Identification and partial characterization of gonadotropin-releasing hormone-like factors in human seminal plasma

Gonadotropin-releasing hormone (GnRH)-like material was measured by radioimmunoassay in acid-ethanol-extracted human seminal plasma using radiolabeled D-[Leu6] GnRH ethylamide as labeled ligand, authentic GnRH as standard, and antibody raised against D-[Lys6] GnRH analog. The mean amount of GnRH-like material measured in the seminal plasma of semen samples with sperm counts greater than 20 X 10(6)/ml was 229.0 +/- 66 pg/ml, with sperm counts less than 20 X 10(6)/ml was 213 +/- 42 pg/ml, and from vasectomized samples was 252 +/- 36 pg/ml. There was no significant difference among the three groups. Scatchard analysis of radioreceptor binding data demonstrated significant displacement of GnRH agonist ligand from castrated male rat pituitary membrane preparations. Ultrafiltration and gel column chromatography of pooled extracted seminal plasma identified two compounds with apparent molecular weights of 2600 and 5000 that differ chemically and immunologically from native GnRH. Further characterization using affinity column chromatography suggests that at least one of these GnRH-like factors is a glycosylated protein.

A comparison of the specificity of the 1971 and 1982 American Rheumatism Association criteria for the classification of systemic lupus erythematosus

The specificity of the preliminary and the revised American Rheumatism Association criteria for the classification of systemic lupus erythematosus (SLE) was tested in 207 of our patients with other rheumatic diseases which were considered to be important in the differential diagnosis of SLE. Using the preliminary criteria, the data revealed that 5 patients were falsely classified as having SLE (2 with scleroderma, 2 with Raynaud's disease, and 1 with systemic necrotizing vasculitis), whereas using the revised criteria, only 2 patients (1 with scleroderma and 1 with systemic necrotizing vasculitis) were falsely classified. The calculated specificity was 99% for the revised criteria and 98% for the preliminary criteria. Thus, the data revealed that the specificity of the revised criteria is high and comparable with that of the preliminary criteria when applied to a group of patients with related rheumatic diseases.

Cytologic manifestations of cervical and vaginal infections. II. Confirmation of Chlamydia trachomatis infection by direct immunofluorescence using monoclonal antibodies

We found inflammatory patterns of transparent lymphocytes on increased numbers of histiocytes suggestive of chlamydial infection in 68 (56%) of 121 cervical cytologic smears. Chlamydia trachomatis was isolated from 36 (53%) of those with and only two (4%) of those without such inflammatory patterns. Direct stain with fluorescein-conjugated monoclonal antibodies demonstrated elementary bodies of C trachomatis in 30 (79%) of the 38 culture-positive patients, including 29 of the culture-positive patients who had an inflammatory cytologic pattern suggestive of C trachomatis infection. Thus, Papanicolaou smears can be screened for inflammatory pattern, and separate endocervical smears from patients with a pattern suggestive of chlamydial infection can then be stained by immunofluorescence to confirm the presence of C trachomatis infection. This two-step approach detected 29 of 38 infections confirmed by culture in the present study, giving a sensitivity of 76%, a specificity of 100%, and a positive predictive value of 100% in a population having a 31% prevalence of C trachomatis infection.

Self-inflicted gunshot wounds: lethality of method versus intent

The authors studied 30 patients treated at an urban trauma center for self-inflicted gunshot wounds, most or all of which would have been fatal without emergency treatment. About half the patients had used alcohol or drugs immediately before wounding themselves, and slightly more than half had experienced interpersonal conflict just before the incident. Thirteen of the 30 were women. Only nine were given diagnoses of major depressive episode or dysthymia; none of the patients had written suicide notes. These data indicate that the reported demographic and clinical characteristics of impulsive, violent self-injury must be reexamined.

