Skin sensitization in asthmatic children less than 36 months of age

BACKGROUND

Atopy is reported to play an insignificant role in wheezing during infancy in contrast to later childhood. For this reason skin testing may not be included in a workup of wheezing infants.

OBJECTIVE/METHOD

In order to evaluate the degree and evolution of skin sensitization to allergens in infants with asthma, we have retrospectively analyzed the skin test results from 40 referred asthmatic children less than 36 months of age, who had had more than three wheezing episodes and whose symptoms improved on treatment with beta-agonist and anti-inflammatory agents.

RESULTS

Skin sensitization (epicutaneous) to common indoor and outdoor aeroallergens and foods were demonstrated in 23 (58%) of these patients. Asthmatic children with the onset before 12 months of age and duration of less than 12 months were sensitive predominantly to foods. Those with later onset asthmas and longer duration developed sensitivity first to indoor and then to outdoor allergens. The most common food, indoor, and outdoor allergens were egg, dust mite, and pollens, respectively. Six of these patients had repeat skin tests later. Two demonstrated a decrease in skin sensitivities to foods, one gained a new sensitivity to grass, while three remained unsensitized.

CONCLUSION

Skin sensitization to allergens was common in selected asthmatic infants and evolves in the order of exposures: foods, indoor allergens, and outdoor allergens. Repeat skin tests showed changing skin test patterns in some patients.

Acute monoarthritis associated with positively birefringent maltese cross appearing lipid spherules in a hyperlipidemic diabetic patient

A 63-year old man developed acute monoarthritis in the dorsum of the left foot. Polarized light microscopy of the synovial fluid from his third metatarsophalangeal joint revealed numerous positively birefringent lipid spherules with a maltese cross appearance. Positively birefringent lipid spherules can be found in association with acute, otherwise unexplained arthritis, and may induce synovial inflammation similar to that seen in other types of crystal-induced arthritis. We report a case of acute monoarthritis in which large numbers of positively birefringent lipid spherules were present in a hyperlipidemic diabetic patient.

Effect of 13-cis-retinoic acid with neoadjuvant chemotherapy in patients with squamous cervical carcinoma

Retinoids are strong inhibitors of epithelial cancer promotion and progression in experimental carcinogenesis. Recently, therapeutic trials of retinoids have demonstrated activities in cervical cancer and precancerous lesion of cervix. Our purpose was to determine whether additional administration of 13-cis-retinoic acid would improve the treatment effect of neoadjuvant chemotherapy in patients with squamous cell carcinoma of the cervix. From January 1994 through January 1995, 40 patients with invasive cervical cancer were enrolled in this prospective study and randomized into the two groups. Group 1 had neoadjuvant chemotherapy alone and group 2 had neoadjuvant chemotherapy plus 13-cis-retinoic acid (RA) at a dosage of 1 mg/kg/day for 1 month. Patients in group 1 and group 2 were similar with respect to age, parity, clinical stage, and histological subtype. Therapeutic responses were compared using Fisher's exact test, Mann-Whitney test, and Wilcoxon signed-rank test. RA increased the complete response rate of neoadjuvant chemotherapy from 0% in group 1 to 5% in group 2. However, a difference of overall clinical response rate between the two groups was not evident. The drug toxicities in group 1 and group 2 included anemia in 30.0% and 23.7%, leukopenia in 6.7% and 15.2%, and hepatotoxicity in 6.7% and 6.8%, respectively. More frequent incidence of mucocutaneous side effects was seen in group 2 than group 1, but these side effects were mild and reversible. The clinical response rate achieved in this trial indicates that the combination of 13-cis-retinoic acid and neoadjuvant chemotherapy, at least when used on the schedule reported herein, is not superior to treatment of neoadjuvant chemotherapy alone for patients with squamous cell carcinoma of the cervix. However, a single patient achieved a complete response on this therapy, and the impact of such a treatment on survival needs to be explored.

Pulmonary damage by Vibrio vulnificus cytolysin

Vibrio vulnificus is an estuarine bacterium that causes septicemia and serious wound infection. Cytolysin produced by V. vulnificus has been incriminated as one of the important virulence determinants of bacterial infection. Cytolysin (8 hemolytic units) given intravenously to mice via their tail veins caused severe hemoconcentration and lethality. Cytolysin treatment greatly increased pulmonary wet weight and vascular permeability as measured by (125)I-labeled albumin leakage without affecting those factors of other organs significantly. Blood neutrophils were markedly decreased in number after cytolysin injection, with a concomitant increase in the level of pulmonary myeloperoxidase activity, indicating that cytolysin-induced neutropenia might be due to pulmonary sequestration of neutrophils. By microscopic examination, severe perivascular edema and neutrophil infiltration were evident in lung tissues. These results suggest that increased vascular permeability and neutrophil sequestration in the lungs are important factors in lethal activity by cytolysin.

