Delayed peritoneal and retroperitoneal abcesses caused by spilled gallstones: a complication following laparoscopic cholecystectomy

Many complications following laparoscopic cholecystectomy have been reported. We report a case of delayed peritoneal and retroperitoneal abcesses caused by spilled gallstones from a laparoscopic cholecystectomy performed 1 year earlier. This diagnosis was suggested only at sonography because the aggressive behavior of the lesions containing nonopaque gallstones suggested, by computed-tomography scan, peritoneal metastatic disease.     

Bilateral aniridia, multiple webs and severe mental retardation in a 47, XXY/48, XXXY mosaic

Numerous congenital malformations consisting of aniridia, hypertelorism, bilateral webbing of the cubital and the popliteal regions and bilateral cryptorchidism were documented in a phenotypic male infant. Severe mental retardation, bilateral cataracts, exophthalmia and glaucoma followed by complete blindness were noted by the time the child was 9 1/2 years of age.
Leukocyte and fibroblast cultures were reported to show two cell lines, a majority of the cells showing a 47, XXY complement and a minority showing a 48, XXXY complement.     

Oral lecithin and linoleic acid in Friedreich's ataxia: II. Clinical results

Twenty-two patients with Friedreich's Ataxia and ten normal controls were followed for one year and assessed as to their clinical performance after two successive six-month periods of lecithin or safflower oil. Results demonstrated no significant difference in performance scores according to group assignation, neither in patients nor in controls. According to stages, two patients in stage I and to a lesser degree, one patient in stage IV showed better scores for muscle strength and some motor accuracy and coordination tests with lecithin. Controls as groups maintained positive scores in all tests. Patients as groups showed negative mean values in nine out of eleven tests. Again as groups, patients receiving safflower oil demonstrated a mean 8% less deterioration than patients receiving lecithin. This study demonstrates that objective clinical tests and the participation of normal controls are a must in a therapeutic trial implicating patients with a progressive disorder such as Friedreich's Ataxia. The possible role of linoleic acid as the active factor from which clinical improvement proceeded in some specific patients and with early functional stages of the disease, has to be considered and reevaluated in the near future.     

Treatment of patients with low-grade B-cell lymphoma with the combination of chimeric anti-CD20 monoclonal antibody and CHOP chemotherapy.

PURPOSE: To determine the safety and efficacy of the combination of the chimeric anti-CD20 antibody, Rituxan (Rituximab, IDEC-C2B8; IDEC Pharmaceuticals Corporation, San Diego, CA), and cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy. PATIENTS AND METHODS: Forty patients with low-grade or follicular B-cell non-Hodgkin's lymphoma received six infusions of Rituxan (375 mg/m2 per dose) in combination with six doses of CHOP chemotherapy. RESULTS: The overall response rate was 95% (38 of 40 patients). Twenty-two patients experienced a complete response (55%), 16 patients had a partial response (40%), and two patients, who received no treatment, were classified as nonresponders. Medians for duration of response and time to progression had not been reached after a median observation time of 29 + months. Twenty-eight of 38 assessable patients (74%) continued in remission during this median follow-up period. The most frequent adverse events attributable to CHOP were alopecia (38 patients), neutropenia (31 patients), and fever (23 patients). The most frequent events attributed to Rituxan were fever and chills, observed primarily with the first infusion. No quantifiable immune response to the chimeric antibody was detected. In a subset of 18 patients, the bcl-2 [t(14;18)] translocation was positive in eight patients; seven of these patients had complete remissions and converted to polymerase chain reaction (PCR) negativity by completion of therapy. CONCLUSION: This is the first report demonstrating the safety and efficacy of Rituxan anti-CD20 chimeric antibody in combination with standard-dose systemic chemotherapy in the treatment of indolent B-cell lymphoma. The clinical responses suggest an additive therapeutic benefit for the combination with no significant added toxicity. The conversion of bcl-2 from positive to negative by PCR in blood and/or marrow suggests possible clearing of minimal residual disease not previously demonstrated by CHOP chemotherapy alone.     

Maternal alphafetoprotein screening by the polypropylene tube immunoradiometric assay on dried blood

The polypropylene tube immunoradiometric assay for alphafetoprotein (AFP) determination was applied to maternal serum along with a radioimmunoassay technique during the second trimester of pregnancy. Blood from pregnant women was collected by finger prick on strips of chromatography paper (Schleicher and Schuell No. 903C) and air dried. A 4.75 mm disc spot was eluted in anti-AFP coated tubes containing 1.0 ml of assay medium. After one hour the medium was vortexed and the tubes washed and counted on a Concept 4tm (Micromedic Systems, Horsham, PA. 19044). The sensitivity of the technique is about 9 micrograms/l (35 ng/l in the assay) by the Rodbard formula. The concordance between the dried blood and the serum RIA tests in normal pregnancies was over 90 per cent at the 95th and 97th percentiles. This assay on dried blood spotted on chromatography paper was tested on 1003 patients and proved to be an ideal alternative to whole serum screening techniques: it minimizes sample manipulations and can easily be integrated into an existing newborn screening programme.     

