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Four patients who underwent transplantation for hepatitis B virus-related liver disease developed rapidly progressive liver failure attributable to recurrent hepatitis B disease typified by hyperbilirubinemia and distinctive hepatocyte ballooning and progressive fibrosis consistent with recently reported fibrosing cholestatic hepatitis. Among these four patients, the mean interval from transplantation to redocumentation of hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) was 5 months, to development of malaise and jaundice 6 months, to histological diagnosis 7 months, and to graft failure 8 months. The only patient who underwent retransplantation had accelerated recurrence of the same syndrome with biopsy documentation 1 month later and graft failure 2 months later. Distinctive histological features included confluent hepatocellular ballooning and progressive periportal fibrosis followed by lobular collapse over 4-6 weeks without significant inflammation. Immunohistochemical staining showed marked HBsAg and hepatitis B core antigen (HBcAg) immunoreactivity. The rapid development of cytolytic hepatocellular necrosis and lobular collapse with prominent HBcAg immunoreactivity without significant inflammation suggests a cytolytic rather than immune pathogenesis for this unique and devastating form of recurrent hepatitis B that might better be termed "fibrosing cytolytic hepatitis."
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PMID:Fibrosing cytolytic liver failure secondary to recurrent hepatitis B after liver transplantation. 139 95

We analyzed the CT features of 22 patients with endobronchial tuberculosis (EBTB) showing segmental collapse and/or mas-like infiltrates. The CT findings of involved bronchi were bronchial stenosis with wall thickening or peribronchial cuff of soft tissue (n = 9), bronchial obstruction with peribronchial cuff or soft tissue (n = 7), bronchial involvement with tuberculous lymphadenitis (n = 5), or intraluminal lower density polypoid mass with narrowing (n = 1). Enhancement of the peribronchial cuff following intravenous contrast medium administration was noted in four of seven patients in the bronchial obstruction group. The parenchymal lesions distal to the bronchial lesion were segmental collapse, collapse with multiple low density areas (presumed caseous pneumonia), cavities, and round low density lesion (presumed mucoid impaction distal to an endobronchial obstruction). Ill-defined small nodular densities and larger confluent densities suggesting endobronchially disseminated pulmonary tuberculosis were found in the adjacent lung in 10 patients.
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PMID:Endobronchial tuberculosis: CT features. 202 3

A 23-year-old black female presented with general malaise, headache, high white cell count (136 x 10(9)/L), thrombocytopenia and nephrotic syndrome. She proved to have large granular lymphoproliferative disease with a natural killer cell phenotype and without a clonal rearrangement of the T-cell receptor genes. Renal biopsy demonstrated focal segmental glomerulosclerosis (FSGS). She developed a monophasic neurological illness, and rapidly became comatose six days after the initiation of high dose prednisone therapy. Computerized tomography of the brain showed marked hypodensity of the subcortical white matter. She regained consciousness subsequently, but died six months after her initial presentation with uncontrolled lymphocytosis and renal failure. Autopsy revealed FSGS with glomerular collapse and microcystic dilatation of the renal tubules, and there was perivascular demyelination in the subcortical white matter of the brain. We speculate that lymphokines released by the natural killer cells may have played an important role in the pathogenesis of both the nephrotic syndrome and leukoencephalopathy.
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PMID:Large granular lymphoproliferative disease associated with nephrotic syndrome, renal failure and leukoencephalopathy. 822 Jan 46

H. felis is a rickettsial parasite that causes hemolysis and sequestration of feline erythrocytes. It should be considered as a potential primary pathogen or opportunist in any cat presented with signs ranging from episodic malaise to acute anemic collapse. Diagnosis requires visualization of the organism in properly prepared blood smears. Treatment uses antirickettsial drugs, corticosteroids, and supportive measures. Clinical recovery requires immune containment of the organism. Treatment does not eliminate the organism from the host. Carrier cats may relapse when their immunity is severely compromised by other diseases such as FeLV. Transmission is presumed to be by blood-sucking parasites and possibly bite wounds between cats. Prevention requires prudent health management of cats. Future advances in the knowledge of the disease will relate mainly to the development of a diagnostic technique that will allow identification of all infected cats.
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PMID:Feline hemobartonellosis. 842 90

