Immunoglobulin VH gene structure and diversity in Heterodontus, a phylogenetically primitive shark

A mouse VH probe has been used to identify and isolate VH homologs in a DNA library of Heterodontus francisci (horned shark). The complete nucleotide sequence of one VH gene, HXIA, has been determined and found to exhibit striking organizational homology and nucleotide identity with mammalian prototype VH genes. Metric analysis of the complete sequence is consistent with the early phylogenetic diversification of framework and complementarity-determining regions (CDR). Both the predicted amino acid sequence and the specific hybridization of the CDR2-specific, synthetic oligodeoxynucleotide probe in spleen mRNA suggest that HXIA is functionally expressed. A probe consisting of the entire coding region of this gene hybridizes with multiple components in Southern blot analysis of Heterodontus genomic DNA and together with the identification of additional unique VH+-lambda clones indicates that considerable complexity is associated with the germline VH gene family in a contemporary species that represents an early stage in the phylogenetic development of the vertebrates.

Amylase isoenzymes in the evaluation of trauma patients

In traumatized patients, elevation of the levels of serum amylase is often noted and may lead to a diagnosis of pancreatitis or pancreatic injury. In the presence of multiple injuries, it is often difficult to evaluate clinically for pancreatitis or pancreatic injury. Since the serum amylase is derived from both the pancreatic and the salivary glands, it is useful to determine the origin of the elevated levels of serum amylase in these patients. A total of 31 patients including 21 trauma patients were studied, and the total serum amylase and also the pancreatic (P) and salivary (S) fractions were determined by isoelectric focusing. Compared with the normal control group, most trauma victims had elevated total amylase levels (normal, 30-128 U). In six patients with head and facial trauma, the P-fraction was 7.6 per cent, and the S-fraction was 92.4 per cent (normal, P 35-50%; S 50-65%), while in six patients with penetrating abdominal trauma, the P-fraction was 81 per cent, and the S-fraction was 19 per cent. These differences were statistically significant. The data demonstrate the value of measuring fractions of amylase in addition to total amylase levels. In patients with head and facial trauma alone, elevated levels of serum amylase are due to an increase in the salivary fraction. Elevation of total serum amylase in traumatized patients does not necessarily indicate pancreatic injury. Measurements of amylase fractions were thus useful in evaluation of trauma patients.

The role of spinal cord transmission in the ventilatory response to exercise in man

The ventilatory response to electrically induced exercise was studied in thirteen patients with traumatic spinal cord transection at or about the level of T6. The steady-state and on-transient responses to this exercise were compared with those obtained in eighteen normal subjects (Adams, Garlick, Guz, Murphy & Semple, 1984). Exercise was produced by surface electrode stimulation of the quadriceps and hamstring muscles so as to produce a pushing movement at 1 HZ against a spring load. At rest there was no significant difference between normals and patients, except that the patients had a lower CO2 elimination (VCO2) and end-tidal PCO2 (PET,CO2) and a higher heart rate. On exercise the mean rise in VCO2 for the patients was 172 ml min-1 (S.D. 72), and for the normals was 287 ml min-1 (S.D. 143). The corresponding mean changes in ventilation (VI) were 4.4 l min-1 (S.D. 2.2) and 7.6 l min-1 (S.D. 3.2). However, the ventilatory equivalent for CO2 (delta VI/delta VCO2) in the steady state was not significantly different between patients (26.0, S.D. 5.9) and normals (28.5, S.D. 7.4). In the steady state there was a mean rise in PET,CO2 of 0.9 mmHg (S.D. 1.4) in the normals, and 3.2 mmHg (S.D. 2.7) in the patients, but there was overlap between the two groups. In many experimental runs in both groups, PET,CO2 did not rise, and sometimes fell. Where PCO2 did rise, the ventilatory response to exercise could not be accounted for on the basis of the ventilatory sensitivity to CO2 inhalation. From arterial sampling in three of the patients it was found that when PET,CO2 rose, the corresponding change in Pa,CO2 was less. During the on transient, there was a significant rise in both VCO2 and VI by the second breath in both groups. At the end of the on transient the normal subjects had achieved 84% (S.D. 40) of the steady-state increase in VCO2 and 88% (S.D. 24) of the increase in VI. The corresponding values for the patients were 67% (S.D. 17) and 77% (S.D. 16) respectively; these differences between normals and patients are significant. The increase of VI during the on transient in the patients was achieved almost entirely by an increase in tidal volume whereas in normals, an increase in respiratory rate was a more important component. We conclude therefore that in man, spinal cord transection with a presumed loss of muscle afferents allows a ventilatory response to electrically induced exercise that cannot be explained by classical chemoreception.(ABSTRACT TRUNCATED AT 400 WORDS)

