The long march of the cerebrospinal fluid profile indicative of clinical definite multiple sclerosis; and still marching

Much progress has been made, especially in the last two decades, in laboratory aids to diagnosis and to follow the course of patients with multiple sclerosis (MS). The cerebrospinal fluid (CSF) profile indicative of MS, though not pathognomonic of MS, is present in almost every case of clinical definite MS in a chronic progressive phase (probably also true for early MS). The cardinal aspect of the profile is intra-blood-brain barrier (BBB) IgG synthesis which can be qualitatively detected by determining unique CSF oligoclonal IgG bands and quantitated by rate formula, mg/day. We believe that intra-BBB IgG synthesis is caused by a persistent antigen, most likely a virus, possibly measles. A number of issues about the profile are proposed and opportunities are presented to resolve them.

The primary care physician and psychiatric services

This article describes the relationship of self-assessed psychiatric skill among primary care physicians to their role in treating mental disorders. Physicians rated diagnostic skills more favorably than therapeutic skills. Factor analysis was used to identify three dimensions of physician skill: confidence in treatment of major disorders; confidence in treatment of anxiety; and diagnostic confidence. These variables were found to be associated with the reported number of patients with specific mental disorders managed by the physician.

Human alpha-lymphoblastoid interferon. A phase I study including pharmacokinetics and effects on hematologic stem cells (CFU-GMs)

Human alpha lymphoblastoid interferon (Wellferon) was administered to 33 patients in a phase I study. Patients received Wellferon intramuscularly every 12 hours for 14 doses in nine dosage levels ranging from 0.75 X 10(6) units to 50.0 X 10(6) units. Toxicity tended to be dose dependent and included fever/chills, malaise, hematologic toxicity, and digestive tract toxicity. Thirty X 10(6) u q 12 h was felt to be the maximum tolerated dose. Three partial responses (renal cell carcinoma, diffuse histiocytic lymphoma, Hodgkin's disease) were achieved. Interferon rapidly (2 to 3 hours after the initial injection) reached peak serum levels which varied generally with dose and exceeded 500 u/ml at the 30 and 50 X 10(6) u dosages. Multiple doses of interferon resulted in cumulative peak levels substantially higher than first dose levels (greater than 500 u/ml at dosages greater than 3 X 10(6) u/ml and greater than 1,500 u/ml at dosages greater than or equal to 18 X 10(6) u). Interferon given at high dosages persisted up to 10 days beyond the final injection. Despite hematologic toxicity, inhibition of CFU-GM was not seen.

Cytotoxic activity of peripheral blood and cerebrospinal fluid lymphocytes from patients with multiple sclerosis and other neurological diseases. Analysis at the single cell level using morphological and surface marker phenotype criteria

The large granular lymphocyte (LGL) has been identified in normal individuals' MNC population as the NK-K cell (Ault and Weiner 1978; Timonen et al. 1981); it bears the OKM1 surface antigen (Breard et al. 1981; Fast et al. 1981) and while negative for T cell antigens OKT4 and OKT8, is a low avidity E-rosette forming cell. However, in a unfractionated nylon wool passed peripheral blood lymphocyte (NWP PBL) population, we show that not more than 50% of KN activity in normal or OND control NWP PBL and 30% NK activity in MS NWP PBL can be attributed to this cell. Nevertheless, 100% of control K cell activity and 50% of MS K cell activity can be mediated by an LGL. MS patients have normal proportions of LGLs in their NWP PBL. The proportion of LGLs in CSF of MS and OND patients is too low to account for the number of CSF K cells. While in control NWP PBLs, the LGLs are OKM1+ and mediate NK and ADCC, in MS the LGL NK effectors are probably different from LGL-K cell effectors. In MS both populations include effector cells with cell surface antigens. Thus, the OKM1+ LGL characteristics may not be used in analysis of NK and K cells in multiple sclerosis.

A prostaglandin endoperoxide analog increases gastric emptying and suppresses gastric secretion in rhesus monkeys

The effects of a stable endoperoxide analog, U-46619, were studied in five conscious chair-adapted rhesus monkeys. A dye dilution technique was used to determine simultaneously gastric fractional emptying, fluid output and ion output. A continuous infusion of either saline or U-46619 (0.2 micrograms/kg/min i.v.; 1 or 2 micrograms/kg/min s.c.) was given during a basal period and after distension of the stomach with an 80-ml water load. These studies demonstrate that U-46619 increases basal, but not postload fractinal emptying, and inhibits parietal secretion. These actions are similar to some of the effects of prostacyclin, prostaglandin E2 and prostaglandin F2 alpha on gastric emptying and secretion.

Effect of prostacyclin on gastric emptying and secretion in rhesus monkeys

The effects of prostacyclin (PGI2) on gastric emptying and secretion were studied in five unanesthetized chair-adapted rhesus monkeys. A dye dilution technique was used to determine simultaneously gastric fractional emptying, hydrogen ion (H+) output, fluid output, and H+ concentration of the gastric juice. A continuous intravenous infusion of either sodium carbonate buffer (control) or PGI2 (125, 175, or 250 ng/kg/min) was given during a 40-min basal period and following the intragastric administration of an 80-ml water load. During the basal period, 175 and 250 ng/kg/min significantly decreased H+ output compared to control. Only 250 ng/kg/min, however, significantly reduced basal fluid output compared to control. As a result, the H+ concentration of the gastric juice was lowered by both 175 and 250 ng/kg/min. The effects of PGI2 on H+ output, fluid output, and H+ concentration of the secreted juice after the water load were similar to those observed during the basal period. In addition to its anti-secretory action, PGI2 inhibited significantly postload, but not basal, gastric fractional emptying. Because a fall in intragastric H+ concentration is known to enhance fractional emptying, it appears that the retarding effect of PGI2 on fractional emptying is not mediated by its ability to suppress H+ output.

