Histamine release in sepsis: a prospective, controlled, clinical study

OBJECTIVE: To determine if histamine release occurs in clinical sepsis. DESIGN: Prospective, controlled, clinical study. SETTING: Interdisciplinary intensive care unit and trauma ward. PATIENTS: Sepsis was confirmed in 20 patients (test group) by the criteria of the Veterans Administration Systemic Sepsis Cooperative Study Group (1987) and was verified by positive blood culture. In addition, patients were scored by the Elebute and Stoner Sepsis Score (1983), as modified by Dionigi et al (1985). A concomitant control group consisted of 20 postoperative patients with non-life-threatening trauma to the extremities and without signs of local or systemic infection. INTERVENTIONS: Observational study. Blood samples were collected for determination of plasma histamine concentrations in both groups at the time of study entry and on five succeeding days. MEASUREMENTS AND MAIN RESULTS: The patients were well matched, and the groups were not significantly different for all criteria known to influence histamine release. Comparison of the median values of each group on days 1 through 5 demonstrated significantly higher plasma histamine values in the test group on days 1 through 4, but these values were no longer significantly higher on day 5. While none of the nonseptic control patients achieved a plasma histamine concentration of > 1 ng/mL (the concentration of which was considered to be the pathologic cutoff point representing histamine release), these values (i.e., > 1 ng/ mL) were found in nine of 20 test group patients. In the test group, nonsurvivors (n = 9) had significantly higher plasma histamine concentrations than survivors (n = 11) throughout the whole study and eight of nine nonsurvivors showed a plasma histamine concentration of > 1 ng/mL. Correlation of plasma histamine concentrations on day 1 to sepsis severity (initial Sepsis Score) showed that all but one patient with a combined low Sepsis Score (< 20 points) and histamine concentration of < 1 ng/mL survived, while all patients with a Sepsis Score of > 20 points and histamine release (plasma histamine concentration of > 1 ng/mL) died. CONCLUSION: Increased histamine concentrations were shown to be causally associated (contributory determinant) with sepsis.     

Corticobasal degeneration: a combined clinical, PET and pathological study

OBJECTIVE: The purpose of this study was to evaluate the application of helical CT-generated three-dimensional images of the upper airway. MATERIALS AND METHODS: Thirty patients, 10 healthy and 20 with upper-airway disease, were studied with helical CT (5-mm collimation). Overlapping images at 2-mm intervals were retrospectively generated. In the group of healthy patients, two radiologists in independently compared overlapping with nonoverlapping images, ranked confidence in identifying small airway structures on a scale of 1-5, and tabulated the number of images demonstrating these structures. In the 20 patients with disease, three-dimensional (3D) surface models were rendered on an independent workstation and were reviewed by two radiologists and one otolaryngologist for image quality, appreciation of lesion morphology, and ability to judge lesion extent, using a similar scale. A phantom was used to optimize parameters for the 3D reconstructions. RESULTS: Viewing of the retrospectively generated overlapping images increased by 122% the number of images in which laryngeal and hypopharyngeal structures could be identified (p < .01). Image confidence scores for the radiologists averaged 3.3 for nonoverlapping and 4.0 for overlapping (p < .05). Radiologists and otolaryngologist rated the quality of the 3D images equally. The otolaryngologist's assessment of the value of the models for understanding the lesion morphology was 3.5 compared with the radiologists assessment of 2.5; and for judging the lesion extent, the otolaryngologist's assessment was 3.8 compared with 2.7 for the radiologist, a statistical significance of p < .01. CONCLUSION: Helical CT with the application of overlapping images and 3D reconstructions significantly assists the understanding of upper-airway disease.     

Aspirin-sensitive urticaria; a clinical study

In the paper clinical characteristics of patients with aspirin-induced urticaria were performed. The group of 71 patients, 49 women (69%) and 22 men (31%), mean age of sensitivity symptoms demonstration--32.5 years, underwent allergological, laryngological and histamine dihydrochloride inhalatory tests. Nasal polyps were found in 2 persons (2.8%), atopic diseases in 23 persons (32.3%) and at least one feature of atopy in 37 persons (51.9%). 49 subjects (69%) suffered from urticaria which was not associated with ingestion of aspirin. In 22 patients urticaria developed solely due to aspirin. Urticaria not associated with aspirin had been presents for 2 weeks to 30 years before the onset of sensitivity to aspirin. The authors conclude that aspirin-sensitive urticaria results from concomitance of two different phenomena in one person, i.e. sensitivity to aspirin and urticaria not associated with ingestion of the drug.     

