Effect of presensitization with BCG and Mycobacterium leprae on granuloma formation to M. leprae

Granulomas which develop in draining lymph nodes, following the intradermal injection of cobalt-irradiated Mycobacterium leprae into the ear of the guinea pig 2 and 5 weeks earlier, were studied in animals which had been presensitized with BCG vaccine or M. leprae and compared with granulomas that developed in previously unsensitized guinea pigs. Presensitization with mycobacteria accelerated the development of the granulomas. Granulomas in previously unsensitized guinea pigs were found ultrastructurally to contain phagocytosing macrophages similar to those in lepromatous leprosy, and M. leprae presensitization did not alter the type of granuloma found. Those in BCG-presensitized guinea pigs contained secretory epithelioid cells with rough endoplasmic reticulum similar to those found in borderline tuberculoid leprosy or reversal reactions. The significance of these findings in relation to the current use of vaccines in leprosy is discussed.

Acrofacial dysostosis with ambiguous genitalia

We report on a 46,XY infant with mandibulofacial dysostosis, preaxial and postaxial limb anomalies, urethral stenosis with left hydronephrosis, and ambiguous genitalia with phallic/scrotal transposition. This infant with atypical pre/postaxial acrofacial dysostosis (AFD) is the first to be reported with ambiguous genitalia. The acrofacial dysostoses are a heterogenous group of disorders characterized by varying degrees of mandibulofacial dysostosis with acral limb defects and may represent a polytopic field defect. These disorders have generally been separated on the basis of their limb anomalies into preaxial, postaxial, lethal, and atypical types. Most cases are sporadic, but various causes have been postulated including autosomal dominant and recessive inheritance, a chromosome 2q duplication, and a possible case of diabetic embryopathy. We review the nonfacial/limb anomalies in other cases of AFD and compare them to those of our case, thereby expanding the spectrum of anomalies in these disorders.

Congenital hypothyroidism and goitre in childhood

The problems of congenital hypothyroidism and goitre are relatively common in childhood. The investigation and treatment of these disorders requires a knowledge of their various causes, appropriate investigation, and referral for specialist consultation as necessary, as well as involvement of the family physician in the monitoring of effectiveness of and compliance with treatment. Many of these disorders have life-long implications for the individual affected.

Inhibition of urethane leukaemia virus, a murine retrovirus, in mice by zidovudine

The purpose of the study was to characterize in vivo an immunodepressive murine retroviral 'model' for the possible testing of drugs against HIV infection. Urethane leukaemia virus (ULV) injected into adult BALB/c mice (10(5) focus-forming units/mouse) caused a small, significant splenomegaly from 2 to at least 9 weeks after virus inoculation. Virus was also present in up to 60% nucleated splenocytes (XC 'infectious centre assay'). Effects on splenomegaly and virus in splenocytes were assayed following various regimens of zidovudine given as 0.5 mg/ml or 0.25 mg/ml in drinking water. Regimens included continuous treatment both before and after ULV, only before, and only after ULV inoculation. Zidovudine was also given for a limited period immediately after virus, or initiated after virus infection was established. Zidovudine given continuously at and following ULV infection completely prevented splenomegaly and virus expression in splenocytes. No other regimen was as effective; however, limited zidovudine treatment immediately after virus inoculation greatly reduced the effects of virus, while the same dose initiated after virus infection was established had only a small ameliorating effect. We conclude that ULV may prove to be a useful addition to other available murine systems, and this is discussed.

Major histocompatibility complex class II antigen expression in nerves in leprosy; an immunoelectronmicroscopical study

A technique for immunoelectronmicroscopy has been used to investigate major histocompatibility class II expression in leprosy nerves. In normal nerves, endothelial cells and occasional endoneural cells (not Schwann cells) were constitutively class II positive. In both paucibacillary and multibacillary leprosy nerve biopsies, infiltrating leukocytes were positive but class II-positive Schwann cells were not seen. These observations indicate that Schwann cells may not be involved in presenting Mycobacterium leprae antigens to T cells in leprosy. This conflicts with evidence from in vitro studies, but may be explained by the fact that in vivo Schwann cells are surrounded by basement membranes and are closely associated with axons.

