Antibodies to neurofibrillary tangles of Alzheimer's disease raised from human and animal neurofilament fractions

Antibodies reacting with neurofibrillary tangles (NFT) of Alzheimer's disease were consistently obtained using neurofilament (NF) fractions as antigen. NF fractions were obtained from normal human spinal roots or guinea pig peripheral nerves and used to immunize BALB/c mice. Mice receiving a total dose of 300 to 600 micrograms of protein developed antibodies that were indistinguishable with immunostaining of tissues and of polypeptides separated on sodium dodecyl sulfate-polyacrylamide electrophoresis gels. These antibodies reacted with NFT from cases of Alzheimer's disease and with NFT induced with aluminum, as well as with structures rich in NF such as central and peripheral axons and cerebellar basket fibers. When used to immunostain polypeptides separated by sodium dodecyl sulfate-polyacrylamide electrophoresis, all antisera recognized the three NF subunits. Absorption of the antisera with 5 micrograms/ml of purified human NF proteins blocked immunostaining of Alzheimer's NFT. It is concluded that human and animal NF fractions are excellent antigens to produce antibodies that consistently react with NFT of Alzheimer's disease. The present findings further support existing evidence that the paired helical filaments of Alzheimer's disease share antigenic determinants with normal NF.

Intrasinusoidal metastatic melanoma of the liver with reactive hepatitis. An immunologic phenomenon?

The macrophage migration inhibition factor (MIF) test toward extracts of choroidal melanoma was repeated four times in a patient with ocular malignant melanoma. In the initial stage, when there was only an ocular finding, the MIF test result was positive. It remained so for a period of two years, even when intrasinusoidal hepatic diffusion developed concomitantly with a nonspecific reactive hepatitis. These histologic findings can be interpreted as evidence of the presence of an immune reaction at a particular moment in the disease process. Several months later, when the patient's condition went into an abrupt decline and showed extensive nodular spread, the results of MIF test were found to have become negative.

Clinical usefulness of monoclonal-antibody phenotyping in childhood acute lymphoblastic leukemia

Lymphoblasts from 59 children with non-T, non-B acute lymphoblastic leukaemia were studied with monoclonal antibodies to four cell-surface proteins. 87% of the children had lymphoblasts positive for HLA-DR, 82% for p30, 75% for p24, and 72% for CALLA. The commonest composite phenotype was HLA-DR+ p30+ CALLA+ p24+. Significant correlations were seen between expression of HLA-DR, p30, and CALLA, but not p24. p30- and CALLA phenotypes were found in patients with high white-blood-cell counts (WBC) and splenomegaly. With standard chemotherapy, disease-free survival from time of remission was shorter in p30- and CALLA- patients than in others. Splenomegaly was associated with poor disease-free survival and provided prognostic information independent of phenotype. High WBC was less significant than phenotype in predicting outcome and was not independent of phenotype.

Postabortal laparoscopic tubal sterilization. Results in comparison to interval procedures

This report documents our experiences in 3 groups of women undergoing laparoscopic tubal sterilization: those undergoing sterilization as an interval procedure, those performed in association with suction curettage, and those performed within 18 hours of second trimester pregnancy termination via intraaminiotic injection of prostaglandin F 2 alpha. As a postabortal sterilization procedure, laparoscopy is effective, logistically appealing, and convenient. There is, however, an increased risk of complications to the procedure when performed on the postabortal women. These include specifically, a 10-fold increased risk of infection and a 2.5-fold increased risk of bleeding complications as seen in our series. The results of these findings are discussed, and some suggestions for reducing these risks are offered.

Uterine trauma associated with midtrimester abortion induced by intra-amniotic prostaglandin F2alpha with and without concomitant use of oxytocin

Five of 80 (6.2%) nulliparous women sustained uterine trauma in association with midtrimester abortion induced by intra-amniotic prostaglandin F2alpha and intravenous oxytocin. All five women suffered cervical lacerations, one extending to the lower uterine segment of the corpus and another associated with myometrial necrosis caused by cornual sacculation and ischemia. No uterine trauma was observed among 95 parous women aborted in the same fashion during this study. The different mechanisms of cervical dilation in the parous woman and the nullipara are offered as an explanation for this difference. Thirty-nine other cases of uterine injury associated with the use of intraamniotic prostaglandin F2alpha from the literature were reviewed, and found to indicate that midtrimester abortion induced by intra-amniotic prostaglandin F2alpha is associated with a significant risk of uterine trauma in the nullipara. The risk seems to increase with the use of oxytocin and with increasing gestational age.

Second trimester abortion: single dose intra-amniotic injection of prostaglandin F2alpha with intravenous oxytocin augmentation

One hundred-sixty mid-trimester pregnancies were terminated by intra-amniotic injection of Prostaglandin F2alpha with concomitant intravenous oxytocin. Only four of 77 nulliparas and one of 83 multiparas required a second prostaglandin injection. Mean injection-abortion interval was 22.8 hours, and 17.0 hours respectively. This difference between groups was statistically significant. Four nulliparas sustained uterine trauma, a high incidence suggesting that this method may be ill-advised in these women. Because of the predictable short injection-abortion interval in the multipara, this method can be combined conveniently with surgical sterilization.

Acquired hypertrichosis lanuginosa associated with endometrial malignancy

A 46-year-old nulligravida complained of the recent development of an erythematous skin eruption and fine blond hair over her face. These complaints appeared to be symptoms of acquired hypertrichosis lanuginosa, which may be associated with malignancy. The patient was found to have an endometrial adenocarcinoma with nodal metastases and was treated with hysterectomy and irradiation. Eighteen months later there was no evidence of the cancer, and the lanugo hairs had vanished. This is the first known instance of hypertrichosis lanuginosa associated with a gynecologic cancer and the first ever observed in which the lanugo hairs disappeared after cancer therapy.

