[Relation between systolic and diastolic elastic muscle properties and the morphology of the hypertrophic pressure-loaded left ventricle]

According to Maxwell's model, left ventricular (LV) systolic elastic properties are characterized by a series-elastic element and LV diastolic properties by a parallel-elastic element. It is not known whether this functional concept is reflected by some morphological counterparts. In 12 patients with aortic stenosis (AS) before and 19 months after aortic valve replacement, and in ten controls, LV biplane volume and simultaneous high-fidelity pressure measurements were performed during diagnostic catheterization. The constant (k) of systolic myocardial stiffness was determined from LV peak wall stress, the maximum rate of systolic stress rise and instantaneous LV midwall circumferential fiber shortening rate at peak stress. The constant (k*; circ-1) of diastolic stiffness was assessed from the diastolic stress-stiffness relationship, using a viscoelastic model. In AS patients pre- and postoperative endomyocardial biopsies were taken to assess muscle fiber diameter, interstitial fibrosis and LV fibrous content. Systolic myocardial stiffness constant was 15 circ-1 in controls, 14 circ-1 in preoperative and 12 circ-1 in postoperative AS patients (P less than 0.01 vs. controls). Diastolic myocardial stiffness constant was 19 circ-1 in controls, 23 circ-1 in preoperative AS patients and increased slightly but not significantly to 33 circ-1 after valve replacement. Parallel to the postoperative decrease in systolic stiffness, muscle fiber diameter decreased significantly from 33 to 27 mu (P less than 0.05). The slight increase in diastolic stiffness was accompanied by a significant increase in interstitial fibrosis from 15% to 26% (P less than 0.05); LV fibrous content remained essentially unchanged after operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Ectopic expression of Thy-1 in the kidneys of transgenic mice induces functional and proliferative abnormalities

Hybrid human--mouse Thy-1.1 genes were injected into pronuclei of Thy-1.2 mice to produce transgenic animals. A hybrid gene composed of the 5' part of the mouse Thy-1.1 gene combined with the 3' human untranslated regions was expressed abnormally in the kidney podocytes, which resulted in severe protein-uria and subsequent death in several founder mice. A hybrid Thy-1 gene composed of the human coding region with the 5' and 3' flanking regions of the mouse gene was expressed abnormally in a different part of the kidney (the tubular epithelia), which resulted in a proliferative kidney disorder. In addition, a neoplasm was found in the brain of one of these mice. These results show that the Thy-1 protein can play an important role in the activation, proliferation, and differentiation of many different cell types.

The use of invasive techniques, angiography and indicator dilution, for quantification of valvular regurgitations

Angiographic techniques have been used for the quantification of mitral or aortic and rarely tricuspid regurgitation. Mitral or aortic regurgitant volume per beat and the regurgitation fraction (fao and fm, respectively) are obtained from the angiographic determination of total left ventricular stroke volume (TSV) and forward stroke volume (FSV) estimated by a different technique. Although this procedure is generally accepted as the gold standard for quantification of left heart regurgitations, there are several limitations: In the presence of mitral and aortic regurgitation no separate quantification of fao and fm is feasible; heart rate at the time of determination of FSV (from Fick or dye dilution cardiac output) and of TSV (angio) may be different; there is a tendency to consistently overestimate stroke volume by angio techniques; repeated estimations of TSV by angio are influenced by the circulatory effects of the contrast dye. In contrast indicator dilution techniques, where upstream and downstream sampling allow the simultaneous estimation of forward and regurgitant flow, the accuracy of the determination of FSV is well established and repeated estimations of fao and fm are possible because the indicators do not have cardiovascular effects. These methods are, however, crucially dependent on thorough mixing of the regurgitant volume with the blood in the upstream chamber. In 23 patients with isolated aortic regurgitation there was a positive correlation between fao evaluated by thermodilution and fao determined by the biplane angio-Fick method (r = 0.59). fao by thermodilution averaged 0.40 and fao by angio-Fick 0.46 (NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Is there coronary vasoconstriction after intracoronary beta-adrenergic blockade in patients with coronary artery disease

