Q fever endocarditis: relapse five years after successful valve replacement for a first unrecognized episode

A 59-yr-old man presented with mitral endocarditis and negative blood cultures. Antibodies to phase 2 and phase 1 antigens of Coxiella burneti were detected and a diagnosis of Q fever endocarditis was made. Five years earlier, this patient had been successfully treated by aortic valve replacement for a first episode of endocarditis with negative blood cultures. Giemsa and Machiavello stains of the native aortic valve were made retrospectively and showed coccobacilli highly suggestive of Coxiella organisms. It is concluded that the first episode was Q fever endocarditis and that the failure to recognize this aetiology at that time, and the absence of adequate medical therapy, is the cause of the present episode.

In vitro antiproliferative activity of combinations of ether lipid analogues and DNA-interactive agents against human tumor cells

Ether lipid analogues of platelet-activating factor (1-octadecyl-2-acetyl-sn-glycero-3-phosphocholine) possess a wide range of biological activities, including inhibition of neoplastic cell growth in vitro and in vivo. This activity is believed to be membrane mediated. Three different ether lipid analogues, 1-octadecyl-2-methyl-rac-glycero-3-phosphocholine, 1-thiohexadecyl-2-ethyl-rac-glycero-3-phosphocholine, and 4-amino-methyl-1-[2,3-(di-n-decyloxy)-n-propyl]-4-phenylpiperidine , were combined with three DNA-interactive drugs, Adriamycin, 4-hydroperoxycyclophosphamide, and cisplatin, in the expectation that combinations of drugs with different mechanisms of action might show enhanced antitumor activity. The in vitro antiproliferative activity of the combinations was measured with a semisoft agarose clonogenic assay of an ovarian adenocarcinoma cell line. Various permutations of drug combinations were studied. Isobologram analyses and different treatment schedules were performed. Enhanced antiproliferative activity was found with combinations of ether lipids with DNA-interactive drugs in comparison with single agents. Statistical evaluation of the data indicated that the increase in activity was due to an additivity phenomenon. Neither synergism nor antagonism was found.

Synthesis and evaluation of neoplastic cell growth inhibition of 1-N-alkylamide analogues of glycero-3-phosphocholine

Previously unreported analogues of the synthetic antitumor phospholipid ET-18-OMe (1-octadecyl-2-methoxy-rac-glycero-3-phosphocholine), in which the 1-ether oxygen has been replaced by an amido group, have been prepared and evaluated for in vitro cytotoxic effects and for inhibition of protein kinase C. The title compounds exhibit cytotoxic effects against several tumor cell lines and are approximately equipotent to ET-18-OMe. The compounds were also found to inhibit protein kinase C in an in vitro assay. This work is a continuation of our previous structure-activity studies on thio-substituted derivatives of ET-18-OMe.

Neoplastic cell inhibition with new ether lipid analogs

Bioactive phospholipid analogs of platelet-activating factor (PAF) represent a new approach to cancer chemotherapy. Various modifications of the basic structure of PAF lead to different ether lipid (EL) analogs. Data from the evaluation of thioalkyl and amidoalkyl glycerophosphocholine and of glycerophosphoinositol EL analogs against different experimental tumors in vitro (HL60 and K562 human leukemia cells, BG1 and BG3 ovarian adenocarcinomas) are presented. Exclusion of trypan blue after short exposure to the drugs determined cytotoxicity, and a soft agarose clonogenic assay measured the ability of the analogs to inhibit tumor cell proliferation. The thioalkyl EL are very active against the cell lines using both end points, and the amidoalkyl EL showed efficacy against the leukemic cell lines, whereas the phosphoinositol EL are active only at high concentrations. Combined use of EL analogs, which are membrane-interactive, with classical DNA-interactive chemotherapeutic drugs revealed that the combinations have additive antiproliferative effects. These results are promising leads in the development of the anticancer potential of ether lipid analogs.

