Pneumonia carcinomatosa from small cell undifferentiated carcinoma of the lung presenting as "reverse radiation pneumonitis"

We describe a patient with recurrent small cell undifferentiated lung carcinoma after chemotherapy and mediastinal radiation therapy who presented with peripheral pulmonary infiltrates on chest radiograph. At autopsy the patient was found to have carcinomatous pneumonia confined to the radiographically abnormal lung. The descriptive term "reverse radiation pneumonitis" is applied in view of the striking nonsegmental distribution of these pulmonary infiltrates, which occurred only outside the irradiated field. In this patient, radiation therapy successfully controlled disease in the treated lung parenchyma, thus accounting for this unusual radiologic and histologic picture. Pneumonia carcinomatosa, occurring after lung irradiation, can therefore be added to the differential diagnosis of radiographic peripheral pulmonary infiltrates.

Spontaneous osteonecrosis of the knee. Scintigraphic findings

Three cases of spontaneous osteonecrosis (SON) of the knee, comprised of two cases involving the medial tibial plateau and one involving the medial femoral condyle, are reported. Because of the relatively normal x-rays early in the course of the disease, the differential diagnosis of a painful knee is markedly shortened with the typical scintigraphic findings in SON. The scintigraphic findings represent a focal area of increased activity at the affected site on a three-phase bone scan.

Mutation plus amplification of a transducer gene disrupts general chemotactic behavior in Escherichia coli

Transducers are transmembrane receptor proteins that generate intracellular signals on stimulation and participate in adaptation by appropriate changes in the level of methylation. The transducer mutation trg-21 conferred a Trg- phenotype and defective taxis to galactose and ribose but a normal response to other attractants when present in a single chromosomal copy. Amplification of trg-21 by a multicopy plasmid made host cells generally nonchemotactic. The dominant phenotype resulted from a strong counterclockwise rotational bias of flagellar motors in Che- cells. Apparently, the Trg21 transducer sends a continuous counterclockwise signal to flagella independent of tactic stimulation. It appears that the cell has a homeostatic capacity that is sufficient to compensate for the effect of mutant transducers produced from a single chromosomal copy of trg-21, but the capacity is exceeded in cells that have multiple copies of the gene. The Trg21 protein did not have a significant effect on methylesterase activity, indicating that the two global effects of a stimulated transducer, that is, on flagellar rotation and on modification enzymes, can occur independently. The mutant protein exhibited essentially normal turnover of methyl groups but had a drastic defect in deamidation which thus reduced the number of methyl-accepting sites. The trg-21 mutation substitutes a threonine for Ala-419. This alanine is a conserved residue in all sequenced transducers and is in a region of the carboxy-terminal domain in which homology among the transducers is very high. The Trg21 phenotype implicates this conserved region in the generation of the excitatory signal which is directed at the flagella.

Mutations specifically affecting ligand interaction of the Trg chemosensory transducer

The Trg transducer mediates chemotactic response to galactose and ribose by interacting, respectively, with sugar-occupied galactose- and ribose-binding proteins. Adaptation is linked to methylation of specific glutamyl residues of the Trg protein. This study characterized two trg mutations that affect interaction with binding protein ligands but do not affect methylation or adaptation. The mutant phenotypes indicated that the steady-state activity of methyl-accepting sites is independent of ligand-binding activity. The mutation trg-8 changed arginine 85 to histidine, and trg-19 changed glycine 151 to aspartate. The locations of the mutational changes provided direct evidence for functioning of the amino-terminal domain of Trg in ligand recognition. Cross-inhibition of tactic sensitivity by the two Trg-linked attractants implies competition for a common site on Trg. However, the single amino acid substitution caused by trg-19 greatly reduced the response to galactose but left unperturbed the response to ribose. Thus Trg must recognize the two sugar-binding proteins at nonidentical sites, and the complementary sites on the respective binding proteins should differ. trg-8 mutants were substantially defective in the response to both galactose and ribose. An increase in cellular content of Trg-8 protein improved the response to galactose but not to ribose. It appears that Trg-8 protein is defective in the generation of the putative conformational change induced by ligand interaction. The asymmetry of the mutational defect implies that functional separation of interaction sites could persist beyond the initial stage of ligand binding.

Transfer of chromosomal mutations to plasmids via Hfr-mediated conduction

Nonconjugative plasmids can be transferred from an Hfr donor to a recipient by Hfr-mediated conduction. We found that this phenomenon can be employed to obtain a plasmid in which a mutation in a chromosomal gene has been transferred to the copy of that gene contained in the hybrid plasmid.

