PRIMARY CUTANEOUS NOCARDIA INFECTION DUE TO NOCARDIA ASTEROIDES

A 34-year-old white man was admitted to the hospital for treatment of cyclosporine toxicity. He was referred to the dermatology service for the evaluation of two lesions that had been present for 4 weeks on the dorsum of his left hand. The patient stated that he had cut his hand on a fence and later cleaned his aquarium two weeks before the skin lesions appeared. The past medical history was significant for a cadaveric renal transplant in 1984 for renal agenesis of the left kidney and obstructive nephropathy of the right kid-ney. His oral medications included methylprednisolone, dil-tiazem, ranitidine, cyclosporine, and ketoconazole. The recent addition of ketoconazole for oral thrush was felt to have caused the cyclosporine toxicity. The patient was cushingoid in appearance with promi-nent generalized hypertrichosis. The vital signs and the chest examination were normal. Skin examination revealed a 6-mm tense vesicle with surrounding erythema with an adjacent 5-mm firm linear papule (Fig. 1). There was no lymphadenopathy. Both lesions were biopsied, hemisec-tioned, and sent for routine light microscopy and for fungal, atypical mycobacterial, and bacterial cultures. Laboratory studies were significant for a blood urea ni-trogen of 56 mg/dL, creatinine of 2.6 mg/dL, WBC of 13,100/mm¹³, and a cyclosporine level of 2333 ng/mL (thera-peutic level 100–300 ng/mL). X-ray of the left hand showed no abnormality. Chest x-ray and computerized axial tomog-raphy scan revealed a widened superior mediastinum sec-ondary to mediastinal lipomatosis. Tissue cultures grew Nocardia asteroides. Bacterial and mycobacterial cultures, including atypical mycobacteria, were negative. The biopsy showed a mixed cellular infiltrate with scat-tered multinucleated giant cells and focal microabscesses. Brown and Brenn stain showed gram-positive filamentous organisms. A modified Fite stain (Fig. 2) demonstrated acid-fast filamentous organisms. The patient was diagnosed as having primary cutaneous nocardiosis with no evidence of dissemination. He was treated with trimethoprim sulfamethoxazole (TMP/SMX), one tablet orally four times daily, with resolution of the skin lesions within 3 weeks, but the patient developed neurolog-ic toxicity and elevation of his serum creatinine with this therapy. He was unable to tolerate a lower dose of TMP/SMX and the medication was changed to sulfisoxazole 500 mg orally four times daily, with plans to continue the treatment for 12 months. There has been no recurrence after almost 12 months of therapy.     

Risperidone interacts with serum albumin forming complex

The aim of the work is to study the mechanisms of the interaction of risperidone with human and bovine serum albumins using the fluorescence quenching technique. Risperidone is an atypical antipsychotic drug used to treat many psychiatric disorders. We selectively excited the fluorescence of tryptophan residues with a 290 nm wavelength light, and observed quenching by titrating human and bovine serum albumin solutions with risperidone. Emission spectra were recorded in the range from 300 to 450 nm for each quencher addition. Stern-Volmer graphs were plotted and quenching constants were estimated. Results showed that the drug quenches the fluorescence of the human serum albumin by the formation of a complex risperidone-albumin. Association constants calculated from Stern-Volmer equation for low concentrations (lower than 1:10 ratio risperidone/albumin) were of 2.56 × 10(5)M(-1), at 25 °C, and 1.43 × 10(5)M(-1), at 37 °C. As the quenching intensity of bovine serum albumin, which contains two tryptophan residues, was found to be higher than that of human serum albumin, which contains only one tryptophan residue. Hence, we suggest that the primary binding site for risperidone in albumin should be located in sub domain IB.     

