Bowel preparation for the double-contrast barium enema: how to maintain coating with cleansing?

AIM

Poor mucosal coating, due to excess of fluid in the colon lumen, is a problem when the oral lavage method (4 litres of an iso-osmotic saline solution containing polyethylene glycol) is used as a preparation for double-contrast barium enema. Our aim was to assess the value of prior administration of sennosides to obtain a clean colon with a reduced volume of polyethylene glycol (PEG)-saline solution, but maintaining good mucosal coating.

MATERIALS AND METHODS

After a 2-day low-residue diet, three different oral preparations were compared: (i) 4 litres of a PEG-saline solution (SELG) and 15 mg of bisacodyl (116 patients, SELG-4 group); (ii) 156 mg of sennosides, 15 g of magnesium sulphate, and 2 litres of water (116 patients, SennMg group); (iii) 156mg of sennosides and 2 litres of SELG (116 patients, SennSELG group). Compliance, complaints, cleansing, mucosal coating, and fluid retention were evaluated.

RESULTS

Compliance was > 94% in every group. A higher percentage of mild nausea was observed in SELG-4 group, of mild abdominal cramping in SennMg group, of substantial abdominal cramping in SennSELG group (P < 0.02). Cleansing was better in SennSELG than in both the SELG-4 (P = 0.0003) and SennMg (P = 0.0353) group. Mucosal coating was better in SennMg than both SELG-4 (P = 0.0034) and SennSELG (P < 0.0001) group. There was more residual fluid in the SennSELG group than both in SELG-4 (P = 0.0029) and SennMg (P = 0.0059) group.

CONCLUSION

For colon cleansing, the combination of sennosides and PEG-saline solution was better than either the 4 litre PEG protocol or the combination of sennosides and magnesium sulphate. For mucosal coating, the protocol combining sennosides and magnesium sulphate was more effective than either protocols using the PEG-saline solution. This may be due to the interaction of residual magnesium ions in the colon lumen with the barium suspension.

Simultaneous determination of tramadol and its major active metabolite O-demethyltramadol by high-performance liquid chromatography with electrochemical detection

A novel, highly sensitive method was developed for simultaneous determination of tramadol and its main active metabolite O-demethyltramadol (ODMT) in rat plasma. The method involves a single-step extraction procedure and a specific determination by high-performance liquid chromatography with electrochemical detection, using an ethoxy analogue of tramadol (L-233) as internal standard. The dual-electrode detector was operated in the oxidation-screening mode. Absolute recoveries of tramadol and ODMT were about 80%. Calibration curves were linear over a concentration range of 10-1000 ng/ml for ODMT and 10-10000 ng/ml for tramadol with intra- and inter-day coefficients of variation not exceeding 10% and 15%, respectively. The limit of quantification for tramadol and ODMT was lower than 15 ng/ml and 10 ng/ml using 100 microl of plasma, respectively. The described method allows an adequate characterization of the plasma vs. time profiles for both compounds.

IHF protein inhibits cleavage but not assembly of plasmid R388 relaxosomes

Relaxosomes are specific nucleoprotein structures involved in DNA-processing reactions during bacterial conjugation. In this work, we present evidence indicating that plasmid R388 relaxosomes are composed of origin of transfer (oriT) DNA plus three proteins TrwC relaxase, TrwA nic-cleavage accessory protein and integration host factor (IHF), which acts as a regulatory protein. Protein IHF bound to two sites (ihfA and ihfB) in R388 oriT, as shown by gel retardation and DNase I footprinting analysis. IHF binding in vitro was found to inhibit nic-cleavage, but not TrwC binding to supercoiled DNA. However, no differences in the frequency of R388 conjugation were found between IHF- and IHF+ donor strains. In contrast, examination of plasmid DNA obtained from IHF- strains revealed that R388 was obtained mostly in relaxed form from these strains, whereas it was mostly supercoiled in IHF+ strains. Thus, IHF could have an inhibitory role in the nic-cleavage reaction in vivo. It can be speculated that triggering of conjugative DNA processing during R388 conjugation can be mediated by IHF release from oriT.

