Effects of low-protein diet and starvation on the activity of branched-chain 2-oxo acid dehydrogenase kinase in rat liver and heart

The activity of branched-chain 2-oxo acid dehydrogenase kinase was 3-fold greater in extracts of heart mitochondria than in extracts of liver mitochondria from rats fed on normal diet. Feeding rats on a 0%-casein diet for 10 days increased the activity of branched-chain kinase 4-fold in extracts of liver mitochondria and in branched-chain dehydrogenase complex purified from such extracts; starvation (48 h) was without effect. In extract of heart mitochondria, kinase activity was increased 2-fold by feeding on 0%-casein diet and 1.5-fold by 48 h of starvation.

Infections in patients with non-small-cell lung cancer treated with intensive induction chemotherapy

The records of 65 consecutive patients with non-small-cell lung cancer (NSCLC) treated with intensive induction chemotherapy were reviewed to study the infectious complications during therapy and to analyze the relationship of the frequency of infections to various predisposing factors. A total of 44 infectious episodes were observed among 30 of the 65 patients. Of the 44 infections, 18 were microbiologically documented and 19 clinically. Seven (16%) infections were without microbiological or clinical documentation and were categorized as "possible" infections. Among the 18 microbiologically documented infections, fifteen (83%) were caused by bacteria and three by fungi. The most frequent bacteria identified in 11 (61%) of the 18 infections were gram-negative organisms, Escherichia coli and Klebsiella pneumoniae being the most frequent. Eight of the 44 infections were associated with bacteremia and three with microbiologically documented pneumonias. There were three drug-related infectious deaths, two associated with bacteremia and one with possible infections. All 44 infectious episodes presented with WBC counts of less than 1,000/microliter, and 34 (79%) had WBC counts of less than 500/microliter. We observed that during therapy, patients with poor performance status (less than 80%) are at a much higher risk to develop infectious complications than those with good performance status (greater than 80%; p less than .001). Although encouraging responses with intensive chemotherapy have been reported for NSCLC in several studies, a major impact of chemotherapy on the survival of patients with this disease has yet not been established. Thus, intensive chemotherapy for NSCLC should remain an experimental treatment modality and should be offered only to patients with good prognostic factors such as those defined by pretreatment performance status.

Brazilian pemphigus foliaceus autoantibodies are pathogenic to BALB/c mice by passive transfer

Brazilian pemphigus foliaceus (fogo selvagem) is a cutaneous blistering disease endemic to certain areas of South America that has distinctive epidemiologic features suggestive of an infectious disease transmitted by an insect vector. Patients with the disease have antiepithelial autoantibodies, both circulating in the serum and bound to lesional epidermis. In order to examine the possible pathogenic role of these autoantibodies, IgG from the sera of these patients was purified and injected into the peritoneum of neonatal BALB/c mice. Thirty-four of 46 mice (74%) receiving parenteral IgG fractions from these patients developed cutaneous lesions that were identical to the human disease by clinical, histologic, immunologic, and ultrastructural criteria. High-titer Brazilian pemphigus foliaceus sera produced lesions more consistently and rapidly than low-titer sera. When injections were discontinued, new lesions ceased to appear and old lesions resolved. The extent of disease correlated with the titer of human antiepithelial antibodies detected in the mouse serum (z less than 0.01). Similar concentrations of IgG fractions obtained from sera of unaffected Brazilians living in endemic areas and from American donors did not induce disease when injected into littermates. These results establish that the antiepithelial autoantibodies play an important role in the pathogenesis of the cutaneous lesions in Brazilian pemphigus foliaceus.

