Results of tricuspid valve replacement for nonrheumatic and noninfective disease

Because of the rarity of isolated, nonrheumatic, noninfective tricuspid valvular disease, the long-term results of treatment by tricuspid valve replacement are uncertain. From June 1967 to April 1986, we implanted 23 biological or mechanical tricuspid valve prostheses in 20 patients for nonrheumatic, noninfective endocarditis. All cases were followed from 1 to 20 years after the procedure, for a total of 215.08 patient-years. There were 2 hospital deaths and 3 late deaths. Actuarial analysis indicated a mortality rate of 1.39% + 1.6% per year. Late morbidity included 3 episodes of prosthetic thrombosis in 2 patients, arrhythmias in 5 patients, and recurrent spontaneous abortions in 1 patient. New York Heart Association Functional Class improved in all survivors. We conclude that tricuspid valve replacement, especially when a bioprosthesis is used, can be performed with a low operative risk and good long-term results in patients who have nonrheumatic, noninfective, valvular disease.

Transient radial nerve injury related to the use of a self retaining retractor for internal mammary artery dissection

Peripheral nerve injuries and brachial plexopathies are frequent complications for coronary artery surgery, and are related to median sternotomy. Radial nerve injury has been uncommon hitherto. We report the case of a patient who sustained a radial nerve palsy associated with the use of a Pittman retractor, but who achieved rapid and complete recovery.

In vitro activities of several new macrolide antibiotics against Mycobacterium avium complex

The in vitro activities of 12 macrolide compounds against 28 Mycobacterium avium complex strains isolated from patients with acquired immunodeficiency syndrome were determined by the conventional proportion method and by the BACTEC method. Clarithromycin (A-56268; TE-031), a new macrolide compound, was the most active agent tested, inhibiting 90% of strains at an MIC of 4 micrograms/ml by the BACTEC method. Roxithromycin (RU 28965) and erythromycylamine inhibited 90% of strains at 16 micrograms/ml. The organisms showed high levels of resistance to most other macrolide compounds.

Comparative study of oral and intramuscular atropine sulphate as a premedicant in paediatric age group

The use of atropine sulphate in the paediatric age group as a premedicant orally in a dosage of 0.02 mg/kg body weight 70 minutes prior to surgery was found to be as effective as atropine sulphate given intramuscularly 35 minutes prior to surgery in a dosage of 0.01 mg/kg body weight. This avoids the unpleasant memory of needle prick; The duration of effect as studied in the normal healthy children not subjected to surgery was found to be 2 1/2-3 hours.

Pulmonary hamartoma presenting 40 years after lobectomy and thoracoplasty for tuberculosis

We report a case of giant pulmonary hamartoma found in a patient who had undergone lobectomy and thoracoplasty 40 years previously. This particular case may be consistent with the theory of hamartomas as acquired lesions.

Hepatocyte cell surface polarity as demonstrated by lectin binding

We performed an investigation at the ultrastructural level of the differential distribution of lectin-binding sites among sinusoidal, lateral, and bile canalicular domains of adult rat hepatocytes. Lectin binding to hepatocyte glycocalices was studied in situ or after cellular dissociation by enzymatic (collagenase), chemical (EDTA), and mechanical methods, as well as during cell culture. Using thirteen biotinylated lectins and an avidin-biotin-peroxidase complex (ABC), we have identified lectin-binding sites that are predominantly localized in the bile canalicular [Ricinus communis agglutinin (RCA)] or sinusoidal [Phaseolus vulgaris (PHA)] domains in situ and in mechanically dissociated cells. Lens culinaris (LCA) staining was prominent on sinusoidal surfaces, slight along lateral surfaces, and completely absent in the bile canalicular domain. Concanavalin A (ConA) was unique in binding equally to all domains. Triticum vulgaris [wheat germ agglutinin (WGA)] was also bound to all domains, but most intensely to the bile canalicular region. Cells dissociated via collagenase or EDTA treatment exhibited a spherical morphology characterized by many surface microvilli and absence of morphological domains. Lectin binding to dissociated cells was uniformly distributed over the entire cell surface, suggesting a redistribution of lectin receptors that was independent of the separation procedure. Hepatocytes in culture exhibited a partial restoration of morphological domains, but lectin binding polarity was not re-established.

