Clinical indicators of mycobacteraemia in adults admitted to hospital in Blantyre

The aims of the study were to measure the prevalence and outcome of mycobacteraemia in febrile hospitalised adults; to determine what proportion could be identified using routine methods; to assess clinical indicators of mycobacteraemia and the usefulness of a diagnostic trial of anti-TB treatment. We prospectively examined adults with fever or a history of fever admitted to adult medical wards of QECH, Blantyre. All had blood cultured for bacteria and mycobacteria, chest x-ray and sputum smears. M. tuberculosis was the commonest blood isolate, affecting 57 of 344 patients (17%). In 44 (77%) patients with mycobacteraemia, TB was identified using routine investigations; in only 6 (11%) it was not suspected. Strong clinical indicators of mycobacteraemia were anaemia, HIV seropositivity, cough, chronic fever, and a clinical diagnosis of AIDS on the day of admission. Of nine patients selected for a therapeutic trial of TB treatment, six had mycobacteraemia, of whom five died during the trial. Mortality on short course chemotherapy on the TB ward after one month, was similar whether patients had mycobacteramia (21%) or not (32%). TB can be identified with routine methods in most patients with mycobacteraemia. If treated, mycobacteraemia has as good an early outcome as TB without mycobacteraemia. Strengthening of basic facilities is likely to improve detection and treatment of mycobacterial disease.     

Topical corticosteroids in dental practice

Topical corticosteroids represent an important therapeutic aid in the management of a range of oral mucosal disease conditions. Like all medications, their successful use depends upon an understanding of the disease process. This includes an appropriate diagnosis, a clear view of the desirable treatment outcomes and knowledge of whether treatment is aimed at management of a chronic disease or enhanced resolution of a short-term condition. This paper reviews the use of topical corticosteroids and their possible roles in the management of oral disease.     

Hirsutism secondary to topical testosterone: report of two cases and review of the literature

Topical testosterone has been used as a treatment for different vulvar conditions. It is usually well tolerated, although hirsutism and other signs of virilization have been described related to hormonal tests alteration. We report two female patients with vulvar diseases that developed hirsutism after treatment with topical testosterone. Because of its potential virilization, females under this treatment should be closely monitored.     

Tuberous sclerosis: characteristics at CT and MR imaging

Computed tomography (CT) and magnetic resonance (MR) imaging findings were reviewed in 26 patients with tuberous sclerosis. All patients underwent CT; 16 patients underwent both. The CT features included subependymal nodules in 25 of 26 patients (96%) and calcifications in 23 of 26 (88%). Parenchymal hamartomas (cortical tubers) were seen in 23 of 26 patients (88%). These lesions had less attenuation than surrounding brain in 16 of 26 patients (62%) and were calcified in 14 of 26 patients (54%). Contrast enhancement of a lesion, indicating a subependymal giant cell astrocytoma, occurred in three of 26 patients (12%). The MR imaging characteristics included subependymal nodules (periventricular nodules) of intermediate signal intensity in ten of the 16 patients (63%). Parenchymal hamartomas, demonstrated in 15 of the 16 patients (94%), usually exhibited long T1 and T2 relaxation characteristics. The pattern was noted to be reversed in the two newborn patients (13%). One parent demonstrated a forme fruste at CT but had a normal MR image.     

Rapid determination of platelet alloantigen genotypes by polymerase chain reaction using allele-specific primers

BACKGROUND: The technique of allele-specific polymerase chain reaction (PCR) amplification has been adapted for DNA-based human platelet alloantigen typing. STUDY DESIGN AND METHODS: Sequence-specific primers were used to discriminate between the alleles encoding the six major human platelet alloantigens in a series of patients and normal blood donors. RESULTS: This technique allows the direct determination of platelet antigen genotypes from genomic DNA after PCR amplification and agarose gel electrophoresis. It offers significant advantages over previously described techniques for alloantigen identification, as the additional analytical steps of restriction enzyme digestion or dot blot hybridization are not required. The results obtained with this technique correlated precisely with those derived from serologic typing and allele-specific oligonucleotide hybridization. CONCLUSION: The use of allele-specific PCR for platelet alloantigen typing should facilitate the development of DNA-based typing in other regional blood centers and clinical laboratories.     

