Quantification of metamorphopsia using hyperacuity techniques

We have developed a new technique for quantification of metamorphopsia using a simplified and modified Amsler grid. Furthermore, the technique used is a bisection task, a form of hyperacuity determination. This allows for very fine assessments of metamorphopsia even in the presence of cataracts.

Recognition, management, and prevention of Clostridium septicum abscess in immunosuppressed patients

Spontaneous gas gangrene due to Clostridium septicum is a rapidly progressing disease that usually ends in fatal toxemia. We report three cases of asymptomatic C septicum abscesses to document the clinical course of this entity and to establish guidelines for its prevention and treatment. In contrast to previously reported data, C septicum infections can produce abscesses in solid organs, the retroperitoneum, and the extremities. These lesions often occur in patients with cancer, producing liver abscesses without gas formation that may be misinterpreted as metastatic carcinoma. Symptoms may be minimal or nonspecific before fulminant toxemia. Asymptomatic bacteremia should prompt a search for unsuspected cancer and an abscess. Computed tomography is the diagnostic modality of choice. The treatment consists of surgical débridement of necrotic tissue in concert with an appropriate course of antibiotics. We have found recurrences after adequate débridement and short-term antibiotic therapy, suggesting that prolonged and even lifelong prophylactic oral penicillin G potassium may be necessary to prevent further recurrences.

Protein electrophoresis in tuberculosis

Serum electrophoresis was done in 31 patients with pulmonary tuberculosis and 62 age and sex matched controls. Protein values amongst controls were higher than those described by others. In tuberculosis there was significant decrease in total proteins, and albumin with corresponding increase in globulin, mainly due to an increase in gamma globulin fraction. There was no significant increase in alpha-2 levels. Decrease in albumin/alpha-2 ratio was significant in sputum positive cases, but it was due to reduction in albumin rather than increase in alpha-2 globulin. Decrease in albumin/alpha-2 ratio in this study was not diagnostic of tubercular activity.

Hepatotoxicity to different antituberculosis drug combinations

Hepatotoxicity to different combinations of anti-tuberculosis drugs containing, Rifampicin (R), Streptomycin (S), Isoniazid (H), Pyrazinamide (Z) and Myambutol (E) is described in 47 patients who completed 6 to 9 months therapy. Seven cases (15%) showed signs of toxicity and in 4 patients (8.5%) the drugs had to be withdrawn. Two patients developed hepatitis, one with jaundice and the other with fever and deranged liver functions, while others 2 developed severe hypersensitivity reactions. Burning palms, difficulty in micturition, itching and giddiness were complained of by one patient each, which settled in due course without recourse to withdrawal of drugs.

Unconventional lymphocytes involved in rejection of xenogeneic heart grafts

In this report, the efficacy of cyclosporine A and two monoclonal antibodies, anti-L3T4 and anti-Lyt-2.2, was assessed on first-set rejection of cardiac xenografts. Neither cyclosporine nor anti-Lyt-2.2 monoclonal antibody prolonged the survival of heart xenografts. Anti-L3T4 enhanced acceptance of rat hearts transplanted to C57BL/6 mice 5-fold relative to that observed in control recipients; it did not, however, prolong acceptance of hamster hearts transplanted to mice. Histologic analysis indicated that the cellular infiltrate within rejected hearts was composed of greater than 95% lymphocytes; of these, greater than 99% were Thy-1- and sIg-. These results suggest that rejection of xenogeneic hearts is mediated by unconventional lymphoid cells. This is discussed in the context of whether rejection of allografts and xenografts occur by similar or dissimilar mechanisms.

Molecular characterization and nonradioactive detection of beta-thalassemia in Malaysia

The spectrum of beta-thalassemia mutations in Malaysia has been determined in 45 beta-thalassemia chromosomes using dot blot hybridization of the polymerase chain reaction amplified DNA and direct DNA sequencing. Eleven different molecular defects, including those previously detected in Chinese, Asian Indians, and American blacks, and a novel frameshift mutation causing beta zero-thalassemia were detected. Since this novel mutation, a T deletion in codon 15 creates a new restriction site for EcoRII enzyme; the mutation could be detected by EcoRII digestion of the appropriate amplified fragment. The results of the present study provide additional information on the molecular heterogeneity of beta-thalassemia in this population. We also demonstrated the nonradioactive detection method of the beta-thalassemia mutation based upon the digoxigenin-labeled oligonucleotide probes.

