[Plasmid analysis and antibiotic resistance pattern measurement of Shigella in Chengdu].

A total of 81 strains of Shigella isolated from sporadic cases and cases in an outbreak of Shigella sonnei infection was analysed by plasmid profiles and antibiotic resistance patterns. The strains had a high resistance patterns. The strains had a high resistance of ampicillin, tetracycline, trimethoprim-sulfamethoxazole and chloramphenicol; while 97.2% of the strains were susceptible to gentamicin, kanamycin. The results showed that 50% of the strains harbored plasmid patterns within each species, which indicated that many genetically different strains of Shigella were responsible for dysentery epidemics in Chengdu. According to the results of the plasmid analysis and antibiotic resistance pattern measurement made in the outbreak strains, it was clearly seen that most of the strains were similar or fundamentally similar, which suggested that one or two strains with genetical homology were the main causative agent for the outbreak. We think that plasmid profiles and antibiotic resistance patterns are applicable to the identification of the outbreak strains of dysentery as an efficient epidemiologic tool.


[Biochemical studies of the temporomandibular ligament in dogs].

The purpose of this investigation was to determine the biochemical composition of the normal adult dog's temporomandibular ligament (TML) along its ligament (TML) along its length. Water content and hexosamine concentration as an index of glycosaminoglycan content and collagen concentration were quantified; and the results compared statistically with anatomically identified TML segments. The TML contained lower water content and higher collagen, hexosamine concentration than capsule (P less than 0.05). All the contents of these components in different locations along the ligament were not significantly different, with the exception that on the insertion site of the temporal eminence the concentration of the hexosamine was less than that in other areas (P less than 0.05). This study provided useful data for the analysis of TML functions and its mechanical properties.


[Technique of measuring esophageal pressure in rabbits and its application to measurement of pulmonary compliance and resistance].

Esophageal pressure (Pes) was measured under non-invasive condition by an esophageal balloon made by ourselves, and the optimal position of rabbits for measuring Pes was explored. The correspondence between Pes and pleural pressure (Ppl) was examined in rabbits during different depths of breathing with varied lengths of balloon and varied depths of insertion of balloon into the esophagus. The results showed that the amplitude of Pes only on supine position was higher than that on the left and right lateral and prone positions, but no significant difference was noticed among the 3 positions. The optimal balloon length was 4-6 cm. The optimal depth of insertion of balloon into the esophagus was 20 cm. The pulmonary dynamic compliance and pulmonary resistance were measured in 11 white rabbits with 5 cm balloon, 20 cm depth of insertion, on the left lateral position. The results were correspondent with other authors. No significant difference was noticed in repeated measurements on 8 of the 11 rabbits 5 days later.


[Study on variation of plasma gamma-aminobutyric acid concentration in rat model of hepatic encephalopathy due to fulminant hepatic failure].

The plasma gamma-aminobutyric acid (GABA) concentration was measured by a radio-receptor assay in rat model of hepatic encephalopathy due to fulminant hepatic failure (FHF) induced by intraperitoneal injection of D-galactosamine (GalN). The results showed that, in FHF group, the plasma GABA increased parallelly with the degree of hepatic encephalopathy after GalN i.p. (r = 0.944, P less than 0.05). In about 48 h, mean plasma GABA concentration was elevated nearly 8-fold. These findings suggest that, in liver failure, elevated plasma GABA concentration may play a role in the pathogenesis of hepatic encephalopathy.


[A preliminary study of the chord and specific time constants in 342 healthy children].

Using Knudson's method, the chord time constant, tau ch, tau ch75, tau ch50, tau ch25, and specific time constant, S tau, 1/V75, 1/V50, 1/V25, at high, middle and low lung volumes were calculated from V75, V50 and V25 of the MEFV curves measured previously from 342 healthy children of 3-6 years of age in a nursery. The multiple stepwise regression equation were built with age, height and FVC as independent variables by the IBM-XT/PC computer. The result showed that the S tau corrected by volume from tau ch could reflect the time required for change of unit lung volume more precisely than tau ch owing to the elimination of the influence of lung volume. The S tau was shortened with the increase of age, and was negatively correlate with age and FVC. These facts reflected the growth of lung elastic pressure (PLel) and airway conductance (Gaw) with the increase of age. The prolongation of S tau with the decay of lung volume just reflected the decrease of PLel and Gaw with the decay of lung volume. No regular changes of tau h were observed with age and lung volume. Probably, it was concerned with the complexity of factors affecting the tau ch.


[Observation of monoclonal antibody E4B7D5 inhibitory effect on leptospiral adherence using scanning electron microscope].

BALB/c mice were immunized intraperitoneally with outer envelopes of serogroup icterohaemorrhagiae lai serovar strain 017 leptospires. Monoclonal antibody (McAb) E4B7D5 against outer envelopes (IgG1, agglutinating titre 1:25,600) was produced by hybridoma technique. Passive immunoprotection experiments have demonstrated the immunoprotection of McAb E4B7D5 against strain 017 leptospires. Effect of McAb E4B7D5 on leptospiral adherence to the surface of normal human pulmonary embryonic fibroblasts was observed by using scanning electron microscope. The results indicated that the leptospiral adherence noted in various agglutinating titre McAb E4B7D5 groups was less frequent than that in the three control groups. It was concluded that the inhibitory effect of McAb E4B7D5 on leptospiral adherence may play a role in the immunoprotection.


[Effects of tian-ma injection on myocardial ischemia and lipid peroxidation in rabbits].

Lipid peroxidation initiated by oxygen free radicals played an important role in the pathogenesis of coronary heart disease. The purpose of this study was to explore the effects of Tian-Ma (Gastrodia elata Bl.) injection on myocardial infarct size and lipid peroxidation by observing serum malondialdehyde (MDA) levels. Twenty-six New Zealand rabbits were divided into control group (n = 6), ischemic group (n = 10), and Tian-Ma treated group (n = 10). Left ventricular branch (LVB) of coronary artery was ligated at its middle third in ischemic and treated groups. LVB was not ligated in control group. Tian-Ma injection was given intravenously (1 mg/kg) every 8 hours after ligation in treated group for 48 hours. Precordial 12-lead ECG mapping was recorded before operation and at 3, 24 and 48 hours after occlusion. Hemodynamic changes (HR, LVP) were monitored before and 0.5, 3 and 48 hours after ligation. Serum MDA levels were determined by thiobarbituric acid spectrophotometry before operation, and 0.5, 3, 9, 24, and 48 hours after ligation. Dual staining technique was used 48 hours after ligation to determine the area at risk and infarct size. The results showed that Tian-Ma injection did not decrease sigma ST elevation (P greater than 0.05), but NQ was significantly lower during ischemia in treated group (P less than 0.01), Tian-Ma injection reduced the area at risk by 23.5% (P less than 0.05) and infarct size by 34.5% (P less than 0.01). Tian-Ma injection significantly decreased the levels of serum MDA 24 and 48 hours after occlusion (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)


[Detection of G2m(n) factor in bloodstains using ELISA inhibition test].

For the purpose of detecting G2m(n) factor in human bloodstains, an ELISA inhibition test using mouse antihuman G2m(n) monoclonal antibody was established. The results revealed that the correctness rate for G2m(n) factor detection was 100%. The minimal amount of bloodstain required for detecting G2m(n) factor was 0.25 cm x 0.125 cm. This approach provided a new method for individual identification of human bloodstains.


[Clinical significance on expression of the ras gene product P21 in human cervical carcinoma tissues].

Using MAB-P21 as a probe, the expression of gene product was studied by immunohistochemical ABC method, ABC staining of gel electrophoresis and ELISA quantitative analysis. The expression of P21 was detected in 107 cases of uterine cervix tissues, among which 70 were cervical carcinoma, 30 were chronic cervicitis and 7 normal cervix. Experimental results showed that obviously positive expression was noted in the specimens of cervical carcinoma and its positive rate was 72.8% (51/70). It was observed that the expression of P21 varied with grades of cell differentiation in cervical carcinoma. The level of P21 expression in high differentiated type was higher than that of the middle and low differentiated types. On the contrary, there was no detectable ras P21 in the normal cervix tissue and only 2 cases of cervicitis expressed positively (2/30). The results of ABC staining of electrophoresis showed that there was a P21 special staining band in cervical carcinoma tissues. And the contents of P21 protein were higher in cervical carcinoma than in normal cervix and cervicitis (t test, P less than 0.001). The expression of P21 was considerably enhanced in malignant tissue as compared with that in benign lesion.


[Study of the estrogen receptor and progesterone receptor in human cervical carcinoma].

Three hundred and twelve different cervical specimens have been tested for estrogen (ER) and progesterone receptor (PR) content with dextran-coated charcoal method (DCC). The results showed that the concentrations of ER and PR in normal cervical tissues were higher than those in malignant cervical tissues, and that the percentage of positive scores for ER and PR in cervical squamous epithelial tissues were higher than that in malignant cervical tissues. That the variances of ER and PR in cervical malignant tumors were not parallel suggested that the production or/and the mechanism of receptor action might be impaired. The percentage of positive scores for ER was not correlated with the clinical stages whereas that of PR was inversely proportional to clinical stages. That some patient with cervical cancer had high level of PR and had both ER and PR positive implied the possibility for endocrine therapy. The content and distribution of ER and PR in normal cervical tissues are consistent with the effects of sex hormone.


[Estrogen and progesterone receptors in laryngeal carcinoma].

The existence of hormone receptors on or within neoplastic tissue has potential diagnostic, therapeutic, and prognostic importance. It has now been demonstrated in many reports that cancers of the breast and prostate often express hormone receptors and can be controlled by hormone manipulation. The fact that larynx is a target organ for androgenic steroids has long been known. The question of whether laryngeal carcinoma expresses hormone receptors has been a matter of interest. We adopted the fluorescent hormone conjugate method to measure the estrogen receptor (ER) and progesterone receptor (PR) in 25 patients with laryngeal cancer. Our findings indicated that in 25 samples of laryngeal cancer 48% were ER positive, and 68% were PR positive. Cells of the laryngeal cancer not only contain ER and PR but also have relationship between the presence of receptors and the degree of histologic differentiation. Low differentiated cancers are inclinable to contain low level receptors. From this initial survey it appears that the hormone receptors could play an important role in the cancer of larynx. The presence of receptors in some laryngeal carcinoma implicates that these tumors are possibly hormone sensitive.


[Study of quantitative diagnosis of cerebral arteriosclerosis].