Relationship between the basal glucose concentration, glucose tolerance and forearm glucose uptake in maturity-onset diabetes

The relationship between the basal glucose concentration, glucose tolerance and peripheral glucose uptake has been studied in nonobese diabetic males not requiring insulin by determining forearm glucose uptake (FCU) during a 100 gm. oral glucose tolerance test (GTT) before and after carbohydrate restriction.

On a normal diet basal glucose concentrations were elevated and glucose tolerance was grossly impaired; the increment in FCU during the CTT (0 to 180 minutes) amounted to 52.8 mg./100 ml. forearm. After carbohydrate restriction basal glucose concentrations were reduced, the glucose tolerance curve was lowered and the increment in FCU rose to 76.5 mg./100 ml. forearm; glucose tolerance, however, expressed as the incremental area under the glucose tolerance curve (0 to 180 minutes), remained unchanged.

Serum insulin responses during the tests were low and uninfluenced by carbohydrate restriction. Blood lactate concentrations were increased by glucose loading before but not after carbohydrate restriction. FFA and β-hydroxybutyrate concentrations fell progressively after glucose loading while, conversely, acetoacetate concentrations were initially unchanged. During the GTT acetoacetate was taken up by the forearm while lactate and β-hydroxybutyrate were released.

In addition, the responses of three diabetics on a normal diet were compared with those of age-matched normal men; in each diabetic FGU was equal to or greater than that in the normal subjects, but nonetheless, the increment in glucose concentrations was several times greater.

The results suggest that in these patients with diabetes [1] the lowering of the glucose tolerance curve by carbohydrate restriction is not synonymous with an over-all improvement in tissue glucose disposal but is due primarily to a fall in the basal glucose concentration and [2] the impairment of glucose tolerance both before and after carbohydrate restriction is predominantly the result of a reduction in hepatic rather than peripheral glucose uptake.

Forearm glucose uptake during the oral glucose tolerance test in normal subjects

Total forearm glucose utilization (FGU) was determined during 100 gm. oral glucose tolerance tests (GTT) in twenty-five normal volunteers. In addition, the concomitant balance of insulin, growth hormone, and lactate across the forearm was studied in thirteen subjects.

The increment in FGU during the three hours following glucose ingestion amounted to 74 mg./100 ml. forearm; it may be calculated that increased peripheral glucose utilization accounted for the disposal of 42 per cent of the 100 gm. load and that during the GTT some 58 gm. of extra glucose reached the peripheral circulation.

Serum insulin concentrations in mixed venous (MY) blood rose steeply after glucose loading, while growth hormone levels were reduced. Additional observations in thirteen subjects showed that MV insulin levels remained significantly lower than corresponding arterialized venous (AV) concentrations between thirty and 150 minutes, suggesting that insulin was being continually removed bythe forearm tissues during this time. Significant AV-MV differences were not detected in growth hormone levels.

Plasma lactate concentrations rose immediately after glucose loading, reaching a peak at sixty minutes and declining thereafter. The initial elevation was associated with lactate uptake by the forearm and the subsequent fall with lactate release, suggesting that peripheral lactate metabolism has little or no influence on the shape of the lactate response curve. It is suggested thatthis early rise in lactate concentrations is the result of increased hepatic lactate production and that the timing and height of the lactate peak reflect the pattern of enhanced hepatic glucoseutilization after oral glucose loading.

Our results suggest that the disposition of a 100 gm. oral glucose load is accounted for mainly by hepatic glucose conservation rather than peripheral uptake and, therefore, that the former is the major determinant of the shape of the oral glucose tolerance curve.

Dietary diabetes. The influence of a low carbohydrate diet on forearm metabolism in man

Forearm glucose uptake and lactate balance across the forearm were determined in normal subjects during 100-gm. oral glucose tolerance tests (GTT) before and after a lowcarbohydrate diet; in addition, β-hydroxybutyrate and acetoacetateresponses were measured following carbohydrate restriction. After a low-carbohydrate diet, glucose tolerance was significantly impaired (dietary diabetes) and the rise in seruminsulin levels was frequently, but not invariably, delayed. Forearm glucose utilization, however, was not significantly decreased at any phase of the GTT or during the GTT as a whole.

With a normal diet, lactate levels rose immediately after glucose loading, reaching peak concentrations at sixty minutes and falling progressively thereafter; this rise was associated with lactate utilization by the forearm and the subsequent fall in plasma concentrations with lactate release. In contrast, following carbohydrate restriction lactate concentrations were initially reduced by glucose administration, this reduction taking place despite continuing lactate release from the forearm. These results suggest that after glucose loading the shape of the lactate response curve is not determined primarily by changes in peripheral lactate balance.

Marked elevation in basal FFA, β-hydroxybutyrate, and acetoacetate levels accompanied carbohydrate restriction. FFA and β-hydroxybutyrate concentrations were immediately decreased and acetoacetate levels initially increased by glucose loading, the latter declining only during the second hour of the GTT; throughout the test, acetoacetate was taken up by the forearm while β-hydroxybutyrate was released. Basal FFA and β-hydroxybutyrate concentrations were not correlated with the degree of glucose intolerance induced in the volunteers.

The results show that the impairment of glucose tolerance following carbohydrate restriction is not the result of decreased peripheral glucose utilization. It is suggested that the major cause of dietary diabetes is a delay in the hepatic uptake of the glucose load and that this is primarily the. result of low hepatic glucokinase activity rather than delayed insulin secretion.