Serum CA125 regression in epithelial ovarian cancer: correlation with reassessment findings and survival.

Findings at reassessment laparotomy and disease-free survival are reported for a group of patients with advanced-stage epithelial ovarian cancer who have had a complete clinical response to cytoreductive surgery and multiagent platinum-based chemotherapy. The predictive value of the number of chemotherapy cycles to achieve a serum CA125 of < 35 U/ml is compared to the predictive value of s, the rate of achieving a normal serum CA125. s is generated from an exponential regression model. This study suggests that s accurately predicts which patients have residual disease at reassessment laparotomy, who will be free of disease, and, of those in the latter group, who are at greatest risk to recur, as well as overall survival. If these observations are confirmed, physicians may base further therapeutic intervention on the basis of a calculated parameter following complete clinical response to first-line treatment rather than relying on findings at reassessment laparotomy.


Localization and therapy of human cervical tumor xenografts with radiolabeled monoclonal antibody 1H10.

Murine IgG3 monoclonal antibody (Mab) 1H10, which recognizes a tumor-associated antigen expressed on the surface of more than 40% of human cervical carcinoma tissues, was used for in vivo localization and therapy of cervical tumor xenografts. A human cervical carcinoma cell line, CaSki, was used as our experimental tumor system. Mab 1H10 antigen expression on the surface of CaSki cells was found to be cell-cycle independent. The ability of Mab 1H10 F(ab')2 to bind to CaSki tumor xenografts was verified by direct immunohistochemical staining of thin tumor sections with a Mab 1H10-peroxidase conjugate. Radioimmunoscintigraphy of nude mice bearing CaSki tumors after iv administration of [131I]1H10 F(ab')2 showed clear tumor images 48 hr after Mab injection. Radiolabeled Mab 1H10 F(ab')2 was found to specifically localize in solid CaSki tumors 96 hr after antibody injection. Radioactivity in tumor tissue was 4 times higher than that in kidney tissue and over 6 times higher than that in liver tissue. Mab 1H10 F(ab')2 binding to xenografted CaSki tumors was 17 times greater than a control IgG3 F(ab')2 after 96 hr. Therapy of athymic mice bearing established CaSki tumors with three iv injections of 100 microCi [131I]1H10 F(ab')2 resulted in extensive tumor necrosis and significant suppression (p < 0.05) of tumor growth compared to that in control mice. These results indicate that Mab 1H10 F(ab')2 may be clinically useful for detection or treatment of cervical cancer.


Parity-related prevalence of rhesus antigens among Mozambican parturients.

The potential risk of rhesus alloimmunization and the ensuing risk of fetal death with increasing parity were investigated in two groups of parturients; primiparous and grand multiparous (para > or = 5) women with liveborns. It was hypothesized that significantly fewer women of the latter than of the former group would be rhesus negative, since grand multiparity would be expected to be associated with an increased risk of late fetal death in rhesus-negative parturients. Primiparous (n = 390) and grand multiparous (n = 755) parturients with liveborns were studied in order to identify D- and Du-negative individuals. Sixteen out of 390 primiparas (4.10%) and 28/755 (3.71%) grand multiparas were D and Du negative. The difference did not reach statistical significance. It appears that being a D- and Du-negative grand multiparous parturient, in the absence of anti-D prophylaxis, is not a significant reproductive disadvantage to being primipara in terms of an increased risk of having stillborn babies.


Serum progesterone and 17-hydroxyprogesterone in the diagnosis of ectopic pregnancies and the value of progesterone replacement in intrauterine pregnancies when serum progesterone levels are low.

The corpus luteum function was evaluated in patients with surgically confirmed ectopic pregnancy (EP) in a multicenter study. In addition, the minimal threshold of serum progesterone (P) concentration required for salvaging intrauterine pregnancies (IUP) was also examined. Results show that single P or 17-OHP measurements are not diagnostic for EP, since mean P levels in EP were similar to those with spontaneous abortion though significantly lower than those in controls. 17-OHP levels in EP overlapped in 50% with IUP, and the mean levels were significantly lower only at 6-7 weeks. The 17-OHP levels when compared to hCG supports the view that corpus luteum defect is primary. In IUP, P levels < 8 ng/ml still were associated with viable (60%) pregnancy; thus no minimal threshold could be established.


Role of rhesus alloimmunization in the etiology of late fetal death in Maputo.

Grand multiparous parturients with unexplained late fetal death (n = 70) and with surviving newborns (n = 755) were analyzed and compared regarding blood group in general and presence of D and Du antigens in particular. In the stillbirth group, none of the parturients had any signs of disease (syphilis, preeclampsia, placental abruption, severe anemia or fever) that could be associated with the fetal death. It was found that none of the parturients with stillbirth were D- and Du-negative while 28/755 (3.71%) of parturients with liveborn babies were D- and Du-negative. It is concluded that, among grand multiparous parturients with otherwise unexplained late fetal death, the risk of having fetomaternal rhesus incompatibility as stillbirth etiology is insignificant. The advantage of introducing anti-D immunoglobulin for prophylaxis against rhesus alloimmunization would presumably be insignificant.


Effect of smoking on fibronectin production by human amnion and placenta.

Fibronectin production from amnion and placental tissues was evaluated in pregnant woman smokers and nonsmokers in order to examine if there were alterations of fibronectin metabolism in intrauterine tissues. In both amnion and placental tissues, cycloheximide inhibited the fibronectin output indicating that it was being synthesized. Mean fibronectin output by amnion in pregnant woman smokers was significantly lower than that in pregnant woman nonsmokers. In contrast, in the placenta from pregnant woman smokers, the output was significantly higher than that in pregnant woman nonsmokers. The present observations indicate that smoking alters an important biochemical constituent in amnion and placenta, possible leading to some complications.


Low-dose aspirin in primigravidae with positive roll-over test.

In a prospective, randomized, double-blind study for the prevention of pregnancy-induced hypertension and preeclampsia, 41 primigravidae with positive roll-over test (28th-32nd week of pregnancy) received 80 mg aspirin/day or placebo until the end of the 37th week. In the patients treated with acetylsalicylic acid (n = 22), 3 cases of proteinuria occurred, but no hypertensive pregnancy complication. In the placebo group (n = 19), 10 patients developed pregnancy-induced hypertension (6 of them preeclampsia). Group-specific differences concerning the occurrence of hypertension were statistically highly significant (p = 0.0004). No relevant differences were observed with regard to pregnancy duration, birth weight and umbilical artery pH value. The placebo group included 1 intrauterine death. No increased tendency to maternal or fetal bleeding was noticed.


Beta-endorphin in amniotic fluid in normal and hypertensive gestations: relationship with maternal blood pressure parameters.

beta-Endorphin (beta-E) immunoreactivity was measured in the amniotic compartment of 52 normotensive and 45 hypertensive gestations. All the fetuses of the normal group were healthy and showed appropriate intrauterine growth, whereas only suffering and growth-retarded fetuses were included in the pathological group. As expected, amniotic beta-E concentration was found to be significantly higher in hypertensive than in normotensive pregnancies (mean +/- SEM: 129.1 +/- 8.15 vs. 59.1 +/- 2.68 pg/ml; p < or = 0.005). A positive correlation between the hormone levels and the diastolic as well as the mean maternal blood pressure (r: 0.554; p < or = 0.05 and r: 0.525; p < or = 0.05, respectively) was present only in pregnancies complicated by hypertension. Furthermore, a negative correlation (r: -0.555; p < or = 0.05) linked amniotic beta-E and the pulse pressure in normal but not in complicated pregnancies. Unless beta-E in the amniotic compartment is also of amniochorial origin, our results suggest that the fetal endorphinergic tone is either activated by elevated diastolic and mean maternal pressure levels or lowered by increased pulse pressure values in normally elapsing pregnancies.


Uteroplacental Doppler velocimetry during Braxton Hicks' contractions.

Pulsed-wave Doppler ultrasound was used to evaluate the influence of Braxton Hicks' contractions on flow velocity waveforms in the uterine arteries. Flow velocity waveforms were obtained from a standardized site, at the crossing of the uterine artery with the external iliac artery near the uterine wall. Doppler signals were recorded in 16 healthy near-term nulliparous pregnant women. During Braxton Hicks' contractions, a considerable increase in pulsatility index (PI) was found in the uterine arteries increasing from 0.71 +/- 0.21 (mean +/- SD) to 1.14 +/- 0.67 (p < 0.005). Maternal heart rate decreased slightly but significantly during contractions. Despite the high PI values that were found during Braxton Hicks' contractions, a diastolic notch in the flow velocity waveform was never noticed. The findings indicate that during Braxton Hicks' contractions, resistance to blood flow in the uteroplacental circulation is considerably increased.


Maternal plasma and milk free cortisol during the first 3 days of breast-feeding following spontaneous delivery or elective cesarean section.

In a view of the increased clinical interest in the presence of hormones in human milk, the objective of this study was to evaluate maternal plasma and milk cortisol levels in early puerperium and their relationship in breast-feeding in women who underwent elective cesarean section or who delivered vaginally. During the first 3 days of breast-feeding, plasma and milk cortisol levels declined significantly both in women who underwent elective cesarean section and in women who had spontaneous deliveries. Moreover, the breast-feeding procedure did not affect maternal plasma and milk hormonal levels, since no differences between the cortisol levels measured immediately before and after morning daily breast-feeding were detected. Furthermore, a very high positive correlation (p < 0.001) was found between plasma and milk cortisol concentrations. Therefore, maternal plasma cortisol levels can be considered a very reliable measure to predict the hormonal concentration in breast milk.


Suppression of human chorionic gonadotropin in the human placenta at term by human thyroid-stimulating hormone in vitro.

Human chorionic gonadotropin (hCG) exerts a clinically apparent negative feedback on the secretion of human thyroid-stimulating hormone (hTSH) in pregnancy, and the two have cross-reactivity for the TSH receptor in membrane preparations of the thyroid. We examined whether hTSH, in turn, has an influence on the secretion and synthesis of hCG in short-term cultures of human placenta at term. A dose- and time-dependent decrease in the extracellular hCG concentration caused by hTSH was demonstrated. To examine whether hTSH inhibits de novo synthesis of hCG or decreases hCG depletion, we determined the amount of hCG secreted and the size of the intracellular pool by using an enzyme immunoassay. By incorporating a radiolabeled amino acid in the hCG molecule, we measured the amount of hCG synthesized de novo. We concluded that hTSH acts by decreasing the rate of de novo synthesis of placental hCG.


Perinatal audit of one hundred consecutive vacuum extractions in Maputo.

