The task-force approach to solving radiology problems

A task force approach to resolving radiology problems has been used successfully at Hartford Hospital. The involvement of nursing, medical staff, and other ancillary personnel has resulted in the solution of issues common to all hospitals and imaging departments, including problems in patient scheduling, transportation, monitoring, and preparation. Sharing of issues and ideas and the development of direct lines of communication have brought about beneficial change and contributed to quality patient care.

Newly synthesized proteoglycans in pseudoachondroplasia

In an attempt to elucidate the biochemical defect in pseudoachondroplasia, proteoglycan metabolism was investigated in cartilage from a patient with the dominant form of this condition. Iliac-crest cartilage was radioactively labeled with 35S-sulfate and the newly synthesized proteoglycans examined for their hydrodynamic size and glycosaminoglycan composition. The banding pattern of the purified proteoglycans was analyzed by gel-electrophoresis using large pore polyacrylamide-agarose. We found a normal chain-length of glycosaminoglycans and a normal ratio of chondroitin-6-sulfate to chondroitin-4-sulfate. The proteoglycans were not enriched in keratan sulfate. Gel electrophoretic analysis of the proteoglycans disclosed a banding pattern comparable to that of two normal controls. In contrast to the findings of other authors no differences between the proteoglycans of pseudoachondroplastic and normal cartilage were detected.

Morquio's disease type B (beta-galactosidase deficiency) in three siblings

The clinical and biochemical findings in 3 siblings with Morquio's disease type B (mucopolysaccharidosis (MPS) IV B) are presented. Their phenotype is characterised by short trunk dwarfism with kyphoscoliosis and thoracic deformity. Radiographic findings include general platyspondyly, dysplasia of the pelvis and epiphyseal abnormalities. The patients are of normal intelligence. In the urine of all 3 affected children abnormal oligosaccharide excretion was found by thin-layer chromatography and in 1 of them keratosulphaturia was detected. The clinical diagnosis was confirmed biochemically by demonstration of a profound deficiency of beta-galactosidase activity in cultured fibroblasts. The clinical picture is compared with that of other cases in the literature and the possible molecular basis of the different phenotypes of beta-galactosidase deficiency (variants of monosialo-ganglioside-1 (GM1)-gangliosidosis, Morquio's disease type B) is discussed.

Central cholecystokinin octapeptide reduces glucose utilization in subcortical but not cortical rat brain

Cholecystokinin octapeptide was administered intraventricularly to laboratory rats in a behaviorally active dose. Quantitative regional glucose utilization was assessed as a measure of neuronal activity using [14C]2-deoxyglucose. CCK-8 reduced glucose utilization in selected subcortical nuclei, but left most areas of cortex unaffected. The subcortical nuclei were chiefly extrapyramidal systems. The diminutive pharmacologic action on cortical neuronal activity implies CCK-8 may act here as a neuronal modulator, in concert with other central transmitters, rather than having prominent singular actions.

Stress-related immune suppression: health implications

This study used a year-long prospective design to assess linkages among distress, immunity, and illness. Serial blood samples were collected from 40 first-year medical students at the first, third, and fifth examination periods, as well as 1 month before each. There were significant decrements in the production of gamma-interferon by concanavalin A-stimulated lymphocytes obtained at the time of examinations. Antibody titers to Epstein-Barr virus (EBV) increased during examination periods, suggesting reactivation of latent EBV and therefore poorer cellular immune control of latent virus. We obtained data that suggest that T-cell killing by memory T lymphocytes of EBV transformed autologous B lymphocytes also declined during examination periods. The activity of a lymphokine, leukocyte migration inhibition factor, normally suppressed during recrudescence of herpes simplex virus type 2 infections, was altered during examination periods and an increase in both plasma and intracellular levels of cyclic AMP associated with examination stress was observed. An increase in the incidence of self-reported symptoms of infectious illness was also associated with examination periods. The data support the linkage between stress-related immunosuppression and health.

