Expression of atrial natriuretic peptide in cultured adult cardiac ventricular muscle cells as studied by immunofluorescence microscopy

Atrial natriuretic peptide (ANP) is known to be present predominantly in the granules of adult cardiac atrial muscle cells. The functional role of this peptide is known to be involved in diuresis, natriuresis and control of blood pressure. The present study using antibody to ANP, revealed that the cultured adult cardiac ventricular muscle cells, unlike their counterparts in vivo, expressed ANP to be as abundant as in adult atrial cells. Cultured atrial cells did not express ANP any more than their counterparts in vivo. Both cells, specifically ventricular cells, contained various forms of ANP such as granular, aggregate, ring-shape, fibrous and amorphous in different parts of the cell body. Vesicular or granular ANP was also observed beneath the cell membrane, above the cell membrane or outside the cell body, which were possibly suggestive of exocytosis of ANP by cells. The current studies were extended to the cultured embryonic ventricular and atrial cardiac myocytes, and revealed that these cells expressed considerable ANP, which were comparable to those in in vivo cells, reported by others. The high expression of ANP in cultured adult ventricular cardiac muscle cells indicates that these adult cells are capable of producing high content of ANP as observed in embryonic ventricular cells.

Gonadoblastoma and chroiocarcinoma in dysgenic gonads: report of a case

Dysgenetic gonads are well known to be associated with gonadoblastoma and various germ cell tumors, but very rarely with choriocarcinoma. We describe a 16-year-old, phenotypic female patient with a 46XY karyotype who developed gonadoblastoma on the right gonad and choriocarcinoma on the left. There was no co-existence of the two tumor cell types in the same gonad. This case emphasizes the importance of bilateral gonadectomy for "46XY female" patients, as soon as the cytogenetic evidence is known.

Bacteremia with nontyphi Salmonella and therapeutic implication

OBJECTIVES

The recent decades witnessed the increased incidence of bacteremia with nontyphi Salmonella, especially in patients with underlying diseases. To evaluate clinically the patients with bacteremia by nontyphi Salmonella, we investigated the clinical records of the patients.

METHODS

Retrospective study was performed on 30 cases of bacteremia with nontyphi Salmonella admitted to Soon Chun Hyang University Hospital from 1987 to 1993, and we analyzed with regard to age distribution, underlying diseases, clinical presentation and fatality.

RESULTS

Children below 2 years of age were seven patients and patients over 55 years of age were 8 patients. The male to female ratio was 3:2. Only five cases were nosocomially acquired. More than two-thirds (21 patients) had no discernible other illness at the time of their bacteremia. A quarter of the patients presented without gastrointestinal manifestation. There were four deaths in the 30 patients with nontyphi Salmonella septicemia (13.3%).

CONCLUSIONS

We investigated the clinical characteristics of 30 cases of non-typhi Salmonella bacteremia, which has a relatively high incidence nowadays while, to the contrary, Salmonella typhi trends toward being on the decrease in Korea.

Neonatal enterovirus infection: virology, serology, and effects of intravenous immune globulin

A prospective study of the virology of and serological responses to enterovirus infection in 16 neonates (< or = 2 weeks of life) and their mothers was performed. At study entry, 11 neonates did not have detectable serum neutralizing antibody to their own viral isolates, despite the presence of neutralizing antibody in 9 of 11 mothers of these infants. Viremia and viruria were demonstrated in 8 and 7 neonates, respectively, with maximal detected titers of 6.3 x 10(3) 50% tissue culture infective dose per mL (TCID50) and 6.8 x 10(1) TCID50/mL, respectively. Viremia was associated with onset of illness in the first 5 days of life, low initial serum neutralization titer, and the presence of echovirus serotypes. Randomized administration of intravenous immune globulin (IVIG; 750 mg/kg) to nine neonates overall modestly increased serum neutralization titers but did not reduce the daily incidence of viremia and viruria compared with that of controls. However, receipt of IVIG containing a neutralization titer of > or = 1:800 to the patients' own viral isolates was associated with significantly higher serum neutralization titers and more rapid cessation of viremia and viruria. Future trials of IVIG for neonatal enterovirus disease should assess the efficacy and safety of higher or repeated doses of this agent and/or of IVIG selected for their high titers to frequently circulating and/or particularly virulent enterovirus serotypes.

Visualization of pulmonary vein obstruction by pulmonary artery wedge injection and documentation by pressure tracings: report of one case with persistent wheezing following correction of total anomalous pulmonary venous connection

A 21-month-old boy presented with persistent wheezing 16.5 months after cardiac surgery for supracardiac total anomalous pulmonary venous connection. He had presented at birth with cyanosis and at the age of 25 days, underwent initial cardiac surgery in the form of anastomosis of the pulmonary venous confluence to the left atrium. Non-invasive investigations including transthoracic and transesophageal echocardiograms revealed stenosis of the right pulmonary veins. Visualization and documentation of right pulmonary vein obstruction by pulmonary arterial wedge angiography and pressure tracings are presented.

Flow characteristics in infants with hypoplastic left heart syndrome: an echocardiographic study

From July 1992 to January 1993, a total of 5 cases of hypoplastic left heart syndrome were diagnosed by echocardiograms and confirmed by available angiographic, surgical or autopsy results. The flow dynamics disclosed by spectrum display in the aortic root and patent ductus arteriosus (PDA), in systole, were: (1) antegrade in the ascending aorta and descending aorta (below PDA), and retrograde in the transverse aorta, and (2) right-to-left shunt in the PDA. While in diastole, there were (1) antegrade in the transverse aorta, and retrograde in the ascending aorta and descending aorta (below PDA), and (2) left-to-right shunt in the PDA. No ventriculocoronary fistulas were identified. With both the characteristic flow pattern and the extremely narrow diameters of the ascending aorta in hypoplastic left heart syndrome, we can differentiate it from those heart diseases associated with secondary hypoplastic left heart due to total anomalous pulmonary venous connection or congenital pulmonary venous stenosis. Both help us understand better the hemodynamics and pathophysiology of hypoplastic left heart syndrome in these patients.

