Antigenic determinants shared between HLA-A, -B, -C antigens and H-2 class I molecules modified by bovine beta-2 microglobulin

The specificity of the mouse class I-specific antibody COB6-3 was examined in detail. It was found to react with the mouse class I molecules H-2Db, Kd, and Qa-2, and with human HLA-A, -B, -C antigens. The specificity pattern of COB6-3, despite its different origin, was similar to that of the monomorphic HLA class I-specific antibody W6/32. Cross-inhibition studies show that on human cells the antigenic determinants recognized by the two antibodies are situated close together and may be identical. On mouse cells, reactivity of both antibodies was generated upon replacement of mouse beta-2 microglobulin (B2m) with its bovine counterpart, but differences in specificity were observed using human B2m.

A structural somatic variant of the Kk antigen is generated by point mutation

We have previously selected structural variants of the Kk antigen from a (C3 X D2)F1 T-cell lymphoma. Those mutants were identified by the loss of certain epitopes defined by monoclonal antibodies. The variant Kk molecule from HK13.S3 cells is no longer recognized by 40% of the trinitrophenyl-specific, Kk-restricted cytotoxic T lymphocytes. Here we report on the primary structure of the altered Kk molecules from the cell line HK13.S3. Comparison with the parental Kk reveals a single base pair exchange, GCG to GTG, that results in an alanine to valine exchange in position 40 of the protein. This observation emphasizes that minor structural alterations in class I molecules may have a strong effect on the H-2-restricted T-cell response.

An objective assessment of the physiologic changes in the postthrombotic syndrome

To determine what physiologic changes might contribute to the development of the postthrombotic syndrome, venous outflow, venous refilling time, and valvular competence were assessed in 32 patients (39 limbs) with documented deep venous thrombosis. The follow-up ranged from nine to 144 months (mean, 41 months) after the acute deep venous thrombosis. Pain was noted by 49% of the patients, but more objective end points occurred less frequently (edema, 21%; pigmentation, 26%; ulceration, 3%). Venous outflow was lower in the affected limbs but was not a good indicator of those patients with or without symptoms. Venous refilling time after calf compression was markedly reduced in limbs with incompetent valves (mean +/- SD, 8.4 +/- 3.8 s v 25.3 +/- 12.1 s), as well as in those with edema, pigmentation, and ulceration. It appears that most of the sequelae of the postthrombotic syndrome can be attributed to the loss of valvular function.

Compression of the right pulmonary artery by aortic aneurysms: CT demonstration

Two cases are presented in which compression of the right pulmonary artery by thoracic aortic aneurysm was demonstrated using dynamic CT. The patients initially presented with symptoms suggestive of pulmonary embolus and were found to have unilateral absence of perfusion on isotope lung scan. Computed tomography was useful in demonstrating pulmonary artery compression by aortic aneurysm as the cause in both cases, and in demonstrating an aortic dissection in one case.

Pathophysiology of venous claudication

Patients with chronic iliofemoral venous obstruction may develop severe thigh pain and a sensation of tightness with vigorous exercise (venous claudication). The discomfort requires 15 to 20 minutes to subside. In the seven patients studied the venous capacitance (VC) and venous outflow (VO) are lower than those of the unaffected limb even at rest. With exercise to the point of pain, the VO was unchanged but the VC decreased even further. The problem appears to rest with the venous collaterals, which have a high and fixed resistance. Because of this high outflow resistance, venous volume increases to near maximum during exercise. With this rise in venous volume, the amount the VC can increase during the period immediately following exercise is further reduced.

Sex differences in inpatients with major depression

To assess sex-related differences, 53 inpatients with major depression were evaluated with the Zung, Dempsey , and Hamilton depression scales, and part of the Beck scale. Women had more fitful sleep, easy crying, social withdrawal, agitation, somatic anxiety, gastrointestinal symptoms, genital symptoms, crying spells, constipation, and fast heartbeat. Men had more self-dislike and lack of clear mind. Differences in manifestations of major depression may account for misdiagnosis of female depressives as suffering from anxiety or functional insomnia and lead to treatment with anxiolytics rather than antidepressants. Self-dislike and mental clouding may lead male depressives to serious suicide attempts and work failures.

