Variability of the methionine loading test: no effect of a low protein diet.

The methionine loading test is used for the diagnosis of impaired methionine/homocysteine metabolism, in particular the transsulfuration pathway. Usually this test is performed on a low protein diet to control the intake of methionine. However, this is inconvenient and relatively expensive.

Hyperhomocysteinemia as a risk factor for deep-vein thrombosis.

Background: Previous studies have suggested that hyperhomocysteinemia may be a risk factor for venous thrombosis. To assess the risk of venous thrombosis associated with hyperhomocysteinemia, we studied plasma homocysteine levels in patients with a first episode of deep-vein thrombosis and in normal control subjects.

Methods: We measured plasma homocysteine levels in 269 patients with a first, objectively diagnosed episode of deep-vein thrombosis and in 269 healthy controls matched to the patients according to age and sex.

Systemic Fusarium nygamai infection in a patient with lymphoblastic non-Hodgkin's lymphoma.

We report the case history of a 35-year-old male patient with lymphoblastic non-Hodgkin's lymphoma who acquired a systemic infection with Fusarium nygamai during the granulocytopenic phase of cytostatic treatment. The patient survived this infection after haematological recovery and treatment with intravenous amphotericin B (total dose 543 mg). Subsequent chemotherapy courses were not complicated by fungal infections.

Is hyperhomocysteinaemia a risk factor for recurrent venous thrombosis?

Several studies have shown a relation between hyperhomocysteinaemia and arterial vascular disease. We looked at the association between hyperhomocysteinaemia and venous thrombosis which could be clinically important as hyperhomocysteinaemia is easily corrected by vitamin supplementation. We studied 185 patients with a history of recurrent venous thrombosis and 220 controls from the general population.

Treatment of recurrent squamous cell carcinoma of the hand in immunosuppressed patients.

Since 1981, 14 patients with kidney transplants have been treated for recurrent squamous cell carcinoma of the skin of the dorsum of the hand by total skin resection. Frozen sections of the base of the tumor sites were carried out and the denuded area was resurfaced with split-skin grafts harvested from non-sun-exposed areas on the buttock and upper thigh. During follow-up examinations, no recurrence was seen in the grafted areas.

Lung function, CT-scan and X-ray in upper airway obstruction due to thyroid goitre.

The purpose of this study was to assess the clinical reliability and to compare routine lung function tests (maximal flows and resistance) and radiological images (computed tomography (CT)-scan and X-ray) in upper airway obstruction. We, therefore, performed these examinations prospectively in 28 female patients (aged 68 +/- 13 yrs) with a goitre and without pulmonary disorders. Lung function measurements consisted of maximum expiratory and inspiratory flow-volume curves and of airway resistance.

Kaposi's sarcoma in an HIV-negative CLL patient as the cause of thrombocytopenia.

A patient is described with a rapidly progressive Kaposi's sarcoma following immunosuppressive therapy with fludarabine monophosphate (FAMP) for chronic lymphocytic leukemia. The development of this tumor was accompanied by progressive thrombocytopenia, due to trapping of the platelets in the Kaposi sarcoma, without signs of consumptive coagulopathy or microangiopathic hemolytic anemia. This sequestration process might be caused by the abnormal structure of the tumoral vessels, leading to exposure of subendothelial structures like collagen, von Willebrand's factor, and tenascin to the vessel lumen.

A nearly fatal tracheal obstruction resulting from a transtracheal oxygen catheter.

In a patient with a transtracheal oxygen catheter (ITO2C), a nearly fatal complication occurred due to the formation of a mucous plug on the tip, which almost totally obstructed the tracheal lumen. To our knowledge, this complication has not been reported before with the use of this type of transtracheal oxygen catheter.

The effect of estriol on the cytology of urethra and vagina in postmenopausal women with genito-urinary symptoms.

In a double-blind, randomised trial, 62 postmenopausal women with genito-urinary symptoms were treated with oestriol or matching placebo for 4 weeks. Estriol (Synapause-E3, Nourypharma Nederland) was given orally for 4 weeks in a single daily dose (8 mg/day first week, 4 mg/day second and third week, 2 mg/day fourth week). The influence of estriol on the vaginal and urethral epithelium was assessed by using the karyopycnotic index and the maturation value.

Human immunodeficiency virus, fever, dyspnoea and a dry cough. Expect the unexpected?

This report describes an HIV-seropositive patient with symptoms suggestive of Pneumocystis carinii pneumonia. The final diagnosis of pulmonary embolism was delayed because initially only HIV-specific complications were considered. The relation between AIDS and pulmonary embolism is discussed briefly.

A prospective randomized study comparing amoxycillin/clavulanate with cefuroxime plus metronidazole for perioperative prophylaxis in gynaecological surgery.

