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The objective of the study was to investigate the nationwide occurrence of sinonasal pleomorphic adenoma in Finland. A retrospective study was conducted at The Departments of Otorhinolaryngology-Head and Neck Surgery, and Pathology at the five university hospitals in Finland. Data were obtained by searching for sinonasal pleomorphic adenoma cases in the clinical and histopathological registries at these institutions for the past two to four decades. All patients who had had a histologically proven pleomorphic adenoma in the sinonasal area were included as participants. Ten cases with pleomorphic adenoma of the nasal cavity were found. The majority of these tumours originated in the septum, and there were no malignant transformations. Pleomorphic adenomas of the nasal cavity were found to be extremely rare in this nationwide investigation. [ABSTRACT FROM AUTHOR]

Lung infections can be severe consequences of chemotherapy-induced immune defects. Aetiological causes of infection include bacteria (most commonly Pseudomonas aeruginosa, Stenotrophomonas maltophilia, and Nocardia species), viruses (eg, respiratory syncytial virus, parainfluenza virus, influenza virus A and B, and cytomegalovirus), and fungi (eg, Aspergillus, Fusarium, and Mucorales species, and Pneumocystis jirovecii). Most infections are caused by bacteria (especially Gram negative), but viruses are being increasingly identified. Diagnosis is difficult and frequently time-consuming. Treatment can be ineffective for many patients, particularly those with fungal infection. The greatest hope for the future is the availability of more targeted anticancer drugs that have fewer side-effects on the immune system. [ABSTRACT FROM AUTHOR]

Peripheral neuropathy has emerged as the most common neurologic complication of human immunodeficiency virus (HIV) infection. It will continue to play an Important role in HIV Infection given the fact that HIV-infected Individuals are living longer, are at risk of long-term metabolic complications, and face an Increasing exposure to potentially neurotoxic antiretroviral drugs. We review the various types of peripheral neuropathy that have been associated with HIV infection, including distal symmetrical polyneuropathy, toxic neuropathy from antiretroviral drugs, diffuse infiltrative lymphocytosis syndrome, inflammatory demyelinating polyneuropathies, multifocal mononeuropathies, and progressive polyradiculopathy. [ABSTRACT FROM AUTHOR]

Patients with cancer who are undergoing chemotherapy are highly susceptible, especially if neutropenic, to almost any type of bacterial or fungal infection. These infections cause substantial morbidity and mortality. Prophylactic use of antibiotics should be avoided, however, since this practice is associated with a risk of emergence of resistant bacteria and it does not lower the risk of death. However, chemoprophylaxis has a role for candidal fungal infections. Because infection in a neutropenic host can be rapidly fatal if not treated, the empirical administration of broad-spectrum intravenous antibiotics is generally indicated for these patients, and the local frequencies, susceptibility, and resistance patterns of various pathogens must be taken into account. Once therapy has been initiated, changes in antibiotic regimens during the first 5 days are useless unless the patient's clinical condition deteriorates substantially. The treatment of invasive fungal infections is particularly difficult. Many unsolved questions remain, and studies are proposed here that may shed light on these issues. [ABSTRACT FROM AUTHOR]

Although the aetiology of polyps is still, for the most part, unknown, the disease is known to involve tissue oedema. Vascular permeability/vascular endothelial growth factor (VPF/VEGF) is a major inducer of angiogenesis and capillary permeability. This study investigated VPF/VEGF expression in biopsies of nasal polyps from 39 patients and in healthy nasal mucosa from 10 patients by immunohistochemical staining. Staining for VPF/VEGF in the mucosal surface and in the glandular epithelium of nasal polyps was weaker than in normal controls. In two patients, strong staining for VPF/VEGF was found in a granular pattern in mast cells, while the mast cells in other polyposis patients appeared to be largely degranulated. VPF/VEGF was not seen in the mast cells of control patients. Although expression of VPF/VEGF was not increased in the epithelium of the nasal polyps, VPF/VEGF secreted from mast cells may take part in nasal polyp formation. [ABSTRACT FROM AUTHOR]

