Red cell aplasia caused by parvovirus B19 in AIDS: use of i.v. immunoglobulin

We describe the case of a 34-year-old man with AIDS who developed severe anemia due to chronic pure red cell aplasia (PRCA) caused by parvovirus B19. Following initial treatment with an infusion of intravenous immunoglobulin (IVIg), 1 g/kg, PRCA resolved, but there was a recurrence of severe anemia in 3 months. Retreatment with 2 g/kg IVIg over 2 days resulted in normalization of hemoglobin and a significantly longer remission duration. Two doses of 0.4 g/kg IVIg q 4 wk failed to prevent a relapse of PRCA in our patient. The dose and schedule of IVIg in the treatment of PRCA caused by parvovirus B19 in AIDS requires further definition.     

In vitro changes in clips and bars used to retain implant overdentures

Although implant-retained overdentures are a less expensive alternative to fixed implant-supported prostheses in certain situations, problems with retentive clips fracturing and needing frequent replacement have been reported. This study compared baseline and posttest retention of metal and plastic clip-retained overdenture analogs and monitored surface changes in bars and clips throughout the testing process. A laboratory model was made with two implant analogs processed into an acrylic resin platform to which three bars were fitted. Two overdenture analogs were made and retained on the model with metal or plastic clips. Each bar-clip assembly was subjected to 5500 insertion and removal cycles to simulate 3 years of in vivo insertion and removal. Although the differences in retention between metal and plastic clips and between clips before and after testing were statistically significant, it is questionable whether they are clinically significant. Neither clip fracture nor loss occurred during this study, which suggests that it may be functional or parafunctional loading and not repeated insertion and removal of an implant overdenture that may cause the stated problems.     

Safety and cost-effectiveness of MIDCABG in high-risk CABG patients

BACKGROUND: Myocardial revascularization without cardiopulmonary bypass has been proposed as a potential therapeutic alternative in high-risk patients undergoing coronary artery bypass grafting. To evaluate this possibility we compared 15 high-risk (HR) patients in whom minimally invasive direct coronary artery bypass grafting was used as the method of revascularization with 41 consecutive patients who underwent conventional coronary artery bypass grafting during 1 month. METHODS: Patients undergoing myocardial revascularization without cardiopulmonary bypass were significantly older than their low-risk (LR) counterparts (72.2 +/- 11.6 versus 63.3 +/- 9.7 years, p = 0.006). The demographic profile for HR versus LR patients was as follows: female patients, 60.0% versus 26.8%, p = 0.02; diabetes, 20.0% versus 24.4%, p = 0.7; prior stroke, 33.3% versus 7.4%, p = 0.03; chronic obstructive pulmonary disease, 60.0% versus 9.8%, p < 0.0001; peripheral vascular disease, 33.3% versus 12.2%, p = 0.03, congestive heart failure, 26.6% versus 9.8%, p = 0.09; impaired left ventricular (ejection fraction < 0.40), 40.0% versus 17.0%, p = 0.07; urgent operation, 86.6% versus 46.3%, p < 0.0001; and redo operation, 20.0% versus 0%, p = 0.003. RESULTS: There were no deaths in the HR group and one death in the LR group. The average intensive care unit stay was 1.1 +/- 0.5 days in HR patients versus 1.6 +/- 1.6 days in LR individuals (p = 0.2), and the average hospital stay was 6.1 +/- 1.8 versus 7.3 +/- 4.4 days, respectively (p = 0.3). We used an acuity risk score index developed by the Adult Cardiac Care Network of Ontario to predict outcome in the HR group. The expected intensive care unit stay in HR patients was 4.1 +/- 1.2 days (versus the observed stay of 1.1 +/- 0.5 days, p < 0.0001), and the expected hospital stay was 12.5 +/- 1.5 days (versus the observed stay of 6.1 +/- 1.8 days, p < 0.0001). The expected mortality in the HR group was 6.1% versus 0%, p = 0.3. A cost regression model was used to examine predicted versus actual cost (in Canadian dollars) for the HR patient cohort (based on Ontario Ministry of Health funding). The expected cost for the HR cohort would have been $11,997 per patient. In contrast, the average cost for these 15 patients was $5,997 per patient, an estimated cost saving of 50%. CONCLUSIONS: Myocardial revascularization without cardiopulmonary bypass appears to be a safe and cost-effective therapeutic modality for HR patients requiring myocardial revascularization.     

Developmental intrahepatic shunts of childhood: radiological features and management

The purpose of this study was to evaluate the role of radiological techniques in the diagnosis and management of developmental intrahepatic shunts. Hepatic vascular fistulae are recognised sequelae of liver trauma and intrahepatic tumours. However, there are rare developmental malformations which may present in childhood or later life and which may carry life-threatening complications. Retrospective analysis of clinical and radiological data was carried out in 24 patients. Anomalies evaluated were: (a) direct communication between hepatic artery and hepatic veins; (b) congenital hepatoportal arteriovenous malformations; and (c) congenital portocaval anastomosis with persistent flow through the ductus venosus. Although rare, the prompt recognition of these vascular anomalies allows early surgical or radiological intervention and reversal of the haemodynamic complications.     

Myocardial involvement in diphtheria patients (a review)

The authors analyze emotional features in workers with occupational exposure to hydrazines, hydrocarbons and nitroglycols. Chronic occupational poisoning with those chemicals induce numerous emotional symptoms that are specific and varying in severity. The materials presented by authors could be interesting for occupational therapist, internist and psychiatrist for early diagnosis of chronic occupational intoxications, treatment of emotional disorders in workers and better occupational safety.     

Effect of heparin on mesangial cell growth and gene expression of matrix proteins

BACKGROUND: Mesangial cell (MC) proliferation and matrix expansion are characteristics of many glomerulopathies. Heparin has been shown to inhibit MC proliferation in vitro and mitigate cell proliferation, matrix expansion, proteinuria, renal insufficiency, and hypertension in experimental glomerulonephritis and subtotal renal ablation. We examined the effect of standard heparin on MC proliferation and matrix protein expression in vitro which necessarily excludes the confounding influences of haemodynamic, inflammatory, haemostatic, and various other processes that are present in vivo. METHODS: Gene expression and release of fibronectin (FN), collagen IV and laminin by cultured rat MC were tested in the presence and absence of heparin. In addition the effect of transforming growth factor-beta1 (TGF-beta1) on the gene expression of those matrix proteins was assessed. RESULTS: Within a 3-1000 microg/ml concentration range, heparin inhibited gene expression and release of FN by 10% fetal calf serum (FCS)-stimulated MC in a concentration-dependent manner. At concentrations of 300 and 1000 microg/ml, heparin inhibited fibronectin mRNA levels in TGF-beta1 (6 ng/ml) stimulated cells. However, heparin had no effect on gene expression or release of collagen IV or laminin under these conditions. Heparin markedly inhibited 10% FCS-stimulated MC proliferation in a concentration-dependent manner. CONCLUSIONS: Heparin inhibited MC growth and fibronectin production. These effects may, in part, account for the reported beneficial effects of heparin on the course of renal disease in experimental animals.