Orbital unifocal Langerhans cell histiocytosis [eosinophilic granuloma]

Langerhans cell histiocytosis [LCH] is a clinical entity characterized by abnormal proliferation of Langerhans cells that probably results from an immunoregulatory defect which can be triggered by several different factors. Orbital involvement by LCH most often represents unifocal disease [eosinophilic granuloma]. The condition is uncommon and descriptions of eosinophilic granuloma of the orbit generally have been limited to single case reports or small case series. A case of orbital eosinophilic granuloma is reported, followed by a discussion encompassing a literature review

vascularization of symphysis pubis in the albino RAT

Little attention has been paid to study the vascular nutritional pathways to the symphysis pubis. Knowledge regarding the nutrient sources and degree of vascularisation of the fibrocartilaginous structures especially the articular discs of symphysis pubis in virgins and during late period of pregnancy is fundamental for physiotherapists and physicians for clinical decision making. This work was undertaken to describe the vascular nutritional pathway to the symphysis pubis in rats using light microscopy and immunohistochemistry and to describe the structural transformation observed in the symphysis pubis during the intrapartum period. 20 rats [8 males and 12 females] 80 - 100 days of age were used in this study. The symphysis pubis was excised and specimens were prepared for light microscopy and immunohistochemistry. The interpubic disc has two distinct portions: an inner bearing portion made up of cartilage and a peripheral portion made up of dense connective tissue. Blood vessels that supply the medial extremity of each pubic bone, penetrate the muscle attachments and the articular tissue to supply the pubic ligaments and the fibrous rim of the interpubic disc. The subchondral bone also share in giving blood supply to the symphysis pubis as it shows several marrow contacts linking the marrow space of the pubic bones with the interpubic disc. Histological examination revealed more intense factor VIII staining in the joint in intrapartum specimens indicating more angiogenesis. The lengthening of the articular gap is seen in intrapartum specimens. The symphyseal gap changes morphologically in intrapartum specimens as a result of pregnancy. Its width increased and it assumed the structure of a ligament. Mononuclear cellular infiltration was demonstrated in the interpubic tissue around parturition. As a result of delivery, traumatic changes occur leading to progressive loosening of the symphysis pubis and production of cartilaginous nodules. Changes in the symphysis pubis noticed as an effect of pregnancy are increased vascularity, increased deposition of collagen, mononuclear cellular infiltration and formation of cartilaginous nodules. These results are of interest to physiotherapists and physicians. Knowledge regarding the degree of vascularisation of the symphysis pubis in virgins and during late period of pregnancy is fundamental for clinical decision making. A clear understanding of the changes that occur in the symphysis pubis at term would be of great benefit to the diagnosis and management of any pathophysiological condition that may happen at parturition

Utilization of digoxin and theophylline assays in the eastern province

The utilization of therapeutic drug monitoring [TDM] for serum digoxin and theophylline was assessed with respect to the indication, time of sample collection and contribution to patient care. A total of 585 serum drug level determinations of digoxin [275] and theophylline [328] were done in a four month period. Reasons for requests were subtherapeutic response [27.5%], suspected toxicity [3.8%], baseline data [26.7%], patients at risk for toxicity [7.7%], and for the remaining 34.4% of orders, no reason was stated. The highest number of requests 246 [42.1%] were from the inpatient ward [INP], followed by emergency room [ER] 32.6%, outpatient department [OPD] 13% and intensive care unit [ICU] 12.3%. Repeated assays accounted for 363 determinations of which 55.9% had levels similar to the previous ones. In this study, we found a high incidence of inappropriateness in patient selection [34.4%], time of serum sample collection [28.4%], and dosage adjustment [46.8%]. However, when these audit criteria were analyzed together, the overall appropriateness was as low as 33.5%. This indicated that serum drug monitoring was poorly utilized and did not contribute much to the patient's care. This results in an estimated financial loss per year [for inappropriate use of digoxin and theophylline levels] of about 37,344 Saudi Riyals [US $ 9,956.00]. Corrective educational programs for the staff, based on standard guidelines for TDM, have been initiated and this study is a baseline for future prospective audits