Distribution of titanium and vanadium following repeated injection of high-dose salts

Titanium and its alloy of 6% aluminium and 4% vanadium are used extensively in orthopedic and dental surgery. However, in conditions of motion leading to wear, there is significant generation of wear products with deposition of black debris in the tissue. The questions remain as to how much of this debris is generated and to where it is transported. Previous studies have been hampered by low levels of detected elements giving values just above the background levels found in normal tissue and body fluids. The purpose of these experiments was to increase the body burden of titanium and vanadium by injecting larger doses of titanium and vanadium salts over an extended period of time. Each animal (Syrian hamster) received 100 micrograms of each element once a week for six weeks. The hamster was sacrificed on the seventh week and body fluids and tissue harvested. The results indicate that in the experimental animals there was transport of vanadium with levels above control in urine, plasma, liver, spleen, and the mineralized portion and organic portion of bone. Titanium had less transport but still showed levels in the experimental animals in plasma, kidney, liver, spleen, and both phases of bone above those in the control animals. Neither element was found above control levels in lung or red blood cells. The levels of titanium and vanadium in control bone were high, possibly indicating bone as a site for storage and accumulation of these elements when encountered in the activities of daily living.

Stress, vulnerability and adult alcohol relapse

OBJECTIVE

Alcoholics experiencing highly threatening or chronic psychosocial stress following treatment are more likely to relapse than abstaining individuals not experiencing such stress. Expanding upon this stress-relapse hypothesis, we predicted that individual risk and protective characteristics would contribute to vulnerability to relapse in alcoholic men confronted with significant life adversity. The present investigation examined the relationship between psychosocial vulnerability and return to drinking.

METHOD

A group of abstinent male alcoholics (N = 67) who experienced marked life adversity that posed a severe and/or chronic threat participated in this study. Men completed a psychosocial assessment first as an inpatient in treatment for alcohol dependence, and again at 3 months and 1 year following discharge.

RESULTS

Among alcoholic men exposed to severe psychosocial stressors, those with higher composite psychosocial vulnerability scores were more likely to subsequently relapse than those with lower vulnerability scores. Additionally, men who improved in psychosocial functioning following treatment had better outcomes than men whose vulnerability increased. In particular, coping, self-efficacy and social support most consistently predicted relapse among this sample of severely stressed abstaining alcoholics.

CONCLUSIONS

These findings supported the stress-vulnerability model of relapse. Results indicated that improvement in psychosocial domains (e.g., coping skills, social networks, perceived ability to tolerate relapse-risk situations) enhanced the ability of these men to remain abstinent despite severe stress. This study highlights the importance of cognitive and behavioral interventions for increasing improvement in these psychosocial domains.

Mixed-metal fretting corrosion of Ti6Al4V and wrought cobalt alloy

Corrosion has been reported at the modular interfaces of total joint replacement implants, but with conflicting theories as to the cause of such damage. The modular design itself leaves the interface susceptible to galvanic, crevice, or fretting corrosion, or a combination of the three. The purpose of this study was to quantify the effect of material combination on fretting corrosion of orthopedic alloys. Each test specimen consisted of a two-hole plate with spherical countersinks and two cortical bone screws. The plates and screws were made of either Ti6Al4V or wrought cobalt-chromium-molybdenum (CCM), and were tested in all mixed-metal and similar-alloy combinations. Fretting corrosion experiments were conducted for 14 days in 10% calf serum, according to ASTM F897. Corrosion damage was evaluated by weight-loss measurements, atomic absorption spectrophotometry and scanning electron microscopy analyses. The results indicated that Ti6Al4V suffered relatively severe damage when fretted against itself, as a result of adhesive galling. The extent of titanium damage was reduced considerably, however, when Ti6Al4V was fretted against wrought CCM. In contrast, there was essentially no difference in wrought CCM damage when the alloys was fretted against itself compared to fretting against Ti6Al4V. Finally, in similar-alloy combinations, Ti6Al4V suffered more severe damage than wrought CCM.

