Microthrombotic renal involvement in an SLE patient with concomitant catastrophic antiphospholipid syndrome: the beneficial effect of rituximab treatment.

Antiphospholipid syndrome is characterized by multiple arterial and/or venous thrombotic events, recurrent fetal losses in the presence of antiphospholipid antibodies (aPL). Catastrophic antiphospholipid syndrome is a life-threatening, rare subset of antiphospholipid syndrome when the thrombotic events affect at least three organs, and clinical manifestations develop simultaneously or within a week. Diagnostically, small vessel occlusions can be detected by histopathology in the presence of aPL. Our case report describes an 18-year-old man who has been treated for antiphospholipid syndrome associated with systemic lupus erythematosus (SLE) since 2011. The clinical findings were dominated by recurrent deep vein thrombosis, and severe proteinuria caused by lupus nephritis, accompanied by mild serological and laboratory findings. The patient was hospitalized in March 2014 because of severe thrombocytopenia and infective diarrhoea. At this time the renal functions deteriorated rapidly. Simultaneously, left upper extremity paresis was observed; computed tomography showed ischaemic lesions in the territory of the middle cerebral artery. Abdominal discomfort and pain occurred. On computed tomography scan ischaemic lesions were seen in the spleen, the right kidney and the coeliac trunk. Laboratory and serological findings verified the presence of aPL and anti-DNA antibodies, anaemia and thrombocytopenia. Based on the above-mentioned clinical and laboratory findings, the diagnosis of catastrophic antiphospholipid syndrome was established. Anticoagulation, corticosteroids and plasma exchange treatment, as well as haemodiafiltration were initiated. Although the thrombotic cascade decelerated following these interventions, we could not see an improvement in the renal function. Rituximab treatment was started, leading to a significant improvement in renal function. After 5 weeks of treatment the patient was discharged from hospital.

Leaf litter decomposition in Torna stream before and after a red mud disaster.

The aim of the study was to estimate the breakdown of the allochthonous litter in an artificial stream running in an agricultural area and compare it with the same values following a toxic mud spill into the same stream. Litter bags were filled with three types of leaves (Quercus robur, Populus tremula and Salix alba) and placed to the bottom of the river. Ergosterol was used to detect fungal biomass. We supposed the absence of fungi and the retardation of leaf litter decomposition. Only pH and conductivity increased significantly. Leaf mass loss after the catastrophe was much slower than in 2009 and the decay curves did not follow the exponential decay model. Prior to the catastrophe, leaf mass loss was fast in Torna, compared to other streams in the area. The reason is that the stream is modified, the bed is trapezoid and covered with concrete stones. Fungal biomass was lower, than in the pre-disaster experiment, because fungi did not have enough leaves to sporulate. Leaf mass loss followed the exponential decay curve before the disaster, but after that it was possible only after a non-change period.

A feasible model for prevention of functional decline in older home-dwelling people--the GP role. A municipality-randomized intervention trial.

BACKGROUND: Danish municipalities are required by state law to offer two annual home visits to all non-disabled citizens > or =75 years. Visits are primarily carried out by district nurses. GPs are rarely directly involved. OBJECTIVE: To evaluate the effects of offering an educational programme to home visitors and GPs on mortality, functional ability and nursing home admissions among home-dwelling older people. DESIGN: Municipality pair-matched randomized trial. SETTING: Danish primary care. SUBJECT: 2863 home-dwelling 75-year-olds and 1171 home-dwelling 80-year-olds living in 34 municipalities. INTERVENTION: Home visitors received regular education for a period of 3 years. In nine of 17 intervention municipalities, GPs participated in one small group training session during the first year. MAIN OUTCOME MEASURES: Mortality, functional ability and nursing home admission during 4(1/2) years of follow-up. RESULTS: INTERVENTION was not associated with mortality. Home visitor education was associated with reduction in functional decline among home-dwelling 80-year-olds after the three intervention years in municipalities where GPs accepted and participated in small group-based training. Effects did not persist after the intervention ended. When analyses were restricted to baseline non-disabled persons, intervention was associated with beneficial effects on functional ability after three intervention years among 80-year-olds, regardless of education was given to home visitors alone or to visitors and GPs. Nursing home admission rates were lower among the 80-year-olds living in the intervention municipalities. CONCLUSION: A brief, practicable interdisciplinary educational programme for primary care professionals postponed functional decline in non-disabled 80-year-old home-dwelling persons.

