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PubMedDate not supplied

Management of cold agglutination syndrome.

Cold haemagglutination syndrome is difficult to treat. Fortunately it seldom needs treating. In most cases cold agglutinins are an incidental finding representing either normality or a benign chronic monoclonal gammopathy that does not cause ill health. Two sorts of symptoms are likely in the more severe cases. Acrocyanosis is usually treated by keeping the patient warm and if necessary removing him or her to Florida or the Canary Islands. In the rare cases of haemolytic anaemia, an underlying lymphoid tumour should be sought and treated. If none exists, then it is unlikely that the treatments that are useful in warm antibody haemolytic anaemia will be helpful. Plasma exchange ought to work but in practice there are frequently problems of red cell agglutination within the cell separator or the plastic tubes. For this reason plasma exchange within a heated room is advocated. When cardiac surgery is contemplated pre-operative plasma exchange is sometimes helpful, or the heart may be stopped by potassium solutions and the operation is carried out in the warm.

Anemia, Hemolytic↗

PubMed2005

Cold urticaria: a case report and review of the literature.

Cold urticaria represents a form of physical urticaria. The disorder is uncommon, and patients with the condition are at risk for systemic reactions and thus must be identified, counseled, and treated accordingly. Diagnosis principally is clinical and is confirmed by the results of cold stimulation tests such as placing an ice cube on the patient's forearm. Treatment primarily consists of preventive counseling, epinephrine autoinjections, and antihistamines. We present the case of a 9-year-old girl with acquired cold urticaria and review the literature.

Anti-Allergic Agents↗

PubMed2026

Hot vs cold knife for endoscopic ablation of posterior urethral valves: a systematic review by the EAU-YAU paediatric urology working group.

INTRODUCTION: Posterior urethral valves (PUV) are the most frequent cause of congenital lower urinary tract obstruction in males. Despite early surgical ablation, up to 22% of patients develop chronic kidney disease and 11% progress to end-stage renal disease. Multiple endoscopic modalities have been described for valve ablation but the optimal technique remains uncertain. This systematic review aims to determine whether cold or hot knife ablation provides superior effectiveness for primary endoscopic treatment of PUV in a single surgical session. MATERIAL AND METHODS: A systematic search of PubMed and Embase databases was conducted to identify studies comparing cold and hot knife techniques for endoscopic ablation of PUV in children, covering all publications up to December 2025. The review was performed in accordance with PRISMA 2020 guidelines and was prospectively registered in PROSPERO (ID CRD420251180556). Original studies including patients <18 years who underwent primary valve ablation with postoperative cystoscopy or VCUG and ≥6 months of follow-up were included. Quality assessment was done using RoB 2.0 for randomized trials and MINORS for observational studies. RESULTS: A total of 1581 studies were identified, of which 26 met the inclusion criteria, comprising one randomized controlled trial, five prospective, and 20 retrospective studies constituting a sum of 1725 paediatric patients. The overall methodological quality of included studies was moderate, with marked heterogeneity in design, follow-up duration, and outcome reporting, limiting direct comparisons across series. Thus statistical analysis was not possible. Of these, 829 (48.1%) underwent cold valve ablation and 896 (51.9%) underwent hot ablation techniques. Within the cold group, most patients were treated with a cold knife (80.2%), followed by balloon dilatation (7%), the Mohan valvotome (6.5%), cold hook (5%), and, rarely, a modified venous valvulotome (1.3%). Among hot techniques, 32.8% of procedures were performed by electro-fulguration with a resectoscope, 29.4% using a Bugbee electrode, 23.8% with a hook electrode and 14% with laser-based systems. Follow-up ranged from 6 months to 22 years across studies. Single-session success rates for valve ablation ranged from 22% to 100% in the cold resection group and from 71.4% to 100% in the hot resection group. Reintervention for residual valves was reported in 0%-78% of cold cases and in 0%-28.6% of hot resections. Urethral stricture rates ranged from 0% to 11.1% after cold incision and from 0% to 23.8% after hot techniques. Reporting of postoperative outcomes such as urinary tract infection, incontinence, bladder dysfunction, vesicoureteral reflux (VUR) resolution, hydronephrosis improvement, and renal function varied widely among studies and was assessed using different methodologies. CONCLUSIONS: Both cold and hot ablation techniques for PUV achieved high single-session success rates and low complication rates. Cold resection appeared slightly safer, although this finding should be interpreted cautiously given the heterogeneity and observational nature of the available data.

