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Thrombotic Thrombocytopenic Purpura (TTP) is a rare hematologic emergency, congenital or acquired, characterized by ischemic damage of various organs because of platelet aggregation. It is the common name for adults with microangiopathic hemolytic anemia, thrombocytopenia, with or without neurologic or renal abnormalities, and without another etiology; children without renal failure are also described as TTP. Plasma exchange (PE) is the main stay of treatment in combination with steroids and immunosuppressive therapies. The monoclonal antibody against CD20 Rituximab decreases the production of antibodies from B lymphocytes and it is used for antibodies-mediated diseases including TTP. We present our data on retrospective analysis of rituximab in treatment of TTP at University of Cincinnati in a series of 22 patients from 1997 to 2009. Our results showed that PE with immunosuppressive therapy resulted in decreased duration of PE, relapse rate, and increased duration of remission in patients with TTP.
RESUMO
BACKGROUND: Human T-lymphotropic virus (HTLV) type I is the causative agent of HTLV-associated myelopathy (HAM)/tropical spastic paraparesis, and a number of HAM cases with HTLV-II infection have also been reported. However, despite some reports, it is unclear whether HTLV-I or -II infection is associated with other neurologic manifestations. METHODS: An analysis of medical histories and screening neurologic examinations from a prospective cohort of 153 HTLV-I, 388 HTLV-II, and 810 HTLV-seronegative individuals followed up for means of 11.5, 12.0, and 12.2 years was performed. Participants diagnosed with HAM were excluded. We calculated odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for age, sex, race or ethnicity, income, educational attainment, body mass index, alcohol and cigarette consumption, injection drug use, diabetes, and hepatitis C virus status, using generalized estimating equations for repeated measures. RESULTS: HTLV-I and -II participants were more likely than seronegative participants to have leg weakness (ORs 1.67 [95% CI 1.28-2.18] and 1.44 [1.16-1.78]), impaired tandem gait (ORs 1.25 [95% CI 1.07-1.47] and 1.45 [1.27-1.64]), Babinski sign (ORs 1.54 [95% CI 1.13-2.08] and 1.51 [1.18-1.93]), impaired vibration sense (ORs 1.16 [95% CI 1.01-1.33] and 1.27 [1.14-1.42]), and urinary incontinence (ORs 1.45 [95% CI 1.23-1.72] and 1.70 [1.50-1.93]). For both HTLV-I and -II participants, higher odds of sensory neuropathy by monofilament examination were no longer significant after adjustment for confounding. CONCLUSIONS: These results provide strong evidence that human T-lymphotropic virus (HTLV)-I and -II are associated with a spectrum of predominantly motor abnormalities in patients without overt HTLV-associated myelopathy. Further investigation of the clinical course and etiology of these abnormalities is warranted.
Assuntos
Infecções por HTLV-I/epidemiologia , Infecções por HTLV-II/epidemiologia , Vírus Linfotrópico T Tipo 1 Humano , Vírus Linfotrópico T Tipo 2 Humano , Transtornos das Habilidades Motoras , Doenças do Sistema Nervoso , Paraparesia Espástica Tropical , Adolescente , Adulto , Idoso , Estudos de Coortes , Feminino , Seguimentos , Infecções por HTLV-I/diagnóstico , Infecções por HTLV-II/diagnóstico , Vírus Linfotrópico T Tipo 1 Humano/isolamento & purificação , Vírus Linfotrópico T Tipo 2 Humano/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos das Habilidades Motoras/diagnóstico , Transtornos das Habilidades Motoras/epidemiologia , Transtornos das Habilidades Motoras/virologia , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/virologia , Paraparesia Espástica Tropical/diagnóstico , Paraparesia Espástica Tropical/epidemiologia , Estudos Prospectivos , Adulto JovemRESUMO
The use of normal immersion oil, developed for 23 degrees C, at 37 degrees C greatly compromises both axial resolution and signal intensity. We developed and characterized an immersion oil for optimal performance in live-cell imaging at 37 degrees C. We quantify the improvements in resolution and intensity obtained when using the new oil instead of its standard 23 degrees C counterparts.
