The toxic shock syndrome toxin-1 induces anergy in human T cells in vivo.

TSST-1 is a Staphylococcus aureus-derived superantigen which has been implicated in the pathogenesis of toxic shock syndrome. In mice, superantigen-induced proliferation is followed by deletion or anergy of reactive T cells. So far, superantigen-induced T-cell anergy has not been observed in humans. We therefore examined PBMCs derived from a 15-year-old patient suffering from severe toxic shock syndrome. Markedly elevated levels of circulating TSST-1-reactive T cells were found by cytofluorometric analysis. Upon in vitro restimulation with TSST-1, hyporesponsiveness of TSST-1-responsive V beta 2+ T cells was detected, thus confirming results obtained in the murine system.

Polymerase chain reaction monitoring reduces the incidence of cytomegalovirus disease and the duration and side effects of antiviral therapy after bone marrow transplantation.

Culture-based preemptive therapy with ganciclovir was shown to reduce the incidence of cytomegalovirus (CMV) disease after bone marrow transplantation (BMT). Culture techniques did not detect CMV in 12% to 13% of patients before the onset of CMV disease. In a prospective study, 71 patients either received preemptive therapy based on polymerase chain reaction (PCR) technique (37 patients) or on culture assays (34 patients). In both groups, therapy was continued until clinical signs disappeared and PCR negativity was documented. Twenty-two patients in the PCR group and 15 patients in the culture group received antiviral therapy. PCR allowed detection of the virus (median day, +32 v day +49; P = .006) and introduction of antiviral therapy (median day, +44 v day +54; P = .02) earlier than did culture assays. The incidences of CMV disease (2 of 37 v 8 of 34 in PCR group v culture group, respectively; P = .02) and CMV-associated mortality (0 of 37 v 5 of 34 in PCR group v culture group, respectively; P = .02) were decreased, and the duration of ganciclovir therapy (P < .001) was shorter in the PCR-monitored group. Incidence and median duration of severe neutropenia (less than 500/microL) were lower in the PCR group (two v eight episodes, P = .02; median duration, 1.5 v 5 days, P = .04), as was the incidence of nonviral infections during/after antiviral therapy (2 of 37 v 9 of 34; P = .012). Thus, preemptive therapy based on more sensitive detection methods such as the PCR assay reduces the incidence of CMV disease and CMV-related mortality. Additionally, stopping and withholding antiviral therapy in a PCR-negative patient is safe and allows reduction of the duration and side effects of antiviral therapy.

Autologous transplantation with peripheral blood stem cells in children and young adults after myeloablative treatment: nonrandomized comparison between GM-CSF and G-CSF for mobilization.

Recombinant human granulocyte-monocyte colony-stimulating factor (rhGM-CSF) was compared with recombinant granulocyte colony-stimulating factor (rhG-CSF) in 34 patients for mobilization of peripheral blood stem cells (PBSC) and for posttransplantation use. Peripheral blood stem cell mobilization was initiated by a single 1 h infusion of cyclophosphamide (4 g/m2) in all patients, followed by either a continuous infusion of rhGM-CSF (250 micrograms/m2/day) in 17 patients (group A) or a daily subcutaneous injection of rhG-CSF (10 micrograms/kg/day) in 17 patients (group B). PBSC were collected using a Fenwal CS 3000 continuous flow blood cell separator in one to three sessions. All patients suffered from various childhood malignancies. No difference in the number of collected cells among both groups was found. A mean of 2.7 x 10(8)/kg mononuclear cells (MNC) and of 7.9 x 10(4)/kg CFU-GM (colony-forming unit-granulocyte-macrophage) were collected in group A. In group B, 2.3 x 10(8)/kg MNC and 11.8 x 10(4)/kg CFU-GM were collected. In 33 patients, PBSC were reinfused after myeloablative therapy. Patients of group A (n = 17) were treated with rhGM-CSF (250 micrograms/m2/day) starting day +1, and patients in group B (n = 16) were treated with rhG-CSF (10 micrograms/kg/day) i.v. All patients showed a rapid and complete hematopoietic recovery without significant differences in both groups. Time to achieve 0.5 x 10(9)/L granulocytes was 10.9 days in group A and 11 days in group B.(ABSTRACT TRUNCATED AT 250 WORDS)

Catheter-related Rahnella aquatilis bacteremia in a pediatric bone marrow transplant recipient.

