A case of lymphomatoid granulomatosis masquerading as a lung abscess

Lymphomatoid granulomatosis (LG) is a rare T cell rich, B cell non-Hodgkin's lymphoma which is difficult to diagnose. We present a patient with LG who demonstrated many of the difficulties in diagnosis and highlighted the importance of reviewing the diagnosis if treatment does not have the anticipated effect.     

Fluorinated surface-modifying macromolecules: modulating adhesive protein and platelet interactions on a polyether-urethane

Polyether-urethanes (PEUs) have been the materials of choice for the manufacture of conventional blood-contacting devices. Nevertheless, biostability and blood compatibility are still among the principal limitations in their long-term application. Studies investigating the development of protective coatings for PEUs have shown that degradation can be reduced with the use of fluorinated surface-modifying macromolecules (SMMs). It has also been hypothesized that SMM-modified PEU surfaces may exhibit improved blood compatibility because other studies have shown a modulation in fibrinogen adsorption onto these surfaces. To determine the blood compatibility of a PEU-containing fluorinated SMMs, a series of in vitro experiments were designed to study the pattern of protein adsorption from plasma and then to assess the nature of platelet adhesion and activation on each substrate. Western blot analysis as well as single protein studies revealed that the dominant "adhesive proteins" [fibrinogen (Fg), fibronectin (Fnc), and vitronectin (Vnc)] were adsorbed on two of the SMM-containing PEUs in lower amounts relative to unmodified base. Platelet adhesion and activation data further highlighted the differences among the various substrates. It was shown that the unmodified base had a higher number of adhered platelets relative to the SMM-modified surfaces, and that of the SMM-containing substrates, which showed the lowest levels of adhesive proteins also, exhibited significantly lower platelet densities. Close morphological examination further revealed that platelets residing on these latter substrates were not appreciably activated. Based on the current evidence, it is believed that the fluorinated SMMs demonstrate good potential for the development of surfaces with minimal thrombogenic character in in vivo applications.     

Representing arithmetic table facts in memory: Evidence from acquired impairments

In this article we explore how arithmetic table facts (e.g., 6 × 9 = 54) are stored in memory and evaluate the possibility that arithmetic facts are exclusively stored in a phonological or sound-based form. We present two single-case studies of brain-damaged patients who suffer specific number processing impairments. Both patients often retrieve the correct answer to simple arithmetic problems from memory when unable to generate the phonological representation of either the arithmetic problem or the answer to that problem. We argue that this pattern of performance is incompatible with the hypothesis that arithmetic facts are stored and retrieved from memory exclusively in a phonological form. Accounts consistent with out findings are proposed.     

Clodronate in the management of breast cancer and multiple myeloma

The rationale for the use of the bisphosphonates in tumour-induced osteolysis is well established. The evidence to date supports the view that bone destruction continues despite of sysytemic therapies directed against the tumour so that supplementary bone protection should be considered. Long-term treatment with clodronate or pamidronate has been shown to modify the progression of skeletal disease. The efficacies or oral and intravenous bisphosphonates seem similar and the numbers-needed-to-treat compare very favourably with the use of treatments as secondary prevention in other diseases. Further research is required to determine if we can better identify sub-groups of patients who will derive particular benefit, or perhaps not benefit at all, from bisphosphonate therapy. The use of biochemical markers of bone resorption and formation to evaluate the risk of skeletal disease and its response to treatment also requires further study.     

Randomized, placebo-controlled trial of clodronate in patients with primary operable breast cancer.

PURPOSE: The development of bone metastases depends on tumor-induced osteoclastic resorption of bone, which may be inhibited by the antiosteolytic bisphosphonate clodronate. Given to patients with primary breast cancer, clodronate might reduce the subsequent incidence of bone metastases. PATIENTS AND METHODS: This double-blind, multicenter trial accrued 1,069 assessable patients with operable breast cancer between 1989 and 1995. All patients received surgery, radiotherapy, chemotherapy, and tamoxifen as required. Patients were randomized to receive oral clodronate 1,600 mg/d or a placebo for 2 years starting within 6 months of primary treatment. The primary end point was relapse in bone, analyzed on an intent-to-treat basis, during the medication period and during the total follow-up period (median follow-up, 2,007 days). Secondary end points were relapse in other sites, mortality, and toxicity. RESULTS: During the total follow-up period, there was a nonsignificant reduction in occurrence of bone metastases (clodronate, n = 63; placebo, n = 80; hazards ratio [HR], 0.77; 95% confidence interval [CI], 0.56 to 1.08; P =.127). During the medication period there was a significant reduction in the occurrence of bone metastases (clodronate, n = 12; placebo, n = 28; HR, 0.44; 95% CI, 0.22 to 0.86; P =.016). The occurrence of nonosseous metastases was similar (clodronate, n = 112; placebo, n = 128; P =.257), but there was a significant reduction in mortality (clodronate, n = 98; placebo, n = 129; P =.047) during the total follow-up period. CONCLUSION: Clodronate, given to patients with primary operable breast cancer, may reduce the occurrence of bone metastases, although this reduction was only significant during this medication period. There was a significant reduction in mortality.