A cross-reactive anti-myelin basic protein idiotope in cerebrospinal fluid cells in multiple sclerosis.

We wanted to find evidence of antibody to myelin basic protein (MBP) in patients with MS by detecting their shared usage of immunoglobulin genes. As demonstrated by the idiotopes (i.d.

The effect of 17 beta-estradiol on adrenocortical sensitivity, responsiveness, and steroidogenesis in postmenopausal women.

Aging in women is associated with reduced production of adrenal androgens (AAs); this decrease may in part be the result of menopausal hypoestrogenism. To determine the effects of physiological concentrations of estradiol (E2) on adrenocortical sensitivity and responsiveness in postmenopausal women, we determined steroid responses to a continuous incremental ACTH-(1-24) infusion (0, 20, 40 80, 160, 320, 640, and 1280 ng/1.5 m2/h), followed by an ACTH-(1-24) bolus of 0.

History of echocardiographic contrast agents.

Since its experimental introduction over 30 years ago, the use of cardiac ultrasound has expanded expeditiously, particularly in the last decade. The inception of managed care has fueled this expansion because ultrasound technology has the potential to enhance cost-effective diagnosis and medical care. Another important factor driving the growth of cardiac ultrasound has been the recent and rapid development of contrast echocardiography (CE).

Elevated second-trimester dimeric inhibin A levels identify Down syndrome pregnancies.

Objective: Our purpose was to determine whether second-trimester dimeric inhibin A levels distinguish Down syndrome pregnancies from euploid pregnancies.

Study Design: With use of a commercially available enzyme-linked immunosorbent assay (Serotec, Oxford) inhibin A medians were established in stored sera from 40 to 50 euploid pregnancies at each week of gestation from 14 to 20 weeks and from 33 Down syndrome pregnancies. Maternal serum alpha-fetoprotein, unconjugated estriol, and human chorionic gonadotropin levels measured in each sample before storage were retrieved.

Alpha-fetoprotein, free beta-human chorionic gonadotropin, and dimeric inhibin A produce the best results in a three-analyte, multiple-marker screening test for fetal Down syndrome.

Objective: The purpose of this study was to determine, among six second-trimester maternal serum analytes, the best three-analyte combination for fetal Down syndrome detection.

Study Design: With use of commercially available assay kits, medians for free beta-human chorionic gonadotropin, CA 125, and dimeric inhibin A were established in stored sera from 45 to 50 euploid pregnancies at each week of gestation from 14 to 22 weeks and from 33 Down syndrome pregnancies. Maternal serum alpha-fetoprotein, unconjugated estriol, and intact human chorionic gonadotropin levels measured in each sample before storage were retrieved.

Randomized trial of single-dose versus multiple-dose cefotetan for the postpartum treatment of intrapartum chorioamnionitis.

Objective: Our purpose was to determine whether a single postpartum dose of a cephalosporin would effectively treat women with intrapartum chorioamnionitis and decrease the length of hospitalization.

Study Design: After vaginal delivery consenting women who had received antibiotics for chorioamnionitis were assigned to postpartum treatment with either a single 2 gm intravenous dose of cefotetan or to cefotetan 2 gm given intravenously every 12 hours for a minimum of 48 hours. Chorioamnionitis was defined as an intrapartum temperature of > or = 100.

Genotypic investigation of multidrug-resistant Acinetobacter baumannii infections in a medical intensive care unit.

Multi-resistant Acinetobacter baumannii isolates obtained from 13 hospitalized patients over a six-month period were evaluated. One patient had an isolate susceptible only to imipenem; the next three had isolates susceptible to imipenem and ampicillin/sulbactam; the next six patients had isolates which were susceptible to imipenem, amikacin, and ampicillin/sulbactam; while the final three patients had isolates which were susceptible to imipenem and ampicillin/sulbactam. Ten patients died, five within 10 days of a positive culture.

Aging alters zonation in the adrenal cortex of men.

