[Experimental study of laser ablation on lethal arrhythmias in dogs]

To study the effect of laser ablation on arrhythmogenic ventricular myocardium, we applied aconitine on 36 local epicardial sites of ventricles (22 in LV, 14 in RV) in 12 dogs. Severe monographic persistent VTs or VFs were induced by aconitine and then these foci were irradiated by Nd: YAG laser. RV refractoriness (RVR) and local epicardial pacing threshold (LEPT) were measured by programmed electrical stimulation (PES) before aconitine applying and after resuming sinus rhythm. That VT or VF could not be induced by PES and the heart had persistent sinus rhythm was considered success. Aconitine doses were 7.9 +/- 4.8 micrograms in LV, 3.3 +/- 1.9 micrograms in RV, P less than 0.01. The data of time from aconitine applying to the appearance of VT were 237 +/- 228 s in LV and 148 +/- 101 s in RV, P less than 0.05. VF incidence rate was 75% (27/36). All of VT, VF could be abolished by mapping-guided laser irradiation on VT foci. The mean laser energy was 1542 +/- 893 joules (n = 36). RVR and LEPT increased significantly (P less than 0.001) after tests. Results showed that: (1) Lethal ventricular arrhythmias could be induced by giving little aconitine on the ventricular epicardium; (2) Mapping-guided lasering on arrhythmogenic myocardium could eradicate VT and VF; (3) RVR and LEPT would increase greatly after ablation.

Hereditary hemorrhagic macular dystrophy

We treated two brothers who had a hemorrhagic macular lesion in one eye; a similar problem affected the fellow eye of both patients within eight months. Generalized fine granularity of the retinal pigment epithelium and peripheral iris transillumination defects were observed in both siblings. A study of the family suggested that the disorder was dominantly inherited and probably was Sorsby's pseudoinflammatory macular dystrophy. The macular lesions in one brother were treated by argon green laser photocoagulation and in the other brother by krypton red laser photocoagulation. Although the brother treated by krypton red laser photocoagulation attained better final visual function, additional differences in treatment methods also may have contributed to the final outcome.

Combining position and acceleration measurements for joint force estimation

The calculation of joint forces in biomechanics is usually based on the measurements of the kinematics of a given body segment, the estimation of the inertial properties of that segment and the solution of the 'inverse dynamics problem'. Such a process results in estimates of the joint forces and moments needed to sustain the monitored motion. This paper presents a new approach that combines position and acceleration measurements for the purpose of deriving high-quality joint force estimates. An experimental system that is based on an instrumented compound pendulum was designed and tested. The joint forces necessary to maintain a swinging motion of the pendulum were measured by an array of strain gauges, and were compared to the forces estimated by the integrated kinematic segment that measured the position and acceleration of the pendulum. The joint force measurements were also compared to the force estimates that were based on the calculated segmental acceleration generated by the differentiation of the segmental position alone. The results show a high degree of correlation between the forces estimated by the integrated segment and those measured by the strain gauges. The force estimates based on the position measurements alone were less accurate and noisier. The application of the integrated segment to the study of human kinetics is discussed and illustrated by the ankle and knee forces during slow walking. The results suggest that the use of accelerometers is necessary for the estimation of transients and high-frequency components of joint forces.

Stimulation of neurite outgrowth in neuroblastoma cells by neuraminidase: putative role of GM1 ganglioside in differentiation

Treatment of three neuroblastoma cell types in culture with neuraminidase resulted in enhanced neurite outgrowth. These included the mouse Neuro-2A and rat B104 and B50 lines. The morphological changes depended on the presence of exogenous Ca2+ and were accompanied by modest but statistically significant increases in 45Ca2+ influx. Neuraminidase-stimulated neuritogenesis was blocked by the B subunit of cholera toxin (cholera B) and anti-GM1 antibody, a finding suggesting the effect was due to an increased amount of GM1 on the cell surface. Cholera B also blocked the increase in 45Ca2+ influx. The mouse N1A-103 line, previously characterized as "neurite minus," did not respond to neuraminidase with either neurite outgrowth or enhanced Ca2+ influx. These results point to an influence of GM1 on neuritogenesis in cells with differentiation potential and suggest a mechanism involving modulation of Ca2+ flux.