Twice vaccinated recipients are better protected against epidemic measles than are single dose recipients of measles containing vaccine

OBJECTIVE

To study measles risk after revaccination.

DESIGN

A population-based case-control study during an epidemic season.

MAIN OUTCOME MEASURE

Relative serologically confirmed measles risk.

PARTICIPANTS AND METHODS

153 vaccinated cases, mostly from rural areas, were serologically confirmed as measles at the central laboratory in 1988-89. A randomly selected group of 453 controls from either municipalities of vaccinated cases or from areas where measles attack rate was > 600/10(5), was identified via the population registry. Vaccination and measles histories of cases and controls were determined from official vaccination cards.

RESULTS

Once and twice vaccinated had crude relative risk 15.6 and 2.3 compared with thrice vaccinated. When cases who had received their first vaccination at less than 14 months of age were omitted from analysis, once vaccinated had 4.0 (95% CI 1.2, 16.6) times higher age adjusted measles risk compared with twice vaccinated. When, omission was extended to cases from one particular municipality where even revaccinees had high measles risk during an explosive outbreak the corresponding risk ratio was 17.8 (2.8, 67.8).

CONCLUSIONS

Twice vaccinated have better protection against epidemic measles compared with single dose recipients.

Altered plasma and brain disposition and pharmacodynamics of methadone in abstinent rats

The pharmacokinetics and pharmacodynamics of methadone were investigated in control and abstinent rats. Minipumps filled with saline (control group) or saline-morphine (abstinent group) solutions were used to induce physical dependence. Solutions were delivered continuously by minipumps for 6 days. The physical dependence was evaluated 12 h after minipump removal by measuring specific withdrawal signs. Animals from the abstinent group showed clear withdrawal signs such as hostility on handling and weight loss. Plasma and brain disposition and pharmacodynamics of methadone were evaluated after a 0.35 mg/kg i.v. bolus dose administered 12 h after minipump removal. Plasma clearance, distribution clearance, and volume of distribution at steady-state were significantly decreased (P < 0.05) in the abstinent group. Plasma levels of alpha1-acid glycoprotein and plasma protein binding were significantly increased (P < 0.05) in the abstinent group. The estimates of pharmacokinetic parameters based on unbound plasma concentrations did not differ between groups, with the sole exception of the unbound apparent volume of distribution. The access of methadone to the brain was significantly faster (P < 0.05) in the abstinent group, although the extent of distribution in the brain was diminished in comparison with the control group. Analgesia recorded with tail-flick was used as the pharmacodynamic endpoint. Analgesic response and effect compartment concentrations of methadone were related by the sigmoidal Emax model. Estimates of C50 [steady-state plasma concentrations eliciting half of maximum effect (Emax)]] based on unbound concentrations did not differ between groups. On the other hand, the estimate of Emax had decreased by 65% in the abstinent group.

Vaccine-induced measles virus antibodies after two doses of combined measles, mumps and rubella vaccine: a 12-year follow-up in two cohorts

In Finland, a two-dose vaccination programme against measles, mumps and rubella (MMR) was begun in 1982. The programme with high coverage (97-98%) has eliminated these three diseases from Finland. The aim of the present study was to follow up the kinetics of measles virus antibodies in MMR vaccinated cohorts. We have followed the kinetics of measles virus antibody levels induced by vaccination in the same individuals immunized with their first MMR vaccine in 1982. After 12 years 80% of the original children remained available for sampling. Antibodies to measles virus were measured by haemagglutination inhibition (HI) and plaque reduction neutralization (NT) techniques. The primary dose induced 99.4% seroconversion for measles with a geometric mean HI antibody titre (GMT) of 1/269 (+/- 219), equivalent to 4304 mIU (milli-International Units) ml-1 in group A. The 12-year follow-up specimens showed a measles seropositivity rate of 100% as assayed with the HI and NT tests with a mean HI antibody titre of 1/39 (+/- 54), equivalent to 624 mIU ml-1. The vaccination-induced measles virus antibodies decline in the absence of natural booster infections. It is important to follow how long the protection achieved by the present vaccine programme will last after elimination of indigenous measles.

