Whole bowel irrigation: experience in pediatric patients

Whole bowel irrigation (WBI) was used in 50 children aged 16 months to 14 years in preparation for surgery (n = 30) and colonoscopy (n = 20). The patients were divided into three groups according to age: group A, 12 to 36 months; group B, 3 to 6 years; and group C, 6 to 14 years. A hydroelectrolytic solution (Na 150 mEq/L, K 30 mEq/L, Cl 130 mEq/L, HCO3 50 mEq/L) was administered to all the groups at a variable rate established according to tolerance, weight, and age. Neomycin (1 g) and erythromycin (50 mg/kg) were administered in the last liter of the solution of the patients being prepared for colorectal surgery. Vital signs (heartbeat, arterial tension, and central venous pressure) and blood parameters (Na, K, HCO3, pH, and Hct) were assessed before and after irrigation and remained stable in all the groups. The rate of administration of the solution was best tolerated in each group as follows: group A, 75 mL/kg/h; group B, 60 mL/kg/h; and group C, 45 mL/kg/h. Colonic preparation was satisfactory in 49 of the 50 cases. Postoperative infectious complications were reduced to 3.3%. WBI in pediatric patients is a fast, simple, and well-tolerated method that gets a colon in excellent condition for surgery and colonoscopy exploration and considerably decreases the number of postoperative complications.

Complement activation by human lymphocytes from different lymphoid organs: role of sialic acid and lack of relationship to electrical surface charge

A study was made of the complement activation (CA) capacity of human lymphocytes from lymphoid organs. Whereas thymocytes did not show complement membrane fluorescence (CMF) following incubation in normal homologous serum (NHS), a mean of 18 and 34%, respectively, of tonsil and spleen cells were positive for antihuman C3 fluorescent serum. Isolated T cells did not show CA capacity, while 62% of a purified tonsil B population possessed this capacity. The CMF was abolished by adding EDTA and when the incubation was performed in C1q and factor-D-depleted serum. Addition of EGTA, supplemented with MgCl2 to NHS failed to abolish the fluorescence, indicating that the alternative pathway was involved in the phenomenon. Removal of sialic acid with neuraminidase increased the percentage of cells showing CMF. Since sialic acid significantly contributes to the extent of net negative surface charge, we have studied whether this parameter influences the CA capacity. Tonsil B cells were separated in fractions with different electrophoretic mobility by preparative cell electrophoresis, and similar percentages of CMF-positive cells were found in all fractions. Therefore, it is likely that the capacity to activate complement is unrelated to the membrane electrical charge.

Differential proliferative responses of B cells from BALB/c and autoimmune NZB mice to B-cell growth factor(s)

Highly purified B cells from NZB mice have altered responses to various stimuli which require additional costimulatory signals supplied by factors present in EL-4 supernatants when compared to age-matched control nonautoimmune strains. Both crude preparations of EL-4 supernatants as well as partially purified BSF-p1 induced peak proliferation in B cells from normal strains of mice only in the presence of another stimulatory signal, anti-mu. In contrast, B cells from autoimmune-prone NZB mice proliferated in response to B-cell growth factors, with an age-dependent variation. Splenic B cells from 16- to 22-week-old NZB mice, an age where pronounced autoimmune disease is not observed, demonstrated a near maximum proliferative response with B-cell growth factors alone. While normal B cells responded maximally to BSF-p1 in the presence of anti-mu, B cells from young adult NZB mice (16-22 weeks of age) were not further stimulated to proliferate upon the addition of anti-mu. Such NZB B cells appeared to lack the requirement for a stimulation signal delivered by anti-mu in order to respond to B-cell growth factors. These results suggested that NZB cells were partially activated in vivo in the preautoimmune state so that subliminal triggers lead to full activation.

