Simultaneous demonstration of bone alkaline and acid phosphatase activities in plastic-embedded sections and differential inhibition of the activities

Bone alkaline (AlP) and acid phosphatase (AcP) activities were simultaneously demonstrated in tissue sections obtained from mice, rats, and humans. The method involved tissue fixation in ethanol, embedding in glycol methacrylate (GMA), and demonstration of AlP and AcP activities employing a simultaneous coupling azo dye technique using substituted naphthol phosphate as a substrate. AlP activity was demonstrated first followed by AcP activity. Both enzyme activities were demonstrated in tissue sections from bones fixed and/or stored in acetone or 70% ethanol for up to 14 days or stored in GMA for 2 months. AlP activity in tissue sections from bones fixed in 10% formalin, 2% glutaraldehyde, or formal-calcium, however, was markedly inhibited after 3-7 days and was no longer detectable after 14 days of fixation. Moreover, AlP activity was diminished in tissue sections from bones fixed in 70% ethanol or 10% formalin and subsequently demineralized in 10% EDTA (pH 7) for 2 days, and the activity was completely abolished in tissue sections from bones subsequently demineralized in 5% formic acid: 20% sodium citrate (1:1, pH 4.2) for 2 days. Methyl methacrylate (MMA) embedding at concentrations above 66% completely inhibited AlP activity. AcP activity, however, was only partially inhibited by formalin, glutaraldehyde, or formal-calcium after 7 or 14 days of fixation or by MMA embedding and was unaffected by the demineralizing agent formic acid-citrate for 2 days. While AcP activity was preserved in bones fixed in formalin and subsequently demineralized in EDTA, the activity was completely abolished when EDTA demineralization was carried out on bones previously fixed in 70% ethanol.(ABSTRACT TRUNCATED AT 250 WORDS)

Significance of Staph. saprophyticus as a uropathogen in adult Saudi females

Staphylococcus saprophyticus is a well documented aetiological organism of urinary tract infections in young sexually active females. This report highlights its role as an added cause of urinary infection in Saudi women and its previously unrecognized importance as a uropathogen in this population. The diagnosis is based on laboratory identification of coagulase-negative staphylococci (novobiocin resistance), absence of haemolysis, and production of intense pigmentation.

Imbrication reconstruction following partial laryngectomy

Experience over a 16-year period with 38 patients who underwent partial laryngectomy with imbrication reconstruction is reviewed. We have found this technique to be an expeditious and highly successful means of eradicating T1 or T2 glottic cancer. The use of the patient's own full-thickness, adjacent normal tissue with imbrication of cartilage produces an adequate airway, an almost normal-appearing larynx, and a remarkable posttreatment voice quality, better results than from most cordectomies or vertical hemilaryngectomies. It is valuable as a salvage procedure after full-course radiation. Imbrication laryngoplasty is an alternative and a preferred modality for treatment of young people with early glottic carcinoma for whom the possible carcinogenic properties of radiation must be considered. The survival results are comparable with the more extensive vertical laryngectomies.

Clonal origins of lymphoproliferative disease induced by Epstein-Barr virus

Analysis of immunoglobulin gene rearrangements in 16 B-cell lineages clonally propagated from two mononucleosis patients supported the notion that mononucleosis is a polyclonal B-lymphoproliferative disorder. Three of seven cell clones from a patient with a fatal B lymphoma revealed the same pattern of immunoglobulin gene rearrangement, indicating that this patient's disease was oligoclonal. The three similar clones were propagated from two sites (blood and spleen), indicating that they represent a metastatic cell lineage which arose during the patient's fatal B lymphoproliferation.

