Inhibitor of prostacyclin production in sporadic haemolytic uraemic syndrome

Prostacyclin (PGI2) production was diminished when rat aortic rings were incubated with plasma from 5 of 6 patients with the sporadic form of haemolytic uraemic syndrome but was normal in the presence of plasma from 7 patients with the epidemic form of haemolytic uraemic syndrome or from patients with other renal diseases. The reduced PGI2 production was caused by an unstable inhibitor, extractable into polar lipid solvents, in sporadic haemolytic uraemic plasma. These results suggest that there may be at least 2 different pathogenetic mechanisms in epidemic and sporadic haemolytic uraemic syndrome and that the reduced PGI2 production observed in the sporadic type is due to an inhibitor of PGI2 production rather than a deficiency of stimulating factors.

Goodpasture's syndrome: treatment with plasmapheresis, immunosuppression, and anticoagulation

We report 3 children with Goodpasture's syndrome. In 2 children the diagnosis was delayed, treatment began late, and they did not recover renal function. In the third child early diagnosis and intensive treatment with plasmapheresis, immunosuppression, and anticoagulation resulted in an initial return of renal function after a prolonged period of anuria. In this child, however, although there was no evidence of disease activity, further deterioration of renal function subsequently occurred.

Relationship of adriamycin concentrations to the DNA lesions induced in hypoxic and euoxic L1210 cells

Exponentially growing L1210 mouse leukemia cells were incubated with Adriamycin (ADR) under hypoxic (95% N2:5% CO2) or euoxic conditions (95% air:5% CO2) for 1 hr at 37 degrees at a drug concentration ranging from 2.8 X 10(-8) to 2.8 X 10(-4) M, i.e., from levels attained clinically by bolus delivery to the high levels used as an i.p. drug dwell or experimentally, in in vitro conditions. High-pressure liquid chromatography analyses showed diminishing efficiency in drug uptake by the cells as the dose was increased. There were no significant differences between hypoxic and euoxic cells in drug uptake and metabolism. The frequency of DNA protein-associated single-strand breaks and DNA-protein cross-links per 10(6) nucleotides, detected by the alkaline elution technique, increased with the dose in the range of 2.8 X 10(-8) to 2.8 X 10(-6) M in both euoxic and hypoxic cells and declined thereafter. However, the number of DNA lesions relative to a normalized drug level declined steadily, starting with the 2.8 X 10(-7) M concentration. Concentrations greater than 2.8 X 10(-6) M of ADR induced still another type of lesion, direct DNA strand breaks, only in euoxic cells. The results indicate that a common mechanism of interaction between drug and DNA is present in hypoxic and in euoxic cells at low ADR, while an O2-dependent mechanism becomes operational in euoxic cells at high ADR levels.

Haemorrhagic shock and encephalopathy: a new syndrome with a high mortality in young children

In the past year, ten infants have been admitted to hospital with a new or previously unrecognised disorder, characterised by an acute onset of encephalopathy, fever, shock, watery diarrhoea, severe disseminated intravascular coagulation, and renal and hepatic dysfunction. Seven of the infants died. No specific causative agent has been identified, but preliminary studies suggest that the pathophysiology of the disease may involve release of proteolytic enzymes (such as trypsin) into the circulation, with destruction of the microcirculation.

Pneumocystis pneumonia: importance of gallium scan for early diagnosis and description of a new immunoperoxidase technique to demonstrate Pneumocystis carinii

Pneumocystis pneumonia presented in a homosexual with fever, a normal chest radiograph, and pulmonary gallium uptake. Bronchial washings yielded Mycobaterium tuberculosis, but despite antituberculosis therapy he remained febrile, and gallium uptake in the lung increased. Subsequently, silver stain of transbronchial lung biopsy obtained 2 months earlier at the time that tuberculosis was diagnosed showed many Pneumocystis cysts in alveolar spaces. In contrast to Pneumocystis cysts in infected lung tissue from other humans, our patient's Pneumocystis cysts reacted more avidly with antiserum to rat Pneumocystis than with antiserum to human pneumocystis, raising the possibility that organisms that infect humans may have varied surface antigenic properties.