Criteria for diagnosis in pulmonary tuberculosis

In a retrospective study, case records of 1061 patients treated with antituberculosis drugs were examined to assess the criteria for diagnosis in each case. Seventy six percent had sputum examined for A.F.B. and 45% had mantoux test done. Five hundred and eighty one (55%) were diagnosed on radiology alone, while 262 (25%) had positive sputum for A.F.B. Only 50 (5%) of cases had positive Mantoux in addition to positive sputum and radiological changes. Practical significance of this practice is discussed.

Improved lung preservation using Euro-Collins solution for flush-perfusion

Satisfactory extended preservation of the lung has been difficult to obtain. This study investigated the influence of different total volumes and flow rates during flush-perfusion of the lung, and their effect on pulmonary artery pressure, flow distribution, regional lung temperature and functional performance of the lungs following transplantation after 24 hours. Fifteen mongrel dogs served as donors of the heart and lung block. Cold modified Euro-Collins solution was used as flush perfusate. Pulmonary artery and perfusion-line pressures were measured. The regional lung temperature was measured at one minute intervals with 5 myocardial temperature probes. Flow distribution was determined with micro-aggregated albumin labelled with Technetium 99. The heart-lung block was harvested, the right lung removed, and samples taken for gamma-counting. The left lung was stored in cold Euro-Collins solution and then transplanted. The inspired oxygen fraction (FiO2) was set at 0.4 and was kept constant throughout the procedure and the entire postoperative course. There were 3 groups of 5 animals each. In group A, the flush perfusate was administered at a total volume of 20 cc/kg over a period of 6 minutes. In group B the same volume of perfusate was administered at a pulmonary artery pressure (PAP) of 18 to 20 mmHg, resulting in a considerably shorter perfusion time (1.3 minutes). In group C 60 cc/kg of perfusate were given at the same flow rate as in group B, also resulting in PAP of 18 to 20 mmHg, but the perfusion time was increased to 4 minutes. Thus, groups B and C investigated the effect of increased pressure and volume of perfusate, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Cyclosporine serum concentrations soon after heart or heart-lung transplantation

The accumulation of cyclosporine was evaluated in 11 patients following either heart or heart-lung transplantation. Blood samples were drawn frequently for the first few postoperative days, and the plasma was analyzed by both radioimmunoassay (RIA) and high-performance liquid chromatography (HPLC). The levels determined by RIA were higher than those assessed by HPLC, and it is hypothesized that the difference is due to antibody reactive metabolites of cyclosporine, which are measured by the RIA procedure. We did not find any consistent trends in the accumulation of these metabolites. Analysis of early clinical data did not suggest any relationship between levels of cyclosporine or its metabolites and clinical outcome.

Effort-related axillosubclavian vein thrombosis. A new theory of pathogenesis and a plea for direct surgical intervention

Four cases of effort-related axillosubclavian thrombosis are described. The pathogenesis of this disorder is related to an anatomic constriction of the vein by the clavicle and first rib complex associated with repetitive trauma to the vein and resultant changes in the vein wall itself. Therapy must, therefore, not only address the superimposed thrombosis but must also provide a reliable correction of the constricting mechanism and the resultant lesion in the proximal subclavian vein. Our operative approach resulted in a full return to daily activities and no recurrence or persistence of symptoms in our series. Although early intervention is advisable, patients who present with long-standing venous occlusion should also be considered for operation. Medical therapy, consisting either of anticoagulation or thrombolytic therapy, results in an unsatisfactory clinical outcome because it does not correct the underlying mechanical abnormality.

The Mantoux reaction in pulmonary tuberculosis

The Mantoux test was done on 181 tuberculous patients, of which 124 were sputum-positive. In 102 (93%) sputum positive cases the tuberculin reaction was between 10 and 19 mm. and in only 2 cases was the reaction less than 6 mm. In the sputum negative cases 7 (12%) were Mantoux negative and 5 (9%) had reactions of less than 10 mm. In some of the sputum-negative cases the diagnosis of tuberculosis may have been incorrect.

