New aspects in the control of parathyroid hormone secretion

Ca2+ binds to a parathyroid cell Ca2+ receptor, which is G protein-coupled and activates inositol triphosphate production. Mutations in the Ca(2+)-sensing receptor gene cause familial hypocalciuric hypercalcemia and neonatal severe hyperparathyroidism. Chronic hypocalcemia increases parathyroid hormone messenger RNA levels and parathyroid cell hyperplasia. Parathyroid cells in vitro are heterologous in their response to Ca2+. The concept of a higher Ca2+ set-point in secondary hyperparathyroidism is controversial. Calcitriol is more effective than the less hypercalcemia analogues in decreasing parathyroid hormone messenger RNA and immunoreactive parathyroid hormone levels, and its kinetics are well established. Phosphate and estrogens regulate the parathyroid independently of 1,25 dihydroxyvitamin D3 and Ca2+. The physiology of the effects of endothelin and insulin-like growth factors on the parathyroid need to be established. Important advances are being made in understanding the regulation of parathyroid hormone synthesis and secretion, which are relevant to both normal physiology and the pathogenesis and treatment of diseases such as the secondary hyperparathyroidism of renal failure and osteoporosis.

Recalling basal cell carcinoma patients. A regional survey

BACKGROUND

Patients with a basal cell carcinoma (BCC) are at increased risk for developing further BCCs, and long-term follow-up has been recommended to detect new cancers at an earlier, more easily treatable stage. The majority of BCCs are treated by dermatologists in their offices; we do not know to what extent they perform long-term follow up on their patients.

OBJECTIVE

To determine how practicing dermatologists follow up their BCC patients.

METHODS

A mailed questionnaire survey of 166 practicing members of a regional dermatologic society (the San Francisco Dermatological Society), to which 142 (85%) replied.

RESULTS

Two thirds of the respondents recalled BCC patients for screening examinations; of these, 58% followed up non-responders. Recall efforts were hampered by inefficient, unwieldy, and time-consuming techniques.

CONCLUSION

Practicing dermatologists are motivated to recall BCC patients for examination, but guidelines and techniques for effective and efficient computerized recalling of skin cancer patients are needed. It is suggested that the American Academy of Dermatology set up a task force to develop guidelines and criteria for effective recall software.

The anomaly of silicon in plant biology

Silicon is the second most abundant element in soils, the mineral substrate for most of the world's plant life. The soil water, or the "soil solution," contains silicon, mainly as silicic acid, H4SiO4, at 0.1-0.6 mM--concentrations on the order of those of potassium, calcium, and other major plant nutrients, and well in excess of those of phosphate. Silicon is readily absorbed so that terrestrial plants contain it in appreciable concentrations, ranging from a fraction of 1% of the dry matter to several percent, and in some plants to 10% or even higher. In spite of this prominence of silicon as a mineral constituent of plants, it is not counted among the elements defined as "essential," or nutrients, for any terrestrial higher plants except members of the Equisitaceae. For that reason it is not included in the formulation of any of the commonly used nutrient solutions. The plant physiologist's solution-cultured plants are thus anomalous, containing only what silicon is derived as a contaminant of their environment. Ample evidence is presented that silicon, when readily available to plants, plays a large role in their growth, mineral nutrition, mechanical strength, and resistance to fungal diseases, herbivory, and adverse chemical conditions of the medium. Plants grown in conventional nutrient solutions are thus to an extent experimental artifacts. Omission of silicon from solution cultures may lead to distorted results in experiments on inorganic plant nutrition, growth and development, and responses to environmental stress.

Short-term experiments on ion transport by seedlings and excised roots : technique and validity

The absorption of K(+) by excised roots of barley (Hordeum vulgare L. cv California Mariout) has been systematically compared with that of entire, undisturbed seedlings. Some experiments have also been done with wheat (Triticum aestivum L.) and an amphiploid obtained from a cross between it and salt-tolerant tall wheatgrass (Lophopyrum elongatum Host Löve [syn. Agropyron elongatum Host]). For all three genotypes, the rate of K(+) absorption measured in a 20-min period was identical for entire 8-d-old seedlings and their excised roots within the experimental error. Manipulation gentler than root excision, viz. careful transfer of seedlings from one experimental solution to another, was also without effect on the rate of K(+) absorption. Absorption of K(+) measured by assay of its (86)Rb label in the tissue was identical with that measured by K(+) depletion of the experimental solutions assayed chemically. For the plant materials and conditions of these experiments, the excised root technique for studying ion transport into roots is validated. The advantages of the technique, and findings differing from the present ones, are discussed.