Explosive school-based measles outbreak: intense exposure may have resulted in high risk, even among revaccinees

Even high levels of measles vaccination coverage have not always prevented outbreaks of measles spread by airborne transmission. It has been suggested that a large inoculum might increase vaccine failure risk. Airbome transmission might occasionally entail a large measles inoculum. The epidemiologic relevance of measles among properly vaccinated persons (i.e., those vaccinated after 15 months of age and with live attenuated virus) is increased when they become contagious. The authors studied inoculum intensities as measured by proxy variables and the contagiousness of properly vaccinated persons who contracted measles among 51 measles patients infected in one school, at home, or elsewhere, utilizing preexisting records of measles cases and 214 healthy controls from an explosive school outbreak that occurred in a rural Finnish municipality in 1989. One "super-spreader" infected 22 others in one day, including eight once-vaccinated students and one twice-vaccinated student, probably during an assembly of 144 students in a poorly ventilated hallway with no sunlight. Those infected later at home had high measles risk, even if they were revaccinees. When siblings shared a bedroom with a measles case, a 78 percent risk (seven out of nine children) was observed among vaccinees. Vaccinees had approximately 2 days' shorter incubation time than unvaccinated persons. Vaccinated and unvaccinated students were equally able to infect their siblings. Total protection against measles might not be achievable, even among revaccinees, when children are confronted with intense exposure to measles virus.

Etiology of measles- and rubella-like illnesses in measles, mumps, and rubella-vaccinated children

The viral etiology of measles- or rubella-like illnesses after MMR (measles, mumps, and rubella) vaccination was studied prospectively in 993 acutely ill Finnish children with fever and rash in 1983-1995. Their sera were tested for adeno-, entero-, and parvovirus B19 antibodies. Sera of 300 children <4 years old were also tested for human herpesvirus 6 (HHV-6) antibodies. Measles and rubella had been excluded by previous antibody testing. Serologic diagnosis of adeno-, entero-, or parvovirus infection was based on EIA (IgM or IgG antibodies) and that of HHV-6 on indirect immunofluorescence. A viral etiology was verified in 368 cases, most commonly parvovirus (20%), followed by enterovirus (9%) and adenovirus (4%). Among young children, HHV-6 infection was found in 37 (12%). Thirty-eight children (4%) had double infections. This study confirms that measles- or rubella-like illnesses in MMR-vaccinated children are often caused by other viruses. Each suspected vaccine failure requires laboratory confirmation to maintain reliable surveillance and control and to establish the specific etiology of the disease.

Persisting Helicobacter antibodies in Finnish children and adolescents between two and twenty years of age

BACKGROUND

Helicobacter pylori is an important gastric pathogen usually acquired in childhood. The presumed lifelong progression of H. pylori infection has recently been called into question in some longitudinal studies on children. In this follow-up study the prevalence and persistence of H. pylori antibodies in Finnish children and adolescents from three communities was determined.

METHODS

We measured H. pylori antibodies in follow-up serum samples of 337 Finnish children who participated in a measles-mumps-rubella vaccine study started in 1982. All available samples collected in 1983, 1987 and 1995 were studied first; additional serum samples collected yearly were studied from children who became seropositive during the follow-up period.

RESULTS

The overall prevalence of H. pylori antibodies was 5.6%. About two-thirds of the Helicobacter infections were acquired before the age of 7 years; of the remaining one-third the time of seroconversion varied between 7 and 19 years. No seroreverters were found. There were no statistically significant differences in the seroprevalence of H. pylori antibodies in the three communities studied.

CONCLUSIONS

The prevalence of H. pylori antibodies in Finnish children studied was low. Although the majority of new infections were found in children younger than 7 years of age, new Helicobacter infections were acquired throughout childhood and adolescence. Once acquired H. pylori infection, as verified by Helicobacter antibodies, persisted.

