A [14C]phenacetin breath test to measure hepatic function in man

Phenacetin, a high-clearance drug, was labeled as [14C-ethyl]phenacetin and used in a breath test of hepatic function. 14CO2 appeared rapidly in breath such that more than 30% of the administered radioactivity was expired in 2 hr. For all means of expression used to describe the appearance of 14CO2 in breath, normal controls and hospitalized patients without liver disease were clearly separated from cirrhotic subjects with moderate and severe liver damage. The phenacetin breath test was validated by the close correlation of 14CO2 appearance with the disposition of the parent compound examined after its intravenous administration, and by demonstration that the rate-limiting step in 14CO2 generation from labeled phenacetin occurred proximal to 14CO2 generation from [14C]acetate given intravenously. Correcting for the actual volume of CO2 exhaled by control and cirrhotic subjects did not increase the sensitivity of the test. The phenacetin breath test has potential as a simple procedure to quantitate hepatic metabolism of drugs, particularly those mediated by cytochrome P448.

Antigen-specific human B-cell responses: modulation by immunoregulatory T-cell subsets

In vitro T-cell requirements for and modulation of human B-cell responses were studied in individuals immunized in vivo to the protein antigen keyhole limpet hemocyanin or tetanus toxoid. T cells were required for antibody synthesis in both antigen-driven and pokeweed mitogen (PWM)-driven cultures. T cells were separated into T4+ and T8+ subpopulations using monoclonal antibodies, and their modulation of antibody synthesis was studied. T4+ cells functioned as helper cells in both antigen-driven and PWM-driven cultures in a dose-dependent manner. Whereas T8+ cells suppress both total and specific immunoglobulin secretion in PWM-stimulated cultures, in antigen-stimulated cultures T8+ cells do not suppress unless activated by another cell population present in peripheral blood mononuclear cells (PBMNC). This cellular requirement was further investigated by prestimulation of cells prior to addition to optimally stimulated antigen-driven cultures of PBMNC or B cells, monocytes, and helper T cells. No suppression of these optimally stimulated cultures was seen when T8+ cells were precultured with antigen or PWM. However, after 3-5 days preculture of total T cells with PWM or antigen and then selection of T4+ cells, these cells were able to induce fresh autologous T8+ cells to suppress optimally stimulated antigen-driven cultures. Addition of a precultured mixture of T8+ cells with 20% T4+ cells also resulted in antigen-induced suppression. These data indicate that T8+ cells can suppress antigen-driven cultures but require the presence of preactivated T4+ cells for induction of this suppression of antigen-specific T-cell-dependent human B-cell responses.

Alcoholic hepatitis: granulocyte chemotactic factor from Mallory body-stimulated human peripheral blood mononuclear cells

The characteristic histopathological features of acute alcoholic hepatitis include hyaline degeneration of hepatic parenchymal cells (Mallory bodies), hepatocellular necrosis, and granulocyte infiltration of the liver. The chemotactic response of neutrophils to highly purified Mallory bodies was studied. Mallory bodies, per se, were not chemotactic for granulocytes, nor did they generate chemotactic factors when incubated with serum. However, a factor(s) chemotactic for both granulocytes and mononuclear cells was generated when Mallory bodies were incubated with mononuclear cells, both from patients with alcoholic hepatitis or from normal controls. It was concluded that Mallory bodies stimulate peripheral blood mononuclear cells to release a factor chemotactic for granulocytes and mononuclear cells. This factor may be important in the etiology of the cellular infiltration in the livers of patients with alcoholic hepatitis.

RT to tactile stimuli presented ipsi- and contralaterally to the responding hand

Subjects had to react with the hand which received a tactile stimulus (uncrossed condition) or with the hand opposite to the hand which received the stimulus (crossed condition). Four experiments were conducted. In the first three, subjects knew which hand would receive the stimulus and which hand would have to respond. In the first two experiments, subjects reacted to a simple tactile stimulus while in the third subjects had to perform a tactile discrimination before responding. No significant differences in RT under the crossed and uncrossed conditions were observed in the first three experiments. In the fourth experiment, subjects did not know which hand would receive the stimulus, and they also did not know which hand would have to respond. Under these conditions, large significant differences in RT between the crossed and uncrossed condition emerged.