Salt tolerance and ionic relations of wheat as affected by individual chromosomes of salt-tolerant Lophopyrum elongatum

Bread wheat cv. Chinese Spring (CS), an amphiploid from a cross between CS and salt-tolerant Lophopyrum (= Agropyron) elongatum (Host) Löve, 19 of 21 possible disomic substitution lines of L. elongatum chromosomes for CS homoeologues, and a check cultivar, PI 178704, were grown in a replicated field trial under two levels of salinity and control conditions. Under salinity, the amphiploid greatly outperformed CS in grain yield, biomass, and other characters, indicating that it is more salt tolerant than CS. Of the seven L. elongatum chromosomes, six increased salt tolerance in disomic substitution lines; the most dramatic increase was conferred by chromosome 3E. Increased salt tolerance of the amphiploid was associated with the exclusion of Na+ and Cl− and inclusion of K+ as well as retranslocation of K+. Lophopyrum chromosomes controlling these physiological characters were identified. Some of the chromosomes had multiple effects, where as others affected only a specific character. The largest effects were associated with chromosome 3E. In addition, several wheat chromosomes controlled the exclusion or inclusion of these ions; the most notable effects were by chromosome 4D. Salt tolerance correlated negatively with Na+ and positively with K+ concentration in the flag leaf and with the K+/Na+ ratios. The relationships were strong enough to be exploited as selection tools in the breeding of salt-tolerant wheat cultivars.Key words: salt tolerance, wheat, Lophopyrum elongatum.

Occurrence and in Vivo Biosynthesis of Indole-3-Butyric Acid in Corn (Zea mays L.)

Indole-3-butyric acid (IBA) was identified as an endogenous compound in leaves and roots of maize (Zea mays L.) var Inrakorn by thin layer chromatography, high-performance liquid chromatography, and gas chromatography-mass spectrometry. Its presence was also confirmed in the variety Hazera 224. Indole-3-acetic acid (IAA) was metabolized to IBA in vivo by seedlings of the two maize varieties. The reaction product was identified by thin layer chromatography, high performance liquid chromatography, and gas chromatography-mass spectrometry after incubating the corn seedlings with [(14)C]IAA and [(13)C(6)]IAA. The in vivo conversion of IAA to IBA and the characteristics of IBA formation in two different maize varieties of Zea mays L. (Hazera 224 and Inrakorn) were investigated. IBA-forming activity was examined in the roots, leaves, and coleoptiles of both maize varieties. Whereas in the variety Hazera 224, IBA was formed mostly in the leaves, in the variety Inrakorn, IBA synthesis was detected in the roots as well as in the leaves. A time course study of IBA formation showed that maximum activity was reached in Inrakorn after 1 hour and in Hazera after 2 hours. The pH optimum for the uptake of IAA was 6.0, and that for IBA formation was 7.0. The K(m) value for IBA formation was 17 micromolar for Inrakorn and 25 micromolar for Hazera 224. The results are discussed with respect to the possible functions of IBA in the plant.

Accidental intravascular injection during infiltration anesthesia of the skin

Accidental intravascular injection of lidocaine during the induction of infiltration anesthesia for dermatologic surgery is an occasional and harmless occurrence. The author noted nine such episodes in a three-year period of full-time private dermatologic practice. A very brief, sharp, stinging pain lasting only seconds and immediately followed by blanching in a vascular distribution characterized these episodes. The blanching, resulting from the 1:200,000 epinephrine solution used in the lidocaine solution usually disappeared within five to ten minutes. Patients experienced no ill effects. The standard textbooks and reviews caution practitioners to aspirate before injecting a local anesthetic; this is unnecessary when performing infiltration anesthesia of the skin.

Laboratory measurement of bilirubin

Several methods for determination of total bilirubin and its fractions have been critically discussed. Methods for serum determinations are summarized in Table 1. Because results of direct bilirubin cannot necessarily be equated with conjugated bilirubin, care must be taken in interpreting results from different laboratories, and clinicians are encouraged to become familiar with methods in use at their own institutions. Despite problems reported in the literature, bilirubin determinations, together with a reference range established for one's own patient population, should provide valuable information for patient management.