Release of hexavalent chromium from corrosion of stainless steel and cobalt-chromium alloys

Experiments were undertaken to determine whether hexavalent chromium was released during corrosion of orthopedic implants. Uptake of chromium (Cr) by cells and separation using amberlite resin were the methods used to determine that hexavalent Cr was present. We used salts of chromium as trivalent chromium (chromic chloride) and hexavalent chromium (potassium dichromate) to verify that the amberlite separation technique separates hexavalent Cr into the upper phase and trivalent Cr into the lower phase. The use of the salts also verified that only the hexavalent Cr became red blood cell-associated and that most of this was intracellular rather than membrane bound. The use of the amberlite separation technique demonstrated that the hexavalent Cr in the red blood cells was rapidly reduced to trivalent Cr. Cellular uptake of chromium was documented in red blood cells following corrosion of stainless-steel and cobalt-chromium implants in vivo, in the red blood cells of patients undergoing total joint revisions, and in fibroblasts subjected to products of fretting corrosion of stainless-steel and cobalt-chromium implants. Thus, corrosion of implants can lead to the release of the biologically active hexavalent chromium into the body. This chromium is rapidly reduced to trivalent chromium in cells.

A community-based, culturally sensitive education and group-support intervention for Mexican Americans with NIDDM: a pilot study of efficacy

The purpose of this study was to determine the feasibility of providing a diabetes patient education and group-support intervention that was directed by a Mexican-American clinical nurse specialist (CNS), dietitian, and community worker; consistent with national standards; and designed for the Mexican-American culture. In a rural Texas-Mexico border community, subjects with diabetes were randomly selected to participate in the intervention, and a family member of each subject participated as a support person. The intervention involved 8 weeks of educational sessions with instruction on nutrition, blood glucose self-monitoring, exercise, and other diabetes self-management topics, and provided group support. Group discussion was facilitated using a series of Spanish-language videotapes that had been developed and previously tested in the target Mexican-American community. Results suggested statistically significant improvements in diabetes knowledge, fasting blood sugar levels, and glycosylated hemoglobin levels. The study documented the feasibility and potential benefits of the intervention.

Withdrawal and dependency symptoms among adolescent alcohol and drug abusers

Due to differences in duration, intensity and topography of alcohol and drug use patterns, the withdrawal and dependency symptoms of adolescent substance abusers may differ from those of adult substance abusers. To explore these potential differences, 166 adolescents recruited from inpatient alcohol and drug treatment programs in the USA were assessed for alcohol and other drug withdrawal and dependency symptoms. Teens were administered the Customary Drinking and Drug Use Record following 2 weeks of abstinence and evaluated for recent (< 3 months) DSM-III-R psychoactive substance withdrawal and dependency symptoms. Adolescents were all multiple substance users with a life-time average of 4.27 drugs used in addition to alcohol. Amphetamines were the most frequently used drug (50% of sample) and the most prevalent withdrawal symptoms were those associated with central stimulant use. However, the number of different withdrawal symptoms (M = 11.27) was greater than expected for uncomplicated stimulant withdrawal or withdrawal from any single substance. On average, participants reported dependency symptoms more than DSM-III-R criteria for the diagnosis of alcohol dependency (M = 3.30), as well as dependency on their two most frequently used drugs. Heavy alcohol and cigarette use were found to exacerbate withdrawal symptoms of other drugs. These findings highlight the importance of assessing adolescent substance abusers for withdrawal from and dependency on multiple substances.

Impaired renal autoregulatory ability in dogs with reduced renal mass

In normal dogs, the renal autoregulatory mechanism limits the effect of changes in renal arterial pressure (RAP) on RBF, renal outer cortical blood flow (OCBF), and GFR by adjusting the vascular tone of the preglomerular arterioles. To determine the extent to which autoregulatory ability was impaired in remnant renal tissue in dogs, the effects of variations in RAP on RBF, OCBF, and GFR were studied after sham-operation (Group 1; N = 5), 3/4 nephrectomy (Group 2; N = 5), or 7/8 nephrectomy (Group 3; N = 5). In Group 1, the RBF, OCBF, and GFR were not significantly affected by variations in RAP between 75 and 125 mm Hg, indicating intact renal autoregulatory ability. In contrast, both groups of partially nephrectomized dogs exhibited a loss of renal autoregulatory ability below 100 mm Hg (P < 0.05). As RAP rose above 100 mm Hg, dogs with 7/8 nephrectomy exhibited a greater increase than control dogs in RBF (0.586 +/- 0.211 versus -0.080 +/- 0.030 percent change in RBF/mm Hg change in RAP; P < 0.05), OCBF (0.408 +/- 0.157 versus -0.059 +/- 0.054 percent change in RBF/mm Hg change in RAP; P < 0.05), and GFR (0.784 +/- 0.230 versus 0.134 +/- 0.049 percent change in RBF/mm Hg change in RAP; P < 0.05). The ability of the renal vasculature to maintain renal function stable above 100 mm Hg was intermediate in Group 2 and not significantly different from corresponding values for Group 1.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinicopathologic effects of a 21-aminosteroid compound (U74389G) and high-dose methylprednisolone on spinal cord function after simulated spinal cord trauma

