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PubMed2000

Phase reconstruction from undersampled intensity patterns.

We demonstrate the uniqueness and convergence of phase recovery from high-spatial-frequency and undersampled intensity data. Furthermore, this is accomplished without the ambiguities that arise in phase unwrapping and without the need to employ a priori information. The method incorporates the technique of line integration of the phase gradient to find the first approximation to the phase and the algorithm of synthetic interferograms to find the unknown phase with high accuracy. The method may be used with any experimental method that at a certain data processing step obtains generalized sine and cosine intensity functions.

Algorithms↗

PubMed1975

Study of the protection on afforded by nicergoline against the effects of cerebral ischemia in the cat.

The cortical evoked potential of the two cerebral hemispheres of the cat is taken as the parameter of brain function; its course is studied during strangulation which determines its disappearance, and especially during strangulation release (recovery phase). Under these experimental conditions, the injection of 9% NaCl solution in each carotid does not modify the symmetry of recovery in the two cerebral hemispheres. The unilateral injection of increasing doses of 1,6-dimethyl-8beta-(5-bromonicotinoyl-oxymethyl)-10alpha-methoxyergoline tartrate (nicergoline) (20 to 400 mug) produces more rapid recovery on the treated side. This is also the case for the unilateral injection of 40 mg of sodium malonate. Observation of this effect in the hypoventilated, hypercapnic animal, with an already dilated cerebral network suggests that the mechanism of the protection afforded is not due to vasodilatation of the cerebral network produced by either of the two products. The effect of nicergoline disappears when a previous i.v. injection of sodium malonate has inhibited anoxic depolarization of the cellular membrane and inhibited the fall in cerebral ATP caused by ischemia. It would thus appear that the anti-ischemic properties of nicergoline, acting at the level of the central nervous system, are due to an effect on the cellular membrane or to an inhibiting effect on the metabolism of the brain cell. Supplementary experiments, involving the use of more specific pharmacological reagents should allow its action to be localized at the level of the membrane and/or of cellular metabolism.

Animals↗

PubMed1995

Immunological unresponsiveness and apoptotic cell death of T cells in measles virus infection.

The phenotypic alterations associated with T cells during measles virus infection have been demonstrated and an attempt has been made to show programmed cell death (PCD) of T cells activated in vivo. During the acute phase of illness, activated T cells increased rapidly. Memory T cells (CD45RO+), especially CD8+ memory T cells also tend to increase. During the recovery phase, CD8+ T cells declined rapidly, and naive (CD45RA+) T cells increased in numbers. The anti-CD3 monoclonal antibody-induced expression of interleukin-2 receptor (CD25) was suppressed. However, the addition of phorbol 12-myristate 13-acetate (PMA) caused the significant recovery of CD25 expression. In addition, PCD of activated T cells from measles patients was induced in culture. After triggering of the T cell receptor-CD3 complex, cells became more susceptible to PCD. Interestingly, the addition of PMA could inhibit PCD of activated T cells. Taken together, these data suggest unresponsiveness and activation-induced cell death of T cells during the primary response to measles virus antigens, depending on the activation status of protein kinase C.

Apoptosis↗

PubMed2000

Growth hormone isoforms in newborns and postpartum women.

The neonatal and postpartum periods are characterized by alterations in pituitary GH secretion. We have investigated the proportion of circulating non-22kDa GH isoforms in newborns, in women within the early postpartum phase (just after the disappearance of placental GH from the maternal circulation) and in women during late postpartum (during the somatotroph recovery phase). We studied 10 newborns (7 males; 3 females; median postnatal age, 45h), who had been admitted because of polycythaemia, 10 women in the early postpartum phase (median, 48h after delivery; range, 42-54h), 18 women in the late postpartum phase (median, 10 weeks after delivery; range, 3-25 weeks) and 9 healthy non-pregnant women. The proportion of non-22kDa GH isoforms was determined by the 22kDa GH exclusion assay, which is based on immunomagnetic extraction of 22kDa GH from serum, and quantitation of non-22kDa GH isoforms using a polyclonal GH assay. In newborns, non-22kDa GH isoforms were measured in two arterial blood samples obtained with a 5-6h interval. In the other groups, serum samples were obtained 40min after an i.v. bolus administration of the GH secretagogue, GH releasing peptide-1 (GHRP-1). In newborns, the median proportion of non-22kDa GH isoforms was 10% (range, 7. 2-19.4%) and the values were similar in samples collected at different times. In early postpartum women, total GH levels after GHRP-1 were lower and the proportion of non-22kDa GH isoforms was higher compared with the values in non-pregnant and late-postpartum women. In late postpartum, there was a partial recovery of GH response to GHRP-1, as shown by an increment in total GH levels, which was associated with a decrease in the fraction of non-22kDa GH isoforms. In conclusion, we found that (i) the proportion of non-22kDa GH isoforms in the newborn is comparable to that in the adult (non-pregnant women), (ii) in early postpartum, the non-22kDa fraction is high within the small pool of readily releasable GH, (iii) in late postpartum, recovery of pituitary GH responsiveness is associated with a relative decrease in the release of non-22kDa GH isoforms.