On the basis of clinical diagnostic criterion of cerebral arteriosclerosis, we selected, 72 patients with cerebral arteriosclerosis, 72 patients with suspected cerebral arteriosclerosis and 70 healthy individuals and screened 42 variables obtained from clinical and accessory examination with a stepwise discriminant analysis and a stepwise regression analysis. Finally we performed a logistic discriminant analysis of 15 selected variables in order to establish diagnostic discriminant formulas, Ya and Yc. It was found that a diagnostic coincidence rate for rediscriminant analysis of 212 individuals with the formulas was 100%. Very high sensitivity (96.7%), specificity (100%), positive predicted value (100%), negative predicted value (83.3%) and accuracy (97.1%) were noted in a prospective double-blind test on 34 subjects. The authors suggest that the discriminant formulas Ya and Yc established for diagnosis of cerebral arteriosclerosis be widely applicated.


[Relationship between height, collagen metabolism, hair zinc and excessive fluoride intake].

After eliminating confounding factors, the study was made on the relationship between height, collagen metabolism, hair zinc and excessive fluoride intake. 140 schoolchildren aged 12-13 years born and reared in endemic fluorosis areas were surveyed. The results were as follows: 1. The average height of children with dental fluorosis III degree (DF III degree) was appreciably smaller than that of children without dental fluorosis. Among children with excessive fluoride intake, a negative correlation between the height and fluoride level in staple foods was seen. 2. The more the fluoride ingested, the higher the urinary THP excreted, showing that fluoride intoxication interfered with the collagen metabolism. 3. Among children with excessive fluoride intake, the height showed negative correlation with urinary THP/Cr, suggesting that the effect of fluoride on collagen metabolism indicated the mechanism of height retardation. 4. As compared to control group with the excessive fluoride intake but without dental fluorosis group, there was a significant reduction in hair zinc in group with DF III degree, suggesting that the zinc in the body decreased because of zinc metabolism disturbance by excessive fluoride intake. But among cases with excessive fluoride intake, no appreciable correlation between hair zinc and height was found. Therefore, it could not be confirmed that the effect of fluoride on zinc metabolism affected the height development.


[Relationship among dosages of aminophylline, plasma levels of theophylline and variation of pulmonary arterial pressure].

The relationship among the dosages of aminophylline, plasma levels of theophylline and variations of mean pulmonary arterial pressure (mPAP) in 72 patients with COPD was investigated. The results showed that after a different loading dosage of aminophylline (6 mg/kg, 5 mg/kg and 4 mg/kg) was administered by intravenous injection, mPAP in the 6 mg/kg group was decreased more significantly (P less than 0.01) than that in the 4 mg/kg group. In the 6 mg/kg group, the decreased mPAP period sustained for 120 min, which was longer than that in the other 2 groups. The plasma levels of theophylline in the 6 mg/kg group of patients 30 to 120 min after loading dose injected were 115.54-79.04 mumol/L, which were higher than that in the others. Within the 120 min period of observation after the drug was administered no patients in any of these groups showed severe untoward effects. According to the results of this experiment, we suggest that the 6 mg/kg as a loading dose should be advised for the treatment of pulmonary hypertension in COPD. The optimum time to give the maintenance dosage should be set within 2 h after the loading dose. It is necessary to monitor the plasma levels of theophylline while aminophylline is administered, so that optimal therapeutic effects could be achieved without side effects.


[The expression of oncogenes in the development of human brain].

Seven oncogenes (c-myc, L-myc, N-myc, v-erbB, c-fos, Ha-ras and mos) were used as the probe to detect the total RNA of every part (cerebellum, temporal folium, frontal folium and occipital folium) in human brain from 2 cases of 6 mon fetus and the total RNA in fetal development (4 mon, 5 mon, 6 mon, 7 mon, and newborn) of human brain tissue by RNA dot hybridization analysis. The results showed that most oncogenes were expressed at high level in cerebellum and occipital folium of 6 mon fetus and at low level in temporal folium; there was similar expression of c-myc, L-myc and N-myc in fetal development of human brain tissue, and the highest level was in the 5 mon fetal brain. There was no expression of erbB gene in normal human brain. The high level expression of Ha-ras and c-fos genes was in the middle and later stages of fetal development. These results suggested that c-myc, L-myc, N-myc, erbB, Ha-ras, c-fos and mos genes might play an important role in the fetal development of human brain.


[Plasma fibronectin determination in acute bacterial pneumonia].

Plasma fibronectin (PFn) level was measured with immunoelectrophoresis in 40 healthy adults and 30 patients with acute bacterial pneumonia. The results showed that PFn was considerably lowered in acute bacterial pneumonia (214.49 +/- 77.84 micrograms/ml) when compared with that of healthy controls (292.48 +/- 43.11 micrograms/ml), (P less than 0.001). In the pneumonia group (10 severe cases) the level of PFn was significantly lowered than that in the moderate or mild cases (127.45 +/- 31.03 micrograms/ml vs. 255.11 +/- 54.16 micrograms/ml), (P less than 0.001). In 11 cases of recovering pneumonia, PFn was significantly higher than that in exacerbation period (213.13 +/- 41.32 micrograms/ml vs. 154.52 +/- 51.27 micrograms/ml) (P less than 0.001). We think that PFn level is helpful to evaluate the clinical course and prognosis of acute bacterial pneumonia.


[The variations of PRL, LH, FSH and testosterone in renal disease].

Blood PRL was measured with RIA in 22 males and 19 females with various degrees of renal insufficiency. At the same time, blood LH, FSH, testosterone were studied in all the male patients and 20 sex-age matched healthy subjects. The results showed that the levels of PRL and LH were increased, and the level of testosterone was decreased significantly in male uremic patients. There was a significant negative correlation between PRL and testosterone. All the above parameters were measured again 8-25 days after continuous ambulatory peritoneal dialysis (CAPD) therapy in 5 male uremic patients. The BUN and Cr levels decreased and the clinical manifestations of uremia improved, but the levels of PRL, LH, FSH and testosterone showed no significant changes. The mechanisms of these variations were discussed.


[The antigastroulcerative activity of beta-sitosterol-beta-D-glucoside and its aglycone in rats].

Beta-sitosterol-beta-D-glucoside and its aglycone (the major constituent of the seed oil of Hippophae rhamnoides L.) were investigated for their antigastroulcerative activity in rats. Two experimental gastric ulcer models were selected: chronic acetic acid-induced ulcers and cold stress-induced ulcers. Both the glucoside and its aglycone showed antiulcerative activity in chronic acetic acid-induced gastric ulcer models, and their effects were at least comparable to the effects of wishupin in combination with cimetidine. The effect of aglycone appears better than the glucoside's. Glucoside also showed visibly antiulcerative effects on cold stress-induced ulcers, but wishupin combined with cimetidine did not have such effects.


Slateworker's pneumoconiosis.

Slate is a metamorphic rock comprising silica, aluminum silicates, and small amounts of chlorite, hematite, magnetite, and various carbonates. In the United States slate is quarried in Virginia, Pennsylvania, New York, and Vermont. Workers are exposed during mining and processing of the slate and in crushing mills that prepare gravel. We have conducted detailed mineralogic and pathologic studies on the lungs of 12 workers who developed a pneumoconiosis while employed in the quarries of west central Vermont and adjacent areas of New York. Perivascular and peribronchial lesions accompanied by interstitial fibrosis and macules were scattered diffusely in the lungs. The lesions were associated with a variable number of silicotic nodules. Scanning electron microscopy combined with energy-dispersive x-ray spectrometry demonstrated aluminum and silicon-containing particles with variable cationic constituents and silicon alone in a pattern typical of free crystalline quartz. By x-ray diffraction analysis the majority of the mineral particulates were free crystalline quartz and muscovite, an aluminum silicate in the mica group of minerals. Slateworkers are exposed to respirable airborne dust that has the capacity to produce a pneumoconiosis that differs from classic silicosis.


Neuropathology of the spinal cord in the acquired immunodeficiency syndrome.

The neuropathologic findings in the spinal cord were reviewed in 138 consecutive autopsies of patients with the acquired immunodeficiency syndrome. In all cases both the brain and spinal cord were examined by conventional histologic techniques, and in 63 cases immunohistochemistry was used to detect human immunodeficiency virus (HIV), Toxoplasma gondii, cytomegalovirus, and JC papovavirus antigens. The most common observation was a normal spinal cord (60%). Vacuolar myelopathy (VM) was observed in 23 (17%) cases. Human immunodeficiency virus myelitis was evident in 8% of cases. Human immunodeficiency virus myelitis was associated with HIV encephalitis in 65% of the cases. Opportunistic infections of the spinal cord were uncommon, consisting of cryptococcosis (five cases), cytomegalovirus (four cases), toxoplasmosis (one case), and progressive multifocal leukoencephalopathy (one case), and almost always were seen with cerebral and/or systemic infection by these agents. Malignant lymphoma rarely involved the spinal cord (four cases); all were B-cell lymphomas and were associated with cerebral and/or systemic lymphoma. Other abnormalities rarely observed were Wallerian degeneration of the corticospinal tracts or posterior columns (6%) and focal microinfarcts. Most cases of VM (78%) were not associated with HIV myelitis, and in the five patients with both VM and HIV myelitis, HIV-infected cells were not found in the regions affected by VM. In contrast, 65% of cases with VM were associated with HIV encephalitis. The pathogenesis of VM remains unknown; it is probably not due to direct infection by HIV.


Nodular lymphocyte-predominant Hodgkin's disease: study of immunoglobulin light chain protein and mRNA expression.

The techniques of immunohistochemistry and in situ hybridization were applied to 10 formalin- or B5-fixed, paraffin-embedded cases of nodular lymphocyte-predominant Hodgkin's disease to determine whether lymphohistiocytic (L&H) cells contain any detectable amount of immunoglobulin light chain protein or messenger RNA. None of the cases studied demonstrated any detectable amount of either kappa or lambda light chain mRNA within L&H cells or Reed-Sternberg cells despite positive labeling of plasma cells, immunoblasts, and germinal center cells. Polyclonal kappa light chain antibody studies showed positive staining of L&H cells in seven cases, including three costaining with polyclonal lambda light chain antibody. Monoclonal kappa and lambda light chain antibody studies, however, showed no staining of L&H cells despite positive staining of immunoblasts and plasma cells. It is suggested that L&H cells do not synthesize appreciable amounts of light chain immunoglobulin protein and are not closely related to reactive immunoblasts or germinal center cells.


Cardiac histologic pathology characteristic of trisomies 13 and 21.