Quality-specific taste changes in multiple sclerosis

Taste sensitivity in 79 patients with multiple sclerosis (MS) and 65 age- and sex-matched control subjects was measured with a sip-and-spit, suprathreshold scaling, magnitude estimation procedure using six concentrations each of sodium chloride, sucrose, citric acid, and quinine hydrochloride. Results were analyzed with a taste scoring system and by plotting psychophysical functions (log concentration versus log magnitude estimate) normalized to 1.0 M sucrose. Gender did not affect taste scores, but age was inversely related, so the results were analyzed by an analysis of covariance with age as the covariant. There was a significant alteration in taste sensitivity in the subjects with MS for sodium chloride and quinine hydrochloride stimuli but not for sucrose and citric acid; these results were confirmed by a separate analysis of the psychophysical functions. Some of the MS taste scores correlated with MS functional and physical disability scores. Taste sensitivity was not correlated with clinical history or presence of facial symptoms.

Intramucosal carcinoma of the small intestine arising in regional enteritis (Crohn's disease). Report of a case studied for carcinoembryonic antigen and review of the literature

A case of carcinoma of the small intestine arising in a patient with regional enteritis (Crohn's disease) of the ileum is reported. The patient, a 54-year-old woman, had a 21-year history of regional enteritis which was treated intermittently with sulfasalazine and prednisone. Segmental resections of the ileum had been performed on two previous occasions. Because of recurrent low-grade intestinal obstruction, another segment of ileum was resected. The bowel demonstrated the typical gross and histologic appearance of regional enteritis. Histologic examination also disclosed a carcinoma that was confined to the ileal mucosa. This case is the first reported in which a small bowel carcinoma arising in regional enteritis has been found only in the mucosa. Adjacent to the carcinoma, the mucosa showed varying degrees of dysplasia consistent with the "precancerous" changes that have been described in inflammatory bowel disease. Using a peroxidase-antiperoxidase immunoperoxidase technique, carcinoembryonic antigen was identified in normal, hyperplastic, dysplastic, and carcinomatous mucosa, but the most intense staining was seen in hyperplastic and dysplastic cells. Carcinoembryonic staining, however, did not aid in differentiating between hyperplasia, dysplasia, and carcinoma because of an overlap in staining frequency and intensity.

A comparison of the sensitivity of the 1971 and 1982 American Rheumatism Association criteria for the classification of systemic lupus erythematosus

The sensitivity of the American Rheumatism Association's preliminary and revised criteria for the classification of systemic lupus erythematosus (SLE) was tested in 156 of our SLE patients. Eighty-eight percent met the 1971 preliminary criteria. Eighty-three percent fulfilled the 1982 revised criteria when arthritis was strictly defined (nonerosive arthritis) and 91% when arthritis was more liberally defined (nondeforming arthritis). Analysis revealed that of the 3 serologic tests added in the revised criteria (antinuclear antibody, anti-Sm, anti-DNA), the antinuclear antibody test accounted for the increased sensitivity of the revised criteria.

Some biochemical correlates of panic attacks with agoraphobia and their response to a new treatment

Thirty-two patients with chronic debilitating agoraphobia and panic attacks participated in a comparative study of the triazolobenzodiazepine alprazolam and the anti-inflammatory agent ibuprofen. After a 2-week placebo washout period, patients were randomly assigned to 8 weeks of treatment with alprazolam (2 to 6 mg/day) or ibuprofen (0.8 to 2.4 g/day). Medication was identically packaged and patients were blind to the treatment condition, but investigators were aware of which medication was dispensed. Alprazolam recipients (mean daily dose: 5.4 mg) improved markedly with respect to physician and patient global rating of disease severity, frequency and severity of panic attacks, and phobic anxiety target symptoms on the 90-Item Hopkins Symptom Check List. Ibuprofen recipients (mean daily dose: 2.13 g) experienced significantly less clinical improvement than patients on alprazolam. After 8 weeks of treatment, ibuprofen patients were crossed over to alprazolam, while the original alprazolam group continued on that drug. The daily dosage ceiling was increased to 10 mg. In the ensuing 4 weeks (mean daily alprazolam dose: 6.3 mg), all patients achieved comparably marked clinical improvement relative to baseline. Pretreatment plasma concentrations of platelet factor 4 and beta-thromboglobulin--two measures of platelet turnover and release--were significantly elevated in patients relative to normal controls. The elevated platelet factor 4 and beta-thromboglobulin normalized during treatment with both drugs. Alprazolam appears to produce rapid and specific clinical improvement in patients with severe agoraphobia and panic attacks and deserves further evaluation under double-blind conditions.

