Refining the diagnosis of schizophreniform disorder

Schizophreniform disorder, a potentially useful construct, is difficult to operationalize either for clinical or research purposes. According to DSM-III-R, schizophreniform disorder is descriptively identical to schizophrenia, differing only in duration of symptoms. This study suggests several features that, at initial examination, differentiate schizophreniform disorder from schizophrenia, such as higher DSM-III axis V ratings, lack of flattened affect, and better rapport with the examiner. The data suggest that when defined according to appropriate clinical criteria, schizophreniform disorder can be distinguished from either schizophrenia or affective disorder.

Prognostic significance of histologic findings in resected small hepatocellular carcinoma

Fifty-one patients with histologically proven small (less than 5 cm) hepatocellular carcinoma underwent hepatic resection. In ten cases (group A) the cancer cells were confined within the tumor capsule, in ten (group B) there was extracapsular extension of growth, in 23 (group C) there was also invasion of the portal vein from the main tumor or from satellite nodules, or both, and in eight cases (group D) the findings were the same as in group C but there was no tumor capsule. The mean follow-up period was 54 +/- 12 months, minimum 37 months. The estimated 7-year survival rates in groups A-D were, respectively 100, 47.5, 47.5 and 37.5%. The classification of gross tumor appearance as typical or atypical was fairly well correlated to the histologic pattern in groups A, C and D, but not in group B. Although safety margin at resection did not emerge as a prognostic factor, the group A patients with a good margin were free from tumour recurrence.

The effect of YAG laser anterior capsulotomy on prostaglandin concentration in aqueous humor

The YAG (yttrium aluminum garnet) laser has been recommended for anterior capsulotomies. One major complication is elevated intraocular pressure. We report a study of the biochemical content of the aqueous humor after a YAG laser anterior capsulotomy. We analyzed 6-keto-prostaglandin F1 alpha, thromboxane B2 and protein concentrations in the aqueous humor of human eyes. The average values of protein, 6-keto-prostaglandin F1 alpha, and thromboxane B2 in the control eyes were 81.3 +/- 14.0 mg/dL, 17 +/- 30 pg/mL, and 10 +/- 10 pg/mL, respectively. These values were elevated to 182.4 +/- 81.3 mg/dL, 401 +/- 55 pg/mL, and 576 +/- 148 pg/mL, respectively, after YAG laser anterior capsulotomy. The samples with a moderate level of 6-keto-prostaglandin F1 alpha (less than 300 pg/mL) had negligible changes of thromboxane. The elevation of thromboxane was obvious only when prostaglandin levels rose above 300 pg/mL.

Crystallization of human neutrophil elastase

Human neutrophil elastase was inactivated by methoxysuccinyl-L-Ala-L-Ala-L-Pro-L-Ala-chloromethane. The modified enzyme was crystallized from 40 mM ammonium phosphate, pH 7.0 in the hexagonal space group P6(3) with unit cell parameters a = 74.53 A, b = 74.53 A, c = 70.88 A, alpha = beta = 90 degrees, gamma = 120 degrees. These crystals were resistant to radiation damage and diffracted beyond 1.84-A resolution. The asymmetric unit contained one 25,000-dalton monomer of human neutrophil elastase. Crystals were also grown from the enzyme modified with the analogous iodinated inactivator, p-iodoanilinosuccinyl-L-Ala-L-Ala-L-Pro-L-Ala-chloromethane. These crystals proved to be isomorphous with those of methoxysuccinyl-L-Ala-L-Ala-L-Pro-L-Ala-chloromethane-modified human neutrophil elastase, and served as a single-site, heavy atom derivative for solving the tertiary structure of the enzyme.

[The study of the controlled ovarian stimulation and sperm capacitated AIH for the treatment of refractory infertility]

The clomiphene or hMG to stimulate ovarian follicle maturation which we call "controlled ovarian stimulation (COS)", in vitro capacitation (IVC) of spermatozoa and artificial insemination of husband's sperm (AIH) were simultaneously given to refractory infertile couples. The following couples were studied in 5 groups, 1 male subfertility 27 cases, 2 functional infertility 25 cases, 3 ovulatory dysfunction due to central mechanism 8 cases, 4 cervical mucous insufficiency 3 cases, 5 endometriosis 6 cases. The pregnancy rate was 21.7% in total (15 of 69 cases): 25.9% in group 1, 16.0% in group 2, 25.0% in group 3, 33.3% in group 4 and 16.7% in group 5. The follicle size and serum estradiol were measured every day during the periovulatory phase to evaluate follicle maturation. The Percoll centrifugation method was compared with the washing-centrifugation method with respect to the recovery rate and the concentration rate of motile spermatozoa. The recovery rate was 67.9% with the Percoll centrifugation method, and 40.0% with the washing-centrifugation method. The concentration rate was 1.81 times in the Percoll centrifugation method, and 1.19 times in the washing-centrifugation method. The present studies indicated that the combination of COS and IVC methods for AIH in refractory infertile couples was very effective.

