Identification of the HLA-Cw*0774 and DQB1*060105 alleles.

Cw*0774 differs from Cw*070201 by one nucleotide within the coding sequence of exons 2-4. DQB1*060105 differs from DQB1*060101 by one nucleotide within the coding sequence of exons 2-3.

A novel HLA-B*44 allele, B*4466, discovered in a potential donor for a hematopoietic stem cell transplant.

This report describes the discovery and characterization of the human leukocyte antigen-B*4466 allele.

Discovery of a novel HLA-Cw*08 allele, Cw*0817.

This report describes the discovery and characterization of the HLA-Cw*0817 allele.

A novel HLA-C locus allele with codon 54 deletion, Cw*0346.

This report describes the discovery and characterization of the novel Cw*0346 allele.

A novel HLA-Cw*05 allele, Cw*0517.

This report describes the discovery and characterization of the HLA-Cw*0517 allele.

A novel HLA-B*51 allele, HLA-B*5149.

Discovery of the novel HLA-B*5149 allele in a North American Caucasian individual is described. It differs from B*510101 by one nucleotide within the coding sequence of exons 1-6. A substitution at nucleotide position 488 in exon 3 changes alanine to glycine in amino acid position 139.

Hyperthyroidism associated with hyperemesis gravidarum.

Hyperemesis gravidarum is an uncommon presentation of hyperthyroidism in pregnancy which is usually attributable to autoimmune (Graves') disease. While this condition necessitates treatment with antithyroid drugs, a syndrome of transient hyperthyroidism associated with hyperemesis gravidarum that resolves spontaneously is also recognised. Differentiation between these two conditions may prove problematic in practice. We report two cases of hyperthyroidism associated with severe hyperemesis gravidarum. Intractable hyperemesis continued in one patient despite normalisation of circulating free thyroid hormone concentrations with carbimazole. Neither patient exhibited clinical or immunological features of autoimmune thyroid disease, suggesting in retrospect that they had the syndrome of transient hyperthyroxinaemia associated with hyperemesis gravidarum rather than Graves' disease. The role of antithyroid drugs in the treatment of self-limiting transient hyperthyroidism associated with hyperemesis gravidarum requires clarification.

Use of universal precautions in interventional radiology: results of a national survey.

OBJECTIVE: To determine current use of universal precautions by practicing interventional radiologists in the United States. METHODS: National survey mailed to interventional radiologists, conducted anonymously in November 1991. Of 1530 survey forms mailed to practicing interventional radiologists, 817 (53%) were returned and 804 (52%) were completed and evaluable. Both academic and private practice settings were represented. RESULTS: Eighty-five percent of respondents had changed their use of infection control measures in the previous 10 years. Of these, 96% cited personal concerns about AIDS as a reason for making changes. Sixty-two percent made changes in response to Centers for Disease Control and Prevention and Occupational Safety and Health Administration recommendations as well. Use of barrier precautions was quite variable. Although 86% of respondents always wore a sterile gown during procedures, only 32% routinely wore a face mask or shield and only 29% of those who did not wear corrective glasses routinely wore protective eye gear during procedures. Seven percent of respondents routinely double gloved for procedures. Twenty percent of reported percutaneous injuries occurred during recapping of used sharps; an additional 6% were related to improper disposal of used sharps. CONCLUSIONS: We conclude that use of universal precautions by interventional radiologists in the United States is variable. Some practices that may lead to preventable injury to health care workers remain common.

Pulmonary embolism: comparison of MR images with radionuclide and angiographic studies.

PURPOSE: To assess the accuracy and potential of magnetic resonance (MR) imaging in evaluation of patients in whom pulmonary embolism is suspected. MATERIALS AND METHODS: Blinded, prospective interpretations of multiphasic, cardiac-gated spin-echo MR images were compared with retrospective chart review in 86 patients in whom pulmonary embolism was suspected. In 64 patients, the presence or absence of pulmonary emboli was established with x-ray angiography (n = 34) or ventilation-perfusion (V-P) scans and concurrent clinical impression (n = 30). RESULTS: In the subgroup with angiographic proof, MR imaging had a sensitivity of 90%, specificity of 77%, positive predictive value of 86%, and negative predictive value of 83%. In 21 patients with intermediate probability of pulmonary embolism on V-P scans and angiograms, MR images enabled diagnosis of pulmonary embolism in 12 of 12 patients (sensitivity, 100%) and absence of pulmonary embolism in seven of nine patients (specificity, 78%). CONCLUSION: MR imaging reliably depicts large and medium-size pulmonary emboli, regardless of infiltrates or effusion; hence, it may clarify findings on V-P scans that show intermediate probability of pulmonary embolism or are at variance with the clinical impression.

Needle-stick injuries and blood contacts during invasive radiologic procedures: frequency and risk factors.