Public perception of population health risks in Canada: Risk perception beliefs

A national survey of health risk perception among 1,503 adult Canadians was conducted in 2004 as a follow-up to a previous survey in 1992. Respondents were asked to indicate their personal opinion regarding a range of risk perception belief statements reflecting environmental concern, social concern, genetic concern, dependence on regulators, locus of health risk control (internal, powerful others, chance), risk acceptability and technological enthusiasm. The results indicated considerable concern over the state of the environment in general, however, less concern existed for the environment nearest to the individual. A high degree of concern was expressed over stress in the workplace, and poverty was perceived to represent an important health risk for Canadians. A strong sense of the importance of personal lifestyle factors and personal control over one's health was also observed as were notable increases in trust and dependence on the ability of government and experts to make decisions and regulate health risks in Canada as compared to the previous survey. Belief statements reflecting environmental and social concern correlated with the level of risk perceived for a variety of health hazards and outcomes.     

Clinical pharmacokinetics of encapsulated oral 9-aminocamptothecin in plasma and saliva.

OBJECTIVE: To study the pharmacokinetics and pharmacodynamics of the novel topoisomerase I inhibitor and antitumor agent 9-amino-20(S)-camptothecin in patients with solid tumors after repeated oral administration. METHODS: Thirty-two patients with cancer received oral 9-aminocamptothecin formulated in capsules with polyethylene glycol-1000 as excipient at doses that ranged from 0.25 to 1.5 mg/m2/day. Serial plasma and saliva samples were obtained on days 1 and 6 or days 1 and 8 of the first cycle and analyzed for the lactone and carboxylate forms of 9-aminocamptothecin by HPLC. RESULTS: 9-Aminocamptothecin showed linear and dose-independent pharmacokinetics, with extremely small intrapatient kinetic variability (coefficient of variation: <10%). However, interpatient variability in plasma pharmacokinetics was large (coefficient of variation: 99%). The relative extent of lactone to carboxylate interconversion was large (>90%) and predictable from individual pretreatment serum albumin values (P = .0099). The 9-aminocamptothecin concentration ratio in plasma and saliva was strongly patient dependent, and highly variable around a mean value of <0.8, suggesting that saliva is an unreliable matrix for kinetic monitoring. The area under the curve of the lactone form of 9-aminocamptothecin was significantly correlated with the dose-limiting hematologic toxicity (P < .001). CONCLUSION: Our data indicate that the large interindividual pharmacodynamic variability in response to 9-aminocamptothecin is caused mainly by a variability in kinetic characteristics, suggesting that a kinetic-dynamic guided study design is warranted in future clinical investigations.     

Comparison of oropharyngeal leak pressure between the Ambu® AuraGain™ and the LMA® Supreme™ supraglottic airways: a randomized-controlled trial

Purpose

Studies comparing the recently introduced Ambu® AuraGain? (Auragain) with the LMA® Supreme? (Supreme) supraglottic airway (SGA) have reported conflicting results regarding differences in oropharyngeal leak pressure (OLP). This randomized-controlled trial investigated the OLP of the Auragain compared with the Supreme in patients undergoing ambulatory surgery.

Methods

Adult patients with a body mass index ≤ 40 kg·m^?2 presenting for ambulatory surgery and requiring an SGA were randomized to receive either the Auragain or the Supreme. Anesthesia was induced with lidocaine (1 mg·kg^?1), fentanyl (1-2 μg·kg^?1), and propofol (2-3 mg·kg^?1). The SGA was inserted using a standard technique with the cuff inflated to 60 cmH₂O. The groups were compared for the primary outcome of OLP.

Results

One hundred sixty-five patients (n = 81, Auragain; n = 84, Supreme) completed the study. Demographics were similar between the groups. The mean (standard deviation [SD]) OLP was significantly higher in the Auragain than in the Supreme group [26.4 (2.8) cmH₂O vs 21.6 (3.4) cmH₂O, respectively; difference in means (MD), 4.8 cmH₂O; 95% confidence interval (CI), 3.9 to 5.8; P < 0.001]. The mean (SD) insertion time was longer in the Auragain than in the Supreme group [13 (4) sec vs 11 (3) sec, respectively; MD, 2 sec; 95% CI, 1 to 3 sec; P < 0.001].

Conclusion

In patients undergoing ambulatory anesthesia, the OLP was higher but took longer to insert with the Auragain than with the Supreme. A higher OLP may allow for SGAs to be utilized in a wider range of patients and procedures.

Trial registration

www.clinicaltrials.gov (NCT02816463). Registered 28 June 2016.