Disseminated intravascular coagulation in a case of fatal lindane poisoning

After an accidental or intentional ingestion of lindane, clinical manifestations of poisoning may include rapid onset of nausea and vomiting, coma, seizures, respiratory failure, and death. While rhabdomyolysis, secondary renal failure, and aplastic anemia have also been reported, coagulopathies have not been observed following poisoning with this pesticide. In this case report we describe a 43-year-old female who intentionally ingested 8 oz of a 20% lindane solution. Her serum lindane concentration reached 1.3 mcg/ml and her clinical manifestations included seizures, coma, rhabdomyolysis, secondary renal failure, and disseminated intravascular coagulation. The coagulopathy presented early in her clinical course and resolved when serum lindane levels fell. The patient died 11 days after the ingestion.

Immunocytological demonstration of HSV-II antigen on exfoliated cells from precancerous and cancerous lesions of the uterine cervix

Cancer of the uterine cervix is the most common malignancy among Indian women. Evidence has shown that cervical cancer is preceded by dysplastic, or precancerous, lesions. HSV-II has been associated with this process of cervical carcinogenesis. We collected 167 cervical smears that had been diagnosed as normal, dysplastic, or carcinoma-in-situ and found a significantly high positivity of HSV-II antigen in women with cervical dysplasia (38.8%) and carcinoma-in-situ (33.3%) versus women with normal cytology (17.02%). Latent HSV-II infection of cervical epithelium may be considered of prognostic value to identify a population at high risk for cervical cancer.

Adenosine deaminase activity in leprosy (a preliminary study)

Adenosine deaminase (ADA) activity was studied in 25 patients having different types of leprosy and 25 healthy volunteer as control. There was definite rise of ADA activity in BL (72.9 +/- 6.85), LL (56.7 +/- 3.35) and BT (39.1 +/- 8.28) which was statistically significant when compared to ADA activity in healthy control (9.7 +/- 0.53).

Immunospecificity and affinity studies on the monoclonal anti-gonadotropin releasing hormone (GnRH) antibodies: monoclonals produced by azotized GnRH preferentially recognise to native GnRH

Monoclonal anti-GnRH(MoAb) antibodies generated by using azo-GnRH-TT conjugate were purified by affinity chromatography using azo-GnRH-BSA-Sepharose 4B column. The affinity column bound (A-MoAb) and unbound (U-MoAb) fractions were tested for immunoreactivity towards GnRH(NH2), azo-GnRH(NH2) and GnRH free acid and its fragments of sequence 4-6, 7-10 and 4-10. Both fractions reacted best with native GnRH and about 20 times less to azo-GnRH. The cross-reactivity with other GnRH(OH) fragments and affinity characteristics of A-MoAb, and U-MoAb was comparable with those of MoAb. The immunoreactivity of both the fractions was regained when C-terminus of GnRH free acid was blocked by MDP-Lys, Lys or Ala-Ala-Thr-Lys-Pro-Arg-OH indicating the importance of C-terminus amide in the recognition ability of antibodies.

Effect of respiratory exercises on asthma. The Pink City lung exerciser

Twelve subjects with mild asthmatic episodes in the form of nocturnal precipitation were studied. A two-week schedule of placebo administration, pranayamic breathing exercises using a Pink City lung exerciser alone, and exercises using the lung exerciser with hot, humid air were performed. Five of the 12 asthmatics showed highly significant increases in peak expiratory flow rate (PEFR) with the lung exerciser alone, while eight of the 12 cases showed highly significant increases in PEFR with exercise using hot, humid air. The frequency of nocturnal wheezing also declined. It can be inferred that slow breathing alone and in combination with hot, humid air has a nonspecific bronchoprotective or bronchorelaxing effect.

Thoracic pressure and nasal patency

Maximum nasal flow rate in the right and left nostrils was simultaneously determined during expiration with the help of two flowmeters in 10 healthy subjects in different postures and in two patients, one with Horner's syndrome and the other with facial palsy. It was found that pressure on the hemithorax from any surface (i.e., lateral, anterior, posterior, or superior) leads to reduced patency of the ipsilateral nostril but increased patency of the nostril on the opposite site. In the patient with Horner's syndrome, the nostril on the affected side remained blocked even on compression of the opposite hemithorax, and in the one with facial nerve palsy, the nostril on the affected side remained patent despite compression of the hemithorax on that side. The findings suggest that compression of hemithorax leads to changes in the congestion of the nasal mucosa that may be mediated through autonomic nerves.

