Thrombotic Disease in Hemophilic Patients: Is This a Paradox in a State of Hypocoagulability?

Hemophilia patients have a deficiency in or dysfunction of clotting factors, which can lead to a bleeding tendency. However, paradoxically, some hemophilia patients may also be at an increased risk of developing thrombotic events such as deep vein thrombosis or pulmonary embolism. The pathophysiology of thrombosis in hemophilia patients is not fully understood, but it is thought to involve a complex interplay of various factors, including the severity of the hemophilia, the presence of other risk factors such as obesity, smoking, or the use of hormonal therapies, and the presence of certain genetic mutations that increase the risk of thrombosis. In addition, it has been suggested that the use of clotting factor replacement therapy, which is a standard treatment for hemophilia, may also contribute to the development of thrombosis in some cases.

Effectiveness and Safety of Wide Awake Local Anesthesia no Tourniquet (WALANT) Technique in Hand Surgery

The aim of the study was to confirm the effectiveness and safety of wide awake local anesthesia no tourniquet (WALANT) technique in hand surgery, to present our results and to encourage its use on Romania and all over the world. The study group consisted of 120 patients in which local anesthesia with 1% lidocaine and 1: 100,000 epinephrine solution was used. The conditions requiring surgery were Dupuytren disease (DD) stages II and III affecting one or two digital rays, carpal tunnel syndrome (CTS), trigger finger (TF), rupture of the flexor pollicis longus�(FPL) tendon. The amount of anesthetic used, onset time, intraoperative bleeding, surgeon�s comfort during surgery, patient�s comfort, operative time, the immediate postoperative complications and length of hospital stay were evaluated, correlations between these parameters being made with the help of SPSS 20.0 software using regressions (ANOVA), and taking into account Pearson correlation coefficients with statistical significance, alpha at most .05 and CI 95%. In the group of 120 operated patients (58 men - M and 62 female -F) (M/F ratio = 0.93), no cases of digital necrosis or other vascular complications were recorded. Also, the absence of tourniquets did not result in intraoperative bleeding causing discomfort to the surgeon. The amount of anesthetic varied, being less than that recommended in the literature in approximately 40% of the cases. In all cases, patient comfort and satisfaction were highest, and length of hospital stay was several hours. Phentolamine, an antidote used to reverse the effects of epinephrine, was not used in any case. The correlation coefficient between the amount of anesthetic and waiting time = 0.3372 (p = 0.0001) � positive, direct, moderate, and statistically significant correlation. The correlation coefficient between the amount of anesthetic and length of hospital stay = 0.2700 (p = 0.002) - positive, direct, weak and statistically significant correlation. Correlation coefficient between age and length of hospital stay = 0.1361 (p = 0.1380) - positive, direct, weak correlation, but statistically insignificant. WALANT technique is safe and has many advantages: no need it is not necessary to use the tourniquet and intravenous sedation, surgeon and patient comfort is maximum, there is no risk of finger necrosis, intraoperative collaboration and last but not the least, hospital stay is short and costs are minimal.

Management of Collapse Tibial Plateau Fractures Using a Hydroxyapatite-Tricalcium Phosphate Ceramic(ATLANTIK�) and Plate Osteosynthesis

The treatment of bone defects in complex proximal tibial plateau fractures is a challenging situation and biphasic tricalcium phosphate (BCP) ceramics are considered the most promising alternative to autologous bone graft. The aim of the experimental part was to retrospectively asses the use of Atlantik� BCP (a mixture of 70% Hydroxyapatite and 30% beta-tricalcium phosphate) combined with plate osteosynthesis for management of 27 collapse tibial plateau fractures. All fractures healed after a mean time 2.8 months, while the mean time for disappearance the radiolucent zones between the implanted ceramic and receiving tissue was 15 weeks. We noticed a Neer score of 85 points with no reaction to bone substitute or evidence of biomaterial degradation. The study demonstrated that biphasic ceramic biomaterial Atlantik�, combined with supportive plate osteosynthesis, is an effective synthetic bone substitute due to a fast healing and good quality osseointegration.

