Transmural penetration of sigmoid colon and rectum by retained surgical sponge after hysterectomy

Gossypiboma is a surgical sponge that is retained in the body after the operation. A 39-year-old female presented with vague lower abdominal pain, fever, and rectal discharge 15 mo after hysterectomy. The sponge remaining in the abdomen had no radiopaque marker. Therefore a series of radiographic evaluations was fruitless. The surgical sponge was found in the rectosigmoid colon on colonoscopy. The sponge penetrated the sigmoid colon and rectum transmurally, forming an opening on both sides. The patient underwent low anterior resection and was discharged without postoperative complications.     

An audit of patient perception compared with medical and nursing staff estimation of pain during burn dressing changes

In order to prescribe appropriate analgesia for burns dressing changes the pain experienced by 30 burned patients during this procedure was recorded. Patients received analgesia prior to their dressing changes according to the current protocol in the burns unit. During the same period the medical and nursing staff in the unit who were involved in prescribing and administering the analgesia for the dressing change, were asked to assess the severity of pain that they thought patients experienced during dressing changes. Patients recorded their worst pain as none or mild in 64% of procedures. In contrast, no surgeon and only one nurse, rated pain as none or mild. The discrepancy between severity of pain recorded by patients and the pain predicted by staff prescribing and administering analgesia has clinical implications.     

Diamond-Blackfan anemia: promotion of marrow erythropoiesis in vitro by recombinant interleukin-3

To clarify the defective erythropoiesis in eight patients with Diamond- Blackfan anemia, we studied their bone marrow response in vitro to recombinant human interleukin-3 (IL-3) and recombinant granulocyte- macrophage colony-stimulating factor (GM-CSF). In an erythropoietin- containing assay system, specimens from six of the eight patients yielded low numbers of erythroid colonies compared to control values, and in five of these no erythropoietin dose-response could be elicited. Addition of IL-3, GM-CSF or both to cultures from the six patients had no effect on CFU-E-derived colonies. In contrast, IL-3 but not GM-CSF induced a marked increase in the number (183%) and size of the BFU-E- derived colonies in five of the six cases and partially corrected the impaired dose-response to erythropoietin in four. Bone marrow from the other two patients yielded numbers of CFU-E and BFU-E colonies comparable to controls and manifested similar increments in colonies with increasing concentrations of erythropoietin. When IL-3 was added to these cultures, further increments were observed in the number and size of BFU-E colonies. We conclude that IL-3 enhanced the marrow erythropoiesis in most of the patients and exerted a corrective effect on the aberrant colony formation in the presence of erythropoietin. The data raise the possibility of IL-3 as a therapeutic agent in Diamond- Blackfan anemia.     

Urinary oestrogen excretion after the menopause in relation to age and body mass

We have measured urinary excretion of free immunoreactive oestrone and oestradiol and their respective glucuronides in relation to creatinine in early morning samples in 132 fit, active postmenopausal women. None of the oestrogen/creatinine ratios was significantly correlated either with age or with years since menopause. However, we did demonstrate significant positive correlations between the levels of all four oestrogens and the body mass index, weight and fat mass. These results are similar to those obtained by other workers for plasma or serum oestrogen levels. Since assessment of oestrogenic status from plasma or serum may call for several samples to allow for the rapid minute-to-minute variation in levels, urinary oestrogenic assays as described may provide a valuable non-invasive measurement of oestrogenic status. Such measurements may have a place in the identification of women at greater risk of developing symptomatic osteoporosis in later life.     

