[Extrinsic allergic alveolitis. Apropos of a severe case]

A case of atypical extrinsic allergic alveolitis in a 13-year-old is reported. Onset was sudden with gradually increasing dyspnea on exertion over a four-day period. The chest film evidenced a reticulonodular syndrome with decreased respiratory movements. The patient's clinical status worsened over the next 48 hours with the development of respiratory distress. Under oxygen therapy (3 l/min), PO2 was 49 mmHg and SO2 was 82%. Dramatic improvement occurred after initiation of corticosteroid and antimicrobial therapy. Etiologic investigations were negative except for the immunofluorescence test with pigeon droppings which showed three precipitation arcs. A CT scan of the chest disclosed diffuse micronodular densities without thickening of connective tissue trabeculae, suggesting alveolar disease. Mediastinal lymph nodes were not enlarged. Vital capacity was 26% of the theoric value. Corticosteroids were given for one month. On follow-up chest films, the reticulomicronodular syndrome was seen to abate, globally at first, then from the apices to the bases of the lungs. However, a repeat CT scan at the 4th month showed that diffuse lesions were still present although the chest film was normal; 8 months after onset, there was only a bulla in the left lung base, with no evidence of fibrosis. Lung function tests slowly returned to normal, as did CT scan findings.

Characterization of a hyaluronic acid-binding protein from sheep brain comparison with human brain hyaluronectin

1. A hyaluronic acid (HA)-binding glycoprotein from sheep brain was characterized. 2. The specific affinity for HA was shown in vitro by high performance liquid chromatography, polyacrylamide gel electrophoresis and ELISA methods. 3. The KD for high molecular weight HA was 5.4 10(-9) M at 37 degrees C and lower than 10(-10) M at 4 degrees C. 4. No link protein was found and HA molecules could bind up to 10 times their weight of the glycoprotein. 5. The specific site for interaction was the HA-derived decasaccharide HA10. 6. The protein is composed of one polypeptidic chain. Tryptophan and lysine play a prominent role in the conformation of the binding site to HA. 7. Enzyme analysis indicated that the protein different forms are due to differences in glycosylation and that N- and O-linkages coexist in the molecules. 8. Immunohistochemistry localized the glycoprotein at the nodes of Ranvier and at the periphery of neurons. The perineuronal labeling was seen around all neurons studied in the cerebellum whereas it was almost undetectable in the cerebral hemispheres. 9. HA is not saturated by hyaluronectin (HN) in the sheep nervous system. 10. The glycoprotein is largely similar to human brain HN, and different from the hyaluronate-binding protein characterized in the cartilage.

The extracellular matrix during neural crest formation and migration in rat embryos

Changes in the distribution of extracellular matrix components have been investigated immunohistochemically during neural crest development in the rat. Inside the ectodermal epithelium basal lamina components are formed resulting in a separation of neurectoderm and epidermal ectoderm. Within the presumptive neural crest area fibronectin, hyaluronan and chondroitin sulphate become apparent. Upon subsequent neural crest migration the basal lamina becomes disrupted. As the neural crest cells take part in mesectoderm formation, fragments of the basal lamina remain attached to their surface, as is demonstrated with antibodies against laminin and collagen type IV. The extracellular matrix is therefore active both in the separation of neuroectoderm from epidermal ectoderm and in mesectoderm formation.

Wound repair and the potential use of growth factors

Failure of wounds to heal increases the physical and financial burden of hospitalization and increases the work load for health care professionals. Although careful attention to nutrition (including adequate replacement of vitamins and trace mineral elements), tissue perfusion and oxygenation, and wound dressing and sanitation promote more rapid and complete healing, some wounds respond only slowly or not at all to these conventional treatment modalities. A group of polypeptide growth factors, including epidermal growth factor, platelet-derived growth factor, transforming growth factor beta, and basic fibroblast growth factor, have been found to promote or hasten healing in animal models. This technology is now moving into the clinical arena where its potential for human healing must be evaluated.

[Intra-arterial thrombolytic therapy of lower limb ischemia]

