Pneumocystis pneumonia in 3 non HIV patients

We report 3 cases of pneumocystis pneumonia (PCP) in 2 female and 1 male patients (mean age=50 years) free of human immunodeficiency virus (HIV) infection. One female patient presented with breast neoplasm the other with Wegener's granulomatosis, the male patient with lymphoma. All patients were taking immunosuppressive treatment at the time of infection. Persistent cough, dyspnea, and severe hypoxemia were the most characteristic clinical signs. All patients presented with lymphopenia (average CD4-cell count=275/mm3), two with hypoalbuminemia, and one with renal failure. In all cases, the microscopic analysis of bronchoalveolar lavage was used to establish the diagnosis. All patients were treated with trimethoprim and sulfamethoxazole and a tapering dose of corticosteroids. Outcome was favorable for 1 patient, 1 was transferred to the intensive care unit for acute respiratory failure, and 1 died.     

Reverse Shoulder Arthroplasty in Patients With Amputation or Paralysis of the Contralateral Upper Extremity (One-Arm Patients)

Background

Theoretically, patients with only one functional arm secondary to contralateral amputation or paralysis will subject their only functional upper extremity to increased loads. This could become an issue after reverse shoulder arthroplasty (RSA). However, there are no reported data on the implant survival or function for patients with a nonfunctional contralateral upper extremity.

Use of peripheral blood instead of bone marrow to monitor residual disease in children with acute lymphoblastic leukemia

In children with acute lymphoblastic leukemia (ALL), response to treatment is assessed by bone marrow aspiration. We investigated whether minimal residual disease (MRD) can be effectively monitored in peripheral blood. We used flow cytometric techniques capable of detecting 1 leukemic cell among 10 000 or more normal cells to compare MRD measurements in 718 pairs of bone marrow and peripheral blood samples collected from 226 children during treatment for newly diagnosed ALL. MRD was detected in marrow and blood in 72 pairs and in marrow but not in blood in 67 pairs; it was undetectable in the remaining 579 pairs. Remarkably, findings in marrow and blood were completely concordant in the 150 paired samples from patients with T-lineage ALL: for each of the 35 positive marrow samples, the corresponding blood sample was positive. In B-lineage ALL, however, only 37 of 104 positive marrow samples had a corresponding positive blood sample. Notably, peripheral blood MRD in these patients was associated with a very high risk for disease recurrence. The 4-year cumulative incidence of relapse in patients with B-lineage ALL was 80.0% +/- 24.9% for those who had peripheral blood MRD at the end of remission induction therapy but only 13.3% +/- 9.1% for those with MRD confined to the marrow (P =.007). These results indicate that peripheral blood may be used to monitor MRD in patients with T-lineage ALL and that peripheral blood MRD may provide strong prognostic information in patients with B-lineage ALL.     

Bone mineral density (BMD) and osteoporosis risk factor in Egyptian male and female battery manufacturing workers

The study was conducted to estimate the relation between lead exposure and the risk of various symptoms of osteoporosis in male and female battery manufacturing workers by using dual energy X-ray absorptiometry. A total of 18 female and 24 male workers were chosen with the same age range, duty hours per day, work history and weight. A total of 15 healthy controls were chosen with no previous history of bone illness and normal blood lead concentration. Blood lead concentration was measured in all workers and controls. Non-lead elevated subjects were excluded. Bone mineral density was measured by X-ray-based dual-energy X-ray absorptiometry scan machine. Spine, femur neck and radius sites were studied. Results showed that both male and female workers recorded significant elevated levels of lead concentration accompanied by osteoporosis when compared with control. Interestingly, the data revealed that fracture risk in female was significantly higher than male workers. It was concluded that lead poisoning may act as osteoporosis risk factor or co-factor in female workers by activating the conversion of osteopenia to osteoporosis.     

Right ventricular function before and after an uncomplicated coronary artery bypass graft as assessed by pulsed wave Doppler tissue imaging of the tricuspid annulus

Background

Right ventricular (RV) function using myocardial velocities before and after a coronary artery bypass graft (CABG) is not known.

Methods

Using pulsed wave Doppler tissue imaging, RV function was studied in 35 patients before and after CABG. Patients were followed-up for 1 year after the CABG. Myocardial velocities at the tricuspid annulus at the RV free wall were recorded from the apical 4-chamber views.

