Regulation of HIV replication in infected monocytes by IFN-alpha. Mechanisms for viral restriction

In a survey of 15 different virus isolates, no IFN-alpha or IFN-beta activity was detected in culture fluids of HIV-infected T cells or monocytes. Exogenous rIFN-alpha added to T lymphoblast or monocyte cultures induced restriction in replication of the amphotropic HIV that infect both cell types. With IFN-treated HIV-infected T cells, levels of reverse transcriptase (RT) activity in culture fluids were half those in control cultures, but the frequency of infected cells or the levels of p24 Ag released in culture fluids were unchanged. In contrast to the modest effect of IFN on HIV-infected T cells, IFN-induced antiviral activity in monocytes was quite dramatic. Monocytes treated with IFN at the time of virus challenge showed no evidence of HIV infection: no p24 Ag or RT activity, no viral mRNA, and no proviral DNA. In this system, IFN interrupts one or more early event(s) in the virus replication cycle before formation of proviral DNA. Monocyte cultures infected with HIV 7 days before IFN treatment showed a gradual decrease in levels of p24 Ag and RT activity to baseline by 3 wk. HIV-induced cytopathic changes were markedly reduced, and the frequency of productively infected cells was less than or equal to 1% of total cells. Virus particles released 24 h after IFN treatment were 100- to 1000-fold less infectious than equal numbers of control virions. But, monocytes treated with IFN 7 days after HIV infection were not free of the retroviral pathogen: levels of proviral DNA in the IFN-treated and control HIV-infected cells were indistinguishable. The presence of large quantities of proviral DNA in cells with little or no evidence for active transcription documents a situation approaching true microbiological latency.

[Primary assessment of X-ray images in a casualty department]

During a period of three months, the primary diagnoses made by the duty officer in the casualty department on x-rays taken on patients with orthopaedic conditions were compared with the definitive diagnoses made after a conference with the radiological department. The consequences of possible erroneous diagnoses were also recorded. A total of 634 regions were examined in 555 patients. Incorrect diagnoses were made in 55 regions (8.5%). In 21 of these, alterations in the primary treatment were required. All of the treatments could be corrected by telephone (7) or an additional visit by the patient (14). X-rays of the cranium and the spine are known to be difficult to evaluate by inexperienced doctors. This was also found to be the case in the present investigation.

High-performance liquid chromatography of rat and mouse islet polypeptides: potential risk of oxidation of methionine residues during sample preparation

After preparative high-performance liquid chromatography of mouse islet culture medium, concentrated on disposable C18 cartridges (Sep-Pak), an unexpected insulin immunoreactive peak eluting earlier than mouse insulin I and II was detected. Molecular mass determination by mass spectrometry supported its suspected identity as methionine sulphoxide insulin II. We have examined the formation of Met-O derivatives of insulin II, glucagon and pancreatic polypeptide during sample preparation (Sep-Pak and Speed-Vac concentrating). The oxidation of methionine residues was found to depend very much on the buffer, the organic modifier and the procedure. In particular the use of methanol-trifluoroacetic acid resulted in extensive oxidation. The oxidation could be minimized by adding 2 mM dithiothreitol to the buffer and by degassing and/or nitrogen-bubbling of the buffer. Minimal formation of Met-O derivatives is important for the quantitation of methionine-containing polypeptides.

[Isolated sphenoid sinusitis]

A case of isolated sphenoid sinusitis following an influenza-like illness in a woman aged 34 years is presented. The importance of the diagnosis and treatment is emphasized.

Training physicians about smoking cessation: a controlled trial in private practice

STUDY OBJECTIVE

To test the hypotheses that physicians in private practice who receive a continuing education program (entitled "Quit for Life") about how to counsel smokers to quit would counsel smokers more effectively and have higher rates of long-term smoking cessation among their patients.

DESIGN

Randomized trial with blinded assessment of principal outcomes.

SETTING

Private practices of internal medicine and family practice.

SUBJECTS

Forty-four physicians randomly assigned to receive training (24) or serve as controls (20) and consecutive samples of smokers visiting each physician (19.6 patients per experimental and 22.3 per control physician).

