Selective protection against IgG binding to red cells treated with phthalocyanines and red light for virus inactivation

BACKGROUND

Irradiation with red light of red cells (RBCs) containing the photodynamically active phthalocyanine (Pc) dyes is being studied for inactivation of lipid-enveloped viruses. One of the outstanding problems with this treatment is the binding of IgG to RBCs. The effects of oxygen and type I or type II quenchers on this IgG uptake were evaluated.

STUDY DESIGN AND METHODS

The Pc compounds used were aluminum phthalocyanine tetrasulfonate (AIPcS4), HOSiPcOSi(CH3)2(CH2)3N(CH3)2 (Pc 4); HOSiPcOSi(CH3)2(CH2)3N+(CH3)3I- (Pc 5); and SiPcOSi[(CH3)2(CH2)3N+(CH3)3](2)2I- (Pc 6). RBCs were analyzed by flow cytometry for the presence of IgG.

RESULTS

Irradiation with red light for 30 minutes of RBCs containing either 2 microM Pc 4, 2 microM Pc 5, 2 microM Pc 6, or 6.5 microM AIPcS4 resulted in an uptake of IgG. These conditions completely inactivated the lipid-enveloped vesicular stomatitis virus (VSV) (> 5 log10 kill). IgG uptake was reduced when oxygen was depleted. The addition of reduced glutathione (GSH) or mercaptoethanol prevented the binding of IgG with RBCs treated with AIPcS4, Pc 4, Pc 5, and Pc 6. Specific binding of IgG2 but not of C3d was observed upon irradiation of RBCs with Pc 5 and Pc 6 in the absence of GSH. No gross changes were observed in RBC antigen strength after irradiation with the dyes in the presence of GSH. Inactivation of VSV by Pc plus light was not affected by GSH.

CONCLUSION

Sulfhydryl compounds are useful in preventing IgG binding to RBCs following Pc photosensitization. Since virus inactivation proceeds at the same rate in the presence and the absence of sulfhydryl compounds, their addition to treated RBCs should allow crossmatching for transfusion after treatment. The binding of IgG depends to a large extent on the generation of reactive oxygen species.

Case report: pseudotumoral pelvic retroperitoneal fibrosis associated with orbital fibrosis

We report the case of a man with bilateral orbital fibrous pseudotumours and a large pelvic mass which was initially thought to be malignant. Sonographically guided transrectal core biopsies showed it to be a fibrotic retroperitoneal pseudotumour. The mass decreased after steroid therapy. The computed tomography and magnetic resonance imaging features of this unusual form of pelvic fibrosis as well as the association with heterotopic fibrosis are discussed.

Benign angiomyolipoma involving the renal vein and vena cava as a tumor thrombus: case report

A 53-year-old woman presented with a renal angiomyolipoma extending as a thrombus into the renal vein and vena cava. This case is most unusual and we are unaware of any report of a benign angiomyolipoma that has presented as a tumor thrombus. The intravascular growth of a benign angiomyolipoma has previously been described.

[Spiral CT in parenchymatous disorders of the kidney]

Spiral-CT enables accurate diagnosis of renal parenchymal diseases and tumors, and when necessary, staging. Important prerequisites are optimal timing after injection of contrast medium and problem-tailored reformatting. In the optimal setting, this allows to reduce the examination time, the radiation dose, and the dose of contrast medium. Moreover, many other so-called complementary examinations as MRI, angiography, cavography, and diagnostic puncture can be avoided.

K12 is located on the Kell blood group protein in proximity to K/k and Jsa/Jsb

K12 is a high-prevalence antigen, with no known antithetical partner, that is associated with the Kell blood group system. We report studies on the 5th propositus (MS) with the K:-12 phenotype and the second case to show that the K12 is inherited. The anti-K12 in his serum did not destroy antigen-positive incompatible red cells transfused on at least 3 occasions over 6 years. Red cell membranes from MS possessed the Kell protein that was indistinguishable from control membranes. K12 antigen was shown by immunoprecipitation to be on a protein with an apparent molecular mass of 93,000 and by monoclonal antibody immobilization of erythrocyte antigens (MAIEA) assay to be on the Kell protein in proximity to K/k and Jsa/Jsb antigens. These data remove the K:-12 phenotype from its current Kell-related (or para Kell) status and elevates the K12 antigen to a bona fide member of the Kell blood group system.

Juxtaglomerular cell tumor: importance of clinical suspicion

This case report of a reninoma or juxtaglomerular cell tumor illustrates that careful preoperative radiological investigation and preoperative frozen-section examination does not always lead to a correct diagnosis. The preoperative diagnosis of juxtaglomerular tumors should therefore primarily depend upon clinical suspicion, eventually followed by directed renal vein renin ratio blood sampling. The importance of early preoperative diagnosis and treatment is stressed.

