Analysis of leukocyte adherence to measles-infected cells in multiple sclerosis

An assay for leukocyte adherence to measles-infected cells (MIC) was evaluated in 56 patients with multiple sclerosis (MS), 37 normal subjects, 29 patients with nonneurological diseases, and 57 patients with other neurological diseases. In the assay, rosettes were formed consisting of three or more leukocytes adherent to one MIC. Two aspects of the rosetting phenomenon were analyzed: (1) quantity of rosettes and (2) quantity of leukocytes contained in the rosettes. By both criteria significant differences (p less than 0.05) were observed between MS patients and subjects in other groups, but data sets overlapped extensively. Results in MS patients were variable; some MIC lines produced more leukocyte adherence than did others, even though all lines had surface measles antigen present. A low degree of leukocyte adherence to uninfected cell lines was also observed frequently in MS. Exposure of MS leukocytes to extracts of MIC or oligodendroglioma tissue prior to the rosette assay significantly (p less than 0.05) decreased rosette formation. These data suggest that leukocyte adherence to target cells in MS is partially dependent on target cell expression of determinants, which may resemble glial antigens.

Binding of arylazidocytochrome c derivatives to beef heart cytochrome c oxidase: cross-linking in the high- and low-affinity binding sites

Two arylazidocytochrome c derivatives, one modified at lysine-13 and the second modified at lysine-22, were reacted with beef heart cytochrome c oxidase. The lysine-13 modified arylazidocytochrome c was found to cross-link both to the enzyme and with lipid bound to the cytochrome c oxidase complex. The lysine-22 derivative reacted only with lipids. Cross-linking to protein was through subunit II of the cytochrome c oxidase complex, as first reported by Bisson et al. [Bisson, R., Azzi, A., Gutweniger, H., Colonna, R., Monteccuco, C., & Zanotti, A. (1978) J. Biol. Chem. 253, 1874]. Binding studies show that the cytochrome c derivative covalently bound to subunit II was in the high-affinity binding site for the substrate. Evidence is also presented to suggest that cytochrome c bound to the lipid was in the low-affinity binding site [as defined by Ferguson-Miller et al. [Ferguson-Miller, S., Brautigan, D. L., & Margoliash, E. (1976) J. Biol. Chem. 251, 1104]]. Covalent binding of the cytochrome c derivative into the high-affinity binding site was found to inhibit electron transfer even when native cytochrome c was added as a substrate. Inhibition was almost complete when 1 mol of the Lys-13 modified arylazidocytochrome c was covalently bound to the enzyme per cytochrome c oxidase dimer (i.e., congruent to 280 000 daltons). Covalent binding of either derivative with lipid (low-affinity site) had very little effect on the overall electron transfer activity of cytochrome c oxidase. These results are discussed in terms of current theories of cytochrome c-cytochrome c oxidase interactions.

Recurrent dislocation of the shoulder after age fifty

Recurrent dislocation of the shoulder is infrequent in patients over the age of 50. In a small group of 6 patients with an average age of 64 years and multiple recurrences, 4 subsequently were treated by anterior capsulorraphy (Bankart). There was an unusual degree of loose jointedness in all 6 cases. When compared with a group of patients under the age of 30 with recurrent dislocation of the shoulder, the older group was functionally rated 19.4 out of a possible score of 25 points, compared with a rating of 10.8 in the younger group. In the older population, recurrent dislocation may become a problem if the patient is loose-jointed. Immobilization for 3 to 4 weeks may not be helpful in this group of patients. Anterior capsulorraphy is as successful as in younger patients and is not followed by unusual joint stiffness.

Cell-mediated cytotoxicity to cardiac cells of lymphocytes from patients with primary myocardial disease

The etiology of primary myocardial disease is unknown. With the advent of immunologic technics, an immune process related to primary myocardial disease has been sought, but none has been elucidated as diagnostic or causative. The authors attempted to study the possibility of a cell-mediated component in the etiology of primary myocardial disease. Cell-mediated immunologic injury of cultured, human myocardial cells was studied in cells from patients with primary myocardial disease and controls by means of a 51chromium-release method. Significant lymphocytic cytotoxicity against myocardial cells was detected in cells from 23 (30%) of 73 patients with primary myocardial disease, compared with two (4%) of 49 normal, healthy control subjects. Significant cytotoxicity was also observed in cells from 36 (24%) of 148 patients who had other cardiac diseases, mainly rheumatic and atherosclerotic diseases. No group showed cytotoxicity against a long-term culture of Chang hepatic cells. No clinical correlation between the severity of the disease and increased cytotoxicity could be found. It is concluded that lymphocytic reactivity against myocardial cells probably results from myocardial damage due to a variety of causes, and that it is not specific for primary myocardial disease.

Epidemiology of traumatic and nontraumatic osteonecrosis

In reviewing the epidemiology of traumatic and nontraumatic osteonecrosis the only common denominator appears to be that of circulatory compromise. Causative mechanisms seem to be quite distinct. A number of factors may predispose to postfracture hip necrosis, i.e. the type of fracture, the quality of reduction and union of the fracture. For postdislocation necrosis, causative factors include the type of dislocation as well as the timing and nature of the reduction. For nontraumatic osteonecrosis, an array of consistently associated systemic disorders appears to be largely linked by frequent lipid elevations. Alcoholism and corticosteroid use account for the bulk of cases and there is consistent predisposition to males and bilateral involvement. Multifocal lesions attest to the systemic basis for this form of necrosis.

