The clinical efficacy of plasmosorption in stenocardia]

Follow-up examinations of 52 anginal patients who have received combined treatment involving plasma sorption indicate a good response in 77%, satisfactory in 11.5% and no response in 11.5% of the examinees. Exercise tolerance and performance increased by 34.3 and 52.1%, respectively. The scope of chemotherapy was related to the initial severity of the disease. Clinical remission after plasma sorption lasted 8.4 +/- 0.7 months.     

Suprasternal Doppler ultrasound for assessment of stroke distance

An assessment of a non-invasive technique for measurement of stroke distance was made using a portable Doppler ultrasound machine. The aim was to determine the measurement error of repeated stroke distance measurements (Within-observer variability) and to assess measurement agreement between two operators (between-observer variability). The measurement error (within-observer variability) for both operators was similar at approximately 2 cm. However, the measurements of the two operators (between-observer variability) did not agree well. Using the mean (SD) of three readings by each operator, the mean difference between the operators was -0.21 cm (1.96) giving a 95% confidence interval for the differences of -4.0 to +3.6 cm. There were significant positive and negative correlations between stroke distance and a variety of variables (age, height, weight, heart rate), but the relations were weak. The results indicate that the Doppler ultrasound technique for measurement of stroke distance would best be used to study trend changes in an individual patient, or subject, by a single operator.     

Contrasting effects of recombinant human granulocyte-macrophage colony- stimulating factor (CSF) and granulocyte CSF treatment on the cycling of blood elements in childhood-onset cyclic neutropenia

Recombinant human granulocyte colony-stimulating factor (G-CSF) treatment has been shown to increase average neutrophil counts substantially in patients with childhood-onset cyclic neutropenia (or "cyclic hematopoiesis"), but not to eliminate the cyclic oscillations of neutrophil counts or those of other blood elements (monocytes, platelets, eosinophils, and reticulocytes) that are characteristic of this hematopoietic disorder. Indeed, oscillations of neutrophil counts are amplified during G-CSF treatment. We have compared the effects of recombinant granulocyte-macrophage-CSF (GM-CSF) with those of G-CSF in three patients with this disease (2 men and 1 woman, 17, 30, and 32 years of age). These patients were treated with GM-CSF (2.1 micrograms/kg/day, subcutaneously) for 6 weeks, preceded and followed by 6 to 13 weeks of detailed observation to document changes in the cyclic oscillations of blood neutrophils and other blood elements; two of the patients were subsequently treated with G-CSF (5.0 micrograms/kg/d, subcutaneously) and observed for comparable periods of time. Unlike G-CSF treatment, which increased average neutrophil counts more than 20-fold, GM-CSF increased neutrophil counts only modestly, from 1.6- to 3.9-fold, although eosinophilia of varying prominence was induced in each patient. However, at the same time, GM-CSF treatment dampened or eliminated the multilineage oscillations of circulating blood elements (neutrophils, monocytes, platelets, and/or reticulocytes) in each of the patients. In contrast, G-CSF treatment of the same patients markedly amplified the oscillations of neutrophil counts and caused the cycling of other blood elements (monocytes in particular) to become more distinct. These findings support the conclusion that the distinctive cycling of blood cell production in childhood-onset cyclic neutropenia results from abnormalities in the coordinate regulation of both GM-CSF-responsive, multipotential progenitor cells and G-CSF-responsive, lineage-restricted, neutrophil progenitors.     

Mycobacterial infection in an inner city children's hospital

Childhood tuberculosis is perceived by many as a disease of the past. Experience in a children's hospital serving a deprived population suggested that tuberculosis and other mycobacterial infections were not declining in clinical practice. Fifty three tuberculous and 11 atypical mycobacterial infections were identified between 1978 and 1992. There was no decline in tuberculosis and nine of the 11 atypical infections occurred in the last five years. Altogether 40% of cases of tuberculosis were in non-Asian children; 32% had arrived in the UK or visited family overseas in the previous year; and 38% had a history of tuberculosis contact, usually a close adult relative. Nationally, the previous decline in tuberculosis in all ages has reversed. In the local health districts in London's east end, childhood tuberculosis has also stopped declining and seems to be increasing. It is regrettable that BCG vaccination has been abolished by some districts in the UK, against current recommendations. Childhood tuberculosis is still common in the practice described here, including among children who do not fall into conventionally recognised high risk groups. Inner city dwellers and junior doctors are both highly mobile populations, adding to the risk that paediatricians, particularly those in training, may encounter tuberculosis with little or no previous experience of the condition.     

Effect of adrenergic and histaminergic disorders on the subclinical course of atopic bronchial asthma

To characterize membrane-receptor peculiarities of the adrenergic and histaminergic systems under the model of peroxide and hyperosmolar effect in atopic bronchial asthma (ABA) and preclinical stage of BA, we have examined 25 patients with ABA, 19 patients with nonpulmonary allergy, 28 healthy men and 21 healthy blood relatives of ABA patients. The phenomenon of inversion of the effect of beta-adrenoblocker (obzidan) and of the combined effect of histamine and H1-antagonist (dimedrol) was revealed in ABA patients. The same phenomenon was registered at the preclinical stage of BA. In ABA and in preclinical BA the shift of H1/H2-histaminergic balance to increased H1-activity exists. Peroxide and hyperosmolar effects modeled on red cell membranes allowed us to characterize reactivity of adrenergic and histaminergic systems not only in ABA but also in preclinical BA.     

NO-inhibiting and vasotropic activity of some compounds with thioamidine group

Using the method of electron paramagnetic spectroscopy we demonstrated that thiazine-thiazoline compounds and aminoethyl isothiourea containing the thioamidine group inhibit NO production in the liver of endotoxin-treated mice. Injection of these agents to anesthetized rats increased arterial pressure and enhanced respiration rate. This effect probably reflects inhibition of not only inducible, but also the constitutive synthesis of NO by compounds with thioamidine group.     

Feasibilities of cytological diagnosis in the static telepathology mode

Results of cytological diagnosis in the static telepathology mode are analyzed. Three expert cytologists made the diagnosis on the basis of images of cytological preparations obtained from 94 patients with tumors of soft tissues and bones. A total of 113 diagnoses were correct: benign or malignant type of the tumor and its histological type were identified. In general, a total of 152 (88.9%) diagnoses were correct as regards their significance for treatment strategy. Errors classified as groups 3 and 4 were the most significant (erroneous assessment of tumor type--benign or malignant--in 6.4% cases). Analysis of discrepancies between cytological and pathoanatomical diagnoses and data of routine optic microscopy of similar cytological preparations of the same material (bone and soft tissue tumors) showed the same value: 6.8% of cytological and pathoanatomical diagnoses were at disagreement (groups 3 and 4 of errors). Therefore, telepathology can be resorted to for consultations and discussion of obscure cases. It is particularly important for a morphologist to discuss complex cases by means of telepathology at a specialized institution, distant from him or her.