Assessment of gelatin supplementation of PEDS Plus BACTEC blood culture medium

Gelatin supplementation of blood culture media has been shown to neutralize the effects of sodium polyanetholesulfonate and enhance detection of Neisseria species. We evaluated the effect of 1.2% gelatin supplementation of nonradiometric Peds Plus Bactec blood culture medium on the rate and speed of recovery of pathogens from pediatric patients. From June 1991 to June 1992, a total of 6451 paired comparisons of blood cultures in Peds Plus medium and gelatin-supplemented Peds Plus medium were done: 465 organisms were isolated, of which 338 were significant. There were no significant differences in recovery of organisms or the speed of detection of microbial growth between the two media. In particular, the recovery of Neisseria meningitidis (eight isolates) was not improved with gelatin supplementation. In conclusion, gelatin supplementation of Peds Plus Bactec medium does not offer any advantage over the regular Peds Plus Bactec medium.

Utility of a respiratory virus panel containing a monoclonal antibody pool for screening of respiratory specimens in nonpeak respiratory syncytial virus season

An indirect immunofluorescence respiratory virus panel containing monoclonal antibodies directed against respiratory syncytial virus, parainfluenza virus types 1, 2, and 3, adenovirus, and influenza viruses A and B was used to screen specimens in the nonpeak respiratory syncytial virus seasons in 1989 and 1990. The results indicate that the respiratory virus panel is fairly sensitive (79%) and very specific (99%) for the detection of respiratory viruses directly in clinical specimens during these time periods.

Sick building syndrome in a Canadian office complex

A comprehensive questionnaire survey with limited environmental measurements was undertaken in a large sealed office complex where health complaints had been made by employees since the complex was first occupied. Most respondents suffered from upper respiratory tract irritation, eye and skin irritation, and many less specific complaints. Symptoms started shortly after first employment, were troublesome only at work, and persisted at other work locations within the complex. Employees who worked in cubicles tended to complain more than those who worked in open areas or closed offices; however, evidence of less than optimal ventilation, temperature, and humidity correlated poorly with symptom prevalence. The building was designed and ventilated for open-plan use; later partition into offices and cubicles appeared to aggravate the situation. Although concern about pregnancy outcome was expressed by women who conceived while employed at the complex, rates of spontaneous abortion and fetal defect were close to expectation.

Soluble HLA class I in the serum of transplant recipients

BACKGROUND

Soluble HLA, Class I (S-HLA-I) has been found in serum, plasma, body fluids, peritoneal dialysates, and urine. S-HLA-I may be a product of membrane shedding, proteolysis, and/or alternate gene splicing. Previous assays to quantitate S-HLA-I were cumbersome, required radioisotope labeling procedures, or the purification of Class I antigen preceding antigen quantitation. The authors developed a solid-phase, enzyme-linked immunoassay that can be used to quantitate S-HLA-I and to study its relevance in transplantation.

METHODS

A solid-phase enzyme-linked immunoassay employing monoclonal anti-Class I to catch S-HLA-I present in plasma and peroxidase-labeled monoclonal anti-beta 2-microglobulin (B2M) to quantitate bound S-HLA-I was employed. Values were correlated with rejection and infection episodes. Pre and postoperative determinations were made from the sera of liver, heart, and kidney recipients. Size chromatography was used to compare the molecular weight of S-HLA-I from baseline and peak serum concentrations obtained during rejection episodes (2 liver, 1 heart, 1 kidney), and from 1 kidney recipient with a wound infection.

RESULTS

All 9 liver recipients and 12 heart recipients demonstrated a fall in S-HLA-I, or very low initial values, for the first 10 days and then a progressive increase in values substantially above preoperative concentrations. Values from renal recipients were more variable. There were temporary increases in S-HLA-I preceding or during 16 of 20 (80%) biopsy-proven rejections (all reversible), and in 9 of 11 (83%) episodes of infection (bacterial, viral, and fungal). In heart and liver rejection, as well as the wound infection, the sera contained increased S-HLA-I, which was almost all of the same molecular weight (approximately 52,000 daltons). In serum from the one patient with renal rejection, two additional S-HLA-I peaks occurred, one with a molecular weight near 1,000,000 daltons and the second at a molecular weight approximately 11,000 daltons suggesting cellular breakdown of the donor organ.

