Case report: bladder opacification following enteral iopamidol as a sign of occult intestinal infarction

A case of intestinal infarction due to superior mesenteric artery embolism is described in a 30-year-old female with Crohn's disease. This was accompanied by bladder opacification following enteral iopamidol administered at endoscopic retrograde cholangiopancreatography. The likely mechanism of this finding is transmural and transperitoneal absorption of enteral contrast medium and its significance as a sign of mesenteric ischaemia is discussed.     

Thrombocytopenia following liver transplantation is associated with platelet consumption and thrombin generation

PSA-based screening substantially increases the prostate cancer detection rate and the percentage of organ-confined tumors. It appears that there is some benefit from screening for prostate cancer because of the increased amount of potentially curable disease discovered and the fact that 96% of the pathologically staged tumors detected have histologic features associated with aggressive cancer. Additional evidence that nearly all tumors detected on the basis of initial PSA screening are apt to be clinically significant may be derived from the information that PSA-based screening decreases the incidence of incidental A1 grade III and A2 tumors but does not increase the detection of clinically insignificant A1 grade I and II tumors. At this time, PSA represents the most effective and valuable tool to detect early prostate cancer; therefore, PSA should be used to improve early diagnosis of prostate cancer. Some advances have been made with the introduction of age-specific reference ranges and the ability to measure free to total PSA ratios. The data presented support the clinical usefulness of age-specific reference ranges for serum PSA. Calculation of the free to total PSA ratio is valuable in deciding which screening volunteers require further evaluation, increases the specificity of PSA screening, and as demonstrated may be useful in deciding which patients with isolated PIN should undergo repeat biopsies. Based on these facts, PSA truly can be described as the most important and useful marker for adenocarcinoma of the prostate. Based on these encouraging results and the obligingness of the social insurances, we will be able to continue PSA screening for early detection of prostate cancer for all concerned Tyrolean men in the future.     

Anaphylactic shock following intravenous administration of lignocaine

A 26-year-old female, presenting for dental surgery, developed anaphylactic shock immediately after intravenous administration of lignocaine without preservative added to the propofol to alleviate pain during intravenous injection. We describe the clinical circumstances, the management and the investigations carried out to detect the cause.     

Near fatal respiratory distress following massive ether intravenous injection

To the best of our knowledge, no case of ether-induced acute respiratory distress syndrome (ARDS) has been published as yet. A 36-year-old female developed pneumonitis which showed all the characteristics of a chemical-associated ARDS due to intravenous self-administration of ether: the hemodynamic investigation demonstrated a normal blood flow pattern with low left-heart filling pressure while the anteroposterior roentgenogram evidenced disseminated bilateral lung edema. Advanced symptomatic respiratory support including inhaled nitric oxide and steroidal anti-inflammatory use was the treatment of choice.     

Pharmacokinetics of theophylline in patients following short-term intravenous infusion

Serum theophylline concentrations after intravenous administration of a new short-term infusion (Euphyllin Kurzzeitinfusion) were measured in 50 out-patients with chronic obstructive airways disease (COAD). An intravenous infusion of theophylline ethylenediamine 480 mg (corresponding to approximately 350 mg anhydrous theophylline) in 50 ml isotonic solution was given in 20 min. Blood samples were taken beforehand and 25 to 30 min and 1, 3 and 6 h after starting the infusion. 86% of the patients had a one-hour serum level in he therapeutic range of 8.20 mg/l, and 2 h later, this was true of 64% of the patients. The short-term infusion was well tolerated, even in cases with unknown high pre-infusion serum levels. Pertinent pharmacokinetic parameters were determined, such as total body clearance, apparent volume of distribution, and half-life of elimination. Geometric mean an 95%-confidence limits, derived from the log-normal distribution of these parameters, were: Cl = 0.044 (0.018-0.190) l/h/kg ideal body weight, Vd = 0.451 (0.258-0.789) l/kg ideal body weight, and t 1/2(el) = 7.1 (2.6-19.1) h.     

Neonatal immune neutropenia following the administration of intravenous immune globulin

Liver flukes Fasciola hepatica and Fasciola gigantica are polymorphic and vary morphologically depending upon the host being parasitized. It is known also that mixed infection occurs where both species are present. A technique involving protein separation was used to distinguish the 2 species. Isoelectric focusing of soluble proteins was performed on polyacrylamide gels using whole-body proteins from adult flukes. Although many bands appeared common to both species and some were shared with host tissues, the banding patterns could be used to distinguish 1 species from the other. Soluble protein isoelectric focusing is simple, reproducible, and has very good resolution. It seems well suited to the differentiation of the 2 fluke species.     

