Emergency department analgesia without narcotics for adults with acute sickle cell pain crisis: Case reports and review of crisis management

Vaso-occlusive crises are one of the most debilitating features of sickle cell disease. There appears to be no standardization of care for adults with pain crisis, and some commonly utilized regimens, such as those employing intramuscular meperidine, are pharmacologically unsound. Parenteral narcotic use may be associated with respiratory compromise acutely and with dependence over the long term, but nonopioid preparations are often unsatisfactory in relieving pain. We have recently enjoyed success with a combination of a parenteral nonsteroidal anti-inflammatory medication and an oral tricyclic antidepressant. We report four representative cases and review the salient points of the management of pain crisis in adult patients in the emergency department.     

Estimating the risk of rabies transmission to humans in the U.S.: a delphi analysis

Background  

In the United States, the risk of rabies transmission to humans in most situations of possible exposure is unknown. Controlled studies on rabies are clearly not possible. Thus, the limited data on risk has led to the frequent administration of rabies post-exposure prophylaxis (PEP), often in inappropriate circumstances.     

Early changes of the portal tract on microcomputed tomography images in a newly‐developed rat model for Budd–Chiari syndrome

Background and Aim: The effect of increased sinusoidal pressure on the portal tract in Budd–Chiari syndrome (BCS) is as yet not elucidated. Our aim was to investigate portal changes in a newly‐developed rat model for BCS. Methods: We created an outflow obstruction in Sprague–Dawley rats (n = 6) by diameter reduction of the inferior vena cava. Left and right liver lobes with portal vein contrast were scanned using microcomputed tomography, and volumes of the portal tree and liver parenchyma were computed by the ANALYZE software program. Results: Portal branching density was significantly lower in BCS than the shams, and decreased over time (P < 0.01). There was a significant drop in volume of both parenchyma and the portal tree in the left but not right lobes. At 6 weeks post‐surgery, the perfusion index (i.e. ratio between both volumes) became equal to (left) or even higher than (right) the shams, suggesting a new equilibrium with preserved portal perfusion. Histological findings were consistent with those observed in humans. Conclusion: As early as day 2, a significant loss of peripheral portal branches was seen, which progressed over time. Inter‐lobar differences in vascular abnormalities suggest compensatory mechanisms. Despite a decrease in both liver and portal vein volume, relative portal perfusion appeared spared.     

Ecology of Pseudoterranova decipiens (Krabbe, 1878) (Nematoda: Anisakidae) from Antarctic waters

The present study provides further data on the occurrence of Pseudoterranova decipiens in fish from two different sampling sites in the Antarctic. A total of 690 fish belonging to 33 species from the eastern Weddell Sea and 322 fish belonging to 12 species from the South Shetland Islands were examined. Altogether, 23 fish species were found to be infested and 11 new host records could be established. P. decipiens occurred at a water depth of between 80 and 820 m. Chaenocephalus aceratus and Notothenia coriiceps from the South Shetland Islands were the species with the highest prevalence (95%) and intensity (2–194 and 1–121, respectively) of infestation. Both are transport hosts, which mainly feed on benthic nototheniid fish species and accumulate the nematodes. Bathypelagic, pelagic, or mainly euphausid feeding fish species were only lightly infested, if at all. This demonstrates the benthic life cycle of P. decipiens in the Antarctic. The preferred site of infestation was the body cavity and the liver; no specimen could be isolated from the fish musculature. This might be explained by the low water temperatures. The infestation of fish from the Weddell Sea was distinctly lower than that of fish around the South Shetland Islands. Besides possible differences in final host populations at the two localities studied, the loss of eggs and larvae under the eastern Weddell Sea shelf ice and over the continental slope and differences in the availability of the first intermediate and macroinvertebrate hosts led to a lower level of infestation. Another role, although nondecisive, may be played by the reduced time of development and infectivity of eggs and larvae, respectively, in the extremely cold waters of the Weddell Sea. P. decipiens is not a rare but, rather a well-established parasite of the Antarctic fauna, which demonstrates the ability of this cosmopolitan species to complete its life cycle even under conditions of subzero temperatures. Received: 8 March 1999 / Accepted: 29 March 1999     

Polyclonal long-term MFGS-gp91phox marking in rhesus macaques after nonmyeloablative transplantation with transduced autologous peripheral blood progenitor cells.

We have recently reported that the RD114-pseudotyped MFGS-gp91phox vector achieves unprecedented levels of correction of the NADPH-oxidase gp91phox (approved gene symbol CYBB) defect in CD34(+) cells from patients with X-linked chronic granulomatous disease in the NOD/SCID mouse model. Considering clinical use of this vector, we transplanted autologous mobilized peripheral blood CD34(+) progenitor cells, transduced with the RD114-MFGS-gp91phox vector, into two healthy rhesus macaques following nonmyeloablative conditioning. The moderately high levels of in vivo marking seen in the first months following transduction decreased and stabilized at about 8 months posttransplant. Marking for both healthy animals after 15 months was 0.3 to 1.3 vector copies per 100 cells in lymphocytes, neutrophils, and monocytes. Vector insertion analyses performed by linear amplification-mediated PCR and sequencing identified 32 and 45 separate insertion sites in the animals. Identical insertion sites were found in myeloid cells and lymphocytes, demonstrating the successful transduction of lymphomyeloid progenitors. Some inserts landed in the vicinity of genes controlling cell cycle and proliferation. Statistical analyses of insertion sites 1 year posttransplant suggest a high diversity of insertion sites despite low marking.