Role of surgery in the treatment of primary carcinoma of the liver: a 31-year experience

During the 31 year period 1954 to 1985, 225 major hepatic resections have been performed for symptomatic primary carcinoma of the liver, of which right hepatic lobectomy was performed in 115, extended right hepatic lobectomy in 11, trisegmentectomy in 2, left hepatic lobectomy in 94, and middle hepatectomy in 3. In addition there were 107 partial hepatic resections for 89 asymptomatic small hepatocellular carcinomas. In the 225 patients undergoing major hepatic resection, the operative mortality was 8.0 per cent. In the 107 patients undergoing partial hepatic resection, the operative mortality was 5.6 per cent. Of the total of 314 hepatic resections for primary carcinoma of the liver, 309 were undertaken for hepatocellular carcinoma and the remaining 5 were carried out for cholangiocarcinoma. All hepatic resections in this series were performed with the finger fracture technique without controlling the hepatic hilar vessels, hepatic ducts or hepatic veins outside the liver, although hepatic clamping and the Pringle manoeuvre were also used in selective cases. Of 207 cases who survived major hepatic resection, 119 cases died within one year after the operation, mainly due to recurrence of cancer in the remaining residual lobe, lung metastasis or late hepatic failure. The 5 year survival rate is 18.0 per cent, 12 patients are still alive and well after more than 5 years and the longest survival is 23 years. Of the 89 patients with small asymptomatic hepatocellular carcinomas, 28 died within one to four years of surgery because of a second new growth.

Crystallographic study of a beta-lactam inhibitor complex with elastase at 1.84 A resolution

The continuing discovery and development of beta-lactams as antibiotics has had an unparalleled impact on the overall health and well-being of society. Recently, appropriately substituted cephalosporins were shown to be potent inhibitors of elastase, suggesting a novel therapeutic role for the beta-lactams in the control of emphysema and other degenerative diseases. We have now solved and partially refined at atomic resolution the structure of a complex of porcine pancreatic elastase with the time-dependent irreversible inhibitor 3-acetoxymethyl-7-alpha-chloro-3-cephem-4-carboxylate-1,1-dioxide tert-butyl ester (I), the most potent of the beta-lactam elastase inhibitors yet reported. (Porcine pancreatic elastase is a close relative of the desired drug target, human polymorphonuclear leukocyte elastase.) A mechanism of action is presented, based on the structure and on biochemical evidence (T.-Y.L. et al., in preparation), which clarifies the operational similarities and differences between beta-lactam elastase inhibitors and antibiotics. Features of the reaction include the expulsion of a leaving group at the cephalosporin 3' position and the formation of two covalent bonds with the active site of porcine pancreatic elastase at residues Ser 195 and His 57.

Two Japanese families: a cultural perspective

Some of the difficulties in treating second and third generation Japanese immigrant families are reviewed. An authoritarian, rather concrete approach to symptom relief is expected by, and is effective in, some families. The emphasis placed on academic achievement may lead to particular problems and misunderstandings. Two case examples of very different families are presented to emphasize a flexible therapeutic approach. Particular details of Japanese internment and population movements make the attitudes and behaviors of some families more comprehensible.

Pig pancreatic anhydro-elastase. Role of the serine-195 hydroxy group in the binding of inhibitors and substrate

