Murine IRF8 Mutation Offers New Insight into Osteoclast and Root Resorption

Interferon regulatory factor 8 (IRF8), a transcription factor expressed in immune cells, functions as a negative regulator of osteoclasts and helps maintain dental and skeletal homeostasis. Previously, we reported that a novel mutation in the IRF8 gene increases susceptibility to multiple idiopathic cervical root resorption (MICRR), a form of tooth root resorption mediated by increased osteoclast activity. The IRF8 G388S variant in the highly conserved C-terminal motif is predicted to alter the protein structure, likely impairing IRF8 function. To investigate the molecular basis of MICRR and IRF8 function in osteoclastogenesis, we generated Irf8 knock-in (KI) mice using CRISPR/Cas9 technique modeling the human IRF8G388S mutation. The heterozygous (Het) and homozygous (Homo) Irf8 KI mice showed no gross morphological defects, and the development of hematopoietic cells was unaffected and similar to wild-type (WT) mice. The Irf8 KI Het and Homo mice showed no difference in macrophage gene signatures important for antimicrobial defenses and inflammatory cytokine production. Consistent with the phenotype observed in MICRR patients, Irf8 KI Het and Homo mice demonstrated significantly increased osteoclast formation and resorption activity in vivo and in vitro when compared to WT mice. The oral ligature-inserted Het and Homo mice displayed significantly increased root resorption and osteoclast-mediated alveolar bone loss compared to WT mice. The increased osteoclastogenesis noted in KI mice is due to the inability of IRF8G388S mutation to inhibit NFATc1-dependent transcriptional activation and downstream osteoclast specific transcripts, as well as its impact on autophagy-related pathways of osteoclast differentiation. This translational study delineates the IRF8 domain important for osteoclast function and provides novel insights into the IRF8 mutation associated with MICRR. IRF8G388S mutation mainly affects osteoclastogenesis while sparing immune cell development and function. These insights extend beyond oral health and significantly advance our understanding of skeletal disorders mediated by increased osteoclast activity and IRF8's role in osteoclastogenesis.

Hyperhemolysis Syndrome Following Pre-Operative Red Blood Cell Exchange

Introduction/Objective

Pre-operative red blood cell exchange (RBCX) for patients with Sickle Cell Disease (SCD) is a category III indication. In our institution, RBCX is routinely performed pre-operatively when general anesthesia is necessary with the goal of HbS%<30 and reduction in adverse events related to general anesthesia. In the context of elective surgery, the risks and benefits of both the operation and any pre-operative transfusion must be discussed with the patient. Herein, we present an extreme case of Hyperhemolysis Syndrome resulting from a pre-operative RBCX.

Methods/Case Report

A 23-year-old transgender female with SCD (Hb S Lepore) treated with Hydroxyurea presented for elective breast augmentation for gender-affirmation. Her pre-operative plan included a RBCX. Her pre-exchange hemoglobin (Hb) and hematocrit (Hct) were 10.3 g/dL and 29.3%, respectively. Hb electrophoresis revealed HbS 52%, HbF 41.4%, HbA2 7.4%, and HbA was not detected. Type and Screen (T&S) demonstrated O + blood group, with a negative antibody screen, and with no known historical alloantibodies.

RBCX was performed using the Spectra Optia (TerumoBCT, Lakewood, CO, USA) with exchange volume of 1.9 L of group O+ RBCs, phenotypically matched for C, E, and K, an end Hct of 30% and an FCR of 30%. Her post-exchange Hb and Hct were 10.2g/dL and 29.5%, respectively. Hemoglobin fractionation revealed HbS 12% and HbA 73%.

She underwent surgery without intraoperative complications. Two weeks post RBCX, her Hb had decreased to 5.3 g/dl, and her LDH and Total Bilirubin had increased to 253 ul and 1.8 mg/dl, respectively. A repeat T&S drawn 8 days after RBCX revealed a positive antibody screen and direct antiglobulin test (DAT). Three new alloantibodies were identified: anti-Fya (present in plasma and eluate); anti-Jkb (present in plasma); anti-S (eluate). She was treated with IVIG, 0.4 g/Kg/day for 5 consecutive days and 2 doses of subcutaneous darbepoetin 100 mcg and subsequently discharged with close outpatient follow up. Her Hb returned to baseline at 11 g/dL, 48 days post RBCX.

