Recognition of intussusception around gastrojejunostomy tubes in children

OBJECTIVE

We describe antegrade intussusceptions of duodenum and jejunum around gastrojejunostomy tubes seen on sonography and fluoroscopic contrast tube studies. Reduction of the intussusception was achieved by bolus injection of air or contrast medium through the tube or exchange over a wire.

CONCLUSION

Sonography and fluoroscopic contrast tube studies permit diagnosis of intussusception around gastrojejunostomy tubes.

Characteristics of stereotypic movement disorder and self-injurious behavior assessed with the Diagnostic Assessment for the Severely Handicapped (DASH-II)

The first experiment involved 143 individuals with severe and profound mental retardation. Individuals with Stereotypic Movement Disorder, Self-Injurious Behavior (SIB), and Stereotypic movement disorder with self-injurious behavior as assessed by the Diagnostic Assessment for the Severely Handicapped-II DASH-II were validated against Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; American Psychiatric Association, 1994) criteria. In a second study DASH-II scores for 1480 individuals with severe and profound mental retardation were compared on demographic variables, core and associated features of each disorder. Characteristics of persons in each group were reviewed. Persons with profound mental retardation were more likely to evince stereotypies or self-injury compared to their severely impaired counterparts. Also, those with stereotypies were more likely to present with Pervasive Developmental Disorder (PDD)/autism, organicity, and eating disorders, while persons with SIB were more likely to evince sleep, sexual, and eating disorders.

Dietary sugar and colon cancer

It has been hypothesized that levels of triglycerides, glucose, and insulin are associated with risk of colon cancer and that diets high in simple sugars increase risk of colon cancer because of their impact on these factors. Limited epidemiological evidence supports the association between simple carbohydrates and risk of colon cancer. Using data from a population-based case-control study (n = 1993 cases and 2410 controls), we examined the associations between dietary sugars, foods containing high level of sugars, and dietary glycemic index (GI) and colon cancer. A dietary GI was developed to estimate metabolic response to a diet that may increase plasma glucose levels. Dietary data were obtained using a validated diet history questionnaire. High levels of sucrose intake were associated with increased risk of colon cancer among younger men [odds ratio (OR) for highest quintile relative to lowest, 1.59; 95% confidence interval (CI), 1.07-2.37]. There was also a trend of increasing colon cancer risk associated with a higher sucrose:dietary ratio for proximal tumors in both men and women. Individuals with proximal tumors who consumed a diet ranked as having a high GI were at increased risk (for men, comparing highest quintile to lowest quintile: OR, 1.58; 95% CI, 1.06-2.36; P trend 0.04; for women: OR, 1.72; 95% CI, 1.11-2.67; P trend 0.04). Those at greatest risk from a high dietary GI were those who were sedentary (for men, relative to those who were most active and had a low-GI diet: OR, 3.46; 95% CI, 1.78-6.70; for women: OR, 2.00; 95% CI, 0.98-4.07). We also observed that people who had a high sucrose: dietary fiber ration and who also were sedentary and had a large body mass index were at increased risk (OR, 4.58; 95% CI, 2.33-8.98) relative to those who had a low sucrose:dietary fiber ratio, were active, and had low body mass indices. These findings support previous reports that dietary sugars, especially diet high in simple carbohydrates relative to complex carbohydrates, increase risk of colon cancer, possibly through their impact on plasma glucose levels.

Dietary energy sources and colon cancer risk

Because energy-contributing nutrients are highly correlated with total energy, the association with colon cancer from energy versus other components of energy-providing nutrients is often not clear. Dietary data from a population-based case-control study of colon cancer were analyzed in subjects from California, Utah, and Minnesota in 1991-1994 to assess the colon cancer risk associated with consumption of energy, fat, protein, and carbohydrate. After adjustment for long-term physical activity, total energy intake increased risk of colon cancer in men (odds ratio = 1.74, 95% confidence interval 1.14-2.67 for highest vs. lowest quartile) and in women (odds ratio = 1.70, 95% confidence interval 1.07-2.70). Various methods of analysis suggested that intakes of individual sources of energy (dietary fat, protein, and carbohydrate) were not associated with colon cancer risk after total energy intake was taken into account. People who consumed a high-calorie diet that was dense in fiber and calcium appeared to be at lower risk than people with the same caloric intake who consumed smaller amounts of dietary fiber and calcium. Individuals with a first-degree relative with colorectal cancer, especially those diagnosed at a younger age, were at a greater risk from a diet high in energy than were individuals without a family history of colorectal cancer.