The extraordinary demands on obstetrical services that prevail in many developing countries necessitate critical reviews of existing norms for obstetrical management. Vacuum extractions were studied in this context as a part of the regular perinatal audit carried out at the Maputo Central Hospital, the only hospital in Maputo with emergency surgery catering to the 43,000 annual deliveries. Extractions performed with the fetal head above the ischiatic spines were associated with a high number of complications and an 81% risk of neonatal asphyxia and also with a number of severe neonatal traumas. The risk of intracranial hemorrhage tended to be higher with extractions of fetuses with the head at or above the ischiatic spines, particularly when there was concomitant intrapartum asphyxia. It is concluded that a frequent perinatal audit of selected risk deliveries is a useful monitoring tool for examining prevailing indications for various obstetric interventions.


Neuropeptide Y, its localization in the human cervix and possible effect on the contractile activity of cervix smooth muscle.

Immunochemical methods were used to identify neuropeptide Y (NPY) in the cervical tissue of women at early and term pregnancy. NPY-containing fibers could not be demonstrated in the upper and lower uterine segments at term, but the cervical innervation persisted during labor. Moreover, NPY alone did not affect cervical contractile activity, although the stimulatory effect of noradrenaline was enhanced.


Effect of the short follicular phase on subsequent conception.

The present study was designed to evaluate whether there is a lower pregnancy rate in women with short follicular phases, as defined by attaining the peak estradiol level before day 11 of the cycle. Thirty-two early ovulators with mature follicles were matched with 32 women being treated for similar infertility problems, who ovulated between days 12-20. Pregnancies were achieved by 9 (28.1%) of the early ovulators compared to 19 (59.4%) of the controls. The mean number of cycles required to achieve a pregnancy was 8.6 in the early ovulators compared to 6.4 in the controls. Using the clinical life table method, the 12-month pregnancy rate was estimated to be 31.4% for early ovulators as compared to 66.3% for controls. Whether lengthening the follicular phase by drug treatment will improve pregnancy rates remains to be seen.


Influence of valve surgery on female fertility.

Pregnancies following cardiac valve surgery represent a considerable maternal and fetal risk. The present paper is a report of 163 women in child-bearing age who underwent cardiac valve surgery. Congenital (14.7%) and acquired (85.3%) cardiac defects required a total of 72 alloplastic and 16 bioprosthetic valve implantations. In 69 patients, purely instrumental correction was performed, in 6 patients conduits were placed. Thirty-four pregnancies were observed and led to the delivery of 18 healthy infants. The birth weight was always in the 2-sigma normal range or slightly above. Three cesarean sections were performed due to the cardiac defect, in 6 patients vacuum extraction or forceps delivery was done, and in 9 patients delivery was spontaneous. We observed 4 cases of spontaneous abortion, and in 12 cases interruption of pregnancy. 75.1% women never became pregnant. Potential risks in terms of endocarditis, repeated valve implantation and anticoagulation are emphasized, methods to decrease the physical strain during delivery are discussed.


McRoberts maneuver for the management of the aftercoming head in breech delivery.

A case report of breech delivery complicated by entrapment of the aftercoming head is presented. McRoberts maneuver was applied to facilitate the release of the head. It is suggested that the same theoretical basis that stands behind the use of McRoberts maneuver in shoulder dystocia might make it applicable as one of the maneuvers to release the aftercoming head in breech delivery.


Retrohymenal vaginal atresia with perforate transverse vaginal septum.

A transverse vaginal septum is the most common congenital anomaly of the vagina. Vaginal atresia is seen less frequently. There have been some variations in cases of transverse vaginal septum and vaginal atresia. This is the first report of a patient with retrohymenal vaginal atresia and perforate transverse vaginal septum.


A prospective comparison of alpha-IFN and conventional chemotherapy in Ph+ chronic myeloid leukemia. Clinical and cytogenetic results at 2 years in 322 patients. The Italian Cooperative Study Group on Chronic Myeloid Leukemia.

Standard or conventional treatment of chronic myeloid leukemia (CML) had little effect on the course and the duration of the disease. Treatment with human natural and recombinant alpha-interferon (IFN) was shown to induce hematologic responses, together with partial or complete repopulation of the marrow with Ph negative cells (karyotypic response). These findings prompted a prospective comparison of IFN and conventional treatment in CML. A multicenter prospective controlled study in previously untreated or minimally treated chronic phase Ph+ CML was employed: 322 patients were recruited between 1986 and 1988 and assigned to treatment with human recombinant alpha-IFN (Roferon-A) or hydroxyurea, with a randomization ratio of 2:1. The results of the first 2 years of treatment were analyzed and compared, based on the intention-to-treat policy. From 8 mo of treatment on, hematologic and karyotypic responses (KR) were more frequent and better in the IFN arm than in the CHT arm. Overall, a major KR (Ph neg greater than 66%) was achieved at least once in 35/218 (16%) IFN-treated patients vs 1/104 CHT-treated ones (P less than 0.0001). None of these 36 patients has progressed from chronic to blastic phase as yet. After 2 years of treatment, 21 of 218 IFN patients (10%) had a major KR vs 1 of 104 CHT patients (P = 0.003), and the cumulative proportion of blastic metamorphosis was 19% in the IFN arm vs 27% in the CHT arm (P = 0.17). Side effects were more frequent in the IFN arm, but compliance with the treatment policy was identical in both arms. The treatment cost was about 11 US dollars per patient per month in the CHT arm, and 200 times higher in the IFN arm. During the first 2 years of treatment, IFN was more expensive, had more side effects, but was more effective than CHT in terms of hematologic and karyotypic responses.


Molecular characterization and functional studies on Hb Kempsey, beta 99 (G-1) Asp----Asn, a high-oxygen affinity variant.

Hb Kempsey (beta 99 Asp----Asn) is a high-oxygen affinity hemoglobin, never before reported in Italy, associated with secondary erythrocytosis. It has been found in the heterozygous state in two subjects from the same family originating from the Verona area in Northern Italy. The abnormal hemoglobin was studied both at the protein and at the DNA level. The amino acid substitution was identified by fingerprinting and amino acid analysis. The nucleotide replacement was investigated by means of polymerase chain reaction (PCR) of the beta gene and direct sequencing. Oxygen affinity and other functional parameters were assessed on whole blood and on the separate hemoglobin fractions. These studies allowed us to establish the molecular substitution GAT (Asp)----AAT (Asn) at codon 99. Functional studies revealed a left-shifted and biphasic dissociation curve of the proposita, with a very low p50. The two carriers of this hemoglobinopathy have different degrees of polyglobulia, since iron deficiency in one of them reduces total and abnormal Hb. The compensatory mechanisms for tissue hypoxia are discussed with the conclusion that erythrocytosis has to be preserved in these patients to maintain adequate tissue oxygenation.


Presence and significance of cold agglutinins in patients with HIV infection.

HIV-infected patients may contract a variety of other concurrent infections, including Mycoplasma pneumoniae, cytomegalovirus (CMV) and Epstein-Barr virus (EBV), that are known to be causes of transient cold agglutinins (CA). The aim of this study was to search for the prevalence, the persistence and the significance of CA in HIV antibody-positive patients. Ninety patients belonging to different risk groups (drug addicts, homosexuals and hemophiliacs), including 15 with AIDS, 20 with ARC, 25 with PGL, 30 symptom-free individuals and 100 healthy blood donors were assessed for the presence of CA for at least six months. In 20 cases (22%) CA were found: 3, 7, 5 and 5 respectively, in each of the above mentioned HIV-positive groups, while the group used as control was CA-negative. There were no differences between CA-negative and CA-positive patients with regard to the presence of anemia, frequency of other infections, or development of lymphatic malignancy during the follow-up period. Serological specificity of CA included 14 of type anti-I, 5 of anti-i and 1 of anti-Pr specificity. It appears that CA production is another immune disorder of patients with HIV infection.


Thymic dysfunction in childhood T-acute lymphoblastic leukemia: a possible linkage with a primary thymus involvement.

Experimental models, clinical and histopathological observations suggest a thymic origin of childhood T acute lymphoblastic leukemia (T-ALL). We studied thymic epithelial function in childhood T-ALL as compared to normal controls in order to improve our understanding of the cellular immunodeficiency mechanisms operating in a thymus-linked malignant process. The levels of Facteur Thymique Sérique (FTS) were measured in 9 patients at diagnosis, according to the rosette inhibition assay of Dardenne & Bach (1975). This method is based on the capacity of human serum containing FTS activity to confer on rosette-forming cells (RFC) from adult thymectomized mice a sensitivity to azathioprine identical to that of normal mouse RFC. All patients presented low age-corrected titres of FTS. No zinc deficiency was found, suggesting that low FTS levels are not related to unexpressed FTS biological activity. Plasma from all the children studied contained factors capable of inhibiting the biological activity of FTS in vitro. However, the nature of this inhibitor has not yet been elucidated. Our study shows the presence of a thymic dysfunction in childhood T-ALL, which could partially explain the immunodeficiency described in these patients. The linkage of the leukemic process with a primitive thymic involvement is discussed.


Volumetric changes in phorbol myristate acetate activated neutrophils: a rapid and simple assay using Coulter counter STKR and STKS hematological analyzers.

The aim of this study was to investigate some physical changes (volume, conductivity and scatter) in human polymorphonuclear leukocytes (PMN) activated with phorbol myristate acetate (PMA). Volume changes in PMA-activated neutrophils were assayed by both STKR and STKS, two Coulter hematological analyzers. Scatter changes in PMN activated by PMA in suspensions containing nitro-blue tetrazolium (NBT) were investigated on STKS scattergrams. PMA activation induced PMN volumetric increases that could be assayed with STKR and displayed with STKS. The activation of PMN in suspension containing NBT induced cellular scatter changes on STKS scattergrams. The differences in scatter between resting and PMA-activated neutrophils may thus provide a semiquantitative assay of NBT reduction and superoxide production. Volume changes in PMA-activated neutrophils were due to cellular swelling through water uptake, induced by Na+/H+ antiport activation and Na+ influx. Since volume changes in PMA-activated neutrophils might occur without O2- production and vice versa, in the cases in which PMA activation of protein kinase C cannot be demonstrated by O2- production, the effect of PMA on protein kinase C- mediated Na+/H+ antiport activation, and in turn on PMA volume changes, reflects protein kinase C activation. A screening of neutrophils unresponsive to volumetric changes from PMA activation may be easily performed using both Coulter STKR and STKS analyzers, whereas expected or defective PMA-induced production of O2- may be semi-quantitatively evaluated by STKS.


Fulminant sepsis in adults splenectomized for idiopathic thrombocytopenic purpura.

Splenectomy is still a mainstay in the treatment of idiopathic thrombocytopenic purpura (ITP). Although the risk of fulminant sepsis after splenectomy in children and in adults has been known for a long time, the true prevalence of fulminant sepsis in adults splenectomized for ITP has still not been well established, despite many anecdotal reports. In this paper we have tried to estimate this risk by reviewing the available literature and by analyzing a large cohort of adults splenectomized for ITP at our Institute since 1970. Two cases of fulminant sepsis (a 21-year-old man and a 24-year-old woman) were traced in a group of 133 splenectomized adults, with a crude incidence of 1.5% or, equivalently, of 0.17 cases per 100 patient-years. No case of sepsis occurred in a control group of 323 non splenectomized ITP adults. This estimation seems sufficiently precise for the large population analyzed and the duration and completeness of follow-up (1,126 patient-years, mean 101 months, 2 patients lost from follow-up), and it is in agreement with the estimations yielded by a literature review (1.8%). The risk of fulminant sepsis seems to be a real hazard in adults splenectomized for ITP, and a conservative approach in recommending splenectomy seems advisable. Antipneumococcal vaccination should also be recommended.


