Leukemic synovitis as the cause of arthritis in myelodysplastic syndrome.

Up to 10% of patients with myelodysplastic syndrome (MDS) may have arthralgias as a feature of their disease. All patients with MDS have the potential to progress into acute leukemia. We describe the case of a 59-year-old male with MDS who presented with synovitis due to leukemic infiltration of the synovium as the first symptom heralding the conversion of MDS into acute leukemia.

Combined surgical audit by microcomputer involving units in four health regions.

General surgeons from hospitals in four well-separated health districts collected audit data about their patients using common software. They pooled their results in order to make comparisons between their practices. Data on 22,497 admissions including 17,473 operations were available. The data were found to be easy to collect and analyse using this program. There were significant differences in overall complication rates between the four centres, but these seem to be explained by differences in the emergency workload, case mix, and age range of the population treated. A study of inguinal hernia repairs and appendectomies showed low complication rates with no significant differences between centres, with the single exception of a higher incidence of wound problems in one centre. Because of the multiplicity of factors affecting them, complication rates could only be properly understood in a professional surgical context. Isolated figures would be open to damaging misrepresentation. Meetings between surgeons well armed with their own results seem to be the best way to forward the audit process.

Oral contraceptive use: prospective follow-up of women with suspected glucose intolerance.

593 women from a cohort of 8,652 healthy women failed a 1-hr glucose screening test. These 593 women with suspected glucose intolerance were classified as normal or as having impaired glucose tolerance (IGT) or diabetes mellitus (DM) after an oral standard glucose tolerance test (SGTT) and were followed over a mean 8.55 years. No permanent change in glucose status as a result of oral contraceptive use was found in an analysis for impaired glucose tolerance, diabetes mellitus, diabetic symptoms, or use of oral agents and/or insulin. Increased glucose intolerance was observed for women who were older, had a positive family history of diabetes, or were of greater relative weight. Diabetic symptoms correlated most closely with the onset of persistent fasting hyperglycemia.

PIP: 593 women from a cohort of 8652 healthy women failed a 1-hour glucose test screening. These 593 women with suspected glucose intolerance were classified as normal or as having impaired glucose tolerance (IGT) or diabetes mellitus (DM) after an oral standard glucose tolerance test and were followed over a mean of 8.55 years. No permanent change in glucose status as a result of oral contraceptive use was found in an analysis for IGT, DM, diabetic symptoms, or use of oral agents and/or insulin. Increased glucose tolerance was observed for women who were older, had a positive family history of diabetes, or were of greater relative weight. Diabetic symptoms correlated most closely with the onset of persistent fasting hyperglycemia.

Transplantation and in vitro perifusion of rat islets of Langerhans after slow cooling and warming in the presence of either glycerol or dimethyl sulfoxide.

The cryoprotectants dimethyl sulfoxide (Me2SO) and glycerol have been used for the cryopreservation of fetal rat pancreases but only Me2SO has been reported for the cryopreservation of adult rat islets. Since glycerol may be preferred to Me2SO for clinical use, this study was undertaken to compare the effectiveness of these cryoprotectants during the slow cooling of isolated adult rat islets. Islets of Langerhans prepared from the pancreases of WAG rats by collagenase digestion were stored at -196 degrees C after slow cooling (0.3 degrees C/min) to -70 degrees C in the presence of multimolar concentrations of either Me2SO or glycerol. Samples were rewarmed slowly (approximately 10 degrees C/min) and dilution of the cryoprotectant was achieved using medium containing sucrose. Function was assessed by determination of the time course of the glucose-induced insulin release during in vitro perifusion at 37 degrees C and also by isograft transplantation. Transplants were carried out by intraportal injection of a minimum of 1700 frozen and thawed islets into streptozotocin-induced diabetic recipients and tissue function was assessed by monitoring blood glucose levels and body weight changes. Without exception the islets frozen and thawed in the presence of glycerol failed to reduce high serum glucose levels of recipient rats and in vitro dynamic release curves showed to demonstrate a glucose-sensitive insulin release pattern. Reversal of the diabetic conditions was achieved in two of five animals receiving islets which had been frozen and thawed with 2 M Me2SO; and in one of three animals receiving islets cryopreserved with 3 M Me2SO. Nevertheless, perifusion studies showed that the pattern of insulin secretion from groups of cryopreserved islets which did show an ability to secrete insulin was atypical compared with that of untreated controls, suggesting that the tissue was altered or damaged in some way.

Renal and segmental pancreatic grafting with draining of exocrine secretion and initial continuous intravenous cyclosporin A in a patient with insulin-dependent diabetes and renal failure.

A patient with renal failure and insulin-dependent diabetes received renal and segmental pancreatic allografts from the same donor, with exocrine drainage of the pancreas being directed into the bowel. An attempt was made to maintain the serum concentrations of cyclosporin A between 300 and 1000 mug/l to avoid serious nephrotoxicity and rejection. Considerable difficulty was experienced in controlling the serum concentrations even with continuous intravenous infusion. When the concentrations were maintained between 300 and 1000 mug/l function in both allografts was satisfactory.At seven months the patient required no insulin and had good renal function. He was not receiving corticosteroids.

Improved survival after orthotopic liver grafting.

A total of 108 orthotopic liver transplants have been carried out in the Cambridge/King's College Hospital series. Over 13 years, changes in patient selection, immunosuppression, and surgical and anaesthetic techniques have led to a steady improvement in results. Results obtained in the last 22 patients indicated that over half survive for one year. Although at considerable risk during the operation, patients with non-malignant cirrhotic diseases who survive one year have a good long-term chance of survival

Tetanus in phlegmasia caerulea dolens.

A case of phlegmasia caerulea dolens is reported. Thrombolytic therapy was instituted. The patient developed tetanus. Adequate tetanus prophylaxis under such circumstances is advised.

Torsion of the Fallopian tube in a premenarchal girl.

A case of isolated torsion of the normal Fallopian tube, masquerading as acute appendicitis, in a premenarchal girl is presented. The aetiology is considered and the literature reviewed.

Cyclosporin A in cadaveric organ transplantation.

The use of cyclosporin A (CyA) with a protocol designed to avoid the effects of nephrotoxicity resulted in a one-year survival of 86% in recipients of renal allografts from unmatched cadaveric donors. The drug also controlled rejection of liver and pancreatic allografts. It was possible to change patients initially treated with CyA to azathioprine and corticosteroids and vice versa, thus enlarging the potential value of CyA in organ allografting. Of 34 recipients of renal allografts, 29 were currently receiving only CyA as immunosuppressive treatment. Twelve patients never required any adjuvant steroid treatment. These results suggest that CyA is an effective immunosuppressant, and if used with care side effects need not be severe.

Reversible ischaemic colitis in young adults.

Ischaemic colitis, while well recognized in older patients, is rare in patients under 30 years of age. Four such patients with transient ischaemic colitis are presented and the literature is reveiwed.