Systemic fungemia and hepatic localizations of Fusarium solani in a liver transplanted patient: an emerging fungal agent.

The incidence of invasive fungal infection is increasing especially in the field of transplantation, affecting as many as 50% of bone marrow transplant (BMT) patients with neutropenia and 5-20% of solid-organ transplant (SOT) recipients. Fusarium species are soil saprophytes and plant pathogens. They may cause superficial mycoses or important opportunistic infections in patients with bone marrow suppression and neutropenia, they have been rarely described in solid organ recipients, and up to now there have been no reports of such infection in isolated liver transplanted patients. We describe a case of disseminated Fusarium solani infection with hepatic localization in a liver transplanted patient that resolved with the administration of amphotericin B. Our observation confirms that Fusarium spp. are emerging pathogens that may most frequently affect not only BMT patients and patients with hematological malignancies, but also SOT patients. They may cause both localized and disseminated infection. In conclusion, Fusarium spp. etiology should be considered in the context of infectious diseases following liver transplantation.     

The Effect of Desensitization Protocols on Human Splenic B-Cell Populations In Vivo

Rituximab, intravenous immunoglobulin (IVIG) and rabbit antithymocyte globulin (rATG) all have been suggested to have an effect on antibody producing cells, however, supporting data are lacking. To assess the impact of these agents on splenic B‐cell populations in vivo, we retrospectively examined 25 spleens removed from patients treated with these agents as part of desensitization protocols in either ABO incompatible or positive crossmatch living donor kidney transplantation. These were compared to control (CTL) spleens removed for trauma. CTLs and spleens removed at transplant after multiple pretransplant plasmaphereses (PP) plus low‐dose IVIG showed similar large numbers of naïve B cells (CD20⁺ and CD79⁺), plasma cells (CD138⁺) and memory B cells (CD27⁺ cells). Adding rituximab to this PP/IVIG regimen reduced the number naïve B cells, but had no effect on memory or plasma cells. Combination treatment (PP/IVIG, rituximab and rATG) showed a trend toward the reduction of CD27⁺ cells, but again plasma cells were unchanged. We conclude that none of these protocols reduces splenic plasma cells in vivo. PP/low‐dose IVIG does not alter splenic B cells, but the addition of rituximab decreases mature B cells. Memory B cells may be affected by combination therapy including rATG and requires further study.     

Skin cancers and precancerous lesions in Parkinson's disease patients.

Our objective was to evaluate the frequency of neoplastic and preneoplastic skin lesions in Parkinson's disease (PD) patients when compared with an aged-matched population. We performed a cross-sectional survey in PD patients and in an age-matched control group. Patients and controls were examined by a movement disorder specialist and a dermatologist. 150 PD patients and 146 controls were included. Thirty-five PD patients (23.3%) presented skin lesions that could be classified as neoplastic or preneoplastic vs. 20 subjects in the control group (13.7%) (OR 95%, CI 1.92 [1.05, 3.51]). However, this difference lost statistical significance when adjusted for gender (recruitment of controls was matched just for age with an over representation of males in the PD group). Twenty-nine PD patients (19%) presented actinic keratosis and basal cell carcinoma was diagnosed in 4 patients (3%). Although nonconclusive, our results are in agreement with previous studies suggesting an increased risk of skin cancer in PD patients. The frequency of actinic keratosis in PD patients and the associated risk to develop melanoma recommends its screening in future epidemiological studies.     

18F-FDG PET/CT delayed images after diuretic for restaging invasive bladder cancer.

PET with (18)F-FDG has been considered of limited value for detection of bladder cancer because of the urinary excretion of the tracer. The purpose of this study was to investigate the role of PET/CT in the detection and restaging of bladder cancer using furosemide and oral hydration to remove the excreted (18)F-FDG from the bladder. METHODS: Seventeen patients with bladder cancer (11 without cystectomy, 6 with total cystectomy and urinary diversion) underwent (18)F-FDG PET/CT from head to the upper thighs 60 min after the intravenous injection of 370 MBq of (18)F-FDG. Additional pelvic images were acquired 1 h after the intravenous injection of furosemide and oral hydration. PET/CT findings were confirmed by MRI, cystoscopy, or biopsy. RESULTS: PET/CT was able to detect bladder lesions in 6 of 11 patients who had not undergone cystectomy. These images changed the PET/CT final reading in 7 patients: Recurrent bladder lesions were detected in 6 patients, pelvic lymph node metastases in 2 patients, and prostate metastasis in 1. This technique overcame the difficulties posed by the urinary excretion of (18)F-FDG. Hypermetabolic lesions could be easily detected by PET and precisely localized in the bladder wall, pelvic lymph nodes, or prostate by CT. Seven of 17 patients (41%) were upstaged only after delayed pelvic images. CONCLUSION: Detection of locally recurrent or residual bladder tumors can be dramatically improved using (18)F-FDG PET/CT with delayed images after a diuretic and oral hydration.     

When distraction is not distracting: a behavioral and ERP study on distraction in ADHD.

