Postnatal changes in maternal and neonatal plasma antioxidant vitamins and the influence of smoking

OBJECTIVE

To study the postnatal changes in the plasma concentrations of fat soluble antioxidant vitamins and malondialdehyde (MDA) in mothers and their newborns and their relation to smoking.

DESIGN

Prospective cohort study.

SETTING

Tertiary perinatal centre.

SUBJECTS

Eighteen non-smoking and 14 smoking mothers and 33 infants.

MAIN OUTCOME MEASURES

Plasma concentrations of vitamins E, A, and beta-carotene and MDA were measured in mothers and infants at delivery and on day 4 post partum.

RESULTS

Neonatal plasma levels of vitamins E, A, and beta-carotene were significantly lower than maternal levels both at delivery and on day 4 in both groups. There was a significant postnatal increase in plasma vitamin E levels in smoking mothers and neonates of both groups. A significant postnatal increase in maternal, but not neonatal, plasma vitamin A was noted in both groups. Cord plasma vitamin E levels were significantly lower in infants of smoking mothers (mean 4.7 v 6.5 micromol/l, p = 0.041). Plasma MDA was paradoxically lower in smoking mothers at delivery (3.19 v 4.01 micromol/l, p = 0.03) and on day 4 (1.37 v 3.29 micromol/l, p = 0.005) and in infants of the smoking group on day 4 (2.18 v 3.12 micromol/l, p = 0.014). Also, there was a significant postnatal fall in plasma MDA levels on day 4 in mothers and infants in the smoking group.

CONCLUSIONS

The postnatal changes in plasma vitamin E were more pronounced in the smoking group. The postnatal changes in plasma vitamins A and beta-carotene were similar in both groups. The rapid decline in plasma MDA in smoking mothers and their infants suggests withdrawal of oxidative stress from smoking around delivery. This coincided with the increase in plasma vitamin E.

New aspects in the pathogenesis and treatment of thrombotic thrombocytopenic purpura and hemolytic uremic syndrome

The thrombotic microangiopathy (TM) syndromes, thrombotic thrombocytopenic purpura and the hemolytic uremic syndrome, are a rare and heterogeneous group of disorders characterized by widespread microvascular thrombosis and end organ injury. Decades of descriptive studies have defined clinical subsets of TM syndromes by clinical and laboratory features. Despite many advances, however, progress towards understanding of the etiology and pathogenesis of TM disorders remains limited. The rarity of occurrence and lack of natural animal models of TM syndromes have hampered progress in experimental and clinical studies. Treatment remains essentially empirical and options are limited. However, recent advances in the genetic and molecular understanding of subsets of TM disorders and the development of relevant animal models offer new resources to explore the pathogenic mechanisms. With these new advances more effective and individualized treatments for TM syndromes can be developed.

Extracellular polysaccharides of modified strains of Erwinia spp

The structure of the extracellular polysaccharide (EPS) produced by Erwinia chrysanthemi strain A2148 has been determined using low pressure size-exclusion and anion-exchange chromatographies, high pH anion-exchange chromatography, glycosyl-linkage analysis, and 1D 1H NMR spectroscopy. The polysaccharide is structurally similar, if not identical, to the EPS produced by E. chrysanthemi strain A350. A streptomycin-resistant strain of E. chrysanthemi Ech6 (Ech6S(+)) has been generated and has an elevated production of EPS, as does a streptomycin-resistant strain (Ech9Sm6) of E. chrysanthemi Ech9. These modified E. chrysanthemi spp. have been ribotyped and found to be closely related to their parent strains.

β-Elimination of glucosyluronic residues during methylation of an acidic polysaccharide from Erwinia chrysanthemi CU 643

The Erwinia chrysanthemi CU643 EPS has a linear hexasaccharide repeating unit in which a 4-linked uronic acid residue is present. The EPS was methylated by either the NaOH-Me2SO-MeI or Li-dimsyl procedure. MALDI-TOF MS analysis of the methylated products indicates that the beta-eliminative degradation occurs during the methylation, as characterized by serial fragments of the hexasaccharide repeating units. The degradation was clearly defined from the methylation of a glucosyluronic-containing pyruvated pentasaccharide.

