Parvovirus: the expanding spectrum of disease

Treatment of parvovirus infections among immunocompromised hosts using immunoglobulin has provided the clinician with a useful therapeutic tool but has also highlighted the problems concerning chronic disease states. The discovery of the human parvovirus B19 in 1975 and subsequent studies of its effects in humans have identified this virus as the causative agent of a broad spectrum of diseases. Recent improvements regarding the development of sensitive PCR techniques and methods for cultivation have provided new insight into its pathogenic role, its virology and immunology, and the varied clinical manifestations. The current state of knowledge concerning parvovirus enabled us to divide the long list of diseases caused by this virus into three main categories: (1) diseases found among normal hosts (asymptomatic disease, erythema infectiosum, arthropathy, hydrops fetalis), (2) hematologic diseases (aplastic crisis, chronic anemia, idiopathic thrombocytopenic purpura, transient erythroblastopenia of childhood, Diamond-Blackfan anemia) and, finally, (3) a heterogeneous group of diseases, in which the etiologic role of parvovirus is less clear and sometimes putative (neurologic disease, rheumatologic disease, vasculitic and myocarditic syndromes). In particular, arthropathy, hydrops fetalis and the hematologic disorders may be of pediatric concern. Consequently, it is of paramount importance that in all of these cases the clinician includes parvovirus as a differential diagnosis.     

Upper Limit Ventricular Stimulation in Respiratory Rate Responsive Pacing due to Electrocautery

Transient programmed upper limit stimulation (150 bpm) was observed during repetitively utilized electrocautery in the beginning of an open-heart surgical procedure in a patient with a minute ventilation rate responsive ventricular pacemaker. This tachycardia caused severe hemodynamic deterioration, and was also initiated by internal heart massage and manual ventilation. Considering the recommendations of the manufacturer, this series of serious events could have been prevented, when reprogramming to the inhibited mode had been executed in anticipation of the operation.     

Brain tumors and occupational exposures in a cohort of female textile workers in Shanghai, China

OBJECTIVES： This study assessed the associations between brain tumors and specific processes and exposures among female textile workers in Shanghai, China. METHODS： A case-cohort study was conducted that was nested in a cohort of textile workers originally included in a randomized trial of breast self-examination. Incident brain tumor cases （N=114） were identified from 1989 to 1998 from a tumor and death registry operated by the Shanghai Textile Industry Bureau. A subcohort （N=3188）, representing an agestratified random sample of the entire cohort, was selected as a comparison group.     

Donor cell leukemia developing six years after marrow grafting for acute leukemia

A patient who developed recurrent leukemia more than six years after marrow grafting from an HLA-identical same-sex sibling is reported. Difference in DNA restriction fragment length polymorphisms between donor and host demonstrated that the DNA in the recurrent leukemia sample was probably of donor origin. Possible mechanisms that could explain the long latent period between transplantation and expression of leukemic transformation are discussed. We conclude that future cases of late leukemic recurrence after marrow grafting should be studied to determine whether, in contrast to early relapses, late relapses occur in donor cells in most or all instances.     

Reconciling scientific and religious discourse about madness during the age of reason: lessons for today?

Reconciling scientific and religious discourse about madness during the age of reason: lessons for today? This paper argues that the secularization of madness, during the seventeenth and eighteenth centuries, occurred as a consequence of cultural change that accompanied the social upheavals of the age. In examining the reconciliation of competing explanations for madness, from theological and empirical viewpoints, it is suggested that these paradigms were never totally separated and argued that developments during this period were a consequence of continual interaction and dialogue between these contrasting views. Furthermore, it is suggested that an understanding of these changing times can illuminate present debates surrounding mental illness.     

The Effects of Combined Intravenous and Inhaled Steroids (Beclomethasone Dipropionate) for the Emergency Treatment of Acute Asthma

Objective : To compare the efficacy of high-dose inhaled steroids in conjunction with IV steroids with that of IV steroids alone in the emergency treatment for acute asthma.
Methods : A double-blind, placebo-controlled, randomized trial was conducted on 60 ED patients presenting with acute asthma. All patients received nebulized salbutamol, and IV methylprednisolone, 80 mg at baseline and 40 mg at 6 hours. In addition to the above therapy, the experimental group received beclomethasone dipropionate (BDP) 7 mg over 8 hours via a metered-dose inhaler (MDI) attached to a holding chamber, while the control group received a placebo administered in the same fashion. Patients were treated on the protocol for 12 hours with the primary outcome measure being the change in % predicted FEV₁.
Results : Of 60 patients, 30 were randomized to BDP (age: 42 ± 16 years; FEV₁: 0.97 ± 0.42 L) and 30 were randomized to placebo (age: 37 ± 18 years; FEV₁: 0.98 ± 0.35 L). Spirometry and dyspnea measured by the Borg Scale improved significantly in both groups compared with baseline (p < 0.001). Changes in spirometry measures, dyspnea, and vital signs did not differ between treatment groups over the 12 hours of study (p > 0.05).
Conclusion : Inhaled BDP added to the standard regimen of IV methylprednisolone, and β-agonist did not further improve flow rates or dyspnea scores measured for up to 12 hours after presentation to the ED.