Day to day care of Rett syndrome children

Girls with Rett syndrome are profoundly handicapped and are incapable of an independent life. The basic living skills of feeding, toileting, dressing, mobilising and communication are examined and advice as to how these girls can best be helped in these areas is suggested. The changing impact of the diagnosis on parents, as the condition becomes more widely know, is mentioned, and the physicians' attention is directed to the parental and family stresses caused through the presence of a profoundly handicapped child in a family so that he or she may be careful in not adding to this stress by making further unrealistic demands, but rather be encouraged to act in a supportive and encouraging manner cognisant of the sometimes limited resources which are available to individual families.

Tumor necrosis factor and lymphotoxin induce differentiation of human myeloid cell lines in synergy with immune interferon

We show that the cytotoxins tumor necrosis factor (TNF) or lymphotoxin (LT), at concentrations of approximately 10(-11) M induce monocytic differentiation of human myeloid cell lines. After 5 d of culture in the presence of rTNF and LT, a significant proportion of the myeloid cell lines express monocyte differentiation antigens and ANAE activity, and become able to reduce nitroblue tetrazolium (NBT) and mediate low levels of ADCC against tumor target cells. These markers of differentiation, however, are maximally induced when rIFN-gamma, at concentrations as low as 4 U/ml, is present simultaneously with the cytotoxins, and the two classes of cytokines act synergistically to induce terminal differentiation. The appearance of monocytic antigens is accompanied by acquisition of morphology and other functional properties of mature monocytic cells, such as chemiluminescence and phagocytosis, and by expression of FcR for monomeric IgG. A decrease in cell proliferation accompanies induced differentiation, and is not due to the cytotoxic properties of TNF or LT, as indicated in simultaneous analysis of surface phenotype and cell cycle. The lack of cytotoxicity of TNF on the HL-60 cell line is also demonstrated by the enhancing effect of TNF on HL-60 cell growth and nucleoside uptake in the first 2 d of culture. These data show that the cytotoxins TNF and LT mediate complex effects on cells of the myelomonocytic lineage and, in synergy with IFN-gamma, can fully induce immature myeloid cells to differentiate into cells with phenotypic, functional, and proliferative characteristics of terminally differentiated myelomonocytic cells.

Gamma interferon and lymphotoxin, released by activated T cells, synergize to inhibit granulocyte/monocyte colony formation

We have shown that lymphocytes stimulated by PHA produce colony-forming unit of granulocyte/monocyte (CFU-GM)-stimulating and -inhibiting activities, IFN-gamma, and lymphotoxin (LT). IFN-gamma is necessary for inhibition of CFU-GM by PHA-conditioned medium (CM), as shown by experiments in which removal of IFN-gamma from PHA-CM abrogated inhibition. However, experiments in which rIFN-gamma was added to IFN-gamma-depleted PHA-CM revealed the presence, in PHA-CM, of other factors that act in synergy with IFN-gamma to inhibit CFU-GM. Fractionation of PHA-CM on a Sephadex G-100 column was used to separate IFN-gamma and LT. Colony-inhibiting activity was eluted in fractions that contained both IFN-gamma and LT activities, identifying LT as a factor present in PHA-CM that synergizes with IFN-gamma to inhibit CFU-GM. Treatment of PHA-CM with mAb against either IFN-gamma or LT completely abrogated the colony-inhibiting activity, demonstrating a requirement for both lymphokines in PHA-CM-induced inhibition of CFU-GM. Experiments using rIFN-gamma and preparations of purified LT confirmed that neither lymphokine alone, when added to bone marrow cells at the concentrations present in PHA-CM, strongly inhibited day 7 or day 14 CFU-GM, but that the two lymphokines, added together, behaved synergistically to inhibit CFU-GM by up to 70%. The inhibition observed using purified preparations of lymphokines shows that synergy between IFN-gamma and LT is sufficient to explain PHA-CM-induced inhibition of CFU-GM. Our findings suggest that activated T cells regulate hematopoiesis through the release of inhibitory as well as stimulatory factors, and that the simultaneous production of IFN-gamma and LT may represent a mechanism of suppression of hematopoiesis in the cases of bone marrow failure associated with the presence of activated T cells.

