Characterization of Anti-Myosin Monoclonal Antibodies

The characterization of monoclonal antibodies (MAbs) with regard to reactivity and specificity is important for the successful application as a molecular probe and/or diagnostic reagent. Furthermore, it is recognized that some monoclonal reagents perform well in some assay systems but not others. In this study, the reactivity profiles of two anti-myosin MAbs (H1 and DH2, raised against human cardiac myosin) were evaluated in enzyme-linked immunosorbent assay (ELISA), slot-blotting, and immunocytochemistry. Both antibodies performed well in slot-blotting against myosin heavy chain preparations from cardiac and skeletal muscle and from non-human sources. In general, MAb H1 demonstrated strong to moderate reactivity in all assay systems, whilst MAb DH2 faired poorly in ELISA. MAb H1 also showed reactivity to synthetic peptides of myosin, one of which possessed a motif (ERRDA, single amino acid code) that was found in other human and nonhuman myosin protein sequences that could explain its cross-reactive profile. Intriguingly, this motif was found on viral and other pathogenic agents associated with myocarditis. Hence, it is speculated that this region could give some credence to the mechanism of molecular mimicry associated with some cardiac diseases. Overall, MAb H1 may serve as a useful probe of myosin structure.

Audit of operating theatre time utilization in neurosurgery

Utilization of operating theatre time is an important issue in neurosurgery, in a National Health Service Hospital. NHS Trusts are under ever increasing pressure to meet specified 'targets' in relation to admissions and operations. We performed a retrospective audit on the utilization of neurosurgical operating theatres at Royal Preston Hospital, analysed the times required for various common neurosurgical operations, and broke them down into clinical (operating and anaesthetic) and non-clinical times. We have also looked at the adequacy of available theatre sessions, and the under or over-running of available theatre sessions. A detailed time-based evaluation of 810 procedures over a 16-month period is presented. The mean and 80th centile of the time taken for anaesthesia, surgery and other non-clinical activities are described along with the total time spent in theatre for common neurosurgical procedures. The mean times for transit, preparation for anaesthesia, preparation for surgery, recovery in theatre and time between cases were 16, 13, 14, 15 and 8 minutes, respectively. The mean time duration between the end of one surgical procedure and the beginning of the next was 101 minutes. It was found that actual operating time was surprisingly only 56% of the time available. These data could be used to schedule operating theatre sessions for neurosurgery in the UK, as we believe our practice to be representative of a majority of units in the country.

Glucagon does not affect catecholamine release in primary cultures of bovine adrenal chromaffin cells

OBJECTIVE

Human pheochromocytoma tumor cells express glucagon receptors, and bolus i.v. glucagon injection rapidly increases plasma epinephrine levels, suggesting that glucagon can directly stimulate adrenomedullary secretion. In this study, we tested whether the catecholamine secretory response to glucagon was present in bovine chromaffin cells or exclusive to the tumor cells.

DESIGN AND METHODS

Adrenomedullary cells were cultured in 24-well plates (10(6) cells per well). After 48-72 hours, wells were incubated for 1-20 minutes with (1) incubation medium (control), (2) catecholamine secretagogues (nicotine or potassium ion), or (3) glucagon (10(-8) to 10(-5) M). After incubation, catecholamine contents in medium and cells were assayed by high-pressure liquid chromatography with electrochemical detection. Fractional release rates of epinephrine, norepinephrine, and dopamine were calculated and compared to controls. Reverse-transcriptase PCR was performed to compare expression of mRNA of the glucagon receptor in chromaffin cells and pheochromocytoma cells.

RESULTS

Nicotine and potassium evoked time-dependent release of epinephrine, norepinephrine, and dopamine. Glucagon did not affect catecholamine secretion at any concentration. Reverse-transcriptase PCR failed to detect mRNA for glucagon receptor in bovine adrenomedullary cells, but did detect it in human pheochromocytoma cells.

CONCLUSIONS

In contrast to pheochromocytoma tumor cells, bovine adrenomedullary chromaffin cells do not express the glucagon receptor, and therefore do not secrete catecholamines in response to glucagon.

