The Hermansky-Pudlak syndrome. Evidence for a lowered 5-hydroxytryptamine content in platelets of heterozygotes

A Dutch kindred with the Hermansky-Pudlak syndrome (HPS) is described. We show for the first time evidence of a lowered platelet 5-hydroxytryptamine content in obligate heterozygotes. Platelet ATP and ADP levels and ATP/ADP ratio were normal in these patients. Platelet aggregation with ADP, collagen and adrenaline was within the normal range. In contrast to the homozygous HPS patients the heterozygotes are normally pigmented and none has diaphanous irides, nystagmus or a bleeding tendency. All homozygous HPS patients have the typical triad of oculocutaneous albinism, pigmented macrophages in the bone marrow and a bleeding disorder, based on a platelet dysfunction. The platelets showed the typical characteristics of a storage pool deficiency. Their platelet factor 3 availability was decreased and the aggregation patterns showed an absent second wave with ADP, adrenaline and absent collagen aggregation. Platelet ADP levels were strongly decreased in all homozygous HPS patients, whereas ATP was lowered only in 3 out of 6 HPS patients. The 5-hydroxytryptamine content of their platelets was very low (15-20% of normal).

Toxic psychosis due to cyproheptadine in a child on hemodialysis: a case report

In 1971 Simmons et al. presented evidence that children receiving regular dialysis therapy required approximately seventy percent of recommended caloric intake to achieve normal growth. Since that time, pediatric nephrologists and dietitians have strived to meet that requirement. In an effort to attain adequate caloric intake, cyproheptadine, a known appetite stimulant, was prescribed to a child on chronic hemodialysis. The following reports the unexpected complication of toxic psychosis that resulted.

Murray Valley encephalitis in Australia, 1974: antibody response in cases and community

Fifty-three patients accepted on clinical grounds as cases of Murray Valley encephalitis (MVE) in Australia in 1974 were examined for antibody to MVE virus. Only one (who died early in the disease and whose diagnosis was confirmed by virus isolation) did not develop antibody; 13 patients showed stationary or single convalescent titres not diagnostic of recent infection, but other evidence that infection was recent was obtained in eight; 39 showed significant rise or fall in titre confirming recent infection. Haemagglutination-inhibition (HI) was more effective in establishing a diagnosis than complement-fixation (CF) although both tests were of value. Patients varied widely in timing and magnitude of rise and fall of titre. Two showed late rises in antibody titre which raises the possibility of recrudescent persisting infection. CF titres were enhanced in some sera by increase in the number of units of antigen used and by inactivation at 56 degrees C rather than 60 degrees C. Five patients with clinically-acceptable diagnoses of MVE (and one with minor illness) showed higher HI titres to Kunjin than to MVE virus. The results in several cases suggest that Kunjin virus was the infecting agent. In others it is possible that MVE infection had occurred in patients with pre-existing Kunjin antibody. HI reactivity to MVE virus was found in IgM fractions of sera taken for at least 40 days and in some cases for over 100 days after onset of symptoms. IgM fractions gave similar titres to MVE and Alfuy virus but clearly distinguished MVE-Alfuy and Kunjin viruses. HI antibody to MVE virus was found in about 10% of sera from family contacts or neighbours of patients with encephalitis, and in a similar proportion of patients in Victoria with various febrile illnesses not accepted as MVE. One patient with minor illness had antibody response to Kunjin virus. 2589 sera from pathology laboratories in towns in the Murray Valley gave additional evidence of community immunity to flaviviruses and suggested some increase in the proportion reactive between January and May 1974. HI and plaque reduction tests on these sera also gave evidence of antibody to Kunjin virus in the Murray Valley.

A possible role for cyclic nucleotides in the regulation of erythrocyte shape and permeability

Erythrocytes treated with vinblastine or colchicine become spheroidal, more permeable to sodium, and of diminished deformability; upon reinjection they are rapidly sequestered and destroyed in the spleen. These deleterious effects are competitively inhibited by the cyclic nucleotides, guanosine 3',5'-monophosphate or adenosine 3',5'-monophosphate. The data suggest that cyclic nucleotides may be involved in normal erythrocyte shape and survival by interacting with membrane components that also react with vinblastine and colchicine. Similar interactions have been noted previously in diverse proliferating cells as well.