Thrombocytopenia in the neonate

Pediatricians caring for newborns will eventually be confronted with the problem of thrombocytopenia in the neonatal period. Familiarity with the differential diagnosis of neonatal thrombocytopenia and understanding the pathogenesis of the more common entities allows physicians to design a selective diagnostic and therapeutic plan to benefit these thrombocytopenic infants.     

Thrombocytopenia in HIV infection

Thrombocytopenia commonly occurs in individuals with HIV disease. However, profound thrombocytopenia, occurring in only 1.5% of cases, is relatively rare. The mechanisms of thrombocytopenia appear to be multifactorial: profound thrombocytopenia in HIV disease is related to an immune destruction either by antiplatelet antibodies or by immune complexes. In addition, a defect in platelet production is quite frequent both in immune thrombocytopenia (ITP) and in mild thrombocytopenia. This impaired platelet production may be due to an HIV infection of megakaryocytes that express a functional CD4 molecule. Treatment of HIV-associated thrombocytopenia is quite similar to that of non-HIV ITP. However, zidovudine increases the platelet count without correlation with its antiviral effect. In animal models and HIV patients, this enhancement of platelet count appears to be due to a stimulation of platelet production, the precise mechanism of which remains unknown. Splenectomy is as effective in severe HIV thrombocytopenia as in non-HIV ITP and has no significant adverse effects on HIV disease.     

Decreased resistance to intravenous tumour-cell challenge during reticuloendothelial depression following surgery

The influence of surgical stress on resistance to i.v. challenge with Walker 256 tumour cells was investigated in rats, with respect to the functional state of the reticuloendothelial system (RES). Phagocytic activity of the RES was evaluated by colloid (gelatinized [131I] "RE test lipid emulsion") clearance, and opsonin levels were determined by bioassay. Reticuloendothelial clearance capacity was significantly (P less than 0-05) depressed 60 min following surgery (coeliotomy plus jejunal enterotomy) as quantified by both humoral and cellular parameters of RE function. Phagocytic depression was primarily due to impaired hepatic Kupffer cell function and related to a deficiency in the phagocytic supporting capacity of plasma, also referred to as opsonic or recognition factor (RF) capacity. During the postoperative period of RES colloid clearance depression, pulmonary localization of the blood-borne test particulate matter increased. Rats challenged with 51Cr-labelled viable tumour cells at a dose of 1-0 X 106 i.v., either prior to or during the postoperative period of RE depression, manifested a significant (P less than 0-05) increment in pulmonary localization of the viable tumour cells, and a decrease (P less than 0-05) in hepatic clearance. Evaluation of survival patterns demonstrated a significant (P less than 0-01) decrease in host resistance to i.v. tumour cell challenge (2 X 103 cells) during the postoperative period of RE depression and hypo-opsonaemia. Sham-anaesthetized control animals survived 17-9 +/- 0-8 days, while animals challenged during the period of RE depression survived 7-9 +/- 0-4 days. An increased incidence of respiratory distress and nasal discharge was observed in the animals with impaired survival. Thus, surgical manipulation may transiently compromise RES systemic host defence and may be reflected in an increment in the pulmonary localization of blood-borne tumour cells. The relationship of this altered pattern of tumour cell distribution to the impaired survival remains to be determined, and warrants investigations.     

Rapid increase in plasma nitrite concentration following intravenous administration of nipradilol

The microscopical and immunohistochemical features of a rare cutaneous leiomyoma in a cat are described. The principal characteristics of this tumour were multiple bundles of smooth muscle, either discrete or conjoined, with numerous collagen fibres between the muscle cells, and osteoid metaplasia. The tumour was designated a piloleiomyoma as it was considered to have arisen from the arrector pili muscles.     

Thrombocytopenia in pregnancy--a case report

Currently used tendon transfers for persistent traumatic paralysis of the common peroneal nerve are based on the transfer of the posterior tibial muscle, an antagonist muscle to the paralytic group of muscles. In order to achieve voluntary active dorsiflexion of the foot and automatic walking we have transposed the lateral head of the gastrocnemius to the anterior side of the lower leg, at the same time suturing the undamaged proximal end of the deep branch of the peroneal nerve to the motor branch of the tibial nerve innervating the lateral head of gastrocnemius muscle. After nerve regeneration and neurotisation the transposed lateral head of gastrocnemius was innervated by the deep branch of the peroneal nerve and thus it took over the function of the paralytic muscles. The indications for the operation, the surgical technique, and the results obtained in 6 cases are presented.     

