A Ca2+ influx in response to hypo-osmotic stress may alter osmolyte permeability by a phenothiazine-sensitive mechanism

The phenomenon of cell volume recovery following a hypo-osmotic stress mediated by intracellular osmolyte regulation is well known. In many, perhaps all, cell types, the osmolytes involved are usually inorganic ions and amino acids. The details of the regulatory mechanisms for the organic-type osmolytes are not well known. We have found that an immediate influx of external Ca2+ occurs coincident with the application of a hypo-osmotic stress into red cells of two invertebrate species. In both, the influx is initiated by the osmotic stress, not the concomitant ionic decrease. Volume recovery in clam red blood cells is blocked by phenothiazines. In addition, the effect of the phenothiazines is to reduce the amino acid efflux; the ionic portion of the volume response is unaffected. In contrast, the phenothiazines potentiate the volume recovery in worm red coelomocytes. A23187 also potentiates the volume recovery of the worm red cells. The results suggest that the Ca2+ influx is involved in the mechanism that alters cell membrane permeability permitting the amino acid efflux by a mechanism that may involve calmodulin.

The association of nephrolithiasis and autosomal dominant polycystic kidney disease

Despite the frequency and morbidity of nephrolithiasis in autosomal dominant polycystic kidney disease (ADPKD), this association has not been subject to a detailed study. One hundred fifty-one of 751 ADPKD patients seen at the Mayo Clinic between 1976 and 1986 had nephrolithiasis. Seventy-four had passed calculi or had stones surgically removed. Stone analysis was available in 30 patients: uric acid, calcium oxalate, calcium phosphate, and struvite were present in 56.6%, 46.6%, 20%, and 10%, respectively. Calculi were observed in 71 of 79 patients with excretory urograms available for review. Faintly opaque and bull's eye stones, probably containing uric acid, were present in 12.7% and 14.1% of these patients, respectively. Precaliceal tubular ectasia was observed in 15.5%. Ninety-seven patients had preserved renal function (serum creatinine less than 1.5 mg/dL) at the initial evaluation. Six were excluded because they had other known causes of stone disease. The most common metabolic abnormality in the remaining 91 patients was hypocitric aciduria (ten of 15 patients with measurements). The urine pH in the first voided morning specimens (5.66 +/- 0.05) was significantly lower than that of an unselected control population (5.92 +/- 0.03, P less than 0.001). Hyperuricosuria, hyperoxaluria, and hypercalciuria were observed in six of 32 (18.8%), six of 31 (19.4%), and three of 39 (9.7%) patients with preserved renal function. The composition of the stones, the frequency of hypocitric aciduria, and the low urine pH (possibly related to the defect in excretion of ammonia described in ADPKD), suggest that metabolic, along with mechanical, factors are responsible for the frequent occurrence of nephrolithiasis in this disease.

Generation of human monoclonal antibodies to cancer-associated antigens using limited numbers of patient lymphocytes

A limiting dilution method for the efficient transformation by Epstein-Barr virus (EBV) of human B lymphocytes has been applied to the production of human monoclonal antibodies to ovarian cancer-associated antigens. Limited numbers (e.g., 2 X 10(5)) of EBV-infected B lymphocytes from ovarian cancer patient spleen, lymph node, tumor, ascites and blood were successfully transformed using this method. An immunofiltration assay system was employed to identify EBV transformants secreting IgM antibody which reacted selectively with ovarian cancer patient ascites tumor cells, but not with a mixture of normal cell types. A miniature Western blot assay was utilized to screen for IgG reactivity to protein species in detergent extracts of ovarian cancer tumor cells. EBV-transformed cells selected after screening were then fused with heteromyeloma fusion partner SHM-D33 resulting in efficient recovery of hybridomas secreting MAb of the desired specificity. Human MAbs which selectively react with antigens associated with ovarian cancer tumor cells were obtained.

Clinical applications of monoclonal antibodies in gynecologic oncology

The advances of both murine and human monoclonal antibody (MoAb) technology have allowed the development of several antibodies against gynecologic tumors. The goals are to produce effective and specific reagents for both immunodiagnosis and therapy. However, despite an extensive research effort, a clear demonstration of specific cancer-associated antigens in gynecologic malignancies, or of specific immune responses to such antigens has been elusive. Currently, most antibodies found are cross reactive with either oncofetal antigens or some normal adult tissues. Clinical usefulness of these MoAbs as a screening test in radioimaging or in immunotherapy remains to be proven. However, the use of MoAb technology in defined antigens/tumor markers such as beta-human chorionic gonadotropin, and alpha fetal proteins has provided convenient, reproducible and highly specific reagents. More recently, promising antibodies have been shown to detect tumor antigens in serum of patients with ovarian cancer.