CONCLUSION

In summary, different patterns of S-HLA-I concentrations occur after kidney transplantation. Most liver and heart recipients reached a steady state higher than preoperative levels. Transient increases in S-HLA-I occurred with rejection and infection. In one severe rejection episode, larger and smaller fractions of S-HLA-I were detected and may represent cell membrane breakdown.

Risk of liver disease in HCV-seropositive kidney transplant recipients

OBJECTIVE

This study determined whether renal allograft recipients with antibodies to hepatitis C virus (HCV) at the time of transplantation experienced increased morbidity or mortality from hepatitis, liver disease, or hepatocellular carcinoma compared with patients without anti-HCV.

SUMMARY BACKGROUND DATA

Chronic liver disease is a cause of significant morbidity and mortality after kidney transplantation and the contribution of HCV to this problem has not been determined. The recent characterization of the HCV genome has resulted in the development of screening tests for antibody to HCV, allowing the identification of end-stage renal disease patients with anti-HCV who are candidates for transplantation. The risk to these patients for the development of hepatic complications after subsequent transplantation is unknown.

METHODS

Archived sera obtained from 163 kidney transplant recipients at the time of transplantation were tested for anti-HCV using the Abbott HCV 2.0 second-generation test system. Sera containing anti-HCV were further analyzed for reactivity against specific HCV recombinant proteins, including core, NS3 (c33c), and NS4 (c100-3), to determine whether a pattern could be identified in patients with hepatic complications. The follow-up of all patients was current (mean length of follow-up was 33 months) to identify patients with hepatic complications. All patients had previously been tested for HBSAg.

RESULTS

Twenty-nine patients (18%) had anti-HCV and three (1.8%) had HBSAg. Forty-five patients (28% of total) had transient elevations of AST or ALT without subsequent evidence of liver disease. Three patients had a syndrome of acute hepatitis. Chronic liver disease developed in only six patients (3.6%) after transplantation. Four had anti-HCV only, one had HBSAg only, and one was positive for both. However, of the 29 patients with anti-HCV, chronic liver disease developed in 5 (17%), including 1 patient who was positive for HBSAg. No patient had hepatocellular carcinoma.

CONCLUSIONS

Perturbations of liver function were common in the kidney transplant recipients studied, most were self-limited, and few were associated with evidence of viral hepatitis. The risk of developing

Tophaceous gout in patients with renal transplants treated with cyclosporine A

Hyperuricemia and gout have been associated with cyclosporine A (CyA) therapy in transplant recipients. We describe 4 patients who developed severe tophaceous gout after renal transplantation. All of the patients received CyA, prednisone, and diuretic therapy. Three had episodes of allograft rejection. No patient had the diagnosis of gout before transplantation. All developed tophi within 5 years of the first attack of gout. Management of these patients has been difficult due to renal insufficiency, drug interactions and toxicity. Clinicians should be aware that tophaceous gout can occur rapidly in CyA treated transplant recipients.

Measurement of activity in anthropomorphic organ phantoms

This paper describes two nondestructive measurement techniques for determining the radioactivity in a homogeneous organ phantom with an acceptable error and the capability of being traceable to the National Institute of Standards and Technology. These two techniques are based on a method developed by Robley D. Evans in 1937 for measuring the amount of radium deposited in a living person. There are two significant improvements in the new techniques: 1) the radially-dependent error is eliminated, and 2) the effect of self absorption in the unknown body is measured and taken into account. The first assay method is a single-source technique involving four measurements and requiring only one standard source, the second one is a double-source technique involving six measurements and requiring two unequal standard sources. Three pairs of lung phantoms radiolabeled with 241Am, 137Cs, and 154Eu were measured with both the single- and double-source techniques. The results imply that the self-attenuation of photons within the organ phantom cannot be neglected, especially at low energies. Finally, potential applications (other than the calibration of bioassay phantoms of the single- and double-source techniques) and their limitations are discussed.

