Myopathy induced by epsilon-aminocaproic acid. Case report

The authors present a case of proximal myopathy secondary to epsilon-aminocaproic acid (EACA) administration. This well recognized entity does not occur immediately after institution of therapy, but follows a delay of several days and a cumulative dose. Its consequences include a spectrum of symptoms from myalgias to severe myopathy with rhabdomyolysis, myoglobinuria, and acute tubular necrosis. A presenting symptom of calf pain in a patient receiving EACA should not automatically imply deep vein thrombosis. Serial creatine phosphokinase measurements are essential in monitoring a patient undergoing EACA therapy, especially after 2 weeks of treatment and a total dose of greater than 500 gm.

Mapping of aminoacylase-1 and beta-galactosidase-A to homologous regions of human chromosome 3 and mouse chromosome 9 suggests location of additional genes

Conserved linkage groups have been found on the X and autosomal chromosomes in several mammalian species. The identification of conserved chromosomal regions has potential for predicting gene location in mammals, particularly in humans. The genes for human aminoacylase-1 (ACY1, N-acylamino acid aminohydrolase, E.C.3.5.1.14), an enzyme in amino acid metabolism, and beta-galactosidase-A (GLB1, E.C.3.2.1.23), deficient in GM1-gangliosidosis, have been assigned to human chromosome 3. Using human-mouse somatic cell hybrids segregating translocations of human chromosome 3, expression of both ACY1 and GLB1 correlated with the presence of the p21 leads to q21 region of chromosome 3. In a previous study, assignment of these genes to mouse chromosome 9 used mouse-Chinese hamster somatic cell hybrids, eliminating mouse chromosomes. To approximate the size of the conserved region in the mouse, experiments were performed with recombinant inbred mouse strains. An electrophoretic variant of ACY-1 in mouse strains was used to map the Acy-1 gene 10.7 map U from the beta-galactosidase locus. These data suggest that there is a region of homology within the p21 leads to q21 region of human chromosome 3 and a segment of mouse chromosome 9. Since the mouse transferrin gene (Trf) is closely linked to the aminoacylase and beta-galactosidase loci, we predict that the human transferrin (TF) gene is on chromosome 3.

Genetic studies of an acardiac monster: evidence of polar body twinning in man

Two maternally derived chromosome sets and both maternal histocompatibility antigen haplotypes were identified in the tissues of a malformed triploid acardiac twin that developed within the same chorion as its normal twin. These findings indicate that the twins arose as a result of independent fertilizations, by two different spermatozoa, of a normal haploid ovum and its diploid first-meiotic-division polar body.

Abnormal platelet function in myeloproliferative disorders

Platelet aggregation and circulating platelet aggregates (CPAs) were evaluated in 18 patients with myeloproliferative disorders, both with and without thrombocytosis. No specific patterns of platelet aggregation were detected, but 11 of 18 patients demonstrated abnormal aggregation to epinephrine, nine of 18 had abnormal aggregation to adenosine diphosphate, and seven of 18 had abnormal aggregation to collagen. There was no definitive correlation of bleeding episodes with abnormal aggregation. However, significant bleeding was observed in a patient with a platelet count of 1,500,000/cu mm and abnormal aggregation. The aggregation defects persisted despite lowering of platelet count. Evidence of increased circulating platelet aggregates and normal platelet aggregation was seen in two patients, one of whom had transient cerebral ischemic attacks relieved by antiplatelet therapy, with return of the CPA index to normal. In two patients with digital ischemia, claudication, and angiographic evidence of peripheral vascular disease, no laboratory evidence of increased circulating platelet aggregates was observed, but one patient had regression of symptoms with antiplatelet therapy.

Parapodium redesigned for sitting

Clinical experience with the Toronto parapodium demonstrates it to have valuable functional use. Young children wearing the orthosis, however, do not participate in group activities requiring unaided sitting and standing. We have redesigned the hip and knee locks to make these maneuvers easier. This modification has allowed the young child to sit and stand without assistance and to develop greater confidence and independence at home and in the classroom.

The insulin gene is located on the short arm of chromosome 11 in humans

The human insulin gene has been previously localized to chromosome 11. We have analyzed the human DNA sequences present in a human-mouse somatic cell hybrid line possessing a translocation involving human chromosomes 11 and X. These data indicate that the human insulin gene is located on the short arm of chromosome 11 in the region p13 leads to pter.

