Extended hemipelvectomy in a Jehovah's Witness with erythropoietin support

The care of patients refusing blood transfusion who require major ablative surgery for malignancy is a continuing challenge. The use of recombinant human erythropoietin is clearly efficacious in patients with renal disease and may be useful in anemic patients who refuse transfusion. Herein, we report a successful extended hemipelvectomy in a Jehovah's Witness using recombinant human erythropoietin support.

Acute clozapine overdose: plasma concentration and outcome

Clozapine is a tricyclic dibenzodiazepine derivative that is classified as an "atypical neuroleptic" drug for treatment of psychotic diseases. A 19-year-old schizophrenic female, treated with 400 mg clozapine per day, was admitted to the emergency department after ingestion of 5000 mg (50 x 100 mg tablets) of clozapine. Clozapine plasma level 2.5 hours after ingestion was 3.8 microg/ml (normal range 0.2-0.7 microg/ml) and very high in gastric lavage. Contrary to reported cases with such high plasma concentrations the patient suffered only from somnolence with intermittent periods of agitation and a mild anticholinergic syndrome with sinus tachycardia and slight hypotension. After detoxication with gastric lavage and short-term administration of pyridostigmine she remained stable, and 24 hours after ingestion she was transferred to the psychiatric unit without further sequelae. To prevent late-onset complications she was carefully monitored for five days. The clozapine plasma level 24 hours after the first measurement was normal. This case and others reported in the literature confirm that signs and symptoms after clozapine intoxication are variable and that high plasma levels are not lethal in every case.

Hyperosmotic induction of the mitogen-activated protein kinase phosphatase MKP-1 in H4IIE rat hepatoma cells

The action of hyperosmotic stress on the MAP kinase phosphatase MKP-1 mRNA expression was studied in H4IIE rat hepatoma cells. Hyperosmotic (405 mosmol/L) challenge of the cells led to a transient expression of MKP-1 mRNA, which was maximal after 6-8 h and disappeared completely after 24 h. Hyperosmotic MKP-1 mRNA induction was preceded by a transient activation of the MAP kinases Erk-1, Erk-2, and JNK-2, which were not prerequisite for MKP-1 mRNA accumulation. However, the hyperosmolarity-induced MKP-1 mRNA expression was sensitive to antioxidants and to inhibition of p38 by SB203580. A reduced sensitivity of Erk-1/Erk-2 to other stimuli was found after prolonged hyperosmotic exposure. The data are consistent with a hyperosmolarity-induced MKP-1 expression via reactive oxygen intermediates and p38, which may participate in the termination of MAP kinase activation and contribute to desensitization of the MAP kinases after prolonged hyperosmotic exposure of the cells.

Role of MRI in diagnosis of childhood sarcoidosis with fever of unknown origin

Childhood sarcoidosis is a disease with multisystem organ involvement, and initial presentation as fever of unknown origin (FUO) is relatively common. We describe herein three children (aged 9, 7, and 11 years) with sarcoidosis who were seen initially with FUO. Common clinical and laboratory features include fever of > 2 weeks' duration, weight loss, fatigue, leg pain, anemia, increased erythrocyte sedimentation rate, elevated immunoglobulin G level, negative antinuclear antibodies and rheumatoid factor, and negative purified protein derivative and Candida skin tests. Two patients had iridocyclitis, one had hilar adenopathy, and two had angiotensin-converting enzyme serum levels. All three had no evidence of pulmonary infiltrates on chest radiographs. Bone marrow biopsies for all three were normal, and with no evidence of malignancy. Plain radiographs of the lower extremities and bone scan were normal. Magnetic resonance imaging (MRI) of the lower extremities revealed intact bone architecture and multifocal nodular lesions within the marrow. Bone biopsy from the tibia performed on two patients showed normal bone trabeculae and a solitary noncaseating epithelioid cell granuloma. Noncaseating granuloma was found on reevaluation of the bone marrow biopsy in the third patient. All three patients had negative marrow stains and cultures for fungi and mycobacteria. We conclude that MRI was very useful in the diagnosis of sarcoidosis in children with FUO.

Fibrous cortical defect with bizarre nuclear features

A femoral neck fibrous cortical defect with typical radiographic features had bizarre nuclear features on histological examination. Recognition of the benign radiographic appearance, similar bizarre features of accompanying macrophages, and paucity of mitoses led us to consider this a pseudoanaplastic ischemic or degenerative change in an old fibrous cortical defect. Because the biological behavior was not known with certainty, we closely followed this case. After 25 months, there has been no recurrence or regrowth. The close cooperation between the pathologist and other disciplines facilitates recognition of these pseudoanaplastic lesions and development of treatment strategies for lesions of unknown or uncertain biological behavior.