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Microscopia Confocal/métodos , Microscopia de Fluorescência/métodos , Óleos , Temperatura , Animais , Células Cultivadas , Rim/citologia , CamundongosAssuntos
Articulação Atlantoaxial/crescimento & desenvolvimento , Articulação Atlantoccipital/crescimento & desenvolvimento , Vértebras Cervicais/crescimento & desenvolvimento , Adulto , Fatores Etários , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoccipital/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Criança , Humanos , Recém-Nascido , Luxações Articulares/diagnóstico , Palpação , Seleção de Pacientes , Radiografia , Fatores de RiscoRESUMO
PURPOSE: The frontal axial angle of the occipitoatlantal complex in adults is well known. Clinical radiological investigations of the infantile cervical spine indicate other proportions. Extensive radiological studies concerning the postnatal development of the frontal axial angle are unknown. Knowledge about the special biomechanical relation of the infantile cervical spine is necessary for understanding several high cervical irritation syndromes in newborns. MATERIALS AND METHODS: To measure the occipitoatlantal angle C0/C1, 1016 AP radiographs of the upper cervical spine were investigated. The radiographs were obtained on female and male patients ranging from 0 - 10 years of age. RESULTS: The frontal axial angle C0/C1 is distinctly flatter in infants (153 degrees in newborns at the age of 0 to 3 months) and only approaches an adult state after the 10 th year of life. CONCLUSION: The distinctly flatter configuration of the frontal axial angle C0/C1 in newborns could be interpreted as constituting a different morphology for better adaptation to the biomechanical strain of the upper cervical spine during labor. The postnatal development of the frontal axial angle of the occipitoatlantal complex is illustrated.
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Desenvolvimento Ósseo/fisiologia , Osso Occipital/crescimento & desenvolvimento , Crânio/crescimento & desenvolvimento , Coluna Vertebral/crescimento & desenvolvimento , Envelhecimento/fisiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Osso Occipital/diagnóstico por imagem , Radiografia , Caracteres Sexuais , Crânio/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagemRESUMO
BACKGROUND: Almost 20 years after its discovery, the prevalence and clinical course of human T-lymphotropic virus type I (HTLV-I)-associated myelopathy (HAM, also known as tropical spastic paraparesis [TSP]) remain poorly defined. Whereas the causative association of HTLV-I and HAM/TSP is generally recognized, controversy still surrounds the relationship between HTLV-II and HAM/TSP. METHODS: The HTLV Outcomes Study (HOST-formerly Retrovirus Epidemiology Donor Study [REDS]) is a prospective cohort study including 160 patients with HTLV-I, 405 patients with HTLV-II, and 799 uninfected controls who have been followed every 2 years since 1990-1992. Clinical outcomes are measured by health interviews and examinations, and blood samples are obtained. RESULTS: Six cases of HTLV-I-associated myelopathy (3.7%, 95% CI 1.4 to 8.0) and four cases of HTLV-II myelopathy (1.0%, 95% CI 0.3 to 2.5) have been diagnosed since the formation of the cohort. There have been no cases of HAM/TSP diagnosed among HTLV-negative subjects (0.0%, 95% CI 0.0 to 0.5). Clinical features of the cases include lower extremity hyperreflexia, variably associated with weakness, spasticity, and bladder dysfunction. CONCLUSIONS: Systematic screening of HTLV-infected blood donors reveals a high prevalence of HAM/TSP. The clinical course of HAM/TSP appears highly variable. HTLV-II-associated myelopathy generally presents with milder and more slowly progressive signs and symptoms.
