Unusual findings in two patients with acquired deletions of the long arm of chromosome 5 (5q-)

Two patients with acquired deletions of the long arm of chromosome 5 (5q-) are presented and discussed. For both, clinical and other laboratory tests are highly atypical of patients with haematological malignancy characterized by 5q-. These unusual presentations of the 5q- anomaly further emphasize the heterogeneity of clinical presentations associated with this acquired chromosomal abnormality.

Biosorption of Cr(VI) by three different bacterial species supported on granular activated carbon: a comparative study

The ability of three different bacterial species supported on granular activated carbon (GAC) to remove hexavalent chromium from low concentration liquid solutions was investigated, in batch and column studies. The microorganisms tested were Cr(VI) reducing types: Streptococcus equisimilis (CECT 926), Bacillus coagulans (CECT 12) and Escherichia coli (CECT 515). The results showed metal uptake values of 5.82, 5.35 and 4.12 mg/g(bios.), respectively, for S. equisimilis, B. coagulans and E. coli, for an initial metal concentration of 100 mg/l. In the same order and for the initial concentration of 50 mg/l, metal uptake values were 2.33, 1.98 and 3.60 mg/g(bios.). Finally, for the initial metal concentration of 10 mg/l, those values were, respectively, 0.66, 1.51 and 1.12 mg/g(bios.). Studies made with an industrial effluent, with the aim of testing these biofilms in a real situation, showed values of Cr uptake of 0.083, 0.090 and 0.110 mg/g(bios.), respectively, for S. equisimilis, B. coagulans and E. coli, for an initial concentration of 4.2 mg/l of total Cr. The quantification of polysaccharides, playing a key role in the whole process, was made and it was concluded that the production of polysaccharides is higher for B. coagulans followed by S. equisimilis and E. coli (9.19, 7.24 and 4.77 mg/g(bios.)). The batch studies data were described using the Freundlich, Langmuir, Redlich-Peterson, Dubinin-Radushkevich, Sips and Toth model isotherms. The best fit was obtained with Sips and Toth model isotherms, respectively, for the S. equisimilis and for the B. coagulans biofilms. For the E. coli biofilm the Freundlich, Redlich-Peterson, Sips and Toth models fitted very well to the experimental data. The Adams-Bohart, Wolborska and Yoon and Nelson models were applied to column studies data. Those models were found suitable for describing the dynamic behaviour of the columns with respect to the inlet chromium concentration. Obtained results showed that the biofilms tested are very promising for the removal of Cr(VI) in diluted industrial wastewater. Despite differences in the cell wall structure and composition, the three bacteria exhibit comparable sorption affinities towards chromium, in the open systems studies. The Gram-positive bacteria tested (B. coagulans and S. equisimilis) presented best metal removal percentages in batch studies.

Duration of intravenous antibiotic therapy in people with cystic fibrosis

BACKGROUND

Respiratory disease is the major cause of mortality and morbidity in cystic fibrosis (CF). Life expectancy of people with CF has increased dramatically in the last 40 years. One of the major reasons for this increase is the mounting use of antibiotics to treat chest exacerbations caused by bacterial infections. The optimal duration of intravenous antibiotic therapy is not clearly defined. Individuals usually receive intravenous antibiotics for 14 days, but treatment may range from 10 to 21 days. A shorter duration of antibiotic treatment risks inadequate clearance of infection which could lead to further lung damage. Prolonged courses of intravenous antibiotics are expensive and inconvenient and the incidence of allergic reactions to antibiotics also increases with prolonged courses. The use of aminoglycosides requires frequent monitoring to avoid some of their side effects. However, some organisms which infect people with CF are known to be multi-resistant to antibiotics, and may require a longer course of treatment.

OBJECTIVES

To assess the optimal duration of intravenous antibiotic therapy for treating chest exacerbations in people with cystic fibrosis.

SEARCH STRATEGY

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches, handsearches of relevant journals, abstract books and conference proceedings. Most recent search of the Group's Cystic Fibrosis Trials Register: February 2008.

SELECTION CRITERIA

Randomised and quasi-randomised controlled trials comparing different durations of intravenous antibiotic courses for acute respiratory exacerbations in people with CF, either with the same drugs at the same dosage, the same drugs at a different dosage or frequency or different antibiotics altogether, including studies with additional therapeutic agents.

