Spontaneous bacterial peritonitis in fulminant hepatic failure

Ascites may be associated with fulminant hepatic failure (FHF), but spontaneous bacterial peritonitis (SBP) is an extremely rare complication. We report on two patients with FHF who developed SBP. One patient died and the other recovered.     

In vitro and in vivo selectin-blocking activities of sulfated lipids and sulfated sialyl compounds

There is accumulating evidence that sulfated lipids, sulfated oligosaccharides and other sulfated compounds are reactive with selectins in a manner that interferes with selectin interactions with their natural ligands. In the report we describe the ability of sulfated lipids (sulfatides and gangliosides) and multimeric forms of sulfated sialic acid to block binding of P- and E-selectin-Ig to neutrophils. The in vivo ability of these compounds to block lung injury in rats following i.v. infusion of purified cobra venom factor (CVF), which induces injury that is L- and P-selectin dependent, was also determined as well as effects on recruitment of neutrophils, as measured by lung myeloperoxidase. There was a significant correlation between the ability of sulfated lipids and sialyl compounds to interfere in vitro with P-selectin-Ig binding to neutrophils and to protect against P-selectin-dependent acute lung injury induced by CVF. The biological effects of these sulfated compounds were also associated with diminished accumulation of neutrophils. The protective effects of these compounds may be linked to their ability to interfere with P- selectin binding to counter-receptors on neutrophils.      

Assessment of tissue reaction at suture knots; an adaptation of Sewell's scoring system

From a theoretical point of view and from reported animal work the knot side should be considered the most relevant part of the suture loop for studying inflammatory foreign body reaction. In the present study a semi-quantitative histological assessment of inflammatory tissue reaction around the knots of implanted sutures is presented. To test the reliability of this method an animal model was used in which two suture materials with well-known differences in tissue reactivity were studied. Differences in tissue response around the knots between these materials proved to be highly significant statistically (tissue reactivity score (TRS) 44.17 vs. 58.71: p less than 0.001). No differences in TRS could be demonstrated between different localizations in the anterior abdominal wall of male Wistar rats. Implications of these findings with respect to future studies are discussed.     

What did the doctor say--what did the patient hear? Operational knowledge in clinical communication

OBJECTIVES: We aim to introduce Piaget's concept of 'operational knowledge' from the cognitive theory of learning--as a contribution to the broader understanding of clinical interaction. METHOD: Our study involves a theoretical presentation of different kinds and levels of human understanding, illustrated by a case story in which the difference between operational and figurative knowledge was demonstrated. This study used the case story of a male patient aged 80, who was suffering from ulcerative colitis. We appealed to the reader's perceived relevance of these perspectives, in order to understand what was going on between doctor and patient. RESULTS: The case story demonstrates the phenomenon of operational knowledge in the patient, the close links between communicative action and cognitive understanding, and the importance for the doctor of reflecting upon this level of interaction. CONCLUSION: According to the patient-centred clinical method, the doctor should explore the social and emotional context of the patient in order to understand the meaning of the illness. We suggest that a cognitive dimension should also be added, and that the concept of 'operational knowledge' might be useful for such investigations.      

The treatment of advanced ovarian carcinoma (I): clinical variables associated with prognosis

New therapy regimens including cytoreductive surgery and cisplatin-based combination chemotherapy have improved survival for a small group of patients with advanced ovarian carcinoma. However, for the entire group survival remains poor. In this analysis of 65 patients treated at Leiden University Medical Center, the patient group that benefited the most from this approach was characterized by a younger age, good performance status, less extensive disease, low histologic grade and the absence of peritoneal carcinomatosis and ascites, and residual disease less than or equal to 15 mm (successful cytoreduction) after the first operation. Patients who did not have these favorable characteristics but in whom the first operation resulted in residual disease less than or equal to 15 mm, did survive worse than the other patients with individual tumor nodules less than or equal to 15 mm, but still better than those in whom a successful cytoreduction at the first operation could not be achieved. The diameter of the largest residual disease, the diameter of the largest metastasis before cytoreduction, and the presence of ascites and peritoneal carcinomatosis influenced prognosis. Thus the initial tumor burden as well as the burdened tumor volume left behind are of significance with respect to prognosis. However, in the Cox regression analysis the performance status and ascites proved to be the only independent factors influencing survival. A prospective study is needed to establish the proper value of cytoreductive surgery in advanced ovarian carcinoma.     

Performance of the Cytobrush in patients at risk for cervical pathology: does it add anything to the wooden spatula?

In 130 high-risk patients for cervical pathology paired smears were obtained with a wooden spatula and a Cytobrush. The Cytobrush was useful in lowering the amount of inadequate smears (2 vs 22%, p less than or equal to 0.01), and detected more abnormal cytology in combination with the spatula compared to the spatula smear alone (27 vs 35%, p less than or equal to 0.05). In 6 cases, adequate false-negative spatula smears, containing endocervical cells, were corrected by the Cytobrush. It is concluded that the Cytobrush is useful in lowering the amount of inadequate smears and false-negative cytology, while there is little evidence of false-positive cytology. The use of the wooden spatula/Cytobrush-combination is recommended in high risk populations.