Pharmacokinetics and efficacy of 2-methoxyoestradiol and 2-methoxyoestradiol-bis-sulphamate in vivo in rodents

2-Methoxyoestradiol (2-MeOE2) is an endogenous oestrogen metabolite that inhibits the proliferation of cancer cells in vitro, and it is also antiangiogenic. In vivo 2-MeOE2, when administered at relatively high doses, inhibits the growth of tumours derived from breast cancer cells, sarcomas and melanomas. Sulphamoylated derivatives of 2-MeOE2 are more potent inhibitors of in vitro breast cancer cell growth than 2-MeOE2. In the present study, we have compared the pharmacokinetic profiles and metabolism of 2-MeOE2 and its sulphamoylated derivative, 2-methoxyoestradiol-bis-sulphamate (2-MeOE2bisMATE), in adult female rats. Their ability to inhibit tumour growth was compared in nude mice bearing xenografts derived from MDA-MB-435 (oestrogen receptor negative) melanoma cancer cells. After a single oral 10 mg kg⁻¹ dose of 2-MeOE2bisMATE, significant concentrations of this compound were still detectable at 24 h. In contrast, no 2-MeOE2 or metabolites were detected in plasma at any time after a 10 mg kg⁻¹ oral dose. Thus, the bioavailability of 2-MeOE2 is very low, whereas for 2-MeOE2bisMATE it was 85%. No significant metabolites of 2-MeOE2bisMATE were detected in plasma after oral or intravenous dosing, showing that this drug is resistant to metabolism. In the tumour efficacy model, oral administration of 2-MeOE2bisMATE, at 20 mg kg⁻¹ day⁻¹ daily for 28 days, almost completely inhibited tumour growth. Inhibition of tumour growth was maintained for a further 28 days after the cessation of dosing. At this dose level, 2-MeOE2 did not inhibit tumour growth. The resistance to metabolism shown by 2-MeOE2bisMATE and its ability to inhibit tumour growth in vivo suggest that this compound should have considerable potential for development as a novel anticancer drug.

Microbiology of cerebral abscess at the neurosurgical unit of the National Hospital of Sri Lanka

OBJECTIVES

To determine the microbial pathogens responsible for cerebral abscess, ascertain the most suitable antibiotic for treatment and to determine the predisposing causes of cerebral abscess.

DESIGN

Prospective study with microbiological investigation of pus aspirated from cerebral abscesses.

SETTING

Neurosurgical Unit, National Hospital of Sri Lanka, Colombo.

STUDY GROUP

41 patients with cerebral abscess.

PERIOD OF STUDY

18 months (May 1997 to December 1998) RESULTS: Of the 41 samples of pus 26 (63.1%) gave a positive microbial culture. The Gram stain of the direct smear was positive in 77% of the 26 positive cultures. The most frequently occurring species were Streptococcus milleri group (35%) followed by Staphylococcus aureus (10%). Anaerobes accounted for 23% of positive cultures. All Streptococcus milleri isolates were penicillin and cefotaxime, and all anaerobic isolates except one were susceptible to sensitive to metronidazole. 75% of Gram negative bacilli isolated were sensitive to cefotaxime. All Staphylococcus aureus isolates were methicillin resistant, but sensitive to vancomycin and chloramphenicol. Common predisposing conditions were congenital heart disease (30%), trauma (25%), middle ear disease (7%), and meningitis (7%).

CONCLUSIONS

Organisms of the Streptococcus milleri group were most frequently found in cerebral abscesses. The present empirical therapeutic regime adopted in the unit which consisted of cefotaxime 1 g intravenously three times daily and metronidazole 500 mg intravenously three times daily was found to be satisfactory as a majority of the organisms isolated were sensitive to these antimicrobials. In the case of methicillin resistant Staphylococcus aureus (MRSA), it is recommended that chloramphenicol be added to the current regime in management until the antibiotic sensitivity pattern is available.

Stroke Impact Scale-16: A brief assessment of physical function

OBJECTIVES

To 1) develop a short instrument (Stroke Impact Scale-16 [SIS-16]) to assess physical function in patients with stroke at approximately 1 to 3 months poststroke using items from the composite physical domain of the Stroke Impact Scale (SIS) version 3.0, and 2) compare the SIS-16 and a commonly used disability measure, the Barthel Index (BI), in terms of their ability to discriminate disability.

METHODS

A total of 621 subjects enrolled in the GAIN Americas randomized stroke trial were included in this study. Rasch analysis, which models the probability of a subject's response to an item using both subject ability and item difficulty, was used to construct the SIS-16, describe its properties, and compare its ordering and range of item difficulties to those of the BI. Box plots and analysis of variance were used to examine differences in BI and SIS-16 scores across modified Rankin categories.