Preoperative management of sickle cell patients

During a 12-year period, 59 patients with sickle cell disease underwent a total of 73 operative procedures. There was a total of 30 non-sickle-cell-related and 7 sickle-cell-related complications for an incidence of 41% and 10% respectively. There were no deaths. When complications were compared between patients that were transfused and those not transfused, there was no difference in the incidence of sickle-cell-related complications with an 8% incidence for the non-transfused group and 10% for the transfused group. A higher incidence of non-sickle-cell-related complications (46% versus 32%) was noted in the transfused group, with atelectasis being the most common complication (p = .29). The type of transfusion therapy did not influence morbidity, since the complication rates in the simple and exchange transfusion groups were similar. In conclusion, our data indicate that routine preoperative blood transfusion does not appear to be beneficial in the surgical sickle cell patient, since preoperative blood transfusions did not reduce the incidence of sickle-cell-related complications.

Ferruginous body counts in sputum as an index of past exposure to mineral fibres

Previous work by our group among vermiculite miners exposed to fibrous tremolite demonstrated that asbestos body counts in sputum closely reflected intensity and duration of past exposure. In the present project sputum samples from nearly 600 volunteers from 11 cohorts of workers exposed to asbestos and other mineral fibres were found to contain much lower numbers of asbestos bodies than had been observed in vermiculite workers and these counts did not reliably reflect past levels of exposure. No evidence was found that occupational exposure to man-made mineral fibres led to any ferruginous body formation. Asbestos body counts appeared to differentiate between mesothelioma cases and controls and between levels of radiological asbestosis, but in both comparisons, based on small numbers, the power of discrimination was low. Substantial variation was found both in asbestos body and in macrophage counts in daily sampling of vermiculite workers but it was not sufficient to invalidate comparison between groups for epidemiological study. In individual subjects, however, little reliance can be put on results from a single sputum sample, particularly if negative.

Assessment of gelatin-supplemented BACTEC blood culture medium in a pediatric hospital

Sodium polyanetheolesulfonate (SPS), an anticoagulant used in blood culture media, adversely affects the isolation of Neisseria meningitidis. The addition of gelatin appears to counteract this effect. Studies using the radiometric BACTEC system, however, have noted a lower isolation rate of other bacteria from gelatin-supplemented media. We wished to evaluate the effect of the addition of gelatin (1.2%) to a nonradiometric BACTEC aerobic medium (NR6A) on the recovery of N. meningitidis and other pathogens. The NR6A medium with gelatin (NR6A analogue) also contained a lower concentration of SPS (0.025% vs 0.035%). We did 6045 paired comparisons of blood cultured in routine NR6A medium and the NR6A analogue. Eight isolates of N. meningitidis were recovered, five only from the gelatin-supplemented medium and three from both bottles. There was no statistically significant difference in total recovery of aerobic and facultative bacteria or Candida species from both bottles. Haemophilus influenzae was detected earlier in the nonsupplemented NR6A medium. We conclude that the use of the NR6A analogue medium appeared to increase the yield of N. meningitidis without adversely affecting the recovery of other common pathogens, although the recovery of H. influenzae was slightly delayed.

