Acute torsion of a wandering spleen

The 'wandering spleen' is a rare condition due to extreme laxity or absence of ligaments that fix the organ in its normal anatomical position within the left upper quadrant. Without early surgical intervention, wandering spleen can lead to torsion and subsequent splenic infarction or rupture. Clinical suspicion plus urgent investigation and intervention are important, so as to salvage the spleen and prevent complications. We present a case of torsion of a wandering spleen in a 21-year-old young woman, who presented with a painful pelvic mass. We also reviewed the literature on this entity.

Intracranial aneurysms in twins: case report and review of the literature

Intracranial aneurysm in twins is a rare clinical disease entity. Only 15 cases have been described in the literature. We report on a pair of identical twins with intracranial aneurysms. One presented with subarachnoid haemorrhage; digital subtraction angiography showed a left posterior communicating artery aneurysm, which was treated by coiling. The patient's twin sister was called for screening, whereupon digital subtraction angiography revealed a right ophthalmic internal carotid artery aneurysm that was treated conservatively.

A randomized cross-over trial comparing single-agents capecitabine (C) and UFT plus leucovorin (LV) in patients (Pts) with advanced colorectal cancer (CRC): Preliminary data of a patient preference study

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Background: Oral fluoropyrimidines such as C and UFT plus LV (U) are widely used pro-drugs dedicated to the care of CRC. Although their toxicity profile may slightly differ, no direct comparison between these treatments has been done as both molecules are converted into fluorouracil. To help the physicians to choose between C and U, we initiated this randomized cross-over trial aimed to assess patient's preference.

Methods: Pts with advanced CRC received either a first cycle of C (1,250mg/m2 x 2/d for 14 days, q3 wks) or a first cycle of U (UFT 300mg/m2/d plus LV 75 mg/d in 3 divided doses every 8 hrs for 28 days, repeated at 35-day intervals). Patients were randomized to receive C at cycle 1 followed by U (arm A) or U at cycle 1 followed by C (arm B). After 2 cycles, pts were asked which treatment they preferred. Treatment was then continued with the chosen regimen. Preferences rates are presented with 95% confidence intervals and the two groups are compared with the chi-squared test.

Results: 89 pts were enrolled from 10/2005 to 6/2010. Treatment arms were well balanced for baseline characteristics: male 57%; median age 66 years; PS 0-1 81%. Most of the pts were heavily pretreated (0/1/2/ and >2 previous chemotherapy lines: 6/2/15/66). 64 (arm A: 35, arm B: 29)/89 pts received at least 2 cycles of chemotherapy and were evaluable for preference. At cycle 1, 21% and 43% of the pts presented at least 1 severe toxic event with C and U, respectively. Pts with U at cycle 1 presented more likely with severe fatigue and anorexia. There was 1 toxic death under C (gr. 3 diarrhea, gr.4 neutropenia) at cycle 1. Overall, 66% (95%CI: 52-77%) of evaluable pts expressed preference for C, and there was a statistically significant difference between arms A and B (p<0.02) with more pts preferring C in arm A: 79% (95%CI: 61-91%), as compared to arm B: 50% (95%CI: 31-79%).

Conclusions: Pts with advanced CRC preferred C over U, especially when given during the first cycle.

No significant financial relationships to disclose.

Mapping the high-affinity binding domain of 5-substituted benzimidazoles to the proximal N-terminus of the GluN2B subunit of the NMDA receptor

BACKGROUND AND PURPOSE

N-methyl-D-aspartate (NMDA) receptors represent an attractive drug target for the treatment of neurological and neurodegenerative disorders associated with glutamate-induced excitotoxicity. The aim of this study was to map the binding domain of high affinity 5-substituted benzimidazole derivatives [N-{2-[(4-benzylpiperidin-1-yl)methyl]benzimidazol-5-yl}methanesulphonamide (XK1) and N-[2-(4-phenoxybenzyl)benzimidazol-5-yl]methanesulphonamide (XK2)] on the GluN2B subunit of the NMDA receptor.

EXPERIMENTAL APPROACH

The pharmacological antagonistic profiles of XK1 and XK2 were assessed using in vitro rat primary cerebrocortical neurones and two-electrode voltage clamp on Xenopus oocytes expressing heterologous GluN1/GluN2B receptors. Direct ligand binding was determined using the recombinant amino-terminal domain (ATD) of GluN2B.