Pulmonary and renal responses to furosemide in infants with stage III-IV bronchopulmonary dysplasia

Pulmonary and renal responses to furosemide were evaluated in ten infants with stage III-IV bronchopulmonary dysplasia. Furosemide was given intravenously for two doses, 1 and 2 mg/kg, at approximately 24-hour intervals. The following indices were evaluated in series before and after entry into study: clinical respiratory distress syndrome score; blood pH; partial pressure of arterial carbon dioxide; alveolar-arterial oxygen gradient; urine output; glomerular filtration rate; fractional excretion of filtered sodium, chloride, potassium, and calcium; osmolar clearance; water clearance; and concentrations of serum electrolytes and calcium. A significant decrease in the respiratory distress syndrome score and in the partial pressure of arterial carbon dioxide was seen only transiently at two hours following each dose. There was no significant improvement in the alveolar-arterial oxygen gradient during the study. Furosemide induced diuresis and urinary excretion of sodium, chloride, potassium, and calcium. A significant decrease in serum chloride and potassium concentrations was seen at 48 hours after entry into study; serum sodium and calcium concentrations remained unchanged. This study has demonstrated that furosemide administration has only a short-term effect in the lung but has a potential for long-term complication on electrolytes and calcium balance in infants with well-established stage III-IV bronchopulmonary dysplasia.

An acquired form of epidermolysis bullosa without immunoreactants. Report of a case

A patient with a 10-year history of an acquired, scarring bullous eruption localized to the anterior surfaces of the lower extremities is described. Clinical, histologic, and electron microscopic features of an acquired form of epidermolysis bullosa are shown to occur in the absence of immune deposits, a finding not previously documented.

Finite element method modeling of craniofacial growth

The application of the concepts of continuum mechanics and of the numerical techniques of the finite element method permits the development of a new and potentially clinically useful method of describing craniofacial skeletal growth. This new method differs from those associated with customary roentgenographic cephalometry in that its descriptions and analyses are invariant; that is, they are independent of any method of registration and superimposition. Such invariance avoids the principal geometric constraint explicit in all analytical methods associated with conventional roentgenographic cephalometry. The conceptual and mathematical bases of the finite element method (FEM) are presented and illustrated by the numerical and graphic descriptions of the two-dimensional growth of the rat skull, for which two sets of longitudinal growth data are used. In practice, the FEM permits analysis of the skull at a scale significantly finer than previously possible, by considering cranial structure as consisting of a relatively large number of contiguous finite elements. For each such element, independently, it is then possible to describe and depict both the magnitude and the direction of temporal size and shape changes occurring in that element relative to itself at some initial time. It is emphasized that such descriptions are completely independent of any local reference frame.

Cystic fibrosis heterozygotes have normal autonomic innervation of the heart

Five simple tests of autonomic nerve function based on measurements of cardiovascular responses to various stimuli were used to investigate possible autonomic dysfunction in obligate heterozygotes for cystic fibrosis. There were no significant differences between the heterozygotes and control groups in any of the tests, suggesting that cystic fibrosis heterozygotes have normal autonomic innervation of the heart.

Vindesine and high-dose cisplatin in the treatment of advanced non-small-cell lung cancer

Seventeen patients with advanced non-small-cell lung cancer (NSCLC) were entered on a combination chemotherapy protocol including vindesine and high-dose cisplatin. All patients had measurable disease and had not previously received chemotherapy. All patients entered were evaluable for toxicity and response. Tumor regression was limited to one complete and one partial response (response rate, 11.7%; 95% confidence limits, 0 to 27%). The complete and partial response lasted 260 + and 82 days, respectively. For the 15 nonresponding patients, the median time to disease progression was 76 days. Median survival was 141 days for the whole group. Significant toxic effects were vindesine-related peripheral neuropathy and cisplatin-induced emesis. Myelosuppression was mild and manageable. The response for the vindesine-cisplatin combination observed in our study is inferior to that seen in a previous vindesine-cisplatin trial reported by others. Thus, the true value of this two-drug regimen in the treatment of NSCLC remains to be established.

Multiple system atrophy with neuronal intranuclear hyaline inclusions. Report of a case and review of the literature

A 31/2-year-old girl presented with frequent falls. She had an unsteady gait, delayed behavioural development absent tendon reflexes and in the legs decreased strength tone and equivocal plantar responses. She then developed ataxia, nystagmus, choreoathetosis, cranial nerve palsies, diminished strength and tone in the arms, sensory deficit in the limbs and autonomic nervous system dysfunction. She became progressively less responsive and succumbed at the age of 63/4 years. Examination of the central, peripheral and autonomic nervous system showed ubiquitous neuronal intranuclear hyaline inclusions and neuronal loss in several sites.