ICI 147,798: a novel diuretic agent with beta adrenoceptor blocking activity

ICI 147,798 is a novel compound which has both diuretic and beta adrenoceptor blocking properties in a single molecule. The natriuretic activity at 30 mg/kg p.o. was about 65% of the hydrochlorothiazide value at 10 mg/kg p.o. in saline-loaded rats; the corresponding kaliuretic activity was 42%. The natriuretic and the kaliuretic activity of ICI 147,798 in dogs were similar to that of hydrochlorothiazide over the doses 1 to 20 mg/kg p.o., although significantly less kaliuresis was obtained with ICI 147,798 at 1 mg/kg p.o. In the toad bladder preparation (analogous to the distal mammalian nephron), ICI 147,798 inhibited Na+ transport with mucosal and serosal IC50 values of 56 and 120 microM, respectively. ICI 147,798 inhibited isoproterenol-induced tachycardia in rats, cats, guinea pigs and dogs; these effects were associated with antagonism of isoproterenol vasodepressor responses. The pKB values of ICI 147,798 were 9.1 and 8.8 in isolated right atria and trachea of guinea pigs, respectively. ICI 147,798 did not exhibit local anesthetic activity in rabbit cornea and intrinsic sympathomimetic activity in catecholamine-depleted dogs and rats. Duration of beta blockade after a p.o. dose of 1 mg/kg in dogs followed the sequence: nadolol greater than ICI 147,798 greater than atenolol greater than timolol greater than propranolol. It is concluded that ICI 147,798 is a novel diuretic agent with nonselective beta blockade, and it appears to have the potential of a direct tubular action.

Skin tumorigenic potential of crude and refined coal liquids and analogous petroleum products

The skin tumorigenic potential of seven complex hydrocarbon mixtures was determined: a coal-derived raw blend composed of light and heavy oils, a low- and high-severity hydrotreated product of that blend, and naphthas and fuel oils from the raw blend or from natural petroleum. Male and female C3H/Bdf mice were exposed three times per week to each test mixture by dermal application of 50 microliters of neat, 50, or 25% (w/v) preparations. Room, vehicle, and benzo[alpha]pyrene control groups were run concurrently. The raw blend produced an almost 100% incidence of skin tumors at all three doses while tumorigenicity was considerably decreased by hydrotreating the blend both in terms of incidence and onset. The tumorigenicities of the naphthas and fuel oils derived from the raw blend or from petroleums were low relative to that of the parent mixture. Although tumorigens in the raw blend were much reduced by hydrotreatment, tumorigenicity of the other agents did not parallel the content of polycyclic aromatic hydrocarbons known to be good tumor initiators.

Stimulus-response coupling in a cell-free platelet membrane system. GTP-dependent release of Ca2+ by thrombin, and inhibition by pertussis toxin and a monoclonal antibody that blocks calcium release by IP3

The Ca2+-mobilizing action of thrombin was demonstrated in a cell-free platelet membrane system consisting of open sheets of plasma membrane plus sealed membrane vesicles that accumulate Ca2+ and release Ca2+ in response to IP3. Thrombin plus GTP, acting on plasma membrane (not vesicles), produced a soluble factor (destroyed by alkaline phosphatase) that released Ca2+ from the vesicles. This effect of thrombin/GTP was blocked by a monoclonal antibody that binds to vesicles and prevents Ca2+ release by IP3. Pertussis toxin plus NAD ADP-ribosylated plasma membrane polypeptides of 39 and 41 kDa and blocked Ca2+ release by thrombin/GTP, but not by IP3.

