Management of cardiovascular disease risk factors in children. A national survey of primary care physicians

A national survey of family physicians, general practitioners, and pediatricians revealed substantial physician differences in managing cardiovascular disease risk factors in children aged 2 to 18 years. Pediatricians tended to screen younger children but were more conservative in treatment. General practitioners tended to screen less and to initiate intervention in older children, but were more aggressive in therapy. While only 9% of surveyed physicians measured blood cholesterol levels routinely, 72% screened children with family histories of cardiovascular disease. The majority routinely measured blood pressure, but the ages of first measurements differed among physicians. Surprisingly, of those who had treated children with elevated blood pressure or blood cholesterol, 54% said that they had ever used antihypertensive and 12% used lipid-lowering drugs in children, including angiotensin converting enzyme inhibitors and clofibrate. Half the surveyed physicians felt prepared to provide dietary counseling, but only 14% felt successful with it. When asked what they considered were the major cardiovascular risk factors, less than one third of the physicians cited all three major factors: hypertension, hypercholesterolemia, and smoking.

Monocyte/macrophage Fc gamma RIII, unlike Fc gamma RIII on neutrophils, is not a phosphatidylinositol-linked protein

The low affinity IgG Fc receptor, Fc gamma RIII, expressed on circulating neutrophils, natural killer (NK) cells, and tissue macrophages, is involved in effector functions such as cytotoxicity and immune complex clearance by these cells. While Fc gamma RIII is reported to be a phosphatidylinositol (PI)-linked, rather than peptide-linked, protein on neutrophils and NK cells, its membrane linkage in macrophages has not been studied. We examined the sensitivity of Fc gamma RIII to cleavage by PI-specific phospholipase C (PI-PLC) in cultured monocytes and alveolar tissue macrophages and report that this receptor is not PI-linked on these cells. We also observed normal levels of Fc gamma RIII on cultured monocytes of a patient with paroxysmal nocturnal hemoglobinuria, a disease in which PI-linked proteins are deficient. The results suggest that Fc gamma RIII occurs solely in a transmembrane form in cells of the monocyte/macrophage lineage. In addition, we studied Fc gamma RIII on a cloned NK cell line and found it to be resistant to the effects of PI-PLC under conditions that cleaved Fc gamma RIII on neutrophils. Taken together, our results provide evidence for a distinct form of Fc gamma RIII that differs from the neutrophil receptor in its structure and, possibly, in its function.

Effects of treadmill exercise on the distribution of blood flow between the hindlimb muscles and abdominal viscera of the laying fowl

1. Blood flow distribution between the abdominal viscera and the leg muscles of regularly-laying Rhode Island Red hens was measured at rest and immediately following treadmill exercise, using the radioactive microsphere technique. 2. Exercise brought about a 150% increase in metabolic rate and this was maintained continuously for 90 min. 3. Although there was a small shift in blood flow distribution towards the hindlimb muscles at the expense of the kidneys and reproductive organs, this was not statistically significant. 4. There was a significant reduction in blood flow to the preovulatory follicles of the ovary during exercise, relative to the rest of the abdominal viscera. 5. It is concluded that exercise of this intensity is insufficient to bring about gross changes in blood flow distribution between the abdominal viscera and the hindlimb muscles. The implications of this finding are discussed in relation to the nutrient and blood flow requirements of the reproductive organs.

Treatment of a malignant bronchial carcinoid affecting the mediastinum and left atrium by radical two stage resection with cardiopulmonary bypass and somatostatin infusion

At operation a malignant bronchial carcinoid that had invaded the left atrium produced a carcinoid crisis in a 63 year old woman. A somatostatin infusion was required to resuscitate the heart and circulation and to allow subsequent resection of the carcinoid under cardiopulmonary bypass.

Modulation of Ig gene expression by Ig binding factors. Suppression of alpha-H chain and lambda-2-L chain mRNA accumulation in MOPC-315 by IgA-binding factor

