Pre-exposure rabies prophylaxis: efficacy of a new packaging and delivery system for intradermal administration of human diploid cell vaccine

The efficacy of a newly designed syringe prepacked with human diploid cell vaccine in a sufficient quantity to deliver individual 0.1 ml doses intradermally was tested by injecting 40 veterinary students with a single dose on each of days 0, 7 and 28. A second group of 20 students received the ordinary series of three 1.0 ml intramuscular vaccine doses by needle and syringe. All participants in both groups developed neutralizing antibodies to rabies above the suggested minimum of 0.5 international units per ml by day 49. The geometric mean titres were somewhat lower in the group receiving the 0.1 ml doses compared to the group given 1.0 ml doses; however, this was considered of no clinical significance since everyone achieved a titre above the suggested minimum. There was little difficulty in reconstituting the vaccine prepacked in the lumen of the syringe and the syringe was easy to manipulate.

Accumulation of coated vesicles bearing mannose 6-phosphate receptors for lysosomal enzymes in the Golgi region of I-cell fibroblasts

The distribution of mannose 6-phosphate (Man6P) receptors for lysosomal enzymes was investigated in human normal and mucolipidosis II (I-cell) disease fibroblasts by light and electron microscopic immunocytochemistry. In normal fibroblasts whose lysosomal enzymes contain Man6P recognition markers required for binding to the receptor, intracellular immunoreactive receptors were concentrated in one or two cisternae located on one side of the Golgi stack, in coated vesicles, and in lysosomes and endosomes. Presumably, this distribution delineates the Man6P-dependent transport pathway for newly synthesized lysosomal enzymes. In I-cell fibroblasts whose lysosomal enzymes lack the Man6P recognition marker, intracellular receptors were found almost exclusively in one or two Golgi cisternae and in numerous coated vesicles located near the immunoreactive cisternae but were rarely detected in lysosomes and endosomes. The results obtained on I-cell fibroblasts suggest that in the absence of endogenous ligands (lysosomal enzymes bearing Man6P residues), Man6P receptors do not constitutively shuttle-via coated vesicles-between the Golgi complex and lysosomes or endosomes. Rather, they accumulate in coated vesicles concentrated at the presumptive sorting site in the Golgi complex. The findings suggest that a specific subpopulation of coated vesicles (primary lysosomes) is involved in Man6P receptor transport of lysosomal enzymes from the Golgi complex to lysosomes and that their relocation is triggered by ligand binding.

Redistribution of mannose-6-phosphate receptors induced by tunicamycin and chloroquine

The distribution of Man-6-P receptors was determined by immunoperoxidase cytochemistry in Clone 9 hepatocytes cultured in the presence or absence of tunicamycin and chloroquine, agents that perturb lysosomal enzyme sorting and lead to their secretion. In control (untreated) cells, receptors were localized in cis Golgi cisternae, coated vesicles, and in endosomes or lysosomes. After tunicamycin treatment, receptors were found in coated vesicles lined up along the cis cisternae but were not detected in endosomes or lysosomes. After chloroquine treatment, receptors were localized in large vacuolated endosomes or lysosomes but were not usually detected in Golgi cisternae or in coated vesicles. These results demonstrate a redistribution of receptors along the normal Man-6-P-dependent sorting pathway after these treatments. In ligand-deficient (tunicamycin-treated) cells, immunoreactive receptors accumulate at the presumptive sorting site in the cis Golgi and are depleted from endosomes and lysosomes. When the intralysosomal pH is increased (by chloroquine treatment) preventing ligand-receptor dissociation, receptors accumulate at the presumptive delivery site (lysosomes and endosomes) and are depleted from the cis Golgi region. The findings also suggest that (a) ligand binding triggers movement of the receptor to endosomes or lysosomes, and (b) ligand dissociation triggers their movement back to the cis Golgi region.

Intracranial sparganosis: an uncommon infection. Case report

The first case of intracranial sparganosis to be reported from the United States is presented. The patient, a 27-year-old woman, complained of focal seizures involving the right lower extremity. A left parietal parasagittal craniotomy was performed, and a granuloma containing a sparganum was excised from the parietal lobe. The clinical and pathological features of sparganosis are reviewed. Only five cases of intracranial sparganosis have previously been described.

Lipomatous meningioma associated with cerebral vascular malformation

A unique epileptic patient with intracranial neoplasm is reported in which a meningioma with lipomatous and osseous components was found associated with cerebral arteriovenous malformation at the same location in the right frontal lobe. The development of the leptomeningeal neoplasm may have been influenced by the underlying vascular anomaly. The cerebral arteriovenous malformation and altered hemodynamics also could have induced the sudden onset of clinical seizures, hemiparesis, and unconsciousness.

Intracranial ultrasound diagnosis of neonatal periventricular leukomalacia

Periventricular leukomalacia (PVL) is characterized by focal areas of white matter necrosis adjacent to the external angles of the lateral ventricles. The diagnosis of PVL has hitherto been limited to autopsy findings. The authors discuss pertinent literature and report in vivo diagnosis of nonhemorrhagic PVL by real-time intracranial ultrasonography. They recommend further study of ultrasound as a diagnostic method for evaluating infants at risk for PVL.

