The effects of diclofenac sodium on arachidonic acid metabolism

Evidence has been presented that inhibition by diclofenac sodium of the production of leukotrienes by cells participating in the inflammatory process is due to a decreased availability of intracellular arachidonic acid which results from enhanced uptake of the substrate into triglyceride pools. The diminished leukotriene production does not result from direct inhibition of 5-lipoxygenase or phospholipase A2. Reduced availability of arachidonic acid would also limit production of prostaglandins, although in this case manifestation is obscured by the potent inhibitory effect of diclofenac sodium on cyclooxygenase. This recently discovered action of diclofenac sodium, which has been characterized by studies on isolated leukocytes, appears to be operative in vivo. Consistent with this mechanism, and not explainable by classical cyclooxygenase inhibition, diclofenac sodium inhibited leukotriene production in whole blood from drug-treated animals and also suppressed leukocyte infiltration of subcutaneously implanted sponges. The latter effect contrasts with increased infiltration frequently obtained with other NSAIDs and thought to reflect enhanced production of leukotrienes. In conclusion, the findings suggest that patient acceptance or preference for diclofenac sodium is not merely subjective but has a logical scientific basis.

Combined intrauterine and ovarian pregnancy. A case report

A case of combined ovarian and intrauterine pregnancy occurred. The ovarian pregnancy was an incidental finding during cesarean section. A literature survey revealed only 17 cases of combined ovarian and intrauterine gestation.

Reactions during hemodialysis caused by allergy to ethylene oxide gas sterilization

In patients receiving long-term hemodialysis (HD), we have examined the presence of IgE-dependent sensitization to ethylene oxide (EO) gas, which is used for sterilization of disposable medical products including dialyzers. Serum was obtained from 25 patients who experienced acute allergic reactions during HD, five patients receiving HD with isolated eosinophilia, and 37 unselected patients receiving HD. Sera from 22 of 25 of the allergic reaction group and from five of 35 of the unselected group were demonstrated to contain IgE antibodies with specificity for EO. Corresponding IgG antibodies were also present. No such antibodies were detected in serum from normal controls or ragweed-allergic patients. The serum from one patient with isolated eosinophilia had a borderline elevated IgE antibody level. These results demonstrate a close relationship between the presence of IgE antibodies to EO and HD-related allergic reactions in this patient population.

Outbreak of systemic Candida albicans in intensive care unit caused by cross infection

The first documented outbreak of systemic candidosis shown to be due to cross infection with a particular strain of Candida albicans is reported. Over nine months in an intensive care unit 13 patients developed definite and one probable systemic candidosis. Twenty five further patients had superficial candidal infections. The strain that caused the outbreak (serotype A, morphotype A1, biotype 0/(1)5 5/7) was responsible for all the cases of systemic candidosis acquired in the intensive care unit, 11 (44%) of the superficial candidal infections in the unit, and 17% of candidal infections outside the unit but in the same hospital. The strain was also isolated from oral swabs taken from four nurses working in the unit and the hands of one of these nurses. Two out of 17 nurses were shown to have acquired the strain on their hands when examined immediately after nursing systemically infected patients. No environmental source could be identified. The strain also showed enhanced survival in handwashing experiments and was relatively resistant to Hibiscrub. Management of patients with systemic candidosis might include measures to prevent cross infection and handwashing with disinfectants that are active against candida.

Characterization of Limulus amoebocyte lysate-reactive material from hollow-fiber dialyzers

Hollow-fiber hemodialyzers containing cellulose-based membranes have been shown to produce positive results with the Limulus amoebocyte lysate test. This study was undertaken to determine whether endotoxin was causing the reaction. Rinses from 45 parallel-plate and hollow-fiber dialyzers from eight different manufacturers were tested before and after treatment with cellulase, using three lysates and four Limulus amoebocyte lysate methods. In addition, four in vitro cellular methods--human leukocytic pyrogen, lymphocytic activating factor, peritoneal macrophage, and arginase release--were used to evaluate endotoxin activity. The substance causing the reaction was identified by chromatographic methods. Results indicate that the Limulus amoebocyte lysate reactive material is cellulose derived and not pyrogenic.

