Blood Signs Research Articles

An Enzymatically Cleavable Tripeptide Linker for Maximizing the Therapeutic Index of Antibody-Drug Conjugates.

Valine-citrulline is a protease-cleavable linker commonly used in many drug delivery systems, including antibody-drug conjugates (ADC) for cancer therapy. However, its suboptimal in vivo stability can cause various adverse effects such as neutropenia and hepatotoxicity, leading to dose delays or treatment discontinuation. Here, we report that glutamic acid-glycine-citrulline (EGCit) linkers have the potential to solve this clinical issue without compromising the ability of traceless drug release and ADC therapeutic efficacy. We demonstrate that our EGCit ADC resists neutrophil protease-mediated degradation and spares differentiating human neutrophils. Notably, our anti-HER2 ADC shows almost no sign of blood and liver toxicity in healthy mice at 80 mg kg-1. In contrast, at the same dose level, the FDA-approved anti-HER2 ADCs Kadcyla and Enhertu show increased levels of serum alanine aminotransferase and aspartate aminotransferase and morphologic changes in liver tissues. Our EGCit conjugates also exert greater antitumor efficacy in multiple xenograft tumor models compared with Kadcyla and Enhertu. This linker technology could substantially broaden the therapeutic windows of ADCs and other drug delivery agents, providing clinical options with improved efficacy and safety.

Een bacterie vermomd als schimmel: pulmonale actinomycose bij een geriatrische patiënte

A bacteria masked as a fungus: a case of pulmonary actinomycosis in a geriatric patient Pulmonary actinomycosis is a relatively rare diagnosis which probably results from the aspiration of oropharyngeal or gastrointestinal secretions. Individuals with aspiration, alcoholism, poor oral hygiene, chronic obstructive lung disease and a decreased immune response are at risk. The most common symptoms are nonspecific and often present late. The imaging of pulmonary actinomycosis is not specific. Therefore, the disease is frequently confused with a malignancy or tuberculosis. The gold standard for the diagnosis is a histological examination and bacterial culture of a lung biopsy. Its treatment requires high doses of penicillin during at least 3 months. In this article, the case of an 82-year-old patient with malaise but without any respiratory complaints is presented. Further examination revealed inflammatory blood signs, as well as infiltration of the right upper lobe on a CT scan of the thorax. To exclude an underlying malignancy, a bronchoscopy was performed. Gram staining of the bronchoalveolar washing showed gram-positive branching rods suspicious for Actinomyces species. Histological examination confirmed the diagnosis of pulmonary actinomycosis. By means of an antibiotic treatment with amoxicillin the patient recovered both clinically and biochemically.

Recombinant tissue plasminogen activator (rTPA) in young adult patient with acute ischemic stroke: a case report

Background: Stroke is one of the highest causes of morbidity and mortality in the world. The incidence rate of ischemic stroke is about 80% of all stroke incidents. The use of recombinant tissue plasminogen activator (rtPA) is recommended under 4.5 hours of stroke onset. Stroke in young adults are reported as being uncommon, compromising 10% -15% of all stroke patients. Many studies were reported the most common risk factor in young adults were obesity and dyslipidemia. This case report will discuss a 33-year-old men with ischemic stroke with obesity and dyslipidemia treated at dr. Kariadi Hospital Semarang.Case presentation: A 33-year old obese man with left-sided hemiparesis and central facial nerve palsy with an onset of 1 hour. On laboratory examination, it was obtained total cholesterol 179mg/dL, LDL level 123mg/dL, and HDL level 39mg/dL. The protocol code stroke was performed in emergency room with alteplase (r-TPA) 0.6 mg/kgBW, after his head MSCT shows there was no sign of blood in the brain parenchym.Conclusion: The increased risk of ischemic stroke in young patients is due to dyslipidemia, hypertension, obesity, physical inactivity, and smoking. Treatment of the hyperacute phase of ischemic stroke with thrombolysis can reduce the outcome of stroke due to the disability.

How Do Some Iranian Grooms React if There is not Any Sign of Blood Stained Bed Sheets?

“Blood stained bed sheets” is considered as an index of virginity for the brides in most areas of Iran. The present study was conducted to determine the prevalence of bleeding at the first intercourse in brides who claimed to be virgin in Kerman city, Kerman province, Iran. Practices of the grooms encountering lack of bleeding were investigated. Totally, 52.5% of the brides reported bleeding at the first penile-vaginal intercourse. Among the grooms who encountered no bleeding at the first intercourse, half of them had a violent reaction. Findings of the study revealed that valuing bleeding as a virginity index will damage the couple’s relationship and sexual life of young brides, highlighting the need for more attention and education.