Pancreatitis after cardiac and cardiopulmonary transplantation

In a review of 176 patients who died after either cardiac or cardiopulmonary transplantation, 15 cases of pancreatitis were identified. The diagnosis was clinically inapparent in 11 of the 15 cases of pancreatitis. A high index of suspicion should therefore be maintained when these patients are cared for. A variety of factors may have contributed to the occurrence of pancreatitis in these patients. These include infection, steroids, azathioprine, low-flow states, extracorporeal circulation, vasopressors, renal failure, and rejection.

Mucormycosis in patients with multiple-organ failure

Mucormycosis in two patients with multiple-organ failure appeared as a cutaneous lesion and spread rapidly. In the first case, wet mounts and potassium hydroxide preparations were unhelpful, but a punch biopsy specimen established the diagnosis. Prompt and extensive debridement and amphotericin B administration arrested the infection. In the second case, virulent progression of the lesion occurred despite limited amputation, debridement, transfer factor, and amphotericin B, but finally responded to further amputation. Diagnosis was made by histologic examination of infected tissue. Both patients shared the following predisposing factors: sepsis, low blood flow, acidosis, multiple-organ failure, and multiple-antibiotic therapy. Although the mucormycosis was controlled, as confirmed in the first case at autopsy and in the second case by clear margins following reamputation, the outcome was fatal in both cases due to other features of multiple-organ failure.

Technetium-99m pyrophosphate in diagnosis of acute cardiac rejection in the rat with effect of cyclosporine: concise communication

Tc-99m pyrophosphate (PPi) uptake has been measured in a rat model of heterotopic heart transplant at 5 days after transplantation. comparison of tracer uptake, as a ratio between the heterotopic transplanted heart and the recipient's native heart, was made in four groups of animals. Group 1, with transplants between animals of isogeneic strain showed a lower ratio, significantly different from the ratio in Group 2 in which transplants were between nonisogeneic animals. The ratio of uptake after transplantation between nonisogeneic animals treated with 10 mg/kg-day of cyclosporine (Group 3), was not significantly different from Group 1. In contrast, the ratio of uptake between nonisogeneic animals treated with subtherapeutic doses of cyclosporine (Group 4), was not significantly different from Group 2. In Groups 1, 2, and 3 there was a correlation between the histology of the transplanted hearts, graded 1 to 5 according to the severity of rejection, compared with the uptake of Tc-99m PPi. This agent can therefore be used to diagnose cardiac rejection in a rat model, and the results correlate well with the severity of rejection as assessed histologically.

Recurrent use of disposable syringe-needle units in diabetic children

Fourteen insulin-dependent diabetic children reused their disposable syringe-needle units an average of 6.3 times per needle. Between uses, the needle was wiped with alcohol and stored in the refrigerator. There were no infections reported during the study for an average duration of 94 days. Dullness of the needle was the major reason for changing to a new one. Recurrent use of disposable needles for insulin injections appears safe in children and may be advised. It will help decrease some of the high cost of the daily care of a person with diabetes.

Use of cyclosporin A in allotransplantation of rat limbs

An experimental model for limb transplantation as a composite tissue transfer has been developed using two genetically well defined strains of rats, BUF and LEW. The study shows that cyclosporin A (CyA) is very effective as an immunosuppressive agent in preventing rejection of transplanted limbs in rats. It is found to suppress rejection of the homotransplants as long as treatment is continuous. No untoward side effects have been noted at the current experimental dosage of the medication. CyA is superior to the conventional agents, such as azathioprine and prednisolone, which allow rejection of the limbs while treatment is in progress. There is a period of immune tolerance following CyA treatment; however, this period becomes shorter as the length of the treatment is increased. This may indicate that CyA treatment should be continuous and not pulsed at the dosage used in this experimental model. Additional experiments are underway to further elucidate this phenomenon.

Spontaneous hepatic hemorrhage during pregnancy

Spontaneous rupture of the liver during pregnancy seems to represent an extreme vascular complication of toxemia. The very high mortality rate has generally been attributable to uncontrolled hemorrhage. However, control of the hemorrhage may not be sufficient to achieve recovery. Hepatic dysfunction may proceed to necrosis associated with multiple organ failure, even after successful hemostasis. Although ligation of the hepatic artery has been successful in controlling hemorrhage in hepatic trauma, this maneuver may contribute to injury in patients with this lesion in whom there is a preexisting hepatic abnormality. In this brief review, the relationship of the underlying pathology to a variety of therapeutic measures in the context of a catastrophic complication of pregnancy are discussed.