An in vivo single- and multiple-dose study of several marketed brands of conventional and controlled-release theophylline

In a single-dose study, 18 healthy adult males consumed each of six dosage forms of theophylline. A conventional-release tablet, a syrup, and four competing brands of controlled-release theophylline were studied. Serial serum samples were obtained and analyzed via high pressure liquid chromatography (HPLC). After achieving steady state, 15 healthy adult males consumed each of five dosage forms of theophylline in a multiple-dose study. Serial blood samples were obtained between 0 and 72 hours and subjected to analysis with HPLC. The results indicated that the controlled-release products were not bioequivalent, although they achieved longer time-to-peak values than did the immediate-release syrup and the conventional-release tablet. A single sustained-release product was uniquely different on most pharmacokinetic parameters when compared with the remaining three controlled-release products. In general, the dosage form variation exceeded the individual subject variation on the single-dose study, but the opposite was true for the multiple-dose study.

The mannose-6-phosphate receptor for lysosomal enzymes is concentrated in cis Golgi cisternae

Mannose-6-phosphate (Man-6-P) receptors for lysosomal enzymes were localized by immunocytochemistry in several secretory and adsorptive cell types using monospecific antireceptor antibodies. By immunofluorescence, the receptors were found in the Golgi region of polarized cells. When localized by immunoperoxidase at the electron microscope level, they were detected in Golgi cisternae, coated vesicles, endosomes, and lysosomes of all cell types examined (hepatocytes, exocrine pancreatic and epididymal epithelia). Within the Golgi complex, immunoreactive receptors were restricted in their distribution to one or two cisternae on the cis side of the Golgi stacks. They were not detected in trans Golgi or GERL cisternae. Based on their high concentration of Man-6-P receptors, we propose that the cis Golgi cisternae represent the site where the secretory and lysosomal pathways diverge: lysosomal enzymes bearing the Man-6-P recognition marker bind to Man-6-P receptors in this location and are delivered to endosomes and lysosomes via coated vesicles.

Specific and azurophilic granules from rabbit polymorphonuclear leukocytes. I. Isolation and characterization of membrane and content subfractions

The specific and azurophilic granules of rabbit polymorphonuclear heterophils (PMNs) have been isolated and fractionated into membrane and extractable subfractions. Analysis by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS PAGE) revealed several features of the protein composition of the two granules: (a) Whereas each type of granule had 40-60 proteins separable on one-dimensional gradient gels, few of the proteins were common to both granules. (b) The proteins of the extractable fractions (which comprised approximately 98% of the total granule protein) of each granule were distinct from the proteins of the membrane fractions (which comprised approximately 2% of the total granule protein). (c) The extractable proteins co-migrated with those collected from the medium of ionophore-treated, degranulating PMNs and therefore were defined as content proteins. These results were confirmed by radiolabeling studies. Lactoperoxidase-catalyzed iodination of intact granules did not label the content proteins but did label proteins that co-migrated with major granule membrane proteins. Moreover, disruption of the granules before iodination led to labeling of both content and membrane proteins. We conclude that the membranes of specific and azurophilic granules, which arise from different faces of the Golgi complex, are composed of unique sets of membrane proteins some of which are exposed on the cytoplasmic face of the granules.

Specific and azurophilic granules from rabbit polymorphonuclear leukocytes. II. Cell surface localization of granule membrane and content proteins before and after degranulation

The compositional relationship between the cell surface of rabbit polymorphonuclear leukocytes (PMNs) and the membranes of PMN cytoplasmic granules has been investigated. Heterophilic PMNs obtained from peritoneal exudates contained 13 cell surface polypeptides ranging in molecular weight from 220,000 to 12,000 daltons as determined by lactoperoxidase-catalyzed protein iodination and gel electrophoresis. Of these, four polypeptides co-migrated with proteins identified as the major constituents of specific (SpG) and azurophilic (AzG) granule membranes. The most notable of these were cell surface proteins of 145,000 and 96,000 daltons that co-migrated with proteins identified as granule content proteins released from PMNs during exocytosis. Extensive washing did not remove these proteins from the cell surface. Iodination of PMNs after the release of SpG and AzG contents by calcium ionophore- induced exocytosis revealed that there was not a dramatic quantitative change in the proteins on the cell surface. Instead, there were large, quantitative increases in the relative amounts of (125)I that were incorporated into several pre-existing cell surface proteins; all of these cell surface proteins co-migrated as a set with those polypeptides identified as either granule membrane or content proteins. Although nearly all of the major polypeptides of SpG and AzG had counterparts on the cell surface of freshly isolated peritoneal exudates PMNs, there were several polypeptides that were unique to the cell surface. Thus, the PMN has at least three membrane compartments with strikingly different protein compositions.

The effects of cholestyramine, colestipol, and ADR-132 on the rat prostate and dunning R-3327 adenocarcinoma

The effects of three compounds known to have hypocholesterolemic activity in several species were investigated on the rat prostate and the hormone-dependent R-3327 rat prostatic adenocarcinoma. Cholestyramine, colestipol, and ADR-132 are bile acid-sequestering anion exchange resins which were fed to separate groups of adult male Copenhagen X Fischer (F1) hybrid rats in doses of 0.25%, 1.00%, and 2.00% of diet. The results indicate that serum cholesterol levels in tumor-bearing rats and controls fed these compounds for 29 days were not reduced. The body and organ weights as well as the histological features of the prostate gland, seminal vesicles, and the R-3327 tumor were unaffected by these agents.

