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Biomedical subjects

G Shulman

Publications and source records attributed to G Shulman.

At least 19 recordsLinked to original sources

A survey of hepatitis B surface antigen-positive blood donors: degree of understanding and action taken after notification.

All blood donors in the United States are tested for hepatitis B surface antigen (HBsAg) upon donation; if the test result is positive, the primary method of notification is by letter. To assess the effectiveness of this notification methods in stimulating HBsAg-positive donors to seek medical care and take preventive measures, 54 donors who tested HBsAg-positive on donation at the American Red Cross Blood Services. Atlanta Region, from January 1987 to July 1989 were interviewed. Thirty-nine donors (72%) had sought medical care after notification; the only motivating factor was that the letter told the donor to consult with his or her physician. Compared with donors who did not seek medical care, donors who did so were more likely to understand that the blood test was abnormal or that they were infected, and they were more likely to understand how hepatitis B virus is transmitted and that a vaccine is available. The differences were not significant, however. Of those donors who sought medical care, less than half received appropriate recommendations for protection of contacts, and of those who did, only one-third received prophylaxis. In-person and telephone interviews with donors, revision of the notification letter, and hepatitis B education programs targeted at medical care providers are suggested.

Blood Donors

Indeterminate HTLV serologic results in U.S. blood donors: are they due to HTLV-I or HTLV-II?

Current screening tests to detect human T-lymphotropic virus type I (HTLV-I) in volunteer blood donors commonly yield indeterminate HTLV serologic results (mostly isolated gag reactors). To assess the significance of indeterminate HTLV serologic results in U.S. blood donors, we compared 56 persons who had such serologic patterns with 30 HTLV seropositive blood donors and with HTLV seronegative controls. Polymerase chain reaction assays showed that none of the 56 individuals with indeterminate HTLV serologic results were infected with HTLV-I or HTLV-II, while all 30 HTLV seropositive blood donors were infected with either HTLV-I (in 15) or HTLV-II (in the other 15). The seroindeterminate blood donors were also different from the HTLV seropositive blood donors and more like HTLV seronegative controls in their demographic characteristics and the presence of HTLV risk factors. These results are evidence that volunteer blood donors with isolated and persistent gag seroreactivity in the United States are unlikely to be infected with HTLV-I or HTLV-II.

Adolescent

Seroprevalence and epidemiological correlates of HTLV-I infection in U.S. blood donors.

Screening for human T-lymphotropic virus type I (HTLV-I) antibodies was performed on sera from 39,898 blood donors at eight blood centers in geographically distinct areas of the United States. Ten donors (0.025 percent) showed evidence of HTLV-I seropositivity by enzyme immunoassays; this was confirmed by protein immunoblot and radioimmunoprecipitation. Seroprevalence rates ranged from 0 to 0.10 percent at the locations sampled, with HTLV-I antibodies found predominantly in donors from the southeastern and southwestern United States. Matched case-control interviews and laboratory studies were performed on five seropositive women and two seropositive men who participated in an identity-linked collection of sera from a subset of 33,893 donors at six of the eight blood centers. Four of the women and both men are black; one woman is Caucasian. Four of the seven seropositive individuals admitted to prior intravenous drug abuse or sexual contact with an intravenous drug user. Sexual contact with native inhabitants of an HTLV-I endemic area was the only identified risk factor for one male. The distribution of HTLV-I antibodies in this U.S. blood donor sample corroborates the previously reported epidemiology of this agent and suggests that additional donor screening measures, including the testing of donated blood for HTLV-I markers, may be necessary to prevent the spread of HTLV-I to transfusion recipients.

Adult

Double contrast arthrography of the knee. A comparison to clinical diagnosis and arthroscopic findings.

The accuracy of pre-arthroscopic double contrast arthrography was evaluated in 100 consecutive patients. Meniscal tears were correctly diagnosed arthrographically in 76% of cases, and clinically in 85% of cases. Although reasonably accurate in determining the location of the meniscal tear, arthrography was significantly inaccurate in the evaluation of the type of tear. The status of the anterior cruciate ligament was correctly interpreted by arthrogram in 76% of cases; the integrity of the ligament was correctly assessed in 94% of cases by clinical examination without anesthesia. It appears, therefore, when compared to initial clinical examination, double contrast arthrography is of limited usefulness as a pre-surgical aid to the diagnosis of intra-articular knee pathology.