Fourth molars: a clinical study

Supernumerary teeth may be found in both the primary and permanent dentition, although they are more common in the permanent dentition. Presence of a fourth molar is rare, and such a tooth is almost invariably impacted. Dental practitioners should be aware of the possibility of encountering this rare supernumerary, its diagnosis and treatment. The authors of this article conducted a survey of patients in Montreal, looking specifically at the prevalence, aetiology, diagnosis, pathology and treatment of fourth molars. Their findings are reported here, and compared with data from the literature over the past 15 years.     

Familial adenomatous polyposis-associated thyroid cancer: a clinical, pathological, and molecular genetics study

The par genes are required to establish polarity in the Caenorhabditis elegans embryo. Mutations in two of these genes, par-3 and par-6, exhibit similar phenotypes. A third gene, pkc-3, gives a similar phenotype when the protein is depleted by RNA interference. PAR-3 and PKC-3 protein are colocalized to the anterior periphery of asymmetrically dividing cells of the germline lineage and the peripheral localizations of both proteins depends upon the activity of par-6. Here we report the molecular cloning of par-6 and the immunolocalization of PAR-6 protein. We found that par-6 encodes a PDZ-domain-containing protein and has homologues in mammals and flies. Moreover, we discovered that PAR-6 colocalizes with PAR-3 and that par-3 and pkc-3 activity are required for the peripheral localization of PAR-6. The localization of both PAR-3 and PAR-6 proteins is affected identically by mutations in the par-2, par-4 and par-5 genes. The co-dependence of PAR-3, PAR-6 and PKC-3 for peripheral localization and the overlap in their distributions lead us to propose that they act in a protein complex.     

Atopic eczema: a clinical psychiatric study

The method of Deutsch and Weeks was modified to provide a reliable and reasonably quick method for assaying the L-ascorbic acid content of culture medium. The modified method was used to determine the decay of L-ascorbic acid under various conditions of culture and the concentration of the vitamin in commercially prepared media. The half-life of L-ascorbic acid in a modified New circulator gassed with 95% O2 + 5% CO2 was 1.5 hr.; and when gassed with 20% O2 + 5% CO2 + 75% N2, about 2 hr. In Petri dishes gassed with 20% O2 + 5% CO2 + 75% N2, the half-life of L-ascorbic acid was 0.9 hr. About 4% of the L-ascorbic acid was lost per day when medium was stored at 0 degrees C and about 9% per day when stored at 5 degrees C. When medium with an initial content of 300 microng per ml was stored at room temperature, the half-life was found to be 15.5 hr. The L-ascorbic acid in five commercially available media, which contain the vitamin in their formulations, was assayed immediately after their delivery to the laboratory. The values of L-ascorbic acid measured in these media were in all cases far lower than prescribed. A continuous-flow organ culture system has been designed which allows the provision of a relatively constant level of L-ascorbic acid to explant by taking advantage of the slow oxidation of L-ascorbic acid at 0 degrees C.     

Mantle-cell lymphoma: a population-based clinical study

PURPOSE: From a population-based non-Hodgkin's lymphoma (NHL) registry, 41 patients with mantle cell lymphoma (MCL) -- a recently defined distinct B-cell NHL -- were selected and compared with patients with low- or intermediate-grade NHL from the same registry. PATIENTS AND METHODS: The incidence and behavior of MCL in the area of the Comprehensive Cancer Center West (CCCW) from 1981 to 1989 were analyzed. Age, performance, tumor bulk, extranodal localization, stage, response to therapy, and survival were registered. Expression of cyclin D1 protein and Ki-67 were measured in 29 patients. RESULTS: MCL made up 3.7% of NHLs. The median age was 68 years, and the male-to-female ratio was 1.6:1. Seventy-eight percent presented with stage IV, with the majority having bone marrow involvement. The complete response (CR) rate was 32% (13 of 41), with a median duration of 25 months. The median overall survival time was 31.5 months. The International Prognostic Index identified five patients with a low-risk score and a median survival time of 93+ months. In 23 of 29 patients, cyclin D1 overexpression was present, without any relation to overall or disease-free survival. In contrast, a proliferative index less than 10% was significantly related to a better overall survival time (50 v 24 months). CONCLUSION: MCL is a disease of the elderly, who present with widespread disease and with a poor response to therapy. Although it harbors features of an indolent NHL, it behaves clinically as an aggressive NHL with a short overall survival time.     