Although the aetiology of polyps is still, for the most part, unknown, the disease is known to involve tissue oedema. Vascular permeability/vascular endothelial growth factor (VPF/VEGF) is a major inducer of angiogenesis and capillary permeability. This study investigated VPF/VEGF expression in biopsies of nasal polyps from 39 patients and in healthy nasal mucosa from 10 patients by immunohistochemical staining. Staining for VPF/VEGF in the mucosal surface and in the glandular epithelium of nasal polyps was weaker than in normal controls. In two patients, strong staining for VPF/VEGF was found in a granular pattern in mast cells, while the mast cells in other polyposis patients appeared to be largely degranulated. VPF/VEGF was not seen in the mast cells of control patients. Although expression of VPF/VEGF was not increased in the epithelium of the nasal polyps, VPF/VEGF secreted from mast cells may take part in nasal polyp formation. [ABSTRACT FROM AUTHOR]

A-mode ultrasound (A-US) is a simple, non-invasive and non-ionizing method for detecting fluid or even mucosal swelling in inflamed maxillary and frontal sinuses. A-US has been shown to be a quite reliable tool in the diagnosis of acute maxillary sinusitis. However, controversy still exists over the reliability of A-US in detecting fluid retention or mucosal swelling in patients suffering from chronic polypous rhinosinusitis or in transantrally operated maxillary sinuses. We have compared the results of maxillary sinus A-US with computed tomography (CT) images in a selected series of chronic polypous rhinosinusitis comprising 40 patients. Fluid retention was seen in 20 of 79 maxillary sinuses on CT scanning. Only 6 of these 20 retentions were detected with A-US. There were 11 false positive findings. In six of these cases a back-wall echo was received through polypoid masses in the sinus. Mucosal swelling was also difficult to diagnose. The results of A-US were not easily reproduced; only in 50% of cases were identical results obtained by two investigators. We do not recommend the use of A-US to diagnose fluid retention or mucosal swelling in a patient with chronic mucosal changes in the maxillary sinus or if surgery has been performed on the anterior wall of the maxillary sinus. [ABSTRACT FROM AUTHOR]

Presents a prospective study for four years of 58 healthy relatives of 13 patients with autoimmune chronic active hepatitis (CAH) in order to identify possible factors contributing to the pathogenesis of the disorder. Hepatitis A virus is a trigger for autoimmune CAH in susceptible individuals.

The article informs that despite over 15 years of investigations, the immunopathogenesis of chronic active hepatitis is still obscure, and problems remain as to the interpretation of the results and especially to the relevance of the findings for the sequence of events initiating and maintaining liver cell damage in vivo. In the opinion of the authors, T cell killing of hepatitis B virus-infected hepatocytes cannot account entirely for the pattern of liver cell damage seen in HBsAg-I-ve CAH, as infected hepatocytes are found throughout the lobule and are not particularly concentrated in the periportal areas.

Previous studies of cellular immunity in asymptomatic HBV carriers have been limited to evaluation of responses to plasma-derived HBsAg preparations. We have explored the specificity of cellular immune responses to HBV antigens in these subjects using an indirect T-lymphocyte migration inhibitory factor assay and three antigen preparations (recombinant nucleocapsid antigen (HBcAg), plasma-derived HBsAg with or without pre-S2, and Saccharomyces cerevisiae-synthesized HEsAg without pre-S2 region). T cells from 10 asymptomatic chronic HBV carriers with normal liver function tests were responsive to nucleocapside determinants (mean migration index = 0.55 ± SD 0.07) and to pre-S2-positive plasma-derived HBsAg (MI = 0.62 ± 0.05). However, none responded to HBsAg devoid of pre-S2 sequences (M1=0.98±0.04). In further experiments, T cells from three HBV carriers, cultured with six different HBsAg preparations, exhibited responsiveness only to those preparations containing significant pre-S2 activities. Our results show that T-cell immunity to nucleocapsid determinants of the virus and HBsAg in present in asymptomatic HBV carriers; the latter is restricted to antigenic preparations containing significant pre-S2 activities. Hence, T-cell immunity to pre-S determinants may not always be associated with HBV clearance. [ABSTRACT FROM AUTHOR]

