Encephalopathy in liver transplantation: neuropathology and CMV infection

The clinical histories and pathological findings of 27 autopsied cases of orthotopic liver transplantation (OLT) were reviewed. Fatal OLT was complicated in 93% of cases by neurological dysfunction, usually manifested by encephalopathy, with or without seizures. The etiology of the encephalopathy was largely multifactorial (44%) or undetermined (20%). Subarachnoid hemorrhage, central pontine myelinolysis, meningitis, brain infarction, polyclonal B cell lymphoma and spinal cord necrosis were common neuropathological findings. These diagnoses were often masked by other systemic illnesses. The role of cytomegalovirus (CMV) in neurologic dysfunction was explored with in situ hybridization and immunohistochemical techniques. OLT cases showed a significantly higher (89%) frequency of CMV genomic material in brain tissue compared to age-matched non immunocompromised (NIC) patients (23%). All OLT cases with encephalopathy of undetermined cause demonstrated usually prominent hybridization to the CMV probe. CMV may be an important cause of encephalopathy in such patients.

Pulmonary disease progress in sarcoid patients with and without bronchoalveolar lavage collagenase

To assess the usefulness of bronchoalveolar lavage (BAL) collagenase measurement in gauging disease severity and outcome in sarcoidosis, we analyzed BAL fluids from 84 patients with sarcoidosis for collagenase and monitored disease progress in these patients for a minimum of 12 months. Twenty patients (24%) were found to have BAL collagenase activity on initial evaluation (collagenase-positive group). Compared with patients without BAL collagenase (collagenase-negative group), the collagenase-positive group had (1) a higher proportion of BAL suppressor T cells (p less than 0.03); (2) a lower helper-suppressor T-cell ratio (p less than 0.002); (3) lower mean percent predicted FEV1, FVC, and DLCO levels (p less than 0.05); and (4) a higher proportion of patients with advanced (Stage 4) disease on chest roentgenogram (p less than 0.001). Significant differences were also observed between the collagenase-positive and collagenase-negative groups during follow-up. A higher proportion (55%, n = 11) of collagenase-positive patients required corticosteroid therapy than did collagenase-negative patients (26%; n = 17; p less than 0.025). Of those who remained untreated, pulmonary function tended to decrease in the collagenase-positive group, whereas mean pulmonary function levels actually improved in the collagenase negative group (p less than 0.05). Of those who required therapy, mean percent predicted FVC and DLCO levels improved significantly after treatment in the collagenase-negative group (p less than 0.01 and p less than 0.05, respectively), whereas an improvement in percent predicted FVC levels only (p less than 0.01) was observed in the collagenase-positive group.(ABSTRACT TRUNCATED AT 250 WORDS)

The relationship between bronchial immunopathology and hyperresponsiveness in asthma

Physiological and Immunopathological parameters were investigated in 15 patients with diagnosed asthma, and 6 non-asthmatics presenting with other chest symptoms. The 15 symptom-free asthmatics expressed bronchohyperresponsiveness with a mean provocative dose producing a 20% fall in forced expiratory volume in one second (PD20FEV1) of 1 mg histamine. None of the non-asthmatics responded to 16 mg histamine. Twenty four hours later bronchoscopy was performed and endobronchial biopsies were obtained. Histological staining of frozen biopsy sections revealed a mononuclear cell infiltrate in all 15 asthmatics, while only 1 of the 6 non-asthmatics showed mild inflammation. Monoclonal antibodies were used to identify subsets of lymphocytes, activation markers, macrophages, and HLA-DR expression within the peribronchial infiltrates. In all samples, activated T-cells and macrophages were identified and HLA-DR expression was found to be raised, but the CD4: CD8 ratio was highly variable. No clear relationship was found between cellular distribution and measured lung function parameters. A highly significant correlation was found between the level of HLA-DR expression on the infiltrating cells (quantified microdensitometrically) and bronchial hyperresponsiveness. These results show for the first time that a chronic T-cell-mediated immune response is present in the bronchial tissue of asymptomatic asthmatics, and that the HLA-DR expression promoted correlates with the hyperresponsive status. These data promote the hypothesis that a T-cell-mediated response contributes to a predisposition to bronchial hyperresponsiveness in asthmatics.

