An avoidable cause of thymoglobulin anaphylaxis.

BACKGROUND: Thymoglobulin® (anti-thymocyte globulin [rabbit]) is a purified pasteurised, gamma immune globulin obtained by immunisation of rabbits with human thymocytes. Anaphylactic allergic reactions to a first injection of thymoglobulin are rare. CASE PRESENTATION: We report a case of serious anaphylactic reaction occurring after a first intraoperative injection of thymoglobulin during renal transplantation in a patient with undiagnosed respiratory allergy to rabbit allergens. CONCLUSIONS: This case report reinforces the importance of identifying rabbit allergy by a simple combination of clinical interview followed by confirmatory skin testing or blood tests of all patients prior to injection of thymoglobulin, which is formally contraindicated in patients with a history of hypersensitivity to rabbit proteins.

The importance of EN ISO 15189 accreditation of allergen-specific IgE determination for reliable in vitro allergy diagnosis.

BACKGROUND: Allergen-specific serum immunoglobulin E detection and quantification have become an important step in allergy diagnosis and follow-up. In line with the current trend of laboratory test accreditation to international standards, we set out to design and assess an accreditation procedure for allergen-specific serum IgE. METHODS: Method validation according to the accreditation procedure under the EN ISO 15189 standard was carried out for allergen-specific immunoglobulin E determination using the fluoroimmunoenzymatic method ImmunoCAP(®) (ThermoFisher). Data were produced by 25 hospital laboratories in France. A total of 29 allergen specificities including mixes, extracts, and molecular allergens were assayed. Allergen-specific serum immunoglobulin E concentrations ranged from 0.1 to 100 kUA /l. RESULTS: Repeatability, reproducibility, and accuracy results fulfilled method validation criteria for automated laboratory tests and proved similar irrespective of the allergen specificity, allergen-specific serum immunoglobulin E concentration, or individual laboratory. CONCLUSION: Allergen-specific serum immunoglobulin E determination with the fluoroimmunoenzymatic method ImmunoCAP(®) is a highly repeatable, reproducible, and accurate method which may be considered as a single analyte assay in view of the EN ISO 15189 accreditation procedure.

[Proacrosin, an acrosomal marker for the detection of spermatogenic cells in ejaculates from azoospermic men]. / La proacrosine, un marqueur acrosomal pour la détection des cellules spermatiques dans le sperme éjaculé de patients azoospermes.

Between January 2003 and April 2004, a prospective study was performed on ejaculates from non-obstructive azoospermic men (n = 95), for the identification of spermatogenic cells using an immunohistochemical labeling for proacrosin. 48.4% of ejaculates (46/95) displayed labeled spermatogenic cells. A 38/95 (40%) of men had testicular sperm extraction (TESE) followed by intracytoplasmic sperm injection (i.c.s.i.). Testicular spermatozoa were extracted from 21 men (52.5%). The sensitivity of detecting spermatogenic cells is 66.7% in predicting the presence of testicular spermatozoa, and its specificity is 76.5%. Compared to histopathological diagnostic testicular biopsy, the detection of spermatogenic cells using proacrosin immunohistochemical method offers a predictive parameter for successful TESE. The immunohistochemical method for proacrosin has the advantages of simplicity and low cost. It could be used to predict spermatogenesis from non-obstructive azoospermic men. Further evaluation is required with extensive results to improve sensitivity and specificity.

Resistance to aspirin in vitro is associated with increased platelet sensitivity to adenosine diphosphate.

BACKGROUND: Platelet activation plays an important role in arterial thrombosis and the widespread use of aspirin has reduced major events by 25% in the secondary prevention of cardiovascular diseases. However, it appears that aspirin antiplatelet effect is not uniform and 8-45% of the population are, in vitro, aspirin resistant, and it is well recognized that platelets can be activated by pathways that are not blocked by aspirin, such as adenosine diphosphate (ADP). OBJECTIVES: To investigate whether aspirin-resistant patients have a modified sensitivity to ADP-induced platelet activation MATERIALS AND METHODS: Seventy-two patients were enrolled. Platelet function was measured by the PFA-100(R) analyser; platelet GP IIb-IIIa activation by ADP 10 micro M was assessed by flow cytometry using PAC-1 MoAb. RESULTS: Using a collagen/epinephrine coated cartridge on the PFA-100(R), the prevalence of aspirin resistance was 29.2% (n=21). For aspirin-resistant patients, the collagen/ADP coated cartridge showed a closure time significantly shorter (p=0.004) compared to the sensitive and control groups. Platelets from aspirin-resistant patients bound PAC-1 significantly more (p=0.03) than the aspirin-sensitive patients and controls when activated with 10 micro M ADP. CONCLUSIONS: Platelets from aspirin-resistant patients appear to be more sensitive and activable by ADP. This hypersensitivity could provide a possible explanation for the so-called aspirin resistance, and this could justify therapeutic improvement with alternative antiplatelet agents.