There have been conflicting reports of the clinical outcome of acute hepatitis A virus (HAV) infection in patients with chronic hepatitis C virus (HCV) infection. A prospective study evaluated 432 patients with chronic hepatitis C (183 with cirrhosis) over a 7-year period. Of the 17 patients with concurrent HAV infection, seven developed fulminant hepatitis and six died. None of these patients had cirrhosis; however, the HLA phenotype (A1; B8:DR3) appeared to be a significant factor in the development of fulminant hepatitis. Patients with this phenotype had high titres of antinuclear antibodies, antismooth muscle antibodies and antiasialoglycoprotein-receptor antibodies, possibly reflecting the induction of autoimmune hepatitis in this group. The high frequency of fulminant hepatitis in patients with HAV/HCV coinfection contrasts with other surveys, although a large Centers for Disease Control and Prevention (CDC) survey demonstrated that HAV infection in patients with pre-existing chronic liver disease (CLD) is associated with increased mortality. It is likely that CLD has some importance as an underlying factor in the development of fulminant hepatitis following HAV infection. Further prospective studies are needed to clarify this issue. [ABSTRACT FROM AUTHOR]

Background: Fulminant hepatitis on withdrawal of chemotherapy has been described in chronic hepatitis B virus infection, but not in hepatitis C virus (HCV) infection. The relation between HCV and immune response to this virus, and disease severity, has not been examined. We present two patients with HCV who developed fulminant liver failure after chemotherapy was stopped.Patients and Findings: Two patients with chronic HCV infection and malignant lymphoma received chemotherapy (cyclophosphamide, adriamycin, vincristine, bleomycin, etoposide, and prednisolone in patient 1; doxorubicin, bleomycin, vinblastine, and dacarbazine in patient 2), on withdrawal of which both developed fulminant hepatitis. Alanine aminotransferase (ALT) concentrations were greatly raised (6030 and 3870 IU/L in patients 1 and 2, respectively), and serum HCV-RNA was low in both patients when severe disease developed (10(2) genome equivalents per mL). Patient 1 died, and necropsy showed massive liver necrosis.Interpretation: The findings suggest an immune-mediated mechanism for hepatocyte damage in HCV infection. Careful monitoring of ALT concentrations is necessary in such patients during and after chemotherapy. [ABSTRACT FROM AUTHOR]

The article presents a study which focuses on the interrupted treatment of HIV-infected patients while having high CD4 cell counts. Forty six HIV-infected patients were enrolled in an Outpatient Clinic of the Infectious Disease Unit, having CD4 counts higher than 500 cells per micro liters and having undetectable HIV RNA or at least three years. Results have indicated that treatment interruption can be feasible and safer for patients taking antiretroviral therapy with high CD4 counts.

A central issue in olfaction concerns the characterization of loss of olfactory function: partial (hyposmia) or total (anosmia). This paper reports the application in a clinical setting of the European Test of Olfactory Capabilities (ETOC), combining odor detection and identification. The study included three phases. In phase 1, anosmics, hyposmics and controls were tested with the 16-items version of the ETOC. In phase 2, a short version of the ETOC was developed: patients with and controls without olfactory impairment were tested on a 6-items ETOC. In phase 3, to predict olfactory impairments in new individuals, the 16-items ETOC was administered on samples of young and older adults, and the 6-items version was applied in samples of young, elderly participants and Alzheimer patients. In phase 1, linear discriminant analysis (LDA) of ETOC scores classified patients and controls with 87.5 % accuracy. In phase 2, LDA provided 84 % correct classification. Results of phase 3 revealed: (1) 16-items ETOC: whereas in young adults, 10 % were classified as hyposmic and 90 % as normosmic, in elderly, 1 % were classified as anosmic, 39 % hyposmic and 60 % normosmic; (2) 6-items ETOC: 15 % of the young adults were classified as having olfactory impairment, compared to 28 % in the older group and 83 % in Alzheimer patients. In conclusion, the ETOC enables characterizing the prevalence of olfactory impairment in young subjects and in normal and pathological aging. Whereas the 16-items ETOC is more discriminant, the short ETOC may provide a fast (5-10 min) tool to assess olfaction in clinical settings. [ABSTRACT FROM AUTHOR]

Examines the cryptococcal meningitis during cyclosporin treatment in patients with psoriasis. Symptoms of cryptococcal meningitis; First description of cryptococcal meningitis during treatment with cyclosporin; Cause of fever and headache in patients with psoriasis treated with cyclosporin; Inhibition of antifungal cellular immune response.

