The origin of plasma proteins in human amniotic fluid: the significance of alpha 1-antichymotrypsin complexes

12 proteins were studied in serum and amniotic fluid from 20 women in late pregnancy by two-dimensional immunoelectrophoresis. A close inverse relationship was observed between the amniotic fluid/serum concentration ratios of 11 proteins and their Stokes radii. These proteins enter the liquor from the maternal blood by molecular filtration. The concentration of alpha 1-antichymotrypsin in amniotic fluid was often higher than expected and the protein was often partially complexed. alpha 1-Antichymotrypsin is probably not actively secreted into amniotic fluid but may be selectively retained after complexing.

Granulocyte transfusions: current status

Since granulocyte transfusions first became widely used in clinical medicine, there have been advances in the treatment of acute leukemia and improvement in prevention and management of infection in neutropenic patients. Improved understanding now exists concerning prognosis of infections in such patients, and advances have been made in procurement of granulocytes. Granulocyte transfusions should be given for specific indications, and used adjunctively to other established antiinfective therapy. Once initiated, transfusions should be given in adequate doses at daily intervals (at least) with ongoing evaluation and periodic reassessment of the whole antiinfective program. Serious complications of granulocyte transfusion therapy are relatively rare, but the physician should be prepared to manage them intelligently. Research continues in discerning exactly how granulocyte transfusion work, in preservation of granulocytes, and in delineation of immunologic phenomena affecting the efficiacy of such therapy. Granulocyte transfusions will continue to be important in the management of acute leukemia, and other reversible bone marrow failure states, and in marrow transplantation and autotransplantation.

A study of plasma proteins in the sol phase of sputum from patients with chronic bronchitis

We have studied the sputum/serum protein concentration ratios from 23 patients with bronchitis both in the stable clinical state and during acute chest infections. During the stable state there was a significant negative correlation (2 P less than 0.005) between the ratio and protein size. The ratios of IgG, IgA, C3, and alpha 1-antichymotrypsin were significantly displaced from this relation suggesting local production in the lung. IgM was found in all samples and alpha 2-macroglobulin in 55% of non-infected samples which may be the result of local production rather than transudation from serum, because of their larger size. During acute chest infections the albumin content of sputum rose from a mean sputum/serum ratio of 0.83 (SE +/- 0.08) X 10(-2) to 13.77 (SE +/- 3.21 X 10(-2) suggesting increased transudation from the blood. In the presence of increased transudation, local production of protein appears to be less significant.

Tumour markers in breast cancer

The clinical usefulness of 8 potential tumour markers has been evaluated in 69 patients with Stage I and II breast cancer and 57 patients with Stage III and IV. Serum CEA concentrations were raised in 13% of patients with local and 65% of those with advanced breast cancer. In patients with clinical evidence of progression or regression of tumour, serum CEA levels changed appropriately in 83% of cases. Taking 4 of the markers (carcinoembryonic antigen (CEA), lactalbumin, alpha subunit and haptoglobin) serum concentrations of one or more were raised in 33% of patients with local disease and 81% of those with advanced breast cancer. However, marker concentrations were often only marginally raised, and are unlikely to provide sensitive guide to tumour burden. CEA, lactalbumin and alpha subunit were detectable in 68%, 43% and 40% respectively of extracts of primary breast cancers.

Alpha,-antitrypsin and leukocyte elastase in infected and noninfected sputum

Leukocyte elastase and alpha 1-antitrypsin have been implicated in the pathogenesis of pulmonary emphysema. The relationship between these proteins has been studied in sputum both qualitatively and quantitatively in bronchitic patients with and without chest infections. Leukocyte elastase was found in 75% of the noninfected samples but was enzymatically inactive, suggesting complete inhibition. During infection, leukocyte elastase and alpha 1-antitrypsin concentrations increased, although the enzyme was only partially inactivated. The proportion of alpha 1-antitrypsin present as "complex" was smaller in the presence of infection, suggesting damage of the protein by excess enzyme.

The metabolism of methaqualone in patients with biliary cirrhosis or secondary carcinoma of the liver

The metabolism of methaqualone has been studied in three patients with secondary carcinoma of the liver and two with biliary cirrhosis. The urinary excretion of five C-monohydroxy metabolites and the N-oxide was studies in the 24 h period immediately after oral dosing with 250 mg methaqualone (Melsed). In both patients with biliary cirrhosis and one with primary carcinoma of the bile duct or pancreas with secondaries in the liver the pattern of metabolites was normal. In a patient with oat cell carcinoma with secondaries in the liver some metabolite patterns were disturbed and increased metabolite excretion occurred. A patient with primary carcinoma of the breast with secondaries in the liver gave a completely abnormal metabolite pattern.

The effect of the protein content of diluents on peak height in rocket immunoelectrophoresis

We have investigated the effect of different diluents in the quantitation of proteins by rocket immunoelectrophoresis. alpha2-Macroglobulin produced taller peaks as the protein content of the diluent fell to zero, and the dilution was increased. A maximum increase in height of 25-30% was recorded when saline was used as the diluent compared to a sample diluted in sheep serum. Albumin and transferrin showed similar, but less significant effects. Samples and standards should therefore contain approximately equal concentrations of protein for maximum accuracy.