The importance of nasal fractures during different growth periods of the nose

Fifty-seven patients who had sustained nasal fractures during childhood were divided into three groups, according to the age at which the fracture had taken place. These three groups were based on the normal periods of development of the nose. They were compared with regard to possible sequelae after fracture. The results are discussed and an example from each group is shown.

Nasal fractures in children: influence on the development of the nose

Fifty-seven patients between the ages of zero and 16 years, treated for nasal fractures during childhood by means of closed reduction, have been subjected to follow-up examination after development of the nose has ceased. These patients have been compared to a control group of 50 persons without any known nasal trauma. No difference was found between the two groups with regard to functional complaints, but deviations of the osseous and cartilaginous pyramid, humps and saddle formations, as well as spine formations and deviations of the septum, were particularly prevalent in the fracture group. Crista formation and angulation were found to be equally frequent in both groups. The findings are discussed.

Essential and nonessential sequences in malPp, a positively controlled promoter in Escherichia coli

A plasmid bearing the malPp promoter was digested with Bal31 to obtain a set of deletions with closely spaced endpoints in the upstream region of this promoter. Some of these deletions were sequenced, and their effect on malPQ expression was determined after having transferred them onto the chromosome. We found that a site which binds the cyclic AMP receptor protein in vitro and which is centered at position -93 with respect to the site of transcription initiation could be deleted without affecting malPQ expression. In contrast, the activity of the malPp promoter decreased abruptly when the deletions reached position -72. The downstream region of the promoter was analyzed by using a technique of "sequence replacement" which involved the selection of Mal+ pseudorevertants from strains which carried small deletions in the -25 region. The pseudorevertants, which expressed the malPQ operon in a manner indistinguishable from wild type, had grossly different sequences downstream from position -38, except for a few positions, some of which must be important for promoter function. By combining all presently available information, it is suggested that the malPp promoter contains three binding sites for its activator, the product of gene malT. These sites are defined by three quasi-identical hexanucleotides present in one orientation around position -37 and twice in the other orientation around positions -60 and -73.

Indirect effects of the 3'-5' cyclic adenosine monophosphate binding protein (CAP) on the transcription of the malPQ operon in Escherichia coli

Uninduced malPQ transcription, as followed by measuring beta-galactosidase expression in a strain carrying a malP-lacZ hybrid gene and grown in the absence of maltose, requires the presence of CAP. However this requirement is lost when the expression of malT, positive regulator gene of the maltose regulon, is rendered independent of CAP by a mutation in the malT promoter. This result suggests that the effect of CAP on uninduced malPQ expression is mediated through a modulation of MalT protein synthesis. The effect of CAP on the induced expression of malPQ is presumably mediated, in addition, through a modulation of the synthesis of the maltose transport system and, hence, of the entry of the inducer. Therefore the effect of CAP on malPQ expression seems to be merely indirect, and this is surprising since a CAP binding site is present at the malPQ promoter.

Caffeine induces sister-chromatid exchanges during the whole S-phase of the cell cycle

The capacity of caffeine to induce sister chromatid exchanges (SCEs) in different cell cycle stages and the proliferation kinetics were studied. Continuous treatment with this xanthine during the whole second cycle significantly increased the baseline SCE frequency. Pulse-treatment experiments showed that the induction of SCEs by caffeine, which was dose-dependent, was restricted to the S-phase of the cell cycle without effect on G1 or G2 cells. Moreover, unlike other SCE-inducing agents, such as DNA-synthesis inhibitors and DNA-damaging agents, caffeine produced similar SCE increases in cells treated at different times throughout the S-phase. In the light of Painter's model for SCE formation and the known effects of caffeine on the DNA replication pattern, the most likely mechanism of SCE induction by caffeine is an increase in the number of DNA-replication sites.