A prospective, randomized, open study was performed in 199 patients at the Leyenburg Hospital comparing amoxycillin/clavulanate (AMX/CL) with cefuroxime plus metronidazole (CR/MN) in the prophylaxis of infection following gynaecological surgery. AMX/CL was given as a single dose of 2200 mg i.v.

Mitoxantrone, teniposide, chlorambucil and prednisone (MVLP) for relapsed non-Hodgkin's lymphoma. The impact of advanced age and performance status.

Fifty-seven patients with relapsed non-Hodgkin's lymphoma (NHL) of low, intermediate and high-grade malignancy were treated with mitoxantrone, teniposide (Vm26), chlorambucil (Leukeran) and prednisone (MVLP). The median age was 71 years; none of the patients was excluded due to poor performance status (PS). Out of 44 patients with PS (according to WHO) < or = 2, 38 responded with a median progression free survival (PFS) of 21.

Bleeding varices due to portal hypertension in sarcoidosis. Favorable effect of propranolol and prednisone.

A 58-year-old white man had bleeding varices in the gastric fundus due to portal hypertension attributable to histologically proven hepatic sarcoid involvement with a giant splenomegaly and with an angiographically demonstrated significant flow toward the liver. Treatment with corticosteroids and beta-blockade (30 mg propranolol daily) resulted in no rebleeding for over one year follow-up.

Mechanisms of brachial plexus lesions.

The main causes of brachial plexus palsies are traction, due to extreme movements, and heavy impact. In downward traction of the arm and forcible widening of the shoulder-neck angle the lesion will occur in the upper roots and trunk. Forcible upward traction will cause avulsion of T1 and C8.

Dialysis associated mucormycosis and desferrioxamine treatment: a case report with review of the role of oxygen radicals.

A hemodialysis patient with pulmonary and cerebral mucormycosis is reported. Recently the occurrence of this infection in dialysis patients has been associated with desferrioxamine (DFO) treatment. A causal relation seems likely, but has not been proved.

Infection with Dengue virus.

We report a male Caucasian, with a Dengue virus infection imported from Thailand to The Netherlands. General characteristics of the disease are presented and the supposed pathogenetic mechanisms of the disease are discussed.

Recurrence of hyperthyroidism in multinodular goiter after long-term drug therapy: a comparison with Graves' disease.

The chance of permanent remission after prolonged drug therapy was investigated in 41 patients with toxic multinodular goiter. For purposes of comparison a group of 41 patients with Graves' disease was also studied. After euthyroidism was achieved all patients received a combination of thionamide and thyroxine for at least 12 months.

Carbamyl phosphate synthetase-1 deficiency discovered after valproic acid-induced coma.

Valproic acid induced coma is presented in an adult patient without a history of metabolic disease. Liver biopsy revealed a reduction in activity of carbamyl phosphate synthetase-I, an enzyme obligated for transformation of ammonia to urea in the urea cycle. After recovery CT scan follow-up showed marked cerebral atrophy which did not exist prior to the state of coma.

A thyroglossal duct node as presenting symptom of Hashimoto's thyroiditis: a report of two cases.

Two patients with thyroglossal duct nodes are described. Both patients were suffering from autoimmune thyroiditis. The tumours resembling thyroglossal duct cysts presented as palpable nodes in the midline of the neck and moved upwards on swallowing.

Hyaline-vascular type Castleman's disease with concomitant malignant B-cell lymphoma.

This case report describes a patient with localized hyaline-vascular (H-V) type Castleman's disease with concomitant malignant B-cell lymphoma. Malignant lymphoma has been described in association with multicentric type Castleman's disease, but not in association with the localized H-V type. Evidence for a relation between the two lesions in this patient by means of histologic, flow-cytometric, cytogenetic and gene rearrangement studies was not found.

1891-1991: the centenary of innovative reconstructive hand surgery by Carl Nicoladoni.

Austrian surgeons, trained at the famous surgical school in Vienna, played a very important role in general and reconstructive surgery at the end of the 19th century. Nicoladoni introduced original ideas in reconstructive hand surgery, including a tubed pedicle flap and, later, a toe-to-hand transfer to replace amputated parts of a thumb.

Tibial fracture after transposition of the tibial tubercle.

Eight weeks after transposition of the tibial tubercle for recurrent subluxation of the patella, the patient sustained a tibial fracture during rope jumping. In spite of consolidation of the osteotomy in the frontal plane, there remained a small gap in the anterior cortex in the transverse plane through which the tibia failed during bending stress.

Digits in the mouth; a peculiar chapter in cleft lip and palate surgery.

In 1901 von Eiselsberg reported closing a fistula of the hard palate using the patient's little finger. The case is reviewed here and set in the context of its time.