Infection of cardiac mural thrombus associated with left ventricular aneurysm

Infection is a rare complication of cardiac mural thrombus andmay prove difficult to diagnose and treat. We describe a patientwith infected thrombus associated with a left ventricular aneurysm,involving Salmonella typhimurium. Cross-sectional echocardiographyproved helpful in establishing the diagnosis.     

Reproductive Toxicity of Butylated Triphenyl Phosphate and Tricresyl Phosphate Fluids in F344 Rats

The effects of tricresyl phosphate (TCP) and butylated triphenylphosphate (BTP)-based hydraulic fluid on reproduction were studiedin F344 rats using a modification of the National ToxicologyProgram's Continuous Breeding Protocol. Groups of breeding pairsreceived single daily oral doses of an equal volume of either0, 0.6, 1.0 g BTP/kg or 0.4 g TCP/kg in sesame oil or 1.7 gneat BTP/kg for up to 135 days. A naive control group allowedto breed, but not dosed or handled daily, demonstrated thatdaily dosing and handling of the rats had no effect on reproduction.The fertility index and number of litters born were significantlydecreased in rats exposed to 1.0 and 1.7 g BTP/kg and 0.4 gTCP/kg. The number of pups per litter was significantly decreasedin the TCP group. A crossover mating experiment using 0.4 gTCP/kg/day and 1.0 g BTP/kg/day groups, each mated with vehiclecontrols, demonstrated that TCP caused 100% infertility in malerats but did not affect reproduction in females. BTP causeda significant decline in reproduction in female rats characterizedby low mating and fertility indices, decreased number of litters,and abnormal estrous cycles. Fertility was decreased in theBTP-dosed male rats. Both sexes of rats in the crossover experimentwith TCP and BTP had significant decreases in terminal bodyweights and increases in adrenal gland and liver weights. OnlyTCP-dosed male rats had significantly decreased testicular andepididymal weights. TCP-dosed female rats had increased ovarianweights, while BTP-dosed females had significantly lower uterineweights. The results of this study indicate that BTP and TCPare reproductive toxicants in F344 rats.     

Outcomes in total elbow arthroplasty in patients with haemophilia at the University of California,San Francisco: a retrospective review

Summary. Severe haemophilic arthropathy of the elbow is a significant cause of morbidity among adults with haemophilia. However, previous reports of total elbow arthroplasty (TEA) in the haemophilic population have been based on small numbers of patients with relatively short‐term follow‐up. The records of seven total elbow arthroplasties in six adult men with haemophilia at the University of California, San Francisco who underwent TEA over a period of 25 years were retrospectively reviewed. Type of haemophilia, age at time of TEA, HIV infection status, pre‐ and postoperative range‐of‐motion (ROM) scores, complications (including infections), need for subsequent surgical revision and functional outcomes were recorded. Four patients had severe factor VIII deficiency and two patients had severe factor IX deficiency. None of the patients had an inhibitor. The mean age at the time of surgery was 34 years (range, 22–46 years) and the mean follow‐up period was 118 months (range, 37–176 months). One of the six patients had TEA in both elbows. Five of the six patients were infected with HIV. There were no immediate perioperative complications. At a mean of 19.2 months postoperatively, ROM had improved in five of seven TEAs: mean flexion had increased from 110.7° (SD = 15.0) to 120.1° (SD = 14.5), whereas mean preoperative extension increased from ?44.3° (SD = 21.5) to ?36.9° (SD = 27.0). One patient required a revision at 30 months because of ulnar component loosening. This same patient sustained a staph epidermidis infection and ultimate removal of the prosthesis 15 years postoperatively. At a mean of 118 months postoperatively, five of six patients continued to report reduced pain and preserved functionality, with ability to perform normal daily activities. TEA resulted in favourable results in six of seven procedures. Our findings support the viability of TEA for individuals with severe haemophilic arthropathy of the elbow, especially to reduce pain and preserve or restore functionality. Level of evidence .  Level IV.     

