Mitral E point septal separation: a reliable index of left ventricular performance in coronary artery disease

The diagnostic value of E point septal separation (EPSS) was assessed in 108 patients with coronary artery disease who underwent coronary angiography and M-mode echocardiography within a 2-year period at LAC/USC Medical Center. In patients with anterior myocardial infarction, EPSS correlated well with angiographic ejection fraction, with a specificity of 85% and sensitivity of 82%. In inferior myocardial infarction, a 21% frequency of falsely elevated EPSS values was encountered; the sensitivity for detecting reduced ejection fraction was 100% and the specificity was 67%. In combined anterior and inferior myocardial infarction, EPSS accurately estimated abnormal ejection fractions with a sensitivity and specificity of 100%. An abnormal EPSS (more than 7 mm) was found to be more sensitive (87%) and specific (75%) in detecting individuals with angiographically reduced ejection fraction (less than 50%) compared to other echocardiographic indices of pump function. Importantly, EPSS was effective in estimating left ventricular function in the presence of left bundle branch block, paradoxical septal motion, and angiographic septal, posterior, and anterior wall motion abnormalities.

Analysis of the HLA-DRw8 haplotype: recognition by HTC typing of three distinct antigen complexes in Caucasians, Native Americans, and Orientals

We have used seven HLA-D homozygous typing cells (HTC) in a comparative study of the DRw8 antigen complex in three racial groups. Three distinct HLA-D specificities were recognized, each associated with HLA-DRw8. Four of the HTC defined a DRw8-associated HLA-D specificity designated 8.1, one defined a specificity designated 8.2, and two defined a specificity designated 8.3. Each of the three specificities showed an association with a distinct racial group: Dw"8.1" in Caucasians, Dw"8.2" in Pacific Northwest Indians, and Dw"8.3" in Orientals. An informative primed lymphocyte (PLT) cell generated against a Dw"8.1" haplotype was able to distinguish 8.1 from 8.2 and 8.3. Using selected anti-DRw8 sera, a serologic distinction between 8.1 and 8.3 could also be made. It was thus possible, by using both cellular and serologic techniques in a comparative population study, to recognize at least three HLA-D-defined splits of the DRw8 haplotype.

Cytotoxic effector cells against HLA antigens in strong linkage disequilibrium: identification of a strong, new CML determinant

Three sets of cytotoxic effector cells were generated against the A1, B8, DR3 haplotype using haploidentical individuals in three different families. The three sets of effector cells generated against this haplotype showed excellent reproducibility testing, strong cytotoxicity against their specific targets, low autologous kill, and segregation with the sensitizing haplotype within the family. When tested against a panel of cells bearing all combinations of the A1, B8, DR3 antigens, a hierarchy of contribution of the individual HLA antigens as CML target determinants was seen. A new strong target cell determinant was identified by cytotoxicity with one of the effector cells not explicable in terms of the A1, B8, DR3 antigens or known HLA cross-reactivity. A family study demonstrated that this determinant clearly segregates with HLA. The success of this approach in defining new CML determinants may result from the generation of effector cells across a single haplotype in strong linkage disequilibrium or from the presentation of CML determinants in the context of self.

Differential behavior of cytotoxic effector cells against HLA antigens in strong genetic linkage disequilibrium

Five sets of cytotoxic effector cells were generated, using haplo-identical, first degree relatives in five different families, against the HLA-A3; B7 serological determinants combined with different DR antigens. When tested against a panel of cells bearing combinations of the HLA-A, -B and -DR antigens it was shown that the HLA-B7 antigen was as strong a CML target determinant alone as it was in the presence of HLA-A3. The strength of the HLA-A3 antigen as target determinant varied. With effector cells primed to the HLA-A3; B7; DR2 haplotype, the A3 antigen alone behaved as a weak target determinant. When the same target cells were tested with the effector cells generated against HLA-A3; B7 without DR2, the A3 antigen behaved as a strong target determinant. A number of target cells lacking the serologically detectable HLA determinants present on the sensitizing HLA haplotype were identified as being killed by specific effector cells. These data suggest either a number of new CML target determinants controlled by different loci or the presence of a single, new locus with multiple alleles controlling CML targets.

Clinical studies with cefoperazone in the treatment of bacterial infections in surgical practice

Cefoperazone was given to 33 surgical patients who had bacterial infections. A dose of 1 to 2 g bid was administered intravenously for an average of 8.2 days. The overall satisfactory response rate (which includes excellent and good responses) was 79%: 83% in 18 cases of peritonitis and/or intra-abdominal abscesses. 75% in 8 cases of hepatobiliary infections: 100% in 5 cases of skin and soft tissue infections; and 0 in 2 cases of sepsis. The satisfactory response rates according to the isolated organisms were: 11 of 15 Escherichia coli, 15 of 18 streptococci (including 4 of 6 enterococci) 3 of 6 Pseudomonas aeruginosa. 3 of 4 staphylococci 2 of 3 Proteus species, and 3 of 3 Klebsiella pneumoniae. No side effects were observed and there were no abnormal laboratory findings.

