Prognostic and therapeutic observations of manifestations in the genitourinary tract of adenocarcinoma of the colon and rectum

To evaluate the significance of involvement of the genitourinary tract in adenocarcinoma of the colon and rectum, we received the records of 178 patients with adenocarcinoma of the colon and rectum admitted to the University of Massachusetts Medical Center from 1980 to 1985. Sixty-eight patients (38 per cent) had urologic manifestations categorized as ureteral obstruction or injury (34 per cent), invasion to the bladder or prostate, or both (10 per cent), isolated gross hematuria (18 per cent), radiation cystitis (6 per cent) and neurogenic bladder (26 per cent). Involvement of the genitourinary tract was more common among patients with recurrent versus primary carcinoma (53 versus 32 per cent) and among patients with high stage (Dukes' C and D) versus low stage (Dukes' A and B) carcinoma (48 versus 21 per cent). The survival rate was worse in patients with high stage compared with low stage disease and no patient with recurrent high stage disease survived beyond three years. Short term survival (less than two years) was not statistically different among patients with or without manifestations in the genitourinary tract: 63 and 45 versus 71 and 66 per cent at one and two years, respectively; however, the five year survival rate was worse among patients with genitourinary involvement (30 versus 54 per cent, p less than 0.05). Surgical and endoscopic intervention of the urinary tract was performed upon 36 patients with Dukes' C and D carcinoma because of life-threatening sepsis or azotemia, or both.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical criteria for the detection of pneumonia in adults: guidelines for ordering chest roentgenograms in the emergency department

Adults presenting to an emergency department with acute respiratory illness were studied prospectively in an effort to identify sensitive clinical criteria for the diagnosis of pneumonia. Of 308 patients studied, 118 (38%) had definite or equivocal infiltrates and were considered to have pneumonia. No single symptom or sign was reliably predictive of pneumonia. Cough was the most common symptom in patients with pneumonia (86%), but was equally common in those with other respiratory illness. Fever was absent in 36 patients with pneumonia (31%). Abnormal findings on lung examination, that is, rales, rhonchi, decreased breath sounds, wheezes, altered fremitus, egophony, and percussion dullness, were each found in fewer than half of the patients with pneumonia. Twenty-six patients (22%) with a completely normal chest examination had pneumonia. Abnormal vital signs (temperature greater than 37.8 degrees C (100 degrees F), pulse greater than 100/min, or respirations greater than 20/min) were 97% sensitive for the detection of pneumonia. These criteria retained their sensitivity when films were subjected to a second, blinded interpretation by a senior radiologist. We conclude that restricting chest roentgenograms to patients with at least one abnormal vital sign will detect almost all radiographically demonstrable pneumonia in adult emergency department patients.

Visual and phonological components of working memory in children

Previous studies have shown that young children's immediate memory for a short series of drawings of objects is mediated by a visual component of working memory, whereas older children rely chiefly upon a phonological component. Three experiments investigated the hypothesis that older children rely also, but to a lesser extent, on visual working memory. Experiment 1 confirmed previous evidence that 11-year-olds' memory is disrupted by phonemic similarity of object names, but is unaffected by visual similarity of the objects themselves. However, when articulatory suppression was used to prevent phonological coding, levels of recall were sensitive to visual rather than phonemic similarity. Experiment 2 compared the effects of interpolating an auditory-verbal or a visual postlist task on memory for drawings viewed either with or without suppression. The visual task had a clear disruptive effect only in the suppression condition, where it interfered selectively with recall of the most recent item. Experiment 3 compared the effects of interpolating an auditory-verbal or a mixed-modality (visual-auditory) postlist task when subjects were not required to suppress. There was greater interference from the mixed-modality task, and this effect was confined to the last item presented. These experiments are taken as confirming the presence of a small but reliable contribution from visual memory in 11-year-old children's recall. As in younger children, visual working memory in 11-year-olds is sensitive to visual similarity and is responsible for a final-item visual recency effect. The results also show that older children's use of visual working memory is usually masked by the more pervasive phonological component of recall. Some implications for the structure of working memory and its development are discussed.

Risk of fractures in an intermediate care facility for persons with mental retardation

The epidemiology of fractures among 553 residents of an intermediate care facility for persons with mental retardation was examined. In a 10-month period, 61 fractures occurred among 55 residents; application of fracture rates in the United States revealed an expected number of 15 fractures among the 553 residents, p less than .001. Although 52% of fractures involved small bones of the hands and feet, elderly residents were more likely to fracture major bones and to suffer their fractures from a fall than were younger residents. The relationship between potential risk factors and fracture risk were examined and implications for preventive and rehabilitative measures discussed.