Chorionic villus sampling: clinical experience of the initial 750 cases

OBJECTIVE

To assess the factors that might influence the success rate, safety and reliability of chorionic villus sampling (CVS) and to evaluate the relationship between CVS and other congenital anomalies.

DESIGN

Analysis of the outcome of 750 cases of CVS (730 cases with transcervical and 20 cases with transabdominal).

SETTING

The outpatient prenatal genetic clinic of a university tertiary care center.

SUBJECT

Seven hundred and fifty pregnant women that underwent CVS for prenatal genetic diagnosis from 7 to 12 weeks of gestation.

RESULTS

Advanced maternal age was the most common indication for CVS (32.8%). The overall sampling success rate was 98.0% (735/750), representing 93.9% at 7 to 8 weeks, 98.1% at 9 to 10 weeks, and 98.3% at 11 to 12 weeks of gestation. The majority of cases (93.1%) required one or two aspirations. Cytogenetic analysis routinely included direct overnight and long-term culture methods which revealed 16 abnormalities (2.2%). Of 735 cases in which CVS was successful, 700 advanced to normal offspring, 17 had therapeutic termination, and 18 resulted in spontaneous abortions; there was an overall fetal loss rate of 2.4% (18/750).

CONCLUSION

CVS in early pregnancy is a relatively safe and reliable method of prenatal genetic diagnosis capable of replacing genetic amniocentesis. However, it must be done by experienced personnel. No congenital anomalies were found to be related to CVS in this series.

Expression of epidermal growth factor receptor in carcinoma of the cervix

Increased expression of the epidermal growth factor receptor (EGFR) gene has been shown in a large number of tumors, generally indicating a more aggressive biological behavior of cancers than those with low or normal expression. The role of EGFR in the tumorigenesis of the uterine cervix has been poorly understood and controversial. In order to explore the relationship between EGFR status and cervical carcinoma, tissues were analyzed from 40 patients, each of whom had invasive cervical carcinoma prior to treatment, 20 patients with cervical intraepithelial neoplasia (CIN) and 10 control cases who underwent hysterectomy due to benign gynecological disease at Yonsei University College of Medicine. We measured EGFR with an enzyme-linked immunosorbent assay which was a sandwich type using a mouse monoclonal capture antibody and a rabbit antiserum as detector. Patients with invasive cervical cancer were found to have significantly higher median EGFR expression than either the patients with CIN (P = 0.002) or the control (P = 0.001), respectively. However, there was no significant difference in EGFR status between CIN and the control groups. Overexpression of EGFR was found in 29 of 40 (72.5%) invasive cervical cancers and in 5 of 20 (25%) CIN patients. In invasive cervical cancer, no significant difference in EGFR levels was noted when stratified according to age, menopausal status, histological cell type, or clinical stage. With regard to tumor size, lesions of 4 cm and larger had significantly higher receptor levels than those lesions under 4 cm (P = 0.003). Even though quantitative EGFR status did not correlate with other prognostic parameters except tumor size, our results were consistent with the concept that EGFR may play an important role in malignant transformation and tumorigenesis in cervical cancer.

The clinical implications of early diastolic notch in third trimester Doppler waveform analysis of the uterine artery

To evaluate the clinical utility of third trimester Doppler waveform analysis of the uterine artery in predicting complicated pregnancies and fetal well-being, we compared adverse pregnancy outcomes in 2321 women with the presence of an elevated systolic-diastolic ratio (greater than 2.6) with the persistence of an early diastolic notch and with the combination of an elevated systolic-diastolic ratio and an early diastolic notch. The positive predictive values are 47.5%, 82.9%, and 92.6%, respectively. From these data we can conclude that determination of the presence or absence of an early diastolic notch is more valuable in predicting the perinatal outcome than is the presence of an elevated systolic-diastolic ratio alone. We also suggest that an assessment of the uterine artery systolic-diastolic ratio combined with the evaluation for persistent early diastolic notch would be a clinically useful test for fetal well-being.