Prognostic value of cervical ligamentum flavum thickness as a morphological parameter to predict cervical stenosis

One of major causes of cervical central stenosis (CCS) is thickened change of cervical ligament flavum (CLF). The association of a morphological parameter called cervical ligament flavum thickness (CLFT) with CCS has not been reported yet. Thus, the purpose of this research was to investigate the relationship between CCS and CFJT.Data were obtained from 88 patients with CCS. A total of 87 normal controls also underwent cervical spine magnetic resonance imaging (CSMRI). All subjects underwent axial T2-weighted CSMRI. Using our picture archiving and communications system, thickness of ligament flavum of the cervical spine at C6/7 level was analyzed.The mean CLFT was 1.41 ± 0.24 mm in normal subjects and 2.09 ± 0.39 mm in patients with CCS. The CCS group was found to have significantly (P < .001) higher rate of CLFT than normal subjects. ROC curves were used to assess the usefulness of CLFT as a predictor of CCS. In the CCS group, the best practical cut off-point of CLFT was 1.71 mm (sensitivity = 90.9%; specificity = 90.8%), with AUC of 0.94 (95% confidence interval: 0.90--0.98).Greater CLFT values were associated with greater possibility of CCS. Thus, treating physician should carefully examine CLFT, as it can help diagnose CCS.     

The adaptation and relationship of FGF-23 to changes in mineral metabolism in Graves' disease

OBJECTIVE: The aim of this study was to observe the changes in bone and mineral metabolism and to confirm the regulation of fibroblast growth factor-23 (FGF-23) in untreated Graves' disease. PATIENTS AND MEASUREMENTS: The study comprised 39 patients, with or without Graves' disease. The Graves' disease group was made up of 21 newly diagnosed patients, enrolled before starting treatment. Their disease was determined by biochemical and radiological means. The control group was composed of 18 people who were proven to be euthyroid without any diseases affecting bone and mineral metabolism. FGF-23, calcium, phosphate, PTH, 25-hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)2D] levels and bone turnover markers were compared between these groups. RESULTS: Serum calcium and phosphate, plasma FGF-23 and free T4 were significantly higher in the Graves' disease group than in the healthy control group (P < 0.05). The bone turnover markers serum osteocalcin and C-terminal cross-linked telopeptide of type 1 collagen (s-CTx) were also significantly elevated in the Graves' disease group, and had a positive correlation with free T4 levels. However, there was no significant decrease in PTH and 1,25(OH)2D in the Graves' disease group. Plasma levels of FGF-23 exhibited a positive correlation with serum phosphate levels and with free T4 levels (P < 0.05). CONCLUSIONS: These findings suggest that FGF-23 is physiologically related to serum phosphate homeostasis, as indicated indirectly by the changes in bone and mineral metabolism, in untreated Graves' disease.     

Pre-dosing antibody levels and efficacy of thrombolytic drugs containing streptokinase.

OBJECTIVE--To evaluate the influence of pretreatment streptokinase resistance titre and the concentration of IgG antibodies to streptokinase on the efficacy of thrombolytic drugs containing streptokinase in restoring coronary patency in acute myocardial infarction. DESIGN--Comparative observational study. SETTING--City general hospital. PATIENTS--One hundred and twenty four previously unexposed patients presenting within six hours of onset of acute myocardial infarction. INTERVENTIONS--Streptokinase, 1.5 MIU as intravenous infusion over 60 minutes (60 patients), or anistreplase, 30 units as intravenous injection over five minutes (64 patients). MAIN OUTCOME MEASURES--Pretreatment streptokinase resistance titre and concentration of IgG antibodies to streptokinase were measured in 96 and 124 patients respectively and coronary patency assessed angiographically at 90 minutes and 24 hours. RESULTS--Pretreatment streptokinase resistance titre and concentrations of IgG antibodies to streptokinase were low and skewed towards higher values. Those patients with coronary occlusion at 24 hours had a significantly higher median streptokinase resistance titre (100 v 50 streptokinase IU ml-1, P = 0.02). There were trends towards a higher streptokinase resistance titre in those patients with coronary occlusion at 90 minutes (50 v 20 streptokinase IU ml-1, P = 0.06) and higher concentrations of IgG antibodies to streptokinase in those with coronary occlusion at both 90 minutes and 24 hours (1.53 v 0.925, P = 0.03; 1.65 v 1.04 micrograms streptokinase binding ml-1, P = 0.06). Coronary patency rates were similar in the two treatment groups. CONCLUSIONS--In the range measured in previously unexposed patients the streptokinase resistance titre has a small, but significant, negative influence on the efficacy of streptokinase and anistreplase. This effect should be considered if retreatment with streptokinase or anistreplase is proposed.