Failure of atractyloside to inhibit synaptosomal mitochondrial energy transduction

Studies on synaptosome mitochondrial respiration are complicated by "free" mitochondria. Veratridine stimulation of synaptosomal respiration was due to increased Na+ cycling at the synaptosome membrane associated with increased oxidative phosphorylation of intraterminal ADP and was inhibited by oligomycin, ouabain or Na+ free medium. Atractylate or carboxyatractyloside failed to block veratridine-stimulated respiration but inhibited exogenous-ADP-stimulated respiration. Protein synthesis in the synaptosome fraction was inhibited by oligomycin, valinomycin or 2,4-dinitrophenol but was unaffected by excess atractylate. No change in synaptosomal adenine nucleotide content was found in the presence of atractylate, although a significant decrease in the [ATP]/[ADP] was found with oligomycin, veratridine or valinomycin. These findings show that atractylate does not modify intraterminal mitochondrial energy transduction and indirectly suggest an impermeability of the synaptosome membrane to atractylate.

Pathological findings underlying focal temporal lobe hypometabolism in partial epilepsy

Histopathological studies were carried out on temporal lobe tissue from 25 patients with partial complex seizures who were studied by interictal positron computed tomography (PCT) with 18F-fluorodeoxyglucose and subsequently underwent anterior temporal lobe resection. Abnormalities were identified on x-ray computed tomographic scans in 7 patients, but none indicated the site of a pathologically confirmed structural lesion. Hypometabolic zones were observed on PCT scans of 22 patients and corresponded to focal pathological abnormalities in 19 (15 mesial temporal sclerosis, 2 small neoplasms, 1 angioma, 1 heterotopia). In 1 patient with a focally abnormal PCT scan and no pathological changes, the lesion may have been located posterior to the resection. In the remaining 2 patients, the hypometabolic zones later disappeared and may have represented a transient response induced by depth electrode implantation. Three patients with normal PCT scans had no pathological abnormalities in their resected tissue. The degree of relative hypometabolism measured by PCT correlated well with the severity of the pathological lesion, but the size of the hypometabolic zone was generally much larger than the area of pathological involvement. This discrepancy could not be considered an artifact of technique and must represent either structural abnormalities below the resolution of routine histopathological studies (e.g., loss of synapses) or functional inactivation of neuronal elements associated with the epileptogenic lesion.

Mesenchymal differentiation in trigeminal neurilemmoma

An unusual neurilemmoma of the trigeminal nerve in a 31-year-old woman is described. The neoplasm was roentgenographically calcified and contained various types of mesenchymal tissue, including a cavernous angioma, cartilage, bone, and adipose tissue. Angioma in combination with neurilemmoma occurs more frequently than other forms of mesenchymal tissue. Lipoma is an uncommon component of neoplasms affecting the cranial nerves. Cartilage and bone are rarely encountered in benign intracranial neurilemmomas. The histogenesis of this combined neoplasm is discussed in relation to the ectomesenchymal properties of the neural crest.

Thermo-magnetic surgery for experimental renal cancer

Thermo-magnetic surgery is an innovative modality in the treatment of malignancies. This unique combination can produce selectively controlled destruction of deep tumors. Heating of the magnetic metallic compounds of ferrosilicone by hysteresis produces temperatures which are incompatible with cancer cell survival. The intense focal heating causes a coagulation necrosis. Damage to surrounding normal tissue can be avoided by careful temperature monitoring and power control of the magnetic field. Cell destruction in the target tissue has been demonstrated by light and electron microscopy. Reproducible and predictable VX2 renal carcinomas in rabbits have been produced and used as the tumor model in the initial experiments of this research project. A clinical trial with selected cancer patients, performed with this technique of thermo-magnetic surgery, is now a reasonable and feasible procedure.

Community-acquired methicillin-resistant Staphylococcus aureus endocarditis in the Detroit Medical Center

Between June 1980 and September 1981 we evaluated 24 cases of endocarditis from methicillin-resistant Staphylococcus aureus. All of the cases occurred in drug addicts and all were community-acquired. The patients ranged in age from 21 to 59 years and represented an older population than that generally reported for bacterial endocarditis in addicts. Men and women were equally represented (one man presented twice). This unusually high proportion of women may reflect a difference in the rate and location of carriage of methicillin-resistant S. aureus compared with that of methicillin-sensitive staphylococci. Three patients died, one of whom had signed out of the hospital on the 14th day and returned moribund 27 days later. Vancomycin treatment for 28 days was adequate therapy for most patients.

