Long-term continuous spinal anesthesia in severe tetanus with autonomic disturbance

The mortality rate from tetanus is still high if the disease is accompanied by signs of autonomic nervous system dysfunction. We treated a 75-year-old woman with tetanus and autonomic dysfunction with continuous high spinal anesthesia for 23 days. She recovered. Spinal anesthesia may be a useful adjunct for the treatment of severe tetanus.

[Development of an animal model of autonomic over-activity in tetanus]

Although present day progressive respiratory management has decreased the tetanus mortality rate, tetanus-related autonomic overactivity remains a lethal condition. The cause, pathophysiology, and treatment of this condition are controversial and no animal model has ever been reported. So we tried to make a rabbit model of this condition. At first we injected 30 micrograms of purified tetanus toxin intravenously. Blood pressure oscillation occurred, but the degree of oscillation was smaller than that was seen in the clinical cases. The degree of oscillation had not changed by addition of 30 micrograms purified toxin 12 hours after first injection. Secondly, 7 days before the experiment we injected 0.5 micrograms of purified tetanus toxin intravenously. On the experiment day, we injected 30 micrograms of purified toxin again. By this method there occurred blood pressure oscillation as same as that was seen in the clinical cases. But no rabbits progressed to circulatory collapse by purified toxin. Then to the last group of rabbits, we injected crude tetanus toxin for purified toxin. The degree of blood pressure oscillation was same as that of cases in which purified toxin was injected, and all rabbits progressed to circulatory collapse.

[Renal tubular impairment in traumatized patients]

Urinary beta 2-microglobulin (beta 2M) and N-acetyl-beta-D-glucosaminidase (NAG) in addition to conventional renal parameters such as creatinine clearance (Ccr), free water clearance (CH2O) and fractional excretion of sodium (FENa) were measured in 79 traumatized patients. These patients were separated into two groups, one with shock on admission (N = 43). In patients with shock, CH2O, FENa and urinary excretion of Beta 2M and NAG indicated abnormal levels correlating with impairment of Ccr, inspite of adequate urine output, on the day of trauma. Even in patients without shock, urinary Beta 2M and/or NAG increased without impairment of urine output, Ccr, CH2O and FENa, and did not return to normal level during the following 7 days. The results suggest a liability to damage and the delayed improvement of renal tubulus in traumatized patients.

Amplification of c-erbB-2 oncogene in human adenocarcinomas in vivo

There are two genes related to the viral erbB gene in the human genome. c-erbB-1 is the same as the gene for the epithelial-growth-factor (EGF) receptor, and c-erbB-2 encodes a receptor-like protein very similar to, but distinct from, the EGF receptor. Hybridisation analysis of DNA from 101 fresh human malignant tumours showed that the c-erbB-2 gene was amplified in 5 of 63 adenocarcinomas and none of 38 other types of tumours, whereas the c-erbB-1/EGF-receptor gene was amplified only in 1 of 8 squamous-cell carcinomas. Thus, the protein products of the amplified c-erbB-2 gene may have a role in the evolution of adenocarcinomas, as does the EGF receptor in some squamous-cell carcinomas.

Alterations of myc, myb, and rasHa proto-oncogenes in cancers are frequent and show clinical correlation

Alterations of c-myc, c-rasHa, or c-myb oncogenes were found in more than one-third of human solid tumors. Amplification of c-myc occurred in advanced, widespread tumors or in aggressive primary tumors. Apparent allelic deletions of c-rasHa and c-myb can be correlated with progression and metastasis of carcinomas and sarcomas.

[Chloride and lactate composition of hypertonic sodium solution for fluid resuscitation of burn injury]

This study was performed to determine the appropriate anion composition of hypertonic sodium solution for fluid therapy of severely burned patients. Two different solutions with equal sodium concentration (Na 300 mEq/1) were prepared. The first one, low chloride solution (C1 88 mEq/1), was used for ten patients (group I); the second, high chloride solution (C1 244 mEq/1), for other ten patients (group II). Two groups had the same severity of burn injury. The infusion rate was controlled to achieve an adequate urine output (1.0 ml/kg/hour). The observation period was eight hours after injury and water and sodium intake and renal function were measured. Ccr and FENa were identical in two groups. Although both had same urine output, CH2O of group I increased. Water and sodium intake of group I were lower than those of group II. Water diuresis was related with limited chloride intake in group I and this suggested the relation between urine concentration and chloride loading in kidney. conclusively, hypertonic sodium solution with low chloride concentration requires less volume for resuscitation and may be preferred to high chloride solution in the initial therapy of burn injury.

