"Semenly" Harmless Back Pain: An Unusual Presentation of a Subcutaneous Abscess

Aims We report, with review of the literature, the case of a patient who developed a subcutaneous abscess after intravenously injecting his own semen in an attempt to treat longstanding back pain. He had devised this "cure" independent of medical advice. Methods A review of EMBASE, PubMed, google scholar and the wider internet was conducted with an emphasis on parenteral semen for the treatment of back pain and for other medical and non-medical uses. Results There were no other reported cases of intravenous semen injection found across the medical literature. A broader search of internet sites and forums found no documentation of semen injection for back pain treatment or otherwise. Conclusion While suicide attempt by intravenous injection of harmful substances is well described, this unique case demonstrates risks involved with innovative treatments prior to clinical research in the form of phased trials inclusive of safety and efficacy assessments.

Infection of rabbits with human immunodeficiency virus 1. A small animal model for acquired immunodeficiency syndrome.

Injection of rabbits with a human T cell line infected with HIV-1 caused seroconversion within 6 wk, and HIV-1 could be isolated from PBL cultures of infected rabbits. Identity of the isolated virus with HIV-1 was shown by analysis of products amplified by the polymerase chain reaction. HIV-1 infection was seen in rabbits injected with HIV-1-infected cells alone as well as in those that were first infected with HTLV-1 and subsequently with HIV-1. There were no consistent signs of disease in the rabbits infected with HIV-1 alone but HTLV-1/HIV-1-infected rabbits showed signs of illness including diarrhea and weight loss, transient neurologic impairment and, in one animal, a rapidly progressing mammary adenocarcinoma. Examination of organs taken at necropsy from both HIV-1- and HTLV-1/HIV-1-infected animals showed splenic hyperplasia and lymphocyte infiltration of the lungs, as well as moderate damage to liver and kidney in some cases.

Genomic heterogeneity of AIDS retroviral isolates from North America and Zaire.

In an analysis of the genomic variation of AIDS retroviral isolates from patients living in New York, Alabama, and Zaire, restriction maps were constructed by using seven enzymes, each known to cleave the proviral DNA more than once, in conjunction with Southern blot analysis. The maps of LAV, HTLV-III, and ARV-2 as deduced from their published nucleotide sequences were included in this analysis. The results demonstrated that (i) several "signature" restriction sites were common to all isolates; (ii) with the exception of LAV and HTLV-III, the North American and European isolates were all different from one another and showed no geographical specificity; (iii) the African isolates as a group were more diverse than those from North America and Europe; and (iv) the genomic variability was concentrated within the env gene.

Development of disease and virus recovery in transgenic mice containing HIV proviral DNA.

Transgenic mice containing intact copies of the human immunodeficiency virus (HIV) proviral DNA were constructed. Founder animals were not viremic for HIV and remained healthy during a 9-month observation period. After being mated with nontransgenic animals, one founder mouse (No. 13) gave rise to F1 progeny that developed a disease syndrome characterized by marked epidermal hyperplasia, lymphadenopathy, splenomegaly, pulmonary lymphoid infiltrates, growth retardation, and death by day 25 of life. Infectious HIV, indistinguishable from parental virus by immunoblot analysis, was recovered from the spleen, lymph nodes, and skin of five of five affected animals.

Community-based organizations are critical partners in providing complete cancer care.

In Canada people affected by cancer access psychosocial care and support from two systems. In the conventional medical system, psychosocial professionals focus mainly on screening for and treating those most distressed by their diagnosis. Many patients and family members go beyond this step to find information and support provided by community-based organizations (CBOS). This article outlines the components of complete cancer care effectively provided by CBOS and why the integration of the two systems of care is critical in delivering seamless high-quality psychosocial care for all.

Gene expression analysis of primordial shoot explants collected from mature white spruce (Picea glauca) trees that differ in their responsiveness to somatic embryogenesis induction.

Within a plantation of clonal somatic embryo-derived white spruce trees that belonged to four genotypes, one genotype (G6) has consistently responded for the last 16 years, to the induction of somatic embryogenesis within primordial shoot explants. Analysis of fourteen individuals within this genotype subsequently revealed a group of clonal trees that were nonresponsive. This in turn provided a unique opportunity to conduct differential gene expression analysis in the absence of genotype-specific factors. Absolute qPCR was first used to expand the analysis of several genes previously identified via microarray analysis to be differentially expressed during SE induction, along with the inclusion of two nonresponsive genotypes. While this demonstrated a high level of repeatability within, and between, responsive and nonresponsive genotypes, it did not support our previous contention that an adaptive stress response plays a role in SE induction responsiveness, at least with respect to the candidate genes we analyzed. RNAseq analysis was then used to compare responsive and nonresponsive G6 primordial shoots during the somatic embryogenesis induction treatment. Although not analyzed in this study, this included samples of callus and embryonal masses previously generated from G6 explants. In addition to revealing a large number of differentially expressed genes, de novo assembly of unmapped reads was used to generate over 25,000 contigs that potentially represent previously unidentified transcripts. This included a MADS-domain gene that was found to be the most highly differentially expressed gene within responsive shoot explants during the first seven days of the induction treatment.

