Scanning electron microscopy of human lungs in various forms of heart disease

The surface morphologic features of the lung obtained from 21 patients with various forms of heart disease were investigated by scanning electron microscopy, with particular emphasis on the correlation between the surface pathology and cardiopulmonary hemodynamics. There were almost no pathologic findings on the bronchiolar and alveolar surfaces in patients with normal pulmonary arterial wedge pressure (PAWP). The characteristic changes of the surface morphology of the lung parenchyma in patients with abnormal elevation of PAWP included various degrees of desquamating loss of the bronchiolar epithelium associated with inflammatory cell infiltration and fibrotic changes and focal epithelial disruption of the individual alveoli which often extended to involve the surface of the entire alveoli with perforated rupture of the alveolar septa. The severity of abnormal surface morphologic findings of the lung seemed to correlate to the degree of PAWP. From our results it is concluded that chronic lung congestion plays a major role in the pathogenesis of the surface pathologic changes of the lung in patients with heart disease of various etiologies. Our findings may provide a clearer understanding of the structural and functional relationship of congestive lung and a clinical explanation for pulmonary manifestations in patients with chronic congestive heart failure.

Partial restriction map of Marek's disease virus DNA

A partial restriction map of Marek's disease virus (MDV) DNA was constructed by digestion with endonucleases BamHI, Bg/I and SmaI and by blotting hybridization. The data suggest that there is a terminal heterogeneous sequence at least on one end of the MDV DNA molecule. The data did not reveal four different orientations of the terminal fragments of MDV DNA molecules despite the observation that MDV DNA contains inverted repeat sequences as also present in Herpes simplex virus (HSV) DNA molecules (Cebrian et al., 1981). Terminal deletion of MDV DNA, SalI-H and I, was found in high passage number preparations.

Effects of oral disopyramide phosphate on induction and sustenance of atrioventricular reentrant tachycardia incorporating retrograde accessory pathway conduction

We performed electrophysiologic studies before and after oral administration of disopyramide phosphate, 200 mg every 6 hours, in 20 patients with atrioventricular (AV) reentrant tachycardia using a retrogradely conducting accessory pathway. Disopyramide markedly depressed retrograde accessory pathway conduction by increasing the mean ventricular paced cycle length that produced ventriculoatrial block (less than or equal to 287 +/- 4 to greater than or equal to 392 +/- 22 msec, p less than 0.01); it also depressed antegrade normal pathway AV conduction by increasing the atrial paced cycle length that produced AV block (287 +/- 9 to 328 +/- 7 msec, p less than 0.01). In 14 patients, tachycardia could not be induced or sustained after disopyramide phosphate. In 13 patients, this reflected depression of the retrograde limb with either absence of atrial echoes (nine patients) or induction of nonsustained tachycardia that terminated after the QRS complex (four patients), and in one, it reflected depression of the antegrade limb with induction of a single atrial echo not followed by a QRS response. In six patients, sustained tachycardia could still be induced after disopyramide. Oral disopyramide phosphate is effective in preventing induction of sustained AV reentrant tachycardia in most patients. This effect is achieved by depression of the retrograde limb of the reentrant circuit.

The surface morphology and ultrastructure of renal arterial smooth muscle cells in patients with renovascular hypertension

The surface and internal ultrastructure of renal arterial smooth muscle cells were investigated in 3 patients with renovascular hypertension. The most characteristic features of the surface pathology in hypertrophied smooth muscle cells consisted of various degrees of surface defects, including both extensive loss of surface details and an irregular thickening and disruption of the basement membrane, which was widely separated from the plasma membrane by a clear space. Ultrastructural changes include the appearance of highly lobulated nuclei, multinucleation, disorganization of myofilaments and increased numbers of rough-surfaced sarcoplasmic reticulum and mitochondria, which are usual manifestations of cellular hypertrophy. These results suggest that ionic movement across the cell membranes, particularly of Ca2+, is probably abnormal in hypertrophied smooth muscle cells. This may result in functional disorders of hypertensive arteries.

