How Long Will I Be Blue? Prolonged Skin Staining Following Sentinel Lymph Node Biopsy Using Intradermal Patent Blue Dye

Zusammenfassung

Hintergrund: Der für die Sentinel-Knoten-Biopsie bei Mammakarzinom-Patientinnen verwendete blaue Farbstoff kann längerfristige Hautverfärbungen im Injektionsbereich verursachen. Ziel dieser Studie war es, die Dauer derartiger Hautverfärbungen zu bestimmen. Patientinnen und Methoden: 236 aufeinanderfolgende Mammakarzinom-Patientinnen, bei denen eine brusterhaltende Operation und Sentinel-Knoten-Biopsie durchgeführt worden waren, wurden von Januar 2007 bis Dezember 2009 prospektiv untersucht. Ergebnisse: Bei 2 der 236 Patientinnen war eine bilaterale chirurgische Behandlung erfolgt, und 41 wurden im Rahmen jährlicher Nachuntersuchungen beurteilt. Blaue Verfärbungen im Injektionsbereich waren nach 12, 24 bzw. > 36 Monaten bei 36,5, 23,6 bzw. 8,6% der Patientinnen weiterhin sichtbar. Schlussfolgerung: Die Anwendung von Patentblau zur Identifikation des Sentinellymphknotens bei chirurgisch behandelten Mammakarzinom-Patientinnen kann zur längerfristigen Verfärbung der Haut im Injektionsbereich führen.     

Virus reduction in the preparation of intravenous immune globulin: in vitro experiments

BACKGROUND: While immune globulins for intravenous administration (IGIV) have an excellent record with respect to virus safety, concern regarding these preparations has been raised by reports of transmission of hepatitis C virus (HCV) to patients treated with IGIV and the presence of genetic material for HCV in IGIV preparations. STUDY DESIGN AND METHODS: This in vitro study evaluated the effectiveness of several manufacturing steps, including ethanol precipitation and pasteurization, in reducing HIV and model viruses including encephalomyocarditis (EMC) virus, pseudorabies virus (PRV), bovine viral diarrhea virus (BVDV), Sindbis virus, vaccinia virus, and vesicular stomatitis virus (VSV), as well as HCV RNA, in IGIV. RESULTS: Ethanol precipitation carried out after pasteurization resulted in virus reductions (log10) of >3.97 for HIV, 1.95 for EMC virus, >5.39 for PRV, and 3.52 for BVDV. Pasteurization inactivated EMC virus by 4.52 log10 and resulted in a log10 reduction of >6.54 for HIV, >5.39 for PRV, >6.64 for BVDV, >7.78 for Sindbis virus, >5.84 for vaccinia virus, and >6.99 for VSV. All viruses except EMC virus were reduced below the limit of detection within 6 hours of the beginning of pasteurization. Cohn processing of Fraction II + III paste and the 4.5-percent alcohol precipitation step prior to pasteurization provided additional virus removal. Studies using the polymerase chain reaction technique found that HCV RNA was detectable in the starting fraction of Cohn Fraction II paste, but not in the final IGIV preparation. CONCLUSION: These findings strongly support the viral safety of IGIV prepared by this method and show a significant added measure of virus safety associated with pasteurization of this preparation.     

Nurse physician communication in the perioperative environment: discourse and actions to transform health care

In a previous article by Weeks, discourse regarding nurse physician communication within acute care settings is presented and analyzed following the principles of critical discourse analysis (CDA). An understanding of what shapes nurse physician communication discourse and its role in the reproduction of the dominance of nurses by physicians is gained in this previous article. This understanding allows for further exploration of the role of discourse in the challenge of that dominance leading to suggested actions to transform health care delivery, which is the focus in this article.     

