Twenty-year follow-up of patients with new perioperative Q waves after coronary artery bypass grafting

It is unclear whether the development of new Q waves on the electrocardiogram after coronary artery bypass grafting (CABG) is associated with an adverse prognosis. We analyzed the 20-year survival of 227 patients who underwent CABG, and found that new perioperative Q waves had no impact on long-term survival; therefore, conservative management may be appropriate for uncomplicated patients with new Q waves after CABG.     

Rapid growth of a basilar aneurysm

We describe a patient who developed, over a 22-month period, a giant aneurysm of his basilar artery. A prior MRI of the brain done for nonspecific symptoms showed a normal brainstem and basilar artery. At presentation, he had a repeat MRI scan for a 4-month history of a partial right oculomotor nerve palsy and left hemiparesis. The MRI revealed a giant aneurysm of the top of the basilar artery. This was treated by angiographic placement of Guglielmi detachable coils (GDC) after surgical intervention was deemed unfeasible. This case illustrates the acquired nature of intracranial aneurysms. All inoperable intracranial aneurysms should be closely monitored and MRI and MR angiography may currently be the best noninvasive methods for this purpose. Intra-arterial GDC embolization of aneurysms is an alternative treatment when surgery is not possible.     

Transmission of Salmonella worthington by oropharyngeal suction in hospital neonatal unit

An outbreak of Salmonella worthington infection in a neonatal unit occurred in a pediatric ward of Holy Family Hospital, Rawalpindi, Pakistan. The index case was a prematurely born male child from whose clinical specimens S. worthington was recovered. After this finding 40 infants kept in that nursery were included in an investigation. Major symptoms were diarrhea, septicemia and jaundice. Three developed meningitis. Disease morbidity rate was 45% and mortality occurred in 16.6% of the total positive cases. The source of infection was traced to a contaminated rubber tubing of a suction apparatus which was used for oropharyngeal suction of the babies. S. worthington was recovered from the clinical specimens of all 18 babies who received suction. Multiple drug resistance of these S. worthington strains was found.     

Sex steroids enhance endotoxin-stimulated phospholipase A2 activity in hum endometrial cells

Summary Growing evidence suggests an association between intra-amniotic infection and preterm labor. We recently demonstrated that some factor(s) including endotoxin produced by the organism stimulated endogenous phospholipase A₂ resulting in liberation of arachidonic acid and prostaglandin formation (Takahashi et al. 1988). The studies presented in this report were designed to evaluate whether ovarian steroids alter activity of the phospholipase A₂ responsive to endotoxin. Exposure of human endometrial proliferative- or secretory-phases epithelium to endotoxin fromEscherichia coli increased the level of lysophosphatidylcholine (lyso-PC) by 15- and 25-fold, respectively. When the endometrial cells were preincubated with progesterone alone or progesterone and estradiol-17β for 16 h, the increase of lyso-PC by endotoxin was enhanced by approximately 1.5-fold. Progesterone showed a stimulatory effect on the response of phospholipase A₂ to bacterial endotoxin in endometrial cells. These observations may explain the mechanism(s) by which preterm or term labor associated with intra-amniotic infection is initiated.     

E-SHAP: An effective treatment in selected patients with relapsed non-Hodgkin's lymphoma

BACKGROUND:: The optimal treatment of relapsed or refractory non-Hodgkin'slymphoma is unknown. The reported encouraging results of a salvageregimen, E-SHAP (etoposide 40 mg/m²/day x 4, methyl prednisolone500 mg daily x 4, cytosine arabinoside 2 gm/m² one dose andcisplatinum 25 mg/m²/day x 4), at the MD. Anderson Hospitalin Texas, which resulted in a 65% response rate, could not bereproduced in the United Kingdom (0% response). PATIENTS AND METHODS:: Twenty-six patients with relapsed (n = 16) or refractory (n= 10) non-Hodgkin's lymphoma were treated at our Centre by amodified E-SHAP regimen (cytosine arabinoside 1 gm/m² one dose).The treatment was intended as remission induction before BMT(n = 16), as salvage by itself (n = 5) and for palliation ofsymptoms (n = 5). RESULTS:: The overall response rate was 72% (CR = 7 and PR = 11). A comparisonof Kaplan-Meier curves showed a statistically significant improvementin median relapse-free survival in patients who had previouslyachieved CR (p = 0.0012), no bulky disease (P = 0.0006) andno B-symptoms (P = 0.0004). The toxicity was acceptable: 8 instancesof febrile neutropenia, 2 of reversible renal impairment and2 symptomatic electrolyte abnormalities. No fatal toxicitieswere encountered. The median time to treatment failure was 191days and median overall survival was 190 days. CONCLUSIONS:: E-SHAP is an active combination chemotherapy when used as asalvage regimen or for remission induction before bone marrowtransplantation in selected patients with relapsed non-Hodgkin'slymphoma. Patients who previously achieved CR, with low tumourburden and no B-symptoms are the best candidates for this treatment.It has a limited palliative effect. non-Hodgkin's lymphoma, salvage chemotherapy, etoposide, cisplatinum     

Comparison of mathematical models for exposure assessment with computational fluid dynamic simulation

For many years exposure to airborne contaminants has been estimated by air or biological monitoring. In occupational settings, mathematical models increasingly are employed as adjuncts to monitoring, for instance, during process design or in retrospective epidemiological studies. Models can make predictions in a wide variety of scenarios, can be used for rapid screening, and may reduce the need for monitoring in exposure assessment. However, models make simplifying assumptions regarding air flow and contaminant transport. The errors resulting from these assumptions have not been systematically evaluated. Here we compare exposure estimates from the single-zone completely mixed (CM-1), two-zone completely mixed (CM-2), and uniform diffusivity (UD) models with workroom concentration fields predicted by computational fluid dynamics (CFD). The room air flow, concentration fields, and the breathing zone concentration of a stationary worker were computed using Fluent V4.3 for factorial combinations of three source locations, three dilution air flow rates and two emission rate profiles, constant and time-varying. These numerical experiments were used to generate plausible concentration fields, not to simulate exactly the processes in a real workroom. Thus, "error" is defined here as difference between model and CFD predictions. For both constant and time-varying emission sources, exposure estimates depended on receptor and source location. For the constant source case, ventilation rate was shown to be inconsequential to CM-1 model error. CM-1, CM-2, and UD models differed in their agreement with CFD. UD was closest to CFD for estimating concentration in the simulated breathing zone (BZ) near the source, although large errors resulted when the model was applied to the plane of possible breathing zones. CM-1 performed better for this plane but underestimated the near-source BZ exposure. For the near-source BZ location, CM-2 replicated CFD predictions more closely than CM-1 did, but less closely than UD did. Error in CM-1 model estimation of short-term average exposure to a time-varying source was highly dependent on ventilation rate. Error decreased as ventilation rate increased.     

Amyloid P component in normal human placentae

The presence of tissue amyloid P component was determined by using a direct immunofluorescence technique on frozen sections of normal human placentae and umbilical cords from gestations of various durations. Amyloid P component was first detected at the 16th week of gestation and appeared to increase progressively in amount so as to be present in abundance in the term placenta. Placental amyloid P component was present in the perifetal capillary zone where basement membrane-like material and reticulin fibres are also found. Amyloid P component may be related to the maturation of the placenta.