The Rh antigen specificity of erythrocyte proteolipid

A proteolipid was purified from erythrocytes by chloroform-methanol extraction and reconstituted into lipid micelles. This purified micellar proteolipid was used to demonstrate that different Rh antigens reside on the same protein molecule.

Stress fracture of the fifth metatarsal

Stress fractures of the fifth metatarsal have been reported with increasing frequency, especially in athletes. Prolonged healing time and the risk of refracture following conservative treatment have led to recommendations for operative treatment including bone grafting of these fractures. An axial intramedullary screw, inserted without opening the fracture site, was used in 10 athletes with stress fractures of the fifth metatarsal. Union was obtained in all patients in an average of 7.5 weeks. All patients returned to their sports in an average of 8.5 weeks postoperatively. There were no operative complications or refractures after screw insertion. Complaints of local pain over the screw head and/or the fifth metatarsal head, seen in 7 of the 10 patients, were relieved by local shoe modifications.

Defective spectrin dimer-dimer association in a family with transfusion dependent homozygous hereditary elliptocytosis

Red cell membrane proteins have been examined in a family in which three children have severe transfusion-dependent homozygous hereditary elliptocytosis. The membranes in all three show a considerable excess of spectrin dimers over tetramers in spectrin extracts. The red cell membranes of their parents with heterozygous hereditary elliptocytosis show a lesser but significant increase in spectrin dimers. Some of the family members also have an alpha-globin gene deletion and haemoglobin D trait. The present results are the first demonstration of a defect of spectrin dimer-dimer association in homozygous elliptocytosis and provide strong support for the concept that this defect is the primary cause of the red cell abnormality in at least some families of hereditary elliptocytosis.

Detection of an antigen on the inner surface of Rh negative erythrocytes which binds anti-D IgG

Previous investigation have demonstrated the presence of the Rho(D) antigen in Rh negative erythrocytes. The intact Rh negative cell, however, does not bind anti-D IgG. Presently we have shown that an anti-D binding antigen resides on the cytoplasmic surface of Rh negative erythrocyte membranes. Unsealed Rh negative membranes, in which both the inner and outer surface are exposed, bind anti-D IgG. Dicyclohexylcarbodiimide specifically blocked the binding of anti-D IgG to these membranes. Sealed Rh negative membranes which expose only their external surface, failed to bind anti-D antiserum. These results were confirmed by proteolytic digestion of membrane preparations and subsequent Rho(D) antigen purification. Only when protease had access to the inner surface of Rh negative erythrocyte membranes did degradation of this 'D' antigen occur. Thus, intact Rh negative erythrocytes contain an antigen which binds anti-D antibody but is located on the inner surface of the membrane. In contrast, Rh positive erythrocytes expose Rho(D) antigen on the external surface of the membrane.

Reflections on nuclear warfare

The author looks back on his more than 70 years of familiarity with Americans involved in warfare, noting their loyal support for our country's objectives. Drawing on the Einstein equation, his own visits to Hiroshima and Nagasaki, and current literature, he, as a physician, belatedly concurs with those who look on the use of nuclear weapons as irrational and untenable. Their employment under present circumstances would create a "final epidemic" to be avoided only by prevention. He suggests that medical perceptions must be considered by our national leaders in assessing the many factors that he hopes will lead to rational answers to this urgent, highly complex, and vital enigma. He cites physicians' efforts to help in finding answers and asks that his colleagues consider the issues with attention to the gravity of the situation and act according to their best judgment.

The Rhesus D antigen. A dicyclohexylcarbodiimide-binding proteolipid

Previous studies on the human Rhesus D antigen revealed several similarities between the D antigen and proteolipids. Proteolipids are a family of low-molecular-weight, hydrophobic proteins that are soluble in chloroform/methanol. In addition, many proteolipids bind dicyclohexylcarbodiimide (DCCD), an ATPase inhibitor. For determination of whether the D antigen was a proteolipid, the chloroform/methanol solubility and DCCD binding of the antigen were investigated. DCCD specifically inhibited the binding of anti-D IgG to Rh-positive red blood cells and to partially purified D antigen as determined by enzyme-linked immunoassays. The antigen was not only soluble in chloroform/methanol but was purified to apparent homogeneity by extraction with these solvents and subsequent discontinuous sucrose gradient centrifugation. The antigen's chloroform/methanol solubility, DCCD binding, low molecular weight, and previously reported phospholipid dependence allow classification of the D antigen as a proteolipid. The discovery that the D antigen is a proteolipid provides further clues to the antigen's cellular function.