Adverse reactions to radiopharmaceuticals are comparatively few in number. Various estimates quote an incident rate of 1 to 6 reactions per 100,000 injections. Other figures quoted are 1 in 800 for the bone-seeking radiopharmaceutical methylene diphosphonate, and 1 in 400 for the lung visualisation agent macroaggregated albumin. The very low numbers of reported adverse effects probably reflect the tiny amounts of material which are used in the formulation of radiopharmaceuticals. Adverse reactions to radiopharmaceuticals are usually mild and transient and require little or no medical treatment. A few reactions involve respiratory or circulatory collapse or loss of consciousness. Several fatalities have been reported with the liver scanning agent 99mTc (technetium 99m)-albumin colloid. Clinical manifestations may be categorised under the headings of vasomotor effects i.e. faintness, pallor, diaphoresis or hypotension, and anaphylactoid effects such as nausea, dermographism, wheezing, bronchospasm, erythema and pruritus. The most prominent group of radiopharmaceuticals that have been reported to produce adverse events are the diphosphonates, which are used for scanning the skeleton. Typical diphosphonate reactions include erythema (especially over the extremities), nausea, vomiting and malaise. The onset of reaction is usually 2 to 3 hours after injection. The second group of radiopharmaceuticals which give rise to adverse events are the colloids, which are used for liver and spleen scintigraphy. Typical colloid reactions include pallor, nausea, flush and pulse changes. Adverse events may also occur as a result of the patient's medication interfering with the disposition of the radiopharmaceutical. Although not usually hazardous or dangerous, such events may be so pronounced that a marked deviation in the expected pharmacokinetics may occur. Drug interactions can be conveniently categorised under the headings of unusual handling of the radiopharmaceutical because of pharmacological action, genuine in vivo interaction between the medication and radiopharmaceutical, drug-induced disease and interaction between the radiopharmaceutical and catheters or syringes. The most serious drug interactions are those where the patient is taking cortisone or cytotoxic agents prior to tumour scintigraphy. Other important effects occur in patients undergoing bone scanning who are receiving iron preparations. Nifedipine has been reported to produce quite severe problems in scanning, including difficulties in the radiolabelling of red cells (for cardiac scintigraphy), and other effects where the drug appears to prevent the transport of bone-seeking materials into the skeleton. Many drugs alter hormonal status and these effects may produce marked deviations from the expected biodistribution. Diethylstilbestrol (stilboestrol), digitalis, gonadotrophins, phenothiazines and cimetidine all increase estrogen levels in high doses.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Adverse reactions and drug interactions with radiopharmaceuticals. 848 Dec 15

We report a case whose renal failure was due to malignant hypertension and in whom steroid facilitated the recovery of renal function. The patient, a 41-year-old man, was admitted to our hospital because of malaise and macrohematuria. On admission, his blood pressure was 270/160 mmHg. The plasma renin activity (PRA) and aldosterone were markedly elevated. Chest X-ray, echo cardiography and electrocardiogram revealed marked hypertrophy. Hypertensive retinopathy and arteriosclerotic change were noted on ophthalmoscopy. Because of renal dysfunction (blood urea nitrogen 45.6 mg/dl, serum creatinine 4.9 mg/dl with massive proteinuria and increased FENa, renal biopsy was performed on the 8th clinical day. The specimens showed slight proliferation of mesangial cells with mesangiolysis and interstitial cell infiltration, in addition to marked arteriosclerosis and partial collapse of the glomerular tuft. After the administration of a Ca antagonist and angiotensin converting enzyme inhibitor (ACE-I), his mean blood pressure decreased to 100-130 mmHg, and urinary protein decreased as well. Nevertheless, renal dysfunction remained unchanged during the following 3 weeks. Thus, prednisolone (PSL, 30 mg/day) was administered on the 22nd clinical day and renal function improved thereafter without a significant change in blood pressure. The improved renal function was maintained after PSL tapered off on the 184th clinical day. It is suggested that PSL might be the therapy of choice in malignant hypertension, when the renal function has not been improved by anti-hypertensive treatment alone.
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PMID:[A case of malignant hypertension in whom steroid improved renal function]. 1065 31

