Pamidronate treatment of steroid associated osteonecrosis in young patients treated for acute lymphoblastic leukaemia--two-year outcomes

AIMS: To assess outcomes of young patients with osteonecrosis (ON) treated with pamidronate in terms of relief of pain, prevention of progress and bony collapse of involved area. PATIENTS AND METHODS: A non-randomised interventional study in six patients with a history of acute lymphoblastic leukaemia (ALL) for which treatment protocols included long-term, high dose use of glucocorticoids. Subsequent development of ON was treated with a bisphosphonate (pamidronate) for 2 years. Mobility and pain control were assessed regularly with MRI and X-ray of affected areas at 0, 12 and 24 months. RESULTS: Reduction in pain was reported in four of six patients in the first year with increased mobility. Two patients who had radiological evidence of joint destruction prior to treatment and when continued on corticosteroids reported no improvement in pain or mobility. In the second year, patients who started treatment in the first few months after diagnosis were stable while patients who had treatment initiated later deteriorated but had less pain than prior to treatment with pamidronate. MRIs of affected areas were completely unchanged over 2 years. X-rays revealed no new bony collapse in four of six patients after 12 months of treatment. However, three of six patients continued to undergo extensive collapse of femoral heads (one at 12 months, two at 24 months) and all these required urgent hip replacement. CONCLUSION: Pamidronate treatment has a palliative effect in control of pain and may delay the natural history of bony collapse in the acute phase of ON, especially in early treated patients, but does not prevent late bone collapse and joint destruction in corticosteroid treated patients with ALL. Larger studies are needed to provide evidence as to whether bisphosphonate is indicated for treatment of ON for patients using corticosteroids.     

Cellular infiltration and cytokine mRNA expression in perennial allergic rhinitis

BACKGROUND: Allergen challenge in allergic rhinitis patients leads to local eosinophilia and Th2-type cytokine expression. Natural exposure to grass pollen is additionally characterized by epithelial mast-cell infiltration. We hypothesized that perennial allergic rhinitis is also associated with T-cell and eosinophil infiltration of the nasal mucosa, local Th2-type cytokine expression, and increased numbers of nasal epithelial mast cells. METHODS: Nasal biopsies from perennial allergic rhinitis patients and controls were analysed by immunocytochemistry for different cell populations and in situ hybridization for cytokine mRNA-expressing cells. RESULTS: Perennial allergic rhinitis was associated with increased numbers of submucosal CD3+ T cells (P=0.05), EG2+ activated eosinophils (P=0.01), and CD68+ macrophages (P=0.01) compared to controls. Epithelial, but not submucosal, tryptase-positive mast cells were also elevated in rhinitics compared to controls (P=0.01). The numbers of cells expressing interleukin (IL)-5 were higher (P=0.01) and the numbers of cells expressing IL-2 were lower (P=0.04) in rhinitic patients than controls. There were no significant differences for either IL-4 or interferon-gamma between the groups. CONCLUSIONS: Perennial allergic rhinitis is characterized by mast-cell migration into the epithelium; submucosal infiltration by T cells, eosinophils, and macrophages; and an imbalance in local T-cell cytokine production in favour of enhanced IL-5 and reduced IL-2 expression.     

cis-Retinoic acid stimulates the clonal growth of some myeloid leukemia cells in vitro

We studied the effects of cis-retinoic acid (cisRA) on the clonogenic growth of samples of leukemic cells from 35 patients with acute nonlymphocytic leukemia (ANLL). We observed significant inhibition of leukemic colony growth in 17 samples by 10(-7) to 10(-6)M cisRA. However, we found that retinoid exposure resulted in striking stimulation of clonal growth in ten samples at the same drug concentrations. With the exception of cases with promyelocytic features, there was no morphologic or functional evidence that cisRA induced the leukemic blasts to differentiate. Both inhibition and stimulation were dose-dependent and observable at pharmacologically achievable levels of cisRA. Leukemic cells with monocytic features more frequently demonstrated a stimulatory response than did those without monocytic features. Depletion of T lymphocytes and monocytes did not alter the type of growth response. Assays for cellular retinoic acid- binding protein (CRABP) were performed on five samples (two with inhibitory growth responses, two with stimulatory responses, and one with no growth) and failed to reveal detectable levels of CRABP in any case. The addition of cisRA to liquid suspensions of leukemic cells produced no significant change in the number of viable cells. We conclude that the effects of cisRA on leukemic colony growth are not cytotoxic and not mediated by T lymphocytes, monocytes, or CRABP. More importantly, cisRA appears to enhance the growth of certain human leukemia cells in vitro. Taking into account the increasing use of retinoids in clinical trials for patients with leukemia, the latter findings may represent a significant cautionary note.     

Titanium Mini-Plate for Securing Septal Cartilage – A Case of High-Impact Nasal Trauma

A technique is presented of securing the cartilaginous nasal septum using titanium mini-plates in the repair of a complex open comminuted type I nasoethmoid fracture, with internal impaction of the external cartilaginous nose. This technique allows primary skin closure and obviates the need for external metal-work and the attendant potential complications.     

