Identification of carcinoma cells in ascitic and pleural fluid. Comparison of four panepithelial antigens with carcinoembryonic antigen

The cell membrane antigens epithelial membrane antigen (EMA), epithelial glycoprotein 34, (egp34), BW-495 and tumor-associated antigen 72 (TAG-72) are present in most benign and malignant epithelial cells and can be demonstrated with the help of monoclonal antibodies. In a study on the identification of carcinoma cells in samples of ascitic and pleural fluid involving 170 patients, we compared the value of immunocytochemical labeling of these antigens with that of immunocytochemical demonstration of carcinoembryonic antigen (CEA). Antibodies to EMA and egp34 occasionally also reacted with reactively proliferating mesothelial cells in benign conditions and thus appear to be inappropriate for diagnostic use. Cells positive for BW-495, TAG-72 and CEA, however, have never been found in benign conditions; the specificity of these antigens thus permits their use in diagnosis. Antigen-expressing cells were found in 85% (BW-495), 62% (TAG-72) and 60% (CEA) of cytologically positive samples from carcinoma patients. Similarly, positive reactions for BW-495, TAG-72 and CEA were observed in, respectively, 36%, 29% and 34% of cytologically negative or suspicious samples. BW-495 thus appears to be a suitable marker for the demonstration of carcinoma cells in samples of pleural and ascitic fluid and to have a higher degree of sensitivity than does either TAG-72 or CEA.

The risks of blood transfusion: the relative influence of acquired immunodeficiency syndrome and non-A, non-B hepatitis

PURPOSE

The acquired immunodeficiency syndrome epidemic has greatly increased concern about the risk of blood transfusion. Many transfusions are now autologous, and when these are not available, both physicians and patients are more likely to question the advisability of transfusion. We evaluate the risk of preoperative blood transfusion and the contribution of human immunodeficiency virus (HIV) infection to that risk.

METHODS

We used decision analysis to characterize the risk associated with HIV infection in days of life lost. The contributions to risk of acute transfusion reaction, hepatitis B, and non-A, non-B hepatitis are also estimated. Sensitivity analyses show the implications for transfusion risk of recent information about HIV infection in the blood supply and a new test for hepatitis C.

RESULTS

The analysis shows that the contribution of HIV infection to the risk of death from transfusion, expressed in days of life expectancy lost, has become extremely small over the last several years. Currently, HIV infection accounts for less than 1% of the risk of death, while non-A, non-B hepatitis accounts for 97% to 98%. Further reductions in the risk of HIV infection, even to zero, will make relatively little difference in the safety of transfusion. The analysis also shows that the remaining risk from transfusion should decrease sharply, by more than two thirds, with the adoption of the test for hepatitis C.

CONCLUSIONS

Efforts to improve the safety of blood should focus on reducing the risk of non-A, non-B hepatitis. The remaining risk of HIV infection is very small.

[Music therapy single case process research--development and organization of a research field]

Music therapy yet to be discovered as a target of psychotherapy research. A first step consists in creating adequate samples of significant musical dialogues. Video-recording is an essential requirement for establishing such data. To test the clinical view that the emotional content of the musical dialogue in music therapy reflects the basic relationship issues of a patient was the objective of this study. By using ratings of significant musical dialogue sequences with the instrument of semantic differential comparing groups with varying clinical expertise (music therapists, psychoanalyts, lay persons) the results demonstrate that there is considerable stability of the judgments; however, systematic differences exists among the three groups of raters.

Interstitial chemotherapy of experimental gliomas

Two new approaches of interstitial (intratumoral) chemotherapy of gliomas are presented. Using s.c.-transplanted rat gliomas (G616) the therapeutic activity of biologically degradable polylactide rods as carriers for methotrexate was investigated. Carrier-mediated intratumoral chemotherapy was superior both to a systemic treatment and an intratumoral treatment with the free drug. The activity of the alkyllysophospholipids Et-18-OCH3 and BM 41.440 and of the alkylphosphocholine He-PC was investigated in a human glioma xenograft (T 406). All three compounds were highly active following intratumoral administration.