The study includes a criticism of a simple structural interpretation of interhemispheric transmission time (IHTT) as proposed by Bashore (1981). Support is provided for the view that in paradigms of the kind used here, allocation of attention to a psychologically defined hemispace is a more important factor in observed RT than structural links between stimulus and response mechanisms.

Stresses of hospitalization in the elderly: nurses' and patients' perceptions

A study of stress in hospital is reported. Twenty-five patients (aged 70-93 years) and their nurses were interviewed about the patient's perceived stresses during the first and third weeks of hospitalization. The ward was modern in design and a 'patient allocation' system of nursing care was in operation in which one nurse had primary responsibility for each patient. Patients differed significantly from nurses in their use of a 16-item stress scale, using low scale values rather than high (stressful) values. Although as groups, patients and nurses showed significant correlations between stress ratings over the items, this was interpreted as their sharing common stereotypes about the hospital situation. There was no significant relation between nurses' and patients' ratings of the overall stress being experienced by the patients. An analysis of stress items showed there to be significant differences between type of stress. There was least discrepancy between nurses and patients concerning aspects of physical illness and most on the stressful impact of the hospital environment and routine. While patients rated items within this group (e.g. toiletting) to increase in stress during their stay in hospital, nurses rated the stress value as decreasing.

Selective activation of antigen-specific human B cells in recently immunized individuals by nonspecific factors in the absence of antigen

The in vitro effect of nonspecific factors (derived from mixed lymphocyte culture [MLC] supernatants) on human B cell responses was studied in individuals recently immunized in vivo to keyhole limpet hemocyanin, tetanus toxoid, and/or diphtheria toxin. In T cell-depleted fractions of peripheral blood mononuclear cells, nonspecific factors alone, without antigen, selectively induced a specific antibody response to the antigen to which the individual had been recently immunized, at dilutions that did not generate a significant polyclonal response in the remainder of the B cell repertoire. The source of these factors, with respect to MLC donors, did not affect the antibody response. Supernatants of MLC from nonimmunized individuals induced a specific antibody response as effectively as supernatants of MLC from immunized individuals, when added to B cells plus monocytes from recently immunized individuals. Studies in which the same individuals were followed over time showed that these factor-sensitive B cells are seen in the peripheral blood of recently immunized individuals for only a finite period of time. Thus, in vivo immunization with a specific antigen results in the transient appearance in the peripheral blood of B cells that are specific for the antigen in question. These B cells are probably preactivated in that nonspecific factors selectively induce in vitro their further differentiation into antibody-secreting cells, in the absence of added antigen or mitogen. These studies may add further insight into our understanding of the sequential steps involved in the activation and differentiation of human B lymphocytes and provide a model for the combined in vivo and in vitro study of human B cell physiology.

Selective activation of antigen-specific human B cells in recently immunized individuals by nonspecific factors in the absence of antigen

The in vitro effect of nonspecific factors (derived from mixed lymphocyte culture [MLC] supernatants) on human B cell responses was studied in individuals recently immunized in vivo to keyhole limpet hemocyanin, tetanus toxoid, and/or diphtheria toxin. In T cell-depleted fractions of peripheral blood mononuclear cells, nonspecific factors alone, without antigen, selectively induced a specific antibody response to the antigen to which the individual had been recently immunized, at dilutions that did not generate a significant polyclonal response in the remainder of the B cell repertoire. The source of these factors, with respect to MLC donors, did not affect the antibody response. Supernatants of MLC from nonimmunized individuals induced a specific antibody response as effectively as supernatants of MLC from immunized individuals, when added to B cells plus monocytes from recently immunized individuals. Studies in which the same individuals were followed over time showed that these factor-sensitive B cells are seen in the peripheral blood of recently immunized individuals for only a finite period of time. Thus, in vivo immunization with a specific antigen results in the transient appearance in the peripheral blood of B cells that are specific for the antigen in question. These B cells are probably preactivated in that nonspecific factors selectively induce in vitro their further differentiation into antibody-secreting cells, in the absence of added antigen or mitogen. These studies may add further insight into our understanding of the sequential steps involved in the activation and differentiation of human B lymphocytes and provide a model for the combined in vivo and in vitro study of human B cell physiology.