Seasonal distribution in conceptions achieved by artificial insemination by donor

The distribution of conceptions after artificial insemination from a donor was studied in 259 conceptions at an artificial insemination clinic and found to be seasonal. Conception was not influenced by the number of donors or patients attending the clinic, the frequency of inseminations, or medical skill. Conception was more common from early winter until early spring (October to March) with a peak in November. As variables such as frequency of intercourse and ovulation were irrelevant in these women and highest sperm counts occur from February to March these results suggested a seasonal variation in the quality of the ovulated egg or endometrial receptivity. The waste of eggs after ovulation (or preimplantation conceptuses) at specific times of the year has implications in the treatment of infertility, particularly for in vitro fertilisation and gamete intrafallopian transfer.

Persistence of heart reactive antibodies (HRA) in acute rheumatic fever (ARF) and rheumatic heart disease (RHD) patients

Heart Reactive Antibodies (HRA) of IgG and IgM classes were investigated in 79 patients in four clinically classified groups. Group I comprised of 16 children with Acute Rheumatic Fever (ARF) and Group II consisted of 15 cases with active Rheumatic Heart Disease (RHD). Twenty seven cases of ARF and RHD in remission and 21 adults with quiescent RHD were included in Groups III and IV respectively. Control groups comprised of 14 normal, healthy, donors and eight Post Streptococcal Acute Glomerular Nephritis (PSAGN) cases. Low levels of HRA of IgG and IgM classes were detected in control groups. The overall incidence of HRA of IgG and IgM classes was 82.28 and 39.24% respectively in the patient group. An increased frequency of HRA-IgM antibodies was observed in Groups I, III and IV (p less than 0.01, 0.001 and 0.025 respectively). All the four groups demonstrated a highly significant increase in incidence of HRA--IgG class (p less than 0.0005). Persistence of high titres of HRA-IgG class in ARF and RHD is reported in the paper.

A quantitative analysis of lectin binding to adult rat hepatocyte cell surfaces

A quantitative evaluation of lectin binding to adult rat hepatocyte cell surfaces was done using cells isolated by two different collagenase perfusion methodologies and cultured as monolayers with two different tissue culture media formulations (protocol I vs. protocol II). The presence of alpha-D-mannosyl and alpha-D-glucosyl groups was detected by the binding of Concanavalin A (Con A), Lens culinaris agglutinin (LCA), and Pisum sativum agglutinin (PSA) to freshly isolated cells. Furthermore, beta-D-galactose [Ricinus communis agglutinin (RCA)] and sialic acid residues [wheat germ (WGA)] were also found. Protocols I and II served as models for evaluation of: a) the stripping effect of collagenase separation procedures, b) the restoration in culture of collagenase-stripped sugar residues, c) the effect of the culture environment on cell viability [as measured by lactic acid dehydrogenase (LDH) leakage] and the protein content of hepatocytes, and d) the presence of cell surface sugar residues as a function of culture duration. The ultrastructural morphology of freshly isolated and cultured hepatocytes was also evaluated. These studies indicated that a decline in lectin binding invariably occurred earlier than a massive leakage of LDH and a decrease in the protein content of the cells in culture. Ultrastructurally, autophagocytosis was an early phenomenon in cells isolated and cultured by protocol I, which was also inferior to protocol II regarding the preservation of hepatocyte glycocalyces. Sugar residues lost due to the collagenase-stripping effect were restored, as shown by lectin binding, within the first 24 h of culture. This stripping effect was confirmed by quantitative evaluations of lectin binding to hepatocytes in culture after an incubation with collagenase. This study shows that the binding of peroxidase-labeled lectins is a useful tool for quantitative evaluation of the sugar composition of hepatocyte cultures.