Cimetidine reduces running-associated gastrointestinal bleeding

A prospective observational study was undertaken to compare the effect of cimetidine usage immediately before and during a 100-mile running race on the frequency of detectable gastrointestinal bleeding and to relate these data to the frequency and intensity of gastrointestinal symptoms and to training data collected from pre- and postrace questionnaires. Nine of 25 runners in the 1989 Old Dominion 100-mile Endurance Race took 800 mg of cimetidine 1 hr before the start and at 50 miles. Sixteen other runners acted as controls and were not different in age, gender, or training data. All runners also submitted three stool specimens from the week before the race and from the first three bowel movements after the race on standard Hemoccult cards. All runners were Hemoccult negative before the race. One of the 9 (11%) cimetidine runners and 14 of the 16 (87.5%) control runners were Hemoccult positive afterwards (P less than or equal to 0.05). Nausea and vomiting were less in those runners taking cimetidine (P less than or equal to 0.05). There was no difference in the race performance as related to the ability to finish or in the number of miles run during the race. This study may help to define the etiology of this common gastrointestinal bleeding in these ultradistance runners and may be useful in preventing some of the symptoms associated with long-distance running.     

微柱凝胶与聚凝胺交叉配血试验比较

1一般资料2004年受血者的血清标本,急诊受血者的血清标本用聚凝胺配血法进行交叉配血,其他受血者的血清标本用微柱凝胶配血卡进行交叉本配血,发现有阳性结果的标本再分别用微柱凝胶配血法和聚凝胺配血法进行测定.微柱凝胶配血法按照达亚美公司提供的微柱凝胶配血卡操作手册进行;聚凝胺配血法见<输血技术学>[1].在13 879例交叉配血试验中,这两种交叉试验共同出现阳性结果的有15例(表1).对这15份阳性标本用谱细胞进行抗体筛查,其中抗-c阳性的标本4例,抗-E阳性的标本4例,抗-e阳性的标本3例,抗-cE阳性的标本2例,抗-JKb阳性的标本1例,抗-Mia阳性的标本1例.     

II. Demographic Variables and Illness Onset in an Attack Carrier’s Crew

Approximately one third of the enlisted crew of an attack carrier (N = 738) was studied during a six-month deployment to Vietnam. Questionnaires about personal background and military status were given at the beginning of the cruise, and the illnesses developed by these men during the cruise were tabulated. This paper discusses the relationship of 16 demographic variables to illness onset: job specialty, pay grade, age, race, religion, birth region, marital status, number of dependents, education, intelligence level, parents’ status (living or deceased), birth order, father’s occupation, father’s education, socioeconomic status, and active duty status (regular vs reserve).

On the basis of analyses of variance, the following demographic variables were found to have a significant overall relationship to illness incidence: job specialty, age, pay grade, race, birthplace, and number of dependents. The remaining ten variables were statistically unrelated to illness incidence. Relatively high illness rates occurred in younger, nonrated seamen, especially those in the Fireman/Fireman Apprentice category who worked on the ship’s engines. Relatively high illness rates also occurred in Negro and American Indian sailors.     

Antioxidant and antimutagenic properties of the monoterpene indole alkaloid psychollatine and the crude foliar extract of Psychotria umbellata Vell.

Psychollatine is a monoterpene indole alkaloid produced and accumulated by Psychotria umbellata Vell. (Rubiaceae) leaves in relatively high amounts (approximately 3% of the dry weight). The alkaloid has been shown to display opioid-like analgesic, anxiolytic, antidepressive and antipsychotic activities in rodents. In vitro assays suggested a protective role for this molecule in plant oxidative stress responses. This work reports antioxidant properties of psychollatine and the crude foliar extract from P. umbellata in strains of Saccharomyces cerevisiae proficient and deficient in antioxidant defenses exposed to H2O2 and paraquat. The antimutagenic activity of P. umbellata and its main alkaloid were assayed in S. cerevisiae N123 strain in presence of H2O2. Moreover, the antioxidant capacity of these substances on the hydroxyl radical (OH.) was investigated, using the hypoxanthine/xanthine oxidase assay. Psychollatine and the crude foliar extract of P. umbellata showed protective effect against oxidative stress in yeast, acting both as antioxidant and antimutagenic agents.     