Enteral nutrition in patients receiving mechanical ventilation. Multiple sources of tracheal colonization include the stomach

Nutritional therapy of patients receiving mechanical ventilation includes enteral feeding. To determine the frequency of gastric microbial colonization in patients receiving enteral nutrition, 18 patients with acute respiratory failure receiving ventilation were studied. Multiple sources of tracheal colonization were then evaluated to determine the frequency of tracheal transmission of gastric flora and the relationship of gastric colonization and transmission to nosocomial respiratory infection. The stomach was colonized in every patient who received enteral feeding. Tracheal colonization occurred in 89 percent (16 of 18) of patients. In 12 of these 16 patients, 14 organisms colonized the trachea after transmission from the stomach and/or oropharynx. Thirty-six percent (five of 14) of organisms transmitted to the trachea originated from the stomach, whereas another 36 percent (five of 14) were first recovered from the oropharynx. Four tracheally transmitted organisms were first recovered simultaneously from the stomach and oropharynx. Nosocomial respiratory infection developed in 11 patients (63 percent). Three infections occurred during the six-day study period, one of which was associated with transmission of a gastric organism. Multiple sources of tracheal colonization occur in patients receiving enteral nutrition. The stomach is an important source of tracheal colonization. Enteral nutrition can be associated with gastric flora colonizing the trachea and causing nosocomial respiratory infection.

Prefabricated ossicular homografts in middle ear reconstructions

This paper is a review of 132 cases of ossicular reconstruction utilizing prefabricated homografts by clinical staff members of the UCLA Division of Head and Neck Surgery (specializing in ear surgery) in their private practice over the past decade. Another 20 cases completed over the past 2 1/2 years in the UCLA teaching programme are also reviewed. Although ossicular homografts have been used for some time in middle ear reconstruction, this report presents the innovation of prefabricating homografts into specific shapes that lend themselves appropriately to reconstruction problems. In such an ossicular bank, a variety of different shapes, in a number of sizes, is maintained for quick selection. This greatly decreases operating room time and, in addition, provides an effective method for ossicular reconstruction that has already been applied to a resident training programme. The cases in this review can be divided into 3 basic categories: (1) mastoidectomy ossicular reconstruction; (2) exploratory tympanotomy with reconstruction; (3) stapedectomy. This study indicates that ossicular homografts are very well tolerated in their new transplanted positions. Our very low extrusion rate, extremely rare evidence of absorption, and lack of foreign body reaction to these ossicles coincides with the experience of others. This is an advantage over plastic prostheses. In addition to pre- and postoperative air conduction level data, analysis of changes in bone conduction and speech discrimination scores are also presented to evaluate possible neurosensory damage related to manipulation in placing these ossicles.

Effects of dietary alteration of bicarbonate and magnesium on rat bone

To study the effects of bicarbonate and magnesium on bone, mild acidosis and/or hypermagnesemia were produced in growing rats by feeding ammonium chloride and/or magnesium sulfate. Bone composition, quantitative histomorphometry, and mineral x-ray diffraction (XRD) characteristics were measured after 6 wk of treatment. The results demonstrated that both acidosis (decreased HCO3) and hypermagnesemia inhibited periosteal bone formation, and, when combined, results were summative; and the previously observed in vitro role of HCO3- and Mg2+ as inhibitors of crystal growth were confirmed in vivo. XRD measurements demonstrated that decreased plasma HCO3 resulted in larger crystals and increased Mg resulted in smaller crystals. However, the combined XRD effects of acidosis and hypermagnesemia resembled acidosis alone. It is postulated that the final composition and crystal structure of bone are strongly influenced by HCO3- and Mg2+, and the effects are mediated by the combined influence on both osteoblastic bone formation and the growth of hydroxyapatite.

Multicenter study of the clinical efficacy of imipenem/cilastatin for treatment of serious infections

The efficacy and safety of imipenem/cilastatin was evaluated in a multicenter study. For 49 of the 78 patients with 79 infections entered into the study, the clinical and bacteriologic efficacy of therapy could be evaluated. Toxicity data were analyzed for all 79 infections. Overall, 35 of 49 infections were cured or improved: 10 of 11 cases of pneumonia; 8 of 15 cases of pyelonephritis; 4 of 5 cases of osteomyelitis; 3 of 4 intravascular infections; 6 of 9 soft tissue infections; and 4 of 5 miscellaneous infections. There were 13 bacteriologic failures; superinfections with resistant organisms (i.e., Candida albicans, methicillin-resistant Staphylococcus epidermidis, and Pseudomonas maltophilia) occurred in three patients; reinfection with sensitive pathogens complicated one urinary tract infection; relapses developed of five urinary tract infections and of one case of endarteritis; and bacteriologic persistence occurred in three soft tissue infections. Infections with Pseudomonas aeruginosa were the most difficult to treat. In only six of 11 P. aeruginosa infections was both bacteriologic and clinical cure achieved. Adverse effects were minimal; no serious hematologic or hepatic toxicity and no adverse renal effects were noted.