Spindle cell neoplasms of lymph nodes of probable reticulum cell lineage. True reticulum cell sarcoma?

Primary spindle cell neoplasms involving hematolymphoid organs are extremely rare. We present four cases of spindle cell neoplasms of unusual phenotype arising within lymph nodes. Two of the four cases showed morphologic and immunophenotypic features suggestive of interdigitating reticulum cell lineage; these cases expressed several macrophage antigens and S-100 protein but not CD1. The other two cases showed evidence suggestive of dendritic reticulum cell lineage. Both cases expressed HLA-DR, several macrophage antigens, complement receptors C3b and C3d; one case expressed R4/23; both showed the presence of desmosomes on ultrastructural examination. A germline configuration for the immunoglobulin heavy chain and beta-T--cell receptor genes was detected in all four cases. Of the two patients in the first group, one had local recurrence of tumor; the other died of widespread metastases. Of the two patients in the second group, both are alive and well at 12 and 27 months follow-up, respectively.

Experience with Ommaya reservoir in 120 consecutive patients with meningeal malignancy

The Ommaya Reservoir plays an important role in a select group of neuro-oncology patients with meningeal malignancy. The benefits derived must be balanced against potential complications associated with insertion and use of the apparatus. Side effects may be minimized by careful attention to patient selection, pre-operative CAT scan (or MRI), precise surgical technique, perioperative prophylactic antibiotics and meticulous procedure during use of the reservoir.

Monosynaptic connexions of single V interneurones to the contralateral V motor nucleus in anaesthetised rats

We have used the extracellular spike triggered averaging method to obtain evidence for a monosynaptic connexion of single V (trigeminal) interneurones, located in the region immediately caudal to the V motor nucleus, onto neurones within the contralateral V motor nucleus. The extracellular fields recorded in the contralateral nucleus are of smaller amplitude than those detected within the ipsilateral nucleus and the implications of this are discussed.

Herpes zoster: etiology, clinical course, and suggested management

Herpes zoster is an acute viral infection that results from reactivation of a latent varicella-zoster virus often acquired as chickenpox during childhood. Fifty percent of all people living to the age of 85 will have an attack of zoster. The goal of intervention is to reduce associated pain and discomfort. A prompt diagnosis and appropriate management can best be achieved by understanding the disease and treatment options. While herpes zoster occurs with greater frequency in the geriatric population, it can occur throughout an individual's life span. The nurse practitioner working in any setting is likely to see patients present with herpes zoster. A protocol for patient management is included in this article as a resource for the nurse practitioner who encounters this diagnosis.

An immunoelectronmicroscopical study of the expression of major histocompatibility complex (MHC) class II antigens in guinea pig sciatic nerves following induction of intraneural mycobacterial granulomas

A guinea pig model of nerve damage in leprosy has been used to investigate the expression of major histocompatibility complex (MHC) class II antigens in granulomatous lesions in nerves. Using an immunoelectronmicroscopical technique, infiltrating mononuclear cells and endoneural fibroblast-like cells are shown to be class II-positive in the experimental neural lesions. Schwann cells are not class II-positive under these conditions, although at the light microscope level Schwann cell-like cells appear to be positively stained. This illustrates the value of immunoelectronmicroscopy in the investigation of cell surface proteins in situ as compared with conventional light immunohistochemistry.

Ultraviolet irradiation for hepatic rickets

An infant with chronic cytomegalovirus hepatitis and a child with atypical Alagille's syndrome had vitamin D deficiency rickets due to malabsorption. Both received ultraviolet irradiation. This treatment corrected biochemical abnormalities and healed the rickets. In the infant use of a sunlamp at home maintained normal 25 hydroxy-vitamin D for over a year. Our study shows that ultraviolet irradiation is an effective treatment of hepatobiliary rickets.