The pattern of hydatidiform moles in Singapore

Hydatidiform mole is common in Singapore, and the the incidence of malignant trophoblastic neoplastic neoplasia is significantly higher than in Western countries. Within a 10-year period (1968-1977), 538 cases of hydatidiform mole were diagnosed. On retrospective study, 498 (92.6%) were considered to be complete and 40 (7.4%) partial. The ratios of complete to partial moles were similar for the major population groups. In the present study, only complete moles were found to give rise to persistent trophoblastic disease. The lack of such association in partial hydatidiform moles is in keeping with their known low malignant potential. Occasional abnormal post-evacuation hCG curves, however, are being described from other centres, and while the underlying pathology remains largely undocumented, partial moles have to be dealt with on an empirical basis in the light of the hCG follow-up levels.

The surface morphology of the infundibular muscle in patients with tetralogy of fallot

The surface morphology of the infundibular muscles obtained from open heart surgery was investigated in 10 patients with tetralogy of Fallot. Various degrees of abnormal surface morphological changes were observed from the endocardium to the myocardium. In the endocardium striking proliferation of the endothelial cells was usually accompanied by focal loss of the endothelium with fibrotic change. Based on the characteristic alterations of the surface morphology 4 different groups of myocardial cells could be identified: normal myocytes, defective myocytes, sclerotic myocytes, and necrotic myocytes. Because intact surface morphology is responsible for integrated cellular function these pathological findings observed on the surface morphology of the endocardium and myocardium can provide a valuable reference to further understanding of functional disorders of the infundibular muscle in patients with tetralogy of Fallot.

Preoperative and postoperative echocardiographic studies of pulmonic valvular endocarditis

The echocardiographic manifestations of pulmonic valvular endocarditis in a patient with underlying heart disease consisting of a ventricular septal defect and infundibular stenosis are reported. The abnormal shaggy echoes observed on the pulmonic valve were confirmed to be vegetations based on surgical and pathologic findings. This was further proven by the disappearance of the shaggy echoes after surgical excision of the vegetations. We conclude that echocardiograms can detect the presence and disappearance of pulmonic valvular vegetations, which may be of aid in the diagnosis of pulmonic valvular endocarditis.

A fatal congenital myopathy with severe type I fibre atrophy, central nuclei and multicores

An unusual fatal congenital myopathy in a Chinese female infant is described. Muscle biopsy showed type I fibre smallness with central nuclei and focal decrease in oxidative enzyme activities affecting mainly larger type II fibres. Longitudinal sections from glutaldehyde-fixed araldite-embedded material stained with toluidine blue revealed multiple small foci of myofibrillar degeneration (multicores) along the muscle fibres. Electron-microscopic examination confirmed the presence of multicore lesions affecting mainly the larger fibres. In addition, there were definite degenerative changes involving the smaller fibres with central nuclei. The degenerative process started around the pericentronuclear zones with diffuse extension along the whole length of the muscle fibres resulting in severe atrophy. These degenerative changes were similar to those described in pericentronuclear myopathy. It is therefore suggested that the patient might have either had 2 co-existing myopathies viz. multicore disease and pericentronuclear myopathy or a single entity with combinations of features which had not hitherto been described.

Cloning of Epstein-Barr virus (EBV) DNA fragments in pBR32 and Charon3A

Restriction fragments of Epstein-Barr virus (EBV; B95-8) DNA were cloned in the Tc gene of pBR322 (HindIII-F, -G, -I, -J, -K, -L, and -M) and in Charon3A (EcoRI-GI and -G2). Altogether these cloned fragments covered 39% of the entire viral genome. The cloned EcoRI-G2 fragment of EBV (B95-8) DNA was shown to contain, in addition to HindIII-J, two more HindIII-fragments : HindIII-M, which had not been located on the linkage map of the viral genome (Given and Kieff, 1978) and HindIII-N, which had been unrecognized up to now. The utility of this cloning method is discussed in regard to the detailed mapping of a viral genome and large-scale production of the viral DNA.

