Herniarin, Dimethylfraxetin and Extracts from Tagetes lucida, in Psychosis Secondary to Ketamine and Its Interaction with Haloperidol

Tagetes lucida Cav., is a medicinal plant used in Mexico to alleviate different disorders related to alterations of the central nervous system, such as behaviors associated with psychosis. The present work evaluated the effect of different extracts separated from this plant, TlHex, TlEA, TlMet, and TlAq, and of two isolated coumarins, herniarin (HN) and dimethylfraxetin (DF), on haloperidol-induced catalepsy (HAL), and psychotic behaviors provoked with a glutamatergic antagonist, ketamine (KET) on ICR mice. The extracts TlEA, TlAq, and the isolated compounds HN and DF, induced an increment of the cataleptic effect of HAL. Schizophrenia-like symptoms caused by KET were analyzed through the behavior of the animals in the open field (OFT), forced swimming (FST), passive avoidance test (PAT), and social interaction test (SIT). Treatments derived from T. lucida could interact with this substance in all tests except for FST, in which only TlMet blocks its activity. Mainly, TlEA, TlAq, HN, and DF, blocked the effects of KET on stereotyped behavior, hyperlocomotion, cognitive impairment, and detriment in the social interaction of rodents. T. lucida interacted with dopaminergic and glutamatergic systems.

A New Subspecies of Heliconius hermathena (Nymphalidae: Heliconiinae) from Southern Amazonia

The present paper describes Heliconius hermathena curua Freitas & Ramos ssp. nov. This subspecies exhibits a non-mimetic phenotype typical of H. hermathena, but is characterized by the merging of the yellow streak over the forewing cubitus with the red postmedian band in the dorsal forewing. The subspecies is known from two localities in the south of Altamira, Pará State, Brazil, where it inhabits an isolated patch of "campina" vegetation more than 600 km from the nearest known H. hermathena populations. Geographic isolation of the population is supported by molecular data; based on the mitochondrial gene COI, all individuals of H. hermathena curuassp. nov. form a monophyletic group and all haplotypes found in it are unique, suggesting that gene flow is not currently on-going. Given the fragile situation of Amazonian white sand forests and the proximity of the population to areas of intensive agriculture, this new subspecies and its habitat deserve attention.

Inga edulis fruits: a new source of bioactive anthocyanins

The extraction conditions and chromatographic analysis from seeds of Inga edulis were optimized and provided one anthocyanin from aqueous fraction and a mixture of three anthocyanins from methanolic fraction. The pure anthocyanin obtained was subjected to structural modifications and the products obtained were subjected to chemical and pharmacological assays, as well as quantum chemical calculations based on DFT and TD-DFT methods. Hence, the anthocyanin fractions were evaluated for their chemical-pharmacological potential through chemical and biological assays: antioxidant activity by the DPPH, determination of the Solar Protection Factor (SPF) and cytotoxic activity (hepatocellular carcinoma infected with hepatitis C virus). The results indicated that even the anthocyanin and derivatized compounds having high antioxidant potential showed an SPF lower than six, which is lower than the minimum accepted by current Brazilian legislation. In addition, none of compounds presented significant cytotoxic activity against the tumour cell line studied.

The impact of anthropogenic food supply on fruit consumption by dusky-legged guan (Penelope obscura Temminck, 1815): potential effects on seed dispersal in an Atlantic forest area

Frugivorous birds are important seed dispersers and influence the recruitment of many plant species in the rainforest. The efficiency of this dispersal generally depends on environment quality, bird species, richness and diversity of resources, and low levels of anthropogenic disturbance. In this study, we compared the sighting number of dusky-legged guans (Penelope obscura) by km and their movement in two areas of Serra do Japi, one around the administrative base (Base) where birds received anthropogenic food and a pristine area (DAE) with no anthropogenic resource. We also compared the richness of native seeds in feces of birds living in these two areas. Although the abundance of P. obscura was higher in the Base, these individuals moved less, dispersed 80% fewer species of plants and consumed 30% fewer seeds than individuals from DAE. The rarefaction indicated a low richness in the frugivorous diet of birds from the Base when compared to the populations from DAE. We conclude that human food supply can interfere in the behavior of these birds and in the richness of native seeds dispersed.