Nerve damage induced by mycobacterial granulomas in guinea pig sciatic nerves

A possible model for nerve damage in leprosy has been developed in the sciatic nerve of the guinea pig. Intraneural injection of 10(7) BCG organisms into an unsensitized animal induces an epithelioid cell granuloma in 2 weeks similar to that found in tuberculoid leprosy patients. In contrast, intraneural injection of 10(9) cobalt-irradiated Mycobacterium leprae organisms induces a macrophage granuloma in 5 weeks, similar to that found in lepromatous leprosy patients. Histological, immunohistochemical, electron microscopical and electrophysiological studies have demonstrated that the lesions induced in the experimental animals show many of the features documented in studies of nerve damage in leprosy patients.

Conceptualizing adult development

On the premise that human development is a lifelong process, and with awareness of certain limitations of the stage model, the authors conceptualize a new model based on developmental process. This model is offered as a basic model for the development of mental functions and structures in both childhood and adulthood.

Magnetic resonance imaging for monitoring relapse of acute myeloid leukemia

Magnetic resonance provides a non-invasive tool for monitoring normal and leukemic bone marrow. Measurements of the T1 relaxation times are elevated in acute myelogenous leukemia. However, interpatient variability diminishes the usefulness of MR measurements for diagnosing leukemia. In following the time course of individual patients, T1 relaxation time measurements appear to give an early and sensitive indication of leukemic relapse after remission and this may serve a clinical role in the management of leukemia by reducing the regularity of necessary marrow aspirates and biopsies.

Accessory cell function of dendritic cells from lymph nodes containing Mycobacterium leprae induced granulomas

Dendritic cells were enriched from guinea pig auricular lymph nodes containing Mycobacterium leprae induced granulomas by immunomagnetic depletion of other cells. These cells were strongly positive for major histocompatibility complex class II antigens and labelled with an antidendritic cell monoclonal antibody, but not with an antimacrophage antibody. Interdigitating dendritic cells were identified in the granulomatous lymph node by staining with the antidendritic cell antibody and by transmission electron microscopy. When cultured in vitro with purified T lymphocytes, these cells acted as accessory cells for both purified protein derivative and concanavalin A induced proliferation. Although previous studies have shown that macrophages from these lymph nodes do not act as accessory cells, the present results indicate that dendritic cells from M. leprae granuloma containing lymph nodes may act as antigen-presenting cells.

Idiopathic small airways pathology in patients with graft-versus-host disease following allogeneic bone marrow transplantation

In a retrospective analysis (July 1979 to March 1984) of 120 allogeneic adult bone marrow transplant recipients, we identified seven patients with small-airway disease for whom no microbiologic agent was detected. Six had pulmonary function studies demonstrating air flow obstruction. Five of the seven patients had an open-lung biopsy showing pathologic changes within small airways; these varied from early bronchiolar wall damage to bronchiolitis obliterans. The inflammatory cell infiltrate was peribronchiolar, and consisted of polymorphonuclear leukocytes and lymphocytes in varying proportions. Three of the seven patients recovered following increased immunosuppressive therapy; the other four died. Because all seven patients had acute and chronic graft-versus-host disease, in the absence of any identifiable pathogen, we postulate that small-airway damage represents one of the facets of graft-versus host-disease. An additional analysis of 26 patients with respiratory symptomatology and available histologic material supports the hypothesis that small-airway disease in bone marrow transplant patients represents a risk factor for the subsequent development of respiratory opportunistic infections.

Epithelioid cell granuloma induction in the guinea pig by haptenated Mycobacterium leprae

Fluorescein isothiocyanate (FITC)-conjugated Mycobacterium leprae (FITC-M. leprae) was injected intradermally into the ears of guinea pigs and granuloma formation in the draining postauricular lymph nodes was studied. At 2 weeks, there was an increase in weights and infiltration of the draining lymph nodes in half of the animals injected with FITC-M. leprae. At 5 weeks, there was a significant increase in the weights and infiltration of these draining lymph nodes in the guinea pigs injected with haptenated M. leprae compared with those injected with unconjugated M. leprae. At 5 weeks, there was also a significant increase in delayed type hypersensitivity responses to 25 micrograms purified protein derivative. Histologically, epithelioid cell granulomas were seen in these lymph nodes as early as 2 weeks when FITC-M. leprae was used as the source of antigen. Enhancement in the immunogenicity of M. leprae by conjugation with FITC has been postulated.

