Low antithrombin III levels in neonates with idiopathic respiratory distress syndrome: poor prognosis

Automated microanalytic chromogenic coagulation assays allow serial monitoring of critically ill newborn infants. In this study 84 premature infants [26 healthy prematures and 58 neonates with idiopathic respiratory distress syndrome (IRDS)] were studied daily during the first week of life, to investigate the possible significance of hemostatic abnormalities in IRDS. In neonates with IRDS, coagulation factors II and X, antithrombin III (AT-III), plasminogen, and alpha 2-antiplasmin were significantly lower than control values. Recovery of the initially low AT-III levels was delayed relative to the other coagulation parameters measured. An AT-III less than or equal to 0.15 U/ml was present within the first 6 h of life in eight patients who developed IRDS, seven of whom died within 48 h. Autopsy of these neonates showed widespread fibrin deposition and hemorrhage in vital organs consistent with intravascular coagulation. These findings indicate that very low levels of AT-III are associated with disseminated intravascular coagulation in neonates with IRDS and suggest that a deficiency of AT-III is predictive of a poor outcome.

Improved techniques for the photometric determination of partition coefficients, with particular reference to the chloroform-ammonia solvent system

Accurate partition coefficients K = Corg/Caq in chloroform-ammonia can be obtained by measuring the absorbance of the aqueous layer, replenishing with fresh aqueous solvent, and remeasuring the absorption after reequilibration. Provided the solute has a reasonably strong UV absorption, only 0.1-5 mg of material is required. Neither the amount, the extinction coefficient, nor (in most cases) the purity of the substrate material need be known. In general, K values ranging from 100 to 0.01 can be measured with a precision of greater than or equal to 10%. A detailed analysis of the absorbance and volumetric error sources permits the optimum combination of experimental conditions such as volume ratios, cell lengths, and absorbance (either direct or differential, or with scale expansion) to be predicted a priori. Quantitative estimates for all primary error sources, such as photometric precision, baseline error, stray light, and volumetric errors were also experimentally determined. The theoretical error model was tested by determining K for aniline under widely ranging experimental conditions and by comparing the experimental standard deviations with those calculated from the theoretical model. The agreement was found to be satisfactory. The method described appears to be of particular usefulness for the determination of extraction or chromatographic parameters of basic drugs.

Mechanism of aprindine induced agranulocytosis: direct toxicity on CFU-C and CFU-GEMM

The in vitro bone marrow growth of 2 patients with aprindine-induced agranulocytosis was studied. Granulocyte-macrophage committed stem cell (CFU-C) growth is inhibited by aprindine in a dose dependent manner. 50% inhibition of CFU-colony growth (TD50) was seen at 5.1 and 3.4 micrograms aprindine/ml medium respectively. The TD50 of control marrow CFU-C was 3.2 micrograms/ml. 100% inhibition was seen at 16 micrograms aprindine/ml, both in patients and controls. Pluripotential stem cell growth (CFU-GEMM) in control marrow was equally inhibited in a dose dependent manner by aprindine, though to a lesser extent (TD50: 9.1 micrograms/ml) and with relative sparing of pure megakaryocyte and erythroid colonies. Co-culturing of patients marrows with their respective acute phase serum did not inhibit CFU-C growth.

Lumbar arterial rupture secondary to iliopsoas hemorrhage in a hemophiliac patient

A 62-year-old subhemophiliac patient developed a severe iliopsoas hemorrhage following minor trauma. CT scanning revealed a large iliopsoas hematoma and intraperitoneal hemorrhage. Angiography demonstrated active bleeding from the fourth right lumbar artery, a complication of an iliopsoas hematoma not previously described.

Australian 10-year-olds' perceptions of food. III. The influence of obesity status

Two studies were conducted which examined the relationships between 10-year-olds' body fat status and their perceptions of foods. The first study of 453 children showed that obese boys linked high-energy foods more to positive consequences, such as growth and satiation, than did slim boys. They also rated bread and potatoes as more fattening than did slim boys. In the second study, one-quarter randomized samples of 40 foods were presented to 500 children, on each of two forms on which the children rated the foods on eight attributes. Results of multivariate analyses showed that obese, average and slim children perceived foods differently along two general themes: (a) properties related to energy, and (b) tastiness-preference. The results are discussed in relation to possible social and physiological causes.