Successful replacement of allergen-specific immunotherapy by allergen-mixture therapy

BACKGROUND

Some clinicians utilize allergen-specific immunotherapy (specific therapy), employing only the extracts of allergens that produce positive skin tests. Others use allergen-mixture immunotherapy (mixture therapy), employing premixed extracts containing both skin reactive and non-reactive (irrelevant) allergens.

OBJECTIVE

The purpose of this study was to compare the efficacy of these two approaches and to identify sensitization to irrelevant allergens included in mixture therapy.

METHOD

A total of 20 adults with allergic rhinitis/asthma who were switched from successful specific therapy (average duration of 6.1 years) to mixture therapy (2.0 years) were evaluated with symptom-medication scores, skin test results, and local/systemic reactions at three time points: before specific therapy, before, and 2 years after mixture therapy.

RESULTS

Symptom-medication scores for all patients improved at the end of specific therapy and remained improved during mixture therapy (12.3 versus 12.0 with P = .75). The sums of positive skin tests at three points were not different (7.8 versus 8.3 versus 9.8 with P > .4 at all points). Reaction rates did not differ either. Skin sensitization to irrelevant allergens occurred in five patients during mixture therapy. These patients, however, also experienced spontaneous conversions from negative to positive reactions to the allergens not included in the therapy, indicating that sensitization may be partly due to a spontaneous increase in skin reactivity.

CONCLUSION

These findings suggest that allergen-mixture immunotherapy is as efficacious as allergen-specific therapy and may be associated with skin sensitization in some patients. There was no evidence of increased adverse clinical reaction.

Rapid chromosome analysis and prenatal diagnosis using fluid from the cystic hygroma, hydrothorax and isolated ascites: new source for chromosome analysis

OBJECTIVE

To determine whether abnormally collected fetal body fluid could be used as alternative cell sources for cytogenetic assessment.

METHOD

Using modified lymphocyte culture, the abnormal fetal body fluids obtained from the five fetal anomaly cases (3 cystic hygromas, 1 hydrothorax, and 1 isolated ascites) were analyzed in order to determine their karyotypes.

RESULTS

Two cases showed 45, X and 46, XX/45, X and the other three showed a normal karyotype.

CONCLUSION

The cytogenetic analysis from body fluid aspiration yields a rapid and accurate result within 96 hours. This method could be helpful when cordocentesis or placental biopsy is not feasible or when time requirement for amniotic fluid cell culture is burdensome to patient management.

Loop diathermy and cold-knife conization in patients with cervical intraepithelial neoplasia: a comparative study

One hundred and sixty-eight cases of cervical conization were performed for cervical intraepithelial neoplasia (CIN) in a 32-month study. The indications for conization were unsatisfactory colposcopic finding, abnormal epithelium that extended into the endocervical canal, a microinvasive cervical cancer, and significant discrepancy among cytology, colposcopy, and/or punch biopsy histology. In the early period of the study, conization was done by the cold-knife method (N = 107), whereas loop diathermy was used in the latter part of the study (N = 61). Both groups were similar in terms of age, indications for conization, and size of cervical cone specimens. Loop diathermy conization was done in a significantly shorter time (5.7 +/- 1.8 minute vs 15.2 +/- 6.1 minute)(P < 0.05) than cold-knife conization. However, the difference in the postoperative complications between loop diathermy(3.0%) and cold-knife conization(4.7%) was not significant. The incidence rate of residual CIN III lesions in the subsequent hysterectomy specimens, found by histological documentation on these specimens was 25.0 and 26.1 percent after loop diathermy and cold-knife conization respectively. These results suggest that loop diathermy is much easier to perform and a more time-conserving treatment modality than cold-knife conization in the management of patients with cervical intraepithelial neoplasia.