Amplification and expression of a cellular oncogene (c-myc) in human gastric adenocarcinoma cells

Three of 16 human gastric adenocarcinoma samples, maintained as solid tumors in nude mice, were found to carry amplified c-myc genes. In two samples with a high degree of c-myc DNA amplification (15- to 30-fold), double minute chromosomes were observed in karyotype analysis. The level of c-myc RNA was markedly elevated in a rapidly growing and poorly differentiated tumor, whereas it was only slightly elevated in a slowly growing and more differentiated tumor.

Biochemical comparison of myeloperoxidase of leukemic myeloblasts and normal neutrophilic granulocytes

Myeloperoxidases were purified from leukemic myeloblasts (Mbl-MPO) and from normal neutrophilic granulocytes (Gra-MPO) and were compared with each other biochemically. Gel filtration studies showed that the molecular weights (Mr) of Mbl-MPO and Gra-MPO were about 70,000 and 130,000, respectively, so that the former is almost one-half the molecular size of the latter. On sodium dodecyl sulfate-polyacrylamide gel electrophoresis with 2-mercaptoethanol, both MPOs split into two major subunits, heavy and light peptide chains. However, each of these chains of Mbl-MPO seemed to be smaller than that of Gra-MPO, Mr 58,000 versus Mr 62,000 for the heavy chain and Mr 12,000 versus Mr 15,000 for the light chain. On the other hand, another band of Mr 34,000 also appeared in Mbl-MPO under nonreducing conditions and in both MPOs after being boiled. The size of this band was not different in the two MPOs, but the ratio of this band to the others was much higher in Mbl-MPO. The activity of Mbl-MPO could be demonstrated in the heavy chain of Mr 58,000, using a blotting method, and was found to be less heat stable than that of Gra-MPO. These findings indicate that Mbl-MPO may represent an incomplete, unstable half-enzyme form of Gra-MPO.

Friend erythroleukaemia cell mutants defective in viral gene expression

Cellular mutants defective in the expression of viral polypeptides were isolated from the Friend erythroleukemia cell line 745a by immunoselection with anti-ecotropic murine leukaemia virus serum in the presence of complement. The mode of appearance of the antiserum-resistant cells showed an interesting pattern which is discussed in the text. One of the mutants obtained contained no detectable gp70 or p15(E) while retaining gPr90env; defects appeared to reside in the processing of the gPr90env to gp70 and p15(E). In another type of mutant, gPr90env was not detected. All these mutants retained spleen focus-forming virus (SFFV)-specific gp55 and gag precursor Pr68gag. The mutants superinfected with the helper virus produced the helper and SFFV also, indicating that these mutations did not affect the replication of the exogenously infecting virus.

Alteration of polypeptide synthesis and composition during differentiation of human leukemia cell line HL60

Using two-dimensional gel electrophoresis, we have analyzed the polypeptide alteration of the human myeloid leukemia cell line HL60 during differentiation induced by dimethylsulfoxide (DMSO) and 12-0-tetradecanoylphorbol-13-acetate (TPA). Three polypeptides increased in synthesis after DMSO treatment, while 5 polypeptides increased after TPA treatment. Most other polypeptides were synthesized at a reduced rate though their net amounts remained unchanged, indicating that myeloid differentiation was associated not only with an increased synthesis of a few specific polypeptides but also with overall depression of most other polypeptides. One of the early differentiation marker proteins (mol. wt. approx. 20,000, pI approx. 6.0) of granulopoietic cells was increased specifically after DMSO treatment, while one of the monocyte specific marker proteins (mol. wt approx. 46,000, pI approx. 4.8) was detected after TPA treatment. But, the pattern of HL60 cells did not necessarily become similar to that of normal mature granulocytes after DMSO treatment, indicating that HL60 cell differentiation might be partial or incomplete.

Morphophysiological study on the divergent projection of axon collaterals of medial vestibular nucleus neurons in the cat

(1) Spikes of single neurons were extracellularly recorded in the medial vestibular nucleus (MVN) in decerebrate cats and were functionally identified as secondary type I neurons by observing their responses to horizontal rotation and monosynaptic activation after stimulation of the ipsilateral vestibular nerve. Axonal projection of these neurons was examined by their antidromic responses to stimulation of the contralateral abducens nucleus, the spinal cord, and the ascending and descending MLF. (2) Almost all secondary type I vestibular neurons which sent their axon to the contralateral abducens nucleus were antidromically activated from the descending MLF at the level of the obex as well. Nearly half of these neurons sent their collateral axon to the level of C1 segment in the spinal cord and approximately one third to the ascending MLF close to the oculomotor complex. (3) The mean conduction velocity was 29 m/s for descending collateral axons and 30 m/s for ascending collateral axons. (4) Systematic tracking for antidromic microstimulation in the contralateral abducens nucleus and spinal gray matter at C2-C3 suggested that collateral axons of single type I vestibular neurons gave off local branches in the abducens nucleus and the motoneuron pool in the upper cervical gray matter. Existence of terminal branches in the neck motoneuron pool was confirmed by intraaxonal staining with horseradish peroxidase (HRP). (5) Neurons which projected to both the contralateral abducens nucleus and the spinal cord were located in a fairly localized region in the ventrolateral part of the rostral MVN. Neurons which projected to the contralateral abducens nucleus and not to the spinal cord were located in a rostrocaudally wider area in the ventrolateral MVN. Neurons projecting to the spinal cord and not to the contralateral abducens nucleus were located in the widest area in the rostrocaudal direction, covering almost the whole extent of the rostral half of the MVN.