Vasomotility of normal and stenosed coronary arteries was studied at rest and during supine bicycle exercise in 10 patients with classical exercise-induced angina pectoris receiving 1 mg intracoronary propranolol before the exercise test (propranolol group). Normal and stenotic coronary lumen areas were determined from biplane coronary arteriograms using a computer-assisted system. Measurements were performed at rest, after 1 mg intracoronary propranolol, during supine exercise (89 W for 3.4 minutes) and 5 minutes after 1.6 mg sublingual nitroglycerin administered at the end of the exercise test. The results were compared with previously obtained data on the effect of dynamic exercise on coronary lumen area in 12 patients receiving no medication (control group) and in 6 patients receiving 0.1 mg intracoronary nitroglycerin before the exercise test (nitroglycerin group). In the control group, coronary stenosis area decreased during exercise to 71% of levels at rest (p less than 0.001) whereas normal coronary lumen area increased to 123% of control (p less than 0.01). In the propranolol group both normal (113%, p less than 0.05 versus rest) and stenotic coronary lumen area (122%, p less than 0.05 versus rest) increased during exercise. A similar increase in both normal and stenotic areas was observed during exercise after pretreatment with 0.1 mg intracoronary nitroglycerin (123%, p less than 0.01 and 114%, p = NS versus rest). Sublingual administration of 1.6 mg nitroglycerin at the end of exercise increased coronary stenosis area to 145% (p less than 0.01 versus rest) in the propranolol group and to 115% in the control group (p = NS versus rest). It is concluded that intracoronary administration of propranolol does not potentiate coronary vasoconstriction of the epicardial vessels at rest and during exercise. In contrast, intracoronary propranolol prevents exercise-induced stenosis narrowing either because of reduced myocardial oxygen demand with a lower coronary blood flow resulting in a smaller transstenotic pressure gradient and, thus, a smaller flow-induced fall in stenosis distending pressure; or because of "local" beta-receptor blockade with unopposed distal arteriolar alpha-receptor tone, resulting in a higher poststenotic pressure and, thus, in a greater stenosis distending pressure; or because of a local anesthetic effect of propranolol with a decrease in calcium influx to the coronary smooth musculature.

Trocar introduction performed during laparoscopy of the obese patient

Obesity, especially morbid obesity, is reported to be a relative contraindication to laparoscopy. A technique for trocar introduction and laparoscopy of the obese patient to eliminate this contraindication is described. The technique presented herein differs from the traditional method by: 1, primary trocar entry at a 90 degree angle to the horizontal plane, and 2, confirmation for intraperitoneal position of the instruments before creating the pneumoperitoneum. A retrospective study was done to compare demographic, medical and surgical data of obese and non-obese patients. No important differences were found and it was also found that obesity was not a relative contraindication to laparoscopy. Obesity was defined by a ponderal index of less than 11.7. No operative complications were found for the 344 obese patients studied and all laparoscopy procedures were completed as intended. These differences in technique can avoid the pitfalls commonly reported concerning laparoscopy of the obese patient.

Pain relief after arthroscopy: naproxen sodium compared to propoxyphene napsylate with acetaminophen

We compared naproxen sodium (550 mg) and propoxyphene napsylate with acetaminophen (PN/A, 100 mg with 650 mg) for pain relief after arthroscopy or arthroscopic meniscectomy. Fifty-two patients entered this multicenter, double-blind, randomized, parallel trial. In each drug group, pain intensity values dropped consistently throughout this six-hour study from mean baseline levels of approximately 55 on a scale of 0 to 100. Pain intensity values were lower at each hour in the naproxen sodium than in the PN/A group and significantly lower at hour 1 (P = .008). Pain intensity differences (PID, reflecting change from baseline) mirrored this trend: greater mean PIDs were seen in the naproxen sodium group at each hour, and this difference between drug groups was statistically significant at hour 1 (P = .017). One patient in the naproxen sodium group and seven patients using PN/A took a second dose within the six hours. Patients in each drug group reported five complaints.

