Relief of seizures from a predominantly posterior temporal tumor with anterior temporal lobectomy

We report the relief of intractable complex partial seizures in a patient with a posteromesial temporal lobe hamartoma after anterior temporal lobectomy, despite minimal tumor removal. We suggest that the key to successful treatment is the mainly medial, or limbic, location of the tumor, which apparently requires anterior limbic structures for full clinical expression of seizures. We conclude that excision anterior to a posterior temporal lesion can result in seizure relief and that a medial tumor location may be important for successful treatment.

Clinical pharmacokinetics of theophylline and levels of alpha 1-acid glycoprotein in smokeless tobacco users

Elimination half-life and apparent volume of distribution of theophylline were determined in ten healthy volunteers who used smokeless tobacco (snuff or chewing tobacco) regularly but did not smoke cigarettes. Serum concentrations of the acute phase reactant alpha 1-acid glycoprotein (AAG) were also measured. The elimination half-life of theophylline was 9.32 +/- 3.40 hours (mean +/- standard deviation), the apparent volume of distribution was 0.45 +/- 0.03 L/kg, and AAG concentrations were 63.8 +/- 15.76 mg/dL. All these values are comparable to values reported for nonsmokers. These results suggest that nonsmoking users of ST should be considered to be tobacco nonusers for purposes of planning theophylline dosing and monitoring strategies.

Immunoperoxidase methods for the localization of antigens in cultured cells and tissue sections by electron microscopy

We have presented our detailed methods for localizing antigens in cultured cells and tissue sections by IP at the EM level. Immunoperoxidase cytochemistry is particularly well suited for the study of sparse antigens as a result of the enzymatic amplification afforded by the method, and of molecules confined within a membrane-enclosed compartment wherein the DAB reaction produce can accumulate. Although IP is commonly used to localize membrane-compartmentalized molecules, reliable qualitative information can also be obtained on cytoplasmic antigens as well (Anderson et al., 1978; Merisko et al., 1986; Rodman et al., 1984). For these and other reasons, it is likely that IP cytochemistry will continue to be an important tool for the cell biologist especially in the study of membrane traffic. Other inventive combinations of immunocytochemical methods will likely be forthcoming, for example, combining IP localization with postembedding labeling by colloidal-gold conjugates to provide triple EM labeling.

Distribution of glutamate-decarboxylase-immunoreactive neurons and synapses in the rat and monkey hippocampus: light and electron microscopy

We have studied the distribution of gamma-aminobutyric acid (GABA) neurons, axons, and synapses in the rat and monkey hippocampal formation by using glutamate decarboxylase (GAD) immunocytochemistry together with Nissl stains, electron microscopy, and double-labeled retrograde transport of horseradish peroxidase. The numbers of GAD-containing (putative GABA) neurons and their percentages compared to all Nissl-stained neurons were calculated throughout all the various fields and strata of the mammalian hippocampus. Although their numbers are greatest in the polymorph region of the fascia dentata (FD) and in the principal cell layers stratum pyramidale (SP) and stratum granulosum (SG), GAD immunoreactive (GAD-IR) cells are numerous in other strata that contain mostly dendrites and scattered cells. These GAD-IR (putative GABA) neurons in dendritic regions may be involved in feedforward dendritic inhibition or may directly inhibit nearby neurons. We used a postmortem delay technique, which resulted in apparent diffusion of GAD into dendrites and axons and allowed better visualization of the extensive dendritic domain of GAD-IR neurons. Computerized image analysis of GAD-IR puncta indicated that putative GABA terminals were numerous on apical and basilar dendrites of all pyramidal cells but unexpectedly highest in the monkey presubiculum. In the rat, GAD-IR neurons projected axons ipsilaterally from every region to the fascia dentata and CA1; however, commissural GAD-IR axons to the fascia dentata arose from GAD-IR neurons in only the contralateral fascia dentata and subiculum. Electron microscopy of GAD-stained hippocampus identified GAD-IR neurons with non-GAD-IR (possibly excitatory) synapses and GAD-IR terminals on somata and dendrites, 80% being the symmetric type and 20% the asymmetric type. In contrast, non-GAD-IR terminals were asymmetric 80% of the time.

