The relationship of the subarachnoid injection of blood and blood fractions with cardiac rate change and arrhythmias

The relationship of subarachnoid hemorrhage and cardiac arrhythmias was studied utilizing a Sprague-Dawley rat model. A total of 30 male animals were divided into five groups and given subarachnoid injections of either blood, blood fractions, or control substances. Blood pressure, intracranial pressure, serum electrolytes, arterial blood gases, hypothalamic multiple unit activity and an electrocardiogram were concurrently monitored. Cardiac arrhythmias were graded on a 0 to 4 + objective scale. Control parameter values were similar for all animals. Arrhythmias, hypotension, and decreased hypothalamic multiple unit activity were seen with infusion of whole blood and packed red blood cells. Packed red blood cells were statistically demonstrated to have the most potent arrhythmogenic effect. Cardiac histopathology revealed myocardial contraction band lesions most predominant in the packed red blood cell group. In addition, significant QT interval prolongation was observed after subarachnoid injection of either whole blood or packed red blood cells. These findings indicate that packed red blood cells, or a component thereof, may play an important role in the etiology of immediate (i.e. acute) post subarachnoid hemorrhage induced cardiac arrhythmias.

Epileptologist's assistant: a cost effective expert system

Epileptologist's Assistant is an expert system designed to cost effectively handle routine care in an epilepsy follow up clinic. The system guides nurses in gathering patient histories and then generates progress notes and a patient information sheet. The progress note, organized in the SOAP format, is reviewed by the physician with the patient. For difficult cases the physician may modify the Assessment or Plan sections; the Subjective and Objective sections rarely need modifications. The assertion of cost-effectiveness is based on time/motion data. Without the system a physician in our epilepsy clinic spends about 21 minutes seeing a patient. With the system the nurse spends about 14 minutes with the patient and the physician spends about 7 minutes. Two nurses and a physician handle the work load of 3 physicians. Physician time is cut by about 66%. Using the average salaries for physicians and nurses at the Department of Veterans Affairs, the cost of a clinic visit is reduced 39% by using the expert system and nurses. In addition, the progress note is more legible, it contains more information, Q/A procedures are implemented at the point of patient contact, and the data is entered into a computer system in a data field format.

Plasma 5-S-cysteinyldopa differentiates patients with primary and metastatic melanoma from patients with dysplastic nevus syndrome and normal subjects

To determine whether plasma 5-S-cysteinyldopa levels are useful in following up patients at risk for melanoma, we measured plasma 5-S-cysteinyldopa in patients with dysplastic nevus syndrome and/or malignant melanoma and in control subjects. In patients with dysplastic nevus syndrome, plasma 5-S-cysteinyldopa levels did not differ from those in control subjects. Conversely, patients with malignant melanomas had significantly higher plasma 5-S-cysteinyldopa levels than did controls. Those with localized cutaneous malignant melanoma and no distant metastases (Stage I and II disease) had 5-S-cysteinyldopa levels twofold greater than those of control subjects, whereas the levels of those with regional lymph node involvement (Stage III disease) were fourfold greater than those of control subjects. Levels of those with extraregional metastases (Stage IV disease) were 7- to 450-fold higher than those of control subjects. Moreover, plasma 5-S-cysteinyldopa levels correlated with the spread of disease and were useful in distinguishing primary melanoma and Stages III and IV melanoma. We conclude that plasma 5-S-cysteinyldopa may be an important tool for identifying melanoma at an earlier, more curable stage and for following up patients at risk for the development of melanoma, for example, those with dysplastic nervus syndrome.

Variable region framework differences result in decreased or increased affinity of variant anti-digoxin antibodies

Rare spontaneous variants of the anti-digoxin antibody-producing hybridoma 40-150 (Ko = 5.4 x 10(9) M-1) were selected for altered antigen binding by two-color fluorescence-activated cell sorting. The parent antibody binds digoxin 890-fold greater than digitoxin. The variant 40-150 A2.4 has reduced affinity for digoxin (Ko = 9.2 x 10(6) M-1) and binds digoxin 33-fold greater than digitoxin. A second-order variant, derived from 40-150 A2.4 (designated 40-150 A2.4 P.10), demonstrated partial regain of digoxin binding (Ko = 4.4 x 10(8) M-1). The altered binding of the variant 40-150 A2.4 was accounted for by a point mutation resulting in substitution of arginine for serine at position 94 in the heavy chain variable region. Antibody 40-150 A2.4 P.10 also contains this arginine but owes its enhanced antigen binding to deletion of two amino acids from the heavy chain amino terminus. This unusual sequence alteration in an immunoglobulin framework region confers increased affinity for antigen.