Antibody-dependent cellular cytotoxicity mediated by lung macrophages: a comparison of two target cells

Mononuclear cell-mediated cytotoxicity may be an important cellular immune function in host lung defense. Prior investigators have shown that lung macrophages participate in cell cytotoxicity which is antibody-dependent (ADCC). We tested the hypothesis that alveolar macrophages share some cell surface receptors for the Fc portion of IgG, i.e., Fc receptors, similar to those found on circulating monocytes in order to function in ADCC. Hence, ADCC mediated by autologous human blood monocytes and lung macrophages was studied by measuring the release of chromium-51 from prelabeled target erythrocytes coated with IgG. Alveolar macrophages were obtained from healthy adult subjects by bronchoalveolar lavage and tested against two different erythrocyte target cells to measure ADCC activity. Our results show significant activity by alveolar macrophages demonstrated against chicken erythrocytes at a target to effector cell ratio of 2:1 or 10:1 and with an antibody concentration of 1:100 or 1:400 (volume per volume, p less than 0.05, Student's test). However, when a peripheral blood monocyte specific target cell (human type B erythrocyte) was utilized, alveolar macrophages were not as capable of significant ADCC activity against these monocyte-specific target cells. The inability of lung macrophages to function in ADCC against other target cells (i.e., human type B erythrocytes) unlike the peripheral blood monocytes suggests that some Fc receptors are not shared. In other words, these different cell types share IgG receptors but differences in activity may be due to some changes in the Fc portions of IgG due to cellular differentiation. The use of these target cells may potentially be useful in functionally discriminating between two types of adherent autologous mononuclear cells (lung macrophages vs. blood monocytes).

The release of residual monomeric methyl methacrylate from acrylic appliances in the human mouth: an assay for monomer in saliva

A gas-liquid chromatography assay has been developed for the estimation of methyl methacrylate monomer (MMA) in whole saliva, with a lower limit of detection in the order of 1 microgram/mL. Healthy human dentate subjects wore recently made autopolymerized or heat-polymerized polymethyl methacrylate (PMMA) palatal appliances. MMA released into saliva was detected for up to one week after insertion of autopolymerized appliances, with a maximum concentration of 45 micrograms/mL in whole saliva or 180 micrograms/mL in the salivary film on the fitting surface. The MMA was not detected in blood or urine. MMA was also present in the saliva of volunteers wearing appliances which had been heat-polymerized at 70 degrees C for one hr but not cured at 70 degrees C for three hr. The maximum amount of monomer released by an autopolymerized base plate was 29.5 micrograms in the first hour, which, while not a toxic or primary irritant dose, could possibly sensitize patients or elicit an allergic reaction. For minimization of monomer release, autopolymerized appliances should be immersed for 24 hr in water before being worn.

Human immunodeficiency virus isolation studies and antibody testing. Household contacts and sexual partners of persons with hemophilia

Virus isolation studies and human immunodeficiency virus (HIV) antibody testing were performed on 87 household contacts of 68 HIV antibody-positive hemophilic patients to determine the extent that HIV could be transmitted through heterosexual or through nonsexual, but intimate contact. Human immunodeficiency virus seropositivity was established for the 68 hemophiliacs by immunofluorescence method or enzyme-linked immunosorbent assay and confirmed by Western blot testing (for 66 patients). Fifty-one nonsexual contacts and 36 sexual partners of these hemophiliacs were tested for HIV antibody by immunofluorescence or enzyme-linked immunosorbent assay and Western blot. All sexual partners and all nonsexual household contacts were HIV antibody-negative, including six partners and nine parents of hemophiliacs from whom the virus had been isolated and seven parents and six partners of patients with AIDS. This study further demonstrates lack of transmission of HIV in intimate, but nonsexual settings, and suggests that heterosexual transmission, although well known to occur, may be relatively uncommon in hemophilic couples when the male and female partner have no other risk factors. It is hoped that intensive education and counseling programs will reduce exposure and maintain a low risk of heterosexual transmission.

Drosophila S virus, a hereditary reolike virus, probable agent of the morphological S character in Drosophila simulans

Isometric reolike virions were found in all the examined Drosophila simulans flies from two strains (SimES-st and Israel-st) presenting the S phenotype, a maternally inherited morphological trait (abnormalities of bristles). Normal flies of both strains appeared virus-free. Virions were found in the cytoplasm of male and female gonads and epidermal cells, including the bristle-forming cells, which appeared disorganized. Steps of virogenesis were described. A positive correlation was demonstrated between expressivity of the S phenotype and degree of viral infection. This hereditary reolike virus seems to be responsible for the S character of D. simulans and was named DSV (Drosophila S virus).