The use of a selective staphylococcal broth v direct plating for the recovery of Staphylococcus aureus

Nine hundred seventy-two cultures taken from the external nares and the vaginal vestibules of 54 women for the isolation of Staphylococcus aureus were studied. The swabs were plated directly to a trypticase soy agar plate containing 5% sheep blood and were then placed into a selective staphylococcal broth. Both culture methods were compared for the ability to recover S aureus. Twenty percent (26/131) and 66% (38/58) of the S aureus-positive cultures taken from the nares and vagina respectively were cultured from the selective broth only. We believe that a selective staphylococcal broth should be used in addition to routine culture techniques to isolate S aureus from infection control surveillance cultures.

National Committee for Clinical Laboratory Standards agar dilution susceptibility testing of anaerobic gram-negative bacteria

One hundred nine recent clinical isolates of anaerobic gram-negative bacteria were tested in triplicate by the National Committee for Clinical Laboratory Standards agar dilution procedure for their susceptibility to 32 antimicrobial agents. All isolates were inhibited by imipenem, but there were significant numbers of strains resistant to other beta-lactam drugs, and therefore the in vitro response to these antimicrobial agents cannot be predicted. This was particularly true for the bile-resistant or Bacteroides fragilis group. beta-Lactamase production was detected in 82% of the bacteroides with the nitrocefin test. Clavulanic acid combined with amoxicillin and ticarcillin and sulbactam combined with ampicillin resulted in synergistic activity against all beta-lactamase-positive organisms. Ceftizoxime was the most active of the cephalosporins. Two percent of the isolates were resistant to chloramphenicol and metronidazole. Clindamycin resistance was detected in 38% of the B. fragilis group, which is a marked increase from the 4% detected 10 years ago at this institution.

Use of Nile red stain in the detection of cholesteryl ester accumulation in acid lipase-deficient fibroblasts

The fluorescent hydrophobic probe Nile red was used to distinguish between normal human fibroblasts and fibroblasts from individuals with a genetic deficiency in lysosomal acid lipase activity (Wolman's disease and cholesteryl ester storage disease). The fluorescence of Nile red-stained cultured mutant cells, indicative of neutral lipid accumulation, was intense when compared microscopically with normal fibroblasts. The cholesteryl ester accumulation in the acid lipase-deficient fibroblasts was demonstrated qualitatively and quantitatively when cellular lipid extracts were subjected to thin-layer chromatography, followed by Nile red plate treatment and fluorescence spectrometry scanning. These results demonstrate the utility of the Nile red stain to document cellular lipid overloading. The techniques are simple to perform and can effectively supplement the standard enzymatic analysis used in the diagnosis of acid lipase deficiency.

The distribution of 215-kilodalton mannose 6-phosphate receptors within cis (heavy) and trans (light) Golgi subfractions varies in different cell types

The distribution of mannose 6-phosphate (Man-6-P) receptors for lysosomal enzymes was investigated in Golgi subfractions prepared from three different cultured cell lines. Total microsomal fractions from clone 9 hepatocytes, normal rat kidney, or Chinese hamster ovary cells were subfractionated by flotation in sucrose density gradients, which resolves Golgi membranes into heavy (cis), intermediate, and light (trans) subfractions. The distribution of Man-6-P receptors within the subfractions was assessed by quantitative immunoprecipitation, and the results were compared to those obtained by immunoperoxidase localization of the receptors in Golgi cisternae of intact cells. In all cases, the results obtained by Golgi subfractionation and by immunoelectron microscopy were in agreement. In clone 9 cells, Man-6-P receptors were enriched in heavy (cis) Golgi subfractions, whose peak density (rho = 1.17) was greater than those containing either galactosyltransferase activity, a trans Golgi marker, or alpha-mannosidase II, a middle Golgi marker. By immunoelectron microscopy, the receptors were localized to a single cis Golgi cisterna. In Chinese hamster ovary cells, Man-6-P receptors were concentrated in Golgi membranes of low density (1.12 g/ml) overlapping the peak of galactosyltransferase activity. By the immunoperoxidase technique, the receptors were usually localized to a single trans Golgi cisterna. In normal rat kidney cells, Man-6-P receptors were found to be broadly distributed across Golgi membranes (rho = 1.12-1.17), and by immunoperoxidase localization they were found to be broadly distributed across the stacked Golgi cisternae. It is concluded that the distribution of Man-6-P receptors within the Golgi complex varies from one cell type to another. These differences in receptor distribution may reflect variations in lysosomal enzyme trafficking among different cell types.