Studies of Doppler aortic flow velocity during supine bicycle exercise

Although Doppler echocardiography is useful in the assessment of left ventricular function at rest, little information is available on the application of this technique during exercise. Consequently, Doppler aortic flow studies were performed in 17 young normal subjects during and after supine bicycle exercise. The purposes of the study were to determine the feasibility of recording Doppler aortic flow velocity with a suprasternal notch transducer during exercise and to assess the changes in normal aortic flow velocity parameters during exercise and early recovery. Each subject exercised until fatigue; mean duration of exercise was 10 minutes. Heart rate increased from a mean of 69 beats/min at control to 159 beats/min at peak exercise. On average, aortic peak flow velocity increased by 45% from control, reaching its maximum at 2 minutes after exercise. Ejection time decreased by 34% during exercise, being shortest at peak exercise. Heart rate, peak flow velocity and ejection time had not returned to normal by 10 minutes after exercise. Aortic flow velocity integral (a relative measure of stroke volume) decreased by 10% at peak exercise (p less than 0.05) compared with control, but had returned to control at 2 minutes after exercise. Despite mild aliasing, increased spectral dispersion, faster heart rates and increased respiratory rate during maximal exercise, aortic flow velocity measurements could be recorded using the suprasternal technique. These baseline Doppler exercise data should be useful in further studies of exercise hemodynamic changes in patients with heart disease.

Rett syndrome--natural history in 70 cases

We evaluated, at our institute, 70 females with Rett syndrome between 2 1/2 to 34 1/2 years old. This provided an opportunity of observing the natural history of this condition. The evolution of a subacute encephalopathy of very early onset, maximizing in the second year of life, with slow recovery and devastating sequelae, was recognized. The hyperorality, visual auditory and tactile agnosia with aphasia and seizures resembled symptoms described in human Kluver Bucy syndrome. Over interpretation of behavioral abnormalities as seizures was common. Scoliosis was not a necessary concomitant of age. A consistent biochemical or neurophysiological abnormality was not detectable in understanding the cause and pathogenesis of this disease process. Life span appears to be unaffected though life tables have not yet been established.

Rett syndrome and the electroencephalogram

The EEG is almost always abnormal in patients with Rett syndrome. This is demonstrated in a study based upon 230 EEG records obtained from 44 patients. Rhythmical slowing (mostly 3-5/sec) represents the most common EEG abnormality (30 patients). Diffuse, scattered or bilateral-synchronous spikes or sharp waves were found in 22 patients. Slow spike-wave complexes were present in 9 patients. With advancing age, the EEG abnormalities tend to decline and ill-defined low voltage records may develop. These changes may parallel an intrinsic disease course with an early active phase followed by a phase of residual impairment.

Chromosome studies in 10 patients with the Rett syndrome

Chromosomes of white blood cells from 10 girls with the Rett syndrome, 9 of their mothers and 17 unrelated controls (5 girls and 12 women) were examined for the presence of the fragile site on Xp22 under different culture conditions. Six of the 10 Rett patients were fra(X)(p22) positive while 4 failed to express this fragile site. In the 6 patients expressing the fragile site it was present in 1 to 3% of all cells. Similarly, 5 of the mothers and 6 of the control women showed this fragile site, with a frequency of 1 to 9%. Concordance analysis showed that in the 9 mother-daughter pairs examined, 5 had concordant results while 4 of the pairs were discordant. These findings are very similar to those found in non-Rett individuals by ourselves and other investigators. These data agree with published findings that fra(X)(p22) is a common fragile site in normal individuals. Therefore, we conclude that the incidence of the Xp22 fragile site in the Rett syndrome does not differ from that found in various non-Rett individuals, including normal persons. This indicates to us that fra(X)(p22) cannot serve as a chromosomal marker for the Rett syndrome.

Balloon angioplasty of coronary bifurcation lesions: the kissing balloon technique

Initial experience with the technique of "kissing balloon" angioplasty is described in 52 patients undergoing coronary angioplasty. Guiding catheters employing both the femoral and brachial approach were used in all but two of the coronary angioplasties and, in addition, the bilateral femoral approach was used in the renal and peripheral angioplasties. Initial success was achieved in 51 (98%) patients. Abrupt closure requiring urgent coronary revascularization occurred in one patient six hours following the completion of the procedure. Another patient developed a new Q-wave on the electrocardiogram and moderate elevation of CPK-MB fraction following the procedure due to loss of a diagonal branch. No deaths occurred in this series. Angiographic restenosis developed in ten patients. In the recurrence group, five had repeat kissing balloon angioplasty, two had repeat single vessel angioplasty, and three patients chose elective surgical revascularization. Based on our experience, the technique of kissing balloon coronary angioplasty can be performed safely utilizing the brachio-femoral technique. The risk of major side branch occlusion can be minimized with this technique and the overall complication rate does not significantly differ from that of our experience in single vessel coronary angioplasty. Patient selection criteria are based upon the angiographic relationship of the major branch to the side branch and is important in determining the initial and long-term success of this technique.