A [14C]phenacetin breath test to measure hepatic function in man

Phenacetin, a high-clearance drug, was labeled as [14C-ethyl]phenacetin and used in a breath test of hepatic function. 14CO2 appeared rapidly in breath such that more than 30% of the administered radioactivity was expired in 2 hr. For all means of expression used to describe the appearance of 14CO2 in breath, normal controls and hospitalized patients without liver disease were clearly separated from cirrhotic subjects with moderate and severe liver damage. The phenacetin breath test was validated by the close correlation of 14CO2 appearance with the disposition of the parent compound examined after its intravenous administration, and by demonstration that the rate-limiting step in 14CO2 generation from labeled phenacetin occurred proximal to 14CO2 generation from [14C]acetate given intravenously. Correcting for the actual volume of CO2 exhaled by control and cirrhotic subjects did not increase the sensitivity of the test. The phenacetin breath test has potential as a simple procedure to quantitate hepatic metabolism of drugs, particularly those mediated by cytochrome P448.

Antigen-specific human B-cell responses: modulation by immunoregulatory T-cell subsets

In vitro T-cell requirements for and modulation of human B-cell responses were studied in individuals immunized in vivo to the protein antigen keyhole limpet hemocyanin or tetanus toxoid. T cells were required for antibody synthesis in both antigen-driven and pokeweed mitogen (PWM)-driven cultures. T cells were separated into T4+ and T8+ subpopulations using monoclonal antibodies, and their modulation of antibody synthesis was studied. T4+ cells functioned as helper cells in both antigen-driven and PWM-driven cultures in a dose-dependent manner. Whereas T8+ cells suppress both total and specific immunoglobulin secretion in PWM-stimulated cultures, in antigen-stimulated cultures T8+ cells do not suppress unless activated by another cell population present in peripheral blood mononuclear cells (PBMNC). This cellular requirement was further investigated by prestimulation of cells prior to addition to optimally stimulated antigen-driven cultures of PBMNC or B cells, monocytes, and helper T cells. No suppression of these optimally stimulated cultures was seen when T8+ cells were precultured with antigen or PWM. However, after 3-5 days preculture of total T cells with PWM or antigen and then selection of T4+ cells, these cells were able to induce fresh autologous T8+ cells to suppress optimally stimulated antigen-driven cultures. Addition of a precultured mixture of T8+ cells with 20% T4+ cells also resulted in antigen-induced suppression. These data indicate that T8+ cells can suppress antigen-driven cultures but require the presence of preactivated T4+ cells for induction of this suppression of antigen-specific T-cell-dependent human B-cell responses.

Alcoholic hepatitis: granulocyte chemotactic factor from Mallory body-stimulated human peripheral blood mononuclear cells

The characteristic histopathological features of acute alcoholic hepatitis include hyaline degeneration of hepatic parenchymal cells (Mallory bodies), hepatocellular necrosis, and granulocyte infiltration of the liver. The chemotactic response of neutrophils to highly purified Mallory bodies was studied. Mallory bodies, per se, were not chemotactic for granulocytes, nor did they generate chemotactic factors when incubated with serum. However, a factor(s) chemotactic for both granulocytes and mononuclear cells was generated when Mallory bodies were incubated with mononuclear cells, both from patients with alcoholic hepatitis or from normal controls. It was concluded that Mallory bodies stimulate peripheral blood mononuclear cells to release a factor chemotactic for granulocytes and mononuclear cells. This factor may be important in the etiology of the cellular infiltration in the livers of patients with alcoholic hepatitis.

RT to tactile stimuli presented ipsi- and contralaterally to the responding hand

Subjects had to react with the hand which received a tactile stimulus (uncrossed condition) or with the hand opposite to the hand which received the stimulus (crossed condition). Four experiments were conducted. In the first three, subjects knew which hand would receive the stimulus and which hand would have to respond. In the first two experiments, subjects reacted to a simple tactile stimulus while in the third subjects had to perform a tactile discrimination before responding. No significant differences in RT under the crossed and uncrossed conditions were observed in the first three experiments. In the fourth experiment, subjects did not know which hand would receive the stimulus, and they also did not know which hand would have to respond. Under these conditions, large significant differences in RT between the crossed and uncrossed condition emerged.

The study includes a criticism of a simple structural interpretation of interhemispheric transmission time (IHTT) as proposed by Bashore (1981). Support is provided for the view that in paradigms of the kind used here, allocation of attention to a psychologically defined hemispace is a more important factor in observed RT than structural links between stimulus and response mechanisms.

