Parotid salivary secretion in diabetic autonomic neuropathy

Parotid salivary flow rates and amylase concentrations were measured in three groups of eight subjects each (normal control, non-neuropathic diabetic, and neuropathic diabetic). Flow rates were significantly reduced in neuropathic diabetic patients as compared with normal controls (p less than 0.001) and non-neuropathic diabetic patients (p less than 0.02). Amylase concentrations were similar. These data are consistent with parasympathetic denervation of the parotid gland in diabetic neuropathy and provide evidence for a widespread distribution of autonomic denervation in diabetes.

Kinetics and pathogenicity of autoantibodies induced by mercuric chloride in the brown Norway rat

Repeated low-dose injections of mercuric chloride (HgCl2) in the brown Norway (BN) rat result in polyclonal activation which includes the induction of anti-glomerular basement membrane (GBM) autoantibodies. We examined the kinetics of various autoantibodies produced in vivo, general features of polyclonal activation such as total IgG levels and immune complex formation, and the relationship between organ specific autoimmunity and tissue injury in the kidney and thyroid. The production of immune complexes and autoantibodies to GBM and thyroglobulin was short lived, and the increase in levels of total IgG and antibodies to ssDNA and dsDNA was prolonged; the antibody response to collagen types I and II was intermediate in duration. Autoantibodies induced by HgCl2 caused only mild and variable tissue injury in the kidneys and did not induce abnormalities in the thyroid. These studies demonstrate that immunostimulation by mercury may result in the formation of a range of autoantibodies, with variable kinetics and pathogenicity.

Renal responses to immersion and exercise in pregnancy

Twelve healthy pregnant women were studied at 15, 25, and 35 weeks' gestation and at 8 to 12 weeks postpartum. Women were immersed for 20 minutes at 30 degrees C. They then exercised at 60% maximum oxygen capacity on a modified ergometer. Substantial diuresis and natriuresis occurred without changes in osmolarity or serum sodium. The diuresis was significantly greater during pregnancy than postpartum. The natriuresis was similar. Diuresis and natriuresis were greater than would be expected from investigations in nonpregnant subjects. This study suggests that immersion may be a beneficial therapy for edema without decreasing plasma volume.

The effects of immersion and exercise on prolactin during pregnancy

Prolactin is an important hormone during pregnancy, affecting mother, fetus, and amniotic fluid volume. Immersion is known to affect prolactin levels significantly. To determine the effect of immersion and exercise on the prolactin response during pregnancy, we examined serum prolactin levels at 15, 25, and 35 weeks' gestation and 10 weeks post partum. Twelve women completed 20 min land rest, 20 min immersion in 30 degrees C water to the xiphoid, and 20 min exercise in the water at 60% VO2max. Resting prolactin levels were 1.91 +/- 0.32, 4.55 +/- 0.5, and 5.85 +/- 0.27 nmol.l-1 +/- standard error of the mean at 15, 25, and 35 weeks' gestation, respectively. Postpartum lactating women had a resting mean prolactin level of 3.95 +/- 1.6 versus 0.22 +/- 0.4 nmol.l-1 in non-lactating women. Prolactin levels declined significantly during immersion even after correction for dilution by plasma volume shifts. The immersion response was inversely related to the duration of pregnancy with 29%, 22%, and 12% drops during 15-, 25- and 35-week trials, respectively. Compared to rest, exercise prolactin levels remained depressed during the 15th and 25th week trials. We hypothesize that immersion in water caused prolactin levels to decline.

Developing a preceptor program: what are the ingredients?

Facilitating the orientation process has historically been the responsibility of staff development personnel. In recent years, hospitals have experienced the need to enhance the clinical orientation of new nurses; thus, the preceptor has emerged as a viable means of orienting nurses to the clinical setting and in socializing the graduate nurse to the role of a professional nurse. This article discusses the preceptor program for nurse orientation at The Cleveland Clinic Foundation.