Bortezomib-induced hyponatremia: tolvaptan therapy permits continuation of lenalidomide, bortezomib and dexamethasone therapy in relapsed myeloma

The development of hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion (SIADH) is well recognised in multiple myeloma (MM). SIADH, due to either MM or Bortezomib can be hazardous as severe hyponatremia may develop if large volumes of hypotonic intravenous fluid are used as an adjunct to chemotherapy. We report a case of Bortezomib-induced SIADH, in whom the use of tolvaptan, a vasopressin receptor-2 antagonist, permitted the continuation of triple combination anti-MM therapy with lenalidomide, Bortezomib and dexamethasone (RVD) in a female with aggressive disease, without the development of hyponatremia. Our patient had a rapid relapse, in which the use of Bortezomib as part of an RVD regimen was life-saving. The use of tolvaptan allowed continuation of therapy that is usually halted in other similarly reported cases. This case highlights the possible use of vaptans, which allows an aquaresis to occur by blocking the antidiuretic effects of vasopressin, as a treatment for Bortezomib-induced hyponatremia.

Afatinib in advanced pretreated non-small-cell lung cancer- a Canadian experience

Background

Afatinib, an irreversible epidermal growth factor receptor tyrosine kinase inhibitor (egfr tki), is approved for first-line therapy in advanced EGFR mutation-positive non-small-cell lung cancer (nsclc) and has previously demonstrated activity after failure of chemotherapy and reversible egfr tkis, with improved response and progression-free survival, compared with placebo. Outcomes in pretreated patients with advanced nsclc receiving afatinib through a Canadian special access program (sap) are reported here.

Methods

Patients with nsclc progressing after at least 1 line of chemotherapy and an egfr tki were eligible to enrol in the sap. Characteristics of patients from the two largest accruing Canadian centres were retrospectively reviewed, including demographics, disease and treatment data, and patient outcomes.

Results

The 53 patients who received afatinib (57% women, 51% never-smokers, 26% of East Asian ethnicity, and 66% with adenocarcinoma) had a median age of 59 years. EGFR mutations were documented in 25%, and EGFR wild-type in 8%. All patients had received prior egfr tki treatment, with 42% achieving a response. Patients took afatinib for a median of 2 months (range: 0-26 months); 17% required 1 or more dose reductions. Of 47 evaluable patients receiving afatinib, 10 experienced tumour shrinkage, and 11, stable disease. Median survival from afatinib initiation was 5 months (95% confidence interval: 2 months to 8 months). Grade 3 or greater diarrhea, rash, paronychia, and stomatitis were seen in 9%, 11%, 6%, and 4% of patients respectively.

Conclusions

In an unselected population of pretreated patients with advanced nsclc after tki failure, median survival with afatinib therapy was 5 months. Through a sap, afatinib demonstrated activity in clinical practice, with manageable toxicity.

Nonacog Alpha - an Efficient Therapeutic Option in Hemostase Management for Hemophilia Type B in Patients with Elective Arthropalsties

Hemophilia is a hereditary coagulopathy that is largely in the attention of developing countries, not because of its low incidence, but because of the high costs involved in the treatment of the disease and its disabling consequences of the disease, if treated inappropriately. The concentrates of coagulation factors currently available for the substitution treatment of hemophilic patients have undergone additional viral purification and inactivation techniques, in order to achieve a higher infectious safety, an aspect that also implies an increase in treatment costs for these patients. Currently, the major morbidity of patients with hemophilia is represented by the disabling articular pathology, secondary to repetitive bleeding episodes developed in the articular space. Although it has been proved that the prophylactic administration of coagulation factors helps to prevent joint disease in the case of patients that were not subject to prophylaxis, the repeated bleeding in the joints induces synovitis, which is irreversible and may progress despite subsequent prophylaxis. Under these conditions, total joint arthroplasty remains the only solution to reduce both, pain and subsequent bleeding episodes of hemophilic arthropathy. Effective hemostasis is a basic condition for successful interventions in hemophilic patients. In this regard, this paper aims to highlight the effectiveness of Nonacog Alpha, a product that contains recombinant factor IX, in the management of hemostasis, in the case of a patient with type B hemophilia, with indication of total endoprosthesis of the left hip.

