The diagnosis of an intramuscular metastasis aid from a finding on a computerized tomography scan

A case of an intramuscular metastasis is reported in which a computerized tomography scan aided in the diagnosis. The clinical features of intramuscular metastases and the importance of performing a thorough review of the soft tissue structures displayed on computerized tomography scans is discussed.     

马来酰亚胺苯甲氨酯聚乙二醇修饰膜蛋白掩盖AB和RhD抗原制备通用血型红细胞

聚乙二醇(PEG)上的活性基团结合在红细胞表面掩盖血型抗原是制备通用血型红细胞的途径之一,这些PEG链有很强的水合作用,能覆盖红细胞表面的大片区域,阻断血型抗原与抗体结合。甲基氧PEG-5000(mPEG-5000)是常用的红细胞修饰剂,主要修饰蛋白上的氨基基团。在氯化氰脲酸(CnCl)催化下,mPEG-5000与红细胞膜上氨基形成共价键连接,掩盖Rh抗原和A或B抗原。CnCl-PEG-5000浓度越高,血型抗原的覆盖效果越好。由于微环境下A和B血型抗原处无氨基基团或者氨基基团不能被CnCl-PEG-5000修饰,不能完全阻断抗-A、B与A和B血型抗原结合。本文报道…     

Pneumocystis carinii pneumonia manifested as a hilar mass and cavitary lesion: an atypical presentation in a patient receiving aerosolized pentamidine prophylaxis

A case of Pneumocystis carinii pneumonia (PCP) in a patient with AIDS was manifested radiographically as a hilar mass and cavitary lesion. The patient had been receiving aerosolized pentamidine as prophylaxis against PCP. Nonuniform deposition of aerosolized pentamidine was probably responsible for this atypical radiographic appearance of PCP.     

Evidence that the Lub blood group antigen is located on red cell membrane glycoproteins of 85 and 78 kd

A murine monoclonal antibody of specificity anti-Lub was produced. Immunoblotting of the electrophoretically separated components of membranes from Lu(b+) red cells with the monoclonal antibody identified two glycoproteins of relative molecular mass 85 and 78 kd, respectively. The expression of Lub antigenic activity on these glycoprotein components was shown to be dependent on the presence of one or more N-glycosidically linked oligosaccharides and on the presence of disulphide bonding.     

Gonorrhea

During a 10-year period from 1976 to 1985, N. gonorrhoeae demonstrated remarkable genetic resiliency in developing clinically important antimicrobial resistance through a variety of chromosomal mutations and by acquiring either entire plasmids or resistance determinants on plasmids from other species. Gonococcal resistance is widespread, and few communities will be spared all types. None of the newer diagnostic technologies has provided any performance or cost advantages over traditional Gram-stained smears and cultures. The two most important components of a control program are (1) the National Gonococcal Isolate Surveillance project and (2) treatment with ceftriaxone, 125 or 250 mg intramuscularly, which is active against all known types of resistance and will cure all forms of uncomplicated gonorrhea, including the more difficult-to-treat infections of the pharynx and anorectum. Fear of AIDS has had a powerful motivating effect on sexual behavior, and in the United States has been associated with an overall reduction in incidence of gonorrhea in homosexual men of over 95%. After peaking in 1985, incidence of gonorrhea in white heterosexual men and women has declined as well. A diagnosis of gonorrhea in 1990 implies recent high-risk behavior for acquiring HIV infection. The gonorrhea epidemic in the United States is rapidly contracting down around poor urban minorities; although this is not good, at least it tells us where to target our resources.     

Treatment of uncomplicated gonorrhea with rosoxacin.

In a randomized, double-blind, dose-ranging study, single oral doses of rosoxacin were used to treat 126 patients with uncomplicated genital or anorectal gonorrhea. Neisseria gonorrhoeae was eradicated from 5 (28%) of 18 men treated with 100 mg, compared with 101 (94%) of 108 men and women treated with 200 mg, 300 mg, or 400 mg (P less than 0.001). Susceptibility to rosoxacin was determined for 6 pretreatment gonococcal isolates from these patients and for 194 stored clinical isolates; 296 (98.7%) of these 300 isolates, including 10 strains of penicillinase-producing N. gonorrhaeae, required a minimal inhibitory concentration of less than or equal to 0.062 microgram/ml. Urethral or cervical infection with Chlamydia trachomatis coexisted with gonococcal infection in 14 (22%) of 63 patients and persisted in 7 of 10 patients treated with rosoxacin. Postgonococcal urethritis developed in 11 (34%) of 32 men who were monitored for 12 to 30 days. Sixty-four subjects (51%) developed transient dizziness, drowsiness, altered visual perceptions, or other symptoms suggestive of central nervous system dysfunction after treatment with rosoxacin, but these symptoms were not clearly dose related. Rosoxacin in doses of greater than or equal to 200 mg appears to be effective for single-dose treatment of uncomplicated gonorrhea, but further studies of its possible central nervous system toxicity are indicated.     

