Carcinoma of the lung and coexistent active pulmonary tuberculosis: diverse morphologic and radiographic presentations

Five patients with coexistent carcinoma of the lung and active tuberculosis within the same pulmonary lesion were studied. These cases represent five distinctly varying radiographic presentations and point out the extreme diversity of the morphological pictures of this particular disease combination. Physicians who regularly deal with patients who might present with either entity alone are cautioned to be alert to the possibility that these two diseases may be present simultaneously within single, specific pulmonary lesions.     

Serum antibody and opsonic responses after immunization with pneumococcal vaccine in kidney transplant recipients and controls.

We immunized 31 renal transplant patients and 6 control subjects with a pneumococcal vaccine containing 14 capsular polysaccharides. Antibody levels to Streptococcus pneumoniae types 3 and 6A were measured by a radioimmunoassay, and opsonic activity to S. pneumoniae types 3 and 6B was determined by using a luminol-enhanced chemiluminescence phagocytic assay on serum samples obtained before and 1 month after immunization. There was a 10.2-fold and a 2.9-fold increase in antibody to S. pneumoniae type 3 (P less than 0.005) and type 6A (P less than 0.01), respectively, but only a 1.3-fold (P greater than 0.05) and 1.1-fold (P greater than 0.05) increase in opsonic activity. For S. pneumoniae type 3, changes in opsonic activity correlated well with antibody concentration (P less than 0.05). However, for S. pneumoniae type 6, these two tests correlated poorly (P greater than 0.05). This poor correlation suggests that concentrations of antibody to type 6A polysaccharide which are achieved after immunization may not be opsonically active in vitro against S. pneumoniae type 6B.     

The diagnosis of recent herpes simplex virus type 2 genital infections by the simplex-2 test.

The prevalence of complement-fixing (CF) antibody against the AG-4 early antigen of herpes simplex virus (HSV) type 2 (HSV-2) was determined in patients with culture confirmed HSV-2 genital herpes and control groups using a commercial HSV-2 early antigen (Simplex-2; Gene Link Australia Ltd). Eighty seven per cent of 39 sera collected between 14 and 28 days after confirmed primary and recurrent HSV-2 infection were positive. In acute sera collected between 2-10 days after onset the Simplex-2 test was negative in all 90 patients with presumed primary infection but positive in 53% of 230 sera from recurrent infection. A specificity of 90-94.5% was obtained by testing 36 patients with recent proven HSV-1 infection and 331 control group patients. The Simplex-2 test may be useful in some cases of culture-negative, clinically suspected genital HSV-2 lesions only when sera are collected between 14-28 days after primary and recurrent infection. Its lack of specificity makes it unsuitable for the routine diagnosis of recent HSV-2 infection in the general population.     

Macular deposits in galactokinase deficiency

Deficiency of the enzyme, galactokinase, is a recognized cause of "juvenile" lens opacities; these opacities are felt to be its only clinical expression. The deficiency itself is inherited as an autosomal recessive and as such is expected to be clinically manifest in the homozygote. We have recently demonstrated cataracts and associated bilateral macular deposits in a white male who is heterozygous for the deficiency of the enzyme and whose dietary intake of milk and its products is extremely high. To our knowledge, intraretinal deposits have not previously been described in patients with galactokinase deficiency, and their clinical significance and biochemical makeup can only be speculative. Dietary restriction of galactose is recommended for all individuals proven to be deficient in this enzyme, whether homozygous or heterozygous.     

Validity of "generalized" equations for body composition analysis in male athletes

Equations by Durnin and Womersley [(D-W), Br. J. Nutr. 32:77, 1974], Jackson and Pollock [(J-P), Br. J. Nutr. 40:497, 1978], and Lohman [(L), Human Biol., 53:181, 1981] for estimating body density (BD) purportedly overcome the problem of specificity by accounting for age and/or the curvilinear relationship between skinfolds (SF) and BD. Their equations were validated on 265 male athletes against percent fat measured by underwater weighing [(UWW); mean +/- SD = 9.2 +/- 4.4%]. Equations by Sloan [(S), J. Appl. Physiol. 23:311, 1967], Katch and McArdle [(K-M), Human. Biol. 45:445, 1973], and Forsyth and Sinning [(F-S), Med. Sci. Sports 5:174, 1973] were included as "linear regression models" to compare to the curvilinear models of J-P, D-W, and L. Differences between UWW and estimated mean values ranged from -1.1 to +5.9%; correlations ranged from 0.58 to 0.85; SEE ranged from +/- 2.41 to +/- 3.61% and total error (E) ranged from 2.38 to 6.97%. The seven D-W equations overestimated mean percent fat by from 3.9 to 5.9%. The K-M, S, and L equations overestimated by 1.3, 0.5, and 1.7%, respectively. The F-S equations overestimated by 2.4 to 3.8%. Of the 21 equations evaluated, only 3 by J-P gave estimates not significantly different from UWW percent fat. Regression analyses of the relationship between UWW (y) and estimated (x) percent fat values from those equations were: y = 1.037x - 0.08 +/- 2.38, E = 2.38, r = 0.84; 0.869x + 1.36 +/- 2.45, E = 2.51, r = 0.83; 1.107x - 1.14 +/- 2.51, E = 2.53, r = 0.82.(ABSTRACT TRUNCATED AT 250 WORDS)     

TNO-6 has no effect in gastrointestinal cancer:N-acetyl-glucosaminidase shows renal damage

Twenty-five patients, 16 with gastric cancer and nine with colonic cancer, received TNO-6 30 mg m^?2 every four weeks. No objective tumour response was recorded. Nausea and vomiting occurred in 21 patients and was severe in 17. Severe marrow suppression developed in five patients. Renal function was unaffected in all but one patients who developed renal failure, probably as a result of septicaemia. However, the renal tubular enzymeN-acetyl-\-d-glucosaminidase was measured in six patients and showed a rise in all. In this study TNO-6 had no anti-tumour activity in gastrointestinal malignancy, but produced significant renal tubular damage.     

Market model addresses hospitals' need for decision support

A Decision Support System should be approached, not as “starting over,” but as a natural extension of the design and development of a hospital's current HIS. Integrated, real-time HISs generate reams of information that, when combined with relevant external data, provide the essential information base for a hospital DDS. The Travenol Market Model is discussed as an example of a DSS specific to hospital needs.     

Validation of low-cost models for minimal invasive surgery training of congenital diaphragmatic hernia and esophageal atresia

BackgroundMinimal invasive surgery (MIS) is increasingly used for the correction of congenital diaphragmatic hernia (CDH) and esophageal atresia (EA). It is important to master these complex procedures, preferably preclinically, to avoid complications. The aim of this study was to validate recently developed models to train these MIS procedures preclinically.MethodsTwo low cost, reproducible models (one for CDH and one for EA) were validated during several pediatric surgical conferences and training sessions (January 2017–December 2018), used in either the LaparoscopyBoxx or EoSim simulator. Participants used one or both models and completed a questionnaire regarding their opinion on realism (face validity) and didactic value (content validity), rated on a five-point-Likert scale.ResultsOf all 60 participants enrolled, 44 evaluated the EA model. All items were evaluated as significantly better than neutral, with means ranging from 3.7 to 4.1 (p < 0.001). The CDH model was evaluated by 48 participants. All items scored significantly better than neutral (means 3.5–3.9, p < 0.001), with exception of the haptics of the simulated diaphragm (mean 3.3, p = 0.054). Both models were considered a potent training tool (means 3.9).ConclusionThese readily available and low budget models are considered a valid and potent training tool by both experts and target group participants.Type of studyProspective study.Level of evidenceLevel II.