Uveitis, a presenting symptom of malignant histiocytosis.

A patient presenting initially with bilateral uveitis was admitted 6 weeks later to the Department of Internal Medicine "A" because of fever, chills, and pancytopenia. Physical examination, ultrasonography and CT scan revealed hepatosplenomegaly only, without lymphadenopathy. A bone marrow trephine biopsy showed areas with a dense infiltrate of abnormal cells, displaying many mitotic figures. Some of the cells resembled better differentiated histiocytes and contained hemosiderin pigment or phagocytosed erythrocytes. Immunohistological tests confirmed the diagnosis of malignant histiocytosis (MH). A survey of the literature revealed two other cases with uveitis and MH.


Bone marrow transplantation for childhood leukemia: five years' experience in a pediatric hematology center.

Fifty-three children (39 male, 14 female, median age 9 years 3 months) with different forms of leukemia underwent bone marrow transplantation (BMT) at our center. Various conditioning regimens were used according to the disease and time of BMT. In this paper we evaluate the impact of the experience of a pediatric hematology center on BMT-related problems in children. We analyzed disease-free survival (DFS), early BMT-related effects, hepatic, cardiac and respiratory function and late endocrine effects as shown by standard instrumental and laboratory tests. Outcome (overall median follow-up 34 months) was satisfactory. Three years DFS was 50.1% in all patients, 58.8% in lymphoblastic leukemia in 2nd complete remission (CR), and 50.0% in acute myeloid leukemia (some in 2nd or subsequent CR). Three of four patients with chronic myeloid leukemia were alive at 38 months. Management of the problems causing early post-BMT toxicity contributed to a progressive fall in early morbidity and mortality (14.3% in the last 3 years). Pre-BMT hepatitis in most patients was not associated with increased post-BMT hepatotoxicity. Cardiac function, even in patients given aggressive anthracycline treatment before BMT, remained normal 3 years after transplantation, as did respiratory function, although 8 cases presented subclinical restrictive and/or obstructive alterations. Compensated hypothyroidism was observed in 9 patients. Six boys received replacement treatment for hypogonadism. Severe height impairment was seen in 2 patients. Post-BMT endocrine and growth effects require a longer follow-up for definitive conclusions to be drawn.(ABSTRACT TRUNCATED AT 250 WORDS)


Chronic neutrophilic leukemia (CNL) with karyotypic abnormalities associated with plasma cell dyscrasia: a case report.

A case of chronic neutrophilic leukemia (CNL), a rare myeloproliferative syndrome associated with monoclonal gammopathy of uncertain significance (MGUS-Type IgGk), is reported. Karyotypic study, carried out on bone marrow, excluded Philadelphia-pos. chronic myeloid leukemia (CML) and showed Y loss (45 XO). Only a few cases of CNL with paraproteinemia have been reported, but no case of associated karyotypic abnormalities and paraproteinemia has so far been described.


Effect of cyclosporin A on T cell clones from severe aplastic anemia: differential sensitivity of TNF and GM-CSF production.

In this study we have analyzed the activity of Cyclosporin A (CsA) on the "in vitro" production of TNF and IL-3/GM-CSF as a preliminary basis for explaining the successful use of CsA in aplastic patients. Thus, 73 T cell clones, obtained by a limiting dilution technique from the peripheral blood and bone marrow of 3 patients with severe aplastic anemia (SAA), were studied for TNF and IL-3/GM-CSF production as induced by stimulation with 1% PHA plus 1 ng/ml TPA. Lymphokines obtained in this manner were then tested by biological assays. Twelve out of the initial 73 T cell clones were selected for the production of a large quantity of IL-3/GM-CSF and/or TNF. With these clones we studied the ability of CsA to inhibit TNF and IL-3/GM-CSF production, which was stimulated with specific monoclonal antibodies directed against the CD2 and CD3 surface antigens. TNF and IL-3/GM-CSF production displayed a different sensitivity to CsA inhibition. In fact, at 400 ng/ml CsA a residual production of IL-3/GM-CSF was present in all clones tested (CD3: 21.8% and CD2: 14.4% of the maximal IL-3/GM-CSF activity), while secretion of TNF was virtually abrogated at 100 ng/ml. Moreover, the mean ID50 for TNF production was significantly lower than that of IL-3/GM-CSF (CD2: p = 0.028, CD3: p = 0.01). Using specific anti-IL-3 and anti-GM-CSF monoclonal antibodies, we showed that only GM-CSF, and not IL-3, was resistant to CsA inhibition. In conclusion, these results may represent a possible explanation of the successful use of CsA in the treatment of some patients with SAA.


AIDS-related complex treated by antiviral drugs and allogeneic bone marrow transplantation following conditioning protocol with busulphan, cyclophosphamide and cyclosporin.

A 26-year-old man with AIDS-related complex (ARC) was treated with high-dose busulphan and cyclophosphamide, followed by allogeneic bone marrow transplantation. For 3 months before transplantation he received a combination of four drugs considered active against human immunodeficiency virus (HIV) to reduce the viral burden: zidovudine, acyloguanosine, fusidic acid and phenylidantoin. Although in reduced doses in coincidence with marrow engraftment, zidovudine therapy was scheduled after transplantation in order to protect donor cells from infection with HIV. Engraftment rapidly occurred and was documented by cytogenetic analyses. The post-transplant course was characterized by severe acute GvHD with irreversible hepatorenal failure. The patient died on day 48 after transplantation. Polymerase chain reaction analyses for detecting HIV DNA showed the persistence of positivity at day +30 and +45 after transplantation. Antibodies to specific HIV proteins evaluated with Western blot testing also persisted at days +21 and +35 after transplantation. Circulating immunocomplexes disappeared on day +31, and an increase in the CD4/CD8 ratio occurred. The short survival of the patient, affected by chronic hepatitis too, does not allow final conclusions about the role of BMT in HIV disease.


Lymph node blast crisis in chronic myeloid leukemia mimicking T-immunoblastic lymphoma.

Chronic myeloid leukemia arises from a somatic mutation in a pluripotent stem cell. It generally terminates with a blastic crisis (BC). One third of BC are lymphoid, and most have a pre-B phenotype. Few cases of T-lymphoid BC have been reported. Here we describe a lymph node blast crisis mimicking T-immunoblastic lymphoma. Bone marrow and lymph nodes were histologically examined by standard methods and by an immunoperoxidase technique. Cytogenetic studies were also performed on lymph node and blood cells. Analysis of T-cell receptor genes and BCR rearrangements were performed on DNA extracted from both frozen bone marrow and lymph-node cells. Lymph-node histology showed an infiltration by large lymphoid blasts, consistent with a diagnosis of immunoblastic lymphoma. Blast cells were CD2, CD7, TDT positive, and negative for myeloid and mature lymphoid antigens. The Ph1 chromosome was found in both bone marrow and lymph-node cells. BCR rearrangement was found in the DNA from both bone marrow and lymph-node cells. TCR genes were not rearranged. The present study provides strong evidence that the lymph-node blast crisis of CML can assume the morphological appearance of immunoblastic lymphoma and may retain the immunological phenotype and genetic features of early T cells with BCR rearrangements.


Therapy with Anagrelide in patients affected by essential thrombocythemia: preliminary results.

Anagrelide, an imidazo-quinazolin compound first proposed as a potent inhibitor of platelet function, was subsequently recognized as a drug able to lower the platelet number both in normal subjects and in myeloproliferative syndromes with thrombocytosis. We report our experience with Anagrelide therapy in 20 patients affected by essential thrombocythemia (E.T.). Twenty consecutive patients with E.T. entered the study from June, 89 to July, 91. Therapy schedule was as follows: 0.5 mg every 12 hours for 7 days; subsequently the daily dose was increased by 0.5 mg/day every week until a response was obtained (a decrease of the platelet count to less than 500 x 10(9)/l = complete response; to less than 600 x 10(9)/l = partial response). Of 19 evaluable patients, complete response (CR) was obtained in 13 (68%) and partial response (PR) in 3 (16%). For all responders, the mean time to response was 5.2 months: mean daily dose of Anagrelide 2 mg. Side effects were recorded in 8/20 patients (40%): tachycardia (n = 4), gastrointestinal distress (n = 3), perimalleolar edema (n = 1). In 6 cases therapy was discontinued definitively. Response rate to therapy with Anagrelide is similar to that with alkylating agents and alpha 2b-recombinant interferon; furthermore, Anagrelide is a drug without cytotoxic properties. The mean daily dose able to obtain a response is 2 mg, but maintenance therapy at similar doses is always necessary. In conclusion, we can say that Anagrelide is an effective drug in the treatment of patients with E.T., but its side effects must be seriously considered. A larger study may show whether it should be considered as a "first-line" drug for all patients with E.T.


Efficacy of liposomal amphotericin B (AmBisome) in the eradication of Fusarium infection in a leukaemic patient.

We recently succeeded in eradicating a Fusarium infection by treatment with liposomal amphotericin B (L-AmB). The patient, a 22-year-old man with acute lymphoblastic leukaemia (ALL), developed fever and diffuse cutaneous maculopapular necrotising nodules during post-chemotherapy neutropenia. Fusarium verticilloides was isolated from the skin, and hyphae were observed on direct microscopy. Despite increased WBC and amphotericin B (AmB) treatment (0.7 mg/kg/day for 11 days), he remained febrile and a chest X-ray revealed pulmonary lesions. Fusarium infection was confirmed by bronchial aspirate. AmB was increased to 1 mg/kg/day, and continued for 16 days (total dose 1630 mg). A slight improvement was observed at tomography, but nephrotoxicity developed. Treatment was changed to L-AmB (3 mg/kg/day). The patient received this drug for 20 days (total dose of 3850 mg) with complete regression of the pulmonary lesions. No adverse event occurred, and nephrotoxicity resolved. The patient was discharged from hospital cured of the Fusarium infection and in clinical and haematological remission. No relapse of fusariosis occurred, despite additional courses of intensive chemotherapy. Ambisome could represent an important advance in antifungal treatment since it allows aggressive treatment and eradication of mycoses refractory to conventional therapy while avoiding renal toxicity.


In vitro inhibition of interferon alpha-2a antiproliferative activity by antibodies developed during treatment for essential thrombocythaemia.

