Analysis of cellular populations in peritoneal effluents of children on CAPD

The characterization of cellular populations in peritoneal effluents (PE) of CAPD patients has been the subject of few studies. In order to establish a possible correlation between PE cells and clinical parameters, we studied the immunocompetent cells that are found in uncomplicated patients. In this study we used cytofluorimetric analysis to characterize phenotypically immunocompetent PE cells. We studied 17 children with a mean age of 8.7 +/- 5.3 years, who had been on CAPD for a mean duration of 16 months. The patients never suffered from peritonitis. The effluents were collected after overnight dialysis and centrifuged to concentrate cells. Surface phenotype of PE cells was tested with a panel of monoclonal antibodies. The analysis of 40 PE samples showed that the various cell types were present with different frequencies, suggesting that a dominant phenotype cannot be defined. The ratio between M3 positive cells (monocytic-macrophagic lineage) and T3 positive cells (T lymphocytes) showed a tendency to decrease after initiation of CAPD. T4/T8 ratio in all samples did not differ from that of peripheral lymphocytes. A high frequency of activated T cells (41% +/- 13), defined by the presence of DR antigens on T3+ M3- cells, was seen in PE and confirmed by the high frequency of T cells expressing the IL-2 receptor.     

Long-Term pH and Manometric Evaluation of the Distal Esophagus After Endoscopic Sclerotherapy of Esophageal Varices

Endoscopic sclerotherapy (ES) of esophageal varices is widely used as an effective treatment for recurrent esophageal bleeding. Retrosternal pain, dysphagia, and esophageal strictures are frequently reported after ES. Alterations in esophageal motility have also been described. In this study, the motility pattern of the esophagus and lower esophageal sphincter (LES) competence were evaluated in a group of 11 patients with portal hypertension and esophageal varices treated by means of ES. Esophageal manometry and pH monitoring of the distal esophagus were carried out before starting ES of esophageal varices, and 2 months and 6 months later. The results of the study demonstrated that ES does not affect LES competence or reduce the amplitude of esophageal motor contractions, but does induce esophageal motility changes consisting of a reduction of esophageal coordination, an increase in the percentage of contraction abnormalities (multipeaked contractions), an increase of the average contraction duration, and an alteration in LES relaxation after swallowing. These motor abnormalities are evident at both early and late control evaluations. However, since only few patients, in the authors' experience, develop esophageal symptoms after ES, these findings represent a minor side effect of the procedure, without clinical implications.     

The platelet count in carcinoma of the lung and colon

Platelet counts were evaluated in 714 patients with advanced non-small cell lung cancer (N-SCLC), small cell carcinoma of the lung (SCCL), and colon cancer entered to a clinical trial. Patients had not received prior chemotherapy. Platelet counts were not different in patients who had received radiation therapy prior to entry to the study. In comparison to the other tumor types, patients with N-SCLC demonstrated an increased prevalence of thrombocytosis (counts greater than 400,000/mm3), higher platelet counts at the time of entry to the study, higher over all mean platelet counts, relative preservation of high platelet levels during disease progression, and no relationship between platelet numbers and the amount of chemotherapy given. By contrast, platelet counts in patients with SCCL were negatively correlated with the absolute amount of cyclophosphamide and adriamycin given, and declined most dramatically with disease progression and death. Platelet numbers did not correlate with fibrinopeptide A or fibrin split product levels suggesting that disseminated intravascular coagulation or fibrinolysis may have had less influence on platelet numbers than certain other factors. By contrast, significant correlations were found for all three tumor types between platelet numbers and other indicators of bone marrow function including anemia, total leukocyte count, and absolute neutrophil count; and the fibrinogen level. Based upon these findings, we postulate that the host response to malignancy, possibly in the form of production of bone marrow-stimulating cytokines, may play a prominent role in regulation of platelet counts in these (and perhaps other) neoplasms, and that a particularly prominent and persistent degree of marrow stimulation exists in patients with N-SCLC.     