Hepatic necrosis masquerading as trauma

We report the case of a child who had deterioration of hepatic function 3 days after suffering a depressed compound skull fracture with underlying brain contusion. An abdominal enhanced CT scan revealed a wedge-shaped region of devitalised liver with associated free intraperitoneal fluid, consistent with a traumatic lesion but due to necrosis secondary to acetaminophen toxicity. Acetaminophen toxicity may occur with therapeutic doses in the presence of an ischaemic hepatitis. Any delay in the performance of CT from the time of trauma should prompt the consideration of alternative diagnoses.

Knowledge of New Zealand youth regarding sexuality and AIDS

A questionnaire (99 questions) was used to gather baseline data on New Zealand youth regarding sexuality and AIDS. The sample consisted of 560 students ranging in age from 12 to 18 years. Findings on general sexual knowledge and AIDS knowledge (15 questions) are reported. There is room for improvement in sexuality education of New Zealand youth.

Randomized controlled trial of a low animal protein, high fiber diet in the prevention of recurrent calcium oxalate kidney stones

Low protein diets are commonly prescribed for patients with idiopathic calcium nephrolithiasis, who account for > 80% of new diagnoses of kidney stones. This dietary advice is supported by metabolic studies and epidemiologic observational studies but has not been evaluated in a controlled trial. Using 1983-1985 data from three Northern California Kaiser Permanente Medical Centers, the authors randomly assigned 99 persons who had calcium oxalate stones for the first time to a low animal protein, high fiber diet that contained approximately 56-64 g daily of protein, 75 mg daily of purine (primarily from animal protein and legumes), one-fourth cup of wheat bran supplement, and fruits and vegetables. Intervention subjects were also instructed to drink six to eight glasses of liquid daily and to maintain adequate calcium intake from dairy products or calcium supplements. Control subjects were instructed only on fluid intake and adequate calcium intake. Both groups were followed regularly for up to 4.5 years with food frequency questionnaires, serum and urine chemistry analysis, and abdominal radiography; and they were urged to comply with dietary instructions. In the intervention group of 50 subjects, stones recurred in 12 (7.1 per 100 person-years) compared with two (1.2 per 100 person-years) in the control group; both groups received a mean of 3.4 person-years of follow-up (p = 0.006). After adjustment for possible confounding effects of age, sex, education, and baseline protein and fluid intake, the relative risk of a recurrent stone in the intervention group was 5.6 (95% confidence interval 1.2-26.1) compared with the control group. The authors conclude that advice to follow a low animal protein, high fiber, high fluid diet has no advantage over advice to increase fluid intake alone.

Functional expression of human topoisomerase II alpha in yeast: mutations at amino acids 450 or 803 of topoisomerase II alpha result in enzymes that can confer resistance to anti-topoisomerase II agents

DNA topoisomerase II is the target of a variety of important antitumor agents, including etoposide, adriamycin, and amsacrine. We have constructed a system for analyzing the action of anti-topoisomerase II agents using the yeast Saccharomyces cerevisiae and have constructed vectors for expressing human topoisomerase II functionally in yeast. We have demonstrated that temperature-conditional yeast TOP2 mutants can be complemented by expression of wild-type human topoisomerase II alpha. Furthermore, expression of human topoisomerase II in yeast results in a quantitatively unique pattern of sensitivity to amsacrine. We also have constructed mutations in human TOP2 based on previously identified mutations from a human cell line selected for resistance to teniposide. Our experiments demonstrate that mutation of either arginine 450 or proline 803 of human topoisomerase II can result in an enzyme that has altered sensitivity to anti-topoisomerase II agents, and that a human enzyme carrying both mutations confers a higher level of drug resistance than enzymes carrying either single mutation.

Molecular modeling of the GM-CSF and IL-3 receptor complexes

A model for the structure of the cytokine interleukin-3 (IL-3) is presented based on the structural homology of the hematopoietic cytokines and utilizing the crystal structures of interleukin-5 and granulocyte macrophage colony stimulating factor (GM-CSF). In addition, models of the receptor complexes of GM-CSF and IL-3 are presented based on the structural homology of the hematopoietic receptors to growth hormone. Several key interactions between the ligands and their receptors are discovered, some in agreement with previous mutagenesis studies and others that have not yet been the subject of mutagenesis studies. The models provide insights into the binding of GM-CSF and IL-3 to their receptors.

