Limited lists and the purchase of pharmaceutical products by government agencies in the RSA

The use of a limited list to restrict the range and type of medication used by medical institutions that operate under the auspices of the provincial authorities has been mooted as one possible method of cost containment. This study discusses the implementation of such measures in other countries and then quantifies the cost savings that might be obtained in the South African case. The possible savings are somewhat offset by other costs such a measure would introduce.     

Hydrochlorothiazide-amiloride causes excessive urinary zinc excretion

Serum zinc levels and urinary zinc excretion were compared in 15 patients with essential hypertension taking chronically a combination of hydrochlorothiazide and amiloride as monotherapy, eight patients maintained with hydrochlorothiazide alone, and eight control subjects. Serum zinc values were statistically comparable in all three groups. However, urinary zinc excretion was abnormally elevated in the two patient groups. In the dosage used, amiloride did not have a zinc-sparing effect.     

Seasonal variation in contact lens-associated corneal ulcers

We undertook a retrospective analysis of 112 patients admitted to Wills Eye Hospital, Philadelphia, between 1983 and 1985 with corneal ulcers associated with the use of contact lenses to test the clinical impression that such ulcers are more common in summer. Over half of the admissions (51%) occurred between June and September. The seasonal variation of the ulcers was statistically significant (p less than 0.01). Possible factors predisposing to corneal ulcers in people who wear contact lenses in the summer include enhanced growth of bacteria at warmer temperatures and wearing the lenses while swimming.     

Prospective analysis of photokeratoscopy for arcuate keratotomy to reduce postkeratoplasty astigmatism

Seven eyes of seven patients with visually disabling postkeratoplasty astigmatism underwent arcuate keratotomy to reduce astigmatism. Keratotomy length was prospectively determined by comparing the corneal shape change needed by each patient with shape changes in cadaver eyes induced by arcuate keratotomy. Keratograph ring ovality quantified corneal shape change. Keratotomies were placed in the wound interface using a diamond knife with blade length set to 100% of corneal thickness. Prekeratotomy keratometric astigmatism was 9.27 +/- 2.14 D (mean +/- SD), and at 2.0 to 18.4 months after keratotomy, astigmatism was 2.75 +/- 2.25 D (mean +/- SD). All corneas had decreased keratometric astigmatism and less oval keratoscope rings. Five corneas had 3.00 D or less residual keratometric astigmatism. Change in ring ovality was significantly correlated with keratotomy length and keratometric astigmatism change. The utility of keratoscope ring ovality as a corneal topography metric was demonstrated by systematically investigating the response to arcuate keratotomy.     

Successful immune reconstitution decreases leukemic relapse and improves survival in recipients of unrelated cord blood transplantation.

Allogeneic hematopoietic stem cell transplantation (HSCT) is established therapy for selected patients with acute leukemia. After transplantation, antileukemic immune responses are believed to eliminate residual leukemia cells and decrease the likelihood of relapse. However, the clinical effect of successful antigen-specific immune reconstitution after HSCT on the likelihood of leukemic relapse and overall survival is not known. Pediatric recipients of unrelated cord blood transplants who underwent transplantation for acute leukemia were sequentially evaluated for their development of antigen-specific T-lymphocyte immunity to herpes viruses. The clinical effect of a positive antigen-specific response on relapse-free survival was determined. The presence of an antigen-specific response resulted in a relapse-free survival advantage (P = .0001), which was primarily due to a decrease in leukemic relapse (P = .003). Proportional hazards modeling for time to relapse and time to relapse or death defined 3 variables that were strongly associated with a poor outcome: female gender, poor remission status before transplantation, and negative antigen-specific T-lymphocyte proliferation. Notably neither acute nor chronic graft-versus-host disease had any effect on the incidence of leukemic relapse. Successful antigen-specific immune reconstitution after unrelated cord blood transplantation results in decreased leukemic relapse and improved overall survival.     

Masculinizing sclerosing stromal tumor of the ovary during pregnancy

Sclerosing stromal cell tumors of the ovary are an uncommon neoplasm that usually does not produce hormonal imbalances. Most patients showing a hormonal effect from this lesion have had menstrual cycle disturbances. Infertility and endometrial hyperplasia have also been described. One other reported case had masculinizing effects. Other authors have documented elevated levels of both estrogenic and androgenic hormones that corrected after surgery. A case of a pregnant 27-year-old Caucasian with hirsutism on her chin and neck and a male suprapubic hair pattern is presented. Elevated androstenedione, dehydroepiandrosterone, and free testosterone levels were present. A 3-cm left ovarian mass was excised and identified as a sclerosing stromal tumor. The histologic features included a pseudolobular pattern with focal areas of sclerosis and a two-cell population of spindled and polygonal cells. Immunohistochemical studies showed a positive vimentin reaction, weakly positive desmin and muscle-specific actin stains, and a negative cytokeratin stain. Following surgery the hormone levels returned to normal and the hirsutism resolved. A normal female infant without evidence of masculinization was delivered from the patient at term.