Differential regulation of a Thy-1 gene in transgenic mice

We have generated Thy-1.1-transgenic Thy-1.2 mice to study the developmental expression of the Thy-1 gene in detail by transcriptional and immunological methods. In brain, the expression of the injected gene was identical to that of the endogenous gene in a tissue- and development-specific manner. In lymphoid tissue, the transferred gene was also expressed correctly in the early phases of T-cell lineage development; however, as the T cells matured, the transcription of the transferred gene, but not the endogenous gene, was suppressed. This result shows that different regulatory elements are used to express the Thy-1 gene in early and late lymphoid development.

Vasoconstriction of stenotic coronary arteries during dynamic exercise in patients with classic angina pectoris: reversibility by nitroglycerin

To study the vasomotility of normal and diseased coronary arteries during dynamic exercise, symptom-limited supine bicycle exercise during cardiac catheterization was performed by 18 patients with classic angina pectoris. The cardiovascular response was assessed by hemodynamic measurements and computer-assisted determination of normal and stenotic coronary artery luminal areas from biplane coronary angiograms made before, during, and after exercise. After baseline measurements were recorded, 12 patients (group 1) performed bicycle exercise for 3.4 min (mean), reaching a maximum workload of 81 W (mean); at the end of exercise they received 1.6 mg sublingual nitroglycerin. After measurements at rest in six other patients (group 2), 0.1 mg intracoronary nitroglycerin was given, followed by exercise (3.8 min, 96 W; NS) and sublingual nitroglycerin as in group 1. During exercise in group 1, luminal area of the coronary stenosis decreased to 71% of resting levels (p less than .001), while area of the normal coronary artery increased to 123% of control (p less than .001). After sublingual nitroglycerin at the end of exercise, area of the normal vessel further increased to 140% of control (p less than .001), while luminal area of the stenosis dilated to 112% of resting levels (p less than .001 vs exercise, NS vs rest). Pretreatment with intracoronary nitroglycerin increased both normal (121%; p less than .05) and stenotic (122%; p less than .05) luminal areas, while preventing the previously observed narrowing of stenosis during exercise (114%; NS). Exercise resulted in a similar heart rate-systolic pressure product and caused angina pectoris in two-thirds of the patients in each group. However, patients pretreated with intracoronary nitroglycerin (group 2) had a lower mean pulmonary arterial pressure during maximum exercise (35 mm Hg) than those patients (group 1) not receiving pretreatment (47 mm Hg; p less than .001). Group 2 patients reached a percentage of their predicted work capacity (65%) that was about the same as that during previous upright bicycle exercise (71%; NS), while group 1 patients had a significantly lower work capacity (51% of predicted) than that before catheterization (82%; p less than .001). Hence, narrowing of coronary artery stenosis during dynamic exercise is attributable to active vasoconstriction due to its reversibility by preexercise intracoronary nitroglycerin. Patients who did not experience narrowing of stenosis during exercise (group 2) had less evidence of myocardial ischemia (lower mean pulmonary arterial pressure) and maintained their work capacity.(ABSTRACT TRUNCATED AT 400 WORDS)

Myasthenia gravis: immunohistological heterogeneity in microenvironmental organization of hyperplastic and neoplastic thymuses suggesting different mechanisms of tolerance breakdown

