Sepsis: a cause of aluminum release from tissue stores associated with acute neurological dysfunction and mortality

We report six cases of patients with renal failure and exposure to aluminum who developed septicemia. In all cases the serum aluminum increased markedly. This may have contributed to the neurological dysfunction seen in five, and the deaths of four of the patients. We suggest that the rise in serum aluminum was due to the release of tissue-bound aluminum, resulting in an increase in free, diffusable aluminum and that this jeopardized both neurological function and immunocompetence.     

Contractile properties and ultrastructure of three types of muscle fibre in the dogfish myotome

Summary Three main types of fibre can be differentiated in the adult dogfish myotome at the immediate post-anal level. An outer band of muscle consists of 80–90 pale multiply innervated fibres (superficial fibres). These fibres are 80–90 m in diameter, lack M-lines and have a low Ca²⁺-activated myosin ATPase activity. Volume densities of myofibrils (V_v(my,f)) and mitochondria (V_v(mt,f)) are respectively 76 and 9.5%. Beneath this layer are around 8000 red multiply innervated fibres. These have an average diameter of 25–40 m. V_v(my,f) and V_v(mt,f) are 62 and 21% respectively, and M-lines are present. Around 11000 white focally innervated twitch fibres lie beneath the red fibre zone. White fibres with an average diameter of 80–120 m have a high Ca²⁺-activated myosin ATPase activity and V_v(my,f) and V_v(mt,f) are 78 and 5% respectively.Contractile properties of single skinned fibres were determined at 12° C. Maximum Ca²⁺ activated tensions (kN m^–2) and unloaded contraction speeds (muscle lengths s^–1) were 49 and 0.5 for superficial, 70 and 1.4 for red and 180 and 4.4 for white muscle fibres.Superficial fibres have not been reported in other elasmobranchs with the exception of the closely related nursehound (Scyliorhinus stellaris L.) It is suggested that they are specialized for sustained force generation, having a tonic (postural) rather than a locomotor role.     

Regional myocardial dysfunction: evaluation of patients with prior myocardial infarction with fast CT

A prototype ultrafast cine computed tomographic (CT) scanner, designed specifically for cardiac imaging, was used to evaluate a preliminary series of patients with prior myocardial infarction (n = 21) and a control group without coronary artery disease (n = 5). Multilevel 50-msec CT scan exposures were obtained during peripheral intravenous bolus injections of contrast medium. A comparison was made between cine-CT scans and standard left ventriculographic images in assessing segmental left ventricular motion. Results indicate that cine CT, performed at sufficiently rapid speeds (20 scans per second) to allow useful analysis of regional ventricular wall motion, can provide adequate image quality. Analysis of 110 segments revealed a good correlation (90.9%) between the two techniques in characterizing normal from abnormal regional wall motion. Cine CT, based on this initial study, demonstrates considerable potential for evaluating not only cardiac chamber dimensions but also segmental wall dynamics.     

Hypocalcaemic chorea secondary to malabsorption

A patient presented with chorea and a recent history of Crohn's disease. Investigation revealed the cause of the chorea to be hypocalcaemia secondary to malabsorption. So far as is known there has been no previous report of hypocalcaemic chorea due to malabsorption.     

Treatment of locally advanced squamous cell carcinoma of the head and neck with concurrent bleomycin and external beam radiation therapy.

Nineteen patients with advanced head and neck cancer were treated with bleomycin (15u BM and irradiation (180 rad, 5d/week, 5040 rad) and have analyzed the effects. Most patients went on to further radical treatment. Both epithelial toxicity and tumor regression seemed enhanced. Approaching 1 year minimum follow-up (2 years maximum) crude survival is 68% and disease-free survival is 57%. Late complications do not seem to be enhanced. Regression in advanced nodal disease was less impressive.     

Intracranial venous thrombosis in the first trimester of pregnancy.

We describe a fatal case of intracranial venous thrombosis occurring in early pregnancy. Such thrombosis usually occurs in late pregnancy or the puerperium but rarely during the first trimester of pregnancy. Computerized axial tomography suggested massive cerebral venous infarction. Necropsy findings showed not only cerebral venous thrombosis but also extensive pelvic and iliac vein thromboses. The relationship of cerebral venous thrombosis and pregnancy is discussed and the literature reviewed.     

Haemodialysis patients' beliefs about renal failure and its treatment

Patients' beliefs about illness are important because they influence adherence and adjustment, but they are often surprising and idiosyncratic. Qualitative research can identify them in ways that are not shaped by psychological theory, but quantification is necessary if clinicians are to be informed about the beliefs that are likely to be prevalent in their patients. Qualitative analysis of interviews with 16 haemodialysis (HD) patients identified beliefs about end-stage renal failure (ESRF) and its treatment that were formed into a questionnaire, completed by 156 similar patients. Patients attributed ESRF to diverse factors including lack of self-care and inadequate medical care. Patients lacked a clear belief in the mechanism of action of dietary control, and its necessity was not readily acknowledged. The common view of haemodialysis as 'cleansing' extended to the reassuring belief that it would purge the body of disallowed food or drink. Many patients regarded haemodialysis and dietary control as externally imposed challenges that dominated life. The findings identify potential targets for educational intervention to improve adherence and adjustment and predictions about effects of patients' beliefs that can be tested in future prospective studies.     

Carboplatin-based chemotherapy for refractory and recurrent Ewing's tumours

BACKGROUND: Failure of first line therapy for the Ewing's family of tumours (EFT) is associated with a very poor outlook. Studies of second line chemotherapy are therefore necessary to identify active agents and drug combinations. Cisplatin-based therapy is frequently used in these circumstances but there are few studies to clearly define activity and toxicity. This report details outcome in a cohort of patients with poor risk EFT treated with a carboplatin-based combination. PROCEDURE: Between 1990 and 1998, 23 males and 16 females aged between 6 and 48 years (median 23) with relapsed or refractory EFT were treated with carboplatin-based chemotherapy. Previous chemotherapy had included ifosfamide and doxorubicin in all but two patients. Twenty patients were treated at the time of recurrence, and 19 after a poor response to initial chemotherapy. Treatment comprised of carboplatin to give an area under the plasma carboplatin concentration versus time curve of (AUC) 6 mg/ml, etoposide 120 mg/m2 for 3 days, and cyclophosphamide 500-750 mg/m2 for 2 days, repeated every 21 days. RESULTS: A total of 105 cycles were given, median 2 per patient (range 1-5). Overall response was 26%, with one complete response and nine partial responses. Median time to progression was 10 weeks (range 2-54). Haematological toxicity was severe requiring dose reductions in 53% of patients. Six patients proceeded to high dose consolidation treatment with bone marrow or peripheral stem cell rescue. CONCLUSIONS: This combination results in a substantial response rate in previously treated patients but with significant toxicity. Responses are, however, relatively short.