Lactic acidosis and renal enlargement at diagnosis and relapse of acute lymphoblastic leukemia

Bilateral renal enlargement was noted on ultrasonography during an extensive renal evaluation for severe hypokalemic metabolic acidosis with an increased anion gap in a 12-year-old Hispanic boy who had normal results of a physical examination and complete blood count. The patient was found to have acute lymphoblastic leukemia. Resolution of the lactic acidosis and bilateral renal enlargement occurred with initiation of chemotherapy and recurred with each subsequent relapse.

Retinoblastoma gene product-associated proteins in human colon cancer cell lines

The expression of cellular proteins that associate with the human retinoblastoma (RB1) gene protein was examined in three colorectal carcinoma cell lines (SW480, SW403, DiFi) by immunoprecipitation analysis, using the mouse monoclonal antibody (RB-MAb-1) directed against the RB1 gene product (RB). The potential of RB-MAb-1 to detect RB-associated proteins by immunoprecipitation analysis was confirmed using three control cell lines (WI-38, J82, T24) known to express RB and/or RB-associated proteins. In all colon cancer cell lines tested, multiple RB-associated protein (RAP) bands were found with molecular weights of 30-50 kDa. Because involvement of the RB1 gene in colorectal tumorigenesis appears to differ from its role in other cancer types (wherein RB1 is lost or inactivated), it will be important to characterize the role of RAPs in RB growth regulatory mechanisms of colonic epithelial cells.

RB1 protein in normal and malignant human colorectal tissue and colon cancer cell lines

The pattern of human retinoblastoma (RB1) gene protein expression was directly examined in normal and malignant human colorectal tissues and in seven colorectal carcinoma cell lines by immunohistochemistry using the mouse monoclonal antibody (RB-MAb-1) directed against the retinoblastoma protein (RB). This is the first demonstration of RB immunostaining in adult human colonic epithelium and colorectal carcinomas. Specificity using RB-MAb-1 was confirmed by western blot analysis, which showed bands of 110-116 kDa corresponding to the sizes of unphosphorylated and phosphorylated RB. RB staining of normal adult colonic epithelium was confined to the nucleus and was most intense in the transitional zone of the crypt, whereas lumenal cells (fully differentiated) were RB negative. Primary colorectal carcinomas and all the colon cancer cell lines stained positively for nuclear RB, but the expression was heterogeneous with varying fractions of RB negative cells present. Because we and others have previously shown that loss or inactivation of the RB1 gene is infrequent in colorectal carcinomas, reduced RB expression in such cells is probably due to a cellular regulatory mechanism. For example, RB negative cells may be those in early-G1 phase (known to have reduced RB levels) or growth-arrested cells that have differentiated. The ability to directly detect RB in primary colorectal carcinomas will permit assessment of whether heterogeneous expression of the RB1 gene product has prognostic significance for survival of patients with this cancer.

The prognostic significance of positive CMV cultures during surveillance of renal transplant recipients

Renal transplant recipients are at risk of severe morbidity and mortality from CMV disease. We have undertaken routine surveillance for CMV shedding on 133 transplant recipients, using a rapid culture technique, in order to assess the incidence of CMV infection and disease in these patients and to assess the prognostic significance of detection in whole blood, throat swab specimens, or urine. Donor CMV seropositivity was associated with posttransplant CMV infection (P < 0.05) and disease (P = 0.06). CMV infection and disease were associated with the receipt of anti-T-cell antibodies (P < 0.0001 and P = 0.08, respectively). First shedding of virus from any site occurred earlier posttransplant in those recipients who developed disease (median 39 days) than in those who did not (median 55 days)(P < 0.05). Detection of virus in blood occurred at a median time of 16 days before onset of symptoms, compared with 9 days before symptoms in urine, and 3 days after onset of symptoms from throat swab. A positive blood culture represented a relative risk of 7.1 for the subsequent development of disease, compared with 2.1 and 1.8 for positive urine and saliva cultures, respectively. The addition of urine cultures to blood cultures increased the sensitivity for identification of those at risk--however, the relative risk was reduced to 5.8. We conclude that routine surveillance for CMV shedding, especially in blood and urine, can identify recipients at high risk of CMV disease, and propose a trial in which those with asymptomatic viremia are allocated to receive ganciclovir or placebo, in order to assess the efficacy of "preemptive" therapy in this group of patients.

Calcium set point progressively worsens in hemodialysis patients despite conventional oral 1-alpha hydroxycholecalciferol supplementation

Calcium set point was measured in 12 patients on chronic hemodialysis. Dialysate calcium concentration was 1.65 mmol/l. Calcium carbonate (CaCO3) was used as the phosphate binder and oral 1-alpha hydroxycholecalciferol (alfacalcidol) was administered in a dose of 0.25-1.0 micrograms/day for 12 months. Comparing base line and post study values, there were no significant changes in ionized calcium (ICa++), intact immunoreactive parathyroid hormone (iPTH), plasma total calcium (TCa++), plasma phosphate (P), alkaline phosphatase (ALP), or aluminum (Al). However, the relative calcium set point significantly worsened (shifted to the right). Three patients developed hypercalcemia (25%) with a total calcium > 2.65 mmol/l. Total bone mineral content (BMC) fell suggesting demineralization. We conclude that this dose of oral alfacalcidol, CaCO3, and a dialysate calcium concentration of 1.65 mmol/l are not sufficient to halt the progression of secondary hyperparathyroidism in chronic hemodialysis patients. Measurement of calcium set point may be the best early measure of failure to prevent worsening of hyperparathyroidism.

