Fixed-dose pegfilgrastim is safe and allows neutrophil recovery in patients with non-Hodgkin's lymphoma

Twenty-nine patients with non-Hodgkin's lymphoma received a single subcutaneous injection of 6 mg pegfilgrastim approximately 24 h after the start of CHOP chemotherapy. The safety of pegfilgrastim in this patient population was determined by reports of adverse events. The pharmacokinetics of pegfilgrastim were characterized and the duration of grade 4 neutropenia, time to absolute neutrophil count (ANC) recovery to > or = 2.0 x 10(9)/l, neutrophil nadir, and incidence of febrile neutropenia were determined in the first 21-day chemotherapy cycle. The incidence of grade 4 neutropenia in cycle 1 was 43% with a mean (SD) duration of grade 4 neutropenia value of 1.0 (1.4) day. No apparent relationship between the duration of grade 4 neutropenia and body weight was observed. The median [quartiles] time to ANC recovery was 10 [9, 11] days. The incidence of febrile neutropenia was 11%. No unexpected adverse events were reported and no patient developed antibodies to pegfilgrastim. Serum concentration of pegfilgrastim reached a maximum (median [quartiles]) of 128 [58, 159] ng/ml at approximately 24 h after administration, and was followed by a second smaller peak (median [quartiles]) of 10.6 [3.0, 20.5] ng/ml at the time of the neutrophil nadir. After the second peak, concentration of pegfilgrastim declined linearly with a median terminal half-life of approximately 42 h.     

Infected myocardial hydatid cyst imitating left ventricular aneurysm

We report a case of infected intracardiac hydatid cyst in a patient who had complaints of chest pain, exertional dyspnea, palpitation, evening fever and fatigue. Echocardiography demonstrated a left ventricular apical cystic mass in 7 cm diameter. Magnetic resonance imaging and hemagglutination test confirmed the diagnosis. Single capsulated cyst full of pus was surgically removed by using cardio-pulmonary bypass. Histopathological examination revealed an infected hydatid cyst. Postoperative recovery was uneventful and the patient remains free of symptoms after one year of follow-up.     

Laparoscopic orchiectomy and simultaneous inguinal herniorrhaphy technique by the transperitoneal route in adult patients

In recent years, laparoscopy has begun to be widely used in many clinics for the diagnosis and repair of nonpalpable testes. Because the technique is noninvasive, it is also used to repair inguinal hernias via the retroperitoneal route. The technique and results of performing laparoscopic orchiectomy and herniorrhaphy simultaneously by the transperitoneal route in patients with abdominal testis and ipsilateral inguinal hernia were addressed in this clinical study. Between 1996 and 2001, laparoscopic intervention was applied in 44 patients ranging in age from 20 to 27 years (average, 23 years) who had both unilateral nonpalpable testis and ipsilateral inguinal hernia. The patients underwent laparoscopic orchiectomy and transperitoneal herniorrhaphy. They were followed for 6 to 24 months postoperatively (average, 16 months). No complications developed during the operation or early postoperative period in any of the patients. No case of recurrent hernia was encountered during the followup period. Efficient laparoscopic transperitoneal hernia repair can be achieved during laparoscopic orchiectomy performed in patients with abdominal testis and ipsilateral inguinal hernia. When this method is used, patients can be discharged on the day after the operation and are able to resume their daily activities within a very short time.     

Evaluation of the mastoid air cell system by high resolution computed tomography: three-dimensional multiplanar volume rendering technique

The mastoid air cell system is an important contributor to the pathophysiology of middle-ear inflammatory disease. The mastoid cavity is not only an air reservoir, but also an active space for gas exchange. Various methods of temporal bone imaging have been designed to investigate mastoid pneumatization. In this study, we examined 100 normal temporal bones for the evaluation of mastoid pneumatization. Mastoid air cell systems were measured by reconstructed axial and coronal high resolution computed tomography (HRCT) images. The reconstructions were made by a three-dimensional multiplanar volume rendering (3D MPVR) technique. The mean volume of the mastoid air cell pneumatization was 7.9 cm(3) (4.0-14.0 cm(3), SD = 2.3 cm(3)). The ears were allocated to the groups with respect to measured mastoid air cell pneumatization. Twenty-eight per cent of the ears have small pneumatization with an air cell system not exceeding 6 cm(3). Fifty-two per cent had an air cell system between six and 10 cm(3), and 20 per cent had an air cell system exceeding 10 cm(3). With its excellent imaging quality and the ability to eliminate bone and soft tissue, HRCT is the best method for evaluating the mastoid air cell system. The 3D MPVR technique must be used to measure the temporal bone/mastoid pneumatization for the best results.     