Results (if a Case Study enter NA)

N/A

Conclusion

Pre-operative RBCX decreases morbidity in sickle cell patients undergoing general anesthesia. In the setting of elective surgery, patients must be counseled on the benefits and risks of surgery as well as the requisite RBCX. In our case, the patient developed multiple alloantibodies, with lifelong implications should she ever need future blood transfusions.

Squamous Metaplasia in Colonic Tubulovillous Adenoma: A Three Case Series and review of literature

Introduction/Objective

Although squamous metaplasia of colonic tubulovillous adenoma is a rare phenomenon, colorectal polyps can show focal squamous metaplasia. While the exact cause in unknown, it has been suggested that mechanical irritation, torsion and chronic inflammation may predispose to squamous metaplasia within large colonic polyps.

Methods/Case Report

We observed this finding in two men and one woman with colorectal polyps who underwent endoscopic mucosal resection in a three-week timeframe. In two cases the polyps were rectal, while in the third case, it was located in the descending colon. Polyp size ranged from 1-5 cm and were semi-pedunculated. Histologically, all three lesions were tubulovillous adenomas with focal high-grade dysplasia and multiple foci of squamous metaplasia characterized by cells with benign-appearing nuclei, eosinophilic cytoplasm, and solid growth pattern. Some metaplastic foci approached the muscularis mucosae, mimicking adenocarcinoma at low power magnification. Interestingly, these metaplastic foci were reactive against p16 immunohistochemical stain.

Results (if a Case Study enter NA)

NA

Conclusion

We present these three cases to add to the few previously reported. Pathologists should be aware of this finding to avoid the overdiagnosis of invasive carcinoma in the setting of nested and pseudo invasive squamous morules, especially in polyps with high grade dysplasia. In addition, squamous metaplasia could be a precursor lesion for colorectal squamous cell carcinoma.

Granular Cell Tumor Confined To The Muscularis Propria Of The Appendix: A Case Report

Introduction/Objective

Granular cell tumors (GCTs) are exceedingly rare soft tissue tumors that are usually benign and are thought to arise from Schwann cell origin. GCTs most commonly occur in the skin, subcutaneous tissue, and oral cavity. However, they can involve any organ, including the gastrointestinal (GI) tract, of which esophagus is most common, followed by large intestine. We report a case of a 58 year old female who presented with acute

appendicitis, followed by an appendectomy to reveal an incidental GCT.

Methods

This report is a retrospective study of an appendiceal GCT in which we reviewed the case and the histology. In addition, a brief literature review of gastrointestinal GCTs was performed to further elucidate the incidence, location, histopathology, and differential diagnoses for this lesion.

Results

Histological analysis of the tumor nodule reveals nests of epithelioid cells with abundant granular eosinophilic cytoplasm. The nuclei are bland, small, and round to oval, with rare spindled morphology.

Immunohistochemistry for S-100 protein shows diffuse strong cytoplasmic and nuclear positivity, which is suggestive of Schwann cell origin. In the GI tract, GCTs are routinely confined to the mucosa, submucosa, or both; however the tumor nodule in our case is contained within the muscularis propria.

Conclusion

It is estimated that 5–11% of GCTs occur in the gastrointestinal tract, while only 13 GCT cases of the appendix have been reported. In addition to the previously stated rarity, is the limited involvement of the muscularis propria, with which GCTs typically are not associated. To our knowledge, this is the first confirmed GCT of the appendix that solely involves the muscularis propria, in English medical literature.

Hepatoblastoma With Rubinstein-Taybi Syndrome: A Rare Association

Introduction/Objective

Hepatoblastoma is a malignant neoplasm of liver, exclusively seen in pediatric population. It has been known to occur with various syndromes like Li-fraumeni, Beckwith-Wiedemann, and Simpson-Golabi- Behmel among others. Small undifferentiated cells and macro-trabecular pattern with increased mitotic activity and AFP>100 are associated with unfavorable prognosis. Rubinstein-Taybi syndrome is a rare genetic disease. Even though there has been intensive research on the genetic and epigenetic function of the CREBBP and EP300 genes in animal models, the etiology of this rare and devastating syndrome is largely unknown. Hepatoblastoma with Rubinstein-Taybi syndrome is an extremely rare occurrence.