Moroctocog Alfa Efficacy in Hemostasis Management in A Type Hemophilia Patients with Elective Arthroplasty

Type A haemophilia is a hereditary coagulopathy caused by coagulation factor VIII deficiency as part of the rare, life-threatening and at-risk group of diseases that has been attributed over time a life-saving substitution treatment providing to patients diagnosed with this pathology a hope for life and quality of life similar to that of healthy population. However, substitution treatment is very expensive so that nowadays globally most patients cannot benefit from proper healthcare. The quality of healthcare is dependent on the socio-economic level of each country, being decisively influenced by the power of the National Hemophilia Organizations to generate solidarity and support of decision-makers of each country. One of the bleeding manifestations specific to haemophilia is haemarthrosis. Each haemorrhagic episode causes locally a disorder that predisposes to relapse, with the onset of the main chronic complication of this condition, haemophilic arthropathy. It has a slow evolution throughout the life of the patient and generates in time severe sequelae (ankyloses) that require total arthroplasty. Effective hemostasis is the essential element for performing this type of orthopaedic surgery, due to bleeding risk that is of vital nature, in this category of patients. In this sense, this study aims to underline the efficacy of Moroctocog alfa in the management of haemostasis in haemophiliac patients with total endoprosthesis indication, aimed to reduce joint pain and improve locomotor function.

Reasons for lack of referral to medical oncology for systemic therapy in stage IV non-small-cell lung cancer: comparison of 2003-2006 with 2010-2011

Introduction

Only approximately 25% of stage iv non-small-cell lung cancer (nsclc) patients receive systemic therapy. For such patients, we examined factors affecting referral to a cancer centre (cc) and to medical oncology (mo), and use of systemic therapy.

Methods

Using the Glans-Look Lung Cancer database, we completed a chart review of stage iv nsclc patients diagnosed in Southern Alberta during 2003-2006 and 2010-2011, comparing median overall survival (mos), referral, and treatment in the two cohorts.

Results

Of the 922 patients diagnosed in 2003-2006 and the 560 diagnosed in 2010-2011, 94% and 82% respectively were referred to a cc, with 22% and 23% receiving traditional chemotherapy (tctx). Referral to a cc or mo and use of tctx correlated with survival (p < 0.0001): The mos duration was 11.2 months in those receiving tctx and 1.0 months in those not referred to a cc. The overall mos duration was similar in the two cohorts (4.1 months vs. 3.9 months, p = 0.47). Major reasons for lack of referral to mo included poor functional status, rapid decline, and patient wish, which were similar to the reasons for forgoing tctx. In the two cohorts, 87 (9.4%) and 42 (7.5%) patients received epidermal growth factor inhibitors, with a mos duration of 16.2 months. Multivariable analysis showed that male sex [hazard ratio (hr): 1.16; p = 0.008] and pulmonary embolus (hr: 1.2; p = 0.002) correlated with worse survival. In contrast, receipt of chemotherapy (hr: 0.5; p < 0.001) and enrolment in a clinical trial (hr: 0.76; p = 0.049) correlated with better survival.

Conclusions

Our experience confirms that, over time, uptake of systemic therapy, including tctx and targeted therapy, changed little despite their established efficacy. Most of the factors limiting systemic therapy uptake appear to be non-modifiable at the time of referral. Rapid diagnosis and the availability of well-tolerated drugs for all nsclc patients will likely be the most important factors in increasing systemic therapy uptake in this population.

Strontium Ranelate in the Healing of Fractures Complicated with Delayed Union. It is Really Effective?

