AZATHIOPRINE INDUCED BONE MARROW SUPPRESSION IN LIVE RELATED RENAL ALLOGRAFT RECIPIENTS

Over a follow-up period of 6 years, 4 out of 31 live related renal allograft recipients (12.9%) developed azathioprine induced bone marrow suppression. Presentation in 3 patients was with fever and 2 patients also had associated graft dysfunction. All patients had leucopenia, 2 patients in addition had anaemia and one patient had pancytopenia. Bone marrow suppression developed 9.6 months (3.5-16.0 months) following transplantation and recovery followed over a period of 30 (18-49 days) days after withdrawal of the drug. One patient succumbed during the phase of bicytopenia.KEY WORDS: Azathioprine, Bone marrow suppression, Kidney transplantation     

CLINICO-PATHOLOGICAL CORRELATION IN NEONATAL AUTOPSIES

Of the 253 neonates admitted to a neonate intensive care unit during the period Jan 91 to Sep 93, 43 neonates died. Autopsy was done in 23 of these (53%). The mean duration of stay of the neonates in the intensive care unit prior to death was 5.6 days (range 2 hours to 10 days). Antemortem diagnoses included asphyxia neonatorum (4), meconium aspiration syndrome (2), septicemia (5), prematurity (3), birth trauma (2), congenital anomalies (2), hypoxic ischemic encephalopathy (1), and non-specific diagnosis (4). There were 6 major autopsy findings that, if known prior to death, would have altered clinical management and might have resulted in cure or prolonged survival. There were 8 additional major findings that, if known prior to death, would not have altered management There were 14 minor findings related to major diagnoses but unrelated to the primary cause of death.KEY WORDS: Autopsy, Cause of death, Perinatal mortality     

Creatine kinase in tibial shaft fractures

Summary The creatine kinase (CK) activity of the serum of 33 male and 24 female patients with tibial shaft fractures has been assayed. In 40 of the 57 patients the CK level surpassed the maximal normal limit of 1.7 tkat/l. Patients with fractures due to direct violence had significantly higher levels than those with fractures due to indirect violence. When the fracture was displaced the CK level was more often abnormal than when there was no displacement. Patients with extensive swelling of the injured leg had significantly higher levels than patients with minor or no swelling. CK determinations could be used to quantify muscle injury.

---

Zusammenfassung Die Serum-Kreatinkinase (CK)-Werte von 33 männlichen and 24 weiblichen Patienten mit einer Tibiadiaphysenfraktur wurden gemessen. Bei 40 von 57 Patienten lag der Serum-CK-Spiegel über dem oberen Normalwert von 1,7 kat/l. Bei Patienten mit Frakturen, verursacht durch ein direktes Trauma, wurden signifikant höhere Serum-CK-Werte gemessen als bei Patienten mit Frakturen, entstanden durch ein indirektes Trauma. Der Serum-CK-Spiegel war öfter erhöht bei Patienten mit einer Fraktur mit Fehlstellung, verglichen mit Patienten mit einer Fraktur ohne Fehlstellung. Patienten mit einer außergewöhnlichen Schwellung des geschädigten Beines hatten signifikant höhere Serum-CK-Werte als Patienten mit geringer oder keiner Schwellung. Die Serum-CK kann dazu benutzt werden, den Muskelschaden quantitativ zu beurteilen.

     

A psychophysiological evaluation of female urethral syndrome: Evidence for a muscular abnormality

This is a preliminary investigation into a recently defined urological disorder occurring in a subgroup of women with urethral syndrome suggestive of pelvic floor muscular (PFM) dysfunction. Symptoms include straining to void, urgency, frequency, hesitation, incontinence and/or retention, and subpubic pain. Finding neither bladder nor urological abnormalities, urologists may consider these women emotionally unstable without organic cause for their symptoms. However, their distress may be a consequence rather than a cause of their voiding problems. Sixteen female urological patients were matched with 16 asymptomatic controls to investigate PFM functioning, psychological status, and symptomatology. Results showed heterogeneity of symptomatology and little elevation of depression or anxiety when comparing patients with controls. Hypotheses of muscular abnormality were confirmed. Patients evidenced poor control over tensing and relaxing PFM, elevations of PFM activity under various conditions, and chronic pain as a prominent symptom. Treatment approaches specifically designed to address PFM dysfunction are discussed.     

Striatum forever, despite sequence learning variability: a random effect analysis of PET data

This PET study is concerned with the what, where, and how of implicit sequence learning. In contrast with previous studies imaging the serial reaction time (SRT) task, the sequence of successive locations was determined by a probabilistic finite-state grammar. The implicit acquisition of statistical relationships between serially ordered elements (i.e., what) was studied scan by scan, aiming to evidence the brain areas (i.e., where) specifically involved in the implicit processing of this core component of sequential higher-order knowledge. As behavioural results demonstrate between- and within-subjects variability in the implicit acquisition of sequential knowledge through practice, functional PET data were modelled using a random-effect model analysis (i.e., how) to account for both sources of behavioural variability. First, two mean condition images were created per subject depending on the presence or not of implicit sequential knowledge at the time of each of the 12 scans. Next, direct comparison of these mean condition images provided the brain areas involved in sequential knowledge processing. Using this approach, we have shown that the striatum is involved in more than simple pairwise associations and that it has the capacity to process higher-order knowledge. We suggest that the striatum is not only involved in the implicit automatization of serial information through prefrontal cortex-caudate nucleus networks, but also that it plays a significant role for the selection of the most appropriate responses in the context created by both the current and previous stimuli, thus contributing to better efficiency and faster response preparation in the SRT task.     

