Factor V Quebec revisited

Factor V Quebec has been described as a bleeding disorder that exhibits an autosomal dominant inheritance pattern and presents severe bleeding after trauma. Two members of a fourth-generation (IV.13 and IV.15) Canadian family have been studied in detail and are the subject of this report. Their clinical presentations and histories have been described previously (Tracy et al: J Clin Invest 74:1221, 1984). Persistent abnormalities include mild thrombocytopenia and defective platelet factor V. Plasma factor V is present at near normal concentration and is fully functional. Thus, the bleeding diathesis appears to reflect the absence of platelet factor V activity. The recent report (Hayward et al: Blood 84:110a, 1994 [suppl, abstr]) of multimerin deficiency in these individuals led us to reevaluate these patients. Western blot analyses of platelet lysates developed with a variety of monoclonal antibodies show that the alpha-granule proteins, fibrinogen, von Willebrand factor, factor V and osteonectin are decreased in concentration and significantly degraded in the platelets of these patients. Thrombospondin, while not degraded, is substantially decreased. In contrast, platelet factor 4 and beta-thromboglobulin do not appear to be affected. These observations suggest that the alpha- granules are correctly assembled but the contents are subsequently subjected to proteolytic degradation. The results indicate that factor V Quebec disorder is probably associated with a generalized defect that leads to degradation of most proteins of the alpha-granules.     

Immune hemolytic anemia associated with tolmetin and suprofen

This article reports the first case of immune hemolytic anemia possibly associated with the ingestion of suprofen. The patient suffered from massive hemoglobinuria and acute renal failure. Serologic studies of the patient's serum revealed suprofen-dependent red cell antibodies. However, tolmetin-dependent antibodies were also found in the serum, showing the same properties as the suprofen antibodies and an even higher titer. The patient not only had drug-dependent antibodies in the serum, but also had developed autoantibodies, a phenomenon that has been described for several other drugs. The working mechanism by which suprofen and tolmetin caused immune hemolysis had properties of both the immune complex model and the induction of autoimmunity. Although it was unclear whether the immune hemolytic anemia was the result of suprofen, tolmetin, or cross-reacting antibodies, we feel that suprofen should be added to the list of nonsteroidal anti-inflammatory drugs associated with a positive direct antiglobulin test.     

Unusual objects in the root canal of deciduous teeth: a report of two cases

Accidental foreign body ingestion or aspiration is a common problem in children. Children often have a habit of inserting objects into their mouth. Some of these objects can be accidentally ingested or even aspirated which can be frightening and a stressful experience. But the presence of foreign objects in the teeth are rare. The foreign objects in the teeth may act as a potential source of infection and pain. In most of the cases, children avoid informing their parents due to fear of punishment. This paper presents two cases of foreign objects embedded in the deciduous teeth. In both the cases, parents were not aware of foreign body ingestion by their children.     

From the Cover: Erosion of functional independence early in the evolution of a microbial mutualism