INTERVENTIONS

Physicians received three hours of training about how to help smokers quit. Physicians and their office staffs were also given self-help booklets to distribute to smokers and were urged to use a system of stickers on charts as reminders to counsel smokers about quitting.

MEASUREMENTS AND MAIN RESULTS

Based on telephone interviews with patients, physicians in the experimental group were more likely to discuss smoking with patients who smoked (64% vs. 44%), spent more time counseling smokers about quitting (7.5 vs. 5.2 minutes), helped more smokers set dates to quit smoking (29% vs. 5% of smokers), gave out more self-help booklets (37% vs. 9%), and were more likely to make a follow-up appointment about quitting smoking (19% vs. 11% of those counseled) than physicians in the control group. One year later, the rates of biochemically confirmed, long-term (greater than or equal to 9 months) abstinence from smoking were similar among patients in the experimental (3.2%) and control (2.5%) groups (95% confidence interval for the 0.7% difference: -1.7 to +3.1%).

CONCLUSIONS

The authors conclude that this continuing education program substantially changed the way physicians counseled smokers, but had little or no impact on rates of long-term smoking cessation among their patients. There is a need for more effective strategies to help physicians help their patients to quit smoking.

Home management of URI in children with Down syndrome

There is an increased risk of upper respiratory infection (URI) for the child compromised by Down Syndrome. Nurses can educate parents to care for the child experiencing mild URI without the need for medical intervention.

High-performance liquid chromatofocusing and column affinity chromatography of in vitro 14C-glycated human serum albumin. Demonstration of a glycation-induced anionic heterogeneity

High-performance liquid chromatofocusing of human serum albumin (HSA) after in vitro glycation with purified [14C]glucose has shown that with increasing glycation time a progressive increase in two major anionic fractions (pI 4.8 and 4.65) occurs, while the pI 4.9 fraction decreases in parallel. As early as after 5 days of glycation time, the [14C]glucose content in the anionic fractions was markedly higher than in the pI 4.9 fraction. After 10 and 15 days of glycation, a considerable heterogeneity of 10-15 components could be demonstrated. In addition, phenyl-boronic acid (PBA) affinity chromatography was applied and an enrichment of the more glycated species could be obtained using this method. We conclude that, in contrast to previous reports, glycation of HSA induces anionic heterogeneity (in accordance with the theoretically expected loss of positively charged amino groups) and, although the efficiency in separating non-glycated from monoglycated HSA was found to be very low, an enrichment of these anionic species can be achieved using PBA affinity chromatography.

Training physicians in counseling about smoking cessation. A randomized trial of the "Quit for Life" program

STUDY OBJECTIVE

To test whether physicians who receive a continuing education program ("Quit for Life") about how to counsel smokers to quit would counsel smokers more effectively and have higher rates of long-term smoking cessation among their patients who smoke.

DESIGN

Randomized trial with blinded assessment of principal outcomes.

SETTING

Four health maintenance organization medical centers in northern California.

SUBJECTS

Eighty-one internists assigned by blinded randomization to receive training (40) or serve as controls (41). Consecutive samples of smokers visiting each physician (mean, 25.6 patients per experimental and 25.2 per control physician).

INTERVENTIONS

Internists received 3 hours of training about how to help smokers quit. Physicians and their office staff also were given self-help booklets to distribute free to smokers and were urged to use a system of stickers on charts to remind physicians to counsel smokers about quitting.

MEASUREMENTS AND MAIN RESULTS

On the basis of telephone interviews with patients after visiting the physician, we determined that internists who attended the Quit for Life program discussed smoking with more patients who smoked, spent more time counseling them about smoking, helped more patients set dates to quit smoking, gave out more self-help booklets, and made more follow-up appointments to discuss smoking than did internists in the control group. One year later, the rate of biochemically confirmed, long-term (greater than or equal to 9 months) abstinence from smoking was 1% higher among all patients of trained internists than among patients of controls (95% CI, -0.1% to +2.3%), and 2.2% (+0.2% to +4.3%) higher among the patients who most wanted to quit smoking.

