Invasive aspergillosis in a renal transplant recipient successfully treated with interferon-gamma.

Invasive aspergillosis is a serious complication of solid organ transplantation. An early diagnosis is hampered by the lack of reliable serum markers and, even if appropriately diagnosed and treated with current antifungal agents, has a high mortality rate. We report a case of invasive pulmonary and cerebral aspergillosis in a renal transplant patient treated with IFN-γ in conjunction with combination anti-fungal therapy for six weeks in whom complete resolution of the fungal infection was achieved. Renal function remained intact throughout the treatment period. Surveillance CT scans of the chest and head showed resolution of prior disease but revealed a new left upper lobe mass four months after completion of treatment with IFN-γ. Biopsy of the lesion was positive for primary lung adenocarcinoma, for which she underwent left upper lobe resection. The pathology report confirmed clear surgical margins and lymph nodes and no evidence of fungal hyphae. IFN-γ should be considered early in the management of invasive aspergillosis in renal transplant patients. To date, allograft rejection has not been encountered.

"Anatomically corrected malposition": a rare case with bilateral absence of a complete subarterial muscular infundibulum.

A unique case of anatomically corrected malposition of great arteries with a bilateral absence of a complete subarterial muscular infundibulum is presented. The other unusual feature of the case was absence of any complex associations and interestingly an intact ventricular septum. The presenting lesion was valvar pulmonary stenosis and balloon valvotomy could not be achieved because of abnormal relationship of the great vessels.

A study of pulmonary function of competitive swimmers.

Pulmonary Function Tests (PFT) of 45 swimmers who swam a distance of 2 to 5 kms per day regularly were compared with age, sex, height and weight matched controls. VC, IRV, FVC, FEV1 and V25 were higher in swimmers (S) than controls (NS) by 20%, 25%, 37.4%, 30.1% and 15.1% respectively. The effect of the period of training on PFT's was also analysed. Inspiratory capacity was significantly higher in Gr IS than NS probably due to a reduction in FRC, FVC and FEV1 were higher in Gr. II than NS. Greater differences were seen between Gr. IV S and NS, where FVC, FEV1, V75 and PEFR were higher by 50.2%, 38.2%, 69.4% and 25% respectively in the S than NS. Probably the first parameter to increase is IC. The greater differences in PFT values of Gr. IV S and NS may be due to hypertrophy of the diaphragm which requires hard work for prolong period. Further longitudinal studies are needed to confirm these observations.

Cardiorespiratory response to stress test in normal Indian boys and adolescents.

Thirty-one boys between the ages of 9 and 17 years were subjected to submaximal exercise stress testing on a treadmill using the Bruce's protocol. All the children completed the test with the younger group (9-13) reaching Grade III and the older group boys (14-17) reaching Grade IV on an average. The heart rate, blood pressure and FEV1 during exercise compared well with other reported studies. On ECG analysis there were no significant ST segment changes or J junction depression. This study was conducted in well nourished boys from high-socio-economic group who regularly took part in sports.

Lymphedema of the lower extremities: evaluation by microcolloidal imaging.

Contrast lymphangiography has been the traditional radiographic method for imaging the lymphatic system of the lower extremities. Because of the difficulty in performing the procedure and its potential side effects, radionuclide lymphangiography is a safe and reliable alternative. Technetium-99m labeled to antimony trisulfide colloid was used in nine patients presenting with lymphedema of the lower extremities. The procedure was relatively simple to perform, and no adverse effects were noted.

Prevalence of cryptosporidium in children with acute diarrhea.

Cryptosporidium is an intestinal protozoa known to cause diarrhea in animals and more recently has been recognised as a cause of diarrhea in humans. The present study was designed to determine the prevalence of cryptosporidium as a cause of diarrhea in children. Faecal samples of 180 children admitted to the hospital for acute gastroenteritis and from 100 normal children were analysed. Eight out of 180 (4.4%) stools from children with acute diarrhea and none from normal showed cryptosporidi. We conclude that this parasite does play a role in the etiology of human diarrhea.

Scintigraphic evaluation of regional migratory osteoporosis.

Three patients with regional migratory osteoporosis (RMO) of the lower extremity were observed over a period of time with clinical and scintigraphic follow-up. The diagnosis of RMO is clinically and radiographically difficult, but a three-phase bone image is very helpful in diagnosing patients with RMO.

Struma ovarii: hyperthyroidism in a postmenopausal woman.

A rare case of struma ovarii producing hyperthyroidism in a postmenopausal woman is reported. The ovarian tumor demonstrated uptake of both [99mTc]pertechnetate and 131I, allowing preoperative diagnosis of the condition. In females with unexplained hyperthyroidism and low 131I uptake by the cervical thyroid gland, imaging of the pelvis should be considered.

Comparison of leukocytes labeled with indium-111-2-mercaptopyridine-N-oxide and indium-111 oxine for abscess detection.

Indium-111 leukocyte scanning has evolved into a practical and highly accurate method for the identification of infectious and inflammatory processes. The most commonly used agent for labeling leukocytes has been [111In]oxine. We have investigated a newer agent, 2-mercaptopyridine-N-oxide (Merc) at our institution which unlike oxine, allows us to label leukocytes in plasma, using a simple kit procedure. Of the 92 consecutive patients referred for detection or localization of an infectious process, autologous leukocytes of 55 patients were labeled with [111In]Merc, while those of the remaining 37 patients were labeled with [111In]oxine. The sensitivities for Merc and oxine procedures were 87% and 92%, respectively, while the respective specificities were 100% and 92%. We conclude that the [111In]Merc-labeled leukocytes are equally effective as [111In]oxine-labeled leukocytes in detecting infectious processes. The use of [111In]Merc is advantageous over [111In]oxine for white blood cell labeling because of its easier preparation.

Cross-sectional echocardiographic recognition of submitral left ventricular aneurysm.

Three cases of annular submitral left ventricular aneurysm precisely diagnosed by cross-sectional echocardiography are reported from the Indian subcontinent. The cineangiographic findings are available in all and morphologic findings in two cases. The apical four-chamber view demonstrated a characteristically large aneurysm arising below the mural leaflet of the mitral valve extending anterolaterally and posteriorly and communicating with the left ventricular cavity in all the cases. Contrast echocardiography performed during cardiac catheterisation promises to be a good technique for the qualitative assessment of the associated mitral regurgitation. Cross-sectional echocardiography is invaluable in diagnosis and assessment of results of surgery in this entity.

Trial of ketotifen in childhood asthma.

An open trial of Ketotifen was conducted on 29 children suffering from asthma of varying duration. The drug was given orally in a dose of 1 mg twice a day. Children were followed up weekly for a period of 3 months. It was found beneficial (though the benefit was not statistically significant) in children having asthma of less than 2 years duration who were taking one drug regularly or were on occasional treatment. There was marginal effect in children taking salbutamol and theophylline together, but irregularly and no benefit in children taking prednisolone.

Renal allograft rejection. Unusual scintigraphic findings.

During sequential renal imagining for evaluation of clinically suspected rejection, focal areas of functioning renal tissue were seen in two cases of renal transplant in the midst of severe and irreversible renal allograft rejection. A probable explanation for this histopathologically confirmed and previously unreported finding is discussed.