Australian and New Zealand journal of medicine最新文献

All-trans-retinoic acid (ATRA) is known to induce differentiation of promyelocytes in vitro and also to induce remission of acute promyelocytic leukaemia in vivo. We treated 11 patients with poor prognosis acute promyelocytic leukaemia (APL) with ATRA and obtained seven complete and one partial remission. Remissions took one to three months to achieve and were associated with adverse effects including dry skin and bone pain. In eight patients the white cell count rose above 20 x 10(9)/L within the first ten days of retinoic acid treatment and this was associated with the development of pulmonary leukostasis in three patients which was fatal in one. Another two patients died of intracranial haemorrhage also within the first ten days. ATRA is a promising new agent in the induction therapy of this particular category of acute leukaemia.

There is increasing evidence of degeneration of nerve cells other than motor neurones in sporadic motor neurone disease (MND). Sporadic MND is occasionally associated with Parkinsonism. The aim of this study was to determine whether neuronal loss occurs in the substantia nigra of MND patients. Case records and pathological material from 14 patients with MND were reviewed. No patient had Parkinsonism documented. Sections of substantia nigra from the patients and 14 age/sex matched controls were analysed by neuronal and macrophage quantitation. The mean number of pigmented neurones at one standard level of substantia nigra was 863 in cases and 1094 in controls (p < 0.02); on average 21% (95% CI, 7-35%) fewer in the cases. The mean number of macrophages containing neuromelanin in cases was 106 and in controls 45 (p < 0.02). The results indicate that patients with MND have degeneration of the substantia nigra. Thus MND should be considered as a type of multiple system atrophy in which the motor neurone bears the brunt of the disease. The implication of this to the relationship between classical MND and MND with Parkinsonism-Dementia of the Western Pacific is discussed.

Streptococcus pneumoniae in the past were uniformly susceptible to penicillin. Increasing levels of resistance are now seen worldwide. To define the prevalence of this resistance in Australia, a collaborative study was carried out on all pneumococcal isolates at 15 large metropolitan teaching hospitals. During 1989 details of results of penicillin testing using routine methods were recorded. Isolates found resistant to penicillin were forwarded to Woden Valley Hospital for determination of penicillin minimum inhibitory concentration (MIC). All invasive isolates from five of these hospitals were also forwarded during 1989 and 1990 for MIC testing. Of the 1822 isolates tested, 31 (1.7%) were recorded as penicillin resistant. However, only 16 of 22 resistant isolates forwarded for MIC testing had MICs of > or = 0.1 mg/L confirmed. After adjustment to account for discrepancies with different laboratory testing methods we calculated the likely penicillin resistance to be 1% of isolates. Two of 105 invasive strains tested were found to be penicillin resistant. We conclude that penicillin-resistant S. pneumoniae isolates, including isolates from invasive sites, are found in Australia. All of these isolates had an MIC between 0.1 and 1 mg/L and are thus regarded as 'intermediately' penicillin resistant isolates. No high level resistance (MIC > or = 2 mg/L) was observed. Ongoing surveillance is essential to detect changes in resistance patterns and prevalence, as this will have implications for the empiric treatment of serious disease caused by S. pneumoniae.