Five-year results of vitrectomy and silicone oil in patients with proliferative vitreoretinopathy

The purpose for this study was to evaluate the results of silicone oil use in patients who have undergone vitrectomy for proliferative vitreoretinopathy (PVR). The authors reviewed the 5-year results of 50 consecutive patients (52 eyes) with grade C1/D3 PVR operated on in 1987. Silicone oil has been removed in 42 eyes. The retina remained attached in 38 eyes. Visual acuities were finger counting in 12 eyes and 0.1 or greater in 19 eyes. Glaucoma was thought to be the major cause of loss of visual acuity after an initial improvement (9 eyes), as well as the most frequent complication of surgery (13 eyes). Silicone oil was deemed nonremovable in 10 operated eyes. A questionnaire was developed to determine the patients' perceptions of the use of silicone oil, and 46 patients responded to the questionnaire. Four patients indicated that they would not have elected to have surgery again. Six patients thought that surgery was not worthwhile, but would permit treatment again. Most patients thought that a modest amount of improvement had taken place and that vision was stable. Subjectively, most patients believed that surgery was worthwhile.

Suppression of lymphocyte proliferation by a retroviral p15E-derived hexapeptide

CKS-17 (LQNRRGLDLLFLKEGGL), a synthetic peptide derived from a conserved region of retroviral transmembrane proteins, has previously been shown to suppress several different immune effector mechanisms. The present study was undertaken to further delineate immunosuppressive site(s) of CKS-17. Overlapping hexapeptides covering the complete sequence of CKS-17 were synthesized. One CKS-17-derived hexapeptide, LDLLFL, suppressed ligand [CD3, interleukin (IL)-2]-induced lymphocyte proliferation. Spontaneous proliferation of transformed lymphoid cell lines, as well as cell lines from myeloid or epitheloid origin, was not inhibited by LDLLFL. Full suppression required the continuous presence of LDLLFL during culturing, and did not involve interference with monocyte function. Radiolabeling studies showed that the hexapeptide did not compete with IL-2 for IL-2 receptor binding. Most likely the LDLLFL motif interferes with steps shared by the IL-2 and CD3 receptor-induced signaling pathways. Since LDLLFL displays multiple immunosuppressive activities, it may constitute a biologically relevant immunosuppressive site of retroviral transmembrane proteins.

Synthetic hexapeptides derived from the transmembrane envelope proteins of retroviruses suppress N-formylpeptide-induced monocyte polarization

Retroviral infections are frequently associated with immunosuppression. Retroviral transmembrane envelope proteins (TM proteins) play an important role in this phenomenon. CKS-17, a synthetic heptadecapeptide, represents the immunosuppressive site of these retroviral TM proteins. Here we support on the further delineation of this immunosuppressive site using CKS-17-derived hexapeptides. The N-formyl-methionyl-leucyl-phenylalanine-induced monocyte polarization assay was used throughout this study because this monocyte function has been shown to be highly sensitive to TM protein p15E-related immunosuppression. We found that in addition to CKS-17 one CKS-17-derived hexapeptide, LDLLFL, reversibly inhibited monocyte polarization, with 50% inhibitory concentrations of 20 and 2 microM respectively. LDLLFL-mediated inhibition was sequence specific because the reverse peptide LFLLDL and scrambled peptides were not inhibitory. Hexapeptides corresponding to LDLLFL, but derived from various retroviruses other than murine leukemia virus, also inhibited monocyte polarization. Peptides most homologous to LDLLFL-LDILFL (feline leukemia virus) and LDLLFW (human T lymphotropic virus types I and II)--were the most potent inhibitors. Peptides homologous to primate and human endogenous proviruses were not suppressive. LDLLFL and some of its homologous also inhibited polarization of neutrophilic granulocytes. These findings lend further support to the view that conserved retroviral TM protein-related peptides can play an important role in suppression of inflammatory cell function as encountered in retrovirus-associated immunosuppression.

