Pyothorax-associated lymphoma. An unusual case with biphenotypic character of T and B cells

Pyothorax-associated lymphoma is known to develop in patients who received an artificial pneumothorax for pulmonary tuberculosis some 30 to 40 years previously. Such patients exhibit large, immunoblastic lymphoma cells and often have a B-cell phenotype. We present a patient with an artificial pneumothorax and such a late developing lymphoma but with the unique finding of aberrant T- and B-cell phenotypes. Southern blot hybridization using immunoglobulin gene JH and T-cell receptor beta chain receptors revealed germline configurations. Lymphomas developing in immunocompromised patients, such as those with acquired immunodeficiency syndrome, may show such unusual phenotypes. The unusual phenotypes found in this patient provide evidence that his pyothorax-associated lymphoma was related to an immunocompromised state.     

Protection by extracellular glutathione against sulfur mustard induced toxicity in vitro

BACKGROUND: Salmeterol xinafoate is a highly selective beta2-adrenoceptor for the maintenance treatment of asthma in adults and children. OBJECTIVE: To review the pharmacokinetics, clinical pharmacology, and therapeutic properties of a recently introduced, long acting antiasthmatic drug. METHODS: Recent English-language publications were selected using Medline as database. RESULTS: Salmeterol's pharmacokinetics, clinical pharmacology, and therapeutic properties are reviewed and aspects related to salmeterol's unusual duration of action, its high potency, beta2-selectivity, possible antiinflammatory actions, its interaction with other drugs, low systemic adverse effects, dosage, and administration are also discussed. CONCLUSION: Salmeterol is a safe long-acting beta2-agonist very useful for maintenance treatment of asthma.     

Idiopathic hypoparathyroidism--a rare disease?

Five patients with nonfamilial idiopathic hypoparathyroidism were observed in a peripheral hospital. There was no association with other autoimmune disorders such as hypothyroidism, adrenal insufficiency or pernicious anemia. Only in one patient with tetany was the diagnosis clinically obvious; all the others presented with unusual clinical symptoms. These manifestations of chronic hypocalcemia are presented, as well as the diagnostic workup and therapeutic management. We suggest that idiopathic hypoparathyroidism is not a very rare disease, but one which is often missed because of the unusual clinical picture.     

Nondepolarizing neuromuscular blocking drugs in the intensive care unit: a clinical review

BACKGROUND: The use of nondepolarizing neuromuscular blocking drugs (NDNMBDs) via continuous infusion in the intensive care unit (ICU) is gaining in popularity. Several new NDNMBDs have been developed recently; these drugs vary in their elimination, metabolism, and half-lives. METHODS: A review of the recent English language literature was done, with those articles relevant to the ICU being incorporated into this paper. RESULTS: The six most frequently used NDNMBDs, consisting of atracurium, cisatracurium, doxacurlum, pancuronium, rocuronium, and vecuronium, were reviewed. The neuromuscular junction and impulse transmission, clinical monitoring, clinical pharmacology, the elimination and metabolism, the adverse reactions, and the drug interactions of these NDNMBDs are reviewed. CONCLUSIONS: The use of NDNMBDs is progressively increasing in ICUs. Proper understanding of normal neuromuscular physiology, clinical pharmacology, and drug interactions is essential to optimize patient care and to minimize the risk of adverse reactions.     

The teaching of pharmacology in Italian medical schools: the point of view of Italian doctors

OBJECTIVE: A survey was carried out to gather the opinions of doctors about the current method of teaching pharmacology in Italy. METHODS: A questionnaire was mailed to 3860 doctors, who were asked a series of questions regarding the teaching of pharmacology to medical students in Italian universities. RESULTS AND CONCLUSIONS: The great majority of those who replied considered the teaching they received to be mainly theoretical. The doctors thought that much more time and attention should be dedicated to those pharmacology subjects that are more closely connected to physiopathology and clinical practice (clinical pharmacology).     