Natural killer (NK) cell-derived hematopoietic colony-inhibiting activity and NK cytotoxic factor. Relationship with tumor necrosis factor and synergism with immune interferon

We characterize the natural killer (NK) cell colony-inhibiting activity (CIA) produced in supernatants from cultures of human peripheral blood lymphocytes (PBL) with NK-sensitive target cell lines, and study its relationship with NK cell-derived cytotoxic factor (NKCF). Using monoclonal antibodies (mAb) specific for NK cells or other lymphocyte populations, we unambiguously identify NK cells as the only PBL subset able to produce both NKCF and NK-CIA. We present functional and biochemical data suggesting that NKCF and NK-CIA represent the same molecule: (a) a highly significant positive correlation exists between the quantity of NKCF and NK-CIA in supernatants independently produced by different PBL subsets; (b) both NK-CIA and NKCF are induced by culture of PBL with NK-sensitive, but not with NK-insensitive cell lines, and with HLA-DR+ bone marrow cells; (c) both NKCF and NK-CIA are absorbed on the same cell lines or bone marrow cell types; (d) the two activities coelute in the same gel filtration fractions; (e) D-mannose-6-phosphate blocks both NKCF and NK-CIA activity, and prevents their absorption by K562 cells; and (f) both NKCF and NK-CIA activity are lost after 2 d at 37 degrees C. The NK-CIA-containing preparations are devoid of antiviral activity, and antiinterferon (anti-IFN) antibodies do not block the inhibitor activity of NK-CIA. The effect of NK-CIA on day 14 (early) colony-forming units of granulocytes and macrophages (CFU-GM) is synergistic with that of IFN-gamma, and this synergy is also evident on day 7 (late) CFU-GM growth. A combination of NK-CIA and IFN-gamma suppresses late CFU-GM, at concentrations of the two lymphokines that are completely ineffective when used independently. No synergy between NK-CIA and IFN-alpha or -beta was observed, due to a direct inhibitory effect of these two IFN types on late CFU-GM. Antibodies specific for tumor necrosis factor (TNF), but not those specific for lymphotoxins, inhibit both NK-CIA and NKCF activity in the NK cell-derived supernatant. Recombinant TNF, in the range of concentrations corresponding to that of the cytotoxic activity on L-929 cells present in supernatants, mediated both NKCF and NK-CIA activity.(ABSTRACT TRUNCATED AT 400 WORDS)

Circulating immunoreactive somatostatin in man. Effect of age, pregnancy, growth hormone deficiency and achlorhydria

Plasma immunoreactive somatostatin (IRS) levels were measured fasting at 09.00 h in groups of adult individuals and children of different ages, as well as in pregnant women, in patients with pernicious anaemia documented to be achlorhydric, and in children with growth hormone deficiency. There was a gradual rise in the mean level of IRS from the third decade (mean 35.8 +/- 3.8 pg/ml), which reached significance at the seventh (61.1 +/- 8.4 pg/ml), eighth (66.7 +/- 5 pg/ml) and ninth decade (82.6 +/- 13.8 pg/ml). No change was observed in the second 28.3 +/- 3.8 pg/ml) and third (31.1 +/- 3.2 pg/ml) trimester of pregnancy when compared with matched, non-pregnant controls (29.7 +/- 2.2 pg/ml); however, the children aged under 2 years (69.6 +/- 11.2 pg/ml) had significantly higher values than the eldest group (12 to 16 years old) (46.3 +/- 7.2 pg/ml) (P less than 0.05). In achlorhydric patients, basal (27.2 +/- 3.7 pg/ml; P less than 0.01) and postprandial IRS (42.8 +/- 7.7 pg/ml; P less than 0.001) was significantly lower than in a matched, normal control group (basal 59.4 +/- 7.2; postprandial 132.1 +/- 26.3 pg/ml). Growth hormone deficiency was not associated with any differences in circulating IRS, basally or after insulin hypoglycaemia, when compared with values in normal children.(ABSTRACT TRUNCATED AT 250 WORDS)

