[Diagnostic image (385). An adolescent with a painful knee]. / Diagnose in beeld (385). Een adolescent met een pijnlijke knie.

A 15-year-old adolescent sustained a left tuberositas tibiae avulsion fracture after a jump.

[Diagnostic image (312). A man with abdominal pain in the right upper quadrant]. / Diagnose in beeld (312). Een man met pijn rechts boven in de buik. Aanvoerende-lissyndroom.

A 79-year-old man had a complication of gastric surgery after 45 years: afferent-loop syndrome after a Billroth II partial gastrectomy.

[Diagnostic image (313). A woman with peracute abdominal pain in the right lower quadrant]. / Diagnose in beeld (313). Een vrouw met peracute buikpijn rechtsonder. Bloeding uit een corpus rubrum.

A 29-year-old woman presented with peracute pain in the right lower quadrant of her abdomen, which at diagnostic laparoscopy appeared to be related to hematoperitoneum caused by bleeding ofa corpus rubrum.

[Gas configuration between the liver and the right diaphragmatic dome: Chilaiditi's sign]. / Gasconfiguratie tussen de lever en de rechter diafragmakoepel: teken van Chilaiditi.

A 64-year-old man of Hindustan origin presented at the Emergency Department with symptoms which suggested stomach perforation. A chest X-ray taken with the patient in the upright position showed gas between the liver and the right hemidiaphragm. After 30 minutes the pain subsided spontaneously. The gas seen on the chest X-ray was diagnosed as Chilaiditi's sign, caused by interposition of the colon between the liver and the diaphragm. This interposition is usually asymptomatic and does not require surgical treatment.

Transfusion-associated transmission of babesiosis in New York State.

BACKGROUND: Babesiosis can be life-threatening in immunocompromised individuals. Although the disease is usually transmitted by tick bite, more than 20 cases have been reported of infection transmitted by transfusion of blood or blood components obtained from apparently healthy donors from endemic areas in the United States. This report describes several recent cases of transfusion-transmitted babesiosis in New York State. STUDY DESIGN AND METHODS: Transfusion-associated incidents of babesiosis infection were identified and investigated. Seroprevalence of babesiosis in healthy blood donors in a highly endemic area was ascertained. RESULTS: In three incidents, babesiosis was diagnosed in five of eight patients given infected blood: two premature infants, an elderly patient with gastrointestinal bleeding, and two patients with thalassemia. Seroprevalence in blood donors on Shelter Island (Suffolk County, eastern Long Island), a highly endemic area, was 4.3 percent in May 1998. CONCLUSIONS: Infected donors lived in endemic areas and were asymptomatic with no history of tick bite. Blood collected in January 1997 from one donor was infectious. Those transfusion recipients who were infected were neonatal, elderly, or chronically transfused patients. Babesiosis should be included in the differential diagnosis of febrile illness in immunocompromised recipients of blood transfusion, particularly in the Northeastern United States.

An overview of state efforts to improve transfusion medicine. The New York state model.

OBJECTIVE: New York State must provide effective oversight for more than 400 facilities that provide blood services, ensuring the safety of transfusion recipients. PROGRAM STRUCTURE: Oversight is based on educated, trained program staff; a council of transfusion medicine experts; regulations governing laboratories and blood banking services; proficiency testing; requirements for reporting transfusion-related errors and incidents; tracking collection, testing, and disposition of all blood; inspections; partnership with the Food and Drug Administration; and investigation of incident reports. Policy letters and guidelines (eg, umbilical cord blood, transfusion-associated infections, intraoperative blood recovery) supplement regulations. OBSERVATIONS: Standards are maintained through education by a responsive, proactive oversight program. Areas warranting stricter regulation or supplemental educational guidelines are identified by periodic assessment of standards of practice and review of reported information. CONCLUSION: The multifaceted oversight program contributes to efforts to improve transfusion medicine.

Isolation, crystallization, crystal structure analysis and refinement of constitutive C-phycocyanin from the chromatically adapting cyanobacterium Fremyella diplosiphon at 1.66 A resolution.

