Cervical ripening with the cytokines interleukin 8, interleukin 1 beta and tumour necrosis factor alpha in guinea-pigs

It has been suggested that the collagenolytic enzymes released from white blood cells which infiltrate the pregnant human uterine cervix at term are responsible for connective tissue changes which take place during the ripening process. Similarly, an infiltration of inflammatory cells occurs in pregnant guinea-pigs either spontaneously at term or at preterm after treatment with the antiprogestin onapristone. The objective of this study was to evaluate the effects of the inflammatory cytokines interleukin 8 (IL-8), interleukin 1 beta (IL-1 beta), tumour necrosis factor alpha (TNF-alpha) and a combination of IL-1 beta and TNF-alpha on cervical ripening in guinea-pigs during advanced pregnancy. The cytokines were applied locally (intracervically) in a gel for 2 days and the effects were assessed on the third day by both extensibility measurements and morphological evaluation. IL-8 treatment on days 42 and 43 post coitum (p.c) and on days 48 and 49 p.c. (term: day 67 +/- 3 p.c.) significantly (P < 0.05) increased cervical extensibility at both stages of pregnancy. Although IL-1 beta treatment (days 42 and 43 p.c.) led to a slight increase in cervical extensibility, this effect was not statistically significant. An electron microscope study performed on days 48 and 49 p.c. revealed a pronounced cervical ripening accompanied by the dissolution of collagen fibres, stromal oedema and the infiltration of polymorphonuclear leukocytes in all cytokine-treated groups. The morphological effects of IL-8 and IL-1 beta were indistinguishable from those observed during normal cervical ripening at term.(ABSTRACT TRUNCATED AT 250 WORDS)

Interleukin 6 response to urinary tract infection in childhood

This study analyzed the interleukin 6 (IL-6) response in 114 children with suspected urinary tract infection (UTI). Urine and serum samples were obtained at the time of enrollment. There were 90 children with UTI, 41 with and 49 without a temperature > or = 38.5 degrees C. The remaining 24 children did not have bacteriuria; 11 were febrile and 13 were not. The urinary IL-6 concentrations were higher in the children with UTI (mean, 129 units/ml) than in the children without bacteriuria (mean, 7 units/ml, P < 0.01). In contrast the serum IL-6 did not differ between children with or without UTI or between children with or without a temperature > or = 38.5 degrees C. The urinary IL-6 response was higher in children who were infected with P fimbriated Escherichia coli than in other children with UTI (P < 0.05). There was a correlation of urinary IL-6 with the degree of proteinuria, hematuria and urinary leukocyte counts (P < 0.001, P < 0.05, P < 0.05, respectively) but not with serum IL-6, CRP or temperature, and of serum IL-6 to C-reactive protein (P = 0.053) and renal concentrating capacity (P < 0.05). The results demonstrate that infections of the urinary tract activate an IL-6 response in children and that the magnitude of the IL-6 response is influenced by the properties of the infecting strain.

Effect of melanocyte stimulating hormone on human cultured choroidal melanocytes, uveal melanoma cells, and retinal epithelial cells

PURPOSE

To establish methodology for the culture of human choroidal melanocytes to compare their responsiveness to melanocyte stimulating hormone (MSH) with that of their transformed melanoma counterparts and with that of the retinal epithelial cell.

METHODS

Choroidal melanocytes from the choroid of eyes enucleated for the presence of malignant melanoma were cultured in MCDB 153 medium supplemented with insulin, transferrin, hydrocortisone, glutamine, nystatin, vitamin E, phorbol myristate acetate, bovine hypothalamic extract, cholera toxin, and chelexed fetal calf serum.

RESULTS

High yields of pure spindle-shaped bipolar melanocytes were obtained with a doubling time of 3 to 4 days in nine consecutive eyes. Cells continued to divide after 4 months in culture. In contrast, uveal malignant melanoma cells grew rapidly in a relatively simple medium of Ham's F12:DMEM (1:1) supplemented with fetal calf serum, insulin, transferrin and glutamine. This medium was unable to support choroidal melanocytes. Choroidal melanocytes were DOPA-positive with appreciable tyrosinase activity that significantly increased with treatment with MSH. MSH also significantly altered the size, local density, and distribution of primary and mature melanosomes of ocular melanocytes. In contrast, uveal melanoma cells had a low level of tyrosinase activity and failed to respond to MSH with either an increase in enzyme activity or melanosome size. Retinal epithelial cells failed to show significant tyrosinase activity under the conditions studied or any increase in melanosome size in response to MSH.

CONCLUSION

Ocular melanocytes show evidence of regulation by MSH and a range of mitogenic stimuli unlike the transformed melanoma cells, implying a loss of regulatory control in the latter.