Osteoporosis is a systemic skeletal disease characterized by low bone strength, which leads to an increased risk of fracture. The primary objective of osteoporosis treatment is the prevention of fragility fractures and the secondary objective is their rapid healing if they occur. Strontium ranelate is an antiosteoporotic therapeutic agent with a double action mechanism: the increase of bone formation and the decrease of bone resorption, contributing thus to the improvement of bone healing. Preclinical studies have demonstrated the efficacy of strontium ranelate for the improvement of bone healing and bone microarhitecture, as well as of the osteointegration of implants. Some clinical cases have been reported regarding the efficacy of strontium ranelate in the healing of long bone fractures complicated by nonunion or delayed union. In the present study we have reported 2 clinical cases that demonstrate the effectiveness of the treatment with strontium ranelate (Osseor) for 3-6 months in the healing of complicated long bone fractures with delayed union. Our cases confirm the results of the open label study CL3-12911-036 (delayed union and non-union fracture study), where the treatment with 2 g/day of strontium ranelate improved healing and led to a better quality of life. Even if there are some cardiovascular contraindications, strontium ranelate is proven to reduce vertebral and non-vertebral fracture risk in osteoporosis and in the same time improves bone microarchitecture and accelerates fracture healing.

The Efficiency of Recombinant Alpha Eptacog in Haemostatis Management of Haemophilic Patients with Elective Arthroplasty

Haemophilia is considered to be the most severe coagulopathy, characterized by a deficiency either of factor VIII (hemophilia A) or coagulation factor IX (hemophilia B), presenting various degrees of severity depending on the residual factor level. Haemarthrosis is the most common clinical expression of a haemophiliac patient. Its repetitive character will cause irreversible lesions in the joints, which mark the beginning of a chronic condition - haemophiliac arthropathy, which slowly develops throughout the patient�s life, leading eventually to ankylosis. Over time, these joints will require total prosthesis, in order to improve locomotor activity. Achieving effective hemostasis is an essential element for the possibility of performing this type of surgery, due to the increased risk of bleeding, of a vital nature, at this category of patients. A series of clinical trials have been carried out to research the role of the Eptacog Alpha Recombinant treatment in the reduction of bleeding in haemophiliac patients with present inhibitors, to whom total arthroplasty is carried out at the level of various joints. In this regard, this paper aims to highlight the effectiveness of Eptacog Alpha Recombinant in the management of haemostasis in haemophiliac patients, with indication of total endoprosthesis.

Hyaluronic Acid and Chondroitin Sulfate Viscosupplementation in Severe Arthropathy of Hemophilic Patients

Type A hemophilia is a hereditary coagulopathy caused by coagulation factor VIII deficiency, clinically characterized by hemorrhagiparous phenomena of different intensity, depending on disease severity or on the intensity of the injury suffered by the patient. The severe forms of the condition may become complicated by spontaneous sometimes even life-threatening bleeding, in the absence of factor VIII substitution treatment. Considerable bleeding may occur at the intraarticular, intramuscular or mucosa level, whereas life-threatening bleeding may occur anywhere in severe injuries. Two types of hemorrhagiparous are specific to the disease and are also the most common: hemarthroses and hematomas. As far as hemarthroses are concerned, each joint hemorrhage episode causes a topical disorder, which predisposes to recurrence, with the onset over time of the main chronic complication of this condition, hemophilic athropathy, which progresses slowly throughout the patient�s life and generates severe sequellae (ankylosis). This paper aims at emphasizing the importance of viscosupplementation by the injection of hyaluronic acid and chondroitin sulfate in the joints of hemophilic patients with severe athropathy, with a view to improving the locomotor function, to reducing the number of bleeding episodes and joint pain.