Accuracy of combined computerized tomography and fine needle aspiration cytology in lymph node staging of localized prostatic carcinoma

The sensitivity and accuracy rate of computerized tomography (CT) in lymph node staging of localized prostatic carcinoma is commonly considered to be low. Fine needle aspiration cytology of pathological lymph nodes seen on radiological staging can enhance this low accuracy rate. We prospectively investigated the accuracy of CT and fine needle aspiration cytology in lymph node evaluation of 285 patients with clinically locally confined prostatic carcinoma. The sensitivity, specificity and accuracy rates of this combined method were 77.8%, 100% and 96.5%, respectively. False-negative staging results were found in only 10 patients with minimal nodal disease. Although in contrast with previous reports, combined CT and fine needle aspiration cytology in our hands seems to be a highly efficient staging method for lymph node involvement. This method could be considered as an alternative to surgical lymphadenectomy in the preoperative evaluation of the nodal status of patients with localized prostatic carcinoma who are scheduled for radical prostatectomy or curative radiotherapy.

[Hormone therapy before radical prostatectomy. Effects on surgical method and resection margins. Belgian Uro-Oncological Study Group (B.U.O.S.)]

127 patients with a clinical stage T2b and T3 prostate cancer were randomized in order to undergo either a radical prostatectomy alone or a radical prostatectomy after hormonal treatment (560 mg of estramustine phosphate daily for 6 weeks) in a prospective multi-center study. The clinical or radiological evaluation of an eventual downstaging being extremely difficult, the authors compared in the 2 groups the influence on the surgical act and the number of positive surgical margins at pathological examination of the resected specimen. There was no significant difference between the 2 groups concerning the surgery (duration of the procedure, blood transfusion, degree of difficulty). For clinical T2 prostate tumors the number of positive surgical margins was significantly lower in the group that had preoperative hormonal treatment. In the group with clinical T3 prostate cancer this difference was not found. The influence of positive margins on the later development of local or systemic recurrence and on survival still has to be awaited. At this moment one could conclude that only patients with a T2 prostate cancer benefit of a preoperative hormonal treatment.

Primary lymphoma of the uterine cervix

A case of primary non-Hodgkin lymphoma of the uterine cervix is reported. The ultrasonographic and computed tomographic findings are described as well as the MRI appearance of this peculiar cervical mass. The best tumor delineation was achieved by T2-predominant and contrast-enhanced T1-weighted images. The lesion was treated successfully with external radiotherapy.

In vitro analysis of urinary calculi: type differentiation using computed tomography and bone densitometry

Thirty-six urinary stones were studied by computed tomography and bone densitometry in order to find a correlation between the chemical composition of the stones and the densitometric data. In vitro, the more common cases of lithiasis can be divided into 3 main groups: uric acid, cystine and the calcium salts, e.g. calcium oxalate monohydrate, calcium oxalate dihydrate and calcium phosphate. Struvite stones fall between the second and third groups. Computed tomography and bone densitometry can differentiate between the groups, provided that the value of the "stone mineral or calcium content" is correlated with the true calculated volume of the stone (resulting in the specific stone density) instead of the projection area (resulting in the area density). This is only possible in vitro. The in vivo application of these technologies in the treatment of stones of unknown composition could provide important information, but major restrictive factors pose difficulties. Further clinical studies are necessary, especially to define the role of bone densitometry.

Tuberculosis of the adrenal glands: diagnosis by CT-guided fine needle biopsy

Bilateral adrenal masses were found in a 64-year-old man with pulmonary tuberculosis and a pulmonary mass lesion suspicious for carcinoma. CT-guided fine needle biopsy of the left adrenal gland revealed tuberculosis. Adrenal metastases were thus excluded and probably Addison's disease, considered to be a potential complication of adrenal tuberculosis, could be prevented.

Xanthogranulomatous pyelonephritis in a child

Xanthogranulomatous pyelonephritis is an uncommon form of chronic aggressive infection of the kidney and surrounding tissues usually affecting middle aged women. It is rarely seen in childhood. We report the case of a female child with a history of fatigue, progressive anorexia, and fever in whom a diagnosis of pyelonephritis on a predisposing factor of lithiasis was suggested. After initial antibiotic treatment, nephrectomy was needed for an acute general deterioration. Pathology demonstrated xanthogranulomatous pyelonephritis.

Surgical versus endoscopic treatment of non-malignant uretero-ileal anastomotic strictures

The classical treatment of uretero-ileal anastomotic strictures after Bricker uretero-ileostomy is open surgical revision. Recent progress in endourology has provided a number of alternatives. The success rate of these endoscopic techniques is less than the success rate of the open surgical revision.