Paediatric pelvic imaging: optimisation of dose and technique using digital grid-controlled pulsed fluoroscopy

BACKGROUND

An audit of paediatric pelvic radiographs identified deficiencies in gonad shield placement and radiographic technique.

OBJECTIVE

A technique using grid-controlled fluoroscopy (GCF), with hard copy images in frame grab and digital spot image (DSI) format was evaluated to optimise gonad shield placement and reduce the dose given to children with Perthes disease and Developmental Hip Dysplasia (DDH) attending for pelvic radiography.

MATERIALS AND METHODS

Phantom and patient dose surveys of conventional and fluoroscopic techniques were carried out. Image quality and radiation dose were compared for the frame grab and DSI techniques. Retrospective evaluation was undertaken to compare their clinical acceptability.

RESULTS

Both fluoroscopic techniques gave considerably less radiation than conventional non-grid radiography (67-83%, P < 0.05). The frame grab technique gave less radiation than DSI (P < 0.05). There was no significant difference in the clinical acceptability scores of the DSI and frame grab images.

CONCLUSION

Fluoroscopy acquired images are now used since the fluoroscopic techniques give much less dose than conventional radiography and provide images of sufficient quality for clinical assessment. Indeed, as there was no significant difference in clinical usefulness between the frame grab and DSI techniques, it is planned to use frame grab alone, thus gaining additional dose saving.

Pyruvated galactose and oligosaccharides from Erwinia chrysanthemi Ech6 extracellular polysaccharide

The acidic extracellular polysaccharide of Ech6 was depolymerized by fuming HCl. The pyruvated sugars were isolated and characterized by methods that included a combination of low-pressure gel-filtration and high-pH anion-exchange chromatographies, methylation linkage analyses, mass (GC-MS and MALDI-TOF MS) and 1H NMR (1D and 2D) spectroscopies. The following pyruvated sugars were obtained: 4,6-O-(1-carboxyethylidene)-D-Galp; 4,6-O-(1-carboxyethylidene)- alpha-D-Galp-(1-->4)-beta-D-GlcAp-(1-->3)-D-Galp; 4,6-O-(1-carboxyethylidene)-alpha-D-Galp-(1-->4)-alpha-D-GlcAp- (1-->3)-alpha-D-Galp-(1-->3)-L-Fucp; 4,6-O-(1-carboxyethylidene)-alpha-D-Galp-(1-->4)-beta-D-GlcAp-(1-->3) -alpha-D-Galp-(1-->3)-L-[beta-D-Glcp-(1-->4)]-Fucp. These oligosaccharides present potential haptenes for the development of specific antibodies and confirm the partial structure proposed previously for the extracellular polysaccharide from Erwinia chrysanthemi Ech6 [Yang, B. Y.; Gray, J. S. S.; Montgomery, R. Int. J. Biol. Macromol., 1994, 16, 306-312].

Extracellular polysaccharide of Erwinia chrysanthemi A350 and ribotyping of Erwinia chrysanthemi spp

Erwinia chrysanthemi spp. are gram-negative bacterial phytopathogens causing soft rots in a number of plants. The structure of the extracellular polysaccharide (EPS) produced by the E. chrysanthemi strain A350, which is a lacZ- mutant of the wild type strain 3937, pathogenic to Saintpaulia, has been determined using a combination of chemical and physical techniques including methylation analysis, low-pressure gel-filtration and anion-exchange chromatography, high-pH anion-exchange chromatography, partial acid hydrolysis, mass spectrometry and 1- and 2D NMR spectroscopy. In contrast to the structures of the EPS reported for other strains of E. chrysanthemi, the EPS from strain A350 contains D-GalA, together with L-Rhap and D-Galp in a 1:4:1 ratio. Evidence is presented for the following hexasaccharide repeat unit: [structure: see text] All the Erwinia chrysanthemi spp. studied to date have been analyzed by ribotyping and collated into families, which are consistent with the related structures of their EPS.

