Serum alpha fetoprotein in 714 mentally retarded carriers of hepatitis B surface antigen

Sera from 714 mentally retarded carriers of hepatitis B surface antigen were screened for alpha fetoprotein (AFP) by monoclonal radioimmunoassay. Serum AFP levels were less than 20 mcg/L in 708 (99.2%) carriers. One 29-year-old carrier with normal liver function had serum AFP level of 1500 mcg/L, which increased to 12,500 mcg/L after 72 days. She died of multifocal hepatocellular carcinoma (HCC) with cirrhosis. Five other carriers with serum AFP levels between 20 and 165 mcg/L are alive without clinical HCC. No correlation was found between serum AFP level and race, age, sex, Down's syndrome, serum alanine aminotransferase level, and hepatitis B e antigen positivity. Single cross-sectional serum AFP screening by itself is not sufficient for early diagnosis of HCC.

Use of fetal cardiotocographic monitor in the evaluation of urinary incontinence

Thirty-five women (mean age 52 years, mean parity 3) were evaluated consecutively for urinary incontinence. Stability of the bladder was evaluated by standing provocative water urethrocystometry, using a microtip pressure transducer and a multichannel electrophysiologic recorder. Cystometry was repeated immediately after emptying of the bladder. Second cystometry (standing provocative) was performed using a fetal cardiotocographic monitor for pressure recording. The simple cystometry (using the cardiotocograph technique) was very sensitive when evaluating women with a stable bladder (n = 25) and less sensitive when detecting bladder instability (n = 10). We conclude that the use of this simple technique is a viable option if urodynamic equipment is unavailable. There is no need for further evaluation in patients with findings of a stable bladder, but if bladder instability is detected, further in-depth evaluation is required.

Hepatocellular carcinoma in hepatitis B surface antigen carriers in eight institutions

We reviewed records of all persons dying between 1979 and 1986 in eight California institutions for the mentally retarded. Autopsies had been done in 71% of the 1,181 deaths. Nine deaths were due to hepatocellular carcinoma, which invariably developed in carriers of hepatitis B surface antigen (HBsAg) and was fatal within four months of diagnosis. The mean age at death was 32.7 years. The incidence of hepatocellular carcinoma in HBsAg carriers was 140 times greater than in the US population. Persistent hepatitis B infection was probably etiologically related to hepatocellular carcinoma in this population, which is relatively free of exposure to other hepatocarcinogens.

Aflatoxin content of foods served to a population with a high incidence of hepatocellular carcinoma

During three seasons, 36 samples of foods served to mentally retarded clients with a high incidence of hepatocellular carcinoma were analyzed for aflatoxin. Aflatoxin was not detected (less than 5 ppb) by thin-layer liquid chromatography in 35 food samples containing peanuts, corn, wheat or milk. One peanut butter sample contained 20 ppb aflatoxin. Aflatoxin content of these foods was at or below the level permitted by the Food and Drug Administration. Aflatoxin is probably not responsible for liver disease in this population.

Anatomical basis of modern thoracotomies: the latissimus dorsi and the "serratus anterior-rhomboid" complex

The latissimus dorsi and the "serrato-rhomboid" complex are the muscles most often involved in present-day thoracotomies for lung surgery. The present anatomic study emphasizes: the continuity between the serratus anterior and the rhomboid levator scapulae mass as a wide muscular sheet with a deep common fascia, extending the serrato-thoracic space (of Gillis) to the vertebral column as the rhomboserrato-thoracic space (the levator scapulae is situated higher up, above the ordinary thoracotomy); the presence of a "composite fascia" in the posterior angle between the seratus anterior and the rhomboid; the long costal attachment area and the presence of two differently oriented layers for the muscular digitations of the middle and inferior parts of the serratus anterior. With a rich vascular supply from multiple sources, the serratus anterior and latissimus dorsi are two large flat muscles with a single longitudinal nervous pedicle proceeding from the brachial plexus. To avoid esthetic (winged scapula) and functional sequelae, it is imperative to safeguard this single innervation as far as possible : by halting division of the serratus anterior before reaching its neurovascular pedicle in lateral or anterolateral thoracotomy, and by transecting the latissimus dorsi very low down in standard postero-lateral thoracotomy. The other muscles are simply freed and retracted.