Detection of cytotoxic activity of Psacalium palladium on normal mouse spleen cells and transformed human cells

A decoction from roots and rhizomes of Psacalium palladium is used in Mexico for the treatment of tumors and for control of diabetes mellitus, among other ailments. Although hypoglycemic activity has been demonstrated in various experimental models and some compounds have been detected in the roots and rhizomes, such as alkaloids, glycosides and tannins, toxicity studies have not yet been performed. Moreover, since various species taxonomically related to P. palladium have pyrrolizidine alkaloids (hepatotoxic, carcinogenic and mutagenic agents) it is possible that these species also contain potentially toxic substances, which represents a risk for users. The aim of this investigation was study the cytotoxicity of P. palladium on mouse hematopoietic cells and transformed human cells, evaluating the cell proliferation by the technique of sulforhodamine B. An aqueous fraction (AS) reduced population of both types of cells by over 50%; meanwhile the other extracts did not alter cell number. Fraction AP was cytotoxic for DU-145 cells at 10 microg/mL, whereas the remaining extracts acted like cytostatic agents.

Cytotoxic activity of Cuphea aequipetala

Cuphea aequipetala (Lytraceae) is a perennial plant that has been used in Mexican traditional medicine to treat different types of tumors since prehispanic times. In the present work the cytotoxic potential of different fractions from acetone-water extract from the whole plant was investigated using a sulforhodamine B assay. Fractions were subjected to a bioscreening assay using several cell lines: HEp-2 (human larynx carcinoma), HCT-15 (human colon cancer) and DU-145 (human prostate carcinoma). Colchicine was used as positive control. Data are presented as the dose that inhibited 50.0% control growth (ED50). The cytotoxic activity is selective since the ED50 is different for the three cell lines employed. The highest activity was seen against the DU-145 cell line. "E" and PB1 fractions had the highest cytotoxic activities with ED50 values of 0.418 and 2.40 microg/ml respectively, on the DU-145 cell line. The "E" fraction was a yellow powder; it was methanol soluble and contained at least four separate components when separated by thin-layer chromatography. PB1 was a solid with metallic appearance; it was water soluble and its two dimensional chromatography showed 9 spots. These fractions have cytotoxic actives because their ED50 is less than 20 microg/ml and they will be further characterized.

Population biology of Parides anchises nephalion (Papilionidae) in a coastal site in Southeast Brazil

A population of Parides anchises nephalion was studied during seven months in SE Brazil. The population size was about 10-20 individuals (with theoretical maximum near 60 individuals), with small variations in some months. Sex ratio was male biased, with males dominating in all months. The age structure was not stable, with an increase in new individuals before the population peak in December. The residence time was 14.1 +/- 8.2 days for males and 9.0 +/- 3.6 for females, with maximum registered of 30 days. Males can travel distances of up to 400 m, but most individuals were always recaptured in the same site. The mean forewing length was greater in females. The population features agree with those found in other species of Parities in other neotropical sites.

Inhibition of platelet aggregation by putrescine, spermidine, and spermine in hypercholesterolemic rabbits

BACKGROUND

Hypercholesterolemia causes alterations in platelet function. Platelet hyperaggregation is considered a predisposing factor for atherosclerosis. In this paper, the antiaggregating effect of the polyamines putrescine, spermidine, and spermine was studied on platelets of normal and hypercholesterolemic rabbits.

METHODS

New Zealand rabbits were fed with a cholesterol-enriched diet for 10 weeks. Lipids and glucose were determined in serum. The assays of platelet aggregation were carried out using platelet-rich plasma (PRP) obtained from both control and cholesterol-fed rabbits. We used 2.5 micromol /mL ADP and 2 microg/mL collagen as inductors of platelet aggregation. In addition, arginase activity and L-arginine content were determined in PRP.