Methods

Here we present an incidental case of Hepatoblastoma with Rubinstein-Taybi syndrome

Results

A 17-month-old Caucasian female with Rubinstein-Taybi syndrome, was found to have an incidental 1.1 cm nodule in the right lobe of liver. Her AFP was elevated (244.9ng/ml). Hepatic resection revealed a well-circumscribed tan white mass, measuring 3.5 cm in the greatest dimension. On microscopy, uniform round to cuboidal cells resembling fetal hepatocytes, with finely granular cytoplasm, small round nuclei, and indistinct nucleoli were seen. The cells were arranged in solid sheets and scant trabecular arrangement separated by narrow sinusoids. The tumor displayed predominantly fetal histology, with rare embryonal and small undifferentiated cell nests. The diagnosis of Hepatoblastoma was made. The patient underwent chemotherapy and was doing well at 5-years follow-up.

Conclusion

Extensive screening of patients in recent times has revealed mutations in CREBBP and EP300 in only around 50% of cases. The genetic and epigenetic associations of the syndrome in the remaining half of cases remains to be identified. Hepatoblastoma with Rubinstein-Taybi Syndrome is an extremely rare occurrence and might shed some light on other genes that could be involved in this syndrome. Further studies to review the mutation spectrum to understand the causative molecular mechanisms are deemed essential.

Russell Body Duodenitis In A Patient With Duodenal Adenoma And High-Grade Dysplasia

Introduction/Objective

Russell bodies are nondegradable, condensed immunoglobulins accumulated in the overstimulated plasma cells, and the plasma cells filled with Russell bodies are called Mott cells. Russell body gastroenteritis is a rare entity that is mainly occurs in stomach and is associated with Helicobacter pylori infection.

However, Russell body duodenitis is very rarely seen, so far only about four cases have been reported. Here we report a case of Russell body duodenitis within concurrent large duodenal adenoma with high-grade dysplasia in a 66- year old female.

Methods

Formalin fixed, paraffin embedded tissue was examined stained with H&E and PAS-Alcian blue stain. Immunohistochemical stains (IHC) with appropriate controls were performed with the following antibodies: H. pylori, CD138, kappa and lambda light chains.

Results

A 66-year old female had symptoms of difficult swallowing and decreased food intake. Upper GI endoscopy was performed to reveal a 7 cm multilobulated mass at the junction of the duodenal bulb and second portion of the duodenum, which involved the ampullary orifice. A biopsy for the mass showed a duodenal adenoma with high grade dysplasia. Numerous Mott cells were diffusely distributed within the lamina propria that was characterized by bright eosinophilic cytoplasmic globules with eccentric nuclei. The Mott cells were confirmed by IHC stains with positive CD138, PAS-Alcian blue, and polytypic expression of kappa and lambda light chains. The Helicobacter pylori immunostain was negative.

Conclusion

Although the etiology is unknown, most of the Russell body gastroenteritis are seen in benign conditions. It is mainly found in stomach associated with Helicobacter pylori infection. To our knowledge, this is the first reported case of Russell body duodenitis with concurrent duodenal adenoma with high-grade dysplasia. Further studies should be conducted on Russell bodies associated with high-grade dysplasia or carcinoma in gastrointestinal tract.

A novel diagnostic algorithm for heparin-induced thrombocytopenia

INTRODUCTION

While diagnostic algorithm using PF4-heparin enzyme-linked immunosorbent assay (ELISA) optical density (OD), and heparin neutralization assay (HNA), or 4T score have been proposed to replace serotonin-release assay (SRA) for heparin-induced thrombocytopenia (HIT), their performance against SRA is unclear. In this study, we proposed and validated the performance of a new algorithm combining PF4-heparin ELISA optical density (OD), HNA and 4T score against SRA for HIT diagnosis.

METHODS

Heparin neutralization assays were performed on specimens submitted for HIT testing with positive PF4-heparin ELISA from December 2015 to September 2017, which were separated into a "training" and a "validation" data set. 4T scores were calculated for ELISA positive cases.