RESULTS

The study sample had an average age of 68 +/- 12.4 years and 56% were men. Stroke diagnoses were classified as minor in 91 patients (NIH Stroke Scale score [NIHSS] 0 to 5), moderate in 304 (NIHSS 6 to 13), and major in 226 (NIHSS >/= 14). Twelve of the original 28 items in the SIS version 3.0 composite physical domain were eliminated to produce the SIS-16, with a minimal loss of reliability. As compared to the BI, the SIS-16 contains more difficult items that can differentiate patients with less severe limitations, and therefore has less pronounced ceiling effects. SIS-16 scores were significantly different across Rankin levels 0 to 1, 2, 3, 4, and 5, whereas BI was significantly different only across Rankin levels 0 to 2, 3, 4, and 5.

CONCLUSION

Compared to the BI, the SIS-16 is an excellent collection of items suitable for assessing a wide range of physical function limitations of patients with stroke at 1 to 3 months poststroke. Because of a less pronounced ceiling effect, the SIS-16 can differentiate lower levels of disability as compared to the BI.

Withholding life prolonging treatment, and self deception

OBJECTIVES

To compare non-treatment decision making by general practitioners and geriatricians in response to vignettes. To see whether the doctors' decisions were informed by ethical or legal reasoning.

DESIGN

Qualitative study in which consultant geriatricians and general practitioners (GPs) randomly selected from a list of local practitioners were interviewed. The doctors were asked whether patients described in five vignettes should be admitted to hospital for further care, and to give supporting reasons. They were asked with whom they would consult, who they believed ought to make such decisions, and whether the relatives' preferences would influence their decision making.

MAIN MEASURES

To analyse the factors influencing the doctors' decisions not to admit otherwise terminally ill patients to hospital for life prolonging treatment.

RESULTS

Seventeen GPs and 18 geriatricians completed the interview. All vignettes produced strong concordance in decision making between both groups. Ten per cent of the doctors would provide life prolonging treatment to patients with severe brain damage. Most would admit a surgical patient regardless of age or disability. Medical reasons were largely used to explain decision making. The wishes of relatives were influential and resource considerations were not. There was variability regarding decision making responsibility.

CONCLUSIONS

Little attempt was made to link decision making with ethical or legal concepts and there may have been non-recognition, or denial, of the ethical consequences of failure to admit. The process of decision making may involve deception. This may be conscious, because of the illegality of euthanasia, or unconscious (self deception), because of deepseated medical and societal reluctance to accept that intentionally withholding life prolonging treatment may equate with intentionally causing death.

Synthetic inhibitors of CDKs induce different responses in androgen sensitive and androgen insensitive prostatic cancer cell lines

AIMS

Because of the high prevalence of prostatic cancer and the limitations of its treatment, enormous effort has been put into the development of new therapeutic modalities. One potential tool is the use of cyclin dependent kinase (CDK) inhibitors, which are based on the trisubstituted derivatives of purine. The aim of this study was to analyse alterations of the regulatory pathways in both androgen sensitive and androgen insensitive prostatic cancer cell lines (LNCaP and DU-145, respectively) after blockage of the cell cycle by the synthetic CDK inhibitors, olomoucine and bohemine.

METHODS

The effects of olomoucine and bohemine were studied on the following parameters: (1) cell proliferation, by measurement of DNA content; (2) viability, by the MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) and/or XTT (2,3-bis[2-methoxy-4-nitro-5-sulfophenyl]-2H-tetrazolium-5-carboxanilide) test; and (3) the expression of p53, pRB, Bcl-2, Bax, p16, p21, p27, cyclins A, B, D1, E, p34(cdc2), and the androgen receptor (AR), by western blot analysis.

RESULTS

Both olomoucine and bohemine were potent inhibitors of growth and viability; however, bohemine was two to three times more effective than olomoucine. The sensitivity of LNCaP cells to both agents was significantly higher. After treatment, both cell lines revealed quite different spectra of protein expression.

CONCLUSIONS

These results indicate the existence of specific cell cycle regulating pathways in both cell lines, which may be associated with both p53 and AR status. CDK inhibitors exhibited valuable secondary effects on the expression of numerous regulators and thus may modulate the responsiveness of tumour cells to treatment, including treatment with hormone antagonists.