Linkage map of the fragments of herpesvirus papio DNA

Herpesvirus papio (HVP), an Epstein-Barr-like virus, causes lymphoblastoid disease in baboons. The physical map of HVP DNA was constructed for the fragments produced by cleavage of HVP DNA with restriction endonucleases EcoRI, HindIII, SalI, and PvuI, which produced 12, 12, 10, and 4 fragments, respectively. The total molecular size of HVP DNA was calculated as close to 110 megadaltons. The following methods were used for construction of the map; (i) fragments near the ends of HVP DNA were identified by treating viral DNA with lambda exonuclease before restriction enzyme digestion; (ii) fragments containing nucleotide sequences in common with fragments from the second enzyme digest of HVP DNA were examined by Southern blot hybridization; and (iii) the location of some fragments was determined by isolating individual fragments from agarose gels and redigesting the isolated fragments with a second restriction enzyme. Terminal heterogeneity and internal repeats were found to be unique features of HVP DNA molecule. One to five repeats of 0.8 megadaltons were found at both terminal ends. Although the repeats of both ends shared a certain degree of homology, it was not determined whether they were identical repeats. The internal repeat sequence of HVP DNA was found in the EcoRI-C region, which extended from 8.4 to 23 megadaltons from the left end of the molecule. The average number of the repeats was calculated to be seven, and the molecular size was determined to be 1.8 megadaltons. Similar unique features have been reported in EBV DNA (D. Given and E. Kieff, J. Virol. 28:524-542, 1978).

Comparative studies of herpesvirus papio (baboon herpesvirus) DNA and Epstein-Barr virus DNA

An Epstein-Barr virus (EBV)-like herpesvirus has been isolated from a baboon cell line (594S/F9) by induction with the tumour promoter 12-O-tetradecanoyl-phorbol-13-acetate (TPA). The herpesvirus papio (HVP) DNA was mixed with B95 EBV DNA and was characterized by sedimentation in neutral glycerol gradient as 55S DNA, with a buoyant density of approx. 1.718 g/ml after equilibrium centrifugation in caesium chloride. DNA-DNA reassociation kinetics between B95 EBV and HVP DNA showed that HVP DNA shares about 40% homology with B95 EBV DNA. Blot hybridization of EcoRI fragments of HVP DNA with a 32P-B95 EBV DNA probe showed that most of the EcoRI fragments of HVP DNA were hybridized to B95 EBV DNA, suggesting that the homologous sequences were dispersed throughout the virus DNA.

Isoproterenol-stimulated C-peptide and insulin secretion in diabetic and nonobese normal subjects: decreased hepatic extraction of endogenous insulin in diabetes

After the iv injection of 2 micrograms isoproterenol, peripheral plasma insulin and C-peptide concentrations were measured in 16 nonobese normal subjects and 53 maturity-onset diabetic subjects. Basal insulin (P < 0.01) and C-peptide (P < 0.05) levels were increased in obese diabetic subjects compared to nonobese normal subjects. Isoproterenol-stimulated insulin (P < 0.01) and C-peptide (P < 0.05) increments were increased in obese diabetic subjects compared to nonobese diabetic subjects. Hepatic insulin extraction, measured by comparing the ratios of insulin increment to C-peptide increment after isoproterenol injection, was decreased in both nonobese and obese diabetics compared to normals (P < 0.05). No significant differences in the ratios were found between nonobese and obese diabetics or between patients on diet or sulfonylurea therapy. Age, sex, duration of disease, familial predisposition to diabetes, and diabetic retinopathy did not influence the ratios. Isoproterenol-stimulated C-peptide increments (P < 0.05) and fasting blood glucose levels (P < 0.05) were decreased in diabetics showing decreased hepatic insulin extraction compared to diabetics with normal hepatic insulin extraction. Isoproterenol-stimulated insulin increments in diabetics showing decreased hepatic insulin extraction were higher than in normals (P < 0.05). These studies indicate that hepatic insulin extraction decreases in nonobese and obese diabetic subjects. It might be postulated that the lesser amount of secreted insulin is able to show biological activities more efficiently in diabetics with decreased hepatic insulin extraction.