Frequency of alloantibodies reacting with PHA-activated T lymphocytes, unexplainable by known HLA activities

Two hundred and three sera obtained from multiparous women were screened to determine the frequency of the appearance of antibodies reactive with PHA-activated T lymphocytes, but not with resting B or T cells from the same donor. The panel of cells on which the sera were tested consisted of lymphocytes from 38 unrelated donors known to be homozygous at the HLA-D locus. Forty-two sera were shown to react uniquely with PHA-activated T cells. The reactivities of these sera could not be explained in terms of the defined HLA-A,-B,-C, or DR antigen specificities on the panel cells, nor on the basis of known cross-reactivities among these antigens. Most of the antisera showed strong cytotoxicity with the activated T cells. Such sera may define antigens presented to the maternal immune system during differentiation and development, which are not expressed on adult T cells unless they are activated.

DR-positive maternal engrafted T cells in a severe combined immunodeficiency patient without graft-versus-host disease

A 2 1/2-year-old male infant with severe combined immunodeficiency was documented by HLA typing and the presence of a female karyotype in the few spontaneously dividing cells to have an intrauterine-derived maternal lymphocyte graft. The presence of DR antigens on the engrafted maternal E rosette-forming T cells was demonstrated by both cytotoxicity and immunofluorescence techniques using both conventional and monoclonal antihuman DR antisera. These DR antigens were of the same allospecificity, DR4, as the mother's peripheral blood B cells. The patient's B cells and monocytes expressed DR alloantigens DR4 and DR3, corresponding to his genotype. Although fresh maternal lymphocytes react strongly in vitro against patient non-T cells, the engrafted maternal T lymphocytes no longer show this activity. Furthermore, clinical evidence suggesting mild graft-versus-host disease was completely resolved by the end of his first year. The presence of the DR-positive maternal cells may reflect the survival of a group of activated suppressor cells mediating graft tolerance of host tissue.

Characterization of antigens from Aspergillus fumigatus. V. Reactivity in immunodiffusion tests with serums from patients with aspergillosis caused by Aspergillus flavus, A. niger, and A fumigatus

Antigen-rich mycelial extract (ME) and fractions of Aspergillus fumigatus were compared with culture filtrates of A. fumigatus. A. flavus, and A. niger for their abilities to detect antibody in serums from patients with confirmed aspergillosis caused by these fungi. In double immunodiffusion tests, homologous antigen preparations were more effective than heterologous preparations in detecting precipitins. Mycelial extract of A. fumigatus was more effective than A. fumigatus culture filtrate in detecting antibody in serums from patients with disease caused by A. flavus and A. niger. It did not, however, detect antibody in the serums from approximately half of the patients with heterologous infections.

Characterization of antigens from Aspergillus fumigatus. III. Comparison of antigenic relationships of clinically important aspergilli

Antigenic relationships between strains of Aspergillus fumigatus, Aspergillus fumigatus var. elipticus, Aspergillus phialiseptus, Aspergillus flavus, and Aspergillus niger were analyzed by fused rocket immunoelectrophoresis and by skin tests. Seventy-three to 89 % of the numbers of antigens detected between strains and species of the A. fumigatus series were shared. The degree of sharing between antigens of A. flavus, A. fumigatus series, and A. niger was much lower and ranged from 19 to 35 %. In reciprocal skin tests in sensitized guinea pigs, similar relationships were shown. Three fractions of A. fumigatus extract proved to be markedly specific for this species. Cross reactivity was associated primarily with carbohydrate and glycoprotein fractions.

Characterization of antigens from Aspergillus fumigatus. IV. Evaluation of commercial and experimental preparations and fractions in the detection of antibody in aspergillosis

Commercially available preparations of Aspergillus fumigatus, experimental extracts and fractions of A. fumigatus, and extracts of 5 other aspergilli were evaluated in a blind manner for their abilities to detect antibody in 66 serum specimens from patients with aspergilloma, allergic bronchopulmonary and invasive aspergillosis, and unconfirmed aspergillosis. Rocket immunoelectrophoresis was more sensitive than immunodiffusion in 2 dimensions. Although qualitative differences in antigen composition could be detected, commercial preparations compared favorably with the best experimental extracts in detecting positive specimens. Extracts from young, actively-growing myceliums were most effective and produced the largest numbers of precipitin bands. In contrast to all unfractionated preparations, several fractions of A. fumigatus were devoid of substances that react with C-reactive protein of serums, yet were as effective as the best preparations in detecting serums positive for Aspergillus.