Constitutive phycocyanin from cyanobacterium Fremyella diplosiphon (Calothrix sp. PCC 7601) grown in green light, has been isolated and crystallized. The crystals belong to the space group R3 with cell constants a = b = 180.26 A, c = 61.24 A, alpha = beta = 90 degrees, gamma = 120 degrees. The crystal structure has been determined by Patterson search techniques using the molecular model of C-phycocyanin from the cyanobacterium Agmenellum quadruplicatum. The asymmetric unit of the crystal cell consists of two (alpha beta)-monomers related by a local dyad. Three asymmetric units are arranged around a crystallographic triad and form an (alpha beta)6-hexamer, the functional unit in the native antenna rod. The initial structure has been refined in a cyclic manner by energy-restrained crystallographic refinement and modelling until the conventional crystallographic R-factor converged at 18.1% with data to a resolution of 1.66 A. The molecular structure resembles closely the C-phycocyanins of Mastigocladus laminosus and A. quadruplicatum. The conformation and configuration of the alpha-84 and beta-84 chromophores is very similar to the corresponding chromophores in the trimeric C-phycocyanin of M. laminosus, whereas the beta-155 chromophore differs in configuration with C(4)-Z, C(10)-Z and C(15)-Z compared to C(4)-Z, C(10)-Z, C(15)-Z,E. The stereochemistry of the beta-155 chiral centres is C(2)-RC(3)-R and C(31)-S, respectively, whereas alpha-84 and beta-84 have C(2)-RC(3)-R and C(31)-R. The amino acid sequences of constitutive and inducible phycocyanin differ mainly in residues located on the surface of the beta-subunits that mediate the inter-hexameric contacts.

EPAP without intubation.

The early institution of end expiratory pressure has been demonstrated frequently to be beneficial in acute respiratory failure. EPAP without intubation allows early therapy while avoiding the complications associated with the high flow rates utilized with CPAP. Three patients are described, illustrating the administration of EPAP for mild ARDS, aspiration penumonia, and postoperative atelectasis.

Continuous positive airway pressure in the prophylaxis of the adult respiratory distress syndrome.

After an operation upon the abdomen, certain patients have a high risk of developing acute respiratory failure or the adult respiratory distress syndrome. These patients at high risk have been mechanically ventilated during the postoperative period in an attempt to prevent the onset of respiratory insufficiency. As a method of prophylaxis, continuous positive airway pressure has the advantages of increasing the functional residual capacity with minimal effects on the cardiac output, low potential for barotrauma and simplicity of equipment. Alternate patients at risk following an operation on the upper part of the abdomen were placed on 8 centimeters of water continuous positive airway pressure for the first 24 hours postoperatively. Fifty-six controls and 56 patients receiving continuous positive airway pressure were studied. In ten controls, adult respiratory distress syndrome developed, and three died in respiratory failure. Only one of the group receiving continuous positive airway pressure met standard criteria for the diagnosis of adult respiratory distress syndrome. In addition, in 25 patients serving as controls, respiratory complications other than adult respiratory distress syndrome developed compared with the development in only 11 receiving continuous positive airway pressure9

Continuous positive airway pressure in the prophylaxis of the adult respiratory distress syndrome (ARDS).

Alternate patients believed to be at risk for developing ARDS were placed on CPAP for the first twenty-four hours post upper abdominal surgery. Ten of the 58 controls developed ARDS, requiring prolonged mechanical ventilation with a 30% mortality rate. Only one of the 59 CPAP patients developed evidence of ARDS. This patient, however, is believed to have had fluid overload, and responded quickly to diuretics and was extubated within two days. Thus, prophylactic CPAP has greatly decreased our postoperative morbidity and mortality related to respiratory causes.

Evidence for a magnesium pump in Bacillus cereus T.

Unlike Escherichia coli, Bacillus cereus T appears to accumulate Mg(2+) in its cell sap against a concentration gradient. Over a range of Mg(2+) in the growth medium from 5 x 10(-5) to 1.35 x 10(-2)m, the concentration of Mg(2+) in the cell sap of B. cereus T was maintained at about 6 x 10(-3)m, and ribosome-bound Mg(2+) and spermidine, as well as the spermidine concentration in the cell sap, appear to be unaffected by the concentration of Mg(2+) in the growth medium. Inhibition of growth of E. coli by streptomycin is progressively reversed by increasing the concentration of Mg(2+) in the growth medium above 5 mm. The finding that similar increases of Mg(2+) in the growth medium did not reverse the inhibition of B. cereus T is also consistent with the conclusion that B. cereus T, unlike E. coli, accumulates Mg(2+) to a constant concentration in its cell sap.