[Louse-borne-relapsing-fever in refugees from the Horn of Africa; a case series of 25 patients]. / 25 Fälle von Läuserückfallfieber bei Flüchtlingen aus Ostafrika.

Background | Relapsing fever is divided into tick borne relapsing fever (TBRF) and louse borne relapsing fever (LBRF). This report describes 25 refugees from East Africa who were diagnosed to suffer from LBRF within a period of 6 month only at a single hospital in Munich / Germany. Material & Methods | The aim was to point out common clinical features as well as laboratory findings and clinical symptoms before and after initiation of treatment in 25 patients with louse borne relapsing fever (LBRF) who were diagnosed and treated at Klinikum München Schwabing from August 2015 to January 2016. To the best of our knowledge this is the largest case series of LBRF in the western world for decades. Main focus of the investigation was put on clinical aspects. Results | All 25 patients suffered from acute onset of high fever with chills, headache and severe prostration. Laboratory analysis showed high CRP and a marked thrombocytopenia. A Giemsa blood stain was procured immediately in order to look for malaria. In the blood smear spirochetes with typical shape and aspect of borrelia species could be detected.The further PCR analysis confirmed infection with Borrelia recurrentis. Treatment with Doxycycline was started forthwith. The condition improved already on the second day after treatment was started and all were restored to health in less than a week. Apart from a mild to moderate Jarisch-Herxheimer-reaction we didn`t see any side effects of the therapy. Conclusion | LBRF has to be taken into account in feverish patients who come as refugees from East-Africa. It seems that our patients belong to a cluster which probably has its origin in Libya and more patients are to be expected in the near future. As LBRF might cause outbreaks in refugee camps it is pivotal to be aware of this emerging infectious disease in refugees from East-Africa.

Hygiene monitoring in a hospital immunohaematological laboratory.

PURPOSE OF THE STUDY: Not only in blood donation services, but also in the immunohaematological laboratory of a hospital including the depository for blood products a hygiene plan must be drawn up and its realization has to be documented. MATERIAL AND METHODS: From 2011 to 2014, some equipment in the depository and in the immunohematological laboratory was microbiologically monitored once a year. The examinations were done by direct contact cultures taken from several places of each device. RESULTS: Most of the devices showed inconspicuous numbers of environmental microorganisms. Sometimes the refrigerators for fresh frozen plasma and a transport container for blood products revealed moderately, the incubator in the laboratory and a transport container for patient blood samples inadequately increased bacterial contamination. CONCLUSION: Microbiological examinations can detect critical points in the immunohaematological laboratory of a hospital. By communicating these results, the staff can be motivated to observe the regulations of the hygiene plan.

[Correct preparation of a transfusion: Part 1]. / Korrekte Vorbereitung der Transfusion: Teil 1.

The administration of blood products is strictly regulated. Several weeks before the operation the preparation for transfusion begins with optimizing the patient's hematological and hemostaseological situation. In elective surgery blood group testing and antibody screening are performed soon after admission of the patient. The identification of the blood sample is important. Informed consent of the recipient has to be obtained. On the day before the operation a further blood sample is necessary for cross-matching if red blood cells are to be transfused. Usually blood products are issued for immediate administration. Before transfusion begins the blood product has to be checked, the identity of the patient must be controlled and in the case of red blood cell transfusions the AB0 bedside test has to be performed.

[Correct performance of transfusion]. / Korrekte Durchführung der Transfusion.

The administration of blood products is strictly regulated. Warming of blood components at body temperature is required only in rare cases. Addition of drugs to blood products is not allowed. During transfusion the monitoring of the patient is continued. In the case of an adverse event, exclusion of acute hemolysis is very important. As emergency transfusions have a higher risk than standard transfusions, their indications have to be restricted. When transfusion is completed the blood bag has to be preserved for 24 h. The effects of the blood transfusion have to be controlled. The administration of blood products must be documented to allow a possible cross-check from the recipient to the donor as well as from the donor to the recipient. The disposal of administered and of non-administered blood components is subject to the guidelines for hospital waste.

