Fine-needle aspiration biopsy of multiple myeloma in a patient with renal-cell carcinoma: A case report

A case of multiple myeloma diagnosed by fine-needle aspiration (FNA) biopsy and confirmed by laboratory studies in a patient with a history of renal-cell carcinoma is presented. The patient was diagnosed with renal-cell carcinoma of the right kidney and a radical nephrectomy was performed. Eighteen months after this diagnosis was made, the patient developed chest wall pain and was found to have osteolytic bone lesions of the ribs and vertebral bodies. FNA of an osteolytic rib lesion disclosed multiple myeloma. Additional laboratory studies confirmed the diagnosis of multiple myeloma. This case report demonstrates the value of FNA as a diagnostic tool for the follow-up of cancer patients, the subsequent discrimination between metatastic lesions and a second primary malignancy, and the cytology of multiple myeloma.     

Dengue haemorrhagic fever: ultrasound as an aid to predict the severity of the disease

In a prospective study, the relationship between the clinical severity of dengue haemorrhagic fever (DHF) and the sonographic findings was examined. The study comprised 73 cases classified as mild (grades I–II) and 75 as severe (grades III–IV). Ultrasonography in the mild group revealed pleural effusions in 30 %, ascites in 34 %, gallbladder wall thickening in 32 %, hepatomegaly in 49 %, splenomegaly in 16 %, and pancreatic enlargement in 14 %. In the severe group, pleural effusions, ascites and gallbladder wall thickening were found in 95 %, pararenal and perirenal fluid collections in 77 %, hepatic and splenic subcapsular fluid collections in 9 %, pericardial effusion in 8 %, hepatomegaly in 56 %, splenomegaly in 16 %, and pancreatic gland enlargement in 44 %. Ultrasound may be useful for early prediction of the severity of DHF in children. Received: 15 January 1997 Accepted: 2 June 1997     

Carotid intima-media thickness and brachial-ankle pulse wave velocity in patients with and without coronary artery disease

BACKGROUND: Carotid intima-media thickness and pulse wave velocity are non-invasive markers of atherosclerosis and have been shown to reliably predict presence and extent of atherosclerotic vascular disease. However, studies examining their association with each other have shown inconsistent results. Hence it was sought to assess correlation between carotid intima-media thickness and pulse wave velocity in patients with and without coronary artery disease. METHODS AND RESULTS: Sixty-four patients with angiographically proven coronary artery disease and 84 age-matched individuals without coronary artery disease but having one or more conventional cardiovascular risk factors were included in the study. Individuals with established cerebrovascular disease and peripheral vascular disease were excluded from the study. Carotid intima-media thickness of far wall was measured at three predefined sites (distal common carotid, carotid bifurcation and proximal internal carotid artery) on each side. Brachial-ankle pulse wave velocity was measured non-invasively using VP 1000 (Colin Corporation) automated ABI/ PWV analyzer. There was no significant difference in gender and presence of cardiovascular risk factors in the two groups. Mean and maximum carotid intima-media thickness and brachial-ankle pulse wave velocity were all significantly higher in coronary artery disease patients as compared to patients without coronary artery disease (0.842 v. ( 0.657 mm, p <0.0001; 1.076 v. 0.795 mm, p <0.0001; 1708.63 v. 1547.26 cm/s, p <0.0004 respectively). There was a significant correlation between brachial-ankle pulse wave velocity and both mean and maximum carotid intima-media thickness in patients with coronary artery disease (r = 0.47, p <0.0001 and r=0.41, p < 0.0008 respectively) but not in individuals without coronary artery disease (r=0.01 and -0.1 respectively). CONCLUSIONS: Presence of significant correlation between carotid intima-media thickness and brachial-ankle pulse wave velocity in patients with coronary artery disease but absence of the same in individuals without major atherosclerotic vascular disease suggests that the correlation between carotid intima-media thickness and brachial-ankle pulse wave velocity becomes stronger with increasing extent of atherosclerosis.     