Comparison of chemical analyses of hollow-fiber dialyzer extracts

Hollow-fiber hemodialyzers containing cellulose-based membranes have been shown to produce positive results with the Limulus amebocyte lysate (LAL) test. This study was undertaken to determine whether endotoxin was causing the reaction. Rinses from 45 parallel-plate and hollow-fiber dialyzers from eight different manufacturers were tested using three lysates and four LAL methods. In addition, four in vitro cellular methods--human leukocytic pyrogen, lymphocytic activating factor, peritoneal macrophage, and arginase release--were used to evaluate endotoxin activity. The substance causing the reaction was identified using chromatographic methods. Results indicate that the LAL-reactive material is cellulose derived and is not pyrogenic.

Allergy to ethylene oxide in chronic hemodialysis patients

Almost a decade ago, a single chronic hemodialysis patient in Hamilton, Ontario, Canada, who was experiencing recurrent acute reactions during hemodialysis was found to have become allergic to ethylene oxide gas (EO). This observation recently provided a stimulus to examine the possibility that others exhibiting acute allergic-type reactions during hemodialysis might be similarly sensitized. Serum was obtained from 27 reacting patients and tested in a radioallergosorbent test (RAST) for antibodies to EO. The test was positive for 22 of these sera. EO-related specificity of the antibodies was confirmed. However, EO sensitization was not found in other hemodialysis patients with isolated eosinophilia. In a survey of the current Hamilton chronic hemodialysis population for EO-related antibodies, 9% had a positive allergy skin test and 12% had a positive RAST. The sensitized individuals had no distinctive symptoms. The lesser sensitivity of the skin test contrasts with usual findings in allergic individuals; however, the use of histamine and codeine in chronic hemodialysis and peritoneal dialysis patients might well explain a reduced sensitivity of the EO-related allergy skin test. Chronic peritoneal dialysis could not be invoked as a source of sensitization. None of these patients had a positive skin test or RAST for EO-related antibodies that could be attributed to peritoneal dialysis.

Electric infusion pole adjuster

A newly developed electric motorized infusion pole stand permits the surgeon to rapidly and accurately alter the rate and pressure of infusion during intraocular surgery.

Comparison of somatostatin distribution in pancreatic duct ligated rats and streptozotocin diabetic rats

The somatostatin content in the pancreas and gastrointestinal tract was examined in normal, streptozotocin (STZ)-diabetic and pancreatic duct ligation (PDL) rats. The somatostatin content in the pancreas and gastric antrum in the STZ-diabetic group showed a higher concentration compared with those in the normal control group (p less than 0.001). The somatostatin content in the duodenum in the PDL group showed a higher concentration compared with those in the sham-operated group (p less than 0.02). There was no significant increase in the lower gastrointestinal tract in the normal, STZ and PDL groups. These facts suggest that the concentration of somatostatin varies according to tissues and organs and that the distribution of somatostatin in chronic pancreatic injury caused by PDL is different from that in diabetes mellitus cases or controls.

Ascorbic acid in lymphocytes: cell preparation and liquid-chromatographic assay

Measurements of ascorbic acid concentration in leukocytes by "high-performance" liquid chromatography (HPLC) provides better nutritional assessment, leading to better management, particularly of presymptomatic and critically ill patients. This procedure includes a simple, reproducible cell-separation technique that requires no more than 2 mL of whole blood. Cell populations are separable with greater than 95% purity and greater than 99% viability. Ascorbic acid is assayed by HPLC. The vitamin can be reproducibly quantified in concentrations as low as 0.1 microgram/mL of cell extract. The chromatographic procedure is very rapid, analysis being completed within 15 min after specimen preparation. The assay is suitable also for urine and protein-free filtrates of plasma and of other biological materials. Reference intervals for plasma, mononuclear leukocytes, and polymorphonuclear leukocytes were established. A preliminary clinical evaluation revealed that hospital patients were at a greater risk of ascorbic acid deficiency than expected.

