Humoral and cellular immune responses in Aspergillus fumigatus pulmonary disease

This study was designed to evaluate immunologic differences between aspergilloma (A) and allergic bronchopulmonary aspergillosis (ABPA), comparing the results to atopic and nonatopic control subjects. Humoral studies included skin tests with common inhalant antigens and Aspergillus fumigatus. Total and specific IgE and other immunologlobulin levels and serum precipitins were evaluated against A. fumigatus. Cellular immunity was studied with routine skin testing and phytohemaqglutinin-induced lymphocyte blast transformation. Antigen-induced blast transformation was also carried out with the use of serial dilutions of A. fumigatus. All patients with ABPA were atopic and had marked elevations of IgE. None of the patients were atopic and they had normal IgE levels. Immediate and late skin reactivity to A. fumigatus was low in control and A groups but high in 2 patients with ABPA. IgG antibody against A. fumigatus was generally greater in the ABPA group. Both ABPA and A had serum precipitating antibody against A. fumigatus. The atopic controls had elevated IgE levels and immediate skin test reactivity to A. fumigatus, and one also had weak serum precipitins against A. fumigatus. IgE antibody against A. fumigatus was generally higher in ABPA than A. ABPA and A patients had elevated stimulation indices (SI) to A. fumigatus. No stimulation could be detected with cells from control subjects. This study indicates that both T and B cell sensitization may play a role in the development of or as a response to aspergillus-related pulmonary disease.

Extracellular water measurements: organ tracer kinetics of bromide and sucrose in rats and man

Bromide and sucrose distributions were measured as functions of time after tracer injection into 14 rat organs that accounted for 93% of body wt, with the goal of evaluating the use of bromide and sucrose as tracers for the extracellular water volume (ECW). The tracers, Na, 82Br, 125I-labeled human serum albumin, [14C]sucrose, and 3H2O, were used to calculate bromide and sucrose content in red cells, plasma, and 13 blood-free organs. Selective concentration of Br- occurs in RBC, stomach, and skin, accounting in part for the discrepancy between the Br- space and the smaller ECW volume as derived from other methods. Sucrose is rapidly metabolized in the rat and its 14C tracer cannot be used for ECW determination in this species. The kinetics of Br- distribution were estimated in rats and in 16 human subjects by measuring plasma disappearance values and specific organ uptakes. A pharmacokinetic compartmental model was derived, containing explicit parameters for blood flow, diffusion constants, and ECW spaces separately for each organ. Precise fitting of experimental bromide data was achieved for the rat; satisfactory fitting was also achieved in man from more limited plasma and biopsy data.

The quantification of IgE antibody specific for ragweed Antigen E (AgE) on the basophil surface in patients with ragweed pollenosis

IgE antibody specific for AgE (IgE—AgE) was eluted from human basophils at acid pH and quantified by its binding of ¹²⁵I AgE in antigen excess. The quantity of Ige—AgE recovered from 30 ml of blood ranged from 0.08 ng to 10.3 ng representing 500 to 56,000 molecules IgE—AgE per basophil. The number of molecules of IgE—AgE per basophil was compared to plasma IgE—AgE, total plasma IgE and leucocyte histamine release in response to AgE.

The ratio of plasma IgE—AgE to basophil bound IgE—AgE ranged from 100 to 4000, indicating that there are a limited number of IgE receptors on the basophil surface as contrasted to the concentration of IgE in the plasma. There was no correlation between IgE—AgE in plasma and the number of molecules of IgE—AgE per basophil. However there was a significant correlation between the ration of IgE—AgE to total IgE in plasma and the number of IgE—AgE molecules per basophil.

Two measures of leucocyte histamine release in response to AgE, cell reactivity (maximum per cent histamine release attainable) and sensitivity (lowest antigen dose leading to 50% release), were compared to the number of IgE—AgE molecules per basophil. Cell reactivity was dependent on the number of IgE—AgE molecules per basophil. Only 2500 molecules IgE—AgE per basophil were required to reach a cellular reactivity of 50%. Cell sensitivity to AgE was not correlated with the number of molecules IgE—AgE per basophil which indicated that other factors played a role in determining the sensitivity of a population of basophils to antigenic stimulation by AgE.

Serum calcium, magnesium, phosphorus, alkaline phosphatase and 25-hydroxyvitamin D concentrations in children

Serum calcium, magnesium, phosphorus, alkaline phosphatase and 25-hydroxyvitamin D concentrations for Coloured children between the ages of 1 and 17 years are reported. No evidence of vitamin D deficiency was found. The problem of the interpretation of 'normal' alkaline phosphatase concentrations is highlighted.