The relationship between bronchial immunopathology and hyperresponsiveness in asthma

Physiological and Immunopathological parameters were investigated in 15 patients with diagnosed asthma, and 6 non-asthmatics presenting with other chest symptoms. The 15 symptom-free asthmatics expressed bronchohyperresponsiveness with a mean provocative dose producing a 20% fall in forced expiratory volume in one second (PD20FEV1) of 1 mg histamine. None of the non-asthmatics responded to 16 mg histamine. Twenty four hours later bronchoscopy was performed and endobronchial biopsies were obtained. Histological staining of frozen biopsy sections revealed a mononuclear cell infiltrate in all 15 asthmatics, while only 1 of the 6 non-asthmatics showed mild inflammation. Monoclonal antibodies were used to identify subsets of lymphocytes, activation markers, macrophages, and HLA-DR expression within the peribronchial infiltrates. In all samples, activated T-cells and macrophages were identified and HLA-DR expression was found to be raised, but the CD4: CD8 ratio was highly variable. No clear relationship was found between cellular distribution and measured lung function parameters. A highly significant correlation was found between the level of HLA-DR expression on the infiltrating cells (quantified microdensitometrically) and bronchial hyperresponsiveness. These results show for the first time that a chronic T-cell-mediated immune response is present in the bronchial tissue of asymptomatic asthmatics, and that the HLA-DR expression promoted correlates with the hyperresponsive status. These data promote the hypothesis that a T-cell-mediated response contributes to a predisposition to bronchial hyperresponsiveness in asthmatics.

Molecular cloning of CD31, a putative intercellular adhesion molecule closely related to carcinoembryonic antigen

cDNA clones encoding CD31 have been isolated by transient expression. The sequence of CD31 expressed on human umbilical vein endothelial cells (HUVEC) is identical to that expressed on the monocyte-like cell line HL60. In HUVEC. CD31 is concentrated in regions of cell-cell contacts. CD31 is a member of the Ig superfamily and is most closely related to the carcinoembryonic antigen CEA, consisting of four contiguous C2 domains. The localization of CD31 to regions of cell-cell contacts, and the sequence similarity to CEA, a known intercellular adhesion molecule (ICAM), strongly suggest that CD31 may function as an ICAM, possibly mediating endothelial cell-cell contacts and also promoting interactions between leukocytes and endothelial cells.

Employment and drinking in early adulthood: a longitudinal perspective

The relationship between drinking and employment was examined in a large, national representative longitudinal sample of young adults in Britain. Teenage drinking did not emerge as a strong influence upon subsequent employment experience: few associations were significant for either sex. However, early employment experiences did appear to be relevant to drinking in young adults, since unemployment of six months or more in total was significantly associated with heavier drinking in men (odds ratio = 1.38, CI 1.14-1.64). Respondents ratings of overall job satisfaction were not generally associated with either previous drinking or with that in early adulthood.

The role of family formation and dissolution in shaping drinking behaviour in early adulthood

The role of family formation and dissolution was examined in relation to alcohol consumption in early adulthood, using longitudinal data from a large representative British sample (the 1958 cohort). In comparison with other potential influences upon drinking, including employment and financial circumstances, social position and psychological wellbeing, the family formation patterns of young adults were most strongly associated with their current drinking. Stability and change in drinking between adolescence and early adulthood were also examined. Results were generally consistent with stable partnerships and family formation exerting a moderating influence on drinking since marriage and parenthood were most prevalent among groups reducing consumption or maintaining the lighter drinking of their teens. Most importantly, partnership breakdown was associated with heavier drinking established at age 16 and increasing consumption between adolescence and early adulthood.

Childhood morbidity and adulthood ill health

STUDY OBJECTIVE

The aim of the study was to investigate the relationship between the state of health in childhood and ill health in early adult life.

DESIGN

The study used data collected as part of the National Child Development Study and related health at 7 years of age to that at 23. A wide range of information on child health in the cohort was available, which was used to construct a broader measure of health status than selected diagnostic categories.

SETTING

The survey population was nationwide.