Rahnella aquatilis, a rarely encountered member of the family Enterobacteriaceae, was twice isolated from the blood of a pediatric bone marrow transplant recipient. This is the first report of a pediatric case of R. aquatilis bacteremia, and it was probably related to inappropriate handling of a Hickman catheter.

[Pericarditis in the acute phase of myocardial infarction: incidence and clinical significance]. / Pericarditis en la fase aguda del infarto de miocardio: incidencia y significado clínico.

STUDY OBJECTIVE: To evaluate the incidence and the clinical significance of pericarditis in the acute myocardial infarction. DESIGN: Retrospective study. SETTING: The Coronary Care Unit of a University Hospital. PATIENTS AND METHODS: We have studied 668 consecutive patients with their first acute myocardial infarction admitted at the Coronary Care Unit, Hospital General de Galicia, Santiago de Compostela, Spain, in the years 1983 to 1988. Pericarditis was defined as the presence of a pericardial friction rub on auscultation during the hospital course. Pericarditis was noted in 86 patients (12.8%), who were considered as group A. The remain 582 patients were considered as group B. Statistical analysis was carried out using the BMDP statistical package. MAIN RESULTS: Pericarditis occurred in 12.8% of the patients. Patients with, compared to those without, pericarditis had a lower age (59.0 +/- 12.4 years; p = .0005), and a higher percentage of males (86.1% versus 75.6%; p = .038), an a higher percentage of smokers (63.9% versus 48.6%; p = .01). The delay to the hospital admission was greater in group A (12.6 +/- 18.5 hours versus 8.0 +/- 11.7 hours; p = .0024). Pericarditis more often occurred in the setting of anterior wall myocardial infarction and in Q-wave infarct. The group A had a higher CPK peak (1877.5 +/- 1548.9 UI/L versus 1240.2 +/- 961.5 UI/I; p = .001) and a higher peak of CK-MB (213.7 +/- 134.7 UI/L versus 160.8 +/- 112.9 UI/L; p = .001). In-hospital mortality was significantly lower in group A (6.9% versus 17.2%; p = .016). The multivariate analysis by stepwise logistic regression identified the Q- wave myocardial infarct, the age, the delay to the hospital admission, the peak of MB creatine kinase and location of infarct as the only independent predictive variables for the pericarditis occurrence. CONCLUSIONS: We conclude that the pericarditis in the setting of Q-wave myocardial infarction, with anterior wall location, and is related to transmural extension of the myocardial necrosis.

[Temporal electric stimulation and right ventricular extension in acute postero-inferior myocardial infarction. Influence on clinical characteristics and prognosis]. / Estimulación eléctrica temporal y extensión ventricular derecha en el infarto agudo de miocardio postero-inferior. Influencia sobre las características clínicas y el pronóstico.

In 386 patients with acute inferior myocardial infarction (AIMI) who were admitted to our institution from 1984 to 1990, temporary pacemaker (TP) was required in 34 patients (9%) due to disturbances in the genesis and/or conduction of the electric stimulus (Group I). The remainder, 352 AIMI, conform the Group II. Each group was divided into groups depending on the presence (Groups Ia and IIa) or absence (Groups Ib and IIb) of right ventricular necrosis (ECG criteria: ST elevation greater than 0.1 mV in a V3r and V4R). Clinical data (cardiovascular risk factors, history of myocardial infarction or angina, CPK and CK-MB peak, Killip class, atrioventricular block and right ventricular infarction) and hospital mortality rate and its cause were analyzed. The Group I patients related to Group II had significantly higher diabetes rate (p less than 0.01), CPK and CK-MB peak (p less than 0.001), Killip class (p less than 0.001), right ventricular involvement and atrioventricular block (p less than 0.001), the mortality rate equally was statistically higher (Group I, 11 patients, 31%, versus group II, 38 patients, 11%) (p less than 0.001). The Group Ia patients related to Group Ib had a higher CPK and CK-MB peak (p less than 0.001), Killip class and atrioventricular block (p less than 0.001). The mortality rate was statistically equal. The group IIb patients related to Group IIb patients had a higher CPK and CK-MB peak (p less than 0.001), without differences in the mortality rates.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical and prognostic implications of age in acute myocardial infarct]. / Implicaciones clínicas y pronósticas de la edad en el infarto agudo de miocardio.