Duplex Doppler analysis of interlobular arteries in transplanted kidneys

The aim of our study was to analyze changes in spectral Doppler waveforms between interlobar and interlobular arteries in renal transplants and to determine whether sampling location at interlobular level can be suitable for intrarenal resistive index (RI) measurements. Paired series of spectral tracings from interlobar arteries and respective interlobular branches were obtained in 62 consecutive renal transplants at 6.5-MHz Doppler frequency. The values of peak systolic velocity (PSV), end diastolic velocity (EDV) and RI were significantly (P < 0.01) reduced when calculated at interlobular level. In 38 % of cases, an interlobar RI higher than 0.70 corresponded to a normal interlobular RI. The values of PSV, EDV, and RI did not differ significantly at interlobular level between allograft subsets with normal and elevated serum creatinine level. Both intra- and interobserver variation were higher at interlobular than at interlobar level when performing the RI. During a conventional study of renal vasculature, an underestimation of abnormal RI findings can be expected from the incidental evaluation of interlobular tracings. We recommend sonologists to pay attention in accurately locating the sample volume at interlobar-arcuate level when evaluating intrarenal RI.

Power Doppler sonography: clinical applications

OBJECTIVE

Color Doppler imaging (CD) has had a great impact on ultrasonography (US). This technique depicts local flow by encoding an estimate of the mean Doppler frequency shift at a particular position in color. However, the choice of the mean frequency shift as the parameter for representing flow in color Doppler is somewhat arbitrary. Power Doppler ultrasound is a technique that encodes the power in the Doppler signal in color. This parameter is fundamentally different from the mean frequency shift. The frequency is determined by the velocity of the red blood cells, while the power depends on the amount of blood present. Providing an image of a different property of blood flow, power Doppler has shown several key advantages over colour Doppler, including higher sensitivity to flow, better edge definition and depiction of continuity of flow. In this paper we review the results of power Doppler clinical studies.

MATERIALS AND METHODS

All relevant information available in the literature on the potential clinical applications of this technique was revised to give a detailed survey.

RESULTS

The increased flow sensitivity and better vascular detailing of power Doppler have been used to detect flow presence and characteristics in vessels that are poorly imaged with conventional color Doppler. The improved depiction of tissue vasculature has shown potential advantages, especially in some areas, such as the cortex of native kidneys and renal allografts, the prepuberal testis, the infant hip and the bowel wall, in which color Doppler is not sensitive enough to detect clinically important, slow and poor flow in small vessels. In inflammatory conditions, power Doppler was valuable in depicting increased flow in vessels that are dilated because of inflammatory response. In this field, advantages have been reported in acute cholecystitis and in inflammatory states of musculoskeletal tissues. The higher sensitivity to slow flow and the improved detailing of the course of tortuous and irregular vessels made power Doppler a promising technique to image intratumoral vessels and, thereby, to ameliorate the accuracy of color Doppler in predicting the likelihood of benign versus malignant nature of nodules. Specific flow patterns, missed at color Doppler studies, have been indicated with power Doppler in some tumors of the liver and breast. In different settings, power Doppler also permitted to monitor serial blood flow changes after therapy and to display them as color intensity, allowing the observer to distinguish flow changes.

CONCLUSION

Although the actual role of power Doppler in changing patient management has not been assessed yet, this technique can depict flow which was previously undetectable, and thus permits an easier and more confident diagnosis in body regions where the ultrasound signal is weak because blood vessels are small.

The biofragmentable anastomosis ring in elective colon resections

METHODS

Sixty-eight patients underwent elective colon resection and intraperitoneal anastomosis with the biofragmentable anastomosis ring (BAR).

RESULTS

Anastomotic dehiscence occurred in 3 patients (4.4%). Two of them had an end-to-end ileocolostomy using a 31 mm BAR. The anastomosis failure was due to ischaemic lesion of the small bowel close to the ileocolostomy, probably caused by a mismatch between the size of small bowel and that of the BAR. Another patient experienced anastomosis dehiscence probably due to a faecal impaction into the BAR. Forty-eight patients (70.5%) experienced troublesome constipation and evacuated after the sixth postoperative day. A bowel obstruction proximal to the BAR was documented in 4 cases who have been treated conservatively.