Hormonal effects of GnRH agonist in the human male: II. Testosterone enhances gonadotrophin suppression induced by GnRH agonist

Superactive analogues of gonadotrophin releasing hormone and testosterone, when administered together, synergistically inhibit gonadotrophin secretion and spermatogenesis in the rat. In order to determine whether testosterone also enhanced gonadotrophin suppression by GnRH agonist in the human male, two groups of four normal male volunteers first received either 10 or 100 micrograms of a GnRH agonist D(Nal2)6GnRH (GnRH-A) daily for 10 d. After at least a 50 d recovery period, the same subjects received a single injection of 200 mg of testosterone oenanthate (TE) on day 1 in addition to the same dose of GnRH-A daily for 10 d. Serum LH, FSH and testosterone (TS) concentrations were measured daily just prior to the next analogue dose, and on days 1 and 10 at 0, 1, 2, 4, 6, 8, 12, 16 and 24 h after the analogue injection. Daily administration of both 10 and 100 micrograms of GnRH-A alone resulted in an early phase of stimulation followed by progressive decline in LH, FSH and testosterone to levels below baseline by day 10 despite continued administration of GnRH-A. Addition of testosterone to 10 micrograms of GnRH-A resulted in hormonal responses identical to those seen with GnRH-A alone. Combined treatment of testosterone with 100 micrograms of GnRH-A did not blunt the peak LH and FSH responses on day 2, but resulted in significantly lower LH (mean integrated responses: 187 +/- 30 vs. 234 +/- 42 mIU-d/ml) and FSH (mean integrated responses: 20.6 +/- 3.3 vs. 32.8 +/- 4.2 mIU-d/ml) responses from days 3 to 11. By day 11, all subjects receiving combined treatment (GnRH-A 100 micrograms + testosterone oenanthate) had undetectable serum FSH levels. In contrast, serum FSH concentrations on day 11 after treatment with GnRH-A alone were 43.6 +/- 8.9% of control and none of the subjects had values below the limit of detection. Serum testosterone levels in the combined treatment group did not fall below baseline by day 10 in either the 10 (161.4 +/- 48%) or the 100 micrograms GnRH-A groups (104.6 +/- 11.2%), while in the group receiving GnRH-A alone, testosterone levels declined to 45.6 +/- 8.3% and 80 +/- 18.8% with the 10 and 100 micrograms dose respectively. We conclude that addition of a suppressive dose of testosterone to an appropriate dose of GnRN-A significantly enhances gonadotrophin suppression by GnRH-A in the human male.(ABSTRACT TRUNCATED AT 400 WORDS)

Counteractive effects of agonistic and antagonistic gonadotropin-releasing hormone analogs on spermatogenesis: sites of action

Both gonadotropin-releasing hormone (GnRH) agonistic and antagonistic analogs have been shown to inhibit reproductive hormonal function. While predictable and complete suppression of spermatogenesis is the ultimate goal of a number of clinical studies aimed at developing male contraceptive agents based on GnRH analogs, neither class of analog has been shown to completely inhibit spermatogenesis in man. The potential for a synergistic interaction of submaximal doses of these two classes of GnRH analogs was investigated in the present studies. In these studies 200 ng/day of a potent agonist (D-Leu6des-Gly10GnRH ethylamide) and 100 micrograms/day of a potent antagonist (NAc-L-Ala1, pCl-D-Phe2, D-Trp3,6GnRH) were administered subcutaneously, both alone and in combination, to adult male rats for 21 days. Serum gonadotropins and testosterone, pituitary GnRH receptor content, gonadal gonadotropin receptors, and intratesticular sperm counts were quantitated in each treatment group. Despite the ability of both GnRH agonists and antagonists to inhibit reproductive function when administered as single agents in this study, combined treatment with the two classes of GnRH analogs was less effective than either agent alone at these doses in the pharmacologic suppression of spermatogenesis.