Physical mapping of adeno-associated virus serotype 4 DNA

The organization of adeno-associated virus serotype 4 (AAV 4) DNA was probed by using restriction enzymes. The cleavage sites of the following enzymes were mapped: BglII, BamI, HincII, KpnI, PstI, SalI, SstI, and XhoI. The orientation of transcription on the physical cleavage map was determined by locating the fragments which contain the 3' end of the mRNA. Strand separation gels were run for HinII fragments of AAV 4 DNA. By hybridizing AAV 4 mRNA to the resolved strands, the polarity of the DNA strands was identified. Restriction digestion of AAV 4 DNA sometimes produced terminal fragments which migrated in agarose gels as doublets. However, when AAV 4 DNA was prepared devoid of any single-stranded nicks, these terminal doublet bands were not observed upon subsequent restriction analysis. During these studies, the molecular weights of both AAV 4 and AAV 2 duplex DNA were measured and were found to be somewhat larger than previously reported (3.18 x 10(6) and 3.10 x 10(6), respectively).

Studies of plasma beta-N-acetylglucosaminidase activity in experimental and clinical diabetes mellitus

Plasma beta-N-acetylglucosaminidase (NAG) activity was measured in streptozotocin diabetic rats, in non-diabetic rats during starvation and refeeding, and in diabetic patients and normal subjects. The enzyme activity increased significantly in the diabetic rats and in the starved non-diabetic rats. The activity decreased markedly after insulin injection in diabetic rats and after refeeding in non-diabetic rats. The plasma NAG activity (532 +/- 24 nmole/hr/ml, M +/- SE) in 21 diabetics with FBS value less than 100 mg/dl was higher than the enzyme activity (455 +/- 15) in 42 normal subjects (p < 0.01), supporting the idea that a more intensive treatment is necessary to normalize the metabolic derangement of diabetes. There was no significant difference between diabetics with and without microangiopathy. While the influence of age and abnormal liver function was noted, there was no correlation between the NAG activity and the platelet adhesiveness or between the NAG activity and the plasma triglyceride. The results suggest that the plasma NAG activity increases in diabetes mellitus, either with microangiopathy or not. The reason for the failure to demonstrate a significant correlation between the total plasma NAG activity and microangiopathy is discussed. The analysis of the subfractionation of the plasma NAG may be necessary to disclose a significant correlation with microangiopathy.

Phosphopeptides and soluble calcium in the small intestine of rats given a casein diet

1. Semi-synthetic diets containing 200 g protein/kg were meal-fed for 1.5 h to groups of rats. The contents of the whole small intestinal tract were collected and the amount of soluble calcium was determined. 2. In the rats given 200 g casein/kg diet, formation of a fraction containing macrophosphopeptide in the small intestine was confirmed by gelfitration of the intestinal contents on Sephadex G-25. However, this macrophosphopeptide fraction was not found when casein alone was fed. 3. In the intestinal contents at 2.5 h after ingestion, the amounts of both soluble Ca and phosphorus were significantly higher in rats fed the casein diet than in those fed diets containing egg albumin, isolated soya-bean protein or an amino acid mixture. However, the amount of insoluble Ca was least in rats fed the casein diet.

HLA-DRw3 in juvenile onset diabetes mellitus in Chinese

Thirty-nine juvenile onset diabetes mellitus (JOD) patients and 57 healthy Chinese were HLA-typed in Taiwan. The incidence of HLA-DRw3 was significantly increased in patients when compared with the control group (R.R. = 5.8, P = 0.0027). The frequencies of HLA-B17, which showed linkage disequilibrium with DRw3, and Bw54 were increased in patients, but these increases were not significant because of the small number tested. The DR antigen associated with JOD was the same among Chinese and Caucasians, which suggested that at least one of the susceptibility genes to JOD would be commonly in linkage disequilibrium with DRw3 in the two populations.

Ruptured congenital aneurysm of the right sinus of Valsalva into the right ventricle: with special reference to pathoanatomic and hemodynamic characteristics in symptomless cases

Clinical features of 19 cases with congenital aneurysm of the right sinus of Valsalva rupturing into the right ventricular outflow region (Type 1) were analysed in relation to their pathoanatomic lesions and hemodynamic alterations. Sixteen cases were operated with one surgical death. All were catheterized together with ascending aortographic study. Rupture of the aneurysm in many cases was silent or symptomless and progressive heart failure was not quite common. Symptomatology of the patients did not seem to be related entirely to status of the pathoanatomical lesions or hemodynamic alterations. Time of the rupture, and inherent right ventricular characteristics, tolerating volume overload rather well, might be, in part, responsible for its better prognosis in some cases. However, all patients with ruptured aneurysm of the sinus of Valsalva should be treated surgically. Bacterial endocarditis is a serious complication leading to death.