Brain cellular and mitochondrial respiration in media of altered pH

This study was designed to investigate the effects of altered pH on cellular aerobic energy metabolism in the immature and adult rat cerebral cortex. Cerebral cortical slice respiration was measured polarographically in acid and alkaline media. In separate experiments, the extracellular pH was changed by altering the HCO3- concentration or the intracellular pH and extracellular pH were changed by altering the CO2. Respiratory rates and oxidative phosphorylation in adult rat cerebral mitochondria also were measured in media with an altered pH. Increased intracellular pH inhibited respiratory rates in cortical slices from immature rats more than in tissue from adults. Decreasing the pH to 6.7 produced no changes in respiration in mature cortical slices and moderate inhibition of immature tissue respiration. In cerebral mitochondria, altered pH caused inhibition of State 3 respiration, respiratory control ratios, and ADP/O ratios. These changes were greater and occurred with smaller pH changes in the alkaline compared to the acid direction. From the results of these studies, we conclude that brain cellular respiration is not affected by moderate decreases in intracellular pH. With increased pH, there is inhibition of cellular and mitochondrial respiration, which may be the mechanism for the rise in lactic acid previously observed to result from hypocarbia in vivo.

Nucleic acid sequence and oncogenic properties of the HZ2 feline sarcoma virus v-abl insert

Hardy-Zuckerman 2 feline sarcoma virus (HZ2-FeSV), isolated from a multicentric feline fibrosarcoma is a replication-defective acute transforming feline retrovirus which originated by transduction of feline c-abl sequences with feline leukemia virus (FeLV) and is known to encode a 110-kilodalton gag-abl fusion protein with tyrosine-specific protein kinase activity (P. Besmer, W. D. Hardy, E. E. Zuckerman, P. J. Bergold, L. Lederman, and H. W. Snyder, Nature (London) 303:825-828, 1983). The nucleotide sequence of the abl segment in the HZ2-FeSV genome was determined and compared with the murine and human v-abl and c-abl sequences. The predicted transforming protein consists of 344 amino acids (aa) of FeLV gag origin, 439 aa of abl origin, and at least 200 aa of FeLV pol origin (p110gag-abl-pol). The 1,317-base-pair HZ2-FeSV v-abl segment (fv-abl) corresponds to 5' abl sequences which include the region known to specify the protein kinase domain. The 5' 189 base pairs of fv-abl correspond to 5' c-abl sequences not contained in Abelson murine leukemia virus (MuLV) v-abl. The mouse c-abl exon which contains these segments was identified, and its nucleotide sequence was determined. Comparison of the predicted amino acid sequence of fv-abl with those of Abelson MuLV v-abl and c-abl revealed five aa differences. The 5' junction between FeLV and abl was found to involve a preferred region in FeLV gag p30 (P. Besmer, J. E. Murphy, P. C. George, F. H. Qiu, P. J. Bergold, L. Lederman, H. W. Snyder, D. Brodeur, E. E. Zuckerman, and W. D. Hardy, Nature (London) 320:415-421, 1986). A six-base homology exists at the recombination site between the parental FeLV and the c-abl sequences. The 3' junction between fv-abl and FeLV pol predicts an in-frame fusion of fv-abl and FeLV pol. A transformed cell line containing a truncated gag-abl-pol protein, p85, that lacks most of the FeLV pol sequences was obtained by transfection of NIH 3T3 mouse cells. This result implies that the pol sequences of the p110gag-abl-pol protein are dispensable for fibroblast transformation. To assess whether the fv-abl segment specifies the unique biological properties of HZ2-FeSV, we constructed a Moloney MuLV-based version of HZ2-FeSV, Mo-MuLV(fv-abl), in which the fv-abl sequences were contained in a genetic context similar to that in HZ2-FeSV.(ABSTRACT TRUNCATED AT 400 WORDS)

[Absorbable synthetic clips and pulmonary excision. Our clinical experience]

Analysis of the first 50 clinical cases confirmed conclusions of experimental studies in large animals with respect to the use of absorbable synthetic clips formed of lactomer and polydioxanone. The advantages of clips when compared with ligatures include rapidity and simplicity of use and ease of insertion, even in regions difficult to approach surgically with the fingers. The advantages of clips of the absorbable synthetic type over conventional metallic material are: safety and reliability due to their locking system and the conservation of sufficient residual resistance, improved behavior in biologic media, radio-transparency and total inertia in magnetic fields compatible with postoperative radiation and modern medical imaging procedures (CT scan, IRM), and finally progressive resorption predictable by simple hydrolysis and then total disappearance after 6 to 7 months. With staplers of the TA and GIA type these clips make sutures and ligatures during lung resection surgery entirely automatic.

Electron microscopic localization of a fucose-binding protein in acrosome reacted boar spermatozoa by the fucosyl-peroxidase-gold method

In this study we have examined the behaviour and the localization of the fucose-binding protein (FBP) in boar spermatozoa during ionophore induced acrosome reaction (AR) by means of normal TEM and specimen preparation in toto. During early stages of AR the FBP is first localized at the border between equatorial segment and anterior acrosome. With the propagation of the AR the FBP is dramatically expressed and visible over the entire surface of the acrosome and equatorial segment. TEM pictures of this stages show that the FBP is associated with the OAM. At later stages of AR, when acrosomal ghost formation occur, the FBP is associated with the acrosomal ghost, and equatorial segment and to a very low degree also with the IAM. It is concluded from this data that the FBP is responsible for the specific binding of the ghost-sperm unit to the zona pellucida.