Educational intervention toward preventive home visitors reduced functional decline in community-living older women.

OBJECTIVE: To investigate whether immediate effects of a 3-year educational intervention in primary health care were confirmed 18 months after the end of the intervention. STUDY DESIGN AND SETTING: A controlled 3-year intervention study in 34 Danish municipalities with randomization and intervention at municipality level. The 17 intervention municipality visitors received regular education, and GPs were introduced to a short assessment program. The effect was measured at the individual level by questions about functional ability at the end of the intervention period and 1(1/2) years later; 4,060 older adults living in the municipalities participated. We adopt the approach introduced by Dufouil et al. (2004) and treat dropouts due to death differently from dropouts from other reasons. RESULTS: Educational intervention to primary care professionals was associated with better functional ability in surviving women at the end of the intervention (odds ratio [OR]: 1.24, 95% confidence interval [CI]=1.07-1.45), from the end of the intervention until 1(1/2) years later (OR: 1.21, 95% CI=1.03-1.44) and during the total study period (OR: 1.22, 95% CI=1.06-1.42). No effects were seen in men. CONCLUSION: The effect of a brief, feasible educational intervention for primary care professionals is sustained in women 1(1/2) years after the end of the intervention.

A scanning drift tube apparatus for spatiotemporal mapping of electron swarms.

A "scanning" drift tube apparatus, capable of mapping of the spatiotemporal evolution of electron swarms, developing between two plane electrodes under the effect of a homogeneous electric field, is presented. The electron swarms are initiated by photoelectron pulses and the temporal distributions of the electron flux are recorded while the electrode gap length (at a fixed electric field strength) is varied. Operation of the system is tested and verified with argon gas; the measured data are used for the evaluation of the electron bulk drift velocity. The experimental results for the space-time maps of the electron swarms - presented here for the first time - also allow clear observation of deviations from hydrodynamic transport. The swarm maps are also reproduced by particle simulations.

Uterine chromatin template activity during the early stages of pregnancy in the rat.

1. The template activity of chromatin prepared from rat uterine nuclei during dioestrus, oestrus and the first 7 days of pregnancy has been examined. 2. The DNA, RNA, histone and non-histone protein contents of uterine chromatin remained constant during early pregnancy. 3. The rate of RNA synthesis on Day 1 uterine chromatin was 8.61 +/- 0.59 (mean +/- S.E.) pmol of UMP incorporated/mg DNA per 10 min. When compared with DNA prepared from rat liver nuclei, 13.20 +/- 0.27% (mean +/- S.E.) of the Day 1 chromatin DNA was available for transcription by Escherichia coli RNA polymerase. 4. Uterine chromatin from rats in early dioestrus had significantly less template activity than during oestrus. 5. Chromatin prepared from whole uterus on Day 5 and from implantation sites on Days 6 and 7 of pregnancy had a significantly higher template activity than chromatin obtained from uteri on Day 1. Chromatin from interimplantation tissue on Day 6 had a lower template activity than that from uteri on Day 1. 6. RNA - DNA hybridisation of RNA transcribed from chromatin obtained on Days 2, 5 and 7 of pregnancy showed that RNA transcribed from Day 5 chromatin obtained species not present (or present in very small amounts) in RNA transcribed by chromatin from uteri on Day 2 and from implantation tissue on Day 7 of pregnancy. 7. The results are discussed in relation to the cellular changes occurring in the stroma immediately before implantation and it is postulated that the appearance of a new species of RNA on Day 5 is related to the preparation of the stromal cells for decidualisation.

Polytenosynovitis caused by Toxoplasma gondii.

Two cases are reported of polytenosynovitis involving the wrists and ankles and caused by toxoplasmosis, together with the investigations that led to the diagnosis. Medical and surgical treatment of the first patient and medical treatment only of the second patient gave satisfactory results.

The effect of some tricyclic antidepressants on the inhibition of mouse brain monoamine oxidase in-vivo by phenelzine.