Adult↗

PubMed1976

Biochemistry and hematology at decompression sickness: a case report.

A 24-year-old hospital corpsman, a volunteer in a series of dry chamber air dives to a simulated pressure equivalent to 188 FSWG (57.3 MSWG), developed left knee pain shortly after standard decompression. A tentative diagnosis of decompression sickness was made and recompression therapy was initiated with alleviation of pain occurring at 60 FSWG (18.3 MSWG). A U.S. Navy Treatment Table "5 (oxygen breathing) regimen was then selected and completed uneventfully. The subject had been undergoing biomedical evaluation for several days prior to diving; thus, a clinically diagnosed case of dysbarism with subsequent treatment was available for study. This individual was then monitored for a 10-d period. The acute phase of decompression sickness was characterized by a marked shortening of clotting time and a thrombocytopenia with accompanying increased platelet aggregates. The recovery phase was categorized by a variety of hematological and bio-chemical changes. Hemodilution, an elevated megathrombocyte index, and a tendency toward eosinopenia were evident for most of the 10-d observation period. Other persistent alterations detected during this period included a relative hyperglycemia, depressed urine Na+/K+, and increased ketosteroid excretion. These observations indicate that abatement of pain after treatment of dysbarism can be followed by the onset of a variety of biochemical and hematological changes. Moreover, complete recovery may require upwards of 10 d.

Adult↗

PubMed1992

[Changes of urinary human epidermal growth factor excretion in 16 patients with acute renal failure].

In order to evaluate the clinical significance of urinary human epidermal growth factor (hEGF) in patients with acute renal failure (ARF), urinary hEGF levels were determined by radioimmunoassay, and were corrected for creatinine (creat.) concentrations in 16 patients with ARF and 12 healthy controls. The urinary hEGF levels significantly decreased in patients with ARF in acute phase compared with normal control subjects (0.98 +/- 0.20 vs 13.74 +/- 1.18 ng/mg creat. p less than 0.01), and it subsequently increased during recovery phase (6.10 +/- 0.73 ng/mg creat. p less than 0.01 vs acute phase). A significant correlation between the urinary hEGF levels and creatinine clearance (r = 0.712, p less than 0.001) and an inverse correlation between urinary hEGF levels and fractional excretion of sodium (r = -0.406, p less than 0.05) was demonstrated. The remarkable decrease of urinary hEGF excretion preceded the increase of urinary beta 2-microglobulin and N-acetyl-beta-D-glucosaminidase levels. Our data suggests that urinary hEGF originates from renal tissues in humans and measurement of urinary hEGF is useful for diagnosing renal damage and recovery of renal tissues from severe tubular injury.

Acetylglucosaminidase↗

PubMed1983

Neuromuscular blockade in infants following intramuscular succinylcholine in two or five per cent concentration.

This study determined the characteristics of the neuromuscular block which followed intramuscular succinylcholine 4 mg . kg-1 in 20 infants during halothane anaesthesia. The infants were divided into two groups of ten; the first received succinylcholine in two percent solution and the second in five per cent solution. The mean maximum depression of the first twitch of the train-of-four (T1) was 89.7 +/- 5.0 per cent in 4.0 +/- 0.6 min, and the mean full recovery of T1 occurred in 15.6 +/- 0.9 min after injection. The maximum block achieved and the onset and recovery times were not affected by the concentration used. Depolarizing block, with equal depression of all twitches of the train-of-four was observed during the onset of neuromuscular blockade. During recovery, phase II block, as determined by a train-of-four ratio (T4/T1) of 0.5 or less, occurred frequently at T1 recovery of 25-50 per cent, but was not associated with prolonged paralysis. It is concluded that the onset time of 4 min for intramuscular succinylcholine 4 mg . kg-1 may be too long for emergency use in infants, and no improvement is obtained by increasing the concentration of injected succinylcholine from two to five per cent.