RESULTS

A total of 123 consecutive unique patient samples had positive PF4-heparin ELISA with also HNA data, SRA data, and 4T scores available. Compared to SRA, a "laboratory criteria" (ELISA OD ≥ 1.4 and HNA ≥ 70%) had a sensitivity of 88% (14/16) and specificity of 91% (42/46), and a "combined criteria" (4T score = 8, or 4T score = 6 or 7 and ELISA OD ≥ 1.0, or 4T score = 4 or 5 and ELISA OD ≥ 2.0) had a sensitivity of 75% (12/16) and specificity of 98% (45/46) in the training data set. Laboratory and combined criteria had 90% (56/62) concordance rate. Importantly, for these concordant cases, the diagnostic specificity is 100% (46/46). Based on the data, a novel diagnostic algorithm combining these 2 criteria was proposed and validated prospectively.

CONCLUSION

A novel algorithm has high diagnostic accuracy and potentially could eliminate the need for SRA testing in at least 90% patients with suspected HIT.

Successful use of endoscopy for transcervical cannulation procedures in the goat

Two methods for transcervical cannulation of the goat were evaluated during a contraception study in 15 adult female Nigerian dwarf and African pygmy goats. Twenty-four transcervical cannulation procedures were conducted in which seven females underwent the procedure 2–3 times. Initially, a rigid 4-mm stainless steel cannula and external light source were used in 19 procedures to introduce the contraceptive compound into the uterus. Placement of the cannula was directed by feel or depth assessment. Of seven females that were euthanized following this procedure, four evidenced complications including penetration of the cervix with the cannula and cervical damage. A 2-mm custom-made endoscope with a specially designed cannula was then used for the remaining five procedures. No complications were found. A single animal, that underwent the endoscopic procedure twice, was euthanized for study purposes and no abnormal findings of the reproductive tract were reported. The use of an endoscope resulted in better outcomes because the uterus could be visualized after traversing the cervix.

A model for genetic complementation controlling the chromosomal abnormalities and loss of heterozygosity formation in cancer

The relationship between the apparently random chromosomal changes found in aneuploidy and the genetic instability driving the progression of cancer is not clear. We report a test of the hypothesis that aneuploid chromosomal abnormalities might be selected to preserve cell-survival genes during loss of heterozygosity (LOH) formations which eliminate tumor suppressor genes. The LOHs and structurally abnormal chromosomes present in the aneuploid LoVo (colon), A549 (lung), SUIT-2 (pancreas), and LN-18 (glioma) cancer cell lines were identified by single nucleotide polymorphisms (SNPs) and Spectral Karyotyping (SKY). The Mann-Whitney U and chi square tests were used to evaluate possible differences in chromosome numbers and abnormalities between the cell lines, with two-tailed P values of <0.01 being considered significant. The cell lines differed significantly in chromosome numbers and frequency of structurally abnormal chromosomes. The SNP analysis revealed that each cell line contained at least a haploid set of somatic chromosomes, consistent with our hypothesis that cell-survival genes are widely scattered throughout the genome. Further, over 90% of the chromosomal abnormalities seemed to be selected, often after LOH formation, for gene-dosage compensation or to provide heterozygosity for specific chromosomal regions. These results suggest that the chromosomal changes of aneuploidy are not random, but may be selected to provide gene-dosage compensation and/or retain functional alleles of cell-survival genes during LOH formation.

Imaging of the gastrointestinal tract

Gastrointestinal imaging has undergone immense and profound changes since the days when radiologists had only plain abdominal radiography, barium studies and cholecystography to offer as a means of investigating the gastrointestinal tract. Advances in technology have made huge differences in the ways and means of investigating the various pathologies afflicting the gastrointestinal tract. Ultrasound provides assessment of the solid organs and the intestine without the use of ionizing radiation. Computed tomography (CT) provides unparalleled imaging of congenital, inflammatory, traumatic and neoplastic processes, providing information on the solid organs and tubular structures, including the vasculature. Information is provided to aid immediate management or to stage lesions for subsequent or combined therapies. Magnetic resonance imaging (MRI) gives unprecedented multiplanar images and soft tissue resolution. There is still a place for plain radiography and barium studies but this is decreasing as technology advances.(c) 2001 Prous Science. All rights reserved.

