Contrasting effects of recombinant human granulocyte-macrophage colony- stimulating factor (CSF) and granulocyte CSF treatment on the cycling of blood elements in childhood-onset cyclic neutropenia

Recombinant human granulocyte colony-stimulating factor (G-CSF) treatment has been shown to increase average neutrophil counts substantially in patients with childhood-onset cyclic neutropenia (or "cyclic hematopoiesis"), but not to eliminate the cyclic oscillations of neutrophil counts or those of other blood elements (monocytes, platelets, eosinophils, and reticulocytes) that are characteristic of this hematopoietic disorder. Indeed, oscillations of neutrophil counts are amplified during G-CSF treatment. We have compared the effects of recombinant granulocyte-macrophage-CSF (GM-CSF) with those of G-CSF in three patients with this disease (2 men and 1 woman, 17, 30, and 32 years of age). These patients were treated with GM-CSF (2.1 micrograms/kg/day, subcutaneously) for 6 weeks, preceded and followed by 6 to 13 weeks of detailed observation to document changes in the cyclic oscillations of blood neutrophils and other blood elements; two of the patients were subsequently treated with G-CSF (5.0 micrograms/kg/d, subcutaneously) and observed for comparable periods of time. Unlike G-CSF treatment, which increased average neutrophil counts more than 20-fold, GM-CSF increased neutrophil counts only modestly, from 1.6- to 3.9-fold, although eosinophilia of varying prominence was induced in each patient. However, at the same time, GM-CSF treatment dampened or eliminated the multilineage oscillations of circulating blood elements (neutrophils, monocytes, platelets, and/or reticulocytes) in each of the patients. In contrast, G-CSF treatment of the same patients markedly amplified the oscillations of neutrophil counts and caused the cycling of other blood elements (monocytes in particular) to become more distinct. These findings support the conclusion that the distinctive cycling of blood cell production in childhood-onset cyclic neutropenia results from abnormalities in the coordinate regulation of both GM-CSF-responsive, multipotential progenitor cells and G-CSF-responsive, lineage-restricted, neutrophil progenitors.     

Assessment of Free Dye in Solutions of Dual-Labeled Antibody Conjugates for <Emphasis Type="Italic">In Vivo</Emphasis> Molecular Imaging

Purpose  

Recent preclinical and clinical studies show that dyes that excite and fluoresce in the near-infrared range may be used for tracking and detecting disease targets in vivo. A method for quantifying free dye molecules in antibody conjugate preparations is required for agent batch release and for translation into the clinic.     

Percutaneous fluoroscopic removal of a knotted Swan–Ganz catheter in a patient with a persistent left‐sided superior vena cava

Knotting of intravascular catheters is an uncommon but a well‐recognized occurrence. The Swan–Ganz catheter (SGC) is the one that knots most commonly. A case of a knotted SGC is described in a patient with a persistent left‐sided superior vena cava, and we propose that the presence of a left‐sided superior vena cava is a risk factor for knot formation not previously reported. We review the published work on the risk factors for knot formation and on the techniques used to remove knotted SGC. We describe a technique using a gooseneck snare and Omni Flush catheter (Angiodynamics, Queensbury, NY, USA) to loosen and untie a knotted SGC.     

Sleep disorders and airway obstruction in newborns and infants

For most infants with a disorder of breathing control or airway obstruction, cause and management can be defined with a careful history and a few simple diagnostic tests. Pneumograms and multichannel studies can identify patterns of apnea and associated hypoxemia and can be used to assess therapeutic efficacy. For the majority of infants with disordered breathing, the outcome is favorable and conservative management is appropriate. More extensive diagnostic evaluation is reserved for infants with severe apnea or those with evidence of a significant contributing underlying disease. For these infants, management should be directed at the underlying cause and at identifying and preventing severe, life-threatening events.     

Hematological and blood viscosity changes in tail-suspended rats

BACKGROUND: Fluid shifts during exposure to microgravity result in a decrease in plasma volume which can lead to a transient increase in hematocrit. This transient increase in hematocrit could result in an increased blood viscosity. Yet, hematocrit returns to near normal values within a matter of hours of microgravity exposure as a result of a reduction in red blood cell mass. Rat tail-suspension models mimic the fluid shifts and hematological changes associated with microgravity exposure. METHODS: Tail-suspended rats were monitored for hematological and hemorheological changes over 4, 24, 72, and 168 h of tail suspension. Additionally, hematological and hemorheological changes were followed during recovery periods of 48, 120, and 192 h following 168 h of tail suspension. RESULTS: Although hematocrit increased significantly by 4 h of suspension, blood viscosity did not differ from controls. However, blood viscosity was significantly greater in the 72-, 168-, and 168/48-h suspension groups relative to controls despite no significant differences in hematocrits between groups. Theoretical calculations of blood viscosity at hematocrits of 50 and 60% (values intended to mimic hematocrits that would occur if red blood cell mass did not decrease) show a significant increase relative to the blood viscosities determined for the actual hematocrits in the experimental groups. CONCLUSIONS: The lowering of hematocrit associated with spaceflight may substantially reduce blood viscosity and thereby maintain the hematocrit at an optimal level for oxygen delivery to tissues.