Polymorphonuclear leukocyte functions in patients with acute rheumatic fever and rheumatic heart disease

Polymorphonuclear (PMN) cell function was assessed in 30 children with active rheumatic fever (ARF) (Group I), 30 cases with active rheumatic heart disease (RHD) (Group II), 28 cases of ARF and RHD in remission (Group III) and 34 adults with quiescent RHD along with their age matched controls. All the groups showed normal spontaneous and chemotactic movement. Phagocytosis of yeast particles was significantly reduced in groups II (P less than 0.0005), III (P less than 0.025) and IV (P less than 0.005). The opsonic activity of disease sera was low in all 4 groups (P less than 0.0005). The intracellular metabolic activity was moderately elevated in Group III. Phagocytosis and opsonic activity were thus persistently low in all the groups including the remission and quiescent group.

Cold reactive lymphocytotoxic antibodies in patients with tuberculoid and lepromatous leprosy

Fifty-seven sera from leprosy patients and 33 sera from age- and sex-matched hospital controls were tested for the presence of cold-reacting lymphocytotoxic antibodies (LCAs) at 15 degrees C against a panel of 30 HLA-typed normal lymphocytes. Eighteen of 57 (31.6%) leprosy sera and 22 of 33 (67%) control sera showed reactivity, but the strength of reactivity of the patients' sera was significantly more than that of the control group (p less than 0.01 by Wilcoxon rank sum test). Within the leprosy group, there was no significant difference in the reactivity of 30 tuberculoid and 27 lepromatous sera. The occurrence of LCAs was independent of the sex or the HBsAg status of the serum donor. LCA activity was not correlated with treatment status, bacillary load, or reaction state.

Neurological complications of acute haemorrhagic conjunctivitis

Forty four cases of the neurological complications of acute haemorrhagic conjunctivitis (AHC) seen in India during 1981 epidemic are reported. The disease predominantly affected adult males. The preceding attack of AHC, a latent period, prodromal symptoms of fever, myalgia and root pains followed by acute onset of lower motor neurone paralysis of limbs and/or cranial nerves formed the classical picture of neurological involvement. The recovery was poor and nearly half of the patients remained severely handicapped. Electrophysiological studies showed early appearance of widespread fibrillations and fasciculations, large polyphasic potentials of increased amplitude and reduced interference pattern. Nerve conduction studies were normal in most of the cases. Cerebrospinal fluid (CSF) examination revealed lymphocytic pleocytosis and rise in protein content. Significant antibody titres against enterovirus type 70 (EV 70) were demonstrated in the serum and the CSF. HLA studies showed low occurrence of A2 and B15 HLA antigens. Muscle biopsies revealed neurogenic atrophy and sural nerve biopsies were histologically unremarkable. The similarities of this disease with poliomyelitis and its pathogenesis are discussed.

Properties of α-galactosidase II(2) from Vicia faba seeds

α-Galactosidase II(2) (MW ∼ 43 390) from resting Vicia faba L. seeds had been shown to possess D-glucose/D-mannose-specific lectin activity. Inhibition studies with monosaccharides and an examination of the effects of heat and pH on the catalytic and lectin activities of the enzyme indicate that the enzyme substrate and the lectin haptens bind at different sites on the protein. D-Mannosebinding has been investigated by equilibrium dialysis and spectrophotometrically. Both methods yield Ka values of approx. 3·10(3) M(-1) for the interaction and there would appear to be two mannosebinding sites per molecule of enzyme protein. The lectin properties of V. faba α-galactosidase II(2) have been discussed in relation to both V. faba lectin (favin) and other legume α-galactosidases.

Attachment and long term survival of adult rat hepatocytes in primary monolayer cultures: comparison of different substrata and tissue culture media formulations

Long-term monolayer cultures of adult rat hepatocytes were tested for their ability to glucuronize phenol red and to maintain initial levels of cell proteins, glucose consumption, and lactic acid production. Lactate dehydrogenase leakage served as an index of culture status because a high value indicates cell death. Three tissue culture (TC) media formulations were the main variables introduced to determine ideal conditions for cell survival in vitro. Investigations of long-term cultures were preceded by studies of hepatocyte attachment to polystyrene surfaces. This attachment was influenced by the amount of substrate deposited and the number of cells seeded, but not by the uniformity of the substrate coating. A statistical analysis of our data revealed that in the absence of fetal bovine serum (FBS), air dried collagen (ADC) and Biomatrix (BMX) were superior to saline precipitated collagen and fibronectin as attachment substrates. In the presence of 10% FBS, all of the substrates performed equally. Chee's Medium (CEM) proved to be the best for preserving cell proteins over a time course of 28 d and Williams' E medium also performed adequately up to 14 d. The glucuronization of phenol red was at 50% of initial values at Day 7 in CEM-ADC hepatocytes in contrast to 30% for cells in Williams' E medium and 5% for cells grown in Waymouth's. At 14 d glucuronization was still present at 40% of original values in CEM-ADC cells but had ceased in the other two media. When BMX was used, none of the TC media supported glucuronization levels comparable to ADC cells.