Discordant gallium-67 and indium-111 leukocyte images in a suspected pelvic abscess

An Indium-111 labeled white blood cell scan suggested the presence of a pelvic abscess in a woman at four weeks postpartum. This was not identified on a subsequent gallium scan. This discrepancy can be attributed to the normal accumulation of white blood cells within the uterus at one month postpartum.

Plantar pressures and gait parameters: a study of foot shape and limb rotations in children

The most frequent referral diagnosis of childhood to an orthopaedic department is a limb rotational anomaly which manifests itself as either an abnormality of gait or flatfeet. The child is usually asymptomatic, the anxiety being generated in the minds of the parents. One hundred normal children were studied using a Pedobarograph to assess underfoot pressures, and a simple walkway to measure dynamic gait parameters. The results have been correlated with age, and the trends suggest that the pedobarograms may be of use in the prognostication of lower limb rotations. The methods, which are totally noninvasive and can be carried out in the clinic, have the added advantage of reassuring parents that "something is being done."

Structure of the Trg protein: Homologies with and differences from other sensory transducers of Escherichia coli

Transducer proteins are central to chemotaxis in Escherichia coli. Three transducer genes comprise a homologous gene family, while a fourth gene, trg, is more distantly related. We have determined the nucleotide sequence of trg. The deduced sequence of the Trg protein has features in common with other transducers as well as regions of significant divergence. The protein sequence suggests the same transmembrane structure postulated for other transducers: an extra cytoplasmic NH2-terminal domain connected by a membrane-spanning region to an intracellular COOH-terminal domain. The COOH-terminal domain of Trg exhibits substantial sequence identity with the corresponding domains of the other transducers, particularly near the sites of covalent modification. Trg appears to have the same five methyl-accepting sites identified in the Tsr protein. Two of those sites are glutamines that are deamidated to yield methyl-accepting glutamates, while the remainder are synthesized as glutamates. Conservation in number but not in position of modified glutamines in Trg compared to the other transducers is consistent with the notion that uncharged glutamines at a specific number of modification sites serve to balance the signaling state of newly synthesized transducers. The NH2-terminal domain of Trg exhibits no significant homology with other transducers, implying that trg may be a fusion of the common COOH-terminal transducer sequence with an unrelated NH2-terminal sequence. The location of specific mutations within trg provides support for the suggestion that ligand-binding sites are in the NH2-terminal domains.

Experience with the microbiologic diagnosis of Campylobacter enteritis in an office laboratory

Campylobacter jejuni has been recognized as a frequent cause of bacterial diarrhea in infants and children. C. jejuni is a fastidious, Gram-negative, comma-shaped or sea gull-shaped, curved rod which is capable, particularly during the summer months, of causing slimy mucoid, blood diarrhea, abdominal pain and fever. In our pediatric office laboratory we found over a 12-month period that 14 (10%) of 126 stool specimens contained this pathogen. All but two children were diagnosed during the late spring and summer. There was no common source for Campylobacter infections in the patients. In 8 (66%) of 12 patients, C. jejuni infection was immediately detected by examining a 1% aqueous basic fuchsin-stained stool smear. Uncontrolled observations from this study suggest that erythromycin therapy, if started within 2 to 3 days of the onset of illness, is clinically effective.

Effect of the extracellular matrix on plasminogen activator isozyme activities of human mammary epithelial cells in culture

Multiple molecular forms of plasminogen activator were detected in normal human mammary epithelial cells in culture. Cells derived from (normal) breast mammoplasty specimens and grown on the surface of collagen gels exhibited three major classes of plasminogen activator isozymes (Mr = 100,000 [100K], 75,000 [75K], and 55,000 [55K]). The activity of the 100K and 75K isozymes was greatly reduced when the cells were grown on conventional tissue-culture-grade plastic surfaces. MCF-7, a human mammary carcinoma cell line, exhibited predominantly or exclusively the 55K isozyme, irrespective of the cell growth substratum. The activity of the 55K isozyme was more than twofold higher for MCF-7 cells grown on collagen gels than for cells grown on plastic. Progesterone, diethylstilbestrol, and estrogen stimulated the activity of the 55K isozyme of MCF-7 cells, but only when the cells were grown on a plastic surface. The plasminogen activator activities of the normal human mammary epithelial cells were not stimulated by these hormones, irrespective of the growth substratum. These results show that the expression of plasminogen activator isozymes by human mammary epithelial cells is subject to modulation by the extracellular matrix. Normal and malignant cells may differ in their responsiveness to these effects.