Humans↗

PubMed2003

fMRI responses to cold pressor challenges in control and obstructive sleep apnea subjects.

Obstructive sleep apnea (OSA) patients exhibit altered sympathetic outflow, which may reveal mechanisms underlying the syndrome. We used functional MRI (fMRI) in 16 control and 10 OSA subjects who were free of cardiovascular or mood-altering drugs to examine neural responses to a forehead cold pressor challenge, which elicits respiratory slowing, bradycardia, and enhanced sympathetic outflow. The magnitude of cold-induced bradycardia was smaller, and respiratory slowing showed greater intersubject variability and reached a nadir later in OSA patients. Both groups showed similar signal changes to cold stimulation in multiple brain sites. However, signal increases emerged in OSA over controls in anterior and posterior cingulate and cerebellar and frontal cortex, whereas signals markedly declined in the ventral thalamus, hippocampus, and insula rather than rising as in controls. Anomalous responses often paralleled changes in breathing and heart rate. Medullary, midbrain areas and lentiform and cerebellar dentate nuclei also showed lower signals in OSA cases. Cold pressor physiological responses are modified in OSA and may result from both diminished and exaggerated responses in multiple brain structures.

Adult↗

PubMed1993

One-shot intravesical instillation of the mucous adhesive anticancer agent hydroxypropylcellulose-doxorubicin for the treatment of superficial bladder carcinoma is sufficient to determine antitumor effects.

A 20 mg/20 ml dose of the membrane adhesive anticancer preparation, hydroxypropylcellulose-doxorubicin (HPC-doxorubicin), was instilled into urinary bladders through a catheter for the treatment of superficial bladder carcinomas (Ta-T1). After 14-30 days, the effects of the drug on tumors was examined by cystoscopy, and the residual tumor tissue where reduction in size was observed was resected by transurethral resection (TUR). Therapeutic effects were as follows: a complete response (CR) was found in 6 cases (37.5%), a reduction in size of more than 50% (partial response = PR) in 4 cases (25%), and a less than 25% reduction (no change = NC) in 6 cases (37.5%). In no case was progression of the disease noted. In CR cases, cold cup punch biopsy revealed no tumor cells remaining at the site where the tumor was present before the instillation. Side effects such as bladder irritation were found in 4 cases, but they were only temporary in nature. The one-dose HPC-doxorubicin approach developed by ourselves allowed detection of antitumor effects between 14 and 30 days after the instillation and therefore determination of sensitivities at an earlier stage than with instillation of the conventional water-soluble type of doxorubicin hydrochloride.

Administration, Intravesical↗

PubMedDate not supplied

Monotherapy with rituximab induces rapid remission of recurrent cold agglutinin-mediated hemolytic anemia in a patient with indolent lympho-plasmacytic lymphoma.

Cold agglutinin mediated immune hemolytic anemia secondary to lymphoproliferative disease (LPD), is primarily treated with measures directed to eliminate the malignant clone and as such, chemotherapy is usually given. The recent availability of monoclonal antibodies, has made it feasible to obtain both a clinical and molecular remission, as well as a remission on the functional level, such as elimination of secondary autoimmune phenomena. Recently we have administered a course of monotherapy with rituximab (4 weekly injections, x 375 mg/m2) to a patient with refractory and transfusion dependent cold agglutinin mediated hemolytic anemia secondary to indolent B-cell lymphoma. She achieved complete remission with a significant improvement in hemolysis and also became transfusion independent with a current follow-up of over one year. In individual cases, Rituximab has the potential of achieving not only a complete clinical remission (CR) but also a molecular CR, as well as a "functional" CR, by eliminating the clinical manifestations of autoimmunity; in this case, cold agglutinin mediated hemolytic anemia, secondary to NHL. Good results in autoimmunity secondary to lymphoma raises the possibility of future potential benefit of this agent in other primary autoimmune disorders.

Aged↗

PubMedDate not supplied

Exclusively aortic cold flushing for liver procurement from hemodynamically stable donors. An experimental study in the pig.