Isolation and characterization of cDNA clones for human skeletal muscle alpha actin

Two cDNA libraries corresponding to polyA+ RNA from human adult skeletal muscle have been constructed by cloning in the PstI site of pBR322. Skeletal alpha actin cDNA clones have been isolated and characterized. Three of these plasmids have overlapping inserts which together contain the complete 5' non-coding and protein-coding region and part of the 3' untranslated region. Determination of the sequence of the cloned cDNA confirms the complete conservation in human of the amino-acid sequence of skeletal alpha actin compared to the rabbit or rat proteins. The 5' untranslated region, but not the 3' untranslated region, shows good homology with the corresponding one in the rat gene. Analysis of changes at silent sites within the protein-coding region suggests that the divergence of skeletal and cardiac alpha actin took place much earlier than the mammalian radiation. The plasmids described here have been used as probes to detect the homologous gene among the about thirty actin sequences present in the human genome.

Repeated femoral vein cannulation for administration of chemotherapeutic agents

A cannulation set has been designed for repeated short-term infusion of vesicant chemotherapeutic agents via the femoral vein. The major complication was thrombophlebitis in 2.1% of infusions. The procedure provides reliable venous access when therapeutic plans are changed or when the inability to provide catheter care makes an indwelling catheter unwarranted.

Phase I clinical trial of 9,10-anthracene dicarboxaldehyde (Bisantrene) administered in a five-day schedule

Bisantrene is a substituted anthracene derivative which preclinically demonstrated a spectrum of activity similar to that of doxorubicin but without associated cardiotoxicity. A Phase I evaluation of the drug has been performed using daily i.v. administrations for 5 days. Sixty courses of treatment were administered to 23 patients at doses from 2.5 to 90 mg/sq m/day. Courses were repeated at 4-week intervals. Dose-limiting toxicities were leukopenia and local cutaneous reactions. The leukopenia was dose related, noncumulative, and of brief duration. Local reactions occurred in 14 of 37 courses administered at doses greater than 60 mg/sq m and in 13 patients resulted in clinical cellulitis of the infused extremity. Gastrointestinal side effects were mild. No alopecia or cardiotoxicity was observed. Two mixed responses were obtained in patients with hypernephromas. Using a daily schedule for 5 days, approximately 40% more drug can be delivered per course than by single-day i.v. administration. However, with this schedule, local cutaneous reactions may prove additionally dose limiting. Phase II studies of Bisantrene in a daily i.v. schedule for 5 days are planned at a dose of 80 mg/sq m/day to be repeated every 4 weeks.

Adriamycin damage: in vivo repair by lymphoma cells

The in vivo repair of ADR-induced cell damage was investigated in the DBA3 transplantable mouse lymphoma. After a single injection of 5 or 15 mg ADR/kg body weight into DBA/2J mice, the survival fraction of clonogens showed a 2.2- to 4.4-fold decrease at 12 or 18 hours post injection and returned to pretreatment levels within 6 hours. These changes were accompanied by the appearance and disappearance of DNA crosslinks and breaks. Because cell division and/or cell loss could not explain the return of clonogens to pretreatment level, the results strongly suggest repair of ADR damage in tumor cells in situ. Such an efficient repair mechanism, responding to a high toxic dose of ADR, constitutes a therapeutically unfavorable event that may contribute to drug resistance.

Alcohol use and psychiatric illness in emergency patients

Screening for alcoholism and associated psychiatric disorders using preselected research criteria demonstrated an overall prevalence of alcoholism of 20% in 200 emergency department patients. The nighttime prevalence of alcoholism was 29%, while the daytime prevalence was 11%. The psychiatric disorders most frequently associated with alcoholism were primary affective disorder (depression) and antisocial personality. The alcoholics had chief complaints relating to trauma in 63% of the cases, vague neuropsychiatric complaints in 23% of the cases, and complaints directly related to alcohol in 8% of the cases. Screening for alcoholism and associated psychiatric illnesses is important in determining an overall treatment strategy for emergency patients.