An allometric network model of craniofacial growth

This study of cranial skeletal growth kinematics details the conceptual principles underlying the development of an allometric network model of such growth. This model is tested by the analysis of longitudinal rat and cross-sectional human growth data and by comparison of this model with a previously described allometric centered model. It is shown that the network model is superior to the centered model in three ways: (1) The allometric network model permits growth prediction when allometric constants are known; (2) the network model has significantly smaller errors than the centered model; and (3) the network model is capable of displaying growth kinematics of both the neural and facial skulls while in time there are marked transformations, such as relative rotations of two sets of cranial anatomic points.

Cytoplasmic body myopathy. Report on a family and review of the literature

A 15-year-old girl who was seen for scoliosis presented with cardiorespiratory failure associated with a respiratory infection. She was found to have weakness predominant in the face, sternomastoid, proximal limb, respiratory, spinal and cardiac muscles. The serum creatine kinase level was slightly elevated and the electrocardiogram was abnormal. The electromyograph was consistent with a myopathy. The course was malignant. Her 14-year-old brother had similar findings and succumbed at the age of 14 and one-half years from cardiorespiratory failure. The mother had minimal weakness of proximal limb muscles since early life. The tendon reflexes were normal as was the serum creatine kinase level. The course was benign. On light microscopy the muscle biopsy in the girl showed fibre diameter variation, centrally placed nuclei, necrosis, fibrosis and cytoplasmic bodies. The muscle biopsy in the brother and mother had similar findings except that the inclusion bodies were not seen in the mother. On electron microscopy, the girl showed typical cytoplasmic bodies, involving predominantly type 1 fibres. The mother also had these structures. The literature is reviewed and the origin, pathogenesis and aetiology of the cytoplasmic body are discussed.

Specificity and inhibition of the epidermal cell detachment induced by pemphigus IgG in vitro

IgG isolated from sera of patients with pemphigus vulgaris (PV) has been shown to induce cell detachment when added to primary epidermal cell cultures (PECC). We studied the specificity of this phenomenon. IgG fractions were purified from the sera of five patients with PV and control IgG fractions from the sera of normal donors and patients with bullous pemphigoid (BP), systemic lupus erythematosus (SLE), and anti-AB blood group sera (anti-AB). IgG fractions were added to PECC either at initial plating (0 hours), at media change (48 hours), or sequentially at both times, and cell detachment was quantitated at 72 and 96 hours. Significant cell detachment occurred only when PV IgG was added to the growth media sequentially at 0 and 48 hours (p = 0.001), and this effect was dose-dependent for either dose. Substitution of an unrelated IgG (BP, SLE, or anti-AB) at either time points reduced cell detachment to near control values. Furthermore, cell detachment was inhibited by the addition of the proteinase inhibitors alpha 2 macroglobulin (70% inhibition of detachment), aprotinin (63% inhibition), soybean and lima bean trypsin inhibitor (62 and 64%, respectively), and pepstatin (49%), but not by the inhibitors chymostatin, leupeptin, or antipain. These data confirm that PV IgG induces increased cell detachment in PECC and shows that this effect is specific for PV IgG, is dose-dependent, and may be inhibited by certain proteinase inhibitors.

Statistical testing of an allometric centered model of craniofacial growth

An allometric centered model of craniofacial growth was tested by several computer-assisted statistical methods on the pure longitudinal growth data of twenty-four close-bred female rats and on cross-sectional human cranial growth data. The study demonstrated that such a model was heuristic and, being incapable of exact definition, was deemed inappropriate for further use in modeling of craniofacial skeletal growth. The necessity for vigorous testing of any hypothesis concerning the modeling of craniofacial growth is stressed.