Four samples of thymoma obtained from patients affected by myasthenia gravis have been immunohistologically analysed on cryostat sections using a panel of antisera and monoclonal antibodies specific for antigens which define different stages of intrathymic lymphocyte differentiation and antigens specific for different types of thymic epithelial cells (cortical, medullary). When the thymoma samples were compared to age-matched normal thymuses and hyperplastic thymuses obtained from patients with myasthenia gravis some evident microenvironmental differences could be demonstrated using these reagents. In all the thymoma samples in fact the neoplastic lobules appeared as grossly enlarged cortical-type areas, formed by accumulations of T lymphocytes exhibiting the cortical immature phenotype (TdT+, T6+, etc.) within a network of putatively neoplastic epithelial cells characterized by cortical phenotype as defined by reactivity with various monoclonal antibodies (RFD4-, MR3+). These 'cortical' epithelia showed some abnormal features such as lack or irregular distribution of HLA-DR and enhanced keratin expression. Small areas of 'medullary' differentiation could be observed in 3/4 thymoma samples. In thymic hyperplasia, on the other hand, the cortical areas appeared somewhat compressed (but comparable to those observed in normal age-matched samples) by enlarged medullary areas. The expansion of medullary areas was due to the infiltration of 'peripheral' lymphoid tissue intruding through the extraparenchymal zone and forming organized B and T areas. These observations are discussed in the light of the clinical heterogeneity observed in myasthenia gravis.

Cefotetan in the treatment of obstetric and gynecologic infections

The efficacy, tolerance, and safety of cefotetan--a new 7-alpha-methoxy cephalosporin--was assessed in controlled and uncontrolled evaluations involving 131 evaluable patients hospitalized with obstetric and gynecologic infections. The 99% satisfactory clinical response rate obtained with this drug was equivalent to that obtained with either moxalactam or cefoxitin, yet the mean amount of cefotetan given was lower than that of the other two drugs. Cefotetan was well tolerated and produced no major adverse reactions. In this era of Diagnosis Related Groups and cost containment, the twice-daily dosage schedule of cefotetan is a decided cost benefit.

[The stunned myocardium: ischemia-induced reversible myocardial dysfunction]

The "stunned" myocardium is the result of an ischemic insult which is not of sufficient severity to produce myocardial necrosis but affects myocardial function, biochemical processes and ultrastructure for a prolonged period of time. A "stunned" myocardium can be expected when preoperative asynergic wall motion is normalized after successful coronary bypass surgery under similar loading conditions. Forty-five patients (mean age 51 years) underwent diagnostic cardiac catheterization before and 9.5 months after successful bypass surgery. Patients with perioperative myocardial infarction and/or occluded vein grafts were excluded from the study. Preoperatively 17 of the 45 patients had a reduced systolic ejection fraction. These patients were further divided into the following two groups: group 1 consisted of 6 patients without or with only a small increase in regional ejection fraction (6 regions of the left ventricle in the right anterior oblique projection) after surgery (control group), and group 2 of 11 patients with a postoperative increase in preoperatively reduced regional ejection fraction (preoperatively "stunned" myocardium). In regard to duration of symptoms, functional classification (NYHA), number of myocardial infarctions, unstable angina pectoris and physical working capacity on the bicycle ergometer, there were no significant differences between the two groups. A mean 2.8 and 3.6 vein grafts (ns) were implanted in groups 1 and 2, respectively. Postoperatively, NYHA class decreased significantly and physical working capacity increased in both groups. Left ventricular end-diastolic and peak systolic pressure remained unchanged after surgery; left ventricular ejection fraction was unchanged in group 1 (49 vs. 51%, ns) but increased significantly in group 2 (38 vs. 50%, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Regulation of T-cell receptor gene expression in human T-cell development

A cDNA clone encoding the alpha chain of the human T-cell antigen receptor was isolated by screening a library from the human T-cell line Jurkat with a mouse alpha-chain cDNA clone. This human alpha-chain clone, together with a human antigen receptor beta-chain cDNA clone, was used to determine the stage of T-cell development at which antigen receptor mRNAs first appear. Blot-hybridization analysis of mRNA isolated from a panel of human thymic tumor lines clearly demonstrated that beta-chain transcripts could be detected in all T-lineage cells. However, alpha-chain transcripts were only found in the most phenotypically mature lines, which express the antigen receptor-associated molecule T3. Furthermore, beta-chain transcripts were abundant in RNA prepared from purified T3-negative thymocytes, whereas alpha-chain transcripts were virtually absent. From these results we conclude that alpha-chain expression occurs later in thymic ontogeny than that of the beta chain and propose that it controls surface expression of the antigen receptor-T3 complex.

