Case report: atypical ectopic pregnancy and culdocentesis. Still a valuable emergency medicine procedure.
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Biomedical subjects
Publications and source records attributed to J Sokal.
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We analyzed survival in 203 children with Philadelphia-chromosome-positive chronic myeloid leukemia (CML). Median survival was 4.1 years; average annual risk of death was 20%. These survival data are similar to those reported in adults. Because there is no possibility of long-term disease-free survival in children with CML with conventional therapies, the findings of this study suggest that bone marrow transplantation should be considered in these patients.
Cytogenetic analysis was carried out in 28 B-CLL patients (21 males and 7 females, 38-85 years old, with median age 64 years, disease stage O-IV). Peripheral nominator cells (1 x 10(7)) or isolated B-lymphocytes were incubated in vitro for 5-7 days. The cells were stimulated by pokeweed mitogen (PWM), or phorbol myristate-acetate (PMA), with or without 10% conditioned medium (CM) derived from a T cell leukemia line or 10% B-cell growth factor (BCGF). Twenty-two patients (79%) responded to PWM + CM; 5 out of 5 patients responded to PWM + BCGF. The average mitotic index (+/- S.E.M.) for PWM, PMA, PWM + CM, PMA + CM, PWM + BCGF were 0.13 +/- 0.01, 0.24 +/- 0.13, 0.51 +/- 0.11, 0.14 +/- 0.06 and 0.63 +/- 0.15, respectively. Cytogenetic analysis revealed the presence of abnormal karyotypes in 22 patients. Fourteen patients (50%) had clonal chromosome aberrations which included: monosomy 1, 9, 17, 18, 21, and X chromosome, and trisomy of chromosomes 7, 9, 20, 21 and 22. The clonal structural aberrations were i(6q), inv(12) (q15q24), del(5) (p13p15), del(10) (q24). No homogeneously staining regions (HSR) were observed. Four patients with resistance to anti-neoplastic drugs showed the presence of double minute chromosomes (dmin) ranging in frequency from 5 to 50%.
The effects of experimental exposure to toluene (100 ppm), xylene (100 ppm) and their mixture (50 ppm of toluene and 50 ppm of xylene) on CNS functions were studied in 10 male volunteers aged 22-35. Changes in CNS functions were measured by means of nine psychological tests. Acute exposure to xylene produced the most adverse effect on simple reaction time SRT and choice reaction time ChRT. Exposure to toluene affected only the memory test performance. The effect of combined exposure appeared to be weaker than the effect of exposure to xylene alone but stronger than the effect of exposure to toluene.
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Female albino rats were exposed to carbon monoxide in concentrations ranging from 130 to 1030 mg/m3 for a period of 40 minutes. During the last 20 minutes of exposure, the rats were subject to forced run on a flat treadmill moving at a rate of 400 m/hour. Immediately after termination of exposure, the concentration of carboxyhemoglobin and lactic acid in blood, as also the concentration of carboxymyoglobin in the heart and skeletal muscles were determined. Work load did not influence the level of carboxyhemoglobin in blood, though inducing an increase in the concentration of carboxymyoglobin in both the heart muscle and the skeletal muscle. The increase in the concentration of lactic acid in the blood was observed only in rats exposed to carbon monoxide in an average concentration of 1030 mg/m3 and simultaneous work load. Results of the observations demonstrate that simultaneous effect of carbon monoxide and work load can induce more severe tissue hypoxia than could be expected on the basis of carboxyhemoglobin concentration in the blood.
In view of divergent opinions concerning MAC value for vinyl acetate, a study on acute and chronic inhalatory toxic effect of this compound on animals was carried out. The scope of the study included determination of CL50 value after Litchfield and Wilcoxon and 10-month exposure of animals to vinyl acetate at concentrations 10, 100 and 500 mg/m3, 5 days weekly, 5 hours daily. During 10-month experiment the animals were observed and body weight controlled. In addition, periodically some hematological examinations and biochemical of blood serum as well as histopathological examinations of inner organs were carried on. Post-mortally the weight of inner organs was determined. CL50 value determined on rats has amounted to 4100 ppm. In the study on chronic effect, the prevalence and the degree of intensity of the changes of the used by us indicators was the least in the group of animals exposed to vinyl acetate at concentration of 10 mg/m3. These changes were transient not involved reticulopenia and animals' body weight decrease. Histopathological examinations revealed some inflammatory changes in respiratory system both in control and exposed animals. Only planoepithelial metaplasia of bronchi was found exclusively in animals exposed to vinyl acetate at all concentrations used. The changes within liver were found only in animals exposed to vinyl acetate at concentration of 100 and 500 mg/m3. These changes involved fatty degeneration of hepatic parenchyma, proliferation and extension of smooth endoplasmatic reticulum and the changes within the biliary canaliculi. Taking the above results into account it seems that the lowest of the recommended in the world MAC value--10 mg/m3 may be accepted as the upper limit of the maximum admissible concentration for vinyl acetate.
