Consumer protection issues in CPE

Recently attention has been focused on consumer protection issues in industry, business, and other areas of our life. Attention is now being focused on consumer protection issues in education. This article applies principles of consumerism to CPE. It is hoped that the readers will be stimulated to evaluate their clinical pastoral education experience from a consumer protection point of view.

Effect of phenobarbitone on plasma (14C)bilirubin clearance in patients with unconjugated hyperbilirubinaemia

1. The clearance of a tracer dose of [14C]bilirubin from the plasma was studied in patients with Gilbert's syndrome, congenital non-haemolytic jaundice, haemolytic jaundice and in normal subjects. Clearance was significantly impaired in the patients with Gilbert's syndrome and in those with congenital non-haemolytic jaundice when compared with the normal subjects, and was normal in the patient with haemolytic jaundice.

2. Treatment for 2 weeks with phenobarbitone (180 mg/day) lowered the plasma bilirubin concentration and improved all indices of plasma clearance of the isotope in patients with Gilbert's syndrome, so that they became indistinguishable from those of normal subjects. The improvement in plasma [14C]bilirubin clearance in these patients was associated with modest increases in hepatic bilirubin glucuronyl transferase in some subjects.

3. Phenobarbitone treatment improved plasma bilirubin concentrations and plasma [14C]bilirubin clearance in patients with congenital non-haemolytic jaundice, so that they resembled those seen in patients with untreated Gilbert's syndrome. Despite this improvement hepatic bilirubin glucuronyl transferase activity remained undetectable.

4. These results are compatible with the hypothesis that Gilbert's syndrome is a manifestation of a relative deficiency of hepatic bilirubin glucuronyl transferase, and differs from congenital non-haemolytic jaundice only in severity.

Further studies on B-lymphocyte suppression in delayed hypersensitivity, indicating a possible mechanism for Jones-Mote hypersensitivity

A previous report of increased intensity and prolongation of contact hypersensitivity in animals pre-treated with cyclophosphamide (CY) has been confirmed using other immunosuppressive agents. Melphalan, ICRF 159 and azathioprine caused a similar increase in contact sensitivity reactions, whereas busulphan, procarbazine and chlorambucil were inactive in this respect. The increased contact hypersensitivity was not associated with increased lymph node activity. Pre-treatment with CY, ICRF 159 and melphalan also caused increased intensity and prolonged Jones—Mote type reactions so that they resembled tuberculin-type reactions. This was associated with a marked reduction in γ₁ antibody production. It is therefore suggested that Jones—Mote hypersensitivity is a further example of a T-lymphocyte reaction modulated by a B-lymphocyte response.

Functional aspects of the selective depletion of lymphoid tissue by cyclophosphamide

The increased intensity and prolongation of contact hypersensitivity reactions in animals treated 3 days prior to sensitization with 300 mg/kg cyclophosphamide (CY) has been investigated. No evidence has been found of increased activity of lymphoid tissue or non-specific skin reactivity following CY treatment. However there was evidence of normal T-lymphocyte function associated with reduced B-lymphocyte function. Partial reconstitution could be obtained by transplanting spleen and the effect of CY treatment could be partially reproduced by splenectomy following sensitization. It is suggested that a B-lymphocyte response to soluble antigen modulates a normal cell-mediated immune response during the development of chemical contact sensitivity in the healthy animal and that this could be blocked completely by treatment with CY prior to sensitization or partially by splenectomy after sensitization.