Centrifugal force: A gedanken experiment

Propafenone is an infrequently used class IC antiarrhythmic drug. We report our experience with a patient who overdosed with propafenone and developed coma, seizures, bradycardia, hypotension, and conduction delay. The clinical manifestations and management of this patient are discussed in light of the known pharmacology of propafenone and compared with the limited number of cases that appear in the literature.     

Endovascular coil occlusion of a traumatic basilar-cavernous fistula: technical report

OBJECTIVE AND IMPORTANCE: We describe an unusual case of an 8-year-old male patient presenting with a traumatic basilar artery aneurysm associated with a basilar-cavernous fistula. CLINICAL PRESENTATION: The fistula occurred as the result of an accident involving a vehicle and a pedestrian. The patient originally presented in a coma and with a dense left hemiparesis. INTERVENTION: The traumatic basilar aneurysm and basilar-cavernous fistula were successfully occluded by endovascular coil embolization in two sessions. By 6 months after injury, the patient had made an excellent neurological recovery, requiring only a left leg brace for walking. CONCLUSION: Endovascular coil embolization provided an effective treatment option in the case of this complex and unusual arteriovenous fistula. We discuss the radiological and clinical features of related traumatic neurovascular lesions.     

Comparison of clinical pictures of mitochondrial encephalomyopathy with tRNA(Leu(UUR)) mutation in 3243 with that in 3254]

We compared clinical pictures of a case of mitochondrial encephalomyopathy with tRNA(Leu(UUR)) point mutation at nucleotide position 3254 of mitochondrial DNA with those at position 3243. The mutation 3254 was a 19-year-old male patient with cardiomyopathy accompanied with muscle atrophy. The first mutant 3243 was a 31-year-old female patient showing clinical features of MELAS and endocrinological abnormalities. The second 3243 mutant was a 27-year-old male patient who had an external ophthalmoplegia and slight mental decline. In all cases, muscle biopsy specimen showed ragged red fibers and strongly SDH-reactive blood vessels, but their limb weakness were unremarkable. These results suggest that tRNA(Leu(UUR)) point mutation 3254 exhibits similar clinical phenotypes as those observed in 3243 mutant.     

Risks of transplanting kidneys from hepatitis B surface antigen-negative, hepatitis B core antibody-positive donors

OBJECTIVES: An indirect inguinal hernia is a common cause of inguinoscrotal swelling in young boys. We describe 3 cases of an extremely unusual entity that has a similar clinical presentation to more commonly diagnosed intrascrotal processes. METHODS: Two patients presented with acute hemiscrotal enlargement and pain, and a third patient presented with scrotal enlargement only. All patients underwent a scrotal ultrasound evaluation and subsequent inguinoscrotal exploration. RESULTS: All patients had a multiseptated peritesticular fluid-filled mass on ultrasound evaluation. Subsequent inguinoscrotal exploration revealed a torsion of the indirect hernia sac in each case. A high ligation and excision of the sac was curative. CONCLUSIONS: Torsion of a hernia sac is an extremely rare entity, and current sonographic imaging fails to clearly diagnose this unusual phenomenon. Because pediatric urologists are commonly called to evaluate a child with an acutely swollen scrotum, awareness of this diagnosis is important.     

Pneumocystis carinii meningoradiculitis in a patient with AIDS

Pneumocystis carinii is a common opportunistic pathogen in patients infected with the human immunodeficiency virus (HIV). Pneumocystis carinii pneumonia is common, while extrapulmonary infections with Pneumocystis carinii have been reported sparingly. The clinical features are frequently nonspecific. The detection of Pneumocystis carinii in cerebrospinal fluid (CSF) has not been reported thus far. In this report, an unusual case of Pneumocystis carinii meningoradiculitis in an HIV-infected patient who had previously received primary prophylaxis with trimethoprim-sulfamethoxazole is presented.     