A model simulating acute-compressive spinal cord trauma at the second lumbar spinal cord segment (100 g, 300 seconds) was used to evaluate the efficacy of a vehicle control, methylprednisolone sodium succinate (MPSS), and a 21-aminosteroid compound (U74389G). Dogs were allocated into one of five treatment groups (A to E) using ultrasonographic determination of spinal cord diameters to ensure even distribution of spinal cord diameters among the treatment groups. Initial dosages of the vehicle control (A), methylprednisolone (30 mg/kg of body weight) (B), or U74389G (30 mg/kg, 3 mg/kg, or 10 mg/kg of body weight) (C, D, or E, respectively) were administered intravenously 30 minutes after trauma. Dosages were reduced by one-half for 2 and 6 hour treatments. Then every 4 hours for 42 hours, dosages were reduced one-third and one-sixth from the original dose of methylprednisolone and U74389G, respectively. Neurological examinations were performed daily for 21 days. Histopathological examination of the traumatized spinal cord showed malacic and degenerative lesions. Although significant differences in some portions of the neurological and histopathologic examinations were observed, clinical efficacy for MPSS and U74389G could not be established in this model.

Fretting corrosion accelerates crevice corrosion of modular hip tapers

The use of multiple-component systems in orthopedic surgery gives the surgeon increased flexibility in choosing the optimal implant, but introduces the possibility of interfacial corrosion. Such corrosion could limit the longevity of prostheses due either to tissue reactions to corrosion products, or to device failure. The incidence and nature of corrosion of modular total hips was evaluated in a consecutive series of 79 retrieved implants from University Hospitals of Cleveland. Surfaces were examined with stereo- and scanning electron microscopy. Several laboratory studies were undertaken to examine mechanisms that might contribute to the initiation of corrosion. The first set of experiments investigated the effect of head neck extension; the second study looked at the effect of material combinations on fretting corrosion and crevice corrosion. Analysis of retrieved implants demonstrated that fretting corrosion played a major role in the initiation of interface corrosion, and that a correlation existed between corrosion and length of neck extensions. Laboratory studies showed that longer head neck extensions may be more susceptible to fretting corrosion because of an instability at the interface. Short-term mixed-metal corrosion studies demonstrated that the coupling of cobalt and titanium alloys did not render the interface more susceptible to corrosion. It is hypothesized that fretting corrosion contributes to the initiation of modular interface corrosion, and that the problem can be reduced by design changes that increase the stability of the interface.

Mechanical and histological fixation of hydroxylapatite-coated pyrolytic carbon and titanium alloy implants: a report of short-term results

Historically, pyrolytic carbon has been a material for cardiovascular applications, but it has several properties suited for orthopedic uses as well. Pyrolytic carbon has an elastic modulus similar to bone and is highly fatigue resistant, but has not been used in orthopedics because of poor fixation to bone. Plasma sprayed hydroxylapatite (HA) has significantly improved the bonding of bone to titanium alloy implants. The effect of plasma-sprayed HA on pyrolytic carbon implants was investigated in this study. Cylindrical samples were implanted through a single cortex in Beagle femurs. The animals were sacrificed after 8 weeks, and a mechanical push-out test was performed on the implants immediately after explantation. Samples were microradiographed, stained for histology, and examined histomorphometrically. Interface strength for each type of implant was calculated. Pyrolytic carbon showed almost no attachment strength with an average strength value of 1.59 MPa. HA-coated pyrolytic carbon (8.71 MPa) yielded the same interfacial strength as HA-coated titanium (8.71 MPa). Histology revealed that bone was in direct apposition to all implants, both HA coated and noncoated. Failures occurred between the core material and the coating, or within the coating, but not at the bone/HA interface. Histomorphometry results confirmed that the two types of HA-coated implants had more bone apposition than the uncoated pyrolytic carbon implants. It was concluded that a plasma sprayed HA coating significantly improves the bone fixation of pyrolytic carbon.

