Pulsed and continuous Doppler evaluation of renal dysfunction after kidney transplantation

Seventy-eight recipients, average age 36 years, of cadaver kidneys were studied to evaluate the usefulness of Doppler ultrasonography for diagnosis of common complications in renal transplant patients. The patients were divided in five groups: Control (normal renal function), acute rejection (AR), acute tubular necrosis (ATN), obstructive uropathy (OU) and pathological vasculature (PV); renal artery stenosis (RAS) and renal artery thrombosis (RAT). Pulsed Doppler ultrasonography (PDUS) was an effective method to diagnose RAS and RAT, but did not sufficiently differentiate between AR and ATN. Despite this, PDUS may be useful for follow-up of renal transplant patients as specific changes in the PDUS curves or differences in successively recorded patterns indicate abnormality, which may initiate more specific diagnostic methods.

hemofiltration reverses left ventricular dysfunction during sepsis in dogs

Depressed left ventricular (LV) contractility in sepsis has been ascribed to the presence of circulating cardiodepressant substance (filterable cardiodepressant factor in sepsis [FCS]); however, this finding is controversial. The authors hypothesized that if a decrease in LV contractility indeed occurred due to a circulating depressant substance, then removal of this substance by hemofiltration would reverse by dysfunction. In this study, LV mechanics were examined before and after hemofiltration in anesthetized dogs during continuous intravenous infusion of live Escherichia coli. Left ventricular anterior-posterior and apex-base dimensions were measured by subendocardial ultrasonic crystal transducers implanted 4 weeks before the experiments. Left ventricular contractility was determined from the end-systolic pressure-dimension relationship. The slope of this relationship (Emax) is an index of contractility. After 4 h of sepsis, Emax was reduced by one half. Hemofiltration resulted in a return of Emax to control values. The FCS activity in the plasma was also assessed by the percent reduction in isometric contraction of electrically stimulated, isolated right ventricular trabeculae obtained from nonseptic dogs. The FCS activity reached a peak 4 h after sepsis and was reduced after 2 h of hemofiltration. The results show that during experimental sepsis, a circulating substance of less than 30,000 d produces a decrease in LV contractility and that this LV dysfunction may be improved by hemofiltration.

Insensitivity of maximum expiratory flow to bronchodilation in normal dogs

We examined the effects of the inhaled parasympatholytic agent atropine and the sympathomimetic agent salbutamol on partitioned frictional pressure (Pfr) losses to the site of flow limitation (choke point, CP) in dogs to see how changes brought about by these agents would affect maximum expiratory flow (Vmax) and response to breathing 80% He-20% O2 (delta Vmax) in terms of wave-speed theory of flow limitation. In open-chest dogs, a Pitot-static tube was advanced down the right lower lobe to locate CP, to determine CP lateral and end-on pressures (PE), and to partition the airway into peripheral (alveoli to sublobar) and central (sublobar to CP) segments. Measurements were obtained at approximately 50% vital capacity. After inhalation, CP locations were unchanged with both bronchodilating agents. After atropine inhalation, Pfr central was decreased by one-half compared with base line. Despite the decrease in Pfr central, however, Vmax failed to increase after atropine because of altered bronchial area pressure (BAP) behavior at the CP site. After salbutamol inhalation, Pfr peripheral was reduced by about one-half compared with base line. However, Vmax failed to increase, because this reduction was too small to significantly increase the CP pressure head (i.e., PE). delta Vmax was also insensitive to these agents. Our results show mechanisms by which small changes in Pfr, as well as the complex interaction of changes in Pfr and BAP, may limit the use of Vmax in detecting bronchodilation at different airway sites.

Chronic intoxication by heroin; histopathological effects on seminiferous tubules

Seminiferous tubules from heroin abusers and from rats chronically intoxicated by heroin samples presented a striking reduction in the thickness of the germinal epithelium. Light and electron microscopical studies showed a considerable increase of lipids and phagosomes in Sertoli cells, disorganization of their junction complexes, detachment of immature germ cells which appeared free in the tubular lumen, and formation of giant multinucleate spermatids. These alterations point out that Sertoli cells could be the target element for the toxic effect of heroin samples on the seminiferous epithelium.

Flow changes in hepatic veins in congestive cardiac insufficiency. A study using pulsed Doppler US

Ten patients with right heart failure and tricuspid regurgitation were studied with both B Scan and pulsed Doppler ultrasound. Variations in the Doppler waveforms were seen in portal vein recordings which indicated flow characteristics similar to those of hepatic veins due to transmission of retrograde pressure waves through the hepatic capillary bed. It was concluded that the pulsed Doppler will permit non-invasive determination of physiological events that may have great practical importance in the diagnosis and treatment of patients with right heart failure.

