CNS angiitis in graft vs host disease

Graft-vs-host disease (GVHD) is a potentially treatable cause of progressive neurologic decline after bone marrow transplantation (BMT). The authors present histologic confirmation of CNS granulomatous angiitis in a child with chronic GVHD after BMT. Since cranial MRI showed only nonspecific findings, CNS vasculitis associated with GVHD after BMT may be underdiagnosed.

Use of recombinant erythropoietin in a pregnant renal transplant recipient

The use of recombinant human erythropoietin (rHuEPO) has been extensively studied among patients with anemia of chronic renal failure. Less well described is its safe use during pregnancy. We report a case of a 17-year-old gravid renal transplant patient with underlying renal insufficiency who became severely anemic and responded to rHuEPO. As the number of renal transplant recipients who become pregnant increases, the need for correction of anemia of chronic renal failure during pregnancy may rise as well. Our case illustrates the use of rHuEPO in this situation.

Adenocarcinoma of the colon metastasizing to the foot masquerading as osteomyelitis

The authors report an unusual case of adenocarcinoma of the colon metastasizing to the foot. The initial diagnosis of osteomyelitis based on clinical, radiographic, and radionuclide uptake findings led to improper prolonged treatment, resulting in a major complication. A diagnostic biopsy of the involved bone is essential in any case in which the clinical diagnosis is uncertain.

A cell line selected for resistance to ionizing radiation exhibits cross resistance to other genotoxic agents and a mutator phenotype for loss of heterozygosity events

An ionizing radiation resistant derivative was obtained from the mouse P19H22 (aprt hemizygote) embryonal carcinoma cell line by repeated exposure to 137Cs gamma radiation. Ionizing radiation resistance in the 6Gy-R cell line was not correlated with a failure to undergo cell cycle arrest or a loss of the p53 response after exposure to 137Cs gamma radiation. Moreover, the cells did not display increased resistance to bleomycin, a double strand break inducing agent. However, the cells did display increased resistance to ultraviolet radiation, ethyl methanesulfonate, and 95% oxygen. A mutational analysis demonstrated a > 700 fold-fold increase in the frequency of aprt mutants for the 6Gy-R cells, but no change in the frequency of hprt or dhfr mutants. A molecular analysis suggested that the aprt mutations in the 6Gy-R cells arose by recombinational events. A possible association between radiation resistance, DNA repair, and a mutator phenotype for large-scale mutational events is discussed.

Effects of hyperglycemia and mannitol infusions on renal hemodynamics in normal subjects

Early diabetes mellitus is characterized by an increase in glomerular filtration rate and effective renal plasma flow which may initiate and potentiate glomerular injury which ultimately results in diabetic nephropathy. To investigate the role of hyperglycemia per se in mediating these hemodynamic changes, eight healthy adults had inulin clearance, creatinine clearance, and para-aminohippurate (PAH) clearance after steady state conditions of hyperglycemia were achieved (549 +/- 86). Clearances were repeated during equivalent osmotic diuresis with Mannitol. Euvolemia was maintained by quantitative fluid and electrolyte replacement of urinary losses. Mean inulin clearances were 87 +/- 6, 87 +/- 5, and 81 +/- 4 ml/min during control, glucose, and mannitol periods (p = ns). Creatinine clearance overestimated inulin clearance by 15-32% but there were no differences between control glucose and mannitol periods. PAH clearance fell from control values of 595 +/- 29 to 340 +/- 22 ml/min during hyperglycemia (p less than .05). During osmotic diuresis with mannitol PAH, clearance rose to control values. In vitro studies excluded the possibility that conjugation between glucose and PAH can explain the clearance results. These results in normal subjects documenting renal vasoconstriction with hyperglycemia are of particular interest in view of recent experimental data suggesting that failure to vasoconstrict characterizes the hemodynamics of early diabetes.

Caffeine intoxication: a near fatality

A 37-year-old woman ingested approximately 27 g caffeine in a suicide attempt. After initial presentation with supraventricular tachycardia, hypotension, and coma, she suffered repeated episodes of ventricular fibrillation. Resin hemoperfusion was performed, with prompt stabilization of the patient's cardiovascular status. Methylxanthine toxicity is briefly reviewed.

Removal of therapeutic drugs by continuous arteriovenous hemofiltration

Plasma and ultrafiltrate drug concentrations were determined for 17 drugs in ten patients receiving continuous arteriovenous hemofiltration. Ultrafiltrate concentrations were not always predictable because of multiple factors, which may include altered drug-protein binding in these very ill patients.

Drug prescribing in renal failure: dosing guidelines for adults

The data base for rational guidelines to safe, efficacious drug prescribing in adults with renal insufficiency are presented in tabular form. Current medical literature was extensively surveyed to provide as much specific information as possible. When information is lacking, however, recommendations are based on pharmacokinetic variables in normal subjects. Nephrotoxicity, important adverse effects, and special considerations in renal patients are noted. Adjustments are suggested for hemodialysis and peritoneal dialysis when appropriate.