Study of DTH and resistance in Mycobacterium lepraemurium infection using a T-cell line isolated from mice infected with Mycobacterium bovis (BCG)

A T-cell line of mixed phenotype (60% L3T4+, 40% Lyt-2+) was isolated from mice infected with Mycobacterium bovis (BCG). This line responded to M. lepraemurium and BCG but not to M. leprae and produced TCGF spontaneously. It also produced factors which stimulated macrophages to secrete hydrogen peroxide and superoxide anion. In vivo studies showed that only L3T4+ cells were required to transfer DTH responses and that Lyt-2+ cells suppressed this response. Both L3T4+ and Lyt-2+ cells were required to inhibit M. lepraemurium multiplication in vivo.

Atypical and malignant neoplasms showing lipomatous differentiation. A study of 111 cases

One-hundred-eleven cases of histopathologically atypical or malignant lipomatous lesions in the somatic soft tissue and retroperitoneum were studied. These consisted of 48 differentiated fatty neoplasms of the somatic soft tissues (DFT-S), 21 fatty neoplasms of the retroperitoneum (DFT-R), 33 myxoid liposarcomas from various sites and nine pleomorphic liposarcomas. DFT-S were defined as lipomatous lesions composed of mature fat and containing atypical stromal cells or lipoblasts. In the somatic soft tissues, this group included lesions that would be classified using published criteria as "atypical lipoma", "pleomorphic lipoma", "well-differentiated lipoma-like liposarcoma", and "sclerosing liposarcoma". All of the DFT-R met previously published criteria for "well differentiated liposarcoma" or "sclerosing liposarcoma". We found no consistent histologic differences between the DFT-S and DRT-R. No pure "round cell" liposarcomas were encountered although many myxoid liposarcomas had "round cell" areas. Follow-up data were available in 80 cases (72%) with a mean follow-up period of over 7 years. Among the DFT-S there were no uncontrollable recurrences, distant metastases, or tumor-related deaths. The depth of the neoplasm correlated with the tendency for local recurrence; no neoplasms primary in the subcutis recurred; 29% of the tumors recurred when they originated in the deep soft tissues or within the muscle. None of the recurrent tumors demonstrated "dedifferentiation." DFT-R had a recurrence rate of 67% and, although there were no distant metastases, nine patients (43%) died of tumor. Five retroperitoneal tumors dedifferentiated but did not metastasize. In light of this experience, we believe that the term "atypical lipoma" is warranted for the DFT-S and "well differentiated liposarcoma" is an appropriate label for the DFT-R. The overall mean survival for the 52 cases of liposarcoma (excluding DFT-S) was 13.6 years. The mean survival in "well differentiated liposarcoma" (11.25 years) was between that for myxoid liposarcoma (16.25 years) and that for pleomorphic liposarcoma (7 years). Six patients (29%) with myxoid liposarcoma developed local recurrences and 6 patients (29%) developed distant metastases and died. Metastasis was always associated with a round cell (or pleomorphic) component with increased numbers of mitotic figures in either the primary tumor or a local recurrence.

Dissociation between delayed-type hypersensitivity and resistance to pathogenic mycobacteria demonstrated by T-cell clones

One Lyt-2+ clone and fourteen T-helper clones (Lyt-1+ L3T4+ Lyt-2-) were isolated from Mycobacterium lepraemurium-infected BALB/c and C57BL/6 mice. All the clones were tested for their ability to transfer delayed-type hypersensitivity adoptively, and six clones were tested for their ability to transfer resistance. It was found that four L3T4+ clones that transferred delayed-type hypersensitivity responses locally and one L3T4+ clone that did not had no effect on resistance. The Lyt-2+ clone transferred increased resistance locally (77% reduction in the numbers of organisms recovered from the infection site) but did not transfer delayed footpad responses.