Increased plasma motilin concentrations in small cell carcinoma of the lung

Plasma samples from 21 patients with small cell carcinoma of the lung were screened for pancreatic polypeptide, somatostatin, motilin, and vasoactive intestinal polypeptide. One patient had severe impairment of both renal and liver function. In the 20 remaining subjects vasoactive intestinal polypeptide concentrations were normal, and only two patients had increased concentrations of somatostatin. Increases in pancreatic polypeptide were detected more commonly (7/20), but these may have been non-specific age related increases. The major finding was high concentrations of motilin (greater than 496 pg/ml) in 17 of 20 patients. Plasma motilin was subsequently assayed in 16 more patients with lung cancer, including 10 patients with non-small cell carcinoma of the lung. At concentrations over 900 pg/ml plasma motilin appears to be a tumour marker for small cell carcinoma of the lung with acceptable sensitivity (59%) and specificity (78%). The origin of increased plasma motilin in small cell carcinoma of the lung was investigated. Bombesin (gastrin releasing peptide), a peptide known to stimulate the release of motilin in man, was, as in previous studies, detected in tumour but not in plasma, except in one patient out of 21. Immunohistochemical studies failed to detect motilin antigen in biopsy samples. Motilin tumour content was found to be low in tumour tissue from three patients with small cell carcinoma of the lung who had appreciable hypermotilinaemia and from three patients with non-small cell carcinoma of the lung who had either normal or slightly raised plasma motilin concentrations. The stimulus to motilin secretion in patients with small cell carcinoma of the lung remains unclear.

Resistive inspiratory muscle training and exercise performance in COPD patients. A comparative study with conventional breathing retraining

Twenty patients with stable COPD (mean age 67.8 yr; mean FEV1 1.08 1), all limited by ventilation at maximum exercise, were randomly allocated after a four week control period, to an eight week programme of either inspiratory resistive training (IRT), with a P Flex device, or conventional breathing retraining (BR). Exercise performance was evaluated every four weeks, using a 12-min walking test, an incremental progressive exercise on a cycle ergometer and a cycle endurance test. Inspiratory muscle endurance was measured as the highest tolerated resistance for 10 min on a P Flex device. IRT produced a significant (p less than 0.05) increase in the highest tolerated resistance, but IRT and BR failed to improve lung function or exercise performance. The present study shows that in COPD patients with ventilatory limitation on exercise an IRT programme may fail to improve exercise performance, in spite of an efficient training effect on the endurance of the inspiratory muscles.

Acute pancreatitis as presenting symptom and sole manifestation of small cell lung carcinoma

A 58-year-old man with no sign of pulmonary disease and a normal chest x-ray presented with acute pancreatitis resistant to conventional medical management and a mass in the head of the pancreas. The presumptive diagnosis was pancreatic cancer with tumor-induced pancreatitis. However, endoscopic retrograde cholangiopancreatography suggested metastatic rather than primary tumor, so that an extrapancreatic primary was actively sought. Further lung work-up demonstrated a small cell carcinoma of the lung. This case indicates that metastasis-induced acute pancreatitis can be the presenting symptom and sole manifestation of lung cancer.

[Nocardia infection: diagnostic and therapeutic problems. 9 cases]

Nocardia asteroides was isolated in 9 patients between June 1982 and February 1984. Clinical manifestations included acute pneumonia (3 cases), chronic lung abscess (2 cases, one of them requiring exploratory thoracotomy) and relapsing infection of the lacrimal canaliculus (1 case). Sputum or bronchial secretions were positive in 3 other patients without evidence of pneumonia, which could represent either an asymptomatic carrier state or a mild bronchial infection. Seven patients had one or several conditions known to favour Nocardia infection, the most frequent being steroid therapy (4 cases), while 2 patients had no predisposing factor. In our series of 5 nocardial lung infections, 2 patients had positive blood cultures. This quite unusually high rate may be related to the use of diphasic bottles and to our systematic policy of prolonged examination of blood cultures taken from immunocompromised patients. Cotrimoxazole was used as the first choice antinocardial agent.