Between 1984 and 1989, 35 patients with recent arterial or graft occlusions have been treated with intra-arterial infusion using sequential association of Urokinase (U.K.) and Lys-Plasminogen. Occlusion was thrombotic in 68.5% of the cases ans embolic in 31.5%, involving 28 native arteries and 7 bypass grafts. The mean duration was 16 days (2 to 90). Continuous infusion of U.K.: 84,000 U.I./H and bolus of Lys-Plasminogen 15 microKatals every 30 minutes were delivered through a catheter embedded into the clot. Intra-venous heparin was always associated. The mean duration of lytic drug infusion was 8 H. Complementary arterial reconstruction by vascular surgery of percutaneous transluminal angioplasty was performed in 23% of the patients. Patients with recent alimentary tract bleeding, hemorragic stroke in the last six months or severe high blood pressures were contra-indicated. Complete lysis was obtained in 23 cases (66%), partial lysis in 7 (20%) and no lysis in 5 (14%). The clinical result was excellent in 24 cases (68.5%), good in 3 (8.5%) and bad in 8 (23%) in which amputation was always necessary. 5 local hematoma (14%) treated by surgery or transfusion and one death (3%) due to neurological complication occurring 24 hours after the end of the procedure were observed. The literature survey has shown that the results of low doses of Streptokinase (S.K.) local infusions were not better, and that higher doses of S.K. or U.K. delivered during a shorter infusion time increased the efficacy of lysis and decreased the rate of hemorragic complications. We have proposed the local thrombolytic treatment to the limb threatening ischemic cases when the traditional medical or surgical techniques where thought to be associated to a high risk of failure or complication. The specific indications are the acute or sub-acute ischemic situation due to atheromatous artery thrombosis, distal or old embolism where the Fogarty catheter is inefficient, and graft thrombosis. Severe acute ischemia with neurologic involvement are not good indications. Local thrombolysis can be successful on arterial occlusion even after one month duration.

Immunoreactivity of boronated antibodies

Boronated antibodies have already been evaluated as agents in neutron capture therapy. Because the boronation procedure may alter the properties of the antibody it is important to study the immunoreactivity of the conjugated antibody before in vivo use. In our studies of two dextran-boronated monoclonal antibodies, anti-glial fibrillary acidic protein antibody, and anti-hyaluronectin antibody, we have used ELISA and immunohistological methods to determine antibody activity and specificity. A ten-fold decrease in activity was observed for both antibodies in ELISA, and non-specific interactions were seen in both immunohistological and ELISA procedures. The boron compound used was shown to be at least partly responsible for these non-specific interactions.

The pain of burns: characteristics and correlates

This study examined the characteristics of pain experienced by burned patients. Sources of inter-individual variations were also studied and the interrelationships between anxiety, depression, and pain were investigated. Forty-two adult patients hospitalized for burn injuries participated in the study. The McGill Pain Questionnaire and a visual analogue scale were employed to measure the pain experienced at rest and during therapeutic procedures. Anxiety and depression levels were assessed with the Spielberger State Anxiety Inventory, the Beck Depression Inventory, and visual analogue scales. The results showed that the pain varies greatly from patient to patient and undergoes wide fluctuations over time in each patient. The greatest pain is usually experienced during therapeutic procedures, the patients reporting significantly more pain on these occasions than at rest. Variations in pain severity were not related to socio-demographic characteristics of the patients, the length of time elapsed since the injury, or the quantity of analgesics administered. The extent of the burns was a significant predictor of pain but only in the first week after the injury. High levels of anxiety or depression were not necessarily associated with higher pain scores during therapeutic procedures but the patients who were more anxious or depressed tended to report more pain when at rest. These results are discussed in relation to pain management strategies, with particular emphasis on the need for the analgesic therapy to be highly individualized and frequently adjusted.

[X-ray computed tomography of fractures of the calcaneum. Apropos of 30 cases]

Computed tomography and lateral plain films have been studied in 30 fractures of calcaneus. C.T. allows us to study in the same time the two feet, with low mobilisation. Two planes are mandatory: --one, along the long axis of the calcaneus, allows a good evaluation of calcaneo-cuboïd joint, of the quality of the bone structure and of the large fragments or comminution; --the other one (coronal in 18 cases of along the tuberosity in 16 cases) shows directly the subtalar joint lesions (impaction, joint incongruence) and plantar fracture line. This study conclude that CT is useful for the evaluation of the severity calcaneus fractures and for treatment selection because of a better evaluation of lesions.

[Tolerance of femoral vein catheterization]

The femoral vein is a convenient venous access site which has remained relatively neglected since earlier reports of major complications. However, over the last 10 years, its beneficial use for various purposes (mainly haemodialysis) justifies a reexamination of the value of femoral venous catheterization. The ease of femoral catheterization and its complications were prospectively studied in 92 intensive care patients. Of the 113 attempts made by physicians, 75% of whom were inexperienced, 103 (91.2%) were successful. Insertion resulted in 17 (15%) arterial punctures and 5 local hematomas. Seventy catheters were left in place for an average of 8.8 days. No clinical manifestations of thrombosis were observed. Bilateral phlebography was carried out before removal of the catheter in 70 cases; 45 (64%) of these controls were normal. Of the remaining 25 pathological phlebograms, there were 11 (15.7%) fibrin sleeves, 2 (2.8%) partial thromboses of the common femoral vein which could be directly linked to the venous cannulation, and various abnormalities not directly due to the catheterization (superficial femoral vein thrombosis (4), thrombosis of calf or popliteal veins (18]. One case of catheter septicaemia occurred. Microorganisms were present in 15 (18.3%) of 82 catheter cultured tips. Percutaneous catheterization of the femoral vein might therefore be considered as a good venous access route. It can be successfully used by inexperienced physicians. There is no serious risk of injury to surrounding structures and the risks of thrombosis and infection are acceptable in comparison with other routes.

