Effect of the vitreous on retinal wound-healing

The healing process of experimental retinal wounds in nonvitrectomized and vitrectomized rabbit eyes was compared. Using light, transmission and scanning electron microscopy, a significant difference was observed at the late stages of the healing process. The retinal wounds in the nonvitrectomized eyes healed properly, forming regular and smooth scars, while the scars that developed in the vitrectomized eyes were irregular and hypertrophic. Our observations suggest that the vitreous plays a role in normal healing of retinal wounds.

A comparison of the immune response to immunotherapy with polymerized grass allergen and monomeric grass allergen

This study compares the immune response of ten patients treated with polymerized grass (PG) immunotherapy with that of 12 patients treated with conventional monomer grass (MG) immunotherapy. The patients treated with PG immunotherapy received a mean cumulative dose of 44,840 protein nitrogen units (PNU), and those treated with MG immunotherapy received a mean cumulative dose of 46,083 PNU. Total antibody binding of perennial rye grass groups I, II, and III (RGGI, RGGII, and RGGIII) was measured in the serum of each individual. In addition, IgG titers to partially purified extracts of Bermuda, timothy, and orchard grass were also determined. A significant increase in the total antibody binding of RGGI, as well as an increase in the mean IgG titer to Bermuda, timothy, and orchard grass was demonstrated after treatment in the patients who had received PG immunotherapy. The mean total antibody binding of RGGII and RGGIII also increased in these patients, although not significantly. No significant difference in the mean total antibody binding of RGGI, RGGII, or RGGIII nor in the mean IgG titer to the three grass extracts was found in the sera of the two groups of patients. This study demonstrates a comparable immune response between immunotherapy with PG and MG, and retention of antigenic determinants during the polymerization process.

Psychosomatic nasal disorder

Present day allergy therapy can provide substantial symptomatic relief to patients with allergic and nonallergic rhinitis. Available measures are so effective that treatment failures with our most potent medications should raise the question of the presence of genuine pathology. Psychosomatic symptoms often involve nasal function. We present three such cases in which failure to relieve symptoms suggested a neurotic fixation on the condition of the nose and no demonstrable nasal pathology.

Outcome of pregnancy in women requiring corticosteroids for severe asthma

We report on the outcome of 56 pregnancies in 51 women with severe asthma requiring prednisone and/or beclomethasone dipropionate. There were no malformations, neonatal deaths, or maternal deaths. The overall incidence of premature (less than 37 weeks gestational age) and low birth-weight infants (less than or equal to 2500 gr) was slightly higher than would be expected in the general population. These findings appeared attributable in part to infants of gravidas whose asthma was complicated by emergency room visits or status asthmaticus. There was a statistically increased incidence of low birth weight and small size for gestational age infants in the eight infants born to women who experienced status asthmaticus when these infants were compared to the 41 infants born to women who did not require emergency room therapy or develop status asthmaticus. Our data confirm that prednisone and beclomethasone dipropionate are appropriate therapy for pregnant women with severe asthma and suggest that the prevention of status asthmaticus may result in a favorable outcome for the fetus. The current study confirms previous evaluations of pregnant women with severe asthma conducted by Northwestern University Allergy Service and extends the series to 171 pregnancies.

Rectus sheath hematoma complicating an exacerbation of asthma

Hematoma of the rectus sheath is a rare complication of asthma. We describe a case of rectus sheath hematoma precipitated by a paroxysm of cough during an exacerbation of asthma. Diagnosis and management of this clinical entity is discussed.

Noncompliance and prevarication in life threatening adolescent asthma

Four cases of noncompliant steroid dependent adolescent asthmatics who intentionally lied about their compliance are presented. All four were followed in the Allergy Clinic at Northwestern Memorial Hospital. Each had psychosocial or family problems which contributed to deliberate failure to take necessary medications and then to lie about it. Frequent E. R. visits, missed school, and hospitalizations for life threatening asthma attacks were seen in these patients. Changes in personal patient patterns of asthma, lack of predicted response to adequate therapeutic regimens, and obvious lack of proper parental supervision were the clues to the correct diagnosis. Undetectable serum prednisolone levels confirmed the diagnosis in one case. We describe the clinical course of these patients including confrontation about noncompliance and therapeutic regimens that have resulted in control of their asthma.

