Further studies of lipid peroxidation in human paraquat poisoning

In patients with subacute toxic reactions from paraquat poisoning (death within 11 to 41 days), the extent of lipid peroxidation, expressed as serum malondialdehyde level, was 2.7-fold higher (12.33 +/- 4.42 nmole/mL) before pulmonary fibrosis than that in normal controls (4.55 +/- 1.23 nmole/mL). The extent of lipid peroxidation in patients with acute toxic reactions (death within one to three days) was not elevated; these patients died of pulmonary edema and hemorrhage (acute respiratory distress), liver failure, renal failure, and adrenal necrosis. Remarkable high levels of paraquat (greater than 5 mg/L) were found in the urine, serum, and tissues of patients with acute toxic reactions; a small amount of paraquat was found in the serum or urine of patients with subacute toxic reactions five to 11 days after ingestion. Patients who survived had no elevation in lipid peroxidation. Administration of vitamin E (100 to 4,000 mg/day from the first hospital day) had no effect on survival.

Reversed-phase liquid chromatographic investigation of nucleosides and bases in mucosa and modified nucleosides in urines from patients with gastrointestinal cancer

Reversed-phase high-performance liquid chromatography (HPLC) has been used to determine the level of nucleic acid metabolites in perchloric acid extracts of gastrointestinal mucosa. By comparing the levels of these compounds in the normal portion with the levels in the neoplastic portion of mucosa resected from patients with malignant cancer, it was found that uracil was significantly elevated in the neoplastic colorectal mucosa (adenocarcinoma) of eight patients with colorectal cancer (P less than 0.01, statistically significant with the paired t test). The mean level of uracil in neoplastic colorectal mucosa was 2.7-fold higher than that in normal mucosa. However, in neoplastic gastric mucosa, only one out of four patients with gastric cancer showed elevated uracil. In neoplastic mucosa, the levels of hypoxanthine and uridine for colorectal cancer, and inosine for gastric cancer, were also significantly higher than those in normal mucosa (P less than 0.05, with the paired t test). The urinary modified nucleosides were prefractionated with a boronate affinity gel column, and their levels determined by the same HPLC method. No significant differences in the concentrations of pseudouridine, 1-methylguanosine, N2-methylguanosine or N2,N2-dimethylguanosine were observed in pre- and post-operative urines from patients with colorectal cancer and normal urines.

Reversed-phase high-performance liquid chromatographic investigation of mucosal nucleosides and bases and urinary modified nucleosides of gastrointestinal cancer patients

Reversed-phase high-performance liquid chromatography (HPLC) was used to determine the levels of nucleosides, bases and their metabolites in perchloric acid extracts of gastrointestinal mucosa. By comparing the levels of these compounds in the normal portion with the neoplastic portion of mucosa resected from malignant cancer patients, it was found that there was significant elevation of the uracil level in the neoplastic mucosa of all eight patients with colorectal cancer (2.7-fold in normal mucosa), but only in the neoplastic mucosa of one out of four patients with gastric cancer. The levels of hypoxanthine and uridine in the colorectal cancer mucosa samples and the inosine in gastric cancer samples were also significantly higher than those in normal mucosa. The urinary modified nucleosides were prefractionated with a boronate affinity gel column, and their levels were determined by the same HPLC method. There was no significant difference in the concentrations of pseudouridine, 1-methylguanosine N2-methylguanosine and N2,N2-dimethylguanosine between urine samples taken before and after surgery from eight patients with malignant colorectal cancer. Contrary to other reports, no significant differences in modified nucleoside levels were observed between urine samples from patients with colorectal cancer and those from normal subjects.

Vibrio vulnificus septicemia

A 33-year-old Japanese male, who had a three year history of biopsy-proved liver cirrhosis, was admitted to the hospital on June, 24, 1983 with a sudden onset of fever (38.6 degrees C), chills, generalized pain, nausea, anorexia, weakness, and eruption over the entire body. The patient went into shock and died about 7 hours after admission. Blood cultures before death were positive for V. vulnificus. Postmortem microscopic examination revealed "necrotizing vasculitis" in the small and large intestines, stomach, and skin, and also showed marked toxic epidermal necrolysis. This case matches the primary septicemia caused by V. vulnificus described by Blake et al. In addition, this case suggests that the septicemia was acquired through the gastrointestinal tract, especially the small intestine, because the V. vulnificus was isolated from blood and numerous Gram-negative bacilli around the submucosal vessels were observed in the area with acute necrotizing vasculitis.