The introduction of highly active anti-retroviral therapy (HAART) led to a radical change in the natural history of HIV infection and of the associated neurological opportunistic infections. However, the mortality of central nervous system (CNS) complications and opportunistic infections is still high in untreated HIV-infected individuals or in patients unaware of their HIV infection. We describe the outcome of HIV-infected patients followed at a single center for AIDS-related neurological syndromes in the 16 years following the introduction of HAART, and compare the findings with those in patients admitted up to 1996. We have conducted a retrospective study of patients with HIV infection or AIDS (based on WHO criteria and classified according to the 1993 CDC criteria) admitted during 20 years (January 1992 to March 2012) to the Infectious Diseases Unit of the University of Verona for the presence of focal or widespread CNS lesion on neuroimaging. Clinical history, CD4 cell count, HIV-RNA level, neurological examination, imaging, cerebrospinal fluid examination and eventual cerebral biopsy results were reviewed as well as the final neurological diagnosis and the treatment. The survival time from the clinical onset of the neurologic syndrome to death was calculated for each patient who died. A statistical analysis was performed comparing data collected up to and after 1996, i.e., before and after HAART introduction. Among 1043 patients with HIV infection or AIDS admitted to the Infectious Diseases Unit of the University of Verona between January 1992 and March 2012, 114 had a CNS lesion. The following diseases were observed: neurotoxoplasmosis (NT), progressive multifocal leukoencephalopathy), primary central nervous system lymphoma (PCNSL), the severe form of HIV-associated neurocognitive disorder, cryptococcal encephalitis (CE) and lesions of undetermined origin. The follow-up period was 4 weeks to 72 months both in the pre-HAART and HAART era. Cerebral lesions were detected in 53/243 patients (21.8 %) in the pre-HAART era and in 61/801 patients (7.6 %) in the HAART era ( p < 0.001). Most patients who developed a neurological complication in the HAART period (40/59, 67.8 %) were untreated or did not know to be HIV-infected; in particular, 27.9 % of patients with a CNS lesion in the HAART era were unaware of their HIV infection vs 13.2 % in the pre-HAART era ( p < 0.05). Some patients were not virologically suppressed (14/59, 23.7 %) or were immunological non-responders (undetectable viral load, with CD4 count <200 cells/μL; 4/59, 6.8 %). Other statistically significant data were the mean age at the onset of neurological complications (32.6 ± 5.4 years in the pre-HAART, 40.3 ± 9.5 in the HAART group, p < 0.001) and the mean CD4 cell count at the onset of illness (median of 38 cells/µL (2-215) in the pre-HAART, 77 cells/µL (2-752) in the HAART group; p < 0.001). In the HAART era a reduction of PCNSL and NT was observed. Our results, while confirming a decrease in the incidence of opportunistic infections of the CNS in the HAART era, show that late presentation of patients with HIV infection remains an important issue in our catchment area. [ABSTRACT FROM AUTHOR]

The article discusess a study and clinical trials made for evaluating the use of dual therapy combined with unboosted atazanavir and lamivudine for the treatment of virologically suppressed HIV-1-infected patients. Topics discussed include role of drugs in reducing bone and renal toxicity; increasing number of nonantiretroviral drugs for treating comorbidities in aging HIV-infected patients; and use of randomized clinical trials for the same.