Occupational therapy issues in the treatment of the long-term mentally ill

In this paper, a single case study is used to facilitate discussion of problems encountered by occupational therapists engaged in working with the long-term mentally ill. The achievement of the long-range and multi-faceted approach necessary for the management of this population is a recognized challenge. Some of the paradoxes and dilemmas involved in programming and the measurement of outcome and success are clarified. As well, sources of stress to individuals involved in working with the long-term mentally ill are considered. Issues addressed include: philosophy of approach, professional and personal conflicts patients' wishes and involvement, and the low priority given to working with this group. Two main objectives of the paper are to: bring an appreciation for the complexity of the difficulties presented and demonstrate how occupational therapists can offer valuable contributions in working with the long-term mentally ill.

Opiate receptor thermodynamics: agonist and antagonist binding

The equilibrium thermodynamics of [3H]etorphine and [3H]diprenorphine binding to rat brain membranes were studied. In the absence of NaCl, the binding of [3H]etorphine was endothermic (delta Ho = +2.31 kcal/mol) and driven by a large increase in entropy (delta So = +51.8 e.u.). Under similar conditions, the binding of [3H]diprenorphine was exothermic (delta Ho = -2.78 kcal/mol). In the presence of 100 mM NaCl, [3H]etorphine binding was relatively isothermic (delta Ho = +0.61 kcal/mol) and driven by a large increase in entropy (delta So = +45.6 e.u.). NaCl significantly decreased both delta Ho (-2.78 to -7.48 kcal/mol) and delta So (33.0 to 18.5 e.u.) for [3H]diprenorphine binding. The data suggest that the agonist configuration of the opiate receptor exists in a more open and mobile (higher entropy) conformation than does the antagonist form of the receptor.

Insulin and cortisol improve heat tolerance in isolated perfused rat liver

Isolated rat livers were perfused at 37 degrees, 41 degrees, 42 degrees, and 43 degrees C with and without insulin and cortisol. Two additional groups were perfused at 42 degrees C with either hormone alone. The perfusate contained red blood cells, amino acids, and albumin in Krebs-Ringer bicarbonate. Bile flow was significantly increased by hormones at 37 degrees C. Bile flow was also increased by hormones at all other temperatures. At 41 degrees C, K+ leakage was the only parameter that indicated injury. Insulin and cortisol significantly reduced K+ leakage at this temperature compared to those without hormones. At 42 degrees C, insulin and cortisol reduced K+ leakage, increased bile flow, reduced transaminase release, and improved ultrastructural integrity. The enhanced bile flow was due primarily to insulin. A reduction in K+ leakage required both insulin and cortisol. Transaminase leakage responded to either hormone alone or in combination; however, only the cortisol-treated group showed a statistically significant reduction in transaminase leakage. At 43 degrees C, indications of irreversible injury were evident and hormones had no beneficial effects. Loss of membrane homeostasis appeared to be the initial event.

Increases in platelet and red cell counts, blood viscosity, and arterial pressure during mild surface cooling: factors in mortality from coronary and cerebral thrombosis in winter

Six hours of mild surface cooling in moving air at 24 degrees C with little fall in core temperature (0.4 degree C) increased the packed cell volume by 7% and increased the platelet count and usually the mean platelet volume to produce a 15% increase in the fraction of plasma volume occupied by platelets. Little of these increases occurred in the first hour. Whole blood viscosity increased by 21%; plasma viscosity usually increased, and arterial pressure rose on average from 126/69 to 138/87 mm Hg. Plasma cholesterol concentration increased, in both high and low density lipoprotein fractions, but values of total lipoprotein and lipoprotein fractions were unchanged. The increases in platelets, red cells, and viscosity associated with normal thermoregulatory adjustments to mild surface cooling provide a probable explanation for rapid increases in coronary and cerebral thrombosis in cold weather. The raised arterial pressure and possibly cholesterol concentration may contribute to slower components of the increased thrombosis.

