Acute Cellular Rejection Predominated by Monocytes Is a Severe Form of Rejection in Human Renal Recipients With or Without Campath-1H (Alemtuzumab) Induction Therapy

Campath-1H has been used successfully for induction and has resulted in a low rate of acute cellular rejection (ACR) in renal transplantation in combination with various postoperative immunosuppression regimens. This study was undertaken to investigate the extent of monocyte involvement in ACR, with or without Campath-1H induction. We found that monocytes represented the majority of inflammatory cells in grades Ib or higher ACR, but not with Ia type of ACR, regardless of the status of Campath-1H induction. Cases of ACR, following Campath-1H induction, appear to demonstrate a 'pure form' of monocytic ACR, whereas monocytes were mixed with many other types of inflammatory cells in the cases of ACR in the absence of Campath-1H induction. In addition with Campath-1H induction, the cases of monocyte-predominant ACR were found to uniformly exhibit a good response to corticosteroid treatment. We conclude that monocyte-predominate ACR may represent a severe form of rejection, with or without Campath-1H treatment.     

Recombinant activated factor VII for intractable bleeding post splenectomy in a patient with myeloproliferative disorder.

Recombinant activated factor VII has been Food and Drug Administration approved to treat hemorrhages in hemophiliac patients with inhibitors and in acquired hemophilia patients. Recombinant activated factor VII use has also been considered for the management of uncontrolled bleeding in a number of congenital and acquired hemostatic abnormalities. The myeloproliferative disorders are a group of clonal hematologic diseases where, frequently, abnormal platelet function is considered a hallmark. This is the first case report addressing the clinical benefit of off-label use of recombinant activated factor VII in an attempt to control intractable bleeding in a patient with a myeloproliferative disorder after splenectomy.     

Comparison of the fertilizing capability of spermatozoa from ejaculates, epididymal aspirates and testicular biopsies using intracytoplasmic sperm injection

A prospective study was carried out to compare the fertilizing capability and pregnancy outcome following intracytoplasmic sperm injection (ICSI) using spermatozoa obtained from ejaculates, or surgically from epididymis or seminiferous tubules. A total of 77 ICSI cycles (one per patient) was included. In all, 28 patients had severe oligoasthenoteratozoospermia, 19 patients had obstructive azoospermia and 30 patients had non-obstructive azoospermia. The main outcome measures were fertilization rate per injected metaphase II oocyte and the clinical pregnancy rate per embryo transferred back to the female recipients. In patients with severe oligoasthenoteratozoospermia, the fertilization and pregnancy rates were 79 and 25 %. In patients with obstructive azoospermia, for whom epididymal spermatozoa were used, these were 75 and 28%, and in the non-obstructive group for which testicular spermatozoa were used for injection, they were 69 and 21% respectively. These rates were not significantly different in the three groups (P = 0.85 and P = 0.14 respectively), suggesting that spermatozoa from the ejaculates and epididymal or testicular biopsies are able to fertilize equally by using ICSI. Live birth per embryo transfer was significantly reduced in patients with non-obstructive azoospermia compared to the other two groups. The high abortion rate (50%) in the group in which testicular spermatozoa were used raises doubts about the developmental competence of such embryos.      

A comparison of the effects of bilateral sections of the chorda tympani nerve and extirpation of the submaxillary and sublingual salivary glands on the eating and drinking patterns of the rat

The chorda tympani nerve (CT) innervates the fungiform papillae on the tip of the tongue and has been considered an important nerve for the sense of taste. The CT also contains the parasympathetic supply to the submaxillary and sublingual salivary glands. Therefore, changes in taste or feeding behavior following bilateral sections of CT are caused by both degeneration of fungiform papillae and the inevitable partial desalivation of the rat. In the present experiments we compared the effects of bilateral chorda tympani nerve sections with extirpation of submaxillary and sublingual glands on daily home cage eating and drinking patterns in the rat. Before and after surgery we analyzed the daily eating and drinking patterns, including such measures as intake, bout number, bout length, interbout interval and rate of consumption during bouts. The results of desalivation and bilateral CT sections were indistinguishable. The most profound change was that eating bout duration was increased following surgery. Since food intake did not increase, the results indicate a marked loss in eating efficiency over the daily ingestion periods. Although the eating patterns of desalivated and chorda tympani sectioned rats are quite similar, the evidence is not compelling that they have the same physiological basis. A second experiment was designed to test the hypothesis that the atypical eating patterns observed following bilateral sectioning of CT were the direct result of partial desalivation resulting from the denervation of the salivary glands. In this experiment a unilateral section was made of one CT and it was shown that the eating behavior was not affected. Then the contralateral submaxillary and sublingual salivary glands were removed. This resulted in a six-fold increase in feeding bout length. In all cases a unilateral CT section combined with extirpation of the contralateral salivary glands resulted in rats whose eating behavior was indistinguishable from the earlier data following either the bilateral CT sections or bilateral desalivations. The conclusion is drawn that the eating irregularities noted following bilateral CT sections result from this partial desalivation. CT sections were verified by taste bud counts in the fungiform papillae and histological examinations were made of salivary glands in rats receiving CT sections.     

A sticky situation: myocardial infarction in a young woman with immune thrombocytopenia on eltrombopag and a history of mediastinal radiation

Journal of Thrombosis and Thrombolysis - More recent immune thrombocytopenia (ITP) treatment strategies enhance platelet production with the use of thrombopoietin receptor agonists (TPO-RA) such as...