Unexpected reactions of the anti-IgA antibody particle gel immunoassay.

BACKGROUND: The cause of allergic transfusion reactions remains often unknown, but in rare cases anti-immunoglobulin A (IgA) antibodies in patients with IgA-deficiency can be found. We report on the use of the DiaMed particle gel immunoassay (PaGIA) for detection of anti-IgA antibodies in patients with allergic transfusion reactions. METHODS: The examination of the suspected adverse reactions included an anti-IgA antibody test (ID-PaGIA Anti-IgA antibody test; DiaMed GmbH, Cressier , Switzerland) and measurement of IgA concentration in the patient's plasma. In the case of a discrepancy IgA subclasses were examined and neutralization of the anti-IgA antibodies by pure IgA was performed. RESULTS: Of 142 patients tested for IgA concentration and anti-IgA antibodies, 8 gave positive results for the anti-IgA antibody test. In seven of these cases (4.9% of the patients tested) IgA levels were found to be normal, and in four of five so tested, the positive result could not be neutralized with purified IgA. Only one patient had confirmed IgA deficiency with anti-IgA antibodies that were neutralized by addition of purified IgA. CONCLUSION: Cause and clinical relevance of a positive reaction of the anti-IgA antibody test in patients with normal total IgA and normal IgA subclasses remains unknown. Because of the high false positive rate we do not recommend this test as a screening test for anti-IgA antibodies when evaluating allergic transfusion reactions, but instead recommend measurement of total IgA in patient's plasma or serum as a primary screen for IgA deficiency with antibodies as a cause of allergic transfusion reaction.

[Fever during blood transfusion. A case of coincidence instead of causality]. / Fieber während einer Bluttransfusion. Ein Fall von Koinzidenz statt Kausalität.

A boy aged 2 years and 5 months showed agitation, shivering and fever with a temperature of 38.9 °C during a red blood cell transfusion. Examination of the assumed adverse transfusion reaction gave no indications of erythrocyte incompatibility, hemolysis or IgA incompatibility. No antibodies against HLA class I antigens or HPA antigens were found in the recipient's blood. Sterility testing of the blood product showed no growth, but in the blood cultures taken from the patient immediately after the blood transfusion, Enterobacter cloacae was detected which also could be found in blood cultures and nose and throat swabs taken 3 days before. Therefore, the fever during blood transfusion was not a case of causality but of coincidence. This case underlines the recommendation to examine blood cultures from the recipient in all suspected cases of adverse transfusion reaction.

[Allergic transfusion reactions in a patient with multiple food allergies]. / Allergische Transfusionsreaktionen bei einer Patientin mit multiplen Nahrungsmittelallergien.

HISTORY AND CLINICAL PRESENTATION: A 13-year-old girl with an osteosarcoma was treated by surgery and chemotherapy. During three transfusions of apheresis platelet concentrates allergic reactions occurred, partly in spite of premedication with an antihistamine and a corticoid. INVESTIGATIONS: As the patient declared to be allergic to some foods, in-vitro tests for allergen-specific IgE antibodies were performed and showed markedly positive results for specific IgE to carrot and celery, less so to hazelnut, peanut and a lot of other food antigens. The donor of one of the unsuitable platelet concentrates remembered when questioned, that he had eaten carrots and chocolate with hazelnuts during the evening before platelet donation. TREATMENT AND COURSE: Two washed platelet concentrates were transfused without any problem. Furthermore, transfusions of nine red blood cell concentrates and one unit of virus-inactivated frozen pooled plasma were well tolerated. CONCLUSION: Patients should be asked for allergies previous to transfusions to be alert to allergic reactions in patients with a positive history of food or drug allergies. If premedication with antihistamines does not prevent severe allergic transfusion reactions, transfusion of washed platelet concentrates and of virus-inactivated frozen pooled plasma can be considered.

Novel aspects in the evaluation of an automated blood group analyser.