The effect of methotrexate pretreatment on 5-fluorouracil kinetics in sarcoma 180 in vivo

Synergy of sequential MTX and 5-FU has been shown in several in vitro and in vivo systems. In the present study the influence of time interval between MTX and 5-FU and MTX dose on 5-FU accumulation in tumor cells has been examined in Sarcoma 180 in vivo. There was a clear relationship between MTX dose applied and amount of 5-FU detected in the acid-soluble fraction, the RNA fraction and the thymidylate synthase complex fraction. Also, the MTX-5-FU time interval affected clearly the amount of 5-FU detected in all three fractions, the optimum time interval being 8-12 hr. The results indicate that for sequential application of MTX and 5-FU selection of an adequate MTX dose and a sufficient time interval is crucial to achieve synergistic action.

Diastolic function in aortic valve disease: techniques of evaluation and pre-/postoperative changes

Passive diastolic properties of the left ventricle are determined by several factors intrinsic or extrinsic to the ventricle. In patients with myocardial hypertrophy due to longstanding pressure or volume overload increased muscle mass and structural alterations of the myocardium are responsible for changes in passive elastic properties. Evaluation of diastolic function includes determination of ventricular (= chamber) and myocardial (= muscle) stiffness from simultaneous pressure-volume and stress-strain relations during passive diastolic filling. The slope of the pressure-volume relationship is equal to the constant of chamber stiffness and the slope of the stress-strain relationship equal to the constant of myocardial stiffness. Passive diastolic properties were determined in ten control patients and 21 patients with aortic valve disease before and 17.5 months after successful valve replacement. Ten patients presented with severe aortic stenosis, five patients with combined valve lesions and six patients with severe aortic insufficiency. Simultaneous high-fidelity pressure measurements and M-mode echocardiography were carried out in all patients. Myocardial stiffness was calculated from a viscoelastic stress-strain relationship using a nonlinear curve-fit program. Standard hemodynamic measurements showed a significant decrease in pressure and volume overload after successful valve replacement. Left ventricular muscle mass index decreased in all three groups significantly after surgery, whereas systolic ejection fraction remained unchanged pre-/postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Pulsus alternans: its influence on systolic and diastolic function in aortic valve disease

Left ventricular high fidelity pressure measurements and simultaneous biplane cineangiocardiography were performed in 12 patients with severe aortic valve disease (aortic stenosis in 10, aortic insufficiency in 1 and combined valve lesion in 1). Left ventricular contractility was estimated from maximal rate of left ventricular pressure rise (max dP/dt), peak measured velocity of contractile element shortening (Vpm) and mean circumferential fiber shortening velocity. Left ventricular relaxation was assessed in 12 patients from the time constant (T) of the decline in left ventricular pressure; this constant was calculated from a nonlinear regression analysis of pressure and time (method 1) and a linear regression analysis of pressure and negative dP/dt (method 2). Left ventricular diastolic function was evaluated in nine patients from simultaneous diastolic pressure-volume relations during the strong and weak beats. During pulsus alternans, heart rate and left ventricular end-diastolic pressure remained unchanged, whereas peak systolic pressure (220 versus 204 mm Hg, p less than 0.01) and end-systolic pressure (101 versus 95 mm Hg, p less than 0.01) were significantly higher during the strong beat than during the weak beat. Max dP/dt was alternating (2,162 versus 1,964 mm Hg, p less than 0.05), whereas the peak velocity of contractile element shortening remained unchanged (1.21 versus 1.18 ML/s). Systolic shortening of the left ventricular minor axis was significantly (p less than 0.02) greater during the strong (24%) than during the weak (19%) beat, but that of the left ventricular major axis remained essentially unchanged (8 versus 7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Diastolic stiffness and myocardial structure in aortic valve disease before and after valve replacement