Liver cooling before grafting is usually achieved by aortic plus portal flushing; exclusively aortic flushing is reserved to hemodynamically unstable or non heart-beating donors. We have compared the effects of "aortic plus portal" (8 cases) and "aortic" (8 cases) cold flushing on the early function of pig liver grafts from hemodynamically stable donors. The time for liver removal (mean +/- standard deviation) was 30.4 +/- 7.1 min. in the "aortic plus portal" and 19.7 +/- 3.3 min. in the "aortic" group (p < 0.01). All the recipients survived for at least 72 hrs; only those of the "aortic plus portal" group showed some degree of primary liver dysfunction; recipient serum aspartate transaminase (AST) was significantly higher in the "aortic plus portal" than the "aortic" group. Since aortic flushing allowed for shorter operation times and was better tolerated than and at least as effective as aortic plus portal flushing, it can be proposed for routine liver procurement even from hemodynamically stable donors.

Animals↗

PubMed1986

Sensory effects in man of lesions of the posterior columns and of some other afferent pathways.

Clinical observations are presented on the sensory effects of lesions of different afferent pathways of the spinal cord, correlated whenever possible with histological evidence of the location and extent of the lesions. They are based on personal cases and on significant cases in the literature, including posterior column section, other causes of damage to the posterior columns, and cases of commissural myelotomy. It is concluded that the traditional view of the effects of lesions of the posterior columns is correct, but that evidence from cases proved by postmortem examination is still needed. When the information normally supplied by the posterior columns is cut off, primary sensibility for light touch and pressure is not lost, but any kind of discrimination is disturbed. There is also a disturbance in knowledge of movement and position, ataxia, and clumsiness in the use of the hands. These defects greatly affect the palpatory examination of objects and, although they may appear slight on routine neurological examination, they can cause severe disturbances in the activities of daily living. For tactile modalities, a lesion of the spinothalamic complex causes minimal or no defects and a lesion of the posterior columns causes only slight defects, whereas a lesion of both pathways gives rise to total loss of tactile and pressure sensibility in the part of the body served by both pathways. This conclusion is based on 2 cases with combined commissural myelotomy and anterolateral cordotomy. The following disturbances of mechanoreception attributed to lesions of the posterior columns are discussed: lability of threshold, persistence of sensation, tactile and postural hallucinations and temporal and spatial disturbances. In man, lesions of the posterior columns cause an increase in pain, tickle, warmth and cold. Cases are presented with and without lesions of the posterolateral columns in conjunction with lesions of one or both anterolateral columns. As these lesions did not affect sensation and as there was no difference in the sensory state following anterolateral cordotomies with or without involvement of the posterolateral column, it is concluded that lesions of this column have no effect on sensation. Cases with lesions of the anterior two-thirds of the cord are also presented to illustrate the sensory state with only the posterior third of the cord intact. In these cases, tactile and pressure sensibility and knowledge of movement and position are normal.

Animals↗

PubMed1985

Combined multiple-valve procedures. Factors influencing the early and late results.

The early and late results were retrospectively evaluated in 57 cases of double or triple valve replacement or repair performed in 1970-1983. The causes of the valvular lesions were rheumatic fever (43 cases), bacterial endocarditis (6), syphilis (1) and unknown (7 cases). The preoperative NYHA classification was III in 29 patients and IV in 28, due mainly to dyspnea of effort. Cardiomegaly (mean radiologic volume 880 cm3/m2) and atrial fibrillation were the dominant clinical findings. Surgery was on emergency indications in five cases. Cold cardioplegia combined with external cardiac cooling has been used for myocardial protection since 1977. The valve replacements were 56 aortic, 50 mitral and 2 tricuspid. In addition there were three closed and two open mitral commissurotomies, two mitral plastic repairs, three tricuspid valve anuloplasties (DeVega) and one aortic anuloplasty. Follow-up (0.3-13, mean 3.5 years) was supplemented with a check-up including two-dimensional echophonocardiography and hematologic tests. The operative mortality (10/57 patients) fell from 26% in 1970-1976 to 12% in 1977-1983. The causes of death were low cardiac output in preoperatively ill patients (5), myocardial infarction (2), technical failure (2) and sepsis (1 case). There were 11 late deaths (6.7/100 patient-years of observation), the commonest cause (5 patients) being congestive heart failure. The respective incidences of thromboembolism, paravalvular leak and postoperative endocarditis were 2.1, 4.2 and 2.1 episodes/100 patient-years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1991

[A case of paroxysmal cold hemoglobinuria (PCH) in the elderly found by severe anemia].