Plasma 5-S-cysteinyldopa correlates with tumor size in melanoma-bearing mice

A sensitive assay method employing high performance liquid chromatography with electrochemical detection (HPLC-ED) was used to compare 5-S-cysteinyldopa (CD) levels in plasma to tumor size in a murine melanoma model system. Plasma CD levels correlated with the sizes of primary tumor masses in mice, and the presence of metastatic tumors did not significantly affect the relationship. Elevated plasma CD levels appear to be directly related to tumor pigmentation: mice who had nonpigmented tumors induced by injections of amelanotic melanoma cells (NP) did not have elevated plasma CD levels. These studies indicate that plasma CD levels may serve as a marker for pigmented malignant melanomas and may be useful in following patients who are at high risk for these tumors.

Serotonin type-2 receptor mediated regulation of substance P release in the ventral spinal cord and the effects of chronic antidepressant treatment

Regulation of the release of substance P (SP) by the coexisting neurotransmitter serotonin (5-hydroxytryptamine, 5-HT) in the ventral spinal cord and the effects of chronic antidepressant treatment mediated changes in serotonin metabolism on the regulation, were examined. The K+ (40 mmol/l) evoked release of (SP) from slices of the ventral spinal cord of the rat was potentiated by (5-HT) applied to 100 mumol/l concentration. This effect was blocked by the serotoninergic antagonists methysergide (10 mumol/l), methiotepin (10 mumol/l) and fully blocked by ketanserin (10 mumol/l). Thus the 5-HT receptor which regulates the release of SP appears to belong to the type-2 5-HT receptors. Chronic treatment with the selective serotonin uptake inhibitor zimelidine (14 days, 2 X 10 mumol/kg/day, p.o.) lowered the tissue levels of the 5-HT metabolite: 5-hydroxyindol acetic acid (5-HIAA) and elevated the tissue levels of SP in both the ventral and dorsal spinal cord as compared to that in the vehicle treated group (14 days, 2 X 5 ml saline/kg/day, p.o.). The decrease in the 5-HIAA levels after chronic zimelidine treatment was quantitatively similar in the dorsal (33%, p less than 0.01) and ventral (31%, p less than 0.05) spinal cord. The increase in SP levels after chronic zimelidine treatment was more pronounced in the ventral cord (80%, p less than 0.01) where the majority of the SP containing nerve endings also contain 5-HT, than in the dorsal spinal cord (22% increase in SP, p less than 0.05), where only a minor fraction of the SP-containing nerve endings shows a 5-HT/SP coexistence.(ABSTRACT TRUNCATED AT 250 WORDS)

Anticholinergic potency of psychoactive drugs in human and rat cerebral cortex and striatum

The affinity of selected antipsychotic and antidepressant drugs for the muscarinic receptor was studied in membranes from both human and rat striatum and cerebral cortex. While there are regional differences in the anticholinergic potency of the drugs, there is good agreement between the obtained inhibition constants from the corresponding human and rat striatum (r: 0.98) and from human and rat cerebral cortex (r: 0.96). There is also good agreement between the obtained Ki values within one species: human cerebral cortex versus human striatum (r: 0.99) and for rat cerebral cortex and rat striatum (r: 0.87). Thus, the previously published quantitative estimates of the antimuscarinic activity of psychoactive drugs which were derived from studies on membranes from rat brain give an accurate estimate of the antimuscarinic activity in human brain. The drugs tested in this study include chlorpromazine acetophenazine, haloperidol, sulpiride, remoxipride (FLA-731 (-), a substituted benzamide), amitriptyline and two serotonin uptake blockers: norzimelidine and alaproclate.

In vivo and in vitro studies on the potentiation of muscarinic receptor stimulation by alaproclate, a selective 5-HT uptake blocker

Alaproclate (10-60 mg/kg) injected i.p. into male mice potentiated and prolonged the oxotremorine and physostigmine-induced tremor in a dose-dependent manner. Atropine completely blocked the tremor caused by oxotremorine or physostigmine both in the presence and absence of alaproclate. Pretreatment with the 5-HT receptor antagonist metitepine completely blocked the enhancement of oxotremorine-induced tremor caused by alaproclate. Biochemical studies indicated that the above effects cannot be explained by assuming that alaproclate a) acts as a cholinergic agonist, b) inhibits the acetylcholine esterase, c) interferes with choline uptake or acetylcholine synthesis, or d) directly potentiates the release of acetylcholine. In ligand binding studies alaproclate was found to be a weak competitive inhibitor of muscarinic antagonist binding to membranes from the rat cerebral cortex, rat striatum, human cerebral cortex and human striatum. (Ki approximately 28-40 microM in all four tissues). The present results suggest that alaproclate may potentiate muscarinic responses by a mechanism involving serotonergic receptor mechanisms rather than by a direct interaction with the muscarinic cholinergic receptors.

