Acquired factor VIII deficiency in an elderly woman on tamoxifen

A case is presented and acquired factor VIII deficiency is discussed. The studied patient was elderly and had cancer of left breast, cancer of the head of the pancreas, history of blood transfusions, and was on tamoxifencitrate therapy for breast cancer. Any one of the above factors could have been responsible for production of factor VIII deficiency.     

Divergence Effect Analysis in Disease-Modifying Trials

ABSTRACT

In this article, we propose a novel slope analysis which we call the divergence effect analysis. The slope analysis has been used in disease-modifying neurodegenerative disorder trials to show whether two groups are parallel or two groups diverge. However, the analysis approach has been criticized because it requires the assumption that the disease progression is linear in either group. The proposed approach assesses the trend of treatment difference over time and does not require the linearity assumption in individual treatment groups. If the trend is upward, one concludes that two groups diverge. If the trend is flat, one concludes that two groups are parallel. A real clinical trial example is used to illustrate the challenges of the traditional slope analysis and advantages of the proposed approach.     

Lack of effect of acupuncture upon signs and symptoms of delayed onset muscle soreness.

The effect of acupuncture upon experimentally induced delayed onset muscle soreness (DOMS) was assessed in a placebo-controlled study under blinded conditions. Volunteers (n = 48; 24 M & 24 F) were randomly allocated to one of four groups: control (20 min rest), placebo (minimal needling at non-acupuncture points), treatment group 1 (acupuncture at classic acupuncture points) and treatment group 2 (acupuncture at 'tender' points). DOMS was induced in the elbow flexors of the non-dominant arm using a standardized eccentric exercise regime. Measurements of elbow range of movement (flexion, extension, relaxed angle), and pain as well as visual analogue scores (VAS), tenderness (using a pressure algometer) were employed as indices of treatment efficacy. Measurements of elbow range of movement and tenderness were made prior to DOMS induction on the first day, and repeated pre- and post-treatment on subsequent days; pain was assessed using visual analogue scales post-induction and post-treatment on the first day, and pre- and post-treatment thereafter. For all conditions, subjects rested supine for a period of 20 min, during which treatment was delivered according to group allocation. Repeated measures and one-way analysis of variance (ANOVA) demonstrated no significant interactive (AB) effects, except for visual analogue scores (P = 0.0483); one factor ANOVA on the second day of the experiment (pre-treatment) indicated significant differences between the control and all other groups. However, such differences were not found on any other day of the experiment. It is concluded that acupuncture has little effect upon the cardinal signs and symptoms of DOMS, at least under the conditions of the current experiment.     

Effects of TENS frequency, intensity and stimulation site parameter manipulation on pressure pain thresholds in healthy human subjects

This study evaluated the effects of varying frequency, intensity and stimulation site, of transcutaneous electrical nerve stimulation (TENS) in an experimental model of pain. In a double-blind design 240 volunteers were randomised to one of six experimental TENS groups, a sham TENS or control (n=30 per group; gender balanced). Two TENS frequencies (110 or 4 Hz) and two intensities (strong but comfortable or highest tolerable) at a fixed pulse duration (200 micros) were applied at three sites relative to the measurement site (segmentally, extrasegmentally or a combination of these), for 30 min. Pressure pain thresholds (PPT) were measured using a pressure algometer, in the first dorsal interosseous muscle, every 10 min, during stimulation and for a further 30 min. The high frequency, high intensity segmental, and combined stimulation groups, showed rapid onset and significant hypoalgesic effects. This effect was sustained for 20 min post-stimulation in the high frequency segmental group. All other TENS intervention groups showed hypoalgesic responses similar to the sham TENS group, and none of these groups reached a clinically significant hypoalgesic level. CONCLUSIONS: The role of TENS frequency, intensity and site are pivotal to achieving optimal hypoalgesic effects, during and after stimulation. Clinical applications of these parameter combinations require further investigations.     

Evaluation of a polymerase chain reaction amplification method for Mycobacterium tuberculosis complex on samples from different sources

Using primers specific for the IS6110 region of Mycobacterium tuberculosis complex, successful amplification by the polymerase chain reaction was demonstrated in 81 of 84 archive specimens from patients who had been clinically diagnosed 2 months to 16 y previously as having tuberculosis. Depending on the time of storage of the specimens, extra DNA bands were found in addition to the IS6110 region band.     