Partial isolation and characterization of testicular GnRH-like factors

We report here partial isolation and characterization of at least two GnRH-receptor binding factors from the ethanol: chloroform: acetic acid (ECA) extracts of rat testis. The displacement curve of defatted, steroid-free and desalted ECA extract was parallel to that of D-(leu)6-des (Gly)10-GnRH-EA in a GnRH-radioreceptor assay. Immunoaffinity chromatography on cyanogen bromide-activated Sepharose 4B beads covalently bound to an antibody raised against d-(lys)6-GnRH resulted in more than a hundredfold increase in receptor binding specific activity. Equivalent amounts of kidney extract after affinity chromatography showed no significant activity. Coincubation of the material purified by affinity chromatography with the labeled ligand did not result in significant peptidase degradation of the label, indicating that apparent displacement of the label in the receptor assay was not the result of cleavage of the ligand. HPLC of the material partially purified by affinity chromatography on a reverse phase 5 micron ODS column revealed two peaks of receptor binding activity. Preliminary estimates of molecular weights of these factors based on SDS-PAGE and gel filtration are 68,000 and 6,000 respectively. We conclude that there are at least two factors in rat testis with GnRH-receptor-binding properties that are chemically distinct from the native decapeptide.

Thromboxane and prostacyclin (epoprostenol) during exercise in diffuse pulmonary fibrosis

Plasma thromboxane A2, a vasoconstrictor, and plasma prostacyclin (epoprostenol), a vasodilator, were assessed by double-antibody radioimmunological assay of their respective stable circulating metabolites, thromboxane B2 (TxB2) and 6-ketoprostaglandin F1 alpha, in 9 patients with severe diffuse pulmonary fibrosis (DPF), who were known to become hypo-oxaemic during exercise, and in 9 healthy volunteers. In the 7 patients with the most severe DPF, mean arterial PO2 fell from 68 mm Hg at rest to 51 mm Hg at peak aerobic exercise, and mean TxB2 increased to twice the value at rest. The 9 controls remained oxygen saturated throughout exercise; their mean TxB2 did not change during aerobic exercise, but during anaerobic exercise increased to twice the value at rest, and increased further during recovery. There were no significant changes in 6-keto-prostaglandin F1 alpha in either group. The selective release of TxB2 during aerobic exercise in hypo-oxaemic patients suggests that thromboxane mediates hypoxic pulmonary vasoconstriction. Its release in normal man during anaerobic exercise may reflect a more general response to the metabolic changes of tissue hypoxia.

Pituitary desensitization and the regulation of pituitary gonadotropin-releasing hormone (GnRH) receptors following chronic administration of a superactive GnRH analog and testosterone

We recently demonstrated that chronic daily administration of a superactive GnRH analog to intact rats resulted in an initial stimulation of serum LH levels with a subsequent return of LH levels to baseline at a time when testosterone levels were markedly decreased. These data demonstrated pituitary desensitization following chronic GnRH analog treatment. Administration of GnRH analog with a dose of testosterone which did not markedly lower serum LH levels when administered alone prevented the stimulation of LH secretion by analog. The present studies were undertaken to determine the effects of GnRH analog and testosterone administration on the regulation of pituitary GnRH receptors. Pituitary GnRH receptor binding was increased by analog treatment alone at 20 days and returned to control levels at 40 and 60 days of treatment in parallel to the observed changes in serum LH, demonstrating that one mechanism by which chronic GnRH analog treatment leads to pituitary desensitization is down-regulation of pituitary GnRH receptors. Testosterone administration alone decreased pituitary GnRH receptor binding. Combined GnRH analog and testosterone administration prevented the increase in pituitary GnRH receptors observed with analog administration alone. These studies demonstrate that change in pituitary GnRH receptor binding correlate with changes in serum LH and that the stimulatory effects of analog administration on LH are sensitive to inhibition by small doses of testosterone.