Alcoholism and affective disorder: clinical course of depressive symptoms

OBJECTIVE

This study compared the severity of and the change in depressive symptoms among men with alcohol dependence, affective disorder, or both disorders during 4 weeks of inpatient treatment.

METHOD

After their primary and secondary psychiatric disorders were defined with the use of criteria based on chronology of symptoms, 54 unmedicated men entering treatment for alcohol dependence or affective disorder were assessed for 4 consecutive weeks with the Hamilton Depression Rating Scale.

RESULTS

The findings indicate that the rate of remission of depressive symptoms was consistent with the primary diagnosis. Depressive symptoms remitted more rapidly among the men with primary alcoholism than among those with primary affective disorder. However, a minimum of 3 weeks of abstinence from alcohol appeared to be necessary to consistently differentiate the groups with dual diagnoses on the basis of their current depressive symptoms. Alcohol dependence occurring in conjunction with primary affective disorder did not intensify presenting depressive symptoms or retard the resolution of such symptoms.

CONCLUSIONS

Diagnoses of alcohol dependence and affective disorder based on symptom chronology appear to have prognostic significance with respect to remission of depressive symptoms in men with both diagnoses. Depressive symptoms of dysphoric mood, dysfunctional cognitions, vegetative symptoms, and anxiety/agitation showed different rates and levels of remission across the primary diagnostic groups.

Isolation and characterization of debris in membranes around total joint prostheses

Particles of wear debris have been implicated in osteolysis around and aseptic loosening of total joint prostheses, but the number and size distribution of particles present in periprosthetic tissues are unknown. A method of particle assay was developed, consisting of nitric-acid digestion of tissue followed by collection of particles, electronic quantitation, and parallel morphological and chemical characterization. Nitric acid had minimum deleterious effects on control samples of titanium, cobalt-chromium alloy, and polyethylene particles, as determined by atomic absorption spectroscopy, scanning electron microscopy, and electronic measurements of the sizes of the particles. Acid digestion of twelve control samples of tissue, including tissue rich in hemosiderin, resulted in particle counts that were no higher than that in the digestion solution background. Other digestion preparations, including hydrochloric acid and sodium hypophosphate, were not as effective as nitric acid. With the low size limit of detection of approximately 0.58 micrometer, particle analysis of tissue adjacent to twenty retrieved total joint implants indicated a range of concentration of 0.85 to 141.85 x 10(9) particles per gram of tissue (dry weight). Although a few particles of more than 100 micrometers were detected, the mode of particle diameter from each sample ranged from the lower limit of detection (approximately 0.58 micrometer) to 0.79 micrometer. The findings of morphological studies and x-ray spectroscopy of isolated particles corresponded with those of light microscopy of the fibrous membranes. These data indicate that most of the particles in implant membranes are smaller than the resolution of the light microscope and that tissue digestion is necessary for quantitation and characterization.

Predicting metabolic control in diabetes: a pilot study using meta-analysis to estimate a linear model

The purpose of this pilot study was to determine the feasibility of using data from replicated descriptive studies to test a four-variable model designed to explain metabolic control in diabetes. Predictors of metabolic control selected for this analysis were knowledge; health beliefs (and the subscales of barriers, commitment, cues, expectancies, impact on lifestyle, support, and susceptibility); and compliance/adherence. A total of 17 studies, published between 1982 and 1991, were located that met inclusion criteria. Findings indicated that health beliefs have direct and indirect effects on diabetes metabolic control, depending on the individual health belief subscale analyzed. For example, commitment to the benefits of therapy was found to have a statistically significant direct effect on metabolic control; barriers had a statistically significant indirect effect through compliance. The effects of knowledge were consistent throughout the five path models explored. An inverse direct effect was noted on metabolic control and a positive indirect effect was noted on metabolic control through compliance.