Reactivation of herpes simplex virus is associated with production of a low molecular weight factor that inhibits lymphokine activity in vitro

Peripheral blood mononuclear cells obtained during recrudescent Herpes simplex virus (HSV) infection and stimulated with UV-inactivated viral antigen (UV-HSV) for 24 hr produced a low molecular weight (dialyzable) factor that inhibited lymphokine activity. This factor prevented the expression of leukocyte inhibitory factor (LIF) activity, but not its production. It was not made in UV-HSV-stimulated cultures grown in presence of 2 X 10(-6) M indomethacin nor in cultures of peripheral blood mononuclear cells obtained during convalescence or quiescence (greater than 4 days from onset of clinical symptoms) or from seropositive controls without a history of recurrent HSV disease. Dialyzable inhibitory factor production required OKM1+, OKT8+, and OKIa+ cells as determined by complement-mediated lysis with monoclonal antibody. Dialyzable inhibitory factor activity was associated with a trypsin-sensitive 8.2 K fraction as determined by Sephadex chromatography followed by sodium dodecyl sulfate-acrylamide gel electrophoresis.

Reactivation of herpes simplex virus is associated with production of a low molecular weight factor that inhibits lymphokine activity in vitro

Peripheral blood mononuclear cells obtained during recrudescent Herpes simplex virus (HSV) infection and stimulated with UV-inactivated viral antigen (UV-HSV) for 24 hr produced a low molecular weight (dialyzable) factor that inhibited lymphokine activity. This factor prevented the expression of leukocyte inhibitory factor (LIF) activity, but not its production. It was not made in UV-HSV-stimulated cultures grown in presence of 2 X 10(-6) M indomethacin nor in cultures of peripheral blood mononuclear cells obtained during convalescence or quiescence (greater than 4 days from onset of clinical symptoms) or from seropositive controls without a history of recurrent HSV disease. Dialyzable inhibitory factor production required OKM1+, OKT8+, and OKIa+ cells as determined by complement-mediated lysis with monoclonal antibody. Dialyzable inhibitory factor activity was associated with a trypsin-sensitive 8.2 K fraction as determined by Sephadex chromatography followed by sodium dodecyl sulfate-acrylamide gel electrophoresis.

A comparison of the periodontal ligament injection using 2% lidocaine with 1:100,000 epinephrine and saline in human mandibular premolars

The purpose of this study is to evaluate, with the electric pulp tester, the anesthetic efficacy of the periodontal ligament injection using 2% lidocaine with 1:100,000 epinephrine and saline in human mandibular premolars. The periodontal ligament injection using 2% lidocaine with 1:100,000 epinephrine was found to be an effective technique for anesthetizing mandibular first premolars. However, the duration of profound pulpal anesthesia was approximately 10 minutes. The periodontal ligament injection using sterile saline was not an effective technique for anesthesia. Teeth mesial and distal to the injected tooth may also become anesthetized with this injection technique. The initial needle penetration and injection of the anesthetic solution in clinically healthy teeth were only mildly discomforting. No increase in tooth mobility was observed 45 minutes after the periodontal ligament injection. No clinically observable pulpal or periodontal damage was seen at 3 weeks after the injection.

A prospective study of intrauterine insemination of processed sperm from men with oligoasthenospermia in superovulated women

The effectiveness of intrauterine insemination (IUI) was compared with that of intracervical insemination (ICI) in 49 infertile couples, in whom the major cause for infertility was oligoasthenospermia. All women had ovulation stimulated with either a clomiphene citrate (CC)-human gonadotropin combination or human gonadotropins alone. The ovulatory dose of human chorionic gonadotropin (hCG) was given after adequate estradiol levels were reached. The timing of inseminations was standardized--IUI was 28 hours after hCG and ICI was immediately after hCG administration. Only one insemination per month was performed with either IUI or ICI. The first treatment cycle was assigned randomly to be either IUI or ICI, and subsequent inseminations were alternated. A total of 182 cycles were completed, with 96 IUIs and 86 ICIs. Pregnancy occurred in eight patients, seven with IUI (14.3%) and one with ICI (2.0%); the difference is significant at P less than 0.05. The pregnancy rate per treatment cycle was 7.3% versus 1.2% (P less than 0.001). This study supports the use of IUI with processed sperm in the treatment of infertility due to oligoasthenospermia.

