Differences in the effects (in vitro) of ethylenediamine on the guinea-pig and rat intestine

The effects of ethylenediamine in different regions of the rat and guinea-pig small intestine were investigated pharmacologically using isolated gut-bath preparations. In the guinea-pig, ethylenediamine caused concentration-dependent neurally mediated contractions or biphasic responses (contraction followed by relaxation). The contractions could be prevented by muscarinic and GABAA receptor antagonists. Ethylenediamine-evoked relaxations and depression of electrically evoked cholinergic twitch responses were blocked by desensitization to baclofen. However, in the rat intestine, the primary response to applied ethylenediamine was a concentration-dependent, non-desensitizing relaxation, evidently due to a direct action of ethylenediamine on the muscularis since it was unaffected by tetrodotoxin or GABAergic blockade.

Uterine unification procedures: post-operative obstetrical outcome

Seventeen patients with different uterine anomalies underwent unification procedures for various indications. Preoperative obstetrical performance segregated them into three main groups: seven patients had only first trimester abortion (group A), seven patients had second trimester abortion with or without first trimester abortion (group B) and three patients were infertile (group C). Postoperatively, all seven patients in group A became pregnant with 100% viable pregnancy rate. Six patients in group B became pregnant (85.7%) and five (57%) had living children. All three patients with primary infertility (group C) became pregnant and two had living babies. The overall pregnancy rate was 94.1% and the viable pregnancy rate was 76.5%. Uterine unification procedures are recommended for patients with repeated first trimester abortions as well as for selected patients with infertility.

Intraocular lens power calculations in the triple procedure

When a triple procedure is planned, calculation of the intraocular lens becomes a problem. Postoperative corneal power bears no relation to preoperative power, and the axial length of the globe also changes. A prospective study of 24 keratoplasties revealed a close relationship between postoperative corneal power and donor corneal power. Changes in axial length were found to be too small to produce errors in calculation. The equation derived in this series to describe the relation between postoperative and donor corneal power is applicable only when certain trephine sizes are used and when the recepient cornea is not excessively scarred.

Acute arsenic toxicity--an opaque poison

We report a patient with fatal acute arsenic poisoning presenting as vomiting and diarrhea with the finding of intra-abdominal radiopacities on radiographs. These represent the classic features of acute arsenic toxicity and are detailed here as a reminder to others facing a similar puzzling patient with this potentially treatable poisoning.

Genetically determined hypercholesterolemia in a rhesus monkey family due to a deficiency of the LDL receptor

A family of rhesus monkeys comprising a sire, a dam, and four male offspring were fed a cholesterol-free Purina Chow diet for several months. The sire, 431-J, and two of the offspring, B-8204 and B-8806, had persistent plasma cholesterol levels in the range of 100-130 mg/dl, whereas the dam, 766-I, and the two other offspring, B-1000 and B-7643, exhibited a marked hypercholesterolemia in the 250-300 mg/dl range associated with an elevation of plasma LDL and apoB. When fed for 12 weeks a diet containing 12.5% lard and 0.25% cholesterol, sire, dam, B-1000 and B-7643 exhibited a marked hypercholesterolemia (500-800 mg/dl range), whereas B-8204 and B-8806 developed only a modest hypercholesterolemia (200-250 mg/dl). All animals were Lp[a]+. Skin fibroblasts from each animal and from control cells were grown in 10% fetal calf serum, transferred to 10% lipoprotein-deficient serum for 48 hr, and then incubated at 4 degrees C or 37 degrees C with 125I-labeled Lp[a]-free LDL. The fibroblasts from dam and offspring B-1000 and B-7643 bound and internalized 125I-labeled LDL less efficiently than control cells. Mathematical analyses of the 4 degrees C binding data indicated that there were no significant differences in LDL binding affinity between test and control cells suggesting that cells from the animals with a spontaneous hypercholesterolemia had a decreased number of LDL receptors. This conclusion was supported by the results of ligand and immunoblot analyses carried out on cell lysates separated by gradient gel electrophoresis. We conclude that a genetically determined LDL receptor deficiency was responsible, in part, for the spontaneous hypercholesterolemia observed in three out of the six family members and that this deficiency accounted for the hyperresponsiveness to a dietary fat and cholesterol challenge by the dam and the two offspring, B-1000 and B-7643. The hyperresponsiveness noted in the sire that had no evidence for LDL-receptor deficiency illustrates that factors other than the LDL receptor were responsible for the hypercholesterolemia attending the fat challenge.

