A case of coincident multiple myeloma and non-Hodgkin's lymphoma

A rare case of coexisting multiple myeloma and non-Hodgkin's lymphoma at the time of diagnosis is presented. The patient presented with petechiae, melena and weight loss. IgA lambda monoclonal gammopathy in the serum and free lambda chain in urine were documented. Bone marrow biopsy demonstrated an interstitial infiltration of neoplastic plasma cells coexisting with localized collection of neoplastic lymphoid cells composed of monotonous small lymphocytes with occasional cleaved nuclei. Immunophenotype of plasma cell was IgA lambda. The patient also had a jejunal mass, with biopsy proven malignant lymphoma, diffuse small cleaved cell type. The tumor was diffusely positive for pan-B marker. After chemotherapy, the IgA lambda monoclonal protein decreased and the patient improved. This case suggest, that the seound B-cell neoplasm may have evolved by transformation of an original neoplastic clone, or that malignant tumors may be polyclonal at onset. Definitive diagnosis and staging of each disorder is important for proper management.

Synthesis and carbonic anhydrase inhibitory activity of 4-substituted 2-thiophenesulfonamides

A series of 4-substituted 2-thiophenesulfonamides was prepared from 3-thiophenecarboxaldehyde using metalation chemistry developed for 3-furaldehyde. Several of these compounds inhibit carbonic anhydrase II in vitro at concentrations of less than 10 nM. In addition, none of these compounds exhibit sensitization potential as determined from in vitro measurement of cysteine reactivity.

A case of giant hemangioma of the liver presenting with fever of unknown origin

A 37 year-old-woman was admitted to the hospital because of 15 days' duration of continuous fever. Routine studies for detection of fever foci were negative. Imaging studies revealed giant hemangioma of the liver with central thrombosis. The fever persisted for a period of 4 weeks, and subsided after conservative management. We report a case of hepatic hemangioma presenting with fever of unknown origin. The condition is very rare, but should be regarded as one of the causes of fever of unknown origin.

Comparative antibacterial activity of the aminothiazolyl cephalosporin RU 29,246

A total of 1,007 clinical isolates from a tertiary care center were tested against RU 29,246, ampicillin, cephalothin, cefoxitin, ceftazidime, Augmentin, oxacillin, piperacillin, gentamicin, amikacin and vancomycin. Bacteria tested consisted of 479 strains of Enterobacteriaceae, 64 pseudomonads, 18 Xanthomonas, 42 other gram-negative bacilli, 56 enterococci and 348 isolates of staphylococci. RU 29,246 showed excellent in vitro activity inhibiting > 90% of Escherichia coli, Klebsiella pneumoniae, K. oxytoca, Enterobacter, Proteus mirabilis, Providencia, Morganella, Salmonella, Shigella, Aeromonas hydrophila, and methicillin-susceptible Staphylococcus aureus at an MIC of 0.5-1.0 mg/l. Seventy-seven percent coagulase-negative staphylococci had an MIC of 1.0-4.0 mg/l. All strains of Pseudomonas aeruginosa and X. maltophilia were resistant to RU 29,246. Fifty-six percent of the enterococcal isolates were inhibited by 1.0-16.0 mg/l of RU 29,246.

Incidence of bacterial respiratory pathogens and their susceptibility to common antibacterial agents

Although most respiratory tract infections are caused by viruses, bacterial pathogens are responsible for higher morbidity and mortality. Because virtually nothing is known about the etiology of bacterial respiratory pathogens in Saudi Arabia, this study examined the incidence of these organisms in 5426 patients over a 1-year period. Of the bacterial pathogens isolated from 904 patients, the most common organism was Hemophilus influenzae (31%), followed by pneumococci (22%), Pseudomonas aeruginosa (16%), and others (31%). Because the first two organisms accounted for more than 50% of isolates, their susceptibility to commonly used antibiotics was also reviewed. The results are presented here.

CI-990 (PD 131112): A new quinolone prodrug

In vitro susceptibility of 1021 strains of recent clinical isolates was determined against the new fluoroquinolone CI-990 (PD 131112) and compared with CI-960, ciprofloxacin, fleroxacin, lomefloxacin, norfloxacin, perfloxacin, sparfloxacin, and temafloxacin. The minimum inhibitory concentrations (MIC) of CI-990 in mg/L required for >90% isolates were 0.03-0.5 for members of Enterobacteriaceae, 0.12-2.0 for Pseudomonas aeruginosa, 0.03-1.0 for Aeromonas hydrophilia, 1.0-2.0 for Acinetobacter calcoaceticus, 0.5-2.0 for Brucella melitensis, 0.06-1.0 for staphylococci, and 1.0-2.0 for enterococci. Its antibacterial activity was comparable or superior to other fluroquinolones tested against most gram-negative and gram-positive bacteria, including enterococci.