Adjuvants, Anesthesia↗

PubMed1997

Mechanotransduction in colonic smooth muscle cells.

We evaluated mechanisms which mediate alterations in intracellular biochemical events in response to transient mechanical stimulation of colonic smooth muscle cells. Cultured myocytes from the circular muscle layer of the rabbit distal colon responded to brief focal mechanical deformation of the plasma membrane with a transient increase in intracellular calcium concentration ([Ca2+]i) with peak of 422.7 +/- 43.8 nm above an average resting [Ca2+]i of 104.8 +/- 10.9 nM (n = 57) followed by both rapid and prolonged recovery phases. The peak [Ca2+]i increase was reduced by 50% in the absence of extracellular Ca2+, while the prolonged [Ca2+]i recovery was either abolished or reduced to less than or = 15% of control values. In contrast, no significant effect of gadolinium chloride (100 microM) or lanthanum chloride (25 microM) on either peak transient or prolonged [Ca2+]i recovery was observed. Pretreatment of cells with thapsigargin (1 microM) resulted in a 25% reduction of the mechanically induced peak [Ca2+]i response, while the phospholipase C inhibitor U-73122 had no effect on the [Ca2+]i transient peak. [Ca2+]i transients were abolished when cells previously treated with thapsigargin were mechanically stimulated in Ca2+-free solution, or when Ca2+ stores were depleted by thapsigargin in Ca2+-free solution. Pretreatment with the microfilament disrupting drug cytochalasin D (10 microM) or microinjection of myocytes with an intracellular saline resulted in complete inhibition of the transient. The effect of cytochalasin D was reversible and did not prevent the [Ca2+]i increases in response to thapsigargin. These results suggest a communication, which may be mediated by direct mechanical link via actin filaments, between the plasma membrane and an internal Ca2+ store.

Actin Cytoskeleton↗

PubMed1985

Echocardiographic versus hemodynamic monitoring during attacks of variant angina pectoris.

Six attacks of variant angina (2 spontaneous, 4 induced by ergonovine) were studied in 6 patients by combined echocardiographic and hemodynamic monitoring. A decrease of percent systolic thickening of the ischemic wall, which occurred as early as the decrease in peak dP/dt of contraction, was detected before the onset of ST-segment elevation ("pre-electrocardiographic phase"). At this stage, no significant change in left ventricular (LV) end-diastolic pressure or end-diastolic diameter was observed. Subsequently, in the presence of clear-cut ST-segment elevation ("electrocardiographic phase"), percent systolic thickening (an index of regional function) reached its nadir, while dP/dt of contraction (an index of global function) was almost back to preischemic values. In this phase, a significant increase in LV end-diastolic diameter and end-diastolic pressure could be also detected. In the recovery phase, when the ST segment had returned to the isoelectric line ("post-electrocardiographic phase"), percent systolic thickening and dP/dt of contraction showed supernormal values, while LV end-diastolic pressure and end-diastolic diameter decreased below basal values. Thus, echocardiographic signs of impairment in LV mechanics are as early and sensitive as hemodynamic indexes during attacks of variant angina. Furthermore, information on morphologic characteristics and regional LV function, not available with hemodynamic monitoring, can be obtained by echocardiography.

Adult↗

PubMed2001

Fast-tracking children after ambulatory surgery.

UNLABELLED: This study was designed to determine the feasibility and benefits of fast-tracking children after ambulatory surgery. One-hundred-fifty-five healthy children undergoing surgical procedures lasting <90 min were studied in a randomized manner. After surgery, children who met predefined recovery criteria in the operating room were entered into one of the study groups. Seventy-one patients (control) were first admitted to the postanesthesia care unit (PACU) and then to the second-stage recovery unit (SSRU). Eighty-four children bypassed the PACU and were directly admitted to the SSRU (Fast-Track group). The demographic data, airway management, and surgical procedures were similar in both groups of patients. During the recovery phase, 62.0% of the PACU group patients and 40.5% of the Fast-Track patients received analgesics (P = 0.01). The total recovery time was 79.1 +/- 48.3 min in the Fast-Track group and 99.4 +/- 48.6 min in the Control group (P = 0.008). A larger percentage of parents in the Fast-Track group (31% vs 16%) reported that their child was restless on arrival at the SSRU (P = 0.037). There were no clinically significant adverse events. However, adequate pain control must be provided before transfer to SSRU. In conclusion, fast-tracking children after ambulatory surgery is feasible and beneficial when specific selection criteria are used. IMPLICATIONS: The results of this study show that the total recovery time is shorter in children who are fast-tracked (bypass the postanesthesia care unit) after ambulatory surgery. A higher percentage of parents of the Fast-Track group felt that their child was restless on arrival at the second-stage recovery unit. Fast-tracking children after ambulatory surgery is feasible and beneficial when specific selection criteria are used.

