Pulmonary infection following exodontia in a patient with glycoprotein-180 deficiency

There is a significant increase in the occurrence and severity of infection in patients with immunodeficiencies, especially after minor invasive procedures. Therefore, alternatives to invasive procedures, continual vigilance of indwelling catheters, and appropriate preoperative evaluation and management of these patients are of paramount importance.     

Invited review: peripheral neuropathy in Sjogren's syndrome

Our experience and review of the literature reveal that Sjogren's syndrome (SS) is an important, poorly recognized cause of peripheral neuropathy. Several forms of peripheral nerve dysfunction occur in SS including trigeminal sensory neuropathy, mononeuropathy multiplex, distal sensory neuropathy, distal sensorimotor peripheral neuropathy and a pure sensory neuronopathy syndrome. Rarely, chronic relapsing inflammatory polyneuropathy and multiple cranial neuropathies appear. Clinical evidence of glandular involvement is often minimal or absent when patients with SS develop peripheral neuropathy; and the diagnosis of the underlying condition is elusive. We review clinical and laboratory features of this disorder and suggest appropriate evaluation of patients with neuropathy and suspected SS.     

Immunophenotypic analysis with enhanced sensitivity of detection by enzymatic amplification staining.

Single cell analysis by flow cytometry is a powerful diagnostic modality that has been limited by poor resolving power. Molecules expressed on the cell surface in abundance (i.e., greater than 1000 molecules per cell) can be detected readily by conventional staining technologies; however, molecules expressed in lower concentrations cannot be easily observed. Because there are many molecules that are functionally significant at lower levels of expression, the capability to detect these molecules is important. Enzymatic amplification staining is a new flow cytometric amplification technology based on the enzymatically catalyzed deposition of reporter molecules. This technology allows for the detection of molecules expressed on the cell surface at low abundance. The authors have demonstrated that EAS can be used to resolve the expression of molecules that cannot be resolved with standard amplification procedures. It has been shown that this capability is valuable in the diagnostic evaluation of patient samples; moreover, it is likely that EAS can be profitably used in the analysis of both malignant and reactive blood cells from various patients.     

Individual differences mean that the costs of treatment of hypertension cannot readily be quantified

Summary The costs of therapy for hypertension, as it becomes increasingly individualized, will be increasingly variable and difficult to pin down, making it nearly impossible, to quantify accurately.     

Nonconvulsive status epilepticus: Epilepsy Research Foundation workshop reports.

In April 2004, a group of physicians with an interest in nonconvulsive status epilepticus representing a spectrum of opinion met in Oxford, sponsored by the Epilepsy Research Foundation (a charitable organization), to discuss and debate the definition, diagnosis and treatment of nonconvulsive status epilepticus. We felt that such a meeting would be useful, as nonconvulsive status epilepticus is a subject that provokes strong reactions, perhaps largely due to the relative lack of evidence and the surfeit of opinion. The meeting was arranged such that there were formal talks followed by a discussion led by one of the attendees. We present here the extended abstracts of the main talks with the points raised by the discussants. Despite disagreements on certain issues there was much in the way of consensus. First, it was agreed that nonconvulsive status epilepticus is a term that covers a range of disparate conditions with varying prognoses and treatments. The agreed definition was thus suitably vague, A. Secondly, it was agreed that even within a specific condition (e.g. complex partial status epilepticus), the prognosis and treatment depends upon the context in which the condition occurs (e.g. in the critically ill, in coma, in the A and in people with prior epilepsy). Perhaps, most importantly it was agreed that we lacked good clinical data, and the challenge was to design good studies for a condition that is underrecognised and often difficult to diagnose.     

Citrobacter diversus and neonatal brain abscess

A 23-day-old infant presented with apnea and was found to have Citrobacter diversus meningitis and brain abscess. The organism persisted in brain abscess fluid for over 4 weeks despite adequate antibiotic therapy. Cranial computed tomography demonstrated persistent radiolucencies in both frontal lobes, and midline shift, long after completion of antibiotic therapy. Effective therapy of C. diversus meningitis and brain abscess may require use of an antibiotic active within phagocytes, and judicious surgical drainage. A high prevalence of brain abscess mandates cranial computed tomography for any infant with C. diversus meningitis.