 female recipients. Among 1001 LTs, there were 438 deceased donors and 563 living donors. The age interval of the patients was 4 months to 71 years old. The median Model for End-Stage Liver Disease score was 20. There were 12 deceased liver donors using the split method. There were 12 cases subject to retransplantation. In living donor LT grafts, 423 right lobes, 46 left lobes, and 94 left lateral sectors were used. In the first monitoring,the total annual mortality rate was 130 cases (13%). The mortality rate in retransplantation was found to be 66%. A 1-year survival rate of 87% was generally stablished.

CONCLUSION

LThas been improving consistently over the last two decades. Ege University is one of the biggest liver transplant centers in Turkey for both technical and educational perspective.

Congenital Infantile Fibrosarcoma of the Thigh in a Newborn

Congenital/infantile fibrosarcoma occurs frequently in the first year of life and differs from fibrosarcoma in adulthood. The clinical course of congenital/infantile fibrosarcoma is more favorable and metastatic spread is rare. While adult fibrosarcomas are common in the thigh, congenital/infantile fibrosarcomas affect chiefly the distal portions of the extremities. Standard treatment is primarily wide surgical excision. Chemotherapy may be given as neoadjuvant or adjuvant treatment in order to avoid the morbidity associated with wide excision. In this case report we present our experience of a newborn affected by congenital/infantile fibrosarcoma of the left thigh.

Pleuropulmonary Blastoma in a Child Presenting with Pneumothorax

Pleuropulmonary blastoma is an uncommon primary malignant tumor of the lung. Surgery is the most important part of the treatment. Despite the use of chemotherapy with or without radiotherapy, the prognosis is poor. Here we report on the case of a 2.5 year-old boy presenting with pneumothorax who turned out to have a right hemithoracic mass. The patient underwent surgical resection of the mass. Pathologic diagnosis was type II pleuropulmonary blastoma. Postoperative thoracic CT showed nodular residual densities so the patient was given adjuvant combination chemotherapy with cisplatin and etoposide. He has been disease free for 12 months.

Disgust and Anger Relate to Different Aggressive Responses to Moral Violations

In response to the same moral violation, some people report experiencing anger, and others report feeling disgust. Do differences in emotional responses to moral violations reflect idiosyncratic differences in the communication of outrage, or do they reflect differences in motivational states? Whereas equivalence accounts suggest that anger and disgust are interchangeable expressions of condemnation, sociofunctional accounts suggest that they have distinct antecedents and consequences. We tested these accounts by investigating whether anger and disgust vary depending on the costs imposed by moral violations and whether they differentially correspond with aggressive tendencies. Results across four studies favor a sociofunctional account: When the target of a moral violation shifts from the self to another person, anger decreases, but disgust increases. Whereas anger is associated with high-cost, direct aggression, disgust is associated with less costly indirect aggression. Finally, whether the target of a moral violation is the self or another person influences direct aggression partially via anger and influences indirect aggression partially via disgust.

Radiofrequency ablation for lung tumors: outcomes, effects on survival, and prognostic factors

PURPOSE

We aimed to evaluate the survival benefit achieved with radiofrequency (RF) ablation of primary and metastatic lung tumors and determine significant prognostic factors for recurrence-free survival.

METHODS

Forty-nine patients with lung cancer (10 primary and 39 metastatic) underwent computed tomography-guided percutaneous RF ablation between June 2005 and October 2013. A total of 112 tumors (101 metastatic and 11 primary non-small cell lung cancer) were treated with RF ablation. Tumor diameter ranged from 0.6 to 4 cm (median 1.5 cm). Effectiveness of treatment, complications, and survival were analyzed.

RESULTS

Primary success rate was 79.5% and local tumor progression occurred in 23 tumors. Among tumors showing progression, 10 were re-treated with RF ablation and secondary success rate was 87.5%. One-, two-, and three-year overall survival rates of 10 patients with primary lung cancer were 100%, 86%, and 43%, respectively. One-, two-, three-, four-, and five-year overall survival rates for 39 patients with metastatic lung tumors were 90%, 73%, 59%, 55%, and 38%, respectively. One-, two-, three-, and four-year overall survival rates for 16 patients with colorectal pulmonary metastases were 94%, 80%, 68%, and 23%, respectively. Complications occurred in 30 sessions (24.6%). Pneumothorax occurred in 19 sessions with seven requiring image-guided percutaneous chest tube drainage. Tumor status (solitary or multiple) and presence of extrapulmonary metastasis at initial RF ablation were significant prognostic factors in terms of recurrence-free survival.

CONCLUSION

RF ablation is a safe and effective treatment with a survival benefit for selected patients with primary and secondary lung tumors.