Comparison of cutaneous and bronchial reactivity to leukotriene D4 in humans

To establish whether a relationship exists between cutaneous and bronchial reactivity to leukotriene D4 (LTD4), endpoint cutaneous reactivity and bronchial reactivity were determined in six patients with asthma, six patients with seasonal allergic rhinitis, and six nonatopic men. In all subjects, increasing doses of LTD4 produced decreases in specific airway conductance (SGaw) and flow at 30% of vital capacity measured from a partial forced expiratory maneuver (V30P). Intracutaneous injections of LTD4 and histamine resulted in immediate wheal and erythema reactions in all patients. Serial 10-fold dilutions of LTD4 and histamine were injected to establish the lowest dose capable of producing a 4 mm wheal with erythema. Endpoint cutaneous reactivity to LTD4 ranged from 1 mumol to 100 pmol in controls and from 100 nmol to 1 fmol in patients with asthma, but statistically significant differences between groups were not apparent even with inclusion of six additional subjects. No meaningful correlations were found between the quantity of LTD4 producing the threshold cutaneous reaction and the dose of inhaled LTD4 that produced a 35% decrease in SGaw and 30% decrease in V30P. In contrast to the bronchi, where subjects in all three groups were 264 to 840 times more sensitive to LTD4 than to methacholine, 11/18 subjects (3/6 with asthma) were less sensitive to LTD4 than to histamine in terms of endpoint cutaneous reactivity. However, seven of 18 subjects who were more sensitive to LTD4 than to histamine had relative potencies ranging from 5 to 500,000.

Ethylene oxide (ETO) as a possible cause of an allergic reaction during peritoneal dialysis and immunologic detection of ETO from dialysis tubing

An infant with end-stage renal disease requiring continuous ambulatory peritoneal dialysis (CAPD) had a cutaneous eruption with eosinophilia. This reaction was not associated with any drug administration. An analysis for antibodies against ethylene oxide-human serum albumin (ETO-HSA) was conducted because IgE antibodies have been correlated with allergic reactions during hemodialysis. IgE and IgG antibodies against ETO-HSA were demonstrated in one of two serum samples available. Serologic evidence is presented that ETO may be eluted from the dialysis tubing, react with HSA in the peritoneum, and immunize the dialyzed host. This may be a possible explanation for allergic manifestations in our patient and others undergoing peritoneal dialysis.

Characterization of the airway response to inhaled leukotriene D4 in normal subjects

To better understand the role of leukotriene D4 (LTD4) in the pathogenesis of airway hyperreactivity, we administered aerosolized LTD4 on multiple occasions to 6 normal subjects and measured specific airway conductance (SGaw) by body plethysmography and the flow rate at 30% of vital capacity from partial forced expiratory maneuvers (V30P). Dose-response curves generated from standard bronchoprovocation tests revealed that LTD4 was 280 to 590 times more potent as a bronchoconstrictor than was methacholine. The airway response to single bronchoconstricting doses of LTD4 administered on separate days was reproducible for SGaw (r = 0.86, p less than 0.05) and V30P (r = 0.95, p less than 0.005). The response to 3 consecutive single-dose LTD4 challenges performed on the same day, allowing SGaw and V30P to return to greater than 90% of the control value between challenges, demonstrated tachyphylaxis: the response to the third dose was significantly less than the response to the first dose for SGaw (p less than 0.001) and for V30P (p less than 0.01). A single bronchoconstricting dose of LTD4, given before a standard methacholine dose-response challenge, lowered the concentration of methacholine needed to decrease V30P 30% (p less than 0.05) and SGaw 35% (p = 0.09). A single bronchoconstricting dose of methacholine preceding a standard methacholine challenge did not have this effect. LTD4 and methacholine demonstrated a cumulative dose-effect when progressively higher concentrations were inhaled. In summary, the airway response to LTD4 is reproducible, exhibits tachyphylaxis, and a cumulative dose-effect occurs. As well, LTD4 increases the responsiveness of normal airways to methacholine.