Interleukin 1 and prostaglandin production by cells of the mononuclear phagocyte system isolated from mycobacterial granulomas

A study has been made of the activity of interleukin 1 (IL-1) and prostaglandins (PGs) in the culture supernatants from unstimulated and lipopolysaccharide (LPS)-stimulated mycobacteria-induced granuloma cells. Both epithelioid cells from bacillus Calmette-Guerin (BCG)-induced granulomas and macrophages from Mycobacterium leprae-induced granulomas, separated on a fluorescence-activated cell sorter using monoclonal antibody specific to guinea pig macrophages, spontaneously secreted low levels of IL-1 (assayed by thymocyte comitogenic and fibroblast mitogenic activities) into culture supernatants. However, culture supernatants from LPS-stimulated epithelioid cells showed significantly higher IL-1 activity than those from unstimulated cells. In contrast, LPS stimulation of M. leprae granuloma macrophages failed to enhance IL-1 production. Nevertheless, IL-1 activity in the culture supernatants from stimulated mycobacterial granuloma cells of both types was much lower than that from LPS-stimulated peritoneal exudate macrophage culture supernatants. There was no detectable amount of prostaglandin E2 (PGE2) in the culture supernatants from both unstimulated and LPS-stimulated BCG- and M. leprae-induced granuloma cells in comparison to much higher levels of PGE2 produced by unstimulated (0.28-6.2 ng/ml) or LPS-stimulated (greater than 15 ng/ml) peritoneal exudate macrophages. However, BCG granuloma cells either secreted prostaglandin F2 alpha (PGF2 alpha) spontaneously or produced comparable levels of PGF2 alpha to those from peritoneal exudate macrophages on stimulation, while M. leprae granuloma macrophages produced much lower levels of PGF2 alpha.

Oxidation of (+)-7,8-dihydroxy-7,8-dihydrobenzo[a]pyrene by mouse keratinocytes: evidence for peroxyl radical- and monoxygenase-dependent metabolism

The role of prostaglandin H (PGH) synthase and peroxyl radicals as well as cytochrome P-450 in the metabolism of 7,8-dihydroxy-7,8-dihydrobenzo[a]pyrene (BP-7,8-diol) was examined in fresh skin keratinocytes isolated from hairless mice. Labeled (+)-BP-7,8-diol was oxidized after incubation with the keratinocytes to syn- and anti-diolepoxides in greater than a 4:1 ratio as estimated by h.p.l.c. analysis of the stable hydrolysis products. Formation of diolepoxides was dependent on cell number and the concentration of BP-7,8-diol. Incubation in the presence of the PGH synthase substrate, 20:4 or the inhibitor, indomethacin did not alter the total formation or the ratio of diolepoxides. However, the addition of butylated hydroxyanisole (1 micron) an inhibitor of peroxyl radical dependent-metabolism significantly inhibited diolepoxide formation. The time course for the formation of the anti-diolepoxide and lipid peroxidation, measured as malondialdehyde was determined. The results suggest an excellent correlation between peroxyl radical and diolepoxide formation. Pretreatment of mice with the cytochrome P-450 inducer, beta-naphthoflavone greatly altered the metabolism of (+)-BP-7,8-diol by keratinocytes. The major metabolite was the syn-diolepoxide with significant formation of two unknown metabolites. Pretreatment of mice with BP-7,8-diol did not induce aryl hydrocarbon hydroxylase activity but did increase the yield of syn-diolepoxide formed from labeled (+)-BP-7,8-diol by 1.5-fold. Our results suggest that peroxyl radical-mediated metabolism is primarily responsible for the oxidation of (+)-BP-7,8-diol in control animals while the cytochrome P-450 system is primarily responsible for oxidation in animals pretreated with inducers.

Accessory cell function of cells isolated from Mycobacterium leprae-induced granulomas

The large cells from Mycobacterium leprae-induced granulomas in guinea pig lymph nodes were separated by Percoll discontinuous density gradient centrifugation and on a fluorescence-activated cell sorter (FACS) using cross-reacting monoclonal antibody to human MHC Class II antigens. Large Percoll-separated cells (83% Class II antigen positive and 52% macrophage-specific antigen positive) and FACS-separated cells are able to act as antigen-presenting cells for T-cell proliferation to PPD. In previous studies, macrophage antigen-positive cells consistently failed to act as accessory cells. This indicates that there is a population of accessory cells which are macrophage antigen negative and MHC Class II antigen positive present in these M. leprae-induced granulomas.