Affinity of nonhomologous amphiphilic peptides toward a monoclonal antibody raised against apolipoprotein A-I

Monoclonal antibodies against human apolipoprotein A-I (apoA-I) were generated by the hybridoma technique. Clone G-10 was selected on the basis of its highest titer. The affinity of this antibody toward a series of synthetic peptides differing in length, amino acid composition, and amphiphilicity was tested by using both the indirect and the competitive enzyme-linked immunosorbent techniques (ELISA). From these measurements we calculated dissociation constants of the complexes of the antibody with apoA-I bound to the surface of the microtiter plate, apoA-I in solution, and any of the several peptides in solution. The dissociation constant (Kd) of the immobilized apoA-I/anti-apoA-I-complex, Kd = 2 x 10(-9) M, was significantly lower than that of the complex resulting from the interaction between anti-apoA-I and either apoA-I in solution or any of the several amphiphilic helical peptides in solution. Peptides devoid of amphiphilic secondary structure were inert. These data are consistent with the proposal that monoclonal G-10 recognizes in antigenic peptides an alpha-helical secondary structure of defined hydrophilic-lipophilic balance and comparatively less the specific amino acid side chains. We propose that the highest contribution to the free energy of binding (8 Kcal/mole) is derived from the docking of the helix to the antibody. It follows that in probing the specificity of a monoclonal antibody the conformation and the physical environment of the interacting antigen must be taken into account.

Antigenic relatedness between human lecithin-cholesterol acyltransferase and phospholipases of the A2 family

A monoclonal antibody, B10, generated against pure human lecithin-cholesterol acyltransferase (EC 2.3.1.43) caused the inhibition of the esterolytic and cholesterol esterifying activities of the enzyme. This antibody also reacted with a number of pancreatic and snake venom phospholipases A2 species but not phospholipase A1. A concentration-dependent inhibition of phospholipase A2 was also seen in the presence of B10. Treatment of lecithin-cholesterol acyltransferase or B10-reacting phospholipases with phenacyl bromide, a reagent known to interact with the active site of phospholipase A2, inhibited both their esterolytic activity and their capacity to bind to B10. A dimeric phospholipase A2 species with a known occluded active site did not cross-react with B10. Thus, lecithin-cholesterol acyltransferase and some enzymes of the phospholipase A2 family share a common antigenic determinant which is probably located near or at their esterolytic active site.

Hepatic angiosarcoma among Egyptian farmers exposed to pesticides

A greatly increased incidence of hepatic angiosarcoma (H.A.S.) among Egyptian farmers involved in pest-control spraying operations attracted our attention. Fourteen patients were diagnosed at Ain Shams University Hospital between the years 1980-1984 as having H.A.S. Eleven were males and 3 females with an average age of 49 years, and a male:female ratio of 3.8:1. Eleven patients reside in Lower Egypt and 3 in Upper Egypt. Ten out of the 14 patients had a definite history of a direct chronic recurrent exposure to agricultural pesticides of variable chemical nature, throughout the year. The period of exposure ranged from 11-20 years with an average of 14 years. The other 4 patients had no history of exposure to any of the known carcinogenic factors. This significant increase in angiosarcoma among farmers involved in pesticide spraying suggests that agricultural pesticides might play a role in the genesis of H.A.S. in Egypt.

Prolactinoma and adrenal androgens

Theories about the relationship between hyperprolactinemia and hyperandrogenism are conflicting. Several reports assert that prolactin affects the delta 5 and delta 4 pathways through its effect on the activity of 3beta-hydroxysteroid dehydrogenase (3beta-OHSD). We measured delta 5 and delta 4 steroids, prolactin and cortisol in 18 amenorrheic, hyperprolactinemic women before and after resection of prolactinomas. Similar determinations of delta 5: delta 4 steroids were made in a control group of five women. The ratios of individual delta 5: delta 4 steroids were also analyzed. Our results support a modification of delta 5, delta 4 pathways through an effect on the rate-limiting enzyme 3 beta-OHSD. In hyperprolactinemic women the differences between the preoperative and postoperative steroid levels were significant. Further, since the androgens decreased irrespective of the prolactin following surgery, there probably is a factor other than ACTH and prolactin modulating the adrenal androgens.