Comparative study of home blood glucose monitoring devices: Visidex, Chemstrip bG, Glucometer, and Accu-Chek bG

Visidex (Ames Company, Elkhart, Indiana) and Accu-Chek bG (Bio-Dynamics, Boehringer Mannheim, Indianapolis, Indiana), two new devices for determining blood glucose at home, were compared with two older devices, Chemstrip bG (Bio-Dynamics) and Glucometer (Ames Company), and the standard laboratory glucose-oxidase method (Beckman autoanalyzer, Beckman Instruments, Fullerton, California). Laboratory serum glucose values up to 400 mg/dl had excellent overall correlation with Accu-Chek bG (r = 0.974), Glucometer (r = 0.974), Chemstrip bG (r = 0.963), and Visidex (r = 0.955). For glucose values less than or equal to 180 mg/dl, Glucometer had the best correlation (r = 0.921). For glucose values of 181-400 mg/dl, Accu-Chek bG had better correlation (r = 0.907) although Glucometer had closer mean value. Visidex was just as accurate as Chemstrip bG. Although the four devices tested tended to give lower values than the lab method, they are sufficiently accurate to be of clinical use in home monitoring of blood glucose. Meticulous care in running the tests is mandatory for accuracy. Individual differences among the four methods are discussed.

Survival of primates following orthotopic cardiac transplantation treated with total lymphoid irradiation and chemical immune suppression

Fractionated total lymphoid irradiation (TLI) has been used for attempts at induction of a donor-specific tolerant-like state in allograft recipients and for immunosuppressive effects. Cyclosporin A (Cy A) has been shown to suppress rejection of organ grafts in many species including man. The present study was designed to test the effectiveness of TLI in combination with either CY A or rabbit anticynomolgus thymocyte globulin (ATG) and azathioprine. Thirty-one orthotopic cardiac allografts were performed using surface cooling and total circulatory arrest in outbred cynomolgus monkeys. TLI was administered preoperatively in fractions of 100 rad until a total of 600 or 1800 rad was achieved. Cy A was administered 17 mg/kg/day. All treatment groups demonstrated extended survival. Myocardial biopsies as early as 4 weeks were consistent with mild rejection in all treatment groups. No significant synergistic effect upon survival could be demonstrated utilizing TLI plus Cy A when compared with using Cy A alone. TLI (1800 rad) plus ATG and azathioprine was associated with a high incidence of early death attributable to leukopenia and infection. Cy A alone or in combination with TLI was associated with the development of lymphoid malignancy.

The detection of messenger ribonucleic acid sequences in heterogeneous nuclear ribonucleic acid fractions of the oestrogen-stimulated rat uterus

cDNA (complementary DNA) complementary to the abundant sequences of mRNA isolated from oestrogen-stimulated uterus was hybridized to polyadenylated and non-polyadenylated uterine hnRNA (heterogeneous nuclear RNA). High-molecular-weight polyadenylated hnRNA, isolated under denaturing conditions, was able to saturate the cDNA, but complementary sequences were low abundance when compared with homologous mRNA. The mRNA sequence content of the polyadenylated hnRNA increased considerably during oestrogen-induced growth of the uterus. Non-polyadenylated hnRNA also contained sequences complementary to the cDNA.

Cyclosporin A initially as the only immunosuppressant in 34 recipients of cadaveric organs: 32 kidneys, 2 pancreases, and 2 livers

34 patients treated with cyclosporin A received 36 cadaveric organ allografts (32 kidneys, 2 pancreases, and 2 livers), 26 kidneys are still supporting life, 3 after more than a year; the pancreases and livers are also functioning. 20 patients are not receiving steroids, and 15 of these have not had any additional immunosuppressive agents. In these patients infectious complications have not been severe, but a gastroduodenal lymphoma has developed in 1 patient. 6 patients were given 'Cytimum' (a cyclophosphamide derivative) and steroids in addition to cyclosporin A: 5 of these died of infections and 1 also had a lymphoma. 11 patients received additional steroids: 1 of these died from septicaemia and lymphoma. Nephrotoxicity can be avoided by perioperative hydration and forced diuresis. Cyclosporin A is effective on its own and is a very potent immunosuppressive drug. Additional immunosuppressive agents may lead to severe complications.