Tuberculous meningitis: role of CT in management and prognosis

Serial computed tomographic scans were performed during the course of tuberculous meningitis in 25 patients aged 1-70 years. Hydrocephalus rarely occurred without other abnormalities. Marked ventricular enlargement was associated with extensive basal enhancement. Basal meningeal enhancement was not a good indicator of the clinical state although marked enhancement was a risk factor for the development of basal ganglia infarction. Infarcts were much more common in children than in adults and were sometimes asymptomatic. Radiological abnormalities sometimes developed during treatment and often did not resolve completely. Many patients had severe residual neurological problems.

Kunjal: a nonspecific protective factor in management of bronchial asthma

Seven asthmatic patients having nocturnal symptoms performed a yogic maneuver called Kunjal. Definite improvement was noticed subjectively and objectively in six patients during the week Kunjal was performed, and improvement in symptoms persisted into the third week in five patients.

Structural requirement for the recognition of luteinizing hormone releasing hormone (LHRH) by monoclonal and conventional anti-LHRH antibodies

Immunochemical studies on monoclonal and conventional anti-LHRH antibodies have been reported. The association constants (Ka) were in the order of 10(9)-10(10) L/mol when calculated from Scatchard and Steward-Petty plots. Heterogeneity indices (a) calculated from Sips plot were nearly 1.0, indicating the homogeneous nature of monoclonals. Most of the conventional anti-LHRH produced by monkey, baboon, rabbit, and dog, by immunization using LHRH linked to tetanus toxoid by the carbodiimide condensation method, showed a single slope in Scatchard analysis (except two dog antisera) and a values were nearly 1.0. Monoclonals and conventionals reacted most strongly with native LHRH(NH2). Monoclonals showed poor reactivity with LHRH free acid and LHRH fragments containing free acid. The C-terminus tetrapeptide 7-10 showed 10 times more reactivity than tripeptide 4-6. The heptapeptide 4-10 showed 100 and 1000 times more reactivity than the tetra- and tri-peptide, respectively. Introduction of the tripeptide pGlu-His-Trp-OH to heptapeptide 4-10 caused five times more inhibition in reactivity than the heptapeptide. Conventional anti-LHRH antibodies manifested specificity to the C-terminus of LHRH. These sera did not react with LHRH free acid and LHRH fragments of sequence 4-6, 7-10, and 4-10. The complete loss of reactivity of conventional antibodies and poor reactivity of monoclonal antibodies was partly regained when LHRH free acid was coupled to Lys, Lys-MDP, or (Ala)2-tuftsin, suggesting that for monoclonals and conventionals the antigenic determinant was confined to the conformation involving the C-terminus amide of LHRH.

Evaluation of E and EAC rosette-forming cells in patients with thermal injuries

Thermal injuries lead to changes in both the cell-mediated and humoral responses of the patient. This study was undertaken to assess these responses in the post-burn period and also to see if bacterial infection altered these responses. It has been concluded that alterations in the cell-mediated and humoral immune responses following thermal injuries are altered by infection and consequently are also important in the healing process.

Enhancement of antigonadotropin response to the beta-subunit of ovine luteinizing hormone by carrier conjugation and combination with the beta-subunit of human chorionic gonadotropin

Previous studies have demonstrated the control of fertility in monkeys on immunization with the beta subunit of ovine luteinizing hormone (beta-oLH) along with Freund's complete adjuvant (CFA). An eventual birth control vaccine would demand immunization without CFA. Beta-oLH linked to tetanus toxoid (TT) adsorbed on alum-induced antibody response in bonnet monkeys with detoxified sodium phthalyl derivative of Salmonella enteritidis lipopolysaccharide added only in the first injection. The antibodies reacted with both LH and human chorionic gonadotropin (hCG). A higher immune response was obtained with the use of a conjugate of beta-oLH and beta-hCG linked to a common carrier (TT) or with a mixture of beta-hCG/TT and beta-oLH/TT. In both cases, the antibodies were of high affinity with Ka ranging from 5 X 10(9) to 6 X 10(10) M-1. The antibodies were devoid of reactivity with human thyroid-stimulating hormone and human follicle-stimulating hormone. Monkeys with titers above 120 ng/ml hCG binding capacity (greater than 60 ng/ml in most cases) were protected from becoming pregnant during repeated mating with males of proven fertility in ovulatory cycles.