Efficiency of Tranexamic Acid in Management of Surgical Orthopedic Bleeding in Patients with Haemophilia

Haemophilia is an inherited bleeding disorder (gonosomala recessive, related to chromosome X, with transmission from carrying women to male descendents) characterised from the clinic point of view by important bleeding, secondary to some minimum and biologic traumas by deficiency of trombo-plastino-formation, consecutive to either a deficit of factor VIII (haemophilia A), or the factor IX (haemophilia B). The most characteristic manifestation of hemophilia is intra-articular � hemarthrosis. Its repetitive character leads to irreversible lesions of the articular structures, inducing lesions of the synovium with degenerative effects over the articular cartilage and destructive effects for the subchondral bone tissue. In time, these lesions require orthopaedic surgery to improve the locomotor activity. Managing an efficient hemostasis is vital during surgery, due to high risk of bleeding triggered by coagulopathy and surgery. Numerous studies carried out underlined the efficiency of the tranexamic acid (TXA) in reducing bleeding, in different surgery branches, by inhibiting the enzymatic degradation of fibrin. In orthopaedic surgery, the tranexamic acid is frequently used in case of hip and knee arthroplasties, reducing the bleeding and blood transfusion necessary to the treatment of posthaemorrhagic anemia. This paper wants to assess the efficiency of the tranexamic acid in realization of hemostasis to another category of patients, haemophiliac patients with indication of total hip and knee endoprosthesis.

THE PREVALENCE AND CLINICAL PROFILE OF MULTIPLE SCLEROSIS IN TIMIS COUNTY, ROMANIA

Introduction. Multiple sclerosis is a neurodegenerative disease for which correct prevalence and incidence data are mandatory to assess the long term health policy in terms of social and economic burden. The present study aims to evaluate the prevalence of MS and the distribution of clinical MS forms in Timis County, a region inhabited by 3.39% of the Romanian stable population according to the 2011 Romanian census, and is meant as a sample of the national situation. There have been no previous attempts to assess the MS prevalence status in Timis County. Material and methods. This study was conducted in a well-defined geographical area (i.e. the Timis County which lies in the Western region of Romania) exploring the prevalence of MS and the patients’ clinical profile. The information regarding MS patients was obtained using hospital records and the files of the patients treated and followed up in the Romanian National MS Program for treatment of MS. Results. The crude calculated prevalence was 53.6 per 100,000 inhabitants. The F:M ratio was 1.7 corresponding to a number of 220 (65.4%) females and 116 (34.5%) males. Discussions. This study is the first attempt to estimate the prevalence of multiple sclerosis in Timis County as part of an ongoing project of the National Romanian Society of Neurology to build up the Romanian MS Registry and our results indicate higher prevalence values than expected, fact due to an increased diagnostic accuracy provided by clear cut diagnosis criteria and MRI standardized magnetic resonance imagery procedures currently available.

MS TREATMENT OPTIMIZATION: FACTORS ASSOCIATED WITH POOR CLINICAL RESPONSE IN NAB POSITIVE PATIENTS

Background and purpose. Interferon beta (IFN beta) belongs to the first line of disease modifying therapy drugs in the treatment of relapsing-remitting multiple sclerosis being widely used in the chronic treatment of this pathology. The serum presence of the neutralizing antibodies (Nabs) has been shown to alter the treatment response, its routine applicability being still debated. In an observational study, we aimed to determine in the Nabs positive patients, correlations with other clinical factors which contribute to IFN beta decreased efficacy. Methods. We measured Nabs in 104 patients who were on IFN beta therapy (29.8% on IFN beta 1a s.c., 27.88% on IFN beta 1a i.m. and 42,3 on IFN beta 1b s.c.) for at least one year in our clinic. Serum was collected at 24 h after treatment injection to avoid transitory antibody peak (12-18 h post administration). We considered positive the patients with a titer higher than 20 TRU. Results. The prevalence of Nabs in our group of patients was 13.43% (42.85% IFN Beta 1b s.c., 50% IFN beta 1a s.c. and 7.14% IFN beta 1 a i.m.). Nabs positivity was associated with an increase in the relapse rate (for IFB beta 1a and 1b s.c. groups) and progression for IFN beta 1 b s.c. patient group. Conclusions. The routine clinical testing for Nabs should impact the clinical decision of switching therapy in multiple sclerosis patients that present with an increased number of relapses, EDSS progression or a higher number of MRI T2 lesions.

