Corrigendum to "Malignant retroperitoneal PEComa: A case report with emphasis on radiological findings" [Radiology Case Reports 18 (2023) 1358-1363].

[This corrects the article DOI: 10.1016/j.radcr.2022.11.042.].

Accessibility and quality of secondary care rheumatology services for people with inflammatory arthritis: a regional survey.

Secondary care rheumatology services for patients with inflammatory arthritis (IA) in the West Midlands were audited using Arthritis and Musculoskeletal Alliance (ARMA) standards of care. Questionnaires were analysed from 1,715 patients in 11 rheumatology departments. ARMA standards recommend full multidisciplinary team assessment; referral rates to nurse specialists (52.3%), physiotherapists (48.7%) and occupational therapists (36.5%) were, however, lower than expected. Attendance at existing hospital-led education groups was rare (8.9%), awareness of existing helplines was moderate (59.2%) but the proportion of patients reporting satisfaction with advice about their disease was high (80.5%). Significant variations were found between departments. For patients with IA < 2 years (n = 236), 84.5% were seen by a rheumatologist within the ARMA standard of 12 weeks of referral; diagnosis of a type of IA was made at the first rheumatology appointment in 66.4%; 82.8% of rheumatoid arthritis patients had commenced disease-modifying drugs, although time to commencement varied across departments. This study raises issues regarding provision of rheumatology services, prioritisation of patient referral and patient education.

Follow-up screening of lead-poisoned children near an auto battery recycling plant, Haina, Dominican Republic.

In August 1997 we performed a follow-up survey of 146 lead-poisoned children from a community near a previously active auto battery recycling smelter in Haina near Santo Domingo, Dominican Republic. Our follow-up survey confirmed a severe incidence of elevated blood lead (BPb) and erythrocyte protoporphyrin/zinc protoporphyrin (EP-ZnPP) levels. The mean BPb level was 32 micrograms/dL and the mean EP-ZnPP level was 128 micrograms/dL. The frequency distribution of BPb showed that only 9% of the children had BPb levels below the currently acceptable 10 micrograms/dL threshold level, 23% had between 10 and 19 micrograms/dL, 40% had between 20 and 39 micrograms/dL, 27% had between 40 and 99 micrograms/dL, and the remainder had > 100 micrograms/dL. These findings are significantly greater than the mean BPb and EP-ZnPP levels of 14 and 35 micrograms/dL, respectively, in a comparison group of 63 children in Barsequillo, 4 miles away. BPb frequency distributions for these groups were < 10 micrograms/dL (42%), 10-19 micrograms/dL (32%), and 20-39 micrograms/dL (16%); in the remaining 10%, BPb levels were between 40 and 99 micrograms/dL. Similarly, the corresponding frequency distribution of EP-ZnPP levels in Haina children were proportional to the severity of lead poisoning and significantly higher than those of the Barsequillo comparison group. This study reveals that at least 28% of Haina children require immediate treatment; of these, 5% with lead levels > 70 micrograms/dL are also at risk for severe neurologic sequelae, and urgent action is imperative.

Clinical use of diuretics in congestive heart failure.

Loop diuretics have become indispensable in the management of patients with cardiac decompensation and severe edema. To evaluate the relative potency of these agents, bumetanide and furosemide were compared in 20 patients with edema associated with congestive heart failure in a double-blind, parallel study design. The dosage of the drugs administered daily for three days was 1 to 2 mg bumetanide or 80 mg furosemide. Both agents were highly effective in reducing the edema and relieving the symptoms of heart failure. Muscle cramps and abdominal pain as side effects were deemed not severe. Laboratory values indicative of mild hypochloremic alkalosis and hyponatremia were observed in two patients. Hypokalemia and reversible eighth-nerve involvement were not apparent in this study.

Renal electrolyte excretion pattern in response to bumetanide in healthy volunteers.