Antitumor activity of a piperidine phospholipid

A piperidine phospholipid ((+/-)-2-[hydroxy] [1-octadecyloxycarbonylpiperidin-3-yl]methoxy-phosphinyl] oxy]-N,N,N, trimethylethaniminium hydroxide inner salt, SDZ 62-826) has been prepared that exhibited weak direct cytotoxicity and strong macrophage-induced cytotoxicity in vitro against a variety of murine and one human tumor cell lines. This compound was found to be as effective as ET-18-OCH3 and SRI 62-834, phospholipids with both strong direct and macrophage-induced cytotoxicity, in increasing survivors and reducing tumor volume when given either orally or intravenously in the mouse MethA fibrosarcoma model. These findings suggest that the macrophage-induced cytotoxicity exhibited by ET-18-OCH3 and other phospholipids may play an important role in this tumor model.

Levoatriocardinal vein in mitral atresia mimicking obstructive total anomalous pulmonary venous connection

This report briefly describes two cases of levoatriocardinal vein, in the setting of mitral atresia and a restrictive interatrial shunt, with clinical as well as echocardiographic features mimicking obstructive total anomalous pulmonary venous connection. One patient died of pulmonary hypertensive crisis, and the other survived the palliative procedures including the atrioseptectomy and pulmonary artery banding. The echocardiography, cine-angiocardiography, and magnetic resonance image for such an anomalous channel are presented. It is tempting to speculate that the thrombocytopenia and indirect hyperbilirubinemia be associated with the destructive consumption of thrombocytes and red blood cells in the serpentine levoatriocardinal vein.

Double-orifice mitral valve: report of two cases

Two cases of double-orifice mitral valve are reported. The first case was associated with coarctation of the aorta and a large perimembranous ventricular septal defect, and the second case had an associated large patent ductus arteriosus. A bridge-type defect created two equal-sized openings in the mitral valve in case 1. In case 2, a small accessary opening was located in the posteromedial leaflet of the mitral valve. Double-orifice mitral valve is a rare anomaly associated with coarctation of the aorta, ventricular septal defect, and patent ductus arteriosus. The morphology of a double-orifice mitral valve can be clearly delineated by 2-D echocardiography.

Infracardiac total anomalous pulmonary venous connection in tetralogy of Fallot with decreased pulmonary flow and masked pulmonary venous obstruction: report of one case

We describe an 8-month-old male infant, who received a rerouting procedure for infracardiac total anomalous pulmonary venous connection and a 4-mm Gore-Tex central shunt for tetralogy of Fallot with pulmonary atresia. The masking effect of the pulmonary outflow in tetralogy of Fallot on the pulmonary venous obstruction in infracardiac total anomalous pulmonary venous connection is discussed. Preoperative recognition of this rare association is warranted, as palliative surgery alone may be disastrous. In addition, juxtaductal pulmonary artery coarctation in tetralogy of Fallot with pulmonary atresia may play a role in camouflaging the pulmonary venous obstruction in this case. Unmasking pulmonary venous obstruction by oral prostaglandin and augmenting pulmonary blood flow by a Gore-Tex shunt, pari passu, did harm this patient.

Passive hyperimmune plasma therapy in the treatment of acquired immunodeficiency syndrome: results of a 12-month multicenter double-blind controlled trial. The Passive Hyperimmune Therapy Study Group

High-titer anti-human immunodeficiency virus (HIV) antibodies reduced circulating HIV viral burden and has shown promise in previous small uncontrolled studies, warranting a larger controlled study of passive hyperimmune therapy (PHT) in persons with acquired immunodeficiency syndrome (AIDS). The objective of this study was to determine the efficacy and safety of PHT in 220 AIDS subjects in a 12-month double-blind placebo-controlled dosing study. Subjects were randomized to receive monthly infusions of 500 mL of plasma (full dose), 250 mL of plasma diluted in 250 mL of 5% human serum albumin (half dose), or 500 mL of 5% human serum albumin (placebo). Positive treatment effects occurred only in full-dose-treated subjects with baseline CD4 cell counts between 50 and 200 cells/mm3. Reduced mortality was observed, 1 death in 21 (full dose) versus 3 deaths in 21 (half dose) and 6 deaths in 30 (placebo) (P = .065). CD4 cells improved an average of 32.7 cells/mm3 over baseline (full dose) versus 0.9 cells/mm3 (half dose) and a loss of 3.5 cells/mm3 (placebo) (P = .043). No adverse effects or toxicity was noted in donors or recipients. Based on these findings, PHT appears to be a safe, promising therapy warranting further study.

Intrauterine intervention in a case of recurrent meconium peritonitis

We present a case of recurrent meconium peritonitis detected in the second trimester and treated by intrauterine intervention. Antenatal ultrasound findings included fetal ascites and intra-abdominal calcification. Aspiration of fetal ascites under ultrasound guidance and determination of the bilirubin concentration established the diagnosis of meconium peritonitis. Paracentesis was repeated to remove irritating intestinal contents and to decrease pressure on the fetal thorax. Although the exact cause of the meconium peritonitis remains unknown, the recurrence of the condition suggests a genetic basis. A possibility of cystic fibrosis was not considered because the clinical picture did not suggest it. Intrauterine intervention helped to establish the diagnosis of meconium peritonitis and may have contributed to the good outcome.

Capillary electrophoresis of nucleotides on ucon-coated fused silica columns

Ucon-coated columns have been used to isolate nucleotides, such as ribonucleotides, deoxyribonucleotides, and pyridine nucleotides, by capillary zone electrophoresis. This neutral, hydrophilic column coating (Ucon) significantly reduced macromolecule adsorption and electroosmotic flow, which provides the maximum resolution of the nucleotides separated under moderate buffer conditions (pH about 5-6). The relative standard deviations of the nucleotides were less than 1%. Low minimum detectable concentrations (about 2-8 microM) and quantities (about 70-360 fmol) of the ribonucleotides were obtained. A qualitative and quantitative analysis of the ribonucleotides in hybridoma cell extracts shows the applicability of the developed methodology for the determination of intracellular nucleotide pools under the desirable buffer conditions.