The hemodynamic effects of anesthetic induction in vascular surgical patients chronically treated with angiotensin II receptor antagonists.

UNLABELLED: The use of angiotensin II receptor subtype-1 antagonists (ARA), recently introduced as antihypertensive drugs, is becoming more prevalent. We studied the prevalence and severity of hypotension after the induction of general anesthesia in 12 patients treated with ARA until the morning of surgery. The hemodynamic response to induction was compared with that of patients treated with beta-adrenergic blockers (BB) and/or calcium channel blockers (CB) (BB/CB group, n = 45) and angiotensin-converting enzyme inhibitors (ACEI) (ACEI group, n = 27). A standardized anesthesia induction protocol was followed for all patients. Hypotension occurred significantly (p < or = 0.05) more often in ARA-treated patients (12 of 12) compared with BB/CB-treated patients (27 of 45) or with ACEI-treated patients (18 of 27). There was a significantly (P < or = 0.001) increased ephedrine requirement in the ARA group (21+/-3 mg) compared with the BB/CB group (10+/-6 mg) or the ACEI group (7+/-4 mg). Hypotension refractory to repeated ephedrine or phenylephrine administration occurred significantly (P < or = 0.05) more in the ARA group (4 of 12) compared with the BB/CB group (0 of 45) or the ACEI group (1 of 27), but it was treated successfully by using a vasopressin system agonist. Treatment with angiotensin II antagonism until the day of surgery is associated with severe hypotension after the induction of anesthesia, which, in some cases, can only be treated with an agonist of the vasopressin system. IMPLICATIONS: Hypotensive episodes occur more frequently after anesthetic induction in patients receiving Angiotensin II receptor subtype-1 antagonists under anesthesia than with other hypotensive drugs. They are less responsive to the vasopressors ephedrine and phenylephrine. The use of a vasopressin system agonist was effective in restoring blood pressure when hypotension was refractory to conventional therapy.

Treatment of intraoperative refractory hypotension with terlipressin in patients chronically treated with an antagonist of the renin-angiotensin system.

UNLABELLED: The goal of the present study was to determine whether terlipressin, an agonist of the vasopressin system, could counteract perioperative hypotension refractory to common vasopressor therapy and to analyze its circulatory effects. We enrolled 51 consecutive vascular surgical patients chronically treated with angiotensin-converting enzyme inhibitors or antagonists of the receptor of angiotensin II, who received a standardized opioid-propofol anesthetic. Of these 51 patients, 32 had at least one episode of hypotension, which responded to epinephrine or phenylephrine. In 10 other patients, systolic arterial pressure (SAP) did not remain above 100 mm Hg for 1 min, despite three bolus doses of ephedrine or phenylephrine. In these patients, we injected a bolus of 1 mg of terlipressin, repeated twice if necessary. Hemodynamic and echocardiographic variables were recorded every 30 s over 6 min. In eight patients, arterial pressure was restored with one injection of terlipressin; in two other patients, three injections were necessary. One minute after the last injection of terlipressin, the SAP increased from 88+/-3 to 100+/-4 mm Hg and reached 117+/-5 mm Hg (P = 0.001) 3 min after the injection and remained stable around this value. This increase in SAP was associated with significant changes in left ventricular end-diastolic area (17.9+/-2 vs 20.2+/-2.2 cm2; P = 0.003), end-systolic area (8.1+/-1.3 vs 9.6+/-1.5 cm2; P = 0.004), end-systolic wall stress (45+/-8 vs 66+/-12; P = 0.001), and heart rate (60+/-4 vs 55+/-3 bpm; P = 0.001). Fractional area change and velocity of fiber shortening did not change significantly. No additional injection of vasopressor was required during the perioperative period. No change in ST segment was observed after the injection. IMPLICATIONS: Terlipressin is effective to rapidly correct refractory hypotension in patients chronically treated with antagonists of the renin-angiotensin system without impairing left ventricular function.

Childhood sexual trauma and substance misuse: a pilot study.

This research investigates the type of and extent to which additional problematic experiences and behaviors are associated with a history of both substance misuse and childhood sexual abuse. In a recent study of women undergraduate students, 30 years and older, 15 disclosed a history of problematic alcohol and/or drug use. Of these, 10 had experienced sexual trauma as children; five had not. This report compares these two subsamples with respect to problematic experiences and behavior. Implications for counseling and research are discussed.

[Real-time ultrasonic pregnancy diagnosis (B-mode) in sheep. 1. Frequent examinations during the first month of pregnancy]. / Die ultrasonographische Trächtigkeitsdiagnostik (B-Mode) beim Schaf. Teil 1: Verlaufsuntersuchungen im ersten Trächtigkeitsmonat.

