Anti-factor IX circulating anticoagulant and immune thrombocytopenia in a case of Takayasu's arteritis

A 38-year-old male with proven Takayasu's arteritis presented, in a routine investigation, with thrombocytopenia, prolonged whole blood clotting time and activated partial thromboplastin time. Further studies demonstrated low levels of factor IX caused by a circulating anticoagulant. Immunological studies revealed an IgG (with kappa chains predominance) nature of this. Corticoid therapy decreased but did not suppress the anticoagulant activity. Since similar coagulation abnormalities have been described in collagen diseases, this observation is in support of this etiology to be considered in Takayasu's arteritis.

Relationship between kallikrein release and factor XII in normal persons and carriers of the Hageman trait

In four healthy subjects with Factor XII levels equal to or below 50% (selected at random from 100 persons) the release of Kallikrein was studied in order to establish the relationship between the above data and those found in four Hageman trait carriers showing levels of Factor XII above the lowest normal limits. It was found that for similar amounts of Hageman activity three of the carriers showed significantly less release of Kallikrein than the control subjects in whom it was normal. The conclusion was reached that the additional determination of the amount of Kallikrein released may be of value in the detection of carriers of the Hageman trait.

Factor-XII congenital deficiency. A new family study

This report describes two people in a family with Hageman trait (homozygotes) (Factor XII = 0.06%). In addition eight family members were studied to evaluate the inheritance of this congenital deficiency. A study of the Kallikrein-Kininogen system induced by the fragments of Factor XII was carried out. It is concluded that the inheritance is as described by Veltkamp and that the Kallikrein release from the prekallikreinogen (Fletcher factor) "in vitro" is related to the amount of Factor XII procoagulant protein.

Metabolic activity of human polymorphonuclear leucocytes: relation to ingestion rate

The ingestion rate and oxygen-dependent metabolic activities of normal human polymorphonuclear leucocytes were measured with heat-killed Klebsiella as the particle. Since the experimental conditions were similar for each measurement, it was possible to make direct correlations between each oxygen-dependent reaction and (1) ingestion rate and (2) the other oxygen-dependent reactions. In the controls, oxygen-uptake was more reliably correlated (r = 0.960) with ingestion rates than with (in order of reliability) hydrogen peroxide produced (r = 0.860) and iodination (r = 0.858 and 0.813 for 100 and 20 micromol/l iodide respectively). Hydrogen peroxide production (r = 0.988), nitroblue tetrazolium reduction (r = 0.969) and cytochrome c reduction (r = 0.862) were more reliably correlated to oxygen-uptake than to ingestion rate, and iodination was better related to hydrogen peroxide production (r = 0.90 and 0.819 for 100 and 20 micromol/l iodide respectively) than to ingestion rate. From these findings it was possible to locate primary defects in abnormal polymorphonuclear leucocytes from individual patients with pyogenic infections, idiopathic refractory anaemia or idiopathic oesteomyelofibrosis with splenomegaly, even when several deficiencies existed.

Relationship Between Kallikrein Release and Factor XII in Normal Persons and Carriers of the Hageman Trait

In four healthy subjects with Factor XII levels equal to or below 50% (selected at random from 100 persons) the release of Kallikrein was studied in order to establish the relationship between the above data and those found in four Hageman trait carriers showing levels of Factor XII above the lowest normal limits. It was found that for similar amounts of Hageman activity three of the carriers showed significantly less release of Kallikrein than the control subjects in whom it was normal.

The conclusion was reached that the additional determination of the amount of Kallikrein released may be of value in the detection of carriers of the Hageman trait.

A new variant of glucosephosphate isomerase deficiency with mild haemolytic anemia (GPI-MYTHO)

A new case of glucosephosphate isomerase deficiency with mild haemolytic anaemia was observed in a 6-year-old girl. Deficient enzyme was characterized by a profoundly decreased activity in the red cells, a normal electrophoretic phenotype, normal isoelectric point, normal optimum pH, a molecular instability and a clearly decreased Michaelis constant for fructose-6-phosphate. Propositus was double heterozygote for a 'silent gene' inherited from the mother and an abnormal enzyme from the father. Because this abnormal enzyme has undescribed characteristics, it responds to a new variant for which we propose the name GPI-MYTHO.