Nephrotic syndrome associated with carcinoma of unknown primary ‎treated with chemotherapy: A rare case report

Different glomerular diseases are associated with various neoplasms. It seems obvious that ‎Carcinoma of Unknown Primary (CUP) induced nephrotic syndrome is rare; in this regard, the ‎present article introduces a patient suffering from nephrotic syndrome associated with CUP. ‎Patient is a 65-year-old non-smoker male who referred to the clinic for one-month generalized ‎edema. The patient was also complaining from coughing and bulky yellowish sputum with no ‎signs of blood. Patient''s chest radiography revealed pulmonary pleural effusion of the left lung, ‎but no other pathological findings were revealed. Patient''s cytology report of pleural fluid ‎indicated metastatic carcinoma, and therefore; the patient needed additional examinations so that ‎the origin of metastases (lung, gastrointestinal tract, pancreas, etc.) could be detected. Finally, ‎chemotherapy treatments began when the patient was diagnosed with Carcinoma of Unknown ‎Primary (CUP). With the continuation of chemotherapy treatment and follow-up after more than ‎a year of diagnosis, the patient is now generally well-off; his nephrotic syndrome has also been in ‎remission parallel to chemotherapy. Significant point in the treatment of this patient is ‎proteinuria, hypercholesterolemia and ‎ yponatremia remission in two stages of chemotherapy. ‎These findings suggest that nephrotic syndrome is para-neoplastic.‎

Sequencing of ZIKV genomes directly from Ae. aegypti and Cx. quinquefasciatus mosquitoes collected during the 2015–16 epidemics in Recife

Zika virus (ZIKV) is a negative sense RNA virus from the Flaviviridae family, which was relatively unknown until the first human epidemic in Micronesia, in 2007. Since then, it spread to French Polynesia and the Americas. Recife, the capital of Pernambuco state and epicenter of the Zika epidemic in Brazil, experienced a large number of microcephaly cases and other congenital abnormalities associated to the ZIKV infection from, 2015 to 16. Evidences suggest that both Aedes aegypti and Culex quinquefasciatus mosquitoes from Recife are capable of replicating and transmitting the virus. Here, we conducted high throughput sequencing of ZIKV genomes directly from Ae. aegypti and Cx. quinquefasciatus mosquitoes collected during the ZIKV epidemics in Recife, in order to investigate the variability and evolution of the virus. We obtained 11 draft ZIKV genomes derived from 5 pools from each Ae. aegypti and Cx. quinquefasciatus species. Genome coverage breadth ranged from 16 to 100% and average depth from 45 to 46,584×. Two of these genomes were obtained from pools of Cx. quinquefasciatus females with no sign of blood in the abdomen. Amino acid substitutions found here were not species-specific. In addition, molecular clock dating estimated that ZIKV draft genomes obtained here were co-circulating in other regions of the country during the epidemics. Overall results highlight that viral mutations and even minor variants can be detected in genomes directly sequenced from mosquito samples and insights about natural viral genomic variability and viral evolution can be useful when designing tools for mosquito control programs.

Aortoduodenal fistula after abdominal aortic aneurism resection: Two case reports

Introduction. Aortoenteric fistula (AEF) is rare and extremely difficult complication of aortic surgery. We presented two cases of secondary aortoduodenal fistula (SADF) as complication after aortic surgery. Case reports. In the first patient SADF happened 11 years after open abdominal aneurysmal resection with gastrointestinal tract (GIT) bleeding. After negative esophagogastroduodenoscopy (EGDS) we performed multislice computed tomography (MSCT) which revealed contrast leakage in duodenum from 10 cm wide visceral aortic aneurysm. The patient was treated with graft excision, aneurysmal reduction, sewing of proximal and distal aortal stumps, bowel repair followed by axillobifemoral bypass (AxFF). The patient dismissed on 30th postoperative day. The second case of ADF happened five months after endovascular reconstruction of abdominal aorta with GIT bleeding and fewer. During following 8 days, he had three negative EGDS. On MSCT we found signs of endoleak, free air in aneurysmal sac, and signs of blood in the intestine. On urgent operation we extracted stent graft, sewed proximal and distal aortal stumps, performed bowel repair and AxFF. The patient died a day after operation with signs of sepsis and multiple organ failure syndrome. Conclusion. Conventional treatment of ADF means extraanatomic AxFF with complete excision of infected graft or stent graft, with closure of aorta?s proximal and distal stumps and duodenal repair. Because of high mortality, prompt diagnostic evaluation and quick decision of an adequate operative treatment is necessary. Although European Society of Vascular Surgery recommendations, as a guide, are very helpful, there is no unique attitude about management of AEF, so each patient should be specifically treated.