Primula contact dermatitis: an easily overlooked diagnosis

Contact dermatitis to Primula obconica is not uncommon in the United States, yet it is scarcely mentioned in current North American dermatologic textbooks and literature. Affecting mainly women, primula contact dermatitis is often misdiagnosed since its nondescript pattern suggests an endogenous dermatitis. The author summarizes his experience with nine patients encountered in his practice during two years. Patch testing is important since a positive patch test reaction confirms the diagnosis and helps to convince the patient to discard the offending plant(s). A simple technique of patch testing with the primula leaf is described.

Selective accumulation of lymphocyte precursor cells mediated by stromal cells of hemopoietic origin

Thymocytes were propagated in long-term cultures supported by stromal cells of both bone marrow and thymus origin. Interleukin 2 (IL-2) supplementation augmented the cell yield and allowed detailed phenotype analysis. Within 2-3 months of culture a cell population was selected in which the expression of Thy-1 antigen persisted, CD4 and CD8 antigens gradually declined, and Pgp-1 antigen, found on less than 5% of fresh thymocytes, was strongly increased. This cultured cell population (Thy-1.2 origin) contained no detectable spleen colony-forming units (CFU-S) but efficiently repopulated the thymus of Thy-1.1-irradiated congenic mice, indicating the precursor T-cell nature of the population. Upon removal from the stroma, the T cells exhibited poor cytotoxicity towards syngeneic tumor cells. Further propagation with IL-2 in the absence of stroma resulted in the acquisition of cytotoxic ability. Replacement of the horse serum used in the above experiments with fetal calf serum resulted in accumulation of cells expressing B220 antigen. This experimental model provides the means to maintain lymphocyte precursor cells in long-term culture and to further study their differentiation in the absence of stroma, both in vitro and in vivo.

In vivo 23Na and 31P NMR measurement of a tonoplast Na+/H+ exchange process and its characteristics in two barley cultivars

A Na+ uptake-associated vacuolar alkalinization was observed in roots of two barley cultivars (Arivat and the more salt-tolerant California Mariout) by using 23Na and 31P in vivo NMR spectroscopy. A NaCl uptake-associated broadening was also noted for both vacuolar Pi and intracellular Na NMR peaks, consistent with Na+ uptake into the same compartment as the vacuolar Pi. A close coupling of Na+ with H+ transport (presumably the Na+/H+ antiport) in vivo was evidenced by qualitative and quantitative correlations between Na+ accumulation and vacuolar alkalinization for both cultivars. Prolongation of the low NaCl pretreatment (30 mM) increased the activity of the putative antiport in Arivat but reduced it in California Mariout. This putative antiport also showed a dependence on NaCl concentration for California Mariout but not for Arivat. No cytoplasmic acidification accompanied the antiporter activity for either cultivar. The response of adenosine phosphates indicated that ATP utilization exceeded the capacity for ATP synthesis in Arivat, but the two processes seemed balanced in California Mariout. These comparisons provide clues to the role of the tonoplast Na+/H+ antiport and compensatory cytoplasmic adjustments including pH, osmolytes, and energy phosphates in governing the different salt tolerance of the two cultivars.

Characterization and Rooting Ability of Indole-3-Butyric Acid Conjugates Formed during Rooting of Mung Bean Cuttings

Indole-3-butyric acid (IBA) is rapidly metabolized by mung bean cuttings during rooting. Twenty-four hours after application, less than 20% of the applied IBA remained in the free form and its level decreased continuously in the later stages of rooting. Indole-3-butyrylaspartic acid (IBAsp) and at least two high molecular weight conjugates were the major metabolites in IBA-treated cuttings. In the latter conjugates, at least part of the IBA moiety is attached to a high molecular weight constituent in an amide linkage. IBAsp level peaked 24 hours after application of IBA to the cuttings and then declined. The level of the high molecular weight conjugates increased continuously throughout the rooting process. The conjugates were active in inducing rooting of cuttings, with IBAsp being superior to free IBA. It is suggested that IBA conjugates, and particularly IBAsp, serve as the source of auxin during the later stages of rooting.