Various authors have reported the development of anti-interferon (IFN) antibodies following IFN-alpha treatment for haematological malignancies. So far the methods for detecting these antibodies have not considered the antiproliferative activity of this IFN, which is its most important property in anticancer therapy. In this in vitro study we evaluated the ability of anti-IFN alpha-2a neutralising antibodies to inhibit the antiproliferative activity of IFN alpha-2a and lymphoblastoid IFN alpha using megakaryocyte colony growth as the revelatory system. These antibodies were detected in two patients affected by essential thrombocythaemia (ET) who lost their haematological response to IFN alpha-2a, but responded to a subsequent treatment with lymphoblastoid IFN alpha. The results show that the inhibition of megakaryocyte colony growth induced by IFN alpha-2a was totally suppressed in the presence of the two ET patients' sera, whereas the inhibition induced by lymphoblastoid IFN alpha was not significantly affected. These in vitro data demonstrate the high specificity and activity of these antibodies on the antiproliferative effect of IFN alpha-2a.


Ultrastructural, immunologic and clinical follow-up of five patients with HCL treated with interferon (IFN) for more than three years.

Treatment results in HCl have been improved by the use of alpha-IFN, which is now the standard first-line therapy for this disease, but the mechanism of IFN action is still unclear. It is known, however, that IFN is able to induce hematologic, immunological and phenotype membrane changes which parallel the patients' (pts) clinical response. The aim of our study was to correlate the clinical response to IFN treatment with ultrastructural and phenotype membrane changes in hairy cells (HCs), in order to elucidate the mechanism of IFN action at the cell level. We assessed the phenotype membrane and ultrastructural changes induced in HCs by long-term alpha-IFN treatment in five pts with HCL; membrane-bound Il 2-R on PHA-stimulated PBL, the release of IL 2-R by PHA-stimulated PBL and the serum levels of s-IL 2-R were also determined in one pt. The surface immunological phenotype, mainly the HCL-related surface antigen CD25, changed after IFN treatment, dropping from abnormally high to normal values. Furthermore, IFN treatment induced ultrastructural changes in HCs, consisting mainly of a sharp reduction in, up to the almost complete disappearance of, the hairy projections: very few, if any, short, thick villi persisted. The ultrastructural changes in HCs paralleled clinical and hematologic response to IFN treatment in such a way that IFN alone may be considered the cause of these changes. As far as detection of the membrane-bound IL 2-R p55 chain on PHA-stimulated PBL is concerned, the expression of p55 is very high on the membrane of HCs; a high level of serum s-IL 2-R was also found in the HCL pt studied before IFN treatment, whereas the release of IL 2-R by PHA-stimulated PBL was higher than normal, but not significantly. Two of our pts, who did not respond or responded very poorly clinically to IFN treatment, should probably be considered cases of HCL "variants". The phenotype membrane and the ultrastructural changes in HCs very closely paralleled the patients' clinical responses to IFN, suggesting that both the immunologic and the morphologic changes induced in HCs by in vivo IFN treatment are a direct counterpart of its biologic effect.


Early response to alpha interferon in a patient affected by hairy cell leukemia.

A 61-year-old splenectomized male patient affected by hairy cell leukemia (HCL) in relapse was treated with interferon (IFN) at a dosage of 3 x 10(6) U/day. After only 11 days of treatment, IFN was stopped because the patient developed fever, jaundice and respiratory distress. Upon recovery from this infectious episode, the patient was judged to be in complete remission of HCL on the basis of clinical and laboratory findings, and he remained off-therapy for 2 years. When an overt relapse occurred, the patient was again treated with IFN and, after a very short time, he achieved a new, good partial remission that is maintained 28 months later without treatment. This observation remains speculative for understanding the mechanism of action of IFN in other comparable HCL cases.


Feasibility of prenatal diagnosis of beta-thalassemia using two highly polymorphic microsatellites 5' to the beta-globin gene.

Short tandem repeats (STRs) are highly informative loci within the human genome, consisting of short nucleotide sequences tandemly repeated in variable numbers. This results in different alleles of variable length. Herein we describe two STRS located 5' to the beta-globin gene. They can be detected by non radioactive methods and may be used to make prenatal diagnosis of beta-thalassemia.


Normal values of total reticulocytes and reticulocyte subsets in children and young adults.

This work provides the values for percentage and total reticulocyte count, as well as the values of reticulocyte fluorescence intensity ratios as determined by an automated fluorescent technique in a normal pediatric population. The peripheral reticulocyte subsets, as assessed on the basis of their degree of maturation, allow a more accurate evaluation of bone marrow activity than the percentage or total count do. This would result in a more appropriate management of erythropoietic disorders in children.


Thrombocytopenic purpura during therapy with simvastatin.

The authors describe a case of very serious thrombocytopenic purpura occurring in a diabetic and hyperlipidemic woman during therapy with simvastatin, an HMG-CoA reductase inhibitor drug. Interruption of the medical treatment produced a prompt reversal of the thrombocytic attack: one year later the patient's platelet count remains within the normal range. The authors have not found other reports in the medical literature of similar serious reactions during therapy with an HMG-CoA reductase inhibiting substance; nevertheless, a causal nexus is hypothesized but not argued in this case, since further studies will be needed before this connection can be established.


Increase in the D-dimer levels during treatment in patients with acute myelogenous leukemia.

Plasma concentration of thrombin-antithrombin III complex (TAT), tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor 1 (PAI-1), PAI-2, D-dimer complex and urokinase-plasminogen activator (u-PA) activity were studied in 30 patients with acute nonlymphoblastic leukemia (ANLL), before and during antileukemic therapy. Fifteen patients showed signs of disseminated intravascular coagulation (DIC), 10 of them classified as M3, 2 as M2 and 3 as M5 subtypes. The initial levels of TAT complex were elevated in all ANLL patients. This increase was more pronounced in patients with DIC (p less than 0.05). TAT increased significantly during the treatment period in all cases. u-PA and PAI-1 levels were elevated but there were no statistically significant differences between patients with and without DIC. PAI-2 levels were below the limit of detection in controls and in patients. However, the initially elevated D-dimer complex levels were significantly higher in DIC cases (p less than 0.01) and they increased during the treatment period. A significant and positive correlation between D-dimer and TAT complex values was found in DIC patients (r = 0.68, p less than 0.001). The high TAT complex and D-dimer levels further increased during chemotherapy treatment strongly suggest a hypercoagulable state with secondary activation of fibrinolysis not severe enough to manifest itself as clinically evident DIC in the majority of cases.


Warfarin-induced skin necrosis in 2 patients with protein S deficiency: successful reinstatement of warfarin therapy.

Warfarin-induced skin necrosis is a rare but serious complication of oral anticoagulant therapy. This condition has been associated with protein C deficiency but only rarely reported in patients with a deficiency of protein S. We have managed 2 patients with a history of warfarin-induced skin necrosis who were diagnosed as being protein-S-deficient. Since both patients were candidates for long-term anticoagulant therapy we elected to reintroduce warfarin using a regimen designed to minimize the risk of recurrent skin necrosis. While they were therapeutically anticoagulated with heparin, warfarin was started at 1 mg/day and the dose was increased gradually. Heparin was not discontinued until the prothrombin times were in the therapeutic range for at least 72 h. Both patients tolerated the reinstitution of warfarin without difficulty and they have now been followed for over 2 years on oral anticoagulants without complication.


Treatment of proximal deep-vein thrombosis using subcutaneously administered calcium heparin: comparison with intravenous sodium heparin.

In a prospective, randomized clinical trial we compared the efficacy of subcutaneously (SC) administered (every 8 h) calcium heparin to intravenous (IV) sodium heparin in the treatment of proximal deep-vein thrombosis (DVT). A secondary objective was to give enough heparin to achieve a therapeutic anticoagulant effect by the end of the first 24 h. Five of 36 patients (14%) in the SC heparin group failed to achieve a therapeutic anticoagulant effect by the end of the first 24 h compared to 2 of 23 patients (9%) in the IV group (p = NS; 95% CI for true difference = -11.7% to 22.1%). Two of 31 patients (6.5%) in the SC group had venographic evidence of clot propagation compared to 1 of 19 patients (5.3%) in the IV group (p = NS; 95% CI for true difference = -12.4% to 14.8%). The rate of major hemorrhagic complications was similar in each group (approximately 15%). We conclude: (1) using a large initial dose of SC heparin, a therapeutic anticoagulant effect can be readily achieved within 24 h, and (2) combining the results of this trial with previous studies, the efficacy of SC administered calcium appears to be comparable to IV sodium heparin.


Effect of mental stress on platelet function in normal subjects and in patients with coronary artery disease.

We studied the effect of emotional stress (mental arithmetic for 10 min) in 10 postinfarction patients and in 10 age-matched apparently healthy subjects as controls. Blood samples for platelet function studies and for the determination of epinephrine levels in serum were taken in basal conditions, at the end of mental stress and after 30 min of recovery. Patients were studied twice, in washout of medications and after oral administration of dipyridamole, 200 mg twice a day for 6 consecutive days. Mental stress induced in patients significant increments in different hemodynamic parameters (heart rate, systolic blood pressure and diastolic blood pressure) and in serum epinephrine levels. Concomitantly, the test produced a significant increase in platelet aggregation (induced by 3 microM ADP or 1 microgram/ml collagen), the formation of circulating platelet aggregates and an increase in plasma thromboxane B2 levels. Hemodynamic parameters and platelet function tests returned to baseline values after 30 min. Similar activation of hemodynamic parameters, similar increase in epinephrine levels and lower increase in platelet function by emotional stress were observed in control subjects. Treatment of patients with dipyridamole had no effect on stress-induced increase in hemodynamic parameters and epinephrine levels, but decreased stress-related platelet activation. These data can contribute to a better understanding of the complex relationships between psychosocial factors, the hemostatic system and vascular disease.


Antithrombotic effect of ticlopidine on He-Ne laser-induced thrombus formation in rat mesenteric microvessels.

The inhibitory effects of ticlopidine and acetylsalicylic acid (ASA) on thrombus formation in rat mesenteric microvessels were studied. The results were compared with the effect of the drugs on platelet aggregation in citrated whole blood. He-Ne laser-induced thrombus formation in arterioles and in venules was significantly inhibited by 100 mg/kg ticlopidine. In contrast, a higher dose of ASA (300 mg/kg) was needed to inhibit thrombus formation and the effects of ASA were observed only in arterioles and not in venules. In addition, although the inhibition by ASA in arterioles was not strong it followed a dose-dependent manner, suggesting that the differential effect of ASA on platelets and endothelium may not be evident in vivo. Ticlopidine and ASA strongly inhibited ADP-induced whole blood platelet aggregation, but not collagen- or thrombin-induced platelet aggregation.


Russell's viper venom: effects on coagulating whole blood in vitro.

