Reactive hemophagocytosis in Ki-l positive large cell lymphoma: a case study

A case of large cell lymphoma presenting with hemophagocytic syndrome is reported. The clinicopathological findings suggested a diagnosis of malignant histiocytosis, but on the basis of immunohistological studies Ki-l lymphoma was diagnosed. Neoplastic cells expressed activation antigens such as HLA-DR, IL 2R, T10 and Ki-l, and showed high proliferative activity, but were devoid of T and B cell markers. The high percentage of reactive macrophages found in the bone marrow and lymph node probably reflected the release of lymphokines by the tumor population. The patient was treated with aggressive chemotherapy and is in complete remission at 8 months from diagnosis.     

Restless legs syndrome: epidemiological and clinicogenetic study in a South Tyrolean population isolate.

Genetic contributions to restless legs syndrome (RLS) have been consistently recognized from population and family studies. To determine the clinical and genetic features of RLS in a population isolate and explore linkage to three previously described susceptibility loci on chromosomes 12q, 14q, and 9p, respectively, an isolated population in the South Tyrolean Alps was identified and 530 adults participated in the study. Using a two-step strategy, 47 patients with idiopathic RLS were ascertained. The prevalence in the population was 8.9%. Twenty-eight patients (59.6%) had at least one affected first-degree relative and were classified as hereditary cases. In a single extended pedigree, linkage to known RLS loci was investigated specifying autosomal dominant and recessive models; parametric and nonparametric multipoint linkage scores were computed. None of the calculated linkage scores was suggestive of linkage between RLS and any of the three investigated loci. This study was conducted in a population isolate providing for a homogeneous genetic and environmental background. The absence of a suggestive linkage signal at the three known RLS susceptibility loci is indicative of further locus heterogeneity of this frequent disorder and encourages further studies to unveil the genetic causes of RLS.     

Analysis of 80 bilateral hip replacement surgeries performed in a single session. Feasibility study

Patients affected with bilateral coxarthrosis often present with clinical and radiographic findings that are similar on both sides. The experience with 80 patients submitted to bilateral hip replacement in a single session demonstrated the usefulness and the reduction in costs in relation to hospitalization and rehabilitation. Indications and contraindications must be taken seriously.     

Characteristics of candidates for surgical sterilization and factors associated with type of procedure

In 1999 the Municipal Health Department in Ribeir?o Preto, S?o Paulo, Brazil, implemented the provision of surgical contraceptive methods according to prevailing legal requirements. This study aimed to characterize the candidates for surgical sterilization and study the variables associated with the type of procedure. A total of 95 candidate patient records were studied, and statistical logistic regression analysis and Fisher's exact test were performed considering a significance level of ? = 0.05. Most candidates had stable partners, low schooling, and low income, were satisfied with their number of children, and had already tried to limit the number of children using reversible contraceptives. Mean age was 34.2 years, 45.3% underwent female sterilization, 35.8% underwent vasectomy, and 18.9% did not submit to any procedure. The odds of a man older than 35 having a vasectomy were 6.1 times that of a younger man (OR = 6.1; 95%CI: 2.4-16.4). More married men submitted to vasectomy than men who cohabited (OR = 4.0; 95%CI: 1.5-12.4). Women with four or more children were more likely to undergo sterilization than those with fewer children (OR = 3.1; 95%CI: 1.1-8.5).     

Comparative study of the topical effectiveness of the Andiroba oil (Carapa guianensis) and DEET 50% as repellent for Aedes sp

DEET (N,N-diethyl-3-methylbenzamide) is nowadays the most effective mosquito repellent available, however, its use can present some topical and systemic side effects. Some botanical compositions, as Andiroba (Carapa guianensis), have been proved repellent properties at low cost and toxicity. An experimental study was driven involving four volunteers submitting their forearms covered with Andiroba oil at 100%, DEET 50%, refined soy oil, Andiroba oil 15% and in the absence of products, directly to healthy females of Aedes sp. The times of first and third bites were checked. The results showed that the median of the first bite without any product was 17.5s and the third bite, 40.0s. In the soy oil, the bites happened in 60.0s and 101.5s, in the presence of Andiroba oil 100%, in 56.0s and 142.5s and in Andiroba oil 15%, in 63.0s and 97.5s. The volunteers using DEET 50% had not received bites after 3600s in most of the experiments (p < 0.001 Wilcoxon). Pure Andiroba oil compared to the soy oil, forearm without product and Andiroba oil 15%, showed discreet superiority (p < 0.001 Wilcoxon). Our conclusion is that this study demonstrated that the pure Andiroba oil presents discreet repellent effect against bite of Aedes sp., being significantly inferior to DEET 50%.     