MRI visualization of bilateral quadriceps tendon rupture in a patient with secondary hyperparathyroidism: implications for diagnosis and therapy

Many musculoskeletal conditions have in the past been best defined on a clinical basis. However, because of pain, limitation of motion and hematomas, tendon ruptures can often be misdiagnosed clinically and it would be quite helpful to the clinician to have a noninvasive imaging technique. This communication defines the role of MRI in the early diagnosis of a nontraumatic rupture of the quadriceps tendons bilaterally in a patient with renal failure and known secondary hyperparathyroidism. The imaging techniques accurately defined the presence of hemorrhage extending into muscle from the ruptured tendons as well as the actual site and extent of tendon rupture. Since tendons have low mobile proton content and have low signal on MRI--disruptions are easily seen--MRI is the ideal noninvasive imaging technique for tendon injury, acute.

Phosphatidylglycerol in amniotic fluid. Comparison of an "ultrasensitive" immunologic assay with TLC and enzymatic assay

Phosphatidylglycerol (PG) in amniotic fluid is recognized as a good indicator of fetal lung maturity and is unaffected by moderate amounts of blood or meconium contamination. A rapid immunologic agglutination assay, Ultrasensitive AmnioStat-FLM (FLM), was compared with two-dimensional thin-layer chromatography (TLC) and an enzymic, colorimetric procedure (E-PG). Eighty amniotic fluid specimens were analyzed. FLM results were reported as high (H), intermediate (I), or low positive (L). TLC was compared with FLM:H (n = 27), mean 0.14 (fraction of total phospholipids); I (n = 7), mean 0.11; L (n = 9), mean 0.03; negative results had no detectable PG by TLC. In 33 cases E-PG was compared with FLM:H (n = 9), mean 7.0 mumol/L; I (n = 5), mean 8.1 mumol/L; L (n = 3), mean 3.0 mumol/L; negative (n = 16), mean 3.2 mumol/L. Records were reviewed in 70 cases. Thirty cases were excluded: sample to delivery time was greater than 72 hours; steroids were given or sepsis was documented. Fetal lung immaturity was clinically present in six cases: respiratory distress syndrome in three cases and transient tachypnea of the newborn (TTN) in three cases. One false positive result was identified (TTN, FLM:H). FLM sensitivity for fetal lung maturity was 85.3%, specificity was 83.3%, and the positive predictive value for fetal lung maturity was 96.7%. FLM is a fast, reliable indicator of fetal lung maturity.

Marking the spot

Tattooing with India ink is a precise and practical method for identifying biopsy sites when there is a significant delay between biopsy and definitive surgery.

Allosensitization in IL-2-containing limiting dilution cultures generates cytotoxic T lymphocytes (CTL) rather than LAK cells reactive with a syngeneic nonimmunogenic murine tumor

We have previously demonstrated that high frequency (1/20) of potent cytotoxic cells reactive with the nonimmunogenic lymphoma PIR-2 of C57BL/6 (B6, H-2b) origin, can be obtained by allosensitization of syngeneic B6 splenocytes against BALB/c (H-2d) splenocytes in limiting dilution cultures (LDC). Since a high concentration (250 U/ml) of exogenous interleukin 2 (IL-2), sufficient for the elicitation of lymphokine-activated killer (LAK) cells, was used in the LDC, and because the LDC-derived cytotoxic cells were active against a wide spectrum of target cells, we investigated whether the anti PIR-2 effector cells are LAK cells or cytotoxic T lymphocytes (CTL). We found that depletion from the B6 responder cell population of Lyt2+ (CTL precursors), but not of asialo GM1+ (LAK cell precursors), prior to LDC, results in the ablation of anti PIR-2 activity. When B6 splenocytes were plated in LDC with IL-2, in the absence of allogeneic stimulating cells, the resulting anti PIR-2 activity was greater than 10- to 500-fold lower than that obtained in LDC in the presence of allogeneic stimulating cells and IL-2. These and other observations suggest that the cytotoxic response against syngeneic tumors elicited by alloantigens in LDC is mediated by CTL rather than LAK cells, and that allogeneic sensitization in LDC can provide a means for the generation of CTL against syngeneic, nonimmunogenic tumors.