Bioavailability of regular and controlled-release chlorpheniramine products

The bioavailability of chlorpheniramine regular-release versus controlled-release products was compared using 15 human subjects. The dosage forms evaluated were an 8-mg barrier coated-bead capsule, an 8-mg repeat action tablet, two 4-mg tablets, and 4- and 8-mg syrups. Single doses of each product were administered orally in a 5-way crossover study, plasma samples were collected at specific time intervals, and chlorpheniramine levels assayed by HPLC. Pharmacokinetic analysis was based on a two-compartment open model. The average plasma elimination half-life of chlorpheniramine was calculated to be approximately 18.3 hr. The controlled-release products gave a higher Cmax than the 4-mg syrup, but less than two 4-mg tablets. The controlled-release products also extended the time necessary to attain peak drug levels compared to the 4- and 8-mg syrups. The area under the curve (AUC) data for the controlled-release products was not equivalent to equal amounts of the regular-release products. The study indicated that while the controlled-release chlorpheniramine products were successful in prolonging the time course of absorption, this was at the expense of incomplete bioavailability of the drug.

Review article: mucolipidosis IV

We review all reported cases of Mucolipidosis IV, add a new one, and present evidence for a generalized phospholipid storage. All phospholipids were increased in the liver, skin fibroblasts and urine. Lysobisphosphatydic acid which was markedly elevated in these samples was the only lipid stored in muscle. A slowly progressive neurological disease with mental retardation and corneal opacities, but lacking mucopolysaccharide excretion, skeletal changes and organomegaly should raise the suspicion of this disease. At this time, the diagnosis is made by EM studies of skin or conjunctiva which should be done if results of tests on serum or bone marrow for lysosomal diseases are normal. We found some of the typical inclusions in skin fibroblasts from an obligate carrier, which suggests that distinction between the homozygote and heterozygote may be difficult. Despite this, two succeeding pregnancies with normal outcomes were successfully monitored.

Variations in the vaginal bacterial flora: a preliminary report

Fourteen women had specimens collected from their nares, hands, vaginal vestibule, and vagina. Samples were taken the week before, during, and the week after menstruation during three menstrual cycles for a total of nine specimens from each location. Qualitative and quantitative studies were done on the vaginal specimens; the other specimens were examined specifically for Staphylococcus aureus. The premenstrual specimens averaged the highest number of bacteria (approximately 10(9)/mL) but the lowest number of different species (approximately 11). The menstrual specimens averaged the lowest total number of bacteria (approximately 4.0 x 10(7)/mL) but the highest average of different species (approximately 14). The highest rate of positive cultures was for the nares, 34%; followed by vaginal vestibule, 20%; vagina, 19%; and hands, 4%. The nine sequential location samples showed the following percentages of S. aureus: nares, 57%; hands, 29%; vaginal vestibule, 57%; and vagina, 64%.

Blood levels following multiple oral dosing of chlorpheniramine conventional and controlled release preparations

An examination of steady-state performance of chlorpheniramine conventional versus controlled release products was conducted using 15 male subjects in a 3-way crossover study with a 2-week washout period between studies. The study was designed to determine if chlorpheniramine formulations provide consistent pharmacokinetic performance between individual units upon going from single dose to multiple dose therapy. In addition, the validity of predicting steady-state levels for these kinds of products using only single oral dose data was examined. The dosage forms evaluated were a conventional 4 mg tablet, and 8 mg barrier coated-bead capsule, and an 8 mg repeat action tablet. Multiple doses of each product were orally administered to each subject for 6 days prior to the study day to achieve steady-state levels and on the actual study day. Serum samples were collected at specific time intervals on the study day, and chlorpheniramine levels assayed by HPLC. Pharmacokinetic analysis was based on a two-compartment open model. The mean plasma elimination half-lives of the various dosage forms were in the range 24.5-25.4 h. There was no rapid release of drug from the controlled release products nor did they have drug release problems during the dosing interval. Good agreement was obtained between predicted average drug concentration at steady-state and drug concentration actually present for all the formulations studied. Based upon comparative examination of AUC, Cmax, and fraction of dose absorbed data, the controlled release products administered every 12 h were comparable in performance to a conventional release tablet administered every 6 h. Since the half-life of chlorpheniramine is approximately 1 day, therapeutic management may possibly be gained with dosing the patient once daily with a controlled release product or twice daily with a conventional tablet.

Changes in intelligence following temporal lobectomy: relationship to EEG activity, seizure relief, and pathology

Pre- and posttemporal lobectomy measures of intelligence and memory in 36 patients with medically refractory complex partial seizures were compared with (1) various aspects of presurgical ictal and interictal EEG activity derived from surface and deep electrodes, (2) postlobectomy seizure relief, and (3) pathological findings in the resected lobe. With respect to interictal EEG data, bilaterally synchronous surface spikes (accompanied or unaccompanied by simultaneous deep spikes) and sharp waves were significantly correlated with lower prelobectomy intelligence scores and a drop in these scores following lobectomy. With respect to ictal EEG data, bilaterally synchronous and multifocal onsets were significantly correlated with a postlobectomy drop in intelligence scores. Patients with poor postlobectomy seizure relief tended to have lower presurgical intelligence scores and a drop in intelligence scores following lobectomy. The patients most likely to show a postlobectomy drop in intelligence were those demonstrating some combination of poor seizure relief, an absence of pathology in the resected specimen, or EEG signs indicative of poor seizure relief. Postlobectomy changes in intellectual status are therefore not necessarily exclusively attributable to the amount of postlobectomy seizure relief experienced by these patients, but might be due to a combination of factors.