BACKGROUND: In contrast to other studies evaluating machines by testing a great number of samples, we focused here on the sensitivity and on the influence of possible disturbing factors on automated blood group testing. MATERIALS AND METHODS: As the gelcards of the DiaMed-ID Micro Typing System are well known, this study examines reading and interpretation of the gelcards by the automated analyser Techno TwinStation. The results of automated reading were compared with visual reading of the gelcards taken out from the machine. RESULTS: The sensitivity, tested by the titers of some complete and incomplete antibodies, was at least the same for automated as for visual reading. Samples with weak antigens were well recognised by the analyser. Mixed field agglutinations were recognised as questionable results by automated reading up to a relation of 1 : 10 for the most part. Antibody screening and reverse typing were not influenced by hyperbilirubinaemia, whereas in lipemic and haemolytic samples doubtful results were reported. CONCLUSION: Interpretation of the results by the automated analyser Techno TwinStation may be disturbed in some difficult samples, but in most of these cases the analyser reports not a false, but a doubtful result, thus triggering visual reading by the operator.

False-positive reactions of some monoclonal anti-c reagents.

Cross-reactivities of monoclonal reagents for red blood cell (RBC) typing are seen very rarely, e.g. in some reagents for testing of ABO or Lewis antigens. We report on two patients in whom we observed weak reactions using a monoclonal anti-c reagent containing clone MS35, but no reactions with anti-c reagents containing other monoclonal or polyclonal antibodies. To resolve this discrepancy, we studied RHCE exon 1 (Ex1) and 2 from genomic DNA of one patient and performed quality controls of the false-positive reacting anti-c reagent. RHCE Ex1 showed no abnormalities as well as RH Ex2 examined with primers specific for Ex2 D/C. No amplification product of RH Ex2 was received with primers specific for c. A titration study with untreated, papain-treated and sialidase-treated adult and newborn RBCs showed anti-i reactivity of the false-positive reacting reagent. This reactivity could not be removed by absorption with c-negative newborn RBCs without reducing the anti-c titre in the same way, indicating a cross-reactivity. Some manufacturers give a remark on a possible cold agglutinin activity of their monoclonal anti-c reagents in the instruction leaflet, but in order to avoid such irritation, we recommend to remove this cross-reactivity by dilution during the manufacturing process.

Reference data representative of normal findings at three-dimensional power Doppler ultrasound examination of the cervix from 17 to 41 gestational weeks.

OBJECTIVES: To develop normal reference ranges for cervical volume and vascular indices using three-dimensional (3D) power Doppler ultrasonography from 17 to 41 gestational weeks. METHODS: This was a cross-sectional study of 352 nulliparous and 291 parous women who delivered at term and underwent transvaginal 3D power Doppler ultrasound examination of the cervix once at 17 to 41 weeks' gestation. We examined approximately 25 women in each gestational week. Cervical volume, vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated. RESULTS: There was no change in cervical volume between 17 and 40 weeks' gestation. At 41 weeks cervical volume was slightly smaller than it was at 17-40 weeks (P=0.03 for nulliparous women and P=0.08 for parous women). The cervical volume was larger in parous than it was in nulliparous women (median 38 cm3 vs. 32 cm3 at 17-40 weeks, P<0.0001; median 31 cm3 vs. 22 cm3 at 41 gestational weeks, P=0.288). FI did not differ between nulliparous and parous women and remained unchanged between 17 and 41 weeks' gestation (median 30.6, range 21.2-55.2). VI and VFI did not change consistently from 17 to 41 weeks, but the values were higher in parous than they were in nulliparous women at 17-30 weeks (median VI 5.3% vs. 3.1%, P<0.0001; median VFI 1.6 vs. 0.9, P<0.0001). At 31-41 gestational weeks the median VI for all women irrespective of parity was 4.9% and the median VFI was 1.4. CONCLUSION: Reference values for cervical volume and blood flow indices as assessed by 3D power Doppler ultrasonography have been established for the second half of pregnancy. These lay the basis for studies of pathological conditions.

Three-dimensional ultrasound assessment of the cervix for predicting time to spontaneous onset of labor and time to delivery in prolonged pregnancy.

