Cytomegalovirus infection associated with clonal proliferation of T-cell large granular lymphocytes: causal or casual?

Clonal proliferation of T-cell large granular lymphocytes (LGL) is an indolent disorder characterized by splenomegaly, lymphocytosis and frequent manifestations of immune disturbances. The LGL are CD3(+) CD4(-) CD8(+) CD56(-). The clonality of the tumor cell population is often only demonstrable by T-cell receptor (TCR) gene rearrangement study because chromosomal abnormality is distinctly rare. We describe a case of T-cell LGL leukemia that presented initially as cytomegalovirus infection. The leukemic LGL are shown to be clonal by both TCR gene rearrangement and chromosomal studies. They persist after subsidence of the cytomegalovirus infection.

Sertraline overdose.

OBJECTIVE: To determine the clinical presenting signs and symptoms in presumed overdoses of sertraline, a recently approved antidepressant. METHODS: A prospective study involving five western regional poison control centers was performed to evaluate the clinical manifestations of presumed sertraline ingestions (overdoses). Information about calls pertaining to sertraline ingestions was recorded on a standard data collection form. Data including subject age, sex, amount ingested, coingestants, time interval to evaluation, vital signs, presenting signs and symptoms, ECG abnormalities, treatment given, disposition, and length of stay in the ED were collected over a nine-month period. RESULTS: Of 42 ingestions reported, two were adverse reactions to normal doses and 40 were overdoses. Stated amounts of sertraline ingested ranged from 50 to 8,000 mg (mean 1,579 mg). Mean patient age was 35.3 years (range 1 to 69 years). Mean interval to presentation was 3.0 hours. Seventeen of the 40 patients ingested sertraline alone. Of this subgroup, ten had no sign or symptom. The most common abnormalties reported in isolated sertraline overdose were tremor, lethargy, and nausea. Less common findings included agitation, confusion, and vomiting. There was no significant morbidity in this subgroup of presumed isolated sertraline ingestion. Of the 23 patients who ingested other medications along with sertraline, four were asymptomatic. Benzodiazepines and alcohol were the most frequently coingested substances. Lethargy, nausea, dry mouth, and mydriasis were the most common features reported in this group. Treatment included lavage, activated charcoal, and observation. Twelve patients were admitted for 24-hour observation, none had an adverse outcome. Of the patients released from the ED, the mean length of stay was 3.9 hours. CONCLUSION: Sertraline is commonly taken in overdose with other medications or alcohol. The signs and symptoms that develop in association with an overdose of sertraline appear to be minor and of short duration.

Comparison of a modification of the ellman method to measure carbamate inhibition of acetylcholinesterase in plasma, erythrocytes and brain tissues in sprague dawley rats using two analytical systems.

Inhibition of the enzyme acetylcholinesterase (AChE) using a carbamate compound was measured in 30 Crl: CD(R)BR Sprague Dawley rats. Erythrocyte, plasma, and brain tissues were analyzed using modifications of the Ellman technique(1) on two different clinical chemistry analyzers. Both EDTA and heparin anticoagulated whole blood were used for the erythrocyte and plasma tests. Results demonstrated similar inhibition of the enzyme in all three tissues between the control and dosed groups using the two technique modifications and instruments. Final inhibition of plasma and erythrocyte AChE for the control vs. treated groups (males and females combined) was 89.5% vs. 82% and 39% vs. 38% for the Technicon AutoAnalyzertrade mark vs. the Boehringer Mannheim Hitachitrade mark 704, respectively. Inhibition of the left and right brain segments for the control vs. treated groups (males and females combined) was 35% vs. 39% and 33.2% vs. 29% for the Technicon and the Hitachi, respectively. All inhibitions were significant at the 5% level using two tailed Dunnett's t-Test. Hemolysates prepared from EDTA whole blood packed cells gave more consistent results on the Hitachi 704.

A critical appraisal of stroke evaluation and rating scales.

BACKGROUND: To judge the efficacy of new, putative stroke therapies, we need a method to measure neurological deficit accurately in groups of patients before and after treatment. No single measurement technique has yet proven to be universally acceptable, but one approach is the use of rating instruments that summarize the neurological deficit found on clinical examination. Currently, stroke assessment scales may be based on the examination of physical deficits, an inventory of activities of daily living, or a global evaluation of functional outcome. SUMMARY OF REVIEW: Scientific methods for authenticating stroke scales are available in the psychometric and statistical literature. We review currently available stroke scales for their validity and reliability and propose investigations needed to refine further the standardized measurement of neurological deficit following stroke. CONCLUSIONS: We suggest that clinical stroke trials include a physical deficit scale and a global rating during the acute phase and that an activities of daily living scale be added at later points in recovery.

Cardiac saphenous vein bypass graft disease.