Florid reactive periostitis

An 11-year-old boy developed florid reactive periostitis several years after minor trauma. The symptoms responded initially to antibiotics, but after cessation, rapidly recurred and progressed, requiring a ray amputation to relieve the pain and to achieve a functional hand. The reactive periostitis affected the volar aspect of two adjacent phalanges with sparing of the intervening joint, confirming that this is a reactive process rather than a benign neoplasm.

Self-starting short-pulse XeCl laser with a stimulated Brillouin scattering mirror

A commercial XeCl laser system is operated with a phase-conjugating mirror based on stimulated Brillouin scattering (SBS). No conventional start resonator is required. The near-field profile is converted from rectangular to near-Gaussian and the far-field spatial beam quality is increased by up to 60% relative to a conventional plane-plane resonator. The small reflectivity of a single SBS cell reduces the laser output power. A double-cell arrangement improves the reflectivity and the laser power, resulting in a simple excimer SBS resonator with improved brightness.

Regulation of taurocholate excretion by a hypo-osmolarity-activated signal transduction pathway in rat liver

BACKGROUND & AIMS

Hypo-osmotic cell swelling increases the capacity of taurocholate excretion into bile in the perfused rat liver. The aim of this study was to clarify the mechanisms linking cell swelling to bile acid secretion.

METHODS

The influence of hypo-osmotic cell swelling on intracellular signal transduction and bile acid secretion was studied in isolated rat hepatocytes and the perfused rat liver.

RESULTS

In rat livers perfused with hypo-osmotic buffer (225 mOsm/L), the maximum velocity of taurocholate excretion into bile is increased by 135% within 10-20 minutes. To unravel signaling events mediating this effect, the activities of the mitogen-activated protein kinases, extracellular-signal-regulated kinase (Erk)-1 and Erk-2, were measured after hypo-osmotic treatment in cultured rat hepatocytes. A rapid parallel activation of Erk-1 and Erk-2 was observed within 1 minute, which became maximal after 10 minutes and returned to the basal level within 60 minutes. The hypo-osmolarity-induced Erk activation and the increase in bile flow after hypo-osmotic liver perfusion were completely abolished by inhibitors of signal transduction at the level of G proteins and tyrosine kinases but remained unaffected by the inhibition of the protein kinase C.

CONCLUSIONS

A G protein-and tyrosine kinase-dependent but protein kinase C-independent activation of mitogen-activated protein kinases is involved in the regulation of taurocholate excretion by liver cell hydration changes.

Bone invasion by a recurrent digital fibroma of infancy in a child with Beckwith-Wiedemann syndrome

We describe a child with features of the Beckwith-Wiedemann syndrome with congenital recurrent digital fibroma of infancy that extended into and replaced the marrow of the terminal phalynx of the little finger. Digital fibromas of infancy have not previously been associated with either Beckwith-Wiedemann syndrome or invasion into underlying bone.

The role of physical therapy in craniofacial pain disorders: an adjunct to dental pain management

Treatment of craniofacial pain disorders is often complicated by diverse factors such as acute or chronic trauma and persistent postural changes. In addition, emotional issues and life stress often cloud the recovery process. Physical therapists, with their diverse knowledge base and highly competent treatment skills, can be quite effective in assisting dentists and physicians with management of the many difficult upper quarter and craniofacial pain syndromes. This article reviews the role of myofascial and craniosacral dysfunction, as well as the function of posture, tension, and stress in the development of these syndromes. Additionally, it provides a comprehensive overview of the many evaluative techniques and treatment options that can be provided by today's physical therapists.

A survey of temocillin sensitivity of strains resistant to newer beta-lactam antibiotics

The susceptibility of a total of 2014 Gram-negative clinical isolates (except Pseudomonas aeruginosa) to a number of antibiotics, including temocillin, was investigated in 2 geographically distinct areas. Overall, more strains were sensitive to temocillin than to mezlocillin, piperacillin, amoxycillin plus clavulanic acid, cefotaxime, cephazolin, latamoxef (moxalactam), cefoxitin, or netilmicin. Susceptibility to temocillin of multiple-resistant strains was studied.