OBJECTIVES: To determine whether three-dimensional (3D) ultrasound including power Doppler examination of the cervix is useful for predicting time to spontaneous onset of labor or time to delivery in prolonged pregnancy. METHODS: A prospective study was conducted in 60 women who went into spontaneous labor. All underwent transvaginal 3D power Doppler ultrasound examination of the cervix immediately before a prolonged-pregnancy check-up at > or = 41 + 5 gestational weeks. Univariate and multivariate logistic regression analysis was used to determine which of the following variables predicted spontaneous onset of labor > 24 h and > 48 h and vaginal delivery > 48 h and > 60 h: length, anteroposterior (AP) diameter and width of the cervix and of any cervical funneling; cervical volume (cm3); vascularization index (VI); flow index (FI); vascularization flow index (VFI); parity; and Bishop score. Multivariate logistic regression analysis was carried out both with and without Bishop score as a predictive variable. Receiver-operating characteristics (ROC) curves were used to describe the diagnostic performance of the tests. RESULTS: The areas under the ROC curves for Bishop score, cervical length, and logistic regression models did not differ significantly (areas ranging from 0.72 to 0.82). If Bishop score was not included in the logistic regression model, cervical length, VI and FI independently predicted delivery > 48 h, the likelihood increasing with increasing cervical length, decreasing VI and increasing FI. CONCLUSIONS: In prolonged pregnancy cervical vascularization as estimated by 3D power Doppler ultrasound is related to time to delivery > 48 h, but the likelihood of delivery > 48 h can be predicted equally well using Bishop score alone or sonographic cervical length alone.

Bishop score and ultrasound assessment of the cervix for prediction of time to onset of labor and time to delivery in prolonged pregnancy.

OBJECTIVES: To determine the ability of Bishop score and sonographic cervical length to predict time to spontaneous onset of labor and time to delivery in prolonged pregnancy. METHODS: Ninety-seven women underwent transvaginal ultrasound examination and palpation of the cervix at 291-296 days' gestation according to ultrasound fetometry at 12-20 weeks' gestation. Sonographic cervical length and Bishop score were recorded. Multivariate logistic regression analysis was used to determine which variables were independent predictors of the onset of labor/delivery < or = 24 h, < or = 48 h, and < or = 96 h. Receiver-operating characteristics (ROC) curves were drawn to assess diagnostic performance. RESULTS: In nulliparous women (n = 45), both Bishop score and sonographic cervical length predicted the onset of labor/delivery < or = 24 h and < or = 48 h (area under ROC curve for the onset of labor < or = 24 h 0.79 vs. 0.80, P = 0.94; for delivery < or = 24 h 0.81 vs. 0.85, P = 0.64; for the onset of labor < or = 48 h 0.73 vs. 0.74, P = 0.90; for delivery < or = 48 h 0.77 vs. 0.71, P = 0.50). Only Bishop score discriminated between nulliparous women who went into labor/delivered < or = 96 h or > 96 h. A logistic regression model including Bishop score and cervical length was superior to Bishop score alone in predicting delivery < or = 24 h (area under ROC curve 0.93 vs. 0.81, P = 0.03) and superior to Bishop score alone and cervical length alone in predicting the onset of labor < or = 24 h (area under ROC curve 0.90 vs. 0.79, P = 0.06; and 0.90 vs. 0.80, P = 0.06). In parous women (n = 52), Bishop score and sonographic cervical length predicted the onset of labor/delivery < or = 24 h (area under ROC curve for the onset of labor 0.75 vs. 0.69, P = 0.49; for delivery 0.74 vs. 0.70, P = 0.62), but only Bishop score discriminated between women who went into labor/delivered < or = 48 h and > 48 h. Three parous women had not gone into labor and six had not given birth at 96 h. In parous women logistic regression models including both Bishop score and cervical length did not substantially improve prediction of the time to onset of labor/delivery. CONCLUSIONS: In prolonged pregnancy Bishop score and sonographic cervical length have a similar ability to predict the time to the onset of labor and delivery. In nulliparous women the use of logistic regression models including Bishop score and cervical length is likely to offer better prediction of the onset of labor/delivery < or = 24 h than the use of the Bishop score alone.