Intracerebral neurilemmoma

Two examples of intracerebral neurilemmoma occurred in the absence of von Recklinghausen's disease. The first case was unique because the patient was clinically asymptomatic, and the second case was unusual with a combination of oligodendroglioma and neurilemmoma in the same mass. The latter lesion arising in persons without stigmata of neurofibromatosis has not been described. The nature of nerve sheath neoplasms in both instances has been verified by electron-microscopy. Clinical features of this rare neoplasm differ from those of acoustic or other cranial nerve tumour, particularly in relation to age and sex. Intracerebral neurilemmoma has been found most often in the first two decades of life and more often in males. Seizures and paresis, although non-specific are common signs and symptoms. Probable histogenesis of this neoplasm from perivascular elements in brain has been suggested.

Neuropathological findings following temporal lobectomy related to surface and deep EEG patterns

Interictal and ictal characteristics of preoperative EEG recordings, derived from limited surface montages, and medial temporal lobe sites, were compared with the results of pathological studies done on resected lobes obtained from 44 patients with complex partial seizures. Pathological material was divided into four groups: (a) sclerosis (mesial temporal or restricted to pes hippocampi); (b) neoplasia (mainly hamartomas); (c) miscellaneous lesions; and (d) no significant lesions. Interictal EEG correlates of no pathology included bilaterally synchronous surface spikes (with or without simultaneous deep spikes) and independent surface spikes (with or without simultaneous deep spikes) on the sides of lobectomy. Ictal EEG correlates of no pathology included unilateral surface or surface/deep onsets, bilaterally synchronous surface onsets, more than one onset location, and suppression at onset. Focal onsets correlated with sclerosis. Frequent interictal spike activity in the nonlobectomized lobe and fast buildup at onset of ictus suggested neoplasia. Many of the EEG correlates of no pathology are known to correlate with poor postsurgical seizure relief, due probably in part to the fact that absence of pathology in the resected specimen is a negative prognostic sign. Patients with sclerosis could be distinguished from patients with no demonstrable pathology with 81% cross-validation classification accuracy using a distribution-independent, nonlinear classifier. Both interictal and ictal EEG measures were used by the classifier, and one may conclude that ictal and interictal EEG recordings contain nonredundant information for predicting the presence and type of underlying pathology.

Ultrastructure of capillaries in acoustic neurilemmoma

The microvasculature of normal acoustic nerve tissue and small intracanalicular and large extracanalicular neurilemmomas was analyzed by electron microscopy. The capillaries of normal acoustic nerve were nonfenestrated, but the microvasculature in nerve-sheath neoplasms was fenestrated. Hypertrophy and hyperplasia of endothelial cells were observed only in the small lesions. The proliferated and enlarge endothelial cells often partially occluded the vascular lumen and formed multichannel vascular lumina. Many fenestrae of capillaries were found in small neoplasms, but these were rarely identified in the large extracanalicular lesions. The gap junctions of endothelium in small nerve-sheath neoplasms were long, wavy, and convoluted, had no openings, and differed from those of large lesions in which the tight junctions were short, straight, and occasionally patent. Additionally, heavy vascularization and erythrocytes within basement membranes were observed only in large neurilemmomas. These ultrastructural features may constitute a basis for differences between large and small acoustic neurilemmomas noted in cerebrospinal fluid findings.

Perinatal methylmercury intoxication: behavioral effects in rats

Sprague-Dawley rats were subjected to perinatal (4th gestational day until Postnatal Day 21) methylmercury intoxication to determine the long-term behavioral effect of the mercury poisoning. Experimental and control animals were evaluated at 110-140 days of age. Compared to controls, the methylmercury animals demonstrated significant behavioral deficits characterized by hypoactivity and by reduced appetitive, escape, and avoidance learning.

Studies on valinomycin inhibition of synaptosome-fraction protein synthesis

The ionophore valinomycin inhibited adult and neonatal synaptosome fraction protein synthesis with half-maximal inhibition at approximately 10nM. Valinomycin had no effect on [3H]leucine uptake into synaptosomes at high or low external [K+]. Synaptosome-fraction protein synthesis was dependent on [K+]e reaching a maximum at 25mM-K+. Valinomycin inhibition of protein synthesis was not reversed at high [K+]e. Valinomycin failed to influence the intrasynaptosomal [K+] even at zero [K+]e. A significant increase in State-4 respiration of synaptosomal fractions was found at 5nM-valinomycin with a decrease in the respiratory control index. At these concentrations of valinomycin there was no inhibition of the ADP-stimulated (State 3) respiration rate. Valinomycin had no effect on cerebral microsomal protein synthesis in vitro, which was inhibited by puromycin (100 micrograms/ml) or the absence of ATP. Valinomycin, 2,4-dinitrophenol and KCN inhibition of protein synthesis was not reversed by added ATP, suggesting impermeability of the membrane to ATP. Valinomycin induced a rapid fall in synaptosome ATP content not observed with atractylate or ouabain. Valinomycin inhibition of protein synthesis under these conditions is secondary to uncoupling of mitochondrial oxidative phosphorylation with a subsequent decrease in intraterminal ATP necessary for translation.