Previous reports by a number of laboratories have shown that Ig-binding factors may play a role in the regulation of Ig production by B cells. Although numerous studies have addressed the specificity and biologic function of Ig-binding factors at the cellular level, little information is available regarding the mechanism whereby Ig-binding factor modulates Ig production by B cells at the molecular level. Herein we have examined the specificity and molecular mechanism of the suppression of IgA production mediated by IgA-binding factor. Using the IgA-secreting plasmacytoma, MOPC-315, as a target cell, we have demonstrated that: 1) IgA-binding factor binds to IgA, but not to IgG, IgM, or BSA; 2) IgA-binding factor can suppress proliferation as well as IgA production by MOPC-315; 3) soluble IgA, but not IgG or IgM can inhibit the action of IgA-binding factor; 4) suppression of Ig production by IgA-binding factor is maximal within 8 to 12 h after exposure to the factor and is reversible; 5) IgA-binding factor suppresses IgA production by selectively down-regulating synthesis of IgA H and L chain proteins; 6) IgA-binding factor selectively suppresses transcription of alpha-H chain and lambda-2-L chain genes; 7) IgA-binding factor suppresses accumulation of c-myc mRNA. These findings suggest that IgA-binding factor binds selectively to surface IgA on MOPC-315 and suppresses IgA production by down-regulating transcription of H and L chain genes. Suppression of MOPC-315 proliferation by IgA-binding factor may be related to the concomitant down-regulation of the expression of the c-myc gene. c-myc is deregulated in MOPC-315 by virtue of the reciprocal 15:12 chromosomal translocation present in MOPC-315 where the c-myc gene is translocated and rearranged into the alpha-H chain gene complex. Simultaneous suppression of the expression of c-myc and alpha-H chain genes suggests that these two genes may be coordinately modulated, in plasmacytomas, by IgA-binding factor.

Modulation of Ig gene expression by Ig binding factors. Suppression of alpha-H chain and lambda-2-L chain mRNA accumulation in MOPC-315 by IgA-binding factor

Previous reports by a number of laboratories have shown that Ig-binding factors may play a role in the regulation of Ig production by B cells. Although numerous studies have addressed the specificity and biologic function of Ig-binding factors at the cellular level, little information is available regarding the mechanism whereby Ig-binding factor modulates Ig production by B cells at the molecular level. Herein we have examined the specificity and molecular mechanism of the suppression of IgA production mediated by IgA-binding factor. Using the IgA-secreting plasmacytoma, MOPC-315, as a target cell, we have demonstrated that: 1) IgA-binding factor binds to IgA, but not to IgG, IgM, or BSA; 2) IgA-binding factor can suppress proliferation as well as IgA production by MOPC-315; 3) soluble IgA, but not IgG or IgM can inhibit the action of IgA-binding factor; 4) suppression of Ig production by IgA-binding factor is maximal within 8 to 12 h after exposure to the factor and is reversible; 5) IgA-binding factor suppresses IgA production by selectively down-regulating synthesis of IgA H and L chain proteins; 6) IgA-binding factor selectively suppresses transcription of alpha-H chain and lambda-2-L chain genes; 7) IgA-binding factor suppresses accumulation of c-myc mRNA. These findings suggest that IgA-binding factor binds selectively to surface IgA on MOPC-315 and suppresses IgA production by down-regulating transcription of H and L chain genes. Suppression of MOPC-315 proliferation by IgA-binding factor may be related to the concomitant down-regulation of the expression of the c-myc gene. c-myc is deregulated in MOPC-315 by virtue of the reciprocal 15:12 chromosomal translocation present in MOPC-315 where the c-myc gene is translocated and rearranged into the alpha-H chain gene complex. Simultaneous suppression of the expression of c-myc and alpha-H chain genes suggests that these two genes may be coordinately modulated, in plasmacytomas, by IgA-binding factor.

Anti-GBM antibody-induced proteinuria in isolated perfused rat kidney

The effect of anti-GBM antibody on protein excretion was studied in isolated rat kidneys perfused with 20 mg of sheep anti-rat GBM (experimental) or nonantibody sheep IgG (control). Six control kidneys excreted 176 +/- 31 micrograms/min of BSA initially, rising to 296 +/- 111 micrograms/min at 2 h. Fractional clearance of BSA rose from 0.51 to 1.70%. Eight experimental kidneys excreted 211 +/- 56 micrograms/min of BSA, increasing to 1,924 +/- 804 micrograms/min at 2 h. Fractional BSA clearance increased from 0.56 to 11.49%. After 60 min, BSA excretion in anti-GBM-perfused kidneys exceeded controls by a factor of 6.5-7.9 (P less than 0.05) and fractional BSA clearance exceeded controls by a factor of 5.8-7.1 (P less than 0.05). Studies with fluorescent markers indicated proteinuria to be of glomerular origin in antibody-perfused kidneys. There were no significant differences between anti-GBM-perfused and control kidneys in perfusion pressures, perfusate flow rates, urine flow rates, inulin clearance, or sodium reabsorption. Antibody to GBM can induce a marked increase in glomerular permeability to BSA and IgG without participation of other systemic humoral or cellular mediation systems.