CASE: 69 year-old female. Two weeks before the admission, the patient had suffered from upper respiratory tract infection. Severe anemia was detected (Hb was 6.0 mg/dl) and she received a transfusion. Four days after the transfusion, she became icteric and was transferred to our hospital on Feb. 3, 1990 for evaluation of anemia. Laboratory data on admission are as follows; Hb 6.3 g/dl, reticulocytes 128%, total bilirubin 4.6 mg/dl, indirect bilirubin 3.4 mg/dl, urobilinogen in urine positive, WR negative, direct anti-globulin test positive, indirect of the test negative, and Donath-Landsteiner test positive (both direct and indirect). Her red blood cells were classified as P2-positive. From these findings, non-syphilitic PCH was diagnosed. She required bed rest and therapy to protect her from cold exposure. The hemoglobin recovered to 8.3 g/dl. The D-L test was positive for 9 months. This is a rare case of PCH because the patient fell ill in old age and PCH was found because of her severe anemia in spite of her unawareness of hemoglobinuria.

Aged↗

PubMed1991

Shock absorbing finger cap.

We describe the use of a custom-made cap or sleeve made of a visco-elastic polymer offering protection for the tip of the hypersensitive finger or thumb. Of 35 digits treated, relief of symptoms was achieved in 83%. In many cases, cold intolerance was also relieved.

Adult↗

PubMed1995

The Utilization of Glycolytic Intermediates as Precursors for Fatty Acid Biosynthesis by Pea Root Plastids.

Radiolabeled pyruvate, glucose, glucose-6-phosphate, acetate, and malate are all variously utilized for fatty acid and glycerolipid biosynthesis by isolated pea (Pisum sativum L.) root plastids. At the highest concentrations tested (3-5mM), the rates of incorporation of these precursors into fatty acids were 183, 154, 125, 99 and 57 nmol h-1 mg-1 protein, respectively. In all cases, cold pyruvate consistently caused the greatest reduction, whereas cold acetate consistently caused the least reduction, in the amounts of each of the other radioactive precursors utilized for fatty acid biosynthesis. Acetate incorporation into fatty acids was approximately 55% dependent on exogenously supplied reduced nucleotides (NADH and NADPH), whereas the utilization of the remaining precursors was only approximately 10 and 20% dependent on added NAD(P)H. In contrast, the utilization of all precursors was greatly dependent (85-95%) on exogenously supplied ATP. Palmitate, stearate, and oleate were the only fatty acids synthesized from radioactive precursors. Higher concentrations of each precursor caused increased proportions of oleate and decreased proportions of palmitate synthesized. Radioactive fatty acids from all precursors were incorporated into glycerolipids. The data presented indicate that the entire pathway from glucose, including glycolysis, to fatty acids and glycerolipids is operating in pea root plastids. This pathway can supply both carbon and reduced nucleotides required for fatty acid biosynthesis but only a small portion of the ATP required

Journal Article↗

PubMed1988

Deconvolution of emission tomographic data: a clinical evaluation.

A method of improving the quality of images in single photon emission computed tomography (SPECT) is demonstrated using transaxial images of the liver and brain. Deconvolution of the nuclear medicine data by a point source response function (PSRF) acquired previously in a scattering medium attempts to compensate for scattered radiation within the patient. The average geometric response of the collimator of the gamma camera is also compensated for with this technique. Three patients with known metastatic lesions in the liver and three with primary lesions in the brain were imaged. Clinical assessment of reconstructed slices both before and after deconvolution demonstrates that compensating for the effects of scatter and of collimator blurring leads to enhanced detail of pathological lesions. In all cases, cold lesions seen prior to deconvolution were enhanced in detail and, in addition, new lesions were seen with this technique.

Adult↗

PubMed2005

Epidemiological study of suicide in Croatia (1993-2003)--comparison of Mediterranean and continental areas.