P141. Neuralgic amyotrophy associated with Hepatitis E infection – A case report

Introduction The cause of neuralgic amyotrophy (NA; Parsonage–Turner syndrome) remains unknown, but different infections often precede NA, and an idiopathic autoimmune response generating nerve inflammation has been postulated. Hepatitis E virus (HEV) infections are endemic in developing countries (genotypes 1 & 2). Within the last years, an increasing number of locally acquired HEV infections have been described in western countries (genotypes 3& 4). We present here the case of a previously healthy 37years old male with NA associated to autochthonous HEV infection, presumably caused by a meal of raw pork one week before symptom onset. Case report Admission was due to bilateral arm and upper spine pain with paraesthesia of both upper extremities. Previous orthopaedic presentation ruled out vertebral disk herniation, myelopathy and foraminal stenosis by Magnetic Resonance (MR) Imaging. Neurological examination revealed right-sided scapula alata and palsies of arm abduction, elbow flexion/extension, thumb opposition and finger splaying. Numbness was present on the radial side of both forearms. Right-sided biceps and triceps reflexes were reduced; Tromner's reflex was absent. Sensible and motoric nerve conduction velocity (NCV) of the median and radial nerve, F-wave examinations, sympathic skin reflex (SSR) and electromyography (EMG; anterior serratus and deltoid muscle) were normal. Liver enzymes were elevated: AST 325 U/L, ALT 1774 U/L, AP 304 U/L, GGT 205 U/L. Cerebral spinal fluid (CSF) revealed lymphomonocytic pleocytosis (14cells/μl), signs of blood–brain–barrier disruption and elevated protein (77.6mg/dl) with normal lactate and glucose levels. CSF HEV-, HSV-, VZV-PCR and Borellia IgM were negative. Further tests ruled out Treponema pallidum, Rubella, Rubeola, Mumps, TBE (tick borne encephalitis), Hepatitis A,B,C, HIV, CMV and EBV. Serum-HEV-RNA was positive (8.3×10 4 cop/ml; genotype 3c). Assuming HEV-associated NA, oral administration of methylprednisolone was started (80mg, tapering thereafter), and patient's pain remarkably decreased. High resolution magnetic resonance neurography (3Tesla) after two months revealed fascicular T2 hyperintense lesions of the ulnar, radial and median nerves and brachial and triceps muscle denervation. Clinical follow-up examination showed typical findings of a Parsonage–Turner syndrome with atrophy of the right upper arm muscles, (improved) scapula alata and palsies of elbow flexion, thumb opposition, flexion and finger splaying. Bilateral hypaesthesia on radial side of forearms persisted. Arm abduction and elbow extension improved. NCV, SSR and F-wave were again normal. However, EMG (abductor digiti minimi, flexor pollicis longus, flexor digitorum superficialis muscles) now discovered denervation. Conclusions NA is rare and association with Hepatitis E infections have been described in single patients. While diagnosis can be difficult, clinicians should consider this sporadic entity, particularly when typical neurologic signs are combined with elevated liver enzymes.

21-Year-Old Woman With Palpitations and Vomiting

© 2010 Mayo Foundation for Medical Education and Research A 21-year-old woman presented to the emergency department with chest palpitations, nausea, and vomiting of 6 hours' duration. Her symptoms originated as a bandlike tightness across the sternum that progressed to include a racing heart with “skipped beats.” She then began to feel nauseous and experienced more than 10 episodes of vomiting. She described the emesis as watery without any signs of blood with eventual progression to retching without output. Before experiencing these symptoms, she had slept for 6 hours without difficulty and had no symptoms entering into sleep. Her medical history was notable for 2 uncomplicated vaginal deliveries. She reported no surgical or psychiatric history. She did not use prescription medications. Although she lived with her mother and 2 children, she spent several nights per week at friends’ homes. During these nights, she drank up to 10 shots of liquor (estimated at 148 mL [5 oz] of alcohol) and occasionally used illicit drugs, including marijuana and cocaine. Physical examination yielded the following vital sign information: heart rate, 120 beats/min; blood pressure, 118/82 mm Hg; respiration rate, 19 breaths/min; and temperature, 36.5°C. The patient appeared uncomfortable. Cardiac examination revealed a regular, rapid tachycardia without murmur or extra heart sounds. Findings on lung and abdominal examinations were unremarkable, as were the remainder of the examination results. Laboratory tests yielded the following results (reference ranges provided parenthetically): hemoglobin, 12.9 g/dL (12.0-15.5 g/dL); white blood cell count, 12.3 × 10/L (3.510.5 × 10/L); lactate, 3.6 mmol/L (0.6-2.3 mmol/L); and unremarkable levels of electrolytes, creatinine, troponin I, and D-dimer.