The binding constants of a number of ligands were measured for pancreatic elastase (PE) and anhydro-elastase (AE) in order to assess the contribution of Ser-195 to substrate and inhibitor binding by PE. AE was purified by affinity chromatography on a column containing immobilized turkey ovomucoid inhibitor. The AE had 0.1 +/- 0.1% of the activity of the native enzyme and contained 0.8 +/- 0.06 residue of dehydroalanine per molecule. A difference electron-density map, derived from an X-ray crystallographic analysis of AE, showed that the modified residue was Ser-195. The complexing of 3-carboxypropionyl-Ala-Ala-Ala-p-nitroanilide (SAN) to the active site of AE was also demonstrated by X-ray-diffraction analysis of an AE crystal soaked overnight with substrate. The nitroanilide moiety was not observed in the difference map. AE was shown to bind turkey ovomucoid inhibitor with a dissociation constant (Kd) of 0.3 +/- 0.06 microM compared with 0.10 microM for PE. The Kd of the AE-SAN complex (0.2 mM) was comparable with the Michaelis constant for SAN with PE (1.0 mM). A number of inhibitors, such as elastatinal, which forms a hemiketal adduct with PE, while others such as the beta-lactams, which function as acylators of the active-site serine residue, bound AE with a lower affinity than to PE. The binding of a peptidylchloromethane (acetyl-Ala-Ala-Pro-Ala-CH2Cl) to AE occurs without evidence for alkylation of histidine. The binding constants for benzoisothiazolinone and 3,4-dichloroisocoumarin to PE differed from their binding constants to AE by less than a factor of 4.0-fold. The contribution of the hydroxy group of Ser-195 to the binding of these inhibitors to PE in their non-covalent complexes is relatively small, even though they inactivate PE by an acylation mechanism. These results suggest that the hydroxy group on Ser-195 in PE is of secondary importance in the energetics of ligand binding, in contrast with its essential role in the catalytic properties of the enzyme.

Factors affecting ascorbate oxidation in aqueous humor

Aqueous humor from human glaucomatous eyes was divided into two groups. Group I aqueous humor contains a negligible amount of ascorbate, while group II contains ascorbate. Group I aqueous humor stimulates ascorbate oxidation. This oxidative effect is inhibited by the addition of EDTA, indicating the presence of metallic ions. The amount of copper determined by atomic spectrophotometry in these samples was 1.54 micrograms/ml. On the contrary, group II aqueous humor protects against ascorbate oxidation. The small amount of albumin present in these samples accounts for part of this protective effect.

A measure of the 'sick' label in psychiatric disorder and physical illness

Persons with psychotic disorders receive devalued labels. Despite considerable theorizing, the proposition that these labels affect the course of psychotic illness has rarely been subjected to investigation. The lack of an adequate operational measure for the labeling construct has hampered research. The present report describes the development of the Social Response Questionnaire (SRQ), a measure of the 'sick' label which incorporates moralistic attitudes, fear of dangerousness and negative expectations attached to the role of the severely psychiatrically ill. This 32-item scale, a multidimensional measure of informal labeling, which may be administered in a self-report format or to significant others, permits the study of dose-response relationships. The SRQ is internally stable. It also exhibits construct validity. Schizophrenics and persons with affective psychosis label themselves and are labeled by others more harshly than persons with Crohn's disease or normals. While self-percepts and the perceptions of significant others are fairly congruent for normals and persons with a significant physical illness, there is no agreement between the self-ratings of psychotics and their significant others. Psychotic persons view themselves more negatively than Crohn's disease sufferers or normals, but not as negatively as their therapists, families and friends. Potential uses for the SRQ in longitudinal research are addressed.

Multiculturalism and Canadian psychiatry: opportunities and challenges

In this lecture, the writer calls the attention of Canadian psychiatrists to the unparalleled opportunities the national policy of multiculturalism has for clinical and research activities. Using illustrations from three important fields in psychiatry--epidemiology, psychopharmacology and psychotherapy, he points out the roles socio-cultural factors play in generating ethnic differences which deserve to be given serious scientific attention for both the understanding of causative factors and the treatment of mental disorders. He emphasizes that medical universalism and ethnocentricism have no place in Canadian psychiatry, and that the next phase of Canadian psychiatry should focus on cultural relevancy based on cultural relativism and equal participation of all cultures and ethnic groups.

Surgical treatment of 109 patients with symptomatic and asymptomatic hepatocellular carcinoma

A total of 109 patients with histologically proved hepatocellular carcinoma (HCC) have undergone hepatic resection during the 56-month period from October 1978 to May 1983. There were two sources of patients: those with symptomatic HCC (n = 47) and those with asymptomatic HCC (n = 62). A family tendency of HCC was noted in 11% of the patients studied. The percent of positive hepatitis B surface antigen (HBsAg) was 87%, and the serum alpha-fetoprotein was less than 20 ng/ml in 30% in the group with symptoms. The operative mortality rate was 3% and the hospital mortality rate was also 3%. The postoperative course was complicated with pleural effusion in 10%, bile leakage in 4%, subphrenic abscess in 4%, and upper gastrointestinal bleeding caused by gastritis in 1% of the patients. The actual survival rate for the 103 cases was 84% for 350 days and 28% for 1400 days. However, in the group with asymptomatic HCC with an average tumor size of 3.35 +/- 1.49 cm in diameter, the rate was 92% for 350 days and 44% for 1400 days. In the group with symptomatic HCC with an average tumor size of 10.6 +/- 5.1 cm in diameter, the rate was 76% for 350 days and 8% for 1400 days. The survival rate of the group with asymptomatic HCC was far better than that of the group with symptoms (p less than 0.05). In analysis of factors that might affect the patient's survival, only second or third operations (p less than 0.05), typical gross findings of tumor appearance (p less than 0.05), and an adequate margin were closely related (p less than 0.001). Neither the tumor size, the status of accompanying liver cirrhosis, the tumor location, nor the patient's sex and age affected the patient's survival (all p greater than 0.05).

