Impact of immunoreactive substances contained in apheresis platelet concentrate on postoperative respiratory function in surgical patients receiving platelet transfusion: a prospective cohort study.

OBJECTIVES: To construct an alternative policy for the donor selection of platelet concentrate (PC), a clinical study exploring the features of lung injury following PC administration is needed. BACKGROUND: Although a male-donor-only policy for plasma products appears to have efficiently reduced transfusion-related acute lung injury (TRALI), this policy may not be applied to PC because of supply shortages. METHODS AND MATERIALS: We prospectively examined pulmonary function after the transfusion of PC in informed surgical patients treated at a tertiary university hospital in Japan. The contributions of immunoreactive substances contained in the PC to respiratory function after PC transfusion was then statistically examined. RESULTS: Eighty-six patients (56 men, 30 women) were enrolled in the analysis. Fifty-four cases experienced respiratory failure (PaO2 /FiO2 <300 mmHg) after transfusion. Five cases were diagnosed as possible TRALI based on permeability pulmonary oedema, while 23 cases were diagnosed as transfusion-associated circulatory overload (TACO) based on chest radiograph findings. A multivariate logistic regression analysis identified the presence of anti-granulocyte antibody as a significant predictor of possible TRALI [P = 0.023; odds ratio (OR), 13.0; 95% confidence interval (CI), 1.4-118.3]. Meanwhile, anti-leukocyte antibody class II was identified as a significant independent predictor of TACO (P = 0.010; OR, 18.4; 95% CI, 2.0-170.1). CONCLUSIONS: Our data suggest that antibodies contained in PC may contribute to the deterioration of respiratory function after PC transfusion, although the diagnoses of TACO and TRALI may have overlapped among the patients with pulmonary distress in this cohort.

Changes in some marker enzyme activities of liver plasma membranes during regeneration after partial hepatectomy in rats.

Liver plasma membranes were isolated from regenerating rat livers between 20 h and 10 days after partial hepatectomy in order to study the effect of partial hepatectomy on some membrane enzyme activities. Mg2+-ATPase (EC 3.6.1.4) activity, but not (Na+ + K+)-ATPase activity, decreased slightly at 2 days, whereas leucyl beta-naphthylamidase (EC3.4.1.1) and 5'-nucleotidase (EC3.1.3.5) activities increased considerably at 1-2 and 3-5 days, respectively. These changes were not parallel to a sharp increase in mitotic activity of liver cells which occurred at 36 h.

Laboratory diagnosis of toxigenic Clostridium difficile by polymerase chain reaction: presence of toxin genes and their stable expression in toxigenic isolates from Japanese individuals.

Clostridium difficile causes pseudomembranous colitis and antibiotic-associated diarrhea. The definitive diagnosis of C. difficile infection is finally accomplished by the isolation of toxigenic C. difficile. However, only a small number of Japanese clinical laboratories are able to reach a definitive diagnosis of C. difficile infection, probably because simple reliable assays for toxins in the isolates are not available. In this study, we examined the compatibility of a polymerase chain reaction (PCR) assay and tissue culture assay to identify toxigenic C. difficile, in toxigenic and nontoxigenic C. difficile isolates from Japanese patients and healthy carriers. The specificity of PCR primers was demonstrated by restriction endonuclease digestion and seminested PCR in C. difficile VPI 10463 strain. No PCR product was amplified in the eight other clostridial species used to check the specificity of the PCR assay. The detection limit was 10(3) cells. Both toxin A and toxin B genes (the genes encoding the major virulence factors of C. difficile) were detected in 58 toxigenic C. difficile isolates, which showed a wide range of cytotoxic activity in tissue culture assays. Neither of the toxin genes was carried by 40 nontoxigenic strains of C. difficile. The results of this study strongly suggest that a definitive diagnosis of C. difficile infection can be accomplished by PCR detection of the toxin genes rather than by tissue culture assay of isolates.

Survey of residual tetracyclines in kidneys of diseased animals in Aichi Prefecture, Japan (1985-1997).