DATA COLLECTION AND ANALYSIS

No eligible trials were identified.

MAIN RESULTS

No eligible trials were identified.

AUTHORS' CONCLUSIONS

There are no clear guidelines on the optimum duration of intravenous antibiotic treatment. Duration of treatment is currently based on unit policies and response to treatment. Shorter duration of treatment should improve quality of life and compliance; result in a reduced incidence of drug reactions; and be less costly. However, this may not be sufficient to clear a chest infection and may result in an early recurrence of an exacerbation. This systematic review identifies the need for a multicentre, randomised controlled trial comparing different durations of intravenous antibiotic treatment as it has important clinical and financial implications.

System and market failures: the unavailability of magnesium sulphate for the treatment of eclampsia and pre-eclampsia in Mozambique and Zimbabwe

Low cost and effective drugs, such as magnesium sulphate, need to be included in initiatives to improve access to essential medicines in Africa

Contamination of chicken carcasses in Gauteng, South Africa, by Salmonella, Listeria monocytogenes and Campylobacter

The presence of the foodborne pathogens, Salmonella spp., Listeria monocytogenes and Campylobacter spp., on 99 fresh and frozen chicken carcasses sourced from various retailers in Gauteng, South Africa, was investigated. Using culture methods, 60.6% of the carcasses were found to be contaminated with one or more pathogens, with 19.2%, 19.2% and 32.3% of the carcasses being found to harbour Salmonella, L. monocytogenes and Campylobacter, respectively. The extent of contamination with one or more pathogens was not significantly different (p>0.1) between fresh or frozen samples or between samples from butcheries, supermarkets or street vendors. Significantly more (p<0.1) fresh carcasses from butcheries than from other outlets were contaminated with Salmonella, while more fresh carcasses from supermarkets were contaminated with Campylobacter. The proportion of carcasses with L. monocytogenes from all sources were similar. Polymerase chain reaction (PCR) results indicate an even higher extent of pathogen contamination, but the PCR techniques need to be further refined before they can be used routinely.

Study of Heavy Metals in Wild Edible Mushrooms under Different Pollution Conditions by X-Ray Fluorescence Spectrometry

In this work we studied and compared the metal uptake in edible mushrooms (Lepiota procera, Boletus badius, Boletus edulis, Tricholoma equestry, Lactarius deliciosus, Cantarelus tubalformis and Cantarelus edulis), relative to sampling sites submitted to different pollution conditions: car traffic, soil pollution due to pesticides and fertilizers used in old vineyards, and incineration of hospital waste. Soil was also collected in some places, and its content was correlated to the corresponding one in some mushrooms species. All samples, without any chemical treatment, were analyzed by an X-ray fluorescence set-up. This technique is based on a monochromatic X-ray beam ionizing the atoms of the sample. Following this ionization, the emitted radiation is characteristic of the element, allowing its identification and quantification. Vineyards are normally submitted to very high amounts of sulfating, containing high copper concentrations. This metal is accumulated on the soil, and can be up-taken by vegetation. Very high levels of Fe and Cu were found in Lepiota procera species in old vineyards. Zinc was found to be always higher than Cu by factors ranging from 1.5 to 8 in clean wood taken as a reference for the whole analyzed species, while in old vineyards the ratio Zn/Cu reach 0.25 for Lepiota procera. This is correlated to the soil content for both elements. In addition, pollution induced by car traffic was checked in some samples, collected in the proximity of highways. Pb was the main contaminant in these areas, and presenting values 10 times higher than the corresponding ones in sites not submitted to pollution, for some species. Mushrooms contamination due to incineration of hospital waste was also studied, but we did not observe any contamination involving heavy metals in the several analyzed species around these areas. This is in agreement with what was expected, taking into account that hospital waste is mostly organic and, in principle, no heavy metals would be observed.