Adolescent↗

PubMed2000

Antioxidant enzymes are induced during recovery from acute lung injury.

OBJECTIVE: To determine the contribution of the pulmonary antioxidant defense enzymes of the hexose monophosphate (HMP) shunt and glutathione systems to recovery from oxidant-mediated lung injury in an animal model shown to closely resemble the clinical syndrome of acute respiratory distress syndrome. DESIGN: Prospective, controlled laboratory study on phorbol myristate acetate (PMA)-induced lung injury in rabbits. SETTING: Animal research laboratory. SUBJECTS: Rabbits were injected with PMA (80 microg/kg) for 3 consecutive days. Control animals received normal saline. MEASUREMENTS AND MAIN RESULTS: Lungs were harvested at 24, 48, 72, and 96 hrs (n = 5/time point) after PMA injection or after the third injection of normal saline in control animals (n = 6). The cytosolic fraction from lung and bronchial alveolar lavage (BAL) fluid was used for measurements of HMP shunt and glutathione enzymes. Pulmonary activity peaked at 48 hrs post-PMA injury with a 40% increase in glucose-6-phosphate dehydrogenase activity and a 32% increase in 6-phosphogluconate dehydrogenase activity over control levels. BAL activity was maximal at 72 hrs with an increase of 98% in glucose-6-phosphate dehydrogenase and 346% in 6-phosphogluconate dehydrogenase activities. Glutathione peroxidase was maximally induced by 77% at 48 hrs in BAL and by 107% at 24 hrs in lung. Glutathione reductase activity did not increase significantly in either lung or BAL. CONCLUSIONS: The observed induction of the antioxidant enzymes in response to PMA suggests that both the HMP shunt and the glutathione systems contribute to the recovery phase of oxidant-mediated lung injury. The inability of natural host defenses to regenerate reduced glutathione may explain failure of recovery from acute respiratory distress syndrome and suggests an avenue for clinical intervention.

Animals↗

PubMed1991

Electrogenic Na(+)-Ca2+ exchanger, the link between intra- and extracellular calcium in the Limulus ventral photoreceptor.

1. Limulus ventral photoreceptors were injected with Arsenazo III and the internal change in the calcium concentration, [Ca2+]i, was measured under voltage clamp conditions. It is shown that in response to a light flash the rising phase of the [Ca2+]i is independent of the clamp voltage, Vm. This observation is contrary to other results reported in the literature. Experiments are reported that resolve this contradiction (see paragraph 4). 2. The relaxation of the [Ca2+]i after a bright light flash was observed to have a fast and slow phase. A function consisting of the sum of an exponential and a ramp was fitted to the relaxation. The fast phase, characterized by the time constant of the exponential, was observed not to depend on Vm, while the slow phase, characterized by the slope of the ramp, was strongly dependent on Vm. Furthermore the slope of the slow phase is shown to depend on the external Na+ concentration, but not the time constant of the fast phase. 3. In the dark the [Ca2+]i was observed to increase when the cell was depolarized and to decrease when the cell was hyperpolarized. This observation was more pronounced when the cell was continuously illuminated. 4. When the cell was clamped to a depolarizing voltage before illumination of the cell, the maximum of the calcium indicator signal was observed to depend on how long the cell had been clamped before applying the light stimulus. This experiment resolves the contradiction mentioned in paragraph 1. 5. The results presented here are consistent with the interpretation that a Na(+)-Ca2+ exchanger with a stoichiometry greater than 2:1 is the predominant link between intra- and extracellular calcium. Secondly that the light-induced intracellular calcium increase comes from a release by intracellular stores. Finally a measurable uptake of calcium occurs after a light-induced release, possibly by the internal calcium stores. The two-phase recovery of [Ca2+]i after a light flash is interpreted as being a calcium uptake by the internal stores, the fast phase, and removal by the electrogenic Na(+)-Ca2+ exchanger, the slow phase.

Animals↗

PubMed2025

Clinical and laboratory profiles of Oropouche virus disease from the 2024 outbreak in Manaus, Brazilian Amazon.