Circadian rhythms in the body temperatures of intensive care patients with brain lesions

The body core temperatures of 31 patients suffering from severe cerebral lesions were measured. Evidence for the existence or nonexistence of circadian rhythms in these patients was found to be associated with diagnosis (acute versus chronic lesions), with the level of consciousness, and with neurological findings (such as best motor response and pupillary reaction), but not with heart rate, corneal reflex, initial Glasgow coma score (GCS), or outcome. This evidence came to light only after multiphasic mathematical transformations of the raw data.

A single origin of phenylketonuria in Yemenite Jews

Phenylketonuria (PKU) is a metabolic disease caused by recessive mutations of the gene encoding the hepatic enzyme phenylalanine hydroxylase (PAH). The incidence of PKU varies widely across different geographic areas, and is highest (about 1 in 5,000 live births) in Ireland and western Scotland, and among Yemenite Jews. A limited number of point mutations account for most of the PKU cases in the European population. Here we report that a single molecular defect--a deletion spanning the third exon of the PAH gene--is responsible for all the PKU cases among the Yemenite Jews. Examination of a random sample of Yemenite Jews using a molecular probe that detects the carriers of this deletion indicated a high frequency of the defective gene in this community. Although the deleted PAH gene was traced to 25 different locations throughout Yemen, family histories and official documents of the Yemenite Jewish community showed that the common ancestor of all the carriers of this genetic defect lived in San'a, the capital of Yemen, before the eighteenth century.

Endoscopic evaluation of exercise-induced pulmonary hemorrhage and chronic obstructive pulmonary disease in association with poor performance in racing Standardbreds

Endoscopic examinations were performed on 965 Standardbred racehorses competing at Yonkers Raceway between June 16 and Aug 3, 1988, to demonstrate an association between exercise-induced pulmonary hemorrhage or chronic obstructive pulmonary disease and poor racing performance. Findings suggested that both exercise-induced pulmonary hemorrhage and chronic obstructive pulmonary disease adversely affect performance, whereas a combination of the 2 conditions more severely affects racing performance than do either of the conditions individually.

Protection of rhesus monkeys from fatal Lassa fever by vaccination with a recombinant vaccinia virus containing the Lassa virus glycoprotein gene

Lassa fever is an acute febrile disease of West Africa, where there are as many as 300,000 infections a year and an estimated 3000 deaths. As control of the rodent host is impracticable at present, the best immediate prospect is vaccination. We tested as potential vaccines in rhesus monkeys a closely related virus, Mopeia virus (two monkeys), and a recombinant vaccinia virus containing the Lassa virus glycoprotein gene, V-LSGPC (four monkeys). Two monkeys vaccinated with the New York Board of Health strain of vaccinia virus as controls died after challenge with Lassa virus. The two monkeys vaccinated with Mopeia virus developed antibodies measurable by radioimmunoprecipitation prior to challenge, and they survived challenge by Lassa virus with minimal physical or physiologic disturbances. However, both showed a transient, low-titer Lassa viremia. Two of the four animals vaccinated with V-LSGPC had antibodies to both Lassa glycoproteins, as determined by radioimmunoprecipitation. All four animals survived a challenge of Lassa virus but experienced a transient febrile illness and moderate physiologic changes following challenge. Virus was recoverable from each of these animals, but at low titer and only during a brief period, as observed for the Mopeia-protected animals. We conclude that V-LSGPC can protect rhesus monkeys against death from Lassa fever.

Altered expression of beta-globin, transferrin receptor, and ornithine decarboxylase in Friend murine erythroleukemia cells inhibited by alpha-difluoromethylornithine

