Clinicopathologic studies in childhood pancreatitis

In a review of pediatric autopsies from 1951 to 1985, we identified 40 cases in which pancreatitis was diagnosed pathologically. Twenty-six of these patients were under 4 years of age, and the male-to-female ratio was 1.5. Six groups of patients were identified: 10 with hepatobiliary disease, including 9 with biliary atresia; 7 with immunosuppressive therapy for tumors (n = 2), leukemia (n = 4) and aplastic anemia (n = 1); 6 with viral infections; 8 with congenital anomalies, including congenital heart disease (n = 3); and 9 with miscellaneous problems. Several patients had surgery and various intercurrent complications. Clinical features attributable to the pancreatitis included vomiting or excessive nasogastric drainage (60%), pleural effusions (40%), and abdominal pain (25%). However, the diagnosis was suspected clinically in only 5 of 40 patients. Our findings suggest several pathogenic mechanisms exist for childhood pancreatitis: biliary obstruction, infections, drug toxicity, immunosuppression (acting in synergy with drug toxicity, trauma, and low-flow states resulting from shock, heart failure, and vasculopathy.

High-performance liquid chromatography of amino acids, peptides and proteins. LXXXIV. Application of derivative spectroscopy to the study of column residency effects in the reversed-phase and size-exclusion liquid chromatographic separation of proteins

The influence of column residency times on the reversed-phase gradient elution behaviour of human and bovine growth hormones has been investigated using on-line photodiode array spectroscopic detection. Stationary phase induced effects on protein conformation were monitored by changes in the maxima to minima ratio of the second derivative spectrum of the eluted protein. Significant changes in the second derivative ratio of the unmodified and the fully reduced and alkylated protein were observed following long incubation times, i.e. t(dwell) greater than 15 min, at the stationary phase surface in the presence of 0.1% trifluoroacetic acid before elution with a 0-75% aqueous acetonitrile gradient. The application of multi-wavelength detection in the study of equilibrium unfolding of growth hormones in urea by size-exclusion chromatography was also investigated. On-line photodiode array instrumentation and derivative spectra rationing was employed to monitor tertiary and quaternary structural changes associated with protein denaturation during a chromatographic separation. These studies clearly demonstrate the powerful detection capabilities of such instrumental approaches for the on-line evaluation of both stationary phase surface and/or mobile phase mediated changes in protein conformation.

Hematologic changes occurring with cardiac catheterization

The composition of the blood influences rheology and therefore might affect hemodynamics. During cardiac catheterization and angiography, blood is sampled and contrast media, fluid, and heparin are administered. To determine the effects of these perturbations on the blood cell count and coagulation, femoral vein samples were obtained at the beginning of cardiac catheterization, before heparin, 4,000 U; at the end, before protamine reversal; and after protamine, 40 mg, was administered. At the end of catheterization, 41 +/- 3 min after heparin administration, all cellular constituents were significantly lower than control: White (W) blood cells (BC) were 8.1 +/- 2.7% lower (P less than 0.05), red (R) BC, 10 +/- 1.8% (P less than 0.05), and platelets (P) 10.9 +/- 1.5% (P less than 0.05). Protamine lowered further WBC by 23 +/- 4% (P less than 0.05 and P) by 14 +/- 2% (P less than 0.05), but did not change RBC (4.13 +/- 0.20 x 10(6) to 4.25 +/- 0.23 x 10(6]. Before protamine administration, all patients had a partial thromboplastin time (PTT) 1.5 times the control value and ten of 13 patients had a value greater than 100 sec. Although four of 13 patients had an incomplete reversal of PTT after protamine, none suffered an untoward event. In conclusion, cardiac catheterization produces changes in the cellular composition of the blood, and such changes might influence hemodynamic measurements.