PARTICIPANTS

The study population included all children born in the week 3-9 March 1958. They were followed up at 7, 11, 16, and 23 years. Of the target population of 17,733 births, 12,537 (76%) were retraced and interviewed at 23.

MEASUREMENTS AND MAIN RESULTS

Children at age 7 were allocated to 13 morbidity groups; 20% of children had reported no ill-health apart from the common infectious diseases, but 10% were included in four or more of the morbidity groups. Children with no reported morbidity retained their health advantage into early adulthood: ratios of observed to expected ill health for four of the five indices examined at age 23 were all significantly below one (self rated health 0.81, asthma and/or wheezy bronchitis 0.63, allergies 0.79, emotional health 0.75). Children with more morbidity at age 7 had higher ratios of ill health in adulthood. A chronic condition in childhood was associated not only with excess morbidity in the short term but also with a poor health rating in early adult life (ratio = 1.38). Morbidity was significantly increased for most of the adulthood indices among children with asthma and/or wheezy bronchitis. However most ill health in young adulthood occurred in study members with a relatively healthy childhood.

CONCLUSIONS

Although the state of health in childhood has long term implications, it does not form a substantial contribution to ill health in early adult life.

Predicting traffic injuries in childhood: a cohort analysis

Data from a sample of more than 16,000 children born in the United Kingdom in 1958 were studied to identify factors that may affect the risk of having a traffic injury. Five sets of risk factors were examined: physical, developmental, educational, behavioral, and family. Information about these factors were obtained systematically from parents, teachers, and physicians when the children were 7 and 11 years of age. The results were related to traffic injuries occurring for the first time during each subsequent 4-year period. Between 8 and 11 years of age, 431 children had a traffic injury requiring medical attention, and between 12 and 16 years the number was 590. Logistic regression analyses identified a small number of factors associated with injuries, which varied according to the age and gender of the child. When all these factors were entered into a final model, only five remained: fidgety, abnormal behavior, and three measures of family disruption or disadvantage--crowding, family problems, and being removed from the family and placed in the care of the local authority. These findings suggest that it may be unwise to place much reliance on "high risk" preventive strategies by measures of this kind. Instead, more emphasis should be placed on community-based passive and environmental strategies.

Adolescent decision-making: the development of competence

This article reviews evidence relating to the development of competence in decision-making during adolescence. The review focuses on cognitive aspects of decision-making and discusses nine indicators of competence: choice; comprehension; creativity; compromise; consequentiality; correctness; credibility; consistency; and commitment. The evidence suggests that by the age of 15 years many adolescents show a reliable level of competence in metacognitive understanding of decision-making, creative problem-solving, correctness of choice, and commitment to a course of action. Young adolescents (12-14 years) are less able to create options, identify a wide range of risks and benefits, foresee the consequences of alternatives, and gauge the credibility of information from sources with vested interests. No evidence is available relating to age differences in willingness to make choices, devise compromises, and show consistency of choices. Barriers to achieving competence in decision-making during adolescence include attitudinal constraints (e.g. beliefs about the proper age for making decisions), peer group pressures to conformity, breakdowns in family structure and functioning, and restricted legal rights to make important personal decisions (e.g. to donate blood or body tissue).

HTLV-1 associated myelopathy in Canada

We report the clinical and laboratory findings of six Canadian patients with progressive myelopathy associated with HTLV-1 infection. The diagnosis was suspected on clinical grounds and supported by serological studies and positive gene amplification. Only five had emigrated from an area endemic for HTLV-1 infection. Tropical spastic paraparesis should be considered in all patients with myelopathy, even those without standard serological markers of HTLV-1 infection. The pathogenesis of this condition and the serological and molecular biological means by which this diagnosis can be made are reviewed.