Historical antecedents of normative vs pathologic perspectives in aging

Differing concepts of aging, i.e., a normative versus a pathologic process, are presented in historical perspective and are traced through selected writings from ancient China, India, Egypt, and Greece into more modern times. These is no consistent shift across epochs from one to the other perspective, and mixed perspectives often appear. Ideas regarding the aging process and age-related disease are influenced by the changing medical state of the art in various areas. Because of the still incomplete knowledge of the basic mechanisms involved, the current status of medical knowledge has not yet resolved the "aging vs disease dilemma." History, however, does reveal insights that promote respect for prescientific observations and intuitions, provide a contextual background for progress achieved, and foreshadow current trends in the theory and practice of geriatrics.

Respiratory treatment of the adult patient with spinal cord injury

The respiratory program of the Spinal Injury Service at Rancho Los Amigos Hospital has demonstrated effective respiratory treatment to be a prerequisite for comprehensive rehabilitation. To facilitate program planning, patients are classified according to functional neurosegmental levels and residual respiratory muscles. Breathing mechanics are the basis of evaluation and treatment. Evaluative elements are strength of residual respiratory muscles, respiratory rate, vital capacity, breathing pattern, chest expansion, and cough. Respiratory functions of patients with spinal injury are compared with respiratory functions of healthy subjects. Treatment objectives are prepared according to the individual patient's functional classification and evaluation. Specific methods are discussed, including strengthening, chest wall mobilization, external support devices, and bronchial hygiene.

Role of thromboxane and prostacyclin in pulmonary vasomotor changes after endotoxin in dogs

Cyclooxygenase inhibitors prevent the pulmonary vasomotor changes in response to low-dose endotoxin. We, therefore, explored the role of two highly vasoactive prostanoids, thromboxane A(2), a vasoconstrictor, and prostacyclin, a vasodilator, in the transient pulmonary vasoconstriction and subsequent loss of alveolar hypoxis vasoconstriction (AHPV) that follows endotoxin. AHPV was tested in the dog with a double-lumened endotracheal tube allowing ventilation of one lung with nitrogen as a hypoxic challenge while the other lung was ventilated with oxygen to maintain systemic oxygenation. Relative distribution of perfusion to the two lungs was assessed with intravenous (133)Xe and external scintillation detectors. The stable metabolites of thromboxane and prostacyclin, i.e., thromboxane B(2) and 6-keto-prostaglandin F(1alpha) were measured in plasma with radioimmunoassay. 15 mug/kg i.v. of endotoxin induced no rise in pulmonary vascular resistance (PVR), but prevented AHPV so that the initial 33% (+/-2 SEM) decrease in perfusion to the hypoxic lung became only a 2% (+/-1) decrease. Circulating levels of thromboxane and prostacyclin concurrently rose (P < 0.01) from nondetectable levels to 380 pg/ml (+/-40) and 360 pg/ml (+/-130). 150 mug/kg of endotoxin induced a transient rise in PVR from 4.09 to 9.00 mm Hg/liter per min in association (r = 0.89, P < 0.01) with a sharp rise in thromboxane levels to 4,460 pg/ml (+/-1,350) whereas prostacyclin levels were elevated less markedly to 550 pg/ml (+/-400). Prostaglandin F(2alpha), another vasoconstrictor, was not elevated. 30 min after endotoxin when PVR was again base line and AHPV lost, thromboxane fell significantly (P < 0.01) to 2,200 pg/ml (+/-1,100) whereas prostacyclin remained elevated at 360 pg/ml (+/-135), a level similar to that seen when 15 mug/kg of endotoxin induced loss of AHPV. Indomethacin prevented the rise in thromboxane and prostacyclin after endotoxin as well as the changes in pulmonary vasomotor tone. Thus, a complex interaction between thromboxane and prostacyclin is involved in the pulmonary vasomotor response to low-dose endotoxin.