Statistics for X‐chromosome associations

In a genome‐wide association study (GWAS), association between genotype and phenotype at autosomal loci is generally tested by regression models. However, X‐chromosome data are often excluded from published analyses of autosomes because of the difference between males and females in number of X chromosomes. Failure to analyze X‐chromosome data at all is obviously less than ideal, and can lead to missed discoveries. Even when X‐chromosome data are included, they are often analyzed with suboptimal statistics. Several mathematically sensible statistics for X‐chromosome association have been proposed. The optimality of these statistics, however, is based on very specific simple genetic models. In addition, while previous simulation studies of these statistics have been informative, they have focused on single‐marker tests and have not considered the types of error that occur even under the null hypothesis when the entire X chromosome is scanned. In this study, we comprehensively tested several X‐chromosome association statistics using simulation studies that include the entire chromosome. We also considered a wide range of trait models for sex differences and phenotypic effects of X inactivation. We found that models that do not incorporate a sex effect can have large type I error in some cases. We also found that many of the best statistics perform well even when there are modest deviations, such as trait variance differences between the sexes or small sex differences in allele frequencies, from assumptions.     

Modulation of human tumor antigen expression

With membrane-enriched fractions prepared from human metastatic breast tissue used as immunogen, a group of monoclonal antibodies (MAbs) were generated that recognized several distinct antigens on breast and other carcinomas. The antibodies were found to react with established human tumor cells in culture as well as in immunohistochemical protocols using sections of primary and metastatic lesions. One MAb, B72.3, demonstrated a high degree of selective reactivity for human carcinomas in that no reactivity was found with a large number of different normal tissues. These MAbs were used to demonstrate the heterogeneity of expression of the tumor antigens as well as the intrinsic cellular factors (i.e., cell-cycle kinetics and clonal variability) that modulate their expression. Additional studies showed that recombinant human leukocyte interferon can act as a potent regulator of surface antigen expression on human carcinoma cells. Analysis of these cells by radioimmunoassay or flow cytometry revealed that interferon treatment resulted in a higher percentage of the cell population that bind the MAb to the surface antigen. Furthermore, interferon treatment also increases the level of expression for particular tumor antigen throughout the tumor cell population. Experimental models were also developed to investigate the active localization of a radiolabeled MAb by a human tumor xenograft in athymic mice. The results demonstrate active uptake of an 125I-B6.2 by a transplantable human breast tumor that expressed significant quantities of the B6.2-reactive 90 kD tumor antigen. In contrast, a human melanoma cell line grown as a solid, subcutaneous tumor in athymic mice did not localize the labeled B6.2 and does not express the associated 90 kD antigen. We report the generation and characterization of anti-breast carcinoma MAbs. These immunologic probes were used to study relevant breast tumor antigens, the factors that influence their level of expression, and the ability of human tumors grown in athymic mice to localize radiolabeled antibodies.     

Does Hextend impair coagulation compared to 6% hetastarch? An ex vivo thromboelastography study

The objective of this study was to determine if coagulation is different between 6% hetastarch in normal saline (NS) and 6% hetastarch in lactated Ringer's solution (LR), with use of an ex vivo thromboelastography (TEG) model with healthy donated volunteer blood. We simulated hemodilution that occurs during clinical resuscitation of hemorrhagic or hypovolemic shock, using healthy human donor whole blood (WB) ex vivo. Coagulopathy related to low, medium, high, or very high dilution of WB with NS or a high-molecular-weight hetastarch-based plasma expander, 6% hetastarch in NS (HSNS) or 6% hetastarch in lactated Ringer's [Hextend (HSLR)], was analyzed by thromboelastography (TEG). No changes were noted in the TEG profile of undiluted WB controls during the 6-hour period of use (P > 0.95). Dilution with HSNS and HSLR significantly impaired coagulation compared to both WB control and NS. Progressive dilution with NS impaired coagulation but to a lesser extent than colloids (P < 0.01). Low dilution of blood with NS increased clot strength by 12% (not significant; P = 0.097). We conclude that WB containing citrate obtained from healthy donors for TEG analysis yields reproducible data over a minimum of 6 hours. Either hetastarch, when present at concentrations comparable to the manufacturer's maximum recommended dose of 20 mL/kg (equivalent to the high dilution used in these experiments), decreases clot tensile strength to levels associated with an increased risk of bleeding. Substitution of lactated Ringer's for NS in 6% hetastarch appears to offer no advantage in avoiding hemostatic compromise in an in vitro model.     