Uncoupler-accelerated efflux of 5-hydroxytryptamine from platelets of healthy subjects and patients with unipolar and bipolar depression

The efflux of 14C-5-hydroxytryptamine (5HT) from platelets of 25 depressed patients (16 unipolar and 9 bipolar) and 22 control subjects was studied in the presence of carbamyl cyanide m-chlorophenylhydrazone (FCCP), which dissipates H+ gradients. FCCP (0.31 microM), at 10 minutes' incubation time, enhanced the efflux of 14C-5HT to a significantly higher extent from platelets of patients with bipolar depression than from platelets of control subjects. An analysis of variance revealed a significant interaction between the diagnostic categories (unipolar, bipolar, and control) and sex in accounting for variation of the FCCP-evoked efflux. The diagnostic category X sex effect was also significant. The results reported indicate that the FCCP-evoked efflux of 5HT is an easily measured biochemical parameter of possible diagnostic interest.

Glucagonoma syndrome: in vitro evidence that glucagon increases epidermal arachidonic acid

A 63-year-old white woman with perioral dermatitis, a sore tongue, and an erythematous dermatosis in the inframammary and perineal regions underwent surgical removal of a pancreatic glucagonoma. The patient's plasma and pooled normal human plasma containing Sigma glucagon were fed to human keratinocyte cultures and increased arachidonic acid levels by 300% and 200%, respectively, when compared to pooled normal human plasma with no added commercial glucagon. These experiments suggest that glucagon may increase inflammatory mediators such as arachidonic acid and its metabolites in the epidermis, causing the skin lesions seen in the glucagonoma syndrome.

Isolation and purification of a pemphigus vulgaris antigen from human epidermis

Pemphigus vulgaris is an autoimmune disease associated with an autoantibody directed against a keratinocyte membrane antigen. The purpose of this study was to purify the human pemphigus vulgaris antigen, to produce an antibody to this antigen, and to use the antibody to induce pemphigus in newborn mice. Various techniques to extract the membrane-rich pellet from human epidermal homogenate were compared; 1% sodium dodecyl sulfate (SDS) and 1% dimethylsulfoxide proved to be superior to extract the pemphigus vulgaris antigen. This antigen was identified by transfer blotting to nitrocellulose paper, incubated with pemphigus vulgaris serum, or 20 control sera, and detected with fluorescein labeled antisera to human IgG. Since concanavalin A inhibits the binding of pemphigus vulgaris antibody to tissue sections, we studied the binding of the extracted proteins to concanavalin A covalently coupled to Sepharose. Pemphigus vulgaris antigen bound to the concanavalin A column and was released by 0.02 M methyl alpha-D-mannopyranoside. The proteins thus recovered were subjected to AcA 54 gel permeation chromatography, and the pemphigus antigen was detected by the transfer blot assay. The antigen corresponded to a discrete peak at 66,000 D by gel permeation and gave one homogeneous band at 33,000 D in urea-SDS-polyacrylamide gel electrophoresis. Monospecific antibody to the antigen raised in rabbits stained human epidermis in the same manner as the pemphigus vulgaris autoantibody and induced pemphigus vulgaris in newborn mice when injected intraperitoneally. A pemphigus vulgaris antigen has been purified from adult human epidermis. It is a 66,000-D membrane glycoprotein that is composed of two apparently identical subunits of 33,000 D each.

Lentiginosis associated with a left atrial myxoma

A 14-year-old white male patient with lentiginosis was in congestive heart failure. He was noted to be redheaded, and the lentigines were especially concentrated on the face, including the lips. A two-dimensional echocardiogram revealed an orange-sized mobile mass in the left atrium. Cardiac surgery for removal of the left atrial myxoma was successful, and a complete recovery was made. This is the second report of lentiginosis associated with a left atrial myxoma and the first in which the immediate family did not have similar pigmentary changes. Lentiginosis and associated cardiac manifestations are briefly reviewed.

Hydralazine-induced systemic lupus erythematosus presenting as pyoderma gangrenosum-like ulcers

A 48-year-old white woman who for 3 years had been taking hydralazine, 100 mg three times a day, propranolol, 160 mg twice a day, and chlorothiazide, 500 mg/day, for hypertension suddenly developed rapidly expanding ulcers that looked like pyoderma gangrenosum. Arthralgias, fevers, and occasional shortness of breath were also noted. A pericardial effusion was diagnosed by echocardiography. The antinuclear antibody (ANA) titer on routine mouse liver substrate was initially negative, but the ANA titer was positive (1:1,920) on human epithelioid cell substrate. Antibodies to histones and single-stranded DNA were also elevated. After discontinuing hydralazine, all signs and symptoms cleared over a 4-week period. At the time of discharge the ANA titer had decreased to 1:480.