Stresses of hospitalization in the elderly: nurses' and patients' perceptions

A study of stress in hospital is reported. Twenty-five patients (aged 70-93 years) and their nurses were interviewed about the patient's perceived stresses during the first and third weeks of hospitalization. The ward was modern in design and a 'patient allocation' system of nursing care was in operation in which one nurse had primary responsibility for each patient. Patients differed significantly from nurses in their use of a 16-item stress scale, using low scale values rather than high (stressful) values. Although as groups, patients and nurses showed significant correlations between stress ratings over the items, this was interpreted as their sharing common stereotypes about the hospital situation. There was no significant relation between nurses' and patients' ratings of the overall stress being experienced by the patients. An analysis of stress items showed there to be significant differences between type of stress. There was least discrepancy between nurses and patients concerning aspects of physical illness and most on the stressful impact of the hospital environment and routine. While patients rated items within this group (e.g. toiletting) to increase in stress during their stay in hospital, nurses rated the stress value as decreasing.

Selective activation of antigen-specific human B cells in recently immunized individuals by nonspecific factors in the absence of antigen

The in vitro effect of nonspecific factors (derived from mixed lymphocyte culture [MLC] supernatants) on human B cell responses was studied in individuals recently immunized in vivo to keyhole limpet hemocyanin, tetanus toxoid, and/or diphtheria toxin. In T cell-depleted fractions of peripheral blood mononuclear cells, nonspecific factors alone, without antigen, selectively induced a specific antibody response to the antigen to which the individual had been recently immunized, at dilutions that did not generate a significant polyclonal response in the remainder of the B cell repertoire. The source of these factors, with respect to MLC donors, did not affect the antibody response. Supernatants of MLC from nonimmunized individuals induced a specific antibody response as effectively as supernatants of MLC from immunized individuals, when added to B cells plus monocytes from recently immunized individuals. Studies in which the same individuals were followed over time showed that these factor-sensitive B cells are seen in the peripheral blood of recently immunized individuals for only a finite period of time. Thus, in vivo immunization with a specific antigen results in the transient appearance in the peripheral blood of B cells that are specific for the antigen in question. These B cells are probably preactivated in that nonspecific factors selectively induce in vitro their further differentiation into antibody-secreting cells, in the absence of added antigen or mitogen. These studies may add further insight into our understanding of the sequential steps involved in the activation and differentiation of human B lymphocytes and provide a model for the combined in vivo and in vitro study of human B cell physiology.

Selective activation of antigen-specific human B cells in recently immunized individuals by nonspecific factors in the absence of antigen

The in vitro effect of nonspecific factors (derived from mixed lymphocyte culture [MLC] supernatants) on human B cell responses was studied in individuals recently immunized in vivo to keyhole limpet hemocyanin, tetanus toxoid, and/or diphtheria toxin. In T cell-depleted fractions of peripheral blood mononuclear cells, nonspecific factors alone, without antigen, selectively induced a specific antibody response to the antigen to which the individual had been recently immunized, at dilutions that did not generate a significant polyclonal response in the remainder of the B cell repertoire. The source of these factors, with respect to MLC donors, did not affect the antibody response. Supernatants of MLC from nonimmunized individuals induced a specific antibody response as effectively as supernatants of MLC from immunized individuals, when added to B cells plus monocytes from recently immunized individuals. Studies in which the same individuals were followed over time showed that these factor-sensitive B cells are seen in the peripheral blood of recently immunized individuals for only a finite period of time. Thus, in vivo immunization with a specific antigen results in the transient appearance in the peripheral blood of B cells that are specific for the antigen in question. These B cells are probably preactivated in that nonspecific factors selectively induce in vitro their further differentiation into antibody-secreting cells, in the absence of added antigen or mitogen. These studies may add further insight into our understanding of the sequential steps involved in the activation and differentiation of human B lymphocytes and provide a model for the combined in vivo and in vitro study of human B cell physiology.

Rapid microanalysis of coagulation parameters by automated chromogenic substrated methods - application in neonatal patients

Daily monitoring of coagulation parameters in critically ill premature born neonates is only possible on small amounts of blood obtained by heelpuncture. Therefore, automated spectrophotometric micro-assays for antithrombin III (AT III), factors II and X, plasminogen and alpha 2 antiplasmin were applied on capillary and venous blood samples concurrently obtained in adults and healthy neonates. No statistically significant difference for any of the parameters was revealed. High levels of platelet factor 4 present in serial capillary samples of adults, did not interfere with the heparin dependent AT III assay. There was no evidence of thrombin or thromboplastin generation in these capillary samples, when examined for Va or VII activities. The levels of AT III, factors II and X and of plasminogen in neonates were 35-45% of the adult levels, in contrast to alpha 2 antiplasmin which was in the adult range.

