Informal use of decision theory to improve radiological patient management

Six radiologists reviewed 50 urograms to determine whether arteriography or needle aspiration should be recommended for evaluation of a space-occupying renal lesion. In addition to their usual decision methods, they were encouraged to think about the problem from a decision theory viewpoint. No computations were required. It was found that even informal, non-numerical application of decision theory resulted in improved outcomes; further improvement was noted with explicit use of numerical methods.     

Tricyclic antidepressants. Prolonged plasma levels after overdose

Twenty-four patients hospitalized for overdose of a tricyclic antidepressant were monitored clinically, and serial plasma-drug measurements were taken for up to 144 hours. Six of 24 patients had maximum antidepressant plasma levels greater than or equal to 1,000 ng/ml, and their plasma levels at 96 hours ranged from 170 to 1,280 ng/ml. Patients ingesting substantial tricyclic overdoses may remain medically unstable for days. When high tricyclic levels persist, accurate psychiatric assessment is often impossible.     

Granulocytic sarcoma (chloroma) initially seen as acute mastoiditis

Granulocytic sarcoma (chloroma) is a localized tumefaction of immature granulocytes that is typically seen in association with myelogenous leukemia. The primitive cell population seen in biopsy material may be misinterpreted as histiocytic lymphoma or other sarcoma unless additional studies are performed. We saw a 36-year-old woman with promyelocytic leukemia in remission who had the signs and symptoms of an acute coalescent mastoiditis. Histologic examination of the surgical specimen, however, demonstrated a granulocytic sarcoma. Our case exemplifies some of the difficulties that may be encountered in the diagnosis of granulocytic sarcoma and illustrates the point that symptoms of an inflammatory process in a patient with a diagnosis of leukemia must be regarded with a degree of suspicion.     

Preliminary characterization and pathogenicity studies of a virus isolated from ticks (Ornithodoros coriaceus) and from tick-exposed cattle

Several viral isolates from ticks (Ornithodoros coriaceus) and from the blood of cattle which aborted after exposure to these ticks were found to be identical by reciprocal cross serum-neutralization tests. Characterization studies indicate that the virus is a member of the Togaviridae family, although specific identification is still incomplete. Whether its natural host is the tick or bovine animals is also unknown. Pregnant cows inoculated with the agent by all conventional parenteral routes, including intrafetal, delivered healthy calves at term. It was concluded, therefore, that it was not a bovine pathogen and that the abortions which occurred after tick-exposure were due to a 2nd agent in O coriaceus ticks which also harbor the virus. While several ciruses believed to be tick-borne have been isolated from cattle in various parts of the world, it is believed that the present report describes the first isolation in the Western Hemisphere for a viral agent from Argasid ticks which has been demonstrated to replicate in cattle.     

Human spinal arachnoid villi and granulations

A commercially available recording of Northwestern University Auditory Test No. 6 (N.U. No. 6) produced by Auditec of St. Louis was evaluated in a series of four studies. Interlist equivalence of this version was initially investigated, and then normative intelligibility functions were developed using listerners with normal hearing. Intelligibility functions for the original version of N.U. No. 6. prepared by Northwestern University, were then derived, concurrently with functions of the Auditec version, using (1) a group of listeners with normal hearing; and (2) a group with sensorineural hearing loss. The results demonstrated good interlist equivalence for the Auditec version of N.U. No. 6. The comparative intelligibility functions for the Auditec and Northwestern versions of N.U. No 6 furthermore indicated a difference between the two recordings, but it was concluded that for clinical purposes the two versions may be considered equivalent.     

Breast-feeding protects against respiratory syncytial virus infections

Eight out of 115 infants admitted to hospital with respiratory syncytial (RS) virus infection had been breast-fed compared with 46 out of 167 controls; this difference was statistically significant. Twenty-one specimens of human colostrum were examined, and all contained RS virus neutralising activity. Specific IgA and IgG were detected in 18 specimens, whereas IgM was detected in none. The titre of IgA antibody was usually higher and correlated more closely to the titre of neutralising activity than that of IgG. Infants inhale milk feeds and regurgitate them through the nose, and the IgA collecting in the respiratory tract might protect against severe respiratory infection. Alternatively, if severe RS virus illness is a sign of hypersensitivity to the virus breast-feeding might protect the infant from an early sensitising infection.     

Anticonvulsant drug concentrations in epileptic patients

Using Wistar stain male rats, it has been shown that 2 atmospheric pressures associated with oxygen saturation, together or singly for 90 minutes daily for successive 46 days, resulted in no significant change on the ratio of testes to body weight. No significant change was observed in the incorporation of 3H-thymidine into testes and pituitary glands between the pressure-treated groups and the control group.