Quinacrine mustard and nucleolar organizer region heteromorphisms in twins

Patterns of NOR activity in 640 metaphase spreads from twelve monozygotic (MZ) and eight dizygotic (DZ) twin pairs were studied to evaluate the heritability of this chromosomal heteromorphism. NORs were stained by a modification of the Ag-AS technique and counterstained with quinacrine mustard dihydrochloride to facilitate chromosome identification and assess their value in zygosity determination. In this study, all karyotypes were read blind with respect to zygosity and pair membership. A discriminant function analysis of pair score differences in MZ and DZ twins revealed that, in our sample, the probability of accurately determining zygosity with NOR scores was 0.93 and with QFQ scores was 0.99. We conclude that NOR and QFQ scores are highly heritable and of great value in zygosity determination. Data were collected from 687 metaphase spreads on the frequency with which an acrocentric chromosome was found in a satellite association. A significant correlation was found between this frequency and the degree of Ag-AS stain of the NOR. This study, therefore, confirms previous results showing that a high degree of NOR activity is found in those chromosomes most often involved in satellite associations.

Salt, Water and Oilseed Proteins Affect Brine Content of Sausages

Brine contents of commercial sausage products ranged from 3.7 to 5.9% and were different among brands. Frankfurters to which either isolated soy or cottonseed protein isolate were added had greater process shrinkage values and higher moisture, lower fat and lower brine contents than did controls. Frankfurters prepared with oilseed proteins had higher (P < .05) process shrinkage percentages, higher moisture percentages and lower brine contents than did controls (all-meat). Although not significant among all comparisons, as in-going (lb per 100 lb raw meat) salt levels increased from 2.5 to 3.0 to 3.5 lb, brine contents increased regardless of level of added water (25, 30, and 35 lb per 100 lb of meat). Within added-salt levels, brine content generally decreased with increasing level of in-going water but these differences were not significant (P > .05). At the beginning and end of a 6-week storage period, frankfurters with high brine contents (4.50-5.25%) had lower total microbial numbers than did frankfurters with low (2.50-3.49%) or medium (3.50-4.49%) brine contents. Because of simplicity, brine content determinations may be further developed as a practical tool for predicting product performance of cured sausages.

Plasma prekallikrein (Fletcher factor) deficiency in a patient with chronic lymphocytic leukemia

We have described the first patient to be reported in whom plasma prekallikrein (Fletcher factor) deficiency and chronic lymphocytic leukemia were both present. This most likely represents a coincidental occurrence, but the markedly elevated peripheral blood lymphocyte count and the detection of the defect using ellagic acid are unique for Fletcher factor deficiency.

Angiotensin and single nephron glomerular function in the trout Salmo gairdneri

Glomerular filtration rate (GFR), urine flow (UV), renal tubular transport maximum for glucose (TMG), and single nephron glomerular filtration rate (SNGFR), determined in anesthetized norepinephrine-infused trout (Salmo gairdneri), were 18.51 +/- 5.78 microliter x min-1 x kg body wt-1, 5.31 +/- 1.38 microliter x min-1 x kg body wt-1, 105.21 +/- 46.84 microgram x min-1 x kg body wt-1, and 3.74 +/- 1.12 nl/min, respectively, when in seawater (SW) and 140.39 +/- 17.24, 76.38 +/- 10.41, 626.16 +/- 77.46, and 1.31 +/- 0.20 in freshwater (FW). Angiotensin II infusions, to reduce UV, GFR, and TMG by 50%, had no effect on the average SNGFR of FW trout, but reduced that of SW fish to 1.42 +/- 0.19 nl/min. Infusions of 20% ferrocyanide, visualized as Prussian blue (PB), identified three glomerular populations: filtering (F) with PB in glomerular vessels and tubular lumen; nonfiltering (NF)--PB in glomerular vessels only; nonperfused (NP)--no PB associated with the nephron. SW and FW kidneys contained about 40% NF tubules. In FW, 45% were F tubules compared with 5% in SW, whereas NP tubules comprised 51% of SW tubules and 13% of FW. During angiotensin II infusions the distributions were 9% and 46% NF in FW and 6% F and 12% NF in SW trout.