Russell's viper venom (RVV) leads to a strong activation of the coagulation system with consumptive coagulopathy and thrombopenia. For better comprehension of the pathophysiologic process, the effect of RVV was examined in an in vitro model of hemostasis. The stimulation of the coagulation system and of platelet activity can be discriminated by sequential measuring of fibrinopeptide A (FPA) generation and platelet factor 4 (PF 4) release, respectively. In coagulating whole blood both parameters show a parallel response curve in the control series (n = 6) with an initial slow phase followed by a rapid phase after 4.7 +/- 0.8 min (FPA) and 6.0 +/- 0.9 min (PF 4) of the incubation period. Varying concentrations of RVV (15, 50, 100 and 1,000 ng/ml; n = 6 each) cause a dose-dependent stimulation of FPA generation as well as of PF 4 secretion. Clot formation time shows a decrease from 9 min (controls) to 6.3 +/- 2.0 min (100 ng/ml RVV) and 2.7 +/- 0.5 min (1,000 ng/ml), respectively. The concomitant addition of antithrombin III (AT III, 20 U/ml) and RVV (100 ng/ml) leads to a nearly complete normalization of hemostasis in vitro. The beginning of the rapid activation phase is comparable to that of the control group, clot formation does not occur during the 10-min incubation period. Heparin (1 IU/ml) acts as an antagonist not only of the venom-induced FPA generation, but also of the PF 4 release. Prostaglandin E1 (PGE1) (150 ng/ml) does not inhibit the RVV-stimulated FPA generation, but causes a moderate inhibition of PF 4 secretion, especially during the rapid phase.(ABSTRACT TRUNCATED AT 250 WORDS)


Assessment of whole-blood spontaneous platelet aggregation during pregnancy using an impedance particle counter.

The slide test method of Velaskar and Chitre for determining platelet aggregation in whole blood after induction of aggregation was modified for spontaneous platelet aggregation and evaluated. The reproducibility was satisfactory (CV 1-3%). The results obtained with this method and the method of Velaskar were not significantly different. The Spearman rank correlation was 0.75 (p less than 0.0001). We established reference values for the particle counter method and Velaskar's method in pregnant and non-pregnant women; no significant change in spontaneous platelet aggregation was seen throughout pregnancy. In order to estimate the clinical value of the test in pregnancy, we followed up a number of pregnant patients with primary enhanced spontaneous whole-blood platelet aggregation before and after treatment with low-dose acetylsalicylic acid. The test was found to be suited for the detection of spontaneous whole-blood platelet aggregation and for the follow-up after treatment with acetylsalicylic acid. Further studies are necessary, however, to assess the predictive value of an aberrant test result during pregnancy.


[Vascular supply of the unsheathed segment of the extensor tendons of the 2d to 5th fingers of the dorsum of the hand].

The dorsal approach to the metacarpal bones is through the peritendinous connective tissue of the extensor tendons. Knowledge of the vascular supply of the distal parts of these tendons, between the distal end of the tendon sheath and the tendon's osseous insertion is important, especially with respect to atraumatic technique. The course and distribution of the vessels to the extensor tendons II-V were investigated. Superficial and deep layers of connective tissue were found to contain blood vessels. The superficial vessels reach the dorsal aspect of the extensor tendon, originating from subcutaneous arteries and the large arteries of the hand. The deep vessels reach the lateropalmar aspect of the tendons and originate from the peritendinous muscular arteries. Vessel distribution suggests a direct relationship between the number of nourishing arteries and the tendon surface area. The vascular supply to the unsheathed parts of the extensor tendons shows morphological adaptations to differential mechanical stress during tendon excursion.


[Morbidity of the donor site of the dorsalis pedis flap].

Detailed information on the dorsalis pedis flap donor-site morbidity is still lacking. In a retrospective analysis, wound-healing, cosmesis, mobility, stability, and thermographic studies of the feet were investigated. The results show a high donor-site morbidity of the dorsalis pedis flap. Indications and alternative methods are discussed.


[Traumatic aneurysm of the hand--a rare complication of a stab injury].

This is a case report of a 22-year-old male who suffered a stab injury to his right hand. Sixteen days after primary wound closure, he complained of pain from a pulsating mass in his right palm, with numbness along the ulnar side of the middle finger. At operation, a false aneurysm was found and resected, after ligation of the common digital artery proximal and distal to the aneurysm.


[Changes in the vascular endothelium after electro- and thermocoagulation].

An experimental study was performed in animals to investigate the effect of various coagulation techniques on the vascular system. Using a microsurgical procedure, the femoral vein of fifteen rabbits was exposed bilaterally and coagulated until the lumen was closed. Electro- and thermocoagulation systems were applied. The light microscopic examination showed endothelial alterations in the course of the vessel. Analyses with the scanning electron microscope were therefore also performed. Extensive endothelial damage could be detected regularly with monopolar currents; the results were not uniform with bipolar applications. The most favorable conditions were found when thermal coagulators had been used. Damage to the parallel arteries was not detectable to a significant degree in these cases. The toxic effect of the energy applied can be morphologically divided into three stages. It should be considered whether extensive endothelial damage leads to the formation of microthrombi and thus causes clinical complications.


[Current aspects of epidermal wound healing].

The multilayered cornifying epithelium of mammalian skin provides a barrier protecting the organism against external damage and preventing loss from the internal milieu. The unique features of the epidermis are responsible for its regenerative capacity. Basal keratinocytes are the stem cells for a vertical differentiation pathway during which an undifferentiated keratinocyte undergoes extensive changes into a keratinized flake of the horny layer. During epithelial repair the cells change their normal pattern of differentiation. Migratory activity and proliferation are the basis for the horizontal migration of the epidermal cells, which is inhibited by cell contact and completed by differentiation and keratinization. The mechanisms of cell activation and migration are currently under intense investigation. A large number of peptide growth factors have been shown experimentally to be active in wound healing. A better understanding of the molecular basis provides new perspectives for a more specific therapy in wound healing. Keratinocyte culturing has first been used in the treatment of large burns. Modifications try to include also dermal elements. Recent developments in molecular and cell biology indicate a perspective of cultured epithelial sheets containing genetically engineered keratinocytes for epithelial gene therapy.


[Long-term results of Russe modified scaphoid screw fixation II].

Proximal pole scaphoid nonunion with a small necrotic proximal fragment presents therapeutical problems. Cannulated screw fixation as a modification of the Russe II procedure combines the advantages of minimal surgical exposure and trauma, preserving the blood supply of the distal fragment, and at the same time achieving rigid fixation of the autogenous bone graft. Six out of seven patients had satisfactory subjective and objective results after a mean follow-up of 12.9 years, although radiographic findings were less favorable.


Bundle nailing in nonunion of the distal radius: case report.

A previously unreported technique for dealing with severe distal radial nonunion in the presence of marked osteoporosis and deformity in a 65-year-old female is presented. The technique involves temporary ankylosis of the wrist with bundle nails connecting the second and third metacarpal with the distal and proximal fragment of the radius, dorsal to the carpal bones and joints. Union was achieved radiographically after nine months. When the bundle nails were removed, there was some recovery of wrist movement and useful function.


[Anomalous course and anomalous division of the median nerve in the distal forearm].

An anatomic variation of the median nerve is demonstrated in a female patient suffering from carpal tunnel syndrome subsequent to a distal radius fracture with malalignment and reflex sympathetic dystrophy. The median nerve coursed anterior to the superficial flexor tendons from proximal ulnar toward the distal radial region of the distal forearm, giving off an ulnar branch just 2.5 cm proximal to the flexor retinaculum. This case proves that in the distal forearm, branches of the median nerve can be found both radial and ulnar to the midline.


[Composite lymphoma in Sjogren's syndrome with mixed cryoglobulinemia].

A 44-year-old woman with Sjogren's syndrome and mixed cryoglobulinemia developed nodal and pulmonary lymphoma 15 years after the initial diagnosis. The nodal lymphoma was of the composite type and included both monoclonal monocytoid and lymphoplasmacytoid B-cells. The extranodal pulmonary lymphoma included only lymphoplasmacytoid lymphocytes. Complete resolution of the lymphoma was achieved following 3 months of chlorambucil, 5 mg/day, and prednisone, 30 mg/day. Composite lymphoma and monocytoid lymphoma are being encountered more commonly among patients with Sjogren's syndrome. Physicians must therefore become more aware of the existence of both entities.


[Kaposi's sarcoma following liver transplantation].

A 54-year-old man developed Kaposi's sarcoma 2 months following orthotopic liver transplantation for hepatitis B-associated liver cirrhosis. At that time he was on combined immunosuppressive therapy (azathioprine, prednisone and cyclosporine A). The disease is very prevalent among immunosuppressed patients following renal transplantation, but is considered to be relatively rare following liver transplantation. The patient ran a relatively benign course without organ involvement and with only the skin disease. This is the first case of Kaposi's sarcoma following liver transplantation reported in Israel.


[Marshmallow for investigating functional disturbances of the esophageal body].

Manometric studies using water boluses do not always demonstrate disturbances in esophageal motility. We tested the use of a marshmallow bolus to induce abnormal manometric patterns in patients with dysphagia in whom manometric studies using water boluses were normal or nearly so. The study group included 12 normal volunteers and 22 patients with dysphagia and nearly normal manometric studies. Pressure was recorded along the esophageal body using 10 "wet" swallows followed by 10 "solid" swallows of marshmallow. In normal subjects there were fewer abnormal contractions after solid swallows than after wet swallows. In 15 patients solid swallows induced abnormal motility patterns which were not observed after wet swallows. The probability of inducing abnormal contractions in patients after solid swallows is significantly greater than after wet swallows (p < 0.0001). Solid swallowing is therefore useful in evaluating functional disturbances of the esophagus in patients with dysphagia.


[Overdosage of glibenclamide presenting with lethargy and seizures in a child].

Management of accidental overdosage with oral hypoglycemic agents in toddlers may be difficult when the history of ingestion is overlooked. We report a 21-month-old girl who presented with lethargy and generalized seizures 12 hours after ingestion of an unknown number of glibenclamide pills. The blood glucose on admission was 0.5 mM/l. Symptoms resolved promptly after an intravenous bolus of glucose. Metabolic and infectious causes of hypoglycemia were ruled out. The parents denied drug ingestion initially, but further investigation revealed that she had ingested several glibenclamide pills used by her diabetic father 12 hours prior to admission. This case illustrates the problem involved in diagnosis and management of accidental drug overdosage in children when no such history is elicited and symptoms are delayed.


[Management of neonatal testicular torsion].

Neonatal testicular torsion is rare, and is distinguished both clinically and anatomically from torsion in the older age group. We describe 2 cases of neonatal torsion treated in different ways, which reflect the current controversy regarding the timing of surgical exploration, the need for orchiectomy, as well as the indications for contralateral orchiopexy. The distinction between prenatal and the postnatal subgroups is emphasized and a policy of treatment is proposed.


[Rectosigmoid carcinoma in an adolescent girl].