Plasma lipoprotein distribution of apolipoprotein E in familial hypercholesterolemia

Although familial hypercholesterolemia (FH) has been well characterized in terms of the etiology of the major lipoprotein abnormality, that of low density lipoproteins (LDL), less information is available on changes in other lipoproteins which could influence the atherogenic process in this disorder. The present study has focused on such potential abnormalities by studying in detail the lipoprotein association of apolipoprotein E (apo E) in a large group of subjects homozygous for FH. Total plasma apo E levels in homozygous subjects were significantly elevated (p less than 0.001) relative to heterozygous subjects which were, in turn, significantly greater (p less than 0.001) than controls (137.6 micrograms/ml, 69.4 micrograms/ml, 46.5 micrograms/ml respectively). After separation of plasma lipoproteins by 4% agarose chromatography, an increased mass of apo E in lipoproteins of intermediate size was present; this may reflect the absence of LDL receptors that normally mediate their clearance. Homozygous FH subjects also demonstrated an increased mass of apo E-enriched high density lipoproteins (HDL) of large size, but a reduction in HDL cholesterol and apo A-I. The increase in the potentially atherogenic remnant lipoproteins and the decrease in HDL are associated with an increased risk for atherosclerosis, even in the absence of the LDL elevation, which is characteristic of FH. The increase in apo E-enriched HDL could reflect a compensatory mechanism that permits reverse cholesterol transport in the absence of LDL receptors.

Immunologic aberrations, HIV seropositivity and seroconversion rates in patients with hemophilia B

Because there have been reports that factor IX concentrate is less immunosuppressive and therefore factor IX users have less immunologic aberrations, we have studied a group of 22 patients with hemophilia B and six patients with factor VIII deficiency and high titer inhibitors with respect to lymphocyte numbers and function, human immunodeficiency virus (HIV) serology, and factor usage. This group was compared to 111 patients with hemophilia A and a group of 28 healthy male volunteer controls. When the study began in 1983, the majority of patients with hemophilia B and with higher titer factor VIII inhibitors were seronegative, 77% and 83% respectively, as compared to only 30% of patients with hemophilia A. At that time the factor IX users also had milder immune aberrations than the hemophilia A group. However, with time and increasing clotting factor concentrate usage, seroconversion and more striking abnormalities in immune function have occurred in the hemophilia B group. In a subgroup of 16 patients with hemophilia B studied twice, the incidence of seropositivity increased from 31% in 1983 to 69% in 1985. We thus conclude that factor IX concentrate in itself is not less immunosuppressive than factor VIII concentrate. Seroconversion in factor IX concentrate users appears to be lagging behind seroconversion in factor VIII concentrate users, perhaps secondary to the lower cumulative dosage of concentrate that patients with hemophilia B utilize.

The effects of low-protein diet and testosterone on sex hormone-binding globulin capacity in male rabbits

The effects of a low-protein high-carbohydrate (LPHC) diet (8% protein 65% to 72% carbohydrate) were compared to those of regular rabbit chow (14% to 16% protein 57% to 64% carbohydrate) on sex hormone-binding globulin (SHBG) capacity in 12 male rabbits. The six rabbits who were fed the LPHC diet for 8 weeks showed a significant increase in their mean SHBG capacity (mean +/- SE: from 70 +/- 16 nmol/L to 332 +/- 45 nmol/L, P less than .01) whereas the six rabbits fed the standard diet showed a slight decrease (from 106 +/- 22 nmol/L to 76 +/- 20 nmol/L, NS). These changes in SHBG capacity were mirrored by a decrease in percent-free T (from 2.64 +/- 0.26% to 1.64 +/- 0.16%, P less than .01) in the LPHC diet group and no change in percent-free T in the regular diet group (from 2.36 +/- 0.21% to 2.19 +/- 0.10%). The changes in SHBG capacity and percent-free T were not associated with significant changes in testosterone (T), free T, estradiol (E2), thyroxine, triiodothyronine, thyroxine-binding globulin, or cortisol binding globulin levels. In a subsequent experiment, testosterone cyclopentyl propionate (TCP) was administered to six male rabbits while on regular rabbit chow and again after 6 weeks of the LPHC diet. TCP administration did not cause any significant change in the SHBG capacity, but the LPHC resulted again in a significant (P less than .05) increase in SHBG capacity from 80 +/- 18 nmol/L. to 198 +/- 22 nmol/L.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevalence of incidental paranasal sinuses opacification in pediatric patients: a CT study

A prospective evaluation of the paranasal sinuses was performed on a consecutive series of 137 pediatric patients referred for cranial CT. Approximately one-half of the patients less than 13 years of age had some degree of maxillary or ethmoid sinus opacification. The prevalence and severity of opacification was approximately the same for the maxillary and ethmoid sinuses. Sphenoid sinus abnormality was less common (16% of patients) and was usually minimal or mild. No incidental frontal sinus abnormalities were observed. This study confirms previous reports, based on plain film radiography, of the prevalence of incidental maxillary sinus opacification in children. However, contrary to some prior studies, we did not find a relatively higher rate of opacification in children less than 1 year of age. This may be due to overdiagnosis of maxillary sinus opacification on plain films, in small children. The diagnosis of sinusitis in childhood must take into account not only the radiographic findings but clinical signs and symptoms. Correlation is needed to avoid overdiagnosis in patients referred for sinus radiography for nonspecific indications or who have incidental opacification noted on radiographic or CT studies of the skull and brain.