Effect of iterative reconstruction on image quality in evaluating patients with coronary calcifications or stents during coronary computed tomography angiography: a pilot study

OBJECTIVE

To determine the effect of "Iterative Reconstruction in Image Space" (IRIS) on image quality by comparing reconstructions of both medium and sharp kernels when evaluating coronary calcifications or stents during coronary computed tomography (CT) angiography.

METHODS

Thirty one consecutive patients were scanned with an electrocardiogram-gated helical technique on a dual-source CT system. Image reconstruction was performed using standard filtered back projection (FBP) and IRIS algorithm on both medium and sharp kernels (B26f, I26f, B46f, I46f). Each reconstruction was derived from the same raw data. Two blinded readers graded image quality using a five-point scale. Noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) were obtained. Noise was derived from the ascending aorta and left ventricle. SNR was obtained from sinus Valsalva, interventricular septum, and coronary vessels. CNR was obtained from septum, coronary vessels, and left ventricle. Comparisons of paired results between FBP and IRIS images were analyzed using the repeated measures analysis of variance method. Interreader correlation was assessed using weighted Kappa statistic.

RESULTS

Noise values of the ascending aorta and left ventricle were significantly lower in the images reconstructed with IRIS than those reconstructed with FBP for the evaluation of the same filters. SNR and CNR values were higher in the IRIS images (p<0.05). Interreader agreement for four reconstructions was interpreted as moderate (κ=0.40-0.59).

CONCLUSION

IRIS significantly reduced image noise and improved imaging of coronary calcifications or stents. When combined with a sharp kernel, IRIS can improve image quality by reducing the negative effects of decreased signal that may result from using a sharp kernel.

Comparison of image quality and radiation dose between prospectively ECG-triggered and retrospectively ECG-gated CT angiography: Establishing heart rate cut-off values in first-generation dual-source CT

Objective:

To evaluate radiation dose and image quality of prospectively electrocardiography (ECG)-triggered and retrospectively ECG-gated coronary computed tomography (CT) angiography and to establish cut-off values of heart rates (HRs) for each technique in firstgeneration dual-source CT.

Methods:

A total of 200 consecutive patients with suspected coronary artery disease were accepted into the study. Patients were selected randomly for each technique (prospective triggering group n=99, mean age 55.85±10.74 and retrospective gating group n=101, mean age 53.38±11.58). Two independent radiologists scored coronary artery segments for image quality using a 5-point scale. Also, attenuation values of each coronary artery segment and dose-length product values were measured. For each technique, cut-off HR values were determined for the best image quality.

Results:

Mean image quality scores and attenuation values were found to be higher in the prospective triggering group (p<0.05). Mean radiation dose was 73% lower for the prospective triggering group (p<0.01). The cut-off HR values for good image quality scores were ≤67 beats per minute (bpm) and ≤80 bpm for the prospective triggering and retrospective gating groups, respectively (p<0.05). Increased HR (≥68 and ≥81 bpm, respectively) had negative effects on image quality (p<0.05).

Conclusion:

The prospective ECG triggering technique has better image quality scores than retrospective ECG gating, particularly in patients who have an HR of less than 68 bpm. Also, a 73% radiation dose reduction can be achieved with prospective ECG triggering. In patients with higher heart rates, retrospective ECG gating is recommended.

Aspects of thermal martensite in a FeNiMnCo alloy

Thermal martensite characteristics in Fe-29%Ni-2%Mn-2%Co alloy were investigated with scanning electron microscopy (SEM) and Mössbauer spectroscopy characterization techniques. SEM observations obviously revealed the lath martensite morphology in the prior austenite phase of examined alloy. As well, the martensitic transformation kinetics was found to be as athermal type. On the other hand, Mössbauer spectroscopy offered the paramagnetic austenite phase and ferromagnetic martensite phase with their volume fractions. Also, the internal magnetic field of the martensite was measured as 32.9T from the Mössbauer spectrometer.

Influence of the relapse and remission periods on hearing status in children with minimal change nephrotic syndrome

OBJECTIVE

Minimal change nephrotic syndrome (MCNS) is characterized by the onset of NS (Nephrotic Syndrome) without systemic disease, hypocomplementemia, or other serious signs of renal disease. Hearing status is not very well known in MCNS. Our objective was to address this question and to find out remission and relapse periods of the syndrome would affect the hearing of the patients.

METHODS AND PATIENTS

Otologic status of 26 children with clinical MCNS was investigated in relapse and remission periods using audiometry and tympanometry. The pure tones that were obtained at the frequencies 250, 500, 1000, 2000, 4000 and 6000 Hz were noted. Pure tone averages (PTAs) were calculated at 500, 1000, 2000 and 4000 Hz frequencies.