To identify fetal histologic features characteristic of specific chromosomal anomalies, we reviewed histologic slides of 415 cases, including therapeutic and spontaneous abortuses, stillbirths, and perinatal deaths. These included 126 cases (30%) with karyotypically confirmed trisomy 21 and 23 cases (5.5%) with trisomy 13. Two histologic abnormalities of the fetal heart were identified that correlated with specific karyotypic abnormalities: (1) a discrete central papillary muscle calcification was present in 14 of 85 (16%) cases with trisomy 21, in seven of 18 (39%) cases with trisomy 13, and in six of 255 (2%) controls (P less than .001); and (2) a focal ventricular epicardial lymphocytic infiltrate was present in 22 of 93 (24%) cases with trisomy 21 versus nine of 284 (3%) controls (P less than .001). When both histologic abnormalities coexisted, trisomy 21 was present in five of six cases (83%). Neither histologic finding was significantly associated with fetal or maternal infection or congenital heart defects. In a restricted prospective study of the hearts of fetuses with trisomy 21, papillary muscle calcification was demonstrated by specimen radiographs in four of six (67%) cases; one case was studied by specimen ultrasonogram, which identified a papillary muscle echodensity. We conclude that (1) a focal ventricular epicardial lymphocytic infiltrate is characteristic of trisomy 21, (2) papillary muscle microcalcifications are characteristic of trisomies 13 and 21, and (3) further studies are needed to determine whether papillary muscle calcification might be useful in antenatal ultrasonographic screening for chromosomal anomalies.


The liver in systemic lupus erythematosus: pathologic analysis of 52 cases and review of Japanese Autopsy Registry Data.

We present pathologic findings for 52 livers (51 autopsy specimens and one wedge biopsy specimen) from patients with systemic lupus erythematosus (SLE). Hepatic congestion was the most common disease (40 livers), followed by fatty liver (38), arteritis (11), cholestasis (nine), peliosis hepatis (six), chronic persistent hepatitis (six), nonspecific reactive hepatitis (five), cholangiolitis (four), nodular regenerative hyperplasia of the liver (three), and hemangioma (three). The data obtained here suggest that arteritis of the SLE liver is more common than has been recognized previously. One patient had hepatic infarction complications induced by arteritis. On the basis of the findings in the present study and a review of the literature, we suggest that hepatic infarction resulting from arteritis is rare in SLE. On the other hand, while occurrence of nodular regenerative hyperplasia of the liver in SLE patients has been considered to be rare, our findings suggest that it may be more common than has been recognized previously. Although congestion and cholestasis may be acute terminal illnesses, fatty change is considered to be specific to the SLE liver. Statistical analysis indicates that exposure to a large dosage of glucocorticoids is a significant factor in the etiology of severe fatty liver. In addition, our review of Japanese autopsy registry data for 1,468 patients with SLE indicates that the incidence of chronic liver diseases in SLE autopsy cases is as follows: chronic hepatitis, 2.4%; cirrhosis, 1.1%; and liver fibrosis, 0.8%.


Pleomorphic variant of invasive lobular carcinoma of the breast.

Infiltrating lobular carcinoma (ILC) of the classic type is well recognized; less well appreciated is a group of variant forms of ILC, which includes solid, alveolar, mixed, apocrine, signet-ring, histiocytoid, and tubulolobular variants. In addition, Page et al (Diagnostic Histopathology of the Breast, Churchill Livingstone, 1987, pp 219-226) recently have emphasized the pleomorphic variant of ILC, which demonstrates the infiltrating pattern of classic ILC; however, the nuclei are more pleomorphic and have features that may overlap with those of infiltrating duct carcinoma. To determine whether pleomorphic ILC shows significant prognostic differences from classic ILC, we reviewed the clinical courses of 25 patients with classic ILC and compared them with 16 patients with pleomorphic ILC. The major determinant in placing ILC into the pleomorphic category was the presence of nuclei of nuclear grade 2 or 3. All classic ILCs had nuclei of grade 1 by the Scarff-Bloom-Richardson criteria. Survival to recurrence was significantly worse (P less than or equal to .05) for the patients with pleomorphic ILC at lengths of survival greater than 30 months. In addition, node-negative patients with pleomorphic ILC were four times more likely to experience recurrence than node-negative patients with classic ILC; those with positive nodes and pleomorphic histology were 30 times more likely to experience recurrence. Although there appeared to be a trend toward decreased overall length of survival for those patients with pleomorphic ILC when compared with patients with classic ILC, this difference was not statistically significant.


Graft eosinophilia in lung transplantation.

Graft eosinophilia was observed in lung biopsies from nine patients who received lung allografts. Five cases were associated with moderate to severe acute cellular rejection and responded well to steroid therapy. In this group the eosinophilia occurred early after transplantation and was associated with an elevated white blood cell count and occasional peripheral blood (one of five cases) and bronchoalveolar lavage (one of five cases) eosinophilia. A second group of four patients had graft eosinophilia due to infectious agents. In these cases patients frequently had underlying bronchiolitis obliterans (two of four cases) and developed tissue eosinophilia late after transplantation. Bronchoalveolar lavage cell profiles often demonstrated dramatic eosinophilia. Histologically, the biopsy specimens displayed an acute eosinophilic pneumonia, which was attributed to Aspergillus sp (two cases), coxsackie A2 virus (one case), and Pseudomonas maltophilia (one case). Two patients in this group died from infection. While eosinophils are a frequent cellular component of acute rejection reactions, they also may be the dominant cellular component in graft infection.


Lectin-binding profile of plasmacytoid monocytes.

The lectin-binding profile of plasmacytoid monocytes, also known as plasmacytoid T cells, was studied in 18 axillary lymph nodes draining invasive breast carcinomas. The plasmacytoid monocytes bound fluorescein-conjugated lectins from Canavalia ensiformis (Con A), Phaseolus vulgaris (PHA-L), Arachis hypogaea (PNA), Ricinus communis (RCA I and II), and Triticum vulgaris (WGA), but no reaction was found with those from Dolichos biflorus (DBA) and Ulex europaeus (UEA I). Fluorescence was bright and the reactivity was distributed in a granular pattern in the cytoplasm of plasmacytoid monocytes, a staining pattern similar to that of monocytes and macrophages. B and T lymphocytes usually exhibited weak staining with the same lectins, and this was limited to the cell membrane. Plasmacytoid monocytes were originally thought to be closely related to the T-cell system. The results of recent immunocytologic studies and the lectin-binding profile of plasmacytoid monocytes observed in this study, however, suggest that these cells are related to the mononuclear phagocytic system.


Anomalous right coronary artery associated with sudden death: an example of a neural crest migration defect.

A unique right coronary artery anomaly of hemodynamic significance was discovered in a young adult who suddenly died. In addition, abnormally migrated, or supernumerary, thymic tissue with embedded parathyroid glands was present. This combination of congenital malformations suggests that the pathogenesis of this rare cardiac anomaly may be explained by a cranial neural crest defect.


Primary large cell lymphoma of the splenic sinuses: a variant of angiotropic B-cell lymphoma (neoplastic angioendotheliomatosis)?

A case of large cell lymphoma of B-cell lineage originating in the splenic sinuses is described. In addition to widening the spectrum of primary malignant lymphomas of the spleen, this case raises the possibility that variants of angiotropic large cell lymphomas may exist that do not involve blood vessels but do involve the spleen and lymph node sinuses.


Adrenocortical blastoma.

We report a previously undescribed virilizing malignant adrenocortical tumor in an 21-month-old infant with elevated serum alphafetoprotein. The tumor consists of a peculiar mixture of immature epithelial and mesenchymal elements as well as slit-like spaces partially lined by primitive epithelial cells. Focally, the tumor has features reminiscent of the normal embryologic development of the adrenal cortex. A panel of immunohistochemical stains revealed only vimentin reactivity. We propose the term "adrenocortical blastoma" for this unusual neoplasm.


Benign lymphocytic angiitis and granulomatosis: a T-cell lymphoma?

Benign lymphocytic angiitis and granulomatosis is a T-cell lymphoproliferative disorder confined to the lung and corresponding to a low-grade angiocentric immunoproliferative lesion. Controversy remains as to whether these lesions are lymphomas. We report such a case in an 8-year-old patient with Burkitt's lymphoma in remission who presented with persistent bronchopneumopathy and bilateral pulmonary infiltrates on tomodensitometry. Surgical resection revealed the histologic changes of benign lymphocytic angiitis and granulomatosis. Immunohistochemistry showed no aberrant pan T-cell marker loss. Genetic analysis of frozen tissue by Southern blot DNA hybridization with probes to T-cell receptor beta- and gamma-chain genes and to the immunoglobulin heavy chain joining region gene (JH) identified no clonal rearrangement. Search for Epstein-Barr virus-DNA sequences by in situ hybridization and Southern blot analysis provided negative results. Our data imply that lowgrade angiocentric immunoproliferative lesions are not exclusively lymphomas but might represent a borderline lymphoproliferative disease (seen in the course of many diseases), perhaps corresponding to host immune response.


Chlamydia trachomatis and oral contraceptive use: a quantitative review.

Chlamydia trachomatis is now recognised as a major sexually transmitted disease; oral contraceptive use is rapidly increasing particularly in developing countries. There are thus important public health implications of the many reports that isolation of C trachomatis is more frequent among users of oral contraceptives. The aim of this analysis was to assess the strength and consistency of this association by summarising published studies between 1972 and 1990. Studies identified were grouped according to whether they were prospective or case-control studies. Data were extracted and pooled estimates of the unadjusted odds ratios were made for all studies, as well as for sub-groups defined by an index of study quality, background prevalence of C trachomatis, and the contraceptive comparison being made. Studies in the analysis were mainly conducted in Europe and North America; the meta-analysis was done at the Harvard School of Public Health, Boston, MA, USA. The pooled estimated unadjusted odds ratio for 29 case-control studies examined was 1.93 (95% CI, 1.77-2.11), indicating an almost twofold increased risk of chlamydial infection for oral contraceptive users. Neither study quality nor prevalence of C trachomatis modified this risk. When compared to the use of barrier contraceptives, however, the risk of infection for women using oral contraceptives increased to 2.91 (95% CI, 1.86-4.55). The pooled estimated protective effect of barrier methods in these studies was 0.34 (95% CI, 0.22-0.54). Cross-study comparisons of the relationship between oral contraceptive use and chlamydial infection are limited by the design and analysis of many component studies which did not control for confounding factors such as sexual behaviour and age. The almost twofold risk of increased chlamydial infection for oral contraceptive users, supported by the findings of two prospective studies, however, points to the importance of considering the risks and benefits of oral contraceptive use in women who are likely to be exposed to C trachomatis and other STDs. The protective effect of barrier methods emphasizes the continued need for promoting barrier methods of contraception.


Factors associated with genital chlamydial and gonococcal infection in females.