Hormones and handedness: left-hand bias in female congenital adrenal hyperplasia patients

An excess of left-handers among males has been attributed to early androgen exposure. This theory was supported by our observation that girls with congenital adrenal hyperplasia (CAH) are more left-biased than their normal sisters. Male CAH patients, with prenatal androgen exposure similar to that of unaffected brothers, had typical male-handedness patterns.

Predictive value of the stomach wall pH for complications after cardiac operations: comparison with other monitoring

The ability to predict impending complications after elective cardiac operations from measurements of BP, cardiac index, arterial pH, and urine output on the day of operation was compared with that of indirect measurement of stomach wall pH in 85 patients. We found that acidosis in the stomach wall was the most sensitive predictor for complications. The specificity of this predictive test increased exponentially as the duration and degree of intramural acidosis increased. Hypotension, acidosis, and oliguria, but not cardiac index, also predicted postsurgical problems. Stepwise logistic regression analysis of the data that showed postoperative complications were best predicted by the duration of hypotension, and the predictive ability was significantly improved when the duration of intramural acidosis was included.

Adult onset diabetes mellitus: glycemic control and family function

To test the hypothesis that family function differs in patients according to their level of diabetes control, family function was assessed using the Family APGAR questionnaire in low-income patients with adult-onset diabetes who were under comprehensive care in five community health centers. From 3,000 active patients, a group of 385 with the following characteristics were randomly selected: mean age, 59.1 (range 25-93); M:F ratio, 1:4; and ethnic distribution (blacks: Hispanics: whites, 48%:31%:21%). Categorizing patients by their extent of diabetes control, good family function was found in 92% of patients in good control of their diabetes mellitus, in 66% of those in fair control, and only in 50% of those in poor control (p less than 0.005, chi 2 = 44.1, df = 2). Since these data point to the association between levels of family functioning and control of diabetes, further studies are needed to ascertain if an improvement in family functioning will lead to better diabetic control.

Gastric antisecretory and antiulcer properties of enprostil, (+/-)-11 alpha, 15 alpha-dihydroxy-16-phenoxy-17,18,19,20-tetranor-9-oxoprosta- 4,5,13(t)-trienoic acid methyl ester

Prostaglandins of the E series have been shown, both in animals and humans to produce gastrointestinal antisecretory and antiulcer effects. Enprostil, a modified allenic prostaglandin E was found to be a highly potent inhibitor of gastric HCl secretion in a variety of species. In rats, in which both the pylorus and esophagus were ligated, p.o. ED50 values and 95% CL for inhibiting acid secretion evoked by histamine, pentagastrin and carbachol were 9.9 (6.7-15), 40 (11-145) and 0.83 (0.78-0.89) micrograms/kg, respectively. In inhibiting histamine-evoked acid secretion, enprostil was more potent when administered p.o. than when injected into the duodenum or s.c. When enprostil was injected directly into the pouch of Heidenhein dogs, intense antisecretory activity occurred, ED50 = 0.9 (0.7-1.1) micrograms/kg, whereas, when given p.o. to the main stomach the ED50 was 6.6 (3.2-13.6) micrograms/kg. Administration of cimetidine either p.o. or to the pouch resulted in virtually identical ED50 values, viz., 2.9 and 3.1 mg/kg. Enprostil also inhibited dimaprit- and pentagastrin-induced acid secretion in cats with permanent gastric fistulae. The oral ED50 values for inhibiting acid secretion evoked by these two secretagogues were 2.5 (1.4-4.3) and 0.8 (0.5-1.5) micrograms/kg, respectively. Enprostil was extremely potent in preventing indomethacin plus "cold stress" ulcers in rats. When given orally the ED50 was 0.61 (0.31-1.22) and s.c. it was 22 (9.0-52) micrograms/kg. It was also highly potent in preventing cysteamine-induced duodenal ulcers when given p.o., ED50 = 20 (17-23) micrograms/kg. Thus, enprostil is a highly potent antisecretory and antiulcer agent. It appears to act topically; directly at gastric mucosal sites.

False-negative peritoneal cytology in metastatic ovarian carcinoma

Seventy-nine laparotomies for disseminated intraperitoneal ovarian carcinoma were reviewed to determine the frequency and possible causes of false-negative peritoneal cytology. Negative peritoneal cytology (defined as any reading other than positive) was found in 16 of 79 cases (20%). False-negative cytology occurred more frequently with peritoneal washings (48%) than with ascites (6%; P less than .001); with second-look surgery (50%) than at primary surgery (12%; P = .004); with peritoneal metastasis less than 0.5 cm (50%) than with metastasis greater than 0.5 cm (16%; P = .02); and with bloody cytology specimens (25%) rather than specimens without blood (0%; P = .06). Volume of peritoneal specimen, architectural grade, cytologic grade, and stage of disease (III versus IV), did not affect the frequency of false-negative cytology. The high prevalence of negative cytology associated with peritoneal washings, small tumor size, and second-look surgery suggests that negative cytology is a result of poor distribution of peritoneal washings and infrequent exfoliation of malignant cells rather than misinterpretation of malignant cells present in cytology specimens.

