Brucellosis: a continuing problem.
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Biomedical subjects
Publications and source records attributed to A B Glassman.
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E corrodens occurs as a significant clinical infection more frequently than suspected or cultured at the present time. It is essential that the dentist or physician work closely with the laboratory clinician in order to use proper techniques for its isolation. Inconsistencies between in vitro disk sensitivity and clinical drug response are noted. Because of clinical response, the clinician must carefully follow the patient's daily progress to recognize antibiotic treatment failure so that combination therapy or appropriate incision and drainage procedures may be initiated.
We have described the isolation of Mycobacterium chelonei subspecies abscessus which on two occasions grew out within 4 days in routine cultures after inoculation with purulent material from injection abscesses in a patient with diabetes mellitus. Media isolation and culture characteristics of this organism in comparison to others in the Mycobacterium fortuitum complex are described. Mycobacteria in routine laboratory media can be mistaken for diphtheroids or other "contaminants" or can be overlooked entirely. The possibility of clinical infection of mycobacterial species should be kept in mind when confronted with "sterile" abscesses at injection sites.
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Successful cryopreservation of human lymphocytes has been previously described. Cryopreserved lymphocytes are useful for a variety of in vitro immunologic studies. This study was performed to determine the applicability and/or advantages of using a programmable freezing system, and compares glycerol versus dimethyl sulfoxide (DMSO) at varying concentrations on post-thaw viability, E-rosetting and immunoglobulin fluorescence. Prefreeze T and B lymphocyte percentages were determined. Cells were then frozen in varying concentrations of glycerol and DMSO. Optimum cryoprotectant type and concentration was determined. Lymphocytes from seven individuals were frozen by the batch method in a mechanical freezer and with the automated liquid nitrogen injection system. Data on post-thaw T and B percentages and viability revealed 10% DMSO and liquid nitrogen control freezing method at 1 C/minute as the best conditions for lymphocyte preservation as reflected by post-thaw in vitro testing.
An IgG antibody defining a high-frequency red cell antigen was detected in the sera of two unrelated, nontransfused black women GT (gravida 1, para 0) and DLC (gravida 4, para 2). Inheritance of the antigen was established by the family study of DLC. The clinical significance of the antibody is not yet known. The antibody has been designated anti-Tca, and the corresponding antigen, Tca. No Tc(a-) individuals were found among 5000 Caucasians, 5000 Japanese, or 450 blacks; however, anti-Tca was identified in the sera of two other unrelated black women (LZ and WM). A relationship between Tca and Cra has been proposed by other serologists, but further evidence is needed to confirm the association.
Various antibodies and immune complexes have been demonstrated in patients with Guillain-Barré syndrome (GBS). These factors may be part of the pathogenesis of the disease process through immune complex deposition and/or suppression of the immune system. Four patients with typical GBS were treated by plasma exchange. Aliquots from the first 100 ml of plasma removed from each patient were incubated with cultures of normal human peripheral lymphocytes that subsequently were exposed to mitogens, followed by incubation with tritiated thymidine. A decrease (p less than 0.001) in response to each of the mitogens was noted after incubation with patient plasma. Peripheral lymphocytes were taken from the patients before and after plasma exchange. An increase (p less than 0.01) in DNA synthesis following mitogen exposure was observed after plasma exchange in each patient. All patients exhibited subjective and objective clinical improvement. Plasma exchange for GBS appeared to remove a lymphocyte suppressor factor, which was characterized by column fractionation. The suppressor factor was determined to be a substance of approximately 10,000 to 12,000 daltons that reproducibly decreased the responsiveness of normal lymphocytes to mitogens.
Lymphocytes were frozen at a density of 5 to 10 X 10(6) cells per ml at 1 degree C per minute in a programmable liquid nitrogen freezer. T-subsets were determined by using monoclonal antibodies. A fluorescein-conjugated polyvalent antisera with B-cell specificity was used to define B-cells. No significant change in numbers of total T-lymphocytes or -subsets was identified in the frozen lymphocytes when compared to fresh controls. Liquid nitrogen cryopreservation is an acceptable method of storing lymphocytes for subsequent determination of T-subsets using monoclonal antibodies.
Neutrophils isolated from cord blood of healthy newborns (33 blacks and 21 whites) were investigated by EDTA-microagglutination for their expression of neutrophil specific antigens that have been associated with isoimmune neonatal or autoimmune neutropenia. Equal volumes of various neutrophil antisera (2 microliter) and cord neutrophils (3-5 X 10(6)/ml) were mixed in tissue typing microplates under oil and were incubated at room temperature for 6-8 hr, following which the degree of agglutination was noted. Our data revealed that all the currently recognized neutrophil antigens are readily demonstrable by antineutrophil antibodies in cord blood, (NA1, 52-54%; NA2, 81-85%; NB1, 95-96%; NC1, 90%; 9A, 29-30%) suggesting that neutrophil antigens are fully expressed at birth.
Testing of blood for antibodies to the human immunodeficiency virus type 2 (HIV2) has begun. A major benefit of this testing will be the elimination of the exclusion of blood donors on the basis of geographic origin. Will this test be helpful? Present anti-HIV1 testing detects between 60 to 90 percent of those samples containing the HIV2 antibody. A Food and Drug Administration (FDA) licensed enzyme immunoassay for HIV1/HIV2 antibodies became available for clinical use in March of 1992. (There is an FDA unlicensed HIV-2 Western Blot (WB) Test). The specificity and sensitivity of either the HIV2 EIA or HIV2 WB are not well defined. In a survey of 24 million U.S. donors, no antibodies to HIV2 were detected. With the incidence of HIV2 infection being so small, it is probable that the majority of positive tests will be false-positives causing needles concern for the blood donor who must be counseled. The benefits to the blood supply remain to be evaluated.
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Imaging modalities are a major part of the diagnosis and follow-up to therapy of hepatobiliary disease. Changes of the liver, spleen, gallbladder and pancreas can be assessed by a variety of highly technical and evolving methods. The purpose of this paper is to review briefly some diseases of the hepatobiliary tree and pancreas and how they may be diagnosed through imaging modalities. Hepatic diseases may include those that affect the parenchyma, biliary tree, or gallbladder. The spleen is often altered in size secondary to liver disease. Pancreatic diseases present particular difficulties in diagnosis as they relate to clinical chemistry tests, tumor markers or imaging. Imaging modalities for hepatobiliary disease include x-ray studies with or without contrast, and with or without computerized tomographic enhancements. Some of the x-ray procedures are done in association with percutaneous or endoscopic retrograde approaches. Ultrasound is an excellent technique for evaluation of cholelithiasis and gives useful information for hepatic and splenic size. Radionuclide studies can be either anatomically or physiologically based. Magnetic resonance imaging is evolving as a very useful, specific and sensitive method of evaluating the liver, gallbladder, spleen and pancreas. There is a diverse armamentarium of imaging modalities available for the evaluation of hepatobiliary disease. Ultrasound is the first choice for cholelithiasis. Endoscopic retrograde cholecystography (ERCP) is a definitive method for evaluating the biliary tree. Radionuclide studies with the iminodiacetic acid (IDA) derivatives are very useful for functional disorders of the gallbladder. Computer assisted tomography and magnetic resonance imaging (MRI) provide optimal anatomic resolution for tumors, abscesses, and other metastatic lesions involving the liver and spleen.