Pemphigus vulgaris with nail involvement presenting with vegetating and verrucous lesions

We report the case of a 68-year-old female with longstanding insulin-treated diabetes mellitus, observed for the first time in our department in August 1999 with multiple painful erosive lesions of the oral cavity and many bullous or erosive lesions on the abdominal wall, back, and thigh. She also had vegetating and verrucous lesions, similar to common warts, involving the hands and feet, mainly on the palms, palmar surface of the fingers, and nail folds. Her lesions were present for 1 year. Skin and mucous biopsies showed the characteristic histopathologic findings of pemphigus vulgaris, with an epidermal intercellular IgG deposition on direct immunofluorescence. Histology of a warty lesion of the finger also showed suprabasal acantholysis. After partial improvement with low doses of oral steroids and azathioprine, her disease progressed to involve the oral cavity, trunk, hands, feet, and scalp. Control of her disease required successive treatments of mycophenolate mofetil and cyclophosphamide, as well as corticosteroids. A partial response was obtained with all these treatments. After being controlled by cyclophosphamide that was slowly tapered, she is now well controlled with azathioprine and oral steroids, showing only discrete lesions of the oral mucosa after 1 year of followup. We report this case of pemphigus vulgaris with unusual clinical aspects, namely vegetating and verrucous lesions as well as nail involvement, rarely described in this disease.

Performance characteristics of the Sysmex XT-2000i hematology analyzer

The XT-2000i is a new hematology analyzer combining aperture impedance and optical technologies. It is capable of generating a 30-parameter hematologic assay on peripheral blood at a throughput of 80 samples per hour. We have evaluated the performance characteristics of the XT-2000i analyzer and compared them with those of the state-of-the-art XE-2100 analyzer and the manual differential count. The XT-2000i compared favorably with the XE-2100 analyzer and exceeded the manufacturer's specifications in all parameters tested. The XT-2000i has a user-friendly graphical user interface, and there was virtually no downtime during the period of evaluation. This analyzer can be recommended as a backup to the XE-2100 analyzer or as a stand-alone analyzer in a laboratory with moderate volume and a broad complexity of samples.

Temporal arteritis presenting with scalp ulceration

We report the case of a 75-year-old-woman who presented with bilateral scalp ulcerations and blindness, accompanied by severe headache and scalp tenderness, due to bilateral temporal arteritis without systemic involvement. A biopsy taken from the border of an ulceration showed evidence of giant cell arteritis. She was treated with oral prednisone, 60 mg per day. The ulcerations healed in a few weeks but the vision loss was irreversible. This case highlights for temporal arteritis the importance of accurate and timely diagnosis as well as the need for prompt therapy with systemic steroids in order to avoid major complications, namely loss of vision. It also demonstrates that scalp necrosis and ulcerations are skin signs associated with a poor prognosis.

A pilot study to assess physician knowledge in transfusion medicine

INTRODUCTION

An assessment of transfusion medicine knowledge and practice in Canada was carried out over a 3-week period.

METHODS

Fifty-five questions were posed to evaluate both basic information on blood and blood products and on clinical use. The form was distributed through the Canadian Society for Transfusion Medicine with designated individuals asked to handle regional distribution. Some used provincial mailing lists, others distributed within each hospital. Approximately, 2000 forms were sent, including 500 in French.

RESULTS

A total of 294 forms were returned; answers were recorded as 'correct', 'incorrect', 'no answer' or with 'added comments'. Overall, 52% of the questions were answered correctly or were answered with qualifying comments. In clinical practice questions, 63% were answered correctly or with qualifying comments. Basic knowledge questions drew correct answers in 37% of the cases. Several issues were answered poorly. The volume of an apheresis plasma unit was correctly estimated by less than 10% of respondents with many understanding the volume (500-600 mL) by as much as 300-400 mL. Anaesthesiologists responded most often (21%); few haematologists participated (4%). Provincial response varied: most were received from Ontario (30%) and British Columbia (22%).

CONCLUSIONS

The answers show that clinical application of transfusion is generally accompanied by a questioning process - it is not entirely by rote. Basic knowledge about products needs improvement.