Oculoleptomeningeal Amyloidosis associated with transthyretin Leu12Pro in an African patient

Oculoleptomeningeal amyloidosis is a rare manifestation of hereditary transthyretin (TTR) amyloidosis. Here, we present the first case of leptomeningeal amyloidosis associated with the TTR variant Leu12Pro mutation in an African patient. A 43-year-old right-handed Nigerian man was referred to our centre with rapidly progressive neurological decline. He presented initially with weight loss, confusion, fatigue, and urinary and erectile dysfunction. He then suffered recurrent episodes of slurred speech with right-sided weakness. He went on to develop hearing difficulties and painless paraesthesia. Neurological examination revealed horizontal gaze-evoked nystagmus, brisk jaw jerk, increased tone, brisk reflexes throughout and bilateral heel-shin ataxia. Magnetic resonance imaging showed extensive leptomeningeal enhancement. Cerebrospinal fluid analysis showed a raised protein of 6.4 g/dl. Nerve conduction studies showed an axonal neuropathy. Echocardiography was characteristic of cardiac amyloid. TTR gene sequencing showed that he was heterozygous for the leucine 12 proline mutation. Meningeal and brain biopsy confirmed widespread amyloid angiopathy. TTR amyloidosis is a rare cause of leptomeningeal enhancement, but should be considered if there is evidence of peripheral or autonomic neuropathy with cardiac or ocular involvement. The relationship between different TTR mutations and clinical phenotype, disease course, and response to treatment remains unclear.

Zinc in health and chronic disease

Zinc is a trace element essential for the optimal function of a variety of biochemical and physiological processes. Its role in healthy aging is particularly important as it prevents neo plastic cell growth, is involved in mitotic cell division, DNA and RNA repair. Although zinc is widely available in food, the daily intake in many persons may be suboptimal. Other causes of low zinc concentrations may be due to small bowel conditions that cause mucosal damage and thus decrease absorption. Chronic diseases associated with alterations in zinc status are bronchial asthma, rheumatoid arthritis and Alzheimer disease. At present it is uncertain if therapy with zinc would assist in the management of these chronic diseases. In view of the important cellular functions of zinc in the human body, a diet with an adequate zinc content is beneficial in promoting healthy aging and maintaining good health.

Fusarium sp. growth inhibition by wheat germ agglutinin

The antifungal role of wheat germ agglutinin (WGA) isolated from a Romanian dihaploid variety of wheat against two pathogenic fungal species of Fusarium, F. graminearum and F. oxysporum, is demonstrated. WGA was prepared from unprocessed wheat germs by a new purification procedure using chitin and fetuin-Sepharose as affinity chromatography supports. SDS-PAGE and chitinase assay showed that the WGA preparation migrated as a single protein band and was devoid of any contaminating enzyme chitinase, well known for its antifungal effects. Based on its affinity for N-acetylglucosamine residues, WGA binding to the chitin-containing walls of the fungi was detected by fluorescence microscopy using WGA coupled with fluorescein isothiocyanate (FITC). In vitro testing of WGA action on early developmental stages of both fungal strains resulted in various modifications of the germ tubes, visualised by light microscopy: swelling, vacuolation of the cellular content and lysis of cell walls. Viability tests performed on potato tuber slices showed that the microbial infection was prevented from spreading by pretreatment of the fungal suspension with WGA.

Transendoscopic laser treatment of rostral displacement of the palatopharyngeal arch in four horses

OBJECTIVE

To document the use and clinical outcome of transendoscopic laser techniques for treatment of rostral displacement of the palatopharyngeal arch (RDPA) in horses.