Hemoglobin solution: Is a normal [Hb] or P50 more important?

Although stroma-free hemoglobin solution (SFH) supports normal levels of oxygen consumption in baboons exchange transfused to zero hematocrit, a significant decrease occurs in the mixed venous oxygen tension ($\text{P}\text{v}\text{O}{}_2$). The hemoglobin concentration (6–8 g%) and P₅₀ (12–17 Torr) are both low in the current SFH preparations, and it is likely that they contribute to the low $\text{P}\text{v}\text{O}{}_2$ values. A multiple linear regression analysis was used to quantitate the contribution of simultaneous changes in [Hb] and P₅₀ to the observed change in $\text{P}\text{v}\text{O}{}_2$ during total exchange transfusion with SFH. During the study the average $\text{P}\text{v}\text{O}{}_2$ decreased from 51.4 to 22.4 Torr; the [Hb] fell from 11.6 to 5.1 g%; and the P₅₀ decreased from 31 to 19.5 Torr. The resulting equation was $\text{P}\text{v}\text{O}{}_2\text{= 4.0[}\text{Hb}\text{] + 0.33 P}{}_{50}\text{- 4.2}$. The equation calculates that the 6.5 g% decrease in [Hb] was responsible for a fall in $\text{P}\text{v}\text{O}{}_2$ of 26 Torr, while the fall in P₅₀ of 11.5 Torr decreased the $\text{P}\text{v}\text{O}{}_2$ only 3.8 Torr. The data suggest that an increased [Hb] should be more effective in raising $\text{P}\text{v}\text{O}{}_2$ than a higher P₅₀. Since a low $\text{P}\text{v}\text{O}{}_2$ is an indication of a reduced oxygen reserve, future efforts should attempt to achieve a hemoglobin solution with a normal [Hb].     

Non-invasive assessment of endothelial function by brachial artery flow mediated vasodilatation and its association with coronary artery disease: an Indian perspective

Endothelial dysfunction is the final common pathway through which various coronary risk factors culminate into atherosclerosis and subsequent coronary artery disease (CAD). Endothelial function can be reliably assessed by flow mediated vasodilatation (FMD) in the brachial artery using high-resolution ultrasonography and has been shown to be an excellent surrogate marker for the presence of CAD. Two hundred and forty-one individuals comprising of 101 patients with CAD (angiographically proven, or with history of documented myocardial infarction) and 140 individuals without CAD were included in the study. All subjects underwent clinical evaluation, fasting lipid profile, treadmill test and FMD assessment. Selected individuals underwent coronary angiography too. Brachial artery diameter and Doppler indices (systolic and diastolic velocity time integrals) were recorded using high resolution ultrasonography at baseline, immediately after and at one minute after release of cuff (occlusion time 5 minutes). FMD was calculated as percentage increase in brachial artery diameter at one minute. FMD index was calculated as the ratio of FMD and percentage increase in flow during reactive hyperaemia. Mean FMD was significantly higher in non-CAD group (8.71+/-4.77%) than in CAD group (3.77+/-2.03%; p < 0.0001). The FMD index was also significantly higher in the non-CAD group (0.031 ) than in CAD group (0.021; p=0.0117). On multiple regression analysis, FMD index was found to be significantly associated with presence of CAD (p=0.0015), independent of conventional cardiovascular risk factors. Endothelial function as assessed by FMD is significantly depressed in patients with established CAD and this association is independent of presence of conventional cardiovascular risk factors.     

