Sex difference in the paradoxical response of serum GH to thyrotrophin releasing hormone in cancer patients

It was demonstrated that thyrotropin-releasing hormone (TRH) elicited a paradoxical increase in basal GH levels in cancer patients. Out of 94 cancer patients, 50 were found to be GH responders and this phenomenon was more frequently recognized in female than in male cancer patients. In cancer patients under 59 years of age, the GH response to TRH was significantly greater in females than in males, although there was no sex difference in the GH response in patients above 60 years of age. In female cancer patients, the GH response to TRH was significantly greater in patients under 59 years of age than in patients above 60 years of age, while there was no age difference in the GH response in male cancer patients. It was concluded that paradoxical responses of serum GH to TRH were recognized in 53 per cent of cancer patients and were more frequently observed in female than in male cancer patients.     

Psittacosis in Manitoba

Paired blood specimens submitted to the Virus Laboratory, between January and September 1970, from 200 patients with a lower respiratory tract infection were examined for antibodies to the psittacosis-human pneumonitis group antigen. A high static titre of antibodies was found in four patients and a rising titre in three. The illness varied in the seven patients, tending to be severe, chronic and recurrent. All patients recovered following a course of antibiotic therapy which was repeated in four; treatment tended to be inadequate since the diagnosis of psittacosis was made retrospectively. The likely source of the infection in four of the patients was budgerigars, in one it was pigeons, in one it was a canary as well as a pigeon, and in one the source was not identified. Two additional patients had a fairly high static titre of antibodies to the psittacosis-human pneumonitis antigen but were excluded from this report since they showed a diagnostic increase in antibodies to a respiratory virus during the course of their illness; both patients had an avian contact and are being followed up.     

Hyperkalaemia in patients in hospital.

Significant hyperkalaemia occurred in 406 out of 29 063 patients admitted to a major Scottish teaching hospital in one year (1.4%). Mortality was higher in these patients than in control patients and was strongly correlated with the severity of the hyperkalaemia. Overall seven deaths were directly due to hyperkalaemia (out of 58 deaths among patients with hyperkalaemia). Factors contributing to a poor prognosis were severity and speed of onset of hyperkalaemia and the presence of appreciable renal impairment. Patients with hyperkalaemia were older and more likely to be male; this trend was present in all diagnostic subcategories. Genitourinary disease, gastrointestinal disease, and cancer were significantly more common among the patients with hyperkalaemia than the controls. Hyperkalaemia due to drug treatment was invariably mild and non-fatal, whereas genitourinary disease was often associated with moderate to severe hyperkalaemia, which in two cases proved fatal. Use of electrocardiographic monitoring was rare, and although the treatment of hyperkalaemia was effective, it was often used when not required. Hyperkalaemia is a potential hazard in diabetic ketoacidosis, and use of potassium supplements should be carefully monitored during correction of the acidosis.     

Amikacin in the treatment of infectious-inflammatory diseases in patients at a therapeutic hospital

Amikacin sensitivity of 157 strains which caused infectious inflammatory diseases in patients of a therapeutic hospital was studied. It was shown that 52 and 42.9% of the isolates from patients with bronchopulmonary infections were highly and moderately sensitive to amikacin, respectively. 5 pneumococcal strains were resistant to amikacin. Among the isolates from urine of the patients with urinary infections there were no strains resistant to amikacin. Study of amikacin pharmacokinetics demonstrated expediency of antibiotic endobronchial administration to patients with bronchopulmonary diseases and aggravation of chronic purulent inflammatory processes. A favourable clinical effect of amikacin after its intramuscular or endobronchial administration was observed in 53.3% of the patients. In 30% of the patients the effect was satisfactory. In 16.7% of the patients the treatment failed. Satisfactory antibiotic tolerance in the majority of the patients was stated.     

Calcium Metabolism in Acromegaly

A total of 78 acromegalic patients were studied before and after treatment by yttrium-90 needle implantation.Among the untreated patients 16% had a borderline or raised serum calcium. In half of these patients the serum calcium fell to normal after remission of their acromegaly. In the others the hypercalcaemia was due to associated proved or probable hyperparathyroidism. A downward trend of the serum calcium was noted even in the normocalcaemic patients with remission of their disease.Only 20% of untreated patients had a raised serum phosphate, and follow-up showed this measurement to be a poor index of disease activity.Net calcium absorption and calcium balances in five patients in this series and 12 others from the literature were essentially normal for their given level of calcium intake. No patient showed definite radiological evidence of osteoporosis and vertebral fractures.Bone uptake rate of calcium-47 and stable strontium was raised in the untreated state in all nine patients studied. The 24-hour strontium space was raised in 73% of untreated patients and fell to normal after treatment in all the retested patients in whom it was high initially.     