Transvection in the iab-5,6,7 region of the bithorax complex of Drosophila: homology independent interactions in trans

The Abdominal-B (Abd-B) gene of the bithorax complex (BX-C) of Drosophila controls the identities of the fifth through seventh abdominal segments and segments in the genitalia (more precisely, parasegments 10-14). Here we focus on iab-5, iab-6 and iab-7, regulatory regions of Abd-B that control expression in the fifth, sixth and seventh abdominal segments (parasegments 10-12). By analysis of partial BX-C deficiencies, we show that these regions are able to promote fifth and sixth abdominal segment identities in the absence of an Abd-B gene in cis. We establish that this ability does not result from cis-regulation of the adjacent abd-A or Ubx genes of the BX-C but rather occurs because the iab-5,6,7 region is able to interact with Abd-B in trans. We demonstrate that this interaction is proximity dependent and is, therefore, a case of what E. B. Lewis has called transvection. Interactions of this type are presumably facilitated by the synapsis of homologues that occurs in somatic cells of Dipterans. Although transvection has been detected in a number of Drosophila genes, transvection of the iab-5,6,7 region is exceptional in two ways. First, interaction in trans with Abd-B does not require that homologues share homologous sequences within, or for some distance to either side of, the BX-C. This is the first case of transvection shown to be independent of local synapsis. A second unusual feature of iab-5,6,7 transvection is that it is remarkably difficult to disrupt by heterozygosity for chromosome rearrangements. The lack of requirement for local synapsis and the tenacity of trans-interaction argue that the iab-5,6,7 region can locate and interact with Abd-B over considerable distance. This is consistent with the normal role of iab-5,6,7, which must act over some 20-60 kb to influence its regulatory target in cis at the Abd-B promoter. Evidence is presented that trans-action of iab-5,6,7 requires, and may be mediated by, the region between distal iab-7 and Abd-B. Also, we show that iab-5,6,7 transvection is independent of the allelic state of zeste, a gene that influences several other cases of transvection. The long-range nature of interactions in trans between iab-5,6,7 and Abd-B suggests that similar interactions could operate effectively in organisms lacking extensive somatic pairing. Transvection may, therefore, be of more general significance than previously suspected.

Predictive modelling of the 3-D structure of interleukin-13

Several atomic structures are now available for the family of helical cytokines, which includes growth hormone as well as many of the interleukins. Using structural information from five members of this family, two alternative models of interleukin (IL)-13 are proposed. IL-13 has biological properties similar to those of IL-4 and, like the other interleukins, is a potentially important pharmaceutical target. The model of IL-13 is discussed and compared with the known interleukin structures.

A computerized diet history questionnaire for epidemiologic studies

OBJECTIVE

To describe methods used to computerize the diet history questionnaire developed for the Coronary Artery Risk Factor Development in Young Adult (CARDIA) study and to describe quality-control procedures used in conjunction with dietary assessment.

DESIGN

The computerized diet history is being used in a case-control study. Because of the computerized nature of the questionnaire, we developed quality-control procedures that incorporate listening to an audiotape of the interview while visually reviewing recorded data.

SETTING

Three centers involved in a population-based epidemiologic study of colon cancer.

SUBJECTS

Men and women between the ages of 30 and 79 years.

RESULTS

Quality-control results showed that 100% of the computerized forms would be free of errors if the data were subjected to visual review only. Probing errors, which accounted for 47.3% of all errors, were the most commonly encountered errors. In probing errors the interviewer did not probe in a nondirective manner, or the interviewer failed to verify responses that might be considered questionable.

APPLICATIONS

The CARDIA diet history was computerized for use in epidemiologic studies of the association between diet and disease. Review of the audiotapes of the interviews showed that most errors made in obtaining a dietary assessment were not detectable from visual review of the data. Although the quality-control procedures were developed for a computerized diet history questionnaire, they are applicable to other dietary assessment methods.

A prospective study of dietary intake and acquired immune deficiency syndrome in HIV-seropositive homosexual men

We prospectively studied the relationship between dietary intake at baseline and the development of AIDS over 6 years in a population-based sample of 296 human immunodeficiency virus (HIV)-seropositive men. Nutrient intake was assessed before HIV serostatus was known. Subjects diagnosed with AIDS at baseline or during the 1st year were excluded. After adjustment for baseline CD4 T-lymphocyte count, HIV symptoms, and other risk factors, no nutrients were significantly associated with AIDS. However, when the continuous CD4 count and HIV symptom variables were replaced with a single binary health status variable, the hazard of AIDS decreased as consumption increased for all 11 micronutrients; this relationship was statistically significant for iron, vitamin E, and riboflavin and approached significance for vitamins C, thiamine, and niacin. Higher intake of all 11 micronutrients was associated with higher CD4 counts at baseline, and was significantly so for six of them. Daily multivitamin use was associated with a reduced hazard of AIDS [hazard ratio (HR) = 0.7; 95% confidence interval (CI) = 0.5, 1.0] and a significantly reduced risk for low CD4 counts at baseline (HR = 0.6, 95% CI = 0.4, 0.9). Additional studies are needed to determine whether dietary intake modifies the rate of developing AIDS in those who are HIV seropositive.

