Platelet counts during pregnancy in essential thrombocythaemia treated with recombinant alpha-interferon.
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Biomedical subjects
Publications and source records attributed to P Genet.
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We report a previously unrecognized complication of totally implanted subcutaneous ports. A patient with a totally implantable central venous device developed a septic syndrome. Blood and injection-reservoir cultures grew Staphylococcus aureus. There was no evidence of endocarditis. The port was removed but acute oliguric renal failure developed. A percutaneous renal biopsy showed acute diffuse proliferative glomerulonephritis. There was no extracapillary crescent. On immunofluorescence study, capillary wall granular deposits stained brightly for IgG and C3. These findings were thought to be consistent with infection-associated immune-complex glomerulonephritis.
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We report four cases of varicella-zoster pancreatitis in immunocompromised hosts. All 4 patients presented a severe immunodeficiency because of chronic lymphoproliferative disorders (mainly lymphoma and Hodgkin disease) and long-term immunosuppressive therapy. Varicella zoster pancreatitis is a very unusual presentation of varicella-zoster infection. Few cases of pancreatitis occurring after bone marrow transplantation have been reported. All 4 patients presented with acute epigastric pain associated with transient elevation of serum amylase. The vesicular rash followed the presenting symptoms of severe abdominal pain by 8 days. This clinical presentation, occurring in immunocompromised patients, defines a set of symptoms which should lead the physician to suspect varicella-zoster pancreatitis, even in the initial absence of the characteristic skin vesicular eruption. Early institution of antiviral therapy seems mandatory.
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Agranulocytosis is the most serious problem, potentially fatal, that can occur during antithyroid drug therapy. The use of hematopoietic growth factors is an attractive approach to reduce the period of this drug-induced neutropenia. We report two cases of severe antithyroid drug-related agranulocytosis (granulocyte count < 0.1 x 10(9)/L) treated with Granulocyte Colony-Stimulating Factor (G-CSF) or Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF). The delay to observe a granulocyte count superior to 1 x 10(9)/L was respectively 1 and 5 days. Our results, with others, clearly show that hematopoietic growth factors are effective in severe antithyroid drug-induced agranulocytosis.
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There have been few reports of exercise induced left branch hemiblock. In order to assess its frequency and significance, a retrospective study of 8684 patients was undertaken: 24 cases (11 anterior and 13 posterior) were recensed. Nineteen of these patients had typical effort angina, 3 had a history of myocardial infarction and 3 had aortiocoronary bypass surgery. Twenty patients developed ST-T wave abnormalities included 11 ST segment depressions. Four patients refused coronary angiography: 3 of these patients had probable coronary artery disease (typical effort angina, positive exercise stress tests and in 1 case, inferior wall hypofixation during myocardial scintigraphy). Twenty patients underwent coronary angiography. In 2 patients, the exercise stress test was performed under Class IC antiarrhythmic therapy; 1 had a normal coronary angiogram and the other had patient coronary bypass graft. A control exercise stress test after withdrawal of drug therapy was negative in these 2 cases. The other 18 patients had significant coronary artery disease. The recording of left branch hemiblock during exercise stress testing would seem to indicate severe coronary artery narrowing (greater than or equal to 90% in 15 cases; greater than or equal to 80% in 3 cases) and left anterior hemiblock is indicative of left main coronary or proximal left anterior descending artery disease. In this series, medical therapy did not make exercise-induced left branch hemiblock regress, in contrast to aortocoronary bypass surgery and angioplasty.
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Four personal cases of exercise-induced conduction defects occurring during stress testing are reported. The significance of these changes is discussed in the light of the authors' observations and of the cases published in the literature. The development of atrioventricular block is usually related to pre-existing disease of the conduction system, whilst left anterior or posterior hemiblock is usually due to transient ischaemia related to significant stenosis of the coronary artery responsible for the vascularisation of the relevant bundle branch (usually a proximal stenosis of the left anterior descending artery). Complete left bundle branch block may be due to a number of conditions (including chronic ischaemic heart disease).
In a plant producing manganese (Mn) oxides and salts, 11 different workplaces were identified. The current exposure to airborne Mn (total dust, personal sampling, n = 80) varied from 0.07 to 8.61 mg/m3. The geometric mean and median values amounted approximately to 1 mg/m3 and the 95th percentile was 3.30 mg/m3. The concentration of Mn in blood (Mn-B) in a group of 141 Mn-exposed male workers ranged from 0.10-3.59 micrograms/100 ml compared to 0.04-1.31 micrograms/100 ml in a group of 104 control subjects. The ranges of the concentrations of Mn in urine (Mn-U) were 0.06-140.6 and 0.01-5.04 micrograms/g creatinine for the exposed and control groups, respectively. The average level of Mn-B in the Mn group was more than twice as high as in the control group (arithmetic mean, 1.36 vs 0.57 microgram/100 ml) and that of Mn-U was ten times higher in the Mn group (geometric mean, 1.56 vs 0.15 microgram/g creatinine). The Mn-B level did not change significantly after 8 h of Mn exposure, whereas the Mn-U level dropped rapidly when exposure ceased (half-life less than 30 h). On an individual basis, neither Mn-B nor Mn-U correlated with the current levels of Mn-air or duration of Mn exposure. There was also no relationship between Mn-B and Mn-U. On a group basis, there was no correlation between the mean Mn-B levels and the current levels of Mn-air at each workplace.(ABSTRACT TRUNCATED AT 250 WORDS)
A cross-sectional epidemiological study was carried out among 141 male subjects exposed to inorganic manganese (Mn) in a Mn oxide and salt producing plant (mean age 34.3 years; duration of exposure, mean 7.1 years, range 1-19 years). The results were compared with those of a matched control group of 104 subjects. The intensity of Mn exposure was moderate as reflected by the airborne Mn levels and the concentrations of Mn in blood (Mn-B) and in urine (Mn-U). A significantly higher prevalence of cough in cold season, dyspnea during exercise, and recent episodes of acute bronchitis was found in the Mn group. Lung ventilatory parameters (forced vital capacity, FVC; forced expiratory volume in one second, FEV1; peak expiratory flow rate, PEFR) were only mildly altered in the Mn group (smokers) and the intensity and the prevalence of these changes were not related to Mn-B, Mn-U, or duration of exposure. There was no synergistic effect between Mn exposure and smoking on the spirometric parameters. Except for a few nonspecific symptoms (fatigue, tinnitus, trembling of fingers, increased irritability), the prevalence of the other subjective complaints did not differ significantly between the control and Mn groups. Psychomotor tests were more sensitive than the standardized neurological examination for the early detection of adverse effects of Mn on the central nervous system (CNS). Significant alterations were found in simple reaction time (visual), audioverbal short-term memory capacity, and hand tremor (eye-hand coordination, hand steadiness). A slight increase in the number of circulating neutrophils and in the values of several serum parameters (ie, calcium, ceruloplasmin, copper, and ferritin) was also found in the Mn group. There were no clear-cut dose-response relationships between Mn-U or duration of Mn exposure and the prevalence of abnormal CNS or biological findings. The prevalences of disturbances in hand tremor and that of increased levels of serum calcium were related to Mn-B. The response to the eye-hand coordination test suggests the existence of a Mn-B threshold at about 1 microgram Mn/100 ml of whole blood. This study demonstrates that a time-weighted average exposure to airborne Mn dust (total dust) of about 1 mg/m3 for less than 20 years may present preclinical signs of intoxication.