[False-positive hepatitis serology after administration of immunoglobulins]. / Falsch-positive Hepatitis-Serologie nach Immunglobulingabe.

HISTORY: A 17-year-old boy with chronic myelogenous leukemia received a bone marrow transplantation (BMT) from an unrelated donor. 22 days before BMT he had been HBs antigen and anti-HBc negative. 68 days after BMT he was tested again and showed a "seroconversion" for hepatitis B (anti-HBc positive, anti-HBs 59 IU/l), raising the suspicion of a posttransfusion hepatitis. The patient had not received any blood transfusion in the 6 months before BMT. From day 0 to day + 68 he received four red blood cell concentrates and 18 platelet concentrates. The bone marrow donor had been HBs ag and anti-HBc negative. INVESTIGATIONS: A stored serum sample of the recipient obtained on day -8 was available and proved to be negative for HBsAg and Anti-HBc IgM, but positive for anti-HBc and anti-HBs. A serum sample from day -22 was negative for all these parameters. DIAGNOSIS: These results can be explained by the administration of 17.5 g of a polyvalent immunoglobulin (Ig) concentrate for CMV prophylaxis on day -9: anti-HBc and anti-HBs (1814 IU/l) were found in the lot that the patient had received. Nine further doses of immunoglobulin concentrates were given up to day + 68. COURSE: Four months after the last administration of Ig concentrates, the patient was negative for HBs ag, anti-HBc and anti-HBs. CONCLUSION: Ig concentrates contain not only those antibodies, which are given to a patient for treatment, but also all other antibodies contained in the donor plasma pool. Thus administration of Ig concentrates can cause a "false-positive" hepatitis B serology by passive transfer of these antibodies. Such an artificial seroconversion may also lead to a false suspicion of a transfusion transmitted hepatitis B infection.

Reference data representative of normal findings at two-dimensional and three-dimensional gray-scale ultrasound examination of the cervix from 17 to 41 weeks' gestation.

OBJECTIVES: To create reference values representative of normal findings on two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasound (TVS) examination of the cervix from 17 to 41 weeks' gestation and to determine the agreement between cervical measurements taken by 2D and 3D TVS. METHODS: Cross-sectional study covering 17 to 41 weeks in 419 nulliparous and 360 parous women who delivered at term and who underwent 2D and 3D TVS examination of the uterine cervix. We examined approximately 25 women in each gestational week. The length, anteroposterior (AP) diameter and width of the cervix (and of any cervical funnel) and AP diameter of the cervical canal were measured. Results were plotted against gestational age. The agreement between 2D and 3D ultrasound results was expressed as the mean (+/- 2 SDs) difference between the results of the two methods and as the interclass correlation coefficient (inter-CC). RESULTS: There was excellent agreement between measurements taken by 2D and 3D ultrasound (inter-CC values, 0.80-0.98) but measurements of cervical length taken using 3D ultrasound were greater than measurements taken by 2D ultrasound (mean difference, -0.04 +/- 0.36 cm). Cervical length did not change substantially between 17 and 32 gestational weeks but decreased progressively thereafter. Cervical length was similar in nulliparous and parous women at 17-32 weeks, but from 33 weeks the cervix tended to be longer in parous women. In nulliparae, cervical length decreased from a median of 3.8 (range, 0.7-6.1) cm at 17-32 weeks to 2.3 (range, 0.4-6.0) cm at 33-40 weeks and to 0.7 (range, 0.2-1.5) cm at 41 weeks. In parous women, the corresponding figures were 3.9 (range, 1.0-6.1) cm, 3.0 (range, 0.4-5.7) cm and 0.8 (range, 0.4-3.4) cm (results obtained by 3D ultrasound). Cervical AP diameter and width did not differ between nulliparous and parous women. Median AP diameter increased from 3.0 (range, 2.0-4.6) cm at 17-30 weeks to 3.5 (range, 1.8-5.5) cm at 31-40 weeks and to 4.0 (range, 2.8-5.9) cm at 41 weeks. Cervical width was 3.7 (range, 2.3-6.0) cm at 17-30 weeks and 4.5 (range, 2.3-6.1) cm at 31-41 weeks. The percentage of women with funneling increased from 4% (3/84) at 17-18 weeks to 63% (12/19) at 41 weeks and the percentage of women with an open cervical canal increased from 19% (15/84) to 72% (13/19). Funneling and opening of the cervical canal were equally common in nulliparous and parous women. CONCLUSIONS: Reference data provide the basis for studies of pathological conditions. Common reference values for nulliparous and parous women can be used for cervical AP diameter and width from 17 to 41 weeks and for cervical length from 17 to 32 weeks. Separate reference values for cervical length for nulliparous and parous women should be used from 33 to 41 weeks.