RESULTS

Serum total cholesterol and LDL-cholesterol concentrations were increased from 26.3 +/- 8.1 to 1,485.0 +/- 26.8 mg/dL and from 15.9 +/- 5.9 to 1,383.8 +/- 58.9 mg/dL, respectively, whereas triglyceride concentration increased from 88.3 +/- 35.6 to 411.0 +/- 154.5 mg/dL upon cholesterol feeding. Seventy-five percent of platelet aggregation inhibition was observed with 10 microM of polyamines in PRP of normal rabbits. Spermine inhibited platelet aggregation by 54% in PRP of hypercholesterolemic rabbits when ADP was used as agonist. The order of polyamine action was spermine > spermidine > putrescine. In addition, we found that platelet arginase activity and L-arginine content were unaltered upon hypercholesterolemia.

CONCLUSIONS

These results show that the polyamines putrescine, spermidine, and spermine have antagonist action in platelet aggregation and suggest a key role of polyamines in platelet aggregation under normal and hypercholesterolemic conditions.

Fine needle aspiration cytology of penile tumors

OBJECTIVE

Penile tumors are unusual and can represent neoplastic or inflammatory processes. We report a series of penile tumors diagnosed by fine needle aspiration (FNA) cytology.

STUDY DESIGN

Files from the Division of Clinical Cytology, Karolinska Hospital, were searched, and cases of FNA cytology of the penis selected. Clinical information and cytologic diagnoses were recorded and observations from aspiration smears made.

RESULTS

Eleven patients had presented to Karolinska Hospital for FNA cytology of the penis. They ranged from 46 to 89 years of age; all were uncircumcised. Tumors were present in various locations, including the glans and shaft. Five patients had squamous cell carcinoma (SCCA) of the penis; three were primary, one locally recurrent and one metastatic from primary lung SCCA. There were three carcinomas metastatic from primary colon, prostate and bladder tumors. There was one each of locally recurrent malignant melanoma, locally metastatic testicular mesothelioma and Peyronie's disease. Discomfort associated with the procedure was tolerable, there were no complications, and each biopsy provided sufficient material for a cytologic diagnosis.

CONCLUSION

FNA cytology of penile tumors is a successful, well-tolerated procedure capable of providing a cytologic diagnosis and useful information for patient management.

Lymphocyte-depleted Hodgkin's disease: diagnostic challenges by fine-needle aspiration

The diagnosis of Hodgkin's disease by fine-needle aspiration (FNA) can be problematic. A case of Hodgkin's disease, lymphocyte depleted subtype, sample by FNA biopsy is presented. We describe the cytomorphologic features present in this unusual subtype of Hodgkin's disease and discuss the differential diagnosis. Immunohistochemical and morphologic findings of a subsequent biopsy specimen supported the diagnosis. Although FNA is an increasingly used diagnostic modality to evaluate tumors including malignant lymphomas, Hodgkin's disease remains, as in this case, a difficult diagnosis by FNA.

Combined fine needle aspiration biopsy, and immunophenotypic and genotypic approach to posttransplantation lymphoproliferative disorders

OBJECTIVE

To report our experience with a combined approach to posttransplant lymphoproliferative disorders (PT-LPDs) that utilizes fine needle aspiration biopsy.

STUDY DESIGN

A review of the files in the Department of Pathology, Saint Louis University Health Sciences Center; from 1988 to 1996 identified six patients with a diagnosis of PT-LPD who underwent either percutaneous or radiologically guided fine needle aspiration biopsy (FNAB). In all cases, material was collected for cytomorphology, flow cytometric analysis and, in selected cases, DNA polymerase chain reaction (PCR). Subsequent evaluations and clinical outcomes were obtained from the medical record.

RESULTS

The six transplant recipients (4 men and 2 women; 3 cardiac, 2 renal and 1 hepatic transplant) had an age range of 16-65 years. The aspirate material on these six patients had a polymorphic pattern of lymphoid cells with varying sizes. By flow cytometry, two were monoclonal, while four had a polyclonal pattern. DNA PCR analysis on two FNABs demonstrated a monoclonal rearrangement of the immunoglobulin heavy chain gene.

