Homogeneous substrate-labeled fluorescent immunoassay for carbamazepine

Carbamazepine is an anticonvulsant drug useful in the management of epilepsy. Because of the narrow therapeutic range, serum carbamazepine monitoring is useful for ensuring adequate drug therapy without toxicity. We report the development of a homogeneous substrate-labeled fluorescent immunoassay for carbamazepine in human serum. A carbamazepine fluorogenic reagent (FR) has been synthesized. Upon hydrolysis by beta-galactosidase, the nonfluorescent FR produces a fluorescent product. This enzymic hydrolysis sin inhibited when the FR binds with antibody against carbamazepine. The inhibition is relieved when carbamazepine competes with FR for available antibody binding sites. Thus, increasing levels of carbamazepine result in increasing levels of fluorescence that can be conveniently monitored with any conventional fluorometer. For low, medium, and high control sera (4, 12, and 16 micrograms carbamazepine/ml), the within-run coefficient of variation for the assay is 5.5%, 1.6%, and 2.9%, respectively, while the respective between-run coefficients of variation are 3.5%, 1.9%, and 2.3%. Fifty-three clinical serum samples were assayed by the SLFIA, gas chromatography (GC), high pressure liquid chromatography (HPLC), and an enzyme immunoassay method. The SLFIA method compares favorably with the HPLC technique (r - 0.97, slope = 1.10, y-intercept = 1.21), the enzyme immunoassay (r = 0.98, slope = 1.07, y-intercept = 0.82), and the GC method (r = 0.95, slope = 1.01, y-intercept = -0.03).

Intracranial pressure and cerebral arterial pulsatile flow measurement in neonatal intraventricular hemorrhage

We examined the clinical significance of noninvasive intracranial pressure measurements and pulsatility indices in 74 infants with confirmed IC-IVh. The intracranial pressure measurements were obtained using the applanation principle, and the pulsatility indices were calculated from the Doppler flow velocity tracings of the anterior cerebral artery. Fifty-three infants (71.6%) who died had a significantly lower birth weight and gestational age than those who survived. Survival rate decreased significantly with increased intracranial pressure (P less than 0.0002) and increased pulsatility indices (P less than 0.0001). We found no significant relationship between outcome and the size of IC-IVH demonstrated by CT scan. Birth weight, intracranial pressure measurements, and cerebral arterial pulsatile flow changes appear to be major prognostic indicators in neonatal IC-IVH.

The thoracic outlet syndrome produced by costochondritis

Thoracic outlet syndrome (TOS) is a rare condition in children. Compression of the neurovascular bundle as it passes from the neck through the thorax into the arm may be produced by numerous anatomic and structural abnormalities. This case represents compression produced by spasm of the pectoralis minor muscle originating from costochondritis.

Radio-ligand immunoassay for human hemoglobin variants

A quantitative method is described for the individual assay of human hemoglobin variants occurring singly or in mixture. The hemoglobin to be assayed is bound to specific antibody; the immune complex is attached to protein A-containing S. aureus and removed from the mixture. The hemoglobin thus isolated is quantified by its ability to bind radiolabeled haptoglobin. The technique is accurate and distinguishes among the 4 hemoglobins tested, namely Hb A, S, C and F. It has the advantage over conventional radioimmunoassay that a single probe, radiolabeled haptoglobin, is needed for the specific assay of any hemoglobin.

Thiabendazole-resistant strains of Haemonchus and Ostertagia in California lambs

Ten parasite-free experimental lambs were inoculated intraruminally with a mixed-larvae inoculum which contained approximately 5,000 Haemonchus contortus infective larvae. Five lambs were treated with thiabendazole (66 mg/kg of body weight) and 5 were untreated controls. All lambs were killed 35 days after inoculations were done, and parasites present were recovered. Reduction in numbers of recovered Haemonchus contortus (25.7%) and Ostertagia spp (26.8%) were not significant (P greater than 0.05).

Synthesis and biological activities of arachidonic and alpha- and beta-alkyl-substituted arachidonic acid derivatives

In the male retired breeder rat, arachidonic acid 1a and 2,2-dimethylarachidonic acid 3a exhibited plasma platelet disaggregation as measured after 3 hr after the compounds were administered intragastrically at 15 and 13 mg/kg/rat mean effective dose (MED), respectively. The corresponding p-t-butylphenol ester of the acids showed a remarkable potentiation of platelet disaggregation. The MED for p-t-butylphenol ester of AA was 1.1 mg/kg/rat.