Influence of vertebral fat content on quantitative CT density

Single- and dual-energy (85 and 130 kVp) computed tomographic (CT) measurements of bone density were made in 74 lumbar (L-3) vertebral specimens. Single-energy CT densities at 130 kVp consistently underestimated actual ash density by about 25 mg/cm3 in men and 40 mg/cm3 in women. CT densities overestimated age changes by 73% in women and 26% in men. These errors of the single-energy CT approach seemed due to increased marrow fat caused by age. At 130 kVp, there was a large decrease in apparent bone density (13 mg/cm3) for each increase of 100 mg/cm3 in fat content, but the decrease was lower at 85 kVp (11 mg/cm3), suggesting the use of lower energies for quantitative CT. In the vertebrae from the younger subjects (up to age 69), the relative error was 20%-31%, but in the oldest group it amounted to 31%-45%. The 95% confidence interval for an individual determination was +/- 38 mg/cm3. Dual-energy CT greatly reduced the above errors. Ash density was predicted with only a small accuracy error (7 mg/cm3) using a postprocessing dual-energy calculation, but the prediction error was 19 mg/cm3 for determinations at 130 kVp. The large uncertainty in the fat content of marrow (+/- 110 mg/cm3) and the variability in distribution of fat make dual-energy approaches necessary for accurate determinations of vertebral mineral density.     

Lung cancer risk among refractory brick workers exposed to crystalline silica: a retrospective cohort study.

We conducted a retrospective cohort study among 1,022 refractory brick workers exposed to crystalline silica. Mortality from lung cancer (SMR = 1.77) and respiratory diseases (SMR = 3.15) was elevated in workers first employed less than or equal to 1957 who are likely to have shared the highest exposure to crystalline silica. Workers with at least 19 years of cumulative employment in the plant experienced particularly increased risks for lung cancer (SMR = 2.01) and respiratory diseases (SMR = 3.89). Relative mortality from these specific causes increased with years since first employment (that is, first exposure) and decreased with age at first employment. Indirect adjustment for smoking habits and the lack of excess mortality from cardiovascular diseases and emphysema indicated little effect of smoking on the increased risks for lung cancer and respiratory diseases.     

Hepatic cavernous hemangioma: magnetic resonance imaging. Work in progress

Using a 0.35-T superconducting magnet and spin echo imaging, we prospectively evaluated 11 patients who had proved hepatic cavernous hemangioma. Magnetic resonance (MR) identified more lesions than either contrast-enhanced CT, or ultrasonography. The MR appearance was consistent; hemangiomas were homogeneous and generally isointense at short TR and TE intervals but were hyperintense at long TR intervals and greatly hyperintense at long TR and long TE intervals. However, the MR appearance of hemangioma was not specific; 2/14 other focal hepatic masses had similar features. The calculated relaxation times (T1, T2) were not useful in lesion characterization, although the intensity ratio of hemangioma to normal liver at the TR = 2.0 sec TE = 56 msec pulse sequence was useful in diagnosis since hemangiomas always had a ratio greater than 1.4.     

Successful treatment of gangrene in systemic necrotizing vasculitis with iloprost

Systemic necrotizing vasculitis is uncommon in children and may be rarely associated with gangrene. We describe a 3-yr-old girl with parvovirus B19-induced necrotizing vasculitis whose digital gangrene was successfully treated with iloprost, a prostacyclin analogue.      

Effectiveness of an acute pain service in surgical patients — a hospital comparison study

The implementation of an acute pain service (APS) has been advocated as the cornerstone of effective pain management. However, convincing evidence demonstrating the effectiveness of an APS in controlled studies is scarce. In this study we compared both subjective and objective variables of surgical patients in two similar hospitals, one of which had established an APS. During the study period of two years 498 patients were prospectively enrolled. Pain and other related variables (appetite, mobility, need for sleep, fatigue, and general satisfaction) were assessed pre- and postoperatively by means of 10 cm VAS scales printed on two identical questionnaires. Additional data were retrieved from the patients' records. Those patients who were cared for by an APS suffered less pain (25 mm VAS at rest), sleepiness (13 mm VAS), mobility restriction, and loss of appetite. For most measures the beneficial effects of the APS were present pre- and postoperatively. However, hospital stay was similar in both hospitals (13.7 vs 14.3 days; A vs B). Our data indicate large and patient-relevant benefits of an APS, but our study design was vulnerable to various kinds of bias.