alpha-Difluoromethylornithine (DFMO) is an irreversible inhibitor of ornithine decarboxylase (ODC) and restricts the proliferation and differentiation of Friend murine erythroleukemia cells. We have studied the effect of this compound on the expression of ODC, transferrin receptor (TFR), and beta-globin during normal cellular proliferation and dimethylsulfoxide-induced terminal differentiation. Elevated RNA levels for ODC were observed during both normal Friend murine erythroleukemia cell division and replication associated with terminal differentiation, but these transcripts decreased as the cells ceased proliferating. However, in the presence of DFMO the levels of ODC remained elevated even when the cells had stopped dividing; this appears to be a feedback mechanism to overcome the effects of the inhibitor. TFR expression paralleled regular cell division and was curtailed when replication was reduced by DFMO. However, the inhibitor was unable to prevent the differentiation associated maintenance of TFR levels, well after proliferation terminated. While DFMO was able to restrict differentiation and hemoglobin synthesis, it did not inhibit the dimethylsulfoxide-induced expression of beta-globin RNA. We concluded that the block in differentiation caused by DFMO occurs along some pathway(s) other than the activation of beta-globin or TFR.

Vesicoureteral reflux in asymptomatic siblings of patients with known reflux: radionuclide cystography

The familial nature of vesicoureteral reflux among siblings of patients with vesicoureteral reflux has been reported to be from 8% to 32%. These included both symptomatic and asymptomatic siblings. The incidence of vesicoureteral reflux in asymptomatic siblings, however, has not been studied extensively. Sixty asymptomatic siblings of patients known to have vesicoureteral reflux were studied with radionuclide voiding cystography. Their ages ranged from 2 months to 15 years (mean, 4.2 years). Vesicoureteral reflux was detected in 27 of 60 (45%) of the siblings. Vesicoureteral reflux was unilateral in 15 and bilateral in 12 of the siblings. Radionuclide cystography is more sensitive than radiographic cystography and results in a very low radiation dose to the patient. The gonadal dose with radionuclide cystography is only 1.0 to 2.0 mrads. Because of these features, radionuclide cystography is a nearly ideal technique for the diagnosis of vesicoureteral reflux in siblings of patients with known vesicoureteral reflux. All siblings (symptomatic or asymptomatic) of patients with known vesicoureteral reflux should have a screening radionuclide cystography.

Activity of phagocytic granulocytes in patients with prostatic cancer

Chemilumenescence (CL) occurs due to the phagocytosis of bacteria and of tumor cells by polymorphonuclear neutrophils (PMN). Levels of CL were measured in patients with prostatic cancer and from normal subjects. Patients with advanced disease (stage C, D) showed no elevated CL levels as compared to healthy individuals or patients with minimal disease (stage A, B). Following external radiation therapy in patients with stage A-C prostatic carcinoma high levels of CL were recorded. Estrogen medication also resulted in increased CL levels, while estramustine did not affect phagocytic activity. Intradermal BCG vaccination caused increased PMN activity. Progressive prostatic cancer in hormone treated patients was associated with increased CL as compared to patients with stable or regressive disease.

Diltiazem inhibits transferrin receptor expression and causes G1 arrest in normal and neoplastic T cells

Transferrin receptor expression is essential for the proliferation of both normal and malignant T cells. While transferrin receptor expression in normal T cells is tightly coupled to interleukin-2 receptor expression, transferrin receptor expression in malignant cells is usually constitutive and is released from this constraint. Temporally, the appearance of these membrane receptors is preceded by changes in the expression of the proto-oncogenes c-myc and c-myb. In addition, although an increase in the level of intracellular free calcium occurs early in the sequence of T-cell activation, the activation events dependent on this calcium flux have not been resolved. In the present study we report that diltiazem, an ion channel-blocking agent that inhibits calcium influx, arrested the growth in vitro of both normal and malignant human T cells in the G1 phase of the cell cycle. However, diltiazem did not inhibit the expression of c-myc or interleukin-2 receptor mRNA and protein in normal mitogen-activated T cells or the constitutive expression of c-myc and c-myb mRNA in malignant T cells (T acute lymphoblastic leukemia cells). In contrast, diltiazem prevented the induction of transferrin receptor (mRNA and protein) in normal T cells and caused a progressive loss of transferrin receptor (mRNA and protein) in malignant T cells. These data demonstrate that diltiazem can dissociate several growth-related processes normally occurring in G1 and thereby disrupt the biochemical cascade leading to cell proliferation.