OBJECTIVE: Although an increased distractibility is one of the behavioral criteria of Attention Deficit Hyperactivity Disorder (ADHD), there is little empirical evidence that children with ADHD are in fact more distractible than their normal peers. METHODS: We recorded event-related potentials (ERPs) to distracting novel sounds (novels) and standard sounds, (standards) while children performed a visual two-choice reaction time task. Twenty-five children with ADHD were compared with eighteen normal controls (aged 8-12 years). RESULTS: Children with ADHD showed a larger early P3a (150-250 ms), both in response to the standard and in response to the novel. The late phase of the P3a had a larger amplitude in the ADHD group in the 250-300 ms window compared to the control group, which was only present in response to the novel. Interestingly, the novel reduced the errors of omission in the ADHD group to a greater extent than in the normal control group. CONCLUSIONS: Although children with ADHD show an increased orienting response to novels, this distracting information can enhance their performance temporarily, possibly by increasing their arousal to an optimal level, as indicated by the reduced omission rate. SIGNIFICANCE: These data indicate that distraction is not always distracting in children with ADHD and that distraction can also have beneficial effects.     

Copper,Zinc and Lead Enrichments in Sediments from Guacanayabo Gulf,Cuba, and Its Bioaccumulation in Oysters,Crassostrea rhizophorae

Levels of iron, copper, zinc and lead were determined in sediments and soft tissue of the oyster Crassostrea rhizophorae collected from Guacanayabo Gulf, Cuba. Metal-to-Iron ratio in sediments shows an average enrichment for Cu (5,1), Pb (11,7) and Zn (1,3) in the last 20 years. Metal concentrations found in soft tissue of C. rhizophorae are site dependent. The average biota-sediment accumulation factors (BSAFs) obtained for Fe, Cu and Pb are less than unity in all cases, indicating that only a little fraction of Cu and Pb in the sediments is bioavailable, independently of their enrichments. Zinc has an average BSAF value of 2.4 and may represent a serious impact in the area. The concentrations of zinc and copper in some of the oysters are above typical public health recommended limits.     

On the structure of the mesomorphic form of syndiotactic polystyrene

In this contribution, the X-ray diffraction (XRD) pattern of a highly oriented sample of syndiotactic polystyrene in the mesomorphic form, collected by an automatic diffractometer, is presented, thus providing quantitative and more complete information relative to the diffracted intensity. The structural changes induced by annealing procedures in mesomorphic samples are shown through the analysis of the XRD patterns: both unoriented and oriented mesomorphic samples are transformed gradually into α-form crystals. On the basis of these evidences and of preliminary comparisons between the calculated Fourier transform of simplified models and the experimental diffraction intensity, it is suggested that the local organization in triplets of trans-planar chains, typical of the different modifications of the α-form, would be largely present also in the disordered chain agglomerates of the mesomorphic form.     

Classification of thoracic and lumbar spine fractures: problems of reproducibility

Reproducibility of fracture classification systems in general has been a matter of controversy. The reproducibility of spinal fracture classifications has not been sufficiently studied. We studied the inter-observer and intra-observer reproducibility of the Magerl (AO) classification using radiograms, CTs and MRIs of 53 patients. We compared this classification with the older and simpler Denis classification. Five observers classified the fractures, first using the radiograms and CTs and, 6 weeks later, with radiograms and MRIs. Three of the observers repeated the readings after 3 months. Three observers also classified the fractures according to Denis. Agreement was measured using Cohen's kappa test. The type (A, B, C) classification of the AO system was fairly reproducible with CTs. With MRI this was only moderate. Group subclassification of the types yielded higher kappa values, corresponding to substantial agreement. The agreement was, in general, better with the Denis classification, but the variance was higher due to the difficulty of finding proper categories for some injury patterns. Although the AO classification allows proper registration of all kinds of injury, the reproducibility, especially at the type level, is problematic. Use of MRI and better definition of the distinctive properties of the three different types may enhance the reproducibility of the scheme.     

Effect of elevated prolactin levels on the synthesis and release of catecholamines from the adrenal medulla in female rats

Recent evidence suggests that increased plasma prolactin (PRL) levels could be modifying the synthesis and release of catecholamines (CA) from the adrenal medulla. In order to study this possibility, female rats bearing an anterior pituitary gland, from a litter-mate donor, under the right kidney capsule since day 30 of life and their sham-operated controls were sacrificed by decapitation 45 days after the transplant operation. Plasma PRL and CA levels and CA content in the adrenal medulla were analyzed. A significant increase in plasma PRL levels was shown in grafted (22 +/- 2 micrograms/l) when compared to control rats (6 +/- 0.3 micrograms/l), together with a significant increase in plasma norepinephrine (NE) (4.2 +/- 1.1 micrograms/l vs. 1.7 +/- 0.7 micrograms/l) and epinephrine (E) (2.9 +/- 0.6 micrograms/l vs. 1.6 +/- 0.2 micrograms/l). Similar plasma dopamine (DA) levels were found in both groups (0.6 +/- 0.2 micrograms/l vs. 0.8 +/- 0.3 micrograms/l). An increase in adrenal DA content (29.1 +/- 6.8 ng/mg protein), together with a decrease in NE (33.3 +/- 6.8 ng/mg protein) and E content (65.9 +/- 11.8 ng/mg protein) was detected in grafted as compared to control rats (DA: 12.0 +/- 3.6 ng/mg protein; NE: 79.3 +/- 22.1 ng/mg protein; E: 184.2 +/- 39.2 ng/mg protein). We can conclude from these data that the elevation of circulating PRL levels induced by a pituitary graft is able to increase the synthesis and release of CA from the adrenal medulla in female rats.