CONCLUSION

FNAB provides cytomorphologic characterization of PT-LPDs in transplantation patients and sufficient material for successful use of flow cytometry immunophenotyping and DNA PCR analysis. FNAB, therefore, has an important role in the evaluation of organ transplantation patients and is a valuable tool for assessing and diagnosing PT-LPD.

Fine-needle aspiration of Merkel cell carcinoma of the skin with cytomorphology and immunocytochemical correlation

Merkel cell carcinoma (MCC) of the skin is a rare, primary malignant skin neoplasm which can present as a cutaneous nodule. These neoplasms are seen primarily in the elderly and located in the head and neck area or extremities. Twenty-nine aspirates from primary and metastatic lesions obtained by percutaneous fine-needle aspiration in 19 patients have been studied. The cytomorphologic features, clinical information, and immunocytochemical (ICC) findings are detailed. Aspirate smears demonstrated small-to-intermediate-sized cells with a loosely cohesive pattern. Nuclei were round with finely granular chromatin and multiple, small nucleoli. Cells possessed a thin rim of cytoplasm, and infrequent pseudorosette formations were noted in cell groups. ICC results were universally positive for cytokeratin, which showed a paranuclear "dot-like" pattern. Neuron-specific enolase, epithelial membrane antigen, and S-100 protein were positive in varying degrees. Leukocyte common antigen was universally negative. The diagnosis of MCC of the skin by FNA can be made by applying cytologic features in addition to ancillary studies and clinical information.

Fine needle aspiration biopsy of recurrent and metastatic osteosarcoma

OBJECTIVE

To assess the utility of fine needle aspiration (FNA) biopsy in evaluating local recurrence or disseminated metastases in patients with osteosarcoma.

STUDY DESIGN

Cytology files from Saint Louis University Hospital and Indiana University Medical Center were searched for patients with osteosarcoma who had undergone FNA biopsy for evaluation of local recurrence or disseminated metastases. Clinical information was collected and all aspirate smears reviewed.

RESULTS

Six FNA biopsies in five patients were procured by either the percutaneous or radiologically guided method. All six aspirates were diagnostic. Cytologic features showed a discohesive, cellular neoplasm with intermediate to large cells and oval to spindle nuclei. Chromatin was coarsely granular, with single or multiple nucleoli. Aspirate material included multinucleated giant cells and a variable amount of "osteoidlike" extracellular matrix.

CONCLUSION

FNA biopsy is accurate, and these results reflect its ability to diagnose osteosarcoma when there is local recurrence or widely disseminated metastases.

Mixed (neutrophil-rich) interstitial pneumonitis in biopsy specimens of lung allografts: a clinicopathologic evaluation

STUDY OBJECTIVES

Mixed interstitial pneumonitis (MIP), defined herein as a diffuse neutrophil-rich inflammatory infiltrate within the interstitial tissues, is an uncommon finding that is not a standard manifestation of acute or chronic rejection. This study examines the clinical significance of MIP in lung allograft recipients at St. Louis University Hospital.

DESIGN

We retrospectively reviewed surgical pathology reports from a selected 50-month period, and identified MIP reported in 13 transbronchial biopsy specimens in lung transplant recipients, representing 4.7% of all lung allograft biopsy specimens seen during this 4-year period. Biopsy specimens with MIP were examined to confirm the presence of a neutrophil-rich interstitial infiltrate and other associated histopathologic findings. The culture results, cytopathologic findings, and clinical charts of the affected patients were also reviewed.

MEASUREMENTS AND RESULTS

The detection of MIP at some point in a patient's posttransplant course was found to be associated with a significantly shorter (p < 0.01) survival, when compared to lung allograft recipients who did not show this finding. A total of seven lung allograft recipients (23% of total) showed MIP at some point in their posttransplant course. Four of the seven (57%) were actively smoking following lung transplantation, compared to 0 of 22 patients who did not show MIP. Six of the 13 MIP biopsy specimens were associated with positive cultures. In no case did MIP coexist with the conventional histologic patterns of acute or chronic rejection. MIP also did not correlate with levels of immunosuppressive therapy or with the incidence of rejection at other times in the patients' posttransplant courses.

