MANAGEMENT OF INVASIVE ASPERGILLOSIS WITH ITRACONAZOLE

SUMMARY A case of chronic invasive paranasal aspergillosis is described which, despite an initial poor prognosis, responded well to treatment with itraconazole.     

Late functional deterioration following paralytic poliomyelitis

Many patients with previous poliomyelitis develop 'post-polio syndrome' (PPS) in which late functional deterioration follows a period of relative stability. The frequency with which PPS can be attributed to clearly defined causes remains uncertain. We reviewed 283 newly- referred patients with previous poliomyelitis seen consecutively over a 4-year period; 239 patients developed symptoms of functional deterioration at a mean of 35 (5-65) years after the paralytic illness. Functional deterioration was associated with orthopaedic disorders in 170 cases, neurological disorders in 35, respiratory disorders in 19 and other disorders in 15. Progressive post-polio muscular atrophy was not observed. Functional deterioration following paralytic polio- myelitis is common, and associated with orthopaedic, neurological, respiratory and general medical factors which are potentially treatable.      

Biomechanical characteristics of human trabecular bone

Objective. To evaluate the effect of strain rate (ġ3), apparent density (_a) and tissue density (_t) on Young's modulus (E), strength (σ_u) and ultimate strain (_u) on intervertebral bone from a Chinese population.

Methods. Testing was performed by uniaxial compression at five strain rates on 36 human trabecular bone specimens from three male T₁₂˜L₄ vertebrae.

Results. Apparent density ranged between 0.46 and 0.71 g/cm³. Tissue density ranged between 1.02 and 1.54 g/cm³. Non-linear regression analyses using strength, Young's modulus or ultimate strain as dependent variables (Y) and strain rate and apparent density or tissue density as independent variables were performed using the following equation: Y = a^bġ3^c. The exponent of apparent density and strain rate to Young's modulus were 1.88 and 0.07, separately (P = 0.0007). The variation of strength was explained only by apparent density with an exponent of 1.29 (P = 0.0107). The variation of Young's modulus was explained equally by the quadratic and cubic relationship to apparent density or tissue density (P < 0.01). Ultimate strain varied independently of apparent density or tissue density and strain rate.     

Hypotensive reactions to white cell-reduced plasma in a patient undergoing angiotensin-converting enzyme inhibitor therapy

BACKGROUND: Hypotensive reactions to platelet transfusions performed with white cell (WBC)-reduction filters with negatively charged surfaces have been reported recently in patients taking angiotensin- converting enzyme (ACE) inhibitors. Experimental studies have shown that the filter material can activate bradykinin, which may cause symptoms in patients with reduced bradykinin catabolism. Symptomatic adverse reactions after the administration of fresh-frozen plasma (FFP) through a WBC-reduction filter have not been reported in a patient on ACE Inhibitor medication. CASE REPORT: A 58-year-old man with congenital coagulation factor V deficiency and hypertension treated with an ACE inhibitor was admitted for rehabilitation after orthopedic surgery. On 3 consecutive days, he received FFP through a WBC-reduction filter; within minutes of the beginning of each infusion, he experienced a drop in blood pressure, facial erythema, abdominal pain, and anxiety. When the infusions were stopped, symptoms quickly abated without treatment. Multiple prior transfusions of unfiltered FFP and FFP filtered through a WBC-reduction filter made by a different manufacturer, as well as subsequent transfusions of unfiltered FFP, had not produced such reactions. CONCLUSION: Facial flushing, hypotension, and abdominal pain after FFP administration in a patient on ACE inhibitor medication appeared to be associated with a specific type of WBC-reduction filter. This association and other reported studies suggest that special caution is warranted when patients who are treated with ACE inhibitors receive blood components administered through WBC- reduction filters capable of generating bradykinin.     

Elevated serum levels of neopterin in adult patients with polymyositis/dermatomyositis

We determined serum concentrations of neopterin, soluble tumour necrosis factor (55 kDa) receptor (sTNF-R) and soluble interleukin-2 receptor (sIL-2R) in plasma of 44 patients with polymyositis (PM)/dermatomyositis (DM), including 15 patients with primary PM, 13 patients with primary DM, and 16 patients with myositis and systemic sclerosis in overlap. Concentrations of neopterin, sTNF-R and sIL-2R were measured using commercially available immunoassays. Serum neopterin was increased in 35 of 44 PM/DM patients (80%), sTNF-R in 14 (32%) and sIL-2R in 18 (41%) patients, respectively. There were significant correlations between serum neopterin and sTNF-R, sIL-2R and erythrocyte sedimentation rate (all P < 0.001). Neopterin, as well as sTNF-R and sIL-2R, did not correlate with clinical (neuromuscular and activities of daily living scores) and laboratory (creatine kinase levels) manifestations of myositis. Increased serum levels of neopterin were associated with non-muscular manifestations of PM/DM. In conclusion, serum neopterin appears to be a useful laboratory marker for ongoing immune activation and global disease activity in PM/DM.      

肝动脉栓塞米托蒽醌乙基纤维素微球的研究

利用正交实验设计法,优选适用于肝动脉栓塞的米托蒽醌乙基纤维素微球制备条件和工艺;采用动态透析法研究了该微球的体外释药规律;根据混悬液的稳定性理论,优选并制备了适于临床肝动脉介导栓塞使用的米托蒽醌乙基纤维素微球混悬注射液。结果表明∶在优化工艺条件下制得的米托蒽醌乙基纤维素微球外形圆整,球径在40～200μm范围内的占总数的91.9%,平均球径为110.24±38.19μm;包封率为55.6%;载药量为12.5%;体外释药符合单指数模型,释药方程为lg(Y_∞-Y)=-0.116t-1.198×10^-3(γ=0.9992,t₅₀=2.6h);其混悬液适于临床应用。用狗进行的实验表明肝血药浓度高,平均驻留时间比注射剂长2.45倍。     

联苯双酯（DDB）对Bel－7402人肝癌细胞株一些表型的作用及其机理

Ｂｅｌ－７４０２人肝癌细胞在ＤＤＢ（１０￣（－４）ｍｏｌ·Ｌ￣（－１））处理后，生长和克隆形成受到明显抑制，电子显微镜观察到ＤＤＢ作用过的细胞核仁减少或消失，核与胞浆比例缩小。Ｂｅｌ－７４０２细胞内环化腺苷酸（ｃＡＭＰ）和钙调蛋白（ＣａＭ）的含量，经ＤＤＢ处理不同时间后皆显示明显高于对照组。此外，ＤＤＢ还能降低从Ｂｅｌ－７４０２细胞内提取出的ＤＮＡ拓扑异构酶ＩＩ（ＴｏＰｏＩＩ）活力。说明ＤＤＢ对Ｂｅｌ－７４０２人肝癌细胞的作用机理与ｃＡＭＰ，ＣａＭ和ＴｏＰｏＩＩ有关。