Clozapine-induced elevated C-reactive protein and fever mimic infection

Clozapine-induced fever has been reported frequently, but clozapine-induced elevated serum C-reactive protein (S-CRP) over 100 mg/L with early onset, without associated myocarditis, has not been reported in the literature. In this case report, we present a case of an 80-year-old Slovenian female with dementia and psychotic symptoms who developed elevated S-CRP (122 mg/L) and fever (38.2°C) on the seventh day with 25 mg of clozapine daily, which improved after clozapine discontinuation. The patient did not have symptoms and signs of infection. This case report can be used to remind clinicians of keeping in mind the potential of clozapine associated with very high elevated S-CRP with fever, which can be easily confused with more serious conditions.     

Effect of calcium ions on the gelling and drug release characteristics of xanthan matrix tablets

Xanthan is a well-known biopolymer. It is an anionic polysaccharide, whose primary structure depends on the bacterial strain and fermentation conditions. Xanthan was extensively studied in combination with galactomannans, and over 90 patents cover the technology of this preparation. Our aim was to investigate the relation between the physical properties of a xanthan matrix in the absence or presence of calcium ions and its influence on the release of pentoxifylline. The release of pentoxifylline from xanthan tablets in purified water was shown to be very slow and governed by the process of polymer relaxation. The presence of calcium ions significantly increased the drug release, changing the release mechanism into a more diffusion controlled one. Xanthan matrices showed substantially faster and more extensive swelling in water than in the presence of Ca2+ ions. Surprisingly, negative correlation between drug release and degree of swelling was obtained for xanthan: the higher the swelling, the slower the drug release. Higher ionic strength led to lower erosion of xanthan tablets, and the gel layers formed were more rigid and of firmer texture, as shown by rheological experiments and textural profiling. The results indicate that the presence of Ca2+ ions in the solution or in matrices does not cause crosslinking of xanthan polymers, but causes charge screening of ionized groups on the trisaccharide side chains of xanthan, leading to lower inter-molecular repulsion and changing water arrangement. The understanding of the parameters influencing drug release leads to the conclusion that xanthan is suitable for controlled release formulations, especially with the incorporation of certain small counterions.     

A rabbit used as a model for testing hematopoietic tissue transplants.

Allogenic transplantations of bone marrow or spleen cells were carried out on rabbits treated with cyclophosphamide. About 50% of the recipients developed chimerism of peripheral blood cells. Chimerism was a passing phenomenon prevailing from 14 to 180 days after grafting. A phenomenon indicating that not all cell lines develop after transplantation from the donor stem cells, was observed. This phenomenon has been called "restricted chimerism". The GvH reaction was of a chronic type. Relative spleen weights were significantly increased in animals receiving the spleen cell grafts, but not in animals receiving bone marrow grafts. A direct positive erythrocyte Coombs test was found in almost all graft recipients. In addition cytotoxic autoantibodies against lymphocytes were present in sera of about 20% of the recipients.     

Hypothesis of regulation of hip joint cartilage activity by mechanical loading

Hypothesis of regulation of proteosynthetic activity of chondrocytes is suggested. A deformation of the cartilage caused by contact hip joint stress and consequent deformation of the chondrocytes are considered as main factors that could influence the metabolism of the cartilage.     

Distribution and prognostic significance of cell cycle proteins in squamous carcinoma of the larynx,hypopharynx and adjacent epithelial hyperplastic lesions

Alterations of cell cycle proteins contribute to the development and biological behaviour of malignant tumours. We evaluated the distribution and prognostic significance of immunohistochemically detected proteins p53, p21, Rb, and cyclin D1 in 101 laryngeal and hypopharyngeal squamous cell carcinomas (SCC) and adjacent epithelial hyperplastic lesions (EHL). Protein expression was correlated with tumour grade and stage. Varying patterns of protein expression were found in SCC. A significant correlation (p<0.05) was found between Rb expression and tumour grade. Different grades of EHL exhibited randomly distributed p53 and cyclin D1 positive cell clusters with no association to the pattern of their expression in SCC. Our study demonstrated derailment of cell cycle regulation in almost all cases of SCC of the larynx and hypopharynx. However, only cyclin D1 expression had an independent prognostic value for cancer-specific survival. The results also suggest that Rb gene inactivation, although rare, might be more important in the development of SCC than previously thought.     

Multiple system atrophy and Alzheimer's disease: a case report of a rare association of two neuro-degenerative disorders

Multiple system atrophy (MSA) is a neurodegenerative disorder typically characterised by cerebellar dysfunction, parkinsonism, pyramidal signs and dysautonomy. Cognitive impairement is usually limited to a moderate subcortical dysexecutive syndrom. We report the case of a 62-year-old woman suffering from MSA who progressively developed severe dementia. Neuropathological examination confirmed the diagnosis of definite MSA and also showed histopathological hallmarks of Alzheimer's disease. This association is extremely rare in the literature. Our observation confirmes that franc dementia in MSA should prompt a search for another associated cause and underlines the usefulness of neuropathological verifications in atypical clinical pictures.