Association between alcoholic and caffeinated beverages and premenstrual syndrome

We examined the association between alcohol and caffeine consumption and premenstrual syndrome (PMS). One hundred two women with PMS matched by age and race to an equal number of women without PMS were compared for differences in intake of alcoholic and caffeinated beverages, with differences determined using Student's t-tests and conditional logistic regression for matched pairs. Information on alcohol and caffeinated beverage consumption was obtained from three 24-hour dietary recall interviews conducted during the postmenstrual period and from three conducted during the premenstrual period. Results showed that no significant difference was observed in total caffeine intake or in the individual caffeinated beverages consumed during either the post-menstrual or the premenstrual period. For alcohol consumption, however, women with PMS drank 1.41 (95% confidence interval; range, 0.34-2.47) more servings per week during the postmenstrual period. Based on post-menstrual consumption, women in the heaviest drinking category (> or = 10 drinks per week) were significantly more likely to have moderate to severe PMS (P < .005) than nondrinkers. This same significant relation, but to a lesser degree, was observed based on premenstrual consumption. We conclude that because PMS is more strongly associated with alcohol consumed in the symptom-free, postmenstrual period, drinking is unlikely to be simply a response to PMS symptoms as others have previously suggested.

Unfolding and refolding of the NAD(+)-dependent isocitrate dehydrogenase from yeast

The unfolding of the NAD(+)-dependent isocitrate dehydrogenase from yeast in guanidinium chloride (GdnHCl) has been monitored by changes in c.d. and fluorescence. Major structural changes occur over the range of GdnHCl concentrations from 0.5 to 1.5 M, although loss of catalytic activity is complete at 0.3 M. After incubation in GdnHCl, activity can be regained on dilution; however, the extent of this regain is dependent on the initial concentration of GdnHCl and is very small at a concentration of 2 M or above. Under these conditions there is only limited regain of the secondary and tertiary structure of the enzyme. Considerably more structure and activity can be regained if the concentration of GdnHCl is lowered by dialysis. The implications of these results for the folding and assembly of the enzyme are discussed.

Theory in vivo

Due to a formerly held assumption that psychoanalytic theories operate exclusively in the positivistic manner associated with the natural sciences, current thinking on how they operate specifically or in their own terms is addressing a long-neglected task. In this paper it is suggested that inherent and acquired modes of theorizing interplay when an analyst is working; and that a dialogue involving these two modes which began in Freud's inner life has evolved into our communal conceptual discourse. A series of situationally connected interchanges with a female analysand, over a two-week period, is presented. An attempt is made to demonstrate some theorizing, not 'in vitro'--'in the test-tube' of abstraction, but where most use and discovery of theory happens, 'in vivo'--within the living experience of therapeutic analysis.

Unfolding and refolding of hen egg-white riboflavin binding protein

The unfolding and refolding of riboflavin-binding protein (RfBP) from hen egg-white induced by addition of guanidinium chloride (GdnHCl), and its subsequent removal by dialysis have been studied by c.d. and fluorescence for both the native and reduced protein. The reduction of its nine disulphide bonds causes a reduction in the secondary structure (alpha-helix plus beta-sheet) from 63% to 33% of the amino acid residues. Unfolding of the native protein occurred in two phases; the first involving a substantial loss of tertiary structure, followed by a second phase involving loss of secondary structure at higher GdnHCl concentrations. By contrast this biphasic behaviour was not discernible in the reduced protein. The loss of ability to bind riboflavin occurred after the first phase of unfolding. Comparison of unfolding of the holoprotein and apoprotein suggested that riboflavin has only a small stabilizing effect on the unfolding process. After removal of GdnHCl, the holoprotein, apoprotein and reduced protein assumed their original conformation. The significance of the results in relation to various models for protein folding is discussed.

Percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy is a useful alternative to long-term nasogastric feeding or surgical gastrostomy for dysphagic patients. It is simple to perform and is relatively safe.