Environmental exposure to asbestos in eastern Turkey

In this study, the authors investigated the prevalence of asbestos-related disorders among the inhabitants of Güzelyurt, a town in Malatya, located in eastern Turkey. The authors examined river bed, white soil, and stucco samples taken from various locales in Güzelyurt, and they confirmed the presence of tremolite and chrysotile asbestos fibers. Subjects (N = 920; 449 males and 471 females) were examined by photofluoroscopy. Eighty-five patients (9.2%) had asbestos-related radiological findings; risk increased with age. Calcified pleural plaques were seen more frequently in individuals > or = 50 yr of age, compared with younger subjects (p < 0.01). Asbestos-related disorders were prevalent in the inhabitants of Güzelyurt, the population of which is exposed environmentally to asbestos--primarily the result of the stuccoing and whitewashing of houses with soil that contains asbestos.     

A prospective,longitudinal, multicenter study of service utilization and costs in fibromyalgia

Objective. To study, for the first time, service utilization and costs in fibromyalgia, a prevalent syndrome associated with high levels of pain, functional disability, and emotional distress. Methods. Five hundred thirty-eight fibromyalgia patients from 6 rheumatology centers were enrolled in a 7-year prospective study of fibromyalgia outcome. Patients were assessed every 6 months with validated, mailed questionnaires which included questions regarding fibromyalgia symptoms and severity, utilization of services, and work disability. Results. Fibromyalgia patients averaged almost 10 outpatient medical visits per year, and when nontraditional treatments were considered, this number increased to ∼1 visit per month. Patients were hospitalized at a rate of 1 hospitalization every 3 years. In each 6-month study period, patients used a mean of 2.7 fibromyalgia-related drugs. Costs increased over the course of the study. The mean yearly per-patient cost in 1996 dollars was $2,274. However, results were skewed by high utilizers, and many patients used few services and had limited costs. Total costs and utilization were independently associated with the number of selfreported comorbid or associated conditions, functional disability, and global disease severity. Compared with patients with other rheumatic disorders, those with fibromyalgia were more likely to have lifetime surgical interventions, including back or neck surgery, appendectomy, carpal tunnel surgery, gynecologic surgery, abdominal surgery, and tonsillectomy, and were more likely than other rheumatic disease patients to report comorbid or associated conditions. Almost 50% of hospitalizations occurring during the study were related to fibromyalgia-associated symptoms. Conclusion. The average yearly cost for service utilization among fibromyalgia patients is $2,274. Fibromyalgia patients have high lifetime and current rates of utilization of all types of medical services. They report more symptoms and comorbid or associated conditions than patients with other rheumatic conditions, and symptom reporting is linked to service utilization and, to a lesser extent, functional disability and global disease severity.     

Accurate diagnosis of acute pyelonephritis: How helpful is procalcitonin?

AIM: This prospective study aimed to investigate the diagnostic value of serum procalcitonin levels in children with acute pyelonephritis documented by Tc-dimercaptosuccinic acid (DMSA) scintigraphy. METHODS: We compared the symptoms and laboratory findings of fever, vomiting, abdominal/flank pain, leukocyte count, serum C-reactive protein and procalcitonin levels with the results of the DMSA scan obtained within the first 72 h after referral in children who were diagnosed as having acute pyelonephritis. Thirty-three children (31 female and two male) aged 1-11 years (mean 4.42 years) were enrolled in this prospective study. RESULTS: Twenty-one of 33 patients (64%) had positive DMSA scans. On the scans obtained after 6 months, five of 21 patients (23.8%) had renal scars. No correlation was found between clinical and laboratory parameters, alone or combined with each other, and positive DMSA scans. Serum procalcitonin levels were 0.767+/-0.64 and 1.23+/-1.17 ng . ml in children with normal and positive DMSA scans, respectively. The cut-off value for procalcitonin using receiver operating characteristic analysis was 0.9605 ng . ml, while sensitivity and specificity were 86.4% and 36.4%, respectively. However, if the cut-off value was chosen as 2 ng . ml, the sensitivity increased to 100% while specificity did not change markedly. CONCLUSION: The serum procalcitonin test, like other commonly used laboratory parameters, e.g. serum C-reactive protein and white blood cell count, was inadequate in distinguishing renal parenchymal involvement in acute febrile urinary tract infections.     

A 4-year study of the epidemiology of Vibrio cholerae in four rural areas of Bangladesh

How Vibrio cholerae spreads around the world and what determines its seasonal peaks in endemic areas are not known. These features of cholera have been hypothesized to be primarily the result of environmental factors associated with aquatic habitats that can now be identified. Since 1997, fortnightly surveillance in 4 widely separated geographic locations in Bangladesh has been performed to identify patients with cholera and to collect environmental data. A total of 5670 patients (53% <5 years of age) have been studied; 14.3% had cholera (10.4% due to V. cholerae O1 El Tor, 3.8% due to O139). Both serogroups were found in all locations; outbreaks were seasonal and often occurred simultaneously. Water-use patterns showed that bathing and washing clothes in tube-well water was significantly protective in two of the sites. These data will be correlated with environmental factors, to develop a model for prediction of cholera outbreaks.