Ocular manifestations of congenital toxoplasmosis.

PURPOSE: To evaluate the ocular manifestations of congenital toxoplasmosis at the first ophthalmological examination of children up to the age of 12 months. METHODS: Cross-sectional study of 44 children with a confirmed diagnosis of congenital toxoplasmosis. In all patients, complete ophthalmological examinations were performed under sedation. The patients underwent biomicroscopy of the anterior segment, skiascopy under cyclopegia, and indirect binocular ophthalmoscopy with maximum mydriasis. RESULTS: The mean age of patients was 4.2 months. Of the 44 children evaluated, 31 (70.4%) presented ocular involvement and 29 (65.9%) of them had retinochoroiditis lesions. The retinochoroiditis lesions were bilateral in 22 (75.8%) patients and unilateral in 7 (24.2%). The retinochoroiditis lesions were active in 8 (15.7%) eyes and had healed in 43 (84.3%). Most of the lesions were concentrated in the papillomacular area (76.3%). Other associated ocular alterations were present in 22 children, the most prevalent being cataract, microphthalmia, and strabismus. CONCLUSION: Ocular involvement in congenital toxoplasmosis might be much more frequent and occurs earlier than previously described.

Emergency medicine in Southern Brazil.

Emergency medicine is developing rapidly in southern Brazil, where elements of both the Franco-German and the Anglo-American models of emergency care are in place, creating a uniquely Brazilian approach to emergency care. Although emergency medical services (EMS) in Brazil have been directly influenced by the French mobile EMS (SAMU) system, with physicians dispatched by ambulances to the scenes of medical emergencies, the first American-style emergency medicine residency training program in Brazil was recently established at the Hospital de Pronto Socorro (HPS) in Porto Alegre. Emergency trauma care appears to be particularly developed in southern Brazil, where advanced trauma life support is widely taught and SAMU delivers sophisticated trauma care en route to trauma centers designated by the state.

Phase II trial of bryostatin 1 in patients with relapsed low-grade non-Hodgkin's lymphoma and chronic lymphocytic leukemia.

Bryostatin 1 is a natural product isolated from the marine bryozoan Bugula neritina in 1982 and is currently undergoing evaluation in a number of malignancies. Twenty-five patients with relapsed, low-grade non-Hodgkin's lymphoma or chronic lyphocytic leukemia (CLL) received bryostatin 1 by 72-h continuous infusion every 2 weeks at a dose of 120 microg/m2 per course. Patients who progressed while receiving bryostatin 1 alone could participate in a feasibility study by receiving vincristine administered by bolus i.v. injection immediately after the completion of the bryostatin 1 infusion. The dose of vincristine was escalated in groups of three patients as follows: level 1, 0.5 mg/m2; level 2, 1.0 mg/m2; and level 3, 1.4 mg/m2 with vincristine doses capped at 2.0 mg for all patients. Bryostatin 1 alone resulted in one complete remission and two partial remissions. Nine patients received sequential treatment with bryostatin 1 and vincristine. The addition of vincristine at a dose of 2 mg was feasible and caused the expected dose-related sensory neuropathy. Phenotypic analysis by flow cytometric analysis on pre- and post-bryostatin 1-treated peripheral blood lymphocytes revealed up-regulation in the coexpression of CD11c/ CD22 on CD20+ B cells in two of four CLL patients studied, which is consistent with in vitro findings of differentiation of CLL cells to a hairy cell phenotype.

Sterility of filgrastim (G-CSF) in syringes.

OBJECTIVE: To determine if the sterility of filgrastim (G-CSF) is maintained for up to 7 days when aseptically transferred from the vial to tuberculin syringes in a laminar air flow environment. DESIGN: The study was conducted in two phases: a validation and an experimental phase. The method was validated by inoculating samples of sterile filgrastim solution with common bacterial and fungal skin contaminants. Samples were aseptically drawn into syringes in a class 100 horizontal laminar air flow hood and refrigerated. The samples were equally divided and transferred to microbiology culture media at times 0, 24 hours, 48 hours, and 7 days; incubated; and the organisms identified and quantitated. In the experimental phase, samples of filgrastim were aseptically drawn into syringes, separated into three groups, and refrigerated. At 24 hours, 48 hours, and 7 days, the samples were transferred to broth, incubated, and observed for the development of turbidity. SETTING: A class 100 laminar air flow hood in a pediatric hospital pharmacy and a home-infusion pharmacy class 100,000 clean room. MAIN OUTCOME MEASURES: The sterility of filgrastim in syringes was determined by comparing experimental broth culture tubes to a control tube and observing for the development of turbidity. RESULTS: Filgrastim demonstrated the ability to support the growth of intentionally inoculated skin contaminants, both qualitatively and quantitatively. However, when aseptically transferred to syringes and refrigerated, all tested filgrastim samples remained sterile for at least 7 days. CONCLUSIONS: Syringes of filgrastim remain sterile for 7 days when prepared in a class 100 laminar air flow hood, using aseptic technique, and stored under refrigeration. This change in practice can result in significant cost savings.

Accuracy and reliability of dosing equations to individualize theophylline treatment of apnea of prematurity.

Apnea of prematurity is associated with high morbidity and mortality. Treatment generally includes supplemental oxygen and theophylline or caffeine. The half-life of theophylline is prolonged in newborns because of their immature cytochrome P-450 system, and there is considerable variation in the drug's metabolism in infants. We compared the accuracy, precision, and reliability of two equations that use postnatal age (PNA) to determine a maintenance dosage of theophylline with a standard maintenance dosage (SMD) that produced a steady-state serum theophylline concentration (STC) of 8 micrograms/ml for apnea of prematurity in 46 infants less than 34 weeks' gestational age (GA) and less than 36 weeks' postconceptional age (PCA). The two equations were mg/kg/day = [(0.2 x PNA in wks) + 5], and mg/kg/day = [(0.3 x PNA in wks) + 8]. Their reliability to predict the SMD was determined by correlation analysis. The precision and accuracy with which they predicted SMD were determined and analyzed by chi 2. The SMD did not correlate with the maintenance dosages calculated by equations 1 and 2 (r = 0.296 and 0.296, p > 0.05 in both cases). Multiple linear regression of SMD versus GA, PNA, and PCA was not significant (r = 0.33, p = 0.32). After stratifying data based on GA and performing correlation analysis of SMD versus PNA, a weak but significant correlation (r = 0.42, p = 0.517) was found for infants with GA between 31 and 34 weeks. Poor correlation was found between SMD versus PNA for infants 27-30 weeks' GA. Two new equations of the best fit line were generated using the same data.(ABSTRACT TRUNCATED AT 250 WORDS)