Predictors of chlamydia and gonorrhoea can be used to increase the cost-effectiveness and acceptability of screening programmes, and allow targeting of control strategies. All women attending an STD clinic in 1988-1990 were offered screening for chlamydia and gonorrhoea, and the test results correlated with a wide range of potential predictors using multiple logistic regression. Of 4822 attenders, 3533 (73.3%) were tested for chlamydia over a total of 5430 episodes, yielding 348 (6.4%) positives, and 3510 (72.8%) were tested for gonorrhoea over a total of 5450 episodes, yielding 100 (1.0%) positives. Independent predictors of chlamydial infection were being an STD contact, having endocervical gonorrhoea, being under 25, not having genital herpes, being Aboriginal, using oral contraception, not having a steady partner and having vaginal discharge or dysuria. For gonorrhoea such predictors were being Aboriginal, an STD contact, under 25, tattooed, having vaginal discharge or dysuria, and having had sex outside the state in the past three months. Selective screening criteria for gonorrhoea provided 91% of positives, eliminated the need for 42% of tests and resulted in an increased yield ratio of 1.5 whereas the corresponding outcomes for screening criteria for chlamydia were 91%, 29% and 1.3, respectively. The diversity of STD epidemiology requires development of empirical screening guidelines for diverse settings. Standardisation of methodology to facilitate comparisons and extrapolation should include investigation of a wide range of variables, available before patient examination, by multivariate analysis, and choice of selective criteria to cover at least 90% of the infected population as well as resulting in a substantially increased yield (preferably an increased yield ratio of at least 1.5).


Seroepidemiological and socioeconomic studies of genital chlamydial infection in Ethiopian women.

To measure the prevalence of chlamydial genital infection in Ethiopian women attending gynaecological, obstetric and family planning clinics; to identify the epidemiological, social and economic factors affecting the prevalence of infection in a country where routine laboratory culture and serological tests for chlamydial species are unavailable; to determine the risk factors for genital chlamydial infection in those with serological evidence of other sexually transmitted diseases. 1846 Ethiopian women, outpatient attenders at two teaching hospitals and a mother and child health centre in Addis Ababa, Ethiopia. Gynaecological outpatient department, antenatal, postnatal and family planning clinics. Sera were tested for type-specific anti-chlamydial antibodies using purified chlamydial antigens (C. trachomatis A-C (CTA-C), C. trachomatis D-K (CTD-K), Lymphogranuloma venereum (LGV1-3), and C. pneumoniae (CPn)), in a micro-immunofluorescence test. The genital chlamydia seropositivity was analysed against patient's age, clinic attended, ethnic group, religion, origin of residence, age at first marriage and first coitus, income, number of sexual partners, duration of sexual activity, marital status/profession, obstetric and contraceptive history, and seropositivity for other sexually transmitted diseases. Overall exposure to chlamydia species was found in 84%, genital chlamydial infection in 62%, and titres suggestive of recent or present genital infection in 42% of those studied. Genital chlamydial infection was highest (64%) in family planning and lowest (54%) in antenatal clinic attenders. Exposure to genital chlamydia species was influenced by ethnic group and religion. Those married and sexually active under 13 years of age had greater exposure (69%) to genital chlamydial infection than those first sexually active aged over 18 (46%). Prevalence of infection was highest in those with more than five sexual partners (78%) and in bargirls (84%). The lowest income groups had a higher prevalence (65%) of genital chlamydial infection than the wealthiest (48%). Multivariate analysis showed the most important factors to be age at first coitus, religion, prostitution and present age of the woman in that order. Risk for genital chlamydial infection was increased in those with seropositivity for syphilis, gonorrhoea, HSV-2 but not HBV infection. CONCLUSION/APPLICATION: Chlamydial genital infections are highly prevalent in both symptomatic and asymptomatic Ethiopian women. The high prevalence of infection reported reflects a complexity of socioeconomic factors: very early age at first marriage and first coitus, instability of first marriage, subsequent divorce and remarriage or drift into prostitution, all of which are influenced by ethnic group, religion and poverty--together with transmission from an infected group of prostitutes by promiscuous males to their wives, lack of diagnostic facilities and inadequate treatment of both symptomatic and asymptomatic men and women. The problem of chlamydial disease in Ethiopia needs to be addressed urgently in the context of control of STD.


Incorporating patients' views in planning services for women with HIV infection.

To determine the preferences of HIV seropositive women for out-patient care facilities. Cross sectional survey. An HIV out-patient clinic, a genitourinary medicine (GUM) clinic and a self support group for HIV seropositive women. Fifty consecutive HIV seropositive women attending the out-patient clinic and 18 women attending the self support group. Eighty percent of the women were comfortable in the HIV clinic. The discomfort felt by the remainder related to time spent in the waiting room. All the women reported feeling comfortable in the GUM clinic. However, 46% indicated a preference for a clinic attended only by female patients and 34% stated that they preferred only female staff. At the time of the survey only 61% of women attending the self support group were attending an outpatient clinic. An HIV clinic with integrated family planning, gynaecology, social workers and a creche was a universal preference expressed by these women. They also indicated a preference for female doctors (83%). Women with HIV infection have clear views on the facilities which they would prefer to be available in regard to their out-patient care. In response to these wishes and particularly because of the high percentage of women not currently attending for outpatient care we have commenced a women only clinic.


Teenagers and the risks of sexually transmitted diseases: a need for the provision of balanced information.

Evaluation of teenagers' knowledge and understanding about sexually transmitted disease, conception and contraception. A questionnaire study. Schools 1025 teenagers aged 15/16 years (mean 16.00). Scores attained in response to questions about sexually transmitted disease related to the sources of information given as most helpful. Teenagers have an incorrect understanding of the risks of sexually transmitted diseases. Teenagers may substantially underestimate their personal risk of contracting sexually transmitted diseases following the promotion of information about HIV/AIDS. Apparently simple messages about HIV and AIDS given in mass media advertising programmes may have unwanted results and need to be balanced by appropriate professional interpretation to teenagers.


Sexual behaviour in Zulu men and women with genital ulcer disease.

OBJECTIVE--To investigate patterns of sexual behaviour in men and women with genital ulcer disease (GUD) and their relevance to HIV-1 transmission. METHODS--A sexual behaviour questionnaire was administered by the same interviewer to all participants who were also entered into a study of the microbial aetiology of GUD. SETTING--City Health Sexually Transmitted Diseases Clinic, King Edward VIII Hospital, Durban, South Africa. PARTICIPANTS--100 Zulu men and 100 Zulu women. RESULTS--36 (%) of men and 36 (%) of women had continued with sexual intercourse despite GUD. Patients with donovanosis and secondary syphilis were more likely than those with other causes of GUD to have intercourse despite ulcers. During swab collection bleeding was observed from ulcers in 59 women and 26 men. Prostitutes were not identified and were rarely named as source contacts. Men had more sexual partners (190) than women (122) during the previous three months. Condom use was minimal. Men who migrated between urban and rural areas appeared to have the most sexual partners. Urban women had more partners than women from rural areas. CONCLUSIONS--Men and women with GUD are practising riskful sexual behaviour and could benefit from behaviour modification programmes. In this community men who travel between urban and rural areas and who present late with GUD that bleeds easily are probably the most important high-frequency HIV transmitter core group. A significant potential risk of blood to blood contact during sexual intercourse exists in patients with GUD.


IgM rheumatoid factor removal and performance of the FTA-ABS (IgM) test in congenital syphilis.

To determine the performance of the FTA-ABS (IgM) test in congenital syphilis after eliminating interference by IgM rheumatoid factor (RF) and preventing competitive inhibition by IgG. The FTA-ABS (IgM) test was carried out before and after RF removal (achieved by immunoprecipitation of the IgG) in infants with congenital syphilis and controls. Newborns delivered in the Peninsula Maternal and Neonatal Services in Cape Town and infants presenting at Red Cross War Memorial Children's Hospital. Infants with congenital syphilis aged 0-4 months were divided into those with clinical signs at presentation and those who were asymptomatic at delivery. In addition, patients without congenital syphilis but with similar clinical signs at presentation were investigated as were control infants. The diagnosis of congenital syphilis was based on the criteria suggested by Kaufman et al (1977). Amongst symptomatic infants with congenital syphilis the FTA-ABS (IgM) test was positive in 34 (92%) of 37 cases prior to abolishing the RF effect and in 29 (78.4%) of 37 cases afterwards (p = 0.19). In 12 cases of congenital syphilis who were asymptomatic at birth, 10 had positive FTA-ABS (IgM) tests before RF removal and only three had positive tests afterwards (p = 0.006). False positive tests were not found amongst 15 symptomatic infants whose clinical features mimicked those of the infants with congenital syphilis. Among 51 healthy infants the test had a false-positive rate of 2% in newborns and 13% in older infants. The false positive reactions were eradicated by IgG precipitation. Following IgG and RF removal there was an improvement in the specificity of the FTA-ABS (IgM) test but this was at the expense of a loss of sensitivity, particularly in asymptomatic newborns. For newborns, if the FTA-ABS (IgM) test was positive, the patient was likely to require treatment for congenital syphilis, regardless of whether the result was due to the presence of RF or specific IgM.


Transmission of HIV-1 infection by oroanal intercourse.

We report the cases of two homosexual men, one of whom is believed to have been infected with HIV-1 during oroanal intercourse with the other, his only current sexual partner. Both patients had sero-conversion illnesses with similar symptoms and signs, and of similar duration. The practise of oroanal intercourse is known to be associated with the transmission of enteric infections and has been implicated in the epidemiology of Kaposi's sarcoma. These well-documented cases indicate that HIV-1 may also be transmitted by this route and supports a cautious approach to recommendations regarding "safer" sex.


Concurrent salmonellosis and histoplasmosis in AIDS: an unusual co-existence in Britain.

A patient is described with systemic salmonellosis which was unresponsive to therapy. Histoplasma capsulatum was isolated after death and we suggest that dysfunction of the reticuloendothelial system by H. capsulatum may have altered the prognosis.


A serological test for granuloma inguinale.

An indirect immunofluorescence technique applied to paraffin embedded tissue sections of lesions containing Donovan bodies was evaluated as a serological test for the diagnosis of granuloma inguinale. Sera from patients with proven granuloma inguinale, other sexually acquired genital ulcerations and blood donors from areas where granuloma inguinale is rarely encountered as well as from disease-endemic regions were tested. Sera were tested either unabsorbed or following absorption with whole Klebsiella pneumoniae bacteria. Using unabsorbed sera at a dilution of 1:160 the test was found to have a sensitivity of 100%, specificity of 98%, positive predictive value (PPV) of 89% and negative predictive value (NPV) of 100%. There proved to be no advantage in preabsorbing sera with K. pneumoniae antigen. In the absence of culture methods for Calymmatobacterium granulomatis, an indirect immunofluorescence technique may prove valuable for the diagnosis of individual cases of granuloma inguinale and as an epidemiological tool in studies of the disease.


Health in education for all: enabling school-age children and adults for healthy living.

The goals of Education for All and Health for All are inseparably linked. Both aim at equity and must be achieved concurrently. Good health is essential for effective learning, and education is a powerful means of enabling children and adults to attain and maintain health and wellbeing.