Influence of antigen distribution on the mediation of immunological glomerular injury

To determine if the site of immune reaction could influence the mediation and morphological expression of glomerular injury in experimental anti-glomerular basement membrane (anti-GBM) nephritis and membranous nephropathy, we studied the events that followed the in situ reaction of rat antibody with antigen planted in either the GBM (especially the lamina rara interna) or in the subepithelial space (SE). Non-nephritogenic amounts of noncomplement-fixing sheep anti-GBM or anti-tubular brushborder antibody were injected into separate groups of rats to plant sheep IgG in the GBM and SE, respectively. Kidneys containing sheep IgG were then transplanted into naive recipients that were passively immunized with rat anti-sheep IgG. There was marked proteinuria after 2 days (antigen in GBM: 226 +/- 50.7; antigen in SE: 69 +/- 50.7 mg/24 hr) that was abrogated by prior depletion of complement in both groups (antigen in GBM: 10.2 +/- 1.7; antigen in SE: 14.3 +/- 8.7 mg/24 hr). When antigen was planted in SE, inflammatory-cell depletion with either anti-neutrophil (PMN) serum or lethal irradiation had no effect on proteinuria. In contrast, anti-PMN abolished proteinuria (12.0 +/- 5.6 mg/24 hr) and irradiation reduced it by 60% when antigen was in GBM. Glomeruli of kidneys with antigen in GBM were significantly larger and more hypercellular than those with antigen in SE after transplantation into immunized recipients. Endothelial cell injury and adherence of inflammatory cells to denuded GBM were prominent in the former (antigen in GBM), while glomeruli with antigen in SE showed only subepithelial deposits, adjacent slit-diaphragm displacement, and epithelial cell foot-process effacement. Thus, the reaction of antigen and antibody in glomeruli produced complement-mediated injury which was cell-independent when complex formation occurred on the outer aspect of the GBM but was cell-dependent when the same reagents reacted more proximally to the circulation. We therefore conclude that antigen distribution can critically influence the mediation and morphologic expression of immune glomerular injury and may, in part, account for variations in the clinical and histological manifestations of antibody-induced glomerular disease in humans.

Role of terminal complement pathway in the heterologous phase of antiglomerular basement membrane nephritis

Terminal complement components, including the membrane attack complex, have been demonstrated in glomeruli of patients with immune complex and anti-GBM nephritis. We recently demonstrated the functional significance of C6 in the mediation of experimental membranous nephropathy in rabbits. In the present study, the role of C6 was examined in the heterologous phase of rabbit anti-GBM nephritis by studying normal and C6-deficient (C6D) rabbits. In C6D rabbits, C6 hemolytic activity was less than 0.01% of control. All control rabbits became heavily proteinuric in the first 24 hr following injection of a standard dose of sheep anti-rabbit GBM antibody (mean, 42.0 +/- 26.3; range, 18.4 to 83.5 mg protein/mg creatinine, N = 5). In contrast, C6D rabbits excreted a mean of only 5.1 +/- 5.5 mg/mg creatinine (range, 0.06 to 14.4, N = 6, P = 0.002). Protein excretion in normal rabbits was less than 0.06 mg/mg creatinine. Both control and C6D rabbits had similar deposits of sheep anti-rabbit GBM IgG in glomeruli when measured by radiolabeling techniques (control 15.8 +/- 2.71, N = 5; C6D 18.7 +/- 1.99 micrograms of sheep IgG/10(4) glomeruli, N = 6, P greater than 0.05). Control rabbits had a greater rise in serum creatinine in the first 24 hr (1.74 +/- 1.15 vs. 0.53 +/- 0.44 mg/dl, P less than 0.05). Both groups had similar deposits of sheep IgG and rabbit C3 by IF. By light microscopy at 4 and 24 hr, both groups had qualitatively similar proliferative changes and similar numbers of neutrophils infiltrating glomeruli.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of antibody charge and concentration on deposition of antibody to glomerular basement membrane