Is the voluntary control of exercise in man necessary for the ventilatory response?

The ventilatory response to electrically induced exercise (EEL) was studied in eighteen normal subjects and compared with the response to performing the same exercise voluntarily (EV). EEL was produced by surface electrode stimulation of the quadriceps and hamstring muscles so as to cause a pushing movement at 1 HZ against a spring load; this produced no pain or discomfort. Matching of EV to EEL was achieved by subjects copying a tension signal recorded during EEL and displayed on a storage oscilloscope. There were no differences between the resting states measured before either form of exercise. The ventilatory response (change in ventilation as a ratio of the change in CO2 elimination) was similar in the two types of exercise. The increases in ventilation and CO2 elimination were greater with EEL. Small but significant increases in the gas exchange ratio and serum lactate were found for EEL but not for EV, suggesting an increase in anaerobic metabolism in EEL. End-tidal PCO2 showed little change in either form of exercise. In some runs end-tidal PCO2 rose, but insufficiently to account for the ventilatory response as judged by the response to inhaled CO2. In two subjects arterial blood samples showed small and inconsistent changes in both Pa,CO2 and PaO2 for EV and EEL. pH and base excess changes also were consistent with more anaerobiosis with EEL compared to EV. The first ten breaths of exercise were used to study the on transient. In EV, expiratory duration shortened and ventilation increased significantly on the first breath but CO2 elimination did not increase until the second breath; in EEL, these variables did not change significantly until the second breath. For the remainder of the on transient the pattern of the ventilatory response was similar for EV and EEL. By the end of the on transient both EV and EEL had reached approximately 80% of their final steady-state values. These results suggest that a normal ventilatory response can occur in the absence of a drive to exercise from the cortex.

Complete nucleotide sequence of an immunoglobulin VH gene homologue from Caiman, a phylogenetically ancient reptile

Immunoglobulin variable (V) gene regions typify extensive multigenic families in terms of overall size, chromosomal arrangement and presence of large numbers of apparent pseudogenes. A unique mechanism of somatic reorganization involving recombination of VH, D and JH or VL and JL segments accompanies the differentiation of lymphoid cells and together with somatic mutation and other types of recombination accounts for V-region diversity. Although these processes have been well characterized in higher mammals, little is known concerning their origin and diversification during phylogenetic time. Previously, we described the blot-hybridization characteristics of murine VHIII probes with restriction enzyme-digested genomic DNA isolated from several phylogenetically critical species, including Caiman crocodylus, a modern representative of an ancient reptilian subclass. Here we have used a murine probe, S107V, to select homologous clones from a library of Caiman genomic DNA constructed in a lambda bacteriophage. The complete nucleotide sequence of a Caiman gene homologous to the murine VH gene and its adjacent 5' and 3' region is described. Comparison of the sequence with mammalian prototypes shows evidence of considerable organizational and structural homology extending outside the presumed VH-coding region and including elements believed to be involved in somatic recombination. Inferences about the evolution of this multigenic family can now be extended to the level of phylogenetic class.

