Membranoproliferative glomerulonephritis type I, mixed cryoglobulinemia and lymphoma in the absence of hepatitis C infection

Chronic hepatitis C virus infection has been linked to cryoglobulinemia, membranoproliferative glomerulonephritis, and malignant B-cell lymphoproliferation, suggesting a possible pathogenetic link between these disorders. We report a patient with the latter clinical triad in the absence of hepatitis C infection. We postulate that the persistent and dysregulated immunologic activity associated with chronic antigen stimulation, inflammation and/or B-cell malignancy induces nephritogenic autoantibodies, including cryoglobulins, that produce a similar clinical syndrome in genetically susceptible individuals. Copyright Copyright 1999 S. Karger AG, Basel     

Direct orbital manometry in healthy patients

PURPOSE: To determine orbital tissue tension and orbital compartment compliance in normal patients. METHODS: An orbital manometer was designed to directly measure orbital tissue tension before, during, and after a 5-ml retrobulbar injection of anesthetic in patients undergoing ocular surgery. Tissue tension was recorded for 5 minutes after the injection. Orbital compliance was calculated as change in volume divided by change in pressure. Data were collected from 18 normal orbits. RESULTS: Resting orbital tissue tension was 4.0 +/- 1.5 mmHg (mean +/- standard deviation). After retrobulbar injection, orbital tissue tension rose to 11.6 +/- 2.6 mmHg (p = 0.00000000009 compared with baseline). After 5 minutes, tissue tension declined to 6.6 +/- 1.9 mmHg (p = 0.00000001 compared with preinjection and p = 0.00002 compared with postinjection). Orbital compartment compliance was 0.74 +/- 0.31 ml/mmHg. No adverse events occurred. CONCLUSIONS: The authors' orbital manometer safely determined orbital tissue tension and orbital compartment compliance in normal orbits. Retrobulbar injection causes consistent measurable changes in orbital tissue tension. Directly assessing orbital dynamics in vivo may prove useful both as an adjunct in the clinical evaluation of patients with disorders resulting in an orbital compartment syndrome as well as in assessing the risk of retrobulbar injection in orbits at greater risk for complications from this procedure.     

Audit of extracapsular cataract extraction and posterior chamber lens implantation as a routine treatment for age related cataract in east Africa

AIMS: To evaluate the outcome of extracapsular cataract extraction (ECCE) and posterior chamber intraocular lens implantation (PC-IOL) in an African eye clinic during the transition from intracapsular cataract extraction to ECCE and PC-IOL. METHODS: A retrospective survey of 461 consecutive operations for age related cataract with a mean follow up of 52.9 weeks (range 0-275) and a minimum follow up of 4 weeks in 87.9% of eyes. RESULTS: A best corrected vision of 6/18 or better was obtained in 94.3% of eyes, and an uncorrected vision of 6/18 or better in 78.2% of eyes. Six eyes (1.5%) had a best corrected vision of less than 6/60. The visual acuity at 2 months was strongly predictive of the vision at 1 year or more after surgery. Preoperative biometry and IOL power calculation increased the proportion of eyes obtaining an uncorrected vision of 6/18 or better from 73.8% to 81.3%. Four eyes developed visually significant posterior capsule opacity. CONCLUSION: ECCE and PC-IOL can give very good results in an African setting. A better visual outcome should lead to increased demand for cataract surgery, which will eventually reduce the number of cataract blind people in Africa.     

Thoracolumbar disc degeneration in young fast bowlers in cricket: a follow-up study

OBJECTIVE: To determine the progression of thoracolumbar disc degeneration in young fast bowlers in cricket. DESIGN: Prospective fast bowling technique and MRI follow-up study. BACKGROUND: Previous studies on high-performance young fast bowlers have found that lumbar spine pathology was related to the mixed bowling technique. METHODS: Nineteen young male fast bowlers (mean age 13.6 years) underwent MRI scans to detect the presence of intervertebral disc abnormalities. Subjects were also filmed laterally (200 Hz) and from directly above (100 Hz) whilst bowling two maximum velocity deliveries (session 1). Subjects were tested using an identical methodology 2.7 years later (session 2). RESULTS: At session 1, the incidence of thoracolumbar disc degeneration was 21%; however, at session 2, the incidence significantly (P = 0.008) increased to 58%. Furthermore the increase in the incidence of back pain between session 1 and session 2 was also significant (P = 0.002). The progression of disc degeneration was found to be significantly (P = 0.015) related to the group of fast bowlers who utilized the mixed technique during both session 1 and 2 when compared to those who used this technique during one session only. CONCLUSIONS: Thoracolumbar disc degeneration and back pain increase significantly during the time period examined in this study. Further, bowlers who utilize the mixed bowling technique stand a greater chance of developing degenerative changes of the spine.     

Post-Chemotherapy Resection of Nonseminomatous Germ Cell Testicular Tumors Metastatic to the Mediastinum

Purpose

We determined if the behavior of germ cell tumors metastatic to the mediastinum is different from that of primary mediastinal germ cell tumors, a group known to have distinct clinical features.

Materials and Methods

A search of the computerized data base for germ cell tumors metastatic to the mediastinum at our university revealed 80 patients, 65 of whom underwent concomitant retroperitoneal lymph node dissection at mediastinal surgery.

Results

Of the patients 60 (75 percent) are free of disease, 14 (18 percent) died of cancer and 6 (8 percent) are living with disease. Mediastinal pathology included teratoma in 65 percent of the patients, cancer in 26 percent and fibrosis in 9 percent. Of the 65 patients who underwent retroperitoneal lymph node dissection 75 percent had teratoma, 15 percent had fibrosis and 10 percent had cancer. Mediastinal relapses after dissection were rare (4 of 80 patients).

Conclusions

Germ cell tumors metastatic to the mediastinum appear to behave similarly to those metastatic to the retroperitoneum. Primary mediastinal germ cell tumors have an entirely different clinical course. Teratoma is the predominant pathological type of post-chemotherapy germ cell cancer metastatic to the mediastinum.     

Biological reaction to carbon fiber implants: the formation and structure of a carbon-induced "neotendon"

In 43 young rabbits, the tendo Achilles and flexor digitorum longus tendon were excised and replaced by filamentous carbon fiber. Tendo-Achilles in controls was repaired by silk or nylon sutures or left without replacement. Concurrent excision of the posterior tibial nerve was performed in one group of the carbon-replacing tendo-Achilles operations. When fully functioning, carbon-induced "neotendon" rapidly developed from young fibroblastic tissue outgrowths of the loose mesenchymal tissue of the perineurium and adventitia of the blood vessels in the adjacent neurovascular bundle. Silk or nylon replacement of the excised Achilles tendon did not lead to successful production of a new substitute. Carbon fibers were unsatisfactory for replacement implants for the flexor digitorum longus tendons.     

Legal and ethical issues in clinical pharmacy research--informed consent, Part I

The continued growth of hospital and clinical pharmacy should be paralleled by the development of sound research methods justifying innovative practices. Such research will, on occasion, require experimentation involving human subjects. The principal means of assuring that the welfare of research participants is not compromised is through the procurement of effective informed consent. Pharmacists, like many other health professionals, have had relatively little exposure to methodology involved in the writing of an informed consent instrument. A comprehensive document must not only conform to the requirements of federal regulatory agencies, but must also satisfy various institutional guidelines. Past instances of unethical human experimentation are discussed, and a format for preparation of an informed consent instrument is examined. Circumstances requiring informed consent and identification of the basic elements of consent are also explained.