Vasculitis due to gemcitabine

We report the first occurrence of gemcitabine-induced vasculitis. It concerns a 45-year-old man diagnosed with non-small lung cancer since 2 months. After the first cycle of chemotherapy, consisting of gemcitabine and cisplatin, he developed myalgia and swelling of arms and legs with impairment of movement. This re-occurred during the second cycle of chemotherapy. Further anemia, elevated ESR and increased creatininephosphokinase. A surgical biopsy showed leucocytoclastic vasculitis and necrosis of muscle tissue. The chemotherapy was stopped and the complaints disappeared and did not return.     

Balloon angioplasty in the treatment of pulmonary hypertension caused by pulmonary embolism

We present a 30-year-old man with pulmonary hypertension after pulmonary embolism. Pulmonary angiography showed multiple stenoses in the pulmonary vascular tree. We treated four of these stenoses by balloon angioplasty in three sessions. Pulmonary artery pressure was reduced from 90/25 mm Hg (mean 46) to 78/13 mm Hg (mean 35) with concomitant increase of aortic pressure from 105/60 mm Hg (mean 75) to 134/68 mm Hg (mean 90). Pulmonary perfusion scintigraphy showed increase of perfusion in the treated segments. Two procedures were followed by transient segmental pulmonary edema, but no other complications were noted. We conclude that balloon angioplasty is a promising method of lowering pulmonary artery pressure and improving pulmonary perfusion in suitable cases of pulmonary hypertension secondary to pulmonary embolism.     

Pollution by animal production in The Netherlands: solutions.

Provided that the application rates of manure do not exceed the crop uptake of nutrients, pollution by animal production is mainly caused by nitrogenous substances. Applying manure outside the growing season causes pollution of groundwater and surface water due to leaching and runoff. In regions with a high livestock density, the evaporation of ammonia has a serious impact on the environment. It contributes to acidification and causes a nutrient imbalance in natural vegetation. The prevention of nutrient losses from manure is unprofitable. The environmental impact is not caused by the individual farmer but is a result of the sum of activities in a region. This means that legislation is necessary to impose limits in order to arrive at production without pollution. Within this framework, the farmer should optimise the utilisation of minerals from manure by more efficient animal nutrition and better handling of the manure. One of the most difficult problems is the prevention of ammonia evaporation. A reduction of these losses generally also has a favourable effect on odour emissions. A new development is the processing of manure surpluses into a dried manure of sufficient quality to compete on the fertiliser market. As is usually the case with pollution control, these measures raise the costs of livestock production.