ABO-incompatible bone-marrow transplantation: removal of red blood cells from donor marrow avoiding recipient antibody depletion

Eight patients with acute leukaemia undergoing allogeneic bone-marrow transplantation from ABO-incompatible donors received red-cell-depleted donor marrow without any procedure to diminish their anti-ABO antibody titres. Successful marrow red-cell removal (mean 98.8%) was achieved by means of a large-volume separation technique on Ficoll-Metrizoate in the IBM 2991 blood-cell processor. Clinically significant ABO-haemolytic reaction was prevented in all patients, and there was neither failure of engraftment nor rejection. This approach used alone is satisfactory for most ABO-incompatible marrow-transplant recipients, although combining this with some method of recipient antibody depletion, such as plasma exchange, is recommended in the occasional patient with high anti-ABO titres.

Retropubic, hypotensive, no-catheter prostatectomy: a review of 100 cases

One hundred patients underwent retropubic prostatectomy. Hypotensive anaesthesia was used and urethral catheters were not used routinely in the post-operative period. Operative and post-operative blood losses were greater than anticipated, especially when compared with the blood lost by patients who have balloon catheters left in place after this operation. The absence of a catheter in the post-operative period did not result in a significant reduction in the rate of urine infection. Fourteen patients required catheterisation after operation for suprapubic leakage of urine and obstruction of the urethra by blood clot. Clot retention did not occur. There were 2 deaths in the series. Sixty-seven patients were discharged on the sixth post-operative day.

Identification of Rho(D) antigen in polyacrylamide gels by an enzyme-linked immunoassay

Human erythrocyte membranes were solubilized in sodium dodecyl sulfate at 100 degree C and subjected to polyacrylamide gel electrophoresis. The gels were sliced into segments and each segment was incubated with anti-Rho(D) IgG, washed, and then incubated with goat anti-human IgG covalently linked to alkaline phosphatase. Para-nitrophenyl phosphate was added to each slice and the absorbance of the solution surrounding each slice was measured at 405 nm. This technique demonstrated that the Rho (D) antigen is a protein with a mol, wt between 13, 000 and 30,000. This method should be applicable to the investigation of other membrane-bound antigens.

Steroid receptor proteins in human meningiomas

Steroid receptor assays play an important role in determining the efficiency of endocrine therapy for patients with breast cancer. Other tumors could also be hormonally dependent and patients with these tumours might also benefit from endocrine manipulation. Thus, patients with meningiomas were tested for the presence or absence of estrogen and progesterone receptors. The results showed that a majority of meningiomas lacked estrogen receptors but contained large amounts of progesterone receptor. Therefore, it should be possible to use antiprogestin therapy in cases where complete surgical resection of meningiomas is not possible.

Jejunal villous changes associated with farmer's lung

Eighty-one patients with farmer's lung were screened for evidence of coeliac disease by assessing their clinical features, haemoglobin indices, serum vitamin B₁₂ and folic acid levels. HLA typing was carried out and the frequency of antireticulin and other auto-antibodies was determined. Two out of 21 patients selected for jejunal biopsy had subtotal villous atrophy, a further 6 had partial villous atrophy and 8 out of 21 had increased lamina propria cellularity. The group as a whole had an increased number of intra-epithelial lymphocytes in the jejunal musosa. Sera of 7 out of 81 patients contained antireticulin antibody compared with 2 of 81 control subjects, a difference without significance. Other autoantibodies were not more frequent in the patient than in the control group and were of normal incidence. HLA antigens were also similar in both groups.