Epidural neurostimulation in the treatment of frostbite

Epidural spinal cord stimulation (SCS) and conventional treatment produced good therapeutic effects in four young patients with frostbite of the lower limbs. The mechanism of action is unknown but the treatment resulted in rapid recovery with reduced pain and a more peripheral level of amputation. These preliminary results warrant further studies of SCS in the treatment of frostbite.

Role of different lymphocyte subsets in human anti-viral T cell cultures

We have systematically studied uncloned human cell lines derived from anti-influenza A virus or anti-Epstein-Barr virus (EBV) bulk cultures, or from cultures highly enriched for CD4+ or CD8+ lymphocytes. The most noteworthy results are the following: (1) Anti-viral bulk cultures consisted of more than 90% of CD8+ cells in all cases. In contrast, anti-HLA cell lines are composed of approximately 50% CD8+ and 50% CD4+ cells. All of the CD8+ and CD4+ cells present in the culture were also 4B4+/2H4-. (2) In anti-viral bulk cultures, the cytolytic activity was restricted by HLA class I molecules and almost exclusively through a single HLA class I molecule. (3) Positively or negatively selected CD8+ lines showed the same restriction pattern. They grew less efficiently than bulk cultures but could be maintained in the absence of CD4+ cells. The CD4+ cells were however necessary at the beginning of the culture for the development of cytolytic anti-influenza virus CD8+ cells, whereas they were not required for the development of cytolytic anti-EBV CD8+ cells. (4) The CD4+ cell lines grew more actively than bulk cultures. A cytolytic activity for virus-infected cells was constantly detected in these culture from the third passage onward and it was always restricted by HLA class II molecules. This activity was maintained throughout the culture period. However, class II-restricted cytolytic cells were not detected during primary or secondary responses in vitro.

Diltiazem enhances gentamicin nephrotoxicity in rats

The effect of the calcium antagonist, diltiazem, was examined in gentamicin-induced nephrotoxicity states in rats. Animals were injected for 5 days with diltiazem intraperitoneally (40 mg/kg/day), or gentamicin subcutaneously (100 mg/kg/day) or simultaneously with both preparations using the same doses. At the time of sacrifice, the urea and creatinine clearances, as well as urine osmolality were determined and the renal tissues were processed for examination by light microscopy. Gentamicin-injected rats demonstrated the typical pattern of aminoglycoside nephrotoxicity characterized by poliuric renal failure and necrosis of the proximal tubular epithelium. Rats injected with diltiazem revealed only mild depression of urine osmolality. There was no elevation of blood urea nitrogen and serum creatinine or depression of urea and creatinine clearances, and no focal tubular cell necrosis was detected. However, concomitant administration of both compounds considerably increased nephrotoxicity by according both histological indications and renal function measurements. Thus, we conclude that the combination of diltiazem and gentamicin must be used carefully in human clinical practice.

A virus-specific CD4+ cell-mediated cytolytic activity revealed by CD8+ cell elimination regularly develops in uncloned human antiviral cell lines

Antiviral HLA class II-restricted cytotoxic CD4+ clones have been relatively well characterized in vitro but their significance in the immune response remains unknown. Here anti-influenza A and anti-EBV CD4+ CTL have been studied by using permanent cell lines either untreated or depleted of CD8+ cells. In bulk cultures, HLA class I-restricted anti-viral CD8+ CTL account for all of the detectable killer cell activity, whereas after elimination of CD8+ cells an HLA class II-restricted killer activity mediated by CD4+/2H4-/4B4+ cells was consistently observed. The CD4+ CTL were fully differentiated in all of the cultures tested from the third in vitro passage because they could be demonstrated immediately after elimination of CD8+ cells. These CD4+ killer cells were equivalent to the CD8+ cells in terms of their lytic capacity. The absence of any class II-restricted antiviral activity in bulk cultures seems to be related to the very small numbers of CD4+ cells present in these antiviral cell lines. However, CD4+ cytolytic activity could not be detected during the first two in vitro passages, even when limiting dilution analysis of the CTL precursors were performed, showing that the killer function of Th cells differentiate only after several in vitro stimulations.

