A seronegative arthritis is an associated finding in MDS. The arthritis can precede the development of the bone marrow disorder, and can be a guide to the diagnosis of this haematological disorder in elderly patients presenting with an inflammatory arthritis and cytopenias.
Although the SSRIs may cause abnormal hemostasis, this effect is probably rare. Another possibility is that abnormal hemostasis is more likely to occur when high doses of SSRIs are administered.
Mycobacterium leprae cells extracted from the skin biopsies of 14 bacilliferous lepromatous patients were maintained in human-murine macrophage cultures for 3 weeks in the presence of [3H]thymidine and DDS (4,4'-diaminodiphenyl sulfone). All cultures except one containing freshly extracted viable bacilli showed significant incorporation of [3HJthymidine as compared to control cultures containing heat-killed bacilli of the corresponding strain. Six susceptible strains of M. leprae obtained from untreated, freshly diagnosed patients showed significant inhibition of the uptake of the radiolabel in the presence of 3 and 10 ng of DDS per ml per culture. Eight strains of M. leprae obtained from patients clinically suspected of DDS resistance were tested in a similar manner. These strains were also concurrently inoculated in the footpads of mice given orally 10-2, 10-3, and 10-4 g of DDS per 100 g of body weight for 9 months. Concordant results were obtained by both methods: five strains were found to be resistant, one was susceptible, and one was partially resistant. Strain VIII did not incorporate [3H]thymidine in the macrophage cultures and proved to be resistant in the mouse footpad. The macrophage culture system provides a sensitive, rapid screening method for the early diagnosis of DDS resistance.Mycobacterium leprae continues to evade in vitro cultivation by conventional methods. The problems related to the study of the pathogenesis of leprosy, the effect of antileprosy drugs (9, 13,22,27), and the diagnosis of resistant strains (16,19) were partly overcome with the development of the mouse footpad model as a useful tool in various laboratories (3,21,26 of resistance in the endemic areas using monotherapy.After the reports of radiolabeling of mycobacteria (15) and, in particular, M. leprae (1, 4,12,31), our laboratory was able to confirm the uptake of [3H]thymidine by more than 50 M. leprae strains resident in human (20) and murine (25) macrophages. Differentiated macrophages maintained in vitro provide a suitable environment for the short-term maintenance of M. leprae, as indicated by morphological criteria (24) or, in our hands, by the selective uptake of [3H]thymidine by the bacilli (20,25). The incorporation of the radiolabel appears to be maximal by the third week in culture, and the increase in radioactive counts is cumulative. That the incorporation is related to the viability of M. leprae is indicated by the significant increase in counts in cultures containing freshly extracted bacilli as compared to cultures with the corresponding heat-killed strain.The present study was designed to assess the utility of this in vitro system for the identification of DDS resistance in clinically suspected patients. To test the validity of the system, studies were undertaken in three independent centers in India. The patients were screened in the Central Leprosy Training Research Institute, Chingelput, and the skin biopsies were air-
The efficacy of predeposited autologous blood transfusion (PABT) with and without intra/postoperative blood salvage to reduce or eliminate the need for homologous blood transfusion (HBT) in primary total hip or knee replacement surgery was investigated by retrospective and prospective studies. Depending on the type of surgery, one to three units of PABT eliminated the need for HBT in 50 to 78% of patients, but, intra/postoperative blood salvage alone reduced the need only in 11 to 29%. In contrast, blood salvage, when combined with three units of PABT, eliminated the need for HBT in all patients undergoing primary joint replacement surgery. A cost comparison analysis showed that blood salvage was more expensive than PABT, and therefore it should be limited to patients who had predeposited fewer than three units of autologous blood.
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