Management assessment center technique: an evaluation of the literature

In this article Lee Myers, manager, Medical Records, Geisinger Medical Center, Danville, PA, reviews the literature, mainly in the manpower development area, to provide an evaluative insight into the use of management assessment centers as a part of an organization's overall manpower planning and organizational development.

Mammographic patterns and risk of breast cancer

A study of 171 breast cancer cases matched by age and race to asymptomatic controls was undertaken to check Wolfe's assertion [1, 2] that breast cancer risk depends strongly on the mammographic classifications N1, P1, P2, and DY. The classifications were made blindly relative to all variables, including the case-control factor. Distribution of the four categories among the breast cancer patients in this study was consistent with the distribution found by Wolfe. (P = .46). Our age-standardized risk ratio estimates of the categories, relative to N1, are 1.5 for P1, 2.7 for P2, and 7.2 for DY. While not as striking as Wolfe's estimates, the same monotone trend is evident, and the cases and controls differ significantly with respect to the distributions of the four categories (P less than .01).

Subclinical eye movement disorders in patients with multiple sclerosis

Eye movements were quantitatively evaluated in 16 patients with well-documented multiple sclerosis who had minimal or no clinically apparent eye movement disorder. Induced saccade and pursuit eye movements were recorded with electro-oculography and analyzed with newly developed programs on a laboratory digital computer. Thirteen of the 16 patients had significant (p less than 0.05) impairment of saccades and/or smooth pursuit when compared with 25 normal subjects tested in our laboratory. The type and frequency of abnormalities were as follows: saccade dysmetria, eight; delayed saccade reaction time, five; bilateral saccade slowing, four; slowing of adducting saccades only (medial longitudinal fasciculus syndrome), one; and impaired smooth pursuit, both directions, three, and one direction only, three. In addition, four patients had vestibular nystagmus with eyes closed, and one patient had typical rebound nystagmus. These data suggest that quantitative assessment of eye movements in patients with suspected multiple sclerosis can help in identifying the important "second lesion."

The association of HLA antigens A3, B7, and DW2 with 330 multiple sclerosis patients in the United States

Reported associations of HLA antigens with MS have varied considerably. In this study we have examined 330 clinically definite MS patients from the United States. The frequency of DW2 (52%) was highly statistically significant in MS patients as compared to controls (p less than 0.00001). Neither A3 nor B7 was significantly increased in MS; however, the joint occurrences of A3-DW2 (20% vs 7%, p less than 0.001) and B7-DW2 (30% vs 13%, p less than 0.0002) are highly associated with MS.

Na+-K+-activated adenosine triphosphatase and intestinal electrolyte transport. Effect of adrenal steroids

Sodium-potassium-activated adenosine triphosphatase (Na-K-ATPase) is associated with electrolyte transport in many tissues. To help delineate its role in intestinal transport, changes in rat intestinal electrolyte and water transport induced by injecting methylprednisolone acetate 3 mg/100 g or deoxycorticosterone acetate (DOCA) 0.5 mg/100 g per day for 3 days were correlated with changes in Na-K-ATPase activity. Methylprednisolone increased sodium and water absorption, potassium secretion, transmural potential difference, and Na-K-ATPase activity in the jejunum, ileum, and colon. Examination of isolated epithelial cells demonstrated that the jejunal and ileal increase in Na-K-ATPase occurred in both the villus tip and crypermeability, Mg-ATPase, and adenylate cyclase activities were unchanged by methylprednisolone. DOCA increased sodium and water absorption, potassium secretion, transmural potential difference, and Na-K-ATPase activity in the colon alone. Colonic Mg-ATPase and adenylate cyclase activities were unaffected. Jejunal and ileal enzyme activity, electrolyte transport, and permeability were unchanged by DOCA. Methylprednisolone and DOCA were not additive in their effect on colonic Na-K-ATPase activity. Methylprednisolone and DOCA increased electrolyte and water transport and Na-K-ATPase activity concomitantly in specific segments of small intestine and colon. These data are consistent with an important role for Na-K-ATPase in intestinal electrolyte and water transport.

Serum linoleic acid in multiple sclerosis

Total serum fatty acids were analyzed in 30 patients with multiple sclerosis and in 33 controls. No significant decrease in linoleic acid was found in the patients with multiple sclerosis. A disturbance in linoleic acid metabolism is not inevitably associated with this disease.

Gel filtration of myelin using 2,2,2-trichloroethanol as the solvent

The use of 2,2,2-trichloroethanol as a solvent for myelin from both the central and peripheral nervous systems is described. Concentrated, optically clear solutions of lyophilized myelin in this solvent are stable for weeks. The preparation of highly concentrated myelin proteins by gel filtration in trichloroethanol is described.

Amyotrophic lateral sclerosis: effect of serum on anterior horn cells in tissue culture

A high proportion of diluted serums of patients with amyotrophic lateral sclerosis were toxic to the anterior horn cells of the mouse in tissue culture. This is not a general cytotoxicity, since apparently only the neurons were killed. Serums from other degenerative neurological diseases were inactive.