Multiple drug combinations with “low-dose” cyclosporin for renal transplantation

The factors affecting graft survival in transplant recipients receiving cyclosporin (CsA) are still being debated. Our report is based on an analysis of 202 successive transplantations performed in our institution from May 1984 to December 1986, using low-dose CsA as the basic means of immunosuppression. A total of 142 patients received the triple combination CsA, azathioprine (AZA), and corticosteroids. Sixty patients received a prophylactic combination of CsA, corticosteroids, and antilymphocyte globulins (ALG). From January to December 1986, both regimens were compared in a prospective randomized trial. The factors that affect graft survival were analyzed using the Cox multivariate hazard analysis. The relative risks were calculated for pretransplant baseline risk factors and for outcome-dependent post-transplant risk factors for surviving grafts at 1 month. Transplants performed with a prolonged ischemia time and patients whose graft did not function immediately were statistically at higher risk of graft loss. Adding prophylactic ALG to CsA was associated with better graft survival. patients who experienced more than 1 rejection crisis and patients whose 1-month CsA dose was lower than or equal to 5 mg/kg per day were also at significantly higher risk of further graft loss. Neither HLA matching, peak panel reactivity, age of the recipient, occurrence of post-transplant renal dysfunction nor 1-month renal function affected the short-term graft outcome.     

Preservation of acid phosphatase activity in medico-legal specimens

Vaginal acid phosphatase has been preserved with a protective broth containing, per liter, 50 of bovine albumin, 0.2 g of sodium azide, 10 mmol of phosphate (pH 7.4), and 9.0 g of NaCl. Samples may be maintained at ambient temperature for one month without loss of activity. Several other commonly used preservative methods are compared and are shown to be inadequate. With a constant 2.5 ml volume of the support medium, and use of a sodium thymolphthalein monophosphate method (Worthington Diagnostics), vaginal acid phosphatase activity in non-coital women is less than 10 U/liter of broth, and in recently post-coital women is more than 50 U/liter (242 +/- 104 U/liter). In vivo degradation of vaginal activity follows a nearly logarithmic course until four days after intercourse, when it reaches nearly normal values.     

Transfusion-related acute lung injury in an infant during craniofacial surgery

Transfusion-related acute lung injury (TRALI) is a potentially life-threatening, systemic, immune-mediated reaction to transfused blood product. The symptoms may be masked under general anesthesia. In this case report, we describe an infant who developed TRALI under general anesthesia for craniofacial surgery. The difficulty with diagnosis, the pathophysiology, and the need for understanding and recognition to reduce morbidity and mortality are discussed. IMPLICATIONS: Transfusion-related acute lung injury (TRALI) is a life-threatening problem that can occur during blood product transfusion in patients of any age. Understanding the pathophysiology may help make an earlier diagnosis to reduce more serious adverse outcomes.     

Winged-helix transcription factors and pancreatic development

The forkhead gene family, named after the founding gene member in Drosophila, is characterized by a unique DNA-binding domain. This so-called forkhead box encodes a winged-helix DNA-binding motif, the name of which describes the structure of the domain when bound to DNA. The three Fox (forkhead box) group A genes, Foxa1, Foxa2 and Foxa3, are expressed in embryonic endoderm, the germ layer that gives rise to the digestive system, and contribute to the specification of the pancreas and the regulation of glucose homoeostasis. Deletion of the Foxa2 gene in pancreatic beta-cells in mice results in a phenotype resembling PHHI (persistent hyperinsulinaemic hypoglycaemia of infancy). Molecular analyses have demonstrated that Foxa2 is an important regulator of the genes encoding Sur1, Kir6.2 and Schad (short chain L-3-hydroxyacyl-CoA dehydrogenase), mutation of which causes PHHI in humans. Foxa1 was shown to be an essential activator of glucagon gene expression in vivo. An additional winged-helix protein, Foxo1, contributes to pancreatic beta-cell function by regulating the Pdx1 gene, which is required for pancreatic development in cooperation with Foxa2.     

Relapsing polychondritis studied by computed tomography

Computed tomographic findings in a patient with relapsing polychondritis are described. Collapse of the cartilage of the nose and calcification in cartilages of the ears were clearly demonstrated. CT scanning was also helpful in evaluating the tracheobronchial tree for airway compromise, which could prove fatal in this condition.     

Comprehension of idioms in adolescents with language-based learning disabilities compared to their typically developing peers

Adolescents with language-based learning disabilities (LBLD) often interpret idioms literally. When idioms are provided in an enriched context, comprehension is compromised further because of the LBLD student's inability to assign multiple meanings to words, assemble and integrate information, and go beyond a local referent to derive a global, coherent meaning. This study tested the effects of context and familiarity on comprehension of 24 idioms in 22 adolescents with LBLD. The students completed the Idiom Comprehension Test (ICT) [Language, Speech, and Hearing Services in Schools 30 (1999) 141; LSHSS 34 (2003) 69] in one of two conditions: in a story or during a verification task. Within each condition were three familiarity levels: high, moderate, and low. The LBLD adolescents' data were then compared to previously collected data from 21 age-, gender-, and reading ability-matched typically developing (TD) peers. The relations between reading and language literacy and idiom comprehension were also examined in the LBLD adolescents. Results showed that: (a) the LBLD adolescents generally performed poorly relative to their TD counterparts; however, the groups performed comparably on the high and moderate familiarity idioms in the verification condition; (b) the LBLD adolescents performed significantly better in the verification condition than in the story condition; and (c) reading ability was associated with comprehension of the low familiarity idioms in the story condition only. Findings are discussed relative to implications for speech-language pathologists (SLPs) and educators working with adolescents with LBLD. LEARNING OUTCOMES: As a result of this activity, the participant will be able to (1) describe the importance of metalinguistic maturity for comprehension of idioms and other figures of speech; (2) understand the roles of context and familiarity when assessing idiom comprehension in adolescents with LBLD; and (3) critically evaluate assessments of idiom comprehension and determine their appropriateness for use with adolescents with LBLD.