CONCLUSIONS

The low rate of major complications justify the use of the BAR in elective colon surgery, but the surgeon must be aware of tedious postoperative obstructive episodes frequently encountered in this series.

Influenza vaccination in 22 developed countries: an update to 1995

This study expands and updates through 1995 our earlier report on influenza vaccine use in 18 developed countries. Five of the six countries with high levels of vaccine use in 1992 (> or = 130 doses/1000 population) showed little change or slight declines over the subsequent 3 years. The exception was the United States, where a new federal program for vaccination reimbursement for the elderly helped to increase vaccine distribution from 144 to 239 doses/1000 population. The six countries with medium levels of vaccine use in 1992 (76-96 doses/1000 population) increased to > or = 100 doses/1000 population by 1995. Among the six low-use countries in 1992 (< or = 65 doses/1000 population), only Finland showed substantial improvement (96 doses/1000 population) in 1995. Four new countries were added to the study. In Germany, vaccine use increased to 80 doses/1000 population in 1995, but in Ireland it remained at a low level (48 doses/1000 population). In Korea, vaccine use increased from 17 to 95 doses/ 1000 population during the period 1987-1995. In Japan, very high levels of vaccine use (approximately 280 doses/1000 population) in the early 1980s were associated with vaccination programs for school children. However, vaccine use fell precipitously when these programs were discontinued, and only 2 and 8 doses/1000 population were used in 1994 and 1995, respectively. In all 22 countries, higher levels of vaccine use were associated with vaccination reimbursement programs under national or social health insurance and were not correlated with different levels of economic development. Excluding Japan, in 1995 there was still a greater than fourfold difference between the highest and lowest levels of vaccine use among the other 21 countries in the study. Given its well established clinical effectiveness and cost-effectiveness, none of these countries has yet achieved the full benefits of its programs for influenza vaccination.

Hepatitis A outbreak amongst intravenous amphetamine abusers in Finland

This article describes a widespread outbreak of hepatitis A virus (HAV) infection amongst drug abusers in Finland. Although attempts to demonstrate the virus in amphetamines failed, the infection was assumed to be linked to intravenous use of the drug. The unusual mode of transmission prompted us to analyse possible atypical clinical features as well as the spread of the virus to the general population, nowadays practically without protective immunity. Serologically verified cases that occurred in Helsinki were interviewed, their hospital records were analysed and their contacts were serology tested. Amphetamine lots, as well as faecal samples from patients, were examined with RT-PCR. Detailed information was obtained from 238 subjects, among whom 131 admitted drug abuse and 67 cases were classified as secondary cases. Phylogenetic analysis of virus strains from HAV-infected cases suggested a common origin, and epidemiological observations linked it with particular lots of amphetamine. Three cases died, and 3 presented with severe clinical disease. Icterus was more common among i.v. drug abusers than others. Infection with hepatitis A virus was probably related to the faecal contamination of amphetamine associated with the transportation of the drugs in the gastrointestinal tract.