The effect of ketone bodies on nitrogen metabolism in skeletal muscle

1. The ketone bodies, D-beta-hydroxybutyrate and acetoacetate, inhibit glycolysis thereby reducing pyruvate availability which leads to a marked inhibition of branched-chain amino acid metabolism and alanine synthesis in skeletal muscles from fasted mammalian and avian species. 2. The rate of glutamine release from skeletal muscles from fasted birds is increased at the expense of alanine in the presence of elevated concentrations of ketone bodies because of an increase in the availability of glutamate for glutamine synthesis. 3. Ketone bodies inhibit both protein synthesis and protein degradation in skeletal muscles from fasted mammalian and avian species in vitro. The mechanisms involved remain unknown. 4. Inhibition of amino acid metabolism and protein turnover in skeletal muscle by ketone bodies may be an important survival mechanism during adaptation to catabolic states such as prolonged fasting.

Lactate production is the major metabolic fate of glucose in splenocytes and is altered in spontaneously diabetic BB rats

Enhanced glucose metabolism is necessary to support the activation and proliferation of lymphocytes. To define further quantitatively the metabolic fates of glucose and assess glucose utilization both in normal cells and in an autoimmune disease with abnormal lymphocytes, [U-14C]glucose conversion into 14CO2 and the production of lactate and pyruvate were measured in splenocytes. Cells from non-diabetes-prone (BBn) and spontaneously diabetic (BBd) rats were studied both freshly isolated 'resting' and cultured for 96 h with and without concanavalin A (Con A) stimulation. (1) Lactate was confirmed to be the major end product in both freshly isolated (53% of utilized glucose) and unstimulated cultured (62% of utilized glucose) cells from BBn animals studied at (2-8) x 10(6) cells/ml concentration. The use of concentrations from 10 x 10(6) to 300 x 10(6) cells/ml resulted in progressively less lactate production per 10(6) splenocytes. (2) Cells from BBd animals after stimulation with Con A incorporated less [3H]thymidine and produced significantly less lactate (155 +/- 14 versus 305 +/- 24 nmol/2 h per 10(6) cells) than did BBn cells (P less than 0.05). (3) However, more lactate (101 +/- 8 versus 78 +/- 6 nmol/5 h per 10(6) cells) was produced by 'resting' cells from BBd animals compared with BBn (P less than 0.03), and this difference was sustained after 4 days in culture. (4) Significantly greater amounts of pyruvate were produced by BBd than by BBn cells, particularly when stimulated with Con A, suggesting an alteration in the availability of reducing equivalents in BBd cells. (5) These results are consistent with prior metabolic as well as immunological 'activation' of cells in vivo in the BB diabetic animals.

The macular photostress test in diabetic retinopathy and age-related macular degeneration

We propose the macular photostress test for the evaluation of macular function in the office setting. Eighty eyes were tested and divided into four diagnostic categories: background diabetic retinopathy, diabetic macular edema, age-related macular degeneration, and normal. The recovery times for the eyes with age-related macular degeneration were longer than for eyes with macular edema (P = .03). Age-matched patients with age-related macular degeneration had longer recovery times than did those without age-related macular degeneration (P = .0001). A possible explanation is that the prolonged recovery time in the eyes with age-related macular degeneration reflects that the anatomic lesion is located in the retinal pigment epithelium-photoreceptor complex. In comparison, the eyes with macular edema, whose lesion is in the inner retina and not the retinal pigment epithelium, show a less-prolonged recovery time than the eyes with age-related macular degeneration.

[A study on the dental adhesive containing phosphate diesters]

Although a lot of kinds of dental adhesives have been applied recently, all of them cannot meet clinical requirement completely. This paper reports a new dental adhesive containing partial phosphate diesters developed by us. We synthesized aryl phosphorodichloridates (APDC), nine kinds of phosphate diester (PDE) adhesive monomers, sodium p-toluenesulfinate (TSS) and p-toluenesulfinic acid (TSA) accelerators, polymethyl methacrylate (PMMA) powder and the other compounds. The chemical structures of PDE adhesive monomers were confirmed by IR, 1HNMR, 31PNMR, refractive index and elementary analysis etc. The results showed that the tensile bond strength (TBS) between PDE dental adhesive and human tooth was better than others reported in China and some others reported in literature.