Seroepidemiology and evaluation of passive surveillance during 1988-1989 measles outbreak in Taiwan

A seroepidemiological study was carried out to explore the risk factors of a measles outbreak that occurred among school children at a rural village (Li-Tse) in Taiwan. Among the 1166 participants, the percentage susceptible before the outbreak was 10.5% (122/1158) which was estimated as the sum of measles IgG-negative (29/1158) and IgM-positive (93/1166) individuals. Among 340 vaccinated children, 16 (4.7%) were measles IgM-positive and 10 (2.9%) were measles IgG-negative; therefore the vaccine failure rate was estimated to be 7.6% (26/340) and vaccine efficacy was 79.7% (95% confidence interval [CI] : 65.0-88.5). The most important risk factors for acquiring measles infection were the presence of other measles cases in the family (Odds Ratio [OR] = 32.5, P = 0.002) and the presence of more than two cases in a class (OR = 29.1, P = 0.003). The physician reporting rate was 6.1% (4/66), and the sensitivity of passive measles surveillance was only 4.3% (4/93) by active serosurvey. A concomitant rubella epidemic also amplified the inaccuracy of a passive reporting system based only on clinical diagnosis. Five children developed measles IgM but did not experience any symptoms, indicating that asymptomatic measles infection can occur. Our experience has highlighted three important areas for future measles elimination: (1) the need for serological evaluation of vaccinees, particularly those who were born during the introduction of mass immunization; (2) improvement in measles vaccine efficacy; and (3) further investigations on the role of asymptomatic transmission and susceptibles who remain after mass immunization.

Numerical simulation for the propagation of nonlinear pulsatile waves in arteries

The behavior of nonlinear pulsatile flow of incompressible blood contained in an elastic tube is examined. The theory takes into account the nonlinear convective terms of the Navier-Stokes equations. The motion of the arterial wall is characterized by a set of linearized differential equations. The region bounded by the flexible arterial wall is mapped into a fixed area in which numerical discretization takes place. The finite element method (Galerkin weighted residual approach) is used for the solution of this nonlinear system. The results obtained are pressure distribution, velocity profile, flow rate and wall displacements along the elastic tube (20 cm long).

Can isolation of Aeromonas hydrophila from human feces have any clinical significance?

A total of 27,480 stool specimens from 15,548 patients with gastroenteritis were analyzed for bacterial enteropathogens during a 4-year period between 1986-89 at a major referral center in Saudi Arabia. Bacterial pathogens were isolated from 1,152 patients, Salmonella being the most frequent, followed by Campylobacter, Shigella, and Aeromonas hydrophila. The latter bacterium was found in 58 patients; seven of them were associated with other enteric pathogens, but A. hydrophila was the only organism in 51 patients. All had gastrointestinal symptoms, the most common being diarrhea (92%), followed by abdominal pain (68%), fever (37%), and vomiting (27%). Stool specimens from 1,368 control patients were negative for A. hydrophila.

In vitro activity of lomefloxacin, a difluorinated quinolone, compared with other antimicrobials

A total of 3,144 clinical isolates from 3,011 consecutive patients were tested against lomefloxacin by the agar dilution method. They consisted of 1,380 isolates of Enterobacteriaceae, 527 pseudomonads, 47 Haemophilus influenzae, 53 Acinetobacter, 42 Brucella melitensis, 903 staphylococci and 192 strains of enterococci. In vitro activity of lomefloxacin was compared with ciprofloxacin, norfloxacin, beta-lactams and aminoglycosides. Over 98% of Enterobacteriaceae were susceptible to lomefloxacin with an MIC of 0.06-4.0 micrograms/ml. It also inhibited 93 and 85% clinical isolates of Pseudomonas aeruginosa and Xanthomonas maltophilia, respectively. All isolates of Haemophilus, Brucella and Staphylococcus aureus were susceptible to this fluoroquinolone. However, only 43% of the 192 strains of enterococci exhibited in vitro susceptibility. Lomefloxacin was found to be comparable to ciprofloxacin and norfloxacin in its in vitro activity, and superior to most penicillins, cephalosporins and aminoglycosides against both gram-negative and gram-positive bacteria except enterococci.

Theoretical and computational investigations of nonlinear wave propagations in arteries. (I)--A theoretical model of nonlinear pulse wave propagations

In this paper, a new theoretical model of nonlinear wave propagations in arteries with surrounding tissues was put forward. The equations of motion for the blood vessels and their peripheral tissues as a system have been derived. These equations were expressed in terms of the stresses of the vessel wall and fluid, and the geometry of the blood vessel. They can be used to solve numerically the problems for the propagations of nonlinear pulse waves in arteries together with the momentum and continuity equations of incompressible-viscous flow, as well as the constitutive equations of fluid and vessel wall. The numerical solutions can involve pressure, velocities and flowrate of the blood flow, as well as displacements, velocities and stresses of the vessel wall. These physical variables of propagations of pulse waves in arteries are all of significance physiologically and clinically.