Influence of atrioventricular synchrony on hemodynamics in patients with normal and low ejection fractions following open heart surgery

The authors wished to test the hypothesis that atrioventricular synchrony has a relatively greater effect on hemodynamic parameters in postoperative patients with low ejection fractions compared to those with normal ejection fractions. Temporary pacing wires were placed on the right atrium and right ventricle of patients undergoing open heart surgery. Duplicate thermodilution cardiac outputs were determined during atrial pacing and ventricular pacing at 100 beats/min. Mean left atrial and systemic blood pressures were monitored. Thirteen patients with ejection fractions of 45 per cent or less (range 24 to 45%, mean 37.3%) were included in the low ejection fraction group, and 27 patients with ejection fractions of 59 per cent or greater (range 59 to 80%, mean 66.8%) were considered in the normal ejection fraction group. All hemodynamic parameters improved significantly when changing from ventricular pacing to atrial pacing in both the normal ejection fraction group and low ejection fraction group (P less than 0.05). The magnitude of change between the groups showed no significant difference for all parameters except left atrial pressure, which decreased by a greater percentage in the low ejection fraction group with atrial pacing (P less than 0.001). The atrial contribution to hemodynamic enhancement is important in patients with normal and low ejection fraction following open heart surgery. Patients with low ejection fractions do not sustain a relatively greater reduction in cardiac output, stroke volume index, or systemic blood pressure with loss of atrioventricular synchrony when compared to patients with normal ejection fractions.

Extraction of corticosterone from cell homogenates and subcellular fractions of the rat adrenal cortex. III. ACTH-induced temporal subcellular redistributions of steroid precursors to corticosterone

Cholesterol, pregnenolone, progesterone, 11-deoxycorticosterone (11-DOC) and corticosterone were quantitated in subcellular fractions isolated from in vivo adrenocorticotropin (ACTH)-stimulated rat adrenal zona fasciculata/reticularis. Six adrenal subcellular fractions separated by discontinuous sucrose gradient centrifugation (lipid, 0.125 M sucrose, cytosolic, microsomal, mitochondrial and nuclear) were extracted with alkaline ether/ethanol and assayed by high pressure liquid chromatography (HPLC). Lipid fractions contained the major cholesterol stores, while most pregnenolone and progesterone was found in lipid, microsomal and mitochondrial fractions. The 0.125 M sucrose and cytosol fractions together contained approximately 75% of the total 11-DOC and corticosterone. The five steroids were only present in small amounts in organelle fractions containing steroidogenic enzymes. Homogenate and lipid fraction cholesterol decreased between 10 and 15 min and again 30 min after ACTH injection. In the homogenate, lipid, microsomal and mitochondrial fractions, pregnenolone and progesterone were increased after ACTH injection; peak pregnenolone and progesterone concentrations were often measured in adrenal gland sucrose, cytosolic, microsomal and mitochondrial fractions 15 to 20 min after rats were injected with ACTH. Although ACTH increased 11-DOC and corticosterone in all but the mitochondrial and nuclear fractions, the sucrose, cytosolic and microsomal 11-DOC, and cytosolic corticosterone increased most dramatically. In many fractions, peak 11-DOC and corticosterone concentrations were most often observed between the 10 and 15 min periods and again at 30 min.

The effect of hydrocortisone and cyclosporin A on bacillus Calmette-Guérin epitheloid cell granulomas

The injection of bacillus Calmette-Guérin (BCG) intradermally into the ear of guinea pigs leads to the formation in the draining lymph node of granulomas containing epithelioid cells with rough endoplasmic reticulum (RER) and an absence of phagocytosed material. BCG granulomas in hydrocortisone- or cyclosporin A (CsA)-treated animals contain mononuclear phagocytes with no RER. In CsA-treated animals, these cells contain fragments of phagocytosed organisms. CsA was given at two doses, 25 mg/kg orally and 50 mg/kg ip. The higher dose completely suppressed the delayed hypersensitivity (DH) response to purified protein derivative (PPD) but the lower dose did not affect the level of the DH response, but had a profound effect on epithelioid cell formation. The role of lymphokines in the maturation of the monocyte/macrophage to epithelioid cells is discussed.