CONCLUSIONS

We found no evidence that MIP represents an unusual form of acute or chronic rejection. Instead, it appears to represent a response to acute injury, similar to other injury patterns (hyaline membranes, organizing pneumonia) in transplant recipients. Exposure to tobacco smoke is likely to have played a role in the development of MIP in at least some cases. Because patients with MIP had a significantly shorter posttransplant survival, MIP may usefully identify lung allograft recipients at risk for an adverse outcome.

Histopathologic diagnosis made in lung tissue resected from patients with severe emphysema undergoing lung volume reduction surgery

STUDY OBJECTIVES

This study reports histopathologic findings in a group of emphysema patients who underwent thoracoscopic lung volume reduction surgery (75) or sternotomy (five) with the purpose to induce functional improvement and relief of dyspnea. Immediate outcome and complications were correlated to histologic patterns.

DESIGN

Histopathologic material obtained in lung volume reduction surgery in 80 consecutive patients was analyzed. Thirty patients who had other histopathologic diagnoses in addition to emphysema were grouped and compared with 50 patients found to have emphysema exclusively. Postoperative outcome and preoperative lung function variables were compared.

MEASUREMENTS AND RESULTS

All patients had severe obstructive lung disease and significant air trapping preoperatively documented by pulmonary function testing. All had severe exertional dyspnea. All had chest radiographs, CT, and nuclear medicine lung scans consistent only with emphysema. All portions of resected lung tissue were weighed, lung volume was estimated, and routine histopathologic studies were made. Thirty patients (37.5%) had unsuspected findings such as interstitial fibrosis, noncaseating granulomatosis, chronic inflammation, and unsuspected neoplasia (three carcinomas, one carcinoid). Retrospective review of imaging studies in these patients failed to show infiltrative processes. The average lung weight resected in this group was significantly heavier (65+/-18 g) compared with the other group (56+/-13 g), although both had the same estimated lung volume. Average number of days requiring chest tubes and length of hospitalization was also significantly higher (12.8+/-19 vs 6.4+/-5 days with chest tubes and 17.4+/-22 vs 8.5+/-6 days of hospitalization, respectively). None of the preoperative pulmonary function tests variables were different between the two groups. Serious postoperative complications were more frequent in these patients compared with those who showed only emphysema.

CONCLUSIONS

A significant portion of patients diagnosed as having severe emphysema will have other unsuspected histologic findings. When subjected to lung volume reduction surgery, this subgroup will have more serious complications and longer periods of air leaks, requiring longer hospitalization time. Retrospective review of imaging studies and preoperative pulmonary function tests used to select patients for lung volume reduction failed to identify this subgroup.

Small noncleaved cell lymphoma presenting as a massive pericardial effusion. A case report

BACKGROUND

Non-Hodgkin's lymphoma (NHL) is commonly associated with cardiac involvement, especially in cases of advanced stages with mediastinal involvement. Much rarer is the initial presentation of NHL as a pericardial effusion; there are only 12 cases reported. In addition, only 5 of these 12 cases were correctly diagnosed based on examination of pericardial fluid prior to death: 3 were based on routine cytology; 1 on immunoperoxidase staining and 1 on an immunofluorescent slide method.

CASE

A 71-year-old, white female presented with a massive pericardial effusion. Small noncleaved cell lymphoma was expeditiously diagnosed by cytologic examination combined with flow cytometric immunophenotyping. No further diagnostic tissue was obtained; the patient was staged and offered treatment with a protocol for high grade lymphoma.

CONCLUSION

Combining cytomorphology and flow cytometric immunophenotyping in such cases results in an expeditious, nonsurgical diagnosis, upon which therapeutic decision making may be based.

[Tissue expansion of the superior limb]

In order to get better results in the treatment of the superior limbs defects we have attempted to take profit of the expansion tissue techniqu.

PURPOSE

With the objective of studying the utilization of expansion tissue technique to repair defects in the superior limbs caused by scars or tattoos removal.

METHODS

6 patients with 7 superior limbs defects to be repaired were treated by the technique of tissue expansion with 8 tissue expanders. In 3 patients the lesions were caused by tattoos removal (4 lesions), 2 patients presented lesions caused by burn scars removal nd 1 patient showed lesion caused by removal of a childhood scar.