Renal electrolyte excretion patterns were determined in nonedematous healthy volunteers following bumetanide and furosemide in two separate clinical studies. In study 1, intravenous bumetanide was administered to 24 subjects at four dose levels. In study 2, bumetanide (1 or 2 mg) or furosemide (40 or 80 mg) was administered in a single oral dose to 32 subjects assigned at random to one of the four treatment groups. In study 1, there was a significant dose-related increase in urine volume and sodium, potassium, and chloride excretion, with chloride exceeding sodium at all dose levels, and the Na+/K+ ratios after bumetanide were greater than 3:1. In study 2, the Na+/K+ ratio increased significantly after treatment in all four treatment groups. The relative Na+/K+ ratios showed higher natriuretic potency and lower kaliuretic potency for bumetanide than for furosemide, but the differences were not statistically significant. Additionally, all four treatment groups demonstrated elevation in titratable acidity, ammonia formation, and total acid excretion. There was a significant degree of positive correlation in the bumetanide-treated groups between Na+/K+ and the three variables. In the furosemide-treated groups, this positive correlation was statistically significant between the Na+/K+ ratio and ammonia and total acid secretion but not for titratable acidity. The results support the view that increased H+ formation after the administration of loop diuretics has a relative potassium-sparing effect.

Carriage of Cryptococcus neoformans in the crops of pigeons.

Cryptococcus neoformans was found in the crops of four (1.3%) of 319 pigeons in the Charity Bird Hospital and the University Campus, Delhi. It was demonstrated repeatedly at the Bird Hospital in old pigeon excreta as well as in the air. The findings substantiate the current view that the pigeon itself is not a reservoir of C. neoformans although it may serve as a carrier of the fungus.

Unusually high creatine kinase BB isoenzyme and study of lactate dehydrogenase pattern in metastatic adenocarcinoma of the prostate.

We report a case of metastatic adenocarcinoma of the prostate with widespread bony and hepatic involvement having extremely high BB isoenzyme of creatine kinase in serum (2405 U/liter). The serum LD5/LD1 ratio is greater than one, with total LD activity more than twenty-five fold the normal value. The homogenate of prostate gland of the patient shows an extra band with electrophoretic mobility between MM and MB isoenzymes of creatine kinase and highly elevated LD5 fraction compared to LD1 (33% vs. 9%), a remarkable LD isoenzyme pattern of malignant prostate tissue.

Signification of high density and total cholesterol and triglycerides in acute myocardial infarction -- a case-control study.

This case-control study of acute myocardial infarction showed no statistical significant difference between the mean total cholesterol levels (5.45 vs. 5.26 mmol/L) of coronary patients (n = 40) and matched controls (n = 80). Also no significant association (p = 0.180) was found for HDL cholesterol between cases and controls (1.05 vs. 1.43 mmol/L). However, coronary patients had significantly (p = 0.0001) higher values of both total triglycerides (2.38 vs. 1.75 mmol/L) and HDL triglycerides (0.411 vs. 0.76 mmol/L) than the matched controls. Furthermore, for all subjects (cases and controls), both HDL cholesterol and (r = 0.337, p = 0.0002) and total triglycerides (r = 0.459, p = 0.0001). Findings of this study and others cast doubt on the use of HDL cholesterol levels, especially single determinations, in the management of coronary patients by the clinicians. We suggest that levels of total and HDL triglycerides, along with modification of other risk factors, should constitute the intervention modality for coronary artery disease.

Screening of azo dyes for mutagenicity with Ames/Salmonella assay.

Azo dyes, the largest portion of manufactured dyestuffs, are primarily used as colouring substances in food, textiles, and the plastic industry. It has been estimated that 128 tonnes per annum of dyes are released into the environment worldwide [Anliker, 1977]. Certain azo compounds are known to be mutagenic in bacterial tests [Yahagi et al., 1975; Venitt and Bushell, 1976; Brown et al., 1978]. Watersoluble dyes are biotransformed by intestinal micro-organisms in the gastro intestinal tract, and the toxicity, mutagenicity, and carcinogenicity of these dyes in the gut or liver may be attributed to their metabolites. Since it is desirable to have a genotoxic evaluation of a chemical being released into the environment in order to check their indiscriminate use, a project has been initiated to determine the mutagenicity of the azo dyes being used commercially. The present report deals with the results of 13 dyes tested in Salmonella typhimurium with and without metabolic activation.