Ascorbic acid in lymphocytes: cell preparation and liquid-chromatographic assay

Measurements of ascorbic acid concentration in leukocytes by "high-performance" liquid chromatography (HPLC) provides better nutritional assessment, leading to better management, particularly of presymptomatic and critically ill patients. This procedure includes a simple, reproducible cell-separation technique that requires no more than 2 mL of whole blood. Cell populations are separable with greater than 95% purity and greater than 99% viability. Ascorbic acid is assayed by HPLC. The vitamin can be reproducibly quantified in concentrations as low as 0.1 microgram/mL of cell extract. The chromatographic procedure is very rapid, analysis being completed within 15 min after specimen preparation. The assay is suitable also for urine and protein-free filtrates of plasma and of other biological materials. Reference intervals for plasma, mononuclear leukocytes, and polymorphonuclear leukocytes were established. A preliminary clinical evaluation revealed that hospital patients were at a greater risk of ascorbic acid deficiency than expected.

Caring for Indochinese refugees

A refugee camp in Hong Kong and a health center in Los Angeles provide data on patterns of health care among Indochinese refugees. American physicians need to be aware that incoming refugees use both Western and traditional Chinese models of medical care. In addition, they are subject to special psychologic problems resulting from their past ordeals and their resettlement in a different country. Increased emergency aid should be provided to geographic areas with large concentrations of refugees.

Ankle-knee synchronous knee lock mechanism: a revision

An ankle-knee synchronous mechanism in a new endoskeletal above-knee (A-K) prosthesis has been designed and a preliminary clinical study has been conducted. A revision of the knee mechanism which is mainly focused on the basis of reducing the energy cost of the prosthetic wearer has been developed. It provides multiple position of the knee lock. It also provides anterior placement of the knee joint and a synchronous motion with the ankle joint. It enables the prosthetic wearer to minimize the effect of hip extensor contraction, to stabilize the knee, and maximize the sense of security and to balance the body over the artificial limb through the stance phase of gait. It permits the amputees to assume various body postures which enable them to perform daily activities. A new concept for alignment of A-K prosthesis is accomplished by using a weight bearing line instead of a trochanter and ankle (TKA) line, especially for the short A-K amputees. Deletion of the inertia control mechanism becomes possible by simply inserting a bumper in the knee to prevent terminal impact at swing phase and a built in coil spring acts as a knee extension aid.

Surgical and medical experience with 734 premature infants with patient ductus arteriosus

During the past 5 years, patent ductus arteriosus (PDA) presented in 734 preterm infants (less than 2.5 kg and 37 weeks gestation) of 2,532 admissions (29%). The ductus presented with murmur, bounding pulses, and often congestive heart failure. Medical treatment consisted of the following: fluid restriction, furosemide, respiratory support, and rarely digoxin. The patients who were unresponsive to medical treatment had surgical ligation (306 of 734 or 42%). The patients who had ductal ligation were smaller, i .e., 82% of the surgical patients weighed less than 1.5 kg as compared to 38% of the medical patients. Of those patients weighing less than 1.5 kg, the surgical and medical groups were compared and the following observations made: The incidence of respiratory distress syndrome was greater in the surgical group (86% or 216 of 252 patients versus 69% or 111 of 161 medical patients, p less than 0.001) and the long-term survival was better (89% or 224 of 252 surgical patients versus 77% or 124 of 161 medical patients, p less than 0.005). In addition, the average duration of intubation was shorter in this surgical subgroup (8.9 versus 13.6 days). Significant left atrial enlargement and echocardiographic left atrial/aortic (LA/Ao) ratios of greater than 1.5:1 occurred in 58% or 171 of 290 surgical patients versus 32% or 59 of 190 medical patients (p less than 0.001). During the first 3 years of this study (medical treatment averaged 5 days), the duration of intubation in the surgical patients averaged 15.2 days; by comparison, in the last 2 years of this study (medical treatment averaged 1 to 2 days), the duration of intubation was 6.5 days (p less than 0.001). Necrotizing enterocolitis (NEC) occurred in 11% or 46 of 428 medical patients versus 0.3% (one of 305 patients) in the ligated group postoperatively (p less than 0.001). Late deaths were related to lung disease, central nervous system problems, NEC, and so on. From this study, it was determined that ligation of a significant PDA is associated with (1) zero surgical risk, (2) a reduced incidence of NEC, (3) reduced duration of intubation, especially with early ligation, and (4) improvement in late survival. Thus the surgical approach is our treatment of choice for a refractory PDA.