Tungsten and molybdenum heteropolyacids as staining and contrasting agents: reactivity with epoxyresin-embedded cell and tissue structures

In this work, we carry out a further approach to the knowledge of the reaction mechanism of phosphotungstic and phosphomolybdic acids (PTA and PMA), as well as some derivatives, with cell structures from epoxyresin-embedded materials. Applied on thin sections from glutaraldehyde-fixed tissues, PTA and PMA induced a strong electron contrasting reaction in spermatid acrosomes, goblet cell mucin, callose and plant cell walls, endexine, intine and starch granules. In light microscopy, the localization of heteropolyacids on these structures was achieved by treatments of semithin sections with suitable reducing agents (titanous sulfate, stannous chloride, sodium borohydride, or p-phenylenediamine) to form the mixed-valence heteropolyblues, or with Schiffs's reagent. The use of PTA-dye complexes (pyronin-PTA and Mallory's PTA-hematoxylin) also showed the same staining pattern. Taking into account the chemical characteristics of the PTA- and PMA-reactive tissue elements, the present results indicate that heteropolyacids selectively enter into the highest hydrophilic structures from non-polar epoxy-embedded sections; after brief washing, they appear predominantly retained in tissue structures containing a great amount of carbohydrate components.

A virus-specific CD4+ cell-mediated cytolytic activity revealed by CD8+ cell elimination regularly develops in uncloned human antiviral cell lines

Antiviral HLA class II-restricted cytotoxic CD4+ clones have been relatively well characterized in vitro but their significance in the immune response remains unknown. Here anti-influenza A and anti-EBV CD4+ CTL have been studied by using permanent cell lines either untreated or depleted of CD8+ cells. In bulk cultures, HLA class I-restricted anti-viral CD8+ CTL account for all of the detectable killer cell activity, whereas after elimination of CD8+ cells an HLA class II-restricted killer activity mediated by CD4+/2H4-/4B4+ cells was consistently observed. The CD4+ CTL were fully differentiated in all of the cultures tested from the third in vitro passage because they could be demonstrated immediately after elimination of CD8+ cells. These CD4+ killer cells were equivalent to the CD8+ cells in terms of their lytic capacity. The absence of any class II-restricted antiviral activity in bulk cultures seems to be related to the very small numbers of CD4+ cells present in these antiviral cell lines. However, CD4+ cytolytic activity could not be detected during the first two in vitro passages, even when limiting dilution analysis of the CTL precursors were performed, showing that the killer function of Th cells differentiate only after several in vitro stimulations.

Aminophylline has little positive inotropic effect and a slightly negative diastolic effect on the left ventricle during hypoxic conditions in dogs

We examined the effect of aminophylline on left ventricular (LV) mechanics and central hemodynamics under normoxic and hypoxic conditions in respective groups of dogs. In an open-chest preparation, LV end-systolic and diastolic dimensions were measured with ultrasonic crystal transducers seated subendocardially along the anterior to posterior and apex to base axes. In the group studied during hypoxia, measurements were obtained during 3 conditions: normoxia; hypoxia to a PO2 of 30 mm Hg; and during hypoxia when aminophylline was infused to a blood level of about 15 mg/L. In the group studied under normoxic conditions, measurements were initially obtained during normoxia after which aminophylline was also infused to a blood level of 15 mg/L. Intravascular volume was given or removed to maintain LV filling pressures at about 10 mm Hg during all conditions. In the normoxic group, aminophylline caused an increase in stroke volume (SV) and had a positive inotropic effect on the LV. End-systolic dimensions were reduced, while end-diastolic dimensions did not change with aminophylline. On the other hand, under hypoxic conditions, aminophylline did not have a positive inotropic effect: SV did not increase and end-systolic dimensions remained unchanged. Under hypoxic conditions, moreover, aminophylline caused a slight decrease in end-diastolic dimensions by augmenting hypoxia-induced increases in myocardial resting tension. Our results indicate that unlike normoxic conditions, aminophylline may have little beneficial effect on LV performance during hypoxic conditions.