Background: To determine the frequency and pattern of malignant tumours of the female genital tract among Batswana women. Design: A four-year retrospective histological study of the pattern of female genital tract malignancy in Botswana. Setting: University of Botswana and the National Health Laboratory Gaborone, Botswana. The National Health Laboratory is the only public tertiary referral laboratory that provides diagnostic pathology services in the South-Eastern part of Botswana. It is located just adjacent to Princess Marina Hospital, the major tertiary referral hospital in the country. Methods: All histologically confirmed diagnoses of female genital tract malignancies from January 1st 2006 to December 31st 2009 were reviewed by two pathologists and diagnoses e-confirmed by taking fresh tissue sections from paraffin embedded archival tissue blocks. Results: The age of patients ranged from 13-96 years with a mean age of 54.5 ± 6.4 years. Cancer of the cervix constituted 80.6%, followed by uterine cancer (10.0%), carcinomas of the vulva (4.5%) and ovary (3.4%) in that order. Ovarian cancers predominated in the younger age group. There was a steady increase in the frequencies of cervical, uterine and ovarian cancers over the 4-year study period with a decline in uterine cancer in the 4th year. Conclusion: Cervical cancer incidence is high among Batswana women and all female genital tract cancers occurred at a relatively early mean age. Therefore the importance of established and accessible screening programs and awareness campaigns need more emphasis than it is being given currently. [ABSTRACT FROM AUTHOR]

To cite this article: Videler WJ, Badia L, Harvey RJ, Gane S, Georgalas C, van der Meulen FW, Menger DJ, Lehtonen MT, Toppila-Salmi SK, Vento SI, Hytönen M, Hellings PW, Kalogjera L, Lund VJ, Scadding G, Mullol J, Fokkens WJ. Lack of Efficacy of long-term, low-dose azithromycin in chronic rhinosinusitis: a randomized controlled trial. Allergy 2011; 66: 1457-1468. Abstract Background: In persistent chronic rhinosinusitis (CRS), conventional treatment is often insufficient. Long-term, low-dose administration of macrolides has been suggested as a treatment option. The MACS (Macrolides in chronic rhinosinusitis) study is a randomized placebo-controlled trial evaluating the efficacy of azithromycin (AZM) in CRS. Methods: We describe a group of patients with recalcitrant CRS with and without nasal polyps unresponsive to optimal medical and (in 92% also) surgical treatment. Patients were treated with AZM or placebo. AZM was given for 3 days at 500 mg during the first week, followed by 500 mg per week for the next 11 weeks. Patients were monitored until 3 months post-therapy. The assessments included Sino-Nasal Outcome Test-22 (SNOT-22), a Patient Response Rating Scale, Visual Analogue Scale (VAS), Short Form-36 (SF-36), rigid nasal endoscopy, peak nasal inspiratory flow (PNIF), Sniffin' Sticks smell tests and endoscopically guided middle meatus cultures. Results: Sixty patients with a median age of 49 years were included. Fifty per cent had asthma and 58% had undergone revision sinus surgery. In the SNOT-22, Patient Response Rating Scale, VAS scores and SF-36, no significant difference between the AZM and the placebo groups was demonstrated. Nasal endoscopic findings, PNIF results, smell tests and microbiology showed no relevant significant differences between the groups either. Conclusion: At the investigated dose of AZM over 3 months, no significant benefit was found over placebo. Possible reasons could be disease severity in the investigated group, under-dosage of AZM and under-powering of the study. Therefore, more research is urgently required. [ABSTRACT FROM AUTHOR]

Abstract: In order to preserve, characterize and improve the quality of some accessions in Entre Ríos province, Argentina, a germplasm bank of aromatic and medicinal plants has been set up, including among other species, the oregano (Origanum spp.). To simplify the identification and characterization of the accession entries belonging to this genus, a chart containing 41 descriptors has been elaborated to allow the easy and quick individualization of any material being added to the collection. The first four accessions added to the collection were characterized using this chart and studied taking into account their biomass and essential oil yields and the quality of their volatile fraction. The materials analyzed are locally known as “27-09”, “Peruvian” and “native” clones and are taxonomically identified as hybrids of Origanum × majoricum Cambess; and a fourth material, known as “green Spanish” clone belonging to the species Origanum vulgare L. ssp. viridulum (Martrin-Donos) Nyman. The essential oil yield was similar for all the materials (1.7% (v/w) on dried basis). The estimated aired biomass yield was superior for the Origanum × majoricum hybrid clones (ranging from 4700 to 11,900kgha−1), whereas the “green Spanish” clone only reached a biomass of 2450kgha−1. Meanwhile, based on the quality of the essential oils, O. vulgare ssp. viridulum was more promissory, since it corresponded to a carvacrol type oregano. Finally, it will be necessary to assess the role of the agronomical and ecological variables on the latter clone, in order to increase the content of carvacrol in the essential oil and, at the same time, to improve its biomass yield. [ABSTRACT FROM AUTHOR]