Results

Both the systolic and early diastolic tricuspid annular velocities (TAV) were significantly reduced 1 month after CABG (P < .001 for both). During the follow-up period, there was no improvement in the diastolic TAV. The systolic TAV showed no improvement 3 months after CABG but recovered partially 1 year after the CABG (systolic velocities were 11.8, 8.7, 8.7 and 9.7 cm/s, the early diastolic velocities were 11.0, 8.1, 8.1 and 8.2 cm/s before and 1 month, 3 months and 1 year after the CABG, respectively). The systolic and early diastolic velocities of the interventricular septum were unchanged during the follow-up period. Unlike the right ventricle, the mitral annular systolic velocity was unchanged shortly after CABG and showed signs of improvement after 1 year (6.4, 6.9, 6.8 and 7.3 cm/s respectively before and after CABG). Patients underwent dobutamine stress echocardiography (DSE) before and 3 months after the CABG. The systolic TAV increased significantly during the DSE before CABG (11.8 vs 15.8 cm/s, P < .001). However, the increase in systolic TAV was limited during DSE 3 months after CABG (8.7 vs 9.9 cm/s, P < .05).

Conclusion

RV function, as assessed by TAV, decreased significantly after CABG and the changes were still evident after 1 year. The response of systolic TAV during DSE was more pronounced before CABG than after CABG.     

Amplification of the steroidogenic factor 1 gene in childhood adrenocortical tumors

Southern Brazil has one of the highest incidences of childhood adrenocortical tumors (ACTs), occurring 10-15 times more frequently than worldwide estimates. The reasons for this increase remain elusive. In an attempt to further characterize the genetic changes in childhood ACTs, we recently detected a consistent gain of 9q (or a portion of it) in eight of nine cases of pediatric ACTs and amplification of 9q34 in the majority of these cases using comparative genomic hybridization. Other studies involving both childhood and adult ACTs have corroborated these findings. To follow up on these results, we examined whether the steroidogenic factor 1 (SF-1) gene, which is located in this chromosomal region and plays an important role in the development and function of the adrenal cortex is amplified in these ACT cases. We detected increased copy number of the SF-1 gene in all eight cases with 9q gain, suggesting an association between an increased copy number of the SF-1 gene and adrenocortical tumorigenesis.     

Systemic lupus erythematosus in Tunisia. A multicentric study. About 295 cases

PURPOSE: Systemic lupus erythematosus (SLE) is an autoimmune disease with a great clinical polymorphism. Wide variety of genetic, hormonal, immunological and environmental contributes to release the disease. Our objective was to describe and precise the epidemiological, clinical and immunological profile of this disease in Tunisia. METHOD: It is a retrospective study conducted by the Tunisian society of internal medicine during the period from January 1990 to December 1999. All patients fulfilled at least four of the revised American Rheumatism Association's criteria for SLE. RESULTS: Two hundred and ninety-five SLE have been examined (271 women, 24 men). The most frequent clinical manifestations were: articular 90%, malar rash 62%, photosensitivity 46%, seritis 32% and glomerulonephritis 56%, dominated by WHO class III and IV: 60 cases (renal biopsy was performed in 95 patients). Neurological features were observed in 14.5%. The abnormal laboratory findings were leucocytopenia 45%, lymphopenia 47%, thrombocytopenia 16% and hemolytic anemia in 6.7%. Antinuclear antibodies, anti-ds DNA and anti-Sm were at 92%, 74% and 57%, respectively. Eighty-three percent of patients were treated by steroids, and in 52 cases (18%), we added immunosuppressive drugs. Two hundred and eighteen patients were followed up with a mean follow-up duration of 51 months. Twenty-eight percent were in complete remission and in 60%, the SLE was active. In contrast, death occurred in 29 cases. CONCLUSION: Our study confirmed the clinical polymorphism of SLE, the great similarity with other studies apart the world, the gravity of renal and cardiac features and the infectious complications induced by corticosteroids.     

The effect of bariatric surgery on inflammatory markers in women with polycystic ovarian syndrome

Aim

The aims of this study is to address the improvement in CRP and adiponectin in obese PCOS and non PCOS after bariatric surgery, and to show that obese PCOS women have a slower rate of improvement when compared to obese non PCOS women.