Hyaluronic acid accumulation and endothelial cell detachment in intimal thickening of the vessel wall. The normal and genetically defective ductus arteriosus

The closing ductus arteriosus (DA) was studied as a model for the development of intimal thickening of vessel walls using ultrastructural and immunohistochemical techniques. The material consisted of DA from neonatal dogs of three types: normal beagles, DA-defective pups from a line of mixed poodles with a genetic defect in the closure of the DA leading to persistent ductus arteriosus (PDA line), and normal litter-mates of DA-defective pups in the PDA line. The DA of the normal litter-mates of DA-defective pups did not differ from those of normal beagles. In the DA of normal beagles and normal PDA-line pups, closure is preceded by intimal thickening characterized by formation of a widened subendothelial region (SR), detachment of endothelial cells, invagination of endothelial cells, and migration of smooth muscle cells into the SR. It was observed that immediately before and after endothelial cell detachment, there was an increase in hyaluronic acid (HA) in the SR and inner media. In the DA-defective pups, the increase in hyaluronic acid failed to occur and there was no intimal thickening. The SR failed to expand, endothelium remained attached to the internal elastic membrane, and there was no invagination of endothelium or migration of smooth muscle cells. It is hypothesized that the increased synthesis of HA is an important early event leading to intimal thickening in the normal DA and perhaps to abnormal intimal thickening of other vessels. By its hygroscopic properties, HA may be directly involved in the formation of a wide SR, inducing endothelial cell detachment and favoring smooth muscle cell migration. In affected pups of the PDA line, there is a genetically-determined "block" in the normal process of intimal thickening at or before the initiation of increased HA synthesis.

Hyaluronectin: detection with monoclonal antibodies in human tumors

Two monoclonal IgG1 antibodies (MAbs) were raised against human brain hyaluronectin (HN) and used to characterize tumor HN. They were screened using an enzyme immunological technique (ELISA) combined with the HN property of specific binding to hyaluronic acid. They were shown to detect two different epitopes (HN1 and HN2) in human normal brain as well as in most tumors. Both HN1 and HN2 epitopes were found associated with mesenchymal benign or neoplastic proliferations (e.g. connective areas of fibroadenomas, extracellular matrix of fibrosarcomas) and with reactive connective tissue (e.g. stroma reaction of carcinomas, ground substance of gliomas). The results corresponded with those previously obtained with polyclonal rabbit antibodies and confirmed that HN is a constant marker of desmoplasia. Thus anti-HN MAbs recognize an antigen that is associated with tumor development and will be suitable for targeting.

Specific monoclonal antibodies to glial fibrillary acidic protein (GFAP)

Anti-glial fibrillary acidic protein (GFAP) monoclonal antibody has been obtained by fusing SP2/O myeloma cells with splenic cells from mice immunized with human GFAP. It belongs to the IgG1 class and it recognizes an epitope on GFAP which is shared by each fragment of the protein. Immunohistological studies show that the epitope characterized is absolutely specific for GFAP.

Characterization of hyaluronic acid on tissue sections with hyaluronectin

An affinity immunological procedure for hyaluronic acid detection on tissue sections is described. This new, sensitive, and specific technique is based on the high affinity of hyaluronectin for hyaluronic acid, utilizing anti-hyaluronectin-hyaluronectin immune complexes. Elimination of binding when the reagent was supplemented with hyaluronic acid or when Streptomyces hyaluronidase-digested tissue sections were used emphasizes the specificity of the assay. This technique made possible accurate HA localization in embryonic mesenchyme, in neural tissue, in kidney medulla, and in tumors.

[Digitalized angiography of the thorax in children]

Technical aspects and indications for the use of digital subtraction angiography of thorax in 109 children are discussed, and the interest of this exploratory method emphasized in chronic respiratory disease in children. Results obtained are compared with other investigations for screening of bronchopulmonary dysplasia. Although generally reliable for exploration of thoracic aorta anomalies (coarctation and abnormal vascular arch) it is considered to be incompletely effective for investigation of congenital heart disease.