Specialized dementia programs in residential care settings

The authors conducted a telephone survey in 7 states to determine the prevalence of residential care specialized dementia programs (RC-SDPs) and to identify a sample of homes (n = 56) for more detailed study. The 56 homes were site visited, and data were gathered on facility administration, therapeutic environment, and characteristics of 259 randomly selected residents. Comparison data from 138 nursing home Special Care Units (NH-SCUs) and 1,340 of their residents were obtained from 4 studies conducted in the same 7 states. RC-SDPs were smaller, provided a more homelike environment, and had a higher proportion of residents paying privately, compared with NH-SCUs. Mean levels of cognitive and physical impairment among residents were higher in NH-SCUs; prevalences of psychotropic medication use and problem behaviors were similar. Among RC facilities, small homes were more homelike, provided fewer structured activities, and charged less than larger facilities. RC-SDPs include 5 types: small, independently operated homes; multiple small homes with joint administration; larger, all-dementia facilities; SDPs operated within larger, exclusively RC facilities; and RC-SDPs in multilevel facilities.

Degree of acetylation of heteropolysaccharides

The acetyl groups in polysaccharides and glycoproteins have been determined using 4 N HCl at 120 degrees C for acid hydrolysis. Acetic acid and hexosamine were determined by high-performance cation-exchange chromatography with UV detection and high-performance anion-exchange chromatography with pulsed amperomeric detection, respectively. The method compares well with other procedures and shows an additional advantage of being able to analyze for hexosamine in the same hydrolyzate, thus permitting the degree of acetylation of hexosamine-containing biopolymers to be determined directly without correction for additional components in the material of interest.

Autohydrolysis of phytic acid

The autohydrolysis of phytic acid at 120 degrees C resulted in the formation of most of the phosphate esters of myo-inositol in varying amounts depending upon the reaction time. Eighteen of the 39 chromatographically distinct myo-inositol mono-, bis-, tris-, tetrakis-, pentakis-, and hexakisphosphates have been characterized using two different HPLC systems. These myo-inositol phosphates were partially purified by preparative anion-exchange chromatography under acidic and alkaline elution conditions. The combination of these two methods provides a two-tiered chromatographic approach to the rapid and sensitive identification of inositol phosphates in complex mixtures. Identification of the products was confirmed by 1D and 2D (1)H NMR analysis. The analytical procedure was applied to the autohydrolysis of the mixture of inositol phosphates from corn steep water.

Intravenous ondansetron for the control of opioid-induced nausea and vomiting. International S3AA3013 Study Group

This randomized, double-masked, placebo-controlled, multicenter trial was conducted in 9 countries to assess the safety and efficacy of 2 doses of intravenous ondansetron (8 and 16 mg) for the control of opioid-induced nausea and vomiting. A total of 2574 nonsurgical patients who presented with pain requiring treatment with an opioid analgesic agent participated in this trial. The most common presenting painful condition was back or neck pain, reported by approximately one third of patients. A total of 520 patients (317 females, 203 males) developed nausea or vomiting after opioid administration and were randomly assigned to receive a single dose of 1 of 3 study treatments: placebo (n = 94), ondansetron 8 mg (n = 215), or ondansetron 16 mg (n = 211). Ondansetron 8 and 16 mg led to complete control of emesis in 134 of 215 patients (62.3%) and 145 of 211 patients (68.7%), respectively. Results with both doses were significantly better than those seen with placebo (43 of 94 patients [45.7%]). Complete control of nausea was achieved in 6.8% of placebo patients, 14.8% of ondansetron 8-mg-treated patients, and 19.4% of ondansetron 16-mg treated patients; only ondansetron 16 mg was significantly better than placebo (P = 0.007). Significantly more patients who received ondansetron 8 mg than patients who received placebo were satisfied/very satisfied with their antiemetic treatment, as assessed by 4 patient-satisfaction questions. Significantly more patients who received ondansetron 16 mg compared with placebo were satisfied/very satisfied on 2 of 4 satisfaction questions. In conclusion, based on the observed incidence of opioid-induced nausea and vomiting in this study, it may be more appropriate to treat symptoms on occurrence rather than administering antiemetic agents prophylactically. The results of this study demonstrate that intravenous ondansetron in doses of 8 or 16 mg is an effective antiemetic agent for the control of opioid-induced nausea and vomiting in nonsurgical patients requiring opioid analgesia for pain.

