Histomorphological changes after renal X-ray arteriography using iodine and gadolinium contrast media in an ischemic porcine model.

BACKGROUND: Gadolinium contrast media (Gd-CM) are regarded as non-nephrotoxic or considerably less nephrotoxic than iodine contrast media (I-CM), and have therefore come to be used as a substitute for I-CM in patients with renal insufficiency in a variety of radiographic examinations. PURPOSE: To investigate renal histomorphological changes caused by Gd-CM in comparison with I-CM after renal X-ray arteriography in an ischemic porcine model,and to evaluate these changes in relation to the nephrotoxicity of the CM used. MATERIAL AND METHODS: Test solutions: gadopentetate, gadodiamide, iohexol, gadobutrol,iopromide, iodixanol, mannitol, and saline. The experiments were performed on 152 animals. Each pig was randomized to receive one test solution injected into the balloon occluded(10 min) right renal artery. The kidneys were evaluated histomorphologically.The severity of histomorphological changes was graded subjectively: 15 minimal, 25 mild, 35 moderate, and 4=marked. RESULTS: The main histological changes were 1) proximal tubular and glomerular necrosis,2) hemorrhage/congestion of the cortex, medulla, and glomeruli, 3) proximal tubular vacuolation, and 4) protein-filled tubules in the cortex and medulla. Necrosis and hemorrhage/congestion were more frequent after injections with gadopentetate, mannitol solution iso-osmotic to gadopentetate, and gadobutrol compared to all other groups(P<0.001). The degree of necrosis and hemorrhage/congestion was related to the degree of impairment of renal function, but inversely related to vacuolation and tubular protein filling. CONCLUSION: In ischemic porcine kidneys, the histomorphological changes caused by Gd-CM are similar to those caused by I-CM. Vacuolation appears to be independent of the osmolality and viscosity of the CM, and does not seem to be an indicator of renal impairment. "High-osmolal" Gd-CM are more nephrotoxic than "low- and iso-osmolal" I-CM when compared in equal volumes of concentrations, resulting in equal X-ray attenuation.

Nasal oncocytoma in a domestic shorthair cat.

An oncocytoma was diagnosed in the nasal cavity of a 12-year-old Domestic Shorthair cat who presented with periocular swelling and sneezing. Histologic examination from biopsy material revealed monomorphic sheets, anastomosing cords, tubules, and acini composed of large polygonal to oval cells that contained abundant finely granular eosinophilic cytoplasm. No vascular or lymphatic invasions were noted. Histochemical stains revealed positive staining of tumor cells with periodic acid-Schiff (PAS) (before and after diastase digestion) and phosphotungstic acid-hematoxylin. Immunohistochemical evaluation of the tumor cells demonstrated positive staining for cytokeratin and negative staining for vimentin, desmin, S-100, glial fibrillar acidic protein, and neuronal specific enolase. Ultrastructurally, the tumor cells contained large numbers of mitochondria within their cytoplasm, which confirmed a diagnosis of oncocytoma.

A blood grouping and antibody screening system using image analysis.

An effective, modular automated blood grouping system has been developed which performs more effectively than the AG16C autogroupers and which uses readily obtainable reagents and disposables. Operating and maintenance costs are low by comparison with currently available equipment of similar capacity. The 99.2% success rate for blood grouping using this image analysis-based system compares well with the 98.3% success rate on the AG16C autogroupers. Staffing requirements are reduced and the flexible modular approach allows this Newcastle system to be used for a range of serological functions, including grouping, antibody screening and screening for antigen donors. The ability to operate with small sample numbers without long start-up times and the relatively low capital cost makes the Newcastle system an option that could be considered by the larger hospitals as well as transfusion centres. The sensitivity of the system could be developed to include compatibility testing as a feature of the system.

Product liability in the medical laboratory.

Under recent product liability legislation patients who suffer damage from any treatment materials administered to them will not have to prove negligence in order to claim compensation for any injury suffered. Optimum quality assurance and detailed documentation will be necessary for defence against litigation by a patient. Transfusion medicine is the main area of laboratory practice where litigation can be expected, but implications for other medical laboratories are referred to.

A further example of IgM anti-K2 (Cellano).

An example of a cold-reacting IgM anti-K2 is described. The patient has a history of blood transfusion and two pregnancies. It is, therefore, not possible to differentiate between natural occurrence or immune stimulation as an explanation of this antibody's presence. In 1966, Thomas and Konugres reported an unusual example of anti-K2 composed entirely of IgM and reacting optimally at 20 degrees C, although some reactions at 37 degrees C were observed. We wish to report a further example which does not react at 37 degrees C.

The association of HLA-B8 with visceral disease in systemic sclerosis.

Seventy-one patients with systemic sclerosis (SS) were typed for twenty-seven HLA alleles of the A and B loci, and the findings were related to both the extent of visceral disease and tests of cellular immune competence in a subgroup of fifty-two of these patients. Nineteen pa;ients with widespread visceral involvement and more rapidly progressive disease had an increased frequency of HLA-B8 (relative risk = 4.14; P less than 0.05) when compared to thirty-three less severely affected patients and 3000 controls. Patients with severe and progressive disease also had defective cell-mediated immunity with reductions in both the numbers of circulating thymus-dependent (T) lymphocytes and in the lymphocyte transformation response to phytohaemagglutinin. These findings suggest that a genetic factor, such as an abnormal immune response gene, may be involved in the progression of the disease.

Some parameters of lymphocyte antibody activity through pregnancy and further eluates of placental material.

One hundred and sixty-nine pregnancies with lymphocyte cytotoxic antibody activity were found out of 851 full term pregnancies. A rise in incidence of antibody activity was found through first, second and third pregnancies. The average scores for antibody titre and avidity were similar for antibodies to the A and B loci in first, second and third pregnancies though individual scores varied greatly. Five cases are reported where antibody activity was not detectable till the 6-month post-natal stage. ABO compatibility did not have any effect on antibody production. A further 40 placental eluates are reported with the same findings as reported previously.

A relation between HLA antigens and clinical features in patients with acquired valvular heart disease.

Analysis of the HLA antigen patterns in patients with acquired valvular heart disease showed that antigens A29 and AW30/31 occurred more often in those patients whose valvular disease was not preceeded by a history of rheumatic fever or chorea. Patients with no rheumatic history but with antigen A29 or AW30/31 had clinical features that distinguished them from others with valvular disease--namely, (a) isolated mitral valve disease and (b) the need for surgery, often at an early age, after a relatively short duration of symptoms.

HLA antigens and acquired valvular heart disease.

The frequency of HLA antigens was determined in 133 patients with acquired valvular heart disease and compared with the frequency of HLA antigens in 1,000 normal individuals by the relative incidence ratio method of Woolf (1955). No significant increases were observed. However, when the patients were divided into those with no rheumatic history and those who have had rheumatic fever or chorea, a significant increase in AW 30/31 and A29 was observed in the group with no rheumatic history.

HL-A27 and W10 in Reiter's syndrome and nonspecific urethritis.

By means of a standard lymphocyte microcytoxic technique, the tissue types were fully determined in 41 patients with non-gonococcal urethritis and 25 patients with Reiter's syndrome. The antigen HL-A27 was identified in 14 of the patients with Reiter's syndrome and occurred in 3 of the patients with non-gonococcal urethritis. An excess of the genotype HL-A27/W10 was found in patients with Reiter's syndrome. There was no correlation between the duration or the severity of the clinical manifestations of the syndrome and the presence of the antigens. The possibility that the syndrome might result from various pathogenic mechanisms is discussed.