Psychomotor development in 65 home-reared children with cri-du-chat syndrome

The psychomotor development of 65 noninstitutionalized individuals with cri-du-chat syndrome was examined through parental questionnaire responses and supporting medical records. Social quotients determined by a Vineland Maturity Scale ranged from 6 to 85, the ages at which developmental milestones were attained varied from the upper limits of normal to six years delayed. Achievement levels were influenced favorably by the early introduction of special education, and were affected adversely by the presence of an unbalanced translocation. This study suggests that many children with cri-du-chat syndrome can attain developmental and social skills normally seen in 5- to 6-year-old children, although their linguistic abilities are seldom as advanced. Contrary to the commonly portrayed clinical picture of severe mental retardation and bedridden debilitation, the older home-reared cri-du-chat child was usually ambulatory, had a moderate degree of independence in self-care skills, and was able to communicate either verbally or through gestural sign language. Physicians and parents should be aware of the full range of psychomotor potential of the child with cri-du-chat syndrome in order to make informed decisions concerning institutional placement.

Chronic myelogenous leukemia. Association with 45 XO Philadelphia chromosome karyotype and prolonged survival

A 42-year-old man with chronic myelogenous leukemia for ten years was found to have a 45 XO Philadelphia chromosome karyotype in myeloid cells with normal 46 XY pattern in peripheral blood lymphocytes. This chromosome pattern has been postulated to be associated with delay in onset of blastic transformation. The prolonged survival of this patient, with only minimal initial chemotherapy and lack of symptoms for ten years, lends support to the concept that the missing Y chromosome may be associated with a favorable prognosis in Philadelphia chromosome-positive men with chronic myelogenous leukemia.

Collagen-induced platelet shape change. The role of collagen quaternary structure

Multimerization of collagen molecules appears to be a prerequisite for collagen-induced platelet aggregation and release. Whether a similar requirement exists for collagen-initiated platelet disc-to-sphere transformation, one of the earliest events in the platelet:collagen interaction, is not known. We have studied platelet shape change by highly purified type I collagen in the presence of EDTA to prevent interference from platelet aggregation and release. The ability of soluble collagen to induce platelet shape change was dependent on prior fibril formation. Tropocollagen from which multimers were removed was not able to initiate the disc-to-sphere transformation, indicating that monomeric collagen is insufficient as a platelet activator. Increasing the extent of multimerization by preincubation at 37 degrees led to an increase in the response rate and a decrease in the lag time for initiation of shape change, but even after maximal multimerization, the lag time was not eliminated. The increase in the turbidity of the collagen solution preceded its ability to stimulate platelet shape change, suggesting that a minimum size of the multimer is needed for platelet activation. L-Arginine, an inhibitor of multimerization, prevented collagen-induced shape change in a dose-dependent relationship. Enhancement of the shape change response rate as a function of the concentration of collagen multimers was found.

Effect of deglycosylation of yeast invertase on its uptake and digestion in rat yolk sacs

The uptake by rat yolk sacs of native invertase and invertase which was deglycosylated by treatment with endo-beta-N-acetylglucosaminidase was compared. The initial rate of uptake of the deglycosylated enzyme was severalfold greater and its accumulation leveled off much earlier than that of the native enzyme. Uptake rates of the deglycosylated and native forms of the enzyme were proportional to their concentration in the medium in the range employed and were inhibited about 85% by 10(-6) M glucagon in both cases. After preloading of yolk sacs with native invertase, the tissue level of activity remained relatively constant over a subsequent 6-h time period, while with the deglycosylated form, activity declined substantially. Since this difference appears not to be attributable to differences in thermal stability, it is suggested that the deglycosylated form of the protein is more susceptible to intracellular proteolytic digestion. In vitro studies on the digestion of these two forms of invertase by trypsin are consistent with this suggestion.

