A carrier state of X-linked juvenile retinoschisis

The carrier state of X-linked juvenile retinoschisis has not been known to be associated with any fundus abnormalities. We report a case where there are funduscopic changes and mild visual acuity changes in one eye of a carrier.

Continuous ambulatory peritoneal dialysis: no longer experimental

Many patients with end-stage renal disease have now been maintained for 5 years or more with continuous ambulatory peritoneal dialysis (CAPD). Viewed initially as an experimental alternative to be used only when hemodialysis was not feasible, CAPD is now seen as the treatment of choice in an increasing number of situations. CAPD is suitable for self-care. The main concern in the early years--peritonitis--is now less frightening and less frequent (one episode occurring every 18 patient-months as compared with every 8 initially), and this has allowed chronic complications of CAPD, such as malnutrition and loss of the peritoneum's capacity for ultrafiltration, to come to light. As would be expected, among patients of advanced age and those who have heart disease or diabetes, survival rates tend to be lower than among other CAPD patients. However, hypertension seems to be more easily controlled, pre-existing anemia can be significantly ameliorated, and young children grow more normally than they do with hemodialysis. Diabetes-related changes in vision stabilize in most CAPD patients, and control of the blood glucose level is good; insulin is administered intraperitoneally. CAPD is thus showing itself to be a feasible form of long-term treatment for end-stage renal disease.

Electron microscopic study of the peritoneal kinetics of iron dextran during peritoneal dialysis in the rabbit

Iron dextran, an electron-dense tracer, was given intravenously (100 mg of iron/100 g of body weight) to 8 normal rabbits to study its movement from the plasma to the peritoneal cavity during peritoneal dialysis. The dialysate infused at 75 ml/kg contained 1.5 g/dl of glucose in 4 animals and 4.25 g/dl in the remainder. Peritoneal dialysis was discontinued and the peritoneum was fixed in vivo at various times (20-120 min) after the injection of the iron dextran. Large amounts of tracer were detected in the effluent after draining the peritoneal cavity. Electron microscopic examination of the mesentery showed particles of iron dextran in the endothelial cells of small vessels (capillaries and venules) the interstitium and the mesothelial cells adjacent to vessels irrespective of the dialysate concentration or duration of dialysis. Tracer was not clearly demonstrated in the interendothelial or intermesothelial spaces. In the mesothelial cells, the particles were found exclusively in (small, elongated or large) vesicles, while in the endothelial cells they were both in vesicles and free in the cytoplasm. Our findings suggest that during the 20- to 120-min period after intravenous administration, the intracellular transport of iron dextran, depends on either moving vesicles or the presence of pre-existing tunnels in the mesothelial cells of rabbit mesentery.

Update on continuous ambulatory peritoneal dialysis

By now many patients have been successfully maintained on CAPD for five years or more, thus demonstrating that CAPD is a viable long-term treatment for end-stage renal disease. Peritonitis--the main concern of the earlier years--is now a less frightening complication. We know better how to treat peritonitis and its incidence has decreased from one episode every 8 months initially to one episode every 18 months now. In addition, several innovations, which have been or soon will be introduced, promise to decrease the frequency of peritonitis to an even lower rate. The problem of peritonitis is now being replaced by the chronic complications of CAPD, predominantly malnutrition and decrease in peritoneal ultrafiltration. CAPD has become an important adjunct in the treatment of children with ESRD, especially the very young. Even though not normal, their growth on CAPD is better than that of children on hemodialysis and as good as that after a successful transplant. CAPD has become a promising treatment for the diabetic with ESRD. This experience has stimulated interest and research in the role of intraperitoneal administration of insulin for blood glucose control. With the present worldwide experience of CAPD, this treatment has ceased to be experimental. A percentage of patients requiring dialysis will be better off on CAPD than on hemodialysis. Even though this percentage will vary among various countries, the nephrologist who wants to provide the best treatment for each patient must be well experienced in and have all treatments at his disposal including CAPD.

Perichondrial arthroplasty in the hand: a case report

A two-stage arthroplasty technique was used to treat an isolated fibrous ankylosis that developed in the index metacarpophalangeal joint of a 14-year-old boy after a rattlesnake bite. The first stage consisted of a minimal joint resection combined with rib perichondrial grafts to resurface the joint. The second stage, performed 5 months later, consisted of a capsulotomy and removal of a silicone membrane left within the joint to separate the grafts. Biopsy of the joint surfaces revealed the presence of hyaline-like cartilage. Nearly normal pain-free motion was restored. Follow-up now exceeds 30 months.