Treatment of nickel dermatitis with Trientine

23 nickel-sensitive patients with hand eczema were treated with Trientine 300 mg daily and a placebo in a double-blind, crossover trial. No significant improvement occurred in the hand eczema. A surprising finding was that there was no detectable increase in urinary nickel excretion, in contrast to animal studies.

Heterogeneity of Morquio disease

Further clinical heterogeneity of Morquio disease, mucopolysaccharidosis IV (MPS IV), is delineated by the observation of a 30-year-old man with unusually mild clinical manifestations. He is 156 cm tall, has comparatively mild skeletal abnormalities and fine corneal deposits. Keratosulfaturia is absent. N-Acetylgalactosamine-6-sulfate (GalNAc-6-S) sulfatase (E.C. 3.1.6.-) was markedly reduced in his fibroblasts. The residual enzyme activity exhibited a pH profile comparable to that of patients with the "classical" form of the disorder. From our observation and a review of the literature it is concluded that Morquio disease can be divided in several subgroups: besides the severe ("classical") type A there exist an intermediate and a mild form that are also caused by a GalNAc-6-S sulfatase deficiency. A late-onset variant of Morquio disease, which is due to a deficiency of beta-galactosidase, has been classified as type B. In addition, patients with mild manifestation of the disease and normal activities in fibroblasts of GalNAc-6-S sulfatase and beta-galactosidase have been observed (type C). The genetic nature of the broad clinical variability of Morquio disease is incompletely understood: it is partially caused by different enzyme defects. Other factors thought to influence the clinical expression include the pH profile of the residual enzyme activity and an additional neuraminidase defect.

[Ocular findings in Barsy syndrome]

Report on a male newborn with progeroid aspect, cutis laxa, intrauterine growth retardation, bilateral dislocation of the hip, generalized anomalies of ossification, peripheral corneal opacification comparable to corneal senile arcus, a diffuse, very discrete clouding of the stroma and an anterior polar cataract OD. Diagnosis and differential diagnosis of other progeroid and cutis laxa syndromes are discussed on the basis of the corresponding ocular findings.

Intralysosomal formation and metabolic fate of N-acetylglucosamine 6-sulfate from keratan sulfate

The physiological relevance of the ability of beta-N-acetylhexosaminidase A to liberate N-acetylglucosamine 6-sulfate from polymeric keratan sulfate was investigated. Upon intravenous injection into rats of [35S]sulfate-labeled proteokeratan sulfate up to 25% of the radioactivity excreted with the urine were identified as N-acetyl-glucosamine 6-sulfate. Within 24 h, however, excretion of inorganic sulfate rose at the expense of the sulfated monosaccharide. Upon incubation in vitro of liver lysosomes from rats treated with proteokeratan sulfate, inorganic sulfate and minor amounts of sulfated monosaccharide were found in the incubation fluid. Cultured rat peritoneal macrophages ingested proteokeratan sulfate with a clearance rate of 6-9 micrograms X h-1 X mg cell protein-1 and degraded it rapidly. Inorganic sulfate but not N-acetylglucosamine 6-sulfate was delivered to the culture medium. During a chase period the amount of intracellular N-acetylglucosamine 6-sulfate fell, and a corresponding amount of sulfate could be found extracellularly. Significant amount of N-acetylglucosamine 6-sulfate were only found in the culture medium when the cells were challenged with zymosan. These results suggest that N-acetylglucosamine 6-sulfate is a physiological intermediate during the degradation of keratan sulfate, but is usually hydrolyzed intralysosomally by N-acetylglucosamine-6-sulfate sulfatase. Genetic deficiency of the sulfatase in humans therefore results in excessive excretion of the sulfated amino sugar but not of keratan sulfate.

