Ascitic fluid analysis in hepatocellular carcinoma

BACKGROUND: Ascites in patients with hepatocellular carcinoma (HCC) is a poorly characterized subgroup of malignancy-related ascites. Not only the underlying liver disease, but also the tumor growth and spread contributes to the ascites formation. The authors differentiated ascites in HCC from other types of ascites. METHODS: The authors analyzed the ascitic fluid of 185 consecutive patients (89 liver cirrhosis, 33 HCC, 31 peritoneal carcinomatosis, 22 liver metastases, 10 spontaneous bacterial peritonitis). RESULTS: Each subgroup showed a typical pattern. Compared with the cirrhotic patients, those with HCC showed a higher frequency of positive cytologic findings (4 of 33 versus 0/89, P < 0.004), elevated fibronectin concentration (10/33 versus 8/89, P < 0.004), and elevated polymorphonuclear cell count (10/33 versus 5/89 P < 0.004). CONCLUSIONS: A significant number of patients with ascites and HCC patients showed signs of peritoneal infiltration with positive cytologic findings and increased concentration of fibronectin. Moreover, neutrocytic ascites without signs of superinfection is relatively common (30%).     

Trypanosoma cruzi: nitrogenous-base-containing phosphatides in trypomastigote forms--isolation and chemical analysis

Increasingly clinicians attempt to base decisions regarding patient management on the results of clinical studies in addition to expert opinion and their own practical experience. In this article, the author reviews the published studies available to assist clinicians to make evidence-based decisions in three topics related to small volume red blood cell (RBC) transfusions for preterm infants; namely, studies examining the effects of RBC transfusions on possible symptoms of anemia such as tachypnea, apnea or other cardiorespiratory irregularities, studies investigating the collection and transfusion of umbilical cord blood and finally studies addressing the duration of storage and use of additive solutions for RBCs for transfusion to neonates. Based on the review of these studies, guidelines for small volume RBC transfusions in preterm infants are suggested.     

Primary lymphoma of the breast. Three cases of non-Hodgkin lymphoma

Primary and sole breast lymphoma is a very rare disease. With the review of our series of 616 cases operated on for breast cancer, only 3 cases (0.48%) of primary breast non-Hodgkin lymphoma (LNH) have been observed. The authors outline the problems concerning diagnosis and therapy of this rare disease: pathological and immunohistochemical aspects are discussed. They stress the importance of staging in order to plan a correct multidisciplinary approach.     

Marie-Fran?oise Collière--nurse and ethnohistorian: a conversation about nursing and the invisibility of care. Interview by Jocalyn Lawler

The purpose of this study was to describe an episode of increased mortality, whose cause was initially unknown. This retrospective cohort investigation was conducted on a dementia special care unit of a Department of Veterans Affairs facility, with more than 75% of residents clinically diagnosed with dementia of the Alzheimer type. One hundred five residents residing in the facility during February 1995 were included as subjects. A cluster of deaths occurred, triggering the investigation. Ultimately, 21 deaths (three times greater than any previous month in the past 5 years) occurred during the 1-month period. Measures included the presence of clinical influenza-like illness based on signs, serology, and autopsy results. Of the 105 residents, 45 (42.8%) met the clinical definition for influenza-like illness. Eight autopsies were performed, and the causes of death consisting of bronchopneumonia in seven and aspiration pneumonia in one were compatible with influenza. There were no differences among those who died from those who lived with regards to age, race, gender, clinical influenza-like illness, vaccination status, diagnosis of Alzheimer disease, or duration of dementia (all p > or = 0.2). However, those who died were at a higher risk of dying due to a greater number of coexisting conditions (p < 0.01). Also, overall the groups differed in Mini-Mental State Examination and Bedford Alzheimer Nursing Scale scores with those who died being more impaired (p < 0.01). Thus, the presentation of influenza-like illness can be subtle in onset, underappreciated in this population, and not recognized until excess mortality, which affects the most frail, is noted. Care providers need to be vigilant during the winter months for the presence of influenza.     

Using anthropology to analyse healthcare situations

An anthropological approach to caring has much to offer practising health workers, especially nurses. While its attitude towards knowledge differs from that used in much traditional medical and clinical education, its capacity to draw on the observations and life experiences of both carers and those cared for in the design of care plans can provide insights and information crucial to recovery and to an extended healthy life. This article models Claude Lévi-Strauss' structural anthropological method within nursing care situations.     

1-Thio-beta-D-galactofuranosides: synthesis and evaluation as beta-D-galactofuranosidase inhibitors

Beta-D-galactofuranosidase is a good chemotherapeutic target for the design of inhibitors, since beta-D-galactofuranose is a constituent of important parasite glycoconjugates but is not present in the host mammals. With this aim, we have synthesized for the first time alkyl, benzyl and aryl 1-thio-beta-D-galactofuranosides by condensation of penta-O-benzoyl-alpha,beta-D-galactofuranose with the corresponding thiols, in the presence of SnCl4as catalyst. The complete chemical and spectroscopical characterization of these compounds showed that the reaction was stereoselective. Debenzoylation with sodium methoxide afforded the beta-S-galactofuranosides in high yield. The thioglycosides were tested as inhibitors of the beta-D-galactofuranosidase of Penicillium fellutanum, using for the first time 4-nitrophenyl-beta-D-galactofuranoside as chromogenic substrate. The 4-aminophenyl-1-thio-beta-D-galactofuranoside, obtained by catalytic hydrogenation of the nitrophenyl derivative, was the best inhibitor being then an adequate ligand for the preparation of an affinity phase aimed at the isolation of beta-d-galactofuranosidases from different sources. Also the inhibitory activity of d-galactono-1, 4-lactone was shown.     

Hepatic artery resistance in alcoholic liver disease

This first known case of concurrent congenital dyserythropoietic anaemia (CDA) and autoimmune haemolytic anaemia (AIHA) which occurred in a hispanic male and spanned 6 years from the age of 2. Light and electron microscopy of bone marrow erythroblasts and immunophenotyping confirmed CDA; serum/eluate warm autoantibodies and positive direct antiglobulin tests (DAT) associated with severe, episodic anaemias established AIHA. Cytogenetic analysis of bone marrow cells and peripheral blood lymphocytes ascertained sex chromosome aneuploidy (48 XY,+ Y,+ Y). Recurrent, life-threatening episodes of transfusion-dependent anaemia refractory to steroids and intravenous immune globulin, were put into stable remission at age 8 years when splenectomy successfully managed both disorders.     

A Distributed Model of Iron Kinetics for Clinical Assessment of Normal?Abnormal Erythropoietic Activity

The use of mathematical models of iron metabolism has been recognized as an essential tool for analyzing ferrokinetic data. Multicompartment models, however, did not make it possible to describe marrow iron kinetics, taking into account that marrow erythroid cells uptake iron from the plasma according to their maturity.