A population-based study of personality in 34,000 sib-pairs

Several theoretical studies have suggested that large samples of randomly ascertained siblings can be efficiently used to ascertain phenotypically extreme individuals and increase power to detect genetic linkage. Phenotypes that can be reliably measured by questionnaire are of obvious utility for such selection strategies, as large numbers of individuals can be contacted without laborious individual interview. As the first step in developing a large randomly-ascertained family cohort in southwest England, a sample of 88,000 individuals, including more than 34,000 sibling pairs in 20,000 sibships, was administered the Eysenck Personality Questionnaire (EPQ) by commercial mailing. The sample age ranges were 20-67 years and comprised 59% males and 41% females. Descriptive properties of the EPQ scales are similar to those reported from other large family cohorts. Test-retest correlations on 1681 probands in the sample are substantial for the N-scale (r = 0.93), but somewhat more modest for the other scales (range r = 0.70-0.88). Phenotypic and sibling correlations correspond quite closely to those of twin studies.

Obesity solutions: report of a meeting

A workshop entitled "Obesity Solutions" was held on January 11, 1996, at St. Luke's-Roosevelt Hospital in New York City and was jointly sponsored by the St. Luke's-Roosevelt Obesity Research Center and the Nestlé R&D Center, Inc., of New Milford, Connecticut. The purpose of the workshop was to bring together experts from the research community and the pharmaceutical and food industries to address the epidemic of obesity in the United States and offer potential solutions. The following is a report of that meeting.

Suicide in San Francisco, CA: a comparison of Caucasian and Asian groups, 1987-1994

Completed suicides in the city of San Francisco, California, were examined across all ages in the racial groups of Caucasians (n = 798) and Asians (n = 124) from 1987 to 1994. A comparison of Caucasians and Asians showed that there were differences between them in their rates across all age groups. The major findings are: (1) Caucasians predominantly used gunshot to complete suicide whereas Asians predominantly used hanging to complete suicide, (2) Asian women over the age of 85 have the highest rates across both groups and genders, (3) Asians, as compared to Caucasians, used fewer drugs and alcohol at time of death. Theoretical connections between differences in suicide and definition of the self, as influenced by culture, are discussed.

Long-term benefits of aggressive treatment for primary colorectal cancer

The long-term follow up of 128 colorectal cancer patients is reported. Seventy-nine percent (101/128) of the patients had curative resections: 70 patients had radical lymphadenectomies with wide removal of tumor-adjacent nodes, and 31 patients had standard resections. The 5-year overall survival rates for Dukes' stage B and C patients and for all rectosigmoid cancer patients significantly favored radical resection (60% vs. 38%, 57% vs. 29%, respectively, P < 0.05). Tumor-free survival rates were also higher after radical lymphadenectomy but did not reach statistical significance. Eleven percent (14/128) of the patients required multiorgan resections, and/or preoperative radiation to render fixed cancers resectable, and these patients had a 10-year tumor-free survival rate of 45%, compared to zero % 5-year survival for the 27 patients who underwent palliative procedures (P < 0.01). These results confirm that many colorectal cancer patients will be cured with aggressive treatment and they support the need for a controlled trial for evaluation of lymphadenectomy for this disease.

Ambulatory elderly patients of primary care physicians: functional, psychosocial and environmental predictors of need for social work care management

With increasing numbers of elderly people, and the escalating costs of health care, screening becomes increasingly important for identifying those older people with social health care needs who appear in their primary care physicians' offices. Many people are not aware of available social services. Families with serious social problems are not finding the help they need. The aim of this study was to develop and refine a questionnaire as a screening tool to identify elderly outpatients in primary care settings who are at high risk for psychological, social or environmental needs. This study identified those ten factors at each site which were most indicative that further intervention was needed. There were consistencies among the coordinators across sites in terms of what factors triggered intervention. Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) were more likely to be predictive of the coordinator's intervention than were other factors.

Pseudomonas aeruginosa wound infection associated with a nursing home's whirlpool bath

Whirlpool baths are fitted with hydrojet circulation and/or air induction bubble systems. Water in a whirlpool bath, unlike a spa pool, is not filtered or chemically treated but the bath is drained and cleaned between each bather. This is, we believe, the first report of Pseudomonas aeruginosa wound infection associated with the use of a whirlpool bath in a nursing home. Microbiologically confirmed infections with P. aeruginosa of identical antibiotic sensitivity patterns arose in one week in wounds of four of 24 residents who used a whirlpool bath from which P. aeruginosa was also isolated. P. aeruginosa was not isolated from the wounds of a further seven residents who did not use the whirlpool bath. The incident control team advised that use of the whirlpool bath should be restricted to continent residents with intact skin, and that the bath should be cleaned with a degreasing agent and disinfected with hypochlorite between use by individual residents. The hazard of infection posed by whirlpool baths, particularly in nursing homes, needs to be assessed. National guidance for their cleaning, maintenance, and disinfection is required.

