Analytic inaccuracy resulting from hematology specimen characteristics. Three cases of clinically misleading artifacts affecting white blood cell and platelet counts.

Sporadically, hematology analyzers generate grossly erroneous results for one or several parameters of the complete blood count (CBC) because of a characteristic or peculiarity of an individual patient specimen. This article presents three cases of relatively less well-known analytic errors of this sort, falsely elevating white blood cell count and platelet count and decreasing total white blood cell count, as determined on a Coulter Aperture Impedence Analyzer. The type of alteration in the CBC parameters and the instrument histogram abnormalities seen in each of these different types of analytic inaccuracy are discussed.

Signals from the dorsal blastopore lip region during gastrulation bias the ectoderm toward a nonepidermal pathway of differentiation in Xenopus laevis.

Epi 1, a monoclonal antibody, was generated against an epidermal specific epithelial antigen; it does not stain neural epithelium. We have used Epi 1 as a marker to determine when the spatial patterns delineating neural from nonneural epithelium become established. We used ventral ectoderm in a sandwich assay to show that signals from the central blastopore lip region, passing through the plane of the ectoderm sheet, define the pattern and boundary characteristics of Epi 1 expression.

Chloroform-induced multiple forms of ornithine decarboxylase: differential sensitivity of forms to enhancement by diethyl maleate and inhibition by ODC-antizyme.

The role of glutathione (GSH) and ornithine decarboxylase-antizyme (ODC-AZ) in the regulation of the chloroform-mediated stimulation of rat hepatic ornithine decarboxylase (ODC) was investigated. We have previously implicated roles for each while examining the chloroform effect on crude cytosolic enzyme preparations. In this study we examined the effect of pretreatment with diethyl maleate (DEM), a GSH-depleting agent, on the chloroform stimulation of the two forms of the rat hepatic ODC enzyme and the sensitivity of these two forms to inhibition by the ODC-AZ.

Elective cross-hand transfer: a case report with a five-year follow-up.

The elective free microvascular cross-hand transfer of the right hand to the left distal carpus was successfully performed in a 35-year old professional photographer. Traumatic loss of the left hand with preservation of a useful thumb and concomitant right upper extremity injury leaving the right hand with an amputated thumb, but paralyzed and insensate from a brachial plexus palsy 5 years before transfer, set the stage for such a reconstruction. Multiple immediate tendon transfers and primary nerve grafting provided for finger flexion and extension plus functional sensibility in this first reported case of an elective cross-hand microvascular transfer.

Metacarpal fracture fixation with interosseous nylon suture in a patient with metal allergies.

The successful repair of two oblique metacarpal shaft fractures with interosseous nylon sutures is reported. The technique was devised for the treatment of a 54-year-old woman with severe asthma and metal allergies that precluded the use of more conventional methods. Allergic reactions to mental implants and alternative stabilization techniques are discussed.

Chloroform mediated refractory state against ornithine decarboxylase induction by serial chloroform treatment.

The chloroform mediated refractory state against ornithine decarboxylase induction in male and female rat liver was further studied. One aspect of the investigation was to determine the duration of the induced refractory period while the other component focused on the extent to which the inhibitory effect was dependent upon the concentration of the first dose. When the dosing interval between the first and second dose was varied from 1 to 31 days, the magnitude of the resistance to further stimulation by chloroform only decreased gradually.

The influence of wrist position on the minimum force required for active movement of the interphalangeal joints.

Active and passive muscle tension is discussed in relation to finger flexor and extensor tendons. Minimising active tension required to produce finger movement is seen as an important part of post-operative finger mobilisation following flexor tendon repair in which active movement is used. It is argued that "minimal active tension" in the flexors is equal to, or just exceeds, the passive tension in the extensors.

Trustees at the crossroads: strengthening their future position.

Boards of trustees of Catholic healthcare facilities must strengthen their position to meet the changing healthcare environment. Their influence on delivery decisions is often questionable, and their continued existence may be in jeopardy. Boards may not determine an institution's survival, but their responsiveness to environmental situations in the next five years will determine the viability of their leadership.

Pregnancy in a woman with partial absence of the left pericardium. A case report.

Absence of the left pericardium is a rare congenital anomaly, occasionally associated with chest pain syndromes. There have been six cases of death due to strangulation of the left atrial appendage in patients with this condition. We present the first report of a patient with this anomaly who was followed through pregnancy.

Chloroform induction of ornithine decarboxylase antizyme (ODC-AZ) in male rat liver.

Chloroform stimulation of rat hepatic ODC is most dramatic at 18 h following a single injection. Repeated dosing, 1 dose/d for up to 7 d, results in a daily decline in the ability of the liver enzyme to respond 18 h after the final injection. We postulated that this decline was due to an increased synthesis and accumulation of the OCD-AZ protein.

Studies on the mechanism of action of chloroform stimulation of rat hepatic ornithine decarboxylase (ODC).

We have previously reported that chloroform is a very potent stimulator of rat hepatic Ornithine Decarboxylase (ODC) activity. At that time we conducted the obligatory time course and dose response studies in male and female rats. However, in an attempt to more thoroughly understand the mechanism of this stimulation, we have examined the effects of a series of pharmacologic, physiologic and toxicologic manipulations on the chloroform response.

Reversible valvulitis in Wegener's granulomatosis.

A patient with Wegener's granulomatosis sustained a myocardial infarction. Subsequent echocardiography showed aortic valvulitis, which resolved with therapy with cyclophosphamide and prednisone.

Massive hemolysis in Clostridium perfringens infections.

Over a 14-month period at the Cleveland Clinic Foundation, 424 strains of Clostridium were isolated; of these, 52 strains were Clostridium perfringens isolated from 41 patients. Eight strains of C. perfringens were isolated from the blood of six patients; five of these patients had neoplastic disease and three developed massive intravascular hemolysis with rapidly developing shock and death.

Marrow myxedema. Gelatinous transformation of marrow ground substance in a patient with severe hypothyroidism.

Replacement of marrow ground substance by hyaluronic acid-rich mucopolysaccharides (gelatinous transformation) has been previously reported to occur in severely malnourished patients. A patient with severe anemia and hypothyroidism without malnutrition was found to have gelatinous transformation of the marrow. This process is similar histologically to dermal myxedema, and the findings in this patient suggest questions for further study involving possible roles for thyroid-stimulating hormone in the development of marrow and visceral myxedema and the alterations in the normal partitioning process between serum and red blood cell low-density lipoproteins that produce acanthocytes in blood smears from patients with hypothyroidism.

Discovery of multiple organofluorophosphate hydrolyzing activities in the protozoan Tetrahymena thermophila.

Recently it has been found that homogenates of Tetrahymena thermophila can hydrolyze the potent acetylcholinesterase inhibitors O,O-diisopropylphosphofluoridate (DFP) and O-1,2,2-trimethylpropylmethylphosphonofluoridate (soman). Upon purification of the DFP hydrolyzing activity 10-fold it had been noted that the soman hydrolyzing activity increased only 2-3 fold. Treatment with manganous ion and comparison of the soman and DFP hydrolysis rates of the homogenate indicated that a mixture of the squid-type and Mazur-type DFPases may be present.