[Potentiating effect of L-tetrahydropalmatine on the suppression of cortical tooth-pulp evoked potentials by electroacupuncture in rabbits]

Cortical potentials evoked by stimulation of the contralateral tooth-pulp were recorded epidurally from the SI cortex of rabbits anesthetized with urethane and chloralose. It was found that nociceptive components of the evoked potential consisted of P1 and P2 wavelets with a relative stable peak latency of 22.5 +/- 1.2 ms and 66.1 +/- 1.9 ms respectively. Higher intensity of tooth pulp stimulation was required for appearance of P2 than P1. Diazepam, a non-analgesic sedative, reduced P1 but not P2 amplitude. On the contrary, dolantin, an analgesic, suppressed P2 but showed no significant influence on P1. The results suggest that P2, but not P1 might be related to pain. The effects of l-tetrahydropalmatine (1-THP) and electroacupuncture on P2 were observed on 12 animals. The results showed that both iv l-THP 8mg/kg and electroacupuncture brought forth a decrease in P2 amplitude by 40.3 +/- 14% and 59.3 +/- 10% respectively, while electroacupuncture combined with l-THP produce a further decrease in P2 amplitude by 92.8 +/- 7%. Furthermore, the inhibitory periods of P2 amplitude were significantly prolonged after electroacupuncture combined with l-THP. The results indicated that l-THP enhanced the suppression of P2 by electroacupuncture.

Effects of four dopamine agonists on l-tetrahydropalmatine-induced analgesia and electroacupuncture analgesia in rabbits

The effects of icv 4 dopamine (DA) agonists on analgesia caused by iv l-tetrahydropalmatine (THP) 8 mg/kg or by electro-acupuncture (EA) were studied by using the potassium iontophoretic dolorimetry in rabbits. The results showed that both THP-induced analgesia and EA analgesia were markedly attenuated by icv of DA or apomorphine (Apo), 2 mixed D1/D2 agonists. Similar results were obtained when SKF-38393, a selective D1 agonist, was applied. On the contrary, quinpirole hydrochloride (Qui), a selective D2 agonist, was found to enhance the analgesic action of THP or EA. However, DA, Apo, SKF-38393 or Qui per se did not influence the baseline pain threshold. All these observations indicate that functional alterations in DA receptor activities may be involved in THP-induced analgesia and EA analgesia, in which D1 and D2 subtype receptors exert different roles.

Variations in c-fos mRNA expression during serum induction and the synchronous cell cycle

Induction of c-fos mRNA levels associated with the stimulation of growth by fetal bovine serum following quiescence was examined in three cell types following brief (24 h) serum starvation. Starved NIH-3T3 and HeLa S3 cells experienced c-fos mRNA induction 20-30 min after addition of serum. In contrast, Swiss-3T3 cells expressed c-fos constitutively following serum starvation. The pattern of oncogene expression coincided with the level of quiescence of each cell line prior to induction. Serum inductions of c-fos expression was dependent upon the response of each cell line to serum starvation, c-fos expression was also examined in HeLa S3 cells that had been separated into sequential cell cycle phases by centrifugal elutriation, c-fos expression peaked during the earliest part of the synchronous G1 phase. The amount of c-fos mRNA measured was approximately twice that found during other cell cycle phases. This suggests that, in addition to its role during the transition from quiescence, the c-fos gene product may play a regulatory role during the earliest part of G1 phase of the continuous cell cycle.

[Potentiation of electroacupuncture analgesia by l-tetrahydropalmatine and its analogues in rabbits]

l-Tetrahydropalmatine (l-THP), tetrahydroberberine (THB) and l-stepholidine (l-SPD) are the homologues of tetrahydroproto berberines and have a common antagonistic effect to central dopamine receptors. In the present experiment, the potassium iontophoretic dolorimetry was used to determine the pain threshold of rabbits. Unilateral "Hegu" point (the dorsum of the front paw, between 1st and 2nd metacarpals) and "Waiguan" point (the dorsum of the foreleg, between radius and ulna, 2 cm above the wrist joint) of each rabbit were electrically needled. The effects of iv l-THP 8 mg/kg, THB 16 mg/kg or l-SPD 4 mg/kg on electroacupuncture analgesia were investigated. The experimental results indicated that these 3 agents enhanced the potency of electroacupuncture analgesia and prolonged the duration as well. This investigation gives the evidence that the drug possessing antagonistic effect to central dopamine receptors could be used as a synergist of acupuncture analgesia.