Effects of oral exposure to trichloroethylene on female reproductive function

The present study was conducted to determine if subchronic oral exposure to trichloroethylene (TCE) influenced female reproductive performance, and if TCE or major metabolites trichloroacetic acid (TCA) and trichloroethanol (TCOH) preferentially accumulated in female reproductive organs or neonatal tissues. Female Long-Evans hooded rats were exposed to vehicle (corn-oil), 10, 100 or 1000 mg/kg/day by gavage for 2 weeks before mating and throughout mating to day 21 of pregnancy. Gas chromatography analysis of tissues from females at the end of premating exposure indicated that TCE levels were uniformly high in fat, adrenals and ovaries across treatment groups, while uterine tissue had relatively high levels of TCA. Female fertility, however, was not influenced in any treatment group. In the 1000 mg/kg/day group, 5 out of 23 females died and weight gain was significantly depressed throughout the treatment period. Neonatal survival was significantly depressed in this group alone, with the majority of deaths occurring among female offspring at the time of birth. TCA levels in blood, liver, and milk contents of the stomach in female but not male neonates increased across treatment groups. These results indicate that oral exposure to TCE at levels below those causing limiting maternal toxicity had no influence on pregnancy outcome, and that the accumulation of TCE and TCA in ovaries, adrenals and uteri had no influence on mating success.

A fifteen-month double-blind cross-over study of the efficacy and antigenicity of human and pork insulins

The antigenicity and efficacy of semi-synthetic human and pancreatic pork insulins have been compared in a double-blind double cross-over study in 96 insulin-treated diabetic patients. Transfer from pork to human insulin was associated with a 1.2 +/- 0.5 mmol/l deterioration (p less than 0.05) in the fasting blood glucose level, while the opposite change caused a 1.1 +/- 0.5 mmol/l improvement (p less than 0.05). After 4 months treatment, glycosylated haemoglobin levels were lower on pork (11.1 +/- 0.3%) than on human (11.7 +/- 0.3% p less than 0.01) insulin. The incidence of hypoglycaemia was similar with the two insulins. IgG insulin antibody levels were identical after human insulin treatment (5.7 +/- 0.4 micrograms/l) compared to pork insulin treatment (5.9 +/- 0.5 micrograms/l). Patients with high levels of antibodies (greater than 10 micrograms/l) showed a similar reduction in level when switched to either species of highly purified insulin. The deterioration in fasting blood glucose control is consistent with similar reports for biosynthetic human insulin and suggests, in the absence of changes in insulin antibody levels, a small but clinically significant pharmacokinetic difference between human and pork insulin.

Nucleotide sequence and expression in E. coli of a human interferon-alpha gene selected from a genomic library using synthetic oligonucleotides

The complete nucleotide sequence of a human interferon-alpha gene is reported. The gene, designated IFN-alpha M1, was isolated from a human genomic library in phage lambda Charon 4A using synthetic oligonucleotides as hybridization probes. Based on a comparison of nucleotide sequence data obtained from this recombinant phage with published interferon-alpha gene sequences, a region of DNA capable of coding for a pre-interferon of 189 amino acids was identified. An AluI fragment containing the coding region for the mature interferon was inserted into the HincII site of the phage M13mp11, resulting in a fusion of portions of the IFN-alpha M1 and the beta-galactosidase genes. Antiviral activity was detected in extracts from E. coli infected with the recombinant M13 phage carrying the fused gene. The antiviral activity was completely neutralized by antibodies to human interferon-alpha.

Prospective comparative trial of moxalactam versus ampicillin or chloramphenicol for treatment of Haemophilus influenzae type b meningitis in children

In a prospective, randomized study, moxalactam in 44 children was compared with ampicillin or chloramphenicol in 47 children for the treatment of Haemophilus influenzae type b meningitis. Both groups were comparable in terms of clinical and laboratory findings at admission. The hospital course, neurologic sequelae including deafness, and number of deaths were the same for both groups. The incidence of adverse reactions also was the same except that diarrhea and thrombocytosis occurred significantly (P less than or equal to 0.04) more frequently in children given moxalactam. Moxalactam was equivalent to ampicillin or chloramphenicol in the treatment of H. influenzae type b meningitis in children.

Rabies induced in a cat by high-egg-passage Flury strain vaccine

An adult male domestic short-hair cat developed posterior paralysis 22 days after being vaccinated for rabies with a high-egg-passage Flury strain vaccine currently approved for use in cats. A diagnosis of rabies was confirmed by mouse inoculations, and viral typing using a panel of monoclonal antibodies demonstrated that it was vaccine induced.