Factor V Leiden in patients with venous thrombosis in Slovak population

Resistance to activated protein C determined by factor V Leiden (FVL) is the most frequent inherited risk factor of venous thrombosis. The purpose of our work was to reveal the frequency of FVL in Slovak patients with venous thromboses, to characterise the nature of venous thromboses in this inherited thrombophilia, and to consider the screening approach to investigation of FVL in patients with venous thromboses. 350 patients with a diagnosis of venous thromboembolic disease from various regions of Slovakia were investigated. FVL, detected by polymerase chain reaction, was found in 128/350 (37%) patients with venous thromboses. 118/128 (92%) patients were heterozygous and 10/128 (8%) were homozygous carriers. In 108/128 (84%) patients with FVL the thromboembolic disease occurred spontaneously. Phlebothrombosis occurred predominantly in the lower limbs--117/128 (91%) patients, atypical localisations were rare. The first thromboembolic event was manifested before 40 years of age in 69% of patients. The family history was positive in 60/128 (47%) FVL carriers with thromboembolic disease. Recurrent thrombosis occurred in 30% of patients with FVL. In agreement with findings in other European countries, the prevalence of FVL was high in Slovak patients with thromboembolic disease. The investigation of FVL seems to be justified in patients before 40 years of age with venous thrombosis of lower limbs, in the absence of triggering factors and with a family history of venous thromboembolic disease.     

Poikilocytosis in Cancer Patients

The incidence of poikilocytosis in 100 patients with cancer of various organ systems was found to be 12 per cent. Poikilocytosis was more frequently seen in patients with adenocarcinoma of the gastrointestinal tract and with inoperable metastatic carcinoma than in patients with other malignant lesions. Anemia was associated in three cases, but in nine instances the patient was not significantly anemic at admission. Two of these patients may have been dehydrated. Uremia was not a factor in any of the cases.Fifty per cent of the patients exhibiting poikilocytosis died or were in a terminal condition within one month after the observation was made, as compared with 21 per cent of the patients who did not have evidence of poikilocytosis. These findings show that poikilocytosis may occur in cancer patients without anemia or uremia; and they indicate that its presence is an unfavorable prognosis sign.     

Morphology of the orbital region in adults following the cleft lip-palate repair in childhood

Four measurements and two qualitative signs related to the orbits of 145 adult Caucasian cleft lip/palate patients operated on in childhood were compared with similar data on 100 normal Caucasian Canadians. The average interorbital distance in male patients with unilateral and bilateral cleft lip/palate was greater than in controls, while the interorbital distance in both male and female patients with isolated cleft palate was the same as that in controls. A hypertelorism increased interorbital distance of greater than 2 S.D. above the normal was recorded in 10 cleft patients out of 145, the maximum in male cleft patients being 48 mm and in female cleft patients 38 mm. Orbital eye fissure length asymmetry was seen only in the cleft study group while a dislocation of the eye fissure levels in the frontal plane was found both in patients with clefts and in controls. No direct relationship was found between the extent of the cleft and the incidence of hypertelorism, nor between the site of the cleft and eye fissure asymmetry in unilateral cleft lip/palate patients. The epicanthic fold was significantly more frequent in cleft lip/palate patients (28/145) than in controls (10/100). Anti-mongoloid eye fissure type was recorded only in patients with cleft but mongoloid eye fissure was present both in patients with clefts and controls.     

Changes in electrical brain activity in patients with panic disorders

Brain electrical activity was recorded in 38 patients with typical and in 42 patients with atypical panic disorders, also in 30 normal controls. Compared to controls, patients both with typical and with atypical panic disorders differed significantly in reduced spectral power of the EEG alpha band in the right hemisphere. Moreover, in patients with typical panic disorders, the spectral power of the EEG beta1 band was increased in the frontal, temporal, central, and parietal areas of the right hemisphere. In patients with atypical panic disorders, the spectral power of the theta band was increased in the temporal areas of the right hemisphere. The changes in the EEG activity in patients with typical panic disorders are supposed to reflect an increase in activity of non-specific systems of the mesencephalic reticular formation, and the EEG changes in patients with atypical panic attacks may be associated with increased activity of the temporolimbic brain structures.     