The purpose of this study was to evaluate the clinical characteristics and the factors related to early mortality in the acute myocardial infarction of the geriatric population. We studied 814 consecutive patients with their first acute myocardial infarction admitted to the coronary care unit at tha Hospital General de Galicia. 401 patients were older than 65 years (Group A) and 413 were younger (Group B). Group A was found a significantly lower percentage of males (64.7% versus 88.4%; p less than 0.001) and smokers (46.7% versus 72.7%; p less than 0.001; and older patients showed a greater incidence of diabetes mellitus (28.1% versus 15.2%; p less than 0.001) and arterial hypertension (45.6% versus 31.7%; p less than 0.01). In the geriatric population, the clinical course of the acute myocardial infarction is characterized by a greater incidence of heart failure (35.3% versus 11.1%; p less than 0.001), cardiogenic shock (18% versus 5.7%; p less than 0.001) and post-acute myocardial infarction angina pectoris (18.3% versus 12.2%; p less than 0.05). Early mortality (first month) was significantly higher in elderly patients (22.7% versus 6.3%; p less than 0.001). The multivariate analysis by stepwise logistic regression identified cardiogenic shock, age and heart failure as the only independent predictive variables for early mortality. We conclude that early mortality in the acute myocardial infarction is high and related to severe degrees of pump failure and age.

Effect of a chimeric anti-ganglioside GD2 antibody on cell-mediated lysis of human neuroblastoma cells.

An anti-GD2 ganglioside human/mouse chimeric monoclonal antibody, ch14.18, like its murine counterpart, 14.G2a, was shown to bind to human neuroblastoma cells. This chimeric antibody proved to be more effective than 14.G2a in mediating the lysis of neuroblastoma cells with human effector cells, such as granulocytes and natural killer cells within the peripheral blood mononuclear cell population. A comparison of these two effector cell populations isolated from the same donor revealed granulocytes to be more effective than peripheral blood mononuclear cells in lysing neuroblastoma cells, which were coated with monoclonal antibody ch14.18. Addition of recombinant human granulocyte-macrophage colony-stimulatory factor increased ch14.18-mediated lysis of neuroblastoma cells by granulocytes but not by peripheral blood mononuclear cells. In fact, granulocytes were effective in mediating lysis of neuroblastoma cells coated with ch14.18 irrespective of whether they were obtained from normal adults or from neuroblastoma patients.

Natriuresis-pressure relationship in polycystic kidney disease.

We studied, under outpatient conditions, nine patients with autosomal dominant polycystic kidney disease who were hypertensive on their usual diet, and nine normotensive healthy probands. The subjects were examined in random order on the 7th day after equilibration on a low-sodium diet (20 mmol/day) and again on the 7th day after equilibration on the same diet but with added sodium to yield a final intake of 200 mmol/day (or vice versa). Blood pressure was monitored non-invasively for 2 h at 4-min intervals using an automatic system. In healthy probands, mean arterial pressure (MAP) was similar on the low- and the high-sodium diets (92.7 versus 91.9 mmHg). In hypertensive patients, a significant (P less than 0.02) increase in mean MAP (107.2 versus 111.2 mmHg) and in systolic blood pressure (140.6 versus 148.7 mmHg) was observed irrespective of whether the glomerular filtration rate (GFR) was normal or reduced. The natriuresis pressure curve showed an upward shift (resetting) and a positive slope (sodium sensitivity). Patients with a reduced GFR as shown by inulin clearance differed from probands and patients with a normal GFR, by showing greater proportional changes in GFR and body weight. In hypertensive patients, atrial natriuretic factor (ANF) levels were higher at baseline and showed an exaggerated response to sodium loading. Changes in angiotensin II (Ang II) or in Ang II binding sites on platelets were similar in patients and controls and changed appropriately with the sodium intake. These data show a resetting of the natriuresis-blood pressure relationship and an increased blood pressure sensitivity to sodium in hypertensive patients with adult, dominant, polycystic kidney disease.

[Digital subtraction angiography of the hand]. / Digitale Subtraktionsangiographie der Hand.