Penile fracture: presentation and management.

To evaluate the clinical presentation, therapeutic options and outcome of the treatment of penile fracture. Case series. The Department of Urology and Transplantation, Civil Hospital Quetta, between March 1995 and March 2009. One hundered and thirty seven patients of penile fracture were admitted. Detailed history was taken. Physical examination was done in order to get the extent of penile hematoma, sign of blood at the meatus and side of curvature. Patients with rupture of the superficial and deep dorsal vein of the penis were excluded from the study. The operative plan consisted of immediate exploration, debridement and primary repair of the tear in tunica albuginea and urethra via a degloving inscision. Data analysis was performed to obtain descriptive statistics. The mean age was 25 years (ranging from 14-50 years). Causes of fractures were manipulation in 56 (40.87%) cases, sexual maneuver in 39 (28.46%) cases, rolling or fall on bed in 18 (13.13%) and direct blow on erect penis in 11 (8.02%) patients. Injury involved unilateral corpora cavernosa in 126 (89.78%) and bilateral corpora cavernosa plus urethra in 11 (8.02%) respectively. The interval from time of injury to presentation was 4 hours to 45 days. All the patients presented with the typical clinical picture of a characteristic sound at the time of injury, pain, detumescence, and hematoma. In all the patients the tunical and urethral injuries were promptly repaired. Complication occurred in 7 (5.10%) patients.The mean hospital stay was 2 days. Eighty nine (64.96%) patients available for follow-up reported achieving adequate erection for intercourse without erectile or voiding dysfunction. Common clinical presentation were snapping or popping sound, sudden penile pain, detumescence and penile deviation. The aim of surgical repair was to avoid complications and preserve both sexual and voiding functions which was satisfactorily achieved in the majority.

Drug-induced colitis

Various medications can on rare occasions lead to intestinal infection. The article examines the known intestinal ailments and describes the clinical endoscopic and histological characteristics including therapeutic recommendations. Older patients particularly run the risk of antibiotic-associated colitis. It should be noted that antibiotic colitis and pseudomembranous colitis are not synonymous. Along with a medical history and endoscopic examination colitis should be established be evidence of clostridium difficile in the stool or in biopsy and/or by evidence of toxins in the stool. The therapy of choice is withdrawal of the antibiotics. Enterocolitis appears following treatment with mercury silver and arson as well as gold. In young women hormonal contraceptive use has led to colitis. The clinical symptoms are abdominal pains and diarrhea with signs of blood accompanied by fever and leucocytosis. Smoking is an additional risk factor. After covering a series of medication-related symptoms of colitis the author discusses a number of medications where relationship between therapy and the appearance of colitis has not been sufficiently established.

Abstract 59: The Incidence Of Pulmonary Aspiration With Laryngeal Mask Airway Use During Cardiopulmonary Resuscitation And Positive Pressure Ventilation In Swine.

Objective: Pulmonary aspiration of gastric contents occurs 20 –30% of the time during cardiopulmonary resuscitation (CPR) of cardiac arrest. This is due to loss of protective airway reflexes, pressure changes generated during CPR, and positive pressure ventilation (PPV). Even though the American Heart Association (AHA) has recommended the laryngeal mask airway (LMA) as an acceptable alternative airway for use by EMS personnel, concerns over the capacity of the device to protect from pulmonary aspiration remain. We sought to determine the incidence of aspiration after LMA placement, CPR and PPV. Methods: We conducted a prospective study on 16 consecutive post-experimental mixed-breed domestic swine of either sex (mean mass 25.7 ±1.4 kgs). A standard size-4 LMA was modified so that a vacuum catheter could be advanced into and past the LMA diaphragm. The LMA was placed into the hypopharynx and its position confirmed using End-tidal CO 2 and direct visualization of lung expansion. Fifteen milliliters of heparinized blood were instilled into the pharynx. After 5 PPVs with a mechanical ventilator, chest compressions were performed for 60s with asynchronous ventilations continuing at a rate of 12 per minute. After chest compressions, a suction catheter was inserted through the cuff and suction applied for approximately 1 minute. The catheter was removed and inspected for signs of blood. The LMA cuff was deflated and the LMA removed. The intima of the LMA diaphragm was inspected for signs of blood. In a validation cohort of 4 animals, the LMA was reinserted, a cricothyrotomy performed and 5 mL of blood instilled directly into the trachea. Results: There were 0/16 (95% CI=0 –17%) with a positive tests for the presence of blood in both the vacuum catheter and the intima of the LMA diaphragm. In the validation cohort, all four were positive for blood in both the vacuum catheter and the intima of the LMA diaphragm. Conclusions: In this simple model of regurgitation of after LMA placement, there was no sign of pulmonary aspiration, and no evidence that blood had passed beyond the seal created by the LMA cuff. Concerns over aspiration with LMA use may be unfounded. Future studies should determine the frequency of pulmonary aspiration after LMA placement in the clinical setting.