Prediction of the development of sigmoid ischemia on the day of aortic operations. Indirect measurements of intramural pH in the colon

A deviation in an indirect measurement of intramural pH below the limits of normality (6.86) was used as a diagnostic test for sigmoid ischemia in 25 high-risk patients undergoing abdominal aortic operations. The clinical diagnosis of ischemic colitis was made by the attending physicians in only two of the 25, on the day after operation in one and three months after operation in another. In neither was the ischemic colitis considered to have been a causative factor in their subsequent deaths. In contrast, six patients developed pH evidence of ischemia on the day of operation. All six subsequently developed a transient episode of guaiac-positive diarrhea, four developed physical signs consistent with ischemic colitis, and four died. Of 19 who did not develop pH evidence of ischemia, none developed guaiac-positive diarrhea, none developed any signs of ischemic colitis, and none died. Stepwise logistic regression showed the duration of pH evidence of ischemia on the day of operation to be the best predictor for the symptoms and signs of ischemic colitis and for death after operation.

Inter-relatedness of some isoenzymes of cytochrome P-450 from rat, rabbit and human, determined with monoclonal antibodies

Monoclonal antibodies have been raised to rat liver cytochromes P-450 b and c, and rabbit liver cytochrome P-450 form 4. A total of six antibodies have been studied. Each antibody reacted strongly both with its homologous antigen and with microsomal fractions selectively enriched with that antigen by treatment of animals with inducing compounds. However, several of the antibodies showed cross-reactivity, either within or between species. A combination of enzyme-linked immunosorbent assay, immunoadsorption, Western blotting and competitive radioimmunoassay revealed that each of the antibodies reacted with a different epitope. Proteolytic digestion of antigen followed by Western blotting of the peptide fragments enabled antibodies, otherwise identical in their reactivity, to be distinguished. It is concluded that complex structural relationships exist amongst the different isoenzymes of cytochrome P-450 and that epitope mapping will help in characterizing both animal and human cytochromes P-450.

A comparison of the succinylcholine induced ocular position and the postoperative alignment in strabismus

Succinylcholine was injected intraoperatively in 41 strabismus patients with congenital esotropia or intermittent or constant exotropia. Regression analyses were performed to investigate the predictive relationships between the one-, six-, and 26-week postoperative alignment and the intraoperative, succinylcholine-induced ocular position. Ocular position, determined by the interlimbal distance in millimeters, was calculated using a semi-automated, video replay analysis system. Large, statistically significant correlation coefficients were obtained for patients undergoing bimedial recessions of 4.0 to 5.5 mm and bilateral lateral rectus recessions of 5.0 to 7.0 mm. Small correlations were obtained for esotropes undergoing the recession/resection procedure and those with bimedial recessions of 6.0 mm or greater. These data support the theory that the succinylcholine-sensitive subgroup of the extraocular muscle fibers are those whose tonic contracture provide the motor component to ocular alignment. Sample sizes at present are insufficient to suggest clinical use of these data. In future research, these relationships will be tested for their ability to predict postoperative alignment and thereby, improve success rates in strabismus surgery.

Reliability and variability in the measurement of interlimbal distance with a semiautomated video replay analysis system (SAVRAS)

This paper reports on the reliability and variability of a semi-automated, video replay and analysis system (SAVRAS) in determining interlimbal distance in patients with strabismus. Factors under investigation were: choice of observer, choice of video frame, patient age and patient state (awake or anesthetized). It was demonstrated that SAVRAS was a highly reliable and reproducible system. This system is currently in use to evaluate the relationship between the succinylcholine induced ocular position, under anesthesia, and the postoperative awake alignment.

Amiodarone for refractory atrial fibrillation

Atrial fibrillation (AF) is a difficult arrhythmia to manage with antiarrhythmic agents. Amiodarone is highly effective in restoring and maintaining normal sinus rhythm in patients with AF. However, the mechanism and predictors of efficacy for amiodarone in treating AF have not been adequately addressed. Various measures of success or failure of amiodarone therapy were examined in 68 patients who had paroxysmal or chronic, established AF refractory to conventional antiarrhythmic agents. The patients were 25 to 75 years old (mean 59) and mean follow-up was 21 months (range 3 to 56). Maintenance amiodarone dosages were 200 to 400 mg/day. Overall, amiodarone therapy was effective long term in 54 of the 68 patients (79%). Left atrial diameter, age, gender and origin of AF were not helpful in predicting success or failure of amiodarone therapy. The presence of chronic AF for longer than 1 year was an adverse factor in maintaining normal sinus rhythm (p = 0.007), although the success rate even in this group was relatively high (57%). Thirty-five percent of the patients had adverse effects, which precluded long-term therapy with amiodarone in 10%.

