Xanthone additives for blood storage that maintain its potential for oxygen delivery. I. 2-Hydroxyethoxy- and 2-ethoxy-6-(5-tetrazoyl) xanthones in citrate-phosphate-dextrose-adenine (CPDA-1) blood

Two xanthones, 2-hydroxyethoxy-6-(5-tetrazoyl) (BW A440C) and 2-ethoxy- 6-(5-tetraozyl) (BW A827C), are members of a chemical series tested in vitro as potential additives to citrate-phosphate-dextrose-adenine (CPDA-1) medium for blood storage. P50 was maintained in the presence of these compounds during 42 days' storage by a partial maintenance of 2,3 diphosphoglycerate (2,3 DPG) and by a direct effect on hemoglobin previously reported for BW A827C. Red cell 2,3 DPG levels for BW A440C (n = 5), BW A827C (n = 5), and control (n = 6), respectively, were 3.38 +/− 0.47, 3.44 +/− 0.25, and 1.20 +/− 0.10 mM +/− SEM on day 7; 1.16 +/− 0.13, 1.52 +/− 0.37, and 0.16 +/− 0.02 mM on day 21; and 0.67 +/− 0.09, 0.61 +/− 0.08, and 0.06 +/− 0.006 mM on day 42. Red cell adenine triphosphate levels at the same time intervals were 1.84 +/− 0.09, 1.46 +/− 0.18, and 2.11 +/− 0.04 mM; 2.10 +/− 0.05, 2.07 +/− 0.17, and 2.13 +/− 0.05 mM; and 1.42 +/− 0.13, 1.37 +/− 0.13, and 1.38 +/− 0.06 mM, respectively. The degree of hemolysis was less with the addition of the compounds, and the methemoglobin formation, plasma Na+ and K+, and lactate production were unaffected by the compounds.     

Nasal IgA response in wheezy infants

It is unknown why some infants wheeze during upper respiratory tract infections. One possibility is that secretory IgA, which has a major role in mucosal defence against viral infection, might be deficient in wheezy infants. The nasal IgA response to upper respiratory tract infection in 32 wheezy infants (median age 5.8 months) was compared with nine siblings (median age 2.6 years) who had nasal symptoms only. Nasal lavage was performed during infections and on follow up when free from symptoms, using inulin as a marker of dilution to determine absolute concentrations of IgA in the nasal secretions. The two groups showed a similar increase in total IgA and total protein levels during infection, but secretory IgA concentrations were unchanged. This study shows that wheezy infants have a normal nasal IgA response to infection and that the increase in total IgA during early infection is due to plasma exudation rather than increased production of secretory IgA.     

Bone sialoprotein does not interact with pro-gelatinase A (MMP-2) or mediate MMP-2 activation

Background  

A recent model for activation of the zymogen form of matrix metalloproteinase 2 (MMP-2, also known as gelatinase A) has suggested that interactions between the SIBLING protein bone sialoprotein (BSP) and MMP-2 leads to conformational change in MMP-2 that initiates the conversion of the pro-enzyme into a catalytically active form. This model is particularly relevant to cancer cell metastasis to bone since BSP, bound to the αvβ3 integrin through its arginine-glycine-aspartic acid motif, could recruit MMP-2 to the cell surface.     

Spontaneously perforated pyometra: an unusual cause of acute abdomen and pneumoperitoneum

Pneumoperitoneum is usually associated with gastrointestinal perforation or following surgical and endoscopic procedures. We report a rare case of spontaneously perforated pyometra presenting with generalised peritonitis and pneumoperitoneum. Perforation of the uterus is also unusual and often associated with the presence of an intrauterine device, a gravid uterus or malignancy. Our case illustrates the importance of clinical knowledge of acute and neoplastic gynaecological diseases, which are not uncommonly encountered by the general surgeon. Moreover, good appreciation of pelvic anatomy and close collaboration with gynaecology colleagues is essential as operative intervention is often required.     

How to Develop the Medical Neighborhood

Significant attention has been directed towards developing the medical home and improving the patient experience. The medical home is targeted towards optimizing the quality of patient care while also reducing overall costs. An extension of the medical home is the concept of a medical neighborhood. The medical neighborhood utilizes the success of the medical home and incorporates it into the coordination of care between primary care physician and specialists. In order to create an ideal system, though, the framework for making referrals, ordering tests prior to referrals, documentation and communication of recommendations must be addressed a priori. In this perspective we discuss the necessary steps to implement a medical neighborhood for patients with chronic medical conditions and the use of medical technology to facilitate this process.     

A COMPARISON OF THE ANTIANGINAL EFFICACY OF NIFEDIPINE ALONE AND THE FIXED COMBINATION OF ATENOLOL AND NIFEDIPINE

SUMMARY The antianginal efficacy of a fixed combination of atenolol (50 mg) and nifedipine (20 mg) was compared with nifedipine (20 mg) alone; 102 patients experiencing three or more anginal attacks on their current monotherapy received each treatment twice daily for 3 weeks in a randomised, double-blind crossover trial. Both treatments reduced the weekly number of angina attacks compared with existing therapy; treatment with the fixed combination resulted in significantly fewer angina attacks per week than treatment with nifedipine alone. Also, when the fixed combination treatment followed the period of nifedipine therapy a further decrease in weekly angina attack rate was apparent. Comparison of individual patient response to each treatment showed that twice as many patients reported lower attack rates while on the fixed combination: 6 patients were withdrawn while receiving fixed combination compared with 10 patients on nifedipine alone. However, the incidence of commonly reported complaints was similar with both treatments.