Summary. Human parvovirus B19 infection has been shown to be transmissible by blood and blood products and to result in transient aplastic crisis in patients with rapid red cell turnover. We report three cases of iatrogenic parvovirus B19 infection resulting from the use of the same batch of ®brin sealant under operation. Fibrin sealant, which is a typical haemostatic agent produced from blood, has been used during surgery. Human parvovirus is resistant to existing virusinactivating techniques, suggesting that infection may occur from blood products contaminated with it. Use of recombinant products for these proteins may thus be necessary.Keywords: parvovirus B19, aplastic crisis, ®brin sealant, surgery.Infection with human parvovirus B19, which is the smallest DNA-containing virus, usually causes a minor, febrile illness or is asymptomatic (Cossart et al, 1975;Shneerson et al, 1980;Anderson, 1990). Blood group P antigen is the cellular receptor for this virus, which can only replicate in proliferating and differentiating erythroid precursor cells (Brown et al, 1993). Transient aplastic crisis as a result of maturation arrest within the erythroid lineage occurs in patients with chronic haemolytic anaemia. Aplastic crisis also occurs in patients who have rapid red cell turnover, such as those with acute blood loss. Transmission of this virus is by respiratory secretions, transplacentally and by transfusion of blood and blood products. We report here three cases of iatrogenic symptomatic human parvovirus B19 infection, resulting from the use of the same batch of ®brin sealant during surgery. CASE REPORTSBetween March 1998 and May 1998, three patients were infected with human parvovirus B19 during surgery in the gynaecology ward of our hospital. The clinical characteristics of the three patients are shown in Table I. One of the three cases has been described previously (Hino et al, 1999). All patients had blood group P2 phenotype (P1 antigen negative/P antigen positive). P antigen is the cellular receptor for parvovirus B19. In all three patients, fever and leucopenia were observed between days 6 and 11 after the operation. The lowest white blood cell counts were 1´11 0 9 /l to 1´4´10 9 /l. Bone marrow examination revealed severe erythroblastopenia (0´8%±1´8% of total nucleated cells) with giant proerythroblasts, suggesting recent human parvovirus B19 infection. Reticulocytopenia and anaemia developed subsequently. The lowest haemoglobin levels were 7´7±8´1 g/dl. Haematological ®ndings spontaneously improved within 10 days in all three patients. Anti-human parvovirus B19 IgM and IgG were detected in serum, and human parvovirus B19 DNA was detected by polymerase chain reaction (PCR) in all three patients (Sevall, 1990). Autologous bone marrow cultures revealed a high degree of inhibition of BFU-E-and CFU-E-derived colony growth by the patients' acute-phase serum, whereas CFU-GM-derived colony formation was normal. Human parvovirus B19-induced aplastic crisis was diagnosed in each of these three patients. Only one pa...
A new approach is described for imaging mass spectrometry (IMS) of methamphetamine (MA) incorporated into human hair using matrix-assisted laser desorption/ionization (MALDI)-time-of-flight (TOF) and MALDI-Fourier transform ion cyclotron resonance (FTICR). A longitudinal section of a lengthwise manually-cut single human hair shaft from a chronic MA user was directly analyzed by MALDI-TOF-IMS after deposited with α-Cyano-4-hydroxycinnamic acid matrix. A barcode-like image, which was most probably generated with repeated intakes of MA, was for the first time obtained by monitoring MA-specific product ion in the selected reaction monitoring mode. Laser beam scan lengthwise-cut hair shafts gave only poor mass spectra of MA, probably due to the loss of MA and/or the thermal denaturation of hair. The identity of MA detected in hair was further confirmed by MALDI-FTICR mass spectrometry. A combination with ultra-high resolution mass spectrometry by FTICR provided indisputable identification of MA. The MALDI-FTICR-IMS of another hair shaft from the same MA user also provided a barcode-like image by monitoring the protonated molecule of MA with ultra-high resolution. The two barcode-like images exhibited a close resemblance. Thus, MALDI-IMS can offer a new perspective: 'imaging hair analyses for drugs'.
Background: Rheumatoid arthritis (RA) is the most common inflammatory joint disease. The aetiology of RA remains unknown, but autoimmune responses are considered to play an important role in the disease pathophysiology. Currently available data suggests that the process of diagnosing RA may benefit from testing for anticyclic citrullinated peptides. Identification of the presence of citrullinated proteins in rheumatoid synovial fluids is important for the elucidation of the aetiology of RA as well as in the differential diagnosis of rheumatic-related diseases. Methods: A proteomics-based approach using electrophoresis/mass spectrometry was applied to identify the citrullinated proteins in synovial fluids from patients with RA. Synovial fluids from patients with RA were subjected to sodium dodecyl sulfate -polyacrylamide gel electrophoresis and Western blot analysis to detect the citrullinated proteins. Identification bands were then subjected to mass spectrometry. Results: Three proteins -citrullinated fibrinogen, citrullinated fibronectin and citrullinated vimentin -in synovial fluids from RA patients were identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Conclusions: Proteomics-based analysis can be used to detect citrullinated proteins in synovial fluids from RA patients.
The association between Helicobacter pylori (H. pylori) infection and idiopathic thrombocytopenic purpura (ITP) has been reported by several groups. We investigated the prevalence of H. pylori infection and the effectiveness of its eradication in Japanese patients with ITP. H. pylori infection was found in 21 of 30 patients (70.0%) by 13 C urea breath test and presence of serum antibodies to H. pylori. H. pylori was eradicated in 18 of the 21 infected patients (85.7%) by administration of a proton pump inhibitor and two kinds of antibiotics. In only one patient was medication discontinued due to skin rash on the 4th day of treatment. Platelet recovery was obtained in ten patients (55.6%). In two patients with treatment failure, platelet recovery was obtained after successful re-eradication. In three patients without H. pylori infection, platelet counts did not significantly increase with the same treatment. On the other hand, eradication therapy did not affect platelet counts in patients with gastric ulcer. In conclusion, H. pylori eradication can be used for initial treatment with tolerable adverse effects in some ITP patients.
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