Insulin-like growth factor I and interleukin-6 contribute synergistically to disability and mortality in older women

The physiology of age-related functional decline is poorly understood, but may involve hormones and inflammation. We hypothesized that older women with both low IGF-I and high IL-6 levels are at high risk for disability and death. We assessed walking speed and disability in 718 women enrolled in the Women's Health and Aging Study I, a 3-yr cohort study with 5-yr mortality follow-up. Women with IGF-I levels in the lowest quartile and IL-6 levels in the highest quartile had significantly greater limitation in walking and disability in mobility tasks and instrumental activities of daily living than those with neither risk factor (adjusted odds ratios, 10.77, 5.14, and 3.66). Women with both risk factors were at greater risk for death (adjusted relative risk, 2.10) as well as incident walking limitation, mobility disability, and disability in activities of daily living compared with those with high IGF-I and low IL-6 levels. The combination of low IGF-I and high IL-6 levels confers a high risk for progressive disability and death in older women, suggesting an aggregate effect of dysregulation in endocrine and immune systems. The joint effects of IGF-I and IL-6 may be important targets for treatments to prevent or minimize disability associated with aging.     

Role of visceral proteins in detecting malnutrition in the elderly

OBJECTIVE: In the clinical practice, visceral proteins are used as indirect markers of protein energy malnutrition (PEM), but their reliability could be reduced with advancing age. The aim of this work is to investigate the reliability of albumin, prealbumin, retinol-binding protein (RBP) and transferrin in evaluating nutritional status in old patients and their relationship with fat-free mass (FFM). DESIGN: Cross-sectional study. SETTING: Padua, Italy. SUBJECTS: In 44 underweight (body mass index < 20 kg/m(2)) (66-97 years) and 69 normal weight or overweight elderly subjects (62-98 years), albumin, prealbumin, transferrin and RBP were determined in the plasma. Body composition and particularly FFM was obtained by dual X-ray absorptiometry. FFM was also expressed as FFM index (FFMI) calculated as FFM divided by height squared. Subjects affected by acute illnesses and inflammatory states were excluded. RESULTS: Albumin, prealbumin and RBP mean values were significantly lower in underweight subjects. No differences between two groups were found for transferrin. Albumin prealbumin and RBP resulted under the normal range in 55, 25 and 54% of underweight subjects, respectively. Transferrin's values were low in about 40% of underweight and normal weight subjects, respectively. In all subjects, FFMI shows a significant correlation with albumin (r: 0.52), prealbumin (r: 0.64) and RBP (r: 0.57). No correlation between FFMI and transferrin was found. CONCLUSIONS: Visceral proteins, except for transferrin, seem to be useful indexes in detecting malnutrition in the elderly; low values still in the normal range should also be carefully evaluated because they could suggest a poor nutritional status.     

Summarizing amount of difficulty in ADLs: a refined characterization of disability. Results from the women's health and aging study

Activities of Daily Living (ADLs) rating scales often classify older persons as independent or dependent in self-care activities. However, with this type of classification system little information is available on people who, while not dependent, do report some difficulty in performing self-care activities. This 3-year prospective cohort study presents an ADL summary scale that assesses a gradient of difficulty in ADLs for moderately to severely disabled women aged 65 and older living in the Baltimore, Maryland area. At baseline and for each of six interviews done at 6-month intervals, an ADL summary score measuring ADL difficulty was created. ADL summary score slopes were created for each woman who completed at least the baseline and first three follow-up interviews. The baseline ADL summary score and slope of the ADL summary score were used to predict risk of future hospitalization, nursing home admission and death. Additionally, 6-month ADL summary change scores were calculated in order to assess change in the ADL summary score for women who did and did not report an acute event (MI, stroke or hip fracture) at follow-up. The ADL summary scale showed excellent reliability. Intraclass correlation coefficients ranged from 0.83 to 0.93 for measures made one week apart. The 6-month average correlation coefficient was 0.77. The ADL summary scale also performed well in tests of validity. Poorer scores on the ADL summary scale were significantly and inversely related to an objective physical performance scale. The baseline ADL summary score and slope of the ADL summary score predicted future risk of hospitalization, nursing home admission and death. Each unit increase in the slope of the ADL summary score was associated with a 19% (95% CI 1.10, 1.29) increased risk of hospitalization, a 57% (95% CI 1.37, 1.81) increased risk of nursing home admission and a 41% (95% CI 1.22, 1.64) increased risk of death, adjusting for potential confounders. The mean 6-month ADL change score for women reporting an acute event (2.59) was significantly different from those not reporting an acute event (0.52). The strongest and most significant mean 6-month ADL change score was observed for women who reported a hip fracture (4.52) followed by stroke (2.40) and MI (1.00). These results demonstrate that the ADL summary scale presented has validity, reliability and is sensitive to change. This scale, therefore, offers the opportunity to classify functional problems in a larger proportion of the population than do ADL dependence scales. Additionally, it gives us a way to identify earlier functional changes, and a way to track the natural history of functional problems as well as a response to interventions.