Extracellular polysaccharide of Erwinia chrysanthemi CU643

Erwinia chrysanthemi are gram-negative bacterial phytopathogens causing soft rots in a number of plants. The structure of the extracellular polysaccharide (EPS) produced by E. chrysanthemi strain CU643, pathogenic to Philodendron, has been determined using a combination of chemical and physical techniques including methylation analysis, high- and low-pressure gel-filtration and anion-exchange chromatography, high-pH anion-exchange chromatography, partial acid hydrolysis, mass spectrometry, and 1- and 2-D NMR spectroscopy. In contrast to the structures of the EPS reported for other strains of E. chrysanthemi, the EPS from strain CU643 is a linear polysaccharide containing L-Rhap, D-Galp, and D-GlcAp in the ratio 4:1:1. Evidence is presented for the following hexasaccharide repeat unit: -->3)-beta-D-Galp-(1-->2)-alpha-L-Rhap-(1-->4)-beta-D-GlcAp- (1-->2)-alpha-L- Rhap-(1-->2)-alpha-L-Rhap-(1-->2)-alpha-L-Rhap-(1-->(1 ).

Heterogeneity of glycans at each N-glycosylation site of horseradish peroxidase

The tryptic glycopeptides of horseradish peroxidase isozyme c (HRPc) were studied by methylation linkage analysis, exoglycosidase degradation, and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDITOFMS). Over 90% of the predicted tryptic peptides and glycopeptides of HRPc could be identified in the unfractionated digest. Four glycans, namely (Xyl)Man3(Fuc)GlcNAc2 (major species), (Xyl)Man2(Fuc)GlcNAc2, (Xyl)Man3GlcNAc2, and Man3(Fuc)GlcNAc2 (minor species), were observed at all of the N-glycosylation sites and account for greater than 95% of the carbohydrate. Other members of this glycan family, namely (Xyl)xManm(Fuc)f GlcNAc2 (x = 0 or 1, f = 0 or 1, m = 4, 5, 6, or 7), account for the rest of the glycans. Only traces of high mannose-type glycans were detected in HRPc. Two sites, namely those at Asn-57 and Asn-267, were found to be more heterogeneous than the sites at Asn-13, Asn-158, Asn-186, 198 (doubly glycosylated peptide), Asn-214, and Asn-255. Two of the glycopeptides were observed as part of disulfide-linked species. MALDITOFMS confirmed the N-glycosylation sites previously reported [K.G. Welinder, Eur. J. Biochem., 96 (1979) 483-502] and was used to determine the heterogeneity of the glycan pool at each site.

The N-glycosylation sites of soybean seed coat peroxidase

Tryptic digestion of apo-soybean peroxidase (apo-SBP), with and without acetamidation, chromatographic separation of the tryptic fragments and MALDI-TOF analysis of the major components, both before and after digestion with glycopeptidase A, demonstrated the presence of six carbohydrate groups on five peptides. Five of the glycopeptides can be mapped with confidence to the peptides containing Asn16, Asn90, Asn104, Asn169, and Asn174. The sixth N-glycosylation site is not known and does not appear to be Asn145. It may be present on the N-terminus of SBP, which has not been sequenced.

Predictive assessment of vocal efficiency (PAVE). A method for voice therapy outcome measurement

A prospective study was carried out to examine the degree to which a standard voice assessment could discriminate between the potential benefits of two different voice therapy programmes for individual patients. The study encompassed 200 dysphonia subjects who were referred for voice therapy and had completed treatment within a prescribed two-year period. A standard assessment procedure was carried out on first attendance for each patient and guidelines were used to assign patients to different treatment programmes on the basis of the assessment results. The assessment discriminated well between patients requiring voice therapy to change physiological parameters of voice usage and patients able to self adjust voice usage, and provided an objective means of measuring outcomes.