Accessory cell function of cells of the mononuclear phagocyte system isolated from mycobacterial granulomas

Epithelioid cells from BCG-induced granulomas and macrophages from Mycobacterium leprae-induced granulomas were examined for their ability to act as accessory cells for T-cell proliferation to mitogen (Con A) and antigen (PPD). The granuloma cells were separated on a FACS using monoclonal antibody specific to guinea pig macrophages. Epithelioid cells (which are Ia negative) were able to support proliferation to Con A but not to antigen. Cultures containing Ia positive granuloma macrophages from M. leprae sensitized animals did not show responsiveness to Con A or to PPD. Oil-induced peritoneal exudate macrophages from BCG or M. leprae immunized animals were able to act as accessory cells for both mitogen and antigen proliferation. The nonresponsiveness of cultures containing epithelioid cells stimulated with PPD or M. leprae granuloma macrophages stimulated with Con A was not due to suboptimal or supraoptimal accessory cell:lymphocyte ratios.

H-2-linked genes which modify resistance of C57BL/10 mice to subcutaneous infection with Mycobacterium lepraemurium

Strains of C57BL/10 mice with recombinants within the H-2 complex were used to map the genes which control the mononuclear cell response at the infection site and modify resistance to subcutaneous infection with Mycobacterium lepraemurium. Strains with b in the K-E beta regions of the H-2 complex mounted a more rapid cellular response in the infected footpad and were more resistant than mice with d or k in the K-E beta regions. Significant differences between strains with k in the K-E beta regions appeared to be controlled by a gene in the D region.

Isolation and analysis of circulating immune complexes in leprosy

Circulating immune complexes (CIC) were isolated by two antigen nonspecific methods from 60 leprosy patients belonging to borderline tuberculoid (BT) and lepromatous (LL) types with and without reactions. CIC were elevated in both BT and LL reactions. CIC from BT in reaction (BTR) were found to consist largely of IgG and C3, whereas, C-reactive protein could be found in CIC from LL reactions (LR). In addition, IgM and rheumatoid factor were demonstrated in the complexes of LR patients who had mainly arthritis. Antimycobacterial antibody was seen in the complexes of two-thirds of LR patients who had predominantly skin manifestations as part of their reaction. The relevance of these findings to the clinical manifestations of different types of reactions is discussed.

Efficacy of clear antacid prophylaxis in obstetrics

We studied 33 women scheduled to undergo general anesthesia for cesarean section. Prior to induction of anesthesia, each patient received in a random fashion one of two prophylactic antacids. Group I (n = 17) received 30 ml Gelusil orally and Group II (n = 16) received 30 ml of 0.3 mol/l sodium citrate. After induction of general anesthesia an oro-gastric tube was passed. The amount and pH of the gastric aspirate were measured at the time of delivery and 45 min after delivery "before extubation." Both antacids elevated gastric pH above 3.5 in all patients but one in the Gelusil group. The pH remained elevated 45 min later. It is concluded that 0.3 mol/l sodium citrate is effective as an antacid when given orally prior to induction of anesthesia.

T cell proliferation in Mycobacterium lepraemurium infection. II. Characterization of cells that transfer resistance in subcutaneously infected mice

T lymphocyte proliferation, Lyt phenotypes and their role in the evolution of protective immunity were studied in BALB/c and C57BL/6 mice infected subcutaneously with Mycobacterium lepraemurium. Antigen-induced proliferation was not demonstrable with T-enriched cells obtained from the spleens. However, these cells were capable of spontaneously proliferating in the absence of added antigen for a limited period. This proliferation was dependent on the presence of a phagocytic and adherent accessory cell. During the period when the T cells proliferated spontaneously they consisted of a mixture of Lyt-1 and Lyt-23 and were able to transfer protection to syngeneic recipient mice. Furthermore, the multiplication of the organisms was curbed during the same period demonstrating a strong association between the ability to proliferate spontaneously Lyt-1/Lyt-23 cells and protective immunity. T cells from normal BALB/c mice showed a marked suppressive effect on protection suggesting that these cells may be responsible for the susceptibility of this strain to a moderate subcutaneous infection.