T-lymphocytes subpopulation before and after surgical removal of hepatocellular carcinoma

This study included 16 histologically confirmed hepato-cellular carcinoma (HCC) patients. At the same time, 32 normal healthy individuals and 20 asymptomatic hepatitis B surface antigen (HBsAg) carriers were served as control groups. The study disclosed that T cells, OKT4 cells and the ratio of OKT4 cells/OKT8 cells in peripheral venous blood of HCC patients before surgery were lower than that of either normal control or asymptomatic HBsAg carriers. The difference was statistically significant. The T cells, OKT4 cells and the ratio of OKT4 cells/OKT8 cells of 4 HCC patients with positive HBeAg did not show further decrease as compared with that of 12 HCC patients with negative HBeAg. Periodic examination of T cells, OKT4 cells and OKT8 cells in 16 HCC patients after surgical removal of hepatocellular carcinoma tumor revealed that preoperative depressed T cells will decline further in the first postoperative week, but it will gradually increase to near normal range in the fourth or fifth postoperative week. However, OKT4 cells still remained in depressed state during the postoperative observation period. In the conclusion, it has been suggested that the derangement of T-cell subsets observed in HCC patients is not related to either HBsAg or even HBeAg. It can be either precondition to HCC formation or further follow up period being needed to look for the change of OKT4 cells.

Renin inhibitors. Syntheses of subnanomolar, competitive, transition-state analogue inhibitors containing a novel analogue of statine

Analogues of the renin octapeptide substrate were synthesized in which replacement of the scissile dipeptide with (3S,4S)-4-amino-3-hydroxy-6-methylheptanoic acid (statine, Sta) transformed the substrate sequence into potent, transition-state analogue, competitive inhibitors of renin. Synthesis and incorporation of the cyclohexylalanyl analogue of Sta, (3S,4S)-4-amino-5-cyclohexyl-3-hydroxypentanoic acid (ACHPA), gave the most potent inhibitors of renin yet reported, including N-isovaleryl-L-histidyl-L-prolyl-L-phenylalanyl-L-histidyl-ACHPA-L -leucyl-L- phenylalanyl amide [Iva-His-Pro-Phe-His-ACHPA-Leu-Phe-NH2,3], with renin inhibitions of Ki = 1.6 X 10(-10) M (human kidney renin), IC50 = 1.7 X 10(-10)M (human plasma renin), IC50 = 1.9 X 10(-9)M (dog plasma renin), and IC50 = 2.1 X 10(-8) M (rat plasma renin). This inhibitor 3, containing ACHPA, was 55-76 times more potent vs. human renin than the comparable Sta-containing inhibitor 1 and 17 times more potent vs. dog renin than 1. Inhibitor 3 lowered blood pressure in sodium-deficient dogs, with in vivo potency 19 times that shown by 1, in close agreement with the relative in vitro potencies. Structure-activity results are presented that show the minimal N-terminus for these inhibitors. An ACHPA-containing pentapeptide, N-[(ethyloxy)carbonyl]-L-phenylalanyl-L- histidyl-ACHPA-L-leucyl-L-phenylalanyl amide [Etoc-Phe-His-ACHPA-Leu-Phe-NH2,8], retained subnanomolar inhibitory potency. Molecular modelling studies are described that suggested the design of ACHPA.