Specificity of power improvements through slow and fast isokinetic training

College age males performed maximal two-legged isokinetic knee extensions three times per week for 6 wk at either 60 degrees/s (slow) or 300 degrees/s (fast) or both 60 and 300 degrees/s (mixed). The velocity specific and action specific (two-leg vs. one leg) improvements in peak torque (PT) were compared to a placebo group receiving low-level muscle stimulation. The slow group improved PT significantly (P less than 0.05) more than the placebo group only at its training velocity (60 degrees/s) and more so when the specific two-legged training action was mimicked (+32% with two legs vs. +19% with one leg). The mixed group enhanced PT by 24 and 16% at their respective training velocities of 60 and 300 degrees/s. These improvements were significantly larger than placebo and also significantly larger than the 9% improvement observed at the midvelocity of 180 degrees/s. The training specificity demonstrated by the slow and mixed groups suggest that neural mechanisms contributed to their improvements in power. This is supported by their unchanging muscle morphology. Training solely at 300 degrees/s (fast) however improved PT significantly more than placebo not only at the training velocity (+18%), but also at a slower velocity of 180 degrees/s (+17%). The fast group demonstrated a significant enlargement (+11%) of type II muscle fibers. These data suggest type II fiber hypertrophy to be a plausible mechanism for the nonspecific improvement of the fast group; however, a neurological adaptation that enhances power at and below the training velocity cannot be excluded.

Central serous choroidopathy in the Hallermann-Streiff Syndrome

Central serous choroidopathy was observed in a young patient with the Hallermann-Streiff syndrome. Typical features of this syndrome include microphthalmos, proportionate dwarfism, dyscephaly with birdlike facies, dental abnormalities, and hypotrichosis. Exceptional aspects of this case include age of onset (11 years), high hyperopic refractive error (+ 13.00 sphere), and multiple recurrences caused by six separate documented leaks from the choroid. Fundus changes previously reported in the Hallermann-Streiff syndrome, interpreted as chorioretinal pigmentary changes, may have been secondary to previous undiagnosed central serous choroidopathy. Periodic ophthalmoscopy should be performed and may detect unrecognized episodes of central serous choroidopathy for which photocoagulation would be beneficial.

The effect of diabetes on leucine and fucose incorporation into PNS myelin proteins

Peripheral neuropathy is a common complication associated with diabetes mellitus. Segmental demyelination and other pathological changes frequently accompany loss of sensory amd motor nerve function. Morphological changes seen in diabetic nerve myelin may be a result of altered Schwann cell metabolism under hyperglycemic conditions. Using both alloxan and streptozotocin - induced diabetic rats of 2, 4 and 8 months duration of diabetes, metabolic changes in isolated sciatic nerve myelin were assessed using a double-label in vitro incubation system. Incorporation of 3H-fucose and 1-14C-leucine into myelin was determined per microgram protein. Specific activities of incorporated protein precursors were compared as a ratio of fucose to leucine. Using the Newman-Kuels test for multiple comparisons, statistically significant increases were found in the incorporation ratios of diabetic rats at 2 and 4 months of diabetes when tested against age-matched controls.

Angiosarcoma of the heart: ultrastructural study

Two angiosarcomas of the heart, both arising from the right atrium, were studied with the electron microscope. Ultrastructural characteristics of angiomatous development were demonstrated both at the better differentiated vascular areas and at the less differentiated, spindle-cell foci. Both tumors were dominated by immature endothelial cells. These cells were associated with primitive mesenchymal cells and transitional forms of pericytes. Intracytoplasmic lumen formation and junctional specialization with neovascular development are unique features of angiogenesis in these tumors. Ultrastructural studies may provide useful diagnostic features separating a true malignant vascular neoplasm of endothelial cell origin from other forms of mesenchymal neoplasia that may have a prominent stromal vascular component.