Resistance to subcutaneous infection with Mycobacterium lepraemurium is controlled by more than one gene

The resistance of C57BL (high) and BALB/c (low) mice, their F1 hybrids, and the offspring derived from backcrosses of the F1 to both parental strains was assessed at 20 weeks after subcutaneous infection with 10(7) Mycobacterium lepraemurium organisms. The numbers of bacilli recovered from the infected foot and draining lymph node indicated that resistance to subcutaneous infection is controlled by more than one non-H-2-linked gene of intermediate dominance. In general, female mice were more resistant than males.

T cell proliferation in Mycobacterium lepraemurium infection. I. Lack of correlation between antigen-specific proliferation of Lyt 1 + 23- cells and resistance in lethal infections

Antigen specific T lymphocyte proliferation and Lyt phenotypes of the T lymphocytes were studied in BALB/c and C57BL/6 mice infected with 10(9) M. lepraemurium organisms intravenously. A highly disseminated form of the disease developed to which all mice succumbed by 17 weeks. Maximal antigen-specific T lymphocyte proliferation was detected at 4 weeks after the infection and persisted thereafter even when the mice started to die of the infection. Accessory cells of phagocytic and adherent type did not appear to be a requirement for this proliferation. The T lymphocytes generated during the course of the infection were mostly of the Lyt 1 phenotype. However, there appeared to be no correlation between sensitized Lyt 1 cells capable of antigen-induced T lymphocyte proliferation and protective immunity.

Macrophage specific antigen is expressed by resting microglia in the CNS but not by Langerhans cells in the skin

Controversy exists as to whether Langerhans cells in the epidermis and resting microglia in the brain should be included among cells of the mononuclear phagocyte series (MPS). A monoclonal anti-guinea-pig macrophage antibody has been prepared that is specific for a macrophage membrane antigen and does not react with Fc receptors or Ia antigens. This antibody fails to react with Langerhans cells despite reacting with peritoneal exudate macrophages, alveolar macrophages, Kupffer cells and macrophages in infectious granulomas. It does, however, react with resting microglia in the brain. This could suggest that Langerhans cells, despite a similar bone marrow origin, are not typical cells of the MPS, whereas resting microglia share features with this cell system.

High-amplitude peristaltic contractions in a patient with esophageal intramural pseudodiverticulosis

In their initial radiographic description of esophageal intramural pseudodiverticulosis (EIP) in 1960, Mendl and coworkers suggested that elevated esophageal intraluminal pressure might be etiologically important. Chronic inflammation and moniliasis have also been implicated. A patient is reported with EIP and a primary esophageal motility disorder characterized by esophageal contractions of increased amplitude and duration. Features confusing the interpretation of esophageal motor abnormalities in previously reported cases, such as diabetes mellitus, fungal esophagitis, and stricture formation, were not present in this case.

The resistance of C57BL/6 mice to subcutaneous infection with Mycobacterium lepraemurium is dependent on both T cells and other cells of bone marrow origin

Thymectomized or sham-thymectomized C57BL/6 mice were irradiated and reconstituted with either C57BL/6 bone marrow cells or bone marrow cells from H-2 matched BALB/B mice. The ability to limit organism multiplication at the site of infection in response to a moderate dose of Mycobacterium lepraemurium is shown to be T-cell mediated and not dependent on the type of bone marrow cells used for reconstitution. Dissemination of the organisms on the other hand appeared to be dependent on both T cells and cells of bone marrow origin.

Role of the major histocompatibility complex in resistance and granuloma formation in response to Mycobacterium lepraemurium infection

Resistance to a subcutaneous infection with a moderate dose of Mycobacterium lepraemurium was investigated in C57BL/6 mice and in three congenic strains with the BALB background (BALB/c, BALB/B, and BALB/K). Resistance after 10 weeks of infection was found not to be linked to the major histocompatibility complex. The ability to develop a delayed hypersensitivity response to an ultrasonicate of M. lepraemurium was associated with the background genes, and this ability had no influence on resistance to M. lepraemurium. Granuloma formation at the infection site in the early stages appeared to be linked to the H-2b haplotype. The types of cells involved in the granulomas were also investigated.