Clinical characteristics in a kindred with early-onset Alzheimer's disease and their linkage to a G-->T change at position 2149 of the amyloid precursor protein gene

Patients from five generations of a family developed presenile Alzheimer's disease (AD) early in the fifth decade. Recent memory, information-processing speed, sequential tracking, and conceptual reasoning were the earliest cognitive functions affected. Language and visuoperceptual skills were largely spared early in the course of the disease. Later, there were progressive cognitive deficits and inability to perform the activities of daily living. Death occurred, on average, 6 years after onset. Three autopsies in affected members revealed cerebral amyloid deposits and neurofibrillary tangles. Clinical and pathologic features were typical for familial AD. Direct DNA sequencing revealed a G-->T change at position 2149 of the amyloid precursor protein (APP) gene that resulted in the substitution of phenylalanine for valine in the transmembrane domain of the mature protein. This mutation was present in DNA from all four examined affected individuals and linked to the disease with a lod score of 3.25, and was the most probable cause of AD in this family.

Detection of the apoptosis-suppressing oncoprotein bc1-2 in hormone-refractory human prostate cancers

The oncoprotein encoded by bc1-2 is unique because of its intracellular location (a mitochondrial membrane protein) and apparent mode of action (suppression of apoptosis). To date, this oncogene has been associated only with the development of certain forms of human B-cell lymphoma. In this report, we describe our experience with a monoclonal antibody made against a synthetic peptide for bc1-2 that can recognize the bc1-2 protein and identify cells in human prostate glands expressing this proto-oncogene with in situ immunohistochemical procedures. These procedures were utilized to survey a series of 62 human tissues to evaluate whether bc1-2 might have a role in the developing prostate gland or in prostate oncogenesis. While all primordial epithelial cells in a fetal prostate gland immunostain for bc1-2, normal and hypertrophic prostate glands of the adult show bc1-2 expression restricted to the basal cells. All epithelial cells in areas of prostatic intraepithelial neoplasia were stained by this antibody, as were most (62%) localized invasive prostatic carcinomas. In contrast, all primary prostatic carcinomas and metastases obtained from metastatic prostate cancer patients after hormone treatment (hormone-refractory tumors) stained positive for bc1-2. This study demonstrates that the oncoprotein encoded by bc1-2 can be detected at sequential stages in the natural history of human prostate cancer. Since the bc1-2 oncoprotein is known to suppress the cellular response to apoptotic stimuli, it will be important to determine whether bc1-2 expression is a factor in the development of prostate cancers and in the survival of hormone-refractory prostate cancer cells.

Myofibroblasts in hollow visceral myopathy: the origin of gastrointestinal fibrosis?

A patient with hollow visceral myopathy is reported in whom light microscopical studies of the small and large intestine showed typical features of degeneration, thinning, and fibrous replacement of smooth muscle of the gastrointestinal tract. Electron microscopy showed a striking increase in collagen with minimal fibroblast proliferation. Smooth muscle fibres had a range of ultrastructural abnormalities including myofilament disarray, electron lucency of the cytoplasm, and proliferation of the endoplasmic reticulum. Some fibres seemed to have typical ultrastructural characteristics of myofibroblasts, and others to be transition forms between typical smooth muscle cells and typical myofibroblasts. It seems likely that the fibrosis typical of this disorder has its origin in the transformation of smooth muscle fibres from a purely contractile to a myofibroblast collagen synthetic phenotype.

Imaging of mediastinal masses in children

Conventional radiographs show the mediastinum to be the most frequent location of thoracic masses in children. The compartmental approach to evaluation of pediatric mediastinal masses is advised. Compartmental localization and lesion internal characteristics are best determined by cross-sectional imaging techniques. These techniques as well as the causes and significance of the common pediatric mediastinal masses are discussed. Imaging of the thymus is emphasized because normal thymic tissue can mimic pathologic conditions and the thymus is a common thoracic location for neoplasms in children.

Does platelet size correlate with function in patients undergoing cardiac surgery?

OBJECTIVE

Platelet dysfunction secondary to cardiopulmonary bypass (CPB) is one of the major reasons for nonsurgical post-operative bleeding in cardiac surgery. Whether platelet size is an indicator for platelet function was investigated in patients undergoing coronary artery bypass grafting.

DESIGN

Prospective study.

SETTING

Intra-operative, cardiac surgery operations.

PATIENTS

80 consecutive patients undergoing coronary artery bypass grafting. Excluding criteria were pre-operative coagulation disorders and medication with anticoagulants within the last 10 days before the operation day.