Fall history is an independent predictor of adverse health outcomes and utilization in the elderly

OBJECTIVE

To determine whether a history of falls predicts functional decline, adverse health events, and hospitalization.

STUDY DESIGN

Twelve-month prospective cohort study.

PATIENTS AND METHODS

Participants were members of a Medicare managed care program. Outcomes were assessed each quarter and included functional status, healthcare utilization (hospitalization), and adverse events (hospitalizations, nursing home placement, or death). Subject healthcare utilization diaries were corroborated with health system data files.

RESULTS

At baseline, 70% reported no falls (NF), 18% had 1 fall (F), and 12% reported 2 or more falls (RF). Fall status predicted functional decline; new ADL deficits were seen in 18% of NF, 28% of F, and 55% of RF (P < or = .0001). Following adjustment for baseline function, this association remained predictive (adjusted odds ratio [OR] for new ADL deficits: 3.5, P = .007; and for new ADL and IADL deficits: 12.0, P= .0001). Fall frequency was a univariate predictor of adverse events (hospitalizations, nursing home placement, or death) and of hospital utilization alone. One or more adverse event(s) occurred in 18% of NF, 22% of F, and 38% of RF (P = .049). Hospitalization occurred in 16% of NF, 22% in F, and 35% of RF (P = .03). Following adjustment for likelihood of future hospitalization (P(ra)), these associations remained predictive for RF (adjusted OR for one or more adverse event[s]: 2.4, P = .05; OR for hospitalization 2.4, P = .06).

CONCLUSIONS

Fall history predicts decline in function, hospitalization, and adverse events among a Medicare managed care population and remains independently predictive of poor outcomes after controlling for baseline function and likelihood of future hospitalization.

Microbiological aspects of peritonitis in patients undergoing chronic peritoneal dialysis at the dialysis unit of Sri Jayawardenapura General Hospital

BACKGROUND

Peritoneal dialysis (PD) is an established form of therapy in the management of end stage renal disease. Peritonitis is the main complication of PD.

OBJECTIVES

To study the incidence and microbial aetiology of peritonitis in patients undergoing chronic PD at the dialysis unit of Sri Jayewardenapura General Hospital (SJGH); to assess the diagnostic value of the Gram's stain; and to study the relationship of the total white cell count of effluent to peritonitis.

DESIGN

A prospective study over three months.

SETTING

Dialysis unit of SJGH.

PATIENT POPULATION

The study involved 18 patients undergoing manual intermittent peritoneal dialysis (IPD), 4 patients undergoing chronic ambulatory peritoneal dialysis (CAPD), and 1 patient undergoing nocturnal intermittent peritoneal dialysis (NIPD).

MEASUREMENTS

Clinical presentation of patients with peritonitis; total and differential white blood cell counts of effluent samples; Gram stain and culture of the centrifuged deposit to determine microbial aetiology; incidence of peritonitis in different categories of dialysis.

RESULTS

32 samples were examined from patients on IPD, and 17 from patients on CAPD. In IPD most episodes were due to Gram negative organisms whereas in CAPD most episodes were due to Gram positive organisms. Sensitivity of Gram's stain in relation to culture was 32.4%. 98% of effluent samples had white blood cell counts of > 100/ml and none showed neutrophil counts of < 49%.

CONCLUSIONS

The incidence of IPD associated peritonitis was 11.1 episodes per patient year, and the incidence of CAPD associated peritonitis was 14 episodes per patient year. Flavobacterium spp. were the predominant organisms in IPD associated peritonitis, whereas CAPD associated peritonitis was commonly caused by coagulase negative staphylococci. Gram's stain was not useful in the initial identification of the causative agent, but the white cell and neutrophil counts were found to be sensitive indicators of peritonitis.

The value of taking an 'ethics history'

OBJECTIVES

To study the value of taking an ethics history as a means of assessing patients' preferences for decision making and for their relatives' involvement.

DESIGN

Questionnaire administered by six junior doctors to 56 mentally competent patients, admitted into general and geriatric medical beds.

SETTING

A large district general hospital in the United Kingdom.

MAIN MEASURES

To establish whether patients were adequately informed about their illness and whether they minded the information being communicated to their relatives. To establish their preference regarding truthful disclosure and participation in decision making with risk attached. To establish whether they wished to be involved in CPR decision making, and if not, who should make the decision. To establish whether they knew of living wills and whether they had any advance directives.