Bone mineral density in premenopausal anovulatory women

To examine the impact of amenorrhea on bone mineral density in women of reproductive age, we performed a cross sectional study in 190 amenorrheic women, comprising 113 premature ovarian failure, 27 primary hypothalamic amenorrhea, 38 hyperprolactinemia and 12 Sheehan's syndrome. Measurement of bone mineral density was carried out using dual photon absorptiometry at four sites: femur neck, ward's triangle, trochanter and spine (L2-4) and we compared the result with that of 163 normal-cycle control women with age matched. Bone mineral densities was significantly low in patients with primary hypothalamic amenorrhea and premature ovarian failure at all four sites. In those with hyperprolactinemia a decrease in bone mineral density was noted at femur neck and spine while those with Sheehan's syndrome is associated with decreased bone density at femur neck, ward's triangle and trochanter. The degree of bone loss and the affected sites seems differ depending on the type of amenorrhea. In patients with primary hypothalamic amenorrhea, significant bone loss was already noted at all four sites by age 20. The decrement in bone density continued rapidly during the early twenties up to age 25 and then slowed after age 25. In those with premature ovarian failure with secondary amenorrhea there were no decrease in bone mineral density within the first year after onset of amenorrhea, however, in the subsequent 2 years, the reduction in BMD was rapid and thereafter the reduction slowed remarkably. The BMD in this study positively correlated with the body mass index and negatively with the phosphorus intake.

Antibodies in patients with inflammatory bowel disease and the apparent influence of medications

Patients with inflammatory bowel disease (IBD) are known to have increased antibodies to several food and bacterial antigens. To assess selected isotype contributions in greater detail, we examined the concentrations of IgA, IgG, IgE, and IgG4 antibodies to five selected antigens, two of bacterial and three of food origin. Thirty patients with IBD and thirty matched healthy controls were studied. Most antibodies were increased in IBD patients compared to controls. Statistically significant increases were more frequent in Crohn's disease (CD) than in ulcerative colitis (UC). An unexpected finding was that IBD patients treated with sulfasalazine had statistically higher levels of most IgA antibodies than healthy controls, while steroid treated patients had lower levels. These findings suggest differing effects on the immune systems of IBD patients by each of these commonly used drugs.

Pulsatile gonadotrophin-releasing hormone therapy in patients with pituitary tumours treated by surgery and irradiation

OBJECTIVE

Pulsatile administration of GnRH for induction of ovulation is effective for women with idiopathic hypogonadotrophic hypogonadism. We were interested to assess the pituitary-ovarian response to pulsatile GnRH infusion and the therapeutic effectiveness of restoring ovulation in a group of hypogonadotrophic women previously treated with surgery and irradiation to pituitary tumours.

PATIENTS

The group of patients comprised 15 hypogonadotrophic women, aged 29-40 years (mean 32.4 years), who had undergone transsphenoidal adenomectomy or craniotomy and irradiation with a total of 4500-5400 cGy in 25 fractional doses divided over 5-6 weeks. The time interval from irradiation to study was 6.3 +/- 2.0 years (mean +/- SD).

TREATMENT

A single bolus GnRH (100 micrograms) test and pulsatile infusion of GnRH were performed to assess the pituitary gonadotrophin reserve and induce ovulation. We tried to correlate the pituitary response with characteristics of intracranial lesions on computerized tomography findings. We undertook ovarian biopsy in one patient who failed to respond to gonadotrophin therapy and pulsatile infusion of GnRH.

RESULTS

Twelve women (80%) showed evidence of ovulation in response to pulsatile GnRH treatment and five subsequently became pregnant. Four of 12 ovulators were previous non-ovulators to exogenous gonadotrophin therapy. There was no correlation between pituitary response and character of lesions based on computerized tomography findings. A patient who failed to respond to either gonadotrophin or pulsatile infusion of GnRH had premature ovarian failure on ovarian histology.

CONCLUSIONS

The functional reserve capacity of pituitary gonadotrophs may remain less impaired by tumour encroachment, pituitary surgery or irradiation than had previously been thought. This holds promise for ovulation induction in hypogonadotrophic patients who had been treated with surgery and irradiation for pituitary tumours.

Gonadoblastoma and dysgerminoma associated with 46,XY pure gonadal dysgenesis--a case report

Gonadoblastoma and dysgerminoma developed in a 24-year-old phenotypic female patient with 46,XY pure gonadal dysgenesis. This patient presented with primary amenorrhea. Clinical characteristics showed a typical stigmata of gonadal dysgenesis: primary amenorrhea, sexual infantilism, a small uterus and bilateral streak gonads. A 46,XY karyotype was made by lymphocyte culture. The patient was counseled to undergo a prophylactic bilateral gonadectomy, but she refused. Three years and three months after the initial diagnosis she felt a growing pelvic mass. Bilateral gonadectomy and total hysterectomy were performed. Histological examination revealed gonadoblastoma and dysgerminoma on both gonads. After surgery the patient received radiation therapy and also was started on hormone replacement therapy. Two years and two months after treatment by surgery the patient is well and free of recurrence.