Arrangement of lambda light chain genes in mutant clones of the MOPC 315 mouse myeloma cells

The synthesis of lambda light chains and the arrangement of the lambda-chain genes was examined in cells of the mouse myeloma MOPC 315, which is an alpha lambda 2 producer, and in several mutants derived from it. The mutants produce lambda 2 chains only (MOPC 315.26, MOPC 315.34, and MOPC 315.37) or fail to produce alpha and lambda 2 chains (MOPC 315.25 and MOPC 315.36). Messenger RNA from the lambda 2 chain-producing cells directed the synthesis of a lambda 2 chain precursor and a fragment of the lambda 1 chain (lambda 1 F) in a wheat embryo cellfree system, whereas mRNA from the cells that do not produce lambda 2 chains directed the synthesis of lambda 1 F only. DNA from the parental MOPC 315 cells and from the lambda 2 chain-producing cells contained discrete EcoRI restriction fragments coding for rearranged lambda 1 and lambda 23 chain genes and their respective germ-line V and J-C regions. DNA from the no-Ig-producing cells contained fragments coding for the rearranged lambda 1 chain gene and the germ-line V lambda 2 region, but it lacked the sequences coding for the rearranged lambda 2 chain gene and the germ-line V lambda 1 and J-C lambda 1 regions. These results suggest that rearrangements of the lambda 1 and lambda 2 chain genes occur on different chromosomes in MOPC 315 cells and imply that rearrangements of the lambda 1 and lambda 2 chain genes on the same chromosome may be mutually exclusive.

Arrangement of lambda light chain genes in mutant clones of the MOPC 315 mouse myeloma cells

The synthesis of lambda light chains and the arrangement of the lambda-chain genes was examined in cells of the mouse myeloma MOPC 315, which is an alpha lambda 2 producer, and in several mutants derived from it. The mutants produce lambda 2 chains only (MOPC 315.26, MOPC 315.34, and MOPC 315.37) or fail to produce alpha and lambda 2 chains (MOPC 315.25 and MOPC 315.36). Messenger RNA from the lambda 2 chain-producing cells directed the synthesis of a lambda 2 chain precursor and a fragment of the lambda 1 chain (lambda 1 F) in a wheat embryo cellfree system, whereas mRNA from the cells that do not produce lambda 2 chains directed the synthesis of lambda 1 F only. DNA from the parental MOPC 315 cells and from the lambda 2 chain-producing cells contained discrete EcoRI restriction fragments coding for rearranged lambda 1 and lambda 23 chain genes and their respective germ-line V and J-C regions. DNA from the no-Ig-producing cells contained fragments coding for the rearranged lambda 1 chain gene and the germ-line V lambda 2 region, but it lacked the sequences coding for the rearranged lambda 2 chain gene and the germ-line V lambda 1 and J-C lambda 1 regions. These results suggest that rearrangements of the lambda 1 and lambda 2 chain genes occur on different chromosomes in MOPC 315 cells and imply that rearrangements of the lambda 1 and lambda 2 chain genes on the same chromosome may be mutually exclusive.

The demonstration of lymphatic channels on wrist arthrography in rheumatoid disease with particular reference to associated lymphoedema

Delineation of lymphatic vessels is a frequent finding in arthrograms of rheumatoid joints. Arthrography of the rheumatoid wrist when associated with oedema of the upper limb reveals a characteristic pattern consistent with lymphatic obstruction. In our opinion, these findings may be regarded as further evidence in favour of lymphatic obstruction as the cause of peripheral oedema in rheumatoid arthritis. The syndrome appears to be a separate entity from idiopathic oedema of women.

Hyphema in the newborn: report of a case

This is a case report of an anterior chamber hemorrhage noted two days after spontaneous delivery in a full-term infant with perinatal asphyxia. There was probably vitreous hemorrhage in the same eye and extensive retinal hemorrhages in both eyes. By two weeks, the hyphema and vitreous hemorrhage had resolved and the retinal hemorrhages largely cleared.