Percutaneous endoscopic gastrostomy in elderly patients

Percutaneous endoscopic gastrostomy (PEG) was performed on 28 elderly patients (mean age 82 years) who were dysphagic and intolerant of naso-gastric feeding. Twenty-six patients were recovering from a stroke; the interval between the onset of stroke and PEG averaged 63 days. The procedure was successful and well tolerated by all patients. Nineteen (68%) still had a functioning PEG a median of 14 weeks after placement. One patient whose swallowing recovered had the tube removed 6 months after its insertion. Seven patients (25%) subsequently died from their underlying disease, a mean of 92 days following PEG. There was one procedure-related death from peritonitis. PEG is a useful alternative to surgical gastrostomy in selected elderly patients with dysphagia who are intolerant of naso-gastric feeding.

A comparative study of the structure of egg-white riboflavin binding protein from the domestic fowl and Japanese quail

1. The riboflavin binding proteins from domestic fowl and Japanese quail have been isolated and their structures compared by circular dichroism, fluorescence and peptide mapping. 2. The two proteins have similar secondary structures, but differ in their tertiary structures as reflected in the environments of aromatic amino acid side chains. 3. Differences in amino acid sequence between the proteins are indicated by the digestion patterns obtained with thermolysin, chymotrypsin and V8 proteinase from Staphylococcus aureus. Both proteins are resistant to digestion by trypsin.

Suspected actinobacillosis manifested by facial enlargement in a heifer

Actinobacillosis was the suspected cause of severe, bilateral facial enlargement of 8 months' duration in a 2.5-year-old Holstein heifer. Serum protein electrophoresis revealed a polyclonal gammopathy. Necropsy findings indicated that facial swelling was caused by fibrosis between the skin and underlying bone. Lesions were characterized microscopically by scattered pyogranulomas containing eosinophilic, club-like colonies surrounding gram-negative bacterial rods. The lesion was compatible with diagnosis of actinobacillosis. It is unusual for severe bilateral facial enlargement to be associated with actinobacillosis.

Stimulation of mutations suppressing the loss of replication control by small alcohols

Transient exposure of lysogenic Escherichia coli cells to small alcohols stimulated the frequency of mutations suppressing the lethal loss of replication control from a prophage fragment of bacteriophage lambda. The stimulation in mutation frequency paralleled the effect of mutagenic agents, and in this sense the alcohols behaved as mutagens. 10-min treatments above distinct threshold concentrations at 23%, 18%, 10% and 4% (v/v) were required in order for methanol, ethanol, isopropanol and propanol to evoke mutagenic effects. The selected mutant cells were, in general, equally or more sensitive to ethanol than the starting cells. The mutagenicity of methanol and ethanol was detected only with E. coli strains with lambda fragments that included the site-specific and general recombination genes found within the phage int-kil gene interval; whereas, stimulation of the frequency of phenotypically identical mutations by nitrosoguanidine or ionizing radiation did not require that the lambda fragment encode these genes. Treatments of lysogenic cells with mutagenic concentrations of ethanol did not trigger prophage induction and were concluded not to induce a cellular SOS response nor to denature the prophage repressor, or to disrupt repressor-operator binding. The toxicity of ethanol was pH-dependent. Cellular sensitivity to ethanol toxicity was unaffected by the integrated lambda fragment(s) or by an intact lambda prophage; but, it was increased by deletions of the E. coli chromosome extending rightward from bio into uvrB, and rightward from chlA.

Feasibility of reversible pulmonary artery banding: early results and intermediate-term follow-up

Development of a reversible pulmonary artery band might obviate the need for a second cardiac surgical procedure in children with some forms of congenital heart disease. We evaluated a segmented Silastic-coated Dacron mesh band 2 to 4 mm wide sewn together with absorbable 2-0 polydioxanone suture for use as a reversible pulmonary artery band. Nine puppies 6 to 8 weeks old (mean weight, 5.8 kg) underwent placement of this pulmonary artery band. All survived the operation with a mean initial systolic gradient of 6.5 +/- 1.6 mm Hg and underwent cardiac catheterization at monthly intervals for 3 months. Two puppies died of right ventricular failure. The remaining puppies underwent balloon angioplasty with balloons 20 to 25 mm in diameter. No complications resulted from balloon angioplasty, but 1 puppy died 24 hours later of unidentified causes. Balloon angioplasty decreased the mean gradient from 46.7 +/- 6.8 mm Hg to 6.7 +/- 2.6 mm Hg. Angiography showed an increase in mean diameter of the site of the pulmonary artery band from 5.2 +/- 1.0 to 10.8 +/- 1.7 mm Hg. There was no evidence of vessel injury on angiograms. Fourteen months after balloon angioplasty, the mean gradient was 22.3 +/- 17.0 mm Hg. Our data demonstrate that a functionally reversible pulmonary artery band constructed of segmented Silastic-coated Dacron mesh and 2-0 polydioxanone suture is feasible.