Epidermal and hair follicle transglutaminases and crosslinking in skin

Epidermal and hair follicle transglutaminases crosslink structural proteins in the skin by epsilon-(gamma-glutamyl)-lysine bonds. This crosslinking produces protein polymers that are extremely insoluble and, until recently, difficult to characterize. Epidermal transglutaminase is localized to the granular layer of the epidermis. It catalyzes the crosslinking of a soluble cytoplasmic precursor to form the cornified envelope that lines the inner membrane of the mature keratinocyte in the stratum corneum. Hair follicle transglutaminase is localized to the inner root sheath and medulla of the hair follicle. It crosslinks a poorly characterized citrulline-rich protein. The enzymes and their substrates have been shown to be important markers of normal differentiation. Regulation of these processes is currently under investigation.

Keratolinin: the soluble substrate of epidermal transglutaminase from human and bovine tissue

Substrates of human and bovine epidermal transglutaminase (glutaminyl-peptide gamma-glutamyltransferase, R-glutaminyl-peptide:amine-gamma-glutamyltransferase, EC 2.3.2.13) were isolated and purified by ion exchange chromatography and preparative zone electrophoresis. These substrates of Mr 36,000, which we propose to call keratolinin, incorporated dansylcadaverine and were precipitated by antibody. Keratolinin is ultimately polymerized on the inner leaflet of the keratinocyte membrane to form the cornified envelope. Each Mr 36,000 substrate was dissociated by chaotropic agents or detergents into noncovalent subunits; the Mr of these subunits was 6,000-6,200 on electrophoresis in 15% acrylamide/1% NaDodSO4/6 M urea gels. Isoelectric focusing of human or bovine keratolinin revealed two moieties separated by 0.3-0.4 pH unit (human, 5.4/5.0; bovine, 6.3/6.0). The two proteins were readily resolved by chromatofocusing and each isoelectric moiety of bovine keratolinin incorporated dansylcadaverine by epidermal transglutaminase and calcium and reacted with identity to antiserum to soluble Mr 36,000 keratolinin. Antiserum to human keratolinin failed to crossreact with its bovine counterpart. Antiserum to involucrin did not crossreact with either keratolinin or epidermis by immunodiffusion. Human and bovine epidermal keratolinins are biochemically similar but immunochemically distinct proteins from the epidermis. Involucrin appears only in significant quantities in cell culture.

Biochemistry of transglutaminases and cross-linking in the skin

Transglutaminase is a calcium-dependent enzyme found widely in nature. It catalyzes the formation of epsilon-(gamma-glutamyl)lysine bonds that participate in processes varying from fibrin clot formation to epidermal cell envelope formation. Epidermal transglutaminase is localized to the granular layer of the epidermis. It catalyzes the covalent cross-linking of a soluble cytoplasmic substrate into large polymers to form the cornified envelope that lines the inner membrane of keratinocytes in the stratum corneum. The soluble precursor from epidermis has been named keratolinin, and from keratinocyte culture, it has been named involucrin. Hair follicle transglutaminase is biochemically and immunochemically distinct from its epidermal counterpart. It has been localized to the inner root sheath and medulla of the hair follicle. The substrate of hair follicle transglutaminase has been poorly defined but appears to be rich in the amino acid citrulline. Transglutaminase has been shown to be an important marker of normal differentiation. There is a rise in its activity at the time of keratinization, and transglutaminase activity has been shown to be greatly decreased in basal cell epithelioma and in psoriasis. Keratinocyte cell culture has proven most helpful in delineating the processes of normal differentiation and keratinization, since the formation of the cell envelope in culture appears to parallel the formation in vivo.

Purification of human epidermal calmodulin

Human epidermal calmodulin was purified by phenothiazine-Sepharose affinity chromatography. The protein stimulated activator-deficient phosphodiesterase and was identified to be calmodulin by radioimmunoassay. Epidermal calmodulin demonstrated a Mr of 17,000 on gel permeation chromatography and migrated on sodium dodecyl sulfate-urea-polyacrylamide gel electrophoresis as a single band at the same location as rat testes calmodulin. The exact role of calmodulin in the epidermis remains to be defined.

