肾移植后多瘤病毒相关性肾病

背景：多瘤病毒感染是导致多瘤病毒相关性肾病和移植肾失功的重要原因之一。 目的：观察分析多瘤病毒相关性肾病的临床特征及其病理学特点。 方法：121例患者移植肾活检行多瘤病毒大T抗原染色,发现9例阳性诊断为多瘤病毒相关性肾病,利用SV-40 大 T 抗原免疫组织化学染色,对确认为多瘤病毒相关性肾病患者进行临床、病理、免疫荧光、免疫组织化学观察。 结果与结论：多瘤病毒相关性肾病组肾活检时检测霉酚酸-AUC 0-12和他克莫司血药浓度均明显高于同期非多瘤病毒相关性肾病组(P < 0.05)。9例活检组织经SV-40 大T抗原染色,肾皮质和髓质均可见散在的肾小管多瘤病毒阳性。免疫荧光IgG,IgM,IgA,C3,C4,C1q和C4d全阴性,所有肾组织病理均可见肾间质大量聚集的CD3,CD4,CD8,CD68阳性细胞,1例合并排斥反应者,人白细胞DR抗原和白细胞介素2受体高表达;不合并排斥者人白细胞DR抗原和白细胞介素2受体表达多小于5%。9例多瘤病毒相关性肾病患者随访均超过半年,移植肾失功1例,3例好转,2例稳定,3例恶化。结果表明,多瘤病毒相关性肾病的诊断主要依赖于移植肾活检组织病理;利用SV-40 大T 抗原免疫组织化学染色可提高多瘤病毒相关性肾病的诊断率;移植肾组织C4d、白细胞介素2受体和人白细胞DR抗原检测对多瘤病毒感染相关性肾病的鉴别诊断具有极其重要的临床价值。     

Psychological Correlates of Outcome after Coronary Artery Bypass Graft

Background

Psychological effects of Coronary Artery Bypass graft (CABG) have been of interest all over the world but there is a paucity of Indian work.

Methods

30 patients undergoing CABG at a service hospital were included. All patients filled a specially designed proforma. Mini Mental Status Examination, Hospital anxiety and depression scale, Coronary scale, Seattle angina questionnaire and Euro-QOL 5D were performed before and seven days after CABG.

Results

43.3% had significant anxiety and 30% had significant depression before CABG. Following CABG, 36.67% of the patients had significant anxiety while 40% had significant depression. On the Seattle angina questionnaire, physical limitation reduced from 71.6 ± 7.9 to 53.1 ± 14.6. There was significant improvement in treatment satisfaction from 37.8 ± 6.1 to 59.4 ± 4.2 following CABG. On th euro quality of life scale (EQ5D) health status improved from 38.17 ± 9.51 before CABG to 68.5 ± 5.28 after CABG.

Conclusion

There is a significant incidence of anxiety and depression in patients undergoing CABG, both before and after surgery.Key Words: CABG, anxiety, depression     

Rapid typing of the human Fc gamma receptor IIA polymorphism by polymerase chain reaction amplification with allele-specific primers

BACKGROUND: The human Fc gamma receptor IIa (Fc gamma RIIa) is expressed in two polymorphic forms, Fc gamma RIIa-H131 and Fc gamma RIIa-R131, that differ by the replacement of histidine by arginine at position 131. This replacement is caused by a single-nucleotide exchange of A–>G. The resulting receptor forms differ in their binding to human IgG2 and mouse IgG1, which may lead to a different immunologic defense to bacterial polysaccharides and encapsulated bacteria. STUDY DESIGN AND METHODS: A rapid and easy polymerase chain reaction(PCR) method of genotyping the Fc gamma RIIa was developed. Allele-specific primers discriminate between the Fc gamma RIIa-H131 and the Fc gamma RIIa-R131 forms of the receptor. The results were compared with those obtained by another DNA-based genotyping method, in which PCR-amplified DNA was hybridized with allele-specific oligonucleotides, and with a functional phagocytosis assay using mouse IgG1-coated red cells as target antigens. RESULTS: The genotypes deduced from the PCR with allele-specific primers were in complete accordance with those obtained by the data from the hybridization of PCR-amplified DNA with allele- specific oligonucleotides. Furthermore, the Fc gamma RIIa genotypes of 28 individuals in all cases corresponded to the functional phenotypes. CONCLUSION: The use of PCR with allele-specific primers provides a rapid and easily performed method for the determination the Fc gamma RIIa polymorphism.     

Diagnostic error due to vicarious excretion of rectal iodinated contrast

Introduction of iodinated contrast into the intact colon is not expected to result in imaging‐visible renal excretion of this contrast and is a phenomenon that has only rarely been described. We present a case in which such vicarious renal excretion was misinterpreted as a recto‐vesical fistula which resulted in unnecessary delay in the patient’s management.     