CONCLUSIONS

This continuing education program substantially changed the way physicians counseled smokers. As a result, a few more patients who wanted to quit smoking achieved long-term abstinence.

Leukotrienes. Biology and role in disease

Leukotrienes are a novel group of chemical messengers derived from arachidonic acid. They are produced by several different tissues by processes linked to phospholipid flux in response to specific stimuli. The leukotrienes interact with specific receptors in target cell membranes to initiate a response. Most of these responsive cells are derived from bone marrow, skin, smooth muscle, and vascular endothelium. Leukotrienes are powerful mediators of inflammation and smooth muscle contraction, and there is increasing evidence that they are important factors in immune-mediated disease. Several available effective antiinflammatory drugs may act partially by inhibiting the production of leukotrienes.

Smoking counseling and preventive medicine. A survey of internists in private practices and a health maintenance organization

Physicians could help a large number of patients quit smoking by taking time to advise them about quitting, helping them plan a date to quit, giving them self-help materials, following up, and referring some to smoking cessation programs. To determine the attitudes and practices of internists concerning smoking cessation and selected preventive medical practices, we surveyed a random sample of internists in private practice and in a large health maintenance organization (Kaiser-Permanente Medical Group) in the San Francisco Bay area. Overall, internists consider counseling about smoking to be at least as worthwhile as many other practices, such as screening for breast cancer, and more worthwhile than periodic physical examinations. Despite these beliefs, 57% to 65% of internists reported that they spend two minutes or less counseling smokers during new patient visits. Many internists never use recommended strategies for counseling about smoking: 33% to 44% never help patients plan dates to quit, 68% to 75% never make follow-up appointments with patients primarily about smoking, and 27% to 48% never give smokers self-help pamphlets about quitting. Although they believe that counseling about smoking is worthwhile, internists are not doing as much as they could to help their patients quit.

High-performance liquid chromatographic separation of membrane proteins isolated from erythrocyte ghosts

Membrane proteins extracted from erythrocyte ghosts with sodium dodecyl sulphate (SDS), 3-(3-cholamidopropyl)-dimethylamminopropane sulfonate (CHAPS) or octylglucoside have been analyzed in various reversed-phase high-performance liquid chromatographic systems. Only SDS was able to solubilize considerable amounts of membrane proteins with mol.wt. greater than 15,000 daltons, but these membrane proteins were recovered in poor yield from a silica-based C4 column eluted with an acetonitrile gradient in trifluoroacetic acid (TFA). A resin-based phenyl column eluted with a similar TFA-acetonitrile gradient was found to be a better choice with respect to the recovery of membrane proteins with mol.wt. greater than 15,000 daltons, and when this column was eluted with an acetic acid gradient with increasing amounts of acetonitrile, erythrocyte ghost membrane proteins solubilized in SDS (mol.wt. 10,000-200,000 daltons) were separated in six major and several minor components with satisfactory recovery.

Reversed-phase high-performance liquid chromatographic analyses of insulin biosynthesis in isolated rat and mouse islets

Two RP-HPLC systems were developed for the separation of the products of the conversion of proinsulin into insulin in rat and mouse islets, including proinsulin I and II. Peaks were identified by microsequencing and radiosequencing. It was confirmed that mouse C-peptide I has a two amino acid deletion compared to rat C-peptide I. A marked species difference in the ratio between insulin I and II was observed, i.e., 2:1 in the rat and 1:2 in the mouse. Pulse-chase experiments in rat islets have demonstrated that the ratio between insulin I and II in newly synthesized insulin is higher than that of the stored insulin, indicating a slower conversion rate of proinsulin II compared to proinsulin I.

[Histiocytosis X. Review of the literature and a case report]

Histiocytosis X is a non-lipid reticuloendotheliosis, characterized by histiocyte proliferation. The proliferating cells resemble the Langerhan's cells in the epidermis. The main clinical types include eosinophile granuloma, Hand-Schüller-Christian's disease (HSC) and Letterer-Siwe's disease (LS). Eosinophile granuloma is localized to the skeleton and runs a spontaneously benign course. HSC and LS are serious, generalized conditions. HSC runs a chronic and occasionally lethal course. LS usually runs a rapidly lethal course. LS commences before the age of three years while HSC occurs both in children and young adults. A case of HSC is described.