MEASUREMENTS AND RESULTS

Platelet function was assessed by aggregometry using a turbidimetric method (inductors: ADP 2.0 mumol/l, collagen 4 micrograms/l, epinephrine 25 mumol/l). Mean platelet volume (MPV) was measured by an electrical conductivity method. Measurements were carried out before, during, and after CPB until the 1st post-operative day on intensive care unit (ICU). Platelet size decreased significantly during CPB (max. -25% after weaning from bypass) and returned to baseline values on the 1st post-operative day. Platelet count (ranging from 93 - 304 x 10(9)/l) did not correlate significantly with MPV or aggregation variables. Maximum aggregation and maximum gradient of aggregation induced by ADP and collagen were significantly decreased by CPB with the most pronounced reduction at the end of CPB (ranging from -25% to -45%). Analyses of co-variance revealed a significant correlation between changes in MPV and changes in aggregation variables (ADP, collagen).

CONCLUSIONS

Platelet volume is easy to measure even in the operation room or in ICU and may indicate abnormalities in platelet function in the post-bypass period of cardiac surgery patients.

Characterization of an isoelectric focusing variant of SAA1 (ASP-72) in a family of Turkish origin

An acidic variant of serum amyloid A (SAA) identified previously by isoelectrofocusing in a family of Turkish origin has been characterized at the genomic level. DNA sequence analysis revealed that individuals expressing the variant pI6.1/pI5.7 isoforms (the mother and three of four children) were heterozygous at the SAA1 gene locus. Their SAA1 gene sequences contained an adenine, as well as the usual guanine, at the position corresponding to the second base of codon 72. The presence of both bases predicts two SAA1 protein sequences, one having aspartic acid and the other glycine at position 72. While the Gly-72 SAA1 (+/- Arg-1) sequence represents the normal pI6.5/pI6.0 isoforms, the Asp-72 SAA1 (+/- Arg-1) sequence corresponds to the variant pI6.1/pI5.7 isoforms.

Effect of an incontinence training program on nursing home staff's knowledge, attitudes, and behavior

To test a behavioral approach for urinary incontinence (UI), 166 staff in four nursing homes participated in a quasi-experimental study that measured knowledge and attitudes about UI and compliance with toileting protocols. The intervention group (N = 96) showed a slight increase in knowledge; their attitudes remained positive over the four testing times. Compliance with the more critical component of the toileting protocol was only 72%, although evidence existed that the protocol reduced UI. Results are discussed in terms of the sociocultural environment of nursing homes.

6,7-Diepicastanospermine, a tetrahydroxyindolizidine alkaloid inhibitor of amyloglucosidase

A tetrahydroxyindolizidine alkaloid, 6,7-diepicastanospermine, was isolated from the seeds of Castanospermum australe by extraction with methanol and purified to homogeneity using ion-exchange, preparative thin-layer, and radial chromatography. A very low yield of a pyrrolidine alkaloid, N-(hydroxyethyl)-2-(hydroxymethyl)-3-hydroxypyrrolidine, was also obtained by analogous methods. The purity of both alkaloids was established by gas chromatography of their trimethylsilyl (TMS) derivatives as better than 99%. The molecular weight of each alkaloid was established as 189 and 161, respectively, by mass spectrometry, and the structure of each was deduced from their 1H and 13C NMR spectra. The structure of the pyrrolidine alkaloid is suggestive of a possible biosynthetic route to the polyhydroxyindolizidine and polyhydroxypyrrolizidine alkaloids which co-occur in C. australe. 6,7-Diepicastanospermine was found to be a moderately good inhibitor of the fungal alpha-glucosidase, amyloglucosidase (Ki = 8.4 x 10(-5) M) and a relatively weak inhibitor of beta-glucosidase. It failed to inhibit alpha- or beta-galactosidase, alpha- or beta-mannosidase, or alpha-L-fucosidase. Comparison of its inhibitory activity toward amyloglucosidase with those of its isomers, castanospermine and 6-epicastanospermine, demonstrated that epimerization of a single hydroxyl group can produce significant alteration of such inhibitory properties.

Prenatal diagnosis of hereditary amyloidosis in a Portuguese family

Portuguese-type amyloidosis is an autosomal dominant condition caused by a point mutation of the prealbumin (transthyretin) gene. The mutation can be detected directly by the presence of a restriction site for Nsil. We report the first prenatal diagnosis for this condition, performed in the first trimester by chorionic villus sampling, polymerase chain reaction, and restriction enzyme digestion.