Electron microscopic studies on the alveolar-capillary barrier in the patients of chronic pulmonary edema

Electron microscopic studies on the alveolar-capillary barrier were carried out in 13 patients of chronic pulmonary edema and/or congestion resulting from heart disease of various etiologies. The characteristic findings are tremendous proliferation of type II granular pneumocyte and irregular thickening of alveolar epithelial and capillary basement membrane. These ultrastructural changes correlated to the duration of heart failure and mean pulmonary arterial wedge pressure despite of disease groups and the age of the patients. In particular, lamination of capillary basement membrane with fragmentation was more specific finding which was observed only in patients with mean pulmonary arterial wedge pressure above 35 mmHg and duration of heart failure over 6 hears. There was no apparent relationship existed between the ultrastructural changes and pulmonary arterial pressure. In addition to these characteristic changes the remaining ultrastructural changes of the alveolar-capillary barrier were difficult to make a correlation to clinical course and cardio-pulmonary hemodynamics.

Antigen E content of pollen from individual plants of short ragweed (Ambrosia artemisiifolia)

A study was conducted to ascertain how much variation in allergenic potency of ragweed pollen occurs among individual plants and different plant populations in a restricted geographic area. Seeds of the short ragweed (Ambrosia artemisiifolia) were collected from 38 different sites in Champaign County, Ill. Plants from these seeds were grown under similar conditions, and antigen E (AgE) was determined on pollen samples harvested from individual plants. The populations from various sites in Champaign County differed by as much as severalfold with respect to mean AgE values. There were statistically significant differences among population means, although large variations occurred among plants within populations. Further research was conducted to learn whether the level of AgE was determined by genetic factors within the plants. Genetic regulation was indicated by the finding that 3 plants which had unusually low levels of pollen AgE all produced offspring with significantly lower mean AgE levels than those of control plants.

The pattern of liver diseases in Singapore. An autopsy study

This study is based on an analysis of 1839 consecutive necropsies. Liver diseases are common in Singapore. Of particular importance are cholelithiasis, cirrhosis and primary carcinoma of the liver. Gallstones are mainly of the pigment variety and a significant proportion are present in the bile ducts. The multiracial composition of the population is reflected in a difference in the pattern of liver diseases among the different ethnic groups. Indians are found to have more alcoholic hepatitis and cirrhosis which are often of the micronodular type, while the Chinese have significantly more macronodular cirrhosis and hepatocellular carcinoma. Clonorchiasis and schistosomiasis are confined to the immigrant Chinese. The pattern of liver diseases is changing. Cholangitis and cholangitic abscesses as a result of cholelithiasis are becoming more common while amoebic abscesses and hepatic ascariasis are definitely on the decline. This is attributable to improved sanitary conditions.

Longterm favorable effect of oxygen administration on a patient with primary pulmonary hypertension

A 17-year-old girl with primary pulmonary hypertension was treated with longterm administration of oxygen. Oxygen was delivered only at night for eight hours daily. Her clinical status has been improved for more than 17 months. Cardiac catheterization revealed almost 50 percent reduction of pulmonary vascular resistance. This is the first known report of successful treatment of primary pulmonary hypertension with oxygen administration.

Isolation of mouse hepatitis virus from infant mice with fatal diarrhea

An epizootic of fatal diarrhea occurred in mice which were approximately 10 days of age. The enteric lesions were similar to those reported in lethal intestinal virus of infant mice, but many diseased mice also had necrotic hepatitis. Mouse hepatitis virus antigen was demonstrated in the affected intestine and liver, and a virus that produced syncitium formation in mouse brain tumor cell culture was isolated from the intestines, livers, and brains. The virus was capable of producing intestinal and hepatic lesions similar to the naturally occurring disease after inoculation into suckling mice. Electron microscopy revealed viral particles within affected intestinal epithelial cells of the inoculated mice.