Chronic myelomonocytic leukemia with a chromosome abnormality (46,XY,20q-) in all dividing myeloid cells: evidence for clonal origin in a multipotent stem cell common to granulocyte, monocyte, erythrocyte, and thrombocyte

In a typical case of chronic myelomonocytic leukemia (CMML), a chromosome abnormality, 46,XY,20q-, was observed in all the dividing cells including up to 16-ploid cells in the bone marrow and the blood. As the mitotic figures could be easily seen not only in myelomonocytoid cells but also in erythroblasts in the bone marrow smear, it was concluded that all the cell lineages except lymphocytes had the abnormality. The present case will support the view that the leukemic process in CMML affects a multipotent stem cell rather than a granulocyte-monocyte committed stem cell.

Decreased TCGF activity in the culture medium of PHA stimulated peripheral mononuclear cells from patients with metastatic cancer

Activities of T cell growth factor (TCGF) of conditioned media from PHA stimulated cultures of peripheral mononuclear cells (PHA-MNC-CM) were compared among patients with cancer, patients with non-malignant disease and normal persons. In nine out of 10 cases of cancer with metastasis (including extensive infiltration to surrounding tissues), the activities were much lower than normal persons, whereas in four out of five cases of cancer without metastasis, the activities were almost the same as those of normal persons. The low activities of PHA-MNC-CM from patients with metastatic cancer were not due to the older age of patients, nor did it seem to be attributed to the malnutritional state of patients. When we examined the activity using non-adherent MNC instead of the whole MNC, the activities in patients with metastatic cancer rose up to almost the normal levels. In normal persons the decline of the activities after 3 days of culture were not observed after the removal of adherent cells. Our data indicate that the adherent cells have a suppressive effect on TCGF production in both normal persons and cancer patients, but that the effect may be exaggerated in patients with metastatic cancer.

Alterations of glycolipids of human leukemia cell line HL-60 during differentiation

Alterations of glycolipids of human leukemia cell line HL-60 during differentiation were investigated. The neutral glycolipids of HL-60 cells are of the lacto-types such as lactosylceramide (LacCer) and lactoneotetraglycosylceramide (nLcOse4Cer). The gangliosides of HL-60 cells consisted of a mixture of the lacto-types and the ganglio-types. Chemical inducers of differentiation, 12-O-tetradecanoylphorbol 13-acetate (TPA) and dimethyl sulfoxide, altered the glycolipid profile; II3-alpha-acetylneuraminyl-lactosylceramide (GM3) increased in amount and LacCer and nLcOse4Cer decreased. Tunicamycin had no effect on the glycolipid synthesis. The GM3 accumulated more than tenfold in the TPA-induced macrophage-like cells. This accumulation could be due to the increased activity of LacCer sialytransferase.

Alterations of polypeptide composition of mature granulocytes obtained from patients with chronic myelogenous leukemia

In order to compare the polypeptide composition of the CML mature granulocytes with that of the normal whole cell lysates, mature granulocytes from four healthy volunteers and six CML patients were analyzed by two-dimensional gel electrophoresis. In the normal subjects, 60 major spots were commonly and reproducibly identified. In the CML, there were constant alterations in some of these major spots. Four spots were totally absent in all the CML samples, and another four spots were absent in five of the six samples. In addition, one spot was larger in CML than in normal cells, and another spot, which was only faintly visible or not detectable in the normal samples, was massively present in all the CML samples. Our data suggest specific changes in the polypeptide compositions of CML granulocytes. This method could be clinically applied for the analysis of granulocytic disorders.

Divergent projection of individual corticospinal axons to motoneurons of multiple muscles in the monkey

Intracellular staining with horseradish peroxidase (HRP) of physiologically identified corticospinal (CS) axons originating from the monkey motor cortex revealed the intraspinal morphology of their branching patterns. CS collaterals spread in a delta-like fashion in the intermediate zone and lamina IX. Virtually all CS axons examined terminated in lamina IX, and it was shown by labeling motoneurons with retrograde transport of HRP that individual CS axons made direct contacts with dendrites of motoneurons of different muscle species.