Tuberculous peritonitis in a child undergoing continuous ambulatory peritoneal dialysis

We present a 13-year-old girl with Arnold-Chiari syndrome and uremia secondary to neurogenic bladder. She had been treated with continuous ambulatory peritoneal dialysis (CAPD) for 13 months prior to the development of peritonitis. The patient demonstrated no improvement with a 3-day therapy of intraperitoneal vancomycin and netilmicin. Meanwhile, smear of centrifuged dialysate revealed acid fast bacilli on two occasions. We, then, started anti-TB therapy with oral isoniazid (INAH), rifampin and ethambutal. The symptoms subsided within three days. In the first week, the patient lost her peritoneal ultrafiltration and needed daytime automatic peritoneal dialysis. At the last follow-up examination, 12 months after treatment, she remained well on standard CAPD.

Endothelial cell adhesion molecules in psoriasis

Skin biopsies from patients with psoriasis and normal controls were examined for the expression of cell adhesion molecules including intercellular adhesion molecule-1 (ICAM-1), endothelial leukocyte adhesion molecule-1 (ELAM-1), HECA-452 and 4D10, using an immunoperoxidase techique. This study demonstrates that psoriatic skin exhibits a wide variety of markers of endothelial cell activation which are either induced or increased in expression (ICAM-1, ELAM-1 & 4D10). Moreover, ICAM-1 & HECA-452 are also expressed on leukocytes. These antigens may facilitate the adhesion of inflammatory cells to endothelium and antigen-presenting cells in psoriatic skin. Thus, they may play a role in faciliating the infiltration of leukocytes into psoriatic skin.

A cross-over pharmacokinetic and thrombogenicity study of a prothrombin complex concentrate and a purified factor IX concentrate

A prospective cross-over study was carried out on 19 patients with haemophilia B. comparing the pharmacokinetics of a purified factor IX concentrate prepared by metal chelate affinity chromatography (9MC) with a conventional three-factor prothrombin complex concentrate (9A). The highly purified factor IX concentrate was shown to have a half-life comparable to the PCC; the in vivo recovery of the purified concentrate was significantly greater than that of the complex (P < 0.01). The 20% change in the value of the International Standard for Factor IX Concentrate, introduced in 1988, might have been expected to lower the recovery values. However, the in vivo recovery for both concentrates was somewhat higher than reported previously, particularly in the older literature. In nine patients, serial assays for fibrinopeptide A, prothrombin fragment F1+2 and thrombin-antithrombin complexes (TAT) were performed to assess the potential thrombogenicity of the two concentrates. Evidence was obtained that there was significantly less activation of coagulation following administration of purified factor IX (9MC), as compared to the activation that occurred after the PCC.

Cyclosporin treatment of atopic dermatitis: five case studies and literature review

This study reports on five adult patients with severe atopic dermatitis who were treated in our department with a three month course of cyclosporin. All patients demonstrated significant clinical improvement with minimal side effects. We conclude that provided safety guidelines are observed, cyclosporin can be used with good effect in those patients where conventional treatment is unsatisfactory. This paper also reviews the use of cyclosporin in atopic dermatitis and includes a brief discussion of how it may alter pathophysiologic mechanisms.

Oral bioavailability of the antiretroviral agent 9-(2-phosphonylmethoxyethyl)adenine (PMEA) from three formulations of the prodrug bis(pivaloyloxymethyl)-PMEA in fasted male cynomolgus monkeys

The bioavailability of PMEA from three oral formulations of the prodrug bis(POM)-PMEA has been evaluated in fasted male cynomolgus monkeys. The formulations examined included a hydroxypropyl-beta-cyclodextrin (HPBCD) complex, a PEG based cosolvent solution, and an aqeous suspension. Oral formulations containing 3H-bis(POM)-PMEA were compared to intravenous 3H-PMEA at 10.9 mg-eq/kg in a crossover study in four monkeys, with a 7 day washout period. No intact bis(POM)-PMEA or monoester were detected in plasma. Bioavailabilities of PMEA from the prodrug were 24.7 +/- 6.5%, 27.3 +/- 12.3% and 22.2 +/- 15.6% for the HPBCD complex, PEG solution and aqueous suspension, respectively. The oral bioavailability of PMEA from bis(POM)-PMEA was not limited by dissolution rate of the prodrug. Data for the PEG cosolvent solution and suspension indicate that the prodrug could potentially be formulated as a soft gelatin capsule or a tablet.

A capillary electrophoresis method for studying apo, holo, recombinant, and subunit dissociated ferritins

A capillary electrophoresis (CE) method is described for detecting and quantitating apo and holo ferritins from horse spleen (HoSF), rat liver (RLF), recombinant human light chain (rLF), recombinant human heavy chain (rHF), site-directed variants of human light chain, and Azotobacter vinelandii bacterial ferritin (AVBF). This procedure is carried out at pH 8.2, where the ferritin molecules are associated into their 24-mers. Protein mobilities as expressed as elution times were clearly resolved and could be used to distinguish one ferritin type from another, providing a means for detecting and quantitating various ferritin species in purified or partially purified states. Measurements of these and other ferritins were also conducted at pH 2.0, where dissociation into their respective subunits occurs. For HoSF and RLF, the individual L and H subunits were resolved and their relative concentrations were determined by integrating the areas of the elution peaks. HoSF gave 89.8% L and 10.2% H and RLF gave 70.7% L and 29.3% H, while rLF, rHF, and AVBF gave only a single subunit, all in agreement with reported values obtained by polyacrylamide gel electrophoresis. CE of HoSF, containing increasing amounts of iron in the interior, in general, showed that protein mobilities increased, reached a plateau, and then slowly decreased with increasing core size, although buffer effects altered this CE behavior to some extent. Such results indicate that species formed early during core formation have individual iron atoms present and differ from those formed later in which the oligomeric iron core has formed.(ABSTRACT TRUNCATED AT 250 WORDS)

Mixed-effect models for predicting microbial interactions in the vaginal ecosystem