SUMMARY BACKGROUND DATA

Rostral displacement of the palatopharyngeal arch is a rare cause of upper respiratory noise and exercise intolerance in horses, and may be associated with abnormal laryngeal anatomy. There are few reports of successful treatment of this condition, and no reports of the treatment of RDPA using laser techniques.

METHODS

The diagnosis of RDPA was based on the presence of palatal tissue covering the dorsal aspect of the arytenoid cartilages on endoscopic examination. Either a neodymium:yttrium aluminum garnet (Nd:YAG) laser noncontact technique (1060 nm, 100 W continuous mode) or a diode laser contact technique (808 nm, 14 W, continuous mode) was used.

RESULTS

In 3 horses in which the Nd:YAG laser was used, displaced palatal tissue was not fully divided at surgery, but separated after latent thermal necrosis within 3 days. In the horse in which the diode laser was used, tissues were fully divided at the time of surgery. Two horses had abnormal laryngeal anatomy and laryngeal hemiplegia. One of these 2 horses was subjected to arytenoidectomy, and had limited success as a race-horse, while the other was retired as a broodmare. One of 2 horses with no other laryngeal abnormalities raced once unsuccessfully, while the other horse was never raced.

CONCLUSIONS

Rostral displacement of the palatopharyngeal arch may be corrected in standing horses using transendoscopic surgery, but despite successful ablation of displaced tissue the prognosis for athletic performance is poor.

Saquinavir-mediated inhibition of human immunodeficiency virus (HIV) infection in SCID mice implanted with human fetal thymus and liver tissue: an in vivo model for evaluating the effect of drug therapy on HIV infection in lymphoid tissues

Treatment with protease inhibitors alone or in combination with inhibitors of reverse transcriptase potently suppresses levels of human immunodeficiency virus (HIV) RNA in plasma and thereby may significantly delay the progression of HIV-mediated disease. To investigate the effect of treatment with the protease inhibitor saquinavir on HIV replication in the lymphoid tissues, we used a SCID-hu mouse model that we developed, in which human thymic and liver tissues (hu-thy/liv) were implanted under both kidney capsules in SCID mice (thy/liv-SCID-hu mice). These mice are populated in the periphery with large numbers of human T cells and develop disseminated HIV infection after intraimplant injection. thy/liv-SCID-hu mice with established HIV infection that were treated for 1 month with saquinavir had a significantly lower viral load present in the implanted hu-thy/liv and mouse spleen than did the untreated HIV-infected thy/liv-SCID-hu mice. To examine the capacity of acute treatment with saquinavir to prevent HIV infection, some thy/liv-SCID-hu mice were inoculated with HIV and then immediately started on saquinavir. Although treated mice had markedly lower viral loads in the thy/liv implants and spleens, HIV infection was not completely prevented. Thus, the effect of antiviral therapy on HIV infection in the major site of HIV replication, the lymphoid tissues, can be readily evaluated in our thy/liv-SCID-hu mice. These mice should prove to be a useful model for determining the in vivo effectiveness of different therapeutic interventions on acute and chronic HIV infection.

Mucosal morphology, cell proliferation and faecal bacteriology in acute pouchitis

A study was performed to investigate whether acute reservoir ileitis (pouchitis) is associated with specific changes in mucosal morphology, crypt cell kinetics and faecal bacteriology in the ileal pouch. Forty-six patients were studied (ileal reservoir, 36; end ileostomy, ten) using clinical grading, sigmoidoscopy and biopsy; 24 patients with a reservoir were restudied after therapy for 1 month with metronidazole 400 mg three times daily. An index of villus atrophy and crypt cell production rate (CCPR) were determined in all biopsy material. Faecal bacteriology was assessed in 12 patients with a pouch before and after metronidazole therapy. The mucosa of patients with pouchitis was associated with a lower villus atrophy index (P = 0.052), a higher CCPR (P = 0.03) and a higher grade of acute inflammation than that in those without pouchitis. There was no difference in faecal bacterial counts between patients with and without pouchitis. A low atrophy index correlated with a high CCPR (P < 0.001), worse functional score (P < 0.001) and more severe pouch mucosal acute inflammation (P < 0.001), but not with faecal bacteriology. Following metronidazole therapy there was resolution of acute pouch inflammation, increased villus atrophy index (P = 0.049), decreased CCPR (P = 0.049) but no differences in faecal bacterial counts apart from Bacteroides species. These data show that metronidazole therapy does not specifically alter the growth of common faecal bacteria in patients with pouchitis, apart from Bacteroides species. However, metronidazole causes resolution of the typical changes in pouch mucosal morphology and crypt cell kinetics associated with pouchitis.