Effects of tamoxifen and somatostatin analogue on growth of human medullary, follicular, and papillary thyroid carcinoma cell lines: tissue culture and nude mouse xenograft studies

The knowledge that (1) the normal thyroid contains somatostatin, (2) polypeptide growth factors influence thyroid cell function, and (3) thyroid cells contain steroid hormone receptors prompted us to add somatostatin analogue No. 201-995 (SMS) (5 ng/ml) and/or tamoxifen citrate (TAM) (5 mumol/L) to 7-day monolayer cultures (50,000 cells/well) of three separate human thyroid carcinoma cell lines: DR081 (medullary), WR082 (follicular), and NPA'87 (papillary). Results, tabulated as cell numbers/well (X10(5) on day 7, revealed that TAM inhibited growth of medullary and follicular cells and that TAM plus SMS inhibited growth of papillary cells. In vivo studies of subcutaneous tumor cell xenografts in nude mice have documented that TAM (5 mg subcutaneous pellet) significantly inhibits the growth of medullary implants. Flow cytometric DNA studies of medullary cell cultures demonstrated a reduced G2 + M phase with TAM treatment. For papillary cell implants, TAM plus SMS (5 micrograms subcutaneously, twice daily) did not suppress tumor growth. All three cell lines were negative for estrogen receptor; addition of estradiol (5 ng/ml) to medullary cell cultures neither stimulated replication nor reversed the inhibitory effects of TAM in vitro. We conclude that (1) TAM slowed the growth of a cell line of human medullary carcinoma, both in vitro and in vivo; (2) this effect was not reversed by estradiol; (3) TAM plus SMS inhibited replication of a papillary carcinoma cell line in vitro, but not in vivo; and (4) TAM alone and TAM plus SMS inhibited replication of cultures of a human follicular thyroid carcinoma cell line. TAM and SMS may be useful in treatment of some human thyroid carcinomas.

Haemangioma of the optic disc

Isolated capillary haemangiomata of the optic disc are uncommon; they may be associated with the von Hippel-Lindau syndrome. Renal carcinoma occurs in almost one-third of patients with this condition, and it may go unnoticed until metastases occur. Early nephrectomy offers a cure. It is important, therefore, that all patients with optic disc capillary haemangiomata as well as their relatives are referred for screening for the stigmata of this disease.

Inhibition of growth of human breast carcinomas in vivo by somatostatin analog SMS 201-995: treatment of nude mouse xenografts

Minced tumor fragments were xenografted into subcutaneous tissue of the lateral thoracic regions of young adult, virgin female nude mice to study the effects of somatostatin analog SMS 201-995 on growth of estrogen-dependent (MCF-7) and estrogen-independent (BT-20) human breast carcinomas. When tumors became palpable (6 to 10 days), mice were assigned randomly to receive either SMS (4 to 50 micrograms) or acetate buffer (0.2 ml) subcutaneously twice a day. For MCF-7, mean tumor volume was significantly lower on day 20 and days 30 through 50 in SMS-treated mice than in controls (p less than 0.05), and tumor doubling time was increased from 13.2 to 19.0 days. Calculated growth increment was significantly lower with SMS than with buffer treatment (1.1 +/- 0.1 vs 1.9 +/- 0.2) (p less than 0.001). For BT-20, mean tumor volume of SMS-treated mice was slightly, but not significantly, lower than that of controls; however, calculated growth increment was significantly lower for SMS treatment (3.2 +/- 0.3 vs 3.9 +/- 0.4) (p +/- 0.001), and tumor doubling time was increased from 4.0 to 5.8 days. For MCF-7, flow cytometric DNA analysis of tumor biopsy samples demonstrated a reduced G2 + M phase with SMS treatment. We conclude that SMS slows the growth of both MCF-7 and BT-20 human breast cancer xenografts in nude mice and that SMS may be clinically useful in the management of patients with breast carcinoma.

A monoclonal immunoglobulin A (kappa) factor VIII:C inhibitor associated with primary amyloidosis: identification and characterization

Factor VIII:C inhibitors associated with primary amyloidosis have not been previously reported. A patient with autopsy-proved primary amyloidosis developed renal failure requiring peritoneal dialysis. Purpura and a prolonged partial thromboplastin time (PTT) were first observed 3 years later, after treatment was changed from peritoneal dialysis to hemodialysis. Plasma contained a time-dependent factor VIII:C inhibitor. The inhibitor on isoelectric focusing showed two peaks of activity, one with an isoelectric point (pl) of approximately 4 and the second larger, with a pl of approximately 8. Both were neutralized only by antisera to IgA and kappa light chain. A monoclonal antibody prepared in Balb/c mice against the variable region of the kappa light chain also blocked the inhibitor. The delayed onset of the coagulopathy could be explained by the change from peritoneal to hemodialysis, because in the former, significant amounts of the paraprotein, indicated by an "M-spike," were recovered in the dialysate. N-terminal amino acid sequencing of the first 20 amino acids of the variable region of the kappa light chain from the urinary protein and the splenic amyloid subunit showed identity.