Immunocytochemical identity of hepatocellular hyalin in alcoholic and non-alcoholic liver diseases

Intracellular, eosinophilic, hyaline inclusions (alcoholic hyalin, Mallory bodies) are found in livers of patients with a number of hepatic disorders, although they are most common in alcoholic liver disease. Tissues from patients with primary biliary cirrhosis, jejunoileal bypass, hepatocellular carcinoma, Wilson's disease, and Indian childhood cirrhosis were all positive for hyalin by hematoxylin and eosin staining. Immunocytochemical labeling, using guinea-pig antiserum specific for alcoholic hyalin, was utilized to determine the extent of crossreactivity between hepatocellular hyalin in these various conditions. This antiserum bound to hyalin in fixed paraffin-embedded sections of all liver tissues studied as detected by indirect immunoperoxidase labeling. Binding to normal human liver, however, was restricted to light staining at the surface of hepatocytes. Preimmune guinea-pig serum did not bind to either normal liver or to the test tissues. Our results suggest that hyalin found found in a diverse group of liver conditions represents an immunologically related structure and that its formation may involve a common mechanism.

[Perinatal mortality and acidosis morbidity rate in pelvic presentation and vertex presentation deliveries]

Pelvic presentation deliveries in the period between 1975 and 1981 were analyzed and compared with a randomly chosen group of vertex presentation deliveries from the same period. On clarification of the group of patients delivered of pelvic presentations, the mortality rate was comparable with that resulting from vertex presentation. In both groups of patients both the mortality and acidosis morbidity rates were affected by the tendency towards premature birth. In cases of pelvic presentation, caesarian section represents the least risky method of delivery. Particularly in the event of premature birth, caesarian section should thus be given preference in all cases. Given careful individual diagnosis, mature infants -even, selectively, in the case of women giving birth for the first time--can be vaginally delivered from the pelvic presentation position.

State licensure for occupational therapists

This is the first in a series of article addressing critical issues facing the profession. Those issues are presented to inform members of their complexity and to provide members with specific actions they can take to support the continued strengthening of the role of occupational therapy in health and education. This article was prepared by Jane D. Davy, OTR, and Mary Peters, M.S., OTR, Government and Legal Affairs Division, The American Occupational Therapy Association, Inc.

Alcohol unrelated hepato-biliary disorders in the alcoholic: the role of liver biopsy in determining the aetiology of liver disease

Alcoholics with abnormal liver function tests are generally assumed to have one of the recognised patterns of alcoholic liver injury. This report described a group of nine patients who were initially thought to have alcoholic liver disease but were found on liver biopsy to have a variety of liver disorders unrelated to alcohol. Liver biopsy showed granulomatous hepatitis in three, primary biliary cirrhosis in two, and cholestasis of unknown cause, large duct biliary obstruction, haemochromatosis with secondary carcinoma and Budd-Chiari syndrome in one each. The histological changes observed in liver biopsy samples are believed to represent a chance occurrence of liver disease due to some agent other than alcohol and illustrates that forms of hepatic disease that affect the population at large can and do occur in heavy alcohol consumers.

Interference between concurrent speaking and sequential finger tapping: both hands show a performance decrement under both visual and non-visual guidance

Report that concurrent speaking reduces right hand sequential finger tapping performance selectively only if the movements are guided non-visually. In these replication experiments, concurrent speaking of both rhyme and prose passages reduced performance both of the right and left hand under visual and non-visual guidance. In the replication experiments the performance of the right hand was slightly more reduced by concurrent speaking than was the case for the left hand. The interference effects are interpreted in terms of the temporal constraints imposed by given motor tasks.

Handedness: coordination of within- and between-hand alternating movements

Two models of coordination of within- and between-hand alternating movements are compared. Model 1 assumes that control of bimanual movement passes back and forth between two independent systems, each of which guides one hand, and that the performance of alternating tapping movements (e.g., right index, right middle fingers) within a hand is very different from performance of alternating movements between hands (right index, left index fingers). The model suggests that right/left performance asymmetries on given tasks reflect the characteristics of the independent systems and would therefore predict that factor analysis would yield a "hand" factor. Model 2 assumes that a single system initiates and terminates movement in two subsystems, each of which guides one hand, and it suggests that the task of guiding alternating tapping movements within a hand is very similar to the task of alternating movement between hands. Model 2 would not predict an independent "hand" factor in the factor analysis of performances of tasks yielding left/right asymmetries; the asymmetries presumably arise because the single higher order system has better access to one of the subsystems than to the other. Analyses of performance of within- and between-hand alternations, single-finger tapping movements, and a pursuit rotor task in 92 subjects lend clear support to Model 2.