Omalizumab as a steroid-sparing agent in chronic eosinophilic pneumonia

Chronic eosinophilic pneumonia (CEP) is an idiopathic eosinophilic pulmonary disease characterized by an abnormal and marked accumulation of eosinophils in the lung. Common presenting complaints include cough, fever, dyspnea, wheezing, and night sweats. Common laboratory abnormalities are peripheral blood and BAL eosinophilia. The pathognomonic radiographic finding is bilateral peripheral infiltrates. Corticosteroids are the mainstay of therapy, and dramatic improvement follows treatment. Relapses are common, and most patients require prolonged therapy. Side effects associated with chronic corticosteroid therapy must be monitored. Our case was that of a 36-year-old woman who had characteristic clinical and radiologic features. She was treated with corticosteroids but she needed prolonged therapy, and side effects occurred. Because the patient had high IgE levels and a positive skin prick test result, we used omalizumab for the treatment. The patient responded well. To our knowledge, this is the first CEP case in the literature successfully treated with omalizumab.From the Turkish Armed Forces Rehabilitation Center (Dr Kaya); the Department of Pulmonary Medicine (Drs Gümü?, U?ar, Aydo?an, Tozkoparan, and Bilgi?); and the Department of Allergy and Clinical Immunology (Dr Mu?abak), Gulhane Military Medical Academy, Ankara, Turkey.Correspondence to: Hatice Kaya, MD, TSK Rehabilitasyon Merkezi, 06540, Bilkent, Ankara, Turkey; e-mail: drhaticekaya@yahoo.comFinancial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.     

Immunological approaches for amyloid-beta clearance toward treatment for Alzheimer's disease

The pathology of Alzheimer's disease is characterized primarily by extracellular plaques and intracellular neurofibrillary tangles. Plaques are composed mainly of the amyloid-beta peptide, whereas tangles are derived from the cytoskeletal protein tau. The most studied hypothesis of development of the disease is that of the amyloid cascade, which states that overproduction of amyloid-beta peptide, or failure to clear this peptide, leads to Alzheimer's disease primarily through amyloid deposition, which is presumed to be involved in neurofibrillary tangle formation; these lesions are then associated with cell death, which is reflected in memory impairment, the hallmarks of this dementia. We developed a new concept showing that site-directed antibodies against amyloid-beta peptide may modulate formation of amyloid filaments, which has become the theoretical basis of the immunological approach for treatment of Alzheimer's disease. The performance of anti-beta-amyloid antibodies in transgenic mouse models of Alzheimer's disease showed they are delivered to the central nervous system, clearing amyloid plaques and protecting the mice from learning and age-related memory deficits. Amyloid plaque clearance via specific anti-amyloid-beta peptide antibodies follows multiple mechanisms. As immunotherapy is at the crossroads of immunology and the nervous system, a deeper understanding of the amyloid-beta peptide clearance mechanism may lead to an optimized therapeutic approach to the treatment of Alzheimer's disease. Antibodies generated with the first-generation vaccine might not have the desired therapeutic properties to target the "correct" mechanism, however, new immunological approaches are now under consideration.     

A surgical technique for pediatric forearm pronation: brachioradialis rerouting with interosseous membrane release

PURPOSE: In this study we used a tendon transfer technique (consisting of rerouting of the brachioradialis with interosseous membrane release) to restore active forearm pronation in patients with supination deformity secondary to brachial plexus birth palsy. METHODS: Four children (3 with flexible supination deformities, 1 with a fixed supination deformity) whose ages ranged between 5 and 9 years had brachioradialis rerouting with interosseous membrane release. RESULTS: Mean active forearm rotation was improved from 28 degrees supination before surgery to 49 degrees pronation after surgery. No patient developed elbow contracture during a minimum of 12 months of follow-up evaluation (40 months in 2 patients, 14 months in 1 patient, 12 months in 1 patient). CONCLUSIONS: These results suggest that brachioradialis rerouting combined with interosseous membrane release may be a successful means to correct supination deformity of the forearm.     

Monte Carlo modeling of a conventional X-ray computed tomography scanner for gel dosimetry purposes

Our purpose in the current study was to model an X-ray CT scanner with the Monte Carlo (MC) method for gel dosimetry. In this study, a conventional CT scanner with one array detector was modeled with use of the MCNPX MC code. The MC calculated photon fluence in detector arrays was used for image reconstruction of a simple water phantom as well as polyacrylamide polymer gel (PAG) used for radiation therapy. Image reconstruction was performed with the filtered back-projection method with a Hann filter and the Spline interpolation method. Using MC results, we obtained the dose–response curve for images of irradiated gel at different absorbed doses. A spatial resolution of about 2 mm was found for our simulated MC model. The MC-based CT images of the PAG gel showed a reliable increase in the CT number with increasing absorbed dose for the studied gel. Also, our results showed that the current MC model of a CT scanner can be used for further studies on the parameters that influence the usability and reliability of results, such as the photon energy spectra and exposure techniques in X-ray CT gel dosimetry.     