Value of MRI in the diagnosis and staging of testicular tumors

Ultrasound is currently the primary imaging modality for the assessment of scrotal disease. In acute pathology, colour Doppler adds further confirmation about blood flow to the testicles and surrounding structures. MR is emerging as a powerful tool to image the scrotum. Compared with sonography, MR has a wider field of view and a greater tissue contrast. The current status of MR imaging and its role in the evaluation and local staging of testicular tumors is evaluated in this retrospective study. MR is able to differentiate seminomatous from non-seminomatous tumors in nearly all cases. However, stromal tumors (e.g. Leydig cell tumors) cannot be differentiated from seminomatous tumors, and some benign lesions, as an intratesticular hematoma, cannot be differentiated from non-seminomatous tumors. Microscopic extension in or beyond the tunica albuginea cannot be evaluated.

Spontaneous rupture of the bladder: an uncommon finding on excretory urography

A case of recurrent intraperitoneal bladder rupture is reported. Tearing occurred after minor trauma in a woman who had suffered a fracture of the pelvic rim 6 years earlier. Spontaneous rupture of the bladder is rare. The symptoms of an intraperitoneal bladder rupture may suggest intestinal disease and intravenous urography may be misleading. A retrograde cystogram is required to obtain the diagnosis.

Radical prostatectomy for localized prostate cancer

A retrospective analysis of 70 patients, undergoing a radical prostatectomy in 1989 and 1990 is reported. The value of computed tomography (CT) scanning in preoperative lymph node staging should be reconsidered. Evaluation of the resection margins is of utmost importance as is the distinction between capsular invasion, penetration and transgression. The etiology of local failure and its treatment are discussed.

Temperature steering in prostate by simultaneous transurethral and transrectal hyperthermia

Localized hyperthermia (HT) is presently under investigation as a treatment for benign prostatic hyperplasia and carcinoma of the prostate (CaP). One popular approach employs a transrectal (TR) device, a directional microwave (MW) applicator inserted into the rectum and aimed at the prostate. Alternatively, in the transurethral (TU) technique, a symmetrically radiating MW antenna is placed directly within the prostatic urethra. Used individually, TR applicators are capable of effectively heating (> 42 degrees C) the prostate up to 2 cm from the rectum, whereas TU applicators selectively heat the periurethral tissue with effective radial penetration of about 0.6 cm. Neither technique is of much value in heating the anterior prostate. In general, the highest temperatures are produced in the tissue immediately adjacent to the surface of intracavitary microwave devices. However, when MW antennas are used in arrays, the resulting heating pattern can differ significantly from that of the individual antennas. Heating at depth can be selectively enhanced and "steered" by adjusting the phase relationship between the devices. Prostatic temperature profiles were measured in 6 patients treated with TR alone, TU alone, and simultaneous TR and TU heating. In the combined treatments different phase relationships between the antennas were applied. We found that a higher temperature could be produced in the center of the prostate than on the surface of either applicator for certain phase relationships, and that the temperature profiles could be changed by shifting phase. The results of these measurements are in agreement with those of a computer simulation. Based on the above data we feel the combined use of TU and TR hyperthermia may be justified in Phase I-II trials for patients with locally advanced CaP.

Renal pseudotumor due to a retained perirenal sponge: CT features

A case of a surgically retained, encapsulated sponge presenting as an unusual cause of renal pseudotumor is described in a man who had a partial nephrectomy for renal cell carcinoma 1 year before. The nonspecific sonographic appearance of a hyperechoic renal mass and the atypical CT features of a thick-walled indeterminate mass suggested a hematoma, a hemorrhagic cyst, or a hemorrhagic neoplasm. A retained surgical sponge within a thick fibrotic capsule adhesive to the renal capsule was found at surgery.

Endovaginal sonography: new diagnostic approach for urethral diverticula

Too often a urethral diverticulum is a long-standing and unrecognized problem. Suprapubic sonography has been proposed for assessment of this pathological condition. We report on endovaginal sonography as a new improved imaging modality for the diagnosis of urethral diverticula. In positive cases additional morphological information can be obtained from positive pressure urethrography or from diverticulography via fine needle puncture under digital guidance or under sonographic control. Direct puncture of the lesion allows the injection of contrast material to facilitate the diverticulectomy.

Experience with the intraprostatic spiral

Thirty-six patients have been followed up after insertion of an indwelling intraurethral device for prostatic obstruction. Follow-up exceeded 1 year in some cases. The main problem was dislocation of the spiral not only in the early stages but also after several months. Endoscopic assessment of the obstruction seems important during the pre-operative investigations. The ideal indication is prostatic obstruction in patients who are unsuitable for surgery and who need relief of acute retention for a limited time only. In selected patients the prostatic spiral has a place in the treatment of obstructive prostatism.