Strain A mouse pulmonary tumor test results for chemicals previously tested in the National Cancer Institute carcinogenicity tests

Sixty-five chemicals were coded and examined for their ability to induce lung tumors in strain A/St (laboratory A) or strain A/J (laboratory B) mice. Thirty-five chemicals were tested in laboratory A only, 6 in laboratory B only, and 24 in both laboratories. Two-year carcinogenicity test results as well as genotoxicity test data are available for most of these chemicals. There was poor interlaboratory agreement in strain A test results for the 24 chemicals tested in both laboratories. In addition, there was poor agreement between strain A test results from either laboratory and 2-year carcinogenicity test results or genotoxicity results. Possible explanations for these findings include selection of a large number of aromatic amines in the group of chemicals submitted for strain A testing, differences in strain A testing protocols and in statistical analysis of results from the two laboratories, low sensitivity of the strain A/St mice used in this particular study, and general problems inherent in comparing any relatively short-term animal tumor model with 2-year carcinogenicity tests. Since there is no absolute reference for carcinogenicity, no one test system is better than another. Carcinogenicity test data are relevant only to the test model employed.

Inhibitors of crystal growth of hydroxyapatite: a constant composition approach

Pyrophosphate, citrate and magnesium, inhibitors of hydroxyapatite crystal growth, were studied using a seeded crystal growth system of constant composition at pH 5.80, 6.60 and 7.40. With this technique, crystal growth was studied at constant supersaturation at different pH values without the induction of other calcium phosphate phases. One inhibitor unit (that concentration of material that results in a reduction of 50 per cent in the growth rate from control) was calculated using the Langmuir adsorption isotherm. Pyrophosphate and citrate increased inhibitor activity with decreasing pH, whereas magnesium increased inhibitor activity with increasing pH. These data suggest that, at the urinary concentrations of these inhibitors, pyrophosphate is the most potent inhibitor, citrate less, and magnesium least. Pooled urine collections were studied using the same system and were found to have decreased inhibitor activity as pH decreased. This suggests that other modulators of hydroxyapatite, either promoters or inhibitors, are active in this system at the pH values studied.

EQUIL2: a BASIC computer program for the calculation of urinary saturation

A BASIC computer program for the calculation of urinary supersaturation with respect to the common kidney stone components is described. In vitro and in vivo tests show that the program described accurately calculates supersaturation. The application of this computer program to urolithiasis research is discussed.

Bladder secretion of inhibitors of calcium oxalate crystal growth

Differences in calcium oxalate crystal growth inhibition were studied in normally voided urine (bladder urine) and in urine collected directly from the kidney (kidney urine) in nine dogs. Urine samples were collected before and 10 days after bilateral ureterostomies. Calcium oxalate crystal growth inhibition was measured in a standard seeded crystal growth system. The alcian blue-precipitable material of the urine samples was determined. Significantly lower values were observed in kidney urine than in bladder urine for calcium oxalate crystal inhibition (mean difference, 0.07 +/- 0.02 inhibitor units/mg creatinine; P less than 0.01) and for the alcian blue-precipitable material (mean difference, 0.07 +/- 0.02 mg/mg creatinine; P less than 0.01). We conclude that the bladder adds calcium oxalate crystal growth inhibition to urine. Glycosaminoglycans from the bladder mucosa may be responsible; however, other acidic polymers such as RNA fragments or glycopeptides have been shown to be a constituent of the alcian blue-precipitable material. These are potent inhibitors of calcium oxalate crystal growth, and their participation in the increase of inhibition observed in bladder urine cannot be excluded. Total calcium oxalate crystal growth inhibition present in normally voided urine may be an overestimation of the actual inhibition present at the level of the kidney, where calculi usually form.

Transport of citrate across renal brush border membrane: effects of dietary acid and alkali loading

Dietary acid or alkali loading was given to rats by providing 150 mM NH4Cl or 150 mM NaHCO3 in place of drinking water for 6 days; control animals received 150 mM NaCl. After 6 days, the citrate clearance was 0.04 +/- 0.01 ml/min (mean +/- SE) in the acid-loaded group, 0.9 +/- 0.1 ml/min in the control group, and 2.5 +/- 0.2 ml/min in the alkali-loaded group. At the end of the experiment, the rats were killed, and the Na+ gradient-dependent (Nao+ greater than Nai+) citrate uptake (pmol/mg protein) was measured in brush border membrane (BBM) vesicles prepared from each group. At 0.3 min, the [14C]citrate uptake was 198 +/- 8 pmol/mg protein (mean +/- SE) in the acid-loaded group, 94 +/- 16 pmol/mg protein in the control group, and 94 +/- 13 pmol/mg protein in the alkali-loaded group. The rate of Na+-independent (NaCl in medium replaced by KCl) [14C]-citrate uptake by BBM vesicles was the same for acid-loaded, control, and alkali-loaded animals. Thus, the increased capacity of the proximal tubular BBM to transport citrate from the tubular lumen into the cell interior may be an important factor that contributes to decreased urinary citrate in the presence of metabolic acidosis induced by chronic dietary acid loading.