Characteristics of serum protein binding of felodipine

The protein binding of felodipine in concentrations ranging from 3 to 65 nmol L-1 has been characterized in pooled serum, and in isolated human plasma proteins: albumin (HSA) and a1-acid glycoprotein (AAG). Protein binding was determined by an ultrafiltration technique using an Amicon Micropartition System. Serum protein binding of felodipine (16 nmol L-1) was measured in five groups of individuals: I: healthy subjects (n = 16). II: patients with chronic renal disease before and after dialysis (n = 10). III: patients with liver disease (n = 9). IV: diabetics Type I (n = 10) and Type II (n = 12) and V: cancer patients (n = 12). Concentrations of HSA, AAG, lipoproteins and non esterified fatty acids (NEFA) were also measured. The drug was extensively bound in pooled serum and the protein binding was essentially unchanged over the concentrations of felodipine studied (99.60 +/- 0.31% at 3 nmol L-1; 99.70 +/- 0.15% at 65 nmol L-1). In albumin solution (40 g L-1) felodipine was also highly bound. The mean of percentage bound was not significantly different from that in serum and was also independent of the felodipine concentrations (98.57 +/- 0.35 at 3 nmol L-1; 98.31 +/- 0.90 at 65 nmol L-1). The extent of binding to AAG was significantly lower than in serum (p < 0.01) and HSA (p < 0.01) and was independent of felodipine concentrations (85.64 +/- 2.25 at 3 nmol L-1; 85.68 +/- 2.3 at 65 nmol L-1). The percentage of bound felodipine in group II (before dialysis) was significantly lower than in group I (p < 0.001). The variability in the percentage of bound felodipine was greater in group II, before dialysis, than in the rest of the groups. After dialysis, protein binding was similar to that in group I. HSA did not change and AAG was increased. NEFA was significantly higher after dialysis when compared with group I (p < 0.01). In vitro carbamylation of serum did not change felodipine protein binding. HSA was decreased significantly in group III patients (p < 0.05). However, protein binding did not change. Binding of felodipine in the rest of the groups was not significantly different from that in group I. Linear regression analysis of the data for all individuals indicated that the binding of felodipine was related to serum lipoproteins and that age, HSA, AAG, and NEFA were not significant determinants of binding.

The interaction of DNA with bacteriophage phi 29 connector: a study by AFM and TEM

The connector of bacteriophage phi 29 is involved in DNA packaging during viral morphogenesis and we have studied its in vitro binding to DNA using either linear or circular DNA. The protein-DNA complexes have been analyzed by transmission electron microscopy (TEM) and by atomic force microscopy (AFM) of samples directly deposited on mica. TEM showed the presence of a specific binding due to the interaction of the protein with the free ends of the DNA. The study of these samples by AFM showed two major types of morphologies: The interaction of the connector with circular DNA revealed that the strands of DNA that enter and exit the protein complex form an angle with a mean value of 132 degrees. Nevertheless, when the connector was incubated with linear DNA (and later circularized), there was an additional bend angle of about 168 degrees. Further morphological analysis of the latter samples by AFM revealed a structure of the protein-DNA complex consistent with the DNA traversing the connector, probably through the inner channel. On the other hand, images from the samples obtained by incubation of the connector with circular DNa were consistent with an interaction of the DNA with the outer side of the connector.

Acute and chronic changes in atrial natriuretic factor induced by ventricular pacing: a self controlled clinical trial

A self controlled clinical trial was carried out to study the acute and chronic effects of ventricular pacing (VVI) on the atrial natriuretic factor (ANF). Eleven people were selected from a pool of 20 DDD paced patients. Pacemakers were programmed to the VVI mode for 1 month and their effectiveness tested by ECG at rest and after an effort test. AnF was measured by radioimmunoassay at baseline, after 15 minutes, and again 1 month after programming. The reliability of the radioimmunoassay was confirmed using the coefficients of variation between (12.5%) and within assay (9.7%). Data analysis was done using Wilcoxon's test. Our results showed that the onset of VVI pacing led to a sudden sharp rise in ANF in all patients (P < 0.0001). During VVI pacing, three patients were dropped from the study (2 were withdrawn because of symptoms and 1 voluntarily withdrew). After 1 month of VVI pacing, a significant increase of ANF above the baseline was observed (P < 0.05). The results showed that ventricular pacing led to an immediate rise in ANF and, that with long-term VVI pacing, there was an increase in ANF levels as well. The role of these findings in the pathophysiology of the pacemaker syndrome calls for further research.

Persistence of anti-mumps virus antibodies after a two-dose MMR vaccination. A nine-year follow-up