Sigmoidal curve-fitting redefines quantitative real-time PCR with the prospective of developing automated high-throughput applications.

Quantitative real-time PCR has revolutionized many aspects of genetic research, biomedical diagnostics and pathogen detection. Nevertheless, the full potential of this technology has yet to be realized, primarily due to the limitations of the threshold-based methodologies that are currently used for quantitative analysis. Prone to errors caused by variations in reaction preparation and amplification conditions, these approaches necessitate construction of standard curves for each target sequence, significantly limiting the development of high-throughput applications that demand substantive levels of reliability and automation. In this study, an alternative approach based upon fitting of fluorescence data to a four-parametric sigmoid function is shown to dramatically increase both the utility and reliability of quantitative real-time PCR. By mathematically modeling individual amplification reactions, quantification can be achieved without the use of standard curves and without prior knowledge of amplification efficiency. Combined with provision of quantitative scale via optical calibration, sigmoidal curve-fitting could confer the capability for fully automated quantification of nucleic acids with unparalleled accuracy and reliability.

Mathematics of quantitative kinetic PCR and the application of standard curves.

Fluorescent monitoring of DNA amplification is the basis of real-time PCR, from which target DNA concentration can be determined from the fractional cycle at which a threshold amount of amplicon DNA is produced. Absolute quantification can be achieved using a standard curve constructed by amplifying known amounts of target DNA. In this study, the mathematics of quantitative PCR are examined in detail, from which several fundamental aspects of the threshold method and the application of standard curves are illustrated. The construction of five replicate standard curves for two pairs of nested primers was used to examine the reproducibility and degree of quantitative variation using SYBER Green I fluorescence. Based upon this analysis the application of a single, well- constructed standard curve could provide an estimated precision of +/-6-21%, depending on the number of cycles required to reach threshold. A simplified method for absolute quantification is also proposed, in which quantitative scale is determined by DNA mass at threshold.

Gene expression profiling of shoot-derived calli from adult radiata pine and zygotic embryo-derived embryonal masses.

BACKGROUND: Although somatic embryogenesis has an unprecedented potential for large-scale clonal propagation of conifers, the ability to efficiently induce the embryonal cultures required for somatic embryo production has long been a challenge. Furthermore, because early stage zygotic embryos remain the only responsive explants for pines, it is not possible to clone individual trees from vegetative explants at a commercial scale. This is of particular interest for adult trees because many elite characteristics only become apparent following sexual maturation. FINDINGS: Shoot explants collected from adult radiata pine trees were cultured on four induction media differing in plant growth regulator composition, either directly after collection or from in vitro-generated axillary shoots. Six callus lines were selected for microscopic examination, which failed to reveal any embryonal masses (EM). qPCR expression profiling of five of these lines indicated that explant type influenced the absolute level of gene expression, but not the type of genes that were expressed. The analysis, which also included three EM lines induced from immature zygotic embryos, encompassed five categories of genes reflective of metabolic, mitotic and meristematic activity, along with putative markers of embryogenicity. Culture medium was found to have no significant impact on gene expression, although differences specific to the explant's origin were apparent. Expression of transcriptional factors associated with vegetative meristems further suggested that all of the callus lines possessed a substantive vegetative character. Most notable, however, was that they all also expressed a putative embryogenic marker (LEC1). CONCLUSIONS: While limited in scope, these results illustrate the utility of expression profiling for characterizing tissues in culture. For example, although the biological significance of LEC1 expression is unclear, it does present the possibility that these callus lines possess some level of embryogenic character. Additionally, expression of vegetative meristem markers is consistent with their vegetative origin, as are differences in expression patterns as compared with EM.

Isolation and expression of cDNA clones coding for two sequence variants of Xenopus laevis histone H5.

