Cutaneous foreign bodies: elusive presentation. Case report and review of the literature

Injuries by foreign bodies are a common problem in children, and sewing needles are not uncommonly found foreign bodies. Cutaneous foreign bodies are also occasionally seen, and these patients are referred to dermatologists because of skin findings resulting from body reactions. In this report we present an unusual case of a foreign body presenting as a linear skin eruption.     

The cerebellum at birth in therian mammals,with special reference to rodents

The stage of cerebellar development at birth was assessed in 23 species of placental mammals. Serial histological sections were examined and five stages in the differentiation of the cerebellar cortical layers were defined. A wide diversity of conditions at birth was found. The available evidence (after parsimony reconstruction) suggests that the last common ancestor of placentals was born with an altricial cerebellum in which the molecular layer was just present between the external granular layer and the prospective Purkinje cell layer. Some placental species have an even more altricial cerebellum at birth (e.g., Muscardinus avellanarius, Sorex araneus), with Mesocricetus auratus as the most altricial species among the taxa studied. In the newborn M. auratus a cerebellar anlage was present with only a loose accumulation of cells located at the dorsal cerebellar anlage above the ventricular neuroepithelial layer. The five species of caviomorph rodents examined here are relatively precocial as far as the cerebellum is concerned. The only other rodent species that has a similarly advanced state was the murid Acomys sp. Most of the life history variables examined were not strongly correlated with the cerebellar stage at birth if at all. However, a significant positive correlation (r(2) = 0.67) was observed between the cerebellar stage at birth and the gestation length and a significant negative correlation (r(2) = 0.31) was observed between cerebellar stage and the average litter size. The weak correlation may be due to sampling among different distantly related clades. The most mature cerebella at birth still had an external granular layer, indicating that the mossy fiber-granule cell connectivity is not yet fully developed and further indicating that this connectivity may depend on external experience to fully mature. All species that have their eyes open at birth also have the most mature cerebelli. The growth of the cortical layers was also studied in a postnatal ontogenetic series of the marsupial Monodelphis domestica. As is the case with placentals, the most advanced stage of cerebellar development coincides with the opening of the eyes.     

Polystyrene derivatives as candidates for extracorporeal adsorption of Factor VIII antibodies in the management of haemophiliac patients

BACKGROUND AND OBJECTIVES: This article presents a new approach for removing the Factor VIII inhibitors (anti-FVIII) in haemophiliac patients by immunoadsorption using an affinity matrix. MATERIALS AND METHODS: Ten blood samples from haemophiliac patients with anti-FVIII were assayed for antibodies, total immunoglobulins, procoagulant proteins and complement C3 protein after circulation over one or two columns filled with the polymers under investigation. RESULTS: These new synthetic sorbents are able to remove in vitro 90% of anti-FVIII from haemophiliac plasma with inhibitors (up to 540 Bethesda Units/ml). Neither coagulation factor adsorption nor effects on complement system activation were observed. CONCLUSIONS: The data presented clearly show that these polymers allow a rapid and efficient reduction of inhibitor titre. In view of the parameters studied, these polymers fulfil the requirements for use in a blood purification process to decrease high inhibitor titres without losing essential proteins.     

Low dose intraarterial thrombolysis with tissue plasminogen activator: does it deliver as promised?

The widespread use of intraarterial thrombolytic therapy has been based on perceived benefits over operative treatment and the downgrading of the magnitude of subsequent surgery. Thirty-three patients who had thrombolysis for peripheral artery occlusion were retrospectively analyzed at St. James's Hospital from 1991 to 1997. One patient received streptokinase unsuccessfully. Five other patient's records were inadequate for analysis. Twenty-seven patient's notes were analyzed for risk, duration of occlusion, duration of treatment, dosage of tissue plasminogen activator (tPA) and conduits thrombolysed. There were 15 males and 12 females. The mean age was 62 years (range, 20-87). Fourteen were current or reformed smokers. Five were diabetic. Indications for treatment included acute graft occlusion (n=13), embolus (n=6), and primary and secondary arterial thrombosis (n=8). Duration of occlusion was less than 24 hours in seven, 1 to 7 days in ten, and more than 7 days in ten patients. Twelve (44.44%) patients had complete clot lysis, four (14.81%) had partial clearance, and 11 (40.74%) remained occluded. Eight (29.63%) had serious complications including one death. Eighteen (66.66%) patients needed further surgical intervention to maintain graft patency. Data were analyzed using the chi-square and pooled t test. No significant difference was observed in results from thrombolysis from different conduits, gender, etiology, or smoking history. Increased duration of tPA administration was associated with an increased risk of failure. Administration of total dosages greater than 60 mg was associated with a higher risk of failure. Diabetics had a poor outcome (p=0.0520). Only 44 % of patients successfully underwent lysis. A primary surgical option may be a more sensible course than lysis, given that the vast majority of patients ended up having surgery anyway.     