The assessment of immunologic and clinical changes occurring during corticosteroid therapy for allergic bronchopulmonary aspergillosis

Twenty-two patients with allergic bronchopulmonary aspergillosis have been treated and evaluated for a period ranging from two months to nine years. Twelve are available for periodic blood sampling. Data are presented suggesting the following: (1) Patients with allergic bronchopulmonary aspergillosis have high initial levels of total serum immunoglobulin E (IgE). These levels are significantly higher in those patients who had not been previously treated with prednisone for the control of asthma. (2) Treatment with alternate day prednisone (0.5 mg/kg given on alternate days) caused clinical and roentgenologic improvement as well as marked decreases in total serum IgE but does not necessarily prevent recurrence of the disease. (3) Total and specific IgE against Aspergillus antigen may increase prior to and during exacerbations of disease. (4) Specific IgG and IgE against Aspergillus antigen are increased in most patients with allergic bronchopulmonary aspergillosis and reflect disease activity as evidenced by x-ray and clinical exacerbations in some cases. (5) Lymphocyte transformation using Aspergillis antigen, as measured by the whole blood technic, is present in patients with allergic bronchopulmonary aspergillosis, but serial changes in lymphocyte transformation do not correlate with disease activity. (6) Precipitin reactions are present in patients with allergic bronchopulmonary aspergillosis, but presence or absence does not reflect disease activity in most cases.

Rickets in children of rural origin in South Africa: is low dietary calcium a factor?

Studies of nine children 4 7/12 to 13 years of age who had rickets are presented. No evidence of renal abnormalities, vitamin D deficiency, or of the inherited varieties of rickets was found. The salient features were their rural origins, mild hypocalcemia with evidence of secondary hyperparathyroidism, and improvement with a normal diet that contained an average of 944 mg calcium/24 hours. It is proposed that the etiology of the rickets is related to low calcium intake with or without a high oxalate concentration in the diet.

Radiation sensitivity of cultured human glioblastoma cells

Glial cells from 2 normal brains and 9 astrocytomas were cultured in vitro. The most rapidly proliferating cell lines were obtained from Grades III-IV astrocytomas. Normal glia proliferated slowly and growth ceased after 20 to 40 generations. The response of 3 Grade III-IV lines to graded doses of radiation was determined by colony formation and end point dilution technique. Two of the 3 lines were relatively radioresistant compared to other human cell lines; this may partially account for the radiation resistance of high grade astrocytoma tumors.

Estimation of composition of weight loss in man: a comparison of methods

Five different procedures were used to estimate composition of weight loss by six obese individuals maintained on low-calorie regimens: 1) energy-nitrogen (E-N) balance; 2) total body water-nitrogen balance (TBW-N); 3) total body water (TBW); 4) total body potassium (TBK); and 5) an anthropometric method. Quantity of weight lost by obese subjects during comparison periods lasting 25-40 days ranged from 7.9 to 17.1 kg. Expressed as percent of aggregate weight loss, collective fat loss was 47.6 by E-N balance; 46.3 by TBW-N balance; 51.7 by TBK; 50.9 by anthrometry; and 33 by TBW. The E-N balance method yielded a tight cluster of individual means, whereas the other procedures gave a wide scatter of means. For short-term studies, the E-N balance procedure, although tedious and difficult, should yield results less variable than those generated by any of the other methods examined.

Serum levels of 25-hydroxycholecalciferol as a diagnostic aid in vitamin D deficiency states

The measurement of serum levels of 25-hydroxycholecalciferol in the diagnosis of rickets is discussed in the light of recently acquired knowledge of vitamin D metabolism. A useful clinicopathological classification of rickets is presented and various aetiological mechanisms are discussed.

A competitive protein-binding assay for 25-hydroxyvitamin D

1. We describe a modified competive protein-binding assay for 25-hydroxyvitamin D, which does not require the prior separation of vitamin D from 25-hydroxyvitamin D. 2. Bovine albumin was used in the buffer, at a concentration of 1mg/ml, as a protein stabilizer and lipid solubilizer. Bovine albumin from different manufactures produced very different non-specific binding of 25-(3H)hydroxycholecalciferol (ranging from 3.3 per cent to 58.9 per cent). 3. The mean concentration of 25-hydroxyvitamin D in sera from normal children in Johannesburg was 76.75 +/- 24.75 mumol/ml (30.7 +/- 9.9 ng/ml).

