IgG for intravenous use, autologous serum and plasma induce comparable interleukin-1 receptor antagonist liberation from human mononuclear cells: an in vitro phenomenon depending upon plastic adherence

Immunoglobulin G (IgG) for intravenous use (IVIg) selectively stimulates production of interleukin-1 receptor antagonist protein (IL-1ra) by mononuclear cells in vitro and has been proposed to stimulate IL-1ra production in vivo as part of the therapeutic effect. We tested if IVIg differed from human IgG-containing media (i.e., autologous serum (HS) and plasma (HP)) in stimulating IL-1ra release by MNC in vitro and whether IVIg induced a delayed increase in serum levels of IL-1ra. IVIg, 0.01-0.5 mg/ml, increased the IL-1ra liberation from MNC 10-15 times over that of untreated controls. HP and HS (5% v/v) had comparable effects. However, the stimulated IL-1ra liberation was reduced to less than twice the background liberation when fetal calf serum (FCS)-precoated tubes were used. Three days of high-dose IgG infusion had no significant effect on the serum levels of IL-1ra. It is concluded that therapeutic effects of IVIg cannot be ascribed to significant stimulation of IL-1ra production in vivo, as previously suggested, and that the observed stimulation of IL-1ra production in vitro is an epiphenomenon strictly dependent upon adherence of human serum and plasma constituents.

Measurements of proteinase 3 and its complexes with alpha 1-proteinase inhibitor and anti-neutrophil cytoplasm antibodies (ANCA) in plasma

Wegener's granulomatosis (WG) is a systemic vasculitis which is diagnosed on clinicopathological findings. The diagnosis may be aided by the presence of anti-neutrophil cytoplasm antibodies (ANCA). In WG, ANCA are primarily directed to proteinase 3 (PR3), a serine protease of the azurophilic granules of the neutrophilic granulocyte. The main plasma inhibitor of PR3 is alpha 1-proteinase inhibitor (PI). To study if free PR3 or complexes between the enzyme and PI or PR3 and ANCA could be found in the plasma from patients with WG we have developed three ELISA systems for the detection of these complexes and free PR3. In all three assays monoclonal antibodies against PR3 were used as capture antibodies. After incubation with plasma, free PR3 was detected by affinity purified rabbit anti-PR3 followed by alkaline phosphatase-labelled swine anti-rabbit IgG. Serial dilutions of purified PR3 was used as standard. The detection limit was 3 ng/ml. PR3 complexed with PI was measured by rabbit anti-PI antibodies and alkaline phosphatase-labelled swine anti-rabbit IgG. Pre-formed in vitro complexes of PR3/PI in serial dilutions were used as standard. The detection limit of this assay was 1 ng/ml. PR3/IgG-ANCA complexes were detected by alkaline phosphatase labelled goat anti-human IgG. A positive plasma sample in serial dilutions was used as standard. Plasma samples from nine patients with WG, eight patients with fever of infectious origin without evidence of vasculitis and ten healthy donors were examined by these methods. Free PR3 could not be found in any of the plasma samples. PR3/PI complexes were detected in healthy donors at levels between 41-85 ng/ml. All WG patients, both active and inactive, had PR3/PI concentrations above this level, and so had all patients with fever. PR3/IgG-ANCA was found in three of the patients with WG, two being ANCA negative with inactive disease and one was ANCA positive with active disease. Thus, the developed methods can be useful for future studies of the clinical relevance of these complexes in patients with WG and possibly other vasculitides.

Management of thyroid papillary carcinoma with radioiodine in a patient with end stage renal disease on hemodialysis

Metastatic papillary carcinoma was diagnosed in a 42-year-old woman. The cancer had invaded out of the gland and was present in many lymph nodes. After her surgical procedure, she was advised to have radioiodine. However, the patient had total renal failure and was on dialysis. Studies were carried out using a tracer dose of 2 mCi of radioiodine, demonstrating that approximately 60% of the radioactivity in the body was removed with each dialysis. Calculations indicated that a meaningful dose of radiation could be delivered to residual thyroid and metastases with 100 mCi of radioiodine and the total body radiation would be < 100 rad delivered over several days. Based on these analyses, she received 100 mCi of I-131 on two separate occasions and on follow-up scan, clinical evaluation and thyroglobulin measurement is free of disease.

Myoglobinuric acute renal failure in a cardiac transplant patient taking lovastatin and cyclosporine

Acute renal failure can occur in cardiac transplant patients for a variety of reasons. A case of a patient who developed acute renal failure secondarily to drug-induced rhabdomyolysis is reported. The literature regarding acute renal failure and lovastatin and other 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors is reviewed. The potential mechanisms of myoglobinuria and nephrotoxicity and the therapeutic implications are discussed.

[Disseminated histoplasmosis in AIDS]

A 41-year-old man infected with HIV-1 developed fever up to 39.8 degrees C together with nonproductive cough and dyspnoea. Lactate dehydrogenase concentration rose from a level of 998 U/l to 6307 U/l. As pneumocystis carinii pneumonia was at first suspected he was treated with co-trimoxazole (1600 mg sulfamethoxazole and 320 mg trimethoprim, four times daily). But the symptoms did not abate. Bone-marrow puncture revealed numerous macrophages containing ovoid inclusions typical of Histoplasma capsulatum varietas capsulatum. The diagnosis of disseminated histoplasmosis was confirmed by culture and serologically by an increase in Histoplasma polysaccharide antigen. On treatment with amphotericin B (at first 10 mg, then 50 mg daily for 4 weeks) the symptoms regressed within a few days. After the concentrations of lactate dehydrogenase and Histoplasma antigen had become normal again, maintenance treatment was changed to itraconazole (200 mg twice daily), after a total amphotericin B dose of 1150 mg. The patient has remained free of recurrence.