A two-dose vaccination program against measles, mumps, and rubella (MMR) viruses was started in Finland in 1982. In this program the trivalent MMR-II vaccine (MSD, USA) was offered to children at the ages of 14-18 months and 6 years followed by revaccination 4-5 years later. The vaccination coverage has been high (97%) and MMR infections have practically been eliminated in the Finnish population. In a serological follow-up program sequential serum samples were obtained from 254 children (127 14-18-month-old vaccinees and 127 6-year-old vaccinees) during a 9-year follow-up period. Anti-mumps virus antibody titers were determined by enzyme immunoassay using purified whole mumps viruses as the antigen. In seronegative (n = 120) 14-18-month-old vaccinees the seroconversion rate was 86% (geometric mean titer 1/1670 +/- 1/270). The antibody levels fell rapidly (significance p < 0.01) within the first year of follow-up (mean titer 1/1080 +/- 1/190), but remained relatively stable in subsequent years. After revaccination the seropositivity rate was 95% (mean titer 1/2310 +/- 1/260) and declined more slowly thereafter to 86% (mean titer 1/1510 +/- 1/210) at year 9 of follow-up. The mean antibody titer was significantly (p < 0.05) higher 4 years after the second MMR vaccination when compared with the corresponding time point after the first vaccination. In 6-year-old seronegative vaccinees the increase and decay of anti-mumps virus antibodies after the first MMR vaccination was similar to that seen in the group of younger vaccinees. A two-dose MMR vaccination protocol resulted in a high mumps immunity level in the vaccinated population.

Impaired response to hepatitis B vaccine in children receiving anticancer chemotherapy

Serologic responses to hepatitis B vaccine were investigated in 197 pediatric cancer patients. The patients, ages 1 to 21 years, comprised 66 with solid tumors, 101 with hematologic malignancies and 30 with various benign conditions. Of them 51 were receiving cytotoxic chemotherapy and 114 had not received chemotherapy for 0.2 to 11 years. Three doses of plasma-derived hepatitis B vaccine (20 micrograms) were given at 0, 1 and 6 months; and antibody concentrations to hepatitis B surface antigen were determined at 3, 6 and 8 months. The geometric mean antibody concentration after 3 vaccine doses was 1076 mIU/ml in cancer patients receiving chemotherapy and 18,833 mIU/ml in cancer patients not receiving chemotherapy. The protective titer of antibody (> or = 10 mIU/ml) was reached after 3 doses of vaccine by 67% of patients receiving chemotherapy and by 97% of those not receiving chemotherapy. The patients being treated for solid tumors had weaker responses than those being treated for hematologic malignancies: after 3 vaccine doses no response was observed in 6 of 11 patients with solid tumors compared with 3 of 25 of patients with hematologic malignancies. Children receiving anticancer chemotherapy have essentially weaker responses to hepatitis B vaccine than children not receiving chemotherapy or those with benign conditions. This reflects the profound immunosuppression during chemotherapy. The effect of more intensive immunization schedules should be investigated.

A new case of trisomy 5 as sole cytogenetic anomaly in acute myeloid leukemia

We present a case of acute myeloid leukemia (AML-M2) with trisomy 5 (+5) as the sole cytogenetic abnormality in a woman previously diagnosed with schizophrenia. To date, only two cases of AML (other than M2) with +5 as the only change have been reported. Moreover, an association between schizophrenia and partial trisomy of chromosome 5p has been described recently. To our knowledge, this is the first report of AML (subtype-M2) with +5. Noteworthy is the association with schizophrenia.

Mouse hepatitis virus type 3 infection provokes a decrease in the number of sinusoidal endothelial cell fenestrae both in vivo and in vitro

Fenestrations of hepatic endothelial cells play an active role as a sieving barrier allowing extensive exchange between the blood and liver parenchyma. Alteration of these structures may be induced in the course of various pathological events and provoke important perturbations of liver function. We demonstrate here that sinusoidal endothelial cells are permissive for mouse hepatitis virus 3 (MHV3) in vivo and in vitro and that this infection leads to a striking decrease in the number of fenestrae. The disappearance of these structures observed under scanning electron microscopy or in cryofracture preparations in vivo and in vitro cannot be reversed by the action of cytochalasin B on the microfilament network. The decrease in the porosity seems to be related directly to the productive infection of the endothelial cells, because it was not observed in A/J mice resistant to the virus and in susceptible BALB/c mice immunized with a thermosensitive mutant in which no viral replication occurs. In conclusion, a viral infection of liver endothelial cells may cause extensive loss of the fenestrations and thus lead to important functional pertubations.