Effect of warming and flow rate conditions of blood warmers on red blood cell integrity.

BACKGROUND AND OBJECTIVES: Fluid warmers are routinely used to reduce the risk of hypothermia and cardiac complications associated with the infusion of cold blood products. However, warming blood products could generate haemolysis. This study was undertaken to compare the impact of temperature of blood warmers on the per cent haemolysis of packed red blood cells (RBCs) heated at different flow rates as well as non-flow conditions. MATERIALS AND METHODS: Infusion warmers used were calibrated at 41·5°C ± 0·5°C and 37·5°C ± 0·5°C. Cold RBC units stored at 4°C in AS-3 (n = 30), aged 30-39 days old, were divided into half units before being allocated under two different scenarios (i.e. infusion pump or syringe). RESULTS: Blood warmers were effective to warm cold RBCs to 37·5°C or 41·5°C when used in conjunction with an infusion pump at flow rate up to 600 ml/h. However, when the warmed blood was held in a syringe for various periods of time, such as may occur in neonatal transfusions, the final temperature was below the expected requirements with measurement as low as 33·1°C. Increasing the flow with an infusion pump increased haemolysis in RBCs from 0·2% to up to 2·1% at a flow rate of 600 ml/h regardless of the warming device used (P < 0·05). No relevant increase of haemolysis was observed using a syringe. CONCLUSIONS: The use of a blood warmer adjusted to 41·5°C is probably the best choice for reducing the risk of hypothermia for the patient without generating haemolysis. However, we should be cautious with the use of an infusion pump for RBC transfusion, particularly at high flow rates.

Role of glutathione redox cycle and catalase in defense against oxidative stress induced by endosulfan in adrenocortical cells of rainbow trout (Oncorhynchus mykiss).

The role of antioxidants in maintaining the functional integrity of adrenocortical cells during in vitro exposure to endosulfan, an organochlorine pesticide, was investigated in rainbow trout (Oncorhynchus mykiss). Aminotriazole (ATA), an inhibitor of catalase (CAT), L-buthionine sulfoximine (L-BSO), an inhibitor of glutathione (GSH) synthesis, and N-acetyl cysteine (NAC), a glutathione precursor, were used to investigate the role of CAT and GSH redox cycle in protection against the adrenal toxicity of endosulfan, a pesticide that impairs cell viability (LC50 366 microM) and cortisol secretion (EC50 19 microM) in a concentration-related manner. Pretreatment with ATA and L-BSO enhanced the toxicity of endosulfan (LC50 and EC50, respectively, 302 and 2.6 microM with ATA, 346 and 3.1 microM with L-BSO), while pretreatment with NAC had no significant effect on cell viability and increased the EC50 of endosulfan to 51 microM. CAT activity was significantly reduced following exposure to endosulfan when cells were pretreated with ATA. Pretreatment with L-BSO significantly decreased glutathione peroxidase (GPx) activity and reduced glutathione (GSH) levels in a concentration-related manner following exposure to endosulfan, while GSH levels were significantly higher in NAC pretreated cells compared to untreated cells. Finally, pretreatment with ATA and L-BSO increased, while pretreatment with NAC decreased, lipid hydroperoxides (LOOH) levels. CAT, GPx, and GSH were identified as important antioxidants in maintaining the function and integrity of rainbow trout adrenocortical cells and ATA, L-BSO, and NAC were identified as effective modulators of CAT and GSH redox cycle. Moreover, this study suggests that the glutathione redox cycle may be more efficient than catalase in protecting adrenocortical cells against endosulfan-induced oxidative stress.

Oxidative stress and loss of cortisol secretion in adrenocortical cells of rainbow trout (Oncorhynchus mykiss) exposed in vitro to endosulfan, an organochlorine pesticide.