Congenital hydrocephalus in two pregnancies following the birth of a child with a neural tube defect: aetiology and management

A family is described with congenital hydrocephalus occurring in two pregnancies following the birth of a child with a neural tube defect (NTD). Prenatal diagnosis of hydrocephalus at mid-gestation was achieved by ultrasonography. The increased frequency of hydrocephalus among sibs of probands with a NTD and vice versa suggests that, following the birth of a child with either malformations, subsequent pregnancies should be monitored at mid-gestation by amniotic fluid AFP and serial ultrasound examination.

Estrogen receptors in acoustic neurilemmomas

Acoustic neurilemmomas are more frequent, larger, and more vascular in women, and such lesions have a rapidly progressive clinical course in pregnant women; these findings suggest that the growth of these neoplasms may bear a relationship to certain hormone levels. Tissues from 8 patients with acoustic neurilemmoma (3 men and 5 women) were studied by a new fluorescent steroid histochemical technique to detect the presence of estrogen receptors in or on neoplastic cells. Estrogen receptor protein has also been found in meningioma cells in women. Neurilemmoma of the acoustic nerve is the second neoplasm of the central nervous system in which such receptors have been demonstrated.

Meningioangiomatosis in the absence of von Recklinghausen's disease

Two patients who had been having seizures for 10 years or longer were found to have a peculiar neoplastic alteration in the cerebral cortex. The lesion in both instances consisted of a combined proliferation of meningothelial and endothelial cells; and are best described as meningioangiomatosis. The tissues were surgically excised and the frequency and severity of the patients' seizures decreased. In neither instance were there stigmata of von Recklinghausen's disease. In one example, as long as 8 years after craniotomy, no evidence of any disorder of the peripheral nerve was found. A review showed that such lesions have always been associated with multiple intracranial and spinal neoplasms; therefore, these two patients appear to be unique.

Development of capping ability during differentiation of HL-60 human promyelocytic leukemia cells

Developmental changes in cell surface and cytoskeletal elements have been studied in human promyelocytic leukemia cels (line HL-60) which differentiate into functionally mature myeloid cells when grown in dimethyl sulfoxide (DMSO)-supplemented medium. Both differentiated and undifferentiated HL-60 cells bind fluorescent concanavalin A (F-Con A) in a diffuse pattern over the entire cell surface. As with normal neutrophils, pretreatment of the differentiated HL-60 cells with colchicine before incubation with Con A causes the formation of large cytoplasmic protrusions over which the lectin associates into a cap. On the other hand, similarly treated undifferentiated HL-60 cells do not form the cytoplasmic protuberances and are unable to cap the Con A. Transmission electron microscopy reveals that the number and distribution of microtubules and microfilaments change during differentiation. Thus, developing myeloid cells undergo important alterations in the structure and function of the cytoskeleton as they differentiate into mature phagocytes.

Systemic carnitine deficiency--a treatable inherited lipid-storage disease presenting as Reye's syndrome

A 3 1/2-year-old boy presented at three months of age with an acute episode of lethargy, somnolence, hypoglycemia, hepatomegaly, and cardiomegaly, which responded poorly to restoration of the blood sugar level to normal. The absence of ketonuria during subsequent episodes of severe hypoglycemia prompted a search for a defect in fatty acid oxidation. Plasma carnitine (2.0 to 5.0 mumol per liter), muscle carnitine (0.01 to 0.02 mumol per gram, wet weight) and liver carnitine (0.021 to 0.065 mumol per gram, wet weight) were all less than 5 per cent of the normal mean. During a 36-hour fast, ketones were barely detectable. Prolonged treatment with oral carnitine over a six-month period resulted in increased muscle strength, a dramatic reduction in cardiac size, relief of cardiomyopathy, partial repletion of carnitine levels in plasma and muscle, and complete repletion in the liver. Systemic carnitine deficiency is an easily treatable cause of recurrent Reye's-like syndrome. Its diagnosis requires measurement of carnitine levels.

Use of the rapid fermentation test in determining carbohydrate reactions of fastidious bacteria in clinical laboratories

The rapid fermentation test was used to determine the carbohydrate reactions of some of the fastidious bacteria encountered in clinical laboratories, such as: Haemophilus species, including Haemophilus vaginalis; Actinobacillus actinomycetemcomitans; Cardiobacterium hominis; Kingella species; Corynebacterium species; Propionibacterium species; and Erysipelothrix rhusiopathiae. Results were usually obtained within 4 h by using inocula from 24- or 48-h blood or chocolate agar media.

Effects of long-term raphe nucleus stimulation on chronic limbic seizures in monkeys

Long-term electrical stimulation of the raphe nuclei was performed in two monkeys with chronic psychomotor seizures. The daily seizure rate was significantly reduced in one monkey when a stimulus charge of 0.1 microC was used, but not during a subsequent experiment using a 0.4 microC charge. A charge of 0.4 microC also failed to alter the frequency of limbic seizures in a second monkey. The raphe stimulation caused neural damage to the brain stems of both animals. The possible effect this damage may have had on the repeatability of the results suggests that long-term raphe stimulation, like some other neural prostheses, may have diminishing effectiveness over time.