RESULTS

Twenty-four (43%) were inadequately informed of their illness. Forty-six (82%) said they would want to know were something serious to be found. Twenty-eight (50%) wanted to make their own decision if requiring risky treatment and 11 (20%) wanted family members involved. Thirty-one (55%) wanted to make a cardiopulmonary resuscitation (CPR) decision and five of these decisions differed from those made by the doctors. Twenty-five (45%) preferred the doctors to decide. Eleven (20%) of the patients had heard of living wills but only one had executed such a will. Seven (13%) of the patients wished to provide advance directives. Three (5%) did not find the history taking helpful but none were discomforted.

CONCLUSION

Taking an ethics history is a simple means of obtaining useful information about patients' preferences.

Physiological aspects of multiple blood feeding in the malaria vector Anopheles tessellatus

The malaria vector Anopheles tessellatus is able to take several blood meals in a gonotrophic cycle. The fecundity is largely dependent on the first blood meal and is not generally increased by subsequent blood meals during a gonotrophic cycle. Larval rearing densities influenced adult body size. There is an inverse relationship between wing length and larval rearing densities. Smaller mosquitoes produced from larvae reared at higher densities had reduced body reserves of protein, lipid and carbohydrates. At emergence, ovarian development in An. tessellatus is in the previtellogenic stage and it remained at this stage until the intake of a blood meal. The number of ovarian follicles is related to wing length and, irrespective of adult body size, An. tessellatus developed oocytes to maturity with a single blood meal. This is attributed to the availability of metabolic reserves above the threshold level required for further development of oocytes. Mosquitoes that took more than one blood meal had largely digested their previous blood meal and had ongoing vitellogenesis. Blood meals subsequent to the first one apparently contribute mainly to increasing metabolic reserves. The stimulus for a second and third blood meal in An. tessellatus appears to be completion of the digestion of the previous blood meal. There was no evidence that multiple blood meals taken in the first gonotrophic cycle influenced fecundity significantly in the second cycle.

Loss of PTEN expression in paraffin-embedded primary prostate cancer correlates with high Gleason score and advanced stage

The tumor suppressor gene PTEN/MMAC-1/TEP-1 (referred to hereafter as PTEN) maps to chromosome 10q23 and encodes a dual specificity phosphatase. The PTEN protein negatively regulates cell migration and cell survival and induces a G1 cell cycle block via negative regulation of the phosphatidylinositol 3'-kinase/protein kinase B/Akt signaling pathway. PTEN is frequently mutated or deleted in both prostate cancer cell lines and primary prostate cancers. A murine polyclonal antiserum was raised against a glutathione S-transferase fusion polypeptide of the COOH terninus of PTEN. Archival paraffin tissue sections from 109 cases of resected prostate cancer were immunostained with the antiserum, using DU145 and PC-3 cells as positive and negative controls, respectively. PTEN expression was seen in the secretory cells. Cases were considered positive when granular cytoplasmic staining was seen in all tumor cells, mixed when areas of both positive and negative tumor cell clones were seen, and negative when adjacent benign prostate tissue but not tumor tissue showed positive staining. Seventeen cases (15.6%) of prostate cancer were positive, 70 cases (64.2%) were mixed, and 22 cases (20.2%) were negative. Total absence of PTEN expression correlated with the Gleason score (P = 0.0081) and correlated more significantly with a Gleason score of 7 or higher (P = 0.0004) and with advanced pathological stage (American Joint Committee on Cancer stages T3b and T4; P = 0.0078). Thus, loss of PTEN protein is correlated with pathological markers of poor prognosis in prostate cancer.

