Benzylpenicillin preparations can evoke a systemic anaphylactic reaction in guinea pigs

All of the five commercially available benzylpenicillin preparations obtained from different sources and a PcG preparation prepared by filtration of a commercial PcG on Sephadex G10 elicited the systemic anaphylactic reactions in guinea pigs which had been immunized with benzylpenicilloyl (BPO)-Ascaris extract conjugate (BPO-As) mixed with aluminum hydroxide gel. These preparations could evoke no such reactions in guinea pigs immunized with BPO-bovine gamma globulin conjugate (BPO-BGG) emulsified with complete Freund's adjuvant. The severity of the systemic anaphylactic reactions correlated significantly with the titers of either 8-day passive cutaneous anaphylactic (8-day PCA) reactions or 4-hr PCA reactions evoked with the same benzylpenicillin preparations. In vitro benzylpenicillin preparation contracted the tracheas of the guinea pigs immunized with BPO-As. These results indicated that the commercially available benzylpenicillin preparations have enough antigenicity to evoke systemic anaphylactic reactions in guinea pigs immunized with BPO-As mixed with aluminum hydroxide gel. Such guinea pigs represent an animal model for investigation of penicillin allergy.     

亚稀褶红菇对大鼠致死毒性分级研究

目的 为了解亚稀褶红菇对大鼠的半数致死量（LD50）,进行毒性分级。方法 采用急性毒性试验经典方法寇氏法,设亚稀褶红菇175、248、350、495、700 mg/kgBW共 5个剂量组和阴性对照组(等体积生理盐水),每组大鼠12只,雌雄各半,腹腔注射,连续观察14 d大鼠的毒性反应和死亡情况。并对试验大鼠进行病理组织学检查。结果 根据试验结果,经计算,亚稀褶红菇对SD大鼠腹腔注射LD50为406 mg/kgBW,95%可信限为348～473 mg/kgBW。病理学检查显示大鼠心脏、肝脏、肾脏均有损害,随剂量增加损害程度加重。结论 按照大鼠急性毒性（LD50）剂量分级亚稀褶红菇为中等毒性,相当于人的致死量为5 g/人。     

Identification of a Novel Titin Variant Underlying Myocardial Involvement in Neurofibromatosis Type 1

Because of the rare co-occurrence, it remains a question whether cardiomyopathy is a true association of neurofibromatosis type 1. A boy with café-au-lait spots manifested restrictive cardiomyopathy. Whole exome sequencing confirmed the genetic diagnosis of neurofibromatosis and further identified a novel titin (TTN) missense variant. The significance of the variant is supported by its de novo origin, in silico predictions, and evolutionary conservation. Modern genetics raises an intriguing explanation for the unexpected phenotype and adds to the evolving role of TTN variants in cardiomyopathy.     

Appropriate treatment planning method for field joint dose in total body irradiation using helical tomotherapy

Total body irradiation (TBI) using helical tomotherapy (HT) has advantages over the standard linear accelerator-based approach to the conditioning regimen for hematopoietic cell transplantation. However, the radiation field has to be divided into two independent irradiation plans to deliver a homogeneous dose to the whole body. A clinical target volume near the skin increases the skin surface dose; therefore, high- or low-dose regions arise depending on the set-up position accuracy because the two radiation fields are somewhat overlapped or separated. We aimed to determine an adequate treatment planning method robust to the set-up accuracy for the field joint dose distribution using HT-TBI. We calculated treatment plans reducing target volumes at the interface between the upper and lower body irradiations and evaluated these joint dose distributions via simulation and experimental studies. Target volumes used for the optimization calculation were reduced by 0, 0.5, 1.0, 2.0, 2.5, and 3.0 cm from the boundary surface on the upper and lower sides. Combined dose distributions with set-up error simulated by modifying coordinate positions were investigated to find the optimal planning method. In the ideal set-up position, the target volume without a gap area caused field junctional doses of up to approximately 200%; therefore, target volumes reduced by 2.0–3.0 cm could suppress the maximum dose to within 150%. However, with set-up error, high-dose areas exceeding 150% and low-dose areas below 100% were found with 2.0 and 3.0 cm target volume reduction. Using the dynamic jaw (DJ) system, dose deviations caused by set-up error reached approximately 20%, which is not suitable for HT-TBI. Moreover, these dose distributions can be easily adjusted when combined with the intensity modulation technique for field boundary regions. The results of a simulation and experimental study using a film dosimetry were almost identical, which indicated that reducing the target volume at the field boundary surface by 2.5 cm produces the most appropriate target definition.     

Bacterial peritonitis in a patient with malignant ascites caused by pancreatic carcinoma: Case report and review of literature

Bacterial peritonitis, an infection of the ascitic fluid, can be classified etiologically as spontaneous or secondary bacterial peritonitis. The former is mainly caused by portal hypertension and its subsequent effects, whereas the latter is caused by the direct dissemination of bacteria into the peritoneal cavity. Previous reports have described some distinguishing features of these two entities. Here, we report the first known case of bacterial peritonitis with Aeromonas hydrophilia and Escherichia coli in a patient with malignant ascites associated with pancreatic carcinoma who exhibited features of both spontaneous and secondary peritonitis. Our report suggests that clinicians should also consider bacterial peritonitis in patients with malignant ascites who present with ostensibly cancer-related symptoms.     