Tuberculosis in HIV-infected patients in Croatia between 1986 and 2005

A retrospective medical chart review was performed on 65 HIV-infected patients with tuberculosis hospitalized between 1986 and 2006 at the University Hospital for Infectious Diseases "Dr. Fran Mihaljevi?", Zagreb. Thirty two patients presented with pulmonary involvement, 13 with extrapulmonary, and 20 patients had disseminated tuberculosis. Forty five patients had an abnormal chest X-ray. Mycobacterium tuberculosis was identified in 35 (53.9%) patients. Ten (15.3%) of 65 patients had already been receiving antiviral therapy, while another 31 (47.7%) initiated antiviral therapy after antituberculosis therapy. Tuberculosis-associated immune reconstitution inflammatory syndrome was observed in 11/27 (40.7%) patients. Forty one patient received the standard six month course of antituberculous therapy, while in 12 patients the therapy was prolonged. Twenty one patient (32%) experienced an adverse event to antituberculosis drugs. Twelve patients died (18.5%). After the introduction of highly active antiviral therapy (HAART) the mortality decreased. The incidence of tuberculosis in HIV-infected patients in Croatia is increasing, and tuberculosis is still an important opportunistic infection in our HIV-infected patients.     

Liver in Felty's Syndrome

Liver function and histology, together with the haematological changes, were investigated in 12 patients with Felty''s syndrome. Six of them were anaemic. The red cell mass was either normal or increased, and the anaemia was due to a considerable increase in the plasma volume. Two patients had increased haemolysis associated with red cell sequestration by the enlarged spleens.In eight patients liver function tests were abnormal, while in five the liver histology showed lymphocytic infiltration of the sinusoids and portal tracts together with portal tract fibrosis. One of these was later found to have a macronodular cirrhosis. In another there were apparent nodules without a true cirrhosis, and this appearance was also seen in two other patients with Felty''s syndrome in whom histology was available. An increased blood flow through the spleen was found in the two patients examined.     

Hypernatraemic dehydration in patients in a large hospital for the mentally handicapped.

OBJECTIVE--To determine the prevalence of hypernatraemic dehydration and to assess the hydration and nutritional state of patients in a large hospital for the mentally and physically handicapped; also to assess the efficacy of an intervention programme to reduce the prevalence of hypernatraemic dehydration in the hospital. DESIGN--Prospective study of patients admitted with hypernatraemic dehydration from a large hospital for mentally and physically handicapped patients (hospital A) to a district general hospital between 1986 and 1988. In 1986 the hydration and nutritional state of a random sample of patients from hospital A was compared with a random sample of patients from a small hospital for the physically and mentally handicapped (hospital B) and with control groups from the community. The hydration of the patients from hospital A examined in 1986 was reassessed in 1988. PATIENTS--12 Patients were admitted from hospital A to the district general hospital during 1986-8 (seven women, five men; age range 29-82). In 1986, 72 patients were randomly selected for the assessment of hydration and nutritional state from hospital A, 33 who required help with feeding and 39 who could feed independently. Fifty patients were similarly selected from hospital B, half of them requiring help with feeding. In 1988 the hydration state of 60 of the 72 patients from hospital was reassessed. Control values were taken from two published studies. INTERVENTIONS--In 1987 nursing staff in hospital A were asked to provide between 2.5 and 3.0 litres of fluid daily for all patients. The use of hypertonic enemas was discontinued, and the ratio of staff to patients was increased. MAIN OUTCOME MEASURES--Serum concentrations of urea and electrolytes (hydration) and body mass index (nutritional state). RESULTS--Of the 10 patients admitted with hypernatraemic dehydration from hospital A to the district general hospital in 1986, four died of intercurrent infection. No patients were admitted from hospital B with hypernatraemic dehydration during the same time. In 1986 the hydration and nutritional state of patients in hospital A were inferior to those in patients from hospital B and control subjects from the community (serum urea concentrations were 6.1 (SD 1.8) mmol/l v 5.5 (1.9) and 5.6 (0.4) mmol/l, respectively) 50% (36/72) of patients in hospital A had a body mass index less than or equal to 20 compared with 34% (17/50) of patients from hospital B and 12% (1141/9434) of control subjects). After the initiation of the preventive programme only one patient was admitted with hypernatraemic dehydration in each of the years 1987 and 1988. The mean serum urea concentration of the 60 patients who were reassessed in 1988 fell significantly between 1986 and 1988 from 6.1 (SD 1.8) mmol/l to 5.7 (2.1) mmol/l, the value in a control group matched for age and sex. CONCLUSIONS--Hypernatraemic dehydration, subclinical underhydration, and undernutrition were common in a large hospital for the mentally and physically handicapped. The problem of hypernatraemic dehydration was successfully dealt with by the hospital management team. Similar problems may be encountered in hospitals for patients who are mentally and physically handicapped and mentally ill, including psychogeriatric units.     