Coronary artery bypass grafting is an effective treatment for myocardial ischaemia and is particularly important in patients with multivessel disease and diabetes. However, up to 40% of saphenous vein grafts will occlude within 10 years of surgery. The predominant mechanisms for saphenous vein graft disease are thrombosis, intimal hyperplasia, and accelerated atherosclerosis. The pathology of these changes and the role of key factors such as nitric oxide, cellular proliferation, and the role of hypercholesterolemia and hypertriglyceridaemia, are reviewed. Saphenous vein graft disease is among the first cardiovascular conditions to show significant benefit from gene therapy and promises to show remarkable developments in the near future.

Numerous transcription initiation sites exist for the maize mitochondrial genes for subunit 9 of the ATP synthase and subunit 3 of cytochrome oxidase.

Transcripts for plant mitochondrial genes are frequently present as multiple size classes. In maize, these differences often result from variation in the 5' noncoding region. To determine where transcription initiates, primary (unprocessed) transcripts were specifically labeled in vitro by the capping reaction catalyzed by guanylyltransferase. Direct mapping of transcription initiation sites was accomplished by hybridization of in vitro-capped RNA with the 5' flanking sequences of mitochondrial genes and subsequent digestion with single-strand-specific RNases. The RNase protection experiments identified three transcription initiation sites for subunit 3 of cytochrome oxidase and at least six transcription initiation sites for subunit 9 of ATP synthase. Thus, transcript size heterogeneity is primarily the result of multiple transcription initiation sites for these genes rather than RNA processing. Primer extension analyses of maize mitochondrial RNA were used to precisely establish the sequences at the initiation sites. Comparison of sequences at transcription initiation sites suggests that some homology exists at these sites, although no highly conserved consensus sequence is obvious.

Decreased bacterial adherence to silver-coated stent material: an in vitro study.

Bacteria are important in causing biliary stent blockage through adherence and subsequent biofilm formation. In our in vitro system, surface modification using test polyurethane discs with silver coating led to a reduction in the number of adherent bacteria compared with untreated controls by 10- to 100-fold in an apparently dose-related manner. The effect was more marked in the presence of bile. These results suggest that silver coating may have a potential benefit in preventing stent blockage.

Hepatitis B virus DNA in peripheral blood leukocytes. A comparison between hepatocellular carcinoma and other hepatitis B virus-related chronic liver diseases.

BACKGROUND: Hepatitis B virus (HBV) DNA has been detected in the peripheral blood leukocytes (PBL) during acute and chronic HBV infection. Possible pathobiologic significance includes infectivity and altered immunity. There are few data relating PBL HBV-DNA with severity of the liver disease, in particular with hepatocellular carcinoma (HCC). METHODS: HBV-DNA was detected by dot-spot hybridization technique in PBL separated from venous blood samples of 209 hepatitis B surface antigen-positive patients (28 healthy carriers and 95 chronic hepatitis, 29 cirrhotic, and 57 HCC patients). Serum HBV-DNA and hepatitis B e-antigen (HBeAg) were also measured. RESULTS: Thirty percent of HCC patients were hepatitis e-antigen-positive compared to 50%, 84% (P < 0.0001), and 69% (P < 0.00001) of healthy carriers and chronic hepatitis and cirrhotic patients, respectively. Furthermore, only 11% of HCC patients had detectable serum HBV-DNA compared to 39% (P < 0.001), 58% (P < 0.001), and 31% (P < 0.05) of these respective patient groups. despite low viral replication among HCC patients, 58% had PBL HBV-DNA. Corresponding figures for healthy carriers and for chronic hepatitis and cirrhotic patients were 39%, 58%, and 56%. Fifty-two percent of HCC patients had positive PBL HBV-DNA in the absence of serum HBV-DNA, compared with 25% in healthy carriers (P < 0.05) and 22% in chronic hepatitis (P < 0.001) and 35% in cirrhotic patients (P = NS). CONCLUSION: The high detection rate of PBL HBV-DNA among HCC patients may reflect certain pathogenetic processes of HBV infection and indicate a higher risk of development of HCC.

Embryonic XMab21l2 expression is required for gastrulation and subsequent neural development.

Cell fate determining gene mab-21 regulates the proper establishment of neural cell fate and sensory organ identity in nematode. Mammalian homologs of mab-21 have also been implicated to play critical roles in mid-, hindbrain and craniofacial differentiation. We report here the isolation of a mab-21 homolog, XMab21l2, from Xenopus. We showed that its expression in Xenopus was initiated at gastrulation and prominent signal was detected in neurulating embryos at the neural tube, the optic tissue, the developing midbrain, and the pharyngeal pouches. We demonstrated by RNA interference (RNAi), together with other antisense approaches, that XMab21l2 expression is required for the completion of gastrulation and subsequent neural development.