RESULTS

The result of this procedure was excellent in 5 cases and provided total repair of the lesion. However hazards have occurred in one patient who showed a necrosis of the expansion neighbouring area (not a consequence of the expansion) and in other patient the aesthetic result was not satisfactory because he developed a hypertrophic scar. Good aesthetic results were obtained in the other 4 patients.

CONCLUSIONS

We have had good results with the utilization of tissue expanders in the superior extremities. The superior limbs have good capacity of expansion and lead to good aesthetic results. Any significant hazards were observed as being a consequence of superior limb tissue expansion.

[Indications of exploration and repair of the orbital floor in fractures of the maxillozygomatic complex]

Patients with orbital fractures may develop late complications like enophthalmos, orbital dystopia or diplopia, as a result of untreated orbital floor lesions, with herniation of orbital fat. Clinical and radiological findings are not enough for diagnostic and indication of orbital floor repair.

PURPOSE

To evaluate the indication of repair of the orbital floor, during the surgical treatment of maxillozygomatic or zygomatic-maxillary compound fractures, by means of systemic exploration and to compare clinical with surgical findings.

METHODS

112 patients with unilateral zygomatic-maxillary compound fracture were submitted to exploration of the orbital floor, during the surgical treatment of the fracture. Open reduction and rigid internal fixation was performed with steel wire or miniplates. An autogenous conchal cartilage graft was used to repair the floor lesion, when there was bone loss of the inferior orbital wall and periorbita discontinuity, with fat herniation.

RESULTS

The repair of the orbital floor was indicated in 46.4% of the patients. Early diplopia (before surgery) was observed in 26.6% and enophthalmos in 3.30% of the cases. Among patients with early diplopia, 60% needed repair, while 36.6% of the patients without early diplopia received cartilage graft. No important complications was observed.

CONCLUSION

Orbital floor exploration is a complementary maneuver for the treatment of zygomatic-maxillary compound fractures that permits the precise diagnostic of the lesion and the correct indication of repair.

Fatal outcome in a patient with autoimmune hemolytic anemia associated with an IgM bithermic anti-ITP

BACKGROUND

Several cold autoantibodies (usually IgG) with IT specificity have been reported previously, as have autoantibodies with joint I and P blood group specificities (IP1, ITP1, iP1, IP). A fatal outcome associated with an IgM cold autoantibody of ITP specificity is reported.

CASE REPORT

A 54-year-old man suffered from progressively severe cold autoimmune hemolytic anemia for 9 months. Hemoglobin concentration ranged from 6 to 7 g per dL (60-70 g/L) and reticulocytes from 3 to 5 percent (0.030-0.050). The direct antiglobulin test was weakly positive for IgM and strongly positive for C3d. The serum contained a cold agglutinin that reacted strongest with cord i red cells (RBCs) > adult I RBCs > adult i RBCs, which is consistent with IT specificity. The Donath-Landsteiner test was positive; the reaction was neutralized by globoside. The serum reacted weakly or was negative with RBCs from five group p blood donors, which suggests anti-ITP specificity. Dithiothreitol treatment of the serum abolished the cold agglutinin reactivity, which suggests that the anti-IT was IgM. The patient received > 40 RBC transfusions and failed to respond to oral steroids, oral cytoxan, high-dose pulse intravenous steroids, and plasma exchange at room temperature and at 35 degrees C. He died of sepsis following an unsuccessful trial of chlorambucil. Autopsy revealed unsuspected disseminated non-Hodgkin's lymphoma.

CONCLUSION

Serologic studies are consistent with our patient's having a single IgM cold autoantibody with IT and P specificities (anti-ITP) and requiring both specificities on the same RBC to permit maximal antibody expression.

Low retention of white cell fragments by polyester fiber white cell-reduction platelet filters

BACKGROUND

There is intense interest in the potential of current white cell (WBC)-reduction filters to prevent the alloimmunization of patients by the residual donor WBCs in filtered blood components transfused to them. Little attention has been paid to the capacity of current synthetic fiber filters to remove WBC membrane fragments bearing detectable leukocyte antigens.