Single-photon emission tomography studies of rubidium-81 in the detection of ischaemic heart disease, using a stress-reinjection protocol

The present study was designed to determine the feasibility of using single-photon emission tomography (SPET) imaging with rubidium-81 (T1/2 = 4.54 h) to detect ischaemic heart disease, using a stress-reinjection protocol and a specially constructed 511-keV hexagonal hole collimator for a standard gamma camera. The diagnostic performance of 81Rb SPET in detecting coronary artery disease (CAD) was investigated in 52 patients with a high prevalence of CAD. Coronary arteriography was performed in 34 patients, 25 of whom were classified as having significant stenosis (> or = 50%). At peak exercise (Cornell protocol), 111-222 MBq 81Rb was injected i.v. for stress imaging, and after 3 h of rest, 74-111 MBq was reinjected for rest imaging. The displayed short- and long-axis slices and the polar map images were interpreted qualitatively. In comparison to coronary arteriography, which served as the gold standard, the performance of 81Rb SPET revealed a sensitivity of 95% for the detection of CAD. Images of diagnostic quality were obtained in all patients, these being comparable to thallium-201 SPET images. In conclusion, these results indicate that the described method can be routinely used for the positron emitter 81Rb with a conventional gamma camera and special shielding. 81Rb has the well-known advantages of a potassium analogue and 81Rb SPET permits better visualization, particularly of the posterior wall of the myocardium, due to the higher photon energy. Considering the typical dose of 201Tl used for SPET (74-148 MBq), a 81Rb SPET scan imposes a significantly lower radiation burden on the patient.

In vivo effect of beta 2-microglobulin on bone resorption

beta 2-Microglobulin (beta 2-M) deposits have been found in the destructive bone lesions associated with dialysis-related amyloidosis. To examine whether beta 2-M can cause bone resorption in vivo, doses of beta 2-M alone were compared with parathyroid hormone (PTH), aluminum, and vehicle alone. Eleven injections of 10 micrograms each were made over a period of 56 hours into the subcutaneous tissue overlying the occipital region of mice. Using a computerized image analysis system we measured (1) periosteal and inner bone length, (2) bone marrow interface length, and (3) the extent of resorption along these surfaces expressed as percentage of total length. Injections of either beta 2-M or PTH were associated with 22% +/- 4% and 25% +/- 4% resorption of periosteal surface, respectively, and 15.9% +/- 2% and 19.9% +/- 5% resorption of marrow bone surfaces, respectively, compared with control. In contrast, aluminum did not increase bone resorption over controls. The simultaneous injection of calcitonin, an osteoclast inhibitor, with beta 2-M or PTH did not increase periosteal resorption over controls. The resorption of inner bone surface was similar in all groups. These studies show that beta 2-M and PTH cause bone resorption in the bone surfaces proximate to the site of injection. This suggests that beta 2-M may contribute to the development of the bone cysts in dialysis-related amyloidosis.

[Expert systems in medicine: possible uses in anesthesia]

The euphoric assumption that powerful computers fed with sophisticated software programmes may serve as a substitute for human knowledge and decision making has been replaced by a more realistic concept of how computers may help in collecting data and their interpretation on the basis of human knowledge and experience. The computer is now used as a dedicated tool to support man in overtaking cumbersome and monotonous processes and tedious calculations. Running 24 hours a day, a specific feature of the computer is that depending on unequivocal software programmes it does neither forget or alter commands and information. Computer programmes imitating human thinking and information processing are called expert or knowledge based systems. These are especially useful when multiple possible combinations of data make a given task very complex. This review presents several systems used in different medical disciplines to describe fundamental ideas, different problem-solving methods, techniques and possible working fields including anaesthesia. It is made clear why computers have found widespread use in all administrative areas. In contrast, no system comparable in potency has been developed for use in clinical medicine in spite of 25 years of research in expert systems. This review starts with a definition of expert knowledge and the appropriate transformation of this knowledge to the computer. In addition, a general survey about the structure of expert systems and a state of the art in some current problem solving methods is given. Additional aspects and restrictions including technical, psychological and legal problems which seem to be unimportant from the outside but are essential for the development of expert systems are presented.