Acute Abdomen Associated with Organophosphate Poisoning

Background

Pesticides are extensively used in developed and developing countries.

Objectives

The present study was designed to evaluate the clinical course of patients with carbamate or organophosphate poisoning presenting to a University-based emergency department (ED).

Methods

All consecutive patients admitted to our ED due to intoxication with carbamate or organophosphate compounds over a 2-year period were enrolled prospectively.

Results

A total of 49 consecutive patients (26 females) were diagnosed with carbamate or organophosphate poisoning in the 24-month study period. The mean age of the patients was 32 ± 13.1 years (range 16-70 years). Signs and symptoms most frequently noted in patients with organophosphate or carbamate poisoning were perspiration, vomiting, and bronchorrhea. Abdominal pain was reported by 65.3% of the patients. Abdominal ultrasonography was performed in 22 patients who complained of abdominal pain as a leading symptom. Among these, 63.6% were found to have abdominal free fluid. Pancreatitis and peritonitis developed in one case. Atropine treatment was administered for approximately 24-36 h, with a mean total dose of 13.75 ± 6.75 mg. Pralidoxime was administered to 70.9% of patients with organophosphate poisoning, but was not used in patients intoxicated with carbamates. Endotracheal intubation and mechanical ventilatory support were required in 14.2% of the patients. Mean duration of mechanical ventilation was 3.7 ± 2.2 days. The overall mortality rate was 10.2%.

Conclusion

Patients with a diagnosis of organophosphate poisoning should be screened for acute abdomen. The findings in our study suggest that these patients should undergo routine abdominal ultrasonography, especially in cases with abdominal pain along with other abdominal complaints.     

Pericardial monocusp reconstruction for pulmonary valve vegetation secondary to patent ductus arteriosus

A case of pulmonary valve endocarditis in a patient with a ductus arteriosus (PDA) is reported. The PDA was ligated, the septal leaflet of the pulmonary valve was excised, and a pericardial monocusp reconstruction was performed.     

Combined bilateral asymmetric hip dislocation and anterior shoulder dislocation

BACKGROUND:

Traumatic bilateral hip dislocation is a rare condition. Anterior shoulder dislocation combined with this condition is even a rare occurrence. A 57-year-old man had bilateral asymmetric hip dislocation with a posterior wall fracture of the left acetabulum associated with right shoulder anterior dislocation caused by falling down from a cherry tree. Traumatic hip dislocation and anterior shoulder dislocation represent a true orthopedic emergency.

METHODS:

Closed reduction was performed immediately for three of the dislocated joints. Posterior wall fracture of the left acetabulum was treated with open reduction and internal fixation by screws. Because of the severity of associated complications like aseptic necrosis or posttraumatic osteoarthritis, efforts were made to ensure prompt diagnosis, therapy and prognosis.

RESULTS:

The patient was successfully treated by open reduction and internal fixation of the left acetabulum, and discharged from the hospital.

CONCLUSION:

Traumatic asymmetric hip dislocation and anterior shoulder dislocation are an orthopedic emergency and early diagnosis with immediate reduction of the dislocation is the key determinants of excellent result of treatment.KEY WORDS: Trauma, Asymmetric hip dislocation, Shoulder dislocation, Immediate therapy     

Synthesis and antimicrobial activities of hexahydroimidazo[1,5-a]pyridinium bromides with varying benzyl substituents

Variously substituted benzyl bromides were employed to quaternize hexahydrobenzylimidazo[1,5-a]pyridine (A) and the resulting bromides (1-11) were evaluated for their in vitro antimicrobial activity against 10 pathogenic microorganisms: Staphylococcus aureus, Staphylococcus epidermidis, Bacillus cereus, Micrococcus luteus, Proteus vulgaris, Escherichia coli, Salmonella typhimurium, Klebsiella pneumonia, Candida albicans and Candida krusei. Antimicrobial activities were surprisingly high (MIC: 0.78-400 μg/mL) and the sensitivity of the salts tested has been found to depend strongly both on the benzyl substituents and the microorganisms used. However, the correlation observed between antimicrobial activity and calculated partition coefficient (ClogP) was poor. Acute toxicity assessment of these salts showed LD₅₀ of 757-2000 mg/kg, after oral administration in mice in 24 h.