Fixed anionic sites within the glomerular capillary wall influence the permeation of serum proteins, the localization of various antigens, and the deposition of antibody in the subepithelial space. In anti-GBM nephritis antibody deposition occurs very rapidly to antigenic sites located relatively proximal in the glomerular capillary wall. We examined the influence of the glomerular charge barrier on anti-GBM antibody deposition by comparing the rate of deposition of antibodies with cationic and anionic isoelectric points. Purified sheep anti-rat GBM IgG was isolated from acid eluates of kidneys obtained 24 hr after rats were injected with sheep antiserum to rat GBM. Anti-GBM IgG was separated into cationic (pI 6.4-8.5) and anionic (pI 4.2-6.8) fractions, which were radiolabelled with 131I and 125I, respectively, shown to have equal antibody contents measured by in vitro binding to normal glomeruli, mixed in equal amounts, and injected in incremental doses to ten rats. At 1 hr the glomerular antibody binding of each fraction was directly related to the blood level (r = 0.95, r = 0.97) and delivery of antibody (r = 0.98, r = 0.98). Glomerular binding of cationic antibody was four times greater than anionic antibody over the entire range of deliveries studied (P less than 0.001). We conclude that glomerular deposition of anti-GBM antibody is directly related to blood concentration and delivery of antibody. Furthermore, the deposition of cationic antibodies to GBM antigens was significantly greater than the deposition of anionic antibodies. The charge-selective glomerular filtration barrier may be an important determinant of the quantity and subclass composition of anti-GBM IgG deposits in glomeruli, and therefore of the severity of tissue injury produced.

Zinc in post prostatic massage (VB3) urine samples: a marker of prostatic secretory function and indicator of bacterial infection

The value of biochemical examination of post-prostatic massage (VB3) urine samples has been investigated. Measurement of zinc levels provides a good marker of prostatic secretory function. In the absence of prostatic carcinoma findings of greater or equal to 100 micrograms zinc in VB3 urines is strong evidence (2% false negatives) of an absence of infectious or inflammatory prostatic disease. Less than 40 micrograms of zinc is suggestive (14% false positives) of prostatitis. There is little need to consider the endogenous urinary zinc levels. This simple test should be of particular value in cases where an expressed prostatic secretion is not obtained (about 40% of this series of patients), when it would be a valuable adjunct to cytological and bacteriological examination of split urine samples.

Creatine kinase and ATPase in human seminal fluid and prostatic fluid

A creatine kinase assay based on estimation of creatine liberated from creatine phosphate was accurate and reproducible for use with seminal or prostatic fluid, after allowance was made for acid phosphatase interference. Comparison of this method with one which relies on enzymic coupling of ATP formation to NADP+ oxidation shows that the latter under-estimates creatine kinase activity by a factor of about 3. This discrepancy could be due to the high ATPase activity found in prostatic and seminal fluid. Uncritical use of the NADP+ assay might account for different seminal creatine kinase values reported in the literature. Interrelationships between ATPase, creatine kinase and zinc suggest that seminal ATPase is a prostatic secretory product while creatine kinase may be multiglandular in origin.

Simultaneous recording of myoelectrical activity and resistance from the human colon

A system used to record myoelectrical activity from the rectosigmoid colon has been modified so that a continuous recording of electrical resistance is obtained simultaneously. Normal subjects, patients with diverticular disease and patients with the irritable colon syndrome have been studied by this method. There were variations in resistance in the form of waves for 74.7, 88.5 and 89.0% of the time in the three groups. These changes were abolished by intravenous glucagon. The predominant frequency of the waves was 2-4 c/min and often coincided with myoelectrical waves of the same frequency. It is concluded that the resistance changes are produced by local movement in the colonic wall at the electrode site and that this technique may be valuable in studying colonic motility.

The response of seven prostatic fluid components to prostatic disease

282 human prostatic fluid samples have been investigated for their pH value, zinc, and citrate concentration and their acid phosphatase, leucine aminopeptidase, diamine oxidase, and beta-glucuronidase activities. The results have been analysed in terms of the clinical status of the patients. Significant differences between patient categories were found with all but diamine oxidase and beta-glucuronidase. These differences were mainly found between men with apparently healthy prostates and prostatitis patients; the pH being raised and the acid phosphatase, leucine aminopeptidase, zinc and citrate being reduced. The diagnostic value of these parameters was evaluated, each could be used to classify correctly 90% of patients from these 2 groups. Zinc, citrate and leucine aminopeptidase showed no age relationship and were better than acid phosphatase and pH in discriminating between BPH and prostatitis. Evidence was also found for a return of normal secretory function sometime after an episode of prostatitis. Zinc and citrate are likely to be the most useful parameters for clinical evaluation.