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Infecções por HTLV-II/diagnóstico , Infecções por HTLV-II/epidemiologia , Paraparesia Espástica Tropical/diagnóstico , Paraparesia Espástica Tropical/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores de RiscoAssuntos
Transfusão de Componentes Sanguíneos/normas , Medicina Baseada em Evidências , Leucaférese , Transfusão de Componentes Sanguíneos/efeitos adversos , Transfusão de Componentes Sanguíneos/métodos , Preservação de Sangue , Análise Custo-Benefício , Humanos , Leucaférese/economia , Leucaférese/métodos , Leucaférese/normas , Medição de Risco , Estados Unidos , United States Food and Drug Administration/legislação & jurisprudência , Precauções UniversaisRESUMO
Intravenous immunoglobulin (IVIG) preparations are a mainstay for a number of disorders that include primary immuno-deficiency, acute inflammatory conditions, hematological disorders, infections, and neuroimmunological disorders. The range of therapeutic activity is attributed to IVIG's myriad action mechanisms. IVIG can interact and bind onto complement factors, which can prevent complement-mediated tissue damage, modulate T-lymphocytes, alter cytokine profiles, and modulate the immune system. These interactions can act alone or in combination to maintain immune balance while preserving homeostasis. A consensus panel was convened in 2000 to evaluate and define new advances in IVIG therapies.
Assuntos
Imunoglobulinas Intravenosas/uso terapêutico , Feminino , Humanos , GravidezRESUMO
CONTEXT: The human T-lymphotropic viruses types 1 and 2 (HTLV-1 and HTLV-2) are highly prevalent among injection drug users in the United States. However, the clinical course of infection has not been well characterized. OBJECTIVE: To understand HTLV-1-and HTLV-2-associated laboratory abnormalities, which may provide insights into their underlying pathophysiology. DESIGN: Cohort study. SETTING: Five US blood centers. PARTICIPANTS: A total of 133 HTLV-1-and 332 HTLV-2-seropositive former blood donors and 717 HTLV-seronegative donors followed up prospectively since 1991. MAIN OUTCOME MEASURES: Selected serum chemistry tests and complete blood cell counts were analyzed at enrollment and approximately 2 years later in participants. Repeated-measures analyses were conducted to evaluate the effect of HTLV infection on laboratory measures. RESULTS: Compared with seronegative subjects, HTLV-1-seropositive subjects had 13% higher creatine kinase (P =.02) and slightly elevated lactate dehydrogenase (P =.03) levels at follow-up. The HTLV-2-seropositive participants had 11% higher absolute lymphocyte counts than seronegative subjects (P =.0001). Infection with HTLV-2 also appeared to be associated with slightly higher hemoglobin levels (P =.03) and hematocrit (P =.03) and with lower albumin levels (P =.01). CONCLUSIONS: These results further our understanding of the biological mechanisms underlying HTLV and suggest that HTLV-associated laboratory changes are unlikely to alter clinical evaluation or counseling of otherwise healthy HTLV-infected subjects.
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Contagem de Células Sanguíneas , Doadores de Sangue , Infecções por HTLV-I/sangue , Infecções por HTLV-II/sangue , Bancos de Sangue , Estudos de Coortes , Feminino , Seguimentos , Hematócrito , Humanos , Contagem de Leucócitos , Contagem de Linfócitos , Masculino , Contagem de Plaquetas , Valores de Referência , Fatores de Tempo , Estados UnidosRESUMO
The final decade of the last century of the second millennium ad has seen dramatic changes in all aspects of science and health care. In transfusion medicine, the blood supply is the safest it has ever been. Newer refinements and innovations are continuously being researched and implemented to achieve and further enhance safety. Advances in blood conservation, pharmacologic manipulation, engineered blood derivatives, and recombinant growth factors can now provide safer and more effective alternatives to blood transfusions for many patients. This overview highlights selective innovations in transfusion medicine and emphasizes some significant advances that have occurred in blood donor screening, blood component collections and therapy, and laboratory testing. Newer technologies are anticipated that will further enhance the safety of blood and transfusions and potentially augment annually the blood supply on a worldwide basis.