Measurement of endotracheal tube cuff leak to predict postextubation stridor and need for reintubation.

BACKGROUND: The purpose of this study was to determine the predictive value of an endotracheal tube cuff leak for the development of postextubation stridor and the need for reintubation. STUDY DESIGN: Consecutive trauma patients who required intubation at a level I trauma center from July 1997 to July 1998 were studied prospectively. Pediatric patients and those who did not meet the standard weaning protocol criteria established by the Division of Trauma and Surgical Critical Care were excluded. Injury Severity Score, endotracheal tube size, reason for intubation, and the number of days intubated before the initial extubation attempt were recorded. At the time of extubation, the difference in exhaled tidal volume from before to after endotracheal tube cuff deflation was calculated. This number was then divided by the exhaled tidal volume before cuff deflation and was recorded as the percent cuff leak. Patients were followed for 24 hours after extubation for the development of stridor or need for reintubation. Statistical analysis to compare subgroups of patients was performed using ANOVA with Scheffé post hoc analysis. RESULTS: Among the 110 patients analyzed, the most common reason for intubation was closed-head injury. Seven patients (6.4%) developed stridor alone and had a mean cuff leak of 5 8 mL (8.4% of tidal volume before cuff deflation). Six patients (5.5%) experienced stridor that required reintubation and had a mean cuff leak of 68 mL (9.2% of tidal volume before cuff deflation). Patients who developed stridor or needed reintubation had been intubated for a significantly greater length of time than those not developing stridor or requiring reintubation (2.6 versus 3.0 days, p < 0.001). There were no differences in Injury Severity Score, endotracheal tube size, or reason for intubation between these groups. CONCLUSIONS: A cuff leak of less than 10% of tidal volume before cuff deflation is useful in identifying patients at risk for stridor or reintubation (96% specificity). It appears that the amount of cuff leak decreases after intubation for more than 3 days, increasing the risk of stridor and need for reintubation. This information may be helpful in identifying those patients who need treatment for laryngotracheal edema, ie, use of steroids or anesthesia during extubation, the efficacy of which remains to be determined.

Purification and properties of four monocot lectins from the family Araceae.

Four new monocot lectins from the tubers of araceous plants, namely, Arisaema consanguineum Schott (ACA), A. curvatum Kunth (ACmA) and Sauromatum guttatum Schott (SGA) from the tribe Areae, and Gonatanthus pumilus D. Don (GPA) from the tribe Colocasieae have been purified by affinity chromatography on asialofetuin-linked amino activated silica beads. These lectins possess similar physicochemical and biological properties. All the lectins gave a single peak on HPLC size exclusion and cation exchange columns, and a single band on PAGE, (pH 4.5). In SDS-PAGE, all the lectins gave a single band corresponding to a subunit of M(r) 1,3000. All the lectins yielded multiple peaks on anion-exchange column, multiple bands on non-denatured PAGE (pH 8.3) and a family of bands on isoelectric focusing. The lectins agglutinate rabbit, rat and sheep red blood cells (RBCs) but are inactive towards human ABO erythrocytes. The haemagglutination activity of these lectins is inhibited by asialofetuin only, while simple sugars/derivatives including chitin, porcine mucin and fetuin did not react. In serological studies against rabbit anti-SGA serum, all four lectins produced immunoprecipitin lines. The lectins within each tribe were identical but the lectins belonging to the tribe Areae were only partially identical to the lectins from the tribe Colocasieae.

Amaranthus hypochondriacus and A. tricolor lectins: isolation and characterization.