Antifungal properties of lectin and new chitinases from potato tubers

We have purified from potato tubers, the lectin STA devoid of chitinase activity and two chitinases devoid of lectin activity. Both enzymes are 16 kDa glycoproteins, and probably belong to a new family of plant chitinases. The respective antifungal properties of lectin and chitinases were studied by following their effects against early developmental stages of Fusarium oxysporum, a fungal potato pathogen. Here we demonstrate that: (1) lectin does not inhibit mycelial growth but irreversibly inhibits conidia germination and alters the germ tubes; and (2) chitinases block mycelial growth as well as conidia germination and lyse germ tubes.

[Clinico-radiologic and morphopathologic aspects of mediastinal-pulmonary hemangiopericytoma]

The paper points out the diagnosis of intrathoracic hemangiopericytoma in 13 patients in the "M.Nasta" Institute of Pneumophthisiology, a seldom seen disease considered quite serious because of its malignant form and its late finding out. This is due to its non-distinctive, small number of symptoms, which has a negative influence upon the disease prognosis and evolution.

A post-marketing surveillance survey on the use of dipotassium clorazepate in clinical practice in the Philippines

A post-marketing surveillance survey of dipotassium clorazepate usage was carried out in the Philippines between July 1990 and April 1991. Data were analyzed on 562 patients suffering from conditions in which anxiety was a major component. The results suggest that the medication was prescribed in accordance with the generally accepted best practice for benzodiazepines. Overall, 85% of patients were reported to have recovered and only 2% reported minor side-effects. Dipotassium clorazepate was thus confirmed to be a highly effective and relatively safe anxiolytic agent.

Laser Doppler assessment of human colonic blood flow

We have used laser Doppler flowmetry to assess human colonic blood flow in patients with healthy mucosa and in those with active proctitis. We report a significant correlation between colonic serosal laser Doppler flux readings and serosal tissue oxygen tension (n = 45: r = 0.671: p = 0.001). Mucosal blood flow was measured using the PF309 probe of a Perimed Pf2b set on 12 kHz frequency shift. There was no significant difference throughout the colon in healthy patients. The flow in rectal mucosa was significantly higher in patients with proctocolitis than in normal mucosa.

Clinical and radiographic features of simple and hydatid cysts of the liver

The advances of hydatid chemotherapy and the non-operative management of simple (epithelial) hepatic cysts make a correct diagnosis of increasing importance. Twenty-six patients with hepatic hydatid cysts and eleven with simple cysts were reviewed. In both groups clinical presentation was most frequently due to pain. Sex, age and size of the cysts were similar. Hydatid serology was negative in six of the hydatid patients (23 per cent). None of the simple cyst patients had positive serology but one had a borderline titre. Ultrasound and computerized tomography identified daughter cysts within the main cyst in only 17 hydatid cysts (65 per cent) and considerable intra-cyst debris was also present in five of the simple cysts. Seven of the simple cysts were deroofed surgically and the remainder underwent percutaneous aspiration. Sixteen of the hydatid cysts were found to have a biliary communication whereas this was not found with any simple cyst. The difficulties in making a precise diagnosis in some patients with a liver cyst should deter the interventional radiologist and restrain the hydatid chemotherapist.