Rhabdomyolysis in an obese patient after total knee arthroplasty.

We report the case of a morbidly obese patient who developed rhabdomyolysis with acute renal failure, hepatic dysfunction, and an increase of cardiac troponin-1 after total knee arthroplasty. Postoperative rhabdomyolysis has a wide range of triggers and differential diagnoses that should be considered by the anaesthesiologist and surgeons. We would like to emphasize that morbidly obese patients have an increased risk of developing postoperative rhabdomyolysis potentially leading to life-threatening disease. Intensified postoperative observation seem justified in these patients.

CD64 surface expression on neutrophils is transiently upregulated in patients with septic shock.

OBJECTIVE: To clarify the changes in total leukocyte counts, CD64 neutrophil receptor expression and serum granulocyte colony-stimulating factor (G-CSF) concentrations in critically ill patients without infection and sepsis and in patients with septic shock. DESIGN: Prospective study. SETTING: Intensive care unit (ICU) and research laboratory of a university hospital. PATIENTS: Eleven critically ill patients without infections and 22 patients with proven infections in septic shock for the first time and of at least 3 days' duration. MEASUREMENTS AND RESULTS: Over a 6month period, a longitudinal analysis of expression of the monomeric Fc receptor type I (CD64, FcgammaRI) on neutrophils was performed by flow cytometric analysis on a daily basis in all postoperative/post-traumatic patients admitted to the ICU until discharge from the ICU or death. Out of 273 patients, 11 patients without sepsis had organ failure and 22 patients with proven infections had septic shock for the first time and of at least 3 days' duration. Ten out of the 22 patients survived, 12 died. CD64 expression was greater in patients with septic shock than in patients without sepsis. Moreover, CD64 expression was only initially and transiently elevated in most survivors (9/10) and non-survivors (8/12) of septic shock. In survivors, G-CSF serum concentrations were markedly decreased in the 2nd week. CONCLUSIONS: Decreased neutrophil CD64 expression in an acutely ill population with septic shock may reflect the development of a non-responsive state as well as the early downregulation of neutrophil activation prior to the resolution of an ongoing infection.

[Hydroxy-methyl-glutaryl-coenzyme A lyase deficiency manifesting as Reye's syndrome in a 3-year-old girl]. / Déficit en hydroxy-méthylglutaryl-coenzyme A lyase révélé par un syndrome de Reye chez une fille de 3 ans.

The authors report on one case of 3-hydroxy-3-methylglutaryl-coenzyme A lyase (HMG-Co A lyase) deficiency in a 3 year-old girl, presenting as Reye's syndrome. Urinary organic profile suggested this inherited metabolic disease; decreased activity of HMG-Co A lyase was demonstrated in cultured fibroblasts. The metabolic etiologies of Reye's syndrome are summarized; clinical, biological, and therapeutic assessment of HMG Co A lyase deficiency are developed. The pattern of organic aciduria must be studied in all patients presenting with Reye's syndrome.

Splenic variations affecting sarcomagenesis among mice of an inbred strain.

Among overtly identical mice of an inbred strain, some are relatively susceptible and some relatively resistant to sarcomagenesis by large concentrations of 3-methylcholanthrene (MCA) (Prehn, 1975 a). Spleen cells from mice, subsequently shown to be relatively susceptible, conveyed a relative resistance to oncogenesis when transferred to irradiated recipients; spleen cells from mice, subsequently shown to be relatively resistant, conveyed to secondary hosts a relative susceptibility.

Is work conducive to self-destruction?

While the current literature contains numerous studies and even more numerous assumptions linking aspects of the work setting, stress, and mortality; no systematic investigation has been made of possible patterns of stress-induced self-destructive behaviors among the work settings per se. This research paper attempts to help fill that gap by reporting on an analysis of data on industry, age and mortality rates for seven stress-related causes of death (suicide, homocide, hypertensive heart disease, cirrhosis of the liver, arteriosclerotic heart disease, ulcer of the stomach, and hypertension). Using available United States' mortality statistics, a consistent pattern is found for all of the stress-related types of deaths by industry and age. A suggested explanation of this pattern is based on status integration theory.