Impact of newly revised sterile medication compounding guidelines USP {797} on allergy vial preparation

OBJECTIVES: To highlight newly revised guidelines on sterile medication compounding released by the United States Pharmacopeia (USP 797) in December 2007, and the implications on immunotherapy vial preparation. STUDY DESIGN AND METHODS: A policy review. RESULTS: The newly revised USP chapter on sterile medication guidelines was released December 2007 and becomes effective June 2008. The revised USP 797 now has specific guidelines addressing immunotherapy vial preparation that are a significant change from the previous version. The revised guidelines should be a useful tool for clinicians who are developing and setting office mixing standards. CONCLUSIONS/SIGNIFICANCE: Offices preparing immunotherapy vials should consider formalizing and implementing vial preparation guidelines. These guidelines should be based on expert opinion, experience, and scientific literature.     

Nucleic Acids and Cytological Changes in the Thyroid Gland after Thiouracil.l

1) By the action of thiouracil the follicular cell is not brought into the state of physiological inactivity and it shows signs of apparent secretion which differ however in details remarkably from the effective secretion stage. 2.) The quantity of follicular cells in mitosis is temporarily increased to the multiple. This disturbance is the result of the inhibition of caryokinesis in the stage of metaphase. 3) The absolute quantities of ribonucleic and of desoxyribonu-cleic acid are considerably reduced. 4) The ratio KNA/DNA shows a decrease to a fractional part of the normal value, according to the increase of the cell mass.     

Pulmonary histiocytosis X: comparison of radiographic and CT findings

The authors retrospectively evaluated radiographs, computed tomographic (CT) scans, and results of pulmonary function tests (when available) for 17 patients with biopsy-proved pulmonary histiocytosis X. In 11 patients, high-resolution CT was used. In 12 patients, CT demonstrated cystic air spaces, usually less than 10 mm in diameter. In three of these 12, cysts were the only abnormality, but in six others, nodules (usually less than 5 mm in diameter) were also present. Two patients had only nodules and one, only emphysema. CT showed that many lesions that appeared reticular on plain radiographs were actually cysts. CT showed no central or peripheral concentration of lesions, but it did reveal that many small nodules were distributed in the centers of secondary lobules around small airways. CT findings correlated better with the diffusing capacity (rho = -0.71) than did the plain radiographic findings (rho = -0.57). Thus, CT was better than radiography at showing the morphology and distribution of lung abnormalities.     

The effect of injection immunotherapy on mucociliary clearance in allergic patients.

OBJECTIVE: To assess the effect of injection immunotherapy on mucociliary clearance in allergic patients with the use of the saccharin test. METHODS: In this prospective cohort study, mucociliary clearance in 42 allergic patients treated with injection immunotherapy was determined with the saccharin test. Of these patients, 23 were retested 1 year later to assess changes in mucociliary clearance times. Mean results for historical controls were determined in a review and meta-analysis of the existing literature. RESULTS: Saccharin clearance times (SCTs) were initially prolonged in allergic patients who received injection immunotherapy when compared to historical controls (one-sided P value < 0.05). However, after 1 year of immunotherapy, there was a significant reduction in SCTs in our patient population. This finding was independent of other evaluated patient characteristics, with the exception of nasal steroid use, which was also significantly associated with a decrease in SCT. CONCLUSIONS: After 1 year of injection immunotherapy, there was a significant reduction in mean SCT in our patient population. Of the other factors studied, only nasal steroid was associated with decreased mucociliary clearance times. To our knowledge, this is the first report in the literature documenting the beneficial effect of injection immunotherapy on mucociliary clearance as measured by saccharin clearance times. Nevertheless, further research is warranted, given the confounding effect of nasal steroid use.     

Digital imaging of the chest

During the past several years, image acquisition in nuclear medicine, computed tomography, ultrasonography, subtraction angiography, and magnetic resonance has been by digitization. Despite these advances, research in the development of digital imaging in conventional radiography has lagged behind. Although studies with a variety of digital techniques have been carried out on several fronts, we still do not possess a method that has captured the imagination of the majority of radiologists and other physicians to a point where it could replace conventional screen-film imaging. This article reviews the current status and general principles of the technology, focusing on the four digital radiographic techniques that have shown the greatest promise - film digitization, an image intensifier - based system, photostimulable phosphor plates, and a scanned projection system. The physical aspects of each of the four systems and the clinical results that have been reported to date, as well as the advantages and disadvantages of each system, are presented.     

Dialysis and nutrition practices in Korean hemodialysis centers.

OBJECTIVE: Survey the dialysis practices and nutritional status-related patient characteristics. DESIGN: Cross-sectional survey. SETTING: Twenty-eight randomly selected Korean hemodialysis facilities. METHODS: Medical record review of 140 randomly selected patients in 28 Korean dialysis facilities. The Student t test and chi-square tests were used to compare facility types and locations. RESULTS: The mean number of dialysis treatments per week was 2.7 +/- 0.4. Mean dialysis treatment length was 253 +/- 27.5 minutes. Rural dialysis centers reported fewer treatments per week and shorter dialysis treatment times than did urban centers but, otherwise, there were few differences by either location (urban v rural) or by facility type (hospital affiliated v freestanding facility). The mean age of the patients surveyed by record review was 51 +/- 14 years, and 59% of the patients were men. The primary causes of end-stage renal disease were chronic glomerulonephritis, hypertension, and diabetes. Average vintage of dialysis was 53 +/- 46 months. Adequacy of dialysis was usually assessed by using clinical judgment; urea kinetic modeling and urea reduction ratios were used less frequently. Patients' mean body mass index was 20.7 +/- 2.3, which was at the lower end of the healthy range of 18.5 to 25, and most (93%) of their weights had been stable over the previous 6 months. Their mean serum albumin level was 4.0 +/- 0.4 g/dL. Forty-two percent of patients used iron supplements and 68% of them received erythropoietin treatment. However, their mean hematocrit levels were only 25.9% +/- 4.2%, suggesting that iron supplements were underused or erythropoietin doses were lower than optimal. Virtually all patients (94%) had received initial diet instruction but few (6%) received follow-up nutrition counseling. CONCLUSION: Greater attention to dialysis adequacy, hematocrit levels, nutrition assessment, weight monitoring, and diet therapy are recommended.     

Imaging of cranial chordomas

The clinical, pathologic, and imaging characteristics of clival chordomas in 14 patients who underwent magnetic resonance examinations were evaluated. Magnetic resonance imaging (MRI) was compared with skull series, tomography, computed tomography (CT), and magnification angiography in the diagnosis of clival chordomas. Although all examinations were highly sensitive for the detection of clival chordomas, MRI was the best single study because of its ability to image in orthogonal planes, its excellent soft-tissue contrast, and its demonstration of the relationship between the neoplasm and regional vital structures, particularly the brainstem, cavernous sinus, cranial nerves, and neighboring vessels. The deficiencies of MRI are poor visualization of tumoral calcification and osseous destruction--findings that are better identified on CT. In all 14 cases, MRI revealed the neoplasms to be black on inversion-recovery, gray on partial-saturation, and white on T2-weighted pulse sequences. Three chordomas had a speckled signal void pattern, typical of tumor calcification.     

Hypothalamic Syndrome and Central Sleep Apnoea Associated with Toluene Exposure

We describe a young man who developed extensive hypothalamicdysfunction including diabetes insipidus, adipsia, hyperprolactinaemia,and poikiliothermia together with central sleep apnoea followingexposure to toluene.