The polysaccharide antibody response after Streptococcus pneumoniae vaccination is differentially enhanced or suppressed by 3,4-dichloropropionanilide and 2,4-dichlorophenoxyacetic acid.

Propanil (3,4-dichloropropionanilide) and 2,4-D (2,4-dichlorophenoxyacetic acid) are commonly used herbicides that have toxic effects on the immune system. The present study determined the effect of exposure to these chemicals on the immune response to a bacterial vaccine. The antibody responses to the T-independent type 2 antigen, phosphorylcholine (PC) and the T-dependent antigen, pneumococcal surface protein A (PspA) were characterized in C57BL/6 mice after heat-killed Streptococcus pneumoniae (HKSP) immunization and single or mixture herbicide exposure. Propanil exposure significantly increased the number of PC-specific IgM, IgG2b, and IgG3 antibody-secreting B cells (ASC) in the spleen 4-6-fold over control animals in a dose-dependent manner. However, the number of ASC in the bone marrow and serum titers were comparable in control and propanil-treated mice. In contrast, 2,4-D exposure decreased the number of PC-specific IgM and IgG bone marrow ASC 2-3-fold from control animals. The decrease in bone marrow ASC in 2,4-D-treated mice corresponded to a 3-4-fold decrease in PC-specific IgM, IgG2b, and IgG3 serum titers compared to control mice. The number of ASC in the spleens of 2,4-D-treated mice was, however, comparable to control mice. The antibody response to PspA was not affected by any of the treatments. There were no mixture interactions between the two herbicides in any of the responses measured. These results characterize the primary PC-specific antibody response in the bone marrow, spleen, and serum after HKSP vaccination and herbicide exposure. The differential effects of propanil and 2,4-D on the antibody response to a bacterial vaccine demonstrate the potential of chemical exposure to augment or suppress immune responses to vaccines and infectious diseases.     

Mediastinal lymphangioma in adults: CT and MR imaging features

Adult mediastinal lymphangiomas are rare lesions the diagnosis of which is difficult based on imaging studies. A retrospective study of CT, MR, and pathologic findings of mediastinal lymphangioma was performed in order to correlate pathological and imaging findings. Nine cases of adult lymphangiomas were identified in the records of our institution over a 12-year period. The CT, MR, and pathologic findings were reviewed. Lesions were classified pathologically as unilocular, cavernous, and intermediate types. Pathologic examination identified six cases of unilocular lesion, two cases of cavernous type, and one intermediate type. The CT features (n = 9) included a smoothly marginated non-enhancing mass of water attenuation (n = 7), a non-enhancing mass of soft tissue attenuation (n = 1), and an enhancing multiseptated mass (n = 1). Lesions were located in the anterior mediastinum (n = 2), right paratracheal (n = 4), subcarinal (n = 1), aortopulmonic window (n = 1) areas, and below the left hilum extending into the posterior mediastinum (n = 1). The MR features (n = 3) were characterized by an enhancing multicystic and multiseptated appearance, evocative of a cavernous type in two cases. The CT appearance of mediastinal thoracic lymphangioma is variable depending on the pathologic type. The most common unilocular type is a non-enhancing thin-walled mass on CT. A less frequent cavernous type can be suggested based on a multiseptated and loculated mass on CT and/or MR examination. Received: 21 June 1999; Revised: 30 September 1999; Accepted: 23 February 2000     

Safety and tolerability assessment of intrastriatal neural allografts in five patients with Huntington's disease

This study describes issues related to the safety and tolerability of fetal striatal neural allografts as assessed in five patients with Huntington's disease. Huntington's disease (HD) is characterized by motor, cognitive, and behavioral disturbances. The latter include psychological disturbances and, as a consequence, we took particular care to analyze behavioral changes, in addition to the usual "safety" follow-up. We conducted multidisciplinary follow-up at least 2 years before and 1 year after grafting. Psychological care extended to close relatives. The grafting procedure itself was altogether safe and uneventful, and there were no apparent clinical deleterious effects for 1 year. The immunosuppressive treatment, however, was complicated by various problems (irregular compliance, errors of handling, side effects). Direct psychological consequences of the transplantation procedure were rare and not worrisome, although mood alteration requiring treatment was observed in one patient. Indirectly, however, the procedure required patients and relatives to accept constraints that tended to complicate familial situations already marred by aggressivity and depression. All patients and close relatives expressed major expectations, in spite of our strong and repeated cautioning. It is clearly important to be aware of these particular conditions since they may eventually translate into psychological difficulties in coping with the long-term clinical outcome of the procedure, if not beneficial. Despite an overall good tolerance, therefore, this follow-up calls for caution regarding the involvement of HD patients in experimental surgical protocols.     

Postoperative death and malpractice suits: is autopsy useful?

This report demonstrates the extremely high yield of autopsies performed in the case of postoperative death with suspicion of malpractice. They frequently identified undetected complications. They could also suggest faulty or negligent practice that would otherwise go unrecognized. This report supports the widespread use of autopsies to investigate perioperative death.     

Animal Model for Cerebral Arteriovenous Malformation

Summary  Background. The present study was conducted to establish an animal model for the investigation of the pathophysiology and haemodynamics of cerebral arteriovenous malformation (AVM) but also to assess therapeutic aspects.  Method. For anatomic and haemodynamic reasons, dogs were chosen as the animal model. An arteriovenous fistula was created by interposing a segment of the superficial temporal artery between one of the main branches of the middle cerebral artery and the dorsal sagittal sinus. A temporal muscle graft supplied by this artery was implanted intracerebrally in the ischaemic area.  Findings. The angiographic and histopathologic findings obtained in the animal model are comparable with the situation found in intracerebral AVM in humans.  Interpretation. The animal model of intracerebral AVM established in this study allows for further investigation of the pathophysiology and dynamics of this disorder. It may help to develop better therapeutic options and thus improve the prognosis of affected patients.     

Complexity of Family Life Among the Low‐Income and Working Poor: Introduction to the Special Issue

Like all families, low‐income and working‐poor families need economic stability, safety, good health, and engagement in the larger community. However, the complexity of their lives is greatly impacted by limited economic resources. Three primary themes are explored by the 12 articles in this special issue: competing stressors and tensions, effective parenting, and economic stability and financial decision making. Key findings and program and policy implications identified by each set of authors are discussed. This body of work provides research‐based practice and policy suggestions to guide future efforts in partnering with families to strengthen their families and communities for successful enhancement of child well‐being.     

Methodology in meta–analysis: a study from Critical Care meta–analytic practice

Methodological aspects of meta-analytic practice, heterogeneity, publication bias, metaregression and effect metric, were investigated in 14 meta-analyses reflecting major therapeutic concern in Critical Care practice. Compared with the standard Q test, the exact Zelen test was more sensitive in identifying heterogeneity. Assessment of heterogeneity impact by the I ² statistic was consistent with inferences afforded by both the Q and Zelen test. Publication bias was subject to test and metric determination: funnel plots exhibited variable asymmetry across studies and between metrics; the regression asymmetry test appeared more sensitive than the rank correlation test; the “trim and fill” method was the most sensitive, but suggested, on the basis of quantification of the effects of potentially missing studies, that meta-analyses may be resistant to such missingness. Metaregression of treatment effect against control risk using Bayesian hierarchical regression in all metrics (log odds ratio, log risk ratio and RD) suggested that naïve linear regression approaches over-diagnosed significant relationships and exhibited regression dilution. Heterogeneity, publication bias and risk related treatment effects all demonstrate estimator and metric dependence; the RD metric would appear the most capricious in this regard.