Pseudomonas peritonitis and continuous ambulatory peritoneal dialysis

In a population of 44 patients receiving continuous ambulatory peritoneal dialysis (CAPD) for a total of 591 patient months, there were 104 episodes of peritonitis. The organisms were gram-positive in 65.4%, gram-negative in 23.1%, and cultures of the dialysate were sterile in 11.5%. Pseudomonas aeruginosa was the most frequently encountered gram-negative organism, accounting for 38.5% of the gram-negative infections or 9.6% of all infections. In all cases of P aeruginosa peritonitis, aminoglycoside antibiotic therapy for up to four weeks failed to eradicate the infection, and all patients required removal of the Tenckhoff catheter because of the presence of a sinus tract infection. We conclude that P aeruginosa is the most frequent cause of gram-negative peritonitis in patients receiving CAPD. The presence of a sinus tract infection should be suspected in all patients in whom peritonitis secondary to this organism develops. Removal of the Tenckhoff catheter will be required to cure the peritoneal infection.

Model experiments to study the stress distributions in a seated buttock

Mechanical stress states that develop in the buttock during sitting may exceed tissue tolerance and lead to decubitus ulcer formation in susceptible patients, such as those with spinal cord injury. The danger of this complication can be reduced by using suitable cushions to minimize stress magnitudes and gradients within soft tissues. In this investigation, a two-dimensional physical model of the buttock-cushion system was developed to aid in cushion design. The model consists of PVC gel simulating flesh, cast around a wooden core simulating the ischium bone. A grid etched on the gel permits measurement of strains via photographs of the undeformed and deformed model buttock supported by various cushion materials. The displacement field is analyzed, using a finite strain theory and a strain energy function, to obtain the "tissue stresses'. In this manner, the performances of five clinically used cushion materials were compared with respect to the high stress regimes developed in the model buttock.

Experience with the cerebral function monitor during deliberate hypotension

Forty-five healthy patients (30 aged 15-46 yr and 15 aged 58-82 yr) undergoing various types of plastic surgery were studied during deliberate hypotension produced by a combination of ganglion- and beta-blockade, halothane, head-up tilt and positive end expiratory pressure. A Cerebral Function Monitor was used to assess the adequacy of cerebral perfusion. Cerebral activity did not undergo any significant change if the systolic arterial pressure was decreased gradually and maintained at approximately 60 mm Hg at heart level. However, a rapid decrease in pressure may depress cerebral activity in a reversible manner.

In vitro alterations of epidermal cell adhesion induced by temperature, substrate, and cations

Epidermal cell-to-cell or basal cell-to-substrate adhesion in vitro, involves as yet, unknown mechanisms. The rate of attachment of newly dissociated neonatal mouse epidermal cells and the rate of keratinocyte detachment from preformed epidermal monolayers was investigated under a variety of experimental conditions. In the present investigation, we obtained the following results: (1) variables such as temperature, nature of substrate, and presence of cations in the growth medium were important in the initial cel-to-substrate attachment; (2) removal of Ca++ and Mg++ from the growth medium was associated with a very low attachment rate (less than 5% at 24 hr and 48 hr); (3) the initial cell-to-substrate attachment of epidermal cells decreased about 50% when maintained in medium deficient in either Mg++ or Ca++ indicating that both cations are important in the cell-to-substrate attachment; (4) keratinocyte-detachment from preformed monolayers increased in medium deficient in Ca++, Mg++ as well as in medium only deficient in Ca++. However, detachment in cultures maintained in Mg++ deficient medium was similar to controls. In conclusion, Ca++ is one factor that may regulate epidermal cell-to-cell and cell-to-substrate interactions in vitro. Mg++ appears to influence also in the initial attachment process of epidermal basal cells.

Inhibitory interactions contributing to the ocular dominance of monocularly dominated cells in the normal cat striate cortex

Experiments have been carried out to ascertain whether intracortical inhibitory processes influence the ocular dominance of monocularly dominated cells in the primary visual cortex of the normal cat. The GABA antagonist bicuculline has been iontophoretically applied to the cells studied to produce a localised block of inhibitory mechanisms acting on them. The ocular dominance of these cells was tested before, during, and after bicuculline application. In a sample of 42 cells studied, approximately 50% (19) showed a significant change in ocular dominance during bicuculline application. Some exclusively monocular cells became equally driven by either eye during bicuculline application. All the effects were reversible. Receptive field properties revealed in the non-dominant eye were not identical to those in the dominant eye. Evidence is presented to suggest that for some of the cells there is a selective GABA-mediated inhibitory process suppressing the non-dominant eye input. The possible implications of these data are discussed.

