Parvovirus B19 outbreak on an adult ward.

In November and December 1992, an outbreak of parvovirus B19 infection occurred among patients and staff on an adult mixed surgical ward at a large hospital in London. Three patients and 15 staff members were serologically confirmed as acute cases. The attack rate among susceptible members of staff was 47%. In those infected, arthralgia (80%) and rash (67%) were the most common symptoms. Of six susceptible in-patients on the ward, three became infected. One of the in-patients who had carcinoma of the mouth was viraemic for more than 10 days with marrow suppression resulting in the postponement of chemotherapy until intravenous immunoglobulin was given and he was no longer viraemic. Control measures taken included closure of the ward to new admissions, transfer of only immune staff to the ward, and restriction of the ward nursing staff to working only on that ward. Although no specific exposure was conclusively identified as a risk factor, there was a suggestion of an increased risk of acquiring parvovirus B19 infection among those staff who did not adopt strict hand washing procedures after each physical contact with a patient (RR = 2.33; P = 0.07). Knowledge of parvovirus B19 among interviewed health care workers was poor: only 42% reported knowing about parvovirus B19 and only 38% could name a patient category at risk of a severe outcome following infection. This is the first report of a nosocomial outbreak affecting an adult ward and of possible transmission of parvovirus B19 infection from staff to in-patients. Hospital control of infection teams should include parvovirus B19 in their outbreak containment plans.     

Recombinant tumor necrosis factor causes activation of human granulocytes

We have tested the hypothesis that tumor necrosis factor (TNF), by binding to and activating granulocytes, may contribute to the pathogenesis of gram-negative sepsis and the adult respiratory distress syndrome (ARDS). Buffy coat granulocytes incubated with as little as 0.5 ng/mL of recombinant TNF (rTNF) showed a dose-related increase in nitroblue tetrazolium dye reduction, in granulocyte polarization, in superoxide anion release, and in visually apparent aggregation. Purified lipopolysaccharide (1 microgram/mL) caused polymorphonuclear (PMN) aggregation and activation that was neutralized by polymyxin B. The release of superoxide was augmented by preincubation of the PMNs with gamma-interferon. The effect of TNF was neutralized by TNF- specific murine monoclonal antibodies but not by polymyxin B. Scatchard analysis of 125I-rTNF binding to granulocytes revealed about 1,200 receptors per cell with a Kd of 4.9 X 10(-10) mol/L. These results suggest that the release of TNF by mononuclear phagocytes contributes to granulocyte activation and aggregation during inflammation.     

Sacrococcygeal chordoma metastatic to penis

A rare case of sacrococcygeal chordoma metastatic to the penis is presented The symptoms, diagnosis, and management of sacrococcygeal chordoma are discussed.     

Laser photocoagulation control of diabetic macular oedema without fluorescein angiography.

This study included 40 eyes in 22 diabetic patients with focal macular oedema. Laser photocoagulation was directed at decompensated or leaking microvascular lesions clinically detected without using pretreatment fluorescein angiograms. Post-treatment fluorescein angiograms performed after adequate clinical control of disease showed complete resolution of the macular oedema in 25 eyes (62.5%), whereas persistent leakage from microvascular lesions closer than 500 microns from the centre of the foveola was noted in 15 eyes (37.5%). These were clinically detected during the pretreatment examination and were found not to impair or threaten the patient's vision. Our data confirm the clinical impression that fluorescein angiography is not necessary for effective treatment and should be used only if necessary.     

Adjunctive surgery after chemotherapy for nonseminomatous germ cell tumors: recommendations for patient selection

One hundred eighty-five patients who underwent surgery within 6 months of completing chemotherapy were identified from 360 patients with nonseminomatous germ cell tumors (NSGCT) treated with Memorial Hospital front-line cisplatin- or carboplatin-based combination chemotherapy protocols between 1979 and 1988. Clinical, pathologic, and radiologic features were correlated with the pathologic findings at surgery. The size of a residual retroperitoneal mass, the degree of shrinkage that occurred with chemotherapy, and the presence of teratomatous elements in pretreatment pathology specimens were each correlated with the pathologic findings of retroperitoneal resections after chemotherapy. Multivariable logistic regression analysis of those undergoing retroperitoneal resections identified the size and shrinkage of the residual mass and the prechemotherapy lactate dehydrogenase (LDH) and alphafetoprotein (AFP) levels as the best predictors of finding only necrotic debris. No factors could be found, however, that could selectively exclude patients who had residual viable malignancy or teratoma in the retroperitoneum. Of 39 patients with residual retroperitoneal masses measuring less than or equal to 1.5 cm in maximal diameter, three had residual malignancy and five had teratoma resected. No factors were identified for residual lung or mediastinal masses that could be used to select a group of patients who could safely avoid surgery. If serum markers have normalized after chemotherapy for NSGCT, resection of all residual abnormalities on imaging studies of the retroperitoneum, lungs, and mediastinum is recommended. In addition, retroperitoneal lymph node dissection (RPLND) is recommended for all patients with initial bulky metastases (greater than or equal to 3 cm in diameter) in the retroperitoneum, irrespective of the findings of postchemotherapy computed tomography (CT).     

苦红菇化学成分的研究

从野生真菌苦红菇(Russula rosacea(Bull)Grrayem,Fr.)子实体酸性部分得到两个新的四环三萜酸化合物,经光谱(IR,¹HNMR,¹³CNMR,MS)、尤其是二维核磁共振(¹³C-¹HCOSY,COLOC,NOEDIFF)谱解析,确定其结构分别如Ⅰ和Ⅱ所示,Ⅰ命名为苦红菇酸A(rosaceaacidA),Ⅱ为苦红菇酸B(rosaceaacidB)。     

A controlled study of lithium carbonate in the treatment of alcoholism

A prospective double-blind placebo-controlled trial conducted during a 6-month period showed that lithium carbonate was no better than placebo in producing total abstinence in patients with alcoholism, regardless of whether they were depressed. A high dropout rate, the effect of compliance, and difficulties in measuring improvement in these patients impose some limitations in interpreting the results of this study.     

Hepatoma, arterioportal shunting, and hyperkinetic portal hypertension: therapeutic embolization

Four patients with hepatocellular carcinoma, shunting of blood from the hepatic artery to the portal vein, and hyperkinetic portal hypertension were treated by transcatheter embolization of the hepatic artery. In three acutely bleeding patients variceal hemorrhage was controlled by the embolization. Following embolization hepatofugal portal venous flow became hepatopetal in all four patients. No serious complications were encountered. When hepatoma is complicated by arterioportal shunting and hyperkinetic portal hypertension, occlusion of the fistula by transcatheter embolotherapy can reduce the portal pressure.