Four tricyclic antidepressants, amitriptyline, imipramine, desipramine and iprindole have been shown to partially protect mouse brain monoamine oxidase in-vivo from the irreversible enzyme inhibition produced by subsequent injection of phenelzine. Levels of protection were similar when the enzyme was assayed with selective substrates (5-hydroxytryptamine and phenethylamine) for both the A and B forms of the enzyme. Although other explanations cannot at this stage be ruled out, these observations are consistent with the tricyclic antidepressants acting as reversible inhibitors of brain monoamine oxidase in-vivo.

Expression of liver functions in immortalised rat hepatocyte cell lines.

The differentiated hepatic function of two rat liver cell lines, P9 and SV40RH1, immortalised by transfection with SV40 DNA has been investigated in terms of the glutathione synthesis, and the activities of gamma-glutamyltransferase, glutathione-S-transferase and UDP-glucuronosyltransferase. SV40RH1 is a highly differentiated cell line at early passage, but the expression of some aspects of its differentiated phenotype is unstable and some functions are lost by passage 12-13. P9 is a less-well differentiated cell line, with relatively stable expression of functions between passages 4 and 13. In terms of differentiated function both cell lines represent a marked improvement over primary cultures of rat hepatocytes which de-differentiate rapidly within 24-48 h in culture. This retention of liver function in proliferating cell lines offers the opportunity to use such cells in in vitro toxicological studies.

[Development of use of subsidized prescription drugs. A comparison of drug consumption requiring subsidy in the county of Storstrøm during the periods 1 January--30 April 1991 and 1 January--30 April 1992]. / Udviklingen i forbruget af tilskudsberettiget medicin. En sammenligning af medicinforbrug, som har udløst amtskommunalt tilskud i Storstrøms Amt, i perioderne 1.1.-30.4.1991 og 1.1.-30.4.1992.

In all counties in Denmark, the consumption of subsidized prescribed drugs is registered. The drugs are listed in accordance with the international anatomical-therapeutical-chemical classification system and the consumption is listed in defined daily doses and prices. Comparing the first four months of 1991 with the first four months of 1992 in a Danish county (Storstrøms Amt) shows a general increase in the amount of prescribed drugs (mean 11.0%). Ulcer-drugs, antihypertensiva, antibiotics and analgetics have increased more than 20%. The increase in prices has been 3.8%. It is concluded that these sort of statistics justify the debate on drug prescriptions and act as a tool for monitoring drug prescriptions in general practice for wanted groups of drugs. Further refinements of the statistics can be made. The increase in county grants in "running prices" has been nearly constant over the last ten years, except for 1990 due to the introduction of a special law.

Employee dependents: the future focus of worksite health promotion programs and the potential role of the allied health professional.

The prevalence of health promotion activities has increased in worksites over the last five years. Many companies that have offered health promotion programs in the past have done so primarily for their employees. In the last several years, programs have extended to employee dependents by opening current employee programs to dependents. However, employee health promotion programs may not be relevant or accessible to employee dependents, particularly when children or elderly parents are taken into consideration. This paper outlines several reasons for expanding health promotion benefits to include dependents, suggests a working construct for dependent programs, and discusses the possible roles of allied health professionals in these programs.

[Is the new LAE 355 certificate useful for extended sick leave benefits?]. / Er den udvidede attest LAE 355 anvendelig ved langvarige sygedagpengesager?

In Storstrøm county an investigation was carried out concerning certificates in connection with sickness benefit during a period of two months, and the general practitioners and the social-workers were asked about their opinion of and attitude to sickness-certificates. A total of 420 sickness benefit certificates were collected consecutively, and all the social-workers and 85% of the general practitioners participated. About half of the certificates were not completely filled out and only one fifth supplied constructive supplementary information. Forty-five percent of the social-workers and 33% of the general practitioners regarded the certificates as useless when dealing with social medical cases. A systematic followup of patients with long-term sickness is an important task in primary health care, and should be carried out in co-operation with other health- and social-workers.

[Rehabilitation of anoxic brain injured patients after reanimation]. / Az anoxiás agykárosodást szenvedett betegek rehabilitációja reanimáció után.