We have cloned and characterized cDNAs coding for two variants of Xenopus laevis H5 histone protein (previously called H1s). cDNA was synthesized from RNA of immature erythrocytes in a single reaction using a modification of the method of Gubler and Hoffman [Gene 25 (1983) 263-269], and blunt-end ligated into the HincII site of the phage vector M13mp9. Immunological screening with a polyclonal antibody yielded two clones expressing H5 peptide. Sequence characterization revealed that both clones contained partial cDNA inserts and that the smaller 340-bp clone initiated reverse transcription within the coding region, at a site rich in adenine. Rescreening of the cDNA bank by nucleic acid hybridization produced eleven additional H5 clones, one of which coded for a second variant of H5. These two variants, called XLH5A and XLH5B, are very similar in sequence and code for proteins of 195 and 193 amino acids, respectively, which may be the H1D and H1E variants observed previously. XLH5, avian H5 and human H1O share identity at both nucleotide and amino-acid sequence levels. Further, the XLH5-coding mRNA is likely polyadenylated and lacks the highly conserved, 23-nucleotide dyad symmetry element found within the 3' untranslated regions of most histone-coding mRNAs.

Rapid synthesis and cloning of complementary DNA from any RNA molecule into plasmid and phage M13 vectors.

We describe several modifications of the Gubler and Hoffman procedure [Gene 25 (1983) 263-269] for complementary DNA (cDNA) synthesis that expand the versatility of this method for the rapid synthesis and cloning of double-stranded (ds) cDNA. These modifications include: (1) The combination of first and second strand synthesis into a single two-step reaction, which reduces the time for synthesis of blunt-ended ds-cDNA to less than 4 h. (2) The use of random hexadeoxyribonucleotide primers (RP) for the synthesis of ds-cDNA, which allows the synthesis of cDNA from any RNA template. (3) The combined use of random primers and DNA ligase treatment of cDNA/RNA hybrids prior to second-strand synthesis, which promotes the production of nearly full length ds-cDNA molecules. (4) The use of gel filtration to size-fractionate ds-cDNA, which allows the selection of specific size classes of ds-cDNA for cloning. (5) The use of blunt-end ligation to insert the ds-cDNA into the vector, which reduces the total time required for the construction of cDNA libraries to less than 24 h.

Synthesis and diuretic profile of 3-(3-amino-1,2,4-oxadiazol-5-yl)-5-chloro-2,6-pyrazinediamine, an amiloride-type diuretic.

The synthesis of an analogue of amiloride in which the acylguanidine moiety has been replaced by a 1,2,4-oxadiazol-3-amine unit is described. This substance (3, CGS 4270) exhibited a diuretic profile similar to that of amiloride when evaluated in the rat and the dog. In the rat, combination with hydrochlorothiazide increased diuresis and saluresis and returned potassium levels to control values. A series of 5-aryl-1,2,4-oxadiazol-3-amines not directly related to amiloride was prepared, but these substances had no diuretic activity.

A statewide, population-based, time series analysis of access to liver transplantation.

While the number of patients listed for liver transplant has increased, the pool of donor organs has remained constant. Questions have arisen regarding equitable access to organs. The purpose of this study was to analyze factors associated with access to liver transplantation (LT) using a large, population-based, hospital discharge database. The primary hypothesis was that a variety of factors other than medical need could be associated with access to LT. The rate of LT was defined as the number of liver transplants per admission for liver disease. The data sources were selected to allow a population-based, time-series analysis of all patients admitted with liver disease and those receiving liver transplants in all 157 nonfederal hospitals in North Carolina from 1988 to 1993. The hypotheses of this study were that age, gender, payment source, type of liver disease, distance from the transplant center, and rural county of residence were associated with patients' likelihood of access to LT. During the six years studied, 56,803 patients were admitted with liver disease and 126 underwent liver transplantation (LT). The rate of LT increased from 0.07% to 0.27%. Age, gender, source of payment, type of liver disease, rural county of residence, and distance of residence from the transplant center were associated with rates of transplantation. In the multivariate model, source of payment appeared to have the strongest association with the likelihood of LT. These findings raise important questions associated with equitable access to health care, need for physician education, and transplant center regionalization.

The mini-gastric bypass: experience with the first 1,274 cases.