Transfacial resection of intracranial tumor

Tumors of the skull base with intracranial and extracranial components pose special access problems. Traditional craniotomy and extensive external incisions produce morbidity that can be avoided in properly selected cases. Current surgical techniques extend previously described operations to allow good visualization and safe resection through the face for certain intracranial tumors. Meticulous attention to surgical techniques and wide exposure for complete tumor visualization are essential to ensure the safety of these procedures.

The effect of endotoxin on peripheral blood lymphocytes in the rat

We have studied the effects on peripheral blood lymphocytes of the administration to rats of a single dose of endotoxin. Lymphopenia occurred during the first hour, and persisted during 24 hours. Lymphocyte subpopulations were examined by flow cytometry. T-lymphocytes were relatively resistant to the initial effects of endotoxin, but there were no differences in the responses of cells identified as T-helper or T-suppressor/cytotoxic lymphocytes. The effects of endotoxin on peripheral blood lymphocytes is less extreme but appears more persistent than the effects on granulocytes.

Restriction of human IgG subclass expression in the population of auto-antibodies to glomerular basement membrane

To study the possible relationship between individual subclass expression and pathogenesis of antibody-mediated disease, we examined the immunoglobulin-G subclass of antiglomerular basement membrane (GBM) antibodies, in the sera of 20 patients with auto-antibody mediated nephritis, as well as in a limited number of kidney eluates, using a solid phase radioimmunoassay and monoclonal antibodies specific for human IgG subclasses. Only anti-GBM antibodies of the IgG1 and/or IgG4 subclass were detectable, both in the circulation and in renal eluates. Recurrence of circulating anti-GBM antibody during convalescence occurred in two patients out of 49 studied sequentially for more than 12 months. In both cases only antibodies of a single subclass were involved. The recurrence of IgG1 antibody (which can fix complement and bind macrophages) was associated with clinical manifestations of disease, whereas the reappearance of IgG4 antibody (which cannot engage amplifiers of the inflammatory response) did not appear to be harmful. Thus, in anti-GBM auto-antibody mediated nephritis, clear restriction in the subclass of IgG auto-antibody occurs, and this may be important in disease expression.

Circulating T-cell populations during mercuric chloride-induced nephritis in the Brown Norway rat

Fluorescence-activated cell sorter analysis was used to study the peripheral lymphocyte populations during mercuric chloride (HgCl2)-induced autoimmune nephritis in the Brown Norway (BN) rat. Sequential studies showed a transient loss of T cells from peripheral blood attributable to decreases in the percentage of T-helper cells. In addition, there was a decrease in the percentage of T-cytotoxic/suppressor cells prior to the appearance of circulating anti-GBM antibodies, followed by elevated levels of T-suppressor cells during down-regulation of the response. This method may allow closer inspection of the events linking changes in T-cell populations and induction and termination of an autoimmune response.

Antiglomerular basement membrane antibody mediated disease in the British Isles 1980-4

Clinical and pathological data on 71 patients from throughout the British Isles who developed antiglomerular basement membrane antibody mediated nephritis in the period 1980-4 were studied. Two principle patterns of disease were recognised: young men presenting in their 20s with Goodpasture's syndrome (glomerulonephritis and lung haemorrhage) and women presenting in their 60s with glomerulonephritis alone. The effect of treatment on prognosis of a total of 108 patients was also reviewed (the 71 patients plus patients seen before 1980 at Hammersmith Hospital). Treatment with prednisolone, cytotoxic drugs, and plasma exchange hastened the time to clearance of autoantibody and improved the outlook of patients who were not dependent on dialysis and those with lung haemorrhage.

Clinical application of a radio-immunoassay for auto-antibodies to glomerular basement membrane

We describe a sensitive radio-immunoassay for auto-antibodies to glomerular basement membrane (GBM). The assay discriminates patients with glomerulonephritis associated with circulating auto-antibodies to glomerular basement membrane from those with other forms of nephritis. Monitoring of antibody levels in sequential serial serum samples enables drug therapy to be tailored precisely to control the aberrant immune response, a situation unique in the management of glomerulonephritis.