Diastolic flutter of aortic valves in aortic regurgitation: a report of seven cases

Seven patients with aortic regurgitation, manifesting diastolic flutter of the aortic valve cusps (DFAVC) in the echograms, are described. Five patients with infective endocarditis revealed coarse or fine, irregular DFAVC. Two patients with severe aortic regurgitation and a musical murmur manifested regular DFAVC with a frequency identical to that of a simultaneously recorded diastolic murmur. Of the 5 patients with infective endocarditis, 4 required urgent aortic valve replacement and 1 died. The 2 patients with musical murmurs are clinically stable without surgery. This report extends the clinical spectrum of patients with DFAVC and describes the character of the flutter in patients with muscial murmurs. Furthermore, it suggests that DFAVC is a sign of severe aortic regurgitation.

Oxidation of formate by mycobacteria of the scrofulaceum group

Intact cells obtained from Mycobacterium scrofulaceum as well as from mycobacterial strains M.A6 and M.R56 isolated respectively from leprous tissues of armadillo and rat leproma and grown with glycerol as the oxidizable substrate catalyzed complete oxidation of formate. The stoichiometry of formate oxidase system yielded a value of 2 mol of CO2 produced per mole of O2 or per 2 moles of formate consumed. Cell-free preparations from these three strains of mycobacteria contained formate dehydrogenase which was associated exclusively in the particulate fraction. Formate oxidation was markedly stimulated by small amounts of selenite and molybdate added together. Formate-reduced minus oxidized difference spectra disclosed cytochromes of the b type while spectral evidence did not suggest the existence of cytochromes a or c components. The effect of 2-N-heptyl-4-hydroxyquinoline-N-oxide on the redox state of cytochromes indicated that formate oxidation was mediated by cytochrome b with absorption maximum of 556 nm and not of 562 nm.

Administration of a vaccine prepared from the Australian V4 strain of Newcastle disease virus by aerosol and drinking water

An experimental vaccine containing the avirulent Australian V4 strain of Newcastle disease virus was used to vaccinate 3-or 6-week-old chickens by aerosol and drinking water application. The chickens lacked maternally derived antibody to Newcastle disease virus. When the vaccine virus was diluted in tap water more than 90% of the infectivity was destroyed immediately. The addition of 0.25% skim milk prevented this loss and there was no loss in distilled water. Rates of inactivation at 37 degrees C were similar in tap water and distilled water and were unaffected by the addition of skim milk. Both methods of vaccination resulted in the production of haemagglutination-inhibition antibodies which persisted for at least 8 to 12 weeks. The antibody response to aerosol vaccination was significantly better than that following drinking water vaccination. No clinical disease was induced by exposure to vaccine virus. Serum neutralisation antibodies paralleled those detected by haemagglutination-inhibition in chicks vaccinate once by drinking water. After revaccination through the drinking water, haemagglutination-inhibition antibodies were boosted temporarily while neutralising antibodies were maintained at an enhanced level. From chickens vaccinated by aerosol, Newcastle disease virus was recovered for 10 days from lungs and for 7 days from tracheas and caecal tonsils. Peak viraemia was detected 2 and 3 days after vaccination while both neutralising and haemagglutination-inhibition antibodies became detectable 5 days after vaccination.

Characterization of antigens from Aspergillus fumigatus. I. Preparation of antigens from organisms grown in completely synthetic medium

Aspergillus fumigatus was found to grow well in completely synthetic asparagine glycerol medium. Four-day-old mycelia were totally disrupted by vigorous mechanical shaking with 0.45-micrometer glass beads. Such mechanically produced extracts contained at least 52 precipitating antigens. The number of protein and carbohydrate components was maximal in 4-day-old organisms and decreased in older cultures. Conversely, the number of components in culture filtrates increased with longer incubation periods, but was only approximately one-half that produced by the 4-day-old mycelial extracts.

Problems in ultrasonic estimates of septal thickness

Problems related to cardiac anatomy and ultrasonic instrumentation affect the accuracy of echographic identification of endocardial echoes. A cadaver model and 13 patients were studied, with direct identification or with the aid of echographic contrast techniques, to identify accurately the endocardial echo. The study showed that (1) echographic contrast agents delineate an endocardial echo in the central portion of the ultransonic beam; (2) a specular reflector exists within the right ventricular cavity; (3) specular reflectors within the septum may give the false appearance of border-forming echoes; (4) septal thickness varies by 1 to 5 mm after the endocardial echo has been identified by the contrast agent; and (5) spurious echoes, related to a wide beam angle, can be confused with the endocardial echo. In light of these problems, three criteria were utilized for endocardial echo identification: the prominent notch in the left septal echo, the specular quality of the right septal echo, and the association of multiple myocardial echoes moving in parallel. With these criteria, the endocardial echoes in 11 of the 13 patients could be accurately identified without the use of a contrast agent. The identification of these problems should provide helpful guidelines in developing more accurate and reproducible criteria for septal thickness measurements.