Osteomyelitis associated with pressure ulcers

Bone biopsies were performed in spinal cord injured patients with pressure ulcers in whom osteomyelitis was suspected. Roentogenograms and bone and gallium scans were also evaluated to determine their usefulness in diagnosing osteomyelitis. Infected bone underlying pressure ulcers revealed only mild focal inflammatory changes which did not correlate well with x-ray and nuclear scan abnormalities. Negative scans, however, essentially ruled out osteomyelitis. There was no clear association of delayed healing or recurrence of pressure sore with osteomyelitis. Antibiotic therapy of greater than three weeks' duration did not significantly affect the outcome of the disease.

Electrochemistry of purine derivatives. 1: Direct determination for the antiviral drug 9-[(1,3-dihydroxy-2-propoxy)methyl]guanine by anodic differential pulse voltammetry

Differential pulse voltammetry at a stationary glassy carbon electrode was used for the sensitive and selective analysis of a potent new antiviral analogue of 2-deoxyguanosine in a pharmaceutical formulation. In the electrochemical method for analysis of 9-[1,(3-dihydroxy-2-propoxy)methyl] guanine (1), an electroactive internal standard (uric acid) was used. Linear peak current-concentration relationships were obtained at 1 concentrations of 0.4-2.0 mM, with a quantitation limit of 0.1 mM. Degraded solutions of 1 were assayed directly by differential pulse voltammetry and also by two chromatographic methods to demonstrate the specificity of the electrochemical method. The voltammetric method reliably provides accurate and reproducible results in considerably less time than conventional chromatographic analysis.

Nonlinear elastic analysis of blood vessels

Based on the theory of Green and Adkins [9], a strain energy function is proposed to describe the nonlinear mechanical behavior of arteries. The arterial tissue is assumed to be a nonlinear elastic, incompressible material with local triclinicity and transverse isotropy. Although the arterial tissue shows viscous phenomena, experimental results have indicated that viscosity is only a second-order effect as compared to the nonlinear elasticity of the tissue. The advantage of the formulation presented herein is that it is relatively simple and results in an accurate stress-strain relation that can be used readily for the study of wave propagations in the blood vessels. For nonlinear finite strain elasticity of the order two, ten elastic constants are needed to describe the material nonlinearity of the arterial tissue. Based on the orthogonal, transverse isotropies and the incompressibility conditions, ten constraint equations may be established and the elastic constants can be uniquely determined by correlating with the experimental results. An example of calculating these elastic constants is made by using the experimental data of Patel, et al. [14-17] for the intercoastal arteries in living dogs. The predicted mechanical behavior of canine arteries is quite satisfactory as compared to the experimental data except when the longitudinal and the circumferential stretches exceed 1.60. However, such a strain magnitude may not be expected in in-vivo arteries because of the constraints of peripheral connecting tissues. Otherwise, the strain energy function including higher order strain terms should be used.(ABSTRACT TRUNCATED AT 250 WORDS)

On nonlinear viscoelastic properties of arterial tissue

Nonlinear viscoelasticity is important in a variety of studies in biomechanics. One of the subject areas is the necessity to characterize the dynamic properties of blood vessels. This study concerns a theoretical formulation to examine the higher order nonlinear viscoelastic relaxation functions for arterial tissue based on the assumption of transversely isotropic material properties. Simple numerical results for the first-order theory are compared with those available in the literature.

4-Chloro-6-methoxyindole is the precursor of a potent mutagen (4-chloro-6-methoxy-2-hydroxy-1-nitroso-ndolin-3-one oxime) that forms during nitrosation of the fava bean (Vicia faba)

Fava beans (Vicia faba) upon treatment with nitrite under simulated gastric conditions, form a direct-acting bacterial mutagen, comparable in specific activity to the most potent known mutagens for several strains of Salmonella typhimurium. The precursor of the mutagen was isolated and identified as 4-chloro-6-methoxyindole by u.v., i.r., m.s. and n.m.r. The precursor was dechlorinated with NaBH4 and PdCl2 as the catalyst and the product obtained from this reaction was identified as 6-methoxyindole. Since synthetic 4-chloro-6-methoxyindole was not available, structure activity studies were conducted on substituted indoles. Nitrosation of 4-chloroindole closely follows the results for nitrosation of 4-chloro-6-methoxyindole. The major product of nitrosation of 4-chloroindole is 4-chloro-2-hydroxy-N1-nitroso-indolin-3-one oxime. Thus, it appears that the major nitrosation product of 4-chloroindole and of 4-chloro-6-methoxyindole is a stable alpha-hydroxy N-nitroso compound. This is the first reported case of stable alpha-hydroxy N-nitroso compounds. In the presence of N-(1-naphthyl)ethylenediamine dihydrochloride (NEDD), the alpha-hydroxy N-nitroso compound rearranges to an aromatic diazonium ion which couples with the diamine to form an azo dye. Studies on nitrosation kinetics indicate that the nitrosation of indoles are relatively fast reactions. Both the structural and rate studies give strong support to the hypothesis that intragastric nitrosation of fava beans yield the putative gastric carcinogen in the high-risk area in Colombia.