Influenza virus typically causes a febrile respiratory illness, but it can present with a variety of other clinical manifestations. We report a fatal case of myocarditis associated with influenza A infection. A previously healthy 11-year-old girl had malaise and fever for approximately 1 week before a sudden, witnessed fatal collapse at home. Autopsy revealed a pericardial effusion, a mixed lymphocytic and neutrophilic myocarditis, a mild lymphocytic interstitial pneumonia, focal bronchial/bronchiolar mucosal necrosis, and histologic changes consistent with asthma. Infection with influenza A (H3N2) was confirmed by virus isolation from a postmortem nasopharyngeal swab. Attempts to isolate virus from heart and lung tissue were unsuccessful. Immunohistochemical tests directed against influenza A antigens and in situ hybridization for influenza A genetic material demonstrated positive staining in bronchial epithelial cells, whereas heart sections were negative. Sudden death is a rare complication of influenza and may be caused by myocarditis. Forensic pathologists should be aware that postmortem nasopharyngeal swabs for viral culture and immunohistochemical or in situ hybridization procedures on lung tissue might be necessary to achieve a diagnosis. Because neither culturable virus nor influenza viral antigen could be identified in heart tissue, the pathogenesis of influenza myocarditis in this case is unlikely to be the result of direct infection of myocardium by the virus. The risk factors for developing myocarditis during an influenza infection are unknown.
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PMID:Influenza A virus infection complicated by fatal myocarditis. 1111 1

We report a case of fatal intoxication with 2% viscous lidocaine. A 18 month old infant was admitted after malaise and cardiorespiratory arrest at home. He was resuscitated, then seizures appeared before arrival at the hospital. Treatment was symptomatic, including cardiorespiratory resuscitation and administration of anticonvulsants. Identification of lidocaine and its metabolite monoethylglycinexylidide (MEGX) MEGX was performed after organic extraction by High Performance Liquid Chromatography (HPLC) with Diode Array Detection (DAD); the serum concentrations, determined by Fluorescence Polarisation Immuno Assay (FPIA), were: 1.1 micrograms/ml for lidocaine and 0.94 microgram/ml for MEGX (H + 7) and 0.30 microgram/ml for the lidocaine (Day + 1). Neurotoxic manifestations appear at lower concentrations than cardiotoxic symptoms which are correlated with plasma levels of lidocaine. The toxic symptoms begin with headache, hallucinations, seizure, coma, respiratory arrest and circulatory collapse. The toxic symptoms can persist even after the decrease of lidocaine concentration under therapeutic levels. There is no antidote and acute lidocaine toxicity is managed with supportive therapy (diazepam for seizures, intubation, chronotropic agents). Considering the gravity of these poisonings which remain rare, the 2% viscous lidocaine prescription is forbidden for children under 6 years old.
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PMID:[Fatal intoxication after accidental ingestion of viscous 2% lidocaine in a young child]. 1197 45