Retropharyngeal infection in a pregnant diabetic. A case report

A retropharyngeal infection occurred in a pregnant class C diabetic at 31 weeks' gestation. Early diagnosis, prompt therapy with antibiotics and possibly surgery for drainage if an abscess develops constitute optimal management.

Comparison of hospitalization between nursing home and community residents

The authors prospectively identified 96 consecutive nursing home residents (NHR) admitted to the medical wards of their affiliated hospitals to determine the outcome of hospitalization for these patients in comparison with 88 admissions in a similarly aged community residents (CR) population. Nursing home and community resident groups were similar in age, sex, marital status, and distribution among the four study hospitals. Dementia was a more common preexisting diagnosis in NHR than in CR. Reasons for admission differed between the two groups. Although NHR experienced a longer hospitalization than CR, frequency and duration of intensive care unit admissions were similar. Fatal outcome occurred more commonly in NHR compared with CR (27 v 11%, P less than .001). Predictors of mortality were examined. Nursing home residents also experienced a higher mortality than CR within the six months after hospitalization (35 v 20%, P less than .005).

Thyrotropin-releasing hormone metabolism and extraction by the perfused guinea pig placenta

This report describes the extraction of synthetic TRH and its metabolic conversion in the perfused guinea pig placenta. These studies were performed to obtain an estimate of fractional fetal TRH losses through the placenta and to determine if some of these losses are due to TRH metabolism. The in situ guinea pig placenta was perfused through an umbilical artery for 90 min, and placental effluent fractions were collected at timed intervals from the umbilical vein. Experiments were performed in which the perfusion buffer contained 0.01, 1, and 10 micrograms/ml or no synthetic TRH. Synthetic TRH was always perfused in the presence of 3H2O. In experiments in which TRH was perfused, the perfusion reservoir contents and placental effluent fractions were counted for 3H, and TRH and deamido-TRH were determined by RIA. Similarly, cyclo(His-Pro) was measured when 10 micrograms/ml TRH were perfused. When no TRH was perfused, the perfusion reservoir and placental effluent contents were processed to determine their content of TRH immunoreactivity. When synthetic TRH was perfused, steady state TRH concentrations were achieved in placental effluent fractions by 20-30 min. The single pass extraction of TRH by the placenta was 11.4 +/- 2.6% (mean +/- SE) compared to 56.9 +/- 7.0% for 3H2O (P less than 0.001). No significant difference was detected regardless of whether 10, 1, or 0.01 micrograms/ml TRH were perfused. A portion of the TRH that perfused the placenta was converted to deamido-TRH at all concentrations of perfused TRH. No conversion of TRH to cyclo(His-Pro) was noted when the highest concentration (10 micrograms/ml) of TRH was perfused. The conversion of TRH to TRH-OH was 4.2 +/- 0.7% in a single pass. When the perfusion buffer was devoid of synthetic TRH, a small but significant increase in the content of TRH immunoreactivity was noted in the placental effluent compared to that in the perfusion reservoir. This was not large enough to affect calculations of the placental extraction of TRH. These studies, in addition to demonstrating that the placenta contains TRH deamidase activity, suggest that losses of fetal TRH through the placenta are not large. They do not support the current impression, based on the fetal TSH response to maternal TSH administration, that the placenta is freely permeable to TRH.

Segregation of centric Y-autosome translocations in Drosophila melanogaster. I. Segregation determinants in males

A special screening procedure for the detection of induced Y-autosome translocations with centric breakpoints was applied. A series of Experimental stocks was constructed, each containing a different half of one of the induced T(Y; 2)'s (T element). The three other elements that were involved in the segregation experiments in each stock were a sex chromosome (X element), an inverted chromosome 2 (A element), and a free arm of chromosome 2 (F element). It is not feasible to determine the relative frequencies of all the 16 possible gamete types by mating an Experimental stock to one tester, nor to different testers that have each at least one class of progeny of the same genotype. Each Experimental stock was mated to four different Tester stocks and the data were calibrated so that a coherent segregation pattern could be obtained.

Segregation patterns in meiosis of males from 15 Experimental stocks, each with a different T element were studied. In most Experimental stocks the T element was of the left autosomal arm, while the F element was of the right autosomal arm. In four Experimental stocks the X element segregated independently of the A, F and T elements. In these Group 1 stocks, both the F and the T elements disjoined regularly from the A element. It was concluded that the T element of these stocks had no sex-chromosome disjunction determinants (‘S-determinants’) to interact with the determinants on the X element. Both the T elements and the F elements carried autosomal disjunction determinants (‘H-determinants’) that secured the segregation of the autosomal elements. The H-determinants of the left autosomal arm were qualitatively different from those of the right arm.