Rapid microanalysis of coagulation parameters by automated chromogenic substrated methods - application in neonatal patients

Daily monitoring of coagulation parameters in critically ill premature born neonates is only possible on small amounts of blood obtained by heelpuncture. Therefore, automated spectrophotometric micro-assays for antithrombin III (AT III), factors II and X, plasminogen and alpha 2 antiplasmin were applied on capillary and venous blood samples concurrently obtained in adults and healthy neonates. No statistically significant difference for any of the parameters was revealed. High levels of platelet factor 4 present in serial capillary samples of adults, did not interfere with the heparin dependent AT III assay. There was no evidence of thrombin or thromboplastin generation in these capillary samples, when examined for Va or VII activities. The levels of AT III, factors II and X and of plasminogen in neonates were 35-45% of the adult levels, in contrast to alpha 2 antiplasmin which was in the adult range.

Immunocytochemical identity of hepatocellular hyalin in alcoholic and non-alcoholic liver diseases

Intracellular, eosinophilic, hyaline inclusions (alcoholic hyalin, Mallory bodies) are found in livers of patients with a number of hepatic disorders, although they are most common in alcoholic liver disease. Tissues from patients with primary biliary cirrhosis, jejunoileal bypass, hepatocellular carcinoma, Wilson's disease, and Indian childhood cirrhosis were all positive for hyalin by hematoxylin and eosin staining. Immunocytochemical labeling, using guinea-pig antiserum specific for alcoholic hyalin, was utilized to determine the extent of crossreactivity between hepatocellular hyalin in these various conditions. This antiserum bound to hyalin in fixed paraffin-embedded sections of all liver tissues studied as detected by indirect immunoperoxidase labeling. Binding to normal human liver, however, was restricted to light staining at the surface of hepatocytes. Preimmune guinea-pig serum did not bind to either normal liver or to the test tissues. Our results suggest that hyalin found found in a diverse group of liver conditions represents an immunologically related structure and that its formation may involve a common mechanism.

[Perinatal mortality and acidosis morbidity rate in pelvic presentation and vertex presentation deliveries]

Pelvic presentation deliveries in the period between 1975 and 1981 were analyzed and compared with a randomly chosen group of vertex presentation deliveries from the same period. On clarification of the group of patients delivered of pelvic presentations, the mortality rate was comparable with that resulting from vertex presentation. In both groups of patients both the mortality and acidosis morbidity rates were affected by the tendency towards premature birth. In cases of pelvic presentation, caesarian section represents the least risky method of delivery. Particularly in the event of premature birth, caesarian section should thus be given preference in all cases. Given careful individual diagnosis, mature infants -even, selectively, in the case of women giving birth for the first time--can be vaginally delivered from the pelvic presentation position.

State licensure for occupational therapists

This is the first in a series of article addressing critical issues facing the profession. Those issues are presented to inform members of their complexity and to provide members with specific actions they can take to support the continued strengthening of the role of occupational therapy in health and education. This article was prepared by Jane D. Davy, OTR, and Mary Peters, M.S., OTR, Government and Legal Affairs Division, The American Occupational Therapy Association, Inc.

Alcohol unrelated hepato-biliary disorders in the alcoholic: the role of liver biopsy in determining the aetiology of liver disease

Alcoholics with abnormal liver function tests are generally assumed to have one of the recognised patterns of alcoholic liver injury. This report described a group of nine patients who were initially thought to have alcoholic liver disease but were found on liver biopsy to have a variety of liver disorders unrelated to alcohol. Liver biopsy showed granulomatous hepatitis in three, primary biliary cirrhosis in two, and cholestasis of unknown cause, large duct biliary obstruction, haemochromatosis with secondary carcinoma and Budd-Chiari syndrome in one each. The histological changes observed in liver biopsy samples are believed to represent a chance occurrence of liver disease due to some agent other than alcohol and illustrates that forms of hepatic disease that affect the population at large can and do occur in heavy alcohol consumers.