Chemo-immunotherapy of murine tumors using interleukin-2 (IL-2) and cyclophosphamide. IL-2 can facilitate or inhibit tumor growth depending on the sequence of treatment and the tumor type

The antitumor effect of interleukin-2 (IL-2), alone and in combination with cyclophosphamide was assessed in mice with established sarcoma (MCA 105, H-2b), carcinoma (M109, H-2d) and T lymphoma (PIR-2, H-2b). Whereas administration of IL-2 alone (5 x 10(4)-10 x 10(4) U, i.p. twice daily, for 4-8 consecutive days) prolonged the survival of mice with the solid neoplasms, it enhanced tumor growth and decreased survival of mice with the lymphoma. In the PIR-2 lymphoma, no IL-2 receptor (TAC) could be detected, nor could we demonstrate IL-2 tumor growth stimulation in vitro. A synergistic therapeutic effect was achieved in mice with the solid tumors, but not in mice with the lymphoma, only when IL-2 was given 1-4 days after cyclophosphamide (100-200 mg/kg). Conversely, administration of IL-2 1-4 days prior to cyclophosphamide resulted, in all three tumor systems, in enhanced tumor growth and in decreased survival as compared with mice receiving cyclophosphamide alone. Similarly, treatment with IL-2 both before and after cyclophosphamide was less efficacious than a single course of IL-2 given afterwards. It is concluded that for maximal therapeutic efficacy, IL-2 should be administered following chemotherapy, and that certain tumors may respond adversely to IL-2 treatment.

Electrophoresis and the isomune-LD and LD-1 immuno methods compared for measurement of lactate dehydrogenase isoenzyme-1

We evaluated three different methods for measuring lactate dehydrogenase (EC 1.1.1.27) isoenzyme LD-1 activity--agarose gel electrophoresis and two immunoassays, Isomune-LD (Roche) and LD-1 Immuno (Seragen)--in patients' samples for which measurement of creatine kinase-MB was ordered. Regression analyses of the comparisons gave the following results: LD-1 (%) from Isomune-LD (y) vs electrophoresis (x) (n = 51), y = 1.05x + 1.99, r = 0.92; LD-1 (%) from LD-1 Immuno (y) vs electrophoresis (n = 27), y = 1.05x + 3.94, r = 0.88; LD-1 (%) from LD-1 Immuno (y) vs Isomune-LD (x) (n = 41), y = 1.06x + 0.48, r = 0.95. Comparison by Student's paired t-test yielded significant differences between the mean values by electrophoresis and both Isomune-LD (P less than 0.005) and LD-1 Immuno (P less than 0.001), but no significant difference between the two immunoassays (P greater than 0.2). Analyzing these results by the overlap index, we conclude that electrophoresis shows the best clinical correlation followed, in order, by the Isomune-LD and the LD-1 Immuno methods. Both immunoassays are simpler and more rapid than electrophoresis, but in our hands the Isomune-LD method demonstrated greater precision and better correlation with electrophoretic values.

Electrophoresis and the isomune-LD and LD-1 immuno methods compared for measurement of lactate dehydrogenase isoenzyme-1

We evaluated three different methods for measuring lactate dehydrogenase (EC 1.1.1.27) isoenzyme LD-1 activity--agarose gel electrophoresis and two immunoassays, Isomune-LD (Roche) and LD-1 Immuno (Seragen)--in patients' samples for which measurement of creatine kinase-MB was ordered. Regression analyses of the comparisons gave the following results: LD-1 (%) from Isomune-LD (y) vs electrophoresis (x) (n = 51), y = 1.05x + 1.99, r = 0.92; LD-1 (%) from LD-1 Immuno (y) vs electrophoresis (n = 27), y = 1.05x + 3.94, r = 0.88; LD-1 (%) from LD-1 Immuno (y) vs Isomune-LD (x) (n = 41), y = 1.06x + 0.48, r = 0.95. Comparison by Student's paired t-test yielded significant differences between the mean values by electrophoresis and both Isomune-LD (P less than 0.005) and LD-1 Immuno (P less than 0.001), but no significant difference between the two immunoassays (P greater than 0.2). Analyzing these results by the overlap index, we conclude that electrophoresis shows the best clinical correlation followed, in order, by the Isomune-LD and the LD-1 Immuno methods. Both immunoassays are simpler and more rapid than electrophoresis, but in our hands the Isomune-LD method demonstrated greater precision and better correlation with electrophoretic values.