Association of parental characteristics with adverse outcomes of adolescent pregnancy

BACKGROUND: It is well-known that pregnancy in adolescence has an increased risk of adverse reproductive outcomes. It remains unclear whether this association is due mainly to the unfavourable sociodemographic status or due solely to biological immaturity of pregnant adolescents. OBJECTIVE: The purpose of this study was to determine the association of parental sociodemographic characteristics with the adverse outcomes of adolescent pregnancy. METHOD: Data from certificates of live births in Taichung County, Taiwan in 1994 of 7994 singleton, first-born babies whose mothers were 15-34 years of age were analysed. The relative risk of having adverse pregnancy outcomes for adolescent subgroups was obtained as compared with that among mothers 20-34 years of age with the same characteristics. The adjusted relative risk of having adverse pregnancy outcomes for each covariate was calculated by a multiple logistic regression analysis. RESULTS: Of 7994 babies born to mothers of 15-34 years of age, 8.3% were born to adolescent mothers. In all age groups, the younger adolescent mothers (15-17 years of age) had the highest percentage of both infants with low birth weight (10.6%) and preterm births (7.1 %). Younger adolescent mothers in almost all sociodemographic categories had higher risks of having both low-birth-weight and preterm births than those of older adolescent mothers. Multiple logistic regression analysis showed that a younger maternal age is the only significant risk factor for having infants with low birth weight (adjusted RR = 2.5, 95% Cl 1.8-4.5 and adjusted RR = 1.7, 95% Cl 1.2-2.6 for younger and older adolescent mothers, respectively) or preterm birth (adjusted RR = 1.9, 95% Cl 1.1- 3.4 and adjusted RR = 1.5, 95% Cl 1.0-2.3 for younger and older adolescent mothers, respectively). CONCLUSIONS: Adolescent pregnancy carries an increased risk of having low-birth-weight and preterm births, and a younger maternal age is causally implicated.      

Lack of alloimmunization to D antigen in D-negative immunosuppressed liver transplant recipients

BACKGROUND: Orthotopic liver transplantation (OLT) sometimes requires large amounts of blood. An adequate supply of Rh-negative blood for Rh- negative patients is not always available. STUDY DESIGN AND METHODS: Seventeen Rh-negative patients, out of 327 receiving OLT in this hospital, received from 5 to 41 units of Rh-positive red cells during surgery. Each of the 17 patients was followed for 7 weeks to 70 months after OLT for detection of unexpected antibodies. Cyclosporin A and prednisone, azathioprine, and adjunctive rabbit antilymphocyte globulin or monoclonal OKT3 antibody were used to prevent graft rejection. RESULTS: Evidence of immunization, either to D or to antigens in the rest of the red cell antigen systems, did not appear in any patients. CONCLUSION: It is hypothesized that cyclosporin A affects the immune humoral response, inhibiting lymphocyte activation and the primary immune response; consequently, Rh-positive blood may be transfused to Rh-negative OLT recipients so treated with little or no risk of alloimmunization.     

Laparoscopic management of organic ovarian cysts: is there a place for frozen section diagnosis?

Only benign ovarian cysts can be treated by laparoscopic surgery. Although clinical examination and the results of pre-operative work-up do make a real contribution in indicating the benign or malignant nature of cysts, only histology can provide the absolute diagnosis. In this context, the goal of this study was to establish whether there is any advantage in performing frozen section during laparoscopic surgical management of organic ovarian cysts. Between January 1989 and March 1996, 228 patients underwent an adnexectomy for an ovarian mass. After the pre-operative work-up and the diagnostic phase of laparoscopy, 26 patients (11.4%) presented with suspected signs of malignancy restricted purely to the ovary. These 26 patients underwent a laparoscopic adnexectomy with extraction of the excised tissues using an endoscopic bag, followed by frozen section. For all these patients the results of the frozen section concluded that the lesion was benign. In every case the definitive histological results confirmed the frozen section findings. This strategy enabled us to avoid laparotomy, especially for the nine post-menopausal patients whose adnexal masses appeared to be complex by ultrasound. These encouraging preliminary results need to be confirmed by a larger series of patients, so as to specify the place of frozen section in the laparoscopic surgical management of organic ovarian cysts.