Haemophilus influenzae infections following licensure of the Hib vaccine.
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Biomedical subjects
Publications and source records attributed to J F Shaw.
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The case of a newborn boy with a congenital cystic neck mass causing respiratory distress is reported. This lesion extended from the submandibular region through a bone defect to the middle cranial fossa but remained totally extradural. There was no underlying brain abnormality. The cyst was composed mainly of mature neuroglial tissue, with some ependymal and choroid plexus elements, and was diagnosed as heterotopic brain. After 8 years' follow-up, the child still has no deficits.
The authors present a patient who developed an acute hemorrhage around a Silastic dural substitute 13 weeks after excision of a meningioma and implantation of the graft. The relevant literature is reviewed.
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A 5-year-old white boy presented with life-threatening haematemesis from spontaneous rupture of an aneurysm of the high cervical internal carotid artery (ICA). The haemorrhage was controlled by emergency trap ligation of the distal ICA in the neck. The child made an excellent recovery and 7 years later has no neurologic deficit other than an Horner's syndrome. The diagnosis of an extracranial carotid artery aneurysm without a pulsatile lump may be very deceptive.
An epidemic of nonbacterial gastroenteritis affected nearly 100 students at a college campus in Jefferson County, Alabama. The outbreak closely resembled food poisoning, since there was a rapid occurrence of multiple cases within a short period. Vomiting occurred in 79% and diarrhea in 64%; fever was uncommon. We found a significant association between the illness and the eating of lettuce at a meal one day before the outbreak began. Paired serologic specimens showed evidence of Norwalk virus infection. Twenty acutely ill students had leukocytosis (mean WBC 12,780/cu mm) and lymphopenia--a pattern that may be characteristic of Norwalk virus gastroenteritis. Outbreaks of Norwalk virus infection as well as other nonbacterial gastroenteritis may closely mimic epidemics caused by more familiar foodborne pathogens such as staphylococci.
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The apparent specificity of activation of lysine-sensitive aspartokinase (E.C.2.7.2.4) from E. coli by monovalent cations differs depending on the assay used and on the Mg2+ concentration. Activity is nearly absolutely dependent on and is highly specific for a monovalent cation in the aspartate semialdehyde dehydrogenase coupled assay or the adenosine triphosphate-adenosine diphosphate exchange assay. Little specificity for monovalent cations is observed using the aspartyl hydroxamate assay. Activation and specificity are also altered by Mg2+ concentrations at a constant 5 mM nucleotide concentration. At a low (1.25 or 1.6 mM)Mg2+ concentration, monovalent cation activation and specificity are nearly absolute. Less dependence on monovalent cations and less specificity are observed at a higher Mg2+ concentration (6 mM). Li+ inhibits aspartokinase competitively with respect to either K+ or NH4+. Monovalent cations are also thermoprotective and differential thermal inactivation experiments at 56 degrees C reveal that NH4+ and K+, either of which will produce maximum catalytic activity, interact differently with aspartokinase. K+ interacts with positive cooperativity, whereas NH4+ does not. K+, NH4+, and Na+ are about equally effective in enhancing the dissociation of the aspartokinase-aspartylphosphate complex. Li+ is less effective.
Hearts taken from DA (RT1a) rats were transplanted heterotopically to PVG (RT1c) rats of the same sex (day 0). On day 1 or on day 5 rats were treated with prostacyclin (PGI2), 250 ng/kg/min, by continuous infusion of alkaline solution into the inferior vena cava until the time of rejection. Controls received glycine buffer infusion alone, from day 1 or day 5. Cessation of palpable graft beat was taken as the end point of rejection. When PGI2 was infused from day 5 median graft survival time was prolonged from a control of 7.8 days to 9.3 days (P less than 0.05). When PGI2 was infused from day 1, graft survival time was prolonged from a control of 7.4 days to 8.6 days (P less than 0.05). Other groups of rats were treated from day 1 or from day 5 with aspirin (acetylsalicylic acid), 200 mg/kg/day, by 8-hourly subcutaneous injection in saline. Control groups received saline alone. When aspirin was given from day 5, graft survival time was prolonged from a control of 7.3 days to 9.5 days (P less than 0.05). When aspirin was given from day 1 graft survival time was prolonged from a control of 7.2 days to 14.9 days (P less than 0.01), and in two cases this led to very prolonged survival. Histological examination at the time of rejection showed lymphocyte and neutrophil infiltration to be much more prominent than vessel occlusion in all groups. These results imply that PGI2 and aspirin may be beneficial to graft survival in acute rejection, but this is not due to reduced occlusion of blood vessels by platelets.
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Thirty two human tumours, mainly neurogenic, have been investigated for the presence of adenovirus-related RNA sequences. 3H-labelled tumour virus DNA probes derived from human adenoviruses types 2 and 12, bovine adenovirus type 3, and avian adenovirus CELO were hybridized in-situ on tumour kryostat sections under conditions that detect complementary RNA. Tumour virus-related RNA was detected in 62% of all tumours tested, but was not detectable in normal human brain tissues. Expression of tumour virus-related RNA was found in 2/4 astrocytomas, 2/4 metastatic brain carcinomas, 2/2 glioblastomas, 1/1 melanoma, 5/7 meningiomas, 4/4 neurinomas, 1/2 oligodendrogliomas, and 1/1 rhabdomyosarcoma. The presence of adenovirus-related RNA in the majority of human neurogenic tumours may reflect a viral involvement in the pathogenesis of these tumours.
The effect of pretransplant stored donor-specific blood transfusions (DSBTs) on early renal allograft survival in 37 consecutive one-haplotype living related donor (LRD) transplants (group B) was compared with a similar consecutive series of 38 one-haplotype LRD recipients (group A) who did not receive DSBTs. All transplant recipients in both groups were treated with identical immunosuppressive protocols using azathioprine and prednisone. Forty patients received pretransplant DSBTs and three of these patients (8%) developed cytotoxic antibodies to their prospective donors. Neither hyperacute rejection nor hepatitis occurred in group B patients following DSBTs. One group B patient experienced a technical graft loss on the 1st postoperative day and was excluded from the rejection data. Graft survival at 3 and 6 months was 100 and 90% in group B recipients and 68% in group A recipients. All 12 group A graft failures resulted from acute nonreversible rejection episodes occurring during the first 3 months post-transplant. The three group B graft failures occurring at 6 months were attributable to chronic vascular rejection. Chronic rejection of the renal allograft was histologically documented in six group A and five group B patients by 6 months post-transplant. The use of stored donor blood offered a simple and easily monitored method of administering pretransplant DSBTs that was convenient to the donor and recipient. The administration of DSBTs did not appear to be harmful to the recipient. In fact, the use of pretransplant stored DSBTs in one-haplotype LRD renal transplantation appeared to improve the prospects of early graft survival in our experience.
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