Meningococcal disease in New York City, 1973 to 1978. Recognition of groups y and W-135 as frequent pathogens

In the period 1973 through 1978, the New York City Department of Health serogrouped 648 isolates of Neisseria meningitidis and investigated 259 cases if meningococcal meningitis and meningococcemia. Although meningitis and septicemia were mainly due to groups B and C, groups Y and W-135 caused nearly one third of the cases. There was no difference in mortalities when disease caused by the classic groups A, B, and C was compared with disease caused by the new serogroups X, Y, Z, W-135, and Z'. Most isolates from the respiratory tract were from the new serogroups, especially Z and Z' (some from patients with pneumonia), as were most of those from the genitourinary tract, anal canal, and miscellaneous sites. Group X was infrequently seen. Although most of the isolations of these groups of N meningitidis are apparently from asymptomatic carriers, Y and W-135 do cause a substantial number of acute symptomatic infections, in particular, septicemia.

Pulmonary lamellar bodies in human amniotic fluid: their relationship to fetal age and the lecithin/sphingomyelin ratio

We investigated the appearance of pulmonary lamellar bodies (LBs) in human amniotic fluid as a function of fetal age. We also studied their relationship to the lecithin/sphingomyelin (L/S) ratio and to the results of the rapid surfactant test (RST). LBs observed in amniotic fluid generally ranged in diameter from 1.5 to 2.0 mu and were seen as single structures or in clusters. When patients were grouped by gestational age, there was a significant difference (P less than 0.001) in the distribution of amniotic fluid LBs. No LBs were observed in amniotic fluid before 26 weeks' gestation, but 50% of specimens at 28 to 32 weeks' gestation and 85% of specimens at term had LBs. Patients with amniotic fluid LBs had higher L/S ratios and intermediate or mature RST values when compared to patients without LBs, but a statistically significant relationship between the presence of LBs and the L/S ratio or RST was not found. We conclude that qualitative examination of amniotic fluid LB content by conventional electron microscopy is unlikely to reflect fetal lung maturation in a precise manner. However, direct quantification of LBs may provide a more specific index of fetal lung maturity and the risk of respiratory distress syndrome.

Detergent-containing glucose oxidase reagent for use with the Beckman glucose analyzer

We describe a modified glucose oxidase reagent for use in the polarographic determination of glucose with the Beckman "Glucose Analyzer." The reagent contains 1 mL/L of a surfactant (Brij-35 250 g/L solution) as the wetting agent instead of glycerol. Precipitation of components associated with the formulation recommended by Fischl et al. [Clin. Chem. 21, 760 (1975)] does not occur with this reagent. It can be used immediately after preparation. When compared to analytical performance of the commercially prepared reagent, the precision was unchanged by the modified reagent, but the upper limit of accurate response was diminished (7.5 g/L vs. 6.7 g/L). The modified reagent is less expensive than are commercially prepared reagents.

Detergent-containing glucose oxidase reagent for use with the Beckman glucose analyzer

We describe a modified glucose oxidase reagent for use in the polarographic determination of glucose with the Beckman "Glucose Analyzer." The reagent contains 1 mL/L of a surfactant (Brij-35 250 g/L solution) as the wetting agent instead of glycerol. Precipitation of components associated with the formulation recommended by Fischl et al. [Clin. Chem. 21, 760 (1975)] does not occur with this reagent. It can be used immediately after preparation. When compared to analytical performance of the commercially prepared reagent, the precision was unchanged by the modified reagent, but the upper limit of accurate response was diminished (7.5 g/L vs. 6.7 g/L). The modified reagent is less expensive than are commercially prepared reagents.