Spontaneous bacterial peritonitis: clinical study, microbiological findings and clinical course

One hundred and forty-four episodes of spontaneous bacterial peritonitis (SBP) treated in our service between July 1988 and September 1995 were studied retrospectively to assess the clinical presentation, microbiological findings, possible pathogens, treatment and course. Ascites, abdominal pain and fever were the most common symptoms. Only 3.5% of cases were asymptomatic. The outcome was fatal in 12 (8.33%). Among the factors analyzed, only a prothrombin time of less than 35% correlated significantly with a higher mortality rate (60% and 8.33%, respectively; p < 0.01). Ascitic fluid culture was positive in 43.05% of cases; significant differences existed between these patients and those with negative ascitic fluid culture with respect to clinical findings or course. Gram-negative microorganisms were those most frequently isolated (48.38%). Treatment was initiated within 12 hours in 77.7% of the patients, between 12 and 72 hours in 11.8% and later in 10.41%. Intravenous cefotaxime was administered in 86.1% of cases and other drugs or drug combinations in only 13.9%; the mortality rate was much lower with cefotaxime (2.4% vs 45%; p < 0.01).     

Striato-nigral degeneration. Apropos of a clinical, therapeutic, and anatomic study of 2 cases

The authors report two anatomo-clinical cases of striato-nigral degeneration with trial of L-Dopa; one of them included an olivoponto-cerebellar degeneration. The features of this degeneration are compared with the literature and related to heredo-degenerative diseases of the nervous system.     

Analysis of post-operative hypalbuminaemia: a clinical study

OBJECTIVE: Analysis of severity, causes and relevance of hypalbuminaemia developing after surgery. SUBJECTS: Patients undergoing elective aortic surgery (n = 11) or minor extra-abdominal surgery (n = 6). METHODS: Serum albumin concentration, blood loss, nitrogen balance and complications were determined until the fifth post-operative day. The contributions of haemodilution, albumin loss, albumin catabolism and redistribution were calculated using existing formula. The relation of hypalbuminaemia to the endocrine-metabolic response was determined. RESULTS: Significant hypalbuminaemia occurred after aortic surgery, in the absence of significant complications. No haemodilution occurred. Analysis indicated that 18% of hypalbuminaemia was caused by blood loss. Only 6% could be attributed to albumin catabolism, despite a significant correlation with the endocrine-metabolic response. Seventy-seven percent of hypalbuminaemia was attributed to albumin redistribution. No hypalbuminaemia occurred after minor surgery. CONCLUSION: Post-operative hypalbuminaemia is a normal finding early after aortic surgery. It is mainly caused by albumin redistribution, not by metabolic changes.     

Bovine leptospirosis: a serological and clinical study

Antibodies to serotypes representing one or more of 10 Leptospira serogroups were detected in the sera of 1766 (49-1 per cent) cows and heifers out of a total of 3600 sera tested. Infection by the Hebdomadis serogroup was the predominant infection; antibodies to serotype sejroe were found in 1503 (41-8 per cent) sera. Antibodies to the Icterohaemorrhagiae (7-7 per cent) and Balllm (7-3 per cent) serogroups were the next most common, while antibodies to the Australis, Javanica, Canicola, Panama, Cynopteri, Pyrogenes and Autumnalis serogroups were detected in a small number of animals. Only the Hebdomadis and Icterohaemorrhagiae serogroups were associated with clinical disease.     

Thiopurine methyltransferase: a review and a clinical pilot study

Diagnosis of Alzheimer's disease is made on clinical grounds, and the availability of a simple and sensitive quantitative index of the disease might aid in the routine diagnosis. The aim of this study was to assess whether linear measures of brain atrophy as detected by magnetic resonance imaging can be helpful in the differentiation of mild to moderate Alzheimer's disease from nondemented elderly. Measures of global (bifrontal index and interuncal distance) and hippocampal (minimum thickness of the medial temporal lobe, hippocampal height, width of the choroid fissure, and width of the temporal horn) atrophy were taken from 26 cases and 21 controls. Measures of hippocampal atrophy were the most sensitive in the differentiation of cases from controls, and among them width of the temporal horn yielded the highest sensitivity, predicting the disease in 73% of cases with 95% specificity. A compound measure comprising width of the temporal horn, width of the choroid fissure, and hippocampal height increased sensitivity to 85%. These results suggest that selected simple indices of hippocampal atrophy might be useful in the diagnosis of Alzheimer's disease.     