Pyrogenic reactions after inadvertent infusion of endotoxin during cardiac catheterizations

In April 1976 the attack rate of chills and fever with or without falls in blood pressure increased in association with cardiac catheterizations. Fevers were associated with coronary angiography and right and left heart catheterizations. Blood cultures were negative, and reactions did not correlate with amounts of contrast materials infused or with procedures done by a single operator. Significant numbers of Acinetobacter calcoaceticus (var. anitratus) and a Pseudomonas species were cultured from hospital-reservoir distilled water when it was flushed through a catheter before gas sterilization. This same water after ethylene oxide sterilization contained 2 x 10(5) ng/mL of endotoxin by limulus lysate test and was positive by rabbit pyrogen test. When washed reusable cardiac catheters were sterilized daily or when disposable catheters were substituted, febrile reactions ended. Pyrogenic reactions in patients undergoing cardiac catheterizations correlated with emptying retained endotoxin with injected contrast material from reused washed-sterilized catheters.

Plasma levels of clobazam after 10-, 20-, and 40-mg tablet doses in healthy subjects

It is evident that substantial intersubject and intrasubject varition in the bioavailability of clobazam exists following ingestion of 10, 20 and 40 mg doses in these 12 volunteers. Peak concentrations and area under the plasma level-time curve were directly proportional to the dose of clobazam and the mean plasma half-life of clobazam was about 18 hours regardless of dose administered. The t1/2 value was less than that previously reported, as the current results allow differentiation of parent drug from metabolites. This 18 hr t1/2 compares favorably with the half-life of other benzodiazepines.

Epithelial melanosis of the gingiva possibly resulting from the use of oral contraceptives

This case is typical of others we have seen. All cases have been those of female patients who were taking oral contraceptives. A relationship is suggested between use of oral contraceptives and gingival melanosis in individuals with light complexions. It would be appropriate, therefore, to question such patients about the use of oral contraceptives and to consider this relationship in a differential diagnosis.

Sequential vaginal cultures from normal young women

Vaginal specimens were collected two to three times a week for 1 month from seven nurses. A total of 65 specimens were collected. Each sample consisted of three swabs and a saline wash. Semiquantitation of anaerobic and aerobic bacteria, mycoplasma and ureaplasma, and yeast was performed. Numerous species were recovered in each specimen; at least 37 species were isolated. Lactobacilli, Corynebacterium, Ureaplasma, Mycoplasma, Bacteroides melaninogenicus, and Candida albicans, when present, tended to remain throughout the entire month. Other organisms were present on a more sporadic basis. The number of organisms varied greatly during the sampling for each individual, whereas the types of organisms isolated from a particular subject remained relatively constant.

Susceptibility testing of clinically isolated anaerobic bacteria by an agar dilution technique

Agar dilution minimal inhibitory concentrations (MICs) of penicillin, tetracycline, chloramphenicol, and clindamycin were determined using Wilkens-Chalgren agar for 1,266 clinical isolates of anaerobic bacteria. In addition, a reference strain of Bacteroides fragilis was repeatedly tested and demonstrated the precision of the technique. Fifty-six percent of our Bacteroides melaninogenicus strains were resistant (MIC greater than or equal to 4.0 microgram/ml) to penicillin. Resistance to this antibiotic was also seen among other anaerobes, but the results are more in accord with previous reports. Resistance to tetracycline (MIC greater than or equal to 4.0 microgram/ml) was found in 60% of our isolates. Chloramphenicol proved to be the most effective agent in vitro with only 2.0% of strains resistant (MIC less than or equal to 16 microgram/ml). Only 5% of strains were resistant to clindamycin (MIC greater than or equal to 8.0 microgram/ml), and this included 10 isolates of B. fragilis and 4 of B. melaninogenicus. The incidence of resistance of anaerobic bacteria to these frequently used antibiotics is greater than previous reports and indicates the need for reliable susceptibility testing of anaerobic bacteria.

Purification of rat liver lysosomal cholesteryl ester hydrolase

An acidic cholesteryl ester hydrolase (EC 3.1.1.13) from rat liver lysosomes was purified approximately 120-fold with 5% recovery of the original homogenate activity. The sequential steps were: digitonin solubilization, agarose gel filtration, DEAE-agarose and CM-agarose column chromatography. The enzyme was at least 90% pure as judged by polyacrylamide gel electrophoresis and sodium dodecyl sulfate polyacrylamide gel electrophoresis. It exhibited a molecular weight of about 60 000 as determined by sodium dodecyl sulfate polyacrylamide electrophoresis and gel filtration. The soluble enzyme required substrate which was incorporated into phospholipid vehicles for optimal activity. On the contrary, aggregates of the enzyme required a substrate preparation that involved the direct addition of cholesteryl ester in acetone. The enzyme also catalyzed the hydrolysis of emulsions of triacylglycerol. The ratio of the two activities remained almost constant during purification suggesting that the two activities (EC 3.1.1.13 and EC 3.1.1.3, respectively) may be the result of the broad specificity of one enzyme. The effects of some inhibitors and some properties of the enzyme have been studied and discussed.

