Bone marrow biopsy in the diagnosis of fever of unknown origin in patients with acquired immunodeficiency syndrome

BACKGROUND: Fever is commonly observed in patients with human immunodeficiency virus (HIV) disease and frequently eludes diagnosis. The role of bone marrow biopsy in the diagnosis of fever of unknown origin in patients infected with HIV remains controversial. PATIENTS AND METHODS: One hundred twenty-three consecutive patients with 137 episodes of fever lasting 10 or more days without diagnosis after 1 week of hospitalization were evaluated by bone marrow biopsy. RESULTS: Overall, a specific diagnosis was achieved in 52 episodes by means of culture and histopathological examination (diagnostic yield, 37.9%). Three types of disease were found: mycobacterial infections (n = 36, 69% of documented episodes), including 18 patients with disseminated tuberculosis and 14 with Mycobacterium avium-intracellulare complex infections; non-Hodgkin lymphomas (n = 12, 23%); and visceral leishmaniasis (n = 4, 8%). Although bone marrow cultures were more sensitive than microscopic examination with special stains for the diagnosis of mycobacterial infections, the pathological examination of bone marrow led to a more rapid diagnosis of disease. In addition, the histopathological examination of bone marrow alone led to the diagnosis of a specific condition in 43 episodes (31.3% of all episodes). CONCLUSIONS: Bone marrow biopsy is a useful procedure for the diagnosis of fever in patients with advanced HIV disease, particularly in areas where tuberculosis and leishmaniasis are prevalent. Involvement of the marrow may be the first indication of the existence of extranodal non-Hodgkin lymphoma. For Mycobacterium avium-intracellulare complex infection, blood cultures were more sensitive than bone marrow biopsy.     

Microbiologic depuration of Anadara tuberculosa (Mollusca: Arcidae)

In Costa Rica the mollusk Anadara tuberculosa represents a risk for human health due to the contamination of the growing waters and the fact that its is consumed raw. The families depending on the income obtained through commercialization of these animals have a low education and economic status. Therefore, it is of great importance to develop and evaluate simple methods of depuration that could be easily used by these families to make these mollusks safe for consumption. Bottles containing 11 of saline solution (25g/l) were prepared in duplicates to test the bactericidal effect of acetic acid. The solution in each bottle was adjusted to ph 4.5, 5.0 or 5.5 or held at ph of 7.0 or 8.0 for the controls. The solution in each bottle was then inoculated with approximately 1 X 104 cfu/ml of coliforms. Counts of coliforms were determined for each bottle 0, 1, 2, 4 and 8 hours after inoculation. For the depuration studies, specimens with diameters ranging from 4.0 to 4.5 cm were collected from a harvester at the estuary of Puntarenas, Gulf of Nicoya. Fifty specimens each were depurated in separate tanks containing 25 1 of oxygenated saline solution adjusted with acetic acid to an initial ph of 4.5 (treatment) or non adjusted ph of 8.0 (control). Counts of Enterobacteriaceae were determined, in duplicates, every 12 hr for 48 hr. An additional fifty animals were depurated using the defined method and tested to determine if they met international standards of microbiological quality for aerobic plate count, Enterobacteriaceae count, Escherichia coli count and presence of Salmonella. A sensory evaluation using a triangle test was performed to compare a typical dish prepared with depurated or non-depurated animals. A significant coliform reduction was determined in a saline solution (25 g/l) at a pH range of 4.5 to 5.5. This reduction, during 8 hr, was higher in the acid treatments compared to the controls. During depuration, the elimination of Enterobacteriaceae bacteria was faster when acetic was used (initial ph = 4.5) than when it was not. This elimination was more important the first 24 hr, time defined as adequate for the application of the method. The method has the advantage of transforming the bivalve in a product that is safe for human consumption, since it guarantees that the international standards of microbiological quality, for raw and depurated mollusks, are reached. On the other hand, the sensory qualities of a typical dish prepared with depurated animals are not affected by the method, which can be easily implemented and applied by the people that work in the extraction of this mollusk.     

Stoichiometric dye-binding procedure for the determination of the reactive lysine content of soya bean protein

A new analytical method has been developed for the determination of the reactive lysine content of soya bean protein. The method is based on the reaction of the free basic groups of the protein with 1-phenylazo-2 naphthol-6,8 disulphonic acid. With regard to the stoichiometry of the procedure, it has been proved, contrary to earlier reports, that the basic amino acids, histidine, arginine and lysine, each combine with one mole of the dye. After acylation with propionic anhydride lysine alone loses its dye reactivity. The usefulness of the proposed method has been demonstrated by the determination of the reactive lysine content of several untreated, heat-treated and acid-treated soya bean samples. The results show that heat damage of about 5% in reactive lysine content can be measured in 1·5 h with good reproducibility.     