KEY RESULTS

XK1 and XK2 effectively protected against NMDA-induced excitotoxicity in rat primary cortical neurones. Low concentrations of XK1 (10 nM) and XK2 (1 nM) significantly reversed neuronal death. Both compounds failed to inhibit currents measured from oocytes heterologously expressing GluN1-1a subunit co-assembled with the ATD-deleted GluN2B subunit. XK1 and XK2 showed specific binding to recombinant protein of GluN2B ATD with low nanomolar affinities. Several residues in the recombinant ATD of GluN2B were identified to be critical for conferring XK1 and XK2 sensitivity. The inhibitory effects of XK1 and XK2 were pH-sensitive, being increased at acidic pH.

CONCLUSIONS AND IMPLICATIONS

These results demonstrate that XK1 and XK2 are effective neuroprotective agents in vitro and indicate that 5-substituted benzimidazole derivatives inhibit GluN1/GluN2B receptors via direct binding to the ATD of the GluN2B subunit. These compounds represent valuable alternatives to the classical antagonist ifenprodil as pharmacological tools for studying GluN2B-containing NMDA receptors.

On the sensitivity of wall stresses in diseased arteries to variable material properties

Accurate estimates of stress in an atherosclerotic lesion require knowledge of the material properties of its components (e.g., normal wall, fibrous plaque, calcified regions, lipid pools) that can only be approximated. This leads to considerable uncertainty in these computational predictions. A study was conducted to test the sensitivity of predicted levels of stress and strain to the parameter values of plaque used in finite element analysis. Results show that the stresses within the arterial wall, fibrous plaque, calcified plaque, and lipid pool have low sensitivities for variation in the elastic modulus. Even a +/- 50% variation in elastic modulus leads to less than a 10% change in stress at the site of rupture. Sensitivity to variations in elastic modulus is comparable between isotropic nonlinear, isotropic nonlinear with residual strains, and transversely isotropic linear models. Therefore, stress analysis may be used with confidence that uncertainty in the material properties generates relatively small errors in the prediction of wall stresses. Either isotropic nonlinear or anisotropic linear models provide useful estimates, however the predictions in regions of stress concentration (e.g., the site of rupture) are somewhat more sensitive to the specific model used, increasing by up to 30% from the isotropic nonlinear to orthotropic model in the present example. Changes resulting from the introduction of residual stresses are much smaller.

Anti-U-like: a common antibody in Black individuals

BACKGROUND AND OBJECTIVES

Anti-Uz, a scarce antibody, defines a glycophorin B high-incidence antigen, which is protease-sensitive. In a few years, we have encountered 12 antibodies of similar specificity, made by Black individuals of the S- s+ U+ phenotype.

MATERIALS AND METHODS

Antibodies were characterized by serological methods, with common and rare MNS types, as well as red cells treated with various proteases.

RESULTS

Anti-U-like, mostly an autoantibody, was of IgG class and reacted optimally by indirect antiglobulin test at 20 degrees C. The corresponding antigen was destroyed by several proteases. Tests with papain-treated or Dantu+ cells suggested the existence of several subspecificities.

CONCLUSION

Anti-U-like is common in the African population, though its reactions are often misinterpreted. The fact that antibody producers are always Black patients remains unexplained. No relationship with a pathological state could be established.

High-yield, in vitro protein expression using a continuous-exchange, coupled transcription/ translation system

The Rapid Translation System (RTS 500) (Roche Molecular Biochemicals) is a high-yield protein expression system that utilizes an enhanced E. coli lysate for an in vitro transcription/translation reaction. In contrast to conventional transcription/translation, this system allows protein expression to continue for more than 24 h. We demonstrated the utility of the RTS 500 by expressing different soluble and active proteins that generally pose problems in cell-based expression systems. We first expressed GFP-lunasin, a fusion protein that, because of its toxicity, has been impossible to produce in whole cells. The second protein we expressed, human interleukin-2 (IL-2), is generally difficult to produce, either as the native molecule or as a GSTfusion protein, in a soluble form in bacteria. Finally, we demonstrated the capacity of the RTS 500 to co-express proteins, by the simultaneous production of GFP and CAT in a single reaction. This new technology appears to be particularly usefulfor the convenient production of preparative amounts (100-900 microg) of proteins that are toxic or insoluble in cell-based systems.