[Chemotherapy of the non-small cell carcinoma of the lung with ifosfamide and cisplatin]

80 patients with inoperable non-small cell bronchial carcinoma were treated, at an interval of 4 weeks between them, with ifosfamide (2 g/m2 on days 1-5) and cisplatin (75 mg/m2, day 1). All diagnoses had been confirmed histologically. The course of 72 patients (36 with squamous carcinoma, 25 with adenocarcinoma, two with alveolar-cell carcinoma and nine with large-cell carcinoma) could be evaluated. There were four complete and 21 partial remissions (response rate 35%). In a further 14 patients temporary arrest of tumor growth was registered. Median survival time of all patients was 8.3 months, for those with complete and partial remission 11.5 months. Patients in whom the tumor progressed lived on average 3.9 months. Age and general state of the patients, as well as histological tumor type, had no influence on the results of treatment. Patients in stage IV lived, at seven months, significantly less long than those with only loco-regional spread (11 months). Main side-effects were vomiting, bone-marrow depression and neuropathy. Urotoxicity was not significant, as a result of treatment with mesna. Remission rate and survival time of these patients corresponded with the results obtained with other cisplatin combinations.

Sleeve resection of the bronchus and pulmonary artery for pulmonary lesions

The tissue preserving resections for non-small-cell bronchial carcinoma were grouped into 3 main categories: I. bronchoplastic procedures, II. angioplastic procedures, and III. concomitant bronchoplastic and angioplastic procedures, and into the subgroups of standard and extended sleeve resections. The indications were: elderly patients, impaired respiratory reserve, limited tumor growth, and palliative surgery. The analysis of 229 cases yielded follow-up data in 192 cases. The estimated 5-year survival rates were 34% in category I, 19% in II, and 14% in III. The decreasing survival is due to greater tumor burden. The operative mortality rate was 8.9% in category I, and 17% in category III, and therefore comparable with standard or extended pneumonectomy respectively. Surgical techniques and postoperative complications are discussed.

Sleeve resection of the bronchus and the pulmonary artery for pulmonary lesions

The tissue preserving resections for non-small-cell bronchial carcinoma can be grouped into three main categories: I. bronchoplastic procedures, II. angioplastic procedures, and III. concomitant broncho- and angioplastic procedures, and into the subgroups, standard and extended sleeve resection. The indication are; elderly patients, impaired respiratory reserve, limited tumour growth, and palliative surgery. The analysis of 229 cases yielded follow-up data in 192. The estimated 5 year survival rate was 34 per cent, 19 per cent and 14 per cent in categories I, II and III, respectively. The decrease in survival was due to a greater tumour burden. The operative mortality rate was 8.9 per cent in category I and 17 per cent in category III, such being comparable with standard or extended pneumonectomy, respectively. Surgical techniques and postoperative complications are discussed.

[Actual resistance of Staphylococcus aureus: beta-Lactamase production and susceptibility to various penicillins and erythromycin (author's transl)]

The actual resistance of Staphylococcus aureus from different clinics in Bielefeld was examined on the basis of 155 strains freshly isolated from clinical specimens during a period of two months. Sensitivity of these strains was assessed by minimum inhibitory concentrations (MICs) as determined by agar dilution method. As expected oxacillin proved to be the most effective compound according to its stability to beta-lactamases. Ampicillin and amoxicillin were nearly as active as penicillin G, while propicillin exhibited a higher activity than penicillin G against those strains which were moderately sensitive to penicillin G. Mics of erythromycin were similar to those of propicillin and most of the highly penicillin resistant strains proved to be resistant to erythromycin too. When comparing the acylureidopenicillins and ticarcillin nearly identical MIC values resulted for azlocillin, mezlocillin and piperacillin; ticarcillin was found to be slightly less active. The qualitative assay for beta-lactamase activity performed after induction with methicillin demonstrated strong correlation between presence or absence of beta-lactamases and sensitivity of the bacteria to penicillin G. beta-lactamase activity could be found in almost all strains with MIC greater than or equal to 0.25 micrograms/ml for penicillin G. These results are discussed with respect to the recommendations for susceptibility testing.

[Parenchyma-preserving resection techniques for bronchial carcinoma (author's transl)]

Parenchyma-preserving resection techniques are grouped into two categories: (1) Broncho- and angioplastic resections that help avoid pneumonectomy and (2) Wedge or segment resections that help avoid lobectomy. The indications are: (a) Elderly patients (70 years); (b) Impaired respiratory reserve; (c) Palliative surgery; (d) Limited tumour growth. The analysis of 288 relevant cases yielded follow-up data in 232 cases: Survival and mortality of group I operations are comparable to those after (extended) pneumonectomy; higher tumour stages prevailed in the combined plastic surgery subgroup. The data of group II are similar to those with lobectomy; the relatively high local recurrence rates render group II operation techniques unreliable until more data are available.