Alcohol treatment of defective lambda lysogens is deletionogenic

We ascertained that transient exposure to ethanol, above 18%, was deletionogenic to an Escherichia coli strain with a fragment (12.5 kb) of bacteriophage lambda integrated within the chromosome. The lambda attL B.P' through P fragment provided a forward selection for mutants, and a target for mutagenesis. The cells were killed by thermal derepression of transcription and replication of the lambda fragment when transferred from 30 degrees to 42 degrees C. Survivor mutants, capable of forming colonies at 42 degrees C, were selected from untreated starting cells. About half no longer supported marker rescue of the lambda fragment imm lambda (immunity) region, comprising the cI repressor, and the PL and PR promoters. Ethanol treatment of starting cells increased the occurrence of imm lambda-defective clones to near 100%. The mutations responsible for the imm lambda defect were found to be large deletions (12 kb or more of DNA). Ethanol treatment of the starting cells also produced a 5- to 18-fold increase in the occurrence of E. coli pgl mutations, which likely arose by the deletion mechanism generating the imm lambda defects, since pgl was closely linked to the integrated lambda fragment. A unifying hypothesis for these observations was that ethanol was deletionogenic. The inclusion or substitution of the int-kil segment of the lambda fragment produced no real change in the spontaneous occurrence of large imm lambda deletions from the untreated cells. Substitution of this segment suppressed the deletionogenic effect of ethanol, implying a prerequisite for sequence homology or gene function from this interval.(ABSTRACT TRUNCATED AT 250 WORDS)

Purification and characterisation of NAD-glutamate dehydrogenase from Aspergillus nidulans

NAD-Glutamate dehydrogenase has been purified from mycelia of A. nidulans. The enzyme comprises subunits of 110 kDa. It is located in the cytosol. It is completely denatured by 1.0 M guanidine hydrochloride, and is not renatured by subsequent dilution. Isophthalate is a strong competitive inhibitor and the enzyme is also inhibited by thiol reagents. The properties of the enzyme were compared to those from other fungi in terms of size, sensitivity to inhibitors, intracellular distribution and mode of regulation, and were found to resemble most closely those of Neurospora crassa.

Absorption characteristics of human fetal hemoglobin at wavelengths used in pulse oximetry

The absorption characteristics of fetal and adult human hemoglobin samples were determined for the range of 600 to 1,050 nm. Over this range, fetal hemoglobin absorption is nearly identical to that of adult hemoglobin. Since currently available two-wavelength pulse oximeters base their calculations of arterial oxyhemoglobin saturation on absorption at the wavelengths of 660 and 920 nm, we conclude that the accuracy of two-wavelength pulse oximetry previously demonstrated in adults can be extrapolated to infants with high concentrations of fetal hemoglobin.

Hypertonic saline as a resuscitation solution in hemorrhagic shock: effects on extravascular lung water and cardiopulmonary function

To determine the effect of resuscitation with hypertonic saline on extravascular lung water, seven adult sheep were endotracheally intubated; mean arterial pressure (MAP), pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PCWP), and central venous pressure (CVP) were monitored. A 5-French, thermistor-tipped catheter was used to measure extravascular lung water (EVLW). Colloid oncotic pressure (COP), serum electrolytes and osmolality, and arterial and mixed venous blood gas tensions were measured. The COP-PCWP gradient and the shunt fraction (Qsp/Qt) were calculated. After baseline measurements, the animals were bled to an MAP of 50 mm Hg (blood volume removed, 16.2 +/- 3.6 ml/kg), which was maintained for 30 min, measurements then being repeated. Three percent sodium chloride solution was infused at 500 ml/15 min until two of three parameters--cardiac output (CO), PCWP, or MAP--were restored to baseline values. Data were recorded again and then 60 min later. No shed blood was reinfused. The total volume of hypertonic saline infused was 39 +/- 19 ml/kg. Pulmonary artery pressure did not vary throughout the study. PCWP, MAP, and CO were significantly lower than baseline (P less than 0.05) 30 min after bleeding but all except MAP returned to baseline with resuscitation. Throughout the study, EVLW did not vary despite a COP-PCWP gradient less than 4 mm Hg. Serum sodium levels and serum osmolality were significantly above baseline values after resuscitation. In this animal model of hemorrhagic shock, infusion of hypertonic saline effected resuscitation without compromising cardiopulmonary function or increasing EVLW.

