Causes of jaundice during hepatic artery infusion chemotherapy

Jaundice develops in many patients with liver metastases from colorectal adenocarcinoma during hepatic arterial infusion chemotherapy (HAIC). The usual cause is thought to be hepatotoxicity from the chemotherapeutic agent or biliary obstruction from progressive neoplastic disease. The authors evaluated the abdominal computed tomography and ultrasound examinations performed on 49 patients who were jaundiced during long-term HAIC. In only one patient was diffuse intrahepatic biliary dilatation caused by an obstructing mass in the porta. Two patients had metastatic hepatic lesions causing focal biliary obstruction. Intrahepatic dilatation without an obstructing mass occurred in 20 patients. Percutaneous or endoscopic cholangiograms were commonly interpreted prospectively as showing extrinsic compression by metastases, but no mass was confirmed on imaging studies. Seven patients had focal intrahepatic ductal dilatation from stricture without an associated mass. The remaining 19 patients had normal-caliber ducts; their jaundice was caused by chemical hepatitis. This series suggests that the most common causes of jaundice in these patients are chemical hepatitis and common bile duct stricture, complications of intraarterial chemotherapy, rather than neoplastic obstruction. Stricture formation may be confused with extrinsic compression on direct cholangiograms.     

Fungal keratitis in far north Queensland,Australia

Background: Aboriginals and Torres Strait Islanders form a significant proportion of the population in far north Queensland and are at increased risk for many eye conditions. This study describes the pattern of fungal keratitis seen at Cairns Base Hospital, far north Queensland, Australia. Methods: A retrospective review of all cases of culture positive fungal keratitis presenting between 1998 and 2008. The records of 17 patients were reviewed for epidemiological, risk factor, microbiological, treatment and outcome data. Results: The study included 16 eyes from 16 patients. Five (31.25%) patients were of Aboriginal and Torres Strait Islander descent. Pre‐disposing factors were ocular trauma (n = 7) and contact lens wear (n = 3). No patients were on topical steroids at presentation. All patients grew filamentous fungi with Fusarium the most common isolate (50%). Aspergillus, Curvularia and Lasiodiplodia theobromae were the next most common accounting for two cases each. Two patients developed corneal perforations, whereas two required penetrating keratoplasty and one required evisceration. Eight patients had a visual acuity of 6/18 or better at presentation and this increased to 13 patients at final follow up. Conclusions: A significant proportion of the patients presenting to Cairns Base Hospital with fungal keratitis are Indigenous. The very high percentage of cases due to filamentous fungi is similar to other tropical regions of the world. The very low rates of Candida infection and steroid use prior to presentation are in contrast to studies from temperate areas such as Melbourne and Philadelphia.     

On the use of mercury as a means of locating background sources in ultra low-background HPGe-detector systems

In low-level gamma-ray spectrometry, it is common to measure large samples in order to obtain low detection limits for the massic activity (in mBq/kg). These samples have significant shielding effects. In order to study whether the background sources in three ultra low-background HPGe detectors were located in the detector or in the shield, Marinelli beakers filled with hyperpure mercury were measured. Although the measurements were hampered by the presence of cosmogenically produced ¹⁹⁴Hg, information regarding the major background location of ⁴⁰K, ⁶⁰Co, ¹³⁷Cs, ²¹⁰Pb, ²²⁶Ra, ²²⁸Ra and ²²⁸Th could be obtained.     

Nebulization of nanoparticulate amorphous or crystalline tacrolimus - Single-dose pharmacokinetics study in mice.

Developing a pulmonary composition of tacrolimus (TAC) provides direct access to the graft in lung transplant offering the possibility of high drug levels. The objective of this study was to investigate the physicochemical and pharmacokinetic characteristics of the nanostructured aggregates containing amorphous or crystalline nanoparticles of TAC produced by ultra-rapid freezing (URF). TAC and lactose (1:1 ratio; URF-TAC:LAC) and TAC alone (URF-TAC) were investigated for pulmonary delivery and compared to unprocessed TAC. X-ray diffraction (XRD) results indicated that URF-TAC was crystalline, whereas URF-TAC:LAC was amorphous. In vitro results revealed the superior physiochemical characteristics of both URF formulations compared to unprocessed TAC. The surface area of URF processed TAC was higher (25-29m(2)/g) than that of the unprocessed TAC (0.53m(2)/g) and subsequently enhanced dissolution rates. In addition, URF-TAC:LAC displayed the ability to supersaturate in the dissolution media to about 11 times the crystalline equilibrium solubility. Similar aerodynamic particle sizes of 2-3mum, and fine particle fraction between 70% and 75% were found in both formulations. The local and systemic pharmacokinetic studies in mice showed similar AUC((0-24)), higher C(max), and lower T(max) for the URF-TAC:LAC compared to the URF-TAC. Nanostructured aggregates containing amorphous or crystalline nanoparticles of TAC were demonstrated to be effectively delivered via nebulization, with similar in vitro and in vivo performances.     

The current role for femorofemoral bypass

We reviewed our experience with femorofemoral bypass during the past 10 years to define its role relative to other methods in the treatment of aortoiliac occlusive disease. The cumulative patency rate for 82 patients was 80% +/- 5% at 1 year and 67% +/- 7% at 2 and 3 years. The operation was most likely to be successful if the indication was claudication (p less than 0.05) and if the operation was performed as the primary procedure (p less than 0.01). There was no significant difference when patients with or without profundaplasty were compared. It is concluded that femorofemoral bypass is indicated to treat symptomatic unilateral iliac disease when transluminal dilatation is not possible. Femorofemoral bypass is also the procedure of choice for aortofemoral graft occlusion when the thrombosed limb cannot be reopened. Femorofemoral bypass is recommended for both high- and low-risk patients when indicated.