INADEQUACY OF ACTIVE IMMUNIZATION ALONE IN PREVENTION OF RABIES (A Case Report)

A case of dog bite where prompt immunization with antirabies vaccine alone proved inadequate in prevention of fatal rabies is reported to emphasize upon the need of concomitant passive immunization with either human rabies immune globulin or equine antiserum.KEY WORDS: Rabies, Active immunization, Passive immunization     

Present-day aspects (diagnosis, clinical course and treatment) of acute progressive pulmonary tuberculosis

A total of 103 patients with acute progressive pulmonary tuberculosis whose age ranged from 18 to 60 years were examined. Caseous pneumonic, infiltrative-caseous, disseminated, and rapidly progressive fibrocavernous tuberculosis was found in 45.6, 17.5, 16.5, and 20.4% of cases, respectively. The clinical picture was characterized by its acute onset with significant intoxication syndrome. Moreover, all the patients had respiratory and immunological failure, varying disseminated intravascular coagulation syndrome, non-specific bronchopulmonary infection; some presented with pulmonary hemorrhage, spontaneous pneumothorax and pleural empyema. The sputum smear test was positive in all the patients. If there was no evidence for drug resistance, patients had a 4-month regimen using isoniazid, rifampicin, pyrazinamide, ethembutol, and kanamycin. In the subsequent 10-12 months, isoniazid, rifampicin, and ethambutol were given. The patients with multidrug resistant tuberculosis were administered protionamide, ofloxacin, amikacin, supplemented by pyrazinamide and ethambutol. The combined chemotherapy could stop bacterial isolation in more than 80% of patients, make the process stable, and prepare them for planned surgical treatment. When complications occurred and the disease was in steady progress, salvage operations were made, which was the only possible way of preventing the progression of disease at times and of saving life in the patient.     

Characterization of hydroxyl radical formation by microsomal enzymes using a water-soluble trap, terephthalate

Using terephthalic acid as a water-soluble trap, we characterized hydroxyl radicals (HO?) formation by liver microsomal enzymes from isoniazid-treated rats. We found that HO? formation was entirely dependent on intact microsomal enzymes, the presence of NADPH, and iron complexed with EDTA. In contrast to the other radical traps, we found no evidence that terephthalate is a substrate for cytochrome P450. Cumene hydroperoxide, an artificial supporter of cytochrome P450-catalyzed oxidation, failed to maintain HO(.-) formation. HO(.-) formation in liver microsomes was inhibited by the HO(.-) radical scavengers: dimethyl sulfoxide (DMSO), mannitol, and citrulline. It was abolished by catalase, but not superoxide dismutase (SOD), indicating that hydrogen peroxide was the sole precursor of the HO(.-). Therefore, the generation of hydroxyl radicals by microsomal enzymes appears to be dependent on two processes: (1) the rate of hydrogen peroxide production; and (2) the availability of iron ions or other transition metals for Fenton type reactions.     

Accessory Splenectomy with Gastroesophageal Devascularization for Recurrent Hypersplenism and Refractory Bleeding Varices in a Patient with Liver Cirrhosis: Report of a Case

We report a case of recurrent thrombocytopenia associated with symptomatic enlargement of an accessory spleen, 2 years after splenectomy, in a 36-year-old man with posthepatitic liver cirrhosis. The patient suffered three episodes of variceal bleeding, but the esophageal varices were not eradicated by two sessions of endoscopic injection sclerotherapy and endoscopic band ligation. Abdominal ultrasonography and computed tomography showed a giant accessory spleen (6 × 6 × 5cm), gallbladder stones, and complete postsplenectomy splenomesoportal thrombosis. Subsequent ^99mTc scintigraphy confirmed the presence of a functioning residual splenic nodule. Thus, we performed gastroesophageal devascularization (Hassab-Paquet procedure) with accessory splenectomy and cholecystectomy, after which the platelet count normalized and no further variceal bleeding occurred during 17 months of follow-up. To our knowledge, this is the first report in the English medical literature of accessory splenectomy for recurrent thrombocytopenia in a patient with liver cirrhosis.     

Comparative clinical,X-ray,and immunogenetic characteristics of respiratory tuberculosis actively detected in risk groups and in individuals turning for medical help

Clinical, X-ray, and immunogenetic parameters were comparatively assessed in two groups of first identified patients diagnosed at annual fluorographic studies in groups at risk for tuberculosis and in individuals visiting general health care facilities for symptoms of inflammatory bronchopulmonary disease. Great differences were established in the clinical and X-ray manifestations, the course of the disease, and the patients' immunogenetic status in these groups. Tuberculosis in the patients identified on their referral to general health care facilities is characterized by more severe clinical manifestations, a greater spread of inflammatory and destructive changes in the lung, and massive bacterial isolation. There were certain associations of the HLA antigens A2 and A 11 as markers indicative of tuberculosis resistance with the antigens B35 and Cw4 suggestive of predisposition to tuberculosis in patients with chronic bronchitis.     

Antigenic and genetic properties of Seoul virus strains--a causative agent of hemorrhagic fever with renal syndrome

Data on the circulation of a new genetic variant of Seol virus, which was designated as "Vladivostok" (the name of the place where it was isolated)--VDV, were obtained, by using the antigenic and genetic analysis of hantavirus strains isolated from patients with hemorrhagic fever with renal syndrome (HFRS) and from brown rats, and described in the present paper. A complete identity of nucleotide sequences of the M-segment fragment of isolates obtained from HFRS patients and of those obtained from rats was demonstrated, which confirms the key role of brown rat as a source of infection.     

Dose-dependent localization of TCDD in isolated centrilobular and periportal hepatocytes

Dose-response relationships for 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) suggest a differential sensitivity of liver cell types to the induction of cytochrome P450 gene expression, and that the induction of hepatic protein CYP1A2 causes sequestration of TCDD. In addition, immunolocalization of hepatic CYP1A1/1B1/1A2 proteins is not uniform after exposure to TCDD. The mechanism for the regio-specific induction of hepatic P450s by TCDD is unknown, but may involve the differential distribution of participants in the AhR-mediated pathway and/or regional P450 isozymes, as well as, non-uniform distribution/sequestration of TCDD. Therefore, this study examined the effects of TCDD in unfractionated, centrilobular and periportal hepatocytes isolated from female Sprague-Dawley rats acutely exposed (3 days) to a single oral dose of 0.01-10.0 microg [3H]TCDD/kg. A dose- dependent increase in concentration of TCDD was accompanied by a dose- dependent increase in CYP1A1, CYP1A2, and CYP1B1 mRNA expression and associated enzymes in all liver-cell populations. Centrilobular hepatocytes showed a 2.7- to 4.5-fold higher concentration of TCDD as compared to the periportal hepatocytes at doses up to 0.3 microg TCDD/kg. Centrilobular hepatocytes also exhibited an elevated MROD activity as compared to the periportal hepatocytes at doses up to 0.3 microg TCDD/kg. Furthermore, centrilobular hepatocytes showed an elevated concentration of induced CYP1A2 and CYP1B1 mRNA as compared to periportal hepatocytes within the 0.01- and 0.3-microg TCDD/kg- treatment groups. This is the first study to demonstrate that a dose- dependent difference in distribution of TCDD exists between centrilobular and periportal cells that might be related to regional differences in P450 induction.