During the past few years, efavirenz has been increasingly used in the treatment of HIV1 infection. Its main side effect is a syndrome of central nervous system stimulation occurring in 40–50% of adults in the first few weeks of therapy which might be observed at increased frequency in subjects concurrently using recreational substances. We therefore conducted a single center, retrospective study in 134 patients treated with efavirenz and found no significant differences in CNS side effects or discontinuation rates between recreational substance (cocaine, ecstasy, cannabis) users and non-users. Although our study is limited, the results support the idea that efavirenz can be safely prescribed to patients using recreational substances. [ABSTRACT FROM AUTHOR]

Hypercalciuria is a frequent cause of non-glomerular hematuria in pediatric patients. Because hypercalciuria can be secondary to primary hyperparathyroidism, measurement of serum parathyroid hormone (PTH) levels is often performed in children with this urinary abnormality. A retrospective chart review was performed to determine the diagnostic yield of PTH measurements when performed under these clinical circumstances. Over a 30-month period (January 1, 2001 to September 30, 2003), among 31 children who had a PTH determination, the level was elevated in 1 (3%) patient. Based on these findings and the serious nature of untreated primary hyperparathyroidism, serum PTH level should be measured in pediatric patients with newly diagnosed hypercalciuria. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented related to the reduction of efavirenz doze in HIV-infected patients.

A letter to editor regarding mycobacterium avium is presented.

Discusses about the role of tumor necrosis factor alpha in HIV1-associated lipodystrophy (LD). Association between increased serum interferon alpha and LD in HIV1-infected individual; Contribution of anti-retroviral therapy in the development of HIV-associated LD syndrome.

Examines a rapidly growing ulcerative genital mass in an HIV-infected woman. Association of the mass with herpes simplex virus type 2 infection; Effects of antiretroviral therapy on the immune system; Recurrence of genital herpes with oral aciclovir.

A letter to the editor is presented concerning the treatment of patients with chronic hepatitis C with interferon.

OBJECTIVE: Children and adolescents with newly diagnosed hypertension undergo various tests to define the cause and target organ consequences of the elevated blood pressure. We tested the hypothesis that the diagnostic yield of individual components of the currently recommended assessment does not justify performance for all patients with mild-to-moderate hypertension. METHODS: A retrospective chart review was conducted of patients who were referred between July 2002 and June 2007 for mild-to-moderate hypertension, defined as maximum blood pressure at >or=95% + 20/10 mmHg. The assessment included history and physical examination, nutritional assessment, urinalysis, biochemical and fasting lipid profile, renal ultrasound, echocardiogram, and 24-hour ambulatory blood pressure monitoring. RESULTS: A total of 249 patients were identified, and charts for 220 (88%) were available for review. There were 156 boys and 64 girls aged 13.3 +/- 4.4 years. BMI was 26.1 +/- 6.7 kg/m(2), and 143 (65%) had a BMI of >or=90%. Results of urinalysis and serum biochemical testing were clinically normal in all cases. Among those with a lipid profile, 59 (42%) had total cholesterol values of >170 mg/dL, and 26 (19%) had severe hypercholesterolemia (>200 mg/dL). Renal sonography revealed findings plausibly associated with hypertension in 14 (8%) patients; 4 (2%) had renovascular abnormalities. Yield of echocardiography was 17%. On ambulatory blood pressure monitoring, 47 (60%) children had systolic readings of >95% at least 20% of the time, and 28 (36%) had diastolic readings of >95% at least 20% of the time. CONCLUSIONS: For children and adolescents with mild-to-moderate hypertension, on the basis of a cutoff of 5% to 20% abnormal results to define a useful test, the initial evaluation can range from a serum cholesterol level and ambulatory blood pressure monitoring to a panel that consists of a fasting lipid profile, renal ultrasound, echocardiogram, and ambulatory blood pressure monitoring. Additional assessment should be guided by specific clinical features and the nature of the patient population. [ABSTRACT FROM AUTHOR]

