HLA-DR antigen-negative acute myeloid leukemia.

Human leukocyte antigen (HLA) Class II antigens are variably expressed on acute myeloid leukemia (AML) blasts. The biological and clinical significance of HLA Class II antigen expression by AML cells is not known. Therefore, we sought to characterize cases of AML without detectable HLA-DR expression. Samples from 248 consecutive adult AML patients were immunophenotyped by multiparameter flow cytometry at diagnosis. HLA-DR antigens were not detected on AML cells from 43 patients, including 20 with acute promyelocytic leukemia (APL), and 23 with other subtypes of AML. All APL cases had t(15;17), but there were no characteristic chromosome abnormalities in non-APL cases. No direct expression of other antigens was identified in HLA-DR-negative APL and non-APL cases. Interestingly, cells from three HLA-DR-negative non-APL patients had similar morphology to that of the hypogranular variant of APL. This morphology, however, was not present in any HLA-DR-positive AML cases. Treatment response was similar in the 23 HLA-DR-negative non-APL and the 205 HLA-DR-positive patients. Finally, relapse was infrequently associated with changes in HLA-DR antigen expression, as the HLA-DR antigen was lost at relapse in only 4% of HLA-DR-positive cases, and was gained at relapse in only 17% of HLA-DR-negative cases. We conclude that HLA-DR-negative AML includes approximately equal numbers of APL and non-APL cases, and that the morphology of HLA-DR-negative non-APL cases can mimic the hypogranular variant of APL. The diagnosis of APL cannot be based on morphology and lack of HLA-DR antigen expression; rather, it requires cytogenetic or molecular confirmation.

Truncated STAT proteins are prevalent at relapse of acute myeloid leukemia.

Signal transducer and activator of transcription (STAT) proteins are implicated in the control of cell survival, proliferation and differentiation in response to hematopoietic cytokines. C-terminally truncated STAT isoforms (STATbeta), as opposed to the full length form (STATalpha), have a competitive or even transdominant negative effect on gene induction mediated by the STAT pathway. We have previously demonstrated that while constitutively active STAT proteins were detected in ten of 36 (28%) for STAT3 and eight of 36 (22%) for STAT5 in pretreatment samples from newly diagnosed acute myeloid leukemia (AML) patients, a significantly larger fraction of samples [21 of 27 (78%)] expressed STATbeta proteins. To determine whether STATbeta expression was maintained or increased after relapse in AML, we compared STAT activity and isoform expression at diagnosis and at relapse in 17 patients. In this selected group, constitutively active STAT3 was detected in 13 of 17 (76%) AML samples at diagnosis but was detected in only four of these patients at relapse. Constitutively active STAT5 was detected in three of 17 (18%) AML samples at diagnosis; but only two at relapse. In contrast, STATbeta protein expression was observed in 12 of the 17 pretreatment samples (71%) and in 16 of 17 samples at relapse. Only one patient did not express STATbeta at relapse. Our results suggest that STATbeta isoform expression, rather than level of constitutive activity, may be involved in disease progression in AML.

Retrospective multivariate analysis of hepatic veno-occlusive disease after blood or marrow transplantation: possible beneficial use of low molecular weight heparin.

This retrospective cohort study of 462 consecutive adult allogeneic and autologous blood or marrow transplantation (BMT) patients compared the incidence of hepatic veno-occlusive disease (VOD) after BMT with three prophylactic regimens. Patients receiving heparin (Hep), heparin + prostaglandin E1 (Hep + PGE1) or low molecular weight heparin (LMWH) as a prophylactic VOD regimen were compared to a historical cohort receiving no VOD prophylaxis. Of 462 BMT patients, VOD was diagnosed in 22% (31 of 142) of the no prophylaxis group, 11% (11 of 104) of the Hep, 12% (13 of 110) in the Hep + PGE1 and 4% (four of 106) of the LMWH group (P = 0.0002). VOD was the primary cause of death in 20% (12 of 59). By multivariate logistic regression, independent risk factors for developing VOD were: no VOD prophylactic regimen, unrelated allogeneic BMT, Karnofsky performance score (KPS) < 80 and aspartate aminotransferase (AST) > or =50 U/l. There was no increase in the rate of death due to hemorrhagic events or VOD in any prophylaxis group compared to the control group. Prospective randomized trials of Hep vs LMWH vs placebo are warranted to assess the efficacy of heparin compounds in the prevention of VOD.

Maternal perceptions of newborn umbilical cord treatments and healing.

OBJECTIVE: To determine mothers' cord care practices and perceptions of their newborns' cord treatment and healing. DESIGN: Exploratory, descriptive. SETTING: Urban teaching hospital providing care for children, women, and families in eastern Canada. PARTICIPANTS: A convenience sample of 30 women with healthy full-term infants. MAIN OUTCOME MEASURES: Mothers' concerns about newborn umbilical cord care and cord treatments using an 18-item questionnaire, the Cord Rating Scale. RESULTS: Mothers' concerns regarding their newborns' cord included bleeding at the time of cord separation and cord odor. Several mothers (20%) did not recall being given information on cord care, and others had received conflicting information. Although most other mothers did begin the recommended treatment, they did not follow the recommended schedule. There was a strong positive relationship between the mothers' and nurses' ratings of the newborns' cord condition. CONCLUSIONS: The findings suggest that mothers continue to have concerns about their newborn's cord and cord care after hospital discharge. These concerns have implications for nursing practice. The findings also support the role that a mother has in accurately reporting the condition of her newborn's cord.