Central effects of iohexol and iopamidol, non-ionic contrast media

BACKGROUND: The relationship between uveitis anterior in childhood and juvenile chronic arthritis (JCA, respectively JRA) has been known since 1950. In a review, the clinical picture of uveitis anterior, its prevalence, pathogenesis, prognosis and current therapy of ocular complications are presented. In addition, we will report our results of a clinical study. PATIENTS AND METHODS: In a cross-sectional study, 64 patients with juvenile chronic arthritis (JCA) had an ophthalmological screening for eye complications either from the disease itself or from the treatment. RESULTS: In 16% of the patients, an iridocyclitis was found, in one case acute, in 9 cases chronic. The cases of chronic uveitis anterior showed in 43% a combination with the classic risk factors (ANA-positive, oligoarticular, female). At the beginning of uveitis, the patients had a mean age of 81 months, at the beginning of JCA disease a mean age of 37 months. Four of 10 patients (= 40%) had eye complications from uveitis (cataract, posterior synechiae, glaucoma). Complications from therapy were found in 27%, mostly cataract as a complication of systemic and topical steroid treatment. Eighteen % had a visual acuity of 0.4 or less. CONCLUSIONS: Because of the often asymptomatic progression of chronic uveitis anterior, the risk of severe undetected eye complications is high. Therefore, an intensive interdisciplinary cooperation between rheumatologists, pediatrics and ophthalmologists is required.     

Cocaine disposition in saliva following intravenous, intranasal, and smoked administration

BACKGROUND: In our previous studies, chronic treatment of rats with a new beta 3-adrenoceptor agonist, CL 316,243, retarded diet-induced obesity and promoted thermogenesis in young animals and reversed established diet-induced obesity in older animals that continued to eat a high fat diet. Reversal of obesity was associated with shrinking of enlarged white adipocytes but the number of mature white adipocytes, which had not been increased by the diet, was not reduced. Drug-treatment induced appearance of abundant brown adipocytes in white adipose tissue (WAT) depots as well as hypertrophy of brown adipose tissue (BAT) in both lean and diet-induced obese rats. OBJECTIVES: To find out whether the known hyperplasia of white adipocytes in the obese fa/fa rat could be reversed by CL 316,243-treatment and whether the grossly enlarged WAT depots of the obese fa/fa rat contain precursors to brown adipocytes. RESULTS: CL 316,243 infusion (1 mg/kg/d) reduced abdominal fat. The loss of fat was due to a decrease in white adipocyte size, with no loss of the markedly elevated number of adipocytes in the fa/fa rats. Resting metabolic rate increased by 40% in lean rats, by 70% in fa/fa rats. Food intake decreased in the hyperphagic fa/fa rats but did not change in lean rats, in both lean and fa/fa rats, a marked increase in protein content of retroperitoneal WAT was associated with appearance of abundant densely-stained brown adipocytes expressing uncoupling protein (UCP) but total number of cells (from DNA content) actually decreased. Hyperinsulinemia and hyperglycemia of fa/fa rats were reduced by treatment, indicating improved sensitivity to insulin. CONCLUSIONS: Abundant precursors to brown adipocytes are present in WAT depots of fa/fa rats and much of the exaggerated increase in resting metabolic rate induced by CL 316,243 occurs in these cells. This beta 3-adrenoceptor agonist is an effective anti-obesity and anti-diabetic agent in fa/fa rats. It does not bring about disappearance of mature white adipocytes but does bring about a remodelling of WAT, with a marked change in cell composition.     

Effect of maltose, following long-term intravenous infusion, on the metabolism

6 healthy subjects received a 20% electrolyte containing maltose solution over a period of 6 hours. The concentration of maltose rose up to 109 (76-215 mg/100 ml). During the infusion period 3,7 (1,9-7,7) g maltose were excreted. The concentration of glucose and insulin was not altered, although the renal glucose loss was 20,2 (7,5-38,7) g. In the same period 49,8 +/- 13,2 mval potassium and 135,4 +/- 35 mval sodium were eliminated. Maltose induced an osmotic diuresis which was not caused by hyperglycemia. Such a type of osmotic substance has not been described before.     

Thrombocytopenia associated with long-term levodopa therapy

A 63-year-old man had severe thrombocytopenia after long-term levodopa therapy. Serologic studies and clinical features indicate that the thrombocytopenia was due to an autoimmune process, presumably similar to that induced by the chemically similar drug methyldopa. Direct allergy to levodopa was ruled out by controlled challenge of the patient receiving levodopa. Combined levodopa-prednisone therapy was then instituted, with good clinical response and no recurrence of thrombocytopenia.