Renin-angiotensin system in neonatal rats: induction of a renal abnormality in response to ACE inhibition or angiotensin II antagonism

In experiments designed to analyze cardiovascular structure in response to antihypertensive therapy with an ACE inhibitor, we decided to start very early in life with the aim to prevent blood pressure increases and the development of vascular structural changes. In these treated groups of rats we unexpectedly observed that after they were weaned, their water consumption and urine volume, respectively, increased substantially. The present study was designed to determine if inhibition of the renin-angiotensin system produced similar effects in different strains of rats, and focused on characterizing the abnormal fluid balance occurring as a consequence to neonatal treatment with ACE inhibitors or angiotensin II blockers. Three-day-old Wistar Kyoto (WKY), Wistar (WR) and spontaneously hypertensive rats (SHR) were given either saline, enalapril, captopril, losartan and the AT2 blocker, PD123319, in the same amount of volume for 20 days. Treatment was stopped and rats were examined with regard to renal morphology at 4, 14 and 30 weeks of age. In addition, water consumption, urine volume, urine electrolytes and osmolality were analyzed at 14 weeks of age, that is, 10 weeks off treatment. Early treatment with the ACE inhibitors, enalapril and captopril, and the AT1 blocker, losartan, but not the AT2 blocker, PD 123319, in the SHR and in the normotensive strains WKY and WR produced persistent, irreversible histopathological renal abnormalities in adult life, long after the rats had been taken off treatment. These abnormalities consisted of mainly cortical tubulointerstitial inflammation, various degrees of papillary atrophy and pelvic dilation.(ABSTRACT TRUNCATED AT 250 WORDS)

[The effect of different flavophospholipol levels in rabbit feed on the fattening rate of hybrid rabbits]

The present study was designed to evaluate the effects of dietary flavophospholipol ("Bambermycin") levels on the growth performance in 400 hybrid rabbits from weaning at 28 days until slaughter at 74 days of age. The fryers were randomly assigned to one of the four dietary treatments that consisted of either 0, 4, 8 or 16 ppm supplemental flavophospholipol. Each treatment was applied to 100 animals each. Dietary treatments exerted no significant effects on live weight, daily weight gain and feed consumption across the entire fattening period. However, daily weight gains in treated fryers were increased by 2.4% on the average. The only significant treatment effect was found in feed conversion (food/gain) in fryers fed 16 ppm supplementation; kilogram food intake per kilogram weight gain was reduced by 0.16 kg as compared to the control group. Mean feed conversion in treated groups was improved by 3.5% on the average. In addition of flavophospholipol a significantly decreased mortality was observed. It was remarkable, that losses caused by infection in control were exclusively due to infections by Bordetella species, while the treated groups were only caused by Pasteurella species.

[Erroneous vision determination and quantitative effects]

The experimentally determined psychometric function for Landolt rings (8 orientations, 183 eyes) is used to calculate the statistics of visual acuity results according to DIN 58,220 and their bias due to deviations from DIN 58,220. Test procedure fulfilling DIN 58,220, criterion 3/5: With a second test the first result is reproduced in 33.7%. In 47% the difference is 1 step, in 16.2% 2 steps, and in 2.8% 3 steps. Selecting the highest acuity value out of several tests yields a bias of +0.44 steps (2 tests), +0.66 steps (3), +0.81 steps (4 tests). Deviations from DIN 58,220, criterion 3/5: Linearly instead of log-scaled optotypes: above acuity 0.2 the effect is minimal (< 0.1 steps). For acuity 0.1 the bias is -0.9 steps. Old criterion 3/4: bias -0.55 steps; Repetition of a failed optotype: bias +1.11; Repetition of a failed acuity step: +0.61; Continued test despite fulfilled break condition: bias +0.3 steps; Weakened criterion of 2/5: bias +0.89 steps.

CONCLUSIONS

Visual acuity values can contain considerable errors. There is a need for more effective algorithms and an unbiased investigator. The solution is programmed automatic testing on a computer screen.

Specific nitrogen-15 labelling of leucine residues in human growth hormone

Biosynthetic human growth hormone (hGH) specifically 15N labelled in the leucine residues has been obtained by recombinant DNA technology, using 15N-labelled leucine and an E. coli strain that requires leucine. It is shown that, despite the possibility of minor transaminase activity, the labelling on the whole is specific, and that the two-dimensional 1H-15N correlation NMR spectra of hGH can be greatly simplified by this methodology.

Anti-cardiolipin antibodies (IgG and IgA) in women with recurrent fetal loss correlate to clinical and serological characteristics of SLE

AIM OF STUDY

We investigated to which degree IgG, IgA and IgM anti-cardiolipin antibodies (aCL) are associated in recurrent abortion or late fetal death with other signs of autoimmune disease and in particular SLE.

MATERIAL AND METHODS

Serological variables typical of SLE and of the anti-phospholipid antibody syndrome were measured once eight to 16 weeks after the last fetal loss in 158 women with recurrent abortion or late fetal death; women with manifest autoimmune rheumatic disease were excluded.

RESULTS

(1) Positive values, i.e. above the 99th percentile of reference material, of IgG aCL and IgA aCL were observed in 4% and 7%, respectively, whereas 26% had positive values of IgM aCL. (2) IgG aCL and IgA aCL but not IgM aCL correlated to anti-nuclear antibodies and to anti-double stranded DNA. (3) Anti-double stranded DNA, IgG aCL and IgA aCL but not IgM aCL correlated to previous occurrence of thrombosis. (4) ANA correlated to lower blood platelet concentrations and higher erythrocyte sedimentation rates.

CONCLUSIONS

Women with recurrent abortion or late fetal death who have higher but not necessarily abnormally high levels of IgG aCL or IgA aCL constitute a group with increased occurrence of clinical and serological characteristics of SLE. We suggest that these women be kept under surveillance for future development of autoimmune disease especially SLE. The women with high IgM aCL constitute another group without these characteristics.