The effect of prenatal diagnosis on the incidence of Down syndrome livebirths in the Singapore General Hospital

During a 3-year-period between January 1988 and December 1990, there were 12 Down Syndrome (DS) livebirths out of 13,794 livebirths at the Department of Obstetrics and Gynaecology, Singapore General Hospital, giving an incidence of 1 in 1,150 livebirths or 0.87 per thousand. There were 1569 mothers who were 35 years or older at the expected date of delivery (EDD) and 5 of these 12 DS livebirths were from these older mothers. Although only 11.5% of all mothers were 35 years or more, as a group, these older mothers contributed to 42% of the DS livebirths. There were 5 DS fetuses diagnosed prenatally and 4 were aborted electively. The fifth DS fetus which was diagnosed prenatally was allowed to continue to term because of the mother's religious objection to an induced abortion. The failure to offer prenatal diagnosis and selective procreation to all mothers 35 years or older had resulted in 4 unnecessary DS births, reducing our DS detection rate by a factor of 33%. All these 4 cases were booked late for antenatal care.

Double-blind, placebo-controlled trial of human lymphoblastoid interferon prophylaxis of cytomegalovirus infection in renal transplant recipients

We have conducted a double-blind, placebo-controlled trial of human lymphoblastoid interferon prophylaxis of cytomegalovirus (CMV) infection in 74 renal transplant recipients. Interferon (3 x 10(6) units was given thrice weekly for the first 6 weeks, then twice weekly for a further 8 weeks. During the period of interferon therapy, the incidence of CMV excretion was lower in the interferon group (28% versus 50%, P = 0.065), mainly due to a significant reduction of CMV reactivation (9% versus 56%, P = 0.02). However, for the whole study period (including the follow-up period after interferon therapy), there was no difference in the incidence of CMV excretion (44% versus 53%). The onset of CMV excretion was delayed (8.2 +/- 0.8 to 20.9 +/- 5.5 weeks, P = 0.04). The duration of CMV excretion was also reduced (11.1 +/- 3.1 to 29.4 +/- 5.7 weeks, P = 0.008). The number of positive CMV isolates from urine and saliva was significantly less in the interferon group. There was no difference in the site of CMV excretion. Of the patients in the treatment group who excreted CMV, 43% developed disease as compared to 63% in the control group (difference not significant). There was also no significant difference in the severity of the CMV infection between the two groups. Benefit appears to be restricted to seropositive recipients of seronegative kidneys. The interferon regime used in this study was well tolerated, with mild fever being the only reported side-effect. No patient had to stop therapy because of toxicity. The incidence of rejection and graft loss was not different between the two groups.

Phase coherence of the middle-latency response in the elderly

We compared phase coherence of the auditory-evoked, middle-latency response (MLR) and the 40-Hz steady-state evoked potential (SSEP) in two groups of elderly listeners, matched for degree of audiometric hearing sensitivity loss. In group A, speech understanding was appropriate to the degree of audiometric sensitivity loss. In group B, speech understanding was disproportionately poor in relation to the degree of loss. In both modes of measurement (MLR and SSEP) phase coherence was significantly poorer in group B than in group A. In the case of MLR, maximum phase coherence was observed at the expected 40 Hz in group A, but at 30 Hz in group B. In the case of SSEP, maximum phase coherence was observed at 40 Hz in both groups but was poorer at almost all Fourier components in group B.

Studies on Balanites aegyptiaca fruits, an antidiabetic Egyptian folk medicine

An aqueous extract of mesocarps of the fruits of Balanites aegyptiaca exhibited a prominent antidiabetic activity by oral administration in streptozotocin induced diabetic mice. From one of the active fractions of this extract, two new steroidal saponins were isolated, and their structures were determined as 26-O-beta-D-glucopyranosyl-(25R)-furost-5-ene-3 beta,22,26-triol 3-O-[alpha-L-rhamnopyranosyl-(1----2)]-[beta-D-xylopyranosyl-(1---- 3)]-[alpha-L-rhamnopyranosyl-(1----4)]-beta-D-glucopyranoside and its 22-methyl ether. In addition, two known saponins, 26-O-beta-D-glucopyranosyl-(25R)-furost-5-ene-3 beta,22,26-triol 3-O-(2,4-di-O-alpha-L-rhamnopyranosyl)-beta-D-glucopyranoside and its methyl ether were isolated and identified. It was revealed that the individual saponins did not show antidiabetic activity, while the recombination of these saponins resulted in significant activity. From an ethanolic extract of the epicarps, two known flavonol glycosides, isorhamnetin-3-O-robinobioside and isorhamnetin-3-O-rutinoside were isolated and identified.