An arterio-venous study of serum alpha1-antitrypsin in patients with chronic bronchitis

The effect of passage through the lung on alpha1-antitrypsin was studied in sixteen patients with chronic obstructive airways disease. The average mixed venous value of alpha1-antitrypsin (106.2% standard serum value) was not different from the the mean arterial value (105.6%). Where individual differences were found there was a similar difference in serum albumin. However, there was a small but significant rise (p less than 0.005) in serum alpha1-antitrypsin "complex" as blood traversed the lung (mixed value = 6.3%; mixed arterial value = 6.8%). The reason is not yet clear.

Inter- and intra-individual variation in the metabolism of methaqualone in man after a single oral dose

The urinary excretion of five C-monohydroxy metabolites and the N-oxide metabolite of methaqualone in the 24 h period immediately after oral dosing with 250 mg methaqualone (Melsed) has been measured in ninteen healthy adults (13 male, 6 female) to assess interindividual variations and in five adults (3 male, 2 female) on five separate occasions to assess intraindividual variation. The overall importance of the six metabolites was 4'-hydroxy greater than N-oxide greater than 2'-hydroxymethyl greater than 3'-hydroxy greater than 6-hydroxy = 2-hydroxymethyl. Variations in this order both within the 24 h period and within each of the three eight-hour periods constituting the 24 hours were minor and variations in the absolute amount of each metabolie excreted ranged from two to three-fold. Intraindividual variations were generally smaller than interindividual variations and for each individual the pattern of metabolism was similar on the five occasions. There is evidence that the C-oxidation of methaqualone may be more sensitive to cyclical variations in hormone levels than is N-oxidation.

Metabolism of methaqualone in geriatric patients

The urinary excretion of five C-monohydroxy metabolites and the N-oxide of methaqualone has been measured in a group of eleven geriatric patients aged 71--90 years. The total excretion of the six metabolites in 24 h after the oral administration of a single dose was approximately one-half of that in a group of young healthy adults. The relative importance of the six metabolites was 4'-hydroxy greater than N-oxide greater than 2'-hydroxymethyl = 3'-hydroxy greater than 6-hydroxy = 2-hydroxymethyl which was the same order as that in young adults. The ratio of C-to N-oxidation was also the same in the two groups. There was no impairment of conjugation of the C-hydroxy metabolites with glucuronic acid in the geriatric group but there was greater interindividual variation in metabolite excretion. There was also evidence for delayed metabolism in the geriatric patients.

Filtration leukapheresis: effects of donor stimulation with dexamethasone

Dexamethasone was administered to 51 donors prior to filtration leukapheresis. The results of this maneuver, including the consequences of transfusion, were contrasted with results in 52 donors who did not receive the steroid. Yields of polymorphonuclear leukocytes, the posttransfusion increments in recipients, themorphologic polymorphonuclear leukocytes obtained, and the incidence of donor and recipient reactions were all beneficially influenced by this manipulation. Possible mechanisms responsible for these observations are discussed. It is recommended that dexamethasone stimulation be used in filtration leukapheresis when circumstances do not otherwise contraindicate such a maneuver.

Cancer-associated proteins in effusion fluids

Two cancer-associated proteins, carcinoembryonic antigen (CEA) and pregnancy-associated alpha2 glycoprotein (PAG), together with 13 normal serum proteins were measured in the serum and effusion fluid of patients with ascites and pleural effusions. The results indicate that CEA measurement in effusion fluid is more effective than serum measurement in distinguishing cancerous from congestive or inflammatory effusions. Comparisons with the results of cytological examination suggest that fluid CEA estimation may prove a useful clinical tool. Serum PAG levels were higher in patients with cancer, but fluid determination offers no advantage in separating the disease groups. Similarly, the estimation of individual normal serum proteins in effusion fluids is unlikely to be of diagnostic value.

Quality control in the simultaneous assay of anticonvulsants using an automated gas chromatographic system with a nitrogen detector

An automated gas-liquid chromatographic technique for the routine determination of phenobarbitone, primidone and phenytoin using a nitrogen-detector is described. The high selectivity of the detector for nitrogen-containing compounds allows a direct extraction procedure and the use of a phenytoin analogue as an internal standard obviates the need for accurate aliquot measurement after extraction. The anticonvulsants are chromatographed as methyl derivatives produced by on-column methylation with trimethylphenyl ammonium hydroxide following automatic liquid injection. Quality control data from an internal quality control scheme is presented and the performance of the laboratory in an inter-laboratory control scheme is reported and discussed.

Pregnancy associated alpha2-glycoprotein in post-menopausal women receiving hormone replacement therapy

Serum pregnancy associated alpha2-glycoprotein (P.A.G.) concentrations were measured in a group of post-menopausal women receiving hormone replacement therapy. The P.A.G. concentrations increased from a mean basal level of 48.1 mug/ml (range 20.6--104.4 mug/ml) to a maximum after six months therapy of 359 mug/ml (range 82--1290 mug/ml). This represents a mean increase of 647%. Two months after cessation of therapy the P.A.G. concentrations decreased but the mean level (60.3 mug/ml) was still significantly higher than the pre-treatment level. There was a significant correlation between the pre-treatment P.A.G. concentrations and the levels after six months of therapy. These findings may be of relevance to the use of P.A.G. determinations in the monitoring of malignant disease.

