Urinary Charcot-Leyden crystals in the hypereosinophilic syndrome with acute renal failure

A 48-year-old man with idiopathic hypereosinophilic syndrome (IHS) developed blast crisis along with a fulminant autoimmune hemolytic anemia. Hemoglobinuria and anuric acute renal failure (ARF) ensued. Urinalysis revealed countless Charcot-Leyden crysals (CLC). This is the only known report of Charcot-Leyden crystalluria. The CLC protein (lysophospholipase) should normally undergo glomerular filtration and catabolism by the tubules during reabsorption. Its abundant presence in the urine of our patient may reflect impairment of tubular reabsorption, saturation of the tubular reabsorptive process by excessive CLC load through residual functioning glomeruli, or a combination thereof. The extreme degree of hypereosinophilia suggests a massive load of CLC protein and acute tubular necrosis implies impaired tubular function, so both mechanisms should have been operative. At the autopsy, no eosinophilic infiltrates were present in the kidneys, which points against a local spillage of CLC protein into the tubules.     

The existence of a layer IV in the rat motor cortex

We have reconstructed the laminar pattern of rat primary motor cortex (Fr1) using a computerized analysis system based on the so-called 'optical dissector'. Data were visualized on a graphics terminal. In contrast to current views, which state that there is no prominent layer IV in the motor cortex of the rat, our method of analysis revealed a genuine layer IV consisting of densely packed small neurons.      

Atypical affective disorder with episodic dyscontrol: a case of von Economo's disease (encephalitis lethargica).

The case is described of a patient with atypical affective disorder, episodic behavioural dyscontrol and parkinsonism resulting from presumed encephalitis lethargica. EEG abnormalities were found which were compatible with a post-encephalitic state and suggestive of epileptiform complications. Poor or deleterious response to neuroleptics, sleep disorder, and parkinsonism are features that may allow recognition of this illness in a psychiatric setting.     

Identification of appropriate outcomes for an aging population

Outcome measures are necessary for assessment of the appropriateness, quality, necessity for, and effectiveness of oral health care. With the growing number of older adults in the United States, it is appropriate to reflect on the unique characteristics of this segment of our society and how these characteristics may influence the identification of appropriate outcome measures. Older people often demonstrate multiple acute or chronic oral diseases with interrelated symptoms and clinical findings. Older persons are more likely to take medications with potentially adverse oral health effects. Patients experience a variety of disease processes over many years and have variable access to and experiences with the dental care system. These characteristics make the selection and interpretation of outcomes complex. Limitations of existing measures and considerations for the development of new outcomes measures specifically for older populations are reviewed.     

Prognostic importance of myelosuppression during maintenance treatment of lymphoblastic leukaemia. Leukaemia in Childhood Working Party of the Medical Research Council.

Children from the UKALL V trial were studied to assess the clinical importance of myelosuppression during uninterrupted ''maintenance'' treatment of ''standard risk'' lymphoblastic leukaemia. Those receiving daily 6-mercaptopurine and weekly methotrexate who were in first remission 20 months from diagnosis were divided into two groups on the basis of whether or not they had ever had an absolute neutrophil count of less than 0.5 x 10(9)/l recorded during maintenance treatment up to that time. Of 105 evaluable children, 45 (43%) became neutropenic at least once, and 60 (57%) did not. Seven (16%) of the neutropenic group subsequently relapsed compared with 27 (45%) of the remainder. This difference was still significant if the analysis was stratified by total treatment time (two or three years), age, sex, or diagnostic white cell count. Seven (16%) neutropenic children died in remission, compared with one (2%) of the non-neutropenic children. Therapeutic myelosuppression during standard maintenance treatment of ''standard risk'' lymphoblastic leukaemia is associated with increased toxicity but a reduced risk of relapse. The unexplained improvement in long term survival in the United Kingdom in recent years may in large part be due to this.     

The longitudinal time course of QTc in early infancy. Preliminary results of a prospective sudden infant death syndrome surveillance program

Eleven hundred one healthy neonates in Charleston County, SC, were enrolled in a prospective, serial measurement sudden infant death syndrome/QT surveillance program. Automated computer-enhanced ECGs were recorded at 1 day of age in the hospital nursery and again at 1 week and 1, 2, and 3 months in the participant's home. At 1 year, the families were contacted by phone or mail and questioned as to the health of the child. Validation studies demonstrated the computer-enhanced ECGs to be 96% accurate, whereas traditional ECG recording and measurement was 94% accurate. No systematic differences in the QTc according to race and sex were observed. There were parallel longitudinal time courses for each race and sex group with a significant (P less than .001) shortening of the QTc at 1 week. There was no evidence of tracking of the QTc during the first 3 months of life. In conclusion, (1) automated, enhanced ECG QTc intervals are superior to traditional electrocardiography while retaining the advantages of automation; (2) there is a significant shortening of the QTc during the first month of life; and (3) a home follow-up sudden infant death syndrome surveillance program is feasible and produces accurate, reliable information.