SS-B/La antigen purification, and ELISA detection of anti-SS-B/La antibodies in sera from patients with inflammatory connective tissue diseases

SS-B/La antigen was purified by immunoadsorbent columns with immunoglobulin from a patient with primary Sjögren's syndrome. Monitoring of the purification was facilitated by the fused rocket-immunoelectrophoresis technique. Technical ELISA variables for the detection of serum antibodies against the SS-B/La antigen were evaluated, and a recommended procedure is described. Prospective investigation of anti-SS-B/La antibodies in 103 blood donors and 131 patients with chronic inflammatory connective tissue diseases, including 43 patients with primary Sjögren's syndrome was performed. Anti-SS-B/La antibody concentrations were above normal in 65% of the patients with primary Sjögren's syndrome (verified by the strictly objective Copenhagen criteria for keratoconjunctivitis sicca and xerostomia) and 9% of patients with other chronic connective tissue diseases. The predictive value for primary Sjögren's syndrome among patients with increased levels of the anti-SS-B/La antibodies attending a rheumatology clinic was 78%.

Effect of low-dose exogenous secretin on pentagastrin- and meal-stimulated gastric acid secretion in humans

Intravenous infusion of secretin in a dose of 0.05 CU/kg/hr inhibited pentagastrin-stimulated (100 ng/kg/hr) acid secretion by 42% (P less than 0.05) abd meal-stimulated (10% peptone, pH 5.5) acid secretion by 33% (P less than 0.05) in 10 healthy subjects. Median serum gastrin concentration during peptone stimulation was reduced by 24% (P less than 0.05) during secretin infusion. Median plasma secretin concentrations were 6.0 and 5.2 pmol/liter, respectively. Since these secretin concentrations are of the same magnitude as those seen after duodenal acidification, it is concluded that secretin may participate in the physiological inhibition of gastric acid secretion.

Internists and nicotine gum

Nicotine gum may be a useful aid to help patients quit smoking. The effectiveness of the gum and incidence of side effects may depend on using the gum properly. To describe internists' current practices of prescribing nicotine gum and other drugs for smoking cessation, we surveyed randomly selected internists. Most internists prescribe nicotine gum to fewer than 25% of patients who try to quit smoking. Contrary to current recommendations, nearly half of internists would suggest gum to help patients cut down on smoking, and a majority would limit its use to less than three months. There is no evidence that sedatives are useful for smoking cessation, but one fourth of internists had recently prescribed them for that purpose. There is a widespread need for physician education about how to use nicotine gum more effectively.

Artificial ventilation and prognostic factors in bacterial meningitis

The use of artificial ventilation in patients with bacterial meningitis was increased from 8.0% of 176 patients admitted in 1966-1968 to 31.5% of 162 patients admitted in 1975-1976. The therapeutic regimen was otherwise unchanged. The fatality rate decreased from 14.2% in the first period to 8.6% in the second, whereas the rate of neurological sequelae increased from 11.3% to 16.9%. A linear logistic model analysis was applied to correct for the influence of factors of known prognostic importance in the two periods, e. g. age, level of consciousness at admission, mode of admission and etiology. The analysis showed a significant 50% reduction in fatality rate (p = 0.05), whereas the corrected rate of neurological sequelae appeared similar in the two periods. Our results suggest that an increased use of respirator treatment may improve the prognosis in bacterial meningitis.