Cervical laminar exostosis in multiple hereditary osteochondromatosis: anterior stabilization and fusion technique for preventing instability

PURPOSE: To describe an unusual presentation of posterior scleritis in a healthy young patient. METHOD: We reviewed the medical record of 21-year-old man for clinical presentation, course, and ancillary studies. RESULTS: The healthy patient had a painless, bilateral posterior scleritis that presented with a combination of circumscribed fundus masses and exudative macular detachment. On fluorescein angiography, different hyper-fluorescent patterns characterized the two manifestations of posterior scleritis. An ultrasound confirmed the scleral thickening. Fundoscopic abnormalities resolved with oral prednisone. CONCLUSION: Pain is not always present in this disease. A combination of exudative macular detachment and circumscribed fundus masses can be a form of presentation in posterior scleritis.     

Heparin-induced thrombocytopenia and thrombosis

Although heparin is widely used as the injectable anticoagulant of choice, it has several potential shortcomings. These include heparin resistance, excessive bleeding, allergic reactions, and, with longterm use, occasional osteoporosis or alopecia. Perhaps the most notorious complication is heparin-induced thrombocytopenia and thrombosis (HITT); although unusual, it often results in major morbidity or death. Until recently, reliable diagnostic tests and anticoagulation alternatives have not been widely available. After a review of the pharmacology of heparin and related drugs, advances in the prevention, diagnosis, and treatment of this problem are discussed.     

Phenotype-genotype relationships in complementation group 3 of the peroxisome-biogenesis disorders

The peroxisome-biogenesis disorders (PBDs) are a set of often lethal genetic diseases characterized by mental retardation and defective peroxisomal matrix protein import. Mutations in PEX12 are known to underlie the disease in two patients from complementation group 3 of the PBDs. Here we show that all patients from this group carry mutations on both alleles of PEX12. A comparison between PEX12 genotypes and the clinical and cellular phenotypes of the corresponding PBD patients suggests a relatively straightforward relationship between genotype and phenotype in this group of the PBDs, such that the loss of PEX12 function leads to more-severe cellular and clinical phenotypes. However, one patient who presented relatively mild clinical and cellular phenotypes was a compound heterozygote for two seemingly severe mutations on each PEX12 allele. PEX12 mRNA present in the patient's cells was derived from only one allele, the one that carried a 2-bp deletion early in the PEX12 coding region, c.26,27Delta. The deduced protein product of this mRNA would contain only the first eight amino acids of the protein, and yet this mutant PEX12 cDNA displayed significant PEX12 activity in a functional complementation assay. Surprisingly, the PEX12/c.26, 27Delta cDNA directed the synthesis of a 29-kD PEX12 protein in vitro, a result that is consistent with translation initiation at a downstream AUG codon. Transfection studies confirmed the expression of similarly sized PEX12 proteins from the PEX12/c.26,27Delta allele. Thus, it appears that translation initiation at internal AUG codons may modulate disease phenotypes and should be considered whenever unexpectedly mild phenotypes result from severe mutations early in the coding region.     

成人复发性特巨大型脑膜瘤的临床分析(附1例报告)

The authors reported the case of a 35-year-old woman with an unusual huge recurrent meningioma in the left cerebral hemisphere confirmed by the pathological examination. This patient's clinical presentation was very unusual. Brain magnetic resonance imaging (MRI) demonstrated a huge tumor in the left frontal region. The extracranial surface dimensions of the mass were 12 cm craniocaudal × 11 cm transverse × 9 cm anteroposterior; and the intracranial dimensions were 9 cm craniocaudal × 7 cm transverse × 10 cm anteroposterior respectively. The patient underwent left frontal recurrent meningioma resection by microsurgery, with total tumor resection. Following which the patient was discharged in a stable condition. To the best of the authors' knowledge, such an unusual huge recurrent meningioma has not been reported. The authors reviewed the literatures with reference to recurrent meningioma, analyzed the unusual imaging appearances of this patient, and explored the mechanism underlying the huge volume formation. The fundamental principle to reducing or completely avoiding meningioma recurrence is to achieve total tumour resection. Recurrent meningiomas are also amenable to surgery.     

