Vancomycin-induced thrombocytopenia

Vancomycin-induced thrombocytopenia has only been reported once previously in the medical literature. We describe a patient in whom sudden severe reversible thrombocytopenia developed on two separate occasions after exposure to vancomycin hydrochloride. A 54-year-old man was admitted to the hospital for bilateral swelling and erythema of his extremities. At the time of admission he received 2 days of vancomycin therapy without incident. On day 14 he was reexposed to vancomycin and thrombocytopenia developed, with a nadir value of 17 x 10(9)/L. On day 30, a single dose of vancomycin was administered, and thrombocytopenia once again developed, with a nadir value of 11 x 10(9)/L. Hematologic cytopenias are infrequent adverse effects of vancomycin therapy. It is postulated that these effects may be due to an immunologically mediated mechanism. With the increasing use of vancomycin due to the emergence of methicillin-resistant Staphylococcus aureus, this case should alert clinicians to this rare but potentially lethal manifestation of vancomycin.     

Chemotactic responsiveness and random motility of polymorphonuclear leukocytes from patients with progressive systemic sclerosis

Polymorphonuclear leukocyte (PMNL) random motility and chemotactic responsiveness and serum chemoattractant ability in 20 patients with progressive systemic sclerosis (PSS) were compared to those from 21 normal controls using a microchemotactic assembly. PSS leukocyte random motility was found to be significantly increased (p less than 0.02) compared to that in the control group. However, there were no statistically significant differences between the chemotactic migration of control and patient cells in response to C5a or zymosan activated control or patient sera. The chemotactic responsiveness of normal PMNL and the chemotactic activity of zymosan activated normal serum or C5a were not affected when treated with 10% PSS plasma. This suggests the absence of inactivators of chemotactic factors and circulating cell directed inhibitors of chemotaxis in the sera of patients with PSS.     

Anticomplementary activity of cornea, vitreous and chorioretina in rabbits.

We wished to determine if inhibitors of the complement system are present in different rabbit ocular tissues. Soluble extracts of cornea, vitreous humor and chorioretina in different dilutions were incubated with normal human serum (as source of complement). The ability of the latter to lyse sheep erythrocytes sensitized with antisheep rabbit hemolysin was assessed. The cornea did not show any inhibition of complement. The vitreous humor exhibited very low inhibitory activity. The extracts of the uveo-retinal tissue contained heat-labile and heat-stable factors capable of cleaving C3 and factor B.     

Stability of Immune Serum Globulin During Storage: Effects of Modifications in the Fractionation Scheme

Summary. Data are presented which show the extent of fragmentation found in Immune Serum Globulin (ISG) stored for various intervals of time at 2°C. As an assay of fragmentation in ISG preparations, gel filtration analysis was found to give results which correlated well with those obtained by ultracentrifugation.
The pH at which the fraction III is separated in the cold ethanol fractionation process, Method 9, has been shown to be important in determining the stability of the fraction II separated subsequently. When fraction III was precipitated at pH 5.4 instead of pH 5.15-5.2 the fraction II separated subsequently under the usual conditions yielded ISG solutions which were stable at 2°C. The antibody in this preparation appeared to be normal in quality but reduced in quantity by about 15%. Removal of the fraction III at pH values below pH 5.2 allowed the separation of fraction II which yielded ISG solutions which readily underwent fragmentation during storage.     

Biosynthesis of complement Factor P (properdin) by the human Pre-monocyte cell line (U-937)

The human monocyte-like cell line, U-937, is known to differentiate into macrophage-like cells following stimulation with phorbol myristate acetate (PMA) or interferon-γ (IFN-γ). The activated cells have been reported to have enhanced capacity to synthesize C2, C3, Factors B and H. Here, U-937 cells were used as a model system to investigate the effects of immunomodulatory agents on the biosynthesis of Factor P by monocytoid cells. Non-stimulated U-937 cells progressively secreted increasing amounts of Factor P over a 72-hr culture period. The secreted Factor P was hemolytically active. The daily production of Factor P was nearly linear (approx. 2.1 ± 0.2 ng/10⁶ cells; mean ± SEM). Factor P synthesis was reversibly inhibited by cycloheximide indicating de novo synthesis. Both secreted Factor P and Factor P in normal plasma contained Factor P of heterogeneous molecular sizes and eluted from Sephacryl S-300 gel filtration column as a broad peak (mol. wt 250–800 kDa). The synthesis of Factor P by U-937 cells was augmented 1.8-, 2.1- and 2.5-fold respectively following induction with PMA (30 ng/ml), IFN-γ (100 U/ml) and LPS (0.1 μg/ml).