Spontaneous secretion of thyroid autoantibodies by cultured peripheral blood lymphocytes from patients with Hashimoto's thyroiditis detected by micro-ELISA techniques

The spontaneous in vitro production of anti-thyroglobulin (aTg) and anti-microsomal (aM) antibodies by mononuclear cells (MNC) from patients with Hashimoto's thyroiditis (HT) was analysed by an ELISA detection system. MNC from 35 HT patients spontaneously produced detectable levels of both autoantibodies in vitro (i.e., without mitogenic or antigenic stimulation). aTg was quantified using a reference aTg IgG standard and ranged from 55 to 9,000 ng aTg. Specificity of aTg by ELISA was assessed using heterologous Tg antigen (Ag). Microsomal Ag obtained by gel filtration was far less contaminated with Tg than the ultracentrifugation pellet. Specificity of aM ELISA was assessed using insulinoma membrane as unrelated Ag and by blocking aM detection only with microsomal Ag. aM levels in the 35 supernatants ranged from 0.1 to 1.12 OD. A direct correlation was found between aM serum titres detected by haemagglutination and in vitro aM spontaneous production, but not for aTg. This lack of correlation for aTg might have biological relevance. Tg restimulation in vitro enhanced aTg production in only four out of 18 cases, of which only one was significant. This system provides a tool for studies of the immunoregulation of thyroid autoantibody formation in vitro.

Pituitary thyrotroph hyperplasia mimicking prolactin-secreting adenoma

A 32-year-old woman with persistent postpartum galactorrhea, hyperprolactinemia and a sellar configuration compatible with pituitary adenoma underwent transsphenoidal surgery. Mild hyperthyroidism had been suspected clinically preoperatively and thyroxine plus cortisol therapy was given. Morphological features of pituitary thyrotroph hyperplasia were present as shown by light microscopy, immunoperoxidase staining and electron microscopy. The thyrotroph hyperplasia was secondary to primary hypothyroidism as demonstrated by the TSH response to TRH stimulation and subsequent suppression with thyroid hormone treatment. Although prolonged severe hypothyroidism has been reported to cause pituitary enlargement, this is the first case of thyrotroph hyperplasia with detailed morphologic study of the surgically-removed adenohypophysial tissue. The presentation of this patient calls attention to the possibility of mistaking pituitary enlargement due to primary hypothyroidism for a prolactinoma.

Ultrasonography as a new important potential in improving family planning service

Population control in developing countries is a very significant and pressing problem. Therefore improving family planning service is mandatory. Four gynaecologists from four major hospitals in Egypt express their experiences and their uniform agreement about the improvement in family planning services through ultrasonography in both free hospital and private patients.

[Ankylosing spondylitis and amyloidosis. Apropos of 2 cases]

The authors report 2 cases of ankylosing spondylitis complicated by amyloidosis. In the first case, the development of a nephrotic syndrome in a long-standing case of spondylitis (16 years) led to discovery of the amyloid. In the second case, a nephrotic syndrome appeared in a 38 year old man with a three year history of ankylosing spondylitis. In both cases, the amyloidosis was confirmed on histological examination.

A simple diagnostic culture method for use in a tuberculosis control programme

A simple, widely applicable method for the culture of tubercle bacilli was compared with the classical standard method in a controlled trial on 500 specimens. The method consisted of treating sputum samples with a detergent-alkali mixture, and inoculating this on to buffered medium. The technique was found to be as sensitive as the standard method for the isolation of tubercle bacilli, and also to reduce contamination rates. Consistent results were obtained in 10 026 routine specimens, confirming the diagnosis for 86.4% of the new patients within 3 weeks. Cultures were not affected by delayed incubation.

Tumor-necrotizing serum production by administration of BCG + Pseudomonas: its application in treatment of fibrosarcoma in mice

A Pseudomonas aeruginosa (i.v.) treatment (10(8) killed organisms) has shown the capacity to induce the release of tumor-necrotizing factor in the serum of BCG-pretreated mice to the same extent as an LPS treatment. Lower doses of P. aeruginosa (10(7) killed organisms) were applied in BCG-pretreated mice (1 mg given IV 7 days prior to or 1 day after tumor graft) bearing a methylcholanthrene-induced fibrosarcoma. In both cases this combined treatment significantly delayed tumor growth without a toxic side effect.