Insulin release by glucagon and secretin: studies with secretin-glucagon hybrids

Secretin and glucagon potentiate glucose-induced insulin release. We have compared the effects of secretin and glucagon with that of four hybrid molecules of the two hormones on insulin release and formation of cyclic AMP (cAMP) in isolated mouse pancreatic islets. All six peptides potentiated the release of insulin at 10 mM D-glucose, and their effects were indistinguishable with respect to the dynamics of release, dose-response relationship, and glucose dependency. However, measurements of cAMP accumulation in the presence of the phosphodiesterase inhibitor 3-isobutyl-1-methylxanthine (10(-4) M) showed that the fold increase compared with glucose alone had the following ranking order: secretin = [Tyr10, Tyr13]-secretin 1.6 less than [Tyr10, Tyr13, Trp25]secretin 1.8 less than glucagon 1.9 less than [Asp3, Glu9, Arg12]glucagon 2.3 = [Asp3, Glu9]glucagon. These results suggest that despite similar potentiating effects of secretin and glucagon on glucose-induced insulin release, their modes of action may be different.

Interaction of NPY and VIP in regulation of myometrial blood flow and mechanical activity

The occurrence, molecular characteristics and biological function of neuropeptide Y (NPY) has been studied in the female genital tract of non-pregnant rabbits. NPY immunoreactivity was demonstrated throughout the genital tract. Maximum concentrations were found in the salpinx (fallopian tube), 570 pmol/g (median) lower within the uterine body (1.5 pmol/g), cervix (2.8 pmol/g) and vagina (3.6 pmol/g). In vitro, NPY had a dose-dependent stimulatory effect on non-vascular smooth muscle (ED50 10(-9) mol/l) as studied by myometrial tension recordings. In vivo, NPY (50 pmol/min.kg) induced a dose-related, non-adrenergic and non-cholinergic decrease in myometrial blood flow. Small C-terminal (NPY31-36) or N-terminal (NPY1-16) fragments of NPY had no effect on myometrial blood flow. NPY was found to interact with the smooth muscle effect of VIP; the presence of VIP (10(-8) mol/l) counteracted the contraction elicited by NPY (10(-8) mol/l) returning the response to control value. VIP and NPY displayed a similar physiological antagonism on myometrial blood flow. There was a clear difference in the response to VIP and NPY as the effect of NPY on myometrial blood flow first appeared after a lag period of 2 minutes whereas the effect of VIP was almost instantaneous. It is concluded that NPY and VIP may interact in the local nervous control of genital functions.

The hypereosinophilic syndrome. Report of a case with successful medical treatment following cardiac biopsy

Together with pronounced blood eosinophilia an endomyocardial biopsy is the method of choice in diagnosing and assessing the severity of the systemic disorder hypereosinophilic syndrome (HES). Eosinophilia is not uncommon in several connective tissue diseases which may share clinical manifestations with HES. We report a case of HES, investigated and followed up with cardiac biopsies. A missing right radial artery pulsation gave rise to several differential diagnostic considerations.

Recovery of polypeptides after reversed-phase high-performance liquid chromatography

Mass recovery of individual polypeptides may be estimated under various practical conditions. With the purpose of obtaining rapid and reliable standard procedures for recovery measurements, we have compared five individual methods utilizing a silica-based stationary phase [Nucleosil C18 (7 microns)/ammonium sulphate-perchlorate-acetonitrile, pH 3.0] and a resin-based stationary phase (TSK Phenyl 5 PW RP/ammonium phosphate-acetonitrile, pH 7.0). The recoveries of insulin (6 kilodaltons), human growth hormone (22 kilodaltons) and human serum albumin (68 kilodaltons) estimated under five different experimental conditions were found to be concordant. Variations in column load, flow-rate, gradient shape and column dwell time and addition of cyclame did not increase the (reduced) recovery of serum albumin and growth hormone.

Testicular cancer risk in boys with maldescended testis: a cohort study

Testicular maldescent is considered as a predisposing condition for development of testicular malignancy. Male subjects with a history of cryptorchidism have been suggested by some authors to have a 40 to 50 times increased risk of testis cancer. However, the magnitude of this risk is a point of considerable disagreement. Therefore, we studied the records of 506 consecutive patients hospitalized for maldescended testis from January 1949 to December 1960. Testis cancer developed in 6 patients, which when compared to the 1.3 expectant Danish incidence rate, yielded a statistically significant relative risk of 4.7 (95 per cent confidence interval 1.7 to 10.2). Thus, our study confirmed that male subjects with a history of testicular maldescent have an increased risk for testis cancer, although the magnitude of this risk was lower than suggested previously.