Early infectious complications in allogeneic marrow transplant recipients with acute leukemia: effects of prophylactic measures

One hundred eighty-two patients with acute leukemia underwent allogeneic marrow transplantation and received one of two forms of infection prophylaxis: isolation and decontamination procedures in laminar air flow rooms (90 patients) or prophylactic granulocyte transfusion from a single family member (92 patients). Infection acquisition and survival were analyzed from the time of admission to 100 days posttransplant. There were 20 major local infections in the laminar air flow group and 16 in the prophylactic granulocyte group. Of the patients in the laminar air flow group, 24 (27%) had 27 episodes of bacteremia, while 23 (25%) of the prophylactic granulocyte group had 25 episodes of bacteremia. There were no significant differences in infection acquisition between the two groups during the period of granulocytopenia or after engraftment. The mortality during the first 100 days was 28% for the laminar air flow group and 35% for the prophylactic granulocyte group. Thirteen patients (14%) in the laminar air flow group and five (5%) in the prophylactic granulocyte group died with bacterial or fungal infections. There were no statistically significant differences between the two groups in overall incidence of or mortality from interstitial pneumonitis which was the predominant cause of death. However, the subset of patients who were seronegative for cytomegalovirus antibody at the time of transplant and received granulocytes from seropositive donors had a significantly higher incidence of and mortality from cytomegalovirus interstitial pneumonitis.

Pneumothorax in an athlete

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Reversible alterations in immunoregulatory T cells in smoking. Analysis by monoclonal antibodies and flow cytometry

We characterized T-lymphocyte subsets in peripheral blood of smokers (N = 60) and nonsmokers (N = 35). Total T-lymphocytes and T cell subsets were similar to nonsmokers in light and moderate smokers. In heavy smokers, total OKT3+ cells were increased, the percentage of OKT4+ cells was decreased, and percentage and total number of OKT8+ cells were increased. The ratio of OKT4+ to OKT8+ lymphocytes was decreased in heavy smokers. The percentage of OKT8+ cells and the OKT4+/OKT8+ ratio returned to normal in heavy smokers six weeks after they stopped smoking. These findings suggest that cigarette smoking causes reversible alterations in immunoregulatory T cells.

Sudden infant death syndrome associated with rotavirus infection

Rotavirus was detected in the stools of five children stricken with sudden infant death syndrome (SIDS) over a three-week period. While none of the children had acute gastroenteritis, four of the five had acute upper respiratory infections. Rotavirus was also identified in tracheal aspirates from two of the infants. Extensive investigations failed to reveal the presence of any other viruses or toxins in specimens obtained from the five children with SIDS. Rotavirus was not found in the stool specimens obtained from a control group of 36 infants including six who died of causes other than SIDS. Future attempts at the prevention of rotavirus infections should be directed at populations susceptible to sudden infant death syndrome.

Effect of bypass surgery on survival in patients in low- and high-risk subgroups delineated by the use of simple clinical variables

A multivariate risk function was developed on data from all 508 medical patients in the Veterans Administration (VA) randomized study of coronary bypass surgery. The variables, in order of importance, were ST-segment depression on resting ECG, history of myocardial infarction, history of hypertension and New York Heart Association functional classification III or IV. These noninvasive variables have been reported to be risk factors in natural-history studies of coronary heart disease (CHD). Applying the risk function to medical and surgical patients of the 1972-1974 cohort yielded a 5-year probability of dying for each patient. Investigation of treatment effects in approximate terciles obtained by collapsing the probability distribution into low-, middle- and high-risk groups showed that surgery was beneficial for patients in the high-risk tercile even after removal of patients with left main coronary artery disease (17% surgical vs 34% medical mortality at 5 years; p less than 0.01). This finding was accentuated when patients in the 10 hospitals with the lowest operative mortality (3.3%) were compared. Mortality results in the low-risk tercile favored medical treatment (medical vs surgical mortality 7% vs 17%; p less than 0.05). The risk function predicted mortality well not only for te VA medical group, but also for an independent symptomatic CHD population from the University of Alabama arteriography registry. This report further delineates the advantages and limitations of coronary bypass surgery in CHD patients with chronic stable angina.

Social consequences of vesico-vaginal fistula in northern Nigeria

The social consequences to the patient who suffers from vesico-vaginal fistula are discussed. Patients are mainly young, come from subsistence farming backgrounds, are often considered to have brought shame on their families, and frequently lose their husband's support, especially if their condition is of long standing. In a society that places a high value on childbearing they have little hope for the future.