School health education at the crossroads.

There are about one billion [corrected] young people of school age in the world today. Out of this number, hundreds of millions are actually attending school. They constitute the greatest single readily reachable population group providing the ideal opportunity for achieving a brighter health future.


Comprehensive school health education: suggested guidelines for action.

This document is an outcome of the WHO/UNESCO/UNICEF Consultation on Strategies for Implementing Comprehensive School Health Education/Promotion Programmes held in WHO, Geneva from 25 to 29 November 1991. Twenty-five experts attended from the health education sectors of sixteen countries, as well as six NGOs together with the three cosponsors WHO, UNESCO and UNICEF plus UNFPA. The Consultation arrived at a consensus on a comprehensive approach to school health education and guiding principles for action.


Selecting measures for human factors research.

Selecting measures is a necessary component of human factors research. Proper selection must take into account the representation problem (how is the assignment of numbers to objects or phenomena justified?) and the uniqueness problem (to what degree is this assignment unique?). Other key human factors measurement issues include subject representativeness, variable representativeness, and setting representativeness. It is difficult to create a single measure that captures essential characteristics of complex systems. Several examples illustrate how theory can guide measurement selection in such diverse human factors research as vigilance, turning off warning alarms, information requirements for military command centers, subjective workload, heart-rate signal analysis, and heat stress in nuclear power plants.


Establishment and characterization of monoclonal antibodies to carbohydrate antigens on peanut agglutinin receptor glycoprotein of gastric cancer KATO-III.

Eight mouse monoclonal antibodies, GOM-1, GOM-2, GOM-3, GOM-5, GOM-6, GOM-7, GOM-8 and GOM-9 were established that recognized carbohydrate antigens on the human gastric cancer cell line KATO-III. Their binding specificities were studied by enzyme-linked immunosorbent assay, cellular enzyme-linked immunosorbent assay, flow cytometry analysis and thin layer chromatography immunostaining. All these monoclonal antibodies bound to peanut agglutinin receptor glycoproteins and neutral glycolipids extracted from KATO-III cells, but they could be divided into three groups, namely GOM-1, -3, -9 group, GOM-5 and GOM-2, -6, -7, -8 group. GOM-3 specifically bound to the Le(a) structure, Gal beta 1-3 (Fuc alpha 1-4) GlcNAc beta 1-, and GOM-5 specifically bound to the Lec structure, Gal beta 1-3GlcNAc beta-. GOM-2 showed specific binding to KATO-III, but little or no binding to various other cell lines examined or to normal human leukocytic cells. It also did not bind to the synthetic glycoconjugates tested, carrying 10 different terminal sugar chains including T, Tn, Le(a), Lec and Le(x) structures. The binding specificity of GOM-2 was also different from those of the monoclonal antibodies anti-Le(x), anti-Leb and anti-Ley. These results suggest that GOM-2 recognizes a new carbohydrate antigen on KATO-III cells that is distinct from Le(a), Leb, Lec, Le(x), Ley, T and Tn structures.


Quadroma-secreted bi(interferon alpha 2--peroxidase) specific antibody suitable for one-step immunoassay.

A mouse hybridoma (quadroma) was prepared by fusing hybridomas producing monoclonal antibody of G1-isotype to human interferon-alpha 2 with hybridomas producing monoclonal antibody of G2a-isotype against horseradish peroxidase. The established quadroma line secreted immunoglobulins of both G1/G2a-isotypes which manifested parental and bispecific binding characteristics. Culture supernatant containing the bifunctional antibody cross-linking interferon and peroxidase was used for a one-step immunoassay. The developed sandwich ELISA was able to detect the human interferon-alpha 2 at a concentration of 10 units/ml (0, 1 ng/ml) within 2-3 hours.


Human hybridoma generation by hypo-osmolar electrofusion: characterization of human monoclonal antibodies to Schistosoma mansoni parasite antigens.

Human monoclonal antibodies which bind Schistosoma mansoni worm and egg antigens were identified and characterized from hybridomas generated using the hypo-osmolar electrofusion technique of somatic cell fusion. Splenocytes from S. mansoni infected individuals were mitogen-activated in vitro and subsequently fused by electrofusion. The greatest number of HAT resistant hybridomas per helical fusion chamber was obtained with unfrozen splenocytes cultured for 4-6 days after introduction of mitogen. Hybridomas secreting IgG antibodies recognizing parasite antigens were identified by ELISA. Twenty-one cloned cell lines secreting IgG antibody were maintained for at least 6 months. Characterization of antigen reactivity by Western blot analysis of nien cloned cell lines revealed antibodies which bound stage specific parasitic antigens. The data show that the technique of hypo-osmolar electrofusion produces stable, antibody producing hybridomas. The human monoclonal antibodies screened represent candidate molecules useful in the investigations of the human pathogen S. mansoni.


Preparation of monoclonal antibodies against acid alpha-D-glucosidase for study of Chinese glycogenosis type II patients.

Two monoclonal antibodies (Mabs), 8-23 and 4-6, against human acid alpha-D-glucosidase were generated to analyse the intracellular alpha-D-glucosidase from seven Chinese Pompe's disease families with the following study design: [1] Purified alpha-D-glucosidase from normal human urine was used as antigen for immunization of mice. [2] The splenic cells of immunized mice were isolated and fused with myeloma cells NS-1 for generation of hybridomas and production of anti-human alpha-D-glucosidase Mabs and detection of presence of the enzyme in skin fibroblasts obtained from the Pompe's disease families and normal controls. [3] Functional assay of acid alpha-D-glucosidase was done. Both generated Mabs were IgG1 with a kappa light chain. Mabs 8-23 and 4-6 can recognize 70 kd (kilodaltons) alpha-D-glucosidase evidenced by radioimmunoprecipitation (RIP). Our results showed that alpha-D-glucosidase did exist in the skin fibroblasts of all seven Pompe's disease patients by RIP and in the hepatic cells by immunohistological study. However, functional assay of alpha-D-glucosidase of the seven patients with Pompe's disease showed that the enzyme function of alpha-D-glucosidase was defective. This finding is at variance with the results of other workers which indicated that the amount of mature enzyme was reduced or totally absent in most of the juvenile and adult Caucasian and South African patients. The discordance may imply that the cause of alpha-D-glucosidase deficiency in Chinese patients is quite different from that in Caucasian and South African patients. This needs further study to clarify.


Quantification of glomerular epithelial cell adhesion by using anti-DNA antibodies in ELISA.

A sensitive and reproducible microassay is described for quantification of adhesion of cells to matrix-coated 96-wells plates under different experimental conditions. For this purpose glomerular visceral epithelial cells (GVEC) were used. Attached GVEC were fixed with methanol and incubated with a monoclonal anti-DNA antibody. Following standard procedures, the amount of bound antibody was quantified by ELISA. A positive linear relationship in the range of 800-5000 cells per well was found between OD values and cell numbers obtained by hand-counting (r = 0.94, p less than 0.001). The assay is 10 to 100 times more sensitive than most other adhesion assays. The applicability of the ELISA assay was demonstrated by manipulation of the temperature during adhesion and by using different concentrations of the matrix-molecules fibronectin, EHS-laminin and collagen type I. The ELISA assay was found to be unaffected by non-specific interaction of anti-DNA antibodies with the matrix molecules used for coating. The assay was neither affected by potential release of DNA from the GVEC under these different experimental conditions. In conclusion, this cell adhesion microassay is simple, reliable, sensitive, and cost-effective, since it requires small amounts of GVEC and reagents.


Angioplasty of total coronary occlusions using combination of intracoronary Probing Catheter and balloon on wire Probe.

We describe our experience with a technique for PTCA of total coronary occlusions using the ultra low profile balloon on wire Probe. An intracoronary Probing Catheter was used to facilitate crossing the stenosis with a guide wire. This was followed by exchanging the guide wire for the Probe into the obstruction for balloon dilatation. This technique was used in 22 consecutive patients undergoing PTCA for chronic total occlusion. The total obstruction could be crossed by guide wire (0.014 flex or 0.016 standard) passed through Probing Catheter in 19 patients (86%). The obstruction could be successfully dilated by the Probe, delivered through the probing catheter, in 17 of these patients. Of the remaining 2 patients, one could be dilated by sequential dilatation using over the wire low profile balloon system and the other one by dilatation with the Probe, respectively. The Probing Catheter technique offers a new method to apply balloon on wire technology to the dilatation of chronic total coronary occlusions with very promising results.


Cross sectional echocardiographic left ventricular ejection fraction: method based variability.

Cross-sectional echocardiographic left ventricular ejection fraction (LVEF) by five different Methods (Teichholz, Area-length, single-plane Simpson, Bullet and Baran Formulae) was determined in 24 normal healthy volunteers (male-17, female-7, age range 16-80 years, mean 37 +/- 13) to assess the method-dependent variability in left ventricular volumes and LVEF. Although the Teichholz and Bullet methods gave somewhat higher values, there was no significant difference between LVEF determined by any of the methods (F = 0.16, p greater than 0.50). There was an a symmetrical distribution of LVEF in this normal group with an absolute mean positive skewness of 6 per cent (range 4-7 percent, coefficient of skewness = +0.43 to +0.87). A cut-off normal lower limit of LVEF at 50 per cent encompassed 88-100 per cent (mean 93.3) of subject population depending upon the method used. Similarly there was no significant difference between left ventricular volumes obtained by various methods. Therefore all the above five methods for quantitation of left ventricular global function are equally useful in clinical studies in patients with normal left ventricular geometry and in absence of segmental asynergy.


Semi-quantitative planar scintigraphy using thallium 201 for detection and localization of coronary artery disease: correlation with coronary angiography.

Thallium 201 exercise redistribution planar myocardial perfusion scan using semiquantitative technique was performed in 80 symptomatic patients undergoing coronary angiography. Out of the 240 vessels studied by angiography, more than 70% luminal narrowing was detected in 87 vessels, borderline stenosis was found in 49 arteries and the remaining 104 vessels were normal. Thallium scan correctly identified the significant stenosis in 76 vessels and the absence of stenosis in 102 vessels. In addition, perfusion abnormality was found in relation with 21 vessels of borderline stenosis. The sensitivity and specificity of Thallium scan were estimated as 92% and 95% for left anterior descending artery (LAD), 79% and 98% for left circumflex artery (LCX), 88% and 100% for right coronary artery (RCA) and 87% and 98% for all coronary arteries combined together (ACA).


Do hemodynamic indices correlate with maximum exercise capacity and oxygen consumption in chronic congestive heart failure?