Comparison of passive haemagglutination test with Widal agglutination test for serological diagnosis of typhoid fever in an endemic area

A passive haemagglutination test, using sheep red blood cells sensitised with Salmonella typhi lipopolysaccharide, was compared with the Widal test for the serological diagnosis of typhoid fever in an endemic area. The results obtained on sera from 152 patients with bacteriologically confirmed typhoid and 183 patients who did not have typhoid were analysed in terms of sensitivity, specificity, simplicity, and rapidity of the respective tests. The passive haemagglutination test was found to be more sensitive (80%) than the S typhi O antigen (71%) but marginally less sensitive than the H antigen (82%) of the Widal test. The false positive rate on control sera was 1.2% and 6.6%, respectively, for the Widal O and H antigens, and 1.6% for the passive haemagglutination test. Our findings indicate that the passive haemagglutination test is comparable with the Widal test for the serological diagnosis of typhoid fever in endemic areas, but is more simple, rapid, and economic. The passive haemagglutination test may be a useful alternative to the Widal test for the serological diagnosis of typhoid fever in busy microbiology laboratories in areas in which the disease is endemic.

Management of massive air embolism during open heart surgery

Two patients in whom a massive bolus of air was introduced into the arterial circuit and ascending aorta during valve replacement and in whom the recovery was complete are presented. The technical details of the management of this serious accident are described.

The dominant role of amide group at C-terminus for recognition by antibody in primates against gonadotropin releasing hormone

A monkey and a baboon immunized with GnRH-tetanus toxoid conjugate developed high anti-GnRH antibody titres which resulted in disruption of cyclicity and low estradiol and progesterone levels indicative of the inhibition of follicular development and ovulation. Sera of both animals reacted with GnRH(NH2) but were devoid of reactivity with peptide sequences, 4-6, 7-10 and 4-10 of GnRH as well as GnRH free acid. Both sera were however reactive with GnRH-Lys-muramyl dipeptide analogue and GnRH-Ala-Ala-Thr-Lys-Pro-Arg-OH. As these compounds differ from GnRH-free acid by the presence of amide linkage at C-terminus of GnRH, these studies point to the importance of the conformation involving amide group at this position for immunoreactivity.

Bioeffective monoclonal antibody against the decapeptide gonadotropin-releasing hormone: reacting determinant and action on ovulation and estrus suppression

A monoclonal antibody generated against the decapeptide gonadotropin-releasing hormone (GnRH) was effective in intercepting the bioactivity of the hormone; it blocked ovulation in rats. The antibody reacted optimally with the native hormone. Substitution of amide at the COOH terminus by a carboxyl group decreased immunoreactivity by a factor of 200. The antibody recognized the amino acid sequences 4-6, 7-10, and 4-10 to a variable degree, which suggests that the epitope has a conformation involving the entire molecule, with the NH2- and COOH-terminal regions probably in proximity. The antibody was also competent to suppress the progression of estrus in dogs, an indication that GnRH may play an inductive role in the reproductive function of dogs.

Penicillin concentrations in serum and cerebrospinal fluid after intramuscular injection of aqueous procaine penicillin 0.6 MU with and without probenecid

Paired specimens of cerebrospinal fluid and serum were taken from 21 patients to estimate penicillin concentrations two to three hours after the last dose of a course of 14-21 daily intramuscular injections of procaine penicillin 0.6 MU. Of 10 patients treated with procaine penicillin alone, eight had no detectable penicillin and two had sub-treponemicidal concentrations (less than 0.018 mg/l) in the cerebrospinal fluid. Of 11 patients treated with procaine penicillin as above and probenecid 2 g a day by mouth, three had no detectable penicillin, two had sub-treponemicidal concentrations, and six had treponemicidal concentrations of penicillin in the cerebrospinal fluid. All 21 patients had treponemicidal concentrations of penicillin in the serum. This dose of procaine penicillin alone or with probenecid is therefore not recommended for treating neurosyphilis.

Gastric lesser curve superficial seromyotomy: an experimental study in dogs

Lesser curve superficial myotomy has been investigated in the dog. The anatomical basis for the operation is discussed. The operation has the advantage of being easily performed and the risk of damage to the nerve of Latarjet or ischemic necrosis of the lesser curvature is obviated. Acid studies in the dogs confirmed that the operation was capable of producing secretory inhibition in keeping with vagotomy of the parietal cell area. The experiment needs further investigation in animals and in man, for assessment of the potential of the operation to replace other forms of vagotomy in patients with duodenal ulcer.