[Comparison of complications after intra- and extracapsular cataract extraction with lens implantation. Results of a prospective, randomized, clinical study]

BACKGROUND

The postoperative complications of ICCE with ACL implantation are compared with those of ECCE and PCL. Our clinical experience with ICCE and ACL implantation can not confirm the widespread rejection of this method.

PATIENTS AND METHOD

A prospective, randomized, clinical study with participation of medical statisticians was performed. A total of 190 patients with ICCE and ACL and 170 patients with ECCE and PCL were followed up for 2 years. The follow-up examinations were performed upon dismission from the hospital, after 6, 12 and 24 months. The data were compiled in a computer program designed for this study and evaluated by the statisticians. The surgical procedures and the surgeons were defined prior to the beginning of patient recruitment.

RESULTS

ICCE with ACL shows much less postoperative complications as usually emphasized. There were only 2 (1.2%) of retinal detachment and no case of corneal decompensation. Cystoid macular edema 8 (4.7%), postoperative vitreous prolaps into the anterior chamber 4 (2.3%) and spontaneous complaints of pain 16 (9.4%) occurred in a low percentage after ICCE with ACL. These complications did not occur after ECCE with PCL. The patients with ECCE and PCL showed capsular fibrosis in 48 (28%) making it the most frequent complication of the whole study. 33% of these patients required YAG-laser capsulotomy. Since retinal detachment occurs in 2.5% after YAG-laser capsulotomy we can not regard capsular fibrosis as a totally harmless complication. It is noteworthy that visual acuity is almost identical 1 year after surgery in both methods.

CONCLUSIONS

The results of this study show that the evaluation of ICCE with ACL is too negative. The elimination of postoperative complications in this method is more difficult. ECCE with PCL is burdened by frequent capsular fibrosis. Visual acuity is almost the same in both methods 1 years after the operation. ACL-implantation remains our method of choice for secondary implantation in patients with an intact iris diaphragm.

Characterization of human tissue factor pathway inhibitor variants expressed in Saccharomyces cerevisiae

Human tissue factor pathway inhibitor (TFPI) and three derivatives with deletions of: 1) the complete COOH-terminal third of the polypeptide including the third Kunitz domain, 2) the third Kunitz domain alone, or 3) the penultimate basic COOH-terminal region alone were expressed in yeast as secreted products. High expression yield was obtained only with the derivative that lacked both the third Kunitz domain and the penultimate COOH tail (TFPI1-161). The purified short form was heterogeneously glycosylated with a high mannose glycan. The specific activities of the different mutant polypeptides toward FXa.tissue factor.FVIIa in a chromogenic assay were similar to that of TFPI expressed in baby hamster kidney cells, suggesting that correct folding takes place in yeast and that neither the third Kunitz domain nor the COOH-terminal region is required for this activity. However, in a clotting assay the anticoagulant activities of yeast-produced TFPI and the shortened derivative TFPI1-161 were about 5- and 50-fold lower, respectively, than for full-length TFPI from mammalian cells. Clotting assays with purified short form TFPI showed that it acted mainly via inhibition of FVIIa.tissue factor rather than FXa. The anticoagulant activity of short form TFPI was comparable with that of high affinity antibodies toward tissue factor.

Cellular immune responses and pathogenesis in c-ANCA positive vasculitides

Very little is known about the cellular immune response in c-ANCA (classical anti-neutrophil cytoplasm antibodies) positive vasculitides or Wegener's granulomatosis (WG). The present review is mainly based on published and unpublished observations of the Cattegat Study Group of Wegener's Granulomatosis. Immunohistochemical examinations of nasal biopsies from untreated patients with active WG revealed the presence of substantial amounts of cells belonging to the immune system (CD3+, CD4+, CD8+, CD20+, CD38+ and CD68+). The IgG response of peripheral mononuclear cells from untreated WG patients to PWM and EBV stimulation was significantly depressed when examined by the reverse haemolytic plaque forming cell assay. T lymphocyte proliferation was observed by in-vitro stimulation with extract of human neutrophil alpha granules, containing the autoantigen for c-ANCA, proteinase-3, only in patients with c-ANCA and active disease. Electron microscopy of biopsies from nasal lesions in untreated patients with active WG did not show structural abnormalities of the organelles of macrophages, giant cells or epithelioid cells. It is concluded that the immune response leading to c-ANCA production involves the full spectrum of immunocompetent cells normally engaged in IgG production to a foreign antigen. This would be in agreement with a theory of cross reactivity of proteinase-3 with a microbial antigen as a pathogenetic mechanism.

Autoantibodies in IDDM primarily recognize the 65,000-M(r) rather than the 67,000-M(r) isoform of glutamic acid decarboxylase

Glutamic acid decarboxylase autoantibodies may aid in rapid screening strategies predicting IDDM before clinical onset. Rat islets contain GAD65 and GAD67 autoantibody targets, but human islets express only GAD65, now confirmed by direct immunoprecipitation from radiolabeled rat and human islets. Because human IDDM involves beta-cell-specific autoimmunity, we tested 190 new IDDM patients and 51 healthy control subjects for antibodies to recombinant human islet GAD65, rat islet GAD67, or human insulinoma/cerebellum GAD67, each expressed separately in hamster fibroblasts. By using immunoprecipitation, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and densitometric fluorogram scanning, 132 of 190 (70%) of new IDDM patients had GAD65 autoantibodies, whereas only 17 of 190 (9%) had antibodies to rat GAD67 (P < 0.001). Of healthy control subjects, 2 of 51 (3.9%) and 1 of 51 (1.9%) had antibodies to GAD65 and GAD67, respectively. All 17 GAD67 antibody-positive patients also had GAD65 antibodies; 14 of 17 with greater GAD65 than GAD67 index. Control studies showed comparable reactivity between recombinant rat and human GAD67 and between different subcellular preparations of recombinant GAD67 of either species. In conclusion, only GAD65 is expressed in human islets, the autoantibody response is primarily to this isoform, and GAD67 antibodies add little to IDDM detection.

