Fatal haemorrhage following fine needle aspiration of the thyroid.

Fine needle aspiration is routinely performed as part of the assessment of thyroid nodules. It is generally regarded as a very safe procedure, though rarely significant bleeding can occur in its aftermath. A 79-year-old female was referred for assessment of an incidental thyroid nodule which had been identified on computed tomography of the chest and extended into the retrosternal space. The patient was referred for fine needle aspiration under ultrasound guidance. Three passes were made with a 25 gauge needle into the nodule; a haemorrhagic aspirate was obtained and sent for cytological examination. Several hours later, the patient developed a cough and progressive breathlessness and died at home before she could be taken to hospital. The key finding from the post-mortem was extensive haemorrhage within the capsule of thyroid. In the absence of another identifiable aetiology, the cause of death was considered to be acute haemorrhage into the thyroid gland. Thyroid fine needle aspiration is generally a safe procedure, but it is important to recognise that, rarely, major complications can occur.

A high tuberculosis case-fatality rate in a setting of effective tuberculosis control: implications for acceptable treatment success rates.

Worldwide, the case-fatality rate of smear-positive pulmonary tuberculosis among persons on treatment is 3.8%. We assessed the case-fatality rate among such patients in Baltimore between January 1993 and June 1998. Tuberculosis incidence was < 17/100 000 population, and 99% of patients received directly observed therapy. Of 174 patients, 42 (24%) died on treatment. Patients who died were older (mean age 62 vs. 47 years; P < 0.001) and were more likely to have underlying medical conditions. In multivariate analyses, older age, diabetes mellitus, and renal failure were independently associated with an increased risk of death. With effective control, tuberculosis may become concentrated in older persons with chronic diseases and be associated with high case-fatality rates. In such settings, acceptable treatment success rates may need to be revised.

Solvent extraction of scandium from malonic acid with high molecular-weight amines.

Scandium is quantitatively extracted with 4% Amberlite LA-1 or Amberlite LA-2 in xylene at pH 2.5-5.5 from 0.1M malonic acid. Scandium is stripped from the organic phase with 0.5M hydrochloric acid and determined spectrophotometrically at 525 nm, as its complex with Alizarin Red S. Primene JM-T, tri-iso-octylamine, tributylamine and tribenzylamine have also been studied as extractants, but found to be unsatisfactory for various reasons. Xylene, toluene, benzene, chloroform, carbon tetrachloride, hexane, cyclohexane and kerosene have been studied as diluents. Xylene is found to be the most efficient. Scandium can be separated from most metals by selective extraction, and from gallium, thallium(III), bismuth, antimony(III), chromium(III), copper(II), iron(III), uranium(VI), cerium, zirconium, indium, thorium and titanium by selective stripping, in some cases combined with use of suitable complexing media to retain the other metals in the organic phase.

Analytical applications of a liquid anion-exchanger for the separation of uranium(IV) in malonate solution.

Uranium was quantitatively extracted with 4% Amberlite LA-1 in xylene at pH 2.5-4.0 from 0.001 M malonic acid. It was stripped from the organic phase with 0.01 M sodium hydroxide and determined spectrophotometrically at 530 nm as its complex with 4-(2-pyridylazo) resorcinol. Of various liquid anion-exchangers tested, Amberlite LA-1 was found to be best. Uranium was separated from alkali and alkaline earth metal ions, thallium(I), iron(II), silver, arsenic(III) and tin(IV) by selective extraction, and from zinc, cadmium, nickel, copper(II), cobalt(II), chromium(III), aluminium, iron(III), lead, bismuth, antimony(III) and yttrium by selective stripping. The separation from scandium, zirconium, thorium and vanadium(V) was done by exploiting differences in the stability of chloro-complexes.

Gender identity disorder : a report of three cases.

Gender Identity Disorder (GID) is a complex problem. This report describes three cases of GID with more or less similar clinical presentation. It was interesting to note that inspite of the similarity in their early clinical features, their own approach towards their illness, the reaction of the family members and the outcome were different. The report also highlights the need for different therapeutic approaches required in the individual cases.

An open study of clozapine in the treatment of resistant schizophrenia.

This open study was undertaken to assess the efficacy of clozapine in resistant schizophrenics, its side effects and safety profile and the mean dose required. Sample consisted of 28 patients who had been previously treated with neuroleptics and ECTs. A special proforma was prepared for recording the psychopathology and side effect profile. The complete blood count, differential count and BPRS scores were recorded weekly for a period of 3 months. Within 1 month of treatment on a dose range of 100-200 mg/day a 25%-50% decline in the BPRS score was noticed, the mean dose required was 241 mg/day. Sedation and sialorrhoea constituted the commonest side effects in 90% patients. No case of agranulocytosis was reported. The implications of the study are discussed.

A low prevalence of the C677T mutation in the methylenetetrahydrofolate reductase gene in Asian Indians.

The prevalence of the C677T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene in Asian Indians from India was determined and the association of the mutant allele with coronary artery disease (CAD) was evaluated in a case-control study. The case group consisted of 251 patients with CAD; 195 male and 56 female aged from 29 to 82 years (mean age +/- SD, 57.5 +/- 10.6 years). The control group consisted of 216 apparently healthy individuals without evidence of CAD; 161 male and 55 female aged from 30 to 83 years (mean age +/- SD, 54.9 +/- 10.4 years). All the patients were assessed by coronary angiography. While 33 patients had normal coronaries, 23, 25 and 39 patients had single-vessel, two-vessel and triple-vessel disease, respectively. Eighty-three patients (33%) had suffered myocardial infarction less than a year to five years earlier. The C677T polymorphism in the MTHFR gene was assessed. While 31% of the controls and 38% of the patients had the heterozygous genotype, 2% of the control group and none of the patients had the mutant homozygous genotype. The overall 'T' allelic frequencies were comparable in control and patient groups (0.18 and 0.19, respectively), but the association of the sum of heterozygous and homozygous genotypes with CAD (1, 2 or 3-vessel disease) was statistically significant for females only [Odds ratio (95% confidence intervals), 2.8 (1.1-6.9), p = 0.023]. No association was found between genotype distribution and previous myocardial infarction or severity of atherosclerosis.

In vivo evaluation of tigemonam, a novel oral monobactam.

Tigemonam, a new monobactam with excellent activity against gram-negative bacteria, was evaluated for in vivo efficacy and absorption after oral administration to laboratory animals. Tigemonam is absorbed when administered orally to mice and dogs. In a variety of gram-negative systemic infections in mice, orally administered tigemonam was efficacious in all infections studied. Comparison drugs such as amoxicillin, cephalexin, and cefaclor were less efficacious, especially in infections caused by beta-lactamase-producing organisms. In localized infections, tigemonam also demonstrated excellent in vivo activity. In acute pyelonephritis in mice caused by Escherichia coli or Proteus sp., tigemonam was very effective. In a rat lung model with Klebsiella pneumoniae, tigemonam was active with a median effective dose of 46 mg/kg compared with 160 mg/kg for cefaclor and over 200 mg/kg for amoxicillin. Tigemonam was well absorbed in laboratory animals and with its excellent gram-negative spectrum of activity should prove of value in oral antibiotic therapy in humans.