Reduction of lethal graft-versus-host disease: transplantation of cultured murine bone marrow across minor histocompatibility differences

The murine bone marrow culture technique was used to prepare donor marrow for bone marrow transplantation across minor histocompatibility complex differences. Previous studies have shown that theta-positive cells are rapidly lost from such cultures and that transplantation of cultured marrow across major histocompatibility complex differences results in a delay in the development of lethal graft-v-host disease (GVHD). In this study, a total of 1 to 2 X 10(7) nonadherent cells (740 to 1560 CFUs [colony-forming units]) from three-day-old cultures were used as a source of donor marrow. Three strain combinations were evaluated; LP/J into C57BL/6; BIO.BR into CBA/J; and C57BL/6 into LP/J. Donor mice were immunized with recipient spleen cells prior to culture in order to increase the graft-v-host response. For LP/J marrow into C57BL/6 mice, 5 X 10(7) donor spleen cells transplanted along with the marrow were needed to induce lethal GVHD. However, lethal GVHD was seen without the addition of spleen cells for BIO.BR into CBA/J and C57BL/6 into LP/J strain combinations. Most animals receiving fresh marrow were dead of GVHD five weeks after transplantation. With the use of cultured marrow the three-month survival was 80%, 51%, and 93%, respectively, for LP/J into C57BL/6, BIO.BR into CBA/J, and C57BL/6 into LP/J strain combinations. Long-term donor engraftment in all recipient animals receiving cultured marrow was confirmed by analyzing hemoglobin polymorphisms between the strain combinations. These results demonstrate that in contrast to transplantation across major histocompatibility complex differences, the use of cultured cells for bone marrow transplantation across minor histocompatibility complex differences allows for engraftment while reducing the risk of lethal GVHD.     

Study of Clinicobiochemical Spectrum of Hypothyroidism

Background

The aim of this study was to assess the clinico biochemical spectrum of hypothyroidism and the relative importance of thyroid function tests, clinical symptoms and signs in thyroid dysfunction.

Methods

A retrospective study was done and 1702 requisitions for screening of hypothyroidism were analysed. The clinical presentation of cases was correlated with the results of thyroid profile tests.

Results

31.5% of the 1702 cases referred had thyroid dysfunction in the form of subclinical or overt hypothyroidism. In the hypothyroid group generalized weakness, weight gain and myxoedema was common. In cases of primary infertility and depression, subclinical and overt hypothyroidism was high (40% and 45.8% respectively). The average age of females with subclinical hypothyroidism was 30.8 years, 5.4 years less than females with overt hypothyroidism.

Conclusion

We conclude that hypothyroidism is common and often under-diagnosed. Therefore routine evaluation of female patients with weight gain, generalized weakness, infertility, depression and mood changes should include thyroid profile.Key Words: Hypothyroidism, Thyroid profile, Screening, Infertility, Depression     

Community-acquired Staphylococcus aureus bacteraemia in patients who do not abuse intravenous drugs

Despite advances in antimicrobial therapy and intensive care support, Staphylococcus aureus continues to cause significant morbidity and mortality. We studied community-acquired S. aureus bacteraemia in a population where intravenous drug abuse is extremely uncommon, prospectively reviewing all such patients (n = 113) admitted to Groote Schuur Hospital from February 1986 to January 1991. Overall mortality was 35%. Factors associated with poor outcome were: confusion on presentation, failure to mount a febrile response, acute renal failure, adult respiratory distress syndrome, shock, endocarditis, disseminated intravascular coagulation and platelet count of < 100 x 10(9)/l. Only confusion, acute renal failure and shock were independently associated with death by stepwise regression analysis. Skin infections were the most commonly identified source of bacteraemia (22%), but in 58% of patients the source was not determined. Twenty-six percent of patients were diabetic. Almost all patients (90%) developed one or more complications. In those who survived, therapy was generally prolonged, with a median of 70 days and range of 7-393 days, depending on the associated complications. Community-acquired S. aureus bacteraemia is a serious condition associated with a high complication rate and mortality.      

Diffuse pulmonary opacification in infants undergoing extracorporeal membrane oxygenation: clinical and pathologic correlation

Diffuse pulmonary opacification is commonly seen on chest radiographs from infants with severe respiratory failure treated with extracorporeal membrane oxygenation (ECMO). The chest radiographs and clinical records of 18 such infants were reviewed to determine the correlation among degree of abnormality on chest radiograph (as determined by a radiographic score), clinical severity of disease (as measured by ECMO requirements [ECMO flow rate]), and dynamic lung compliance determinations. Increasing lung compliance and decreasing ECMO flow rates correlated well with decreasing (improving) radiographic score. Pathologic changes were mainly those associated with intensive respiratory support and the underlying pulmonary condition. One patient had diffuse pulmonary hemorrhage. Other than bleeding, no distinctive pathologic features could be attributed to therapy with ECMO. We conclude that the degree of pulmonary opacification seen in infants undergoing ECMO therapy is an accurate reflection of markedly decreased lung compliance and lung volumes caused by hyaline membrane formation, pulmonary edema, and atelectasis associated with the various causes of severe respiratory failure.     

Postoperative hysterosalpingogram: radiographic-surgical correlation

The hysterosalpingograms of 46 patients who underwent previous uterine or tubal surgery were reviewed. Surgical procedures performed included cesarean section, myomectomy, uterine septal repair, tubal reimplantation and reanastomosis, and fimbrioplasty/cuff salpingostomy. The procedures and their resulting hysterosalpingographic appearances are discussed.     

Academic uroradiology: the future

Radiologic education, research, and the practice of radiology will be of the highest quality in the future if academic departments stress organ-system subspecialization while continuing to integrate and interface with technique-based specialists. Planning should begin now to effect an orderly progression to an organ-system-based subspecialty structure for radiology training in general and for uroradiology specifically. Uroradiologists should remain as central consultants to their clinical counterparts, working collaboratively with urologists in clinical endeavors of mutual relevance. More fellowships in uroradiology should be offered that attempt to incorporate all imaging methods and procedures into the curriculum. These issues are addressed in the context of patient care, service, education, and cost containment.