Increased secretion of tumor necrosis factor-alpha, interleukin-1-beta, and interleukin-6 by alveolar macrophages from patients with sarcoidosis

BACKGROUND

Alveolar macrophages from patients with sarcoidosis were analyzed for their ability to secrete tumor necrosis factor-alpha (TNF-alpha), interleukin-1-beta (IL-1-beta), and interleukin-6 (IL-6).

RESULTS

Constitutive release of all three monokines in these patients was concomitantly increased in the active state of disease in comparison with inactive sarcoidosis or healthy control subjects. Alveolar macrophages from patients with inactive sarcoidosis compared with cells from healthy subjects showed increased spontaneous secretion of TNF-alpha and IL-6 only, whereas the constitutive release of IL-1-beta was similar as in healthy volunteers. In vitro stimulation of alveolar macrophages from healthy control subjects with lipopolysaccharide or pokeweed mitogen led to a time- and dose-dependent enhanced secretion of TNF-alpha, IL-1-beta, and IL-6. In a similar manner, with corresponding cells from patients with sarcoidosis the secretion of all three cytokines could be further increased by stimulation with lipopolysaccharide or pokeweed mitogen.

CONCLUSIONS

The data presented indicate that an increased release of TNF-alpha, IL-1-beta, and IL-6 correlates to disease activity and may play a critical part in the pathogenesis of sarcoidosis.

Purification and characterization of the trefoil peptide human spasmolytic polypeptide (hSP) produced in yeast

Recombinant human spasmolytic polypeptide (r-hSP) has been produced in relatively large amounts in Saccharomyces cerevisiae. The two intronless trefoil domains of the hSP-DNA were cloned separately by PCR from human genomic DNA, and the remaining parts of the gene synthesized. Recombinant plasmids were constructed to encode a fusion protein consisting of a hybrid leader sequence and the hSP sequence. The leader sequence serves to direct the fusion protein into the secretory pathway of the cell and to expose it to the Kex 2 processing enzyme system. The secreted r-hSP was found in a glycosylated and an non-glycosylated form. The two forms of r-hSP were purified from the yeast fermentation broth by a combination of ion-exchange chromatography and preparative HPLC. The overall yield from 8 litres of fermentation broth was 160 mg r-hSP and 219 mg glycosylated r-hSP corresponding to 50% and 34%, respectively. The structure of the r-hSP and the glycosylated r-hSP was determined by amino acid analysis and carbohydrate composition analysis as well as by peptide mapping, amino acid sequencing and mass spectrometric analysis.

Differences in cytokine secretion by intestinal mononuclear cells, peripheral blood monocytes and alveolar macrophages from HIV-infected patients

Mononuclear cells of the lamina propria (LpMNC), isolated from endoscopically taken biopsies of the large bowel from AIDS patients, were analysed for their ability to secrete tumour necrosis factor-alpha (TNF-alpha), IL-1 beta and IL-6. Stimulation of LpMNC from normal controls with pokeweed mitogen (PWM) led to a time- and dose-dependent enhancement of TNF-alpha, IL-1 beta and IL-6 secretion. In contrast, PWM stimulation of LpMNC from AIDS patients resulted in only a small increase in TNF-alpha release. Constitutive secretion of IL-1 beta and IL-6 in these patients was already increased to the concentration range of stimulated cells from normal controls and could not be further increased, probably due to maximal in vivo stimulation. Secretion of TNF-alpha, IL-1 beta and IL-6 by peripheral blood monocytes (PBM) and alveolar macrophages from AIDS patients was elevated with or without stimulation compared with normal controls. Obviously, the regulation of TNF-alpha secretion is dependent on the microenvironment. Since it is known that interferon-gamma (IFN-gamma) may induce the production of TNF-alpha, the secretion of this cytokine was examined. Release of IFN-gamma was constitutively and under stimulation lowered in LpMNC from AIDS patients compared with normal controls. Addition of IFN-gamma to LpMNC did not result in enhanced TNF-alpha secretion. Our data indicate a defective function of intestinal mononuclear cells in AIDS patients as shown by the diminished TNF-alpha secretion.

Reemergence of self-induced abortions

Two cases of adolescent females attempting self-induced abortions are presented. Many ramifications and complications of illegal abortions are discussed as they affect the patient and society. In addition, we discuss the future of medical education as well as the economic aspects of health care in relationship to illegal abortions.

