Epstein-Barr virus load for early detection of lymphoproliferative disorder in pediatric renal transplant recipients.

AIM: The aims of this study were to establish a protocol for monitoring Epstein-Barr virus (EBV) infection for identification of pediatric renal transplant recipients with a high risk of developing posttransplant lymphoproliferative disorder (PTLD) and to predict the development of PTLD. SUBJECTS AND METHODS: Peripheral blood mononuclear cells (PBMCs) and plasma EBV loads were measured by nested PCR (n-PCR) and real-time PCR (r-PCR) every 1 - 3 months after grafting in 17 pediatric recipients who were seronegative for EBV before grafting (4 with EBV-associated symptoms, including 2 with PTLD (Group A); 6 with asymptomatic persistent high EBV loads in PBMCs of > 1,000 copies/µgDNA for over 6 months (Group B); and 7 with neither EBV-associated symptoms nor persistent high EBV loads in PBMCs (Group C)). RESULTS: n-PCR revealed EBV-DNA in PBMCs from all patients. The EBV genome was present in plasma in 3 (75%), 1 (17%), and 0 (0%) in Groups A, B and C (p < 0.01 for A vs. B and A vs. C). EBV loads detected by r-PCR in PBMCs were significantly higher in Groups A (p < 0.05) and B (p < 0.01) compared to Group C. EBV genomes in plasma were detected by n- and r-PCR in only the 2 cases with PTLD. One patient with lymphadenitis in Group A and 1 patient in Group B had EBV-DNA in plasma based on n-PCR, but the viral loads using r-PCR were < 250 copies/ml. CONCLUSION: EBV loads in PBMCs alone are insufficient for predicting EBV-associated symptoms including PTLD. Plasma EBV loads (over 250 copies/ml) estimated by r-PCR may be useful to distinguish PTLD from other EBV-associated diseases or asymptomatic viremia.

Monitoring of Epstein-Barr virus load and killer T cells in pediatric renal transplant recipients.

AIM: The aim of this study is to establish a monitoring method to prevent Epstein-Barr virus (EBV)-associated symptoms including post-transplant lymphoproliferative disorder (PTLD) that occur after pediatric renal transplantation. SUBJECTS AND METHODS: Circulating EBV loads were quantified by real-time PCR every 1 - 3 months after grafting in 22 pediatric recipients (13 EBV-seronegative [R(-)] and 9 EBV-seropositive [R(+)] recipients before grafting). The peripheral blood cell populations of non-specific activated killer cells (CD8+HLA-DR+ phenotype) in 13 R(-) recipients and EBV-specific cytotoxic T cells (CTLs) reactive with a tetramer expressing HLA-A24-restricted EBV-specific antigens in 8 of 13 R(-) recipients were determined by flow cytometry. RESULTS: EBV-associated symptoms including PTLD (2 cases) were found in 4 R(-) and none of the R(+) recipients. The maximum of EBV load in the R(-) group was significantly higher that in the R(+) group. In R(-) recipients, 4 symptomatic cases had significantly more EBV genome than asymptomatic cases. EBV-specific CTLs were detected in 6 of the 8 R(-) recipients, but these CTLs could not be detected in 1 of the 2 cases at onset of PTLD. The percentage of CD8+HLA-DR+ cells was significantly higher in asymptomatic recipients than in recipients with EBV-associated symptoms whose EBV loads were over 400 copies/microg DNA. CONCLUSION: Monitoring of killer T cells and EBV loads may allow assessment of the risk of EBV-associated symptoms, and high EBV loads and low EBV-specific and/or non-specific CTL responses may be predictive for development of EBV-associated symptoms such as PTLD.

Some aspects of sleep disturbance in coronary patients.

Of 42 coronary care patients studied during 10 hr. of polygraphically recorded sleep, 28 were in an open-ward coronary care unit and 14 were in a semi-private telemetry unit. The observed sleep disturbances were not a function of type of unit, length of hospitalization, sex, or medications. Sleep was significantly less fragmented in those patients judged less severe in pathology. These results indicate that alterations in normal sleep patterns occur routinely within coronary care environments, even in the absence of disturbing environmental stimuli and suggest that a closer analysis be made of sleep in these settings in light of the known relationships between sleep and cardiac function.

[Experimental study of flow rates in microcatheters using various kinds of contrast materials: comparison of imaging capability by iodine delivery rates].

In order to establish the optimal injection technique for abdominal digital subtraction angiography (DSA), flow rate measurement was performed under various combinations of all the currently available iodinated contrast materials with two types of coaxial microcatheters. In vitro study was done utilizing a plastic model of the abdominal aorta with the tip of the catheter positioned at the presumed proper hepatic artery. A total of 20ml of contrast material was injected by a pressure injector at a rate of 3 ml/sec at 300 or 600 psi, and actual flow volume was measured. Imaging capability was evaluated by calculating iodine delivery rates (IDRs). IDRs were highest in iopamidol 300 mgI/ml and iomeperol 300 mgI/ml, nonionic monomeric contrast materials of medium concentration. The results suggest that the best quality DSA images with injection to the proper hepatic artery using a coaxial microcatheter can be obtained with nonionic monomeric contrast materials of medium concentration.

Sleep-waking changes in cardiac arrhythmia in a coronary care patient.

A single case is reported in whom ventricular cardiac arrhythmias were related to the occurrence of polygraphically verified sleep. A strong relationship was found to exist between the heart rate in any one minute and the number of premature ventricular contractions, with higher rates associated with a greater number of these ectopic beats.