The zygomatic arch and its possible influence on craniofacial growth and development

This study was designed to investigate the role of the zygomatic arch and craniofacial growth along the anteroposterior axis. One may conclude that: 1. Surgical intervention on the zygomatic arch results in a generalized inhibition of regional zygomatic arch growth. 2. When only one zygomatic arch is sectioned, the posterior root of the sectioned side appears to be displaced posteriorly. This is a possible result of the normal growth process proceeding without the restraints of an intact zygomatic arch. 3. A decrease in anteroposterior dimension occurs in the posterior zone as a result of surgical intervention. 4. Further studies to determine the influence of the zygomatic arch on transverse maxillary growth must be completed before any clear or complete concepts of its role in craniofacial growth and development may be more fully elucidated.

Posterior compartment syndrome resulting from a dissecting popliteal cyst. Case report

Calf swelling, associated with an intra-articular effusion of the knee, should be considered a dissecting popliteal cyst until proven otherwise. The posterior compartment syndrome caused by an increase in pressure within the deep posterior compartment of the leg is usually secondary to trauma. This case history of a dissecting popliteal cyst reports another unusual cause of the posterior compartment syndrome. Popliteal cysts, especially dissecting ones, are typical of connective tissue diseases, and are not limited to rheumatoid arthritis.

Osteoid osteoma of the hip in children

In 31 children with osteoid osteoma lesions about the hip ranging in age from 2 to 16 years, there was an inordinate frequency of diagnostic delay with 16 patients having symptoms for more than 12 months. The clinical features were dominated by pain, limp, restricted hip motion and thigh atrophy. Twelve patients did not have classical night pain. Errors in diagnosis occurred in 22 instances. The roentgenographic appearance of most lesions consisted of a radiolucent central nidus encircled by sclerotic bone. Twenty-nine of the 31 patients were operated upon utilizing intra-operative roentgenograms and the nidus fully excised, with histological confirmation in 24 cases. All were relieved of preoperative symptoms. Two patients, who did not have surgical treatment, had pain for about one year and thereafter became pain free for 2 and 12 years. The sequelae observed at follow-up were meralgia paresthetica in 12 patients and mild asymptomatic leg length discrepancies in 7 patients. In view of these findings and since the process of apparent regression is slow and characterized by pain, blocked surgical excision of the lesion is the procedure of choice.

Acute undifferentiated human diarrhea in the tropics. I. Alterations in intestinal micrflora

The microflora of the small and large intestine was determined in 17 adults with acute undifferentiated diarrhea in Calcutta, India. On the basis of bacteriologic findings, the patients could be divided into two groups: those with a predominant flora of Escherichia coli (eight patients) and those with a mixed coliform flora (nine patients). In the former group, E. coli were distributed throughout the small and large bowel. Broth filtrates of these isolates contained an enterotoxin which caused fluid accumulation in the rabbit intestinal loop model. Toxigenic E. coli were cleared rapidly from the small bowel during the acute period; some patients only had the "hot" strains in their fecal effluent. During convalescence, the serotypes of E. coli changed and the new strains did not elaborate enterotoxin. Only one of the eight patients had a serotype previously associated with diarrhea. Acute undifferentiated diarrhea in the remaining cases was apparently caused by untypable E. coli or by typable strains not generally considered pathogenic. Small bowel and fecal cultures from the mixed flora group revealed a heterogeneous mixture of Gram-negative enteric bacilli and a distinct pattern could not be discerned. Further study will be needed to elucidate the cause of diarrhea in these cases.

The use of oral replacement solutions in the treatment of choleraand other severe diarrhoeal disorders

Despite the progress that has been made in the treatment of cholera, mortality rates from this disease remain high in rural areas where intravenous fluids are not readily available. The authors have therefore conducted controlled studies into the efficacy of a simpler form of maintenance therapy-the administration of glucose-containing electrolyte solutions by mouth. The results obtained from the study of 51 adult patients (36 with cholera and 15 with severe non-cholera diarrhoea) indicate that oral fluids are adequate for maintenance therapy in cholera and severe diarrhoeal disease, and that there is no significant increase in the duration of diarrhoea or in the stool volume in patients receiving such therapy.The addition of a non-specific adsorbent, charcoal, to the fluid led to a significant increase in the volume of diarrhoeal stools and to prolongation of vibrio excretion; its use is therefore not recommended. The use of oral replacement solutions should result in improvement of cholera treatment of adults in rural areas and in a reduction in the cost of treatment.

Intraperitoneal fluid therapy in cholera and non-cholera diarrhoea: with special emphasis on the treatment of infants and children

Because of the relative difficulty in maintaining continuous intravenous infusions in small children suffering from cholera, a simpler method of maintenance fluid therapy would be useful. With this in mind, the role of intraperitoneal fluid administration was evaluated in 8 adults and 26 children (aged 6 years or less) having moderate to severe cholera or cholera-like diarrhoeal disease.In adults intraperitoneal fluid was found to be of no significant value in maintenance therapy because peritoneal absorption was not sufficiently rapid to replace expected stool losses. In children, however, this form of therapy was considerably more successful. In 16 of 19 children with cholera and in all 7 with non-cholera diarrhoea, intraperitoneally administered fluid was absorbed rapidly enough to replace a major part of the initial fluid deficit on admission and all subsequent stool losses. No complications of intraperitoneal puncture were encountered.