A COMPARATIVE STUDY OF THE SAFETY AND EFFICACY OF DYSPROSIUM-165 HYDROXIDE MACRO-AGGREGATE AND YTTRIUM-90 SILICATE COLLOID IN RADIATION SYNOVECTOMY--A MULTICENTRE DOUBLE BLIND CLINICAL TRIAL

The aim of our study was to compare the safety and efficacyof a new preparation, Dysprosium-165 Hydroxide Macro-aggregate(¹⁶⁵Dy) with Yttrium-90 Silicate (⁹⁰Y) for radiation synovectomyof the knee in patients with RA and OA. A multicentre doubleblind clinical trial with subjects randomized to receive ¹⁶⁵Dyor ⁹⁰Y was undertaken in Sydney, Melbourne and Perth. Seventyknees of 59 patients were studied, using as clinical end pointmeasurements pain in the knee on walking, pain in the knee atrest and stiffness in the knee after rest. Cytogenetic damage,knee retention and extra-articular spread of the radionuclideto regional lymph nodes, liver, urine and blood were evaluated.There was no significant difference in clinical response inthe two treatment groups for either RA or OA. Chromosomal changesoccurred with equal frequency and the knee retention and extra-articularleakage of radiocolloids to regional lymph nodes and liver werecomparable in the two groups. For radiation synovectomy of theknee, ¹⁶⁵Dy is at least as safe and as effective as ⁹⁰Y andhas the advantage of a short half-life (2.334 h) and hence requiresa shorter period of post-injection immobilization and hospitalization. KEY WORDS: Radiation synovectomy, Dysprosium-165, Yttrium-90, Rheumatoid synovitis, Osteoarthritis     

IS DIET IMPORTANT IN RHEUMATOID ARTHRITIS?

There is evidence from several well documented case reportsthat occasional patients with rheumatoid arthritis (RA) maydevelop aggravation of their arthritis as a result of allergyto some ingredient in the diet. A variety of foodstuffs havebeen implicated including milk and milk products, corn and cereals.Total fasting results in improvement in rheumatoid arthritis,but appears to be mediated by diminution in production of chemicalmediators of inflammation, rather than by elimination of a dietaryallergen. There is conflicting evidence from studies using variousintestinal probes that patients with rheumatoid arthritis mayhave a ‘leaky’ intestinal mucosa allowing food allergensto be more easily absorbed. Clinical therapeutic trials of exclusiondiets have employed the standard strategy of the double-blindrandomized method. However, this presupposes that patients enteredinto such a study are capable of improvement with dietary manipulation.Since this is often not the case, a more appropriate methodwould be to employ the ‘intensive research design’also known as ‘single case experiment’ and ‘Nof 1’ study. ‘Masked food intolerance’ isan attractive hypothesis, but extremely difficult to prove. It is doubtful whether fish oils and/or evening primrose oilwill be of significant long term benefit for patients with RA.However, they do provide for the possibility that a fatty acid-likesubstance may be found which may be incorporated into cell membranes,thereby preventing production of mediators of inflammation,such as prostaglandin E₂ and leukotriene B₄ KEY WORDS: Arthritis, Allergy, Food, Fasting, Gut permeability, Trace elements, Protein, Fatty acids, Therapy     

THE POLAROGRAPHIC MEASUREMENT OF HALOTHANE

The polarographic reduction of halothane on silver cathodeswas studied. Silver catalyses the reduction of halothane: twoelectrons are exchanged in the reduction process. Experimentsusing a rotating disc electrode showed a linear relationshipbetween observed current and halothane concentration. A Silasticmembrane-covered polarographic electrode was constructed usinga silver cathode which gave a good linear response to changesin halothane concentration over the range 0–5% v/v halothanein nitrogen. Oxygen interferes with the measurement of halothane,but can be removed from a gas sample before analysis.     

NAPROXEN AND DIFLUNISAL IN OSTEOARTHROSIS

Sixty-two patients with osteoarthrosis entered a 10-week double-blindcross-over trial of diflunisal and naproxen. Eight patientswithdrew for drug-related reasons, and seven for other reasons.There was no statistically significant difference in parametersof disease activity on each treatment period, but naproxen producedfewer withdrawals due to drug-related side-effects.