Automated calibration in vascular X-ray images using the accurate localization of catheter marker bands

RATIONALE AND OBJECTIVES: To develop a new automated calibration method for vessel measurements in vascular x-ray images. METHODS: Radiopaque marker bands mounted equidistantly on a small catheter were acquired in vitro at five image intensifier (II) sizes in x-ray projection images. The positions of the marker centers were detected by using a Hough transform and were computed at subpixel precision by using either a novel, iterative center-of-gravity approach (CGA) or a symmetry filter. Curve-fitting procedures were used to reject false-positive marker detections and to calculate intermarker distances. The calibration factor was calculated from the true marker distance and the average of the measured distances in pixels. Results were compared statistically with a grid calibration method, which was taken as the gold standard. A simulation study was performed to assess the influence of image noise on the CGA method. RESULTS: The iterative CGA method was convergent and faster than the symmetry-based technique. For four II sizes (17, 20, 25, and 31 cm), the results from the CGA method were not significantly different from the results obtained with grid calibration. For the II size of 38 cm, a significant difference (0.3% of the grid calibration factor) was found; however, this was caused by the quantification error in the image data and was not clinically relevant. In general, the performance of the CGA method improved with increasing signal-to-noise ratio. CONCLUSIONS: A practical new calibration method for small catheter sizes was developed and validated for quantitative vascular arteriography.     

Nuclear morphometry and molecular biomarkers of actinic keratosis, sun-damaged, and nonexposed skin.

Computer-assisted image analysis is useful for quantifying the histologic and molecular changes of sun-induced squamous cell carcinoma progression. We used the CAS 200 image analysis system to measure nuclear morphometric parameters, p53 expression, and proliferation markers in actinic keratosis (AK), sun-exposed, and normal skin in 51 patients. Nuclear morphometry revealed significant increases in nuclear absorbance, irregularity of nuclear shape, and nuclear size in AK compared with normal and sun-damaged skin. These parameters showed significantly greater variability in AK nuclei. Argyrophyllic nucleolar organizer area and number were also significantly greater in AK compared with sun-damaged skin and normal skin. Ki67 and p53 expressions were both increased in sun-damaged skin relative to normal and greater still in AK. These data are evidence that sun damage induces proliferation and p53 abnormalities before the appearance of nuclear abnormalities and their associated DNA instability. Following these changes during a skin cancer chemopreventative trial can then help assess the efficacy of the agent and help determine where in the progression of neoplastic changes it exerts its biological effects.     

Psychosocial counseling after diagnosis for non-carriers of hereditary breast cancer or ovarian cancer; is it needed?

In 4 women, aged 29, 44, 51 and 63 years, from families with hereditary breast and ovarian cancer (BRCA1 and BRCA2), DNA testing had shown that they were non-carriers of a genetic mutation. They were invited for a study of what this finding meant to them. Two of them had no problems and 2 experienced psychological problems such as guilt feelings and distress from changed future perspectives. Psychosocial care was offered. One woman first accepted the psychosocial care, but later refused, because talking provoked painful memories. One woman got psychosocial care in the region where she lived. To select women with distress who need psychosocial care after being identified as non-carriers, the counsellor could ask after deaths in the family, the kind of contact in the family, complaints of gloominess or worrying, and previous psychosocial therapy.     

A PATHOLOGICAL STUDY OF BENIGN AND MALIGNANT TUMOURS OF SALIVARY GLANDS

Interest in the knowledge of salivary gland tumours is highlighted. A sample of 315 cases, collected over a period of 25 years in a busy pathology centre, is analysed both on total and individual aspects of tumours. The findings are compared to earlier works on the subject and also with contemporary literature.KEY WORDS: Pathological study, Salivary tumours     

Wound ventilation with ultraclean air for prevention of direct airborne contamination during surgery.

BACKGROUND AND OBJECTIVE: Despite the novelties in operating room ventilation, airborne bacteria remain an important source of surgical wound contamination. An ultraclean airflow from the ceiling downward may convey airborne particles from the surgical team into the wound, thus increasing the risk of infection. Therefore, similar ventilation from the wound upward should be considered. We investigated the effect of wound ventilation on the concentration of airborne particles in a wound model during simulated surgery. DESIGN: Randomized experimental study simulating surgery with a wound cavity model. SETTING: An operating room of a university hospital ventilated with ultraclean air directed downward. INTERVENTIONS: Particles 5 microm and larger were counted with and without a 5-cm deep cavity and with and without the insufflation of ultraclean air. RESULTS: With the surgeon standing upright, no airborne particles could be detected in the wound model. In contrast, during simulated operations, the median number of particles per 0.1 cu ft reached 18 (25th and 75th percentiles, 12 and 22.25) in the model with a cavity and 15.5 (25th and 75th percentiles, 14 and 21.5) without. With a cavity, wound ventilation markedly reduced the median number of particles to 1 (range, 0 to 1.25; P < .001). CONCLUSIONS: To protect a surgical wound against direct airborne contamination, air should be directed away from the wound rather than toward it. This study provides supportive evidence to earlier studies that operating room ventilation with ultraclean air is imperfect during surgical activity and that wound ventilation may be a simple complement. Further clinical trials are needed.