Medical discipline and licensing in the State of New York: a critical review

This review examines the current medical disciplinary process in New York State and assesses whether it protects the public and is fair to respondent physicians. Clearly there is urgent need for reform. Results of 1,036 disciplinary actions over the years 1982-1989 have been reviewed, with special attention to the 878 cases during 1985-89. The types of misconduct and their incidences among these physicians represent but a small segment of the more than 40,000 licensed practising physicians in this state. Extrapolations concerning their incidence should not be made from these limited data to the general population of physicians. The many flaws in the present system have been noted. A brief review of the process in 32 other states, Ontario, and Great Britain has shown that New York's is the most cumbersome and lengthy. Changes are suggested to modify the present system preserving some features of the current process but eliminating others. Licensing and disciplinary processes should be included in a single agency within the Health Department and this must be kept independent.

Acute hematogenous osteomyelitis of the epiphysis

The case of an 11-year-old boy with acute hematogenous epiphyseal osteomyelitis is presented. Previous reported cases of epiphyseal osteomyelitis have been only of the subacute type. This case is presented to emphasize that osteomyelitis can occur in the epiphysis and reinforce the need for early diagnosis.

Immunoglobulin allotypes are not involved in systemic amyloidosis

To evaluate the role of immunoglobulin (Ig) allotypes in the pathogenesis of amyloidosis, 8 Gm allotypes and the Km 1 allotype were determined in the sera of patients with amyloid AL (n = 27) and amyloid AA (n = 43). As controls we selected normal individuals (n = 204), 2 patients groups with multiple myeloma (both n = 40) and patients with rheumatoid arthritis (n = 71) and Crohn's disease (n = 47). Our results clearly show that Ig allotypes are not involved in the development of amyloidosis. Our results indicate that the Km 1 allotypic marker is associated with RA.

Multiple ureteral diverticula

Only 30 cases of multiple ureteral diverticula have been reported previously. We present a new case of this benign condition and review concepts concerning its etiology. Usually discovered on retrograde pyelography, multiple ureteral diverticula are only inconsistently associated with a history of obstruction or infection. When present, however, these factors may play a role in precipitating mucosal herniation through preexisting weak areas in the ureteral wall.

President's Remarks

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President's remarks

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Presentation of the Academy Plaque to Saul Jarcho, M.D

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Constituents of chyme responsible for postprandial intestinal hyperemia

While local venous outflow was measured in anesthetized dogs, various constituents of intestinal chyme were placed in the jejunal lumen to identify those responsible for postprandial intestinal hyperemia. Digested food and its supernatant increased local blood flow, whereas its precipitate, undigested food, and pancreatic enzymes did not. In the jejunum bile alone had no effect, but it markedly enhanced the hyperemic effect of digested food. Bile in the ileal lumen, however, increased local blood flow. At physiological postprandial concentrations in the jejunum, glucose, and micellar solutions of oleic acid and monoolein increased flow, but taurocholate and 16 common dietary amino acids did not. The hyperemic effect of lipids required the presence of taurocholate. Of the 16 amino acids, only Glu and Asp increased flow at 10 times the physiological concentrations (28 and 20 mM, respectively). The study indicates that the constituents of chyme responsible for postprandial intestinal hyperemia are the hydrolytic products of food, especially those of carbohydrates and fats and that bile plays an important role in the hyperemia.

Steroid metabolism in human breast cancer cell lines

The metabolism of 1,2-3H-androstenedione was studied in 2 cell lines, MCF-7 (estrogen responsive) and BT-20 (estrogen nonresponsive) over 48 hrs. Water soluble and unconjugated metabolites were separated by solvent partition and the former was submitted to chromatography on Sephadex LH-20 and enzyme hydrolysis. The resulting unconjugated steroids were separated by paper chromatography and identities were established by reverse isotope dilution. The unconjugated steroids initially obtained were separated by chromatography and identified by reverse isotope dilution. About 70% of the androstenedione was metabolized by both cell lines. However, the respective conversions to conjugates by MCF-7 and BT-20 were 31% and 0.32%. In the former, glucosiduronates predominated (94%) and consisted of androsterone (55%), etiocholanolone (9.4%) and androstanediol (5alpha-androstane-3alpha,17beta-diol) (9.3%). Androsterone comprised most of the unconjugated metabolites in both cell lines. Androstanediol was found in both cell lines, 2% in MCF-7 and 12% in BT-20. Testosterone, 5alpha-androstane-3,17-dione and 3beta-hydroxy-5alpha-androstan-17-one were isolated only from MCF-7. The metabolism of 3H-estriol was studied in a similar way. Both cell lines produced about equal amounts of estriol-3-sulfate (9%) and a compound with properties of estriol-3-glucosiduronate (0.15--0.5%). The results worthy of emphasis are: 1. The far greater conjugation of androgens exhibited by the MCF-7 cell lines as compared to the BT-20 cell lines; 2. In MCF-7, the high conversion of androstenedione to etiocholanolone (glucosiduronate form), a metabolite reported to form only in liver and sebaceous cysts; 3. The possible formation in both cell lines of estriol-3-glucosiduronate, normally a metabolite of the intestine.