Three statistical models that predict microbial interactions within the vaginal environment are presented. A large data set was assembled from in vivo studies describing the healthy vaginal environment, and the data set was analyzed to determine whether statistical models which would accurately predict the interactions of the microflora in this environment could be formulated. During assembly of the data set, two new variables were defined and were added to the data set, that is, cycle (sequence of menstrual cycle) and flow stage (subdivision of cycle determined by day of menstrual cycle). Concentrations of total aerobic (includes facultative) bacteria, total anaerobic bacteria, and a Corynebacterium sp. were identified by correlation analysis as variables with significant predictors. By using a regression method with a backward elimination procedure, significant predictors of these outcome variables were identified as the concentrations of Lactobacillus spp., anaerobic Streptococcus spp., and Staphylococcus spp., respectively. For all three outcome variables, pH and flow stage were also identified as significant independent variables. Because some of the data in the data set are repeated measurements for a subject, a mixed-effect model that accounts for the random effects of repeated-measurement data fit best the data set for predicting interactions between various members of the vaginal microflora. The predictive accuracies of the three models were tested by a comparison of model-predicted outcome-variable values with actual mean in vivo outcome-variable values. From these results, we concluded that it is possible to accurately predict vaginal microflora interactions by using a mixed-effect modeling system. The application of this type of modeling strategy and its future use are discussed.

Mitochondrial myopathy, encephalopathy, lactic acidosis and strokelike episodes (MELAS): report of a sporadic case and review of the literature

We studied a 5-year-old boy with mitochondrial myopathy, encephalopathy, lactic acidosis and strokelike episodes that are characteristic of the MELAS syndrome. Results of biochemical, histopathological, and molecular genetic studies from the patient's tissue meet the criteria for diagnosis of mitochondrial disease. An A to G transition at the 3243th nucleotide position of mitochondrial DNA (mtDNA) was found in the blood cells and hair follicles, instead of in muscle, from the propositus. To the best of our knowledge, this is the first reported MELAS case associated with mtDNA mutation in blood cells and hair follicles, instead of in the target muscle tissue, that has ever been documented in Taiwan. Brain lesions demonstrated by angiography, computed tomography (CT) and magnetic resonance imaging (MRI) are discussed.

Molecular entrapment of small molecules within the interior of horse spleen ferritin

A procedure for trapping small molecules inside the interior of horse spleen ferritin (HoSF) and methods for characterizing HoSF and its small entrapped molecules are described. HoSF is first dissociated into subunits by adjustment to pH 2 in the presence of the small molecules to be trapped. The pH of the dissociated HoSF is then increased to 7 at which time the dissociated subunits reassemble reforming the 24-mer HoSF, thereby trapping solvent within its interior. HoSF is then separated from unbound molecules by dialysis, ultrafiltration, and/or ammonium sulfate precipitation. Sephadex G-25 and DEAE chromatographic methods were also used to separate HoSF from unbound small molecules. Capillary electrophoresis (CE) was used to demonstrate the association of small molecules with HoSF after the pH-induced unfolding-refolding process. The pH indicator neutral red was clearly associated with HoSF and presumed trapped within the ferritin interior. Acid/base titrations suggested that the trapped indicator had a different pKa than the free indicator, a result which indicates that the ferritin interior is different than the external solution. The utility of using trapped molecules for gaining information on ferritin function is proposed and discussed.

Epidemiology of community-acquired Clostridium difficile-associated diarrhea

The epidemiology of clinically recognized community-acquired Clostridium difficile-associated diarrhea was assessed in a retrospective cohort study of members of a health maintenance organization (HMO). Potential cases were identified through positive toxin assay results and confirmed by review of automated full-text medical records. Of 51 cases identified (7.7 per 100,000 person-years), 42 (82%) were diagnosed and treated exclusively in the ambulatory care setting; 33 cases occurred within 42 days after 494,491 exposures to antibiotics dispensed by an HMO pharmacy. Antibiotic-specific attack rates varied from 0 to 2040 cases per 100,000 exposures. Increased age was associated with C. difficile-associated diarrhea (P < .001). Age-adjusted antibiotic-specific attack rates were at least 10-fold higher (P < .05) for nitrofurantoin, cefuroxime, cephalexin plus dicloxacillin, ampicillin/clavulanate plus cefaclor, and ampicillin/clavulanate plus cefuroxime than for ampicillin or amoxicillin; several other antibiotics were associated with similar but not significantly increased risks.

Solute adsorption on polymer-coated fused-silica capillary electrophoresis columns using selected protein and peptide standards

Three series of basic proteins and peptides were selected for use in studying the adsorption behavior of fused-silica capillary electrophoresis columns. A comparative study of untreated and treated fused-silica columns was done. The polymers used as coating materials ranged from very hydrophobic to very hydrophilic. The average efficiency of weakly hydrophilic Ucon-coated capillaries for basic proteins was over 1 million theoretical plates at a buffer pH of 4.8. For this coating, it was found that the maximum column efficiency was obtained at a film thickness of approximately 100 nm. It was easily seen that both ionic and hydrophobic interaction forces can play important roles in protein adsorption onto the capillary walls. Furthermore, strongly hydrophilic polymer coatings may possibly lead to hydrogen-bonding interactions, which decrease column efficiency. Studies have been conducted using two series of polypeptides with varying chain lengths. One series was used to study the effect of polypeptide chain length on retention behavior. Efficient separations of bioactive peptide drugs on Ucon-coated columns were achieved. The results indicate that high efficiency and resolution of basic peptides tested can be realized on columns modified with weakly hydrophilic polymers at a pH value of about 5.

Effects of administration of an anti-CD5 plus immunoconjugate in rheumatoid arthritis. Results of two phase II studies. The CD5 Plus Rheumatoid Arthritis Investigators Group

OBJECTIVE

To evaluate the safety and activity of an immunoconjugate of ricin A chain and anti-CD5 monoclonal antibody (anti-CD5 IC), with and without concomitant methotrexate and/or azathioprine, in the treatment of rheumatoid arthritis (RA).

METHODS

Seventy-nine patients with active RA were enrolled in 2 prospective open-label protocols.