Comparative study of the histologic reactions to intravenous injections of heat-killed Pseudomonas aeruginosa and of BCG

Intravenous injection (i.v.) of heat-killed Pseudomonas aeruginosa in mice produced histologic changes in the thymic cortex, some of which resembled, while others differed from, those produced by i.v. injection of living BCG. The changes that were similar consisted of pyroninophilia of cortical lymphocytes and hyperplasia of epithelial cells in the medulla and at the corticomedullary junction with increased PAS positive cells and secretions. Major differences, however, in the sequence and nature of the histologic events were observed. Pseudomonas injections produced thymic epithelial cell hyperplasia with increased PAS positive cells and secretions and pyroninophilia of thymic cortical lymphocytes earlier than did i.v. BCG (day 1 versus day 7). Corticomedullary inversion of thymic structure and early transient hyperplasia of the thymus dependent areas in the lymph nodes and spleen occurred after Pseudomonas but not after BCG injections. Hyperplasia in the B cell areas and germinal centers started to appear at day 10 after injection of Pseudomonas and persisted up to day 21 (compared to day 7 and day 14, respectively, for BCG). In contrast to i.v. BCG, Pseudomonas injections did not produce granulomas or macrophage proliferations.

Histopathologic sequence of events in adult mice undergoing lethal graft-versus-host reaction developed across H-2 and/or non-H-2 histocompatibility barriers

The sequence of histologic events in graft-versus-host reaction (GVHR) caused by major and/or minor histoincompatibilities was studied. It was discovered that GVHR may manifest itself in the form of two distinct multiphasic disease entities, depending on whether the donor cells are incompatible with the host for both major and minor histocompatibility antigens ("major GVHR") or for minor histocompatibility antigens alone ("minor GVHR"). The acute or major GVHR has four phases: 1) a transient phase of aplasia, 2) a repopulation phase, 3) a proliferative phase involving lymphoid, presumably immunocompetent, cells, and 4) a phase of acute organ rejection (terminal). The chronic or minor GVHR is characterized by six phases, namely: 1) a transient phase of aplasia, 2) a repopulation phase, 3) a phase of proliferation and tissue infiltration by lymphoid, presumably immunocompetent cells, 4) a phase of major immunologic injuries, 5) a phase of repair, and 6)a terminal phase with advanced sclerosis and proliferative glomerulonephritis. In acute or major GVHR the disease was manifested by the tissue reactions characteristic of acute organ rejection. Lesions were seen in the kidney, liver, bone marrow, lymph nodes, spleen, thymus, intestine, and skin. In the chronic or minor GVHR, tissue injuries were more widespread, affecting the collagen, vessel walls, adipose tissue, renal glomeruli, heart muscle, fascias of skeletal muscles, lymph nodes, spleen, thymus, bone marrow, intestine, skin, esophageal mucosa, and urinary tract. A pronounced plasma cell proliferation was a striking feature in the minor GVHR. Its evolution coincided with advanced thymic epithelial atrophy. It is suggested that the destruction of thymic epithelium resulted in depletion of suppressor T cells and, consequently, in an unopposed proliferation of plasma cells.

Impact of anti-tuberculosis legislation in Libya on the prevalence of primary and acquired resistance to the three main drugs at a majortuberculosis centre

The effect of legislative actions taken in 1973 on the prevalence of primary and acquired drug resistance was studied from the records on the Regional Tuberculosis and Chest Diseases Centre in Benghazi during the period June 1971 to August 1976. There were available for analysis 771 culture-positive cases of newly diagnosed pulmonary tuberculosis in Libyan nationals, and 789 cases of both Libyan nationals and others with positive cultures during treatment. The legislative actions included screening of all foreign and local workers for tuberculosis before employment or in the course of employement for those already employed and strict control of the use of antituberculosis drugs, which were not made available to private practitioners, private pharmacies, general dispensaries and general hospitals. The proportion of newly diagnosed cases with resistance to one or more of the 3 drugs streptomycin, isoniazid, PAS (resistance to PAS was negligible, occurring in only 0.7% of the whole series) during the first 3 months of the survey was 16.6%. During the first 9 3-month periods there was a small decrease of 0.15% per quarter. However, after adoption of the antituberculosis measures in mid-1973 the rate of decline accelerated to 0.61% per quarter, a 4-fold increase over the earlier rates (P less than 0.001 for comparison of rates). If the rate of decline observed in the first 9 quarters had continued unchanged the expected proportion resistant at the end of the period would have been 13.5%, compared with the observed proportion of 8.6%. The proportion of patients under treatment from whom resistant cultures were isolated was 33.3% in the first quarter. It remained at about this level until the 14th quarter, approximately a year after the legislation came into force, when the proportion began to decline. By the end of the period it was only 14.7%.