Subacute hemorrhage and resolution of edema in Rose Bengal stroke model in rats coincides with improved sensorimotor functions

The Rose Bengal model in rats is widely used to study brain plasticity, functional recovery and restorative therapies. The present study evaluated temporal profiles of hemorrhage and edema by magnetic resonance imaging (MRI) in rats in relation to sensorimotor impairment after photochemically induced cortical infarct. Adult, male Wistar rats were injected with Rose Bengal dye followed by illumination to produce a lesion over the sensorimotor cortex. Brain damage including infarct volume, edema, and bleeding was determined from postoperative days 1 to 10 by using MRI. Prussian blue staining was used to confirm hemorrhage in perfused brain sections. Functional outcome was assessed by limb-placing test during the follow-up. A consistent cortical lesion was detected in T(2) weighted MRI 24h after cortical photothrombosis without any signs of blood in T(2)(*) weighted images. However, from postoperative days 3 to 8, hemorrhage was indicated by almost complete signal void in T(2)(*) weighted gradient echo images and confirmed by Perls' Prussian blue staining on postoperative day 10 for presence of iron in corresponding lesion areas. The subacute appearance of hemorrhage on postoperative days 3-8 and resolution of edema coincides with improved performance in the limb-placing test. The results suggest that bleeding around cortical infarct is part of the wound healing process and may not impair functional outcome.

3-D Conformal radiotherapy of localized prostate cancer within an Austrian–German multicenter trial: a prospective study of patients' acceptance of the rectal balloon during treatment

Patients with localized prostate cancer are treated with 3D radiotherapy using a rectal balloon catheter for internal immobilization of the prostate, thereby reducing the radiation dose to the dorsal rectal wall. The purpose of the study was to investigate clinical feasibility and the influence of acute rectal side effects and pre-existing hemorrhoids on patients' acceptance of the rectal balloon catheter. 442 patients who underwent primary radiation therapy for localized prostate cancer were included in this prospective Austrian-German multicenter trial. The total radiation dose was either 70 Gy or 74 Gy. Acute rectal side effects were documented using the EORTC/RTOG grading score (European Organisation for Research and Treatment of Cancer/Radiation Therapy 225 Oncology Group) at weeks 2, 4 and 7 of radiation treatment. Within the same time intervals patients were interviewed about their tolerance of the rectal balloon catheter, evaluating five categories of acceptance (1 = no major complaints, 2 = pain at/during application, 3 = signs of blood at the balloon catheter after application but without any pain, 4 = signs of blood at the balloon catheter after application and pain, 5 = balloon application had to be stopped). Voluntary rectoscopy prior to radiotherapy was performed in 310 patients. 429/442 patients (97 %) were treated with the balloon catheter. No major complaints were reported in 79 % of the patients and no acute rectal side effects were seen in 52 % of the patients. Grade 1 side effects were seen in 31 % patients, Grade 2 in 17 % and Grade 3 in 0.5 %. Balloon use had to be stopped in only 4 % of the patients. There was significant correlation between balloon discomfort and rectal side effects (p < 0.01). The presence of hemorrhoids in 36 % patients prior to irradiation had no influence on balloon tolerance. The rectal balloon can be used in 3D radiotherapy of localized prostate cancer with a high degree of acceptance by the patients. Use of the balloon is safe within daily clinical treatment. Patients reporting acute rectal side effects experienced significantly more balloon discomfort, but the presence of hemorrhoids was not found to influence acceptance of the balloon.