Expiratory flow limitation in dogs with regional changes in lung mechanical properties

We examined maximum expiratory flow (Vmax) in two canine preparations in which regional changes in lung mechanical properties were produced. In one experiment serial bronchial obstructions were made to determine whether flow-limiting sites (choke points, CP) would occur in series. With the right lung tied off, constrictions were placed at the left lower lobar bronchus (LLL) and left main-stem bronchus. On deflation from total lung capacity, the obstructed LLL and nonobstructed left upper lobe (LUL) emptied into the obstructed left main-stem bronchus. Although a CP common to both lobes was identified at the main-stem obstruction, which limited total Vmax, we questioned whether there was also a CP at the lobar obstruction that fixed LLL flow. In that case the rate of LLL emptying would not be dependent on the presence of the common (i.e., central) CP and thus the flow contribution of the LUL. We found that when the LUL was removed, the LLL increased its rate of emptying. Thus a lobar CP did not fix LLL flow and CP did not occur in series. In a second experiment emphysema was produced in the left lung to reduce lung recoil, whereas the right lung was normal. CP were identified at approximately lobar bronchi of each lung, and the lungs were emptied at different rates. A CP common to both lungs was not identified. Our results indicate that in localized lung disease, if flows from the different regions are high enough, then wave speed is reached in proximal airways, and a CP occurs centrally rather than peripherally. On the other hand, if flows are low, then wave speed is reached peripherally and a CP common to all lung regions does not occur.

Characterization of muscarinic receptor subtypes in human tissues

The affinities of selective, pirenzepine and AF-DX 116, and classical, N-methylscopolamine and atropine, muscarinic cholinergic receptor antagonists were investigated in displacement binding experiments with [3H]Pirenzepine and [3H]N-methylscopolamine in membranes from human autoptic tissues (forebrain, cerebellum, atria, ventricle and submaxillary salivary glands). Affinity estimates of N-methylscopolamine and atropine indicated a non-selective profile. Pirenzepine showed differentiation between the M1 neuronal receptor of the forebrain and the receptors in other tissues while AF-DX 116 clearly discriminated between muscarinic receptors of heart and glands. The results in human tissues confirm the previously described selectivity profiles of pirenzepine and AF-DX 116 in rat tissues. These findings thus reveal the presence also in man of three distinct muscarinic receptor subtypes: the neuronal M1, the cardiac M2 and the glandular M3.

Polyclonal B-cell activation by influenza A/Texas virus-specific human T-cell clones

A previously described proliferating class-II-restricted CD4+ human T-cell clone (TA4) specific for the N2 neuraminidase of the influenza A/Texas virus was tested for its ability to induce B cells to polyclonal immunoglobulin (Ig) production. The data reported in the present study show that, when stimulated by T-depleted autologous peripheral blood mononuclear cells (E-) and A/T virus, the TA4 clone was able to induce B cells to polyclonal Ig production. This effect was also seen using another class II-restricted human T-cell clone specific for the H3 haemagglutinin of the A/Texas virus and autologous polyclonal T cells. This Ig production was MHC-restricted at the inductive level, i.e., the stimulating-virus-treated E- population and the clones or the T cells had to share the same HLA-DR determinants. However, the responding B cells could be allogeneic provided the helper T cells were activated in the presence of autologous irradiated virus-infected E- cells.

Increased left ventricular stiffness impairs filling in dogs with pulmonary emphysema in respiratory failure

In a chronic canine model of pulmonary emphysema, we studied the interaction between left ventricular (LV) mechanics and pulmonary disease during severe hypoxemia. The hypoxemia was similar to that which may occur during a severe exacerbation of chronic obstructive lung disease. In six dogs with papain-induced emphysema and in seven dogs without emphysema, LV mechanics were examined when a hypoxic gas mixture was inspired to reduce PO2 to about 35 mmHg (hypoxic study) and during nonhypoxic conditions (room air study). In both groups, LV diastolic compliance was reduced during the hypoxic study by a similar amount. This finding could not be explained in terms of ventricular interdependence. Our analysis suggested that hypoxia decreased diastolic compliance (i.e., increased LV diastolic stiffness) by impairing LV relaxation. The primary effect of hypoxia was to decrease the extent to which LV relaxation occurred for a given end-diastolic pressure, while the rate of LV relaxation was decreased just slightly. This study indicates that severe hypoxemia because of respiratory failure may impair myocardial relaxation leading to a decrease in LV filling.

Characterization of muscarinic receptors in human submandibular salivary glands

We studied the binding of the muscarinic antagonist [3H]N-methyl-scopolamine [( 3H]NMS) in order to characterize muscarinic receptors located in human submandibular salivary glands obtained from intrasurgical biopsy. [3H]NMS bound with a Kd value of 1.56 nM to a single class of muscarinic receptors (Bmax 37.3 fmol/mg protein) since pirenzepine exhibited a homogeneous binding profile.