Thiotepa-associated cardiomyopathy during blood or marrow transplantation: association with the female sex and cardiac risk factors.

Thiotepa (TT) has not been reported to cause cardiomyopathy, whereas cyclophosphamide (Cy)-related cardiomyopathy is well characterized. To search for cases of acute onset cardiomyopathy associated with TT, we retrospectively reviewed 171 patients who received TT-containing conditioning regimens for blood or marrow transplantation (BMT). Nine of 171 patients (5.3%) developed clinical congestive heart failure in the post-BMT period. The median time to onset of heart failure was 15 days after BMT (range 5-30). The median pre-BMT left ventricular ejection fraction (LVEF) was 50% (range 42-65%) as determined by two-dimensional echocardiogram, or gated blood pool scan. At the time of cardiomyopathy onset, LVEF was 30%. Six patients died of causes unrelated to heart failure. All affected patients who developed congestive heart failure following administration of TT had some evidence of cardiac dysfunction prior to transplantation. Significant risk factors for the development of cardiomyopathy included low pre-BMT-LVEF and female sex--particularly in females receiving allogeneic transplantation. The incidence of congestive heart failure with TT-containing regimens was similar to the incidence using other regimens with and without Cy. The mean time to clinical evidence of TT-associated cardiomyopathy was longer than the mean time reported with Cy. We recommend caution in using high-dose TT-containing regimens for patients with histories of cardiac dysfunction.

Stabilization of the subluxed second metatarsophalangeal joint: flexor tendon transfer versus primary repair of the plantar plate.

Surgical treatment of the subluxed second metatarsophalangeal joint (MTPJ) has been a consistently frustrating problem for the foot and ankle surgeon. The plantar plate is the principal stabilizing structure of the second MTPJ and compromise to its integrity has been implicated as the cause of the subluxed second toe. Flexor tendon transfer has been reported as the mainstay of treatment to stabilize the subluxed second MTPJ. Recently, primary repair of the plantar plate has been advocated, yet no research exists comparing it to flexor tendon transfer. Eight freshly frozen lower extremity cadaver specimens were mounted on a custom-fabricated load frame. A vertical dorsally directed force was applied to the base of the proximal phalanx of the second toe via a pneumatic actuator to stimulate the Lachman test. Dorsal displacements of the proximal phalanx were measured with a linear variable distance transducer. This investigation examined the comparative strength of flexor tendon transfer versus primary repair of the plantar plate in stabilizing the second MTPJ. Results showed a significant difference between the transected plantar plate and the intact plantar plate. Displacements for the repair groups were similar to the intact plantar plate group and also significantly different from the transected plantar plate. Primary repair of the plantar plate is a viable alternative to flexor tendon transfer in stabilizing the second MTPJ with the advantage of addressing the pathology anatomically. Clinical studies are needed to substantiate these laboratory findings.

The many meanings of uncertainty in illness: toward a systematic accounting.

Uncertainty is widely believed to be a central feature in illness experiences. Moreover, communication is thought to be essential to the construction, management, and resolution of uncertainty. Not surprisingly, however, there are substantial variations in conceptions and analyses of this focal construct and its relation to communication. In this article, we first argue that understandings of the role of communication in health and illness can be improved substantially--thereby enhancing both theory development and practical applications of health communication theory--by recognizing and reconciling sources of variation in conceptions of uncertainty and by synthesizing various specific conceptions. We then review individual-psychological models. linguistic and discourse analyses, and sociocultural and historical perspectives on uncertainty in illness Following the review, we present a framework that synthesizes many conceptions of uncertainty We close with a discussion of 5 challenges and opportunities for research and application.

A preliminary analysis of memorable support and nonsupport messages received by nurses in acute care settings.

This study presents a preliminary analysis of recalled messages for support and nonsupport received by nurses in a midsize, midwestern hospital. In interviews nurses recalled specific incidents of support and nonsupport they had experienced in the workplace. The structural and functional characteristics of these memorable messages of support and nonsupport were then independently coded by trained coders within the following categories: (a) the structure and form of the message, (b) the context and timing of the message, (c) the relationship between the source and receiver, and (d) the content of the message and the message effects. The results of chi-square analyses and McNemar tests are presented. The results suggest that in the specific categorical areas examined, support and nonsupport messages exhibit a relatively high degree of similarity within-participants. That is, participants appeared to use a cognitive template for classifying communication acts as supportive and nonsupportive. Specific between-participant message similarities and differences are also enumerated and explained.

Association of Cytophaga psychrophila with mortality among eyed eggs of Atlantic salmon (Salmo salar).