Pancoast's tumor: irradiation or surgery?

Seventy-three patients with Pancoast's tumor treated at the University of Maryland Hospital between 1955 and 1978 were reviewed. Three were 34 squamous cell carcinomas, 13 undifferentiated, 10 adenocarcinomas, 4 mixed adenosquamous, 1 alveolar cell, and 11 undetermined. Twenty-nine patients received irradiation, with 7% survival at 3 years; 19 patients underwent preoperative irradiation followed by en bloc resection of chest wall, with 23% survival at 3 years; 5 patients underwent extended resection, with 60% survival at 3 years; and 18 patients underwent operation followed by irradiation, with 7% survival at 3 years. Retrospective staging of 42 patients undergoing operation indicated that 22 (52%) were inoperable. Prognosis was related to staging of the disease, the extent of local invasion, nodal involvement, cell type, and adequacy of operation.

Hypoplasia of the lumbar vertebral body simulating spondylolisthesis

Fifty cases of spondylosis and spondylolisthesis were reviewed. In 9 of the 20 cases interpreted as Grade I spondylolisthesis at L5-S1, the sagittal diameter of L5 was shortened, creating a false impression of vertebral slippage. Such cases are felt to represent spondylolysis with hypoplasia of the vertebral body rather than true spondylolisthesis.

Cytological changes senescing WI-38 cells: a statistical analysis

Changes in the cell, nuclear, nucleolar dry masses and areas were monitored simultaneously during in vitro senescence of WI-38 human fetal lung fibroblast cells, and the results were analyzed statistically. There was a two-step increase in all six parameters studied, following an initial decrease. The patterns of increase were strikingly similar for all six measures, i.e., an initial lag period was followed by a sharp increase, a plateau and a final, abrupt increase. In all cases, there was a strong correlation between corresponding area and dry mass measurements for each cell component. The dry mass/area ratio also increased as a function of in vitro aging and ultimately doubled in value. Weak intrapassage correlations between cell, nuclear and nucleolar dry masses indicated that there were passage to passage differences in the relative rates of dry mass increases which were not apparent over long periods of growth. The increases in all muclear and nucleolar areas were interdependent until the last doubling where they increased independently. The standard deviation for all six parameters increased as a function of in vitro senescence indicating that there was an increase in the heterogeneity of cells relative to these parameters.

Air pollutants and the admission rate of psychiatric patients

The authors studied the correlation between mean daily levels of several air pollutants and the number of emergency room visits and inpatient admissions to a psychiatric hospital in St. Louis during one summer and fall. Nitrogen dioxide and carbon monoxide showed a positive correlation with emergency room visits by all patients, and nitrogen dioxide also had a positive correlation with inpatient admissions of subjects with diagnoses that were unknown or could not be specified as psychotic. Nitrogen monoxide showed a negative correlation with inpatient admissions during working days (but not during weekends and holidays) for all patients, as well as for those with diagnoses that were unknown or could not be specified as psychotic.

Bronchopleural fistula. Thirteen-year experience with 77 cases

Bronchopleural fistula, although reduced in incidence in recent years, remains a grave complication of pulmonary disease and of pulmonary resection. In a series of 77 patients treated for bronchopleural fistula over a 13 year period, 49 of whom had postresection fistulas, only 44 (57.1 percent) were cured of the fistula and 15 (19.5 percent) died. Prevention assumes great importance. Key factors in prevention are avoidance of pulmonary resection in tuberculous patients with positive sputum; overzealous dissection of the bronchus; a long bronchial stump; tumor in the bronchial stump; contamination of the pleural cavity; and too little tissue left behind to fill the pleural space. Treatment should be surgical. In none of the six patients treated conservatively was the fistula obliterated. Seventy-one patients were treated surgically, and 133 operations were needed to effect fistula obliteration in the 44 patients (62 percent) in whom this was achieved. Adequate surgical drainage has always been the sine qua non of effective treatment, and yet this alone brought about closure of the fistula in only nine patients. Early resuture of the bronchial stump succeeded in only two of five patients. Thoracoplasty combined with drainage effected closure in seven of 11 patients. The highest rate of fistula closure with the lowest mortality occurred among the 20 patients who underwent myoplasty, usually combined with a limited thoracoplasty. In this group, the fistula was obliterated in 16 patients, with one death.