Carcinoma of the colon and rectum is very rare in childhood and adolescence. We describe a 16.5-year-old girl with rectal bleeding and constipation. She had been treated symptomatically for 6 months without being properly examined. Only with onset of weight loss was rectal examination performed. After workup a diagnosis of locally advanced carcinoma of the rectosigmoid with multiple lung metastases was reached. From review of the literature and our own case, it seems that the unfavorable prognosis in young patients is mainly due to lack of awareness of such a possibility, resulting in delayed diagnosis and treatment. An additional factor is the invasive nature of most colon cancers in this age group.


The differentiation between freshwater and marine fish trypanosomes by lectin agglutinability.

The agglutinability of three fish trypanosomes, Trypanosoma boissoni and T. triglae senegalensis from marine fish, and T. carassii from freshwater fish was compared. The tests were performed with trypomastigotes and epimastigotes in the exponential and stationary growth phases. The simple agglutination test, performed in microwell plates, used ten purified lectins, and revealed a clear difference between marine and freshwater strains when compared for their agglutinability with the HPA lectin. Whereas the cells of T. boissoni and T. triglae senegalensis became strongly agglutinated by this lectin, those of T. carassii remained unagglutinated in the same conditions. However, the cells of T. triglae senegalensis reacted positively with ConA lectin in the stationary phase only. The differences in structure and composition of surface polysaccharides stable after prolonged cultivation in vitro are inferred on the basis of the results obtained.


Histochemistry of the racemose form of Cysticercus cellulosae.

The racemose form of brain cysticercosis arises from an intense proliferation of the bladder wall after the scolex part has degenerated. The proliferating zones are 2-3 times thicker than the remaining parts of the bladder and are characterized by a densely folded tegument and thick subtegumental and parenchymal layers. The tegument and subtegumental cells contain a large amount of acid mucosubstances with sulpho groups and hydrophilic lipids, and exhibit a high activity of alkaline and acid phosphatases. The parenchyma contains a large amount of glycogen. With the gradual aging of the bladder wall and with the first signs of autolysis, the enzymatic activity as well as the amounts of glycogen, neutral and acid mucosubstances, and proteins decrease, and the hydrophobic lipids prevail over the hydrophilic ones. The results obtained are important for the differential diagnostics of cestode larval stages in the human brain.


Susceptibility of some species of rodents to rickettsiae.

The present study was designed to test the susceptibility of free-living rodents, viz Apodemus flavicollis, Microtus arvalis, Clethrionomys glareolus, Mus musculus, and outbred white mice from Dobrá Voda farm, CSFR, to Coxiella burnetii, rickettsiae of the spotted fever group (Rickettsia sibirica, R. conorii, R. slovaca and R. akari) and rickettsiae of typhus group (R. typhi and R. prowazekii) by various routes of administration. The highest levels of antibodies to C. burnetii were found in A. flavicollis and M. arvalis inoculated intraperitoneally and intracerebrally. Antibodies to C. burnetii exerted peak levels between days 13 and 16 in contrast to white mice which showed maximum levels on day 28. When 10(0.5) and 10(0.05) EID50/0.25 ml of C. burnetii was administered intraperitoneally to A. flavicollis, M. arvalis and white mice, the agent was detected only in organs of wild animals. In addition to spleen, the bone marrow appeared as a predilective tissue for the detection of this agent. R. akari at a dose of 10(4.5) EID50/0.25 ml caused overt illness and death in rodents. Antibody levels to R. sibirica and R. conorii were dependent on dosage, route of inoculation and duration of infection, but were not dependent on animal species. Antibodies to R. slovaca and R. akari were dependent on dosage, infection duration and animal species but were not dependent on the route of infection. For R. conorii, R. sibirica and R. slovaca a sharp increase of antibody levels with high titres on days 4-6 and peak levels about day 11 post intraperitoneal infection was characteristic. Antibody level to R. akari increased up to day 21. Spotted fever group rickettsiae in rodents inoculated intraperitoneally were observed in various organs, particularly in tunica vaginalis and spleen at days 2-8 post infection. R. typhi at a dose of 10(4.3) EID50/0.25 ml inoculated intracerebrally or intraperitoneally killed white mice and inoculated intraperitoneally killed C. glareolus and M. musculus. The antibody response of white mice to intraperitoneal, subcutaneous or intranasal inoculation of this rickettsia was low and no antibody was detected following peroral administration. M. musculus did not develop antibodies after intracerebral, intranasal, subcutaneous or peroral inoculation of R. typhi. The target organs for this rickettsia were the spleen and tunica vaginalis. R. prowazekii inoculated intraperitoneally into white mice at a dose of 10(6.5) EID50/0.25 ml and at a dose of 10(4.5) EID50 into C. glareolus was fatal for these rodents.(ABSTRACT TRUNCATED AT 400 WORDS)


[Hemorheological effect of KB-2796, a new Ca2+ antagonist].

The hemorheological effect of KB-2796, 1-[bis(4-fluorophenyl)methyl]-4-(2,3,4,-trimethoxybenzyl)piperazine dihydrochloride, was studied in guinea pigs and rabbits in comparison with those of flunarizine (FNZ) and pentoxifylline (PXF). KB-2796 and FNZ at 10-100 microM dose-dependently prevented crenation of rabbit erythrocytes induced by the Ca2+ ionophore A23187. After incubation of guinea pig whole blood at 37 degrees C, blood micropore-filterability decreased and blood viscosity increased with the progress of erythrocyte crenation. After a 4-hr incubation, KB-2796 inhibited erythrocyte crenation and decreased blood filterability at a concentration of 30 microM, and it increased blood viscosity at 10 microM. Treatment with FNZ (30 microM) and PXF (100 microM) also inhibited erythrocyte crenation and decreased blood filterability. Intravenous administration of KB-2796 at 3 mg/kg significantly inhibited the decrease of blood micropore-filterability after occlusion of the bilateral carotid arteries in rabbits. Although FNZ (3 mg/kg, i.v.) had no effect, PXF (3 mg/kg, i.v.) produced significant inhibition. These results suggest that KB-2796 prevents increase of blood viscosity and decrease of blood filterability by inhibiting the crenation of erythrocytes and suggest that this effect may be useful for the improvement of hemorheology in ischemic disease.


[Effects of a new antiarrhythmic drug, KW-3407, on canine ventricular arrhythmia models].

The antiarrhythmic and direct cardiovascular effects of the new antiarrhythmic agent KW-3407, 5-[[2-(diethylamino)ethyl]amino]-7-methoxy-5,11- dihydro[1]benzoxepino[3,4-b]pyridine 1.5 fumarate, were examined. To evaluate antiarrhythmic effects, two-stage coronary ligation-, digitalis- and adrenaline-induced spontaneously occurring arrhythmias were used. KW-3407, 20 mg/kg/10 min, suppressed these three arrhythmia models, similar to flecainide, mexiletine and phenytoin. The antiarrhythmic plasma concentrations, IC50, of KW-3407 for 24-hr and 48-hr coronary ligation-, digitalis- and adrenaline-induced arrhythmias were 18.1, 14.4, 18.3 and 21.4 micrograms/ml, respectively; and these values were similar to one another. In the canine blood perfused atrioventricular (AV) node, sinoatrial node and papillary muscle preparations, KW-3407 decreased the sinoatrial rate and contractile force, and increased the coronary blood flow and AV conduction times, but these effects were weaker than those of disopyramide and flecainide and were short-lived. These results indicate that KW-3407 can be expected to become a clinically useful antiarrhythmic drug.


[Effects of selenium on the serum glucose and insulin levels in diabetic rats].

We investigated the effects of selenium (Se) on the serum glucose and insulin levels in rats with diabetes induced by streptozotocin (STZ, 75 mg/kg, i.p.) and pancreatectomized rats. Moreover, the direct action of Se on insulin release from the isolated pancreatic islets using a slight diabetic rat was studied. The following results were obtained: 1) Selenite at a dose of 173 micrograms/kg (78.9 micrograms/kg of Se base equivalent) drastically reduced the very high level of serum glucose in acute diabetic rats within 5 to 30 min after treatment. During this time period, the insulin level in the serum showed an increasing tendency. 2) The high serum glucose level in chronic diabetic rats returned to the original level with injection of selenite for 4 days, once a day. However, Se did not elicit a significant increase in serum insulin level. 3) Although there was a tendency for the serum glucose level to decrease when selenite was administered into pancreatectomized rats, no secretion of insulin into the serum was observed. 4) Insulin release from isolated pancreatic islets was dose-dependently accelerated by the addition of selenite. These data present the new finding that Se reduced the high level of serum glucose in diabetic rats.


[Effects of Kamikihi-To on autonomic imbalances in SART-stressed (repeated cold-stressed) mice].

The effects of Kamikihi-To (KMK), a traditional Chinese medicine, on autonomic imbalances were evaluated in SART-stressed (repeated cold-stressed) mice. These animals exhibited decreases in pain threshold and contraction of duodenum by acetylcholine, and they showed changes in their electrocardiogram and hematological parameters. All symptoms are thought to be caused by dysautonomia. KMK in dosages of 0.5 and 1.0 g/kg were administered to mice once a day for 8 consecutive days. SART stress was induced from the second day. KMK prevented the decrease in the pain threshold and contraction of the duodenum, although it had no effect on the electrocardiographic or hematological changes. KMK had no similar effect on unstressed mice. This data suggests that KMK might be useful for the treatment of clinical autonomic imbalances.


[Overview of the progress in drug dependence studies--mainly focussing on psychic dependence].

The technical term 'drug dependence' was officially adopted by WHO's Expert Committee on Addiction in 1964. Until this, to describe a state of dependence, terms such as 'poisoning', 'habit', 'ism', and 'addiction' had been used from time to time. Until the 1950's, investigators were mainly focussed on the phenomena of physical dependence. However, once the concept of psychic dependence had been introduced, behavioral and neuropharmacological studies on the modes of drug action that produce psychic dependence were activated and have progressed in the last two decades, and among the points clarified by these studies are the following: 1. The critical drug properties that produce psychic dependence are those of rewarding subjective and reinforcing effects of drugs but these effects are not the properties that produce physical dependence, although the development of physical dependence on particular drugs such as opiates may substantially enhance craving for the drugs. 2. The mesolimbic and mesocortical dopamine systems in the brain and also the N. Accumbens play a primary or at least a partial role in producing the subjective and reinforcing effects of major dependence-producing drugs such as cocaine, opiates, barbiturates, benzodiazepines, and ethanol. 3. Many drugs such as naltrexone, methadone, and some dopamine antagonists and serotonin reuptake inhibitors or antagonists were found to be effective in the pharmacotherapy of the dependence on opiates, cocaine, or ethanol.


Underbite and the scaling of facial dimensions in colobine monkeys.

