[Pharmacobezoar in a woman with a clomipramine intoxication]. / Een bezoar bij een vrouw met clomipramine-intoxicatie.

BACKGROUND: Medicines with controlled release can cause a rare phenomenon, known as pharmacobezoar, following overdose of these medications. CASE DESCRIPTION: A case of a 56-year-old women with severe clomipramine intoxication is described. X-ray of the abdomen showed a cluster of tablets in the caecum. Lab results showed severe plasma concentration of clomipramine. Patient was treated with active coal and remained stable. CONCLUSION: It is important to be aware of the presence of pharmacobezoar in intoxication with controlled release medicines. The formation of pharmacobezoar can lead to unpredictable duration of intoxication.

Circulating APRIL levels are correlated with advanced disease and prognosis in rectal cancer patients.

We have previously shown that the tumor necrosis factor family member a proliferation-inducing ligand (APRIL) enhances intestinal tumor growth in various preclinical tumor models. Here, we have investigated whether APRIL serum levels at time of surgery predict survival in a large cohort of colorectal cancer (CRC) patients. We measured circulating APRIL levels in a cohort of CRC patients (n=432) using a novel validated monoclonal APRIL antibody (hAPRIL.133) in an enzyme-linked immunosorbent assay (ELISA) setup. APRIL levels were correlated with clinicopathological features and outcome. Overall survival was examined with Kaplan-Meier survival analysis, and Cox proportional hazards ratios were calculated. We observed that circulating APRIL levels were normally distributed among CRC patients. High APRIL expression correlated significantly with poor outcome measures, such as higher stage at presentation and development of lymphatic and distant metastases. Within the group of rectal cancer patients, higher circulating APRIL levels at time of surgery were correlated with poor survival (log-rank analysis P-value 0.008). Univariate Cox regression analysis for overall survival in rectal cancer patients showed that patients with elevated circulating APRIL levels had an increased risk of poor outcome (hazard ratio (HR) 1.79; 95% confidence interval (CI) 1.16-2.76; P-value 0.009). Multivariate analysis in rectal cancer patients showed that APRIL as a prognostic factor was dependent on stage of disease (HR 1.25; 95% CI 0.79-1.99; P-value 0.340), which was related to the fact that stage IV rectal cancer patients had significantly higher levels of APRIL. Our results revealed that APRIL serum levels at time of surgery were associated with features of advanced disease and prognosis in rectal cancer patients, which strengthens the previously reported preclinical observation of increased APRIL levels correlating with disease progression.

Coralline hydroxyapatite is a suitable bone graft substitute in an intra-articular goat defect model.

Intra-articular defects can be filled with an autologous bone graft taken from the iliac crest. This can be indicated after trauma or following correcting osteotomy. Patients may encounter donor site morbidity after this procedure. In this in vivo study, we studied if coralline hydroxyapatite (CHA) is a suitable material to replace autologous bone graft to fill a defect in the femoral trochlea of goats. CHA did not evoke any negative reaction in the synovium, and the articular cartilage was comparable to controls. In the bone graft group, we found scattered areas of (enchondral formed) bone. Most bone graft had been resorbed or remodeled, and the scarce remnants were incorporated into new bone. Resorption of CHA was limited or absent and most CHA was surrounded by new bone. In areas with fragmented CHA, close to the joint surface, numerous giant cells were found. The study shows that in this animal model, CHA inserted in a defect that directly communicates with the joint space incorporates into bone. This study did not show any negative effects of CHA in a joint environment.

Retinal detachment in ocular toxoplasmosis.

PURPOSE: To report on the clinical course and prognosis of retinal breaks and detachment occurring in patients with ocular toxoplasmosis. DESIGN: Retrospective cross-sectional observational study. PARTICIPANTS: One hundred fifty consecutive patients with ocular toxoplasmosis. INTERVENTION: A review of all records of patients with ocular toxoplasmosis who had consulted our department from 1990 through 1997 was performed. MAIN OUTCOME MEASURES: The presence of retinal detachment or breaks and possible risk factors, such as age, myopia, the interval between the last recurrence of inflammation and the onset of retinal detachment, severity of vitritis, previous treatment methods, and the location of the retinal abnormalities, were analyzed. RESULTS: We found a frequency of 6% (9/150) for retinal detachment and an additional 5% (7/150) for retinal breaks among our patients with ocular toxoplasmosis. Attacks of active ocular toxoplasmosis preceding the retinal detachment or retinal breaks were characterized by severe intraocular inflammation. The frequency of myopia in our patients with retinal detachment or retinal breaks was significantly higher than in patients with ocular toxoplasmosis without retinal detachment or retinal breaks. The functional prognosis for the patients with retinal detachment was poor; legal blindness (visual acuity < or = 20/200) resulting from retinal detachment occurred in five of the nine patients. CONCLUSIONS: Careful retinal examination in ocular toxoplasmosis is warranted, especially in patients with myopia and severe intraocular inflammation.

The Schöpf-Schulz-Passarge syndrome.

The Schöpf-Schulz-Passarge syndrome is a rare genodermatosis with autosomal recessive transmission. It is characterized by palmoplantar keratoderma, eyelid apocrine hydrocystomas, hypodontia, hypotrichosis and hypoplastic nails. Several epithelial tumors have been described in this syndrome. This report describes a case with actinic keratoses, two tumors of the follicular infundibulum and one poroma with follicular differentiation. This is the first report of an association between the Schöpf-Schulz-Passarge syndrome and a poroma with follicular differentiation.