Plasma fibrinogen in diabetes mellitus

Plasma fibrinogen was measured in 285 diabetics (age range 15-85 years) and 209 controls (age range 23-74 years). Plasma fibrinogen concentration showed a positive skew distribution and an approximate normal distribution was obtained by log transformation. The mean log plasma fibrinogen in the diabetics was significantly increased (p less than 0.0001). Patients treated with a sulphonylurea (n = 81) had the highest mean log plasma fibrinogen concentration and this was significantly higher than in patients treated with insulin (n = 76; p less than 0.01), biguanides (n = 28; p less than 0.01) or sulphonyluera plus biguanides (n = 38; p less than 0.05). The biganide treated group had the lowest mean log plasma fibrinogen concentrations. No correlation was found between plasma fibrinogen and blood glucose, duration of diabetes or the presence of complications. Subjects with proliferative retinopathy (n = 38) had a similar mean plasma fibrinogen to those with background retinopathy (n = 55). Twenty-two maturity onset diabetics treated with a sulphonylurea and followed prospectively showed a significant increase in plasma fibrinogen after five months (p less than 0.0001), while a control diet treated group showed no alteration in plasma fibrinogen. It is concluded that plasma fibrinogen is significantly increased in diabetics and apart from age, the main factor related to the increase is treatment with sulphonylureas. It remains speculative whether this association has any correlation with long term cardiovascular morbidity.

Bullous pemphigoid antigen. II. Isolation from the urine of a patient

This report concerns the isolation of bullous pemphigoid antigen from the nondialyzable urinary components of a patient with the disease. The isolation was accomplished by ion exchange chromatography and gel filtration. Pemphigoid antigen was found to be a basic glycoprotein that on SDS gel electrophoresis showed two major bands, one in the 18,000 m. w. region and the second with a m. w. of 74,000. Between these two bands, two additional bands appeared; one of 35,000 daltons and the other of 68,000 daltons. The 18,000 m. w. band was eluted from the gel and rerun on SDS gels. These gels showed the 18,000 m.w. band and also the appearance of the 35,000 and 74,000 m.w. bands. This finding indicates that urinary pemphigoid antigen may exist both as a single monomeric form and in polymeric aggregates.

Gray-scale ultrasound: utility preoperatively and postoperatively in a patient with obstructive jaundice

We present a case of obstructing calculi of the common bile duct diagnosed by ultrasonography. Postoperatively, a sterile abscess due to bile leakage at the distal common bile duct developed, and was also diagnosed by ultrasound Ultrasonography was useful in following the course of clearing of the bile collection. Preoperative ultrasound evaluation of the jaundiced patient should be followed by postoperative sonography, especially if complications occur.

Radionuclide venography of the lower extremities and inferior vena cava by continuous injection and moving bed gamma camera technique

Radionuclide venography has proved to be a tedious procedure because of the need for multiple imaging set-ups with coordinated, repeated injections of radionuclide. The use of a moving bed gamma camera has shortened the procedure. This method enables the entire sapheno-femoral-iliac-caval system to be visualized in continuity on a single film. The moving table top system also adequately imaged the suspected areas of thrombi or endothelial damage on the post-exercise study on a single film.

The effects of deliberate hypotension and foot down tilt on the incidence of deep vein thrombosis during plastic surgical operations: a pilot survey

The incidence of postoperative deep vein thrombosis (DVT) has been investigated in a group of 88 patients undergoing plastic surgical operations on the head and neck, and upper limb. Fifty-two cases were operated upon in the foot-down tilt position and 36 were horizontal. With the effects of blood pressure ignored as a possible contributory factor, the incidence of thrombosis in the latter group was 8-3% and was slightly higher in the tilted group (11-5%). Of those who were hypotensive, 3 developed DVT out of 41 (7-3%) who were tilted; whilst in the 11 who were normotensive and tilted 3 developed DVT, an incidence of 27-3%. Of those who were normotensive and operated flat the incidence of deep vein thrombosis was 8-0%, while in those subjected to a foot-down tilt it was 27-3%. The hypothesis has been advanced that frequent inflation and deflation of the cuff used for monitoring blood pressure in the hypotensive patients may release fibrinolytic activity and explain these differences. Age, sex and operative duration were not found to have an effect. It is concluded that the incidence of postoperative deep vein thrombosis in patients undergoing plastic surgical operations is lower than that found in general surgery, and is not worsened by deliberate hypotension.