Bildgebende Diagnostik bei Chordomen des Beckens: Vergleich der Modalit�ten CT und MRT

Sacral chordoma is a primarily benign tumor with a high tendency to recur. A correct definition of tumor volume is a significant prognostic factor. We compared the value of CT and MRI in diagnosing a sacral chordoma. 31 patients with a histologically proven sacral chordoma were included in this study. Following parameters were analyzed by two independent radiologists: septation, signs of blood and ossification in the tumor tissue, contrast enhancement, maximal tumor diameter, infiltration of the soft tissue, the dural salc and the cauda equina and multifocality. In CT all chordomas showed a hypodensity to the normal tissue and in MRI a hyperintensity on T2w images with a low level of contrast enhancement. On the basis of the more precise soft tissue contrast of MRI compared with CT, MRI was significantly more accurate in all tested parameters (p <0.05) besides in detecting tumor ossification. In CT tumor volume was frequently underestimated. MRI in sacral chordoma is an essential tool in the pretherapeutic diagnostic regimen and in a state of relapse.

Use of Blood and Blood Products

It is sometimes necessary for the practitioner to transfuse the ruminant with whole blood or plasma. These techniques are often difficult to perform in practice, are time-consuming, expensive, and stressful to the animal. Acute loss of 20% to 25% of the blood volume will result in marked clinical signs of anemia, including tachycardia and maniacal behavior. The PCV is only a useful tool with which to monitor acute blood loss after intravascular equilibration with other fluid compartments has occurred. An acutely developing PCV of 15% or less may require transfusion. Chronic anemia with PCV of 7% to 12% can be tolerated without transfusion if the animal is not stressed and no further decline in erythrocyte mass occurs. Seventy-five percent of transfused bovine erythrocytes are destroyed within 48 hours of transfusion. A transfusion rate of 10 to 20 mL/kg recipient weight is necessary to result in any appreciable increase in PCV. A nonpregnant donor can contribute 10 to 15 mL of blood/kg body weight at 2- to 4-week intervals. Sodium citrate is an effective anticoagulant, but acid citrate dextrose should be used if blood is to be stored for more than a few hours. Blood should not be stored more than 2 weeks prior to administration. Heparin is an unsuitable anticoagulant because the quantity of heparin required for clot-free blood collection will lead to coagulation defects in the recipient. Blood cross-matching is only rarely performed in the ruminant. In field situations, it is advisable to inject 200 mL of donor blood into the adult recipient and wait 10 minutes. If no reaction occurs, the rest of the blood can probably be safely administered as long as volume overload problems do not develop. Adverse reactions are most commonly seen in very young animals or pregnant cattle. Signs of blood or plasma transfusion reaction include hiccoughing, tachycardia, tachypnea, sweating, muscle tremors, pruritus, salivation, cough, dyspnea, fever, lacrimation, hematuria, hemoglobinuria, collapse, apnea, and opisthotonos. Intravenous epinephrine HCl 1:1000 can be administered (0.2 to 0.5 mL) intravenously or (4 to 5 mL) intramuscularly (preferable) if clinical signs are severe. Pretreatment with antipyretics and slowing the administration rate may decrease the febrile response. Blood or plasma administered too rapidly will also result in signs of cardiovascular overload, acute heart failure, and pulmonary hypertension and edema. Furosemide and slower administration of blood or plasma should alleviate this problem. Administration rates have been suggested starting from 10 mL/kg/hr; faster rates may be necessary in peracute hemorrhage. Plasma should be administered when failure of absorption of passive maternal antibody has occurred or when protein-loosing enteropathy or nephropathy results in a total protein of less than 3 g/dL or less than 1.5 g albumin/dL. Plasma can be stored at household freezer temperatures (-15 to -20 degrees C) for a year; coagulation factors will be destroyed after 2 to 4 months when stored in this manner. To maintain viability of coagulation factors, plasma must be stored at -80 degrees C for less than 12 months. When administering plasma, a blood donor set with a built-in filter should always be used. When bovine plasma is thawed, precipitants form in the plasma and infusion of these microaggregates may result in fatal reactions in the recipient.

A Planned Pregnancy

Getting pregnant starts with wondering: when, or even if, the next period will arrive. Then, waiting. A woman may urge this monthly punctuation, that she often begrudges, to arrive, or she may actively will it to stay away for once. Either way, accompanied perhaps by fatigue, nausea, or swollen breasts, when the telling sign of blood fails to appear, its absence is as profoundly mystifying as, at twelve or fourteen, its initial appearance, those red stains, which magically altered our perception of ourselves. Since then, this very moment of absence has always been menstruation's distant promise, or threat. When a woman finds herself pregnant, her sense of self is again transformed. At thirty-one, married just over a year, I am pregnant-mutually agreed upon and endlessly discussed and (surprisingly) easily accomplished. Inside me, like snow during a blizzard, a mass of cells are accumulating; I see nothing, feel little, except for tender breasts, fatigue, and intermittent waves of nausea. However, in about eight months, a baby will-if all goes well-appear in my arms, move into our house, and become a part of our lives for many years to come. Long before this, I will begin to sense, then to get acquainted with, this baby with whom I'll be sharing my living quarters. Planned and dreamt of, I still find this sea change in my life, in our lives, beyond comprehension. Barbara Katz Rothman once speculated that if abortion and birth control were truly woman-centered, then abortion would not be considered a major decision because women-from that initial tingling of the breasts onwards-understand that having children is as large an undertaking as one can commit to and hence that no woman would take on such a task unless she believed herself ready and able to do so.1 I first read her essay on this subject while I was working as an abortion counselor. What she wrote rang true; on a daily basis I was granted an intimate view into women's decision-making processes. Teenagers needed abortions; women