Neglected squamous cell carcinoma of the frontal area: a clinical report

Neglected skin carcinomas are not very often in our days. It is known that skin is the most common site of malignancy Squamous cell carcinoma (SCC) is the second most common malignancy of the skin. We report a combined surgical treatment in an unusual case of a squamous cell carcinoma (T4 n0 m0) localized on scalp, presented primarily as a frontal ulcerative bloody mass, with no palpable lymph nodes and a whole body negative computed tomography. Three months after the first surgical procedure, the tumour reappeared presenting left frontal lobe invasion. A combined surgical management (neurosurgery and plastic surgery) was realized, in order to remove the tumour and to cover the defect. Three months later the tumour recrudesced invading the left antrum, infiltration of remained parotid gland and an ipsilateral mandible osteolysis, besides a 2 cm size distal metastasis at the right upper lobe of the lung was revealed. This article, through case report and a brief review of the literature, offers criteria for the surgical treatment of SCC that arise on the scalp.     

Influence of vitamin C on bisphenol A,nonylphenol and octylphenol induced oxidative damages in liver of male rats

The purpose of this study was to investigate whether bisphenol A (BPA), nonylphenol (NP) and octylphenol (OP) induce oxidative stress in the liver of male rats and co-administration of vitamin C can prevent any possible oxidative stress. Wistar male rats were divided into seven groups (vehicle, BPA, NP, OP, BPA + C, NP + C, OP + C). BPA, OP and NP groups (25 mg kg⁻¹ day⁻¹) were administered orally to rats three times a week for 50 days. In BPA + C, NP + C, OP + C groups, vitamin C (60 mg kg⁻¹ day⁻¹) was administered along with BPA, OP and NP (25 mg kg⁻¹ day⁻¹) treatments. Aspartate transaminase (AST), alanine transaminase (ALT), lactate dehydrogenase (LDH), thiobarbituric acid-reactive substances (TBARS) were increased, glutathione (GSH) levels were decreased in treatment groups. AST, ALT, LDH and TBARS levels were increased whereas GSH levels were decreased in BPA + C, NP + C and OP + C groups compared to BPA, NP, and OP groups, respectively. Hepatic necrosis and congestion were observed in livers of rats treated. In conclusion, the present results demonstrate that BPA, NP, and OP cause oxidative damage by disturbing the balance between ROS and antioxidant defenses system in liver of male rats. Vitamin C co-administration along with BPA, NP, OP aggravates the damage in liver of male rats.     

Comparison of noninvasive oscillometric and intra-arterial blood pressure measurements in hyperacute stroke

OBJECTIVES: This study aims to compare automatic oscillometric blood pressure recordings with simultaneous direct intra-arterial blood pressure measurements in hyperacute stroke patients to test the accuracy of oscillometric readings. METHODS: A total of 51 first-ever stroke patients underwent simultaneous noninvasive automatic oscillometric and intra-arterial blood pressure monitoring within 3 h of ictus. Casual blood pressure was measured in both arms using a standard mercury sphygmomanometer on hospital admission. Patients who received antihypertensive medication during the blood pressure monitoring were excluded. RESULTS: The estimation of systolic blood pressure (SBP) using oscillometric recordings underestimated direct radial artery SBP by 9.7 mmHg (95% confidence interval: 6.5-13.0, P<0.001). In contrast, an upward bias of 5.6 mmHg (95% confidence interval: 3.5-7.7, P<0.001) was documented when noninvasive diastolic blood pressure (DBP) recordings were compared with intra-arterial DBP recordings. For SBP and DBP, the Pearson correlation coefficients between noninvasive and intra-arterial recordings were 0.854 and 0.832, respectively. When the study population was stratified according to SBP bands (group A: SBP160 mmHg and SBP180 mmHg), higher mean DeltaSBP (intra-arterial SBP-oscillometric SBP) levels were documented in group C (+19.8 mmHg, 95% confidence intervals: 12.2-27.4) when compared with groups B (+8.5 mmHg, 95% confidence intervals: 2.7-14.5; P=0.025) and A (+5.9 mmHg, 95% confidence intervals: 1.8-9.9; P=0.002). CONCLUSION: Noninvasive automatic oscillometric BP measurements underestimate direct SBP recordings and overestimate direct DBP readings in acute stroke. The magnitude of the discrepancy between intra-arterial and oscillometric SBP recordings is even more prominent in patients with critically elevated SBP levels.