Psoas abscess — Fact and mimicry

Seven patients with processes involving the psoas muscle are presented. These included psoas abscess (3), metastatic tumor and abscess (1), lymphoma (1), and psoas hematoma (2). The role of radiologic studies in the diagnosis and management of these patients is discussed with particular reference to ultrasound and computed tomography.     

On the structure of the COOH-terminal part of the a alpha chain of human fibrinogen.

Human fibrinogen has been digested with plasmin: 1) for 22 hours, and a fragment, Hi2-A1a, with a molecular weight of 25,000 has been isolated; 2) for 10 minutes, and an early degradation product with molecular weight of 50,000 was obtained. This fragment may contain a COOH-terminal amino acid of the A α chain. On further plasmic hydrolysis of the 50,000 MW fragment it gave rise to Hi2-A1a in addition to smaller fragments.Both Hi2-A1a and the 50,000 MW fragment are shown to originate in the A α chain of fibrinogen. Furthermore, the relationship between these fragments and the fragment Hi2-DSK, obtained by cyanogen bromide cleavage of fibrinogen is elucidated. Partial amino acid sequence analyses of the different fragments are shown.     

Long-term functional and urodynamic results of 50 patients receiving a modified sigmoid neobladder created with a short distal segment

PURPOSE: We assessed the long-term functional and urodynamic outcomes of a modified sigmoid neobladder. MATERIALS AND METHODS: A total of 50 patients received a sigmoid neobladder with a short distal segment after radical cystoprostatectomy. Patients were followed at 3-month intervals the first year and every 6 months thereafter. Continence and voiding patterns were assessed using questionnaires and interview. The International Continence Society classification was used after 1996. Urodynamic assessment was performed 3 times during followup. RESULTS: Mean sigmoid segment length +/- SD was 18 cm (+/- 2.8). Mean followup was 38 months (+/- 24.8). Ureter stricture and reflux were present in 8% and 17% of the reimplanted units, respectively. Mean creatinine serum levels did not change after surgery and remained stable during followup. At 2 years 89% of the patients were continent in the daytime and 90% had good or satisfactory daytime continence according to the International Continence Society classification. At 3 years 77% of the patients voided every 3 or 4 hours during the day. Nighttime continence was poor. Only 10% of the patients complied with an alarm program. Mean maximal capacity of the reservoir was 300 ml and remained stable during followup. Mean intrareservoir pressure at maximal capacity decreased from 61 to 51 cm H2O from the first to the third urodynamic evaluation. No patient required clean intermittent catheterization. CONCLUSIONS: This modified sigmoid neobladder offers good daytime continence with low post-void residual and adequate daytime micturition frequency. Nighttime continence is poor. The presence of high intrareservoir pressures did not impair renal function.     

Successful maintenance electroconvulsive therapy for more than seven years

We report on a patient with recurrent major depressive episodes with psychotic features who was successfully treated with maintenance electroconvulsive treatment (M-ECT) over a long period without the need for concurrent treatment with an antidepressant or mood stabilizer. She started ECT in 1996 and has received M-ECT for more than 7 years. To date (2005), she has received 244 treatments. After 5 admissions in nearly 4 years, involving 29 months in hospital, she has not needed any further psychiatric admission for 7 1/2 years since the start of the M-ECT. Her depression has been in complete remission for nearly 6 years, with the exception of one mild-to-moderate nonpsychotic depressive episode lasting for 2 months. The patient exhibited slight cognitive deficits but had no subjective complaints before ECT, and her cognitive deficits did not worsen after the initial ECT. Thus M-ECT does not appear to cause cognitive deterioration. M-ECT is being continued on the patient's request.     

A liquid hexavalent combined vaccine against diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type B and hepatitis B: review of immunogenicity and safety

To reduce the number of injections needed to comply with paediatric vaccination requirements, a liquid, hexavalent vaccine (DTaP-IPV-PRP-T-HBs; Hexavac; Aventis Pasteur MSD) has been developed for primary and booster vaccination of infants and toddlers. In extensive clinical studies, Hexavac has been shown to be highly immunogenic. Seroconversion or seroprotective titres of antibodies against all antigens were achieved in the majority of infants following a primary series of three doses administered at 1-2-month intervals from 2 months of age. Hexavac also induced immunologic memory, as evidenced by the anamnestic response to booster vaccination at 12-18 months of age. These responses were comparable with those seen following concomitant administration of Pentavac (DTaP-IPV//PRP-T) and monovalent hepatitis B vaccine (H-B-Vax II), and were also within the ranges observed for other relevant licensed vaccines. Clinical studies comparing the immunogenicity of Hexavac administered at either 2, 3 and 4 months or 2, 4 and 6 months demonstrated that it can be used by either vaccination schedule. A further study also supported the use of primary doses of Hexavac at 3 and 5 months with a booster at 12 months of age. Hexavac demonstrated a good reactogenicity and tolerability profile. The most frequently reported adverse events after both primary and booster doses were local reactions of redness and swelling/induration and a systemic response of mild fever, irrespective of the vaccine used for priming. Hexavac provided immunity against six important childhood diseases with a single injection at each visit.     

Near-fatal asthma: a population-based study of risk factors

BACKGROUND: The study of near-fatal asthma (NFA) may provide a means to further our understanding of fatal asthma. Studies of NFA often are derived from a single ICU rather than from a defined population. We therefore aimed to identify factors distinguishing NFA patients (cases) from those persons treated in an emergency department (ED) [ED control subjects] and in the community (community control subjects [CCs]). METHODS: This was a population-based case-control study conducted over 20 months of 45 NFA patients (age range, 5 to 50 years), 197 ED control subjects treated in an ED, and 303 CCs, all of whom were residents of Alberta. RESULTS: The age distribution was similar between NFA patients and control subjects, with the majority being < 22 years of age (NFA patients, 68.9%; ED control subjects, 71.3%; CCs, 60.7%). Those patients with NFA were significantly more likely to have received a diagnosis before 5 years of age (66.6%), compared to ED control subjects (39.6%) and CCs (28.7%). The NFA group was significantly more likely to report moderate-to-severe disease and more frequent symptoms than the other groups. Therapy with bronchodilators was used most frequently by the NFA group compared to the ED control subjects and CCs (p < 0.001), as was therapy with inhaled steroids (p < 0.001) and oral steroids (p < 0.001). NFA patients had higher scores for vulnerability and were most likely to admit to stress as an asthma trigger. All groups had high exposure to cigarette smoke and pets. CONCLUSION: NFA patients have many modifiable risk factors and many similarities to ED control subjects and CCs with asthma. General measures to improve asthma control and awareness of risks are required in all groups.