New Days, and: This Peaceful Street, and: Clouds, and: The Method, and: Terror, and: The Smallest Gesture, and: Intensive Care Unit, and: The New Life

NEW DAYS / Uz Rosenberg Sunlight, strong as tobacco, that shines so hard it seems to push the door ajar just as you and I leaned into a kiss, reached under clothes to find our skins. Bright earth, forgive this darkness working in me. 32 · The Missouri Review THIS PEACEFUL STREET / Liz Rosenberg On this peaceful street with its busy cars and twilit headlamps, no sign of blood, not even road-kiU. Out on the highway, the deer lie sideways. In markets, the meat sits bloodless in plastic. Our violence is habitual: one man might say, Fight to kill while in hospital basements, the x-rayed fight only to Uve. Across an ocean, young men pace on either side, scan the night sky for missiles or angels. The Missouri Review · 33 CLOUDS / Liz Rosenberg They hung in the sky, the size of houses, wilder than the trees. We lived on our backs, stared up forever past the shadowy twin towers of our knees to watch the shapes go by like carriages without wheels. And sometimes a chink of gold would slowly widen like a door opening—a door! where God and all his angels strolled. We'd be about to see them when our mother's calls would rise and one by one, so would we, called home to supper, home to bed where we would sleep, clouds boiling above our heads. 34 · The Missouri Review THE METHOD / Liz Rosenberg What was Maria Montessori thinking when she crossed the tenement courtyard that first morning— that she could free the children from their chairs, would free the chairs themselves from the floor? That morning, she demonstrated how to blow one's nose, so quietly the children burst into instant applause. She wrote, "The child is Uke the beggar, who looks for something and fails to attain it, who is robbed of his home and civil rights." The press called her crazy, outlandish; of course, ugly. On the next bridge over, the young Mussolini loped like a starved wolf from locked door to locked door. Fascist and anti-fascist sharing the mirror of the Tiber River. "The chairs might be moved and cleaned every day, easily lifted even by a child." One girl, among fruit trees for the first time cried out in amazement, "Up there, is a garden of things to eat!" The Missouri Review · 35 TERROR / Liz Rosenberg When the first blue fireworks explode Uke giant thistles, glassy on the sky my son is playing a few yards off. He freezes when it happens, his whole torso shakes the way I've seen smaU animals burst into motion from a dead stand-stiU as he runs crying, arms out for his father Uke those chUdish figures in the A.P. photos real under real skies who are really dying. 36 · The Missouri Review THE SMALLEST GESTURE / Liz Rosenberg MUUe's daughter is a thin sixteen, sick and tired of waiting for Death to carry her off. Her medicines shine like jewels in the wide kitchen window where she sits patiently, sketching the snow. And MUUe's so busy chattering, vacuuming—rushing around. By four she's exhausted, done in for the day. Fallen into her flowered armchair in the front parlor dim and square as a box, Millie's small hand dangles down— thinking of her daughter and pointing toward the earth. The Missouri Review · 37 INTENSIVE CARE UNIT / Liz Rosenberg Somewhere a TV set is always on, suspended like a gun three feet above our heads. A doctor is summoned on the intercom in a voice calm as a bell, while a young man screams, thumping the wall— an overdose—next door; then quiets, calling hoarsely for his mother. Down the hall, a chUd's machines are shut down at last and an hour later her parents shuffle past our door, listing like wrecked boats, crying dully, with a wracked sound, like a cough. And here is our baby son inside a metal crib. One pinpoint in the center of his chest pumps wildly in and out, a moth's wing whipping the light, frantic for air and here's the only movie in his room, the bright green screen...