Quantitative two-site enzyme-linked immunosorbent assays for inhibin A, activin A and activin B

We have developed three specific enzyme-linked immunosorbent assay (ELISA) formats which quantitate inhibin A in conditioned media and serum. The assays are sensitive in a range 0.078-5.0 ng/ml and have been characterized in terms of cross-reactivity to inhibin related proteins. The CK:CK assay format recognizes inhibin A, inhibin B and inhibin-related molecules, while the 9A9:CK assay format recognizes inhibin A and inhibin A precursors, but not free alpha-subunit. The 11B5:CK assay appears to recognize only mature 32 kDa inhibin A. Additionally, we have developed separate, specific ELISA formats which quantitate activin A and activin B. The assays have a range of 0.2-50 ng/ml and 0.4-50 ng/ml for activin A and recombinant activin B, respectively. These assays are presently being used to examine the concentration of inhibin A, activin A and activin B in clinical serum samples.

Incidence and pattern of jaundice in healthy breast-fed infants during the first month of life

The incidence and pattern of jaundice in 155 normal, full-term, breast-fed, white infants was examined. Infants were screened for jaundice on Days 2, 3, 5, 7, 9, 11, and 13 following birth using transcutaneous bilirubinometry (TcB). By Day 3, 49.7% of the infants were classified as jaundiced (> 10 mg/dl). Infants with low TcB indices on Days 2, 3, and 5 never developed jaundice as indicated by elevated TcB indices on Days 7, 9, 11, and 13. Hence, it may be possible to target infants at risk for severe jaundice prior to discharge. The observed rate of 10.3% for breast-milk jaundice (jaundice present at Day 13) is significantly higher than the highest reported rate of 2.4% (z = 6.43, p < .01). Furthermore, the pattern of jaundice in these infants does not appear to have two peaks, indicating that it is not possible to distinguish between exaggerated physiologic jaundice and breast-milk jaundice using TcB.

Chromosomal and genetic analysis of the electrophoretic karyotype of Trichoderma reesei: mapping of the cellulase and xylanase genes

An electrophoretic karyotype has been established for Trichoderma reesei strain QM6a, and several of its derivatives, by pulsed-field gel electrophoresis. All strains examined appear to have seven chromosomes with a total genome size of approximately 33 megabases (Mb). The sizes of the chromosomal bands in strain QM6a are approximately 6.2, 6.0, 5.1, 4.2 (doublet), 3.6 and 3.2 Mb. Genes encoding the cellulase complex and xylanases of T. reesei have been mapped, as have several other genes.

Difficulties in localization and treatment of insulinomas in type 1 multiple endocrine adenomatosis (MEA)

A 15 year old girl with a family history of type 1 multiple endocrine adenomatosis presented with reversible neurological disturbances, hypoglycaemia and hyperinsulinaemia. Initial radiology was normal, but portal venous sampling suggested an insulinoma in the tail of the pancreas which was removed with conservation of the spleen. Hypoglycaemia persisted despite high doses of diazoxide and intravenous dextrose. A second laparotomy revealed a pancreatic endocrine tumour and sub-total pancreatectomy was performed. Histology revealed islet cell microadenomatosis. Hypoglycaemia persisted despite treatment with somatostatin analogues and 40% intravenous dextrose was required to maintain normoglycaemia. A possible lesion near the splenic hilum on computed tomographic scan was reported as a splenunculus although further peripheral, hepatic and portal venous sampling suggested hepatic or systemic lesions. A positron emission scan and selective visceral angiography suggested a lesion in the left upper quadrant. Acute lactic acidosis, rhabdomyolysis and renal failure supervened. Post mortem revealed the putative 'splenunculus' to be a residual insulinoma, whilst the splenic vein was thrombosed, accounting in part for discrepant venous sampling data. Hyperinsulinaemia in type 1 multiple endocrine adenomatosis may require more aggressive surgical and hormonal intervention than when dealing with solitary insulinomas. Insulinomas may mimic developmental abnormalities on computed tomographic scanning.