Partial hepatectomy on cirrhotic liver with a right lateral tumor

A total of 24 patients with cirrhotic liver and solitary, small hepatocellular carcinoma (HCC) located at the lateral part of the right lobe underwent surgery with our technique of hepatic clamping and finger dissection. There were no operative mortality or acute or chronic hepatic failure. Total operating time was 129 +/- 20 minutes; actual resection time was only 22.7 +/- 4.9 minutes. The average amount of blood transfused during this procedure was 1552 +/- 909 ml. The preoperative serum bromsulphalein retention rate proportionately reflected the postoperative peak serum conjugated bilirubin concentration if the weight of the resected specimen was less than 310 gm (p less than 0.001). An evaluation of the enzymes (SGOT, SGPT, and lactate dehydrogenase) released from liver cells on the first postoperative day found that more prominent elevation was observed in the group of patients with hypotension than in those without hypotension (all p less than 0.001). Although all enzyme levels returned to the preoperative level on the fourteenth postoperative day, the excretory capacity of liver cells as measured by serum bromsulphalein retention rate on day 14 time was still abnormally high (p less than 0.001) and took 2 to 3 months to decline to a level that still exceeded preoperative levels (p less than 0.05). In conclusion, partial hepatectomy on cirrhotic liver by hepatic clamping and finger dissection was a simple, rapid technique without any serious side effects.

Bacteriological efficacy of nafcillin and vancomycin alone or combined with rifampicin or amikacin in experimental meningitis due to methicillin-susceptible or -resistant Staphylococcus aureus

The pharmacokinetics and bacteriological efficacy of nafcillin (NFPC), vancomycin (VCM), amikacin (AMK) and rifampicin (RFP) alone and in VCM combinations were evaluated in the experimental rabbit meningitis caused by methicillin-susceptible Staphylococcus aureus (MSSA) or methicillin-resistant Staphylococcus aureus (MRSA). The mean concentrations of NFPC, VCM, AMK and RFP in cerebrospinal fluid (CSF) with MSSA meningitis exceeded the minimal bactericidal concentrations of MSSA during 8 hours therapy period. The mean CSF penetration rates of the 4 drugs during therapy were from 1% to 26% which are comparable to those observed in humans with meningitis. The median CSF bactericidal titers of RFP, VCM plus RFP, AMK, VCM plus AMK regimens were larger than 1:8 during therapy of MSSA meningitis study. In experimental MRSA meningitis, RFP and VCM plus RFP achieved titers greater than 1: 16 during therapy and at 24 hours. No statistically significant reduction in the CSF bacterial colony count was obtained with any of the antibiotic regimens in MSSA meningitis. By contrast, in 8 hours MRSA meningitis model, significant reductions in the number of MRSA were observed in animals treated for 8 hours with VCM plus RFP (P less than 0.01), RFP (P less than 0.05), and NFPC plus RFP (P less than 0.01).

Seven days of ceftriaxone therapy is as effective as ten days' treatment for bacterial meningitis

Seventy-nine children were enrolled in a study to compare seven vs ten days of ceftriaxone therapy for bacterial meningitis. On the basis of a computer-generated list of therapy assignments, 35 children with Haemophilus, pneumococcal, or group B streptococcal meningitis each were assigned to seven- or ten-day treatment regimens; nine children with meningococcal meningitis received seven days of therapy. The population characteristics and etiologic agents were similar for the two treatment groups, as were also the findings on examination and culture of cerebrospinal fluid at completion of therapy. There were no significant differences in the frequency and types of neurological complications between the two treatment groups; four patients in each group had two or more neurological abnormalities. The rates of nosocomial infections and prolonged and secondary fever were similar in those who received seven days of therapy compared with patients treated for the conventional ten days. Diarrhea occurred in 44% of those receiving the drug. Patients treated with the seven-day regimen were discharged from the hospital approximately two days earlier than those with the ten-day regimen.

Renin cleavage of a human kidney renin substrate analogous to human angiotensinogen, H-Asp-Arg-Val-Tyr-Ile-His-Pro-Phe-His-Leu-Val-Ile-His-Ser-OH, that is human renin specific and is resistant to cathepsin D

A synthetic tetradecapeptide, H-Asp-Arg-Val-Tyr-Ile-His-Pro-Phe-His-Leu-Val-Ile-His-Ser-OH, which corresponds to the 13 amino terminal residues of human angiotensinogen plus a carboxy terminal serine to replace a suggested site of carbohydrate attachment, has been shown to be a good substrate for human kidney renin. At pH 7.2 and 37 degrees C the KM or Michaelis constant was 8.4 +/- 2.9 microM, and the VM or velocity at infinite tetradecapeptide concentration was 11.3 +/- 2.4 mumol angiotensin I made per hour per milligram renin. The tetradecapeptide was highly resistant to cleavage by mouse submaxillary renin. The tetradecapeptide was also slowly cleaved by human liver cathepsin D, by rabbit lung angiotensin-converting enzyme, and by reconstituted human serum, but did not yield angiotensin I. Thus, this synthetic renin substrate should permit more specific measurement of human kidney renin activity.