STUDY DESIGN AND METHODS

Fluorescein isothiocyanate-conjugated monoclonal antibody to a universal WBC membrane antigen (CD45) and high-speed centrifugation coupled with ficoll-hypaque differential sedimentation were used to quantitate low-density WBC fragments in single-donor platelet components before and after filtration to determine if a polyester fiber filter retained WBC fragments.

RESULTS

Prefiltration measurements in 25 single-donor platelet components indicated that WBC fragments increased with length of storage up to 5 days at room temperature (p < 0.0001). When fragments in eight components were measured before and after filtration, absolute values for differences were insignificant (p = 0.15).

CONCLUSION

WBC fragments were poorly retained by these polyester fiber WBC-reduction filters. The antigenicity of WBC fragments could contribute to the WBC alloimmunization of some recipients of WBC-reduced blood components.

A severe case of Beare-Stevenson syndrome and associated congenital deformities

A severe case of congenital anomalies is described, with several characteristics of Beare-Stevenson syndrome, such as cutis gyrata, acanthosis nigricans, craniofacial anomalies, ear defects, enlarged umbilical stump and anogenital anomalies. He does not have craniosynostosis or clover leaf skull, which has also been described in this syndrome. This patient also shows hands and feet anomalies, absence of skin adnexa in several locations and dental anomalies, which could suggest an associated ectodermal dysplasia.

A latex particle assay for platelet-associated IgG

A modified, sensitive, solid-phase assay for platelet-associated IgG is reported. Direct comparisons were made between a 125I monoclonal radioimmunoassay (RIA) and the polyclonal antibody latex particle assay. In 209 simultaneous comparisons with the RIA, the sensitivity of the latex test was 91 percent, specificity was 100 percent, and overall efficiency was 97 percent. Commencing with platelet-rich plasma, the direct latex particle test for platelet-bound IgG requires 45 minutes; 90 minutes are required to crossmatch one patient with 12 donors. The advantages of the latex assay are absence of radioactivity, stability of reagents, economy, speed, specificity, and sensitivity.

Refractory immune hemolytic anemia with a high thermal amplitude, low affinity IgG anti-Pra cold autoantibody

A 54 y.o. woman presented with acute Coombs-negative hemolytic anemia at an outside hospital where she received 25 RBC transfusions and did not respond to prednisone or splenectomy. On transfer to our hospital, routine DAT and IAT were weakly positive, occasionally negative. When a modified "cold" antiglobulin test was employed, the result was strongly positive for IgG, weakly positive for C3d. Cold agglutinin titer was 32, and the Donath-Landsteiner test was negative. The autoantibody exhibited Pra specificity. The patient failed IV-IgG, high dose IV pulse steroids and cyclophosphamide, and continued to require daily transfusions. She responded 21 days after receiving daily plasma exchange (x3), with pulse cyclophosphamide on the third day, followed by escalating daily oral cyclophosphamide.

A gracilis myocutaneous flap for reconstruction of the scrotum

A gracilis myocutaneous flap was used in a case of severe avulsion of the scrotum and loss of both testicles. The flap was transposed and inset in such a way as to simulate a scrotum of the right volume, shape and texture: the operation gave the patient good psychological support and a very good aesthetic repair of this mutilating injury.

[Participation of splenic vessels in blood supply to the pancreas (experimental-mathematical study)]

In 60 objects the participation of splenic vessels in human pancreas blood supply was studied roentgeno-angiographically and by means of anatomical preparation. Morphometrical data obtained were treated by computers "Minsk-22" and "M-220-M" to calculate main statistic values and their correlations. Some recommendations of applied importance for pancreas surgery were suggested. Maximal and minimal dimensions of the pancreas segments, which can be used for grafting with the following blood supply restoration in the transplant at the expense of the splenic vessels only, were represented.

An areolar approach to reduction mammaplasty

The authors present a new technique for selected cases of reduction mammaplasty and correction of ptosis, based solely on a aureolar approach. The skin is undermined, the glandular contents reduced if required and a mastopexy carried out. The excess skin is not removed but adapts itself to the new size and shape of the gland.