A multivariate analysis of mortality and hospital admissions with high-flux dialysis

The use of high-flux dialysis in clinical practice increased rapidly despite an absence of reports on the clinical effectiveness of the technique. Mortality and hospital admission rates of patients treated with high-flux dialysis were evaluated and compared with those of patients treated with conventional dialysis in a hospital-based renal dialysis unit in northern California. By use of a retrospective, cross-over design, 253 patients enrolled in the dialysis unit from January 1987 to January 1991 were studied. During this period, 107 patients were treated with high-flux dialysis for at least 1 month, and all but 17 of them had received conventional dialysis before switching to high-flux dialysis. The remaining 146 patients were treated with only conventional dialysis. Of the 80 patients who died during the study period, 69 were receiving conventional dialysis and 11 were receiving high-flux dialysis. The multivariate analyses, adjusted for age, gender, ethnic background, type of renal failure, comorbid conditions, and duration of ESRD, showed that annual mortality was substantially less for patients treated with high-flux dialysis compared with that for patients treated with conventional dialysis (7 versus 20%; P < 0.001). The difference in the rate of hospital admissions was not statistically significant. In this nonexperimental study, methods were applied to control for selectivity bias and other factors that might confound the apparent treatment effect. The findings suggest that the potential benefits of high-flux dialysis are sufficient to justify further confirmation in a randomized, controlled trial.

[The significance of the weaning age of young rabbits for the development of young animals and their food consumption]

The experiment reported compared the influence of weaning at 25, 28, 31 and 35 days of age on the development of liveweight and food consumption during the pre- and post-weaning period hybrid rabbits. Results of 44 does and 949 offspring showed that late weaning exerted a positive influence on live-weight development in comparison with already weaned kits of the same age. In all weaning age groups a depression in growth occurred shortly after weaning which was compensated thereafter. There was no significant difference between treatments with regard to total food consumption of does and offspring. This lack of difference was due to the high food intake of lactating does after weaning that surpassed maintenance requirements.

Capillary electrophoretic determination of the protease Savinase in cultivation broth

The highly basic washing enzyme Savinase and various analogues were analysed by micellar electrokinetic chromatography (MEKC) and electrophoresis. Broth samples were withdrawn during the cultivation of Savinase by recombinant microorganisms. Savinase peak areas obtained by MEKC-electrophoretic analysis were normalized with respect to migration time and compared with traditional enzyme activity measurements. The electropherograms indicated thermal degradation of the Savinase molecule at high field strengths. Baseline separation of Savinase and two analogues was achieved.

Direct and correlated responses to bidirectional selection for dustbathing activity in Japanese quail (Coturnix coturnix japonica)

Bidirectional selection was conducted for dustbathing activity in male Japanese quail over 17 generations. The response to selection was slightly asymmetrical, due mainly to scale effects and a threshold imposing discontinuity on the visible expression of dustbathing in the low line. Correlated responses to selection were found for latency to dustbathe, duration, intensity, and incidence of nonbathers. In general, changes followed linear patterns over time in both lines with the exception of quadratic change in nonbathers in the high line. Under artificial environment, only minor natural selection pressure is assumed to act on the expression of dustbathing behavior.

Erythropoietin therapy in patients with chronic renal failure

Symptomatic anemia is a common complication of chronic renal failure. Treatment is now possible with the availability of recombinant human erythropoietin (epoetin alfa). Previous experimental studies have suggested that correcting the anemia of chronic renal failure may be harmful in that renal failure may be accelerated. Although experience with this drug has been primarily restricted to its use in patients with end-stage renal disease, several recent trials have been reported in patients with varying degrees of chronic renal failure. We review these studies with particular reference to the progression of renal failure and the drug's reported side effects. We conclude that the use of epoetin is beneficial and well tolerated and that there is no compelling evidence for the acceleration of renal failure associated with its use in patients.

Sensitivity and specificity of different methods for the isolation of Salmonella from pigs

Three different selective enrichment media, Rappaport-Vassiliadis broth (RV), selenite broth (SB) and Müller-Kauffmann tetrathionate broth (MKTB), in combination with plating on modified brilliant green agar (BGA), were compared for the isolation of Salmonella from samples of pig feces. These conventional methods were also compared with a new ELISA kit in conjunction with RV and SB enrichment. Of the conventional methods, enrichment in RV had a higher sensitivity and selectivity than SB and MKTB. Recovery of S. typhimurium from MKTB was significantly poorer than recovery of other serotypes. The combination of RV enrichment and ELISA was as good as the conventional method involving RV enrichment, with a similar high sensitivity and specificity.

Effect of methylxanthine derivatives on T cell activation

In a Phase I-II trial examining the effect of prophylactic administration of pentoxifylline (PTX) on bone marrow transplant-associated morbidity, there was an apparent reduction in the incidence and severity of acute graft-versus-host disease. To determine if PTX might be directly immunosuppressive, its effects on T cell activation and proliferation were examined. PTX and several cogeners were found to directly suppress T cell proliferation in response to phytohemagglutinin, to allogeneic cells in a mixed leukocyte reaction, and to cross-linking the CD3 complex. The effects were dose-related and associated with suppression of secretion of tumor necrosis factor-alpha (TNF alpha). However, the inhibition of proliferation was not solely due to this effect since adding excess recombinant TNF alpha did not restore the proliferative response. These data suggest that PTX may be clinically useful in suppressing allogeneic reactions in bone marrow transplantation.