Gas-liquid chromatographic measurement of guanidino acids

We present a method for separating and measuring guanidino acids by gas-liquid chromatography. Compared to ion-exchange techniques, this system is faster, more sensitive, requires smaller sample volumes, is independent of colorimetric reactions, and permits simultaneous determination of both amino and guanidino acids. N-Trifluoracetyl-n-butyl esters are formed and then are separated by using a column containing a mixed silicone liquid phase coated on Chromosorb W-HP. Analytical recoveries from plasma ranged from 86 to 112% and were done without prior protein precipitation. Speculations as to the cause of this interference by protein include coprecipitation, protein-binding, and cyclization of the guanidines in the acids used for denaturation. Evidence presented suggests that all three occur: ultrafiltrability is diminished in the presence of protein and nuclear magnetic resonance demonstrates cyclization of some of these esters.

Optic nerve hypoplasia with hypopituitarism. Septo-optic dysplasia with hypopituitarism

Four children had optic nerve hypoplasia with hypopituitarism, and their clinical picture varied with age. The newborn had apnea, hypotonia, seizures, hyopglycemia, and prolong jaundice. The young infant had defective vision, behavioral delay, hypotonia, and seizures. Except for a mildly receding lower jaw and a high-arched palate, the appearance of the patients was not unusual. The fasting blood glucose level was mildly depressed. In two cases the liver was palpable and results of liver function tests were abnormal. The older child, who was blind and mentally retarded, had growth failure. The extent of the pituitary hormone deficiencies was variable, including diabetes insipidus. The septum pellucidum was not invariably absent. Clinical and pathological findings indicate that the brain lesion might be more diffuse than hitherto recognized. Early recognition of this syndrome and timely intervention might diminish serious sequels.

Carotenemia in mentally retarded children. I. Incidence and etiology

The incidence and etiology of carotenemia in mentally retarded children were examined. Fasting serum carotenoid and vitamin A levels were measured in 77 profoundly mentally retarded children aged 3 to 19 years who were receiving a standard diet containing 2000 IU of carotene (expressed in terms of vitamin A activity) and supplemented by 2000 IU of vitamin A daily. Seventeen of the 77 patients had serum carotenoid levels of more than 300 mug./ml. The particulate size of food had a significant inverse relationship to serum carotenoid levels and was an important factor in determining carotenemia. The serum vitamin A level was also higher in children on homogenized diet than in those on pureed feeds, while the lowest level was noted among patients on a chopped diet. Besides particulate size of food, other factors may also be operative in determining carotenemia.

The problem of routine circumcision

One hundred male infants were studied at the Kingston General Hospital, Kingston, Ontario, to determine the incidence and complications of routine circumcision. The parents were also interviewed concerning the reason for operation.In these 100 infants, complications, usually minor, were very common, and included hemorrhage (35), meatal ulcers (31), infection (eight), phimosis (one) and meatal stenosis.The reasons given for operation were prophylactic-to avoid the psychological trauma of later operations for infection, phimosis and "troubles" (40), cleanliness (11) and phimosis (four). The remaining cases were for social and other non-medical reasons. Attitudes of parents and physicians regarding circumcision varied from firm belief in its value to a casual approach. One-half of the babies had partial circumcisions, confirming previous suspicions that non-Jewish males frequently had partial operations. Partial operations do not always guarantee cleanliness and probably do not eliminate the risk of penile carcinoma in all cases, if smegma is carcinogenic. Routine circumcisions spare a few children psychologically traumatic operations at a later date and relieve parents of anxiety about the future of the uncircumcised child. This should be balanced against the complications which, although usually minor, may occasionally be serious.Between 1961 and 1962, at the Kingston General Hospital, 349 (48%) of 727 male newborn babies were routinely circumcised.