Effect of equine ehrlichial colitis on the hemostatic system in ponies

Hemostatic function was determined in 10 ponies at various times after inoculation with Ehrlichia risticii to determine whether equine ehrlichial colitis (EEC) caused changes in the hemostatic system and to determine the prognostic value of hemostatic function tests during EEC. Mean platelet count; plasma fibrinogen, fibronectin, factor VIII: coagulant, alpha 2-antiplasmin, and plasminogen values; and serum concentrations of fibrin/fibrinogen degradation products changed significantly (P less than 0.05) from base line (day 0, before inoculation) during 18 days after inoculation with E risticii. Four ponies that died or were euthanatized because of severe clinical signs of EEC had significantly (P less than 0.05) greater mean plasma fibrinogen concentrations plasma factor VIII:coagulant values, and activated partial thromboplastin times immediately before death than did the 6 surviving ponies. Factor V concentrations were significantly (P less than 0.05) lower on postinoculation days 10 and 20 in nonsurvivors. Seemingly, changes in hemostasis took place during EEC. Ponies that did not survive EEC had greater laboratory evidence of coagulopathy.

Quantitative evaluation of tomographic 201-thallium myocardial scintigraphy

Myocardial 201Tl emission computed tomography was performed on 25 normal subjects and 27 patients with angiographically significant coronary artery disease. A semi-automatic computer program was designed to define the left ventricular myocardial volume in all short axis sections. Within this volume the relative mean myocardial pixel count was calculated. This parameter was found to separate the 2 patient groups with a sensitivity of at least 81% at a specificity of 100%.

Alpha-interferon in superficial bladder cancer: a Northern California Oncology Group Study

Thirty-five patients with superficial transitional carcinoma of the bladder were treated intravesically with escalating doses of recombinant alpha-2-interferon administered weekly for 8 weeks. Of the 19 patients with high-grade intraepithelial neoplasia (17 carcinoma in situ [CIS], two severe dysplasia, all cytology positive), six (32%) had complete resolution of all histologic and cytologic evidence of disease (complete response). An additional three patients (16%) had complete resolution of CIS, but the interval appearance of a low-grade transitional cell neoplasm. Five (26%) had a partial response (complete resolution of all evidence of CIS on multiple bladder biopsies but persistently positive cytologic preparations). Sixteen patients with recurrent papillary tumors and extensive prior therapy were also treated. Four (25%) had a complete response. Twenty-three of the 35 patients had prior intravesical therapy. Seven of the 23 (30%) patients with prior intravesical chemotherapy or immunotherapy had a complete or partial response to interferon, while eight of the 12 patients (67%) without prior intravesical treatment responded. These responses were achieved with minimal local and systemic toxicity. Of the ten complete responders, five remain in continuous unmaintained remission for 18+ to 37+ months. Intracavitary alpha-2-interferon is an effective new treatment for some patients with bladder cancer.

Computed tomography as the method of choice in the diagnosis of emphysematous cholecystitis

Computed tomographic (CT) findings in 4 cases of acute emphysematous cholecystitis are described. The use of CT in the diagnosis of this condition is discussed in relation to the use of sonography and plain radiography.

Psoas abscess demonstrated by CT as the first evidence of carcinoma of the colon

We report a case of right psoas abscess resulting from a carcinoma of the ascending colon. Abdominal CT examination suggested a preoperative diagnosis of neoplasm of the colon, which was confirmed on barium enema films and at surgical operation.

Vesicoureteral reflux and urinary tract infections in renal transplant recipients

Fifty-six children who received kidney transplants were evaluated for postoperative vesicoureteral reflux and frequency of urinary tract infection. Two methods of ureteral implantation were compared: a nonantireflux extravesicular ureteroneocystostomy and an antireflux intravesicular ureteroneocystostomy. Reflux was found in 79% of children who had the nonantireflux procedure vs 19% of children who had the antireflux procedure. This disparity was present regardless of sex and age. Infections occurred at a rate of one per 11 patient-months after the nonantireflux procedure vs one per 40 patient-months after the antireflux procedure. Regardless of surgical technique, the incidence of infection was higher in children with reflux. The potentially harmful effect of infection with reflux warrants concern. Because of the need to maximize allograft function for a longer time period, an antireflux procedure is recommended in all pediatric kidney transplants.

Characterization of two human cell lines (TK-10, TK-164) of renal cell cancer

Two previously unreported cell lines of human renal cell carcinoma are presented. TK-10 and TK-164 have each been in culture for over 4 years. The epithelial nature of both cell lines has been documented by light and electron microscopy. The cells in each line contain a Y chromosome, have specific marker chromosomes, and a distinct flow cytometric histogram. Both lines grow in agar, albeit not in athymic mice.