Although Pseudomonas fluorescens was the predominant bacterium associated with Atlantic salmon (Salmo salar) eggs incubated at the White River National Fish Hatchery (Bethel, Vermont) during January 1992, the fish pathogen Cytophaga psychrophila was isolated only from specific lots of eggs that displayed poor survival (35% eye-up).

Common obstacles to the daily functioning of pediatric traumatically brain injured patients: perceptions of caregivers and psychologists.

Common difficulties encountered by patients with pediatric traumatic brain injuries (referred to hereafter as pediatric TBI patients) were identified, and the congruence between caregiver and professional perceptions of these problems was examined. Forty-seven caregivers identified 118 obstacles experienced in the care of their pediatric TBI patients. Another sample of 46 caregivers cross-validated these problems by rating each for its frequency and difficulty. Items were tank ordered by their composite score, a derived measure obtained for each item by cross-multiplying the frequency and difficulty ratings. Twenty psychologists who work with pediatric TBI patients also rated each of the 118 problem situations. A modest correlation (tau = .28, p < .001) between the two groups' rank orders of the problem situations, although significant, suggests that there are discrepancies between caregiver and professional perceptions of problem situations. Items perceived as most common and difficult by caregivers often received far lower ratings by psychologists and vice versa. The results suggest that carefully evaluating individual patient concerns may contribute to more efficient use of professional resources and improved patient education and follow-up care.

Relationship between resistance of salmonids to furunculosis and recovery of Aeromonas salmonicida from external mucus.

Fish were sampled at the Ed Weed State Fish Hatchery (South Hero, Vermont, USA) in September 1992. Aeromonas salmonicida was common, with concentrations as high as 10(5) to 10(7) colony-forming units per gram of mucus, and readily recovered from most mucus samples obtained from furunculosis-sensitive populations of brook trout (Salvelinus fontinalis), lake trout (Salvelinus namaycush), and Atlantic salmon (Salmo salar). The pathogen was the predominant microorganism and accounted for greater than 85% of the total number of bacteria isolated from the mucus of these fish. By comparison, A. salmonicida was recovered only from two rainbow trout (Oncorhynchus mykiss), and bacterial frequencies did not exceed 10(3) colony-forming units per gram of mucus. The pathogen was not recovered from the mucus of steelhead (O. mykiss) or Rome brown trout (Salmo trutta) selectively bred for resistance to furunculosis, even though there was widespread contagion throughout the hatchery and fish were cultured on a common, unprotected water supply.

Isolation of Aeromonas salmonicida from paddlefish, Polyodon spathula.

Aeromonas salmonicida was isolated from paddlefish (Polyodon spathula) mortalities collected during an epizootic of furunculosis at the Spring River State Hatchery, Arkansas (USA), in 1992. Isolates of the bacterium were obtained from culture of gill and kidney tissue. This is the first epizootic of bacterial etiology to be reported in paddlefish.

Functional outcome of pathologic fracture secondary to malignant disease in a rehabilitation hospital.

Fifty-eight patients with 62 pathologic fractures secondary to metastatic disease were admitted to a rehabilitation hospital during a 5-year period. Thirty-four patients were discharged home, 7 were transferred to other facilities, and 17 died. The average hospital stay for the patients who went home (37 days) was only 3 days longer than for patients with nonpathologic fractures. No patient could transfer independently or ambulate at the time of admission, but 26 and 23, respectively, could do so by the time of discharge; 27 patients showed significant improvement in their ability to perform activities of daily living as measured by Kenny scores. All 11 patients who had hypercalcemia died. Eleven of 13 patients requiring parenteral narcotics died. Patients with pathologic fractures secondary to metastatic disease are excellent candidates for intensive rehabilitation programs, but hypercalcemia and administration of parenteral narcotics suggest a poor rehabilitation outcome.

S-layer positive motile aeromonads isolated from channel catfish.

Motile aeromonads are ubiquitous aquatic bacteria that can cause motile aeromonad septicemia (MAS), a disease which affects channel catfish and can produce significant economic loss. Motile aeromonads isolated from commercially-raised channel catfish were screened for production of S-layer protein in order to evaluate its potential role in natural epizootics. The S-layer protein was produced by 14 of 24 (58%) isolates from epizootics evaluated in this study. Concomitant infections with other internal pathogens were detected in 10 of the 24 cases used in this study, and only one of those 10 isolates (10%) produced the S-layer protein. When Aeromonas sp. was the only internal pathogen diagnosed, 13 of 14 (93%) isolates produced the S-layer protein.

Mental status variation in a case of multiple sclerosis.

Various psychiatric symptoms have been described in patients with multiple sclerosis. The literature is reviewed, and it suggests that individual patients develop specific psychiatric syndromes. A case is presented with multiple psychiatric syndromes occurring within a single patient.

Mercury content of common foods determined by neutron activation analysis.

The mercury contents in samples of flour, sugar, nonfat dry milk, potatoes, hamburger, chicken breast, shrimp, liver, eggs, and whole milk were determined by neutron activation analysis. The mercury was separated by anion exchange chromatography and precipitated as the sulfide. The mercury concentrations for all these foods were below 50 parts per billion.