Laparoscopic assisted live donor nephrectomy--a comparison with the open approach

Live donor renal transplantation provides significant advantages when compared with cadaveric donor renal transplantation in terms of improved patient and graft survival, a lower incidence of delayed function, and a shorter waiting time. Yet despite these advantages, live donors continue to be an under utilized source of kidneys for transplantation. Disincentives to live donation include the length of hospitalization, postoperative pain, cosmetic concerns, and the prolonged convalescence associated with the donor operation. In many instances minimally invasive video-assisted techniques have proven more efficacious than standard open procedures in terms of patient discomfort, length of hospital stay, cost, and length of time until the patient can return to full activity. Laparoscopic live donor nephrectomies are being performed at our institution in an attempt to make live donation more attractive to the potential donor. The purpose of this study was to retrospectively review the results of laparoscopic live donor nephrectomy (LapNx) and to compare them with those obtained using the standard open approach (OpenNx). Ten consecutive LapNx were performed from February 1995 through April 1996. The control group consisted of the 20 consecutive OpenNx performed at the same institution from January 1991 through January 1995 immediately before the initiation of the LapNx program. Live donors were considered candidates for LapNx if they possessed at least one kidney with normal renal anatomy with single renal vessels and a single ureter. LapNx was safely performed in all cases. No patients required open conversion or blood transfusions. The allograft warm ischemic time for the laparoscopic cases was 4.2+/-1.3 min. All kidneys harvested laparoscopically produced urine on the table immediately upon revascularization. Presently nine of the ten recipients have functioning allografts. At three months posttransplant the calculated recipient creatinine clearances were 67.0+/-11.5 ml/min and 64.8+/-21.4 ml/min for the LapNx and OpenNx groups, respectively (P=NS). The LapNx donors had a significantly decreased estimated blood loss, shorter time until resumption of oral intake, decreased postoperative pain (in terms of decreased analgesic requirements), shorter hospitalization, and a shorter interval until the resumption of full activities (P<0.05 for all). In addition, the LapNx group donors returned to work sooner than the OpenNx group (3.9+/-1.6 wk vs. 6.4+/-3.1 wk, respectively) (P=0.024). Four individuals agreed to donate a kidney only after learning of the availability of the laparoscopic approach. We conclude that laparoscopic live donor nephrectomy is technically feasible. In addition, it may offer significant advantages over the standard open approach in terms of patient comfort and convenience. These advantages may make live donor renal transplantation more attractive to prospective donors. The potential decrease in hospitalization and convalescence may also prove to be financially advantageous. We believe that further careful study of this procedure is warranted.

The structure of stewartan, a capsular polysaccharide produced by Erwinia stewartii strain DC283

Stewartan is a capsular polysaccharide produced by Erwinia stewartii, the causative agent of Stewart's wilt of maize. The structure of stewartan is shown, by a combination of methylation analysis, Li/ethylenediamine degradation, 1D and 2D NMR spectroscopy, partial acid hydrolysis and isolation of oligosaccharides, Smith degradation, MALDI-TOFMS analysis and exoglycosidase digestion, to have the following repeating unit: [sequence: see text]

Comparison of extracellular polysaccharides of Erwinia chrysanthemi spp

Two extracellular polysaccharides from strains of Erwinia chrysanhemi Ech 1 and 9, phytopathogens of potatoes, have been isolated and purified. Both have similar compositions and other properties to that produced by strain SR 260, a phytopathogen of corn. These polysaccharides are composed of L-rhamnose, D-mannose, D-glucose, D-glucuronic acid in the ratio 3:1:1:1. Initial structural aspects of these polysaccharides are reflected in the 600 MHz 1H NMR spectra and the products of partial acid hydrolysis, which are presented for comparison.

Do cyanobacteria swim using traveling surface waves?