Acute renal failure in primary macroglobulinemia with small-molecule IgM

Primary macroglobulinemia with acute renal failure developed in a 46-year-old man after administration of contrast medium (containing diatrizoate sodium and meglumine [Urografin]) for intravenous pyelography. On admission, the monoclonal protein peak could not be detected in serum by cellulose acetate electrophoresis, but the serial electrophoresis revealed a gradual increase in monoclonal protein peak, which later became two peaks. The serum of the patient contained the monoclonal small-molecule IgM kappa-chain protein with 13 to 14 Svedberg units in sedimentation constants, which is antigenetically the same as native IgM heavy chain. Although acute renal failure is extremely rare in primary macroglobulinemia, the small-molecule IgM seems to be one factor that induces acute renal failure.

Familial adult T-cell leukemia

Two siblings who developed adult T-cell leukemia (ATL) are presented. The patient and 7 of 26 healthy family members examined had the serum antibodies against ATL-associated antigens (ATLA). This family study shows that two main routes of transmission of human T-cell leukemia virus (HTLV) may be involved: one is the route from parents to children and the other is horizontal transmission among spouses, especially from husband to wife; the anti-ATLA-positive family is considered to be a high-risk group for ATL.

Immunopathological characterization of the delayed hypersensitivity skin reaction to carrier protein

Characteristics of the allergic skin reaction to free carrier protein in sensitized guinea pig with hapten-carrier conjugate have been studied. The animals sensitized with a low dose (4 micrograms) of dinitrophenylated bovine gamma globulin with Freund's complete adjuvant demonstrated a dermatitis when challenged intradermally with a small dose (10 micrograms) of bovine gamma globulin on the 10th or 14th day. The dermatitis was grossly and histologically similar to the classical form of delayed-type hypersensitivity skin reaction except lesser induration and less abundant neutrophil infiltration in the former. This reaction was clearly different from cutaneous basophil hypersensitivity because of the long lasting time course and fewer basophil infiltration in the former. No humoral antibody to carrier protein was detected in the sera of the sensitized animals by passive cutaneous anaphylaxis or by immunodiffusion in agar plates, and the state of the hypersensitivity could be passively transferred with peritoneal exudate cells and spleen cells. These observations indicated that the skin reaction to carrier protein might be of primarily delayed-type hypersensitivity. The vascular permeability change at the reaction sites was observed as a single phase delayed response and preceded the maximum erythema by about ten hours.

On the calculation of a "reference change" for comparing two consecutive measurements

We describe a statistical method for calculating a "reference change," defined as that difference between two consecutive test results in an individual that is statistically significant in a given proportion of all similar persons. By allowing for variation in within-person variances, this procedure computes a reference change that is more specific (i.e., less prone to false positives) than that obtained directly from the distribution of observed differences between measurements. Moreover, the method may easily be extended to a test for trend in three successive measurements. The method has been applied to semi-annual measurements of serum calcium and alkaline phosphatase in 698 men and women enrolled in a large health-maintenance program. We believe that these ideas may also be usefully applied to successive laboratory tests in carefully defined patient populations--but this introduces special problems, which are discussed briefly.

On the calculation of a "reference change" for comparing two consecutive measurements

We describe a statistical method for calculating a "reference change," defined as that difference between two consecutive test results in an individual that is statistically significant in a given proportion of all similar persons. By allowing for variation in within-person variances, this procedure computes a reference change that is more specific (i.e., less prone to false positives) than that obtained directly from the distribution of observed differences between measurements. Moreover, the method may easily be extended to a test for trend in three successive measurements. The method has been applied to semi-annual measurements of serum calcium and alkaline phosphatase in 698 men and women enrolled in a large health-maintenance program. We believe that these ideas may also be usefully applied to successive laboratory tests in carefully defined patient populations--but this introduces special problems, which are discussed briefly.

Enrichment by counterpart centrifugal elutriation of human lymphocytes cytotoxic to human tumour cells

The enriched fractions of cytotoxic cells responsible for natural killer (NK) activity against both human sarcoma and neuroblastoma (LA-N2) cell lines were readily obtained by countercurrent centrifugal elutriation (CCE). The NK cells were obtained in the larger lymphocyte fractions (fraction 6 +/- 1), having a mean cell volume of 180 u3. The cytotoxic-enriched fraction contained 51% large lymphocytes having cytoplasmic granules. On the other hand, monocytes were purified to greater than 90% and isolated in another fraction (final fraction) and these cells had the lowest NK activity against both human tumour cell lines. However, compared with the lymphocyte fractions, small and large monocytes displayed greater antibody-dependent cellular cytotoxicity (ADCC) activity against human B erythrocytes. These results indicate that NK found to have activity against both tumour cells lines were larger lymphocytes, not small monocytes. Thus, countercurrent centrifugal elutriation (CCE) can provide a sensitive method to obtain enriched fractions of large lymphocytes contained tumoricidal activity against human sarcoma and neuroblastoma cell lines.