Bronchial adenoma--benign or malignant?

Bronchial adenomas grow slowly and are potentially malignant. Of the 45 cases reviewed, 36 were carcinoids, six were adenocystic carcinomas, two were mixed tumors, and one was mucoepidermoid carcinoma. The carcinoid group is subdivided into histologically typical 27(75%), atypical 9 (25%), and metastasizing 9 (25%) adenomas. There were 32 lobectomies, seven pneumonectomies, one sleeve resection, and two tracheal resections for adenocystic carcinoma. Ten-year survival rate was 88% for typical carcinoids, 66% for atypical carcinoids, and 44% for metastasizing carcinoids. In the cylindroma group, one patient was lost to follow-up, one died postoperatively, and one developed recurrence of the tumor eight years later. The only patient with mucoepidermoid carcinoma is alive without evidence of recurrence nine years after operation.

Anthelmintic efficacy of oxfendazole in calves

Oxfendazole, methyl [5-(Phenylsulfinyl)-1H-benzimidazol-2-yl]carbamate given to calves at dose level of 2.5 mg/kg as a paste, as a bolus, or as a drench resulted in excellent (97 to 100%) anthelmintic efficacy against mature Ostertagia ostertagi, Trichostrongylus axei, Cooperia oncophora, C mcmasteri, C pectinata, C punctata, Nematodirus helvetianus, Trichostrongylus longispicularis, Chabertia ovina, and Oesophagostomum radiatum. Against the early 4th stage larvage of O ostertagia and N helvetianus, these formulations had anthelmintic efficacies of 71% to 87% and 21% to 65%, respectively. As the result of differences in drug intake by individual calves, a pelleted feed additive given as top dress on chopped alfalfa hay gave an unsatisfactory mean anthelmintic response. Anthelmintic action in individual calves ranged from none to 98--100%.

The use of chest wall muscle flaps to close bronchopleural fistulas: experience with 21 patients

Nineteen patients with bronchopleural fistulas associated with tuberculosis and 2 patients with fistulas following resection for bronchiectasis underwent closure of the fistulas with pedicled flaps of chest wall muscle. The muscle grafting was combined with a limited thoracoplasty in 13 patients. The initial myoplasty produced prompt fistula closure in 15 patients and delayed closure in 2 others. A repeat myoplasty was successful in 2 patients in whom the initial myoplasty failed. Compared with other methods of treating bronchopleural fistulas used during the same period, muscle grafting carried a higher rate of successful fistula closure and a lower mortality rate.

Encephalocraniocutaneous lipomatosis

Two patients with encephalocraniocutaneous lipomatosis have been studied. The main features of the syndrome are unilateral cutaneous and ophthalmologic lesions with ipsilateral cerebral malformations. Seizures beginning in infancy and varying degrees of mental retardation are present in affected patients. The involved tissues are derived from the embryonic ectodermal and mesodermal layers.

Hypolipidemic activity of 5-aryl-3-methylvaleric acid derivatives

Several 5-aryl-3-methylvaleric acid derivatives have been shown to be more potent hypolipidemic agents than the previously reported 5-(4-biphenylyl)-3-methylvaleric acid (1). The most active compound in this series was 5-(4-phenylsulfonylphenyl)-3-methylvaleric acid (10) which lowered serum cholesterol levels 45% and serum triglyceride levels 60% in normal rats. Significant lowering of the serum triglyceride levels was the predominant effect noted with most of the compounds tested.

Studies of methods for in situ observation of gastric motility in domestic turkeys

The normal gastroduodenal contraction cycle of turkeys is believed to be controlled and coordinated by the myenteric plexus which lies just under the serosa of the muscular stomach. Methods which would permit direct application of chemical and physical stimuli to these gastric nerves were studied in intact and decerebrate turkeys using both radiographic and direct observations to monitor contraction cycles. In intact turkeys, general anesthetics (sodium pentobarbital, halothane; and ketamine hydrochloride) inhibited gastric motility. A local anesthetic (lidocaine hydrochloride) injected into the skin and abdominal muscles caused a depression of motility. In both intact and chronically decerebrate turkeys laparatomy (after local anesthetic in intact birds) and a neuromuscular blocking agent (gallamine triethiodide) also depressed gastric motility. Motility was slightly reduced by artificial respiration and exposure of the serosal surface of the stomach and intestines to air via an abdominal fistula.