A novel mass spectrometric procedure for the rapid determination of the types of carbohydrate chains present in glycoproteins: application to alpha-galactosidase I from Vicia faba seeds

A fast atom bombardment mass spectrometric protocol has been developed to determine the type of oligosaccharide chain present in glycoproteins. The procedure is based on acetolysis of the intact glycoconjugate, extraction of the peracetylated carbohydrate fragments and analysis by fast atom bombardment mass spectrometry. The molecular ions present in the FAB spectra uniquely define the composition of the oligosaccharides with respect to hexose, aminohexose and sialic acid content. High mannose oligosaccharides yield a series of peracetylated hexose oligomers whereas complex-type oligosaccharides afford a series of N-acetyl-lactosamine containing species. Fucosylation is usually not detected but sialylated oligosaccharides are readily identified and the type of sialic acid is also defined. The method has been tested on three glycoproteins of known structure - fetuin, ribonuclease B and erythrocyte Band 3 - and on a glycoprotein of unknown structure - alpha-galactosidase I, an enzyme lectin from Vicia faba. The latter is shown to contain high mannose carbohydrate chains.

Role of macrophage-processed antigen in a Plasmodium berghei model

The present study demonstrates that malarial parasite could be processed by macrophages in vitro to release 'super antigens'. These super antigens obtained from the peritoneal macrophages were more protective than those processed by the splenic adherent cells. BCG-stimulated macrophages were also able to process the antigens efficiently and these antigens were even superior to those obtained from the unstimulated macrophages. These modified antigens were potent inducers of DFPS to malarial antigens. It is thus concluded that parasite antigens, processed in vitro, carry specific immunogenic potential and are able to protect the recipients to parasite challenge.

Cytotoxicity of a non-HLA serum towards lymphocytes from blood group B, Lewis negative and ABH secretor individuals

Seven serum samples from a multiparous Hispanic woman (Cano) were found to be lymphocytotoxic against 2% of the cell donors in a large multiethnic cell panel. The reactivity of these sera segregated independently of the HLA region. The lymphocytotoxicity of Cano sera appeared associated with the simultaneous presence of red cell antigen B, Le (a-b-), and ABH secretor status. It could be adsorbed out by red cells from Cano-reactors, but not by those from Cano-non-reactors. Cano sera are clearly detecting a non-HLA antigen on lymphocytes. The exact relationship between this new immunogenetic system (Cano) and the ABO, Lewis and Secretor systems remains to be elucidated.

Flurbiprofen in the treatment of primary dysmenorrhoea

1 In a double-blind crossover study, flurbiprofen produced marked relief of pain which was significantly more than with aspirin and placebo in patients suffering from primary dysmenorrhoea. In contrast, there was no significant difference between the relief of pain obtained with aspirin and placebo. 2 The clinician's overall assessment of efficacy also indicated that flurbiprofen produced better response as compared to aspirin and placebo in these patients with dysmenorrhoea. 3 Both flurbiprofen and aspirin did not produce any apparent adverse effects on blood loss during the menstrual period. 4 In conclusion, the analgesic effect of flurbiprofen seen in this trial establishes the therapeutic usefulness of the drug in the treatment of primary dysmenorrhoea.

Canidida infection of the upper gastrointestinal tract superadded upon chemical injury with acids

Two male patients, who presented with Candida albicans infection of the upper gastrointestinal tract, superadded over local mucosal injury due to corrosive chemical agents and chronic alcoholism have been described. Such an association of prior local injury with this type of fungal infection has not been hitherto documented. One of these patients had a gastric antral stricture due to ingestion of concentrated sulfuric acid and Candida esophagitis, whereas the other had severe erosive gastritis and Candida gastritis following ingestion of thiocyanates.