Many species have evolved to function as specialized mutualists, often to the detriment of their ability to survive independently. However, there are few, if any, well-controlled observations of the evolutionary processes underlying the genesis of new mutualisms. Here, we show that within the first 1,000 generations of initiating independent syntrophic interactions between a sulfate reducer (Desulfovibrio vulgaris) and a hydrogenotrophic methanogen (Methanococcus maripaludis), D. vulgaris frequently lost the capacity to grow by sulfate respiration, thus losing the primary physiological attribute of the genus. The loss of sulfate respiration was a consequence of mutations in one or more of three key genes in the pathway for sulfate respiration, required for sulfate activation (sat) and sulfate reduction to sulfite (apsA or apsB). Because loss-of-function mutations arose rapidly and independently in replicated experiments, and because these mutations were correlated with enhanced growth rate and productivity, gene loss could be attributed to natural selection, even though these mutations should significantly restrict the independence of the evolved D. vulgaris. Together, these data present an empirical demonstration that specialization for a mutualistic interaction can evolve by natural selection shortly after its origin. They also demonstrate that a sulfate-reducing bacterium can readily evolve to become a specialized syntroph, a situation that may have often occurred in nature.From flowering plants and their pollinators to the microbial endosymbionts of insects, there are many examples in nature of obligate mutualists (1, 2), or species dependent upon a mutually beneficial interaction for their survival or reproduction. How these interactions evolve is a mystery because much theory predicts that cooperative interactions should be unstable (3) and because of the difficulty of inferring evolutionary events that occurred in the distant past (4). Although there are few, if any, empirical observations of evolution toward dependence on mutualism, there are now several examples of mutualisms evolving de novo in the laboratory (5–8). This advancement has provided researchers an experimental framework to study populations and ecological conditions in the early stages of evolution (5–8).Here, we describe our observations of rapid and repeated evolution of increased dependency on a mutualism through natural selection. This interaction is similar to a widespread relationship between prokaryotes that plays a pivotal role in the decomposition of carbon in many oxygen-free environments. In these syntrophic mutualisms, bacteria ferment organic acids, producing hydrogen or formate as by-products, which are then used by hydrogen-consuming species, often methanogenic archaea (9). Removal of hydrogen and formate benefits the bacteria because the free energy (ΔG) available decreases with increasing concentrations of these products (9). A variety of bacterial species have been described that seem to be specialized for fermenting organic acids in syntrophic association with hydrogen-consuming species (10–13). Notably, most clades of characterized syntrophs share a recent common ancestry with sulfate reducers (10, 14). Some retain vestiges of the sulfate-reducing pathway, and several lines of evidence hint at the possibility that specialized syntrophs were once sulfate reducers (11, 14).Sulfate-reducing bacteria gain energy from organic acids, such as lactate, in the absence of oxygen by coupling their oxidation to the reduction of sulfate to sulfide. These bacteria play a critical role in sulfur and carbon cycling, contribute to corrosion in the petroleum industry and wastewater treatment plants, and have been used for bioremediation of toxic heavy metals (15). The ability of sulfate reducers to grow in syntrophic association with methanogens was first demonstrated in laboratory studies (16) and is now generally recognized to be of environmental relevance (17–19). Many sulfate reducers would therefore be better described as facultative syntrophs, well adapted to environments of fluctuating electron acceptor availability (17, 20). Past evolutionary transitions of sulfate-reducing bacteria between obligate and facultative syntrophs is also indicated by comparative analyses indicating horizontal transfer of genes in the pathway of sulfate respiration (21, 22). Thus, the evolutionary adaptive flexibility of sulfate-reducing bacteria suggests that they offer an attractive experimental system to study the evolution of mutualism.To understand how mutualisms, and syntrophic interactions in particular, might evolve from their origin, we paired the sulfate-reducing bacterium, Desulfovibrio vulgaris Hildenborough, with the archaeon, Methanococcus maripaludis S2, and propagated 22 initially isogenic planktonic cocultures for 1,000 generations in medium with lactate but no sulfate or added hydrogen. In this environment, neither species can gain energy from the oxidation of lactate without syntrophic cooperation.Within the first 300 generations of evolution, the cocultures evolved increased stability, higher yields, and higher growth rates, with both species contributing to these changes (6), a trend that continued through 1,000 generations. We describe a common evolutionary outcome of these experiments. Many of the independently evolved D. vulgaris accumulated loss-of-function mutations in genes required for the reduction of sulfate, suggesting strong selection for mutations resulting in loss of the ability to respire sulfate during evolution in syntrophy.     

Hemorrhagic tumor necrosis during a pilot trial of tumor necrosis factor-alpha and anti-GD3 ganglioside monoclonal antibody in patients with metastatic melanoma

Hemorrhagic tumor necrosis is an inflammatory event that leads to selective destruction of malignant tissues, with both potentially toxic and beneficial consequences. A pilot clinical trial was undertaken combining tumor necrosis factor-alpha (TNF-alpha) with the monoclonal antibody R24 (MoAb R24) against GD3 ganglioside in patients with metastatic melanoma. Patients received MoAb R24 to recruit leukocytes to the tumor followed by low doses of recombinant TNF-alpha to activate leukocytes. Eight patients were treated and seven patients had mild toxicity. One patient with extensive metastatic melanoma developed tumor lysis syndrome within hours after treatment with almost complete necrosis of bulky tumors in multiple visceral sites. To our knowledge, this is the first documented case of hemorrhagic tumor necrosis in a patient with metastatic cancer in multiple visceral sites.     