Bilirubin mono- and diglucuronide formation by human liver in vitro: assay by high-pressure liquid chromatography

Bilirubin diglucuronide, the major pigment in human bile is formed in two steps. Bilirubin is converted to bilirubin monoglucuronide by transfer of the glucuronosyl moiety of uridine diphosphoglucuronic acid catalyzed by the microsomal enzyme, uridine diphosphoglucuronate glucuraonosyl transferase (UDP glucuronyl transferase, EC 2.4.1.17). Bilirubin monoglucuaronide is converted to bilirubin diglucuronide in vitro by two enzymatic mechanisms: (a) UDP glucuronyl transferase-mediated transfer of a second mole of glucuronic acid form UDP-glucuronic acid to bilirubin monoglucuronide; (b) dismutation of 2 moles of bilirubin monoglucuronide to 1 mole of bilirubin diglucuronide and 1 mole of unconjugated bilirubin, catalyzed by bilirubin monoglucuronide dismutase (bilirubin glucuronoside glucuronosyl transferase EC 2.4.1.95). Assay methods for the three enzymatic mechanisms in human liver homogenate by high-pressure liquid chromatography analysis of underivatized bilirubin tetrapyrroles have been developed. UDP glucuronyl transferase was activated in five human liver homogenates with digitonin, Triton X-100, or UDP-N-acetylglucosamine. Greatest activation was observed with Triton X-100. The pH optimum for conversion of bilirubin to bilirubin monoglucuronide was 7.4, and UDP glucuronyl transferase activity was 625 +/- 51 nmoles per 20 min per gm liver. At high initial bilirubin concentrations (342 microM), the product of UDP glucuronyl transferase assay with bilirubin as substrate was predominantly bilirubin monoglucuronide. At lower initial bilirubin concentrations (6.5 to 34 microM), up to 15% bilirubin diglucuronide was formed. Glucuronyl transferase-mediated UDP glucuronic acid-dependent conversion of bilirubin monoglucuronide to diglucuronide was assayed using UDP-14-C-glucuronic acid. The pH optimum was 7.4, and the rate was 21 +/- 7 nmoles per gm liver per 20 min. The rate of bilirubin diglucuronide formation by enzymatic dismutation of bilirubin monoglucuronide was 470 +/- 112 nmoles per gm liver per min. The pH optimum was 6.6. The products of enzymatic dismutation were of the IX alpha configuration.

THe hazards of injecting local anesthetic solutions with epinephrine into flaps: experimental study

In a study using paired longitudinal flaps on the back of the rat, we found evidence to support the findings of previous investigators regarding the toxic effects of injecting local anesthetic solutions containing epinephrine into delayed flaps. Epinephrine concentrations of 1:200,000 and 1:400,000 were demonstrated to significantly increase losses in these flaps. Epinephrine concentrations of 1:100,000, 1:200,000, and 1:400,000 were not demonstrated to be harmful to undelayed flaps, in the dosages used.

Auxin increases the hydraulic conductivity of auxin-sensitive hypocotyl tissue

The ability of water to enter the cells of growing hypocotyl tissue was determined in etiolated soybean (Glycine max (L.) Merr.) seedlings. Water uptake was restricted to that for cell enlargement, and the seedlings were kept intact insofar as possible. Tissue water potentials (ψ w) were measured at thermodynamic equilibrium with an isopiestic thermocouple psychrometer. ψ wwas below the water potential of the environment by as much as 3.1 bars when the tissue was enlarging rapidly. However, ψ w was similar to the water potential of the environment when cell enlargement was not occurring. The low ψ w in enlarging tissue indicates that there was a low conductivity for water entering the cells.The ability of water to enter the enlarging cells was defined as the apparent hydraulic conductivity of the tissue (L'p). Despite the low L'p of growing cells, L'p decreased further as cell enlargement decreased when intact hypocotyl tissue was deprived of endogenous auxin (indole-3-acetic acid) by removal of the hypocotyl hook. Cell enlargement resumed and L'p increased when auxin was resupplied exogenously. The auxin-induced increase in L'p was correlated with the magnitude of the growth enhancement caused by auxin, and it was observed during the earliest phase of the growth response to auxin. The increase in L'p appeared to be caused by an increase in the hydraulic conductivity of the cell protoplasm, since other factors contributing to L'p remained constant. The rapidity of the response is consistent with a cellular site of action at the plasmalemma, although other sites are not precluded.Because the experiments involved only short times, auxin-induced changes in cell enlargement could not be attributed to changes in cell osmotic potentials. Neither could they be attributed to changes in turgor, which increased when the rate of enlargement decreased. Rather, auxin appeared to act by altering the extensibility of the cell walls and by simultaneously altering the ability of water to enter the growing cells under a given water potential gradient. The hydraulic conductivity and extensibility of the cell walls appeared to contribute about equally to the control of the growth rate of the hypocotyls.

Velopharyngeal incompetence without overt cleft palate. A collective review and experience with 98 patients

Our experience in patients with velopharyngeal incompetence but without overt cleft palate is described, and the literature is reviewed.