Fever during treatment for bacterial meningitis

The records of 476 infants and children with bacterial meningitis treated between 1979 and 1982 were reviewed. By the sixth hospital day 90% or more of children with pneumococcal or meningococcal infection compared with 72% of children with Haemophilus infection (P less than 0.001) were afebrile. The rates of prolonged fever for 10 days or more, persistent fever for 5 to 9 days and secondary fever were 13, 13 and 16%, respectively. The conditions associated with prolonged fever for 10 days or more were subdural effusion (27%), drug fever (23%) and concomitant arthritis or pneumonia (20%); 15% were of indeterminable cause. The principal conditions associated with persistent fever for 5 to 9 days were other foci of disease (17%), nosocomial infections (16%) and subdural effusion (14%); in 42% the cause was unknown. The conditions associated with secondary fever were nosocomial infections (27%) and subdural effusion (23%); 39% were of indeterminable cause. Neither the duration nor the patterns of fever correlated with neurologic abnormalities at discharge, including hearing deficit.

Neurological control of fetal heart rate in 20 cases of anencephalic fetuses

Fetal heart rate (FHR) is influenced by the central nervous system, cardiac automatism, biochemical factors, etc. Changes in FHR were correlated with the anatomic defect in autopsy material from 20 anencephalic infants, and, on this basis, the following hypotheses were formed, subject to later experimental proof. (1) The FHR baseline level is controlled by the medulla oblongata and vagus nerve. (2) The biphasic sleep-awake pattern is controlled by the cerebral cortex. (3) The midbrain is involved in the occurrence of acceleration. (4) A relative high level of short-term variability is shown when small lesions of the lesser central nervous system are present, but we cannot conclude that the cortex is critical for short-term variability. On the other hand, long-term variability seems to be correlated to the presence of the medulla oblongata and midbrain, and might be amplified by the cerebral cortex. (5) U-shaped decelerations are connected with the medulla oblongata, but V-shaped decelerations depend on intracardiac reflexes and myocardial stretch.

T-lymphocytes subpopulations in peripheral blood of hepatocellular carcinoma patients

Using commercially available monoclonal antibodies, we can classify the subpopulations of T-lymphocytes into OKT4+ cells (inducer/helper) and OKT8+ cells (cytotoxic/suppressor). Total of 32 histologically confirmed hepatocellular carcinoma (HCC) patients and 32 normal healthy individuals compatible in age and sex were included in this study. The result indicated that decline of OKT4+ cells, increase of OKT8+ cells and decrease of OKT4+ cells/OKT8+ cells ratio were observed in HCC patients as compared with normal control group.

Detection of teichoic acid antibodies in children with staphylococcal infections

The presence of serum antibodies to teichoic acid was evaluated by gel diffusion and enzyme-linked immunosorbent assay in 14 patients with deep-seated staphylococcal infection, in 5 patients with superficial staphylococcal infections, in 10 patients with Gram-positive infections other than staphylococcal and in 12 age-matched, uninfected patients. Serum samples were obtained on admission and serially each week during hospitalization. Teichoic acid antibodies were detected by gel diffusion in only 5 of 14 patients with deep-seated staphylococcal infections, in 1 of 10 patients with other Gram-positive infections and in none of the other patients. With the enzyme-linked immunosorbent assay method all patients with deep-seated staphylococcal infections had concentrations of teichoic acid antibodies of 1:1600 or greater, and these titers were significantly larger than those in the other groups of patients. Using a titer of 1:3200 or greater as a diagnostic level in children with deep-seated Staphylococcus aureus infections, the sensitivity was 93% and the specificity was 89%. For all staphylococcal infections the sensitivity was 79% and the specificity was 96%.

Human polymorphonuclear leukocyte collagenase and gelatinase. Comparison of certain enzymatic properties

Collagenase and gelatinase of human PMN leukocytes were separated by serial chromatography. The enzymes were shown to be similar in latency, activatability, chromatographic and electrophoretic behavior and the response to inhibitors. They recognize the same peptide linkage for cleavage, only each with a distinct difference in the effect caused by the secondary binding sites of the substrate molecules.

