Long-standing symptomatic cryptosporidiosis in a normal man: clinical response to spiramycin.

A healthy immunocompetent 26-year-old man developed prolonged symptomatic cryptosporidiosis. He only achieved clinical improvement after treatment with spiramycin. Other family members suffered from chronic undiagnosed diarrhea, and resolution occurred only after a trial of spiramycin. Thus, Cryptosporidium had provoked a prolonged symptomatic infection in a normal host; spiramycin therapy was required for parasite eradication and clinical cure, and a therapeutic trial with spiramycin was beneficial for family members with chronic undiagnosed diarrhea. Many infections with Cryptosporidium have serious morbidity, and thus, spiramycin may be more generally indicated in the treatment of this infection.

Identification and characterization of an 8-kd peptide stimulating late erythropoiesis.

Chronic renal failure is often associated with severe anemia, subnormal levels of erythropoietin (EPO), and the presence of erythropoietic inhibitors. We studied an anephric patient with polycystic kidney disease maintaining a hemoglobin level of 13-14 g. Biochemical, endocrine, and hematological parameters were all within normal limits. EPO levels examined on two occasions during the clinical investigation were found to be low to subnormal. Plasma of this patient supported human bone marrow erythroid colony formation without the addition of exogenous EPO. Following reversed-phase high pressure liquid chromatography (HPLC) and gel filtration HPLC of the patient's plasma, a small polypeptide was identified that stimulated thymidine incorporation into fetal calf liver cells and supported erythroid colony formation of human marrow cells. This molecule is different from EPO with respect to its molecular weight and its functional and chromatographic properties. In this report we provide evidence of a human plasma-derived peptide of an anephric patient regulating late erythropoiesis.

Reading habits of house-staff: what, where and why.

As in-training evaluations often comment that house-staff do not read enough about cases, this study looked at the reading habits of internal medicine students and house-staff to assess whether they were reading about cases. All 38 trainees at a major teaching hospital were surveyed with a questionnaire. Overall, the house-staff read 8.7 hours/week, of which half is spent reading about cases. They read around approximately half of the cases they see. The more senior house-staff use journals and one major textbook; the medical students use only textbooks. The reading is done mainly at home, except by the senior residents who spent a quarter of their reading time in the library. The major reasons why the house-staff read are to prepare for presentations or for rounds with the attending physicians. These results suggest that contrary to what we anticipated, house-staff do indeed read about the cases they see on the wards.