Cryotherapy and nerve palsy

Ice application is one of the most extensively used treatments for athletic injuries. Frostbite is a recognized danger. Five cases of nerve palsy resulting from ice application are reported here. These palsies were temporary. They usually resolve spontaneously without any significant sequelae. This complication can be avoided by not using ice for more than 30 minutes and by guarding superficial nerves in the area.

Bacterial content of enucleated prostate glands

An investigation has been done to study the bacterial content of the prostate gland in a group of 100 patients who underwent retropubic prostatectomy. The operation was performed under hypotension, and catheters were not used in the postoperative period. One-half the patients presented with retention of urine; the remainder underwent elective operation. Eighty-seven patients had sterile urine at the time of surgery, but bacteria were isolated from the prostate gland in 42 patients. It was confirmed that the longer a catheter was left indwelling before operation, the greater would be the likelihood that bacteria would be isolated from the gland. In patients who did not require catheterization before operation, the incidence of bacterial infection of the gland was 40.8 per cent. Bacteria isolated from the prostate were responsible for the majority of the cases of postoperative septicemia and wound infections.

Different ionic forms of estrogen receptor in rat uterus and human breast carcinoma

Estrogen receptors from rat uterus and human breast carcinoma were analyzed by diethylaminoethyl-cellulose chromatography. Cytosols which had been incubated for short periods of time demonstrated a single discrete elution peak, indicating a single ionic form, while cytosols incubated for longer periods of time generated a second ionic form of receptor. Addition of cations to cytosols also promoted the rapid appearance of this second ionic form of receptor. Either leupeptin, a protease inhibitor, or sodium molybdate prevented the appearance of this second ionic form of estrogen receptor. The estrogen receptor from rat uterine cytosol incubated without leupeptin or molybdate had a smaller apparent molecular weight than did estrogen receptor from cytosols incubated with leupeptin or molybdate. Altogether, these experiments suggested that a cation-dependent protease present in the cytosols from both tissues was degrading the estrogen receptor to a second smaller species during extended incubation times.

Microvascular management of ring avulsion injuries

Microsurgical revascularization has proved to be a useful method in managing the ring avulsion injury where both neurovascular bundles are damaged with only partial skin avulsion. Representative cases are used to illustrate guidelines for a practical classification for helping to decide the optimal method of treatment of acute ring avulsion injuries in light of digital revascularization techniques. Nine ring fingers were successfully revascularized of 24 acute ring avulsion injuries reviewed. Sensibility recovery was good and a functional range of motion obtained. No patient who has had his ring finger revascularized has requested its amputation because of appearance, painful neuromas, stiffness, or cold intolerance. Complete amputations, especially proximal to the superficialis insertion, and complete degloving injuries of the ring finger are usually best managed by surgical amputation of the digit.

Synovectomy of the elbow and excision of the radial head in rheumatoid arthritis

Twenty-two patients with rheumatoid arthritis who had partial synovectomy and excision of the radial head were reviewed at an average of five years and four months after operation. Of these, 84% obtained satisfactory pain relief and 76% had improved range of motion postoperatively. Eighty-eight percent were satisfied with the final outcome. We believe satisfactory results can be expected even in the late stages of the disease.

Orchiopexy in prepubertal boys. Five-year survey

A series of 141 prepubertal boys with undescended testes operated on in a provincial teaching hospital has been analyzed five years after operation. The main features noted at presentation were the mature age of the patients and the small number of boys referred by pediatricians. The incidence of unsatisfactory results was 36% in unilateral and 35% in bilateral operations. The majority of the patients (81%) were referred for surgery after the age of five years, commonly regarded as the most suitable time for surgical correction. Three patients required a primary orchiectomy for a small atrophic testis, while 2 patients had an orchiectomy done on a previously operated testis. The complication rate for the series was 4.5%. Testicular biopsy was not done at the time of operation, and no patients were referred for semen analysis. Eight patients underwent a second orchiopexy after the first operation failed. In 6 patients an atrophic testis developed after the second procedure. The need for more than one postoperative examination is stressed in view of the fact that an initially favorable result may not persist since the testes may be found, at a later date, to have retracted into an unsatisfactory position. The reasons for the poor results are discussed and compared briefly with previous reports.