Autoregulation of autoantibody synthesis in mercuric chloride nephritis in the Brown Norway rat. I. A role for T suppressor cells

Mercuric chloride injections in the Brown Norway rat induce the transient formation of anti-glomerular basement membrane (GBM) autoantibodies. Transfer of spleen cells from convalescent animals, after circulating anti-GBM autoantibodies are no longer detectable, inhibits reinduction of the disease by HgCl2 in naive recipients. This inhibition is significantly less when the T suppressor cell population is depleted by the monoclonal antibody, MRC OX8 , before transfer. Our studies suggest a role for T suppressor cells in autoregulation in this animal model of autoimmune nephritis and may form a basis for the design of specific therapy for anti-GBM disease in man.

Recurrence of circulating anti-glomerular basement membrane antibody three years after immunosuppressive treatment and plasma exchange

A patient with auto-antibody mediated Goodpasture's syndrome was successfully treated with cytotoxic drugs, steroids and plasma exchange. After an absence of three years, circulating anti-glomerular basement membrane antibodies reappeared, and linear IgG staining of the glomeruli was shown by immunofluorescent studies. Renal function did not change and there was no evidence of pulmonary hemorrhage. Antibody levels then fell spontaneously over the succeeding 18 months.

Effects of cyclophosphamide on autoantibody synthesis in the Brown Norway rat

The effects of cyclophosphamide on autoantibody synthesis were studied in an experimental model of glomerulonephritis due to autoantibodies to the glomerular basement membrane (GBM). Brown Norway rats develop anti-GBM antibodies, as part of a polyclonal response, when repeatedly injected with mercuric chloride (HgCl2). Anti-GBM antibody levels peak between days 11 and 14 and thereafter rapidly fall; convalescent animals show a time-dependent resistance to rechallenge with HgCl2 which remains significant for up to 3 months. The administration of cyclophosphamide, as a single intramuscular injection at day 0, has three distinct dose-dependent effects on anti-GBM antibody production. Firstly, lower doses (2.5 mg/kg) increase antibody levels at the time of peak response; secondly, higher doses (greater than or equal to 20 mg/kg) prevent antibody synthesis following HgCl2; and thirdly, the higher doses also reduce the response to rechallenge with HgCl2 3-4 months later. These effects of cyclophosphamide also apply to the polyclonal response to HgCl2, as judged by measurement of total IgG concentrations. Further investigation of the mechanisms of action of cyclophosphamide in this model should provide information relevant to the treatment of human autoimmune disease.

Remission of pseudo-spondylitis with treatment of Whipple's disease

An HLA-B27 negative case of Whipple's Disease with 'spondylitis' is reported in which antibiotic therapy gave sustained remission of spondylitis as well as intestinal disease.

Anti-glomerular basement membrane autoantibodies in the Brown Norway rat: detection by a solid-phase radioimmunoassay

A solid-phase radioimmunoassay (RIA) is described for the detection of IgG autoantibodies to glomerular basement membrane (GBM) induced in the Brown Norway rat by mercuric chloride. The assay involves the adsorption of a collagenase digest of GBM to plastic microtitre plates and detection of bound antibody with affinity purified radiolabelled rabbit anti-rat IgG. Comparison with existing immunofluorescence methods for detection of anti-GBM antibody showed that the solid-phase RIA is highly sensitive, allowing detection of antibody in solutions with as low as 0.5 ng protein/ml. The assay is suitable for detection of anti-GBM antibody both in serum and in eluates from nephritic kidneys. The assay proved to be specific in competitive studies of inhibition brought by GBM, keyhole limpet antigen and ovalbumin. This solid-phase RIA is reproducible, robust and easy to perform.