Metabolic labeling of U-937 cells and autoradiograms of SDS-PAGE analysis of Factor P immunoprecipitates demonstrated a 54 kDa band in the culture supernate, co-migrating with purified ¹²⁵I Factor P. Intracellular Factor P however had an apparent mol. wt that was 4000 kDa smaller than secreted Factor P. Thus U-937 cells synthesize a precursor Factor P subunit polypeptide chain which undergoes post-synthetic glycosylation and polymerization to give rise to the oligomers characteristic of native Factor P in fresh plasma. Our data also demonstrate that Factor P synthesis by monocytic cells can be enhanced by immunomodulatory factors or mediators that are generally found at sites of inflammation and immune response.     

Rare localization of extrarenal nephroblastoma in 1-month-old female infant

Extrarenal occurrence of Wilms' tumor is exceptional and the diagnosis is almost always made after surgery. The exact mechanism whereby a Wilms' tumor occurs in extrarenal tissue is unknown. The tumor is most commonly located in the retroperitoneum or inguinal region. Localization in subcutaneous tissue is extremely rare. In this paper, the case of a 1-month-old female infant with an extrarenal Wilms' tumor located in the lumbosacral region is presented. Surgical excision is the treatment of choice, and the same general therapeutic rules should be followed as when the kidney is affected.     

Morbidité et mortalité du tétanos dans le service de maladies infectieuses du CHU du Point G à Bamako, Mali (2004–2009)

Our study objectives were to determine annual cases of the tetanus and to describe its clinical, evolutionary and prognostic aspects. It was a transverse study from data records and medical records of patients aged 15 years and above hospitalized for tetanus in the service of infectious diseases of the Point G CHU from January 1, 2004 to December 31, 2009. The tetanus was diagnosed based on clinical (trismus, dysphagia, seizures and point consecutive to an injury) and epidemiological arguments (absence of a correct tetanus immunization, entry way). We collected a total of 119 cases of tetanus out of 1,839 hospitalizations making a prevalence of 6.5%. The hospitalization period was 5 days (73%) for most of the patients. Unskilled laborer and farmers were the most frequent with respectively 30.2 and 21.8% of cases. Tetanus occurred in the course of a traumatic road accident (16%) and from other traumatic causes (48.7%). The clinical form was a generalized type for 94.4% of the cases. A wound was the entry way for 64.7% of the patients. The entry way was located on the lower members 49.6% of the time. The co-morbidity was recorded with infection by Plasmodium falciparum (15 cases, 12.6%) and HIV (1 case). Hospital lethality was 46.2%. The death was statistically linked to clinical severity according to the Dakar score (P = 0.0005) and the Mollaret stage (P = 0.0001). A need for strengthening communication for behaviour change for the gaining of a correct and sustained immunization exists. A strategy based on the capacity building for a rapid tetanus diagnosis and a combined co-morbidities care may reduce the lethality in the context of our limited technical environment.     

Detection of Helicobacter pylori: A faster urease test can save resources

AIM: To investigate whether differences in the rapidity of a positive result for Helicobacter pylori can save res ources, by comparing two commercially available urease kits. METHODS: One hundred and eighty-five adults (130 outpatients, 55 inpatients) undergoing gastroscopy were entered prospectively. Patients were divided into two groups: Group 1 (if they were not on PPIs, antibiotics, H2A, bismuth or sucralfate for up to 14 d prior to the endoscopy) and Group 2 (if they were on, or had been on, any of the...     

Polyphenol-rich strawberry pomace reduces serum and liver lipids and alters gastrointestinal metabolite formation in fructose-fed rats

This study compared the effects of supplementation with a polyphenol-rich pomace from strawberry (US) and a strawberry pomace without most of these compounds (PS) on gastrointestinal, blood, and tissue biomarkers in rats fed diets differing in carbohydrate contents for 4 wk. The diets were: corn starch (group CS), high fructose (60% by weight; group F), starch with 7.7% of either US or PS (groups CS+US and CS+PS, respectively), and high fructose with 7.7% of either US or PS (groups F+US and F+PS, respectively). An interaction (P < 0.05) was observed between diet type and strawberry preparation, showing that upon fructose feeding, US had a greater effect than PS on lowering serum insulin, liver total cholesterol, and conjugated dienes. Additionally, the F+US group had lower serum FFA than the F+PS group (P < 0.05). The extraction of polyphenols diminished the physiological effect associated with strawberry intake, suggesting that the fiber component of the pomace was also active in reducing metabolic complications following fructose feeding to rats.