Temephos collars for control of fleas on dogs and cats

Efficacy of polyvinyl chloride collars containing temephos [0,0'-(thiodi-4,1-phenylene) 0,0,0',0'-tetramethyl bis-(phosphorothioate)] was elevaluated in dogs and cats against the cat flea (Ctenocephalides felis). Over a period of 42 weeks, collared (treated) and control dogs were experimentally infested with 100 fleas 23 times, and control and treated cats were similarly infested 20 times during a 41-week period. Flea populations on treated dogs were reduced by 80% or more for at least 36 weeks. Initially, flea reduction by 80% occurred within 1 day, but in dogs wearing the same collars for 26 weeks, this reduction occurred in 3 to 6 or more days. Only during the first 2 weeks of wearing the collars were all fleas killed on all dogs within a 6-day period after infestation. Residual efficiency was lowest on highly active dogs and greatest on inactive dogs. The residual efficiency on cats was somewhat better than on dogs. At the end of 41 weeks, collars on cats reduced the flea population by 85 to 90% within 1 to 5 days following infestation. Collars on cats, as on dogs, were 100% efficacious only during the first 2 weeks of the trial.

Insecticidal activity of propoxur- and carbaryl-impregnated flea collars against Ctenocephalides felis

Ten dogs were fitted with 10% propoxur-(0-isopropoxyphenyl methylcarbamate) and 10 dogs were fitted with 16% carbaryl-(1-naphthyl-N-methylcarbamate) impregnated flea collars. Ten cats were fitted with carbaryl-impregnated flea collars. There were 5 control animal for each trial. Insecticidal activity against experimental infestations with the cat flea (Ctenocephalides felis) was evaluated. The propoxur collars on dogs reduced the flea populations by 90% within 2 days of infestation for at least 13 weeks. By the 16th week, the flea population was reduced 65% in 2 days and 87% in 7 days. In subsequent infestations, efficiency was less than 80% after 7 days. Carbaryl collars on dogs reduced the flea population by as much as 80% in 2 days for a period of 16 weeks. An efficiency of at least 80% at 7 days was maintaned for 17 weeks. Carbaryl collars on cats reduced the flea population within 2 days by 80% or more for a period of at least 19 weeks--the last experimental infestation.

Metabolic characterization of the viable, residually dividing and nondividing cell classes of recombination-deficient strains of Escherichia coli

The abilities of rec+, recB- recC-, recA-, and recA- recB- rec C- strains to support growth of bacteriophage T4, to take up oxygen, and to maintain cell integrity have been measured. (i) With respect to bacteriophage T4 growth, T4 phage is produced with identical lysis time in single -step growth curves with all strains tested. rec- strains show reduced phage production (fewer infected centers), but the average burst size per infected center is the same for all strains tested. Some rec- cells are unable to produce any phage, whereas the remainder of the rec-cells produce phage as rapidly and as efficiently as rec+ cells. (ii) With respect to oxygen consumption, rec- strains are deficient relative to the rec+ control to the same extent as the deficiency in phage production by theculture. The reduction in oxygen consumption is coordinate with reduction in rate of mass increase of the rec- culture. (iii) With respect to cell integrity, rec- cultures show increased lysis as measured by release of beta-galactosidase into the medium. The kinetics of release suggest that rec- nondividing cells all eventually lyse. These results are most consistent with the idea that rec- residually dividing cells and viable cells are metabolically normal according to the parameters we have measured, whereas nondividing cells are metabolically inactive.

