Prenatal diagnosis of portal vein thrombosis by ultrasound.

Neonatal portal vein thrombosis (PVT) is a rare condition seen in the setting of thrombophilia or after umbilical vein catheterization. We report a case of fetal PVT with abnormal antenatal ultrasound findings at 27 weeks of gestation. This presented initially as dilation of the intrahepatic umbilical vein. To our knowledge, this is the first reported case evaluated prenatally. Color Doppler ultrasound was valuable in detecting constriction of the vessel with a high-velocity jet seen past the obstruction site. A discussion of this condition and differential diagnosis is presented.     

One stop screening for multiple cancers: The experience of an integrated cancer prevention center

BackgroundCancer is a leading cause of mortality worldwide. Screening is a key strategy for reducing cancer morbidity and mortality.MethodsWe aimed to describe the experience of an integrated cancer prevention center in screening an asymptomatic population for the presence of neoplasia. One-thousand consecutive asymptomatic, apparently healthy adults, aged 20–80 years, were screened for early detection of 11 common cancers that account for 70–80% of cancer mortality.ResultsMalignant and benign lesions were found in 2.4% and 7.1% of the screenees, respectively. The most common malignant lesions were in the gastrointestinal tract and breast followed by gynecological and skin. The compliance rate for the different screening procedures was considerably higher than the actual screening rate in the general Israeli population — 78% compared to 60% for mammography (p < 0.001) and 39% compared to 16% for colonoscopy (p < 0.001). Advanced age, family history of cancer and certain lifestyle parameters were associated with increased risk. Moreover, polymorphisms in the APC and CD24 genes indicated high cancer risk. When two of the polymorphisms existed in an individual, the risk for a neoplastic lesion was extremely high (OR 2.3 [95% CI 0.94–5.9]).ConclusionsOne stop shop screening for 11 common cancers in the setting of a multidisciplinary outpatient clinic is feasible and can detect cancer at an early stage.     

Human neutrophil antibodies in a blood donor population: a lookback study

Background and Objectives Human neutrophil antibodies (HNA) have been associated with severe transfusion‐related acute lung injury (TRALI). We identified HNA antibodies in a blood donor population and performed an observational lookback on patients who received products from these donors to determine whether TRALI was associated with these transfusions. Materials and Methods Human neutrophil antibodies were determined in 1171 blood donors (388 non‐transfused males, 390 human leucocyte antigen (HLA) antibody–negative females and 393 HLA antibody–positive females) for IgG and IgM antibodies using a flow cytometric assay. Selected positive samples had a monoclonal antibody immobilization of granulocyte antigen (MAIGA) and neutrophil genotyping performed to confirm specificity. Lookback was performed on patients receiving blood from donors with positive samples by extracting recipient data from hospital medical records. An expert panel of three pulmonary critical care physicians reviewed the summarized data and assigned a diagnosis of TRALI, possible TRALI, cannot distinguish between TRALI and TACO, TACO and other. Results Eight donors had HNA antibodies of which five contributed to this lookback (3‐HNA‐specific antibodies, 2‐HNA non‐specific antibodies). Seventy‐six blood products were transfused from these donors into individual patients. One patient developed TRALI that was associated with a donor with a non‐specific HNA antibody as well as class‐I and class‐II HLA antibodies. Conclusion The incidence of TRALI in this lookback was low and combined with low frequency of HNA antibodies in the donor population suggests not screening donors for HNA antibodies at this time is acceptable.     

Adaptive double data entry: a probabilistic tool for choosing which forms to reenter

Several recent articles have supported differing opinions about the value and cost of double data entry in specific clinical trials. The cost of the reentry, combined with the low error rate typical in controlled clinical trials suggests to some that single data entry may be sufficient, with the cost of reentry allocated to more productive quality assurance tools. In this article, an alternative approach to limiting costs and maintaining the quality of entered data is offered. The technique is a formal, adaptive method for choosing a subset of forms to be reentered. The idea behind the approach is to decide whether a given form should be reentered on a form-by-form basis for each data entry person, using an estimated probability that the form contains an error as a guideline. The method automatically adapts to each data entry person and to temporal changes in accuracy within data entry person. The estimated probability is based on a lagged set of the most recently double-data-entered forms. A simple simulation shows that much of the reentry can be avoided while still detecting many of the errors. A real data example demonstrates that the procedure can be effective in practice as well. Control Clin Trials 2001;22:2-12     

Hepatitis G virus biology, epidemiology, and clinical manifestations: Implications for blood safety

Hepatitis G virus (HGV), also called GBV-C, is a single positive-standard RNA virus belonging to the Flaviviridae family. In 50% to 75% of infections, HGV is cleared with plasma RNA disappearing as anti-E2 becomes detectable; in other cases, HGV infection becomes chronic. The prevalence of HGV RNA in blood donors ranges from 1% to 4%, and the rate of anti-E2, indicating resolved infection, ranges from 3% to 14%. HGV is transmitted by transfusion of blood components and has been transmitted by nonvirally inactivated factor VIII concentrate. Despite extensive study, HGV has not been identified as a causative agent of any type of liver disease or any other known clinical condition. Molecular biology data show a lack of hepatotropism; preliminary data indicate that the site of HGV replication may be in mononuclear cells in bone marrow or spleen but not in peripheral blood or lymph nodes. The combined clinical and laboratory data strongly support the contention that HGV is not a hepatotropic virus and that this virus was inappropriately named hepatitis G. Because the data do not indicate any pathologic effects of HGV, it is not appropriate to screen the blood supply for HGV RNA.