Bacteria that swim without the benefit of flagella might do so by generating longitudinal or transverse surface waves. For example, swimming speeds of order 25 microns/s are expected for a spherical cell propagating longitudinal waves of 0.2 micron length, 0.02 micron amplitude, and 160 microns/s speed. This problem was solved earlier by mathematicians who were interested in the locomotion of ciliates and who considered the undulations of the envelope swept out by ciliary tips. A new solution is given for spheres propagating sinusoidal waveforms rather than Legendre polynomials. The earlier work is reviewed and possible experimental tests are suggested.

The glycans of horseradish peroxidase

Horseradish peroxidase (E.C. 1.11.1.7) isozyme c (HRPc) is a glycoprotein found to contain 21.8% carbohydrate with the average composition: 2 mol GlcNAc, 2.6 mol Man, and 0.8 mol each of Fuc and Xyl. The oligosaccharides of HRPc were investigated by a combination of High pH Anion-Exchange Chromatography with Pulsed Amperometric Detection, methylation analysis and Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry. The structure of the major oligosaccharide released by digestion with glycopeptidase A, accounting for between 75 and 80% of the total, was confirmed to be [sequence: see text]. Most of the remaining oligosaccharides were found to belong to the (Xyl)xManm(Fuc)fGlcNAc2 (m = 2, 4, 5, 6; f = 0 or 1; x = 0 or 1) family. Less than 5% of the oligosaccharides were of the ManmGlcNAc2 (m = 4 to 7) type. Methylation analysis of holo- and apo-HRPc and its tryptic glycopeptides support the structures proposed for the oligosaccharides. Furthermore, methylation analysis of the tryptic glycopeptides provides evidence for the heterogeneity of the oligosaccharides occurring at each of the N-linked sites.

Laparoscopic live donor nephrectomy: the initial 3 cases

PURPOSE

Successful laparoscopic live donor nephrectomy in 3 patients is described.

MATERIALS AND METHODS

The procedures were performed completely laparoscopically and the kidneys were extracted via 8 cm. infraumbilical incisions.

RESULTS

In all 3 cases warm ischemic time was less than 5 minutes, and the renal vessels and ureter of the harvested kidneys were of adequate length for routine transplantation. Donors required minimal postoperative parenteral analgesia and were discharged home 1 to 3 days after the procedure. All harvested kidneys were successfully transplanted, and functioned well initially and at hospital discharge.

CONCLUSIONS

Laparoscopic live donor nephrectomy may be an alternative surgical modality to conventional open nephrectomy. Advantages include less postoperative pain, shorter hospital stay and convalescence, and a more desirable cosmetic result. Additionally, these advantages may encourage more individuals to consider live donation, resulting in an increase in organ supply.

The glycans of soybean peroxidase

Soybean hull peroxidase (SBP, E.C. 1.11.1.7), an anionic glycoprotein, was found to contain 18.2% carbohydrate with the average composition: 2 mol GlcNAc, 3.3 mol Man, 0.9 mol Fuc, and 0.7 mol Xyl. The oligosaccharides of SBP, after release with glycopeptidase A, were investigated by a combination of high pH anion exchange chromatography with pulsed amperometric detection, methylation analysis and matrix assisted laser desorption/ionization-time-of-flight mass spectrometry. The structure of the major oligosaccharide, accounting for 60 to 65% of the total, is Man alpha 1-->6(Man beta 1-->3)(Xyl beta 1-->2)Man beta 1-->4GlcNAc beta 1-->4(Fuc alpha 1-->3)GlcNAc. A further 20 to 25% of the released oligosaccharides belong to the (Xyl)xManm(Fuc)fGlcNAc2 (m = 2, 4, 5, 6; f = 0 or 1, x = 0 or 1) family. The rest of the oligosaccharides were of the high-mannose type. Investigation of the six tryptic fractions containing carbohydrate revealed considerable heterogeneity in the N-linked oligosaccharides present in each fraction. The major glycan (4, Table III) was present in each fraction. Two of the fractions contained the major part of the high-mannose type glycans, ManmGlcNAc2 (m = 5-9), the major species being Man7GlcNAc2. The other four fractions contained mainly members of the (Xyl)xManm(Fuc)fGlcNAc2 (m = 2, 4, 5, 6; f = 0 or 1; x = 0 or 1) family. Methylation analysis of the holo- and apo-SBP provide support for the structures proposed for the oligosaccharides as well as for the heterogeneity of the glycopeptide fractions.