Disulfiram implantation: placebo, psychological deterrent, and pharmacological deterrent effects

In an effort to examine the placebo, psychological deterrent, and pharmacological deterrent effects associated with implanted disulfiram, subjects were given either disulfiram implants or sham operations. Ethanol challenges elicited no disulfiram-ethanol reactions (DERs), indicating that at the time of the challenge neither a pharmacological deterrent nor a placebo effect was operating. Of the patients who resumed drinking, only those with disulfiram implants experienced DERs. Sham operation subjects continued to drink after their first post-challenge drink; four of five disulfiram implant recidivists remained abstinent following their experience of a DER. It is concluded that the pharmacological deterrent effect of the disulfiram implant may have been underestimated in previous reports.

Disulfiram-ethanol reaction to implanted disulfiram

It is postulated that a recent suggestion that the disulfiram implant technique is not pharmacologically effective may be premature. Some literature is cited in support of this contention, and three case histories of disulfiram implant patients who experienced disulfiram-ethanol reactions when they recommenced drinking are reported. It is suggested that the disulfiram-ethanol reactions to implanted disulfiram may be delayed in onset and of longer duration than those obtained from orally-administered disulfiram. Possible mechanisms are discussed.

Computer-stored faculty publication file using the MT/ST in a medium-sized medical center library

The Bowman Gray School of Medicine Library has implemented a computerized faculty publication file adapted from an existing system that utilized a Magnetic Tape/Selectric Typewriter for catalog card production and computer storage. The faculty publication file has provided printouts for the school's annual report and monthly faculty bulletins. After the data for all faculty bibliographies have been stored in the file, it will be possible to retrieve complete author and departmental listings. The file will be continuously updated by adding current citations and the bibliographies of new faculty members and by deleting data when faculty members leave the staff.

Bimanual, bipolar intraocular diathermy

We performed bimanual, bipolar intraocular diathermy by using a No. 22 disposable needle and a vitrectomy instrument. The technique required a smaller wound than unimanual bipolar cautery and was combined with membrane peeling techniques. The bipolar technique limited the extent of coagulation effects better than unipolar diathermy methods.

The clinician's view of diagnostic electron microscopy

From the clinician's standpoint, it has become increasingly evident that use of the electron microscope should no longer be confined to research institutes, but should be applied as an adjunct to clinical diagnosis, a guide to therapy, and a means of elucidating pathogenetic mechanisms. The usefulness of electron microscopy is stressed in relation to hematology, nephrology, virology, gastroenterology, and the study of miscellaneous metabolic conditions such as the storage diseases.

The smell of cancer

A middle aged man presented reluctantly to his General Practitioner with the complaint of offensive body odour and he was referred for a dermatological opinion. On examination a malignant looking ulcer emitting a foul odour was found in the site of his penis.

An oxygen enrichment attachment for use with humidified air

Jebson, P., Dewar, J., and White, J. (1974).Thorax, 29, 371-376. An oxygen enrichment attachment for use with humidified air. An oxygen enrichment attachment is described which fulfils the basic requirements for intubated patients. Using values for tidal volume and inspiratory time found in the type of patients for whom the attachment is intended, a range of mean inspired oxygen concentration has been given for 2, 4, 6, 8, and 10 1/min oxygen flow.

Lithogenic bile in patients with ileal dysfunction

Ileal disease or resection causes bile salt malabsorption and a reduction in the bile salt content of bile. Since cholesterol solubility requires adequate bile salt concentrations, depletion of the bile salt content of bile might, therefore, jeopardize cholesterol solubility and predispose to cholesterol gallstone formation. To study this, we examined biliary lipid composition in 10 patients with ileal dysfunction and in 25 healthy controls. Biliary lipid composition, as analysed in cholecystokinin-stimulated, bile-rich duodenal fluid, was shown to be representative of gallbladder bile and reproducible on repeat duodenal intubation. Nine of the 10 patients with ileal dysfunction had an abnormal, supersaturated bile in which the limits of cholesterol solubility were exceeded, and while nine of 25 control subjects also had an unstable bile, the mean bile composition in the ileal dysfunction group was significantly different from the control population. These studies provide a physicochemical explanation for the clinical observation that patients with ileal dysfunction have an increased incidence of gallstones.