Use of nile red for the rapid in situ quantitation of lipids on thin-layer chromatograms

We describe the use of the fluorescent dye nile red, 9-diethylamino-5H-benzo[alpha]phenoxazine-5-one, as a general-purpose reagent for the rapid detection and quantitation of a wide variety of lipids and other hydrophobic compounds separated by thin-layer chromatography. After samples are applied to silica gel plates and chromatographed, the plate is briefly dipped into a nile red solution (8 micrograms/ml of methanol-water 80:20, v/v). Background fluorescence of nile red dye adsorbed to the silica gel is then preferentially destroyed by dipping the plate in a dilute aqueous solution of bleach. After drying, lipid bands are visualized under ultraviolet light. Reflectance fluorometry (Ex: 580 nm; Em: 640 nm) is utilized for in situ quantitative analysis of the fluorescence of the lipids on the nile red-stained plate. Neutral lipids, phospholipids, sphingolipids, and fatty acids can be examined, although the nile red fluorescence intensity varies significantly among the lipid classes. Also, staining is stronger for unsaturated lipids than for saturated lipids. The lower detection limit of the assay is 25-100 ng for cholesterol, cholesteryl esters, triacylglycerols, and phospholipids.

Silicon radiometry compared with the Australian radiometric scale

Absolute radiometric power measurements made with silicon photodiodes have been compared directly with those obtained by electrical substitution radiometry on which the Australian radiometric scales are based. Inversion layer photodiodes requiring no front-surface electrode were used. Agreement between the two techniques was found at the level of 0.1% averaged over four laser wavelengths from 458 to 633 nm.

Leksell stereotactic radiosurgery in the treatment of eye melanoma

Current experiments indicate that a focussed single radiation treatment with a dose of 6000 to 9000 rads delivered to the 90% zone through a collimator of the Leksell stereotactic radiosurgical unit or 'gamma knife' to the rabbit eye melanoma model is capable of destroying the cancer totally and thus effecting a cure. The beneficial effect in these rabbit eye melanoma experiments appears to be similar to the results obtained by physicians using the Harvard and Berkeley cyclotrons in treating malignant neoplasms in the human eye. Therefore, it is proposed that a properly designed stereotactic radiosurgical unit can be used in patients with eye tumours similar to those selected for the cyclotron systems.

Intravenous therapy of metronidazole-resistant Trichomonas vaginalis

Metronidazole resistance is an uncommon cause of treatment failure of Trichomonas vaginalis. High-dose intravenous metronidazole was used successfully to treat a patient in whom repeated oral therapy with this agent had failed. Metronidazole resistance was documented by aerobic cultures for susceptibility; anaerobic cultures failed to indicate resistance. Metronidazole serum levels were documented. With failure of repeated oral therapy, intravenous metronidazole may be indicated if there is no evidence of other causes for treatment failure, such as patient noncompliance or reinfection.

Mannose-6-phosphate receptors for lysosomal enzymes cycle between the Golgi complex and endosomes

We have examined the distribution of mannose-6-phosphate (Man6P) receptors (215 kD) for lysosomal enzymes in cultured Clone 9 hepatocytes at various times after the addition or removal of lysosomotropic weak bases (chloroquine or NH4Cl). Our previous studies demonstrated that after treatment with these agents, Man6P receptors are depleted from their sorting site in the Golgi complex and accumulate in dilated vacuoles that could represent either endosomes or lysosomes (Brown, W. J., E. Constantinescu, and M. G. Farquhar, 1984, J. Cell Biol., 99:320-326). We have now investigated the nature of these vacuoles by labeling NH4Cl-treated cells simultaneously with anti-Man6P receptor IgG and lysosomal or endosomal markers. The structures in which the immunolabeled receptors are found were identified as endosomes based on the presence of endocytic tracers (lucifer yellow and cationized ferritin). The lysosomal membrane marker, lgp120, was associated with a separate population of swollen vacuoles that did not contain detectable Man6P receptors. When cells were allowed to recover from weak base treatment, the receptors reappeared in the Golgi cisternae of most cells (approximately 90%) within approximately 20 min, indicating that as the intra-endosomal pH drops and lysosomal enzymes dissociate, the entire population of receptors rapidly recycles to Golgi cisternae. When NH4Cl-treated cells were allowed to endocytose Man6P, a competitive inhibitor of lysosomal enzyme binding, the receptors also recycled to the Golgi cisternae, suggesting that lysosomal enzymes can dissociate from the receptors under these conditions (high pH + presence of competitive inhibitor). From these results it can be concluded that the intracellular itinerary of the 215-kD Man6P receptor involves its cycling via coated vesicles between the Golgi complex and endosomes, ligand dissociation is both necessary and sufficient to trigger the recycling of Man6P receptors to the Golgi complex, and endosomes rather than secondary lysosomes represent the junction where endocytosed material and primary lysosomes carrying receptor-bound lysosomal enzymes meet.(ABSTRACT TRUNCATED AT 400 WORDS)

