Procoagulant microparticles in dogs with immune-mediated hemolytic anemia.

BACKGROUND: Studies of some human prothrombotic diseases suggest that phosphatidylserine-positive (PS+) and tissue factor-positive (TF+) microparticles (MPs) might play a role in the pathogenesis of thrombosis or serve as biomarkers of thrombotic risk. HYPOTHESIS/OBJECTIVES: To determine if circulating levels of PS+MP and procoagulant activity (PCA) associated with PS+MPs and TF+ MPs are increased in dogs with IMHA. ANIMALS: Fifteen dogs with primary or secondary IMHA and 17 clinically healthy dogs. METHODS: Prospective case-controlled observational study. Circulating PS+MPs were measured by flow cytometry. PCA associated with PS+MPs and TF+MPs was measured by thrombin and Factor Xa generating assays, respectively. RESULTS: Circulating numbers of PS+MPs were not significantly higher in dogs with IMHA [control median 251,000/µL (36,992-1,141,250/µL); IMHA median 361,990/µL (21,766-47,650,600/µL) P = .30]. However, PS+MP PCA [control median 2.2 (0.0-16.8) nM PS eq; IMHA median 8.596, (0-49.33 nM PS eq) P = .01] and TF+MP PCA [control median 0.0, (0.0-0.0 pg/mL); IMHA median 0.0; (0-22.34 pg/mL], P = .04) were increased. Intravascular hemolysis, which we showed might increase PS+ and TF+MP PCA, was evident in 3 of 5 dogs with PS+MP PCA and 2 of 4 dogs with TF+MP PCA higher than controls. Underlying disease in addition to IMHA was detected in 1 of 5 dogs with PS+PCA and 3 of 4 dogs with TF+MP PCA higher than controls. CONCLUSIONS AND CLINICAL IMPORTANCE: TF+ and PS+MP PCA is increased in some dogs with IMHA. Further studies that determine if measuring TF+ and PS+ MP PCA can help identify dogs at risk for thrombosis are warranted.

Genetic diversity and biochemical characteristics of Trichosporon asahii isolated from clinical specimens, houses of patients with summer-type-hypersensitivity pneumonitis, and environmental materials.

Trichosporon asahii, which is distributed in the environment, is the major causative agent of the opportunistic infection trichosporonosis, and it also causes summer-type hypersensitivity pneumonitis (SHP). Random amplification of polymorphic DNA analysis was used to determine the intraspecies diversity of 39 T. asahii isolates from clinical specimens, SHP patients' houses, and environmental materials. The three primers used revealed 46 polymorphic bands. A phenogram was generated by the unweighted pair-group method with arithmetic mean. Clinical isolates formed a cluster, characterized by a 90% matching coefficient, but they did not cluster with strains isolated from SHP patients' houses or environmental sources. In addition, the biochemical characteristics of 86 strains from three sources were examined with 31 compounds using an ID32C kit, and a phenogram was constructed. The phenogram consisted of three major clusters. Cluster I included most of the clinical SHP isolates, and cluster II included most of the environmental isolates. Cluster III contained only one strain. A remarkable difference was found in the abilities of the strains belonging to clusters I and II to utilize six compounds. These results suggest that the genetic diversity and biochemical characteristics of T. asahii seem to be related to the source of the isolate. We also found a specific DNA fragment for the clinical isolates and strains isolated from SHP patients' houses.

Identification and the role of soluble antigens detected in bile from Eimeria stiedai-infected rabbits.

Antibodies against Eimeria stiedai sporozoites and merozoites were detected in the sera of rabbits immunized with bile obtained from infected rabbits on the 15th day post-infection. The trails made by gliding sporozoites were also detected by the sera. After penetration into the host cell, an antibody-binding region was observed on the parasitophorous vacuole membranes of the parasites. Rabbits administered a combination of the bile and cholera toxin shed fewer oocysts in the feces after infection than control rabbits. The immunized rabbits developed a high level of IgA antibody against soluble antigens in the bile. By immunoblotting, antigens with molecular masses of 32, 37, and 49 kDa were detected in the bile obtained from infected rabbits on the 15th day postinfection. Absorption treatment with sporozoites reduced or abolished the antibody reactivity to the 32-kDa antigen of merozoites and the bile antigens. However, antibody reactivity to the 37- and 49-kDa antigens still remained. These results indicate that soluble antigens are present in the bile of rabbits in the acute phase of infection, and these may be produced and released by merozoites during the host cell invasion process.

[A case report of the patient at a terminal stage of stomach cancer, who had a visiting nurse].

