Retrograde transmission of Proteus mirabilis during platelet transfusion and the use of arbitrarily primed polymerase chain reaction for bacteria typing in suspected cases of transfusion transmission of infection

BACKGROUND: When bacteria are found, after a platelet transfusion, in the recipient's blood as well as in the platelet concentrate (PC), a causal relationship is normally suspected, with the PC as the causative agent. The other alternative, that the patient has bacteremia and contaminated the PC, is less well documented in the literature. CASE REPORT: Arbitrarily primed polymerase chain reaction (AP-PCR) was used for testing strains of Proteus mirabilis isolated from a patient's blood before and after a platelet transfusion and from the PC. Because of a febrile reaction after a platelet transfusion, bacterial culture was performed on the PC used, showing growth of P. mirabilis. The same species was found in the patient's blood after the transfusion. Posttransfusion sepsis caused by a contaminated PC was suspected, and anti-sepsis treatment was given to the recipient. Later, it became apparent that the patient had had bacteremia before the transfusion and that P. mirabilis was one of the species in the isolate. With AP-PCR, the identity of the three P. mirabilis isolates could be distinguished. CONCLUSION: AP-PCR is a useful technique for distinguishing the identity of bacterial isolates from patients and blood components. A patient with bacteremia can contaminate a PC in conjunction with a platelet transfusion. With AP-PCR, the PC could be ruled out as the cause of the posttransfusion sepsis.     

Diagnosis of liver cirrhosis with US: receiver-operating characteristic analysis of multidimensional caudate lobe indexes

To assess the utility of changes in the volume of the caudate lobe in the sonographic diagnosis of liver cirrhosis, the authors studied 58 patients with histologically proved cirrhosis, 18 patients with fatty liver, 28 patients with liver metastases, seven patients with lymphomatous liver involvement, and 75 healthy individuals. The longitudinal (CL), transverse (CT), and anteroposterior (CAP) diameters of the caudate lobe and the transverse diameter of the right lobe (RL) were measured, and one-, two-, and three-dimensional caudate lobe indexes and ratios were calculated. The analysis of the diagnostic performance of these criteria, compared by means of receiver-operating characteristic curves, revealed that the ratio of the three-dimensional caudate index (CI3) to the right lobe diameter (CI3/RL = [CL X CT X CAP]/RL) was superior to all other calculated criteria. At a specificity of 95%, the sensitivity of CI3/RL was 94.7%, compared with 73.3% for CT/RL. No significant differences were found between the control group and patients with fatty liver, metastases, or lymphomatous involvement. The study suggests that CI3/RL is the most reliable quantitative criterion for the US diagnosis of liver cirrhosis.     

ANTIHYPERTENSIVE EFFECTS OF dl- TETRAHYDROPALMATINE: AN ACTIVE PRINCIPLE ISOLATED FROM CORYDALIS

1. The effects of dl -tetrahydropalmatine (dl -THP) on cardiovascular function and hypothalamic release of monomines were assessed in rats under urethane anaesthesia. 2. Intravenous administration of dl -THP (1-10 mg/kg) produced hypotension, bradycardia, a decrease in hypothalamic serotonin and noradrenaline release and in increase in hypothalamic dopamine release in rats. 3. Intrahypothalamic administration of DOI (a serotonergic 5-HT₂ receptor antagonist) or apomorphine (a dopamine D₂-receptor agonist) produced the opposite effects and reversed dl -THP-induced hypotension and bradycardia. 4. The data suggest that dl -THP acts through the 5-HT₂ and/or D₂-receptor antagonism in the hypothalamus to induce hypotension and bradycardia in rats.     

Multiplanar arc boost radiation therapy for prostate cancer

Localized prostatic carcinoma may be treated with either radical surgery or radiation therapy. Radiation therapy techniques for localized prostatic carcinoma include mega-voltage external irradiation or interstitial implantation, usually with iodine-125 seeds. Two external-beam techniques, multiplanar arc and biplanar arc, are additional options for the treatment of localized prostatic carcinoma. Film dosimetry measurements were made in pelvic phantoms to compare the isodose distributions of various external-beam radiation therapy techniques for boost treatment of prostate target volumes. Idealized calculations were performed to determine the isodose distribution of an I-125 implant. A comparison of these techniques shows that the multiplanar and biplanar arc techniques produce isodose distributions that may be useful in the treatment of prostate carcinoma.     

Patient information preferences among breast and prostate cancer patients

Preferences for information about their disease and treatment were collected from 392 patients who had been treated for either breast or prostate cancer an average of 2 years previously. Type of information that they had received, their ratings of its value to them and their preferred format for further information were examined. The most common and most preferred form of information was through doctor interview, followed by educational booklets. Prostate cancer patients preferred videotapes; breast cancer patients tended to prefer individualized approaches including a tour of the department. Effects of age, educational levels, occupational backgrounds and self‐reports for anxiety and depression at the time of the survey and at time of diagnosis were analysed. Prostate cancer patients who were most severely depressed showed a preference for not receiving any information at all, perhaps reflecting a tendency towards withdrawal.     