Arthrography

Acute bacterial arthritis in the adult.

Suppurative arthritis can be a complex and vexing problem. Formal arthrotomy is among the many successful approaches for the treatment of septic joints in the adult, however, it is not without morbidity and may not always be required. The clinical features, pathophysiology, and treatment of this disorder are reviewed.

Acute Disease

Tumor-associated antigens in breast carcinomas. Prognostic significance.

In an attempt to identify biologic markers that might predict prognosis in breast cancer patients, the presence or absence of seven tumor-associated antigens in 54 infiltrating breast carcinomas was correlated with tumor recurrence rates (minimum five-year follow-up), axillary lymph node metastases and tumor volume. Immunohistochemical kappa-casein was present in 30 (56%) tumors, alpha-lactalbumin in 39 (72%) tumors, secretory component of IgA in 26 (48%) tumors, carcinoembryonic antigen in 34 (63%) tumors, pregnancy-specific beta-1-glycoprotein in 7 (13%) tumors, beta subunit of human chorionic gonadotrophin in 1 (2%) tumor and human placental lactogen in 0 (0%) tumors. There was no significant correlation between the presence or absence in tumor of any of the antigens, and prognosis as assessed either by 5-year recurrence rates (P greater than 0.18) or by the presence of axillary lymph node metastases (P greater than 0.20). No significant difference was noted in mean tumor volume (cm3) +/- SEM, between tumors with or without antigen immunoreactivity (P greater than 0.05).

Antigens, Neoplasm

Liver iron stores and hepatitis B antigen status.

Higher serum iron and ferritin levels noted in hepatitis B antigen (HBAg) carriers than in noncarriers suggests that virus might actively replicate in hepatocytes, stimulate ferritin synthesis, and result in increased liver iron stores. A comparative semiquantitative study of immunohistochemical ferritin (0-12) and hemosiderin (0-9) was performed on 54 normal, 13 cirrhotic, and 70 nonneoplastic livers from patients with hepatocellular carcinoma, in each group, comparing amounts in HBAg-positive and HBAg-negative patients. Mean scores for ferritin and hemosiderin were high in all three groups, normal livers averaging 8.3 and 6, respectively, cirrhotic livers, 8.5 and 7.4, respectively, and carcinoma livers, 5.6 and 6.1, respectively. In each group, there was no significant difference in ferritin and hemosiderin mean scores in HBAg-positive and HBAg-negative patients. The large liver iron stores do not appear to be a consequence of hepatitis B virus infection alone. Their role in the development of hepatocellular carcinoma is still to be elucidated.

Carcinoma, Hepatocellular

Changes in plasma haptoglobin and alpha-2-macroglobulin in hemophiliacs receiving factor replacement therapy.

Plasma proteins were studied in 84 patients with hemophilia A, who were receiving factor replacement therapy. Compared with age-matched controls, 63 patients (75%) had subnormal haptoglobin and 58 (69%) had elevated alpha-2-macroglobulin. Causes for depressed haptoglobin were sought by correlating ABO blood types, liver function tests, factor VIII procoagulant levels, and intensity of yearly exposure to clotting factor products. Subnormal haptoglobin levels in chronically transfused patients may relate in part to hemolysis from AB incompatability. However, depressed haptoglobin levels were also found in group O hemophiliacs without other evidence of hemolysis. Most patients lacked evidence of active liver disease, making synthetic deficiency unlikely. There was close correlation between depressed haptoglobin and severity of clotting factor deficiency. The degree of alpha-2-macroglobulin elevation correlated with severity of procoagulant deficiency but not with intensity of clotting factor replacement therapy. Since alpha-2-macroglobulin plays a major role in the catabolism of fibrinogen, elevated levels may represent a compensatory increase in response to exogenous fibrinogen contained in the clotting factor concentrates. Alternatively, since alpha-2-macroglobulin has potent immunosuppressive properties, the elevation may represent a response to transfused alloantigens. Whatever the underlying cause, it is likely the elevations are due to endogenous production rather than to transfusions since clotting factor concentrates contain minimal amounts of alpha-2-macroglobulin.

ABO Blood-Group System

Canthaxanthin.