The effects of endosulfan, a widely used organochlorine pesticide, on cortisol secretion, cell viability, antioxidants and lipid peroxidation were investigated in enzymatically dispersed head kidney cells of rainbow trout (Oncorhynchus mykiss). ACTH- and dbcAMP-stimulated cortisol secretion, and cell viability were impaired in a dose-related manner following acute in vitro exposure to endosulfan (EC(50) 19 microM, LC(50) 366 microM) and the loss of cortisol secretion was detected even at concentrations of endosulfan that did not decrease cell viability. Stimulation with dbcAMP did not restore cortisol secretion in endosulfan exposed cells while stimulation with pregnenolone maintained cortisol secretion until viability of cells was affected. Thus endosulfan may disrupt processes between the step generating cAMP and the step where pregnenolone is used. Activity of catalase increased at concentrations of endosulfan that did not impair cortisol secretion, and decreased at higher doses. Glutathione peroxidase (GPx) activity was significantly reduced at doses of endosulfan that also reduced levels of glutathione, an essential cofactor of GPx. Exposure up to 1 x 10(-7) M endosulfan increased the activity of glutathione transferase. The present in vitro study identified endosulfan as a chemical inducing a loss of secretory responses in teleost adrenocortical steroidogenic cells and alterations in the activity of enzymes known to be involved in oxidative stress pathways. Moreover, the significant increase in lipid hydroperoxides levels provided further evidence for endosulfan-induced oxidative stress.

[Darier's erythema annulare centrifugum of neonatal onset with a 15 years' follow-up. Efficacy of interferon and role of cytokines]. / Erythème annulaire centrifuge de darier à ddebut néonatal avec 15 ans de suivi. Efficacité de l'interféron et rôle de cytokines.

INTRODUCTION: Darier's erythema annulare centrifugum (EAC) is a disease of unknown etiology. Some observations of EAC in infancy suggest a better prognosis for early EA. The observations presented herein gives different information regarding prognosis and pathogenesis. OBSERVATION: A child presents with typical lesions of EAC from early infancy up to the age of 15 years. Laboratory data are normal. Similar lesions were locally reproduced by intradermal injection by candidine but antifungal drugs were unsuccessful. Many antiinflammatory treatments failed to improve the disease. Because of the improvement during hyperthermic episodes, a treatment by subcutaneous interferon alpha (2 millions U 3 times a week) was given for six months with a dramatic success (with seric increase of TNF alpha and IL2) DISCUSSION: The long term duration of EAC suggests that EA of infancy may represent the early beginning of Darier's EAC. The efficacy of interferon suggests that cytokines are involved in the pathogenesis of EAC.

Measuring higher cognitive levels by multiple choice questions: a myth?

Available evidence is inconclusive as to the ability of multiple choice items to measure different taxonomic levels of the cognitive domain. The present study analysed the tests of the Examen de Synthèse for the years 1982, 1983 and 1984. Items used in the study were those for which a consensus was reached between three judges and committees for a given taxonomic level. The initial part of the study showed that judges do not classify items at random but according to a mental representation which is individual, personal and relatively stable. In examining results obtained by students, the study failed to show any significant difference in item difficulty or discrimination for items classified as measuring memorization, interpretation of data and problem-solving. Correlations between results (scores and ranks) obtained for items involving memorization and those obtained for items involving higher cognitive levels fail to show that different traits are measured. If further studies corroborate these results, then future efforts should be directed at developing other instruments to measure higher cognitive levels.

A study of familial lupus erythematosus-like disease and hereditary angio-oedema treated with danazol.

Immunological and genetic studies were performed in a family in which the mother and five siblings had hereditary angio-oedema (HAE). LE cells, antinuclear factors, antibodies to double-stranded DNA and positive direct Coombs' test were not found in any of the subjects. One female sibling had a lupus erythematosus-like illness with skin lesions of the face which responded to danazol treatment. Laboratory evidence of HAE was obtained in the entire kindred and all the siblings shared HLA haplotype AIB7 inherited from the deceased mother.

[Antiperinuclear factors in psoriasis. Correlation with other serological abnormalities in 90 patients]. / Anticorps anti-périnucléaires dans le psoriasis. Recherche d'une corrélation avec les autres anomalies sérologiques chez 90 malades.

