A study of erythrocyte membrane cation transport adenosine triphosphatases in pregnancy-induced hypertension and of in vivo effects of diuretic treatment

Plasma and erythrocyte Na⁺ and K⁺ and erythrocyte membrane (EM) Na⁺, K⁺ ATPase, Mg²⁺ ATPase and Ca²⁺, Mg²⁺ ATPase activities were studied in four groups of women — non-pregnant, normal pregnant, with pregnancy edema (PE) and with pregnancy induced hypertension (PIH). The effect of diuretic therapy in PE and PIH was also evaluated. Plasma Na⁺ concentration was higher in PE and PIH. There was a significant reduction in (Na⁺ + K⁺ ratio between cell and plasma in these two groups. EM Na⁺, K⁺ ATPase was unaltered in PE and PIH. The Mg⁺ ATPase was elevated by 44% in PE and by 100% in PIH subjects. There was a 50% reduction in Ca²⁺, Mg²⁺ ATPase activity in PE. Diuretic therapy had no effect either on electrolyte levels or on any of the EM ATPases.From these results it may be concluded that Na, K, ATPase — which in kidney is a site of action for furosemide, a potent diuretic — is unaffected in PE and PIH and, hence, treatment with diuretics in such patients may be ineffective.     

Decreased bioavailability of rifampin and other antituberculosis drugs in patients with advanced human immunodeficiency virus disease

We evaluated the effects of human immunodeficiency virus (HIV) disease on pharmacokinetics of antituberculosis medications by measuring concentrations of isoniazid and rifampin in blood and of pyrazinamide and ethambutol in urine. Peak concentration and exposure were reduced for rifampin, and rapid acetylators of isoniazid had lower drug levels. HIV and HIV-tuberculosis patients who have diarrhea and cryptosporidial infection exhibit decreased bioavailability of antituberculosis drugs.     

Prevalence of Transfusion Transmitted Infections in Voluntary and Replacement Donors

The aim of the study was to find out the prevalence of transfusion transmitted infections (TTI) in voluntary and replacement donors. A total of 9599 donors were analysed for the prevalence of TTI over a period of 2 years.Of these 61.2% were voluntary donors and 38.8% were replacement donors. Prevalence of TTI in total donors was 0.6%. Prevalence of hepatitis B was highest (0.34%) followed by syphilis (0.11%), HIV&HCV (0.06%) and malaria (0.01%). Prevalence was more in male replacement donors. Extensive donor selection and screening procedures will help in improving the blood safety.     

Consumer Beware: A Systematic Assessment of Potential Bias in the Lay Electronic Media to Examine the Portrayal of “PARP” Inhibitors for Cancer Treatment

This study examined how the lay electronic media covers poly-ADP-ribose polymerase, or “PARP,” inhibitors, a class of cancer agents currently under clinical investigation. Of 771 internet links, 51 targeted the lay public. Independent review by two investigators yielded the following categorizations: 36 (71%) were “overly positive”, 15 (29%) “neutral”, and none “overly negative”. “Overly positive” articles used: (l) overstated benefit, (2) included quotations from enthusiastic scientists, and (3) discussed single or small patient subsets. They used such phrases as “the holy grail of cancer research”, “the most exciting development in cancer research in a decade or more…. it could save thousands of lives”, and “we were surprised and delighted…. it’s the kind of thing you don’t really think will happen”. Healthcare providers should be aware of the foregoing when discussing PARP inhibitors—and perhaps other novel therapies—with cancer patients.     

Unmasking of Neonatal Renovascular Hypertension by Milrinone Used for Cardiac Dysfunction

A neonate initially presented with heart failure, with severe cardiac dysfunction confirmed by echocardiography, at 3 days of age. Blood pressure at presentation was in the high normal range. It was not until there was a rapid improvement of left-ventricular function on intravenous milrinone that the infant was noted to be hypertensive on day of life 7. It is noteworthy that milrinone, a drug with vasodilator and inotropic properties, paradoxically unmasked hypertension by rapidly improving left-ventricular function. Subsequent work-up showed the etiology of hypertension to be left renal artery stenosis. We present this case to alert clinicians to the rarer causes of left-ventricular dysfunction and to point out that its etiology, i.e., hypertension, may not be apparent until there is improvement in the systolic function of the left ventricle.     

Pituitary carcinoma recurrent to the lumbar intradural extramedullary space: case report

Context

Pituitary tumors are rare, and pituitary carcinomas are rarer still. Prognosis is poor, with less than 50% of patients surviving past 1 year after diagnosis. In this case of spinal metastasis from an adrenocorticotropic hormone-secreting pituitary carcinoma, the intradural extramedullary metastases recurred in the same lumbar area 6 years apart.

Findings

Fourteen years prior to presentation in our clinic, a 48-year-old woman was diagnosed with pituitary adenoma which was treated with resection followed by radiation. Eight years later, an intradural extramedullary spinal drop metastasis at L2–L3 was again treated with resection and radiation. Three years later, magnetic resonance imaging (MRI) revealed a mass encasing the right carotid artery, which was treated for 1 year with chemotherapy using temozolomide (Temodar). Three years later, MRI showed intradural extramedullary metastases at the L3–L4 intervertebral disc space and behind the L3 vertebral body; treatment was again resection followed by radiation. Back pain and weakness resolved after surgery and her neurological examination returned to baseline. There was no evidence of recurrence 1 year after surgery.

Conclusion/clinical relevance

In this unusual case, this pituitary carcinoma metastasized twice in 6 years to virtually the same intradural extramedullary lumbar region. Surgical resection of these masses aided in relieving neurological symptoms and prolonging life.