Durations and Delays in Care Seeking,Diagnosis and Treatment Initiation in Uncomplicated Pulmonary Tuberculosis Patients in Mumbai,India

BackgroundTimely diagnosis and treatment initiation are critical to reduce the chain of transmission of Tuberculosis (TB) in places like Mumbai, where almost 60% of the inhabitants reside in overcrowded slums. This study documents the pathway from the onset of symptoms suggestive of TB to initiation of TB treatment and examines factors responsible for delay among uncomplicated pulmonary TB patients in Mumbai.MethodsA population-based retrospective survey was conducted in the slums of 15 high TB burden administrative wards to identify 153 self-reported TB patients. Subsequently in-depth interviews of 76 consenting patients that fit the inclusion criteria were undertaken using an open-ended interview schedule. Mean total, first care seeking, diagnosis and treatment initiation duration and delays were computed for new and retreatment patients. Patients showing defined delays were divided into outliers and non-outliers for all three delays using the median values.ResultsThe mean duration for the total pathway was 65 days with 29% of patients being outliers. Importantly the mean duration of first care seeking was similar in new (24 days) and retreatment patients (25 days). Diagnostic duration contributed to 55% of the total pathway largely in new patients. Treatment initiation was noted to be the least among the three durations with mean duration in retreatment patients twice that of new patients. Significantly more female patients experienced diagnostic delay. Major shift of patients from the private to public sector and non-allopaths to allopaths was observed, particularly for treatment initiation.ConclusionAchieving positive behavioural changes in providers (especially non-allopaths) and patients needs to be considered in TB control strategies. Specific attention is required in counselling of TB patients so that timely care seeking is effected at the time of relapse. Prioritizing improvement of environmental health in vulnerable locations and provision of point of care diagnostics would be singularly effective in curbing pathway delays.     

Fibrinolysis in Cholestatic Jaundice

The fibrinolytic system was studied in primary biliary cirrhosis (16 patients) and large bile duct obstruction (10 patients, nine of whom had carcinoma). Plasma fibrinolysis (plasminogen activator activity) was decreased and fibrinogen increased in both groups of patients, particularly in those with large duct obstruction. These changes were related to the degree of cholestasis. Plasminogen activator activity was inversely related to serum triglyceride levels in patients with primary biliary cirrhosis. Urokinase inhibitors were decreased in both groups and antiplasmins increased in patients with large duct obstruction; fibrin/fibrinogen degradation products were normal in primary biliary cirrhosis and moderately increased in large duct obstruction. None of these fibrinolytic indices was related to the degree of cholestasis. Fibrinolytic activity and fibrinogen returned almost to normal levels after palliative surgery in the three patients with large duct obstruction who were studied. The decreased plasma fibrinolysis and increased fibrinogen may be due to altered lipid metabolism in cholestatic jaundice. In patients undergoing surgery for large duct obstruction there may be an increased risk of thrombosis.     

Micronuclei in human lymphocytes irradiated in vitro or in vivo

Venous blood from healthy donors or from patients with various lympho- and myeloproliferative diseases was incubated in vitro in the presence of cytochalasin B for the induction of binucleated lymphocytes. The time at which cytochalasin B was added depended on the proliferation rate of the lymphocytes. Proliferation was monitored using a semiautomatic microscope photometer/computer system. The background level of micronuclei in binucleated lymphocytes of the patients before radiotherapy was statistically indistinguishable from that of healthy persons. Blood from both groups was irradiated in vitro for the study of the dose-response relationship. The dose-response curves were very similar up to 3.75 Gy, and a somewhat lower micronucleus frequency was found in lymphocytes of patients after a 5-Gy exposure. These in vitro results were compared with in vivo exposure after total-body irradiation of leukemic patients. Due to heavy medication that accompanied radiation therapy, only two doses (1.25 and 2.5 Gy) could be checked after in vivo exposure. There was no statistically significant difference between in vitro and in vivo results after 1.25 Gy, but a slightly lower number of micronuclei was observed after in vivo exposure to 2.5 Gy.     