Small arteries in peripheral lymph nodes: a specific US sign of lymphomatous involvement

Fifty-seven patients with palpably enlarged peripheral lymph nodes underwent detailed ultrasonographic (US) examination with a 5.0-MHz and a 7.5-MHz probe. In 32 of 36 patients with malignant lymphoma (12 with Hodgkin disease, 24 with non-Hodgkin lymphoma) US showed a hypoechoic mass with a centrally located tubular structure. Pathologic examination showed that this structure correlated with small intact arterial vessels encased by confluent lymphomatous masses. This sonographic finding was not seen in patients with carcinomatous metastatic lesions to the lymph nodes (nine patients) or benign lymphadenitis (12 patients). The detection with US of small arteries within enlarged lymph nodes may indicate nodal infiltration by malignant lymphoma.     

Mechanism of transient adsorption of fibrinogen from plasma to solid surfaces: role of the contact and fibrinolytic systems

The transient detection of fibrinogen on surfaces has been described (Vroman effect) and high-mol-wt kininogen (HK) has been shown to play a role in this reaction. In this study, we attempted to identify the form of HK responsible for preventing detection of the fibrinogen initially adsorbed from plasma to various artificial surfaces and to determine if other plasma components were involved. We compared 125I-fibrinogen adsorption in the presence of normal plasma to plasma deficient in specific proteins. On all surfaces tested, we found that fibrinogen was displaced from the surface. The extent of displacement was greatly reduced, however, but not eliminated in HK-deficient plasma. Factor XII- deficient plasma also showed reduced fibrinogen displacement. These data indicate that HK can actually displace fibrinogen; however, factor XII, or a factor XII-mediated reaction also appears to be necessary for this displacement to occur. Furthermore, when normal plasma was first subjected to extensive contact activation by dextran sulfate, during which the HK was extensively degraded to components smaller than the light chain (as assessed by Western blotting), we observed greatly reduced displacement of fibrinogen. Extensive contact activation of Factor XI-deficient plasma failed to show low-mol-wt derivatives, however, and displacement of fibrinogen was similar to normal plasma that had not undergone extensive activation. These data indicate that HKa (active cofactor produced during contact activation by factor XIIa or kallikrein) is primarily responsible for displacing fibrinogen, and that HKi (inactive cofactor generated by factor XIa) cannot displace fibrinogen. The fibrinogen from all plasma samples looked similar by Western blot analysis, suggesting that fibrinogenolysis was not a component of the Vroman effect. In addition, experiments performed with plasma prechromatographed on lysine agarose showed that a lysine- agarose adsorbable protein may be minimally involved in fibrinogen desorption and a synergism may exist between HK and that protein.     

去势雌干眼症模型鼠睑板腺上皮细胞凋亡及其组织损伤

目的:建立去势雌干眼症动物模型并探讨干眼症模型鼠睑板腺上皮细胞凋亡、相关基因表达与组织损伤的关系。方法:实验于2003-07/2004-07在青岛大学医学院附属医院动物实验中心及眼科病理室完成。①实验动物:清洁级健康成年Wistar雌性大白鼠20只,体质量180～200g,无眼疾患。②实验分组:采用随机数字表法分为去势雌组及对照组,每组10只。③实验干预:去势雌组摘两侧卵巢。对照组按相同方法找到卵巢后不摘除。去势雌组分别于手术前和手术后2,3,4,5,6个月行Schirmer试验、泪膜破裂时间及角膜荧光素染色检测。④去势雌组分别于术前、术后第1天、第9天心脏穿刺取血,采用化学发光法测量血清雌二醇水平(取血后有数只大鼠死亡,分别按上述步骤补齐);6个月后麻醉下处死两组动物,取睑板腺进行病理组织学观察,并采用免疫组织化学方法检测睑板腺上皮细胞中的Bax、bcl-2等相关基因蛋白的表达。结果:20只大鼠进入结果分析。①血清雌激素水平测定结果:去势雌组术后血清雌二醇水平明显低于手术前[(16.34±3.15),(43.57±2.81)ng/L,P<0.01]。②两组大鼠眼表损害的检查结果:去势雌组5个月起泪膜破裂时间明显低于正常对照组,且随观察时间的延长差异有显著性(P<0.01);4个月起角膜荧光素染色阳性,且随观察时间延长加重。③两组大鼠睑板腺光镜观察:病理学观察去势雌鼠睑板腺腺细胞萎缩,腺管扩展。④两组大鼠睑板腺上皮凋亡相关基因Bax、Bcl-2的表达:睑板腺上皮细胞中Bax阳性表达的细胞数明显高于对照组(P<0.01);bcl-2阳性表达的细胞数明显低于对照组(P<0.01)。结论:去势后雌鼠雌二醇水平明显低下,睑板腺上皮细胞中Bax增加及bcl-2减少均与促进细胞凋亡有关,可能是导致组织学改变进而功能丧失引起干眼症的原因之一。