Monocyte aggregation and superoxide anion release in response to formyl-methionyl-leucyl-phenylalanine (FMLP) and platelet-activating factor (PAF)

Like the PMN, human peripheral blood monocytes were capable of aggregating in response to FMLP and PAF. Monocyte aggregation was dependent on glycolysis and the presence of divalent cations. Unlike the PMN, monocyte aggregation in response to FMLP was not accompanied by degranulation, nor was it potentiated by cytochalasin B. Furthermore, cytochalasin B and its cogenitor, dihydrocytochalasin B, inhibited aggregation in response to PAF. PAF and FMLP appeared to react with the monocyte at separate receptors because sequential challenge of the monocyte with the same agents failed to elicit further aggregation, whereas rechallenge with the alternative agent induced further aggregation. Because the monocyte will aggregate to chemotactic agents in vitro, it is likely that the cell will be affected by these agents in vivo, which could lead to leukoembolization of circulating monocytes.

Monocyte aggregation and superoxide anion release in response to formyl-methionyl-leucyl-phenylalanine (FMLP) and platelet-activating factor (PAF)

Like the PMN, human peripheral blood monocytes were capable of aggregating in response to FMLP and PAF. Monocyte aggregation was dependent on glycolysis and the presence of divalent cations. Unlike the PMN, monocyte aggregation in response to FMLP was not accompanied by degranulation, nor was it potentiated by cytochalasin B. Furthermore, cytochalasin B and its cogenitor, dihydrocytochalasin B, inhibited aggregation in response to PAF. PAF and FMLP appeared to react with the monocyte at separate receptors because sequential challenge of the monocyte with the same agents failed to elicit further aggregation, whereas rechallenge with the alternative agent induced further aggregation. Because the monocyte will aggregate to chemotactic agents in vitro, it is likely that the cell will be affected by these agents in vivo, which could lead to leukoembolization of circulating monocytes.

Comparing multivariate and univariate subject-specific reference regions for blood constituents in healthy persons

We examined the comparative behavior of subject-specific multivariate and univariate reference regions, using both computer-generated data and serial (semi-annual) measurements of selected analytes in subjects from a large health-maintenance program. Univariate studies under both homeostatic and random-walk time-series models were helpful in defining expected results, but only the homeostatic model was used in multivariate as well as univariate forms. Analysis of the computer-generated data and the real biochemical series produced similar findings, which showed the multivariate subject-specific reference region to be much more conservative than corresponding univariate intervals. That is, a multidimensional point of p correlated observations is quite likely to lie within the individual's multivariate reference region (based on past observation vectors), even when one or more of the observations lie outside their separate reference intervals for that individual. One consequence of this high specificity against univariate false positives in a large surveillance program is a higher than expected proportion of positive multivariate vectors in which none of the values lie outside their univariate ranges. Thus, although the development of multivariate reference regions should be encouraged, they should be used in conjunction with, not instead of, univariate ranges.

Comparing multivariate and univariate subject-specific reference regions for blood constituents in healthy persons

We examined the comparative behavior of subject-specific multivariate and univariate reference regions, using both computer-generated data and serial (semi-annual) measurements of selected analytes in subjects from a large health-maintenance program. Univariate studies under both homeostatic and random-walk time-series models were helpful in defining expected results, but only the homeostatic model was used in multivariate as well as univariate forms. Analysis of the computer-generated data and the real biochemical series produced similar findings, which showed the multivariate subject-specific reference region to be much more conservative than corresponding univariate intervals. That is, a multidimensional point of p correlated observations is quite likely to lie within the individual's multivariate reference region (based on past observation vectors), even when one or more of the observations lie outside their separate reference intervals for that individual. One consequence of this high specificity against univariate false positives in a large surveillance program is a higher than expected proportion of positive multivariate vectors in which none of the values lie outside their univariate ranges. Thus, although the development of multivariate reference regions should be encouraged, they should be used in conjunction with, not instead of, univariate ranges.