Proceed with care: direct predictive testing for Huntington disease

The cloning of the Huntington disease (HD) gene allows highly accurate predictive testing using direct analysis of the CAG repeat. This new test provides results with almost complete certainty but poses unique counseling issues related to direct testing for an adult-onset disease. These include testing individuals who are at 25% risk, without the need for blood from a 50% at risk relative; the assessment of symptomatic individuals; the need for ongoing counseling despite simplification of laboratory procedures; and counseling of persons from families who represent a new mutation for HD. This paper describes protocols for direct predictive testing for adult and prenatal assessment, on the basis of the experience of the Canadian Collaborative Study on Predictive Testing (CCSPT). Over the past 8 years, we have provided > 400 results by using linked markers and, more recently, 416 results by using direct assessment of CAG expansion in the HD gene. The vast majority (86%) of requests for direct predictive testing have been from persons who have not previously received results by using linked markers. Despite the ability to now directly assess for the mutation associated with HD, we still recommend assessment of DNA from an affected relative, as this may significantly enhance the accuracy of information to be provided to the at-risk individual. Distance from a genetics center has previously limited the availability of testing, and therefore we have developed approaches to providing predictive testing in the patient's own community.

Evaluation of a single-injection method for estimating glomerular filtration rate in dogs with reduced renal function

Two methods for evaluating glomerular filtration rate (GFR), after single i.v. administration of inulin, were assessed in dogs after partial nephrectomy. The first method, determination of plasma clearance of inulin (PCIn), was taken as the quotient of the administered dose of inulin (1,000 mg) divided by the area under the plasma inulin concentration vs time curve. The second estimate of renal function was obtained from the plasma concentration of inulin 75 minutes after i.v. administration of 1,000 mg: C(75). The values for PCIn and C(75) were related (R2 = 0.955, P < 0.0001 and R2 = 0.867, P < 0.0001, respectively) to a previously validated method for measurement of GFR in dogs, urinary clearance of exogenous creatinine (CCr). Results of this study support use of PCIn and C(75) values to estimate GFR in dogs with reduced renal function. In particular, PCIn and C(75) were closely related to CCr in partially nephrectomized dogs with plasma creatinine concentration within the reference range for clinically normal dogs.

Effects of aging and dietary protein intake on uninephrectomized geriatric dogs

Thirty-one clinically normal Cocker Spaniels, Miniature Schnauzers, and Doberman Pinschers (28 female, 3 male) 7 to 8 years old were uninephrectomized (month -2) to increase the risk of renal damage associated with reduction of renal mass. Two diets, differing principally in protein concentration, were used to test the hypothesis that high dietary protein intake causes renal damage in aging dogs. For 2 months after uninephrectomy, all dogs were fed diet A (18% protein). After glomerular filtration rate (GFR) was measured (month 0), 16 dogs were assigned to group A and were fed diet A for an additional 48 months. The other 15 dogs were assigned to group B, and were fed diet B (34% protein) for the subsequent 48 months. At 6-month intervals, GFR and urine protein-to-creatinine ratio (UP/C) were determined. At 48 months, terminal studies were done, survivors were euthanatized, and tissues were examined. Of 16 dogs in group A, 10 survived, compared with 13 of 15 in group B. Among survivors, a significant difference in GFR was not found between groups A and B, and decrease in GFR was not evident with time in either group. At 48 months, oral administration of casein caused minor acute effects on GFR and renal plasma flow in dogs of groups A and B. The UP/C values increased significantly (P = 0.001) from baseline values, but the increase was not progressive. The UP/C values were not affected by diet. Some dogs in both groups developed UP/C > 1.0.(ABSTRACT TRUNCATED AT 250 WORDS)

Lipoprotein(a) as a correlate of stroke and transient ischemic attack prevalence in a biracial cohort: the ARIC Study. Atherosclerosis Risk in Communities