Circadian incidence of premature rupture of the membranes in term and preterm births

A highly circadian incidence of premature rupture of the fetal membranes was found in the Collaborative Perinatal Project data base. Among term deliveries without membranitis, the peak incidence of premature rupture of the membranes occurred at 3:00 AM, and the amplitude of a fitted sinusoid was 45%. Rupture hour was markedly influenced by latent interval and by membranitis. In the absence of membranitis, in term cases with a latent interval of less than three hours, rupture hour peaked at 2:00 AM, with an amplitude of 64%. Those with a latent interval of three to 35 hours peaked at 4:15 AM, with an amplitude of 37%. Those with 36 or more hours' latent interval showed little circadian variation. Preterm premature rupture of the membranes was also segregated into subgroups by latent interval. Preterm premature rupture of the membranes with a three- to 35-hour latent interval peaked at 4:00 AM, with an amplitude of 31%, similar to the corresponding term group. A circadian factor thus appears to cause most cases of premature rupture of the membranes in term and preterm births when membranitis is absent. The observed stratification by latent interval indicates that the mechanisms of premature rupture of the membranes may differ between the subgroups. With membranitis, the early-morning peak in premature rupture of the membranes was not statistically demonstrable in any of the term or preterm latent interval subgroups. This indicates that there may be unique rupture mechanisms associated with membranitis. The data in this study should assist efforts to classify premature rupture of the membranes and study its mechanisms.     

Balloon catheter dilation of ureteroenteric strictures: long-term results

Balloon catheter dilation of benign ureteroenteric anastomotic strictures has been proposed as an alternative to either surgical revision or chronic ureteral stenting, with moderately successful short-term results reported by several groups in a limited number of patients. However, the authors' experience with 29 patients exhibiting 37 benign ureteroenteric strictures treated over the past 7 years revealed that in the majority of cases (23 patients, 26 strictures [70%]), strictures recurred within 6 months of balloon catheter dilation/ureteral stent therapy. Furthermore, of the 11 strictures that appeared to have been successfully dilated at a follow-up interval of 6 months, five restenosed within 1 year. Therefore, only six of 37 (16%) ureteroenteric stricture dilations could be considered successful when viewed at least 1 year after interventional therapy. Furthermore, repeat dilations have often been required to maintain ureteral patency in these patients.     

Febrile infants less than 3 months old: value of chest radiography

In the febrile infant less than 3 months old, a chest radiograph is commonly obtained to identify the cause of the fever. The purpose of this study was to evaluate the necessity of obtaining chest radiographs in this population. The clinical records and chest radiographs of 192 febrile infants (greater than 100.5 degrees F, rectal) were reviewed. Nineteen patients had signs of respiratory distress; seven had positive findings on chest radiographs. Of the 173 patients without signs of respiratory distress, five had positive findings on chest radiographs. When chest radiography was considered the gold standard for the presence or absence of pneumonia, findings of respiratory distress on physical examination had a sensitivity of 58% and a specificity of 93% for the detection of pneumonia. The prevalence of positive findings on chest radiographs in febrile infants less than 3 months old was 6%. A chest radiograph should be obtained in febrile infants only when signs of respiratory distress are present.     

Multiinstitution study of non-Hodgkin's lymphomas using frozen section immunoperoxidase: the Southeastern Cancer Study Group experience

This report describes the experience of the Southeastern Cancer Study Group (SECSG) with a transport medium used for immunologic phenotyping of non-Hodgkin's lymphomas. In a 2-mo pilot study, portions of 53 specimens of non-Hodgkin's lymphoma from four member institutions of the SECSG and affiliated community hospitals were sent by regular mail to a central laboratory. Immunologic phenotyping was carried out using a frozen section immunoperoxidase technique. In 48 of the cases, a clear-cut immunologic phenotype was obtained. Thirty-four tumors were of B cell origin and 7 had T cell markers. Six of the remaining lymphomas had neither B nor T cell markers, and the seventh had both. In 12 cases, phenotyping was also carried out at the originating institution using conventional cell suspension techniques; agreement between the two methods was excellent. The immunologic results were correlated with histopathologic diagnosis standardized using the Working Formulation for non-Hodgkin's lymphomas. It was found that the low grade tumors were all B cell, but that the intermediate grade tumors were very heterogeneous immunologically. About one-fourth of the diffuse, intermediate grade or miscellaneous tumors had T cell markers. Our results indicate that immunologic phenotyping may be performed satisfactorily on transported material, making multiinstitution studies on the prognostic significance of immunologic phenotype in non- Hodgkin's lymphomas feasible.