In the remaining 11 Group-2 Experimental stocks the X and T elements disjoined regularly, indicating the presence of S-determinants on the T elements of these stocks. The segregation of the T and the A elements in these stocks varied from nearly complete dependence to complete independence. It was concluded that this gradation reflected differences in the quantity of H-determinants present on the T elements of these Experimental stocks. It was impossible to discriminate between a model of continuous H determinants activity and one of a finite discrete number of determinants. The results do not agree with the claim that there are no autosomal disjunction determinants in the proximal heterochromatin of chromosome 2.

The S-determinants on theBsYy+chromosome were located both adjacent to the centromere and distally on the long arm. The latter were probably translocated to the Y chromosome together with theBsmarker.

Segregation of centric Y-autosome translocations in Drosophila melanogaster. II. Segregation determinants in females

This is a study of the chromosomal segregation patterns in females of 15 Experimental stocks ofDrosophila melanogaster, each carrying one element of a T (Y; 2) with a centric break-point. In each Experimental stock the relative frequency of all eight possible meiotic configurations of four relevant chromosomal elements was followed: an attached-Xchromosome, a multiply-inverted chromosome 2, a free arm of chromosome 2, and a half-translocation element. Although the 15 translocation elements were broken at different sites, there were no basic differences among the Experimental stocks in their segregation patterns. The three two-by-two configurations were the most common. Comparison of this pattern with that of the segregation pattern of stocks similar but for an inversion-free chromosome 2, showed that in the Experimental stocks exchange pairing did not play a significant role in the determination of the segregation pattern.

The results of these experiments, together with the analysis of results from other published studies provide evidence against the model that had been forwarded by Grell. According to this model, chromosomes that did not participate in exchange pairing undergo another pairing cycle, in which total chromosome length is a factor in the determination of segregation.

We support a modified version of Novitski's model of premetaphase chromocenter-like chromosome aggregation. Disjunction of non-exchange chromosomes is regulated by determinants located in the proximal heterochromatin of the sex chromosomes and the autosomes. However, the specificity, especially that of the autosomal determinants, is not high. Thus, if an autosome and a sex chromosome are available, their determinants may interact-to-disjoin by default. More frequently, the determinants of the left-arm autosomal element may interact-to-disjoin with those of the right-arm chromosomal element.

Basaloid follicular hamartoma: three cases with localized and systematized unilateral lesions

Two patients having a localized plaque of alopecia on the scalp, and one with a systematized unilateral epithelial nevus exhibited a histologically distinctive form of follicular hamartoma. In the affected areas individual hair follicles were replaced, or were associated with solid strands and branching cords of undifferentiated basaloid cells, filled in between by fibrous stroma resembling either a miniature premalignant fibroepithelial tumor of Pinkus, a small trichoepithelioma, or a basal cell epithelioma. The relation between these 3 patients and cases reported as linear unilateral basal cell nevus with comedones and generalized hair follicle hamartoma associated with myasthenia gravis is discussed.

Immunologic selection of hemopoietic precursor cells utilizing antibody-mediated plate binding ("panning")

We utilized the property of antibody adherence to plastic to separate and obtain enriched fractions of human myeloid (CFU-GM), erythroid (BFU-E) and pluripotent (CFU-GEMM) hemopoietic precursor cells. Nonadherent buoyant human marrow cells coated with mouse anti-human HLA-DR monoclonal antibody (Mc ab), an anti-pan T lymphocyte Mc ab (Leu 1/17F12) or a granulocyte--monocyte-specific Mc ab (MCS2) were incubated on polystyrene Petri plates coated with affinity purified goat anti-mouse immunoglobulin G (IgG). Cells bound to the coated plates and nonbound cells were separately recovered ("panned") by differential elution. Analysis of the nonadherent buoyant marrow cells demonstrated 12% to possess HLA-DR, 6% T, 40% MCS2 antigens on their surface by indirect immunofluorescence (IMF). After panning, 15% +/- 8%, 14% +/- 4% and 8% +/- 6% cells were plate-bound by their respective antibodies, demonstrating differing binding efficiencies. A substantial degree of purity of the recovered cell fractions was shown for bound 74% +/- 6% and 75% +/- 5% IMF positive cells) and nonbound cells (3% +/- 1% and 0.1% +/- 0.8% positive cells) coated with anti-HLA-DR or anti-T Mc ab respectively, with lesser purity for MCS2 panned cells. Seventy-three percent to 126% CFU recovery was noted, with a sevenfold enrichment of the HLA-DR bound cells for CFU-GM and CFU-GEMM, and 3.5-fold enrichment for BFU-E. Sequential panning, obtaining T nonbound-DR bound-surface immunoglobulin nonbound fractions, resulted in tenfold CFU-GM enrichment (107/10(4) cells, approximately equal to 1/100). Anti-MCS2 antibody was ineffective for panning, but use of this antibody in fluorescence-activated cell sorting (FACS) indicated the absence of the MCS2 antigen on the vast majority of CFU-GM. This study describes a relatively rapid and inexpensive method for obtaining enriched antigenically defined hemopoietic precursors in high yield. These techniques should prove useful for more clearly evaluating cellular and humoral interactions with hemopoietic precursor cells.