Major vascular injuries of the torso

We reviewed autopsy data from 802 trauma deaths in northwestern Louisiana from January 1983 to March 1988 and found that 18% of all such deaths involved noncardiac major vascular injuries of the torso. Ninety-four percent of all deaths from blunt trauma and 45% of all deaths from penetrating trauma involved injury to the aorta, either thoracic or abdominal. Injuries to the thoracic aorta accounted for 11% of all trauma-related deaths in northwestern Louisiana; 68% of all victims died at the scene of the trauma. During this period 57 patients with noncardiac major vascular injuries of the torso were treated at the LSU-Shreveport Medical Center. Fifteen (26%) of these patients were transported to LSU-SMC from neighboring rural parishes outside the Shreveport-Bossier City metropolitan area. The mortality was 37%, and there was no difference in survival between those patients transported to LSU-SMC from within the Shreveport-Bossier City area and those transported from the rural parishes. Multivariate analysis of data showed that survival was determined by the complexity of the injury, the patient's ability to reach the hospital, and the stability of the patient's condition on arrival at the hospital. Transport time did not appear to affect survival.

HLA in human serum--quantitation of class I by enzyme immunoassay

A solid-phase, enzyme-linked immunoassay was used to quantitate the soluble fraction of HLA-class I. The sera of 318 individuals were studied, as well as the urine of six individuals with normal renal function. The stability of blood concentrations of the soluble HLA was also evaluated. The data justify the following six conclusions. (1) All normal people have circulating HLA (mean = 357 ng/ml). (2) The population can be divided into one group of low secretors (mean = 162.4 +/- 65.2 ng/ml) and another group of high secretors (mean = 540.7 +/- 185.9 ng/ml) (P less than 0.01). (3) Blood levels in each individual are reasonably consistent over short (days) and long (years) periods of time. (4) The mean concentration of soluble HLA-class I in all renal failure patients was 590 ng/ml, significantly higher than normal (P = less than 0.05); it was highest in patients on peritoneal dialysis (mean = 683 ng/ml) in spite of substantial chronic loss in peritoneal dialysate. (5) Renal allograft recipients with stable allograft function also had mean values greater than normal at 554 ng/ml (P less than 0.05). (6) Soluble HLA-class I was not detected in the urine of individuals with normal renal function.

Hiroshima-like neutrons from A-bomb replica: physical basis for their use in biological experiments

The lineal energy distribution and several other dosimetric parameters were measured for the neutrons emitted from a replica of the Hiroshima bomb to determine their usefulness in biological experiments designed to estimate the effectiveness of actual Hiroshima neutrons. The "Little-Boy" replica (LBR) was constructed at the Los Alamos National Laboratory in support of the recent atomic-bomb dose reevaluation and was made of identical materials and had nearly identical dimensions and geometry as the Hiroshima bomb. However, the LBR was operated as a steady-state nuclear reactor, which permitted measurements under controlled conditions. Detailed dosimetric measurements and calculations were made at distances of up to 2.1 m from the center of the LBR uranium core. At these distances, the in-air kerma was approximately 97% from neutrons and kerma rates were shown to be particularly useful for biological experiments (up to approximately 7 Gy/h was possible). Quantitative intercomparisons of neutron energy spectra, lineal energy distributions, and measured cytogenetic results for several fission-neutron sources indicate that Hiroshima and LBR neutrons should be of similar biological effectiveness. Based on these evaluations, and cytogenetic results for LBR neutrons reported in a companion paper (this issue), it is estimated that Hiroshima neutrons were 20 to 30% more effective than the fission neutrons commonly used in radiobiology.

Indigenous amebiasis

A case of amebic anemia in a 53-year-old Louisianian prompted us to report it, in order to create awareness of such cases occurring in the absence of foreign travel. If one is cognizant of amebiasis it will be included in the differential diagnosis when it is proper to do so.

Risk assessment using exposure intensity: an application to vermiculite mining

Estimation of exposure-response relations from epidemiological data is complicated by the fact that exposures usually vary in intensity over time. Cumulative exposure indices, which do not separate the effects of intensity and duration, are commonly used to circumvent this problem. In this paper the estimation of relative risk for specific ranges of exposure intensity from such data is considered using existing statistical methods for fitting multivariate relative risk models. This has the advantage that it does not assume that exposure intensity and duration have equivalent effects on risk. It also throws light on the possible existence of a threshold. The procedure was applied to data from a cohort of 406 vermiculite miners to examine the lung cancer risk associated with exposure to fibrous tremolite, which contaminated the vermiculite. The pattern of exposure-response differed substantially from that obtained using a cumulative exposure index to assess risk.

