Spinal Cord Stimulation for Severely Ischemic Limbs

Severe atherosclerosis of the lower limbs causes rest pain, skin ulcerations and gangrene. In such situations and when standard surgical treatment had failed or it is impossible to employ, spinal cord stimulation (SCS) seems to be of value. Since April 1985, we have used this technique on 19 patients. The results have been beneficial in 70.6% of the cases and have shown some evidence of increasing cutaneous flow. However, randomized series are required before accepting it as having a special place in the fight against atherosclerotic disease.     

Pyridoxine-Responsive Anemia: Report of 2 Cases in Brothers and a Review of the Literature

The clinical and laboratory findings in two brothers with severe anemiaare presented. These findings were very similar in both cases. Evidence thatat least one of them suffered from a pyridoxine-responsive anemia is presented.It was assumed that the other had the same disorder since, in addition to thestriking similarity in the clinical and laboratory abnormalities, the latter’s anemia disappeared completely with the parenteral administration of vitamin Bcomplex, which provided him with 2 mg. of pyridoxine daily. These patientshave not relapsed 1.5 and 6 years after stopping the therapy.

A review of the reported cases with anemia responding to vitamin B₆ administration is presented. Common factors observed in some of these casesare: (1) severe anemia, microcytic and hypochromic in type, chiefly due to astriking maturation erythroblastic arrest at the basophilic stage with no defectin leukocytes or thrombocytes; (2) hyperferremia and hemosiderosis; (3) anabnormal tryptophan-loading test; and (4) complete or almost complete correction of all abnormalities with administration of vitamin B₆, even at smalldoses. These data were considered to suggest that the patients had a true deficiency in pyridoxine.

In other patients, no increased excretion of xanthurenic acid has been observed after a tryptophan-loading dose, and pyridoxine administration hasimproved the anemia only partially and has not reversed the serum iron parameters to normality. All of these other patients suffered from a familial hypochromic anemia not due to iron deficiency or from a "sidero-achrestic" or "refractory normoblastic" anemia.

The cause of the disorder in patients in the first group is unknown, but, byexclusion, increased requirement of vitamin B₆ seems to be the most likelypossibility.

Submitted on November 22, 1960 Accepted on February 14, 1961     

Comparison of methods of DNA extraction for real‐time PCR in a model of pleural tuberculosis

Santos A, Cremades R, Rodríguez JC, García‐Pachón E, Ruiz M, Royo G. Comparison of methods of DNA extraction for real‐time PCR in a model of pleural tuberculosis. APMIS 2010; 118: 60–5. Molecular methods have been reported to have different sensitivities in the diagnosis of pleural tuberculosis and this may in part be caused by the use of different methods of DNA extraction. Our study compares nine DNA extraction systems in an experimental model of pleural tuberculosis. An inoculum of Mycobacterium tuberculosis was added to 23 pleural liquid samples with different characteristics. DNA was subsequently extracted using nine different methods (seven manual and two automatic) for analysis with real‐time PCR. Only two methods were able to detect the presence of M. tuberculosis DNA in all the samples: extraction using columns (Qiagen) and automated extraction with the TNAI system (Roche). The automatic method is more expensive, but requires less time. Almost all the false negatives were because of the difficulty involved in extracting M. tuberculosis DNA, as in general, all the methods studied are capable of eliminating inhibitory substances that block the amplification reaction. The method of M. tuberculosis DNA extraction used affects the results of the diagnosis of pleural tuberculosis by molecular methods. DNA extraction systems that have been shown to be effective in pleural liquid should be used.