Glutamic acid decarboxylase (GAD) autoantibodies are additional predictive markers of type 1 (insulin-dependent) diabetes mellitus in high risk individuals

The prevalence of glutamic acid decarboxylase autoantibodies was determined with an immunotrapping enzyme activity assay in newly-diagnosed Type 1 (insulin-dependent) diabetic patients as well as in first-degree relatives using rat brain homogenate as a source of glutamate decarboxylase. Twenty-six out of 86 islet-cell cytoplasmic auto-antibody positive and one out of 24 islet cell autoantibody negative patients of recent onset, had autoantibodies to glutamate decarboxylase above the upper 99% confidence limit obtained from 89 control sera. Among 27 islet cell autoantibody positive relatives including 19 siblings and 8 parents, antibodies to glutamate decarboxylase were found in 8 of 9 (89%) relatives and 7 of 8 (87.5%) siblings with islet cell auto-antibody titres above 20 JDF units, in 1 of 19 (5.2%) relatives with islet cell autoantibody titres between 2 and 5 JDF units, in 2 of 263 (0.7%) siblings and 1 of 139 parents without islet cell autoantibodies. In first-degree relatives, high titre islet cell autoantibodies and autoantibodies to glutamate decarboxylase were tightly associated (X2 = 182, p = 0.0001). None of the relatives with low genetic risk (n = 64), i.e. HLA-different to the diabetic proband, was found to be antibody positive. Antibodies to glutamate decarboxylase were present only in those relatives sharing at least one haplotype with the diabetic proband, including two islet cell autoantibody negative but HLA-identical siblings. Autoantibodies to glutamate decarboxylase were present in 7 of 9 (77%) relatives who developed the disease, including one islet cell autoantibody negative sibling.(ABSTRACT TRUNCATED AT 250 WORDS)

An in vivo analysis of reverse ultrafiltration during high-flux and high-efficiency dialysis

We have developed an in vivo pressure monitoring system to study the phenomenon of reverse ultrafiltration of dialysate during high-flux and high-efficiency dialysis. Under the usual operating conditions of either type of dialysis, driving pressures existed for reverse ultrafiltration of dialysate into the venous end of the blood compartment. Whether or not reverse ultrafiltration could be abolished at higher ultrafiltration rates was dialyzer-dependent, being least with high-efficiency dialysis. In addition, the degree of reverse ultrafiltration was affected by patients hematocrit, dialyzer inlet and outlet oncotic pressures, and the rate and direction of dialysate flow.

Variability among methods to assess patients' well-being and consequent effect on a cost-effectiveness analysis

Cost-effectiveness analysis is emerging as an approach for determining the relative value of health care programs, technologic innovations, and clinical decisions. Increasingly, patients' stated values for quality of life are applied as adjustment in these analyses; the results may vary depending on how individuals assess their well-being. We interviewed 58 patients with chronic renal failure to determine the level of agreement among six methods for assessing well-being, and to determine the effects of variation in assessed well-being on the results of a cost-effectiveness analysis of in-center hemodialysis. Patients reported well-being using the Sickness Impact Profile, Campbell Index of Well-being, Kaplan-Bush Index of Well-being, categorical scaling, standard gamble, and time trade-off. We found that patient well-being was substantially higher as evaluated by the Sickness Impact Profile compared to the other five methods. The Sickness Impact Profile and the Kaplan-Bush Index of Well-being provided much narrower distributions of assessed values relative to other measures. Correlations among assessment methods were poor (Spearman rank-correlation coefficients range: 0.094-0.519). Discrepancies among indices were particularly vivid when we evaluated data at the individual level; many patients reported a high level of well-being according to one index and a low level of well-being according to a different index. The cost effectiveness of in-center hemodialysis varied from $34,893 to $45,254 per quality-adjusted life-year saved according to the Sickness Impact Profile and standard-gamble technique respectively. The substantial variability in patients' stated quality of life may preclude the use of a single method to analyze the cost effectiveness of a health program.

A model of the volumetrically-controlled hemodialysis circuit

We developed a model that predicts the hemodynamics of the volumetrically-controlled circuit used to administer high flux hemodialysis. The equations simulate the entire blood side of the circuit so that blood and dialysate pressures can be predicted from a knowledge of circuit component and patient characteristics. An alternative method of computation has also been devised which permits measured circuit pressures to be used to predict patient blood access pressure, dialyzer resistance to flow and membrane hydraulic conductivity. Success of the model was evaluated by measuring both circuit pressure and component characteristics. The model successfully predicted circuit pressures when measured component characteristics were employed as model inputs. Conversely, the model accurately predicted circuit component characteristics when measured pressures were employed as inputs (8 patients, 30 dialyses). Specific predictions of the model include the following. Elevations of patient blood access pressure will cause blood and dialysate pressures to rise equivalently without affecting the rate of back-filtration or location of pressure equilibrium along the dialyzer axis. Elevated hematocrit is predicted to increase circuit pressures to a degree that is similar to a poorly functioning blood access, however, high hematocrit markedly augments back-filtration and moves the point of pressure equilibrium toward the dialyzer entrance. We conclude that the model provides a predictive tool that can be used to optimize circuit design. Alternatively, the model can be used to separate the influence of a poorly functioning patient access from other factors which can elevate circuit pressures.