BACKGROUND: The 2024 Oropouche virus (OROV) outbreak in Brazil raised public health concerns due to its unprecedented rapid spread, high incidence, and potential neurological complications. OROV symptoms overlap with locally endemic arbovirus diseases, like dengue virus (DENV), complicating diagnosis. The study aimed to compare clinical, laboratory, and immunological profiles in OROV and DENV cases, crucial for improving diagnosis and management. METHODS: This study analyzed 51 OROV and 78 of DENV cases consecutively enrolled in Manaus, Amazonas, Brazil, and monitored for 28 days. OROV diagnosis was performed by real-time PCR (RT-PCR) using serum and urine samples. OROV RT-PCR positive samples were genotyped. A paired Plaque Reduction Neutralization Test (PRNT) was conducted on samples collected at D1 and D28. Patients with a ≥ 4-fold increase in neutralizing antibody titer between D1 and D28 were considered OROV-positive. Clinical manifestations, hematology, biochemistry, and cytokine profiles were analyzed. Statistical analysis included comparison between OROV and DENV patients. RESULTS: Genome sequencing of OROV isolates confirmed presence of a previously reported novel reassortment event, consistent with ongoing localized transmission. Urine RT-PCR demonstrated low positivity compared to serum samples. The paired PRNT increased sensitivity in 45%. Clinically, OROV infection was associated with significantly higher frequencies of severe headache, myalgia, arthralgia, and rash compared to DENV infection (p < 0.001). Elevated alanine aminotransferase (ALT) levels were also observed in OROV patients (p < 0.001). Immunologically, OROV infection induced significantly increased levels of acute-phase CCL11 (eotaxin), CXCL10, IFN-γ, IL-1RA, and IL-10, which declined by day 28, while IL-5 increased during recovery. In contrast, DENV patients exhibited elevated levels of CCL2, G-CSF, and CCL3 in recovery phase. CONCLUSION: OROV symptoms overlap with DENV underscores the need for syndromic diagnostic approach in endemic regions. Continued genomic surveillance and expanded clinical studies are vital to assess long-term consequences. Given OROV's expanding geographic range, targeted public health measures are essential to mitigate future outbreaks and better understand its pathophysiology.

Humans↗

PubMed1990

Recovery of gas exchange variables and heart rate after maximal exercise in COPD.

Studies of the limited exercise capacity in patients with COPD have not assessed the recovery phase, although the phenomenon of increased oxygen uptake after exercise has been thoroughly investigated in normal subjects. Therefore, we compared the recovery of gas exchange variables and HR after maximal cycle ergometry in 16 patients with varying severities of airflow obstruction and ten aged control subjects. Aerobic capacity was reduced in the patients with COPD, and the rates of recovery of VE, VO2, VCO2, excess VCO2, and HR were all significantly slower in the patients with COPD than in the controls. When expressed as the half-time for recovery, patients with COPD had values which were approximately twice that of control subjects for gas exchange and HR. The extent of recovery was similar in patients and controls. We conclude that in patients with COPD, postexercise relative hyperpnea and hypermetabolism are significantly prolonged. In addition, impaired elimination of increased body stores of carbon dioxide may contribute to impaired adjustment to acid-base disorders in these patients.

Aged↗

PubMed2002

Behavioral, psycho-physiological and salivary cortisol modifications after short-term alprazolam treatment in patients with recent myocardial infarction.

BACKGROUND: The aim of this study was to determine the behavioral and physiological effects of the central nervous system depressant alprazolam on a group of cardiac patients. METHODS: Immediately after hospital discharge, the Crown and Crisp Experiential Index (CCEI) was administered, the salivary cortisol was detected and a psycho-physiological profile was recorded in 52 subjects who had suffered from myocardial infarction. Half of the subjects represented the experimental group and the remaining 26 individuals acted as a control group not undergoing treatment. The benzodiazepine alprazolam (0.25 mg) was administered twice daily to the treated group only. With the exception of the administration of the drug, all recruited subjects underwent the same clinical evaluation. RESULTS: The CCEI data of the treated group showed significant decreases for the following scales: free floating anxiety (p < 0.001), phobic anxiety (p < 0.01), somatic complaints (p < 0.05), and depression (p < 0.01). In the same group, with regard to the physiological parameters, the skin conductance response significantly decreased during the baseline phase (p < 0.01), and almost all parameters showed decreased values during mental stress test administration. Cortisol levels also decreased during the recovery phase of the psycho-physiological profile assessment. CONCLUSIONS: Alprazolam seems to be able to reduce sympathetic discharge and some stress-related behavioral and physiological responses. This could be of benefit for selected cardiac patients for whom increases in sympathetic tone may constitute a risk factor.