Normal pressure hydrocephalus in children and young adults

Normal pressure hydrocephalus (NPH) is generally considered to be a disorder of adult and geriatric patients. We report four patients who are children or young adults with chronic neurological disorders, recent deterioration of their levels of function, normal cerebrospinal fluid (CSF) pressures, and ventricular enlargement. All four patients improved after the placement or revision of a ventriculoperitoneal shunt. Frequent symptoms and signs included irritability (three patients), vomiting (three patients), and abnormal limb posturing (two patients). Correct diagnosis was hampered by two factors: (a) Multiple or prolonged recordings of CSF pressures were invariably well within the normal ranges with respect to age, and (b) the patients had chronic neurological deficits. After ventriculoperitoneal shunting, subjective and objective improvement was seen in all cases. Young patients with large ventricles may benefit from shunting procedures despite low CSF pressures. These patients may be clinically identified by symptoms of new neurological dysfunction in cases of previously static neurological disease or acceleration of slowly progressive neurological dysfunction. Some of these underlying neurological disorders may predispose children and young adults to NPH.

Randomized prospective trial of pure porcine and conventional bovine/porcine insulin

Use of pure porcine insulin versus partially purified insulin of bovine/porcine origin might be expected to have certain clinical benefits, e.g., a lower incidence of skin reactions, a lower insulin dosage, better diabetes regulation, and greater preservation of endogenous insulin secretion. To test this hypothesis, we randomly assigned 112 newly diagnosed, untreated, insulin-dependent diabetic children to therapy with either pure porcine or partially purified bovine/porcine insulin. They were followed for 1 yr, data being available on at least 90 subjects at each visit. More skin reactions were found in the group treated with the bovine/porcine insulin. This insulin was of higher antigenicity, and binding of radiolabeled insulin (mean +/- SE) by serum from bovine/porcine insulin treatment was 35.5 +/- 2.6 versus 16.8 +/- 1.4% (P less than .001) for pure porcine insulin treatment 12 mo after initiation of insulin therapy. However, throughout the 12 mo of observation the levels of glycosylated hemoglobin, insulin dosage, fasting plasma glucose, and C-peptide concentration were similar for the groups. Reported incidences of hypoglycemia and nocturia were also similar. Thus, insulin-antibody formation and skin reactions were minimized by the use of pure porcine versus partially purified bovine/porcine insulin, but no other clinical advantages were apparent.

Clinical features, survival rate, and prognostic factors in young adults with cystic fibrosis

The medical records of 142 patients with cystic fibrosis were reviewed. The patient group included 78 males and 64 females; three patients were black. Periods of observation ranged from two to 25 years (mean, 14.5 years). The analysis focused on clinical evaluation at age 18 years and included information gained at an earlier age. Evaluation at age 18 years was based on Shwachman and Kulczycki's (S-K) scoring system, Brasfield chest roentgenographic scoring system, pulmonary function measurements, height-adjusted weight percentile, sputum bacteriologic results, number of hospitalizations for treatment of pulmonary infections prior to the age of 18 years, time of onset of clubbing, and frequency of complications. There were no significant differences between the sexes in clinical features. Median survival from the time of diagnosis to the conclusion of the study period (1955 to 1984) was 22 years for females and 25 years for males (NS). Median length of survival beyond the age of 18 years was eight years for females and 12 years for males (NS). Stepwise logistic regression and Cox regression analysis applied to 11 variables identified the S-K clinical score at 18 years of age as the best predictor of survival to the age of 23 years. The median durations of survival after the age of 18 years for patients with clinical scores of 30 to 49, 50 to 64, and 65 to 75 at age 18 were five, seven and a half, and 12 years, respectively (p less than 0.0001). Low clinical score, low weight percentile, and Pseudomonas cepacia colonization of the lower respiratory tract at the age of 18 years indicated a poor prognosis. On the other hand, high clinical score, good weight percentile, and colonization with Staphylococcus aureus alone were likely to be found in patients with mild disease and an increased likelihood of long-term survival with preserved pancreatic function.

Improved enzyme-linked immunosorbent assay for determination of soy protein in meat products

An indirect, competitive enzyme-linked immunosorbent assay (ELISA) has been developed for quantitation of soy protein in meat products. The methodology allows rapid aqueous extraction of meat samples into a liquid form suitable for assay. The assay is highly specific for soy protein and is designed to measure soy protein levels between 1 and 10% of the wet weight of the sample. Standardized, stabilized reagents for carrying out the procedure are commercially available in a kit. The analysis, including sample preparation, can be completed within a workday, and the actual immunoassay in less than 60 min.