The first report of CCR5 delta 32 mutant in Thai injecting drug users

CCR5, a chemokine receptor, is the principal coreceptor for macrophage-tropic HIV-1 which is the most important variant for viral transmission. It has been demonstrated that a homozygous genotype of a 32-bp deletion in CCR5 gene (delta32CCR5) shows a high degree of resistance to HIV-1 infection. To demonstrate that delta32CCR5 does exist in Thai natives, the CCR5 genotypes and allelic frequencies in 860 Thai injecting drug users (IDUs) were determined by PCR and DNA sequencing. Of these, six (0.7%) were CCR5/delta32CCR5 heterozygotes and no homozygote was found. The overall delta32CCR5 allelic frequency was 0.0035 and in HIV-1 seronegative (n = 490) and seropositive (n = 370) IDUs were 0.0051 and 0.0004, respectively, which were not significantly different (p = 0.3776). Here we report that the delta32CCR5 does exist in Thai IDUs as it is present in other human races. Such low allelic frequency may indicate that this mutation does not attribute a significant role in HIV-1 transmission in Thai IDUs.     

CD8dim but not CD8bright cells positive to CD56 dominantly express KIR and are cytotoxic during visceral leishmaniasis

This study reports a structural and functional heterogeneity of CD8⁺CD56⁺NKT cells, which usually decrease quantitatively during visceral leishmaniasis. Based on fluorescence intensity of CD8 receptors on CD56⁺NKT cells, two populations of CD8⁺CD56⁺NKT cells have been identified. These cells were recognized as CD8^dimCD56⁺NKT and CD8^brightCD56⁺NKT cells. We further analyzed the functional nature of CD8^dim and CD8^bright positive CD56⁺NKT cells. In comparison to CD8^brightCD56⁺NKT cells, a significantly higher percentage of CD8^dimCD56⁺NKT cells expressed KIR during VL. The percentage of CD8^dimCD56⁺NKT cells expressing KIR was found 4 fold higher in VL as compared to healthy subjects. But, the difference was insignificant in case of CD8^brightCD56⁺NKT cells. CD8⁺CD56⁺NKT cells release granzyme B to kill the infected cells. A categorical difference was also observed in the function of CD8^dimCD56⁺NKT and CD8^brightCD56⁺NKT cells during visceral leishmaniasis. The percentage of granzyme B expressing CD8^dimCD56⁺NKT cells was 2.83 fold higher in VL compared to healthy subjects. But, there was no significant difference in granzyme B expressing CD8^brightCD56⁺NKT cells in samples from healthy and VL subjects. However, within VL subject, the percentage of granzyme B expressing CD8^dimCD56⁺NKT cells was 5.7 fold higher in comparison to CD8^brightCD56⁺NKT cells. This study concludes that CD8^dimCD56⁺NKT cells are more cytotoxic than CD8^brightCD56⁺NKT cells during VL.     

Role boundaries – research nurse or clinical nurse specialist? A literature review

This paper focuses on issues relating to the role components of clinical nurse specialists and clinical research nurses working in breast cancer care. Identified issues relate to the lack of agreement as to the role and definition of clinical nurse specialists. At the same time there has been an increase and emergence of clinical research nurses, both within the NHS and university departments. The review fails to reveal the relationship between these two specialist groups in terms of role overlap and role boundaries. The lack of knowledge in this area substantiates the need for further research to be carried out.     

Efficacy of supplemental Occlu-pad therapy with partial occlusion in children with refractive anisometropic amblyopia

Purpose:To study the efficacy of supplemental occlu-pad therapy with partial occlusion in children with refractive anisometropic amblyopia.Methods:Thirty-one children who did not improve after partial occlusion of 6 h for 6 months were supplemented with the use of occlu-pad for 1 h per day and three such sessions in a week.Results:The mean age was 6.8+/-1.4 years (range 5–9 years). A significant improvement of 3.2+/-1.3 lines in visual acuity was noticed at the end of 3 months of starting this supplemental therapy in children. Out of 31 children, 26 children improved at least 2 lines or more at the end of 3 months. All children (n = 9) having anisohyperopic amblyopia improved at the end of 3 monthsConclusion:Occlu-pad is useful in supplementing occlusion therapy in cases of refractive amblyopia and is more effective in anisohyperopic amblyopia.