NADPH-oxidation activities in subcellular fractions isolated from resting or phagocytozing human polymorphonuclears

Using a fluorometric assay for the determination of oxidized pyridine nucleotides (NAD[P]+), total and cyanide-resistant NADPH-oxidative activities have been measured in subcellular fractions isolated from resting and phagocytosing human polymorphonuclears. Enzymatic activies responsible for the oxidation of the NADPH have been recovered in the heavy particles (15,000g/15 min), the low-density particles (100,000g/30 min), and the cytosolic fraction. Stimulation of the cells with opsonized zymosan had a different effect on the NADPH-oxidative activities of these subcellular fractions, which suggests the involvement of various types of enzymatic systems in the oxidation of NADPH. The cytosolic fraction interacted strongly with the enzymatic activities occurring in the sedimentable fractions and is therefore thought to play a central role in the regulation of the activation of the oxidative metabolism associated with phagocytosis.

Cyanide-insensitive NADH oxidation by subcellular fractions isolated from human polymorphonuclear blood cells

The biochemical triad, NADH oxidation, oxygen (O2) uptake and hydrogen peroxide (H2O2) formation, by subcellular fractions of human blood polymorphonuclears (PMNs) was investigated. It was found that this biochemical triad (1) was under the control of the granule-rich fraction (GRF) only; (2) was not inhibited by cyanide; (3) occurred stoichiometrically for its three components, and (4) accounted quantitatively for the respiratory burst of the stimulated PMN. It was also shown that the above biochemical triad (1) involved an enzymatic step; (2) was enhanced by acidic pH (0.5) and Mg++; (3) was inhibited by Cu++ or low concentration of Mn++; (4) was dependent on H2O2, perhydroxyl radical (HO2) and hydroxyl radical (HO) since either catalase or superoxide dismutase or scavengers of HO2 or HO were inhibitor, and (5) involved multistep reactions. Evidence is provided that the sequence of the reactions is first a generation of H2O2, (spontaneously from NADH in our incubation medium), secondly the production of HO from H2O2, thirdly the oxidation of NADH with further production of HO2,O2 uptake and H2O2 formation, probably through a chain reaction. The identification of the enzyme(s) involved in these multistep reactions needs further studies.

Transplantation of the left lung into the right hemithorax to facilitate immediate reconstitution of bronchial artery flow

Immediate bronchial artery reconstitution may be important in the prevention of bronchial anastomotic problems in lung transplantation. To facilitate this reconstitution in circumstances requiring allograft replacement of the right lung, we developed a method for transplanting the left lung together with its bronchial arterial supply into the right hemithorax. With this method, left lungs were allotransplanted into the right hemithorax of nine immunosuppressed dogs. Six recipients survived 1 to 4 weeks. Death resulted from pneumonia or rejection, and there were no bronchial anastomotic problems. Roentgenograms showed that the bronchial artery was patent and that the inverted transplanted left lungs could conform exactly to the thorax without space problems or radiographic abnormalities. Except for the unusual position of the large pulmonary arteries, angiographic patterns, function, and perfusion of the transplanted lungs were often normal and equivalent to those of the recipient's normal left lung. Thus it is possible to transplant a left lung into either hemithorax and immediately reconstitute its bronchial arterial circulation. Bronchial anastomotic problems may thereby be decreased.

The crystal structure of bis(ethyldiazoacetate) mercury(II) Hg(CN2CO2C2H5)2

Bis(ethyldiazoacetate) mercury(II) is orthorhombic with the following unit cell data at 20 °C: Fdd2, a = 19.810(8), b = 14.387(5), c = 9.015(2) Å, V = 2569.3 Å3, ρ0 = 2.17(2), ρc = 2.21, Z = 8 ([Formula: see text]λ = 0.70930 Å). The structure was solved by heavy atom methods and refined to R = 2.2% for 706 reflections. The molecule has a 2-fold axis of symmetry and all thermal parameters are large in the direction of this axis; diffuse scattering was observed in the rotation photograph taken about this axis. As expected the diazoacetate portion is planar.