RESULTS

In both remission and relapse periods, PTA of the patients did not change and was 13 dB. The frequency specific pure tone results were not significantly different between the right and left ears of the patients as well as between the remission and relapse periods (p > 0.05). In the relapsing and remission periods, type A tympanogram was encountered in 86.4% and 92.3% of the ears, respectively. Type B tympanogram was encountered in 11.5% and 3.8% of the ears in the relapsing and remission periods, respectively. Type C tympanogram was encountered in 3.8% of the ears both in the relapsing and remission periods. Differences between the tympanometry results were not significant (p > 0.05).

CONCLUSION

MCNS in childhood is not associated with an alteration in the hearing status, both in remission and relapse periods of the disease.

Extraneural metastasis in a child with atypical teratoid rhabdoid tumor of the central nervous system

Atypical teratoid rhabdoid tumor is a distinctive brain tumor appearing in infancy and early childhood. Leptomeningeal dissemination is common, both at presentation and relapse. Extracranial metastases of the central nervous system tumors are rarely seen. To our knowledge there is only one report with an atypical teratoid rhabdoid tumor metastasizing via a ventriculoperitoneal shunt. We describe the first case of atypical teratoid rhabdoid tumor of the central nervous system who developed lung metastasis without the presence of a shunt.

Urticaria pigmentosa associated with Wilms tumor

Urticaria pigmentosa is the most common manifestation of mastocytosis, with the majority of cases undergoing spontaneous resolution, especially in children. Several reports have documented hematologic malignancies developing in patients with urticaria pigmentosa. We present a 4.5-year-old boy with urticaria pigmentosa who developed Wilms tumor. To our knowledge, coexisting urticaria pigmentosa and Wilms tumor have not previously been described.

Studies on vaginal bioadhesive tablets of acyclovir

Bioadhesive vaginal tablets were prepared using poly(acrylic acid) (PAA); Methylcellulose (MC), carboxymethyl cellulose (CMC), hydroxypropyl cellulose (HPC) and hydroxypropylmethyl cellulose (HPMC) as bioadhesive polymers in different concentrations and acyclovir as drug by direct compression technique (DCT) and wet granulation technique (WGT). Physical tests were applied to the tablets. The swelling behavior of vaginal tablets in distilled water, lactic solution and cow vagina, acyclovir release rate in lactic solution and bioadhesion to vaginal mucosa in cow vagina, in situ, were investigated. Swelling of the tablets containing HPC, CMC and MC was very rapid and caused disintegration of the tablets. The swelling behaviour of the tablets containing HPMC lasted 6 h in lactic solution. The force (N) necessary to detach the tablets from the vaginal tissue was found to depend on concentration and type of the bioadhesive polymer. The tablets containing HPMC needed the most detachment force.

Studies on controlled release dimenhydrinate from matrix tablet formulations

In this study, controlled release dosage forms of dimenhydrinate were prepared with different polymers as MC, HEC, Carbopol 934, Eudragit RLPM and Eudragit NE 30 D at different concentrations (2.5-10%). Direct compression (DC) and wet granulation (WG) techniques were used to prepare the tablets. Magnesium stearate was the lubricant while starch gel was the binder. For the quality control of tablets prepared according to 11 different formulations, weight deviation, hardness, friability, diameter-height ratio, content uniformity of the active substance and in vitro dissolution techniques were performed. Dissolution rate of these tablets was controlled by USP XXII dissolution method and the profile of each tablet was plotted and only for F 5 was evaluated kinetically.

A comparison of the effect of high-dose methylprednisolone with conventional-dose prednisolone in acute lymphoblastic leukemia patients with randomization

In this preliminary study the efficacy of high-dose methylprednisolone (HDMP) during remission-induction chemotherapy was evaluated on 166 children with acute lymphoblastic leukemia (ALL). The St. Jude Total Therapy Study XI protocol with minor modifications was used in this trial. Patients were randomized into two groups. Group A received conventional-dose (2 mg/kg/day orally) prednisolone, and group B received high-dose methylprednisolone (HDMP, Prednol-L, 900-600 mg/m2 orally) during remission-induction chemotherapy. Complete remission was achieved in 97% of the children. For the 80 patients who were followed up for 3 years, median follow-up was 44 (range 5-60) months and the 3-year event-free survival (EFS) rate was 68.5%) overall, 58.6% in group A and 78.4% in group B. The EFS among patients in group B was significantly higher than in group A (p=0.05). When we compared the 3-year EFS of groups A and B in the high-risk groups and high-risk subgroups with white blood cell (WBC) counts > or = 50 x 10(9)/l and age > or = 10 years, the survival rates were 45% versus 77.2%, 33% versus 78% and 45% versus 89%, respectively. During the follow-up of 162 patients, relapses were significantly higher in group A. Bone marrow relapses in 162 patients, and also in a subgroup of patients > or = 10 years of age were significantly higher in group A. These results suggest that HDMP during remission-induction chemotherapy improves long-term EFS, particularly for high-risk patients.