Prostaglandin and thromboxane synthesis by Lewis lung carcinoma during growth

The five stable metabolites [prostaglandin F2 alpha, prostaglandin D2, prostaglandin E2 (PGE2), thromboxane B2, and 6-keto-prostaglandin F1 alpha] of arachidonic acid (AA) via the cyclooxygenase pathway were measured by high-resolution gas chromatography-mass spectrometry in Lewis lung carcinoma homogenates at various times after tumor implantation (11 to 25 days). Vegetating and necrotic sections of the primary tumor and lung metastases were examined. Vegetating tumor showed a very active AA metabolism. Synthesis of PGE2, the most abundant product, markedly increased during tumor growth (up to 30 micrograms/g). A high and increasing synthetic capacity was also noted for prostaglandin D2 (up to 9 micrograms/g). Minor time differences and lower levels (up to 1.4 micrograms/g) were found for the other AA metabolites. PGE2 and prostaglandin D2 were the major products in necrotic tumor, too, but synthesis was markedly less than in vegetating tumor, and no increase was noted over time. Metastatic tissue showed a different AA metabolic profile, as compared to primary tumor and surrounding lung tissue, with PGE2 and 6-keto-prostaglandin F1 alpha being the main metabolites.

Massive vitamin A intoxication with ascites and pleural effusion

Vitamin A intoxication was diagnosed in a 14-year-old girl who presented with massive exudative ascites and right pleural effusion, impaired liver enzymes, and hypertriglyceridemia. Electron microscopy of liver biopsy material demonstrated numerous perisinusoidal lipid-filled Ito cells. The patient had taken 100-200,000 I.U. vitamin A per day for 15 months. Serum vitamin A level remained elevated for 4 months after vitamin discontinuation. The unusual severity of portal hypertension was documented by a high wedged hepatic vein pressure level. The ascites occurred 2 months after vitamin A had been discontinued, probably owing to particularly slow mobilization of large hepatic stores of vitamin A. Portal hypertension disappeared after a 6-month low vitamin A diet, but the liver biopsy failed to demonstrate any decrease in number or size of Ito cells, suggesting that lipid venous obstruction is unlikely to be the only mechanism responsible for portal hypertension in vitamin A-induced liver disease.

Lung function in children and adolescents with antecedents of acute rheumatic fever

Static lung volumes, CO-lung transfer, airway resistance, maximal expiratory flows and lung elastic properties were studied in 29 children and adolescents 1-10 years after recovery from acute rheumatic fever. There were essentially no changes in lung function even in the subjects with a residual valvular disease. The only abnormality was a tendency for the elastic lung recoil at TLC to be low, which is interpreted as probably reflecting a decrease in inspiratory muscle force.

Prostaglandins and aminoglycoside nephrotoxicity

The role of prostaglandins in the development of aminoglycoside-induced acute renal failure was studied in CD-COBS rats (200 to 250 g). The animals were treated with gentamicin (80 mg/kg), acetylsalicylic acid (ASA, 100 or 200 mg/kg), or both drugs or saline for 5 or 10 days. Renal function was studied measuring creatinine clearance, blood urea nitrogen (BUN), and serum electrolytes, urine osmolality, and maximal urinary concentrating capacity after water deprivation and vasopressin administration. Gentamicin toxicity on the proximal tubule was evaluated by measuring urinary excretion of the lysosomal enzyme N-acetylglucosaminidase (NAG). Renal prostaglandin (PG) production was evaluated measuring the concentration of PGE2, PGD2, PGF2 alpha, 6-keto-PGF1 alpha, and thromboxane B2 (TXB2) in whole renal homogenate after a 15-min incubation at 37 degrees C using gas chromatography-mass spectrometry. Gentamicin alone reduced the glomerular filtration rate (GFR) 20 to 30% after 5 and 10 days of treatment. Combination with ASA potentiated the toxic effect of the aminoglycoside after 10 but not after 5 days of treatment. Similarly, gentamicin reduced the urinary concentrating capacity and addition of ASA worsened the effects. Gentamicin markedly increased NAG excretion but this effect was reduced by ASA, probably as a result of lysosomal stabilization. ASA alone inhibited the production of prostaglandins in renal tissue by 70 to 90% after single or multiple doses. The animals treated with gentamicin alone presented a significant, specific increase in PGE2 production after 10 days of treatment but this increase did not occur when the two compounds were given together. Since PGE2 has a vasodilatory effect in the kidney these results suggest that it may play a specific role in maintaining normal renal blood flow and GFR during the development of aminoglycoside nephrotoxicity. The inhibition of prostaglandin production by nonsteroid anti-inflammatory drugs prevents this compensatory mechanism and worsens the renal damage.