Adult↗

PubMedDate not supplied

Recovery following sedation with midazolam or diazepam alone or in combination with fentanyl for outpatient surgery.

Midazolam is a new water-soluble benzodiazepine with a much shorter pharmacologic half-life than diazepam. Despite this shorter pharmacologic half-life, several reports indicate that patients do not recover more rapidly after sedation with midazolam than with diazepam. The purpose of this study was to compare recovery of patients sedated with either midazolam or diazepam alone or in combination with fentanyl using the digit symbol substitution test (DSST) and Trieger test. Patients were randomly divided into treatment groups and recovery tests were administered to the patients prior to sedation and at 60, 120, and 180 minutes after achieving a standardized sedative endpoint. Patients who received midazolam alone had significantly fewer numbers of correct reponses on the DSST than patients who received midazolam plus fentanyl or diazepam with or without fentanyl. When midazolam was combined with fentanyl there was no significant difference between results obtained on the DSST when compared with either diazepam group. Comparisons between all groups using dots missed or millimeter deviation on the Trieger test showed no statistical difference between any groups. These data indicate that midazolam as a single IV agent has a slightly prolonged recovery phase compared to diazepam. The addition of fentanyl to the sedation regimen allows reduction in the midazolam dose resulting in a recovery time comparable to that of diazepam.

Anesthesia Recovery Period↗

PubMed1995

Methacholine inhalation challenge in patients with post-Mycoplasma pneumoniae pneumonia.

We studied methacholine bronchial inhalation challenge in 12 patients at 4th week and 12th week after recovered from Mycoplasma pneumoniae pneumonia, compared with 12 healthy subjects as controls. The aerosolized methacholine was produced by an atomized nebulizer of the Provocationtest I, Pari-Starnberg, Germany and the aerosol was kept into a reservoir bag. Then, it was inhaled slowly by a subject. Increasing concentration of methacholine solutions (0, 0.5, 1, 5, 10, and 25 mg/ml) were used. The results revealed that 67% of the patients had bronchial reactivity to methacholine at the first time of challenge with a mean concentration of methacholine producing a fall in FEV1 of 20% from baseline (PC20) of 12.3 +/- 6.44 mg/ml. Fifty percent of the patients were still positive to the test on the second time of challenge with a mean PC20 of 20.1 +/- 6.89 mg/ml. None of the healthy subjects had bronchial hyperreactivity (PC20 > 25 mg/ml). Two patients experienced wheezing and asthmatic attacks requiring bronchodilator therapy during acute phase pneumonia. They were also diagnosed as having bronchial asthma for the first time. Many patients had prolonged coughing during the recovery phase lasting more than 4 weeks. This prolonged coughing seemed to have a correlation with the development of bronchial hyperresponsiveness (BHR). We concluded that M. pneumoniae could induce BHR which may be transient or persistent. The effect of mycoplasma respiratory tract infection may result in airway inflammations and asthmatic attacks.

Adult↗

PubMed1998

[Hemolytic anemia and thrombocytopenia associated with anti-omeprazole antibody].

An 80-year-old woman was admitted with anemia, jaundice and a bleeding tendency about 5 weeks after starting omeprazole. On admission, the hemoglobin was 6.4 g/dl, platelets 0.1 x 10(4)/microliter, leukocyte count 7,500/microliter, and reticulocyte count 325/1000. The total bilirubin was 1.9 mg/dl, indirect bilirubin 0.6 mg/dl, lactate dehydrogenase 572 IU/l, and haptoglobin < 10 mg/dl. Both the direct and the indirect Coombs' tests were positive. The platelet-associated IgG (PAIgG) was 1,100.0 ng/10(7) cells. A decrease in the complement value was observed. There was an increase in the number of megakaryocytes and erythroblasts in the marrow film. After omeprazole administration was halted, her hemoglobin and platelet levels gradually returned to normal. On the 27th hospital day, the direct Coombs' test was positive but the indirect Coombs' test became negative. The PAIgG value also returned to normal, and she was discharged on the 59th hospital day. The acute phase of the drug-induced lymphocyte stimulation test was negative, however, we detected the IgG antibody to omeprazole. In the recovery phase, the IgG value decreased. Forty days after discharge, the direct Coombs' test had become negative. This is apparently the first report of a patient with acute hemolytic anemia and thrombocytopenia due to omeprazole through an immune complex mechanism.

Acute Disease↗