Whereas aging has been shown to be associated with striking reductions in circulating levels of adrenal androgens in humans, the alteration in adrenal function that occurs in aging has not been identified. We sought to determine if there are changes in the zonation of the adrenal in aging men by performing histomorphologic analyses of adrenal specimens that had been obtained at autopsy following sudden death due to trauma. We evaluated adrenals from 21 young men (20-29 yrs) and 12 older men (54-90 yrs); inclusion criteria required the presence of medullary tissue in the specimen and fixation within the first 24 hrs postmortem.

Clinical utility of the transpulmonary echo enhancing agent Levovist to improve diagnostic confidence in echocardiography.

Echo enhancing agents have been used in echocardiography since 1968 for a variety of applications. Until recently, the agents were unable to survive transit through the pulmonary circulation following intravenous injection, and the technique was therefore restricted to investigations of the right side of the heart. Levovist is an echo enhancing agent capable of left heart--and even systemic--enhancement to improve the images obtained with B-mode and Doppler echocardiography.

Pregnancy outcomes following false-positive multiple marker screening tests.

Pregnancy outcomes in women with a false-positive midtrimester multiple marker screening test (MMST) were reviewed. A genetic database was used to identify all women > or = age 30 who had a MMST at 15-20 weeks of gestation, a targeted ultrasound, and amniocentesis, and complete pregnancy outcome data. All patients with an abnormal fetal ultrasound (US) or karyotype were excluded.

Hextend (hetastarch solution) decreases multiple organ injury and xanthine oxidase release after hepatoenteric ischemia-reperfusion in rabbits.

Objective: We hypothesized that multiple organ injury and concentrations of xanthine oxidase (an oxidant-generating enzyme released after hepatoenteric ischemia) would be decreased by the administration of a bolus of a colloid solution at reperfusion.

Design: Randomized, masked, controlled animal study.

Setting: University-based animal research facility.

Progress toward preparation of universal donor red cells.

Coupling of an inert polymer to the surface of red cells was examined as a potential means of covering blood group antigens and producing cells that could serve as universal donor cells for transfusion. Effective blockade of red cell antigens was achieved with N-hydroxysuccinimide-activated esters of polyethylene glycol. It was possible to block all antigens tested, but lower concentrations of reactants were required to block peptide-defined antigens than carbohydrate-defined antigens.

Mammography of breasts in which catheter cuffs have been retained: normal, infected, and postoperative appearances.

Objective: The purpose of this report is to show that Dacron (DuPont, Wilmington, DE) cuffs retained in breasts after the removal of Hickman catheters may result in complications requiring radiographic evaluation for subsequent management. We also describe potential complications, including infection, associated with a retained cuff and changes after the removal of a retained cuff.

Conclusion: Because of the increased use of Hickman catheters for central vein access, Dacron cuffs more frequently are retained in breasts and are likely to be seen on mammograms.

Clinical applications of C-reactive protein in pediatrics.

The body of literature concerning studies of the applications of CRP measurement in the pediatric population continues to grow. Based on current data serial CRP measurements appear to be most useful for monitoring patient response to therapy after the primary diagnosis of invasive infectious or inflammatory diseases, for monitoring patients after major surgical procedures and those with serious burns. Monitoring CRP over time may be used to assess for recrudescent disease, a secondary process or ineffective therapy.

Identification of early pregnancy landmarks by transvaginal sonography: analysis by logistic regression.

Objective: To assess the feasibility of logistic regression analysis for determining the gestational ages at which detection of early pregnancy landmarks first can be observed.

Design: Retrospective analysis.

Setting: University-based tertiary care clinic.

Free and protein-associated nitrotyrosine formation following rat liver preservation and transplantation.

Nitrotyrosine in human and animal tissues has been associated with pathologic conditions such as atherosclerosis, renal failure, and acute lung disease. In this study, free and protein-associated nitrotyrosine were determined in plasma and tissue samples using a dual-channel electrochemical detection method. Free nitrotyrosine was quantified in acetonitrile-extracted samples while protein-associated nitrotyrosine was determined in proteinase K-digested samples.

Xanthine oxidase mediates myocardial injury after hepatoenteric ischemia-reperfusion.