Bioequivalency and dose proportionality of three tableted promethazine products

Data from a five-way crossover study in human subjects using four talented promethazine products and a promethazine solution are presented. All products were administered as a single oral dose. The five objectives of the study were to investigate bioequivalency, to estimate dose proportionality at two dose levels, to establish validity of a reference production solution for future bioequivalency studies, to estimate intersubject variation, and to compare bioavailability/tablet dissolution data. Blood samples were collected at given intervals over a 24-hour period and analysed for promethazine using an HPLC technique. Pharmacokinetic parameters were calculated using standard procedures and a two-way analysis of variance (ANOVAR) was used to assess whether the differences were statistically significant. The AUC0----infinity data from the ANOVAR analysis showed that the 50 mg innovator and generic products and the 50 mg solution were not significantly different. However, the innovator product had a significantly lower Cmax and longer tmax than the solution. The generic product did not differ significantly from the solution. Promethazine was found to exhibit linear dose proportionality in the range and product studied. Intersubject variation was high for all parameters (23 to 63 per cent) and the in vivo and in vitro data showed a positive relationship.

Rotary pursuit, a measure of human performance, and plasma concentrations of promethazine

Promethazine in doses of 50 mg has demonstrated detrimental effects upon the performance of visual tasks. The purpose of the study was to examine the relationship between the blood concentration levels of promethazine and two human performance tasks. Fifteen paid healthy male volunteers completed a randomized five-way crossover design which included a 25 mg and 50 mg dose of the innovator dosage form, a 50 mg dose of a generic dosage form, a 50 mg solution dosage form, and a placebo. Serial blood samples were obtained in addition to performance measures of rotary pursuit and a simple force choice reaction time. Analysis of the forced choice reaction depicted a mild relationship with the blood concentration levels of promethazine. However, the measures of rotary pursuit, a more sensitive determinant of human motor performance, proved to be more related to both the promethazine blood concentration and the inherent learning which was confounded in the experiment. The degree of impaired pursuit performance and reaction time differences could be defined in terms of a linear relationship to the promethazine concentration.

Comparison of a yellow latex reagent with other agglutination methods for the identification of Staphylococcus aureus

A new commercial yellow latex agglutination reagent (Bacto-Staph) was compared with the slide and tube coagulase tests and three other commercial reagents for the identification of 283 Staphylococcus aureus and 54 non-S. aureus staphylococcal strains. Test sensitivities for the identification of S. aureus were as follows: tube coagulase, 99.6%; slide coagulase, 98.6%; Bacto-Staph, 99.6%; Staphylatex, 98.6%; Sero STAT Staph, 98.2%; and Staphyloslide, 97.5%. No false-positive reactions were observed with any of the commercial reagents.

Antibody response to preexposure human diploid-cell rabies vaccine given concurrently with chloroquine

We conducted a randomized controlled trial to evaluate the antibody response of freshman veterinary students to intradermal human diploid-cell rabies vaccine administered concurrently with chloroquine, a drug frequently used for chemoprophylaxis against malaria. Fifty-one students who had not been vaccinated against rabies were enrolled: 26 received 300 mg of chloroquine base per week (the recommended dose for malaria prophylaxis); 25 did not receive chloroquine and served as controls. All subjects received 0.1 ml of rabies vaccine intradermally on days 0, 7, and 28. Chloroquine was administered weekly to the treatment group, beginning nine days before the first dose of vaccine and continuing until day 48. The mean rabies-neutralizing antibody titer for the chloroquine group was significantly lower than that for the control group on each day of testing--i.e., day 28 (P = 0.0094), day 49 (P = 0.0008), and day 105 (P = 0.0002)--although both groups had neutralizing antibody titers on days 49 and 105, according to the criteria of the Centers for Disease Control. The blood concentrations of chloroquine and desethylchloroquine (the major metabolite of chloroquine, which also has antimalarial properties) were negatively associated with log antibody titers. These results indicate that chloroquine taken in the dose recommended for malaria prophylaxis can reduce the antibody response to primary immunization with intradermal human diploid-cell rabies vaccine.