On the effects of Fusarium toxin contaminated wheat and wheat chaff on nutrient utilisation and turnover of deoxynivalenol and zearalenone in vitro (Rusitec).

The objective of the present study was to investigate the effects of Fusarium toxin contaminated wheat and wheat chaff (mycotoxin diet) on nutrient degradability and the metabolism of the mycotoxins deoxynivalenol (DON) and zearalenone (ZON) using the rumen simulations technique (Rusitec). A 6 day application period with control wheat and wheat chaff (control diet) was followed by an 8 day sampling phase. During this time three fermenters received the mycotoxin diet (64.9 mg DON/kg dry matter (DM) and 500 microg ZON/kg DM) and the remaining fermenters served as the controls (1.0mg DON/kg DM and 6 microg ZON/kg DM). Feed residues of the bags and samples of the effluent liquids were pooled per fermenter during the last 8 days of the experiment. Additionally, effluents of the mycotoxin fermenters were taken 6, 12 and 24h after the morning feeding on the first day of the sampling phase. The degradation of organic matter (OM; P<0.05), neutral detergent fibre (NDF; P<0.01) and protein (P<0.001) were increased by administration the Fusarium contaminated diet which was accompanied by an increased ammonia concentration (P<0.01) and increased butyrate (P<0.01), isobutyrate (P<0.01) and isovalerate (P<0.05) values of the mycotoxin effluents in relation to the controls. High proportions of ingested DON of 90% (85-93%) and ingested ZON of 93% (80-104%) were recovered at the pooled feed residues and effluents in form of DON and de-epoxy DON, and ZON and alpha-ZOL after administering the Fusarium toxin contaminated feed. While adsorption of DON as DON and de-epoxy DON in the feed particles was only minor (5%), a higher amount of 38% of ingested ZON was recovered as ZON and alpha-ZOL at the feed residues. The total recovery of DON plus de-epoxy DON in effluents as a percentage of DON intake reached 8%, 9% and 22% of ingested DON at 6, 12 and 24h after application of the contaminated diet the first time, whereby the recovery of de-epoxy DON as percentage of DON intake was only 5% at 24h. Concentrations of ZON and metabolites were lower than detection limits in the time dependent effluent samples.

[Current aspects of oncological rehabilitation]. / Onkologische Rehabilitation. So finden Krebspatienten in den Alltag zurück.

On completion of acute medical treatment oncological rehabilitation serves the purpose of re-integrating the patient into the everyday situation, family and working life, while at the same time improving his/her quality of life. The aims of outpatient or inpatient rehabilitation are based on an individual analysis of both physical and psychosocial problems and are implemented within the framework of an interdisciplinary therapeutic program. Not the least of the positive effects of rehabilitation is the saving of costs achieved by shortening the patient's time in hospital and reducing the number of working days lost.

Intraobserver and interobserver reproducibility of three-dimensional gray-scale and power Doppler ultrasound examinations of the cervix in pregnant women.