Keynes in 1937 examined the phenomenon of the Great Depression from a longrun perspective in contradiction to the "General Theory," where the focus was on the shortrun. "Some Economic Consequences of a Declining Population," Keynes' article, reveals the context in which the "General Theory" was written. In the "General Theory," the focus is on short-term fluctuations, i.e., business cycles, but Keynes fails to provide any theoretical explanation as to why the depression of the 1930s was so severe and intractable. In the 1937 article, the depression is seen as the result of the combined effects of a decline in longrun growth due to population growth decline and a shortrun cyclical decline, together producing severe economic consequences. What is important for the purposes of this discussion is the implication, within the context of the 1937 article, that not only was the stock market crash of 1929 related to population change (with its accompanying collapse in expectations) but that, in general, changes in the rate of growth of population are accompanied by stock price movements in the same direction. The remainder of the discussion is devoted to a simple empirical test of this relationship. The data used are population size (POP), defined as the total residential population in the US from 1870-1979, and the Standard and Poor 500 Stock index (SP) for the corresponding 109-year period. In addition, a 3rd series was constructed, a price deflated Standard and Poor index (RSP) with a base period of 1870, to account for possible inflationary distortion of the index. The empirical results do not invalidate the hypothesis that population growth rates affect equity markets. In fact, there seems to be strong evidence that they are related in a manner suggestive of Keynes' intutition, namely, that the stock market crash of 1929 was due to factors more fundamental than those often perceived from a shortrun perspective. According to Keynes (1937), population is the most important determinant of longrun movements in real per capita income (given the state of technology, the real rate of interest, the age structure of the population, and the size share of income). So the focus is on population and its effects on economic growth. Due to the fact that the stock market presumably discounts longrun economic conditions as reflected in equity prices, it would seem that if Keynes were correct in his theoretical speculations, longterm equity price movements should relate to population change. In this sense, the paper may be regarded as an empirical test of a proposition of Keynes. More generally, the paper is suggestive in several ways. The relationship between business cycles and stock market cycles has been understood to the point of being rather obvious, but the effects of population on both has been less clear. It does appear on the basis of the evidence presented that the malaise of the stock market during the past 16 years, especially in real terms, may be due to factors more fundamental than those often perceived.
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PMID:Keynes, population, and equity prices. 1226 30

Comments on the UN paper on the Development Decade of the 1980s and the next decade of the 1990s by Gamani Corea are presented. Corea's statements about the future are considered fair, but negative and lacking in quantitative input. As an econometrician and a quantitative economist, the author feels that the shortterm and mediumterm economic prospects are that 1988 was a good year, 1989 all right, and 1990 was recessionary for some countries. Recovery is anticipated by 1992. The Gulf crisis of 1990-91 caused fluctuations in energy prices and uncertainty or fear in people, which is hoped to be transitory and without major impact on economic matters. Positive expansion in the world economy after 1992 is anticipated, in spite of the recessions in the UK and some Nordic countries. Western Europe slowed, but the advent of the Single Market is favorable to an upswing. The Asia/Pacific arena is strong, and achievements in South Korea are considerable. Mexico, Venezuela, Colombia, and Chile are promising. Other economic problems in Latin America are only temporary. South Asia has done well. The Middle East and North Africa may have more lasting consequences of the Gulf war. Sub-Saharan Africa is in trouble with the race between population growth and food supplies, and negative or near zero growth rates/capita. Developing countries are experiencing severe recessionary adjustment periods in world economic malaise. With the collapse of socialism, there is no viable "Second World," and there are industrialized and developing countries. Eastern Europe and the USSR have a skilled population with the potential for producing world class goods and services. Primary commodity markets are expected to rise again which will strengthen export earnings in the developing world. Macroeconomic visions of hope are based on contingencies: financial fragility, issues related to the Gulf crisis, poor financial conditions in the US and to a certain extent in Japan and other financial centers. Trade negotiations in the Uruguay Round are in difficulty, which restricts free trade, and dilutes strong and vigorous activity which helps development. The economic restructuring of Europe is moving more slowly, but the Arms race is still extant in Third World countries such as Iraq. Price stabilization efforts may be futile attempts when underlying behavior patterns of production and consumption take over. Europe is the primary growth area. The Peace Dividend has been reduced because of Iraq's postures. South/South trade may be an option for developing countries. There is potential for expansion in e.g., and electronics, medical care, telecommunications, bioengineering, metallurgy, software construction. Technology and economics and international cooperation and coordination are hopeful prospects for the future.
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PMID:Comments on "International Development Perspectives for the 90s". 1228 64


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