Percutaneous retrieval of Kimray-Greenfield filter from right atrium and placement in inferior vena cava

Inadvertent placement of a Kimray-Greenfield filter into the right side of the heart occurred in the operating room. With the use of intraoperative fluoroscopy while the patient remained under general anesthesia, the filter was extracted and successfully placed in the inferior vena cava. This was accomplished with standard percutaneous catheter techniques from the femoral route.     

Experimental infections of the musculoskeletal system: evaluation with MR imaging and Tc-99m MDP and Ga-67 scintigraphy

Acute osteomyelitis, soft-tissue infection, or both were experimentally produced in 38 New Zealand white rabbits, and three-phase technetium-99m methylene diphosphonate, gallium-67, and magnetic resonance (MR) images were obtained 7 or 14 days after infection. There was no significant difference between radionuclide studies and MR images in the detection of osteomyelitis, but MR imaging was significantly more sensitive (100% vs. 69%; P less than .01) in the detection of soft-tissue infection. In addition, cellulitis could not be distinguished from soft-tissue abscess on radionuclide studies, whereas MR imaging was 92% accurate in depicting soft-tissue abscesses. Further research is necessary to determine how to relate these findings to true human clinical situations.     

原发性子宫颈鳞癌中MTS1基因突变的研究

原发性子宫颈鳞癌中ＭＴＳ１基因突变的研究贺国强张志胜游学科吴宜林唐迪红多肿瘤抑制基因（ｍｕｌｔｉｐｌｅｘｔｕｍｏｒｓｕｐｐｒｅｓｏｒ１，ＭＴＳ１）的突变和缺失广泛存在于人类多种原发性肿瘤组织及肿瘤细胞株中［１，２］。但ＭＴＳ１基因在原发性宫颈鳞癌中的...     

Identification of platelet proteins that bind alloantibodies and autoantibodies

We have used the techniques of radioimmunoprecipitation (RIP) and Western blot to identify the membrane proteins that bind certain alloantibodies. Anti-PlA1 sera precipitated two bands, corresponding to platelet glycoproteins IIb and III, whether or not calcium was present during the procedure. By Western blot, this antibody bound only glycoprotein III. Anti-PlA1 serum does not precipitate proteins from the platelets of a patient with Glanzmann's thrombasthenia. Two monoclonal antibodies reacting with lymphocyte HLA antigens, as well as sera from highly allosensitized patients, precipitated bands of 38,500 and 13,500 daltons. These bands correspond to the molecular weights of the two subunits of the HLA antigen, as it has been described for other cell types. The patients' sera also precipitated a protein of 72,000 daltons from some platelets. The sera of two patients with quinidine- induced thrombocytopenia precipitated a 138,000-dalton band (glycoprotein Ib-alpha) in the presence of quinidine. The purified IgG antibody from one patient did not require other plasma factors to bind to platelets in the presence of quinidine, while purified antibody from a second patient required plasma factors other than, or in addition to von Willebrand factor. Although several sera from patients with idiopathic thrombocytopenic purpura (ITP) were tested, only one precipitated membrane proteins by the RIP method; this serum identified binding proteins corresponding to glycoproteins IIb and III.     

Transfusion and alloimmunization in sickle cell disease. The Cooperative Study of Sickle Cell Disease

In 1,814 patients with sickle cell disease who had been transfused, the overall rate of alloimmunization to erythrocyte antigens was 18.6%. The rate of alloimmunization in this group appears to be an explicit function of the number of transfusions received because it increases exponentially with increasing numbers of transfusions. Alloimmunization usually occurred with less than 15 transfusions, although the rate of alloimmunization continued to increase when more transfusions were given. The rate of alloimmunization was less in patients with hemoglobin SC disease and sickle-beta+ thalassemia because these patients had received fewer transfusions. Children less than 10 years old had a slightly lower rate of alloimmunization than patients in other age groups even after correction for the number of transfusions given. Women were more frequently alloimmunized than men; this was largely due to the fact that women received more transfusions than men, but in the age group 16 to 20 years the increase may have been due in part to alloimmunization owing to pregnancy. Forty-five percent of those alloimmunized made antibodies of only one specificity; 17% made four or more antibodies reacting with different antigens. Antibodies to the C and E antigens of the Rh group, the Kell antigen, and the Lewis antigens were most commonly made. These findings may be important in formulating a rational transfusion policy in sickle cell disease.     

Prediction of short- and long-term outcomes by troponin T levels in low-risk patients evaluated for acute coronary syndromes

STUDY OBJECTIVE: Recent reports suggest a short series of cardiac troponin (cTnT) testing effectively identifies patients at risk for cardiac events. However, there are few studies validating this strategy. The purpose of this study was to determine the ability of cTnT levels to predict short- and long-term outcomes in low-risk patients with suspected acute coronary syndromes. METHODS: This prospective longitudinal study was conducted in a 20-bed emergency department observation unit. Patients at low risk for acute coronary ischemia, with a normal creatine kinase-isoenzyme subunit MB (CKMB) index, were admitted to an observation unit for chest pain evaluation. Serum cTnT levels were measured at baseline and at 4, 8, and 16 hours after admission. The main outcome measures were adverse cardiac events (death, acute myocardial infarction, unstable angina, revascularization) during the index visit and within 6 months after discharge. Using manufacturer's recommendations, the cTnT level was considered abnormal if it exceeded 0.2 microg/L. RESULTS: Two hundred sixty-six patients were evaluated. Twenty-one (7.9%) had an adverse event during their index hospitalization. Troponin testing identified only 2 (9.5%) of these patients. Twenty (7.5%) had a cardiac event within 6 months; none were identified by cTnT testing. The sensitivity and specificity were 9.5% and 99.2%, respectively, at the index visit, and 0% and 98.4% at 6 months. The positive and negative predictive values were 50% and 93%, respectively, at the index visit; and 0% and 92% at 6 months. CONCLUSION: Determination of troponin T levels has a low sensitivity and high specificity for predicting outcomes in low-risk patients evaluated for suspected acute coronary syndromes. This study does not support a strategy of relying solely on troponin testing for disposition decisions.