Isolation of ribosome containing synaptosome subpopulation with active in vitro protein synthesis

Subpopulations of synaptosomes harvested from neonatal rat brain cortices revealed a differential ability to synthesize protein in vitro. Incubation of synaptosomes with radiolabeled leucine, followed by continuous sucrose gradient centrifugation produced an asymmetric shift in the radioactivity toward the higher density sucrose fractions. The bulk of the mitochondrial cytochrome c-oxidase activity was also found in these fractions, however, subfractionation studies of osmotically-lysed synaptosomes suggested that the newly-synthesized proteins reside in an osmotically sensitive, non-mitochondrial compartment. The ability of each subpopulation of synaptosomes to synthesize protein in vitro was assessed after their isolation from linear continuous sucrose gradients. There was an enrichment of highly active protein synthesizing particles in the "heavy" subpopulations of neonatal synaptosomes. The inhibitory effects of chloramphenicol and cycloheximide on the protein synthesis in these particles were similar to those of the original synaptosome fraction. Electron microscopic analysis revealed an increase in the numbers of ribosome-containing structures resembling dendritic and axonal growth cones.

Ultrastructural differentiation and synaptogenesis in aggregating rotation cultures of rat cerebral cells

Cerebral cortices from fetal rats were dissociated into single cells by either trypsinization or mechanical sieving. Then the cells were allowed to form aggregates in rotation cultures. At 7, 14, 21, 28, and 35 days, aggregates were processed for electron microscopic study of morphological differentiation with special emphasis on synaptogenesis. Whether the tissue was initially dissociated by trypsin treatment or by mechanical sieving, the aggregating cultures did not exhibit any apparent differences in ultrastructural differentiation and synaptogenesis. At day 7, most neurons were immature and the extracellular space was large. Cell processes had not yet branched extensively but did contain numerous microtubules. A few immature synapses were observed. Astrocytes and oligodendrocytes displayed many of their typical cytological features. At day 14, dendritic spines had developed, some of which formed axodendritic spinous synapses. Multilayered myelin sheaths were tightly wrapped around axons. At day 21, synapses appeared mature and their number per unit area was maximal. The extracellular space had greatly decreased. At this age, asymmetrical synapses had increased approximately sixfold, whereas symmetrical synapses increased only fourfold when compared with the 7-day-old aggregates. Multifocal degeneration became apparent at 28 days and was accompanied by a significant decline in the number of synapses.

Orbital embryonal rhabdomyosarcoma and intracranial schwannoma

A 39-year-old woman had a large benign intracranial schwannoma of the Gasserian ganglion. Thirty-two years previously, she had an embryonal rhabdomyosarcoma of the orbit. She had been treated by enucleation, local excision, and low-dose supplemental irradiation (1,400 rads). This is the longest survival of which we are aware following any treatment modality in such tumors. No correlation between the two tumors has been established.

Examination of blood clobazam levels and several pupillary measures in humans

The State-Trait Anxiety Inventory was administered to 15 subjects before initiation of the experiment. Three subgroups of five subjects were defined by computing the unweighted sum of the state and trait anxiety scores. A 40-mg dose of clobazam, a 1.5-benzodiazepine, was administered to each subject and repeated with two additional dosage forms following a 2-week washout period. Blood samples were withdrawn, and blood levels were determined by fluorometric analysis. Additionally, pupillary measures of critical flicker fusion, constriction, and dilation in response to a cognitive task were obtained at 0, 2, 4, and 6 hr. A repeated measures analysis of variance revealed that blood levels were, as expected, statistically different over time and dosage form. The pupillary constriction mirrored the blood levels in statistical patterns. The pupillary measure of cognition related to the anxiety state after the performance effects of the cognitive task were statistically removed. The results suggest that clobazam has less immediate human effect than does diazepam.

Synergy between carbenicillin and an aminoglycoside (gentamicin or tobramycin) against Pseudomonas aeruginosa isolated from patients with endocarditis and sensitivity of isolates to normal human serum

Isolates from the blood of 30 patients with endocarditis due to Pseudomonas aeruginosa were tested for synergy between carbenicillin and an aminoglycoside, either gentamicin or tobramycin, by in vitro checkerboard methods in modified (cation-supplemented) Mueller-Hinton broth. Twenty-five of the 30 isolates were affected synergistically. Whether given low (2.5--5 mg/kg) or high (8 mg/kg) doses of aminoglycoside along with 30 g of carbenicillin daily, all of the five patients infected with pseudomonads that were not synergistically affected were refractory to treatment with pseudomonads that were not synergistically affected were refractory to treatment with the carbenicillin-gentamicin combination, whereas the finding of synergy of carbenicillin with gentamicin (or tobramycin) did not assure a medical cure. Tests for synergy between carbenicillin and gentamicin yielded different results in Mueller-Hinton agar than in modified Mueller-Hinton broth. The majority (28) of 30 isolates of endocarditis-producing P. aeruginosa were resistant to the bactericidal effects of 50% pooled normal serum that had been freshly separated. One of the endocarditis-producing strains that was sensitive to 50% serum was resistant to 10% serum. However, sensitivity or resistance to freshly separated, pooled normal human serum did not predict the outcome of antibacterial therapy for pseudomonas endocarditis.