Prevention of perinatally transmitted hepatitis B virus infections with hepatitis B immune globulin and hepatitis B vaccine

A randomised blind controlled trial of hepatitis B immune globulin (HBIG) plus hepatitis B vaccine for the prevention of the perinatally transmitted HBsAg carrier state was conducted in Taipei. Infants of e-antigen-positive HBsAg carrier mothers were given HBIG immediately after birth, and then one of three schedules of vaccination. There was no difference in efficacy between the three schedules; the combined efficacy was 94%, compared with that of HBIG alone (71%) or of vaccination alone (75%). Persistent HBs antigenaemia developed in only 9 (6%) of the 159 infants receiving prophylaxis, but in 88% of the controls. Antibodies developed in all those who did not become antigenaemic and presumably will provide long-term protection from hepatitis B virus infection. HBIG should be given as soon as possible after birth and need not be given again if the infant is subsequently vaccinated. With HBIG coverage from birth, the timing of the start of vaccination does not seem to be of importance within the first month of life, but to maximise compliance and minimise costs hepatitis B vaccination should be initiated during the confinement.

Immunogenicity of hepatitis B virus vaccine in healthy Chinese neonates

The immunogenicity of hepatitis B virus vaccine was studied in 38 Chinese neonates, 23 of whom were healthy and susceptible and 15 of whom had passive serum antibody to hepatitis B surface antigen (anti-HBs). Initially, each infant received two 20-micrograms doses of vaccine by the intramuscular route, with a one-month interval between doses. No adverse reactions occurred, and all susceptible neonates had a brisk antibody response that was comparable to that in older infants and children and superior to that in adults. The first dose of vaccine stimulated the production of anti-HBs within one month in 48% of the neonates. Anti-HBs was detectable in the serum of 91% of the vaccinees at the age of three months--that is, two months after the second dose. By the age of six months, 96% of vaccinees had detectable anti-HBs in their serum. All vaccinees developed anti-HBs after a third dose was administered at the age of seven months. High levels of anti-HBs were sustained after vaccination in infants who initially had passive antibodies.

Experimental cerebral concussion. Part 1: An electron microscopic study

Cerebral concussion was produced in rats by an iron pendulum hitting the external occipital protuberance. This resulted in loss of consciousness lasting from 3 to 10 minutes with prompt recovery and no focal neurological signs. The energy absorbed by the head at the impact was calculated to be about 1450 gm/cm. Light microscopic survey showed only minor pathological changes. However, electron microscopic observation revealed considerable alteration which began at 30 minutes, reached a peak at 1 hour, and disappeared at 24 hours after concussion. The salient changes included severe swelling of the neuronal mitochondria at the point of impact (occipital cortex), and extracellular edema at the site of contre coup (frontal lobe). Topographically, the most severe alteration was seen in structures at the craniospinal junction (medulla oblongata and upper cervical cord), consisting of both mitochondrial and edematous changes. Although there was no visible opening of the capillary interendothelial junctions, extravasated ferritin particles were accumulated in the edematous regions, indicating a transient increase in the permeability of the blood-brain barrier.

Properties of lung parenchyma in distortion

This study offers a basis for evaluating and developing models of stress-strain behavior of the lung in distortion. Tensile forces were applied along three axes to cubes of dog lung parenchyma. With axially symmetrical force-loading, expansion was reasonably symmetrical and pressure-volume relationships were reasonably conventional in range, hysteresis, and time-dependent behavior. When the force load was changed on one axis only, that axis appeared more compliant than it did during symmetrical loading and the other axes changed length in the opposite sign. Similar distortion was apparent at the alveolar level. Data for five specimens over a range of applied loads are filed with the National Auxiliary Publications Service; graphical examples are presented herein. Relationship among the compliances for symmetrical and asymmetrical loadings were consistent with elastic theory. We derived the elastic coefficients, bulk and Young's moduli, and Poisson's ratio from the data. Poison's ratio was about 0.30 in air-filled specimens, but was lower (0.16-0.24) and increases with stress in saline-filled specimens.