Pretreatment with atracurium: the influence on neuromuscular transmission and pulmonary function

The influence of pretreatment with atracurium on neuromuscular transmission was evaluated in 60 healthy volunteers using train-of-four (TOF) nerve stimulation and measurement of respiratory rate (RR), vital capacity (VC), inspiratory force (IF), and peak expiratory flow (PEF). The subjects were randomly allocated to one of four groups: Group I received atracurium 0.02 mg/kg, Group II 0.03 mg/kg, Group III 0.04 mg/kg, and Group IV atracurium 0.05 mg/kg. TOF ratio decreased significantly in all four groups. There was, however, no difference between the groups after injection. PEF decreased significantly in all four groups, VC decreased in Groups I and IV, and RF increased significantly only in Group IV. Three subjects (5%) had shallow, frequent respiration; however, none needed respiratory support. The majority of the volunteers experienced blurring of vision and heavy eyelids: 82% and 67%, respectively. All subjects were able to sustain head lift for 10 s or more after atracurium. Careful observation of respiration is necessary, especially when using the higher doses of atracurium.

Preparative reversed-phase high-performance liquid chromatography of iodinated insulin retaining full biological activity

Insulin monoiodinated in Tyr A14, A19, B16 and B26 can be separated from insulin and diiodoinsulins using reversed-phase high-performance liquid chromatography on LiChrosorb RP-18 columns. Monoiodoinsulins with high and low specific activities were isolated from a number of buffer systems without any reduction in binding affinity and biological activity in isolated rat fat cells. The reason for the previously observed reduction in the binding affinity was probably column bleeding, i.e., chemical degradation of the column support.

Central venous access via the external jugular vein in cardiovascular surgery

In 115 consecutive adult patients scheduled for cardiovascular surgery, 150 catheterizations of the innominate or superior caval veins via an external jugular vein were attempted. The Seldinger technique was employed. In 99 (96-100)% of the attempts a straight, J-modified straight or a J-wire could be passed into the central venous system. One hundred and forty-six (97 (93-99)% of the subsequent catheter insertions were successful. Thirty-five patients had bilateral catheter insertions. Both sides proved to be equally suitable. Six anesthetists participated in the study and the longest catheterization time was 16 min. All catheterization procedures were uncomplicated.

Mortality in the years following bacterial meningitis

During the years 1966-1976, 875 patients were treated for bacterial meningitis at the University Clinic for Infectious Diseases, Copenhagen. By about January 1, 1980, all 782 surviving patients had been traced. 87 had died in the observation period of four to 15 years. Mortality in the years following meningitis was studied by means of a comparison with the expected mortality in a matched normal population, using a computer program for the determination of late excess mortality. Late excess mortality was significantly increased during the first two years following discharge after meningitis and was of the same magnitude in the major etiological groups. The cumulative five-year late excess mortality rate was higher in the group of patients between 30 and 60 years, in those transferred from other hospitals, in those in coma or somnolence on admission and in those developing convulsions during hospitalization. In the group of patients aged 30 to 60 years, 11 patients died during the first two years after discharge. In nine of these cases, the main cause or the concomitant causes of death were conditions predisposing to infections or bacterial meningitis. The frequency of the causes of death in the 87 patients who died was not significantly different from that among the general Danish population.