OBJECTIVE: Possible nosocomial transmission of blood-borne pathogens is a serious concern for health care workers and patients alike. Needle-stick injuries and blood contacts pose a risk of pathogen transmission during procedures. We performed a study to determine the frequency of injuries and blood contacts during invasive radiologic procedures and to examine procedure-related factors that may increase risk of injury or exposure. SUBJECTS AND METHODS: A prospective study of needle-stick injuries and blood contacts during invasive radiologic procedures was performed. During a 10-week period, information about procedures was recorded by technologists or physicians, and needle-stick injuries and exposures to patients' blood and body fluids were noted. Data were analyzed with the SAS statistical package. RESULTS: Accidental exposure to patients' blood and body fluids occurred in 15 of 501 cases (3.0%; 95% confidence interval, 1.7-4.9%). Of 729 operators at risk, 15 were exposed (2.0%; 95% confidence interval 1.1-3.3%). Exposure was parenteral in one case and cutaneous in 14. Risk of exposure was correlated with procedure duration (p = .003), but not with emergency vs elective procedure status (p = .796), procedure type (p = .275), or operator experience level (p = .554). Three needle-stick injuries (0.6% of cases) occurred, all with sterile instruments; bleeding occurred in two cases. Risk of injury was correlated only with procedure type (p = .046). In no case was a patient exposed to a physician's blood. CONCLUSION: Whereas cutaneous exposure of physicians to patients' blood was not infrequent, parenteral exposure was rare in this series. Most of the exposures in this study could have been prevented by the use of protective equipment. Patients' contact with physicians' blood did not occur in this study.

HIV and interventional radiology: a national survey of physician attitudes and behaviors.

PURPOSE: The frequency of parenteral and cutaneous exposure to blood or body fluid during interventional radiologic procedures, current use of barrier precautions by interventional radiologists, and physician attitudes about testing for the human immunodeficiency virus (HIV) and related issues were assessed. MATERIALS AND METHODS: An anonymous survey of interventional radiologists was conducted by mail in November 1991. RESULTS: Of 1,530 surveys, 819 (54%) were returned and 806 (53%) were completed and evaluable. Ninety-six percent of respondents (763 of 794) perform procedures in patients infected with HIV. Sixty-nine percent oppose mandatory testing of physicians for HIV. Eighty-seven percent (693 of 797) reported at least one procedure-related injury (range, 0-99; mean, four). Fifty-eight percent of injuries occurred with use of a sharp instrument (381 of 662), 20% were due to needle recapping (133 of 662), and 7% (44 of 662), to improper disposal of a sharp instrument. Contact between a physician's blood and a patient was reported in only one case (0.2%). Eighty-five percent of respondents (671 of 789) changed their use of barrier precautions in the last 10 years; concerns about HIV were cited by 96% as a reason for change. Reported use of barrier measures was highly variable. CONCLUSION: Exposure to patients' blood or body fluid is not infrequent during interventional radiologic procedures. Exposure of patients to the blood or body fluid of health care workers is rare. Use of recommended precautions in interventional radiology is variable, and practices that could lead to preventable injury remain common. Strategies should be developed to reduce risks even further and to encourage universal compliance with government guidelines.

Vascular proximity: is it a valid indication for arteriography in asymptomatic patients?

The role of arteriography in asymptomatic patients with penetrating extremity wounds in proximity to major vessels is controversial. This prospective study was designed to evaluate a precise definition of proximity, determine the incidence of positive arteriograms, and correlate angiographic interpretation with operative findings. Proximity was defined as any wound located within 1 cm of a major vessel. Excluded were patients with a pulse deficit, bruit, thrill, history of arterial hemorrhage, expanding hematoma, nerve deficit, fracture, or significant soft-tissue injury. One hundred sixty arteriograms were performed in 146 patients. One hundred forty-three (89.4%) were true-negatives. Seventeen (10.6%) were suggestive of injury. These included seven (4.4%) true-positive arteriograms, six (3.8%) false-positive studies, and four (2.5%) positive arteriograms in patients who were not operated upon. The angiographic report correlated with operative findings in five (38.5%) of 13 patients. These data confirm the low incidence (4.4%) of vascular injury in asymptomatic patients. The use of extremity angiography when proximity is the sole indication in an asymptomatic patient with a normal vascular examination must be questioned.

Deep venous thrombosis of extremities: role of MR imaging in the diagnosis.

Current noninvasive imaging techniques for diagnosis of deep venous thrombosis (DVT) of extremities are limited in their ability to demonstrate central vein involvement and to distinguish acute from chronic changes. The utility of spin-echo magnetic resonance (MR) imaging for DVT was evaluated in 100 patients suspected of having either upper- (n = 25) or lower-extremity (n = 75) DVT. Ninety-seven patients were imaged successfully. In a subset of 36 patients, prospective comparison of MR imaging with contrast venography revealed a sensitivity of 90%, specificity of 100%, and Kappa level of agreement of .752 (P less than .0001). MR imaging showed more central extent of thrombus than did venography in all five patients with upper-extremity DVT and in 13 of 25 patients (52%) with lower-extremity DVT. Although all patients in the study were evaluated for acute symptoms, 13 of 59 (22%) MR imaging studies positive for DVT demonstrated chronic disease. MR images demonstrated ancillary abnormalities in 18 of 41 (44%) patients who did not have DVT. Thus, MR imaging has a role as the definitive examination when the results of initial screening studies are unsatisfactory, or as a first-line examination if (a) there is suspicion of upper-extremity or pelvic vein thrombosis, (b) there is a history of prior DVT that necessitates distinction of acute from chronic changes, or (c) other tests are unavailable.