Unilateral pulmonary edema after drainage of a spontaneous pneumothorax: case report and review of the world literature

Unilateral pulmonary edema has been associated with a variety of clinical disorders including post re-expansion of a pneumothorax. We present a case of unilateral pulmonary edema following chest tube drainage of a spontaneous pneumothorax. A literature review of this complication is reported, the pathophysiology explored and therapeutic measures examined.

The role of spinal cord transmission in the ventilatory response to electrically induced exercise in the anaesthetized dog

1. The ventilatory response to electrically induced ;exercise' was studied in six chloralose-anaesthetized dogs. The on-transient and steady-state responses to ;exercise' were compared in the same dogs before and after spinal cord transection at T8/9 (dermatome level T6/7) on fifteen occasions.2. Phasic hind limb ;exercise' was induced for periods of 4 min by passing current (2 Hz modulated 50 Hz sine wave) between two needles inserted through the hamstring muscles. The maximum current used was 30 mA. This was below the level previously found to produce an artifactual stimulation of breathing with the cord intact.3. Cord transection produced no significant change in either the resting values of ventilation ( V(I)) and CO(2) production ( V(CO) (2)) or the ventilatory equivalent for CO(2) during ;exercise' ( big up tri, open V(I)/ big up tri, open V(CO) (2)).4. During the steady state of exercise P(a, CO) (2) was on average significantly lower than at rest with the cord intact (mean big up tri, openP(a, CO) (2), - 2.1 mmHg; range - 5.7 to + 1), and higher, though not significantly, with the cord cut (mean P(a, CO) (2), + 1.2 mmHg; range - 1.5 to + 4.3). However, even in the absence of spinal cord transmission, the ventilatory response to exercise could not be accounted for on the basis of CO(2) sensitivity; the big up tri, open V(I)/ big up tri, openP(a,CO) (2) obtained with exercise (apparent sensitivity) was significantly greater than that obtained with CO(2) inhalation (true sensitivity) both before and after cord section.5. V(I) and V(CO) (2) increased more slowly with the cord cut than with the cord intact. This was thought to be due to a slower increase in venous return in the absence of sympathetic innervation of the lower half of the body following cord transection.6. Similar experiments were performed during muscle paralysis (following gallamine triethiodide). Ventilation was maintained with a respirator controlled by phrenic nerve activity. These experiments showed an increase in ventilation, independent of muscle contraction, which was only present when the cord was intact and which was confined to the on-transient. Only in the absence of spinal cord transmission could there be certainty that the dynamics of the ventilatory response to electrically induced ;exercise' was free of artifact.7. It was concluded that spinal cord transmission is not necessary for the steady-state ventilatory response to electrically induced exercise of the hind limbs.8. The dog with spinal cord transection provides a suitable model for the study of the chemical control of breathing during electrically induced exercise.

The ph oscillations in arterial blood during exercise; a potential signal for the ventilatory response in the dog