Secretin and its C-terminal hexapeptide potentiates insulin release in mouse islets

Peptides representing the C-terminal end of secretin were synthetized and their effects tested along with secretin on column-perifused isolated mouse pancreatic islets. Insulin release induced by 10 mmol/l D-glucose was potentiated by secretin tested in a concentration range of 0.01-10 micrograms/ml; the maximal effect was obtained with 1 microgram/ml secretin. This effect was mimicked by 50-500 micrograms/ml NH2-Leu-Leu-Gln-Gly-Leu-Val-NH2, [S-(22-27)], which represents an amidated C-terminal sequence of the secretin molecule. The consecutive smaller secretin C-terminal peptides had either no effects [Val-NH2, S-(24-27)] or only marginally [S-(26-27), S-(23-27)] potentiating effects on insulin release in the presence of 10 mmol/l D-glucose. The effects of secretin and S-(22-27) were not influenced by 2 mmol/l glutamine. The intact hormone and the five synthetic peptides as well as Val-NH2 had no stimulatory effect on islet glutamate dehydrogenase activity. In fact, S-(23-27), S-(24-27), and S-(25-27) inhibited the islet glutamate dehydrogenase activity, the activation by which amino acids and amino acid derivatives are known to elicit a potentiation of insulin release. Our results suggest that the C-terminal part is important to the marked potentiation of glucose-induced insulin release in vitro by secretin.

Neurotransmitter-role of VIP in non-adrenergic relaxation of feline myometrium

The feline myometrium is heavily innervated by VIP-containing nerve fibres. Transmural electrical stimulation (10 Hz, 2 msec, 150 mA) of muscle strips from feline myometrium in the presence of adrenoreceptor blocking agents caused a muscle relaxation. The smooth muscle relaxation was accompanied by a significant increase in immunoreactive VIP in the superfusate. Both the VIP release and the relaxation were completely annulled by tetrodotoxin, a selective blocker of axonal conduction. Furthermore, passive immunoneutralization with antiserum against VIP markedly reduced the smooth muscle relaxation induced by electrical stimulation. In the light of the previously demonstrated smooth muscle relaxant effect of VIP, the present findings indicate that the peptides may participate as neurotransmitter in non-adrenergic relaxation of the feline myometrium.

Suppression of antibody response and prolongation of skin graft survival by multiple blood transfusions in the rat

The effect of blood transfusions (BT) on antibody response and skin graft survival was studied in the strongly MHC-incompatible BN and LEW combination. One-to-three BT induced high titer antibodies. Additional BT, however, led to a decrease of antibody titers. After 15 BT the recipients either had no detectable antibodies, or they had very low antibody titers. This suppression of response was shown to be distinct from a simple loss of antibody activity caused by lack of further antigenic challenge. In multiple transfused rats, humoral nonreactivity persisted in spite of rechallenge with antigen; in animals that lost their antibodies as a result of lack of further stimulation, an additional BT boosted strong antibody production. In LEW recipients of multiple BN transfusions, not only the specific anti-BN response but also reactivity to third-party BUF blood was suppressed. However, whereas the donor-specific response (anti-BN) was largely inhibited after a ten-week interval, the response to third-party BUF blood recovered. The state of humoral nonreactivity could be transferred by spleen cells to nontransfused syngeneic animals. In LEW rats that received three injections of 5 X 10(7) "suppressor" spleen cells, the antibody response to BN blood was strongly impaired as compared with animals that received normal spleen cells. BN or (BN X LEW)F1 skin grafts survived significantly better in multiple transfused LEW rats than in nontransfused controls. This was even more pronounced when ALS was given additionally. Third-party grafts (BUF) survived only slightly better than controls. It is concluded that multiple BT (1) result in humoral anti-donor nonreactivity secondary to an initial antibody response, (2) induce strong specific and weak nonspecific suppressor cell activity, and (3) increase skin graft survival.

Pneumococcal meningitis: an evaluation of prognostic factors in 164 cases based on mortality and on a study of lasting sequelae

During the period 1966-76, 164 patients with pneumococcal meningitis were admitted to the University Hospital, Copenhagen. Of 111 survivors 94 underwent a series of clinical examinations. The findings in each patient were assessed for their aetiological relationship to meningitis. Of these patients 54% had neurological sequelae, 42% had neuropsychological sequelae, 25% had otological sequelae and 16% had sequelae as judged by computer-assisted tomography of the brain. On the basis of the general clinical condition, each patient was evaluated for the presence of sequelae of meningitis by means of a rating of nil, mild, moderate or severe. These ratings and mortality rates were used to evaluate the prognostic significance of various features present during the acute illness. A fatal outcome was significantly associated with increasing age, concomitant pneumonia, altered consciousness on admission, transfer from another hospital and development of complications while in hospital. There was a statistically significant association between lasting sequelae and the female sex, the age group of 16-50 years, patients who had not received any pre-admission antibiotic therapy and those with positive bacterial cultures of specimens from sites other than blood or cerebrospinal fluid.