Binding constants of IgE receptors on human blood basophils for IgE

The ability to remove receptor-bound IgE but maintain functional integrity of human blood basophils allowed measurement of several parameters of binding of IgE. Non-specific binding was determined by a modification of the standard technique and was found to be only about 10% of specific binding. The number of free receptors varied inversely with the serum IgE of the donor. Forward rate constants were readily measured at 0 degree but were considerably higher at 37 degrees, and a rough estimate of the activation energy for binding was calculated to be 6700 calories/mol. Saturation of basophil receptors with IgE occurred in 1-3 h using 3.6 micrograms 125I-IgE/ml at 37 degrees. For seven donors, the forward rate constant, k1, ranged from 2.9 to 7.25 X 10(4) M/sec with a mean of 5.2 X 10(4)/M/sec. This is about one-third the reported value for cultured cord blood basophils. The backward rate constant, k-1, ranged from 1.4 to 3.9 X 10(-5)/sec with a mean of 2.5 X 10(-5)/sec. This is less than half that of cord blood basophils. The equilibrium association constant, Ka, ranged from 1.4 to 2.7 X 10(9)/M with a mean of 2.1 X 10(9)/M. This is comparable to the high affinity binding reported for cord blood and other basophils. There was no great difference in binding constants among the four atopic and three non-atopic donors studied. The affinity of monoclonal mouse 125I-IgE for IgE receptors on human basophils was about four-fold lower than that of human IgE. Sensitization of human basophils for histamine release with mouse IgE anti-DNP was confirmed. Non-specific human IgE but not IgG inhibited sensitization by mouse IgE, indicating that the same receptors were involved and that they were specific for IgE.

RNA metabolism in nuclei: selective transport of kappa exons from myeloma nuclei and adenoviral transcripts from infected HeLa nuclei

Two independent systems and several analytical procedures have been used to establish that isolated mammalian nuclei selectively transport mature RNA polymerase I and II products. Murine myeloma nuclei retain physiologic restriction in our transport assay as assessed by the transport of the immunoglobulin kappa light chain mRNA and 18S and 28S rRNAs. Nearly 50% of the total kappa exons are transported as structurally intact mature mRNA molecules while less than 8% of either pulse-labeled or steady state kappa intron sequences are detected in the transported fraction. Ribosomal external transcribed spacer sequences also are absent in transported RNA. Release of cytoplasmic RNA from the outer nuclear membrane during the transport assay accounts for less than 10% of transported RNA. Nuclei isolated from adenovirus-infected HeLa cells at 20 hours post infection retain cellular actin mRNA and transport viral poly A+RNA. Ribosomal RNA is transported from infected nuclei although at a reduced rate compared to transport from mock-infected nuclei. Inhibition of transport of host mRNA is paralleled by the absence of pulse-labeled actin mRNA in the cytoplasm of infected cells. The implications of our transport data in relationship to intranuclear RNA trafficking are discussed.

Allergic bronchopulmonary aspergillosis. Natural history and classification of early disease by serologic and roentgenographic studies

Eighty-four patients with allergic bronchopulmonary aspergillosis (ABPA) were evaluated for a total of 294 patient-years with a mean observation period of 3.7 years and classified by the stage of ABPA. The largest percentage of patients were in the stage IV (corticosteroid-dependent asthma stage) group. The next largest percentage were in the stage V (fibrotic, end-stage lung disease) group. Of the latter 24 patients, eight had died. In addition, we describe 13 patients with all serologic characteristics of ABPA but without central bronchiectasis. We propose that these patients have seropositive ABPA and represent the earliest cases of it that can be diagnosed in contrast with ABPA with central bronchiectasis in which lung damage is already present.

Some indications for depot methylprednisolone for asthma or other severe allergic disease

Corticosteroid-dependent asthma is asthma of such severity that function of the patient cannot be maintained without long-term corticosteroid therapy. Occasionally, the optimal alternative day single-dose prednisone regimen that is preferable is not possible because of the inability of patients to comply with such a regimen. We describe cases in which we have to advise depot methylprednisolone to prevent potentially fatal asthma or vasculitis, although this type of therapy is suboptimal in terms of avoiding sustained corticosteroid levels in tissue, adrenal cortical suppression, and potential side effects. The decision to use depot corticosteroids was made after exhausting other alternatives and considering the risk and benefit ratio.