Crack growth in aluminium alloy sheet material under flight-simulation loading

Crack propagation tests were carried out on 2024-T3 sheet specimens to study the effects of omitting low-amplitude cycles from the gust-dominated TWIST load sequence (MiniTWIST) and the removal of small load ranges from the manoeuvre-dominated FALSTAFF load sequence (short FALSTAFF). In other tests high-amplitude loads of TWIST and MiniTWIST were truncated at different levels. The results are compared with data from similar test programmes, including crack initiation. Attention is paid to unstationary crack growth retardation and a transient retardation during initial crack growth started by an artificial crack.     

Multitemporal passive microwave mapping in MACHYDRO'90

MACHYDR0'90 was an experiment conducted in Pennsylvania in 1990 to study the synergistic use of remote sensors in multitemporal hydrologic studies. As part of this mission the pushbroom microwave radiometer was flown and used to produce brightness temperature maps. Verification studies and vegetation algorithms for mixed land cover areas are described     

Spontaneous hematoma of the transverse mesocolon

We describe a patient with aspergillosis of the maxillary antrum, and systemic affectation (anemia, anorexia, fever). Through a Caldwell-Luck approach, the maxillary antrum was opened and an irregular mass removed, postoperatively the patient has done well, disappearing in two months the ORL and systemic symptoms.     

Judgments of social justice: Compromises between equality and efficiency.

Political economists agree that a trade-off exists between equality and efficiency. Using a hypothetical society paradigm, the mean income (representing efficiency) and income variability (representing equality) of distributions of wealth and the correlation between wealth and effort within a society were manipulated. Ss made all pairwise comparisons of distributions within societies of differing meritocracy. A "maximin" principle best described trade-off resolution strategies when effort and outcome were weakly linked: People maximized the minimum standard of living within a society. A compromise principle best described preferences when income was tightly linked to effort: People rejected distributions in which some citizens fell below the "poverty line" but maximized efficiency above this constraint. Ideological polarization was pronounced under moderate meritocracy; here liberals could focus on the role of chance and conservatives on the role of effort and ability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Invasive angiology in acute arterial pathology in a critically ill newborn infant

Four patients who complained of symptoms and signs compatible with biliary tract disease and in whom the diagnosis of gallbladder (three cases) and common bile duct ascariasis (one case) was made sonographically are reported. In two patients with gallbladder ascariasis, cholecystectomy corroborated the presence of the round-worms, and was curative. The third patient was a pregnant woman (32nd gestational week) who took piperazine citrate, and a second sonogram performed 29 days later was completely normal. The fourth patient with common bile duct ascariasis underwent choledochotomy with extraction of one ascaris lumbricoides from the common duct, and a T tube was left in place for 15 days. All patients received antiparasitics and had a favorable outcome. Ultrasonography is an important noninvasive diagnostic procedure in the work-up of these patients, who usually describe a clinical picture suggesting gallstone disease: this is especially true in the presence of pregnancy.     

The molecular biology of bladder carcinoma

OBJECTIVE: The clinical course of transitional cell carcinoma of the bladder can be difficult to predict due to its potential to invade the muscle layer and/or develop to a high grade lesion. Bladder carcinoma can arise from genetic changes that may activate the oncogenes (-c-erbB2, c-erbB1, c-myc, ras, etc.) and/or inactivate the suppressor genes (p53, Rb). The aim of the present study is to continue a study protocol on the molecular biology of bladder tumors. METHODS/RESULTS: From January, 1993 to January, 1995, 85 patients were studied. These patients were divided into two groups: the first group comprised 14 controls of urothelial tissue and the second comprised 65 cases of transitional cell carcinoma of the bladder. p53 expression was determined by an immunohistochemical method (NCL-p53-DO7 monoclonal antibody). Quantification of the p8 oncoprotein in cytosol and EGFR (epidermal growth factor receptor) in membrane was performed by ELISA (Oncogene Science) and RIA (Vienna Lab), respectively. A statistically significant relationship between the expression of p53 and EGFR with tumor stage and grade was found. Quantification of p185 and EGFR showed higher values in the tumor tissue than in the control samples, but a worse survival could not be determined. CONCLUSIONS: The present study shows that p53 expression can be considered to be a prognostic factor. It provides useful information on the aggressive behaviour of the tumor and has a direct relation with the survival rates.