Passive diastolic properties were determined in 10 control patients and 21 patients with aortic valve disease before and 17.5 months after successful valve replacement. Ten patients had severe aortic stenoses (AS), five had combined aortic valve lesions (AS + aortic insufficiency [AI]), and six patients had severe AI. Left ventricular endomyocardial biopsies were obtained before and after surgery in patients with AS, AS + AI, and AI. Simultaneous echocardiographic and high-fidelity pressure measurements were made in all patients, and left ventricular chamber stiffness was calculated from a viscoelastic pressure-circumference relationship and left ventricular myocardial stiffness from a viscoelastic stress-strain relationship. The constant of chamber stiffness, beta', was slightly although not significantly increased in patients with AS (0.27 before and 0.24 after surgery), but was normal in those with AS + AI (0.22 before and 0.17 after surgery) and slightly decreased in those with AI (0.18 before and 0.16 after surgery) when compared with in control subjects (0.21). The constant of myocardial stiffness beta was normal in patients with AS (13.2), AS + AI (11.5), and AI (11.7) before surgery compared with in the control group (12.5). beta increased, however, significantly in those with AS (25.2; p less than .02), but not in those with AS + AI (16.3; NS) and AI (12.8; NS) after surgery. Myocardial morphologic characteristics showed a significant decrease in muscle fiber diameter in patients with AS, AS + AI, and AI, as well as a significant increase in interstitial fibrosis from 15% to 26% (p less than .05) in those with AS and a slight increase from 15% to 22% (NS) in those with AS + AI and from 19% to 24% (NS) in those with AI. Left ventricular fibrous content (left ventricular muscle mass index multiplied by interstitial fibrosis) remained, however, unchanged in all three groups after aortic valve replacement. In conclusion, left ventricular chamber stiffness is increased in AS but decreased in AI, whereas LV myocardial stiffness is normal in patients with aortic valve disease before surgery. After surgery, left ventricular myocardial stiffness increased significantly in AS patients but remained unchanged in those with AI. Postoperative changes in myocardial structure were characterized by a decrease in muscle fiber diameter and a relative increase in interstitial fibrosis, whereas fibrous content remained unchanged. Thus, regression of myocardial hypertrophy in aortic valve disease is accompanied by an increase of myocardial stiffness in concentric hypertrophy that is not seen in eccentric hypertrophy.

Effect of sample dilution on measurements of free (unbound) hormones

We describe the influence of sample dilution on the measurement of free or non-protein-bound hormones in serum or plasma. The concentration of free hormone in the sample will alter after dilution or addition of binding reagents. The extent of this equilibrium perturbation depends on the binding properties of the endogenous carrier proteins, which vary from sample to sample and from sample to reference standard. As examples, we demonstrate the different changes in concentrations of free thyroxin and free cortisol after dilution, both experimentally and by theoretical modeling of the hormone-protein distribution. We also show how this systematic error can be minimized in the design of free hormone assays.

Effect of sample dilution on measurements of free (unbound) hormones

We describe the influence of sample dilution on the measurement of free or non-protein-bound hormones in serum or plasma. The concentration of free hormone in the sample will alter after dilution or addition of binding reagents. The extent of this equilibrium perturbation depends on the binding properties of the endogenous carrier proteins, which vary from sample to sample and from sample to reference standard. As examples, we demonstrate the different changes in concentrations of free thyroxin and free cortisol after dilution, both experimentally and by theoretical modeling of the hormone-protein distribution. We also show how this systematic error can be minimized in the design of free hormone assays.

Effects of the tetracyclic antidepressant pirlindole on sensorimotor performance and subjective condition in comparison to imipramine and during interaction of ethanol

Two experiments were designed to investigate the side-effects on motor performance of the new tetracyclic antidepressant, pirlindole, in healthy volunteers. First, pirlindole was compared with imipramine and placebo. In the second study the interaction of pirlindole with a small amount of ethanol (0.4 g 17 vol%/kg) was analysed. Ratings of subjective feelings and measurements of sensorimotor performance (simple and choice reaction, tracking) of the pirlindole-treated group did not differ from those of the placebo group, whereas imipramine caused a change of the subjective condition to more lethargy and a greater delay of the simple reaction time. The effects of pirlindole proved to be unaffected by ethanol.