Point mutations that reduce the expression of malPQ, a positively controlled operon of Escherichia coli

malPQ is one of three operons controlled by the positive regulator gene malT. With the objective of defining DNA sequences essential for malPQ transcription, we looked for cis-dominant mutations that reduced the level of expression of this operon. We first constructed malP-lac fusion strains, selected from one of them a series of mutants resistant to p-nitrophenyl-beta-D-thiogalactopyranoside (a bacteriostatic compound that enters the cells via lac permease), and retained the clones that contained a mutation reducing the expression of the hybrid operon in a cis-dominant fashion. Nineteen such mutations were sequenced, and their effect on an otherwise wild type malPQ operon was studied. Three of them mapped in a transcribed portion of the operon, and are believed to exert their effect at the translation level. The others map upstream from the transcription startpoint (co-ordinate +1) and help define three DNA segments that must play a predominant role in transcription initiation: the Pribnow box (from positions -7 to -12); and two inverted repeats, extending from position -32 to -36, and -59 to -63, respectively, which are proposed to constitute part of the binding site for MalT protein.

Intranuclear inclusions in hypothalamic neurons: a study in the ageing hamster

Intranuclear inclusions have been observed in a wide variety of locations throughout the nervous system. In the present work we have studied the inclusions that appear within the nucleus of non-secretory neurons from both paraventricular and supraoptic nuclei of the hypothalamus of the ageing hamster. We described four morphological types, namely, micro-filamentous, crystalloid, circular and capsuled inclusions. Their relationships with both the nuclear membrane and the nucleolus are discussed in the light of their ultrastructural features.

Analysis of baseline and BrdU-dependent SCEs at different BrdU concentrations

In the present paper we have used a rationale based on the development of theoretical equations that define sister-chromatid exchange (SCE) frequencies as a function of two variables, namely the baseline (BrdU-independent) and the BrdU-dependent SCE frequencies. The experimental design includes the estimation of SCE frequencies in second division chromosomes when both cycles occurred in the presence of BrdU and when BrdU incubation took place only during the first cycle in a wide range of BrdU concentrations. The final SCE yields in second division chromosomes could be separated into three different components: (1) The BrdU-independent, 'spontaneous' or baseline SCEs, whose low but biologically significant frequency was calculated to be about 0.06 SCEs per pg of DNA; this figure could be similar for most of the cell types; (2) the BrdU-dependent SCEs whose frequency increases with BrdU dose, probably as a result of BrdU substitution for thymidine; (3) the BrdU-dependent SCEs as a consequence of other cellular factors such as disturbance of nucleotide pool sizes. At high BrdU concentrations (300 microM upward) the three components appear to have a significant value in the final SCE yield, whereas at lower BrdU doses the third component seems to be negligible.

Diffuse abdominal uptake of Ga-67 citrate in a patient with hypoproteinemia

A 3-wk-old male, with abdominal distention and severe hypoproteinemia from poor nutrition, underwent a study that showed a persistent diffuse abdominal uptake of Ga-67 citrate, indicating pyogenic or tuberculous peritonitis. However, there were no corresponding clinical or laboratory findings. After a 1-wk course of hyperalimentation with albumin, furosemide, and protein, repeat radiographs showed reduction in bowel gas. It is suggested that hypoproteinemia should be considered as a possibility in the differential diagnosis when there is diffuse abdominal uptake of Ga-67 citrate, with careful clinical correlation. Possible mechanism of Ga-67 uptake in the peritoneal cavity is suggested.

Comparison of radionuclide images and radiographs for skeletal metastases from renal cell carcinoma

68 metastatic bone lesions proven by biopsy, follow-up radionuclide bone imaging, or radiographs in 18 patients with surgically confirmed renal cell carcinoma were retrospectively analyzed. Bone imaging demonstrated 62 lesions (91%): 48 definite, 7 questionable 'hot' lesions, and, 2 definite, 5 questionable 'cold' lesions. The spine was the most common site. 15 patients had more than one metastasis. 27 lesions were undiscovered by radiographs. Serum alkaline phosphatase was elevated in 12 of 18 patients. It is concluded that radionuclide bone imaging is more sensitive than radiographic examination for bony metastasis from renal cell carcinoma, and that it is important to recognize 'cold' metastatic lesions on the bone imaging in patients with renal cell carcinoma.