Presence of IgE suppressor factors in human colostrum

In spite of intensive investigations, the ability of breast feeding to delay and to attenuate atopic diseases in children remains debatable. This study documents a mechanism whereby breast feeding might interfere with the synthesis of IgE by breast-fed infants. Indeed, we show that colostrum contains IgE-binding factors (IgE-BF) capable of suppressing the in vitro synthesis of human IgE. Colostrum obtained from 15 donors was successively depleted of lipids and casein, filtered through Amicon XM50 membrane (mol. mass cut-off 50 kDa) and lyophilized. IgE-BF was demonstrated in such preparations by two different approaches, i.e. a classical rosette inhibition assay and Western blot analysis. In the first instance, lyophilized preparations of colostrum inhibited the binding of IgE-coated bovine erythrocytes to IgE recovered on the surface of RPMI 8866 lymphoblastoid cells. The rosette-inhibiting activity could be absorbed on IgE- but not on IgG-Sepharose 4B and it could be recovered in the eluate of IgE-Sepharose 4B. The molecular mass of IgE-BF was comprised between 10 to 20 kDa as estimated by gel filtration through a calibrated Sephadex G-75 column. After fractionation on 12% sodium dodecyl sulfate-polyacrylamide gel electrophoresis and transfer to nitrocellulose membrane, colostrum displayed one band of 14 kDa and reacted with radiolabeled IgE but not with IgG nor IgM. This 14-kDa band could be removed by absorbing colostrum with IgE- but not with IgG-Sepharose 4B. Most importantly, the colostrum IgE-BF suppressed the spontaneous in vitro synthesis of IgE by B lymphocytes derived from allergic donors without altering the production of IgM.

Production and characterization of rabbit anti-idiotypic antibodies specific to mouse monoclonal anti-human IgE and reacting with IgE-binding factors and lymphocyte receptors for IgE

A mouse monoclonal antibody specific to human IgE (mAb 75) was employed to immunize a rabbit to obtain anti-idiotypes (aId) bearing the internal image of human IgE determinants and reacting with IgE-binding factors (IgE-BF) and/or lymphocyte receptors for IgE (Fc epsilon R). mAb 75 was selected on the basis of inhibition assays where the binding of mAb 75 to radiolabeled IgE was blocked by IgE-BF. The latter were produced by a lymphoblastoid cell line (RPMI 8866) expressing Fc epsilon R. Sequential samples of rabbit serum, collected during the immunization period, were extensively absorbed on mouse and human Ig-Sepharose 4B. The IgG fractions of the rabbit serum displayed the following activities: (a) they reacted with 125I-labeled mAb 75 but not with other labeled mouse Ig including mAb-aIgE, (b) this binding was inhibited in a dose-dependent fashion by human IgE but not by other human Ig classes nor by heat-inactivated IgE, (c) they reacted with a polyclonal rabbit anti-human IgE and (d) they blocked the binding of 125I-labeled IgE to mAb 75. It was concluded that the rabbit IgG contained aId (RaId) bearing the internal image of heat labile determinants of human IgE. The rosetting of IgE-coated bovine erythrocytes with Fc epsilon R-bearing cells was inhibited by preincubating the receptor-bearing cells with IgG RaId or its F(ab')2 but not with normal rabbit IgG. The ability of RaId to react with IgE-BF as well as with Fc epsilon R was also shown in inhibition experiments where IgE-BF and solubilized Fc epsilon R blocked the binding of mAb 75 to RaId. Finally, Western blot analysis of human colostrum, known to contain IgE-BF, indicated that radioiodinated RaId and IgE identified the same 12-16-kDa molecules corresponding to IgE-BF. It is concluded that RaId expresses the internal image of a heat-labile determinant of IgE which is involved in the binding of IgE to IgE-BF and Fc epsilon R. An alternative interpretation is that RaId reacts with an idiotypic determinant of mAb 75 which is shared by IgE-BF and Fc epsilon R.

Anaplastic sacrococcygeal chordoma. Fine needle aspiration cytologic findings and embryologic considerations

A case of sacrococcygeal chordoma with anaplastic features is presented. The diagnosis of the anaplastic component was first established by fine needle aspiration (FNA) biopsy, which demonstrated the sarcomatous elements as well as the physaliferous cells characteristic of chordoma. Subsequent histologic examination confirmed these findings. While the FNA cytologic findings of chordoma have been previously reported, this is the first case of an anaplastic chordoma diagnosed by FNA biopsy. The embryologic origin of this unusual tumor and its differential diagnosis are discussed.