RESULTS

Using composite criteria, response rates were 50-68% at 1 month and 22-25% at 6 months. Transient depletion of CD3/CD5 T cells was observed on days 2 and 5 of treatment, with reconstitution on day 15 or day 29. Treatment-associated adverse effects were common but resolved rapidly without sequelae.

CONCLUSION

These findings suggest activity of anti-CD5 IC in active RA and warrant confirmation in a multicenter randomized study (currently underway).

Differential patterns of response in patients with rheumatoid arthritis following administration of an anti-CD 5 immunoconjugate

As part of the clinical investigation of a new biologic agent in the treatment of rheumatoid arthritis (RA) various outcome measures were utilized to evaluate clinical activity in two multicenter open label protocols. These measures included the single criteria of joint tenderness and swelling counts and scores and composite criteria based on the Paulus analysis of four placebo-controlled CSSRD studies of second line agents in RA. Findings suggest a difference in the pattern of response between early and long-standing RA. Changes in both the swollen and tender joint counts should be utilized, especially in a population with sustained disease.

Augmented lymphocyte binding to cultured endothelium in psoriasis

Lymphocyte binding to cultured human umbilical vein endothelial cells was evaluated using a modified centrifugation binding assay in 15 patients with psoriasis and compared with three patients with atopic dermatitis, 11 patients with rheumatoid arthritis and 28 normal controls. Patients with psoriasis demonstrated 61% augmented lymphocyte binding compared with normal controls (P < 0.0001), which was not explained by differences in age and sex or an effect of psoriatic sera. In serial studies of six patients, this difference was found to be reversible with treatment and clinical improvement. Lymphocytes from patients with atopic dermatitis demonstrated decreased binding to endothelium (P < 0.005), while those from patients with rheumatoid arthritis were not different from normal controls. This is the first skin disease described in which augmented lymphocyte binding to endothelium occurs, and may represent a mechanism by which lymphocytes are targeted to psoriatic skin.

Association of protein kinase C activation with induction of ornithine decarboxylase in murine but not human keratinocyte cultures

The goal of this study was to compare the response of mouse epidermal keratinocytes (MEKs) and human epidermal keratinocytes (HEKs) to 12-O-tetradecanoylphorbol-13-acetate (TPA) with respect to the activation and downregulation of protein kinase C (PKC), the expression of c-jun and c-fos, and the expression and induction of ornithine decarboxylase (ODC) activity. Keratinocytes from adult CD-1 mice and from discarded adult human skin were grown in primary culture in a high-calcium serum-free medium that supported proliferation and differentiation. Immunoblotting of freshly isolated and cultured MEKs and HEKs for isozymes of protein kinase C revealed that fresh HEKs contained PKC alpha, PKC beta, and PKC delta; no PKC gamma, PKC epsilon, or PKC zeta were detected. In fresh MEKs, PKC alpha, PKC beta, PKC delta, and PKC zeta were observed, but not PKC gamma or PKC epsilon. After 2 wk in culture, the isozyme profiles of MEKs and HEKs were similar except that PKC gamma was noticeably present in HEK cultures. Activation of partially purified total PKC by TPA was similar in freshly isolated and cultured MEKs and HEKs, indicating that the two species were similar in this regard and that 2 wk of culture did not alter this characteristic. When MEK and HEK cultures were treated with TPA for 3 h, less than 30% of the control level of PKC activity was detected, indicating that TPA-induced downregulation of PKC was similar in MEKs and HEKs. After treatment with TPA, MEK cultures produced a large induction of both c-jun and c-fos mRNA by 60 min, as determined by northern blot analysis, and a large induction of ODC mRNA and enzyme activity by 6 h. TPA treatment of cultured HEKs, however, did not induce ODC activity; in fact, less activity, compared with that of control cultures, was observed. Northern blot analysis also revealed no increase in c-jun, c-fos, and ODC mRNA in HEKs. However, c-jun and c-fos mRNA and both ODC mRNA and enzyme activity were induced in HEKs fed growth factors after several days of deprivation. This suggests that the lack of ODC induction by TPA in HEKs is probably due to species differences in downstream steps in PKC signal transduction.

High resolution separation and quantitation of ribonucleotides using capillary electrophoresis

A method for the analysis of ribonucleotides using capillary electrophoresis has been developed. A cross-linked polyacrylamide coated column, Tris-HCl, and phosphate-mixed buffer were used, which produced reproducible separations (solute migration time average RSD% of 1.2) of 14 ribonucleotides within 50 min. Linear relationships between peak areas and sample concentrations, an average minimum detectable concentration of 5.4 microM, and an average minimum detectable quantity of 0.08 pmol were obtained. The described method allowed reproducible and reliable qualitative and quantitative analysis of intracellular ribonucleotide pools in HeLa cells.

Risk of malignancy in bilateral streak gonads: the role of the Y chromosome

Although girls with Turner's syndrome (45,X) are not at risk for malignancy, patients with feminizing testicular syndrome with XY chromosome composition and patients with "mixed gonadal dysgenesis" are at risk for malignancy, and bilateral gonadectomy is performed. We have treated seven girls with "Turner-like" syndrome, who we believe are also "at risk" for development of malignancy and in whom gonadectomy should be performed. We present seven cases of phenotypically typical females, without sexual ambiguity, who presented with primary amenorrhea and short stature (5) and/or minor dysmorphic features (2). Chromosome analysis showed 45,X karyotype plus a fragment that we could not rule out as being part of a Y chromosome (in one patient a complete Y chromosome). In two patients, the fragment was subsequently positively identified as a Y, using a DNA probe. In view of the known high incidence of development of gonadoblastoma in the dysgenetic gonads of phenotypic females with a Y chromosome, bilateral gonadectomy was performed in these girls. Bilateral genital streaks with normal uterus and Fallopian tubes were found in all patients. In two patients unsuspected gonadoblastoma, without metastases, was found. In five cases, Leydig cells and tubular structures resembling rete testes were found, cells that are associated with Y-chromosomal tissue. We stress the need for complete chromosomal evaluation of phenotypically female patients with primary amenorrhea or features of Turner's syndrome. If a Y chromosome or the possibility of a Y chromosome cannot be excluded, gonadectomy should be performed because of the risk of malignancy.