Identification, characterization, and quantitation of soluble HLA antigens in the circulation and peritoneal dialysate of renal patients

Human lymphocyte antigen (HLA) class I and class II antigens and beta 2 microglobulin (B2M) were identified in peritoneal dialysate (PD) and serum from patients with end-stage renal disease (ESRD) using monoclonal antibodies in an enzyme-linked immunoassay. The HLA class I and class II antigens each exhibited approximate molecular weights of 50,000 to 60,000 daltons by chromatography on Sepharose CL 6B. Class I antigens in serum and PD fluid were associated with B2M. Free B2M (Mr 11,500) also was detected in both sera and PD fluids. Unlike class I antigens, class II antigens were not found to have attached B2M. Class I and class II antigens eluted from 2-diethylaminoethanol ion exchange gradient columns at 0.07 mol/L (molar) phosphate buffer pH 7.2 and migrated with alpha 2-beta 1 mobility in agarose electrophoresis. Class I antigens were purified from ESRD patients' PD fluid by solid-phase immunoaffinity chromatography. Enzyme-linked immunoassay demonstrated that this purified protein was composed of a class I heavy chain and B2M. Class I allospecificity was confirmed by neutralization on known HLA typing antisera in a microcytotoxicity assay. Soluble HLA class I antigen preparations specifically inhibited blast transformation of responder lymphocytes in mixed lymphocyte culture reactions. Inhibition was dose dependent and ranged from 0% to 95%. The presence of soluble HLA antigens in body fluids may play an important part in the immunologic tolerance to self. This study demonstrates a ready source of large quantities of soluble HLA for detailed analysis.

Retroperitoneal necrotizing fasciitis

We present a case of retroperitoneal necrotizing fasciitis treated by urgent abdomino-perineal resection of the rectum with permanent colostomy. We can find no prior case in the English literature treated in this manner. Retroperitoneal occurrence of this disease is unusual. The process originated from perianal sepsis following chemotherapy for head and neck cancer.

Occupational respiratory disease in the United Kingdom 1989: a report to the British Thoracic Society and the Society of Occupational Medicine by the SWORD project group

A voluntary scheme for the surveillance of work related and occupational respiratory disease (SWORD) was established in January 1989 with help from the British Thoracic Society and the Society of Occupational Medicine and support from the Health and Safety Executive. Three hundred and fifty four chest physicians representing 90% of the chest clinics in the United Kingdom and 361 occupational physicians submit reports regularly of newly diagnosed cases of work related respiratory illness with information on age, sex, residence, occupation, and suspected causal agent. In 1989 2101 cases were notified, of which frequent diagnoses were asthma (26%), mesothelioma (16%), pneumoconiosis (15%), benign pleural disease (11%), and allergic alveolitis (6%). Incidence rates calculated against denominators from the Labour Force Survey showed very large differences between occupational groups, especially for asthma and asbestos related diseases. Substantial regional variation in the incidence of asthma was not explained by the geographical distribution of high risk industries and was probably due to differing levels of ascertainment. The results imply that the true frequency of acute occupational respiratory disease in the United Kingdom may have been three times greater than that reported.

HIV infection in an Ethiopian prison

HIV-1 antibody was detected in 6.0 percent of prisoners in an Ethiopian prison. HIV-1 seropositivity was strongly associated with positive VDRL status (RR = 3.7) and recent admission to prison (RR = 3.5). Seropositive prisoners were more likely to have prostitute contacts. No correlation was found between seropositivity and number of sexual contacts, long-term sex partners, or dental extractions. HIV-1 infection in this area may be of recent origin and the high prevalence may reflect rates in the surrounding community.