The mechanism of exercise intolerance in chronic congestive heart failure remains unclear. We correlated resting haemodynamic variables with the peak exercise capacity and maximum oxygen consumption (VO2 max) in patients with congestive heart failure in 27 studies on treadmill exercise testing using the modified Bruce protocol. VO2 max was measured using breath by breath expiratory gas analysis. The patients were in severe congestive heart failure (NYHA class II and III, pulmonary artery wedge pressure 23 +/- 2 mmHg, cardiac index 2.4 +/- 0.21 l/min/m2). VO2 max was 23 +/- 2 ml/kg/min. Fatigue was the commonest symptom limiting the exercise. None of the hemodynamic variables correlated well with VO2 max. [right atrial pressure (r = 0.08), pulmonary artery pressure (r = 0.05), pulmonary artery wedge pressure (r = 0.08), aortic pressure (r = -0.3) & cardiac index (r = 0.29)]. Both uni- and multi-variate analysis failed to show any relation between VO2 max and resting hemodynamic variables. We conclude that unlike the acute heart failure syndromes, resting hemodynamic variables do not correlate with exercise capacity in patients with chronic congestive heart failure. The abnormal resting haemodynamics do not limit exercise in these patients. Peripheral mechanisms may thus be more important.


Membrane instability in respiring mitochondria: role of phosphate.

Metabolically-induced (spontaneous) high amplitude swelling of mitochondria has been shown to be due to a serial disruption of the mitochondrial membranes [D. Sambasivarao & V. Sitaramam (1985), Biochim Biophys Acta, 806, 195-209]. Phosphate- and arsenate-induced swelling was investigated in mitochondria to evaluate the role of phosphate transport in the instability created in the mitochondrial membranes. Phosphate-induced swelling in respiring mitochondria was similar to spontaneous swelling. Both represent essentially colloidal swelling due to the variable porosity induced in the inner membrane to polyols by respiration. Swelling of non-respiring mitochondria at high ammonium phosphate concentrations was, on the other hand, primarily due to high permeability to phosphate. This membrane instability created by phosphate transport in the surrounding lipid involves neither the endogenous nor the exogenous Ca2+.


Membrane skeletal protein structure and interactions in human erythrocytes after their treatment with diamide and calcium.

To analyse the role of native structures of membrane proteins in their structural modifications induced by the elevated intracellular free Ca2+ levels, we have studied the Ca(2+)-mediated effects on membrane skeletal proteins in human erythrocytes that were loaded with Ca2+ using the ionophore A23187 after their pretreatment with the sulphydryl oxidizing agent, diamide. The diamide treatment not only induced polymerization of the major membrane skeletal protein, spectrin, in the erythrocytes, but it also promoted intersubunit crosslinking within the tetramers and dimers of this protein. Loading of these diamide-treated cells with Ca2+ failed to induce significant structural modifications of spectrin as well as polypeptide 4.1, another major membrane skeletal protein, as compared to the erythrocytes that were loaded with Ca2+ without the diamide pretreatment. These results have been interpreted to suggest that the Ca(2+)-induced membrane skeletal protein changes in erythrocytes depend on both the shape and relative orientation of these proteins within the membrane skeleton.


A comparative evaluation of metoprolol and methyldopa in the management of pregnancy induced hypertension.

Thirty patients matched for age, parity, socioeconomic status and severity of pregnancy induced hypertension (PIH) were randomly allocated to treatment with metoprolol or methyldopa. The average fall in diastolic blood pressure was significant in the group treated with metoprolol as compared with the methyldopa group (p less than 0.01). There were 3 perinatal deaths in the methyldopa group and 1 in the metoprolol group; the mean birth weight of the babies was higher in cases treated with metoprolol. The results suggest metoprolol to be more efficacious with regard to control of hypertension and fetal outcome in cases of pregnancy induced hypertension.


Assessment of left ventricular diastolic function in young diabetics--a two dimensional echo Doppler study.

Left ventricular diastolic function was assessed in 21 young diabetic subjects (less than 35 years) by Doppler transmitral flow velocity examination and compared with an equal number of matched controls. Diabetic subjects had higher heart rates (89 +/- 2 vs 79 +/- 4 beats/minute, p less than 0.015), peak late diastolic (A) velocity and a velocity time integral (56.6 +/- 13.4 vs 45.3 +/- 11.4 cm/sec. p less than 0.005 and 7.3 +/- 5.2 vs 6.5 +/- 2.5 cm p less than 0.03 respectively) and total transmitral flow velocity integral (25.8 +/- 5 vs 22 +/- 3.2 cm, p less than 0.05). Peak E velocities, E velocity time integrals, E/A ratio, and peak filling rates were similar in two groups (p = not significant). These data suggests that young patients with diabetes mellitus have normal left ventricular diastolic function. The minor transmitral flow abnormalities are possibly due to autonomic dysfunction, e.g. increased sympathetic activity resulting in increased heart rate and cardiac output.


Low dose amiodarone in refractory tachyarrhythmias.

Fifty patients with drug resistant tachyarrhythmias were treated with amiodarone for 6-22 months; 16 for recurrent ventricular tachycardia (VT), 2 for VT followed by ventricular fibrillation (VF), 14 for complex ventricular ectopics, and 18 for supraventricular tachyarrhythmias (SVT). Amiodarone was administered in a dose much lower than that used in western trials. The actual incidence of successful amiodarone therapy was 81.2% at 22 months for patients with VT. Among the patients with SVT, 88.6% patients were successfully treated for 22 months (range 3-22 months). Amiodarone toxicity appeared in 22 of 50 patients (44%) treated for more than 12 weeks. Withdrawal of therapy was required in 4 patients. Despite the lower dose, clinical efficacy and onset of action were comparable to the western experience.


Molecular anatomy of the transcription complex of Escherichia coli during initiation.

Transcription is the foremost event in gene expression in which the enzyme RNA polymerase copies the genetic information from DNA to RNA. Much of our understanding of this process have come from studies carried out in Escherichia coli. A faithful and efficient transcription machinery of E. coli can be reconstituted in vitro with purified RNA polymerase and promoter-containing DNA. It is generally believed that in E. coli and most other organisms, the control of gene expression lies with the initiation of transcription. In this review, an attempt has been made to understand the mechanistic details of the initiation of transcription from the structural point of view of the promoter and the RNA polymerase. Allosteric nature of the enzyme has also been discussed at the end.


Congenital complete heart block in structurally normal heart--a study of 44 cases.

Data of 44 patients with congenital complete heart block and structurally normal heart have been analysed. Thirty one patients were asymptomatic (group I) and 13 patients had symptoms of low cerebral perfusion like syncope, near syncope or convulsions (group II). A ventricular rate on surface ECG was found to be significantly lower in the symptomatic group (56.7 +/- 13.2 beats per minute, bpm, in group I and 46.5 +/- 6.0 bpm in group II). Similarly wide QRS escape rhythm of greater than 0.10 seconds was more often seen in group II (2/13) as compared to group I (2/31) though the difference did not reach statistical significance. Presence of pauses of more than 3.0 seconds on ambulatory ECG monitoring were infrequent in both the groups (group I 1/7, group II 2/7), however more often seen in group II. Electrophysiological studies carried out in 11 patients were not helpful in differentiating the two groups and all the patients including two with a wide QRS escape rhythm on surface ECG showed suprahisian level of block. The corrected junctional recovery time in two groups did not show any statistical difference. A persistently slow ventricular rate of less than 50 bpm during waking hours, wide QRS escape rhythm and pauses of greater than 3 seconds on ambulatory monitoring are suggestive of high risk to the patient and may justify implantation of permanent pacemaker even in asymptomatic patients.


Absolute reaction rate and kinetics of protein adsorption at solid-liquid interfaces.

Extents of adsorption of bovine serum albumin from aqueous solution to the surface of alumina, silica, carbon and chromium powder have been studied as function of time for various values of bulk protein concentration, pH, ionic strength and temperature. The rates of adsorption in all cases have been observed to fit in the first order rate equation with two different rate constants Ka1 and Ka2. Effects of addition of SDS, CTAB and neutral salts on values of Ka1 and Ka2 have also been studied. Using Arrhenius equation the activation energy values Ea1 and Ea2 have been evaluated from the values of Ka1 and Ka2 at three different temperatures, respectively. The corresponding values of enthalpy of activation (delta H*), entropy of activation (delta S*), and free energy of activation (delta G*) have been evaluated using Eyring's equation of absolute reaction rate. The mechanism of protein adsorption has been discussed in the light of basic principles of absolute reaction rate. It has been found that for Ka1 the delta H*1 greater than T delta S*1 and for Ka2 T delta S*2 greater than H*2, i.e. the anchorage and binding of protein to the surface are enthalpy controlled processes whereas the surface denaturation as well as rearrangement and folding is an entropy controlled process. The role of diffusion on rate of adsorption has also been discussed.


Amphiphilic properties of polysaccharides: dextrin chains as example.

Polysaccharide chains are usually considered to be highly hydrophilic, since they contain no obvious apolar moieties. However, it is possible for even these chains to display hydrophobic character, arising out of stereochemical constraints in the chain. We had earlier shown that linear dextrin chains display amphiphilic properties, since all the hydroxyl groups are disposed on one side or face of the chain and the hydrogens disposed on the other. We provide further evidence here for this conclusion that dextrins are amphiphilic chains. In contrast, dextrans and cellulosic chains do not display amphiphilicity. Oligosaccharides that can adopt incipient helical structures might display amphiphilicity. This property might be relevant to intermolecular recognition on cell surfaces, lectin-sugar binding, antigen-antibody interactions and the like, and might be manifested more in a heteromolecular recognition process than as homomolecular self-aggregation.


Mechanism of ribosomal subunit association: oligodeoxynucleotides as probes.

From the kethoxal treatment data [Herr, W.; Chapman, N.M.; Noller, H.F. (1979) J. Mol. Biol. 130, 433-439] some regions of ribosomal RNAs are thought to be responsible for the association of 30S and 50S ribosomes of E. coli to form 70S ribosomes. In order to test this possibility about a dozen oligodeoxynucleotides complementary to the suspected regions of rRNAs were synthesised. Their association with ribosomes and naked rRNAs was tested by the gel filtration technique. In order to check the effects on the ribosomal subunit association or rRNA association either intact 30S and 50S ribosomes or naked 16S and 23S rRNAs were preincubated with the individual oligodeoxynucleotide and its effect was checked by density gradient centrifugation followed by UV absorbance monitoring. Some oligodeoxynucleotides interfered with either subunit association or 16S RNA and 23S RNA association, some with both. These data clearly indicate that RNA-RNA interaction plays the major role in ribosomal subunit association.


An analysis of initial results of percutaneous transluminal coronary angioplasty for totally occluded coronary arteries.