Identification of human lymphoma cells by antisera to malignancy-associated nucleolar antigens

The non-Hodgkin's lymphomas (NHL) are a diverse group of human lymphoid neoplasms that have long presented pathologists with formidable diagnostic challenges. These tumors of the immune system are thought to represent neoplastic transformations of most of the recognized stages in T and B lymphocyte ontogeny. Lymphoma cells, however, often simulate their normal lymphocytic counterparts both morphologically and cell surface phenotypically, creating difficulties in discriminating normal from neoplastic lymphocytes. We have used heteroantisera to the human malignancy-associated nucleolar antigen (HMNA) to prospectively evaluate its efficacy in identifying the morphologically neoplastic cells in NHL lesions. In 65 cases of T and B cell histopathologic types of NHL, the antisera reacted with nucleoli in the morphologically and cytogenetically neoplastic lymphoma cells, but not with normal-appearing lymphoid and other cell types present in the lesions. Control specimens from normal and hyperplastic lymphoid tissue also failed to react with anti-HMNA antibodies. Normal activated lymphoid cells in vitro and growth-factor-dependent normal lymphoid cell lines also failed to express the nucleolar antigen(s). These data suggest that the HMNA is a valuable tumor cell marker for neoplastic human lymphoid cell populations and can be used with other types of cell markers for a better definition of the neoplastic cells in NHL.

Affinity-purified antigen-specific products produced by T cells share epitopes recognized by heterologous antisera raised against several different antigen-specific products from T cells

Heterologous antisera to murine or rat T-cell antigen-binding molecules (T-ABM) were raised in rabbits or sheep. The T-ABM used for immunization were purified by affinity for antigen and did not bear known immunoglobulin isotypes. T-ABM and anti-T-ABM were raised in three separate laboratories. Antisera to T-ABM were exchanged and tested for binding to T-ABM in three separate laboratories. Thus antisera to at least three distinct T-ABM were tested directly for binding to T-ABM or by adsorption of biological activity. Rabbit antisera to murine trinitrophenol (TNP)-specific T-ABM or rat AgB-specific T-ABM bound both murine or rat T-ABM, indicating evolutionary conservation of T-ABM. Similar results were found with sheep antisera to murine T-ABM. In addition, all heterologous anti-T-ABM antisera used bound murine T-ABM specific for TNP, 4-hydroxy-3-nitrophenyl acetate (NP), SRBC, or T-cell membrane proteins with similar structure. Thus, there is a commonality of antigenic determinants between various T-ABM and T-cell membrane homologues which may be T-cell surface receptors for foreign antigen.

Somatic variation of H-2Kk expression and structure in a T-cell lymphoma: instability, stabilization, high production and structural mutation

In the heterozygous T lymphoma line LDHB, variants which have lost the expression of individual H-2 class I genes are spontaneously generated in vitro at a frequency of 10(-1)-10(-2). A cell line (HK13) in which the class I gene Kk is stably expressed (frequency of loss variants less than 10(-4) was selected from LDHB cells by fluorescence activated cell sorting. Further selection of HK13 cells for high Kk expression led to the isolation of the HK22 line which expresses twice as much Kk as HK13. From HK13 and HK22 cells, spontaneous structural variants of Kk having lost individual serological determinants of the Kk wild-type molecule, were isolated by fluorescence activated cell sorting. Such variants occur at a frequency of 10(-6)-10(-7) per cell per generation. The analysis of these variants indicates that they carry mutations in the Kk structural gene and that HK13 cells express a single Kk gene which appears to be duplicated in HK22 cells. We did not find evidence for the generation of variants expressing 'alien' class I products in the LDHB cell line. The instability of class I gene expression in LDHB cells and the transition to stable expression may represent steps of T-cell differentiation in the thymus.

Long-term sequelae of acute venous thrombosis

The long-term sequelae of acute deep-vein thrombosis were examined prospectively in a series of 61 patients. The location and extent of the involvement were established by either contrast or isotope phlebography. The mean age of the patients was 47 years, with the duration of follow-up averaging 39 months (range, one to 144 months). Pain and/or swelling was noted in 67% of the patients. Pigmentation developed in 15 limbs (23%). Ulceration developed in three patients. The most important factor with regard to prognosis appeared to be the status of the distal deep veins. If these were found to be patent and competent by ultrasonic velocity studies, the long-term outlook was good, both with regard to symptoms and the development of pigmentation. Only 8% of those limbs with normal distal veins were found to have pigmentation during follow-up, as compared with 40% in those with either occlusion or incompetence of the valves.