MRI of multilocular cystic nephroma

We report the magnetic resonance imaging (MRI) findings in 2 patients with multilocular cystic nephromas. Both underwent MRI immediately prior to resection. The images accurately reflected the morphology of the tumors: in each, the capsule was hypointense on all pulse sequences. Varied intensities of signal from the fluid in the visualized locules presumably represented differing concentrations of old hemorrhage and protein. In one case soft tissue elements became hyperintense on T2-weighted images. We speculate that MRI of multilocular cystic nephromas will produce imaging features that are highly suggestive, but not always pathognomonic, of the disease.

The Drosophila zeste protein binds cooperatively to sites in many gene regulatory regions: implications for transvection and gene regulation

The Drosophila zeste protein binds in vitro to several sites in the white, Ultrabithorax, decapentaplegic, Antennapedia, and engrailed genes and to at least one site in the zeste gene itself. The distribution of these sites corresponds often with that of regulatory elements in these genes as defined by mutations or, in the case of white, by molecular analysis. A zeste binding site is frequently found in the immediate vicinity of the promoter. zeste binding sites are composed of two or more zeste recognition sequences T/CGAGT/CG. Isolated consensus sequences do not bind or footprint. Cooperative interactions are involved both in binding to a given site and between proteins bound at independent sites. zeste bound to one DNA molecule can in fact bind simultaneously to another DNA molecule. These results suggest a general role for zeste in bringing together distant regulatory elements controlling the activity of a target gene. In this model, transvection effects are a by-product of normal intragenic zeste action.

Gene expression during the early phases of regression of the androgen-dependent Shionogi mouse mammary carcinoma

The effects of castration on gene expression were measured in the androgen-dependent Shionogi mouse mammary carcinoma. From 0 to 144 h after castration, polyadenylated RNA from the tumors was analyzed by Northern blotting for the expression of genes associated with cell maintenance (beta-actin and alpha-tubulin), cell growth and differentiation (c-fos and c-myc), and cell stress and death (heat shock 70 and TRPM-2). During the first 48-72 h after castration, the tumor continued to increase its mass but thereafter (72-144 h) began to regress. Throughout, the concentration of polyadenylated RNA recovered and the expression of both beta-actin and alpha-tubulin remained relatively constant, implying that in the surviving cells there are no major decreases in RNA synthesis. By comparison, c-myc exhibited a small increase in relative expression during the entire period examined, whereas c-fos displayed a transient peak at 12 h after castration, suggesting that this gene is acutely sensitive to androgen withdrawal. Heat shock protein 70 displayed a pattern similar to that of c-fos; however, the transient rise in the level of heat shock protein 70 expression could be induced by sham operations alone. The concentration of the transcripts encoding TRPM-2 rose only when tumor regression was most evident (72-144 h after castration). Thus, gene expression in the Shionogi carcinoma following castration can be grouped according to those genes which show little or no response, those which are acutely sensitive, and those which show a late effect and are more closely affiliated with cell death.

Zeste encodes a sequence-specific transcription factor that activates the Ultrabithorax promoter in vitro

Zeste is a Drosophila regulatory gene that is required for transvection at the bithorax complex. Here we find that purified zeste protein binds to multiple sites just 5' of the initiation site of Ubx RNA. Zeste protein purified from Drosophila cells or from E. coli expressing the zeste gene activates Ubx transcription in vitro. This activation is dependent on the presence of zeste protein binding sites, as it is not observed with a Ubx promoter lacking these sites or with an Adh promoter. These results suggest that transvection involves regulatory elements that act at the level of transcriptional initiation and may be mechanistically similar to activation of transcription by enhancer elements, except that transvection occurs across paired chromosomes. These findings are consistent with the hypothesis that zeste may play a more important role in the normal regulation of Ubx and its other target genes than current genetic evidence implies.

The product of the Drosophila zeste gene binds to specific DNA sequences in white and Ubx

Three different segments of the zeste coding sequence were inserted in an expression vector and antibodies were raised against the resulting zeste-beta galactosidase hybrid proteins. The antibodies were used to analyse the zeste protein produced in bacteria from a different expression vector containing the entire zeste coding region. The major products made in bacteria as well as the products of in vitro translation of zeste RNA migrate anomalously upon SDS--acrylamide gel electrophoresis. Specific DNA fragments from the white and Ubx gene co-immunoprecipitate with zeste protein. At least two independent zeste binding sites are found in a 250-bp interval of the white regulatory region that contains also the sites of wsp mutations, which are known to be deficient in zeste interaction.

Bilateral congenital pseudarthrosis of the olecranon

A case of bilateral congenital pseudarthrosis of the olecranon is described. The clinical features, radiological appearance and prognosis are distinct from the type of congenital pseudarthrosis of the forearm reported previously. The lesion appeared to be a localised failure of ossification within the proximal ulnar metaphysis. Excision, stabilisation and bone grafting led to rapid fusion.