Hemodynamic effect of hydralazine in interstitial lung disease patients with cor pulmonale. Immediate and short-term evaluation at rest and during exercise

Hydralazine was administered short-term to 13 patients who had stable interstitial lung disease (ILD), pulmonary arterial hypertension (PAH); mean pulmonary arterial pressure ( [PAP]=26 +/- 9 mm Hg), and cor pulmonale (CP). All patients were studied at rest and during exercise. After intravenous hydralazine at rest, there were statistically significant increases in cardiac index (CI) (p less than 0.001), arterial oxygen saturation (SaO2) (p less than 0.01), and mixed venous saturation (S-vO2) (p less than 0.01). Pulmonary vascular resistance (Rp) (p less than 0.005) and systemic resistance (Rs) decreased (p less than 0.001), and PAP did not change. During exercise, PAP did not change; however, CI (p less than 0.01), PaO2 (p less than 0.001), and S-vO2 (p less than 0.01) increased further. The increase in Rp was significantly reduced (p less than 0.01). After continuation of oral hydralazine therapy in 12 patients for 7 days, PAP at rest was not statistically different from control; Rp and Rs remained decreased (p less than 0.001). The same results were found for CI, PaO2, S-vO2, and Rs during exercise. Although PAP did not change from control values, the drug significantly reduced the increase in Rp (p less than 0.005). Vasodilator therapy with hydralazine could be useful in patients with stable ILD who have inflammation with minimal to moderate fibrosis and PAH and might be used as an adjunct to conventional therapy for ILD and CP.

Mitral valve prolapse secondary to right ventricular enlargement in patients with pulmonary hypertension after toxic rapeseed oil ingestion

A high incidence of mitral valve prolapse (MVP) has been reported in various entities which produce important right ventricular (RV) enlargement with normal or decreased left ventricular (LV) volume. To evaluate the importance of RV enlargement in the genesis of MVP in these cases, we analyzed the echocardiographic studies from 176 patients with 'Síndrome Tóxico'. These patients underwent M-mode, cross-sectional and pulsed Doppler examination because of the suspicion of having dietary pulmonary hypertension, a complication which occurred in almost 20% of patients with this epidemic poisoning and which showed a course of gradual resolution in most of them. RV size was classified according to the RV/LV maximal short-axis dimension ratio as normal, border-line, moderately enlarged and severely enlarged. MPV was diagnosed according to standard M-mode and cross-sectional echocardiographic criteria. A second echocardiographic examination was obtained in 38 patients 12.5 +/- 5.3 months after the first one. The incidence of MVP was 9.3% in patients with normal RV size (N = 107), 9.5% in patients with border-line RV size (N = 23), 30% in patients with moderate RV enlargement (N = 30) and 56% in patients with severe RV enlargement (N = 16) (P less than 0.001). Fourteen (77%) of the 18 patients with MVP and moderate or severe RV enlargement (N = 16) (P less than 0.001). Fourteen (77%) of the 18 patients with MVP and moderate or severe RV enlargement had holosystolic MVP. At pulsed Doppler examination, no patient showed signs of mitral regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain levels of tofizopam in the rat and relationship with benzodiazepine receptors

The effect of tofizopam on 3H-flunitrazepam binding was studied in rat hippocampus and cerebellum. Tofizopam (at a concentration of 10(-7) M) increased 3H-Flu binding through a 30% rise in the Bmax with no modification of Kd in either brain area. Similar results were obtained when the binding was measured in tofizopam (50 mg/kg p.o.) pretreated rats. Even though tofizopam has no anticonvulsive action against pentetrazol-induced convulsions, it significantly potentiated the action of diazepam but with no modification of brain diazepam levels and metabolism. The brain levels of tofizopam are reported and compared to plasma levels after oral administration of 5 and 50 mg/kg to rats.

The epidemiology of Entamoeba histolytica in a rural and an urban area of Mexico. A pilot survey II

Stocks of intestinal amoebae grown in monoxenic culture, were compared against each other and against those previously reported from Mexico City. These were isolated from subjects in San Cristobal de las Casas, Chiapas (rural area) and hospital patients in Merida, Yucatan (urban area). Electrophoretic patterns of the four enzymes: glucose phosphate isomerase (GPI), phosphoglucomutase (PGM), L-malate: NADP+ oxido-reductase (oxalacetate-decarboxylating) (ME) and hexokinase (HK) demonstrated the presence of five groups (zymodemes) of Entamoeba histolytica already described from Mexico City, together with two new zymodemes, one of which gave a recognizable pathogenic pattern, whilst the other gave a contradictory pattern. Zymodemes of Entamoeba coli, Entamoeba hartmanni, Iodamoeba buetschlii and Dientamoeba fragilis, previously described were also isolated. One new zymodeme of D. fragilis was demonstrated.