1. The effect of electrically induced ;exercise' on the respiratory oscillation of arterial pH was studied in chloralose-anaesthetized dogs with spinal cord transection at T8/9 (dermatome level T6/7).2. Respiratory oscillations of arterial pH (presumed to be due to oscillations of arterial P(CO2)) were sensed with a fast-responding electrode in one carotid artery. Breath-by-breath estimates of the maximum rate of change of pH of the downstroke of the pH oscillation (dpH/dt downward arrowmax) were obtained by differentiating the pH signal.3. Consistent with the findings of the previous paper (Cross et al. 1982), the ventilatory response to exercise could not be explained on the basis of sensitivity to CO(2); the Delta V(I)/DeltaP(a, CO2) was significantly greater for ;exercise' than for CO(2) inhalation.4. On average, the amplitude of the pH oscillations decreased during ;exercise'. The change in the phase relationship (varphi) between respiratory and pH cycles, although significant from the second breath onwards, was not thought to be responsible for the increased ventilation V(I); the direction of the change was opposite to that previously found to increase V(I).5. Inspiratory duration (t(i)), expiratory duration (t(e)), V(I) and the dpH/dt downward arrowmax changed significantly by the third breath of ;exercise'. A significantly linear relationship was obtained between t(e) and dpH/dt downward arrowmax during the on-transient (first ten breaths) of ;exercise'. This relationship was maintained throughout ;exercise'. V(I) and dpH/dt downward arrowmax were also linearly related during the on-transient, although the same relationship did not hold true throughout ;exercise'.6. The dpH/dt downward arrowmax was related to CO(2) production ( V(CO2)) lending support to the prediction that the slope of the downstroke of the pH oscillation is a function of V(CO2).7. It was concluded that the dpH/dt downward arrowmax (dpCO(2)/dt upward arrowmax) is a potential humoral signal in ;exercise' and could account totally for the shortening of t(e). Since there was a late rise in V(I) (due to an increase in tidal volume V(T)) in the absence of a change in dpH/dt downward arrowmax, it was considered unlikely that the dpH/dt downward arrowmax was the only humoral signal present during ;exercise'.

Leiomyosarcoma of the inferior vena cava: angiographic and computed tomography findings. Report of two cases and review of imaging criteria

Leiomyosarcoma, a highly malignant tumor of the inferior vena cava, is rare. Only 55 cases have been reported in the world literature, and of these only 18 were evaluated with a special vascular procedure, either arteriography or inferior vena cavography. In two cases of leiomyosarcoma of the inferior vena cava, we performed arteriography and inferior vena cavography. In one, computed tomographic studies were also carried out. Cavography showed a lobulated filling defect in one case and complete caval occlusion with collateral circulation in the other. In the one case in which it was performed, computed tomography clearly demonstrated the tumor's size and its relationship to surrounding organs. Arteriographic studies, however, allowed only an indistinct delineation of the extent of tumor growth in one case. Venography followed by computed tomography should permit adequate assessment of most leiomyosarcomas of the inferior vena cava, with arteriography reserved for tumors involving the upper cava in which hepatic involvement must be evaluated.

Persistence of neutralizing antibody 30-35 years after immunization with 17D yellow fever vaccine

Previous studies on the duration of antibody following vaccination with 17D yellow fever (17D YF) virus vaccine have indicated that immunity persists for at least 17 years and suggest that the vaccine may provide lifelong immunity. We studied sera obtained from 149 veterans of the Second World War, 30 - 35 years after military service during which YF vaccination was required for defined groups. A significantly high proportion of "vaccinated" subjects was found to be seropositive to 17D YF virus. The highest proportion of seropositive "vaccinated" veterans (97%) was among navy and air corps personnel, while only 60% of "vaccinated" army personnel and 19% of "unvaccinated" personnel were seropositive. This study suggests that (i) antibody to 17D YF virus, as measured by the plaque-reduction neutralization test (PRNT), persists for 30 years or more following administration of a potent vaccine; (ii) army personnel often had not received potent vaccine, even though their service history indicated that they should have been vaccinated; (iii) some personnel were vaccinated, although their service did not include vaccination-designated areas; and (iv) 88% of veterans with persistent PRNT antibody to 17D YF virus also had mouse-protective antibody against French neurotropic YF virus.

Gastric bypass for obesity. Results of a community hospital series

Seven hundred patients at a community hospital underwent gastric bypass for morbid obesity. Postoperative complications developed in 14.9 percent. The incidence of major complications was particularly low. Both weight loss and the percentage of excess weight lost in the postoperative period were very satisfactory. The criteria for selecting patients for gastric bypass are presented and preoperative evaluation is reviewed. Major technical points in the operation are stressed. Roux-Y reconstruction of gastrointestinal continuity is the preferred technique in our hands. This report reemphasizes the safety and efficacy of gastric bypass as a treatment for morbid obesity. When careful patient selection, preoperative evaluation and operative techniques are combined. excellent results can be expected in the community hospital.