Plasmid content of piliated and nonpiliated forms of Moraxella bovis

Plasmid profiles were compared between nonpiliated and piliated forms of Moraxella bovis isolates. The piliated form of M bovis isolate IBH64 contained 1 fewer plasmid than did the nonpiliated form. Piliated and nonpiliated cells of IBH64 contained plasmids having molecular size of 45, 32.8, 4.9, and 4.6 kilobases (kb). Single- and double-restriction endonuclease digestion by Ava I and Nde I indicated that the size of the additional plasmid carried by the nonpiliated form of IBH64 was approximately 43.6 kb. The M bovis isolates, Newport and GRS, contained the same number of plasmids in either their piliated or nonpiliated form.

The effect of ketone bodies on protein turnover in isolated skeletal muscle from the fed and fasted chick

1. The addition of 4 mM acetoacetate or DL-beta-hydroxybutyrate to the incubation medium decreased the rate of protein synthesis without influencing the rate of protein degradation in extensor digitorum communis (EDC) muscles from fed chicks and decreased the rates of protein synthesis and degradation in muscles from fasted chicks. 2. Ketone bodies markedly decreased intracellular concentrations of glutamine in EDC muscles from fed chicks by increasing glutamine oxidation. 3. The addition of 0.5 mM glutamine to incubation media containing 1.0 mM glutamine reversed the ketone body-induced decrease in intracellular glutamine concentration to the control value and blocked the inhibiting effect of ketone bodies on protein synthesis in skeletal muscles from fed chicks. 4. The addition of 5 mM pyruvate blocked the ability of ketone bodies to increase glutamine oxidation and prevented the associated decrease in intracellular glutamine concentration and the rate of protein synthesis in EDC muscles from fed chicks. 5. These results suggest that ketone bodies can act directly on skeletal muscle to inhibit the rate of protein synthesis in muscles from fed chicks by decreasing intracellular glutamine concentration by increasing its oxidation.

Characterization of the plasmids of Moraxella bovis

Restriction endonuclease digestions were performed on plasmids purified from Moraxella bovis isolates GRS, Newport, and IBH64. It was determined from single and double digestions of plasmid DNA that GRS and Newport isolates carried 3 large plasmids having molecular sizes of 43.8, 41.3, and 32.8 kilobases (kb). Digestion of the 3 large plasmids and restriction endonucleases Hae III, HindIII, Nde I, and Ava I strongly indicated that these isolates shared structurally identical large plasmids. Timed single digestions with Ava I revealed that the IBH64 isolate carried 2 large plasmids having molecular sizes of 45 and 32.8 kb. The 32.8-kb plasmid was the only large plasmid that appeared to be shared by all 3 M bovis isolates. Two isolates, Newport and IBH64, carried small plasmids in addition to the large plasmids. Restriction maps were constructed for the 43.8-, 41.3-, and 32.8-kb plasmids.

Cell loss in the aging retina. Relationship to lipofuscin accumulation and macular degeneration

We examined the impact of aging on the numbers of photoreceptors and retinal pigment epithelium (RPE) cells, and the number of photoreceptors per RPE cell profile, in selected regions of 30 human eyes. The mean ratio of photoreceptors to RPE cell was higher in the macula than in the paramacula (P less than 0.01) or the equatorial area (P less than 0.001). We found evidence for an age-related loss of RPE in both whites (P less than 0.02) and blacks (P less than 0.0006), although the rate of loss in whites was significantly slower than in blacks. Photoreceptor loss in blacks was inversely correlated with age (P less than 0.04). In whites, however, photoreceptor loss was very significantly and directly correlated with lipofuscin concentration in the opposing RPE (P less than 0.0001) and unrelated to age. The disparity in the rates of photoreceptor and RPE cell loss produced, in older eyes, a higher ratio of photoreceptors per RPE cell profile. In the macula, the ratio for whites over 50 years of age was significantly higher (P less than 0.05) than that in blacks over 50. Our data suggest that the increased phagocytic and metabolic load on the RPE, which ultimately the macula causes a preferential age-related accumulation of lipofuscin in the RPE, which ultimately leads to photoreceptor death. This may prove a useful model of age-related macular degeneration and Stargardt's disease.