Vasoactive intestinal peptide (VIP) stimulates oxytocin and vasopressin release from the neurohypophyis

The concentration of vasoactive intestinal peptide (VIP) was measured by RIA in pituitary extracts of female cats; it was significantly higher in the posterior than in the anterior lobe, 47.3 +/- 3.9 pmol/g wet wt vs. 7.7 +/- 2.0 pmol/g wet wt (mean +/- SE, n = 5 in both instances). To investigate the effect of VIP on the release of posterior pituitary hormones, the concentration of arginine vasopressin and oxytocin was measured by RIA in jugular vein plasma during intracarotid infusion of VIP. The levels of both hormones rose during the 5-min infusion of VIP. Oxytocin levels increased from a mean of 7.9 microU/ml to a maximum of 34.9 microU/ml at 1 min and arginine vasopressin levels from from 27.4 microU/ml to a maximum of 157 microU/ml at 1 min. The levels of both hormones returned to baseline values in about 20 min. Since VIP has been localized to the nerve terminals of the neurohypophysis, these data suggest that endogenous VIP may play a role as a neurotransmitter in the magnocellular hypothalmo-neurosecretory system.

Binding affinity of monoiodinated insulin tracers isolated after reversed-phase high-performance liquid chromatography

Insulin and insulin monoiodinated in tyrosine A14, A19, B16 and B26 can be separated using reversed-phase high-performance liquid chromatography on a number of C18 columns eluted with acetonitrile containing triethylammonium phosphate or acetate buffers. The monoiodoinsulins can be isolated using lyophilization, gel chromatography, or Sep-Pak purification. Compared with similar tracers purified and isolated by disc electrophoresis-ion-exchange chromatography, the resulting binding affinities to adipocytes of the purified tracers are more or less reduced dependent on the choice of column support, buffer, separation temperature, and isolation procedure.

875 cases of bacterial meningitis: diagnostic procedures and the impact of preadmission antibiotic therapy. Part III of a three-part series

Data on the bacteriological findings, diagnostic measures and clinical course of 875 patients with bacterial meningitis are presented. Findings from the medical records and from a follow-up questionnaire survey of 667 of these cases revealed no significant difference between patients treated with antibiotics before admission (pretreated) and those who were not treated before admission (non-pretreated) with respect to clinical condition on admission, mortality and late sequelae. Pretreatment was, however, associated with a longer duration of symptoms. Apart from cases due to Neisseria meningitidis, there were no significant differences in diagnostic findings between pretreated and non-pretreated cases. In the group of pretreated meningococcal patients, however, positive blood cultures, pleiocytosis in the cerebrospinal fluid (CSF) and positive cultures from sites other than blood and CSF were less frequent than in the non-pretreated cases.

Sequelae from bacterial meningitis and their relation to the clinical condition during acute illness, based on 667 questionnaire returns. Part II of a three part series

During the years 1966-1976, 875 patients with bacterial meningitis were treated at the Department of Infectious Diseases, Rigshospitalet, Denmark. In late 1979 and early 1980 a survey by questionnaire was conducted among survivors concerning the impact of the disease. Replies were received from 667 patients (96.4 per cent). The most common complaints after meningitis were headache (32 per cent) inability to concentrate (31 per cent), altered working capability (33 per cent) and loss of memory (24 per cent). Approximately 20 per cent suffered from impaired hearing, visual disturbances and dizziness. Five per cent had convulsions. Each questionnaire was evaluated for sequelae, and when present these were rated as mild, medium or severe. One-third of the patients had sequelae and in 6 per cent these were severe. Sequelae were most commonly associated with drowsiness, coma, agitation and confusion on admission to hospital.