Growth hormone response to L-dopa and pyridostigmine in women with polycystic ovarian syndrome

OBJECTIVE

To evaluate the GH secretion and clarify the factors influencing the GH secretion in women with polycystic ovarian syndrome (PCOS).

DESIGN

Comparison of the GH response to L-dopa with or without pyridostigmine (inhibitor of acetylcholinesterase) pretreatment and insulin response to oral glucose tolerance test in patients with PCOS and matched controls.

SETTING

Outpatients and healthy volunteers studied at a clinical research unit of a university hospital.

PATIENTS, PARTICIPANTS

Ten women with PCOS and 9 controls with regular cycles were recruited.

INTERVENTIONS

After an overnight fast, each subject underwent a GH stimulation test with L-dopa with or without pyridostigmine pretreatment. Plasma insulin and glucose levels were measured after a 75-g glucose load.

MAIN OUTCOME MEASURES

Plasma GH, insulin-like growth factor I (IGF-I), insulin, and nonesterified fatty acids.

RESULTS

Growth hormone responses and GH area under the response curve (AUC) to L-dopa were significantly lower in PCOS than those in controls. Pyridostigmine enhanced the GH response to L-dopa significantly in PCOS. Insulin responses and insulin AUC to oral glucose load were significantly higher in PCOS than those in controls. Plasma IGF-I levels of PCOS were significantly higher than controls. Insulin AUC had a positive correlation with plasma IGF-I levels but an inverse correlation with GH AUC in PCOS and controls.

CONCLUSION

Our result indicated that decreased GH secretion of PCOS may be associated with a high somatostatin activity and a high plasma IGF-I level.

Maternal HEL immunization has no lasting effects on the immune response of offspring to immunization with hen egg-white lysozyme

The effect of prior maternal immunization on the murine offspring response to subsequent immunization with hen egg-white lysozyme was examined. Adult female A/J mice were immunized with 100 micrograms HEL-CFA intraperitoneally 10-27 weeks before conception. The offspring of these experimental female mice were then immunized with HEL-CFA at differing ages. Suppression of the anti-HEL IgG B cell response was observed when the offspring were immunized prior to 3 weeks of age when high levels of maternal antibody were still present. Older offspring, more than 8 weeks of age, were immunized with HEL-CFA to determine if exposure to maternal immunoglobulin early in ontogeny had primed or altered the offspring response to HEL. At this age, suppressive effects of transferred maternal antibody were no longer evident. Priming was not detected in the offspring as judged by the total magnitude of the anti-HEL antibody response or the kinetics of the response when experimental and age-matched control offspring were examined. Furthermore, qualitative differences in the response as evidenced by IgG vs IgM content and fine specificity of the response (primary vs secondary antibody) were not observed. No evidence was found to suggest that exposure to polyclonal maternal anti-HEL antibody had primed the offspring for a more efficient or qualitatively different response to immunization with the protein antigen HEL. After maternal antibody levels decreased, the offspring response was similar to that of controls, suggesting that the response had not been permanently altered by the prior exposure early in ontogeny to polyclonal maternal antibody.

Ovarian transposition with subsequent intrauterine pregnancy

A 28-year-old married, Korean woman was diagnosed with a right unicornuate uterus, a left hypoplastic tube, and a right ovarian necrotic corpus luteal cyst. We performed a right oophorectomy and an excision of the left hypoplastic tube and then transferred the left ovary to the right broad ligament with intact vascular pedicles. Thus the remaining left ovary and right fallopian tube were placed in proximity. The patient conceived 2 months after the operation and delivered a living male infant.

Estrogen and progesterone receptor assay in carcinoma of the cervix with monoclonal antibodies

The normal cervix has been shown to contain estrogen and progesterone receptors (ER and PR), but there have been controversial reports on the presence of these receptors in cervical carcinoma. Thus to explore the relationships between the steroid receptor status and cervical carcinoma, tissues of 34 patients with invasive cervical carcinoma prior to treatment and 30 cases of control who underwent hysterectomy due to benign gynecologic diseases at Yonsei Medical Center were analyzed for ER and PR using immunocytochemical assay with monoclonal antibodies and the results were compared with those of conventional steroid binding assay. ER and PR were positive in 65 and 71% of all tumors, respectively, and 59% of the cases were positive for both receptors simultaneously. No significant difference in receptor levels was noted when stratified according to menopausal status or clinical stage. With regard to tumor size, lesions greater than 3 cm had significantly lower receptor positivity when compared with the control. For the histological cell types, a statistically significant higher mean ER level was noted in adenocarcinoma compared to squamous cells. Even though the potential therapeutic significance of these findings is not yet known, they are consistent with the concept that steroid receptors can be used as a guide to endocrine therapy with respect to other prognostic parameters. However, the small number of advanced-stage carcinomas and the absence of data regarding survival rate in this study preclude any definite conclusions.