Lack of effect of chronic carbamazepine on brain somatostatin in the rat

We investigated the effects of chronic carbamazepine treatment in rats on brain somatostatin. Following 12 days of carbamazepine treatment, no changes in somatostatin levels were found in any of the brain areas examined which included: amygdala, hippocampus, caudate-putamen, median eminence, arcuate nucleus, nucleus accumbens, nucleus interstitialis of the stria terminalis, nucleus periventricularis, parietal cortex, and occipital cortex. Thus, carbamazepine in low doses does not affect basal levels of brain somatostatin in the rat, in contrast to the previous reports of decreased somatostatin in the cerebrospinal fluid of affectively ill patients.

Urinary digoxin-like immunoreactive substance in pregnancy. Relation to urinary electrolytes

High concentrations of digoxin-like immunoreactive substance (DLIS) have been identified in amniotic fluid and in blood during pregnancy. In this study, urine from healthy women was analyzed for DLIS during pregnancy and following delivery, and levels were related to various clinical and urinary findings. Urinary DLIS increased progressively during pregnancy, having a linear relation to gestational week (DLIS = 0.032 week + 0.46, Syx = 0.52, r = 0.46, p less than 0.01), and fell to nonpregnant values during the first postpartum day. The urinary DLIS level correlated with urinary creatinine (r = 0.50, p less than 0.01) and urinary calcium (r = 0.56, p less than 0.01) levels. When adjusted for the gestational week, the urinary DLIS level also correlated with urinary potassium (r = 0.48, p less than 0.01), creatinine (r = 0.55, p less than 0.01), and magnesium (r = 0.55, p less than 0.01) levels. After adjustment for the urinary creatinine level, only the relation of urinary DLIS and urinary calcium levels remained significant (r = 0.44, p less than 0.05). The urinary DLIS level was not found to be related to systemic blood pressure. The ratios of sodium to potassium (r = -0.43, p less than 0.05) and calcium to magnesium (r = 0.37, p less than 0.05) were also related to gestational week but were independent of the urinary DLIS level. Thus, urinary DLIS increases progressively during pregnancy and falls to nonpregnant values on the first postpartum day, the urinary DLIS level can be related to urinary creatinine, urinary potassium, and urinary magnesium levels, and when adjusted for the urinary creatinine level, the urinary calcium level relates independently to the urinary DLIS level.

[A rare cause of heart failure: hypocalcemic cardiopathy]

In this paper, the authors present the case of hypocalcemic cardiopathy observed in a female patient who underwent thyroidectomy which was complicated post-operatively by the development of hypoparathyroidism. Two attacks of heart failure experienced by this patient were improved by the administration of calcium in combination with digitalis treatment. A study of cases published in the medical literature reveals that this condition is a rare cause of heart failure which develops only in the course of chronic hypocalcemia, with few neuromuscular clinical manifestations. The dual negative inotropic and hypovolemic effects caused by hypocalcemia explain the efficacy observed with the administration of calcium therapy, while the usual symptomatic treatment of this condition is inadequate.

[Surgical treatment of hepatoma on a cirrhotic liver]