A survey was conducted to determine the incidence of tetracycline antibiotic (TCAs) residues in the kidneys of slaughtered animals that did not pass inspection for human consumption by the Japanese Food Sanitation Law and the Meat Inspection Law at the slaughterhouses in Aichi Prefecture, Japan, from April 1985 to March 1998. The kidneys were analyzed by the AOAC Official Method 995.09. Among 424 animals (147 cattle and 277 pigs), 131 (30.9%) were contaminated with TCAs, including 69 (16.3%) with chlortetracycline (CTC), 61 (14.4%) with oxytetracycline (OTC), 3 (0.7%) with tetracycline (TC), and 1 (0.2%) with doxycycline (DC). One sample (cattle kidney) was contaminated with both OTC and DC. The frequencies of OTC and TC residues were significantly higher (p < 0.05) in cattle than in pigs, whereas, the frequency of CTC was significantly higher (p < 0.01) in pigs. Pig kidney samples collected in 1991-1997 had significantly higher incidences of TCAs and CTC (p < 0.01) residues than those in 1985-1986.

Selection of scientific periodicals to monitor drug safety information using Excerpta Medica and Japicdoc in the post marketing surveillance of drugs.

In order to select important journals to be monitored for efficient collection of literature information on drug safety, a retrospective search was made of the safety information in the Excerpta Medica (EM) database between 1979 and 1981. The search provided 54,005 references to drug safety, which were found in a total of 2,536 journals. Fifty percent of the references appeared in only 148 journals, or 6% of all journals surveyed. A similar search, carried out using the Japicdoc (JD) database, provided 9,268 references in 172 journals. To cover all the necessary information appearing in overseas journals, however, a retrospective search of a bibliographic database is required as a cost-effective means to improve the comprehensiveness of the collection of information. In domestic journals, because JD includes fewer journals than EM, all of the 172 journals can be monitored for the collection of drug safety information.

[Interdural dermoid cyst of the cavernous sinus presenting with oculomotor palsy: case report].

A 19-year-old female was admitted to our hospital because of diplopia. Neurological examination showed slight anisocoria (right > left), disturbance of ocular movement in upward, downward and medial directions on the right side, and diplopia on upward gaze. Computed tomography (CT) scan demonstrated a well-demarcated cystic lesion in the right parasellar region. The lesion showed non-homogeneous low intensity with a high intensity margin on T1-weighted imaging and high intensity with a low intensity margin on T2-weighted imaging in magnetic resonance image (MRI). The lesion showed enhancement by contrast media on neither CT nor MRI. Cerebral angiography revealed no tumor stains. The lesion was approached via right fronto-temporal craniotomy. The right optic nerve, oculomotor nerve and internal carotid artery were compressed medially by the tumor. The tumor contents appeared to be flaky and greasy containing motor-oil-like fluid, mineralized body, and a few hairs. The tumor was attached to the lateral wall of the right cavernous sinus (inner membranous layer), but was totally resected with careful microscopic dissection. The histopathological examination confirmed the diagnosis of dermoid cyst. The patient's complaint of diplopia showed gradual improvement postoperatively. Supratentorial intracranial dermoid cyst is a rare congenital tumor and, to our knowledge, only one case arising within the lateral wall of the cavernous sinus and presenting oculomotor palsy has been reported. Total removal is ideal and may be possible even when the tumor arises from the lateral wall of the cavernous sinus.

[A case of gastric cancer with multiple liver metastasis responding to combined chemotherapy with low-dose cisplatin and 5-fluorouracil].

A 68-year-old man who had Borrmann type 4 gastric cancer with multiple liver metastases was admitted to our hospital on October 20, 1998. He was considered nonresectable and placed on neoadjuvant chemotherapy consisting of low-dose CDDP and 5-FU. After 9 weeks of administration, the liver metastases had disappeared on abdominal computed tomography, but the primary lesion had progressed. On May 12, 1999, a total gastrectomy with a partial resection of the transverse colon and resectional biopsy of a white nodule of the liver were performed. This was a non-curative operation because of the peritoneal dissemination. A histopathological examination of the liver nodule revealed that the cancer cells had disappeared. The patient had an uneventful postoperative course and 4 weeks of chemotherapy were added. He remains alive with no symptoms or re-growth of the liver metastatic tumor 4 months after the surgery.