A clinical, microbiological, and histopathologic study of trichostasis spinulosa

Trichostasis spinulosa (TSS) is a relatively common follicular disorder that can occur on the face and trunk, especially in the interscapular area. Its cause remains unclear. We examined clinically 30 patients with TSS and follicular materials extracted from each patient were examined microscopically. Bacterial culture and skin biopsy were done in 12 and 10 patients, respectively. Periodic acid Schiff (PAS) and Brown-Brenn Gram stain were used for detection of pityrosporum (malassezia) and bacteria. The interscapular area (14/30), nose (8/30), and cheek (4/30) were common sites of TSS. Pityrosporum and bacteria in the extracted follicular material were found at the rates of 82.6% and 73.3%, respectively. In histologic examination, follicular hyperkeratosis and numerous vellus hairs enveloped within keratotic sheath were common features. Pityrosporum and bacteria were found at the rate of 70% in biopsied specimens on PAS and Brown-Brenn Gram stain. In bacterial culture, Propionibacterium acne was most commonly identified in 75% (9 out of 12 patients). Pityrosporum and bacteria, especially Propionibacterium acne, were commonly found in the extracted follicular material and biopsied specimens. Thus, they may be related to the induction of follicular hyperkeratosis with retention of vellus hairs, and we suggest that these microorganisms may be one of the possible etiologic factors of TSS.     

Pyogenic bacterial pneumonia in human immunodeficiency virus-infected inpatients: a clinical, radiological, microbiological, and epidemiological study

We prospectively studied features of pyogenic bacterial pneumonia in 263 consecutive human immunodeficiency virus-infected inpatients over a 6-month study period. Risk factors for bacterial pneumonia were examined by a case-control study that included 33 cases who presented with at least one episode of bacterial pneumonia and 80 controls without bacterial pneumonia. The estimated cumulative incidence of bacterial pneumonia per year was 12.5 cases per 100 inpatients (95% confidence interval [CI], 8.8-17.2). The 38 episodes of bacterial pneumonia that occurred in the 33 inpatients were mainly unilateral, but 32 episodes were patchy lobar or diffuse infiltrates. Microbiological etiologies were obtained in 33 of the 38 episodes of bacterial pneumonia. Thirty-seven pathogens were identified, including Streptococcus pneumoniae (16, of which 12 had a decreased susceptibility to penicillin), Haemophilus influenzae (6), and Pseudomonas aeruginosa (6). The risk factors for bacterial pneumonia that were identified after logistic regression included prior sinusitis within 1 month before admission (odds ratio [OR], 3.2; 95% CI, 1.1-9.1) and prior bacterial infection of the lower respiratory tract within 6 months before admission (OR, 3.1; 95% CI, 1.1-8.3).     

An experimental and clinical study of Ossocol, a compound of hydroxylapatite and collagen]

Experiments on white rats revealed that introduction of Ossocol, a sponge with a composition of hydroxyl apatite with collagen, into a removed tooth well prevented mandibular atrophy and was conducive to a more smooth defect filling with better compact bone tissue. Ossocol use in 214 patients with bone tissue defects developing after tooth removal, of odontogenic cysts, sequestra, and after radical surgery for periodontal diseases demonstrated a positive effect of this agent on the course of the postoperative period: the defect was more rapidly replaced by bone tissue. No unfavorable local or general reactions to Ossocol implantation were observed.     

Autosomal dominant striatonigral degeneration. A clinical, pathologic, and biochemical study of a new genetic disorder

An autosomal dominant striatonigral degeneration is present in a family of Portuguese ancestry numbering in excess of 329 persons in eight generations. The illness begins in the second, third, or fourth decade, and progresses for about 15 years with parkinsonian rigidity, spasticity, spastic dysarthria, and abnormalities of eye movement. Neuropathologic findings are severe neuronal loss and astrocytic gliosis in the corpus striatum and substantia nigra, with a moderate neuronal loss in the dentate nucleus of the cerebellum and nucleus ruber of the midbrain. This is a new genetic entity, distinct from other autosomal dominant neurologic disorders such as nigrospinodentatal degeneration, olivopontocerebellar degeneration, dystonia musculorum deformans, Machado's disease, and Huntington's disease.     