An immunophenotypic and molecular study of primary large B-cell lymphoma of bone

Primary non-Hodgkin's lymphomas of bone (PNHLB) is a rare form of extranodal lymphoma. Many studies have reported the clinical, radiologic, and histopathologic characteristics of PNHLB; however, their molecular features have not been well studied. In this report, we present the immunophenotypic and molecular characteristics of 20 primary large B-cell lymphoma (PLBCL) of bone from 20 adults. Most demonstrated centroblastic morphology, with the majority exhibiting nuclear multilobation. One case (5%) demonstrated anaplastic features with strong CD30 expression but was ALK-1 negative. BCL-6 expression was seen in 6 of 20 cases, and strong p53 protein expression was seen in 11 of 20 (55%) cases. The majority of cases analyzed (13/18 = 72%) demonstrated a clonal B-cell process by IgH gene rearrangement studies. Of the five cases that did not demonstrate a clonal population, two expressed BCL-6 protein. No cases demonstrated a bcl-2/JH rearrangement, but BCL-2 protein expression was seen in 11 of 20 (55%) cases. In summary, primary lymphoma of bone is largely a non-Hodgkin's lymphoma of large B-cell type. Our studies demonstrate that p53 and BCL-2 expression may play a role in the pathogenesis of PLCBL of bone. In addition, a subset of the cases are of putative germinal center B-cell origin based on the expression of BCL-6 protein and may be genetically distinct from follicle center lymphomas. The results provide evidence for molecular heterogeneity within primary large B-cell lymphomas of bone.

Isolation and morphological characterisation of UHMWPE wear debris generated in vitro

Wear tests are generally carried out on materials used in prosthetic hip implants, in order to obtain a better understanding of the tribological processes involved and improve the quality control of joint prostheses, directed towards reducing the risk of implant failure of innovative prostheses. Ceramic femoral heads of mixed alumina-zirconia oxides as well as zirconia and alumina single oxide heads were tested against UHMWPE acetabular cups in a hip joint simulator. Polyethylene cups and ceramic femoral heads were mounted in a simulator apparatus moving according to a sinusoidal function, under load and in the presence of bovine calf serum as lubricant. Wear particles were isolated from the bovine calf serum collected during the wear tests. An easy to follow method was used to separate the wear particles from the lubricant. Chemical digestive methods were used to separate the wear particles from the lubricant and the isolated particles were studied using scanning electron microscopy. The morphologies of the polyethylene debris showed considerable differences, both in size and shape of the particles, as a function of the coupled head material.

Gelatinous transformation of bone marrow from a starch-free diet

Gelatinous marrow transformation is characterized by marrow hypoplasia, fat atrophy, and gelatinous material deposition, and usually develops as a hematologic complication of chronic wasting disorders. Most of the cases associated with severe nutritional deficiency were seen in anorexia nervosa due to a depletion of protein or fat. This report describes a case of gelatinous transformation attributed to a specific restriction of carbohydrates in diet. The hematologic deficiency was eventually recovered after the patient resumed a regular starch-containing diet. This brief report illustrates the potential side effect of the compulsive dietary behavior on the hematologic system.

Malignant lymphoma of mucosa-associated lymphoid tissue of the lacrimal gland: case report and review of literature

Mucosa-associated lymphoid tissue (MALT) lymphomas are increasingly recognized as a distinct clinical-pathologic entity among the non-Hodgkin's lymphomas. It usually presents as a localized disease process in extranodal tissues or organs such as stomach, salivary gland, thyroid gland, and not infrequently in orbital adnexa. Radiotherapy has an important role in the management, although long-term clinical results specifically addressing localized MALT lymphomas are lacking. We report a case of localized MALT lymphoma of the lacrimal gland, with successful treatment by radiation therapy (total dose 25 Gy) with 3 years of clinical follow-up. A review of the published literature was undertaken to assess the role of radiotherapy in the treatment of this disease involving orbital tissues, specifically, the lacrimal gland. Based on previous reports of patients with orbital lymphomas (low grade) and pseudolymphomas, of which many will now be recognized as MALT lymphomas, radiotherapy has an excellent local control rate and would be the treatment of choice. However, long-term results of pathologically confirmed cases of MALT lymphomas need further study because occasional relapses at distant sites can occur.