Goniometric reliability for a child with spastic quadriplegia

Intrarater and interrater reliabilities were assessed for upper-extremity goniometric measurements of a 5-year-old girl with severe spastic quadriplegia. Percentage agreement was the method used to evaluate goniometric reliability of three motions bilaterally: shoulder flexion, shoulder abduction, and elbow extension. Intrarater reliability for each of the two raters was higher than interrater reliability. The mean differences and the range of differences between raters for each of the six motions measured also were recorded. There was wide variability in measurements both within and between raters. These results suggest that a difference of +/- 10-15 degrees in range of motion over time does not justify conclusions of either significant improvement or significant regression in a child with severe spastic cerebral palsy.

Pentosan polysulfate as an inhibitor of calcium oxalate crystal growth

Pentosan polysulfate was studied as a calcium oxalate crystal growth inhibitor. The inhibition from pentosan polysulfate at concentrations ranging from 3.5 to 110 mg./l. was measured in simple inorganic calcium oxalate solutions at pH 5, 6 and 7. Pentosan polysulfate also was mixed with urine at concentrations from 10 to 350 mg./l. and inhibition determined. Measurement of calcium oxalate crystal growth inhibition was performed in a seeded crystal growth system. One inhibitory unit (concentration of pentosan polysulfate necessary to give a 50 per cent reduction in the rate of crystal growth) was 5.7 +/- 2 mg./l. at pH 5, 7.2 +/- 1.1 mg./l. at pH 6 and 6.0 +/- 2.1 mg./l. at pH 7. Urine-pentosan polysulfate mixtures showed more inhibitory activity than the predicted inhibition present. Addition of pentosan polysulfate to urine at a concentration of 10 mg./l. increased the inhibitory activity from 45 +/- 3 to 59 +/- 3 IU/l. Pentosan polysulfate is a potent calcium oxalate crystal growth inhibitor in urine at physiologic pH levels. If the urinary concentration of pentosan polysulfate after oral administration reaches 10 mg./l., the increase in inhibitory activity in urine that may occur might be important in the treatment of patients who form calcium oxalate calculi within the urinary tract.

Oxalate absorption and postprandial urine supersaturation in an experimental human model of absorptive hypercalciuria

The effect of 1.25-dihydroxyvitamin D [1,25-(OH)2D] on dietary oxalate absorption and postprandial urine supersaturation with calcium oxalate was determined in 11 normal subjects. 1,25-(OH)2D increased the urinary excretion of orally administered [14C]oxalate in the 8 h period after a liquid meal containing 1.875 mmol of calcium and 0.83 mmol of oxalate (P less than 0.01), and during a 48 h period when the subjects ingested a diet containing 25 mmol of calcium and 3.3 mmol of oxalate/day (P less than 0.01); however, 1,25-(OH)2D administration had no effect on [14C]oxalate excretion when calcium was removed from the liquid meal. 1.25-(OH)2D increased 24 h urinary oxalate excretion from 28.7 +/- 2.1 mmol/mol of creatinine to 36.8 +/- 2.6 mmol/mol of creatinine (P less than 0.05) on the 10 mmol/day calcium diet and from 26.4 +/- 2.9 to 33.2 +/- 2.2 mmol/mol of creatinine (P less than 0.1) on the 25 mmol/day calcium diet. A linear correlation (r = 0.72) was found between plasma 1,25-(OH)2D levels and urinary [14C]oxalate excretion after the liquid meal. 1,25-(OH)2D administration produced postprandial supersaturation of urine with calcium oxalate and calcium oxalate crystalluria. These studies suggest that 1,25-(OH)2D increases oxalate absorption (and urinary excretion) by increasing calcium absorption, which results in less binding of calcium to oxalate in the intestine; therefore more oxalate is available for absorption. The combined effect of increased calcium and oxalate absorption results in postprandial supersaturation of urine with calcium oxalate, with resultant crystalluria.