Immunological Studies in Kaposi's Sarcoma in Uganda

An evaluation of humoral and cellular immune mechanisms was performed on patients with Kaposi''s sarcoma in Uganda. Antibody responses and immunoglobulin levels were normal in all patients studied. Nevertheless, a striking impairment in the delayed hypersensitivity response to dinitrochlorobenzene was noted in patients with the “malignant” type of tumour.     

Nd-YAG Laser in Lung Cancer

We administered 45 Nd-YAG laser treatments in 29 patients (18 men) aged 39 to 82 years who had lung malignancy; 26 patients had primary non-oat cell lung cancer and three had metastatic airway malignancy. In all, 25 of the patients had been previously treated with combination(s) of surgical procedure, radiation therapy and chemotherapy. Indications for laser treatment included endobronchial airway obstruction with uncontrolled cough, hemoptysis, dyspnea or unresolved atelectasis-pneumonia. Of 15 patients with partially occluded tracheobronchial airway tumors, immediate palliative relief was achieved in 13 patients and lasted one to six months after a single treatment. In this group there was one postoperative death related to respiratory failure and two patients subsequently died of massive pulmonary hemorrhage. However, of 14 patients with totally obstructed airways, immediate palliative relief was achieved in only five patients and this lasted three weeks to three months after a single treatment. In this group there were two postoperative deaths related to progressive respiratory failure; in one case it was associated with endobronchial combustion of the fiberoptic bronchoscope. All three patients in both groups who died of respiratory failure were in acute respiratory distress and terminally ill before the procedure. These findings suggest that Nd-YAG laser therapy may be most beneficial in patients with partially rather than totally occluded airways due to lung malignancy.     

Polytrauma in elderly

The aim of this study is to present certain particularities in treating polytraumatized patients age of 65 and above. All of the patients were treated in our hospital. 413 patients were included in this 4 year study (2006-2010). Injury severity score was 17 and above (ISS > 17). Patients aged above 65 were sub grouped. In this 4-year period, we treated 52 or 13% elderly patients. In this subgroup there were 30 (58%) males and 22 (42%) females, with mean age of 74 (max age 95 years old). Demographic factors, injury mechanisms, patients resuscitation protocols, imaging used, etc. were also included as variables. Mortality rate in elderly patients was 31%, while in patients below 65 years of age as 12%. Taking relevant data into consideration, a special emphasis was given to certain circumstances of intensive and surgical treatment of elderly patients. A large portion of polytraumatized patients are consisted of elderly. Patients aged 65 and above have higher mortality rate with lower ISS in the mortal group and falls are the most frequent mechanism of trauma. In this study, we tried to emphasize some clinical implications when treating those patients, as well as importance in continuous medical staff education in trauma principles to minimize mortality rates.     

Cefepime in the treatment of infection in neutropenic patients]

Cefepime, a fourth-generation cephalosporin, was used in the treatment of 11 febrile episodes in 8 patients with profound neutropenia. The patients were neutropenic because of high-dose chemotherapy with stem-cell rescue or second-line salvage chemotherapy for malignant lymphomas (5 patients) or solid tumors (3 patients). The median duration of grade-IV neutropenia (according to the WHO classification) was 11 days (7 to 14). Cefepime was used as the monotherapy in a dose of 2 g thrice daily. Disappearance of the infection signs was recorded in 8 episodes (73 per cent). In 3 episodes (23 per cent) cefepime was replaced by another drug. The tolerability of cefepime was good and no adverse events were observed with the exception of 1 event of an allergic reaction.     

Phagocytosis and neutrophil bactericidal capacity in patients with uremia

The phagocytic activity and bactericidal capacity of polymorphonuclear neutrophils (PMN) were evaluated in patients with advanced chronic renal failure. The studies were made in patients undergoing hemodialysis, maintenance peritoneal dialysis as well as in nondialysed patients. Evaluations were carried out by using of the recently described fluorochrome microassay which enabled these parameters to be estimate independently. The phagocytic activity was seriously diminished in nondialysed patients, whereas it was similar to controls in those hemodialysed and undergoing peritoneal dialysis patients. In all evaluated groups of patients the bactericidal capacity was significantly reduced. The lowest values could always be observed in nondialysed patients. The decrease of bactericidal capacity was significantly more evident in patients undergoing peritoneal dialysis as compared with those hemodialysed. The obtained results confirm some previous reports suggesting the impairment of PMN function in uremic patients. This results in their increased susceptibility to infection. They also reveal the existence of a close relationship between the extent of observed dysfunctions and the management applied.