Trisomy 11 in preleukemia

The clinical and cytogenetic findings of a patient with a preleukemic state and trisomy 11 are reported. Trisomy 11 was present as the sole karyotypic alteration at the time of overt leukemia. Trisomy 11 presents an additional chromosomal abnormality not previously described in preleukemia.

Prostaglandin endoperoxide synthetase and the activation of benzo(a)pyrene to reactive metabolites in vivo in guinea pigs

The role of prostaglandin endoperoxide synthetase in the in vivo activation of benzo(a)pyrene to reactive metabolites capable of interacting irreversibly with cellular macromolecules was studied in guinea pig liver, lung, kidney, spleen, small intestine, colon, and brain. DNA and protein covalent binding experiments were made after systemic administration of acetylsalicylic acid (200 mg/kg) followed by radiolabeled benzo(a)pyrene (4 microgram/kg). Results are compared with a control situation in which the prostaglandin endoperoxide synthetase inhibitor (acetylsalicylic acid) was not administered. No decrease in the level of DNA or protein benzo(a)pyrene-derived covalent binding was observed in any of the tissues studied.

Comparison of radioimmunoassay and high-resolution gas chromatography mass spectrometry for the quantitative determination of serum thromboxane B2 and 6-keto-PGF1 alpha after pharmacological blockade of thromboxane synthetase

Radioimmunoassay (RIA) and high-resolution gas chromatography-mass spectrometry (HRGC-MS) were compared for the determination of serum 6-keto-PGF-1 alpha and TXB2 in a situation of drug-altered arachidonate metabolism. Results were comparable for TXB2 in both conditions. 6-keto-PGF1 alpha RIA determinations (with two different antisera) revealed increased levels in dazoxiben-treated samples, which were not confirmed by HRGC-MS. The assay were repeatedly checked in controlled conditions to investigate these discrepancies. Interference was found with both antisera, due to the drug-induced change in metabolism.

Characterization of arachidonic acid metabolic profiles in animal tissues by high-resolution gas chromatography-mass spectrometry

A standardized, highly specific routine method was developed for the quantitative profiling of cyclooxygenase metabolites of arachidonic acid in animal tissues. Whole homogenates were used to assess the potential capacity of tissues to metabolize endogenous arachidonic acid. Samples were analyzed by high-resolution gas chromatography-mass spectrometry in the selected ion monitoring mode. The screening of several rat tissues by this method revealed marked tissue-specificity in both the synthesis capacity and prostaglandin profile. The major products detected were: 6-ketoprostaglandin F1alpha for lung, stomach, muscle and heart; prostaglandin D2 for spleen, brain and liver; prostaglandin F2alpha for kidney and prostaglandin E2 for seminal vesicles. Marked species differences were found when guinea pig tissues were analyzed.

Inspiratory and expiratory lung pressure-volume curve in healthy males and females

Quasistatic lung inspiratory and expiratory pressure-volume curves were obtained in 58 healthy nonsmoking males (mean age +/- SD: 42.8 +/- 15.1 years; range 22.70) and 56 healthy nonsmoking females (mean age +/- SD: 41.4 +/- 15.6 years; range: 21-76). Inspiratory and expiratory lung recoil pressures were measured at fixed percentages of TLC (100, 95, 90, 80, 70, 60 and 50%). In both sexes, inspiratory as well as expiratory lung recoil pressures were found to decrease linearly with aging (p less than 0.01 for all r values). There was no significant difference between males and females. At and above the 70% TLC level, the slopes of the age-related decreases in lung recoil were similar for the inspiratory and expiratory curves. At the 60% TLC level, the decrease in expiratory lung recoil was significantly (p less than 0.01) faster than the decrease in inspiratory lung recoil, presumably reflecting the influence of airway opening on the inspiratory pressure in older subjects. The shape of the expiratory PV curve described by the K index of the exponential model was similar in both sexes and changed with aging, K increasing significantly (p less than 0.01). By contrast, the shape of the inspiratory limb of the PV curve did not vary with aging. Consequently, the shape of the inspiratory PV curve cannot be predicted from the expiratory one and has to be measured directly.