Demonstration of cGMP-dependent protein kinase and cGMP-dependent phosphorylation in cell-free extracts of platelets

Homogenates, membranes and cytosol of rat and human platelets were found to contain cGMP-dependent protein kinase immunoreactivity. Specific cGMP-dependent protein kinase immunoreactivity was about 1.7 pmol protein kinase/mg protein for homogenates of human platelets and 0.7 pmol/mg for homogenates of rat platelets; the majority appeared to be associated with the membrane fraction. In membranes of platelets low concentrations of cAMP (0.5-2 microM) stimulated the phosphorylation of five major proteins with apparent relative molecular masses, Mr, of 240 000, 130 000, 50 000, 42 000 and 22 000 while low concentrations of cGMP (0.5-2 microM) stimulated the phosphorylation of three major proteins with apparent Mr of 130 000, 50 000 and 46 000. An affinity-purified antibody against the cGMP-dependent protein kinase was prepared which specifically inhibited the activity of cGMP-dependent protein kinase. In membranes of human platelets this affinity-purified antibody inhibited the cGMP-stimulated phosphorylation of the three proteins with Mr of 130 000, 50 000 and 46 000 while it had no effect on the cAMP-dependent and cyclic-nucleotide-independent protein phosphorylation. The results demonstrate that platelets contain a cGMP-dependent protein kinase and at least three specific substrates for this enzyme. Two of these substrates, the proteins with apparent molecular Mr of 130 000 and 50 000, are substrates for both cAMP- and cGMP-dependent protein kinase. The protein with apparent Mr of 130 000 appears to be closely related to an intrinsic plasma membrane protein of vascular smooth muscle cells which is a substrate for a membrane-associated cGMP-dependent protein kinase. Therefore, cGMP-dependent protein kinase and cGMP-regulated phosphoproteins may mediate in platelets the intracellular effects of those hormones, vasodilators and drugs which elevate the level of cGMP and inhibit platelet aggregation.

Phorbol ester treatment impairs hormone- but not stable GTP analog-induced inhibition of adenylate cyclase

Treatment of intact human platelets and S49 lymphoma cyc- cells with the phorbol ester, 12-O-tetradecanoylphorbol-13-acetate, impairs GTP-dependent and hormone-induced inhibition of adenylate cyclase, an action mediated by the inhibitory coupling protein Ni. In contrast, receptor-independent activation of Ni with subsequent adenylate cyclase inhibition induced by the stable GTP analog, guanosine 5'-[gamma-thio]triphosphate, was affected in neither the potency nor onset of Ni activation by the stable GTP analog, in both membrane systems studied. The data indicate that modification of Ni following phorbol ester treatment does not impair its activation by stable GTP analogs.

Interactions between the hormone-sensitive adenylate cyclase system and the phosphoinositide-metabolizing pathway in human platelets

At least two signal-generating systems are involved in the actions of various hormonal factors in human platelets--the adenylate cyclase system and the phosphoinositide-metabolizing pathway. The formation of cyclic AMP (cAMP) by the adenylate cyclase system--consisting of the catalyst itself, the Ns and Ni proteins, and various hormone receptors--is stimulated by prostaglandins and adenosine, and is inhibited by alpha 2-adrenergic agonists, ADP, vasopressin, platelet-activating factor, and thrombin. On the other hand, the formation of inositol trisphosphate and diacylglycerol by the phosphoinositide-metabolizing pathway is stimulated by some of the latter agents, particularly by thrombin. There are apparently several mutual interactions between these two signal-generating systems. On the one hand, increases in the level of cAMP inhibit the formation of inositol phosphates and diacylglycerol. It is presently unclear whether this inhibitory effect of cAMP is due to a direct action at the phospholipase C itself or to an indirect mechanism, for example, a depletion of the substrate of the enzyme. On the other hand, protein kinase C, which is activated by diacylglycerol, largely interferes with the adenylate cyclase system. This kinase, when activated by diacylglycerol or phorbol esters, apparently phosphorylates the guanine nucleotide-binding alpha-subunit of Ni, which results in an impairment or loss of the inhibitory hormonal signal transduction to the adenylate cyclase. Thus, available evidence indicates that the two signal-generating systems present in platelet membranes are not completely separated, and furthermore suggests that they may even be causally related to each other.