Azithromycin for ocular toxoplasmosis.

AIMS: To investigate the efficacy of azithromycin in patients with ocular toxoplasmosis. METHODS: 11 immunocompetent patients with ocular toxoplasmosis were treated with azithromycin (500 mg the first day, followed by 250 mg/day for 5 weeks). Ocular and systemic examinations were performed during active retinitis episodes and all patients were followed for at least 1 year. RESULTS: The intraocular inflammation disappeared within 4 weeks in seven patients, including two cases with progressive retinitis despite previous treatment with pyrimethamine, sulphadiazine, and folinic acid. Recurrence of retinitis occurred in three patients (27%) within the first year of follow up. No systemic side effects of azithromycin were encountered. CONCLUSION: These results indicate that although azithromycin cannot prevent recurrent disease it may be an effective alternative for patients with ocular toxoplasmosis who cannot tolerate standard therapies.

Neonatal neurological outcome after low-risk pregnancies.

OBJECTIVES: To study neonatal neurological outcome and obstetrical interventions in a low-risk population. STUDY DESIGN: A prospective non-randomised study. SETTING: Six midwife practices, nine general practices in and around the city of Nijmegen, The Netherlands, and the obstetrical service at the Nijmegen University Hospital. SUBJECTS: 766 midwife/general practitioner deliveries and 268 deliveries guided by obstetricians using electronic fetal monitoring, all after low risk pregnancy (one out of three selected), 49.2% of the women delivered at home. METHODS: Neurological examination of the fullterm newborn infant according to Prechtl (1977). RESULTS: The deliveries directed by the obstetricians showed higher complication and intervention rates for primiparae and multiparae. Primiparous deliveries involved longer labor and firstborns showed lower neurological outcome. There were no differences in neonatal neurological outcome between groups attended by midwives, general practitioners or obstetricians despite the lower social profile of the hospital group. CONCLUSION: For the outcome of low-risk pregnancy, the place of birth in the Nijmegen area is irrelevant. Further investigations on the physiology of the first pregnancy and on the causes of the higher complication and intervention rates in hospital deliveries are recommended.

Computed tomography of pleural hyaloserositis.

Pleural hyaloserositis is an uncommon finding on routine chest X-rays. The images may simulate metastatic lesions. Four cases of pleural hyaloserositis are described in which computed tomography (CT) demonstrated calcified pleural pseudotumors.

Psoas abscess and giant fistula twenty-one years after nephrectomy.

Vague abdominal complaints and low back pain are common in modern medicine. We describe the case of a patient who presented these symptoms twenty-one years after a nephrectomy accompanied by persistent elevated erythrocyte sedimentation rate for unknown reason. CT and fistulography showed a psoas abscess and a giant fistula.

Xanthogranulomatous pyelonephritis: comparison of extent using computed tomography and magnetic resonance imaging in one case.

In a case of diffuse xanthogranulomatous pyelonephritis, computed tomography (CT) and magnetic resonance (MR) were used. The MR proved to be more precise in the preoperative evaluation of inflammatory extension to the spleen and into the abdominal wall. The CT was more accurate in excluding spread to the colon.

Percutaneous transluminal angioplasty during operation.

In certain cases it can be useful to perform percutaneous transluminal angioplasty (PTA) and vascular surgery in the same session. The PTA procedure has to be performed by the radiologist through an artery that has been prepared and visualized by the vascular surgeon. This combined procedure usually lessens the number of hospitalization days and offers the patient the advantage of being cured in one session.

Epidermodysplasia verruciformis. Skin carcinoma containing human papillomavirus type 5 DNA sequences and primary hepatocellular carcinoma associated with chronic hepatitis B virus infection in a patient.

In a case of epidermodysplasia verruciformis with impaired cell-mediated immunity and multiple skin cancers human papillomavirus type 5 (HPV5) DNA sequences were demonstrated in a cutaneous squamous cell carcinoma. HPV5 and HPV8 were detected in the benign disseminated skin lesions together with three newly characterized HPVs: HPV17, HPV19 and HPV24. A chronic infection with hepatitis B virus resulting in macronodular cirrhosis associated with a primary hepatocellular carcinoma was also acquired by this patient. This case provides an example of the circumstantial evidence which suggests that certain types of HPV are potentially oncogenic and stresses the importance of immune surveillance in the protection against virus-associated tumors.

Hepatic disease in erythropoietic protoporphyria.

A standardized hepatological investigation was performed in 9 unselected patients with erythropoietic protoporphyria (EPP). The aim of this study was to detect early liver involvement due to EPP and to determine the significance of several diagnostic procedures. Scintigraphy revealed slight enlargement of liver and spleen in all cases. Light microscopic examination of liver tissue in 7 patients showed protoporphyrin deposition in 4 and signs of fibrosis in 3 cases. Cirrhosis was not found. Electron microscopical examination (EM) of all 7 cases was negative and needle-shaped crystals were not found. Therefore we regard EM of little diagnostic value in the detection of early liver involvement. The literature on fatal and asymptomatic cases of liver involvement in EPP is discussed with emphasis on possible predictive and provocative factors. A proposal for EPP patients intending to reduce possible risk factors is made.