B-cell lymphoproliferative disorders in children after bone marrow transplantation: radiologic manifestations

The radiographic findings in five pediatric patients in whom unregulated B-cell lymphoproliferative disorders developed following bone marrow transplantation are described. Four patients received T-cell-depleted bone marrow from mismatched donors and one received nondepleted marrow from a matched sibling donor. These disorders are similar to B-cell lymphoproliferative disorders that have been described in other immunosuppressed hosts. They are associated with Epstein-Barr virus and range from polyclonal proliferation without cytogenetic abnormalities to monoclonal lymphoma with clonal cytogenetic changes. Unlike other postallograft lymphoproliferative processes, B-cell lymphoproliferative disorders in these patients have not responded to antiviral therapy, immunologic therapy, or chemotherapy. The radiographic patterns of disease include diffuse or focal hepatic involvement; gallbladder wall thickening; and pulmonary, soft-tissue, and basal-ganglion masses. These radiologic findings are not specific and evaluation of tissue histology is required for diagnosis.     

A Mycobacterium tuberculosis cluster demonstrating the use of genotyping in urban tuberculosis control

Background  

DNA fingerprinting of Mycobacterium tuberculosis isolates offers better opportunities to study links between tuberculosis (TB) cases and can highlight relevant issues in urban TB control in low-endemic countries.     

What is a safe waiting time for coronary artery bypass surgery?

To determine the factors that influenced doctors' prioritization and decisions on safe waiting time for coronary artery bypass surgery, 50 'paper patients', based on a random sample of cases who actually had surgery, were assessed by 33 clinicians. We used linear regression models to reflect the impact of clinical and non-clinical 'cues' on safe waiting time and priority decisions. The benefits of surgery tended to be over-estimated. For example, the average perceived gain in life expectancy for patients with left main-stem disease was 6.74 years. However, models incorporating only the perceptions of benefit as independent variables (i.e. the anticipated symptom reduction, MI risk reduction and life expectancy extension), had only modest explanatory power (mean R2 was 0.55 for safe waiting time, and 0.56 for priority decisions). Models which incorporated perceptions of benefit and the cases' clinical and non-clinical characteristics had generally much higher explanatory power (mean R2, 0.83 and 0.86, respectively). Lifestyle and demographic variables had much less impact on the doctors' judgements than the major clinical cues of angina severity and left main-stem stenosis. Demographic and lifestyle cues had different impacts on safe waiting time and priority for about 25% of doctors.      

Intermittent subclavian artery occlusion following clavicular fracture

Although fractures of the clavicle are common, complications are rare. A 41 year old painter developed two uncommon complications of clavicular fracture, mechanical intermittent subclavian artery occlusion and subclavian vein thrombosis. Both conditions were clearly identified on the clinical symptoms and signs and confirmed with dynamic angiography and computerised tomography. Operative intervention led to complete resolution of symptoms.     