Efficacy of oral naltrexone on pruritus in atopic eczema: a double-blind, placebo-controlled study

Aim  The intent of our study was to determine the efficacy of oral naltrexone, an opiod antagonist, in the treatment of pruritus in patients with chronic eczema.
Methods  This double-blind, placebo-controlled study recruited 38 patients with eczema complaining from pruritus. Pruritus scores were evaluated. Patients were given placebo ( n  = 20) or naltrexone 50 mg ( n  = 18) for 2 weeks period. During the study, pruritus scores based on visual analogue scale system (VAS) were assessed three times: at the start of study, after 1 week, and after 2 weeks.
Results  In both groups, decreased VAS scores were observed, but naltrexone showed to be significantly more effective than placebo in decreasing VAS score after 1 week ( P <  0.005) and 2 weeks ( P <  0.001).
Conclusion  Naltrexone is more effective than placebo in the treatment of pruritus in patient with eczema. Naltrexone might be considered as an adjunct treatment in the treatment of pruritus. However, further studies in this aspect are highly fostered.

Conflicts of interest

This study and the authors were not supported by any company with a vested interest in the product being studied and the project was funded by Skin Research Center.     

有严重躯体疾病老年自杀死亡者的特征及其有无精神障碍者间的比较

目的了解有严重躯体疾病的老年自杀死亡者的特征并比较有无精神障碍者特征的异同。方法由精神科医师运用心理解剖方法对全国23个疾病监测点上报的≥55岁的304例自杀案例的家属和周围知情人进行调查,分析其中178例(58.6%)报告自杀死亡前1年内有严重躯体疾病者的自杀特征。结果178例自杀死亡者中,女性占41.6%;79.2%居住在乡村;58.4%从未上过学;38.8%丧偶;25.8%有自杀未遂既往史;10.7%一级血缘亲属有自杀行为;43.3%服农药或鼠药自杀,32.6%上吊;68.0%自杀当时有精神障碍,主要是重性抑郁障碍;仅5.1%自杀当时有人在场。有、无精神障碍者在社会人口经济学特征、有无自杀未遂史和自杀行为家族史、负性生活事件导致的慢性心理压力和急性应激强度以及自杀前一个月的生命质量等方面的差异无统计学意义(P均大于0.05)。结论有严重躯体疾病老年人自杀死亡最常见的两种方式是服毒和上吊,2/3有精神障碍,但有无精神障碍者的自杀相关特征无明显不同。     

一所综合医院七年间因自杀急诊者的临床特征分析

目的　探讨在北京大型综合医院急诊科抢救自杀者的特征及其动态分布。方法　对 1995～ 2 0 0 1年一所综合医院急诊室登记表中诊断为自杀的患者 ,按自编回顾性调查表进行筛查并记录其特征。结果　 7年间共有15 34例自杀患者 ,占急诊室就诊人数的 2 94‰ ,未见逐年上升或下降的趋势 ;女性明显多于男性 (男∶女 =1∶2 6 ) ;年龄以青壮年为主 ,平均 ( 33 3± 15 1)岁 ;90 3%的自杀方式是服毒 ( 75 6 %使用治疗性药 ) ;17例 ( 1 1% )自杀死亡 ;春、夏季自杀患者高于秋、冬季 ;多数在晚 6～ 12时急诊 ,80 4 %在院抢救治疗时间少于 1天。结论　自杀已成为综合医院急诊患者中常见的致命问题 ,在急诊工作中应采取相应的治疗及心理干预措施     

New variant of von Willebrand disease type II with markedly increased levels of von Willebrand factor antigen and dominant mode of inheritance: von Willebrand disease type IIC Miami

A variant of von Willebrand disease (vWD) was identified in six members of a kindred spanning four generations. The proband was a 46-year-old woman with a lifelong history of bleeding, a prolonged bleeding time (> 15 minutes), markedly elevated von Willebrand factor (vWF) antigen (vWF:Ag = 2.09 U/mL), slightly reduced ristocetin cofactor activity, and a plasma vWF multimer pattern similar to that of vWD type IIC. Similar findings were observed in her three children, mother, and brother. In affected family members, platelet and plasma vWF multimer patterns were discrepant with higher molecular weight multimers observed in platelet vWF. Following a 1-Des-amino-8-D-arginine vasopressin (DDAVP) challenge, the proband failed to normalize her bleeding time even though vWF: Ag rose by 70% and higher molecular weight multimers were increased slightly. Genetic studies were consistent with autosomal dominant inheritance of a mutation within the vWF gene. By sequencing of cloned genomic DNA, mutations were excluded in exons 4, 5, 14, and 15, which encode regions of the vWF propeptide proposed to be important in multimer biosynthesis. Mutations also were excluded in exons 28 to 31, which encompass the known mutations that cause vWD types IIA, IIB, and B. This new variant of vWD, characterized by autosomal dominant inheritance, a qualitative defect that resembles vWD type IIC, and increased plasma vWF:Ag, was tentatively designated vWD type IIC Miami.