Antiperinuclear factors (APF), studied in 90 patients suffering from psoriasis, were found in psoriasis without arthritis, in psoriasis with psoriatic arthritis and in psoriasis with true rheumatoid arthritis (RA): respectively 57, 36 and 43 p. 100. Patients with APF did not differ from patients without APF apart form rheumatoid factors detected by indirect immunofluorescence. They were much more frequent in psoriasis with APF. These results are compared with those of RA. They lead to look for other auto-antibodies in psoriasis.

[Accidental localized vaccinia. A report of six recent cases (author's transl)]. / La vaccine accidentelle localisée. A propos de six observations récentes.

Vaccination against smallpox should be discontinued in all countries except for individuals with a high risk of exposure (WHO, 1980). Since this vaccination is performed less and less often, one must expect complications to occur, the etiology of which may not be recognized. This course of events leads the authors to point out the difficulties in diagnosis and therapy of localized accidental vaccinia encountered in six patients hospitalized in Brest (1971-1979). Diagnosis is considered if the patient himself, or a person he came in contact with, was recently vaccinated. Diagnosis should always be established by virology. Such accidents can be avoided by a faultless vaccination technique and by giving sufficient information to the inoculated subject or to his relatives.

[Acquired ichtyosis and bronchial cancer; report on two cases (author's transl)]. / Ichtyose acquise et cancer bronchique. A propos de deux nouvelles observations.

Acquired ichtyosis appears to be a rather rare paraneoplasic syndrome, mainly observed during the course of Hodgkin's disease, but also accompanying visceral cancers. Two cases of generalised ichtyosis in patients with bronchial carcinoma are reported, emphasis being placed on the need for systematic investigations to determine this possible aetiology. Diagnostic problems are discussed, as well as hypotheses concerning the pathogenicity of these affections, which is still obscure, emphasis being placed on the secretory potential of these tumours and the role of immunological phenomena.

[Two cases of skin pigmentation in association with minocycline therapy (author's transl)]. / Deux cas de pigmentation cutanée au cours de traitements par la minocycline.

Report of two cases of skin pigmentation during minocycline therapy. Examination showed confluent blue-gray oval patches on the anterior part of the legs, occurring after ingestion of respectively 12 g and 100 g of minocycline. Microscopic examination of each case was identical and showed two lesions: increase in the amount of melanine deposition in the basal layer of the epidermis; presence of brown-black pigment at all the level of the dermis but specially near the sweet glands. This pigment was strongly positive with Perls' stain. Electron microscopic examination showed a finely granular pigment exclusively intracellular in dermis fibroblast and macrophage. This pigment seemed to contain mainly hemodiderine.

[Diphtheria epidemic occurring on the North Shore of the St. Lawrence River in the fall of 1974]. / Epidémie de diphtérie survenue sur la Côte Nord du St-Laurent à l'automne de 1974

An outbreak of diphtheria occurred on the North Shore of the St. Lawrence River at the beginning of September 1974. It started with the death of an 18-year-old forest worker Sept. 5, spread over a vast area of the North Shore and lasted until the end of October that year. Eleven strains of toxigenic Corynebacterium diphtheriae intermedium, type K were isolated. Eleven of the 12 patients had characteristic diphtheritic pharyngitis with pseudomembranes. Preventive measures, set forth immediately after the third case was declared, included the following: (a) daily surveillance of all contacts, (b) isolation or preventive hospitalization of persons with all types of pharyngitis, (c) mass vaccination of all susceptible persons and (d) search for healthy carriers of the germ. No strains of toxigenic C. diptheriae were isolated from patients preventively hospitalized or from the 1235 individuals among whom carriers were sought. Among the main characteristics of this epidemic, the mean age of the patients (17 years), their mobility and their habits are factors that could have made it almost uncontrollable. It is also remarkable that this outbreak occurred in such a scattered population of adolescents, in 82% of whom the Schick test was negative.

[Atypical achondrogenesis. Review of the literature apropos of 2 cases]. / Formes frustes de l'achondrogénése. Revue de a littérature á propos de deux cas

The authors describe two cases of a minor form of achondrogenesis. This form has not been published previously. A discussion of the different possibilities of differential diagnosis follows.