Etomidate and the osteocalcin response to gynaecological surgery

Circulating osteocalcin is a good marker of osteoblastic activity and decreases significantly after stressful physiological states such as major surgery. Glucocorticoids are known to inhibit osteoblastic activity and result in a decline in circulating osteocalcin. We used etomidate to inhibit the cortisol response to routine gynaecological surgery to determine if this would prevent the postoperative decline in osteocalcin. Twenty-four patients were allocated randomly to receive either thiopental or etomidate for induction of anaesthesia; all other aspects of anaesthesia and perioperative management were standardized. In the thiopental group, circulating cortisol increased significantly at 2 and 6 h after the start of surgery and plasma osteocalcin concentrations decreased significantly to almost 50% of baseline values at 48 h. Etomidate abolished the cortisol response to surgery, and circulating osteocalcin concentrations did not change after operation. There was a significant difference in osteocalcin concentration between the groups at 48 h. We conclude that the cortisol response to surgery is associated with a postoperative decrease in circulating osteocalcin.

Human metabolism of mammalian lignan precursors in raw and processed flaxseed

BACKGROUND

The mammalian lignans enterolactone and enterodiol are produced in the colon by the action of bacteria on the plant precursor secoisolariciresinol diglycoside, which is found in high concentrations in flaxseed.

OBJECTIVE

Two experiments were conducted to determine 1) whether there is a dose response in urinary lignan excretion with increasing flaxseed intake, 2) whether flaxseed processing affects lignan excretion, 3) peak plasma lignan concentrations, and 4) plasma lignan concentrations after chronic supplementation.

DESIGN

Nine healthy young women supplemented their diets with 5, 15, or 25 g raw or 25 g processed (muffin or bread) flaxseed for 7 d during the follicular phase of their menstrual cycles. Twenty-four-hour urine samples were collected at baseline and on the final day of supplementation. As an adjunct to the 25-g-flaxseed arm, subjects consumed the supplement for an additional day and blood and urine samples were collected at specific intervals. All blood and urine samples were analyzed for enterolactone and enterodiol by gas chromatography-mass spectroscopy.

RESULTS

A dose-dependent urinary lignan response to raw flaxseed was observed (r = 0.72, P < 0.001). The processing of flaxseed as a muffin or bread did not affect the quantity of lignan excretion. Plasma lignan concentrations were greater (P < or = 0.05) than baseline by 9 h after flaxseed ingestion (29.35+/-3.69 and 51.75+/-7.49 nmol/L, respectively). The total plasma area under the curve was higher on the eighth than on the first day (1840.15+/-343.02 and 1027.15+/-95.71 nmol x h/L, respectively).

CONCLUSION

Mammalian lignan production from flaxseed precursors is dependent on time and dose but not on processing.

Starch, gloves and extradural catheters

We have investigated contamination of extradural catheters during normal handling with starch powdered gloves. In the laboratory, extradural catheters were handled in sterile fields with both powdered and non-powdered gloves, simulating preparation for patient insertion. The catheters together with glove samples were then examined using a Zeiss 940 scanning electron microscope. Microscopy of samples revealed starch contamination of the catheters handled with powdered gloves, especially in the side hole areas. We conclude that extradural catheters may be contaminated easily by starch powder from surgical gloves. This powder may then be deposited into the extradural space. The effect of starch in the extradural space is not known but starch is known to cause inflammatory and granulomatous reactions in other parts of the body as well as being directly allergenic. Powder contamination of catheters may be avoided easily by the use of powder-free gloves and we feel that these should be used whenever possible.

Purification and characterization of a novel enoyl coenzyme A reductase from Streptomyces collinus

A novel NADPH-dependent enoyl reductase, catalyzing the conversion of 1-cyclohexenylcarbonyl coenzyme A (1-cyclohexenylcarbonyl-CoA) to cyclohexylcarbonyl-CoA, was purified to homogeneity from Streptomyces collinus. This enzyme, a dimer with subunits of identical M(r) (36,000), exhibits a Km of 1.5 +/- 0.3 microM for NADPH and 25 +/- 3 microM for 1-cyclohexenylcarbonyl-CoA. It has a pH optimum of 7.5, is most active at 30 degrees C, and is inhibited by both divalent cations and thiol reagents. Two internal peptide sequences were obtained. Ansatrienin A (an antibiotic produced by S. collinus) contains a cyclohexanecarboxylic acid moiety, and it is suggested that the 1-cyclohexenylcarbonyl-CoA reductase described herein catalyzes the final reductive step in the conversion of shikimic acid into this moiety.