Protein-associated DNA breaks and DNA-protein cross-links caused by DNA nonbinding derivatives of adriamycin in L1210 cells

The effects of Adriamycin derivatives on L1210 mouse leukemia cells were studied with the DNA alkaline elution assay. The exposure of exponentially growing cells to approximately equitoxic concentrations of N-trifluoroacetyladriamycin-14-valerate (13.8 microM) and its metabolites, N-trifluoroacetyladriamycin (9.0 microM) and N-trifluoroacetyladriamycinol (43.7 microM), for 1 hr in vitro resulted in a high frequency of protein-associated DNA breaks and DNA-protein cross-links. These effects were comparable to those observed with Adriamycin (2.8 microM) and with adriamycinol (26.9 microM). In contrast to Adriamycin and its metabolite adriamycinol, N-trifluoroacetyladriamycin-14-valerate and its two major metabolites do not bind to DNA. Despite the absence of this direct interaction, N-trifluoroacetyladriamycin-14-valerate and its metabolites produce alterations in DNA comparable with the effects of intercalating agents. No evidence for conversion of N-trifluoroacetyladriamycin-14-valerate to Adriamycin or adriamycinol was found in L1210 cells. The similar effects on DNA macromolecules, observed between intercalating and non-DNA-binding anthracyclines, are consistent with the concept that mechanisms other than direct interaction with DNA play a role in the toxic effects of these compounds.

Primary lymphoma of the liver

We report here the case of a man who presented with nonspecific clinical symptoms and was found to have abnormal liver function tests and large filling defects on liver scan. At autopsy, a primary histiocytic lymphoma of the liver was found. The liver is frequently involved secondarily by lymphoma; primary hepatic lymphoma however however is rare, only five cases haveing been previously reported.

Sensitivity analysis in optimization of time-distributed parameters for a coronary circulation model

A method has been developed for parameter estimation using sensitivity analysis in a model for transport of substrates and ions between the blood stream and myocardial cells. Experimental data include indicator-dilution curves recorded from the coronary sinus of dogs and rabbits after bolus injections into the aorta. In addition, the intramyocardial density of deposition of radioactive microspheres was used to provide estimates of the heterogeneity of regional flows in the heart. The sensitivity analysis employed a calculation of the domains of dominance (regions of maximal impact defined with respect to the form of the indicator-dilution curves and the time after injection) for each parameter on the basis of their sensitivity functions.

Parameter estimation in a new two-barrier convection-diffusion model of coronary circulation has been achieved with great efficiency. Computation time was reduced to several minutes on an Interdata minicomputer as compared with 45 minutes to several hours using conventional optimization techniques such as STEPT (a direct search routine) or Simplex. The new parameter estimation method based on selective sensitivity is recommended for the class of problems which involve parameters with a well expressed distribution over the range of the independent variable.

Psychiatric illness in a general urban emergency room: daytime versus nighttime population

Two hundred adults presenting to the emergency room of an urban general hospital were interviewed by a standardized technique to evaluate the existence of a current or previous psychiatric illness. Half of the subjects presented between 8:00 a.m. and 4:00 p.m. (daytime group), and 100 presented between 12:00 a.m. and 8:00 a.m. (nighttime group). In the nighttime population 65% were judged to have current or past psychiatric illnesses. In the daytime population only 36% had current or past psychiatric illnesses. The differences between the 2 populations was highly significant. Fewer than 10% of the 200 patients presented with neuropsychiatric symptoms in their chief complaints.