The role of polymorphonuclear leukocytes in delayed hypersensitivity skin reactions: suppressive effects of anti-polymorphonuclear leukocyte serum

Rabbit antisera (APS) against normal guinea pig peritoneal exudate polymorphonuclear leukocytes (PMN), when injected intraperitoneally three times within 24 h into guinea pigs, lead to a marked fall in the blood PMN count (below 100/mm3) 24-72 h after the injection and a mild depression in the number of circulating mononuclear leukocytes (MNC) at 36-72 h. APS treatment of guinea pigs led to a marked suppression of delayed hypersensitivity skin reactions in response to dinitrophenylated bovine gamma-globulin. The volume, induration, mean diameter of the reaction and leukocyte (both PMN and MNC) emigration into local sites were suppressed, as was, to a lesser extent, vascular permeability. Based on these observations it appears that circulating PMN are required for the full expression of delayed hypersensitivity reaction engendered by bovine gamma-globulin.

Functions of human monocyte and lymphocyte subsets obtained by countercurrent centrifugal elutriation: differing functional capacities of human monocyte subsets

Two monocyte subsets from the peripheral blood of healthy humans were isolated by countercurrent centrifugal elutriation (CCE), and their functional heterogeneity was assessed. Cell volume of the smaller monocyte population was (332 +/- 32 mu 3), compared with the larger monocytes (380 +/- 30 mu 3). Superoxide release by large monocytes exposed to opsonized zymosan was 1.5-fold more active than those of small monocytes. Furthermore, the production of colony-stimulating factor (CSF) and myeloperoxidase activity by the larger monocytes was 2-fold and 1.4-fold greater than that of small monocytes, respectively. Thus, CCE provides a useful means to isolate 2 subsets of monocytes with similar functional properties but quantitatively different activities. This suggests that the 2 subsets may be closely related in their developmental spectrum.

Functions of human monocyte and lymphocyte subsets obtained by countercurrent centrifugal elutriation: differing functional capacities of human monocyte subsets

Two monocyte subsets from the peripheral blood of healthy humans were isolated by countercurrent centrifugal elutriation (CCE), and their functional heterogeneity was assessed. Cell volume of the smaller monocyte population was (332 +/- 32 mu 3), compared with the larger monocytes (380 +/- 30 mu 3). Superoxide release by large monocytes exposed to opsonized zymosan was 1.5-fold more active than those of small monocytes. Furthermore, the production of colony-stimulating factor (CSF) and myeloperoxidase activity by the larger monocytes was 2-fold and 1.4-fold greater than that of small monocytes, respectively. Thus, CCE provides a useful means to isolate 2 subsets of monocytes with similar functional properties but quantitatively different activities. This suggests that the 2 subsets may be closely related in their developmental spectrum.

Acceleration of lipid peroxidation in human paraquat poisoning

A 20-year-old man ingested approximately 15 to 20 mL of a 24% solution of paraquat. Acute renal and liver failure developed. The patient began undergoing hemodialysis and receiving vitamin E, but he died of pulmonary fibrosis the 27th day after the ingestion. During a two-week period of observation, evidence of lipid peroxidation in his serum was noted by determining malondialdehyde levels. Guinea pigs exposed to paraquat showed similar patterns of malondialdehyde presence in plasma. These results indicate that increased serum or plasma levels of lipid peroxide occurring in paraquat poisoning might reflect production of highly reactive oxygen free radicals and that, possibly, levels of lipid peroxides could serve as indicators of the efficacy of therapy directed toward scavenging free radicals.

Estimation of subject-specific normal ranges based on some statistical models of an individual's physiological variations

Three statistical models of the individual's physiological variations, proposed by Dr Eugene K. Harris, were applied to the long-term series of individual test results in our health control system. It was found from this study that, in most cases, the homeostatic model shows the best fit to the population level from comparing correlation coefficients between the observations and estimations made based on Harris's three models. It was also found that for most cases, the homeostatic model gives the most reliable estimates in individual's level from the comparison of the chi-square values between the observations and estimations made for the individual's successive test results. Further, for a group of members with hyperglycaemia, the proportion of individuals in whom the random-walk model produced the most accurate predictions was increased to the proportion in the normal group. In the age group under 39 years of age, the autoregressive model showed a relatively high degree of predictive success, while the homeostatic model showed a relatively low degree in comparison with the results found in other age groups. From these investigations, it was found that the physiologically normal state shows strict homeostatic stability.