Disparate hydration of adipose and lean tissue require a new model for body water distribution in man

The intra and extracellular fluid spaces in adipose tissue were determined by by 3H2O, 82Br-(minus), and 35SO4= uptake, and by appropriate chemical methods, in surgical biopsy material from 16 patients undergoing elective laparatomy. Total water space for adipose tissue was 14 +/- 1.4%: extracellular component was 11 +/- 1.1% in mesenteric and subcutaneous depots. Use of these adipose tissue hydration constants, combined with measurements of total body water (TBW), extracellular water (ECW), total body potassium, and experimentally derived age-specific constants for lean body potassium content, permits development of a four compartment model for body water which considers intra and extracellular components separately for adipose (AT) and adipose-free (AFM) tissue masses. This model has the form (see journal) where x is the total hydration and y the extracellular hydration of the adipose-free mass. The equations can be solved for the ECW and ICW of the adipose-free mass, defined by its potassium content. In four normal subjects, x was measured as 0.80 +/- 0.032, and y as 0.24 +/- 0.017. Thus, the adipose free mass, compared with adipose tissue, has approximately six times the total water and twice the extracellular water content per unit weight.

Reaction of 1,3-bis(2-chloroethyl)-1-nitrosourea with synthetic polynucleotides

The antitumor agent BCNU (1,3-bis(2-chloroethyl)-1-nitrosourea) was incubated with poly(C) and poly(G) in aqueous solution at 37 degrees and pH 7 to produce approximately 0.33 and 0.07% substitution, respectively. Under the same conditions, there was relatively little reaction with poly(A) and poly(U). Poylnucleotides reacted with [14C]BCNU were digested by chemical and enzymatic methods, and the derivative nucleotides were isolated by column chromatography. There were identified by a combination of ultraviolet and mass spectroscopy as 3-(beta-hydroxyethyl)CMP, 3,N4-ethano-CMP, and 7-(beta-hydroxy-ethyl)GMP. This would indicate that BCNU generates active two carbon fragments, probably chloroethyl carbonium ions, which are free to react with nucleotides. The production of these substituted bases may be important to the mechanism of action of the therapeutic nitrosoureas since they would probably alter the function of any nucleic acid which contained them.

Prevention of knee instability. Experimental model for prosthetic anterior cruciate ligament

Loss of the anterior cruciate ligament (ACL) in the dog results in a predictable type of arthritis. This condition can be prevented by successful prosthetic substitution of the anterior cruciate ligament (ACL). The condition is a practical model, and a sensitive index of success and failure for evaluation of prototype prostheses. Changes in the joint can be differentiated on the basis of cruciate insufficiency and reaction to the synthetic implant. The model was defined by replacing the ACL with a mesh or tape Dacron prosthesis in 16 Beagle dogs. Gait and anterior drawer sign are unreliable parameters of ACL insufficiency in dogs. At sacrifice up to 3 years postoperatively, 8 joints out of 32 joints were without arthritic changes. Arthritis developed in all joints in which the prosthesis elongated or broke. Failure always occurred intra-articularly at the mouth of a bone tunnel. Successes were inconsistent even with a single material and animal breed. The drillhole techniques used in ACL reconstructions are difficult to standardize. Variability in placement of the prosthesis is compounded by cutting action of bone edges. Porous mesh did not provide a lattice for true ligament regeneration through the joint. Fixation was not a problem in this series.

Improvement in the results of treatment of osteogenic sarcoma

Experience with 70 patients having osteogenic sarcomas treated between 1968 and 1973 demonstrated the importance of persistence in the management of the disease of these patients. Resection for pulmonary metastases in one or both lungs, often on more than one occasion, will salvage a number of these patients, thus improving the cure rate. Adriamycin has proved an effective palliative agent and a useful adjuvant to surgical therapy. Although the cure rate of tumors arising distal to the knee is much higher than that of more proximally situated tumors, resection of osteogenic sarcomas of the distal part of the femur does not require removal of the entire femur when care is taken to resect well above the site of the apparent tumor. Some osteogenic sarcomas are sensitive to adequate dosages of radiation therapy, but the exact role of this method is yet to be determined. No definite beneficial result could be attributed to any of a variety of modalities of immune stimulation therapy.

Minimizing radiation exposure in dental radiology

Rectangular field collimation gives high quality roentgenograms and reduces unnecessary exposure of radiation to the patient by 73-96 per cent.