Structure and sequence of the Drosophila zeste gene

The zeste gene of Drosophila affects the expression of other genes in a manner that depends on the homologous pairing of the chromosomes bearing the target gene. Zeste mediates transvection effects, the ability of one gene to control the expression of its homologous copy on another chromosome. We have determined the structure of the zeste gene and several mutants bearing partial deletions and the sequence of the z+, z1, zop6 and z11G3 alleles. The predicted zeste protein has an unusual structure including runs of Gln, Ala and alternating Gln Ala. Contrary to expectations the z1, zop6 and z11G3 mutations can each be attributed to single amino acid changes. The analysis of the mutants suggests that the zeste gene product is required for normal expression of at least some genes and we argue that za mutants may have residual function.

Multiple primary neoplasms in association with prostate cancer in black and white patients

The current study follows up the 983 patients who were diagnosed as having prostate cancer at the Columbia-Presbyterian Medical Center in New York City between 1970 and 1979 and of whom 106 (11.5%) developed a multiple primary malignant neoplasm (MPMN) in addition to their prostate cancer by January 1, 1986. Of the 283 black patients, 32 (11.3%) developed an MPMN involving 35 sites excluding prostate. Of the 636 white patients, 74 (11.6%) developed an MPMN in association with their prostate cancer. Comparing observed incidence rates to expected on the basis of SEER incidence data, two malignant tumors, urinary bladder cancer and malignant lymphoma, appeared to occur in excess in the present series of patients. The excess of urinary bladder cancer in our series could be explained by detection bias due to the routine use of cystoscopy. The excess incidence of lymphoma in our series appears significant but its etiology is unexplained.

Intrathecal immunoglobulin production and minor motor seizures

Five infants with idiopathic infantile minor motor seizures had an elevated immunoglobulin G (IgG) index ((cerebrospinal fluid IgG/serum IgG):(cerebrospinal fluid albumin/serum albumin)). The infants had prolonged prodromal symptoms, and bad prognosis. It is suggested that immunological mechanisms may contribute to the pathophysiology in certain cases of infantile spasms.

The role of imaging studies in urinary tract infection

Technology has permitted significant advances in the imaging and early diagnosis and treatment of many serious urinary tract infections. The armamentarium is vast, with CT scan, ultrasound, nuclear scan, and magnetic resonance imaging on the horizon, with more studies certainly to follow. Nothing, however, can replace the value of proper assessment of clinical signs and symptoms and the logical pursuit of a diagnosis with knowledge of the capabilities and deficiencies of each study.

Epidural cord compression in association with genitourinary neoplasms

The epidural compression secondary to genitourinary malignancies is relatively uncommon. Of 2118 patients who were diagnosed as having a genitourinary malignancy at the Columbia-Presbyterian Medical Center from 1970-1979, 21 are known to have developed an epidural cord compression by June 30, 1985 (16 from prostate, 1 from urinary bladder, and 4 from renal origin). The following items were reviewed in these 21 patients: age of the patient at diagnosis of the primary tumor; primary site of the genitourinary primary; time in months from the date of diagnosis of the genitourinary primary to the data of diagnosis of the spinal cord compression; methods of diagnosis; presenting symptoms and signs; treatment methods; and survival following the date of diagnosis of the compression. The distribution of location of the epidural metastasis in the current series is as follows: cervical-thoracic, 7%; thoracic, 73%; and lumbosacral, 20%. Skip metastases to the epidural space was the initial sign of malignancy in six patients (31.5%). Five patients (26%) with epidural cord compression survived at least 24 months following the date of diagnosis of their compression. Only two patients in this series with paraplegia (secondary to their compression) had improvement in ambulation following treatment of their compression: of these two patients, one had a prostate primary and the other a renal primary. The indications and techniques for surgery and radiotherapy are briefly described and early diagnosis and treatment are stressed.

Computed tomographic studies of the painful abdomen

Abdominal CT scans were reviewed in a series of 53 patients who had abdominal pain without objective physical, radiographic, or laboratory abnormalities. Forty patients presented with abdominal pain alone, while the remaining patients had abdominal pain associated with nausea, vomiting, or mild weight loss. Abdominal CT scans in all patients were interpreted as normal. In all but one patient, the final diagnosis was an insignificant benign condition. One patient had a pancreatic carcinoma discovered at surgery one month after the CT scan was obtained. The patients were followed up for 6 to 12 months to confirm absence of significant disease. Our analysis suggests a very low yield from abdominal CT in patients with abdominal pain and no other objective findings.