Metastasis-induced acute pancreatitis in small cell bronchogenic carcinoma

Despite frequent metastatic involvement of the pancreas at postmortem examination in patients with small cell lung cancer, clinically observed pancreatitis due to metastatic pancreatic tumor rarely has been reported. This communication describes three cases of clinical acute pancreatitis occurring in a consecutive series of 40 patients with oat cell lung cancer. This complication may appear either as the initial manifestation of the neoplasm or during a recrudescent phase of the malignant growth. The diagnosis should be suspected in the presence of the clinical, laboratory, and radiologic features of acute pancreatitis in patients with known small cell carcinoma of the lung, especially if there is evidence of progression of the neoplastic disease elsewhere and no response to conservative medical management. Aggressive treatment with polychemotherapy can produce rapid clinical improvement and useful prolongation of survival.

Lysosomal arylsulfatase deficiencies in humans: chromosome assignments for arylsulfatase A and B

Genetics of human lysosomal arylsulfatases A and B (aryl-sulfate sulfohydrolase, EC 3.1.6.1), associated with childhood disease, has been studied with human-rodent somatic cell hybrids. Deficiency of arylsulfatase A (ARS(A)) in humans results in a progressive neurodegenerative disease, metachromatic leukodystrophy. Deficiency of arylsulfatase B (ARS(B)) is associated with skeletal and growth malformations, termed the Maroteaux-Lamy syndrome. Simultaneous deficiency of both enzymes is associated with the multiple sulfatase deficiency disease, suggesting a common relationship for ARS(A) and ARS(B). The genetic and structural relationships of human ARS(A) and ARS(B) have been determined by the use of human-Chinese hamster somatic cell hybrids. Independent enzyme segregation in cell hybrids demonstrated different chromosome assignments for the structural genes, ARS(A) and ARS(B), coding for the two lysosomal enzymes. ARS(A) activity showed concordant segregation with mitochondrial aconitase encoded by a gene assigned to chromosome 22. ARS(B) segregated with beta-hexosaminidase B encoded by a gene assigned to chromosome 5. These assignments were confirmed by chromosome analyses. The subunit structures of ARS(A) and ARS(B) were determined by their electrophoretic patterns in cell hybrids; a dimeric structure was demonstrated for ARS(A) and a monomeric structure for ARS(B). Although the multiple sulfatase deficiency disorder suggests a shared relationship between ARS(A) and ARS(B), independent segregation of these enzymes in cell hybrids did not support a common polypeptide subunit or structural gene assignment. The evidence demonstrates the assignment of ARS(A) to chromosome 22 and ARS(B) to chromosome 5. A third gene that affects ARS(A) and ARS(B) activity is suggested by the multiple sulfatase deficiency disorder.

GM1-gangliosidosis: chromosome 3 assignment of the beta-galactosidase-A gene (beta GALA)

The structural gene (beta GALA) coding for lysosomal beta-galactosidase-A (EC 3.2.1.23) has been assigned to human chromosome 3 using man--mouse somatic cell hybrids. Human beta-galactosidase-A was identified in cell hybrids with a species-specific antiserum to human liver beta-galactosidase-A. The antiserum precipitates beta-galactosidase-A from human tissues, cultured cells, and cell hybrids, and recognizes cross-reacting material from a patient with GM1 gangliosidosis. We have analyzed 90 primary man--mouse hybrids derived from 12 separate fusion experiments utilizing cells from 9 individuals. Enzyme segregation analysis excluded all chromosomes for beta GALA assignment except chromosome 3. Concordant segregation of chromosomes and enzymes in 16 cell hybrids demonstrated assignment of beta GALA to chromosome 3; all other chromosomes were excluded. The evidence suggests that GM1 gangliosidosis is a consequence of mutation at this beta GALA locus on chromosome 3.

Assignment of peptidase S (PEPS) to chromosome 4 in man using somatic cell hybrids

A starch gel electrophoretic procedure is described that resolves peptidase S (PEPS) as well as the peptidases A, B, and C in man-rodent, rodent-rodent, and primate-rodent interspecific somatic cell hybrids. The interspecific PEPS cell hybrid phenotype can be resolved into a pattern which suggests that PEPS is composed of five or six identical subunits. Results are presented supporting assignment of the PEPS locus to chromosome 4 in man using man-mouse and man-Chinese hamster somatic cell hybrids. Human genes coding for peptidases A, B, C, and D were assigned to chromosome 18, 12, 1, and 19, respectively, confirming previous assignments. These somatic cell genetic data demonstrate the independent genetic control of the several human peptidases.