Extracellular polysaccharide of Erwinia chrysanthemi Ech6

Many strains of Erwinia chrysanthemi, which are Gram-negative bacterial phytopathogens, produce copious amounts of extracellular polysaccharides. The extracellular polysaccharide from E. chrysanthemi pv. zeae strain SR 260, a phytopathogen of corn, is a branched-chain glucomannorhamnan of proven structure (Gray et al., Carbohydr. Res. 1993, 245, 271-287). The extracellular polysaccharide from E. chrysanthemi Ech6 is different, containing no rhamnose or mannose. It is composed of L-fucose, D-galactose, D-glucose and D-glucuronic acid in the ratio 2:2:1:1. The structure of the polysaccharide is as follows: [sequence: see text]

Separation and analysis of 4'-epimeric UDP-sugars, nucleotides, and sugar phosphates by anion-exchange high-performance liquid chromatography with conductimetric detection

An anion-exchange HPLC method coupled with conductimetric detection was developed for the analysis of UDP-sugars, nucleotides, and sugar phosphates, each in a single chromatographic run. The analysis was applicable to concentrations over 50 pmol. The utility of this technique was demonstrated by the measurement of UDP-sugar 4'-epimerase activity of cell-free extracts from wild-type and mutant Neisseria meningitidis serogroup B strains. Additionally, the method has been applied to the analysis of the intermediates of glycolysis in human erythrocytes.

Merger offers IS managers flexibility & less stressful integrating, downsizing, & outsourcing. Interview by Bill Childs

A merger between two multi-million dollar IS firms in July 1993 created a company with $315 million in sales and a sharp focus on healthcare. National Healthtech Corp., parent firm of MRI, brought the focus to the deal. And Dallas-based Affiliated Computer Services, a data services provider to financial, commercial and healthcare organizations, brought telecommunications and outsourcing expertise. Bill Childs, editor-in-chief, recently spoke with the two firms' principals--Richard A. Montgomery, CEO of National Healthtech Corp., and Steve Carpenter, senior VP of ACS and COO of NHC. Excerpts from their conversation follow.

Structure of an extracellular polysaccharide produced by Erwinia chrysanthemi

Erwinia chrysanthemi pv zeae strain SR260, a phytopathogen of corn, produced from lactose an acidic extracellular polysaccharide which was purified and found to consist of L-rhamnose, D-mannose, D-glucose, and D-glucuronic acid in the ratio of 3:1:1:1. A combination of chemical (carboxyl-group reduction, methylation analysis, periodate oxidation, Smith degradation, and lithium-ethylenediamine degradation) and physical (1 and 2D NMR spectroscopy) methods revealed that the polysaccharide is composed of a hexasaccharide repeating unit 1: [formula: see text]

Left-sided leg edema of the elderly: a common variant of the iliac compression syndrome

BACKGROUND

Anatomically, the right common iliac artery crosses the left iliac vein and its accompanying lymphatics. We hypothesized that this situation could lead to a predominance of edema, telangiectasis, and venous varicosities on the left lower extremities of older persons.

METHODS

To test this hypothesis, a research assistant who was blinded to the study goals examined 215 predominantly elderly residents of North Carolina homes for the aged and disabled.

RESULTS

Among these subjects, 17.7 percent had predominantly left-sided edema, and 5.7 percent had predominantly right-sided edema (P < 0.001). When the 88 subjects with pitting edema greater than 3 mm were studied, 34.5 percent showed a left-sided predominance, and 6.9 percent showed a right-sided predominance (P < 0.001). In contrast, no significant difference was found in the lateralization of venous varicosities or of telangiectasis.

CONCLUSIONS

Asymmetric edema is common and is usually left-sided in older persons. Compression of the left common iliac vein and its accompanying lymphatics by the right iliac artery, rather than overt clinical disease, might explain the majority of asymmetric edema seen in clinical practice.