OBJECTIVES: To determine intraobserver and interobserver reproducibility of three-dimensional (3D) gray-scale and power Doppler ultrasound examinations of the cervix in pregnant women. METHODS: Thirty-two pregnant women underwent transvaginal 3D gray-scale and power Doppler ultrasound examination of the cervix by two examiners. Each observer acquired two volumes, and they each analyzed their volumes twice using the commercially available software Virtual Organ Computer-aided AnaLysis (VOCAL). The variables analyzed were cervical volume (cm3), vascularization index (VI), flow index (FI) and vascularization flow index (VFI). Intraobserver repeatability was expressed as the difference between two measurement results (mean difference +/- 2 SD, i.e. limits of agreement) and as intraclass correlation coefficient (intra-CC). Interobserver agreement was expressed as the difference between the results of the two observers (limits of agreement) and as interclass correlation coefficient (inter-CC). The contribution of various factors (examiner, acquisition, analysis of acquired volume) to intrasubject variance was estimated using different analysis of variance models. All statistical analyses were performed using log-transformed data. The results presented are those obtained after antilogarithmic transformation, i.e. the results are presented as ratios between two results of the same observer, or as ratios between the results of Observer 1 and Observer 2. RESULTS: All intraobserver and interobserver log-transformed differences were normally distributed. There was no systematic bias between the two observers. Both intra- and inter-CC values were high (0.93-0.98) for all variables except FI (0.63-0.88), despite the limits of agreement being wide, especially for VI (widest range 0.4-2.4) and VFI (widest range 0.3-2.6). Acquisition explained most of the intrasubject variance of the flow indices, the contribution of examiner and analysis being unimportant. CONCLUSIONS: Given the wide range between the lower and upper limits of agreement, it would probably not be possible to detect anything but large differences or changes in cervical volume or cervical flow indices using current 3D ultrasound techniques. Because acquisition explained most of the intrasubject variance, the average of several repeated acquisitions should be used to enhance reproducibility. However, it is not worth doing more than one analysis of an acquired volume, because the effect of analysis on measurement results is small.

False-positive result of sterility testing after a supposed adverse transfusion reaction.

We report on the case of a woman who suffered from chills and fever when she was transfused with two units of red blood cell concentrate. Immunohaematological evaluation of the adverse reaction was inconspicuous, as well as sterility testing of one unit, but bacteriological evaluation of the second unit showed growth of Stenotrophomonas maltophilia. The sample for sterility testing of this unit had been drawn from the distal end of the transfusion device that was still connected to the blood bag. Later, two samples were drawn from the blood bag itself and were found to be sterile, whereas another sample drawn from the distal end of the transfusion device also showed growth of S. maltophilia. We conclude that reflux of the patient's blood into the transfusion device has caused a false-positive result of sterility testing of the second unit when the sample was drawn from the distal end of the device.

Reducing the phosphorus concentration in diets for turkeys between 10 and 22 weeks of age.

1. An experiment lasting for 13 weeks was started at the beginning of week 10 with male turkeys weighing 5.38 kg. The experiment comprised three subsequent periods with adjusted metabolisable energy (ME) and nutrient concentrations from weeks 10 to 13, 14 to 17, and 18 to 22. Seven pens of 12 birds each were allocated to each of 5 treatments. Treatments differed in dietary phosphorus concentration and phytase supplementation (500 U/kg) only. Total phosphorus varied between treatments from 4.9 to 8.0 g/kg (weeks 10 to 13), from 4.4 to 7.5 g/kg (weeks 14 to 17) and from 3.5 to 7.0 g/kg (weeks 18 to 22). Phosphorus concentration was adjusted by different inclusions of monocalcium phosphate. Diets were pelleted and offered ad libitum. 2. A final body weight of, on average, 22.3 kg was achieved at the end of week 22. Body weight gain, feed consumption, feed conversion, toe ash, toe phosphorus and toe calcium were not significantly affected by dietary phosphorus concentration. There was no indication of an effect on mortality or on broken or deformed bones. 3. Phosphorus concentrations (g/kg diet) of 5.9, 5.4 and 4.4 without microbial phytase and of 4.9, 4.4 and 3.5 with microbial phytase, respectively, were sufficient in the three periods. As compared with the control, a reduction in phosphorus excretion of turkeys by 0.4 without phytase and by 0.5 with phytase was achieved without negative effects on turkeys. 4. Because the data demonstrate the great potential for a reduction in dietary phosphorus concentration, detailed requirement and availability studies with turkeys should follow.