Nelson's syndrome after Cushing's disease in childhood: a continuing problem

Nelson's syndrome--progressive cutaneous hyperpigmentation with x-ray film evidence of an expanding pituitary tumor--is now a well-recognized sequela of bilateral adrenalectomy for Cushing's disease. It is estimated to occur in 8% to 38% of adults. Because Cushing's disease is rare in children, a higher incidence of Nelson's syndrome has not been suggested until recently. Although transsphenoidal operation is now the treatment of choice for Cushing's disease, children who have undergone bilateral adrenalectomy remain at risk for the development of Nelson's syndrome. A review of our experience and the literature indicates that the incidence of Nelson's syndrome after the treatment of Cushing's disease is higher in children than in adults. In our six children who underwent adrenalectomy between 8 and 17 years of age, four developed Nelson's syndrome at 2, 6, 10, and 12 years after adrenalectomy. Two of these patients remain well at 6 and 9 years after treatment with external irradiation. One patient treated with external irradiation developed recurrence at 5 years and required total hypophysectomy. The fourth patient required total hypophysectomy followed by external irradiation. Of the 37 patients reviewed and analyzed, the mean age at diagnosis of Cushing's disease was 12 years, with a mean interval of 8.4 years between adrenalectomy and Nelson's syndrome. Information regarding treatment for Nelson's syndrome was known in 24 patients and included pituitary irradiation (four patients), pituitary operation (11 patients), pituitary irradiation followed by operation (six patients), and pituitary operation followed by irradiation (three patients).

Measuring gas leakage from bronchopleural fistulas during high-frequency jet ventilation

A simple volumetric system can be used to measure leakage from bronchopleural fistulas even when inspiratory volumes are unknown or when constant suction is required.

Rotational isomerism about the 17(20)-bond of steroids and euphoids as shown by the crystal structures of euphol and tirucallol

The influence of configuration at C-20 on rotation about the 17(20)-bond in steroids and euphoids was examined by x-ray crystallographic studies of the C-20 epimers euphol and tirucallol. The H atom on C-20 was in back next to C-18 in the crystal structures of both of the compounds, and C-22 was found to be cis-oriented ("left-handed") to C-13 in euphol and trans-oriented to it ("right-handed") in tirucallol. The results, which are consistent with the known left-handed crystal structure of 24(25)-dihydroeuphol and right-handed crystal structure of cholesterol and other natural sterols, lend further credence to the earlier suggestion that rotational isomerism at the 17(20)-bond can arise in C-20 epimers and that there is preference for an arrangement with the 20-H atom adjacent to C-18.

Organization and modulation of nuclear lamina structure

The nuclear lamina is a protein meshwork associated with the nucleoplasmic surface of the inner nuclear membrane, that is suggested to be important for organizing nuclear envelope and interphase chromosome architecture. To investigate the structural organization of the lamina, we have analysed rat liver nuclear envelopes by various chemical extraction procedures. From these studies, we have defined conditions that yield a nuclear envelope subfraction that is both highly enriched in the lamina and devoid of pore complexes. This fraction contains mostly lamins A, B and C, the three major lamina polypeptides that are apparently arranged in a polymeric assembly. Our chemical extraction studies also indicate that lamin B has a stronger interaction with nuclear membranes than the other two lamins, and support the possibility that lamin B is important for attaching the lamina to the inner nuclear membrane. We have examined the synthesis and assembly of the lamins during interphase in tissue-culture cells to investigate lamina structure by a second approach. We found that all three lamins are synthesized at similar rates throughout the cell cycle in synchronized Chinese hamster ovary cells, and that their biosynthesis is not temporally coupled to DNA replication. Our studies indicate that newly synthesized lamins are rapidly assembled into an insoluble lamina structure but that the apparent half-time for lamina insertion differs for individual lamins. We have also observed that lamin A is synthesized as an apparent precursor molecule that is converted to mature lamin A only after integration into the lamina structure. The lamina is reversibly depolymerized during cell division, a process that may be mediated by enzymic phosphorylation of the lamins. To investigate this possibility further, we have analysed charge-altering modifications of the lamins on two-dimensional gels, and have found that phosphorylation is the only detectable modification of these proteins that occurs specifically during mitosis. Furthermore, we have determined that when the lamins are disassembled during metaphase, each lamin has approximately 2 moles of associated phosphate/mole lamin, a value that is four to sevenfold higher than the average interphase level. Considering this information, we discuss a model by which depolymerization and reassembly of the lamina can regulate the reversible disassembly of the nuclear envelope during mitosis.