From January 1, 1975 to July 1, 1984, 37 patients with a tentative diagnosis of hepatocarcinoma on cirrhosis were operated upon. There were 34 men and 3 women, aged from 32 to 82 years (mean: 60 years). The diagnosis of cirrhosis rested either on a history of liver failure associated with clinical and biochemical signs of hepatocellular dysfunction (4 cases), or on a positive liver biopsy (5 cases). In 20 cases the diagnosis was suspected on account of abnormal liver function tests, but in 8 patients it was revealed by macroscopic examination of the liver during surgery. Cirrhosis was attributed to chronic alcoholism in 25 cases, haemochromatosis in 11 cases and positive HBs antigen in 7 cases. The diagnosis of hepatocarcinoma, suggested by altered general condition or recent pain, rested on the finding of a tumoral image at scintigraphy (16 cases), ultrasonography (19 cases), computed tomography (7 cases), arteriography (17 cases) or laparoscopy (7 cases). In only 7/32 patients was the alpha-foetoprotein level higher than 500 ng/l. Surgery confirmed the diagnosis of hepatocarcinoma in every case but that of cirrhosis in only 14/37 cases; 10 patients had lesion of hepatic fibrosis and 1 had regenerative nodular hyperplasia. In 10 cases no accurate histological diagnosis could be made since the liver tissue sample had been taken too close to the tumour. The finding of normal liver tissue shows that one should not refrain from operating merely because the diagnosis of cirrhosis rests on clinical grounds. Since 1979, surgical treatment consists in an attempt to excise the tumour. Per-operative mortality is the same with excision surgery (21%) as with exploratory or palliative surgery (17%). Fourteen excisions were performed (i.e. aresectability rate of 38% for the series): 2 liver transplantations, 2 right hepatectomies, 2 left hepatectomies, 2 left lobectomies, 2 bisegmentectomies and 3 tumorectomies. The survival rate of 2 years was 27%, as opposed to 5% with exploratory or palliative surgery. Systematic monitoring of cirrhosis with ultrasonography should result in early diagnosis of hepatocarcinoma at a stage where limited hepatic excision is possible and the chances of surviving are highest.

Use of an antibody to characterize and determine the role of the major Met-tRNAf deacylase from rabbit reticulocyte ribosomes

Inhibition of polypeptide chain initiation in rabbit reticulocyte lysate by phosphorylation of eukaryotic initiation factor-2(alpha) results, secondarily, in the enzymatic deacylation of Met-tRNAf on the 48 S initiation complexes that accumulate. We have prepared an antibody to a highly purified preparation of the major Met-tRNAf deacylase activity on rabbit reticulocyte ribosomes, termed deacylase II. Antibody, but not similarly purified normal IgG, completely neutralizes the activity of Met-tRNAf deacylase II and has no effect on Met-tRNAf deacylase I, a separate, minor, reticulocyte activity with the same substrate specificity but very different physical and enzymatic properties, strongly suggesting that deacylase I and II are distinct proteins. We partially purified Met-tRNAf deacylase activities from rabbit liver, myocardium and bone marrow ribosomes and found them to be similar to each other and to reticulocyte deacylase I in their enzymatic properties and insensitivity to anti-deacylase II, suggesting that deacylase I may be a general form of this enzyme, present in many cells, while deacylase II may be induced specifically during erythroid differentiation. Addition of the antibody to reticulocyte lysate incubated in the absence of hemin or presence of hemin plus 0.1 microgram/ml poly(I X C) did not reverse the inhibition of protein synthesis but did reduce the rate of turnover/utilization of Met-tRNAf and increase the level of Met-tRNAf bound to 48 S initiation complexes, demonstrating that the deacylase does not directly inhibit protein synthesis under these conditions but does mediate the deacylation, loss, and thus greater than expected turnover of Met-tRNAf in the 48 S complexes that accumulate.

Quantification of cerebral infarct size by creatine kinase BB isoenzyme

Creatine Kinase BB isoenzyme (CKBB) has been shown to rise in the serum and CSF following acute cerebral injury. To test the hypothesis that brain infarct size could be estimated from the appearance and disappearance of CKBB in the serum and CSF, strokes of varying size were produced in twelve mongrel dogs by silastic emboli. The rate of disappearance, Kd of CKBB (-.00732 +/- 0.001 min-1 mean +/- SE, N = 8) was determined by injecting purified CKBB (25 IU) intravenously then measuring its disappearance. Following the embolic stroke, serum samples were taken hourly for 24 hours and then at intervals for up to 160 hours for measurement of CKBB by radioimmunoassay until the animals were sacrificed. The brains were then removed, fixed in formalin, cut in 2 mm sections and photographed. The area of the infarct was measured using high pad digitizer interfaced with an Apple computer. The infarct size was then calculated from the area and thickness. Using a one-compartment mathematical model, the infarct size was estimated from the amount of CKBB appearing in the serum, the Kd of CKBB, and the amount of CKBB depleted from tissue. The computed infarct size correlated well (r = 0.94) with the measured infarct size. This model may have value in testing therapeutic modalities in the intact animal.