Quantitative profiling of prostaglandins and thromboxane by high-resolution gas chromatography-selected--ion monitoring

The development and biological application of a rapid method for quantitative profiling of prostaglandins and thromboxane using high-resolution gas chromatography (HRGC) coupled with mass spectrometry in the selected-ion monitoring technique (SIM) are described. The method is based on the single-step extraction of prostaglandins from biological samples on C18 reversed-phase cartridges after addition of deuterated analogues as internal standards, followed by derivatization of functional groups and final analysis by HRGC-SIM with wall-coated open tubular persilanized capillary columns. Biological applications include the determination of endogenous arachidonic acid cascade profiles in rat tissue homogenates and thromboxane synthetase inhibition studies in human serum.

Variability in lung elasticity measurements in normal humans

The variability of quasistatic lung inspiratory and expiratory pressure-volume (P-V) curves has been investigated in 8 young healthy volunteers studied on 4 occasions. The reproducibility of the total lung capacity (TLC) measured by body plethysmography was good, with a mean coefficient of variation of 1.8 +/- 0.9% (SD). The following variables were calculated from the P-V curves: the recoil pressures measured at TLC and 90, 80, 70, 60, and 50% TLC, as well as the compliance at functional residual capacity. For all the variables considered the intraseries variance was similar to the interseries variance so that all the individual results were pooled together. For each variable a coefficient of variation was calculated for each subject, as well as an F ratio to compare the interindividual differences to the intraindividual differences. For the variables obtained from the expiratory P-V curve, the lowest coefficient of variation was found for elastic lung recoil pressure, 90% TLC (6.6 +/- 2.6%, mean +/- SD). The reproducibility of the inspiratory P-V curve was found to be somewhat better than that of the expiratory one, with a coefficient of variation of 3.4 +/- 0.8% at 90% TLC. In absolute terms at that same level, the mean standard error of measurements was 1.2 cm H2O for the expiratory curves and 0.8 cm H2O for the inspiratory ones. It is concluded that in terms of reproducibility the best index of lung elasticity is the recoil pressure measured at 90% TLC and that the inspiratory curve is even better than the expiratory one.

Rectus sheath hematoma mimicking acute splenic disease

In patients with hematological malignancies and splenomegaly, acute abdominal pain in the left upper quadrant is highly suspicious of splenic disease (i.e., hematoma, infarction, or rupture). We report the case of a patient with chronic myelogenous leukemia and splenomegaly who presented an unusual abdominal condition causing pain in the left upper quadrant, with a clinical presentation mimicking acute splenic disease. The diagnostic dilemma was resolved by ultrasonography, demonstrating a rectus sheath hematoma.

Quantitative determination of 6-keto-PGF1 alpha released by rat aorta: comparison of mass fragmentography and high resolution gas chromatography with electron capture detection

Mass fragmentography (MF) and high resolution gas chromatography with electron capture detection (HRGC-ECD) were used for measuring 6-keto-PGF1 alpha, the stable hydrolysis product of prostacyclin (PGI2) released by fresh rings of rat aorta, incubated in the absence of the precursors arachidonic acid or prostaglandin endoperoxide (PGH2). The incubation medium was acidified, extracted, chromatographed on silicic acid column and derivatized. Comparable results were obtained analyzing each sample by MF and HRGC-ECD. Both methods proved to be suitable in terms of sensitivity and specificity for the measurement of 6-keto-PGF1 alpha produce by individual rat aortae.

2,3,7,8-Tetrachlorodibenzo-p-dioxin toxic effects and tissue levels in animals from the contaminated area of Seveso, Italy

After the environmental contamination by 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in the area of Seveso, Italy, thousands of small domestic animals (mainly rabbits and poultry) died within a few weeks. Autopsies on dead animals showed various pathological signs, such as hepatic lesions and haemorrhage. TCDD was monitored in animal tissues by gas chromatography-mass fragmentography; rabbit liver levels corresponded fairly well to soil contamination, which indicated that this species can be used as a tool for tracking the presence of TCDD in the environment.