The embryonically active gene, unkempt, of Drosophila encodes a Cys3His finger protein

The unkempt gene of Drosophila encodes a set of embryonic RNAs, which are abundant during early stages of embryogenesis and are present ubiquitously in most somatic tissues from the syncytial embryo through stage 15 of embryogenesis. Expression of unkempt RNAs becomes restricted predominantly to the central nervous system in stages 16 and early 17. Analysis of cDNAs from this locus reveals the presence of five Cys3His fingers in the protein product. Isolation and analysis of mutations affecting the unkempt gene, including complete deletions of this gene, indicate that there is no zygotic requirement for unkempt during embryogenesis, presumably due to the contribution of maternally supplied RNA, although the gene is essential during post-embryonic development.

Evidence for idiotypic sharing between conventional and naturally activated B cells

In the primary immune response to hen egg-white lysozyme (HEL), approximately 50% of the primary anti-HEL antibody-forming cells (AFC) express IdXE, an idiotype absent from the secondary response. Spontaneous IgM enzyme-linked immunosorbent assay (ELISA)-AFC in spleen cells from naive A/J mice were analyzed for the occurrence of IdXE by use of two affinity-purified rabbit antisera, R213 and R8, each raised against a different primary IdXE+, anti-HEL mAb. Two ELISA-AFC assay methods were used: direct coating of immunoplates with R213 or development of IgM-producing ELISA-AFC with biotinylated R8. From ages 7 days until 6 months, 10-20% of spontaneous IgM AFC were found to be IdXE+. IdXE+ anti-HEL IgG1 monoclonal antibodies, 2F4 or 3C11 (100 micrograms/ml), completely inhibited binding of biotinylated R8 (0.5 micrograms/ml) to spontaneous IgM-AFC while IdXE-, anti-HEL IgG1, 5E11 and 2C7, showed no significant inhibition. Greater than 90% of IdXE+ spontaneous IgM-AFC were not HEL specific. We conclude that a dominant set of idiotopes found in a conventional antigen-driven immune response can also play a major role in the spontaneously activated B cell repertoire. Our data argue against a bifurcation of the immune system into a compartment of idiotypic network-related cells and an independent set of non-network cells subject to antigenic stimulation.

Inhibition of offspring response to HEL-CFA by administration of anti-HEL MAB to the mother is not related to the predominant idiotype, IdXE, or specificity of the MAB

In the neonatal suckling mouse, the antibody response to HEL-CFA can be inhibited by administration of certain anti-HEL monoclonal antibodies to the mother. The murine primary response to hen egg-white lysozyme (HEL), which can be elicited in A/J mice as early as 7 days of age, is characterized by a predominant specificity that includes the 3 N-terminal amino acids of HEL (TIP-dependence) and by a predominant idiotype, IdXE. A panel of murine IgG1 anti-HEL mAbs was administered to the suckling offspring via the mother. These mAbs were not equivalent in their effects on the offspring. Only two of six IgG1 mAbs, 2F4/2E5 (IdXE-positive, TIP-dependent) and 2D1 (IdXE-negative, TIP-independent), consistently induced suppression of the response of A/J offspring when immunized at 16-20 days of age with HEL-CFA. Suppression averaged 71% for 2F4/2E5 and 74% for 2D1 and was always statistically significant (P less than .05) when 275 micrograms mAb was administered IP to the mother within 24 hr postpartum. Since 2D1 is IdXE-negative and TIP-independent, neither of these properties appears to be crucial for suppression. Differences in transfer of the mAbs from the mother to the offspring or differences in catabolism of the mAbs in the offspring were not detected. When various characteristics of the mAbs such as affinity, idiotypy, and fine specificity were considered, there was no single factor which determined suppression. One of the two mAbs that suppressed the offspring response, 2D1, is idiotypically highly connected in the anti-HEL mAb panel. This observation suggests that idiotypic interactions in the developing neonatal repertoire with subsequent perturbation of T and B cell repertoire development may be an area for future investigation.