Analyses of vegetables from the highlands of Papua New Guinea

Ten vegetable foods of the highlands were analysed for crude protein, amino acids and trypsin inhibitor. Pandanus nut, lima bean, fern, greens, pitpit and choko had good to acceptable crude protein contents and the proteins of fern, pitpit, Rungia klossii and Indian mustard were of good quality. Lima beans had a very high content of trypsin inhibitor and all others had small or zero amounts, including fern, which is used at pig feasts and hence does not contribute to pig bel.

Comparison of improved precipitation methods for quantification of high-density lipoprotein cholesterol

We compared the standard Lipid Research Clinics heparin-Mn2+ (46 mmol/L) method and five improved precipitation methods for quantification of high-density lipoprotein (HDL) cholesterol. Three of these methods--a dextran sulfate-Mg2+ procedure, reported as a Selected Method, a modified heparin-Mn2+ (92 mmol/L) method, and a modified phosphotungstate-Mg2+ procedure--all gave similar results. Three other methods--the standard heparin-Mn2+ (46 mmol/L) method and two polyethylene glycol methods (75 g/L or pH 10 reagent at 100 g/L final concentrations)--gave slightly higher values for HDL cholesterol. Addition of NaCl or glucose to specimens did not significantly change protein precipitation. In terms of sedimentation effectiveness with hypertriglyceridemic specimens, the methods were ranked in the following order: polyethylene glycol (pH 10, 100 g/L) greater than dextran sulfate-Mg2+ greater than heparin-Mn2+ (92 mmol/L) = polyethylene glycol (75 g/L) greater than phosphotungstate-Mg2+ greater than heparin-Mn2+ (46 mmol/L).

Comparison of improved precipitation methods for quantification of high-density lipoprotein cholesterol

We compared the standard Lipid Research Clinics heparin-Mn2+ (46 mmol/L) method and five improved precipitation methods for quantification of high-density lipoprotein (HDL) cholesterol. Three of these methods--a dextran sulfate-Mg2+ procedure, reported as a Selected Method, a modified heparin-Mn2+ (92 mmol/L) method, and a modified phosphotungstate-Mg2+ procedure--all gave similar results. Three other methods--the standard heparin-Mn2+ (46 mmol/L) method and two polyethylene glycol methods (75 g/L or pH 10 reagent at 100 g/L final concentrations)--gave slightly higher values for HDL cholesterol. Addition of NaCl or glucose to specimens did not significantly change protein precipitation. In terms of sedimentation effectiveness with hypertriglyceridemic specimens, the methods were ranked in the following order: polyethylene glycol (pH 10, 100 g/L) greater than dextran sulfate-Mg2+ greater than heparin-Mn2+ (92 mmol/L) = polyethylene glycol (75 g/L) greater than phosphotungstate-Mg2+ greater than heparin-Mn2+ (46 mmol/L).

Primary structure of the soybean nodulin-23 gene and potential regulatory elements in the 5'-flanking regions of nodulin and leghemoglobin genes

The nodulin-23 gene of soybean is one of the most abundantly transcribed genes induced during symbiosis with Rhizobium. Using a plasmid (pNod25) from a nodule cDNA library, we have isolated the nodulin-23 gene from a soybean genomic library. Nucleotide sequence analysis of the cDNA and of the genomic clone indicated that the coding region of this gene is 669 bp long and is interrupted by a single intron of about 530 bp. The deduced protein sequence suggests that nodulin-23 may have a signal sequence. The 5'-flanking sequence of two other nodulin genes, nodulin-24 encoding for a membrane polypeptide and one of the leghemoglobin genes (LbC3), were obtained. Comparison of these sequences revealed three conserved regions, one of which, an octanucleotide (GTTTCCCT), has 100% homology. The conserved sequences are arranged in a unique fashion and have a spatial organization with respect to order and position, which may suggest a potential regulatory role in controlling the expression of nodulin and leghemoglobin genes during symbiosis.

