Infantile-onset multisystem inflammatory disease: radiologic findings

Infantile-onset multisystem inflammatory disease (IOMID) is a newly recognized disease that is similar to systemic-onset juvenile rheumatoid arthritis (JRA). The clinical symptoms of IOMID include rash, fever, lymphadenopathy, chronic meningitis, uveitis, and a distinct arthropathic condition. Skeletal involvement is surprisingly constant. The long bones become short, bowed, and widened. The metaphyses flare and simulate rickets. Grotesque epiphyses appear fragmented early in the course of the disease but are gradually incorporated into the widened shafts. We observed these and other radiologic findings in the four cases described in the present study. The findings are distinctive and allow for a specific diagnosis.     

The spleen in Hodgkin disease: diagnostic value of CT

Findings of CT of the spleen were compared with those of histologic examination in 35 patients who had Hodgkin disease. CT provides a simple way to calculate splenic size. This index is also of value in the assessment of the histologic state of the spleen. An accuracy rate of 91%, specificity of 94%, and a sensitivity of 89% in diagnosing splenic localization of lymphoma was found in this study.     

Immunoglobulin and T cell receptor gene rearrangements in human lymphoma and leukemia

DNA samples from blood leukocytes or tumor biopsies of 45 patients with phenotypic B or T cell neoplasms were analyzed for rearrangements of the immunoglobulin (Ig) or T cell receptor (TCR) genes by Southern blot hybridization analysis. Rearrangements of the Ig heavy chain joining region genes (JH) were present in DNA from each of 28 B cell lymphomas and leukemias; 14 of 21 of these tumors also had rearrangements of the Ig kappa light chain joining (JK) or deleting element (KDel) genes. Conversely, 16 of 17 T cell lymphomas and leukemias had rearranged TCR beta chain genes. One B cell and one T cell tumor had rearrangements of both Ig and TCR genes. There was a strong correlation between the rearrangements of specific genes and the immunophenotype of the tumor: JH rearrangement without TCR beta chain rearrangement occurred only in B cell tumors; TCR beta chain rearrangement with or without JH rearrangement occurred only in T cell tumors, with one exception; and JK and KDel rearrangements were found only in B cell tumors. Thus, rearrangements of the Ig heavy and light chain genes and the TCR beta chain genes were found to be highly sensitive markers of monoclonal human lymphomas and lymphoid leukemias, with the type of gene rearrangements well correlated with the cell lineage of these neoplasms.     

Mortality of glass filament (textile) workers

A historical prospective mortality study was conducted at a glass filament plant in Ontario, Canada. The cohort consisted of 1465 men and women who had worked for a total of at least one year between 1951 (when the operations began) and 1986. Ninety six deaths were found in the 96% of persons traced. Mortality was compared by the person-years method with that of the Ontario population. An estimate of cumulative dust exposure was made based on long term employees' recollections of past conditions. Overall mortality was below that expected (standardised mortality ratio (SMR) = 76) based on 82 deaths. There were 11 deaths due to lung cancer; slightly but not significantly more than expected (SMR = 136, p = 0.31). Analysis by both duration of employment and cumulative exposure showed this increase to be inconsistent with an occupational aetiology.     

The effects of cardiopulmonary bypass on thyroid function in infants weighing less than five kilograms.

Triiodothyronine is an important regulator of cellular metabolism and may have potential use as an inotropic agent. The aim of this study was to determine the effects of cardiopulmonary bypass on thyroid function in infants weighing less than 5 kg. Serial measurements of triiodothyronine, thyroxine, and thyroid-stimulating hormone were made in 10 infants and corrected for the effects of hemodilution. We demonstrated a fall in triiodothyronine and thyroxine levels, with some recovery after 3 to 6 hours. An additional decrease then occurred, reaching a trough at 48 hours (representing a fall of 78% for triiodothyronine and 57% for thyroxine) before hormone levels returned to normal at 5 to 7 days. Thyroid-stimulating hormone concentrations increased and decreased, predating and complementing exactly the changes in triiodothyronine and thyroxine. These results are quantitatively and, for thyroid-stimulating hormone, qualitatively different from those previously reported in adults. In two patients who died, however, and in one who had a particularly difficult postoperative course, no increase in triiodothyronine, thyroxine, or thyroid-stimulating hormone concentrations was found after a trough had been reached at 48 to 72 hours, which suggests abnormal function at the hypothalamopituitary level.     