An intravitreal cannula system: long-term follow-up study

An intravitreal cannula for chronic drug delivery was implanted in the eyes of two rabbits and one monkey. The rabbits were followed up for three years after surgery and the monkey was followed up for two and one-half years. Clinical observations did not reveal any adverse effects from the cannula implantation. Patency of the cannula was demonstrated by using sodium fluorescein. Histopathological studies with light and electron microscopy revealed the scar tissue around the cannula to be minimal and localized to the wound site. The optic nerve and the retina and choroid at the posterior pole did not show any abnormalities. These results suggest that this system can be used for repeated or continuous drug delivery to the vitreous over a long period of time in experimental models.

Stereoacuity in young children

Previous investigations of stereopsis in children have found that stereoacuity improves gradually over time and does not reach adult levels until well into childhood. The unusually protracted period of development implied by these data is at odds with the development of other visual capacities, such as acuity, contrast sensitivity, increment thresholds, and flicker fusion. When tested on those dimensions, children, by the age of five, achieve thresholds that are only moderately higher than those achieved by adults. To determine if the elevated thresholds for stereopsis found in children could be attributable to the methods used to obtain them, the authors assessed stereoacuity of children, 3 to 5 yr of age, using a laboratory test combined with procedures designed to optimize the limited attentional, motivational, and response capabilities of young children. The thresholds obtained (median = 12.6 sec) are much lower than previously reported and are close, but not equal, to the thresholds of adults. These data suggest that the development of stereopsis is not unusually protracted relative to the development of other visual capacities. The elevation of threshold relative to adult values is similar to the shortfall found in studies of other visual capacities and has led investigators to suggest, and the authors concur, that children do not possess the sophisticated cognitive strategies that adults can employ when thresholds are approached and uncertainty is high. Given that interpretation, it is suggested that the maturation of stereoscopic capacity is nearly complete in children 3 to 5 yr of age.

Emergency administration of radiocontrast media in high-risk patients

Patients with previous anaphylactoid reactions to radiographic contrast media (RCM) are at increased risk for subsequent reactions on repeat exposure. The most efficacious pretreatment regimens require administration of medications up to 13 hours before the anticipated procedure. Emergency administration of RCM in patients requiring essential procedures precludes prolonged pretreatment. We report results of pretreatment in nine patients requiring emergency administration of RCM. We recommend hydrocortisone, 200 mg intravenously, immediately, and every 4 hours until the procedure is completed, and diphenhydramine, 50 mg intravenously, 1 hour before the procedure. No reactions occurred in these patients, suggesting that this pretreatment regimen may be valuable in prophylaxis for patients requiring emergency administration of RCM who have experienced previous anaphylactoid reactions. Although used in only one additional patient, ephedrine, 25 mg orally, 1 hour before the procedure may also be valuable.

Use of haptenizing ELISA to evaluate respiratory disease in a worker exposed to capacitor-coating powder

We were asked to evaluate respiratory disease in a worker exposed to a powder containing unidentified components that was heated and used to coat capacitors. Because the powder was used as a coating material, we hypothesized that the capacitor-coating powder (CCP) contained either an anhydride or an isocyanate. We modified the initial step of a standard ELISA so that we could use CCP as a hapten in this assay. With this modified ELISA technique and inhibition analysis with antisera of known specificity, we determined that CCP contained a substance that cross-reacted with trimellitic anhydride. Later, we confirmed from the manufacturer that it contained benzophenone tetracarboxylic dianhydride. With the modified ELISA assay we also determined that the worker we were to evaluate did not have antibody to CCP or trimellitic anhydride. From clinical and immunologic evaluation we diagnosed chronic obstructive lung disease. Thus, this modified assay has proved useful in the evaluation of a worker exposed to a powder whose contents were not initially known and may prove useful in immunologic evaluation of workers in other industrial settings.

Aerosolized leukotriene D4 converts monkeys that are negative aerosolized ascaris responders to positive airway responders

We designed studies to determine if Leukotriene D4 (LTD4) could alter airway reactivity such that rhesus monkeys with positive skin reactivity and consistently negative airway responses would respond to ascaris airway challenge. The experiments were complicated by the observation that aerosolized LTD4 would occasionally increase airway hyperreactivity in some monkeys used as controls such that an airway response occurred to saline, the diluent for ascaris antigen. In spite of this, we were able to demonstrate induction of airway responsiveness to ascaris antigen. These results demonstrate that LTD4 will induce airway hyperreactivity to a nonspecific stimulus such as aerosolized saline or to an allergen.