Immune response to phosphorylcholine. I. Characterization of the epitope-specific antibody

The antibodies to phosphorylcholine induced in BALB/c mice were isolated and studied with a variety of biochemical and immunochemical methods. Analysis of the idiotype and the hapten-binding specificities showed no differences to the phosphorylcholine-binding myeloma protein TEPC 15, indicating a high degree of homogeneity. However, disc electrophoresis, isoelectric focusing and amino acid composition data indicated large differences in the structure of anti-phosphorylcholine antibody and TEPC 15. By these criteria the anti-phosphorylcholine antibodies from BALB/c mice are of oligoclonal origin.

Serial liver biopsy observations in hepatitis B antigen carriers by light and electron microscopy

Liver morphology and function were restudied after an interval of 1 1/2-2 years in 21 Chinese men with hepatitis B antigen (HBsAg). Antigenemia and mild liver histopathology disappeared in one individual who developed antibody to HBsAg(Anti-HBsAg). 20 subjects who were chronic carriers of HBsAg had mild histological abnormalities which were usually persistent and were more commonly lobular than portal. Particularly striking were focal necrosis, eosinophilic bodies, ground-glass cytoplasmic change, and, by electron microscopy, microtubular structures within cytoplasmic membranous cysternae. Interval development of chronic aggressive hepatitis was observed in only one subject. This study suggests that the great majority of HBsAg carriers have a good prognosis at least over a 1 1/2-2-year period, and that liver biopsy is most indicated in those with persistent liver function abnormalities.

[Electron microscopic observations of the rat endometrium during the implantation period, with special reference to its sex steroid hormone regulation (author's transl)]

Ultrastructural changes in the rat endometrium under several conditions including experiments of the inhibition of implantation were studied to clarify the sequential changes of the endometrium and their endocrinologic background during ovoimplantation. The following pertinent findings were noted. 1) Normal pregnancy. In the luminal surfaces, the microvilli were short and arranged rather irregularly and lost their so-called glycocalyx on L3. The large fungus-like protrusions appeared on L4. On L5, the luminal surfaces were completely covered with small serrated cytoplasmic protrusions. They formed the interdigitation btween the apposed surfaces and the uterine lumen was disappeared when the uterus was fixed in situ by the arterial perfusion method. High ATP-ase activity was demonstrated at the site of interdigitation. In the apical cytoplasm, many apical vesicles, well developed Golgi apparatuses, and dilated cisternae of the granular endoplasmic reticulum were observed on L3. On L5, however, these apical vesicles decreased in number and the Golgi apparatuses were small. On the contrary, the semilunar and coated vesicles were numerous, and the lysosomes increased both in number and size. Acid phosphatase activity was detected in these lysosomes. In the glandular epithelium, progressive increase in the number of small granules and the amount of amorphous substance were observed in the glandular lumen from L2, to L4. But on L4, some autophagosomes had already appeared in the cytoplasm. Swollen and degenerated mitochondria as well as many vacuoles were recognized on L5. In the stromal cells, the cytoplasm was enlarged, and contained many polyribosomes, granular endoplasmic reticulum with markedly dilated cisternae, lysosomes and lipid droplets on L5. The cytoplasmic protrusions on L5 were elongated and showed various features; one of them was situated very closely to the basement lamina of the luminal epithelium, and the other surrounded the lumen. Some of these protrusions were connected with the desmosomes. High ATP-ase activity was localized in these cytoplasmic protrusions, on the surfaces of the stromal cells, and in the stroma itself. 2) Delayed implantation and estrogenic transformation. In delayed implantation, the luminal surfaces were covered with regular microvilli and several fungus-like cytoplasmic protrusions. The cytoplasm contained many apical vesicles and large Golgi apparatuses that were observed both on L3 and L4 in normal pregnancy. At 48 hrs after the injection of estrogen, the interdigitation between the apposed luminal surfaces was also established. In the glandular epithelium, a slight enlargement of the glandular lumen and the appearance of small granules similar to those observed in normal pregnancy were noted at the 4th hr of estrogen treatment. In the stromal cells, two cells apposed each other very closely at the 4th hr and formed large cell masses at the 48th hr of estrogen treatment...