We have started the visiting nurse system in our Kimitsu Central Hospital since September 1990, and have currently had 33 patients with 4 visiting nurses as of February 2001. Out of these 33 patients with the visiting nurse system, 9 patients are at a terminal stage of diseases. In the present study, we reported here a case of a 63 year-old female patient, who was at a terminal stage of stomach cancer and wished to have a regular home life, having a visiting nurse at home. The patient was not informed of her diagnosis as a cancer, but was convinced of her symptoms by her primary care physician that she was under a good care. Meanwhile, the patient showed less pain than that she was expected to have as a patient at the terminal stage of cancer. A daughter of the patient (actual caretaker) was first considering of hospitalization as an inpatient. However, since the patient strongly desired to stay and get care at home, the caretaker started a dual life of taking care of her mother at home and of raising children in parallel, in aware of a case of pronouncing death at home. While the patient's condition was relatively stable, the good quality of life (QOL) was maintained as she could make a trip of one-night stay. As the symptom progressed, however, the caretaker had a high anxiety with a pressure of accepting her own mother's death. On the other hand, a visiting nurse, who understood the patient's strong desire to stay at home and live her life as usual, also assisted in reducing the caretaker's high anxiety. Therefore, the visiting nurse basically assumed one possibility that the patient would die at home, but also prepared for the another possibility that the caretaker could choose to send her mother back to hospital whenever she felt her limit for being a caretaker. Moreover, the visiting nurse supported the patient and her family with an encouragement that they could live their favorable life till the end. As a result, the caretaker could continue to keep the patient at home, although she had a tremendous fear about taking care of her at home. When the patient's condition suddenly changed and got worsened, however, the caretaker desired to have her mother stay and get medicated in the hospital. Thus, the patient was sent to our hospital by ambulance. Although the caretaker did not have her mother die at home under her direct care, she recognized the great advantages in having a visiting nurse, who really assisted them well. Thus, it was confirmed that participation of a visiting nurse in the home healthcare could give the patient and her family a better, satisfactory life till the end. In general, although the patients or their family members wish to stay home and to have a home healthcare service, their desire or mind can be easily changed according to their situation. Especially in a case of the patient at a terminal stage, the family can be easily influenced by the condition of progression of the disease. One of the major roles of visiting nurses is always to understand the feelings of the patients and family and to prepare for the best as they can.

Ultrasound evaluation of the parathyroid glands in two hypercalcemic cats.

Two parathyroid masses were identified using ultrasound in two hypercalcemic cats. The masses were identified as parathyroid adenomas on surgical biopsy. Both parathyroid masses contained hypoechoic regions with distal acoustic enhancement. Both masses were greater than 1.0 cm in diameter.

[Visiting nurse for a terminal ALS patient].

The authors' hospital is a 585-bed hospital under the direct management of the National Health Insurance System. The hospital has been providing visiting nurses for the past 8 years, who work from local medical centers and the Visiting Nurses Department. Thirty-seven patients have received such home care, among whom 8 had intractable disease. Patient S was a 46-year-old woman who suffered from amyotrophic lateral sclerosis (ALS). The onset of the disease was in April, 1993, when the patient experienced muscular atrophy in both legs and deteriorating muscular strength. The diagnosis was definitive in 1995. On March 1, 1998, the patient received emergency hospitalization for breathing difficulties and aspiration pneumonia, and on March 5 underwent tracheotomy. A cannula had to be inserted for tubal feeding, and the physician in charge explained to her family that her prognosis was 3 months. Both the patient and her family desired home care, and the patient returned home on April 11. Respecting the wishes of the patient, the visiting nurse provided support so that home treatment could be continued. In the end, the patient lived at home while receiving home treatment for 7 months. Through the support provided by the visiting nurse, efforts were made to keep the patient's condition stable, and she was able to continue home treatment and living at home for a higher quality of life.

[Rethinking the visiting nurse system at a major regional hospital].

The authors' hospital is a National Health Insurance System Hospital near four cities. It serves as the central hospital for a region with a population of about 330,000 people. The hospital has 585 beds and sees an average of 1,500 outpatients each day. The average number of hospitalized patients each day is 500. Its visiting nurse department is located in a regional medical center and functions as a "Visiting Nurse Center". The purpose of the present study was to review the visiting nurse system at our hospital that has been operating for the past 8 years. The motivation for this review was our intention to actively increase the number of people advantage of such services, and attempt to provide continuous care for each individual patient. By looking back on the system as it has been practiced, its procedures, and results during the 8 years from 1990 to 1997, we can consider points for improvement from among the problem points discovered. The problems uncovered in our practice of home nursing care are listed below. 1. It is difficult to present a list with an estimated period for the release from the hospital. 2. Instructions for leaving the hospital are not sufficiently detailed. 3. Arranging the schedule and actual visits for diagnosis and treatment is complex. 4. The system for cooperation with the activities that are done in the hospital is insufficient. 5. The system for cooperation with local public health nurses is insufficient. 6. The system for managing equipment is insufficient. 7. The 24-hour support system for terminal patients is inadequate.

[Improved quality of life (QOL) in terminal renal carcinoma patients through home nurse visitation: some considerations].

Ours is a general hospital administered directly by the government. There are 585 beds and some 1,200 outpatients on average per day. Visits by home nurses began in September of 1990, and beginning in April of 1994 a home nursing department has been in place at the Community Medical Center. There are 5 persons in charge of the visits. Home visits are paid to 40 patients at present on an ongoing basis. In recent years, malignant diseases have been increasing, and there has been much discussion devoted to the quality of life (QOL) of the patients. In 1994, 15 of the 60 patients visited had malignant diseases. Presently, a 63-year-old female patient with terminal kidney cancer is receiving HPN. Thanks to home nursing visits, she has been able to be discharged. This patient had been receiving home nursing visits from December 21, 1993 until June 20 of 1994 at the rate of 2 visits per month. The person in charge gave guidance for HPN management, and the patient began to regain her pre-hospitalization life and a sense of her role in her family and society. As a result, though she had not actively fought the disease while in the hospital, she gained confidence with the HPN, and with her husband's help, she became a Culture School teacher, resumed her role in society and found her life meaningful. Since there were limits to her husband's ability to care for her, she agreed to enter the hospital again, but was able to continue meaningful life at home for 6 months with assistance from a caregiver, and thus achieved a high QOL.