High-volume enzyme immunoassay test system for sulfamethazine in swine

A high-volume enzyme immunoassay (EIA) system for slaughterhouse screening of sulfamethazine in swine plasma/serum has been developed. The system includes a robotic sample processor that performs most of the liquid handling requirements in the assay. The assay gives good correlation with the widely used thin layer chromatographic method for determination of sulfamethazine in serum and plasma (r = 0.826). Inter- and intra-assay coefficients of variation are less than 10%. Approximately 2,400 serum/plasma samples can be analyzed in a normal working day (8 h) with this system.

Transcutaneous bilirubinometer: an instrument for clinical research

The transcutaneous bilirubinometer can be an effective instrument for clinical research. With neonatal jaundice occurring in approximately 50-75% of newborns, nurse researchers investigating many important issues surrounding this commonly occurring condition will find the bilirubinometer useful in screening for jaundice, testing effectiveness of various therapeutic modalities, and evaluating clinical progress. This article presents a review of the literature reporting reliability and validity of meter findings and makes recommendations for meter use.

An unusual angiogram in a patient with gastrointestinal bleeding

A patient presenting with upper gastrointestinal bleeding had two visceral angiograms, the second of which demonstrated the hepatic veins in the late phase of the hepatic arterial injection. This observation led to the correct diagnosis of hepatic telangiectasia with arteriovenous shunting and the suspicion, subsequently confirmed at endoscopy, of similar-lesions in the gastrointestinal tract. Visualisation of hepatic veins in visceral arteriography is unusual but may, as discussed, be normal.

Transcutaneous bilirubinometer: intermeter reliability

This study examined intermeter reliability on two transcutaneous bilirubinometers on 30 white prephototherapy infants between 36 and 42 weeks' gestation with birthweights greater than 2500 g. All infants were screened with both meters, on the forehead, within a 5-minute period. Meter readings were taken within 30 minutes following infant heelstick for serum bilirubin. The Pearson correlations between serum bilirubin and jaundice meter measurements were .75 for meter 1 and .76 for meter 2. The correlation between jaundice meter indices from the two meters was .87, leaving 13% of the variance in one meter not accounted for by the correlation with the other meter. An examination of the differences between the two meters revealed that in the upper range (greater than or equal to 16) meter 1 was always higher than meter 2 by, on the average, 2.6 points (SD = 1.3). In readings of 15 or less, the differences between the meters were inconsistent. Additionally, in 16 of 30 cases, the action levels from the two meters led to the same conclusion; in the remaining 14 cases, meter 1 gave a positive reading (indicating the need to determine serum bilirubin) while meter 2 gave an equivocal reading (indicating user discretion in deciding whether serum bilirubin should be determined). These data indicate that each meter should be individually evaluated to determine action indices, and that jaundice meters should not be used interchangeably on the same infant.

Detection of thymic surface antigens and radioactive labeling of mouse lymphoid cells

A method for the permanent and simultaneous detection of tissue-specific surface antigens and internal radioactive labeling of mouse lymphoid cells is described. Target cells were first reacted with a mouse-derived "antithymocyte serum", incubated with peroxidase-conjugated rabbit serum against mouse immunoglobulins and placed in a substrate solution that leads to staining of the antigen-positive cells. Radioactive labeling was demonstrated by autoradiography performed after the antigen assay. More than 90% of antigen-positive thymocytes could be specifically stained in the assay without staining of similarly treated antigen-negative cells. Autoradiographic grains could be detected over both antigen-positive and antigen-negative cells.

Insecticides: Effects on Cutthroat Trout of Repeated Exposure to DDT

Cutthroat trout were periodically exposed to p, pp-DDT, in acetone solution or in the food. Excessive mortality occurred only in lots treated with high concentrations of DDT, probably as a result of decreased resistance to nonspecific stressors. Surviving fish in these lots were significantly larger than those in the control lot, or in the lots treated with low concentrations of DDT. The number and volume of eggs produced was not reduced by DDT, but mortality among sac fry appeared to be highest in the lots treated with high concentrations. The data suggest that the sublethal concentrations of DDT ordinarily encountered in the environment are unlikely to damage a fishery.