The histogenesis of lymph nodes in rat and rabbit

The histogenesis of the popliteal lymph node in the rat and the popliteal and inguinal lymph nodes in the rabbit was examined by light microscopy. Special emphasis has been laid on the initial lymphocyte population in the lymph node anlage. In the rat on the seventeenth day of gestation lymphoid cells populate a limited mesenchymal area along the vein wall. The next day the mesenchyme shows a bulb-shaped outgrowth causing an indentation in the wall of a lymph vessel, running parallel to the vein and having a saccular widening at this place. The bulb-shaped lymphoid outgrowth fills up the widened lymph vessel; the subcapsular sinus originates from the remaining parts of the lymph vessel. At birth the lymph node can be divided into a primitive cortex consisting of an area with evenly scattered lymphocytes among the basic network of reticular cells and a medulla. About three days after birth an ovoid area containing a dense concentration of lymphocytes is observed in the inner cortex. In the next days it expands in both lateral and medullary direction but not into the outer cortex. Primary follicles appear in the outer cortex 18 days after birth. The development of the inguinal and popliteal lymph nodes in the rabbit shows the same characteristics as the histogenesis of the popliteal lymph node in the rat. The morphogenesis of the lymph node is summarized in a schematic diagram.

An approach to defining the etiology of animal abortions

Attempts to define the etiology of abortions on a regular continuing basis have been few, and largely unsuccessful. Problems of such a project include cost, difficulty of securing satisfactory samples, a laboratory organization of sufficient breadth, capacity and dedication to perform and interpret the necessary examinations, knowledgeable cooperation of the practitioner, and past reliance on isolated findings substituting for sound criteria for diagnosis. A program was created which was intended to overcome the difficulties. The plan was so constructed as to permit addition or removal of procedures as indicated.

A rapid in vitro method for measuring cell proliferation in human breast cancer

A method has been developed for studying in vitro the cell proliferation kinetics of human breast cancer, Surgical specimens from primary tumors were studied in 56 patients. Viable cell suspensions for assay were obtained by the dissociation of tumor tissue with collagenase. Mean Labeling indices of 2.43 +/- S.D 2.05 and 4.48 +/- S.D. 3.73, respectiviely, were found after incubation with 3HTdR for 2 hours and 24 hours. Mean S-times of 21.9 +/- S.D. 4.3 hours were estimated by 3H and 14C-TdR double-labeling. The kinetic data have been validated by parallel labeling studies in vivo and in vitro in four patients. The processing of autoradiographs using gold latensification provided slides for kinetic analysis within 3 days. The assay offers a method that is useful in the planning and monitoring of drug therapy.

The proliferative patterns of human breast cancer cells in vivo

The cell proliferation pattern in human breast cancer has been studied in eight patients in vivo using intravenously administered 3HTdR as a pulse and as a continous label. Two to 4% of the tumor cells were engaged in DNA synthesis in six patients, and 7% and 11%, respectively, in two others. From the composite percent labeled mitosis curve the estimated time for G1 + (M/2) was about 4 hours and for DNA synthesis about 24 hours. Many cells which entered the cycle spent longer intervals in DNA synthesis and in the post-DNA synthetic phase before entering mitosis. There was a wide range of intermitotic times among the tumor cells. These findings are of significance in the planning of drug therapy.