Neuropathologic findings in the acquired immunodeficiency syndrome (AIDS)

The acquired immunodeficiency syndrome (AIDS) is characterized by a severe idiopathic deficiency in T-cell mediated immunity. Homosexuals, intravenous drug abusers and Haitians are predominantly affected, predisposing them to opportunistic infections and neoplasms. In this study, the central nervous system (CNS) was examined at autopsy in 29 AIDS patients. Significant CNS complications occurred in 55%, mainly related to opportunistic infections similar to those seen in patients with other causes of immunosuppression. Progressive multifocal leukoencephalopathy (three cases), cytomegalovirus (CMV) encephalitis (five cases), cryptococcal meningitis (four cases), Mycobacterium avium-intracellulare (three cases), and toxoplasmosis (one case) were found. Widespread microglial nodules were observed in 20 patients, 80% of whom had CMV inclusions elsewhere at autopsy. Primary cerebral lymphoma (one case) and lymphomatoid granulomatosis (one case) were present. Subarachnoid (five cases) and intraparenchymal (three cases) hemorrhage was seen although these were not usually clinically significant. A single case of embolic arterial obstruction with cortical infarction was due to non-bacterial thrombotic endocarditis.

Primary carcinoid tumor of urinary bladder

Invasive carcinoid tumor of the urinary bladder in a sixty-five-year-old man who presented with painless gross hematuria was documented by light and electron microscopic studies. The presence of 5-hydroxyindoleacetic acid (5-HIAA) and absence of vanillylmandelic acid (VMA) was determined in the neoplastic tissue by chemical analysis. This was consistent with the findings of elevated 5-HIAA and normal VMA in the twenty-four-hour urine sample. Sections of the tumor yielded negative argentaffin and argyrophil reactions. The relevant literature is reviewed.

Cysticercosis. A modern day plague

The authors describe the magnitude of the cysticercosis problem and describe the organism, the clinical features of the disease, the propensity of the organism for development in the central nervous system, pathologic considerations, clinical diagnosis, and treatment.

Distribution of pyramidal cell density and hyperexcitability in the epileptic human hippocampal formation

Pyramidal cell densities in various regions of the anterior and posterior hippocampal formation were measured from en bloc temporal lobe resections and compared with presurgical stereoelectroencephalography (SEEG) data derived from depth electrodes in 12 patients with temporal lobe epilepsy. These data were compared with cell densities observed in four nonepileptic control patients. Patients who consistently exhibited anterior focal changes in the SEEG accompanying onset of ictus had cell densities that were selectively reduced in the anterior hippocampal formation but normal with respect to controls in the posterior hippocampal formation. Patients who exhibited more regional changes in the SEEG at onset of ictus had reduced cell densities in both the anterior and posterior hippocampal formation. Patients who exhibited focal spike activity in the anterior hippocampal formation as their predominant interictal SEEG pattern also had selectively reduced cell densities in the anterior hippocampal formation, while patients with widespread spiking throughout the hippocampal formation had reduced cell densities both anteriorly and posteriorly. These data support the concept that epileptogenesis occurs in or near those areas of epileptic hippocampus that are most damaged. Hippocampal sclerosis must be viewed as related to adjacent hyperexcitable or epileptogenic neurons and not solely as a passive result of repeated anoxia or ischemia.

Temporal lobe volumetric cell densities in temporal lobe epilepsy

Volumetric cell densities in 13 different subfields of the temporal lobe were calculated to test various hypotheses about mesial and lateral temporal lobe sclerosis in patients with complex partial epilepsy. In patients benefitting (primary group) from anterior temporal lobectomy (ATL), sclerosis was greater (fewer cells) in anterior than in posterior hippocampus. By contrast, the patients lacking full benefit (nonprimary group) from ATL had decreased numbers of neurons equally distributed from anterior to posterior hippocampus, indicating that zones of mesial temporal cell loss are linked to zones of epileptogenicity. These data support a model of focal hippocampal epilepsy originating from zones of cell loss and synaptic reorganization that is epileptic. There were no differences in cell densities in gyrus hippocampi or in lateral temporal gyri when patients with temporal lobe epilepsy and controls were compared. Hippocampal cell densities in mesial temporal lobe were not reduced in psychomotor epileptic patients with extrahippocampal foci consisting of foreign tissue. Variables in seizure histories were not correlated with Ammon's horn cell densities, indicating that most of the sclerosis preceded the seizures, which did virtually no significant further damage to hippocampus with repeated partial or generalized seizures.