Microencapsulation of ketorolac tromethamine by means of a coacervation-phase separation technique induced by the addition of non-solvent

Ketorolac tromethamine (KT) is a non-steroidal drug with potent analgesic and anti-inflammatory activity and is absorbed rapidly (Tmax < 1.0 h) with an efficiency > 87% following oral and intramuscular administration. The plasma half-life of ketorolac ranges from 1.1 to 6.0 h. Its oral bioavailability is estimated to be 80%. Ketorolac has been found 36 times more potent than phenylbutazone, approximately twice as potent as indomethacin, and three times more potent than naproxen in suppressing carrageenan-induced paw oedema in rat. In this study, microcapsules of KT were prepared by means of coacervation-phase separation technique induced by the addition of non-solvent, and release rates from microcapsules were studied. Eudragit S100 was used as the coating material. Coacervation was achieved by the addition of cyclohexane at 2 ml/min at 25 degrees C and 1:4 solvent: non-solvent ratio was used. The microcapsules were washed with cyclohexane to harden the wall and dried at room temperature. Microcapsules with core:wall ratio of 1:1 and 1:2 were prepared and the particles obtained by sieving with an average diameter of 177-500 microns were used. The yield was calculated and the release properties of KT were investigated by USP XXII paddle method and using UV spectrophotometry at 318 and 323 nm.

Spontaneous complete remission in a child with acute lymphoblastic leukemia

A five-year-old girl was admitted to the hospital with fever and tender lymphadenopathy. She was diagnosed with acute lymphoblastic leukemia (ALL-L3). Because of infection she was given antibiotics and a blood transfusion. Her bone marrow was in remission after 15 days without chemotherapy. This case emphases the role of transfusion and/ or infection in obtaining complete remission without chemotherapy.

Serum TNF-alpha, gamma-INF, G-CSF and GM-CSF levels in neutropenic children with acute leukemia treated with short-course, high-dose methylprednisolone

High-dose methylprednisolone (HDMP, 20-30 mg/kg/day po) treatment has been shown to increase the number of bone marrow and peripheral blood CD34 positive progenitors and serum granulocyte-macrophage colony-stimulating factor (GM-CSF) levels in patients with ALL and AML. To investigate the effect of HDMP on some other hematopoietic regulatory cytokines, tumor necrosis factor-alpha (TNF-alpha), gamma-interferon (gamma-INF), granulocyte colony-stimulating factor (G-CSF) and interleukin-6 (IL-6) were studied by microplate ELISA technique in 15 chemotherapy-induced neutropenic episodes of 14 children with acute leukemia (eight with ALL and six with AML) in whom HDMP was given alone (30 mg/kg/day po) for 4 days. The absolute neutrophil counts increased significantly in all neutropenic episodes on the fourth day of HDMP treatment. The TNF-alpha was 93.5 +/- 161 pg/ml in ALL and 78.3 +/- 61.4 pg/ml in AML before treatment and 76.1 +/- 160 pg/ml in ALL and 19.1 +/- 39.8 pg/ml in AML after treatment. The gamma-INF was 204.1 +/- 210.3 pg/ml in ALL and 130.8 +/- 138.3 pg/ml in AML before treatment and 28.6 +/- 50.5 pg/ml in ALL and 23.3 +/- 20.4 pg/ml in AML after treatment (P<0.05). Serum G-CSF and GM-CSF levels increased in all episodes (100%). The GM-CSF levels increased from 12.2 +/- 10.9 pg/ml to 36 +/- 24.7 pg/ml after treatment in ALL (P<0.05) and from 13.3 +/- 4 pg/ml to 45 +/- 48.1 pg/ml in AML (P<0.05). Serum G-CSF levels increased from 13.3 +/- 11.7 pg/ml to 83.3 +/- 86.8 pg/ml after treatment in ALL (P<0.05) and from 6.6 +/- 12.1 pg/ml to 28.3 +/- 11.3 pg/ml in AML (P<0.05). However, IL-6 levels were undetectable in all patients before and after therapy. These preliminary data suggest that short-course HDMP treatment could decrease serum TNF-alpha and gamma-INF and increase G-CSF and GM-CSF levels.

Preparation and in vitro dissolution of salbutamol sulphate microcapsules and tabletted microcapsules

Salbutamol sulphate is a sympathomimetic amine having a rather short plasma half-life. Aiming to achieve sustained release of this drug through microencapsulation, the coacervation method with a 1:1 core-shell ratio was used. In vitro release rate experiments were performed on the microcapsules prepared using ethyl cellulose as the coating agent and compared to the results of intact drug, the tabletted microcapsules and a commercial tablet. The release rate of salbutamol sulphate could be controlled through microencapsulation. The time for the 50% release of the drug was 15 and 90 min for the tabletted microcapsules and microcapsules respectively. The specific surface area of the intact drug was 0.35 m2/cc while it reduced to 0.06 m2/cc after encapsulation.