Objectives: To determine if myocardial injury results from hepatoenteric ischemia-reperfusion. We also proposed to determine if this remote heart injury is mediated by a xanthine oxidase-dependent mechanism.

Design: Randomized, controlled animal study.

In vitro activities of oral antimicrobial agents against penicillin-resistant Streptococcus pneumoniae: implications for outpatient treatment.

We tested 83 penicillin-intermediate (Peni) and 50 penicillin-resistant (Penr) isolates of Streptococcus pneumoniae against eight oral antimicrobials. Clarithromycin's MICs (minimal inhibitory concentration) were generally the same or one to two dilutions less than those of azithromycin. Seventy-two percent of Peni isolates were susceptible to clarithromycin and azithromycin, in contrast to 42% and 40%, respectively, of Penr isolates.

Plasma alkaline phosphatase and pregnancy outcome.

The objective was to determine the relationship between plasma alkaline phosphatase (AP) activity and birthweight (BWT) and preterm delivery (PTD). Five hundred eighty African-American women had plasma AP activities measured at various gestational ages (GA) with the results compared to a number of pregnancy outcomes. Plasma AP activity rose linearly during pregnancy from a mean of 39 U/L at 19 weeks to 130 U/L at delivery.

Trilineage extramedullary myeloid cell tumor in myelodysplastic syndrome.

A patient with a 17-month history of myelodysplastic syndrome (refractory anemia with excess blasts that evolved into chronic myelomonocytic leukemia), which was treated with transfusions and erythropoietin, developed abdominal and inguinal lymphadenopathy. Biopsies of the abdominal nodes revealed virtual obliteration of the architecture by myeloid blasts admixed with maturing granulocytic, erythroid, and megakaryocytic precursors. The lymph node findings appeared to represent extramedullary dyshematopoiesis undergoing a tissue phase blast transformation.

Evaluation of the Etest for detection of tetracycline resistance in Mycoplasma hominis.

The Etest was compared with microbroth dilution for performing in vitro susceptibility tests in 38 isolates of Mycoplasma hominis chosen to represent a wide range of MIC values. MIC50s were 4 micrograms/ml for both methods; whereas, MIC90s were 64 and > 256 micrograms/ml for broth and Etest, respectively. Etest MICs determined on SP 4 agar were usually two or more dilutions greater than microbroth MICs in SP 4 broth, and values were prone to change by one to two dilutions when different inoculum densities were used.

Tourette syndrome.

This survey of recent literature addressing Tourette syndrome reflects clinical and laboratory findings of investigations of behavioral, neuropsychological, imaging, genetic, neurobiological and treatment considerations. Tourette syndrome is a prototypic neuropsychiatric disorder manifesting a full range of objectively describable phenomena from different scientific vantage points and serves as a model for study and integrative understanding of brain and behavior.

Parametrization of mammography normalized average glandular dose tables.

Data from existing tables of normalized glandular doses in mammography were parametrized to determine analytical expressions that match tabulated results within known uncertainties. The parametrization was performed for three different target/filter combinations (molybdenum target-molybdenum filter, molybdenum target-rhodium filter, and rhodium target-rhodium filter) and three different breast compositions (100% adipose, 50% adipose-50% glandular, and 100% glandular). The analytical expressions provide the normalized glandular dose for any breast composition within stated ranges of tabulated input parameters (kVp, half-value layer, and breast thickness).

Detection of genitourinary tract Chlamydia trachomatis infection in pregnant women by ligase chain reaction assay.

Objective: To compare the sensitivity and specificity of a ligase chain reaction assay of cervical swabs and voided urine with those of cervical swab tissue culture for the detection of genitourinary tract infection with Chlamydia trachomatis in pregnant women.

Methods: Infection with C trachomatis was assessed in cervical swabs by culture and in both cervical swabs and voided urine specimens by a ligase chain reaction assay specific for C trachomatis plasmid DNA. The matched cervical swab and voided urine specimens were collected from 462 women during routine visits to prenatal clinics.