A method of measuring a decrease in the respiration rate as an index of chemical substances irritating effects upon mice's upper respiratory tract has been checked and adopted. A dose of irritating substances resulting in the respiration rate decrease by 50%--RD50 has been determined, as related to exposure to chlorine, ammonia and acrolein. The RD50 values for chlorine and acrolein approximated those quoted by Alarie Y., whereas for ammonia exposure this value differed.
A group of 227 cases of non-Hodgkin's lymphoma included seven favorable and four unfavorable histologic classes with collective median survival times of 83 and 16 months, respectively. The favorable group included three follicular subgroups (cleaved, mixed, and large noncleaved) and four diffuse classes (small lymphocytic, cleaved, Burkitt's noncleaved, and convoluted lymphocytic). The unfavorable group consisted of four diffuse subgroups (plasmacytoid lymphocytic, mixed, and small and large noncleaved). There were significant differences in collective median survivals between patients in Stage I--II and those in Stage III--IV in both the favorable group (not reached, NR versus 62 months, P less than 0.001) and the unfavorable group (57 months versus 12 months, P less than 0.01). The incidence of complete response to primary treatment was higher in the favorable than in the unfavorable group (75% versus 56%, P = 0.002) and in those with limited as compared with advanced disease. Complete responders in both prognostic groups had longer survival times than did partial or minimal responders. A significant difference in median complete remission duration was found between responders in Stage I--II versus Stages III-IV in the favorable group (not reached versus 40 months, P = 0.001) but not in the unfavorable one (56 months versus 22 months, P greater than 0.05). The absence of relapses after 41 months among complete responders in the favorable but not in the unfavorable group suggests a potential for cure in a proportion of cases from the former group. The incidence of complete response was lower and median remission duration was shorter after secondary as compared with primary treatment. The results of this study confirm the prognostic value of the Lukes and Collins classification system and the importance of initial staging and of achieving a complete response to primary treatment in both the favorable and unfavorable lymphomas.
Determination of carbon monoxide by gas chromatography was described. Having been separated from other air components, carbon monoxide is reduced to methane in the presence of nickel catalyst and determined on the flame-ionization detector. A rectilinear dependence was found between the peak surface or height and CO concentration within 0,5-1000 ppm. The low detectability limit was 0.2 ppm.
Fifty patients with lymphocytic lymphoma and chronic lymphocytic leukemia underwent splenectomy for various combinations of anemia, thrombocytopenia, and leukopenia. All of these patients had advanced lymphoproliferative disease, and most had infiltration of bone marrow by neoplastic cells. Good response in all hematologic parameters was obtained in 27 of 48 evaluable patients. An additional 13 patients responded in one or two parameters; there were only 8 complete failures. The over-all surgical mortality was 8%. The median duration of response was 4 months, and the mean, 7 months. Increased tolerance to further antitumor therapy and a decreased transfusion requirement were seen among responding patients. Those patients with anemia who had evidence of shortened erythrocyte survival and splenic sequestration of 51Cr-labelled erythrocytes uniformly responded with rises in hemoglobin. However, half of the patients with negative splenic sequestration also showed improvement of anemia. Preoperative diagnostic studies failed to predict favorable responses of patients with thrombocytopenia or leukopenia. The classical criteria for the diagnosis of hypersplenism are not applicable in many cases of neoplastic lymphoproliferative disease; splenectomy could have been considered "contraindicated" in most of the patients in this series. We conclude that splenectomy is worth undertaking in patients with lymphoproliferative disease complicated by hematologic depression regardless of marrow findings or the results of other diagnostic studies.
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The standard minimal scope of experimental toxicity evaluation of industrial chemicals has been proposed. On the basis of literature and own experience the authors propose that the minimal scope of toxicity testing should include determination of lethal doses and evaluation of morphological alterations of inner organs in acute experiments, as well as assessment of eye and skin irritation and contact sensitization. The main lines of uniform procedures are presented. Complementary tests of local and acute systemic toxicity are also recommended.