The detection of an antibody against IgA allotype A2M 2 and a study of the Am genetic marker among the Han Chinese population

The serum of a woman was found by the Ouchterlony double-diffusion and the hemagglutination inhibition (HAI) methods to have immunoglobulin A (IgA) deficiency. Further investigation using the hemagglutination (HA) test with red cells coated with IgA myeloma proteins of different specificities showed that the serum agglutinated only IgA2-, A2M-1, and A2M 2-coated cells. The patterns of the HAI test with a reference panel confirmed the presence of two specificities. One was anti-IgA2 and the other was a rare antibody against the allotype A2M 2. The anti-A2M 2 was used for population studies. Testing of the Han Chinese population, including family studies, confirms that A2M.1 and A2M.2 have an autosomal dominant mode of inheritance and are controlled by a codominant allele. The distribution of the two Am genetic markers among the Han Chinese population demonstrated A2M.1 with a gene frequency of 0.553 and A2M.2 with a gene frequency of 0.447 (chi 2 = 0.145, 0.80 greater than p greater than 0.70).

In vivo thickness of the human detached retina by ultrasonic signal processing

Fourier operations on digitized radio-frequency (rf) data can provide the most sensitive measure of the thickness of thin, deterministic structures such as membranes. After deconvolution against the system transfer function, the cepstrum and the analytic signal magnitude can provide measures of membrane thickness on the order of a half-wavelength. A total of 19 patients with rhegmatogenous retinal detachments were scanned using a diagnostic ultrasound system adapted for analog to digital conversion of rf data. Data were analyzed using the signal processing techniques described above to measure retinal thickness. Recent retinal detachments tended to be significantly thicker than normal attached retinas, and thickness decreased with the age of detachment. A statistically significant correlation was found to exist between retinal thickness and the duration of detachment.

Formation of alanine and glutamine in chick (Gallus domesticus) skeletal muscle

1. Incubation of extensor digitorum communis muscles from fed chicks in the presence of plasma concentrations of branched-chain amino acids (BCAA) increased the formation of glutamate, glutamine and alanine. This effect was inhibited by 1.5 mM L-cycloserine. 2. 2-Oxoisocaproate (0.1 and 0.5 mM) increased the formation of leucine but decreased that of glutamate, glutamine and alanine. 3. NH4Cl (0.3 mM) increased the formation of glutamine, and decreased the release and intracellular concentrations of glutamate and alanine. 4. Our results demonstrate that alanine and glutamine are synthesized de novo in chick skeletal muscle and demonstrate the similarity in alanine and glutamine synthesis in skeletal muscle between the domestic fowl and mammals.

Pathogenesis of atherosclerosis: I: Role of the nervous system

The new method of lateral carotid artery original-location autograft was used in the present study. An animal model was prepared with which to investigate the neurogenic role in the pathogenesis of atherosclerosis. Two experiments were performed in 16 operated rabbits to whom was fed a cholesterol-rich diet for four months. In the first experiment, the expected results were obtained in 9 rabbits. Significant atherosclerotic plaques were observed in 4 of 9 (44.4%) samples of intact carotid artery; lipid deposition was found in another 3 (33.3%) samples in which atherosclerotic plaques were not observed by the naked eye but were exhibited by light microscopy; negative results were shown only in 2 (22.2%) samples both by the naked eye and by light microscopy. However, atherosclerotic plaques were found only in autograft anastomoses but not within the segment of carotid artery autograft. Then, a second experiment as performed with 7 operated rabbits, and similar results were obtained. These results clearly indicate that the nervous system plays a very important role in the pathogenesis of atherosclerosis.