In vitro and in vivo inhibition of [3H]imipramine binding by cadmium

Chronic exposure of rats to CdCl2 altered the specific binding of [3H]imipramine to membranes from platelets and hypothalamus. There was a decrease in Bmax of 10-40% and a decrease in KD values of 30-40% as compared to the control group. In vitro studies on the inhibition of [ 3H ]imipramine binding to membranes from human and rat platelets and hypothalamus by CdCl2 corroborate the in vivo results which imply that the imipramine binding protein contains Cd2+-sensitive groups.

Raynaud's syndrome. Treatment with sublingual administration of nitroglycerin, swinging arm maneuver, and biofeedback training

Sublingual (SL) administration of nitroglycerin, a swinging arm maneuver, and biofeedback were evaluated for their effectiveness in decreasing hand rewarming time after ice immersion in six patients with Raynaud's disease and four patients with Raynaud's phenomenon. After ice immersion of their hands, ten normal patients showed rewarming to baseline temperatures in less than six minutes, while in nine of ten patients with Raynaud's syndrome, rewarming took more than 40 minutes. Two of ten patients with Raynaud's syndrome showed rewarming in less than six minutes after SL administration of nitroglycerin, while eight of ten patients with Raynaud's syndrome showed rewarming in less than 20 minutes after biofeedback training sessions. Six of the ten still showed rewarming in 20 minutes or less eight weeks after the sessions were over. A swinging arm maneuver provided no objective improvement. Sublingual administration of nitroglycerin provides a new alternative therapy for certain individuals. Effective biofeedback training can be learned in a relatively short time but should be reserved for the well-motivated patient.

Rat hair follicle and epidermal transglutaminases. Biochemical and immunochemical isoenzymes

Epidermal and hair follicle transglutaminases (1,4-alpha-D-glucan: orthophosphate alpha-D-glucosyltransferase EC 2.4.1.1) were differentially isolated and subsequently purified from newborn or 4-5-day-old rats. Both enzymes migrated identically on ion-exchange chromatography but were widely separated by block electrophoresis, with the epidermal enzyme migrating further toward the anode. Each enzyme was finally purified by gel filtration. Epidermal transglutaminase had an apparent molecular weight of 56 000-58 000 in this medium and in gels containing sodium dodecyl sulfate (SDS), while hair follicle transglutaminase had a molecular weight of 52 000-54 000 and was reduced to two apparently identical subunits of a molecular weight of 27 000 by denaturing media. Antiserum specific to each transglutaminase was produced in chickens; when conjugated to fluorescein these antisera localized the enzymes to the granular layer of epidermis and the inner root sheath of follicles, respectively.

Physiologic and genetic alterations in human red cell DPGM

Erythrocyte 2,3-diphosphoglycerate levels are determined principally by a single molecule which has both diphosphoglycerate mutase (DPGM) and diphosphoglycerate phosphatase activities. An antiserum containing precipitating antibodies against this molecule was used to measure its amount in red cells from normal controls, from subjects with hypothyroidism or hyperthyroidism, and from a Japanese proband who has hemolytic anemia attributed to heterozygosity for a genetic variant. The amount of DPGM in normal adult erythrocytes is 0.98 +/- 0.014 mg/gm Hb. Slightly increased amounts are found in normal cord blood and in subjects with hyperthyroidism. Hypothyroid subjects have a significantly decreased concentration of DPGM, 0.82 +/- 0.06 mg/gm Hb. Restoration of euthyroid status during treatment results in a return of DPGM amounts to normal. The red cells of the Japanese subject contained 0.67 mg/gm Hb of DPGM as measured by immunoprecipitation.

Red cell diphosphoglycerate mutase. Immunochemical studies in vertebrate red cells, including a human variant lacking 2,3-DPG

Diphosphoglycerate mutase (DPGM) was purified to homogeneity from human erythrocytes. The enzyme and Freund adjuvant were injected into chickens and yielded a monospecific precipitating antibody. Radial immunodiffusion with this antibody was used to measure the amount of DPGM in hemolysates from human adult and cord red cells. Dog, rabbit, rat, chicken, and goat red cells all had DPGM during the neonatal period, but goat adult red cells had no detectable enzyme. Single bands with no spurs were present on Ouchterlony plates in which human hemolysate was placed adjacent to hemolysates from the other species tested. The amount of human red cell DPGM did not differ between young and old cells separated by centrifugation. Red cells from a patient with a DPGM genetic variant who had erythrocytosis and no detectable enzyme activity contained a reduced amount of DPGM as determined by radial immunodiffusion. The abnormal DPGM differed from normal by immunoelectrophoresis and in stability as measured by the amount of crossreacting material in young versus old erythrocytes.