Electrophysiologic manifestations in so-called "sick sinus syndrome"

Electrophysiologic disorders in 17 patients with sick sinus syndrome (SSS) were assessed by recording of intracardiac electrograms, atrial overdrive pacing and extrastimulus technique. Significant suppression of the sinoatrial node (SAN) by overdrive pacing (maximum corrected SAN recovery time of longer than 560 msec) was noted in 14 or 16 patients studied. In nine patients, scanning with atrial extrastimuli, sinus rest was defined in all. In one patient there was a longer interpolation zone. Calculated sinoatrial conduction time (SACT) in individual patients varied considerably. The mean SACT was over 110 msec in 5 of 9 patients (56%). Sinus echo was demonstrated in 3; one manifested SAN- re-entrant tachycardia with rates of 72 to 77 beats/min. AV nodal echo was demonstrated in 3, two of them manifested AV nodal re-entrant tachycardia. Intracardiac electrograms revealed prolonged AV conduction time in 2 of 15 patients and prolonged His-Purkinje system conduction time in 2 of 17 patients studied. Two patients disclosed what we thought to be manifestation of intraatrial conduction disturbance. Both had considerable time interval between pacing impulse and atrial response. In one of them Mobitz type 1 and 2:1 intraatrial blocks were observed on atrial pacing and a possible internodal tract depolarization was also recorded. It is concluded that the electrophysiologic manifestations of patients with SSS cover a wide spectrum. The machanism of tachycardia can be due to either SAN or AV nodal re-entry.

Left ventricular performance in various heart diseases with or without heart failure:--an appraisal by quantitative one-plane cineangiocardiography

Quantitative one-plane cineangiocardiography in right anterior oblique position for evaluation of LV performance was carried out in 62 patients with various heart diseases and in 13 subjects with normal LV. Parameters for evaluating both pump and muscle performances were derived from volume and pressure measurements. Of 31 patients with either systolic hypertension or LV myocardial diseases (coronary artery disease or idiopathic cardiomyopathy), 14 had clinical evidence of LV failure before the study. It was found that mean VCF and EF were most sensitive indicators of impaired LV performance among the various parameters. There was a close correlation between mean VCF and EF, yet discordant changes of both parameters were noted in some patients. Furthermore, wall motion abnormalities were not infrequently observed in patients with coronary artery disease or primary cardiomyopathy. Therefore, assessment of at least three ejection properties (EF, mean VCF and wall motion abnormalities) are considered to be essential for full understanding of derangement of LV function in heart disease. This is especially true of patients with coronary artery disease. LV behavior in relation to different pathological stresses or lesions, such as chronic pressure or volume load, myocardial disease and mitral stenosis, was also studied and possible cause of impaired LV myocardial function in mitral stenosis was discussed.

Latent carcinoma of prostate at autopsy in seven areas. The International Agency for Research on Cancer, Lyons, France

A world-wide comparative study of the frequency and characteristics of latent carcinoma of the prostate was undertaken in seven areas, using standardized methods and "blind" microscopic evaluation in order to reduce selection and observer bias. The morphological features of 350 latent carcinomas found in 1,327 prostates were examined. Two Chinese populations, from Hong Kong and Singapore, showed a low frequency of latent carcinoma in comparison with western Europeans in Sweden and the Federal Republic of Germany and negroes from Jamaica; an intermediate position was found for Israelis and black Ugandans. The frequency of small latent carcinomas was about 12% in all the areas investigated and did not vary with age. Rates for larger latent carcinomas increased sharply with age ans showed an area-to-area variation resembling that of clinical carcinoma of prostate. The small carcinomas were almost exclusively situated in the outer half of the prostate and latent carcinomas of all sizes were evenly distributed between the anterior and posterior halves of the prostate and the right and left sides of the outer prostatic shell. Certain disagreements in diagnosis were noted when the sections from each area were evaluated independently by a different pathologist. Most of these disagreements were resolved by re-reading the sections; their occurrence had no significant effect on the geographical comparisons.