A survey of elementary school health education in West Virginia

The Elementary School Health Education Survey was conducted to determine the health knowledge, health practices, and awareness of the consequences of health behavior of selected elementary school students in West Virginia. An 80-item, multiple-choice inventory was developed to collect student data, and a questionnaire-checklist was employed for each classroom teacher whose students participated in the survey. The survey involved 1,441 students from 85 classrooms in 35 schools. The results indicated a need for mandated health instruction as part of the elementary school curriculum and a need for graduate course work in Health Education for elementary school teachers.

The 8-hour metabolic profile after drinking ethanol

The acute metabolic changes after drinking ethanol have been studied in 11 fasting, healthy, nonobese, medical students, 6 of whom consumed 40 g ethanol diluted with 750 ml of a sugar-free soft drink over 1 h. The other 5 drank the same volume of soft drink alone. Blood levels of ethanol, glucose, immunoreactive insulin and growth hormone were measured over the ensuing 8 h, as well as the plasma concentrations of prolactin, cortisol and triiodothyronine. After ingesting ethanol, the mean plasma glucose concentration declined, but not to hypoglycemic levels (the nadir was 3.9 mmol/l at 6 h), insulin levels fell gradually and the mean growth hormone concentration showed a modest late rise. Other hormones did not change significantly. We conclude that, in the particular setting examined, the oral administration of ethanol does not cause hypoglycemia or other adverse effects on carbohydrate metabolism.

Safety of multiple bolus loading of intravenous disopyramide

Although a single intravenous bolus of disopyramide is an effective antiarrhythmic, side effects occur in some patients. We tested the safety of multiple bolus loading for intravenous disopyramide in 10 patients with frequent premature ventricular beats. Concurrent with a 1.0 mg/kg/hr infusion, a bolus of 0.5 mg/kg of disopyramide was given over 5 minutes. Up to three additional boluses were given 5 minutes after the first bolus unless a 50% reduction in premature ventricular beats or side effects occurred. The infusion was continued for 3 hours and was then decreased to 0.4 mg/kg/hr for 15 hours. All patients had a 50% reduction in premature ventricular beats and attained therapeutic blood levels. Three patients with a history of controlled congestive heart failure developed either hypotension or pulmonary edema. Hypotension and pulmonary edema following intravenous disopyramide is more related to the pharmacology of the drug than to the loading scheme employed.

Synthesis and antihypertensive activity of 4'-substituted spiro[4H-3,1-benzoxazine-4,4'-piperidin]-2(1H)-ones

A series of 4'-substituted spiro[4H-3,1-benzoxazine-4,4'-piperidin]-2(1H)-ones was prepared and evaluated for antihypertensive activity in the spontaneously hypertensive rat (SHR). The basic ring system was prepared in one step by condensation of dilithiated (tert-butoxycarbonyl)aniline (3) with (tert-butoxycarbonyl)piperidinone. Deprotection afforded 6, which was condensed with expoxides or alkyl halides to furnish the title compounds. The most active compound was dl-erythro-4'-[2-(1,4-benzodioxan-2-yl)-2-hydroxyethyl]spiro [4H-3,1-benzoxazine-4,4'-piperidin]-2(1H)-one (9), and various modifications of this compound were made in order to elucidate the structure-activity relationships in the series. Preliminary indications are that 9 may act by both central and peripheral mechanisms.

Amniotic fluid calcium concentration in the prenatal diagnosis of cystic fibrosis

Calcium concentrations were measured in supernatant amniotic fluid in order to establish whether they may be used as a marker for cystic fibrosis. No difference in values were found, whether the sample was derived from a normal pregnancy or from a pregnancy which resulted in a baby affected with cystic fibrosis.

Phenobarbital pharmacokinetics and bioavailability in adults

The pharmacokinetics and bioavailability of phenobarbital were examined in six healthy adult subjects after a 2.6 mg/kg intravenous and a 2.9 mg/kg oral dose. Serum concentrations of phenobarbital were followed by means of a high pressure liquid chromatographic assay for 21 days after drug administration. After the intravenous dose, the mean distribution half-life was 0.18 hour and the mean elimination half-life was 5.8 days. Mean total body clearance and mean renal clearance were 3.0 ml/hr/kg and 0.8 ml/hr/kg, respectively. The apparent volume of distribution was 0.60 liter/kg. After administration of phenobarbital tablets, the maximum phenobarbital serum concentration was 5.5 mg/liter at 2.3 hours after the dose. Adjusted absolute availability of phenobarbital from the tablets studied was 94.9 per cent (range 81-111.9 per cent). The elimination half-life averaged 5.1 days for the oral dose. There was no evidence of autoinduction of phenobarbital elimination over the study period.