Coexisting calcified inferior vena cava thrombus and adrenal hemorrhage in the neonate: Report of three cases

Coexisting calcified inferior vena cava (IVC) thrombus and adrenal hemorrhage are uncommon in children. We present three such cases diagnosed by ultrasound in three boys who were born after 41-, 38-, and 38-week gestations, respectively. In all cases the pregnancy and delivery were unremarkable. The birthweight was 3,630 g, 3,210 g, and 3,390 g, respectively. Left adrenal hemorrhage occurred in all cases. Associated left renal vein thrombus occurred in two cases. The mean followup was 8.5 years. In two cases ultrasound showed persistence of a calcified thrombus and residual stenosis of the IVC. In the third case the IVC thrombus had almost disappeared. © 1994 John Wiley & Sons, Inc.     

ISOLATION OF A TRYPSIN-LIKE ENZYME FROM. STREPTOMYCES PAROMOMYCINUS (PAROMOTRYPSIN) BY AFFINITY ADSORPTION THROUGH KUNITZ INHIBITOR-SEPHAROSE

A trypsin-like enzyme has been isolated from the filtrate of a Streptomyces rimosus forma paromomycinus culture. Purification involves acetone fractionated precipitation, ultrafiltration on a Diaflo UM 10 membrane and affinity adsorption on to Kunitz pancreatic trypsin inhibitor linked to Sepharose. The trypsin-like enzyme (paromotrypsin) appears homogeneous by zone electrophoresis on gelatinized cellulose acetate. Specific activity toward Tos-Arg-OMe, calculated from amino acid analysis, is about 220 u mg^-1. The overall yield in activity is about 30%. The molecular weight of the trypsin-like enzyme, determined by gel filtration, is around 22,000–25,000 daltons. Electrophoretic migration on cellulose acetate strips indicates an isoelectric point around 8. Amino acid composition has been determined; the protein comprises about 210 residues on the basis of a single histidine residue per molecule. Paromotrypsin is unstable in acidic medium and is not stabilized by calcium ions. Enzymic activity towards Bz-Arg-OEt is not increased by the addition of calcium ion in contrast to the activating effect observed on bovine trypsin. Paromotrypsin is inhibited by TLCK and NPGB; it interacts with naturally occurring bovine trypsin inhibitors such as soya bean and Kunitz pancreatic inhibitors, but not with chicken ovomucoid. Proteolytic specificity, examined by hydrolysis of oxidized Kunitz pancreatic inhibitor and characterization of resulting peptides, seems similar to that of bovine trypsin.     

Failure of acyclovir to prevent cytomegalovirus infection in renal allograft recipients

Cytomegalovirus (CMV) is the most common opportunistic pathogen following renal transplantation and remains a major concern in transplantation centers owing to its high morbidity and impact on renal allografts. Pending more effective antiviral drugs, efforts have been directed toward prevention strategies. We conducted a retrospective analysis to evaluate the efficacy of various prophylactic options used at our institution during the period April 1986 to August 1990. All CMV-negative patients with CMV-negative kidneys (D-R-) received screened, CMV-negative blood products (n=19). CMV-specific immunoglobulins (CMV Ig) were used in 6 patients at increased risk for primary CMV infection and acyclovir was administered to 21 patients at an initial intravenous dose of 5 mg/kg body weight; then oral doses of 800–3200 mg per day were given according to the patients' estimated creatinine clearance. Thirty-two patients did not receive any CMV prophylactic treatment and served as controls. CMV monitoring of the patients during the first 6 months after transplantation showed an overall infection and disease rate of 81% and 38.1%, respectively, in the acyclovir-treated group. Compared with controls, the incidences of infection and disease were higher in the acyclovir-treated patients, with a significant difference for CMV infection (P=0.002, generalized Wilcoxon test). Only 1 of the 19 D-R-patients presented with CMV infection. CMV Ig-treated patients tended to have less severe disease without any apparent reduction in infection incidence. Given the high rate of infection in patients at risk, we infer that high-dose acyclovir does not prevent CMV infection in our setting of renal transplantation. We advocate the use of screened, CMV-negative blood products in D-R-patients.Part of this study has already been published as a letter to the editor in the Annals of Internal Medicine     

Course of the resistance of Staphylococcus aureus to pefloxacin. A study based on 782 strains isolated in 1985 and 1986

We studied the evolution of the resistance of Staphylococcus aureus to pefloxacin during 1985 and 1986 in eight hospital units. The pefloxacin resistant Staphylococcus aureus, which amounted to 8.9% in 1985 reached 27% in 1986. They are found mainly among the methicillin-resistant Staphylococcus. There is no obvious relationship between this resistance and the consumption of pefloxacin in each of the units.     

Splenosis: Ultrasound and CT findings in a case complicated by an intraperitoneal implant traumatic hematoma

A case of intraperitoneal splenosis, found incidentally at ultrasound examination in a 35-year-old man, is reported. The diagnosis, suspected on the basis of computed tomographic (CT) and radionuclide studies, was established by surgery. Three years later, after direct trauma, ultrasound and CT studies revealed a surgically proven splenosis implant hematoma. The contribution of radiologic examinations in the diagnosis of splenosis is emphasized.     

Aseptic periprosthetic fluid collection: A late complication of dacron arterial bypass

Fluid collection encompassing an arterial prosthesis often leads one to suspect graft infection. Four cases of aseptic seroma occurring three to five years after insertion of knitted Dacron implants for bypass are reported. The collection was serohematic in three cases, puriform in the other. Repeated bacteriological investigations did not reveal any growth and laboratory tests did not demonstrate any signs of infection. The following pathophysiologic hypotheses have been advanced: modification of the permeability of the prosthetic wall, immunoallergic reaction to the graft, and aging hematoma. The role played by anticoagulant is debatable. Management by needle aspiration or drainage failed. Multiple recurrences led to prosthetic replacement in three cases. Treatment consists of replacing the graft by one of a different fabric. These collections must be distinguished from postoperative lymphoceles, anastomotic false aneurysms, hematomas and infections.     

Renal clubbing and scarring in adults: A retrospective study of 110 cases

A urographic pattern of renal clubbing and scarring was found in 182 scarred kidneys of 110 adult patients. Homolateral vesicoureteric reflux was demonstrated by reliable techniques in 90/135 scarred kidneys. Urinary tract infections occurred in 75 patients. Hypertension developed in 20 patients with normal renal function and was not related to the extent of scarring. Chronic renal failure occurred in 30 patients with diffuse bilateral scarring. Four patients showed histologic changes of chronic pyelonephritis. Two hypertensive patients had a typical histologic pattern of Ask-Upmark kidney (segmental hypoplasia). Development of renal scars in adulthood was demonstrated in 2 cases.     

Suppression of mitogen-induced peripheral B cell differentiation by soluble Fcγ receptors released from lymphocytes

Soluble receptors for FcIgG released from unstimulated human peripheral blood lymphocytes were isolated by affinity chromatography on Sepharose 4B-IgG. This material was shown to interfere with the differentiation of peripheral blood B cells into Ig-secreting cells in cultures stimulated with pokeweed or Nocardia opaca extracts. Neither cell viability nor [³H]thymidine incorporation were altered, but the number of Ig-eontaining cells and that of Ig-secreting cells were decreased. These effects were dose-related. They were found to be associated with Fc IgG-binding soluble material, since absorption on Sepharose 4B-IgG but not on pepsin-digested F(ab')₂ fragments removed the inhibitory activity. This suppressor factor, released by unstimulated lymphocytes, may represent a human analogue of murine immuno-globulin-binding factor (IBF) produced by alloactivated T cells.