Evaluation of cryopreserved bone and synthetic biomaterials in promoting spinal fusion

The purpose of the study was to evaluate the use of cryopreserved allograft bone and tricalcium phosphate in promoting spinal fusion. Nine 20-30 lb swine underwent posterior spinal fusion at T5-T6, T13-T14, and L2-L3. Autogenous bone, cryopreserved allograft bone, or equal parts of allograft bone and tricalcium phosphate were added to the decorticated posterior elements. A total of 27 sites were prepared for fusion. The spines were retrieved at 6 months and evaluated for integrity and stability of the fusion sites by clinical examination, three-point bending tests, multiplanar radiographs, and undecalcified tetracycline-labeled and decalcified histologic sections. The nine sites that received autogenous bone were solidly fused. There were one clinical and two radiographic nonunions in the nine sites that received cryopreserved allograft bone. Sites that received a mixture of allograft bone and tricalcium phosphate demonstrated slight motion at two locations and radiographic evidence of fusion at all levels. The extent and degree of fusion was not site-specific. Three-point bending analysis did not demonstrate a significant trend as to site or materials specificity. No adverse histologic response was noted. Histologic sections and tetracycline labels confirmed abundant new bone formation at all sites at 6 months. Although autogenous bone remains the gold standard for use in spinal arthrodesis, this study demonstrates the value of cryopreserved allograft bone alone and in combination with tricalcium phosphate in promoting spinal fusion.

External fistulas arising from the digestive tract

External abdominal fistulas that arise from the digestive tract are associated with high mortality and prolonged morbidity in terms of infection, malnutrition, and skin excoriation. Such external fistulas most commonly follow anastomotic leak after gastrointestinal surgery. We identified 58 patients seen over a 5-year period at the University of Louisville Hospitals because of external abdominal fistulas that arose from the stomach (8), duodenum (4), small intestine (26), colon (14), biliary tract (9), and pancreas (7). Fifteen patients had multiple fistulas and 32 had high-output fistulas (greater than 200 mL/day). Closure was achieved in 48 patients, and eight of the 10 patients whose fistulas remained open died. Overall mortality was 19%. Principles of management include control of infection, correction of fluid and electrolyte imbalance, nutritional support, proper wound care, and often operative intervention. Multiple staged operations over many months were particularly important in managing complex wounds with large abdominal wall defects and multiple fistulas. Fistula closure is the ultimate goal, and patience is important to achieve it.

Experimental and clinical significance of endotoxin-dependent HLA-DR expression on monocytes

For much of the last decade, an increasing number of surgeons have been interested in objective assessment of cellular contributors to host defense function. In order to study many of these processes, it is apparently desirable that the cells be isolated to the extent feasible for the purpose of analyzing a more or less pure population of cellular elements. The purpose of this paper is to describe the physiologic activation of mononuclear cells that occurs as a result of the isolation process. Therefore, it follows logically that such cells are therein intrinsically less responsive to further physiologic manipulation in vitro. Analyses of such data without an awareness of this intrinsic aberration will undoubtedly lead to misinterpretation of the capacity of such cells for further modulation by immunostimulants or by the intrinsic processes related to injury, anesthesia, and operation. Furthermore, it may indicate that certain agents, e.g., cytokines, are unable to stimulate cellular function when, in fact, the defense function of the cell has been initially stimulated by the isolation procedure. Fractionation of human peripheral blood over Hypaque-Ficoll and subsequent purification of monocytes by adherence to plastic lead to an increase in the relative density of HLA-DR on monocytes. This increase occurred when carried out in endotoxin lipopolysaccharide (LPS)-contaminated or LPS-depleted reagents. LPS, added experimentally to whole blood, enhanced HLA-DR expression on monocytes without further manipulation. Monocyte HLA-DR expression measured in whole blood was reduced in patients with major sepsis (n = 19) compared to normal subjects (n = 10).(ABSTRACT TRUNCATED AT 250 WORDS)