Drug distribution in solid tissue of the brain following chronic local perfusion utilizing implanted osmotic minipumps

Surgically implanted osmotic minipumps were used to apply dye or [3H]-muscimol locally to the nucleus ventralis lateralis or globus pallidus of the cat. Extent of distribution of dye or radioactivity was measured from the site of application. A uniform distribution (1.2-2.5 mm) of dye or radioactivity was found lateral, ventral, and posterior to the perfusion site. Distribution dorsal to the perfusion site (2.5-7.5 mm) is complicated by infiltration into areas damaged by the implanted cannula. Anterior distribution (approximately 5 mm) was extensive, apparently as a result of the dye or labeled compound entering major tracts or projection pathways. This study demonstrates that with the appropriate precautions, distribution of drug following perfusion into solid tissue of the brain can be restricted to a localized area. However, our results also suggest that the neuroanatomical features of the chosen area (and surrounding area) may play a significant role in altering the pattern and extent of drug distribution.

Mechanisms of glucocorticoid hormone action

This work summarizes some of our studies of the mechanisms of glucocorticoid action, including aspects of steroid binding to receptors, the activation of glucocorticoid-receptor complexes and the regulation of expression of endogenous and transferred glucocorticoid-responsive genes. Studies of the receptor-steroid interaction support the notion that steroid entry is passive. A comparative analysis of binding in isolated cytosol and intact cells suggests that the initial receptor-steroid binding reaction and not subsequent steps such as activation and nuclear binding, is predominantly responsible for the high-affinity state that is generated. The binding is driven by entropy and enthalpy changes at low temperature; at higher temperatures it is driven by entropy changes, with enthalpy working against it. Studies of the activation of the receptor-glucocorticoid complex with the use of highly purified receptors suggest that this step is associated with a change in charge of the receptor-glucocorticoid complex (such as would occur with a dephosphorylation reaction), whereas the data do not support the notion that dissociation of a bound RNA or of receptor oligomers is responsible for generating the nuclear- and DNA-binding activity of the complex. Studies of the regulation by glucocorticoids of expression of the endogenous rat growth hormone (rGH) gene in cultured rat pituitary tumor (GC, GH3D6) cells suggest that glucocorticoids increase the expression of this gene by multiple mechanisms. First, there is a modest direct stimulation of transcription by a mechanism(s) that does not depend on protein synthesis; however, if the cells have been exposed to thyroid hormone for several hours, the steroid exerts a much greater increase in rGH pre-mRNA levels. Secondly, the steroid appears to stimulate some relatively stable function or functions that increase the ability of thyroid hormone to increase rGH levels. Thirdly, the steroid probably increases rGH mRNA stability, since the fold-increases in rGH mRNA exceed those of transcription. Finally, the steroid may, by unknown mechanisms, affect rGH mRNA polyadenylation. The gene transfer experiments utilized the rat and human (h) GH genes and hybrid genes containing either rGH and Herpes Simplex virus thymidine kinase (TK) gene sequences or the human metallothionein-IIA (hMT-IIA) and TK gene sequences. The steroid was found to regulate hMT-IIA gene expression in all glucocorticoid-responsive cell types tested by actions on its 5'-flanking DNA. By contrast, the glucocorticoid regulated GH gene expression in some but not all glucocorticoid-responsive cell types.(ABSTRACT TRUNCATED AT 400 WORDS)