Ultrastructural and electrophoretic analysis of Treponema hyodysenteriae axial filaments

Axial filaments of Treponema hyodysenteriae were purified and examined by transmission electron microscopy. The size and fine structure of the filaments were similar to those of Treponema zuelzerae and Treponema phagedenis biotype reiterii. Filaments were dissociated by heat and 2-mercaptoethanol and examined by polyacrylamide-gel electrophoresis. Six protein bands were evident, with approximate molecular weights of 39,000, 29,000, 27,000, 22,000, 21,000, and 18,500 daltons. All the proteins reacted with T hyodysenteriae and T innocens rabbit antisera, using the immunoblot technique.

Arachidonic acid, prostaglandin E2 and F2 alpha inhibit leucine degradation in chick skeletal muscle

Arachidonic acid (5 microM), prostaglandin E2 (0.28 microM) and F2 alpha (14 microM) inhibited (P less than 0.01) the rates of net leucine transamination, leucine oxidative decarboxylation and total CO2 production from leucine in extensor digitorum communis muscles from fed ten-day-old chicks. Indomethacin (50 microM) markedly inhibited (P less than 0.01) the rate of PGE2 production in the presence of 5 microM arachidonic acid and prevented the inhibition of leucine degradation by arachidonic acid in skeletal muscle. These results demonstrate that the actions of arachidonic acid on leucine degradation in chick skeletal muscle are mediated by metabolites generated via the cyclooxygenase pathway and that prostaglandins may play a role in the regulation of leucine degradation in skeletal muscle.

Effect of pyruvate, octanoate and glucose on leucine degradation in skeletal muscle from fed and fasted chicks

1. Pyruvate at 5 mM decreased the rate of leucine oxidative decarboxylation and increased the rate of 2-oxoisocaproate production in extensor digitorum communis (EDC) muscles from both fed and 24-hr fasted chicks. Pyruvate at 5 mM increased the net rate of leucine transamination in EDC muscle from fed chicks and had no effect in EDC muscles from 24-hr fasted chicks. 2. Octanoate at 0.2 and 1 mM markedly increased the rates of net leucine transamination, leucine oxidative decarboxylation and oxidation of decarboxylated leucine carbons 2-6 in EDC muscles from fed chicks, but had no effect on these parameters of leucine degradation in muscles from 24-hr fasted chicks. 3. Glucose at 5 and 12 mM decreased the rates of leucine oxidative decarboxylation and oxidation of decarboxylated leucine carbons 2-6, and increased the net rate of 2-oxoisocaproate production as compared to control (no glucose) group in muscles from fed chicks. Glucose had no effect on these parameters of leucine degradation in muscles from 24-hr fasted chicks.

Diamond-dusted microspatula tips for vitreoretinal surgery

We have developed a microsurgical spatula set consisting of four different tips and a universal handle. The set offers a range of tip angulation of 30 degrees, 45 degrees, 60 degrees, and 80 degrees. The bottom surfaces of the spatula tips are covered with fine diamond dust. The 30 degrees tip has a blunt and tapered end. All tips can be introduced through a conventional 20-gauge sclerotomy in a pars plana vitrectomy. The tips fit on a universal handle. The set has been used as a complement to vitreous forceps in dissecting and removing preretinal membrane.

Ketone bodies inhibit leucine degradation in chick skeletal muscle

1. DL-beta-hydroxybutyrate (4 mM) increased the net rate of leucine transamination and the net rate of 2-oxoisocaproate (KIC) production in extensor digitorum communis muscles from fed chicks. 2. DL-beta-hydroxybutyrate at 1 and 4 mM inhibited leucine oxidative decarboxylation in muscles from fed chicks. 3. Acetoacetate at 1 and 4 mM inhibited leucine oxidative decarboxylation and total leucine oxidation, but increased net KIC production in muscles from fed chicks. 4. Both DL-beta-hydroxybutyrate and acetoacetate at 1 and 4 mM inhibited the net rate of leucine transamination and the rates of leucine oxidative decarboxylation and total leucine oxidation in muscles from 24-hr fasted chicks.