Mosaic ring chromosome 13 analyzed by fluorescence in situ hybridization: report of a case

A five-year-old boy with psychomotor retardation, microcephaly, bilateral cataracts, hearing impairment and hypospadia with microphallus was found to have multiple cell lines from peripheral blood: 46,XY/46,XY, -13,+r(13)/46, Xy, -13, +dic r(13) in the ratio of 35%/61%/4% by trypsin-Giemsa, and C-bandings. Using fluorescence in situ hybridization (FISH) with biotin-labeled alpha-satellite probe (D21Z1/D13Z1) and fluorescence staining (FITC), we confirmed that the ring originated from chromosome 13. To elucidate changes in the chromosome ends in the ring originated from chromosome 13. To elucidate changes in the chromosome ends in the ring formation, we used human telomere-specific probes for FISH study; it showed an absence of telomeres on the ring chromosome, although Ag-NOR staining was positive. These findings yielded different breaking points on the ends of both the short and long arms of chromosome 13 from those reported in the literature.

Identification of sex chromosomal abnormalities by fluorescence in situ hybridization

Chromosomes can be specifically stained in metaphase spreads and interphase nuclei by fluorescence in situ hybridization (FISH). Case 1 was a 20 year-old female patient who had chromosomal analysis six years ago because of primary amenorrhea and short stature. Three cell lines were identified: 45, X (20%); 46, X plus an unidentifiable fragment (50%) and 46, X plus an isodicentric X chromosome of short arm fusion (30%). Case 2 was a 6 year-old girl with the problems of clitoromegaly and growth retardation. By use of in situ hybridization with biotinylated X and Y centromere-specific alpha repetitive sequence probes, we were able to identify the marker chromosomes to be X and Y-chromosome originated, respectively. The use of FISH can facilitate clinical cytogenetic diagnosis, and allows fast screening of a large number of metaphases. This technique is applicable to the screening of other types of chromosomal mosaicism as well.

TPA has no influence on the expression of myosin heavy chain isoforms in cultured adult cardiac muscle cells

The effect of a tumor promoter, 12-O-tetradecanoyl phorbol-13-acetate (TPA), on the expression of myosin heavy chain isoforms in cultured rat cardiac ventricular muscle cells was studied. The previous preliminary report [Claycomb WC (1988): "Biology of Isolated Adult Cardiac Myocytes." In Clark WA, Decker RS, Borg TK (eds): New York: Elsevier, pp 284-287] indicated that TPA turns off the expression of myosin heavy chain genes in cultured adult cardiac myocytes. Electrophoretic and immunocytochemical analyses were carried out in the present studies. The myosin heavy chain isoform profiles of cardiac myocytes exposed to TPA at concentrations of 50-250 ng/ml culture medium for varying periods were similar to those of controls that were grown in the absence of TPA, showing predominant isoform V1. Immunofluorescence microscopy with monoclonal antibodies to cardiac ventricular isomyosin revealed the structural organization of myosin in TPA-treated cells. The organization of myosin was variable among different myocytes and within a single myocyte. Immunofluorescence microscopy was extended to the examination of the organization of alpha-actinin which did not differ from that of myosin in some myocytes. In contrast to the previous report [Claycomb, 1988], this study has demonstrated that TPA has no influence on the expression of myosin heavy chain isoforms in cultured adult ventricular cardiac muscle cells.

Ticlopidine: a new platelet aggregation inhibitor

The chemistry, pharmacology, pharmacokinetics, clinical efficacy, adverse effects, and dosage of ticlopidine are reviewed. Ticlopidine appears to inhibit platelet aggregation induced by adenosine diphosphate. Ticlopidine hydrochloride is rapidly absorbed after oral administration, and maximum antiplatelet effects occur one to three hours after the dose. In multicenter, randomized, double-blind trials, ticlopidine was more effective than aspirin or placebo in preventing stroke, myocardial infarction, or death caused by vascular events. Ticlopidine was more effective than aspirin in preventing recurrent transient ischemic attacks after six months of therapy. Ticlopidine has also been used to prevent occlusion and improve patency of aortocoronary bypass grafts, to prevent ischemic ulcers in patients with chronic arterial occlusive disease, and to slow the progression of diabetic microangiopathy. The most serious adverse effect, neutropenia, occurred in about 1% of patients. The most frequently reported adverse effects are diarrhea, nausea, vomiting, and abdominal cramps. Ticlopidine is indicated for reducing the risk of thrombotic stroke in patients who have experienced a minor stroke, transient ischemic attack, or completed thrombotic stroke. The recommended dosage is 500 mg/day in two divided doses taken with food. Ticlopidine is an alternative agent for the primary and secondary prevention of stroke. Because of the risk of neutropenia and agranulocytosis and the high cost of therapy, ticlopidine should be reserved for patients who are intolerant of or lack benefit from aspirin.

Trisomy 5 mosaicism detected prenatally with an affected liveborn

This paper reports a case of chromosomal mosaicism for trisomy 5 recovered from amniotic fluid cells and from skin fibroblasts of a liveborn dysmorphic male. Routine amniocentesis was performed at 16 weeks' gestation because of parental concern. Trisomy 5 cells were measured from 25 per cent of amniocytes from two culture vessels. No further invasive testing was performed until 32 weeks' gestation, at which time ultrasound examination showed a fetus with intrauterine growth retardation. Fetal blood sampling was then performed, with only karyotypically normal cells recovered. At birth, the child was found to have multiple dysmorphic features and congenital anomalies, including an eventration of the diaphragm and ventricular septal defect, both of which required surgical correction. Chromosomal analysis of cord blood lymphocytes indicated 46,XY; however, 20 per cent of the cultured fibroblasts obtained from the chest skin at the incision site for diaphragmatic repair had a 47,XY, +5 karyotype. Trisomy 5 mosaicism may be another example of tissue-limited mosaicism. Fetal blood sampling can then be falsely reassuring. Furthermore, because some cell lines rarely appear in lymphocyte populations, cytogenetic analysis of multiple tissues is warranted as part of the evaluation of individuals with developmental delay and dysmorphic features.