The Evaluation of Efficacy of Post-Operative Antibiotics in the Open Reduction of the Zygomatic and Mandibular Fracture: A Prospective Trial

Introduction

The administration of pre and post-operative antibiotics for open reduction and internal fixation of facial fracture is the usual norm followed. Although the benefit of antibiotic has been established in the literature, the value of post-operative administration has been questioned and yet not extensively studied or investigated. There are rising concerns over the duration and undesired effects of antibiotics. The purpose of the study was to evaluate necessity and/or efficacy of post-operative antibiotics in the open reduction of zygomatic and mandibular fracture.

Methods

Sixty patients who underwent open reduction and internal fixation were divided into two groups for the trial. Ab group (30 patients) received pre, intra and post-operative antibiotics. Non-Ab group (30 patients) did not receive post-operative antibiotics though pre and intra-operative antibiotics were administered. Patients were evaluated for post-op infection at the end of 1st and 3rd week after operation.

Results

Among 60 patients, 2 patients (1 from Ab group and 1 from non-Ab group) were infected; so statistically no significant difference in result was obtained (Fisher’s exact test, P value = 1).

Conclusion

In this trial, the use of post-operative antibiotics in the open reduction and internal fixation of facial fracture was shown to confer no benefit/efficacy in reducing the chances of infection.     

Novel mechanism for translational control in regulation of ferritin synthesis by iron.

Poly(A)-containing RNA was isolated from the polyribosomal and post-ribosomal fractions of the livers of normal and iron-treated rats. These RNA fractions were then translated in a wheat germ system to provide a measure of the amount of ferritin mRNA present in each fraction. Following iron administration, there was a 2-fold increase in the amount of ferritin mRNA in the polyribosomal fraction. This increase was not inhibited by prior treatment of the rats with actinomycin D or cordycepin, suggesting a cytoplasmic control mechanism. In normal rats, the post-ribosomal fraction contained an amount of ferritin mRNA equal to that in the polyribosomes. When iron was administered, this untranslated ferritin mRNA became reduced to negligible quantities, thus accounting for the doubling of the ferritin mRNA content of the polyribosomal fraction. A scheme is proposed in which translation of the ferritin mRNA in the post-ribosomal fraction is prevented by adhering ferritin subunits. Iron administration removes this inhibition of the translation of ferritin mRNA by promoting aggregation of these subunits into ferritin.     

Systemic lupus erythematosus and sickle cell disease

A case of 10-year-old girl with an unusual association of sickle cell disease (SCO) with systemic lupus erythematosus (SLE) is presented. The report discusses the clues to the diagnosis of this rare combination with review of relevant literature and highlights the diagnostic dilemma that may arise because of the similarity of symptoms.     

Study of mast cells in non-neoplastic skin lesions

Sixty non-neoplastic skin lesions were studied for mast cells by toluidine blue stain. The highest numbers of mast cells were seen in the viral infections of the skin (50/mm2) and lowest number of mast cells in congenital diseases (17/mm2). Out of the cutaneous bacterial infections, highest numbers of mast cells were seen in leprosy (44/mm2) while in lupus vulgaris they were much less (37/mm2). In leprosy cases it was observed that as the lesions moved from indeterminate to both polar tuberculoid and lepromatous, the mast cell count increased. It could therefore be summarised that periodic follow-up of indeterminate and borderline lesions for mast cell count might help in predicting stability of lesions. In non-infectious squamous and papular lesions the mean mast cell count was 39/mm2. The highest numbers of mast cells in the non-infectious vesicular and bullous lesions were in bullous pemhigoid (57/mm2) and lowest in dermatitis (38/mm2).