Sorbents used for removal of urea in the system of artificial kidney

Three copolymers were made from the suspension polymerization of methyl acrylate, divinyl benzene and triallyl isocyanurate; acrylamide and N,N'-methylene-bis-acrylamide; and styrene and divinyl benzene. These copolymers were then converted into derivatives of hydrazides through several steps. They were used as polymeric sorbents. They sorbed in situ a little bit less than 40 mg. of urea per gram of sorbent at 37 degrees C, pH = 7.0-7.4 and the percentage of urea in the buffer solution being 130 mg%. The sorption of urea was related to the specific surface area of the sorbent, temperature of sorption and time of sorption, concentration of urea, pH value of solution etc. In order to find out whether the above-prepared derivatives of hydrazide can be used clinically as polymeric sorbents in artificial kidney system, the junior author carried out experiments with patient's dialysate as imitated to hemodialysis. From the results, it indicates the sorbents might be used in artificial kidney system because they sorbed the urea from hemodialysate as much as that of the pure urea in a buffer solution.

The efficacy and adequacy of continuous ambulatory peritoneal dialysis

Since it was introduced in 1976, continuous ambulatory peritoneal dialysis (CAPD) has won acceptance in many centres and it is now regarded as an important alternative to haemodialysis. CAPD patients have comparable and, in some circumstances, better survival than those on chronic haemodialysis. It is indicated particularly in patients with diabetes mellitus, cardiovascular instability and at the extremes of life. The success of kidney transplantation is similar in those maintained on CAPD and on haemodialysis. CAPD also achieves satisfactory physical and psychological rehabilitation, and the quality of life, including the level of sexual function, is similar during CAPD and haemodialysis. Women on CAPD menstruate more often than those on haemodialysis. CAPD provides adequate clearance of metabolic wastes, maintains fluid balance and ameliorates neurotoxic cognitive dysfunction. CAPD gives control of hypertension and anaemia which is superior to that on haemodialysis. Neuropathy remains stable but osteitis fibrosa seems to progress. CAPD is the most economical of the various forms of dialysis. We conclude that CAPD is an adequate form of replacement and should be made available in every nephrology centre providing treatment for patients with end-stage renal disease.

Spontaneous remission of nephrotic syndrome in IgA glomerular disease

We report two cases of adult onset nephrotic syndrome with pathologic features of minimal change disease but a predominance of IgA in mesangial regions. Both cases underwent spontaneous remission despite an episode of recurrent nephrotic syndrome in one patient. The relationship of the glomerular disease to minimal change and IgA nephritis is discussed.

A carrier state of X-linked juvenile retinoschisis

The carrier state of X-linked juvenile retinoschisis has not been known to be associated with any fundus abnormalities. We report a case where there are funduscopic changes and mild visual acuity changes in one eye of a carrier.

Continuous ambulatory peritoneal dialysis: no longer experimental

Many patients with end-stage renal disease have now been maintained for 5 years or more with continuous ambulatory peritoneal dialysis (CAPD). Viewed initially as an experimental alternative to be used only when hemodialysis was not feasible, CAPD is now seen as the treatment of choice in an increasing number of situations. CAPD is suitable for self-care. The main concern in the early years--peritonitis--is now less frightening and less frequent (one episode occurring every 18 patient-months as compared with every 8 initially), and this has allowed chronic complications of CAPD, such as malnutrition and loss of the peritoneum's capacity for ultrafiltration, to come to light. As would be expected, among patients of advanced age and those who have heart disease or diabetes, survival rates tend to be lower than among other CAPD patients. However, hypertension seems to be more easily controlled, pre-existing anemia can be significantly ameliorated, and young children grow more normally than they do with hemodialysis. Diabetes-related changes in vision stabilize in most CAPD patients, and control of the blood glucose level is good; insulin is administered intraperitoneally. CAPD is thus showing itself to be a feasible form of long-term treatment for end-stage renal disease.