The interrelationships between acid phosphatase, aminopeptidase, diamine oxidase, citric acid, beta-glucuronidase, pH and zinc in human prostatic fluid

Biochemical analysis of 328 human prostatic fluid samples were performed. The urea concentration of 69 samples was similar to that of serum and not indicative of significant contamination with urine. The pH of normal fluids was acidic (mean pH = 6.7). The interrelationships between zinc, citrate, acid phosphatase aminopeptidase, beta-glucuronidase, diamine oxidase and pH were investigated by factor analysis. Two significant factors were extracted, the first accounted for 89% of their common variance and the second for 11%. Zinc, citrate, acid phosphatase and aminopeptidase were positively and pH was negatively related to factor one. Beta-glucuronidase was positively related to factor two and diamine oxidase was largely independent of both factors. It was concluded that variables related to factor one share a common secretory control and mechanism, that some other mechanism operates in the case of beta-glucuronidase and that diamine oxidase may not be a true secretory product of the prostate.

Effects of bile acids on human colonic motor function in vitro

The effect of bile acid perfusion on colonic motor function in vitro has been studied. It was found that bile acid perfusion and carbachol perfusion had no effect on the frequency or incidence of slow wave activity. However, the secondary bile acid deoxycholic acid (15 mmol/l) was shown to cause a statistically significant increase in percentage motility of the isolated colon (control 24.2 + 5.5%, deoxycholic acid 64.9 + 7.3%, p less than 0.01). The magnitude of this increase was similar to the increased colonic motility recorded during carbachol (2.5 micrograms/cm3) infusion. Chenodeoxycholic and cholic acids did not increase colonic motility in vitro.

The effect of increased motility on absorption from the canine colon

The absorption of water and electrolytes and intraluminal pressure were measured from Thirty-Vella loops in 4 dogs under basal conditions and during electrical stimulation of the colonic smooth muscle. Pulse wave electrical stimulation via serosal silver/silver chloride electrodes gave rise to significant increases in both intraluminal pressure and percentage motility. Absorption of water, sodium and chloride was significantly increased during stimulation but the transport of ammonia, bicarbonate and potassium was not significantly affected. It is suggested that motility changes result in altered absorption irrespective of transit time.

Faecal bile acids and the irritable colon syndrome

Faecal bile acid excretion and rectosigmoid myoelectrical activity were measured on three separate occasions over a 12-month period in 21 patients with the irritable colon syndrome. The results were compared with those of a group of normal subjects. Deoxycholic acid excretion was statistically significantly lower in patients with the irritable colon syndrome. In addition, these patients had a persistently high incidence of 0.03-0.06 Hz (2-4 c/m) rectosigmoid slow-wave electrical activity. These abnormal values persisted throughout the period of the study.

An assessment of anorectal motility in the management of adult megacolon

Anorectal motility measurements have been performed on 19 patients with adult megacolon and the results compared with 12 normal subjects. Adult Hirschsprung's disease (4 patients) was recognized by the absence of anal canal inhibition on rectal distension (normal mean inhibition 21.9 +/- 2.3 mmHg). Seven patients with non-Hirschsprung's megacolon (idiopathic) had an elevated anal pressure (mean 90.4 +/- 7.0 mmHg). These patients were treated with repeated anal dilatation. Eight further patients had normal anal canal pressures (mean 33.2 +/- 11.7 mmHg) and were treated with enemas and regular suppositories. Little overall clinical improvement resulted in this group and 1 patient underwent subtotal colectomy. Measurements of anorectal motility have been found to assist in the management of adult megacolon.

Effect of bile acid perfusion on colonic motor function in patients with the irritable colon syndrome

A study was performed to determine the effect of bile acid perfusion on motility in the sigmoid colon of patients with the irritable colon syndrome compared with normal subjects. Deoxycholic acid (15 mM) statistically significantly increased motility in normal subjects (control 25.0 +/- 6.4%, perfusion 71.4 +/- 7.2%, P < 0.05) but neither chenodeoxycholic acid nor cholic acid had any apparent effect. In patients with the irritable colon syndrome, however, deoxycholic acid at 5 mM concentration (control 29.8 +/- 4.2%, during perfusion 57.4 +/- 6.5%, P < 0.05) as well as at 15 mM concentration (control 19.4 +/- 5.7+, perfusion 57.8 +/- 9.6%, P < 0.05) statistically significantly increased rectosigmoid motility. Patients with the irritable colon syndrome had a high resting 0.033-0.066 Hz (2-4 c/m) electrical activity, whereas in normal subjects 0.1-0.15 Hz (6-9 c/m) activity was greater. However, there was no statistically significant alteration in either electrical rhythm during the period of bile acid perfusion. In conclusion, additional evidence is presented to suggest that deoxycholic acid is the only bile acid likely to be implicated in the motor disorder of the irritable colon syndrome.