Canthaxanthin is used as a food-coloring agent, a photoprotective agent in certain photodermatoses, a tan-simulating agent, and a pigment to darken vitiliginous skin. This article reviews the current literature on canthaxanthin and reports the evaluation of oral canthaxanthin as an artificial pigment for the management of vitiligo. Fifty-six patients were studied, using serum canthaxanthin levels, pre- and post-treatment photographs with standard conditions, physician assessment, and patient questionnaires evaluating treatment results. Canthaxanthin was rated "very satisfactory" by 10%, "satisfactory" by 35%, and "unsatisfactory" by 54% of patients. In light-skinned individuals, self-reports were "very satisfactory" in 27%, "satisfactory" in 45%, and "unsatisfactory" in 27%. In dark-skinned individuals, the treatment was less effective. Women were happier with the results than men. Major side effects were red stools and orange palms and soles. Canthaxanthin can be taken orally, is easy to use, and can be a cosmetically acceptable therapy in selected cases of vitiligo.

Adolescent

Crossed immuno-electrodiffusion in the diagnosis of immunoglobulin fragment abnormalities.

The use of crossed immuno-electrodiffusion in the diagnosis of alpha-chain disease is described. The same basic technique is applicable in diagnosis of diseases in which immunoglobulin fragment abnormalities may occur. Crossed immuno-electrodiffusion is shown to be a superior method for demonstrating the abnormaility by providing more powerful resolution. Immunoselection (an adaptation of the classical method of immuno-electrophoresis) or rocket immuno-electrodiffusion both have limitations which are overcome by the use of crossed immuno-electrodiffusion. Mixture of antibodies is avoided by separating antibody-containing gels with interposition of intermediate gel layers free of antibody. Furthermore, precipitin rockets of some specific proteins can also be identified morphologically.

Electrophoresis, Cellulose Acetate

Comparison of specific protein assays in biological fluids by radial immunodiffusion and laser nephelometer.

Laser immuno-nephelometry is presently being used for measuring concentrations of specific proteins in biological fluids. Our findings have not substantiated the highly correlative results with radial immunodiffusion that have been reported. The reason for our poor correlation was found in the lack of uniformity in expressing concentrations of the different specific proteins in the calibrating standards. One value of the laser nephelometer was the greater precision obtained when comparing results to those measured by radial immuno-diffusion. Also, the laser was found to be more sensitive for measuring low level concentrations.

Blood Proteins

Quantitative bacteriology in wound care.

Quantitative bacteriology in the management of wound sepsis provides an objective way to monitor the success or failure of wound care. The clinical appearance of a wound requiring skin grafting may be misleading. Grafting wounds that appeared clinically ready was unsuccessful when analysis showed bacteriological counts of 10(5) or greater organisms per gram of tissue. A rapid and simple method for quantitative tissue culture is described. Three cases are described illustrating the value of the results of the method.

Aged

Semi-automatic data processing in clinical chemistry.

A semi-automatic system for data processing in the Clinical Chemistry Department of the School of Pathology, Johannesburg, is outlined. Careful planning of workflow in the laboratory can provide a better interface of laboratory results with a manual cumulative reporting system in which technologists and clerks co-ordinate their activities. The system used provides a less tedious and less error-prone process via automatic printing facilities. This system achieves improved patient care in terms of quality control (data checks) and cumulative reporting of results. Facility for accounts and administration purpose are also incorporated. In our experience, semi-automatic data processing can provide a solution to the clerical problems generated by the introduction of automatic testing equipment. Hardware costs are minimal in comparison to fully automated systems, which utilize on-line or off-line computers.

Chemistry, Clinical

Bence Jones myelomatosis and intravenous pyelography.

The consequences of intravenous pyelography are described in 3 patients with unsuspected myelomatosis. One patient died, and 1 surviving patient showed unusual solubility of Bence Jones protein to acid pH in vitro. The urine of a third patient was negative for Bence Jones protein. Simple chemical screening of urine, to detect Bence Jones protein, is essential before patients undergo urography.

Acute Kidney Injury

The value of quantitative protein electrophoresis.

Study of serum protein fractions separated by electrophoresis shows variation in subjects of different sex and race. Interpretation of results by clinicians is often difficult since the bands are composed of several different proteins, each responding to different physiological stimuli. Important information can be gained by examining the electrophoretogram and the qualitative appearance of the bands. This should be communicated to the clinician and, depending on the clinical and qualitative electrophoretic findings, an analysis of certain specific proteins should be performed.

Adult