Diversity and complexity of uterine mRNA from rats of differing hormonal states

The diversity and complexity of the uterine mRNA population has been compared at two different stages of uterine growth and development in the rat. Analysis by cDNA hybridization to homologous mRNA indicates that there are 8000 different sequences expressed in the immature rat uterus responding to just 4 h of oestradiol-17 beta-induced growth while the fully developed uterus expresses 36 000 sequences. As a check on our results, the complexity is re-analysed by hybridization of mercurated mRNA to total unique DNA. Analysis by this method indicates that the hormone-stimulated immature rat uterus contains 12 000 poly(A)-containing mRNA sequences while the fully differentiated adult tissue contains 53 000 diverse sequences.

Qualitative and quantitative changes in uterine mRNA populations in response to oestradiol treatment of rats

The mRNA population of immature rat uteri, responding to different lengths of oestradiol-induced differentiation, have been compared by the technique of DNA hybridization with heterogeneous RNA. Over the first 4 h of hormone induction there are continuing qualitative and quantitative changes in the poly(A)-containing mRNA such that, by 4 h after oestradiol administration, the population bears little resemblance to that of the unstimulated animal. Between 2 h and 4 h after oestradiol administration, the most striking changes appear to be in sequences of intermediate abundance. The possible significance of these findings is discussed.

Diabetes mellitus with immune complex glomerulonephritis

The present study describes 3 patients with the simultaneous occurrence of diabetic nephropathy and immune-complex mediated glomerulonephritis. Renal manifestation included proteinuria and hematuria which were preceded by or co-existent with an infectious process. Renal manifestation included proteinuria and hematuria which were preceded by or co-existent with an infectious process. Renal histology showed the characteristic change of diabetic nephropathy along with those of immune complex glomerulonephritis. Immunofluorescence studies showed a linear pattern with a superimposed granular pattern of IgG and C3 deposits. Renal function and urinary findings improved in the 2 patients who were followed up.

Characterization of uterine heterogeneous nuclear ribonucleic acid and the effect of oestradiol-17 beta on its synthesis

An early response to the administration of oestradiol-17 beta to immature rats is a dramatic stimulation in the synthesis of uterine hnRNA (heterogenous nuclear RNA). High-molecular-weight fractions of the hnRNA were purified and subfractionated on poly(U)-Sepharose into fractions that differed in their poly(A) content and their size profile on polyacrylamide gels. Oestrogen treatment of the rats stimulated the synthesis of all three fractions of high-molecular-weight hnRNA, but the kinetics of synthesis, degree of stimulation and size distribution of the newly synthesize RNA differed in each fraction.

Effect of cortisone on aspartate and alanine aminotransferases in a desert lizard

1. Liver and serum aspartate aminotransferase (GOT) and alanine aminotransferase (GPT) activities were measured in a hibernating desert lizard, Uromastix hardwickii. The levels of both enzymes were found to be lower in hibernation than during the active period, particularly in the liver. 2. After intramuscular injection of 2 mg of cortisone acetate there was a rapid rise in the levels of these enzymes with a peak of 18 hours (GOT) and 12 hours (GPT). 3. The response of both enzymes to cortisone was much greater during the active period than during hibernation. 4. GOT showed a much more rapid and greater response to cortisone than GPT. This is in contrast to the response of rat liver where GPT is more responsive to this hormone. 5. These studies indicate that the transferase enzymes of this lizard differ from those of the rat in their sensitivity and time of response to cortisone.

Acid and alkaline phosphatase levels in various tissues of a lizard during activity and hibernation

1. Acid phosphatase (AcPase) and alkaline phosphatase (AlPase) activities and specific activities were determined in six different tissues of Uromastix during active and hibernating periods.

2. The protein concentration was significantly reduced in all the tissues during hibernation.

3. pH optima of acid and alkaline Pases were found to be 4.2 and 9.2 respectively.

4. AcPase activity was increased in all the tissues except liver and small intestine during hibernation.

5. AlPase activity was increased in all the tissues except small intestine during hibernation.

6. Specific activities of both the enzymes were increased during hibernation.