Chronic lower limb ulcer? No--chloroma!

Extra medullary deposits are often associated with myeloproliferative disorders, especially with myeloid neoplasia. These are called granulocytic sarcoma, aleukemic leukemia cutis, myeloblastoma, chloroleukemia, extra-medullary myeloid tumor, and chloroma. They commonly present in the bone, periosteum, soft tissue, lymph nodes, and the skin but can occur anywhere. The authors present their experience with a patient with no history of neoplasm presented with a nonhealing ulcer of the lower limb that was a chloroma associated with chronic myeloid leukemia.     

Initial experience with in-vitro fertilization technology in the English-speaking Caribbean

This audit documents the first experience with in-vitro Fertilization technology in the English-speaking Caribbean. From 1996 to 2000, 121 cycles have been performed in 99 couples utilizing these techniques. After ovarian stimulation, 1,103 oocytes were retrieved (average 9.1) and of these, 65% fertilized normally, with embryo transfer possible in 111 cycles. Twenty-one pregnancies were recorded (21.2% per patient and 18.9% per embryo transfer) and the live birth rate per patient was 12.1%. The trend was for the success rate to be better in patients under age 36 years.     

Pituitary tuberculoma mimicking adenoma: magnetic resonance imaging

A case of a pituitary mass with clinical and MRI findings consistent with adenoma is presented. Transnasal transphenoidal excision biopsy showed it to be a pituitary tuberculoma. The patient was treated with antituberculous drugs, and a follow-up MRI 18 months later showed good response. MRI features and a review of published reports of the sellar tuberculoma are briefly discussed.     

Dermatoses of the hand-an observation

After going through 1000 case files of patients registered in the skin department of K.M.C. Hospital, it was found that 166 (16.6%) of them had dermatoses restricted to their hands. Based on the clinical findings and clinical diagnosis recorded, the various dermatoses were tabulated and evaluated. Ninety-two males and 74 females had dermatoses of hands. Warts and eczemas formed the major chunk of cases. Females out numbered males among patients with warts and eczemas.     

The relative bioavailability of metoprolol following oral and rectal administration to volunteers and patients

The pharmacokinetics, efficacy and safety of metoprolol tartrate 25 mg fatty suppositories were studied in 5 healthy volunteers and in 8 patients suffering from instable angina pectoris. Metoprolol 25 mg capsules were used as a control oral dosage form. Metoprolol showed a considerable rectal bioavailability (AUC, C max) and was absorbed quickly from the rectum (T max). In both groups rectal bioavailability was comparable. However, oral bioavailability was much lower in the volunteer group than in the patient group. Furthermore, ratios of metoprolol/aOHmetoprolol concentrations in plasma and urine gave an indication for a partial avoidance of the first pass effect after rectal administration. Further research is necessary to define an exact rectal dosage of metoprolol. In all patients, a substantial drop in heart rate, systolic and diastolic blood pressure was seen after administration of the first suppository. Metoprolol suppositories appear to be an effective, safe and suitable alternative for patients who are in need for beta blocking medication and who are unable to take oral medication for a certain amount of time.     

Hepatic scintigraphy in management of infants and children with liver disease

Scintiscans of liver and spleen using technetium 99m sulphur colloid in 15 infants with extrahepatic biliary atresia and 11 infants with severe obstructive jaundice (7 with genetic deficiency of alpha 1-antitrypsin) showed similar hepatic size, pattern of isotope uptake, and splenic abnormality with no distinguishing features. In 37 older children with a variety of liver disorders, the scan was invaluable in showing filling defects in five instances. Selenomethionine was taken up not only by the two filling defects due to hepatoblastoma but also in a haemangioendothelioma. In the remaining patiens liver scanning confirmed hepatic abnormality and the necessity for more specific invasive diagnostic investigations.     

进展期霍奇金淋巴瘤的标准化治疗

霍奇金淋巴瘤（HL）为高度可治愈性疾病，多数病变局限。进展期HL（瘤体积〉10cm，B症状，Ⅲ/Ⅳ期）使用葸环类为基础的多药化疗失败率高达30％～40％。已有多项研究系统评估了多药联合化疗和巩固化疗方案，旨在改善疾病控制。随机对照临床实验（RCT）显示，二线化疗后加自体干细胞移植已成为复发、难治HL的标准治疗方案，而对移植前及非移植患者的解救方案仍缺乏共识。