The nasal passage following rhinoplastic surgery

A follow-up examination has been carried out of 238 patients suffering from nasal obstruction and mouth-breathing. Only 75 per cent of the patients achieved normal nasal passages. The results were significantly poorer in patients suffering from allergic or vasomotor rhinitis, in cases of long-standing mouth-breathing, and in those cases in which the patient had been subjected to earlier rhinoplastic surgery. Our investigation has indicated that a re-evaluation of the indications for surgery in the above-mentioned cases is necessary, and that a more cautious attitude should be taken regarding the possibility of achieving a normal nasal passage following rhinoplastic surgery.

Columella implants. Reconstruction of the anterior septum

A follow-up study was conducted of implants used to replace the anterior septal cartilage. The implants used were (1) the cartilaginous septum after correction, (2) parts of the bony septum (when it was impossible to use the cartilaginous septum), (3) or bank cartilage (when there was insufficient autograft material). One hundred cases were examined 12 months after surgery and divided into three groups according to the material used. There was no statistical difference between the percentages of satisfactory results in the three groups: 66% satisfactory and 33% unsatisfactory. Further analysis of the unsatisfactory results indicated that the most difficult feature is judging the size of the implant: too small an implant results in instability, reduction in the nasolabial angle, and retraction of the columella. Previous surgery increases the risk of poor results.

Obtaining a gentle contour to the columella by modifying the maxillary spine

There are several structures involved in columellaplasty, and all affect the support and shape of the tip, the columella, and the upper lip. The present paper considers only the problem of the deformities of the maxillary spine and its lower extension over the midline, causing broadening and asymmetrical development of the columella as well as a short upper lip, and an obtuse columella-lip angle. During rhinoplasty, the nasal spine can be exposed and reshaped by carving and remodeling with drilling. At the same time, the support this structure provides for the columella and tip can be retained. This paper is based on follow-up of 50 patients on whom surgical correction of the maxillary spine was performed with satisfactory results in 90 percent.

[Removal of foreign bodies from the upper airways and the bronchial tree of small children]

Food remnants are the foreign bodies most frequently aspirated by young children. Larger foreign objects are nearly always rejected spontaneously. In many cases, however, aspiration of foreign bodies lead to death by suffocation. From March 1975 to August 1979, 27 endoscopies removing 22 foreign bodies have been carried out by us. All children were less than 7 years old. The foreign bodies most commonly found were peanuts. Endoscopy was not only carried out when diagnosis was clear, but also if there was suspicion of foreign body aspiration. It is nowadays a treatment without risk when the following conditions are met: 1. Careful medical preparation leading to bronchial dilatation. 2. Effective collaboration with a paediatric anaesthetist. 3. Exact knowledge of the bronchial tree of children.

Purification of human T and B cells by a discontinuous density gradient of percoll

A simple technique for isolating human peripheral B and T cells is described. This method is based on the different mobility of cells in a discontinuous density gradient of Percoll. A population with a mean of 72.8% of surface stable Ig (B cells) is found in the top layer (fraction I) whereas T cells with less than 3% of Ig are distributed in the two lower layers (fractions II and III). B cells obtained by this method were highly viable and reacted strongly with anti-DRw specific sera, whereas T cells did not respond. The clear-cut difference between positive and negative reactions makes this technique very suitable for DRw typing. The proliferative response to PHA is decreased in fractions I and III while greatly increased in fraction II. The different mitogenic responses in the two fractions containing T cells probably represent two functionally distinct T cell subsets. Cells from all fractions are less activated than unseparated cells when Con A and PWM are used as mitogen. The technique is very rapid, avoids the interaction of cells with their specific receptors and gives both T and B cells in one step, all advantages over other methods commonly used.