Calcium oxalate dihydrate formation in urine

Factors that promote the formation of calcium oxalate dihydrate (COD) in urine were investigated. Crystals resulting from the incubation of 25-ml aliquots of the solution to be tested and 1 ml of 0.05 M ammonium oxalate were examined by infrared spectrophotometry. With reference spectra of known mixtures, the fractional content of COD could be estimated. At pH 6.5, only COD formed in human urine. In a supersaturated inorganic solution of calcium oxalate, the percentage of COD was 7.5 +/- 1.4. Pyrophosphate (1 to 8 X 10(-5) M), citrate (10(-4) to 2 X 10(-3) M), RNA from yeast (5 X 10(-9) to 0.5 X 10(-7) M), or heparin (2 X 10(-9) to 2 X 10(-7) M) added to a supersaturated solution of calcium oxalate increased the percentage of COD proportional to the concentration of the additives. Chondroitin sulfate and magnesium had no effect. An increase in pH increased the formation of COD in inorganic solutions containing citrate, pyrophosphate, and heparin and in undiluted urine. RNA-citrates and citrate-pyrophosphate mixtures showed additivity. Urine showed an effect that was inversely proportional to its dilution. Substances that promote COD formation in this system had their phase-stabilizing effects at concentrations normally found in urine. Further, these same substances are known inhibitors of calcium oxalate crystal formation. With both inhibition and phase stabilization, there is additivity of effects, and changes in pH alter the response.

Detection of malignant ovarian neoplasms: a review of the literature. III. Immunological detection and ovarian cancer-associated antigens

In summarizing the data on characterization of the immune system in the ovarian cancer patient, it is possible to conclude that both cellular and humoral immune responses occur in the presence of ovarian cancer. However, the specificity of such reactions is less certain. Although most of the tests outlined above are of doubtful utility in cancer immunodetection, data obtained from some studies support the assumption that there exist epithelial ovarian cancer-associated antigens which are expressed in tumors arising in different individuals, and that these antigens are the target of an immune response in many patients. It is unclear, however, how widely distributed such antigens are among normal tissues and other neoplasms. Direct characterization of ovarian cancer-associated antigens may provide more well-defined test antigens with which to assay individuals for a specific immune response. An immune response to specific cancer-associated antigens could precede the appearance of detectable levels of such antigens in the circulation.

Detection of malignant ovarian neoplasms: a review of the literature. I. Detection of the patient at risk; clinical, radiological and cytological detection

Risk factors for epithelial ovarian cancer are summarized in Table 1. Calculation of ovulation-years appears to be a potentially useful and practical method for identification of the high-risk individual. Risk factors for nonepithelial ovarian cancer are largely unknown, and consequently clinical diagnosis is stressed in the early detection of these tumors. Patients with Peutz-Jeghers syndrome or ovarian dysgenesis are significantly at risk and require at least regular pelvic examination. Of course, individuals with sexual precocity are at high risk for sex cord/stromal or germ cell malignancies. Individuals with a family history of Sertoli-Leydig cell tumors and benign thyroid disease also deserve close observation. Early clinical detection requires a sensitivity to presenting symptomatology (e.g., diffuse abdominopelvic complaints) as well as the skill and knowledge needed to recognize and appropriately manage adnexal masses. Harbingers of ovarian malignancy in the elderly woman, including unexplained hypercalcemia, new onset dermatomyositis, and cerebellar degeneration, should motivate thorough gynecologic evaluation. While radionuclide ovarian imaging for detection of early epithelial cancers of the ovary may become more generally available in the future, ultrasound imaging of the postmenopausal ovary, and peritoneal cytology may be of immediate value in screening high-risk women.

Percutaneous lithotripsy

We have performed percutaneous extractions of renal pelvic stones in 194 patients via the Wolf percutaneous universal nephroscope. At 1 session, with the patient under general anesthesia, a percutaneous tract is dilated to 24F and the stone is removed immediately. We have removed 185 stones successfully by ultrasonic lithotripsy, basket retrieval and/or use of forceps. Average operating time was 54 minutes and mean hospitalization was 5 days. The advantages of this technique are that a skin incision of only 1 cm. is required to remove the stone, hospital days are fewer than with open procedures and postoperative morbidity is minimal. In selected situations this method represents a significant advance over standard open surgical procedures for removal of renal pelvic stones.