Effects of dopamine and other catecholamines on the splanchnic circulation

Studies were conducted to evaluate the effects of dopamine (3, 4-dihydroxyphenylethylamine) and other catecholamines on the mesenteric vascular bed in dogs. Mesenteric and hepatic artery blood flows were measured with electromagnetic blood flow transducers. Catecholamines were infused intra-arterially into a branch-of the mesenteric artery. Dopamine consistently decreased mesenteric and hepatic artery blood flows at all dose levels studied (5–100 mg/kg). Phenoxybenzamine (12.5 mg/kg) blocked the effects of norepinephrine (0.05–1.0 μg/kg) and reversed the responses to dopamine in the mesenteric bed to those of pure vasodilation (no transient constriction was observed) but failed to abolish the constrictor action of dopamine on the hepatic artery. Propranolol or haloperidol, when administered with the phenoxybenzamine, did not attenuate the mesenteric responses to dopamine. Haloperidol prevented the hepatic artery vasoconstriction produced by dopamine but did not alter isoproterenol-induced hepatic artery vasodilation. No competitive action was observed between dopamine and norepinephrine or isoproterenol. These results suggest that (1) dopamine produces selective vasodilation of the mesenteric bed which is not blocked by haloperidol, and (2) dopamine has a unique action on the hepatic vascular bed which is blocked by haloperidol.

Total synthesis of acetate from CO 2 . V. Determination by mass analysis of the different types of acetate formed from 13 CO 2 by heterotrophic bacteria

Mass analysis was used to determine the amount of acetate which is totally synthesized from (13)CO(2) during fermentations by Clostridium formicoaceticum, C. acidiurici, C. cylindrosporum, Butyribacterium rettgeri, and Diplococcus glycinophilus. In the fermentation of fructose by C. formicoaceticum, 27% of the acetate was found to be totally synthesized from CO(2), and the remaining acetate was unlabeled, having been formed from fructose. Evidence is presented that the purine-fermenting organisms, C. acidiurici and C. cylindrosporum, totally synthesized about 9% of the acetate from CO(2), and that the methyl group of an additional 9% was formed from CO(2). The remaining acetate was formed from the carbons of the purine and not via CO(2). It has been postulated that the fermentation of the purines and synthesis of acetate from CO(2) both occur via derivatives of tetrahydrofolate. Evidence is presented that a compartmentalization of these folate intermediates is required if both the purine degradation and the CO(2) utilization involve identical intermediates. Neither B. rettgeri nor D. glycinophilus incorporated sufficient (13)CO(2) into acetate to allow determination of the types of acetate by mass analysis, although they did incorporate labeled (14)CO(2) in both positions of acetate.

DNP conjugates in guinea-pig lymph nodes during contact sensitization

Sensitization doses of [¹⁴C]dinitrofluorobenzene (DNFB) were painted on the dorsum of guinea-pig ears and the total radioactivity in the draining lymph nodes was determined, at various time intervals, in the first 72 hours. Of this radioactivity, 25 per cent was found to be centrifuged off with the cell debris after homogenization of the nodes in saline. The radioactivity in the remaining saline soluble material was shown to be precipitated by trichloracetic acid; of this, the DNFB was found to be conjugated, to approximately the same degree, to both the lipid and the protein components of the nodes. The significance of these findings is discussed.

Analysis of soluble antigens in guinea-pig epidermis. 3. The localization of the different tissue specific antigens in the epidermis

The distribution of five epidermis specific antigens in three fractions of guinea-pig epidermis (epidermal cells, intercellular substances and the superficial epidermis, or granular and horny layers) was investigated and compared with the antigens found in guinea-pig embryo and adult epidermis and in guinea-pig hairs. Four of the antigens were considered to be non-bacterial as they were demonstrated in embryo epidermis as well as in the adult tissue. These antigens appeared to be synthesized in the epidermal cells, after which they migrated to the superficial epidermal layers, where they were shown to accumulate and, in some cases, undergo fragmentation. Only one antigen was found in any quantity in the intercellular spaces, however although three of these antigens were found to be stable in 8 M urea, none of these could be demonstrated in guinea-pig hairs. The fifth antigen (Sp4), not found in the embryo tissue, could be of bacterial nature, as its presence, in small amounts, in the epidermal cells is probably due to contamination of this fraction by material from the superficial layers of the epidermis.