Interference between concurrent speaking and sequential finger tapping: both hands show a performance decrement under both visual and non-visual guidance

Report that concurrent speaking reduces right hand sequential finger tapping performance selectively only if the movements are guided non-visually. In these replication experiments, concurrent speaking of both rhyme and prose passages reduced performance both of the right and left hand under visual and non-visual guidance. In the replication experiments the performance of the right hand was slightly more reduced by concurrent speaking than was the case for the left hand. The interference effects are interpreted in terms of the temporal constraints imposed by given motor tasks.

Handedness: coordination of within- and between-hand alternating movements

Two models of coordination of within- and between-hand alternating movements are compared. Model 1 assumes that control of bimanual movement passes back and forth between two independent systems, each of which guides one hand, and that the performance of alternating tapping movements (e.g., right index, right middle fingers) within a hand is very different from performance of alternating movements between hands (right index, left index fingers). The model suggests that right/left performance asymmetries on given tasks reflect the characteristics of the independent systems and would therefore predict that factor analysis would yield a "hand" factor. Model 2 assumes that a single system initiates and terminates movement in two subsystems, each of which guides one hand, and it suggests that the task of guiding alternating tapping movements within a hand is very similar to the task of alternating movement between hands. Model 2 would not predict an independent "hand" factor in the factor analysis of performances of tasks yielding left/right asymmetries; the asymmetries presumably arise because the single higher order system has better access to one of the subsystems than to the other. Analyses of performance of within- and between-hand alternations, single-finger tapping movements, and a pursuit rotor task in 92 subjects lend clear support to Model 2.

Occurrence of tumors and effects on longevity after limited x-irradiation in man

An analysis was made of survival times and causes of death of patients given local irradiation in small dosage during 1948--1960. The study involved 61 patients with peptic ulcers in whom hyperacidity was treated by partial gastrectomy and gastric irradiation, and their mortality was compared with that of 61 age- and sex-matched gastrectomized but nonirradiated control patients. For both groups the survival rates were related to "normal population" survival rates calculated from age-, sex- and year-specific mortality rates for the population of Victoria. Ten years after irradiation the relative survival rates of the irradiated and control groups began to diverge, due to more deaths than expected in the irradiated group. The irradiated group had a significantly increased number of deaths due to cancer, particularly carcinoma of the stomach, as well as an increase in deaths not caused by cancer. The mortality of the nonirradiated control patients was not significantly greater than that of the normal population.

Fungal infection associated with gastroduodenal ulceration: endoscopic and pathologic appearances

Three patients with peptic ulcers diagnosed at upper gastrointestinal endoscopy are reported. All were seriously ill (2 debilitated alcoholics) and died soon afterwards. Fungi were recognized in the antemortem specimen of one of the two ulcers biopsied at the time of endoscopy and in the postmortem specimens of all. In two, demise appears to have been precipitated by erosion of the wall of a major artery by fungal invasion. Culture of the ulcer based as well as throat swabs and stool examination for mycelial and yeast forms of fungus in susceptible patients may allow a more accurate diagnosis to be made and therapy to be instituted.