BACKGROUND: Results of the laparoscopic Mini-Gastric Bypass (MGB) are reported. METHODS: 1,274 MGB patients are continuously monitored as part of an online computer tracking data-base system. RESULTS: Mean preoperative weight (+/- Standard Deviation) was 132 +/- 21 kg, BMI 47 +/- 7. Mean excess weight loss was 51% at 6 months, 68% at 12 months and 77% at 2 years. The mean operating-time was 36.9 +/- 33.5 minutes. The shortest time was 19 minutes. Hospital stay was 1.5 +/- 1.6 days. The overall complication rate has been 5.2%. The overall rate of deep vein thrombosis and pulmonary embolism was 0.08% and 0.16% respectively. The leak rate was 1.6%. There was one hospital death, 0.08%. Associated medical illnesses were either completely reversed or markedly improved. CONCLUSIONS: The MGB is safe, results in major weight loss, has a short operating-time, and has a short hospital stay. The MGB appears to meet many of the criteria of an "ideal" weight loss operation.

Cooper's ligament repair: a 25-year experience with a single technique for all groin hernias in adults.

In the belief that recurrences will be lower if all defects are repaired at the original operation, I performed a Cooper's ligament repair on all groin hernias in adult patients between 1959 and 1984, regardless of the hernia type. This series includes 1142 repairs in 942 patients. Follow-up has been 97%, with 80% of the patients being personally examined by the author. Excluding late deaths, 906 repairs in 747 patients have been followed up for an average of 9 years. There have been 18 recurrences, for a recurrence rate of 2% of live repairs. This breaks down to 1.9% for 779 primary hernias and 2.4% for 127 recurrent hernias. In primary hernias only the recurrence rates are 3.5% for 289 direct hernias, 1.1% for 459 indirect hernias, and 0% for 31 femoral hernias. Seventeen of the 18 recurrences have been indirect along the cord in a subgroup of 147 repairs done with a subcutaneously transplanted cord and followed for an average of 17.4 years (recurrence rate, 11.6%). This method was discarded in 1972. There has been only one recurrence in 572 repairs with the cord left in the natural position and followed for an average of 7.1 years (recurrence rate, 0.2%). This shows the value of not superimposing the internal and external rings (90% confidence limits that the recurrence rate is less than 0.7%). There has been no recurrence in 154 repairs in female patients or 33 repairs with orchiectomy followed for 8.1 and 8.8 years, respectively. A Cooper's ligament repair gives a strong posterior wall and repairs all the defects that can occur in the groin. It can be done safely on all adult groin hernia patients, with a recurrence rate lower than those reported for selective methods of repair.

Methods of repair of noncircumferential bile duct defects.

Although noncircumferential bile duct defects are uncommon, they are important because they require careful repair to avoid subsequent biliary stricture. I have encountered three of these defects in more than 1000 biliary operations. The method of repair chosen for a particular case depends on the pathologic defect, the potency of the ampulla, and the tissues available for use. If the ampulla must be bypassed, a Roux-en-Y jejunal reconstruction is applicable for most biliary defects. An anastomosis between the bile duct and duodenum may be suitable to repair low biliary defects. Occasionally, the gallbladder can be used as a conduit between the bile duct defect and the duodenum or jejunum. If the ampulla need not be bypassed, a Heineke-Mikulicz repair is suitable only for very short defects. A patch technique is a better choice for larger defects. Patches can be made of autogenous vein, gallbladder, knitted Teflon, or a serosal onlay patch of duodenum or jejunum. A vein patch is especially appealing because it will easily cover any extrahepatic defect. A different method was chosen in each of three cases. Side-to-side Roux-en-Y hepaticojejunostomy was used to repair a large cholecystocholedochal fistula with associated pancreatitis. Heineke-Mikulicz repair was employed for a short hepatic duct stricture. Saphenous vein patch was used to repair a long bile duct defect during a left hepatectomy for hepatocellular carcinoma. This patient presumably represents the second successful reported vein patch repair and the only one with subsequent studies showing the fate of the vein patch. The vein patch apparently acts as a temporary scaffold allowing the outgrowth of biliary epithelium from the remaining bile duct wall. Careful initial repair of these noncircumferential bile duct defects is essential to avoid a subsequent biliary stricture with its disastrous consequences.

Primary appendiceal malignancies: rare but important.