A study on intestinal helminths causing human anaemia in Cairo

Haematological and biochemical studies were done for 50 urban and rural Egyptians, from Cairo, suffering from Ancylostoma duodenale, Ascaris lumbricoides, Enterobius vermicularis, Hymenolepis nana, Schistoosma mansoni and Taenia saginata. Anaemia of varying degrees was noticed in all cases. The lowest Hb% and hematocrit value and highest eosinophilia were found in cases of ancylostomiasis with severe hypochromia compared with the other parasitic infections. Total blood protein was normal in all cases, except in 2 cases of S. mansoni, it was higher. Blood cholesterol and blood urea showed no deviation.

Oral contraceptives and the hemostatic system

We studied 30 control women and 131 pill users to evaluate effects of birth control pills and clinical factors on hemostasis. When control patients were matched with an equal number of pill users, none of the direct markers of activated hemostasis (fibrinopeptide A, platelet factor 4, and beta thromboglobulin) were increased. Plasminogen, prekallikrein, and protein C (protective against clotting) were significantly higher in pill users. Fibrinogen, antithrombin, alpha-2 antiplasmin, and fibronectin were comparable. Among the 131 pill users, antithrombin levels decreased with a family history of thromboembolism. Fibrinogen and fibronectin were increased with obesity, but there was no evidence of activated hemostasis. Overall, pill use did not appear to result in hypercoagulability. Considering family history of thromboembolism might further improve the safety of oral contraceptive use.

Interaction of di- and tributyltin chloride with human erythrocyte membrane

Analysis of the binding of tributyltin chloride (TBT) to human erythrocyte membrane indicated a single class of binding site with an affinity of approximately 6.78 X 10(3) M-1, whereas dibutyltin dichloride (DBT) showed the presence of more than one class of binding sites with a high affinity value of 2.53 X 10(4) M-1 and a low affinity value of 2.06 X 10(3) M-1. Membrane protein binding studies revealed that both di- and tributyltin compounds bind significantly with band 3 protein of the erythrocyte membrane. These results indicate the significant interactions of erythrocyte membrane components with alkyltin compounds.

Alkaloidal Constituents of Crinum bulbispermum III: Bulbispermine, a New Alkaloid of Crinum bulbispermum1

The structure, relative and absolute configuration of bulbispermine from CRINUM BULBISPERMUM (Amaryllidaceae) is elucidated with spectroscopic techniques and via its methiodide, UV, CD, IR, MS, (1)H- and (13)C-NMR data, [alpha] (20)(D).

Phytochemical Investigation of Hippeastrum vittatum

The stereochemistry of pancracine, from HIPPEASTRUM VITTATUM, has been fully characterized as free base and as its O, O-di-acetate by means of spectroscopic analyses and CD-data. Carbon magnetic resonance data provide a simple tool in differentiating the contained montanine skeleton from other alkaloid ring systems within the Amaryllidaceae.

Analysis of QT interval in patients with idiopathic mitral valve prolapse

Analysis of QT interval from repeated recordings was made in 56 patients with documented idiopathic mitral valve prolapse (IMVP). The results were compared with a control of 62 healthy volunteers in whom mitral valve prolapse was excluded by both phonocardiography and echocardiography and with two other standard populations, those of Simonson and co-workers and of Ashman. After correction for age, the maximum QT interval of the patients with IMVP exceeded the 97.5 percentile of Simonson population in 51 of 56 patients compared with only three of 62 subjects of the control group. The difference between the QT interval of patients from the upper limits of the predicted mean values of Simonson was significant (P less than 0.002). The mean QTC interval in patients with IMVP was 0.48 +/- 0.035 second compared with 0.038 +/- 0.025 second in the control subjects. The difference between the mean QTC interval in patients with IMVP and the control subjects was significant (P less than 0.005). Spontaneous prolongation in the mean QT interval was noted in 43 of 56 patients with IMVP (76.6 percent) compared with only two of 62 control subjects (3 percent). The incidence of episodic arrhythmias was 72 percent in patients with marked QTC prolongation (mean, 0.58 second) compared with 22.6 percent in patients with lesser degree of QTC prolongation (mean, 0.46 second). The results suggest that QT abnormality is common in patients with IMVP and may play an important role in the genesis of cardiac arrhythmia.

Plasma concentrations and clinical effects of lorazepam after oral administration

The relation between plasma concentrations and properties of lorazepam administered orally as premedication was studied in patients undergoing minor surgery. The drug was found to be reliably absorbed in most subjects producing plasma concentrations similar to those reported after injection. Effective concentrations were obtained within 30-60 min, maintained for 4-6 h and were closely related to the action of the drug on memory and its sedative and anxiolytic properties. Its kinetics were described in about half of the subjects by a one-compartment model, but in others two compartments were required. Variable half-lives were found (range 9.3-32.1 h, mean about 20 h). Sufficient drug remains after 24 h to suggest that residual c.n.s. effects may still be present.