Phase I-II study of two consecutive courses of high-dose epipodophyllotoxin, ifosfamide, and carboplatin with autologous bone marrow transplantation for treatment of adult patients with solid tumors

We describe a phase I-II study of two consecutive 5-day courses of a three-drug regimen of ifosfamide (IFM), carboplatin (CBDCA), and either etoposide (VP-16) (regimen 1) or teniposide (VM-26) (regimen 2) in high doses together with autologous bone marrow transplantation (ABMT), for previously treated patients with ovarian carcinoma (OC), germ cell tumors (GCT), gestational trophoblastic disease (GTD), or oat cell carcinoma (OCC). Forty-four patients entered the study. Two patients with OC received regimen 1, and 22 were given regimen 2. Sixteen patients with GCT, two with GTD, and two with OCC were treated with regimen 1. Six patients (13%) died of toxicity. Nephropathy and esophagitis were the dose-limiting toxic effects. The maximum-tolerated doses (MTDs) were 1,500 and 200 mg/m2/d for 5 days for IFM and CBDCA, respectively, in combination with VP-16 250 mg/m2/d for 5 days (regimen 1), and 150, 1,500, and 200 mg/m2/d for 5 days for VM-26, IFM, and CBDCA, respectively (regimen 2). The response rate of patients with OC was 78% (complete response [CR], 14%). For patients previously resistant to chemotherapy, the response rate was 70%. There were no long-term disease-free survivors among patients with OC. The response rate of patients with GCT was 60% (CR, 33%). All responders with GCT were resistant to previous chemotherapy. Unmaintained CRs lasted 2, 6, 8+, 27+, and 37+ months. Of the two patients with GTD, one with previous resistance to chemotherapy attained a CR of 18+ months. One patient with OCC attained a CR lasting 6 months. The regimen possesses great antitumor activity. It produced CRs of long duration in a number of patients with GCT and GTD who were previously resistant to chemotherapy.

Hypocholesterolemic effect of vegetable protein in a hypocaloric diet

Eleven obese volunteers took part in a 12-week study during 8 weeks of which 2 meals of their control 1000 kcal diets were replaced by a soya based liquid formula (1 month) or a milk based liquid formula (1 month). The mean weight loss per month was 2.5 kg (P less than 0.05). On the soya formula total and LDL cholesterol levels were reduced significantly over the month by 10.0 +/- 2.7% (P less than 0.01) and 17.5 +/- 5.6% (P less than 0.02), respectively. Neither the milk based formula or the control low calorie diet lowered serum cholesterol significantly over the diet period. No change was seen in serum triglycerides on any of the 3 diets. No difference was seen between treatments in 24-h urinary C-peptide excretion. The results indicated that use of a vegetable protein supplement in a weight loss program which induced moderate weight loss was associated with a reduction in blood lipids, whereas moderate weight loss on a control low calorie diet or milk based formula was not.

Prevention of HLA immunization with leukocyte-poor packed red cells and platelet concentrates obtained by filtration

HLA immunization is a common complication of transfusion therapy in 30% to 60% of oncohematologic patients. Evidence shows that leukocytes present in cellular blood products are the main component involved in the occurrence of HLA immunization, and several studies showed that leukocyte-poor blood products are less able to induce it. However, leukocyte-poor platelet concentrates obtained by conventional techniques, ie, centrifugation, frequently have a high level of remaining leukocytes. Cotton wool filter Imugard IG 500 can be used to obtain leukocyte-poor cellular blood products. The technique is easy to perform, even in an emergency, and can be used with either packed RBCs or platelet concentrates. Means of 97%, 92%, and 76% elimination of leukocytes are obtained for packed RBCs, pooled standard platelet concentrates, and single-donor platelet concentrates, respectively. Patients were randomized to receive either standard (control group) or filtered (leukocyte-poor group) blood products. Of 112 randomized patients, 69 were evaluable, 35 in the control group and 34 in the leukocyte-poor group. Both groups are comparable according to age, diagnosis, sex ratio, previous transfusions, and pregnancies. There is a significant difference in regard to the HLA immunization rate (31.4% in the control v 11.7% in the leukocyte-poor group, P less than .05) and frequency of refractoriness to platelet transfusions (46.6% v 11.7%, P less than .05). We conclude that this filtration technique can be an efficient means to reduce the HLA immunization rate in polytransfused oncohematologic patients.