[Clinical trial of an ergometry bicycle with automatic blood pressure registration]

Automatic blood-pressure registration on a computerized ergometer cycle was compared with simultaneous manually registered blood-pressure employing a standard mercury sphygmomanometer during performance of maximal ergometer exercise testing on 50 consecutive patients. The difference in blood-pressure registered by the automatic and the manual methods, respectively, was, on an average +0.2 mmHg with a 95% confidence interval of +/- 20 mmHg. By means of linear regression analysis, a correlation coefficient of 0.97 (p less than 0.001) with an uncertainty of approximately 6% with automatic blood-pressure registration was found. Simultaneously, the uncertainty was independent of the degree of work performed. The apparatus was found to be of practical clinical use.

Eosinophils altered phenotypically and primed by culture with granulocyte/macrophage colony-stimulating factor and 3T3 fibroblasts generate leukotriene C4 in response to FMLP

Normodense eosinophils failed to generate leukotriene C4 (LTC4) in response to incremental concentrations of FMLP but did produce LTC4 when stimulated with calcium ionophore A23187. Normodense eosinophils, maintained in culture with 10(-11) M granulocyte/macrophage colony-stimulating factor (GM-CSF) in the presence of 3T3 fibroblasts, became responsive to transmembrane stimulation with FMLP by day 4 with a maximal effect by day 7. After 7 d of culture, hypodense eosinophils stimulated with 2 x 10(-7) M FMLP generated 26 ng LTC4/10(6) cells, and LTC4 biosynthesis was blocked by N-tertbutoxy-carbonyl-L-methionyl-L-leucyl-L-phenylalanine (N-t-BOC-MLP). Neither calcium ionophore stimulation of LTC4 from endogenous arachidonic acid nor substrate-initiated production of LTC4 from incorporated LTA4 changed when eosinophils were cocultured with GM-CSF and 3T3 fibroblasts. Furthermore, when incubated with 10(-6) M FMLP, normodense eosinophils generated no net superoxide measured by the reduction of cytochrome c, whereas replicate eosinophils cultured for 7 d with 10(-11) M GM-CSF and 3T3 fibroblasts reduced a net of 17 nmol of cytochrome c/10(6) cells. These studies suggest that primed and phenotypically altered eosinophils present at an extravascular site may exert pathobiologic effects by responding to soluble ligands in the tissues.

Anorectal dysfunction in patients with urologic disturbance due to multiple sclerosis

Anorectal function was evaluated in 11 patients with voiding dysfunction due to multiple sclerosis. In six patients with constipation, three also had symptoms of obstructed defecation and one patient was incontinent due to stercoral diarrhea. One patient was only fecal incontinent and one patient had obstructed defecation as the only symptom. Three patients had no anorectal symptoms. Anal manometry in the women compared with a control group revealed significant lower anal resting and squeeze pressures, although no significant difference of rectal sensation to distention with air was found. Pudendal nerve terminal latencies were obtained in seven patients and were all normal. In four patients latency could not be demonstrated due to poor contraction of the sphincter on stimulation of the pudendal nerve. Two of these patients were incontinent and two had both constipation and obstructed defecation. It is concluded that patients with voiding symptoms due to multiple sclerosis often reveal anorectal symptoms or motility disorders. Although anal sphincter function is reduced, fecal incontinence is not prevalent in this group. The reason for this lies probably in the fact that many of the patients are constipated, thus securing fecal continence.

Sensitivity and specificity of different methods for the isolation of Salmonella from pigs

Three different selective enrichment media, Rappaport-Vassiliadis broth (RV), selenite broth (SB) and Müller-Kauffmann tetrathionate broth (MKTB), in combination with plating on modified brilliant green agar (BGA), were compared for the isolation of Salmonella from samples of pig feces. These conventional methods were also compared with a new ELISA kit in conjunction with RV and SB enrichment. Of the conventional methods, enrichment in RV had a higher sensitivity and selectivity than SB and MKTB. Recovery of S. typhimurium from MKTB was significantly poorer than recovery of other serotypes. The combination of RV enrichment and ELISA was as good as the conventional method involving RV enrichment, with a similar high sensitivity and specificity.

Autologous bone marrow transplantation with 4-hydroperoxycyclophosphamide purged marrows for children with acute non-lymphoblastic leukemia in second remission

Although autologous bone marrow transplantation (ABMT) following purging with 4-hydroperoxycyclophosphamide (4HC) has been effective for some adults with acute non-lymphoblastic leukemia (ANLL), there are few data on ABMT for children. We have performed ABMT for 13 patients (median age, 5 years) with ANLL in second remission. Bone marrow was treated ex vivo with 4HC to kill residual leukemic cells. In order to enhance the anti-leukemic effect of 4HC, exogenous red blood cells were eliminated from the marrow/4HC mixture. All patients were conditioned for transplantation with busulfan (16 mg/kg) and cyclophosphamide (200 mg/kg), followed by infusion of the 4HC treated marrow. Eleven of 13 patients had complete hematologic reconstitution; there were no transplant-related deaths. Five patients relapsed at 2, 4, 5, 6 and 6 months post-BMT. Eight patients are disease-free survivors; the median time for survival is 24 months, with a projected disease-free survival of 61%. ABMT is a safe and efficacious treatment modality for children with ANLL in second remission. Our results suggest that the disease-free survival for pediatric patients may be superior to that seen in adults.