Development of antibodies to thrombin and factor V with recurrent bleeding in a patient exposed to topical bovine thrombin

A 65 year old patient who was exposed to topical bovine thrombin during cardiac surgery developed markedly prolonged clotting times and a severe bleeding diathesis. Mixing studies with normal plasma failed to correct the clotting times. Platelet transfusions, immunosuppressive and immunomodulatory therapies were ineffective, but plasmapheresis was effective in decreasing clotting times and in the resolution of clinical bleeding events. The patient's purified IgG reacted with bovine thrombin by immunoblotting and enzyme-linked immunosorbent assay (ELISA). However, the IgG reacted minimally with human thrombin. In view of the severe bleeding, a coexisting inhibitor was sought. The patient's factor V activity was 1% of normal and was not corrected by mixing with normal plasma, demonstrating the presence of an inhibitor against factor V. The patient's IgG reacted with both bovine and human factor V. Immunoblotting localized the site of antibody binding to the light chain of activated bovine factor V. Detectable amounts of bovine factor V were found in commercial bovine thrombin preparations by ELISA. The data suggest that patients exposed to topical bovine thrombin may develop antibodies to thrombin and factor V. Anti-thrombin antibodies may mask coexisting factor V inhibitors responsible for clinical bleeding.     

Congenital total lipodystrophy and peripheral pulmonary artery stenosis

Multiple peripheral pulmonary artery stenoses were detected in three patients with congenital generalised lipodystrophy. This association, which has not been described before, may be clinically important in patients with lipodystrophy who present with impaired exercise tolerance or heart murmurs.     

Intrinsic measurement bias on computed tomography scout view is unpredictable: Computed tomography pelvimetry using a phantom

Our aim was to determine the degree of bias in CT scanogram measurements. We obtained standard lateral and anteroposterior (AP) pelvimetry scanograms of a phantom pelvis after placing ball bearings or aluminium rods to mark bony landmarks. Computed tomography pelvimetry was carried out at the manufacturer‐recommended table height on two commercial CT scanners and at 10‐mm increments up to 50 mm above and below this height. The AP inlet, AP outlet, interspinous distance and transverse diameters were each measured three times for each scanogram. The true measurements were obtained directly from the disassembled phantom. Bias was defined as the difference between the CT measurement and the true measurement. Observer error was negligible. The transverse diameter was overestimated at high table positions and underestimated at low table positions on both scanners (+6 to ?10 mm). After correcting for geometric distortion, up to 6 mm bias was still present. The point at which no bias occurred was different for each scanner and did not correspond to the manufacturers’ recommended table height. The outlet was overestimated on both scanners by up to 5 mm. The true inlet measurement was overestimated by 1.2 mm. The interspinous distance was minimally underestimated on both scanners. The measurements on CT scanogram were underestimated or overestimated in an inconsistent and unpredictable fashion, varying from one type of measurement to another and from CT scanner to CT scanner. This has implications for the accuracy and clinical utility of measurements obtained from a CT scanogram.     

Transient osteoporosis of the hip: MR imaging

Three patients with transient osteoporosis of the hip underwent magnetic resonance (MR) imaging. MR images showed decreased signal intensity of bone marrow in the femur on T1-weighted images and increased signal intensity relative to the intensity of normal bone marrow on T2-weighted images. Joint effusions were seen on MR images of all patients on T2-weighted images. The findings on MR images concurred with histologic findings, such as increased bone turnover and mild inflammatory reaction, in one patient. The clinical symptoms and abnormalities on MR images regressed completely within 6-10 months. Familiarity with the distinct features of transient osteoporosis on MR images may be important in the differential diagnosis of adults with hip pain.     

月桂氮酮及电穿孔技术对萘普生经皮渗透的影响

目的 :研究月桂氮艹卓 酮及电穿孔技术对萘普生经皮渗透的影响。方法 :应用双室扩散池方法研究促渗剂月桂氮艹卓 酮及电穿孔技术对萘普生在离体大鼠腹部皮肤经皮渗透的影响。结果 :电穿孔 (指数衰减型脉冲 ,脉冲幅度为 380V ,电容器电容为2 2 μF ,脉冲率为 4pulses·min 1,脉冲宽度τ≈ 5 .5ms ,脉冲数 10 0个 )、月桂氮 艹卓 酮预处理皮肤或两者合用均可显著促进萘普生的渗透速率和累积渗透量。两者合用的渗透速率与电穿孔或月桂氮 艹卓 酮预处理的渗透速率无显著差异。结论 :月桂氮 艹卓 酮预处理及电穿孔技术均能明显促进萘普生的经皮渗透 ,两者合用并无协同作用     

Meningeal carcinomatosis in the VX2 rabbit tumor model: detection with Gd-DTPA-enhanced MR imaging

Meningeal carcinomatosis developed in 14 of 14 New Zealand White rabbits after infusion of a VX2 tumor cell suspension into the cisterna magna. All died or were killed 7-15 days after inoculation. Within days of the tumor infusion, magnetic resonance (MR) imaging with gadolinium-diethylenetriaminepentaacetic acid (DTPA) at 0.5 or 1.5 T demonstrated enhancement of the cerebrospinal fluid (CSF) secondary to disruption of the blood-CSF barrier by plaquelike lesions along the meninges. Eventually, meningeal enhancement was observed along the base of the brain and cervical spine. Quantitative assessment of the contrast enhancement on T1-weighted images revealed an increase in mean signal intensity of 213% +/- 130%. Contrast enhancement was not observed in four control animals who received an infusion of cell culture medium. These results demonstrate in an animal model that contrast material-enhanced MR imaging can be used to detect meningeal carcinomatosis by revealing breakdown of the blood-CSF barrier.     

Gut-associated lymphoid tissue and dimethylhydrazine-induced colorectal carcinoma in the wistar/furth rat

Although gut-associated lymphoid tissue in the form of discrete lymphoid patches (LP-GALT) in mammalian intestine is most prominent in the distal ileum, appendix, and, in some species, the cecal appendage, LP-GALT can be found throughout the intestinal tract. LP-GALT appears as single or multiple subepithelial lymphoid follicles covered by a specialized, structurally unique epithelium. In the colon of the Wistar/Furth(W/Fu) rat, LP-GALT appears as aggregates of follicles, or lymphoid patches, that can be detected macroscopically. We studied the relationship between 1,2-dimethylhydrazine- (DMH) induced colon carcinomas and the lymphoid patch associated epithelium in these animals. In addition, we defined the normal distribution of colonic lymphoid patches in both DMH-treated and control rats. Patches were found macroscopically and confirmed by histologic examination at five constant sites: lower pole of cecum, proximal ascending colon, the major colonic flexure, mid descending colon, and the rectosigmoid. These are also the predominant sites of DMH induced carcinomas in W/Fu rats. In 120 DMH-treated animals, 109 colon carcinomas were found. Eight percent were in the lower pole of the cecum, 56% in the proximal ascending colon, 16% at the major flexure, 15% in the mid descending colon, and 5% in the rectosigmoid. Lymphoid patches could often be detected histologically in association with DMH-induced tumors. The depth of tumor invasion was found to correlate inversely with our ability to identify tumor-associated lymphoid patches suggesting that tumors arising at the anatomical sites where lymphoid patches occur progressively destroyed them. Of colon tumors confirmed histologically to be associated with lymphoid patches, 88% were superficial lesions confined to the submucosa and 12% were more extensive but confined to the bowel wall. No lymphoid patches could be found associated with tumors that extended through the bowel wall. Thus, DMH-induced colon carcinomas in W/Fu rats arise at sites containing preexisting LP-GALT with associated specialized epithelium.