Selective in vivo removal of rheumatoid factor by an extracorporeal treatment device in rheumatoid arthritis patients

A prospective phase II trial was conducted to assess the feasibility, tolerance, and efficacy of a device designed for selective removal of rheumatoid factor from the plasma of rheumatoid arthritis patients. The device contained terpolymer hydrogel-coated plates with chemically attached, aggregated human immunoglobulin G, and it operated as an immunoaffinity column. Sixty-one patients aged 25 to 73 underwent weekly plasmapheresis treatments (the primary therapy phase). During the trial, patients continued current rheumatoid arthritis medications without dose adjustments. All patients received two to six treatments (primary therapy). Responding patients were eligible to continue apheresis treatment every 2 to 6 weeks (maintenance therapy). No serious, untoward side effects were noted in the course of this study; of 640 treatments, only 2 (in different patients) were aborted, one because of complaints of dizziness and angioedema and the other because of chest tightness and shortness of breath. Except for a significant (p less than 0.05) decrease in serum iron, no significant changes in complete blood count, serum electrolytes, renal and hepatic function tests, or serum C3 and C4 were noted. Although the trial was not designed to determine clinical efficacy, patients noted less morning stiffness, longer time to onset of fatigue, and improved global pain assessment (p less than 0.004); significant objective improvements were noted in joint pain, tenderness, swelling, and the number of affected joints (p less than 0.001). One-half of the treated patients had at least a 50 percent improvement in objective measures of antirheumatic activity.(ABSTRACT TRUNCATED AT 250 WORDS)     

Computed tomography and magnetic resonance imaging evaluation of patellofemoral instability

Malalignment and tracking abnormalities of the patellofemoral joint are common causes of anterior knee pain,which are often difficult to evaluate clinically. Conventional radiography, as well as the cross-sectional imaging modalities of computed tomography (CT) and magnetic resonance imaging (MRI) are useful tools for both detecting and quantifying these abnormalities. Acute transient dislocation of the patella, on the other hand, is a relatively uncommon injury accounting for only 2% to 3% of all acute injuries of the knee, and can also be a difficult diagnosis to establish on the basis of history and physical findings alone. MRI is a sensitive, noninvasive method for detecting prior acute transient dislocation of the patella. This article begins by describing the role of CT and MRI as it pertains to the detection of abnormal patellofemoral tracking. Both static and dynamic techniques are described along with the standard criteria used to establish and quantify patellofemoral malalignment abnormalities. Next, the constellation of MRI findings most commonly encountered after acute transient dislocation of the patella are described. These findings include a typical bone bruise pattern involving the anterolateral aspect of the lateral femoral condyle and inferomedial patella, hemarthrosis, and injury to the medial soft-tissue restraints (especially the medial patellofemoral ligament). After transient dislocation of the patella, patients with significant osteochondral injury or disruption of the medial soft-tissue restraints may benefit from surgical repair. The role of MRI in preoperative planning is discussed as it relates to the detection of osteochondral injuries as well as injury to the medial soft-tissue restraints.     

保存7天单采血小板的体外研究

本项研究的目的是确定单采血小板可允许保存的条件,包括容积、血小板成分的含量和特殊血小板成分保存袋内的血小板总量。材料和方法 本研究用单采机(COBE Spectra LRS Turbo,version 7,Gambro BCT,Denver,CO)从自愿献血者采集血小板成分,献血者符合 FDA和 AABB 献血标准,并在献血小板成分之前 7天内,没有服用改变血小板成分作用的药物和抗生素。控制每袋血小板成分的浓度和容积,以检测这些变量。悬浮在血浆中的血小板成分保存在特制的PVC合成的塑料袋中,枸椽酸钠抗凝,在22℃温控的恒温箱中震荡8天。     

A case of maple syrup urine disease misdiagnosed as Tetanus neonatorum on admission

A case of Maple Syrup Urine Disease (MSUD) is presented with clinical signs and symptoms on admission resembling neonatal tetanus. Diagnosis had to be differentiated between MSUD and other metabolic disorders and neonatal infections (especially neonatal tetanus because of severe opisthotonos) and generalized seizures of the patient. Early diagnosis of the MSUD patient is very important for effective therapy and better long-term prognosis as well as genetic counselling and prenatal diagnosis for future pregnancies.     

Facet joint arthrography in lumbar spondylolysis: anatomic basis for spread of contrast medium

Facet arthrograms in patients with lumbar spondylolyses show spread of contrast medium through pars interarticularis defects into the adjacent ipsilateral facet joint space and across the midline into the contralateral joint space. Transverse and sagittal sections of facet joints from 141 postmortem lumbar spines were studied. Five examples of spondylolysis were found. Anatomic studies of the relationship of the joint recesses to the pars interarticularis demonstrated the basis for the patterns of spread of contrast medium observed radiographically in this and previous series. The pars interarticularis forms the only boundary between the inferior recess of one facet joint and the superior recess of the adjacent joint. Fracture through the pars interarticularis establishes communication between adjacent ipsilateral joints and opens a communication to the retrodural space, through which contrast medium can track to the contralateral joint.     

The effect on the safety of intravenous immunoglobulin of testing plasma for antibody to hepatitis C

BACKGROUND: The safety of intravenous immunoglobulin (IGIV), manufactured from units testing negative for antibody to hepatitis C virus (anti-HCV), was investigated. STUDY DESIGN AND METHODS: A study involving five chimpanzees was performed to determine whether the safety of IGIV would be compromised if units of plasma that reacted for anti-HCV were withheld from pools from which IGIV is manufactured. In the first phase of the experiment, two chimpanzees were infused with 25 mL per kg of unprocessed, pooled plasma from 2887 donors who did not react for anti-HCV in single-antigen (c100-3) enzyme-linked immunosorbent assays. In the second phase, each of three chimpanzees was infused with 1000 mg per kg of IGIV manufactured from the same plasma units. The immunoglobulin was made by seven United States- licensed manufacturers, each using its own approved method. Each chimpanzee received an equal dose of each manufacturer's IGIV. RESULTS: The two chimpanzees that received anti-c100-3-nonreactive, unprocessed pooled plasma became infected with HCV. The three chimpanzees infused with IGIV did not show any evidence of infection with HCV 15 months after inoculation. Two of these animals were challenged with human non- A,non-B hepatitis-infectious plasma, and both subsequently showed evidence of HCV infection. CONCLUSION: These studies demonstrate that, as determined by infectivity for chimpanzees, 1) the withholding of plasma units that react for anti-c100-3 from pools from which plasma products are manufactured does not render the source material noninfectious, and 2) the safety of IGIV manufactured from such plasma pools is not compromised by withholding the units that react for anti- c100-3.