Psychiatry and Chinese culture

When we examine the cultural characteristics that influence mental disorders and related behavior among the Chinese, no major differences are found between Chinese and other groups in the range of disorders or in overall prevalence. Several cultural factors influence the recognition and treatment of mental illness, among which are attitudes toward emotional display, somatic as opposed to psychogenic disorders and features of the traditional medical belief system in Chinese culture. The Chinese have a relatively favorable prognosis of schizophrenia, low rates of depressive illness, a strong tendency towards somatization and the presence of several unique culture-bound syndromes. From studying Chinese in Vancouver, it was found that they have a characteristic way of dealing with mental illness in the family, in that there is first a protracted period of intrafamilial coping with serious psychiatric illness, followed by recourse to friends, elders and neighbors in the community; third, consultation with traditional specialists, religious healers or general physicians; fourth, outpatient or inpatient treatment from specialists, and, finally, a process of rejection and scapegoating of the patient. The efficacy of Western psychiatric treatment of Chinese patients has yet to be objectively assessed.

Monitoring of T lymphocytes before and after surgical removal of hepatic tumors

Monitoring of peripheral T lymphocyte level after surgical removal of hepatic tumors has been periodically carried out in thirty patients to observe the relation between T lymphocytes suppression and presence of tumor. Rosette formation with neuraminidase treated sheep erythrocytes has been considered as T lymphocytes. Twenty-two cases were considered as free from residual hepatic tumor after operation and eight cases were diagnosed as residual or recurrent hepatic tumor postoperatively. The result indicated that significant difference in T lymphocyte level has been observed between preoperative level (59.3 +/- 14.0%) and postoperative 4th week level (69.4 +/- 5.5%) 5th week level (69.5 +/- 8.3%) (both p less than 0.01) in group of complete removal of hepatic tumor. While in group of residual or recurrent hepatic tumor, the average T lymphocytes stayed at rather low level throughout the postoperative course. From another point of view, when we compare the T lymphocyte level between the two groups, significant difference has been observed either at postoperative 4th week (69.4 +/- 5.5% vs 57.8 +/- 12.7%) or at postoperative 5th week (69.5 +/- 8.3% vs 53.8 +/- 11.6%) (both p less than 0.01). Accordingly we believed that there is a close relation between depressed T lymphocyte level and presence of hepatic tumor.

Novel renin inhibitors containing the amino acid statine

The proteolytic enzyme renin (EC3.4.99.19) cleaves the protein substrate angiotensinogen to yield angiotensin I, the decapeptide substrate transformed by converting enzyme into the pressor substance angiotensin II. Although the contribution of this pathway to the maintenance of normal blood pressure is unclear, it seems to be a major factor in various hypertensive states. Important progress in the control of hypertension has been achieved by development of the potent inhibitors SQ-14,225 (captopril) and MK-421 (enalapril maleate), which block the generation of angiotensin II by the inhibition of angiotensin converting enzyme. An attractive alternative to the inhibition of converting enzyme would be the blockade of the preceding step in the cascade, the renin reaction. We report here new highly potent (IC50 = 10(-9)-10(-8) M) competitive inhibitors of renin in which statine, (3S,4S)-4-amino-3-hydroxy-6-methylheptanoic acid, is incorporated into analogues of the pig renin substrate (Fig. 1).

Inhibition of immune aggregate-induced activation of the first complement component by cationic polypeptides

A cationic amino acid copolymer (CP530) with a molar ratio of lysine, leucine, tryptophan and phenylalanine of 11:2:1:1 and a Mr of about 2300 was prepared and its inhibitory effects on the complement cascade was compared with those of polylysine with a Mr of about 3000. The effects by these two cationic peptides appeared to be at the early stage of complement activation. CP530 and polylysine inhibited the binding of C1q to insoluble IgG aggregates with a concentration required for 50% inhibition of 0.7 and 0.9 mM, respectively. Both compounds were also potent inhibitors of immune hemolysis (a concentration causing 50% inhibition, 0.5 and 3.5 microM respectively) as well as assembly of EAC cell intermediates required for formation of C3 and C5 convertases (a concentration of 50% inhibition of 1.0 microM for CP530 and 3.8 microM for polylysine). However, CP530 was shown to be distinctly more effective against the activation of C1r . Cls complex induced by insoluble IgG aggregate-bound C1q, requiring 0.15 mM for 50% inhibition compared to greater than 10 mM for polylysine. The 50% inhibition value for soluble IgG aggregate-induced activation of C1 in whole serum was 0.7 mM for CP530 and 5.0 mM for polylysine. The greater inhibition of C1 activation by CP530 than that exerted by polylysine could be attributable to the presence of non-lysyl residues which provide the structural basis for specificity and potency.