Detection and characterization of monoclonal antibodies specific to IgE receptors on human lymphocytes by flow cytometry

BALB/c mice were immunized with human lymphoblastoid cells (RPMI 8866 cells) expressing surface receptors for IgE (Fc epsilon R). Spleen cells from animals displaying high titres of anti-Fc epsilon R antibodies were fused with HGPRT-deficient NSI myeloma cells. Anti-Fc epsilon R antibodies were identified by a flow cytometric assay based on their ability to block the binding of IgE-coated fluorescent latex particles to Fc epsilon R-positive cells. Fourteen monoclonal hybridoma cell lines secreting antibody of the required specificity were amplified in tissue culture and then grown in the peritoneal cavity of BALB/c mice in order to obtain ascitic fluids with high antibody titres. The specificity of each monoclonal antibody (Mab) to lymphocyte Fc epsilon R was shown by the following observations: (i) the intact monoclonal antibody molecule or, in some cases, its F(ab')2 fragments blocked the binding of IgE to several Fc epsilon R(+) cell lines different from that employed for the initial immunization; (ii) the Mab bound directly to all the Fc epsilon R(+) cell lines tested, but not to several Fc epsilon R(-) cells as determined by indirect immunofluorescence; (iii) the binding of Mab to Fc epsilon R(+) cells was selectively blocked by IgE, but not by the other classes of Ig; and (iv) Mab had no effect on the binding of IgG to Fc gamma R on normal human peripheral blood mononuclear cells (PBMC).

Inactivation of rabbit muscle phosphoglycerate mutase by limited proteolysis with thermolysin

Rabbit muscle phosphoglycerate mutase is inactivated by proteolysis with thermolysin. Inactivation is correlated with the breakage of one (or a few) bond(s) near one end of the polypeptide chain. There is no change in the overall conformation, quaternary structure or binding to Cibacron Blue on proteolysis. The possible analogy with the existence of a flexible tail in the yeast enzyme is discussed.

Purification and preliminary characterization of phosphoglycerate mutase from Schizosaccharomyces pombe

Phosphoglycerate mutase could be purified to over 95% homogeneity by a single step procedure involving elution from Cibacron Blue-Sepharose by a pulse of cofactor 2,3-bisphosphoglycerate. Although the enzyme has been isolated in only small quantities (c. 100 micrograms), gel filtration and sodium dodecylsulphate polyacrylamide gel electrophoresis indicated that it is monomeric with Mr approximately 23,000, an extremely low value for this enzyme. Preliminary investigations of the kinetic characteristics and the nature of important amino acid side chains have been undertaken.

Atlanto-axial instability and spinal cord compression in children--diagnosis by computerized tomography

Five children who were at risk for atlanto-axial instability underwent computerized tomography scanning of the cervical spine in flexion and extension to document the degree of bone instability and the presence or absence of spinal cord compression. Two patients had Morquio's syndrome, two had os odontoideum , and one had Klippel-Feil syndrome, and in all five the lateral radiographs of the cervical spine in flexion and extension were equivocal with regard to instability or were difficult to interpret because of the bone anomalies. The computerized tomography scan then provided a diagnosis by a non-invasion technique and quantitated the amount of compromise of the spinal cord by delineating flattening of the cord. The scan therefore helped the surgeon to decide if the spinal cord was at significant risk and if atlanto-axial fusion was advisable.

Visual screening: an alternative method for reducing stereotypic behaviors

Visual screening, a mildly aversive response suppression procedure, was evaluated across two studies for its effectiveness in reducing topographically similar and dissimilar stereotypic behaviors of four developmentally disabled children. In the first study, a multiple baseline design across subjects and behaviors was used to assess the effectiveness of the procedure as a treatment for reducing the visual and auditory self-stimulatory responses of two 9-yr-old mentally retarded and behaviorally disturbed children. A multiple baseline design across subjects was used in the second study to evaluate the effectiveness of visual screening as a treatment for reducing stereotypic fabric pulling and self-mutilative ear bending, respectively, of two 13-yr-old mentally retarded, autisticlike adolescents. Long-term follow-up data for both studies were reported. The results suggested that visual screening was an easily administered, effective, and exceptionally durable treatment procedure for controlling a variety of stereotypic behaviors commonly associated with the developmentally disabled.