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Transfusão de Sangue/tendências , Transfusão de Componentes Sanguíneos , Doadores de Sangue , Coleta de Amostras Sanguíneas , Transfusão de Sangue/métodos , Política de Saúde , Humanos , LaboratóriosRESUMO
BACKGROUND: To determine whether human T-lymphotropic virus type II (HTLV-II) infection is associated with an increased incidence of bacterial infections, we prospectively observed cohorts of HTLV-I- and HTLV-II-infected and seronegative subjects in 5 US cities. METHODS: Of 1340 present and former blood donors examined at enrollment, 1213 (90.5%) were re-examined after approximately 2 years, including 136 HTLV-I- and 337 HTLV-II-seropositive subjects and 740 demographically stratified HTLV-seronegative subjects. All subjects were seronegative for human immunodeficiency virus. Odds ratios (ORs) for incident disease outcomes were adjusted for covariates, including age, sex, race or ethnicity, education, and, if significantly associated with the outcome, blood center, donation type, income, smoking, alcohol intake, and injected drug use. RESULTS: Compared with seronegative status, HTLV-II infection was associated with an increased incidence of bronchitis (OR, 1.81; 95% confidence interval [CI], 1.20-2.75), bladder and/or kidney infection (OR, 1.94; 95% CI, 1.26-2.98), oral herpes infection (OR, 9.54; 95% CI, 3.33-27.32), and a borderline increased incidence of pneumonia (OR, 2.09; 95% CI, 0.92-4.76); HTLV-I infection was associated with an increased incidence of bladder and/or kidney infection (OR, 2.79; 95% CI, 1.63-4.79). One incident case of HTLV-I-positive adult T-cell leukemia was observed (incidence, 348 per 100,000 HTLV-I person-years), and 1 case of HTLV-II-positive tropical spastic paraparesis-HTLV-associated myelopathy was diagnosed (incidence, 140 per 100,000 HTLV-II person-years). CONCLUSIONS: These data support an increased incidence of infectious diseases among otherwise healthy HTLV-II- and HTLV-I-infected subjects. They are also consistent with the lymphoproliferative effects of HTLV-I, and with neuropathic effects of HTLV-I and HTLV-II.
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Doenças Transmissíveis/complicações , Doenças Transmissíveis/epidemiologia , Infecções por HTLV-I/complicações , Infecções por HTLV-II/complicações , Adolescente , Adulto , Criança , Pré-Escolar , Doença Crônica , Feminino , Seguimentos , Infecções por HTLV-I/epidemiologia , Infecções por HTLV-I/etiologia , Infecções por HTLV-II/etiologia , Humanos , Incidência , Lactente , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/epidemiologia , Razão de Chances , Estudos Prospectivos , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
Large lymphocytes with basophilic cytoplasm and cleaved/cerebriform nuclei called flower cells have been described in human T-lymphotrophic virus type I (HTLV-I) seropositive individuals and may be precursors of adult T-cell leukaemia (ATL). A cohort of 546 HTLV-seropositive former blood donors, 32 HTLV-positive sexual partners of these donors and 799 HTLV-seronegative controls has been followed as part of the Retrovirus Epidemiology Donor Study. A novel methodology was developed to systematically review peripheral blood slides from these subjects for HTLV-related lymphocyte abnormalities, using an algorithm based on morphologic features to objectively identify flower cells. The algorithm included: absence of azurophil granules; nuclear chromatin condensation; cell size >1.5 small lymphocytes; nuclear to cytoplasmic ratio >80%; and presence of nuclear folding/lobulation. Peripheral slides from subjects were screened by a medical technologist blinded to HTLV status. 6.8% of HTLV-I subjects (P = 0.0001 versus seronegatives), 0.9% of HTLV-II subjects and 1.1% of seronegatives were confirmed to have cells classified as flower cells by two haematologists using objective criteria, and blinded to serostatus. Despite the higher prevalence of flower cells in HTLV-I positives, no clinical correlations were found. Longitudinal follow-up may yield higher rates of cellular abnormalities as the sequelae of HTLV infection develop.