Differential effects of dietary linoleic acid on mouse skin-tumor promotion and mammary carcinogenesis

On the basis of reports of rat mammary- and pancreas-tumor models, we hypothesized that an increase in consumption of linoleic acid (LA) would also cause an enhancement in mouse skin-tumor promotion. SEN-CAR mice were placed on diets containing 0.8%, 2.2%, 3.5%, 4.5%, 5.6%, 7.0%, or 8.4% LA, 1 week after initiation with 7,12-dimethylbenz(a)anthracene and 3 weeks before starting promotion with 12-O-tetradecanoylphorbol-13-acetate. An inverse correlation (r = -0.92) was observed between papilloma number and level of LA; however, there was little difference in tumor incidence. A relationship between diet and carcinoma incidence was also found. The fatty acid composition of epidermal phospholipids reflected the dietary LA levels. 12-O-Tetradecanoylphorbol-13-acetate-induced epidermal prostaglandin E2 levels generally decreased with increasing dietary LA. To determine whether this inverse correlation between dietary LA and tumor yield was due to species differences or organ-model differences, a mammary carcinogenesis experiment was performed. SENCAR mice were fed the 0.8%, 4.5%, and 8.4% LA diets. All mice received 6 mg 7,12-dimethylbenz(a)anthracene, administered intragastrically at 1 mg/week. Tumor appearance was delayed in the 0.8% LA diet group, and a positive dose-response relationship between dietary LA and mammary-tumor incidence was observed. These studies suggest that the effect of dietary LA on tumor development is target tissue specific rather than species specific.

The effect of dietary fat on the rapid development of mammary tumors induced by 7,12-dimethylbenz(a)anthracene in SENCAR mice

We recently reported (J. Leyton et al., Cancer Res., 51: 907-915, 1991) an inverse correlation between skin tumor number and level of dietary linoleic acid (LA) in SENCAR mice following an initiation-promotion protocol. These results differed from the reported (C. Ip et al., Cancer Res., 45: 1997-2001, 1985) positive correlation between dietary LA and tumor incidence for the rat mammary gland. The goal of the study reported here was to determine whether this dissimilarity was due to organ site or species differences. Female SENCAR mice were fed 1 of 3 15% fat diets containing LA at levels of 0.8, 4.5, and 8.4% before, during, and after intragastric administration of 6 mg (1 mg/week) 7,12-dimethylbenz(a)anthracene. A positive correlation between level of dietary LA and mammary tumor incidence was observed such that for the first 15 weeks, the incidence was greatest in the 8.4% LA diet group, followed by the 4.5% and then the 0.8% LA groups. Distinct dietary effects on latency were also noted in that 15, 12, and 8 weeks after cessation of 7,12-dimethylbenz(a)anthracene were required for a 40% carcinoma incidence in the 0.8, 4.5, and 8.4% LA diet groups, respectively. A histopathological analysis of all tumors revealed that the predominant type was the adenosquamous carcinoma, which comprised 46.6, 54.1, and 77.7% of all mammary tumors for diets containing 0.8, 4.5, and 8.4% LA, respectively. The second most common tumor was the adenocarcinoma type B, which was found with a frequency of 33% in the 0.8% and 4.5% LA diet groups and 22% in the 8.4% LA diet group. These results indicate that SENCAR mice have a short latency period for 7,12-dimethylbenz(a)anthracene-induced mammary tumor development and that rat and mouse mammary tumor development is modified by dietary LA in a similar manner, although in the SENCAR mouse dietary LA did not have a saturating effect. In addition, high dietary LA was found to be associated specifically with an increased incidence of adenosquamous carcinomas but not of other types of mammary tumors.

Low level mosaicism for a balanced 7;14 translocation in the father of an abnormal 7q+ child

A child with a 7q+ chromosome abnormality had a father with 0.5% mosaicism for a balanced 7;14 translocation. This mosaicism was not found in 100 fibroblasts. This degree of mosaicism is well below the limits usually detected by standard clinical cytogenetic protocols. However, the one abnormal cell cannot be disregarded in this case, since it can serve as an explanation of the child's genotype. This case serves to illustrate the need for detecting subtle degrees of mosaicism for structural anomalies in humans and brings to question the true population frequencies of mosaic balanced translocation carriers.

Treatment of hemophilia A with a highly purified factor VIII concentrate prepared by anti-FVIIIc immunoaffinity chromatography

To reduce the risk of pathogenic virus transmission associated with the therapeutic administration of plasma-derived anti-hemophilic factor (FVIIIc), a process utilizing anti-FVIIIc immunoaffinity chromatography to isolate FVIIIc has been developed. In addition, the starting cryoprecipitate solution has been treated with an organic solvent/detergent mixture to inactivate lipid-enveloped viruses. A final ion exchange chromatography step is used to further remove contaminants, e.g., anti-FVIIIc antibody, potentially leached with FVIIIc during the immunoaffinity step. The purified FVIII is stabilized for lyophilization and storage by the addition of human albumin. The monoclonal anti-FVIIIc antibody used in the immunoaffinity step of the process is not detectable in the final preparation. Viral reduction studies performed at specific steps of the process demonstrate that 11 logs of human immunodeficiency virus (HIV) and greater than 4-5 logs of other lipid-enveloped viruses are inactivated within the first 30 s of exposure to the solvent/detergent mixture and 4-5 logs of various model viruses, e.g. Endomyocarditis virus (EMC), are physically removed during washing of the immunoaffinity column. The lyophilized product is reconstituted using sterile water in a matter of seconds. The pharmacokinetics of Hemofil M were compared to those obtained using a standard heat-treated concentrate (Hemofil CT) in five severe factor VIII deficient hemophiliacs in a randomized, cross-over study. No statistically significant differences were observed in mean half life (p greater than 0.6) or median recovery (p = 0.4) between the two preparations. No clinically significant adverse effects were observed in patients receiving either FVIII preparation.(ABSTRACT TRUNCATED AT 250 WORDS)