Radioimmunoassay of urinary cortisol: comparison of the procedures with and without previous cortisol extraction

Although only less than 1% of the daily secreted cortisol is excreted unchanged into urine, the determination of urinary cortisol has proved to be a valuable parameter in evaluation of adrenocortical function. We compared the procedures of cortisol determination by radioimmunoassay after extraction and without extraction direct in crude urine. Direct determination needs less tracer and antibody and is less laborious. Intra- and interassay variance is 4.5%, 16.0% in the extraction method and 2.7%, 8.2% in the direct method, respectively. Comparison of both methods is acceptable (r = 0.92), recovery and dilution studies prove the direct method to be correct. Despite a lowered specificity, which gives higher results (factor 1.7) compared to the extraction method, the direct method is entirely sufficient for routine laboratory purposes. It can be achieved without additional equipment by laboratories, which determine total cortisol concentration in plasma.

Anthracene-9-carboxylic acid inhibits renal chloride reabsorption

From previous studies, it is known that in the diluting segment, C1- -ions are transported from the tubule lumen into the cell together with Na+ and K+ via a furosemide-sensitive cotransport system. This carrier-mediated process, located in the luminal cell membrane, is driven by the steep "downhill" Na+ gradient (directed from lumen to cell) which is maintained by the ouabain-sensitive Na+/K+-pump at the peritubular cell membrane. C1- -ions are accumulated within the cell cytosol and are supposed to leave the cell by a C1- -conductive pathway. The present experiments, performed in diluting segments of the isolated perfused frog kidney, demonstrate the existence of a significant C1- -permeability of the peritubular cell membrane and its complete inhibition by anthracene-9-COOH. The data indicate that C1- -reabsorption can be reduced not only by the inhibition of luminal C1- -entry (i.e. by furosemide) but also by the blockade of the passive C1- -exit step across the peritubular cell membrane. Since complete inhibition of C1- -permeability reduces transepithelial uphill C1- -transport only to half, the data disclose the existence of an additional C1- -pathway at the peritubular cell membrane.

On the validity of free hormone measurements

The influence of equilibrium perturbation on the measurement of free or non-protein-bound hormones in serum or plasma is described. The free analyte concentration in the sample will alter after dilution or addition of binding reagents. The extent of this perturbation is not constant. It depends on the binding properties of the endogenous carrier proteins which vary from sample to sample and from sample to reference standard. As examples, the different changes of the free thyroxine and free cortisol concentrations after dilution are demonstrated both experimentally and by theoretical modeling of the hormone-protein distribution. It is shown how this systematical error can be minimized in the design of free hormone assays.

46,XX/46,XY chimerism in a phenotypically normal man

Some twenty cases of dispermic chimeras with the karyotype 46,XX/46,XY, discovered because of gonadal dysplasias or a true hermaphroditism, have been reported. This is a report of a phenotypically normal man with 46,XX/46,XY chimerism in whom a prepubertal finding of positive X-chromatin was interpreted as Klinefelter syndrome. The diagnosis was revised 11 years later when the family doctor, who doubted the earlier diagnosis because of the patient's normal-sized testes, sent him to an outpatient clinic. The young man was 23 years old, athletic (74kg, 180cm), with normal body proportions, normal sexual hair distribution, normal libido and potency, normal endocrine parameters, and a normal spermiogram. The karyotype revealed an XX/XY mosaic in a proportion of 1:2. An identical set of maternal markers (Q- and C-banding) was present in male and female cells. Differences were found with respect to two paternal markers. Furthermore, blood, serum, and red cell enzyme groups in five systems showed two phenotypes, again with duality of paternal origin. It is concluded that a positive X-chromatin in prepuperty, especially in the absence of supporting clinical features, must be followed by a karyotype study.