Localization of hyaluronectin in the nervous system

The localization of hyaluronectin was determined by immunofluorescence and immunoperoxidase methods, in the rat, the sheep and the human. The study of the peripheral nervous system revealed the localization of this protein at the node of Ranvier. It was also present at this site in the central nervous system where the appearance was less characteristic than in the peripheral nervous system. The protein was also observed around about 10% of neurones in all of the regions studied. The subcellular structures labelled could not be precisely defined with the optical microscope.

Hyaluronectin in normal human skin and in basal cell carcinoma

The localization of hyaluronectin has been studied in normal skin and in basal cell carcinoma. In fetal skin it is abundant in the dermis but absent from the epidermis, and in adult skin it is totally absent except in the hair sheaths and bulbs. In basal cell carcinoma it is abundant only in the stroma reaction. The presence of this protein in mesenchymatous tissues seems to be linked to zones of physiological or neoplastic proliferation.

Inhibition of active E rosette forming T lymphocytes by hyaluronic acid. Evidence of a receptor for hyaluronic acid on a lymphocyte subpopulation

Previous studies have shown the inhibition of active E rosette forming T lymphocytes by a mesenchyme associated antigen. Recent results clearly indicated that this antigen consisted in the association of a glycoprotein named hyaluronectin with hyaluronic acid. Using the active E rosette technique of Wybran and Fudenberg, we have studied the action of hyaluronic acid on T lymphocytes. We obtained evidence of the partial inhibition of active E rosette formation by hyaluronic acid in 19 of 25 healthy subjects. Among them, inhibition percentage was 45 +/- 4. This inhibition remained significant at a concentration of 22.5 micrograms/ml hyaluronic acid. Hyaluronic acid was labelled with peroxidase by the glutaraldehyde technique: 17 +/- 7% lymphocytes were stained by this preparation. The preincubation of peroxydase labelled hyaluronic acid by brain hyaluronectin lowered this staining. This is in agreement with the presence of hyaluronectin on a subpopulation of lymphocytes as it was shown by immunofluorescence techniques. In conclusion, a receptor for hyaluronic acid (hyaluronectin) was detected on a proportion of lymphocytes. These results suggest that hyaluronic acid could have an immunosuppressive activity.

Brain glycoprotein in tumours of the nervous system

We studied various tumours of the nervous system by the immunofluorescence technique using an anti-brain specific alpha 2 glycoprotein antiserum (anti-NSA3 antiserum). We found the antigen in 24/27 astrocytomas and 4/4 oligodendrogliomas but in none of the 8 meningiomas tested. There was an identity between the astrocytoma/oligodendroglioma antigen and that of normal brain as shown by the immunoprecipitation technique. By the immunofluorescence technique using inhibition of the antiserum we demonstrated that the tumour antigen is devoid of some specific nervous system determinants present in normal brain.

Isolation and characterization of a mesenchyme associated antigen from dimethylbenzanthracene induced rat fibrosarcoma

Using an antiserum directed against human neurospecific antigen and the indirect immunofluorescence technique, we have obtained evidence for the presence of a mesenchyme associated cross-reacting antigen (MAA) in the dimethylbenzanthracene induced fibrosarcoma of the rat. This antigen has been purified from this tumor and compared with the antigen associated with the human nervous system and that associated with the nervous system of the rat. An anti-rat MAA antiserum has been obtained. It has cytotoxic activity against cultured fibrosarcoma cells as measured by release of radioactivity. This antigen can be considered as a marker of fibrosarcomas.

An antigen associated with mesenchyme in human tumours that cross-reacts with brain glycoprotein

Anti-NSA3 antiserum was found to react with many kinds of benign and malignant tumours, as well as foetal skin and intestinal extracts. The corresponding antigens isolated from nervous tissue, benign breast adenoma, and a fibrosarcoma were compared. Immunoprecipitation cannot distinguish between these antigens, and their amino-acid contents were comparable. However, immuno-absorption identified an antigenic determinant that was confined to nervous tissue. Indirect immunofluorescence further confirmed the validity of the concept of a nervous form vs a mesenchymal form of the antigen. Furthermore, immunofluorescence enabled the localization of the antigen found in non-nervous tissue to mesenchyme (mesenchyme-associated antigen: MAA), whether the mesenchymal tissue be normal (foetal organs), tumoral (fibrosarcoma) or reactional (connective-tissue stroma of epithelial tumours).

[Association of brain glycoprotein (NSA 3) with neuronal membranes and with the nodes of Ranvier]

The localisation of brain glycoprotein NSA 3 was studied by means of indirect immunofluorescence on alcohol fixed, paraffin embedded sections of Rat brain. These techniques allowed the localisation of NSA 3 to the membrane of some (about 10%) of the neurons. In the white matter, the patterns were in agreement with the localisation of the Ranvier nodes. The nodes of Ranvier were also stained in peripheral nerves.