Collagenase and fibronectin in bronchoalveolar lavage fluid in patients with sarcoidosis

Bronchoalveolar lavage fluid from 43 patients with biopsy proved sarcoidosis and 10 control subjects were assayed for fibronectin and collagenase activity. Fibronectin was significantly increased in the group with sarcoidosis and was found to be positively correlated with angiotensin converting enzyme activity, protein concentration, percentage of T cells and helper:suppressor ratios in the lavage fluid. Increased fibronectin in the bronchoalveolar lavage fluid was not related to functional or radiographic indices of interstitial disease and did not identify patients subsequently requiring treatment. Latent collagenase was present in bronchoalveolar lavage fluid from 16 patients with sarcoidosis but not in any control sample. There was no association between the collagenase activity and the cell profiles of the lavage fluid. Yet carbon monoxide transfer factor was decreased in patients with bronchoalveolar lavage fluid collagenase. Ten of 16 patients with bronchoalveolar lavage fluid collagenase had radiographic class III or IV disease and a disease duration of more than two years. On follow up 62% of patients with bronchoalveolar lavage fluid collagenase required subsequent treatment, compared with only 23% of patients without collagenase. These results indicate an association between bronchoalveolar lavage fluid collagenase and progressive, prolonged disease in sarcoidosis, whereas increased bronchoalveolar lavage fluid fibronectin is associated with indices of disease activity.

Social class and changes in weight-for-height between childhood and early adulthood

The changes in weight-for-height of those from different social class backgrounds have been examined in the 1958 longitudinal study. Social class differences in the prevalence of overweight and obesity were found to be negligible in childhood but marked by early adulthood, with a greater percentage of overweight and obesity in lower social classes. This different was three-fold among obese men and two-fold among obese women when respondents were classified on the basis of their own occupation. However, a longer term effect of early class backgrounds also emerged. Children from manual backgrounds were more likely to become overweight and obese young adults (7 per cent of those with average weight-for-height at age 7) compared with their non-manual contemporaries (3 per cent). Interestingly, they were also more likely to remain overweight or obese through to early adulthood. Methods preventing weight gain in early life, whilst poorly developed at present, need to ensure that approaches are relevant to young people with lower social class backgrounds.

Autotransfusion: quality of blood prepared with a red cell processing device

The quality of blood salvaged at operation and prepared with the Dideco Autotrans BT 795 autotransfusion device was compared with that of donor blood in 41 patients having cardiac surgery involving cardiopulmonary bypass. Saved blood had a higher haemoglobin concentration (17.3 v. 13.1 g dl-1; P less than 0.001), a higher 2,3-diphosphoglycerate concentration (5.3 v. 1.1 mmol litre-1; P less than 0.00001), higher white cell count (17.1 X 10(9) litre-1 v. 4.1; P less than 0.00001), higher pH (7.5 v. 6.6; P less than 0.00001) and a more physiological potassium concentration (5.4 v. 8.8 mmol litre-1; P less than 0.00001) than donor blood. Saved blood platelet count was 34.5 X 10(9) litre-1 compared with 146.24 X 10(9) litre-1 (P less than 0.00001) and its heparin concentration was 0.64 u. ml-1. We conclude that this autotransfusor is a useful aid to blood conservation, producing good quality red cells with relatively normal pH and potassium values. However, modification of the centrifugation and washing is required to lessen the high white cell count and heparin concentrations found in the saved blood.

Transformation related expression of glutathione-S-transferase P in rat liver cells

A neutral isoenzyme of glutathione transferase designated glutathione-S-transferase 7-7, but also referred to as glutathione-S-transferase P (GST-P) is absent from adult rat liver hepatocytes, but expressed at a very early stage in chemically induced in vivo hepatocarcinogenesis. The expression of this enzyme in a range of aflatoxin B1 (AFB1) associated hepatocarcinogenic systems has been examined, including in vivo induced preneoplastic and neoplastic liver tissue, cell lines derived from hepatomas, primary hepatocytes in culture and an immortalized rat liver cell line before and after transformation in vitro either by transfection with ras oncogenes or by treatment with metabolically activated AFB1. Analyses of total cytosol proteins using a polyclonal antibody to GST-P did not detect the presence of GST-P protein in cytosols from control or regenerating liver. A low level of expression was detected in the immortalized, non-transformed epithelial cell line, but a greatly induced level occurred subsequent to transformation of these cells by either of the two techniques used. High levels of the protein were detected in in vivo induced preneoplastic and neoplastic tissues, and in the cell lines derived from them. Total RNA fractions isolated from the various cells or tissues, when examined with a cDNA probe for GST-P mRNA, showed it to be absent from control and regenerating rat liver. It was present at low levels in the untransformed cell line and primary hepatocytes after 48 h in culture, but present at greatest abundance in the in vivo and in vitro transformed cells. The results indicate that the highest elevation in expression of this protein is associated with the stage of definitive malignant transformation in in vitro carcinogenesis, and this could have relevance in defining comparable events in the in vivo multistage sequence.