Tissue response to implants of calcium phosphate ceramic in the rabbit spine

Recent studies have shown that porous calcium phosphates provide a scaffold for bony ingrowth in various anatomic sites. In this preliminary investigation a type of porous calcium phosphate ceramic was implanted in the vertebral columns of 21 rabbits; the ceramic was studied as a possible bone graft substitute for use in spinal fusions. Animals were killed at three, six, eight, 12, and 24 weeks. Roentgenograms and histologic sections of the implant site were then obtained. Bony tissue ingrowth was progressing during the study period. Woven bone was found by six weeks after implantation, and lamellar bone was evident at 12 weeks. By 12 weeks the bony ingrowth had reached the central portion of the ceramic block. There was no fibrous tissue barrier to normal ossification. This type of calcium phosphate ceramic is compatible with bony ingrowth when implanted in the vertebral column of rabbits.

Epidermoid cysts of the liver

To the four recorded cases of epidermoid cysts of the liver are added two cases recently seen in children. One was in a 4-yr-old girl and associated with biliary cirrhosis. The other was in a 5-mo-old boy. The former was treated by roux-en-y cystjejunostomy, the latter by enucleation. The origin of these cysts is unknown. One theory suggests derivation from accessory foregut buds. Because of their malignant potential, treatment should be by excision. Where this is impossible, roux-en-y cystjejunostomy offers satisfactory palliation.

The accuracy of the plain abdominal radiograph in assessing colonic faecal contamination

A prospective study of 333 out-patients assessed the accuracy of determining colonic cleansing from the plain abdominal radiograph. The results indicate that the amount of colon contaminated with faeces was significantly underestimated and the difference in efficacy between the best and worst preparation regimens could not be detected from the plain film. Nevertheless, plain films have been used in comparative studies of preparation regimens for barium enema. It is suggested that results so obtained are misleading and that comparisons are best made on barium films alone.

Evidence for the structure, and for a non-chair conformation in ring F of two isomeric N-formylsolasodines

Formylation of solasodine results in the formation of two different 3,N-diformylsolasodines whose isomerism is due to a difference in stereochemistry at C22 rather than restricted rotation about the C=N partial double bond of the amide or nitrogen inversion as previously proposed. Mass spectra, 1H and I3C n.m.r. spectra have shown the isomers to possess 22R,25R (major) and 22S,25R (minor) stereochemistry. The 22S,25R isomer is thermodynamically preferred at elevated temperatures while the 22R,25R isomer is kinetically favoured upon recyclization of the ring-F opened intermediate which forms upon heating of either isomer. A non-chair ring-F conformation is proposed for each isomer on the basis of 13C and 1H n.m.r. spectra.

New quinolinone and bis-quinolinone alkaloids from Euxylophora paraensis

Three quinolin-2-one alkaloids were isolated from the heartwood of Euxylophora paraensis andidentified by spectroscopic methods as 2,3,3-trimethyl-2,3,4,5-tetrahydrofurano[3,2-c]quinolin-4-one(2a), its N-methyl derivative (2b), and 3-(1,2-dimethyl-2-hydroxypropyl)-4-hydroxy-1-methylquinolin-2(1 H)-one (3). Four new dimers, E, F, G and B, were also isolated and identified as the bisquinolin-2-ones (5c), (5d), (6) and (9). The unsaturated dimer G and an isomer have been prepared by oxidationof paraensidimerin A and C.

Mineral oil vacuum distillation method for nitrosamines in fried bacon, with thermal energy analyzer: collaborative study

Nine laboratories participated in a collaborative study of a method for determining 6 nitrosamines, dimethylnitrosamine, diethylnitrosamine, dibutylnitrosamine, nitrosopiperidine, nitrosopyrrolidine, and nitrosomorpholine, in the 5-17 ppb range. The coefficients of variation for repeatability were 10.8, 8.5, 10.4, 8.5, 8.7, and 7.8% with corresponding coefficients of variation for reproducibility of 16.4, 12.0, 13.6, 10.8, 11.2, and 10.3% and recoveries of 89.6, 91.6, 84.7, 90.0, 89.6, and 88.1%, respectively. The method was adopted official first action.

Mineral Oil Vacuum Distillation Method for Nitrosamines in Fried Bacon, with Thermal Energy Analyzer: Collaborative Study

Nine laboratories participated in a collaborative study of a method for determining 6 nitrosamines, dimethylnitrosamine, diethylnitrosamine, dibutylnitrosamine, nitrosopiperidine, nitrosopyrrolidine, and nitrosomorpholine, in the 5-17 ppb range. The coefficients of variation for repeatability were 10.8, 8.5,10.4, 8.5, 8.7, and 7.8% with corresponding coefficients of variation for reproducibility of 16.4, 12.0,13.6,10.8,11.2, and 10.3% and recoveries of 89.6, 91.6, 84.7, 90.0, 89.6, and 88.1%, respectively. The method was adopted official first action.