Osteomalacia cured by resection of cutaneous neurinoma

INTRODUCTION: Regression of osteomalacia after exeresis of a skin tumor is unusual. CASE REPORT: A 62-year-old man had suffered from bone and joint symptoms for several years due to osteomalacia which was confirmed both biologically and histologically. The patient also had a plantar neurinoma. After exeresis of the tumor the biological results returned to normal levels within one week followed by regression of the clinical signs of osteomalacia. DISCUSSION: The neurinoma in this patient was apparently the cause of osteomalacia, since signs of the disease disappeared after exeresis. To date, three cases of neurinoma associated with osteomalacia have been published, including a single case with skin localization. The tumor would secrete a substance which inhibits the synthesis of vitamin D and enhances phosphorus excretion.     

Twenty commonly dispensed medications at a United States military installation and their significance to dentists

Understanding the clinical pharmacology of medications commonly used by dental patients is necessary when providing dental care. A significant number of patients may be taking medications that have the potential for adverse effects. The purpose of this paper is to familiarize dental practitioners with the clinical pharmacology of medications most likely to be encountered in a current military dental practice. Product activity reports (records of medications usage) were obtained from the main pharmacy at a United States Army Community Hospital. The product activity reports covered a 1-year period from December 31, 1992, to December 30, 1993. These reports were analyzed according to the number of medications dispensed to determine the 20 most commonly used medications.     

The role and contribution of leukotrienes in asthma

LEARNING OBJECTIVES: Reading this article will reinforce the reader's knowledge of the biochemistry and pharmacology of leukotrienes (LTs), including the enzymes and cells involved in their synthesis, the receptors that mediate their biologic effects, and the evidence that cysteinyl leukotrienes (CysLT) may play an important role in asthma. The 5-lipoxygenase inhibitors, 5-lipoxygenase-activating protein antagonists, and CysLT receptor antagonists are three classes of LTs modulators now in clinical use. The effects of these agents in clinical models of asthma induced by allergens, exercise, and aspirin and in multicenter asthma trials are reviewed. DATA SOURCES: Key papers published in peer-reviewed journals. STUDY SELECTION: Key papers published in peer-reviewed journals. CONCLUSIONS: The pharmacology of these new medications and experience in clinical trials suggest that they may play a therapeutic role in the treatment of asthma.     

Exposure to ELF and VLF electromagnetic fields in the hospital environment: the results of a field study

1. Clinical pharmacology is a key activity in drug discovery and drug development with much to contribute to drug innovation. 2. However, very few clinical pharmacologists choose the pharmaceutical industry as their ultimate career. 3. Medical alumni of the RPMS clinical pharmacology department illustrate this; only four industrial careers vs thirty professors of clinical pharmacology or medicine.     

The genetic analysis of multiple sclerosis

Although monogenic diseases often show extreme clinical phenotypes, the major burden of genetic ill health lies in the more prevalent polygenic disorders, such as diabetes, hypertension and multiple sclerosis. These conditions affect many thousands of individuals and their management consumes vast amounts of health care resources: in the UK some 80,000 people have multiple sclerosis; the estimated financial cost to society of introducing treatments, such as beta interferon, could be as high as 250 million pounds per year. Knowledge on the genetics of these common diseases is poor, but has potentially received a considerable boost with the arrival of whole genome screening. The genome screen in insulin-dependent diabetes mellitus (IDDM) reported in 1994 was the first in a human polygenic disease. Since this publication, whole genome screening has been performed in a variety of human polygenic diseases, including schizophrenia, bipolar affective disorder, non-insulin-dependent diabetes mellitus (NIDDM), inflammatory bowel disease, asthma and multiple sclerosis.