Incidence of renal stones in 18 British towns. A collaborative study

The geographical distribution of renal stones in England and Wales was investigated by selecting 18 towns which encompassed a range of social and economic conditions. Case registers of stone patients were maintained in the hospitals for 2 years; they included out-patients and in-patients. The annual registration rate was 22/100,000 population. Additional information was available for 1980 from Hospital Activity Analysis and the annual rate was 28/100,000. It is suggested that this is the best estimate of the incidence of renal stones in England and Wales. The rate ranged from 56/100,000 in Canterbury to 15/100,000 in Burton-on-Trent. The incidence of renal stones was higher in towns with better social and economic conditions. In comparison, climatic factors, latitude and water hardness were not important determinants of the distribution of renal stones.

Diet and renal stones: a case-control study

The diets of 51 men with renal stones were compared with those of 94 age-matched controls, using a measured record of all food and drink consumed during 4 days. The mean intakes of three nutrients suspected in the aetiology of renal stones, animal protein, refined carbohydrate (sugar) and dietary fibre, were similar for both cases and controls. However, the cases had a higher intake of ascorbic acid. A greater proportion of cases had low fluid intakes or took no exercise in their leisure time.

Long latency spinal cord dorsum potential; suppression by intrathecal morphine and enkephalin analog

We have developed a new method which combines intrathecal recordings of spinal cord dorsum potentials (CDPs) with application of drugs to the spinal cord via an intrathecal catheter. With this technique we have discovered a late component (LC) in the CDP which has not been previously described. The LC is evoked by high intensity electrical stimulation of the rat tail. Whereas previous reports describe early components in the CDP evoked by low intensity A-fiber stimulation, ours is the first to describe a late evoked potential implicating C-fiber activation of the cord. Moreover, we show that the LC is blocked by intrathecal application of morphine sulphate or D-Ala-Met-enkephalinamide in a naloxone reversible manner. We postulate that this LC represents, at least in part, the spinal cord evoked response to C-polymodal nociceptive afferent inputs.

Incidence of diabetes amongst people aged 18-50 years in nine British towns: a collaborative study

The incidence of diabetes among people aged 18-50 years has been studied prospectively in nine towns, chosen to encompass the range of socio-economic conditions and spread of latitude in England and Wales. The incidence of Type 1 (insulin-dependent) diabetes in this age group varied little between the towns. However, the incidence of Type 2 (non-insulin-dependent) diabetes was markedly higher in the towns with 'worse' socio-economic conditions. The mean incidences were 23 per 100 000 for the three 'worse' towns and 10 per 100 000 for the three 'better' towns. This was not explicable by an association between the disease and social class. This finding has to be reconciled with known and hypothesised influences in the aetiology of Type 2 diabetes.

The prevalence of gout in three English towns

The prevalence of gout has been measured in three English towns by means of a postal questionnaire. The three towns were selected to give a range of socio-economic conditions. In each town questionnaires were sent to a sample of approximately 5000 men aged 45 to 74 years. The questionnaire elicited a history of gout and a history of an attack of severe pain in the great toe. There was a progressive increase in prevalence of gout from Ipswich, the town with the most favourable socio-economic status, through Wakefield to Preston, the town with the least favourable socio-economic status. Within each town there was no difference between the social class distribution of cases and age-matched controls

Moral reasoning in alcoholics and addicts: structure vs content

19 alcoholics and 20 addicts were selected from the detoxified inpatient population of a VA hospital. 17 socioeconomically matched controls were drawn from the nonprofessional staff. Kohlberg's Moral Maturity scores were not significantly different for the three groups. However, the content variables involved in choosing between the value of life and law differentiated these groups. The value of reporting both structure and content was examined.