Leishmania infecting man and wild animals in Saudi Arabia. 1. General survey

Using up to 13 enzymes, biochemical characterization of 75 isolates of Leishmania made from man, wild animals and sandflies from a wide variety of localities in the Kingdom of Saudi Arabia has revealed the presence of L. major (two similar zymodemes), L. tropica (two zymodemes) and a parasite of the L. donovani-L. infantum complex. Zymodeme LON-4 of L. major has been found in 52 of 53 isolates so far characterized from man, from one specimen of Phlebotomus papatasi, from 15 Psammomys obesus, from one Meriones libycus and from one dog. One isolate from man has been identified as a new variant of L. major. This variant, zymodeme LON-65, varies from zymodeme LON-4 in a single enzyme. While this is the only example of zymodeme LON-65 identified so far, zymodeme LON-4 has also been obtained from Kuwait and Iraq. These are the first reports of L. major in Meriones libycus from Saudi Arabia and the first proven isolate from the dog in any country. L. tropica was identified from only two foci, whereas L. major appears to be widely distributed in the Kingdom. Two infants with kala-azar were found to be infected with a parasite apparently identical to zymodeme LON-42 of L. donovani (sensu lato) which also occurs in the highlands of Ethiopia.

Infectious mononucleosis: a polyclonal B cell transformation in vivo

We obtained spontaneous formation of Epstein-Barr virus-transformed B lymphocyte colonies from the blood of four patients with mononucleosis with the use of soft-agar medium. The colonies were propagated into separate cell lines and analyzed for their immunoglobulin secretion. Of 52 such lines, 44 produced immunoglobulin composed of a single class of heavy chain and single type of light chain. Among these clonal transformants, 27 (62%) of 44 produced mu-chain, 13 (29%) of 44 produced gamma-chain, and 4 (9%) of 44 produced alpha-chain. Analysis of light-chain secretion revealed that of the 44 cell clones secreting complete, monoclonal immunoglobulin products, 31 produced kappa-chain and 13 produced gamma-chain. One clone secreted mu-heavy chain and no light chain, an observation suggesting the clone is a pre-B cell phenotype. Seven lines derived from clones had aberrant patterns of immunoglobulin secretion that produced either two heavy chains or two light chains. B lymphocytes in different states of immunoglobulin gene expression are, therefore, transformed in vivo by Epstein-Barr virus.

A rapid staining procedure for Anaplasma marginale in bovine erythrocytes

A commercial product that stains cells in less than 1 minute was compared with the Giemsa and the Wright-Giemsa methods for detection of the intraerythrocytic parasite, Anaplasma marginale, in bovine blood smears. The total number of A marginale-infected erythrocytes detected in 5 microscope fields of 18 different samples was determined for each staining procedure. In samples where less than 2% to greater than 25% of the RBC were infected, statistical analysis of the data indicated that the rapid staining method was superior to the Giemsa and Wright-Giemsa methods with regard to determination of the percentage of bovine erythrocytes infected with A marginale.

Effects of ketamine on the adaptive responses of second-order vestibular neurons of the cat

The adaptive characteristics of 80 neurons in the vestibular nuclei of ketamine-anesthetized cats were investigated. All types I and II neurons responded to stimulation of the horizontal semicircular canals by an 8 degree/sec2 stepwise angular acceleration of 40 sec. For the purpose of this study, vestibular adaptation was defined as a decline in response at a rate of greater than -0.01 spikes/sec/sec. According to this criterion, 71 neurons (89 per cent) behaved as adapting neurons, and nine (11 per cent) showed either no adaptation or reverse adaptation. The rate of adaptation varied from neuron to neuron; the average rate was -0.312 spikes/sec/sec. The average resting discharge rate, the maximum response level, and the average adaptation rate were compared with similar neural responses in barbiturate-anesthetized cats. Although the average resting discharge rates of the two groups showed no significant difference, the average adaptation rate and the maximum response level of the ketamine-anesthetized group were significantly higher than those of the barbiturate-anesthetized group. These data suggest that the gain of the second-order neurons is higher and more actively modulated in more alert (ketamine-anesthetized) cats than in barbiturate-anesthetized cats.