Idiotypic and fine specificity analysis of a (4-hydroxy-3-nitrophenyl)acetyl (NP)-specific suppressor T cell hybridoma at the level of cell surface structures, isolated receptor material and functional suppressor factor

The (4-hydroxy-3-nitrophenyl)acetyl (NP)-specific T suppressor cell hybridoma 7C3-13 was established by fusing splenic B10.BR T cells enriched on NP-coated petri dishes with the AKR thymoma BW5147. 7C3-13 was selected by anti-NPb idiotypic and anti-I-Jk antibodies in microcytotoxicity tests. The hybridoma expressed H-2k, I-Jk, Qa-1, Thy-1.1 as well as idiotypic (binding site-related) and framework Ig VH determinants, while it was negative for I-A, I-E/C, Thy-1.2, Lyt-1, Lyt-2 and Ig constant region determinants. Hapten-binding receptor material could be isolated from 7C3-13 cells on NP-coupled nylon nets and functionally active T suppressor factor (TsF) could be extracted from the hybridoma. Both types of soluble molecules express NPb idiotype, but the TsF carries I-J determinants in addition while the isolated receptors do not. The molecular weight of the isolated receptor material is 80 000, that of the TsF activity is 27 000 and 57 000-64 000, respectively. We thus were able to show that NP-binding molecules can be obtained in the form of cellular surface receptors, isolated receptor material and extracted TsF from one and the same, monoclonal, cell source.

A simple mathematical model for predicting lithium dose requirement

Available methods of predicting lithium dose have been based on kinetics of a single test dose. A statistically based mathematical model was developed in which lithium dose is derived by stepwise multiple linear regression based on desired level, form of lithium, concomitant tricyclic use, age, sex, and weight. Predictions of the model were correct to within 300 mg in 66% of the 100 initial cases and within 600 mg in 94% of cases. A validation study of 112 additional cases revealed similar percentage. The simple mathematical expression derived from record review allows the clinician to calculate the relationship of steady-state lithium dosage to serum level prior to initiating treatment.

Sinus node recovery time related to paced cycle length in normals and patients with sinoatrial dysfunction

Depressed conduction in the sinoatrial junction, common in the sick sinus syndrome (SSS), should decrease the maximum pacing rate at which 1:1 capture of the SA node occurs. This may result in shorter than expected sinus recovery times (SRT) and maximal prolongation of SRT at relatively slow pacing rates. To test this hypothesis we evaluated the range of pacing rates necessary to demonstrate maximal SRT in 34 patients with and 20 patients without sinus node dysfunction. Atrial pacing was performed at multiple paced cycle lengths (PCL) between 400 and greater than or equal to 1000 msec, four times at each. A mean corrected SRT (CSRT) was determined at each PCL, and the PCL of the longest CSRT was determined (PCLp). PCLp varied linearly with sinus cycle length, was dependent on sinoatrial conduction time, and was longer in patients with SSS than in normal persons. Only 2 of 20 normal persons, but 21 of 34 patients with SSS, had a PCLp greater than 600 msec. A long PCLp (greater than 600 msec) suggests the possibility of recovery times that have been limited by A-S entrance block and appears to be indicative of sinus node dysfunction.

Pitfall of venous occlusion plethysmography

The supposition that the lower limb expands uniformly in circumference during venous occlusion has been investigated. The 3 compartments of the calf were found to be expand to differing degrees depending on the volume of muscle within the compartment. The effect of this phenomenon on the measurement of venous outflow and capacitance using an overlapping strain gauge was assessed. When using an overlapping strain gauge, the anatomical site of overlap was found to alter the measured values of outflow and capacitance by as much as 50%. These errors do not arise with strain gauges designed to fit a small range of limb circumferences, so that no overlap occurs. The reproducibility of plethysmography may be enhanced by attention to the site and degree of overlap of gauges which are designed to fit all sizes of limb. Technicians performing venous occlusion plethysmography should be aware of these variations, so that the examination technique can be standardized.

Isolation of a cloned cell line expressing variant H-2Kk using fluorescence-activated cell sorting

We describe here a method for the isolation of somatic cell variants that express a structurally altered gene product on their cell surface. The method makes it possible to select positively for cells of the variant phenotype which is defined by loss of a given antigenic determinant. As an example, we present the isolation of a cloned cell line expressing a structurally altered H-2Kk molecule, designated H-2KkS1. Cells of this phenotype were found to be present in the wild-type population at a frequency of 10(-5)-10(-6) and were isolated in three rounds of selection in the fluorescence-activated cell sorter (FACS) and subsequent growth in vitro.