Immunity to herpes simplex virus: virus reactivation modulates lymphokine activity

Cell-mediated immunity to herpes simplex virus (HSV) was studied in patients with recurrent disease and in seropositive controls. Supernatants from cultures of peripheral blood mononuclear cells (PBLs) obtained during recrudescence (zero to three days after onset of lesions), convalescence (four to 14 days), and quiescence (greater than 14 days) were assayed for their ability to augment natural killer activity of normal PBLs against K562 target cells. Supernatants obtained during recrudescence, but not those obtained during convalescence, quiescence, or from seropositive controls, failed to augment natural killer activity but contained interferon and interleukin-2. Dialysis restored the ability of the supernatants to augment natural killer activity, and herpesvirus [UV-HSV-2(G)] stimulation of recrudescent PBLs in the presence of 2 X 10(6) M indomethacin abrogated suppression of natural killer-enhancing activity. However, similar levels of prostaglandin E were observed in supernatants of PBLs collected throughout the disease cycle from individuals with recurrent disease or from seropositive controls. The data suggest that reactivation of latent HSV is associated with the induction of a dialyzable factor(s) that interferes with interferon or interleukin-2-mediated natural killer enhancement or both. Prostaglandin E is necessary but insufficient for suppression of natural killer-enhancing activity.

Aversive and attractive marking of toxic and safe foods by Norway rats

The present series of studies was undertaken to investigate the hypothesis (von F. Steiniger, 1950, Zeitschrift für Tierpsychologie, 7, 356-379; K. A. Stierhoff, & M. Lavin, 1982, Behavioral and Neural Biology, 34, 180-189) that rats poisoned after eating a novel food will mark that novel food in such a way as to dissuade naive conspecifics from ingesting it. Our results provided no evidence of aversive marking of a novel food by rats poisoned after ingesting it. We did, however, find evidence of attractive marking of feeding sites by rats exploiting those sites. This attractive marking rendered exploited feeding sites more attractive to naive conspecifics than other portions of an enclosure that rats had visited. The present findings are consistent with the results of a number of experiments conducted in our laboratory over the last decade indicating that rats directly communicate learned food preferences, but not learned food aversions.

Neuraminidase deficiency presenting as non-immune hydrops fetalis

A newborn infant with oedema, ascites and hepatosplenomegaly is described. In ascites fluid foamy macrophages were found, in a liver biopsy cytoplasmic inclusions and membrane-bound vacuoles were seen. Furthermore the child excreted excessive amounts of sialic acid-rich oligosaccharides in the urine, and therefore a neurovisceral degenerative disorder was assumed. The diagnosis of sialidosis was confirmed by enzymatic assay in cultured fibroblasts, in which a complete deficiency of the lysosomal enzyme neuraminidase could be demonstrated. After recurrent septicaemias the child became dystrophic and died at the age of 6 months. Our case is compared with sialidosis observed by other authors, the wide phenotypic diversity within this biochemical defect is emphasised. The occurrence of hydrops fetalis in lysosomal storage diseases is discussed.

Biosynthesis of proteodermatan sulfate in cultured human fibroblasts

Biosynthesis and secretion of proteodermatan sulfate produced by cultured human skin fibroblasts were investigated employing immunological procedures. During an incubation period of 10 min in the presence of [3H]leucine, two core protein forms of Mr = 46,000 and 44,000, respectively, were synthesized. They were converted to mature proteodermatan sulfate with a half-time of approximately 12 min. Fifty per cent of total mature proteodermatan sulfate were found in the culture medium after a 35-min chase. Six to eight per cent remained associated with the cell layer after a chase of 6 h. In the presence of tunicamycin, fibroblasts synthesized a single core protein of Mr = 38,000 that was converted to mature proteodermatan sulfate and secreted with similar kinetics as the N-glycosylated species. Subtle differences in the molecular size of core proteins were noted when cell-associated and secreted proteodermatan sulfate were degraded with chondroitin ABC lyase, but core proteins free of N-linked oligosaccharides were identical. Labeling with [3H]mannose revealed that secreted proteodermatan sulfate contains two or three complex-type or two complex-type and one high-mannose-type N-linked oligosaccharide chains. The N-glycans are bound to a 21-kDa fragment of the core protein. After incubation in the presence of [3H]glucosamine, the [3H]galactosamine/[3H]glucosamine ratio was 3.76 and 3.30 for secreted and cell-associated proteodermatan sulfate, respectively. Evidence for the presence of O-linked oligosaccharides could not be obtained. Small amounts of core protein free of dermatan sulfate chains were secreted when the cultures were treated with p-nitrophenyl-beta-D-xyloside.