Mechanisms of displacement discrimination with and without perceived movement

A nearby visual reference point improves displacement discrimination. This effect occurs regardless of the delay between successive displays. The delay can be varied from short delays (50 ms), where observers report perceived movement, to long delays (2,000 ms), where observers report no movement. The similarity of reference effects for such different delay conditions was investigated by testing the independence of reference and delay effects. The critical independence property is whether the spatial variables (displacement and separation from the visual reference) combine independently of the temporal variable (delay). This kind of independence did not hold for displacement discrimination at delays of 50 ms and 2,000 ms. A further experiment tested for the independence property at delays of 500 ms and 4,000 ms, where observers reported no perceived movement. For these longer delays, the property was satisfied. These results are discussed using the general concept of a psychophysical mechanism. Such a mechanism combines the effects of several stimulus variables into a single mediating representation. By this analysis, at least two mechanisms must mediate the reference effect on displacement discrimination, one for delays of 200 ms and less and another for delays of 500 ms and more.

Continuous arteriovenous hemofiltration: improved survival in surgical acute renal failure?

Continuous arteriovenous hemofiltration (CAVH) is an effective method for renal failure management that has the potential to decrease mortality rates. This hypothesis has not been comparatively studied. Fifty six patients with acute oliguric renal failure complicating multiple organ failure had measurements of resting energy expenditure by indirect calorimetry, caloric and protein intake, energy balance, and outcome. Two management protocols included hemodialysis, full calories, and low protein (phase I) or CAVH, full calories, and high protein (phase II). The survival rate in phase I was 12% and 28% in phase II (not a statistically significant difference); CAVH did facilitate parenteral feeding. Patients with positive energy balance had improved survival compared with those with significant energy deficit (37.5% versus 9.4%, p less than 0.025). We conclude that full nutritional support improves survival in acute renal failure. The method of renal replacement therapy is of secondary importance, but CAVH has distinct advantages in the nutritional management of surgical patients.

Specific genomic markers for the HLA-DQ subregion discriminate between DR4+ insulin-dependent diabetes mellitus and DR4+ seropositive juvenile rheumatoid arthritis

HLA-DR4, Dw4-associated haplotypes associated with IDDM and JRA were compared using genomic DNA restriction fragment analysis to distinguish among DQ beta and alpha alleles linked to DR4. DQ beta polymorphisms that subdivide the HLA-DQw3 specificity into DQ3.1 and 3.2 alleles were identified. More than 90% of DR4+ IDDM patients express one of these alleles, DQ3.2; restriction enzyme mapping indicates that the presence of this allele also accounts for the genomic fragment patterns previously reported in IDDM. Furthermore, haplo-identical siblings of DQ3.2 IDDM patients also carry the DQ3.2 allele, regardless of clinical presentation. In contrast, DR4+ JRA patients show no allelic preference at DQ beta, implicating different HLA genetic contributions in these two DR4-associated diseases.

Diagnosis of equine monocytic ehrlichiosis (Potomac horse fever) by indirect immunofluorescence

The recent establishment of a system for the continuous in vitro propagation of Ehrlichia risticii, the causative agent of equine monocytic ehrlichiosis (EME; synonym, Potomac horse fever), has facilitated the development of an indirect fluorescent antibody test for the diagnosis of this disease under laboratory and field conditions. The field diagnostic application of the test has aided in the recognition of the disease in 16 states of the United States and in 1 province of Canada. A limited epidemiologic study conducted between January and September 1985, in an area where the disease is known to be enzootic, revealed that conversion from seronegative to seropositive status is not always accompanied by clinical manifestations of the disease. Confirmatory findings in experimentally inoculated horses suggest the existence of clinically undetectable infections.

Metabolism and bioconversion of chromene derivatives inAgeratina adenophora (Asteraceae)

Seedlings ofAgeratina adenophora accumulate the chromenes demethoxyencecalin, encecalin and demethylencecalin. More than 80% of the total chromenes within the seedling are confined to the leaves where they are stored within the mesophyll. Metabolism of the chromenes during development of the seedlings was subjected to analysis by high-performance liquid chromatography. The accumulation kinetics obtained, as well as feeding experiments with non-radioactive chromenes, showed the bioconversion of these compounds to proceed from demethoxyencecalin via hydroxylation yielding demethylencecalin, followed by methylation yielding encecalin. Inhibitor studies with glyphosate indicate that the chromenes arise from precursors derived from the shikimic-acid pathway.