Regulation of G1 progression by the PTEN tumor suppressor protein is linked to inhibition of the phosphatidylinositol 3-kinase/Akt pathway

PTEN/MMAC1 is a tumor suppressor gene located on chromosome 10q23. Inherited PTEN/MMAC1 mutations are associated with a cancer predisposition syndrome known as Cowden's disease. Somatic mutation of PTEN has been found in a number of malignancies, including glioblastoma, melanoma, and carcinoma of the prostate and endometrium. The protein product (PTEN) encodes a dual-specificity protein phosphatase and in addition can dephosphorylate certain lipid substrates. Herein, we show that PTEN protein induces a G1 block when reconstituted in PTEN-null cells. A PTEN mutant associated with Cowden's disease (PTEN;G129E) has protein phosphatase activity yet is defective in dephosphorylating inositol 1,3,4,5-tetrakisphosphate in vitro and fails to arrest cells in G1. These data suggest a link between induction of a cell-cycle block by PTEN and its ability to dephosphorylate, in vivo, phosphatidylinositol 3,4,5-trisphosphate. In keeping with this notion, PTEN can inhibit the phosphatidylinositol 3,4, 5-trisphosphate-dependent Akt kinase, a downstream target of phosphatidylinositol 3-kinase, and constitutively active, but not wild-type, Akt overrides a PTEN G1 arrest. Finally, tumor cells lacking PTEN contain high levels of activated Akt, suggesting that PTEN is necessary for the appropriate regulation of the phosphatidylinositol 3-kinase/Akt pathway.

Increases in salivary lysozyme and IgA concentrations and secretory rates independent of salivary flow rates following viewing of a humorous videotape

Several studies have shown increases in salivary, secretory IgA (sIgA) levels following exposure to humor and various relaxation strategies. However, the use of sIgA as a marker of immunocompetence has been questioned. In this study we investigated the potential of an alternative marker, salivary lysozyme (sLys) in addition to sIgA. sIgA and sLys concentrations and secretion rates were measured from saliva samples collected immediately prior to and alter viewing a humorous (situation comedy) and a control videotape (documentary). sLys concentrations and secretion rates were significantly increased after viewing of the humorous videotape (p = .0007 and p = .009, respectively) but not following viewing of the control video. Similarly, increases were obtained for sIgA (p = .01 and p = .05) following viewing of the humorous tape. sIgA concentration decreased following viewing of the control tape (p = .05). Salivary flow rates did not significantly change following the viewing of either the humorous or the control tapes. Changes following the humorous video were significantly different from changes following the control video for both sLys and sIgA levels (concentration, p = .007 and p = .005; secretory rate p = .02 and p = .03), but not for salivary flow rates. The results suggest an enhancement of the innate and specific mucosal immune parameters following exposure to humor, independent of salivary flow. Use of sLys may serve as a useful additional or alternative marker of the effects of humor on mucosal immunity.

Satisfaction after Photorefractive Keratectomy

PURPOSE

To evaluate patient satisfaction one year after photorefractive keratectomy (PRK) for myopia and myopia astigmatism using the Nidek EC-5000 excimer laser.

METHODS

This study assessed the level of satisfaction of 6280 patients who underwent PRK after a minimum follow-up of 1 year. All patients were asked to enter their level of satisfaction as excellent, good, worthwhile, or disappointed into a networked computer database. Their responses were subsequently analyzed according to baseline and postoperative refractive data.

RESULTS

Patients considered their results to be as follows: 82.3% good or excellent, 14.9% worthwhile, and 2.8% were disappointed with the outcome.

CONCLUSION

A high percentage of patients were satisfied with the outcome following PRK. However, a fair number (14%) of patients considered the treatment to be worthwhile but it did not meet their expectations. Extensive counseling and inculcating realistic expectations before treatment is essential in achieving better patient satisfaction.

Pharmacokinetics and pharmacodynamics of 15-deoxyspergualin in a canine renal allograft model of local immunosuppression