Multiple cardiac anomalies in a family of Saluki dogs

Clinical studies of a family of Saluki dogs demonstrated a spectrum of cardiac malformations, which ranged from mild thickening of a pulmonic valve leaflet to a complex condition composed of tricuspid valve insufficiency, pulmonic stenosis, patent ductus arteriosus, and mitral valve insufficiency. All affected dogs had patent ductus arteriosus or ductus diverticulum, which is an incomplete or atypical form of patent ductus arteriosus. The clinical findings varied with the type of cardiac lesion(s) found. Pedigree evaluation suggested a genetic cause, though environmental factors could not be excluded.

Gonadotropin therapy failure secondary to human chorionic gonadotropin-induced antibodies

A 15-yr-old male with the diagnosis of Kallmann's syndrome manifested secondary gonadal resistance during a third treatment course of hCG. A serum sample obtained 6 months after failure of the patient to respond to hCG bound [125I]hCG 60% at a 1:2 dilution of serum; 50% at 1.5; 28% at 1:50; 21% at 1:100; and less than 5% at a 1:500 dilution. Serial sampling of the patient's serum over a 22-month period demonstrated a progressive decline in binding capacity, decreasing to 32% binding of [125I]hCG at a 1:2 dilution of serum. The data demonstrated that the patient produced a low affinity, high capacity binding substance with a Ka of 5 x 10(7) liters/M and a R0 of 1.8 x 10(16) sites/g gamma-globulin. The binding substance appeared to be a gamma-globulin of the immunoglobulin G class, which bound labeled hCG and human LH (hLH) more avidly than it bound hFSH and interfered with the biological response to hCG therapy. These data further indicated that antibodies produced against hCG may bind other endogenous glycoproteins such as hLH, hFSH, and hTSH. Although binding to hTSH did not occur in this patient, the presence of a common beta-chain in the molecular structures of hLH, hFSH, hCG, and TSH makes such a potential occurrence not implausible. Despite the apparent infrequency of the development of clinically observable interference with the biological activity of hLH/hCG in hCG-treated patients, this report indicates that a potential hazard exists. The possibility should be considered in the decision to treat a patient with normal gonadotropin secretion with exogenous gonadotropins.

Off-axis beam quality change in linear accelerator x-ray beams

The effective energy of the x-ray beam from linear accelerators changes as a function of the position in the beam due to nonuniform filtration by the flattening filter. In this work, the transmittance through a water column was measured in good geometry and the beam quality characterized in units of HVL in water. Measurements were made on a variety of linear accelerators from 4 to 10 MV. The beam energy decreased with increasing distance from the central ray for all accelerators measured.

Calculative technique to correct for the change in linear accelerator beam energy at off-axis points

The change in energy of linear accelerator x-ray beams from the central ray to off-axis points causes errors in the dose calculated by conventional techniques for large, irregularly shaped fields. A modification of conventional calculative methods to correct for the change in beam energy is presented. The results of measurements in irregular fields on a Clinac-4 are reported which verify the validity of the calculative method. A discussion of the clinical significance will point out errors of 3% to 4% in conventional dose calculations.

A special kind of nurse

Pat Johnson is a special kind of nurse. She has helped develop a team of nurse practitioners to function much like the traditional pediatric intern in the newborn intensive care unit of St. Paul's Children's Hospital. She is able to do physical examinations, interprets test results, and then determines a baby's problems and needs from an insight that is a combination of nursing and medicine.

Exogenous progestogen and estrogen implicated in birth defects

A five-year study of possible teratogenicity of exogenous female sex hormones included three case-control studies and one cohort study. The first case-control study disclosed an estimated relative risk of 8.41 and a highly significant difference in maternal hormonal exposure (P less than .001) between controls and infants with three major anomalies of the VACTERL group (V, vertebral; A, anal; C, cardiac; T, tracheal; E, esophageal; R, renal; and L,limb). Relative risk (RR) estimates of 5.58 (P = .017) and 3.35 (P less than .001) were found in two case-control studies involving maternal hormonal exposure and patients with congenital heart lesions without other malformations. A controlled, single-blind prospective study disclosed an excess of patients with major malformations (RR = 2.75), congenital heart anomalies (RR = 6), and neurological and neural tube disorders preponderant in the presence of a precipitously declining exposure rate during a three-year period in our referral area.