The amniostat immunologic slide test for phosphatidylglycerol: a comparison of efficacy among screening tests for fetal lung maturity

The Amniostat Immunologic Slide test detects the presence of phosphatidylglycerol (PG) that occurs in pregnancies complicated by diabetes. This paper reports on the performance of this test against other methods that determine the presence of fetal lung maturity.

[The 2 key muscles in thoracotomy for excision of the lung. The latissimus dorsi and the levator scapulae muscles]

Anatomical data related to the thoracotomies performed most frequently in lung surgery are described in some detail: continuity between serratus anterior and levator scapulae as a vide muscular sheet possessing a common deep aponeurosis (thoracolumbar fascia) extending Gilis' space to the vertebral column as the levator scapulae-thoraci space; presence of a "composite aponeurosis" in the posterior angle between serratus anterior and levator scapulae, covering the 8th rib triangle or triangle of auscultation; long costal insertion area and presence of two differently orientated muscle layers for the digitations, particularly of apical bundle. Supplied by a rich vascularization of multiple sources, the serratus anterior and latissimus dorsi are two muscles with single longitudinal nerve pedicles derived from brachial plexus. It is certainly the denervation which is responsible for the distal atrophy of these muscles "sectioned on the right of the selected ribs" following conventional thoracotomy. To avoid esthetic and functional sequelae this innervation must be preserved as far as possible by: interrupting division of serratus anterior anterior to long thoracic nerve and avoiding inclusion of axillary border of latissimus dorsi during lateral thoracotomy; sectioning the latissimus dorsi as low as possible--the other muscles being simply freed and inclined--during lateral thoracotomy.

Bacterial expression of the acquired immunodeficiency syndrome retrovirus p24 gag protein and its use as a diagnostic reagent

A retrovirus [lymphoadenopathy-associated virus, human T-cell leukemia virus type III, acquired immunodeficiency syndrome (AIDS)-related virus] suspected of causing AIDS has been isolated recently. The detection of exposure to this retrovirus in donors of various blood products is important to prevent transmission of the disease from these donors to recipients. In the majority of cases, the detection of antibodies directed against either the viral core protein, a Mr approximately equal to 24,000 protein termed p24 gag, or the viral envelope antigen is proof of previous viral infection. Thus, we have expressed the p24 gag antigen in Escherichia coli in order to produce a diagnostic reagent for the detection of virus exposure. The bacterially synthesized antigen reacts with human and rabbit antisera directed against the native p24 gag protein in both electrophoretic transfer blot assay and ELISA. In addition, the use of bacterially produced antigens for ELISAs gave results that were comparable to those obtained by using antigens isolated from the virus.

Heparan sulfate proteoglycans from mouse mammary epithelial cells: localization on the cell surface with a monoclonal antibody

Mouse mammary epithelial cells, of the normal murine mammary gland (NMuMG) cell line, bear a heparan sulfate-rich proteoglycan (HSPG) on their surfaces. A hybridoma (281-2) secreting a monoclonal antibody that recognizes this HSPG was produced by fusion of SP-2/0 myeloma cells with spleen cells from rats immunized with NMuMG cells. The 281-2 monoclonal antibody is directed against the core protein of the cell surface HSPG, as demonstrated by (a) recognition of the isolated proteoglycan but not its glycosaminoglycan chains, (b) co-localization of 281-2-specific antigen and radioactive cell surface HSPG on gradient polyacrylamide gel electrophoresis and on isopycnic centrifugation, and (c) abolition of immunofluorescent staining of the NMuMG cell surface by the intact, but not the protease-digested ectodomain of the cell surface HSPG. The antibody is specific for cell surface HSPG and does not recognize the HSPG that accumulates extracellularly beneath the basal cell surface. Therefore, the 281-2 antibody may be used to isolate the cell surface HSPG and to explore its distribution in tissues.