Asialofetuin-linked amino activated silica was used for the affinity purification of lectins from Amaranthus hypochondriacus Linn (AHL) and A. tricolor Linn (ATL). Like a few other Amaranthus lectins, these lectins were also inhibited by N-acetyl-D-galactosamine, fetuin and asialofetuin; they agglutinated human and different animal erythrocytes. The purified lectins yielded a single band on PAGE pH 8.3, pH 4.5 and SDS-PAGE, pH 8.3. These also gave a single peak in gel exclusion on Biogel P-200, HPLC 300 SW and cation exchange columns. However, both lectins gave multiple peaks in anion exchange column and multiple bands in isoelectric focusing. AHL and ATL are dimeric proteins in which the subunits having M(r) 29,000 and 39,000, respectively, are not held together by disulphide linkages. The pure lectins are glycoproteins and do not require Ca2+, Mn2+ and Mg2+ for their agglutination activity.

Prevalence of pulmonary nocardiosis in a tuberculosis hospital in Amritsar, Punjab.

The prevalence of pulmonary nocardiosis in a tuberculosis and chest diseases hospital in Amritsar is reported. Of 1510 sputum samples cultured from 1016 patients, 67 sputa originating from 16 patients were found to be positive for the Nocardia asteroides species complex. Based upon repeated isolation of N. asteroides from the respiratory tract, its microscopic demonstration in KOH wet mounts or stained smears of sputum and clinical evaluation of patients, 14 cases of pulmonary nocardiosis were diagnosed. This gave a prevalence of 1.4% pulmonary nocardiosis in the tuberculosis hospital. The prevalence of the disease was found to be 1.3% in the males as against 1.5% in the females. Of the various clinical categories of patients investigated, pulmonary tuberculosis with sputum negative for acid-fast bacilli (AFB) yielded the highest prevalence of 3.2%, followed by 1.3%, 1.2%, 1.1% and 0.5% in pneumonia, chronic obstructive pulmonary disease (COPD), bronchiectasis and pulmonary tuberculosis with sputum positive for AFB, respectively. Type IV cutaneous hypersensitivity to nocardin was observed in 19 of 908 (2%) patients tested, whereas only a solitary positive reactor was found among 260 healthy volunteers. Twelve of 19 nocardin positive reactors (63%) had unequivocally proven pulmonary nocardiosis. The nocardin skin test gave false negative results in two nocardiosis patients. More comprehensive investigations are warranted in order to evaluate the nocardin skin test as an additional aid for the diagnosis of nocardiosis. Barring a solitary exception, the nocardiosis patients were successfully treated with sulphadiazine or trimethoprim-sulphamethoxazole (TMP-SMZ) combination. To the best of our knowledge, this is the largest series of pulmonary nocardiosis patients in a prospective study as yet reported from India. The observations underscore the point that nocardiosis warrants greater attention in the differential diagnosis of bronchopulmonary diseases.

Immunological significance of Aspergillus fumigatus in cane-sugar mills.

An aeromycological study has revealed the preponderance of Aspergillus fumigatus at the bagasse-containing sites in sugar-cane mills located in the northwestern part of the Punjab State. The fungus was frequently isolated from the sputum cultures of the mill workers and a significant number of the workers were positive reactors when challenged intracutaneously with aspergillin. Immediate Type I and late Arthus Type skin hypersensitivity was observed in 10.6% and 4.4%, respectively, of the 548 workers investigated. Incidence of hypersensitivity was particularly high among workers having chronic respiratory problems. During a sample survey of 238 workers having chronic respiratory diseases, diagnoses of allergic bronchopulmonary aspergillosis, and allergic bronchopulmonary candidiasis based on positive clinical and laboratory findings, were made in 17 (7.1%) and in only 4 (1.7%) of the cases, respectively. Evidence is presented to support that the epidemiology of allergic bronchopulmonary aspergillosis, but not of allergic bronchopulmonary candidiasis, may have an occupational dimension.