Cation transport across the guinea-pig placenta perfused in situ

1. The guinea-pig placenta perfused in situ via the umbilical circulation has been used to measure unidirectional fluxes of Na from mother to fetus, and in the reverse direction, with 24Na and 22Na. There was no significant difference between the two fluxes, each being 22 mumole.min-1. 2. Ouabain 10(-5) M in the perfusion fluid had no detectable effect on radioisotopic movements of Na in either direction. 3. Unidirectional fluxes of 42K in both directions were approximately equal at 1.7 mumole.min-1 mother fetus and 1.8 mumole.min-1 in the reverse direction, despite a K concentration of 3.4 mM on the maternal side and 5.0 mM on the fetal side of the placenta. 4. Extraction of 42K and 86Rb from the perfusion fluid was inhibited by 43% by 10(-5) M-ouabain in the fluid. This effect was largely due to a reduction of isotope uptake by the placental tissue. 5. The relative permeabilities of the placenta, mother to fetus, were Rb approximately K (3.2) greater than Na (1.0) greater than Li (0.55). 6. Under the experimental conditions, the electrical potential difference between perfusion fluid and maternal blood was 6 mV (fetus negative). It was shifted towards the positive by a low Na fluid. 7. The results suggest the presence of a dominant Na-K pump (active component towards mother) sited at the maternal-facing membrane of the syncytiotrophoblast together with a subsidiary pump oriented in the opposite direction and probably sited together with a subsidiary pump oriented in the opposite direction and probably sited at the fetal-facing membrane of the syncytiotrophoblast. 8. A high proportion of Na movement particularly towards the fetus is probably passive, occurring through water-filled spaces, whilst K movement is more dependent on active transport.

Human T cell receptors for monkey erythrocytes

To test the specificity of T cell receptors, erythrocytes and lymphocytes of man and rhesus monkey (Macaca mulatta) and erythrocytes of sheep were mixed in four different combinations to observe the rosette formation. During the study, a major proportion of human T cells formed spontaneous rosettes with the erythrocytes of rhesus monkey. A small number of monkey lymphocytes formed rosettes with human group O Rh-negative cells while T cells both of man and rhesus monkey formed rosettes with sheep red blood cells.

Cell mediated and humoral immunity in experimental Plasmodium berghei infection

Adoptive passive transfer of immunity to Plasmodium berghei infection has been investigated in an inbred strain of Swiss mice. The mice were made hyperimmune by repeated passage of 10(3) parasites and subsequent therapy with an antimalarial drug. Immune sera and cells obtained from thymus, spleen and peritoneal exudate were transferred to normal animals which were subsequently challenged with standard doses of P. berghei. It was observed that: (a) immune serum in high doses (0.5 ml/mouse) enhanced parasitaemia; when used in smaller doses (0.1 ml/mouse), it afforded a considerable degree of protection; (b) viable immune lymphocytes obtained from thymus and lymph node afforded protection; (c) the mixed population of cells obtained from spleens of immunized mice, as well as peritoneal exudate, protected mice against challenge inoculum; (d) glutaraldehyde-treated spleen cells and material obtained after freezing and thawing the same number of spleen cells, macrophages and lymph node also afforded protection. These findings confirm that, under these experimental conditions, immunity against P. berghei is mediated through (i) specific antibody which is dose-dependent, (ii) cell-mediated immunity and (iii) effective response to processed antigen.

A comparative evaluation of bacteriologic and morphologic indices of Mycobacterium leprae in skin, lymph node, bone marrow, nerve and muscle

This study elicits the comparative evaluation of the Bacteriologic Index (BI) and Morphologic Index (MI) of the skin, lymph node, bone marrow, nerve and muscle tissues of 15 untreated leprosy patients. The findings of comparable or even higher BI's and MI's in lymph nodes than skin are of considerable interest, especially the presence of a significant percentage of viable bacilli during reaction states when MI of skin and nerve tissue was found to be negative. Evaluation of the BI's and MI's of lymph nodes has been suggested to be of utmost importance for follow-up studies of patients being treated with antileprosy drugs.