Transfusion-acquired cytomegalovirus infection in neonates. A prospective study

The incidence of cytomegalovirus (CMV) infection was determined in 114 transfused neonates of any birthweight born to CMV antibody-negative mothers. In a second phase of this study, an additional 28 transfused infants weighing less than 1250 g, born to both CMV antibody-negative and antibody-positive mothers, were followed. All infants underwent weekly virus culture and monthly serology during hospitalization and at 6 to 12 weeks after their last transfusion. Only one of 126 (0.8%) seronegative infants and one of 16 (6.3%) seropositive infants developed CMV infection. If the assumption is made that the CMV-infected infant received only 1 unit of infectious blood, the risk of transfusion-acquired CMV infection to seronegative infants is 0.16 percent per cellular unit transfused or 0.37 percent per seropositive cellular unit transfused. Despite similarities in the prevalence of CMV antibody in the donor population, the age of blood products used, and the mean number of donor exposures, a significantly lower incidence of CMV infection was found in the seronegative transfused infants than that in two previously published studies (p less than 0.01, p less than 0.001). Because no mortality and very little morbidity could be attributed to transfusion-acquired CMV infection in the nurseries, the authors can see no justification for the provision of specialized blood components for the prevention of CMV infection in this patient population.

The risk of cytomegalovirus infection in seronegative transfusion recipients not receiving exogenous immunosuppression

We studied 637 transfusion recipients seronegative for cytomegalovirus (CMV) in the following categories: neonates; pregnant women; and patients experiencing trauma, burns, cardiovascular surgery (adult or pediatric), major surgery, or gastrointestinal hemorrhages. Cultures and serological tests were used to follow up subjects for evidence of CMV infection for a period of three months after their last transfusion. Six (0.9%) developed CMV infection. No significant differences in risk among patient categories were observed. Infected patients received a significantly larger mean number of units of cellular blood products (CBP; 50.0 +/- 38.9 vs. 6.2 +/- 8.5; P less than .001) and plasma (23.7 +/- 15.3 vs. 2.6 +/- 4.6, P less than .001) than did uninfected patients. This result represents a risk per unit of CBP transfused of 0.14%, or approximately 0.38% per unit of seropositive CBP transfused. We observed, however, that patients exposed to CBP from greater than 30 donors had a higher risk of acquiring CMV infection than would be predicted if infectious units were randomly distributed among all donors (P less than .01).

Bioavailability of a slow-release theophylline capsule given twice daily to preschool children with chronic asthma: comparison with liquid theophylline

The reliability of slow-release theophylline products in young children has been questioned. Therefore, we studied the bioavailability of a commonly prescribed slow-release theophylline formulation (Slo-Bid Gyrocaps), administered twice daily by sprinkling the beads on applesauce. Serial measurements of serum theophylline concentrations were obtained during steady state in eight children (ages 1.6 to 5 years) after receiving a reference liquid theophylline product every six hours and also while receiving the slow-release product every 12 hours. The morning dose of slow-release theophylline was given before the child had eaten, and the evening dose was given two hours after supper. The extent of absorption of the slow-release product was 98.3 +/- 20.2% (mean +/- SD) relative to the liquid reference. The serum concentration fluctuations, expressed as percentage of the measured trough, did not differ between the two products: 108 +/- 59% v 129 +/- 97% (P greater than .05) for reference and slow-release products, respectively. Three of the eight patients had unacceptably large fluctuations (greater than 100%) while receiving the slow-release regimen, and two of these three had unacceptable fluctuations while receiving the liquid reference. The rate of absorption was slower after the evening dose of slow-release product (postprandial), resulting in significantly smaller fluctuations, and lower peak concentrations. Time to peak concentration while receiving the slow-release regimen varied from two to four hours after the evening dose and from two to eight hours after the morning dose. However, the average difference between the peak concentration and the four-hour measurement after the morning dose was only 0.3 microgram/mL (range 0 to 2.6 micrograms/mL).(ABSTRACT TRUNCATED AT 250 WORDS)

Drug precipitation within i.v. tubing: a potential hazard of chemotherapy administration

Because relatively undiluted concentrations of drugs are maintained for prolonged periods in the Y-side arm of rapidly flowing iv infusions, we visually determined compatibilities of ten commonly used cancer chemotherapy drugs and four adjunctive drugs including droperidol, metoclopramide, furosemide, and heparin. Droperidol was found to be incompatible with furosemide, methotrexate, leucovorin, heparin, and 5-FU. Furosemide was incompatible with metoclopramide, doxorubicin, vincristine, and vinblastine in addition to droperidol. Doxorubicin was incompatible with heparin. If these drugs were administered sequentially into the Y-side arm of an iv infusion, precipitation would be expected with drug inactivation and possible drug embolization to the pulmonary circulation. Flushing the Y-side arm with a compatible solution after drug administration will prevent this problem.

Multiple primary prostate cancer

Although increasing reports are noted of apparent endometrial carcinoma of prostatic origin, the controversy is present of the actual existence of such an entity. The association of papillary prostatic cancer (endometrial or ductal) with the typical microacinar variety has also been previously presented. This report is an account of 2 cases of multiple prostatic primary tumors. The first case is the twelfth reported case of endometrial (utricular) carcinoma not only simultaneously associated with microacinar type carcinoma, but also with a previous transitional carcinoma of the urinary bladder. The second case is a papillary carcinoma and associated microacinar type with the papillary component responding dramatically to chemotherapy. Significant aspects of interest in this case include the site of papillary metastasis to the lungs, elevated estrogen levels with normalization after treatment, and finally response to chemotherapy.

A human plasma component that binds benzo(a)pyrene

A component capable of binding benzo(a)pyrene was measured in plasma from cigarette smokers and nonsmokers. This plasma fraction was found to have a high specificity of binding to benzo(a)pyrene, bound benzanthracene competitively with benzo(a)pyrene, and was positively correlated (r = 0.861, p less than 0.001) with the capacity of the individual subject's lymphocytes to be induced for AHH activity in culture. An inverse correlation (r = -0.957, p less than 0.001) between the presence of the plasma component in lung cancer patients and the capacity of lung cancer patients' lymphocytes to be induced in culture is unexplained at this time. A benzo(a)pyrene-binding fraction was not found in induced or uninduced cultured lymphocytes from smokers or nonsmokers, or in homogenates of lung excisional tissue from smokers with or without primary lung cancer.

Steroid hydroxylase induction in cultured human lymphocytes: effects of the menstrual cycle

Steroid hydroxylases (SAH) are inducible in cultured human lymphocytes following treatment with estradiol-17beta. The enzyme systems induced are carbon monoxide sensitive and convert estradiol-17beta to a metabolite chromatographically indistinguishable from estriol. The level of inducibility of SAH varies drastically over a normal menstrual cycle with maximum induction in the late follicular phase and minimum induction during the luteal phase. The use of an oral contraceptive containing both a synthetic progestogen and ethynyl estradiol reduced SAH induction levels to those typically seen during the luteal phase of the menstrual cycle.