The four main types of appendiceal neoplasms are carcinoid tumors (CT), mucinous cystadenocarcinomas, colonic adenocarcinomas (CAC), and adenocarcinoid tumors. They have different clinical features and require different therapy. They are rarely diagnosed before or during surgery and frequently require a secondary operation for proper treatment. A series of 14 patients treated between 1979 and 1989 at Harris Methodist Fort Worth Hospital are described. There are six important points of management. (1) A frozen section should be done whenever the appendiceal findings are atypical. Then a diagnosis of malignancy can be made during surgery and appropriate surgery can be done primarily. (2) All patients with appendiceal neoplasms should be followed because a second malignancy will develop in 15% to 20% of them. (3) Appendectomy is recommended for patients whose CT are less than or equal to 1.0 cm in diameter and for most patients whose tumors are between 1.0 and 2.0 cm in diameter. Right hemicolectomy is preferred for those patients whose CT are 2.0 cm or more in diameter or between 1.0 and 2.0 cm with heavy lymphatic and mesenteric invasion. (4) Mucinous cystadenocarcinomas are slowly progressive and are best treated by means of right hemicolectomy with aggressive debulking added if pseudomyxoma peritonei is present. (5) CAC require a right hemicolectomy and have the same prognosis as have other colon adenocarcinomas. (6) Adenocarcinoid tumors have a dual cell origin, a predilection for developing ovarian metastases, and a malignant potential between CT and CAC. They are best treated by means of right hemicolectomy with concomitant oophorectomy in postmenopausal women.

Illness severity adjustment for outcomes analysis: validation of the ICISS methodology in all 821,455 patients hospitalized in North Carolina in 1996.

BACKGROUND: Previous work has demonstrated that the International Classification of Diseases 9th Revision (ICD-9) Based Illness Severity Score (ICISS) methodology developed by Rutledge and Osler can perform well in this role as a severity adjustment tool in trauma patients. The purpose of the present study was to extend this previous work to determine the ability of ICISS to predict outcomes in all types of hospitalized patients. METHODS: The ICISS methodology was used to derive predictions of survival, length of hospital stay, and hospital charges in the entire study population. RESULTS: A total of 821,455 hospitalized patients in North Carolina in 1996 had complete data available for analysis. The overall hospital mortality rate was 2.9%. ICISS was an accurate predictor of hospital survival in all hospitalized patients (accuracy 95.9%, sensitivity 97.2%, and specificity 52.7%.) The area of the receiver operator characteristic curve was 0.93. By adding to the model, the area under the receiver operator characteristic curve increased to 0.95. ICISS also explained a large amount of the variance in hospital stay and charges (R2 = 0.38 and 0.56, respectively, P < .0001). CONCLUSIONS: This study extends previous work suggesting that ICISS may be an important improvement over other presently available severity adjustment models. If these findings are confirmed in comparison with other predictive tools, ICISS may find an important place in assessing illness severity.

Mediastinal infection after open heart surgery.

Mediastinal infection occurred in 29 of 2031 patients (1.4%) who underwent median sternotomy for cardiac operation at the National Heart, Lung and Blood Institute between 1956 and 1981. Factors associated with the development of mediastinitis included postoperative complications such as low cardiac output, respiratory insufficiency, reoperation for bleeding, repeat median sternotomy, and triple valve replacement. Factors that were not significantly associated with the development of mediastinitis included preoperative functional class, preoperative cardiac index, age, sex, weight, or presence of diabetes mellitus. The mortality rate in patients who developed mediastinitis was 52%. Factors associated with death included preoperative functional class III or IV, type of operation, type of organism involved, and the development of pneumonia. The mortality rate was significantly lower (35% versus 73%) in the patients who underwent mediastinal exploration for treatment. There was no difference in survival whether the wound was closed over drainage tubes or packed open. Hospital stay, however, was significantly prolonged in the patients whose wounds were packed open.

The relation of serum calcium and immunoparathormone levels to parathyroid size and weight in primary hyperparathyroidism.

This study was designed to determine whether the serum calcium or immunoparathormone (iPTH) level would be of value in predicting the size or weight of the parathyroid gland in patients with single-gland enlargement caused by primary hyperparathyroidism. Ninety-two patients who underwent parathyroidectomy with removal of a single enlarged gland at the North Carolina Memorial Hospital (1974 to 1984) were reviewed. The preoperative calcium and immunoparathormone levels were correlated to the weight and calculated volume of the removed gland. The calcium level was found to be significantly associated with parathyroid gland weight and volume (p less than 0.001), as determined by linear regression analysis. Despite the statistical association, the correlation coefficient (calculated with the Pearson correlation matrix) was low, 0.16 for the relation of calcium to gland weight and 0.25 for the relation of calcium to calculated gland volume. The calculated coefficients of correlation of iPTH (three different assays) to gland weight and volume were similarly low. These findings demonstrate a variable relationship between the preoperative serum calcium level or the iPTH level to the weight or volume of the enlarged hyperfunctioning parathyroid gland. Identification of the pathologic parathyroid gland(s) in primary hyperparathyroidism cannot be based on a perceived relation of preoperative calcium or iPTH levels to the size of the enlarged glands.