Mental health in the Third World

In spite of great national and international efforts and relative success in achieving technological and economic progress, the underlying situation in the Third World offers little cause for optimism. Some notable exceptions notwithstanding, in most countries poverty is increasing at an alarming rate, with its accompanying misery, poor health, and social unrest. Unequal distribution of material wealth, political instability, and the crumbling of traditional and cultural values are also increasingly prevalent. Critical assessment of the philosophy, goals, and methodology of development is an urgent requirement in many nations. Mental health endeavors in the Third World need similar reformulation of both immediate and long range objectives and methods, if ever-increasing mental health demands fostered by such rapid and sweeping changes are to be met. Four major models--the hospital-based model, the medical school-based model, the community-based model, and the voluntary organization model--have so far been the basis for mental health development in Third World nations and, to a certain extent, have produced the needed personnel and services. A fifth model--the primary health care model--seems to hold more promise for the future. By virtue of its integration with general health and other administrative social networks, it can more easily reach out to the community, providing both curative and preventive mental health. Whichever model or combination of models any one nation or region adopts, future mental health endeavors in the Third World should be an integral part of overall social policy and health planning. Taking children, family, and school as major foci, such efforts are indispensible and should constitute a positive force in shaping the continuing process of social evolution.

Inhibition of immune complex-mediated activation of complement. Effects of agents modulating activation of, and the activated C1 complex

Several known chemical compounds were shown to selectively inhibit the interaction between immune aggregates and C1q, the activation of C1r-C1s complex by immune aggregate-bound C1q, and the esterolytic activity of the activated C1s, C1s. These reactions are relevant to the functions of the first complement component, C1, and its activation induced by immune complexes. The effects of these inhibitors on tissue injury mediated by immune complex-induced complement activation, such as immune hemolysis, passive cutaneous anaphylaxis, and experimental glomerulonephritis were examined. The results suggest an approximate correlation between the activity shown on the molecular level and that obtained in vivo. One such compound, suramin, was shown to be an effective inhibitor of PCA and the proteinuria manifestation of EGN while not affecting antibody fixation to tissue or histamine-mediated skin reaction. These results suggest that effective suppression of the initial steps of complement activation may be of value of controlling immune complex-mediated tissue injuries in disease.

Lack of leukocyte migration inhibition by hepatitis B surface antigen in hepatocellular carcinoma patients

Soluble part of hepatocellular carcinoma (HCC) tissue extracts with or without hepatitis B surface antigen (HBsAg) was tested against leukocytes of 13 histologically confirmed HCC patients. Inhibition of leukocyte migration was observed in 9 out of 13 cases when tested by soluble HCC extract containing HBsAg, while inhibition of lukocyte migration was observed in 8 out of 13 cases when tested by solublp greater than 0.05, by Fisher's exact test). In the meantime, soluble HCC extract with or without HBsAg did not significantly cause inhibition of leukocyte migration in 12 non-HCC patients. Therefore, it is concluded that inhibition of leukocyte migration in HCC patients is caused by the tumor-associated antigen, not caused by HBsAg.

Purification of soluble hepatocellular carcinoma extracts

When soluble hepatocellular carcinoma (HCC) extract prepared by 3 M KCl solution was passed through a column of Sephadex G-200, four fractions (designated as I, II, III, IV) could be obtained from the elution profile. By leukocyte migration inhibition assay, the active component of soluble HCC extract which represented tumor-associated antigen was shown to be contained in fractions I and II.

Regeneration of human liver after hepatic lobectomy studied by repeated liver scanning and repeated needle biopsy

Regeneration of the residual lobe of the liver after hepatic lobectomy in humans was studied by repeated liver scanning in seven noncirrhotic and three cirrhotic patients. Each patient was studied for several months during the study which lasted from 1-12 years. Regeneration was apparent in noncirrhotic liver remnants following hepatic lobectomy. In the case of a long standing, space occupying lesions such as benign giant cysts, the liver remnant would complete its regeneration process rather early, usually within a few months of hepatic lobectomy. In hepatoma cases, however, regeneration of the residual lobe after hepatic resection usually took five or six months for completion. On the contrary, no definite increase in the size of the liver remnant was seen on repeated liver scanning in cirrhotic patients. Histologic study of the residual lobe was repeated on needle biopsy specimens in two noncirrhotic and four cirrhotic patients. Regenerative hyperplasia of liver cells with large hyperchromatic, or double nuclei never seen in the preresection liver appeared in the liver remnant five, 11, and 27 days after hepatic lobectomy in noncirrhotic patients. In cirrhotics, however, there were no histologic changes between the preresection liver and the postresection remnant studied three, five, 15, 40 days or even two years and 8 months after hepatic lobectomy.