Lack of effect of a 24-hour infusion of iloprost in intermittent claudication

24 hour infusion of iloprost was compared with placebo infusion in 19 patients with stable intermittent claudication using a double blind, balanced crossover design. Despite significant inhibition of platelet aggregation to ADP and collagen (p less than 0.001) and the typical cardiovascular and gastrointestinal side effects, there was no significant effect on treadmill exercise times at any time up to 6 weeks after infusion. The 95% confidence limits indicated that an improvement of more than 25% was unlikely to occur. No significant changes in B thromboglobulin, platelet aggregate ratio, bleeding time, whole blood viscosity and euglobulin clot lysis time were demonstrated.     

Moderate dose methotrexate, vincristine, asparaginase, and dexamethasone for treatment of adult acute lymphocytic leukemia

Thirty-eight adults with acute lymphocytic leukemia (ALL), 24 previously untreated and 14 previously treated, were entered into a study in which sequential, moderate-dose methotrexate and asparaginase were added to vincristine and dexamethasone (MOAD) for remission induction therapy. Eighteen of 24 previously untreated patients (75%) and 11 of 4 previously treated patients (79%) achieved a complete remission (CR). Once in CR, patients were given remission continuation therapy, which included intravenous high-dose methotrexate that was used without prophylactic cranial irradiation and without intrathecal methotrexate because of its potential activity alone as prophylaxis against central nervous system (CNS) leukemia. The median duration of CR was 11.1 mo (range 0.7-55.9+) and median survival 17.0 mo (range 0.4- 55.9+) for the 24 previously untreated patients. The median duration of CR was 7.5 mo (range 1.9-55.3+) for the 14 previously treated patients. Only 2 of 24 previously untreated patients (8.3%) developed CNS leukemia at 3.3 and 42.7 mo from start of MOAD. None of the previously treated patients developed CNS leukemia as the initial site of relapse. MOAD is useful as induction therapy for previously untreated adults with ALL, as well as for previously treated patients, and is superior to other regimens that we have used for the treatment of adult ALL.     

Complications of wedge hepatic venography

During wedge hepatic venography, mechanical injection should be accomplished at the lowest possible rate in order to avoid hemorrhagic infarction. Small amounts of contrast material should be administered. Hepatic angiography may result in an area of tumor blush at the site of a previous wedge injection.     

Vagal neuropathy: evaluation with CT and MR imaging

The vagus nerve, as a result of its protracted course from the brain stem to the abdomen, can present a difficult imaging problem when it is compromised by a clinically occult lesion. The clinical and radiologic records of 48 patients with suspected vagus nerve dysfunction were reviewed to derive an efficient and effective approach to imaging this patient population. An imaging algorithm is proposed in which vagal neuropathies are divided both clinically and radiologically into proximal and distal categories. Proximal vagal lesions are part of a cranial neuropathy complex and have associated oropharyngeal signs and symptoms (e.g., abnormal gag reflex, uvular deviation). Distal vagal lesions occur as an isolated paralysis of the vagus nerve with no symptoms or signs referable to the oropharynx. Either computed tomography (CT) or magnetic resonance imaging can be used to diagnose proximal or distal lesions. However, CT will be insensitive in the detection of the more cephalic proximal lesions, especially those in the brain stem, basal cisterns, and skull base.     

Answers to wh-questions: a developmental study

Forty children aged 3-6 years responded to items representing nine wh-question forms. Questions referred to three types of referential sources (conditions) based on immediacy and visual availability. The hierarchies of wh-question forms based on degree of difficulty were similar to those described in previous investigations. However, a significant interaction between referential conditions and wh-form was found to influence the relative complexity of the stimulus questions. The children were significantly less successful in giving appropriate and accurate responses when the question referred to objects, persons, or events not represented in the immediate setting. Recognition and delivery of the general category or kind of information required by a wh-form (functional appropriateness) appeared to predate substantially the ability to respond with fact, accuracy, logic, and credibility (functional accuracy). The results suggest consideration and control of referential source as well as appropriateness/accuracy response criteria in the evaluation and treatment of language-disordered children.