Transrectal ultrasonography was performed on 63 ewes (four breeds) to determine the earliest day at which pregnancy, the first embryo, the number of embryos, the embryonal heartbeat and placentoms could be detected. The ewes were examined at intervals of two to three days on day 12/13 to 30 post breeding. An Aloka SSD 500 ultrasound unit was used with a 5-Mhz probe. The diagnosis of the pregnant ewes took place on day 17.6 +/- 1.8 p.c. The first embryo was detected on day 20.5 +/- 1.9 p.c., but not all of the embryos were counted accurately until day 26. The heartbeat of the embryos was detected on day 22.9 +/- 2.9 p.c. and placentoms on day 27.6 +/- 2.4 p.c. The influence of the breed on the results will be discussed. The proportion of sheep with a loss of embryos was 24.6% (partial loss of embryos 18.0%, total loss of embryos 6.6%). In conclusion, transrectal ultrasound is a good method to describe the early pregnancy in sheep.

The meaning of college for survivors of sexual abuse: higher education and the older female college student.

A study of the general college experience of 44 female undergraduates, 30 years of age and older, revealed a high prevalence of childhood sexual abuse. The impact of this abuse on these women and the meaning of higher education in resolving the negative sequelae of their earlier traumatic experiences are examined, and implications for counseling are discussed.

[Optimization of embryo transfer programs in ewes by transrectal ultrasonographic ovary diagnosis (B-mode) in superovulated donors]. / Die Optimierung von Embryotransferprogrammen beim Schaf durch die transrektale ultrasonographische Ovardiagnostik (B-Mode) bei superovulierten Donoren.

The aim of this study was to check the accuracy of transrectal ultrasonography for the ovary diagnosis in superovulated sheep during the estrus (n = 10) and on the day 8 after estrus (n = 10). The results were checked by laparoscopic ovary diagnosis. The real-time ultrasound unit CS-9100 OCULUS was used with a linear 7.5 MHz rectal probe. Transrectal ultrasonography was performed at sheep lying in their dorsal position. In 90% of the sheep it was possible to find both ovaries during the estrus and in 60% on the 8th day of the estrus cycle. Correlation for the number of follicle (diameter > or = 4 mm) per ovary during the estrus counted at ultrasonography and laparoscopy were 0.62 (p < 0.05) and for the number of corpora lutea per ovary on day 8 after estrus 0.97 (p < 0.05). The results suggest, that the ultrasonographic ovary diagnosis is an appropriate method to check the results of superovulation in embryo transfer programs. Non-responding or poorly responding donors can be selected.

Childhood experiences and complicated grief: a study of adult children of alcoholics.

For the most part, grief research concentrates on type of loss (e.g., loss of spouse, parent, or child) and/or type of death (e.g., expected or sudden). In contrast, the present paper focuses on a category of persons generally assumed to have had troubled childhoods, adult children of alcoholics (ACOAs). Because of assumed problematic histories, the grief process of ACOAs should be expected to differ from the grief process of non-ACOAs. Using both quantitative and qualitative techniques, 27 ACOAs and 20 non-ACOAs, recruited by newspaper, radio, and word-of-mouth, are compared across characteristics generally associated with ACOAs and/or unresolved grief. Implications for counseling are presented.

Grieving men: thoughts, feelings, and behaviors following deaths of wives.

Despite the growing body of literature on bereavement, grief, and mourning, little attention has been given to the impact of bereavement on men. This is particularly true for studies on the impact of death of spouse on the survivor. Using in-depth interviews, we explored the thoughts, feelings, and behaviors of twenty men following the deaths of their wives. The findings do not support prevailing assumptions that men are less likely to be emotionally involved in the conjugal relationship and, thus, less likely to grieve than women; or, if emotionally involved, less likely to experience grief. This research suggests that men may be emotionally involved in the conjugal relationship and that the death of a wife may evoke intense feelings. The majority of the men in this study both hurt and knew they hurt. What they did not do was to reach out to others for help. This finding has important implications for bereavement program development.

[Children of hyper- and hypothyroid mothers]. / Les enfants des mères hyper et hypothyroïdiennes.

A multicenter study was able to utilize 120 medical files of children born from mothers who presented an abnormal thyroid function, 67 euthyroid goiters, 29 hyperthyroidisms, and 24 hypothyroidisms. In the first case, whether or not an inhibiting treatment was initiated, all children were perfectly normal. In case of maternal hyperthyroidism, the risk of malformations is not increased, deaths in utero and mostly in utero growth delays (1 case in 2) are more frequent. At birth, the child may present a hyperthyroidism due to the effect of SAT with elevated TSH and a goiter, sometimes compressing and impairing breathing, or also a hyperthyroidism due to transplacental crossing of stimulating immunoglobulins with possibility of thyreotoxic crises and heart failure. The diagnosis could be made in utero in the presence of tachycardia or with T4 and TSH assays in the cord. In case of maternal hypothyroidism, usually the children have no problems and the risk of neonatal hypothyroidism is mostly present in premature infants if the maternal balance is poor (2 in 24 cases in our series). Finally, in the reference population, the risk of neonatal hypothyroidism remains 1 in 3600 and justifies systematic screening on the 5th day of life.