The aim of this study is to analyze eventual differences in characteristic of suicide between two areas of the Republic of Croatia, mediterranean and continental, according to the following variables: suicidal rates, season, month, day, method, places, socioeconomic variables such as gender, ages, marital status, employment, education, and psychiatric or medical characteristic. Data were collected from the Suicide register of the Ministry of Interior, and Croatian Bureau of Statistic. Analysis was done on all suicide cases committed in the period 1993-2003. According to the Suicide Register of Ministry of Interior, 11,359 suicides were reported in period between 1993 and 2003. The average suicide rate in the Mediterranean area was lower (16.44 suicides per year) than in continental area of Croatia (26.34 suicides per year). Suicide committers in the Mediterranean area was statistically significant younger than suicide committers in the continental area of Croatia. In the continental area male suicide committers were more often than in the Mediterranean area of Croatia. In the Mediterranean area suicide committers were in most cases with high school education while in continental area of Croatia most cases of suicide committers were with elementary school education. Alcohol dependence, family conflicts, and medical disorders were more often present as suicidal motive in suicide committers in continental area of Croatia than in the Mediterranean area where undefined and unknown reason of suicide is present in majority of suicide cases. Cold steel, drowning, and jumping from height were more often present as suicidal method in the Mediterranean area of Croatia opposite to continental area of Croatia where jumping in front of car or train and suicide with firearms and explosive were more often. Also, in the Mediterranean area of Croatia suicides was mostly committed on open spaces and public places while in continental area of Croatia suicides was mostly committed in private plot.

Adolescent↗

PubMed1983

Scintigraphic appearance of the tibia in the early stages following fracture.

A scintigraphic study of the human tibia in the early stages following fracture of the shaft was carried out to investigate the condition of the blood supply of the main fracture fragments. Using a gamma camera and 99mTc-MDP, scintigraphs were obtained from less than 24 hours to 21 days after injury. A generalized increase in tracer uptake was found in the tibia in all cases. In some cases very early after injury there was an additional local increase at the fracture site. In 10% of cases "cold spots" were observed, which may indicate an impaired blood supply to bone tissue adjacent to the fracture. Neither the presence of a "cold spot" nor any other scintigraphic feature could be correlated with the progress or time to fracture union.

Adolescent↗

PubMedDate not supplied

[Effects of incubation temperature on the results of passive hemagglutination test].

Passive hemagglutination test was carried out at several incubation temperatures: 4, 21, 37, and 56 degrees C. Blood sera of donors, salmonellosis enteritidis patients, and specific nonadsorbed sera were used in the study. The least fluctuations of the results were seen in tests with the sera with the least manifest immune properties. The optimal incubation temperatures were found 4 and 21 degrees C, and in 1/3 of cases cold incubation was found preferable. The relationship between antibody titers and incubation temperature may be described by the formula: T4 > or = T21 > or = T37 > or = T56, with Tn representing the reverse value of antibody titer in certain incubation temperature.

Antibodies, Bacterial↗

PubMedDate not supplied

Histopathology of the liver in pediatric patients following transplantation.

Recognition of rejection and other hepatic complications by needle biopsy plays a significant role in the management of liver allograft recipients. In this report, 22 pediatric patients (below 18 years old) were selected from the 37 liver transplants. Seven of the 22 cases have an uneventful posttransplant course. The most common cause of allograft injury in these patients appeared to be acute cellular rejection. It occurred in 7 (31.8%) of the 22 cases and was the primary process in 8 of the 25 episodes of liver dysfunction. Other etiologies, such as opportunistic viral infection (3 cases), biliary obstruction (2 cases), preservation injury (1 case), and vascular obstruction (1 case) were less common. Acute graft rejection causing liver dysfunction was associated with a mixed portal inflammation, destruction of the interlobular bile ducts, and varied degree of venous endotheliitis, followed by centrilobular hepatocyte necrosis. Chronic rejection was not seen in our pediatric cases. Cold ischemic injury causing transient graft dysfunction as seen in one of our patients demonstrated focal, limited areas of hepatocyte necrosis, mild centrilobular hepatocyte ballooning, and cholestasis without evidence of bile duct damage. More severe ischemic injury resulted from vascular complication causing diffuse hepatocyte necrosis was seen in one patient with hepatic vein thrombosis. The histologic patterns observed were not pathognomic; however, liver biopsies were helpful in suggesting the probable cause of liver dysfunction and in predicting subsequent allograft recovery when used in conjunction with clinical information, radiologic, and other laboratory tests.

Adolescent↗

PubMed1989

Steroid-responsive idiopathic cold agglutinin disease: a case report.

We report a case of idiopathic cold agglutinin disease (ICAD) that responded well to corticosteroid therapy, though generally these patients show no response to such therapy. The cold agglutinins in this patient were found to be of low titer (1:32) and wide thermal range (4-37 degrees C). Three patients with ICAD were previously reported, also responsive to corticosteroid therapy and having the same characteristics of their autoantibodies. are likely to respond to corticosteroid therapy and that a therapeutic trial with such agents is warranted in these patients.

Adrenal Cortex Hormones↗