Reporter Cell Lines to Monitor Steroid and Antisteroid Potential of Environmental Samples

In order to monitor the (anti)steroid activity of environmental samples, we established stable cell lines expressing luciferase under the control of estrogens, androgens, progestives and glucocorticoids. The breast cancer MCF-7 cells which express the estrogen receptor (ER), the glucocorticoid receptor (GR) and the progesterone receptor (PR) were transfected by an estrogen (ERE-Glob-Luc) or a glucocorticoid/progestin/androgen (MMTV-Luc) regulated luciferase plasmid in order to enable the detection of compounds which bind both ER, PR and GR (MELN and MMLN cells). Human prostatic cells PC3 were stably transfected by both an androgen receptor gene and the MMTV-luciferase plasmid (PALM cells). These three cellular models were validated as tools to check the estrogenic, progestive, glucocorticoid and androgenic activities using several potential xenohormones and environmental samples. As these environmental samples were fractionated after solid phase extraction to isolate active compounds, we used these cellular models to monitor the different fractions. In the estrogenic model mid-polar fractions of environmental samples were found active while in the androgenic model, the same fractions had antagonist activity.     

Generalized tonic-clonic status epilepticus: causes, treatment, complications and predictors of case fatality

We retrospectively reviewed the clinical course of 66 patients treated for generalized tonic-clonic status epilepticus at the Ege University neurological intensive care unit from 1988 to 1997. Seventy-two per cent of the study group had a pre-existing seizure disorder, and antiepileptic drug withdrawal was the most prominent cause of status epilepticus. The other causes included drug toxicity, central nervous system infection, cerebrovascular disease, tumour and trauma. Seventy-three per cent of all patients responded to the first-line therapy (diazepam and/or phenytoin), and the remainder were considered to have refractory status epilepticus and required pentobarbital anaesthesia. Overall case fatality was 21%, but death could be attributed directly to status epilepticus and/or treatment complication in 10% of the study group. Major determinants of fatal outcomes were: increasing age, longer duration of status epilepticus before initiation of therapy and central nervous system infection as a causal factor. Received: 9 December 1997 Received in revised form: 23 February 1998 Accepted: 30 March 1998     

The Three Transcobalamins in Myeloproliferative Disorders and Acute Leukaemia

The unsaturated vitamin B₁₂ binding capacity of whole serum (UBBC) and of the three transcobalamins (TC) has been studied in patients with various haematological diseases including myeloproliferative disorders (MPD) and acute leukaemia. The binding capacity of TC I and TC III was increased in MPD; TC I being particularly high in chronic granulocytic leukaemia (CGL) and TC III especially raised in polycythaemia rubra vera (PRV) and in infectious leucocytosis. The binding capacity of both TC I and TC III correlated with blood neutrophil count and the ratio TC III/TC I was low in CGL and increased in PRV. TC II was increased in acute myelogenous leukaemia, during remission and blast cell crisis of CGL and in refractory anaemia with excess of myeloblasts but not in acute lymphoblastic leukaemia (ALL). TC II correlated inversely with blood neutrophil count. There is an inverse ratio between TC II and TC I at least in myelogenous leukaemia. These abnormalities are discussed in relation to granulocyte kinetics. TC III and TC I reflect probably the total body granulocyte pool and share some biochemical and immunological properties supporting the view that they have a common origin in the more mature stages of the granulocyte cell line while TC II probably originates partly in more primitive granulocytes.     

In Vitro Studies of Bone Marrow in Refractory Anaemia

S ummary . Bone marrows of six patients with refractory anaemia have been studied for their capacity to form colonies in vitro on agar gel medium. They are not capable of forming colonies, and in this they behave as do bone marrows from patients with acute myeloblastic leukaemia in relapse.     

Spectrofluorometric determination of montelukast in dosage forms and spiked human plasma

The native fluorescence of montelukast has been studied under different experimental conditions. The highest fluorescence intensity was obtained in methanol at 390 nm using 340 nm for excitation. Surfactants and sensitizers had either a negative or a slightly positive effect on its fluorescence intensity. The fluorescence intensity-concentration plot was rectilinear over the range 0.125 to 5 microg/ml with a lower detection limit of 0.02 microg/ml (3.4 x 10(-8) M). Interference likely to be introduced from co-formulated drugs (such as loratadine) or co-administered drugs (such as verapamil, carbazepam, propranolol) or other common drugs, was studied. The method was successfully applied to the determination of the drug in tablets (pediatric tablets, chewable tablets and adult tablets). The mean % recoveries were in agreement with those provided by the manufacturer. The method was further applied to the in vitro determination of montelukast in spiked human plasma, the mean % recovery (n = 5) was 100.08 +/- 1.40.