Production and characterization of a bispecific IgG capable of inducing T-cell-mediated lysis of malignant B cells

Bispecific monoclonal antibodies (bsabs) recognizing both CD3 and a tumor antigen can redirect T-cell-mediated cytotoxicity toward cells bearing that antigen. Such bsabs have been shown to be more effective than monospecific monoclonal antibodies (MoAbs) at preventing tumor growth in animal models of B-cell malignancy. The current studies describe the production and preliminary evaluation of a bsab designed to induce the lysis of malignant human B cells by human T cells. The bsab was obtained from a hybrid-hybridoma cell line produced by fusing OKT3-secreting hybridoma cells with hybridoma cells that secrete 1D10. 1D10 is an MoAb that recognizes an antigen found on a majority of malignant human B cells that has not been detected to a significant degree on normal resting or activated lymphocytes. High performance liquid chromatography (HPLC) was used to separate bsab from monospecific antibodies that were also present in the hybrid-hybridoma antibody product. The bsab was then evaluated in vitro for its ability to induce lysis of malignant B cells by activated T cells. The bsab consistently induced extensive lysis in vitro of 1D10 (+) cells, including both cell lines and cells obtained from patients with a variety of B-cell malignancies. No such effect was seen with activated T cells alone or activated T cells with monospecific antibody. No increased lysis was seen with 1D10 (-) cell lines. The bsab also mediated lysis of malignant B cells by autologous T cells. We conclude bsab containing an OKT3 arm and a 1D10 arm can induce T-cell-mediated lysis in a manner that is both potent and specific. This supports further evaluation of this bsab as a potential immunotherapy of B-cell malignancy.     

Precision of genotyping of Epstein-Barr virus by polymerase chain reaction using three gene loci (EBNA-2, EBNA-3C, and EBER): predominance of type A virus associated with Hodgkin's disease [published erratum appears in Blood 1993 Oct 1;82(7):2268]

To precisely determine the genotype of Epstein-Barr virus (EBV) in Hodgkin's disease (HD), we simultaneously analyzed three divergent gene loci (EBNA-2, EBNA-3C, and EBER) that distinguish type A and B viruses. The primers designed to amplify these three gene loci encompass either type-specific deletion sequences (EBNA-2 and EBNA-3C) or type-specific point mutations (EBER) that identify the virus strain based on the sizes of the polymerase chain reaction (PCR)-amplified products or the mobility shifts in single-strand conformation polymorphism analysis. The locations of point mutations were identified by direct sequencing of the PCR-amplified DNA. We analyzed 15 EBV-infected cell lines and found a good correlation between EBNA-2 and EBNA-3C typing results. In contrast, approximately 33% of the cell lines analyzed maintained type A sequences in EBNA-2 and EBNA-3C genes while carrying type B sequences in the EBER region. Data obtained from analysis of cell lines served as a reference for studying HD samples. EBV DNA was detected in about 70% of HD. Among the EBV-positive samples, 56% were associated with type A virus, 13% with type B, and 31% with dual viral sequences. Thus, type A virus is predominant in HD. Based on the histology, the frequencies of EBV positivity were 83%, 71%, and 33% for mixed cellularity, nodular sclerosis, and lymphocyte predominance, respectively. The detection of high frequency of both type A and B sequences in HD may provide a lead in investigating the role of dual viral infection in EBV pathogenesis.     

Results of definitive radiotherapy in T1 and T2 glottic carcinoma: Institute of Rotary Cancer Hospital experience

Early glottic carcinomas (T₁ and T₂) constitute only 2% of all laryngeal cancers in our data. Seventy patients were seen between 1985 and 1992. All patients were treated by cobalt-60 small field radiotherapy using a beam directed shell. The total dose delivered was 60–65 Gy in 31 patients and 66–70 Gy in 39 patients. The follow-up period ranged from 5 to 126 months, with a mean follow up of 37 months overall and 55 months in the surgical salvage group. Radiation therapy controlled disease in 71% (50 of 70) of patients overall; 75% with T₁ and 67% with T₂ lesions. Total laryngectomy as salvage surgery was performed in 70% (14 of 20) of patients whose disease recurred. Ultimate control including surgical salvage occurred in 64 (91%) of 70 patients in the present study. The actuarial 5 year survival was 83 and 80% in T₁ and T₂ tumours, respectively (statistically insignificant). This report supports the policy of definitive irradiation, reserving surgical salvage for radiation failures in early laryngeal cancers.     

单克隆抗体BDI－I导向的阿霉素白蛋白毫微球对人膀胱癌细胞的特异杀伤活性

用化学偶联法将抗人膀胱癌单克隆抗体分子偶联到阿霉素白蛋白毫微球上，构建了一个有靶向杀伤性的免疫毫微球，即：阿霉素白蛋白载单克隆抗体毫微球（ＡＤＲ－ＮＰ－Ａｂ）。改变阿霉素毫微球和单克隆抗体的反应分子比，确定了制备该免疫毫微球的最佳条件。经免疫荧光检测及显微照像分析证明，免疫毫微球可有效地和人膀胱癌细胞结合。体外杀伤试验表明，此免疫毫微球对靶细胞ＥＪ有高度特异杀伤活性，而对无关的人直肠癌Ｌｏｖｏ细胞则无明显作用。     

What does the family pictures subtest of the Wechsler Memory Scale-III measure? Insight gained from patients evaluated for epilepsy surgery

The Family Pictures (FP) task is a new subtest of the Wechsler Memory Scale Version III (WMS-III) used to assess visual memory and learning. This study assessed the extent to which different cognitive abilities contribute to performance on the FP task in 125 patients evaluated for epilepsy surgery. Results indicated that the FP task relies heavily on auditory-verbal based cognitive abilities, as well as visual memory, and may better represent a general measure of memory performance. These results raise questions about the appropriateness of including FP task performance in the calculations of the WMS-III Visual Index scores.