A Family Demonstrating Inheritance of the Leach Phenotype: a Gerbich-Negative Phenotype Associated with Elliptocytosis

One third of very weakly Rh-immunized women show no increase in their level of Rh immunization during pregnancy and after delivery. Administration of 300 micrograms of Rh immune globulin at 6-week intervals does not alter the incidence of lack of progression of Rh immunization in such women. Thirty-three Rh-positive women who ultimately delivered ABO-compatible babies, had Kleihauer fetal transplacental hemorrhage (TPH) screening tests carried out at 2-week intervals during pregnancy and shortly after delivery. One third of the 33 women had no detectable TPH or a TPH of 0.01 ml of fetal red cells. We conclude that one third of weakly Rh-immunized women failed to show any progression of their Rh immune response during pregnancy or after delivery because they were exposed to too few fetal red cells (0.01 ml or less) to produce such a response.     

Upright bicycle exercise echocardiography after coronary artery bypass grafting

Upright bicycle exercise echocardiography and coronary angiography were performed in 42 patients from 1 month to 15 years (mean 6.3 years) after coronary artery bypass grafting (CABG) to determine if exercise-induced wall motion abnormalities could be correlated with the presence and location of nonrevascularized vessels. Nonrevascularized vessels were defined as obstructed vessels without grafts, obstructed grafts or native vessels obstructed distal to bypass graft insertion. Adequate quality echocardiograms were recorded at rest, peak exercise and after exercise in 38 patients (90%). Rest and postexercise echocardiograms were adequate in 3 others. Only 1 patient was excluded from analysis for inadequate peak and postexercise echocardiograms. Exercise-induced wall motion abnormalities were present in 33 of 35 patients (94%) who had 1 or more nonrevascularized vessels and these abnormalities were absent in 5 of 6 (83%) who had all vessels revascularized. Wall motion abnormalities were localized to the territory of the left anterior descending (LAD) artery or to a combined right (R) coronary-left circumflex (LC) region of circulation. Exercise-induced wall motion abnormalities were present in 24 of 27 LAD artery regions (89%) and 23 of 26 R-LC regions (88%) that had nonrevascularized vessels. These abnormalities were absent in 13 of 14 LAD regions (93%) and in 12 of 15 R-LC regions (80%) that had only revascularized vessels. Upright bicycle exercise echocardiography was successfully performed after CABG. The technique detected and accurately localized nonrevascularized and revascularized vessels.     

Defining the anatomic perfusion bed of an occluded coronary artery and the region at risk to infarction: A comparative study in the baboon, pig and dog

To assess selectively the effectiveness of therapeutic interventions to reduce infarct size, it is important to assess both ultimate infarct size as well as the size of the region of myocardium at risk to infarction. The anatomically defined perfusion bed of an occluded artery has generally been assumed to be synonymous with the region at risk of infarction. This assumption was tested by delineating the anatomic perfusion bed of an occluded artery with microvascular dyes and by examining the relation of the anatomic perfusion bed to the region of acute ischemic injury. In 8 baboons, 12 pigs and 15 dogs a major branch of the left anterior descending or left circumflex coronary artery was occluded. At 2 and 30 minutes after occlusion the eplcardial area of ischemic injury was determined by epicardial S-T segment mapping. The boundary of epicardial S-T segment elevation was resolved to within 1 mm and marked directly on the ventricular surface. The heart was then excised and the perfusion bed of the occluded artery was delineated by either (1) injecting different colored silicone rubber microvascular dyes into the previously occluded artery as well as the adjacent perfusion beds (direct method), or (2) injecting dye only into the adjacent perfusion beds (defect method).

Serial cross-sections of the left ventricle from the direct and defect dye-perfused hearts in all three species showed the perfusion bed of the occluded artery to be readily demarcated. Microscopic examination demonstrated no evidence of capillary anastomoses and minimal inter-digitation of capillaries at the perfusion bed boundaries. In dye-perfused hearts, the baboon and the pig showed no evidence of precapillary anastomoses between perfusion beds; however, the dog demonstrated numerous epicardial collateral channels. The epicardial area of the anatomic perfusion bed correlated closely with the epicardial area of S-T segment elevation at 2 minutes after occlusion in the baboon (r = 0.97), pig (r = 0.99) and dog (r = 0.96). The epicardial area of S-T segment elevation did not change through the 30 minute period of occlusion in the baboon and the pig, but in the dog it showed a progressive and variable reduction reflecting the gradual recruitment of existing collateral channels from adjacent perfusion beds.

It is concluded that the techniques of direct and defect dye delineation accurately define the anatomic perfusion bed of an occluded coronary artery. This anatomic perfusion bed corresponds to the region of myocardium undergoing acute ischemic injury and hence the region at risk to infarction immediately after coronary occlusion in the three species studied.