Preoperative autologous blood deposition in support of gynaecological repair procedures

Autologous blood transfusion was evaluated in gynaecological repair procedures including abdominal/ vaginal hysterectomy with vaginal repair, post-hysterectomy vaginal suspension and fixation, uni/bilateral salpingo-oophorectomy with vaginal colpopexy and sling procedures. A total of 247 autologous units were collected from 95 patients at the regional blood centre with 1-3 units (mean 2-6 units) deposition from each patient. One hundred and ninety of all collected units were transfused (collection/transfusion ratio = 1.3). Of these patients, 86 (90.5%) received autologous blood; 12 (13%) being transfused with 1 unit, 44 (46%) with 2 units and 30 (32%) with 3 units. Two of these patients received additional homologous blood. The average preoperative haemoglobin level was 119 g L-1 and average post-operative haemoglobin level was 105 gL-1. The post-operative Hb level was used as a retrospective indicator for the requirement for blood transfusion. The results show that overall 75% of patients had post-operative haemoglobin levels < or = 110 and 33% of patients with Hb levels < 100, respectively. These results suggest that preoperative autologous blood deposition may be appropriate in the patients undergoing reconstructive gynaecological repair procedures since there was a high rate of usage of autologous blood and low post-operative haemoglobin in a significant proportion of patients.

Dominantly transmitted beta-thalassemia arising from the production of several aberrant mRNA species and one abnormal peptide

We describe a dominantly inherited beta-thalassemia intermedia phenotype observed in a five-generation Portuguese family. Carriers are characterized by moderate anemia, hypochromia, microcytosis, elevated hemoglobin (Hb)A2 and HbF levels, splenomegaly, hepatomegaly, and inclusion bodies in peripheral red blood cells after splenectomy. The molecular basis of this condition is a small deletion within the 5' consensus splicing sequence of the second intron of the beta-globin gene, IVS-II-4,5 (-AG). Reticulocyte RNA studies performed by reverse transcription-polymerase chain reaction (RT-PCR) and primer extension analysis showed three abnormally processed transcripts, which, upon sequencing, were shown to correspond to (1) skipping of exon 2, and (2) activation of two cryptic splice sites (between codons 59/60, and at IVS-II-47). In vitro translation studies of these patients' reticulocyte RNA have shown that at least one of these aberrant mRNA species is translated into an abnormally elongated peptide whose cytotoxic properties could, in part, be causing the atypical dominant mode of inheritance observed in this family. We suggest that this elongated beta chain is unable to combine with an alpha-globin chain to form a functional Hb molecule. Its degradation would, then, exhaust the proteolytic defense mechanism of the erythroid precursors, leading to inefficient proteolysis of the free alpha chains in excess.

Physiologic human T-cell responses to OKT3 in the human peripheral blood lymphocyte-severe combined immunodeficiency mouse model

BACKGROUND

Our goal was to study physiologic responses of human T lymphocytes to OKT3 in the human peripheral blood lymphocyte-severe combined immunodeficiency (hu-PBL-SCID) mouse model.

METHODS

SCID mice were pretreated with anti-asialo-GM1 (alpha-ASGM1) and radiation, then engrafted with human peripheral blood lymphocytes (PBLs). Seven to 14 days after engraftment, when most human T cells in the spleen of these mice are CD3+/CD4+ and CD3+/CD8+, mice were treated with OKT3 or control antibody. Mice were killed for histopathologic examination, for flow cytometric assessment of the engrafted human lymphocytes, and for analysis of human tumor necrosis factor-alpha serum levels.

RESULTS

Intravenous injection of 5 microg of OKT3 resulted in early antigenic modulation of engrafted human T lymphocytes, with the emergence of CD3-/CD4+ and CD3-/CD8+ cells in the spleen of hu-PBL-SCID mice. There was an increase in the serum concentration of human tumor necrosis factor-alpha within 4 hr after OKT3 injection, suggesting early T-cell activation. Antigenic modulation and activation of the human lymphocytes in the spleen was followed by their depletion within 24 hr. This human T-cell response to OKT3 in hu-PBL-SCID mice is analogous to the response in humans treated with OKT3 and in BALB/c mice injected with an anti-murine CD3 monoclonal antibody. Graft-versus-host disease in the mice was abrogated by OKT3 treatment, and OKT3-treated mice lived longer than controls. Histopathologic studies showed clearance of lymphocytic infiltration in the liver and lungs of OKT3-treated mice.

CONCLUSIONS

These findings provide further evidence of functional human immune T cells in the hu-PBL-SCID mouse. This model may have useful applications in the study of transplantation immunology.