Although both mean lipoprotein(a) [Lp(a)] concentration and national stroke prevalence estimates are consistently higher in American blacks than in whites, no information exists on the relationship of Lp(a) and stroke prevalence in African-Americans. Associations of Lp(a) with stroke or transient ischemic attack (TIA) are addressed in this report for 15,160 participants--4160 blacks and 11,000 whites--in the Atherosclerosis Risk in Communities (ARIC) Study. Lp(a) was measured in ARIC as its total protein component by double-antibody enzyme-linked immunosorbent assay (ELISA) for apo(a) detection. Self-reported stroke/TIA history was assessed as part of a standardized questionnaire, and resulted in age-adjusted stroke/TIA prevalences of 3.0% in blacks (n = 120) and 2.0% in whites (n = 222). Overall, mean Lp(a) protein levels were markedly higher for blacks than for whites (160.5 versus 81.6 micrograms/mL, respectively), and were statistically significantly higher among individuals reporting stroke/TIA history for both races (191.3 versus 159.6 micrograms/mL in blacks; 100.6 versus 81.2 micrograms/mL in whites). Multivariable logistic regression analysis for the association of Lp(a) protein with stroke/TIA status yielded a prevalence odds ratio (OR) (95% confidence intervals) of 1.17 (1.05, 1.30) overall (based on one standard deviation difference, 108.2 micrograms/mL, in Lp[a] protein). Race-specific ORs, after adjustment for the same covariates, were equivalent for blacks [OR = 1.17 (0.99, 1.39)] and whites [OR = 1.19 (1.04, 1.36)]. These data suggest that Lp(a) is an independent risk factor for stroke/TIA in both blacks and whites, and that the relative risk of stroke/TIA associated with Lp(a) protein does not vary by race.(ABSTRACT TRUNCATED AT 250 WORDS)

Response of striatal astrocytes to neuronal deafferentation: an immunocytochemical and ultrastructural study

This ultrastructural and light microscopic immunocytochemical study describes the time course of anatomical changes that occur in striatal astrocytes in response to neuronal deafferentation in young adult rats and the coordinate distribution of two astrocytic proteins involved in reactive synaptogenesis, glial fibrillary acidic protein and clusterin. We found that following a unilateral lesion of the cerebral cortex, striatal astrocytes undergo a rapid ultrastructural transformation from a protoplasmic to a reactive type of astroglia and are the primary cells involved in the removal of degenerating axon terminals, but not axons of passage, from the neuropil. In addition, at 10 and 27 days postlesion, processes of reactive astrocytes are also seen to occupy vacant postsynaptic spines after degenerating presynaptic terminals are removed, suggesting that they may also participate in the reinnervation of the deafferented neurons. By immunocytochemistry, reactive astrocytes were characterized by a significant increase in the intensity of glial fibrillary acidic protein staining beginning at three days postlesion and lasting for at least 27 days postlesion. Reactive astrocytes were characterized by cellular hypertrophy and an increase in the density of immunoreactive processes distributed throughout the deafferented striatum. However, our analysis of astrocyte cell number found no evidence of astrocyte proliferation in response to the deafferentation lesion. Although previous in situ hybridization studies have reported elevated clusterin messenger RNA in reactive astrocytes after decortication, clusterin immunoreactivity was not seen in the cell soma of reactive astrocytes but was distributed as punctate deposits, ranging from 1 to 2 microns in diameter, within the neuropil of the deafferented striatum. At 10 days postlesion, the distribution of clusterin staining appeared as large aggregates of immunoreactive deposits adjacent to neurons. However, by 27 days postlesion, the aggregates of clusterin reaction product were replaced by a fine scattering of individual punctate deposits distributed evenly over the dorsal part of the deafferented striatum. These data support the notion that reactive astrocytes serve multiple, time-dependent roles in response to brain injury and are involved in both the removal of degenerative debris from the lesion site as well as in reforming the synaptic circuitry of the damaged brain. Our data suggest that, in response to decortication, reactive astrocytes are the primary cells responsible for removing degenerating axon terminals, but not axons of passage, from the deafferented striatum and that the coordinate increase in glial fibrillary acidic protein may serve to stabilize the extension of reactive astrocytic processes during phagocytosis.(ABSTRACT TRUNCATED AT 400 WORDS)

Comparison of measured and calculated values for colloid osmotic pressure in hospitalized animals