This investigation was concerned with the dimensions of the facial skeleton and the incidence of underbite in colobine monkeys. Standard craniofacial dimensions and the notation of the presence or absence of underbite were recorded for skulls of 308 adult, wild-caught colobines belonging to 10 species. Underbite was noted in all species examined, ranging in frequency from 10% in Colobus polykomos to 100% in 2 species of Presbytis. Univariate statistics indicate that species with high frequencies of underbite tend to have shorter, broader maxillary dental arches, shorter faces and rostrums, and longer mandibular dental arches. A multivariate discriminant analysis supported the univariate statistics. Interspecific allometric analysis of facial measurements against a constructed size variable indicated that maxillary dimensions scale in a strongly positive manner in relation to size. However, mandibular dimensions tend to scale isometrically. This pattern of facial scaling indicates that the tendency toward underbite should increase as overall size decreases. This would explain why smaller species have higher frequencies of underbite than larger species and why females often have a higher incidence of underbite than conspecific males. Zingeser has suggested that the high incidence of underbite in colobine and some cebid monkeys is an adaptation to folivory. The results of this study support an alternative hypothesis that the high incidence of underbite in colobine monkeys is related to the pattern of facial scaling with size in combination with relaxed selection on the anterior dentition.


Adoption of an additional infant by a Western lowland gorilla (Gorilla gorilla gorilla).

A 10-year-old Western lowland gorilla, already caring for her own 14-month-old son, adopted a female neonate. The infant's mother (aged 7 years, 4 months) showed no interest in the infant, and it is unclear whether she abandoned the infant or whether it was seized by the dominant foster-mother. The foster-mother gave more maternal attention to the adoptee than to her own son but gave both infants the same protection. She adjusted her forms of transport to the age of each infant. The subadult mother of the neonate did not seek contact with her offspring during the first 4 weeks and in fact showed more interest in the 14-month-old male infant. Interactions between the two mothers were rare. The foster-mother's own male infant died 2 months after she had adopted the female infant. She looked after the adopted infant for 1 year, but then lost interest so that the adoptee had to be separated.


Comparative induction of unscheduled DNA synthesis in cultured rat hepatocytes by allylbenzenes and their 1'-hydroxy metabolites.

The allylbenzenes estragole, methyleugenol and safrole are hepatocarcinogens in rodents at very high doses, but allylbenzene itself is neither hepatotoxic nor hepatocarcinogenic. To elucidate further the significance of metabolic 1'-hydroxylation in the carcinogenicity of the allylbenzenes and to give further insights into the structure-metabolism-genotoxicity relationships of these compounds, comparative data were established on the ability of estragole, methyleugenol, safrole, allylbenzene and their 1'-hydroxy metabolites to induce unscheduled DNA synthesis (UDS) in hepatocytes derived from male Fischer 344 rats. Cytotoxicity was assessed by lactate dehydrogenase leakage. The first three compounds increased UDS in a dose-related fashion but allylbenzene was non-genotoxic. 1'-Hydroxyestragole, -methyleugenol and -safrole were more potent genotoxins than their parent compounds. This difference in genotoxicity indicates the importance of the attachment of the electron-withdrawing methoxy or methylenedioxy substituents to the benzene ring. The non-linear dose-response curves for genotoxicity obtained with the allylbenzenes and their 1'-hydroxy metabolites indicate that it is important to consider dose-dependence in metabolism when interpreting the significance to humans of animal data obtained with very high doses of the compounds studied. It is likely that the use of these high doses markedly overestimates the potential hazard to humans of low doses of allylbenzenes, which generate only very small quantities of genotoxic metabolites.


Lack of carcinogenicity of ferric chloride in F344 rats.

The carcinogenicity of ferric chloride, a compound that is used as a food additive, a haemostatic or treatment for hypochromic anaemia, was examined in F344 rats of both sexes. It was dissolved in distilled water at levels of 0, 0.25 or 0.5%, and groups of 50 male and 50 female rats were given one of these solutions ad lib. as their drinking water for up to 2 yr. The mean body weights of the treated rats were lower than control group values for both males and females. A variety of tumours developed in all groups, including the control group, but all these neoplasms were histologically similar to those known to occur spontaneously in this strain of rats, and no statistically significant increase in the incidence of any tumour was found in the treated groups of either sex. Thus it is concluded that under the conditions of this experiment, ferric chloride exerts no carcinogenic potential in F344 rats.


The potential genotoxicity of sorbates: effects on cell cycle in vitro in V79 cells and somatic mutations in Drosophila.

Sodium sorbate, potassium sorbate and an oxidation product of sodium sorbate, 4,5-epoxy-2-hexenoic acid, were tested for their genotoxic potential in cultured V79 Chinese hamster cells and in somatic cells of Drosophila melanogaster (wing spot test, SMART). In Drosophila only the epoxide showed a weak genotoxic effect. In V79 cells, freshly prepared sodium sorbate solutions at the highest concentrations only (2.5 mg/ml, 24 hr exposure) arrested mitosis at the G2/M cell cycle phase and potassium sorbate (2.5 mg/ml) had no effect. This arrest was reversible after a 24-hr recovery interval. Sodium sorbate solutions stored for up to 208 days were cytotoxic at 2.5 mg/ml, induced cell cycle arrest in the G2/M phase and increased cellular protein content, indicating an action similar to spindle poisoning and a chemical stress reaction (adaptation processes, modification of transcription). Potassium sorbate solutions stored for 28 days were also cytotoxic. With 4,5-epoxy-2-hexenoic acid at concentrations up to 0.01 mg/ml no effects were seen. At higher concentrations (at least 0.1 mg/ml) cell killing was observed, which probably resulted from unphysiologically lowered pH in the culture medium. Overall, the results are interpreted as an indication of a weak genotoxic potential of stored sodium sorbate solutions. Thus, sorbic acid and its potassium salt at the concentrations used for food preservation can still be considered as safe for human consumption.


Effect in vitro of arachidonic acid, eicosapentaenoic acid and docosahexaenoic acid on the hepatic activation of dietary genotoxins by rat post-mitochondrial fractions.

The effect of arachidonic acid, eicosapentaenoic acid and docosahexaenoic acid on the conversion of the heterocyclic amine 2-amino-3-methylimidazo[4,5-f]quinoline (IQ) to its genotoxic metabolites was investigated using a modified bacterial mutation assay. The assay used Salmonella typhimurium TA98 as an indicator of the mutagenicity and hepatic post-mitochondrial fractions (S-9) from male Sprague-Dawley rats as the activating system. All three fatty acids inhibited the mutagenicity of IQ without effect on the uptake of the active metabolites and/or on the DNA repair processes within the bacterial cell. The activation of three other food mutagens, 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx), 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) and aflatoxin B1 (AFB1) was also inhibited by these fatty acids.


Effects of hickory-smoke condensate on development of pepsinogen 1-altered pyloric glands in rats.

Hickory-smoke condensate (HSC) is a popular food flavouring in the USA. Available data have suggested that this food additive has tumour-initiating/promoting potential. Accordingly, a commercial HSC has been investigated for its capacity to promote tumours in the rat glandular stomach using pepsinogen 1 (Pg 1)-altered pyloric glands (PAPG) as the marker of preneoplastic lesions. The development of PAPG initiated by a single intragastric administration of N-methyl-N'-nitroso-N-nitrosoguanidine was significantly increased by feeding rats a diet containing 5% HSC; no effect was observed with lower doses (1.25 or 2.5%) of HSC. The results suggest that HSC has weak tumour-promoting potential in the rat glandular stomach.


Relative protection given by extract of Phyllanthus emblica fruit and an equivalent amount of vitamin C against a known clastogen--caesium chloride.

Aqueous extracts of Phyllanthus emblica L. fruit and an equivalent amount of vitamin C were administered orally by gavage to laboratory-bred Swiss albino mice for 7 days in order to evaluate the protection afforded by the two extracts against clastogenic effects of different doses of caesium chloride (CsCl) on bone marrow cells of Mus musculus in vivo. Both pretreatments significantly reduced the frequency of chromosome aberrations induced by CsCl given at three different doses, indicating that vitamin C, an essential component of P. emblica extract, was the effective agent in protecting against the clastogenicity of the metal salt.


Tissue-binding and toxicity of compounds structurally related to the herbicide dichlobenil in the mouse olfactory mucosa.

The herbicides dichlobenil (2,6-dichlorobenzonitrile), chlorthiamid (2,6-dichlorothiobenzamide) and their environmental degradation product 2,6-dichlorobenzamide are irreversibly bound and toxic to the olfactory mucosa following single injections in mice (Brandt et al., Toxicology and Applied Pharmacology 1990, 103, 491-501; Brittebo et al., Fundamental and Applied Toxicology 1991, 17, 92-102). In the present study, autoradiography showed an irreversible binding of radioactivity in the olfactory mucosa (preferentially in the Bowman's glands) in C57Bl/6 mice treated with the 14C-labelled analogues [14C]2,6-difluorobenzonitrile ([14C]DFBN) and [14C]2,6-difluorobenzamide ([14C]DFBA). Therefore the toxicity of DFBN, DFBA and of some structurally related compounds including benzonitrile (BN) and the herbicides bromoxynil (3,5-dibromo-4-hydroxybenzonitrile) and ioxynil (3,5-diiodo-4-hydroxybenzonitrile) in the mouse olfactory mucosa was examined. No histopathological changes in the olfactory mucosa or in the liver were observed following a single ip dose of any of these compounds [0.145 mmol/kg (all compounds); 0.58 mmol/kg (DFBN, DFBA and BN)]. Also in mice treated with the glutathione-depleting agent phorone, none of these compounds induced any histopathological changes in the olfactory mucosa. The covalent binding of [14C]DFBN in the olfactory mucosa was 16 times lower than an equimolar toxic dose of [14C]dichlobenil, suggesting a low rate of metabolic activation of DFBN in the olfactory mucosa or a low reactivity of the DFBN metabolites formed. The results of this study thus show that single doses of DFBN, DFBA, BN, IX and BX, compounds structurally related to the potent olfactory toxicant dichlobenil, do not elicit acute toxicity in the olfactory mucosa of mice.


Nitroprusside intoxication: protection of alpha-ketoglutarate and thiosulphate.

Protection against the lethal effects of sodium nitroprusside (SNP) was observed in mice after treatment with alpha-ketoglutarate (AKG), either alone or in combination with sodium thiosulphate (STS). The LD50 of SNP was 12.0 (11.0-13.0) mg/kg in mice. Ip injection of AFG (500 mg/kg twice in 20 min) increased the LD50 1.7-fold in mice. STS (1 g/kg, ip) alone increased the LD50 5.5-fold. Furthermore, combined administration of AKG and STS increased the LD50 6.9-fold. SNP elicited increased cyanide levels in blood of mice in a dose-dependent manner. SNP (10 mg/kg, sc) administration gave rise to blood cyanide levels of 73.2 +/- 3.0 microM, 30 min after treatment. Ip injection of AKG significantly decreased blood cyanide levels by 30% in mice 30 min after treatment with 10 mg SNP/kg. A single injection of STS (1 g/kg) or a combination of AKG and STS reduced in blood cyanide levels by 88 or 98%, respectively, in mice after treatment with 10 mg SNP/kg. In addition, the increase in blood cyanide levels induced by injection of 50 mg SNP/kg was markedly inhibited by a combination of AKG and STS or (to a lesser extent) by STS alone. These results suggest that the combined administration of AKG and STS, by preventing the increase in blood cyanide levels induced by SNP, may afford protection against the toxic effects of SNP.