Secretion of the organic anion harmol sulfate from liver into blood. Evidence for a carrier-mediated mechanism

In the liver, drugs with phenolic groups can be converted to sulfate or glucuronide conjugates and are then transported into bile or back into the bloodstream. The mechanism for transport of drugs and drug conjugates from the hepatocytes into the blood at the sinusoidal side of the cell are not well defined. In the case of carrier-mediated transport of these strongly polar conjugates, saturability of transport and mutual competition between structurally related compounds would be anticipated. This competitive aspect was investigated by using two organic anions, dibromosulfophthalein (DBSP) and harmol sulfate. The latter compound was generated by the hepatocytes from harmol, which was continuously infused into the rat in vivo and in isolated perfused rat livers. In addition we loaded the perfused rat livers with preformed harmol sulfate and studied its efflux rate to the perfusate as influenced by DBSP. In steady state, about 80% of harmol was sulfated and 20% was glucuronidated. Harmol sulfate was mainly excreted in the urine, the glucuronide was equally excreted in urine and bile. DBSP lowered the urinary excretion of harmol sulfate by about 30% which was due to a decrease in plasma concentration. However, renal clearance of harmol sulfate (3.2 +/- 0.2 ml/min) was unchanged. At the same time DBSP doubled the biliary clearance of harmol sulfate (1.0 +/- 0.1 and 2.2 +/- 0.2 ml/min in controls and DBSP studies respectively). DBSP decreased glucuronide excretion both in urine and bile. The increase in biliary output and decrease in urinary excretion of harmol sulfate is explained by competitive interaction between the organic anion DBSP and harmol sulfate at the sinusoidal level. Efflux experiments in single pass perfused isolated livers showed a clear decrease of harmol sulfate transport from liver into plasma by DBSP and provided evidence for such an inhibitory phenomenon (t 1/2 of efflux was 3.58 +/- 0.21 compared with 2.46 +/- 0.07 min for controls). These results indicate that organic anion transport from the hepatocyte into the blood stream is very likely carrier-mediated. A decrease in renal output of drug conjugates therefore may not only be due to a decrease in the conjugation process but also to a lower liver to blood transport rate which at the same time may produce a higher biliary output.

[Absorbable synthetic clips and pulmonary excision]

From the beginning of this decade, two new, 2nd generation, resorbable synthetic materials--polydioxanone and lactomer--have been able to be molded into clips which, in contrast to metallic clips, are fitted with an original locking system preventing any slipping, either transversal or longitudinal, on the vessels. An experimental study was conducted to confirm their great reliability and perfect safety on large vessels (up to 8-9 mm) of large laboratory animals--both pulmonary and systemic vessels. Positive results justified their application to pulmonary vessels in humans during surgery, the pulmonary vessel being at a much lower pressure than in the main circulatory system. These new clips possess the advantages of metallic clips and resorbable synthetic threads without their inconveniences: rapidity, simplicity and ease of application, radio-transparency and complete inertia in magnetic fields enabling radiotherapy and modern postoperative investigations (scanner, NMR...) to be carried out.

Avoidance of GABA-containing diets by olfactory bulbectomized rats

In order to test the importance of olfaction in the avoidance of GABA-containing diets by intact rats, olfactory bulbectomized and sham-operated control rats were allowed to choose between a low protein control diet and this diet supplemented with 2.5% GABA; the specificity of the response was examined by also testing for responses to other amino acids. Both groups of rats markedly avoided the GABA diet initially; the bulbectomized rats later tended to increase their intake of this diet. The bulbectomized rats chose similar amounts from the control diet and one supplemented with alanine whereas the control rats ultimately strongly preferred the latter diet. Both groups only moderately avoided a threonine-supplemented diet. The results suggest that (1) the odor of GABA is not critical in the avoidance of diets containing this amino acid; and (2) patterns of food selection from diets containing GABA differ from choices from diets containing other small neutral amino acids such as alanine or threonine.

Shape and elasticity effects on erythrocyte electrostatic repulsion

It is shown that the double-layer interaction between two symmetrically parallel red blood cells depends largely on their shape and elasticity. Various shapes are examined, including the realistic shape of a biconcave discocyte with an elastic membrane. It is found that changes in the shape and the elasticity of the erythrocyte may result in orders of magnitude differences in the forces and energies of pair interaction.

[Assessment of 7 years of automatic suturing in pulmonary surgery]

In 738 patients, the stapler-suturing methods were used in 2 main areas of concern: closure of the major hilar broncho-vascular structures (for smaller pulmonary vessels, we use absorbable ligating clips: Absolok from Ethicon and Polysurgiclip from USSC), suture of the lung parenchyma. Regarding pedicular sutures, our rate of bronchial fistula is 1,0% (or 4,4% if only pneumonectomies are taken into account: 1,4 on the left and 7,7 on the right). These rates are compared with those gathered from the literature, with emphasis on the right main bronchus. Regarding parenchymal sutures, we place TA and GIA on collapsed parenchyma for achieving a wide range of either intralobar or translobar procedures. We lay emphasis on: the conventional segmentectomies with stapling of the intersegmental surface, and the newer and more economical "non réglées" transsegmental resections in which the surgeon is anymore limited by segmental frontiers. The control of blood and air leakage from the cut surface is quite satisfactory, reducing significanthy the postoperative morbidity. For both major pedicular structures and fragile lung parenchyma, the stapler-suturing methods are very reliable and provide a quicker, simpler, safer, easier and more economical surgery in lung resections.