Use of cumulative meta-analysis in the design, monitoring, and final analysis of a clinical trial: a case study

From 1983 to 1987, the Department of Veterans Affairs (DVA) Cooperative Studies Program (CSP) conducted a multicenter clinical trial (CSP #207) to determine whether four different antiplatelet regimens compared to placebo could prevent the occlusion of grafts following coronary artery bypass surgery. The study showed that all of the active regimens tended to be better than placebo and that the three regimens containing aspirin were statistically significantly better. A cumulative meta-analysis of 12 trials performed shortly before the end of CSP #207 raised the issue as to whether the meta-analysis, if done earlier, would have changed the conduct of the trial. At the start of the planning period, one trail of size n = 37 had been published with a nonsignificant odds ratio (OR) of 0.74 (95% CI: 0.18, 3.12). At the time that CSP # 207 was approved by the DVA Cooperative Studies Evaluation Committee, two trials had been published (cumulative n = 150, OR = 0.44, 95% CI 0.19, 0.99). At the time patient intake started, five trials showed cumulative n = 769, OR = 0.42, 95% CI = 0.26, 0.68. Although the first 6-month CSP #207 progress report showed no treatment effect, by the time of the 12-month review by the Data Monitoring Board (DMB) a trend was developing in favor of active treatment. If the results of the meta-analysis had been available to the DMB at that time, conceivably the Board would have recommended stopping the placebo arm because of a convincing treatment effect based on the totality of the evidence. Cumulative meta-analysis could be useful as an adjunct in the planning, conduct, and final analysis of a clinical trial. It could also be used as one piece of evidence in the monitoring of the ongoing phase of a trial.     

Uremic pericarditis: a prospective echocardiographic and clinical study

During a 14 month period 59 male patients with chronic renal failure who were candidates for chronic hemodialysis (HD) were evaluated clinically and echocardiographically for pericarditis. All were evaluated prospectively prior to or at the initiation of HD. Definite pericarditis was present in 8, all of whom were severely uremic and required initiation of HD on a semiemergent basis rather than electively (i.e., preselected level of renal function). In 6 of these 8, pericardial effusion responded to dialysis alone, one required pericardiectomy because of hypotension complicating dialysis, and one expired during a right atriogram. Patients dialyzed on an elective basis were all free of pericarditis at the initiation of HD. Pericarditis arising some months after the initiation of HD was a less frequent problem. It is concluded that (a) the incidence of pericarditis in the uremic state is decreased by early initiation of HD before advanced uremic symptoms have developed; (b) pericarditis present at the initiation of HD usually but not always is resolved with the initiation of HD; (c) echocardiography is an important clinical and epidemiological toole to investigate pericarditis in uremic patient populations.     

Resorcinols and catechols: a clinical study of cross-sensitivity

BACKGROUND: All allergic contact dermatitis caused by Philodendron species is common in the Hawaiian islands, and Toxicodendron species are the most common causes of plant-induced allergic contact dermatitis in North America. OBJECTIVE: The purpose of this study was to determine the incidence of cross-sensitivity between these plant species. METHODS: Alkylresorcinols (pentadec[en]yl and heptadec[en]ylresorcinols) were isolated and purified from extracts of Hawaiian-grown Philodendron scandens subspecies scandens and Philodendron lacerum. Alkylcatechols (mixtures of pentadec[en]ylcatechols from an extract of Toxicodendron radicans (poison ivy) were obtained from the Division of Biologics Standards (National Institutes of Health, Bethesda, MD). Seventeen patients from Hawaii and 8 patients from northern California were skin tested with 5 microL (concentrations, 1 to .001 mg/mL) of each allergen applied to the flexor forearm. The test sites remained open and were graded at 72, 96, and 144 hours. All 8 patients from California were naive to Philodendron species, and 8 patients from Hawaii were naive to Toxicodendron species. RESULTS: No cross-reactivity occurred in patients who were Philodendron sensitive and Toxicodendron naive when tested to the homologous Toxicodendron catechols. Conversely, with one exception, no cross-reactivity occurred in patients who were Toxicodendron sensitive and Philodendron naive when tested to homologous Philodendron naive when tested to homologous Philodendron resorcinols. CONCLUSION: Patients who are sensitive to Philodendron species (or other resorcinol-containing plants) may not necessarily be cross-sensitive to Toxicodendron species and vice versa.