Comparison of the primate alphaherpesviruses. I. Characterization of two herpesviruses from spider monkeys and squirrel monkeys and viral polypeptides synthesized in infected cells

Biological and biochemical properties of two neurotropic herpesviruses of New World monkeys--Herpesvirus saimiri type 1 (HVS-1) and Herpesvirus ateles type 1 (HVA-1)--were examined and compared. HVS-1 and HVA-1 both exhibited a time course of replication similar to another primate herpesvirus, SA 8. Both viruses grew rapidly and high titers of infectious virus were readily produced. HVS-1 and HVA-1 were also able to replicate efficiently in cell lines derived from a number of primate and non-primate species. Analysis of proteins synthesized in infected cells revealed the presence of over 30 virus-specific proteins ranging from less than 30,000 to over 200,000 daltons apparent molecular weight. Both viruses specified synthesis of a major capsid polypeptide of 148,000 daltons. Pulse labeling of cells during infection demonstrated temporal differences in the kinetics of synthesis of individual viral proteins and post-translational modification of a number of viral polypeptides. Glycosylated polypeptides synthesized in HVS-1 and HVA-1 infected cells were identified which ranged from approximately 49,000 to 120,000 daltons. Structural polypeptides of HVA-1 and HVS-1 virions were identified by SDS-PAGE analysis of purified virions. Taken together with clinical data on the diseases caused by these viruses, these studies indicate that HVS-1 and HVA-1 appear similar in many respects to both the human herpes simplex viruses and alphaherpesviruses of other primates.

The effect of estrogen on monoamine systems in the fetal rat brain

The effect of a pharmacologic dose of estrogen on brain monoamine systems in the rat fetus was determined using a semiquantitative measure of histofluorescence. Pregnant rats received a subcutaneous injection of cottonseed oil alone or estradiol (E2) in cottonseed oil just before the monoamine systems began to develop. The fetuses were delivered abdominally and killed on day 22 of gestation. A study of four major monoamine areas of the brain with a glyoxilic acid preparation showed that intrauterine exposure to E2 has a significant effect on the monoamine organization of the fetal hypothalamus. No treatment effects were noted in the areas of locus coeruleus, substantia nigra and corpus striatum. The litter sizes of the E2-treated rats and the body weights of the fetuses were much lower than those of the control group. The effect of E2 on monoamine distribution in the fetal hypothalamus may explain the reported disturbances of reproductive function and sexual behavior seen after perinatal exposure to high doses of estrogen in humans.

Hemangiomatosis of the pleura with hemorrhage and disseminated intravascular coagulation

Hemangiomatosis involving the pleura is a rare cause of bloody pleural effusion in the neonate. When congestive heart failure and consumption coagulopathy are associated, the prognosis is particularly grave. Corticosteroids and radiation therapy have been reported to shrink hemangiomas. We present such a case in a 2.5-mo-old whose condition did not appear to respond to prednisone or radiation therapy but resolved quickly when cyclophosphamide was given. In this case cyclophosphamide appeared to be life saving.

Timing of laparoscopic sterilization in abortion patients

A total of 1604 laparoscopic sterilization procedures with variable time intervals after first trimester therapeutic abortion were performed at the Severance Hospital of the Yonsei University College of Medicine, Seoul, Korea, from May 1973 to October 1975. Two hundred fourteen women were sterilized immediately at the time of abortion; 359 were sterilized between 1 and 42 days later; and the remaining 1031 women were sterilized 43 or more days after abortion. Electrocoagulation and tubal ring application were the tubal occlusion techniques used. The findings indicate that patients who underwent the combined abortion-sterilization procedure did not encounter higher rates of technical problems and/or complications than the other 2 groups. Only a few of these 1604 women studied had potentially serious complications that necessitated subsequent laparotomy, hospitalization after sterilization, and/or hospital readmission.

Thyroid hypofunction in spinal cord injury patients

Our experience in the screening and detection of hypothyroidism in 225 spinal injury patients is described. Clinical features compatible with hypothyroidism are frequently encountered in these patients and require thyroid function testing to exclude or confirm thyroid hypofunction. Two cases of hypothyroidism, equivocal on clinical grounds alone, were first detected by a low value in screening tests for serum thyroxine levels and subsequently confirmed by a high serum TSH level. Low serum triiodiothyronine level is frequently found in apparently euthyroid patients with tetraplegia and is necessarily not an indicator of clinical hypothyroidism in these patients.