坐式排球运动与腰背肌筋膜炎的关系及其损伤预防

目的:对坐式排球运动员进行腰背肌筋膜炎损伤检查与积极治疗,并制定有效措施预防腰背肌筋膜炎损伤的发生,以提高其成绩水平。方法:实验于2006-03/07于鲁东大学体育学院完成。①选取2006年参加山东省残疾人运动会的烟台队坐式排球运动员22名,男12名,女10名,平均年龄(27±2)岁。②对22名坐式排球运动员进行腰背肌筋膜炎损伤状况检查,病历需要详细注明受伤原因、腰背部肌肉筋膜的痛点及运动障碍、确定损伤性质是急性还是慢性、确定损伤位置、抗阻力实验是否为阳性。③检查完毕后,对存在腰背肌筋膜炎损伤的运动员采用日本温热式低周波治疗器 外敷中药治疗。温热式低周波治疗器主要选择拍打、推压、按摩、左右变换按揉,每次治疗时间为15min,温度控制在38～43℃,将(-)导子放在痛点部位,( )导子放在阿是穴、肾俞、命门、腰眼等相应的治疗穴位上。中药以散寒活血祛瘀止痛为主,将川乌头、天南星、生半夏、乳香、没药、独活、马钱子、红花等混合研成粉状,加入体积分数为0.75的乙醇搅拌成糊状,用沙布制成直径约15cm饼状态物,敷于患处,6～12d为1个疗程。④治疗结束后,对所有队员1年的训练过程制定预防腰背肌筋膜炎的有效措施,即训练中加强腰背部肌肉力量和伸展性;通过温热式低周波治疗器 推拿按摩促进腰背部肌肉筋膜的放松及疲劳恢复;训练中采用肌肉牵伸性练习,注意避免牵拉过度;建立急性运动损伤档案,尽量减少急性损伤转变为慢性损伤的可能性。结果:①腰背肌筋膜炎的患病率:烟台队22名坐式排球运动员中,10名存在腰背肌筋膜炎损伤,患病率45.5%,损伤部位集中在腰背部和颈部。②腰背肌筋膜炎损伤治疗结果:采用日本温热式低周波治疗器 外敷中药治疗一两个疗程后效果良好,10名腰背肌筋膜炎损伤运动员中9名痊愈,治愈率90%。③采取预防措施后运动员腰背肌筋膜炎的发生情况:训练中采取预防措施,1年后22名坐式排球运动员腰背肌筋膜炎损伤得到明显控制,腰背肌筋膜炎患病率为29.3%,与治疗预防前比较下降16.2%,效果显著。结论:坐式排球运动损伤部位集中在腰背部和颈部,腰背肌筋膜炎是常发病。针对发病原因及时治疗并给予有效预防措施,可明显降低腰背肌筋膜炎损伤发生率,对其运动训练能力和比赛成绩的提高均具有积极意义。     

Inactivation of human immunodeficiency virus by gamma radiation and its effect on plasma and coagulation factors

The inactivation of HIV by gamma-radiation was studied in frozen and liquid plasma; a reduction of the virus titer of 5 to 6 logs was achieved at doses of 5 to 10 Mrad at -80 degrees C and 2.5 Mrad at 15 degrees C. The effect of irradiation on the biologic activity of a number of coagulation factors in plasma and in lyophilized concentrates of factor VIII (FVIII) and prothrombin complex was examined. A recovery of 85 percent of the biologic activity of therapeutic components present in frozen plasma and in lyophilized coagulation factor concentrates was reached at radiation doses as low as 1.5 and 0.5 Mrad, respectively. As derived from the first-order radiation inactivation curves, the radiosensitive target size of HIV was estimated to be 1 to 3 MDa; the target size of FVIII was estimated to be 130 to 160 kDa. Gamma radiation must be disregarded as a method for the sterilization of plasma and plasma-derived products, because of the low reduction of virus infectivity at radiation doses that still give acceptable recovery of biologic activity of plasma components.     

Prognostic value of anti-ADAMTS 13 antibody features (Ig isotype, titer, and inhibitory effect) in a cohort of 35 adult French patients undergoing a first episode of thrombotic microangiopathy with undetectable ADAMTS 13 activity

To study both the pathophysiologic and the prognostic value of ADAMTS13 in thrombotic microangiopathies (TMAs), we enrolled a cohort of 35 adult patients combining a first acute episode of TMA, an undetectable (below 5%) ADAMTS13 activity in plasma, and no clinical background such as sepsis, cancer, HIV, and transplantation. All patients were treated by steroids and plasma exchange, and an 18-month follow-up was scheduled. Remission was obtained in 32 patients (91.4%), and 3 patients died (8.6%) after the first attack. At presentation, ADAMTS13 antigen was decreased in 32 patients (91.4%), an ADAMTS13 inhibitor was detectable in 31 patients (89%), and an anti-ADAMTS13 IgG/IgM/IgA was present in 33 patients (94%). The 3 decedent patients were characterized by the association of several anti-ADAMTS13 Ig isotypes, including very high IgA titers, while mortality was independent of the ADAMTS13 inhibitor titer. In survivors, ADAMTS13 activity in remission increased to levels above 15% in 19 patients (59%) but remained undetectable in 13 patients (41%). Six patients relapsed either once or twice (19%) during the follow-up. High levels of inhibitory anti-ADAMTS13 IgG at presentation were associated with the persistence of an undetectable ADAMTS13 activity in remission, the latter being predictive for relapses within an 18-month delay.