A retrospective analysis of 680 Percutaneous Transluminal Coronary Angioplasties (PTCA) performed from April 1986 to October 1990 revealed that 81 patients had PTCA performed on 86 totally occluded coronary arteries (1.06 lesions/patient). Four of the 86 were acute occlusions. Angiographic success in the group as a whole was achieved in 57 (66%). Multivariate analysis identified only the target vessel as a statistically significant factor predictive of angiographic success from among a host of clinical and angiographic morphologic variables. Left anterior descending artery lesions were identified with the highest success. In addition the duration of occlusion was significantly lower for the successfully versus the unsuccessfully dilated chronic occlusions.


Effect of different proteolytic enzymes on the nature of subunit composition of arachins from groundnut (Arachis hypogaea L.).

Arachin, the major protein from groundnut, was isolated from three varieties of groundnut (Spanish Improved, TMV-2 and DH-3-30) using a modified procedure involving precipitation with 18% ammonium sulphate to obtain homogeneous protein. The homogeneity was judged by polyacrylamide gel electrophoresis, gel filtration and sedimentation velocity techniques as well as correlation with amino acid composition. Rates of hydrolysis of arachins by trypsin (pH 7.6) and alpha-chymotrypsin (pH 7.8) were significantly different between the three varieties. Arachin from the Spanish Improved variety contained higher amounts of alanine and phenylalanine and lower amounts of carbohydrate and phosphorus as compared to TMV-2 and DH-3-30. Sodium dodecyl sulphate-polyacrylamide gel electrophoresis pattern of arachin from TMV-2 showed only seven bands of which the ones with low molecular weight were more intense than those of the other two varieties. The far-ultraviolet circular dichroic spectra showed no significant differences among the three varieties in respect of alpha-helix content (5 +/- 2%), beta-structure (19 +/- 2%) and the aperiodic structure. The observed differences in hydrolysis rates have been explained as due to the differences in the acidic and basic subunits of arachins.


Heterogeneity in buffalo lutropin.

Lutropin (LH-1) from water buffaloes has been shown to exhibit microheterogeneity in the N-terminal amino-acid sequence of its alpha-subunit. The beta-subunit did not exhibit such microheterogeneity. Another protocol of purification yielded a preparation of buffalo LH (bu LH-2) different from the buffalo LH-1 in certain physico-chemical properties like ease of dissociation into subunits, sugar composition, isoelectric point, and elution profile on S-200. Data appear to indicate the presence of more than one form of buffalo lutropin.


A stoichiometric analysis of bovine serum albumin-gossypol interactions: a fluorescence quenching study.

The interaction of gossypol with bovine serum albumin, human serum albumin and n-bromosuccinimide-modified bovine serum albumin has been followed by fluorescence quenching measurements. The presence of a high affinity site (association constant K = 2.2 x 10(6) M-1) for gossypol on bovine serum albumin and human serum albumin is indicated. The stoichiometry of binding for the high affinity site was evaluated using Job's method of continuous variation, thereby suggesting the formation of 1:1 complex. Modification of the tryptophan residues on bovine serum albumin does not affect the binding of gossypol to either high or low affinity site of albumin.


Partial amino acid sequence of sheep liver serine hydroxymethyltransferase and comparison of peptide maps of the enzyme from human, ox livers and Escherichia coli.

A comparison of the tryptic peptide maps of serine hydroxymethyltransferase from sheep, human, ox livers and Escherichia coli revealed that the mammalian enzymes were similar, while the bacterial enzyme exhibited differences in the primary structure. N-terminus of the reduced carboxymethylated sheep liver enzyme was acetylated. Serine hydroxymethyltransferase was hydrolyzed with trypsin and fragments of peptides were separated by high performance liquid chromatography using a combination of gel permeation, reverse phase and ion-pair chromatography. The peptides were sequenced manually using the 4-N,N'-dimethyl aminoazobenzene-4'-isothiocyanate/phenyl isothiocyanate double coupling method. The tryptic peptides with 80% homology or above were aligned on the rabbit liver enzyme sequence.


Involvement of active site in self-association of proteins: a case of alpha-chymotrypsin.

The self-association of proteolytic enzymes can be looked upon as an interesting possibility of the manifestation of enzyme-substrate complex. Hence the involvement of active site in such processes is a centre of investigation for many years. In the case of alpha-chymotrypsin, considerable controversy exists with regard to the involvement of active site of the enzyme in its self-association. A historical perspective of the problem and an overview of the available evidence, for and against, is presented and critically analysed. Despite contradicting observations, accumulated evidence indicates that His-57 and Ser-195 at the active site are involved, at least partially, in the self-association; a few other groups such as Tyr-146 and Met-192 are also involved in such processes.


In vitro stimulation of microsomal diethyl nitrosamine deethylase activity by vitamin K3 (menadione).

Vitamin K3 (menadione) has been found to stimulate diethyl nitrosamine (DEN)-deethylase activity in rat liver microsomes. The vitamin also takes care of the inhibitory effect of the anaerobic conditions as well as those of cytochrome poisons like sodium azide and sodium cyanide, possibly through production of active oxygen species. The enzyme was also stimulated by H2O2 and SOD and inhibited by catalase, thereby suggesting that H2O2 or some derivatives of it may be the active oxygen species involved in the reaction.


Isolation and characterization of 5'-nucleotidase inhibitor from rat liver.

5'-Nucleotidase (EC 3.1.3.5) is widely distributed in nature. However, it could not be detected in rat liver, because of the presence of specific inhibitors. Such inhibitors were also found in other tissues of rat, but at lower concentrations than that in the liver. The inhibitor activity was enriched in the membrane fraction and was also present in the cytosol fraction. It was sensitive to treatment with 6M urea and trypsin, while heating in a boiling water bath for 10 min or dialysis reduced the activity only slightly. Gel filtration or Sephadex G-50 yielded two types of inhibitors. Inhibitor I inhibited brain 5'-nucleotidase while inhibitor II inhibited both the brain and liver enzymes. Inhibitor II on further purification on CM Sephadex C-25 yielded five fractions with inhibitor activity of which inhibitor IIC was electrophoretically homogeneous. It had a molecular weight of 8500 by SDS gel electrophoresis, was rich in basic amino acids and had a high proportion of beta structure. Interaction of the inhibitor with 5'-nucleotidase brought about modifications in the secondary structure of the inhibitor as seen from the circular dichroism spectrum.


Microenvironment at the substrate binding subsite of the active site of UDPglucose 4-epimerase from Kluyveromyces fragilis using a fluorescent analog of UMP.

A chromophorics and fluorescent analog of uridine 5'-monophosphate (UMP), a known competitive inhibitor of UDPglucose 4-epimerase was synthesised. This analog, namely 2',3'-O-(2,4,6-trinitrocyclohexadienylidene) uridine 5'-monophosphate, was found to be a powerful reversible inhibitor of UDPglucose 4-epimerase indicating its interaction with the substrate binding site of the enzyme. The extreme sensitivity of the fluorescence emission spectrum of this analog to solvent polarity makes it an excellent probe for the study of the environment at the active site of the enzyme. We report here the effective use of this UMP analog to demonstrate that the hydroxyl groups of the ribose moiety of UMP and presumably the substrates (UDPgalactose and UDPglucose) do not reside in a hydrophobic milieu.


Studies on the role of iron binding ligands and the intestinal brush border receptors in iron absorption.

With a view to identifying ligands that could be used as promoters of iron absorption, the affinity of a number of iron chelating agents and the efficiency with which they can donate iron to the brush border receptors has been studied. A number of organic and inorganic compounds were found to chelate iron and keep it soluble at pH 7.5 of the intestinal lumen. This ligand-bound iron was taken up by the intestinal brush border receptors with varying degree of efficiency; ascorbic acid being the most effective and EDTA and citrate the least effective in donating the chelated iron to the receptors. Several polyphosphate compounds, used as food additives, chelated iron and kept it in solution but showed moderate potency for donating iron to the receptors.


Mechanism of lectin-cell interactions: thermodynamic and kinetic analysis of the binding of winged bean acidic lectin (WBA II) to human erythrocytes.

In order to identify the forces involved in the binding and to understand the mechanism involved, equilibrium and kinetic studies were performed on the binding of the winged bean acidic lectin to human erythrocytes. The magnitudes of delta S and delta H were positive and negative respectively, an observation differing markedly from the lectin-simple sugar interactions where delta S and delta H are generally negative. Analysis of the sign and magnitudes of these values indicate that ionic and hydrogen bonded interactions prevail over hydrophobic interactions resulting in net -ve delta H (-37.12 kJ.mol-1) and +ve delta S (14.4 J.mole-1 K-1 at 20 degrees C), thereby suggesting that this entropy driven reaction also reflects conformational changes in the lectin and/or the receptor. Presence of two kinds of receptors for WBA II on erythrocytes, as observed by equilibrium studies, is consistent with the biexponential dissociation rate constants (at 20 degrees C K1 = 1.67 x 10(-3) M-1 sec-1 and K2 = 11.1 x 10(-3) M-1 sec-1). These two rate constants differed by an order of magnitude accounting for the difference in the association constants of the two receptors of WBA II. However, the association process remains monoexponential suggesting no observable difference in the association rates of the lectin molecule with both the receptors, under the experimental conditions studied. The thermodynamic parameters calculated from kinetic data correlate well with those observed by equilibrium. A two-step binding mechanism is proposed based on the kinetic parameters for WBA II-receptor interaction.(ABSTRACT TRUNCATED AT 250 WORDS)


The critical micelle condition revisited.

Several simple alternatives have been examined as a possible basis for micellar size distributions which are internally consistent with the experimentally required concept of a threshold concentration, the critical micelle condition. Among these are the two-state system, monomer in equilibrium with a single high polymer, indefinite self-association, and continuous self-association with an arbitrary upper limit beyond which all further association is absolutely prohibited. Of these, only the last is a possible choice, although lacking experimental support. This report considers in deeper detail a thermodynamic model for micelle distributions, the so-called shell model of the present author, which is in basic agreement with an earlier statistic-mechanical study [Hoeve CA & Benson GC (1957), Colloid Polym Sci, 252, 56] in predicting the possibility of broad distributions of micellar species. A self-consistent distribution model which predicts a critical micelle condition must also predict a location with respect to degree of polymerization having a minimum concentration. Thus, the molar distribution function for the shell model satisfies this requirement, whereas the equivalent concentration distribution function fails to do so, as would the statistical models for multiple ligand binding. Moreover, the position of this minimum is predicted to change with concentration.


Congenital granular-cell myoblastoma.

Congenital granular-cell myoblastoma is a rare jaw tumor presenting in the neonatal period. The differentiation between congenital epulis and granular cell myoblastoma is a controversial issue amongst pathologists. It is a benign swelling in which simple excision is the treatment of choice. Here we report two cases with a brief review of literature.