Surgical pathology of schistosomal obstructive uropathy: a clinicopathologic correlation

Schistosomal obstructive uropathy was studied by clinical, laboratory epidemiologic and pathologic analysis in 155 Egyptian patients treated surgically. Most patients were men; rural farmers or laborers. All had severe urinary schistosomiasis with heavy burdens of Schistosoma haematobium eggs in their urinary tracts. Schistosomal incomplete ureteral stenosis and schistosomal stenosis with ureterolithiasis were the most important obstructive lesions; these lesions were symmetrical and most frequent in the interstitial ureters decreasing proximally. The pathogenesis of these lesions is dependent upon focal destruction of ureteral muscle. The ureteral lesions proximal and consequent to schistosomal obstructive lesions are hydroureters resulting from active dilatation (due to increased hydrostatic pressure consequent to obstruction) and passive dilatation (due to loss of circular muscle action in sites of oviposition in the proximal ureter). Various combinations of these lesions with superimposed effects of bacterial infection and ureterolithiasis produce the spectrum of ureteral lesions attributable to urinary schistosomiasis.

Schistosomal ulceration of the urinary bladder

Clinical, anatomic and digestion studies were done in 91 surgically treated cases of bladder ulceration in Egyptian patients with urinary schistosomiasis. Most patients were rural male farmers; their mean age was 29 years. Symptoms were similar to uncomplicated urinary schistosomiasis except for suprapubic or perineal pain. Two clinicopathologic entities were noted: 1) sloughing of polypoid patches in early active disease; and 2) chronic schistosomal ulceration of the bladder occurring at sites of very heavy Schistosoma haematobium egg burdens. The gross appearance, location, size and shape are described. The cost of treatment and duration of hospitalization are noted.

The effects of certain immunity systemic advuvants, PHA, and human gamma globulin on the thymic cortex of mice: a light and electron microscope study

Thymus of (C57Bl/6 x DBA/2) F1 mice was examined histologically, histochemically and ultrastructurally, seven days after intravenous injection of BCG, pertussis vaccine, lipopolysaccharide or human gamma globulin, or intraperitoneal injection of complete or incomplete Freund's adjuvants or of phytohemagglutinin. Only BCG induced a marked increase of the secretory activity of the thymic epithelium at all histological sites (cortex, corticomedullary junction and medullar). Only with this adjuvant was the epithelial hyperplasia associated with marked mitotic activity and high percentage of cells with cytoplasmic pyroninophilia among cortical lymphoid cells. The other substances tested produced different changes in the thymic epithelial cells according to the histologic zones. These results suggest that the epithelial cells of the cortex, the corticomedullary junction and the medulla respond differently to the agents tested and that the action of these substances upon thymus-dependent lymphoid cells may be indirect perhaps involving factors secreted by the epithelial cells.

The effect of desert conditions on the reactivity of Libyan schoolchildren to a range of new tuberculins

This study was carried out to investigate the effect of desert conditions on the pattern of delayed hypersensitivity to mycobacteria in school children aged 6-10 and 11-18 years. A new range of tuberculins prepared from ultrasonic lysates of living mycobacteria belonging to 12 different species was employed. Three centres were chosen for study, a sea port and two desert towns differing greatly from each other. The results obtained were compared with those of a previous study using the same reagents in Kenya. As expected both the range of mycobacterial species to which the children reacted, the rate of acquisition of specific hypersensitivity with age and the total percentage of children reacting to individual reagents differed from centre to centre. The harsh desert conditions of Ajdabia produced the least, and the proximity of the people's dwellings to those of their farm animals in Kufra produced the most positive reactors to essentially environmental species. The greatest number of reactions to our Tuberculin were found in Benghazi where the cosmopolitan urban conditions probably lead to a high contact with open cases of tuberculosis. As assessed by skin test reactivity, immunization with BCG in Libya was much less effective than in Kenya. The interpretation of the differences between the results from the different test centres and between those for Libya and Kenya are discussed.