Partial barrier-absorption probabilities for the Wiener process

Let {W(t), 0 ≦ t < ∞} be the standard Wiener process. The techniques of computing probabilities of the type are well known. The main purpose of this paper is to present ways of finding barrier-absorption probabilities when the barrier function is defined only on sub-intervals of [0, T].

Management of the deformed rheumatoid forefoot. A comparison of conservative and surgical methods

In a retrospective survey of 65 patients who had rheumatoid arthritis, the late results of excision arthroplasty of the forefoot were investigated and compared with nonoperative management. Subjective assessment of foot shape and severity of pain as well as objective changes in gait and deformity were considered. Surgery relieved pain initially, but the recurrence rate of metatarsalgia was high. In those who wore surgical shoes, lack of cosmesis was the most important factor in determining poor compliance. The operation was recommended at random, and there was little difference in the outcomes of nonoperative and surgical treatments. A long-term randomized prospective trial is required to establish the criteria for selection of a management regime.

Variation in Counts, Enterotoxin Levels and TNase in Swiss-Type Cheese Contaminated with Staphylococcus aureus

In 1977, a number of staphylococcal intoxications occurred as a result of several lots of Swiss-type cheese being contaminated with Staphylococcus aureus . Blocks of cheese representing 59 of the recalled lots manufactured between January 5 and April 25, 1977, were examined for S. aureus counts and for staphylococcal thermonuclease (TNase), enterotoxin and pH. Counts ranged from <25 to 10⁸ S. aureus /g, with most blocks containing between 10⁴ and 10⁶/g. Enterotoxin B was present in 72.6% of 186 samples and TNase in 52.5% of 122 samples tested. The pH was generally between 5.5 and 5.7 with some samples as high as 6.2; normal pH for Swiss-type cheese is 5.7. Variations in levels of these parameters occurred within lots and even within blocks, as well as between lots. Within blocks there seemed to be differences between samples at the center and the periphery. The activity and degree of contamination of the starter cultures, temperatures of cooking and ripening and the speed of salt penetration could be factors causing these variations. TNase was not detectable in all samples containing enterotoxin, especially those with <0.5 μg/100 g. Therefore, cheese suspected of being a health hazard, such as being manufactured under unsanitary conditions or suspected of being contaminated with S. aureus , should be sampled at the center and periphery of blocks, if these are available, and analyzed for S. aureus counts, TNase and enterotoxin.

Tunguska Meteor Fall of 1908: Effects on Stratospheric Ozone

In 1908, when the giant Tunguska meteor disintegrated in the earth's atmosphere over Siberia, it may have generated as much as 30 million metric tons of nitric oxide (NO) in the stratosphere and mesosphere. The photochemical aftereffects of the event have been simulated using a comprehensive model of atmospheric trace composition. Calculations indicate that up to 45 percent of the ozone in the Northern Hemisphere may have been depleted by Tunguska's nitric oxide cloud early in 1909 and large ozone reductions may have persisted until 1912. Measurements of atmospheric transparentiy by the Smithsonian Astrophysical Observatory for the years 1909 to 1911 show evidence of a steady ozone recovery from unusually low levels in early 1909, implying a total ozone deficit of 30 +/- 15 percent. The coincidence in time between the observed ozone recovery and the Tunguska meteor fall indicates that the event may provide a test of current ozone depletion theories.

Growth of human mammary epithelial cells on collagen gel surfaces

We have developed a method for sustained growth of human mammary epithelial cells in monolayer cultures. Epithelial organoids derived from solid breast tissues were grown on the surface of thin (approximately 1 mm) collagen gel layers in an enriched growth medium supplemented with hormones, growth factors, fetal calf serum, and horse serum. To transfer the cultures, the collagen layers were dislodged and digested with collagenase. The monolayers of cells released into suspension were then dissociated into single cells using trypsin-ethylene-diaminetetraacetate. Dissociated single cells were repleted with 75 to 95% efficiency onto collagen layers or tissue culture plastic surfaces. The dissociated cells could also be cryopreserved and reactivated with greater than 80% plating efficiency on collagen layers. Normal human mammary epithelial cells grown under these conditions progressed through 12 to 15 population doublings. The population-doubling times for normal and malignant mammary cells on collagen layers were 34 and 65 hr, respectively. After reaching confluence, cells in some cultures, derived from either normal or malignant tissues, penetrated the gel surface and grew into the collagen. Within the gels, the cells became organized into three-dimensional tubular structures. The use of collagen layers eliminates a major problem in growth of human mammary epithelial cells in culture, difficulty in efficient dissociation, and cell transfer from monolayers.