Special calcium appetite in laying hens

An experiment was conducted to study calcium appetite and dietary calcium level related to laying hen performance. The experiment consisted of three periods: pre-experimental, training, and experimental. A total of 80 commercial strain laying hens (58 weeks old) were divided into two groups. One group (20 birds) served as a control throughout the experiment and was fed 3.5% dietary calcium without a free-choice calcium supplement. The other 60 birds were randomly divided into 3 sets of 20 and were all fed 3.5% dietary calcium for a pre-experimental period (13 days) as an adaptation period to a new environment prior to a training period (5 weeks). Dietary calcium level was decreased by .5% each week through the 5th week (to 1% Ca) for all 60 hens during the training period. The birds were given access to a free-choice calcium supplement (calcium carbonate granules) during both the pre-experimental and training periods. This dietary regimen was used in an effort to allow all hens to adapt to a supplemental feeding program and be prepared or conditioned for sudden changes in dietary calcium level. At the end of the training period, the 3 sets of 20 hens were fed either 1, 3, or 5% dietary calcium and a free-choice calcium supplement for 6 weeks. As dietary calcium level was increased, there was a decrease in free-choice supplemental calcium intake; however, all birds (except controls) consumed very large amounts of calcium. The training procedure was successful: no hens rejected the supplement. Neither dietary calcium level nor total calcium intake affected feed intake.(ABSTRACT TRUNCATED AT 250 WORDS)

Dyggve-Melchior-Clausen syndrome: normal degradation of proteodermatan sulfate, proteokeratan sulfate and heparan sulfate

It had been suggested that Dyggve-Melchior-Clausen syndrome may be due to the deficiency of a specific sulfatase and/or a protease involved in proteoglycan degradation. The ability of Dyggve-Melchior-Clausen fibroblasts to endocytose and degrade 3H-leucine- and 35S-sulfate-labelled proteodermatan sulfate and 35S-sulfate-labelled proteokeratan sulfate, respectively, was therefore investigated. The turnover of cell-associated 35S-sulfate-labelled heparan sulfate was also followed. In all these experiments Dyggve-Melchior-Clausen fibroblasts behaved normally.

Disc oedema in association with Hunter's syndrome: ocular histopathological findings

The histopathology of the posterior half of one eye and the optic nerves of a man with Hunter's syndrome, who was known to have disc oedema without raised intracranial pressure for 11 years of his life, is reported. The possible pathogenesis of the disc oedema is discussed; an important contributory factor was the deposition of abnormal mucopolysaccharides within the sclera. This caused gross thickening of the sclera with compression of the optic nerve at the intrascleral level.

Abnormal proteodermatan sulfate in three patients with Coffin-Lowry syndrome

The properties of [35S]sulfate-labeled proteoglycans secreted by normal human skin fibroblasts were compared with those synthesized by fibroblasts from three patients with Coffin-Lowry syndrome. 60-80% of secreted radioactive macromolecules from normal fibroblasts were eluted from a Sepharose CL-4B column with a mean Kav-value of 0.56 (pool 2); 3-10% of the radioactivity appeared in the exclusion volume of the column (pool 1). In contrast, 17-60% of the proteoglycans from the patients were found in the void volume. The bulk of remaining material was eluted with a mean Kav-value of 0.47. Pool 2 glycan chains from two patients exhibited an increased hydrodynamic size. Pool 1 from normal cells contained predominantly a glucuronic acid-rich proteodermatan sulfate, iduronic acid amounting for approximately 20% of glucuronic acid. In the respective proteodermatan sulfate from the patients, the relative iduronic acid content was at least 33% of that of glucuronic acid. Pool 2 material of all cell lines was characterized predominantly as iduronic acid-rich proteodermatan sulfate. In the proteoglycans from two patients the content of chondroitin 4-sulfate-derived disaccharides was increased at the expense of 6-sulfated chondroitin disaccharides. Native proteoglycans from the patients were less efficiently endocytosed by fibroblasts than their normal counterparts. Coffin-Lowry fibroblasts had a normal capability to synthesize glycosaminoglycan chains on an artificial acceptor, p-nitrophenyl-beta-D-xyloside. They were also normal in 3'-phosphoadenylylsulfate: chondroitin 4- and 6-sulfotransferase activities.