Use of Blood and Blood Products

It is sometimes necessary for the practitioner to transfuse the ruminant with whole blood or plasma. These techniques are often difficult to perform in practice and are time-consuming, expensive, and stressful to the animal. Acute loss of 20-25% of the blood volume will result in marked clinical signs of anemia, including tachycardia and maniacal behavior. The PCV is only a useful tool with which to monitor acute blood loss after intravascular equilibration with other fluid compartments has occurred. An acutely developing PCV of 15% or less may require transfusion. Chronic anemia with PCV of 7-12% can be tolerated without transfusion if the animal is not stressed and no further decline in erythrocyte mass occurs. Seventy-five per cent of transfused bovine erythrocytes are destroyed within 48 hours of transfusion. A transfusion rate of 10-20 ml/kg, recipient weight, is necessary to result in any appreciable increase in PCV. A nonpregnant donor can contribute 10-15 ml of blood/kg body weight at 2-4 week intervals. Sodium citrate is an effective anticoagulant, but acid citrate dextrose should be used if blood is to be stored for more than a few hours. Blood should not be stored more than 2 weeks prior to administration. Heparin is an unsuitable anticoagulant because the quantity of heparin required for clot-free blood collection will lead to coagulation defects in the recipient. Blood crossmatching is only rarely performed in the ruminant. In field situations, it is advisable to inject 200 ml of donor blood into the adult recipient and wait 10 minutes. If no reaction occurs, the rest of the blood can probably be safely administered as long as volume overload problems do not develop. Adverse reactions are most commonly seen in very young animals or pregnant cattle. Signs of blood or plasma transfusion reaction include hiccoughing, tachycardia, tachypnea, sweating, muscle tremors, pruritus, salivation, cough, dyspnea, fever, lacrimation, hematuria, hemoglobinuria, collapse, apnea, and opisthotonos. Intravenous epinephrine HCl 1:1000 can be administered (0.2 to 0.5 ml) intravenously or (4 to 5 ml) intramuscularly if clinical signs are severe. Pretreatment with antipyretics and slowing the administration rate may decrease the febrile response. Blood or plasma administered too rapidly will also result in signs of cardiovascular overload, acute heart failure, and pulmonary hypertension and edema. Furosemide and slower administration of blood or plasma should alleviate this problem.(ABSTRACT TRUNCATED AT 400 WORDS)

Album, and: To Kill A Deer, and: The Migration of Butterflies

ALBUM/ CarolFrost They will put the baby on your belly and you will feel from the white forehead to the ribs where the first sob, simply the lungs, will rise and along the arms to the wrists where the pulse-beats will be like movements of a bird head, the nerves on fast for this beginning, then look for the slope below the belly, simply the sex, and think in the heat of the afternoon how come something created of egg and sperm can so clarify the struggle to come together, then see in the baby's eyes a half-fictive blue candle held by a couple, simply the color of the eyes and the parents entering, without moving, the sequence of moments called now, permanent within the baby, that the brain fixes like the tilt of its chin, as if the entire life ahead were a gallery with so many walls, and you become like someone who asking for meaning will think simply of the pictures, this one, this one. The Missouri Review · 13 TO KILL A DEER / CarolFrost Into the changes of autumn brush the doe walked, and the hide, head and ears were the tinsel browns. They made her. I could not see her. She reappeared, stuffed with apples, and I shot her. Into the pines she ran, and I ran after. I might have lost her, seeing no sign of blood or scuffle, but felt myself part of the woods, a woman with a doe's ears, and heard her dying, counted her last breaths like a song of dying, and found her dying. 1 shot her again because her eyes were open, and her lungs rattled like castenets, then poked her with the gun barrel because her eyes were dusty and unreal. I opened her belly and pushed the insides like rotted fruit into a rabbit hole, skinned her, broke her leg joints under my knee, took the meat, smelled the half-digested smell that was herself. Ah, I closed her eyes. I left her refolded in some briars with the last sun on her head like a benediction, head tilted on its axis of neck and barren bone; head bent wordless over a death, though I heard the night wind blowing through her fur, heard riot in the emptied head. 14 · The Missouri Review THE MIGRATION OF BUTTERFLIES / CarolFrost The green forest lanes that end in the Mexican mountains are strewn with monarch butterflies this March: where the lanes end, evergreens are covered in yellow layers. Alone, can you see these monuments, vast as Stonehenge, and not think of June's ticker-tape parade beating north, and those fallen along the way like a trail of colorful bits left there by someone gone in the woods too far and never come back? In oblivion, a wind with its light hands can scatter several of the butterflies, as a sleeping pensioner can brush away the small flies from his face, shift, and still sleep. The chilled monarchs spiral down, calm as spring showers of snowflakes . Too cold to wake them now! The monuments, dear-achieved, stand under a changing sky where sunlight stirs in its time all the resting butterflies. For some the awakening is early, for others late. The Missouri Review · is ...