Estimation of the Stokes radii of serum proteins for a study of protein movement from blood to amniotic fluid

The effective hydrodynamic (Stokes) radii of fifteen serum proteins were estimated by Sephadex G 200 gel filtration and immunochemical methods. The Waldmann-Meyer and Birch equation (Protides Biol. Fluids, Proc. 21st Colloq. (1974) (Peeters, H., ed.), Vol. 21, pp. 653-656, Pergamon Press, Oxford) was used for maximum accuracy. Three replicate column runs were made to assess the precision for the size determinations (coefficients of variation 0.6-2.7(). Quantive two-dimensional immunoelectrophoresis was used to measure eleven proteins in specimens of serum and amniotic fluid collected from twelve normal pregnancies. There was a close inverse linear relationship between the amniotic fluid/serum ratios of the proteins and their Stokes radii. This indicates that the movement of a protein from the blood to amniotic fluid is determined by the size of the protein. The linear correlation of protein amniotic fluid/serum ratio with Stokes radius was better than that with molecular weight. This demonstrates that, as an expression of protein size, Stokes radius should be used in preference to molecular weight when protein filtration systems are being investigated.

Urinary excretion of methaqualone-N-oxide in man

1. Oral administration of therapeutic doses (250 mg) of methaqualone (Melsed) to adult human subjects gives rise to the urinary excretion of methaqualone-N-oxide. This metabolite has been identified by chromatography and mass spectrometry and quantitatively determined by reduction with titanium trichloride to methaqualone which was then determined by g.l.c. 2. The N-oxide accounts for 5-9% of the dose in 24 h. 3. 2-Nitrobenzo-o-toluidide, a possible oxidation product of methaqualone-N-oxide, has not been detected. 4. The urinary excretion of unchanged methaqualone is less than 0-3% of the dose. The ease with which methaqualone-N-oxide is thermally converted to methaqualone casts doubts on the previously published figures for the urinary excretion of methaqualone.

Urinary excretion of c-hydroxy derivatives of methaqualone in man

1. Six monohydroxy metabolites of methaqualone have been identified by g.l.c.-mass spectrometry in the urine of healthy human subjects who received therapeutic doses (250 mg) of the drug (Melsed) daily for ten day. 2. The three major metabolites were 2-methyl-3-(2'-hydroxymethylphenyl)-4(3H)-quinazolinone, 2-methyl-3-(2'-methyl-3'-hydroxyphenyl)-4(3H)-quinazolinone and 2-methyl-3-(2'-methyl-4'-hydroxyphenyl)-4(3H)-quinazolinone. Three minor metabolites in descending order of importance were 2-hydroxymethyl-3-o-tolyl-4(3H)-quinazolinone, 2-methyl-6-hydroxy-3-o-tolyl-4(3H)-quinazolinone and 2-methyl-8-hydroxy-3-o-tolyl-4(3H)-quinazolinone. 3. The 8-hydroxy metabolite is identified as a urinary metabolite or methaqualone in humans for the first time.

Thyroid function following partial thyroidectomy

The main objective of this investigation was to establish the incidence of hypothyroidism and recurrent goitre following partial thyroidectomy. Accurate measurements of the thyroid remnants and resected specimens have been made in all cases. The postoperative thyroid status has been assessed clinically and also biochemically by serum thyroxine as iodine, T3 resin uptake, free thyroxine index and thyroid-stimulating hormone estimations. Serum calcium and phosphorus have also been measured and the necessary histological material reviewed.

Postoperative hypothyroidism occurred in approximately 11 per cent of previously toxic and 6.5 per cent of non-toxic patients, becoming evident in most cases within a year of operation. The T3 resin uptake measurement following operation in this and previous series suggests that in many patients there is a compensation process which is maintained by increased secretion of thyroid-stimulating hormone. No evidence has been adduced that patients who show this compensation mechanism are, as some have suggested, in a state of ‘subclinical hypothyroidism’ or that they become overtly hypothyroid later.

In this series hypothyroidism was more closely related to small remnant size than the presence of lymphadenoid change. A significantly higher proportion of patients with small thyroid remnants became hypothyroid in both toxic and non-toxic groups. Remnants of about 8–16 ml ‘cuboid’ volume (roughly 8–16 g by weight) have seemed reasonable for our patients.

Assessment of coagulation and fibrinolysis in pre-eclampsia

A method is described for distinguishing coagulation from fibrinolysis by three estimates of fibrinogen. This "fibrinogen series" together with plasma antithrombin and urinary urokinase have been compared in pregnant patients with venous thrombosis and pre-eclampsia. Evidence is presented for active coagulation during deterioration of the pre-eclampsia state and for enhanced fibrinolysis during improvement.

Detection of methaqualone and its metabolites in urine

A method is described for the detection of methaqualone and its metabolites in the presence of large doses of other drugs.