Malignant rhabdoid tumour of kidney. A case report.

A case of malignant rhabdoid tumour of kidney is reported. Interesting features are bony metastasis at presentation and FNAB diagnosis of metastasis.


Malignant granular cell tumour. A case report and review of literature.

A rare case of malignant granular cell tumour of the anterior abdominal wall in a woman of 30 years is reported and and the relevent literature is briefly reviewed.


Heterotopic bone formation in renal cell carcinoma (a case report).

A case of renal cell carcinoma with heterotopic bone formation occurring in a female aged 55 years has been reported. There was no haematuria and the morphological picture showed only ossified stroma and no sarcomatoid appearance.


Mesenchymal chondrosarcoma of the paraspinal region: a case report.

Mesenchymal chondrosarcoma is a very uncommon tumor. An extremely rare presentation of the tumor i.e. arising from the paraspinal region is being presented.


Colonic lipoma, masquerading as malignant tumour.

A case of symptomatic colonic lipoma, mimicking malignant tumour on colonoscopy, barium contrast studies and at laparotomy, is reported. The diagnosis was established on histopathology after left hemicolectomy.


Synchronous bilateral parotid metastases from renal cell carcinoma. A case report.

An unusual case of bilateral synchronous parotid metastases from renal cell carcinoma presenting seven years after nephrectomy is reported. The patient underwent bilateral superficial parotidectomy and is alive free of disease three and half years after the metastatectomy.


Aspergillosis of the paranasal air sinuses (case reports and review of literature).

Aspergillosis of the paranasal air sinuses is a rare entity. It is endemic in Sudan and a few states in South America. It affects healthy and immunocompromised individuals alike. It presents in two forms--the invasive and non-invasive Aspergillosis. The former is difficult to distinguish from carcinoma on clinical examination. Conventional radiographs of the sinus, a CT scan evaluation and a selective culture of the sinus fluid for fungus aid in achieving a positive diagnosis. The treatment of invasive Aspergillosis is always surgical--some form of antrostomy to facilitate sinus drainage or sinus excision supplemented with topical and/or systemic anti-fungal chemotherapy. The authors report two cases of Invasive Aspergillosis, clinically type 'benign' and 'malignant' of the paranasal air sinuses, affecting non-immunocompromised individuals. In both the cases, complete surgical excision was achieved.


[Systematic lupus erythematosus and pregnancy].

Systemic lupus erythematosus (SLE) is an autoimmune disease that affects primarily women of childbearing age. 20-30 years ago it was common belief that SLE is exacerbated during pregnancy. Recent studies, however, could not support this notion. The likelihood of an increase in clinical activity of SLE is similar during pregnancy and in nonpregnant patients. It correlates directly with the activity of disease at the time of conception. The pregnancy outcome in patients with SLE has improved considerably in recent years. The frequency of fetal loss, however, still remains higher in SLE patients than in healthy women. In most of the cases fetal loss is due to habitual abortions, intrauterine death and premature labors. The main reasons are anti-phospholipid antibodies and the activity of SLE at the onset of pregnancy, respectively during the pregnancy. For monitoring disease activity and especially for distinguishing between the development of eclampsia and exacerbation of SLE, periodic determinations of complement proteins CH50, C3, C4 and C3d are helpful. A prophylactic therapy e.g. with prednisone in pregnant SLE patients is not justified. However, when SLE is exacerbating immunosuppressive therapy with prednisone and, if needed in combination with azathioprine, should be administered. In cases with high antiphospholipid antibody titers and prior fetal loss a treatment with low-dose acetylsalicylic acid can be considered.


[Neonatal lupus erythematosus as an example of passively acquired autoimmunity].

Neonatal lupus erythematosus is a typical example of passively acquired autoimmune disease. Congenital heart block is the main complication caused by transplacentally transferred maternal IgG antibodies directed against SS-A- or SS-B-antigen. While the transient lupus dermatitis occurs post partum and is often triggered by UV-light exposition, the irreversible cardial damage takes place between the 18. and 24, week of pregnancy. During this period 52-kD-SS-A- and 48-kD-SS-B-antigen are expressed in the fetal cardial tissue. The autoimmune reaction leads to an irreversible fibrotic destruction of the atrioventricular node. The resulting AV block and an antibody-induced perimyocarditis support the development of fetal bradyarrhythmia and hydrops. The very early diagnosis of a fetal heart block in bradycardiac fetus by echocardiography is essential for a consecutive therapy with steroids. By a reduction of the maternal antibodies an improvement of cardial symptoms in the fetus may be achieved in cases with fetal hydrops. Pregnant women at high risk with known connective tissue disease, previous children with congenital heart block, high titers of SS-A-/SS-B-antibodies and immunogenetic predisposition (HLA-DR3) have to be monitored intensively because of the possibility of a prophylaxis with dexamethasone and, in some selected cases, plasmapheresis.


[Antiphospholipid syndrome].

Antibodies against phospholipids in serum, lupus anticoagulant and anticardiolipin antibodies, are strongly associated with venous and arterial thrombosis. A syndrome characterized by these symptoms and the autoantibodies, the antiphospholipid syndrome, is found mostly in patients with systemic lupus erythematosus or related autoimmune disease, but is also found primary without a systemic disease.


[Thirty years of cellular immunity].

Mackaness' original article about cellular resistance to infection, published in 1962, is recalled. These experiments laid the foundation of the analysis of immune mechanisms against infection with facultatively intracellular microorganisms. Based on a simple murine model with Listeria monocytogenes, an array of data was compiled during three decades, clarifying the mechanism of inborn resistance and acquired immunity to this type of parasites. The idea of various immune cell populations cooperating via cytokines was developed and experimentally proven. Different forms of immunodeficiencies were conceived in the same model, and therapeutic approaches were evaluated. Thus, thirty years after the first publication, Mackaness' concept of cell-mediated immunity to infection is solidly based on experimental data, and is an integral part of our understanding of the mammal immune system.


[The role of interleukin 1 in infection and sepsis].

Interleukin(IL-)-1 is the prototype of a proinflammatory cytokine, produced in response to infection and other forms of trauma. At low concentrations IL-1 brings about increases in a number of defense mechanisms, particularly immunologic and inflammatory responses. However, over- or continued production of IL-1, as seen for example during septic infection, significantly contributes to pathological reactions such as hemodynamic shock. Thus, it is not surprising that IL-1 activities are tightly regulated, most notably at the levels of transcription and secretion. Additional regulation is provided by the action of a protein, that blocks the binding of IL-1 to its receptors. This protein, termed IL-1-receptor antagonist (IL-1ra) has been cloned recently, and may provide the possibility of specific therapeutic measures.


[In vitro proliferation of human bone marrow cells--inhibition by components of Candida albicans].

Candida albicans (CA) components influence the proliferation of human bone marrow cells in vitro (colony-forming assay). Number of colonies per 10(5) bone marrow cells after cultivation with rHuGM-CSF (maximal plateau colony formation): 46.2 +/- 9.1 (n = 6); after cultivation with rHuGM-CSF in combination with CA proteins: 0.05 mg protein/ml: 33.4 +/- 4.6 (n = 3); 0.10 mg protein/ml: 20.8 +/- 3.6 (n = 3).


[Ambulant atypical pneumonia: clinical diagnosis and therapy].

Atypical pneumonias are caused by mycoplasma, chlamydia and legionella species. From a clinical point of view the disease is comparable to influenza-like infections. Macrolide antibiotics covered the species which are most important. Especially new macrolides displayed better pharmacokinetic properties, allowing dose reduction and reduced frequency of intake. For legionella infections also therapy with modern quinolones is possible.


Entamoeba histolytica extract and interferon-gamma activation of macrophage-mediated amoebicidal function.

The effect of recombinant murine interferon-gamma (IFN-gamma) and E. histolytica extract (E.h.E.) on macrophage (M phi) activation for amoebicidal activity was examined. Peritoneal macrophages were harvested from C57BL/6 and A/J mice and preincubated with IFN-gamma and/or E.h.E. It was found that amoebicidal activity could be induced in both C57BL/6 and A/J-derived macrophages by pretreatment with IFN-gamma and E.h.E. Pretreatment of the M phi with E. histolytica extract or IFN-gamma alone did not result in the activation of significant cytotoxic activity against E. histolytica trophozoites. In the presence of IFN-gamma, E.h.E. had a dose-dependent effect on the activation of M phi amoebicidal function.


Modulation of type II collagen-induced arthritis in DBA/1 mice by intravenous application of a peptide from the C1q-A chain.

In this report we are able to show that intravenous (i.v.) application (day 0) of a nonapeptide (residues 26-34) from the human C1q A-chain (designated peptide A-C1q) prior to intradermal (i.d.) administration of chicken type II collagen (CII) in arthritis-susceptible DBA/1 mice (H2q), leads to abrogation of polymorphonuclear neutrophil (PMN) invasion into the joints. This nonapeptide exhibits epitope characteristics and high homology to residues 137-147 of CB11 (a cyanogen bromide fragment of chicken CII, known to contain both arthritis inducing and suppressing determinants). Arthritis index was lowest in animals pretreated i.v. with CII (as internal control), though animals pretreated i.v. with peptide K (residues 137-147 with an additional glycine residue from CB11) or peptide A-C1q exhibited comparative arthritic indices. Only in the arthritis-positive control group (day 0: PBS i.v.) did i.d. application of CII lead to invasion of PMN into the synovial layer and the joint space. Analysis of antibody (Ab) responses at day 48 after i.v. immunization (day 0) and CII challenge (day 7) revealed IgE-Abs to native CII and also to native C1q. IgG titers to CII were highest in animals pretreated with peptide A-C1q. Abs from this group, exhibiting activity to peptide A-C1q (immunizing antigen), were of mainly IgG1 and IgG3 isotypes. Evaluation of the immune response following i.v. application of peptide A-C1q or CII, prior to i.d. CII administration, in DBA/1 mice, revealed IgM responses to peptide A-C1q and peptide K, but not to CII. Intravenous application of peptide A-C1q led to generation of IgG3-Abs reacting only with peptide A-C1q and peptide K, but not with native CII. Additionally, i.v. application of peptide A-C1q elicited IgG responses to a pentapeptide, resembling amino acid residues 26-30 (K-G-E-Q-G) of the C1q A-chain. This five residue antigenic determinant is present in peptide K, in chicken and human CII as well as in human C1q. No specific IgE response to any of the antigens tested could be detected. Since a peptide from the C1q A-chain is both capable of eliciting immune responses and modulating CII-induced arthritis in mice, we postulate that the collagen-like complement component C1q is involved in the development of CII-induced inflammatory arthritic lesions, and may represent, in vivo, the early antigen responsible for inducing anticollagen antibodies prior to CII in hyaline cartilage becoming available as antigen.