Regional extravascular and interstitial lung water in normal dogs

We measured the regional distribution of pulmonary extravascular and interstitial water to examine the possibility that regional differences in microvascular pressure or tissue stress may cause regional differences in lung water. We placed chloralose-anesthetized dogs in an upright (n = 6) or supine (n = 7) position for 180 min. We injected 51Cr-labeled EDTA to equilibrate to the extracellular space and 125I-labeled albumin to equilibrate with plasma. At the end of the experiment, the lungs were removed, passively drained of blood, and inflated before rapid freezing. Lungs were divided into horizontal slices, and extravascular, interstitial, and plasma water, red cell volume, and dry lung weight were determined for each slice. We found that regional extravascular and interstitial water were constant throughout the lungs in both groups and that there were no significant differences between upright and supine dogs. There were no significant differences in hematocrit between slices. We conclude that gravity and body position have no measurable effect on either the total size of the extravascular and interstitial compartments or their regional distribution.

Pseudomonas infection of the sternum and costal cartilages. Report of three cases

Pseudomonas osteochondritis of the chest wall and sternum has rarely been reported, but when present it has been extremely difficult to eradicate. Multiple operations to debride the involved areas and use of antibiotics have often been inadequate to control this resistant infection. This report describes our experience with three patients who had the late development of Pseudomonas osteochondritis of the chest wall. The infection occurred following crush trauma, sternotomy for congenital heart disease, and mastectomy and amputation of the upper extremity for carcinoma of the breast. Antibiotic therapy alone and with limited operations was unsuccessful in controlling the infection in all three instances. Eventually, each patient required extensive regional surgical removal of involved bone and cartilage. Complete healing followed. Our experience favors the early wide removal of bony and cartilaginous tissues in the involved region with preoperative and postoperative coverage by appropriate antibiotics. Operative management is detailed.

Lymphoreticular and myeloid pathogenesis of Venezuelan equine encephalitis in hamsters

Ultrastructural, histopathologic, and virologic studies of adult hamsters infected with virulent Venezuelan equine encelphalomyelitis (VEE) virus (Subtype I-B) demonstrated precise chronologic and topographic progression of lesions and viral replication in extraneural sites. Thymus contained the earliest lesions and the highest initial and subsequent viral titers. No particular cytotropism was observed as highly efficient viral replication and severe cytonecrosis proceded. Early cortical necrosis of splenic periarteriolar lymphocytic sheath was followed by lymphoblastoid repopulation of the peripheral zone. Massive bone marrow necrosis was accompained by ultrastructural evidence of VEE viral particle production in reticulum cells, rubricytes, myeloid cells, lymphoblastoid cells, and megakaryocytes. Speed, efficiency, destructiveness, and relative sensitivity of virtually all lymphoreticular and hematopoetic cells were hallmarks of virulent VEE infection in the hamster.

Goblet cells in the peripheral airways in chronic bronchitis

It was not possible to demonstrate an increase in the proportion of goblet cells in the bronchioles of patients with chronic bronchitis and no emphysema, whereas other lesions, such as mucous gland hyperplasia, airway narrowing, and airway mucus were easily demonstrated in similar cases. Thus, it seems that goblet cell metaplasia is not an important factor in patients who have chronic bronchitis but little evidence of chronic airflow obstruction. Goblet cell metaplasia is an obvious feature of patients with chronic bronchitis and emphysema, especially in those with symptomatic or fatal chronic airflow obstruction, and it may be responsible for producing obstruction in the peripheral airways of these subjects. The role of goblet cell metaplasia in smokers with little airflow obstruction is uncertain from the data presented. No difference was noted in the proportion of goblet cells between bronchitic patients and nonbronchitic smokers who did not have clinical airflow obstruction.