Percutaneous absorption of nicotinic acid, phenol, benzoic acid and triclopyr butoxyethyl ester through rat and human skin in vitro: further validation of an in vitro model by comparison with in vivo data.

The in vitro percutaneous absorption of three model compounds, nicotinic acid, phenol and benzoic acid, and the herbicide triclopyr butoxyethyl ester (triclopyr BEE) has been investigated in flow-through diffusion cells using skin from male Fischer 344 rats and humans. After the application of the four chemicals to the epidermal surface of unoccluded full-thickness rat skin, the absorption of each compound across the skin and into the receptor fluid at 72 hr reached 3.7 +/- 0.3, 5.7 +/- 0.6, 26.7 +/- 3.7 and 48.3 +/- 1.2% (mean +/- SD, n = 2-7) of the applied dose for triclopyr BEE, nicotinic acid, phenol and benzoic acid, respectively. After the application of the four chemicals to the epidermal surface of unoccluded full-thickness human skin, the absorption of each compound across the skin and into the receptor fluid at 72 hr was significantly (P < 0.05) less than through rat skin, reaching 0.7 +/- 0.1, 0.7 +/- 0.2, 18.8 +/- 1.3 and 37.8 +/- 6.9% (mean +/- SD, n = 2-7) of the applied dose for triclopyr BEE, nicotinic acid, phenol and benzoic acid, respectively. Occlusion of the skin surface with teflon caps often significantly (P < 0.05) enhanced the percutaneous absorption of the model compounds, although this effect was not uniform, varying with the compound under study and the skin (rat or human) used. When rat skin was occluded with teflon caps, the extent of absorption at 72 hr reached 8.6 +/- 0.8, 36.2 +/- 1.7 and 51.8 +/- 3.3% (mean +/- SD, n = 3-4) for nicotinic acid, phenol and benzoic acid, respectively. Corresponding values for human skin occluded with teflon caps were 3.3 +/- 1.6, 47.1 +/- 0.5 and 65.5 +/- 7.1% (mean +/- SD, n = 3-4). The experiments on the absorption of each model compound through rat and human skin were repeated and there was generally good agreement between the results from the two sets of experiments. The in vitro data reported compare favourably with data obtained by other workers using both in vitro and in vivo methodologies. The in vitro: in vivo correlation supports the use of the flow-through diffusion cell system as a model for the prediction of percutaneous absorption in vivo in the rat and in humans.


Effects of the colour additive caramel colour III on the immune system: a study with human volunteers.

Administration of the colour additive Caramel Colour III to rats has been associated with decreased numbers of lymphocytes and several other changes in the immune system, as well as in immune function parameters, specifically in animals fed a diet with a relatively low vitamin B6 content. The effects are caused by the imidazole derivative 2-acetyl-4(5)-tetrahydroxybutylimidazole (THI). Caramel Colour III is commonly used in food products such as bakery products, soya-bean sauces, brown sauces, gravies, soup aromas, brown (dehydrated) soups, brown malt caramel blend for various applications, vinegars and beers, and effects in humans on dietary intake cannot be excluded. Elderly male volunteers with a marginal deficit in vitamin B6 were considered a relevant and potentially sensitive group to study possible effects of Caramel Colour III on blood lymphocyte numbers (total and within subsets) or on proliferative responses of lymphocytes to mitogenic stimulation. In addition, several other haematological parameters, as well as serum immunoglobulin levels and immunoglobulin production in vitro by pokeweed mitogen-stimulated mononuclear blood cells were studied. The results of this double-blind intervention study demonstrated that in a selected test group of apparently healthy elderly male volunteers with a biochemically marginally deficient vitamin B6 status, Caramel Colour III containing 23 (commercial sample) or 143 (research sample) ppm THI and administered at the level of the current acceptable daily intake of 200 mg/kg body weight/day for 7 days did not affect any of the factors investigated.


Studies on endogenous formation of N-nitroso compounds in the guinea pig supplemented with proline or thioproline and sodium nitrate.

The endogenous formation of N-nitrosoproline (NPRO) and N-nitrosothioproline (NTPRO, N-nitrosothiazolidine-4-carboxylic acid) was studied by monitoring their excretion in the urine of guinea pigs given oral doses of 10 mg proline or thioproline after supplementation with 34 mg (0.4 mmol) sodium nitrate. In order to estimate the conversion of nitrate to nitrite, the animals were also supplemented with 3.5 mg (0.05 mmol) sodium nitrite instead of sodium nitrate. In animals fed commercial diets, the excretion of NPRO and NTPRO under supplementation with sodium nitrate was 2.0 micrograms and 28.7 micrograms/animal/day, respectively, whereas the excretion under supplementation with sodium nitrite was 0.7 micrograms and 13.3 micrograms/animal/day, respectively. The higher excretion of NTPRO than NPRO in each case shows that thioproline is more effective for nitrite trapping than proline. The animals supplemented with nitrate excreted more than twice the amounts of NPRO or NTPRO than those supplemented with nitrite. It is assumed, therefore, that more than 0.1 mmol nitrate is reduced to nitrite and takes part in the endogenous nitrosation of the guinea pig. When various concentrations of L-ascorbic acid (AsA), known to inhibit the formation of N-nitroso compounds, were also administered orally to animals immediately after supplementation with sodium nitrate, the NPRO excretion decreased with increasing AsA concentration. These data indicate that the guinea pig, which is unable to synthesize AsA as well as humans, may be an appropriate animal model for evaluation of the endogenous nitrosation ability of humans ingesting nitrate.


Effects of phenolic smoke condensates and their components on hepatic drug metabolizing systems.

Treatment of food with wood smoke is a long-established method of preservation and flavouring food. Recently, hardwood smoke condensates, purified of polycyclic hydrocarbons, have become of importance for direct flavouring of sausage-meat. The acute toxicity of the purified phenolic fraction in mice after intraperitoneal administration was therefore investigated. The LD50 was found to be 940 mg/kg body weight, which is about three times the LD50 of phenol (about 300 mg/kg). Only high concentrations of phenols or smoke condensate fractions are able to damage cytochrome P-450 by conversion to cytochrome P-420, whereas lower concentrations exhibit inhibitory effects on monooxygenase activity. Inductive properties of the phenolic fractions could not be demonstrated. Concentrations in vivo of free phenolic compounds do not reach inhibitory levels, since the hexobarbital-induced sleeping-time and 14CO2-exhalation after administration of p-[methoxy-14C] acetanilide are not altered. It is concluded that the phenolic compound intake with food regularly treated with smoke condensate fractions is below a toxicologically relevant level.


A 4-week feeding study of ground red chilli (Capsicum annuum) in male B6C3F1 mice.

The toxicity of red chilli was examined in male B6C3F1 mice fed a commercial meal diet mixed with ground Capsicum annuum (Linn.) at levels of 0.5, 1.0, 2.5, 5.0, 7.5 and 10% by weight. Mice were offered control or test diets ad lib. starting at 6 wk of age. Food consumption was measured daily and individual body weights recorded weekly for the 4-wk feeding period. General health, body weight and food intake were apparently not adversely affected at any level of pepper consumption. Histopathological evaluation revealed slight glycogen depletion and anisocytosis of hepatocytes in the 10% group. However, other organs did not reveal any lesions attributable to the chilli exposure. It appears that red chilli is relatively non-toxic at the doses tested in male B6C3F1 mice.


A novel pharmacological approach for paraquat poisoning in rat and A549 cell line using ambroxol, a lung surfactant synthesis inducer.

Paraquat (PQ) is a widely used herbicide that causes acute adult respiratory distress syndrome (ARDS) and chronic lung damage (diffuse fibrosis). One of the earliest biochemical effects induced by PQ is damage to type II pneumocytes with consequent depletion of surfactant. With the aim of counteracting the toxic effects of PQ, a series of investigations were performed into the possible protective effect of the drug ambroxol, which induces the synthesis of surfactant in lung alveolar type II cells. The number of survivors and survival time of rats treated ip with 35 mg PQ/kg was significantly increased by 3 days of ambroxol pretreatment and by ambroxol treatment 30 min or 2 hr after PQ. Total phospholipid content in lung and bronchoalveolar lavage fluid (BALF) was significantly reduced 30 hr after treatment with PQ alone. The association of ambroxol with PQ significantly antagonized this reduction. In BALF the ratio between palmitic acid and stearic acid concentrations was significantly lower in animals treated with PQ alone but was returned to normal by the association with ambroxol. The cell line A549, exposed in vitro to PQ concentrations from 0.5 x 10(-4) to 2 x 10(-3) M, showed a significant dose-dependent loss of viability. Cells pretreated with ambroxol (10 mg/ml) were more resistant to PQ and their viability started to decrease significantly only from a PQ concentration of 0.8 x 10(-3) M. Membrane microviscosity was measured on the same cells. Cells treated with PQ alone showed a reduction of membrane microviscosity, which was significantly counteracted by ambroxol pretreatment. The curves of modification of membrane microviscosity of cells treated with PQ and with ambroxol plus PQ paralleled those of cell viability, indicating that the stimulation of surfactant synthesis in vitro may be a prerequisite for counteracting some of the early effects of PQ.


Comparison of the partition coefficient and skin penetration of a marine algal toxin (lyngbyatoxin A).

Lyngbyatoxin A is produced by marine algae, and causes local cutaneous toxicity in swimmers. The purpose of this research was (1) to determine the partition coefficient of lyngbyatoxin A in octanol/water and (2) to use methods in vitro to measure the penetration and distribution of lyngbyatoxin A in guinea pig and human skin. Discs of excised guinea pig and human skin were mounted in diffusion chambers that exposed the epidermal surface to air and bathed the dermis with HEPES-buffered Hanks' balanced salt solution with gentamicin sulphate. The epidermal surfaces were dosed with 26 micrograms lyngbyatoxin A/cm2 dissolved in 13 microliters dimethyl sulphoxide/cm2. The diffusion chambers were incubated at 36 degrees C for varying periods (1.0-24 hr). HPLC was used to quantify lyngbyatoxin A. Skin penetration was calculated by summing the amount of lyngbyatoxin A recovered from the dermis and receptor fluid. The mean partition coefficient for lyngbyatoxin A was 1.53. Penetration of lyngbyatoxin A (expressed as a percentage of dose, n = 3) in guinea pig and human skin was 23 and 6.2 (respectively) after 1 hr of topical exposure. The amount of lyngbyatoxin A in the dermis and receptor fluid did not change significantly over time.