Pulmonary aspergillosis: an analysis of 41 patients

During the period 1969 to 1974, 41 patients having cultures positive for aspergillus were seen on the thoracic surgical services of the University of Maryland and Mt. Wilson State Hospitals. Intracavitary mycetoma was present in 36 patients. In 32 the underlying disease was chronic cavitary tuberculosis, 5 had decreased immunity due to other diseases, and in 3 no underlying disease was noted. One final patient developed a mycetoma following repair of tetralogy of Fallot. Hemoptysis, the predominant symptom, occurred in 23 patients, all of whom were from the group with intracavitary mycetoma. Hemoptysis was life-threatening in 8 patients, severe but not life-threatening in 12, and minimal in 3. Fifteen patients underwent pulmonary resection with 2 deaths. Both patients who died had undergone emergency resection for life-threatening hemoptysis; the fungus ball had developed following a previous resection for tuberculosis, and both had poor pulmonary reserve. Of 10 patients with hemoptysis who were not treated surgically, chiefly because they were poor operative risks, 4 died. This study suggests that pulmonary aspergillosis, particularly of the intracavitary type, is a potentially life-threatening disease. Because of the suddenness with which massive hemoptysis may occur, pulmonary resection is recommended for all patients with intracavitary mycetoma who do not constitute prohibitive operative risks.

The value of thoracoplasty before extensive unilateral resection for pulmonary tuberculosis

Among 24 patients who required extensive unilateral resection for tuberculosis, 17 underwent adequate thoracoplasty before resection and seven others received either no thoracoplasty before resection or an inadequate one. These two groups were comparable as to severity of disease and operative risk. The incidence of serious complications was 83 per cent in the latter group compared to 12 per cent in the former. While the number of patients in each group is too small for a statistically valid comparison, the results suggest that an adequate thoracoplasty before resection is of definite value in preventing pleural complications after extensive unilateral resection for tuberculosis.

Insecticidal activity of temephos against Ctenocephalides felis on dogs and cats

Dogs and cats were treated with 2% temephos [0,0'-(thiodi-p-phenylene) 0,0',0'-tetramethyl bis (phosphorothioate)] powder to evaluate its insecticidal activity against the cat flea (Ctenocephalides felis). Dogs and cats were infested each week with approximately 100 unfed, unsexed fleas less than 14 days old. Live-flea counts were made each day. The experiment was terminated when all dogs and cats retained live fleas for 6 days or more. The 2% temephos powder resulted in excellent flea control on dogs and cats for 2 weeks, partial control for 3 to 4 weeks, and no effective control beyond 4 weeks.

Pulmonary tuberculosis and coexisting carcinoma: a 10-year experience and review of the literature

Of 7,986 patients admitted to Mount Wilson State Hospital for Pulmonary Diseases between 1960 and 1970, 72 were proven to have coexisting pulmonary tuberculosis and bronchogenic carcinoma. The patients usually were in the older age group, and usually smoked. There was a high predilection for the tumor to occur in the upper lobes. Active tuberculosis was present in 50 per cent of the patients and tumor and tuberculosis was present in the same area 80 per cent of the time. Cell diagnosis was possible in 60 per cent of the patients without thoracotomy. Diagnosis was usually made late in the course of the disease and therapeutic results were poor. Only 13 patients were operable and only four are presently alive. Earlier recognition is vital to adequate treatment. A plan for earlier recognition based on a high degree of suspicion is presented.

Surgical treatment of pulmonary infections caused by atypical mycobacteria

Pulmonary disease caused by atypical mycobacteria frequently constitutes an indication for operative treatment, since these bacteria are usually resistant to most forms of chemotherapy. Since 1968 11 patients having pulmonary infection caused by atypical mycobacteria underwent pulmonary resection. All patients, except one who had bilateral disease, left the hospital with negative sputum status. Pulmonary resection is an effective means of therapy for atypical mycobacterial pulmonary infection. Such treatment can be carried out with low morbidity and mortality, and is indicated in cases of poor response to drug treatment or persistent residual lesions.

A salt-inhibited cytochrome c reductase obtained from the moderately halophilic bacterium, Micrococcus halodenitrificans

A membrane-bound cytochrome c reductase from Micrococcus halodenitrificans was inhibited by NaCl at concentrations as low as 0.05 m. The inhibition was competitive with respect to cytochrome c and noncompetitive with respect to reduced nicotinamide adenine dinucleotide. Thus the effect of NaCl was to increase the apparent K(m) of the enzyme for cytochrome c and not to inhibit the intrinsic activity of the enzyme.