Vaginal Bacteroides species are associated with an increased rate of preterm delivery among women in preterm labor

The relationship of high concentrations of vaginal microorganisms with an increased rate of preterm delivery (less than or equal to 34 weeks) among women in preterm labor was evaluated. Quantitative vaginal cultures were obtained from 211 women in preterm labor between gestational ages of 22 and 34 completed weeks. Preterm delivery occurred in 139 (66%). The rate of preterm delivery was determined by Cox proportional hazards models. Women with greater than 10(7) cfu/ml of vaginal fluid of facultative lactobacilli had a 40% decreased rate of preterm delivery (rate ratio [RR] = 0.6, 95% confidence interval (CI) = 0.4-0.9). An increased rate of preterm delivery occurred among women with Bacteroides bivius at concentrations of greater than 10(4) cfu/ml (RR = 2.0, 95% CI = 1.4-2.9) and Bacteroides fragilis (RR = 1.7, 95% CI = 1.0-2.8). Other microorganisms, including Gardernella vaginalis, the genital mycoplasmas, group B streptococci, Escherichia coli, and Peptostreptococcus species, were not associated with an increased rate of preterm delivery for women in preterm labor.

Survey of Australian isotretinoin prescribing

In Australia, dermatologists have been designated as the sole prescribers of isotretinoin and thus we are in a unique position to audit national usage of the drug. Questionnaires were sent by the Australasian College of Dermatologists to all 204 practising Fellows in Australia. The aim was to study the number and type of patients treated with isotretinoin, the manner in which the drug is prescribed, adverse reactions and the number of pregnancies occurring during and after treatment. Judging from the 85% of questionnaires which were returned, isotretinoin is an effective and well-tolerated drug for the treatment of severe nodulocystic acne. In the five years that isotretinoin has been used in Australia, 11 pregnancies while taking the drug were reported. These pregnancies occurred despite exhaustive counselling by dermatologists and the patients being fully aware of the risks to the fetus and the need for adequate contraceptive measures. With one exception, all agreed to have a therapeutic abortion. There were two reports of congenital abnormalities after cessation of treatment, neither of which were thought to be related to isotretinoin. In several regions where a dermatologist is not available, a specialist physician may prescribe isotretinoin according to State Health regulations.

Isotretinoin: cost-benefit study

Isotretinoin is a well-established, effective treatment for severe nodulocystic acne. An important consideration which may limit the prescription of isotretinoin is its cost. Based on a literature review, we have compared isotretinoin with the conventional combination of antibiotics and topical therapies for the treatment of severe nodulocystic acne in terms of cost and benefit. Our results show that when duration of treatment is considered, isotretinoin is cheaper and significantly more effective.

The pharmacokinetics of total IgG, IgG subclasses, and type specific antibodies in immunodeficient patients

The advent of immunoglobulin concentrates suitable for intravenous administration has greatly improved the clinical management of patients with a primary immunodeficiency syndrome. However, proper treatment requires understanding of the pharmacokinetics of the infused IgG and its components. We review here the work that has been conducted in this area. In particular, two studies have shown that these concentrates have adequate catabolic properties with regards to total IgG, IgG subclasses, and specific antibodies. We conclude that careful evaluation of the pharmacokinetics of a given IgG preparation is necessary in order to determine an appropriate treatment regimen.

A new approach to the computer-assisted quantitative analysis of nuclear shape

In recent years, researchers have explored the use of computer-assisted morphometric analysis to evaluate nuclear shape. Most of these studies use nuclear shape factors which are based on circumference/surface measurement ratios, such as variations of the nuclear contour index, the form factor, and the nuclear roundness factor. Here we present a new method for the objective evaluation of nuclear shape, involving a simple computer-assisted determination of nuclear area (N) divided by the area of a rectangular figure (F) with sides tangent to the nuclear margin and parallel to the frame of a video monitor. Following calculation of N/F for individual nuclei, our method generates statistical parameters for quantitating nuclear irregularity directly at the population level: the mean N/F ratio; standard deviation; and coefficient of variation. Our use of surface/surface measurement ratios makes our method independent of both magnification and nuclear size. Our method is applied first to normal lymphocytes and neutrophils to manifest the parameters for nuclear irregularity which are generated by our method. The sensitivity of our method is demonstrated using lymphoblasts from patients with acute lymphoblastic leukemia (ALL). Our objective ranking of nuclear irregularity for 20 cases of ALL correlates well with the subjective ranking of two pathologists. Because our method scores irregularity on a population basis and independently of other morphological criteria, it is compatible for use with the French-American-British (FAB) classification system (1981) for ALL.

The problem of therapeutic equivalence with paired qualitative data: an example from a clinical trial using haemophiliacs with an inhibitor to factor VIII

The problem of demonstrating the equivalence of two treatments or drugs occurs fairly frequently in medicine, but is quite often misformulated. The common error is to assume equivalence is demonstrated if the usual null hypothesis of no difference is not rejected, which ignores the potential of a substantial beta-error. We describe here two procedures for testing equivalence when the data are paired and dichotomous, and provide sample size formulas. We give an example based on a clinical trial of haemophiliacs with inhibitor to Factor VIII.

Amoxicillin treatment of bacterial vaginosis during pregnancy

The purpose of this investigation was to evaluate the efficacy of amoxicillin for treatment of bacterial vaginosis during pregnancy. The diagnosis of bacterial vaginosis was established by clinical examination and microscopic examination of a Gram stain and saline preparation of vaginal secretions. In a double-blind, randomized manner, 108 patients at 15-25 weeks' gestation were assigned to treatment with oral amoxicillin, 500 mg three times daily for 14 days, or placebo. Patients were evaluated 2 weeks after treatment, at 34-36 weeks' gestation, and at delivery. There were no significant differences between the two groups with respect to any clinical or microbiologic measure of treatment outcome. There were also no significant differences in the frequency of obstetric complications. We conclude that amoxicillin is not effective therapy for bacterial vaginosis in pregnant women.