Locus of control and adjustment to chronic hemodialysis

The Rotter Inventory was used to assess external vs. internal locus of control in chronic hemodialysis patients. This measure of personality was correlated to psychological and physiologic measures of adaptation to hemodialysis. Patients with high external locus of control had poorer overall compliance with higher interdialytic weight gain, but did not show more psychological distress. Nurses Observation Scale for Inpatient Evaluation correlated negatively with mean K, mean P, Beck Depression rating, and duration of dialysis.

Psychopathology and shamanism in rural Mexico: a case study of spirit possession

The so-called mystical possession of Juan Jose Fong, a socially marginal Chinese-Mexican of hysterical personality is directly related to the subject's psychological conflicts and emotional complexes and familial and social standing within the immediate cultural context. The subject is seen as suffering from conflicting emotions and cognitions centering around guilt, inferiority and non-acceptance by his peer group. The personification of his personal problems in the motif of spirit possessions enables the subject to maintain a measure of self-esteem, social status and personality integration.

Effects of digoxin on sinus nodal function before and after vagal blockade in patients with sinus nodal dysfunction: a clue to the mechanisms of the action of digitalis on the sinus node

To increase the limited knowledge of the effects of digitalis on sinus nodal function in patients with sinus nodal dysfunction and to initiate an investigation into the mechanisms underlying its effects, 34 patients with sinus nodal dysfunction were studied. Twenty patients underwent determination of sinus cycle length, estimated sinoatrial conduction time and maximal corrected sinus recovery time before and after the administration of 0.75 mg of intravenous digoxin. For the group, sinus cycle length did not change, sinoatrial conduction time increased insignificantly and maximal corrected sinus recovery time shortened; however, individual variation occurred. The effects of acute digitalization appeared to predict the effects of chronic digitalis administration on sinus nodal function in the eight patients who subsequently continued to take digoxin. Fourteen patients received digoxin after vagal blockade with atropine. After vagal blockade, digoxin lengthened sinus cycle length, sinoatrial conduction time and maximal corrected sinus recovery time. The effects of digoxin administered after atropine could be antiadrenergic, direct, or both, and are opposite to those induced by atropine alone. Because these effects are similar to those of vagotonia yet are not apparent when the vagi are unblocked, digoxin may have direct excitatory, adrenergic or previously unrecognized vagolytic effects on sinus nodal function in man and their manifestation may be dependent on heart rate or autonomic tone.

Electrograms from the canine sinoatrial pacemaker recorded in vitro and in situ

We have identified extracell potential changes associated with the electrical activity of the canine sinoatrial pacemaker. Small nonpolarizable electrodes and low frequency high gain amplification were used to record unipolar electrograms from both the epicardial and the endocardial surfaces of the canine sinus node. Initially in vitro studies were performed so that transmembrane action potential changes could be recorded simultaneously with the extracell potentials. The sinus nodal electrogram showed two characteristic potentials when the electrode was in immediate proximity to pacemaking cells: (1) During phase 4 there was a steady slope of about -30 to -100 muv/sec, and (2) during the transition from phase 4 to phase 0 of the transmembrane action potential the slope of the electrogram increased smoothly to approximately -400 to -1,000 muv/sec. These potentials were followed by high frequency deflections as cells in the surrounding atrium depolarized. Tetrodotoxin (5 mg/liter) rendered the atrial muscle inexcitable and delayed and then abolished the high frequency activity in the sinus electrogram, which then appeared as a continuous smooth tracing similar to the sinus pacemaker action potential but reversed in polarity. We then recorded these small localized potentials from the in situ canine heart. Sinus nodal electrograms could be obtained from beating hearts with hand held probes on the epicardial surface and with conventional recording catheters on the endocardial surface. The results demonstrate that the canine sinus node gives rise to detectable and characteristic changes in extracell potential and suggest that similar potentials can be recorded from man to evaluate sinus nodal function.

Isolated hapten-binding receptors of sensitized lymphocytes. III. Evidence for idiotypic restriction of T-cell receptors

The primary antibody response of C57BL/6 mice to the 4-hydroxy-3-nitrophenylacetyl (NP) hapten is restricted to antibody molecules expressing the NPb idiotype. This idiotype is a genetic marker for V genes in the heavy chain linkage group. In the secondary response, the frequency of NPb idiotype-positive molecules within the antibody population drops to very low values. Accordingly, isolated NP binding receptors from NP-sensitized B lymphocytes are largely devoid of this idiotype. In contrast, the NPb idiotype is expressed on the majority of the receptor fractions which we consider T-cell derived. This finding suggests that the antigen receptors of T lymphocytes may be restricted to the expression of major (germ-line encoded?) heavy chain idiotypes.