A relation exists between colloid osmotic pressure (pi) and serum total protein concentration; equations describing this relation have been used to determine a calculated value for pi. However, the relation between total protein concentration and pi is altered by the method used to measure protein and by changes in the ratio of concentrations of albumin (A) to globulin (G). We developed nomograms for estimating pi from A and G concentrations, using samples obtained from clinically normal animals and compared the accuracy of these nomograms with that of previously described equations relating pi to total protein concentration. For comparison, serum samples from canine (n = 106), equine (n = 79), feline (n = 24), and bovine (n = 27) patients admitted to the University of Georgia Veterinary Medical Teaching Hospital were used. Results indicated that nomograms based on protein concentration estimated by a refractometer generally were the least reliable. Although predictive nomograms, using total protein concentration determined by the biuret method, provided better results for serum samples, there was considerable variation between measured and calculated values for pi in all species studied. Calculated values for pi derived from A and G concentrations were most closely related to measured values for pi in dogs, horses, and cats. However, calculated values for pi differed from measured values by as much as 5 mm of Hg for some samples by each of the methods of estimation.(ABSTRACT TRUNCATED AT 250 WORDS)

Associations of allelic differences at the A-I/C-III/A-IV gene cluster with carotid artery intima-media thickness and plasma lipid transport in hypercholesterolemic-hypertriglyceridemic humans

Individuals with elevated levels of plasma cholesterol and triglyceride may be at higher risk for coronary artery disease than those with isolated elevations of either cholesterol or triglyceride. Sequence variation in the A-I/C-III/A-IV gene cluster has been implicated in the etiology of some disorders associated with premature atherosclerosis and/or hypertriglyceridemias with or without elevations of cholesterol. This led to the hypothesis that allelic variation at this gene locus alters plasma lipid transport and affects susceptibility for atherosclerosis. The study population, from the Atherosclerosis Risk in Communities (ARIC) Study, consisted of 50 normolipidemic individuals, 48 subjects with elevated plasma cholesterol, 47 subjects with elevated plasma triglyceride, and 123 subjects with both elevated plasma cholesterol and triglyceride who were used to evaluate associations between an Xmn I polymorphic site 2.5 kilobase pairs (kbp) upstream of the structural gene for apolipoprotein (apo) A-I, intimal-medial thickening of the extracranial carotid arteries, and several plasma lipid factors. The relative allele frequencies of the 8.3-kbp allele and the 6.6-kbp allele were .86 and .14, respectively, in the entire study population and did not differ among the lipid phenotypes. In the group with elevated plasma cholesterol and triglyceride, subjects possessing the 6.6-kbp allele exhibited a greater carotid artery intimal-medial thickness (P = .034) and higher plasma levels of apoA-I, high-density lipoprotein (HDL) cholesterol, and HDL3 cholesterol (P < .02) than subjects homozygous for the 8.3-kbp allele. In contrast, subjects with the 6.6-kbp allele displayed lower mean ratios of apolipoproteins C-II to C-III, C-II to A-IV and E to A-IV in plasma (P < .05) and a lower mean ratio of apolipoprotein C-II to C-III in the triglyceride-rich lipoproteins (P = .026). Sequence variation in or near the genes encoding apolipoproteins A-I, C-III, and A-IV may therefore identify a group of hypercholesterolemic-hypertriglyceridemic persons who are at higher risk for atherosclerosis than others with the same lipoprotein phenotype.

Effect of splenectomy on HIV-related thrombocytopenia and progression of HIV infection in patients with severe haemophilia

Between May 1983 and September 1991 eleven patients with severe haemophilia underwent splenectomy for HIV-related thrombocytopenia. The sustained complete remission rate (platelets > 100 x 10(9)/l) was 82% over a mean follow-up period of 54 months. The group was compared with 22 age-matched non-thrombocytopenic HIV seropositive haemophiliacs who had not undergone splenectomy. Both groups had equivalent use of factor concentrate and there was no significant difference between the groups in terms of anti-retroviral treatment. Analysis of clinical progression of HIV infection and CD4 positive lymphocyte (CD4+) counts, for the time since splenectomy, revealed no significant difference in progression of HIV infection in the splenectomized group compared with the control group. It is concluded that splenectomy is an effective treatment for HIV-related thrombocytopenia and has no adverse effect on the progression of HIV infection.