Surgical footwear in rheumatoid arthritis--a patient acceptability study

One hundred patients wih rheumatoid arthritis were questioned about the acceptability of the surgical shoes that they had been prescribed for their foot problems. The approach was made from the records of a surgical supplies manufacturer. While 90 per cent experienced good alleviation of symptoms, 50 per cent had complaints regarding fit, comfort and styling. The implications of changes in the supply of shoes and the staffing of orthotic concerns are discussed, and suggestions are made for the direction of future research.

Stereophotogrammetry and relief photography in the assessment of foot disorders

Expanded polyethylene foam (Plastazote) is used in the treatment of rheumatoid, diabetic, and leprotic foot disorders. This paper describes a diagnostic use for this material. Two photographic techniques combine to give vivid and quantitative representations of foot deformities which are easily applicable to clinical use. Relief photography uses illumination to create an illusion of solidity in a 2-dimensional photography. Stereophotogrammetry produces contour plots from stereopairs of photographs of the Plastazote footprint. After use the impressions are trimmed and slipped into the patient's shoes in the same way as any other foam insole.

Systemic Haemophilus influenzae infections in a community hospital: prevalence of ampicillin resistance

Ampicillin-resistant strains are presently known to account for 10% to 20% of type b Haemophilus influenzae infections in the United States. To determine whether the incidence in a community hospital parallels that of several university hospitals, we reviewed medical records of the 99 children with type b Haemophilus systemic infections for the period 1976 to 1979. These cass represented 1.8% of all pediatric medical admissions. In 1976-1977, 5% of those infections were caused by resistant strains; the incidence increased to 19% for the period 1978-1979. This increase on a community hospital level parallels the increase in ampicillin resistance in Haemophilus noted in university hospitals and underscores the need for chloramphenicol (alone or in combination with ampicillin) as initial treatment for systemic Haemophilus infections.

Pathophysiological studies on hypertension induced in rats by kidney extract and salt

The renin-angiotensin-aldosterone system, electrolyte and water balance, body fluid, and neurogenic tone and reactivity of the vasculature were studied in hypertension induced in uninephrectomized rats by repeated injection of renin-rich kidney extract and 1% saline drinking. The control rats were injected with physiological saline. Various measurements were made in conscious rats on the 10th day of the treatment. As compared with the control, plasma renin concentration and serum sodium increased significantly, while plasma aldosterone and renal excretory function did not differ. Blood volume (BV) expressed as per body weight increased significantly, but absolute BV, absolute or body weight-related plasma volume and hematocrit were not significantly different. The hypotensive effect of 1-Sar-8-Ile-angiotensin II was negligible 12 hours after the preceding injection of kidney extract. It was small but significant 1 hour after the injection. Increase in water turn-over and fractional sodium excretion occurred during the development of hypertension. Spironolactone did not significantly modify the developmental course. We observed increased depressor response to hexamethonium and increased reactivities to noradrenaline and angiotensin II (A II); these response curves relatively resembled those of spontaneously hypertensive rats. Hypertensive vascular changes were seen in the kidney and heart by histology. Thus, it was suggested that a direct vascular action of A II played a partial role in this hypertensive process while aldosterone played little role. The significance of BV increase and possible contribution of A II's other actions were discussed.

Zymogram analyses of various organs, glands and tissues from spontaneously hypertensive rats (SHR) and DOCA hypertensive rats

Esterase and Acid phosphatase isozymes were examined in a number of organs, glands and tissues from Spontaneously Hypertensive Rats (SHR) and kidney and liver from DOCA hypertensive rats at various stages in comparison with those of normotensive rats (CR). In SHR, the abnormalities in the patterns of esterase isozyme were demonstrated in endocrine glands and respiratory tracts as well as in the kidney, liver and digestive tracts throughout the whole life span, and abnormalities in the patterns of acid phosphatase isozyme was also demonstrated in the liver after seven days of age. Moreover, in DOCA hypertensive Rats, minute alterations in esterase isozyme were demonstrated in the kidney and liver after seventh month of the duration of hypertension.