Dopamine stimulates somatostatin release from perifused hypothalamic cells

We studied the release of immunoreactive somatostatin (IR-SRIF) from hypothalamic cells that were obtained from rats and dispersed with the aid of collagenase. Twenty-four hours after dispersion, cells were placed in a column supported by a matrix of preswollen Biogel P2 and perifused. Fractions were collected on ice and subsequently assayed for SRIF. SRIF release was stimulated markedly by potassium depolarization (KCl, 56 mM), by the Na+-K+-ATPase inhibitor ouabain (10(-4) M), and by dopamine at concentrations as low as 10(-11) M. The stimulatory effects of membrane depolarization were calcium dependent and were not observed in the absence of exogenous calcium in the perifusion medium or in the presence of EDTA (0.05 M). Metoclopramide, the dopamine antagonist, abolished the stimulatory effect of dopamine. In conclusion, release of IR-SRIF by dispersed rat hypothalamic cells can be studied in a simple perifusion apparatus. Release is stimulated by membrane depolarization in a calcium-dependent manner and by dopamine at physiological concentrations.

Modulation of myocardial cyclic AMP and vulnerability to fibrillation in the rat heart

In the isolated rat heart, changes in the ventricular fibrillation threshold (VFT) relate to the myocardial cyclic AMP content rather than to the high-energy phosphate content. After coronary ligation the reduction in VFT correlates with the increase in ischemic tissue cyclic AMP. Agents that reduce the myocardial cyclic AMP (propranolol, 16 microM in perfusate, or amiodarone, 42 microM/kg pretreatment) prevent the postligation fall of the VFT without altering high-energy phosphate depletion. Conversely, theophylline (500 microM), which increases cyclic AMP in ischemic myocardium, causes a greater reduction of VFT without increasing high-energy phosphate depletion. Spontaneous ventricular tachycardia and fibrillation are uncommon in coronary ligated hearts in the first 15 min after ligation (10-20%); these arrhythmias are greatly increased either by reducing the perfusate potassium from 5.9 to 3.0 mM or by pretreating hearts with 1-methyl-3-isobutyl xanthine (10 microM), a cyclic-AMP phosphodiesterase inhibitor. Adenosine (100 microM) antagonizes the increased arrhythmogenesis in both low perfusate potassium and cyclic-AMP phosphodiesterase-inhibited hearts, in the latter without reducing the ischemic tissue cyclic AMP levels. The antiarrhythmic action of adenosine in these hearts is independent of reducing tissue cyclic AMP. Adenosine generated in ischemic myocardium may serve as an endogenous antagonist to the arrhythmogenic action of cyclic AMP.

Antiarrhythmic action of labetalol and its effect on adenine metabolism in the isolated rat heart

Labetalol, a combined alpha- and beta-adrenergic antagonist, was assessed for antiarrhythmic activity in the isolated perfused rat heart. Inclusion of 5.0 and 7.5 mumol/liter labetalol in the perfusate reduced the fall in ventricular fibrillation threshold and eliminated ventricular arrhythmias during the coronary occlusion period of 15 minutes. In treated hearts, levels of high energy phosphates were significantly higher and lactate, adenosine and hypoxanthine levels were lower in ischemic myocardium. Cyclic adenosine monophosphate levels were reduced in uninvolved myocardium (0.31 +/- 0.01 and 0.24 +/- 0.02 versus 0.43 +/- 0.02 nmol/g fresh weight) and in the ischemic myocardium (0.38 +/- 0.02 and 0.34 +/- 0.04 versus 0.65 +/- 0.05 nmol/g) in hearts treated respectively with 5.0 and 7.5 mumol/liter labetalol versus control hearts. When untreated hearts were perfused with 3.0 mmol/liter potassium in perfusate, all had ventricular tachycardia or fibrillation during coronary ligation and developed ventricular fibrillation after reperfusion. Labetalol, 5.0 mumol/liter, reduced ventricular tachyarrhythmias during coronary occlusion and after reperfusion, whereas labetalol, 7.5 mumol/liter, eliminated tachyarrhythmias during occlusion and reperfusion. Labetalol had potent antiarrhythmic activity in the hearts rendered uniformly prone to arrhythmias by perfusion with a low potassium solution.