The report deals with 66 digital subtraction angiograms of the hand performed on 61 patients; 60 were carried out by direct puncture of the brachial artery and six by trans-femoral catheterisation. In 39 patients a peripheral organic vascular abnormality was demonstrated (usually arterial sclerosis, thromboangiitis obliterans or collagenosis). Purely functional flow abnormalities were found in 17 patients. In 15 patients an organic abnormality was demonstrated, but its type could not be identified. Intra-arterial DSA is able to differentiate between functional abnormalities of blood flow and peripheral organic vascular abnormalities.

[Preserving the accessory nerve in neck dissection]. / Zur Frage der Schonung des Nervus accessorius bei der Neck dissection.

A total of 104 patients who had undergone neck dissection were examined with respect to disturbance of shoulder function on the operated side. The accessory nerve had been severed in half the patients and preserved in the other half. A dynamo-meter was used to measure the force a patient standing upright could exert in pulling upward with his arm outstretched. The relative loss of strength after neck dissection was determined by relating the difference between the two sides to the strength of the healthy shoulder. On average, the loss of strength in the operated shoulder was significantly less after preservation of the accessory nerve than after its severance. An additional influence due to tumour stage or postoperative irradiation was not found. The functional loss determined by the difference quotient correlated well with the patients' subjective account of their functional impairment. Preservation of the eleventh cranial nerve is discussed with respect to the question of increased risk of lymph node recurrence.

[Cryosurgery of the healthy rat liver]. / Kryochirurgie an der gesunden Rattenleber.

Cryosurgical treatment was applied to normal liver tissue of 13 clinically intact rats, with a view to investigating effects of freezing temperatures upon normal liver tissue. The animals were sacrificed after different intervals from surgery, and their liver tissue was macroscopically and histologically examined. Major postoperative complications were not observed but for one animal which died of wound healing disorder. The method seems to be suitable also for treatment of liver cell carcinoma or liver metastases.

[Animal experiment studies of cryosurgical treatment of DS sarcomas and Morris hepatomas implanted in the liver]. / Tierexperimentelle Untersuchungen über die kryochirurgische Behandlung von in die Leber implantierten DS-Sarkomen und Morris- Hepatomen.

Cryosurgical treatment was applied to solid liver tumours of rats with a view to studying the effects of freezing temperatures upon liver carcinoma. Such treatment was applied to twelve rats to which carcinomas, 0.5 cm to 3.0 cm in size, had been implanted. Cryosurgical treatment was successful in one case. Many of the animals died of complications which resulted from freezing of surrounding organs, such as stomach or greater liver vessels.

[Computed tomography and angiography in aortic dissection]. / Computertomographie und Angiographie bei der Aortendissektion.

The authors report on 32 patients with dissecting aneurysm examined via computed tomography, 21 of whom were also additionally examined by means of angiography. Whereas CT with contrast medium bolus resulted in a diagnosis in dissecting aneurysm in all the cases, aortography failed in 2 patients because of a thrombosed dissection. Aortography offers clear advantages over CT, besides better spatial representation, in respect of clarification as to which aortic branches are involved, especially in the region of the aortic arch. On the other hand, the advantages of CT are lower invasiveness, high sensibility and the possibility of including concomitant complications when establishing the diagnosis.

[Digital subtraction angiography and large-film angiography of the pelvic and leg arteries]. / Digitale Subtraktionsangiographie (DSA) und Blattfilmangiographie der Becken- und Beinarterien.

The diagnostic information and image quality of 1153 DSA studies of pelvic and lower limb arteries and of 104 conventional large film angiograms have been analysed. Using intra-arterial contrast, all large film angiograms and all DSA studies of the iliac, femoral, popliteal and upper calf arteries were satisfactory. For demonstrating the distal calf vessels and vessels in the foot, intra-arterial DSA was superior to large film angiography. Using intravenous DSA, 98% of the iliac, femoral and popliteal arteries were adequately demonstrated, although image quality was reduced.

[Magnetic resonance tomography (MRT) of the orbit]. / Magnetische Resonanztomographie (MRT) der Orbita.

By using high field strengths and surface coils, MRT achieves a resolution comparable with CT in the orbita. The advantages of MRT are good contrast resolution and imaging in several planes. Twenty-six patients have been examined by MRT, which has shown high sensitivity and good detail for the demonstration of pathological changes. In spite of this, MRT at present is not a realistic alternative to ultrasound and CT, because it is unable to demonstrate bone and calcification; its specificity is low, but the time and cost of the examination is high. It is indicated only for problems involving the optic nerve and chiasma.