Electron microscopic study of the peritoneal kinetics of iron dextran during peritoneal dialysis in the rabbit

Iron dextran, an electron-dense tracer, was given intravenously (100 mg of iron/100 g of body weight) to 8 normal rabbits to study its movement from the plasma to the peritoneal cavity during peritoneal dialysis. The dialysate infused at 75 ml/kg contained 1.5 g/dl of glucose in 4 animals and 4.25 g/dl in the remainder. Peritoneal dialysis was discontinued and the peritoneum was fixed in vivo at various times (20-120 min) after the injection of the iron dextran. Large amounts of tracer were detected in the effluent after draining the peritoneal cavity. Electron microscopic examination of the mesentery showed particles of iron dextran in the endothelial cells of small vessels (capillaries and venules) the interstitium and the mesothelial cells adjacent to vessels irrespective of the dialysate concentration or duration of dialysis. Tracer was not clearly demonstrated in the interendothelial or intermesothelial spaces. In the mesothelial cells, the particles were found exclusively in (small, elongated or large) vesicles, while in the endothelial cells they were both in vesicles and free in the cytoplasm. Our findings suggest that during the 20- to 120-min period after intravenous administration, the intracellular transport of iron dextran, depends on either moving vesicles or the presence of pre-existing tunnels in the mesothelial cells of rabbit mesentery.

Update on continuous ambulatory peritoneal dialysis

By now many patients have been successfully maintained on CAPD for five years or more, thus demonstrating that CAPD is a viable long-term treatment for end-stage renal disease. Peritonitis--the main concern of the earlier years--is now a less frightening complication. We know better how to treat peritonitis and its incidence has decreased from one episode every 8 months initially to one episode every 18 months now. In addition, several innovations, which have been or soon will be introduced, promise to decrease the frequency of peritonitis to an even lower rate. The problem of peritonitis is now being replaced by the chronic complications of CAPD, predominantly malnutrition and decrease in peritoneal ultrafiltration. CAPD has become an important adjunct in the treatment of children with ESRD, especially the very young. Even though not normal, their growth on CAPD is better than that of children on hemodialysis and as good as that after a successful transplant. CAPD has become a promising treatment for the diabetic with ESRD. This experience has stimulated interest and research in the role of intraperitoneal administration of insulin for blood glucose control. With the present worldwide experience of CAPD, this treatment has ceased to be experimental. A percentage of patients requiring dialysis will be better off on CAPD than on hemodialysis. Even though this percentage will vary among various countries, the nephrologist who wants to provide the best treatment for each patient must be well experienced in and have all treatments at his disposal including CAPD.

Perichondrial arthroplasty in the hand: a case report

A two-stage arthroplasty technique was used to treat an isolated fibrous ankylosis that developed in the index metacarpophalangeal joint of a 14-year-old boy after a rattlesnake bite. The first stage consisted of a minimal joint resection combined with rib perichondrial grafts to resurface the joint. The second stage, performed 5 months later, consisted of a capsulotomy and removal of a silicone membrane left within the joint to separate the grafts. Biopsy of the joint surfaces revealed the presence of hyaline-like cartilage. Nearly normal pain-free motion was restored. Follow-up now exceeds 30 months.

Arrangement of lambda light chain genes in mutant clones of the MOPC 315 mouse myeloma cells

The synthesis of lambda light chains and the arrangement of the lambda-chain genes was examined in cells of the mouse myeloma MOPC 315, which is an alpha lambda 2 producer, and in several mutants derived from it. The mutants produce lambda 2 chains only (MOPC 315.26, MOPC 315.34, and MOPC 315.37) or fail to produce alpha and lambda 2 chains (MOPC 315.25 and MOPC 315.36). Messenger RNA from the lambda 2 chain-producing cells directed the synthesis of a lambda 2 chain precursor and a fragment of the lambda 1 chain (lambda 1 F) in a wheat embryo cellfree system, whereas mRNA from the cells that do not produce lambda 2 chains directed the synthesis of lambda 1 F only. DNA from the parental MOPC 315 cells and from the lambda 2 chain-producing cells contained discrete EcoRI restriction fragments coding for rearranged lambda 1 and lambda 23 chain genes and their respective germ-line V and J-C regions. DNA from the no-Ig-producing cells contained fragments coding for the rearranged lambda 1 chain gene and the germ-line V lambda 2 region, but it lacked the sequences coding for the rearranged lambda 2 chain gene and the germ-line V lambda 1 and J-C lambda 1 regions. These results suggest that rearrangements of the lambda 1 and lambda 2 chain genes occur on different chromosomes in MOPC 315 cells and imply that rearrangements of the lambda 1 and lambda 2 chain genes on the same chromosome may be mutually exclusive.