Local immunosuppression is based on the rationale that one can simultaneously prevent rejection and reduce systemic side effects by administering appropriately chosen immunosuppressive agents directly into the allograft. We utilized a mongrel canine renal transplant model with a programmable, implantable pump/catheter system to estimate the first-pass extraction of 15-deoxyspergualin (DSG) during renal artery infusion and to compare the efficacy and toxicity of continuous intraarterial (ia) versus intravenous (iv) DSG delivery. Six autotransplanted dogs were given DSG by both iv bolus (1 mg/kg) and ia infusion (1.0 mg/kg/d). DSG was administered to allograft recipients by continuous ia infusion at 0.5 (n = 11) and 0.75 (n = 8) mg/kg/day and by continuous iv infusion at 0.5 (n = 12) and 0.75 (n = 6) mg/kg/day. Mean +/- SD elimination half-life was 0.6 +/- 0.1 hr, and the transplanted kidney removed as much as 55-88% (mean 66%) of locally infused DSG. When compared with untreated controls [mean survival time (MST) = 8 days], low-dose (0. 5 mg/kg/day) DSG produced a significant antirejection effect when given ia (MST = 12 days; P = 0.04) but not iv (MST = 9 days; P = 0. 09), with equivalent overall mean drug levels during normal renal function. However, two of the four longest-surviving animals in the ia group died from severe systemic toxicity, manifested by anorexia, diarrhea, leukopenia, and sepsis. High-dose (0.75 mg/kg/day) DSG significantly prolonged survival via both local (MST = 12 days; P = 0.04) and systemic (MST = 11 days; P = 0.02) routes, but half of the iv-treated dogs died from, and four of the longer-surviving ia-treated animals manifested signs of, systemic toxicity, with significantly higher mean drug levels in the iv group. DSG significantly suppressed vascular rejection at both doses when administered locally and systemically, dose-dependently affected the severity of tubulointerstitial rejection and graft edema, and was not nephrotoxic. Our autotransplant pharmacokinetic data overestimated the allografted kidney's ability to extract DSG during local infusion of slightly lower, but immunosuppressive, doses, so that death from systemic toxicity was not prevented and a direct survival benefit of ia vs iv therapy was not realized. Local DSG administration might be combined with other immunosuppressants to therapeutic advantage.

Salivary lysozyme: A noninvasive marker for the study of the effects of stress on natural immunity

Salivary lysozyme levels were measured to determine the effect of stress on innate mucosal immunity. In the first study perceived stress levels of 39 participants were using a stress/arousal checklist questionnaire. Salivary lysozyme levels were found to show a negative correlation (r = -.477, p < .01) with the perceived stress level. In a second study, salivary lysozyme concentrations were measured during periods of high and low stress in the form of an actual stressor--final year examinations. The concentration of lysozyme was found to be significantly (p < .05) lower in the sample taken before the examination when the students were awaiting entry into the examination hall compared to the levels after completion of all examinations. These results indicate that salivary lysozyme concentrations are sensitive to psychological stress and could be utilized as a potential marker in studies looking at the effects of stress on immunity. Because the usefulness of sIgA as a marker has been questioned, the use of salivary lysozyme as a noninvasive index of mucosal immunity warrants further investigation.

Spinal cord compression caused by ossification of the transverse ligament of the atlas

Although ossification of the posterior longitudinal ligament and ligamentum flavum are well known, ossification of the transverse ligament of the atlas is extremely rare. We present the case of a 79-year-old man who developed a gradually progressive spastic quadriparesis caused by upper cervical canal stenosis due to ossification of the transverse ligament of the atlas together with ligamentum flavum hypertrophy.

Chronic simultaneous bilateral extradural haematomas

Bilateral extradural haematomas are rare, usually acute, and generally associated with severe trauma and a high mortality. We report the case of a 39-year-old man who presented with chronic simultaneous bilateral extradural haematomas in whom the trauma appeared to be trivial and initially unrecognised and in whom a unilateral evacuation was curative.

Prevalence of lipid abnormalities in Sri Lankan patients with non-insulin dependent diabetes mellitus

OBJECTIVE

To determine the prevalence of hyperlipidaemia in Sri Lankan patients with non-insulin dependent diabetes mellitus (NIDDM) and a normal control population.

DESIGN

A cross-sectional study.

SETTING

Patients with NIDDM randomly selected from a diabetic clinic register and non-diabetic controls randomly selected from an electoral register.

PATIENTS

498 patients with NIDDM (197 females mean age 53.5, SD 6.2 years) and 253 non-diabetic controls (101 females, mean age 53, SD 5.5 years matched for age and sex.

METHODS

Diabetes and impaired glucose tolerance (IGT) were excluded in the control group by a 75g oral glucose tolerance test. Total cholesterol, high density cholesterol and triglycerides were determined in fasting blood samples.

RESULTS

The prevalence of lipid abnormalities was significantly higher in diabetic patients than in controls. The prevalence of hypercholesterolaemia was 21% vs 14% and that of hypertriglyceridaemia 16% vs 8.3%. Mean fasting blood glucose was higher (9.7 + 2.7) in hyperlipidaemic patients than in normolipidaemic diabetic patients (7.5 + 2.1)

CONCLUSIONS

Hyperlipidaemias are common in Sri Lankan patients with NIDDM and screening for them should be an essential component of management of patients with diabetes mellitus.