Integrity of perfused rat liver at different heat loads

Isolated rat livers were perfused for 90 minutes at temperatures from 37 degrees to 43 degrees C. to evaluate the effects of heat alone on bile production, alanine aminotransferase, and asparate aminotransferase release, and light and electron microscopic structure. Bile production reached a plateau after 45 minutes at 43 degrees C. and after 60 minutes at 42 degrees C. At temperatures between 39 degrees and 41 degrees C., bile production was not significantly different from that produced at 37 degrees C. The timing and levels of alanine aminotransferase and aspartate aminotransferase released into the perfusates were similar, with increases after 45 minutes at 43 degrees C., after 60 minutes at 41 degrees and 42 degrees C. and after 75 minutes at 39 degrees and 40 degrees C. At the end of the 90-minute perfusion, light microscopy indicated vacuolization and severe dissociation of hepatocytes at 42 degrees and 43 degrees C., and pronounced centrilobular vacuolization at 41 degrees C. Electron microscopy demonstrated that hepatocytes had sustained extensive damage at 41 degrees to 43 degrees C. Mild focal and probably reversible damage occurred at 39 degrees and 40 degrees C. Since pH and O2 levels were regulated in a nonrecirculating system and perfusion rates were constant, neither acidosis, hypoxia, nor circulatory inadequacy were responsible for the alterations. Therefore, changes were attributed to the direct effects of heat, reflected a continuum from no detectable damage at 37 degrees C. to occasional necrosis of individual cells at 39 degrees to 40 degrees C. and culminated in widespread necrosis at 41 degrees to 43 degrees C. with a 90-minute exposure. These results reflect a time/temperature relationship over a range of temperatures. A hypothesis for the sequence of events in the pathogenesis of heat-induced hepatic injury is described.

Mitochondrially synthesized protein subunits of the yeast mitochondrial adenosine triphosphatase. A reassessment

Evidence is presented that a mitochondrial translation product (Mr, 32,000) previously thought to be a subunit of the membrane sector of the yeast mitochondrial ATPase is a contaminant, consisting of subunit II of the cytochrome oxidase complex and cytochrome b apoprotein. Our data suggest that only two subunits (Mr, 7600 and 20,000) of the mitochondrial ATPase are synthesized in the mitochondria.

Differentiation of ob 17 preadipocytes to adipocytes. Triggering effects of clofenapate and indomethacin

Conversion of ob 17 preadipocytes to mature adipose cells is accelerated by addition of clofenapate or of indomethacin, in either the absence or presence of insulin. General stimulation of triacylglycerol-pathway enzymes is observed, as well as dramatic increase in endogenous fatty-acid synthesis. This increase is a function of drug concentration and exposure time. In contrast to indomethacin, the continuous presence of clofenapate after the cells reached confluence was required to observe the effects on adipose conversion. Growth of ob 17 fibroblasts in the presence of 5-bromo-2'-deoxyuridine normally prevents their differentiation to adipose cells. Addition of either clofenapate or indomethacin to these cells at confluence overrides this block. The effects of hypolipidemic drugs such as clofenapate observed on a long-term basis in vitro are consistent with the results of studies on adipose tissue in vivo.

Biogenesis of mitochondria. oli2 Mutations affecting the coupling of oxidation to phosphorylation in Saccharomyces cerevisiae

1. Two oligomycin-resistant strains of Saccharomyces cerevisiae have been isolated and shown to have mutations in the oli2 region of the mitochondrial DNA. On solid media containing a non-fermentable energy source, the mutant strains were able to grow only slowly at 28 degrees C and not at all at 18 degrees C or 36 degrees C. 2. When grown in a glucose-limited chemostat at 28 degrees C, the mutant strains were almost completely defective in oxidative metabolism. The mutant mitochondria contained significant levels of all respiratory enzymes, and an active, oligomycin-sensitive ATPase, but the ATP-32Pi exchange activity and P : O ratio were very low. 3. The mutations in these strains are genetically closely linked to mit mutations which have been shown to affect a 20 000-dalton ATPase subunit (Roberts, H., Choo, W.M., Murphy, M., Marzuki, S., Lukins, H.B. and Linnane, A.W. (1979) FEBS Lett. 108, 501-504). Since the mitochondrial ATPase in these mutant strains appears to be fully assembled, the defect in the coupling mechanism is probably a result of a small alteration in the structure of the 20 000-dalton ATPase subunit. 4. When the mutant strains were grown at 18 degrees C, the mitochondria had very low cytochrome oxidase activities, and reduced levels of cytochrome aa3. The largest subunit (Mr 40 000) of this enzyme was not synthesized.