Effect of rifampicin administration on theophylline pharmacokinetics in humans

Theophylline pharmacokinetics were studied before and after rifampicin administration (600 mg daily for 1 wk). Rifampicin reduced the area under the concentration-time curve by 18% after the oral administration of sustained release aminophylline (450 mg) to 7 normal subjects (p less than 0.05) and increased the metabolic clearance and volume of distribution by 45% (p less than 0.05) and 17% (p less than 0.05), respectively, after the intravenous administration of aminophylline (5 mg/kg over 30 min) to 8 normal subjects. These findings are consistent with an inducing and choleretic effect of rifampicin on theophylline disposition. In patients receiving theophylline, blood levels should be monitored closely and dosage adjusted if rifampicin therapy is introduced or withdrawn.     

Long-term hemodynamics following combined heart and lung transplantation in primates

To assess the long-term hemodynamic consequences of combined heart and lung transplantation, we investigated six rhesus monkeys 2.6 to 4.6 years (mean 4.0) after operation. Total follow-up was 24.0 primate-years. Autotransplantation had been carried out in four animals and allotransplantation in two, and the hemodynamic results were compared with those in three normal monkeys of similar size. Each animal underwent simultaneous right and left heart catheterization and pulmonary arteriography. Hemodynamic measurements were made at three levels of inspired oxygen. Arterial oxygen tension was within normal limits in all animals, and pulmonary artery pressure and pulmonary vascular resistance index did not change significantly with changes in the levels of inspired oxygen. Indices of left ventricular systolic function were normal in all animals. Values for pulmonary artery pressure and pulmonary vascular resistance index were similar in the autograft and normal groups: in the allograft group, the average pressure was 30/17 mm Hg (mean 24) and the index was 5.6 units . m2--both levels significantly higher than normal (pressure was 16/10 mm Hg, mean 13, [p less than 0.001] and index was 2.5 units . m2 [p less than 0.02]). Pulmonary arteriography in the allograft group with the highest pulmonary vascular resistance index (6.1 units . m2) was compatible with pulmonary vascular disease. Pulmonary arteriograms in the remaining eight monkeys were normal. Prolonged survival following combined heart and lung transplantation is possible in primates. Autotransplantation (and probable persisting denervation of the cardiopulmonary axis) does not necessarily result in abnormal long-term hemodynamics. The elevation in pulmonary artery pressure and pulmonary vascular resistance index in the allograft group may be related to previous episodes of pulmonary rejection, infection, or drug reaction.     

Mortality of glass filament (textile) workers.

A historical prospective mortality study was conducted at a glass filament plant in Ontario, Canada. The cohort consisted of 1465 men and women who had worked for a total of at least one year between 1951 (when the operations began) and 1986. Ninety six deaths were found in the 96% of persons traced. Mortality was compared by the person-years method with that of the Ontario population. An estimate of cumulative dust exposure was made based on long term employees' recollections of past conditions. Overall mortality was below that expected (standardised mortality ratio (SMR) = 76) based on 82 deaths. There were 11 deaths due to lung cancer; slightly but not significantly more than expected (SMR = 136, p = 0.31). Analysis by both duration of employment and cumulative exposure showed this increase to be inconsistent with an occupational aetiology.     

RESECTION OF ANATOMICAL SEGMENTS OF THE LIVER

The aim of this report is to review recent experience of removal of anatomical segments of the liver. Resection of one or more segments of the liver was undertaken in 49 patients; in 32 patients, the resection was for malignant disease and in the remainder it was for benign disease. Operating time was 130 (60–600) min and the median transfusion requirement was 0 (0–15) units, with 31 patients having a resection without the need for a blood transfusion. There was no postoperative or in-hospital mortality. The removal of anatomical segments of the liver is a very useful technique for the safe removal of benign and malignant lesions.