Bowel and mesenteric injury following blunt abdominal trauma: evaluation with CT

Computed tomography (CT) used in cases of blunt abdominal trauma has been found sensitive in detection of bowel and mesenteric injuries and discrimination of operable from nonoperable candidates. In 51 patients with suspected bowel or mesenteric injury following blunt abdominal trauma, CT correctly depicted bowel hematoma or mesenteric injury in 17 of 19 nonoperable patients (89%) and severe injuries in one patient who died preoperatively. In 26 of 28 patients who underwent therapeutic laparotomy (93%), initial CT enabled identification of surgically confirmed injuries. In two cases, initial scan misinterpretation delayed diagnosis of serious bowel injuries. The correct interpretation was rendered preoperatively and at blind retrospective review. CT findings that correlated with bowel or mesenteric injury requiring surgery were free peritoneal fluid (27 of 28, 96%), mesenteric infiltration (24 of 28, 86%), thick-walled bowel (17 of 28, 61%), associated abdominal injuries (12 of 28, 43%), and free air (nine of 28, 32%). In nonoperable cases, CT scans demonstrated bowel thickening (84%) but less frequently peritoneal fluid (21%), mesenteric infiltration (26%), or associated injuries (5%). In three of four patients who underwent nontherapeutic laparotomy, preoperative CT correctly imaged the limited abdominal injuries.     

Caveolin-3 in muscular dystrophy

The dystrophin-glycoprotein complex (DGC) serves as a link between cytoplasmic actin, the membrane and the extracellular matrix of striated muscle. Genetic defects in genes encoding a subset of DGC proteins result in muscular dystrophy and a secondary decrease in other DGC proteins. Caveolae are dynamic structures that have been implicated in a number of functions including endocytosis, potocytosis and signal transduction. Caveolin (VIP-21) is thought to play a structural role in the formation of non-clathrin-coated vesicles in a number of different cell types. Caveolin-3, or M-caveolin, was identified as a muscle- specific form of the caveolin family. We show that caveolin-3 co- purifies with dystrophin, and that a fraction of caveolin-3 is a dystrophin-associated protein. We isolated the gene for human caveolin- 3 and mapped it to chromosome 3p25. We determined the genomic organization of human caveolin-3 and devised a screening strategy to look for mutations in caveolin-3 in patients with muscular dystrophy. Of 82 patients screened, two nucleotide changes were found that resulted in amino acid substitutions (G55S and C71W); these changes were not seen in a control population. The amino acid changes map to a functionally important domain in caveolin-3, suggesting that these are not benign polymorphisms and instead are disease-causing mutations.      

Massive delayed hemolysis following peripheral blood stem cell transplantation with minor ABO incompatibility

After hematopoietic stem cell transplantation, delayed immune hemolysis may occur when donor-derived B lymphocytes carried with the graft produce immune antibodies against the recipient’s incompatible red cells. We report the occurrence of this syndrome in the context of minor blood group incompatibility between donor and recipient after peripheral blood stem cell (PBSC) transplantation. On day 12 post-transplant there was abrupt onset of hemolysis necessitating supportive treatment with hydration and transfusions. Because, as compared to bone marrow, PBSC grafts are enriched with lymphocytes, more frequent and intense delayed immune hemolysis may be anticipated when using PBSC. This complication is described most often when cyclosporine alone is used for immunosuppression following the graft. The addition of methotrexate, which with CyA forms the classic regimen for the prevention of graft-vs-host disease, may diminish the frequence and severity of this adverse reaction.     

Maternal zinc, iron, folic acid, and protein nutriture and outcome of human pregnancy

Four hundred fifty women were observed during pregnancy and postpartum. Forty-three variables including 12 laboratory indices of maternal nutrient status were assessed. Of the variance in fetal weight and head circumference 9.9 and 8.1%, respectively, were predictable by polynomial stepwise regression of laboratory indices of maternal nutriture. Maternal plasma zinc levels were inversely correlated with fetal weight. The occurrence of pregnancy complications in the highest and lowest quartiles of maternal plasma zinc, albumin, iron, and folic acid were compared. Using data only from the initial blood samples for which the trimester was identified precisely (n = 394), a significant association was found between the total occurrence of fetomaternal complications and zinc and albumin levels in the lowest quartile (zinc, p less than 0.02; albumin, p less than 0.02). Low zinc or low albumin were also associated with the specific complications of fetal distress (zinc, p less than 0.002; albumin p less than 0.002). High plasma folate was also associated with the total occurrence of complications (p less than 0.008) and with fetal distress (p less than 0.002). When all data (n = 713) including repeat blood samples and data from 56 mothers in whom the trimester could not be verified precisely were evaluated, associations between other complications and lowest quartile zinc and albumin and highest quartile folate were identified. Discriminant analysis of data from the initial blood samples revealed that plasma zinc was a discriminator for fetomaternal complications only in women in the lowest quartile for plasma zinc.