The crystal structure of tert- butyl ethyldiazoacetate mercury(II)

tert-Butyl ethyldiazoacetate mercury(II) is monoclinic with the following unit cell data at 20 °C: P21/n, a = 8.089(3), b = 18.720(10), c = 7.893(3) Å, β = 93.20(3)°, V = 1193.3 Å3, ρo = 2.09(1), ρc = 2.06, Z = 4. The structure was solved by heavy atom methods and refined to R = 6.6% for 1003 reflections. The diazoacetate portion is planar; the CN2 portion is linear.

Effective preservation and transportation of lung transplants

To evaluate a system for preserving and transporting lungs before transplantation, we removed the left lungs of 37 dogs, flushed them with a hypertonic solution having an electrolyte composition resembling intracellular fluid, and immersed them at 4 degrees C. for 7 to 24 hours. Some lungs were maintained at exactly 4 degrees C. during transport by means of a mixture of solid and liquid l-hexadecene. The lungs were allografted into immunosuppressed dogs whose right pulmonary artery was immediately ligated. Twelve recipients (32 per cent) survived 5 days or more solely on the function of the preserved lung. Four survived 10, 19, 40, and 40 days with lungs that had been preserved for 7 to 21 hours. Survival of recipients of preserved lungs (5 +/- 2 days) was equivalent to that of 75 comparably immunosuppressed recipients of nonpreserved allografts (6 +/- 1 days). One group of 10 dogs receiving lungs flushed against outflow resistance survived 12 +/- 5 days. In recipients of preserved allografts, arterial oxygen tensions remained in the normal range up to 5 weeks after transplantation, and radiographic infiltrates in the transplant were no greater than those present in recipients of nonpreserved transplants. Thus lungs transported and preserved up to 21 hours can provide total pulmonary function after transplantation and can function at least as well as nonpreserved transplants. The effectiveness and simplicity of this method are such that it might be considered for use in man.

Alveolar lavage cytology in transplanted lungs. I. Staining methods and findings in dogs with autografts and allografts without immunosuppression

Alveolar lavages were performed repetitively on the normal and transplanted lungs of dogs that had recieved autografts or allografts without immunosuppression. One half of the lavage returns was fixed as a cytologic smear; the other half was subjected to semi-thin section or electron microscopic examination. Of the staining methods was used, the periodic acid-Schiff (PAS) and Giemsa techniques were best for differentiating and counting cells. The Ladewig technique was best for evaluating the presence and location of fibrin. After autotransplantation, the proportion of so-called alveolar marcophages increased, reached a peak in 4 to 7 days, and then returned to normal. Phagocytized fibrin increased for the first postoperative week, but not extracellular fibrin was ever observed. After allotransplantation, a progressive decrease in the proportion, size, and vacuolization of so-called alveolar macrophages was noted along with an increase in extracellular fibrin. Intracellular fibrin could be detected only up to the third day. These findings define adequate methods for preparing and staining material obtained from diagnostic alveolar lavages, and they suggest that the procedure may serve as an index of lung allograft rejection.

Single lung transplantation in experimental and human emphysema

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The role of renin in the exaggerated natriuresis of hypertension

Hypertensive patients were classified according to their plasma renin response when challenged by the potent diuretics, ethacrynic acid (50 mg IV), or furosemide (40 mg IV), into renin-unresponsive and renin-responsive groups. In the latter plasma renin activity rose by at least 0.5 ng of angiotensin/ml/hr after the diuretic. The response to volume expansion with 2 L of isotonic saline infused over 60 min was then studied. Peak rate of sodium excretion after saline loading was 994±186 µEq/min in the renin-unresponsive group and peak urine flow was 11.9 ± 2.1 ml/min. In the renin-responsive hypertensives peak sodium excretion was 448 ± 149 µEq/min and peak urine flow was 5.4 ± 1.5 ml/min. Both the sodium excretion and urine flow responses were significantly higher ( P < 0.05) in the renin-unresponsive group. The degree of saline-induced diuresis and natriuresis was not related to the preexisting level of aldosterone production. Plasma renin changed little in either group during saline infusion but tended to be higher at all times in the renin-responsive subjects. The enhanced capacity of the renin-unresponsive hypertensive subjects to excrete a salt load suggests either a functionally significant degree of extracellular fluid volume expansion or a direct role for renin in the natriuresis accompanying volume expansion.