Oral promethazine hydrochloride in ethylenediamine-sensitive patients

A study of 12 patients with allergic contact sensitivity to ethylenediamine has shown that exposure to the oral antihistamine promethazine hydrochloride (Phenergan) did not result in an exacerbation or recrudescence of eczema. This would suggest that promethazine may be safely administered to ethylenediamine-sensitive patients contrary to advice given in some of the dermatological literature.

Effect of percentage cut-off scores and scale point variation on preclinical project evaluation

Several modifications were introduced in a criterion-referenced evaluation system to determine which modification would result in optimal evaluator reliability and performance differentiation on two representative wax-up projects. Variables investigated included the use of percentages as cut-off scores and the number of scoring options. The use of percentage cut-off scores to define minimal competency significantly increased intrajudge reliability for one of the two projects. Two-option scoring resulted in significantly higher rater agreement than three-option scoring in half of the comparisons.

Heterogeneity of metatropic dysplasia

Metatropic dysplasia is a neonatally manifest entity that is characterized clinically by a rapidly progressing kyphoscoliosis leading to severe shortening of the originally long trunk ("metatropism"). Major radiographic features include flattening and defective ossification of the vertebral bodies, a narrow thorax and a marked hypoplasia of the basilar portions of the ilia with crescent-shaped iliac crests. There is some evidence of genetic heterogeneity. From five personal observations and from a review of the literature we conclude that metatropic dysplasia comprises at least three genetic entities: (1) a nonlethal type with autosomal recessive transmission; (2) a nonlethal dominant type and (3) a lethal type with death before or shortly after birth and possibly autosomal recessive inheritance. A careful clinical and radiologic analysis permits their classification and differentiation from similar, not yet well-delineated disorders. Attention is also drawn to the possibility of atlanto-axial instability in metatropic dysplasia which may cause severe neurologic defects.

Detection of an antigen on the inner surface of Rh negative erythrocytes which binds anti-D IgG

Previous investigation have demonstrated the presence of the Rho(D) antigen in Rh negative erythrocytes. The intact Rh negative cell, however, does not bind anti-D IgG. Presently we have shown that an anti-D binding antigen resides on the cytoplasmic surface of Rh negative erythrocyte membranes. Unsealed Rh negative membranes, in which both the inner and outer surface are exposed, bind anti-D IgG. Dicyclohexylcarbodiimide specifically blocked the binding of anti-D IgG to these membranes. Sealed Rh negative membranes which expose only their external surface, failed to bind anti-D antiserum. These results were confirmed by proteolytic digestion of membrane preparations and subsequent Rho(D) antigen purification. Only when protease had access to the inner surface of Rh negative erythrocyte membranes did degradation of this 'D' antigen occur. Thus, intact Rh negative erythrocytes contain an antigen which binds anti-D antibody but is located on the inner surface of the membrane. In contrast, Rh positive erythrocytes expose Rho(D) antigen on the external surface of the membrane.

Papilloedema in association with Hunter's syndrome

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Antiviral and anti-invasive titers of human interferons

The titers of preparations of human leukocyte and human fibroblast interferon were examined to determine their antiviral and anti-invasive activity. The examinations showed a very high correlation of these activities in human fibroblast interferon (r = 0.99), whereas the correlation for human leukocyte interferon was lower. These two interferons have also been found to differ in the relation between antiviral and anti-invasive titers. This difference is highly significant (p less than 0.001).