Craniofacial penetration by a wooden stick

IntroductionPenetrating craniofacial injuries caused by stick-like foreign bodies occur as a result of accidents particularly in children, and often lead to significant morbidity.Case summaryWe describe a 5-year-old boy who sustained facial trauma after falling on a wooden stick which penetrated his left cheek. At the initial visit, his vital and neurological signs were normal. However, the stick had penetrated the frontal lobe to a depth of 3 cm via the orbital cavity and the anterior skull base. The stick was successfully removed while visualizing the anterior skull base in an endoscopic transethmoidal approach. A follow-up examination one year after the accident demonstrated normal visual acuity and ocular motility, with no diplopia, tearing or pain.DiscussionPenetrating facial injuries caused by stick-like objects carry a significantly higher risk of serious neurological involvement. Even if penetrating facial injuries sometimes appear trivial, the external injury site is often insufficient to determine the position of the object within the head. Although the cheek is a rare entry site for intracranial injuries, the extent of damage should be assessed fully before attempting removal.     

Regular and irregular astigmatism after superior versus temporal scleral incision cataract surgery

OBJECTIVE: To evaluate the effect of superior and temporal scleral incisions on regular and irregular astigmatism in small incision cataract surgery. DESIGN: Prospective, randomized, comparative clinical trial. PARTICIPANTS: One hundred seventy-four eyes of 87 patients with bilateral cataracts scheduled to undergo routine cataract surgery. METHODS: One eye of each patient was randomly assigned to the superior incision group, and the contralateral eye was allocated to the temporal incision group. Phacoemulsification and intraocular lens implantation were performed through an unsutured 4.1-mm scleral incision. Patients were examined 1 day and 1, 3, and 6 months after surgery. MAIN OUTCOME MEASURES: Surgically-induced regular astigmatism calculated with vector analysis method, irregular astigmatism obtained by Fourier analysis of videokeratography data, and uncorrected and corrected visual acuity. RESULTS: Postoperatively, the superior incision group showed slight against-the-rule astigmatic changes, whereas slight with-the-rule astigmatism was seen in the temporal incision group. The amount of against-the-wound astigmatism and absolute value of length of the induced vector did not differ significantly between groups (P > 0.05, paired t test). In both groups, irregular astigmatism 1 day after surgery was significantly greater than the preoperative levels (P < 0.001), but not thereafter. No significant intergroup difference was observed in the amount of irregular astigmatism at any postoperative visits (P > 0.05). There was no significant difference in uncorrected and corrected visual acuity between groups postoperatively (P > 0.05, chi-square test). CONCLUSIONS: In small scleral incision cataract surgery, superior and temporal approaches are comparable in terms of visual rehabilitation and induction of regular and irregular astigmatism.     

Mechanical detachment of the anterior hyaloid membrane from the posterior lens capsule1

Objective

To investigate the incidence of spontaneous detachment of the anterior hyaloid membrane from the posterior lens capsule and to explore the possibility of surgical separation of the anterior hyaloid membrane.

Prostaglandin F2 alpha metabolite levels in plasma, amniotic fluid, and urine during pregnancy and labor.

Levels of 13, 14-dihydro 15-keto-prostaglandin F2alpha (dhk PGF2alpha) in the plasma of 30 patients as well as in the amniotic fluid of 17 patients, and 5alpha,7alpha-dihydroxy 11-keto tetranor-prostane 1,16-dioic acid (the main urinary metabolite of PGF2alpha [PGF2alpha MUM]) levels in the urine of 30 patients were measured by radioimmunoassay during pregnancy, labor, and the puerperium. During pregnancy, no increase in dhk PGF2alpha (ng/ml) in plasma was detected as the time of delivery approached. The levels of dhk PGF2alpha during the second stage (0.64 +/- 0.15) and also at delivery (0.88 +/- 0.27) were significantly elevated over those in the first stage (0.38 +/- 0.29) (P less than 0.025 and P less than 0.005, respectively). Its level 2 hours after delivery was reduced to predelivery levels. Its levels in umbilical arterial and venous blood were 0.71 +/- 0.26 and 0.67 +/- 0.26, respectively. A significant elevation (P less than 0.01) of dhk PGF2alpha from 0.89 +/- 0.21 before labor to 6.16 +/- 2.40 at delivery was found in amniotic fluid. The hourly excretion of PGF2alpha MUM (microgram/hour) increased significantly from pregnancy levels to 1.06 +/- 0.45 in the first stage (P less than 0.01), to 7.67 +/- 4.31 (P less than 0.005) for the first 2 hours after delivery, and 2.37 +/- 1.08 from 2 to 12 hours after delivery (P less than 0.01). The excretion of PGF2alpha MUM decreased to pregnancy levels 12 hours post partum. These data indicate that during labor the production of PGF2alpha is remarkably increased.     

beta-Galactosidase in mucopolysaccharidoses and mucolipidoses. Deficiency of GM1 beta-galactosidase in liver and leukocytes.

beta-Galactosidase activities were studied in livers and leukocytes of mucopolysaccharidoses and mucolipidoses (I-cell disease and adult "beta-galactosidase deficiency" with macular cherry-red spots). Marked deficiency of hepatic 4-methylumbelliferyl (4MU) and GM1 beta-galactosidases was demonstrated in these diseases. Leukocyte GM1 beta-galactosidase was also deficient in mucolipidoses. The parents of the patients with I-cell disease and "beta-galactosidase deficiency" had normal beta-galactosidase activity in plasma and leukocytes, compared to the low enzyme activity in heterozygous carriers of GM1-gangliosidosis. The cause of this enzyme deficiency in these diseases is not clear at present. It seems to be affected seondarily by exgenous factors such as unknown stored materials in the cells. Mucopolysaccharides were not increased in the livers of two cases of I-cell disease and a case of "beta-galactosidase deficiency".