Prevalence of congenital heart defects in monochorionic/diamniotic twin gestations: a systematic literature review.

OBJECTIVE: Congenital heart defects (CHDs) affect approximately 0.5% of all neonates. Recent literature points to a possible increase in the CHD prevalence among monochorionic/diamniotic (MC/DA) twin gestations. We hypothesized that MC/DA twin pregnancy is a risk factor for CHD. METHODS: A systematic review of all published English literature was conducted on MEDLINE (Ovid and PubMed) from January 2000 through April 2007 using the medical subject heading terms "congenital heart defect" and "monozygotic twins." Four observational studies were included in the final analysis. Published historical data were used for the population background risk of CHD. Relative risk (RR) estimates with 95% confidence intervals (CIs) were calculated by fixed and random effect models. RESULTS: We included a total of 40 fetuses with CHDs among 830 fetuses from MC/DA twin gestations. Compared with the population, CHDs were significantly more prevalent in MC/DA twins regardless of the presence of twin-twin transfusion syndrome (TTTS) (RR, 9.18; 95% CI, 5.51-15.29; P < .001). Monochorionic/diamniotic twin gestations affected by TTTS were more likely to be complicated by CHDs than those that did not have TTTS (RR, 2.78; 95% CI, 1.03-7.52; P = .04). Ventricular septal defects were the most frequent heart defects. Pulmonary stenosis and atrial septal defects were significantly more prevalent in pregnancies complicated with TTTS. CONCLUSIONS: Monochorionic/diamniotic twin gestation appears to be a risk factor for CHDs. Conditions that lead to abnormal placentation may also contribute to abnormal heart development, especially in MC/DA twin pregnancies complicated with TTTS. Fetal echocardiography may be considered for all MC/DA twin gestations because ventricular septal defects and pulmonary stenosis are the most common defects.     

HIV seroprevalence in hospital patients in rural Georgia.

To determine human immunodeficiency virus (HIV) seroprevalence among hospital patients in three rural community-based hospitals in southern Georgia, we anonymously tested patients 15 to 54 years old for antibodies to HIV-1 from residual blood specimens collected for routine diagnostic purposes. Data collected included age, sex, race, hospital service, presenting condition, physician's knowledge of HIV infection status, and discharge diagnosis. Of 1319 patients tested, seven (0.5%, 95% confidence interval = 0.2% to 1.1%) had antibodies to HIV-1. Of those seven, five had HIV infection unsuspected by their physicians, and four had an infectious disease. HIV seroprevalence was 0.5% for both men and women, 1.0% for blacks, and 0.3% for whites. HIV-positive patients were found on all hospital services. These results suggest that in rural southern Georgia hospitals, HIV should be routinely considered in the differential diagnosis of conditions that may be related to HIV. In addition, these data demonstrate a need for medical services or referral networks for HIV-related illnesses and a need for continuing HIV counseling and testing offered by local health departments in rural southern Georgia.     

Chemiluminescent labeled-antibody assay for thyroxin in serum, with magnetic separation of the solid-phase

A chemiluminescent labeled-antibody immunoassay has been developed for measurement of total thyroxin (T4) in serum. Monoclonal antibodies to T4 labeled with a chemiluminescent acridinium ester are used. Serum samples are incubated with the labeled antibodies and a thyroxin-rabbit immunoglobulin conjugate, then reacted with magnetizable particles containing sheep anti-rabbit immunoglobulin. The total reaction time is 40 min. The chemiluminescence intensity of the solid-phase immune complexes is inversely proportional to the concentration of T4 in the sample. The sensitivity of the assay is 1 nmol/L, and the working range of 20-190 nmol/L is characterized by CVs less than or equal to 10%.