Renal glycosuria due to gentamicin in rabbits

Gentamicin sulfate was given to rabbits for four weeks in two dosage regimens, either 4 or 8 mg/kg subcutaneously twice a day. Two of the seven animals in each group regained nearly normal renal function after a transient rise in the level of serum creatinine, but the remainder developed severe renal failure leading to the death of all but one of these rabbits. None of the animals showed significant hyperglycemia, buy glycosuria appeared in all and was significantly correlated with the extent of renal damage. These findings demonstrate gentamicin-induced derangement of proximal tubular function and thus amplify the previously demonstrated histologic changes due to the drug. When the drug was administered twice daily, there was marked nephrotoxicity in rabbits given dosages of gentamicin only slightly higher than those employed clinically.

Epidemiology of diseases in adult males with leukemia

In the Tri-State Leukemia Survey, the history of diseases in 605 adult male leukemia cases 15 years and older and in 668 adult male population controls was examined. These diseases occurred at least 1 year before leukemia was diagnosed. The data were based on respondents' answers that the disease was diagnosed by a physician; the respondent was either the subject or his spouse. Of 30 diseases studied, 7 showed an excess among the patients with leukemia: infectious hepatitis, eczema, psoriasis, diabetes, arthritis and rheumatism, heart disease, and ankylosing spondylitis. Mumps had a lower reported occurrence among the cases, whereas pneumonia was less frequent in acute lymphatic cases than in population controls. Three diseases occurred significantly less in controls than in persons with specific histologic types of leukemia. Our data revealed a more frequent history of herpes zoster (shingles) in chronic lymphatic leukemia, more hives in acute chronic myeloid cases, and meningitis in acute myeloid leukemia. When we only considered the patients' responses, more of them admitted having had acne than did our controls. The remaining diseases--childhood viral diseases, infectious mononucleosis, smallpox, typhoid fever, dysentery, scarlet fever, tuberculosis, asthma, hay fever, and goiter did not occur more frequently in cases than in controls. The findings were consistent with evidence from previous laboratory and clinical studies. The increased occurrence of infectious hepatitis in our case series is consistent with the findings of other studies showing an increased frequency of Australia antigen in patients with hepatitis, leukemia, and Down's syndrome.

Syndrome of fetal gigantism, renal hamartomas, and nephroblastomatosis with Wilms' tumor

A new case of the fetal gigantism-renal hamartomas-nephroblastomatosis syndrome is described, in which a Wilms' tumor occurred. It is considered that this observation provides strong evidence for the interrelationship between renal dysplasia and renal neoplasia.

Driving with a bioptic telescope: an interdisciplinary approach

Six low vision patients were fitted with bioptic telescopes in order to obtain driver's licenses. They were given intensive coordinated training to prepare them for the complexities of driving a motor vehicle.

Immunologic studies of the major nonimmunoglobulin protein of amyloid. I. Identification and partial characterization of a related serum component

Antisera have been prepared against the major nonimmunoglobulin component of secondary and familial Mediterranean fever (FMF) associated amyloid which has been called A component or acid soluble fraction (ASF). The antisera were shown to be monospecific for ASF by precipitation of (125)I-labeled antigen and gave a reaction of identity with four different ASF preparations. The antisera were able to detect a circulating component in human serum that migrated in the alpha1-globulin region. This circulating component gave a line of identity with degraded ASF by double immunodiffusion. 57 normal sera and 89 sera from patients with diseases known to be frequently associated with amyloidosis were tested by immunodiffusion for the circulating ASF component. 7% of normal sera and 50-80% of the pathologic sera had elevated amounts of this component. Absorption studies showed that all normal sera probably have small amounts of this component while cord sera do not have detectable amounts. This component was partially purified and was shown to be slightly larger than albumin. The relation of the circulating component to the acid soluble fraction of amyloid is discussed.

The amino acid sequence of a major nonimmunoglobulin component of some amyloid fibrils

The complete amino acid sequence of a protein, acid soluble fraction, (ASF) which constitutes up to 50% of amyloid fibrils from a patient with familial Mediterranean fever has been obtained. Partial amino acid sequences of three other proteins from patients with secondary amyloidosis were identical in the regions studied except for an alanine-valine interchange in one. The ASF contains no cysteine, does not resemble any known immunoglobulin, and has not been detected as yet in myeloma-associated amyloid.