BACKGROUND: Failure to thrive (FTT) poses a diagnostic dilemma for pediatricians. The kidney disorder that is considered most often is renal tubular acidosis (RTA). However, the prevalence of RTA may be overestimated, leading to unnecessary referrals for subspecialty evaluation. Moreover, preliminary data suggest that venous blood gas (VBG) testing may provide a more accurate measurement of the serum bicarbonate concentration than routine biochemical testing. OBJECTIVE: 1) To compare the results of bicarbonate measurements by using VBG and routine clinical biochemistry methods under a variety of in vitro conditions; 2) to determine the frequency of RTA as a cause of FTT; and 3) to assess the utility of VBG measurement of serum bicarbonate in the clinical assessment of RTA. EXPERIMENTAL DESIGN AND METHODS: In blood samples collected from healthy volunteers, bicarbonate was measured by using a VBG apparatus and a clinical biochemistry analyzer under a variety of in vitro conditions including variation in time until sample processing (0-4 hours), variations in temperature (room temperature versus on ice), addition of sodium fluoride, or addition of heparin. A retrospective chart review was also performed of all children referred to the renal clinic for evaluation of FTT during the 5-year period of 1997 to 2002. The following data were collected for each case: demographic and clinical information and laboratory testing including serum bicarbonate determined by both routine biochemical testing and VBG analysis. Data are reported as mean +/- standard deviation. RESULTS: In the in vitro studies, VBG determination of bicarbonate concentration consistently yielded a value that was 3 to 6 mmol/L higher than routine biochemical analysis regardless of whether the sample was processed immediately or up to 4 hours later, maintained at room temperature or on ice until the measurement was performed, or the sample tube contained sodium fluoride or heparin. Thirty-six children were referred to exclude a renal etiology of FTT with a presumptive diagnosis of RTA in all cases. The patient group was comprised of 16 males and 20 females whose ages ranged from 4 to 156 months (mean: 27 +/- 33 months). The serum bicarbonate concentration determined by biochemical testing was 18 +/- 4 mmol/L, whereas the bicarbonate level by VBG was 24 +/- 3 mmol/L. The mean difference between the bicarbonate by VBG and bicarbonate by routine biochemistry measurements was 5.6 +/- 4.4. Only 1 child (2.8%) was confirmed to have RTA. CONCLUSIONS: RTA is a rare renal cause of FTT in children. VBG determination of serum bicarbonate yielded a significantly higher value than the result obtained by routine biochemical testing under both in vitro and in vivo conditions. These data suggest that reliance on routine biochemical testing results in an overestimation of the importance of RTA as a cause of FTT. We recommend the use of a VBG determination of serum bicarbonate concentration for the evaluation of a child with FTT who is thought to have a metabolic acidosis. Adoption of this practice will reduce the number of children suspected of having RTA and decrease the need for referral to a nephrologist for further evaluation. [ABSTRACT FROM AUTHOR]

Presents the medical case of a young man diagnosed with bilateral tubercular chorioretinitis. Bilateral vision loss which occurred; Retinal fluorescein angiography of the left eye; Antitubercular treatments given; Outcome.

Reports on the increase in the notification rate for syphilis in the Russian Federation and Eastern Europe in the 1990s among prostitutes. The international travel and migration from Eastern Europe increasing the common sexually transmitted diseases (STD); The prevalence of active syphilis among immigrants from Eastern Europe; The data reflecting inexperience in the practice of prostitution among Eastern European immigrants having little knowledge of the risks of STD.