Amoebic liver abscess: a retrospective clinical evaluation of twenty-seven cases

Twenty-seven patients with Amobebic Liver Abscess were observed during the last two years and were analysed retrospectively with respect to diagnostic procedures and therapeutic strategies. Seven of the 27 patients had surgery and were subsequently referred to our hospital. Those patients with surgery had a longer duration of illness and hospitalization (3.3 months) compared to the other 20 patients with chemotherapy alone (2 months). Most important diagnostic parameters for extraintestinal amoebiasis were: typical clinical findings, time spent in tropical or subtropical countries, strongly positive Latex agglutination against Entamoeba histolytica antigen, and isotope and/or ultrasound scanning to confirm abscess formation in the liver. The vast majority of abscesses were found in the right liver lobe. Response to treatment with complete cure was seen in all patients, regardless of whether Metronidazole alone or combinations of Metronidazole with Chloroquine and Metronidazole and Dehydroemetine or Chloroquine and Dehydroemetine were used. There is a need for prospective therapeutic studies to compare the different drug regimen concerning side-effects, toxicity, costs, application, and duration of hospitalization. From the retrospective data it seems that surgery is not beneficial for the patients.

Left-Handers and Right-Handers Compared on a Motor Task

Finger-tapping performance of 45 subjects of each sex and handedness combination, for a total of 180, was compared. Performance measures were speed (mean intertap interval) and regularity (standard deviation of intertap interval). Males tapped faster but not more regularly than females. The between-hand differences in performance were smaller for both measures in left-handers. When absolute magnitudes of between hand differences were compared, females showed smaller differences in regularity of tapping than males. Speed and regularity of tapping were statistically independent; both measures discriminated well between the preferred and nonpreferred hand of both handedness groups, but the differences in speed were more marked than the differences in regularity. Data on the performance of children on the same task are included for comparative purposes.

Suction capillaries with U-shaped opening for holding moving cells during intracellular electrical recording

The production of suction capillaries with an U-shaped cross-section is described. The capillary may be used for holding contractile cells during intracellular recording to diminish movement artifacts. In addition microelectrode penetration is facilitated by stretching the surface of the cell.

Motor innervation of the pharynx levator muscle of the snail, Helix pomatia: physiological and histological properties

(1) Motor innervation of the pharynx levator muscle of Helix pomatia was investigated with intracellular recording and axonal iontophoresis of cobalt chloride. (2) Muscle fibers respond to direct electrical stimulation of the muscle with active graded responses or non-overshooting spike potentials. (3) Each fiber is innervated via the external and internal lip nerves by several (mostly 3) excitatory nerve fibers each. Two types of EPSPs can be distinguished according to amplitude, duration, and facilitation. (4) Axonal CoCl2-staining via an external lip nerve branch revealed many nerve fibers entering the muscle and branching there into a rich network of blebbed fibers of various diameters.

Studies on the enhancement of rat islet allografts

Attempts to improve the induction of immunological enhancement of (AS X August)F1 pancreatic islet allografts in diabetic AS rats have been carried out. First, by treating the diabetic AS recipient with enhancing serum obtained from AS rats with functioning enhanced (AS X August)F1 islet allografts. In these rats on 1 of 5 islet allografts had a prolonged survival, the other 4 being rejected by 2 days. Second, by transplanting (AS X August)F1 islet allografts into diabetic AS rats bearing functioning enhanced (AS X August)F1 cardiac allografts. All of these islet allografts were rejected by 2 days.

Dietary therapy of gastrointestinal disorders

Diet therapy is mandatory in only a very small number of GIT disorders. While the available evidence does not support its use in other conditions, many physicians will wish to make an individual decision regarding diet therapy according to the patient's symptoms, to the patient's attitudes and expectations and very importantly, to the financial and social implications of the diet in question.

Tests for treponemal antibody in CSF

We studied the potential usefulness of CSF treponemal tests in the diagnosis of neurosyphillis. The CSF was tested with the microhemagglutination test for Treponema pallidum (CSF-MHA-TP test) and with the CSF-FTA test by using undiluted CSF and CSF diluted in saline and in sorbent. In a prospective evaluation, of 177 nonsyphilitics, none had reactive CSF-MHA-TP tests and only one had a reactive CSF-FTA test. However, five of 15 syphilitics with no other evidence of neurosyphilis had reactive CSF-FTA tests. The CSF-FTA test reactivity appeared most likely when the titer of the serum FTA test was high. In a retrospective evaluation of syphilitics with reactive CSF-FTA tests, similar patterns of reactivity occurred in patients with and without other evidence of neurosyphilis. Without other supporting clinical or laboratory data, the diagnostic value of a reactive CSF-FTA test is unknown.