Authors report rehabilitation outcomes of anoxic brain injured patients, following reanimation. In the past 12 years (1988-1999) they treated 54 patients. The patients were selected from other hospitals after successful reanimation, but sustained diffuse anoxic brain injury. The CT and MR examination was generally negative, but small hypodensities were shown rarely (18/54). At the time of admission 21 patients were quadriparetic, 5 patients were hemiparetic, 2 were paraparetic and there were no any paresis in 26 cases. The mean age of the patients was 32 years (7-61). At the time of admission 31 patients were dependent in basic activities of daily living, the mean Barthel Index score was 15 (0-100) but at the time of discharge it was 45 (0-100). 41 patients were discharged into their home and 13 patients had to be transmitted to another hospital for further treating, but later 5 of them died. At the time of discharge only 7 patients had score 100 of the Barthel Index, but they were not able for independent living. Family support, mainly guidance was necessary. Memory deficits, apraxia, attention disturbance, ataxia were the main problems during the rehabilitation process.

[Late post-tracheostomy airway complications in patients with central nervous system injuries]. / Központi idegrendszeri sérültek késöi posttracheostomiás légúti szövödményei.

At decannulation or often weeks later some of the patients undergone long-term mechanical ventilation through tracheostoma reveal symptoms of airway stenosis. Posttracheostomy airway complications detected during the rehabilitation of 34 patients with central nervous system injury are presented. Endoscopic examinations (total 130) were performed with Olympus BF B3 and OES 20-type fiberscopes and Friedel-type rigid bronchoscopes under local or general anaesthesia. Stridor (20 cases) and possible decannulation (10 cases) were the main indications of the first endoscopic examinations. Stridor was caused by tracheal (12 cases) and laryngeal (8 cases) stenosis. With six patients decannulation was possible after the first endoscopy. Removal of granulomas and sutures was successful in 8 cases. Rigid bronchoscopic dilatations were temporarily successful in 7 cases, but in five of them it had to be repeated on emergency. Further therapeutic interventions were: recannulation (3 cases), retracheostomy (4 cases), implantation of silicon T-endoprothesis (5 cases), tracheal resection (4 cases). Three patients are discussed in details. Eliminating airway complications largely contributed to rehabilitation of the nervous and musculoskeletal system, improved the quality of life, and in acute cases it was a life-saving measure. In order to prevent the development of late airway complications or detect them in time, it is recommended to have an endoscopic protocol following every tracheostomy: 1. at the time of decannulation 2. at closing the trachea and 3. 2-3 months after decannulation.

Preventive home visits to older home-dwelling people in Denmark: are invitational procedures of importance?

Since 1998 all municipalities in Denmark have been required by law to offer two annual preventive home visits to all home-dwelling citizens aged 75 or over. The influence of invitational procedures on acceptance rates has not been investigated. The aim of this study was to describe and investigate whether different invitational procedures were associated with first preventive home visit acceptance rates. The study was based on secondary analyses of data from the Danish Intervention Study on Preventive Home Visits. Data were collected from 1998 to 2002. Of the 4060 participants in the main study, 3245 reported receiving an offer for an identifiable preventive home visit, of whom 2399 (73.9%) provided complete data for the main analyses in the present study. Invitational procedures were categorised as: (1) a letter with a proposed date and time for the visit, (2) a visitor telephone call, and (3) a letter with encouragement to phone the visitor for appointment (letter without a proposed date). Covariates included sex, age, experience with preventive interventions, functional ability, self rated health, social relations and psychosocial characteristics. Statistical analyses included chi-square tests, and bi- and multivariable logistic regression analyses. Different invitational procedures were associated with first preventive home visit acceptance rates. Significantly more men (75.1%) than women (62.8%) declined the first preventive home visit regardless of the invitational procedure. Compared to 'letter with a proposed date', men had an odds ratio of 1.78 (95% CI: 1.16-2.74) for declining visits when 'telephone call' was used and an odds ratio 2.81 (95% CI: 1.79-4.40) when 'letter without a proposed date' was used as the invitational procedure. In women the odds ratios were 1.23 (95% CI: 0.91-1.68) and 1.87 (95% CI: 1.37-2.55), respectively.