Histopathology of neurosensory deafness in sarcoidosis

Sarcoidosis is an idiopathic systemic granulomatous disease which occasionally causes fluctuating auditory and vestibular dysfunction. The temporal bones from a 32-year-old man deaf for 5 years from CNS sarcoidosis were examined histologically and compared with other nervous system tissues. It was found that the acoustic, vestibular, and facial nerves were involved in a striking perivascular lymphocytic infiltration resulting in myelin and axonal degeneration. The cochlear and labyrinthine neuroepithelium and stria vascularis had degenerated. It is hypothesized that neurosensory deafness and vestibular dysfunction in sarcoidosis starts as a reversible neuropathy. In some patients, an ischemia secondary to the vasculitis results in irreversible damage to the inner ear neuroepithelium.

Prospective randomized reappraisal of 5-fluorouracil in metastatic colorectal carcinoma. A comparative trial with 6-thioguanine

In order to redefine the effectiveness of 5-fluorouracil (5-FU) as palliative therapy in patients with metastatic colorectal carcinoma, and to compare the effectiveness of 6-thioguanine (6-TG) with that of 5-FU, we studied 176 patients with metastatic colorectal carcinoma in a randomized prospective trial (SEG 79G1268 ). The pretreatment performance status of all patients was greater than 50% (ambulatory), and there was an equal distribution of patients with favorable pretreatment characteristics into each of the treatment regimens. Complete responses were only seen to 5-FU, but were obtained in only 3% of instances. The overall complete plus partial response rates were not different for 5-FU (8%) versus 6-TG (3%), or for patients who had shown prior progression on chemotherapy and who then received 6-TG in a nonrandomized fashion (7%). The time to tumor progression on each of the treatment programs was similar, 1.0 months. Survival was also similar in each regimen in the randomized study (6.3 months for 5-FU versus 7.9 months for 6-TG). However, survival was only 4.8 months for patients with previously drug-resistant tumors treated with 6-TG in the nonrandomized arm. In 16 patients failing 6-TG who then received 5-FU, there were no objective responses. Similarly, in patients failing 5-FU on this study who then received 6-TG, there were no responses in nine patients. Dose-limiting toxicity was observed in 40% to 51% of patients, and consisted of myelosuppression, vomiting, or diarrhea. It is concluded that 5-FU is a minimally effective agent in a very small number of patients with metastatic colorectal carcinoma. The drug 6-TG is equally ineffective in this setting. Alternative treatment programs to the systemic use of 5-FU should be considered in patients requiring palliative chemotherapy.

A histological comparison of the temporal bone in strangulation and drowning

The temporal bones from a two year old drowning victim are compared with those of a 13 month old strangulation victim. Tympanomastoid hemorrhage and submucosal edema and petechiae with moderate vascular congestion were characteristic in drowning. Marked congestion with edema but no sign of hemorrhage was found in strangulation. It is concluded that respiratory effort against a closed glottis is not solely responsible for the tympanomastoid hemorrhage known to occur frequently as a result of drowning.

Acute myelogenous leukemia as a second malignant neoplasm following the successful treatment of advanced Hodgkin's disease

Of 209 Hodgkin's disease patients treated at least 6 months with a five-drug combination of induction chemotherapy and having a complete remission, four patients developed acute myelogenous leukemia (AML) as a second malignant neoplasm. The overall relative risk for development of AML is 185.0 (P less than 0.05) and the mean time to occurrence of AML is 5.3 years (median, 5.25 years). When examining patient subgroups, the highest relative risk noted was 338.5 (P less than 0.05) for that group of patients receiving an additional 6 months of postinduction MOPP (nitrogen mustard, vincristine, procarbazine, and prednisone). Patients receiving only 6 months of induction BVCPP (BCNU, vinblastine, cyclophosphamide, procarbazine, and prednisone) had a relative risk of 166.2 (P less than 0.05). These data results are consistent with previous reports that patients treated for Hodgkin's disease are at high risk for development of AML. However, to date, no patients in this series have developed second malignancies other than AML.