[A comparison of intravenous and infusion cholangiography with intraoperative and tomocholangiography (author's transl)]

Seventy-four patients are described who were examined by various cholangiographic methods. 1. In the diagnosis of stenosis of the papilla, intraoperative cholangiography was found to be the most reliable. Intravenous and infusion cholangiography were of equal value and provided less information than the intra-operative examination. 2. For stones, intravenous and infusion cholangiography is significantly better than the intro-operative cholangiogram. Tomography provides no additional information. 3. For stones in the papilla, the intra-operative method is best and is superior to intravenous and infusion cholangiography. Pre-operative tomography resulted in a loss of information.

Innervation of the ventral diaphragm of the locust (Locusta migratoria)

1. Innervation and some electrical properties of the locust ventral diaphragm were investigated with electrophysiological and histological methods. 2. Muscle fibres are coupled electrically. Electrical stimulation evokes a graded active membrane response. 3. Each segment is innervated by four motor neurones as follows. Two motor neurones are situated in each abdominal ganglion. Branches of their axons supply the ventral diaphragm in the respective and the next posterior segment. 4. This pattern of innervation was confirmed by axonal Co and Ni staining of the motor nerve endings. 5. Neuromuscular junctions are excitatory. EPSPs show summation but no facilitation. 6. Spontaneous electrical activity of the diaphragm is to a certain degree coupled to activity of the main inspiratory muscles.

Comparative survival of pancreatic islets, heart, kidney, and skin allografts in rats, with and without enhancement

Enhancement of (AS X Aug)F1 pancreatic islet allograft survival in diabetic AS rats was achieved by treating the recipient with a course of antidonor antiserum. Their survival in both untreated and treated recipients was compared with the survival of transplanted heart, kidney, and skin allografts similarly treated. The islet allografts in the untreated group were rejected by a mean of 3.2 days whereas the other allografts were rejected by a mean of 8.3 days. In the enhanced group all of the kidney allografts, 7 of 11 heart allografts, and 4 of 10 islet allografts had a prolonged survival, whereas none of the skin allografts had a prolonged survival. Islet allografts are thus more susceptible to rejection than other tissues, but their survival can be prolonged using specific immunosuppression. The reasons for the increased susceptibility to rejection are discussed.

Complete remission of metastatic malignant melanoma following immunotherapy with Bacillus Calmette-Guerin (BCG): report of a case

A complete response to BCG is described in a case of recurrent melanoma. In a woman aged 38 years, intracutaneous metastatic deposits confined to the limb of origin had occurred after excision of a malignant melanoma from the ankle, and elective groin dissection had shown two lymph nodes infiltrated with melanoma. BCG vaccine was applied to the buttock, initially by scarification and later by a multiple puncture gun. All metastases slowly regressed, and biopsy of a metastatic site at six months showed no tumour cells. The patient remains free of detectable disease 36 months after the commencement of therapy. It is inferred that BCG may facilitate remission of melanoma, perhaps by reason of antigenic cross-reactivity between BCG and surface components of human melanoma cells.

Phaeochromocytoma in a footballer

A young footballer with phaeochromocytoma showed classical exercise-induced symptoms. Noradrenergic clincial phenomena suggested an extra-adrenal site. The usefulness of urine metabolite estimation and of localizing procedures and the importance of preoperative alpha and beta blockade are stressed. Nitroprusside was used successfully to control hypertension during surgery. Unexplained fever after operation is reported.

Prolonged practice of a simple motor task by preferred and nonpreffered hands

After prolonged practice (1300 10 sec. trials) the tapping speed of the nonpreferred hand reached that of the preferred hand on a simple finger-tapping task. Analysis of the intertrap intervals showed the variability of the duration of intertrap intervals was smaller for the preferred than for the nonpreferred hand, the difference was not affected by the prolonged practice for N = 1.